Vol 341, No 10 (2020)

The article presents the results of an experimental study of neuromuscular transmission disorders caused by acute poisoning with a model organophosphorus compound dimethoate. In order to diagnose synaptic transmission disorders, methods of single and rhythmic stimulation electromyography were applied. It was found that the most characteristic and early EMG signs of acute poisoning with organophosphorus compounds are repeated M - responses and the phenomenon of decrement - increment during rhythmic stimulation with a frequency of 10-30 Hz. The diagnostic sensitivity of high - frequency rhythmic stimulation is higher than the routine technique used at a stimulation frequency of 3 Hz. Organophosphorus - induced synaptic transmission disorders are due to cholinergic hyperreactivity and prolonged activation of H - cholinergic receptors. The results of this study can be used both in the diagnosis of poisoning by unknown poisons, and to establish the fact of violation of neuromuscular transmission and assess its severity during intoxication with organophosphorus compounds.

The study aimed to assess the correlation of ultrasound examination results with the data of computed and magnetic resonance imaging in the diagnosis of structural changes in the kidneys in a military clinical hospital. One hundred twenty - one patients were examined, including 35 women aged 68.3±12.8 years and 86 men aged 68.5±14 years. A high and very high connection (rЈ0.7) was found in neoplasms, calculi and simple (type I according to Bosniak) cysts as a result of an unambiguous interpretation of the echographic picture based on a characteristic sign of structural changes: hyperechoic - calculus, anechoic - cyst, vascular weakly echogenic against the background of the parenchyma - a neoplasm. With complicated cysts (types II-III according to Bosniak), peripelvic cysts with and without expansion of the cavity system, moderate and noticeable correlations were established (r>0.4 and r<0.69). The proposed scoring of the diagnostics’ complexity is aimed at leveling the often - unjustified expectations of the accuracy of ultrasound results by attending physicians.

The study was carried out in the period from 2010 to 2019 in 88 patients with sternomediastinitis after cardiac surgery (mean age 63.4±one year). Depending on the treatment tactics, the patients were divided into three groups: group 1 (comparisons, n=48) - the «traditional» method of treatment was used; group 2 (primary, n=20) - the technique of local negative pressure (vacuum therapy) was used as monotherapy; group 3 (primary, n=20) - vacuum therapy in combination with bacteriophages. In 10 patients from each group, randomly selected on the 3rd, 7th, and 14th days, venous blood sampling was performed to determine the dynamics of indicators of the immune status. Upon admission, all patients showed a decrease in the immunoregulatory index to 0.6±0.14 units (half the norm). In group 3, average indicators of cellular immunity were observed already from the 3rd day, the immunoregulatory index on the 7th day was 1.5 units. In groups 1 and 2 - mild compensatory dynamics, imbalance of CD4 and CD8 subpopulations of T-lymphocytes, immunosuppression. On the 14th day, the T- and B-lymphatic link cells, NK-cells, were at the lower limit of the norm, and the immunoregulatory index (1.2 units) did not reach optimal values. On the 7th and 14th days, normal immunological parameters were significantly more often detected in group 2 (p=0.05), on the 3rd, 7th, and 14th days - in group 3 (p=0.05).

In modern thoracic surgery, minimally invasive methods of surgical treatment using video thoracoscopy are widely used. Video thoracoscopic resections of a small volume are performed, «large» pulmonary resections, which are commonly understood as forehead, biloba, and pneumonectomy, are performed only in the form of video - assisted interventions. We used video - assisted lung resections with video support for tuberculosis in 96 patients aged 18-54 years, all under general anesthesia with separate mechanical ventilation. The results confirmed that minimally invasive accesses under the control of video thoracoscopy in patients with pulmonary tuberculosis contribute to a reduction in the morbidity of surgical interventions, the duration of postoperative rehabilitation, and a significant decrease in the period of inpatient treatment and its cost.

The article presents the materials on the 18 days treatment of a 72 - year - old patient who had been for 18 days at the P.V.Mandryka Central Military Clinical Hospital with a severe form of coronavirus infection COVID - 19, complicated by bilateral polysegmental pneumonia. Comorbid pathology: type 2 diabetes mellitus, subcompensation of carbohydrate metabolism; cardiac ischemia; exertional angina, II functional class; atherosclerotic cardiosclerosis; paroxysmal supraventricular tachycardia; chronic heart failure 2A degree; hypertension stage 2, arterial hypertension - 1, risk 4. The patient was admitted in a stable condition without signs of respiratory failure. During the day, there was a lightning - fast deterioration requiring a transfer to the lungs’ artificial ventilation, followed by ventilation in the prone position. On the 8th day, extubation was performed. On the 18th day, he was discharged in a satisfactory condition.

The article describes the possibilities of the reflexology room for the planned treatment of service members under contract and conscription, reserve and retired, members of families of military personnel, and patients under voluntary medical insurance programs and the provision of paid services. A vast arsenal of reflexotherapy methods has been introduced into the practice of complex treatment of service members with exceptional working conditions, which achieves a stable positive effect in 98% of cases. The relief of neuropsychic stress (neurotic reactions, asthenic states) is noted in 95%, and the normalization of the psychophysiological state of service members - in 99% of cases.

The functional state of the organism of 30 conscripts aged 19-20 with autonomic dysfunction syndrome was assessed. Using the QOL questionnaire SF-36, the effectiveness of complex standard and osteopathic methods of treating patients with autonomic dysfunction syndrome was revealed.

The clinical characteristics of acute peripheral paralysis, or Guillain-Barre polyradiculoneuropathy, are given. An example of the use of acupuncture in the treatment of this disease in severe form is provided. The high efficiency of applying various acupuncture techniques as part of the complex therapy of polyneuropathy has been shown. Their use is recommended for military medical organizations with an acupuncture room as part of the physiotherapy department.

The conduct of a civil war differs from other wars not only in tactics and strategy but in the particular importance of organizing medical affairs, in the forms of the evacuation of the wounded from the battlefield, since in conditions of civil confrontation, the attitude towards the wounded becomes a weapon of ideological struggle. The civil war in Russia took place on different fronts and often in various forms. The intensity of the clashes, the relationship between the army and the local population was due to the natural and climatic conditions. Primary care for the wounded in a civil conflict often took the form of improvisation. The article attempts to reconstruct military doctors’ daily activities in the specific conditions of the Northern Front, specifically its Arkhangelsk region. Due to the limited source base, the author used a set of sources of different nature, applying the procedure of their cross - checking.