Vol 19, No 4 (2017)

Despite significant progress in pathogenesis understanding, rational antimicrobial therapy and respiratory support for community-acquired pneumonia, the incidence of severe community-acquired pneumonia is currently increasing. In the etiology of severe community-acquired pneumonia in Russia, proportion of legionellosis reaches 15%. The lethality in different outbreaks varies from 8 to 40%. The main causes of death are bilateral subtotal lung damage, severe respiratory or renal and hepatic failure, toxic shock, toxic encephalopathy. The formation of complications and the outcome of «Legionnaire’s disease» directly depends on the terms of appointment of adequate antimicrobial chemotherapy. Being an intracellular parasite, legionellas are found to be insensitive to all antibiotics that are able to accumulate exclusively or mainly in interstitial space.

The presented clinical case of pneumonia legionella demonstrates the difficulty of diagnosis, solution to the problem of choosing an optimal antibiotic therapy. For the treatment of «Legionnaire’s disease», it is necessary to use drugs penetrating well through biological membranes and characterized by a high intracellular accumulation - macrolides and fluoroquinolones, which is reflected in the accepted recommendations and confirmed by our clinical observations. Early entry into the stage of specialized medical care, control of epidemiological factors, analysis of the clinical picture, use of high-tech X-ray, endoscopic, molecular genetic diagnostics and procedural recommendations for the diagnosis and treatment of severe community-acquired pneumonia in a timely manner allow to correct diagnosis in order to prevent fatal outcome and to achieve a full recovery.

Hip joint replacement in trauma and orthopedic practice has become a standard surgery for adult patients. Among all complications, which have negative effect on the outcome of joint replacement, the special place is taken by a deep infection of the surgical wound, chronic osteomyelitis. Timely diagnostics and revealing the character of the infection process play an enormous role in determining amount of surgical intervention. In recent years it has been proposed to include morphologic confirmation of the stage and extension of the infection process in diagnostic algorithm of osteomyelitis. In 58 patients with chronic osteomyelitis peculiarities of structure of the proximal femur were studied by method of multisection computer tomography and histologically. Radiographic and morphological properties of acute, sub-acute course of osteomyelitis and bone condition during remission were revealed. Visual differences and morphological parallels of anatomy and architectonics of bone during acute stage and remission were discovered. The head of the femur (or a fragment thereof), the cervical stump had uneven contours, contained resorption zones with density in the negative spectrum of the Hounsfield scale, the density of the acetabular roof, the area of the large trochanter was significantly reduced in the period of exacerbation and in the subacute phase. Cortical plate had a different thickness and density and was below normal values. Cortical plate defects of various lengths were detected in the presence of fistulas. The specified spongy bone of the femoral head was determined histologically with almost complete destruction of the articular cartilage, thinning of the subchondral bone plate, necrosis of the bone trabeculae, substitution of the intertubular space with necrotic detritus fields, clusters of purulent exudate, granulation tissue, fibrosing fields. In the subacute form, a large number of segment-nucleated leukocytes were determined in the intertrackal spaces of a spongy portion of the examined material. The phenomena of osteoporosis in the acetabular region and the preserved part of the femur remained, no fresh destructive changes were detected in the period of remission. In a number of cases, small, loose, caseless granulomas of lymphocytic and macrophagal composition, parts of reparative bone formation on the surface of partially necrotic bone trabeculae with a layer of newly formed osteoid and a layer of osteoblasts on the endosteal surface of the bone trabecular complex were morphologically determined.

Reproductive health of young people determines thefuture of any state, and the quality of health and the number of the next generation, provision of economic and defense security and the development of the state are associated with it. An early and high sexual activity, spreading of bad habits, low level of sexual culture among young people contribute to the rise tn number of sexually transmitted infections, including the human immunodeficiency virus, and the decline in reproductive function in the future. Unfavorable tendencies in youth health values are becoming more widespread and require the development and implementation of effective prevention programs and technologies in order to improve reproductive potential of the younger generation. Factors of risky sexual behavior of young people with an early onset of sexual activity are considered. It has been established, that the first sexual experience have 25.3% of respondents aged 14 to 17 years. In this group of persons, multiple sexual intercourse is observed 1.5 times more often than in young people with a later entry into a sex life. In the group of young people with early sexual experience, the constant use of condoms with multiple sexual relationships with regular and casual partners occurs 1.3 times less frequently than in the group of people with a later onset of sexual activity. Persons with an early onset of sexual activity often use alcohol and had experience of taking psychoactive substances. Thus, it is shown that people with early sexual intercourse have a risky behavior pattern that poses a threat of infection and the spread of sexually transmitted infections and can lead to reproductive health problems.

The experience of examination and treatment of330 victims with lesions of the chest is generalized. Medical care was provided in one of the city's multidisciplinary hospitals in Staint Petersburg, in which there are no posts for specialists in the field of thoracic surgery. An algorithm for therapeutic and diagnostic measures based on mandatory primary thoracoscopy under local anesthesia in cases of drainage of the pleural cavity performed according to indications is developed. It has been demonstrated that navigation ultrasound tomography can play a special role in increasing the effectiveness of thoracoscopic manipulations in the provision of medical care to victims with chest trauma. It is proved that the results of rendering medical assistance to victims with chest trauma essentially depend on the quality of treatment of patients after the completion of the hospital stage of medical provision of the population. The use of combined variants of restorative treatment of victims with lesions of the chest justifies itself. It is advisable to attach special importance to the pulmonological support of the technologies of thoracic surgery, which should be considered not as competing but as complementary components of the treatment and diagnostic process.

Motivation, knowledge and skills on individual oral care of480 certified employees of internal affairsbodies in Saint Petersburg and the Leningrad region at the age of 19 to 57 were studied. It was established that individual hygiene of the oral cavity is performed regularly by 57,92%, at the same time, at least 2 times a day 76,67% of the examined patients take care of their teeth and oral cavity. Necessary and sufficient knowledge of the technique and tools for personal care of the oral cavity have 44,16%, and the corresponding manual skills for oral care only 10,62% of them, which indicates the need to practice with the rules of cavity care as a part of ongoing medical examination and sanitation of the oral cavity. The study was conducted by interviewing patients and determining on the phantom the level of manual skills for oral care of examined individuals in the course of carrying out a planned sanitation of the oral cavity. Special scales have been developed to evaluate the studied indicators. The knowledge of certified employees of internal affairs bodies was assessed on a five point scale: 0 -there are no ideas about methods and tools for oral care; 1 - has only an idea of the methods and tools for oral care; 2 - has a superficial knowledge of methods and tools for oral care; 3 - has knowledge of methods and tools for oral care but not fully; 4 - has sufficient knowledge about methods and means for oral care; 5 - has a deep knowledge of the methods and tools for oral care.

We conducted a comparative analysis of the dynamic parameters of physiological systems voltage of the patient’s organism with chronic hepatitis C from all groups of viruses receiving antiviral therapy by means of polyfunctional psychophysiological testing (stress testing). It was revealed that there is an increase in the stress index in the first six months of therapy; an increase in the index of low-frequency waves of cardiac rhythm with a simultaneous decrease in power of contribution of high-frequency waves, as well as an increase in a coefficient of the vagosympathetic balance in the first three months of taking medications; decrease in values of skin-galvanic reaction in the first three months of therapy. These changes indicate an increase in the activity of sympathetic part of an autonomous nervous system, the predominance of a central contour of regulation in patients of different age groups against the background of treatment with antiviral drugs. In addition, there was a pronounced tendency to increase in values ofthe neurotic index in different age groups during the first six months of antiviral therapy and to stabilize it by the end of the observation period. The indicator of mental tension increased in both age groups during the whole period of observation, however, its values did not exceed the level corresponding to the state of psychological adaptation to workloads. The results of the study testify to the tension o compensatory-adaptive mechanisms of organism of patients with chronic viral hepatitis C against the background of antiviral drugs in different age groups. These changes are more pronounced in the age group from 40 to 58.

The article analyses the peculiarities of psychological status among boys in the Republic of Dagestan mothers, which period before pregnancy experienced a high risk of a terrorist threat during the occupation by militants in September 1999. They revealed that mild depression and masked depression in boys of mothers, who experienced psychological trauma associated with life-threatening was defined, is much more frequently than in the group of boys whose mothers have not experienced the vital stress. In both groups of cases of severe depression was not observed. Boys, whose mothers are in a period before pregnancy experienced mental trauma associated with life-threatening, characterized by a high level of neuroticism combined with introversion. They demonstrate a lack of confidence, emotional instability, and vulnerability combined with resentment and suspicion, at the same time at the age of 13 to 14 years, these boys are less aggressive than peers in the control group. They have masked depression much more often than boys of the control group, coldness, formality in contacts; they are less interested in the life of the school community, have a destructive position in a conflict, are more exposed to affective experiences, more labile and emotional. Typical treats for them are unjustified resentment, emotional excitability, irritability, high neurotic fatigue, moodiness, impulsivity, anxiety, distractibility, lack of concentration, frustrations and high level of anxiety.

Thefeatures of influence of physical activity of long swimming under water on dynamics of physiological parameters of underwater swimmer are investigated. A brief characteristic of the features of various strokes of swimming under water in a waterproof coverall is given. The factors influencing the choice of one or another stroke of swimming under water are indicated. The necessity of using methods of movement under water depending on their profitability and its influence on the efficiency of solving professional problems is substantiated. The possibility of maintaining breathing through the respiratory tube and self-contained breathing apparatus during swimming in and without waterproof coveralls has been studied. Possible criteria for choosing the ways to solve professional problems under water are formulated: data on changes in physiological parameters under the influence of a long load in swimming with various strokes and in various waterproof clothing. It is revealed that the nature and degree of influence of a prolonged load on the physiological functions of the organism depends on the methods of breathing and swimming under water. The results of studies characterizing differences in changes in physiological parameters of subjects depending on the chosen method of swimming are presented. It was established that under the influence of physical activity by means of various methods of swimming under water with a respiratory tube and an autonomous respiratory apparatus, progressive changes in physiological characteristics occur. Simultaneous movements of legs leads to a greater strain on the physiological functions of the body of a swimmer both in swimming with an autonomous respiratory apparatus and in kit No 1. The functioning of a circulatory system proceeds more actively by 4-5%, respiratory system by 2-3%.

The article presents the experience of using optical coherence tomography in diagnostics of lesions in the anterior segment of a rabbit eye caused by inducing an experimentally modeled trauma resulting from exposure to a gas-based selfdefense weapon. Gas-based weaponry is presently used tn special forms by law enforcement agencies for the purpose of not control as well as for self-defense. The law enforcement structures and means of self-defense have been provided in the last years by modern gas-based weapons: oleoresin capsaicin and its synthetic analogues, used alone or in combination with ort ochlorbenziloidenmalonodinitrile. Diagnostics and treatment of eye trauma have largely been neglected in Russian medical literature and their criteria have not been sufficiently defined. The optical coherence tomography data illustrate changes in the cornea structure at various times after the trauma incident and in relation to the applied therapeutic treatment. These structural changes have been confirmed by pathomorphology studies. It has been found that optical coherence tomography is a high-sensitivity method of study of the cornea damaged by the gas-based weaponry, which allows to track dynamically, the development of the trauma and the results on various media (electronic, paper), letting to perform a retrospective analysis as well. It has been concluded, as a result of this study, that applications of optical coherence tomography for diagnostics and evaluation of treatment pertaining to experimental animals are acceptable and effective.

The technique of modeling acute cholecystitis using the influence of pathogenic intestinal microflora is presented. The experiments were carried out on 21 rabbits of chinchilla breed in two groups. A model of acute peritonitis was developed on 5 rabbits from the first group, according to the method of F.F. Usikov [11]. Then a highly toxic peritoneal exudate was injected into the gallbladder of animals of the second group (16 rabbits). The administration of highly toxic peritoneal exudate into the gallbladder led to the development of an inflammatory process in the gallbladder. The pathological process developed slowly and in the interval from 7 to 15 days of modeling was of acute nature. The injection of a highly toxic peritoneal exudate that includes many types of pathogenic microflora of the intestine causes the development of acute cholecystitis. This model reflects the corresponding underlying etiopathogenetic links of gallbladder diseases. The adequacy of the proposed model is confirmed by the results of changes in the markers of acute cholecystitis increasing the level of alkaline phosphatase, alanine transferase, aspartate transferase, total bilirubin, у-glutamine transferase and amylase in blood after modeling.

The article presents theoretical analysis of professional health components and its level in various sample groups of flying personnel. Structural complexity of the professional health, which consists of such components as clinic (medical status), functional stability and professionally important qualities, is considered. Impact of unfavorable professional factors of flying labor causes reduction of body functional reserves and after 8-10 years of flying service it becomes damaging, that is why 30 percent of pilots were diagnosed with various health deviations, and 60 percent of aviators older than 35 were found to have diseases, implying some or other limitations to flying work. Medical component offlying personnel professional health is determined during flight medical expertise. According to the results, 85 percent of flying personnel are disqualified due to medical evidences at the age of 31-45 years. Professionally important qualities, as significant aspects of professional health, are estimated in a process of professional psychological selection and support for flying personal education. The results of experimental researches of the peculiarities of professionally important qualities of the applicants to aviation school and cadets-pilots with different level of professional health have shown that certain psychological and psycho-physiological features correlate with medical survey criteria. It turned out that cadets suitable for flying education truly differ both from candidates, unsuitable for enrollment into aviation school and from cadets, recognized as inapplicable for further flying education according to flight medical board assessment due to many psychological and psycho-physiological characteristics, detected on the stage of professional psychological selection.

The problem of terrorism becomes one of the main of social dangers threatening humanity. The number of terrorist attacks and the number of victims are increasing. Protection of sports competitions from terrorism is actual in modern conditions. Large international competitions create ideal conditions where international terrorists can manifest themselves. Conducting events with mass concentration of people puts the problem of ensuring public security to the forefront. At the same time, an important task arises in front of the medical service: to ensure the timely provision of medical care to victims and their evacuation to a medical organization where medical assistance can be provided in full extent. The materials of work of the specialized aeromedical evacuation brigade are being analyzed during the preparation and holding of matches of the Confederations Cup 2017 in Sochi. The reanimation brigade was separated from the medical unit (special purpose) of the 1602nd Military Clinical Hospital to carry out medical evacuation of victims in the event of possible terrorist attacks. The medical staff of the brigade provided medical assistance in an urgent and urgent form to the personnel of the air commandant's office and to the duty crews of combat helicopters. In general, when planning a medical support of major sporting events, it is advisable to allocate a medical-nursing team for airmanship evacuation. Moreover, it is preferable to use equipped sanitary helicopters for these purposes. An important task for a specialized aeromedical evacuation brigade is to monitor the degree of charging of medical equipment for medical modules (helicopter) and timely recharging. In August 2017 in Zernograd, Rostov Region, the state flight test center (Moscow) successfully tested an operation of medical modules (helicopter) in the conditions of new electrical equipment, which allows adapting the module's equipment to the on-board helicopter network.

The irrational personnel policy in the initial period of the reformation of the medical service of the Armed Forces of the Russian Federation led to a massive discharge and reduction of specialists engaged in the organization of medical equipment properties for troops (forces). This inevitably led to the growth in the personnel deficit in the medical supply system, and soon the well-trained and highly qualified specialists of the pharmaceutical profile again were of high demand. The related issues to their training, professional development and career growth require an effective solution. The analysis of works of the national scientists devoted to problems of reformation, working with pharmaceutical personnel using scientific methods, significant practical researches’ results and their introduction into civil health is presented. It has been revealed that the management issues, problems of effective and rational use of pharmaceutical personnel in units (military units) and military medical organizations were not enough studied. An analysis of various literary sources revealed the main trends that can be used to solve problems of improving the work with pharmaceutical personnel in military healthcare. The reasonableness of conducting scientific research on improving the work with pharmaceutical personnel in the medical service of the Armed Forces of the Russian Federation, the problems and possible solutions to them have been identified. This will allow developing a multi-level system of training, creating reserves and moving up on the career ladder of leading personnel of the system of medical supply of troops (forces) in accordance with the needs of military health.

The adaptation disorders to training circumstances in military universities and it’s psychological correction specificity in female cadets are considered. It is shown, that military occupational adaptation process takes the first two- three years and namely in this period the most thorough and intensive intervention of the medical and psychological support service is required. The approaches to psychological prevention and correction of adaptation dysfunction are analyzed. It was established that the general principle of psychological prevention and correction programs creation should be a differential combination of psychophysiological, personality-oriented and psychosocial methods. Among psychophysiological methods, special attention should be devoted to method of biological feedback. This method is the most effective both for diagnosis and correction of adaptation disorders in female cadets. Personality-oriented psychological correction can be based on the D. Keirsey’s adapted questionnaire, which is showing the statistically significant correlation with such an external criteria as the incidence of morbidity and progress of trainees. Well-thought-out development of such typological features, as «sensation», «judging» and «thinking» on early stages of adaptation contribute to prevention of psychosomatic diseases and increase the professional success. The basis for psychosocial training can serve the Stress Associative Coping Strategies questionnaire, which is showing statistically significant correlation of coping-models with somatic health and academic performance. Work in groups of psychosocial training should be aimed at developing constructive and understanding the inefficient coping-models.

The results of studies on the liver failure of different etiology are generalized, the present situation with regard to the pharmacological treatment of pathological changes in the liver are considered, and the opportunities for prevention and treatment of such pathologies are determined. It has been established that toxic liver damage caused by an increased rate of drugs intake, alcoholization of society, environmental degradation and unhealthy lifestyles also play an important role in the development of liver diseases alongside with infections. It was also found that regardless of the etiology of the liver failure, the pathogenesis is distinguished by two mechanisms: direct and autoimmune hepatic cell damage. This causes inflammatory, necrotic and apoptotic reactions, leading to hepatic cells death in the terminal phase. There have been identified the similarities in body compensatory reaction processes aimed at defending the liver against intense pathogenic impact of both exogenous and endogenous factors. It was found that eventual failure of the compensatory mechanisms results in the impairment of hepatocytes, followed by the development odfevheelpoatitides and hepatosis with the potential to transform into cirrhosis and hepatocellular carcinoma. The probability of these pments in terms of both time and frequency depends primarily on the activity level of immune system, adaptive capacities of the body, duration and intensity of the exposure to the damaging factors, certain genetic factors, accompanying other diseases, lifestyle and nutrition habits and timely and correct treatment strategies and etc. It was also found that regardless of the etiology of the pathologic process, the rehabilitation period is distinguished by restoration of the compensatory mechanisms in the first instance. Thus, the intensity of liver metabolic processes is increased, and phagocytosis is activated along with enhancement of toxic substances excretion, development of anastomosis. The blood is redistributed, which leads to the activation of hepatic cell regeneration.

The problem of prevalence of oncological diseases is becoming more urgent every year. Modern science has made some significant progress in the diagnosis and treatment of cancer. However, despite this, a large number of tumors is not always possible to identify in the early stages, resulting in reduced survival rates ofpatients after treatment even in the best cancer centers, and in some cases modern medicine is powerless. In the structure ofoncological morbidity, ones of the leading localizations are malignant neoplasms of the gastrointestinal tract. As theprocess of development ofpre-cancer takes several decades, theprospects of early detection arefavorable, but the problem lies in the lack of suitable samples for screening ofgastric cancer, the symptoms appear within a short period prior to the development ofgastric cancer. The main problem in the study ofHelicobacter-associated diseases remains theprevention ofgastric cancer, therefore, the search for adequate ways of early detection of this disease continues, which, in turn, determines the need for new markers ofprecancer and cancer of the stomach, including genes that increase the risk of adenocarcinoma of the stomach. The ability to prevent the development of a stomach cancer is due to the fact, that timely started treatment ofsome changes of the mucosa are reversible, which in turn depends on their early diagnosis. In the article the problem of identifying predictors ofgastric cancer: role of Helicobacter pylori, the impact of some virulence factors of H. pylori infection on the development of intestinal metaplasia and dysplasia ofgastric mucosa in the screening stages of the study is discussed. Detection ofpredictors ofcancerous changes in the mucous membrane of the stomach - is the best way to reduce morbidity and mortality from stomach cancer.

The article contains a discussion on the features of the buttress of a lower jaw. It is shown that the maxillofacial segment is its morphofunctional unit, while the total chewing pressure from all dentition segments is transmitted along the ascending buttress, which should be considered in a broader view as a basal-condylar-coronary buttress. It is shown that in its essence the ascending buttress in the process of evolution of a masticatory function was divided into two buttresses - basal-condyle and basal- venous-muscular - in a region of the angle of the lower jaw. It is shown that when the basal-condyle buttress is not working, the masticatory tension on the structures of a facial and cerebral skull transmits the basal-venous-muscular buttress through the chewing musculature, which takes up most of the masticatory tension and forms a new basal-muscular-cranial buttress consisting ofseveral parts: coronary-temporal, basal-cheek-temporal, basal-pterygoid and condylar-pterygoid. It is proved that the development, structure and biomechanics of the chewing apparatus at various stages of its evolution were determined by the ways offeeding and processing offood. These methods were the main shaping factors of the dentoalveolar system and the temporomandibular joint formation through the chewing pressure, which determined all their biomechanics. In the implementation of the counterforce function of the lower jaw, an important role is played by the chewing muscles and temporomandibular joint.

Trends in the development of higher, secondary professional and additional professional education identify a fundamental change in the educational process and necessitate a completely new approach to training and introduction of modern educational technologies. Requirements of State educational standards aimed at the introduction in the educational process of simulation courses that provide practical skills and skills for all categories of students, practicing the skills of team work, development of clinical thinking and the formation of professional competencies. Introduction in educational process of training simulation courses contributes to reducing errors and improving the quality of medical care. The present level of development of the technology and methodology of simulation training, including original techniques, has allowed us to implement in the medical education system is a brand new kind of practical training and objective assessment of the level of practical knowledge and skills of trainees - simulation training - realistic simulation scenarios of pathological conditions, medical procedures, surgeries and other clinical situations. A significant advantage of using simulation training in conjunction with the traditional training system is the possibility of multiple practicing certain exercises and activities. Objective quality control jobs in progress and the results of training allows to improve the management of simulation training. Assessment of the level of proficiency of a specialist after conducting simulation training allows one to determine the effectiveness of a simulation course, to plan further training with the use of simulation technologies to achieve the specific quality values of the available jobs. Following the completion of the program of training simulation course, data on recorded in the learner portfolio. This allows an objective control of the correct development of practical skills, that enables the learner to progress from one training level to another.

Damaging factors of munitions of explosive action were considered. It is known that explosive injury have ceased to be the prerogative of local wars and armed conflicts nowadays. Terroristic acts, sweeping across many countries all over the world, are increasingly being committed by undermining camouflaged explosive devices in crowded places and public buildings. As a result of exposure explosion factors to human a number of damage with different mechanisms arise, which in most cases are multiple and combined by anatomic localization and combined in mechanogenesis. The main damaging factors in the explosion are explosive gases with high pressure and high temperature, shock wave, shards of the ammunition (mines) and secondary shells. Thermal impact of explosive ordnance is manifested by local burns, localized, usually, in the explosion area. The gases formed during the explosion can additionally cause severe poisoning. Specificity of the pathological changes that arise in the organism from the explosion requires from medical specialists of all levels a full knowledge of the features of the formation of trauma when the factors of the explosion act on the human body. An equally important aspect of the comprehensive study of the mechanism of explosive effects is the creation of individual and collective protection against explosion, as well as the development of methods for assessing the effectiveness of their usage.

The results of computed tomography in patients with acute traumatic brain injury and the relationship between computer tomography scan results and the level of Glasgow coma scale are presented. The computer tomography scans in 90 individuals with traumatic brain injury were studied. The average age of patients studied was 31,56±2,09 years, 88,9% of which were men and 11,1% - women. The severity of traumatic brain injury was assessed using the Glasgow coma scale. Computed tomography was carried out according to standard methods in the normal mode without contrasting. The main reasons for traumatic brain injury were traffic accidents (60%), falling down (32,2%), sport trauma (6,7%) and criminal trauma (1,1%). Mild traumatic brain injury was diagnosed in 43,3% of cases with the average score on the Glasgow coma scale - 13,14±0,84. The average degree of head injury is noted in 44,4% of cases, the average score is 9,2±1,28 and severe head injury in 12,2% of cases, the average score is 6,36±1,27 mm. Mixed lesions have lower indices on Glasgow coma scale (9,78±1,65) than solitary lesions (12,89±1,24). Mixed lesions combined with fractures have the lowest value on the Glasgow coma scale (6,42±1,03). It is shown that computed tomography is a widely available, fast and effective diagnostic technique that allows to accurately determine the location of a lesion in acute craniocerebral trauma. Early and timely diagnosis using computed tomography is essential for further treatment tactics and predicting the result.

There are a short introduction about youth and scientific activity of Tuvia Yakovlevich Ariev. Some little-known facts were established from his childhood and youth. First independent researches and publications were already highly appreciated by his scientific adviser and published in foreign scientific literature. The main milestones of his becoming as a doctor-researcher and scientist are considered. This stage in life was promoted by studying in the adjuncture of the Military Medical Academy and the subsequent work in the clinic of hospital surgery under the direction of the outstanding scientist and surgeon S.S. Girgolava. The proposed problem of the cold effect on the human body with surgeon point of view became the main direction of independent scientific activity in the 1930-1940s for T.Ya. Aryev. The study and analysis of numerous and often contradictory in their conclusions of domestic and foreign literature, the clarification of controversial and poorly studied questions in the experiment and during the treatment of patients with cold trauma that came to the clinics of the Academy and city hospitals in Leningrad enabled young scientist to systematize and clarify many of the teaching’s fundamental principles about frostbite. In this period T.Ya. Aryev mastered the methods ofsetting various experiments, acquired solid surgical skills, greatly strengthened his analytical abilities when working with domestic and foreign scientific literature. The subsequent participation in the armed conflicts of the 1930s allowed to receive the practice of rendering assistance to the wounded with combat surgical pathology during the stages of medical evacuation. New clinical observations made possible to develop a number of fundamentally new provisions for the theory and practice of treating frostbites in the everyday clinical practice of military medical institutions. It was during this period that T.Ya. Aryev’s life became a highly trained scientist and clinician, acquired an invaluable scientific, medical, combat experience that tempered his character, allowed him to lead the first in our country department and clinic of thermal lesions.

People remember the Eiffel towers, but not milestones. And if one remembers doctors of long past centuries, we thereby prove that they were outstanding representatives of medicine of their time. In 2017, 240 years passed since the birth of one of the greatest surgeons of France - Guillaume Dupuytren. The article is dedicated to his life stages, personal qualities and professional achievements. He was called «riverside robber» and «wild animal on the Seine», however, he was listened to. The famous surgeon, protege of Pinelo, Cuvier and Corvizar, despite the hardest times for his country, made a huge contribution to the development of not only French, but the world surgery. Absolute perfectionism in everything, gloominess, arrogance towards colleagues and students prevented Dupuytren from finding a common language with the surrounding people, and sometimes making the work under his leadership unbearable. Nevertheless, these features did not prevent Dupuytren from writing his name in the history of world medicine. Some of the symptoms and diseases are named after him, and the most famous among them at the present time is Dupuytren’s flexural contracture. Lectures written by his assistants according to his words, made a huge contribution to the development of surgery. In addition, under his leadership, the oldest hospital in Paris took one of the leading positions among hospitals in Europe. Dedicated to his job, Guillaume Dupuytren saw patients until the very last day. Outstanding skills, enthusiasm and conscientious work made Dupuytren one of the greatest surgeons in history, his contribution in science impossible to overrate.

The article presents the main milestones of life and creative path of one of the leaders of Saint Petersburg and Leningrad school of surgeons of Ivan Ivanovich Grekov - doctor of medical Sciences, Professor, honored worker of science. Ivan Grekov published more than 150 scientific papers on surgery of lungs, heart, abdominal organs, heal wounds and etc. He was one of the first in Russia to introduce a method of surgical field treatment with tincture of iodine (1909). The best-known scientific works of I.I. Grekov are in the field of abdominal surgery. He developed methods of resection of the sigmoid colon (1910, 1924) implemented in practical surgery as the operation «Grekov I and Grekov II» (double-stage method of resection of the sigmoid and descending large intestine). He created to the method of ileocecal valve plastics during a spasm (Grekov method), methods of gut emptying at high and low intestinal obstruction (Grekov methods). For Hirschsprung’s disease he suggested producing the mobilization of sigmoid and rectum (operation Swenson - Grekov). He identified the functional and reflexive relationship of appendicitis with gastric ulcer, ileocecal valve with a pylorus and pointed out that in diseases of the cecum violations of motor and secretory functions of the stomach may occur. For the first time in Russia he successfully performed the operation of removal of a pancreas (1913). I.I. Grekov proposed modification of operations if the damage to the cruciate ligaments of the knee joint or resection of intestine in strangulated hernia took place; in 1903 successfully performed stitching of the heart wound, and in 1928 opened the cavity of the heart to remove the bullet. About 40 years he was working in the Obukhov hospital.

The analysis of the manual of L.N. Soldatova, G.A. Grebnev, A.K. Iordanishvili «Military-medical examination on the dent-alveolar anomalies» is represented. The main information of the frequency of occurrence of major dent-alveolar anomalies at recruits, applicants, cadets of high military educational institutions and also the military personnel are covered in the manual and the characteristic of these anomalies is given. The features of medical examination of citizens at initial military registration and military conscription in connection with dent-alveolar anomalies are described. The occurring imperfections of work of the military-medical commissions which examine the young with dent-alveolar anomalies are brought. The existent difficulties in providing the orthodontic help in conditions of the military service are noted. The ways of solving problems on the examination of young people during the initial military registration and induction into military service in connection with their dental anomalies, as well as military personnel, in connection with injuries and loss of teeth are indicated.