[Contribution of the Vishnevsky Central Military Clinical Hospital N 3 to the history of combat casualty care and delivery of care to the injured soldiers].

The article is dedicated to the 45-year history of combat casualty care in the Vishnevsky Central Military Clinical Hospital N 3. In the echelon system of medical care the Vishnevsky Central Military Clinical Hospital N 3 ranks the echelon (level) N 3. Specialists of the hospital, along with a medical and preventive activity, practice methodological, educational and innovative activity, participate in different scientific forums. Temporary duty assignment to the combat, human-made disaster and natural disaster areas is a real functional test. 64 physicians have an extreme situation experience. The Vishnevsky Central Military Clinical Hospital N 3 is a clinical base of department of surgery, advanced physician training department, combat casualty care department of the Institute for advanced physician training of Mandryka scientific and educational clinical center. For the purpose of reducing the terms and improving the quality of medical care it was suggested to make the integration connections with leading hospitals of the Ministry of Defense of the Russian Federation.

[The painting of A. Laktionov "After the surgery" and destiny of its characters].

The article is devoted to the plot of the painting of Alexander Laktionov (1910-1972) "After the surgery", stored in the Kursk art gallery n.a. A.A. Deineka. The central theme is outstanding surgeon, member of the USSR Academy of Medical Sciences S.S. Yudin has a casual conversation about the team work in N. V. Sklifosovsky First Aid Research Institute with his colleagues D.A. Arapov, A.A .Bocharov and B.S. Rozanov. Each of the painted surgeons made a great contribution to the military medicine. Biographical summaries and medical contribution of these surgeons are described.

[Surgical help organization during wartime].

Immediate proximity of medical groups of special purpose from the troops led to reduction of transportation time. 64% of wounded received medical help during first 2 hours after the incident. All wounded received medical help, even those, who were lethally wounded. 0.6% of wounded finished their treatment on the stage of qualified medical help, 97.3% were evacuated on the next stages and 2.1% had died. 10.2% of patients finished treatment in hospitals of specialized medical stage, 88.2% were sent to next evacuation stages and 1.6% had died. Emergency specialized surgical help was rendered to 43% of wounded. All stages of medical evacuation should be developed in full, in view of the impossibility of further evacuation under certain conditions. At the same time, multiple staging of medical evacuation should be avoided. Evacuation by means of air-transportation should be considered the main way of transportation of the wounded. Medical groups of special purpose are considered to be the leading field medical formations during wartime.

[Organization of scientific-methodological work in Central Military Clinical Hospital named after A.A. Vishnevskii].

There was congested a wide experience of organization and management of scientific work in the 3rd CMCH by Vishnevsky A.A. for a term of more than 40 years. This experience is subjected to generalization, analyze for the purpose of determination of it's priority orientations of improvement. Scientific-methods work in hospital is rated as a complex of measures, organisationaly-planed and coordinated by purpose and reinforcement of scientific schools of the 3rd CMCH by Vishnevsky A.A., as a basis of effective delivery of specialized medical aid. The vector of scientific researches is directed, generally, to solving questions of military and field medicine.

[Organization of surgical aid for gunshot wounds of the large bowel in the armed conflicts on Northern Caucasus].

The article presents generalization of experience of organization of surgical aid for gunshot wound of large bowel in the armed conflicts on Northern Caucasus. Were studied results of treatment of 272 wounded persons. Were detected 249 wounds of segmented intestine, 23 wounds of straight intestine. 78% of injured had multisystem injuries. All wounded persons had fire peritonitis, which is a logical result penetrating wound of stomach. On the base of results of treatment were proposed algorithms of surgical tactic in condition of wound of large bowel, also were proposed original methods of closing of major softgranulating wounds of perineum. The article presents a generalized experience of work in sphere of treatment of given category of wounds in coloproctologic center CMCH by Vishnevsky A.A.

[Use of tourniquets in limb combat injuries].

The garrot is one of the most well-known means by stemming of an exterior flow of blood of injured limbs. The article presents analyze of frequency, of indicated values and faults during the using of garrot in modern conditions of the combat in the Northern Caucasus (1994-2002). On the base of 104 wounds of great vessels, the authors make a conclusion about the necessity of using of the garrot only in the cases of absolute indications, when the other method of hemostasia, more simple and secure, is impossible.

[Valuation of effectiveness of optimized algorithm of diagnostics and treatment of acute pancreatitis].

The work is founded on the results of examination and treatment of 1242 patients with acute pancreatits in 1991-2007. There was compared results of diagnostics and treatment of 520 patients in 1991-1999 (group of comparison) before insertion of protocols of diagnostics and treatment of acute pancreatitis and after their insertion and optimization - 722 patients in 2000-2007 (main group). Compared groups are equitable in all categories. It's determined that that after insertion of standardized algorithm of diagnostics and treatment of acute pancreatitis in the work of surgical units of the 442nd Regional military clinical hospital of Leningrade military region, it was achieved a decrease of general lethality in conditions of this disease from 8.8% in group of comparison to 3.4% in main group (p<0.05). In conditions of sthenic acute pancreatitis after-operational lethality decreased from 39.6% to 23.1%, and general lethality - from 33.3% to 15% (p<0.001).

[Experience of application of intellectual computer technologies in the treatment-and-diagnostic practice].

To improve the screening system, the early pre-clinical diagnosis, the choice of therapeutic tactics and medicaments for treating some diseases about 1800 patients were investigated with the use of up-to-date technologies. The new method allows the physicians optimizing the process of decision making and improving the significant element of demonstration medicine, i.e. the transformation of investigational results into argumentative practical recommendations. The method's precision reached 93%.

[Gunshot trauma in persons wearing a bullet-proof vest]. / Ognestrel'naia travma pri nalichii bronezhileta.

In the military conflict in the North Caucasus only 19,8% patients with gunshot chest trauma had bullet-proof vest at the moment of injury. Features of mechanogenesis, clinical manifestation and diagnosis of gunshot trauma with armored protection were studied; recommendations for usage of bullet-proof vests were developed. The following terms were described for the first time: "closed injuries in the presence of bullet-proof vest" (bullet-proof vest is not damaged) -- clinical picture of visceral contusion prevails; "wounds in the presence of bullet-proof vest" (bullet-proof vest is damaged) -- there is a combination of visceral contusion with penetrating or non-penetrating wound. Gradation of this kind of gunshot trauma was proposed, recommendations for usage of bullet-proof vests were developed that permitted to improve results of treatment.

[Experience of organization of the skilled and emergency specialized surgical care rendered during the armed conflicts in the North Caucasus]. / Opyt organizatsii kvalifitsirovannoi i neotlozhnoi spetsializirovannoi khirurgicheskoi pomoshchi v vooruzhennykh konfliktakh na Severnom Kavkaze.

At present the hepatosurgery in the Vishnevsky Central Military Clinical Hospital has become one of the most perspective and rapidly developing directions of the surgery. The authors present the review of hepatosurgery development in the hospital with the detailed analysis of treatment results at each stage of development, the description of technical support of the new methods for conducting the complex operations on liver. For the short time (since 1991) we have passed the way from atypical hepatic resections up to the liver autotransplantation. The importance of additional surgical manipulations and procedures facilitating the surgery, the postoperative period and improving the operation results are underlined.

[Experience in organizing the surgical work of a garrison hospital in an armed conflict]. / Opyt organizatsii khirurgicheskoi raboty garnizonnogo gospitalia v vooruzhennom konflikte.

The authors have summarized organizational experience of surgical work of garrison military hospital strengthened with specialized brigades during the period of armed conflict in Republic of Dagestan (August-September, 1999). From the start of active actions in order to render assistance specialized surgical teams from district military hospital equipped with special kits (at the rate of 7 operations/day during a week) were sent to garrison hospital. In this armed conflict there are features characterising both mine-and-explosive war in Afghanistan and sniper war in Chechen Republic resulting in increase in the number of seriously wounded (up to 46.7%) casualties during Botlikhskii operation constituted 1:4, Novolakskii (Kadarskii)--1:5. Bullet injuries were fatal in 49.4% of the cases, fragmentation (including MET)--50.6%. During 1.5 month of hospital work there were performed 303 surgical interventions. 22.7% of slightly wounded from local garrisons were treated in garrison hospitals. Treatment results--postoperative lethality in gunshot trauma at the given stage constituted 1.1%.

[Experience in the training of surgeons in an internship of the medical staff of the North Caucasus Military District]. / Opyt podgotovki khirurgov v internature meditsinskogo sostava SKVO.

Beginning in 1971 the 72nd internship has trained more than 200 surgeons for the medical service of the military district. A very important task for the internship administration has been "screening" of personnel with a view that there should not be "casual" people among military surgeons. Upon completion of the 5-month courses, certified graduates can enter the Academy of Military Medicine.

[The vagotomy results in relation to the predominance of neural reflex or hormonal mechanisms regulating acid production in patients with a chronic duodenal ulcer]. / Rezul'taty vagotomii v zavisimosti ot preobladaniia nervno-reflektornykh ili gormonal'nykh mekhanizmov reguliatsii kislotoproduktsii u bol'nykh khronicheskoi iazvoi dvenadtsatiperstnoi kishki.

Results of prognostic tests of vagotomy were studied in 365 patients with chronic duodenal ulcers (CDU). It was established that the atropin test can not be taken as the main criterion of prognosis of vagotomy. However, according to its results the patients can be divided into 2 groups: atropin sensitive (69.3%) and atropin-resistant (30.7%). According to the parameters of the atropin test and the night gastric secretion the patients were divided into 3 groups: favorable (45.7%), doubtful (31.0%) and unfavorable (23.3%) prognosis of effectiveness of vagotomy with draining operations of the stomach.

[Atropine resistance and its significance in the selection of the method of surgical treatment of duodenal ulcer]. / Atropinorezistentnost'i ee znachenie v vybore metoda khirurgicheskogo lecheniia bol'nykh iazvoi dvenadtsatiperstnoi kishki.

Medical vagotomy with atropine allows two types of patients with duodenal ulcer to be distinguished--atropine-resistant and atropine-sensitive. A complicated course of the disease, high values of nocturnal gastric secretion before the operation, and positive Hollander's insulin test after vagotomy are encountered most frequently in atropine-resistant patients. The values of gastrin are significantly higher in these patients than in atropine sensitive patients. In 3-year follow-up periods, recurrence of the ulcer after vagotomy was revealed in 6.5% of atropine-resistant patients but in none of the atropine sensitive patients. Medical vagotomy with consideration for atropine sensitivity may be a reliable prognostic criterion in the choice of the operative intervention in patients with duodenal ulcer.