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Vol 39, No 1 (2020)

Articles
PATHOMORPHOLOGICAL CRITERIA FOR EVALUATING DONOR LIVER IN PREDICTING TRANSPLANT RESULTS
Kazakov A.D., Dzidzava I.I., Smorodskiy A.V., Chirskiy V.S., Kharina S.V., Soldatov S.A.
Abstract
Currently, there is a high need for liver transplantation in patients with end-stage chronic diffuse liver diseases. The number of patients on the waiting list is increasing, but the number of potential donors remains low. One of the possible and actual approach to this problem is a definition of the optimal criteria for selecting liver transplants from suboptimal donors. The aim of the study was to determine the influence of morphological features of the donor liver on the post-transplant period. The results of examination and treatment of 18 patients with end-stage liver disease of various etiologies, operated in the hospital surgery clinic in the period from November 2016 to January 2020 years, were analyzed. Anamnestic, clinical, laboratory data of potential (effective and ineffective) donors, pathomorphological characteristics of liver transplants, and their relationship to the development of post-transplant complications, were studied. Studies established that when making a decision about using a graft, it is necessary to pay attention to the anamnestic and laboratory data: the duration of stay in the intensive care unit and the duration of artificial lung ventilation, AST and ALT levels. Their values are significantly higher in patients with low graft quality. The study showed that a visual evaluation of the graft with a zero-biopsy score according to the histological Protocol allows us to determine the graft that is undoubtedly suitable for use, that is important when removing cadaveric liver from suboptimal donors (donors with extended criteria). The main visual parameters are: the color of the parenchyma, form edges, texture, color and impression after holding over the surface of the liver, the color on the cut, color and texture after cold perfusion. Among the histological data: the degree of fat hepatosis, protein dystrophy, hepatocyte necrosis, as well as the final assessment of the Protocol used (3 tables, bibliography: 12 refs).
Russian Military Medical Academy Reports. 2020;39(1):3-8
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THE IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS AND ALZHEIMER’S DISEASE IN THE PRACTICE OF A NEUROLOGIST: COMORBIDITY AND DIFFERENTIATION
Lapina A.V., Lobzin V.Y., Kolmakova K.A., Alizade M.R.
Abstract
In the article was evaluated clinical, neuropsychological, laboratory and neurovisual changes in idiopathic normal pressure hydrocephalus and Alzheimer’s disease. The aim was to improve the diagnosis of idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination based on neuropsychological, cerebrospinal fluid and neuroimaging. There were 60 patients in our study: 20 idiopathic normal pressure hydrocephalus, 17 - Alzheimer’s disease, 8 - their combinations, 15 - control. All conducted advanced neuropsychological testing. A 10 meter test and a TUG test were used to evaluate walking. Interpretation of MR-images was carried out using the following scales: iNPHRadScale, MTA, Koedam, GCA. Lumbar puncture was performed with CSF using an enzyme-linked immunosorbent assay. In the course of this study, specific features of the clinical neuropsychological, cerebrospinal fluid and neuroimaging profiles of patients with idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination were identified, which improves the quality of diagnosis and determines the direction of treatment for these diseases. Results can be used in the assessment of cognitive disorders of various origins. It is proposed to conduct an extended neuropsychological study using specific techniques that evaluate memory and attention. A special role in the diagnosis of idiopathic normal pressure hydrocephalus is played by walking disorders. That is why it is proposed to introduce into clinical practice a mandatory gait study using special tests. The value of the assessment of MR-images using several techniques is shown, which assess both dilatation of the ventricular system and atrophy of the substance of the brain. It is necessary to comprehensively apply these scales for differential diagnosis. Evaluation of biomarkers of amyloidosis and neurodegeneration coefficients are an integral aspect in differentiating these diseases. An algorithm is proposed for mandatory clinical-neuropsychological and laboratory-instrumental examination of patients with cognitive impairment in idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination (4 figs, 7 tables, bibliograp hy: 15 refs).
Russian Military Medical Academy Reports. 2020;39(1):9-16
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GINGIVOTOMY AS THE BASIS OF MINIMALLY INVASIVE TREATMENT OF CHRONIC GENERALIZED PERIODONTITIS IN THE DENTAL OFFICE OF THE MEDICAL ITEMOF THE MILITARY UNIT
Sheenko L.I.
Abstract
Objective. Justification of the effectiveness of the use of gingivotomy as the basis of a minimally invasive method of treating chronic generalized periodontitis in the work of a dentist at a medical unit of a military unit. Materials and methods. A statistical analysis of the performance of dental offices for 2017-2019 was carried out according to the data of the Main Military Medical Directorate according to Form 3/MED. The number of surgical interventions for chronic generalized periodontitis was studied. On the basis of the dental clinic of the Military Medical Academy named after S.M. Kirov was performed statistical processing of treatment data for chronic generalized periodontitis based on the documentation of an outpatient appointment for 2017-2019. Processing statistical data of the study was carried out using the program for working with spreadsheets Microsoft Excel 2016. As a minimally invasive surgical technique aimed at eliminating periodontal pockets, it is proposed to use a modification of the gingivotomy operation with the introduction of Osteomatrix and suturing in the military unit. Results of the study. During statistical data processing it was found that the main method of treating chronic generalized periodontitis in the military unit is tooth extraction. In a polyclinic unit (using the example of a dental clinic of the Kirov Military Medical Academy) tooth extraction for periodontitis is carried out strictly according to indications, curettage of periodontal pockets prevails among surgical interventions. A clinical example of minimally invasive surgical treatment of chronic generalized periodontitis, based on the method of gingivotomy, shows the most effective result in a limited time. Conclusion. It is necessary to improve periodontal care in the Armed Forces of the Russian Federation, especially in the military unit. Gingivotomy is the optimal minimally invasive surgical intervention in the complex treatment of chronic generalized periodontitis in the dental office of a medical unit of a military unit (1 figure, bibl iography: 11 refs).
Russian Military Medical Academy Reports. 2020;39(1):17-22
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PREDICTING THE EFFECTIVENESS OF TRANSCATHETERARTERIAL EMBOLIZATION OF LIVER HEMANGIOMAS
Lopatin Y.R., Petrov N.A., Dzidzava I.I., Alentyev S.A., Smorodsky A.V., Apollonov A.A., Soldatov S.A.
Abstract
Objective: optimization results of treatment of patients who have liver hemangiomas by predicting the results of transcatheter arterial embolization. Materials and methods. Retrospective analysis of 37 cases of patients who has liver hemangiomas who underwent transcatheter arterial embolization at the hospital surgery clinic of the Kirov Military Medical Academy in the period from 2011 to 2019 was conducted. Single hemangiomas were detected from 23 cases, multiple hemangiomas from 14 cases. Growth of hemangioma was observed at 26 patients, and stable size was observed at 11 patients. The size of liver hemangiomas in patients ranged from 35 to 159 mm (on average 85.4 ± 31.5 mm), depending on the size of the beingness, all cases were divided into 3 groups: 1) down 60 mm (n = 12); 2) from 61 to 90 mm (n = 13);3) from 91 mm or more (n = 12). Results of the study: in the groups with single and multiple liver hemangiomas, transcatheter arterial embolization efficiency indicators were similar: 50 and 52.2%, respectively (p = 0.85). In the group with dynamic growth of liver hemangiomas, the effectiveness was 38.5%, in the group without dynamic growth - 81.8% (p < 0.05). In the group with the size of liver hemangiomas up to 60 mm, the efficiency of transcatheter arterial embolization was 91.7%, in the group with the size from 61 to 90 mm - 46.2%, in the group with the size of 91 mm or more - 8.3% (p < 0.05). Conclusion. The effectiveness of transcatheter arterial embolization liver hemangiomas is negatively affected by the size of the hemangioma more than 60 mm and its dynamic growth. The correlation between the number of liver hemangiomas and the effectiveness of transcatheter arterial embolization was not revealed (5 figs, bibliog r aphy: 15 refs).
Russian Military Medical Academy Reports. 2020;39(1):23-28
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OCCIPITAL REGION AS A SOURCE OF ADDITIONAL INFORMATIONTO THE «VERBAL PORTRAIT» OF MEN OF MILITARY AGE
Martynov Y.A., Bozhchenko A.P.
Abstract
Objective: develop a highly informative system for describing the appearance from the back of the head for men of young (military) age. Materials and methods. The material of the study was photographs of the occipital region of 200 young relatively healthy men (conscripts and contract soldiers, 18-25 years old, 34 nationalities belonging to the Caucasian and Mongoloid races). Methods: survey, description, measurement; descriptive statistics, correlation analysis; analysis, comparison, synthesis, deduction; photographic; “verbal portrait” in the original modification. Results of the study. It was found that when describing the appearance of relatively healthy young men by the method of “verbal portrait” from the back of the head and adjacent areas, 24 stable, unambiguously interpreted (standardized) signs are recognized, each of which can take from 2 to 7 values (a total of 89). The frequency of occurrence of differentiable values of the studied appearance features varies widely (from 0.5 to 94.5%). 32 out of 89 values of 12 out of 24 signs have a high identification significance (if the occurrence is less than 10%). The identification significance of 19 appearance features is statistically significant (p < 0.05) depending on the person's ethno-territorial identity. Taking into account this system-forming factor, the number of feature values with high identification significance increases by 1.5 times, and the number of informative features increases from 12 to 16. The vast majority of the studied appearance features have a weak or medium strength (23) correlation relationship (p < 0.05), which determines the possibility of solving identification problems by integral evaluation of the information content of each of them. Conclusion. The aggregate informativeness developed indicative system appearance allows to uniquely distinguish the described entity from the totality of similar objects with a volume of 100 thousand people or more that is of value to forensic and forensic identification of an unidentified corpse or photograph of the offender from cameras covert surveillance (4 tables, bibliography: 8 refs).
Russian Military Medical Academy Reports. 2020;39(1):29-35
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MODEL INTOXICATION OF LABORATORY ANIMALS BY POLYACRYLONITRILEPIROLYSIS PRODUCTS
Chaykina M.A.
Abstract
In the modern world, various polymeric materials are widely used, for example, “artificial wool” which containing 85% polyacrylonitrile. When polyacrylonitrile is burned, for example in a fire, hydrogen cyanide, carbon monoxide and other toxic compounds are released into the atmosphere. To date, in the Russian Federation, only sodium thiosulfate is available as an antidote for cyanide poisoning (State Register of Medicines (as of 12 January 2020)). However, this antidote is not specific for cyanide poisoning. In the conducted experimental study on laboratory animals (rats), the static inhalation effect of polyacrylonitrile pyrolysis products was simulated (weight of the sample was 0.8 grams, pyrolysis temperature was 270-350 °С, and the duration of the pyrolysis was 3 min). Registered changes in general condition, body position in space, rectal temperature, heart rate, respiratory rate of animals. The oxygenation parameters and indicators of the acid-base state of the blood of laboratory animals after intoxication were determined. Qualitative detection of cyanides in samples of the brain and myocardium was carried out by gas chromatography. A model of acute severe intoxication of laboratory animals with the products of polyacrylonitrile pyrolysis was developed. As a result of the analysis of the gas-air mixture, it was found in it: hydrogen cyanide at a concentration of 80-120 ppm, carbon monoxide - 900-1000 ppm. It wasshown that intoxication of laboratory animals with polyacrylonitrile pyrolysis products leads to changes(p < 0.05) in vital signs, a decrease in oxygen arteriovenous difference (p = 0.03), and the development of decompensated metabolic acidosis. By gas chromatographic analysis, a peak of cyanides with a retention time of 3.78 min was detected in the tissues of the brain and myocardium (1 figure, 2 tables, bibliograph y: 7 refs).
Russian Military Medical Academy Reports. 2020;39(1):36-41
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COMPARATIVE CHARACTERISTIC OF PROLIFERATION OF FIBROBLASTSAND FUNCTIONAL ACTIVITY OF MAST CELLS IN REGENERATION HISTOGENESISAFTER A GUNSHOT WOUND
Birina V.V., Odintsova I.A., Rusakova S.E.
Abstract
Objective. To give a comparative description of the functional activity of mast cells and the proliferation of fibroblasts in regenerative histogenesis after gunshot damage. Materials and methods. The material for the study was histological preparations, obtained after a gunshot wound in the fold of the rat's back skin with a shot at the stop from the Margolin pistol with a 5.6 mm bullet. Taking the material was carried out 6, 24 hours, 3, 6, 15 and 25 days from the beginning of the experience (3 animals for each term). Control group (without injury) - 3 animals. Methods of research - light microscopy, histoautoradiography method, quantitative analysis and statistical processing of data. Fat cells and proliferating cells of the fibroblast differon in the perinecrotic region were studied, taking into account histotopography. Resullts of the study. An immediate response to injury is active degranulation of mast cells (MC), recorded 6 hours after the damage. For the first time, proliferating cells of fibroblastic differential are observed in the deeper layers of the skin on the second day. Regenerative histogenesis of connective tissue and the formation of granulation tissue occurs from 3 to 15 days from cambial sources of the connective tissue “case” of the skin muscle. MC degranulation is observed throughout the observation period. By day 25, the largest number of MC and fibroblasts, includingH3-thymidine, was recorded in subepithelial loose connective tissue. Conclusion. Quantitative, topographical, temporal characteristic of population change and localization of MC in comparative aspect with the same criteria in relation to proliferating cells of fibrooblast differon shows the participation of biologically active substances in attracting the precursors of fibroblasts to the wound surface and regulating their proliferation during the wound histogenesis (4 f igs, bibl iography: 5 refs).
Russian Military Medical Academy Reports. 2020;39(1):42-47
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CHANGES IN VENOUS TONE AND PERIPHERAL BLOOD CLOTTING PARAMETERSAFTER LAPAROSCOPIC LUMBAR SYMPATHECTOMY IN THE EXPERIMENT
Boytsova Y.A., Mikulich A.A.
Abstract
Objective: to develop the technique of laparoscopic lumbar sympathectomy in experiments on laboratory animals, to evaluate changes in venous tone and peripheral blood clotting after experimental surgical interventions using ultrasound and laboratory methods. Materials and methods. The study was performed on 9 rabbits. It included four stages united by a common target: an anatomical study of the sympathetic, preoperative study of venous tone and function of the blood clotting system, experimental surgery: in animals of the control group - diagnostic laparoscopy, in animals of the experimental group-laparoscopic right-sided lumbar sympathectomy, postoperative study of venous tone and function of the blood clotting system. Results of the study. According to blood coagulology tests these results have been obtained in the control animal: in the postoperative period comparing with the preoperative period, the increase in prothrombin time was 22.5% of the initial value, thrombin time was 14.6%, activated partial thromboplastin time was 3.1%, and fibrinogen was 52.3%. In the experimental group, the average increase was, respectively: prothrombin time 24.2%, thrombin time 26.1%, activated partial thromboplastin time 25.3%, fibrinogen 55.5%. According to the analysis of echograms in animals of the experimental group the index of orthostatic dilatation increased on the side of surgery, while on the contralateral (intact) side it decreased. The tone of the femoral vein on the animal's limb, on the side of which sympathetic ganglia have been coagulated, was reduced. Conclusion. Lumbar sympathectomy causes a decrease of the tone of the pelvic limb veins which was revealed according to the performed orthostatic test and increase in the time of peripheral blood clotting in the postoperative period (2 tables, bib liography: 7 refs).
Russian Military Medical Academy Reports. 2020;39(1):48-52
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PREDICTORS OF THE DEVELOPMENT OF TOXIC PULMONARY EDEMA IN LABORATORY ANIMALS DURING INTOXICATION BY PULMONOTOXIC SUBSTANTIONS
Lopat'ko V.S.
Abstract
Pulmonotoxicants are substances that cause structural and functional disorders of the respiratory system with various routes of entry. The latent period for intoxication with pulmonotoxicants can vary from several hours to several days. In case of mass inflow of affected pulmonotoxicants, it is necessary to determine their need for specialized medical care. To date, there are no clear markers that would suggest the possibility of developing acute pulmonary edema in such victims. So, the purpose of research is to determine the predictors of the development of toxic pulmonary edema in laboratory animals during toxicity with pulmonotoxicants. The research was performed on laboratory animals (rats). They were subjected to static intoxication with hydrogen chloride, perfluoroisobutylene and nitrogen dioxide. Before exposure and one hour after intoxication, indicators of vital functions were determined: respiratory rate, heart rate, and rectal temperature. The average life expectancy of laboratory animals and the value of the pulmonary coefficient were determined at various times after intoxication. A correlation analysis was carried out, the magnitude and significance of the correlation coefficient between the vital function indicators and the average life expectancy of animals and the pulmonary coefficient were determined. As a result of the study, it was found that during intoxication with the products of pyrolysis of chlorinated paraffin, there is a strong correlation(r = 0.81, p = 0.04) between a decrease in the frequency of respiratory movements and the magnitude of the pulmonary coefficient; when intoxicated with polytetrafluoroethylene pyrolysis products, there is a strong correlation (r = 0.84, p = 0.03) between a decrease of heart rate and a decrease of average life expectancy; with of nitrogen dioxide intoxication, there is a strong correlation (r = 0.79, p = 0.04) between a decrease of rectal temperature and a decrease of average life expectancy (3 tables, bi bliography: 23 refs).
Russian Military Medical Academy Reports. 2020;39(1):53-59
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COMPARISON OF EFFICIENCY OF METHYLENE BLUE DRUGS FOR VISUALIZATIONOF LYMPHOTOUS WAYS IN THE EXPERIMENT
Kovalenko V.V., Barinov O.V., Fufaev E.E., Dmitrochenko I.V., Kurakevich I.V., Ovcharenko A.P.
Abstract
Objective. compare and evaluate the effectiveness of using methylene blue solutions to visualize lymphatic outflow pathways in laboratory animals (outbred rat). Materials and methods. In the experiment were used 16 female outbred rats aged about 40 days with an initial body weight of 180-220 g contained in standard vivarium conditions. For anesthesia was used “Zolazepam“ (Zoletil®100). Animals were randomized into 2 groups - 8 in each. The first group was injected subcutaneously in the left thigh with a 1% aqueous solution of methylene blue, the second group - solution of methylene blue with human serum albumin. Depending on the time of exposure, animals were divided randomly into 4 subgroups - 15, 30, 45 and 60 minutes. There was evaluated the effectiveness of marking the pathways of lymph outflow from the injection site. Results. As a result of the study, it was demonstrated that the use of a 1% methylene blue solution allows visualizing of the lymphatic outflow paths during drug exposure for 30 minutes. Staining of the lymph nodes of the next order occurs with an increase in exposure time. A solution of methylene blue in combination with human serum albumin stains the first node in the lymph drainage path 30 minutes after administration. The drug is characterized by slow migration from the first order lymph nodes (>60 minutes). Conclusion. The use of methylene blue solution in combination with serum albumin characterized by slow migration from the first order lymph nodes, which makes its use preferable in surgical interventions (8 figs, 1 table, bibliography: 14 refs).
Russian Military Medical Academy Reports. 2020;39(1):60-65
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THE ACTUAL QUESTIONS OF SAILORS PSYCHOPHYSIOLOGICAL STATE CONTROL DURING LONG VOYAGES
Popov A.N.
Abstract
At the present stage of development of the Navy does not lose relevance, requires constant monitoring and improvement of the organization of psychophysiological support for submariners. Objective: is to analyze the modern organization of monitoring the functional state of submariners in long voyages, to develop recommendations for its improvement on the basis of functional surveys of submarine crews. Materials and methods. A comprehensive psychophysiological and clinical physiological examination of 58 submariners over a long voyage (from 30 to 54 days) in diesel submarines was carried out. The survey was carried out three times: at the initial stage of swimming, approximately in its middle and 1-2 days before arrival at the base. Results of the study. The history of the development of methods for monitoring the functional state of submariners in long voyages, the current guidelines, the shortcomings and difficulties in the state of this problem at the present stage of development of the domestic submarine fleet are analyzed. Conducted comprehensive surveys of diesel submarine operators during sea trips revealed the presence of significant features in the dynamics of the functional state and operability of this category of naval specialists requiring mandatory monitoring. As a result of research, proposals were made that contribute to solving this problem. Conclusion: it is advisable to consider issues of monitoring the functional state of submariners in a unified medical support system, including not only activities carried out during the voyage, but also in the pre-navigation period, as well as after returning to the base. This requires the development of guidelines for doctors of the Navy taking into account modern requirements for the medical support of ships. (1 table, bibliography: 7 refs).
Russian Military Medical Academy Reports. 2020;39(1):66-71
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