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Vol 341, No 1 (2020)


Medical support for the Armed Forces of the Russian Federation: results of activities and tasks for 2020

Trishkin D.V.


The analysis of the activities of the medical service of the Armed Forces in 2019 in the main areas, the dynamics of the main indicators characterizing the system for preventing the incidence of military personnel, providing medical care, spa treatment, medical and psychological rehabilitation is presented. The main changes in the legal regulation of issues of medical support and training of medical personnel are presented. The results of work in 2019 are estimated and the main tasks for 2020 are formulated, among which are: maintaining a high level of combat and mobilization readiness of the medical service to carry out its mission, taking into account the introduction of modern methods of medical support for troops (forces), methods of organization and command medical support during preparation and during the hostilities; improving the regulatory framework for medical support; improving the quality and accessibility of all types of medical care, spa treatment, medical and medical-psychological rehabilitation; prevention of diseases relevant to the troops and ensuring favorable conditions for military service; maintenance of the provision of medicines and expendable medical property to military units and military medical organizations, etc.
Voenno-medicinskij žurnal. 2020;341(1):4-19
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Ways to reduce mortality in modern hybrid warfare: injured to a surgeon or surgery to a wounded?

Fisun A.Y., Samokhvalov I.M., Goncharov A.V., Reva V.A., Kanibolotskii M.N., Pochtarnik A.A., Evich Y.Y., Ovchinnikov D.V., Alimov A.A., Kozovoi I.Y.


In the current military conflict, among those killed on the battlefield, more than 90% of the wounded die from bleeding, 2/3 of which - from internal bleeding, which can only be stopped with surgical assistance. Moreover, the terms of evacuation of the wounded can reach 4-6 hours or more. Mortality reduction can be achieved by: accelerating the evacuation of the wounded; the use of systemic and local hemostatic agents; the creation of mobile surgical groups and their extension as close as possible to the battle zone. The article discusses the purpose and composition of the autonomous surgical group, its approximate equipment and deployment procedure. The main task of the unit should be the implementation of life-saving surgical interventions in the area close to the line of combat with such a view as to provide surgical assistance 30 minutes after the injury. The recommended list of performed surgical aids, possible problems in the organization of work and ways to solve them are presented.
Voenno-medicinskij žurnal. 2020;341(1):20-29
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Voenno-medicinskij žurnal. 2020;341(1):29
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Forensic diagnosis of the direction of traumatic effects in blunt spleen injury

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


Since the spleen takes the second place after the liver in terms of the frequency of injury, forensic experts often encounter injuries of this organ both in the study of corpses and in the examination of living persons. In the literature there is a large amount of scientific data relating to the establishment of the mechanism of formation of spleen injury. At the same time, there are no data in the scientific literature on the mechanism of formation of damage to the spleen with the tangential direction of the traumatic effect (oblique impact). In the present study, the method of finite element analysis of the distribution of deformations and stresses on the surfaces of the spleen was used to predict the destruction of the spleen tissue characteristic of perpendicular and oblique shock effects. The obtained data can be used in practice by forensic experts in deciding on the direction of the traumatic effect in a closed blunt spleen injury.
Voenno-medicinskij žurnal. 2020;341(1):30-33
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Treatment of bone-vascular polytrauma of limbs in a multidisciplinary military hospital

Esipov A.V., Pinchuk O.V., Obraztsov A.V., Peshekhonov E.V., Yamenskov V.V., Rakov A.A.


Literature data on the frequency and mechanism of damage to the main arteries in case of bone injury of the musculoskeletal system are presented. The emphasis is on a fairly high level of diagnostic errors, postoperative complications. The treatment results for this severe injury need further improvement. We analyze our own experience in the diagnosis and treatment of 12 patients with combined bone-vascular trauma in a multidisciplinary military hospital. In 7 (58.3%) cases, the lower limbs were damaged, and in 5 (41.7%) cases, the upper limbs. Subclavian (3), brachial (2), popliteal (3), femoral (2) arteries and lower leg arteries (2) were damaged. Decompensation of blood circulation of the limbs was noted in 8 cases. The difficulties of diagnosis, the use in the treatment of modern endovascular technologies are considered on a clinical example of axillary artery damage due to a fracture of the humeral head.
Voenno-medicinskij žurnal. 2020;341(1):34-38
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New approaches to the rehabilitation of patients with diabetic angiopathy of the lower extremities

Kryukov E.V., Frolov D.V., Kulikov A.G., Makarova M.R., Luppova I.V.


The aim of this work is to increase the efficiency of rehabilitation of patients with diabetic angiopathy through the combined use of therapeutic exercises, training walking and functional electrical stimulation of the muscles of the lower extremities. An examination and treatment of 90 patients with a diagnosis of type 2 diabetes mellitus complicated by angiopathy of the lower extremities, with a disease duration of at least 2 years, was carried out. Patients divided into 3 groups, comparable in age, gender and main clinical manifestations, were prescribed generally accepted basic drug therapy, diet, exercise therapy in the form of physiotherapy and training walking on a treadmill. Additionally, patients of the main groups after therapeutic exercises before training walking underwent functional electrical stimulation of the lower extremities using a pulsed bipolar current with a frequency of 10-30 Hz in the 1st group and 80-100 Hz in the 2nd group. It was revealed that the inclusion of functional electrical stimulation in the treatment complex contributes to a more effective regression of pain, a decrease in the manifestations of functional hemodynamic insufficiency. The most significant changes in clinical and functional parameters were achieved in patients during electrical stimulation with a frequency of 10 to 30 Hz.
Voenno-medicinskij žurnal. 2020;341(1):38-44
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The experience of using ultrasonic navigation of nerves with blockade of the brachial plexus and large nerves of the lower limb

Azbarov A.A., Apevalov S.I., Kalinin A.G., Sinitsin M.S.


Under ultrasound control, a blockade of large nerve trunks and plexuses of the extremities was performed in 865 patients. All of them, depending on the blockade performed, were divided into groups: blockade of the brachial plexus by axillary access; blockade of the brachial plexus supraclavicular access; blockade of the brachial plexus with interstitial access;) combined blockage of the femoral and sciatic nerves. Anesthesia was carried out with a local anesthetic solution consisting of 10 ml of 2% lidocaine and 10 ml of 1% ropivacaine (total 20 ml). Because of the work, the high efficiency of the ultrasonic nerve navigation technique (99.3%) and its safety (the absence of repeated attempts to identify nerves and complications of anesthesia) were shown. The use of ultrasonic navigation in our modification when performing blockades of large nerves and nerve plexuses of the extremities helps to determine the localization of nerves, to observe the position of the needle relative to the anatomical structures during its advancement.
Voenno-medicinskij žurnal. 2020;341(1):44-51
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Voenno-medicinskij žurnal. 2020;341(1):51
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The structure of the causative agents of influenza and other acute respiratory viral infections isolated during the period of the epidemic from sick vaccinated servicemen

Alimov A.V., Kalmykov A.A., Mukhachev I.S., Artebyakin S.V., Mamontov O.I., Slobodenyuk A.V., Markaryan A.Y., Vyalykh I.V., Malchikov I.A.


The analysis of the epidemiological situation in 2019 during the epidemic spread of the influenza A virus in military teams is presented. It was revealed that the etiological structure of respiratory viral infections significantly differed in species composition. Of the five military collectives among those vaccinated against influenza, only two were diagnosed with incidence. The presence of influenza A(H1N1)pdm09 viruses was confirmed in 15% of cases of acute respiratory viral infection, which may indicate that individuals were unvaccinated at vaccination sites or lack of seroconversion in some vaccinated individuals. Among the circulating viruses of non-influenza etiology, adenovirus dominated, which accounted for 15 to 70%.
Voenno-medicinskij žurnal. 2020;341(1):52-56
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Prospects for the development of military toxicology: chemical safety and countering its threats

Chepur S.V., Chubar O.V., Yudin M.A., Shefer T.V., Basharin V.A., Kuz’min A.A., Sidorov S.P., Tyunin M.A.


Modern chemical threats that exist after the elimination of stockpiles of chemical weapons actualize research on the search for means and methods of counteracting them, increase the importance of using the latter in practice. This determines the role of military toxicology as an independent system of military-applied knowledge, the formation and implementation of which form the basis of the readiness of the medical service to counteract chemical factors, ensure the effectiveness of solving the tasks of preserving the life of military personnel and maintaining the combat readiness of troops. Based on the analysis of these threats and considering the experience of creating medical protective equipment, the article shows the unresolved problems of military toxicology, identifies promising areas of research to improve the means and methods of preserving the life of military personnel under the influence of chemical damaging factors. The tasks of the medical service for indicating rapidly degrading toxicants and restoring the combat readiness of military personnel by using antidote, symptomatic and pathogenetic therapy are noted.
Voenno-medicinskij žurnal. 2020;341(1):57-63
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Voenno-medicinskij žurnal. 2020;341(1):63
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Brachiothoracic wound with damage to the right lung and migration of a bullet through the superior pulmonary vein, left atrium into the left ventricle of the heart

Chuprina A.P., Kryukov E.V., Voinovskii A.E., Kranin D.L., Vasyukevich A.G., Fokin A.V., Gudkov M.M., Varochkin K.A., Zachinyaev G.V.


A clinical case of a rare chest injury accompanied by a bullet embolism in the cavity of the left ventricle is presented. The problems of preoperative diagnosis of penetrating wounds of the breast with the localization of foreign bodies in the projection of the heart are considered. The possibilities of providing highly qualified medical care in a multidisciplinary medical institution are shown.
Voenno-medicinskij žurnal. 2020;341(1):64-70
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The Battle of Stalingrad: the organization of medical support for the fronts in the defensive period

Kulnev S.V., Shelepov A.M., Leonik S.I.


The data of the analysis of the work of the medical service of the fronts in the defensive operation of the Battle of Stalingrad are given. In its course, a large discrepancy between the medical forces and facilities and the amount of sanitary losses in the troops was revealed. The organization of medical support for the fronts in the initial period of this battle was negatively affected by the insufficient development in the pre-war period of the theoretical foundations and principles of the medical service in strategic defensive operations. The decisive influence on the forms and methods of medical support for the troops was exerted by the specific conditions of the combat, rear and medical situation, the need to find the most effective means and methods of medical service activity, considering the tasks facing the troops and the prospects for their implementation during the operation. During the defensive period of the Battle of Stalingrad, the medical service gained experience in providing medical and sound support for troops engaged in prolonged battles in a large administrative and industrial center, and in organizing mass transportation of the wounded and sick through a wide water barrier.
Voenno-medicinskij žurnal. 2020;341(1):71-82
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The Military hospital in Saratov celebrates the 40th anniversary

Kalmykov A.A., Arsentev O.V., Sabaeva M.N.


The history of a military hospital (branch N 1 of the 428th military hospital of the Ministry of Defense of Russia) located in the city of Saratov is described. Today it is a modern multidisciplinary military medical institution, deployed in more than 100 beds, where specialized and qualified medical assistance is provided.
Voenno-medicinskij žurnal. 2020;341(1):82-85
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From the history of the branch Nо. 1 of the Medical and Rehabilitation Clinical Center of the Ministry of Defense of the Russian Federation

Turlai M.V., Khmil A.Y.


The article is dedicated to the 65th anniversary of the branch Nо. 1 of the treatment and rehabilitation clinical center of the Ministry of Defense of Russia. Currently, it is a central military hospital, deployed to several hundred beds. The state has surgical, traumatological, gastroenterological, pulmonological, otorhinolaryngological, urological, cardiological, ophthalmological, skin and venereological departments, two neurological departments, departments of maxillofacial surgery and dentistry, purulent surgery, gynecological, neurosurgical, etc. The whole range of examination and treatment is performed. according to the latest techniques and technologies, using modern equipment of the latest generation.
Voenno-medicinskij žurnal. 2020;341(1):85-87
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To the history of the military health resort «Divnomorskoe»

Loktionov Y.V., Neburchilov V.G., Ivashkin G.I.


The article talks about the history and today of the health resort «Divnomorskoe». The history of the formation and development of a military health resort from the moment of its creation is described. Data on the work of the institution in different years in the interests of improving health resort treatment and rehabilitation of military personnel, pensioners of the Ministry of Defense, and their families are given.
Voenno-medicinskij žurnal. 2020;341(1):88-90
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Voenno-medicinskij žurnal. 2020;341(1):91-92
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Voenno-medicinskij žurnal. 2020;341(1):93
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Conference on modern approaches to the treatment of surgical infection in a multidisciplinary hospital

Vinogradov A.V., Chalyi A.N., Malovichko V.V., Biryukov D.A.


The results of the scientific-practical conference «Modern approaches to the treatment of surgical infection in a multidisciplinary hospital: from a purulent wound to osteomyelitis», held in September 2019 at the Medical and Rehabilitation Clinical Center of the Ministry of Defense of the Russian Federation, are presented. During the conference, urgent directions were identified for improving the treatment of purulent surgical infection, including the importance of a differentiated approach to the treatment of decubital ulcers in sedentary patients. Criteria for diagnosing periprosthetic infection have been developed, treatment tactics have been determined for various forms of this pathology in patients with purulent complications, false joints after focal osteosynthesis of long tubular bones.
Voenno-medicinskij žurnal. 2020;341(1):94-96
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