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Desensitization therapy



   

[Intro]

Desensitization therapy, also known as desensitization or specific immune treatment is unavoidable and skin test or other means confirmed or suspected major antigenic substance, made of a certain concentration of the leaching solution to gradually increasing doses and the concentration method of injection, repeated to the patient is injected with specific antigen, prompting the body to produce antibodies.


desensitization therapy

Introduction

these antibodies are igg type, these specific antibodies increased in body fluids, such as re-accept the alien-specific allergen, these antibodies first bind to the ige antibody competition with the body of the original, resulting in the immune response rather than an allergic reaction. Gradually decreased after continuous desensitization therapy, the serum ige and allergic reactions below the threshold, which can prevent allergic reactions occur, and thus to achieve desensitization purpose.

applicable in

desensitization therapy is best for the inhalation of allergen-induced allergic rhinitis or allergic asthma, inhalant allergens released into the atmosphere everywhere, difficult to avoid, so the use of desensitization therapy is a preventive asthma relapse important measures. The how

desensitization treatment?

1, to identify allergens

first to identify the allergen, the current method of looking for allergens are mainly the following four:
1. intradermal method
2. intradermal threshold method
3. caught needling
4. a variety of allergy tests at the same time-specific antibodies
5 skin points thorn experiment, the Act more commonly used in clinical
currently the most used a variety of specific antibodies in allergy testing and skin point barbed experiment. The former is safe and convenient, high specificity, the needs of the patients about 6c.c. blood samples can detect 20 to 35 different allergens reaction; latter intuitive response to the body's allergies, test results 15 minutes out.

treatment

In determining what kinds of allergens, you can select the appropriate allergen desensitization therapy.
sublingual sublingual desensitization therapy
2001, WHO published the white paper says that sublingual desensitization completely replace the traditional subcutaneous therapy. Sublingual desensitization therapy is currently only for dust mites and house dust mite allergic patients. The Act is safer to use, the patient compliance. Use as follows: according to different ages use different maintenance dose. Relatively fixed time each day drops under the tongue sublingual 1-3 minutes, easy to use. Incremental phase of the dose is divided into 1, 2 and 3. The maintenance dose is divided into 4 and 5. Generally maintain the age of 14 on the 4th, to maintain over the age of 14 on the 5th.
dust mites cause allergic rhinitis, allergic asthma, allergic conjunctivitis, allergic rash, allergic urticaria, allergic conjunctivitis. Change patients after in vivo immunological parameters before and after sublingual dust mite immunotherapy sublingual mucosal tissue and thinner in the mucosal surface of langerhans cells in contact with the antigen capture enough to allergens signal allergen vaccine can rapidly absorb, in order to start the desensitization response. Including serum IgG4 levels rise, the Th2/Th1 cell ratio improvement. By sublingual administration, usually do not produce anaphylactic shock and other serious adverse reactions, a very small number of patients with occasional mild rash or mild diarrhea, stop the treatment or reduction can be restored. The mechanisms of sublingual desensitization therapy is because the sublingual mucosa the number of Langerhans cells, by absorption of micro-dust mite allergen original after its processing into mites peptide information presented to the Th0 cells, so that th0 cells to th1 cells into to prevent the occurrence of allergy.
sublingual desensitization and sublingual desensitization therapy is the purpose of instillation of allergen extract sublingual tolerance to the respiratory mucosa, so as to reduce or control allergy symptoms, desensitization therapy is reached . Its clinical features are:
the fastest growing desensitization therapy (ie, specific immunotherapy or immunosuppressive therapy), in line with World Health organization recommended symptomatic + due to the rational treatment plan.
tackling the problem: a fundamental treatment of allergic disease, the onset of significant, the desensitization thorough; to overcome the traditional hormonal chemicals in disease onset, only symptomatic treatment, palliatives limitations, and with the take time, with varying degrees of adverse reactions may have some resistance.
security: a global scale, used for 30 years is not serious side effects, the maximum degree of protection desensitization treatment of long-term drug safety; avoid injectable desensitization therapy may cause serious adverse systemic reactions (including anaphylactic shock and even death), so as to reduce the psychological burden of health care workers and patients.
the course of development of the

desensitization therapy 1909, Noon to use the auto-immune treatment of pollen rhinitis to be successful, creating a new era of immunotherapy. After half a century of practice, immunotherapy shows some of the clinical effect, but since the 1980s, the United Kingdom the number of cases of deaths due to injection immunotherapy agents, leading to relevant government agencies ordered a total ban on immunotherapy .
Scadding and Brostoff in 1986 for the first time the use of sublingual desensitization therapy (ie, sublingual specific immunotherapy (SLIT)) successful treatment of allergic rhinitis, so that people renewed hope immunotherapy.
In 1992, the World Health organization (WHO), immunotherapy of type I allergic disease confirmed by the methods of evidence-based medicine is effective, and that "If the conditions are met, the application" as soon as possible, immunotherapy can be Re-promotion.
1993 European Academy of Allergology and Clinical immunology (EAACI) pointed out that sublingual specific immunotherapy (SLIT) is a potentially valuable treatment.
1998, the WHO allergen allergen immunotherapy submissions "submission pointed out that" desensitization therapy is the only possible method to cure allergic diseases "point of view, and formally recommended sublingual specific immunotherapy The efficacy and safety. Sublingual desensitization therapy in Europe and the United States and other developed countries have been vigorously promoted, subcutaneous immunotherapy method because of its potential harm to gradually fade out of mainstream health care scheme.
2001 Global asthma (ARIA) confirmed the high doses of allergens in sublingual desensitization therapy (at least 100 times the cumulative dose of subcutaneous immunotherapy) of children and adult treatment security.
2004, one of the World Health organization approved SLIT for the treatment of allergic diseases such as allergic asthma, allergic rhinitis and other treatment.

academician zhong nanshan

July 8, the first World allergy Day, academician Zhong Nanshan, president of the Chinese Medical Association pointed out that China has 200 million people suffering from allergic disease, desensitization is generally accepted efficacious therapy.
academician Zhong Nanshan, the world 22% of the population suffer from allergic rhinitis, asthma, eczema and other allergic diseases, and increase to 23 times every 10 years, is expected to reach in 2010 40% of the global population. And so on of the 200 million people suffer from allergic diseases, attention should be paid.
allergenic antigens known as allergens. A necessary condition for allergen allergy. Common antigen substances that cause allergic reactions 2000-3000 medical literature of nearly 20,000 kinds. By inhalation, ingestion, injection or contact the body to produce allergy. Common allergens are as follows:
A, inhaled allergens: pollen, catkins, dust mites, animal dander, soot, paint, car exhaust, gas, cigarettes and so on.
B, ingested type allergen: milk, eggs, fish, beef, mutton, seafood, animal fats, the variant protein, alcohol, drugs, antibiotics, anti-inflammatory drugs, sesame oil, flavor, onion, ginger , garlic, and some vegetables, fruits, etc..
C, contact allergens: such as cold air, hot air, UV, radiation, cosmetics, shampoos, detergents, dyes, soap, chemical products, plastics, metal jewelry (watches, necklaces , rings, earrings), bacteria, fungi, viruses, parasites.
D, injection of allergens: such as penicillin, streptomycin, heterologous serum.
E, in their tissue antigens: mental stress, job stress, infection by microorganisms, ionizing radiation, burns and other biological, physical and chemical factors of the fallout of the structure or composition changes in their tissue antigen, as a result of trauma or infection The release of hidden antigens can also be allergens.
treatment of intractable allergic to the most effective measure is to find out the allergy-inducing factor (allergens), but in the 20,000 kinds of different predisposing factors to find the exact causative agent is like a haystack needle. The latest authoritative experiments confirmed that: the number of allergy crowd of free radicals are much higher than the non-allergic people! Free radicals on the body's immune system against allergies that formed the basis, but also the direct oxidation of human mast cells and basophils, leading to cell membrane rupture, release of histamine, an allergic reaction. Therefore, improving the allergy is necessary to remove free radicals.
radicals derived from two sources: First, in the oxidative metabolism of the body; and environmental pollution, radiation, and bad habits will continue to generate free radicals. Free radicals can be called the root of all evil, sickness culprit. The generation of many diseases are closely related to the aging of the human body. lipid peroxides formed by free radicals that can damage the biofilm, damage cells and hinder the normal metabolism, and accelerated aging, such as immune imbalance, allergies, stubborn dermatitis, rhinitis, conjunctivitis, asthma, eczema, high blood pressure and can cause myocardial infarction, diabetes, hepatitis, gout, nephritis, cataracts and other diseases.
in the detection of the current hospital, just check 50-100 allergens was originally far from complete, but we can through the general broad desensitization factor series to completely change their allergies.
World Health organization (WHO) in its guiding document on the immune desensitization treatment clearly pointed out, "The immune desensitization therapy is the fundamental treatment of the only definitive treatment of allergic diseases.
allergy Research authoritative organizations also proposed the use of high-quality standardized desensitization preparations should use the best allergy treatment options, including the removal of allergens, immune restoration in patients with allergic concurrent inflammation of the appropriate symptomatic drug treatment, standardized desensitization preparations immunotherapy, referred to as the "Four quadruple therapy" program.

desensitization Note

1. long duration. desensitization requires a long time, sublingual desensitization therapy is generally two years, subcutaneous desensitization therapy for at least three years. Half of desensitization therapy before the subcutaneous injection once a week, then once every two weeks last January, otherwise it will come to naught or need to spend more time to treat allergic rhinitis.
2. on the concentration of drug intolerance. Sublingual desensitization is a daily medication, intolerance is relatively minor. Subcutaneous desensitization allergen injection into the patient's body to produce tolerance, so there may be a systemic reaction, half an hour after the injection of patients should remain in the hospital for observation, in order to have an emergency situation such as shortness of breath, skin irritation, itching as soon as possible .
3. allergic individual differences is relatively large, clinical efficiency of 80%. desensitization is not able to 100% cure allergic rhinitis, but it is only a solution for the problem.
4. during the desensitization treatment of allergy symptoms in time to meet the drug treatment to control symptoms. desensitization in stable condition, only need to do injection therapy is like, if the weather changes unexpectedly, or cold, to drugs and local treatment.
5, the onset is relatively slow. desensitization therapy need to adhere to at least two years, generally the onset time of 3-9 months.


[Cause]

boil is caused by what the?

infection and skin dirty, scratches, high ambient temperature or lower the body resistance to infection-related. Boils can occur in any follicles of the skin area, often to the head, face, neck, armpits and buttocks so often by the friction of the parts is more common.

(a) causes

boil the pathogenic bacteria Staphylococcus aureus based, Streptococcus, Staphylococcus epidermidis, are also caused by the disease. Local and systemic skin's resistance to infection is reduced mainly due to Benbingfasheng, so infants, malnutrition, diabetes is a good risk of this disease. Dirty skin, skin abrasions, high ambient temperatures often lead to local infection such as the direct cause.

(B) the pathogenesis

bacteria invade the hair follicle and their sebaceous glands and sweat glands, in hair follicles and surrounding tissue multiply rapidly, producing toxins, causing local tissue degeneration, necrosis, and the center of the formation of boils, the performance of local congestion, exudation, induration. Aggregation of neutrophils to the damaged body tissue cells and bacteria to be destroyed, and he gradually necrosis and dissolution, the formation of abscesses in the dermis. Due to Staphylococcus aureus, coagulase contain toxins, so the formation of pus bolt, protruding outward. Swelling and induration clinically visible in the center of a yellow-white pus plug. This is Staphylococcus aureus infected lesion characteristics. Ulceration after discharge pus, abscess gradually by the new fibrous tissue repair and healing.

[Sign]

boil the early symptoms?

1. redness, swelling, heat, pain summary, cylindrical cone.

2. inflammation to the development of nodules increases, the pain intensified.

3. A few days later nodules central necrosis, abscess formation, dissolution, soft induration, pain relief, the central pus head most of the self-rupture, discharge pus, inflammation subsided recovery.

4. furuncle usually no obvious symptoms, but if the blood flow occurred in the rich parts of the body resistance weakened, it can cause discomfort, chills, fever, headache and loss of appetite and other symptoms of toxemia.

5. Facial Boil such as intracranial infection, facial swelling and severe, may be associated with chills, fever, headache, sinus infections and other embolization.

boil because of location, severity of different clinical manifestations may vary.

local swelling and pain sclerosis: no systemic symptoms of early disease and more, only infection redness, swelling, pain, range of not more than 2cm in diameter, small nodules gradually enlarged, as papules bulge. A few days later lesions extended about 3 ~ 5cm, nodules gradually softened, the center was white, a slight touch of the fluctuations; then ulceration pus, and the emergence of yellow-white pus plug. Pus bolt off, pus shed, the inflammation subsides and healing. There is no pus boil bolt (the so-called headless boil), since the collapse a bit late, need to find ways to promote its pus discharge (Figure 2 ).

fever, swollen lymph nodes: furuncle serious infection, the local area of ​​the lymph nodes, tenderness, and may be associated with body heat, and sometimes lymph node abscess formation.

nose, upper lip and around (called "dangerous triangle") of the surface boil, add or pushed in touch, the bacteria via the angular vein, ophthalmic vein into the brain, causing intracranial suppurative infection. At this point may have fever, headache, vomiting, consciousness disorders.

early follicular redness, swelling, heat, pain, induration. After the white purulent center, there is volatility. May be associated with systemic fever, elevated white blood cell count and differential count.

[Aftertreat]

boil ate?

therapeutic side:

1. composed of: a single head of garlic, honey, 9 grams. Usage: pound evenly wrap the affected area.

2. consists of: single head of garlic amount. Usage: Peel and slice into 2 to 3 mm, with the first affected area with warm salt water when dry wash, and then sticking garlic, and gently massage the 10 to 20 minutes, 2 or 3 times a day, 2 3 There is no more. Indications: Boil, folliculitis. Note: In severe cases, such as local irritation may reduce the massage time, a serious condition should be added to serve anti-inflammatory drugs.

3 . composed of: tea 2 grams of dried honeysuckle 1 gram. Usage: boiling water 6 minutes after each meal drink in a cup. Indications: Boil, exogenous heat.

4. composed of: fresh Malan first 100 grams, the amount of liquor. Usage: Add a little salt before blindly smashed wine Ban Cheng paste, coating the surface of the skin furuncle carbuncle. Indications: furuncle, carbuncle.

5. Composition: rosin 10 grams of white wine. Usage: rosin research to fine tune white wine into a paste, resisting heat, wrap the affected area after dissolution, for the degree of responsibility to cover all of the above and then covered with wax paper and tape securely, to enhance efficacy, can drop a few drops of wine, rosin to keep moist. Indications: furuncle, carbuncle, folliculitis.

6. smashed topical papaya leaves, swollen boil carbuncle treatment drug.

7. fresh peach leaf, plug smashed the lesion, treatment of nasal furuncle.

8. rhizome or fresh banana leaves smashed Jiao Zhi, coating the surface of the skin, cure carbuncles, boils, swelling.

9. almond powder with sesame oil paint, heat treatment boil.

10. Purple cane coal deposit of the skin, powder, paint the affected area or sesame oil dressing, boil carbuncle treatment, stomatitis , eczema.

11. raw taro add a little salt, smashed drunk wrap the affected area twice a day replacement, bones can cure pain, swelling of unknown drugs, pediatric head hot boil, finger boil.

12. raw loofah (or leaf), smashed juice, coated surface of the skin, soak sore treatment days, yellow water sores, heat boils, urticaria .

13. mung bean sugar kelp: seaweed 60 grams, shredded, green beans, 150 grams, with the soup, add brown sugar to taste food. There Sedative, diuretic, soft-kin, Phlegm, scattered gall tumor effect. For hypertension, beriberi edema, neck lymphadenopathy, simple goiter, prickly heat boils hot summer day in children poison, phlegm cough embolism.

14. yi melon soup: melon (not peeled) 500-600 g, yi 50-100 grams of soup. Can be flavored with sugar or salt, on behalf of the tea used, heat, hot weather, diuretic, dehumidification effect. Drugs for Rush boils, eczema athlete's foot, yellow urine deficient.

15. Daozhi raw turnip, vinegar and rub the affected area transfer, heat treatment boil.

16. green beans 30 grams of powder, each 10 grams, water delivery service, boils cure breast swelling and pain.

17. failure to adopt the open rose 3 - 5 朵 wash, add water, two pregnant, suffering from a cup of low heat, ice sugar 30 grams, made of rose soup, until the temperature dose, to cure blood stasis amenorrhea, boils Chung pain, traumatic swelling and pain.

18. boils and pus ulceration of the skin sore or eczema, rinse with water, tea, allow the wound clean and promote healing.

19. a white sweet potato, peeled and chopped, smashed, can also be added with the same amount of fresh Houttuynia smashed, spreads in the affected area, apply to the local heating that line replace (about two three hours long), and even apply a few days more, boils cure mastitis.

20. soybeans amount, turn on the water immersed soft, add a little alum were smashed drunk, external surface of the skin, swollen boils boil treatment.

21. adzuki beans with water until soft, mash with water or vinegar, or honey or egg amount, into a paste, external surface of the skin, cure mumps, hot boil.

22. Kapok 30 - 50 grams of sugar amount, fry a bowl with water and drink two bowls and a half. Favorable moisture, heat effect. For enteritis, urethritis, eczema, summer boil embolism.

23. fresh buckwheat leaves 60 grams, Shuijianbi day one; or fried yellow noodles with the vinegar into a paste, applied to the lesion, sooner or later be replaced. Governance sore, swollen boils, erysipelas, mastitis, and swelling of unknown drugs.

appropriate patients to eat what?

1, edible grapes plus zinc salt or zinc, other foods such as soy, sunflower seeds, wheat bran, yeast, brown sugar and so on.

2, Yi Shi taste light, the cold food, such as Malan head, purslane, melon, red and white radish, bitter gourd, sponge gourd, mung bean, red bean, lily, chrysanthemum brain and celery.

patients unfit to eat what?

not eat ginger, pepper and other spicy foods , as well as mustard, yellow croaker, shrimp, crab, chicken head, goose, Zhu Tourou so fat objects.

should avoid fried foods and meat, edible oil cans.

data only refer to the specific, please ask a doctor.

[Prevent]

how to prevent boils?

boil is born of acute suppurative superficial skin disorders, widely available health, children, young people more common. "Surgical management case" that: "boil persons, birth processes, floating red rootless feet, swollen found in the skin, only the width of an inch, there is less pain, a few days later Microsoft, thin peel, the beginning of the blue water, the latter from breaking the pus out of. "The disease occurs in the summer and autumn, protruding roots shallow, swelling potential limitations, lift the red pain, mostly in the range of about 3cm, easily swollen, easy to collapse, Yi Lian. Early can be divided into a head, without the first two kinds of general light and easy to cure the symptoms, so the saying goes, "no boil the size of a pus like." ;;; ;;;;; ;;;;; ;;;;; But also due to the formation of improper treatment or care "mole cricket boils," or repeated seizures, lack of disunion. Multiple furunculosis ", is difficult to cure.

[Treat]

boil precautions before treatment?

attention to the skin clean, timely replacement of underwear and avoid skin injuries, especially in the summer, to bathe, wash your hair, hair, changing clothes, nails, children in particular should pay attention. With honeysuckle and wild chrysanthemum Jiantang tea. Boil the surrounding skin should be kept clean and coated with 70% alcohol to prevent infection spread to nearby hair follicles.

boil Chinese medicine treatment methods

total boil caused by the toxic heat treatment to detoxify the basic principles.

A Differential Treatment:

1. Heat toxin Accumulation card: lesion processes, such as cone, burning pain, or fever, thirst, tongue pink, yellow fur, rapid pulse. Detoxification. Flavors disinfection decoction.

2. Shushi heat Melancholia: seen in summer and autumn, the affected area, such as agglomeration cone, single or multiple, burning pain, chest tightness, anorexia, deficient urination, red tongue, greasy or yellowish, veins slippery. Qingshu dampness, detoxification swelling. Qingshu Decoction.

3. Is virtual evil love cards: distributed in the body, local color dark red, pus scarce, one after another, delayed healing, with fever, irritability, thirst, or fatigue, limb soft, red tongue thin yellow, rapid pulse. Righting detoxification. Liu Wei Di Huang Decoction.

Second, external treatment and other treatment:

1. The beginning of detoxification should be swelling, moderate to henbane, water reconcile, wrap the affected area. Or wishful golden powder for external application. Or green cream Waicha.

2. Pus, the clip bolt out the pus.

3. Unhealed after the collapse, sores can be a little ninety-one Dan to drugs or drug line twist into sores, topical berberine gauze.

4. Oral Meihuadianshe Dan, Niuhuangjiedu, Fang Feng Tong Sheng Wan, Liushen other medicine.

5. Unilateral prescription: Silver Flower 30g, licorice 10g, decoction, on behalf of the tea.

Western boil treatment

1. Local treatment, such as heat, physical therapy, 10% ichthyol coated ointment. Facial Boil should rest in bed should not squeeze or prick Boil, so as not to spread to the brain.

2. Swelling or have a large range of obvious symptoms, should give systemic antibiotics (third-generation cephalosporin antibiotics).

3. The formation of abscess, incision and drainage should be timely but should be avoided Boil the face cut.

(a) treatment

1. The principles of early treatment to promote inflammation subsided, after early drain purulent pus; timely elimination of systemic adverse reactions.

2. Local treatment

(1) Physical therapy: early, ultraviolet micro-irradiation, can promote local anti-inflammatory, to prevent proliferation. Swelling stage, the selection of FM, infrared and other heat, promote Boil liquid. 2 to 3 times / d, 20 ~ 30min / times.

(2) Drug eraser: 0.5% povidone-iodine scrub, the drug not only for skin irritation, and the role of long-lasting, no pigmentation. Can also be used erythromycin, tetracycline ointment.

(3) topical cream: local swelling and a small pustules, use ichthyol, wishful golden powder, Gyokuro powder and so on.

(4) incision and drainage: Boil into pus, nodules soften, a sense of volatility, you can make a small incision drainage or fire needle drainage. Taboo squeeze purulent lesions.

(5) to keep local clean and dry: adhere to local skin cleaning, daily showers are the best conditions. Young children with skin, topical lip after taking a bath in summer, to avoid the formation of multiple Boil.

3. Systemic treatment usually does not require systemic treatment of boils. But facial boils or accompanied by chills, fever, headache, general malaise, etc., should be given antibiotics. Clinical observations and experimental results show that the efficacy of penicillin, cephalothin, cefazolin and amikacin better effect.

(B) the prognosis

generally good prognosis after active treatment, without sequelae.

[Examine]

boil should be how?

1. Peripheral blood

(1) white blood cell count: fever, elevated WBC count may have.

(2) white blood cell count: white blood cell count was elevated often accompanied by increased neutrophils .

2. diabetes check

(1) fasting plasma glucose measurement: two fasting blood glucose were increased, should consider the possibility of diabetes.

(2) glycated serum protein: This clinical trial is not the impact of fluctuations in blood glucose higher than normal to help the diagnosis of diabetes.

(3) glycosylated hemoglobin: glycosylated hemoglobin and blood glucose were positively correlated, and the irreversible reaction. Diabetes is often higher than the normal 2 to 3 times.

3. bacteriologic

(1) bacterial culture: the multiple, repeated infections, abscesses can be extracted directly pus for bacterial culture, positive results will help the diagnosis of pathogens.

(2) drug susceptibility testing: bacterial culture in the pus, while line drug susceptibility testing can provide the scientific basis of clinical drug treatment.

[Diff]

boil diseases easily confused?

1. Multiple sweat gland abscesses are summer disease, more common in infants and young children and frail mother's head, forehead, etc .. Lesions of multiple subcutaneous abscesses. Surface tenderness, inflammation lighter. No pus bolt, left scars. Usually accompanied by a lot of prickly heat. Generally known as prickly heat poison. It was also known as pseudo furunculosis (Pseudofurunculosis).

2. Hidradenitis suppurativa common in young women, lesions of the skin induration. Subcutaneous abscess formation, followed by skin redness, swelling, heat, pain, ulceration scarring. Lesions occur in the armpits, groin, genital and perianal, umbilical, etc.

3. acne acne mild infection, red, swollen, painful, but the disease is small, the top a little bit like creamy.

4. sebaceous cysts sebaceous cyst infection are redness, swelling, pain, but the previous round has been painless mass over an extended period , the epidermis as usual.

5. carbuncle carbuncle with redness, swelling, pain, but there are several hair follicle infection, lesions larger than the boil.

[Disease]

hump-related diseases

juvenile osteochondrosis of vertebral osteoporosis youth sexual hump sore scoliosis ankylosing spondylitis vitamin D deficiency disease

more back symptoms

small blisters appear back back pain back spasms, back pain does not have subtle linen spine back pain sinus pain Road with sensory ataxia spinal nerve root damage spinal cord hemisection syndrome, spinal cord lesions of hemorrhagic infiltration of the spinal cord injury spinal cord infarction, cauda equina involvement across the spinal cord within the spinal cord gliosis in the spinal cord anterior horn of the spinal cord lesion cavity formed spinal thalamic tract compression

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