1. Department of faculty and hospital surgery Tashkent Medical Academy
Pleural diseases

2. The prevalence of pleural diseases
Empyema refers to the common diseases of the chest. In 30-50% of cases, it complicates the course of acute and chronic pneumonia, 80-90% - of gangrene of the lung, in the 9-15% - lung abscess, 6-8% - bronchiectasis
At 4-34 patients with acute empyema developed after surgical treatment for lung and pleura. In times more disease in men

3. With the treatment of diseases of the pleura (empyema) began thoracic surgery. The first description of thoracic surgery belongs to Hippocrates, who diagnosed pleural empyema and cured the sick releasing the pus by a cut (now it's called - torakostomiya)
Hippocrates
(about 460 years BC)

4. Hans Christian Yakobeus
The clinic as a diagnostic method thoracoscopy was first performed by the Swedish physician, pulmonologist Hans Christian Yakobeusom in 1910 with the help of a cystoscope to diagnose the state of the pleural cavity in patients with tuberculosis. Later Yakobeus designed optical instrument called thoracoscope, whereby initially inspect the pleural cavity, and from 1910 to 1913, he completed 89 of thoracoscopy.
In 1913 Yakobeus upgraded Thoracoscope, adjoining the galvanokauter, and began using thoracoscopy for pleural adhesions perezhiganiya. In 1925, he first performed pleural biopsy in patients with mesothelioma and reported on the implementation of 120 thoracoscopy in patients with pulmonary tuberculosis.
Hans Christian Yakobeus
( )

5. In 1925, PA Herzen performed the first in the USSR thoracoscopy in chronic pleural empyema. Subsequently, it is most often used in TB for the intersection of adhesions by galvano-cautery for the formation of a therapeutic pneumothorax.
Peter A. Herzen
( )

6. Sergey Yudin
( )
Boris Petrovsky
( )
Ivan Greeks
( )
Mikhail Davydov

7. Vasit Vakhidovich Vahidov
Sadik Aliyevich
Masumov
Shavkat Ibrahimovic Karimov
Nikolai Fedorovich Krotov

8. Duties of the general practitioner in diseases of pleura
- Provision of primary health and social care;
- Health education (promoting healthy lifestyles);
- Preventive work (timely detection of early and latent forms of the disease, risk groups);
- Dynamic monitoring;
- Emergency assistance in case of emergency and acute conditions;
- Timely consultation and hospitalization in the prescribed manner;
- Medical and rehabilitation work in accordance with the qualifying characteristic;
- An examination of temporary disability;
- The organization of medical and social care and household together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill;
- Maintaining the approved forms of records and reports.

9. Anatomy of the pleura

10. Anatomy of the parietal pleura
Neck part
Costal part
Mediastinal part
Diaphragmatic part

11. Classification of Diseases of the pleura
Empyema
Spontaneous pneumothorax
Injuries of the chest
Clotted hemothorax
Fibrothorax
Tumor of the pleura

12. Classification of empyema
I. By the origin
primary
secondary
II. The clinical course
acute (disease lasts less than 8 weeks)
chronic (illness lasts more than 8 weeks)
III. By the nature of exudate
purulent
putrid
IV. By the nature of the microflora
specific (tuberculosis, fungal)
nonspecific (staphylococcal, dyplococcal, anaerobic)
mixed
V. By the distribution process
total and subtotal
limited empyema: parietal, basal, interlobarnaya, apical, mediastinal an multi-chamber
VI. Iatrogenic empyema

13. Clinical signs of pleural empyema
Cough
Sputum
Signs of intoxication
Fever
Asymmetry of chest
Auscultation reduction or absence of pulmonary respiration in the affected side

14. Empyema

15. Empyema

16. Empyema
computed tomography
radiography

17. Changing the location of the fluid in the pleural cavity according to the position of the patient

18. Puncture of the pleural cavity

19. Thoracostomy by Seldinger

20. The location of the needle with respect to the fins during the puncture of the pleural cavity

21. Thoracostomy with the help of the trocar

22. Technique of chest draining

23. The valve is used for drainage of the pleural cavity

24. Device for drainage of the pleural cavity by Byulau

25. Thoracostomy by Bobrov

26. Modern plant for active aspiration of the pleural cavity

27. The scheme of pleuroevacuator

28. Pleuroevacuator

29. Methods of rehabilitation of the pleural cavity

30. Decortication of the lung

31. As a rule, spontaneous pneumothorax is a complication, not a cause

32. Spontaneous pneumothorax

33. Position of the patient on the operating table
Intubation tube to separate light

34. Thoracoscopic intervention in spontaneous pneumothorax
Coagulation of the bull
Ligation of the bull
Suturing of the bull
Partial atypical resection
Diagnostic thoracoscopy

35. The advantages of VATS intervention
Reducing trauma surgery
Reduction in pain
There is no need to find a patient in the intensive care unit
Early activation of patients
Reducing the number of complications associated with physical inactivity on the part of the surgical wound
Reduction in length of hospital stay
Reduction in general terms of disability
Reducing the flow of drugs and surgical material
Good cosmetic effect

36. Pronounced cosmetic effect after thoracoscopic interventions

37. Radiographic signs of damage to the chest
Partial or complete alveolar infiltrates
Mediastinal shift
Subcutaneous emphysema
Pneumomediastinum
Fractured ribs
Expansion of the shadow of the mediastinum
The disappearance of the contour of the aortic arch
Mixing of a nasogastric tube to the right
Expansion of cardiac contour
Presence of gastric bubble and bowel loops in the pleural cavity

38. Clinical signs of damage at the chest
Cyanosis
The absence of spontaneous breathing
Subcutaneous emphysema
The presence of abnormal noise in the pleural cavity
The presence of chest injury
Bulging neck veins
Paradoxical pulse

39. Hemothorax

40. Tension pneumothorax Subcutaneous emphysema
For percussion tympanitis on the affected side
Mixing of the trachea in a healthy way
The weakening of the respiratory noise
Unstable hemodynamics

41. schematic representation of
Open pneumothorax
Tension pneumothorax
schematic representation of

42. Treatment of injuries of the chest
Thoracostomy
Surgical treatment
Conservative therapy

43. Indications for drainage of the pleural cavity
Pneumothorax
Injuries of the chest
Hemothorax

44. Indications for surgical treatment of injuries of the chest
Cardiac tamponade
Large open wound of the chest
Signs of damage to the mediastinum
Profuse bleeding continues or pleural cavity
Massive pnevmoreya on drainage of the pleural cavity
Damage to the trachea or main bronchus
Rupture diaphragms, aorta, esophagus
Foreign body chest