Search

On the basis of experimental data were studied peculiarities of ballistic of wounds after passing barriers. Authors analyzed forensic medical examination reports concerned about murdered and wounded with gunshots in Saint Petersburg. As research objects were used: simulators of biological materials (block of glycerin soap) and experimental animals. The following bullets were used: automat cartridge 7H22, 7H24 - gauge 5,45x39 mm, pistol cartridge 7H29 - gauge 9,0x21 mm; gun reach - 50 and 100 meters; barriers - steel plates, glass, brickwork. The following assessment of exposure was used: in simulators - according to volumes of temporary cavity; in experimental animals - according to results of morphofunctional researches. Data about damaging action of pistol cartridge 7H22, 7H24 with gauge 5,45 mm and automat cartridges 7H29 and 9,0 mm is received.

Acute surgical diseases were and remain one of the most important problems of the organization of medical care and treatment of patients in the conditions of long distant sea voyage, when there is no possibility for medical evacuation. We analyzed the positive experience of surgical care in the sea, gained by Soviet and then and by Russian Navy physicians. As we haven't registered significant changes in morbidity of Navy crewmembers, we think that studying and creative application of this experience will have the positive effect.

In the period from 2011 till 2012 the Otcreotide-depot was used by the authors in treatment of 34 patients. The patients were divided into two groups: the first group--the prevention of development and the second group--the treatment of external pancreatic fistulas. Ocreotide-depot was applied in 17 patient of the first group: as part of the complex therapy of severe pancreatitis in 4 patients and after pacreaticoduodenectomy in 13 patients. Ocreotide-depot was used in 17 patients of the second group: 7 cases of patients after different types of pancreatic resections and after external drainage of pancreatic cysts in 10 patients. The positive effect of using the drug was obtained in 30 patients (88.25%): the cases of preventive application of drug in 17 patients and during the treatment of external pancreatic fistulas in 13 patients. The preventive and therapeutic usage of Ocreotide-depot facilitated an uncomplicated postoperative period in 13 cases and the healing of the external pancreatic fistulas in terms from 5 till 7 days in 13 patients. The application of Ocreotide-depot could be recommended as a preventive measure against the incompetence of pancreaticojejunoanastomosis after pancreaticoduodenectomy in complex therapy of severe pancreatitis and also in treatment of external pancreatic fistulas after pancreaticoduodenectomy and percutaneous drainage of postnecrotic pseudocysts.

The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies.

Two groups of patients in whom two-stage treatment of cholecystocholedocholithiasis was performed with different succession of using endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy (LCE) were compared. In 59 patients (1st group) EPST was used as the first stage, in 67 patients (2nd group) LCE and drainage of choledochus preceded the endoscopic intervention. The effectiveness of EPST was 93.3 and 95.5% correspondingly in the first and second groups. There were no considerable differences in the frequency of complications, period of treatment at the hospital in the two groups. Lythextraction was obtained considerably more often at the first attempt in the second group of patients (79.1% versus 59.9%, p0.05). Due to inefficiency of EPST in three cases in the second group of patients reoperations were required. Thus, EPST should be performed before LCE for the rationally planned further treatment in case of its inefficiency.

In order to improve radicalism of emergency surgical interventions an appropriate method of total mesocolonectomy and D3-lymph node dissection in the medial-lateral direction and the principle of "no-touch technique" were used in 14 patients. This technique is safe, effective, does not prolong the duration of operation and postoperative period, is not followed by increased number of complications and lethality.

The authors have analyzed experience with treatment of pain syndrome in 45 patients, in 31 of them thoracoscopic sympathsplanchnectomy was fulfilled. The operation was shown to give a pronounced analgetic effect and improved quality of life of patients.

For the period from 2000 through 2007 there were 27 patients treated for lesions of extrahepatic bile ducts of different genesis. Since all the lesions were high, we have formed biliodigestive anastomoses on the exchangeable transhepatic drains by the method of Groetz-Saypol-Kurian. In a month after the operation and a standard management of the exchangeable transhepatic drains we departed from the classical technique and applied nonperforated drains. Using the nonperforated exchangeable transhepatic drains in patients after reconstructive operations on the extrahepatioc bile ducts gave good immediate results of operations and substantially improved quality of life of the patients in the postoperative period.