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Vol 340, No 6 (2019)


30th Anniversary of the Organizational Planning Directorate of the Main Military Medical Directorate of the Ministry of Defence of the Russian Federation

Kalachev O.V., Plakhov A.N., Murzo A.V., Zyabkin S.V., Loginov A.E.


A brief essay on the history of the organizational planning of the Main Military Medical Directorate of the Ministry of Defense of Russia, founded in 1989, was originally created to fulfill the role of a kind of headquarters of the Central Military Medical Directorate of the USSR Ministry of Defense and coordination, coordination of the work of departments and divisions, as well as medical services of the types (branches) of troops (forces), military districts and fleets, the management subsequently expanded the scope of activities. Currently, the work of the Directorate is aimed at planning the application and development of the medical support system and the organizational construction of the medical service of the Armed Forces, as well as maintaining the combat readiness of the medical service personnel.
Voenno-medicinskij žurnal. 2019;340(6):4-8
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Military medicine and digital technologies: theory, practice, problems and prospects

Krainyukov P.E., Stolyar V.P.


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.
Voenno-medicinskij žurnal. 2019;340(6):9-19
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New methods of training military surgeons - a necessary step to save the wounded in military conflicts

Goncharov A.V., Samokhvalov I.M., Petrov A.N., Reva V.A., Nosov A.M., Suvorov V.V., Markevich V.Y., Kuraev P.I., Loshenko Y.A., Skakunova T.Y.


The problem of the effectiveness of training surgeons in the field of injury surgery is becoming more and more discussed in the largest surgical forums. The training of military surgeons on these issues is traditionally held at the Department of Military Field Surgery of the Military Medical Academy, which is included in the regional traumatic system of St. Petersburg. In recent years there has been a significant reduction in the time allotted for the training of trainees in the discipline «military field surgery». A retrospective analysis of 1255 case history of victims who were treated at the clinic of military field surgery (2011-2015) showed a significant decrease in the number of incoming victims and surgical interventions performed by them. As a result, the effectiveness of traditional teaching and the ability of students to acquire the necessary practical skills are reduced. The way out may be the introduction of new teaching methods, the most promising of which are practical cycles using bioobjects, as well as the use of modern simulation technologies.
Voenno-medicinskij žurnal. 2019;340(6):20-27
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Features of the morphology and mechanism of formation of output gunshot injuries with the diligence to them of a solid barrier

Pinchuk P.V., Shakiryanova Y.P., Leonov S.V., Vereskunov A.M.


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.
Voenno-medicinskij žurnal. 2019;340(6):28-32
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Voenno-medicinskij žurnal. 2019;340(6):32
pages 32 views

Septic shock: clinical and morphological comparisons

Chirskii V.S., Yuzvinkevich A.K., Andreeva E.A.


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.
Voenno-medicinskij žurnal. 2019;340(6):33-37
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Biophysical processes in radiofrequency catheter ablation of cardiac arrhythmias

Steklov V.I., Sergoventsev A.A., Emel’yanenko V.M., Rzaev F.G., Emel’yanenko M.V., Vladimirov Y.A.


Modern technologies of endovascular treatment of cardiac arrhythmias allow the doctor with a thin catheter to inflict local damage on any anatomical structure of the heart without any damage to cardiac function. The purpose of such a local effect - ablation - is to interrupt the propagation of the pulse in the endocardium. Understanding the basic principles and biophysical processes during ablation can improve the results and safety of this procedure. The article discusses the principles of thermal effects on endocardial tissue during radiofrequency catheter ablation of cardiac arrhythmias.
Voenno-medicinskij žurnal. 2019;340(6):38-49
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Comparison of the effectiveness of extracorporeal detoxification methods in the treatment of post-load rhabdomyolysis complicated by acute renal damage

Belskikh A.N., Zakharov M.V., Marukhov A.V., Korolkov O.A.


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.
Voenno-medicinskij žurnal. 2019;340(6):49-54
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Factors determining the severity of atherosclerosis of the coronary arteries in soldiers with myocardial infarction

Gordienko A.V., Sotnikov A.V., Sakhin V.T., Nosovich D.V., Yakovlev V.V., Godina Z.N.


The features of risk factors for cardiovascular diseases and their prognostic significance in male military personnel with myocardial infarction to clarify current prevention strategies were assessed. For this purpose, the results of treatment of 566 men younger than 60 years due to myocardial infarction have been studied. A comparative analysis of the prevalence of risk factors for cardiovascular diseases, comorbidity, clinical predictors of myocardial infarction in groups of military personnel and civilian patients, as well as survivors and deceased were performed. These data are compared with the results of coronary angiography. It was determined that the structure of risk factors for cardiovascular diseases in the group of military personnel corresponds to the general population but has some differences. The risk group with the highest probability of myocardial infarction is military personnel with a combination of dyslipidemia, moderate obesity, alcohol abuse with arterial hypertension and smoking. For the prevention of myocardial infarction in the group of military personnel, in addition to the correction of traditional risk factors for cardiovascular diseases, infections of the oral cavity (34%), psycho-emotional stress (49%) and participation in local military conflicts (5%) are also significant. The severity of coronary artery disease depends on the duration of coronary artery disease, the presence of arterial hypertension, dyslipidemia and renal dysfunction.
Voenno-medicinskij žurnal. 2019;340(6):55-61
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Sanitary and anti-epidemic (preventive) measures in the outpatient organization

Zotkin A.V., Kruglov S.E.


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.
Voenno-medicinskij žurnal. 2019;340(6):62-67
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Experience of using the method of ion chromatography to determine the mass concentration of anions in drinking water samples

Polyakov V.S., Kucherov A.S., Vasyanovich A.A., Torshin A.S.


Physical and chemical studies of drinking water constitute a significant amount of work on hygienic laboratory monitoring of the quality of water supply to military camps. A significant place in their structure is occupied by the measurement of the mass concentration of anions. With a variety of official and proposed approaches to such research, the choice of an optimal method is necessary for real practice. The article presents an analysis of the experience of using the method of ion chromatography in sanitary-hygienic studies to determine the mass concentration of anions in drinking water samples. The results of 156 studies of this type using the Stayer ion chromatograph are presented. The introduction of the ion chromatography method into the laboratory allowed us to significantly speed up and simplify the process of determining the content of inorganic anions in drinking water. The ion chromatograph is available for work in the hygienic laboratories of the centers of state sanitary and epidemiological surveillance of military districts and fleets. Equipping this equipment and training specialists with appropriate qualifications will allow to bring the research of the content of inorganic substances in water to the level of modern requirements.
Voenno-medicinskij žurnal. 2019;340(6):68-72
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Proposals to improve the system of providing medical equipment for troops

Levchenko V.N., Stavila A.G., Besedin R.G., Moshchevikin I.V.


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.
Voenno-medicinskij žurnal. 2019;340(6):73-79
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Voenno-medicinskij žurnal. 2019;340(6):79
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Major General of Medical Service M.A.Lushchitskii - an outstanding naval surgeon

Solovev I.A., Utochkin A.P., Lukyanyuk P.P.


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.
Voenno-medicinskij žurnal. 2019;340(6):80-82
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V.F.Voino-Yasenetskii - the leading surgeon of the Krasnoyarsk evacuation hospital No. 1515 during the Great Patriotic War

Kalikinskaya E.I.


The article presents for the first time documents and information about the branch of the Central Archive of the Ministry of Defense of the Russian Federation (military medical documents, St. Petersburg) about the work of V.F.Voyno-Yasenetsky: on his initiative, the hospital took not only general surgical patients, but also patients with chest injuries, neurosurgical injuries, those requiring plastic and vascular operations. According to the memoranda of the hospital chiefs, already in December 1941 the volume of surgical work reached a maximum. Working in Krasnoyarsk, Voyno-Yasenetsky continued to apply and improve new methods of anesthesia. According to the reports, spinal anesthesia was used in 10% of cases; operations on the skull, plastic and others were performed under local anesthesia, many operations on the lower extremities were performed under regional anesthesia. Leaving the hospital in 1944, V.F.Voyno-Yasenetsky left two pupils-surgeons who continued his work.
Voenno-medicinskij žurnal. 2019;340(6):83-89
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Voenno-medicinskij žurnal. 2019;340(6):90
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K 300-letiyu Kronshtadtskogo voenno-morskogo gospitalya

Lobzin Y.V.
Voenno-medicinskij žurnal. 2019;340(6):92-95
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Kafedre voenno-morskoy khirurgii - 80 let

Nikitin E.A.
Voenno-medicinskij žurnal. 2019;340(6):95-96
pages 95-96 views

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