[Applying of the multifaceted approach to the treatment of patients with a phlegmon of hand].

Presented the experience of treatment of 189 patients with a phlegmon of hand. Conducted multifactorial analysis of the importance and influence on the outcome of disease and prognosis of each of the indicators used to determine the severity of the pathological process. Proved that individual determination of the severity and prognosis of the disease allows correcting choice of treatment methods, to evaluate the probability of complications development and to determine timing and amount of outpatient rehabilitation. Complex of clinical and laboratory methods and ray studies allowed to differentiate medical tactics depending on the location, extent and severity of the pathological process. Diferentiated approach allowed to optimize the schemes and determine indications for immunomodulators, systemic enzyme therapy, and indirect lymphotropic therapy. In 70,9% of cases good resonse to the treatment in patients'with a phlegmon of hand was obtained, in 22,7% satisfactory response to the treatment and only in 6,3% of cases response to the treatment was unsatisfactory (including deep and combined phlegmons). Obtained results allow to recommend developed treatment and diagnostic algorithm for using in clinical practice.

[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.

[Medical care for the burnt in modern local military conflicts]. / O meditsinskoi pomoshchi obozhzhennym v sovremennykh lokal'nykh voennykh konfliktakh.

The article is devoted to the experience of treatment of the servicemen who burned during the hostilities in Afghanistan (1979-1989), Tadjikistan (1992-1994) and in Republic of Chechnya (1994-2996). Medical care rendered in 18,921 cases of burns and combined trauma (the burn prevailed) is analyzed: 1201--in Afghanistan, 205--in Tadjikistan and 415--in Republic of Chechnya. In the structure of sanitary losses of surgical character the burned persons constituted 2.5% in Afghanistan, 7.0%--in Tadjikistan and 3.9%--in Republic of Chechnya. The most effective was the medical-evacuation system in Afghanistan. The optimal medical-evacuation system during the local armed conflicts and wars is the evacuation consisted of two stages: first medical aid--specialized medical care.

[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 immediate and late results of a gastropancreatoduodenal resection]. / Neposredstvennye i otdalennye rezul'taty gastropankreatoduodenal'noi rezektsii.

The results of gastropancreatoduodenal resection (GPDR) in 111 patients have been analysed. It is indicated that GPDR application in the presence of recommendation and technical possibility of performing in oncological patients is reasonable. This operation should be carried out in specialized institutions, where early diagnosis and exact identification of biliopancreatoduodenal zone injury character are possible, as well as qualitative preoperative preparation and intensive therapy during the operation and in early postoperative period.

[The surgical treatment of stomach ulcer in young patients]. / Khirurgicheskoe lechenie iazvy zheludka u bol'nykh molodogo vozrasta.

Clinical observations of 247 patients with ulcer disease of the stomach younger than 30 years of age were analyzed. Ulcers of the body and the proximal part of the stomach were diagnosed in 39 patients, associated gastroduodenal ulcers--in 37 patients, pyloric and propyloric ulcers in 171 patients. Conservative treatment was effective almost in 2/3 of the patients. Surgical treatment included resection of the stomach and vagotomy with draining operations. Vagotomy used in gastric ulcer can be considered valid in patients of young age.

[Evaluation of the results of gastropancreatoduodenal resection in oncological patients]. / Otsenka rezul'tatov gastropankreatoduodenal'noi rezektsii u onkologicheskikh bol'nykh.

The results of gastropancreatoduodenal resection (GTDR) carried out in 111 patients were evaluated. Application of said procedure was shown to be justified in cancer patients, if indications and necessary logistics are provided. The procedure should be carried out in special facilities enabling early diagnosis, adequate identification of lesions in biliopancreatoduodenal area, effective preparation and intensive care before and shortly after operation. The operating surgeon should be capable of doing reconstructive surgery at all stages of the procedure taking due account of the peculiarities of each individual case.