Mikulich's disease
Contents:
Description:
Mikulich's disease is the slowly progressing symmetric increase in the lacrimal and sialadens caused by a general disease of the lymphatic device.
Mikulich etiologies:
Exact etiologies of Mikulich are not established. Any autoimmune disease or development of a malignant tumor can be an etiology. Assume that defeat of the hemopoietic system is the cornerstone of a disease. It is carried to group of chronic lymphoid leukoses and aleukemic lymphadenoses. From other etiological factors it is necessary to point to tuberculosis, syphilis, epidemic parotitis (mumps), epidemic encephalitis.
Symptoms of a disease of Mikulich:
Mikulich's disease is usually observed aged from 20 up to 30 years, is more rare – at more young or elderly people. Initial forms of a disease practically differ in nothing from chronic parotitis and even simulate it at stratification of inflammatory complications. As a rule, process happens bilateral. The main symptom is swelling of the lacrimal glands. Their palpation is painful, the lacrimal glands can increase to such an extent that strongly displace an eyeglobe from top to bottom and knutr and partly stick out it forward. Consistence of glands dense. Suppuration is not observed. Quite often except the lacrimal glands, also hypoglossal glands, and also lymph nodes increase parotid, submaxillary, sometimes. Patients note dryness in a mouth, dry quite often comes to light konyyuktivit, caries of teeth. In the most typical cases the leukocytosis, a lymphocytosis is noted, the liver, a spleen and separate groups of lymph nodes increases that, to a certain extent reminds clinic of the general lymphadenosis (according to A. I. Abrikosov). In rare instances of Mikulich's disease the unilateral swelling of the lacrimal and sialadens is observed.
Diagnosis:
The diagnosis is made on the basis of a clinical picture. The method of a puncture gistobiopsiya was widely adopted. On sialogramma find increase in a sialaden, reduction of a shadow of a parenchyma, narrowing of output channels. Differential diagnosis is carried out with lymphoma of eye-sockets at which sialadens do not suffer. Histologically at Mikulich's disease the lymphomatous hyperplasia of the lacrimal and sialadens comes to light. Diagnosis is helped by researches of peripheral blood, and also a marrow punctate research. It should be noted that a disease gland capsule therefore gland fabric unions with skin or mucous membranes are not observed is never surprised. It is the main sign distinguishing this disease from chronic productive inflammations of sialadens.
Sialogramma at Mikulich's disease
Treatment of a disease of Mikulich:
Treatment is carried out together with the hematologist. Use arsenic drugs – 1% Natrii arsenas solution in the form of subcutaneous injections; doses for adults: in the beginning 0,2 ml with gradual increase up to 1 ml once a day, before the termination of a course of treatment gradually reduce a dose; quantity of injections till 20-30. Duplex solution - aqueous solution of strychnine of nitrate (0,1%) and Natrii arsenas (1%) – is applied subcutaneously in the same doses, as sodium arsenate. Solution of potassium of arsenate is appointed inside on 1-2-3 drops by 2-3 times a day within 3-4 weeks. Arsenical tablets apply on 1 tablet 2-3 times a day within 2-3 weeks. Myelosanum – on 0,002 g 1-3 times a day within 3-5 weeks, Dopanum – on 0,01 g of 1 times in 5 days. Also hemotransfusions are shown. Sometimes the roentgenotherapy gives good effect.
