[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.

[Extraperitoneal complications in gun-shot penetrating wounds of the stomach].

The article after a short literature review presents data of analyze of progression of extra-peritoneal visceral pathology by wounded persons with penetrating wound of stomach. There was described frequency of morbidity of extra-peritoneal organs in dependence on flow of peritonitis. Were marked differences in frequency of progression of peritonitis in conditions of fragment and ballistic wounds. In course of effectuated research was marked dependence between frequency of lethal outcomes and flow of peritonitis and added diseases of respiratory organs, uropoiesis, cardiovascular system. There was effectuated a comparative analysis of frequency of appearance of pathology of marked systems in dependence on localization of ballistic wound. Also there was shortly described a clinical-laboratorial presentation in conditions of appearance of diseases of extra-peritoneal organs.

[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.

[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.

[Development of liver surgery at the Vishnevsky Central Military Clinical Hospital]. / Razvitie gepatokhirurgii v TsVKG im. A. A. Vishnevskogo.

The work of coloproctological center of Vishnevsky Central Military Clinical Hospital for he last 10 years is analyzed. The increased number of treated patients and surgical interventions is noted. The greatest group includes the oncological patients and 90% of them are operated radically. Among the peculiarities of treatment tactics the introduction of laparoscopic operations, interoperation intraperitoneal hyperthermal chemotherapy for relapses and metastases, Lango operation for haemorrhoids are noted. 72 casualties with colon injuries were treated in the center.

[The use of artificial neuronal networks in the treatment of peptic ulcer]. / Primenenie iskusstvennykh neironnykh setei v lechenii iazvennoi bolezni.

Today the use of artificial neuronic nets (ANN) is the most perspective method in the prediction of clinical course and in the choice of correct therapeutic tactics. The experimental complex "Axon" with the software was created in the hospital that permitted to predict the course if gastric and duodenal ulcers. We introduced the data of 909 patients that contained the anamnesis, results of objective examination and late results of the treatment. These data has become the base for training and formation of ANN similar to the structure of human cerebral cortex. Having received the information about a new patient and using the previous experience of therapy of 909 patients mentioned above the trained ANN gives an accurate information concerning this patient. It is presented in the form of protocol of prognosis of ulcer clinical course, the probability of complication development, the results of conservative and surgical treatment. The protocol includes the conclusion with recommendations on the choice of therapeutic tactics.

[Reconstructive and plastic microsurgery in the treatment of combat trauma to the extremities]. / Rekonstruktivnaia i plasticheskaia mikrokhirurgiia v lechenii boevoi travmy konechnostei.

In the department of microsurgery of A.A. Vishnevsky Central Hospital the transplantation and transposition of the at the gunshot injuries of the extremities have begun to execute since 1990. For this time 94 surgical interventions have been conducted at 88 wounded: 57 transplantations and 37 transpositions of the bloody tissues. The transplantation and transposition of the vascularized complexes of tissues with application of microsurgical technique is the effective method of the treatment of the wounded in the extremities. In the conditions of the local armed conflicts it is necessary to provide deployment of the department of microsurgery at stages of the specialized medical care.