卷 340, 编号 6 (2019)

The prospects for improving the management of the medical service of the Armed Forces based on the creation of a digital subsystem of medical support for attached contingents, the creation and operation of digital hospitals and a modern patient monitoring system are evaluated. The possibility of introducing digital services into practical work for assessing medical prescriptions, adhering to clinical and economic standards and fulfilling the results of examinations and treatment of patients (patients), as well as new directions of telemedicine - electronic (eHealth) and mobile health (mHealth) is shown. Modern digital technologies can be widely used to provide practitioners and patients even in remote regions. The introduction of digital services will make it possible to raise military medicine to the level of world standards, more fully use the collected medical information in the interests of preserving the health of military personnel and other contingents.

The characteristics of the morphology of the output gunshot lesions on clothes and biological tissue simulators that were obtained with shots from the AK-74 submachine gun equipped with 5.45ґ39 cartridges with a steel core bullet are described, subject to the diligence of two types of armor panels (steel and ceramic-expanded clay) to the output damage area. The stages of damage formation, as well as the features of deposition of metal particles in the damage region, detected by X-ray spectral fluorescence analysis, are considered. The analysis of the stages of deformation and destruction of the bullet because of contact with steel and ceramic-expanded clay panes is given. In view of the data obtained, computer-aided simulation was performed.

A study of 45 protocols of pathoanatomical autopsies in 2010-2018 was conducted, in 32 of these protocols the diagnosis of sepsis was confirmed by microscopic examinations - metastatic purulent foci were found in the internal organs during pyemia and septicemia. The remaining 13 observations according to clinical and laboratory data allowed to designate as infectious-toxic shock. According to the criteria of septic shock proposed by the international consensus group «Sepsis-3» 2016, for clinical and morphological comparisons, 8 autopsies with a clinical diagnosis of septic shock were selected, 24 with sepsis without shock and 13 with infectious and toxic shock. Retrospective histological studies of archival microscopic preparations of the brain, heart and kidneys were performed. In the observations dated 2017 and 2018 were used additional histological and histochemical technologies, microphotography with a scanning microscope. Histological signs of microcirculatory disorders were divided into five types - leukostasis, sludge-phenomenon, descending of the endothelium, thrombosis, diapedemic hemorrhages. In the preparations of myocardium, liver and kidneys, using additional techniques, foci of dismetabolic necrosis were revealed, which objectively indicated morphogenesis of insolvency of these organs. The study expanded the understanding of the morphological microcirculatory equivalents of septic shock, which clinically formed the basis of the syndrome - the body’s hyper-allergic response to the hematogenous generalization of infection with severe hemodynamic disorders, microcirculation, and severe metabolic disorders.

To study the effectiveness of different methods of renal replacement therapy for treatment of afterload rhabdomyolysis was considered a case of treating a patient of 21 years with postload rhabdomyolysis complicated by acute renal damage. The patient was counted and compared the values of clearance and elimination (relative clearance) of myoglobin during different variants of renal replacement therapy: hemofiltration in predilution and postdilution modes, as well as hemodiafiltration in predilution and postdilution modes. The highest values of clearance and elimination of myoglobin (69.2 ml/min and 23.1%, respectively) were obtained during hemodiafiltration in the post-dilution mode, which made it possible to level the damaging potential of myoglobin and contributed to the complete restoration of renal function.

Outpatient polyclinic organization is an important link in the system of medical care at the prehospital stage. The safety of its activities is achieved by conducting a complex of sanitary and anti-epidemic (preventive) measures, which are among the main tasks along with therapeutic and diagnostic measures. The article shows the importance of effective control of the safe conditions of medical activity, which is an integral part of the work of the managerial staff and the day-to-day responsibility of the clinic staff. Based on the requirements of sanitary legislation for medical organizations and practical experience, preventive measures are mandatory for medical personnel and logistics services that contribute to the safety of medical activities in outpatient clinics.

In accordance with modern requirements it is necessary to optimize the medical property supply system. The article presents proposals for the reorganization of the structure of the center of pharmacy and medical equipment, centers providing medical equipment and property of the Ministry of Defense, highlighted the problematic issues of military pharmaceutical organizations of legal (legal) nature, as well as organizational problems of technical and metrological support of medical equipment in the Armed Forces.

The article is devoted to the 100th anniversary of the birth of a prominent naval surgeon, Major General of the Medical Service Mikhail Alekseevich Lushchitsky (1919-1999) - the author of more than 140 scientific works, editor and co-author of monographs about Ju.Ju.Dzhanеlidze, the head of the N.I.Pirogov surgical community. Under his leadership, 7 doctoral and 18 master’s theses were prepared and defended. M.A.Lushchitsky headed the Department of Naval and Hospital Surgery of the S.M.Kirov Military Medical Academy in 1973-1986.