Vol 20, No 1 (2018)

Pulmonary sarcoidosis is one of the most common interstitial lung diseases. The prevalence in Russia is 10-20 per 100 thousand population. Overwhelmingly it is found among working age population, and the peak of morbidity is 30-40 years. In half of the cases, sarcoidosis occurs in oligosymptomatic form. According to research conducted by our scientists, the adverse course of the disease with exacerbations and progressive decrease in pulmonary function found in 27,3% of patients. The diagnosis is based on clinical, X-ray and histological examination. Material for histological study was prepared depending on the extent of the process. Preference is given to minimally invasive methods of biopsy: transbronchial puncture of intrathoracic lymph nodes, peripheral lymph nodes, bone marrow aspiration, skin sarcoid items, etc. In the case of the intrathoracic localization of the disease, the treatment of choice is videothoracoscopy. The detection of epithelioid cell granuloma without necrosis confirms the diagnosis of sarcoidosis. First of all it is necessary to exclude tuberculosis, oncohematological diseases, disseminated lung diseases, combined with alveolitis syndrome and mediastinal lymphadenopathy. The primary diagnosis should be carried out under conditions of a multifunctional clinic. The verification of the pulmonary sarcoidosis should be held in close cooperation of different specialists: pulmonologists, radiologists, thoracic surgeons, pathologists, etc. Further treatment of the patient should be implemented by the pulmonologist in the place of residence. A clinical case of late diagnosis of diffuse diseases of connective tissue, which at its beginning started under the mask of sarcoidosis is demonstrated. The main mistake that led to deep disability of the patient, was absence of timely histological verification of the diagnosis.

The component composition of the body of men with normal body weight and insufficient body weight in the age from 18 to 44, patients with community-acquired pneumonia of non-severe course, was studied. Its changes at various periods of treatment are revealed. These changes were expressed in the statistically significant dynamics of indicators of total water content, total muscle mass with water and total fat content in men with normal body weight, as well as significant changes in the total water content and total muscle mass with water in men with insufficient body weight. At the same time, all examinees showed slight changes in body mass, body mass index and stability of the total defat-dehydrated bone mass. At the same time, the total water content and total muscle mass with water were lower at the 3rd, 7th and 15th days of treatment compared to the day of hospitalization. The lowest values of these parameters were recorded on the 3rd day of treatment. In addition, in men with normal body weight, significant changes in the total fat content on the 3rd and 15th days of treatment were noted, compared with 1 day of treatment. It was found that the total water content of men with insufficient body weight was not normal even by the 15th day of treatment. This fact indicates the need for medical rehabilitation after completion of treatment in order to normalize the body composition and prevent recurrence of the disease.

Correlation between the annual average values of minute volume of blood flow in healthy men with different psychosomatic status, suffering from arterial hypertension, and Solar activity from 1995 to 2015 was investigated. Variations of γ-background during the study period did not exceed the limits of normal regional values (7-9 µr/h). However, the analysis of solar activity dynamics represented periodic increase and a momentary increase by the 2005-2006. With the increase in solar activity and γ-ray background a significant reduction of oxygen utilization coefficient by tissues of healthy individuals and patients with different temperament was noted. The increase in solar activity was followed by an increase in ambient temperature and atmospheric pressure. The study showed a significant increase in minute volume of blood flow in the groups of healthy individuals and patients in the same years as the increase in solar activity and γ-background environment. There has been established a significant correlation relationship between indicators of solar activity, meteorological factors and minute volume of blood flow that indicates on the possibility of combined effects of the studied environmental factors to affect the course of physiological processes in organism of both healthy and hypertension person. Overall, it was reflected in the increase of functional activity of the cardiovascular system (by minute volume of blood flow).

Two groups of women aged from 50 to 72 years, conditionally assigned to the senior age category, were examined. The main group of patients was 51 women suffered from the prolapse of genitalia of various degrees. In control group we included 71 women without clinical signs of this disease. The study of the body composition was carried out using bioimpedance scales (Tanita BC-545N fat analyzer, Japan).In both groups the examination was carried out in accordance with the rules of this procedure on the day of hospitalization. The statistically significant differences in the total content of the fat component, the level of visceral fat, as well as the level of physical development between the women of the primary and control groups were revealed. It was established that the patients with prolapse of pelvic organs suffered mainly first and second degrees of obesity, while the control group had normal or excessive body weight. The analysis of the components of the body in patients with prolapse of the genitals indicates a significant change in the ratio of the water-fat balance in comparison with the examined women without this pathology. The bio-impedance measurement is a method for studying the component composition of the body, allowing in a fairly short period of time to assess the state of water, lipid and protein metabolism of an organism, as well as highlight the risk of genital prolapse development.

Arterial hypertension and ischemic heart diseases continue to lead among cardiovascular diseases. In this regard, an importance of fixed-combination antihypertensive therapy is noted. There is an evidence that in years of high solar activity in a group of healthy persons and patients with arterial hypertension and ischemic heart disease reduces the quality of professional activity, cardiovascular diseases exacerbate so that some patients end up developing a heart attack or stroke. There was revealed the correlation between γ-background dynamics of the external environment (within the boundaries of the regional standards) and indicators of electrolyte metabolism in patients with arterial hypertension with different temperament and anxiety, which take an empirical variant of antihypertensive therapy or another variant targeted to the blockade of temperamental peculiarities of psychosomatic status, the most effective antihypertensive therapy was determined. When the power of γ-background in medium was increased, the concentration of potassium and magnesium in blood serum and erythrocytes decreased, but the concentration of sodium increased as the erythrocyte resistance decreased. These shifts are closely related to the increase in osmolar pressure of blood plasma, permeability of erythrocyte membranes for sodium ions, and hemolysis (low resistance of red blood cells, increased indirect bilirubin), and hepatocytes (increase of direct bilirubin). On the background of the targeted antihypertensive therapy the severity of the processes is low and nearly similar to those in healthy persons of corresponding temperament that is the evidence of high efficiency of targeted treatment option.

Comparative analysis of immune status and pubertal development in healthy girls and those suffering from acne disease. It is revealed that the immune status of girls suffering from acne disease, characterized by a decrease in cytotoxic lymphocytes, increase T-lymphocytes helper cells and immunoregulatory index. In the peripheral blood of these girls there was an increase in interleukin-4 and serum tumor necrosis factor, level of circulating immune complexes, mainly due to the low was significantly lower than in g concentration of serum interferon healthy girls. In girls suffering from acne in puberty the concentration of luteinizing and follicle-stimulating hormone in peripheral blood was significantly lower than girls in the control group. While menarche in girls 14-13 years old, with acne, there were significantly less than in the control group. The formation of breast and pubic hair at puberty, they lagged behind in comparison with girls in the control group. The indicators of basal metabolism indicate that girls with acne disease higher rates of creatinine and glucose, and also lower essential fatty acids and enzyme activities of alanine and aspartic transferases than girls in the control group. Thus, ladies suffering from acne, was characterized by delayed and at the same time disharmonious puberty. They are characterized by a later menarche, delayed the establishment of the rhythm of the menstrual cycle, some changes of rhythm humoral regulation and biochemical homeostasis.

Research data on level and structure of sensorineural hearing loss among flight personnel who underwent medical and flight expertise for 2012-2016 is given. Among the analyzed evidences of the disease, 12,8% of military personnel have sensorineural hearing loss of varying degrees. The average age of the contingents tested was 42,1±0,5 years, however, the greatest number of cases occurred in the range of 40-44 years, with a flight time of 20,6±0,5 years in the study group. It was also revealed that bilateral hearing loss was observed in 72,28% cases, in 16,83% - left-sided and in 10,89% - right-sided, with prevalence of II degree in 48,51%, I degree in 35,15%; III degree in 15,35% and IV degree in 0,99% of the subjects. In addition, a significant prevalence of military personnel of the flight crew, dismissed from military service for health reasons, with bilateral sensorineural hearing loss of I and II degrees was revealed. So, among the discharged service members 6,44% had a steady decrease in hearing of both ears to the degree of whisper speech hearing at a distance of less than 1 m and are found not suitable for flight work;16,34% - had a persistent decrease in hearing with one ear to a degree of whisper speech hearing up to1 meter, while perceiving a whisper with another ear from 1 to 4 m and found to be not suitable for flight work; 34,16% had a steady decrease in hearing with one ear to a degree of whispered speech hearing up to 1 meter or close to an external ear, while it takes 4 m minimum hearing a whispered speech with another or it could be persistent hearing loss on both ears to a degree of perception of a whispered speech on each ear in limits from 2 to 3 m and which are not suitable for flight work; the remaining43,07% of the service members had initial manifestations of deafness without changing the category of workability. The information presented in this work justifies the development of measures for prevention of the pathology of the hearing organ expansion and progression and will help to justify the need of creating a center for hearing aid and cochlear implantation in the medical service of the Russian Federation Armed Forces.

Smoking and experience of previous work in coal mines have a negative impact on the incidence of acute respiratory viral infection and pneumonia in the servicemen. Isolated cessation for six months leads to a reduction in the numbers of acute respiratory viral infection cases, complicated forms of acute respiratory viral infection, episodes of community- acquired pneumonia, however, the duration of acute respiratory viral infection and pneumonia do not change. The structure of complicated forms of acute respiratory viral infection with a predominance of sinusitis over bronchitis changes. L.Kh. Garkavi’s adaptation index before the study in the group of smokers reflects the marginal tension of adaptation mechanisms. After 6 months there were significant differences with the group continuing to smoke, significant differences remain with a group of non-smoking servicemen. Pharmaceutical expanses after 6 months were different with the smoking group and there were no reliable differences with the non-smoking group. The authors consider an isolated cessation to smoking tobacco in a group of military with previous experience of underground work in coal mines to be an insufficiently effective measure of primary prevention of acute respiratory viral infection and pneumonia, and consider it reasonable to use medicines and biologically active additives with proadaptive action.

The most common clinical symptom in dentistry is pain. Doctors-dentists of practical health care have to face symptoms that doctors-forensic experts regard as a defect or neurological complication after dental treatment. Quite often there is acute toxic-traumatic neuropathy of the lower alveolar and chin nerve, which occurs when a filling material enters the mandibular canal during treatment of pulpitis or periodontitis of the premolars of the lower jaw [1-3]. During the filling of the canals, the patient has a very intense acute pain in the area of the lower jaw with numbness of the lower lip and chin. In connection with the wide spread and availability of implantological dental care to the population, neuropathies of traumatic genesis occur, the causes of which are mistakes in the setting of implants. One of the earliest manifestations of the above complications is a painful symptom leading to sleep disruption, the inability to fully fulfill their professional duties, fully eat and communicate, that is, to reduce the quality of life of patients. Using the short form (SF-36) as a questionnaire, 86 patients of dental clinics, who according to the medical documentation, had complications after performing dental interventions with different degrees of pain, found that the quality of life in general, with an increase in pain up to 100%, decreases to an average of 60%.

The histological examination method is the «gold standard» in evaluating of age-related skin changes, however in most cases biopsy is an unacceptable option by ethical reasons. An alternative option are non-invasive diagnostic methods, in which the evaluation of changes can be carried out in real time without damaging the skin. Nowadays, such methods as high-frequency ultrasound, optical coherence tomography, laser scanning confocal microscopy, magnetic resonance imaging are used. In addition to the above-mentioned methods, it is necessary to hold a standardized clinical evaluation and determination of the physiological parameters of the skin. The evaluation of age-related skin changes of face zone and neck zone before and after the application of the combined erbium and neodymium laser exposure on the «Fotona» apparatus using the «Fotona 4D» technique has been held. There were 80 examined patients aged from 32 to 66 who, after a comprehensive clinical examination, conducted 2 procedures using the «Fotona 4D» method with an interval of 1 month. There was a significant decrease in the index of evaluation of age-related facial skin changes in the process of correction, which indicates a pronounced clinical effectiveness of the proposed technique (27 points at the screening stage and 12 points at 2 months after correction). There was also a normalization of skin moisture and an improvement in relief, reduction of pore diameter and pigmentation area. Analysis of high-frequency ultrasound data showed a statistically significant increase in skin thickness, mainly due to the dermis.

Possibilities and options of surgical treatment of complications of Crohn’s disease in the general surgical hospital are considered. Patients underwent various surgical interventions: ileum resection with «side-to-side» anastomosis (4 patients), resection of ileocecal department with the formation of ileoascendoanastomosis (2 patients), total coloproctectomy with the formation of ileostomy (2 patients), right-sided hemicolectomy (1 patient), obstructive resection of transverse colon (1 patient), obstructive resection of sigmoid colon (2 patients). Postoperative complications developed in 3 patients (25%), among them: postoperative wound suppuration - 2, dehiscence of anastomosis in 1 patient, which led to the formation of internal intestinal fistula and death. It was found that with limited lesions of colon in Crohn’s disease (less than a third of the colon) can be limited to resection of the affected segment with formation of intestinal anastomosis in the limits of healthy tissues. In the presence of lesions in the ascending department of colon proximal border of resection should be at the level of middle colic vessels with preservation of the latter. In long Crohn’s disease of colon with severe clinical manifestations of the operation of choice is a subtotal resection of colon with the imposition of single-barrel ileostomy. Surgical treatment of complicated forms of Crohn’s disease is in all cases performed in surgical profile hospitals, taking patients by ambulance. Most often, patients have delayed indications for operations, which gives the opportunity to carry out a comprehensive preoperative preparation. In all cases, complications of Crohn’s disease requires an individual approach, which combines conservative and surgical treatment. Surgical intervention is determined by the shape and characteristics of the course of complications of Crohn’s disease.

Pathology of an eruption of wisdom teeth is importance for a military odontology because the vast majority of the military contingents on age coincides with time of their physiological eruption (16-40 years). In work, on the basis of clinic-radial methods of a research, features of a teething of wisdom at young people of military age are studied and analyzed 3D-tomograms and orthopantomograms of 325 servicemen aged from 18 up to 27 years. During work estimated existence of wisdom teeth on top and lower jaws, extent of their eruption, existence of a retention (or dystopias) and also an adentia or loss of wisdom teeth. It was established that most often eruption of the third molar teeth of jaws at recruits occurs at the age of 23-27 years, at the same time at a series of recruits eruption of the lower wisdom teeth usually is followed by various complications, such as pericoronitis, an acute purulent periostitis of a mandible, a false «acute periodontitis» of the lower second molar tooth that becomes perceptible at mesial shift of a wisdom tooth and dense contact of its coronal part with a distal root of the second molar tooth. The essential value for a full-fledged teething of wisdom has their situation in an alveolar process (part) of a jaw, and further - in dentition. It in many respects defines a clinical picture of the shown eruption complications and also tactics of stomatologic treatment - orthodontic treatment, surgical treatment or their combinations. The infectious and inflammatory complications bound to the complicated their eruption (85,93% of cases) served as the reasons of an exodontia of wisdom. In 14,07% of cases wisdom teeth on both jaws were extracted in a planned order in connection with the forthcoming orthodontic treatment on elimination of dentoalveolar anomalies. Thus, terms and features of a teething of wisdom at recruits need to be considered in clinical practice of a military odontology as their military service can pass in specific living conditions and activity of troops and health service, and at complications of a teething of wisdom the acute stomatologic surgical management, including stationary is in most cases necessary.

The possibility of using multiplanar reformations oriented on the axis of heart in diagnosing the common arterial trunk with X-ray computed tomography is substantiated. Examination data of 140 patients aged 1-19 days of life, 3030-3890 g body weight with conotruncal congenital heart diseases was analyzed, and common arterial trunk was detected in 7 patients (4 - boys, 3 - girls). In 5 (72%) patients, it developed mainly from the morphological right ventricle, 1 (14%) - completely from the morphologically right ventricle, and 1 more (14%) - evenly located above the ventricles. In four (57%) cases, the trunk valve had three leaflets, in two (28,5%) cases - two, in one (14,5%) case - four. All the patients had mitral-semilunar fibrous prolongation, intraventricular septal defects, doubled coronary arteries system, and the pulmonary arteries had their origin from ascendant part of common trunk. Pulmonary arteries had also their own common trunk in 4 (57%) cases, separate estuary in 3 (43%) cases. Aortic arc abnormalities included dextral aortic arc (2 cases), discontinuity of aortic arc (1 case), discontinuity of fourth aortic arc with persistence of fifth left aortic arc (2 cases). In general, computed tomographic angiocardiography heart-axis-oriented multiplanar reformations permit full and correct assessment of heart and main vessels, which is important for surgical treatment planning in congenital heart diseases.

The results of treatment of 97 patients with perforations of the hollow organs of the gastrointestinal tract were analyzed, 31 acute intestinal infections of which were verified. Clinical features of perforation of hollow organs on the background of acute intestinal infection have been revealed. A comparative analysis of clinical and instrumental methods for diagnosing perforations in patients with intestinal infections and without them was carried out. The most sensitive in identifying perforations of hollow organs in patients with acute intestinal infections instrumental methods of investigation were diagnostic laparoscopy (100%) and radiography of abdominal organs (80%). It was established that the combination of the two diseases contributes to the growth of diagnostic errors, increase in the number of common forms of peritonitis and development of the syndrome of mutual aggravation. Analysis of surgical interventions showed that in patients with confirmed diagnosis of acute intestinal infection the primary surgical interventions in most patients resulted in the formation of laparostoma with programmed relaparotomy, in connection with the presence of contraindications for the formation of a primary interintestinal anastomosis. Postoperative complications in the study groups developed in 61,3; 41.7 and 23,8% of cases, respectively. In patients with confirmed diagnosis of acute intestinal infection, lethality was 32,3%, in patients with atypical flow of perforations of hollow organs, simulating the symptoms of acute intestinal infection - 16,7 and 14,3% - in patients with perforations of hollow organs without concomitant acute intestinal infection. The results of the research testify to the relevance of the problem under study and the need to optimize therapeutic-diagnostic algorithm for this category of patients.

Аbstract. Quality of life of young men in the view of existential compliance is considered. In its most general form, the term «existence» means «specifically human way of being», the main characteristic of which is the freedom of choice, that is the way of being a person, when he is constantly in a situation that asks him: «How does a man will be a person in this situation?». А person’s subjective assessment of his life was investigated by the technique of A. Langle and K. Orgler «Scale of Existence» in 42 practically healthy young men (24,12±1,1 years). Scores diagnosed on such scales as Self-distancing, Self-Transcendence, Freedom, Responsibility, Personality, Existentiality, and Fulfillment testify to the absence of grounds for the development of existential crisis (for a crisis of subjective evaluation of one’s own life). Thus, with the right medical and psychological support of young people, they have the ability to cope with themselves and with the world, and the feasibility of interaction with the internal and external demands and proposals presented to circumstances, correlating with their own values. At the same time, one should keep in mind that a possible conflict can lead to nervous breakdowns, decrease in the level of professional health (a professional fitness). In order to prevent this, it is necessary to identify persons at risk and prevent possible psychosocial adaptation disorders in advance, using direct methods of psychodiagnostic. To this end, both methods of psycho-counseling and solving personal problems through the provision of advice or other assistance are recommended.

Effectiveness of pyridoxine hydrochloride and inosine glycyl-cysteinyl-glutamate dinatrium (molixan) in monotherapy and in combination in acute poisoning by unsymmetrical dimethylhydrazine on survival, blood biochemical indicators and the state of plasma coagulation hemostasis was assessed. Unsymmetrical dimethylhydrazine was administered intraperitoneally at a dose of 115 mg/kg (LD50) once. Drugs under examination were also admistered intraperitoneally: pyridoxine hydrochloride in a dose of 50 mg/kg once, 30 minutes after the administration of unsymmetrical dimethylhydrazine, the inosine glycyl-cysteinyl-glutamatedinatrium (molixan) in a dose of 60 mg/kg seven times: 30 minutes after the administration of unsymmetrical dimethylhydrazine, and then daily for 6 days. Biochemical parameters of blood, plasma coagulation hemostasis, were evaluated 7 days after the administration of unsymmetrical dimethylhydrazine. The use of pyridoxine as a monotherapy and in combination with molixan prevents death of experimental animals and the development of convulsive syndrome. In addition, the combination of molixan with pyridoxine eliminates the development of toxic lesions of liver that is having hepatoprotective effect. The efficiency of molixan as hepatoprotector, apparently, related to the fact that in its structure it is a combined preparation containing the peptide and purine components. The peptide component (glycyl-cysteinyl-glutamate dinatrium) is a pharmacological analogue of oxidized glutathione, purine is represented by inosine. Oxidized glutathione has cytoprotective activity, inhibits the cytolysis of hepatocytes, and reduces the severity of inflammatory process during toxic damage of liver cells by the products of metabolism of xenobiotics. Inosine also has hepatoprotective properties. As a precursor to the synthesis of adenosine triphosphoric acid and nucleotides, it stimulates a number of metabolic processes in body, supports energy balance in various tissues, particularly in liver and myocardium.

Provisions and requirements of the Internal service regulations of the Armed Forces of the Russian Federation regarding the rights and obligations of military personnel for life and health protection are analyzed. Provisions in regulations of 1993 and 2007 years are compared. The compliance of articles of the Regulations to the Constitution of the Russian Federation, Federal laws from May 27th, 1998 No. 76 «Concerning the status of military personnel», from November 21st, 2011No. 323 «On fundamental healthcare principles in the Russian Federation» and from March 30th, 1999 No. 52 «Concerning the Sanitary and Epidemiological Welfare of the Population» are described. Insufficient legal confirmation of the duties of a serviceman in protection of his own health is noted. One of the problems of education and training of the military personnel of various classes is the lack of such subject as a military hygiene in the curriculum. In prerevolutionary military educational establishments, the hygiene was studied and at the course end there was examination. One of the important elements of the health protection of the servicemen is a sanatorium-resort therapy which can be treated as a part of preventive medical examination. Data on decline of sanatorium service of the military personnel in connection with the legislation changes are presented. Considering physical and mental health of servicemen as a guaranty of high-degree alert and military efficiency it is proposed to start studying the Instruction on life and health protection of the serviceman in the period of a basic military training (soldier, sailor, cadet). Proposals on hygiene studying in fostering and educational institutions of the Ministry of Defense.

The results of a survey of physicians of various specialties with the purpose of revealing a level of training of specialists in the field of psychosomatic medicine are presented. The importance of this study is determined by the wide spread of psychosomatic pathology among the population. Wide prevalence of psychosomatic pathology in the practice of doctors of various profiles was revealed. It was found that a significant proportion of patients (on average, 11,1±1%) had complaints at the time of examination, but no objective evidence was provided in favor of one or another pathology. At the same time, it was shown that insufficient awareness of physicians in psychosomatic issues, including an understanding of terminology of psychosomatics and nosologies capable of inducing psychosomatic disorders as well as the possibility of using different scales for a mental pathology detection. Almost a quarter of the doctors surveyed (23,1%) misinterpret the term «psychosomatic disorder», while the incorrect interpretation of this concept is significantly higher among general practitioners and therapists than among doctors of particular specialities. In addition, the need for doctors to expand their knowledge in the field of psychosomatic medicine has been established. Thus, 67,3% of doctors note a lack of knowledge in the field of psychiatry. At the same time, only 11,5% of respondents use questionnaires and surveys in their daily practice to identify various psychiatric disorders among their patients. Practically one third of the doctors surveyed (28,8%) cannot list any indications for sending patients to the psychosomatic department. The results of the study confirm the importance of developing and implementing a course of psychosomatic medicine for clinical residents of various specialties.

The analysis of legal base of genetic researches in clinical practice is carried out. Modern standards of medical care are analyzed. The list of the diseases and pathological states demanding performance of genetic researches is made. The list of the medical services connected with genetic researches is also made. It is shown, that genetic researches make 10% of the nomenclature of medical services. From them about 60% medical services provide diagnosis of somatic pathology, the others are directed to identification of nucleinic acids of causative agents of infectious and parasitic diseases. Genetic researches are carried out mainly at a stage of specialized and primary medical care. Genetic researches are included in20% of standards of medical care. Genetic researches are conducted concerning 15 classes of diseases. More often genetic researches are conducted for diagnosis of the latent infections, enzimopatiya, hereditary diseases of a metabolism, and also cancer. There are some problems of cytogenetic and molecular genetic diagnostics in hospitals. Genetic researches are complex and expensive. Interpretation of the received results is difficult. It is necessary to develop standards of genetic researches. It is necessary to improve legal base of genetic researches.

An increasing number of injuries with damage of peripheral nerves, including a substantial number of injuries with extensive defects of large nerve trunks, requires improvement in approach to surgical treatment of patients. High-energy impact injuries in peacetime and wartime often lead to persistent violations of musculoskeletal apparatus, a significant part of which is due to injuries of peripheral nerves. During peacetime, various types of peripheral nerve injuries occur in 2-6% of trauma patients. In today’s armed conflicts, various types of peripheral nerve injuries occur in nearly 80% of neurosurgical patients and are mostly of combined injury. Improvements in surgical methods of recovery of lost innervation due to an injury are directly associated with the development of fundamental understanding of the nature of occurring degenerative and regenerative processes in damaged nerve fiber. Nerve suture is only the creation of appropriate conditions that contribute to regeneration of nerve fibers and recovery of lost functions. When extensive defects of nerve trunks exist, connection of distal part damaged nerve with side surface of the intact nerve is the alternative to traditional replacement of extensive defects with nerve grafts. Positive outcomes of such interventions that were seen during tests on laboratory animals led to trials of this method on patients and resulted in a number of positive outcomes as well. Despite the fact that the question of morphological substantiation of reinnervation processes of the distal portion of a damaged nerve is the cause of heated disputes among scientists, some surgeons make attempts to define a set of specific conditions needed to justify the use of end-to-side neurorrhaphy.

The main pathogenetic aspects of non-alcoholic fatty liver disease as a comorbid factor of chronic hepatitis C are considered. Non-alcoholic fatty liver disease is currently the most common liver disease worldwide, both among adults and children. It is usually accompanied by obesity, insulin resistance and diabetes mellitus. Non-alcoholic fatty liver disease includes a spectrum of pathologies from simple fatty liver infiltration to non-alcoholic steatohepatitis, which is characterized by inflammation with potential progression to fibrosis and cirrhosis over time. On average, non-alcoholic fatty liver disease occurs in 55% of patients with chronic hepatitis C, which is significantly higher than the prevalence of each disease individually. This condition leads to a greater rate of progression of fibrosis, as well as a continuing high risk of developing cirrhosis and hepatocellular carcinoma even after achieving a sustained virological response. In this regard, complex therapy aimed at normalization of the nutritional status, optimization of body weight, correction of impaired intestinal microflora, reduction of severity of liver steatosis and achieving a sustained virological response is a priority task in the treatment of patients with chronic hepatitis C.

Main aspects of histogenesis, morphology and classification of tumors of the thymus, the current state of their diagnosis and treatment are submitted. Clinical manifestations of thymomas are dependent on their endocrine activity, pace and nature of growth, size and relationship with surrounding structures of mediastinum. Hormonal tumors of thymus are often accompanied by the development of generalized myasthenia gravis. Spiral computed and magnetic resonance tomography are recognized as the leading methods of diagnostics and differential diagnostics of the tumors of thymus gland. However, frequency of diagnostic errors can reach 10-30% of observations. The main method of treatment is surgical, as providing radical and the best long-term results. An adequate volume of surgical treatment of tumors of the thymus gland is thymomthymectomy- enblock removal of a tumor and the entire gland tissue along with fatty tissue and lymph nodes of anterior mediastinum. Various «open» and endovideosurgical approaches to thymus removal have been proposed. Minimally invasive endovideoscopic removal of thymus has a number of advantages over traditional, «open» thymectomy and is characterized by a much smaller intraoperative blood loss and duration of drainage of the pleural cavities, early activization of a patient and a shorter hospital stay. The implementation of endovideosurgical intervention is prescribed with the removal of thymoma I-II stage of cancer progression, as well as in some cases of combined operational benefits at stage III. However, international experience is not sufficient for making decisions regarding the selection of an optimal surgical approach in each case. In invasive tumors of thymus, combined treatment with the inclusion of radiation and chemotherapy is recommended. However, the choice of components of a treatment, modes and sequence remain controversial.

Data on variant anatomy of the celiac trunk, typical and atypical variants of its architectonics, topography, existing classifications, morphometric characteristics, development of the vessels of abdominal aorta in embryogenesis and the clinical significance of anatomical features is presented. The issues under consideration are important for surgical practice, in particular, for abdominal surgery, transplantology, interventional X-ray endovascular surgery and oncosurgery. It is shown that the anatomy of the celiac trunk and its branches have a pronounced variability, and more than 15% of the population have significant deviations from the typical branching variant. A significant number of different variants of the celiac trunk dividing, a different frequency of occurrence of these variants, morphometric indices, apparently depends on the size of the sample of the investigated objects, gender and other reasons. Data on the development of branches of the abdominal aorta in embryogenesis and the causes of atypical variants is presented. In a comparative aspect, existing classifications of the most authoritative authors are considered. It is shown that, despite the large number, there is no universal, simplest in practice, classification of variants of the celiac trunk branching. Nosological examples that demonstrate the need to take into account the variant of formation of the celiac trunk and its morphometric features in operative and diagnostic manipulations on the organs and vessels of the upper floor of the peritoneal cavity are analyzed. Certainly without understanding the architectonics of the gastrosplenicpancreatoduodenal zone arteries, there is a significant risk of error, which can even lead to lethal complications.

Control of infectious morbidity is considered as a functional tool for ensuring the sanitary-epidemiological well- being of servicemen studying in military educational organizations. At the same time, scientifically substantiated structural and logical schemes for interaction of officials of these organizations to control morbidity in the system of ensuring sanitary and epidemiological well-being of servicemen are absent. Literature data on the development of organizational and functional form of controlling the infectious morbidity of servicemen studying in military educational organizations is analyzed. The connection of infectious morbidity with the level of sanitary-epidemiological well-being of military contingents is mentioned. The concept of infectious morbidity in relation to the activities of officials of the military educational organization control in the sphere of ensuring sanitary and epidemiological well-being is explained. Existing approaches to the development of organizational and functional models in the field of health care are considered. The principles of development of the organizational and functional form of control of the infectious morbidity of personnel of the military educational organization are proposed and the expected results of its implementation are mentioned.

Gazenko Oleg Georgievich - an academician, one of the founders of space biology and medicine, deputy head of the state Research and Experimental Institute of Aviation and Space Medicine of the Ministry of Defense of the Union of Soviet Socialist Republics (1963-1969), director of the Institute of Medico-Biological problems (1969-1988), president of the Russian society named after I.P. Pavlov (1983-2004), advisor to the Russian Academy of Sciences at the State Scientific center of the Russian Federation - Institute of Medico-Biological Problems of the Russian Academy of Sciences (1988-2007). He was immediate participant of the preparation for the flight of Yuri Gagarin. He was the author of Monographs «Animals in Space», «Life and Space», «Man in long Space flight», «Space Cardiology», «Humanity and space». He was in charge as an editor-in-chief of a number of magazines - «Successes of Physiological Sciences», «Space Biology and medicine», as well as large serial monographs - «Scientific results of researches in space missions», «Problems of space Biology». O.G. Gazenko represented Russia at the sessions of the United Nations Scientific and Technical Committee on Outer Space. International recognition of his merits in this field was marked by numerous awards, honorary ranks and titles. The most significant result of the creative path of academician Oleg Georgievich Gazenko was in creation of a new direction - space biology and medicine, which his students and followers still continue to develop.

The work presents little-known facts of the service of Professor T.Ya. Arieva in the post of the head of theDepartment of Military Surgery of the Military Medical Faculty S.M. Kirov at the Saratov Medical Institute in the period1951-1958. Arriving to a new duty station as a member of the staff of teachers from the Military Medical Academy, hesupported the command of the faculty of medical institute in a short time was able to staff the cathedral team and begin thecurrent work. Possessing significant personal scientific and pedagogical experience and the technique of performing complexsurgical interventions, he was able to effectively organize on a scientifically grounded principles the methodology of teachingdiscipline on the basis of a city clinical hospital. In his work he successfully used the rational distribution of study time, theoptimal schedule of the day of medical and nursing staff. As the head of the department T.Ya. Aryev paid much attentionto the professional growth of the teaching staff, regularly summarized in the press the accumulated experience, shared anddiscussed with colleagues promising ways to improve the pedagogical process. Scientific and clinical work complementedeach other, allowed not only to find answers to urgent questions and problems of medical science, improve the effectivenessof treatment of patients, but also to identify the most gifted listeners and teachers of the department. Such students are T.Ya.Aryev, as M.I. Lytkin and N.E. Povstyanoy, working under his leadership, became later known physicians and scientists, headsof surgical departments in large universities, created their own scientific schools. Service in Saratov allowed to accumulateT. I Aryev considerable experience in the management of the surgical department. It was this factor, combined with personalqualities, that enabled him to lead the first in our country chair of thermal defeats of the Military Medical Academy S.M.Kirov. Under his leadership, the team created a well-known clinic not only in our country but also abroad, a large scientificand educational center, which became a real school of professional skill for a large number of specialists.