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Vol 341, No 2 (2020)


The evolution of the concept of medical care for the wounded and injured with injuries of the musculoskeletal system

Trishkin D.V., Kryukov E.V., Chuprina A.P., Khominets V.V., Brizhan L.K., Davydov D.V., Kolobaeva E.G., Grechukhin D.A.


Over 60% of victims of local military conflicts and emergencies have injuries of the musculoskeletal system, 90% of them need surgical treatment in a specialized medical institution. Mortality at the advanced stages of medical evacuation in case of severe multiple and combined injuries associated with traumatic shock is up to 10-15%; disability is more than 30%, no more than 50% of victims who have suffered severe injuries of the musculoskeletal system are returned to service. More than 30% of these wounded develop purulent-septic complications. The authors have developed a fundamentally new concept for the treatment of victims of injuries of the musculoskeletal system in emergencies and local military conflicts in combination with air medical evacuation using aviation and helicopter medical modules. The concept is based on antishock therapy, primary surgical treatment of wounds, and fixation of fractures of the extremities and pelvis in the early period after injury (the «golden hour»), as close as possible to the focus of sanitary losses. The authors have developed a medical military field mobile complex «Clover», which has no analogs in the world. Using the complex allowed: to reposition (comparison) of bone fragments at the advanced stage of medical evacuation in 95% of cases (2 times higher than when using domestic external fixation devices of previous designs); to reduce the time of surgery by 50%, which reduced the number of repeated operations of remounting the external fixation apparatus by 2.5 times. The implementation of the concept allowed to reduce the treatment time for patients with injuries of the extremities and pelvis by 1.5 times and by 55% the cost of inpatient treatment; reduce the number of complications in injuries of the extremities by more than 15%, with gunshot fractures - by 25%. The use of the medical aviation (helicopter) module and the Clover mobile complex led to a significant reduction in mortality, disability of the wounded, and an increase in the quality of treatment.
Voenno-medicinskij žurnal. 2020;341(2):4-11
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Comparative evaluation of the effectiveness of compression bandages, time sheets and promising dressings

Boyarintsev V.V., Golovko K.P., Nosov A.M., Trofimenko A.V., Kudarov M.A., Fil’kov G.I., Samokhvalov I.M., Kharin V.A.


Significant success was achieved in solving the problem of stopping external bleeding, mainly due to the introduction of modern domestic developments - compression bandages - KBP-O, KBP-U, and KBP-A products. Their effectiveness and safety were evaluated in comparison with a personalized medical device (individual dressing package) and a potential analog (bandage dressing) of domestic production «PPI-(E)». It was found that the individual dressing package does not allow the necessary local compression, is not always reliable, and not convenient compared to its elastic counterparts. The developed compression bandages KBP-O and KBP-U provide the optimal (51.3±4.3 and 37.8±4.6 mm Hg, respectively) compression necessary to stop external bleeding from large veins, capillaries, and arterioles, with preserved arterial blood flow, are safe to use.
Voenno-medicinskij žurnal. 2020;341(2):12-20
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Expert assessment of the number and nature of traumatic effects in blunt spleen injury

Pinchuk P.V., Leonov S.V., Skrebnev A.V., Levandrovskaya I.A.


One of the issues of interest to investigating authorities and the courts in ordering forensic medical examinations of injuries of internal organs is the possibility of determining the number of traumatic effects. In the specialized scientific literature, there is no data on the determination of the number of traumatic effects on the spleen, as well as the establishment of signs of repeated trauma in the morphology of ruptures of this organ. As a result of the study, it was found that with repeated shock trauma, the morphology of the primary damage to the spleen changes due to the addition of shear deformations to the shock load due to the loss of strength of the organ as a whole during its primary damage. Such morphological changes are characteristic of repeated trauma to the spleen. The obtained data can be used in practice by forensic experts in solving questions about the number of traumatic effects and the presence of signs of repeated trauma to the spleen.
Voenno-medicinskij žurnal. 2020;341(2):21-24
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Criteria for indications for fluid resuscitation burned in a hospital

Matveenko A.V., Tarasenko M.Y., Samarev A.V.


In the paradigm of burn injury, the indication for burn resuscitation is a burn shock or its likely development. The introduction of fluid is recommended if the total burn area is more than 15-20%, or the area of severe damage is more than 10% of the body surface. Over the past two decades, the volume of injected fluid has doubled, and this trend continues. Over resuscitation caused the phenomenon of «runaway fluid» («fluid creep»), compartment syndromes, and severe pulmonary complications. Their association with high mortality forces experts to search for the best resuscitation formulas, optimal types of solutions, and the rate of their administration, to improve monitoring of resuscitation. One of the reasons contributing to the excessive introduction of fluid is the non-differentiated area and degree of damage to the skin. The main criteria for the indications for the initial liquid resuscitation of burned with different severity conditions are determined.
Voenno-medicinskij žurnal. 2020;341(2):25-31
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Surgical tactics in case of gunshot and traumatic injuries of the pancreas (Literature Review)

Kim I.Y., Panov V.V., Panov A.V.


Mortality in pancreatic injuries reaches 60%, which is associated both with the combined nature of trauma to the organs of the abdominal cavity and retroperitoneal space, and with the development of multiple complications, up to destructive traumatic pancreatitis. Even though in the modern period of the war they are local in nature, there is no tendency to reduce the frequency of pancreatic injuries. A special group consists of gunshot wounds of the pancreas. Most scientific publications note that the latter are represented by isolated cases (except for the World War II). The initial serious condition of patients caused by the syndrome of mutual complication causes difficulties in the diagnosis of traumatic damage to the pancreas, poses difficult tasks in terms of choosing a rational method of surgical intervention.
Voenno-medicinskij žurnal. 2020;341(2):31-39
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Modern functional diagnostics and artificial intelligence

Sergoventsev A.A., Levin V.I., Borisov D.N.


The equipment of functional diagnostics departments with modern medical equipment with computer support significantly speeds up the implementation of diagnostic methods and improves the quality of medical reports. The article presents an overview of the achievements in the use of digital medicine methods for the purposes of functional diagnostics. Modern information technologies allow automatic processing of research results. When working in local and medical information networks, the main formats for exchanging medical data are the HL7 standards of various versions and the DICOM standard for transmitting images. On this basis, structured electronic medical documents are formed, which serve as the basis for the interaction of functional diagnostics doctors and other medical specialists. The problems of using artificial intelligence systems to improve diagnostic accuracy are discussed. It is predicted that storing many decoded diagnostic examination results and conclusions on them in electronic form will allow you to create reliable and valuable software products that can provide effective assistance to the doctor. The interaction of specialists in the field of medical informatics and information technology specialists should ensure the improvement of diagnostic methods in clinical practice.
Voenno-medicinskij žurnal. 2020;341(2):40-45
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Recurrent community-acquired pneumonia in young people from organized groups: clinical and prognostic aspects

Dobrykh V.A., Makarevich A.M., Zaytsev A.A., Aliev A.M., Voronina N.V., Ten T.K., Uvarova I.V., Mamrovskaya T.P.


The clinical and laboratory-instrumental manifestations of repeated community-acquired pneumonia, disease risk factors in young people from organized groups were studied and the prognostic capabilities of the data obtained were evaluated. The analysis of the results of the examination of 194 patients aged 18-27 years with repeated community-acquired pneumonia that developed within a year after previously transferred pneumonia of mild course was carried out. The control group consisted of 526 patients with community-acquired pneumonia of patients of a similar age, gender and social status. It was established that repeated community-acquired pneumonia significantly more often had the same localization as the previous one. Most of cases of repeated pneumonia (72.6%) developed during the first 3 months after the first case of the disease. Its clinical course in most cases was not severe and was characterized by a more rapid normalization of clinical and laboratory parameters.
Voenno-medicinskij žurnal. 2020;341(2):46-50
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Voenno-medicinskij žurnal. 2020;341(2):50
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Features of the organization of anti-epidemic measures in the troops (fleet forces) in the Far North and in the Arctic

Aminev R.M., Smirnov A.V., Ivanov A.A., Seleznev A.B., Stepanov A.V., Komissarov N.V., Musaev A.A., Fisun A.Y., Bychkov A.P.


The problem of organizing anti-epidemic measures in the Far North and the Arctic has become urgent in connection with the re-establishment of a permanent grouping of troops and fleet forces here. The formation of risks for their sanitary and epidemiological well-being is influenced by the complex of natural and climatic conditions inherent in this region, environmental features, conditions for the deployment of military personnel, transport, and logistics of military units. These circumstances determine and transform the structure and dynamics of infectious diseases, the implementation of mechanisms and factors of transmission of pathogens, the resistance of the human body, the timing, and the nature of the immune response. The article gives medical and geographical, epizootological, and epidemiological characteristics of the region. Information on factors determining the organization of anti-epidemic measures in the troops (fleet forces) is summarized.
Voenno-medicinskij žurnal. 2020;341(2):51-59
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The influence of the value system on the adaptive capabilities of military personnel in the initial period of service

Vorona A.A., Shakula A.V., Lyapin A.S., Semenishchenkov D.A., Syrkin L.D.


The study is devoted to the influence of the serviceman’s value system on the predicted success of adaptation in the initial period of service. This forecast is expressed by the results of professional psychological selection and established categories of professional suitability. Military personnel assigned to categories III and IV of professional suitability have low adaptive potential, physiological and personal resources, insufficient to perform professional tasks in extreme conditions of a combat and training-combat situation. It is from the number of military personnel of this category that it is supposed to form risk groups. The inclusion of servicemen of the I and II categories of professional fitness in the risk group is possible in cases of complex crises that cause the exhaustion of the resources of the body and psyche. As diagnostic tools, the recommended psycho-diagnostic methods were used, which are part of the automated workstation of the professional selection specialist «Selection», as well as G.Kelly’s repertory grid and the method of E.B.Fantalova.
Voenno-medicinskij žurnal. 2020;341(2):60-65
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Voenno-medicinskij žurnal. 2020;341(2):65
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The use of oral stress renal tests to determine the resistance of divers to hyperbaric factors

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


A survey of 44 men aged 19-23 years was conducted to identify changes in renal function and water-electrolyte metabolism under the influence of various factors of hyperbaria. Using oral stress tenae tests the relationship between the state of the functions of the excretory system and the body’s resistance to decompression gas formation, the toxic effect of oxygen and nitrogen, and hypoxic hypoxia is determined. It was found that in subjects with high resistance to these factors, the indicators of the functions of the excretory system are better than in individuals with medium and low resistance. It is concluded that it is necessary to take into account the results of oral stress renal samples when taking divers who are most resistant to the effects of hyperbaria.
Voenno-medicinskij žurnal. 2020;341(2):66-72
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Voenno-medicinskij žurnal. 2020;341(2):72
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Methodology for evaluating the effectiveness of a hemostatic tourniquet

Shperling I.A., Yudin A.B., Vasyagin S.N., Romanov P.A., Shperling N.V., Krupin A.V.


A methodology has been developed for a comparative assessment of the effectiveness of hemostatic tourniquets, which is based on the totality of ratings for each product characteristic. This methodology can be used to test created or existing samples of hemostatic tourniquets. The results of a comparative assessment of domestic-made tows (ZhK-01-«Medplant», such as Esmarch) are presented.
Voenno-medicinskij žurnal. 2020;341(2):73-79
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Voenno-medicinskij žurnal. 2020;341(2):79
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Experience in the treatment of patients with gastric cancer

Pashaev A.A., Kharisov A.M., Suturin S.P., Kirichenko S.S., Bazin D.V., Lesik P.S.


The statistical indicators of treatment of 337 patients with gastric cancer for the period 2010-2017 are presented, including 67.6% of men. The average age is 62 years. Concomitant pathology had 91.1% of patients. The prevailing cancer was the body of the stomach - 47% and the output department - 30.7%. After one month, from the onset of the first symptoms of the disease, 66.3% were received. The 5-year survival was traced in 68 (20.2%) patients who recovered after the primary operation, as well as in 7 (2.1%) patients who received chemotherapy after the procedure. Operational activity amounted to 49.8%. Radical procedures were performed in 34.1% of cases. In the hospital, 21 (6.2%) patients died.
Voenno-medicinskij žurnal. 2020;341(2):80-81
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The prevalence of non-viral chronic diffuse liver diseases among military personnel

Zhirkov I.I., Gordienko A.V., Gulyaev N.I.


The article presents data on the prevalence and structure of the incidence of chronic diffuse diseases of the liver of non-viral etiology among military personnel. The study included 282 male military personnel aged 19 to 54 years. It was found that the prevalence of non-viral chronic diffuse liver diseases among the examined military personnel was 58.1%, including non-alcoholic fatty liver disease in 33.3, alcoholic liver disease in 7.8%, and fatty liver disease of an alcohol-metabolic etiology in 17% of patients.
Voenno-medicinskij žurnal. 2020;341(2):82-83
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Clinical and forensic diagnosis of cerebral concussion

Starnovskii A.P., Butin A.P., Reshetnikova S.S., Burdienko T.O.


The problem of objective medical and forensic assessment of the diagnosis of concussion is considered. Despite a significant number of scientific publications, this problem is still relevant. Attention is drawn to the inadmissibility of omissions by clinicians when describing the anamnesis, local status, important symptoms confirming the diagnosis, and the need to consider the peculiarities of the approaches of forensic doctors to questions of damage assessment. The further assessment of the injury will depend on the completeness and quality of the information contained in the medical documents.
Voenno-medicinskij žurnal. 2020;341(2):84-86
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Phased rehabilitation treatment of military pilots with alimentary obesity

Chernetsov V.A., Kostyuchenko O.M., Kazakov S.P., Lim V.S., Ovinnikov A.A., Karakozov A.G., Sheenkov Y.A., Levchenko O.B., Molodova A.I.


The stage-by-stage treatment of military pilots with alimentary-constitutional obesity is developed and introduced into practice. The flight crew of the Armed Forces of the Russian Federation, suffering from alimentary-constitutional obesity, goes to the annual medical and flight commission at the Branch No. 1 of the N.N.Burdenko Main Military Clinical Hospital. In the future, military pilots are transferred to the next stage of treatment in the Branch No. 2 of the Medical and Rehabilitation Clinical Center of the Ministry of Defense of the Russian Federation. Upon arrival, they are assigned a comprehensive treatment and rehabilitation program aimed at weight correction and leveling of concomitant pathology. Upon completion of treatment, the pilots return to Branch No. 1 of the N.N.Burdenko Main Military Clinical Hospital for subsequent submission to the hospital medical flight commission.
Voenno-medicinskij žurnal. 2020;341(2):86-88
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The 354th Military Clinical Hospital of the Ministry of Defense of Russia celebrates the 100th anniversary

Kalmykov A.A., Konovalov P.P., Burekhin A.A., Soldatov I.K.


In February 2020, the 354th Military Clinical Hospital of the Ministry of Defense of Russia celebrates its 100th anniversary. The article describes the history of the formation and development of a military hospital since its inception. Nowadays, the main tasks of the hospital are to carry out the functions of a district medical and preventive institution, provide advisory, methodological and practical assistance to medical institutions of the Central Military District in improving medical and diagnostic work during the examination and treatment of the most severe and complex patients, and provide primary medical and specialized medical assistance to the provided contingents based on modern medical technologies; improvement of the combat and mobilization readiness, medical examination of persons undergoing examination and treatment.
Voenno-medicinskij žurnal. 2020;341(2):89-93
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Voenno-medicinskij žurnal. 2020;341(2):93-94
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Voenno-medicinskij žurnal. 2020;341(2):95-96
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Voenno-medicinskij žurnal. 2020;341(2):96
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