Obstetrician's hand syndrome in adults. Clinic and treatment of hypoparathyroidism. Trousseau's sign - the hand of the obstetrician and Chvostek. DIC syndrome in obstetrics

Hand in spasm is in a state of extension, the forearm is bent in semiflexion, and the shoulder is in a state of adduction (Trousseau's symptom - the obstetrician's hand).
On lower limbs There is increased extension of the thigh and lower leg with flexion of the foot and toes. In severe cases, cramps can involve all the muscles of the face, causing it to become distorted. The face takes on a characteristic expression, the forehead is wrinkled, the lips are contracted and protruded forward. The muscles of the eyes, tongue, larynx, and the diaphragm also take part in a spastic attack. With convulsions of the muscles of the larynx, which is more often observed in children, laryngospasms occur, with suffocation, cyanosis, and prolonged spasm severe asphyxia appears with loss of consciousness, which may result in fatal. Often, patients with chronic hypoparathyroidism experience trophic disorders: dry skin, brittle bones, hair loss, cataracts, significant weight loss. Patients often experience tachycardia, arrhythmia, and compressive pain in the heart area. The electrocardiogram shows an increase QT interval, which is caused by hypocalcemia.

Permanent symptom of hypoparathyroidism is a violation mineral metabolism- hypocalcemia up to 5-6 mg%, hyperphosphatemia up to 7-10 mg%, hypocalciuria and hypophosphaturia. Impaired function of the organ of vision is expressed in convergence disorders, eyelid spasms, diplopia, nystagmus and the development of cataracts. During an attack, you can observe a narrowing or dilatation of the pupils and a slow reaction. With spasm of the intercostal muscles, abdominal muscles and diaphragm, significant respiratory distress is observed.
Vegetative nervous system is in a state of increased excitability with a tendency to vasomotor phenomena.

Functional disorders gastrointestinal tract are expressed in increased peristalsis, constipation followed by diarrhea, and increased secretion of gastric juice. Gastric or duodenal ulcers may often develop.
By clinical course There are acute, chronic and latent forms of parathyroid tetany.

In acute tetany attacks often recur and continue long time, they may arise unexpectedly.
Development tetany in acute form after any injury and strumectomy, it indicates complete or almost complete shutdown of the function of the parathyroid glands. Acute form tetany may end in recovery or progress to chronic form depending on the nature of the disease, treatment, etc. This form has a less severe course, attacks are rare. In its origin, provoking moments, overheating or hypothermia, are important. exercise stress, mental trauma, pregnancy, acute infections.

Seasonal exacerbation, diseases in spring and autumn. Often, patients with chronic hypoparathyroidism exhibit trophic disorders: dry skin, brittle nails, hair loss and weight loss. Changes in the teeth are reduced to enamel defects; teeth break and crumble easily.

Recognition of idiopathic is hidden ongoing hypoparathyroidism presents known difficulties. This form is characterized by the absence of spontaneously occurring attacks, which can occur under the influence of various provoking factors. Idiopathic tetany more often occurs at a young age, men are more often affected, the presence of changes in calcium and phosphorus metabolism gives grounds to classify idiopathic tetany as a parathyroid form associated with congenital inferiority of the parathyroid glands.

Complaints patients with a latent form of tetany are usually associated with cardiac disorders: they complain of palpitations, chest pain, a feeling of tightness in the chest, fainting, and often complain of goosebumps crawling in their fingers. Physical and X-ray examinations internal organs no changes are detected. The simplest way is to identify Chvostek's symptom, which is based on increased excitability of the facial nerve when it is mechanically irritated. In response to irritation, the upper lip twitches (Khvostek I), or the upper lip and nose (Khvostek II), or twitching of the corner of the mouth is added (Khvostek III).

Diagnosis and differential diagnosis. It is necessary to think about the possibility of hypoparathyroidism if in patients after partial removal thyroid gland signs of topical seizures appear. When making a diagnosis, one should also differentiate tetany from hysteria and epilepsy. In patients with hysteria and epilepsy, calcium and phosphorus metabolism disorders are not found.
It should also be kept in mind hypoglycemic cramps, at which they are observed characteristic features, feeling of hunger, weakness, pale skin. The question is resolved by examining blood sugar and calcium levels.

Treatment of hypoparathyroidism. When treating an attack of tetany, it is necessary to administer 10 ml of 10% calcium chloride intravenously, 2-4 ml of parathyrsocrine intramuscularly.
Intravenous administration 10% calcium chloride solution or 10% calcium gluconate solution usually quickly stops an attack of convulsions during tetany, which is very important for laryngospasm, when this is the main measure during first aid.

Depending on the duration and the frequency of attacks, calcium chloride and parathyroid injections are recommended to be carried out 2-3 times a day under the control of calcium levels in the blood.
In the inter-iristune period Calcium preparations are prescribed in the form of a 10% solution of calcium chloride, one tablespoon 3 times a day, or calcium gluconate in tablets, 3-4 tablets a day. At the same time prescribed orally alcohol solution vitamin D2 50,000-75,000 IU 2 times a day.

This syndrome is named after the person who first established the relationship between the combination of thrombophlebitis and cancer of internal organs - the French doctor Andre Trousseau. A typical symptom of spasmophilia – “obstetrician’s hand” – is named after him. Trousseau syndrome refers to paraneoplastic processes, and links together spontaneous migratory thrombophlebitis and advanced cancer of the esophagus or other internal organs (usually the stomach, liver).

Paraneoplastic processes are processes occurring in the body of elderly and old people (they are much less common in young people), which develop when oncological diseases, but are in no way connected directly with the tumor itself - that is, neither with its metastases, nor with its growth. Such nonspecific reactions occur in response to those changes that arise due to the presence of an altered, neoplastic, essentially foreign process for the body.

Causes

There are several causes of Trousseau syndrome. One of them lies in the excessive formation of thrombus-forming factors. Almost any tumor, starting from a small size, produces fibrinopeptide A, which, when detected, can be a marker of a tumor of internal organs - this is due to the fact that quantitative indicators fibrinopeptide A and tumor size are associated with fairly high degree accuracy.

The second reason is a change in hemostasis in cancer patients according to the type of external coagulation mechanism - that is, after substances that are not part of its composition (in this case, tumor cells) enter the blood. Tumors are a constant source of tissue thromboplastin, as well as a special “cancer procoagulant” that converts coagulation factors VII and X into serine proteinase.

More often this symptom appears with tumors of the gastrointestinal tract.

Symptoms

As often happens in medicine, the discovery of this syndrome associated with the death of the author himself. Andre Trousseau had been studying neoplastic pathology for a long time, and had already noticed signs of spontaneous thrombosis. Since the relationship between thrombosis and tumors was obvious to Trousseau, he assumed that he himself had one, especially since there were not too obvious, but, nevertheless, alarming symptoms. And so it turned out - Andre died of stomach cancer.

Tumors of internal organs do not always make themselves felt with typical symptoms. And people often tend to reduce the significance of what they consider to be terrible complaints and symptoms. The tumor grows, its external influence on the body increases, and pareneoplastic processes are provoked. If phlebothrombosis is formed in different places, are difficult to treat, or even not treatable at all, if there are thromboses of large arteries not associated with any diseases known to the patient, it is worth assuming a cancerous tumor.

Diagnosis and treatment

Diagnosis must be thorough. Increased thrombotic processes, constant changes in blood parameters, indicating changes in coagulation factors. It is necessary to conduct a blood test for the presence of fibrinopeptide A and other coagulation factors, and also pay attention to all nonspecific complaints that the patient has. A thorough diagnosis will also be required to determine the location of the tumor.

There is no specific treatment for Trousseau's syndrome (as well as other paraneoplastic processes). They can only clinically weaken or regress with successful treatment (even palliative treatment).

Forecast

Entirely depends on the prognosis of the tumor and the possibilities of its radical treatment.

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Spasmophilia- I Spasmophilia (spasmophilia; Greek spasmos cramp, spasm + philia tendency; synonym: rickitogenic tetany, spasmophilic diathesis) is a pathological condition that occurs in children with rickets in the first 6-18 months. life; characterized by... ... Medical encyclopedia

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Spasmophilia (tetany) is a painful condition in which there is increased neuromuscular excitability with a tendency to convulsions and spastic manifestations, usually detected in early spring during a period of increased insolation. Occasionally occurring in adults, spasmophilia mainly affects children aged 6 months to 3 years, premature babies and those on artificial mixed feeding. Spasmophilia occurs when there is a calcium deficiency in the child’s body and is often combined with rickets.

Causes of spasmophilia in children

Spasmophilia develops as a result of a lack of calcium in the blood due to intake high doses vitamin D in the treatment of rickets or with increased insolation and excessive formation of this vitamin in skin. Its overproduction in the body has a negative effect on the functions of the thyroid gland, provokes the absorption of calcium and phosphorus salts in the intestine and their further reabsorption (reabsorption) in the renal tubules, which causes alkalosis. Active deposition of calcium in the bones leads to a decrease in its amount in the blood - hypocalcemia, and also increases neuromuscular excitability, leading to seizures.

Symptoms of latent spasmophilia

The disease can have a hidden (latent) or obvious form. The latent form of spasmophilia in children is very difficult to determine - they are actually healthy, they have normal physical and psychomotor development, but they often show symptoms of rickets. There are a number of symptoms characteristic of spasmophilia that confirm its latent form. Let's name some of them:

• Chvostek's sign. Characterized by contraction facial muscles face with light tapping on the cheek between the corner of the mouth and earlobe along the trunk of the facial nerve;
• Weiss's sign. It is characterized by the occurrence of contraction of the muscles of the forehead and eyelids when tapping with a percussion hammer in the area of ​​the edge of the orbit from the outside;
• Trousseau's sign. When the shoulder is intensively pulled with a tourniquet or cuff, a convulsive contraction of the hand muscles occurs in the overtightened arm. This leads to the position of the hand in the form of an “obstetrician’s hand”. Convulsions in spasmophilia are preceded by a feeling of numbness and pain in the fingers;
• Maslov's symptom. In children suffering from spasmophilia, unlike healthy ones, when a needle is pricked in the leg, not only rapid breathing is observed, but also apnea (short-term cessation of breathing) recorded by a pneumograph.

The latent form of spasmophilia in children is determined quite often. Under the influence of certain factors, such as fear, vomiting, sudden exposure to sunlight, or increased temperature due to an infectious disease, it can become obvious. If spasmophilia is detected, treatment must be carried out immediately.

Clinical picture and symptoms of obvious spasmophilia

An obvious form of spasmophilia in children can be expressed by laryngospasm, carpopedal spasm, eclampsia, or a combination of them:

• Laryngospasm. One of the most common forms of spasmophilia, also called “rodchik”, is characterized by a sudden acute narrowing glottis, with its possible partial or complete closure, which occurs when crying or fright. With moderate manifestations of laryngospasm, the child’s skin turns pale, cold sweat appears, and a change in voice occurs with hoarse or sonorous inhalation. The attack can last up to 2 minutes, then when breathing is restored, the child falls asleep. In the absence of adequate treatment for spasmophilia, attacks can be repeated; during severe laryngospasm, complete cessation of breathing and loss of consciousness are sometimes observed; in the most severe cases, death is possible;
• Carpopedal spasm. Symptoms of spasmophilia in this form of the disease are tonic spasms of the hands, feet and face. In this case, the child has arms bent at the elbows, hands down with characteristic symptom Trousseau, bent legs and feet. Attacks of spasmophilia can last from several minutes to several hours, with reactive swelling of the hand and foot appearing; spasms of the respiratory muscles are also possible, threatening to delay and stop breathing, and spasms of the heart muscle with possible cardiac arrest;
• Eclampsia. The rarest and most dangerous form spasmophilia, manifested by attacks of clonic-tonic convulsions, spreading to the entire musculature. With a mild course, facial muscle spasms, the appearance of cyanosis, intermittent breathing and numbness of the child are characteristic. During a severe attack of spasmophilia, convulsions of the whole body, loss of consciousness, tongue biting, involuntary urination and defecation occur; the attack can last up to 25 minutes. In severe cases, respiratory and cardiac arrest is possible; eclampsia most often affects children in the first year of life.

These forms of spasmophilia pose a threat to the health and life of children and require emergency medical care for immediate resuscitation.

Spasmophilia in adults

Spasmophilia in adults is much less common than in children; it can be caused by the following reasons:

• Surgical operations to remove the parathyroid glands;
• Hemorrhages;
• Tumors that have a negative effect on the thyroid gland.

In some cases of spasmophilia in adults, its etiology remains unknown. Factors that provoke the detection of the disease in a latent form include pregnancy, lactation, infectious diseases, and nervous strain. To prevent attacks of spasmophilia, it is recommended to avoid stressful situations, be able to control your breathing and relax, and include foods containing calcium, magnesium and phosphorus in your diet.

Treatment of spasmophilia

When diagnosing spasmophilia in children, the age of the child, the time of year, the presence of signs of rickets, and laboratory research symptoms of hypocalcemia, hypophosphatemia, and metabolic alkalosis are determined.

In the treatment of spasmophilia, relief convulsive syndrome carried out using anticonvulsants– seduxene, relanium, magnesium sulfate, gamma-aminobutyric acid. To restore calcium levels in the blood and eliminate alkalosis, use a 10% solution of calcium gluconate and 3-5% ammonium chloride. Subsequently, vitamin therapy is carried out, and after normalization of calcium levels in the blood, therapeutic doses of vitamin D are prescribed.

If an attack of laryngospasm develops, before the ambulance arrives, it is necessary to lay the patient on a hard surface, ensure rest and air access, and spray the face and body cold water, ammonia or other means cause irritation of the nasopharyngeal mucosa. To relieve an attack of spasmophilia, doctors administer a solution of calcium and magnesium intravenously, and intramuscularly sedatives. If the measures taken are ineffective and there is no breathing, tracheal intubation is necessary, as well as indirect cardiac massage when it stops.

Prevention of spasmophilia consists of timely diagnosis and adequate treatment of rickets.