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%.
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.
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.
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