Download 2. Disease and injuries of the chest

Surgical diseases and
injuries of the chest:
lungs, mediastinum and
heart.

In surgery most often meet with acute and
chronic purulent destructive lung disease:
Abstsedic pneumonia, abscesses, gangrene,
bronchiectasis, empyema, cysts and lung
cancer.

This is multiple destructive fire size 0.3-0.5 cm,
localized within 1-2 segments of the lung and is
not prone to progression. Cover for this is
pronounced perifocal infiltration of the lung
tissue.

Purulent or putrid decay necrotic areas of the
lung tissue of a segment with the formation of
one or more cavities filled with pus, separated
from the surrounding parenchyma pyogenic
capsule and marked perifocal infiltration of the
surrounding lung tissue. Occurs in patients
with preserved reactivity.

- Purulent putrid necrosis of lung tissue within
2 ~ 3 segments, separated from the
surrounding areas of the parenchyma with a
penchant for sekvestral producing. Can
transform into a festering abscess (after lysis
sequestration) or gangrene, depending on the
reactivity.

- Diffuse purulent putrid necrosis of tissue with
no tendency to clear limitation of dynamically
distributing band necrosis and collapse of
parenchyma. Characterized by severe
intoxication, a penchant for pleural
complications and pulmonary hemorrhage.
With the defeat of one particle gangrene is
limited by the coverage of large areas –
common.

In the genesis of purulent destructive lung diseases crucial
plays:
- An infectious inflammation of the lung tissue; pathogens are
anaerobic clostridial bacteria, staphylococci, gram-negative
bacteria, often in associations.
- Impaired bronchial patency with the development of
atelectasis;
- Regional circulatory disorders (embolism small branches of
the pulmonary arteries), followed by necrosis areas of
parenchyma.

Clinical manifestations of acute suppurative
lung destruction depend on the destructive
nature of fire and decay, reactivity, stage of
disease, the characteristics of drainage of
purulent cavities and complications.

I stage - necrotizing pneumonia;

II stage - the collapse and sloughing;

III stage - purification and scarring.

1. Adequate antibiotic, anti-inflammatory therapy
involves intravenous broad-spectrum antibiotics.
2. Evacuation content purulent cavities.
3. Detoxification therapy (intra-and extra-corporeal).
4. Immunotherapy (controlled immunogram).
5. Desensitizing, anti-inflammatory therapy, regulation
of protease activity: antihistamines, nonsteroidal antiinflammatory drugs, protease inhibitors, antioxidants.
6. Correction of disorders of the vital organs and
systems, solve problems, symptomatic therapy.

- pulmonary hemorrhage II-III degree;
- progression to active background and
adequate therapy;
- busy pneumo-empyema that can not
eliminate thoracostomy:
- inability to eliminate suspicion of malignancy.




Lung cancer develops most often from the epithelium of the
bronchi - 95% or alveoli - 5% .. Lung parenchyma affected,
usually secondary.
Right lung is affected more than the left. Increased cancer
gradual, and in some cases continued for 5-6 years.
More common is squamous cell carcinoma, adenocarcinoma
then, bazal-cellular and skiroze form of cancer.
Cancerous tumors can grow into the lumen of the bronchus
(endobronchial form), or spread on the periphery
(peribronhial form).
All damage chest share:
1. In closed (slaughter, compression,
concussion, broken ribs, clavicle,
sternum)
2. Open (non-penetrating and
penetrating) with damage and without
damage to its organs.

Resulting from:
1. Penetrating injury to the chest wall
or damage lung tissue.
2. In some lung diseases (bullous
disease, tuberculosis, lung abscess,
etc..) Can occur so-called spontaneous
pneumothorax.

1. As the prevalence of the process are
distinguished: a) unilateral and b) bilateral
pneumothorax.
2. The degree of collapse of the lung: 1) partial
(collapsed lung to 1/3 volume), 2) subtotal
(collapsed lung to 2/3 volume), 3) total
(collapsed lung over 2/3 volume).
On the mechanism of: 1) a closed, 2) Open, 3)
valve (tight).
This - accumulation of blood in the pleural cavity
(amount of blood can reach 1.5-3 l.).
Formed from:
a)damage intercostal arteries (rib fractures), large vessels
heart or lung tissue,
b)at break-tuberculosis spheral cavity decay cancerous
tumor, purulent diseases of the lung and pleura and
others.



There are: a) small hemothorax (accumulation
of blood within the costal-diaphragmatic
sinuses): b) medium (blood accumulates to a
level V-VI ribs), c) large (up to level II-III
edges).
Hemothorax may be: free and encysted
Prolonged blood in the pleural cavity resulting
in the postponement of fibrin formation and
massive adhesions, suppuration hemopleura.



The sample for the presence of bleeding that
lasts:
1. If blood is taken from the pleural cavity
within 3-15 min minimized - bleeding
continues.
2.If remains unchanged - stopped (since the
bleeding was at least 6 hours).


Pleural blood is centrifuged and determine the plasmaerythrocyte index (ratio of plasma and red blood cells,
which in whole blood is 1.0). When diluted exudate
blood index increases.
Simultaneously, count the number of red blood cells
and blood leukocytes. Reducing the number of
erythrocytes, hemoglobin, compared with indices of
peripheral blood indicates the presence of old blood
and stop bleeding, increase the number of white blood
cells - its suppuration.

These injuries can be gunshot, sliced and
chopped. Most damaged anterior surface of the
heart and left ventricle. The result-thirds of all
cases of wounds of the heart or aorta is sudden
death from bleeding. Other patients without
providing qualified and timely assistance to die
within 1-3 days of bleeding and cardiac
tamponade.
THANK YOU FOR
YOUR ATTENTION