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Vol 340, No 4 (2019)


Organizational aspects of medical rehabilitation of military personnel in sanatorium-resort organizations of the Ministry of Defense in modern conditions

Dolgikh S.V., Kirsanova A.A., Ostroukhov A.E., Didenko S.V.


The current state of medical rehabilitation of servicemen at the sanatorium and health resort stage is outlined, the main issues of rehabilitation measures are shown. To increase the effectiveness of measures aimed at strengthening and preserving the health of military personnel, the order of their referral to medical rehabilitation in a sanatorium after completion of treatment in a day hospital (previously - only from military hospitals after inpatient treatment with a round-the-clock stay) was further defined. The further development of sanatorium-resort organizations of the Ministry of Defense of the 2nd stage of medical rehabilitation (somatic diseases, pathology of the peripheral nervous system and musculoskeletal system) seems promising, which will require taking measures to form medical rehabilitation units, equip them with medical equipment, and train doctors.
Voenno-medicinskij žurnal. 2019;340(4):4-7
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Improving the system of medical rehabilitation in the Armed Forces of the Russian Federation.

Yudin V.E., Shchegolkov A.M., Yaroshenko V.P., Ovechkin I.G., Kosukhin E.S.


Improving the system of medical rehabilitation in the Armed Forces of the Russian Federation is carried out in accordance with the trends of civilian health care, with an emphasis on the specifics of military medicine. It is stated that medical rehabilitation should be carried out by specialists of the multidisciplinary team - a functional association of medical and non-medical professionals in the course of providing assistance in the field of medical rehabilitation. In the future, the activities of the multidisciplinary team will include the definition of a rehabilitation diagnosis using the international classification of functioning. Changing the nomenclature of specialties will require organizing the training (retraining) of specialists in the specialty «Physical and Rehabilitation Medicine» in educational institutions of the Russian Ministry of Defense.
Voenno-medicinskij žurnal. 2019;340(4):8-13
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Actual issues of military medical expertise of citizens in the reserve of the Armed Forces

Sanakoeva E.G., Nikolenko S.L., Brovkin S.G., Ignatov Y.G.


The article describes the procedure for creating a stock of the Armed Forces, its structure and characteristics of the main elements. It is shown that a necessary condition for maintaining the stock is maintaining up to date information about the health status of persons to be mobilized, but the existing organization of medical examination of citizens in stock does not fully ensure the fulfillment of this task. To solve it, it was proposed to make several changes to the Provision on military-medical examination, which will increase the objectivity of information about the state of health of citizens in stock and reduce the number of returns for health reasons from points of reception of personnel ready for military units during the mobilization period.
Voenno-medicinskij žurnal. 2019;340(4):13-18
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Voenno-medicinskij žurnal. 2019;340(4):18
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Carbuncle - the actual problem of modern surgery (Literature review)

Lipatov K.V., Cherkasov Y.E., Khrupkin V.I., Lysenko M.V., Dekhissi E.I.


Analyzed the features of the surgical treatment of carbuncles. The severity of the purulent-necrotic process was assessed, the significance of the timely diagnosis of the inflammatory stage and the choice of the timing of surgical treatment is shown. The features of the options of surgical tactics - from gentle to radical surgical interventions, methods of intraoperative assessment of tissue viability in the inflammatory focus are described. The necessity of a differentiated approach to the treatment of carbuncles depending on the stage of the disease, the prevalence of the pathological process and its localization is substantiated. The significance of restorative skin-plastic surgery in the replacement of postnecrectomy defects of epithelial tissues in the treatment of extensive carbuncles is shown. Ways of improving the results of treatment of patients with carbuncles are outlined, including timely diagnosis, a differentiated approach to surgical treatment, rational antibacterial therapy, and adequate general treatment.
Voenno-medicinskij žurnal. 2019;340(4):19-24
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Experience in the diagnosis and treatment of acute appendicitis in a military hospital.

Klyuchnikov O.A., Klyuchnikov D.A., Panov V.V., Bagmet A.D., Groshilin V.S.


The possibilities of improving the quality of diagnosis and treatment of acute appendicitis by identifying the correlations of its clinical manifestations and diagnostic polymorphism of morphological changes of the appendix, as well as diagnostic methods of this surgical pathology are analyzed. Out of 361 patients admitted for 3 years to a military hospital with clinical manifestations of acute appendicitis, the diagnosis was confirmed in 195 (54%). Of those who underwent laparoscopy, the operation at the diagnostic stage was completed in 12 (26.1%) patients, in 34 (73.9%) patients during laparoscopy, the diagnosis of the destructive form of acute appendicitis was confirmed. Of these, laparoscopic appendectomy was performed in 9 patients, other methods of appendectomy were performed in 25 patients. In all cases, the performance of diagnostic laparoscopy made it possible to clarify the diagnosis, and to avoid errors in the diagnosis of other diseases under the mask of «acute appendicitis.» It is important to note that when performing diagnostic laparoscopy and laparoscopic appendectomy there were no differences in clinical and morphological diagnoses. According to the results of work, in the diagnosis and treatment of acute appendicitis, laparoscopy is the primary method.
Voenno-medicinskij žurnal. 2019;340(4):25-34
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Voenno-medicinskij žurnal. 2019;340(4):34
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Community-acquired and nosocomial pneumonia: semiotics of lung damage, microbiological spectrum and sensitivity of pathogens to antibiotics.

Lakhin R.E., Zhirnova E.A., Grachev I.N.


The localization of pneumonia, the microbiological spectrum and the sensitivity of pathogens to antibiotics in community-acquired and nosocomial pneumonia has been studied. The material for the study served as medical records of patients who were treated in clinics of the S.M.Kirov Military Medical Academy in the period from 2010 to 2017. The data obtained showed that pneumonia is more often localized in the lower lobes of the lungs. The main causative agent of community-acquired pneumonia is Streptococcus pneumoniae, nosocomial pneumonia is Klebsiella pneumoniae. Revealed high antibiotic resistance to pathogens of pneumonia. The causative agent of Klebsiella pneumoniae was resistant to the entire spectrum of antimicrobial agents studied, maintaining sensitivity in some cases only to colistin. Bacteriological analysis of pneumonia pathogens is necessary for subsequent timely targeted antibiotic therapy. Therefore, for effective treatment of pneumonia, it is important to continuously monitor pathogens and their sensitivity to antibiotics.
Voenno-medicinskij žurnal. 2019;340(4):35-41
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Immunological reactivity status in the process of professional adaptation of flight personnel.

Churilov Y.K., Moiseev Y.B., Richei I.I.


The impact of unfavorable factors of aviation flight causes a significant strain in the flight crew of the functional state of the body, including various parts of the immune system. To date, research on the problems of interaction between different parts of the immune system in flight personnel in the process of professional adaptation is practically absent. In this regard, a study was conducted of immunological reactivity according to calculated data from 100 pilots of fighter aircraft and 102 pilots of other types of aircraft. The data obtained indicate significant dissociation of the flight composition in the immune system and changes in its reactivity. Studies of immunological reactivity in terms of integral leukocyte indices seem promising and, in combination with other methods of clinical and functional diagnostics, will expand the possibilities of assessing the overall functional status of pilots in the process of medical examination.
Voenno-medicinskij žurnal. 2019;340(4):42-46
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Prospects for the development of technical devices and dosage forms for the use of medical protection.

Ivanov I.M., Chepur S.V., Nikiforov A.S., Yudin M.A., Averina A.L.


The article assesses the current level of technical devices and dosage forms intended for the use of medical protective equipment, discusses global trends and prospects for their short-term and medium-term development. Considered foreign samples autoinjectors, portable inhalers, patch pump, nasal, transdermal and buccal forms. Presents indicators of the effectiveness of various dosage forms, their advantages and disadvantages, discusses ways to overcome the latter in the provision of medical care in the prehospital stages and in transporting the wounded and affected. When assessing the possibility of using medical protection in various technical devices or dosage forms, it is necessary to consider the characteristics of their manufacturability and the readiness of the domestic production base for mass production and state registration as medicines or medical products. It was concluded that in the short term for the development of domestic medical remedies it is advisable to introduce inhaled and intranasal forms of drugs for use in the prehospital medical care.
Voenno-medicinskij žurnal. 2019;340(4):47-53
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Development of technical means of auscultation.

Miroshnichenko Y.V., Khalimov Y.S., Umarov S.Z.


In everyday medical practice, the classical method of auscultation is used to diagnose almost the entire spectrum of cardiovascular and pulmonary diseases. The history of the creation and development of auscultation tools (stethoscope, phonendoscope, microstethoscope) is described, the analysis of existing technical means for the behavior of classical auscultation is carried out. The basic requirements for devices for general purpose auscultation are most fully met by the stethophonendoscope, a binaural device with combined stethoscopic and phonendoscopic heads. The main characteristics of stethoscopes produced by leading global manufacturers are given. An assessment of the prospects for digital (digital) stethoscopes is given. A digital stethoscope can transform acoustic signals into electronic ones that can be further enhanced for optimal listening. In addition, electronic signals can be further digitized using a personal computer or laptop. The emergence of a digital stethoscope means a new stage in the development of the classical method of auscultation to identify the pathology of the cardiovascular and respiratory systems. The underlying technologies allow the use of a digital stethoscope for the needs of telemedicine.
Voenno-medicinskij žurnal. 2019;340(4):54-59
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Current state and prospects of cell engineering, additive manufacturing and tissue engineering in military medicine

Nagibovich O.A., Golota A.S., Krassii A.B.


The article briefly describes the current state and prospects of cell engineering, additive manufacturing and tissue engineering in military medicine on the basis of analysis of domestic (РИНЦ) and foreign (Medline) scientific medical publications 2017-2018 . It has been found 14 relevant publications on the topic in Medline. Their analysis revealed the following. The researches abroad give much attention to the topic. Although despite the multibillion investments the results in the field are more than modest due to significant scientific and technical difficulties encountered by researchers and developers in this direction. That is why the current trend in employment of cell engineering, additive manufacturing and tissue engineering in military medicine is concentration of material and financial resources on applied research for medical provision at a theater of operation.
Voenno-medicinskij žurnal. 2019;340(4):60-63
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Voenno-medicinskij žurnal. 2019;340(4):63
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Criteria for adverse prognosis for mitral valve prolapse.

Ovchinnikov Y.V., Gadzhieva L.R., Palchenkova M.V., Muracheva N.V., Tkachenko S.B.


On the basis of a survey of 151 patients, diagnostic criteria for an unfavorable prognosis of mitral valve prolapse were revealed according to echocardiography. Transthoracic and transesophageal echocardiography, daily Holter ECG monitoring were performed. Repeated echocardiography was performed in 12-18 months. Statistical analysis of the material allowed us to identify criteria for poor prognosis of mitral valve prolapse according to echocardiography: severe mitral regurgitation, mitral valve leaflet thickness in diastole 6 mm or more, dilatation of the left ventricular cavity, dilatation of the left atrial cavity, dilatation of the mitral ring.
Voenno-medicinskij žurnal. 2019;340(4):64-66
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On the use of ultrasound in the diagnosis of acute appendicitis and its complications

Avakyan S.G., Kim I.Y., Tatevosov E.S., An G.F G.F., Zotova N.V., Fokina M.A.


The article summarizes the long-term experience of the department of ultrasound diagnostics on the use of ultrasound in the diagnosis of acute diseases of the abdominal organs for urgent reasons, including acute appendicitis and its complications. During the period from 2007 to 2017, more than 4.5 thousand patients were examined. The analysis showed that with a relatively stable indicator of the total number of studies, the share of ultrasound studies for urgent indications during this time increased from 9 to 14.5% per year. The experience shows that the use of ultrasound in the diagnosis of acute diseases of the abdominal organs should include a targeted study of the right iliac region to exclude acute appendicitis, especially in cases where it is not possible to identify the cause of acute pain from other abdominal organs, kidneys and pelvic organs.
Voenno-medicinskij žurnal. 2019;340(4):66-70
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New approaches to the use of therapeutic gymnastics and pelotherapy in the rehabilitation of patients after arthroscopic shoulder joint operations

Mikhaleva A.V., Kulikov A.G., Makarova I.N.


To increase the effectiveness of the rehabilitation of patients after surgical treatment of a rotator cuff rupture, 98 patients were examined and treated. It was revealed that the inclusion of exercises with dynamic controlled muscle tension in combination with thin layer pelotherapy in the medical complex, has an impact on the main clinical symptoms of the disease, regeneration processes, and contributes to an earlier restoration of the impaired functions of the shoulder joint, which is more significant than basic therapy.
Voenno-medicinskij žurnal. 2019;340(4):70-74
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Perilymphatic fistula of labyrinth in case of explosive trauma, especially their identification.

Egorov V.I., Kozarenko A.V., Egorov S.V.


The variability of the clinical picture of injuries of the ear labyrinth after mine-explosive injuries, the possibility of differential diagnosis of symptomatically similar pathologies are considered, which makes it possible to increase the effectiveness of care and improve the results of treatment. Reported on the author’s experience in helping people with cochleo-vestibular disorders.
Voenno-medicinskij žurnal. 2019;340(4):74-76
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Prevention of infectious and inflammatory complications after odontectomy in military personnel using an antiseptic hydrogel.

Grebnev G.A., Iordanishvili A.K., Muzykin M.I., Lyskov N.V., Korovin N.V.


Based on analyzes of the primary medical records of military medical organizations and dental offices of military units, the incidence of infectious and inflammatory complications after odontectomy was set at 17.7%. It has been shown that the use of a domestic antiseptic hydrogel containing collagen hydrolyzate, sodium alginic acid, sodium hypochlorite and antiseptics to prevent a blood clot in a post-extraction wound from decay reduces the incidence of infectious and inflammatory complications by 10.9%.
Voenno-medicinskij žurnal. 2019;340(4):76-77
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Voenno-medicinskij žurnal. 2019;340(4):77
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Organizational design of the medical service of the Russian army in the XVII - early XVIII centuries

Kulnev S.V., Kryuchkov O.A.


The article is devoted to the consideration of issues of organizational design of the medical service of the Russian army in the XVII - early XVIII centuries. The prerequisites and main directions of the evolution of the legal regulation of the organization of the medical service of the Russian army, as well as the duties of the medical (nursing) staff are indicated. A high-quality transition to the creation of the army medical service as a special organization with clearly defined work principles, staffing structure, a system of staffing the army with medical personnel was noted, which was reflected in Peter I’s «Military Regulations». The issues of creating a system for training domestic medical personnel and financing their work, the recruitment of the Russian army and navy with medical personnel, military medicine management.
Voenno-medicinskij žurnal. 2019;340(4):78-82
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Contribution of scientists of the Military Medical Academy in the provision of professional psychological selection of military personnel.

Shamrei V.K., Yusupov V.V., Ovchinnikov B.V.


Presents information about the work of scientists of the Military Medical Academy for the formation of a unified system of professional psychological selection and the development of methodological approaches to the study of the problems of professional suitability of military personnel.
Voenno-medicinskij žurnal. 2019;340(4):82-87
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Voenno-medicinskij žurnal. 2019;340(4):87
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Ofitsial'nyy otdel

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Voenno-medicinskij žurnal. 2019;340(4):88-90
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Voenno-medicinskij žurnal. 2019;340(4):90
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Nam soobshchayut

Ibadulin R.R.
Voenno-medicinskij žurnal. 2019;340(4):91-93
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Anniversary scientific-practical conference «Actual issues of medical support of the Navy».

Chernikov O.G., Chernyi V.S., Kupriyanov S.A.


A report on the held at the S.M.Kirov Military Medical Academy jubilee scientific and practical conference dedicated to the 80th anniversary of the departments of the organization and tactics of medical service fleet (with the course of the tactics and weapons of war fleet), naval surgery, training faculty physicians for Navy of the S.M. Kirov Military Medical Academy is presented.
Voenno-medicinskij žurnal. 2019;340(4):94-96
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