Vol 345, No 2 (2024)

In the structure of sanitary losses at the stage of providing qualified surgical care (level 2) in a modern military conflict on a regional scale, the wounded make up 61.9% of the incoming flow, including the seriously wounded – 15.2%. 7.6% of the wounded need specialized surgical care for emergency indications at level 2, and 10.3% of the incoming flow of wounded need to be provided in advanced medical organizations of level 2–3. Specialized surgical care at the advanced stages of level 2–3 was provided in three options (models), depending on the developing medical and tactical situation. In a modern military conflict, it is impossible to implement a unified scheme for the provision of specialized surgical care; its organization is determined by the conditions of the conflict, the operational and medical-tactical situation. Timely and correct management decisions make it possible to quickly maneuver with forces and means - to carry out targeted strengthening of the stages of medical evacuation with the expected high volume of sanitary losses by specialized specialists from military medical organizations of the district and center, primarily general surgeons, orthopedic traumatologists and vascular surgeons. It is necessary to have an operational reserve of these specialists, and also to provide for short-term courses for general surgeons in traumatology, angiotraumatology, and transfusiology.

Osteoperforative methods for treating local defects of the articular cartilage of the knee joint remain the most common today. According to clinical protocols, 73 patients aged 20 to 40 years with local and deep defects of the cartilage of the femoral condyles, a comparative assessment of the effectiveness of methods of osteoperforative stimulation of chondrogenesis – tunneling and microfracture of the area of local articular cartilage defect was carried out according to the standardized VASH, KOOS, LKSS scales before surgery and after treatment. Tunnelization and microfracturing operations improved the patients’ condition on all scales (between-group differences are not significant). There was a trend toward higher levels of functional status in the group of patients using tunnelization. Despite the positive effect, patients are not completely satisfied with the results of treatment. Arthroscopy in both groups revealed partial replacement of the area of articular cartilage defects with scar tissue. The use of osteoperforative techniques in the treatment of local defects of the articular cartilage of the knee joint of III – IV degrees according to Outerbridge gives a limited effect, and tunneling and microfracture techniques have similar effectiveness.

The influence of sarcopenia on the development of general and hematological toxicity during chemotherapy in patients with locally advanced and metastatic pancreatic cancer was studied. The study included 66 patients with pancreatic cancer (average age 59.3 years) undergoing chemotherapy treatment. Sarcopenia was examined on computed tomographs with a slice thickness of 1.5 mm. The results of the study suggest that sarcopenia in patients with locally advanced and metastatic pancreatic cancer may be a predictor of worse survival prognosis. Also, sarcopenia, which, in fact, is a predictor of increased toxicity of chemotherapy, including associated with an increased risk of anemia and thrombocytopenia, leukopenia, although no significant differences were found. This confirms that sarcopenia does not have a drastic effect on hematological toxicity. The above circumstances should be considered in the process of chemotherapeutic treatment of patients with pancreatic cancer, and if sarcopenia is detected and hematological toxicity develops, appropriate therapy should be carried out in a timely manner.

The decrease in the incidence of tuberculosis among the Russian population contributed to the creation of conditions for a significant reduction in severe, chronic destructive forms of respiratory tuberculosis. These favorable trends are especially noticeable in the Armed Forces of the Russian Federation. Therefore, the basis of surgical interventions was segmental lung resections, performed mainly for tuberculoma. The medical histories of 420 patients with pulmonary tuberculoma who were hospitalized in a military hospital were analyzed. Among the patients we observed, complete clinical effect was achieved in 415 (98.8%) of patients, 5 (1.2%) patients were discharged with improvement. There were no deaths. The presented result was achieved thanks to the developed system of preoperative preparation of patients and competent management of the postoperative period provided for patients with tuberculosis.

In the field of treatment of gonarthrosis, the search for methods to enhance the analgesic effect of drug therapy and reduce the risk of adverse reactions of anti-inflammatory drugs is relevant. The author proposes the use of platelet-rich autologous plasma for these purposes, which has the ability to activate repair at the level of tissue structures, cell proliferation and stimulate angiogenesis in the lesion. The effectiveness of treatment of gonarthrosis with platelet-rich plasma against the background of standard systemic anti-inflammatory therapy was assessed. The data obtained indicate greater effectiveness of treatment of patients with gonarthrosis using platelet-rich plasma in comparison with the results of only basic therapy with oral non-steroidal anti-inflammatory drugs.

The effectiveness of treating diseases of the ENT organs using an ultrasonic device for jet-cavitation irrigation UZOL-01-«CH» KAVITAR (УЗОЛ-01-«Ч» КАВИТАР) with a built-in phototherapeutic complex was studied. Using this device reduced the treatment time by an average of 1.5 days compared to traditional methods. The technique is simple, painless and psychologically comfortable for the patient.

In 1892 a course in dental diseases was opened at the Imperial Military Medical Academy. For the management and teaching of the course, a single position was provided – a private assistant professor or a private teacher. The first private assistant professor of the course was the doctor of medicine Pyotr Fedorovich Fedorov, a graduate of the Military Medical Academy and an experienced naval doctor, who became interested in dentistry during his service on the White Sea. For 22 years he held the position of private assistant professor, despite the fact that the course of dental diseases was not included in the program of compulsory subjects. P. F. Fedorov is a mentor who trained a galaxy of students and subsequently supported them in the field of dentistry. An organizer who managed to overcome the prejudices of higher authorities and organize a system of dental care for lower ranks and officers in the Russian Imperial Navy.