Vol 21, No 2 (2019)

Articles
The effect of cardiopulmonary bypass on the morphological characteristics of red blood cells and the gas transmission function of blood
Khubulava G.G., Romanovskiy D.Y., Volkov A.M., Biryukov A.V., Skibro I.R., Butuzov A.G., Lyubimov A.I., Sizenko V.V., Didenko A.V.
Abstract
Investigate the effect of extracorporeal circulation on the erythrocyte morphology, the intensity of gas exchange in the body tissues of the patient was determined before the operation, during the operation and during the postoperative treatment using morphometric analysis of the form of erythrocytes. It was established that during the operation with artificial blood circulation, the ratio of the voltage of oxygen and carbon dioxide in arterial and venous blood changes, indicating a shift in the oxygen capacity of the blood. Since the oxygen concentration in the oxygenator is known and under constant control, a decrease in the oxygen capacity of the blood reflects the intensity of tissue respiration on the one hand, and the degree of mechanical damage to red blood cells on the other. The intensity of tissue respiration was judged on the basis of a previously unknown fact that the form of erythrocytes depends on the degree of their saturation with oxygen. It is noted that blood, saturated with oxygen (arterial) under normal conditions of gas exchange in the lungs, is 90-95% composed of small red blood cells (villous length 0,3-0,4 μm), venous blood is represented mainly by large vorous forms of red blood cells (villous length 0,4-1 μm). The form of red blood cells is reversible and changes both after passing through the lungs (oxygenator), and after gas exchange in the tissues. The inhibition of oxygen consumption by red blood during perfusion indicates a change in the metabolic processes, shape and resistance of red blood cells, which allows a more complete assessment of the pathophysiological changes that occur in the body in response to perfusion. The proposed methods of morphometric analysis of erythrocytes, as well as determining their osmotic resistance, can serve as express methods for analyzing red blood during heart operations using extracorporeal circulation, in order to correct it in time and replenish it.
Bulletin of the Russian Military Medical Academy. 2019;21(2):7-12
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Analysis of clinikal and morphological features of missed abortions, associated with chromosomal abnormalities of the chorion
Romanova O.A., Pechenikova V.A., Kartashova T.S., Klyukovkina A.S., Ellinidi V.N.
Abstract
Nowadays the problem of recurrent miscarriage is relevant. 17-20% of all registered pregnancies end with inevitable miscarriages. 80% of them are early pregnancies and in most cases represent missed abortions. Besides, one of the leading cause of missed abortion are chromosomal abnormalities. Analyzed the clinical and anamnestic data of patients, diagnosed with missed abortion during early pregnancy, examined in Saint-Petersburg in 2005-2006 and 2015-2017: patients with normal chorion karyotype and patients with chromosomal abnormalities of the chorion. Revealed that the prevailing chromosomal abnormality is aneuploidy, among all types of aneuploidy the most frequently are trisomy 16, trisomy 13, trisomy 22 and trisomy 21. The structure of aneuploidy has changed in 10-11 years. Now, in comparison with 2005-2006, at missed abortion the trisomy 16 in chorionic villi is found 3.8 times more often, the trisomy 13 is found 2.8 times more often and the trisomy 22 is found twice less often (p<0,01). The groups with normal chorion karyotype and with chromosomal abnormalities of the chorion are clinical-anamnestic comparable, but recurrent miscarriage and complicated childbirth in history are more common in patients with normal chorion karyotype, than in patients with chromosomal abnormalities of the chorion. Histologic research of abortion material revealed differences in the microscopic picture, depending on the type of chromosomal abnormalities. It can be used for the purpose of improvement of quality of diagnostics in the absence of a possibility of realization of a cytogenetic research.
Bulletin of the Russian Military Medical Academy. 2019;21(2):13-17
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The effect of ingaron on the dynamics of copies of deoxyribonucleic acid Epstein - Barr virus in saliva samples and on the manifestation of clinical
Rakityanskaya I.A., Ryabova T.S., Todzhibaev U.A., Kalashnikov A.A., Manuilov A.S.
Abstract
A total of 60 patients (38 women and 22 men, 36,54±2,14 years old) with a Epstein - Barr infection were examined. The patients were divided into two groups depending on the treatment regimen: 1 group - 34 patients received ingaron therapy (10 intramuscular injections of 500000 units every other day); group 2-26 patients received valcyte (450 mg 2 times a day, by mouth, 2 months) + ingaron at the same dosage. One month after the end of antiviral therapy in the1st group, negative results of half-chain reaction were obtained only in 29,41% of patients. The combination of valcyte and ingaron in patients of the 2nd group was different and differed in the duration of the injection of ingarone: 2a group: ingaron10 injections of 500000 IU intramuscularly every other day; 2b group: ingaron 20 injections of 500000 IU intramuscularly every other day; 2c group: ingaron 10 injections of 500000 IU and 15 injections of 100000 IU intramuscularly every other day. The best result after the introduction of ingaron was obtained in 90% of patients who received the longest course of ingaron in the form of 20 injections of 500000 IU every other day in combination with valcyte. In the other groups, where the total dose of ingaron was lower, positive results were found in 60 and 66,7% of patients. A significant positive change in the number of copies of deoxyribonucleic acid Epstein - Barr virus was found in samples of saliva and the severity of clinical complaints in patients one month after the ingaron monotherapy or combination therapy (valcyte and ingaron) was completed. The best effect of treatment with ingaron is achieved in patients with chronic Epstein - Barr infection with the prolonged introduction of ingaron (at least 20 injections).
Bulletin of the Russian Military Medical Academy. 2019;21(2):18-23
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The incidence of alleles and genotypes of polymorphic genes leptin G(-2548) A, adiponectin G(276) T and receptor adiponectin A(+219) T in patients with psoriasis alimentary obesity
Rychkova I.V., Pritulo O.A., Malyi K.D.
Abstract
Investigated prevalence of alleles and genotypes G(-2548)A (rs7799039) gene leptin and G(276)T (rs1501299) of the adiponectin and A(+219)T (rs11061971) adiponectin receptor 2 in patients with psoriasis with abdominal obesity. The frequency of the allele A of the promoter region of the G(-2548) A polypeptide leptin gene in 99/226 (43,8%) patients with a body mass index ≥30 kg / m2 was found to be higher than in69/228 (30,3% ) patients with a body mass index <30 kg/m2 (OR=1,8; 95% CI: 1,2-2,69; Se=0,44; Sp=0,7; p<0.05). In 54/226 (23,9%) patients with a body mass index ≥30 kg/m2, a higher incidence of the T allele of the G (276) T adiponectin gene was detected than in 79/228 (35%) patients with a body mass index <30 kg/m2 (OR=1,69; 95% CI: 1,12-2,54; Se=0,41; Sp=0,44; p <0,05). An analysis of the distribution of the genotypes of this polymorphism revealed an increase in the frequency of the AA genotype among patients suffering from psoriasis, with a body mass index of ≥30 kg/m2 in comparison with patients with psoriasis with a body mass index of <30 kg/m2 42/113 (37,2%) and 15/114 (13,2%), respectively (OR=3,9; 95% CI: 1,92-8,02; Se=0,74; Sp=0,58; p<0,05). The frequency of the A allele of the A (+219) T polymorphism of the adiponectin receptor gene was higher in 147/226 (65.1%) patients with a body mass index ≥30 kg/m2 than in 103/228 (45,2%) patients with a body mass index of <30 kg/m2 (OR=2,26; 95% CI: 1,55-3,3; Se=0,41; Sp=0,39; p <0,05). Thus, an association was found between the development of abdominal obesity in patients with psoriasis and the A allele of the G (-2548) A polymorphism of the leptin gene, the AA (+219) T allele of the adiponectin-2 receptor gene. Genetic testing of the studied polymorphic genes in patients with psoriasis at the onset of the disease will make it possible to predict the development of obesity, which must be considered when choosing the tactics of treating such patients.
Bulletin of the Russian Military Medical Academy. 2019;21(2):24-27
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Functional pathology of the chewing apparatus in the military
Serikov A.A., Iordanishvili A.K.
Abstract
During the clinical examination, 620 military personnel (502 men and 118 women) aged 25 to 55 years serving in the land forces of the Armed Forces of the Russian Federation, determined the incidence and severity of the pathology of the temporomandibular joint and masticatory muscles. A clinical study was performed using a survey, clinical examination, auscultation of the temporomandibular joint, and the determination of the tone of the masticatory muscles. To identify the temporomandibular joint pathology, the degree of mouth opening, the presence of mandibular deviation during opening and closing of the mouth, the presence of sound phenomena in the temporomandibular joint during mandibular movements, as well as the presence of arthralgia in the state of physiological rest and during lower jaw movements were evaluated. Symptom analysis to assess the severity of the temporomandibular joint pathology was carried out in points. To identify and determine the severity of the clinical course of the pathology of the masticatory muscles, a technique was used in the work that allows such an assessment in points based on the severity of complaints of fatigue of the masticatory muscles, compression or gnashing of teeth, the presence of hypertrophy or hypertonus of the masticatory muscles, and the presence of generalized forms of periodontitis and or) increased tooth wear. It was found that diseases of the temporomandibular joint in male military personnel are less common (12,8%) than female military personnel (22,9%), while parafunctional masticatory muscles are more common in men (2,4 %) than women (1,7%). Pathology of the temporomandibular and masticatory muscles, regardless of gender and age, usually combines, aggravates each other, and in 25-66,7% of cases occur in moderate or severe. It has been shown that in the course of planned in-depth medical examinations of military personnel, it is necessary to identify persons with clinical signs of pathology of the temporomandibular joint and masticatory muscles, and send them to the military medical organizations to clarify the diagnosis and conduct specialized treatment. It is noted that it is advisable for dentists when conducting scheduled in-depth examinations or military-medical examination it is advisable to carry out auscultation of the temporomandibular joint with the use of an electronic stetofonendoskop and myotonometry of the chewing muscles proper. This, with minimal time, will significantly increase the efficiency of detecting temporomandibular joint and masticatory muscles in military personnel.
Bulletin of the Russian Military Medical Academy. 2019;21(2):28-31
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Ischemic complications of operations on intracranial aneurysms and their relationship with the dynamics of cognitive functions
Voytsekhovsky D.V., Svistov D.V., Zheleznyak I.S., Lytkin M.V., Savello A.V., Babichev K.N., Landik S.A., Martynov R.S., Rudnev A.A., Dikikh K.A., Polezhaev A.V., Bannikov A.S.
Abstract
Surgical treatment remains the only way to primary prevention of intracranial hemorrhage in patients with cerebral aneurysms. The implementation of such interventions is associated with the risk of the development of secondary cerebral circulation disorders. The effect of ischemic damage to cerebral structures on the state of mental functions and the quality of life of patients is currently not well understood. The interrelation of the formation of foci of cerebral infarction according to magnetic resonance imaging and the dynamics of the state of cognitive functions of patients undergoing surgery for unruptured cerebral aneurysms is considered. It has been established that «fresh» foci of ischemic damage are formed in a third of patients. Among patients operated on with intravascular access, brain infarction zones are formed in half of the patients. Endovascular interventions under balloon assistance are associated with a high risk of asymptomatic ischemic complications. When comparing the results of neuropsychological examination in patients with diagnosed foci of cerebral infarction and the group where the ischemic complications were absent, no significant differences were found. According to the neuropsychological examination, the results before and after the operation did not differ significantly in patients with infarction foci. Thus, after surgery for unruptured aneurysms, local foci of cerebral infarction are often detected. In most cases, these changes are not associated with the deterioration of the higher mental functions of patients and are asymptomatic.
Bulletin of the Russian Military Medical Academy. 2019;21(2):32-36
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Comparative characteristics of the morphometric parameters of the abdominal part of aorta and its unpaired branches in the age and sex aspects
Gaivoronsky I.V., Bykov P.M., Gaivoronskaya M.G.
Abstract
Computer tomograms of the abdominal part of the aorta and its unpaired branches of adults belonging to three age groups are analyzed: the first, the second mature, and the elderly. It has been established that individual morphometric parameters of the abdominal part of the aorta and its unpaired branches in men and women significantly change with age. It is proved that the diameter of the aorta at different levels significantly increases with age from the first mature age to the elderly by an average of 5 mm. In addition, in men, the length of the abdominal aorta, celiac trunk and main trunk of the superior mesenteric artery do not change with age. In women, the length of the celiac trunk increases with age by 5,9 mm, the length of the main trunk of the superior mesenteric artery - by 17 mm. It can be assumed that this fact is due to the structural features of the connective tissue structures of the arterial wall in women, and, in particular, the elastic framework. The angle of discharge of the celiac trunk in men changes unevenly with age - in the second period of mature age, there is a statistically significant decrease on average of 12,3°, then in old age an increase of 15°. Moreover, in women, the values of this indicator vary more evenly. The angles of discharge of other vessels did not show a clear age dependence, since this parameter is largely due to the constitutional features. The aorto-mesenteric distance changes with age only in women. In old age, it is on average 4,4 mm larger than in the first period of mature age. In general, a number of morphometric parameters of the abdominal part of the aorta and its unpaired branches significantly changes with age. The findings are important for endovascular interventions.
Bulletin of the Russian Military Medical Academy. 2019;21(2):37-42
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Evaluation of cellular and humoral indicators immunity in the treatment of various types of sepsis in immunocompromised hemoblastosis patients
Yurkin A.K.
Abstract
It was established that the course and development of sepsis in patients with hemoblastosis, are held against the background of complex violations of indicators of cellular and humoral immunity. However, in patients with acute myeloid leukemia, they are more pronounced, which most likely explains the higher mortality rate in this group of patients compared with patients suffering from lymphoproliferative diseases. Some features of the development of post-cytotoxic complications after chemotherapy in patients with hemoblastosis are identified. In addition, the most significant predictors of post-cytotoxic complications in patients with hemoblastosis, who are most susceptible to post-cytotoxic infectious complications and life- threatening emergency conditions, have been identified. The most probable causes of deaths in primary and secondary immunodeficiencies of the cytotoxic type in immunocompromised patients suffering from hemoblastosis with proven sepsis on the background of neutropenia after polychemotherapy are presented. Revealed some post-cytotoxic complications that significantly affect the course and outcome of the disease in patients with hemoblastosis. The nature of these complications and emergency conditions allows you to determine the volume and priority of ongoing proactive intensive therapy after polychemotherapy in the period of neutropenia or agranulocytosis, on the background of a violation of the immune status of patients. An assessment of some humoral and cellular indicators of the immune status of patients with various types of proven sepsis is given.
Bulletin of the Russian Military Medical Academy. 2019;21(2):43-47
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Clinical-hemodynamic efficiency of fixed combined hypotensin therapy for patients with heavy arterial hypertension
Gizi Azayeva N.R.
Abstract
The efficacy of treatment was evaluated by the fixed combination drug «Exforge-H» in 40 patients suffering from grade 3 arterial hypertension. All patients underwent general clinical and laboratory and instrumental examination (electrocardiography, echocardiography, 24-hour blood pressure monitoring) before and after 6 months of treatment. It was established that treatment with «Exforge-H» statistically reliably reduces the level of blood pressure, normalizes the variability and daily blood pressure profile. So, two weeks after the start of treatment, the systolic and diastolic pressure levels during clinical measurement decreased by 32,1±2,7 and 30,4±1,9 mm Hg. Art. respectively. After 3 months of treatment, 60% of patients showed achievement of the target level of blood pressure, and after 6 months - 96%. High hypotensive efficacy of treatment was also demonstrated during the daily monitoring of blood pressure in all its indicators. A significant decrease in systolic and diastolic pressure was observed during the day and night hours. The amplitudes of systolic and diastolic pressure variability have also been improved. At the same time, the variability of systolic pressure during the day was reduced by 46%, diastolic - by 49%, and at night by 59,3 and 52,8%, respectively, indicating a normalization of blood pressure during the day. All this was also accompanied by a decrease in the clinical manifestations of the disease. So, after 6 months of treatment, 84% of patients had positive clinical dynamics: a decrease in cardiac and cerebral symptoms, as well as emotional lability, which positively correlated with a decrease in the level of clinical blood pressure. The cardioprotective effect of the drug is expressed in the form of regression of left ventricular hypertrophy. In general, the use of the three-component fixed drug «Exforge-H» (valsartan - 80 mg, amlodipine - 5 mg and hydrochlorothiazide - 12,5 mg) is manifested by an increased antihypertensive effect due to the influence of its constituents side effects and the development of metabolic changes.
Bulletin of the Russian Military Medical Academy. 2019;21(2):48-51
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Exceptional case of surgical treatment of huge inguinal hernia at the woman
Solovyov I.A., Cherkashin D.V., Vasilchenko M.V., Bromberg B.B., Balyura O.V., Kuzmin D.N., Koshelev T.E., Pastukhov A.V., Serko V.M.
Abstract
Despite significant progress in a health care system the started cases of huge inguinal hernias still meet. For successful treatment of such patients objective diagnostics, preoperative preparation, the choice of suitable tactics of surgery and treatment in the postoperative period is important. The clinical case of treatment by not reducible huge inguinal hernia at the patient of 73 years is presented in article. The patient showed complaints to presence of the big sizes of the hernia in the bottom of a stomach limiting movement of the patient and self-service reducing quality of life. For the first time hernial protrusion in inguinal area has appeared in 2008 which gradually increased in sizes. Since 2015 I have noted the intensive growth of hernia. I didn’t ask for medical care. To clinic it is brought by an ambulance crew with the diagnosis of The Restrained Inguinal Hernia direction. At the time of survey data for infringement weren’t. After comprehensive examination to the patient surgery in volume has been executed: a gryzhesecheniye on the right, plasticity across Liechtenstein. The postoperative period proceeded without complications. The patient is written out for the 13th days after operation. Extremely exceptional clinical case, the choice of adequate stage-by-stage preoperative inspection and treatment, optimum surgical tactics and postoperative kuration is shown. The chosen approach led to prevention of development of a cascade of the complications including a compartment syndrome, to elimination of cosmetic defect and restoration of quality of life.
Bulletin of the Russian Military Medical Academy. 2019;21(2):52-57
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The operation of Troyanov - Trendelenburg in the modern minimally invasive approach to the treatment of varicose disease with endovenous laser photocoagulation
Akhadov R.A., Sazonov A.B., Sizenko V.V., Khubulava G.G.
Abstract
Despite the widespread and active introduction of new minimally invasive technologies in clinical phlebology, the Troyanov - Trendelenburg operation today is an important step in the extensive complex of various methods of surgical treatment of varicose veins of the lower extremities. This intervention can be performed under local anesthesia with minimal trauma and excellent cosmetic results. The leading position in the treatment of chronic venous diseases currently takes endovenous laser photocoagulation, the implementation of which is being offered now even to patients with complicated and advanced forms of the disease. The combination of Troyanov - Trendelenburg operation and laser thermocoagulation can significantly reduce the risk of downward recanalization of the great saphenous vein, as well as eliminate side effects and complications that occur during traction of the vein. To eliminate technical errors in the course of ligation of great saphenous vein in the area of sapheno-femoral anastomosis under local infiltration anesthesia and to simplify the detection of the target vessel, especially in obese patients with severe subcutaneous fat, we have developed a method for performing Troyanov - Trendelenburg, which decreases the time of the surgical treatment of the mouth section is up to 10-15 min; the risk of possible complications is reduced. In addition, this treatment does not increase the bed-day and recovery periods. It was concluded that the use of a laser beam at the end of the working part of the fiber, previously carried out under ultrasound control directly into the area where the great saphenous vein falls into the deep system, as a visual guide, greatly facilitates the search for the main saphenous vein, especially in obese patients. The operation of Troyanov -Trendelenburg allows you to process all branches of the Delbe beam and eliminate the continued progression of thermally induced thrombosis proximal to the anastomosis, and therefore possible pulmonary thromboembolism from the large subcutaneous vein subjected to laser coagulation.
Bulletin of the Russian Military Medical Academy. 2019;21(2):58-62
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The results of surgical treatment of patients with lumbosacral radiculopathy, caused by paraarticular and disc cysts
Kravtsov M.N., Pomet'ko D.V., Leonov V.I., Gaydar B.V., Svistov D.V.
Abstract
The results of the conservative and surgical treatment of 12 patients at the Neurosurgery Clinic of the Military medical academy. CM. Kirov, in the period 2016-2018, about the paraarticular and disc cysts of the lumbar spine. Performed open microsurgical and full-endoscopic operational aids. Evaluation of the effectiveness of surgical treatment was carried out using the subjective assessment scale and magnetic resonance imaging over time. The follow-up period ranged from 6 to 24 months. Most often, extradural cysts were located at the level of the LIV-LV segment. Clinical manifestations were characterized by radiculopathy and local back pain. The average duration of pain syndrome was 3±0,7 months. Conservative treatment led to a regression of pain and resorption of a disk cyst in one patient. In other cases, surgical treatment was required. The average duration of a microsurgical operation was 131,6±73,4 minutes, video endoscopic - 80±10,8 minutes. The hospitalization period in the group of microsurgical treatment was 10,4 days, in the group of video endoscopy - 4,7 days. Control magnetic resonance imaging revealed the recurrence of paraarticular cysts in the area of the previous operation in 3 patients. Relapse in patients with disc cysts is not marked. Necessity in repeated operations did not arise in one supervision. It has been established that the main clinical manifestations of extradural cysts of the lumbar spine are local moderate pain, radiculopathy, and intermittent claudication. Microsurgical and percutaneous video endoscopic treatment of lumboischialgia due to extradural cysts is significantly more effective compared with conservative therapy. Full-endoscopic interventions in comparison with microsurgical ones are less invasive and long-lasting and can reduce the time of inpatient treatment.
Bulletin of the Russian Military Medical Academy. 2019;21(2):63-69
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Clinical and epidemiological aspects of human toxocarosis in the Astrakhan region
Arakelyan R.S., Okunskaya E.I., Shendo G.L., Polyakov V.K., Almukhambedova A.R., Ityaksova V.A., Saltereyev S.R.
Abstract
Analyzed the clinical and epidemiological aspects of human toxocariasis in the Astrakhan region. It was established that from 2013 to 2017 in its territory 34 cases of human toxocariasis were recorded. In the structure of the total number of helminthoses for the analyzed period, the share of toxocariasis accounted for 0,2% of cases and 0,2% of the total number of all parasitosis recorded in the Astrakhan region. Both adults and children were affected by toxocariasis. Thus, the share of the adult population was 82,4%, incl. persons employed in production (working population) - 67,6%, pensioners- 11,8% and unemployed - 2,9%. The proportion of children in the overall incidence of toxocarcosis was 17,6%, of which11,8% attended kindergartens and secondary school 2,9%. And in one case the child was unorganized - he was at home withhis parents - 2.9%. The main complaints of people seeking medical care were: cough - 23,5%, general weakness - 17,6%,pain in the epigastric region and temperature rise to subfebrile numbers - 11,8%, allergic rhinitis and muscle pain and joints- by 5,9%, as well as decreased appetite, allergic rashes on the skin of varying degrees of intensity, feeling of suffocation andweight loss - by 2,9%.When ascertaining the epidemiological history, it was found that the probable cause of the development of the diseasecould be: not following personal hygiene rules - 94,1%, eating unwashed fruits and vegetables - 88,2%, close contact withdomestic dogs - 52,9%, onigophagy - 20,6%, contact with domestic cats - 14,7%, geophagy and the habit of licking hands- 8,8% each, and contact with stray dogs - 5,9%. Personal hygiene rules were observed in 5,9% of patients. Generally, thecurrent situation on human toxocariasis in the Astrakhan region remains highly relevant. The main causes of the diseasewere close contact with both domestic and stray animals, as well as non-compliance with the rules of personal hygiene. Thepresence of diseased antibody titers in the formulation of enzyme immunoassay 1:800 and above, as well as the presence ofa clinical picture of the disease, indicates the direct presence of parasitic invasion in the examined.
Bulletin of the Russian Military Medical Academy. 2019;21(2):70-73
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Issues of prevention of suicidal behavior in the Armed Forces of the Russian Federation
Shamrey V.K., Dnov K.V.
Abstract
The issues of prevention of suicidal incidents in the Armed Forces of the Russian Federation are considered. The analysis of suicide prevalence among military personnel of various categories and their prevailing causes for the period from 2013 to 2017 is indicated. Indicates a change in the percentage ratio of various categories of military personnel who committed suicide, with a steady increase in the proportion of privates and sergeants serving in military service under the contract (from 24,6% in 2011 to 57,4% in 2017). It was established that among the servicemen under the contract family and everyday reasons for suicide prevailed, while conscripts were military professional. A comparison was also made of the long-term (2007-2017) dynamics of suicide rates and the incidence of mental disorders among military personnel, and certain patterns were identified. Thus, in the group of officers and ensigns, a significant correlation was noted between the long-term dynamics of suicide rates with neurotic (r=0,74) and addictive disorders (r=0,86), as well as general mental morbidity (r=0,83), and for conscripts, with personality disorders (r=0,79) and organic mental disorders (r=0,71). A comparison of the long-term dynamics of the overall incidence of mental disorders and the suicide rate among conscripts also showed a positive correlation (r=0,69). Analyzed the system of prevention of suicidal incidents in military personnel, which currently exists and proposed measures for its improvement, including the areas of activity of officials for the prevention of suicidal incidents in the military. It also indicates the need to shift the focus from specific prevention (direct detection and prevention of suicidal actions in military personnel with mental disorders) to non-specific (prevention of general mental distress and suicidal tendencies in mentally healthy people).
Bulletin of the Russian Military Medical Academy. 2019;21(2):74-77
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Multipattern botulinum toxin therapy of post-comatose long-term consciousness disorders: central effects
Vainshenker Y.I., Zinserling V.A., Melucheva L.A., Bobrova V.V., Korotkov A.D., Ivchenko I.M., Tsygan N.V., Odinak M.M., Litvinenko I.V.
Abstract
The data of electroencephalography, evoked potentials of the brain and positron emission tomography are analyzed before and 3 weeks after the multipattern botulinum toxin therapy of spasticity in 25 patients with post-comatose long-term consciousness disorders, including one patient who died against the backdrop gradual improvement of consciousness from acute heart failure four months after the end of second course of multipattern botulinum toxin therapy. Found that improvements of the brain functional state against the backdrop of reduced spasticity were observed regardless of primary brain damage origin, level of consciousness and of multipattern botulinum toxin therapy course repeatability. The observed dynamics of neurophysiological indicators had a normalizing direction, some differences associated with the initial level of consciousness. Electrophysiological changes during the improvement of consciousness against the background of multipattern botulinum toxin therapy were not specific. Features of improving energy metabolism in the certain areas of the brain could be caused by just such treatment, and reflected the contribution of pathological sensorimotor integration in maintaining impaired consciousness. Postmortem neuromorphological study of the patient brain identified progenitor stem and proliferating cells and newly formed neurons in brain areas whose in-life functional state was continuously improving, newly formed neurons migrating flow through the corpus callosum and diffuse activation of axonogenesis. We assume that the central effect of multipattern botulinum toxin therapy associated with improvement of consciousness, may be a double. The first is immediate, due to a decrease in pathological afferentation from the muscles, the second - apparently deferred and prolonged, manifested in the activation of functional neurogenesis and axonogenesis in the brain. The continuation of complex multimodal research on the study of post-comatose long-term consciousness disorders seems promising.
Bulletin of the Russian Military Medical Academy. 2019;21(2):78-87
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The prognosis of the patients with violations of rhythm of the heart
Getman S.I.
Abstract
The effect of an active 2-year outpatient regimen in patients with persistent cardiac rhythm disturbances in terms of cardiovascular prognosis was studied. The clinical status and outcomes of treatment in patients with ventricular, supraventricular, and combined cardiac arrhythmias were compared for 2 years. During this time, the patients did not reveal significant differences in the number of non-fatal complications (acute cerebrovascular accident, acute myocardial infarction, thromboembolism of the branches of the pulmonary artery, etc.).So, in the group with predominantly supraventricular rhythm disorders identified 5 strokes and 1 pulmonary embolism in the group with a primarily ventricular rhythm disturbances recorded 2 cases of acute myocardial infarction and 1 stroke and in the group with combined ventricular and supraventricular rhythm disorders in 4 patients who developed stroke. Meanwhile, deaths registered significantly more frequently only in patients with predominantly supraventricular rhythm disorders (7 cases vs. 1 and 0 respectively, p<0,05). And five of them had permanent atrial fibrillation, one paroxysmal and one female patient were fixed frequent supraventricular premature beats. Six died from stroke and one from thrombosis of mesenteric vessels. In the analysis of treatment in 7 patients of the above, it was revealed that five had attended kardiomagnil and trombas, and twowarfarin, and the indices of international normalized ratio of the last blood sampling of both were less than the acceptable range from 2 to. In addition, patients with predominantly supraventricular rhythm disorders were significantly more frequently hospitalized for urgent indications (45 hospitalizations compared with 18 and 11, respectively, p<0,05). The most frequent reason of hospitalization was another paroxysm of atrial fibrillation and new-onset atrial fibrillation. In 3,3%, frequent supraventricular premature beats during 2 years of follow-up documented transition of this arrhythmia in a more aggressive form-in atrial fibrillation, a dangerous thromboembolic complications. Frequent supraventricular extrasystoles a predictor atrial fibrillation.
Bulletin of the Russian Military Medical Academy. 2019;21(2):88-91
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Psychological features of cadets with military professional maladjustment
Yatmanov A.N.
Abstract
The psychological characteristics of professionally maladapted cadets are considered. For signs of maladjustment were taken: performance - 3,5 points and below; physical fitness - 3 points and below; high incidence: the number of days of work loss from the beginning of the school year - 11 days or more; low discipline; poor relationship with the command and with colleagues, low psychological stability. Psychological personality traits can both contribute to the military-professional adaptation, and hinder it. Well-adapted cadets for training in a military college are characterized by a high level of stress tolerance, they are curious, have flexible thinking, they have hyperthymic characterological features. Professionally maladjusted cadets are characterized by stereotyped thinking, the prevalence of anxious and exalted character traits, the use of physical force against another person, readiness for the manifestation of negative feelings with the slightest excitement (hot temper), suspicion of relations with others, the expression of negative feelings as through form (cry , screeching), and through the content of verbal responses (curses, threats), the oppositional manner in behavior from passive resistance to active struggle From established customs and laws, they are more aggressive. Based on discriminant modeling, a highly informative forecast model of military professional maladjustment of cadets was developed as part of medical and psychological support measures (Wilks lambda: 0,29207 approx. F (4,58)=35,146; p<0,0001, predictive ability - 95,24 %). Predictors of military-professional maladjustment of cadets of a military university are a combination of indicators: stress tolerance, aggressiveness index, suspicion, guilt. It is advisable to use the mathematical model of the forecast of military-professional maladjustment of the cadets of the military higher educational institution in the framework of the activities of medical and psychological support for the cadets of the military higher educational institutions.
Bulletin of the Russian Military Medical Academy. 2019;21(2):92-96
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Morphological characteristics of postoperative acute perforated ulcers of the small bowel
Singaevskiy A.B., Vinnichuk S.A., Nesvit E.M.
Abstract
The basic morphological characteristics of acute postoperative perforated ulcers of the small intestine were presented by analyzing cases of patients with this postoperative complication. It was determined that in the majority of patients (69,4%) the complication occurred after operations for various types of oncological diseases. Found a significant increase in the frequency of occurrence of this pathology over the past 2 decades by 8 times. The following macroscopic characteristics were revealed: in the majority of patients (83,9%), isolated perforations were initially encountered, but in almost half of the cases (46,7%) there were recurrence. The «favorite» dates of occurrence are 4-10th day and the «favorite» localization in different parts of the small intestine are from 101 to 151 cm from the ligament of Treitz (47,7%) and 51-100 cm from the ligament of Treitz (21,8%). Microscopy of the resected areas of the small intestine besides inflammatory changes in the layers of bowel wall in 100% of cases showed significant dyscirculatory changes: on the side of the submucosal layer the plethora and development of the erythrocyte sludge - 100%, vascular thrombosis - 45,5%, hemorrhagic soaking - 27,3%. Inflammatory changes were nonspecific with a predominance of various inflammatory phases: alterative (desquamation and necrosis of the epithelium of the villi), exudative (moderate to massive neutrophilic infiltration) and proliferative (proliferation of granulation tissue followed by fibrosis and lipomatosis wall). In addition, a histological study of areas of the small intestine affected by acute perforative ulcers revealed that the mucous was primarily damaged.Key words: acute ulcers of the small intestine, non-specific ulcers of the small intestine, perforation of the small intestine, peritonitis, operations on the abdominal and pelvic organs, relaparotomy, closure of the small intestine, resection of the small intestine.
Bulletin of the Russian Military Medical Academy. 2019;21(2):97-100
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Medical technology of early recovery of the ability to move independently after amputation of the lower limb
Suslyaev V.G., Scherbina K.K., Smirnova L.M., Sokurov A.V., Ermolenko T.V.
Abstract
Results of early restoration of the ability to independent movement after amputation of the lower extremities as possibilities of prevention of development of the complications connected with a hypodynamia for reduction of terms of medical rehabilitation and restoration of quality of life are presented. Preparation for prosthetics was carried out with the application of modern methods of medical physical culture according to four motor activity levels. For prevention of development of contractures of joints, decrease in the puffiness of tissues of a stump will be applied techniques of medical physical culture, orthopedic laying, elastic bandaging of a stump of a shin and hip, carrying compression elastic and polymeric (silicone) covers. For improvement of lympho-venous outflow, reduction of puffiness of soft fabrics and of a phantom pain syndrome elastic glue bandaging (a therapeutic adhesive tapes) of a stump is shown. Non-drug treatment of phantom pain syndrome is especially relevant at contraindications, intolerance the patient of medicines. Among non-drug techniques of simplification of a phantom pain, syndrome use various techniques of reflexotherapy (acupuncture, an akupressura, etc.), to an empatotekhnik, a mirror therapy, phantom-impulsive gymnastics. Holding sessions of a mirror-therapy was followed with phantom-impulsive gymnastics by the standard technique. For prevention of formation of a flexion contracture of a knee joint after below-knee amputation used universal adjustable elastic orthosis for the knee made of polyurethane foam in the form of the rolled design with the fixing tapes is offered. Besides of, the technique of training moving by artificial limb helps the truncated extremity with the regulated reception sleeve or the made reception sleeve which is put on a stump from the water hardened plastic bandage is improved. The value of the offered technique consists in the imitation of end-bearing on a stump in the adjustable socket with the put-on reception sleeve and to training in use before fitting and walking with an artificial limb. This medical technology of early restoration of moving ability after amputation of a shin or a hip with the application of new designs of adjustable reception sleeves from thermoplastic materials in the form of a adjustable socket row with modular connection for assembly of artificial limbs of the lower extremities by express methods provides essential positive social and economic effect. The technical documentation set on new designs of artificial limbs of a shin and hip is developed for early primary prosthetics. The offered medical technology of early primary prosthetics is introduced at 27 state and five non-state prosthetic and orthopedic enterprises of the Russian Federation and also the prosthetic and orthopedic enterprises of Dushanbe (Republic of Tajikistan), Tashkent (Republic of Uzbekistan).
Bulletin of the Russian Military Medical Academy. 2019;21(2):101-109
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Using the Paramecium caudatum test object to determine acute toxicity of physiologically active substances
Andreev V.A., Andreeva E.Y., Erdniyev L.P., Stepanov Y.A., Mikshta A.Y., Mokshanov I.V., Yermolayeva I.A., Stepanova N.V., Apchel V.Y.
Abstract
The advantage of biotesting in comparison with the physicochemical analysis of the use of Paramecium caudatum for toxicological studies has been shown. Physical and chemical analysis often fails to detect unstable compounds. In addition, these tools are not possible to determine the ultra-low concentration of chemicals. In addition to the traditional use of laboratory animals, representatives of protozoa have recently been used. In connection with this, a test object of the Sim-plest type was chosen and justified. The advantages of using the simplest compared with the use of laboratory animals. The various models used to test toxic substances are described. Their advantages and disadvantages are noted. The main advantages of second-order models using alternative models (various hydrobionts, bacteria, cell cultures, etc.) are described. The relevance of using the culture of cells of the ciliate Paramecium caudatum for toxicological studies has been shown. The methodological aspects of the biotesting of organic solvents using the proposed test object are presented. A unidirectional change in the toxicometric parameters of organic solvents for two types of biological objects: a white mouse and a culture of infusoria Paramecium caudatum were revealed. The possibility of using Paramecium caudatum for toxicological studies has been shown. A correlation was noted between the indicators of the general toxicity of organic dyes and those of white mice.
Bulletin of the Russian Military Medical Academy. 2019;21(2):110-113
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Development of nomograms to assess the risk of clinical outcome
Korneenkov A.A., Kuzmin S.G., Dergachev V.B., Borisov D.N.
Abstract
A methodology is presented for developing nomograms for assessing and stratifying the risk of a clinical outcome based on the created virtual data set using the R software environment. The virtual data set included input numerical and factor variables (variable types correspond to the R software documentation) and outcome. For quantitative variables, descriptive statistics were calculated at all levels of the outcome variable, and mosaic diagrams were constructed for factor variables. As a model that describes the association of input variables with the outcome, a logistic regression model was used. A bootstrap method was applied to validate and evaluate the model performance. The calculated validity indicators showed an acceptable discriminatory ability of the predictive model. The statistical calibration demonstrated the proximity of the model’s calibration curve to the ideal calibration curve. Based on the logistic regression coefficients, a nomogram was constructed using which the risk value of a specific outcome was calculated for each subject (patient). It is shown that with the help of the presented technique it is possible to stratify patients effectively by the risk of an adverse outcome, thus adequately altering the diagnosis and treatment tactics. The use of a nomogram greatly simplifies risk assessment and can be used in paper form as a supplement to the patient examination protocol. The article contains the codes of the R programming language with explanations.
Bulletin of the Russian Military Medical Academy. 2019;21(2):114-121
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The anatomical variations of the gall-bladder in relation to gender, body constitution type, according to results of topographical study
Trunin E.M., Shchegolev A.I., Semenova E.A., Timohov G.V., Sigua B.V., Babaev D.B.
Abstract
This work presents the results of in a noninvasive topographic and anatomical study of the gallbladder and the anterior abdominal wall parameters in the right hypochondrium region (based on the results of spiral computed tomography and 3D modeling) in both sexes with different body types. It is established that there are some features of the gallbladder’s bottom and neck holotopia, depending on sex and body type of the patient. Extreme variants of the gallbladder’s position are revealed. The bottom of the gallbladder is located: a) the most lateral position in hyperstenic men; b) maximum medial in astenic women; c) maximum cranial in astenic men; d) the most caudal in astenic women. The gallbladder’s neck is located: a) the maximum lateral position in normostenic men; b) maximum medial in astenic women; c) maximum cranial in astenic men; c) the maximum caudal in astenic women. A mathematical algorithm is proposed and a software package is developed to determine the gollbladder’s bottom and neck probabilistic location in the three-dimensional coordinate system in patients depending on gender and body type. The developed technique allows to choose the type of operative access, to plan its individual localisation, and also to calculate criteria of operative access depending on patient’s anthropometric data during preparation for intervention. This allows to decide on the rationality of the use of a surgical access, choose its optimal location, the size of the skin incision, thereby reducing surgical trauma during the intervention and leads to improved quality of treatment of patients with gallstone disease.
Bulletin of the Russian Military Medical Academy. 2019;21(2):122-128
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The requirement for achievement in young people
Uliukin I.M., Kiseliova N.V., Kostin D.V., Berezovskii A.V., Orlova E.S.
Abstract
Аbstract. The desire to improve results, a dissatisfaction with what has been achieved, a perseverance in achieving their goals, the desire to achieve their own at any cost - all of this is one of the nuclear traits of a person that influence all of human life. It is believed that a person in his profession can accomplish one of two main missions: a professional self-realization, with a predominant orientation «towards society» (to make a successful career, to reach the heights of excellence and, accordingly, a public recognition), or an self-realization of himself as an individual (a predominant «self-directed» orientation, which may not always coincide with his professional self-realization). It is believed that the motives of the choice of a profession by students are closely related to their value orientations, and the study of factors influencing a person’s attitude to the profession and himself allows determining the specificity of the professional field, where the subject area of work activity is designated as a new psychological reality, activating a personality to self-transformation and the world around us. It is shown that the level of achievement motivation, the motivation for success among young people is medium. Reduced and increased need identified in isolated cases. The nature of the distribution of ego states in the personality structure of young people (men and women) is due to the sex characteristics of the groups. In the study of tightness between correlation between indicators of the need for achievement and indicators of ego-states of personality structures, it is shown that this force is weak in men, while in women it is moderate between the need for achievement and indicators «Rebellious child» and «Caring parent». This corresponds to the idea of the possibility of considering your life as an interrelation of a number of events with subjective experiences, since the psychological fate of an individual determines the way of experiencing the events of life. The adequacy of self-esteem is characterized by the measure of an individual’s assessment of his activity with external assessments of these results, the nature of reflection of this coincidence in his mind, but it also depends on the need for achievement. This will allow the development of effective integrated programs that help optimize both perseverance and self-realization of the individual.
Bulletin of the Russian Military Medical Academy. 2019;21(2):129-132
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A comparative evaluation of the effectiveness of aspiration and automatic systems for percutaneous liver biopsy in experimental rats
Zhdanov K.V., Saulevich A.V., Karev V.E., Kozlov K.V., Zakharkiv Y.F., Zakharenko S.M., Lyashenko Y.I., Ivanov K.S., Sukachev V.S., Shakhmanov D.M., Popov D.V., Kariakin S.S., Bedarev A.V., Chernenok M.G., Gemst I.I., Tashimov M.M.
Abstract
The effectiveness and quality of liver biopsy in rats are applicable to the aspiration and automatic liver biopsy system. Histological examination of 240 biopsy specimens in 100% of cases identified portal tracts. The number of portal tracts to determine the stage of liver fibrosis in rats of the 1st group who underwent liver biopsy was performed using an 18 G aspirating needle from the puncture liver set (Menghini type), which is 4-5, you have the 2nd group, which one-time guillotine soft tissue biopsy with a semi-automatic action of 16G×20 cm, Italy) - 7-8 portal tracts. The average size of the biopsy in the 1st group is 0,5 cm, in the 2nd group - 1 cm. Thus, the automatic biopsy system allows you to get liver tissue in 100% of cases. At the same time, the automatic system eliminates the additional traumatization of experimental animals, as well as minimizes efforts to separate the biopsy material from the organ. In addition, the automated system for liver biopsy allows to evaluate 7-8 portal tracts with a biopsy size of 1 cm, this provides a reliable histological assessment of pathological changes in liver tissue to assess the stage of fibrosis and the activity of the inflammatory process over time.
Bulletin of the Russian Military Medical Academy. 2019;21(2):133-139
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Tticks collection of academician E.N. Pavlovsky and modern prospects of molecular genetic research
Solovev A.I., Bondarenko E.I., Timofeev D.I., Rakin A.I., Kravtsov V.Y.
Abstract
E.N. Pavlovsky is founder of doctrine about the natural foci diseases. The unique collection of ticks (Argasidae), which are highly specialized ectoparasites of terrestrial vertebrate animals. Part of the collection was formed during the Great Patriotic War (1941-1943) in Iran in the Trans-Iranian Route zone (Persian Corridor), one of the strategic directions for the delivery of American and British military aid to the Soviet Union. Currently, the richest collection of ticks is stored at the Department of Biology of the Military Medical Academy. C.M. Kirov, the permanent leader of which for over 40 years was E.N. Pavlovsky. The collection includes more than 15 thousand copies of arthropods. Among them are Ornithodorus papillitis, Ornithodorus tartakovsky, Ornithodorus lahorensis, Ornithodorus Verrucosus, Argas persicus, as well as some other carriers of human infectious diseases. The historical collection of ticks is considered as a unique resource for the study of infectious pathogens and their vectors using molecular genetic techniques. The preservation of genetic material in the museum samples of ticks was studied in order to determine the possibility of detecting in them deoxyribonucleotide markers of tick-borne pathogens (tick-borne infections).. Genetic markers of tick-borne infections were identified in 10 instances from of 48 ticks instances. The 8 samples were positive for the presence fragments of nucleic acids of tick-borne rickettsia (Rickettsia species). There were identified the genetic markers of causative agent Lyme disease (Borrelia burgdorferi s.l.) in one of the samples. In addition, the deoxyribonucleic acid fragments specific to Q-fever (Coxiella burnetii) were discovered in one case. The obtained data testify to the high scientific significance of the E.N. Pavlovsky collection in modern conveniences. The unique biological material can be used to study the structure and evolution of the genome of ticks Argasidae, as well as etiology and the spread of tick-borne infections.
Bulletin of the Russian Military Medical Academy. 2019;21(2):140-148
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Application of early necrectomy of a deep skin burn on rats with acute radiation syndrome of mild severity
Kozyaev V.A., Chmyrev I.V., Seleznev A.B., Legeza V.I., Ivchenko E.V., Kondakov A.Y., Zubov N.N., Nosov A.M., Beldymenko E.L., Kuznetsova A.A.
Abstract
The involvement of countries possessing nuclear weapons in local and regional armed conflicts poses a threat of use of nuclear weapon. In the case of this combined radiation injuries can make up to 70% of sanitary losses. The existing ideas about the methods of surgical treatment of combined radiation-thermal injures are contradictory and do not clearly provide procedure depending on the severity of injury or in non-classical forms of injury. The idea of the study was to estimate the effectiveness of performing an early necrectomy of a burn eschar after a two-factor injury, which includes modeling mild acute radiation syndrome in addition to a thermal burn on rats. A deep skin burn was simulated with hot water over an area of 10% of the body surface after total γ-irradiation at a dose of 3 Gy. Then after 3 h the burn eschar necrectomy was performed. It was established that the chosen method of surgical treatment of a deep burn significantly aggravates the severity of irradiated animals, which is manifested by the death of more than 50% of rats in the first 4 days after necrectomy. The operative trauma became the leading component of the combined injury formed and determined the severity of its course. Thus, the burn eschar necrectomy modifies a light two-factor radiation-thermal injury to a classic combined radiation injury. Despite the severe postoperative period, necrectomy significantly accelerates the healing of burn wounds in irradiated animals. This indicates the promise of finding methods for compensating abnormalities developing in the postoperative period in order to accelerate wound healing before the onset of radiation sickness and prevent infectious complications.
Bulletin of the Russian Military Medical Academy. 2019;21(2):149-154
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The role of subclinical hypothyroidism in lipid metabolism disorders
Volkova A.R., Dygun O.D., Galkina O.V., Belyakova L.A., Bogdanova E.O.
Abstract
Subclinical hypothyroidism is common in general practice. The clinical significance of latent thyroid dysfunction has not yet been determined. The parameters of lipid metabolism and oxidative stress were studied in patients suffering from subclinical hypothyroidism between the ages of 18 and 50 years. They had a level of thyroid stimulating hormone ≥4 mIU/l, the level of free thyroxine was normal. The control group consisted of healthy individuals with thyroid-stimulating hormone level of 0,4-2,4 mIU/l. Thyroid status, thyroid peroxidase antibodies, lipid profile, malondialdehyde-modified low-density oxidized lipoproteins, antibodies to low-density oxidized lipoproteins, homocysteine were determined for all individuals. With the repeated determination of thyroid-stimulating hormone in 16,8% patients spontaneous recovery of thyroid-stimulating blood hormone level was observed, which was associated with lower values of thyroid-stimulating hormone and the absence of thyroid peroxidase antibodies. In the group of patients with thyroid stimulating hormone levels ≥7 mIU/l, the total cholesterol level was significantly (p=0,02) higher than in the control group. In patients with elevated values of malondialdehyde-modified oxidized low-density lipoprotein, thyroid stimulating hormone level of ≥7 mIU/l was more frequently detected. A negative correlation was found between the level of IgG antibodies to low-density oxidized lipoproteins and the concentration of free thyroxin. In the control group, the correlation was found between the concentration of IgG antibodies to low-density oxidized lipoproteins and the level of thyroid-stimulating hormone. In the group of subclinical hypothyroidism, the concentration of homocysteine was significantly (p=0,01) higher in men. In patients with subclinical hypothyroidism, more often hyperhomocysteinemia was detected compared with the control group. The results suggest that subclinical hypothyroidism is associated with initial changes in the metabolism of lipids and homocysteine.
Bulletin of the Russian Military Medical Academy. 2019;21(2):155-159
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Level options for the formation and branching of the common peroneal nerve
Isaev D.M., Gaivoronsky A.I., Gaivoronsky I.V., Goryacheva I.A.
Abstract
The study of topographic and anatomical features of the common peroneal nerve and its main branches was performed on 72 lower extremities of adult corpses. Morphoscopic and morphometric established that the higher the level of development of the common peroneal nerve, the greater the diameter, it has held more distance to the branch of the lateral cutaneous nerve of the calf. The average value of the diameter of the common peroneal nerve at the place of formation is10,1±2,8 mm. Differences in the level of development of the common peroneal nerve play an important role in the evaluation of the clinical picture of his injuries. In the «high» version of the formation, the probability of isolated damage to the common peroneal nerve is higher with trauma to the upper and middle third of the thigh. In this embodiment, the formation between the tibial and the common peroneal nerve revealed «anastomoses». Their presence helps to explain the possible dissonance between the clinical picture and the anatomical substrate of the lesion. It is shown that the lower the level of nerve formation, the greater the angle at which the nerve departs. The loose type of branching of the common peroneal nerve at the level of the head of the fibula does not allow adequate mobilization of the nerve in this area. This, in turn, does not allow intraoperatively overcome diastasis with nerve injury at the level of the fibula head. The surface location of the nerve, as well as its immobility in this place cause a high risk of compression-ischemic neuropathy. These features of the formation and variant anatomy of the common peroneal nerve explain a small percentage of favorable outcomes of surgical treatment of lesions of the common peroneal nerve and its main branches. The obtained morphometric data should be used as an indicator of the range of anatomical norms in the conduct of neuroimaging examination techniques (ultrasound, magnetic resonance) in the diagnosis of damage to the common peroneal nerve.
Bulletin of the Russian Military Medical Academy. 2019;21(2):160-165
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Reactive changes in the rat spinal cord in experimental neuropathy with and without magnetic stimulation
Zhivolupov S.A., Rashidov N.A., Onishchenko L.S., Kravchuk A.Y., Kostina O.V., Yakovlev E.V., Trufanov A.G.
Abstract
Performing an experiment in which electronically microscopically studied the nature of reactive changes in the structural thin section of the spinal cord, as well as their dynamics during transcranial magnetic stimulation for 1 month after experimental neuromesis and after compression-ischemic neuropathy of the sciatic nerve. The reported development of compensatory-restorative processes in neurons, glial cells and the microvasculature of the lumbar spinal cord in rats that receive treatment with transcranial magnetic stimulation has been established. It was shown, that in all groups of rats changes in the structures of the lumbar thickening of the rat spinal cord developed in the form of depletion of the cytoplasm, destruction of organelles, changes in the nuclei and development of apoptosis of neurons and glial cells, destruction of the membranes and axial cylinders of myelin fibers. Moreover, these changes are more pronounced in groups after experimental neuromesis. However, in groups of rats, both after compression-ischemic neuropathy and after experimental neuromesis after treatment with transcranial magnetic stimulation, there were signs of the development of recovery processes in the form of intracellular repair of neurons, proliferation of oligodendrocytes, restoration of the structure of myelin fibers and capillaries, and the absence of free red blood cells in the extracellular space. The obtained morphological data confirm the effectiveness of treatment of transcranial magnetic stimulation of injuries of the peripheral nervous system in relation to neurons, glial cells, myelin and non-myelin fibers of the spinal cord.
Bulletin of the Russian Military Medical Academy. 2019;21(2):166-172
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Physiological characteristics of cognitive functions of cadets with military-training experience
Petrenko M.I., Pavlov K.I., Syrtsev A.V., Archimuk A.N., Mukhin V.N., Sysoev V.N.
Abstract
Investigation of physiological mechanisms of cognitive functions and efficiency of cognitive activity is the major problem of military service psychophysiology. We have studied the effect of military-training experience on cognitive functions, heart rate variability and bioelectrical activity of sensorimotor cortex of cadets. Cadets with military-training experience from Suvorov Military (quantity of errors in Shulte’s test (0,16±0,57) in comparison with the cadets without military-training experience (0,54±1,08) (F=4,7; p=0,03). Cadets from Suvorov Military School had a higher quantity of false start (46,36±17,68) and lower quantity of retardation (86,39±17,44) on visual stimulus of test «Reaction on moving object». Cadets without military-training experience had quantity of false start - 38,04±18,95 (F=5,8; p=0,02) and quantity of retardation - 100,48±20,37 (F=15,1; p=0,001). Cadets with military-training experience solved a lower quantity of tasks in the test «Hours with rotation» (26,18±6,71) in comparison with the cadets without military-training experience (29,10±7,89; F=4,3; p=0,04). The maximum time of solving one task at cadets with military-training experience is more (38,07±10,66 sec) than at cadets without military-training experience (34,07±10,57 sec; F=4,0; p=0,05). Cadets with military-training experience had lower heart rate, the higher standard deviation of R-R-intervals and variation range, high level of relative power in the high-frequency spectral bound. They had high activity of sensorimotor cortex of right cerebral hemisphere in the tests with the switching of attention and had low activity of sensorimotor cortex of left cerebral hemisphere in the test with arithmetic tasks.
Bulletin of the Russian Military Medical Academy. 2019;21(2):173-177
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Application of telemedicine technologies in military innovative technopolis «Era»: the first experience and prospects
Kachnov V.A., Rudchenko I.V., Tyrenko V.V., Fisun A.Y.
Abstract
The article substantiates the need for the use of telemedicine technologies in the Armed forces of the Russian Federation. On the basis of the analysis of the literature presents the main directions of their use: remote consultation of doctors with each other, the transfer of data about the patient in a single center, remote monitoring of physiological parameters. The directions for the use of telemedicine technologies in the interests of the Ministry of defense and the need to develop a portable individual device for monitoring the basic physiological parameters of soldiers. Information on the creation of the military innovative technopolis «Era» is presented, the main goals and objectives that will be implemented on its basis are given. The urgency of the creation of «Research laboratory for monitoring vital functions of the body of soldiers and prevention of pathological conditions» on the basis of military innovative technopolis «Era» is emphasized. The main directions of the work of this laboratory and the expected results to be obtained at this site are given. In November 2018 the work of the laboratory, its main goals, objectives and prospects were presented to the President of the Russian Federation. Currently in the laboratory by the specialists of the Military medical Academy n.a. S.M. Kirov and the scientific company of the military innovative technopolis «Era» testing of various domestic wearable devices is carried out comparing them with reference diagnostic systems and software revision.
Bulletin of the Russian Military Medical Academy. 2019;21(2):178-183
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Evaluating of the system of institutional medical care organization for road accident injured in the subject of the Russian Federation
Bugaev D.A., Gorbunkov V.Y.
Abstract
We examine organization of institutional medical care for road accident injured and validate strategies of improvement in the subject of the Russian Federation. Road accidents are one of the crucial reasons of premature mortality, which cause great demographic and social-economic damage. The leading way in global best practices is making traumatologic systems, which also proceeds in the Russian Federation. The research is done in Stavropol region, which possess more than20,1 thousand kilometres of roads. Institutional medical care for road accident injured is provided by 2 traumatologic centres of I level, 3 of II level, 15 of III level. In 2014 the number of injured taken into centres was 3595, in 2017 - 3185. Hospital lethality rate decreased from 4,9% (n=179) in 2014 to 3,7% (n=117) in 2017. However, in 2014 the rate of injured taken into centres of I and II levels was about 37,1%, in 2017 - 46,7% (aimed rate 82%). Complex approach, which includes analyses of location, resource supply, rate of medical centres work and results of the expertise of the provided medical care revealed great shortages in medical care organisation for road accident injured not only in certain centres, but also in the subject in general. Strategies of improvement of institutional medical care for road accident injured are validated in the subject of the Russian Federation (Stavropol region). That includes expanding traumatologic centres network, accreditation of existing traumatologic centres, creating a supplementary sheet for injured in road accident.
Bulletin of the Russian Military Medical Academy. 2019;21(2):184-187
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Experience in consulting with the use of telemedicine technologies in psychiatry and narcology
Skripov V.S., Semenova N.V., Kochorova L.V., Shvedova A.A., Chekhonadsky I.I.
Abstract
The results of the telemedicine advisory center, organized on the basis of the Bekhterev Psychoneurological Research Institute, for the semi-annual period (from October 2018 to March 2019). The center provides scheduled consultations on the profiles of «psychiatry» and «psychiatry - narcology». Consultations are organized through the circulation of documents in the system developed by the Ministry of Health of Russia and the All-Russian Center for Disaster Medicine «Protection». For half a year of work of the telemedicine center from the subordinate regions (Southern, North-Western, North-Caucasian and Volga federal districts) 76 requests for consultations were received. More than half (57,9%) of patients requiring telemedicine consultation were women. The largest number of requests for telemedicine consultations came in February 2019. It has been established that the Southern Federal District showed the greatest interest in consultations with the use of telemedicine technologies, the number of their requests was 35,5%, and the smallest number of requests came from the North-West Federal District. 88,2% of all complaints were in the «psychiatry» profile, 11,8% - «psychiatry - narcology». 90,9% of women and84.4% of men received counseling on the «psychiatry» profile. 30,2% of requests were returned to doctors for revision, due to the lack of completeness of the documents provided. At the end of the consultation, a medical report is sent to the attending physician, which indicates recommendations for the further management of the patient. Recommendations on the need for additional examinations and the appointment of drug therapy received 52,8% of patients, respectively.
Bulletin of the Russian Military Medical Academy. 2019;21(2):188-190
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Т- lymphocytes - «censorial» cells of immune system
Moskalev A.V., Gumilevskiy B.Y., Apchel A.V., Tsygan V.N.
Abstract
The characteristic of population Т-lymphocytes is presented. The variety of effects of these cells is connected with presence of many subpopulations which name small subpopulations helper T-lymphocytes: Тh1, Тh2, Тh3, Тh9, Тh17, Тh22. Mechanisms of activation of these cells and their role in development of mechanisms of the adaptive immune answer, and also possible variants of development of immune dysfunctions and an immune pathology are described. However, the leading part is allocated to the characteristic regulatory T-lymphocytes. From all subpopulations regulatory lymphocytes subpopulation CD4+CD25+high-Т-lymphocytes. Regulatory function autoimmunity а from these cells is most well investigated is shown already at early age. Given subpopulЫation Т-lymphocytes is capable to render suppressor influence on various types immunocompetent the cells providing functioning both congenital, and got immunity. Very important role in functioning CD4+CD25+high-Т-lymphocytes belongs transcriptional to factor FoxP3. It is established, that FoxP3 renders negative effect on activation of T-cells, possibly, owing to oppression efferent functions interleukin 2. Suppressor the effect of these cells is not limited to the T-cells specific to self-antigens. Their influence extends on all microenvironment lymphocytes. Regulatory function CD4+CD25+high-Т-lymphocytes is carried out by means of rendering cytotoxic effect on a cell-target by means of perforins, granzyme A and CD18 without participation of a Fas-receptor. CD4+CD25+high-Т-lymphocytes can render suppressor effect through production transforming growth the factor and expression him on a membrane of a cell. Except for these cells are described Тh3-lymphocytes and inducible regulatory cells. Effects which they cause, are connected with production transforming growth the factor, interleukins 4 and 10. The given biological functions lead to oppression of production of antibodies plasmacytes and modulate presenter activity of macrophages and dendritic cells.
Bulletin of the Russian Military Medical Academy. 2019;21(2):191-197
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Diagnosis and prevention of infectious complications of acute pancreatitis
Ivanusa S.Y., Lazutkin M.V., Chebotar A.V.
Abstract
Based on the analysis of domestic and foreign literature, promising and most frequently used methods of diagnosis and prevention of infectious complications of acute pancreatitis are highlighted. The literature increasingly raises the question of the insufficient efficiency of the study of the concentration of C-reactive protein and procalcitonin samples and suggests new markers of systemic infection. The interest of experts in recent years turned to the study of CD64-neutrophil index, which showed a number of advantages over the previously mentioned methods of diagnosis of infectious complications of acute pancreatitis. Presepsin is actively investigated from humoral markers of inflammation. In prospective studies, he also showed high sensitivity and specificity in the diagnosis of pancreatogenic infection. Approaches to the study of the cultural composition of flora in the developed infectious complications have changed. Gas chromatography - mass spectrometry and matrix associated laser desorption/ionization combined with time-of-flight separation and ion detection mass spectrometry are successfully used in this field. From the methods of prevention of infectious complications of acute pancreatitis actively investigated the effectiveness of minimally invasive surgical techniques, selective intestinal decontamination, alternative routes of administration of drugs. In this area, the latest trend is the most popular, which is confirmed by publications on the effectiveness of endarterial and endolymphatic administration of antibiotics and other drugs. Unsolved problems of accurate prediction, prevention, timely diagnosis of infectious complications of acute pancreatitis justifies the urgency of the problem and the need for further comprehensive research in this area.
Bulletin of the Russian Military Medical Academy. 2019;21(2):198-203
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Analysis of diagnostic and tactical errors in the management of patients with traumatic limb neuropathies
Litvinenko I.V., Zhivolupov S.A., Bulatov A.R., Kuzina E.E., Rashidov N.A., Ivanov V.S., Trufanov A.G.
Abstract
Diagnostic and tactical errors in the management of patients with traumatic neuropathies of the limbs are considered. Attention is drawn to the problem of treatment of traumatic lesions of the peripheral nerves and the organization of medical care in modern conditions for patients with this pathology. The paper describes the difficulties encountered in the differential diagnosis and interpretation of the clinical picture of peripheral nervous system damage, as well as the possibilities of neurophysiological and neuroimaging methods of diagnosis, describes the most common variants of innervation. The most common traumatic neuropathies after medical interventions are presented. It is established that a high degree of mechanization of production, an increase in the number of road accidents, growing household injuries and the mass introduction into everyday life of extreme sports lead to an increase in injuries of the peripheral nervous system. The article pays special attention to the organization of medical care for patients in hospital conditions, as well as the main subjective and objective causes of errors in practitioners during topical diagnosis and treatment of nerve injuries. Attention is drawn to the fact that in order to provide modern high-tech medical care for damage to the nerves of the upper and lower extremities, specialists of surgical and neurological profile need to know the architectonics of the peripheral nervous system and the basic laws of degenerative-regenerative processes in damage to the nerves and plexuses. Rational therapy of victims of this profile should be planned and implemented in the early period of traumatic disease.
Bulletin of the Russian Military Medical Academy. 2019;21(2):204-208
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Occupational diseases caused by exposure to laser radiation
Khalimov Y.S., Vlasenko A.N., Tsepkova G.A., Sosukin A.E.
Abstract
Sources of laser radiation are firmly entrenched in all spheres of human activity: different branches industry, biology, gene engineering, medicine, agriculture. In cases of gross safety violations, laser radiation can be dangerous for people working with it. Biological action of laser radiation is not completely found out. By the nature of human exposure to laser radiation, it is divided into direct, diffuse, specularly reflected and diffusely reflected. It can cause both primary effects, which include organic changes that occur in irradiated tissues, and secondary effects, which are nonspecific changes that occur in response to radiation. The «critical» organs for laser radiation are the eyes and the skin. Laser lesions are divided into acute and chronic. Acute lesions occur either in cases of gross security breaches or emergencies. The development of chronic lesions is possible in cases of prolonged work with low-intensity laser devices. Other adverse factors, such as noise, vibration, light from flash lamps, ultraviolet radiation, tiredness of visual analyzer, air pollution (ozone, oxide of nitrogen), neuro-emotional tension, affect workers during exploitation of laser radiation’s sources. Diagnostics of laser lesions is based on the occupational history data of sanitary and hygienic characteristics of working conditions as well as on the results of clinical examination and dosimetry data. There is no specific treatment for laser lesions.
Bulletin of the Russian Military Medical Academy. 2019;21(2):209-214
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The severity degree estimation for the lower extremity blast injury
Anisin A.V., Denisov A.V., Shapovalov V.M.
Abstract
The present review is concerned with the modern state of the problem connected with the severity degree estimation of the lower extremity blast injury. The specific character of modern combat activity is considered to be the prevalence of the blast trauma in the structure of casualties, this trauma amounting up to 69% of all the combat injuries. The problem of the adequate unbiased estimation of the severity degree for this kind of trauma appears to be critical, because it is important for the appraisal of the necessary volume of medical care provided for the casualties and optimal assignment of the casualties to the medical evacuation stages beginning from the combat zone up to the specialized trauma center. The combat blast trauma is distinguished from the civilian trauma, it also differs from blast injuries occurring during technological disasters. In this regard, the use of traditional estimation parameters for the lower extremity trauma severity, based on clinical findings of civilian injuries, seems not possible. The development of appropriate severity estimation technique for the lower extremity blast trauma is essential not only for the medical care, but also for the adequate experimental modeling processes using human cadavers and biomorphic models, and the development of virtual “mathematical” simulators. Currently, investigators are involved in developing specific severity degree estimation scales for the lower extremity blast injury, based on the case histories analysis and casualties’ follow-up. Foreign experts have proposed a number of assessment classifications of mine-explosive injury, allowing to formulate a diagnosis and determine the severity of the injured explosive limb injuries. In our country, there is currently no generally accepted classification developed in relation to the explosive injury of the lower extremities, but the methods proposed by domestic military field surgeons and traumatologists allow us to effectively assess the severity of this injury and make a certain sorting decision.
Bulletin of the Russian Military Medical Academy. 2019;21(2):215-218
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Key points of etiopathogenesis of non-alcoholic fatty liver disease
Zhirkov I.I., Gordienko A.V., Serdyukov D.Y., Dorokhov G.Y.
Abstract
Based on the analysis of Russian and foreign literature sources, the definition of non-alcoholic fatty liver disease is given, modern data on the etiology, prevalence, risk factors for the development and progression of non-alcoholic fatty liver disease are presented. Nonalcoholic fatty liver disease found in at least a quarter of the world’s population and the main target of this disease is the most able-bodied and economically active part of the population. These circumstances give this problem special medical, social and humanitarian significance. Two different pathomorphological states represent non-alcoholic fatty liver disease: nonalcoholic fatty liver and nonalcoholic steatohepatitis, which, in turn, includes liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. Non-alcoholic fatty liver disease is determined not only on the basis of the results of histological studies in the presence of steatosis in more than 5% of hepatocytes, but also in excess of proton density of more than 5.6% during proton magnetic resonance spectroscopy, or when performing selective magnetic resonance imaging with quantitative determination of fat and water. Modern data on the pathogenesis of nonalcoholic fatty liver disease are presented. Attention is focused on such key mechanisms in the development of the disease as insulin resistance, lipotoxicy, oxidative stress, systemic aseptic inflammation, mitochondrial dysfunction and endoplasmic reticulum, which served as the basis of the pathogenetic theory of «multi hit». The pathogenesis of nonalcoholic fatty liver disease plays an important role visceral adipose tissue, which also synthesized proinflammatory cytokines and adipokines, as well as the syndrome of excessive bacterial growth, due to the formation of endotoxemia and atherogenic dyslipidemia.
Bulletin of the Russian Military Medical Academy. 2019;21(2):219-222
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Experience of the objective structured clinical examination in the framework of state certification of graduates of the clinical ordinature on the specialty «Anesthesiology and reanimatology»: station «Сathering of the internal nuclear vene under the control of ultrasound»
Lakhin R.E., Tsygankov K.A., Andreenko A.A., Shchegolev A.V.
Abstract
The evaluation sheet was tested and practical skills for conducting puncture and catheterization of the internal jugular vein in clinical residents at the station «Catheterization of the internal jugular vein under ultrasound control» were evaluated. The manipulation was performed by 28 second-year clinical interns on the phantom, which allows the puncture of the vessel under the control of ultrasound. The evaluation of manual skills, independently of each other, was carried out by two teachers. Successfully station passed 100% of the examinees. The total time spent on the passage of one resident station was 6,3 (5,1; 7,3) minutes. In100% of cases, the residents demonstrated their knowledge of the technique of puncture and catheterization of the internal jugular vein. In 8 (28,5%) cases, the most frequent errors encountered during the passage of the station were associated with the absence of time fixation after the manipulation, in 10 (35,7%) residents the state of health was not monitored. The differences in the completed evaluation sheets of teachers amounted to 3%. It is shown that the developed evaluation sheet allows you to objectively assess the practical skills of graduates of residency. This evaluation sheet will be further used in the assessment of practical skills at the stage of primarily specialized accreditation for graduates of residency in the speciality «Anesthesiology and reanimatology».
Bulletin of the Russian Military Medical Academy. 2019;21(2):223-227
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Efficiency of high-fidelity simulation-based difficult airways management training of clinical ordinators
Andreenko A.A., Arsentev L.V., Tsygankov K.A., Schegolev A.V.
Abstract
It justifies the effectiveness of the use of high-fidelity simulation when training clinical ordinators on the difficult airway management After the theoretical course and obtaining practical skills of airway management, 26 1-st year clinical ordinators were divided into 2 equal groups. The members of the main group took part in each of 4 «difficult airways» scenarios with the use of a human-patient simulator with subsequent debriefing. Then, after 1, 3 and 6 months, the all ordinators from both groups passed one of the «difficult airways» scenarios with the performance assessment by checklists and the assessment of knowledge with multiple choice questions. In the main group, the high level of retained knowledge was revealed for 6 months (after 1 month - 86 points (81,3-91,2); after 6 months - 83,5 points (78,4-88,9); p>0,05). In the control group, the level of knowledge significantly decreased after 6 months (after 1 month - 82,2 points (75,4-89,2); after 6 months - 69 points (60,7-75, 2); p<0,05). Performance assessment during simulated «difficult airways» scenarios after 1, 3 and 6 months showed an insignificant decrease of the score in the main group (after 1 month - 90,5 points (84,3-94,2); after6 months - 85,5 points (80,4-88,9); p>0,05). The control group showed a significant deterioration in the score assessment after 3 months, followed by its growth and the lack of difference between the groups after 6 months. The simulation-based difficult airways management training enhances the performance and retained theoretical knowledges and skills of trainees during simulated «difficult airways» clinical situations up to 6 months.
Bulletin of the Russian Military Medical Academy. 2019;21(2):228-232
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To the 150 anniversary of the Military medical academy department of dermatology and venerology
Samtsov A.V., Ravodin R.A., Zhukov A.S.
Abstract
Abstact. Described the stages of the formation of one of the first in Russia departments of skin and venereal diseases of the Military medical academy. S.M. Kirov. The contribution of eminent dermatovenerologists of the department leaders is noted: A.G. Polotebnova, V.M. Tarnovsky, T.P. Pavlova, P.A. Velikanova, M.G. Mgebrova, S.T. Pavlova, О.K. Shaposhnikova, A.N. Rodionov. So, A.G. Polotebnov is considered to be the founder of Russian dermatology and venereology. V.M. Tarnovsky was the initiator of the creation of the first in Europe Russian Syphilidological and Dermatological Society. T.P. Pavlov is known for his works on the histopathology of dermatoses, and also raised a large school of dermatology. S.T. Pavlov described for the first time in the world acantholytic cells in pemphigus, and Academician OK Shaposhnikov was the country’s leading specialist in immunology and histopathology of skin vasculitis. Currently, the department’s priorities are: the study of the molecular genetic basis of psoriasis, lymphoproliferative, bullous skin diseases, the study of foci of chronic infections in various dermatoses, the creation of teledermatology and teledermatohistopathology systems in medical institutions of the Ministry of Defense of the Russian Federation, pathohistology, trichology, psychodermatology, development of new external agents for the prevention and treatment of infectious skin diseases using liposomal yy technologies. It is shown that as a result of the work done, the Department of Skin and Venereal Diseases of the Military medical academy. S.M. Kirov reliably secured the status of Russia’s leading scientific and methodological center for the study and treatment of skin diseases.
Bulletin of the Russian Military Medical Academy. 2019;21(2):233-240
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Problems of military medicine eyes Zinovy Petrovich Soloviev
Shpanka A.V., Koshelev V.P., Kornushko I.G.
Abstract
The main milestones in the life and work of the brilliant organizer of the state and military health care of the young Only Soviet Republic - Zinovy Petrovich Soloviev-are considered. A talented doctor-but still a civilian doctor, was able in the fire of fires and the incredible tension of the country to consider the main tasks for the creation and development of military medical service, to highlight them and to formulate brilliantly, including for future generations of military doctors. They are so marked with a distant sight and depth that in General are very relevant for the modern military medical school. Whatever the issues are not related to the inquiring thought of the first chief of the Main military-sanitary Directorate of the worker-Peasant Red Army and the Deputy of the people’s Commissariat of health of the RSFSR, she always found creative ways of their solution. This was not just about military health. Zinovy Petrovich Soloviev has done a lot for the development and improvement of The Russian Red Cross Society. The breadth of perception of care for the health of citizens of the country shows his constant care for the younger generation. He is the main and the main inspirer of the creation of the all-Union health resort for children-pioneer camp «Artek», which operates and develops in modern conditions and performs the tasks that were set by its founder. Soloviev Z.P. did a lot for the development and improvement of social hygiene as a science. His theoretical foundations and directions of scientific research in the field of social hygiene are still used in modern research scientists in this area. Zinoviy Petrovich Solovyov during his brief but eventful life has done much for the establishment and development of Soviet public health, and highlights its contribution to the restructuring, the formation and further development of military health of the country.
Bulletin of the Russian Military Medical Academy. 2019;21(2):241-251
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The first academician from dentistry, professor, colonel of medical service A.I. Rybakov
Iordanishvili A.K.
Abstract
Presents information from the life of a maxillofacial surgeon and dentist, one of the patriarchs of domestic dentistry, a veteran of the Great Patriotic War, academician of the Academy of Medical Sciences of the Union of Soviet Socialist Republics, doctor of medical sciences, professor, colonel of medical service Anatoly Ivanovich Rybakov, known in our country and abroad. , who was the first director of the Central Research Institute of Dentistry. The data on the formation of A.I. Rybakov as a military doctor and dentist, his combat path during the Great Patriotic War. Turning to the life and professional and social activities of Anatoly Ivanovich, one can find not only interesting scientific facts from the history of dentistry and maxillofacial surgery, but also analogies with modernity, answers to many clinical problems of the specialty and medicine of today. The main directions of his scientific activity, which touched questions of almost all sections of dentistry and maxillofacial surgery, are noted. A.I. Rybakov was one of the creators of the working concept of the pathogenesis of dental caries and periodontal diseases, the author of the first recorded discovery in dentistry on the phenomenon of the production of intestinal antigen by the oral mucosa of mammals, the founder of the study of the epidemiology of dental diseases in Russia and the Republics of the Soviet Socialist Republics. It is noted that he was a refined connoisseur of the history of national ballet, a true professional and an authority in this field of art. Anatoly Ivanovich, being one of the founders of domestic dentistry, as well as the school of dentists and maxillofacial surgeons, is rightfully recognized as one of the patriarchs of domestic dentistry.
Bulletin of the Russian Military Medical Academy. 2019;21(2):252-255
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Museum N.I. Pirogov: history and modernity
Budko A.A., Chigareva N.G.
Abstract
Сolleagues, students, members of the Russian Surgical Society of Pirogov put a lot of effort to create the Pirogov Museum to perpetuate the memory of the great Russian surgeon. The construction of the museum was carried out according to the project of the architect V.A. Schroeter for funds allocated from the State Treasury and collected from philanthropists. Museum of Pirogov was opened on October, 26 (November, 7), 1897. The collection of the museum included: items related to the life and work of N.I. Pirogov, preparations for surgical anatomy, surgical pathology, collection of instruments, orthopedic and surgical devices, patient and wounded patient care items, portraits, engravings, manuscripts and documents reflecting all stages of the history of domestic surgery, etc. The museum hosted meetings of Pirogov Russian Surgical Society, conferences and all-Russian congresses of doctors. The events of the first third of the 20th century negatively affected the fate of the Pirogov Museum. Since 1930 the museum of N. I. Pirogov was under the jurisdiction of the Military Medical Academy, its funds were transferred to several departments of the Academy, and the building of the museum in the 70iеs of the twentieth century was torn down. In 1946 part of the valuable items of Pirogov’s museum became the property of the Military Medical Museum. December 19, 2018 there was a significant event in the history of Russian medicine happened: a grand opening of Pirogov’s museum took place in the Military Medical Museum. At the opening greetings were made by representatives of Pirogov National Medical and Surgical Center (Moscow), Military Medical Academy. S.M. Kirov, Surgical Society, Committee on Culture of St. Petersburg, the Consulate of the Kingdom of the Netherlands, etc. The basis of the exposition of the revived Pirogov’s museum make up the original things of the great surgeon: a hat, a sword belt, a sword hat, a cocked hat, a box made of Karelian birch, a smoking pipe, orders and medals, manuscripts, letters, as well as atlases, medical instruments, lithographic stones, etc.
Bulletin of the Russian Military Medical Academy. 2019;21(2):256-260
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The Contribution of Scientists of the Kirov Military Medical Academy to the Development of Military Transfusiology, in Commemoration of the 100th Anniversary of the Birth of Professor S.V. Ryzhkov
Vilyaninov V.N., Popova N.N.
Abstract
June 23, 2019 marks the 100th anniversary of the birth of prominent Russian transfusiologist, professor, student of academic V.N. Shamov, participant of the Stalingrad Battle Semyon Vavilovich Ryzhkov (1919-2004). He was the one who established the Russian Ministry of Defense Blood Service. In 1961, he founded the Research Laboratory of Fibrinolysis Blood and Tissue Preservation, which since 1964 bears the name of the Blood and Tissue Center. He had been the head of the Center for20 years. His academic interests covered such issues as the use of hemodialysis in acute renal failure, the cryopreservation of red blood cells and bone marrow, which brought him the Union of Soviet Socialist Republics State Prize in 1978, the substantiation of the safety of a 400 ml blood donation, and the use of donor hardware plasmacytopheresis. The article presents data on the contribution of the scientists of the Military Medical Academy to the development of the national blood transfusion service from the 2nd half of the XIX century till the establishment of the Ministry of Defense Blood Service in 1965. June 21, 1919V.N. Shamov, N.N. Elansky, and I.R. Petrov carried out the first donor and recipient matching blood transfusion in Russia. They contributed a lot to teaching medical practitioners to do blood type tests. In 1926, N.N.Yelansky was the first in Russia to publish the study Blood Transfusion. In 1944, V.N.Shamov was the first in Russia to publish The Blood Transfusion Manual for Military Doctors. On the battlefields of Lake Hassan, the Khalkhin Gol River, and in Spain, the surgeons of the Military Medical Academy proved the universal type 0 blood transfusion to be a successful technique. The opinions of scientists on blood donation and preservation, indications and contraindications to blood transfusion in peacetime and wartime are presented.
Bulletin of the Russian Military Medical Academy. 2019;21(2):261-266
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From the hospital barracks to the general hospitals at the Vyborg Side
Samoilov V.O., Milasheva N.V.
Abstract
For our study, we used lots of documentary materials from the collections of the Russian State Historical Archive in Saint Petersburg, documents from the funds of the Russian State Archive of Ancient Acts in Moscow relating to the construction of an architectural complex of buildings of the general hospitals at the Vyborg Side in the epoch of Peter the Great. All the facts of the history of construction of the general hospitals are confirmed by archival documents, including decrees and orders by Peter I on the construction of hospital buildings, contractors hiring, by official documents and protocols of the Chancellery of buildings on the non-completed construction of wattle and daub huts for hospital purposes as well as by documents on the run-away contractors, on the demolition of wattle and daub huts and transfer of buildings to Admiralty college«for use as cable sheds», about the stay of the sick and wounded in old wooden hospitals, by documents on the construction of stone buildings of the Admiralty (Marine) and Land military hospitals, the correspondence of the Chancellery of buildings with the Military and the Admiralty collegia, by contractors’ agreements, reports by D. Trezzini on the construction of wattle and daub huts (1718) and stone hospital buildings («Part of hospital buildings at the Vyborg Side…», 1720), reports by D. Trezzini on the prolonged period of construction works and other documents. The study shall be continued.
Bulletin of the Russian Military Medical Academy. 2019;21(2):267-272
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In memory of Academician Ivan Petrovich Pavlov (on the 170th anniversary of his birth)
Apchel V.Y., Morgoshiia T.S.
Abstract
The main years of the life and scientific creativity of I.P. Pavlova. Illuminated little-known facts from the life of a scientist. It is noted that IP Pavlov is one of the most prominent representatives of modern natural science, the creator of the materialistic theory of higher nervous activity of humans and animals, the founder of the largest physiological school of modernity and new approaches and methods of research in physiology. Pavlov I.P, studied many topical problems of physiology and medicine, but his most systematic and thorough research relates to the physiology of the circulatory and digestive systems, as well as the higher parts of the central nervous system: they are rightfully considered classic, which opened new pages in the relevant sections of physiology and medicine. New and valuable were the results of his research also on individual issues of the physiology of the endocrine system, comparative physiology, physiology of labor and pharmacology. Being deeply convinced that “for a natural scientist, everything is in a method,” IP Pavlov elaborated and introduced the practice of physiological research into the method of a chronic experiment, based on the need for a multilateral and detailed study of the body’s functions in natural conditions, in inseparable communication and interaction with the environment. This method brought the physiology out of the impasse created by a one-sided, analytical method of acute vivisection experiment that prevailed for a long time. Used in the early works of Pavlov on the physiology of blood circulation, the method of chronic experiment was elevated to the rank of a new scientific experimental principle in basic research on the physiology of digestion and then perfected when studying the functions of the higher parts of the central nervous system. Pavlov I.P comprehensively researched and studied the dynamics of the secretory process of the gastric and salivary glands, pancreatic glands, the work of the liver in the use of food of different quality, proved their ability to adapt to the nature of the causative agents of secretion. Created by Pavlov’s theory of higher nervous activity is one of the greatest achievements of natural science in the 20th century. It is a system of the most reliable, complete, accurate and deep knowledge of brain functions and is of great practical importance for medicine, psychology, pedagogy, and scientific organization of complex labor processes.
Bulletin of the Russian Military Medical Academy. 2019;21(2):273-279
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