Vol 39, No 1S (2020)

Currently, there are many different instrumental methods for diagnosing lesions of articular and periarticular soft tissue. The most popular of them: magnetic resonance imaging, radiography, computed tomography, ultrasound. Of the above methods, the most affordable is ultrasound, which is also according to recent studies is characterized by high sensitivity in detecting early changes in articular tissue. A type of ultrasound technique is elastography, which is aimed at diagnosing tissue elasticity by measuring its deformation under the influence of an ultrasonic wave. In rheumatology, most diseases are manifested by damage to the articular tissue, therefore their early diagnosis is very important, before clinical manifestation. The method of elastography is a very promising research method, since inflammatory and dystrophic tissues can reveal changes in their elasticity. The aim of this study was to compare color cartograms and numerical values of tissue elasticity of people exposed to rheumatic joint damage with healthy people. Of particular interest and interest was an attempt to study the cartilage tissue, namely the patellar cartilage itself, in order to assess the possibility of visualizing the elasticity of the cartilage tissue by elastography and the objectivity of numerical values when comparing two groups of people. The study included 20 people. Her own ligament of the patella, cartilage of the patella, Achilles tendon and plantar fascia were examined. As a result, a characteristic color palette of the cartogram for each group was revealed, and the average numerical values of the elasticity of the articular and soft periarticular tissues, expressed in the speed of ultrasonic wave propagation and tissue density, were calculated. The results obtained characterize these instrumental research methods, as the most accessible and sensitive in rheumatology for identifying the initial manifestations of joint pathology, but requiring more research and development of examination methods.

Recurrent ischemic events extremely negatively affects on the prognosis of myocardial infarction (MI). It has been shown that their frequency has recently increased against the background due to the increasing role of percutaneous coronary interventions. Moreover, information about the influence of risk factors of cardiovascular disease (CVD) on the development of recurrent episodes of ischemia (REI) is contradictory. The purpose of the study: a comparative assessment of the structure of CVD risk factors of men younger than 60 years old with recurrent episodes of ischemia (REI) in MI to improve prevention. It includes men from 18 to 60 years old with type I myocardial infarction with a glomerular filtration rate of 30 or more ml / min / 1.73 m2, who, in addition to the standard diagnostic algorithm, carried out a targeted search and analysis of the presence of basic and additional CVD risk factors. Patients were divided into two age-comparable groups: I - the study group, with REI (recurrent MI and / or early post-infarction angina pectoris) - 95 patients; II - without these complications - 471 people. Patients were examined and treated according to local standards at the time of hospitalization. Assessment of lipid metabolism included determination of concentrations of total cholesterol and its fractions, triglycerides, coefficient and atherogenicity indices. It is believed that the main cause of REI is the progression of coronary atherosclerosis. The main risk factors of REI include lipid metabolism disorders, physical inactivity, smoking, hypertension and obesity. Alcohol abuse, impaired renal function and diabetes mellitus have a lower frequency of observations. Recently, attention has been focused on an increase in the proportion of stent thromboses after percutaneous coronary intervention and distal embolism of the coronary arteries. Additional importance for the development of REI are physical inactivity, smoking, unstable angina, MI and history of bypass surgery, psychoemotional stress, as the cause of MI, winter and autumn periods of the year. The listed factors should be used when creating high-risk groups for the development of REI for monitoring and conducting preventive measures, as well as for prognostic modeling of REI.

A survey was conducted of 139 military personnel of the first age group, including 98 military personnel serving in the Far North, as well as 41 military personnel serving in a temperate climate. The survey included assessment of lifestyle (survey of parameters of physical activity, Smoking), anthropometric data (height, body weight, body mass index), physical examination, including measurement of blood pressure at rest, obtaining laboratory data (lipid spectrum, carbohydrate metabolism). It was noted that among military personnel serving in the Far North, the number of smokers was almost 2 times higher than in the comparison group, the percentage of people with high nutrition was more than 2.5 times higher, in contrast to the indicators of physical inactivity, which, however, were also higher than in the group of military personnel serving in a temperate climate. Among the representatives of the Far North group, there is also a tendency to a higher prevalence of arterial hypertension. When assessing lipid metabolism, it was shown that the level of total cholesterol and LDL cholesterol was statistically significantly higher than in the comparison group. The results of the oral glucose tolerance test after 1 hour in the study group were significantly higher, although after 2 hours it corresponded to the norm there was no statistically significant difference. As a result of the study, it was shown that service in the Far North is associated with a higher prevalence of the studied predictors of cardio-vascular risk (physical inactivity, Smoking, high nutrition, hypertension, dyslipidemia, and carbohydrate metabolism disorders).

Cardiovascular diseases in patients with сhronic obstructive pulmonary disease are one of the most common comorbid conditions, exacerbate the course of сhronic obstructive pulmonary disease, increase the chances of fatality and make the prognosis worse. A study was conducted to assess changes in the heart and blood vessels in patients with сhronic obstructive pulmonary disease. The most sensitive indicators of right ventricular systolic-diastolic dysfunction were established, and a significant increase in local vascular stiffness and thickness of the intima-media complex of the carotid arteries was revealed. Visualization of heart chambers during echocardiography in patients with сhronic obstructive pulmonary disease is known to often have difficulties due to the presence of emphysema of the lungs. Therefore, the presented arsenal of used indicators of the right ventricle, being independent of the increased airiness of the lung tissue, can be especially useful in this situation. We explain the increased prevalence of cardiovascular diseases in the study group to the presence of additional risk factors that are not included in the traditional cardiovascular risk assessment,but are present in patients with сhronic obstructive pulmonary disease. The increased stiffness of the arterial wall, which we verified in patients with сhronic obstructive pulmonary disease, provides an additional increase in afterload on the myocardium, provoking a deterioration in coronary perfusion of both the left and right ventricles.

Studied the frequency and types of cardiac arrhythmias and cardiac conduction in patients with epilepsy without concomitant cardiac pathology in comparison with a group of healthy individuals. The results obtained during the studies showed that in patients with epilepsy, episodes of sinus tachycardia, a single polytopic supraventricular extrasystole, as well as episodes of lengthening the QT interval and rigidity of the circadian profile were significantly more likely to occur (p <0.05). No significant differences were found in the frequency of occurrence of sinus bradycardia, atrial pacemaker migration, atrial heart rhythm, pauses in the heart for more than 2 seconds, degree 1 AV block and degree 2 AV block, mobility 1, single monotopic supraventricular extrasystoles, single monotopic ventricular extrasystoles. Other rhythm and conduction disturbances were not determined. Thus, it is shown that the presence of epileptiform activity may be associated with a higher risk of rhythm and conduction disturbances. Some of these reported disorders can be life threatening, possibly leading to cases of sudden death in epilepsy. The obtained results emphasize the need to treat patients with epilepsy as patients with a high risk of cardiovascular events and confirm the prospect of further studies to identify the risks of sudden cardiac death, as well as the possibilities of its medical correction. Promising is the further study of this problem: simultaneous daily EEG and ECG monitoring to assess changes in the ECG directly during an epileptic seizure, as well as the search and implementation of new physiological, genetic and biological markers of this pathology.

Myocardial infarction (MI) in young and middle-aged people is a socially significant problem, and arterial hypertension (AH) is one of the most important risk factors for cardiovascular complications. Despite the availability of studies on MI in the presence of AH, data on structural and functional changes in the heart and prognosis in men of young and middle age are few and contradictory. The purpose of the study was to study the structural and functional characteristics of the heart that affect the prognosis of young and middle-aged men in the acute and subacute periods of MI in the presence of AH to improve treatment and prevention. It is included 497 men from 19 to 60 years old with type I IM who, in the first 48 hours (1) and at the end of the third week of the disease (2), are performed the standard diagnostic algorithm. Patients were divided into four groups depending on the presence / absence of AH and age: up to 49 years (with AH (112 patients, without AH 75 patients) and 50-60 years (with AH 230 patients, without AH 80 patients). It was established that in the presence of AH there is a more pronounced systolic dysfunction. Such patients are more likely to have sudden cardiac death and cardiovascular complications, therefore this category of patients requires more careful monitoring for the timely detection and treatment of chronic heart failure and the prevention of cardiovascular catastrophes in the future.

At Department of Hospital Therapy Military Medical Academy has been performed prospective study with the participation of 122 st servicemen. Patients after primary carrying out oral glucose tolerance test have been divided into 2 groups: 1 - 60 men with the level of nd glycemia ≥ 8,6 mmol/l after 1 hour of the test; 2 - 62 with a normal 1-hour glycemia. All of the examined patients initially and over time have been evaluated lipid, carbohydrate metabolism, an ultrasound scaning of the heart and of the common carotid arteries. The patients st curation have been realized for 3.8 to 1.5 years. In the initial examination, the two samples were compared in AH (78% vs 74% for the 1 and nd 2 groups, respectively, p>0.05) at average blood pressure values of 156/98 and 153/97 mm Hg. accordingly (p>0.05); AO (42% vs 40%, p>0.05), BMI 29.3 vs 27.4 ± 4.2 kg/m (p=0.015); hypodynamia (42% vs 38%, p>05). Smoking prevailed in men in the 1st group (53 vs 31%, χ =5.0; p=0.02). Against the background of drug therapy, there was an achievement of normotensia in 35 and 46% of patients in the 1 and 2 2 2 st nd groups, respectively (p>0.05); smoking cessation - in 30 and 15% of the subjects (p>05). Alimentary obesity after curation was determined in 67 2 and 50% of men in these subgroups (χ =3,6; p=0.05), which indicated a negative dynamics compared to the initial anthropometric data (p>0.05). Has been identified a number of characteristics for patients with early postprandial hyperglycemia: more atherogenic changes in lipid spectrum, high incidence of prediabetes and diabetes mellitus type 2 in the dynamics. Has been observed more active progression of atherosclerosis as a thickening of the intima-media complex for men with 1-hour hyperglycemia. The presence of 1-hour hyperglycemia is an early marker of development prediabetes and diabetes mellitus type 2, with the result that this indicator should be assessed in everyday clinical practice, along with levels of fasting plasma glucose and 2-hour plasma glucose after postload test.

At the clinic of propaedeutics of internal diseases, 33 patients were selected for whom a severe degree of OSA was diagnosed by cardiorespiratory monitoring (YAG ≥ 30 sob / h). All patients had a history of drowsiness (drowsiness school according to the Epworth questionnaire 12 ± 3), the presence of snoring during sleep, and short-term respiratory arrest. Two groups were formed using telephone monitoring: the first group was patients with severe OSAS who purchased a device for CPAP therapy (15 people, 13 of them were men and 2 women), the second group were patients with severe OSAS who did not buy or only are going to purchase a device for CPAP therapy (18 people, 17 of them are men and 1 woman). When analyzing the data, it was found that patients who purchased a device for CPAP therapy 85% have good compliance with the therapy, use the device> 4 hours per night 80% of the nights. With good compliance with therapy, the average weight of the patients of the first group before the start of therapy was 132 ± 8 kg, then at the time of the survey the average weight decreased to 118 ± 5 kg. In patients of the second group without CPAP therapy, the average weight was 111 ± 8 kg, after a trial course and recommendations from the attending physician for weight loss, at the time of the survey, the average weight of the group decreased to 105 ± 5 1 kg. Based on these data, it can be concluded that patients of the first group on CPAP therapy reduced their weight from the original by 1%, in contrast to the second group, where the weight decreased by 6%. According to the results of the study, patients with OSAS who have good compliance with therapy have a higher percentage in weight loss compared with patients without CPAP therapy.

Modern approaches to drug therapy should be based not only on effectiveness, but also on a comprehensive assessment of the safety of drugs. Pharmakogenetic testing allows to define efficiency and safety of therapy, to choose the most effective medicine as prime therapeutic means that leads to reduction of quantity of the medical products necessary for adequate treatment. At present, advances in clinical genetics are associated with the isolation of alleles (variants) of various genes, the assessment of their frequency and the detection of associations of certain alleles with phenotypic manifestations, with an attempt to identify prognostic signs. On the basis of complex pharmakogenetic analysis is possible to identify significant of genetic markers in the prediction of the flow and effectiveness of pharma-cotherapy of arterial hypertension. The study involved 40 of patients with arterial hypertension. Performed pharmakogenetic testing with the study of polymorphisms of gene α-adductin. As a result of which it was possible to obtain results: “normal” alleles of the α-adductin G / G gene were found in the majority of the studied (29 out of 40 patients), while the “risk” allele of the α-adductin G / T gene and the “risk” allele T / T - in 11 studied patients, and the frequency of occurrence of the G / T allele is 4 times greater than the T / T allele. The identification of genetic markers in cardiology is subjected to intensive study and research in order to identify genetic risk. Thus,оn the basis of the results of genetic testing can not only build the forecast of disease, but also rationally choose the drug therapy, which helps to prevent the development of severe complications.

Renal dysfunction (DP) in myocardial infarction (MI) significantly worsens the prognosis of the disease in men under 60 years of age. The aim of the study was to assess the significance of various factors for the development of DP at the end of the subacute period of myocardial infarction (MI) in men under 60 to improve prevention. It includes men from 18 to 60 years old with type I IM who, in the first 48 hours (1) and at the end of the third week of the disease (2), performed the standard diagnostic algorithm, which included complex echocardiography and lipid metabolism assessment. Patients were divided into two age-comparable groups: I - the study group, with a decrease in glomerular filtration rate at the end of the third week of MI less than 60 ml / min / 1.73 m2 (renal dysfunction (DP)) - 21 patients; II - without impaired renal function - 176 people. It was found that the most significant indicators of the risk of developing DP at the end of the subacute MI were the index of the final systolic volume of the left ventricle, the size of the left atrium, tachycardia of more than 108 per minute and hypertriglyceridemia (6.7 mmol / l or more) in the first hours of the disease in association with aneurysm of the left ventricle and its thrombosis, fibrillation and atrial flutter both before the development of MI and during the period of the disease. The combination of these factors with a history of unstable angina, prothrombin level (84% or more), GRACE value (134 points or more) and TIMI (8 points or more), dyslipidemia at the end of the subacute period of the disease indicates a high risk of developing DP in this period. The listed factors can be used to form a high-risk group for the development of this condition for more in-depth observation and prevention activities.

Adverse indicators of morbidity and mortality from myocardial infarction (MI) with a high frequency of detection of cardiovascular diseases (CVD) risk factors actualizes the search for ways to improve their prevention. The purpose of the study: a assess the risk profile of CVD in men younger than 60 years with MI, depending on the outcome of the nearest to improve prevention. It includes men from 18 to 60 years old with MI of type I with a glomerular filtration rate of 30 or more ml/min/1.73 m2. In addition to the standard diagnostic examination, patients underwent a targeted search for the presence of primary and secondary risk factors for CVD. Patients were divided into two age-comparable groups: I - the study group; 30 patients who died during the first eight weeks of the disease; II - survivors - 536 patients. It has been established that the main risk factors for CVD in the group of adverse outcomes are tobacco using, physical inactivity, signs of social and psychological maladaptation, seasonal deterioration and hereditary burden of coronary heart disease, alcohol abuse and a history of heart failure. Hypertension, overweight, diabetes mellitus and chronic foci of infection were observed somewhat less frequently. The closest unfavorable prognosis was associated with smoking, alcohol abuse, signs of social maladaptation, the presence of MI and heart failure, as well as a history of revascularization. The use of these indicators will help to improve the characteristics of the developed forecast models and the effectiveness of prevention. Statistical treatment of data packets performed using Statistica 10.0 and SAS JMP software applications 11. Quantitative indices are represented as: M ± S, where M - average; and S - standard deviation. The significance of differences was determined by U-Mann-Whitney test. For binary and nominal terms it was evaluated by chi-square test. The level of statistical significance when received error probability less than 0.05.

291 patients were examined at the clinic, there were 191 male and 100 female patients, for the presence of left ventricular hypertrophy using echocardiography. All included patients were divided into 4 types depending on left ventricular remodeling. To determine the type of heart remodeling, we used the determination of the left ventricular mass index (the ratio of the left ventricular myocardial mass to the body surface area) using echocardiography, and the determination of the relative thickness of the left ventricular wall (the ratio of the doubled thickness of the posterior wall of the left ventricle to its end diastolic size). Arterial hypertension was detected in 186 patients: 117 males and 69 females. A statistical analysis of the data was carried out, which took into account the gender of the patients. We found the dependence of the type of remodeling on the level of blood pressure. According to the results of the study, it was found that the normal geometry of the left Известия Рос. Воен.-мед. акад. 2020. №1. Том 1 Прил.

The idiopathic normal pressure hydrocephalus (Hakim-Adams syndrome) is characterized by the expansion of liquor-containing cavities, which is clinically manifested by a triad of symptoms: impaired gait, cognitive impairment, and impaired urination. One of the most common diseases associated with iNPH is Alzheimer's disease. Both diseases are found in the same age group with similar complaints of memory impairment. In clinical practice, their differential diagnosis is based on the identification of the Hakim-Adams triad. However, the determination of the combination of these two states, which is observed with a frequency of up to 75%, is a difficult task. In the study, the concentrations of biomarker proteins of amyloidosis and neurodegeneration in cerebrospinal fluid were determined. A total of 47 patients were examined (14 with a diagnosis of idiopathic normotensive hydrocephalus, 25 with Alzheimer's disease, 8 with their combination). The level of proteins in the cerebrospinal fluid was assessed using enzyme-linked immunosorbent assay (ELISA). Tablets for 96 samples were used to determine each of the evaluated indicators: the content of beta-amyloid (Aβ-42), tau protein (tau) and 218-phosphorylated tau protein (ftau). The neurodegeneration coefficients were calculated (ftau/Aβ-42, tau/Aβ-42). Specific cerebrospinal fluid changes in patients with idiopathic normotensive hydrocephalus were found to have higher levels of amyloid beta, a decrease in the content of tau and phosphorylated tau protein compared with patients with Alzheimer's disease. In the case of a combination of diseases (“comorbidity”), the presence of “intermediate” results by liquorological indicators is characteristic. A higher level of amyloid beta compared with Hakim-Adams syndrome indicates amyloidogenesis. We also revealed patterns of transformation of moderate cognitive impairment into dementia (according to the ratio of tau / Aβ-42 and ftau / Aβ-42).

The review is devoted to the pathogenetic features of the formation of metabolic disorders in critical state medicine and to integral methods for monitoring their severity - capnography and the calculated indicators obtained using this method. A component of the pathogenesis of the septic process is metabolic stress, characterized by a violation of all types of metabolism, forming a cycle of interdependent processes that potentiate tissue oxygenation and microcirculation disorders. It was revealed that in the scientific literature this condition has been defined as microcirculatory-mitochondrial distress syndrome. Almost all metabolic processes are accompanied by the completion of glucose catabolism by the formation of carbon dioxide and water, carbon dioxide, in turn, having high diffusion activity, quickly gets from the tissues through the microvasculature into the systemic circulation and is eliminated with exhaled air. In this regard, it is possible to dynamically assess the level of metabolism in tissues by the volume percentage of CO2 in exhaled air, which is implemented in the method of capnography. The use of capnography is an important element of intensive care. The informativeness of the method of capnography is sufficient for an integrated assessment of the severity of metabolic changes when monitoring the vital functions of patients in ICU with various types of pathology, accompanied by changes in the energy balance of the body and the speed of metabolic processes. The diagnostic value of capnography lies in the method of its continuous implementation, non-invasiveness, relative low cost, as well as the ability to automatically inform the medical staff when registering capnogram values that are critical for the patient. It is advisable to take into account the possibility of including the method of capnography in clinical guidelines and treatment protocols for diseases and conditions requiring controlled correction of metabolic disorders.

Critical conditions are the result of acute diseases or chronic decompensation. With them, part of the vital functions of the body are usually violated or there is a threat of their violation in the coming hours. Bacteriemia, products of septic and aseptic inflammation, hyksemia and hypoxia of organs and peripheral tissues, lead to impaired function of the organs that were initially not involved or not initially involved in the initial process. To improve the quality of medical care for patients with a therapeutic profile in critical condition, the development of new methods for assessing the severity of their condition continues. In acute and chronic stressful influences, regulatory systems are depleted, which plays an important role in the development of threatening conditions and deaths. The circulatory system is very sensitive to stress reactions. An analysis of heart rate variability (HRV) is a reliable indicator of stress levels in the body. HRV can be estimated by electrocardiographic indicators, or by pulse oximetric, which are easier to do in clinical practice. Angioscan-01P is a personal diagnostic device for analyzing the state of the vascular wall. It allows you to measure not only the stress index (visualization of the Baevsky index using a chart), but also the degree of stiffness of the vessels (the reciprocal of the elasticity of the vessels), the saturation index (saturation of hemoglobin with oxygen). To determine the role of the stress index, it is necessary to compare it with the main clinical and laboratory indicators of liver and kidney function, the state of the vascular wall, and endothelial function. The found reliable relationships can be used to improve the study evaluating the status of critical patients with a therapeutic profile.

A clinical evaluation of the effectiveness of the translingual electrical stimulation method in the system of complex treatment of violations of the function of maintaining static and dynamic balance in patients with long-term consequences of acute cerebral circulation in the vertebral-basilar pool was carried out. In order to improve stability, the patient trained the function of maintaining balance by consistently performing exercises in the standing position and in motion. A total of 6 patients were examined. Each of them received two courses of treatment with 10 procedures. During the second year, the exercises were supplemented with translingual electrical stimulation during the procedure. The total training time was 20 minutes per procedure. The following scales were used to evaluate the effectiveness: the Berg scale, The « Timed Up and Go» (TUG) for 10 meters, and ВАШ (patient satisfaction was evaluated). It is shown that the joint use of training in combination with translingual electrical stimulation is more effective than the isolated use of exercises, and it is well tolerated by patients, and contributes to their compliance. The absence of the need to use stationary equipment allows using the proposed method at all stages of rehabilitation treatment of patients with acute cerebral circulation disorders in the vertebral-basilar pool, including independently under the dynamic control of a doctor.

Cerebrovascular diseases holds the second place in the structure of mortality and the first place in the structure of primary disability. Meanwhile, the proportion of ischemic strokes in the population is 80%, in which 11-15% of cases occur in young people. More than 1 mln. people who have suffered a stroke live in the Russian Federation, while one third of them are people of working age. Only 40% of young people with a diagnosed ischemic stroke return to work. The etiology of ischemic strokes in young people often remains unclear, which complicates secondary prevention. In our study, we determined the features of etiopathogenesis and secondary prevention of ischemic stroke in young people. For this, 10 patients aged 19 to 45 years with diagnosed ischemic stroke were examined. The incidence of etiopathogenetic subtypes of ischemic stroke in young people differs from the general population, because this pathology is more common among people of an older age group. Ischemic stroke of unknown etiology are most often diagnosed owing to a certain difficulty in verifying risk factors. In 3 patients, concomitant diseases were identified that are risk factors for the development of ischemic stroke, which were not known before the vascular event, therefore, these patients did not receive primary prevention of ischemic stroke. When searching for a possible pathology of the blood coagulation system in 40%, screening tests turned out to be positive, which affected the measures for the secondary prevention of ischemic stroke.

Cardiovascular diseases, particularly myocardial infarction the cause of death of 45% of young and middle-aged men. One of the most serious and common risk factors for myocardial infarction is excess body weight - obesity that leads to metabolic and hemodynamic disorders. Modern prevention methods should take into account the comorbidity of patients for a more individual approach to treatment. The causes and mechanisms behind the predisposition of patients with myocardial infarction and metabolic syndrome (MS) to larger myocardial injury damage have not been sufficiently studied. The aim of the study is to assess the frequency of observation of risk factors of cardiovascular diseases in men under 60 years of age to improve the prevention methods. It includes men from 18 to 60 years old with type I myocardial infarction, who performed a standard diagnostic algorithm in the first 48 hours and at the end of the third week of the disease. Patients were divided into two age-comparable groups: I - investigated, with metabolic syndrome - 85 patients; II - without metabolic syndrome - 481 people. It has been established that the main risk factors for development of myocardial infarction in men with metabolic syndrome are diabetes mellitus, obesity, dyslipidemia, arterial hypertension, alcohol abuse, hypodynamics in history. These patients require observation for timely verification and correction of chronic heart failure, further additional examination to verify and eliminate comorbid risk factors, treatment and prevention of repeated myocardial infarctions.

Spend a genetic analysis of the blood of 41 patients with using polymerase chain reaction (PCR) to detect the presence of a mutation in the nitric oxide synthase (NO) genes. All patients were clinically diagnosed with diseases of the cardiovascular system. Among the patietnts there are a part of them, based on an anamnesis, that have a relationship between the genetic predisposition and the presence of cardiovascular diseases which were also observed in parents and grandparents of the examined patients. During the study there were 2 polymorphic variants of genes of type III synthase nitric oxide (NOS3, endothelial or eNOS) - T786C and G894T. As a result there were revealed that 70% of the patients have a mutation of at least one of the polymorphic variants of the NOS3 genes and only 30% of the patients have a “ normal” allels, which indicates that there is a relationship between genetic mutations of nitric oxide synthase (NO) and an increased risk of developing diseases of the cardiovascular system in patients, in particular, such as neurocirculatory asthenia, hypertension, coronary heart disease. Besides there are a relationship between polymorphism of nitric oxide synthase genes (NOS3 or eNOS) and the risk of developing a pathology such as stroke, which is a prognostically unfavorable sign and it can lead to aggravation of concomitant diseases of the cardio-vascular system and the development of their complications, also it can lead to a decrease in the quality and life expectancy of patients. A decrease in the synthesis of nitric oxide (NO) affects the physiological properties of platelets which is manifested by a high risk of blood clots and an increase in mortality among patients.

An analysis of 120 case histories of patients hospitalized in the clinic of the hospital therapy of S.M. Kirov Military medical academy for 2018 with various forms of coronary heart disease, among which 30 patients were diagnosed with angina pectoris, 11 had myocardial infarction, 30 had post-infarction cardiosclerosis, and 50 patients had a constant form of atrial fibrillation. 70.8% of patients had hypertension. 120 patients showed a high risk of developing thromboembolic complications, and therefore they were prescribed oral anticoagulants and / or antiplatelet therapy. The presence of lesions of the upper gastrointestinal tract was revealed in all patients with coronary heart disease taking antiplatelet and / or anticoagulant therapy. The analysis of the results of fibroesophagogastroduodenoscopy revealed the following diseases of the upper gastrointestinal tract: esophagitis reflux in 28.33% of patients, including erosive - 1.67%, chronic gastritis - in 59.17%, including erosive 10.8% peptic ulcer - 12.5%. In order to treat and prevent erosive and ulcerative bleeding from the upper gastrointestinal tract, only 42.5% of patients were prescribed drugs from the group of proton pump inhibitors. Thus, it is advisable for patients with various forms of coronary heart disease and a high risk of cardioembolic complications to start treatment with oral antiplatelet agents and / or anticoagulants with fibroesophagogastroduodenoscopy to timely identify the pathology of the esophagus, stomach and duodenum, and it is also necessary to conduct fibroesophagastroduodenoscopy in dynamics for timely detection of pathology, treatment and reduction of the risk of erosive and ulcerative bleeding. In order to treat and prevent erosive and ulcerative changes in the upper gastrointestinal tract in patients with coronary heart disease, drugs from the group of proton pump inhibitors for long-term use should be prescribed simultaneously with oral anticoagulants and / or antiplatelet agents.

The relevance of the problem of diagnosis of irritable bowel syndrome in military personnel is determined by its prevalence among the population, which is an average of 15-25% in the structure of pathology of the gastrointestinal tract, as well as a significant decrease in the quality of life of such patients, a possible negative impact on their performance of official duties. A study was conducted in a group of military personnel using an original visual questionnaire for evaluating bowel function, the purpose of which is to identify hidden bowel dysfunction. Military personnel were asked to describe the number and nature of defecations in the previous week using the Bristol scale of fecal forms. These data were later processed using the world health organization's clinical guidelines. According to the results of the research, a group of military personnel with hidden intestinal dysfunction was identified: 57.1% of them have intestinal dysfunction with a predominance of constipation, 28.6% - intestinal dysfunction with a predominance of diarrhea, and 14.3% - mixed-type intestinal dysfunction. It is also noted that there is often a difficulty in diagnosing this disease due to the low turnout of patients to specialists on this issue, and that the use of an original visual questionnaire for evaluating bowel function allows to overcome the psychological barrier in patients, provided the correct, competent questionnaire, to improve the differential diagnosis among diseases of the lower digestive tract. The expediency of using this original visual questionnaire for evaluating bowel function in the in-depth medical examination of military personnel for further expansion of diagnostic measures for the purpose of early diagnosis of organic pathology and timely treatment of diseases of the gastrointestinal tract is demonstrated.

Symptomatic delirium of the early postoperative period (SDEPP) is a common clinical type of postoperative cerebral dysfunction in surgery. The most common and common risk factors for all types of surgical interventions are: age, concomitant comorbid diseases, previous cognitive deficit, impaired vision and hearing. An important provoking factor of SDEPP is the use of anticholinergics, narcotic drugs, withdrawal symptoms, systemic infections, iatrogenic complications, metabolic disorders and pain. Severe infectious complications are typical risk factors of SDEPP and some authors consider delirium to be the earliest clinical manifestation of these complications. At present, it is also known that dementia increases the risk of SDEPP, while a higher initial educational level significantly reduces it. SDEPP is frequently found after structural alteration of the reticular formation, ventrolateral area of the hypothalamus and frontal lobes. There is evidence that alteration to the basal ganglia, lingual gyrus (on both sides), bilateral or right-sided damage to the prefrontal gyrus, superficial parietal cortex, and thalamus may be associated with the development of SDEPP. The current understanding of the pathogenesis of SDEPP includes supposed role of systemic inflammatory reaction that starts during the perioperative period, and is possibly exacerbated by the anticholinergic effect of drugs administered during this period. However, this hypothesis and the relationship between peripheral inflammation and neuroinflammation need further study. An important element in the pathogenesis of postoperative cerebral dysfunction in trauma and orthopedic surgery is cerebral embolism. During the surgical operations on the hip and knee joints, cerebral microemboli were found in 40-100% of patients. But at present, the connection of this fact with the onset of postoperative cerebral dysfunction has not been proved. The article presents a clinical case of symptomatic delirium of the early postoperative period in a patient according to the profile of traumatology and orthopedics.

Alzheimer's disease has not been spared and painting, which is able to reflect changes in both the psychological and physical condition of the artist, which allows you to feel the severity of the disease and the helplessness of such patients, both in front of themselves and in front of society. Alzheimer's disease is characterized by several criteria, such as reduced cognitive abilities, where a large number of variations in memory loss are given high priority, regulatory functions and speech also suffer, and personality and behavior changes. However, special attention should also be paid to violations of the visual-spatial function. The aim of the work was to identify artists who suffered from Alzheimer's disease, analyze their work before the onset of the disease and during its progression, find the main signs of the disease in painting, and systematize these signs. We used the method of vertical and horizontal analysis, as well as a comparison method based on a number of NINCDS-ADRDA criteria that allow us to find and systematize the obtained data. The study revealed common features of pathological deviations in works of art by artists with Alzheimer's disease - the appearance of two-dimensionality and simplification (simplicity) in painting, the total number of angles decreases and their sharpness decreases, the deterioration of perspective and atmosphere in the image, the loss of meaning and content, sometimes there was a transition to abstraction, copying previous works when creating a new work. There was a decrease in the ability to perform previous work, a decrease in cognitive functions compared to the previous functional level, especially violations of visual and spatial functions and memory, as well as a decrease in regulatory abilities.

In the structure of heart valve defects, the aortic valve is most often susceptible to pathological changes - 64.5%. Conservative treatment of valvular heart disease is mainly aimed at reducing the severity of heart failure, at a certain stage the implementation of a surgical operation becomes a vital manipulation. The aim of the study was to evaluate the frequency and determine the structure of postoperative cerebral dysfunction during surgical correction of acquired aortic valve defects, as well as to compare it with other cardiac surgery for heart valve defects in cardiopulmonary bypass. We examined 134 patients (86 men and 48 women, average age 64 years), who underwent planned operations for prosthetics of heart valves in conditions of cardiopulmonary bypass. Postoperative cerebral dysfunction was diagnosed in 41% (55 of 134 patients). The incidence of postoperative cerebral dysfunction during prosthetic surgery for aortic stenosis is 49% with the following structure: perioperative stroke 4.3%, symptomatic delirium of the early postoperative period 25.5% and 29.8% delayed cognitive impairment. In patients with other operations on the heart valves, postoperative cerebral dysfunction was diagnosed in 36.8%: perioperative stroke 1.15%, symptomatic delirium of the early postoperative period, delayed cognitive impairment 23.2%. There were no significant differences in the incidence of perioperative stroke and delayed cognitive impairment (p>0.05). Acute clinical types of postoperative cerebral dysfunction and symptomatic delirium early postoperative period were significantly more often (p<0.05) detected after prosthetics for aortic stenosis.

The aim of the study was to analyze the long-term effictiveness of high-dose immunosuppressive therapy (HDIST) followed by autologous hematopoietic stem cell transplantation (AHSCT) in long-term observation (more than 20 years) of two MS patients. This therapy was performed for the first time in Russia at the S.M.Kirov Military Medical Academy. The therapy was carried out for the first time in Russia at the S.M. Kirov Military Medical Academy at the Department of Hematology and Clinical Immunology together with the Department of Nervous Diseases in 1999 and 2000. The research was carried out by long-term dynamic observation of changes in neurological status according to EDSS (Expanded Disability Status Scale), recording of disease exacerbations and control of brain magnetic resonance imaging (MRI) results. It has been established that as a result of conducting a HDIST with AHSCT, a record duration of more than twenty years of remission without any additional treatment is possible in comparison with other PITRS. At the same time, a high frequency of side effects was observed during the therapy. Thus, taking into account its high effictiveness, manifested as a regression of neurological symptoms and long-term long-term remission with no activity on MRI, HDIST with AHSCT is one of the promising methods of MS treatment. Significant frequency and severity of side effects requires further improvement of treatment technology as well as observation to assess the safety of this therapy.

Obesity is a multifactorial pathology. The medical community still has debatable questions about the multidirectional impact of obesity on the body. So there is still no reliable scientific data on metabolically healthy obesity, the obesity paradox. The aim of the study is to compare the prevalence and structure of metabolic disorders in men with "metabolically healthy" and "metabolically neutral" obesity. The analysis of 590 case histories of male patients aged 30 to 45 years who were treated in the hospital therapy clinic was carried out. At the first stage of the study, patient data were divided into 3 groups depending on the presence of abdominal obesity and metabolic syndrome criteria: the metabolically healthy obesity group-155 people with a body mass index >30 kg / m without insulin resistance, the metabolic syndrome group-134 men with a body mass index >30 kg / m2 and metabolic syndrome, the control group-301 men without abdominal obesity. At the second stage of the study, the same indicators were compared in groups of patients with metabolically neutral obesity (86 men) and metabolically healthy obesity (155 men). The study examined the prevalence of various metabolic types of abdominal obesity. In the study sample, metabolic syndrome occurred in 23% of cases, metabolically healthy obesity in 26% of cases, of which 55% included a group with metabolcally neutral obesity, and 51% of cases had normal body weight. Determining the level of leptin in alimentary obesity is a necessary diagnostic criterion that characterizes the likelihood of metabolic disorders. In practical medical practice, it is advisable to use the term and criteria for "metabolically neutral" type of obesity, which allow stratifying patients who need active prevention and treatment.

The chronic nature of the course, as well as the limited possibilities of specific therapy, determine the particular relevance of the use of quality of life assessment tools in planning the follow-up and treatment of patients with myeloproliferative neoplasms (MPN). Despite this, the issue of the lack of specific and sufficiently accurate methods for assessing the quality of life in patients with MPN remains unresolved. Currently, the MPN10 questionnaire is recommended for assessing symptoms in patients with MPN and symptoms of myelofibrosis. Given the low stage of validation in Russia and the narrow symptomatic focus of the questionnaire for a more complete and accurate assessment of the quality of life, it is recommended that it be used simultaneously with nosologically non-specific validated questionnaires. A comparative study of the effectiveness of various quality agents was conducted (SF-36, EQ-5D-5L, EORTC QLQ-C30, MPN-10), which revealed the relationship between the influence of constitutional symptoms and quality changes in patients with Ph-negative MPN (n = 20). The EQ-5D-5L questionnaire is the most sensitive tool for assessing the quality of life to the influence of constitutional symptoms of the disease. Thus, it is necessary to note the importance of using strictly specific tools for assessing the quality of life in relation to each nosological unit. However, the results of this study prove that changes in the quality of life in patients with Ph-negative MPN are not always due to the influence of constitutional symptoms. That is why the question of finding the most appropriate means of assessing the quality of life for this group of oncohematological diseases remains relevant. At the moment, for a more complete and accurate assessment of the quality of life of patients with Ph-negative MPN, simultaneous use of MPN-10 in combination with EQ-5D-5L is recommended.

We studied blood pressure, heart rate, body mass index, waist circumference, and purine metabolism of 239 military men of young and middle age with hypertension and arterial hypertension of 1 degree, stratified into the categories of low and medium cardiovascular risk according to the Framingham risk scale. To clarify the role of risk factors for arterial hypertension in the formation of the clinical picture and structural and functional changes of men with initially low and medium risk factors for the development of cardiovascular diseases according to the Framingham risk scale, we studied the correlation between body weight parameters and age, heart rate, office parameters blood pressure, risk on the Framingham risk scale, waist circumference and uric acid. It was revealed that young and middle-aged men with pre-hypertension and arterial hypertension of 1 degree, classified as medium cardiovascular risk, are characterized by significantly higher values of blood pressure, heart rate, body mass index, waist circumference, blood uric acid level and average risk according to Framingham scale compared with subjects of low calculated risk. It is concluded that transformation of pre-hypertension into arterial hypertension, as well as the estimated low cardiovascular risk to medium, is accompanied by an increase in heart rate, body mass index, waist circumference and an increase in uric acid in the blood serum. This indicates the advisability of expanding the volume of regularly performed screening studies in male military personnel with determination of the level of uric acid of blood doesn’t from the age of 41, but from the age of 25-30 and to evaluate the cardiovascular risk not only on the SCORE scale, but also on Framingham scale of total cardiovascular risk

Diagnosis of immune-mediated rheumatic diseases is a multi-stage and complex process. Many researchers have recognized that rheumatoid arthritis is of a psychosomatic nature. The study of psychosomatic status is a promising direction today in the comprehensive diagnosis of various diseases. This section is multidimensional, which gives the rheumatologist a wide diagnostic field for the search for certain patterns in the development of the disease. Many concepts have been proposed that try to explain the selectivity of damage to organs and systems during periods of psychoemotional stress. It should be noted that this crucial issue of psychosomatic medicine is still unresolved. Some concepts are aimed at the physiological basis of this disease. Others, on the contrary, pay more attention to the psychological approach, losing sight of the physiological foundations of the body laid down by nature. his one-sided approach to the problem under consideration is not permissible, since these systems are interconnected. The unique work of American cardiologists M. Friedman and R. Rosenman made it possible to combine all these factors, adding to his model the functional response of the system to the impact of a specific (psycho-emotional) load. This concept (1959) was developed on the basis of many years of experience working with cardiological patients and called them “a behavioral risk factor for coronary heart disease (type A)”. It has proven its effectiveness and has been successfully applied by a number of domestic and foreign scientists not only on cardiological patients, but also on patients with gastroenterological, psychological and neurological profiles. This work is an attempt to apply this concept to patients with rheumatoid arthritis.

Early diagnosis and prevention of pulmonary embolism is an urgent problem of modern medicine. Cancer patients have been described as a special group of the high risk for the development of this complication especially in the postoperative period. This article presents clinical observations of two patients with oncological pathology who had pulmonary embolism in the postoperative period. The diagnosis has been confirmed by CT angiography. The dynamics of transaminases activity in the postoperative period has been analyzed, certain regularities of their activity have been found, and the correlation of the obtained data with the links of the pathogenesis of pulmonary embolism has been studied. In the postoperative period there was a gradual increase of the activity of AST and ALT both no more than 5 times, then at the time of the appearance of clinical symptoms in the form of shortness of breath - a slight decrease in the activity of both indicators, followed by a sharp rise in activity. Probably such changes are associated with changes in pulmonary microcirculation, damage of the lung tissue cells. The study of the dynamics of AST and ALT activity in blood serum is an available method and is proposed as one of the ways of early diagnosis of pulmonary embolism.

The main treatment method of the manifest forms of primary and tertiary hyperparathyroidism is surgical. In doing so, the success of surgical intervention is determined by the removal of all pathologically altered parathyroid tissue. In spite that the only interoperative increasing of the parathyroid hormone may validate the radicalism of intervention, nowadays the fluorescence diagnostic, techniques, which provides the visualisation and differentiation of altered and unchanged parathyroid glands during the surgery, are being developed. The results of examination and treatment of patients with surgical diseases of the parathyroid glands who were operated using a minimally invasive endoscopically-assisted technique under conditions of intraoperative parathyroid monitoring with 5-aminolivulenic acid. Examination of patients was carried out in the framework of international protocols and clinical recommendations. All patients underwent preoperative topical diagnosis of pathologically altered parathyroid glands, including ultrasound examination of the neck and scintigraphy with 99mTc-technetrile. An intraoperative search for parathyroids accumulating 5-aminolevolenic acid was carried out using a polarized blue source in a darkened operating room. As a result of the study, it was found that the use of intraoperative parathyroid monitoring with 5-aminolevulinic made it possible to search and differential diagnosis of not changed parathyroid glands and parathyroid, thereby facilitating the radicalism of interventions, the prevention of postoperative hypoparathyroidism, relapse and persistence of the disease. Thus, photodynamic imaging of the parathyroid glands is a safe auxiliary methodology aimed at achieving a new level of evidence and safety of surgical interventions in primary and tertiary hyperparathyroidism.

An ulcer or Dielafua disease is a rare disease that manifests itself through an anomaly of the vessels of the submucosal layer of the stomach and the formation of an acute ulcer with profiled bleeding from an unusually large artery of artery artery. Typical for this disease are repeated relapses of bleeding, the treatment of which is one of the current and unresolved problems in clinical practice. The article demonstrates two clinical cases of treatment of patients with recurrent bleeding from Dielafua ulcer, who used a complex of endoscopic, endovascular methods of hemostasis in combination with open surgery. In the first clinical observation a patient with Dieloafua ulcer on the background of liver cirrhosis of portal hypertension syndrome is presented. Due to repeated recurrence of hemorrhage, the patient used a combined endoscopic hemostasis (injection, clipping, argon-plasma coagulation), laparotomy, gastrotomia, suturing of the Dieloafua ulcer of the stomach floor. However, the final hemostasis was achieved by endovascular method. Super-selective embolization of the bleeding source, the branches of the left gastric artery, was performed.In the second clinical observation in a patient with multiple recurrences of bleeding from Dieloafuan ulcer against the background of combined endoscopic hemostasis and impossibility of selective embolization due to the risk of spleen infarction, a laparotomy was performed, complete devascularization of the abdominal section of the esophagus and stomach by large and small curvature with preservation of the right gastric artery.The possibilities of minimally invasive technologies in complex treatment of patients with recurrent bleeding from Dielafua ulcer are shown on clinical examples.

The improvement of restorative treatments for patients with knee gonarthrosis has so far remained one of the most pressing and complex problems of modern reabilitology. Despite the wide range of drugs available, and the manipulations and physiotherapy methods used, the recovery of motor activity in military personnel when gonarthrosis is exacerbated remains a difficult task, requiring an integrated approach to its solution. To this end, the Department of Surgery of Injuries and Limb Diseases of the Clinic of Outpatient and Polyclinic Care of the S.M. Kirov Military medical academy treated 70 soldiers with gonarthrosis of the knee joint with intra-articular injection therapy hyaluronates (Armaviscon). Clinical method, radiation diagnostic methods were used to assess the initial condition of the affected joint and clinical effectiveness. The clinical study included military personnel whose military work involves heavy loads on the lower limbs between the ages of 21 and 84 suffering from deforming arthrosis. Analysis of the obtained data showed safety and sufficient effectiveness of "Armaviskon" application in treatment of knee joint gonarthrosis in patients. The highest efficacy of the drug was observed at the early stages of gonarthrosis development.

The research work is devoted to the development of a method for an objective assessment of the postoperative inflammatory response in patients undergoing combined intervention (cataract phacoemulsification with endoscopic laser cyclodestruction) in comparison with standard cataract phacoemulsification. Performing a combined intervention can significantly improve visual function, as well as simultaneously reduce intraocular pressure. The question arises about the safety and effectiveness of this tactic in comparison with standard phacoemulsification. In this regard, it is of great interest to compare the postoperative inflammatory response, as well as the creation of an algorithm for its objective assessment. As a result of a study based on optical coherence tomography, a method was developed that allows to evaluate objectively the postoperative inflammatory response. The purpose of this study is to develop an algorithm and conduct an objective analysis of the severity of the postoperative inflammatory response in patients undergoing combined intervention (cataract phacoemulsification with endoscopic laser cyclodestruction) in comparison with standard phacoemulsification. The study involved 30 patients (30 eyes). The main group - 15 patients (15 eyes) with uncompensated open-angle glaucoma in various stages and an initial complicated cataract. The control group consisted of 15 patients (15 eyes) with an initial age-related cataract. On the morning of the day after the intervention, patients of both groups underwent optical coherence tomography of the anterior segment of the eye. During the analysis, 10.0 ± 7.5 inclusions were detected in the main group, and 2.5 ± 2.3 in the control group. The difference is statistically significant (p <0.001). The developed algorithm allows you to objectively assess the degree of inflammatory reaction in the anterior chamber of the eye. Comparison with the control group virtually eliminates the effect of phacoemulsification on the inflammatory response. During the analysis of the severity of the postoperative inflammatory reaction, a greater number of inflammatory inclusions were revealed after a combined intervention.

Nowadays, in the thyroid surgery a great experience of using different variants of minimally invasive approaches, including endovideosurgical and da Vinci surgical robotic technologies. However, there are still no approved recommendations (protocols) for the application of these approaches; indications and contraindications remain the subject of debate and rely on the experience of the individual authors. Based on the indicated positions the purpose of our study was to determine the criteria for selecting patients with surgical diseases of the thyroid and parathyroid glands for the reasonable implementation of optimal minimally invasive surgical interventions. The article analyzes the results of a comprehensive medical examination and treatment of 417 patients with surgical diseases of the thyroid and parathyroid glands, who were operated by using various minimally invasive procedures. The medical examination of patients was conducted under international protocols and management guidelines. The patients were divided into four groups based on the nature of the minimally invasive techniques used: the 1st (n = 151) includes the patients, who underwent minimally invasive nonendoscopic thyroidectomy; the 2nd (n = 141) - is a minimally invasive video-assisted thyroidectomy; the 3rd (n = 110) - is an endoscopic thyroidectomy with the use of axillo-bilateral-breast approach; the 4th (n = 15) - is a transoral endoscopic thyroidectomy vestibular approach. It was stated that the main criteria that determine the rationale for minimally invasive interventions on the thyroid gland are: the nodule size and the thyroid volume; hyperfunctioning thyroid and clinical thyroiditis; substernal extension; extrathyroid extension and the necessity of implementation of central neck dissection due to central and laterocervical lymph node metastases. The application of the determined criteria based on the integrated use of modern diagnostic techniques for patients with surgical diseases of the thyroid and parathyroid glands can justify the selection of optimal surgical interventions, avoid unreasonable operations, to avoid increasing of the frequency of specific complications, reduces surgical trauma and duration of stay in hospital, improves cosmetic outcome and enhances the quality of life of the patients.

The analysis of objective research data obtained during the examination of patients suffering from chronic dacryocystitis is presented. The importance of modern as well as traditional methods was defined. It was shown that the modern diagnostic method - lacrimal endoscopy is indicative and informative, not only with confirmed chronic dacryocystitis but also in the absence of pathological changes in the lacrimal ducts in patients of the control group. The aim of the studi was to improve the quality of diagnosis of chronic dacryocystitis. There are traditional methods for diagnosing chronic dacryocystitis. They were also used in patients of the control group (without pathology of lacrimation) and in patients with chronic dacryocystitis. Refers to them sounding of the lacrimal ways, washing them with lacriminal cannulas, slit lamp biomicroscopy, color nasal lacrimal test 2% fluorescein sodium solution for its implementation, lacrimal endoscopy with lacrimal endoscope. A total of 20 patients were examined. In the control group of patients, with the help of lacrimal endoscopy, the normal appearance of the mucous membrane of the lacrimal tubules, lacrimal sac, the nasolacrimal duct was determined. Active patency of the tear ducts was confirmed by a positive color nasal lacrimal breakdown. When performing endoscopy of the lacrimal passages in patients of the second group, the criteria for pathological changes in the lacrimal sac and nasolacrimal duct, characteristic for chronic dacryocystitis, are determined: hyperemia, the presence of detachable, grayish folds of the mucous membrane, whitish-gray membrane in the area of stricture. The preliminary diagnosis of chronic dacryocystitis was also confirmed by traditional diagnostic methods: color lacrimal-nasal functional test, diagnostic sounding. and lacrimal lavage, dacryocystography. As a result of the study, it was found that lacrimal endoscopy significantly expands the possibilities of diagnosing chronic dacryocystitis, confirms and complements the data of traditional research methods, allows you to see structural changes along the tear ducts, determines the degree and level of obliteration. The combination of traditional diagnostic methods and lacrimal endoscopy allows the surgeon to choose the most appropriate way of surgical treatment of this pathology.

The article gives a retrospective clinical study of 82 patients being treated at the clinic of faculty surgery named after S.P. Fedorov of the Military Medical Academy named after S.M. Kirov with the diagnosis "Acute cholangitis." Patients were divided into "no sepsis" (n = 42) and "with sepsis" (n = 40) groups. The following data were analyzed: clinical, surgical. In the postoperative period, early diagnosis of sepsis development was carried out in patients diagnosed with Acute cholangitis. The diagnosis was based on complaints, objective examination and laboratory and instrumental methods. Patients were assessed with diagnostic scales such as SOFIA, APACHE II, APACHE III, SAPS2, SAPS3.В the following analysis of their accuracy, sensitivity, specificity of prognostic positive and negative capacity, and statistical method of ratio OSH and Criterion Chi-square was used. The SOFIA scale in this study is the "gold standard" in the diagnosis of sepsis in patients with acute cholangitis. This is related to the least number of indicators among other scales, and the SOFIA scale does not require additional examination of the patient by another specialist. The APACHE III and SAPS3 scale requires a license agreement as opposed to a SOFIA scale. However, in our study, the use of the APACHE II scale showed the highest specificity (85.71%) and prognosticality of the negative result. The SAPS2 scale showed the greatest sensitivity (95.00%) and prognostics of the positive result. The most accurate scale is APACHE III, its accuracy is 73.17%. The lowest accuracy and sensitivity is SAPS3 (Se = 55.00%), (Ac = 64.63%).

Mechanical jaundice is the most widespread and severe syndrome of surgical diseases of hepatopancreatobiliary zone. Modern development of surgical technologies allows applying one- or two-stage surgical interventions in this category of patients. Single-stage tactics is characterized by performing a radical surgical intervention, but is associated with a high frequency of postoperative complications and lethality, reaching up to 60 - 70% [9,10]. Two-stage approach is conditioned by drainage of bile ducts and execution of radical surgical intervention after elimination of mechanical jaundice phenomena that takes on the average from 4 to 6 weeks. This approach reduces the frequency of postoperative lethality development up to 30% [16, 19], but increases the frequency of infectious complications development [20] and is associated with the increase of time before the radical operation, which becomes key in patients with mechanical jaundice of tumor origin, because no more than 16% are resectable at the moment of mechanical jaundice manifestation [10]. Thus, correct assessment of hepatic insufficiency and choice of the most rational approach are the key points of patient management. Objective of the study: to improve treatment results of patients with mechanical jaundice. Materials and methods. The examination of 17 patients with mechanical jaundice who were treated in the clinic of general and hospital surgery was carried out. The interrelation between the severity of mechanical jaundice according to E.I. Galperin, hepatic insufficiency determined by the green clearance test in Indocyanine, the state of coagulation link of hemostasis revealed by means of low-frequency piezotromboelastography and development of postoperative complications was assessed. Piezotromboelastography and Indocyanine green clearance test demonstrated a relationship to surgical complications. They are accessible, minimally invasive, promising to be introduced into a broad clinical practice. However, the accumulation of material, its analysis, and systematization of data are required.

The study of the functional state of the colon is important not only for the objectification of its pathology, but also in the planning of treatment of its diseases. Compared to evacuation, an assessment of the motor function of the colon is not so common in clinical practice. However, the data obtained in this case are often very valuable and convenient for understanding the dysfunction of the colon. This study reports a study of the contractile response of the sigmoid colon to dilation of the rectal ampule in patients with complaints of constipation. To assess the motor function of the sigmoid colon, the method of balloon manometry was used. Using a recording device with three pressure sensors and a computer for data processing in the Exel program, studies were performed in 9 patients with slow-transit chronic constipation and in 6 patients with irritable bowel syndrome with constipation. In a rectal ampoule, a rubber balloon fixed to a catheter was inflated with air until distinct urge to defecate appeared, and against this background, the motor reaction of the distal part of the sigmoid colon was evaluated. It was found that dilation of the rectal ampoule leads to inhibition of the contractile activity of the sigmoid colon. This reflex (inhibitory recto-sigmoid motor reflex) was detected both in patients with irritable bowel syndrome and in patients with chronic constipation. The conclusion is drawn on the importance of a functional study of the sigmoid colon, which allows not only to identify dysfunction of the nervous structures of the intestine, but can also be used to justify the option of forming an intestinal anastomosis after resection of the colon in patients with chronic constipation.

The analysis of the data of literary sources of domestic and foreign researchers on the problem of the occurrence and development of nosocomial infections in general and in the surgical departments in particular is carried out. The relevance of the study is confirmed by the following data: the spread of nosocomial infections in the Russian Federation is 2.5 million annually; the minimum damage inflicted by them in Russia alone is approximately 6-7 million rubles. The data of foreign scientists have been studied, suggesting that infections in the field of hirirurgic intervention were recorded in 13% of cases after performing "clean" operations, in 16% after and in 29% after < contaminated>. In St. Petersburg, with selective studies, the frequency of infections in the field of surgical intervention revealed 9% of patients among 1,500 operated It was revealed that the number of potential causative agents of nosocomial infections increases every year due to opportunistic bacteria that differ in biological characteristics from hospital strains and have multiple drug antibiotic resistance. A retrospective and prospective analysis of the frequency of occurrence of microorganisms in patients of the surgical department of 2008-2019 was carried out. The microbial spectrum and prevalence of nosocomial infection pathogens in the surgical department were investigated. An epidemiological analysis of the causative agents of nosocomial infection in patients with pneumonia, infections in the surgical field and urinary tract, as well as with generalized infections, was carried out. The analysis of the bacterial flora of the clinical microbiological culture of the wound discharge, sputum, urine and blood was carried out. The following microorganisms were most prevalent in these samples: Staphylococcus aureus, Acinetobacter baumannii, Candida albicans, Klebsiella pneumonia. A tendency to increase the proportion of Candida albicans in patients of the surgical department, as well as a high prevalence of Staphylococcus epidermidis in blood cultures, was revealed.

The training of military surgeons to assist the wounded is one of the fundamental directions for improving the medical support of troops. One of the most effective forms of training surgeons in the treatment of severe wounds and injuries is considered to be continuing education courses in trauma centers of the first level. For military surgeons this center is the Department of Field Surgery of the Military Medical Academy named after S.M. Kirov. However, in recent years, due to the steady decrease in the number of incoming wounded, the demonstrativeness of the educational process, the possibility of real participation of students in the treatment process have decreased. To increase the efficiency of training of military surgeons, to improve their manual skills, it is necessary to introduce new forms of training. The most promising of them is the introduction of combined practical courses using simulators and real tissues. The first such course in Russia was practical course on damage surgery SMART (Modern Methods and Algorithms for the Treatment of Wounds and Injuries), created by the teaching staff of the Department of Military Surgery of the Military Medical Academy named after S.M. Kirov, during course participants were given the opportunity to listen to a short lecture cycle on pressing issues of damage surgery and military field surgery, as well as to work out the most relevant life-saving surgical operations and manipulations that form the basis of Damage Control tactics. The aim of the study was to substantiate the introduction of practical courses for surgeons on issues of field surgery and to evaluate their efficiency. The efficiency of the SMART training course has been proven by testing the initial and final level of knowledge of 55 participants.

The study is devoted to the development of a reliable, reproducible and effective way to create chronic corneal erosion (CCE) in experimental animals, as well as the assessment of the clinical and morphological features of corneal regeneration in response to the use of platelet-rich plasma (PRP) under experimental chronic corneal erosion (ECCE). It relates to experimental medicine, namely to ophthalmology, and military ophthalmology in particular. Studies were performed on 12 chinchilla rabbits (24 eyes). At the first stage, all animals were reproduced a model of experimental chronic erosion of the cornea: local ultraviolet (UV) irradiation with an exposure of 45 min on the previously deepithelized surface of the cornea. At the second stage, all the studied animals were divided into three groups (4 rabbits in each). In the 1st main group (MG), instillation of PRP was carried out in 1 drop every 1 minute for 10 minutes (10 drops) once, in the 2nd group they were treated according to the above method daily for 5 days. In the control group (CG), treatment for PRP was not used. As a result of the study, it was shown that local exposure to ultraviolet radiation prevents the corneal epithelization in the irradiation zone up to the 30th day of the experiment. In this case, the relief of inflammation and the completion of epithelization of the irradiated area becomes possible only after the growth of superficial vessels to it. The therapeutic effect of the use of platelet-rich plasma in experimental chronic erosion of the cornea due to growth factors, adhesive molecules and dissolved fibrin contained in it is based on the formation of a normal adhesion complex between the epithelium and the Bowman membrane and stimulation of reparative regeneration, as a result of which the corneal epithelium is restored.

Noise, being a general biological stimulus, affects all organs and systems of the body. When exposed to noise, certain physiological changes and pathological conditions develop, which depend on specific conditions: the level and nature of the noise, the duration of its exposure. Noise occupies one of the leading places among the adverse factors in the Armed Forces (AF), its impact leads to a decrease in military professional capacity and an increase in the incidence of military personnel. This is facilitated by the high mechanization and power supply of weapons and military equipment, the absence and insufficient number of personnel protection from noise (collective and individual), which in most cases have low acoustic efficiency. In the Sun, noise was not identified as a harmful factor leading to the development of occupational pathology; the issues of professional selection and examination of noise pathology were not fully developed. Military personnel who have been exposed to intense noise for a long period of time have diseases of noise genesis, which, however, in accordance with the regulatory legal documents in force in the Armed Forces, are not considered occupational diseases. After dismissal from the Armed Forces, such persons are not adequately protected socially, since the causal relationship of the pathology revealed in them has the phrase “the disease was received during the military service” instead of the necessary disease was received while performing military service duties (“military trauma”).

Diseases of the cardiovascular system in most economically developed countries occupy a leading position among the causes of morbidity, disability and mortality. In 60-80% of patients with obliterating atherosclerosis of the vessels of the lower extremities with multiple and distal forms of pathology, severe ischemia develops, leading to amputation of the limb in 20-30%. Objective: based on the data of X-ray contrast angiography, show the features of arterial blood supply to the lower third of the leg and ankle joint and evaluate the compensatory potential. The images of 20 patients with atherosclerosis obliterans of the lower extremities were studied. Thus, we can say that the compensatory blood flow in these areas is well developed. But a large number of anastomoses on angiograms with atherosclerosis was not characterized by adequate blood supply, in this regard, it was manifested by the depletion of the compensatory capabilities of the vascular bed and its gradual defeat, resulting in ischemia and foot necrosis.