卷 338, 编号 5 (2017)

The article deals with actual problems of military medical examination and dispensary dynamic monitoring of military personnel with chronic viral hepatitis. The state of implementation of the requirements of the governing documents regulating the corresponding division of the medical service of the Armed Forces of the Russian Federation and work of the non-standard Center of the Ministry of Defense of the Russian Federation for the treatment of chronic viral hepatitis at the S.M.Kirov Military Medical Academy named have been highlighted. Based on the results of the analysis, a number of shortcomings in the organization of dispensary dynamic observation and military medical examination in the system of medical care for servicemen with chronic viral hepatitis have been revealed, and possible ways of their elimination have been proposed.

For the medical service of the Armed Forces of the Russian Federation, the urgency of the problem of arterial hypertension (AH) is caused by a significant increase in its frequency among military personnel, which from 1999 to 2013 was 41%. According to the department of arterial hypertension FGKU «GVKG n.a. N.N.Burdenko» hypertensive disease was diagnosed in 69-78% of patients, secondary hypertension - in 22-31%. In the article, special attention in the light of the differential diagnosis of secondary AH is given to the problems of resistant hypertension and so on. Incident. According to the authors of the resistance, AH occurs in 14% of patients with hypertension, and the frequency of incidence of the incident reaches 23% in the group of people in high blood pressure. Taking into account the given literature, and also on the basis of own experience the modified algorithms of differential diagnostics of secondary hypertension are offered. A reasonable amount of differential diagnostic activities at the stages of medical care will allow us to clarify the genesis of AH with minimum costs, recommend the optimal drug therapy aimed at manometric not only lowering of blood pressure, but also contributing to organoprotection and reduction of cardiovascular risk.

Today CT-coronary angiography is a minimally invasive method, alternative to invasive coronary angiography, for coronary arteries permeability evaluation. This method allows defining a majority of myocardial ischemia causes, including variants and coronary arteries abnormal development, visualizing myocardial structural changes, receiving data on contraction function of the heart, and on possible causes of myocardial ischemia in case of the absence of coronary artery disease (atherosclerosis). CT-coronary angiography is the only minimally invasive method for quantitative evaluation of the coronary arteries lumen, which may replace invasive coronary angiography. But quantitative evaluation of lesion as the only method doesn’t allow defining its hemodynamic relevance. For the appropriate tactics of treatment and planning of heart revascularization CT-coronary angiography should be accompanied by methods, which approve hemodynamic relevance of lesions or myocardial ischemia.

At present, there is a sufficient amount of data on the effect of thyroid hormones on the cardiovascular system. Of particular interest are the structural and functional changes in the myocardium in manifest and subclinical thyrotoxicosis. At the same time, if the effect of manifest thyrotoxicosis on the cardiovascular system is known for a long time, the nature of changes in the geometry of the heart in subclinical thyrotoxicosis has not been adequately studied now.

The article highlights the work of civilian health authorities in cooperation with the military medical service on the territories of the USSR liberated from the Nazi invaders during the Great Patriotic War.

Authors performed a comparative efficacy analysis of pregabalin and amitriptyline as prescribed medications for 56 patients with different forms of postherpetic neuralgia. Patients were divided into two groups. The first (main) group consisted of 14 patients, whom was prescribed pregabalin at a dose of 150 mg/day and 14 patients, which took pregabalin at a dose of 300 mg/day. The second (control) group consisted of 14 patients, which were treated with amitriptyline at a dose of to 25 mg/day and 14 patients - at a dose of to 50 mg/day. Time of pain intensity reduction was determined according to VAS scale. It is determined that pregabalin is an effective mean for postherpetic neuralgia treatment. Its effectivennes grows parallel to dosage increase and treatment duration and almost comply to amitriptyline effectiveness.

127 patients with traumatic injuries of the cervical spine before and after surgery were examined. Studies were performed with the help of different computer topographies. Preoperative morphometric parameters, the nature of the fracture of spinal bones, the magnitude and direction of the displacement of bone fragments, the presence of instability of the cervical spine were determined. In the postoperative period study was conducted during the first day after surgery, and then monthly for 3-4 months for the control specified in the design. Performing CT immediately after surgery to assess the quality corporodesis made, and for the next 3-4 months - signs of consolidation of bone changes and timely rehabilitation.

Based on the survey 156 patients with chronic gastritis, gastritis estimated frequency, associated with Helicobacter pylori and the effectiveness of standard triple eradication scheme, which amounted to 85% (in the military at the age of 18-20 years - 94,4%).

The biography of the chief military sanitary inspector of the Russian Army Alexander Yakovlevich Evdokimov, 15(27).08.1854 - 08(21).05.1917, who headed the Chief Military Sanitary Directorate in 1906-1917 is presented for the first time. The reforms of military medicine, which А.Ya.Yevdokimov tried to put into practice, are considered. A number of new facts cited in the article are connected with the history of the Military Medical Academy in the beginning of the 20th century. Some of the archival documents are published for the first time.

The report on the first World Symposium on Endovascular Methods of Trauma and Bleeding Treatment, which was held on February 2-4, 2017 in Orebro, Sweden, is presented. The symposium brought together 350 doctors of various specialties: general, military and vascular surgeons, specialists in surgery for injuries and orthopedic traumatologists, interventional radiologists and specialists in emergency medicine, anesthesiologists, resuscitators, nurses and anesthetists. The scientific program considered during the symposium was at the junction of many medical specialties, involving not only civilians, but also military doctors from all over the world.