FISTULAS of OGRAFYYa (Latin of fistula a tube - f Greek grapho to write, represent) — a method of X-ray inspection of fistulas by filling with their radiopaque substance. T. apply to clarification of extent, identification of branchings of the fistular channel and establishment of its bonds with the next bodies and fabrics.
T. it was for the first time made in 1897 by A. Graff. The indication to F. existence of fistulas is (see). It is applied at inborn fistulas (e.g., median and side fistulas of a neck), the fistulas which developed in connection with abscesses of various localization, osteomyelitis and a tuberculosis of bones and joints at fistulas of a traumatic origin, postoperative fistulas (outside pulmonary and pleural, bronchopleural, intestinal, bilious, uric, etc.). At fistulas with purulent separated F. allows to define the reasons of inflammatory process (abscess, the destructive center in bones, the sequester, a foreign body, etc.), to reveal purulent flow in soft tissues (fig).
Contraindications to F. — a serious general condition of the patient and acute inflammatory process in the field of fistula. As a relative contraindication serve strongly bleeding fistulas.
Before F. make survey roentgenograms of the explored area in two perpendicular projections. The patient on a table for a X-ray analysis is given horizontal position, at Krom the outside opening of fistula is located from above. Leather around a fistular opening is processed alcohol or 5% spirit solution of iodine; contents of fistula are sucked away the syringe; at the plentiful purulent separated or dense exudate make washing of the fistular course. For F. enter a thin polyethylene catheter with the syringe attached to it filled turnips tgen windows of a trust ym prophetic with a seam
(see) into a fistular opening. At a big opening of fistula sometimes directly enter a cannula of the syringe with the rubber tip which is put on it from Tarkovsky's syringe into it (or wind a cannula of the syringe with a narrow strip of a gauze). If the opening of fistula narrow, radiopaque substance is entered into it through the blunted needle. At administration of radiopaque substance it is important to provide tightness. For a research of fistulas in the head and a neck, a thorax and a basin
of Fig. of Fistulogramm at chronic purulent pelvic peritonitis with outside fistula: 1 — a purulent cavity in a small basin; 2 — the long twisting fistular course.,
apply the solution of water-soluble radiopaque substance which is warmed up to body temperature oil propilyodon, yodoliiol or 50%. In fistulas on extremities or connected with intestines introduction of a water suspension of fixed white is allowed. Previously powder of fixed white is dried, pounded in a mortar, sifted through a fine-mesh screen. Further train from it the talker in 1% starched broth or a liquid suspension in glycerin or peach-kernel oil (the suspension will be sterilized). In fistulas of a throat, trachea and bronchial tubes previously pour
in 2 — 3 ml of 2% of solution of novocaine to avoid during the research of a fit of coughing. In the presence of several fistulas having the general reason, filling should be begun with the largest. The quantity of the entered contrast medium depends on the nature of fistula and existence of purulent zatek in soft tissues. It is reasonable to enter water-soluble radiopaque substance into the narrow fistular courses.
Administration of contrast medium should be made under X-ray television control, choosing the best moments and projections for shooting. The injection is usually continued to feeling of easy elastic «?otdacha» with a piston pressure of the syringe or before emergence of complaints of the patient to feeling of a raspiraniye in the explored area. Having finished administration of drug, the outside opening of fistula is closed a gauze ball and from above stuck with an adhesive plaster, having enclosed under it the lead tag marking a fistular opening on roentgenograms; then make pictures in two perpendicular projections. In need of them supplement with aim roentgenograms. For specification of communication of fistula from a sosedshsha by bodies resort to their contrasting. For the best idea of space vzaimoot-
carrying fistula with the next bodies the stereox-ray analysis can be also used (see).
Upon termination of F. the sticker is removed, radiopaque substance is sucked away the syringe or it spontaneously follows from fistula. If it is not enough, fistula is washed out isotonic solution of sodium chloride or antiseptic solution and apply a sterile bandage.
In day of a research fervescence, pains in the field of fistula can be noted. If temperature reaction remains also in the next days, washing of fistula is repeated. T. can be complicated by break of radiopaque substance in the next cavity or body that is, as a rule, caused by excessive pressure at its introduction.
Bibliography: Zedgenidze G. А^.
X-ray inspection of fistulas of a fire origin. (Fistulo-grafiya), L., 1945, bibliogr.; L and N d e N-braten L. D. and Naumov L. B. Methods of X-ray inspection of bodies and systems of the person, Tashkent, 1976. L. D. Lindenbraten.