Forms of the chest in normal and pathological conditions. What are the types, types and forms of the chest

The hypersthenic chest (in persons with a hypersthenic physique) has the shape of a cylinder. Its anteroposterior size approaches the lateral; supraclavicular fossae absent, "smoothed". The angle of connection of the body and the handle of the sternum is pronounced significantly; epigastric angle greater than 90°. The direction of the ribs in the lateral sections of the chest approaches the horizontal, the intercostal spaces are reduced, the shoulder blades fit snugly against the chest, the thoracic section is smaller than the abdominal one.

The asthenic chest (in persons with an asthenic physique) is elongated, narrow (both the anteroposterior and lateral sizes are reduced), and flat. Supraclavicular and subclavian fossae are distinctly expressed. The angle of connection of the sternum with its handle is absent: the sternum and its handle form a straight "plate". The epigastric angle is less than 90°. The ribs in the lateral sections acquire a more vertical direction, the X ribs are not attached to the costal arch (costa decima fluctuans), the intercostal spaces are widened, the shoulder blades pterygoidly lag behind the chest, the muscles of the shoulder girdle are poorly developed, the shoulders are lowered, the thoracic region is larger than the abdominal.

The pathological forms of the chest are as follows: 1. The emphysematous (barrel-shaped) chest resembles hypersthenic in its shape. It differs from the latter in its barrel-shaped form, bulging of the chest wall, especially in the posterolateral sections, and an increase in the intercostal spaces. Such a chest develops as a result of chronic emphysema, in which there is a decrease in their elasticity and an increase in volume; the lungs are, as it were, in the inspiratory phase. Therefore, natural exhalation during breathing is significantly difficult, and the patient not only has expiratory shortness of breath during movement, but often at rest. When examining the chest of patients with emphysema, one can see the active participation in the act of breathing of the auxiliary respiratory muscles, especially the sternocleidomastoid and trapezius, retraction inside the intercostal spaces, lifting the entire chest up during inhalation, and during exhalation - relaxation of the respiratory muscles. muscles and lowering the chest to its original position.

2. Paralytic chest resembles asthenic in its characteristics. It occurs in severely malnourished people, with general asthenia and weak constitutional development, for example, in those suffering from Marfan's disease, often in severe chronic diseases, more often in pulmonary tuberculosis. Due to the progression of chronic inflammation, fibrous tissue developing in the lungs and pleura leads to their wrinkling and a decrease in the total surface of the lungs. When examining patients with a paralytic chest, along with signs typical of an asthenic chest, pronounced atrophy of the chest muscles, an asymmetric arrangement of the clavicles, and unequal retraction of the supraclavicular fossae often attract attention. The shoulder blades are located at different levels and during the act of breathing they move asynchronously (non-simultaneously).

3. Rachitic (keeled, chicken) chest - pectus carinatum (from Latin pectus - chest, carina - boat keel) is characterized by a pronounced increase in anteroposterior size due to the sternum protruding forward in the form of a keel. At the same time, the anterolateral surfaces of the chest wall appear as if squeezed from both sides and, as a result, are connected to the sternum at an acute angle, and the costal cartilages at the site of their transition into the bone thicken clearly (“rachitic beads”). In persons who previously suffered from rickets, these "rosaries" can usually be palpated only in childhood and adolescence.

4. The funnel-shaped chest in its shape may resemble normosthenic, hypersthenic or asthenic and is also characterized by a funnel-shaped depression in the lower part of the sternum. This deformity is considered as the result of an anomaly in the development of the sternum or long-term compression on it. Previously, such a deformation was observed in teenage shoemakers; The mechanism for the formation of the "funnel" was explained by the daily long-term pressure of the shoe last: one end of it rested against the lower part of the sternum, and a shoe blank was pulled over the other. Therefore, the funnel-shaped chest was also called the "shoemaker's chest."

5. The navicular chest is distinguished by the fact that the recess here is located mainly in the upper and middle parts of the anterior surface of the sternum and is similar in shape to the recess of the boat (rook). Such an anomaly is described in a rather rare disease of the spinal cord - syringomyelia.

6. Deformation of the chest is also observed with curvature of the spine that occurs after trauma, tuberculosis of the spine, ankylosing spondylitis (Bekhterev's disease), etc. There are four variants of curvature of the spine: 1) curvature in the lateral directions - scoliosis (scoliosis); 2) backward curvature with the formation of a hump (gibbus) - kyphosis (kyphosis); 3) curvature forward - lordosis (lordosis); 4) a combination of curvature of the spine to the side and backwards - kyphoscoliosis (kyphoscoliosis).

Scoliosis is the most common. It develops mainly in school-age children with improper sitting at a desk, especially if it does not correspond to the height of the student. Much less common is kyphoscoliosis of the spine and very rarely - lordosis. Curvature of the spine, especially kyphosis, lordosis and kyphoscoliosis, cause a sharp deformation of the chest and thereby change the physiological position of the lungs and heart in it, creating unfavorable conditions for their activity.

7. The shape of the chest can also change due to an increase or decrease in the volume of only one half of the chest (chest asymmetry). These changes in its volume may be temporary or permanent.

An increase in the volume of one half of the chest is observed with effusion into the pleural cavity of a significant amount of inflammatory fluid, exudate, or non-inflammatory fluid - transudate, as well as as a result of air penetration from the lungs during injury. During examination on the enlarged half of the chest, one can see the smoothness and bulging of the intercostal spaces, the asymmetric arrangement of the clavicles and shoulder blades, the lag in the movement of this half of the chest during the act of breathing from the movement of the unchanged half. After resorption of air or fluid from the pleural cavity, the chest in most patients acquires a normal symmetrical shape.

A decrease in the volume of one half of the chest occurs in the following cases:

due to the development of pleural adhesions or complete closure of the pleural fissure after resorption of exudate that has been in the pleural cavity for a long time;

with wrinkling of a significant part of the lung due to proliferation of connective tissue (pneumosclerosis), after acute or chronic inflammatory processes (croupous pneumonia with subsequent development of lung carnification, pulmonary infarction, abscess, tuberculosis, pulmonary syphilis, etc.);

after surgical removal of part or the whole lung;

in the case of atelectasis (collapse of the lung or its share), which may occur as a result of blockage of the lumen of the large bronchus by a foreign body or tumor growing in the lumen of the bronchus and gradually leading to its obstruction. At the same time, the cessation of air flow into the lung and the subsequent resorption of air from the alveoli lead to a decrease in the volume of the lung and the corresponding half of the chest.

The chest, due to the reduction of one half, becomes asymmetrical: the shoulder on the side of the reduced half is lowered, the collarbone and scapula are located lower, their movements during deep inspiration and expiration are slow and limited; supraclavicular and subclavian fossae sink more strongly, intercostal spaces are sharply reduced or not expressed at all.

13. Inspiratory and expiratory dyspnea. Various forms of respiratory rhythm disturbances. The concept of respiratory failure. Graphical recording of respiratory rhythm disturbance. Shortness of breath (dyspnea) is a violation of the frequency and depth of breathing, accompanied by a feeling of lack of air.

By its nature, pulmonary dyspnea can be: inspiratory, in which it is mainly difficult to inhale; characteristic of a mechanical obstruction in the upper respiratory tract (nose, pharynx, larynx, trachea). In this case, breathing is slowed down, and with a pronounced narrowing of the airways, the breath becomes loud (stridor breathing). expiratory dyspnea - with difficult exhalation, is observed with a decrease in the elasticity of the lung tissue (emphysema) and with narrowing of the small bronchi (bronchiolitis, bronchial asthma). mixed shortness of breath - both phases of respiratory movements are difficult, the reason is a decrease in the area of ​​\u200b\u200bthe respiratory surface (with inflammation of the lung, pulmonary edema, compression of the lung from the outside - hydrothorax, pneumothorax).

Breathing rhythm. The breathing of a healthy person is rhythmic, with the same depth and duration of the inhalation and exhalation phases. In some types of shortness of breath, the rhythm of respiratory movements can be disturbed due to a change in the depth of breathing (Kussmaul breathing is pathological breathing characterized by uniform rare regular respiratory cycles: deep noisy inspiration and increased exhalation. It is usually observed with metabolic acidosis due to uncontrolled diabetes mellitus or chronic renal failure in patients in serious condition due to dysfunction of the hypothalamic part of the brain, in particular in diabetic coma.This type of breathing was described by the German doctor A. Kussmaul), the duration of inhalation (inspiratory dyspnea), exhalation (expiratory dyspnea) and respiratory pause.

Violation of the function of the respiratory center can cause a type of shortness of breath, in which, after a certain number of respiratory movements, a visible (from several seconds to 1 minute) lengthening of the respiratory pause or short-term breath holding (apnea) occurs. Such breathing is called periodic. There are two types of dyspnea with periodic breathing

Biot's breathing is characterized by rhythmic, but deep respiratory movements, which alternate at approximately equal intervals of time with long (from several seconds to half a minute) respiratory pauses. It can be observed in patients with meningitis and in an agonal state with a deep disorder of cerebral circulation. Cheyne-Stokes breathing (from several seconds to 1 min) of a respiratory pause (apnea) first appears silent shallow breathing, which quickly increases in depth, becomes noisy and reaches a maximum at the 5-7th breath, and then decreases in the same sequence and ends with the next regular short pause. Sometimes patients during a pause are poorly oriented in the environment or completely lose consciousness, which is restored when the respiratory movements are resumed. Such a peculiar violation of the rhythm of breathing occurs in diseases that cause acute or chronic cerebrovascular insufficiency and cerebral hypoxia, as well as in severe intoxications. It often manifests itself in sleep and often occurs in older people with severe atherosclerosis of the cerebral arteries. The so-called wave-like breathing, or Grocco's breathing, can also be attributed to periodic breathing. In its form, it somewhat resembles Cheyne-Stokes breathing, with the only difference being that instead of a respiratory pause, weak shallow breathing is noted, followed by an increase in the depth of respiratory movements, and then its decrease. This type of arrhythmic dyspnea, apparently, can be considered as a manifestation of an earlier stages of the same pathological processes that cause Cheyne-Stokes respiration. Currently, it is customary to define respiratory failure as a state of the body in which the normal gas composition of the blood is not maintained or it is achieved due to more intensive work of the external respiration apparatus and the heart, which leads to a decrease in the functional capabilities of the body. It should be borne in mind that the function of the apparatus of external respiration is very closely related to the function of the circulatory system: in case of insufficiency of external respiration, increased work of the heart is one of the important elements of its compensation. Clinically, respiratory failure is manifested by shortness of breath, cyanosis, and in the late stage - in the case of heart failure - and edema.

14. Determining the type of breathing, symmetry, frequency, depth of breathing, respiratory excursion of the chest.

Starting to study the respiratory system, first visually determine the shape and symmetry of the chest, then the frequency of breathing, its rhythm, the depth and uniformity of the participation of both halves of the chest in the act of breathing. In addition, attention is paid to the ratio of the duration of the inhalation and exhalation phases, as well as to which muscles are involved in breathing.

The chest is examined from all sides with direct and side lighting. Its shape is judged by the ratio of the anterior-posterior and transverse dimensions (determined visually or measured with a special compass), the severity of the supraclavicular and subclavian fossae, the width of the intercostal spaces, the direction of the ribs in the lower lateral sections, the magnitude of the epigastric angle. In the case when the epigastric angle is not outlined, in order to determine its value, it is necessary to press the palmar surfaces of the thumbs against the costal arches, resting their tips against the xiphoid process (Fig. 35).

When measuring the circumference of the chest, it is advisable to compare the distance from the middle of the sternum to the spinous process of the vertebra on both sides.

The respiratory rate is usually determined by visual observation of the respiratory excursions of the chest, however, with shallow breathing of the patient, one should put the palm on the epigastric region and count the respiratory movements by raising the brush while inhaling. The counting of respiratory movements is carried out for one or more minutes, and this must be done unnoticed by the patient, since breathing is an arbitrary act. The rhythm of breathing is judged by the uniformity of respiratory pauses, and the depth of breathing is determined by the amplitude of respiratory excursions of the ribs. In addition, comparing the amplitude of movements of the ribs, collarbones, angles of the shoulder blades and shoulder girdle on both sides, one gets an idea of ​​the uniformity of the participation of both halves of the chest in the act of breathing.

Comparing the duration of inhalation and exhalation, it is necessary to pay attention to the intensity of the noise generated by the air flow in both phases of breathing.

Normally, the chest is of a regular, symmetrical shape. In normosthenics, it has the shape of a truncated cone with its apex downwards, its anteroposterior size is 2/3-3/4 of the transverse size, the intercostal spaces, supraclavicular and subclavian fossae are not sharply expressed, the direction of the ribs in the lower lateral sections is moderately oblique, the epigastric angle approaches direct.

In asthenics, the chest is narrow and flattened due to a uniform decrease in its anteroposterior and transverse dimensions, the supraclavicular and subclavian fossae are deep, the intercostal spaces are wide, the ribs go steeply down, the epigastric angle is sharp.

In hypersthenics, the anteroposterior and transverse dimensions of the chest, on the contrary, are evenly enlarged, therefore it appears wide and deep, the supraclavicular and subclavian fossae are barely outlined, the intercostal spaces are narrowed, the direction of the ribs approaches the horizontal, the epigastric angle is obtuse.

Changes in the shape of the chest may be due to pathology of the lung tissue or improper formation of the skeleton during development.

For patients with tuberculosis of both lungs with cicatricial wrinkling of the lung tissue, the so-called paralytic chest is characteristic, resembling the extreme version of the chest of asthenics: it is significantly flattened and is constantly in the position of complete exhalation, there are marked convergence of the ribs to each other, retraction of the intercostal spaces, supra- and subclavian fossae, atrophy of the pectoral muscles.

With emphysema (swelling) of the lungs, a barrel-shaped chest is formed, which resembles the extreme version of the chest of hypersthenics: both diameters of it, especially the anteroposterior one, are significantly enlarged, the ribs are directed horizontally, the intercostal spaces are expanded, the supraclavicular and subclavian fossae are smoothed or even bulge in the form of so-called emphysematous pillows. At the same time, the amplitude of respiratory excursions is significantly reduced and the chest is constantly in the position of a deep breath. A similar shape of the chest, but with sharply thickened collarbones, sternum and ribs, can be observed in patients with acromegaly. It should also be borne in mind that the smoothness of both supraclavicular fossae due to myxedematous edema is sometimes detected in hypothyroidism.

Congenital malformations of the chest sometimes result in the formation of a funnel-shaped depression in the lower part of the sternum (the funnel-shaped chest, or "cobbler's chest") or, less commonly, an oblong depression that runs along the upper and middle sections of the sternum (navicular chest). The navicular shape of the chest is usually combined with a congenital disease of the spinal cord, characterized by a violation of pain and temperature sensitivity (syringomyelia).

In patients who have had rickets in early childhood, in some cases a characteristic deformity of the chest is observed: it is, as it were, squeezed on both sides, while the sternum sharply protrudes forward in the form of a keel (rachitic, or keeled, chest, "chicken breast"). The keeled shape of the chest can also be detected in Marfan's syndrome.

15. Palpation of the chest. Determination of soreness, elasticity of the chest. Determination of voice trembling, the reasons for its amplification or weakening.

First, the degree of resistance of the chest is determined, then the ribs, intercostal spaces and pectoral muscles are felt. After that, the phenomenon of voice trembling is investigated. The patient is examined in a standing or sitting position. The resistance (elasticity) of the chest is determined by the resistance to its compression in various directions. First, the doctor puts the palm of one hand on the sternum, and the palm of the other - on the interscapular space, while both palms should be parallel to each other and be at the same level. With jerky movements, it squeezes the chest in the direction from back to front (Fig. 36a).

Then, in a similar way, it alternately produces compression in the anteroposterior direction of both halves of the chest in symmetrical areas. After that, palms are placed on symmetrical sections of the lateral parts of the chest and squeeze it in the transverse direction (Fig. 36b). Further, placing the palms on the symmetrical sections of the right and left halves of the chest, they sequentially feel the ribs and intercostal spaces in front, from the sides and behind. Determine the integrity and smoothness of the surface of the ribs, identify painful areas. If there is pain in any intercostal space, the entire intercostal space from the sternum to the spine is felt, determining the length of the area of ​​pain. Note whether the pain changes with breathing and torso tilts to the sides. The pectoral muscles are felt by grasping them in the fold between the thumb and forefinger.

Normally, the chest, when compressed, is elastic, pliable, especially in the lateral sections. When feeling the ribs, their integrity is not broken, the surface is smooth. Palpation of the chest is painless.

The presence of increased resistance (rigidity) of the chest to the pressure exerted on it is observed with significant pleural effusion, large tumors of the lungs and pleura, emphysema, and also with ossification of the costal cartilages in old age. Soreness of the ribs in a limited area may be due to their fracture or inflammation of the periosteum (periostitis). When a rib is fractured, a characteristic crunch appears at the site of palpation detected pain during breathing, due to the displacement of bone fragments. With periostitis in the area of ​​\u200b\u200bthe painful area of ​​\u200b\u200bthe rib, its thickening and surface roughness are probed. Periostitis of the III-V ribs to the left of the sternum (Tietze's syndrome) can mimic cardialgia. In patients who have had rickets, in places where the bone part of the ribs passes into the cartilaginous part, thickenings are often determined by palpation - "rachitic beads". Diffuse soreness of all ribs and sternum during palpation and tapping on them often occurs in diseases of the bone marrow.

Soreness that occurs during palpation of the intercostal spaces may be caused by damage to the pleura, intercostal muscles or nerves. Pain caused by dry (fibrinous) pleurisy is often detected in more than one intercostal space, but not throughout the intercostal spaces. Such local pain increases during inspiration and when the body is tilted to the healthy side, but it weakens if the mobility of the chest is limited by squeezing it on both sides with the palms. In some cases, in patients with dry pleurisy, during palpation of the chest over the affected area, one can feel a coarse pleural rub.

In the case of damage to the intercostal mice, pain during palpation is detected throughout the corresponding intercostal space, and with intercostal neuralgia, three pain points are palpated in places of the superficial location of the nerve: at the spine, on the lateral surface of the chest and at the sternum.

For intercostal neuralgia and myositis of the intercostal muscles, the connection of pain with breathing is also characteristic, but it intensifies when tilting to the affected side. The detection of pain when feeling the pectoral muscles indicates their damage (myositis), which may be the cause of the patient's complaints of pain in the precordial region.

In patients with significant effusion into the pleural cavity, in some cases it is possible to palpate thickening of the skin and pastosity over the lower sections of the corresponding half of the chest (Wintrich's symptom). If the lung tissue is damaged, subcutaneous emphysema of the chest may develop. In this case, areas of swelling of the subcutaneous tissue are visually determined, during palpation of which crepitus occurs.

Voice trembling is the fluctuations of the chest that occur during conversation and are felt by palpation, which are transmitted to it from the vibrating vocal cords along the air column in the trachea and bronchi.

When determining voice trembling, the patient repeats words containing the sound "r" in a loud low voice (bass), for example: "thirty-three", "forty-three", "tractor" or "Ararat". The doctor at this time puts his palms flat on the symmetrical sections of the chest, slightly presses his fingers to them and determines the severity of the vibrating tremors of the chest wall under each of the palms, comparing the sensations received from both sides with each other, as well as with voice trembling in neighboring areas of the chest. If unequal severity of voice trembling is detected in symmetrical areas and in doubtful cases, the position of the hands should be changed: put the right hand in place of the left, and the left hand in place of the right and repeat the study.

When determining voice trembling on the anterior surface of the chest, the patient stands with his hands down, and the doctor stands in front of him and puts his palms under the collarbones so that the bases of the palms lie on the sternum, and the ends of the fingers are directed outward (Fig. 37a).

Then the doctor asks the patient to raise his hands behind his head and puts his palms on the lateral surfaces of the chest so that the fingers are parallel to the ribs, and the little fingers lie at the level of the 5th rib (Fig. 37b).

After that, he invites the patient to lean forward slightly, head down, and cross his arms over his chest, placing his palms on his shoulders. At the same time, the shoulder blades diverge, expanding the interscapular space, which the doctor palpates by placing his palms longitudinally on both sides of the spine (Fig. 37d). Then he places his palms in the transverse direction on the subscapular regions directly under the lower angles of the shoulder blades so that the bases of the palms are near the spine, and the fingers are directed outward and located along the intercostal spaces (Fig. 37e).

Normally, voice trembling is moderately expressed, generally the same in symmetrical areas of the chest. However, due to the anatomical features of the right bronchus, voice trembling over the right apex may be somewhat stronger than over the left. With some pathological processes in the respiratory system, voice trembling over the affected areas may increase, weaken, or completely disappear.

An increase in voice trembling occurs with an improvement in sound conduction in the lung tissue and is usually determined locally over the affected area of ​​the lung. The causes of increased voice trembling may be a large focus of compaction and a decrease in the airiness of the lung tissue, for example, with croupous pneumonia, pulmonary infarction, or incomplete compression atelectasis. In addition, voice trembling is enhanced over a cavity formation in the lung (abscess, tuberculous cavity), but only if the cavity is large, located superficially, communicates with the bronchus and is surrounded by compacted lung tissue.

Evenly weakened, barely perceptible, voice trembling over the entire surface of both halves of the chest is observed in patients with emphysema. However, it should be borne in mind that voice trembling can be slightly pronounced over both lungs and in the absence of any pathology in the respiratory system, for example, in patients with a high or quiet voice, thickened chest wall.

The weakening or even disappearance of voice trembling may also be due to the displacement of the lung from the chest wall, in particular, the accumulation of air or fluid in the pleural cavity. In the case of the development of pneumothorax, the weakening or disappearance of voice trembling is observed over the entire surface of the lung compressed by air, and with effusion into the pleural cavity, usually in the lower chest above the place of accumulation of fluid.

When the lumen of the bronchus is completely closed, for example, due to its obstruction by a tumor or compression from the outside by enlarged lymph nodes, there is no voice trembling over the collapsed section of the lung corresponding to this bronchus (complete atelectasis).

16. Percussion of the lungs. Physical substantiation of the method. percussion methods. Types of percussion sound.

Percussion (percussio) - tapping, one of the main methods of objective examination of the patient, which consists in tapping out parts of the body and determining, by the nature of the resulting sound, the physical properties located under the percussed place of organs and tissues. The nature of the sound depends on the density of the organ, its airiness and elasticity. According to the properties of the sounds arising from percussion, the physical properties of the organs lying under the percussion place are determined.

Direct percussion - Auenbrugger's percussion - is rarely used today; sometimes when determining the boundaries of the heart, with comparative percussion of the lower parts of the lungs, with percussion along the collarbones, although in the latter case we already have, as it were, a transition from direct to mediocre percussion, since the clavicle plays the role of a plessimeter. With direct percussion, we have a very low intensity of the percussion sound and the difficulty of distinguishing between sounds, but here we can fully use the sense of touch and the sensation of resistance of the percussion tissues. The development of direct percussion in this direction led to the development of methods that can be called methods of silent percussion: here, for example, to a certain extent, Obraztsov's clicking method and the stroking or sliding method can be attributed. Obraztsov used for percussion a click (hit) with the pulp of the index finger of the right hand when it slipped from the back surface of the middle finger. Stroking or sliding percussion is performed with the pulp of three or four fingers on the exposed surface of the chest. In this way it is possible, as our own experience convinces us of this, to determine the boundaries of organs with sufficient accuracy. Mediocre percussion in its various forms, due to the influence of the plessimeter (which compresses the percussed area, makes it more dense and elastic, and therefore more capable of vibrations and sound transmission) has two main advantages: the percussion sound becomes louder and more distinct. In addition, with mediocre percussion, there is a much greater possibility of adapting percussion sound for various purposes pursued by percussion. The finger-finger method of percussion has a number of advantages: 1) with it, the doctor is independent of the instrumentation, 2) the finger plessimeter is convenient and easily adapts to any surface of the body , 3) with this method, both acoustic and tactile sensations are used to evaluate the research data, 4) when mastering this method of percussion, it is already easy to master others. The plessimeter is the middle or, more rarely, index finger of the left hand. For this purpose, it is applied with its palmar surface to the percussed area tightly, but easily (without much pressure). For percussion, use the middle or index finger of the right hand. The finger should be bent best so that the last two phalanxes of it, or at least the terminal phalanx, are at right angles to the main one. In any case, the angle of its bending should always be the same. The remaining fingers should not touch him (should be moved away from him). The stroke movement must be free and flexible and the valleys must be made in the wrist joint. A blow to the plessimeter finger (on its middle phalanx, less often on the nail) should be made with the flesh of the hammer finger and have a perpendicular direction to the percussion surface. This is a very important condition for obtaining a good, strong percussion sound. Further, the blow must also have a number of properties: it must be short, jerky, fast and elastic (it is best to remove the finger - hammer immediately after the blow from the finger - plessimeter, the blow must be rebounding). This achieves a greater impact force and its greater distribution in depth than on the surface. For a successful assessment of percussion sound and in the interests of a certain summation of auditory impressions, repeated blows should be used, i.e., two or three identical and with equal intervals of blows should be made at each percussion place. Deep and superficial percussion. A further subdivision of percussion in terms of its methodology is its division into: 1) deep, strong or loud and 2) superficial, weak or quiet. To a large extent, the distribution of oscillatory movements over the surface and in depth, the amount of air brought into vibration and the intensity of the percussion tone depend to a large extent on the strength of the percussion blow. With deep (strong) percussion, the vibrations of the percussion tissues propagate over the surface by 4-6 cm and up to 7 cm deep. With superficial (weak) percussion, the vibrations propagate over the surface up to 2-3 cm and up to 4 cm deep. In other words, acoustic the scope with strong percussion is approximately twice as large as with weak percussion. Depending on the circumstances - the greater or lesser size of the affected area, the greater or lesser depth of its location, and the purpose of the study - comparing the sound in different places or delimiting two adjacent organs from each other - we use either stronger or less strong percussion. With a small size of the pathological focus in the lungs, its superficial location, when determining the boundaries of organs, it is more advantageous to use weak (superficial) percussion. And vice versa, with foci of large sizes, their deep location, and for the purposes of sound comparison, it is better to use stronger (deep) percussion. A variation and further development of the principles of quiet (weak) percussion is the quietest (weakest), the so-called limiting or threshold percussion of Goldscheider. With this method of percussion, the strength of the percussion sound is reduced to the limits of the threshold for the perception of sound sensations (hence the name of the method), so that when tapping over the airless parts of the body, we do not perceive sound at all, while moving to air-containing organs, a very light sound is heard. Goldscheider's method of limiting percussion is based on the idea that our hearing organ more easily notes the appearance of a sound than its amplification. In practice, however, this method has not found general recognition, and in any case, it is undoubted that stronger percussion, if properly applied, of course, gives no worse results. With the quietest or threshold percussion, it is necessary to percuss only along the intercostal spaces in order to avoid strengthening the beetle on the ribs, and at the same time, either with a finger on a finger or a finger on a special so-called stylus plessimeter. When percussion on the finger, the latter should be held along Plesh (Plesch): the finger-plessimeter straightens in the second (distal) interphalangeal joint and bends at a right angle in the first; the back surface of the second and third phalanges forms a concave surface. Tapping is performed with the pulp of the middle finger of the right hand on the head of the main first phalanx of the plessimeter finger. The latter is in contact with the percussion surface with its most sensitive part - the apex, which ensures the best perception of the difference in the feeling of resistance, which, undoubtedly, plays a significant role with this method of percussion, bringing it closer to tactile percussion. The slate plessimeter is a curved glass rod with a rubber cap at the end. The so-called tactile or palpatory percussion adjoins the quietest (limiting) percussion, although it no longer relies on sound perceptions, but on the sense of touch, on the sensation of resistance, which to a greater or lesser extent occurs with any percussion, but here it is put, so say, in the eye of the corner. Tactile percussion can be, like percussion in general, direct and mediocre, and in the latter case, not only finger-finger, but also instrumental (plessimeter - hammer). A percussive strike in any case should not produce a sound. The blow should not be short and jerky, as with ordinary percussion, but on the contrary - slow, long and pressing. The position of the percussive hand corresponds to its position when writing, and the blow (or rather, pressure) is produced by the soft part of the nail phalanx of the middle finger. Determination of the boundaries of organs by this method is carried out successfully, but apparently it does not have any significant advantages over conventional percussion. Comparative and topographic percussion. Depending on the goal that we set ourselves for percussion, we can distinguish two fundamentally different types of percussion: 1) comparative percussion, which aims to compare anatomically identical areas; 2) delimiting or topographic percussion, which has as its task the delimitation of anatomically different areas from each other and the projection of their boundaries onto the surface of the body. With comparative percussion, it is necessary to carefully monitor the equality (identity) of the conditions when tapping out symmetrical places: the same impact force, the same position and the same pressure of the plessimeter finger, the same phase of breathing, etc. If at all, with comparative percussion, they usually use stronger percussion, then with obscure, doubtful data, one should try successively both strong, and moderate, and weak, and the weakest percussion, and then it is often possible to obtain a completely distinct result. In the interests of a more reliable comparison and for the purposes of self-control, the sequence of percussion strikes should be changed: for example, if, when comparing two symmetrical places, we percussed first the right and then the left side and at the same time received some difference in sound, then we should also percussion in the opposite direction. order (first on the left, then on the right). Often, with this technique, the apparent difference in percussion tone disappears. Comparative percussion, of course, is applicable not only to comparing two symmetrical places, but also to comparing two places with a certain and known difference in their sound on the same side of the body. With comparative percussion, it is not enough to simply establish the fact of a change in sound, for example, dulling it, as with restrictive percussion, but a detailed differentiation of the percussion tone is necessary according to all its main properties: intensity, tonality, timbre. This is extremely important for obtaining a clear idea of ​​the physical condition of the percussed organ. The delimiting topographic percussion, as mentioned above, requires a quiet percussion, a short blow and the smallest possible surface. The latter can be achieved when using a plessimeter by its edge position, and with a finger-plessimeter, by contacting only its top with the percussed surface (the conditions necessary to obtain intermittent vibrations of the percussed body). A very important point in delimiting percussion is the greatest possible elasticity, springy character of both percussion and percussion hands. The necessary conditions for this are difficult to describe, but they are easy to learn in practice. It is necessary to ensure that the finger-pessimeter is superimposed on the place of percussion, as indicated above, perhaps easier, without any pressure. For any strong pressure of the plessimeter already gives the percussion a strong character. When delimiting air-containing parts of the body from airless, some recommend percussion in the direction from air-containing to airless, others - vice versa. In practice, this is not essential, and one must percuss in both directions, crossing the required boundary several times, until its position is clearly determined. The organs of our body are arranged in such a way that they tend to overlap one another, and the boundaries between them never run perpendicular to the surface of the body. Therefore, for most organs, during percussion, we get two areas of dullness: 1) a superficial or absolute area in the part where the organ is directly adjacent to the outer wall of the body and where we get an absolutely dull percussion tone, and 2) a deep or relative area of ​​dullness - there, where an airless organ is covered by an air-containing organ and where we get a relatively dull percussion tone. The rule in determining superficial (absolute) dullness is superficial (weak) percussion, in which in the area of ​​​​absolute dullness the sound is not audible or almost inaudible. In a word, the general rules of topographic percussion apply here. To determine the same deep (relative) dullness, a deeper, stronger percussion is also used. But the percussive impact should in fact be only a little stronger than with superficial percussion (in determining absolute dullness), but the percussion finger should be pressed to the surface of the body much stronger, although again not too much. It must be remembered that a common beginner's mistake is to percussion too much. Of the special methods of percussion, two more must be mentioned - the method of auscultatory percussion or, which is the same, percussion auscultation, i.e., the method of simultaneous use of percussion and auscultation, and then the method of wand-plessimeter percussion. The method of auscultatory percussion is proposed for determining the boundaries of organs and consists in the fact that a stethoscope is deliberately placed on the organ under study and a percussion tone is heard through it, or, better, the sound of friction (scratching) of the skin, which is produced in different directions or from the stethoscope to the periphery, or vice versa” from the periphery to the stethoscope. In the first case, percussion tone. or friction noises are heard clearly as long as they are produced within the organ under study, and abruptly and suddenly muffled, weaken or disappear as soon as the border of the organ is crossed. In the second case, the change in sounds is the opposite: weak and deaf at first, they intensify when crossing the border of the organ. This method has not found wide distribution, because, being more complex, it has no advantages over simple percussion. But in some cases it gives the best results, namely: in determining the boundaries of the stomach and the lower border of the liver. Rod-plessimeter percussion is proposed to obtain a metallic shade of percussion tone, characteristic of air-containing cavities with smooth? walls and due to the sharp predominance of high overtones. It is necessary to percuss according to the plessimeter with some more or less sharp metal object (a metal stick, the end of the hammer handle, the edge of a coin, etc.). .

Depending on the constitutional type in healthy people, normosthenic, asthenic and hypersthenic forms of the chest are distinguished (Fig. 20).

Rice. 20. Normal forms of the chest:
a - normosthenic;
b - asthenic;
c - hypersthenic.
Rice. 21. Determination of the size of the epigastric angle.

Normosthenic (conical) chest resembles a truncated cone with the base facing upwards (the area of ​​the shoulder girdle). Its anterior-posterior diameter is less than the lateral one, the supraclavicular and subclavian fossae are weakly expressed, the ribs along the lateral surfaces are directed moderately obliquely, the intercostal spaces are not pronounced, the shoulders are at right angles to the neck. The muscles of the shoulder girdle are well developed. The epigastric angle (between the costal arches) is 90°, the shoulder blades are not sharply contoured. To determine the magnitude of the epigastric angle, the palmar surfaces of the thumbs are pressed tightly against the costal arches, and their ends rest against the xiphoid process (Fig. 21).

Asthenic chest flat, narrow, elongated (anterior-posterior and lateral dimensions are reduced). It clearly shows the supraclavicular and subclavian fossae, the clavicles are well distinguished, the intercostal spaces are wide, the ribs along the lateral surfaces have a more vertical direction. The epigastric angle is less than 90°. The shoulders are lowered, the muscles of the shoulder girdle are poorly developed, the shoulder blades lag behind the back.

Hypersthenic chest wide, like a cylinder. Its anterior-posterior size is approximately equal to the lateral, and the absolute values ​​of the diameters are greater than the diameters of the normosthenic chest. The supraclavicular and subclavian fossae are weakly expressed or not visible, the shoulders are straight and wide. Intercostal spaces are narrow, poorly expressed. The ribs are almost horizontal. The epigastric angle is obtuse, the shoulder blades fit snugly against the chest, its muscles are well developed.

With pathological changes in the lungs and pleura, or with primary changes in the chest itself, its normal shape can be distorted in various ways.

Rice. 22. Pathological forms of the chest:
a - emphysematous;
b - paralytic (according to A. A. Shelagurov, 1975);
c - rachitic;
g - funnel-shaped;
d - scaphoid;
e - kyphoscoliotic.

Emphysematous chest(Fig. 22, a) has the same features as hypersthenic, but more pronounced. She has an even more increased anterior-posterior diameter, the supraclavicular fossae protrude, the ribs run horizontally. This form of the chest develops in people suffering from chronic emphysema. At the same time, the lungs slightly collapse during exhalation and the size of the respiratory excursion of the chest decreases. If a chronic process in the lungs is accompanied by frequent strong coughing, in which air is forced out into their upper sections, the upper half of the chest especially expands, and it becomes barrel-shaped.

Paralytic chest(Fig. 22, b) is characterized by the same features as asthenic, only more pronounced. It is usually formed in persons suffering from diseases of the lungs and pleura for a long time with the development of fibrous tissue in them, which leads to their wrinkling and a decrease in the total mass of the lungs. In contrast to the asthenic chest, the paralytic chest is often asymmetrical, since the retraction of the intercostal spaces, supraclavicular or subclavian fossae is usually uneven on both sides. During breathing, the shoulder blades move asynchronously.

rachitic chest(“chicken breast”; Fig. 22, c) occurs in people who have had rickets in childhood. Its anterior-posterior section is elongated, and the sternum keeled forward. The anterior-lateral surfaces are, as it were, depressed inwards and connected to the sternum at an acute angle. In addition, there is a retraction of the lower part of the chest, corresponding to the place of attachment of the diaphragm. The cross section of such a cell resembles a triangle with a vertex in the sternum.

Funnel chest(Fig. 22, d) is characterized by a funnel-shaped impression in the region of the xiphoid process and the lower part of the sternum. Since this chest deformity was previously observed in cobblers, it is also called the "shoemaker's chest". In most cases, it is impossible to determine the cause of this deformity.

Navicular chest(Fig. 22, e) differs in that in the upper and middle parts of the sternum there is a depression resembling the depression of a boat in shape. In some cases, such a chest occurs with a disease of the spinal cord - syringomyelia.

Kyphoscoliotic chest(Fig. 22, f) occurs with curvature of the spine as a result of a pathological process in it (with tuberculosis of the spine, rheumatoid arthritis, etc.).

This feature is one of the most constant, changes little with age and is considered fundamental in assessing the constitutional type. There are three main forms of the chest - flattened, cylindrical, conical.

The shape of the chest is associated with the epigastric angle (the angle formed by the costal arches), the value of which varies from acute (less) to obtuse (greater). The chest can be more or less elongated in length, have the same shape along its entire length, or change (narrow or expand downward).

flattened the chest is characterized by an acute epigastric angle. In profile, the chest looks like a cylinder strongly flattened from front to back, usually narrowed downwards.

Cylindrical the chest has a right epigastric angle. In profile, the chest is similar to a rounded cylinder of moderate length.

conical The chest is characterized by an obtuse epigastric angle. In profile, the chest has the shape of a rounded cylinder, noticeably expanding downwards. Like a cone.

B. Assessment of the shape of the abdomen. This feature is largely related to the shape of the chest.

A hollow abdomen is characterized by a complete absence of subcutaneous adipose tissue, a weak muscle tone of the abdominal wall. Protrusion of the pelvic bones is characteristic.

Straight belly. This form of the abdomen is characterized by a significant development of the abdominal muscles and its good tone. Fat deposition is weak and moderate, the bone relief is almost smoothed.

A convex abdomen is characterized by the abundant development of the subcutaneous fat layer. Muscle development may be weak or moderate. With this form of the abdomen, a fatty fold, located above the pubis, necessarily appears. The bone relief of the pelvic bones is completely smoothed and often difficult to palpate.

B. Evaluation of the shape of the back.

A straight, or normal, shape of the back is observed with a normal spinal column, without hypertrophic bends in any of its departments.

The stooped shape of the back is characterized by an increased vertebral bend in the thoracic region. In this regard, pterygoid divergent scapulae are almost always observed.

The flattened shape of the back is characterized by the smoothness of the thoracic and lumbar curves, a special flattening in the area of ​​the shoulder blades.

D. Evaluation of the shape of the legs.

The shape of the legs is taken into account when assessing the constitutional affiliation, but is not of paramount importance. It can be X-shaped, normal and O-shaped.

In the X-shape, the legs touch at the knee joint, and there is a gap between the calves and thighs. Depending on the size of this gap, the degree of X-shape can be assessed as I, II, III.

The O-shape is stated when the legs do not close all the way from the groin to the ankles. The degree of their discrepancy is estimated by points (1, 2, 3).

D. Assessment of the degree of development of the bone component (skeleton).

The massiveness of the development of the skeleton is taken into account according to the degree of development of the epiphyses, bones, massiveness of the joints. The width of the epiphyses is measured on the shoulder, forearm, lower leg and thigh. Their arithmetic mean value can be considered as an indirect characteristic of the massiveness of the skeleton. The assessment is carried out according to a three-point system:

1 point - thin skeleton with thin epiphyses;

2 points - medium in terms of massiveness of the skeleton with medium or large epiphyses;

3 points - strong, massive, with very wide bones and powerful epiphyses. Sometimes intermediate points are also distinguished - 1.5 and 2.5.

E. Assessment of the degree of development of the muscle component.

The development of muscle tissue is assessed by its size and turgor, mainly on the limbs (shoulder and thigh), both in a calm and in a tense state. The assessment is carried out according to a three-point system:

1 point - weak development of muscle tissue, sagging, weak tone;

2 points - moderate development, the relief of the main muscle groups under the skin is visible, good muscle tone;

3 points - a pronounced development of the muscles, its clear relief, strong muscle tone in a tense state.

G. Assessment of the degree of development of the fatty component.

The development of the fat component is determined by the smoothness of the bone relief of the skeleton, as well as by the size of the fat folds. They are measured with a caliper on the abdomen (at the intersection of lines running horizontally at the level of the navel and vertically across the nipple), on the back (under the shoulder blade) and on the back of the shoulder (above the triceps). Then their arithmetic mean value is calculated, which serves as a numerical characteristic of fat deposition. In addition, there is a scoring of the severity of the fat component:

1 point - the bone relief of the shoulder girdle is clearly visible, especially the clavicle and shoulder blades, the ribs are visible at the place of their attachment to the sternum. There is practically no subcutaneous fat layer, the average size of the fat fold ranges from 3 to 6 mm.

2 points - the bone relief is visible only in the region of the collarbones, the rest of the relief is smoothed. Moderate development of the subcutaneous fat layer on the abdomen and back, the average size of the fat fold is from 7 to 9 mm.

3 points - abundant fat deposition in all parts of the body. The bony relief is completely smoothed out. Strong fat deposition in the abdomen, back, limbs. Thickness of fat folds - from 20 mm and above.

Type of somatic constitutionaccording to Chernorutsky's classification, it can be determined using the Pinier index (an indicator of body strength). This indicator reflects the relationship between the circumference of the chest in the exhalation phase (WGC, cm), standing height (P, cm) and body weight (M, kg):

IP \u003d P - (M + WGC).

In the absence of obesity, a lower figure indicates a stronger physique. If IP > 30, then the person is an asthenic, if 30 > IP< 10 - нормостеник, если ИП < 10 - гиперстеник.

If the PI is less than 10, the physique is strong, 10-20 is good, 21-25 is average, 26-35 is weak, and more than 36 is very weak.

To determine the type of constitution in children, you can use stenicity index (SI):

IS = Height (cm) : Shoulder Width (or double vertex, cm)

With IS = 4.4 - asthenic, 4.4 > IS > 4.1 - normosthenic, IS< 4,1 - гиперстеник.

In recent years, the method of R.N. has been used to determine the type of somatic constitution in children. Dorokhov and I.I. Bahrakh, which is based on the use of the results of the study of indicators of physical development on centile scales. According to this scheme, the sum of points (numbers) of the "corridors" of the centile scales is calculated when evaluating individual indicators: body length, chest circumference and body weight. The sum of numbers up to 10 points corresponds to the microsomatic type, up to 15 points - mesosomatic type, 16 - 21 points - macrosomatic type.

1. Shape and type of chest

The purpose of the examination is to determine the static and dynamic characteristics of the chest, as well as external respiratory parameters. To do this, determine the shape of the chest (correct or incorrect); chest type (normosthenic, hypersthenic, asthenic, emphysematous, paralytic, rachitic, funnel-shaped, navicular); symmetry of both halves of the chest; symmetry of respiratory excursions of both halves of the chest; curvature of the spine (kyphosis, lordosis, scoliosis, kyphoscoliosis); respiratory excursion of the chest at the level of the IV rib. The shape of the chest can be correct and incorrect (for diseases of the lungs, pleura, as well as for rickets, trauma of the chest and spine, bone tuberculosis).

The following types of chest are distinguished:

normosthenic type is observed in persons of normosthenic physique. The anteroposterior dimensions of the chest are in the correct ratio with the lateral dimensions, the supraclavicular and subclavian fossae are moderately pronounced, the ribs in the lateral sections are moderately oblique, the shoulder blades do not fit snugly against the chest, the epigastric angle is straight;

asthenic type is observed in persons with asthenic physique. The chest is elongated due to a decrease in the anteroposterior and lateral dimensions, sometimes flat, supraclavicular and subclavian spaces sink, the ribs in the lateral sections acquire a more vertical position, the shoulder blades lag behind the chest, the muscles of the shoulder girdle are poorly developed, the edge of the X rib is free and easily determined when palpation, the epigastric angle is acute;

the hypersthenic type is observed in persons with a hypersthenic physique. The chest is shortened, the anteroposterior dimensions approach the lateral ones, the supraclavicular fossae are smoothed, the ribs in the lateral sections become horizontal, the intercostal spaces are narrowed, the shoulder blades fit snugly against the chest, the epigastric angle is obtuse;

emphysematous (barrel-shaped) chest, in which the dimensions of the anteroposterior and lateral diameters approach each other, as a result of which the shape of the chest resembles a barrel (wide and short); the ribs are located horizontally, the supraclavicular and subclavian fossae are not distinguished, the shoulder blades are very closely adjacent to the chest and are almost not contoured, the epigastric angle is obtuse. Observed with emphysema and during an attack of bronchial asthma;

paralytic chest resembles asthenic (elongated and flattened). The anteroposterior dimensions are much smaller than the transverse ones, the clavicles are sharply outlined, the supraclavicular and subclavian spaces recede. The shoulder blades sharply lag behind the chest, the epigastric angle is sharp. Paralytic chest is observed in patients with tuberculosis, chronic diseases of the lungs and pleura, with Marfan's syndrome, in malnourished people;

rachitic chest (keeled) - the so-called chicken breast, in which the anteroposterior size is sharply increased due to the sternum protruding forward in the form of a keel, and there are also distinct thickenings at the junction of the costal cartilages into the bone ("rachitic beads");

funnel-shaped chest has a funnel-shaped depression or depression in the lower third of the sternum and the xiphoid process. This form of the chest is observed in shoemakers due to the constant pressure of the shoe resting against the lower part of the still pliable sternum ("shoemaker's chest");

the navicular chest has a navicular oblong depression in the middle and upper parts of the sternum (with syringomyelia). In addition, breathing parameters are evaluated: how the patient breathes - through the nose or mouth; type of breathing: chest (costal), abdominal (diaphragmatic or mixed); breathing rhythm (rhythmic or arrhythmic); depth of breathing (superficial, medium depth, deep); respiratory rate (number of breaths per minute).

Symmetry of respiratory excursions of the chest. Notice the movement of the angles of the scapula during deep inhalation and exhalation. Asymmetry of respiratory excursions may be the result of pleurisy, surgical interventions, wrinkling of the lung. Asymmetry of the chest may be associated with an increase in lung volume (due to the accumulation of fluid or air in the pleural cavity) and with its decrease (due to the development of pleural adhesions, atelectasis (collapse) of the lung or its lobe). Measurement of the maximum circumference and assessment of respiratory excursions of the chest is carried out by measuring the circumference of the chest with a centimeter tape at the height of maximum inspiration, while the tape is located behind the corners of the shoulder blades. Respiratory excursion of the chest is determined by measuring the circumference of the chest at the height of inhalation and exhalation. It decreases in the presence of pleural complications (after suffering pleurisy, pneumonia), emphysema, obesity. Deformation of the chest can be manifested by its retraction or protrusion in any area, developing as a result of diseases of the lungs and pleura. Retraction may result from shrinkage (fibrosis) or collapse (atelectasis) of the lung. Unilateral protrusion or expansion of the chest may be due to the accumulation of fluid in the pleural cavity (hydrothorax) or air (pneumothorax). On examination, attention is drawn to the symmetry of the respiratory movements of the chest. The doctor should put his hands on the posterior surface of the chest on the left and right and ask the patient to take a few deep breaths and exhalations. The lag of any half of the chest may be the result of damage to the pleura (dry and effusion pleurisy) and lungs (pneumonia, atelectasis). A uniform decrease and even the absence of respiratory excursions on both sides is characteristic of pulmonary emphysema.

Assessment of breathing parameters: Breathing through the nose is usually seen in a healthy person. Breathing through the mouth is observed in pathological conditions in the nasal cavity (rhinitis, ethmoiditis, polyposis, curvature of the nasal septum). Thoracic type of breathing is usually observed in women, abdominal (diaphragmatic) - in men.

Breathing rhythm: in a healthy person, uniform respiratory movements are observed, uneven respiratory movements occur in coma, agony, and cerebrovascular accident.

Breathing depth: superficial breathing occurs with intercostal neuralgia, pulmonary diseases with involvement of the pleura in the process, breathing of medium depth occurs in a healthy person, deep in athletes.

The measurement of the respiratory rate is carried out by counting the number of respiratory movements in 1 min, imperceptibly for the patient, for which the hand is placed on the surface of the chest. In a healthy person, the number of respiratory movements in 1 minute is 12-20. A decrease in the number of respiratory movements to 12 or less (bradypnea) is observed with cerebral edema and coma. Increased breathing (over 20) is observed in violation of the function of external respiration, as well as in the presence of obstacles to normal breathing (ascites, flatulence, broken ribs, diseases of the diaphragm).

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1

To select the optimal mini-thoracotomy access, axial computerograms were studied in 45 male patients of the II period of adulthood, without pathology of the chest organs, with different body types (TTS): 15 people each with dolichomorphic, mesomorphic and brachymorphic. To determine TTS using the E-film program, the chest width index was measured on an axial tomogram, which was calculated as the ratio of the transverse size to the anterior-posterior, multiplied by 100, and the epigastric angle was determined in the frontal plane. After establishing the TTS, the number of the thoracic vertebra and the intercostal space corresponding to it along the paravertebral line were determined on each section. Next, we studied the correspondence of the bodies of the thoracic vertebrae and intercostal spaces along the remaining six conditional lines of the chest.

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Human ecology. Part 2. Methods for assessing physical health ...

The guidelines are a guide for performing laboratory work on human ecology. Designed for students of the Faculty of Biology, studying in the specialties 013100 Ecology. 511100 Ecology and nature management (discipline "Human Ecology", block of general educational activities), full-time education.

The hypersthenic type is characterized by a relative predominance of transverse dimensions over longitudinal ones, the chest is short and wide, the epigastric angle is obtuse, the pelvis is wide, the muscular system is well developed.

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Body type as a possible marker of diseases and features of students' motor activity organization [Electronic resource] / Meshcheryakov, Levushkin // Sports medicine: science and practice. 2524.2015.1.61 .- Access mode: https://website/efd/372943

Purpose of the study: To reveal the relationship between the body type of male students of a special medical group with their existing diseases and the body's susceptibility to physical loads of various directions. Materials and Methods: 644 students - young men of a special medical group aged 17 to 20 years old, divided into 4 groups according to body types (asthenoid, thoracic, muscular and digestive) were examined. Methods for analyzing heart rate variability, determining physical performance (veloergometry, functional test PWC150, method for determining the intensity of accumulation of pulse debt), tests for determining physical fitness were used. The diagnosis was established during a medical examination and analysis of medical records. Results: The surveyed students revealed a relationship between the existing "basic disease" and body type, identified effective motor modes aimed at optimizing the physical condition for students of different somatotypes. Conclusions: Representatives of different body types are characterized not only by the features of the shape and size of the body, its component composition, but also by the specifics of the activity of the neuroendocrine system, predisposition to various diseases, the body's susceptibility to physical stress of various directions. The revealed features can serve as a basis for building a system of physical education of young people, which would take into account the connection of the somatotype with motor preferences, the structure of motor skills and the presence of deviations in the state of their health.

The chest is flattened from front to back, elongated, often narrowed downwards. The epigastric angle is acute. The back is often stooped with sharply protruding shoulder blades. The abdomen is sunken or straight.

4

The purpose of this study was to identify the morphological and functional characteristics of young sambo wrestlers living in the northern and southern regions of Gorny Altai. Materials and methods. 65 males aged 17 to 20 who regularly go in for sambo sports, representatives of the indigenous population of the Altai Mountains, the Altaians, were studied. All studies were conducted on the basis of the Republican Medical and Sports Dispensary in the first half of the day, the athletes at the time of the study were in the preparatory period of the training cycle. The research program included: 1) analysis of the medical records of the subjects; 2) anthropometric measurements (body length, body weight, chest girth), carried out according to the standard anthropometric program [Bunak V.V., 1941]. Based on the measured somatic characteristics, the Quetelet mass-height index was calculated; 3) somatotyping was assessed according to the classification of body types by M.V. Chernorutsky. The determination of the constitutional type was carried out on the basis of measuring the length, body weight and circumference of the chest and calculating the Pinier index; 4) to determine the functional capabilities of the muscular system, the strength of the muscles of the hand and back (backbone strength) was assessed using hand and back dynamometry; 5) the functionality of external respiration was assessed in terms of vital capacity (VC), using a dry portable spirometer; 6) the obtained experimental data were analyzed using the STATISTIKA 6.0 package. Results and discussion. Athletes from the low-mountain northern regions of Gorny Altai are distinguished by their greater body length and weight, higher values ​​of chest circumference, compared with athletes from the high-mountainous southern Gorny Altai. Among the former, there are more people with a hypersthenic body type, they have higher indicators of muscle strength (hand and back strength) and better indicators of external respiration function compared to sambo wrestlers from the south of Gorny Altai. There are three main reasons that cause differences in morphological and functional indicators among sambo athletes of the North and South of the republic: extreme natural and climatic conditions, environmental pollution and socio-economic instability of society. For a more complete answer to the questions raised, further research is needed on the morphofunctional indicators of Altaian youths, both involved and not involved in sports, as well as a more detailed description of the social and living conditions of the youth of Gorny Altai, taking into account environmental factors. Conclusions. 1) Athletes from the north of Gorny Altai have significantly higher anthropometric indicators (LW, MT, OGK) compared with athletes from the south of Gorny Altai. 2) The normosthenic body type is more often represented among sambo wrestlers from the south compared to athletes from the north of Gorny Altai. There are more people with a hypersthenic body type among sambo wrestlers from the north of Gorny Altai, and the asthenic type is more common among representatives of the southern regions of Gorny Altai. 3) Sambist athletes from the north of Gorny Altai have better indicators of external respiration (ZHEL, JEL), muscular system of the body (hand strength and back strength) compared to sambo athletes from the south of Gorny Altai.

5

The content and methods of assessing physical development: ...

The guidelines are written in accordance with the state program and are devoted to the section of sports medicine - medical control. They present methods of examination of athletes and athletes: somatoscopy and physical development. This section of the doctor's practice allows you to indirectly assess the body's reserve capabilities. The presented work timely compensates for the shortage of textbooks and other educational literature in the libraries of medical universities. Methodological recommendations are intended for students of medical, pediatric and medical-prophylactic faculties, interns, residents and doctors of the polyclinic service.

Proportional relations of longitudinal and transverse dimensions: the shoulders are wide enough, the chest is cylindrical and sufficiently developed, the epigastric angle is straight, the fatness is moderate, the muscles are developed satisfactorily, relief.

6

We studied the role of mitophagy - the selective removal of mitochondria by autophagy - 48 hours after subarachnoid hemorrhage (SAH) in rats. The ability of mitophagy through voltage-gated anion channels (PGACs) interacting with light chain 3 (LC3) of microtubule-associated protein 1 to control the induction of apoptotic and necrotic cell death in neurons was specifically evaluated. PZAK1siRNA and the activator rapamycin (RM) were used. 112 male Sprague-Dawley rats were divided into 4 groups: sham-operated, SAH, SAH+PZAK1siRNA, and SAH+PM. Parameters measured included mortality rate, severity of cerebral edema, blood-brain barrier disruption, and behavioral tests.

The epigastric angle was determined in the frontal plane. After establishing the TTS, the number of the thoracic vertebra and the intercostal space corresponding to it along the paravertebral line were determined on each section. Next, we studied the correspondence of the bodies of the thoracic vertebrae and ...

7

"Terminologia Anatomica", containing 7428 terms, as well as textbooks and atlases, do not consider in detail the anatomy of the palmar surface of the hand, despite the growing interest in biometric documents and access control systems in the world. On the distal phalanges of the fingers, arcs, loops, curls are described, the ridge count is measured, which has individual and age characteristics. In addition to the above elements, papillary lines have a number of morphological features: branching, hooks, bridges, eyes, bends, endings, fragments and dots, notches and protrusions, pores. A number of fairly noticeable formations are revealed on the palm. Deltas (triradii) - 4 finger and 3 axial. The folds of the palm include: metacarpophalangeal, flexor thumb, three-finger and four-finger (distal and proximal transverse palmar lines), carpal flexion folds. These morphological objects appear in a number of federal legislative acts. Dactylocard data is used by the Ministry of Internal Affairs to search for and identify criminals, to identify people. Dermatoglyphics parameters are used in their activities by geneticists and psychologists. Access control systems are based on recognition of fingerprints, iris, face shape. There is a need for a description of the anatomy of the palmar surface of the hand in "Terminologia Anatomica"

The epigastric angle was determined in the frontal plane. After establishing the TTS, the number of the thoracic vertebra and the intercostal space corresponding to it along the paravertebral line were determined on each section. Next, we studied the correspondence of the bodies of the thoracic vertebrae and ...

8

Preparation of the final qualifying work on...

The study guide presents research methods that are differentiated not only depending on the area and direction of the study, but also classified taking into account the tasks to be solved.

This is a relatively narrowly built type: with a cylindrical, sometimes flattened chest, an average width of the shoulders and pelvis. The epigastric angle is close to straight or straight. The back is straight, sometimes with protruding shoulder blades.

9

Anthropological monitoring of preschoolers studies. allowance

M.: Physical culture

The textbook presents the anatomical and physiological features of preschool children, the individual typological diversity of children during the first childhood, as well as the main methods for assessing the physical development of preschoolers and their implementation in monitoring the physical health of the younger generation. The textbook was prepared within the framework of the subprogram "Physical education and rehabilitation of children, adolescents and youth in the Russian Federation" (2002-2005) of the Federal Target Program "Youth of Russia" (2001-2005).

The shape of the thorax is conical, short and widened downwards, the epigastric angle is obtuse. The abdomen is convex, rounded, usually with fatty folds, especially above the pubis. The back is straight or flattened.

10

In order to detail the data on the structure of bone tissue (CT) of the proximal epiphysis (PE) of the femur (BC), frontal cuts of 196 certified BC adults were studied. The material was grouped into 3 groups depending on the shape of the BC and the value of the thickness-length indicator. In the entire sample of BC, the spongy substance (HS) of PE in 26.7% had a "lamellar" type of structure, in 20.0% - "network" and in 53.3% - "transitional". HS PE has a different structure in different forms of BC: in dolichomorphic ones, it has a “lamellar” type of structure

The epigastric angle was determined in the frontal plane. After establishing the TTS, the number of the thoracic vertebra and the intercostal space corresponding to it along the paravertebral line were determined on each section. Next, we studied the correspondence of the bodies of the thoracic vertebrae and ...

11

M.: PROMEDIA

The author continues to acquaint readers with the main provisions of Dr. Mayr's therapy. To increase the effectiveness of Mayr's therapy, in addition to the diet, a variety of therapeutic measures are used that intensify the processes of cleansing the body, namely: self-massage of the abdomen and rectum, intestinal lavage. A set of exercises for training abdominal breathing is given.

12

Key points in the diagnosis of internal diseases Educational ...

Much attention is paid to the description of clinical syndromes, which allows demonstrating the algorithms of medical diagnostic search. Separate chapters are devoted to the description of clinical manifestations, diagnostics and treatment of private pathology of internal organs.

For its study, it is convenient to use the following technique: the palmar surface of the thumbs of both hands is pressed against the lower costal arches. The epigastric angle is the angle between the fingers.

13

Sports medicine textbook. Direction of preparation...

NCFU publishing house

The manual is a course of lectures developed on all topics of subject training, includes theoretical material and control questions for the student's independent work, and also includes a list of terms, tables, which greatly facilitates the student's work. The manual tells about the main pathological conditions that occur in athletes and people involved in physical culture, reveals the basics of the etiopathogenesis of many diseases

The asthenoid type is characterized by narrow forms of the body, hand, foot. The epigastric angle is acute. The back is stooped, the shoulder blades protrude. The bones are thin. Weak development of fat and muscle components.

14

Propaedeutics of internal diseases. General clinical...

Medicine DV

The course of lectures was prepared in accordance with the standard program for teaching propaedeutics of internal diseases, approved by the Ministry of Health of the Russian Federation. They consistently present the basics of medical deontology, the main general clinical methods for diagnosing internal diseases, modern additional (functional, laboratory, instrumental) research methods, as well as the spectrum of syndromes under consideration. Particular attention is paid to semiotics, the most difficult part of diagnostics. The lectures are presented based on the experience of teaching this discipline at the Department of Propaedeutics of Internal Diseases of the Pacific State Medical University and the traditions of the Russian school of therapists. The book is intended for students of the second or third year of medical schools, it may be useful for senior students and novice doctors.

The supraclavicular and subclavian fossae are not pronounced, the shoulder blades fit snugly against the posterior surface of the chest. The epigastric angle is straight. The muscles of the shoulder girdle are well developed. Asthenic chest is narrow, long, flat.

15

No. 4 [Bulletin of Moscow University. Series 23. Anthropology. , 2011]

First of all, the journal publishes original articles on the biological problems of human evolution and its modern diversity, ontogenetic development and morphology, as well as on the ecology of human groups and anthropological aspects of the ethnogenesis of ancient and modern peoples. It also highlights the main events in the life of the domestic and world anthropological community, contains information about upcoming and past conferences, symposiums and seminars, critical reviews of newly published books and other bibliographic information. The problems of related sciences, closely related to the main subject of the journal, will also be reflected. We hope that the new journal will be of interest not only to specialists, but also to a wider readership interested in the problems of biological and historical anthropology.

Normosthenic - has an average development of bone and muscle tissues, moderate fat deposition, harmoniously combined height and weight, an epigastric angle of about 900; IP within 10–30 arb. units

16

Fundamentals of sports training: assessment methods and ...

M.: Soviet sport

The scientific and methodological manual summarizes the theoretical and methodological material obtained by the author in the course of numerous scientific studies, as well as on the basis of 35 years of experience. The description and characteristics of the prerequisites for sports activities are given on the basis of the analysis of morphological parameters, physical and functional readiness, biological analysis, as well as the features of the formation of motor actions and their complex control in the process of sports activities.

The epigastric angle protrudes. Anatomically, this type is characterized by an extremely strong development of all parts of the large intestine asthenoid. Thin, delicate bones. Predominant development of the lower extremities.

17

Physical education of children 5-7 years old, taking into account somatic ...

Publishing house of ZabGGPU

The textbook was developed in the research laboratory "Modeling the content and biomedical substantiation of physical culture and sports" of the Transbaikal State Humanitarian and Pedagogical University. The manual considers a model for building physical education classes for children aged 5-7 years in preschool educational institutions, taking into account the somatic characteristics of the body. The model of the educational process has been tested and is recommended for physical education teachers, methodologists and educators of preschool educational institutions, teachers of physical culture, as well as for students, graduate students, teachers of secondary and higher educational institutions of physical culture.

b Fig.5. Shape of the chest: a) flattened, epigastric angle sharp; b) cylindrical, epigastric angle straight; c) conical, obtuse epigastric angle 2. Back shape: - straight or normal - this shape of the back is observed with normal ...

18

Innovative approaches to content and organization...

Publishing house of ZabGGPU

This work is the result of a fruitful integration of the theory and practice of preschool education and upbringing and provides an opportunity to get acquainted with the result of the cooperation of a scientific school with practical work in kindergartens of the Trans-Baikal Territory on innovative technologies for the recovery of the younger generation.

5–3 2–3 2–3 flattened convex obtuse conical а b Fig.3. Shape of the chest: a) flattened, epigastric angle sharp; b) cylindrical, epigastric angle straight; c) conical, obtuse epigastric angle 2. Shape of the back: - straight or...

19

Sports medicine textbook. allowance

M.: Man

The textbook was written in accordance with the sports medicine curriculum for higher education institutions of physical culture and the requirements of the Federal State Educational Standard of Higher Professional Education. This manual contains a glossary of medical terms.

The anteroposterior (sterno-vertebral size) is smaller than the lateral (transverse), supraclavicular fossae are slightly expressed. The epigastric angle approaches 90.

20

Sports selection: theory and practice [monograph]

M.: Soviet sport

The monograph, consisting of two books, on the basis of modern scientific data, reveals the theoretical and practical foundations of sports selection. The first book outlines the theoretical foundations of sports selection, considers the systems of sports selection that exist in countries with developed sports. The structure and genetics of sports talent are determined, the organizational and methodological foundations of sports selection are given, as well as diagnostics of the development of general and special abilities of athletes. The second book deals with the key issues of sports selection in certain sports (athletics, gymnastics, figure skating, football, basketball, tennis, swimming, rowing, cycling, skiing, wrestling, boxing, fencing, weightlifting, power lifting).

It is characterized by abundant fat deposition. The shape of the chest is conical, short and expanded from top to bottom, the epigastric angle is obtuse. The abdomen is convex, rounded, usually with fatty folds (especially above the pubis).

21

Correction of the figure of female students by various types of gymnastics in...

The manual contains information about the history of the beauty of female figures and the concept of beauty in the modern world. The definition of various types of physique, proportionality of the figure and constitution of the body is given. The history of the development of various gymnastic types and their influence on figure correction, health, and improvement of appearance are considered. Anthropometric measurements (I.V. Prokhortsev), methods of body weight regulation are presented. The manual includes exercises aimed at correcting the figure, and the rules of a healthy diet.

This type is characterized by the proportionality of the longitude and latitudinal dimensions of the body: - fairly wide shoulders with a well-developed chest: - epigastric angle is straight or close to straight; - moderately narrow pelvis; - Relief and well developed...

22

Physiological and hygienic bases of physical education of children...

M.: FLINTA

This textbook supplements information about the physiological and hygienic foundations of physical education for children of early and preschool age. The manual discusses modern ideas about health, various approaches to identifying the typological characteristics of children, reveals the patterns of building skills and muscle development, and features of the development of movements in children at different age periods.

The abdomen is strongly developed, with pronounced fatty folds, especially above the pubis, the epigastric angle is obtuse. The skeleton is large, massive. Bone relief is not visible. Muscle mass is plentiful, good muscle tone.

23

Pathophysiology: issues of general nosology

Medicine DV

The manual includes materials reflecting the current state of issues of general nosology: the concepts and categories of nosology (health, norm, pre-disease, disease, pathological process, etc.). The role and significance of reactivity, resistance and body constitution in pathology are presented in detail. Attention is focused on the relative pathogenicity of reactivity mechanisms, the relationship of constitutional types of people not only with certain diseases, but also with professional inclinations.

The temperature corresponding to the asthenic type, Kretschmer called schizoid;  picnic type - people of this type have a wide stocky figure, a short neck, a round head, a wide chest, a protruding abdomen, an obtuse epigastric angle.

24

Physical examination of the patient: examination of the respiratory, ...

The manual describes in detail the methods of physical examination of the patient. For each stage of the study, the sequence of performing various methods and the technique for their implementation are outlined. At the end of each section, examples of describing the results of the study in normal and pathological conditions are given. The manual is designed both for independent training of students and for work during practical classes. For medical students.

18 An example of a conclusion for a norm: The chest is cylindrical, corresponds to the normosthenic constitutional type, symmetrical, the epigastric angle is straight.

25

Collection of tests on propaedeutics of internal diseases

52. Asthenic chest: 1) resembles a truncated cone; 2) elongated, narrow, flat; 3) has a cylindrical shape; 4) happens in patients with emphysema; 5) has an epigastric angle > 90°.

26

Guide to practical exercises on topographic...

The textbook is intended for independent work of students in preparation for practical classes in topographic anatomy and operative surgery. The manual is compiled in accordance with the Exemplary Program for the discipline "Operative Surgery and Topographic Anatomy" for the specialties: 060101 (040100) - General Medicine, 060103 (040200) - Pediatrics, 060104 (040300) - Medical and Preventive Care, 060105 (040400) - Dentistry (Moscow, Federal State Educational Institution "VUNMTs Roszdrav", Ministry of Education and Science of the Russian Federation 2006). The need to issue this manual is dictated by the fact that when studying the subject, certain difficulties arise due to the large amount of material, the unequal interpretation of some issues in various manuals, the time limit and insufficient training of students in clinical terms. The textbook highlights the key moments of each topic of the practical lesson, which provides motivation for the cognitive activity of students, reveals the applied value of topographic anatomy in relation to clinical disciplines.

her "1) Hypersthenic is characterized by _ epigastric angle. 2) The length of the upper opening of the hypersthenic chest is located in the _ direction. 3) Upper aperture of normosthenics _ forms.

27

Operative and clinical surgery of the abdominal organs

The manual presents basic information on topographic anatomy and surgical interventions in the abdominal cavity in an accessible form. The textbook on the discipline "Operative and Clinical Surgery" was compiled in accordance with the requirements of the Federal State Educational Standard and is intended for students in higher education programs - specialist's programs, in the specialties "General Medicine", "Pediatrics".

The dolichomorphic physique is characterized by the shape of the abdomen, when the interspinous line is larger than the intercostal line, which is typical for a narrow lower chest aperture and a wide pelvis. The epigastric angle is narrow, equal to 85-95, long.

28

Surgery of the abdominal organs. T.I Topographic...

Publishing House of the Far Eastern Federal University

The manual presents the patterns and basic information on topographic anatomy and surgical interventions on the anterior abdominal wall and abdominal organs, provided for by the program for the development of students of the block of the Federal State Educational Standard in the specialty General Medicine and Pediatrics, taking into account the relevant competencies. In preparing the presented textbook, many years of experience of its compilers in teaching the relevant section of the curriculum for students of the above specialties was used. For the second edition, the manual has been revised and supplemented with modern technologies used in surgery. It is intended for students of medical universities studying under the programs of the specialist in General Medicine and Pediatrics.

The dolichomorphic physique is characterized by the shape of the abdomen, when the interspinous line is larger than the intercostal line, which is typical for a narrow lower chest aperture and a wide pelvis. The epigastric angle is narrow, equal to 85°-95°, long.

29

No. 3 [Morphology, 2008]

Founded in 1916 (former name - "Archive of Anatomy, Histology and Embryology"). Publishes original research, review and general theoretical articles on anatomy, anthropology, histology, cytology, embryology, cell biology, morphological aspects of veterinary medicine, issues of teaching morphological disciplines, history of morphology.

Standard morphometric criteria were established: weight, parietal-coccygeal, parietal-calcaneal dimensions, epigastric angle; head dimensions (biparietal, sagittal); head circumference...

30

A short guide to practical classes in propaedeutics...

The proposed textbook provides basic information about semiotics, etiopathogenesis and diagnosis of diseases, presents the main modern classifications of diseases of internal organs. The main objective of the proposed textbook is a concise presentation of theoretical material with a syndromic approach to the diagnosis of diseases. For each topic, test tasks are given that allow you to control the assimilation of basic theoretical information. The proposed manual does not replace modern guidelines on internal medicine and cannot replace a deep and systematic study of textbooks on the course of propaedeutics of internal diseases, but is an additional material that helps future doctors to master clinical thinking at the initial stage of clinical training.

13. Asthenic chest: 1) resembles a truncated cone; 2) elongated, narrow, flat; 3) has a cylindrical shape; 4) happens in patients with emphysema; 5) has an epigastric angle of more than 90°.

31

No. 9 ["60 years is not age" appendix to the magazine Be healthy! for pensioners, 2010]

Today, 60 years is the age of the second youth. It is no coincidence that 35% of pensioners in Russia continue to work. How to maintain physical tone, maintain active thinking and creative spirit? Experienced doctors, psychologists, healthy lifestyle enthusiasts talk about this in the magazine.

Expansion and rigidity of the chest are reversed. The costal humps decrease and soften, the epigastric angle, the level of the sternum and the lateral part of the torso begin to return to normal.

32

Mark Midler's Tale of a Swordsman

M.: Man

A documentary story about the life of the famous foil fencer Mark Midler, a participant in the first Olympics for Soviet athletes in 1952, a two-time Olympic champion and a six-time world champion in team competitions, a four-time winner of the European Cup, a six-time national champion and a permanent captain of the national team for many years, who by right called "the legend of the twentieth century."

Uh… shoulders wider than hips, arms and legs are average,” Vitaly Andreevich switched to muttering, “the epigastric angle between the lower ribs is straight, the muscle strength is clearly large, and endurance, as we know, is absolutely not characteristic of the muscular type, it ...

33

Basic aerobics in group programs ucheb.-method. allowance...

The manual deals with the problems of organizing and conducting basic aerobics in group programs, the impact of physical activity on the functional systems of the body and the anatomical and physiological characteristics of the human body. The manual contains theoretical and practical information, diagrams and illustrations, which facilitates the perception of educational material. The purpose of this manual is to increase the level of knowledge of fitness club instructors on the selection of the optimal load during basic aerobics classes and is a valuable educational and pedagogical material for preparing students in the direction 032100 "Physical Education", as well as students of the FPC.

In representatives of brachymorphic 11 (with a predominance of width) types, the chest becomes barrel-shaped, short, with an obtuse epigastric angle. In the intermediate mesomorphic type, the epigastric angle is right. Skeleton of the upper limb.

34

#1 [Pacific Medical Journal, 2004]

The Pacific Medical Journal is intended to bring together specialists from the Russian Far East and countries of the Asia-Pacific region working in the field of medicine and biology on a wide range of issues related to scientific research, educational and methodological work and healthcare practice. Unlike other periodical scientific publications published by academic institutions and medical organizations in Siberia and the Far East, the Pacific Medical Journal is primarily focused on topical regional problems, which are considered in a wide range from pilot innovative research to the widespread introduction of scientific developments into practice. The journal provides its pages for publishing the results of research by specialists working in various fields of medicine and biology, the topics of which do not always correspond to the format of scientific publications published in other regions of Russia, but are of high importance for the Far East and Asia-Pacific countries. A wide range of issues covered on the pages of the publication is structured in accordance with the formation of thematic issues of the journal devoted to specific problems of medicine and biology. The journal functions as an information platform for major scientific and practical conferences and forums held in the Russian Far East. Considerable attention is paid to the coverage of issues related to the general ethnic and environmental conditions for the development of pathology for the population of the Russian Far East and the countries of the Asia-Pacific region.

epigastric

38

No. 7 [Siberian Lights, 2012]

"SIBERIAN LIGHTS" is one of the oldest Russian regional literary magazines. It has been published in Novosibirsk since 1922. During this time, several generations of talented writers known not only in Siberia, such as Vyach. Shishkov and Vs. Ivanov, A. Koptelov and L. Seifullina, E. Permitin and P. Proskurin, A. Ivanov and A. Cherkasov, V. Shukshin, V. Astafiev and V. Rasputin and many others. Among the most famous poets are S. Markov and P. Vasiliev, I. Eroshin and L. Martynov, E. Stuart and V. Fedorov, S. Kunyaev and A. Plitchenko. Currently, the literary, artistic and socio-political magazine "Siberian Lights", awarded with diplomas of the administration of the Novosibirsk region (V.A. Tolokonsky), the regional council (V.V. Leonov), the Siberian Agreement MA (V. Ivankov) , edited by V.I. Zelensky, worthily continues the traditions of his predecessors. The editorial staff of the magazine is a team of well-known Siberian writers and poets, members of the Writers' Union of Russia.

I can, I can! - Then tell me, what is his epigastric angle - obtuse or acute? Ah, you don't know. Then here's what: give him hot cabbage soup.

39

Methods for determining and assessing the state of health and physical ...

Medicine DV

The textbook presents didactic material for students to master an important block of the Federal State Educational Standard in the specialty Pediatrics, taking into account the relevant competencies for mastering future pediatricians. This material reveals the essence of the methodology for determining and assessing the state of health and physical development of children and adolescents, which is widely demanded by pediatricians. As a basis, the training manual uses modern information resources, including official methodological documents of the Ministry of Health of the Russian Federation. In preparing the presented methodological publication, the long-term experience of its compiler in teaching the relevant section of the curriculum for students of the above specialty was applied.

The voice is hoarse. The shape of the chest is correct, normosthenic, the epigastric angle is close to a right one. The chest is symmetrical, but the right supraclavicular fossa is somewhat more pronounced than the left.

42

Clinical training on curation of sick children and registration of...

Medicine DV

The textbook presents the materials of the methodological support of clinical training for the formation of a set of professional skills among students of the medical faculty in the process of supervising sick children with various nosological forms of diseases. The scheme of registration of the educational history of the disease and the accompanying medical documentation is given. Standards for indicators of the health status of children and adolescents, standardized tests and educational situational tasks that are as close as possible to practice are given.

Assess the epigastric angle, which allows you to determine the constitutional type of the child.

43

Clinical and pharmacological foundations of modern pulmonology...

Moscow: Laboratory of Knowledge

Clinical experience in the treatment of patients with lung diseases is summarized from the standpoint of evidence-based medicine. For each nosological form, a set of therapeutic measures, physiotherapeutic procedures and other methods of influencing the causative agent of the disease is proposed. Methods for eliminating the intoxication syndrome, restoring the drainage function of the bronchi and normalizing the immunological status of the patient's body are described. Particular attention is paid to drugs used for prophylactic purposes. The diagnostics and therapy of both emergency conditions and chronic diseases of the bronchopulmonary system are considered.

Gaps, increased epigastric angle over 90°С, smoothed supraclavicular fossae, boxed percussion sound, lower lung boundaries are displaced downwards, respiratory excursion of the lower lung boundaries is limited; shallow breathing...