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Vol 342, No 7 (2021)


Experience in organizing primary health care in the context of the COVID-19 pandemic in the treatment and diagnostic center of the Ministry of Defense

Kuvshinov K.E., Klipak V.M., Kostycheva T.V., Zherebko O.A.


The features of the provision of primary health care in the multidisciplinary diagnostic and treatment center of the Ministry of Defense in the context of a pandemic of a new coronavirus infection are outlined. The treatment and diagnostic process were based on the developed algorithm for the work of doctors of treatment and diagnostic units, patient routing. The algorithm is based on the principles and methodological approaches to the diagnosis and treatment of a new coronavirus infection of the Ministry of Health of Russia. The accumulated experience of medical rehabilitation of patients who have undergone COVID-19 and vaccine prophylaxis is analyzed. The performance indicators of a medical organization were evaluated, confirming its sufficient efficiency and high clinical effectiveness.
Voenno-medicinskij žurnal. 2021;342(7):4-10
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Experience in using finite element analysis for predicting and diagnosing spleen injuries

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


The study aimed to study and assess the possibility of establishing the localization and nature of spleen injuries by using finite element analysis when simulating impact in the left hypochondrium. The mechanism of the formation of organ damage is considered. The possible localization and nature of the predicted damage to the spleen, depending on the power load, were established. Critical stresses, which indicate the possibility of rupture, arise on the spleen ligaments when the impact is over 1000 N and on the vascular pedicle - over 2000 N. At lower load indicators, non - critical stresses appear in these areas, which make it possible to predict the formation of subcapsular hemorrhages. Crushing and fragmentation of an organ occur when the impact is over 4000 N, which corresponds to the force of the blow of a professional boxer. Law enforcement agencies can use the results obtained in modeling the spleen injury to establish her injury.
Voenno-medicinskij žurnal. 2021;342(7):11-14
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Methods of prevention of thromboembolic complications in patients with atrial fibrillation

Patsenko M.B., Steklov V.I., Ivanov S.A., Danilov Y.A., Nugaeva N.R.


The analysis of studies devoted to methods of prevention of thromboembolic complications in patients with various forms of atrial fibrillation is presented. The main focus was on pharmacological methods for the prevention of ischemic stroke and systemic thromboembolism. The basic principles of choosing the optimal anticoagulant therapy, taking into account the risk factors for thromboembolic complications and bleeding, as well as patients’ polymorbidity, are outlined. The main indications for the use of oral anticoagulants are described. An algorithm for choosing the optimal anticoagulant therapy in patients with atrial fibrillation after percutaneous coronary intervention with the acute coronary syndrome and stable coronary artery disease, as well as with catheter ablation, has been demonstrated. Non - pharmacological methods for the prevention of thromboembolic complications are highlighted with a description of the main indications for implantation of occluders in the left atrial appendage, its surgical occlusion, or isolation.
Voenno-medicinskij žurnal. 2021;342(7):15-25
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Interrelation of indicators of a general blood test in male patients with the severe clinical course of COVID-19

Pomogaibo B.V., Baranova N.A., Zelenov M.V., Afonaskov O.V., Demyanenko A.V.


The study aimed to study the characteristics of the general blood test indicators of male patients with COVID-19 and to assess their relationship with the severity of the clinical course of the disease. A retrospective cohort study was carried out (96 men with COVID-19 who were treated in the period from September 15 to December 30, 2020): group No. 1 (n=54) - with a severe course and group No. 2 (n=42) - with a mild course (mild to moderate) during COVID-19. The average age was 60.2±1.1 years, the average time from the onset of the first symptoms to hospitalization was 6.8±0.3 days. In terms of age and indicators of objective research, the frequency of concomitant pathology, intergroup differences were not revealed. The predictive ability of NLR in ROC analysis was 0.71, which significantly exceeded the AUC of other hemogram parameters. An NLR level of more than 3.7 can predict a severe course of COVID-19 in male patients in middle and old age.
Voenno-medicinskij žurnal. 2021;342(7):25-30
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High surgical technologies in the treatment of the abdominal aortic aneurysm

Dolgikh R.N., Abrosimov A.A., Obraztsov A.V., Pinchuk O.V., Yamenskov V.V., Leonov S.V., Kryzhov S.N., Voronova M.A., Chernov G.A.


The aim of the study was to determine the influence of the anatomical features of the development of the visceral aortic arteries on the formation of endolics after arthroplasty of the abdominal aortic aneurysm. 54 endoprosthetics were performed. Endolic type II was diagnosed in 4 cases, including 3 cases of its spontaneous closure after 1-6 months. In one patient, the inferior mesenteric artery with a diameter of 2.8 mm was the source of endolysis. Endovascular treatment of an abdominal aortic aneurysm remains the prerogative of large vascular centers with extensive experience in surgical interventions on the aorta and the possibility of long - term patient follow - up. The postoperative examination protocol is aimed at identifying arterial blood flow between the endoprosthesis and the walls of the aneurysm (endolic), determining the dynamics of the size of the residual aneurysmal sac, as well as such mechanical changes in the device as migration, bending, and breakage of the stent - graft. The tactics of treatment for endolysis due to retrograde blood flow from the branches of the abdominal aorta (type II) is not fully defined, and its elimination often requires a non - standard, individual approach. A clinical example of a successful laparoscopic clipping of the inferior mesenteric artery performed to eliminate type II endolics is presented.
Voenno-medicinskij žurnal. 2021;342(7):31-34
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Topicality of pulmonary heart disease against under conditions of the COVID-19 pandemic

Sukmarova Z.N., Demyanenko A.V., Gudantov R.B.


The prevalence of pulmonary heart syndrome among patients in the intensive care unit of the «red zone» (n=48, including 28 men and 20 women, mean age 72.1±1 year) was studied and its dynamics was assessed. Echo - and electrocardiography were used as evaluation methods. Patients were treated for severe pneumonia COVID-19 (in intensive care) and were examined in a hospital 2-12 weeks after discharge. The proportion of patients with pulmonary hypertension in intensive care was 75%. Chronic cor pulmonale was detected in 25%, acute - in 27% of patients. The presence of signs of cor pulmonale (acute and chronic) correlated with death. Despite massive pneumonia therapy, in 37% of survivors, EchoCG signs of cor pulmonale persisted 26 days after discharge. Patients with signs of cor pulmonale were more likely to have shortness of breath in the long - term period after infection as compared with patients with normal pressure in the arteries of the small circle. ECG showed no corresponding changes in cases of chronic and acute cor pulmonale and is not the method of choice for its diagnosis in COVID-19.
Voenno-medicinskij žurnal. 2021;342(7):34-40
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Therapeutic and diagnostic algorithm in patients with cavities of the lungs

Chernekhovskaya N.E., Korzheva I.Y., Povalyaev A.V., Varaksin M.V.


A survey of 256 patients with lungs’ cavities - 211 (82.4%) men and 45 women aged 16 to 85 years was carried out. The following diagnoses were established: lung abscesses, peripheral lung cancer with disintegration, cavernous tuberculosis, true bronchogenic lung cyst, aspergilloma, emphysematous cysts and bullae, pulmonary echinococcosis. All patients underwent a complex radiation examination of the lungs, bronchoscopy with various types of biopsies, followed by bacteriological, cytological, and morphological studies of the biopsy material, as well as transthoracic aspiration biopsy. Sanitation bronchoscopy was performed in 146 patients with lung abscesses. Based on only X-ray methods, it was possible to establish the nosological form of the lung cavity formation in 204 patients (79.7%). With the combined use of radiation diagnostic methods, bronchoscopy with various types of biopsies, and transthoracic puncture biopsy followed by morphological examination of the biopsy material, the correct diagnosis was established 100% of patients. In patients with lung abscesses who received NO-therapy in complex treatment, there was a significant decrease in clearing the abscess cavity.
Voenno-medicinskij žurnal. 2021;342(7):40-46
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Comparative characteristics of the results of objective and subjective methods of studying astigmatism before and after cycloplegia

Egorov A.N., Kamenkova E.A., Egorov V.A., Pravilnikova P.A.


The work aimed to assess the results of the study of astigmatism by subjective and objective methods before and after cycloplegia in military personnel and to clarify the degree of accuracy in determining and correcting astigmatism. We used the subjective method of studying the Krichagin-Volkov refraction and the objective one - skiascopy and refractometry simultaneously in 76 people (152 eyes). The results of the study showed high accuracy of refractive indices with subsequent spectacle correction of astigmatism using the Krichagin-Volkov method in conjunction with skiascopy. The study of astigmatism by three methods at a young age without the use of cycloplegia is unacceptable. In the absence of an autorefractometer in the ophthalmological office, the selection of cylindrical and spherocylindrical corrective glasses using the Krichagin-Volkov method is irreplaceable.
Voenno-medicinskij žurnal. 2021;342(7):47-52
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Experience in the therapeutic use of an infrared laser in the complex treatment of metabolic eye disorders

Orlovskaya L.E., Borodin S.V., Nefedov N.A., Tarasenkov V.N.


The study aimed to evaluate the clinical effectiveness of laser puncture of biologically active points in the treatment of metabolic diseases of the eyes, methods of its application in the pathology of the anterior segment of the eye and the macular zone. Laser puncture of biologically active points has several advantages over acupuncture and their electrical stimulation: there is no need for acupuncture needles, which eliminates the pain factor during treatment, excludes the possibility of transmission of infection, wider indications for use. The procedure is safe and well - tolerated. The results were evaluated according to patient complaints, visual acuity, clinical picture, and the level of the critical flicker frequency of the light source. In most cases, an improvement or stabilization of the pathological process was noted.
Voenno-medicinskij žurnal. 2021;342(7):52-58
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Microbiological monitoring of acute respiratory viral infections in a military collective

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


Microbiological monitoring of acute respiratory viral infections was carried out during four epidemic seasons (2016-2017, 2017-2018, 2018-2019, and 2019-2020) among the military personnel of the same partially replaced team of 480-500 people. In patients with acute respiratory diseases (96-101 people), polymerase chain reaction studies were carried out to identify etiological agents. It has been established that in recent years, against the background of specific prophylaxis of influenza, the etiology of acute respiratory viral infections has changed: the leading role belongs to viruses of non - influenza etiology. The detection rate for adenoviruses was 64-76%, rhinoviruses - 42-44%, influenza A - 15.2%. The focus of preventive measures against acute respiratory viral infections should be comprehensive, with adherence to vaccination against influenza and the use of non - specific protective equipment for military personnel.
Voenno-medicinskij žurnal. 2021;342(7):59-63
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Economic substantiation of the need for a military medical organization in medical equipment

Levchenko V.N., Kolesova E.A., Sedykh A.A.


The quality of medical care is directly dependent on timely reliable instrumental diagnostics and treatment, which is directly related to the provision of military medical organizations with modern medical equipment. The authors propose economically sound calculation methods for planning purchases, use, and write - off of medical equipment. The described methods and the calculations made will help to make the right management decisions on the issues of medical supplies.
Voenno-medicinskij žurnal. 2021;342(7):64-67
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Experience in the use of thermal heliox when carrying out rehabilitation measures for patients after suffering a coronavirus infection

Krainyukov P.E., Demyanenko A.V., Afonaskov O.V., Efremova A.A.


Patients with COVID-19 with moderate and severe forms of lung damage, respiratory failure are especially in need of rehabilitation. The most attractive method of long - term and safe oxygen supply is the use of a thermalized mixture of oxygen and helium (t-He/O2) - Heliox. The results of its implementation in 18 patients were analyzed. On days 2-3 after the start of rehabilitation therapy with heliox, the oxygen saturation in the blood increased by 3-4%, gas exchange improved, the need for oxygen therapy and artificial ventilation decreased, the symptoms of respiratory failure decreased, and the dynamics of the process of resolving pathological changes in the lungs was accelerated, earlier recovery of performance.
Voenno-medicinskij žurnal. 2021;342(7):68-70
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Some tactical and technical approaches in the treatment of patients with coccygeal epithelial passages

Kuznetsov S.M., Kosolapov Y.L., Struchkov A.G., Gordeenok F.D., Loginov O.S.


The problem in the treatment of coccygeal epithelial passages is the choice of the method and method of rehabilitation of patients in the postoperative period. When applying primary sutures to the wound after excision, there is a high proportion of complications and relapses. The use of the technique of suturing the edges of the skin to the bottom of the wound is accompanied by an increase in the healing time up to 1.5 months or more. Open management of a postoperative wound is characterized by a minimal percentage of relapses, but its healing time increases from several months to a year. Plastic surgery with wound closure with a displaced flap is not widely used. Therefore, in each specific case, the most optimal tactical and technical approach is chosen.
Voenno-medicinskij žurnal. 2021;342(7):71-73
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Experience of using endovasal laser obliteration (coagulation) in the treatment of varicose veins of the lower extremities in a military hospital

Ivanov G.G., Stetsenko B.G., Diveev V.A., Siryakov M.V., Gazeev R.R., Vasenin S.A.


The article presents the results of the treatment of 541 patients suffering from varicose veins of the lower extremities, in the treatment of which a diode semiconductor laser «LAMI» (Russia) was used. Conclusions are made about the effectiveness and safety of its use; long - term results are assessed.
Voenno-medicinskij žurnal. 2021;342(7):73-75
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On the effectiveness of using nitrogen - siliceous thermal baths in combination with sulphide - silt mud in the treatment of lumbosacral radiculopathy

Skorikova A.V., Bai S.A., Tikhanskii S.N., Pal’chevskii D.A., Abakumov V.E., Glushko M.V., Voloshinova M.V.


An analysis of the effectiveness of the use of nitrogen - siliceous thermal baths of the Nizhneparatunsky springs combined with the Medvezhye Lake peloid in the Kurgan region in 112 patients with lumbosacral radiculopathies is presented. It was found that with the combined use of nitrogen - siliceous thermal baths and sulfide - silt mud, the time to achieve the expected positive effect on the part of the injured limb is reduced. This is confirmed by a significant decrease in the magnitude of the current required for a pronounced but painless muscle contraction during electroneuromyostimulation by 6-8 mA for the full course of treatment.
Voenno-medicinskij žurnal. 2021;342(7):76-78
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Lenta novostey

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Voenno-medicinskij žurnal. 2021;342(7):78
pages 78 views

Patriarch of Russian Ophthalmology (to the 100th anniversary of the birth of Major General of the Medical Service V.V.Volkov)

Kulikov A.N., Reituzov V.A., Sobolev A.F., Kirillov Y.A., Shamrei D.V.


The article presents a brief biography and main directions of scientific activity of the Hero of Socialist Labor, laureate of the USSR State Prize, Honored Scientist of the RSFSR, Professor Major General of the Medical Service Veniamin Vasilyevich Volkov (1921-2019).
Voenno-medicinskij žurnal. 2021;342(7):79-87
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On the occasion of the 140th anniversary of the formation of the Pirogov Russian Surgical Society (1881-1930)

Kozovenko M.N.


The Pirogov Russian Surgical Society was founded 140 years ago in St. Petersburg. One of his most important achievements was the creation and organization of the N.I.Pirogov Surgical Museum (1897-1930) as a museum and scientific complex. Here, not only a unique collection of Pirogov relics was presented, but also regular meetings of seven medical societies, congresses of Russian surgeons, and other medical forums were held. Over time, the assessment of the achievements of the Pirogov Russian Surgical Society began to include erroneous information. In this regard, the purpose and structure of the Pirogov Surgical Museum as a museum and scientific complex are indicated. The article reflects the conditions for its transfer to the Military Medical Academy of the Red Army and the liquidation of the Pirogov Russian Surgical Society in 1930, as well as the disbandment of the museum (1935) with the transfer of museum funds to unqualified curators. The implementation of the return transfer of Pirogov and other relics (1948) was a result of the formation of the Military Medical Museum and the opening of the Pirogov hall as part of the museum exposition (1951). Opening of the «Pirogov Museum» as a result of the reconstruction of the former Pirogov hall (2018).
Voenno-medicinskij žurnal. 2021;342(7):87-91
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Ofitsial'nyy otdel

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Voenno-medicinskij žurnal. 2021;342(7):92
pages 92 views

Lenta novostey

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Voenno-medicinskij žurnal. 2021;342(7):93-96
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