Vol 344, No 12 (2023)

The results of an analysis of special domestic literature devoted to blast injury, and explosives are presented. Modern approaches to the classification of damaging explosion factors are shown. Cases from expert practice are presented that confirm that the existing classification of damaging factors of an explosion does not consider the damage caused by the explosion because of the detonation of ammunition located in the victim’s clothing. It is proposed to include a quaternary damaging factor in the classification of the damaging factors of an explosion: parts of the ammunition in a person’s uniform or clothing (cartridges, bullets, cartridges), magazines for firearms and their fragments that cause damage due to the detonation of the said ammunition.

Based on the results of a survey of 606 ophthalmologists from different regions of Russia, factors influencing the decrease in the effectiveness of primary antiglaucoma surgery were identified and graded. These included: advanced stage of primary open-angle glaucoma at the stage of primary surgery, low patient adherence to treatment and the duration of use of drug-based antihypertensive topical therapy prior to surgical treatment. The decision on reoperation was mainly influenced by increased intraocular pressure and negative visual function changes, while patient age and primary open-angle glaucoma in the fellow eye were less significant factors. The most commonly used option for reoperation after a previously performed classical trabeculectomy is drainage surgery or a similar operation in a different meridian. The data obtained necessitate the formation of «risk groups» for the development of early decompensation of the surgical treatment performed, the development of algorithms for the management of patients with primary open-angle glaucoma in the event of «failures» of primary surgery, indications for reoperation and criteria for choosing a method of re-intervention.

Emergency surgical treatment of patients with locally advanced colorectal cancer complicated by bleeding, intestinal obstruction, continued growth with tumor recurrence after complex treatment is a laborious task, primarily due to the occurrence of postoperative infectious complications. The scheme of accompanying therapy proposed in the article makes it possible to more often use active surgical tactics in such palliative patients, to minimize general complications, postoperative infectious complications and mortality. 64 patients were examined and operated on, divided into main and control groups of 32 people each. In the primary group, unlike the control group, patients received accompanying therapy. The authors developed accompanying therapy to prepare patients before surgery, during surgery, and in the postoperative period, and this choice of rational surgical tactics enabled a significant reduction in the number of postoperative infectious complications and mortality.

The article is devoted to the ethical problems of informing patients with an oncological diagnosis. The principles of informing patients, including incurable patients, developed in Soviet medical deontology are analyzed. The authors noted that the principle of «benevolent deception», adopted in relation to incurable patients, is undergoing evolution in domestic oncology, but has not been completely overcome. The arguments for and against doctors concealing an oncological diagnosis from incurable patients, as well as the requirements of Russian legislation regarding the observance of patient rights, are considered. Particular attention is paid to informing the patient and tactics for communicating an unfavorable diagnosis in modern Russian oncology.

Currently, persons entering the military service in the Armed Forces of the Russian Federation on conscription and under contract are not examined for the presence of latent tuberculosis infection. This reduces the quality of dispensary observation of this risk group, although, according to the results of studies in the 80s of the last century, persons with a hyperergic reaction to the Mantoux test developed tuberculosis 11 times more often than colleagues without risk factors. The proportion of St. Petersburg citizens aged 15–17 who are under dispensary observation because of examination of persons of this age group, latent tuberculosis infection is detected in 0.5–0.9% of cases. We consider it necessary to organize a survey of persons entering the military service for the presence of latent tuberculosis infection at the stage of military commissariats with the results entered into the medical examination cards of conscripts.

A mobile small-sized installation for plasma processing of medical waste with a capacity of 180 kg/h (1300 tons per year) has been developed for operation in both stationary and mobile versions. The design of a plasma furnace for this installation is proposed, the results of mathematical modeling of ongoing thermal processes are presented, and the calculation of temperature fields in the steady-state operating mode of the plasma furnace is performed. Both plasmоtrons and a bottom heater can be used as a heat source in a plasma furnace. The presence of both heat sources in the furnace design increases the reliability of the installation.

The role and practical significance of the metrological support of the military medical organizations of the Russian Ministry of Defense to maintain and maintaining their potential capabilities to provide medical care are shown, since the presence of certified measuring instruments gives the right to license medical activities (or confirmation of an already obtained license). The mechanisms for verification of medical measuring instruments are disclosed. Reducing potential possibilities leads to a decrease in the quality and safety of medical activities. Options for choosing managerial decisions are proposed to reduce the loss of potential capabilities of military medical organizations and, as a result, fulfill licensing requirements in the implementation of medical activities. A detailed analysis of the results of the activities of the metrological unit - the Central Laboratory of Measuring Equipment (Medical) of the Russian Ministry of Defense revealed several problematic issues in the activities of military medical organizations, and ways to solve them were determined.

Recanalization of chronic occlusions of the coronary arteries is a complex and difficult procedure, associated with a high incidence of intraoperative complications. One of the most serious complications is the perforation of the artery wall with a metal conductor. The article presents the experience of using endovascular balloon hemostasis to treat perforations, on the basis of which it is concluded that achieving endovascular hemostasis through long-term inflation of a balloon in perforation of the coronary artery, which arose in the process of recanalization of chronic occlusion of the coronary bed, is a relatively safe and effective method of stopping bleeding and treatment of this complication. It is important to note that this method requires a highly skilled operator and must be accompanied by continuous monitoring of vital signs.

The 1033rd Center for State Sanitary and Epidemiological Surveillance of the Ministry of Defense of the Russian Federation is the leading sanitary and epidemiological organization of the Northern Fleet. In peacetime and wartime, the specialists of the center have made and are making a significant contribution to ensuring the sanitary and epidemiological well-being of the forces (troops) of the Northern Fleet. Employees of the organization took an active part in the fight against a new coronavirus infection in responsibility.