Vol 340, No 4 (2019)

Improving the system of medical rehabilitation in the Armed Forces of the Russian Federation is carried out in accordance with the trends of civilian health care, with an emphasis on the specifics of military medicine. It is stated that medical rehabilitation should be carried out by specialists of the multidisciplinary team - a functional association of medical and non-medical professionals in the course of providing assistance in the field of medical rehabilitation. In the future, the activities of the multidisciplinary team will include the definition of a rehabilitation diagnosis using the international classification of functioning. Changing the nomenclature of specialties will require organizing the training (retraining) of specialists in the specialty «Physical and Rehabilitation Medicine» in educational institutions of the Russian Ministry of Defense.

The possibilities of improving the quality of diagnosis and treatment of acute appendicitis by identifying the correlations of its clinical manifestations and diagnostic polymorphism of morphological changes of the appendix, as well as diagnostic methods of this surgical pathology are analyzed. Out of 361 patients admitted for 3 years to a military hospital with clinical manifestations of acute appendicitis, the diagnosis was confirmed in 195 (54%). Of those who underwent laparoscopy, the operation at the diagnostic stage was completed in 12 (26.1%) patients, in 34 (73.9%) patients during laparoscopy, the diagnosis of the destructive form of acute appendicitis was confirmed. Of these, laparoscopic appendectomy was performed in 9 patients, other methods of appendectomy were performed in 25 patients. In all cases, the performance of diagnostic laparoscopy made it possible to clarify the diagnosis, and to avoid errors in the diagnosis of other diseases under the mask of «acute appendicitis.» It is important to note that when performing diagnostic laparoscopy and laparoscopic appendectomy there were no differences in clinical and morphological diagnoses. According to the results of work, in the diagnosis and treatment of acute appendicitis, laparoscopy is the primary method.

The localization of pneumonia, the microbiological spectrum and the sensitivity of pathogens to antibiotics in community-acquired and nosocomial pneumonia has been studied. The material for the study served as medical records of patients who were treated in clinics of the S.M.Kirov Military Medical Academy in the period from 2010 to 2017. The data obtained showed that pneumonia is more often localized in the lower lobes of the lungs. The main causative agent of community-acquired pneumonia is Streptococcus pneumoniae, nosocomial pneumonia is Klebsiella pneumoniae. Revealed high antibiotic resistance to pathogens of pneumonia. The causative agent of Klebsiella pneumoniae was resistant to the entire spectrum of antimicrobial agents studied, maintaining sensitivity in some cases only to colistin. Bacteriological analysis of pneumonia pathogens is necessary for subsequent timely targeted antibiotic therapy. Therefore, for effective treatment of pneumonia, it is important to continuously monitor pathogens and their sensitivity to antibiotics.

The article assesses the current level of technical devices and dosage forms intended for the use of medical protective equipment, discusses global trends and prospects for their short-term and medium-term development. Considered foreign samples autoinjectors, portable inhalers, patch pump, nasal, transdermal and buccal forms. Presents indicators of the effectiveness of various dosage forms, their advantages and disadvantages, discusses ways to overcome the latter in the provision of medical care in the prehospital stages and in transporting the wounded and affected. When assessing the possibility of using medical protection in various technical devices or dosage forms, it is necessary to consider the characteristics of their manufacturability and the readiness of the domestic production base for mass production and state registration as medicines or medical products. It was concluded that in the short term for the development of domestic medical remedies it is advisable to introduce inhaled and intranasal forms of drugs for use in the prehospital medical care.

The article briefly describes the current state and prospects of cell engineering, additive manufacturing and tissue engineering in military medicine on the basis of analysis of domestic (РИНЦ) and foreign (Medline) scientific medical publications 2017-2018 . It has been found 14 relevant publications on the topic in Medline. Their analysis revealed the following. The researches abroad give much attention to the topic. Although despite the multibillion investments the results in the field are more than modest due to significant scientific and technical difficulties encountered by researchers and developers in this direction. That is why the current trend in employment of cell engineering, additive manufacturing and tissue engineering in military medicine is concentration of material and financial resources on applied research for medical provision at a theater of operation.

On the basis of a survey of 151 patients, diagnostic criteria for an unfavorable prognosis of mitral valve prolapse were revealed according to echocardiography. Transthoracic and transesophageal echocardiography, daily Holter ECG monitoring were performed. Repeated echocardiography was performed in 12-18 months. Statistical analysis of the material allowed us to identify criteria for poor prognosis of mitral valve prolapse according to echocardiography: severe mitral regurgitation, mitral valve leaflet thickness in diastole 6 mm or more, dilatation of the left ventricular cavity, dilatation of the left atrial cavity, dilatation of the mitral ring.

To increase the effectiveness of the rehabilitation of patients after surgical treatment of a rotator cuff rupture, 98 patients were examined and treated. It was revealed that the inclusion of exercises with dynamic controlled muscle tension in combination with thin layer pelotherapy in the medical complex, has an impact on the main clinical symptoms of the disease, regeneration processes, and contributes to an earlier restoration of the impaired functions of the shoulder joint, which is more significant than basic therapy.

Based on analyzes of the primary medical records of military medical organizations and dental offices of military units, the incidence of infectious and inflammatory complications after odontectomy was set at 17.7%. It has been shown that the use of a domestic antiseptic hydrogel containing collagen hydrolyzate, sodium alginic acid, sodium hypochlorite and antiseptics to prevent a blood clot in a post-extraction wound from decay reduces the incidence of infectious and inflammatory complications by 10.9%.

The article is devoted to the consideration of issues of organizational design of the medical service of the Russian army in the XVII - early XVIII centuries. The prerequisites and main directions of the evolution of the legal regulation of the organization of the medical service of the Russian army, as well as the duties of the medical (nursing) staff are indicated. A high-quality transition to the creation of the army medical service as a special organization with clearly defined work principles, staffing structure, a system of staffing the army with medical personnel was noted, which was reflected in Peter I’s «Military Regulations». The issues of creating a system for training domestic medical personnel and financing their work, the recruitment of the Russian army and navy with medical personnel, military medicine management.

A report on the held at the S.M.Kirov Military Medical Academy jubilee scientific and practical conference dedicated to the 80th anniversary of the departments of the organization and tactics of medical service fleet (with the course of the tactics and weapons of war fleet), naval surgery, training faculty physicians for Navy of the S.M. Kirov Military Medical Academy is presented.