CHONDRITIS

From Big Medical Encyclopedia

HONDRYT (chondritis; Greek chond-ros a cartilage + - itis) — an inflammation of a cartilage.

Due to the elimination of epidemics of typhus, a frequent complication to-rykh there was chondritis, in modern a wedge, to practice they meet seldom. Inflammatory process is more often localized in cartilages of edges, a throat and an outside ear. The inflammation of joint cartilages which is followed usually by defeat of other tissues of joint is a component of arthritis (see Arthritises).

Specific and nonspecific microflora can cause a chondritis. A specific chondritis meets at tubercular and syphilitic damages of joints, being usually a component of these defeats (see Tuberculosis vnelegoch-ny, a tuberculosis of bones and joints; Syphilis). A peculiar specific chondritis is the syphilitic chondritis of Virkhov which is characterized by an ulceration of a cartilage, is more often in its middle part, with the subsequent education on site than a necrosis of hems of a radiant form.

At the chondritis caused by action of ionizing radiation (so-called beam hondronekroz), there is a destruction of the affected cartilage and other fabrics in the radiation zone.

The chondritis caused by nonspecific microflora usually develops owing to a hematogenous drift of activators in cartilaginous tissue (see) at inf. diseases — typhus (see the Typhoid, the Typhinia, the Sapropyra epidemic), a brucellosis (see), flu (see), an ugly face (see), scarlet fever (see) etc. The chondritis can result also from distribution on a cartilage of inflammatory process from surrounding fabrics. Sometimes inflammatory process joins to distrofiche-skikhm to the processes in a cartilage (see the Osteochondritis) which developed because of exchange and dystrophic and neyrodi-strophe diseases and beam damages (see).

Thanks to features of blood supply cartilages seldom are exposed to acute inflammatory diseases. In most cases the chondritis caused by nonspecific microflora begins with primary necrosis of cartilaginous tissue caused by embolic occlusion (see the Embolism) or blood clot (see Thrombosis) the vessel feeding a cartilage. At the same time in a cartilage the small cavity filled with cartilaginous sequesters is formed, and at secondary infection and pus. As a rule, the nadkhryashchnitsa is involved in process (ShM. Perichondritis) also develops hondroperikhondrit. In case of distribution of process there is a dense massive sclerous infiltrate. The pus which is formed in the center of infiltrate can break outside or in the next cavity or hollow body with development of fistula (see).

Costal chondritis. A wedge, manifestations depend on localization. More often the sternal ends of cartilages of the V—VIII edges are surprised. The traumatic chondritis begins right after an injury, infectious — in time inf. diseases or later 2 — 4 weeks, and sometimes and more after it. The main symptoms are pain and a swelling in a cartilage, to-rye gradually accrue. In 5 — 7 days after the beginning of a disease dense sharply painful infiltrate of an oval form is defined; skin over it is not changed. Then in the center of infiltrate the softening appears, over the Crimea the dermahemia is noted. The formed abscess quite often independently is opened. Through the fistular course it is allocated scanty purulent otdelyaekhmy, sometimes with small cartilaginous sequesters. The general state more often satisfactory, body temperature subfebrile, ROE is accelerated. The state worsens at distribution of an inflammation on surrounding fabrics and development of complications.

The costal chondritis can be complicated by intercostal neuralgia (see), break of pus in a pleural cavity with development of pleurisy (see), and also in a mediastinum (see the Mediastinitis); sometimes patol. process passes to the next edges and to edges of the opposite side.

The diagnosis is made on the basis of the anamnesis, by a wedge, pictures, results of a puncture of an abscess, data of a X-ray analysis, fistulografiya, biopsy. Differential diagnosis is carried out usually with osteomyelitis (see) and tumors of cartilages, e.g. a chondroma (see), a chondrosarcoma (see).

Treatment in an initial stage conservative. Apply means of an immunotherapy (see), antibiotics, analgetics (see. Analgesic means), physiotherapeutic procedures — UVCh (see UVCh-therapy), UF-radiation, diadynamic currents (see. Impulse currents), an electrophoresis (see) proteolytic enzymes (see Peptide hydras of an olaza), etc. At identification of an abscess treatment operational, an abscess is opened, excise the affected cartilage (see the Necretomy), the cavity of an abscess is processed antiseptic agents (see), ultrasound (see), the laser (see) and drained (see Drainage). Through drainage tubes continuously suck away pus (see. Aspiration drainage) also carry out sanitation patol. cavities antiseptic agents. At sharply expressed inflammatory process, existence of complications and the general serious condition of the patient operation is carried out in two steps. The first stage — opening of an abscess and the subsequent treatment of a purulent wound, the second (after improvement of the general state and subsiding of an inflammation) — excision of the struck fabrics.

The forecast at an uncomplicated chondritis favorable.

The chondritis of a throat clinically proceeds as hondroiye-rikhondrit. At acute purulent process because of hypostasis of a mucous membrane there are pains in a throat (see), are noted the complicated breath, body temperature increases, the fever is sometimes observed. At a palpation the painful swelling of a throat, a thickening of her cartilages is defined. At preferential damage of a thyroid cartilage change of a voice, cricoid and arytenoid cartilages — disturbance of breath and swallowing is observed. At hron. an inflammation all phenomena are expressed less sharply. Possible complications in the acute period — sepsis (see), break of pus in a gleam of a throat and trachea with development of aspiration pneumonia (see).

The diagnosis is made on the basis by a wedge, pictures, data of a laringoskopiya (see) and rentgenol. researches of a throat.

Conservative treatment same, as well as at a costal chondritis. Besides, locally apply inhalations of antibiotics with a hydrocortisone, and also novocaine with adrenaline and Dimedrol. At a sharp dysphagy irrigation of 1% is shown by solution of cocaine of a hydrochloride. At destruction of cartilages make a necretomy (see), at asphyxia — a tracheostomy (see).

The forecast is not always favorable. As an outcome of a disease deformation and a stenosis of a throat are possible.

The chondritis of an outside ear often begins as a perichondritis (see. The outside ear), also proceeds as hondroperikhondrit. The painful swelling of an auricle or outside acoustical pass (except a lobe of an auricle), a dermahemia are noted; at a palpation — fluctuation because of accumulation of serous or purulent liquid between a cartilage and a nadkhryashchnitsa, is sometimes palpated a pulled, chicken skin of a cartilage. In the started cases purulent fusion of a cartilage and sloughing is noted.


Fig. 1. The roentgenogram of a finger of a brush at a hondroblastoma of a proximal phalanx (a direct projection): sharp deformation and thickening of a bone in a zone of tumoral defeat (it is specified by shooters) with thinned, but a continuous layer of cortical substance.


Conservative treatment same, as at a costal chondritis. Locally apply lotions from burovsky liquid, greasing by spirit solution of iodine. In the presence of fluctuation open with a wide section an abscess cavity and scrape out it an acute spoon, deleting pieces of a nek-rotizirovanny cartilage.

Forecast favorable. However during the healing the hems wrinkling and disfiguring an auricle are quite often formed. In these cases there can be a need of a plastic operative measure (see. Plastic surgeries).

Bibliography: Baranova I. A. and H e r-t about to E. I. A recurrent polychondritis with multiple organ defeats, Vopr. revm., No. 1, page 66, 1982;

In about y N about - I with e N e c to and y V. F. Sketches of purulent surgery, page 232, L., 1956; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 2, page 273, M., 1964, t. 5, page 234, 1960; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 10, page 237, M., 1950; And b of h and sh sen A. M and. In

e r g an u s t B. Relapsing polychondritis, Acta med. scand., v. 185, p. 175, 1969.

V. A. Vertyanov, A.S. Yakovlev.

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