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Vol 341, No 9 (2020)


Clinical features of a gunshot injury to military personnel protected by body armor, defining tactics of medical aid delivery

Krainyukov P.E., Denisov A.V., Logatkin S.M., Kokorin V.V., Demchenko K.N.


The widespread use of body armor to protect the chest and abdomen has led to the emergence of a new type of injury - a gunshot injury through the body armor. According to the formation mechanism, three main types of combat pathology can be distinguished. Wound, when the bulletproof vest is not penetrated, is characterized not only by external manifestations in the form of bruises of the skin and subcutaneous tissue but also by pronounced closed injuries of the internal organs of the chest and abdomen in the projection of a wound projectile. Non - penetration of the «soft» armored panel can also lead to penetrating injuries of the chest and abdomen. Through penetration of bulletproof vest, the severity and volume of gunshot damage can significantly increase due to deformation and dismantling of the bullet, the introduction of fragments of deformable shells, and damaged armor panel into the wound channel when a bullet hits a bulletproof vest at an angle of 20 degrees. And more, its elements ricochet, capable of inflicting severe wounds on both the soldier himself and those around him. These features must be taken into account when assisting the wounded at the stages of medical evacuation. The success of treatment depends on a detailed history of the wound, the timing of medical care, proper sorting, and a thorough clinical examination, including identifying the nature and extent of closed injuries of the chest and abdomen’s internal organs.
Voenno-medicinskij žurnal. 2020;341(9):4-12
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Voenno-medicinskij žurnal. 2020;341(9):12
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Physical rehabilitation of patients with a new coronavirus infection SARS-CoV-2 (COVID-19) in a hospital

Trishkin D.V., Kryukov E.V., Frolov D.V., Zaitsev A.A., Kostyuchenko O.M., Gevorkyan A.R.


The work aimed to evaluate the effectiveness of the developed methods of physical rehabilitation in the treatment of patients with coronavirus infection (SARS-CoV-2). The study included 103 patients with confirmed coronavirus infection SARS-CoV-2 and damage to the lung tissue, including 84 men and 19 women, distributed in 2 groups. The 1st (primary) group (n=57, men - 49, women - 8, age 27-58 years, average - 38) included patients who underwent full rehabilitation measures at the first stage of treatment according to the temporary clinical recommendations of the N.N.Burdenko Main Military Clinical Hospital according to the technique developed in the department of physiotherapy exercises. The 2nd (control) group (n=57, men - 35, women - 11, age 26-64 years, average - 35) included patients whose rehabilitation measures turned out to be limited due to their admission to the hospital at the stage of coordinating tactics their treatment using physical therapy methods. Positive dynamics of indicators reflecting resistance to hypoxia (Stange and Genchi tests) was noted in both groups, but in the 1st group, it was significantly (p<0.05) more significant and amounted to 38% in the Stange test (from 34 to 47 s ), according to the Genchi test - 46% (from 24 to 35 s). Against the background of the inclusion in the treatment program of measures for physical therapy in the 1st group, the excursion of the chest increased significantly (p=0.005) from 2 to 7 cm.
Voenno-medicinskij žurnal. 2020;341(9):13-19
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The experience of surgical treatment of bicuspid aortic valve disease in a military clinical hospital

Kranin D.L., Nazarov D.A., Gaidukov A.V., Fedorov A.Y., Varochkin K.A.


The presence of a bicuspid aortic valve is associated with an increased risk of morbidity and mortality from valvular dysfunction, endocarditis, and aortic dissection. When signs of damage to the aortic valve and aorta appear, surgical intervention is necessary. The study aimed to evaluate the results of surgical treatment of patients with bicuspid aortic valve disease. The treatment results of 96 patients (men - 92, women - 4) aged 17 to 81 years (average - 50.9±14.2) in 2006-2016. prove the effectiveness and safety of the radical correction of complicated forms of the bicuspid aortic valve. Complications in the postoperative period amounted to 8.3%, hospital mortality - 2.1%. The choice of surgical treatment tactics should consider the age of the patient, the structure and function of the aortic valve, the size of the ascending part of the aorta and its root, and the experience of the surgical team.
Voenno-medicinskij žurnal. 2020;341(9):19-25
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Chronic diffuse liver disease of non - viral etiology in military personnel exposed to adverse military professional factors

Zhirkov I.I., Gordienko A.V., Gulyaev N.I., Vashchenkov V.V., Makoveeva O.V.


The article presents data on the prevalence and structure of chronic diffuse liver diseases of non - viral etiology among military personnel whose service is associated with adverse military - professional factors. It was found that the frequency of these diseases in the group of military personnel of the radio engineering troops was 77.3%, among those engaged in diving and pressure chamber descents, 65.9%, among pilots of the Aerospace Forces of Russia 62.8%, in the group without an adverse military - professional factors - 69.5%. The most significant number of people with chronic non - viral liver pathology in the group of military personnel of the radio engineering troops is probably due not only to their low level of physical activity and higher body mass index but also to the influence of a microwave field that can enhance the damaging effect of lipid peroxidation.
Voenno-medicinskij žurnal. 2020;341(9):26-30
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Orthopedic disorders in children with diseases of the nervous system and their correction in a specialized balneological health resort

Ponomarenko Y.N., Nen’ko A.M., Deryabin A.V., Vlasenko S.V., Khashchuk A.V.


The article contains an analysis of the complex treatment of 2400 patients with cerebral palsy in a specialized balneological sanatorium. Medical and social rehabilitation is the principle of simultaneous interdisciplinary correction with surgical treatment as its stage. All operated children underwent comprehensive rehabilitation treatment, including balneotherapy, physiotherapy, physiotherapy and massage, climatotherapy, thalassotherapy, speech therapy and psychological help, occupational therapy, and hippotherapy. Excellent treatment results were achieved in 996 patients, satisfactory in 1222, unsatisfactory in 182 children. Indicators of social adaptation of former patients: studied or study in various educational institutions - 12%, received higher or secondary specialized education - 67%, work, and study - 80%, married, and have healthy children - 55%.
Voenno-medicinskij žurnal. 2020;341(9):31-36
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Functional state and performance of military personnel in the initial period of service

Tsygan V.N., Kim A.E., Kudryashov V.S.


Conscription for military service remains a dominant stressful factor for young people. The article analyzes the components of the stress factor that affect the functional state and performance of draftees in the initial period of military service, the primary mechanisms for the development of the state of maladaptation of the body of a military man are described. The main groups of characteristics of the psychophysiological state of draftees in the initial period of service are identified, based on which one can distinguish the factor structure of the functional state of military personnel. This allows you to determine the cardinal directions of the correction of the operational state, which are also presented in the article.
Voenno-medicinskij žurnal. 2020;341(9):37-41
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Experience in applying modern correction technologies for accelerated restoration of the functional state of flight personnel

Filatov V.N.


The article presents a course of modern corrective - recovery hardware technologies (inhalation of oxygen - xenon gas mixtures, adaptive biocontrol training, biomechanical correction of the musculoskeletal system, monochrome audio - visual stimulation) in flight personnel after intense professional loads. Persons in the leading group recorded a significant decrease in the median of the index of functional changes, changes in the structure of the spectrum of the variability of heart rhythm, indicating normalization of the neurovegetative balance, an increase in the relative values of the power of the alpha rhythm of the brain. The positive effect of the course of corrective procedures on the subjective state of the flight crew is demonstrated. The fundamental possibility of using modern corrective - recovery hardware technologies in the conditions of the military unit was confirmed.
Voenno-medicinskij žurnal. 2020;341(9):42-46
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Voenno-medicinskij žurnal. 2020;341(9):46
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Description of modern standards for supplying medical equipment of sanatorium - resort organizations of the Ministry of Defense

Miroshnichenko Y.V., Dolgikh S.V., Stavila A.G., Rodionov E.O., Skibo I.A., Kiselev A.V.


Studies on the rationing of medical property for sanatorium - resort organizations of the Ministry of Defense of Russia are presented. The norms for supplying medical property, adopted for them in 2020, incorporate the latest medical and pharmaceutical science and practice; they are the result of the consensus of leading Russian scientists and practitioners working in the field of military health. A brief description of the new standards for the supply of medical property is given, their features, and the procedure for using them to determine the needs of military health resorts in medicines and medical devices are disclosed. In order to achieve flexibility in restructuring the work of military health resorts depending on the changing tasks set by the leadership of the Ministry of Defense, a mechanism should be put in place to review the supply standards of medical institutions as a whole or in certain areas at least once every five years.
Voenno-medicinskij žurnal. 2020;341(9):47-53
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Rational perioperative prevention of infectious and inflammatory complications of prostate surgery

Krainyukov P.E., Bonetsky B.A.


The study included 195 patients who underwent robot - assisted prostatectomy. In group I (n=97), prolonged perioperative antimicrobial prophylaxis with Cefazolin at a dose of 1000 mg was performed for 7 days, in group II (n=98) - rational perioperative antimicrobial prophylaxis with Cefazolin at a dose of 1000 mg no more than 72 hours. Infectious and inflammatory complications occurred in 17 (17.53%) patients of group I and 14 (14.29%) of group II. The prevailing complication was urethritis - 9.28 and 7.14%, respectively. Reducing the use of antibiotics according to the principles of rational antimicrobial prophylaxis does not significantly affect the frequency and structure of infectious and inflammatory complications of robot - assisted prostatectomy.
Voenno-medicinskij žurnal. 2020;341(9):54-55
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Legal forms of public - private partnership in healthcare

Sushilnikov I.S.


The legal forms of instruments used in practice in healthcare are analyzed. Examples are given from Russian and foreign practice, statistics on the use of public - private partnerships in the healthcare sector. Traditional tools and new ones are considered - an exclusive investment contract, a life cycle contract, and an offset contract. The ratios of these forms of interaction between the state and business in public - private partnerships, their compliance with the criteria for trust management agreements, participation in the capital of a private partner, and leasing are shown since these legal relations are governed exclusively by civil law. Given the dynamics of the implementation of defense projects in 2019-2020, it can be stated that the public - private partnership in Russia is at the initial stage of its development.
Voenno-medicinskij žurnal. 2020;341(9):56-58
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A process approach to managing the quality and safety of patients with superficial thrombophlebitis of the lower extremities against the background of varicose disease of the lower extremities

Voskanyan Y.E., Nikolaev K.N., Kurdyukov S.I., Golubov E.A., Chemurziev R.A., Alborov Y.R.


The results of the treatment of 153 outpatients and inpatients (2005-2011) with varicose veins of the lower extremities complicated by superficial thrombophlebitis, which, depending on the duration of the operation, were divided into three groups. In the 1st (n=46) radical phlebectomy was performed as soon as possible from the onset of the disease, in the 2nd (n=31) radical phlebectomy was performed up to 14 days from the onset of the disease, in the 3rd (n=76) patients received conservative treatment followed by a delayed operation. A standardized approach to the choice of tactics and treatment planning was applied in all groups based on process analysis, network planning of examination and treatment, measurement of process indicators, and performance indicators. The nearest results were studied up to 75 days, long - term - up to 5 years. The best results soon were in the 3rd group. According to long - term results, no significant intergroup differences were revealed.
Voenno-medicinskij žurnal. 2020;341(9):58-61
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The use of bioacoustic psychocorrection in the comprehensive rehabilitation of military personnel with various mental disorders who were injured in counter - terrorism operations

Bulavin V.V., Filatov V.N., Kal’manov A.S., Yaroshenko V.P., Vorona A.A., Zueva L.V., Remizov Y.I., Amirov A.M.


Mental disorders were studied in 480 wounded injured in a counter - terrorist operation in Dagestan (1999-2001). Mental disorders were diagnosed in 408 wounded, divided into clinical groups: psychological stress reactions (50.8%), pathological psychogenic reactions (28.9%), post - traumatic stress disorders (20.3%). The use of classical medical and psychological rehabilitation methods using bioacoustic correction contributes to the successful rehabilitation of the wounded, increasing social activity, and the quality of life of the wounded.
Voenno-medicinskij žurnal. 2020;341(9):62-65
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Laparoplasty of the pyelourethral segment with hydronephrosis in young military personnel

Protoshchak V.V., Sivakov A.A., Kushnirenko N.P., Karandashov V.K., Sinel’nikov L.M.


The article is devoted to the treatment of hydronephrosis by the laparoscopic method in young military personnel. A clinical case of using endoscopic equipment when performing a pyelourethral segment plastic surgery with hydronephrosis in a contractual soldier of 19 years is described. In his example, the methods of diagnosing hydronephrosis, the features of laparoscopic pyeloureteroplasty, the course of the postoperative period, and solving the issue of the military-medical examination are considered. The use of the laparoscopic method ensures the restoration of an adequate outflow of urine from the kidney, making it possible not to change the patient’s fitness for military service and to return the serviceman to duty as soon as possible.
Voenno-medicinskij žurnal. 2020;341(9):65-66
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A case of tolerance to neprilysin inhibitors as a new factor in the cumulation of mortality in patients with chronic heart failure

Tsygvintsev A.A., Lishchuk A.N., Storozhilov V.A.


Based on four years of clinical experience with saсubitrile/valsartan use, the authors faced the problem of cumulation of mortality in patients. Long-term clinical observation of a comorbid patient who received adequate therapy of high functional class chronic heart failure, which ended in death, is presented. The concept of management of such patients used by us from the perspective of evidence-based medicine is considered.
Voenno-medicinskij žurnal. 2020;341(9):67-69
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Always in combat formation (on the history of the department of organization and tactics of the medical service of the Military Medical Academy)

Kulnev S.V., Shelepov A.M., Kryuchkov O.A.


The Department of Organization and Tactics of the Medical Service, which celebrated its 90th anniversary, is the leading department of the Academy, as well as the leading educational, methodological and scientific center of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation. The department has always taken an active part in the development, preparation and conduct of research command and staff and tactical and special exercises with the medical service of the Armed Forces, as well as in the stages of the «Military Medical Relay» with the medical staff of military districts (fleets), types of the RF Armed Forces and military branches, including the international stage. The department is currently developing scientific and practical tasks for the construction of medical services and medical support of the Armed Forces in peacetime and wartime, is preparing guidelines in its area, analyzing the effectiveness of medical support for troops (forces) in the daily activities of the medical service and combat conditions. The department is doing a great job of training qualified personnel of the medical service’s senior staff and military doctors for the military link.
Voenno-medicinskij žurnal. 2020;341(9):70-77
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Professor Vyacheslav Manassein (1841-1901): a doctor, an encyclopedic scientist, a public figure

Borodulin V.I., Poddubny M.V., Topolyanskii A.V.


The article is devoted to the activities of an outstanding Russian doctor, professor of the Medical and Surgical Academy Vyacheslav Manassein (1841-1901), whose 180th birthday will be celebrated next year. Manassein served as a professor in some therapeutic departments of the Academy from 1875 to 1892. Having an exceptional capacity for work, engaged in teaching, medical, and scientific work, he also created a scientific therapeutic school. It had a unique character in the last quarter of the 19th century. His social activities, which gained an all-Russian scale thanks to the weekly «Physician», published and published by Manassein (1880-1901). The authors used material from some central archives, first introduced into scientific circulation.
Voenno-medicinskij žurnal. 2020;341(9):77-86
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Voenno-medicinskij žurnal. 2020;341(9):86
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Voenno-medicinskij žurnal. 2020;341(9):87-88
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Voenno-medicinskij žurnal. 2020;341(9):88-90
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All-Russian Scientific and Practical Conference «Actual issues of maxillofacial surgery and dentistry»

Grebnev G.A., Zheleznyak V.A., Guk V.A., Chepik G.S.


In November 2019, the All-Russian Jubilee Scientific and Practical Conference «Actual Issues of Oral and Maxillofacial Surgery and Dentistry» was held based on the Kirov Military Medical Academy, dedicated to the 90th anniversary of the Department of Oral and Maxillofacial Surgery. The conference was attended by representatives of the dental community from Moscow and St. Petersburg and other cities of Russia. Participants’ reports were devoted to scientific and practical research on topical issues of maxillofacial surgery and dentistry, improving methods for the diagnosis, treatment, and prevention of diseases and injuries of the maxillofacial region, etc. A conference was held on the maxillofacial surgery and dentistry section of the Main Military medical department of the Ministry of Defense of Russia.
Voenno-medicinskij žurnal. 2020;341(9):91-96
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