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MINISTRY OF PUBLIC HEALTH OF UKRAINE KHARKIV NATIONAL MEDICAL UNIVERSITY S U R G E R Y Textbook for Vth year students of medical faculties Thoracic, cardiovascular, endocrine surgery Kharkov 2017 UDC 616.712 + 616.1 + 616.43/.45] – 089 (075.8) Х 49 Reviewers: M. D. Professor M. M. Veligotsky (KhMAPE) M. D. Professor B. I. Peev (KhMAPE) Authors: V. V. Boyko, V. N. Lisovyi, L. I. Goncharenko, I. A. Taraban, I. A. Krivoruchko, Yu. I. Kozin, P. M. Zamyatin, Yu. B. Grigorov, V. V. Makarov, V. O. Prasol, V. G. Groma, D. O. Evtushenko, S. V. Sushkov, O. К. Тolstanov, O. S. Larin, І. А. Lurin, V. V. Shafranskyi, V. I. Shcherbakov, O. V. Kuznetsov, R. M. Smachilo, N. F. Mizhiritskaya , L. O. Ponomarev, S. I. Makeev , D. V. Minukhin, M. M. Goloborodko, D. G. Dotsenko, K. M. Smolyanik, A. V. Tokarev, Yu. V. Avdosev, K. V. Gorbenko, V. V. Tsodikov, M. S. Chernyayev, S. Yu. Basylaishvili, D. V. Okley Х 49 Thoracic, cardiovascular, endocrine surgery: Textbook for Vth year students of medical faculties / Authors: V. V. Boyko, V. N. Lisovyi, L. I. Goncharenko, I. A. Taraban at alias; edited by V. V. Boyko and V. M. Lisovyi. – Kharkiv, 2017. – 400 p. ISBN 978-617-578-116-6 APPROVED Academic Council of KNMU. Protocol №v3 from «17» 03 2011 In connection with the transition of teaching at universities in Ukraine on the principles of credit-modular system of learning from ESTS IV year medical students learn surgery on the new model curriculum «Surgery», which includes 5 modules. Under the new program, students study surgery V courses on topics of Module 2 «Thoracic, cardiovascular, endocrine surgery». The textbook combines educational materials of department, designed for classroom study of 7 themes in practical classes and extracurricular self-study in 5 subjects according to the thematic plans of discipline «Surgery» on the topics of Module 2. Each topic is outlined in the textbook, contains sections that correspond to professionally-oriented tasks of medical practice, approved by industry standards of Higher Education — «Educational and professional program» and «Educational qualifying characteristic» (Kiev, 2003) as amended and updated in 2010 year. Prepared by the teaching staff of the Department of Surgery № 1 KNMU tutorial is designed to provide students the necessary teaching materials comprehensively on all topics of practical training and for self extracurricular work that will improve the training of future doctors surgery according to the requirements of national industry standard for higher education. ISBN 978-617-578-116-6 UDC 616.712 + 616.1 + 616.43/.45] – 089 (075.8) © Boyko V. V., Lisovyi V. N., Goncharenko L. I., Taraban І. А. at al., 2017 © «НТМТ», 2017 Contents Foreword ...........................................................................................................4 List of abbreviations ..........................................................................................5 CHAPTER І. SURGICAL PATHOLOGY OF THE RESPIRATORY SYSTEM .............................................7 І.1. Purulent diseases of lungs and pleura ........................................................7 І.2. Chest injuries .........................................................................................38 CHAPTER ІI. SURGICAL PATHOLOGY OF THE HEART ...........................45 ІI.1. Acquired valvular disease ......................................................................45 ІI.2. Coronary heart disease and its complications ........................................90 II.3. Modern methods of diagnosis, mini-invasive methods of surgical treatment of heart diseases .........................................................117 CHAPTER III. DISEASES OF THE MEDIASTINUM ................................ 131 III.1. Diseases and injuries of the esophagus ............................................... 131 III.2. Diseases of the mediastinum and diaphragm ......................................152 CHAPTER IV. ENDOCRINE SURGERY ..................................................... 176 IV.1. Toxic goiter (TG) ...............................................................................176 IV.2. Euthyroid goiter ................................................................................ 182 IV.2 Inflammatory, dishormonal diseases andtumors of thebreast ................186 IV.4 Diabetic foot ...................................................................................... 218 CHAPTER V. SURGICAL PATHOLOGY OF THE ARTERIAL SYSTEM ..... 250 V.1. Chronic occlusive diseases of major arteries of extremities ....................250 V.2. Arterial thrombosis and embolism of the extremities ............................ 272 V.3. Abdominal ischemic syndrome ............................................................290 V.4. Aortic aneurysmes ...............................................................................311 CHAPTER VI. SURGICAL PATHOLOGY OF THE VENOUS AND LYMPHATIC SYSTEMS .............................................. 335 VI.1. Varicose veins of lower extremities ..................................................... 335 VI.2. Acute thrombosis of the main veins of extremities .............................. 341 VI.3. Pulmonary embolism ........................................................................ 355 VI.4. Postthrombophlebitic syndrome ........................................................ 365 VI.5. Lymphedema of extremities ...............................................................379 CHAPTER VII. MODERN MINI-INVASIVE TECHNOLOGIES IN SURGERY OF GREAT VESSELS AND HEART ............ 385 CHAPTER VІII. ALLOGRAFTS AND LASER SURGERY IN ANGIOLOGY ............................................................... 393 — 3 — Foreword Ukraine’s integration into the European community dictates the need to restruc- ture higher education in the country in this direction and teaching at universities in Ukraine according to the principles of the Bologna Declaration, which will prepare young Ukrainian professionals compete with graduates of European and other institutions of higher education. In Kharkiv National Medical University is over-passage teachers of all disci- plines, including surgery, for all courses on the principles of credit-modular system of training ESTS. Starting from the IV course, students learn surgery on the new model curriculum “Surgery”, which includes 5 modules, for students in higher educational institutions III-IV of the levels of accreditation in the field of 7.110101 “Medicine”, 7.110104 “Pediatrics” and 7.110105 “Medical-prophylactic case“ (Kiev, 2008). Under the new program, students of Vth year learn surgery on the subject of the module 2, “Thoracic, cardiovascular, endocrine surgery”, consisting of two informative modules 3 and 4. The textbook combines educational materials of department, dedicated for practical training (classroom studying 7 themes № 16-22) and for self extracurricular study of 5 subjects according to the thematic plans of discipline “surgery” on the subject of Module 2. Each topic is outlined in the textbook, contains sections that correspond to professionally-oriented tasks of medical practice, approved by industry standards of Higher Education – “Educational and professional program” and “Educational qualifying characteristic” (Kiev, 2003). Highlights issues of etiology and pathogen- esis, classification of disease according to ICD-10 (2001), clinical symptoms, standard regimens of additional laboratory and instrumental examination of the characteristic features of evidence-based medicine for each disease, emergency care at the prehospital stage under emergency conditions in surgical patients, justifies the choice of treatment tactics , is pathogenetically grounded conservative therapy, in- dications and types of surgical interventions. Considerable attention is paid to modern minimally invasive interventions — video endoscope, VATS, X-ray endovascular. For each topic listed recommended modern literature. Prepared by the teaching staff of the Department of Surgery № 1 textbook is designed to provide students the necessary teaching materials integrated in all themes of workshops and self extracurricular work that will improve the training of future doctors surgery according to the requirements of national industry standard for higher education. — 4 — LIST OF ABBREVIATIONS AA — aortic aneurysm DBD — dishormonal disease of the breast AAO — acute arterial obstruction DCM — diffuse cystic mastitis AAT — acute arterial thrombosis DFA — diffuse ﬁ broadenomatosis ABB — acid—base balance DFS — diabetic foot syndrome ABI — ankle—brachial index DLF — destructive lesions of the feet ACA – aminocapronic acid DM — diabetes mellitus ACD — acute coronary death DVT — deep vein thrombosis ACE – angiotensin converting enzyme E – emergency ACED — anticholinesterase drugs ECG — echocardiogram ADVT — acute deep vein thrombosis ECG — electrocardiogram AE — acute empyema EF — ejection fraction AE — arterial embolism EPT – electropulse therapy AIS — abdominal ischemic syndrome ESR – erythrocyte sedimentation rate AIVB — anterior interventricular branch GRH — gonadotropin—releasing hormone ALA – acute lung abscess HBO — hyperbaric oxygenation AMI — acute myocardial infarction HF — heart failure API — associated with proteins iodine HH — hiatal hernia APTT — active partial thromboplastin time HR — heart rate APV – artiﬁ cial pulmonary ventilation Ht – hematocrit ARD – acute respiratory disease HT – hemothorax AS — aortic stenosis HT — hormone therapy AVB — atrioventricular block INR —

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