[Experience in provision of medical services to earthquake victims in Armenia in 1988].

The most devastating catastrophe in the USSR was the Armenian earthquake occurred on 7th December 1988. The city of Leninakan and towns of Kirovokan, Spitak (the epicenter), Stepanovan were destroyed by the earthquake with a magnitude 10. Up to 25 542 people have died, more than 500 000 were homeless and 39 795 were rescued. Medical service of the Ministry of Defence of the USSR took part in rescue work. Medical service units finished their rescue work on 31st December after results of work were summed up. Lethality rate was an index of successful rescue work of the unit. Only 6% of injured rescued by the medical unit have died, meanwhile 40%-50% of injured have died in Erevan hospitals. Mortality rate in patients with crush syndrome was 8.9% (according to other authors--30-75%). 75 injured remained in hospital, 25 injured were evacuated to central military hospitals for reconstructive plastic surgery. Officers of the medical unit, embodied from the main and central hospitals, successfully completed the task and received experience in provision of medical services to earthquake victims.

[Surgery of modern combat damage of breast].

The article presents an overall estimate of experience of surgical treatment of ballistic penetrating wounds of bosom of 1920 wounded in Afgan war (1979-1989) and 367 wounded during the armed conflict on Northern Caucasus (1994-1996). Ballistic penetrating wounds of bosom in modern military conflicts are characterized by high mortality on battle field, achieving 30%. In conditions of heavy wound the choice of optimum surgery tactics poses several difficulties, and due to it indications urgent thoracotomy are often increased. Multistage system of delivery of health care, used in Afgan war, during battle actions on the Northern Caucasus was changed to 2-stage system, where wounded persons during 1-2 hours were delivered to a specialist in multiprofile base hospital, placed in a combat zone. Effectuating of thoracocentesis with a closed drainage of pleural space stays the most popular and extended method of treatment ballistic penetrating wounds of bosom, used by 85% of wounded persons. Using of operative videothoracoscopia in 1995 during delivery of emergency specialized surgical medical care to wounded persons in forward base hospital leaded to decreasing of frequency of using of large thoracotomy to 2,4%. There was overviewed the modern conception of surgical treatment of patients, having bosom wounds.

[Experience in the use of Y-shaped anastomosis during surgical treatment of acute colonic ileus of tumoral genesis]. / Opyt primeneniia Y-obraznogo anastomoza pri khirurgicheskom lechenii ostroi tolsto-kishechnoi neprokhodimosti opukholevogo geneza.

Among the total number of patients suffered from colonic cancer the incidence of acute ileus constitutes 32%. In 1978-1997 we studied 198 patients with such pathology. In 1993-1997 the Y-form anastomosis was applied in 33 patients (37.9% of the cases); anastomosis incompetence was not observed. 1 month after operation the anastomosis provided the natural passage over intestine and in 2-3 months allowed performance of early and safe extraperitoneal closure of unloading stoma. The use of Y-form anastomosis in colonic surgery against the background of acute ileus (of tumoral genesis) permits to decrease the postoperative lethality and to conduct rapid social-and-labor rehabilitation of the patients with the help of early safe extraperitoneal reconstruction operations.

[Advanced techniques in surgical treatment of penetrating gunshot wounds of the chest]. / Novye tekhnologii pri khirurgicheskom lechenii ognestrel'nykh pronikaiushchikh ranenii grudi.

The results of treatment of 322 wounded with penetrating gun-shot wounds of the chest during local hostility from 1994 till 1996 are analyzed. Aggravation in the condition of the hospitalized wounded was observed due to reduction of time of evacuation in hospitals. The indications for surgery were in 96.3% wounded. The main surgical methods were thoracocentesis and drainage of pleural cavity performed in 80.1% wounded. Thoracotomy was performed in 9.6% wounded. High efficiency of operative videothoracoscopy performed in 4.4% wounded in hospital of the first aid is demonstrated, it allowed to reduce frequency of thoracotomy to 2.4%.

[Rendering emergency surgical aid in gunshot penetrating thoracic wounds]. / Okazanie neotlozhnoi khirurgicheskoi pomoshchi pri ognestrel'nykh pronikaiushchikh raneniiakh grudi.

In modern limited military conflicts the gunshot penetrating wounds of breast (GPWB) are the most severe type of fighting trauma with high lethality on field and development of complications. Today the main method of treatment in GPWB is low-invasive intervention--thoracocentesis and drainage of pleural cavity. In stationary conditions it is reasonable to conduct the active drainage of pleural cavity with the help of vacuum-aspirators and during evacuation of casualties to use the devices for drainage of pleural cavity with petalled valve. In GPWB to provide rendering of surgical service in time it is necessary to equip hospitals with home-produced equipment and apparatus according to achievements thoracic surgery as well as training of military field surgeons.

[Specialized surgical care of severe mechanical multiple trauma]. / Okazanie spetsializirovannoi khirurgicheskoi pomoshchi pri tiazheloi mekhanicheskoi sochetannoi travme.

The authors share their experiences with diagnosing and surgical treatment of 1792 patients with mechanical combined traumas. The average age of the patients was (31.6 +/- 1.4) years. All the patients were divided into two groups according to the medico-diagnostic methods. The traditional methods of diagnosis and treatment were used in 811 patients of the first group. Complications took place in 39.2%, lethality was 28.4%. The diagnosis in 981 patients of the second group included an ultrasound investigation, computed tomography, videothoraco- and laparoscopy. The surgical treatment was based on the objective multifactorial assessment of the trauma severity and determination of the prognosis criteria. Complications developed in 24.8% of the patients. Lethality was 19.5%.

[Surgical treatment of perforated gastroduodenal ulcers in young persons]. / Khirurgicheskoe lechenie perforativnykh gastroduodenal'nykh iazv u lits molodogo vozrasta..

The knowledge of surgical tactics in treatment of ulcerous disease and its complications in young persons is of great practical importance for military health service. The problem of choice of surgical method in perforated gastroduodenal ulcers remains contradictory. Many authors draw attention to merits and demerits of both palliative and radical interventions. The long-term results of identical operations obtained by different authors often vary and not infrequently are quite opposite. The review of our and foreign literature concerning the surgical treatment of perforated gastroduodenal ulcers in the young patients shows that the unequivocal decision of this problem today is not available. Discussions about expediency to perform different interventions in the young patients are generally concentrated around the notions of "acute" and "chronic" ulcer. However both these categories are poorly defined because the criteria of their evaluation vary in different authors. Obviously the choice of surgical method in the young patients with perforated gastroduodenal ulcers should be based both on multi-factor analysis of anamnestic data, the patient's general state, intraoperative picture and on retrospective and prospective analysis of conservative treatment, its possibilities and efficiency, on the patient's opinion. The availability of technical possibilities to perform the operation and presence of the adequately trained surgeons are necessary.

[The problems in and the means for improving ambulatory surgical care in the Armed Forces]. / Problemy i puti sovershenstvovaniia ambulatornoi khirurgicheskoi pomoshchi v Vooruzhennykh Silakh.

The article presents some conclusions on ambulatory surgery in the Military Medical Academy and Surgery Centers in St. Petersburg resulting in higher efficiency of surgical aid and its availability for military beneficiaries. Organization frames and staffing principles for day-time ambulatory surgery stations.