[Fwd: Re: Re: Fr>En fusée purulente]

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Sujet : Re: Re: Fr>En fusée purulente

Date : Wed, 10 Feb 2010 18:12:03 +0100

De : cgtradmed

Pour : medical_translation

Références : <hkuki2+u633eGroups>

Dans la maladie de Verneuil ou hidrosadénite suppurée (caractérisée par

ces fusées purulentes) N.B. : Les fusées interviennent avant les fistules.

Voir http://www.orpha.net/data/patho/GB/uk-hidradenitis-suppurativa.pdf

Onset is usually after puberty, although it is most common during the

third decade and may persist in old age. The disease tends to become

chronic with subcutaneous extension leading to indurations, *sinus,* and

fistula having a profound impact on the quality of life.

This leads to *chronic sinus formation, with intermittent release of

serous, purulent, or bloodstained discharge.* Ulceration sometimes

occurs, and the abscesses may burrow and rupture into the neighboring

structures. Multiporous or uniporous " tombstone " comedos are frequent.

Healing occurs with dense fibrosis, which may appear as indurate

plaques, which in axilla and groin, manifest as linear bands. Regional

lymphadenopathy is characteristically absent..

*Sinus track ( lire " tract " ) formation* is a hallmark of the disease.

(Janssen et al 2001) An echographic study of hair follicles of healthy

skin of HS patients highlighted their wide diameter and distorted shape

and their deep location contrarily to what is observed in acne. (Jemec

et al 1997 a). These structural abnormalities could explain the specific

findings of HS and may be a clue to determine the genetic factors.

Severity grading

The classical 3 clinical stages as defined by Hurley (Hurley 1989) are:

- Stage 1: Single or multiple abscesses formation, without *sinus

tracts* and cicatrisation.

- Stage 2: Recurrent abscesses, with *tract formation* and

cicatrisation. There may be single or multiple widely separated lesions.

- Stage 3: Diffuse or near diffuse involvement or multiple

interconnected *tracts *and abscesses are observed across the entire area.

Radical excision and healing with secondary intention or graft

It is the best option in stage III. The extent of excision must be

enough wide and deep to remove all suppurative lesions and *tracts*, and

also if possible all apocrine glands to avoid recurrence. Using

starch/iodine/oxytocin may help to delineate the limits. (Parks et al

1997) *Mapping of sinus tract with methyl violet intra operatively* is

useful. Primary closure is possible in the axilla but may lead to

limited mobility of arms. Secondary closure is mandatory in genital and

perianal locations. It may be done by graft or flaps. Transitional colic

derivation may be necessary to allow healing in peri-anal location.

Recurrences may occur either because of insufficiently wide excision or

because of the presence of apocrine glands in aberrant location. The

recurrence rate after wide excision is less than 30%.

J'ai trouvé d'autres exemples de " suppurative sinus "

J'ai également trouvé cette définition de " sinus " sur le Webster : *1*.

An abnormal passage leading from a suppurating cavity to the body surface.

RenzoB a écrit :

> Fistula => an abnormal, channel, path, connection between the deep site of

purulent inflammation (infection generally) and either the surface of the body

or another deep site or hollow organ which is formed by the

infection/inflammation.

> fusée = fistula; spindle; track. (Schreiber's Dictionnaire de médecine)

> N.B. I have never in twenty five years as an MD in US heard the term " spindle "

used this way. Furthermore, the word " track " seems confused with the word

" tract " which, I believe is the way (tract) that most North American doctors

would write the word.

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>> I have this term to translate (in the context of leg ulcers) and have found a

nice definition: " En termes de Chirur., Fusée purulente, Conduit, trajet

fistuleux que forme le pus d'un abcès, lorsqu'il tend à s'échapper au

dehors. "

>>

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