Elephantiasis - a chronic, progressive disease that is directly related to the violation of lymph flow through the lymph vessels, and hyperplasia of the subcutaneous tissue and / or skin, which manifests itself in a persistent increase in different parts of the body as a result of diffuse edema.
this disease affects not only people, but animals and people call it - "elephantiasis".Elephantiasis is more common in younger women.Not to be confused with elephantiasis lymphostasis as "lymphedema" is only an initial step in the pathogenesis of elephantiasis.The epicenter of the disease elephantiasis are considered countries with subtropical and tropical climates, but there are also isolated cases in European countries.
prognosis for life in patients suffering from any form of elephantiasis favorable, but forecasts in terms of patient health are extremely unfavorable, sincethe disease is not only unsightly external appearances, but also limits the elementary motor activity.
By etiological features all cases of elephantiasis can be attributed to one of the two major groups: primary or secondary.
Under primary meant idiopathic elephantiasis due to a congenital defect of the lymphatic vascular bed.The birth limfangiopatiyam include aplasia (complete absence of lymph vessels in any area), hypoplasia (underdeveloped vessels with a decrease in lumen) and hyperplasia combined with valvular insufficiency.
is believed that congenital elephantiasis genetically determined and inherited, as evidenced by numerous randomized trials.The first manifestations of primary elephantiasis appear in adolescence, and the share of this group in the overall incidence is about 5% of cases.
secondary elephantiasis may occur when an existing patient aggregate of predisposing factors, which should also include such diseases as:
- erysipelas, which arises as a result of violations of lymph flow by inflammation of the lymph vessels.The development of elephantiasis in this case due to recurrent erysipelas, accompanied by irreversible changes in the lymphatic system in a limited area of the body;
- surgery accompanied by removal of the group of large lymph nodes, resulting in the body interferes with the normal circulation of lymph.Most often this type of elephantiasis patients suffer oncopathology;
- vascular lesions lymphatic channel specific types of parasites and worms that are not only clog the lumen of the vessel, but also cause a local inflammatory response, exacerbated by the stagnation of lymph;
- at the stage of cancer metastasis to regional lymph nodes create the conditions for violations of lymph;
- chronic venous system (phlebothrombosis, varicose veins) are accompanied by a progressive venous congestion, which causes congestion changes in the vessels of the lymphatic system;
- sepsis, in which the inflammatory changes observed in all organs and systems;
- syphilitic lymph channel;
- isolated primary lymphadenitis and lymphangitis in the absence of adequate treatment.
Normally lymph a constant circulation of lymphatic fluids, which is formed by the filtration of blood plasma in the first interstitial space, and then in the lymphatic vessels of the channel.
The etiopathogenesis elephantiasis should note the following main units: the disruption of lymph flow through the lymph vessels, caused by one reason or another - the development of chronic limited edema - a violation of all exchanges in the subcutaneous fat, which apply to the skin and fascia - impregnating interstitial high molecular weight proteins- the development of fibrosis - the growth failure in the system of lymph - a progressive swelling of the soft tissues - the development of irreversible fibrosis.
Depending on what phase of etiopathogenesis is a disease, identify several pathologic stages of elephantiasis:
- lymphedema (mild stage), which is manifested by progressive severe swelling of soft tissues in a limited area of the body;
- intermediate stage, in which the distal extremities already with signs of fibrosis, and the proximal is at the stage of lymphedema;
- fibredema manifested total fibrosis of soft tissue and skin.
Primary and secondary elephantiasis have much in common in clinical symptoms, but there are specific symptoms.For example, the primary elephantiasis characterized by early onset of the disease (in adolescence) and rapid progressive course, while the formation of the developed clinical picture of secondary elephantiasis sometimes takes years and decades.
The most common clinical form of the disease is elephantiasis of the lower extremities.The initial stage of the disease has no specific symptoms, and occurs only in a small swelling of the distal portions of one or both limbs occurring after prolonged standing.In this phase of the pathological process only complaint of the patient can be a feeling of "fullness" in the lower limbs.An objective examination of the patient are not determined by changes in the structure, color and skin temperature.The only symptoms suggestive of edema stagnant, is - "the appearance of indentations in the soft tissues after palpation and local action."
progression elephantiasis edema becomes persistent and extends to the proximal lower extremity.At this stage there are specific changes in elephantiasis of the skin in the form of the appearance of the local portion of the seal in the soft tissues, the skin over them badly displaced due to the presence of fibrous bridges, but the surface and color of the skin is not changed.Special pain in the affected limb, and the patient does not mark only complaint is often a cosmetic defect.
In the long course of disease and the lack of timely adequate therapy is compounded by the swelling of the lower limb, causing it acquires enormous dimensions and at the slightest trauma skin developed erysipelas, trophic ulcers and hyperkeratosis.Palpation of the soft tissues is difficult because of the presence of large fibroids, separated by skin folds.
Clinical manifestations secondary elephantiasis are directly dependent on the disease, which was the root cause.For example, erysipelas always present signs of inflammatory reactions of the skin in response to the entering of an infectious agent in the form of redness, increased local temperature, swelling, and tenderness to palpation.
hands Elephantiasis occurs much less frequently than the lower limb elephantiasis and has the same clinical stages and manifestations.
peculiar symptoms observed in elephantiasis of the vulva, which is equally observed in both men and women.At the beginning of the disease is a progressive increase in the outer labia and scrotum with a thickening of the skin.Skin have hyperpigmented areas with signs of hyperkeratosis and papillomatoznyh growths.Due to the thickening and coarsening of the skin folds of the foreskin, difficult urination and ejaculation, so patients with elephantiasis of the scrotum suffer from impotence.This clinical form of elephantiasis is often accompanied by the appearance of complications in the form of eczematous dermatitis, hydrocele and development of septic conditions accession streptococcal infection.
Some specific clinical manifestations characterized by elephantiasis caused fillyariozom lymphatic vessels.For these patients, the primary concern is not swelling, both primary elephantiasis, and pronounced itching of the skin, accompanied by the appearance of the rash papular in a limited area of the body (hip, thigh, upper arm, abdomen).The skin structure becomes "lemon peel" and quickly exposed hyperpigmentation and trophic disorders.
Prior to the development of a dense edema the patient should be advised to conservative treatment methods, which imply compliance with the correct motor mode, medication and physiotherapy.Thus, patients should be excluded orthostatic stress and normalize physical activity (walking, swimming).In order to prevent the spread of edema in the proximal parts of regularly wearing special items of medical compression hosiery.
as a medical treatment it is advisable to use diuretics (Diakarb 250 mg 1 r / d) of proteolytic enzymes (trypsin 5 mg dissolved in 2 ml of saline and put in / m 1 p / day for 10 days), procaineblockade (subcutaneous local administration novocaine 0.25% at a dose of 1 ml).
When elephantiasis caused helminthiasis expedient purpose anthelmintic drugs (doxycycline 200 mg 1 r / d, Albendazole 400 mg per day for at least 1.5 months).
Effective physiotherapy helps to reduce swelling are ultraviolet irradiation, electrophoresis using proteolitikov (hyaluronidase, trypsin, lidasa) pneumomassage.
The onset of the disease desired positive effect can be achieved through regular courses lymphatic drainage massage.This type of manipulation carried out through the course of the day at least 12 procedures.Like any medical manipulation, lymphatic drainage massage has contraindications: oncopathology any trimester of pregnancy and infectious nature of the disease in the acute period.
Indications for surgical intervention is the lack of effect from conservative therapy.At the stage of mild edema performed issechenie damaged areas of the lymphatic vessels and the formation of lymphoveinous anastomosis.If the disease is in phase fibrodermy, a more radical surgery, which implies a deep resection areas fibrozirovannyh soft tissue with skin graft, and then need more plastic surgery to replace skin graft.
When elephantiasis external genitalia produce a complete removal of the damaged areas of the scrotum or outer labia.New scrotum is formed by healthy soft tissue taken from the thigh area.In a situation where elephantiasis complicated epidimititom must perform gemikastratsiyu.
Vascular surgeons recommend combining the traditional methods of treatment using the recipes of traditional medicine, among which there are recipes for indoor and outdoor use.
excellent garlic has anti-edema effect, so the treatment of elephantiasis is recommended to use a mixture of garlic and honey (250 g of crushed garlic with 300 g of honey) 1 tablespoon1 p / day for 2-3 months.
as a vehicle for the topical treatment of elephantiasis applied a poultice of crushed leaves of lemon balm or mint, which is superimposed on the injured limb and left overnight.
If there are trophic lesions of the skin in the form of ulcers and excoriations, then wipe affected skin thistle oil, which not only has antiseptic and anti-inflammatory properties, and wound-healing effect.