Vol 64, No 4 (2018)

Articles
Military Medical Academy named after S.M. Kirov - 220 years old
Fisun A.Y., Kruglov V.I., Paliy K.A.
Abstract
History of the Military medical academy is inextricably linked with the name of Peter I, who in 1715 laid the Vyborg district of St. Petersburg admiralty and land hospitals. In those hospitals, January 9, 1733 were formed hospital (surgeon’s) school for training local doctors, which were the prototype of the Academy. In 1786, the school joined to the surgeon’s main medical (medical and surgical) school, where seven professorships were established in 1795. December 18,1798 decree issued by Emperor Paul I «On the dispensation at the main hospital buildings for special medical schools and teaching theater». The construction of a special (separate) building made it possible to have the territorial and administrative independence of the educational institution. The main medical school received the status of Medical-Surgical Academy. In1809 the Academy became the Imperial, it was given the status and functions of the Russian academy of medical sciences. At the same period, there were formed three departments - medical, veterinary and pharmaceutical, allowing Academy initiated the medical, veterinary and pharmaceutical higher education in Russia. In 1858, at the Academy the Institute of doctors (the prototype of post-graduate) was created to prepare teachers for the medical faculties of Russian universities. Establishing in 1872 a «special education course for female scientists midwives», converted in 1876 in the women’s medical courses, the Academy has initiated the formation of women’s medical education, which in those days was not the only one in our country but also in Europe. Staff and graduates of the academy have covered themselves with unfading glory in all the wars in which Russia participated. The Academy in the XIX-XX centuries developed world renowned scientific medical schools which live today. Currently, the Military medical academy named after S.M. Kirov is the major higher military medical school, head research institution and a leading military medical establishment of the Ministry of Defense of the Russian Federation.
Bulletin of the Russian Military Medical Academy. 2018;64(4):7-17
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Experience with the use of daptomycin in patients with infective endocarditis oncohematological and cardiosurgical profile
Khubulava V.G., Turin V.P., Koltsov A.V., Fisun A.Y., Fisun A.Y.
Abstract
The study of the effectiveness of antibacterial therapy with daptomycin in the treatment of gram-positive infection in 44 patients with infectious endocarditis was conducted. Primary infectious endocarditis developed in 15 patients, including 3 patients who were observed for oncohematological diseases (acute leukemia, myelodysplastic syndrome). In 29 patients secondary endocarditis was diagnosed, among the secondary forms of the disease endocarditis prevailed after cardiac surgery. In 32 patients, the bacteriological study revealed the pathogen. Among the identified pathogens included: 7 patients - methicillin-sensitive S. aureus,5 - methicillin-resistant S. aureus, 3 - methicillin-resistant S. Epidermidis in 9 - Enterococcus faecalis, 8 - Streptococcus bovis. All patients were prescribed antibacterial therapy with daptomycin, in monotherapy and in combination with beta-lactams, and surgical treatment was also performed. The average dose of daptomycin was 6,9±0,8 mg/kg/ day, the average duration of treatment 26,2±9,4 days. In 20 (45,4%) patients, repeated surgical treatment with a positive result were performed, there were no fatal outcomes among the operated patients. Of the 44 patients treated with daptomycin, 5 died (due to the inability to provide surgical treatment), in 1 case an early relapse of infectious endocarditis developed, in other cases there was a positive dynamics on the background of treatment, the resolution of infectious complications. No cases of resistance of the infectious agent to daptomycin have been reported. Thus, the use of daptomycin in the treatment of gram-positive infections in patients with cardiosurgical and oncohematological profile is justified and shows good results in tolerability and effectiveness both in monotherapy and in combination with other antibiotics.
Bulletin of the Russian Military Medical Academy. 2018;64(4):18-21
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Prevention and treatment of infectious complications of penetrating thoracic injuries
Kotiv B.N., Samokhvalov I.M., Markevich V.Y., Chuprina A.P., Dzidzava I.I., Barinov O.V., Suvorov V.V., Goncharov A.V., Rud A.A., Petukhov K.V.
Abstract
Results of treatment of 325 wounded are analyzed with penetrating wounds of the chest and identify risk factors for the development of infectious complications. Found that infectious complications of the chest organs developed in 49 (15,1%) cases. It has been established that the most frequent infectious complications of penetrating wounds of the chest are post-traumatic pneumonia (67,3% of cases) and acute empyema of the pleura (26,5% of cases). The most prognostic significant risk factors for the development of infectious complications were identified: the type of injury (odds ratio - 2,48;95% confidence interval - 1,34-3,76), the severity of injuries (odds ratio - 7,88; 95% confidence interval - 3,9-15,92), blood loss (odds ratio - 3,09; 95% confidence interval - 1,6-5,94), duration of stay in the intensive care unit (odds ratio - 9,25;95% confidence interval - 4,57-18, 74), the intersection of chest wall structures (odds ratio - 2,84; 95% confidence interval- 1,24-6,47). Measures aimed at the prevention of infectious complications should be started from the moment the woundedperson enters the hospital. The priority tasks are to maintain the patency of the tracheobronchial tree, expanding the lung,adequate drainage and debridement of the pleural cavity. A high risk of developing infectious complications in penetratingwounds of the chest is expected in the wounded in a severe and extremely serious condition (according to the scale of fieldsurgery - condition at admission more than 31 points). The duration of stay in the intensive care unit for more than 4 daysincreases the probability of infectious complications 9 times.
Bulletin of the Russian Military Medical Academy. 2018;64(4):22-25
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Chronic decompression sickness and its diagnosis
Myasnikov A.A., Eficenko E.V., Zverev D.P., Klenkov I.R.
Abstract
Clinical pattern of the chronic decompression sickness is non-specific and there is objective difficulty to reveal the cause-and-effect relationship between the diver’s health condition and his professional activity in each case. This problem is not only obstructing necessary medical and social aid to the patient but also provides the light-minded relation to the preventive measures organization before diving long-term adverse health effects. A clinical case of professional pathology diagnosed in the diver. The patient served in 1993-2000 in Armed Forces of the Russian Federation as diver-welder, during this period no active complains were demonstrated, as he told, for saving diver’s qualification. In 2000 the patient retired for social and economic reasons and was accepted as a healthy person by a military medical expert commission. Until 2007 he was working by speciality not related to increased pressure terms. In 2007 after medical expert commission examination, the patient continued his work as a civilian personnel diver of the Russian Federation Ministry of Defense, during this time the clear relation between pain syndrome and diving episodes was detected. The patient was self-treated with analgesics and heat physical therapy with unstable effect. In 2014 because of increased lower back pain syndrome, he turned to medical aid. In2015 the diagnosis of chronic decompression sickness was established. Pathogenesis of chronic decompression sickness in not enough investigated, including methodical reasons. Prophylactic measures existing in routine medical diving practice are aimed only for acute non-specific and specific diver’s pathologies and this fact doesn’t favour special attention of the medicals for long-term post-diving effects. It provides to the low efficiency of measures for saving divers, aquanauts and caisson workers professional suitability despite known cases of their health disorders during work experience.
Bulletin of the Russian Military Medical Academy. 2018;64(4):26-31
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Comparative evaluation of percutaneous endoscopic and microsurgical lumbar discectomy
Kravtsov M.N., Mirzametov S.D., Malakhovskiy V.N., Gaidar B.V., Svistov D.V.
Abstract
The results of percutaneous endoscopic and microsurgical discectomy have been compared. It was established that the operative intervention time, bed-day medians and disability period were significantly shorter (p<0,001) in the percutaneous endoscopy group. The average effective dose of radiation exposure for a patient during transforaminal endoscopy was 4,4 mSv, for interlaminar endoscopic techniques and microsurgery - 0,8 mSv. The proportions of complications and repeated operations in both groups were comparable. The risk of recurrence was 10% for the endoscopic group, 4,8% for the microsurgical group. Significant differences in terms of local and radicular pain, quality of life and the physical component of health have not been established. The mental component of health was the best in the endoscopic group. Good and excellent results on the MacNab treatment satisfaction scale in the endoscopy group were observed in 78,2% of cases, after microdiscectomy - in84,9%. Lower invasiveness of percutaneous endoscopy affected the reduction in the period of hospitalization and disability. The effectiveness of percutaneous endoscopic discectomy methods was comparable to standard microsurgical techniques. A statistically insignificant increase in the risk of hernia recurrence after percutaneous endoscopic discectomy was noted. Infectious complications were not typical for percutaneous endoscopic discectomy. Differences in the frequency of complications and reoperations between percutaneous endoscopic and microsurgical lumbar discectomy are also not confirmed.
Bulletin of the Russian Military Medical Academy. 2018;64(4):32-37
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Modern approaches to objectivization of diagnostics of mental disorders
Shamrey V.K., Marchenko A.A., Kurasov E.S.
Abstract
586 patients with mental disorders of headings F0-F4 (according to the 10th revision of the International Statistical Classification of Diseases) and 18 mentally healthy people were studied. An automated ethological analysis of psychodiagnostic interviews, an enzyme-linked immunosorbent assay, a pictographic survey, psychometric scales, stress testing, and structural and functional neuroimaging methods were used. Reliable differences are shown when examining patients with mental disorders using a set of instrumental, laboratory and psychophysiological methods for investigating mental disorders. Significant differences in the volume of behavioral reactions in patients with schizophrenic disorder were revealed. With the help of the pictographic methodic, reliable differences are shown in patients with neurotic disorders and depressive episodes, as well as in persons with preclinical neurotic disorders. Neuroimaging methodic showed significant differences in the structure and functional activity of different parts of the brain in patients with endogenous, organic, neurotic depressions, as well as addictive disorders compared with healthy individuals. It was found that, despite the pronounced individual differences, even a simple comparative analysis (ethological part of the study) revealed statistically significant indicators in the volume of behavioral reactions in patients with schizophrenia spectrum disorders, compared with healthy individuals. The results of the study of «neuroimaging markers» of the depressive disorders have shown, that «endogenous» depression at the PET (positron emission tomography) - study was determined by the decrease in the level of metabolism in the heads of caudate nuclei by20-40% of normal with moderate depression (up to 25 points on the HAMD) and more than 40% - severe (more than 26 points on the HAMD) compared to the control group, which was not observed in the «reactive» depression. It was found that the use of «neuroendocrine markers» (platelet serotonin, cortisol) in the diagnosis of depressive disorders allows, on the one hand, to study the causal mechanisms of mental disorders with an externally similar phenomenological picture, and on the other - to assess the pathophysiological consequences and severity of mental pathology. The possibility of modification of approaches to objectification, prognosis and early detection of mental disorders is shown.
Bulletin of the Russian Military Medical Academy. 2018;64(4):38-44
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Early diagnosis of violation of mineral metabolism, as a way of primary and secondary prevention of fractures Arctic army groupings
Tyrenko V.V., Aganov D.S., Toporkov M.M., Tsygan E.N., Bologov S.G.
Abstract
The main challenges leading to the decrease of bone mineral metabolism in the conditions of the North are covered. The presented results of a study of 29 soldiers serving in the extreme conditions of the North, to study the mineral density of bone tissue in the distal forearm. Revealed a significant decrease in bone mineral density, as well as a deficiency of essential elements in this cohort. So, when densitometric training of servicemen serving in the North, the average Z-test was 0±1,8 SD, the change in bone mass corresponded to the Z-test less than -2 SD, was determined at 31,03%. Vitamin D3 deficiency was detected in 96,5% of cases. Analysis of the bio-element state of the hair revealed a deviation of the reference interval in 100% of military personnel, a decrease in essential elements: cobalt, selenium, magnesium, vanadium and an increase in the level of barium, bromine, arsenic, as well as caesium. The interrelation of the elemental status and bone mineral density is revealed. 100% of the examined hair samples showed a significant decrease in the level of cobalt, selenium and iodine. (p<0,05) a decrease in boron, magnesium, calcium, vanadium (p<0,05) and a significant increase in chromium, manganese, and copper. A quantitative study of toxic elements revealed a significant (p<0,05) increase in mercury, rubidium, strontium, and caesium. A correlation was established between the Z-test and the level of vitamin D3, body mass index and dynamometer. The data obtained determine the required level of trace elements in order to prevent disturbances of mineral metabolism and bone loss.
Bulletin of the Russian Military Medical Academy. 2018;64(4):45-51
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Surgical treatment of gemangioma of the small intestine complicated by recurrent bleedings and blood losses of heavy severity
Soloviev I.A., Vasilchenko M.V., Voloshin S.V., Kudryavtseva A.V., Kolunov A.V., Koshelev T.E., Sizonenko N.A.
Abstract
The frequency of gastrointestinal bleeding in the modern structure of emergency surgical pathology still occupies a leading position. In this case, the predominant localization of sources-the stomach and duodenum, as well as the colon and rectum. The literature describes a few observations of severe life-threatening bleeding from tumours of the small intestine. Hemangioma of the small intestine in the structure of tumours of the gastrointestinal tract occurs only up to 0,3% of cases, which is probably due to its rare complications, in particular - bleeding. Presents a case of rare recurrent bleeding from the small intestine hemangioma into the lumen of the gastrointestinal tract with the development of severe posthemorrhagic anaemia. The features of diagnosis and surgical tactics in these cases are discussed. It was established that the classical standards of examination of the patient with signs of gastrointestinal bleeding will not allow establishing the source in the case of bleeding from the small intestine hemangioma. In this observation, using multiphase computed tomography in the mode of two-energy scanning followed by the construction of iodine maps, it was possible to diagnose the source of bleeding, establish its localization and perform a resection of the affected area of the small intestine.
Bulletin of the Russian Military Medical Academy. 2018;64(4):52-55
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Surgical tactics treatment of the peptic ulcer of the stomach, complicated by bleeding
Sinenchenko G.I., Verbitskii V.G., Demko A.E., Parfenov A.O., Sekeev A.N., Zaitsev M.G., Kosachev A.V.
Abstract
Currently, endoscopic hemostasis is the «gold» standard in the treatment of patients suffering from ulcerative gastroduodenal bleeding. General mortality in ulcerative gastroduodenal bleeding according to the Department of ambulance organization of the research Institute of emergency care. I.I. Dzhanelidze in St. Petersburg in 2016 was 5%, and postoperative8,5%. Transcatheter arterial embolization, due to the development of endovascular hemostasis techniques, is an alternative to palliative surgery in the failure of conservative treatment of ulcerative gastroduodenal bleeding using endoscopic hemostasis techniques, especially in the group of patients with high risk of surgery and adverse outcome. It was found that the reduction in mortality in patients with gastric ulcer bleeding can be achieved by reducing the number of palliative interventions, wider use of angiographic embolization for the prevention and treatment of recurrent bleeding and expanding indications for urgent radical operations outside the recurrence of hemorrhage. The use of transcatheter arterial embolization in elderly patients with severe somatic pathology and recurrent gastric ulcer bleeding can prevent the recurrence of bleeding and perform hemostasis. The success of the transcatheter arterial embolization procedure depends on many factors. Primarily from the anatomical features of the patient. In one case, the patient had a 60% stenosis of the proximal segment of the gastrointestinal splenic trunk, which did not allow the procedure to be performed. Important is the choice of agents for embolization depending on the location and diameter of the source of bleeding. Success also depends on the technical equipment of the hospital and the experience of the surgeon. The absence of significant differences in mortality between the main and control groups, in our opinion, is due to the severity of the General somatic condition of patients included in the study. The obtained results determine the need for further studies to optimize the indications and methods of transcatheter arterial embolization in emergency surgery of gastroduodenal bleeding.
Bulletin of the Russian Military Medical Academy. 2018;64(4):56-60
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Morphofunctional changes in the myocardium of the left ventricle at an early stage of the development of hypertension
Kuchmin A.N., Galova E.P., Kazachenko A.A., Yaroslavtcev M.Y.
Abstract
Hypertension, as one of the most common diseases of the circulatory system in the world population, has a large number of complications, including leading to chronic heart failure and other serious complications and, as a result, of disability, deserves the attention of clinicians and scientists, working on techniques that allow early diagnosis of morphofunctional changes in the myocardium within this pathology. As soon as standard echocardiography evaluates the systolic function and is based on the indications of the ejection fraction, which reveals a violation of systolic function only at the late stages of the development of hypertension, often irreversible, in our special study we used a technique that allows us to estimate the longitudinal deformation to detect early violations of contractility myocardium of the left ventricle at the initial stage of the disease. The examination of 68 patients revealed uneven changes in the indices of longitudinal deformation of the left ventricle. It was discovered that the early stage of the development of the disease, the segments of the anterior and anterior-septal area, as well as the basal segment of the lower wall of the left ventricle, suffer. An interesting fact is that the vast majority of the above segments are supplied by blood from the anterior interventricular artery. A negative correlation was found between the thickness of the MES in relation to the longitudinal strain indicators in the respective segments, which confirms the development of systolic dysfunction as the hypertrophy of the walls of the left ventricle develops. Thus, it has been proved that the assessment of myocardial longitudinal strain is highly informative in the early diagnosis of disorders of its contractility among hypertensive patients with early stages.
Bulletin of the Russian Military Medical Academy. 2018;64(4):61-65
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Criteria for the morphological diagnosis of sepsis
Chirsky V.S., Yuzvinkevich A.K., Andreeva E.A.
Abstract
80 cases of lethal outcomes with a clinical diagnosis of sepsis were analyzed. In 31 of them, the pathologoanatomical diagnosis was confirmed - histologically, the internal organs showed metastatic purulent foci. This criterion for the morphological diagnosis of sepsis corresponded to the modern definition of sepsis as a pyogenic bacterial infection with hematogenous generalization and the absence of a specific pathogen. When re-examining archival micropreparations, special attention was paid to finding inconspicuous small metastatic septic foci in the myocardium, kidneys, and brain (mini foci). Their detection required careful searches with a high magnification of the microscope due to fading with adequate antibiotic therapy with therapeutic pathomorphosis. To confirm suppurative inflammation in metastatic septic foci, neutrophilic granulocytes were identified by immunohistochemistry with an expression of CD15. Most often, mini-foci were found in the myocardium, less often in the brain. The presence of morphological signs of microcirculation disorders in all 80 observations was also recorded: leukostasis, «sludge-phenomenon», diapedesis haemorrhages, convolutions in the lumen of the vessels. In the group where sepsis was confirmed, leukostasis, sludge-phenomenon and diapedesis haemorrhages were more common. Comparison of the number of signs of microcirculation disorders in sepsis, confirmed histologically, with violations in the clinical diagnosis of «sepsis», not confirmed pathologically, was made. The obtained ratio made it possible to consider the pronounced and widespread microcirculatory disorders as objective microscopic criteria that require the study of additional sections for the detection of metastatic pustules for reliable diagnosis of sepsis. At the same time, it is possible to detect single mini-foci, indicating the presence of sepsis.
Bulletin of the Russian Military Medical Academy. 2018;64(4):66-71
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The diagnostic value of indicators of acid-forming and pepsinoguena functions of the stomach in the detection of precancerous changes of the gastric mucosa in patients with chronic gastritis
Pavlovich I.M., Alper G.A., Gordienko A.V.
Abstract
It was found that in patients with chronic atrophic gastritis, low gastric secretory functions are present in the localization of atrophy in the mucous membrane of the body of the stomach with a tendency to decrease in indices as the degree of atrophy increases and are not associated with the presence of disregenerative changes in the gastric mucosa (intestinal metaplasia and dysplasia). Reduced levels of pepsin in gastric juice and reduced levels of pepsinogen in the mucous membrane of the body of the stomach reliably reflect the presence of severe atrophy of the mucous membrane of the body of the stomach. However, neither the concentration of pepsinogen in the tissues of the mucous membrane of the body of the stomach nor the level of pepsin in the gastric juice make it possible to differentiate the degree of atrophy of the gastric mucosa. The most profound disregenerative changes in gastric mucosa such as colonic metaplasia or dysplasia were detected, accordingly in 18,4 and 10,5% of patients. The presence of intestinal metaplasia or dysplasia causes a low activity of pepsinogen-pepsin. It worth noting that in case of the presence of intestinal metaplasia and dysplasia there is a significant difference between indicators of the concentration of pepsinogen-pepsin and those at patients with chronic gastritis, but without disregenerative changes of the mucous membrane. Also was found an association between the severity of disregenerative changes in the gastric mucosa and the degree of the reduction of pepsin-forming function.
Bulletin of the Russian Military Medical Academy. 2018;64(4):72-75
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Features of the skin microbiota in patients with diabetes
Khasiev N.D., Shaposhnikova E.B., Shevchuk N.I., Mironov I.V.
Abstract
The assessment of the skin microbiota state in elderly people with diabetes mellitus is given. For the research and development of quantitative and specific indicators of deep microbiota of the skin used the method of agar imprints. The revealed changes in the skin microbiota in patients with diabetes mellitus are of interest as adaptive characteristics of the organism, and also serve as a harbinger of deviations in the clinical and physiological status of patients and give reason to present the basic laws of skin biocenosis in elderly people suffering from diabetes mellitus. It was found that the species composition of the microbiota does not change in the control group in the deep layers of the forearm skin, and the number of colony-forming units increased, which corresponds to skin dysbiosis of the I degree. It was also found that representatives of Staphylococcus spp occupy a dominant position in the skin microbiota in persons with diabetes mellitus, both in frequency of occurrence and in quantitative measure. At the same time, in the observed patients, regardless of the type and stage of diabetes mellitus, an increase in the number of colony-forming units by 1 cm2 of the deep layers of the forearm skin was revealed, which corresponds to the dysbacteriosis of the skin of the III degree. This is 2,6 times greater than in healthy individuals. This increase is directly correlated with the severity of diabetes. It is shown that dysbiosis can manifest itself by clinical local symptoms, and then by General disorders, which aggravate the course of the underlying disease and complicate treatment. An integrated approach to this problem can be used for a more differentiated assessment of the prognosis of complications in patients with diabetes mellitus and to improve the effectiveness of treatment and preventive care.
Bulletin of the Russian Military Medical Academy. 2018;64(4):76-78
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Suppression of brain electrical activity in general anesthesia: the dose-effect relationship
Aleksandrov M.V., Kostenko I.A., Arkhipova N.B., Basharin V.A., Tolkach P.G., Chernyi V.S., Nazarov R.V., Arutunyan A.V.
Abstract
The purpose of this study was to determine to mean effective dosage for propofol and sevoflurane that leads to the generation of burst-suppression pattern on electroencephalogram and electrocorticogram in general anesthesia. It is established that effective dosages that cause the generation of intermittent activity on electroencephalogram exceed those for electrocorticogram. This trend is common both for sevoflurane and for propofol. Discrepancies in the dosage for general anesthetics causing the suppression of electrical activity on electroencephalogram and electrocorticogram defined the «dissociation» of recorded patterns. Simultaneous recording of electroencephalogram and electrocorticogram showed cortical burst-suppression pattern together with the continuous pattern on scalp electrodes. It is concluded that rating and systematization for suppression patterns on electroencephalogram and electrocorticogram should be built upon the common foundation, but with allowances made for technical specifics. Categorization of suppression phenomenon on electrocorticogram implies the critical amplitude to be 20 mkV, whereas for electroencephalogram it is 10 mkV. More formal proposed methods for assessment of intermittent patterns of brain electrical activity during general anesthesia are based on the specific tasks for intraoperative neuromonitoring. Excessive levels of sedation causing rough depression of electrical activity should be avoided, since they may lead to false-negative results of the neuromonitoring.
Bulletin of the Russian Military Medical Academy. 2018;64(4):79-85
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Laboratory assessment of vitamin security of military service organism in the arctic zone of the Russian Federation
Kirichenko N.N., Zakrevskiy V.V., Konovalova I.A., Smetanin A.V., Dar’ina N.I., Plkhkhotskaya Z.V.
Abstract
The content of vitamins A, E, D, C, B1, B2, B9 and B12 in plasma and serum of 156 servicemen serving in the Arctic zone of the Russian Federation in the autumn and spring periods using high-performance liquid chromatography, immunochemoluminescence, fluorimetric and spectrophotometric techniques were established. The study included men aged 18 to 25 years old, somatically healthy, the service life of at least four months from the time of the call. The military personnel are comparable in terms of physical health indicators, have received the same nutrition for a long time under the conditions of the barracks, had equivalent conditions of service and physical activity for a long period of time. In the examined servicemen, the prevalence of hidden (subclinical) forms of vitamin A, E, D, C, B1, B2 B9 and B12 deficiencies were found in both the traditional spring-summer and the epidemically dangerous autumn-winter period. The idea of the seasonal “spring” nature of vitamin deficiency has been revised - at the autumn point of the study, its prevalence was no less than in the spring, although there was indeed a spring deterioration in vitamin C and B1. It was concluded that the need for constant vitamin support for military personnel in the Arctic zone, improving the diagnosis of subclinical vitamin deficiencies, mainly due to the introduction of modern methods of laboratory diagnostics. A scheme of vitamin support is proposed by alternating the intake of a multivitamin preparation and a product enriched in vitamin C for 1 month.
Bulletin of the Russian Military Medical Academy. 2018;64(4):86-90
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Evaluation of metal-ceramic non-removable dentures, prosthetic bed and field during warranty periods
Iordanishvili A.K., Volodin A.I., Muzikin M.I., Petrov A.A.
Abstract
Using the clinical and radiological methods of investigation, the results of an assessment of the state of 287 metal-ceramic prosthetic structures were presented during the warranty period of their use in 186 people (53 men and 133 women) aged from 29 to 62 years who were made dental treatment and prophylactic institutions, located in the city (1 group of patients, 120 people) and rural areas (2 patients, 66 people) in the Krasnodar Territory of various forms of ownership. When assessing the condition of denture prosthesis, prosthetic bed and field, inflammatory changes in the periodontium, mobility and inflammation of the pulp of supporting teeth, recession of the gum, pressure ulcers in the region of the body of the bridge, contact between the prosthesis and antagonizing teeth in the central occlusion or overstrain of the occlusion in several units of dental prostheses structures, the presence of a large washing space in the area of the body of the bridge in the front sections of the dentition rows of the jaws, fracture castings, chips ics, chronic periapical foci of odontogenic infection of teeth under single, welded or supporting artificial crowns, as well as cementing of structures and the presence of hypersensitivity of teeth under artificial crowns. The frequency of occurrence of defects in dentures and complications of prosthetics, which were more often detected in persons who were prosthetically tested in health facilities, was determined, regardless of the form of their property located in rural areas. It is shown that at the moment many of the possible complaints and complaints of patients, in connection with the manufacture of metal-ceramic dentures, can prove to be justified. It is concluded that the introduction of internal quality control of medical care in all dental hospitals, clinics and offices, regardless of their territorial location and form of ownership, is a requirement of the time.
Bulletin of the Russian Military Medical Academy. 2018;64(4):91-95
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Influence polymorphism of genes interleukin-10 (1082G/A; rs1800896) and tumor necrosis factor-α (308G/A; rs1800629) on risks of developing adverse clinical forms of community-acquired pneumonia in young men
Gayvoronskiy I.N., Khalimov Y.S., Koliubaeva S.N., Karimova A.M., Rubtsov Y.E.
Abstract
The influence of the structural polymorphism of the interleukin-10 genes (1082G/A; rs1800896) and tumor necrosis factor-α (308G/A; rs1800629) on the risk of adverse clinical forms of community-acquired pneumonia in young men has been evaluated. In patients with community-acquired pneumonia in young men, the GG genotype of the gene for interleukin-10 (1082G/A; rs1800896) and the AA and AG genotypes of the tumor necrosis factor-α gene (308G/A; rs1800629) have been found to be associated with a severe and prolonged course of this diseases. AA and AG genotypes of the tumor necrosis factor-α gene (308G/A; rs1800629) are associated with the complicated course of community-acquired pneumonia in young people. It was revealed that in young men, in the presence of the GG genotype of the interleukin-10 gene (1082G/A; rs1800896), the relative risk of developing severe disease increases by 3,2 times and the risk of developing long-term community- acquired pneumonia increases by 2,7 times. If young patients suffering from community-acquired pneumonia, AA or AG, have the genotype of the tumor necrosis factor-α gene (308G/A; rs1800629), the relative risk of developing severe course increases by 3,3 times, prolonged course - by 2,6 times, and complicated course - 1,9 times. The results of the study should be used in the diagnosis of community-acquired pneumonia in order to predict the development of adverse clinical forms. Interleukin-10 gene polymorphism (1082G/A; rs1800896) and tumor necrosis factor-α (308G/A; rs1800629) are individual typological features of a person, the verification of which is relevant for use in the diagnosis of community-acquired pneumonia in young people to predict development adverse clinical forms of the disease.
Bulletin of the Russian Military Medical Academy. 2018;64(4):96-100
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Paresthesia of mucosae membranes of an oral cavity against the background of taking inhaled hormonal drugs
Kazarina L.N., Chuvarkova I.M.
Abstract
Bronchial asthma draws the attention of increasing number of doctors worldwide. The prevalence of this disease is from 4 to 10%. Nowadays basic medicines for treatment and control of bronchial asthma are inhalation hormonal drugs which are taken daily and for a long time, often the whole life of a patient. According to numerous literary data, this drug group owing to a way of their introduction causes a series of complications in an oral cavity. The most frequent of them are the oropharyngeal candidiasis, a dysphonia and paresthesia of a mucosa of a mouth. Above-mentioned complications are directly bound to the existence of a dysbiosis of a mouth that contributes to the development of an immune failure and sensitivity to organism microbial antigens. It was established, that patients with bronchial asthma of medium-weight severity with various experience of intake of inhalation hormonal drugs were examined highly often complaint to dryness, a burning sensation not only in an oral cavity, but also in the field of a larynx and a pharynx, on a food faddism, pain at meal, on availability of scurf of white color on various sites of a mucosa of an oral cavity. There were not only existence of characteristic symptoms of these diseases, but also depression of the immunologic status and change of a microbial landscape of an oral cavity at the patients with bronchial asthma taking the inhalation hormonal drugs. The above confirms the fact of obligatory detailed studying of implications in an oral cavity at the patients with bronchial asthma taking the inhalation hormonal drugs and the related complications, their nature, and further development of a rational way of the etiopathogenetic scheme of treatment and also their prevention.
Bulletin of the Russian Military Medical Academy. 2018;64(4):101-105
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The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement
Samokhvalov I.M., Golovko K.P., Denisov A.V., Telitsky S.Y., Zhirnova N.A., Komiagin S.E., Karpenko O.D., Demchenko K.N., Barakov Y.D., Stepanov A.Y.
Abstract
Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.
Bulletin of the Russian Military Medical Academy. 2018;64(4):106-112
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Taxonomic and applied value of profiles utilization of protein amino acids of bacteria Acinetobacterbaumannii, Acinetobacterpittii, Acinetobacternosocomialis
Sivolodskii E.P., Zueva E.V.
Abstract
The profiles of utilization of 20 protein amino acids 118 strains of A. baumannii, 9 strains of A. pitti, 7 strains of A. nosocomial were studied. Utilization of amino acids was determined on a minimum salt agar with an amino acid as the only source of nitrogen and carbon. Species identification of acinetobacters was carried out by matrix-activated laser desorption/ionization with time-of-flight mass spectrometry with a database of Biotyper (by BrukerDaltonics Inc. Germany.) At A. baumannii was identified 14 profiles utilization of protein amino acids, of which the first 6 profiles included 87,3% of the strains. For the first time, a wide spread of A. baumannii strains that do not utilize L-histidine - 56 (47,4%) strains was established. Signs of utilization of L-histidine (His+) or lack of utilization (His-) persist steadily in repeated strains isolated from patients. It is proposed to subdivide all the strains of A. baumannii for two trophies: the «histidine-negative trophy (His-)», which does not utilize L-histidine as the sole source of nitrogen and carbon, and the «histidine-positive trophy (His+)», which utilize it, which will be useful for epidemiological surveillance. In bacteria, A. pittii and A. nosocomial are installed close phenotypic similarity with A. baumannii at the profiles of utilization of amino acids, which proves the validity of combining these species in a complex of A. calcoaceticus-A. baumannii. Bacteria of the species A. pittii and A. nosocomial has no«histidine-negative trophy (His-)», that distinguishes them from A. baumannii.
Bulletin of the Russian Military Medical Academy. 2018;64(4):113-116
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Experimental model of oxidative stress in chronic disruption of free radical balance in the biological system: polymyositis of the Wagner-Unverricht form
Listov M.V., Mamykin A.I.
Abstract
Based on the analysis of simulation results of Wagner-Unverricht form polymyositis on mice of DBA/2 line, theoretical and experimental models of oxidative stress in the biological system were compared. It is shown that oxidative stress develops when the balance between the intake of free radicals and the effectiveness of the antioxidant system of the body is impaired. The main role for maintaining radical balance in the biosystem belongs to reversible electron transport through the plasma membrane during the interaction of the free radical flow with the active centres of the cell membrane. The electromagnetic nature of this interaction is underlined. The possible electrical structure of the active centre of the plasma membrane, based on the physicochemical laws of adsorption of electrically charged particles on the surface of liquid crystals, is presented and discussed in detail. The possibility of ion transport through the active centre in its interaction with the free radical is shown. It is noted that the electron transfer through the cell membrane provides the energy necessary for the non- spontaneous reverse transfer of ions in the energy-dependent component of the thermodynamic process that can form the action potential. The presence of irreversible interactions of the free radical flux with the bilipid layer of the plasma membrane in the places of defects of the liquid crystal structure is shown, which leads to the development of destructive changes. It is noted that the hypothesis of the electromagnetic nature of neurohumoral regulation presented in the paper can serve as a basis for further studies of discrete energy effects on the reflex and automatic activity of neurons, including the understanding of the mechanisms of the trigger of automatic processes in glia neurons, up to large neurons of the cerebral cortex, affecting the activity of the Central nervous system and the whole biosystem.
Bulletin of the Russian Military Medical Academy. 2018;64(4):117-122
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Possibilities of biological control of extracorporeal photochemotherapy
Manuilov A.S., Kudryavtsev I.V., Serebriakova M.K., Trulev A.S., Bardakov S.N., Apchel A.V., Belskih A.N., Zakharov M.V., Tishko V.V., Sokolov A.A., Vasylieva I.A.
Abstract
The results of the determination of levels of apoptosis in vitro in lymphocytes during the procedures of extracorporeal photochemotherapy (extracorporeal photopheresis) using flow cytometry are described. It was found that carrying out extracorporeal photopheresis does not have a significant effect on the viability of cells immediately after the procedures. Thus, the relative content of living cells in the samples after isolation of the mononuclear fraction of peripheral blood did not differ from both samples prepared for photopheresis and samples after this procedure. It should be noted that carrying out extracorporeal photopheresis does not lead to rapid cell death. At the same time, the level of living lymphocytes at the beginning of the experiment averaged about 90%, while the protocol used to extract the mononuclear fraction of peripheral blood cells and further manipulations with them in vitro allowed increasing the percentage of living cells in the samples to90% or more. An increase in the level of cells in the early stages of apoptosis occurs already in the first day after the beginning of the experiment, which is confirmed by the data of other researchers indicating that there are significant differences in the viability of cells with an initial point in the interval of 20-24 h in vitro incubation. The launch of the processes of programmed cell death in the case of own experiments was not related to the preparation of samples for extracorporeal photopheresis (as evidenced by the absence of significant differences between freshly isolated lymphocytes and samples prepared for the procedure), but with the procedure of photopheresis itself.
Bulletin of the Russian Military Medical Academy. 2018;64(4):123-130
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The analysis of prosthetic and orthopedic factories production in the branch of lower extremities prothesis with possibilities of import substitution
Scherbina K.K., Suslyaev V.G., Golubeva Y.B., Sokurov A.V., Ermolenko T.V., Yankovskiy V.M.
Abstract
The needs and possibilities of import substitution in the prosthetic and orthopedic industry for prosthetics and orthotics of lower limbs from local and imported component materials were determined. We analyzed the stock list of special equipment, materials, and modules used in the manufacture of prostheses and orthoses of the lower limbs, indicating local and foreign suppliers. The technical characteristics of equipment, materials, and modules of lower limb prostheses that are not manufactured in the Russian Federation were determined. We indicated the stock list, components, equipment, and materials, which production is more reasonable to be organized in Russia instead of using imported products of similar purpose. We carried out operational tests and clinical trials of prosthetic and orthopedic products that were made from new thermoplastic materials. These materials are developed by local manufacturers for the production of a bucket of the prosthesis for lower and upper limbs, orthoses and orthopedic devices, actively correcting braces, stop holders, etc. We indicated the ways of implementing the state policy to eliminate reliance of local prosthetic and orthopedic industry on import. Proposals for the optimization of reference documentation were developed. The role and position of research organizations that solve the problems of import substitution and that focus on the creation of new and improvement of existing technologies of physical medical rehabilitation of patients with muscle-skeleton disorders were defined. We determined the importance of institutions of advanced training for doctors and other specialists who work in prosthetic and orthopedic enterprises and rehabilitation centers.
Bulletin of the Russian Military Medical Academy. 2018;64(4):131-137
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Evaluation of the opportunity of conservation of plasma and blood serum by freezing for the following investigation of vitamins content
Kirichenko N.N., Zakrevskiy V.V., Smetanin A.L., Konovalova I.A., Martynova Y.S., Lazarenko L.P.
Abstract
The possibility of freezing samples of human plasma and serum at minus 18°C for subsequent research on the content of vitamins has been experimentally proved. Plasma and serum samples of 40 military personnel were examined on the day of blood collection (without freezing) and then compared with the results of the analysis of the same samples that were frozen at minus 18°C after 7, 60 and 120 days of storage. We used the method of simple freezing of plasma and serum samples in the freezer at a temperature of minus 18°C for a period of not more than 120 min after blood collection. Defrosting after storage was carried out passively at room temperature. The content of folic acid, vitamins B1, B2, B12, C, A, D, E wasstudied using high-performance liquid chromatography, immunochemoluminescence, fluorimetric and spectrophotometricmethods. According to the results of the statistical comparison of the content of the studied vitamins in fresh and frozenplasma and serum samples, the absence of significant differences between the samples was established; the deviation from theinitial values did not exceed 1-2% on average. The proposed method of preserving samples of human plasma and serum byfreezing at a temperature of minus 18°C can be used to analyze the content of vitamins in frozen samples, without the use ofcorrection factors. Initially, the technique was tested to organize the study of the vitamin security of military personnel servingin the Arctic zone of the Russian Federation. The practical significance of the study is to offer a convenient and affordablemethod of preserving plasma and serum samples for transportation in frozen form from remote areas, where the laboratorypossibilities of studying the content of vitamins in the blood for therapeutic and prophylactic purposes are limited. Frozensamples are convenient for storage up to 12 days when their immediate laboratory research is impossible.
Bulletin of the Russian Military Medical Academy. 2018;64(4):138-141
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Experience of organizational-methodological and practical work doctors groups gain military medical units and organizations of the Ministry of defence of the Russian Federation
Zhdanov K.V., Sidorchuk S.N., Zakharenko S.M., Potekhin I.V.
Abstract
The epidemiological situation for acute respiratory diseases, chickenpox, meningococcal infection in the garrisons, as well as in the whole regions of Russia, is unstable. Group and flash morbidity are registered, which determines the relevance of this pathology. Diseases of the X class occupy a leading position in the structure of the overall morbidity, both among conscripts and contract soldiers. The prevalence of infectious diseases in the structure of morbidity of servicemen of the armed forces of the Russian Federation is due to the combined effect of factors of communal and domestic arrangement and military labor. The article summarizes the experience of organizational, methodological and practical work of doctors- specialists of strengthening the staff of the Department of infectious diseases of the Military Medical Academy. S.M. Kirov in the organization of medical-evacuation support of patients with infectious diseases in military units (training centers) and military medical organizations of the military districts (Northern Fleet) in the context of daily activities of troops (forces) in the period of the seasonal rise of morbidity. The problematic issues of the organization of medical and evacuation support of infectious patients, the task of improving the level of work as a medical service (especially pre-hospital level) and doctors- specialists strengthening groups to prevent the spread of infectious diseases among the personnel. It is established that the level of General morbidity increased during the analyzed period, mainly due to respiratory diseases. In the structure of infectious diseases, the most relevant are adenovirus diseases, chickenpox, meningococcal infection. Currently, in the military units (training centers) of the armed forces of the Russian Federation, there is no single guide (position) for the organization of additional (non-standard) insulator. The order of actions of commanders (chiefs) on the organization of its deployment and functioning is not defined.
Bulletin of the Russian Military Medical Academy. 2018;64(4):142-148
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Future developments and advances in disinfectants and application modes for use in departments, military units and medical facilities in a climate of the Arctic and Extreme North
Ivanov A.A., Seleznev A.B., Komissarov N.V., Ivchenko E.V., Yudin A.B., Musaev A.A., Prigorelov O.G.
Abstract
There were performed test and development review concerning disinfection procedures in a climate of the Arctic and Extreme North, an assessment of their sophistication, and determination of possible ways to enhancement of efficiency. It was found that long-term low temperatures, geographical distance and hard-to-reach territories, weak natural self-regeneration mechanism of biocenosis, development of human hypersensitivity to infectious agents, congestion of personnel at camping and operation places define the urgency of creation of modern chemical and technical disinfectants which are effective in the north. The basic requirements to these disinfectants were formulated. Thus, process chemical solutions should not become frozen over a period that biocide effect takes; disinfectants to use in human presence should meet the operational criteria for sealable inhabited objects. Engineering tools should be equipped with productive snowmelters, heat-insulated rooms, all-terrain running gear, liquid fuel -powered cauldrons, heaters, electric power station. Promising directions of new disinfectants advancing and development were determined. It’s necessary to study infectious and parasitic morbidity in the Arctic and Extreme North, the causes and conditions governing its structure and dynamics, specificity of epidemic process. The establishment of special climate chambers with variable capacities for materials and goods disinfection mode development, including the use of engineering tools; it is essential to choose or develop the study methods of arctic climatic factors influence on test microorganisms, operating procedure behavior of disinfection, worked objects’ properties. The studies of microbial contamination specifics seemed perspective, both in the environment and within inhabited objects, under long-term exposure of low temperatures; the search of biocidic technologies and factors for making disinfectants, modes and methods of application; substantiation of disinfection procedures tactics. Instructional and methodological base preparing will allow to perform perspective studies and disinfection procedures in a climate of the Arctic and Extreme North in accordance with contemporary requirements.
Bulletin of the Russian Military Medical Academy. 2018;64(4):149-155
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Systemic and morphological method of scheduling of medical support of troops (forces) and the population at elimination of medical and sanitary consequences of emergency situations by forces and means of Medical service of the Armed Forces of the Russian Federation
Lemeshkin R.N., Savchenko I.F., Blinov V.A., Zhukov A.A., Sidorov D.A., Chekhovskikh Y.S., Dmitriyev G.V.
Abstract
The technique of the systemic-morphological analysis allowing to create alternative decisions is provided. Options of medical support of troops (forces) and the population in case of elimination of medical and sanitary consequences of emergency situations of natural, technogenic and social character are developed: «Departmental», «Interdepartmental»,«International». Concerning each option, nine indices (criteria) are offered: legal regulation; controllability system; complexity of the organization of system; resource (material) cost intensity; personnel security; adequacy of medical care; efficiency; experience and innovations; self-sufficiency of actions. For the production of computation and a choice of the most rational option of planning of system the original dialogue program system of «MPRIORITY 1.0» (MY PRIORITY) realizing a method of the analysis of hierarchies by repetitions (iterations) is used. The results characterizing each of the considered alternative options with the replying weight priority are received and their preference is defined. During the first iteration priorities for the system of indices and criteria, characteristic of achievement of result with emphasis on normative legal regulation of activities with the organization structure and management system were defined. In the second - priorities for the system of indices and criteria with emphasis on the organization of delivery of healthcare with the existing system of material support, medical supply and also an adequate level of training of medical frames were changed. Results were subjected system to the analysis and sentences are developed for health service of the Armed Forces of the Russian Federation, in particular for Service of medicine of catastrophes the Russian Defense Ministry, on the organization of system of medical support of troops (forces) and the population in case of elimination of medical and sanitary consequences of emergency situations of natural, technogenic and social character.
Bulletin of the Russian Military Medical Academy. 2018;64(4):156-163
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Possibilities of using endovascular methods of treatment of patients with critical limb ischemia in regional vascular centers
Movchan K.N., Suhov V.K., Artyushin B.S., Shlojdo E.A., Shlomin V.V., Levina A.A.
Abstract
General information about the activity of specialists of the regional vascular centers of St. Petersburg in 2011-2015 is presented. and on the private results of the work of the staff of the center of one of the city’s multidisciplinary hospitals with an assessment of the data on the cases of treatment of 403 patients with critical limb ischemia against the background of arterial lesions of atherosclerosis. Four groups of patients were identified: 278 patients who underwent open reconstruction of the arteries of the lower extremities; 51, who underwent endovascular revascularization; 15, who underwent hybrid surgical interventions. Revascularization was not performed in 55 patients. Among the open operations, loop endarterectomy from the aortoiliac and femoral-popliteal segments (190) and shunting arterial reconstructions (45) prevailed. In endovascular interventions, femoral-popliteal-tibial segments were predominantly corrected - 37 cases. Hybrid operations in 100% of cases are performed through accesses through the femoral arteries. In case of refusal of reconstruction due to the absence of an anatomic substrate for the reconstruction of the vessels, primary amputation of the lower limb (15), lumbar sympathectomy (14) were performed. In 30 cases, angiotropic therapy was performed. Complications of open surgical interventions in the early postoperative period were revealed in 21,6%, endovascular - in 15% of cases, hybrid operations were noted in 13,3% (in total91 complications in 70 patients). Thrombosis of the vascular reconstruction area (35%) and inadequacy of perfusion of limb tissues in permeable vessels (19,7%) prevailed in the structure of complications. There were no lethal outcomes. In general, the use of endovascular and hybrid reconstructions of the vascular bed in specialized divisions of medical organizations in patients with critical limb ischemia with multifocal atherosclerosis contributes to a significant reduction in the frequency of negative consequences of surgical revascularization of the lower extremities.
Bulletin of the Russian Military Medical Academy. 2018;64(4):164-168
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Odontogenic maxillary sinusitis: current state of the problem
Dvoryanchikov V.V., Grebnev G.A., Isachenko V.S., Shafigullin A.V.
Abstract
Odontogenic maxillary sinusitis is a problem that is at the junction of two specialities: otorhinolaryngology and dentistry. According to domestic and foreign authors in the structure of dental diseases, odontogenic maxillary sinusitis is6-24%. According to doctors-otorhinolaryngologists among all types of sinusitis about 40% is odontogenic maxillary sinusitis. Currently, there is a gradual increase in the number of odontogenic maxillary sinusitis. This is due to the improved diagnosis of this pathology. The use of dental computed tomography usually allows establishing reliably the cause of odontogenic maxillary sinusitis. Unsatisfactory results of treatment of some dental diseases, the increase in the number of odontogenic maxillary sinusitis determines the relevance of the study. The problem of odontogenic maxillary sinusitis is considered, modern views on the aetiology, pathogenesis, clinic, diagnosis and treatment according to domestic and foreign authors, as well as some issues of the relationship of pathology of intraosseous structures and the course of odontogenic maxillary sinusitis, the principles of an interdisciplinary approach in the treatment of odontogenic maxillary sinusitis are presented. The search for new methods of treatment of odontogenic maxillary sinusitis is dictated by some differences in clinical manifestations of odontogenic sinusitis from rhinogenic. The approach based on the joint primary examination and treatment of patients with suspected odontogenic maxillary sinusitis by an otorhinolaryngologist and maxillofacial surgeon, as well as the development of further tactics for the management of this category of patients, is, in our opinion, promising. The use of modern methods of functional endoscopic surgery is an effective means of prevention and treatment of odontogenic maxillary sinusitis, as it is a minimally invasive technique that allows you to create conditions for further rational prosthetics of the oral cavity.
Bulletin of the Russian Military Medical Academy. 2018;64(4):169-173
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Development of medical care for the wounded, sick and injured in military conflicts of the past and present
Kul’nev S.V., Kotiv B.N., Kriuchkov O.A., Mavrenkov E.M.
Abstract
The reflects the process of formation and development of medical care systems for the wounded, sick and injured in military conflicts, from ancient times to the present. The following issues are covered: the organization of treatment of the wounded and sick and their evacuation in the armies of ancient Greece, the Roman Empire, the European armies of the Middle Ages and the Renaissance, the Moscow State, the Russian Empire, the USSR and the Russian Federation. The main factors that influence the approaches to the organization of medical support for troops (forces) in wars of the past and the present are revealed, namely: dependence on the specific conditions of the combat situation and methods of conducting combat operations; from the views of the military and political leadership on the role and place of medical service in the army; on the level of development of weapons and military equipment; on the availability of ways and means of medical evacuation; on the level of development of medical science and technology. The contribution of domestic scientists to the improvement of the medical support system for the troops (forces) was noted: the creation of V.А. Oppel theory of staged treatment of the wounded and its final design under the guidance of E.I. Smirnov (1941-1945) as a system of staged treatment of the wounded with evacuation for the intended purpose. Based on the experience of medical support of troops (forces) in the course of military conflicts of the late XX early XXI centuries. Revealed modern trends in the development of this system in the modern army of Russia. It was concluded that the systems for treating the wounded «on the spot», the drainage system, the scattering system of the wounded and sick, and the system of staged treatment with evacuation for the intended purpose can exist in parallel and be used depending on the specific conditions of the combat situation.
Bulletin of the Russian Military Medical Academy. 2018;64(4):174-180
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Methodological approaches to estimation of indicators of marine operators in progressing of medical and physiological researches
Rogovanov D.Y., Chernikov O.G., Hankevich Y.R., Bloschinskiy I.A.
Abstract
Анализ причин происшествий на транспорте и объектах энергетики показывает, что основным их источником является человек. Так, оператор является источником от 70 до 80% нештатных ситуаций на атомных станциях и до 90% на воздушном и морском транспорте. Профессиональная деятельность человека сопровождается ответной реакцией его психических и физиологических функций, которая отражает процессы адаптации к реальному или ожидаемому воздействию рабочей нагрузки, факторов окружающей среды, эмоциональных переживаний, а также характеризует остаточные процессы после этих взаимодействий. Всё это свидетельствует о необходимости обеспечения требуемой функциональной надежности человека в системе«человек - машина - среда», под которой в физиологии труда принято понимать динамическую компоненту, отражающую устойчивость и резервные возможности функциональных систем человека по обеспечению его высокой работоспособности как в обычных, так и в экстремальных условиях.В последние годы при оценке функциональной надёжности значительное внимание уделяется использованию в медико-физиологических исследованиях интегральных показателей. Одними из них являются суммарный обобщённый интегральный показатель и обобщенный логарифмический показатель. Предлагается вариант адаптации нормирования данных интегральных показателей с учетом дисперсий, создаваемых учитываемыми параметрами группы исследуемых лиц, находящихся в тех же условиях, что и сам обследуемый, и формирующих те же приспособительные реакции. Адаптированная таким образом методика расчёта интегральных показателей может быть применена для мониторинга работоспособности и процессов адаптации операторов морской техники в ходе моделирования профессиональной деятельности на тренажерах при условии, что оцениваемые параметры должны иметь количественное исчисление, нормальное или близкое к нему распределение.
Bulletin of the Russian Military Medical Academy. 2018;64(4):181-185
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Meningococcal infection: clinical and epidemiological characteristics in modern conditions
Sharabkhanov V.V., Zhdanov K.V., Zakharenko S.M., L’vov N.I., Kozlov K.V., Lyashenko Y.I., Ivanov K.S., Bulankov Y.I., Yaremenko M.V.
Abstract
The problems of the incidence of meningococcal disease and the epidemiological situation in the world, in the Russian Federation and in the Armed Forces are consecrated. In the past decade, there has been a global decline in the incidence of meningococcal disease, but there is still the possibility of new outbreaks and epidemics. From 1996 to 2016, a decrease in the incidence of meningococcal disease was also noted in Russia. In certain regions of the Russian Federation, an increase in incidence was recorded, which did not affect the general trend. Against this background, the idea was formed that in the coming years, thanks to a favorable epidemiological situation and the possibility of preventing meningococcal infection with the help of a vaccine, it is possible to achieve control of this infection. However, meningococcus showed all the classic properties of variability and fitness. Changes in the structure of circulating serogroups of meningococcus led to the formation of a non-immune layer of the population in the face of increasing pathogenicity of the dominant serogroups. The activity of the epidemic process is indirectly indicated by the high diversity of genetic and serological clonal complexes, serogroups and serotypes of the pathogen. The incidence of meningococcal disease over the past ten years in the Armed Forces of the Russian Federation can be assessed as low, but mortality has high values. The peak incidence was in 2010, but the maximum percentage of mortality was in 2017-18,2%. The increase in mortality from invasive forms of meningococcal infection, on the one hand, is associated with an increase in the total number of sources of this infection, on the other hand, with errors in early diagnosis and, as a consequence, in the incorrect provision of emergency care at the prehospital stage, which recur from year to year and are of a similar nature.
Bulletin of the Russian Military Medical Academy. 2018;64(4):186-191
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Regenerative properties of human extraembryonal organs in tissue engineering
Kalyuzhnaya L.I., Kharkevich O.N., Schmidt A.A., Protasov O.V.
Abstract
The characteristics of the umbilical cord extracellular matrix are discussed relatively of their potential use for tissue engineering. The purpose of this review is to assess the current knowledge about using of homologous biomaterials with regenerative properties to create bioengineered structures. One of the most important components of tissue engineering - matrix (scaffold), resident cells can migrate, attach to it and function. Due to their structure, matrices should be easily integrated into the patient’s tissue and provide conditions for cell growth and differentiation. The cells that populate the matrix in the bioreactor before the transplantation of this construction, or resident cells recruited into the transplanted extracellular matrix), and cell- matrix interactions are absolutely necessary components of tissue engineering. Available commercial bioengineering products made from mammalian tissues have certain advantages and significant disadvantages due to the risks of immunological reactions and transmission of infectious agents. The transplantation of products from xenogenic materials is prohibited by law in the Russian Federation. The donor material is limited, receipt of human cadaver material requires a long period of legal registration, which has a detrimental effect on the biomaterial. Therefore, finding a suitable homologous biomaterial is ongoing. Due to the peculiarities of the embryonic phenotype, extraembryonic tissues have special biological properties, one of which is the scarless healing of wounds. Low immunogenicity, optimal mechanical properties of extracellular matrix, presence of cell adhesion molecules and growth factors promoting regeneration provide anti-inflammatory, anti-fibrotic, anti- scarring properties for tissue engineering structures from umbilical cord and amniotic membrane. Umbilical cord and amnion due to the availability and non-invasiveness of obtaining from healthy young donors are an excellent source of homologous biomaterial for extracting matrices, cells and hydrogels for tissue engineering and regenerative medicine.
Bulletin of the Russian Military Medical Academy. 2018;64(4):192-198
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Formation history and problems of the system of resistance to human immunodeficiency virus infection in the Armed forces of the Russian Federation
Bulankov Y.I., Bulygin M.A., Zhdanov K.V., Kozlov K.V., Lyashenko Y.I., Ivanov K.S., Orlova E.S.
Abstract
Infection rates of human immunodeficiency virus in Army forces have a clear structure divided into stages. Each stage characterized by objective socio-economic, political, epidemical prerequisites, which reflected conditions of epidemic developing, activeness of mechanisms and transmission factor, structure and possibilities of a protective system against infection in country and army. There are three stages of epidemic development. The first stage - infiltration (invasion), 1987 - 1995 years. The common feature this period of developing and functioning counteraction system against infection, produced by human immunodeficiency virus, and acquired immune deficiency syndrome in our country is «recognition by the state of the growing threat of the epidemic spread of infection caused by the human immunodeficiency virus in the absence of a real epidemic and limited material resources». The second period - epidemical infection spreading, produced by human immunodeficiency virus, 1995-2003 years. Significant efforts of counteraction system against infection, produced by human immunodeficiency, and acquired immune deficiency syndrome in the army was concentrated on improving diagnostic and approximation of the possibilities of military-medical expertise to the places where patients are identified. The third period - generalized - in the last2004 year to current period. Stabilization indicators identifying soldiers, infected by human immunodeficiency, archived as a result of barrier preventive measures (examination at the stage of conscription to the Armed Forces) are not accompanied by methodological and regulatory changes that have occurred in civilian health care, which contributes to negative trends in the later detection of the disease. So, the current system of medical help for soldiers, infected by human immunodeficiency, does not provide medical help enough, regulated by the governing documents of the Department of Health of the Russian Federation and state medical standards.
Bulletin of the Russian Military Medical Academy. 2018;64(4):199-207
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The contribution of the faculty of Departments S.M. Kirov’s Military-medical academy into the limitation the consequences of Chernobyl nuclear power plant acciden
Kuznetsov S.M., Petreev I.V., Terentev L.P., Tsvetkov S.V.
Abstract
There is information about the business of professorial and teachers’ faculty of the Department of naval and radiation hygiene and the Department of General and Military hygiene S.M. Kirov’s Military-medical academy into a limitation of consequences the most enormous radiation emergency, which happened on 26 of April 1986, on Chernobyl nuclear power plant. A significant part of the participants in the liquidation of the accident were servicemen, the cause of that military-medical service took the direct part in the implementation of preventive measures. A set of activities for the health protection liquidators and residents of settlements, placed on the contaminated areas allowed to significantly reduce the radiation exposure from external and internal radiation. The basis for the prevention of both acute lesions and long-term consequences was the maximum permissible level of the planned emergency radiation of 25 Rem. The entire faculty of the Department of Naval and Radiation Hygiene and a number of employees of the Department of General and Military Hygiene, who on a rotational basis were continuously in the zone of work to eliminate the consequences of the accident, went through the mill of Chernobyl. Their personal contribution to the solution of urgent scientific and applied problems of minimization of radiation impact and preservation of the health of servicemen-liquidators of the accident were noted.
Bulletin of the Russian Military Medical Academy. 2018;64(4):208-213
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The modern characteristic of biology and diagnostics prospect M. tuberculosis
Moskalev A.V., Sboychakov V.B., Apchel A.V., Cygan V.N.
Abstract
Features of biology M. tuberculosis are considered the including modern data about features of morphology, the antigen structures of the various nature defining virulence of activators of tuberculosis. Based on the method data spoligothipirovanie genetic distinctions of families Mycobacteriaceae, and among them strains genotype Beijing, different by wide prevalence in the Russian Federation and high medicinal stability are especially characterised. Based on difficult antigens structure M. tuberculosis features of the development of the immune answer which allow predicting a current of the infectious process are reflected. The presented characteristics reflect considerable heterogeneity strains M. tuberculosis which is combined with a variety of an immune homeostasis of the carriers which were ill and by that essentially complicates laboratory diagnostics of tuberculosis. Among the considered modern methods of diagnostics of a tubercular infection, the most perspective can be immunologic. One of the ways of improvement serodiagnostic the tests promoting an increase of sensitivity serodiagnostic of tuberculosis is creation polyepitopes chimeric antigens by chemical synapsis fibres with carbohydrate molecules. Creation of a composition from several immunodominant antigens M. tuberculosis can become other direction of increase of sensitivity. that will allow lowering considerably number false-positive results. Creation of hybrid fibers will allow avoiding an inevitable decrease in affinity of antibodies of the way of the blood, arising at the use of several antigens simultaneously.
Bulletin of the Russian Military Medical Academy. 2018;64(4):214-222
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The modern view on сomplex diagnostics of the liquorrhea
Subkhanov K.S., Alekseev D.E., Cherebillo V.Y., Svistov D.V., Abdulkerimov K.T., Konovalov P.P., Glukhaniyk V.D.
Abstract
A modern approach to the complex diagnosis of liquorrhea, both transcranial and nasal, is considered. The terminology and the most common and used variants of classification of liquorrhea are given. An epidemiology and causes of liquorrhea according to the modern literature are described. The history of the study of cerebrospinal fluid and various methods of its study are briefly presented. Special attention is paid to the review of modern methods of diagnosis of liquorrhea which were described in the literature. Both simple samples of «halo-test» and «handkerchief» and high-tech endoscopic methods of visual diagnostics are considered. The data of various authors on the effectiveness of intrathecal administration of fluorescein, indigocarmin and other dyes is presented, their shortcomings are noted. The methods of laboratory diagnosis of liquorrhea by determining the level of glucose, protein and specific for cerebrospinal fluid biomarkers β -transferrin and β-TP are described. The role of neuroimaging methods of examination, such as multispiral computer tomography, cisternography, magnetic resonance imaging and radionuclide studies, in the diagnosis of liquorrhea was determined. Based on the analysis of the literature data and their own experience, the authors present an improved algorithm of complex diagnosis of liquorrhea, including the collection of complaints and anamnesis of the disease, general laboratory diagnostic complex, objective examination (including rhinoscopy), consultations by other specialists, bedside methods of diagnosis of liquorrhea, laboratory methods of verification of cerebrospinal fluid and radiation diagnostic techniques.
Bulletin of the Russian Military Medical Academy. 2018;64(4):223-226
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The use of telemedicine in the organization and provision of medical care to patients in critical conditions
Goncharov S.F., Fisun A.Y., Schegolev A.V., Baranova N.N., Shilkin I.P., Bobiy B.V., Shustrov V.V.
Abstract
Organizational issues of the interdepartmental application of telemedicine technologies in the provision of medical care to patients are considered. The most significant provisions of the concept of interdepartmental application of telemedicine technologies in the organization and provision of medical care to patients in critical conditions are presented. In addition, data on telemedicine consultations on federal districts of the Russian Federation performed by the federal level of health care in 2017 are shown, the frequency of emergency telemedicine consultations is revealed depending on the disease profile of patients or the specialty of a consulting physician. Prospects for the further introduction of telemedicine technologies into daily practical activities and the possibility of their adaptation to crisis situations and military conflicts are substantiated. It has been established that in various natural disasters, accidents, catastrophes, terrorist acts and during military conflicts with a large number of victims, successful organization of medical care and medical evacuation is possible only when combined with the efforts of the Ministry of Health, the Ministry of Defense, the Ministry of internal affairs and the Ministry of the Russian Federation for Civil Defence, Emergencies and Elimination of Consequences of Natural Disasters. Thus, the adequate development of telemedicine systems will increase the level of their rational and effective interdepartmental use for the benefit of saving people as Russia’s human capital.
Bulletin of the Russian Military Medical Academy. 2018;64(4):227-231
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Evolution of gastrostomy in palliative medicine
Gavshchuk M.V., Gostimsky A.V., Zavyalova A.N., Barsukova I.M., Karpatsky I.V., Lisovsky O.V., Gostimsky I.A.
Abstract
The article analyzes the world experience in methods of applying of stomach nutritional fistula. Different methods of gastrostomy are described, their classification is given. The advantages and disadvantages of common surgeries are outlined. The most often used traditional surgeries are: gastrostomy by Stamm, Topver and tubular gastrostomy. Complication rate of these operations led to a further search for minimally invasive techniques: percutaneous puncture, laparoscopic gastrostomy, and laparoscopically- assisted percutaneous endoscopic gastrostomy. A significant disadvantage of minimally invasive puncture techniques is the need to purchase relatively expensive disposable sets for primary installation and replaceable low profile tubes. The cost of these supplies in Russia is much higher than the money allocated in the obligate medical insurance system, which makes the method economically unprofitable for medical institutions and patients. Partially, the costs could be reduced by the use, as a gastrostomy tube, a Foley urinary catheter. There are several studies that have confirmed economic advantages and absence of a reliable difference in the number of complications and duration of use such tubes. However, some complications are reported: migration of catheter into the duodenum with the development of obstruction, decreased comfort and quality of life. The conducted study showed absence of classification of gastrostomy types and their complications. The final consensus in clinical use of different types of gastrostomy in different situations is absent. There is a tendency to decrease rate of traditional laparotomical operations in favor of less invasive interventions making it difficult for adequate analyzing. In cases with need for revision, biopsy and fundoplication, laparoscopic or laparoscopically-assisted percutaneous endoscopic gastrostomies are preferred which has proven itself in children. For a group of palliative patients of elderly age with high risk and doubtful prognosis, minimally invasive puncture gastrostomes are more appropriate.
Bulletin of the Russian Military Medical Academy. 2018;64(4):232-236
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Tolerance in young people in the tuition in an educational institution
Uliukin I.M., Berezovskii A.V., Bolekhan V.N., Orlova E.S.
Abstract
Аbstract. The issues of tolerance in young people in the process of learning in an educational institution are analyzed. At present, representatives of different cultural traditions, principles of life are forced to share one geographical space. This rapprochement, as real experience shows, does not always proceed peacefully and calmly. Interethnic (intercultural) tension, right up to open confrontation, ethnocentrism, xenophobia - all this testifies to serious problems in modern social relations. There is an opinion that in spite of all the relevance and discussion of this topic in broad social science circles there are no unified approaches to understanding the essential characteristics of the phenomenon of tolerance, there is no understanding of who and how tolerant relations are possible, what are the mechanisms for achieving this goal, Some people see it as a kind of a panacea through which only it is possible to save and preserve civilization, while others believe that it serves only to symbolically hide and cure the real schism and indifference that humanity is exhibiting. A theoretical analysis of the essence of the concept of «tolerance» is reduced to the fact that tolerance by origin is a social category (arises and manifests itself in the process of human interaction with society, with man); it fixes a special (non-violent) type of relationship between a person and society. A characteristic feature of tolerance is the stability of manifestations: at the level of consciousness, it manifests itself in the form of an individual’s attitude, and at the level of behavior as a conscious action or deed, as co-creation. Often, researchers formulate such tasks of psychological and pedagogical activity on the formation of ethnic tolerance of students as the formation of a value attitude to one’s own and other ethnocultures; the formation of motivation for intercultural cooperation; fostering a positive attitude towards cultural differences, the development of intercultural sensitivity; development of skills and skills for effective interaction with representatives of different cultures in the spirit of peace, ethnic tolerance and mutual understanding. Therefore, an important condition for joint activities is the creation in groups with a mixed national composition of an atmosphere of inter-ethnic understanding and tolerance, where everyone, regardless of ethnicity, feels comfortable, open to interaction with others, where ethical standards of behavior in interpersonal communication are observed. That is, the cognitive and emotional components of tolerance are most significant when there are contradictions, clashes of values, dissent in conflict situations. Wherein a tolerant behavior is characterized by the ability not to actualize the conflict, which in turn is determined by the level of upbringing and education.
Bulletin of the Russian Military Medical Academy. 2018;64(4):237-242
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Polymorbidity: definition, classifications, prevalence, estimation methods and practical significance
Voronin S.V., Cherkashin D.V., Bersheva I.V.
Abstract
Based on the analysis of Russian and foreign literary sources, the definition of the concept of polymorbidity is given, its classification, information on prevalence, measurement methods and practical significance are given. It is emphasized that at present in the literature the concepts of polymorbidity, comorbidity, multimorbidity coexist, while there is no universally accepted definition of them. This uncertainty is historically conditioned and is associated with the use of these concepts by various scientific schools. In most modern literary sources, polymorbidity (multimorbidity) refers to a combination of two or more chronic diseases in one patient. At present, a considerable number of different methods of measuring polymorbidity are used, which have their own advantages and disadvantages, and a universal method has not been developed. The most convenient for assessing polymorbidity is currently recognized polymorbidity index Charlson. Due to the lack of unified approaches to the measurement of polymorbidity, as well as taking into account the fact that studies are conducted in different population samples, the published figures for the prevalence of polymorbidity vary considerably. Emphasis is placed on the fact that polymorbidity is a multifaceted problem that has not only clinical but also economic and social importance, which requires a further in-depth study.
Bulletin of the Russian Military Medical Academy. 2018;64(4):243-249
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Pages of history and achievements of the Department of Normal Anatomy of the Military Medical Academy named after S.M. Kirov
Gaivoronsky I.V., Nichiporuk G.I.
Abstract
The research presents a brief historical sketch of the formation of the Department of Normal Anatomy of the Military Medical Academy. CM. Kirov. Reflected pre-academic period of development of anatomy in St. Petersburg. The contribution of outstanding scientists, anatomists, heads of the department: P.A. Zagorsky, I.V. Buyalsky, N.I. Pirogov, V.L. Gruber, A.I. Tarenetsky, I.E. Shavlovsky, V.N. Tonkov, B.A. Long-Saburov and E.A. Dyskin. It is noted that at present, the department continues to develop traditional research areas (collateral circulation, neuromorphology, functional anatomy of various parts of the vascular system, the history of anatomy and museum work), modern research is being carried out (the study of the structural transformations of the microcirculatory bed and nervous system when exposed to various extreme factors, innovative technologies for the manufacture and preservation of natural biological objects, anatomical measurement of various organs and systems of human body). In this case, the priority areas are polymeric embalming, modern applied anatomical and clinical research and medical craniology. Much attention is paid to the improvement and integration of the educational process with related theoretical and clinical disciplines, in particular - to ensure its functional and clinical orientation. It is shown that as a result of the done work, the Department of Normal Anatomy of the Military Medical Academy at the beginning of the XXI century secured the status of the leading scientific and methodological centre of Russia for the study and development of the most pressing problems of modern morphology.
Bulletin of the Russian Military Medical Academy. 2018;64(4):250-255
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60 years on the front lines of aviation and space medical support
Blaginin A.A., Sinelnikov S.N.
Abstract
The main historical aspects of the research work of the Department of Aviation and Space Medicine of the S.M. Kirov Military Medical Academy are presented for a 60-year period of its activity with a characteristic of the contribution of the department’s staff at different periods. One of the priority tasks of the department was not only training medical specialists for the Air Force but also carrying out scientific research aimed at solving both applied and fundamental problems of aviation and space medicine. The directions of these studies were laid by the founder of aeronautical physiology academician Leon A. Orbeli and are related both to the development and improvement of science and technology, and to the development of aviation and cosmonautics. Today, the main scientific areas of the Department of Aviation and Space Medicine are: improving the medical support system for flights on modern and promising aviation and space technology; development of methods and techniques for increasing the stability of the body of pilots and cosmonauts to flight factors; assessment and forecasting of the functional state and professional reliability of the flight crew, astronauts and operators for the management of space vehicles, as well as the development of tools and methods for correcting adverse changes in the functional state and improving the professional performance of pilots and astronauts. The Department continues research on one of the most important problems of flight safety - the loss of spatial orientation, new types of illusions are being studied. To ensure the work of the department at the present stage, the educational and material base is represented by the most modern medical and special equipment grouped into adjacent and complementary areas.
Bulletin of the Russian Military Medical Academy. 2018;64(4):256-260
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Treatment and evacuation work of evacuation hospitals in the Saratov region in the period from July 1943 to June 1945
Sokolov V.A., Murylev Y.A., Yakimov D.K., Murylev V.Y.
Abstract
The experience of organizing the treatment of wounded and sick military men of the Red army in Saratov at the final stage of the Great Patriotic War is studied. Priority tasks that were solved in conditions of the location of medical institutions in the deep rear are given. The structure of injuries and injuries with which soldiers and officers of the Red Army were sent from the front to the evacuation hospitals of the city and the region was investigated. Attention is drawn to the change the severity and location of wounds, depending on the progress of our units towards Germany. The factors that contributed to the successful treatment and return to the system of heavy contingents of the wounded and sick are indicated. The importance of the initiative work, which was carried out by medical personnel of evacuation hospitals on the development and introduction of new methods to improve the effectiveness of medical measures in everyday clinical practice, was stressed. Published data on the number of beds that were transferred from the Saratov hospital base in the army. In addition, evacuation hospitals and the Saratov Medical Institute were those institutions of which, even at the final stage of the war, medical personnel were sent for service to the front. At the same time, many honorably and honorably fulfilled their civic duty to the Motherland. Examples of patronage over hospitals from industrial enterprises and public organizations of Saratov and the region are given. A brief overview of the treatment and prophylactic tasks, which were solved in the interests of the civilian population of the city and the region, is given.
Bulletin of the Russian Military Medical Academy. 2018;64(4):261-264
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The activities Imperial military medical academy during First World War
Gadylgareev V.G., Fedorin S.V.
Abstract
Some aspects of the state of the Imperial Military Medical Academy before the beginning of the First World War, the activities of the Academy to train military doctors for the army during the war before the events of October 1917 are presented. The imperialist development path introduced Russia at the beginning of the 20th century in a complex knot both external and internal political and economic contradictions, that influenced the activities of the academy. The sad experience of the Russian-Japanese war of 1904-1905 demanded an introduction to the educational process of military and military-medical disciplines. Since 1907, the Main Military Medical Directorate has proposed the introduction of compulsory study by students of the Academy of military regulations, military administration, military field surgery with radiology and field surgery, military hygiene, the theory of searchable diseases and epidemics, «military medical service» according to the programs approved by the military minister. Despite the fact that such «militarization» during the period of ongoing military reforms was acutely perceived by both students and the Conference, referring to the overload of curricula, the requirements of the time created prerequisites for further development in the second half of the 19th and early 20th centuries scientific schools. Outstanding global discoveries in the field of medicine by the beginning of the First World War allowed the Academy to preserve the status of the main scientific center of medicine, and not only the military, Russian Empire. On the eve of the First World War, Russian military medicine accumulated a wealth of experience both in organizing medical care at the front and in evacuating the wounded and sick and in matters relating to the theoretical justification and practice of treating wounds and diseases. The frontline experience of introducing the latest methods and advanced technologies for treating the wounded, contributing to the further development of military medicine, was noted.
Bulletin of the Russian Military Medical Academy. 2018;64(4):265-269
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Radiation pathology is a part of Military field therapy
Khalimov Y.S., Vlasenko A.N., Matveev S.Y., Sapozhnikov R.Y.
Abstract
A great contribution to the study of problems of radiation pathology, the study of the body’s response to radiation, in the development of treatment and prevention of radiation injuries belong to the staff of the Department of military field therapy. In the period of over 60 years, the Military Field Therapy Department was consistently involved in rectification and study of the medical consequences of the radiological accidents, accompanied by radiation exposure. Problems of radiation pathology took a leading place in scholastic, scientific and clinical research of Department staff. Scientific research was based on established at Department experimental toxic-radiological laboratory where different types of radiation injury were simulated. Obtained results were penetrated into the educational process and have found practical application in the treatment of victims of the accident at the nuclear submarine. Patients with other forms of radiation damage were treated in the clinic of military field therapy in the following years. There are 2 cases of radiation disease due to intestinal irradiation caused by radium poisoning, the intestinal case of radiation disease, which was treated using extracorporal haemadsorption. After Chernobyl disaster Department research is concentrated on biological outcomes of «low dose radiation». The research aimed at solving problems relevant to military radiology is continuing. Organizational forms of specialized assistance to victims of radiation accidents and peacetime disasters within the framework of the disaster medicine service of the Ministry of defense of the Russian Federation are being improved.
Bulletin of the Russian Military Medical Academy. 2018;64(4):270-274
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Imperial Medical and Surgical Academy
Gaydar B.V., Tsygan V.N., Shvets V.A., Palii K.A., Tsvetkov S.A., Baretskaya A.E.
Abstract
The main events related to the assignment of the «Imperial» Medical and Surgical Academy status are considered. In the days of the celebration of the Academy’s 100th anniversary, publications dedicated to this event asserted that grateful offspring would always honor the memory of the Academy high Founders and Patrons. Our great predecessors, who celebrated the jubilee ideologically and organizationally, had recognized and honored Emperor Paul I as its founder. But the name and status the «Imperia Academy» was received from the hands» of Emperor Alexander I. On August 27, 1808, the Medical Surgical Academy, which had received Permission to be called Imperial, that was, a new quality (education) and other rights, the advantages granted to it, opened its first solemn meeting. That day, in our opinion, can claim to be considered the Birthday of the Imperial Medical and Surgical Academy. We emphasize that it is only about of the «Imperial» status. At that meeting the president of the academy James Wylie announced that the emperor «deigned to take on the title of Honorary Member of the Academy». On September 18, 1809, another great celebration took place in the Assembly Hall of the Academy devoted Alexander I and other High Men receiving the title of Honorary Members of the Academy. At the same time, the Emperor «showed his special favor to the Academy and bestowed upon it the Highest Charter, which «protects the rights and advantages of the Academy for all time». The most important provision of the Highest Charter was that, as a pledge of special imperial favor, the Medical and Surgical Academy was given the title of the Imperial Medical and Surgical Academy. That great celebration, its ritual procedure were reflected in the academic records: a thanksgiving service in the name of the Smolensk Mother of God in the academic church; the arrival of guests to a large academic audience (Assembly Hall, Conference Hall), members of the State Council, members of the Holy Synod, government ministers, foreign ministers; the arrival of Emperor Alexander I in «the Academy house»; the announcement of the Highest Diploma; the presentation of the diploma by the Minister of Internal Affairs Prince A. Kurakin to Emperor Alexander I; the highest order to present the diploma of the Academy; the receipt of the diploma by the President of the academy James Wylie and his thank-you speech; receiving diplomas Honorary Members of the Academy; election of new Honorary Members of the Academy; final speech of the President of the Academy; a visit to the Emperor of the academic church; breakfast of the Emperor in the dining room and his departure from the academy; further celebrations in the academy.
Bulletin of the Russian Military Medical Academy. 2018;64(4):275-280
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The evolution of methods and techniques for the diagnosis and treatment of urolithiasis in the Military medical academy named after S.M. Kirov
Protoschak V.V., Paronnikov M.V., Samatygo A.B., Kiselev A.O.
Abstract
Urolithiasis is one of the most common diseases in urological practice. Since the founding of the Military Medical Academy, the study of urolithiasis has occupied a significant place in practice, research and academic work. In this article, we attempted to systematize and structure all the data that are the benefits of the scientific and practical activities of the department staff who studied the problems of urolithiasis. Particular attention is paid to the outstanding role of the founder of Russian urology, S.P. Fedorov. In chronological order, the main directions of scientific activities of the department staff are presented in the study of the aspects of aetiology, pathogenesis, diagnosis and treatment of urolithiasis. The research reflects the main stages of improving the methods of prompt and conservative treatment of patients with urolithiasis. The experience of the introduction and use of one of the first distant lithotriptors in domestic medicine is presented. The main works of the staff of the Academy engaged in the study of urolithiasis are covered in detail, among them are the works of Bush I.F., Savenko P.N., Solomon X.H., Rklitsky I.V., Zablotsky-Desyatovsky P.P., Grebenshchikov G.S., Kurtov A.I., Tovstoles KF, Panin A.G., Levkovsky N.S., Petrov S.B., Gadzhiyev N.K., Paronnikov M.V. The findings have not lost their relevance, are reflected in therapeutic activities and are actively used in clinical practice at the present time. The department maintains the established traditions, develops and develops new scientific directions, methods and methods of diagnosis, treatment and metaphylaxis of urolithiasis.
Bulletin of the Russian Military Medical Academy. 2018;64(4):281-288
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Department of Physical Training from the beginnings to the present
Storozenko I.I., Nikolaeva K.V., Gadylgareyev V.G., Silchuk A.M., Silchuk S.M., Fedorin S.V.
Abstract
The article is devoted to the history of the Department of physical training of the military medical Academy named after S. M. Kirov. The article briefly highlights the key periods of education and formation of the Department of physical training, since 1900, when the initiative of a number of progressive professors of the Academy was formed by the Commission on physical exercises of students, which included the great Russian scientists, professors I.P. Pavlov and G.I. Turner. For students, optional classes in gymnastics, fencing, skating, game in small towns, riding began to be carried out. It was 1900 consider the beginning of the introduction to the educational process of the Academy of physical education classes, which became the basis for the formation of Throughout the period, the faculty of the Department of physical training worked outstanding athletes, the merits of which the Department of physical training and the Academy will always be proud. This is the honored master of sports of the Soviet Union and Russia, Champions and winners of Olympic, World, Europe, Soviet Union, and Russia: a fencer B.B. Melnikov, biathlete N.W. Puzanov, volleyball A.N. Einhorn and P.I. Voronin, gunner M.B. Umarov, a fighter, A.B. Novikov, honored coach of Russia and honored worker of physical culture of the Russian Federation A.S. Rakhlin, and others. For the glorious, eventful history of the Department of physical training, repeatedly changed its name, but one thing has always remained unchanged: at the Department of physical training worked and work highly qualified specialists, and a historical essay about the Department of physical training allows us to come close to all generations from the date of its formation to the present time.
Bulletin of the Russian Military Medical Academy. 2018;64(4):289-293
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Contribution of Institute of preventive sciences of Z.P. Solovyov of Military Medical Academy to development of military health care
Voskresensky V.V., Kuznetsov S.M., Maydan V.A., Zaymagov S.V., Bokharev M.A.
Abstract
Here you can find information based on documentary data about the establishment and activities of Z.P. Solovyov`s Institute of Preventive Sciences of Military Medical Academy from 1925 to 1928. The institute was organized to develop hygienic thinking on November 21 1925, and became one of the first foundations of the Soviet Union, which provided training for preventive specialists. In the order №216 signed by the chief of the Head Military and sanitary department and the deputy national commissioner of health care Z.P. Solovyov on November 19, 1925, were defined strategic objectives of creation of institute among which: 1) full coherence and improvement of teaching a cycle of sanitary and preventive disciplines according to requirements of army; 2) educate listeners and doctors in accordance with the basic principles of Soviet medicine, which gives the lead to disease prevention. As the building for new institute, the three-storyed obstetric and gynecologic clinic of the academician G.E. Rein at Mikhaylovsky hospital of the baronet Villiye which was a part of Imperial Military Medical Academy has served. Many departments in the academic institute were united, among which three were prophylactic: Department of Microbiology with epidemiology and disinfection course, Departments of General and Military, Social Hygiene. On the example of educational, research and public work of departments of a hygienic profile of institute the contribution of an educational institution as in the system of training of highly qualified specialists in the health sector, and in the system of health protection of the military personnel reveals. It has been established that studying by a staff of departments of a number of questions on a perspective of preservation and promotion of health of soldiers and officers, has an exclusive character in our country.
Bulletin of the Russian Military Medical Academy. 2018;64(4):294-298
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Review of the collective monograph of A.A. Mikhaylenko, E.A. Anoshina and N.A. Guseva «Pathological reflexes in neurology», St. Petersburg, «Foliant», 2017
Pomnikov V.G.
Abstract
Bulletin of the Russian Military Medical Academy. 2018;64(4):299-299
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Yakov Vasilyevich Willie - more than half a century in the service of military medicine The Russian Empire and the Medico-surgical Academy (to the 250th anniversary of the birth)
Fisun A.Y., Porokhov S.Y.
Abstract
November 20, 2018 would mark the 250th anniversary of the outstanding Leib-medic, baronet, privy councillor, doctor, military medical administrator, doctor of medicine and surgery, the first President of the St. Petersburg Imperial Medical surgical Academy, honorary member of the St. Petersburg Academy of Sciences (1814) and many domestic and foreign scientific societies Yakov Vasilyevich Willie. He selflessly and selflessly gave military medicine to the Russian army and the Russian Empire, which became his second homeland, 64 years of his life. Was physician to three tsars: Paul I, Alexander I and Nicholas I, was a participant of the great Patriotic war of 1812, where in extreme combat conditions, fully demonstrated their best professional and human qualities. Him personally and under his leadership was saved a huge number of sick and wounded. Many great generals, writers and public figures of tsarist Russia and modernity most highly characterize the invaluable contribution of Willie in the history of military medicine, science, Medical and surgical Academy and the state as a whole, the legacy of which even today are descendants and contemporaries.
Bulletin of the Russian Military Medical Academy. 2018;64(4):300-304
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In memory of Professor G.A. Albrecht the founder of domestic prosthetics in orthopedics (on the occasion of the 140th anniversary of his birth)
Morgoshiya T.S., Apchel V.Y.
Abstract
The main scientific and practical milestones of the founder of the Russian prosthetics in orthopedics of Professor Herman Aleksandrovich Albrecht are covered. November 20, 1907 after the public defense of the thesis on the topic: «Pathology and therapy of lateral knee bends» GA. Albrecht was awarded the Conference of the Academy of Doctor of Medicine degree. After public defence of a thesis on the theme: «pathology and treatment of lateral curvature of the knee». One after another began to appear in print: «the question of fluoroscopy and radiography gunshot injury», «traumatic separation of the lower epiphysis of the radius», «Appetizers as a method for the treatment of genu valgum», «Pathology and treatment of hallux valgus», «the technique of treatment of coxitis tuberculosis», «Isolated fracture of the trochleae humeri with a bloody reduction method, the technique of treatment of pseudoarthrosis autoplastic way». German Alexandrovich considered the prosthesis as a special area of medicine and technology that have important national economic significance. The primary means of training was surgery. In addition, in medical institutions was to be made, fitting, final fitting of prosthetic devices and training in their use patients. Also provides a broad familiarization of surgeons with the essential requirements of the prosthesis. In 1916 G.A. Albrecht put forward a plan to create a state system for the reorganization of prosthetic aid for war invalids, which provided for free prosthetics and preparation for it in medical institutions, the creation of a network of prosthetic workshops, the scientific development of new prosthetic devices and the training of special personnel. These progressive ideas were implemented only in 1919. At his request the Mariinsky shelter was renamed the Institute of Prosthetics, and since 1922 the institute opened its own prosthetic-assembly workshop. In 1928, the opening of a 30-bed medical-prosthetic hospital was opened in the Institute in addition to a 50-bed dormitory intended for waiting prostheses. In this way organized a uniform system of preparation for prosthetics, supply of prostheses and learning to use them in a special institution, which has for this purpose the necessary medical and technical personnel and equipment. German Alexandrovich was a highly qualified physician, research worker and teacher is not unusual for the time, however, harmonically the current profile. After 10 years in the clinic of Professor G.I. Turner, he acquired a comprehensive knowledge of orthopedics, which formed the basis for his later activities. Having a brilliant operative technique, Albrecht has developed its own methods of arthrodesis of the ankle and knee joints, modification kinaesthesia operations on stumps of the upper arm and forearm, as well as highly desirable variation of talangsari the first metacarpal and the splitting of the stump of the forearm by Krukenberg.
Bulletin of the Russian Military Medical Academy. 2018;64(4):305-309
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Perechen' statey za 2018 god
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Abstract
Bulletin of the Russian Military Medical Academy. 2018;64(4):310-318
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Pravila dlya avtorov
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Abstract
Bulletin of the Russian Military Medical Academy. 2018;64(4):319-320
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