Vol 42, No 3 (2023)

BACKGROUND: Currently, the issues of restoring the somatic and mental health of combatants undergoing treatment and rehabilitation in hospital conditions are becoming particularly relevant.

AIM: To examine and compare the mental states and psychological consequences of combat trauma at the hospital stage of rehabilitation of combatants.

MATERIALS AND METHODS: The study involved 97 combatants with various wounds and injuries that were hospitalized in the clinical units of the surgical and therapeutic profile of the Military Medical Academy. Of these, 44 people were examined in 2014 and 53 people in 2022.

RESULTS: Comparison of independent samples of combatants in 2014 and 2022 at the stage of treatment and rehabilitation showed a statistically significant twofold decrease in asthenic manifestations from 38.6% in 2014 to 20% in 2022 (p < 0.05). The relative number of combatants with negative psychological consequences of combat trauma in the form of manifestations of post-traumatic stress disorder in 2014 and 2022 was similar and amounted to 15.9% and 17%, respectively, which is apparently due to the homogeneity of the sample and the similarity of factors causing these stress-reactive changes. Uncompensated negative psychological consequences of combat trauma can be fixed in the form of combatant accentuation and chronic, irreversible personality change. These stress-reactive changes reduce both the professional qualities of the combatants and their quality of life.

CONCLUSION: The clinical and psychological characteristics of patients indicate the need for psychological assistance, starting from the moment of injury and continuing throughout the wound disease.

BACKGROUND: Determination of zonulin level in body fluids is one of the widely used clinical methods for diagnosing the leaky gut syndrome. Meanwhile, a decrease in the glomerular filtration rate can potentially affect the content of zonulin in patients with impaired renal function.

AIM: to evaluate the content of serum and fecal zonulin in subjects at different stages of chronic kidney disease.

MATERIALS AND METHODS: The cross-sectional study included 3 groups of patients: 1) 155 patients with end-stage renal disease receiving hemodialysis treatment; 2) 30 patients with chronic kidney disease C3a-5 (glomerular filtration rate <60 ml/min/1.73 m²); 3) 20 relatively healthy individuals with glomerular filtration rate >60 ml/min/1.73 m². The groups were comparable in gender, age, body mass index, smoking status and etiological structure of chronic kidney disease. The concentration of zonulin in blood serum and feces was assessed by using commercially available ELISA kit.

RESULTS: There were no significant differences in serum zonulin between groups. There was a significant direct correlation of serum zonulin with age, creatinine, C-reactive protein and inverse with glomerular filtration rate in patients at predialysis stages of chronic kidney disease. At the same time, in hemodialysis patients serum zonulin did not depend on any of the defined clinical and demographic indicators.It was also found that the concentration of fecal zonulin significantly increased concurrently with an advance of renal insufficiency and reached maximum values in patients with end-stage renal disease. Meanwhile, the correlation analysis did not reveal association between fecal zonulin and kidney function parameters in individuals with mild and moderate chronic kidney disease. Only the hemodialysis group observed a significant direct correlation of fecal zonulin with C-reactive protein.

CONCLUSION: Evaluation of fecal, but not serum zonulin level is preferable to use as a biomarker of increased intestinal epithelial permeability in patients with impaired renal function, since its concentration in the blood is likely to be significantly affected by reduced glomerular filtration rate.

BACKGROUND: When selecting divers, pilots and caisson workers to determine ear barofunction, the subject’s tolerance to compression or decompression in the hyperbaric chamber and the condition of the eardrums after leaving the chamber are evaluated. This approach to selection and annual examination is quite informative, although there are isolated cases of unreliable assessments due to concealment of complaints by the examinees, due to the desire to work in the profession. In the course of daily professional activities of these specialists, the diving or aviation doctor needs to detect timely barofunction changes caused by acute respiratory diseases, mechanical injuries, allergic reactions, vasomotor edema of nasal mucosa, etc.

AIM: To investigate the possibility of using the tympanometry method for examination and dynamic control of ear barofunction among divers.

MATERIALS AND METHODS: The study involved 42 people who were immersed in a flow-decompression chamber to determine barofunction. After 20 days, the subjects were re-examined by tympanometry method at normal atmospheric pressure using the Valsalva technique.

RESULTS: The tympanometric indexes of the subjects with the I degree of barofunction had statistically insignificant changes, with II–III degrees of barofunction there was an increase of peak pressure index and narrowing of peak curve width after diving in a hyperbaric chamber. Among persons with low barofunction (II–III degrees), the tympanometry method revealed an increase in peak pressure index.

CONCLUSION: The conducted research has shown promising use of tympanometry among specialists working in conditions of varying barometric pressure.

Modern replacement kidney therapy belongs to a life-saving type of medical aid and includes dialysis and kidney transplantation. In the world’s nephrological practice integrated approach is preferable: the treatment starts with peritoneal dialysis as the most physiological method and later kidney transplantation or hemodialysis. Well-functioning peritoneal access is a key factor of successful peritoneal dialysis. Studies have shown that peritoneal dialysis, compared with hemodialysis, especially when performed in a dialysis center (not at home), has some clinical advantages. In particular, this treatment better preserves residual kidney function, better corrects anemia, avoids the need for vascular access, which in turn reduces the risk of access-related infectious complications, which in turn are the main cause of hospitalization and mortality among patients with end-stage renal disease. This review is focused on catheters for peritoneal dialysis access and methods of their placement. Malpractice of implantation technique can lead to unwanted consequences ranging from cuff extrusion and catheter migration to total loss of the latter. Following implantation technique by surgeons helps to avoid malpractice and improve the results. Implantation of a peritoneal catheter is an important component of peritoneal dialysis, which determines the quality of treatment, the development of non-infectious and infectious complications of peritoneal dialysis, and the duration of peritoneal dialysis therapy. A number of methods for implanting peritoneal catheters have been proposed in the world. All of them have the right to exist, each has its own advantages and disadvantages. When choosing a method, the surgeon is guided by the objective data of the patient, the patient’s ability to endure more invasive interventions (duration, anesthesia, volume of surgery), the capabilities of the surgical department, experience and qualifications. Expansion of indications for the use of the peritoneal dialysis technique, its complications, as well as concomitant diseases should determine the optimal method for implanting a peritoneal dialysis catheter for a given patient. It should be noted that to date, sufficient data have not been obtained on the effect of the method of peritoneal catheter implantation on the expansion of indications for peritoneal dialysis, the incidence of complications, and the need for additional surgical interventions.

The kidney stone disease (nephrolithiasis, urolithiasis) is a common urological problem that affects both adults and children and has a high recurrence rate. Early and reliable imaging diagnosis of urolithiasis is important for early pain relief and the avoidance of complications that require surgical intervention. Non-contrast computed tomography is considered the method of choice in the diagnosis of urolithiasis, however, this method is associated with exposure to ionizing radiation. Ultrasound diagnostics or sonography, in contrast, is considered as the method of early diagnosis of urolithiasis that is widely spread, highly accessible and does not use ionizing radiation. Recently, the attention of sonographers has been attracted by the so-called twinkling artifact or the artifact of the “colored comet tail”, which occurs in the Doppler color flow mapping behind a calculus in the urinary tract. The twinkling artifact is a phenomenon of a rapid change (“twinkle”) of red and blue behind the calculus. Among adult patients, the artifact shows high sensitivity in finding urinary stones, but at the same time a high level of false-positive results. However, the sensitivity of the artifact in children is higher than in adults, whereas the rate of false-positive findings is much lower. According to many authors, the sensitivity and specificity of the twinkling artifact as an independent diagnostic sign of urolithiasis are both very heterogeneous, especially compared to non-contrast computed tomography. Nevertheless, the artifact is known to increase the diagnostic efficiency in stone detection to more than 90%. We believe that the twinkling artifact in the Doppler color flow mapping should always be considered as an additional diagnostic tool, which is complementary to B-mode ultrasonography and increases its sensitivity and specificity.

For the first time R. Harris et al. in 2006 a chorionic bump was described, detected by ultrasound examination in the first trimester of pregnancy, having characteristic ultrasound signs and localization. Modern knowledge about the etiology and clinical significance of chorionic bump for predicting the outcome of pregnancy is insufficient and contradictory. Inconsistency of the data may be due to the rarity of occurrence, a small sample of the studied groups, the lack of histopathological studies. Among doctors who make ultrasound investigations there is a low awareness of chorionic bump and as a result an erroneous interpretation of sonography data. Nevertheless, there is more and more evidence that this sign is a predictor of an adverse outcome of pregnancy. Doctors who make ultrasound investigations in the first trimester of pregnancy should be aware of the chorionic bump and be able to differentiate it with other pathological conditions. If a chorionic bump is detected, ultrasound examination in dynamics should be recommended. Based on the study of domestic and foreign literature, this scientific review presents modern ideas about the pathomorphology of chorionic bump, informations about significance in terms of predicting the outcome of pregnancy, and the main aspects of ultrasound diagnostics and differential diagnosis of this pathology.

The purpose of the article is to reveal the role and importance of personal book collections for the formation of the library fund of the Military Medical Academy, as a unique information resource for educational, scientific and practical activities. The historical chain of library patronage is traced in the form of the donation to the library of entire book collections or their fragments by private individuals - representatives of various estates and social groups: statesmen, princes, merchants, publishers, bibliophiles. Information is provided on the largest donations of books and book collections by professors of the Academy and their heirs, on the further fate of these gifts. Among the professors-donors, the names of the leaders of the library are named: V.A. Manassein, A.R. Voynich-Syanozhentsky, D.P. Radoslavova. The origins of the formation of a long tradition of arranging separate cabinets for storing personal libraries of prominent representatives of medical science are considered. In different historical periods, there were personal cabinets of A.G. Bakherakht, Ya.V. Willie, D.I. Kashlakova, S.P. Botkin. The tradition continues to this day: in September 2022, the VMedA library solemnly accepted part of the personal book collection of Academician V.O. Samoilov, placed in a special cabinet, stylized as antique library furniture, which was taken care of by the students and followers of the scientist. Nowadays, the criteria and approaches to evaluating personal libraries are changing: the preservation of their integrity is of particular importance. There comes an understanding that the personal libraries of scientists are of particular interest for historical research: to study the biography, creative path, sources of intellectual development, the network of scientific communications of their owners, to reconstruct their personality and their fate. But only if the libraries are available for study in their entirety, without exceptions. Most of the collections turned out to be scattered in the fund without any hope of re-creation and reunification, at least virtual - in the form of bibliographic lists. Based on the foregoing, it was concluded that there are a number of problems in maintaining the collection unity of personal book collections, modern methods for solving these problems, including those based on the use of special library technologies, are proposed.

Hemorrhage into the large omentum is a general term for a pathological condition in which an omental artery and/or vein ruptures with bleeding into the abdominal cavity and/or forming an omental hematoma. There is a high probability of its diagnosis only during surgery. This is an extremely rare condition, which is described only in clinical case reports. There are primary and secondary omental hemorrhage. Secondary hemorrhage occurs due to various reasons, primary (idiopathic) — in the absence of morphological changes that could lead to bleeding to the large omentum. The article is devoted to a rare case of idiopathic omentum bleeding complicated by hemoperitoneum, diagnosed intraoperatively. The article presents the results of a literary review of the last twenty years on English-language and Russian-language publications on omental hemorrhage, presented in the databases of PubMed and the Russian scientific electronic library (eLIBRARY.RU). According to the results of the analysis of the literature data, ultrasound can be used as a first-line imaging method to assess the presence of hemoperitoneum. But CT angiography is the method of choice in assessing acute intra-abdominal bleeding and determining the cause of bleeding due to its speed, availability and ability to diagnose alternative causes of abdominal pain, and it is also recommended to be performed in cases where ultrasound data do not allow to unambiguously establish the presence of bleeding or localize its source. Also, taking into account the age characteristics and gender of patients, the presence of bleeding into the omentum may be due to conditions such as cystic lymphangioma and interrupted ectopic pregnancy. Other causes may be vascular pathologies, tumors and anticoagulant therapy. When detecting signs of bleeding into the large omentum, in addition to determining the fact of hemoperitoneum and its volume, the most important tasks are to establish the causes of hemorrhage and differential diagnosis between idiopathic and secondary bleeding.