m.d. Shydlovscky. A.V.

tuberculosissyphilisactinomycosis

Tuberculosis is a chronic disease has an undulating character. The world is now experiencing a new, another attack of this disease. In Ukraine the situation is related to the spread of tuberculosis began to deteriorate in 1990, and in 1995 recorded an epidemic of progressive disease. Annual medical and economic losses from tuberculosis in Ukraine are 1,49 . .

Tuberculosis in the factsTuberculosis - an infectious disease that usually attacks the lungsTransmitted via droplets from people with active phase of the diseaseSymptoms of active TB - cough, weight loss, chest pain, fever and night sweatingTuberculosis is treated with a course of antibioticsUkraine - one of 27 countries where tuberculosis detected with resistance to first-line drugs - isoniazid and rifampicinUkraine - one of the 18 European countries where the disease is 8 times higher than average and is 73 persons per 100 thousand population

Head of the Parliamentary Committee on Health Tatiana Bakhteeva State Economic losses from this infection exceeding 3 billion. According to the criteria of the European Office of WHO, Ukraine has the second highest incidence of tuberculosis in Europe (after Russia), and 4 in the world for its prevalence.Ukraine is one of the 27 countries in which concentrated 85% of the total burden of MDR TB. Today we have the total number of new patients with TB is about 9 thousand a year, which indicates that the country's epidemic is rapidly spreading.

RespiratoryOsteo articularUrogenitalThe nervous system and brainIntestines, peritoneum and lymph nodesSkin and subcutaneous tissueThe organs of sight and hearing

Up to 20% of all clinical forms tbc;This is a local manifestation of tbc process;Hematogenous route of infection. The most sensitive tissue is rich in bone marrow: vertebrae - Epiphysis of long tubular bones - Spongy bone - Diaphysis of long bones (less)

Prearthrytyc (primary osteitis) arthritic (secondary arthritis and its three phases: the beginning - height - remission Postarthrytyc (the effects of arthritis, acute, recurrent)

Makes up 40% of the number of patients with osteo-articular tbc;Location: Thoracic - 60%; - Lumbar - 30 - 35%; - Sacral - 5 - 10% Amazed least 2 vertebrae, and the children - 3 or more (up to six)

Hospital vague, not clear, not specific: Malaise, weakness - slimming - Loss of appetite - Indefinite pain in the spine - Limiting the amplitude of the bending motion radiological determined by fire destruction of vertebrae

Severe clinical picture: - Intoxication, fatigue, weight loss; - Pain in the spine (mainly well-localized) - Increased pain with a load on the spine - Symptom "vizhok" - A symptom of "sword" - Curvature of the spine to form a hump - Formation of wandering abscess (rare)

Reducing the height of the intervertebral disc;Destruction of bone lesions with the presence of sequestra and irregular contours;Compression fractures;Angular curvature of the spine (hump);Wandering abscess (80%).Tuberculous spondylitis X, XI thoracic vertebrae. It is evident vertebral deformity and abscess

Regression of clinical symptoms;Functional thickening of the vertebrae below the lesion;Possible exacerbation and relapse;Restitution anatomical changes and restore function does not occur

Accounted for 20% of cases of osteo-articular tuberculosis;Over the course is divided into phases:- prearthrytyc- arthritic- postarthrytyc

Local lesions:Proximal tibia - 80%;- Distal femur - 22%;- Metaphysis of bones - up to 10%;- Rarely patella Clinic - intoxication and indefinite pain in the joint. X-ray - osteoporosis bone foci of destruction.

Joint pain at restLocal redness and swelling of the jointAtrophy of musclesflexion contractureThe increase in the volume of jointWandering abscess, fistulaSubluxation leg (usually backwards)

Joint space narrowingInequality contours of the articular surfacesThe centers of regional destruction of bones that form the jointHaving sequestrationTuberculous gonitis with a fireplace in the epiphysis of the femur

Hospital reducesdeveloping ankylosisFibrotic fusionPathological extremity fixationsubluxation of the tibiaRecurrence and exacerbation

It occupies about 20% of all bone TBC. About 60% of sick childrenClinic Periodic and later permanent lameness Common symptoms of intoxication Steady local pain The gradual restriction of movement Pathological fixation in joint pain flexion contracture Over time, constant pain

Bone osteoporosis (early symptom)After 1 - 1.5 months. from the onset of degradation of the femur firewandering abscessJoint space narrowingThe centers of regional destruction of bone tissueIn the area of bone sclerosis lesions (postarthrytyc phase)Osteoporosis, ankylosis

Up to 4% of patients with bone tbcAge Adults (15 to 40)Weakness in the handPain in the jointsAtrophy of the muscles, especially deltoidRestriction of movementX-ray picture of osteitis, bone osteoporosis laterMarginal source of destruction of the articular surfacesSometimes formed sequestersSometimes radiographic changes the type of "dry cariesRegional uzuration of humerus epiphysis with multiple sclerosisJoint space narrowingAbsence of exudation and effusionShrinkage of the joint capsuleSevere muscle atrophy. In postarthrytyc phase formed osteoarthritis, tendency to relapse

Frequency 2.3 - 2.6% of patients with bone tbcThe weakness of the hands, dull pain in the joint during movementLimitation of movementJoint swelling and muscle atrophyMore often strike metaphysis shoulder and elbow bonesX-ray changes of periosteum, osteoporosisCraiova destruction of bone formation sequestrationFrequently wandering abscess and fistulaPostarthrytyc phase ends by ankylosis

Overall antibiotic therapy Orthopedic treatment: unloading and immobilization (plaster bed, corset splints) Surgical treatmentRadical (stabilizing, restorative, preventive, decompressive) operationsPalliative surgery Spa treatment with restorative physiotherapy (Evpatoria)

Over the past year, compared to 2008, the incidence of syphilis in the Ternopil region increased by as much as 30 percent! One hundred thousand people to 15 people suffer from it and it's a lot. Of course, in the early 90s, the figure was much higher - 900. (Ternopil skins. Ven. Dispensary, O.I.Hara)

Classification (born, tertiary)Bone lesions from 40 to 95%Changes in bone is often the only symptom that indicates syphilis

Specific areas of bone destruction syphilisEpiphyseal cartilage discs that provide growth of long bonesCambial layer of the periosteum, which provides bone growth in thickness Thus, specific changes in bone syphilis is osteochondritis in the epiphysis of long bones and syphilitic peryostitis in the diaphysisSyphilitic osteochondritisSyphilitic periostitis and osteochondritis

Surface are affected by long tubular bones (forearm, leg, bones, nose, hard palate)Developed through years after infectionSerological response in half of the negative casesLiquid damage vertebral joints

Actinomycosis - a chronic purulent uncontagiosedisease caused by a number of luminous fungi Actinomycetales, affects people in middle age, lasts for years, and has significant medical, social and economic losses. Visceral localization among the totality of patients make up 20% lesion face and neck - about 80%. This fungus - saprophyte

Actinomycosis headTongue and neckThoracicAbdominalurinary tractadrectalSkinCentral Nervous System

Thick not pain infiltration of the skinSubsequently, the skin over it purplish-cyanoticappears fluctuationsOpens fistula with purulent discharge which is whitish druse fungusStage of disease: infiltrative, abscessed, fistulas,

Ranked first among all lesions (80%)Affects the cheeks, tongue, lips, tonsils, trachea, larynx

The defeat of the bronchi, lungs, pleuraGeneral weakness, shortness of breathCoughing up sputum with the smell of earth and copperLow-grade constant temperatureFurther development perybronchitis, the transition process in the chest wall to form a fistula communicating with bronchiFlow heavy mortality to 50%

Preferably fistula in the ileo-cecal areaIn clinical mimics acute surgical diseasesSpreading captures other organs (liver, pancreas, kidneys)Fistula with intestinal secretionsWithout treatment, long course, the transition process to other organs - fatal consequence

Fenoksymetylpenitsylin 2 g / day and the duration of the course for at least 6 weeks.Tetracycline 0.75 December 4 times a day four weeks or 3 grams a day only in the first 10 days and then 0.5 g 4 times a day for the next 18 daysErythromycin 0.3 December 4 times a day six weeks

Benzylpenicillin (10 million units / day or more) intravenously for 1 - 1.5 months with subsequent transition to fenoksymetylpenitsylin a daily dose of 2-5 g for 2-5 months.Surgical expedient in bulkFor immunotherapy aktynolizat - 3 ml intramuscularly aktynolizata 2 times a week. At the rate - 20-30 injections, duration of 3 months

Number of people living with HIV: 440 000 (340 000 - 540 000)Prevalence among adults aged 15-49 years: 1.6% (1.2% - 2%)Adults aged 15 and over living with HIV: 430 000 (330 000 - 530 000)Women aged 15 years and older living with HIV: 190 000 (140 000 - 230 000)Deaths by AIDS: 19,000 (14,000 - 25,000)

Typical morphological target HIVAcquired Immune Deficiency Syndrome (AIDS) is the most dangerous infectious disease, leading to death after an average of 10-11 years after infection with human immunodeficiency virus (HIV). The disease has already claimed the lives of more than 18 million people today living in the world 34.3 million HIV-infected people.

Necrosis of the soft tissues of the mouth angle of the backgroundherpes in HIV - infected children

Giant left foot Kaposi's sarcoma

Kaposi's sarcoma of the eye and orbit in stage collapse

The main face of AIDS in surgery is the prevention of HIV infection nursingIt is mandatory the use of gloves, aprons (when dealing with blood and tissues)In procedural and dressing rooms of kits should be the means of HIV prevention

Ingredients kitThe solution marhantsovkyA solution of 5% iodineA solution of 30% albutsida or 1% silver nitrateThe solution protargola70% alcohol

Operative field is prepared using a single device for shavingDo not allow staff to work with damaged skinTo protect the participants during the operation to apply aprons, shoe covers, sleeves, disposable gowns (all of nonwoven materials), goggles, double mask on the nose, the hands two pairs of latex gloves

Use tools only for AIDS patientsCutting and piercing instruments surgeon is veryCarefully, without haste operateAfter surgery, special treatment just tools, usedSpecial processing operating

Ligation and manipulation in specially equipped and only for such patients roomsStaff dressed as an operationUse only marked toolsAfter ligation treatment tool room and everything used - like after surgery

When puncture gloves - replacement of the skin after treatment 70% alcoholWhen injected fluid to the skin - treatment for 2 min 70% alcohol, wash with soap and water, repeated treatment with alcoholWith cuts and punctures the skin - squeeze 2-3 drops of blood and process 5% iodine AMWhen injected into the eye - wash with water and drip silver nitrate