From Big Medical Encyclopedia

TO TITTSA SYNDROME (A. Tietze, is mute. surgeon, 1864 — 1927; synonym: disease to Tittsa, the dystrophy of edges, a kostnokhondralny syndrome, a painful swelling of costochondral connection, relief costal cartilages acting costal cartilages, fractures of a costal cartilage for fatigue, a pseudoneoplasm of costal cartilages etc.) — the damage of a costal cartilage which is characterized by emergence in it painful tumorous formation of not tumoral nature.

The syndrome is described to Tittsa in 1921. In domestic literature the first mentioning of T. the page possesses E. N. Kalinovskoy (1959). To a crust, time this syndrome is a little known and insufficiently studied.

T. the page occurs equally often at men and women, is more often at persons at the age of 20 — 40 years doing manual work and at athletes. In most cases defeat happens unilateral and is localized in the left half of a thorax. According to E. N. Kalinovskoy, at 60% of patients patol. process developed in a cartilage of the II edge, At 30% — in a cartilage of the III—IV edges and at 10% — in a cartilage of I, V, the VI edges.

Etiology and pathogeny are not found out. Opinion to Tittsa, etc. about etiol. roles of the alimentary insufficiency leading to disturbance mineral (in particular, calcic) exchange, it is disproved. Among other theories there is emergence of T. pages are most recognized infektsionnoallergichesky and so-called mechanical, or traumatic. Adherents of the infectious and allergic theory proceed from the fact of coincidence in time of development of T. page and allergic process at nek-ry patients with diseases of easy and upper respiratory tracts. According to the mechanical theory, damage of costal cartilages is a consequence of mechanical impact on a nadkhryashchnitsa and a cartilage, napr, at long and persistent cough at patients with respiratory diseases (a so-called tussive change), professional microtraumas, excess tension big and small muscles, chest and adjacent to them, at athletes, at a stupid injury of a thorax without disturbance of an integrity of edges, etc.

Patol. process in costal cartilages proceeds as an aseptic inflammation of a nadkhryashchnitsa and a cartilage. Results of microscopic examinations are not numerous and contradictory. To Tittsa noted disturbance of a structure of a cartilage in combination with adjournment of salts of calcium and formation of fibrous fabric; Bruin and Smook did not find any changes; Hurttung, Satani, etc. revealed a hyperplasia and a fibrous metaplasia of a cartilage with formation of bone islands and sites of calcification. T. P. Vinogradova, E. N. Kalinovskaya, etc. in some cases noted existence in more thickly cartilage of numerous sites of dystrophy with disintegration of fabric, disturbance of a pair arrangement of cartilaginous cells and numerous vacuoles in them; in the conjunction of a cartilage with a bone — deep implementation of cartilaginous tissue in bone, and in bone crossbeams — the phenomena of the strengthened reorganization. Connected noted T. P. Vinogradov's changes with the strengthened growth of cartilaginous tissue.

The wedge, a picture is characterized sharply arising pla by incremental pain in the field of defeat. In several hours (sometimes days) over the affected edge evenly dense painful swelling which is gradually occupying all mezhreberye and towering on 0,5 — 3,0 cm over a chest wall begins to form. Pains amplify at the movements by hands, heavy lifting, sneezing, cough, turns of a trunk, in a prone position on a sick side. Quite often pains irradiate in a neck, a shoulder girdle, a hand, a shovel. Skin over a swelling of usual coloring, mobile. Regional limf, nodes are not changed, body temperature does not increase, any changes in composition of blood and urine are absent. Pains proceed from several days to several weeks and even months, the swelling disappears considerably later. In rare instances clinical displays of a disease disappear spontaneously in short terms.

Diagnosis in most cases establish on the basis of data of the anamnesis and typical symptomatology. Differential diagnosis is carried out with osteomyelitis (see), specific forms of a perichondritis (see) and osteochondritis (see), a bone callosity after a change (see. A bone callosity), benign and malignant tumors, etc. (see the Thorax). In differential diagnosis results rentgenol have crucial importance. researches. On roentgenograms sometimes already at the first research, and a thicket at dynamic observation asymmetry of calcification and a structure of the respective sites of edges comes to light.

the Roentgenogram of a part of a thorax of the patient with a syndrome to Tittsa (a direct projection): the arrow specified the neoarthrosis which developed in a zone of pathological reorganization of tissue I of edge.

On the party of defeat calcification is more expressed, the edge looks thicker, massivny. After ossification of all costal cartilage grudinoreberny joints can become visible and in them the picture of the deforming arthrosis can be observed (see. Arthroses ). At localization of defeat in the field of osteoarticular connections (is more often in the I edge) on the roentgenogram the typical zone patol is visible. functional reorganization — a strip of an enlightenment with a club-shaped thickening of a bone at this level at the expense of a periosteal osteogenesis, sometimes with development of a neoarthrosis (fig). The tomographic research can give essential help in diagnosis in a direct front projection (see. Tomography ).

Treatment is usually conservative: local subchondral introduction of 0,5% of solution of novocaine with a hydrocortisone (4 — 5 injections in 3 — 5 days), an immobilization of an upper extremity on the party of damage of costal cartilages, physical therapy (an electrophoresis of potassium iodide, UVCh, paraffin applications); inside appoint microdoses of iodine with salicylates; there are roentgenotherapies given about efficiency. After disappearance of a pain syndrome give classes of LFK. An operative measure (a subperiostal resection of a reinforced part of an edge) is made seldom, only at unsuccessfulness of conservative treatment.

The forecast is favorable, however the recurrence coming sometimes in several years is possible.

Bibliography: Brusinenko A. I. Sindr Tittse, Zdravookhr. Belarus, No. 10, page 75, 1978; Vinogradova T. P. To physiology of cartilaginous tissue of the person, Arkh. patol., t. 18, No. 2, page 24, 1956; r e y d and B. P. Medical tactics at a syndrome Tittse, Vestn. hir., t. 126, No. 3, page 29, 1981; it, Sindr Tittse, Surgery, No. 11, page 89, 1982; 3 and - slavskiya E. S. Sindr Tittse, Klin, medical, t. 49, No. 11, page 20, 1971; Kalinovskaya E. N. About «Titts's syndrome», Surgery, No. 5, page 31, 1959; La pikes P. M. O Tittse's syndrome, Klin, medical, t. 53, No. 1, page 117, 1975; Executioner's blocks about in A. Ya. Ob tumorous formation of costal cartilages (Tittse's syndrome), Ortop. and travmat., No. 9, page 24, 1966; Pratsko V. G. A role of a microtrauma in a pathogeny of a disease Tittse, Vestn. hir., t. 114, No. 1, page 74, 1975; Rein - e r S. A. Radiodiagnosis of diseases of bones and joints, book 2, page 123, M., 1964; Giordano A. La roentgen-terapia nella sindrome di Tietze, Ann. Radiol. diagn. (Bologna), v. 43, p. 452, 1971; Tietze A. t) ber eine eigenartige Hau-fung von Fallen mit Dystrophie der Rip-penknorpel, Berl. klin. Wsehr., S. 829, 1921; Wiedemann II. R. Tietze-Syndrom (Chondroosteopathia costalis tuberosa) im friihen Kindesalter, Helv. paediat. Acta, Bd 21, S. 25, 1972.

And. H. Belov; P. L. Zharkov (rents.).