From Big Medical Encyclopedia

CHING (a synonym a zverovy scurvy) — the infectious disease which is characterized by an inflammation of joints of fingers of hands at the people who are engaged in production of seals and other marine animals, cutting of their hulks and processing of the received raw materials.

Ching it is for the first time described by A. Podvy-sotsky in 1885.

Ch.'s etiology is not finalized. A probable disease-producing factor consider the diplococcus found in bodies of seals and sometimes in the affected joints of patients

with Ch. Istochnik of an infection, apparently, marine animals — the Greenland seal, a seal, a sea hare, etc. are. Animal Ch. are not ill. Infection of people occurs through the injured skin of hands (grazes, scratches, chipped and cut wounds) during production and processing of carcasses of marine animals. Ching — an occupational disease of the persons conducting trade of a sea animal in the North Sea.

In the injured skin on hands inflammatory infiltrates with the subsequent involvement in process of an interphalangeal joint are formed (see Arthritises). At this


only infiltration of the soft tissues surrounding a joint, and in some cases damage of joints of fingers of brushes with destruction of cartilaginous surfaces and the metaepiphyseal ends of bones is sometimes observed. At gistol. a research the phenomena of a productive inflammation of tissues of joint without tendency to a necrosis are found. Infiltrates consist of lymphocytes, plasmocytes, colossal cells and fibroblasts located preferential perivaskulyarno.

Immunity is studied insufficiently; cases of a recurrent disease of H are known.

The incubation interval — from 2 to 20 days, is more often than 5 — 7 days. At first there is pain in one of joints of fingers of hands. The movements in a joint are sharply limited, hypostasis of surrounding fabrics quickly develops. In the first days thickness of a finger in a joint increases in 1V2 — 2 of time, folds of skin in a zone of a joint smooth out, skin becomes cyanotic and shines. Hypostasis can extend to all finger and even a brush and accrues during 2 — 3 weeks, then slowly decreases. At the same time also joint pain abates. Longer hypostasis remains in a zone of the affected joint. Temperature throughout all disease happens normal. At a part of patients during the acute period the moderate leukocytosis and acceleration of ROE are noted.

Distinguish articulary and para-articular forms Ch. At the first hypostasis at the beginning of a disease is more expressed (fig. 1). In the affected joint crepitation quite often is noted, formation of incomplete dislocations is possible. Further in the affected joint the anchylosis

of Fig. 1 can develop. Brush of the patient with an articulary form of a chinga: the expressed hypostasis of a proximal interphalangeal joint of the III finger.

(see), a contracture (see), artrozo-arthritis.

At couple to an articulary form of a disease hypostasis happens moderate, crepitation in a joint is absent. The disease lasts 2 — 3 months and comes to an end with development of rigidity in the affected joint that is connected with partial cicatricial regeneration of a joint bag.

Fig. 2. The roentgenogram of the IV—V fingers of the left brush after the postponed chinga: art rozoartrit interphalangeal joint of the V finger; the joint crack is sharply narrowed (it is specified by an arrow), contours of the closing plates of joint surfaces uneven, regional ekzofit the bases of the second phalanx.

The diagnosis is based on data a wedge. pictures, occupational history and results rentgenol. researches. Considerable destructive changes in a joint are noted at an articulary form Ch. that comes to light at rentgenol. a research (at a para-articular form these changes are not expressed). On 10 — the 13th day from the beginning of a disease appears the narrowing of a joint crack in one of joints of the affected finger caused razrusheniyekhm a joint cartilage. The first radiological the found Ch.'s signs in a bone tissue appear not earlier than on the 3rd, and sometimes to the 4th week of a disease. During this period on the roentgenogram in the joint ends of phalanxes the centers of an osteoporosis are defined. Shift of joint surfaces in the frontal or sagittal plane is sometimes observed (incomplete dislocation). On 4 — the 5th week of a disease the joint crack in the affected joint completely disappears. The subcartilaginous bone strip is interrupted by places owing to distribution of destruction on a bone tissue of phalanxes. As a rule, both joint ends of phalanxes are involved in process. Defeat of a diaphysis of phalanxes is not characteristic.

According to N. I. Batygina (1964), most efficiently Ch.'s treatments early (intramuscular) use of antibiotics of a tetracycline row in combination with a section of para-articular fabrics in the invaded zone is; on a course of treatment it is used from 8 OOO OOO to 12 OOO OOO ED of drug. The sore finger is immobilized a plaster bandage. Dvizhe-

a niya in a finger are recovered in 16 — 30 days. The short novocainic blockade (see) which is carried out at the basis of a sore finger was widely used. Sometimes carry out an arthrotomy (see). The forecast in most cases favorable, however at out of time begun treatment a disease, as a rule, comes to an end with development of an atrozoartrit (fig. 2), contractures or an anchylosis.

Ch.'s prevention includes observance a gigabyte. rules of manicuring: obligatory washing of hands after work on crafts of a sea animal and their degreasing in 0,25% solution of spirit of ammonia after contact with marine animals and tools of trade, processing of all microtraumas (grazes, scratches, having pinned) spirit solution of iodine. During the cutting and loading of hulks it is necessary to use mittens (a glove: hectare). Bibliography: Batygina N. I. At

meneny antibiotics at treatment of specific monoarthritis of fingers of hands (chinga), Surgery, N 2, page 29, 1964; In e r ~ x about in with to and y N. A. Ching, Surgery, No. 9, page 67, 1937; Gavrilova K. M. Dynamics of radiological changes in joints of fingers of hands at Ching, Vestn. rentgenol. and radio-gramophones., Ns 5, page 67, 1958; G. A. Ching's Eagles — an inflammation joints of fingers of hands, Arkhangelsk, 1951; it, Specific monoarthritis of fingers of hands (Ching) at seamen-zveroboyev of Primorsky Krai, Surgery, No. 3, page 49, 1961; G. A. Eagles, r and sh and N and - on M. G. and Rayevskaya 3. A. K of an etiology of «chinga» («a zverovy tsynga»), Zhurn. mikr., epid. and immun., Ns 3, page 60, 1950; P about d in y with about c to and y And. The dictionary of a regional Arkhangelsk adverb in its household and ethnographic use, page 185, SPb., 1885; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 1, page 364, M., 1964; In and p-n e 1 1 S. Bunnell’s surgery of the hand, p. 638, Philadelphia — Toronto, 1970.

G. A. Orlov; K. M. Gavrilova (rents.).