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The data obtained in experiments on shoal using plastic charges of 100-50-25 g of equivalent power of antipersonnel mines showed that injuring action on shoal was four times greater than that on land and resulted in considerably graver skeletal traumas and distant injuries. Of special significance in pathogenesis of mine-explosive wounds on shoal is pneumonia followed by arterial air embolism and encephalopathy. Although the undermining on land and on shoal have many common etiopathogenetic features, there are substantial differences first of all due to different mechanisms of their appearance. It must be taken into account while performing evacuatory, diagnostic and medical measures in such patients.

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The paper presents data on clinico-microbiological investigation of gunshot and firemine wounds in 27 injured during the Afghan war at the stage of their qualified surgical treatment 2-5 days after the injury. The quantitative and qualitative compositions of Clostridium that caused the infection and their susceptibility to 20 antimicrobials were determined. It was shown that the main pathogen of the anaerobic infection at the prehospital stage was Clostridium perfringens as a monoculture or association with aerobic and obligate anaerobic microbes. For rational antimicrobial therapy of gas gangrene it was advisable to preliminarily have antibioticograms of the isolates from the wounds. In the empirical therapy it was preferable to use penicillins (benzylpenicillin, ampicillin and others), rifampicin, metronidazole or ceftriaxone. The results are useful for substantiation of schemes for rational antimicrobial prophylaxis of wound infectious complications in injured in war time.

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The clinico-microbiological research of gunshot and mine-explosive injuries in wounded servicemen of Afghanistan army, arriving on stage of the qualified surgical care for 2-5 days after wound is lead. The quantitative and qualitative structure of wound microflora at modern combat trauma on a prehospital stage is determined. It was established, that main kinds of wound infectious complications in injuries are suppuration of wounds and clostridial infection. The advantages and the lacks of benzyl penicillin for prophylaxis of wound infection are investigated.

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Clinical signs of postoperative complications were studied in 642 patients with abdominal wounds, including 102 (15.9%) cases with relaparotomy features. The article makes a comparison between the frequency of various complications on the one hand, and the character of internal lesions, size of the first surgical intervention and the time of the secondary surgical care on the other hand. The authors determine the basic trends of complex intensive therapy taking into account metabolic disorders in patients with gunshot abdominal injuries.

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A profound analysis of 32 cases of general purulent infection that led to aggravation of multiple gunshot injuries proves the pathogenetical connection between the character of trauma, health status of patient and possibility for sepsis development. The main factors which determine the appearance and the course of wound sepsis are the following: the character of reaction of the organism to trauma, volume of invaded tissues, adequacy of health care, type and virulence of agents of the infection. The state of vital systems of human organism as well as the possibilities of medical care play an important role in the sepsis development in the acute period of wound illness. The major part of repeated interventions was conditioned by defects of the first surgical management. The opportune diagnosis on an early phase of sepsis, i.e. toxemia, is of great importance for the determining of tactics for the treatment and for complex intensive therapy in which hyperbaric oxygenation will assume a key role.

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Hyperbaric oxygenation was used in the combined post-operative treatment of 63 victims with distal segments of lower extremities torn off or damaged by mine and burst effect. The patients consecutively received medicamentous therapy, which improved tissue microcirculation (rheopolyglucinum, haemodesum), surgical intervention, course of hyperbaric oxygenation, and after it anticoagulant preparations (heparinum) were used. The article shows that the combined application of hyperbaric oxygenation and medicinal preparation, that improve microcirculation in traumatized tissues, has a pathogenetic approvement.

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