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Vol 22, No 3 (2020)

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Clinical trials

Clinical and epidemiological features of manifestations of Wolf – Parkinson – White syndrome in men of draft age with increased dysplastic stigmatization

Shulenin K.S., Cherkashin D.V., Kutelev G.G., Kachnov V.A., Ivanov V.S., Goncharuk R.N., Bogdanov D.S.


Abstract. Clinical and epidemiological and electrocardiographic features of Wolf – Parkinson – White syndrome in men of military age were studied. The study was a retrospective study with a solid sample of patients. Of the 1,9056 men residents of St. Petersburg between the ages of 18 and 27, Wolf-Parkinson-White syndrome was identified in 107 (0,56%) people. The disease was asymptomatic in 38 (35,5%) patients. All identified individuals with Wolf – Parkinson – White syndrome, in addition to asthenic Constitution type, which was observed in 68,2% of cases, were assessed for signs of systemic connective tissue involvement. It was found that flat feet, scoliosis or kyphosis, myopia, as well as mitral valve prolapse and abnormally located chords in the left ventricle of the heart are detected in almost every second man of military age. Due to the inability to assess the presence of all signs of systemic connective tissue involvement, the isolation of specific variants of dysplastic phenotypes in patients with Wolf – Parkinson – White syndrome was not performed. It was found that in the presence of increased dysplastic stigmatization, the clinical course of Wolf – Parkinson – White syndrome is characterized by a lower number of asymptomatic cases (6,3 and 16,7%, respectively; p<0,05), an increase in the frequency of paroxysmal tachyarrhythmias (81,5 and 63,1%, respectively; p<0,05) and a high incidence of vegetative-vascular disorders (82,8 and 15,4%, respectively; p<0,05).

Bulletin of the Russian Military Medical Academy. 2020;22(3):8-11
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Chronic non-viral liver pathology in military personnel exposed to military-professional factors

Zhirkov I.I., Gordienko A.V., Yakovlev V.V., Serdyukov D.Y., Fomichev A.V.


Abstract. The prevalence and structure of chronic non-viral liver disease of military personnel whose service is associated with the influence of various military-professional factors are estimated. It is established that the frequency of chronic diffuse liver diseases of viral etiology in a group of servicemen radio-technical troops was 77,3%, from persons engaged in diving and altitude descents – 65,9%, pilots of the aerospace defence forces of Russia 62,8%, in persons without exposure to military occupational factors is 69,5%. The largest number of persons suffering from chronic non-viral liver disease in the group of military radio-technical troops, probably related to low levels of physical activity and higher values of body mass index and waist circumference, but also the influence of microwave radiation, can enhance the damaging effects of lipid peroxidation. The lowest prevalence of non-viral chronic diffuse liver diseases among pilots and aquanauts is probably related to the maximum health requirements imposed on military personnel of these categories. It was found that the level of alcohol consumption and the nature of nutrition in the study groups did not significantly differ. The highest values of body mass index and waist circumference in combination with the lowest level of physical activity were observed in the group of military personnel of the radio engineering troops, which is probably due to the nature of daily military service, which is mainly «sedentary». Among the metabolic changes of blood serum, increased total cholesterol levels in groups of divers, pilots and military Radio-technical troops compared with a control. In addition, the level of glucose in Aquanauts, as well as triglycerides in soldiers of the radio engineering troops was higher than in the control group. Ultrasound examination in all groups related to the impact of military occupational factors, recorded an increase in the thickness of the left lobe of the liver, and oblique vertical size and thickness of the right lobe in the group of soldiers of the radio-technical troops compared with a control. In addition, the values of the thickness of the intima-media complex as a marker of preclinical atherosclerosis associated with non-alcoholic and alcoholic-metabolic fatty liver diseases in this category of individuals significantly exceed them in the other groups. The maximum level of liver damage in the group of military personnel of radio engineering troops is confirmed by the highest values of the controlled parameter of attenuation of ultrasound, reflecting the degree of liver steatosis.

Bulletin of the Russian Military Medical Academy. 2020;22(3):12-17
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Association of arterial hypertension gene polymorphisms with the risk of sudden cardiac death in young people

Kachnov V.A., Tyrenko V.V., Kolubaeva S.N., Cherkashin D.V., Kutelev G.G., Myakoshina L.A., Buntovskaya A.S.


Abstract. The frequency of occurrence of arterial hypertension genes in individuals at risk of sudden cardiac death was studied. The relationship between risk factors for sudden cardiac death and the presence of polymorphisms of arterial hypertension genes was revealed. There was a high incidence of homozygous risk variants AGTR2 AA and CYP11B2 TT-polymorphisms responsible for the development of left ventricular hypertrophy, including in young individuals. A correlation was found between deaths in close relatives under 50 years of age and the presence of polymorphisms in the CYP11B2 344 C>T gene in young people at risk of sudden cardiac death. We have obtained data indicating the feasibility of conducting a study of the polymorphism of the CYP11B2 gene in the presence of a risk of sudden cardiac death. A direct correlation was found between the presence of fatal outcomes in relatives under 50 years of age by the mechanism of sudden cardiac death and the number of homozygous variants of arterial hypertension genes. Mathematical models for predicting the presence of polymorphisms in genes responsible for the possibility of arterial hypertension are constructed. Among the constructed mathematical models, the most informative were models for detecting carriers of mutations in the genes ADD1 1378 G>T, CYP11B2 344 C>T and NOS3 894 G>T. The expediency of the analysis to search for mutations of arterial hypertension genes, especially in the CYP11B2 344 C>T gene, for the possibility of earlier and more intensive preventive measures in young people is shown. The data obtained indicate that there are relationships between the risk of sudden cardiac death, some known predictors of its occurrence, and the genes for arterial hypertension.

Bulletin of the Russian Military Medical Academy. 2020;22(3):18-22
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Concept formulation for the early-stage pathogenetic treatment of the severe injuries and traumas

Samokhvalov I.M., Golovko K.P., Boyarintsev V.V., Badalov V.I., Suprun T.Y., Nosov A.M., Vertiy A.B., Denisenko V.V., Chupriaev V.A., Grishin M.S.


Abstract. 451 lethal outcomes of 5581 casualties with gunshot wounds occurring at the medical treatment facilities have been analyzed. Total lethality rate was 8,1%. Lethal outcome time varied from 1 to 19 days (10,6±1,9). 50,3% of casualties died during the advanced trauma management (Role 2), 17,3% – at the Role 3 hospitals, 32,4% – at the Role 4 hospitals. The predominant injury localization causing death was abdominal wounds – 34,8%, and head injuries – 23,1%. The main cause of death of wounds casualties arriving at the medical treatment facilities was life-threatening injury consequences (34,8%) and developing complications (45,5%). Fatal injuries to the major organs and permanent blood loss were considered to be the cause of death in 19,7% of casualties. 37% of the total number of lethal outcomes died because of acute blood loss, in 77,2% of cases it was internal hemorrhage, in 22,8% – external hemorrhage. In 1% of cases early death was caused by acute respiratory failure. In general, the development of more than one third of lethal outcomes could be prevented. Special medical products and equipment were developed by the Department of War Surgery Kirov Military Medical Academy, RF Ministry of Defense in cooperation with the leading research and educational establishments and production enterprises. They are: equipment for the prehospital hemorrhage control, asphyxia management, open and tension pneumothorax management, traumatic shock treatment and complication prevention, as well as activities for creating devices controlling internal hemorrhage. All these form the basis for elimination of life-threatening consequences of injuries at the prehospital stage. This allows us to discuss the development of the idea of a traumatic disease, being put forward by professor Ilia Deriabin, in terms of the concept of «the early-stage pathogenetic treatment of the severe injuries and traumas».

Bulletin of the Russian Military Medical Academy. 2020;22(3):23-28
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Percutaneous Urolithiasis Surgery in Military

Protoshak V.V., Paronnikov M.V., Sivakov A.A., Lukinov K.A., Kiselev A.O., Alentiev S.A., Lazutkin M.V.


Abstract. The clinical efficacy and safety of the use of percutaneous techniques in the treatment of kidney stones in 72 servicemen were studied. All percutaneous operations were performed by one operating team. It was found that percutaneous urolithiasis surgery was effective in 88.9% of people. «Stone free rate» was achieved in 83,8% of military personnel undergoing standard percutaneous nephrolitholapaxy and in 94.3% of patients undergoing minipercutaneous nephrolitholapaxy. With stones larger than 2 cm, the effect was observed in 81.8% of cases with standard surgery and in 96% of patients with mini-percutaneous approach. Percutaneous interventions in military personnel with stones larger than 2 cm were effective in 84,6% of patients with standard surgery and in 90% with mini-percutaneous access. Complications according to the Clavien-Dindo classification were found in 29,1% of servicemen: in 20,8% of cases of standard nephrolitholapaxy and in 8,3% of minipercutaneous nephrolitholapaxy. The bulk of the complications were Grade I–II – 20,8%. Grade III – IV were determined less frequently – in 8,3% of cases. Urosepsis (Grade IV b) and death (Grade V) were not observed in our study. Duration of labor losses for conscripted servicemen were about 17 days, for contract servicemen when performing standard nephrolitholapaxy – 12,8 days, for military personnel with minipercutaneous nephrolitholapaxy – 11,2 days. The dismissal rate among conscripts was 18,2%. There were no contractual servicemen who were dismissed from the ranks of the Armed Forces of the Russian Federation, however, 14,7% of servicemen who underwent a standard operation and 11,1% of patients who underwent mini-percutaneous nephrolitholapaxy after surgery needed sick leave for a period of 15 days. In general, percutaneous techniques are common and effective methods of surgical treatment for military personnel suffering from urolithiasis. Mini-percutaneous approach for nephrolitholapaxy is safer than the standard approach, but it is less effective for coral calculi. Percutaneous methods for removing kidney stones are associated with a low rate of dismissal and short recovery times for military personnel.

Bulletin of the Russian Military Medical Academy. 2020;22(3):29-34
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The effectiveness of autologous mesenchymal stem cells in the treatment of liver cirrhosis and the method of their visualization in the patient’s body

Kotkas I.E., Enukashvili N.I., Asadulayev S.M., Chubar’ A.V.


Abstract. The effectiveness of the influence of autologous mesenchymal stem cells on the function of liver tissue in liver cirrhosis of alimentary etiology is considered, as well as the possibility of visualization of the introduced cell structures with subsequent cytological confirmation. To be able to track autologous mesenchymal stem cells introduced in the patient’s body, they were labeled with iron oxide nanoparticles. Visualization of the introduced cell structures was performed using magnetic resonance imaging and ultrasound examination of the liver. 6 months after the cell therapy, clinical and biochemical blood tests, lidocaine test results, elastography indicators were evaluated, and the dynamics of hepatic encephalopathy was evaluated. The effectiveness of using autologous mesenchymal stem cells was evidenced by the improvement of the above indicators. Also, 6 months after treatment, a liver tissue biopsy was performed from the sites of fixation of previously introduced cell structures. Histological examination revealed the largest number of labeled cells in the liver micro-nodes, as well as at the borders of micro-nodes and fibrous septa. The use of cell therapy in a patient suffering from liver cirrhosis of alimentary etiology helped to improve the indicators of laboratory and instrumental research methods. No complications were detected during the procedure.

Bulletin of the Russian Military Medical Academy. 2020;22(3):35-40
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Prevalence and clinical significance of electrocardiogram abnormalities in older civil aviation pilots

Kuzmina A.Y., Blaginin A.A., Fisun A.Y.


Abstract. Prevalence and clinical significance of electrocardiography findings was studied in 1189 older pilots in aged 55 years and older, who were consistently admitted to the Central Civil Aviation Hospital (Moscow) and examined on the regular bases. Resting 12-lead electrocardiogram was recorded in all subjects according to generally accepted methods. Normal electrocardiogram was found in 78,5% of older pilots. None of the examined showed signs of myocardial infarction. Minor electrocardiogram abnormalities was registered in 21,5% of pilots. Cardiac conduction disorders were predominated – 16,1% of cases, most of them were intraventricular conduction disorders – 13,7% of cases. Another electrocardiogram abnormalities were less common – 4% of cases. Mixed electrocardiogram abnormalities were noted in a small number of observations – in 1,4% of individuals. Thus, older civil aviation pilots are characterized a lower frequency of majority electrocardiogram deviations compared to a population of the same age. The evaluation of fitness to flight in some electrocardiogram deviations is depend of the presence or absence of cardiovascular disease, functional condition of the cardiovascular system and the data of additional examination methods. On the whole, the electrocardiogram use as a screening in asymptomatic individuals has some significant limitations - a number of detected abnormalities may be normal variants, as well as a normal electrocardiogram may be in significant narrowing of the coronary artery. Nevertheless, the need for electrocardiogram recording is recognized by aeromedical specialists of different countries, since this method is exclude a number of pathological changes, which are significant for flight safety.

Bulletin of the Russian Military Medical Academy. 2020;22(3):41-45
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Similarity of manifestations of epidemic processes of infectious mononucleosis and upper respiratory tract infections

Solomay T.V., Filatov N.N., Kaira A.N., Lavrov V.F., Kuzin A.A., Lantsov E.V.


Abstract. The similarity of clinical manifestations of infectious mononucleosis with upper respiratory tract infections is analyzed. The article substantiates the possibility of detecting the presence of common epidemiological patterns of infectious mononucleosis and upper respiratory tract infections. Strong direct correlations were found between long-term and intra-annual dynamics of infectious mononucleosis and upper respiratory tract infections, as well as a significant excess of infectious mononucleosis in children aged 1–17 years and upper respiratory tract infections in children aged 0–17 years over other age groups in Moscow in 2009–2018. It was found that the similarity of manifestations of epidemic processes of infectious mononucleosis and upper respiratory tract infections is due to the action of the aerosol transmission mechanism and consists in the coincidence of long-term and intra-annual dynamics of morbidity and the community of risk groups (children from 1 to 17 years). We have found that differences of these diseases due to the presence of infectious mononucleosis, additional modes of transmission and the long incubation period and polyetiological group of infections of the upper respiratory tract, and occur in higher levels in the incidence of upper respiratory tract infections; seasonal peaks of incidence that falls on different months; the incidence rate among children under one year. Polymorphism of clinical manifestations, lack of clear diagnostic criteria and laboratory interpretation of diagnoses for both nosologies suggest that there is a significant proportion of diseases caused by the Epstein – Barr virus in the structure of upper respiratory tract infections. This assumption requires further in-depth study.

Bulletin of the Russian Military Medical Academy. 2020;22(3):46-51
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The original modification of Albrecht – Staveley operation in the treatment of Wilkie’s syndrome

Sigua B.V., Zemlyanoy V.P., Kachiuri A.S., Melnikov V.A.


Abstract. Presents a clinical case of the treatment of a patient suffering from Wilkie’s syndrome. Wilkie’s syndrome (aorto-mesenteric compression of the duodenum) is a compression of the duodenum (its horizontal section) between the abdominal aorta and the superior mesenteric artery. The causes of this disease are asthenic constitutional type, sharp weight loss, etc. A natural complication of Wilkie’s syndrome is the occurrence of a chronic violation of duodenal patency. The method of choosing treatment for aorto-mesenteric compression is surgery. The most optimal volume of surgery is the formation of duodenojejunoanastomosis according to Albrecht – Staveley, however, after this intervention, there is a high risk of a vicious circle syndrome. Patient M., 28 years old, who was scheduled for treatment, noted constant pain in the upper abdomen for 18 years, aggravated after eating, nausea, periodic vomiting, weakness. As a result of the examination, the patient revealed aorto-mesenteric compression of the duodenum. According to multispiral computed tomography of the abdominal organs with contrast at a distance of 40 mm from the mouth of the superior mesenteric artery, a horizontal branch of the duodenum is located between it and the aorta, its diameter at this level is no more than 4 mm, the angle of departure of the superior mesenteric artery from the aorta is 17 degrees. Violation of the passage through the duodenum was confirmed by fluoroscopy of the upper gastrointestinal tract with contrast. The patient underwent surgery. As a method of surgical treatment, an original modification of Albrecht – Staveley operation was used, which, in addition to achieving the main goal, is aimed at preventing the development of the «vicious circle» syndrome. The patient was discharged from the clinic on the 10th postoperative day in satisfactory condition.

Bulletin of the Russian Military Medical Academy. 2020;22(3):52-55
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The significance of theme expertise of the quality of medical care in achieving successful results in treating patients with acute gastrointestinal bleeding

Skryabin O.N., Movchan K.N., Tvorogov D.A., Tatarkin V.V., Morozov Y.M., Alekseev P.S., Rusakevich K.I., Zhelezniy E.V.


Abstract. This piece of work has evaluated the quality of medical care provided in 2015 to 1,158 patients with acute gastrointestinal bleeding in 11 medical institutions of Saint Petersburg that are licensed to provide in-patient examination and treatment for people with acute surgical diseases abdominal organs. The data on the possible correlative relationship of negative consequences for the implementation of the medical treatment and diagnostic process in cases of insufficient activity in terms of conducting clinical expert work on the profile of emergency abdominal surgery have been analysed in particular. It has been shown that providing medical care to patients with gastrointestinal bleeding is associated with defects in the medical diagnostic process in almost every second case. In the structure of inaccuracies, there prevailed cases of improper examination and treatment of patients (48 and 36%, respectively). Defects in making diagnosis and providing continuity comprise 13 and 3% respectively. The most significant drawback in providing medical care to patients with gastrointestinal bleeding was the use of low-effective anti-ulcer drug therapy schemes (16% of observation cases) and attempts to perform hemostasis by using outdated technologies of intraluminal endoscopy (16% of cases). It is noted that in cases of providing medical care to patients with acute gastrointestinal bleeding, a differentiated principle should be observed. It is proved that the proper quality of medical care for patients with acute gastrointestinal bleeding can be achieved by consistent, programmed provision of it with coordinated activities not only of surgeons directly involved in the treatment and diagnostic process, but also with their purposeful interaction with specialists of other medical fields.

Bulletin of the Russian Military Medical Academy. 2020;22(3):56-60
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Risk factors for the formation of polymorbidity in military personnel based on the results of their medical examination

Voronin S.V.


Abstract. The risk factors for the formation of polymorbidity in military personnel of different age groups were studied during a medical examination to determine the category of fitness for military service. It was established that the most effective indicators in the form of linear dependences were: the level of trans-systemic polymorbidity and body mass index, waist-to-hip ratio, the cardio-anklevascular index, the thickness of the intima-media complex of the common carotid artery, the level of total cholesterol, and alcohol consumption.In the group of military personnel under the age of 35, positive correlation was found between trans-systemic polymorbidity and body fat, body fat percentage, body mass index, total cholesterol and low density lipoproteins.In the group of military personnel aged 36 to 45 years, positive correlation was found between trans-systemic polymorbidity and body mass index, percentage of body fat, and fat tissue in the body. Given the positive correlation between trans-systemic polymorbidity and indicators characterizing overweight, obesity is one of the leading factors in the formation of polymorbidity under the age of 45 years. It is shown that measures aimed at the prevention of polymorbidityshould basicallyinclude generally accepted measures for cardiovascular prophylaxis and obesity.

Bulletin of the Russian Military Medical Academy. 2020;22(3):61-67
pages 61-67 views

Analysis of airmen disadaption factors after combat stress exposure

Schegol’kov A.M., Blaginin A.A., Fisun A.Y., Cherkashin D.V., Makiev R.G., Gornov S.V., Kutelev G.G.


Abstract. Factors of disadaptation of pilots after combat stress are analyzed as one of the main factors in the development of post-traumatic stress disorder. It was found that the effects of combat stress have a great impact on young, thin pilots, with a predominance of the parasympathetic division of the autonomic nervous system and a reduced basic metabolism of the body. The data obtained allow for early diagnosis and identification of functional disorders in pilots for their medical and psychological rehabilitation. The use of the proposed discriminant function can be divided into adapted and unadapted (differently processing traumatic experience), for the development of appropriate rehabilitation programs within their medical and psychological rehabilitation. The revealed decrease in the reserve capabilities of the Central nervous system and the adaptive capabilities of the body of pilots subsequently leads to a decrease in the reliability of the professional activity of the pilot with an increase in its physiological price. In terms of methodology, understanding the postponement of the negative impact of combat stress factors on the pilot’s body requires constant measures for early detection and correction of emerging functional disorders. The consequences of combat stress are considered as an integral reaction of the body to the complex impact of various factors of combat stress, which is manifested at the psychophysiological and somatic levels and leads to early disqualification of pilots for medical reasons.

Bulletin of the Russian Military Medical Academy. 2020;22(3):68-71
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Epidemiological aspects of malaria in the Astrakhan region for the period from 1996 to 2019

Arakelyan R.S., Irdeeva V.A., Gasanova E.D., Abrosimova L.M., Shendo G.L., Kurbangalieva A.R., Karpenko G.A.


Abstract. The epidemiological situation of malaria incidence in the Astrakhan region from 1996 to 2019 is analyzed. During this period, 163 cases of human malaria were registered in the Astrakhan region. The largest number (134 (82,2 %)) cases of malaria were reported between 1996 and 2002. Since 2002, there has been a downward trend in the incidence of malaria from 11 (6,7%) in 2002 to 1 (0,6%) in 2019. Cases of malaria were registered between the ages of 5 months and 70 years, including 41 (25,2%) children aged 5 months to 17 years and 122 (74,8%) cases in adults. At the same time, 91 (74,6%) adults employed in various industries were in the group of people of working age. Three-day malaria was registered in 153 (93,3%) people, 8 (4,9%) people – tropical malaria and 1 (0,6%) – four-day and ovale-malaria, respectively. In the Astrakhan region, 141 (86,5%) people registered imported malaria from both the Commonwealth of Independent States and the African continent. In addition to imported malaria, 11 (6,7%) cases reported secondary malaria from imported malaria. The percentage of repeat cases was 11 people. All cases of malaria were diagnosed on the basis of epidemiological history, clinical picture and laboratory studies. Thus, in recent years, isolated cases of imported malaria have been registered in the Astrakhan region. Both children and adults are susceptible to the disease. Malaria was imported to the Astrakhan region mainly from Azerbaijan, Tajikistan and countries of the African continent.

Bulletin of the Russian Military Medical Academy. 2020;22(3):72-75
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Effect of atorvastatin on the lipid profile, markers of immune inflammation and symptomatic severity of heart failure in patients with myocarditis

Ryzhman N.N., Grishaev S.L., Cherkashin D.V., Gladysheva E.V., Filippov V.Y., Kutelev G.G.


Abstract. The effect of atorvastatin on the immune system and lipid metabolism after 24-week treatment of patients with chronic myocarditis is considered. Statins have been found to improve the clinical course of heart failure with a preserved ejection fraction in patients with myocarditis: they reduce the functional class of heart failure, improve the systolic function of the heart and its arrhythmogenic potential. Despite the large amount of conflicting data in the field of statin use in heart failure, one can think about the possible influence of molecular differences in statins on their pharmacological and pleiotropic effects. In particular, atorvastatin, which has lipophilic properties, is able to penetrate cardiomyocytes in contrast to hydrophilic rosuvastatin, which may partially explain the positive cardiac effects of atorvastatin in patients with heart failure with a preserved ejection fraction. The probable basis for the positive effect of atorvastatin on morphofunctional parameters in heart failure is its positive pleiotropic effects associated with a decrease in рro-inflammatory immune markers and subsequent leveling of negative neurohumoral activation. An additional mechanism that caused the positive effect of atorvastatin on the clinical course of heart failure can be considered a factor of preservation of systolic function of the left ventricle.

Bulletin of the Russian Military Medical Academy. 2020;22(3):76-81
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Endoscopic transversus abdominis release separation in the treatment of patients with midline incisional hernias

Burdakov V.A., Zverev A.A., Makarov S.A., Strizheletsky V.V., Rutenburg G.M., Matveev N.L.


Abstract. The issues of reconstruction of the anterior abdominal wall in patients with median postoperative ventral hernias remain relevant for many years. The paradigm of their treatment is gradually shifting towards functional minimally invasive reconstructions of the anterior abdominal wall. The indications and technical aspects of endoscopic posterior separation surgery are considered. The analysis of 70 transversus abdominis release was carried out. The average age of patients with postoperative ventral hernias was 61,2±10 years. The median follow-up was 14,2±8,2 months and the anaesthesia risk was 2,8±0,5. The mean hernia width was 151,7±73,7 cm2 and the implant size was 832,9±243,3 cm2. In the early postoperative period complications were observed in 7 (10%) patients, including the one with retromuscular hematoma, four with retromuscular space infection and two with superficial vein thrombophlebitis. Late complications were observed in 6 (8,7%) patients, there were persistent seroma (3) and chronic pain (3). No hernia recurrence was detected during this period. Thus, the use of endoscopic abdominal wall separation reduces the risk of local complications compared to similar open surgery. At the same time, there is a low level of hernia recurrence and a satisfactory quality of life. In total there were 70 (100%) transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release operations performed, among them 14 (77,8%) were bilateral transversus abdominis release and 32 (61,5%) were unilateral transversus abdominis release – 4 (22,2%) and 20 (38,4%) respectively were transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal – 10 (14,3%) operations with combined access were performed: 3 (16,7%) and 7 (1,5%) respectively transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release. In 13 (18,6%) cases simultaneous operations occurred, including 7 (10%) laparoscopic cholecystectomy and 6 (8,6%) endoscopic inguinal hernioplasty.

Bulletin of the Russian Military Medical Academy. 2020;22(3):82-87
pages 82-87 views

About the effectiveness of cell technologies in extensive soft tissue defects plasty

Fistal E.Y., Popandopulo A.G., Soloshenko V.V., Movchan K.N., Romanenkov N.S., Yakovenko O.I., Gedgafov R.M.


Abstract. Fetal fibroblast culture transplantation results were evaluated in the treatment of 18 burn victims. Comparison group consisted of 18 burn patients received medical care without cellular technologies utilization. The main comparison parameters in the study groups: the timing of the first stage of autodermoplasty; the number of autodermoplasties during the treatment; hospitalization duration; the newly formed epidermis area estimation. Fetal fibroblast culture transplantation in burn patients with extensive skin defects was performed on average 14,88±3,56 days after the injury. The timing of the first stage of autodermoplasty did not differ in the main and control groups, not exceeding an average of 19,12±2,01 days (p=0,48). An average of 2,71±0,67 surgeries using cell technologies performed in patients of the study group. The use of fetal fibroblasts culture in patients with extensive skin defects reduces the need for autodermoplasty by 1,6 times due to the granulation tissue formation and the epidermal growth beginning 7 days after and complete epidermal formation 14 days after transplantation. Regenerative medicine technologies utilization in patients with extensive skin lesions is possible and appropriate. Due to the fetal fibroblasts culture transplantation a kind of temporary biological coating is formed in the wound. It accelerates the wound healing process phase change from exudation to proliferation and the preparation of skin defects for autodermoplasty, expanding the possibilities of effective patients treatment.

Bulletin of the Russian Military Medical Academy. 2020;22(3):88-92
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Induction of the remission of immune thrombocytopenic purpura

Odin V.I., Lehthlaan-Thynisson N.P., Zolotarev A.D., Mineeva N.V., Polyakov A.S.


Abstract. A review of the literature on remission of immune thrombocytopenic purpura in children and a retrospective analysis of its course in a young patient who was successively applied, first to no avail, standard drug therapy, and then, due to the lack of effect, a physiotherapy technique based on the principles of activation therapy. It is known that immune thrombocytopenic purpura is a rare acquired autoimmune disease characterized by isolated thrombocytopenia with the occurrence of hemorrhagic syndrome of varying severity, which can lead to fatal bleeding. At the same time, antiplatelet antibodies are detected only in half of patients suffering from immune thrombocytopenic purpura, and therefore are not a necessary criterion for diagnosis, which in turn makes it difficult to diagnose the disease and does not allow them to be used as a criterion for the effectiveness of treatment. Despite the fact that in childhood, most cases of immune thrombocytopenic purpura occur in acute form, often with the development of spontaneous remission, but in a significant part of patients, relapses of the disease are accompanied by significant thrombocytopenia, hemorrhagic syndrome, and a decrease in the quality of life, which requires specific therapy up to splenectomy. When using the Reverse wave technique in the treatment of immune thrombocytopenic purpura, a stable, long-term remission was achieved in a young patient. The prospects of studying the application of this physiotherapy technique in clinical practice are discussed.

Bulletin of the Russian Military Medical Academy. 2020;22(3):93-98
pages 93-98 views

Doppler ultrasoundgraphy capability in the evaluation of renal circulation in patients with type 2 diabetes mellitus and chronic kidney disease

Shipilova D.A., Nagibovich O.A., Shchukina N.A.


Abstract. The 72 patients with type 2 diabetes mellitus and chronic kidney were examined to clarify Doppler ultrasound capability in assessing the renal circulation. Hemodynamics changes in kidney tissue appeared on early stage of diabetic kidney disease. Intrarenal hemodynamics disturbances in patients with type 2 diabetes mellitus is revealed through a decrease in the minimum blood flow velocity and an increase in the intrarenal vascular resistance parameters. We found the correlation between dopplerographic indicators, kidney functions and other parameters (age, disease duration, glycated hemoglobin level), which play a pathogenetic role in diabetic kidney disease. Serum creatinine level and glomerular filtration rate were indicators of renal hemodynamic changes. Resistant index above 0,7 conventional units, pulsatility index above 1,54 conventional units, systolic diastolic ratio above 3,8 conventional units were ultrasound signs of kidney damage. Patients without standard signs of chronic kidney disease have diagnostically significant index of resistance in 72% of cases, a pulsation index in 50%, a systolic-diastolic ratio in 28%. Renal blood flow examination in right segmental artery area will be use for non-invasive diagnosis and estimation of kidney dysfunction in patients with type 2 diabetes mellitus.

Bulletin of the Russian Military Medical Academy. 2020;22(3):99-102
pages 99-102 views

Prognostic model of acute pancreatitis

Ivanusa S.Y., Lazutkin M.V., Gal’chenko M.I., CHebotar’ A.V., Kulagin V.I.


Abstract. The models for the prognosis of infectious complications and the outcome of acute pancreatitis are developed based on a mathematical analysis of the totality of clinical and laboratory data on the course of the disease, which have the form of a decision tree. It was revealed that laboratory indicators show statistically significant intergroup differences and allow to form a prognosis of the course of the disease. The threshold values of laboratory parameters calculated as a result of applying the classification and regression algorithm by constructing a decision tree are the nodal points for the distribution of patients according to the likelihood of further development of the disease. Thus, the presence of an international normalized ratio of more than 1,31 or an international normalized ratio of more than 1,31 and a hematocrit of less than 40% with a predictive probability of 80% is associated with the development of infectious complications in any period of the disease in the first 3 days of the development of the disease. If in the first 3 days of the disease the glucose level exceeds 11,55 mmol / L and the concentration of Ca2+ ions is less than 0,66 mmol/L, the probability of death is more than 70%. If the glucose level is more than 11,5 mmol/L and the level of Ca2+ ions is less than or equal to 0,66 mmol / L, or the glucose level is less than or equal to 11,5 mmol/L and the prothrombin index is less than or 83% and the hematocrit is less than or equal to 39,8% the probability of developing a fatal outcome at any period of the disease is 3 times higher compared to other patients. Prediction models of infectious complications and disease outcome have an accuracy of 78 and 87%, respectively. The use of these models allows stratification of patients upon admission to the hospital, highlighting the most disadvantaged patients in the prognostic plan. The models are quite simple and easy to use, do not require complex expensive studies. Thanks to the algorithm used in building models, they have the properties of self-learning, which in the future will increase their accuracy.

Bulletin of the Russian Military Medical Academy. 2020;22(3):103-107
pages 103-107 views

Clinical and epidemiological characteristics of ascariasis of adults and children in the Astrakhan region for 2015-2019

Irdeeva V.A., Arakelyan R.S., Shendo G.L., Bogdanova A.I., Deeva T.M.


Abstract. The article analyzes the incidence of ascariasis in the Astrakhan region for the period from 2015 to 2019. During this period, 18,757 cases of parasitic infestations in humans were registered in the region, of which ascariasis accounted for 125 (0,7%) of the total number of all parasitoses registered in the region. Ascariasis was registered in individuals of different ages. Thus, in children, cases of ascariasis were registered in 59,2%. The adult population accounted for 40,8%. In 48,8% of cases, the clinical diagnosis: «Ascariasis» was made, mainly based on clinical symptoms and complaints, in 45,6% of cases – during annual medical examinations. In 61,6% of cases, the disease was clinically manifested in the form of various complaints, and 38,4% of the patients had no complaints. Ascariasis was registered in patients of various ages, but it was most often observed in children. The cause of the disease in most cases was non-compliance with the rules of personal hygiene – eating unwashed fruits and vegetables, the habit of biting your nails (onigophagia). The diagnosis was necessarily confirmed in the laboratory. Thus, in 82,4% of cases, Ascaris lumbricoides eggs were found in the feces delivered to the laboratory. A negative result of a laboratory study (the absence of parasite eggs in the feces) indicated that the «failed life cycle» of ascariids, due to the presence of a female Ascaris lumbricoides in the host body and the absence of a male there.

Bulletin of the Russian Military Medical Academy. 2020;22(3):108-110
pages 108-110 views

The role of therapeutic nutrition and dietary supplements in the prevention and treatment of osteoarthritis at the initial stages of the disease in military personnel

Nagorny E.B., Smetanin A.L., Ishchyk Y.V., Korosteleva O.G., Konovalova I.A., Plakhotskaya Z.V.


Аbstract. Factors predisposing to the development of osteoarthritis in military personnel are analyzed. The physical stress inherent in military labor, for example, in the airborne troops, creates a high load on the joints and can cause the early dismissal of military personnel from the ranks of the Armed Forces of the Russian Federation. Based on the pharmacodynamics of chondroprotectors (stimulation of chondrocyte function, cartilage tissue regeneration processes, inhibition of the synthesis of inflammatory mediators, etc.), it can be argued that they have a significant effect on the pathogenetic mechanisms of the development of osteoarthritis, i.e. the mechanism of action of chondrocytes is reduced to the suppression of catabolic and stimulation of anabolic processes in the joints. The main principles of therapeutic nutrition for osteoarthritis are, a decrease in calorie intake, limiting the amount of carbohydrates, animal fats and salt consumed. A balanced diet, including sufficient macro- and micronutrients, has a therapeutic effect in patients with complaints of joint pain, helping to restore the damaged structure of the elements of the musculoskeletal system. The inclusion of dietary supplements in the diets of patients with complaints of joint diseases ensures the intake of nutrients necessary for the synthesis of glycosaminoglycans. These factors accelerate the rehabilitation of patients after extreme physical exertion and injuries of the musculoskeletal system inherent in military labor. An analysis of the materials of a clinical study – a comparative study of the effectiveness of the treatment of osteoarthritis of the knee joint at the initial stage of the disease with the help of a representative of the group of chondroprotectors – Аrthra containing chondroitin sulfate, glucosamine and non-steroidal anti-inflammatory drugs, is carried out. The introduction of chondroprotectors as a means of preventing osteoarthritis in the diets of military personnel experiencing extreme joint loads will strengthen the ligamentous-articular apparatus by normalizing cartilage moisture saturation, inhibiting the action of proteolytic enzymes and stimulating the synthesis of glucuronic acid, which improves the elasticity of connective tissue.

Bulletin of the Russian Military Medical Academy. 2020;22(3):111-116
pages 111-116 views

Objective difficulties in differential diagnosis of pneumocystis pneumonia on the background of human immunodeficiency virus infection

Uliukin I.M., Shuklina A.A., Bulygin M.A., Bulankov Y.I., Orlova E.S.


Аbstract. The results of two clinical observations with a description of the examination and treatment of patients with infection caused by human immunodeficiency virus, with pneumocystic lung lesions at various stages of the provision of comprehensive care are presented. Since not a single combination of symptoms, clinical signs, and radiological findings is a diagnostic criterion for pneumocystis pneumonia, its diagnosis is currently mainly based on microscopic visualization of characteristic forms on stained airway preparations. The problem of treating pneumocystis pneumonia is determined by a very narrow range of active drugs available on the market, despite the fact that there is practically no data on the growth of resistance of clinically significant pneumocysts. Defects in the provision of medical care in both cases were a violation of the order and timing of the dispensary, in particular, and the lack of medical monitoring of the structures that monitor the health of patients, in general. Therefore, in the context of an increase in the total number of patients with infection caused by human immunodeficiency virus, and the manifestation of secondary diseases in them, the leading of which is tuberculosis, it is necessary to develop and implement additional professional programs for the early detection, in particular, lung lesions, as part of a continuing medical education for general practitioners, general practitioners and doctors of other specialties providing assistance in organizations of primary health care.

Bulletin of the Russian Military Medical Academy. 2020;22(3):117-122
pages 117-122 views

Experimental trials

Determination of the level of condensate by recording the noise level in the respiratory circuit of mechanical ventilation devices

Geraskin I.V., Geraskin V.A., Geraskina N.V.


Abstract. The method of determining the accumulation of condensate by registering the noise level in the respiratory circuit of ventilators is substantiated. According to the proposed method, the condition and performance of the apparatus is monitored during artificial lung ventilation and oxygen therapy. With hardware ventilation, an increasing turbulent flow of a water or gas stream is formed in the respiratory circuit, accompanied by an increase in the noise effect and vibration. An increase in the level of acoustic noise from fluctuations in the accumulation of condensate in gaseous media was recorded by an instrument for objective measurement of sound level — a sound level meter. Indicators of noise effects reached a higher level on the wet circuit (the presence of condensation droplets or accumulations of mucus) of the liquid compared with the indicators obtained on the “dry” breathing circuit. The difference in recorded noise levels reached 10 dB, and increased from 37,73 to 47,36 dB. Areas of the respiratory circuit with the greatest degree of narrowing of the lumen and critical accumulations of water condensate and mucus are a source of turbulence in the air flow and increased noise. In conditions of prolonged artificial ventilation of the lungs, the rate of humidified air-gas flow is constantly changing, especially with hardware modeling of the phases of inspiration and expiration, and an increase in temperature in the humidifier chamber. The proposed technique is designed to identify critical levels of water condensate in the apparatus breathing circuits by recording the intensity of the increase in noise level and choosing the rational mode of operation of medical equipment. Data on the emerging critical situation are displayed on the sound level meter screen and inform medical personnel about the need to rehabilitate the circuit of the artificial lung ventilation apparatus. The primary field of application is resuscitation and intensive care units, medical transport teams during in-hospital or inter-hospital transportation, and surgical operating rooms during inhalation anesthesia.

Bulletin of the Russian Military Medical Academy. 2020;22(3):123-126
pages 123-126 views

Сlinical use of immune plasma in septic conditions

Skripay L.A., Vilyaninov V.N., Belgesov N.V.


Abstract. The effectiveness of clinical use of immune plasma in comparison with conventional fresh-frozen plasma in septic conditions is considered. It was found that the use of immune plasma in the treatment of patients suffering from septic complications, against the background of antibiotic therapy, is more effective than the use of conventional freshly frozen plasma. In patients who received immune plasma transfusions, there was a significant decrease in the inflammatory response of the blood (decrease in leukocytosis, erythrocyte sedimentation rate, C-reactive protein), and the level of procalcitonin also decreased. The level of total protein, on the contrary, increased after each transfusion of this component. In patients who received fresh frozen plasma transfusion, there were no positive changes in the indicators of inflammatory blood reaction (the number of white blood cells and the rate of erythrocyte sedimentation after each transfusion increased, changes in C-reactive protein were insignificant). The level of procalcitonin and total protein increased after each infusion. In all patients who were transfused blood components, against the background of antibiotic therapy, the result of treatment was also influenced by the number of microorganisms seeded from the wound surface during primary bacteriological seeding. In General, in septic conditions, transfusion of immune plasma was more effective than transfusion of freshly frozen plasma. This effect on normalization of laboratory blood parameters was observed with a smaller average volume of transfused immune plasma (0,58 l) compared to a larger average volume (0,83 l) of transfused freshly frozen plasma.

Bulletin of the Russian Military Medical Academy. 2020;22(3):127-131
pages 127-131 views

Аpplication of the mathematical model of human torso for modeling abbreval influence in wound ballistics

Denisov A.V., Stepanov M.D., Haraldin N.A., Stepanov A.V., Borovkov A.I., Zhukov I.E., Kurinnoy E.D., Tsurikov S.G.


Abstract. In the work, a review of scientific articles on the behavior of tissues and organs of the human body under local mechanical effects on it, as well as a description of the physico-mechanical properties of biological materials. The selection of mechanical behavior for each biological material as part of a mathematical model of the human torso was carried out, its finite element model was created, validation experiments were modeled using data presented in the literature. An original calculation model of a human torso with a tuned interaction of organs with each other was developed. Contact interaction parameters are determined. The developed computational model of a human torso was verified based on data from open sources for an experiment with mechanical action by a cylindrical impactor. An algorithm for processing pressure and acceleration graphs has been implemented in order to obtain tolerance curves. A specialized modular program has been created for the automated processing of calculation results and the output of the main results. 42 numerical tests were carried out simulating the entry of a steel ball into each of 21 zones for power engineers of 40 and 80 J. According to the results of the tests for each organ, pressure and acceleration tolerance curves were obtained, animations of the behavior of organs under shock were created, visualization of the pressure field propagation in organs was obtained torso.

Bulletin of the Russian Military Medical Academy. 2020;22(3):132-139
pages 132-139 views

Prospects for improving pre-hospital care for wounded with gunshot penetrating wounds to the chest

Golovko K.P., Markevich V.Y., Suprun T.Y., Vertiy A.B., Komyagin S.E., Zhirnova N.A., Samokhvalov I.M.


Abstract. The analysis of injuries, life-threatening consequences and outcomes of treatment of wounded with penetrating chest wounds and the results of approbation of a prototype (medical) disposable set «UD-02v» for the elimination of strained and open pneumothorax, hemothorax, pleural drainage and collection of spilled blood with the possibility of subsequent reinfusion at the pre-hospital stage is presented. The prototype of the «UD-02v» set was created as part of the implementation of the state defense order in 2018. Its creation is due to the fact that despite the improvement of medical care at the stages of medical evacuation and the widespread use of individual armor protection, chest injuries currently remain a frequent type of combat surgical injury, accounting for 6 to 12% of all injuries. The main cause of death of injured and injured with chest injuries remains blood loss caused by continuing intrapleural bleeding and concomitant damage to other anatomical areas. Stressful pneumothorax, together with intrapleural bleeding, account for 93% of preventable causes of fatal chest injuries at the pre-hospital stage. Untimely elimination of the consequences of severe breast injuries should be considered as a negative factor affecting the outcome of treatment, and significant improvement in treatment results should be expected only in the case of early elimination of the most severe consequences of breast injuries. The developed set of «UD-02v» exceeds foreign medical devices in its medical and technical characteristics, and is the most promising for acceptance for the supply of the Armed forces of the Russian Federation as part of the samples of complete and service equipment.

Bulletin of the Russian Military Medical Academy. 2020;22(3):140-147
pages 140-147 views

Public Health

Features of the introduction of an information system for monitoring the movement of medicines in civil and military health care

Miroshnichenko Y.V., Shcherba M.P., Merculov A.V., Perelygin V.V.


Abstract. The features of the introduction of an information system for monitoring the movement of medicines in civil and military health care are considered. It has been shown that in order to counteract the inflow of substandard, falsified and counterfeit medicines to medical and pharmacy organizations, from July 1, 2020, all subjects of their circulation in the Russian Federation are required to enter the necessary information into the automated information system for monitoring the movement of medicines. The preliminary results of the experiment on labeling with control (identification) marks of medicines and monitoring of their circulation are evaluated. It is noted that the introduction of an automated information monitoring system in practice is associated with a number of problems that contribute, in particular, to an increase in the cost of medicines. It was established that in the formation of regulatory mechanisms for monitoring the movement of medicines,the specifics of drug provision in military health care were practically not taken into account, which in turn led to the emergence of a number of legal conflicts. It was revealed that, on the one hand, the obligations to participate in the medicine movement monitoring system have been lifted for the Ministry of Defense, the Federal Security Service, the Foreign Intelligence Service, and, on the other hand, other power ministries and departments must provide the required information to the system. It was emphasized that, given all the problematic issues, the introduction of an information monitoring system has a positive effect on the activities of drug circulation entities, as well as enhancing the effectiveness of drug provision for citizens. It is advisable to provide for separate participation in the information system for monitoring the movement of medicines of the Ministry of Defense and some other power ministries and departments, providing the opportunity, on equal terms with other participants, to confirm the quality of the medicines in circulation.

Bulletin of the Russian Military Medical Academy. 2020;22(3):148-152
pages 148-152 views

Justification of the tasks of the register of military personnel, affected by SARS-CoV-2

Zagorodnikov G.G., Uliukin I.M., Orlova E.S., Sechin A.A., Reznik V.M., Shuklina A.A., Telitskiy S.Y., Ovchinnikov D.V., Tegza V.Y.


Аbstract. The current regulatory framework of the Ministry of Health and the Ministry of Defense of the Russian Federation on the regulation of the provision of medical assistance to military personnel affected by the infection caused by the SARS-CoV-2 coronavirus is considered. The state of the problem of information support for the provision of medical care to military personnel of this category is assessed. The developed methodology and the draft regulatory document for organizing the collection of medical information in the register of military personnel affected by the infection caused by the SARS-CoV-2 coronavirus are presented, and a regulation on this register is developed. The content, scope and algorithm of creating an information-analytical system for registering this pathology among military personnel, as well as the need to introduce new medical document management technologies into the medical service of the Armed Forces of Russia based on personified records of military personnel and the medical and psychological assistance provided to them, are substantiated. It is shown that for the smooth functioning of the register within the framework of a justified list of tasks, the presence of high-speed secure communication channels between the participating military units, institutions and medical service management bodies will be required. Consequently, the improvement of the information support system for managing the medical support of troops in peacetime and wartime is an important component of increasing the effectiveness of managing medical support for military.

Bulletin of the Russian Military Medical Academy. 2020;22(3):153-158
pages 153-158 views

The Years of the Potential Life Lost due to Breast Cancer Assessment Results in St. Petersburg Population

Orlov G.M., Romanenkov N.S., Movchan K.N., Botyan A.Y., Senkov R.E., Bahtin M.Y., Zharkov A.V., Yakovenko O.I., Gedgafov R.M., Rusakevich K.I.


Abstract. Data analysis contained in the official forms of medical statistics allows us to state that in St. Petersburg in 2011–2012 yr. 8% breast cancer incidence increase and 6% mortality rates decrease in women were noted. Years of potential life lost due to breast cancer in 2012 yr. among St. Petersburg female residents in aged 30 to 64 years decreased 8% compared with 2011 yr. data (2632 and 2435 in 2011–2012, respectively). Years of potential life lost due to breast cancer in 2011–2012 yr. decreased 16% (1101 and 948 in 2011–2012 yr. respectively) in St. Petersburg women aged 50 to 59 years (group of maximum incidence rate among patients with malignant neoplasms of the mammary glands). The results of medical care assessment providing to breast cancer patients in St. Petersburg over the past 9 years has allowed to state the positive dynamics in the anticancer fight effectiveness. In 2011–2018 yr. the incidence of breast cancer in women in St. Petersburg increased by 28,2% (from 45,670/0000 in 2011 yr. to 58,580/0000 in 2018 yr.), and the 5-year survival rate of patients with breast cancer in St. Petersburg increased by 4,9% (from 60,4% to 63,4% in 2011 and 2018 yr. respectively). Considering these data the number of years of potential life lost due to breast cancer in the analyzed period decreased. This circumstance can be regarded as one of the indicators of the medical care quality in breast cancer patients and as an indicator of the proper organization of oncological service functioning in the administrative and industrial center of Russia.

Bulletin of the Russian Military Medical Academy. 2020;22(3):158-163
pages 158-163 views

Justification and evaluation of the effectiveness of the model for preparing healthcare leaders within the medical higher education institutions by «Тhe public health and healthcare»

Reshetnikov V.A., Tregubov V.N., Sokolov N.A.


Abstract. Characteristics of professional competencies development characteristic of students studied in the laboratory of excellence «Health leaders factory». A vector model of specialist training has been developed, including the basic «classical» educational path, supplemented by a set of measures to develop the skills and competencies of healthcare leaders. Who completed the Health leaders factory course are characterized by the highest levels of both theoretical knowledge and practical skills. The test results showed that for individuals in this group, grades exceeded the corresponding levels in the groups of respondents who received postgraduate education and for students, while the latter group was characterized by minimal values for assessing the level of professional activity. The conditions for the Health leaders factory project implementation comply with the requirements for the training of health leaders, they provide in-depth mastery of the discipline «Public Health and Health Care», the formation of students’ management skills, effective conduct of professional orientation. In addition, this project contributes to the solution of the most important task facing higher medical education: the training of health managers who are ready for innovation, possess knowledge in advanced areas of science and medicine, as well as modern management methods and styles, have the skills of team building and project management.

Bulletin of the Russian Military Medical Academy. 2020;22(3):164-167
pages 164-167 views

Literature reviews

Genetic updating and marks of cellular lines

Moskalev A.V., Gumilevskiy B.Y., Apchel A.V., Tsygan V.N.


Abstract. Despite great advances in the biology of stem cells, there are still many dark spots. Genetic modification techniques, which can be used to track the lines of different cells, primarily stem cells, help to solve this problem. Various methods of biotechnology research are considered, allowing to evaluate the options of introducing new genes into cells and even whole organisms, as well as methods of controlling their expression in time and space, their activation, differentiation and decrease in functional activity, expression of several target genes. Options with multi-cystron vectors encoding several proteins are described. Options for introducing genes using plasmids, electroportation of their disadvantages and advantages are characterized. The most promising and the safest is a retroviral vector using lentivirus vectors capable of generating additional copies of itself, which is very important in the field of biotechnology security. A line of packing cells, usually 293T cells, is used to produce a viral vector. Prospects for the use of adenovirus and adenoassociated vectors are characterized. The achievement of modern biotechnology methods is the system of short palindrome repetitions located in groups, which is a unique tool for genome editing. At the heart of this system is the process of cutting out sequences of deoxyribonucleic acid, which are permanent and which are supported by cells regardless of subsequent divisions or changes in condition. The system allows geneticists and medical researchers to edit parts of the genome by removing, adding or modifying successive sites of deoxyribonucleic acid. An important problem with biotechnology methods is how to control the expression of transgenes. Today, it is quite effective to control expression with a factor present in the gene delivery vector itself and which is only active in a certain type of cell. Endonuclease bacteriophage P1 is used to regulate transgene expression, which cuts deoxyribonucleic acid only at specific sites. This system is introduced in both eukaryotic and prokaryotic systems.

Bulletin of the Russian Military Medical Academy. 2020;22(3):168-175
pages 168-175 views

Prospects for the development of inhalation drugs for the provision of pre-hospital assistance to affected by hazardous chemical substances

Ivanov I.M., Nikiforov A.S., Yudin M.A., Sventitskaya A.M., Pavlova V.S.


Abstract. Pharmacological agents are analyzed, in respect of which it is advisable to develop dosage forms for inhalation use as medical means of protection at the prehospital stage of medical evacuation in case of damage by emergency-hazardous chemicals. It was found that the inhalation intake of hazardous chemicals, especially with a pronounced pulmonotoxic, irritating and generally poisonous effect, is highly likely to develop post-intoxication complications associated with damage to the lung parenchyma, and death. For the therapy of such intoxications, it is advisable to administrate drugs in a dosage form for inhalation administration, which have several advantages: high bioavailability, rapid onset of effect, and severity of local action in various parts of tracheobronchial tree. The data of experimental and clinical studies of the effectiveness of drugs belonging to various pharmacological groups allow us to recommend for the further development of inhaled forms of means of prevention and treatment of toxic pulmonary edema (fluticasone, roflumilast, rolipram). Bronchodilators and donors of sulfhydryl groups (ipratropium bromide, tiotropium bromide, atropine sulfate, fenoterol, salbutamol, formoterol, unitiol dimercaprol) are referred to means of correction of respiratory disorders of various etiologies. Diazepam, midazolam, clonazepam, lorazepam are considered to be the most likely anticonvulsants from the enzodiazepine-class suitable for inhalation. Acetylcysteine, hydroxycobalamin can be used to combat hypoxia. The principal possibility of inhalation application of bioscavengers (acetylcholinesterase, butyrylcholinesterase) for the treatment of cholinopositive symptoms of toxic genesis is shown. Existing methods and means of delivery allow the use of these drugs at the prehospital stage of medical evacuation as part of single dose metered powder inhalers.

Bulletin of the Russian Military Medical Academy. 2020;22(3):176-181
pages 176-181 views

Hemorrhagic fevers of viral nature. State of the problem and directions for creating effective means of prevention and treatment

Stepanov A.V., Buzmakova A.L., Potapova A.V., Yudin M.A., Apchel V.Y.


Abstract. An attempt to summarize the data of available information materials on epidemiological aspects, the state and prospects of prevention and treatment of hemorrhagic fevers was. Hemorrhagic fevers of viral nature-zoonotic diseases caused by viruses containing ribonucleic acid are classified into 4 families: Arenaviridae, Bunyaviridae, Filoviridae and Flaviviridae. They are spread all over the world, and their pathogens are easily transmitted from person to person, thereby spreading quickly enough beyond the main focus of biological infection. That is why the causative agents of hemorrhagic fevers are regarded as highly contagious biological agents, and agents bioterrorism. Unfortunately, there are currently no effective means of specific prevention and treatment of these infections, and therapeutic measures are limited to the use of symptomatic means. In this regard, the search for substances with pronounced antiviral activity against pathogens of hemorrhagic fevers that can effectively protect against these infections, as well as prevent their occurrence and spread is one of the priority areas of research in modern Infectology, and with the involvement of modern achievements in the field of molecular Virology and genetic engineering. The data obtained in this regard allow a more in-depth understanding of the pathogenesis of hemorrhagic fevers, the mechanisms of interaction of the pathogen with the host at the cellular level, the mechanisms of intracellular replication of viruses, the formation of the host’s response to «viral invasion» and clinical manifestations of diseases.

Bulletin of the Russian Military Medical Academy. 2020;22(3):182-187
pages 182-187 views

Irritants: a modern redefining of relevance to the armed forces and the prospect of creating medical means of protection

Kuzmin A.A., Ivchenko E.V., Seleznev A.B., Sidorov S.P., Yudin M.A.


Absract. Arguments are presented in favor of the increasing relevance of irritants to ensure the fulfillment of tasks by military personnel of the Armed Forces of the Russian Federation, as well as the need to reassess the risks to human health arising from their use. The results of an information-analytical data on methods and adverse effects of irritant application for purposes which are not prohibited by the «Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and on Their Destruction» are presented. Modern ideas about molecular mechanisms of the effect of irritants on structures of the nervous system are considered, which are based on the fact that the provocative effect of irritants is realized by changing the permeability of cation channels of the transient receptor potential of type A1, expressed at the ends of sensitive neurons. The results of experimental and clinical studies of specific modulation of these channels using their natural and synthetic antagonists are analyzed. Structural formulas and basic pharmacological characteristics of the most active antagonists are given and the prospect of their use as a basis for the development of drugs for the treatment of irritant lesions is substantiated. The data on the use of solutions based on amphoteric and chelating agents for emergency treatment of skin areas infected with irritants is presented. A number of promising areas of research on the creation of effective medical means of protection against lesions by irritants has been identified.

Bulletin of the Russian Military Medical Academy. 2020;22(3):188-193
pages 188-193 views

Lysis/rejection of split autoderm grafts – solutions

Zinoviev E.V., Soloshenko V.V., Yurova Y.V., Kostyakov D.V., Vagner D.O., Krylov P.K.


Abstract. Analysis of available literature and our own experience, the main causes of the lysis / rejection of autoderm grafts are systematized. It is shown that there is no consensus among combustiologists about the causes of these complications. It is believed that the leading cause of such complications is the general condition of the body, the unpreparedness of wounds for surgical treatment and the development of disseminated intravascular coagulation syndrome in seriously ill people. The frequency of unsatisfactory treatment results also correlates with the level of contamination of the burn wound. An increase in microbial seeding to 107 or 108 colony forming units per gram is a relative contraindication to surgery, while the optimal level for skin grafting is considered to be 104 colony forming units per gram. In addition, locally plastic interventions are possible with a microbial load of 105 colony forming units per gram, subject to compensation for violations of the general condition of the victim. Of great importance are the timing of autodermotransplantation. Conducting skin plastics later than 14 days after the injury increases the risk of postoperative complications. This is due to the peculiarities of the pathophysiological processes characteristic of burn wounds. During the first two weeks from the moment of the injury, the processes of reparative regeneration prevail in them, however, their intensity progressively decreases over time. It has been demonstrated that immune system disorders also have a significant effect on the rate of graft lysis. Domestic experts have developed an original method for predicting the likelihood of an unsatisfactory result of skin grafting, based on an assessment of a number of parameters of the immune system. The results of our observations indicate that the main causes of lysis / rejection of autodermotransplantants in the postoperative period are insufficient preparation of wounds for surgical treatment, changes in the general condition of the body, impaired immune system (autoaggression), and a high level of microbial contamination. The development of common criteria for assessing a patient’s readiness for skin grafting to prevent rejection of transplanted autoderm grafts remains an urgent task of combustiology.

Bulletin of the Russian Military Medical Academy. 2020;22(3):194-198
pages 194-198 views

Toxic effect of organophosphate compounds on the kidneys

Sokolova M.O., Sobolev V.E., Reshetkina D.A., Nagibovich O.A.


Abstract. The study describes: the toxic effect of organophosphate intoxication compounds on the human and animal organism, the contribution of organophosphate to the chronic kidney disease epidemiology and the acute kidney poisoning pathophysiology caused by organophosphate compounds. The study shows oxidative stress and systemic hemodynamic disturbance in the pathogenesis of organophosphate-induced kidney injury. We summarized effects of organophosphate substances on the structural and functional kidneys tissue characteristics in humans and animals. Biomarkers useful for early diagnosis of kidneys toxic damage are shown. In study we considered microscopic and ultrastructural changes in the anatomical and histological kidney structures caused by acute and chronic organophosphate intoxication. The organophosphate compounds are highly toxic, easily overcome the epithelial integument, are able to penetrate cell membranes and the blood-brain barrier. These compounds are involved in the disruption of several key biological processes – the acetylcholinesterase irreversible inhibition and the oxidative stress induction in the excretory organs cells. The kidneys are not the first target in the toxic effect of organophosphate compounds in the human body, but are actively involved in the pathological process. It was established that kidneys tissue damage by organophosphate compounds can manifest itself differently depending on the duration of exposure, type and concentration of the toxic compound. It was shown that the kidney injury pathogenesis during acute and chronic intoxication by organophosphate compounds remains not fully understood. Nephron dysfunction patterns depending from various doses and toxic agents exposure duration have not been identified.

Bulletin of the Russian Military Medical Academy. 2020;22(3):199-205
pages 199-205 views

History of pancreatic cancer surgery

Sigua B.V., Zemlyanoy V.P., Lataria E.L., Zakharov E.A., Rakita S.Y., Lee K.A.


Abstract. The first mention of pancreatic cancer dates back to 1761, when the six-volume work of the famous Italian anatomist G. Morgagni «On the location and causes of diseases discovered through dissection» was published. However, the history of surgical treatment of malignant tumors of the pancreas dates back to the end of the 19th century. The accumulated experience of operational techniques and the introduction of aseptic rules created objective prerequisites for performing operations in complex anatomical zones during that period of time. On July 16, 1882, the famous German surgeon F. Trendelenburg, firstly, performed a successful resection of the tail of the pancreas for sarcoma, founding the development of surgery in this field. However, the success in this sphere could not be shifted to a tumor of the head of the gland due to the subsequent separation of the duct system from the duodenum. Over the following years, many outstanding surgeons tried to solve this problem, such as: A. Codivilla, W. Halsted, W. Kaush, until in the early 40s A. Whipple proposed a new method of pancreatoduodenal resection, that became the gold standard for head cancer treatment pancreas. Although it was not possible to achieve significant success in the treatment of cancer in the original method of operation, as a result at various stages of time this procedure wasn’t used a lot and was almost forgotten. Today, surgery remains the leading method in the complex treatment of patients with pancreatic cancer. Minimally invasive technologies have been actively introduced into pancreatic surgery in the past two decades. The indications for surgery have been expanded, lymphadenectomy standards have been introduced, thereby increasing the chances of a successful cure.

Bulletin of the Russian Military Medical Academy. 2020;22(3):206-210
pages 206-210 views

Fat depot of the heart: contribution to the development of cardiovascular diseases, visualization methods and the possibilities of it’s correction

Bratilova E.S., Kachnov V.A., Tyrenko V.V., Zheleznyak I.S., Cherkashin D.V., Kushnarev S.V., Sobolev A.D.


Abstract. Рresents the possibilities of various visualization methods for assessing heart fat depot in patients with cardiovascular disease, as well as the effect of adipose tissue on myocardial function. The prospects of using the heart fat depot as a therapeutic target are considered on the example of the successful use of various groups of antidiabetic drugs, in particular glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Thus, it has been established that an ectopic fat depot makes a certain contribution to atherogenesis due to its effect on lipid metabolism, participation in the formation of a chronic inflammatory reaction of low intensity, potentiation of endothelial dysfunction, and activation of a coagulant shift. In addition, local organ dysfunctions, such as increased intrarenal pressure, mitochondrial disorders, increased lipogenesis, the formation of insulin resistance and lipotoxicity additionally create prerequisites for an increase in cardiovascular risk. Defines diagnostic and useful methods that not only quantitatively, but also qualitatively describe the relationship of fat depot and potential comorbid pathology. The effect of reducing cardiovascular risk, consisting in reducing the amount of epicardial adipose tissue in the studied, was observed when taking the preparation of the biguanide group, as well as its combination with drugs - analogues of glucagon-like peptide 1 and dipeptidyl peptidase-4 inhibitor. A similar effect was also observed in the case of the use of type 2 sodium-glucose cotransporter-2 inhibitors.

Bulletin of the Russian Military Medical Academy. 2020;22(3):211-216
pages 211-216 views

Education news

Application of new approaches in the organization and conduct of classes on combat and special training of military medical personnel

Kasimov R.R., Zavrazhnov A.A., Blinda I.V., Puchin K.S.


Abstract. Considers an example of organizing and conducting practice-oriented classes on providing emergency medical care for injuries with medical personnel of the military level, garrison and base military hospitals in the Western military district. In large garrisons of the military district in 2019, we conducted four rounds of field training on the organization of emergency medical care for major life-threatening conditions. The format of classes included master classes and blitz lectures on various topics: cardiopulmonary resuscitation, stopping ongoing external bleeding, eliminating asphyxia and pneumothorax, transport immobilization, and features of the use of modern means of emergency medical care. An important practical part of the training was training with surgeons of military and hospital units on living biological objects. At the beginning and end of the course, primary and control tests of the level of knowledge were conducted. During the initial testing, the percentage of correct answers in the groups averaged: surgeons (n=20) – 53,9%, doctors of other specialties (n=25) – 56,5%, average medical staff (n=34) – 52,8%, health instructors (n=52) – 52,6%. During the control testing, the following results were obtained: 71,5; 83,5; 84,3 and 83,9% respectively. The format of classes reliably (p˂0,05) showed their high efficiency in all groups. Thus, the need to actively introduce a practice-oriented form of training in the form of demonstration classes, including the use of biological models and simulators, into the combat and special training of military medical personnel is obvious and beyond doubt.

Bulletin of the Russian Military Medical Academy. 2020;22(3):217-220
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Information awareness of female students about the importance of a healthy lifestyle

Silchuk A.M., Silchuk S.M., Bolotin A.E., Kudritsky V.N., Orlova N.V., Denisov A.V.


Abstract. Questions of information awareness of students about the importance of maintaining a healthy lifestyle are considered. It is shown that such awareness, as a rule, is carried out through the mass media, an Internet resource, but it should be based on the constant awareness of students in physical education classes by teachers who conduct theoretical and practical classes in study groups or on lecture streams. Experimental data are presented, according to which the role and significance of a healthy lifestyle is revealed. It is the constant clarification of these issues that creates motivation for students to lead a healthy lifestyle. Ways to improve the quality of information support for students on the organization of a healthy lifestyle in the daily mode based on systematic conversations, lectures, the use of multimedia, advertising through the local press, television and websites of higher educational institutions are shown. It is established that students do not fully possess knowledge about compliance with the norms and rules of a healthy lifestyle, and do not clearly assess its role in maintaining and strengthening health. In this regard, it is recommended to regularly conduct explanatory conversations about a healthy lifestyle and motivate students to self-study using various means and methods of physical education.

Bulletin of the Russian Military Medical Academy. 2020;22(3):221-224
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Medicine history

Of the 90th anniversary of the birth of professor Alexander B. Zorin

Khubulava G.G., Sizenko V.V., Volkov A.M., Sazonov A.B., Akhadov R.A.


Abstract. On June 12, 2020, Alexander Borisovich Zorin would have turned 90. Most of his life A.B. Zorin worked at the Military Medical Academy named after S.M. Kirov in 1st clinic of surgery (of the perfection of doctors) named after P.A. Kupriyanov. He made a great contribution to the development of cardiovascular surgery in the Russian Federation, performed a number of fundamental research on the diagnosis and surgical treatment of heart defects, on May 31, 1988 he successfully transplanted a heart for the first time in Leningrad, was one of the initiators of the creation of the international program «Heart-to-heart», thanks to which the cardiac surgeons of Leningrad got the opportunity to learn from their foreign colleagues. After demobilization in 1991 he headed the cardiac surgery departments in the city hospitals of St. Petersburg, and headed the department at the Medical Academy of Postgraduate Education. In 2003 A.B. Zorin was awarded the medal «For the Contribution to the Development of Health Care in Russia», in 2004 he was awarded an insignia «St. Petersburg Appreciation» by the Governor of St. Petersburg Va.I. Matvienko and was elected an honorary member of the Public Council of Governors. In 2007 For the high achievements in the development of cardiac surgery, A.B. Zorin was awarded: The International Award named after Academician B.V. Petrovsky «Outstanding cardiac surgeon of the world», the a prize named after A.N. Bakulev «For a longstanding selfless and impeccable work and great personal contribution», the gold medal «For outstanding achievements and unprecedented personal contribution to the development of the world surgery».

Bulletin of the Russian Military Medical Academy. 2020;22(3):243-245
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On the occasion of centenary of the birth of I.I.Deriabin (1920–1987)

Samokhvalov I.M., Tiniankin N.A., Matveev S.A., Suprun T.Y., Liashedko P.P., Bechik S.L.


Abstract. On the 2nd of August, 2020 marked the 100th anniversary of the birth of the famous Russian surgeon, the Head of War Surgery department of the Academy, professor, Major-General of the Medical Corps Ilia Ivanovich Deriabin. I.I. Deriabin was the participant of the Great Patriotic War and the war against militarist Japan, the warfare in Afghanistan, the first postwar postgraduate fellow under professor S.I.Banaitis, a student and associate professor of A.N. Bercutov, an officer working many years at War Surgery department, Kirov Military Medical Academy. I.I. Deriabin was also the Head Surgeon to the Group of Soviet Forces in Germany, the founding principal of War Surgery department at the Military Medical faculty, Moscow Central Institute for Advanced Medical Education, Deputy Chief Surgeon of the Soviet Army. In the history of military medicine professor I.I. Deriabin will stay as a great scientist and organizer in the field of War Surgery, a founder of traumatic disease tactical treatment concept, the author of the idea of medical-transport immobilization (anticipating popular modern tactics Damage Control). He also came up with an idea of an improvised frame for unstable pelvic fracture immobilization, developed the technique of peritoneal dialysis (in cooperation with M.N. Lizanets and E.V. Chernov), devised (coauthored with A.C. Rozhkov) multicomponent anti-inflammatory local wound blockade for injury control and septic complications prevention.

Bulletin of the Russian Military Medical Academy. 2020;22(3):225-231
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In memory of Komarov Fyodor Ivanovich (on the occasion of his centenary)

Fisun A.Y., Yakovlev V.A., Malov Y.S.


Abstract. Fyodor Ivanovich Komarov (08/26/1920 – 01/25/2020) was a participant in the Great Patriotic War, a prominent domestic therapist, an outstanding figure in military medicine, a Hero of Socialist Labor, an academician of the Russian Academy of Sciences, a laureate of the State Prize of the Union of Soviet Socialist Republics, an honorary doctor of the S.M. Kirov Military Medical Academy, a professor and a retired colonel-general of the medical military service. F.I. Komarov’s scientific heritage is huge. Over 600 scientific works, including 33 monographs, were published by him personally and in co-authorship. Due to his comprehensive clinical background and deep knowledge of physiology and biochemistry, urgent problems of gastroenterology, cardiology, pulmonology, chronobiorhythmology and military professional pathology could be successfully solved. He made a great contribution to improve and reform the military medical service. Twenty six doctors and sixty candidates of medical sciences were educated under his leadership. Being a military doctor and holding high leadership positions, he was constantly engaged in the improvement of military medicine and military field therapy. He was also the head of medical support for the troops during the hostilities in Afghanistan, during the accident at the Chernobyl nuclear power plant and following the consequences of the earthquake in Armenia. He was elected chairman of the All-Union Society of Physicians several times. He was also a member of the Lenin and State Prize Awarding Committee under the Council of Ministers of the Soviet Union, chairman of the expert council of the Supreme Attestation Commission of the Union of Soviet Socialist Republics and editor-in-chief of the journal «Clinical Medicine» and an honorary member of a number of foreign academies. In 1999, he was awarded the title «Man of the XX century», became a laureate of four personal prizes: M.P. Konchalovsky (1979), S.P. Botkin (1985), N.I. Leporsky (1992), V. Kh. Vasilenko (2001). For his merits to the Fatherland, F.I. Komarov was awarded the title «Hero of Socialist Labor» (1980) in addition to forty five orders and medals.

Bulletin of the Russian Military Medical Academy. 2020;22(3):232-236
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Training of the pharmaceutical personnel during the Great Patriotic War of 1941–1945 (to the 75th anniversary of the Victory)

Miroshnichenko Y.V., Bunin S.A., Kononov V.N., Perfilev A.B., Kostenko N.L.


Abstract. The characteristic of the functioning of the pharmaceutical personnel training system on the eve and during the years of World War II is presented. It was established that the country’s leadership had carried out a conceptual restructuring of the entire education system in advance and measures had been taken to streamline scientific and scientific-pedagogical work. At the beginning of the war, decisive measures were taken at the state level to preserve both the number of universities with their scientific and pedagogical potential, and the number of students. It is shown that on the eve of the war 22916 pharmaceutical specialists were in stock, of which more than 11 thousand people were drafted into the army, which accounted for about 70% of the staffing requirement. However, these specialists could not fully carry out professional activities without additional knowledge. Many of them, called up from the reserve, in practice in the most difficult wartime conditions, comprehended the organizational features of the work of hospital pharmacies and warehouses, the military field technology for the manufacture of medicines, the principles of medical supply for the army. The contribution of the Military Medical Academy named after CM. Kirov in improving the efficiency of the functioning of the medical supply system and the training of military pharmaceutical personnel. The activities of universities to establish training necessary for the front and rear of specialists, ways to eliminate the “personnel hunger”, the organization of the educational process in besieged Leningrad are shown. The heroism of students and teachers of institutes is reflected. Celebrating the 75th anniversary of the Great Victory, it is difficult to overestimate the dedicated work of the teaching staff and researchers of pharmaceutical universities and faculties, which allowed not only to preserve, but also to increase the potential of the pharmaceutical education system during the Great Patriotic War. Trained pharmaceutical specialists in difficult conditions worked selflessly at the front, in the rear, preserving the life, health of the wounded and sick soldiers and the country’s population, bringing Victory closer.

Bulletin of the Russian Military Medical Academy. 2020;22(3):236-242
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Maxim SemenovichSubbotin – the founder of asepsis and antiseptics in Russia, an outstanding surgeon, scientist, inventor, teacher

Kosachev I.D., Ivanus S.Y., Zubarev P.N., Golovanov P.A.


Abstract. Brief biographical information about Maxim SemenovichSubbotin, the founder of aseptic and antiseptic in Russia, is provided. In 1884, M.S. Subbotin heads the Department of Surgical Pathology at Kharkov University. In addition to scientific and pedagogical activities, he will devote a lot of time to the organizational issues of the clinic. He uses the surgical department of a military hospital as a clinical base for training students at Kharkov University. In addition to the course of surgical pathology with desmurgy, he also conducts a course of surgical surgery, and since 1887, a parallel course of the faculty surgical clinic. However, teaching and scientific work in a small clinic (25 beds) could not satisfy Maxim Semenovich, since by this time he had formed into a major surgeon and scientist, ready for wide surgical and scientific activities. Becoming the head of the Department of Surgical Pathology of the Imperial Medical and Surgical Academy (1890) M.S. Subbotin began its reorganization according to the requirements of asepsis. He organized a new dressing room, the walls and ceilings of which were painted with light oil paint, the floor is covered with ceramic tiles.An operating unit began to function, consisting of two operating rooms, a sterilization room, a bathroom and a material room. A laboratory was established to conduct research and control operations. The clinic strictly and sequentially carried out sterilization of instruments, dressings, processing of the surgical field. M.S. Subbotin studied the effect of carbolic acid on the body, used it to treat wounds. He created his own tent for operations, invented a sterilizer oven, a catgut sterilizer with dry steam, an autoclave, and hemorrhoidal forceps. M.S. Subbotin invented a drainage pump for the treatment of purulent cavities, first made thoracoplasty with pleural empyema. He introduced aseptic and antiseptic into surgical practice. Created a scientific surgical school: P.I. Bukhman, S.S. Girgolav, L.V. Orlov, N.N. Petrov, N.A. Schegolev and others

Bulletin of the Russian Military Medical Academy. 2020;22(3):246-252
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Allen Whipple. American Knight of surgery (to the 80th anniversary of the first successful one-stage pancreatoduodenal resection)

Sigua B.V., Zemlyanoy V.P., Lataria E.L., Zakharov E.A., Rakita S.Y., Lee K.A.


Abstract. In 1940, having baggage of three fatal two-stage pancreatoduodenal resections, during the demonstration surgery, the famous American surgeon Allen Whipple performs the first successful one-stage pancreatoduodenal resection for pancreatic head cancer. It is immeasurable surprise and respect that such a volume of intervention was not planned, since the patient was diagnosed with a tumor of the antral part of the stomach before the operation. The complexity of the situation didn`t stop Allen Whipple’s plans, and the subsequent success, which gave not only 9 years of life of the operated patient, but also to the whole world the original method of operation, became the starting point of a new era of pancreatic surgery Whipple’s contribution to surgery is not limited to performing one-stage pancreatoduodenal resection. He pioneered the reform of postgraduate medical education in the United States of America, founded the world’s first plastic surgery training program, developed new methods of intra- and perioperative management of patients with colon cancer, criteria for diagnosing insulinoma, which are today called the «Whipple’s triad». The study of the structure of the spleen, as well as its role in the spread of tumor cells, made it possible to determine the indications and contraindications for splenectomy. He also developed and applied porto-caval and splenorenal shunting operations, which reduce pressure in the portal vein system in patients with liver cirrhosis.

Bulletin of the Russian Military Medical Academy. 2020;22(3):253-257
pages 253-257 views

The first military hospitals in Saint Petersburg

Milasheva N.V., Samoilov V.O.


Abstract. The documentary materials from the funds of the Russian State Archive of the Navy, other archives, published letters and documents of Peter the Great, his Daily Note and other sources about the history of the first military hospitals (infirmaries) of Saint Petersburg are studied. At the same time, the history of the first military hospitals is reflected against the background of the difficult events of the Northern War of 1700–1721, with which the establishment of hospitals for the Russian army and the navy and the development of military medicine are inextricably linked. The organization of military medicine became aggravated immediately with the outbreak of hostilities, with the first wounded and sick. The fight against the plague epidemic and other infections during the war, the shortage of doctors, healers, infirmaries, hospitals and their own national staff greatly complicated the provision of medical care. Numerous documents and facts prove that the events before 1715 can be attributed to the first stage in the development of military medicine in Saint Petersburg. It was established that in 1704 the issue of establishing a military land hospital in the northern capital was already discussed (Peter I, A.D. Menshikov, N.L. Bidloo); hospital), and the senior physician of the Navy Yang Govi served in it «with zeal» In 1713, by the decree of the Great Sovereign Y. Govi, he was appointed head of the Admiralty Hospital, doctors, apprentices and medical students in it. By that time, Dr. R. Erskine actually assumed the office of archiatrist (until 1712). A detailed statement of Lieutenant General R.V. Bruce on the number of sick and wounded who received medical care in hospitals and hospitals in Saint Petersburg from 1713 to 1715. The decree of Peter I on the construction of a complex of General hospitals with anatomical theaters on the Vyborgskaya side (1715) «according to Dr. Areskin’s drawing», and the establishment of a medical school (until 1719) are the next stage in the development of military medicine in Saint Petersburg, prepared by all previous events.

Bulletin of the Russian Military Medical Academy. 2020;22(3):258-266
pages 258-266 views

The second life of the small anatomical collection of F. Ruysch «The eighth wonder of the world»

Gaivoronsky I.V., Nichiporuk G.I., Tvardovskaya M.V.


Abstract. In November 2019, an important historical event was held. A small collection of F. Ruysch, which is stored in the fundamental Museum of the Department of normal anatomy of the Military medical Academy named after S. M. Kirov, has received a second life, thanks to friendly scientific relations between Military medical Academy and the University of Leiden. The unique collection of anatomical preparations, which Peter I called «The Eighth wonder of the world», was created by the great Dutch anatomist, doctor of medicine, Professor of anatomy and botany at the University of Amsterdam F. Ruysch. A large collection was acquired by Peter I in 1717 specifically to the future of the Kunstkammer (now the Museum of Peter the Great) and taken to Russia under the supervision of the first President of the Petersburg Academy of Sciences L.L. Blumentrost. Small collection of F. Ruysch was presented to Peter I in the late seventeenth century (1697). It has withstood more than 300-year storage period. Numerous movements and different storage conditions, of course, left its mark on the appearance of these precious unique anatomical specimens. The last event of violations were associated with the early repair of the anatomical building of the Military medical Academy.We must pay tribute to the enthusiasm and unselfishness of the staff of Leiden University headed by a great friend of Russia I.F. Hendriks, who was able to organize a team of professionals in the Museum business. This team included the head of Leiden University, Professor P.C.W. Hodendoorn and specialist in restoration and percussively anatomical preparations – A.J. Van Dam. Hard work was multi-stage. First conducted a thorough verification of anatomical specimens of F. Ruysch with the existing directories of the Department’s records. Identification of the preparations to the F. Ruysch collection was carried out by the appearance of containers, labels, appearance of preparations, the study of embalming fluid. Photo documentation of each study drug was accompanied by reports signed bilateral commission. After pre-treatment the special chemicals and equipment were delivered, and conducted direct work on restoration and percussively. It lasted 10 days. Members of the Department received a unique master class on the restoration of wet embalmed museum anatomical specimens, and received recommendations for their storage.

Bulletin of the Russian Military Medical Academy. 2020;22(3):267-270
pages 267-270 views

Scientific works of Professor T.Ya. Aryev – the first head of the department of thermal lesions of the Military Medical Academy them. CM. Kirov for the period 1932–1945

Sokolov V.A., Mamaeva S.A., Butrin Y.L.


Abstract. The subject of scientific research of the first head of the department of thermal lesions of the Military Medical Academy. CM. Kirov Professor Tuviy Yakovlevich Aryev. The presentation of the material is carried out in chronological order and is tied to those events that occurred in the life of a then-young scientist. The role of family members and scientific leaders in choosing a specialty, making a decision on the beginning of scientific work and the research topic, which has become central during the historical period under consideration, is shown. The high quality of the research is indicated by the publication of the results of T.Ya. Aryev in German and French scientific journals. The growth of professional skills was facilitated by the admission to the Department of General Surgery at the Military Medical Academy. The role of the head – Professor S.S. Girgolava manifested itself in the fact that two years after the start of research, the monograph «Frostbite» was written, and a dissertation was successfully defended a year later. The knowledge gained, the development of the principles and methods of performing scientific work have become an integral feature of T.Ya. Aryeva. Even during a business trip to the armed conflict zone on the Halki-Gol River, he was able to collect material and perform a number of works related to the characteristics of surgical combat trauma of that period. The subsequent analysis of the results of the treatment of wounded with frostbite during the Soviet-Finnish War formed the basis for the development of fundamentally new proposals for the prevention, diagnosis and medical care of victims of frostbite at the stages of medical evacuation. New techniques have contributed to increasing the effectiveness of medical support for troops during the Great Patriotic War.

Bulletin of the Russian Military Medical Academy. 2020;22(3):271-274
pages 271-274 views


Professor Anatoly Mikhailovich Shelepov – founder of the scientific school of military healthcare administrators (to the 70th anniversary)

Tsygan V.N., Kulnev S.V., Porokhov S.Y.


Abstract. The paper provides a brief description of the life, academic and teaching activities of Anatoly Mikhailovich Shelepov. His developmental landmarks as the head of one of the leading theoretical departments of the Kirov Military Medical Academy and the scientist are considered in the writing. Having graduated from the Suvorov Military School, he had to live his life with the name of Grand General Alexander Vasilyevich Suvorov and follow his mission «Never Give Up!». When managing the department he displayed his talent of the scientist, teacher, and leader of the academic teaching team. Anatoly Mikhailovich Shelepov created the scientific school of military healthcare administrators. His like-minded colleagues elaborate theories and concepts for development of the Russian Forces Medical Service, as well as practical aspects of medical support of the Armed Forces in military conflicts and peace-time emergency situations; solve the issues related to standardization of the medical support measures; study the history of military medicine. This happened in 1998. In 2003 the status of the leading scientific school was acknowledged at the federal level. Anatoly Mikhailovich Shelepov has been a member of the Russian Geographical Society (section of the military geography) since 1993. The territorial system of Army medical support was offered and developed, the scope of medical support to be provided to servicemen in local wars and military conflicts, as well as peacekeeping operations was justified and the image of the Russian Forces Medical Service until 2030 was offered under his direction.

Bulletin of the Russian Military Medical Academy. 2020;22(3):275-278
pages 275-278 views

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