Vol 341, No 9 (2020)

The widespread use of body armor to protect the chest and abdomen has led to the emergence of a new type of injury - a gunshot injury through the body armor. According to the formation mechanism, three main types of combat pathology can be distinguished. Wound, when the bulletproof vest is not penetrated, is characterized not only by external manifestations in the form of bruises of the skin and subcutaneous tissue but also by pronounced closed injuries of the internal organs of the chest and abdomen in the projection of a wound projectile. Non - penetration of the «soft» armored panel can also lead to penetrating injuries of the chest and abdomen. Through penetration of bulletproof vest, the severity and volume of gunshot damage can significantly increase due to deformation and dismantling of the bullet, the introduction of fragments of deformable shells, and damaged armor panel into the wound channel when a bullet hits a bulletproof vest at an angle of 20 degrees. And more, its elements ricochet, capable of inflicting severe wounds on both the soldier himself and those around him. These features must be taken into account when assisting the wounded at the stages of medical evacuation. The success of treatment depends on a detailed history of the wound, the timing of medical care, proper sorting, and a thorough clinical examination, including identifying the nature and extent of closed injuries of the chest and abdomen’s internal organs.

The work aimed to evaluate the effectiveness of the developed methods of physical rehabilitation in the treatment of patients with coronavirus infection (SARS-CoV-2). The study included 103 patients with confirmed coronavirus infection SARS-CoV-2 and damage to the lung tissue, including 84 men and 19 women, distributed in 2 groups. The 1st (primary) group (n=57, men - 49, women - 8, age 27-58 years, average - 38) included patients who underwent full rehabilitation measures at the first stage of treatment according to the temporary clinical recommendations of the N.N.Burdenko Main Military Clinical Hospital according to the technique developed in the department of physiotherapy exercises. The 2nd (control) group (n=57, men - 35, women - 11, age 26-64 years, average - 35) included patients whose rehabilitation measures turned out to be limited due to their admission to the hospital at the stage of coordinating tactics their treatment using physical therapy methods. Positive dynamics of indicators reflecting resistance to hypoxia (Stange and Genchi tests) was noted in both groups, but in the 1st group, it was significantly (p<0.05) more significant and amounted to 38% in the Stange test (from 34 to 47 s ), according to the Genchi test - 46% (from 24 to 35 s). Against the background of the inclusion in the treatment program of measures for physical therapy in the 1st group, the excursion of the chest increased significantly (p=0.005) from 2 to 7 cm.

The article presents data on the prevalence and structure of chronic diffuse liver diseases of non - viral etiology among military personnel whose service is associated with adverse military - professional factors. It was found that the frequency of these diseases in the group of military personnel of the radio engineering troops was 77.3%, among those engaged in diving and pressure chamber descents, 65.9%, among pilots of the Aerospace Forces of Russia 62.8%, in the group without an adverse military - professional factors - 69.5%. The most significant number of people with chronic non - viral liver pathology in the group of military personnel of the radio engineering troops is probably due not only to their low level of physical activity and higher body mass index but also to the influence of a microwave field that can enhance the damaging effect of lipid peroxidation.

Conscription for military service remains a dominant stressful factor for young people. The article analyzes the components of the stress factor that affect the functional state and performance of draftees in the initial period of military service, the primary mechanisms for the development of the state of maladaptation of the body of a military man are described. The main groups of characteristics of the psychophysiological state of draftees in the initial period of service are identified, based on which one can distinguish the factor structure of the functional state of military personnel. This allows you to determine the cardinal directions of the correction of the operational state, which are also presented in the article.

The study included 195 patients who underwent robot - assisted prostatectomy. In group I (n=97), prolonged perioperative antimicrobial prophylaxis with Cefazolin at a dose of 1000 mg was performed for 7 days, in group II (n=98) - rational perioperative antimicrobial prophylaxis with Cefazolin at a dose of 1000 mg no more than 72 hours. Infectious and inflammatory complications occurred in 17 (17.53%) patients of group I and 14 (14.29%) of group II. The prevailing complication was urethritis - 9.28 and 7.14%, respectively. Reducing the use of antibiotics according to the principles of rational antimicrobial prophylaxis does not significantly affect the frequency and structure of infectious and inflammatory complications of robot - assisted prostatectomy.

The results of the treatment of 153 outpatients and inpatients (2005-2011) with varicose veins of the lower extremities complicated by superficial thrombophlebitis, which, depending on the duration of the operation, were divided into three groups. In the 1st (n=46) radical phlebectomy was performed as soon as possible from the onset of the disease, in the 2nd (n=31) radical phlebectomy was performed up to 14 days from the onset of the disease, in the 3rd (n=76) patients received conservative treatment followed by a delayed operation. A standardized approach to the choice of tactics and treatment planning was applied in all groups based on process analysis, network planning of examination and treatment, measurement of process indicators, and performance indicators. The nearest results were studied up to 75 days, long - term - up to 5 years. The best results soon were in the 3rd group. According to long - term results, no significant intergroup differences were revealed.

The article is devoted to the treatment of hydronephrosis by the laparoscopic method in young military personnel. A clinical case of using endoscopic equipment when performing a pyelourethral segment plastic surgery with hydronephrosis in a contractual soldier of 19 years is described. In his example, the methods of diagnosing hydronephrosis, the features of laparoscopic pyeloureteroplasty, the course of the postoperative period, and solving the issue of the military-medical examination are considered. The use of the laparoscopic method ensures the restoration of an adequate outflow of urine from the kidney, making it possible not to change the patient’s fitness for military service and to return the serviceman to duty as soon as possible.

The Department of Organization and Tactics of the Medical Service, which celebrated its 90th anniversary, is the leading department of the Academy, as well as the leading educational, methodological and scientific center of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation. The department has always taken an active part in the development, preparation and conduct of research command and staff and tactical and special exercises with the medical service of the Armed Forces, as well as in the stages of the «Military Medical Relay» with the medical staff of military districts (fleets), types of the RF Armed Forces and military branches, including the international stage. The department is currently developing scientific and practical tasks for the construction of medical services and medical support of the Armed Forces in peacetime and wartime, is preparing guidelines in its area, analyzing the effectiveness of medical support for troops (forces) in the daily activities of the medical service and combat conditions. The department is doing a great job of training qualified personnel of the medical service’s senior staff and military doctors for the military link.