ORCHITIS

From Big Medical Encyclopedia

ORCHITIS (orchitis; grech, orchis a small egg + - itis; synonym: didymitis, testitis) — inflammation of a small egg.

The lake can proceed sharply and chronically. According to Mono and Ter-riyona (Ch. Monod, O. of R. S. Terrillon, 1889), O.


the Aetiology and a pathogeny === Usually began to describe as an independent disease of bodies of a scrotum at the beginning of 19 century == the Acute orchitis (orchitis acuta) == === O. arises for the second time, as a result of spread of an infection from various centers of an inflammation or as manifestation of a septicopyemia. The most often hematogenous acute O. is observed at epidemic parotitis (in 20 — 30% of cases, according to N. S. Klyachko), at a brucellosis (in 10 — 40% of cases, according to N. V. Antelava, H. M. Voroshilina). It can be also a complication such inf. diseases, as pneumonia, rheumatism, typhoid, paratyphus, epidemic hepatitis, smallpox, plague, malaria, scarlet fever, chicken pox. Quite often the infection limfogenno or passes a contact way to a small egg from an appendage (orkhiepididimit). The canalicular way of an infection on a deferent duct from a prostate, seed bubbles and back department of an urethra is possible. Travkhma and an inflammation of an urethra can also lead to hematogenous infection of a small egg and appendage. O.'s emergence owing to disturbance of blood circulation of a small egg, napr is possible, at the sharp tension of a front abdominal wall leading to squeezing of a seed cord; after the long sexual excitement which did not come to the end with normal sexual intercourse; owing to torsion of a small egg. Injuries, especially a rupture of a small egg, a hematoma of a scrotum can be also complicated by acute O.

Pathological anatomy

At acute O. the small egg is condensed, often increased, on a section fabric its motley, red or yellowish-red color, from a cut surface rather turbid, putreform liquid flows down. Seed «threads» are easily extended by tweezers. Sometimes the separate centers of suppuration come to light, at a subacute current consolidations of gray color, occasionally with calcification are characteristic. Microscopically at acute O. preferential leukocytic infiltration of intersticial fabric at relative safety of seed tubules is found. In the late period death and suppuration of tubules, a sclerosis and their obliteration with a reduction of a spermatogenesis is possible. At epidemic parotitis acute O. usually bilateral, process is characterized focal perivascular, further by diffusion lymphocytic infiltration of an interstitium in the beginning, changes are reversible and seldom lead to infertility. Acute gonorrheal O. is usually preceded by an urethritis, then prostatitis, a spermatocystitis, a deferentitis, an epididymite. The disease proceeds sharply, however transition to chronic (nonspecific) process with development of infertility is possible.

The clinical picture

the Disease begins with emergence of sharp pain in the field of a small egg, increase in its sizes and fever. Pain often irradiates in a seed cord, the pakhovy channel, side area chrevya, lumbosacral area. The small egg quickly increases, becomes intense, dense, its surface remains smooth. Skin of a scrotum externally does not change, but becomes hotter to the touch. The palpation of a small egg is very painful. Along with local displays of a disease the fever and temperature increase to 39 — 40 °, a febricula, a headache, nausea, sometimes vomiting is observed. The leukocytosis, a deviation to the left, increase in ROE is characteristic. Usually in several days temperature decreases, pains abate, the small egg decreases, the composition of blood is normalized. The general condition of the patient improves, but in fabric of a small egg often still the long time is defined consolidation.

At purulent O.'s development the temperature curve gains intermittent, gektichesky character, changes of blood progress. The small egg even more increases, all fabrics of a scrotum are involved in process. The corresponding half of a scrotum increases, her skin becomes smooth, edematous, hyperemic, soldered to a small egg. In the place of a spayaniye the center of a softening quite often is defined. After opening of an abscess through an opening of fistula comes out it is excessive the expanding bleeding granulyatsionny fabric. At necrosis of a small egg through fistula nekrotizirovanny gray-brown fabric of body begins to depart gradually. At big defect of skin of a scrotum the small egg drops out of a wound outside (so-called hernia of a small egg).

Complications

the Inflammation can extend to an epididymis (see. Epididymite ), seed cord (see) and further on cellulose of a basin, an abdominal wall. Prichina peritonitis (see) there can be an inflammation of the small egg which is congenitally located in the inguinal channel, an abdominal cavity (see. Cryptorchism ).

The diagnosis

Acute O. should be distinguished from an acute epididymite, an acute edema, torsion small egg (see), restrained hernias (see). At an epididymite painful infiltrate is formed on a back surface of a small egg, and the sizes and a consistence of the last relatively do not change. The acute hydrocele is followed by the small fever moderated by morbidity. The scrotum in sizes increases, but a consistence its soft; are noted fluctuation, at diafanoskopiya (see) a symptom of clear raying, and at a puncture find transparent liquid. The restrained inguinoscrotal hernia is characterized by emergence of megalgias, increase in the sizes and density of hernial protrusion, a cut becomes unreducible. Torsion of a small egg is followed by the sharp pains extending from a scrotum on a seed cord to the pakhovy canal, ileal area. Increase, consolidation of a small egg is noted; sometimes at acute O. the combination of fever, pain in ileal area, vomitings creates the picture characteristic of an acute abdomen.

Treatment

In the first days of a disease the bed rest, creation of sublime provision of a scrotum with the help is necessary suspenzoriya (see) or bandages, moderate local hypothermia. Novocainic blockade of a seed cord with addition of antibiotics, and also analgetics is reasonable. Antibacterial agents are appointed depending on the nature of the activator O. If it is not known, drugs of a broad spectrum of activity are shown. Administration of inhibitors of proteolytic enzymes is recommended: E-aminocaproic to - you, Contrykal, Gordoxum, etc. After the acute phenomena local thermal procedures in the form of dry or vodka compresses, and also physical therapy are shown. After normalization of temperature of the patient can go, continuing to carry suspenzoriya. Symptoms of suppuration of a small egg are the indication to opening of abscess. The nekrotizirovanny fabric of a small egg appearing in a wound is deleted.

The forecast

Morfol, and funkts, recovery of a small egg is connected with the nature of local inflammatory changes and a current the main inf. diseases. The oligospermatism can come after the parotitis proceeding even without visible signs O. Naiboley failures of purulent O., especially at the bilateral process leading to an atrophy of testicles, loss of function by them and also to weakening of sexual function, disturbance of sexual intercourse to infertility (see). Owing to O., especially at cicatricial changes of bodies of a scrotum, there can be persistent neuralgia of a small egg which is difficult giving in to treatment.

Prevention the main consists in treatment inf. diseases. Usually parotitis is complicated by O. aged after 10 years therefore at the boys of advanced age who did not have in the childhood parotitis it is reasonable to carry out preventive vaccination. By data A. N. Olefir, use of a live vaccine from the weakened virus of parotitis gives falloff of incidence.

The chronic orchitis (orchitis chronica)

the Chronic orchitis (orchitis chronica) can be primary (a chronic inflammation) or secondary, owing to an acute inflammation. Primary chronic O. is characteristic of specific infections (tuberculosis, syphilis, an actinomycosis). Primary nonspecific chronic O. is quite often preceded by an injury of a small egg. The contact arising at the same time immunological of competent cells with autoantigenny elements of a small egg leads to development of reaction like autoantigen — an autoantibody. In the injured small egg destructive processes go beyond the center of damage, there is a diffusion infiltration of interstitial fabric of body cells plazmotsitarno - a lymphoid row and substitution of a parenchyma cicatricial fabric. Intersticial chronic O. can be the response to implementation of spermatozoa out of limits of tubules, in a stroma of a small egg, with formation of granulomas (a spermatozoalny granuloma).

Pathological anatomy

Fig. 1. Microdrug of a small egg at a chronic nonspecific orchitis: syndrome «only sustentotsita» (1), focal proliferation of glandulotsit (2), coloring hematoxylin-eosine; x 200.
Fig. 2. Microdrug of a small egg at a chronic orchitis from the outcome in a tubular sclerosis: the parenchyma of a small egg is completely replaced with fibrous fabric; coloring peak-rofuksinom; X 200.

At chronic O. the small egg is reduced in sizes, condensed, on cuts of gray-brownish or pale is gray go colors, seed threads do not last, torn; the white with commissures, is more rare a cavity than it regional iterated. Treatment by antibiotics and antibacterial himiopreparata sharply changed morfol, O.'s signs, and differential diagnosis became very difficult. At microscopic examination in case of a specific inflammation the granulomas characteristic of this or that type of defeat come to light. Tubercular O. results from hematogenous dissimination of the activator in an epididymis with distribution on a small egg. Tubercular granulomas can be located around vessels where the hyperplasia of glandulotsit (cells of Leydiga) is often noted. The spermatogenesis in tubules rather long is not broken. Further the quantity spermatogoniyev increases and sustentotsit (Sertoli's cells), the quantity of spermatocytes of I and II orders and mature spermatozoa (fig. 1) decreases. Chronic O. can come to the end with reduction and disappearance of cells of a germinogenny epithelium with the subsequent hyalinosis of tubules (fig. 2). Roundish contours of the atrofichny, sclerosed seed tubules remain in the condensed stroma along with islands of giperpla-zirovanny glandulotsit and the hyalinized vessels. Electronic microscopically at a tubular sclerosis the thickening of own plate of a seed tubule, multiple layers and protrusion of basal membranes of tubules between sustentotsita comes to light. The delay of maturing of spermatozoa is followed by vacuolation of sustentotsit, education in cytoplasm of huge lysosomes and lipidic inclusions.

Syphilitic chronic O. meets in the form of gummous defeat of a small egg, a diffusion intersticial inflammation infiltration by preferential plasmatic and lymphoid cells, an early productive endangiitis and the subsequent destruction of an elastic framework. Among fungal infections of a small egg are observed an actinomycosis, the maduromycosis, torulez, a zymonematosis is more rare. Fungi get through the injured skin of it cellulose of a scrotum, and also through a deferent duct and an appendage, at paraproctites — canalicular and limfogematogenny in the ways. At the same time as a result of adjournment of a cell-bound immune complex (IgM) the microcircular bed is surprised; as antigen serves the parasite.

The clinical picture

Chronic O. is followed by moderate pain in the field of a small egg and a seed cord, however in connection with duration of a disease on this soil sometimes there are neurosises, sexual weakness. The small egg at a palpation is painful and increased owing to focal consolidations. In the subsequent the atrophy of a small egg develops. The disease can become aggravated with the advent of acute O.'s signs

the Diagnosis

Nonspecific chronic O. should be distinguished from tuberculosis, syphilis, a tumor of a small egg. At tuberculosis existence of focal consolidations in a small egg and a deferent duct is characteristic; quickly there is an union of a small egg with skin of a scrotum and fistulas are formed. Usually tuberculosis also other bodies are surprised. Syphilis of a small egg is confirmed by the relevant data of the anamnesis and positive serol, reactions. The differential diagnosis of chronic O. and a tumor of a small egg is based on scanning of a scrotum after local administration of mix of isotopes, and also on the basis tsitol, researches of punctate of a small egg. At chronic O. in smears find accumulations of leukocytes, plasmatic, histoid cells, sometimes huge multinucleate cells. Existence in drug of atipichesky cells is characteristic of a tumor of a small egg.

Treatment, Forecast, Prevention

Treatment. Antibacterial drugs, local thermal procedures are shown, at a granulematozny orchitis Glucocorticoid therapy gives good effect.

The forecast is often adverse. At unsuccessfulness of conservative treatment sometimes it is necessary to resort to removal of a small egg.

Prevention: the prevention of an injury of a small egg at sports activities, active complex treatment of the acute Lake.



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K. A. Velikanov; Yu. P. Likhachev (stalemate. An.).

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