EShARA (Greek eschara the center, a scab) — the rare heavy complication arising at hit of an oil suspension of pharmaceuticals in buttock arteries during intramuscular injections.
At hit in a buttock artery of an oil suspension of bioquinol there is a local arterial embolism conducting to a necrosis of tissue of buttock. Experimentally on animals it is shown that the oil suspension getting to blood strikes the smallest vessels, the endothelium to-rykh is as if cauterized that leads to rough inflammatory process in a vascular wall.
At E. in gleams of arterial vessels of a rump the fatty emboluses or emboluses from particles of bismuth having an appearance of acicular crystals are found; perivascular infiltrates consist of histiocytes (see) and a large number of mast cells (see).
AA. develops sharply and proceeds promptly. In the place of an injection of an oil suspension there are shooting pains, skin of a buttock gains purple-red color with shoots in the form of beams from the center to the periphery. Gradually affected area of skin becomes cyanotic-pinkish or crimson-violet color, hypostasis with hemorrhages develops. On 5 — the 7th days are formed sites of a necrosis, and sometimes deep necrotic ulcers. The complication E is possible. consecutive infection. In some cases the drift of a fatty embolus in lungs is observed, at the same time there is painful painful cough, heartbeat, an asthma, cyanosis, feeling of constraint in a breast, the fear of death appears; in the subsequent pneumonia quite often develops.
Treatment is carried out in stationary conditions with observance of a bed rest. At the first signs E. the zone of an injection is cut away by 0,25% solution of novocaine with adrenaline. Appoint antibiotics of a broad spectrum of activity, for removal of a pain syndrome — anesthetics. Locally apply lotions and compresses from 3 — 5% solution of Ichthyolum or 0,1% solution of Aethacridinum of a lactate, 1% solution of silver nitrate; at necrotic disintegration and an ulceration — 5 — 10% a sintomitsinovy emulsion, 10% unguentum xeroformii or dermatolovy ointment, 1 — 3% Unguentum Erytgromycyni. Appoint thermal procedures (paraffin, ozokerite).
The forecast in most cases favorable, at untimely treatment and accession of consecutive infection, and also at an embolism of pulmonary vessels is possible a lethal outcome.
For the prevention E. at use of an oil suspension of drugs of bismuth it is necessary to use long (6 — 8 cm) a needle and to make injections in the double-stage way strictly in an upper outside quadrant of a buttock.
See also Embolism.
Bibliography: Astvatsaturov K. Rch
Syphilis, its diagnosis and treatment, page 356, M., 1971; P. V. O Skinners the mechanism of development of deep gangrene after injection of mercury and bismuthic drugs, Russian vestn. dermas., t. 5, No. 9, page 929, 1927. B. G. Stoyanov.