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Objective: To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN)., Material and Methods: Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3-4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score - 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI)., Results: Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group ( p <0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months ( p <0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group ( p <0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain., Conclusion: Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.

Gunshot head injuries make up 35% of all injuries. Brain injuries are diagnosed in 42.2% of cases, maxillofacial region - 35.7%, eye - 13.9%, outer and inner ear - 3.2%. These damages account 14.8%, 12.5%, 4.9% and 2.9% of the total number of injuries, respectively. In our opinion, primary surgical treatment of gunshot wounds should be carried out in a strict system of multiple-stage surgical management in accordance with the principles of treating wounds from high-speed weapons.

Objective: To demonstrate the approaches' implementation of specialized multidisciplinary and high-tech medical care in multistage complex treatment of patient with multiple trauma including combined severe trauma of the maxillofacial region such as minimally invasive surgical tactics with early and delayed osteosynthesis (e.g. selection of optimal surgical tactics within the periodization of traumatic disease concept). Moreover, the implementation of rational advanced intensive pathogenesis drug therapy with the prevention of infectious complications in cast of severe injuries., Material and Methods: The tactics, approaches and results of multistage complex specialized treatment of patient K. , 56 years old who has got severe concomitant injuries to various areas of the body and extremities (including multiple maxillofacial trauma) after falling from a height are presented., Conclusion: Rational surgical tactics and the timely initiation (immediately after admission of the victim to 1 st level trauma center) of pathogenesis intensive therapy with modern drugs and antibiotics contributed to the exclusion of infectious complications in the third period (the period of maximum likelihood of complications) of traumatic illness. Comprehensive treatment of a victim with multiple trauma based on the principles of specialized, multidisciplinary and high-tech medical care is able to provide a favorable clinical outcome - the recovery with the restoration of the damaged anatomical structures functionality and the absence of cosmetic defects.

Aim: To analyze efficiency of ozone therapy, ultrasound and cryotherapy for infected and purulent wounds due to chronic venous insufficiency., Material and Methods: There were 127 patients with chronic venous insufficiency followed by chronic wounds. Efficacy of systemic and local ozone therapy was assessed. De Sole method was used to analyze chemiluminescent and spontaneous activity of neutrophils of peripheral blood., Results: Advanced generation of active forms of oxygen was revealed in patients with chronic wounds and chronic venous insufficiency. Complex ozone therapy including intravenous administration of ozonized autologous blood, oxygen-ozone and ultrasonic exposure of the wound and cryogenic stimulation reduce painful period up to 3.1±0.6 days, accelerate epithelialization of the wound and normalize release of active forms of oxygen.

Chronic pancreatitis complicated by pancreatic duct stones and pancreatic hypertension, post-necrotic cysts and fistulas requires surgical treatment. There are various procedures from minimally invasive to advanced pancreatectomy. Endoscopic interventions and radical open surgery allow to achieve good results. Successful complex treatment of patient with chronic pancreatitis is presented in this report.