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Mediastinitis - acute inflammation of the mediastinum. Most often is a complication of a variety of acute purulent processes localized in the pleura , lung, oral cavity, pharynx region , the neck, the chest bones . May develop as a result of injury. The infection spreads into the mediastinum lymphatic and hematogenous route , as well as by direct contact with adjacent units . The process may be limited or diffuse
The disease begins abruptly . The temperature increases to 39-40 ° C, there are chest pain , chills , insomnia , anorexia , and weakness. The localization process in the anterior mediastinum and the pain intensifies when tapped on the sternum , tilting the head , there is a swelling of the neck and the front of the chest . At the rear of mediastinitis pain observed in the interscapular region , sometimes - in the epigastric region . With involvement of the esophageal wall , pain when swallowing . Patients are in a sitting or semi-sitting position , his head tilted forward hold that makes breathing easier and reduces pain. Swelling at the rear of mediastinitis occurs on the back, paravertebrally . When percussion dullness marked increase in the sternum at the front of mediastinitis in the back, paravertebrally - at the rear of mediastinitis . For mediastinitis is often complicated by compression of adjacent organs .
Management of patients :
conservative, anti-inflammatory therapy is performed on the general principles of treatment of purulent process .
Surgical treatment is used when there is evidence of abscess , suspected putrid infection. Mediastinotomy conducted .
Prognosis depends largely on the timely diagnosis and treatment of the method employed .
" Cesspool "
Osteomyelitis - purulent inflammation of all three elements of the bone ( bone marrow , periosteum and bone itself ) . Most affected metaphysis of long bones ( tibia , hip, shoulder ) . With less frequently affected flat bones . By hematogenous bone marrow entered septic embolus (staphylococci ) . Bone marrow inflammation extends to compact bone and periosteum , forming okolokostnuyu phlegmon , which opened outward. Inflammatory focus around which is formed from the outside is fistula . " Cloaca " lined sluggish , flabby granulation tissue and contains separate curtailment. Osteomyelitis often occur symptoms are nearby body that is covered by the inflammatory process. Osteomyelitis of the skull bones can be observed brain phenomenon , vertebral osteomyelitis - disorders of the spinal cord. There are forms of gunshot osteomyelitis , developing as a result of a gunshot wound . Adrift osteomyelitis may be acute or chronic . When the process of acute onset in the form of general malaise , aching limbs, muscle pain, headache . Then there are chills , fatigue, fever up to 39 ° C and above , sometimes vomiting , delirium , convulsions, 1 - 2nd day of the disease - a pain in the affected limb . On palpation and pokolachivanii noted severe pain in the site of the lesion . Two days later there swelling , swelling , redness , fever, enlargement of regional lymph nodes in the affected area . After 1-2 weeks in the middle of painful swelling dense determined fluctuation . With the development of suppuration temperature gets remitting character with large fluctuations . Under adverse conditions, purulent process proceeds as stormy common infection , the picture of septicemia, death occurs on 1 -2nd day from the onset.
process differs easier to start and less pronounced and transient common occurrences .
osteomyelitis is usually the outcome of acute osteomyelitis , rarely occurs primarily . Clinically, the flow has two forms : abscess ( sequester ) and sclerosing . form tends to localize in the metaphysis , manifested by the presence of periodic exacerbations and nonhealing fistula through which pus , tissue breakdown products and small curtailment. Exacerbation of the process is accompanied by the appearance of inflammatory manifestations . form develops most often in the diaphysis . Dominated by progressive sclerosis and proliferation of bone tissue. Clinical symptoms are minor , only amplified during exacerbation of the inflammatory process.
Management of patients :
conservative, anti-inflammatory therapy is performed on the general principles of treatment of purulent process .
Surgical treatment is used for acute osteomyelitis in the abscess stage , when running processes with the development of cellulitis , with persistent chronic course . According to the testimony used autopsy cellulitis , dissection of the periosteum , the medullary canal trepanation , sequestrectomy , subperiosteal resection of the bone, in advanced cases - amputation .
Felon - a purulent inflammation , developed in the tissues of the finger . There are the following forms of felon :
• Skin - localized in the thickness of the skin , expressed mild pain , body temperature rises to 37,5 ° C, in a limited area marked redness of tissues, their swelling . A break of pus may come recovery. Process often extends deep into , and there is subcutaneous felon ;
• Subcutaneous - localized in the subcutaneous tissue and is accompanied by her necrosis and purulent melting . Occurs most frequently. Finger is in a half-bent position , marked swelling and tissue tension , expressed mild hyperemia , has a purple tint. Expressed manifestations of intoxication. Process can spread and lead to the development of bone , joint , tendon felon , pandaktilita , cellulitis brush ;
• bone - occurs primarily after infected wounds with damage of the periosteum , bone and secondarily as a complication of subcutaneous felon . In the early symptoms are similar to manifestations of subcutaneous felon , but is more pronounced . Phalanx kolboobrazno thickened , the finger is in bent position. A break abscess fistula persevered with granulations ;
• articulate - purulent inflammation interphalangeal and metacarpophalangeal joints. The infection gets in stab wounds , open injuries , resulting in the spread of the process by subcutaneous , bone or tendon panaritiums , rarely metastatic way. There is pain that bothers the patient not only with finger movements , but also in peace. Showing signs of intoxication . Fistulas often occur ;
tenosynovitis ,
• tendinous or - purulent inflammation of the tendon sheath . Develops rapidly , there is a fever , the temperature rises to 38 ° C and above , note strong pain in the affected finger along the tendon. Finger swollen , bent , severely restricted movement , often observed swelling dorsum of the hand ;
paronychia ,
• okolonogtevoy or - inflammation okolonogtevogo roller . Patient's general condition is satisfactory, expressed mild pain , there is swelling , redness okolonogtevogo roller , usually at the base of the thumb. When pressed roll out pus . The process can take protracted ;
• hyponychial - inflammation that develops under the nail. The total response of the body is weak , the pains are pulsating character , nail phalanx swelling, under the nail can be seen a collection of pus , the pressure on the nail causes a sharp pain . During the protracted process .