Vol 339, No 6 (2018)

June 20, 2018 marks the 50th anniversary of the founding of the Vishnevsky 3rd Central military clinical hospital of the Ministry of Defense of Russia. Today the hospital is one of the leading medical and scientific institutions of the Armed Forces of the Russian Federation. The main medical and scientific directions of his work are cardiosurgery, cardiology, urology, neurosurgery, neurology, combat surgical and therapeutic pathology, early rehabilitation of wounded and sick military personnel, etc. The hospital is a large methodical and educational center of medical service, an institution with rich experience of practical work in conditions of military and peacetime.

The article deals with the implementation of human rights in the sphere of postmortem donation and transplantation of organs and (or) tissues in the Russian Federation. The main problems of the functioning of the «presumption of consent» model in the country, in particular, the lack of an effective mechanism for realizing somatic human rights in the sphere of postmortem donation and transplantation, are revealed.

The article presents the results of examination of 86 patients with the syndrome of compression of the celiac trunk with hemodynamically significant compression of the vessel, confirmed by instrumental methods of investigation - radiopaque aortography, computed tomographic angiography and color duplex scanning. Surgical methods of treatment (47 patients) included conditionally reconstructive operations (45), reconstructive (1), laparoscopic decompression (1). The nearest results are regarded as positive (good and satisfactory) in 78.7% of those operated. In the nearest postoperative period, complications arose in 10 (21.3%) patients, including reactive pancreatitis, pulmonary embolism, partial divergence of aponeurosis sutures, acute cerebrovascular accident, post-vaginal complications (gastrostasis), erosive hemorrhagic gastritis. Postoperative mortality was 2.1%. In a remote period of 38 patients, good results were achieved in 19 (50%), satisfactory in 15 (39.5%), 4 (10.5%) patients had frequent exacerbations of chronic cystic pancreatitis, acute pancreatitis, Mallory- Weiss, frequent exacerbations of peptic ulcer with the formation of stenosis of the bulb of the duodenum.

The efficacy of surgical treatment of 10 patients with a diagnosis of prostate cancer was assessed, which transferred extraperitoneoscopic intrasfacial nerve-sparing radical prostatectomy while preserving the pubovesical complex. Criteria for the effectiveness of this method of surgical treatment were the preservation of erectile function and the absence of incontinence in the early and late postoperative period. As a result of treatment, urine retention was noted in all patients in the postoperative period; in 3-4 months there was a restoration of erectile function without additional stimulation with inhibitors of phosphodiesterase type 5. This technique of prostatectomy involves a detailed understanding of the surgical operative anatomy of the prostate by the surgeon and strict adherence to the basic surgical principles of nerve-sparing in order to significantly improve the quality of life of patients.

The article deals with the acute issues of aortic heart valve replacement in elderly patients (n=487, age - 58-91 year, average age - 69.5±21.5 years). The implantation of the artificial aortic valve for its defect is performed in all patients. The majority of those operated had other diseases of the cardiovascular system, most often the defect of the mitral valve, aortic stenosis, arterial hypertension. The technique of implantation, the results achieved during treatment are described. The five-year survival rate of patients was 98.7%. It was not achieved only in patients whose age at the time of the operation was more than 90 years. The lethal outcome was due to other causes and was not related to the implant operation or the consequences of its implantation. Quality of life of patients after the operation did not deteriorate. The objective mechanical reliability of the implant is underlined.

The aim of the study was to improve the diagnosis of the condition of the tear duct with the help of radial methods and to evaluate the diagnostic significance of cone-beam computed tomography. An analysis of the results of cone-beam computed tomography with contrasting of the tear ducts in 32 patients with suspected stenosis or obstruction was performed. It is established that this method of research allows to accurately visualize the anatomical and topographic features of the lacrimal pathways, to determine the state of the skull bone structures surrounding them, the level and severity of the narrowing and obstruction of the lacrimal ducts, their possible causes - diverticula, neoplasms, concrements. CT scan data allow you to select the most effective method of treatment. The relatively low cost of the study and the low radiation dose of the patient are an important advantage of cone-beam computed tomography in comparison with multispiral computed tomography.

The informational significance of the indices of computer stabilography for the evaluation of the functional capabilities of the pilot’s body under mental stress and psycho-emotional stress was determined experimentally. Correlation of the parameters of the spectrum of the stabilogram with the data of the heart rate variability, which characterize the activity of the autonomic nervous system after the mental load, is revealed. Changes in the parameters of the spectrum of the stabilogram were in the low-frequency zone both in the sagittal and frontal planes in the group with a deterioration in the quality of the equilibrium function. In the group with deterioration of postural stability after mental load, there is a marked increase in the functioning level of the sympathetic part of the autonomic nervous system, which is confirmed by the increase in heart rate variability. In the group of subjects with improvement of the postural function, the influence of the sympathetic part of the autonomic nervous system on the total power of the spectrum of heart rate variability was reduced. The data obtained are applicable for assessing the tolerability of mental loads in the survey of flight personnel and other persons whose professional activity is related to the impact on the body of extreme factors and adverse changes in its functional state.

The article is a brief description of the current state of the Japan Self-Defense Forces medical service and is based on the study of open access foreign sources. At the beginning, the general information about Japan, its Self-Defense Forces, and their medical service is presented. Then the medical service particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training.

The difficulties of diagnostics of small intestine diseases are considered, the clinical manifestation of which is often the so-called bleeding from an unidentified source. The analysis of clinical cases in the conditions of the department of emergency surgery of a military hospital is made and the main directions for solving the problem are formulated.

The complex of medical measures effective for manifestations in patients with enteric insufficiency syndrome was developed for the conditions of a general surgical hospital. 96 patients with acute intestinal obstruction were observed and treated. The curative program of the postoperative period included the draining of the small intestine, enterotrope therapy, the introduction of infusion antihypoxants. The treatment carried out made it possible to significantly improve the manifestations of enteric insufficiency syndrome, in a shorter time to restore the functional consistency of the small intestine.

Experience of antiepidemic support of the Belarusian offensive operation «Bagration». A comprehensive assessment of the sanitary and epidemiological situation in the temporarily occupied territory of the Byelorussian SSR in 1944 on the eve and during the Belarusian Offensive Operation «Bagration» was made. The peculiarities of the anti-epidemic protection system are discussed, which allowed minimizing losses in the Red Army troops and among the population from infectious diseases, and in the shortest time to carry out measures to prevent the mass spread and elimination of epidemic-dangerous diseases. The accumulated experience was used during the fighting in Afghanistan.

The information on the extraordinary reporting and election conference of the interregional public organization «Association of Veterans of the Military Medical Service», held on 1.02.2018 in Moscow, is presented. The conference was attended by members of the council of the association, delegates of regional associations, as well as veterans - representatives of military medical organizations in Moscow and the Moscow region (more than 160 people). It was decided to conduct organizational work to create new regional branches of the association in military districts and fleets, to intensify mentoring over young military medical specialists, patriotic education of the younger generation, and social protection of veterans. After the election of the new board of the association, Major-General of the Medical Service I.G.Kornyushko was elected its chairman.