Russian Military Medical Academy Reports

A feature of modern military conflicts is the high frequency of shrapnel wounds. The search for foreign bodies, even under X-ray navigation, can be technically difficult, lengthy and not always successful. Most injuring objects have ferromagnetic properties.

AIM: The Military Medical Academy, Saint Petersburg purpose of the study: to evaluate the effectiveness of removing ferromagnetic foreign bodies from blind wounds using neodymium magnetic instruments.

MATERIALS AND METHODS: Instruments based on a neodymium magnet for removing foreign bodies and a technique for their use have been developed. An analysis was made of 45 operations where traditional instruments were used and 75 operations using original magnetic instruments. Of these, in 40 cases of blind wounds, foreign bodies were removed from the soft tissues of various areas, and in 35 cases, foreign bodies were removed during videothoracoscopy operations for blind penetrating chest wounds. The criteria for evaluating the effectiveness of the method were the duration of the operation, the duration of work with the X-ray unit and the number of detected and removed foreign bodies in a fixed period of time.

CONCLUSION: High efficiency, simplicity, accessibility, minimally invasiveness of the developed instruments have been proven. Neodymium magnets made it possible to reduce the time of radiation exposure and the duration of the operation, to increase the efficiency of removing ferromagnetic foreign bodies. The use of original instruments makes it possible to detect 80% of foreign bodies in 10 minutes, and within 30 minutes to remove 90% of foreign bodies from the soft tissues of the wounded. With videothoracoscopy, the time of fluoroscopy was halved, and the total duration of the surgical intervention was reduced by 40%.

BACKGROUND: It is known that the development of the carious process is promoted by microorganisms that secrete waste products that penetrate into the tooth tissue during the depressurization of the filling material. That is why high-quality restoration prevents the development of secondary caries.

AIM: Based on the study of the edge fit of restorations made of various types of filling materials, when restoring the chewing surface of the tooth, to determine the most optimal method of filling, which reduces the likelihood of violation of the edge fit of the seal in cases of significant changes in atmospheric pressure.

MATERIALS AND METHODS: The removed teeth were prepared and treated with the Single Bond Universal adhesive system, the samples were divided into 4 groups, the cavities were filled according to the classical method with traditional composite materials Estelite Sigma Quick (Tokuyama Dental), OptiShade (Kerr) and materials of the bulk fill Tetric N-Ceram (Ivoclar Vivadent), SonicFill (Kerr). After sealing, groups 3 and 4 were placed in a pressure chamber (the study was conducted at the Department of Aviation and Space Medicine) and exposed to low atmospheric pressure. Next, the restoration slots were made and the study was carried out using a scanning electron microscope JEOL JSM-6380LV.

RESULTS: As a result of microscopic studies, a violation of the marginal fit along the filling-tooth border was determined in all samples sealed with traditional composite materials (Estelite Sigma Quick, OptiShade) 65 ± 9.18% (p < 0.05) and bulk fill group materials (Tetric N-Ceram, SonicFill) 98 ± 2.69%, (p < 0.05) in cases of exposure to low atmospheric pressure. In the samples that were not exposed to atmospheric pressure, the marginal depressurization was 12 ± 6.25% (p < 0.05) — Estelite Sigma Quick, OptiShade and 21 ± 7.84% (p < 0.05) — Tetric N-Ceram, SonicFill.

CONCLUSION: It has been proved by laboratory method that traditional composite materials and bulk fill group materials are rational to use only in persons who are not associated with extreme effects on the body, since in cases of exposure to atmospheric pressure, there are violations of the marginal fit of the material along the seal–tooth border.

AIM: The aim of the study was to evaluate the effectiveness of the organization and medical provision of complex specific antenatal and postpartum prevention of primary isoimmunization with domestic anti-Rh0(D) immunoglobulin in Rh-negative women.

MATERIALS AND METHODS: To achieve the goal, an algorithm for managing pregnancy in Rh-negative women was developed, complex antenatal and postpartum prophylaxis of primary isoimmunization with anti-Rh0(D) immunoglobulin was carried out, and its effectiveness was evaluated in 37 women who gave birth to Rh-positive newborns. If antibodies to the Rh0(D) antigen were not detected, then at 28 weeks pregnant women were administered human immunoglobulin anti-Rh0(D) at a dose of 1500 IU (300 μg). Anti-Rh0(D) antibody titer was monitored every 2–3 weeks before delivery. Mothers were re-introduced with human anti-Rh0(D) immunoglobulin at a dose of 1500 IU (300 μg) within 24–72 hours after the birth of an Rh-positive child. 6 months after delivery, the antibody titer to the Rh0(D) antigen was re-determined.

RESULTS: After the introduction of domestic human immunoglobulin anti-Rh0(D), side effects and allergic reactions were not registered. All 37 (100%) women were delivered at term, of which 7 (18.9%) were delivered abdominally. All newborns were born with an Apgar score of 8–9 without hemolytic disease. The titer of antibodies to the Rh0(D) antigen was negative in 24 (64.9%) women 6 months after delivery. 13 (35.1%) mothers had a post-vaccination antibody titer not higher than 1 : 2, which is allowed by the instructions for the anti-Rh0(D) human immunoglobulin preparation. They tested negative again 12 months after delivery.

CONCLUSION: The results of the study showed a rather high efficiency of the organization and medical provision of complex specific antenatal and postpartum prevention of primary isoimmunization with domestic anti-Rh0(D) immunoglobulin in Rh-negative women.

BACKGROUND: Despite the abundance of research in the field of high-altitude physiology and medicine, the problem of resistance to moderate hypoxia has not been practically studied. This is partly due to methodological difficulties: the studies were conducted on healthy people and climbers who tolerated the effects of moderate hypoxia well. Such studies have become necessary in connection with the development of hypoxic therapy.

AIM: To search for indicators of the functional state of a person that are highly sensitive to the effects of moderate hypobaric hypoxia.

MATERIAL AND METHODS: The examined group consisted of 65 practically healthy men aged 19–25 years who were selected for work in high mountains. The main indicators characterizing the state of the central nervous system, cardiovascular and respiratory systems were studied in a state of relative rest and when performing a dosed two-stage bicycle ergometric test, in normoxia conditions (altitude 0) and during a pressure chamber rise in the TABAY climate complex (Japan) to altitudes of 3500 and 4500 m Statistically analyzed were the characteristics of the dynamics of indicators during the transition from normoxia to states of moderate hypoxia, correlations between indicators, their sensitivity to hypoxic effects, the significance of reactivity to hypoxic effects and mobilization of the body’s functional reserves in resistance to hypoxia.

RESULTS: It has been shown that the key pathophysiological markers of reduced body resistance to moderate hypoxic exposure are a rapid decrease in the level of peripheral blood saturation, high reactivity of the cardiovascular and respiratory systems to hypoxic exposure, as well as excessive mobilization of the body’s functional reserves in response to additional physical activity.

CONCLUSION: The presented materials confirm that the functional state of a healthy person under conditions of moderate hypoxia at rest is determined by the level of saturation of his peripheral blood. Maintaining saturation at a higher level ensures the maintenance of an optimal level of functional state, physical and operator performance, a lower degree of stress on the respiratory and cardiovascular systems.

The use of cannabis as a therapeutic agent in medical practice in the Russian Federation is one of the current and discussed issues. Cannabis is the tops of the eponymous plant of the genus cannabis (Cannabis sp.) with flowers or fruits (with the exception of seeds and leaves, if they are not accompanied by tops), from which resin has not been extracted, no matter what name they are designated, as well as other products from this plant. More than 400 different chemical compounds have been found in the chemical composition of the above-ground part of cannabis, of which 61 are cannabinoids. Among cannabinoids the most studied are tetrahydrocannabinol, cannabidiol and cannabinol. In Russia, the use of cannabis as a medicine is not currently permitted due to governmental and industrial prohibitions, which limits clinical research to determine the safety and effectiveness of its use in medical practice. At the same time, a number of countries have legalized the use of cannabis for medical purposes. Cannabis-based prescription medications (dronabinol, nabiximols, nabilon, epidiolex) are known to be used abroad to treat various medical conditions. The issue of the use of cannabis for medical purposes on the territory of the Russian Federation requires further elaboration, taking into account the legal and regulatory framework.

The purpose of the article is to introduce into scientific circulation little-known handwritten materials from the library of the Military Medical Academy, containing additions to the facts of the biography, personal characteristics and close circle of the President of the Medical-Surgical Academy, the life physician of the three emperors, Baronet Yakov Vasilyevich Willie. The article presents the historical details of the transfer of the personal archive of the Willie and Ruhl families to the library of the Military Medical Academy by a descendant of famous doctors, a talented artist Mikhail Yakovlevich Willie. Fragments of the correspondence of Willie’s nephew — the full namesake and also the life physician Yakov Vasilyevich Willie Jr. (or 2^nd) — with Scottish relatives and friends are given, in which, in particular, the features of medical education in Russia at the beginning of the 19^th century are revealed. Handwritten in English in an illegible handwriting, the letters of young Willie lay in the manuscript fund for almost 100 years before, thanks to the efforts of the bibliographer Galina Mikhailovna Roslik, they were attracted to the attention of specialists who could read and translate them. The article also describes the details of the career and personal fate of the Scottish doctor Ya.V. Willie II in the Russian service, under Grand Duke Mikhail Pavlovich. The topic of the unprecedented testament of Baronet Willie on the transfer of the entire inheritance for the construction of a civil hospital in memory of Grand Duke Mikhail Pavlovich is touched upon.

An endometrioid ovarian cyst (known as endometrioma) is the most common variant of external endometriosis. Clinical symptoms range from asymptomatic to negatively affecting on quality of life and daily activities of a reproductive age woman. Rupture of an endometrioid cyst with hemorrhage into the abdominal cavity occurs in 3% of women with this pathology, which is a rare complication.

Ruptured endometrioid cysts may present a diagnostic and surgical challenge: patients may have acute abdominal symptoms and hemodynamic instability, also imaging of a ruptured endometrioid cyst may mimic ovarian malignancy. Therefore, the emergency radiologist needs to know the semiotics of an endometrioid cyst with rupture and hemorrhage into the abdominal cavity.

We represent the clinical case of a prime diagnosed large endometrioid cyst in a 32-year-old patient, complicated by hemorrhage in the abdominal cavity. In the emergency department, the patient underwent native computed tomography and ultrasound investigation.

Based on the study of Russian and foreign literature, the review was made about main aspects of radiation semiotics of endometrioid cysts with rupture and hemorrhage in the abdominal cavity and about of differential diagnosis of rupture of endometrioid cysts with ruptures of functional cysts and malignant cystic ovarian formations.