Vol 21, No 4 (2019)

The article presents the study results of the effectiveness of intervertebral joints high-frequency denervation as a modern minimally invasive method of pain management after surgical treatment of degenerative diseases of the spine. The degenerative process affects all the structures of the spine as a complex biomechanical system. The defeat of the intervertebral joints degenerative process accompanies the stenosis of the spinal canal, degenerative vertebral prosthesis, herniated protrusion of intervertebral discs, and makes a significant role in the development of pain in the lumbar region. The creation of spondylodesis in the vertebral-motor segment as a result of surgical treatment causes functional changes in adjacent segments in the form of compensatory hypermobility formation. These changes often lead to exacerbation of chronic arthrosis of the intervertebral joints. It was established that minimally invasive electrosurgical techniques proved to be safe and effective methods of treatment of carefully selected patients with pain in the lower back and legs caused by degenerative-dystrophic process. In this case, complications during such procedures are extremely rare. In all operated patients during 3 months of follow-up the severity of pain syndrome on the visual-analog scale was less, and the level of satisfaction of patients with treatment of degenerative- dystrophic diseases of the spine was higher than in patients with subsequent conservative treatment of pain syndrome. The main advantages of the technique are their safety, effectiveness and minimal invasiveness.

80 cases of lethal outcomes with a clinical diagnosis of sepsis were analyzed. Data on the performance of in vivo microbiological blood tests were in 26 cases, and after sending blood and pieces of organs in 45 observations. Along with the estimated data of microbiological studies, an analysis of the presence and severity of gn-metastasis was carried out. In 31 cases, the pathoanatomical diagnosis was confirmed - metastatic purulent foci were found in the internal organs. When re-examining archival micropreparations, special attention is paid to finding inconspicuous small metastatic septic foci (mini foci) in the myocardium, kidneys, and brain. Signs of microcirculatory lesions were also evaluated for severity: endothelial damage, activation of the blood coagulation system, increased permeability and inflammatory response. All observations, in which an in vivo microbiological study was conducted, were divided into two groups: with gram-positive bacteremia and gram-negative bacteremia. The assessment of the severity of purulent metastasis as a function of the microflora emitted during microbiological examination was carried out. It was revealed that gram-negative microflora is characterized by the absence or minimally expressed metastatic foci in the form of mini-foci. A comparison was made of the number of signs of microcirculation disorders in gram-negative and gram-positive sepsis. The obtained ratio made it possible to consider the pronounced and widespread signs of damage to the endothelium (desquamation of the endothelium, release of single neutrophils, the phenomenon of marginal standing, fibrinoid necrosis of the vessel walls) as objective microscopic criteria in favor of gram-negative sepsis.

The use of ultrasound examination of the lungs gives an idea of the lung tissue, lesion volume and affect the tactics of treatment. However, different lungs ultrasound examination protocols gives the opportunity to get different data. Using ROC analysis by standard of computed tomography were compared the sensitivity and specificity of ultrasound techniques, specifically the protocol for bedside ultrasound examination of the lungs, as well as the 4-zone and 9-zone protocols in the diagnosis of pneumonia. It was revealed that the sensitivity of the researched protocols was 97, 93 and 97%, respectively, specificity – 80, 80 and 90%, respectively. At the same time, the modified 9-zone scanning protocol makes it possible to more accurately search for pneumonic lesions, not only taking into account the lobar structure, but also taking into account the segments of the lungs. The sensitivity of the protocols of bedside ultrasound examination of the lungs, 4-zone and 9-zone in the diagnosis of pneumonic lesions in shares was 69, 80 and 97%, respectively, specificity – 60, 62 and 71%, respectively. The sensitivity of the protocols of bedside ultrasound examination of the lungs, 4-zone and 9-zone in the diagnosis of pneumonic lesions in segments was 73, 68 and 93%, respectively, specificity – 66, 68 and 92%, respectively. In the diagnosis of pneumonia, it is possible to use any of the three protocols with high specificity and sensitivity. The modified 9-zone scanning protocol makes possible to diagnose pneumonic lesions taking into account the lobar structure and taking into account the segmental structure of the lungs with higher sensitivity and specificity.

The results of the examination of pregnant women suffering from thyroid gland pathology are presented. It was found that 15 (37%) pregnant women out of 41 examined had hyperthyroidism and 26 (63%) are hypothyroids. Both pathologies are recommended for iodine deficiency in 200 mcg per day, in addition to special nutritional supplements. The pregnant women with hyperthyroidism, during the first 3 months of pregnancy, are being prescribed 2 tablets 3–4 times daily (300–400 mg) propyltiocracil and 3 tablets per day, in addition to potassium iodine in pregnant women, 30 minutes before the meal, 30–40 mg thymazole has been prescribed. It has been established that the course of pregnancy is proportional to the density of thyroid hormones. The thickness of thyroid hormones in the blood is regulated as a result of the treatment. It has been established that the alteration in the density of hormones in the pathological direction is a risk factor for the flawed development of the fetus in the prenatal period. Based on the findings, we conclude that in pregnant women with pathology of thyroid gland, pregnancy should be determined at the end of first, second and third trimester, and blood pressure should be adjusted to include thyroid hormones, including thyroid-stimulating hormone, triiodothyronine and thyroxine. If an imbalance of hormones is detected, drug therapy aimed at regulating the level of thyroid hormones in the blood is recommended.

Clinical and functional features of renal dysfunction are considered in patients suffering from chronic obstructive pulmonary disease and arterial hypertension. It was found that left atrial hypertrophy in patients suffering from chronic obstructive pulmonary disease, without concomitant arterial hypertension, is 13,9%, with concomitant pathology – 9,37%. In the general group of patients, the frequency of the hypertrophic type of diastolic dysfunction of the left ventricle occurs in 26,7% of cases. The revealed tendency to dilate the left atrium may be associated with impaired diastolic function of the left ventricle. In the group of patients with a combination of chronic obstructive pulmonary disease and arterial hypertension, the frequency of remodeling of the right ventricle of the heart is significantly higher compared to the group of patients without arterial hypertension (21,3% versus 14%), which is due to the complex picture of structural changes in the right ventricle due to ventricular septal hypertrophy and its displacement towards the left ventricle. In addition, with a combination of chronic obstructive pulmonary disease and arterial hypertension, the frequency of diastolic ventricular dysfunction is also significantly higher compared to the group of patients without arterial hypertension (51,1% versus 30,2%). At the same time, the frequency of right ventricular hypertrophy is less in comparison with a group of patients suffering from chronic obstructive pulmonary disease in combination with arterial hypertension. We believe that right ventricular myocardial hypertrophy is a very late and even optional stage in the development of chronic pulmonary heart and right ventricular heart failure, since right ventricular dilation occurs in the initial stage of the disease. Levels of cystatin C and microalbuminuria significantly increase as chronic obstructive pulmonary disease progresses. The presence of a correlation between these markers of renal dysfunction and heart remodeling parameters was revealed, which indicates the contribution of the hemodynamic factor to the progression of chronic kidney disease in patients suffering from chronic obstructive pulmonary disease. An increase in the level of cystatin C in chronic obstructive pulmonary disease is consistent with the results of studies by other authors. Moreover, such deviations are associated with the systemic effects of obstructive pulmonary disease.

The possibilities of assessing the right chambers of the heart and the estimated systolic pressure in the pulmonary artery at rest and against the background of physical activity in the early stages of pulmonary sarcoidosis in the absence of clinical manifestations and obvious complaints of patients are considered. Has been established that the most dangerous conditions for pulmonary sarcoidosis may be the progression of the disease with the formation of pulmonary fibrosis and heart damage. In addition to the primary involvement of the heart, which is less common in clinical practice, heart damage occurs in the form of an overload of the right chambers with the development of pulmonary hypertension. In the early stages of the disease, as a rule, little attention is paid to the examination of the heart in patients with sarcoidosis, due to the lack of clinical manifestations and complaints, therefore, it remains important to perform early diagnostic measures in order to prevent the development of the pathological process and correct treatment. According to the Federal Clinical Guidelines for the Diagnosis and Treatment of Sarcoidosis (2016), echocardiography is not included in the mandatory list of examination of patients suffering from lung sarcoidosis, and is prescribed at the discretion of the attending physician. There is a small amount of work in both domestic and foreign literature on the assessment of the right heart chambers in patients with pulmonary sarcoidosis using modern echocardiographic techniques such as global longitudinal deformation of the right ventricle and ejection fraction in 3D mode. One of the promising methods is the determination of global longitudinal myocardial deformation, the reduction of which can serve as an early predictor of myocardial dysfunction.

The prevalence and structure of chronic diffuse liver diseases of non-viral etiology in 282 military men of the Western military district of different types of troops was studied. These diseases were detected in 164 (58,1%), of which non- alcoholic fatty liver disease was detected in 94 (33,3%) people, alcoholic liver disease – in 22 (7,8%), fatty liver disease of alcoholic metabolic etiology – in 48 (17%) of the examined. There were no cases of cholestatic, drug and autoimmune liver damage in the examined contingent. The proportion of favorable variant of chronic diffuse liver disease in the form of steatosis in persons suffering from non-alcoholic fatty liver disease was 80,9%, with alcohol-metabolic lesions – 75%, in the group of alcoholic liver disease – 100% of cases. The ratio of nosological forms in the structure of incidence of chronic diffuse liver diseases in the examined contingent was as follows: non-alcoholic steatosis – 46,3%, non-alcoholic steatohepatitis – 11%, alcoholic steatosis – 13,4%, alcoholic-metabolic steatosis – 22%, alcoholic-metabolic steatohepatitis – 7,3%. It was revealed that after 30 years the number of persons suffering from chronic diffuse liver diseases increased significantly (p<0,05) from 46,4 to 61,8%, mainly due to the increase in the incidence of fatty liver disease of alcoholic and metabolic etiology from 4,9 to 22,1%. The modulus of liver elasticity characterizing the degree of fibrosis in the group of non-alcoholic fatty liver disease and fatty liver disease of alcoholic metabolic etiology (5,8 kPa [5,2; 6,4] and 6,3 kPa [5,2; 7,4], respectively) was significantly (p<0,001) higher than in the control group (4,6 kPa [4,3; 4,9]). The controlled parameter of ultrasound attenuation reflecting the degree of steatosis in patients with non-alcoholic fatty liver disease and fatty liver disease of alcoholic metabolic etiology was higher than normal parameters (280 dB/m [268; 291], 303 dB/m [284; 322] and 233 dB/m, respectively) and significantly (p<0,001) differed from the values of the control group (223 dB/m [214; 233]). The degree of steatosis in the group of fatty liver disease of alcoholic metabolic etiology was significantly (p<0,05) higher than in the group of non-alcoholic fatty liver disease.

The results of the incidence of acute respiratory viral infection in the village of Poltava in the Krasnoarmeysky district of the Krasnodar Territory in the epidemiological season (December 2018 – March 2019) are presented. There were 120 people under the supervision of 18 to 79 years of age who sought medical help from a local GP in this time range with complaints of fever, weakness, headache, cough, sleep disturbance, sore throat when swallowing, chest pain cage, nasal congestion and hoarseness of voice. All applicants were diagnosed with Acute Respiratory Viral Infection. In all cases, the diagnosis was based on the collection of complaints, anamnesis, physical examination data, a clinical blood test with a white blood cell count and a general urinalysis. It was established that the body temperature of patients with adequately prescribed therapy and the implementation of all the prescribed recommendations lasted from three to five days from the start of treatment, in rare cases up to seven days. The duration of the disease and the number of days of disability during inpatient treatment most often ranged from 10 to 15, with outpatient treatment – 5–10. In rare cases, the duration of the disease and treatment was several days. In the treatment of acute respiratory viral infection, the following drugs were used: Tamiflu, Nomides, Influceil, Ingavirin, Kagocel and Ergoferon.

It was performed a comparative analysis of the hospitalization and operation terms with morphological changes of appendices, removed from 316 patients with acute appendicitis, treated at the St.-Petersburg Research Institute of Emergency Care named after I.I. Janelidze for the year 2017. The patients were from 19 to 91 years old, with an average age of 36,2±13,63 years. Among the patients, there were 188 (59,5%) men and 128 (40,5%) women. The period from the onset of the disease to the moment of hospitalization ranged from 1,5 to 264 hours (11 days), the median was 14 hours, mode – 24 hours, 75% percentile – 24 hours, 25% percentile – 7 hours. Histological examination of removed appendices revealed catarrhal appendicitis in 23 (7,3%) cases, phlegmonous in 232 (73,4%), gangrenous in 48 (15,2%) cases, chronic appendicitis in 1 (0,3%) case. In 3 (0,9%) cases dense appendicular infiltrates were diagnosed and treated conservatively. Tumors were detected in 6 (1,9%) cases. The time required for hospitalization of patients with catarrhal appendicitis was from 2,75 to 120 hours from the onset of the disease, the median – 14 hours, mode – 6 hours, 75% percentile – 24 hours, 25% percentile – 6 hours. The duration of the examination and observation from the moment of appellation for medical treatment to the operation was from 2,68 to 35 hours, the median – 7 hours, mode – no, 75% percentile – 10,9 hours, 25% percentile – 4,5 hours. The period from the moment of onset of the disease to operation was from 7,5 to 120 hours, the median – 24 hours, mode – 36 hours, 75% percentile – 36 hours, 25% percentile – 16,8 hours. Observation in doubtful cases compensated early hospitalization and reduced number of operations for catarrhal appendicitis to 7,3%. At the same time, there was only 1 (0,3%) case of the removal of appendix with signs of only chronic appendicitis.

The features of the formation of the rear deformation of the armored panel as the main mechanism for the development of an armored person’s armor injury protected by a bullet-proof vest during non-penetration using the modern research method - high-speed video filming are investigated. An analysis of the combat pathology of modern military conflicts has shown that a hit of an injuring element in a body of a serviceman protected by body armor can lead to injury to him, which differs in a number of indicators from a «classic» gunshot injury. These injuries are commonly referred to as behind armor blunt trauma in foreign literature or closed localized contusion injury in domestic sources. Closed injury of this etiology can manifest itself in the form of injuries of the skin and subcutaneous tissue with the formation of hemorrhages, and in injuries of internal organs, accompanied in severe cases by ruptures of the liver and lungs with the development of life-threatening complications – intense pneumothorax, intraperitoneal bleeding, etc. In the course of conducting experimental research, it was shown that the design of modern body armor allows effectively countering their penetration by most of the bullets of modern small arms ammunition, but does not completely level the magnitude of the impact pulse transmitted through armor to the protected object. The differences in the physical processes of the formation of rear deformation, which can lead to a direct deformation of a bulletproof vest in the case of «soft» armor based on ballistic fabrics, and to deformation with destruction in «hard» armor made of a ceramic composition are revealed. With the help of high-speed video filming of the impact of the striking element on the armor panel, the features of the behavior of the protective composition were visualized in time. The main amplitude – time parameters of the process of formation of the rear deformation (bulge) corresponding to the 2nd pressure peak in gelatin blocks and causing a local impact, characterizing the development of the temporary cavity that directly influences the severity of closed localized contusion injury, were evaluated. It is proved that the analysis of the characteristics of the subsequent process of movement of the armor plate itself, which leads to the action of a «distributed» impact on the torso, allows us to estimate the possible impact force of the entire armor panel on the object of protection and predict its biological consequences in the form of a blunt-injury blunt injury.

The high demands presented for a hand, as one of the most difficult segments in the anatomical, surgical and functional aspects, are due to a wide range of tasks performed daily by a person with the hand and fingers. The accuracy of manipulations with small-sized objects is due to the ability of a person to oppose the I finger to all three-phalange fingers. The loss of this movement due to injuries of the motor branches to the muscles of the elevation of the first finger leads to significant functional losses up to professional unsuitability. In relation to substantiating the possibility of peripheral nerve restoration by their end-to-side connection, a comprehensive applied anatomical and special X-ray examination was performed on 29 weakly fixed upper limbs of corpses in order to study the features of the topography of the motor branch of the median nerve to the muscles of elevation of the first finger. In the composition of the median nerve, at the level of the lower third of the forearm and wrist channel, the perineural cases forming the return motor branch to the muscles of the elevation of the first finger occupy the most lateral position. After moving away from the main trunk, the motor branch bends around the lower edge of the transverse ligament of the wrist and goes to the innervated muscles from the bottom up, from the inside out and from back to front, forming a bend. The muscular gates of the motor branch are determined at the level of the proximal third of the II metacarpal bone with a distance of 3,83±1,19 and 4,19±1,43 cm, respectively, from the distal folds of the wrist and the line connecting the styloid processes of the radius and ulna. Between the distance of the entrance gate of the motor branch of the median nerve and the length of the hand, a pronounced positive correlation is determined. The interval within which the muscular gates of the motor branch of the median nerve are located relative to the distal fold of the wrist exceeds the range of the sum of the diameters of the II and III fingers. This circumstance indicates the probable location of the motor branch and beyond the «forbidden zone» of the hand, determined by blocking it with the II and III fingers below the distal fold of the wrist. The presented data characterize the features of the topography of the distal branches and the intra-trunk structure of the median nerve. The potential possibility of selective mobilization of motor branches at the level of the distal forearm and hand for performing reconstructive interventions aimed at restoring the innervation of the muscles of the elevation of the first finger is demonstrated.

In an experiment on irradiated rats, the effect of prophylactic and therapeutic administration of recombinant flagellin on the course and outcomes of acute radiation damage, as well as peripheral blood parameters, was studied in dynamics. It has been established that the anti-radiation activity of recombinant flagellin is most effective when prophylactically administered 15-30 minutes before irradiation. Thus, when rats were irradiated at a dose of 6 Gy, the survival rate of animals in the control group by the 30th day was 50±14%, and the average life expectancy was 23±3 days. In the case of prophylactic administration of recombinant flagellin at a dose of 100 μg/kg, the survival of irradiated rats increased by 33%, and the average life expectancy by 5 days was 83±11 and 28±2 days, respectively. The introduction of recombinant flagellin in dosages of 1 and 10 μg/kg was not very effective. With the introduction of recombinant flagellin after irradiation, the radioprotective effect of the drug could not be detected. To elucidate the mechanisms of action of recombinant flagellin, its effect on the peripheral blood indices of irradiated animals was studied. In animals of the control group irradiated at a dose of 6 Gy, pronounced leukopenia was observed in the peripheral blood. By 3 days after irradiation, a decrease in the level of leukocytes to 5,1×109/L was noted. As the hematological syndrome of acute radiation damage developed, leukopenia progressed and by 9 days the leukocyte level was 3,2×109/L. On the 14th day, a gradual recovery of the leukocyte pool was noted, in which an increase of almost 2 times was noted compared with 9 days, which amounted to 7×109/L. The recovery of leukocyte levels to reference values was recorded by 25 days, when their level was 31×109/L. All this suggests that the introduction of recombinant flagellin before irradiation at a dose of 100 μg / kg has a protective effect on hematopoietic and bone marrow cells of irradiated rats at a dose of 6 Gy. The results confirm the literature on the prospects of further research aimed at the development of flagellin- containing chemical protection against radiation damage.

The etiology of community-acquired pneumonia among conscripts was determined, the effectiveness of 13-valent pneumococcal conjugate vaccine for the prevention of pneumonia in military teams was studied in comparison with the effectiveness of non-conjugate 23-valent pneumococcal polysaccharide vaccines, and the effectiveness of a number of antiviral immunotropic drugs for the prevention of acute respiratory diseases in military personnel was evaluated. It is established that in the etiology of pneumonia in military conscripts prevail S. pneumoniae and adenoviruses, whose genetic material was found in 56,3 and 35,9% of samples, respectively. 56,1% of pneumonia had mixed, mainly viral-bacterial etiology. 13-valent conjugate pneumococcal vaccine has been shown to be more effective in preventing community-acquired pneumonia in military teams than the commonly used non-conjugate 23-valent polysaccharide vaccine. It was found that the use of conjugate vaccines among soldiers formed a collective immunity that prevents the circulation of pneumococci and the development of diseases not only in vaccinated but also in unvaccinated persons. Vaccines of both types can equally be recommended for vaccination of conscripts one month before the conscription and soldiers not vaccinated before the conscription. The efficiency of the use of immunotropic antiviral drugs cyclopheron and kagocel together with vaccination against pneumococcal infection and influenza for the prevention of acute respiratory diseases is shown.

The results of the assessment of the indicators of disability; the level and structure of hospitalization for the period from 2013 to 2018 and the analysis of financial and economic spends connected with the respiratory diseases among the cadets studying in a military educational organization are presented here. In the course of the conducted study; it has been specified that respiratory diseases occupy a leading position in the morbidity structure of cadets; in conjunction with their hospitalization and temporary disability. The greatest financial and economic costs in diseases of the respiratory system are caused by community-acquired pneumonia; as well as acute bronchitis and the widespread pathology of the ear; nose and throat; such as the curvature of the nasal septum. We believe that this is connected with a long stay in hospital (21; 10 and 12 bed days; respectively); as well as the severity of the disease course and the complications. The fulfilled assessment of the socio-economic spends by the respiratory system diseases of cadet students studying in a military educational organization shows their relevance and significance; which are determined by their specific nosological forms. The results obtained can contribute to a more objective redistribution of financial resources; as well as to planning the most optimal and effective diagnostic and sanitary anti-epidemic measures. The monitoring and preventing respiratory diseases are of great social importance; since they are allow to reduce the incidence of disease; improve the treatment outcomes; as well as efficiently and competently allocate the resources. In this connection; the procedure for organizing and implementing the prophylaxis of respiratory organs diseases is one of the priority direction in the medical support of military students.

Based on the content analysis of legislative and legal acts, as well as official documents of the Ministry of Defense of the Russian Federation in the field of medical provision of flights safety, the features of the professional practice of an aviation doctor in the field of medical provision of flights safety were studied. A comparative analysis of the functional responsibilities and lines of activity of the head of the medical service of the aviation unit and the heads of other services involved in ensuring safety during flight operations is carried out. It was established that, despite the same number of main lines of activity and functional responsibilities, the head of the medical service has a many times more duties that directly affect flight safety. The main focus of the work of an aviation doctor, comprising more than ninety percent of his functional duties, is to ensure flight safety. In order to quantify and qualitatively assess the content of the professional activities of an aviation doctor in the field of medical provision of flights safety, a comparative analysis of the time allotted to the head of the medical service (aviation doctor) was performed to perform the actions prescribed by the governing documents in order to prevent accidents, depending on the stage (period) training and flight operations. It was revealed that the aviation doctor carries out a whole complex of multidirectional activities in the framework of medical support for flight safety in a strictly limited time. It is noted that in modern conditions, in order to successfully resolve issues of medical safety of flights, when training an aviation doctor, it is advisable to place additional emphasis on the formation of mental stability, the necessary psychophysiological and moral-volitional qualities.

The objective reasons for which there are difficulties in the legal and forensic expert assessment of the correctness, completeness and timeliness of the provision of medical care are considered: 1) disordered regulatory framework governing medical activities; 2) insufficient number of specialists narrowly focused on medical law; 3) the need for a retrospective legal and expert assessment of events; 4) the existence of various approaches to the provision of medical care and assessing its impact on outcome both among forensic experts and among experts and lawyers. Statistical data are provided, indicating an increase in the number of «medical cases» over the past 15 years, significant regional differences in the number of criminal cases initiated and the outcome of their investigation. It is shown that the uniformities of medical activity (orders and standards), although they formalize medical activity and the possibility of evaluating its results, at the same time create prerequisites for substituting substantive for formal arguments for the conclusions of forensic experts. The most common shortcomings made by investigators and representatives of the judiciary conducting «medical cases» are systematized. Possible ways to overcome the considered shortcomings (regulatory, organizational, scientific, methodological) are presented. Considering global trends, an opinion was expressed on the need for a fundamental change in the approach to assessing the results of the relationship between a doctor and a patient - this problem is to a greater extent not a criminal law problem, but a civil law one and should be solved at the level of insurance companies, mediators and arbitration courts.

The modern approaches of clinical and economic analysis used to study the economic efficiency of medical technologies in medicine are described. It is known that one of the main directions of increasing the effectiveness of medical care is the optimization of healthcare costs. The criterion for assessing this activity is a clinical and economic analysis, which is based on a comparative assessment of the quality of two or more methods of prevention, diagnosis, drug and non-drug treatment, rehabilitation as well. In world practice, five basic methods of clinical and economic analysis are used: analysis of «minimizing costs», analysis of «costs – efficiency, analysis of «costs – benefits», analysis of «costs – utility», methods of economic modeling. In Russia, according to the industry standard «Clinical and economic research. General Provisions» (InStd 57525-2017), that is improved by order № 655-st of the Federal Agency for technical regulation and metrology on july 6-th 2017, distinguish between the main (correlation between costs and results obtained) and auxiliary clinical and economic analysis methods. It has been established that the most common option for clinical and economic analysis in urological practice is the «cost minimization» methodology, which allows one to evaluate the economic efficiency of two or more medical treatment methods with the same clinical performance but different cost. An insignificant number of publications on this problem may indicate insufficient attention of specialists to the issues of clinical and economic analysis in the treatment of urological diseases.

The contribution of the distinguished scientist and teacher, world renowned orthopedic surgeon, father of the national orthopedics and founder of the first orthopedic clinic in Russia – professor Henry Ivanovich Turner in the evolvement of the spinal disorders science is analyzed in this article. Of all fields of orthopedic science Henry Turner paid special attention to the spinal disorders. His main research directions included the study of scoliosis, inflammatory spinal diseases, spinal trauma and anomalies, Bechterew’s disease. Henry Turner identified congenital and secondary causes of spinal disorders. In his works on conservative treatment of scoliotic spine deformities he emphasized the importance of physical exercise and spinal corsets treatment. Profound knowledge of the spine biomechanics and clinical manifestations of the disease let him to define the requirements for scoliosis treatment corsets. Pioneer in science, Henry Turner was one of the first in Russia to recognize the significance and prospects of the surgical treatment of severe spine deformities. He disapproved ineffective «short» fusion and fusion on the maximum spine curvature surgery, as well as isolated muscle surgery. In his articles on management of spondylitis of various etiology Henry Ivanovich outlined the clinical picture of the disease, proved the necessity of hard spine immobilization and suggested glue-lignin corset affordable for the most patients. Contribution of Henry Turner in the research of spondylolysis and spondylolisthesis can hardly be overestimated. He described in detail clinical and pathoanatomical signs of the disease, and defined the «telescopic body» symptom and radiographic signs of «sparrow tail» and «gendarme hat» which became classic.

A review of the current literature on the relationship of sarcopenia and chronic kidney disease is presented. Sarcopenia is considered as a common clinical syndrome, with irreversible consequences, such as deterioration of self-care and quality of life, leading to disability (falls and fractures, type 2 diabetes, osteoporosis, cardiovascular diseases and their complications, etc.), an increased risk of iatrogenic complications, hospitalization and the development of death. This process is associated with aging, but is often found in certain diseases and at a young age. Sarcopenia is one of the leading causes of mortality in the elderly and senile. This pathology is rarely diagnosed, despite the fact that it makes a significant contribution during the course of the disease, especially in the older age group. Sarcopenia as a component of comorbidity almost always accompanies advanced and terminal stages of chronic diseases such as chronic heart failure, chronic obstructive pulmonary disease, cancer, liver cirrhosis, diabetes mellitus, rheumatoid arthritis, chronic kidney disease, etc. Sarcopenia and chronic kidney disease closely interconnected by common pathophysiological mechanisms of development, which complicates the course, diagnosis and treatment of the disease. Over the past decades, the problem of sarcopenia has been actively investigated, in connection with which its social and economic aspects have been studied. At the same time, measures aimed at the treatment and prevention of sarcopenia are not well understood and can be significantly difficult and limited due to the presence of concomitant pathology, as well as age-related characteristics of the body.

The relationship of obstructive sleep apnea and road accidents due to sleep while driving is considered. It was established that traffic accidents due to falling asleep while driving are most often accompanied by fatalities and serious injuries, since the driver is unable to take any action to reduce speed or avoid obstacles. The demographic damage from traffic accidents and their consequences annually is about 30 thousand people. The literature data describing the organizational and legal aspects of road traffic injuries in patients with night apnea are summarized. The current level of organization of medical care for patients suffering from obstructive sleep apnea syndrome does not correspond to the level of diagnosis and treatment of the disease in these patients. The list of diseases that may serve as a basis for limiting the issuance of a driver’s license does not include obstructive sleep apnea. The legal aspects of the consequences of traffic accidents due to sleep while driving are shown. The question of the responsibility of doctors who did not diagnose obstructive apnea syndrome in the classic picture of the disease is raised. An attempt was made to justify the need to adjust existing domestic regulatory legal acts in relation to conducting a mandatory examination of drivers for the presence of obstructive sleep apnea syndrome and medical road safety.

In terms of professional activity, radiation injuries caused by internal radiation occur during ground and underwater explosions of nuclear devices, when together with dust and water, fission fragments of uranium nuclei enter the body. This might happen in case of destruction of the core of a nuclear reactor, accompanied by inhalation or oral ingestion of a fragments mixture of radionuclides fission into the body, in safety precautions breach when working with open radioactive substances, as well as in case of an overdose of radioisotopes introduced into the body for therapeutic or diagnostic purposes. Radiation disease caused by internal exposure is a collective concept to a certain extent, due to the variety of clinical manifestations of the disease, depending on the properties of incorporated radionuclides. For this reason, a number of researchers consider its several variants as independent clinical forms: «plutonium», «polonium», «radium», «tritium» disease, etc. Acute radiation disease caused by internal radiation as an isolated form is extremely rare. More often, chronic radiation disease develops due to prolonged contact of a person with radionuclides when they enter the body. The diagnosis of radiation disease caused by internal exposure is based on professional history, clinical manifestations and the results of dosimetric, radiometric and laboratory examinations. It is indispensable for the successful treatment of radiation disease caused by internal exposure to remove the victim from working with a source of ionizing radiation. Further treatment is carried out according to the same principles as the treatment of radiation disease due to external influences: it must be comprehensive, individual and appropriate to the severity of the disease. At the same time, conventional treatment is supplemented by medications and methods that limit the absorption and fixation of radioactive substances in organs and tissues and accelerate their excretion from the body. The medications used when radioactive substances enter the gastrointestinal tract are combined with gastric lavage, cleansing enemas, the use of laxatives, forcing diuresis, and with their inhalation, mucolytics and expectorant medications are used.

The structural analysis of modern views on the physiology of spasticity is presented. Based on the well-known provisions on the physiology of movement and the pathophysiology of damage to the upper (first, central) motor neurons, a hypothesis is developed for the development of spasticity as an «incomplete movement», its individual provisions are formulated. In the context of the stated hypothesis, explanations are given to some clinical phenomena and the definition of spasticity is formulated. An explanation of the variability of the patterns of spasticity is proposed both within the framework of one pathology and with various nosological forms. The main strategies in the treatment and rehabilitation of the syndrome of damage to the upper motor neurons are formulated and their physiological justification is given. From a new point of view, the effectiveness of some rehabilitation techniques (therapeutic styling, taping, early use of physiotherapy exercises, creating a comfortable environment, etc.) has been comprehended. Particular attention is paid to the effects of the administration and pharmacodynamics of type A botulinum neurotoxin preparations. A pathophysiological rationale for the reciprocating positive dynamics in the treatment of spasticity with botulinum toxin drugs is proposed as part of the overall rehabilitation process, which gives grounds to consider botulinum neurotoxin injections as an essential element of rehabilitation programs. The proposed hypothesis of «incomplete movement» allows to take a fresh look at the pathophysiology of spasticity, its clinical manifestations and answer many questions. Nevertheless, it requires critical consideration and the formation of an evidence base to confirm the hypothesis.

The experience of organizing the treatment of the wounded and sick Red Army soldiers in the rear hospitals deployed during the Great Patriotic War in the territory of Saratov and the region is generalized. The key factors that influenced the adoption of priority decisions in the first months of the war, as the enemy approached the region and during the offensive of the Red Army to the west, were published. The structure of injuries and injuries with which Soviet soldiers and officers were sent from the front to the evacuation hospitals of the city and the region is given. Attention is drawn to the change the severity and location of wounds, depending on the strategic situation at the front. The consistency and flexibility of the organization of the treatment process are considered, which has become one of the important factors that contributed to the successful treatment and return of hundreds of thousands of servicemen, including the heaviest contingents. The enormous physical load, dedication and responsibility carried by the medical staff of evacuation hospitals, the population of the city and the region in the conditions of mass receipt of the victims from the battlefields were underlined. The results of the medical and diagnostic work of the Saratov hospital base during the Great Patriotic War were summed up. Attention is drawn to the fact that the specialization of the hospital bed was made in accordance with the structure of the combat trauma, which was different depending on the period of the war. Published data on the number of beds that were transferred from the Saratov hospital base to the Army in force. The above data testify to the unique experience of mass reception, sorting and treatment of hundreds of thousands of servicemen in evacuation hospitals deployed in Saratov and the region. The experience that requires detailed study is in demand for the training of modern specialists, paid for by the human blood and can not be forgotten.

The life and career of a well-known military therapist, corresponding member of the Russian Academy of Medical Sciences, lieutenant general of the medical service Yevgeny Vladislavovich Gembitsky is highlighted. E.V. Gembitsky was born on October 7, 1919 in Astrakhan in the family of a doctor. After graduation, he entered the Astrakhan Medical Institute, and after completing the 2nd year he transferred to the Kuibyshev Military Medical Academy. In August 1941, after completing the 4th year of the academy, Evgeny Vladislavovich was sent to the army in the rank of ordinary doctor. His military career was on the Western, Kalinin, Volkhov, 2nd Baltic fronts. In 1944, E.V. Gembitsky completed his education at the S. M. Kirov Military Medical Academy and was enrolled in the medical department of the faculty of training leading medical staff. After graduating from the faculty, he served as a resident and head of the therapeutic department of the district hospital of the Primorsky Military District. In 1948, E.V. Gembitsky enrolled in the Department of Hospital Therapy of the S. M. Kirov Military Medical Academy, in 1952 he defended his thesis on the topic: «The state of hemodynamics in primary hypotension» and was left at the department as a junior teacher and then a teacher. In 1953, E.V. Gembitsky was appointed chief physician of the Central Group of Forces, since 1955 – chief physician of the Northern Military District. In 1958, E.V. Gembitsky returns to the S. M. Kirov Military Medical Academy. For a short time, he is a teacher in the department of field therapy, then he is appointed to the post of teacher, and then senior teacher in the department of therapy for advanced training of doctors No. 1 of the S. M. Kirov Military Medical Academy. In 1966, he defended his doctoral dissertation on hypotonic conditions in individuals exposed to physical and chemical factors, and in January 1967 he was appointed head of the department of military field therapy of the academy, which he directed for 10 years. In December 1977, E.V. Gembitsky was appointed chief physician of the Ministry of Defense of the Union of Soviet Socialist Republics, he was awarded the next military rank of lieutenant general of the medical service. With the outbreak of hostilities in Afghanistan, he had to solve many problems of organizing therapeutic assistance in the troops of the 40th Army, and during the accident at the Chernobyl nuclear power plant – to direct the work of military physicians directly at the crash site. Evgeny Vladislavovich lived a wonderful life worthy of imitation. His many associates, students and patients will forever retain the bright image of this highly intelligent, kind and responsive person, an outstanding scientist, doctor, and teacher.

November 13, 2019 marked the 70th anniversary of the head of the Department of Operative Surgery (with topographic anatomy) of the Military Medical Academy named after. CM. Kirov (VMA) - Honored Worker of Higher School of the Russian Federation, Doctor of Medical Sciences, Professor, Colonel of the Medical Service, retired Nikolai Fedorovich Fomin.