[The thoracoscopy in complex treatment of non-specific pleural empyema and purulent-destructive diseases of lungs].

The results of treatment of 697 patients with different kinds of non-specific pleural empyema and gangrenous lesions of lungs are presented in the article. Need for complex and differentiated treatment of pleural empyema with obligatory use of thoracoscopy is revealed. High efficiency of early thoracoscopic sanitation improving outcomes and length of hospital stay is proved. Thoracoscopic necrosectomy is alternative and effective surgery in treatment of gangrenous lesions of lungs.

[The complicated intestinal amebiasis in emergency surgery].

18 patients with complicated forms of intestinal amebiasis were operated on acute appendicitis, liver abscess or total necrotic colitis. Appendectomy, abscess drainage and colon resection were performed respectively. There were no postoperative deaths. Features of amebic appendicitis and total necrotic amebic colitis are described using clinical cases demonstrations. Recommendations for the treatment of these forms of amebiasis are given.

[Problems and prospects of post-graduate training at military-medical cadres]. / Problemy i perspektivy poslediplomno podgotovki voennoi-meditsinskikh kadrov.

The actual problems of advanced post-diploma training of RF AF medical cadres is analyzed in the article. The investigation of paramount directions of military-and-medical education reform was conducted, the data on additional military-and-medical education system were generalized. The present average annual output of all bases of additional education in RF AF system was subjected to analysis. The data on the students' training cost in the State institutions for physicians' advanced training (SIPAT) and the same civilian medical higher schools are presented. It is noted that the one student training prime cost in RF AF SIPAT is considerably lower. Present conceptions concerning the advanced system of military-and-medical cadres' training were analyzed. The main problems of RF AF SIPAT are presented; and until the problems are solved it will be impossible to optimize the training of medical service specialists. It is shown that under conditions RF AF, military- and medical reformation SIPAT can become the leading educational, scientific and medical center of post-graduated and additional professional education of military physicians.

[Traumatic disease in wounded patients]. / Travmaticheskaia bolezn' u ranenykh.

Results of clinico-physiological, pathobiochemical, immunological and hemocoagulative studies performed at the postshock period in 186 patients with battle wounds have shown their coincidence with data obtained in critical mechanical trauma of peace-time. A conclusion is made that critical gunshot wounds are followed by trauma disease having main regularities similar to those in a critical mechanical trauma of peace-time. One can speak only about specific features of battle injuries, but to distinguish "wound disease" as an independent clinical form is thought to be illegal.

[Experience in organizing surgical care during the combat operations in the Chechen Republic]. / Opyt organizatsii khirurgicheskoi pomoshchi v period boevykh deistvii v Chechenskoi Respublike.

In the article the final analysis of organization of surgical care during the local military conflict in northern Caucasus was presented. The real possibilities of different medical units such as single medical company and medical squadron of special assignment was described. Also concrete contents of emergency specialized surgical care and its role in improvement of outcomes in patients with combined combat injuries was reflected. Mortality in this patients was decreased from 25.2 to 12.8%. The defects of surgical care were analyzed and the main ways of improvement of surgical care in local military conflict were presented. In the result of using the principle of moving the medical care closer to the wounded in the whole system of consecutive care the mortality was decreased up to 1.3%.

[Syndrome of enteric insufficiency in patients with diffuse peritonitis: evaluation of the severity and outcome of the process]. / Sindrom énteral'noi nedostatochnosti u bol'nykh s rasprostranennym peritonotom: otsenka stepeni tiazhesti i iskhoda protsessa.

The authors have developed a method of assessment of the degree of the enteral insufficiency syndrome (EIS). The method was used in 2006 peritonitis patients on the basis of 42 clinical-laboratory indices expressed by 10 score scale. A formula for establishing the coefficient of EIS is proposed in cases of the absence of all the indices, the average intervals of its possible degrees are shown. An express formula was developed for the calculation of the prognostic coefficient and its degree intervals. Randomization in the approaches to diagnosis and treatment allowed lethality to be reduced from 26.9% to 12.9%, the frequency of complications--from 12.7% to 7.2%.

[Current principles of correction of leg shapes in reconstructive and aesthetic surgery]. / Sovremennye printsipy korrektsii formy nog v rekonstruktivnoi i ésteticheskoi khirurgii.

Main principles which should be followed when choosing the strategy of treatment in patients with deformities of lower extremities are describes. The authors' experience includes 213 patients with deformities of lower extremities, 59 of them were operated upon. Basing on this experience the authors have developed a classification allowing systematization of the methods for correction of deformities of legs. The following factors were taken into account: the character and degree of the deformity, the degree of impairment of the joint functions, compensatory changes, the degree of alteration of soft tissues, patient's age and the esthetic effect estimated by the patient.

[The treatment of combined gunshot and blast injuries at the medical evacuation stages]. / Lechenie sochetannykh i vzryvnykh povrezhdenii na étapakh meditsinskoi évakuatsii.

The article summarizes the experience of medical care to 3980 wounded with gunshot and blast injuries. It was found out that a number of fatal cases in concomitant traumas (23.4% of all other types of wounds) had come to 32.4%, and a number of medical discharges for unfitness--62.7%. The basic trends for the improvement of medical aid for this category of wounded are the following: rational systematization of injured, elaboration of integral prognostic systems which could be applied for concomitant gunshot injuries, differentiated approach to the problems of surgical, reanimatological and anesthesiological procedures.

[Pathogenesis and treatment of gunshot wounds of soft tissues]. / Patogenez i lechenie ognestrel'noi rany miagkikh tkanei.

Based on experimental investigations and generalization of the experience with treatment of wounds the authors pay attention to principal distinctions of the gunshot wound from other kinds of open injuries, as well as to the importance of early primary surgical treatment of the gunshot wound in prophylactics of infectious complications. Data on possible use of microwave radiation and medicamentous agents for stabilization of the wound process and restriction of spread of the secondary necrosis++ are presented.

[Modern ideas about the mechanisms of gunshot injury formation (Report 2)]. / Sovremenye predstavleniia o mekhanizmakh formirovaniia ognestrel'noi rany.

The results of experimental study of circulatory acute phase response to the gunshot trauma have shown that triggering of pathologic cascade defined as the traumatic shock is attributed to the free radical concentration created by the wounding projectile in the damaged tissues due to injury sphere formation. So the further study of etiology and pathogenesis of combat pathology is required, the results of which will permit to improve considerably the quality of medical aid rendered to the wounded and casualties.

[Modern ideas concerning the mechanisms of gunshot injury formation (Communication 1)]. / Sovremennye predstavleniia o mekhanizmakh formirovaniia ognestrel'noi rany (Soobshchenie pervoe).

The affect of gunshot small arms depends on the weight, speed and moment of projectile's inertia, which determine the trajectory of its movement in the object's substance and the degree of braking characterizing the fullness of energy transmission. The experimental investigations on animals show that the mechanism of tissue lesion during the gunshot injuries has a very complex character and includes both the projectile's direct effect and initiation of some physical phenomena leading to significant tissue damage distally from the wound canal.

[Enteral therapy of the syndrome of intestinal insufficiency in patients with peritonitis]. / Enteral'naia terapiia sindroma kishechnoi nedostatochnosti u bol'nykh s peritonitom.

Sixty five patients with peritonitis were examined and divided into two groups. The operative intervention in all the patients included transnasal intubation of the small intestine. The basic enteral therapy used in the first group of patients was made with the glucose-saline solution and transition to a balanced polysubstrate mixture "nutrient standard" with the increasing concentration. For the patients of the second group a special program was developed for enteral therapy in which glutamine and pectine were included in the glucose-saline solution as well as nutrient mixtures containing middle chain triglycerides. Active decompression of the small intestine followed by the enteral administration of the nutrient mixtures facilitated quicker correction of the intestinal insufficiency in patients with severe forms of peritonitis.

[The use of a perfluorocarbon emulsion in the local treatment of wounds complicated by a surgical infection]. / Ispol'zovanie émul'sii perftoruglerodov v mestnom lechenii ran, oslozhnennykh khirurgicheskoi infektsiei.

The article shows effectiveness of the local application of Perftoran in complex treatment of purulent wounds of soft tissues in 50 patients. Perftoran has no necrolytic and antibacterial properties and fails to make the terms of the 1st phase of the wound process shorter. Perftoran maintains the intensified development of young cell elements at different periods of healing of the purulent wounds, decreases the propagation of microorganisms in them, lessens the wound square surface, results in earlier development of marginal epithelialization and formation of the elastic cicatrix.

[Use of gas-current coagulation in the local treatment of gunshot wounds]. / Primenenie gazotokovoi koaguliatsii dlia mestnogo lecheniia pri ognestrel'nykh ranakh.

The article is devoted to the using of gas-current coagulation for treatment of gunshot wounds in experiment. A new technology of physical action on biological tissues allows the simultaneous performing of hemostasis, sterilization of the wound surface, dissection and evaporation of the tissue. The isolation of the wound surface from unfavorable aggressive factors of the environment due to the layer of thermal necrosis results in shortening the 1 phase of the wound process and in earlier development of its second phase. Healing proceeds by the type of productive inflammation. The use of the gas-current coagulation during the performing of the primary surgical treatment of gunshot wounds allowed to considerably reduce its time, improve its quality, substantially lessen the amount of infectious complications, considerably improve the indices of the wound process and results of treatment.

[Minimally-invasive combined radiosurgical interventions in diagnosis and treatment of pulmonary artery thromboembolism]. / Maloinvazivnye kombinirovannye rentgenokhirgicheskie vmeshatel'stva pri diagnostike i lechenii tromboémbolii legochno-arterial'nogo basseina.

Basing on the analysis of results obtained during the investigation and treatment of 38 patients suspected of pulmonary artery thromboembolism (PAT) the algorithm of measures applied in our hospital was developed. Its purpose was to put the PAT diagnosis and treatment in order. In our investigations the leading treatment method was the regional infusion therapy conducted through the transformation of diagnostic catheterization of pulmonary artery trunk into the treatment intervention. With the purpose of embolus hydrodynamic destruction the regional thrombolysis was conducted under conditions of fast high-pressure perfusion. It was preceded by the mechanical recanalization of thrombosis zone by the distal part of probe in order to create more favorable perfusion conditions. To prevent the repeated PAT when the source of thromboembolism was revealed the cava-filter implantation in the infra-renal part of inferior cava was performed.

[The use of air-plasma flows in military field surgery and disaster medicine]. / Primenenie vozdushnykh plazmennykh potokov v voenno-polevoi khirurgii i meditsine katastrof.

Plasma currents of high energy are considered to be very promising in the surgical treatment of modern pathology. The scientists of this country have constructed a portable field surgery apparatus in which a heated atmospheric air assumes a form of a high-temperature thin jet used like a surgeon's scalpel. Experiments and clinical tests proved the efficacy of this microplasmotron that can destroy and coagulate body tissue when treating it with plasma. This new method has, besides hemostatic action, some noticeable antimicrobic effect that leads to acceleration of tissue granulation and wound healing. In specialized and skilled medicare this progressive and priority method should be applied for initial surgical wound treatment, secondary hemorrhage arrests and surgical interventions when a high risk of infection spreading is involved.

[Use of physical plasma in surgery of wounds and wound complications]. / Ispol'zovanie fizicheskoi plazmy v khirurgii ran i ranevykh oslozhnenii.

The article is devoted to the local application of high energy plasma flows in the complex treatment of wounds and wound complications. The new technology of physical action upon the biological tissues allows performing dissections, evaporation and carrying on local hemostasis and sterilization of the wound surface simultaneously. The shortening of the first phase of the wound healing process and earlier development of the second phase are due to the "biophysical isolation" of the wound surface by the thermal necrosis layer from unfavorable effects of the external medium. The healing goes on by the type of productive inflammation. The use of plasma flows during surgical treatment of purulent wounds reduces pains during the postoperative period and considerably improves results of the treatment.

[Local application of low-energy aerial and argon plasma in the treatment of suppurative wounds and trophic ulcers]. / Mestnoe primenenie nizkoénergeticheskoi vozdushnoi i argonovoi plazmy v lechenii gnoinykh ran i troficheskikh iazv.

The authors describe experimental and clinical (113 patients) data demonstrating the antimicrobial, hemostatic and stimulating the regenerating processes property of the low energy plasma in local treatment of purulent and long-standing wounds and trophic ulcers.

[Application of viable cryopreserved alloderm transplants in the treatment of wound defects of soft tissues]. / Ispol'zovanie zhiznesposobnykh kriokonservirovannykh allodermotransplantatov v lechenii ranevykh defektov miagkikh tkanei.

An original method is proposed for treatment of long-standing intractable wounds and trophic ulcers using viable cryopreserved allodermotransplants and a distant air-plasma treatment. The main source of the allodermotransplants is the cadaverous skin. It was shown that the cadaverous skin taken during 17 hours after the donor's death was viable. The maximum period for storage of the viable skin when the worked out preservative is used at the temperature regimen -18 degrees C is 10 days, and at -70 degrees C it can be as long as 45 days. The analysis performed included 101 patients with long-standing intractable wounds and trophic ulcers. In 51 of them the new worked out method was used. An analysis of clinical and histomorphological data has proved that the application of the viable cryopreserved allodermotransplants and distant air-plasma treatment favor the better course of reparative processes. By the end of the forth week the wounds were completely closed in 19.7% of patients, the wound areas were considerably less (more than by 50% of the initial size) in 43.1%, less reduction of the wound area (less than 50% of the initial size) in 27.4%, in 9.8% there was no effect. No negative results were noted. It should be noted that closure of the tissue defect can be achieved by stimulation of the physiological regeneration of the patient's tissues. This method of regeneration of the skin is effective in trophic ulcers, long-standing intractable wounds and is also recommended in case of deficit of donor resources or when the severe state of the patient does not allow active surgical treatment.