From Big Medical Encyclopedia

Palindromia (Latin recidivus renewing) — resuming, return of clinical displays of a disease after their temporary disappearance.

R.'s emergence is always connected with incomplete elimination of etiologies in the course of its treatment that under certain unfavorable conditions leads to repeated development of the pathogenetic processes inherent to this diseases (see), and to the corresponding resuming its wedge, manifestations.

Designation of disease as recuring surely assumes existence between the periods of relapse of the periods remissions (see), prodolzhitelnos to-rykh fluctuates from several days (at inf. diseases) to several months, and in nek-ry cases (is more often at noninfectious diseases) — even up to several years. Duration of remission and probability of emergence of R. in many respects are defined by extent of compensation of functional insufficiency of various systems remaining after incomplete recovery (see) or having genetic conditionality, and also influence of the environment. At partial reduction of activity of various systems of an organism R.'s emergence is possible in usual conditions, however in some cases diseases can lead only extreme conditions to R.

Gout, nek-ry forms of arthritis differ in tendency to R. (see. Arthritises ), rheumatism (see), peptic ulcer (see); it is accepted to speak about a recurrent current hron. bronchitis (see), hron. pancreatitis (see), about recurrent (returnable) forms schizophrenia (see). The recurrent current is characteristic of a number of diseases of system of blood, such as acute leukosis (see), pernicious anemia (see), etc. Emergence of a recurrence is so characteristic of nek-ry diseases that it is reflected in their name, napr, typhinia (see), recurrent paralysis (see).

The wedge, a picture P. of a disease in comparison with its primary manifestations can vary considerably as on degree of manifestation of signs, and in a qualitative sense. E.g., the rheumatism which for the first time arose can proceed in the form of a chorea, and the subsequent R. — in the form of polyarthritis, a rheumatic carditis, etc. At heavy R. symptoms of complications, napr, heart failure, can dominate, sharply changing a wedge, a picture of the main pathology.

At nek-ry recurrent infectious and noninfectious diseases the current and R.'s features are considered at establishment of their diagnosis and carrying out differential diagnosis (typicalness of symptoms at a recurrence of malaria, gout, seasonality of a recurrence of a peptic ulcer of a duodenum, etc.). In nek-ry cases the illegibility, not typicalness or prescription of primary displays of a disease can result in the wrong interpretation of R. as began diseases. Therefore at the diseases inclined to a recurrent current, a basis of diagnosis of R. is always careful collecting anamnesis (see), sometimes with critical revaluation of diagnoses of earlier postponed diseases on the basis of the retrospective analysis of their symptoms and a current (see. Diagnosis , Diagnosis ).

R.'s treatment diseases is defined by the nature of the main pathology, existence of the functional disturbances acquired for all the time of disease and also complications (see), accompanying this recurrence. Remission is reached the easier, than R.'s treatment therefore in cases of a disease with a recurrent current it is necessary to inform the patient on possibility of R. and need of the timely address to the doctor is begun earlier.

R.'s prevention takes the important place in system of secondary prevention of diseases (see. Prevention ). It begins with full therapy of the first acute phase of a disease that in one cases allows to reach an absolute recovery and to prevent transition pathological process (see) in hron. a form, and in others promotes the maximum preservation or the fullest compensation of the functions broken by a disease that reduces probability of River. In many cases an essential role in R.'s prevention

is played by the events for rehabilitation of the patient after an acute phase of a disease held taking into account a form and features of pathology, and also specific features of an organism, a way of life and habits of the patient (see. Rehabilitation ). All-recreational actions, including a balanced diet, physical culture, the correct employment, elimination of addictions are of great importance. At infectious and allergic pathology the actions promoting formation of immunity are preventive: hardening, various forms the stimulating therapy (see), in particular proteinotherapy (see), in some cases — use of vaccines, gamma-globulins (see. Immunoglobulins ), purpose of the hyposensibilizing means, etc.

At the diseases inclined to recuring in a certain season, seasonal prevention of R. V of the USSR is carried out, e.g., R.'s prevention rheumatism is performed in the spring and in the fall (use of Bicillinum, anti-inflammatory drugs). If R. of a peptic ulcer have seasonal nature, then in 2 — 3 weeks prior to the estimated beginning of R. sick more strict is recommended, than during remission, a diet, reception of alkaline mineral waters, drugs of a belladonna, vitamin drugs etc. Such preventive actions prevent R.'s development or considerably reduce degree its wedge, manifestations.

The possibility of prevention of R. and reduction of degree of their weight at timely treatment causes need of dispensary observation for patients with recurrent forms of diseases (see. Medical examination ).

Recurrence of infectious diseases. At infectious diseases (see) R.'s emergence it is caused by preservation of the activator in an organism of the patient after primary infection. Differs in this R. from reinfections (see) — repetitions of a disease owing to repeated infection that the hl is observed. obr. at inf. diseases, in the outcome to-rykh at the person resistant does not form immunity (see). Various individual disturbances of immunity, inborn or acquired immunological insufficiency (see), decrease resistance of an organism (see) can become the reason both reinfection, and transition inf. diseases in hron. form or formations inf. allergies with development of various forms hron. pathologies, characterized by a recurrent current. Complex kliniko-immunological researches of cellular and humoral immunity at inf. patients are shown that the possibility of development of R. increases when in the period of a basic disease low or negative credits of agglutinins are observed that it is connected with oppression of their education. It puts forward need to apply such methods of treatment, to-rye actively would influence an immunogenesis. However are available this, testimonial that artificial strengthening of antigenic irritation, though is shown by growth of a caption of agglutinins, not always prevents development of a recurrence. On the other hand increase in phagocytal activity of leukocytes at inf. diseases has predictively favorable value. In R.'s emergence reversion of L-forms of the activator can play a part (see. L-forms of bacteria ) with recovery of its virulence (a typhoid, an ugly face, a meningococcal infection).

R.'s development is promoted by late hospitalization, inadequate treatment, disturbance and diets, associated diseases, ekzo-and endogenous frustration of food, hypovitaminoses, helminthoses and other factors. In nek-ry cases, napr, at tifo-paratyphoid diseases, the number and R.'s frequency increase at use of antibiotics. As the reasons of it early (unreasonable) drug withdrawal, and also suppression by antibiotics of immune responses of an organism can serve. At use of antibiotics of R. arise usually in later terms.

River at inf. diseases distinguish on frequency rate and terms of emergence. Nek-rym it is peculiar to infections, generally single emergence of R. (anicteric forms of a hay fever), to others — repeated (dysentery, an ugly face, a typhoid). Early R. are characterized by resuming of symptoms of a disease in several days after disappearance of the main displays of a disease; late R. (e.g., at an ugly face, a brucellosis) can come in very remote terms.

The recurrent current is characteristic of such inf. diseases, as belly and returnable (tick-borne and lousy) typhus, paratyphus And yes In, salmonellosis, dysentery, malaria, a viral hepatitis, a brucellosis, etc.

Klin, R.'s manifestations at inf. diseases are in many respects similar to symptoms of a basic disease. In most cases R. proceeds in easier form, than primary display of a disease, duration is shorter than it though heavier and long current is sometimes observed. At R. «loss» of separate symptoms characteristic for given inf is possible. diseases, and in some cases it is shown in other wedge, a form (e.g., R. after a gastrointestinal form of a salmonellosis can proceed in the form of its septic form).

Treatment of patients with a recurrent current inf. diseases shall consist in complex use of antibiotics, vaccines and other stimulators of an immunogenesis (see. Immunotherapy , Infectious diseases ). Besides, the exception of provocative factors, and also purpose of the antihistaminic and nonspecific means increasing body resistance to a contagium is necessary.

A recurrent tumor consider resuming of its growth on site or in the field of the former new growth through any term after the radical operational, beam or other treatment directed to destruction of a tumor, napr, to electrothermic coagulation (see. Diathermocoagulation .), a cryolysis (see. Cryosurgery ). At nek-ry types of new growths (a lymphogranulomatosis, hron. lympho-and a myeloleukemia, a horionepitelioma, a seminoma, etc.) when long remission or treatment as a result of conservative therapy is possible, resuming of a disease is treated as River. Development of metastasises (see. Innidiation ) through various terms after treatment of primary tumor it is designated as progressing of a disease. The metastasis differs from R. of a tumor in what is localized out of a zone of operation in remote limf, nodes and parenchymatous bodies (a liver, lungs, kidneys, etc.) or it is shown in the form of dissimination of a tumor.

Distinguish the early R. arising within the first months and late — in 2 — 3. Rubles in later terms are rare. Rubles can cause the tumor cells and their complexes which are located outside a remote part of body and fields of radiation micrometastasises in partially kept regional limf, nodes, dissimination of tumor cells at mobilization and damage of a tumor during operation, radiation resistance of separate cells and their populations at radiation therapy, primary plurality of rudiments of tumors in one body. True R.'s emergence cannot be distinguished from growth of micrometastasises (implantation in a zone of operation, regional in limf, nodes of the same area) therefore the regrowth of a tumor in a zone of the former operation is defined as a recurrence.

Rubles of a tumor can be single and multiple, directly be localized in a hem or in an anastomosis, on site the former tumor or in a zone of a surgery field, to arise repeatedly.

Frequency and character of River. tumors (see) depend from gistol. forms of a new growth, radicalism of the carried-out treatment, primary localization of a tumor, its stage, the nature of growth, degree of a differentiation of tumor cells, a condition of protective forces of an organism of the patient.

After removal of benign tumors of R. are rare, their emergence is connected with not radical operation or a multitsentrichnost of rudiments of a tumor (polyposes of a mucous membrane of a stomach, large intestine). However R.'s frequency of such benign tumors as a myxoma, embryonal fibroma and a lipoma, does not differ from the frequency of recuring of malignant tumors.

Malignant tumors differ in the special frequency of recuring. From new growths of skin bazalio-we have tendency to R. and planocellular cancer, and from tumors of soft tissues R. of synovial fibrosarcomas, rabdo-and leiomyosarcomas are frequent. Rubles of malignant tumors of bones (a chondrosarcoma, an osteosarcoma) arise at insufficiently radical operations owing to germination of tumors in soft tissues and distribution of process on the marrowy channel. Local R. of a breast cancer arise in the form of single and multiple nodes in a zone of the former operation. The ruble of tumors went. - kish. a path, napr, a carcinoma of the stomach, meet more often when the resection was made in a zone of tumoral fabric. At the same time risk of emergence of R., according to H. N. Blochina (1981), increases in a case of proximity of the level (line) of a resection to a tumor to 1 — 3 cm, and also at localization of a tumor in an upper third of a stomach, at the II—III stage of a disease, a rapid current, the endophytic and mixed form of its growth. If R. of a colon cancer are rare and are a consequence of not considerably executed operation, then at cancer of a rectum they arise in a zone of hems and soft tissues of a crotch, is more often after a resection, than after an extirpation of a gut. Rubles of cancer of lung arise at its central form, a thicket after a lobectomy if the level of a resection passes near a tumoral node. At R. the tumor is located in a stump of the corresponding bronchial tube, growing into its gleam or peribron-hialno. The last usually is a consequence of germination of a tumor from incompleteness of remote metastasises in limf, nodes. R. after radiation therapy of an adenocarcinoma and the low-differentiated cancer of a lung are especially frequent.

For the first two years after treatment to establish an actual reason of progressing of tumoral process (a recurrence or a metastasis) can be difficult, especially at tumors of a neck and a body of the womb. In these cases repeatedly arisen new growth, irrespective of the place of emergence, is regarded as River more often.

R.'s treatment is more often than malignant tumors conservative using radiation therapy (see) and antineoplastic pharmaceuticals (cm, Antineoplastic means) that gives generally palliative effect. Need of the operational and combined R.'s treatment after the previous radiation therapy arises seldom. It happens perhaps generally at tumors of skin, soft tissues, bones, a stomach, large intestine, is more rare — other localizations.

R.'s prevention tumors consists as in early diagnosis and timely operational treatment at locally limited tumor, and in respect for the principles of an ablastika (see. Tumours ): the fullest oncotomy at considerable distance from its borders within healthy fabrics, regional limf, nodes, careful washing of an operational wound for the purpose of mechanical removal of tumor cells for an exception of their implantation. At nek-ry tumors (a carcinoma cutaneum, a throat, a gullet, a rectum, a neck of uterus, etc.) preoperative radiation therapy allows to reduce R.'s frequency, at others (ovarian cancer, a mammary gland, sarcoma of soft tissues) — postoperative therapy by antineoplastic means can reduce R.'s frequency.

For early detection of R. of tumors and performing rational treatment medical examination of oncological patients matters. Its role when it is possible to predict progressing of a disease for the first two-three years after radical operational treatment and radiation therapy is especially big.

V. P. Zhmurkin; S.G. Pak (inf.), A. I. Pirogov (PMC.).