Vol 339, No 4 (2018)


Medical and statistical characteristics of the incidence of military personnel under the contract of the Armed Forces the Russian Federation (2007-2016).

Sivashchenko P.P., Evdokimov V.I., Grigorev S.G., Ivanov V.V., Fefelov D.I.


The incidence of military servicemen under contract in the rank of rank-and-file sergeant for 10 years (2007-2016) was studied by analyzing 60% of the annual reports on the health status of personnel and medical service activities in the form 3/MED military of randomly selected units. The average annual incidence rate was 982±33‰, the primary level was 483±13, the need for dispensary observation was 72±5, the total hospitalization was 239±8, the days of work loss were 3913±115, the dismissal for health reasons was 4.1±0.5‰, mortality - 102.7±8.1 per 100 thousand military personnel under the contract. An increase in the rates of general and primary morbidity and a decrease in the rest have been established. Compared to officers, the contracted servicemen had significantly lower levels of overall morbidity, need for dispensary dynamic follow-up, labor losses and layoffs, higher hospitalizations, almost identical - primary morbidity and mortality. The pathology XIX (trauma, poisoning and some other consequences of external causes), X (diseases of the respiratory system), IX (diseases of the circulatory system), XIII (diseases of the musculoskeletal system and connective tissue), XI (diseases of the digestive system), XII (diseases of the skin and subcutaneous tissue) and V (mental and behavioral disorders) classes. Prevention of diseases and injuries of these classes will help preserve and strengthen the health of contract servicemen - privates and sergeants.
Voenno-medicinskij žurnal. 2018;339(4):4-11
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Acute poisoning with carbon monoxide.

Basharin V.A., Khalimov Y.S., Tolkach P.G., Kuzmich V.G.


The article presents modern data on the problem of acute carbon monoxide poisoning. The main attention is paid to the order of rendering first and medical assistance to victims of intoxication in the Armed Forces. The characteristics of the main clinical manifestations of poisoning, allowing assessing the degree of its severity, are given; express methods for determining the content of carboxyhemoglobin in the blood are given. Modern ways of searching for means of etiotropic therapy of carbon monoxide poisoning are considered. It is shown that in addition to the development of hemic hypoxia due to the formation of carboxyhemoglobin, intoxication leads to indirect damage to various body structures. It is assumed that the implementation of pathogenetic therapy aimed at correcting the mediated mechanisms of toxic effects of carbon monoxide will be effective in preventing these disorders and improving the quality of life of the victims.
Voenno-medicinskij žurnal. 2018;339(4):12-18
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Voenno-medicinskij žurnal. 2018;339(4):18-18
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To the treatment of peritonitis caused by the pathology of the upper parts of the urinary system.

Musailov V.A., Krainyukov P.E., Esipov A.V., Lazarev A.B.


Based on the analysis of the materials of the case histories and clinical observations of 385 patients with peritonitis caused by injuries and injuries of the upper urinary tract, it was established that the use of lymphotropic antibiotic therapy and abdominal treatment with nitrogen monoxide (NO) significantly improved the results of treatment of this pathology. There is a decrease in the length of stay of the patient on the bed, a decrease in the number of relaparotomies and mortality. Determination of the concentration of amikacin during its lymphotropic administration against the background of therapy with nitrogen monoxide showed significant advantages over intravenous administration. The study of cellular and humoral immunity revealed rapid normalization of indicators already by the 7th day. At the same time, an increase in production of nitrogen monoxide in peripheral blood monocytes was observed 3 times, and in macrophages of peritoneal fluid - 4-fold. Clinical and economic analysis revealed that the use of NO- and lymphotropic therapy is 1.3 times more effective and more economical than using a «classical» treatment regimen.
Voenno-medicinskij žurnal. 2018;339(4):19-24
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Optimization of the results of treatment of infectious complications of the sternotoma wound in cardiosurgical patients.

Kokhan E.P., Dolgikh R.N., Asanov O.N., Potapov V.A., Melnikova Y.K.


The article is devoted to infectious complications of the sternotoma wound in cardiosurgical patients. The study included 52 patients with infectious complications of the sternotoma wound after open cardiac surgery. The risk factors for the development of postoperative mediastinitis are severe heart failure of NYHA class III-IV (in 52% of patients), chronic obstructive pulmonary disease (40.4%), diabetes mellitus (32.7%), duration of surgery and artificial circulation, formed instability of the sternum (in 45.8%). The main causative agents of the infectious process were coagulase-negative and golden staphylococci (including methicillin-resistant strains). The treatment of superficial and deep (with mediastinitis) sternal wounds varied from prolonged antibiotic therapy with surgical treatment of the wound to resections of the destructive sites of the sternum, costal arches with gradual application of vacuum assisted bandages and plastic reconstructive interventions. In a prospective group of 12 patients with postoperative mediastinitis of types III-V, there was a decrease in the relapse rate from 27.3 to 16.7% compared with the retrospective treatment indices of patients without using the method of vacuum-drainage of wounds.
Voenno-medicinskij žurnal. 2018;339(4):24-29
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Tuberculosis of the nervous system: features of diagnosis and treatment

Polunina G.I., Levchenko A.E.


Diseases of servicemen with tuberculosis of the nervous system have been rare in recent decades: since 1980, 151 patients with this diagnosis have been treated at the hospital. However, it is impossible to exclude the possibility of new cases of the disease, therefore doctors of military units and military medical organizations need to have a proper amount of knowledge about this complex and extremely life-threatening pathology. One of its most serious forms is tuberculosis of meninges. With the increase in the drug resistance of mycobacteria tuberculosis, tuberculosis meningitis again becomes a hard-to-treat disease with a severe prognosis. When patients enter the military medical organization with signs of the central nervous system disease, they should be examined for the tuberculosis process. The article presents data on clinical forms, symptoms, modern methods of diagnosis of tuberculosis of the nervous system and treatment of patients.
Voenno-medicinskij žurnal. 2018;339(4):30-35
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Voenno-medicinskij žurnal. 2018;339(4):35-35
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Experience in the use of interferon inducers in the complex therapy of adenoviral diseases

Lvov N.I., Maltsev O.V., Zhdanov K.V.


Adenoviral diseases account for a significant share in the overall structure of SARS in the military, especially in the non-epidemic for the influenza period. Taking into account the peculiarities of the clinical course of adenovirus infection, in addition to arresting manifestations of the climax period, the task of antiviral therapy is suppression of the adenovirus persistence and, accordingly, a decrease in the incidence of late pneumonia, protracted and recurrent course. A retrospective analysis of the experience of using interferon inducers and interferons in the treatment of adenoviral diseases in young people revealed that these drugs not significantly reduced the incidence of pneumonia, protracted and recurrent course compared with the baseline (pathogenetic) therapy.
Voenno-medicinskij žurnal. 2018;339(4):36-41
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Voenno-medicinskij žurnal. 2018;339(4):41-41
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Water-electrolyte metabolism and excretory system functions in divers: new approaches to determination of dysbarism resistance.

Zverev D.P., Myasnikov A.A., Shitov A.Y., Andrusenko A.N., Chernov V.I., Klenkov I.R.


44 divers were examined under hyperbaric conditions at the age of 19-23 years to study the resistance to decompression sickness. With the use of original loading oral samples, violations of water-electrolyte metabolism and kidney functions were investigated. The relationship between the state of the excretory system and the body’s resistance to decompression sickness has been revealed: the activity of the kidneys determines the level of decompression gas generation. Divers with medium and low resistance to decompression sickness, renal activity indexes are lower than those of divers who had high resistance to this pathology. It was concluded that when selecting divers for resistance to decompression sickness, it is necessary to take into account the indicators of kidney functions obtained during oral loading tests. A formula is proposed that includes these indicators and allows supplementing the existing technique for determining the stability of divers for decompression sickness.
Voenno-medicinskij žurnal. 2018;339(4):42-48
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Implementation of modern approaches to testing organic equipment of the medical service of the Armed Forces

Miroshnichenko Y.V., Yakovlev S.V., Kononov V.N., Soldatov E.A., Dolgushin E.A., Popov A.A., Rodionov E.O.


The article presents the characteristics of modern organic equipment supplied according to the state defence order for equipment of military units and military medical institutions of the Armed Forces of the Russian Federation in mobile medical complexes on the basis of pneumo-framed constructions. Revealed the procedure for operational tests of medical equipment kits, medical kits and presented its results. Promising ways of improvement of the organic equipment and medical complexes on the basis of pneumo-framed constructions are given.
Voenno-medicinskij žurnal. 2018;339(4):49-54
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Minimally invasive surgical intervention in case of a gunshot blind penetrating injury of the lumbar spine: a case from practice.

Kravtsov M.N., Landik S.A., Dubinin A.A., Orlov V.P., Gaidar B.V., Svistov D.V.


Gunshot wounds of the spine account for 10-21% of all spinal and cerebro-spinal injuries of civil and military time. Most gunshot penetrating wounds do not impair the stability of the spine, and in some cases are not accompanied by damage to the bone structure and do not require stabilizing aids. The article discusses the possibility and discusses the expediency of using minimally invasive surgical methods for gunshot wounds of the spine, in particular percutaneous video endoscopy, on the example of its successful implementation in a 24-year-old man who received a gunshot blind penetrating wound in the lumbar spine.
Voenno-medicinskij žurnal. 2018;339(4):56-57
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Radiological methods of investigation in the diagnosis of damage to soft tissue structures of the shoulder joint in conditions.

Fink L.I., Popov A.P.


The results of a complex clinical, ultrasound, magnetic resonance, X-ray and arthroscopic examination of 350 patients with various types of traumatic and inflammatory changes in the structures of the shoulder joint are presented. The diagnostic characteristics of ultrasound and magnetic resonance imaging have been studied in the visualization of lesions of soft tissue structures. It is shown that the most effective in diagnosing traumatic injuries of soft tissue structures of the shoulder joint and brachial plexus is the integrated use of ultrasound and magnetic resonance imaging. Ultrasound is the method of primary screening, which is recommended at the initial stage of a patient’s examination simultaneously with an X-ray study. Magnetic resonance imaging is an additional, more precise method for traumatic injuries and pain syndrome of the shoulder joint, which is recommended in the second stage after ultrasound and radiography to clarify the condition of bone and soft tissue structures, the nature and extent of damage to the shoulder joint.
Voenno-medicinskij žurnal. 2018;339(4):57-60
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Experience in the use of inhibitors of angiogenesis in a naval hospital.

Murynin V.A., Glukhovskoi V.V., Kondratskii D.I.


The experience of the use of inhibitors of ranibizumab angiogenesis and aflibercept in the treatment of 81 patients with exudative form of age-related macular degeneration is presented. Both drugs have proved to be convenient, high-quality and safe means. In some patients, after cessation of therapy with angiogenesis inhibitors, choroidal neovascularization recurs and disease progresses. Therefore, patients receiving treatment are strongly encouraged to conduct regular medical examinations and regular check-ups from an ophthalmologist.
Voenno-medicinskij žurnal. 2018;339(4):60-61
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Clinical case of acute invasive pulmonary aspergillosis.

Zagalaev B.T., Filonova L.A., Zolotarev A.V.


Clinical, radiological and laboratory aspects of acute invasive pulmonary aspergillosis have been analyzed. The clinical example shows that, without treatment, this disease ends in a lethal outcome within 1-4 weeks after its onset. Mortality in acute invasive pulmonary aspergillosis depends on the «background» pathology, as well as the prevalence or localization of the disease (dissemination, lesion of the central nervous system). Prognostically unfavorable are the use of high doses of glucocorticoids before the detection of invasive aspergillosis, as well as the preservation of immunosuppression and neutropenia after initiation of treatment.
Voenno-medicinskij žurnal. 2018;339(4):62-64
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Experience of medical rehabilitation of children with impaired function of the nervous system and musculoskeletal system in the Central Military Children’s Sanatorium.

Antonov P.F., Sitnikov O.V., Buchko L.A., Borisenko A.M., Tkacheva E.N.


The results of the complex medical rehabilitation in combination with alpha-training using biofeedback for studying the degree of treatment effectiveness of 60 children of primary school age with attention deficient hyperactivity disorder are presented. Restorative treatment was conducted with the use of alpha training in conjunction with standard spa factors.
Voenno-medicinskij žurnal. 2018;339(4):64-66
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Use of magnetic resonance cholangiopancreatography for diagnosis, choice of surgical treatment tactics for patients with Mirizzi’s syndrome.

Sorokin V.G., Berezin A.I., Ilenko G.A., Bystrov D.S., Nasykhov R.N., Shelepova V.V.


Recognize in the pre-operative period, Mirizzi’s syndrome is quite difficult. Using the whole complex of modern diagnostic methods allows you to establish the correct diagnosis before surgery in 12.5-21.9% of patients. The main diagnostic method remains retrograde cholangiopancreatography. However, carrying out this invasive examination is accompanied by complications - pancreatitis, bleeding, perforation of the duodenum. Improvement of the diagnosis of dangerous pathological changes in the bile ducts is possible by using magnetic resonance cholangiopancreatography, which allows increasing the frequency of preoperative diagnosis of Mirizzi’s syndrome, reducing the number of complications with the use of invasive diagnostic methods and predicting options for surgical treatment of this pathology.
Voenno-medicinskij žurnal. 2018;339(4):66-68
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From the history of military medical examination in Russia

Churilov Y.K., Chaplyuk A.L., Brovkin S.G., Vovkodav V.S.


The article presents extensive material on the history of the formation and development of military medical examination in Russia. The role of domestic scientists in the scientific and practical substantiation of the need and tasks of medical examination of draftees and military servicemen in the army, the definition of eligibility criteria for military service, and the preservation of the health of servicemen are discussed in detail. The role of the organizers in the formation and development of the medical-flight examination bodies was noted. Particular attention is paid to the role of military medical examination in the years of the Great Patriotic War (1941-1945), the specifics of the work on the selection and examination of the conscription and military personnel, the monitoring of medical and diagnostic activities of military hospitals, the correctness of the establishment of fitness for military service after wounds. Contains extensive material on the organization of military medical examination in the postwar years, the improvement of its forms and methodological foundations at the present stage of the development of the Armed Forces.
Voenno-medicinskij žurnal. 2018;339(4):69-77
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Features of the system of medical equipment supply for troops at the beginning of the Great Patriotic War and during the Moscow battle

Voronkov O.V.


The article outlines the results of the implementation of the plans for the mobilization deployment of the forces and facilities of the medical service at the beginning of the Great Patriotic War in the border districts and on the Western Front. The reasons for the great need for medical equipment for troops and medical institutions are shown. The measures taken to streamline the supply of medical equipment, as well as arrangements for the organization of medical supplies during the Moscow battle are analyzed. Reflected the participation in this battle of the medical service of the Moscow Military District. In general, the availability of medical equipment was assessed as satisfactory. The troops and medical institutions did not experience serious difficulties in it, although there were cases of inadequate volumes in certain periods and in certain areas of the troops’ actions.
Voenno-medicinskij žurnal. 2018;339(4):77-84
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The Kirov Institute of Epidemiology and Microbiology during the Great Patriotic War of 1941-1945

Svintsova M.N.


The article deals with the activity of the Kirov Institute of Epidemiology and Microbiology during the Great Patriotic War. The Institute was engaged in the production of bacteriological preparations for medical and preventive purposes for the front and rear on a nationwide scale, and also conducted research, organizational, methodological and practical work, actively cooperated with local health authorities and made a significant contribution to the restoration and preservation of the health of the wounded and sick soldiers of the Red Army, the Navy, the peaceful population of the Kirov region and the entire Soviet Union. The activity of the Institute in the scientific literature is practically not covered.
Voenno-medicinskij žurnal. 2018;339(4):85-90
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To the history of the branch of the Main center for the military-medical examination of the Ministry of Defense in St. Petersburg.

Petrova O.N., Krylov V.B., Trofimov A.A.


The article presents a brief history of the department (military medical examination) of branch No. 1 of the Main center for military-medical examination of the Ministry of Defense of the Russian Federation in St. Petersburg from the 1920s, when a military medical commission of the Petrograd Military District of the Red Army was established. The formation and the main periods of development of the department are highlighted. It is told about long-term professional work of the department’s employees in the performance of professional tasks facing military medical examination.
Voenno-medicinskij žurnal. 2018;339(4):91-93
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Voenno-medicinskij žurnal. 2018;339(4):93-93
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Conference on topical issues of the naval medicine dedicated to the 300th anniversary of the Kronstadt Naval Hospital.

Roskostov M.V.


In June 2017 in Kronstadt was held a scientific and practical conference dedicated to the 300th anniversary of the Kronstadt naval hospital «Actual issues of military and naval medicine». In addition to the plenary sessions, sectional sessions were held on the specialties «Organization of Public Health and Public Health», «Surgery» and «Therapy». During the conference there were information and agitation actions «Learn from the military doctor the methods of providing first aid» and «Go to the clinic for prophylactic medical examination».
Voenno-medicinskij žurnal. 2018;339(4):94-96
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