pilonidal disease
Introduction
Introduction to Tibetan Hair Disease Tibetan hairy disease, also known as pilonidalsinus, is a rare sinus that contains hair on the skin. This type of sinus is most common in the dorsal aspect of the posterior coccyx of the anus, so it is also the coccygealpilonidalsinus. As early as 1847, Anderson reported this disease. In 1880, Hodges officially adopted the current name. During the Second World War, the incidence of this disease among American and British soldiers increased significantly. These patients have long-term experience in riding a jeep. People think that this kind of flexing leg sitting and long-term bumps may be related to this disease, so it is called "Jeep disease." basic knowledge The proportion of sickness: 0.04%-0.07% Susceptible people: no specific people Mode of infection: non-infectious Complications: squamous cell carcinoma
Cause
Causes of hairy diseases
(1) Causes of the disease
There are many the causes of this disease, which can be roughly divided into two categories: developmental causes and injuries. Due to the development of embryology in the second half of the 19th century, specific lesions occurring at specific sites of the disease are naturally suspected because of developmental There are three hypotheses that are caused by the reasons that summarize a large number of writings:
1. The dorsal sacral cystic residue theory: French scholar Tourneaux and Herrman proposed in 1887, until 1942, American scholar Kooistra still supported this.
2. The development of the central joint malformation in the appendix area: Fere (1878) proposed that the central joint deformity development in the appendix caused the formation of cysts in the skin. In 1935, Fox advocated this theory.
3. Degenerate remnants similar to the structure of the tail gland of birds: Stone proposed this theory in 1931, and some people think it is a degenerate remnant of a certain gland. Until 1946, Patey et al reported that a hairdresser found a sinus on his finger. The hypothesis of congenital pathogens or developmental causes begins to be suspected and seeks explanations for acquired causes. Later, there have been many such reports, suggesting that hair is implanted after skin damage, or that hair breaks through the skin, causing infection and Peeling, Bearley believes that the sinus sinus is initially formed by the surrounding hair piercing the skin to form a short sinus, while the root of the hair is still connected to its hair follicle. When this hair falls off, it continues to be inhaled by the attraction of the sinus. He suggests The first stage is called piercing sinus tract and the second stage is called inhalation sinus tract. This hypothesis seems to explain some clinical phenomena and historical facts that have been known. For example, the disease is mainly male. Occurs in people or races with many body hairs, where the hairy areas are, and often suffer from convulsions, friction, etc., Bearley said that the reason for the Jeep occupants The high morbidity is due to the fact that these soldiers ride on low and hard jeep on long and bumpy roads, often twisting and rubbing the buttocks. He measured the change in local pressure when the gluteal sulcus was opened, when the hips were separated from the sides. Partial pressure can suddenly reduce 80mmH2O, indicating the attractiveness of the locality. In a discussion in 1975, Rord reported that one case took a hair in the sinus of the sinus, a total of 23 hairs, hair color, thickness, length And the direction is the same, he believes that this is a continuous growth from a "young-type" hair follicle, "young-type" hair follicle does not start function in the fetal period like the "head-type" hair follicle but starts in the youthful sprouting period The function of starting, each hair grows to fall off about 3 to 6 months. When the hair is still growing, the sinus infection is exposed, and the hair is exposed. He thinks it is difficult to accurately cut the histological examination. The structure of the hair follicle has been destroyed by the hair follicle or when it is cut. Therefore, the general pathological report always says that only the hair has no hair follicles. Rord's report indicates that there are still many traditional etiology theories. Explanation of the problem.
(two) pathogenesis
The primary sinus in the dorsal midline of the tailbone is open in the skin, about 2 to 3 cm deep, with a small cavity at the end. The sinus contains hair, and sometimes the hair protrudes at the sinus. This hair is completely free. It is difficult to find the hair follicles. The secondary duct is located deep in the original sinus. After infection, it breaks into the skin and is rich in granulation tissue. The opening of the original sinus is lined with squamous epithelium. This epithelial lining is 2mm deep into the sinus. Left and right is the replacement of granulation tissue, and the secondary pipeline is located on the "cranial side" of the primary sinus.
Prevention
Tibetan hair disease prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Complications of hairy disease Complications squamous cell carcinoma
It has been reported that cancer can occur in the sinus sinus. Philpshen (1981) reviewed only 32 cases of the literature. The lesions were mostly well-differentiated squamous cell carcinoma. The wound sinus had a wound-like change, such as ulceration, rapid growth, and bleeding. Fungal-like edges, etc., should be suspected of cancer.
Symptom
Symptoms of Tibetan hair disease Common symptoms Abscess swine bacterial infection in the midline of the tail is small... Cyst
The disease rarely occurs before the infection occurs in the sinus. The typical case is that there are tiny pits in the midline of the tail but there is no feeling. The pits have fine pores, and some are difficult to penetrate with the lacrimal sac probe. This is the primary sinus. The road is 5-6 cm away from the anus. After infection, a superficial abscess is formed locally. After the rupture or surgical incision, the pus is discharged. The abscess discharges a thin pus a few days later, leaving an induration, and another bacterial infection can cause another abscess. The above symptoms are repeated, so repeated, so that several sinus tracts can appear locally (Fig. 4). These sinus ostiums can be very close, or there may be a distance of 2 to 3 cm. Most sinus can accommodate fine probes, sinus The depth is different, the deepest can reach several centimeters, and the secondary sinus is more than the "cranial side" above the original sinus ostium. It is observed that it tends to be slightly to one side, especially to the left side, especially in the sinus area. The "drying period" can be used here to know a long elliptical induration or cystic mass. The main diagnostic markers of sinus or sacral hair follicles are acute abscesses in the tail or secreted chronic sinus. Local manifestations of pain, tenderness and inflammatory infiltration, and the presence of a sacral cavity in the midline.
Examine
Examination of hairy diseases
The sinus sinus is easily diagnosed by symptoms and signs.
Diagnosis
Diagnosis and identification of hairy diseases
But should be identified with sputum, anal fistula and granuloma.
1. : Growing on the skin, protruding from the skin, the top is yellow, the sputum has multiple outer holes, and there are necrotic tissues inside.
2. Anal fistula: the external mouth of the anal fistula is close to the anus, the fistula is lined to the anus, the percussion has a cord, the anal canal has an internal mouth, and there is a history of anorectal abscess, and the direction of the sinus sinus is multi-directional to the cranial side, very Less down (Figure 5).
3. Others: tuberculous granuloma is connected with bone. X-ray examination shows bone destruction, tuberculous lesions in other parts of the body, syphilitic granuloma with syphilis history, and syphilis seropositive.
