Endarteritis is obstructive
Severe progressive vascular disease, which leads to impaired blood circulation and gangrene of the limb. Suffer mainly men. The etiology of the disease is unknown. The moments that contribute to the development of the disease are: repeated prolonged cooling of the legs, neuropsychiatric injuries, chronic nicotine poisoning (smoking) and other poisons. Obliterating endarteritis is a common disease with primary localization in the vessels of the lower extremities.
It is believed that at the beginning of the development of the disease, changes in the vessel walls are preceded by morphological disorders of the nervous elements of the extremities, which consist of degenerative changes of predominantly pulpy nerve fibers. Later, a spasm of blood vessels appears, and then morphological changes of all layers and walls, which are in the nature of proliferation of connective tissue, their sclerosis, which ultimately leads to obliteration of the vessel lumen. The process begins with the great 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 noted not only on the patient’s limbs, 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, there is rapid fatigue, severe pain in the gastrocnemius muscles during fast walking, which pass 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 trophism (cyanosis, brittle nails, swelling, dryness, peeling, shine of the skin) appear. With the progression of the disease, tissue necrosis develops with the formation of ulcers or gangrene.
During obliterating eudarteritis, there are periods of subsidence and exacerbation of the process (cyclical flow).
There are four phases of the disease.
1. Dystrophy of nerve elements. In this phase, pronounced clinical manifestations do not occur, since disturbances in the blood circulation pattern are compensated by collaterals.
2. Phase of the spasm of the great vessels with collateral circulation insufficiency. It is clinically manifested by cooling, leg fatigue, intermittent claudication 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 the intima. Symptoms of trophic dysfunction, persistent pain, a decrease in pulsation and a decrease in oscillations are clinically observed.
4. Complete obliteration of the great vessels or their thrombosis and the development of sclerotic changes in the vessels of other organs. The symptoms of necrosis and gangrene of the limb are observed clinically. The leading symptoms of the disease: pain, impaired tissue, their necrosis.
The duration of the disease is different. With mild symptoms, periods of exacerbation are replaced by long-lasting remissions, and the disease can last for many years. In other cases, a rapidly increasing impairment of blood circulation to the limb for several months leads to its gangrene. Disruptions in blood circulation and gangrene caused by obliterating endarteritis should be distinguished from senile gangrene that develops in arteriosclerosis due to aging of the body.
Treatment:Currently, there are no treatments 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 influence on the vessels of extremities, 2) general effects on the whole organism, 3) effects on individual systems of the body (nervous, cardiovascular, endocrine, etc.), 4) combined methods of local, general conservative or surgical treatment.
If conservative methods of success do not give, apply surgical tactics, which currently includes four types of operations.
1. Sympathectomy, in which the second and third lumbar nodes of the border sympathetic trunk are removed from the side of the lesion or from both sides, which leads to the expansion of collaterals.
2. Shunting, i.e. the imposition of bypass vascular anastomosis. The vascular prosthesis is sewn above and below the place of the vessel narrowing, as a result of which the blood circulation of the limb is improved. These operations are performed after checking the patency of the lower (distal) parts of the vessel using arteriography.
3. Thrombintimectomy when a blood clot is removed that covers the vessel lumen and overgrown intima.
4. Amputation is performed when tissue is killed, i.e. with gangrene, and due to excruciating pains that cannot be treated.
Epididymitis. Inflammation of the epididymis. Infection penetrates through the sperm duct from neighboring organs or is carried by blood and lymph. Contribute to the disease of hypothermia, injury to the scrotum, sexual excesses. It may develop as a complication of acute gonorrhea, chronic tuberculosis.
Symptoms and course:Pain in the corresponding half of the scrotum, the appearance of a seal on the posterior surface of the testicle, fever, general weakness. The onset of the disease is usually rapid.
Treatment:It is necessary to ensure the testicle rest by means of the suspensor. You can not walk a lot, lift weights, have sexual intercourse. Treatment is usually outpatient.