Severe progressive vascular disease, which leads to circulatory disorders and gangrene of the limb. Mostly men are affected. The etiology of the disease is unknown. Moments that contribute to the development of the disease are: repeated prolonged cooling of the legs, neuropsychic injuries, chronic nicotine poisoning (smoking) and other poisons. Obliterating endarteritis is a common disease with predominant localization in the vessels of the lower extremities.
It is believed that at the beginning of the development of the disease, changes in the walls of blood vessels are preceded by morphological disorders of the nerve elements of the extremities, which consist of degenerative changes of mainly pulpous nerve fibers. In the future, there is a vasospasm, and then morphological changes in all layers and walls, which are in the nature of proliferation of connective tissue, their sclerosis, which ultimately leads to obliteration of the lumen of the vessel. The process begins with the main vessels of the limbs and gradually spreads in the peripheral direction with the involvement of their branches.
In the late phases of the development of the disease, degenerative changes in the nerves and the process of obliteration of the vessels are observed not only on the limbs of the patient, but also in all organs, including the brain and heart.
Symptoms and course:Clinical manifestations are expressed in the fact that the limbs become cold, the skin is pale, fatigue is noted, severe pain in the calf muscles appears when walking quickly, which disappear when stopped (intermittent claudication). The appearance of pain is accompanied by the disappearance of the pulse on the diseased limb. Gradually, the pain intensifies and becomes constant, painful. They deprive the patient of sleep and lead to a severe neurotic state. Further, symptoms of tissue trophic disturbance appear (cyanosis, brittle nails, edema, dryness, peeling, skin luster). With the progression of the disease, tissue necrosis develops with the formation of ulcers or gangrene.
During obliterating eudarteritis, periods of subsidence and exacerbation of the process (cyclic flow) are noted.
There are four phases of the course of the disease.
1. Dystrophy of nerve elements. In this phase, there are no pronounced clinical manifestations, since circulatory trophic disturbances are compensated by collaterals.
2. The phase of spasm of the main vessels with insufficiency of collateral circulation. Clinically manifested by cooling, leg fatigue, alternating limp due to pain, etc.
3. The phase of development of connective tissue in all layers of the walls of the main arteries and their large branches, but more pronounced in intimacy. Clinically observed are symptoms of trophic disturbance, persistent pain, weakening pulsation and decreased oscillations.
4. Complete obliteration of the great vessels or their thrombosis and the development of sclerotic changes in the vessels of other organs. Clinically observed phenomena of necrosis, gangrene of the limb. The leading symptoms of the disease: pain, tissue disorder, their necrosis.
The duration of the development of the disease is different. With mild symptoms, exacerbation periods are followed by prolonged remissions, and the disease can last for many years. In other cases, a rapidly growing circulatory disturbance of a limb over several months leads to its gangrene. Circulatory disorders and gangrene caused by obliterating endarteritis should be distinguished from senile gangrene, which develops during arteriosclerosis due to aging of the body.
Treatment:Currently, there are no treatment methods that could stop the progressive damage to the arteries. Numerous of the applied methods of treatment are aimed at relieving vasospasm and accelerating the development of collaterals.
They are divided into four groups: 1) methods of local effects on the vessels of the limbs, 2) general effects on the entire body, 3) effects on individual body systems (nervous, cardiovascular, endocrine, etc.), 4) combined methods of local, general conservative or surgical treatment.
If conservative methods fail, surgical tactics are used, which currently include four types of operations.
1. Sympatectomy, in which the second and third lumbar nodes of the border sympathetic trunk are removed from the lesion or from both sides, which leads to the expansion of collaterals.
2. Shunting, ie imposition of a bypass vascular anastomosis. The vascular prosthesis is sutured above and below the site of narrowing of the vessel, resulting in improved circulation of the limb. These operations are performed after checking the patency of the lower (distal) parts of the vessel using arteriography.
3. Thrombintimectomy, when a blood clot covering the lumen of the vessel and overgrown intima are removed.
4. Amputation is performed during tissue death, ie with gangrene, and due to excruciating pains that are not treatable.
Epididymitis. Inflammation of the epididymis. The infection penetrates through the spermatic duct from neighboring organs or is introduced by the flow of blood and lymph. Contribute to the disease of hypothermia, trauma of the scrotum, sexual excesses. It can develop as a complication of acute gonorrhea, chronic tuberculosis.
Symptoms and course:Pain in the corresponding half of the scrotum, the appearance of compaction on the back of the testicle, fever, general weakness. Usually the onset of the disease is rapid.
Treatment:It is necessary to provide the testicle with the help of a suspension. You can’t walk a lot, lift weights, have sexual intercourse. The treatment is usually outpatient.