Objective: a comparative analysis of the pharmacological effects of proserin during a drug test with low-frequency direct muscle stimulation by the method of stimulated impedance myography while controlling the effect of thimectomy.

Materials and methods. Patients suffered myasthenia gravis, which had thymoma, were investigated before and after thymectomy by means stimulative impedance myography method. Neostigmine test and low frequency 1.0 Hz direct needle muscle stimulation during 3 minutes were used. Amplitude of direct and transsynaptical evoked contractive reactions were measured in parallel researches.

Results. Results of researches of control group showed normal amplitude dispersion; meanwhile patients after neostigmine injection had right-side asymmetric dispersion and intermittent contractility. The amplitude transsynaptical contraction before thymectomy rose up on 14.0 %, meanwhile after operation – 29.0 %.

Conclusion. Probably neostigmine fell down threshold level of motor nerve terminals and made proposal to their excitationи by big impulses surrounded muscle fibers and impulses of stimulator.

One of the urgent problems of modern surgery continues to be the increasing number of patients with purulent-inflammatory and purulentnecrotic processes of soft tissues – about 60.0 % of patients in the structure of specialized hospitals of a surgical profile. This is due to the adaptation of microorganisms – pathogens of wound infection to existing means for treating wounds. In addition, the number of patients with diabetes mellitus increases annually, and as a result, the number of people suffering from diabetic foot syndrome. Thus, the relevance of developing new modern tools for the local treatment of purulent-necrotic processes of the skin and soft tissues is not reduced.

Materials and methods. The material for the study was a highly porous biodegradable sponge (chitosan-collagen) in the ratio of chitosan: collagen 2: 1 with the inclusion of colloidal particles of metallic silver and chymotrypsin. The experiment was performed on 50 Wistar rats that simulated a purulent necrotic wound. During the treatment, the state of the wounds was visually evaluated, the morphological features of the course of the wound process were evaluated after animals were withdrawn from the experiment and the wound material was taken on days 1, 5, 10, 15 and 21, the sections were stained with hematoxylin-eosin and/or according to Van Gieson.

Results. By visual assessment, by the 10th day it was noted that necrotic tissues underwent lysis, the wound defect was covered with a scab, swelling of the surrounding tissues was not noted, and on the 21st day of treatment the wound defect was covered with epithelium and had an area of about 3 mm2 with the initial - in 250 mm2. When describing micropreparations, it was noted that on the 10th day the exudation phase passed its peak and the activity of proliferation processes increased from the center of the wound to its periphery and from the granulation surface in depth. On the 15th day, the proliferative phase of inflammation was at its height, and on the 21st day, the proliferation phase was completed and the processes of remodeling of dense fibrous connective tissue began.

Conclusion. Based on a visual assessment of the state of wounds and a morphological study, the effectiveness of a chitosan-collagen complex with silver nanoparticles and chymotrypsin was shown to be applied locally to a purulent necrotic wound in an experiment.

The article presents a clinical case of the successful treatment of a patient with traumatic separation of the upper limb and massive damage to the soft tissues of the upper shoulder and chest. The effectiveness of applying the damage control principles and the method of local negative pressure for the prevention of local and systemic infectious complications is emphasized.

The article presents the experience of complex surgical treatment in patient with necrotizing fasciitis of the lower extremity. The features of the clinical picture and the course of the disease are given.