Vol 20, No 1 (2018)
- Year: 2018
- Articles: 54
- URL: https://journal-vniispk.ru/1682-7392/issue/view/776
- DOI: https://doi.org/10.17816/brmma.371
Articles
Quantitative electrophysiological pattern of neurodegeneration in encephalopathies of various origin
Abstract
Electrophysiological characteristics of patients with encephalopathy of different etiology are presented. Pathogenic mechanisms affecting the electroencephalographic pattern and quantitative components of electroencephalogram are discussed. The aim of the study was to determine a universal quantitative electrophysiological criterion for the evaluation of neurodegenerative changes in the brain of patients with encephalopathy. We analyzed the data of anamnesis, neurological examination, laboratory tests and electroencephalograms from 389 patients with encephalopathy of post-traumatic, infectious, vascular and mixed etiology. Spectral analysis of electroencephalograms was performed and the values of relative quantitative electrophysiological criterion - the ratio of spectral power in the alpha/theta ranges at rest and during the test with hyperventilation were counted. The ratio of spectral power in the alpha/theta ranges was the lowest in patients of older age group and low - in patients with encephalopathy of infectious etiology. The ratio of the spectral power in the alpha-theta ranges in patients with post-traumatic encephalopathy was significantly different depending on the severity of the traumatic brain injury - mild or moderate/severe. We studied the possibilities of practical application of selected electrophysiological criterion - the ratio of spectral power of rhythms in the alpha-theta ranges. We counted this criterion in 150 patients with encephalopathy for the effectiveness evaluation of the neuroprotective therapy with сortexin. The chosen electrophysiological criterion had proved its effectiveness in therapy monitoring in patients with encephalopathy. In this article we demonstrated the advantages of additional neuroprotective therapy with сortexin. Increase in spectral power of alpha rhythm and decrease in spectral power of slow-wave components in the electroencephalographic pattern characterizes successful neuroprotective therapy with neuropeptides, such as сortexin.
Bulletin of the Russian Military Medical Academy. 2018;20(1):7-12
7-12
Diagnosis and differential diagnosis of pulmonary sarcoidosis
Abstract
Pulmonary sarcoidosis is one of the most common interstitial lung diseases. The prevalence in Russia is 10-20 per 100 thousand population. Overwhelmingly it is found among working age population, and the peak of morbidity is 30-40 years. In half of the cases, sarcoidosis occurs in oligosymptomatic form. According to research conducted by our scientists, the adverse course of the disease with exacerbations and progressive decrease in pulmonary function found in 27,3% of patients. The diagnosis is based on clinical, X-ray and histological examination. Material for histological study was prepared depending on the extent of the process. Preference is given to minimally invasive methods of biopsy: transbronchial puncture of intrathoracic lymph nodes, peripheral lymph nodes, bone marrow aspiration, skin sarcoid items, etc. In the case of the intrathoracic localization of the disease, the treatment of choice is videothoracoscopy. The detection of epithelioid cell granuloma without necrosis confirms the diagnosis of sarcoidosis. First of all it is necessary to exclude tuberculosis, oncohematological diseases, disseminated lung diseases, combined with alveolitis syndrome and mediastinal lymphadenopathy. The primary diagnosis should be carried out under conditions of a multifunctional clinic. The verification of the pulmonary sarcoidosis should be held in close cooperation of different specialists: pulmonologists, radiologists, thoracic surgeons, pathologists, etc. Further treatment of the patient should be implemented by the pulmonologist in the place of residence. A clinical case of late diagnosis of diffuse diseases of connective tissue, which at its beginning started under the mask of sarcoidosis is demonstrated. The main mistake that led to deep disability of the patient, was absence of timely histological verification of the diagnosis.
Bulletin of the Russian Military Medical Academy. 2018;20(1):13-18
13-18
Pathogenetic and prognostic significance of molecular markers of myocardial remodeling in patients suffering from chronic heart failure
Abstract
It is known that there are features of myocardial remodeling in various heart diseases. However, the influence of signaling regulatory factors in its development and their significance in predicting a course of chronic heart failure remains unclear. The importance of key markers of apoptosis, extracellular matrix, p-38α in myocardium of patients with chronic heart failure of different etiology in the development of cardiovascular complications after cardiac surgery is considered. It has been established that the combination of heart failure with coronary heart disease, heart failure with valvular defects are specific phenotypes with a special reorganization of myocardium. With the combination of heart failure with coronary heart disease without cardiovascular complications in the myocardium, higher activity of caspase-9 and TIMP-1 was noted, and differences in morphometric data were revealed in comparison with the group of heart failure with valvular defects. In groups with an unfavorable outcome of cardiosurgical operations of different etiology of chronic heart failure, there were no differences in the morphological indices and activity of molecular markers of the myocardium. This fact allows one to consider the activation of caspase-9, MMP-9, p38α in the myocardium as prognostic markers of the unfavorable outcome of cardiac surgery in patients suffering from heart failure regardless of etiology. A higher percentage of cardiovascular complications in the combination of chronic heart failure with coronary heart disease is probably associated with a less favorable myocardial phenotype and requires a specific pharmacological correction before cardiac surgery.
Bulletin of the Russian Military Medical Academy. 2018;20(1):19-23
19-23
Comparative characteristics of bioimpedanceometry indices dynamics in young men with normal and insufficient body weight in the treatment of community-acquired pneumonia
Abstract
The component composition of the body of men with normal body weight and insufficient body weight in the age from 18 to 44, patients with community-acquired pneumonia of non-severe course, was studied. Its changes at various periods of treatment are revealed. These changes were expressed in the statistically significant dynamics of indicators of total water content, total muscle mass with water and total fat content in men with normal body weight, as well as significant changes in the total water content and total muscle mass with water in men with insufficient body weight. At the same time, all examinees showed slight changes in body mass, body mass index and stability of the total defat-dehydrated bone mass. At the same time, the total water content and total muscle mass with water were lower at the 3rd, 7th and 15th days of treatment compared to the day of hospitalization. The lowest values of these parameters were recorded on the 3rd day of treatment. In addition, in men with normal body weight, significant changes in the total fat content on the 3rd and 15th days of treatment were noted, compared with 1 day of treatment. It was found that the total water content of men with insufficient body weight was not normal even by the 15th day of treatment. This fact indicates the need for medical rehabilitation after completion of treatment in order to normalize the body composition and prevent recurrence of the disease.
Bulletin of the Russian Military Medical Academy. 2018;20(1):24-28
24-28
Possibility of age-related changes correction in the face and neck skin using laser technology
Abstract
The possibility of using combined erbium and neodymium lasers to correct the age-related changes in the face and neck skin by the «Fotona» apparatus using the «Fotona 4D» technique was investigated. To evaluate the results of the study in dynamics an index of age-related changes in skin was developed and applied. The results of photographic fixation and ultrasound of the facial and neck skin before and after laser procedures were also compared. It was determined, that the combination of two wavelengths of 2940 nm (erbium laser) and 1064 nm (neodymium laser) and the «Fotona 4D» technique with 4 patented technologies allows to carry out the procedure at the level of superficial, middle and deep structures of the face and neck tissues. Nowadays it is the only technology for non-invasive volumetric reconstruction and facial skin voluminisation, which is the result of a combination of synergistic methods of laser exposure. It was shown that one month after the second procedure of laser treatment, the face skin turgor increased, its dryness, pore severity, quantity and depth of wrinkles decreased, side effects and complications were absent. Ultrasound examination of the facial skin and index of age- related changes assessing in the face skin confirmed the positive dynamics of correction. Thus, the thickness of the skin in the area of nasolabial folds and superciliary arches increased by 0,5 mm (from 1,9 to 2,4 mm), derma by 0,6 mm (0,8 to 1 mm). The index of age-related changes assessing in the facial skin decreased by 10-13 points (before the procedure it was within the range of 20-24 points (average degree of age changes), after the procedure it was 11 points (mild degree of age changes). Thus, the use of combined erbium and neodymium lasers using the «Fotona 4D» technique showed a high efficiency of laser correction of age-related changes in the facial skin. Implemention of modern technologies in practice of dermatological clinics will improve skills of medical personnel on the use of laser technology.
Bulletin of the Russian Military Medical Academy. 2018;20(1):29-34
29-34
Influence of heliogeophysical factors on the minute blood volume in hypertensive patients with different temperament
Abstract
Correlation between the annual average values of minute volume of blood flow in healthy men with different psychosomatic status, suffering from arterial hypertension, and Solar activity from 1995 to 2015 was investigated. Variations of γ-background during the study period did not exceed the limits of normal regional values (7-9 µr/h). However, the analysis of solar activity dynamics represented periodic increase and a momentary increase by the 2005-2006. With the increase in solar activity and γ-ray background a significant reduction of oxygen utilization coefficient by tissues of healthy individuals and patients with different temperament was noted. The increase in solar activity was followed by an increase in ambient temperature and atmospheric pressure. The study showed a significant increase in minute volume of blood flow in the groups of healthy individuals and patients in the same years as the increase in solar activity and γ-background environment. There has been established a significant correlation relationship between indicators of solar activity, meteorological factors and minute volume of blood flow that indicates on the possibility of combined effects of the studied environmental factors to affect the course of physiological processes in organism of both healthy and hypertension person. Overall, it was reflected in the increase of functional activity of the cardiovascular system (by minute volume of blood flow).
Bulletin of the Russian Military Medical Academy. 2018;20(1):35-37
35-37
Influence of primary disease incidence on the psycho-physiological adaptation of pilots in the Far North
Abstract
The analysis of three years of primary disease incidence of flight and ground personnel in the Far North is presented as well as the analysis of the main meteorological factors, their complex characteristics and amount of respiratory diseases in flight crews on the day of observation and the subsequent 4 days. Assessment of influence of meteorological factors was carried out simultaneously in two directions: determined differential impact on the body of flight crews of each meteorological factor and simultaneous identification of their complex actions. It was found that pilots (navigators), showed a statistically significant (p<0,001) increase in the average incidence of diseases compared with average index of primary morbidity from other members of the flight crews. It was revealed that flight crews serving in the area of the Far North for less than one year, shows a statistically significant (p<0,01) increase in the average index of primary morbidity, compared with flight crews serving in the area of the Far North more than one year. Thus, a statistically significant increase in the average primary incidence of the pilots (navigators), compared with the average indicators of the primary morbidity from other members of the flight crews and ground troops means that physiological adaptation of pilots (navigators) to the Extreme North occurs with a larger psychoemotional stress than in soldiers of other specialties. The obtained results on the incidence of primary aircrew in the Far North allow to better understand mechanisms of influence of health state on the successful adaptation to extreme climatic conditions.
Bulletin of the Russian Military Medical Academy. 2018;20(1):38-43
38-43
Comparative characteristics of the body composition of older women in the presence or absence of genitalia prolapse
Abstract
Two groups of women aged from 50 to 72 years, conditionally assigned to the senior age category, were examined. The main group of patients was 51 women suffered from the prolapse of genitalia of various degrees. In control group we included 71 women without clinical signs of this disease. The study of the body composition was carried out using bioimpedance scales (Tanita BC-545N fat analyzer, Japan).In both groups the examination was carried out in accordance with the rules of this procedure on the day of hospitalization. The statistically significant differences in the total content of the fat component, the level of visceral fat, as well as the level of physical development between the women of the primary and control groups were revealed. It was established that the patients with prolapse of pelvic organs suffered mainly first and second degrees of obesity, while the control group had normal or excessive body weight. The analysis of the components of the body in patients with prolapse of the genitals indicates a significant change in the ratio of the water-fat balance in comparison with the examined women without this pathology. The bio-impedance measurement is a method for studying the component composition of the body, allowing in a fairly short period of time to assess the state of water, lipid and protein metabolism of an organism, as well as highlight the risk of genital prolapse development.
Bulletin of the Russian Military Medical Academy. 2018;20(1):44-47
44-47
Research of innervation and function of shoulder joint stabilizer muscles and parts of deltoid muscles in patients with old fractures of proximal humerus
Abstract
Neurophysiological study of rotator cuff functions (m. biceps brachii, m. triceps, m. deltoideus dex. et sin.) and its innervation in patients with monolateral old fractures and fracture-dislocations of the proximal humerus are presented. Period after trauma was an average of one year. Significant neuritis of n. axillars and n. musculocutaneus were revealed on the traumatic side. Lowering of M-answers in comparison with individual norm was at 48,5% for n. axillaris, 59% - for n. musculocutaneus, 68% - for n. radialis. Strong degree of n. axillaris damage (M-answer 30% below normal) was observed in 39% of patients, that is more often than neuritis of other plexus nerves: similar effect on n. musculocutaneus was two times more often (18% of cases) and 8 times more often than еffect on n.radialis (5% of cases). An in-depth study of the functions of the anterior, middle and posterior parts of the deltoid muscle was carried out in these patients on both sides. Interferencial electromyography demonstrated significant irregularity of bioelectrical activity of different deltoid parts. Stimulating electromyography of m. deltoideus parts innervation recorded reduced activity of the front part of the muscle, caused by weak innervations of its n. axillaris branch in comparison with the norm. Reliable distinctions in function and innervation of deltoid parts were found between each other as well as between intact and damaged sides. The recommendation to carry out electromyography of each part of deltoid was substantiated for patients with complex old fractures of proximal humerus before reconstruction surgeries or shoulder arthroplasty.
Bulletin of the Russian Military Medical Academy. 2018;20(1):48-53
48-53
Correlation between gamma-background of environment and indicators of electrolyte metabolism in patients with arterial hypertension depending on the variant of antihypertensive therapy
Abstract
Arterial hypertension and ischemic heart diseases continue to lead among cardiovascular diseases. In this regard, an importance of fixed-combination antihypertensive therapy is noted. There is an evidence that in years of high solar activity in a group of healthy persons and patients with arterial hypertension and ischemic heart disease reduces the quality of professional activity, cardiovascular diseases exacerbate so that some patients end up developing a heart attack or stroke. There was revealed the correlation between γ-background dynamics of the external environment (within the boundaries of the regional standards) and indicators of electrolyte metabolism in patients with arterial hypertension with different temperament and anxiety, which take an empirical variant of antihypertensive therapy or another variant targeted to the blockade of temperamental peculiarities of psychosomatic status, the most effective antihypertensive therapy was determined. When the power of γ-background in medium was increased, the concentration of potassium and magnesium in blood serum and erythrocytes decreased, but the concentration of sodium increased as the erythrocyte resistance decreased. These shifts are closely related to the increase in osmolar pressure of blood plasma, permeability of erythrocyte membranes for sodium ions, and hemolysis (low resistance of red blood cells, increased indirect bilirubin), and hepatocytes (increase of direct bilirubin). On the background of the targeted antihypertensive therapy the severity of the processes is low and nearly similar to those in healthy persons of corresponding temperament that is the evidence of high efficiency of targeted treatment option.
Bulletin of the Russian Military Medical Academy. 2018;20(1):54-57
54-57
Cases of amyloidosis with diabetic encephalopathy
Abstract
Basic clinical manifestations of diabetic encephalopathy in pre-stroke and stroke stages in the elderly are considered. Psychometrical tests (Shulte tables of and Mini Mental Score Examination scale) were used to reveal cognitive impairments, which are markers of diabetic encephalopathy progression. The case of intravital visualization of diabetic cerebral angiopathy using magnetic resonance imaging in susceptibility weighted imaging mode was described in detail. And the case of amyloidosis confirmed by kidney biopsy material coloring with Congo Red. The results of immunological examination are given, proving a high rate of Interleukin-1 production - initiator of serum amyloid A synthesis in liver (serum amyloid A). Histories of lethal cases and pathohystological analysis results of ultrathin sections, obtained by the means of cerebrum autopsy with Congo Red coloring, were investigated. Autopsy materials with positive qualitative reaction on amyloid were taken for further analyzing in polarizing light and amyloid typing. AA-amyloid was discovered in all cases. Morphologic characteristic of diabetic encephalopathy was revealed using coloring by hematoxylin, eosin and Van Gieson’s stain: angioedema, microhemorrhagia, leukoaraiosis, gliomatosis and atrophy of neurons. Case of genetic polyorganic AA- amyloidosis, not diagnosed intravital, was described in detail. It was established that impaired protein metabolism with its final conformation in toxic amyloid components of tissues is an early and fairly frequent manifestation of diabetic encephalopathy metabolic disorders. The substantiated opinion, implying the necessity of deep protein metabolism investigation in cases of diabetes complicated with encephalopathy and amyloidosis, is given. The term «diabetic amyloid encephalopathy» is offered to include in diabetic encephalopathy classification.
Bulletin of the Russian Military Medical Academy. 2018;20(1):58-62
58-62
Features of regulation of the immune system and sexual development in girls suffering from acne
Abstract
Comparative analysis of immune status and pubertal development in healthy girls and those suffering from acne disease. It is revealed that the immune status of girls suffering from acne disease, characterized by a decrease in cytotoxic lymphocytes, increase T-lymphocytes helper cells and immunoregulatory index. In the peripheral blood of these girls there was an increase in interleukin-4 and serum tumor necrosis factor, level of circulating immune complexes, mainly due to the low was significantly lower than in g concentration of serum interferon healthy girls. In girls suffering from acne in puberty the concentration of luteinizing and follicle-stimulating hormone in peripheral blood was significantly lower than girls in the control group. While menarche in girls 14-13 years old, with acne, there were significantly less than in the control group. The formation of breast and pubic hair at puberty, they lagged behind in comparison with girls in the control group. The indicators of basal metabolism indicate that girls with acne disease higher rates of creatinine and glucose, and also lower essential fatty acids and enzyme activities of alanine and aspartic transferases than girls in the control group. Thus, ladies suffering from acne, was characterized by delayed and at the same time disharmonious puberty. They are characterized by a later menarche, delayed the establishment of the rhythm of the menstrual cycle, some changes of rhythm humoral regulation and biochemical homeostasis.
Bulletin of the Russian Military Medical Academy. 2018;20(1):63-67
63-67
Significance of the left ventricular ejection fraction in diagnosis of heart failure
Abstract
Left ventricular ejection fraction, not being an indicator of contractility, is widely used in practice for the diagnosis of heart failure. It reflects only a change in volume of the left ventricle. It was found that the ejection fraction is not so much dependent on the shock and final diastolic volume as on the final systolic volume. An inverse relationship was found between the left ventricular ejection fraction and the end systolic volume. The larger the end systolic volume, the lower the ejection fraction. High final ejection fraction corresponds to a small terminal systolic volume of the left ventricle. The ejection fraction, representing the ratio of the impact volume to the final diastolic, reflects structural changes in the left ventricle. The more these disorders, the lower the fraction of the ejection of the left ventricle. Its connection with heart failure is realized indirectly through structural restructuring of the myocardium. Low ejection fraction indicates severe damage to the myocardium and unfavorable prognosis for the patient. The empirically established emission fraction did not receive a scientific justification for the regulatory framework. According to the symmetrical approach to the study of a heart, the volume ratio of the left ventricle represents a golden proportion (0,618). Hence, the ideal left ventricular ejection fraction is 62 %, but not 50-80 %, as is customary. An increase or decrease in the ejection fraction indicates a change in the volume of the left ventricle. The clinical morphological similarity of patients with heart failure, classified according to functional classes and size of the ejection fraction, was revealed, which casted doubt on the introduction of the classification of heart failure by the size of the ejection fraction into practice.
Bulletin of the Russian Military Medical Academy. 2018;20(1):68-74
68-74
Retrospective analysis of professional hearing loss of Аir-space forces military personnel
Abstract
Research data on level and structure of sensorineural hearing loss among flight personnel who underwent medical and flight expertise for 2012-2016 is given. Among the analyzed evidences of the disease, 12,8% of military personnel have sensorineural hearing loss of varying degrees. The average age of the contingents tested was 42,1±0,5 years, however, the greatest number of cases occurred in the range of 40-44 years, with a flight time of 20,6±0,5 years in the study group. It was also revealed that bilateral hearing loss was observed in 72,28% cases, in 16,83% - left-sided and in 10,89% - right-sided, with prevalence of II degree in 48,51%, I degree in 35,15%; III degree in 15,35% and IV degree in 0,99% of the subjects. In addition, a significant prevalence of military personnel of the flight crew, dismissed from military service for health reasons, with bilateral sensorineural hearing loss of I and II degrees was revealed. So, among the discharged service members 6,44% had a steady decrease in hearing of both ears to the degree of whisper speech hearing at a distance of less than 1 m and are found not suitable for flight work;16,34% - had a persistent decrease in hearing with one ear to a degree of whisper speech hearing up to1 meter, while perceiving a whisper with another ear from 1 to 4 m and found to be not suitable for flight work; 34,16% had a steady decrease in hearing with one ear to a degree of whispered speech hearing up to 1 meter or close to an external ear, while it takes 4 m minimum hearing a whispered speech with another or it could be persistent hearing loss on both ears to a degree of perception of a whispered speech on each ear in limits from 2 to 3 m and which are not suitable for flight work; the remaining43,07% of the service members had initial manifestations of deafness without changing the category of workability. The information presented in this work justifies the development of measures for prevention of the pathology of the hearing organ expansion and progression and will help to justify the need of creating a center for hearing aid and cochlear implantation in the medical service of the Russian Federation Armed Forces.
Bulletin of the Russian Military Medical Academy. 2018;20(1):75-77
75-77
New minimally invasive technique of treating patients with de Quervain’s disease
Abstract
A new minimally invasive technique is presented to improve the results and reduce the duration of treatment of patients with stenosing ligamentitis of dorsal carpal ligament (de Quervain’s disease). The high efficiency of the proposed method (on the Disabilities of the Arm, Shoulder, and Hand scales and Visual Analogue Scale) is established, comparable with de Quervain’s open ligamentotomy but with the reduction of rehabilitation period after the surgery from 16-21 days to3-4 days. Clinical approbation of minimally invasive ligamentotomy in all patients revealed excellent long-term results of treatment, with minimal risk of complications. Comparison of the results of treatment of patients of both groups showed the advantage of minimally invasive ligamentotomy before open ligamentotomy in the early postoperative period with the same long-term results, which allows patients to start their labor and professional duties in the early stages. The proposed method can be performed in an outpatient mode and does not require special post-operative treatment, as well as special instruments and equipment, which allows reducing the costs of both the patient and the medical institution.
Bulletin of the Russian Military Medical Academy. 2018;20(1):78-85
78-85
Effect of isolated smoking cessation on incidence rates among military personnel with previous work experience in coal mines
Abstract
Smoking and experience of previous work in coal mines have a negative impact on the incidence of acute respiratory viral infection and pneumonia in the servicemen. Isolated cessation for six months leads to a reduction in the numbers of acute respiratory viral infection cases, complicated forms of acute respiratory viral infection, episodes of community- acquired pneumonia, however, the duration of acute respiratory viral infection and pneumonia do not change. The structure of complicated forms of acute respiratory viral infection with a predominance of sinusitis over bronchitis changes. L.Kh. Garkavi’s adaptation index before the study in the group of smokers reflects the marginal tension of adaptation mechanisms. After 6 months there were significant differences with the group continuing to smoke, significant differences remain with a group of non-smoking servicemen. Pharmaceutical expanses after 6 months were different with the smoking group and there were no reliable differences with the non-smoking group. The authors consider an isolated cessation to smoking tobacco in a group of military with previous experience of underground work in coal mines to be an insufficiently effective measure of primary prevention of acute respiratory viral infection and pneumonia, and consider it reasonable to use medicines and biologically active additives with proadaptive action.
Bulletin of the Russian Military Medical Academy. 2018;20(1):86-90
86-90
Results clinical assessment of the application of nonsteroidal anti-inflammatory drugs for pain symptoms occurring after endodontic dental treatment
Abstract
Pain is one of the most common and most difficult on subjective perception of dental symptoms. These domestic and foreign literature stating a fact that more than 80% of patients after endodontic treatment there is a feeling «fullness» in the tooth, pain when biting on the tooth, radiating to neighboring teeth or along the branches of the trigeminal nerve. From the pathogenesis point of view, the above manifestations are acute toxic-traumatic neuropathy of the trigeminal nerve. This often leads to an unreasonable removal of a qualitatively and competently cured tooth. A comparison was made of the analgesic activity of ketanov in the relief of pain that occurs after root canal filling, with the analgesic activity of nimesulide in 57 patients aged 20 to 55 years. In acute pain, an analgesic effect with the administration of ketanov appeared within 15 to 20 minutes, with the administration of nimesil, the effect occurred within 30-40 minutes. After a course of treatment, patients in both groups significantly decreased irritability, sleep normalized. Patients believed in the success of treatment, because a decrease or a significant decrease in the pain syndrome reflexively leads to an improvement in the psycho-emotional sphere of patients, which in turn favors long-term remission.
Bulletin of the Russian Military Medical Academy. 2018;20(1):91-94
91-94
Influence neurological complications that arose after the dental treatment on the quality of life of patients
Abstract
The most common clinical symptom in dentistry is pain. Doctors-dentists of practical health care have to face symptoms that doctors-forensic experts regard as a defect or neurological complication after dental treatment. Quite often there is acute toxic-traumatic neuropathy of the lower alveolar and chin nerve, which occurs when a filling material enters the mandibular canal during treatment of pulpitis or periodontitis of the premolars of the lower jaw [1-3]. During the filling of the canals, the patient has a very intense acute pain in the area of the lower jaw with numbness of the lower lip and chin. In connection with the wide spread and availability of implantological dental care to the population, neuropathies of traumatic genesis occur, the causes of which are mistakes in the setting of implants. One of the earliest manifestations of the above complications is a painful symptom leading to sleep disruption, the inability to fully fulfill their professional duties, fully eat and communicate, that is, to reduce the quality of life of patients. Using the short form (SF-36) as a questionnaire, 86 patients of dental clinics, who according to the medical documentation, had complications after performing dental interventions with different degrees of pain, found that the quality of life in general, with an increase in pain up to 100%, decreases to an average of 60%.
Bulletin of the Russian Military Medical Academy. 2018;20(1):95-97
95-97
Lipid status and vascular bloodstream of servicemen with initial liver fibrosis
Abstract
Frequency of violations of nutritional status, lipid metabolism, cardiovascular status and large vessels endothelium changes in servicemen with fatty liver dystrophy and early fibrosis are assessed. It is revealed that the prevalence of hepatic pathology with dysmetabolic aetiology in this category has vary from 41 to 67%, increasing in combination with subclinical atherosclerosis. According to the results of the study, it is found out that the fibrotic changes in the liver of servicemen associated with a higher frequency of abdominal obesity (higher body mass index and waist circumference), dyslipidemia and structural atherogenic changes of common carotid arteries intima-media complex by type of subclinical atherosclerosis. Have been determined that a violation of the liver elasticity revealed during conducting of transient elastography on servicemen with initial fibrosis meets I-II stage. In the same group with biochemical study increased hepatic biochemical parameters of cytolysis and cholestasis that may indicate activation of inflammatory reactions and transition from fatty hepatosis to more severe stage of steatohepatitis are revealed. A possible mechanism of relationship of obesity, liver fibrosis and atherosclerotic changes of endothelium is proposed. A primary role of fibrosis in nonalcoholic fatty liver disease as a risk factor for the progression of hepatic and cardiovascular pathology in young men was determined.
Bulletin of the Russian Military Medical Academy. 2018;20(1):98-101
98-101
Assessment of skin condition by the modern non-invasive methods in the process of age-related changes correction using the erbium and neodymium lasers
Abstract
The histological examination method is the «gold standard» in evaluating of age-related skin changes, however in most cases biopsy is an unacceptable option by ethical reasons. An alternative option are non-invasive diagnostic methods, in which the evaluation of changes can be carried out in real time without damaging the skin. Nowadays, such methods as high-frequency ultrasound, optical coherence tomography, laser scanning confocal microscopy, magnetic resonance imaging are used. In addition to the above-mentioned methods, it is necessary to hold a standardized clinical evaluation and determination of the physiological parameters of the skin. The evaluation of age-related skin changes of face zone and neck zone before and after the application of the combined erbium and neodymium laser exposure on the «Fotona» apparatus using the «Fotona 4D» technique has been held. There were 80 examined patients aged from 32 to 66 who, after a comprehensive clinical examination, conducted 2 procedures using the «Fotona 4D» method with an interval of 1 month. There was a significant decrease in the index of evaluation of age-related facial skin changes in the process of correction, which indicates a pronounced clinical effectiveness of the proposed technique (27 points at the screening stage and 12 points at 2 months after correction). There was also a normalization of skin moisture and an improvement in relief, reduction of pore diameter and pigmentation area. Analysis of high-frequency ultrasound data showed a statistically significant increase in skin thickness, mainly due to the dermis.
Bulletin of the Russian Military Medical Academy. 2018;20(1):102-107
102-107
Evaluation of some biochemical indicators of blood of high-qualified short-track sportsmen under the combined influence of specific physical load and low-intensive laser radiation
Abstract
Monitoring of biochemical parameters of blood allows to determine the individual characteristics of athletes’ body and evaluate the effectiveness of building a training process. The increasing volume of physical activity during the preparatory period forces us to search for means of rapid increase in the functional level state and physiological reserves of an organism. In this regard, as one of the methods, the physiotherapeutic course effect of low-intensity laser radiation can be used. It was revealed that a specific physical load leads to a significant increase in lactate and total blood protein levels. So, in short-trackers in a state of relative physiological rest, the concentration of lactate was 2,77±0,24 mmol/l, which is much higher than the norm (the norm is 1,3±0,35 mmol/l). After the course of low-intensity laser radiation, the lactate level decreased insignificantly (2,52±0,19 mmol/l), but did not reach normal values. After the action on the body of a specific physical load, lactate concentration increased significantly, reaching a level equal to 9,24±0,43 mmol/l. The conducted course laser therapy allowed to reliably (р 0,05) lower its level to 6,25±0,32 mmol/l. In this case, urea and creatinine had only a tendency to increase. Thus, low-intensity laser radiation against the background of a specific physical load makes it possible to bring the investigated parameters close to the boundary of the physiological norm.
Bulletin of the Russian Military Medical Academy. 2018;20(1):108-110
108-110
Surgical treatment of complications of Crohn’s disease
Abstract
Possibilities and options of surgical treatment of complications of Crohn’s disease in the general surgical hospital are considered. Patients underwent various surgical interventions: ileum resection with «side-to-side» anastomosis (4 patients), resection of ileocecal department with the formation of ileoascendoanastomosis (2 patients), total coloproctectomy with the formation of ileostomy (2 patients), right-sided hemicolectomy (1 patient), obstructive resection of transverse colon (1 patient), obstructive resection of sigmoid colon (2 patients). Postoperative complications developed in 3 patients (25%), among them: postoperative wound suppuration - 2, dehiscence of anastomosis in 1 patient, which led to the formation of internal intestinal fistula and death. It was found that with limited lesions of colon in Crohn’s disease (less than a third of the colon) can be limited to resection of the affected segment with formation of intestinal anastomosis in the limits of healthy tissues. In the presence of lesions in the ascending department of colon proximal border of resection should be at the level of middle colic vessels with preservation of the latter. In long Crohn’s disease of colon with severe clinical manifestations of the operation of choice is a subtotal resection of colon with the imposition of single-barrel ileostomy. Surgical treatment of complicated forms of Crohn’s disease is in all cases performed in surgical profile hospitals, taking patients by ambulance. Most often, patients have delayed indications for operations, which gives the opportunity to carry out a comprehensive preoperative preparation. In all cases, complications of Crohn’s disease requires an individual approach, which combines conservative and surgical treatment. Surgical intervention is determined by the shape and characteristics of the course of complications of Crohn’s disease.
Bulletin of the Russian Military Medical Academy. 2018;20(1):111-116
111-116
Longitudinal contractility evaluation of left ventricular myocardium in healthy individuals
Abstract
Topical issues of evaluation, as well as practical application of longitudinal deformities of left ventricular myocardium in the diagnosis of cardiovascular diseases are considered. A study was conducted with an estimation of the segmented reference values for longitudinal deformation of the left ventricular myocardium in healthy middle-aged people using the technique of speckle tracking echocardiography. The essence of the methodic is to track coded areas of the myocardium (speckles) in the gray-scale image with subsequent automatic processing of data by special software. The data obtained are presented in the form of graphs and polar diagrams. This methodic has advantages over the method of tissue dopplerography, because it is more objective, sensitive and requires less time for data processing and analysis. At the same time speckle tracking has a number of limitations. To assess deformation, a good visualization of the image and a regular rhythm are required, and, most importantly, there are no generally accepted standards, since each manufacturer of echocardiographic equipment applies various filters that counteract the scattering of an ultrasonic beam. The effect of these filters on the results is unknown and, therefore, it is impossible to compare the data obtained on different devices. In addition, in the present work, correlation links between the structural and functional state of the myocardium and indices of longitudinal deformation of segments of the left ventricle are revealed. These results reveal the physiological features of the process in myocardial contractility occurring in the heart, both in norm and pathology.
Bulletin of the Russian Military Medical Academy. 2018;20(1):117-120
117-120
Age features of the teething of wisdom at persons of military age
Abstract
Pathology of an eruption of wisdom teeth is importance for a military odontology because the vast majority of the military contingents on age coincides with time of their physiological eruption (16-40 years). In work, on the basis of clinic-radial methods of a research, features of a teething of wisdom at young people of military age are studied and analyzed 3D-tomograms and orthopantomograms of 325 servicemen aged from 18 up to 27 years. During work estimated existence of wisdom teeth on top and lower jaws, extent of their eruption, existence of a retention (or dystopias) and also an adentia or loss of wisdom teeth. It was established that most often eruption of the third molar teeth of jaws at recruits occurs at the age of 23-27 years, at the same time at a series of recruits eruption of the lower wisdom teeth usually is followed by various complications, such as pericoronitis, an acute purulent periostitis of a mandible, a false «acute periodontitis» of the lower second molar tooth that becomes perceptible at mesial shift of a wisdom tooth and dense contact of its coronal part with a distal root of the second molar tooth. The essential value for a full-fledged teething of wisdom has their situation in an alveolar process (part) of a jaw, and further - in dentition. It in many respects defines a clinical picture of the shown eruption complications and also tactics of stomatologic treatment - orthodontic treatment, surgical treatment or their combinations. The infectious and inflammatory complications bound to the complicated their eruption (85,93% of cases) served as the reasons of an exodontia of wisdom. In 14,07% of cases wisdom teeth on both jaws were extracted in a planned order in connection with the forthcoming orthodontic treatment on elimination of dentoalveolar anomalies. Thus, terms and features of a teething of wisdom at recruits need to be considered in clinical practice of a military odontology as their military service can pass in specific living conditions and activity of troops and health service, and at complications of a teething of wisdom the acute stomatologic surgical management, including stationary is in most cases necessary.
Bulletin of the Russian Military Medical Academy. 2018;20(1):121-126
121-126
Correction of complications portal hypertension syndrome
Abstract
The results a new approach of simultaneous correction of complications of portal hypertension with endovideosurgical method are considered. Surgeries of 4 patients, suffering from portal hypertension, were performed by laparoscopic access and included gastric devascularization with ligation and the transection of the left gastric and short gastric veins; ligation of the splenic artery; resection of the parietal peritoneum, retroperitoneal tissue, and lumbar muscles in the lumbar triangle. Average duration of one surgery was 120±22 minutes. The highest volume of blood loss was 150±35 ml. There were no intraoperative complications. The average time spent in the IC unit was 14±4,2 hours. On the day following the surgery, all patients were able to get out of the bed, walked on their own and were allowed to have liquid food. Each patient had one session of endoscopic ligation with an overlay of 5 to 8 Cook ligatures to eradicate varicose veins of the esophagus. The postoperative period of hospital treatment was 10±2,3 days, treatment responses were favorable in all patients. The total time of inpatient stay was 22±3 days. All patients underwent two sessions of reinfusion of externally modified ascitic fluid. The postoperative spiral computer tomographies and subtraction digital angiographies showed effectiveness of disconnection of vessels in the gastroesophageal system. Blood flow in the splenic artery is not detected, ultrasound shows shrinkage of spleen. The maximum follow-up after the operation was 10 months. There were no episodes of bleeding recurrence and no signs of ascites. All patients are socially adapted and able to work, and do not present any complaints during follow-up examinations.
Bulletin of the Russian Military Medical Academy. 2018;20(1):127-131
127-131
The possibilities of computed tomography heart-axis-oriented multiplanar reformations in diagnostics of common arterial trunk
Abstract
The possibility of using multiplanar reformations oriented on the axis of heart in diagnosing the common arterial trunk with X-ray computed tomography is substantiated. Examination data of 140 patients aged 1-19 days of life, 3030-3890 g body weight with conotruncal congenital heart diseases was analyzed, and common arterial trunk was detected in 7 patients (4 - boys, 3 - girls). In 5 (72%) patients, it developed mainly from the morphological right ventricle, 1 (14%) - completely from the morphologically right ventricle, and 1 more (14%) - evenly located above the ventricles. In four (57%) cases, the trunk valve had three leaflets, in two (28,5%) cases - two, in one (14,5%) case - four. All the patients had mitral-semilunar fibrous prolongation, intraventricular septal defects, doubled coronary arteries system, and the pulmonary arteries had their origin from ascendant part of common trunk. Pulmonary arteries had also their own common trunk in 4 (57%) cases, separate estuary in 3 (43%) cases. Aortic arc abnormalities included dextral aortic arc (2 cases), discontinuity of aortic arc (1 case), discontinuity of fourth aortic arc with persistence of fifth left aortic arc (2 cases). In general, computed tomographic angiocardiography heart-axis-oriented multiplanar reformations permit full and correct assessment of heart and main vessels, which is important for surgical treatment planning in congenital heart diseases.
Bulletin of the Russian Military Medical Academy. 2018;20(1):132-138
132-138
Etiopathogenetic neuroreparative therapy of encephalopathies
Abstract
The possibility of neural tissue regeneration in encephalopathies of various genesis by influencing brain cell pool with reduced functional activity in the state of parabiosis is discussed. The use of a neuroprotective agent rekognan (citicoline) is a justified etiopathogenetic therapy realizing its effects through mechanisms of synthesis of membrane phospholipids, inhibition of synthesis of phospholipase A2, restoration of Na+/K+-adenosine triphosphate functioning, blocking of oxidative stress and apoptosis, modulation of choline, dopamine and glutamatergic neurotransmission. Electroencephalography study was made in order to investigate reactivity of a brain in 12 patients (6 men and 6 women, average age 57±11 years) with encephalopathies to treatment with the Rekognan. The relative index - K α/θ spectra of electroencephalogram power - was used to assess the dynamics of the functional state of a brain before and after the course of treatment with a neuroprotective agent. The majority of patients (9 patients) had a statistically significant positive electrophysiological dynamics with an average increase of K α/θ by 64%. Deprivation of the focus of irrigation in the form of a «running» of reduced acute waves in the right temporal region was recorded in one case, revealed during the test with hyperventilation. An additional prescription for the main therapy of the course of the recognan is associated with an increase in the power of electroencephalogram spectra in a frequency of the dominant alpha rhythm in 75% of patients with encephalopathies of different etiology. Favorable dynamics K α/θ spectra of electroencephalogram power testifies to the involvement of the cerebral reserve due to the neuroreparative effect of recognan.
Bulletin of the Russian Military Medical Academy. 2018;20(1):139-144
139-144
Problems of diagnostics and treatment of gastrointestinal perforations in patients with acute intestinal infections
Abstract
The results of treatment of 97 patients with perforations of the hollow organs of the gastrointestinal tract were analyzed, 31 acute intestinal infections of which were verified. Clinical features of perforation of hollow organs on the background of acute intestinal infection have been revealed. A comparative analysis of clinical and instrumental methods for diagnosing perforations in patients with intestinal infections and without them was carried out. The most sensitive in identifying perforations of hollow organs in patients with acute intestinal infections instrumental methods of investigation were diagnostic laparoscopy (100%) and radiography of abdominal organs (80%). It was established that the combination of the two diseases contributes to the growth of diagnostic errors, increase in the number of common forms of peritonitis and development of the syndrome of mutual aggravation. Analysis of surgical interventions showed that in patients with confirmed diagnosis of acute intestinal infection the primary surgical interventions in most patients resulted in the formation of laparostoma with programmed relaparotomy, in connection with the presence of contraindications for the formation of a primary interintestinal anastomosis. Postoperative complications in the study groups developed in 61,3; 41.7 and 23,8% of cases, respectively. In patients with confirmed diagnosis of acute intestinal infection, lethality was 32,3%, in patients with atypical flow of perforations of hollow organs, simulating the symptoms of acute intestinal infection - 16,7 and 14,3% - in patients with perforations of hollow organs without concomitant acute intestinal infection. The results of the research testify to the relevance of the problem under study and the need to optimize therapeutic-diagnostic algorithm for this category of patients.
Bulletin of the Russian Military Medical Academy. 2018;20(1):145-148
145-148
Foci of chronic infection and vascular rigidity in persons of military age
Abstract
The role of focal infection as a possible risk factor for development of atherosclerotic cardiovascular diseases is discussed quite intensively now. Estimated some parameters of vascular stiffness in young men of military age with the features of their infectious-inflammatory medical history by the type of foci of chronic infection. It is established that in young men with foci of chronic infection such indicators of vascular stiffness, as peripheral augmentation index, augmentation index, normalized to heart rate, and augmentation index of the aorta were significantly higher than in their peers with a positive history. The differences in the first two indicators have reached a reliable level. It should be emphasized the presence of more low blood pressure in the presence of foci of chronic infection , which eliminates the distortion parameters of vascular status, influenced by the tensile effect from the blood pressure in the time of the study. The obtained data clearly indicate the higher rigidity of the walls of the aorta and large arteries in young men under the influence of their foci of chronic infection. Some tendency to development of left ventricular dysfunction in young people with presence of chronic tonsillitis and other infectious and inflammatory diseases was also revealed. This dysfunction is expressed in reducing the maximum rate of growth of blood pressure and increasing the period of expulsion of the left ventricle. The presented results confirm the concept of lifelong formation of «infectious-inflammatory load» in terms of increasing vascular rigidity and subclinical changes in the functioning of the myocardium at young age, subject to the presence of a focal chronic infection. These data allow us to regard foci of chronic infection as another risk factor of atherosclerosis, which in turn requires consideration when carrying out the relevant preventive measures among young population in the process of health checkups.
Bulletin of the Russian Military Medical Academy. 2018;20(1):149-153
149-153
Fundamental life motivations and prerequisites for their realization in young men
Abstract
Аbstract. Quality of life of young men in the view of existential compliance is considered. In its most general form, the term «existence» means «specifically human way of being», the main characteristic of which is the freedom of choice, that is the way of being a person, when he is constantly in a situation that asks him: «How does a man will be a person in this situation?». А person’s subjective assessment of his life was investigated by the technique of A. Langle and K. Orgler «Scale of Existence» in 42 practically healthy young men (24,12±1,1 years). Scores diagnosed on such scales as Self-distancing, Self-Transcendence, Freedom, Responsibility, Personality, Existentiality, and Fulfillment testify to the absence of grounds for the development of existential crisis (for a crisis of subjective evaluation of one’s own life). Thus, with the right medical and psychological support of young people, they have the ability to cope with themselves and with the world, and the feasibility of interaction with the internal and external demands and proposals presented to circumstances, correlating with their own values. At the same time, one should keep in mind that a possible conflict can lead to nervous breakdowns, decrease in the level of professional health (a professional fitness). In order to prevent this, it is necessary to identify persons at risk and prevent possible psychosocial adaptation disorders in advance, using direct methods of psychodiagnostic. To this end, both methods of psycho-counseling and solving personal problems through the provision of advice or other assistance are recommended.
Bulletin of the Russian Military Medical Academy. 2018;20(1):154-159
154-159
Mathematical model of forecast successfulness of N.G. Kuznetsov Naval Academy cadets’ professional military adaptation
Abstract
The development of mathematical model for predicting forecast successfulness of N.G. Kuznetsov Naval Academy cadets’ professional military adaptation is substantiated. It is established that a group of the most successful cadets has a statistically significantly higher achievement and fitness score, higher discipline and lower morbidity. Thus, 66% (64,7%) of the most successful cadets have high discipline, 14 (13,7%) - moderately high. 6% (5,9%) of less successful cadets have average discipline, 14 (13,7%) - low, 2 (1,9%) - very low. 62 (60,8%) of the most successful cadets did not get sick during the last 2 semesters, 18 (17,6%) - rarely got sick. 4 (3,9%) of less successful cadets for the last 2 semesters also did not get sick, 8 (7,8%) - rarely got sick, 10 (9,8%) - often got sick. On the basis of discriminant modeling, a highly informative model for predicting the success of cadets’ educational adaptation in the framework of medico-psychological support activities was developed (λ-Wilks: 0,42842 F (6,75)=16,677 p<0,0000, predictive power 84,3%). Predictors of successful military-professorial adaptation of military cadets are the combination of discrepancy between the value and availability of material welfare, the amount of discrepancy between the value and accessibility of the indicators of the methodology «The level of value and accessibility correlation in various life spheres», the accessibility of love, personal emotional attitude to the concept of family. For more successful cadets, there is a slight discrepancy between the value and availability of material welfare, the amount of discrepancy between the level of value and accessibility does not reach the level of intrapsychic conflict. Personal emotional attitude towards the future is more pronounced and the level of accessibility of love (spiritual and physical intimacy with a loved one) is lower. The mathematical model of the prognosis of the success of military-professorial adaptation of cadets of a military high school should be used as part of medical and psychological support for cadets of military universities.
Bulletin of the Russian Military Medical Academy. 2018;20(1):160-163
160-163
Efficiency of inosine glycyl-cysteinyl-glutamate disodium and pyridoxine in acute poisoning by unsymmetrical dimethylhydrazine
Abstract
Effectiveness of pyridoxine hydrochloride and inosine glycyl-cysteinyl-glutamate dinatrium (molixan) in monotherapy and in combination in acute poisoning by unsymmetrical dimethylhydrazine on survival, blood biochemical indicators and the state of plasma coagulation hemostasis was assessed. Unsymmetrical dimethylhydrazine was administered intraperitoneally at a dose of 115 mg/kg (LD50) once. Drugs under examination were also admistered intraperitoneally: pyridoxine hydrochloride in a dose of 50 mg/kg once, 30 minutes after the administration of unsymmetrical dimethylhydrazine, the inosine glycyl-cysteinyl-glutamatedinatrium (molixan) in a dose of 60 mg/kg seven times: 30 minutes after the administration of unsymmetrical dimethylhydrazine, and then daily for 6 days. Biochemical parameters of blood, plasma coagulation hemostasis, were evaluated 7 days after the administration of unsymmetrical dimethylhydrazine. The use of pyridoxine as a monotherapy and in combination with molixan prevents death of experimental animals and the development of convulsive syndrome. In addition, the combination of molixan with pyridoxine eliminates the development of toxic lesions of liver that is having hepatoprotective effect. The efficiency of molixan as hepatoprotector, apparently, related to the fact that in its structure it is a combined preparation containing the peptide and purine components. The peptide component (glycyl-cysteinyl-glutamate dinatrium) is a pharmacological analogue of oxidized glutathione, purine is represented by inosine. Oxidized glutathione has cytoprotective activity, inhibits the cytolysis of hepatocytes, and reduces the severity of inflammatory process during toxic damage of liver cells by the products of metabolism of xenobiotics. Inosine also has hepatoprotective properties. As a precursor to the synthesis of adenosine triphosphoric acid and nucleotides, it stimulates a number of metabolic processes in body, supports energy balance in various tissues, particularly in liver and myocardium.
Bulletin of the Russian Military Medical Academy. 2018;20(1):164-167
164-167
Assessment of еnergy expenditure and energy intake of the military institute of physical training cadets associated with their academic and professional activities
Abstract
High energy expenditure of daily activity of cadets trained at the Military Institute of Physical Training sets certain demands for cadets’ diet and correspondence of energy and nutrition value of the diet to energy expenditure. Calculated data on energy expenditures of daily routine activities of the Military Institute of Physical Training cadets, energy costs of academic training and sport-related activities are presented. Along with energy expenditure another issue of balance, namely energy intake, is considered. Calculated findings on nutrition and caloric value of a cadets’ food ration and the Military Institute of Physical Training cadets’ diet and energy consumption of cadets are presented. It is shown that cadets’ diet corresponds to average energy expenditure. A comparison of the energy value of the daily ration of cadets and their energy expenditure revealed that the food ration compensates the average energy expenditure. The exceptions are intensive training in the framework of improving athletic skills (2 trainings per day), as well as periods when individual training takes place at the same time with high energy expenditures of a daily routine (for example, snow cleaning). In these cases daily energy expenditure (up to 5000 kcal) was recorded, exceeding the energy cost of food rations and requiring increased energy supply. In addition, the vitamin status of cadets was investigated. No signs of vitamins deficiency in the food ration were revealed. However, in the spring period, a decrease in the content of ascorbic acid in urine is shown in 80% of the subjects.
Bulletin of the Russian Military Medical Academy. 2018;20(1):168-172
168-172
Improvement of legal basis of life and health protection of military personnel
Abstract
Provisions and requirements of the Internal service regulations of the Armed Forces of the Russian Federation regarding the rights and obligations of military personnel for life and health protection are analyzed. Provisions in regulations of 1993 and 2007 years are compared. The compliance of articles of the Regulations to the Constitution of the Russian Federation, Federal laws from May 27th, 1998 No. 76 «Concerning the status of military personnel», from November 21st, 2011No. 323 «On fundamental healthcare principles in the Russian Federation» and from March 30th, 1999 No. 52 «Concerning the Sanitary and Epidemiological Welfare of the Population» are described. Insufficient legal confirmation of the duties of a serviceman in protection of his own health is noted. One of the problems of education and training of the military personnel of various classes is the lack of such subject as a military hygiene in the curriculum. In prerevolutionary military educational establishments, the hygiene was studied and at the course end there was examination. One of the important elements of the health protection of the servicemen is a sanatorium-resort therapy which can be treated as a part of preventive medical examination. Data on decline of sanatorium service of the military personnel in connection with the legislation changes are presented. Considering physical and mental health of servicemen as a guaranty of high-degree alert and military efficiency it is proposed to start studying the Instruction on life and health protection of the serviceman in the period of a basic military training (soldier, sailor, cadet). Proposals on hygiene studying in fostering and educational institutions of the Ministry of Defense.
Bulletin of the Russian Military Medical Academy. 2018;20(1):173-177
173-177
Practice of information transparency introduction into supervisory actions over medicines turnover
Abstract
The assessment of current transparency introduction practice by Federal Service for Surveillance in Healthcare and its local authorities within implemented in Russia concept of federal executive authority’s transparency. Information data from official site of Federal Service for Surveillance in Healthcare and local authorities was studied. The correspondence between the outcomes of supervisory measures to protect the rights of legal entities and the principles of individual entrepreneurs under state supervision is analyzed. The information openness monitoring of Federal Service for Surveillance in Healthcare and its80 local authorities was performed. It is shown that the existing mechanisms (tools) of openness are not fully consistent with accepted in Russian principles, aims and objectives of transparency. The completeness, clarity and availability of information by Federal Service for Surveillance in Healthcare and its local authorities about control and supervisory activities that are to be disclosed are not ensured. It is concluded that there are shortcomings in the procedure of forming the state information resource containing information about the results of verification activities conducted by Federal Service for Surveillance in Healthcare and local authorities. It is still necessary to detail the mechanisms in the field of ensuring openness and transparency of the information provided in order to improve the efficiency and effectiveness of Federal Service for Surveillance in Healthcare and its local bodies.
Bulletin of the Russian Military Medical Academy. 2018;20(1):178-181
178-181
Increasing in level of education of physicians in questions of psychosomatic medicine as one of the ways of psychosomatic medical aid optimizing
Abstract
The results of a survey of physicians of various specialties with the purpose of revealing a level of training of specialists in the field of psychosomatic medicine are presented. The importance of this study is determined by the wide spread of psychosomatic pathology among the population. Wide prevalence of psychosomatic pathology in the practice of doctors of various profiles was revealed. It was found that a significant proportion of patients (on average, 11,1±1%) had complaints at the time of examination, but no objective evidence was provided in favor of one or another pathology. At the same time, it was shown that insufficient awareness of physicians in psychosomatic issues, including an understanding of terminology of psychosomatics and nosologies capable of inducing psychosomatic disorders as well as the possibility of using different scales for a mental pathology detection. Almost a quarter of the doctors surveyed (23,1%) misinterpret the term «psychosomatic disorder», while the incorrect interpretation of this concept is significantly higher among general practitioners and therapists than among doctors of particular specialities. In addition, the need for doctors to expand their knowledge in the field of psychosomatic medicine has been established. Thus, 67,3% of doctors note a lack of knowledge in the field of psychiatry. At the same time, only 11,5% of respondents use questionnaires and surveys in their daily practice to identify various psychiatric disorders among their patients. Practically one third of the doctors surveyed (28,8%) cannot list any indications for sending patients to the psychosomatic department. The results of the study confirm the importance of developing and implementing a course of psychosomatic medicine for clinical residents of various specialties.
Bulletin of the Russian Military Medical Academy. 2018;20(1):182-184
182-184
Features of primary morbidity of military personnel who serve in conditions of occupational hazards
Abstract
The comparative analysis of primary morbidity of officers involved in work with occupational hazards of chemical or radiation nature in 2007-2014 has been performed. It was established that the group of officers involved in work with organophosphorus compounds has significantly higher rate of respiratory system diseases and lower rate of primary morbidity of the circulatory system diseases than the officers involved in work with ionized radiation sources. It was demonstrated that the main contribution to the primary morbidity was made by the following classes: diseases of respiratory system, diseases of musculoskeletal system and connective tissue, diseases of digestive system and diseases of circulatory system. The primary morbidity for leading categories of diseases among military personnel who worked with organophosphorus compounds in two regimes (immediate activities to destroy organophosphorus compounds and support for this process (guard, medical and fire services) did not depend on the nature of work. The rate of respiratory system diseases was relatively higher among all Russian Federation Armed forces servicemen and among those who worked with highly toxic substances (mainly due to acute infections of the upper respiratory tract). For the other classes considered the primary morbidity was higher in the risk groups. Evaluation of the role of specific nosological forms showed that in a group of servicemen working with organophosphorus compounds the rates of acute infections of the upper respiratory tract of multiple and unspecified localization, other nasal and nasal sinuses diseases, dorsalgia predominated but was inferior to the incidence of chronic ischemic heart disease. In this connection it is necessary to elaborate and conduct the preventive measures against above mentioned categories of diseases and main nosological forms of these categories.
Bulletin of the Russian Military Medical Academy. 2018;20(1):185-189
185-189
Genetic researches in standards of delivery of health care
Abstract
The analysis of legal base of genetic researches in clinical practice is carried out. Modern standards of medical care are analyzed. The list of the diseases and pathological states demanding performance of genetic researches is made. The list of the medical services connected with genetic researches is also made. It is shown, that genetic researches make 10% of the nomenclature of medical services. From them about 60% medical services provide diagnosis of somatic pathology, the others are directed to identification of nucleinic acids of causative agents of infectious and parasitic diseases. Genetic researches are carried out mainly at a stage of specialized and primary medical care. Genetic researches are included in20% of standards of medical care. Genetic researches are conducted concerning 15 classes of diseases. More often genetic researches are conducted for diagnosis of the latent infections, enzimopatiya, hereditary diseases of a metabolism, and also cancer. There are some problems of cytogenetic and molecular genetic diagnostics in hospitals. Genetic researches are complex and expensive. Interpretation of the received results is difficult. It is necessary to develop standards of genetic researches. It is necessary to improve legal base of genetic researches.
Bulletin of the Russian Military Medical Academy. 2018;20(1):190-194
190-194
Chemokines’ role in immunopathogenesis of atherosclerosis
Abstract
The results obtained and conflicting data of immunopathogenesis of inflammation and atherosclerosis are analyzed. The role of macrophages and T-lymphocytes in the endothelium damage and formation of an atherosclerotic plaque is shown. Chemokine-leading processes initiating the data processes - macrophage chemotactic protein, interleukin 8, fractalkine. An important role in the initiation of intercellular interaction with the subsequent development of the alliance CD40 and their ligands, expressed by various cell types, participants in the immune-inflammatory process - CD154. The role of subpopulations of T-lymphocytes - 1st, 2nd and 3rd, as well as regulatory T-lymphocytes in the atherosclerotic process was analyzed. An experimental data on the role of chemokines in the development of atherosclerotic process is described. The role of the factor inhibiting migration and providing the concentration of effector cells in the area of atherosclerotic plaque, which lead to its destabilization, is of great importance. It has been shown experimentally that the expression of inhibition factor migration correlates with the intensity of atherosclerotic process. The information on the factor contributing to the output of stromal cells is presented. Experimental data show that the development of coronary heart disease is associated with it. Its deficiency contributes to the development of the disease, and an increase - improves the course of the disease and has a stabilizing effect on atherosclerotic plaques. The role of hemokine (CXC motif) ligand 10 and 11 in the process of atherosclerosis has been experimentally proved. They have a controlled effect on chemotaxis and T-lymphocyte function in the process of atherosclerotic lesion formation.
Bulletin of the Russian Military Medical Academy. 2018;20(1):195-202
195-202
End-to-side neurorrhaphy: expectations and reality
Abstract
An increasing number of injuries with damage of peripheral nerves, including a substantial number of injuries with extensive defects of large nerve trunks, requires improvement in approach to surgical treatment of patients. High-energy impact injuries in peacetime and wartime often lead to persistent violations of musculoskeletal apparatus, a significant part of which is due to injuries of peripheral nerves. During peacetime, various types of peripheral nerve injuries occur in 2-6% of trauma patients. In today’s armed conflicts, various types of peripheral nerve injuries occur in nearly 80% of neurosurgical patients and are mostly of combined injury. Improvements in surgical methods of recovery of lost innervation due to an injury are directly associated with the development of fundamental understanding of the nature of occurring degenerative and regenerative processes in damaged nerve fiber. Nerve suture is only the creation of appropriate conditions that contribute to regeneration of nerve fibers and recovery of lost functions. When extensive defects of nerve trunks exist, connection of distal part damaged nerve with side surface of the intact nerve is the alternative to traditional replacement of extensive defects with nerve grafts. Positive outcomes of such interventions that were seen during tests on laboratory animals led to trials of this method on patients and resulted in a number of positive outcomes as well. Despite the fact that the question of morphological substantiation of reinnervation processes of the distal portion of a damaged nerve is the cause of heated disputes among scientists, some surgeons make attempts to define a set of specific conditions needed to justify the use of end-to-side neurorrhaphy.
Bulletin of the Russian Military Medical Academy. 2018;20(1):203-208
203-208
Modern approaches to diagnosis and treatment of bacterial liver abscesses
Abstract
Modern notions about etiology, pathogenesis and microbiological characteristics of bacterial liver abscesses are analyzed. Cholangiogenic abscess is a prevailing type among the incidences of liver abscesses. Today Klebsiella pneumoniae strains are the predominant cause of pyogenic hepatic abscess. Diagnosis of liver abscesses is based on a combination of clinical and laboratory findings and visualization survey methods. Success in the treatment of liver abscesses is provided by a multimodal approach, including sanation of purulent focus, rational antibacterial therapy and elimination of the main etiologic factor. Effective antibiotic therapy is based on the results of permanent microbiological monitoring of the abscess cavity, bile and blood contents. The question remains about what is the optimal time frame for antibiotic therapy. The main method of treatment of liver abscess is surgical. In the vast majority of cases, minimally invasive puncture-drainage under ultrasound or CT guidance proves to be an effective and sufficient method of treatment, regardless of the size, location and number of purulent foci. There is no consensus, however, on a differentiated choice of minimally invasive sanitation techniques, drainage periods and removal criteria in medical literature. An algorithm for treatment of cholangiogenic liver abscesses must include methods that ensure restoration of the bile ducts patency, relief of biliary hypertension and cholangitis. If the minimally invasive drainage techniques proves ineffective, as well as in cases of complicated abscess or presence of large sequesters in the destruction cavity, it is recommended to perform laparoscopic or traditional open surgery (including liver resections).
Bulletin of the Russian Military Medical Academy. 2018;20(1):209-215
209-215
Chronic hepatitis С and non-alcoholic fatty liver disease. Main aspects of pathogenesis
Abstract
The main pathogenetic aspects of non-alcoholic fatty liver disease as a comorbid factor of chronic hepatitis C are considered. Non-alcoholic fatty liver disease is currently the most common liver disease worldwide, both among adults and children. It is usually accompanied by obesity, insulin resistance and diabetes mellitus. Non-alcoholic fatty liver disease includes a spectrum of pathologies from simple fatty liver infiltration to non-alcoholic steatohepatitis, which is characterized by inflammation with potential progression to fibrosis and cirrhosis over time. On average, non-alcoholic fatty liver disease occurs in 55% of patients with chronic hepatitis C, which is significantly higher than the prevalence of each disease individually. This condition leads to a greater rate of progression of fibrosis, as well as a continuing high risk of developing cirrhosis and hepatocellular carcinoma even after achieving a sustained virological response. In this regard, complex therapy aimed at normalization of the nutritional status, optimization of body weight, correction of impaired intestinal microflora, reduction of severity of liver steatosis and achieving a sustained virological response is a priority task in the treatment of patients with chronic hepatitis C.
Bulletin of the Russian Military Medical Academy. 2018;20(1):216-221
216-221
The preoperative and postoperative period when phalloendoprosthesis
Abstract
Аbstract. The recommendations on an integrated approach to the management of patients with penile prosthesis are presented. Penile prosthesis is one of the most effective and radical methods of erectile dysfunction treatment and is a common worldwide surgery, which gives a more predictable effect and allows to meet the expectations of 80-90% of patients and their partners. Currently, surgeons and urologists has quite a diverse choice of different models of phalloendoprosthesis and methodical surgical approaches for their installation. However, there are no clear clinical guidelines worldwide for the management of patients subjected to phalloendoprosthesis in the pre - and postoperative period. There is also no unified approach to the prevention of infectious complications of phalloendoprosthesis, including their preoperative antibiotic prophylaxis, based on clinical studies. The authors describe and structure the information about preparation stages and management of patients in pre - and post-operative period to prevent the most common complications. All the developed algorithms are based on extremely small selection and purely descriptive statistics, therefore further studies are needed on the scientific basis of management of patients with penile prosthesis, which should be based on in-depth statistical analysis. We consider it necessary to develop legal acts of management for this category of patients, the creation of Russian clinical guidelines for the prevention of infections in surgical intervention in penile prosthesis.
Bulletin of the Russian Military Medical Academy. 2018;20(1):222-224
222-224
Tumors of thymus gland: clinical features, diagnosis, treatment
Abstract
Main aspects of histogenesis, morphology and classification of tumors of the thymus, the current state of their diagnosis and treatment are submitted. Clinical manifestations of thymomas are dependent on their endocrine activity, pace and nature of growth, size and relationship with surrounding structures of mediastinum. Hormonal tumors of thymus are often accompanied by the development of generalized myasthenia gravis. Spiral computed and magnetic resonance tomography are recognized as the leading methods of diagnostics and differential diagnostics of the tumors of thymus gland. However, frequency of diagnostic errors can reach 10-30% of observations. The main method of treatment is surgical, as providing radical and the best long-term results. An adequate volume of surgical treatment of tumors of the thymus gland is thymomthymectomy- enblock removal of a tumor and the entire gland tissue along with fatty tissue and lymph nodes of anterior mediastinum. Various «open» and endovideosurgical approaches to thymus removal have been proposed. Minimally invasive endovideoscopic removal of thymus has a number of advantages over traditional, «open» thymectomy and is characterized by a much smaller intraoperative blood loss and duration of drainage of the pleural cavities, early activization of a patient and a shorter hospital stay. The implementation of endovideosurgical intervention is prescribed with the removal of thymoma I-II stage of cancer progression, as well as in some cases of combined operational benefits at stage III. However, international experience is not sufficient for making decisions regarding the selection of an optimal surgical approach in each case. In invasive tumors of thymus, combined treatment with the inclusion of radiation and chemotherapy is recommended. However, the choice of components of a treatment, modes and sequence remain controversial.
Bulletin of the Russian Military Medical Academy. 2018;20(1):225-229
225-229
Most important epidemiological tuberculosis indicators in the beginning of the III Millennium
Abstract
Tuberculosis in the beginning of the third Millennium continues to be a major threat to humanity. Its burden in the world is significant and is characterized by great morbidity, mortality, and prevalence. The structure of newly diagnosed tuberculosis in the Russian Federation is 90,4% represented by respiratory tuberculosis and 9,6% by extrapulmonary tuberculosis. These indicators reflect the state of early detection of tuberculosis in the regions and the country as a whole. In tuberculosis of respiratory organs, the proportion of patients with pulmonary tuberculosis, which proceeds with destruction- patients with disintegration in the lungs and with fibrous-cavernous processes is analyzed. In 2015, the registered incidence in Russia declined to 57,7 per 100000 population. It was different in various regions of Russia, which is associated with demographic and socio-economic conditions. The incidence of tuberculosis is also indicated by the high incidence rate in young and middle age with a predominance among men. Patients releasing mycobacterium tuberculosis with sputum represent the greatest danger. At the beginning of the III millennium in Russia, the incidence of tuberculosis with the isolation of the pathogen by any method was 35 per 100,000 population (for bacterioscopy - 23-24, for inoculation - 41,8). A major problem of modern phthisiology, which hardens effective treatment, is the problem of resistance of mycobacterium tuberculosis to anti-tuberculosis drugs - multiple and broad drug resistance. High mortality in tuberculosis is observed in African, East- Mediterranean and South-East Asian regions - more than 40 per 100000 population. In Russia in 2015, the mortality rate for tuberculosis was less than 10 per 100000 population. Thus, there is a constant need in further improvement of principles of active control of this socially significant disease.
Bulletin of the Russian Military Medical Academy. 2018;20(1):230-234
230-234
Clinical significance of variant anatomy of the celiac trunk
Abstract
Data on variant anatomy of the celiac trunk, typical and atypical variants of its architectonics, topography, existing classifications, morphometric characteristics, development of the vessels of abdominal aorta in embryogenesis and the clinical significance of anatomical features is presented. The issues under consideration are important for surgical practice, in particular, for abdominal surgery, transplantology, interventional X-ray endovascular surgery and oncosurgery. It is shown that the anatomy of the celiac trunk and its branches have a pronounced variability, and more than 15% of the population have significant deviations from the typical branching variant. A significant number of different variants of the celiac trunk dividing, a different frequency of occurrence of these variants, morphometric indices, apparently depends on the size of the sample of the investigated objects, gender and other reasons. Data on the development of branches of the abdominal aorta in embryogenesis and the causes of atypical variants is presented. In a comparative aspect, existing classifications of the most authoritative authors are considered. It is shown that, despite the large number, there is no universal, simplest in practice, classification of variants of the celiac trunk branching. Nosological examples that demonstrate the need to take into account the variant of formation of the celiac trunk and its morphometric features in operative and diagnostic manipulations on the organs and vessels of the upper floor of the peritoneal cavity are analyzed. Certainly without understanding the architectonics of the gastrosplenicpancreatoduodenal zone arteries, there is a significant risk of error, which can even lead to lethal complications.
Bulletin of the Russian Military Medical Academy. 2018;20(1):235-239
235-239
Sarcoidosis of respiratory system at the beginning of the III Millennium
Abstract
Sarcoidosis of respiratory system is a systemic granulomatosis disease accompanied by the development of epithelioid cell granulomas. During the treatment by glucocorticosteroid drugs or spontaneously, these granulomas disperse or get compacted. Connective tissue with annular distribution is formed around them. Sarcoidosis is etiologically, clinically and morphologically close to tuberculosis. The highest incidence of sarcoidosis has been observed among the urban population of the North of Europe (England, France, Sweden, Poland) - from 20 to 40 per 100000 population. In Russia summary data on the incidence of sarcoidosis does not exist. In the beginning of the Third Millennium according to the St. Petersburg sarcoidosis data it was 8-11 per 100000 people. The basis for justification of the tuberculous nature of sarcoidosis was the similarity of granulomas structure, its combination with tuberculosis and its transformation into tuberculosis with the release of Mycobacterium tuberculosis. The main argument among the opponents of this etiology of the sarcoidosis - is the lack of effect from taking antituberculous medicine. Inefficiency takes place because the point of application of these drugs is the microbial wall. In sarcoidosis, granular and L-forms of mycobacteria with thin cell wall and changes in its structure with which antituberculous drugs contact them are detected in patients. Growth of such microorganisms on special nutrient media causes the restoration of the structure of microbial wall with the restoration of the bacteriostatic effect of anti-tuberculosis drugs.
Bulletin of the Russian Military Medical Academy. 2018;20(1):240-244
240-244
Organizational and functional form of infectious diseases control of servicemen studying in military educational organizations
Abstract
Control of infectious morbidity is considered as a functional tool for ensuring the sanitary-epidemiological well- being of servicemen studying in military educational organizations. At the same time, scientifically substantiated structural and logical schemes for interaction of officials of these organizations to control morbidity in the system of ensuring sanitary and epidemiological well-being of servicemen are absent. Literature data on the development of organizational and functional form of controlling the infectious morbidity of servicemen studying in military educational organizations is analyzed. The connection of infectious morbidity with the level of sanitary-epidemiological well-being of military contingents is mentioned. The concept of infectious morbidity in relation to the activities of officials of the military educational organization control in the sphere of ensuring sanitary and epidemiological well-being is explained. Existing approaches to the development of organizational and functional models in the field of health care are considered. The principles of development of the organizational and functional form of control of the infectious morbidity of personnel of the military educational organization are proposed and the expected results of its implementation are mentioned.
Bulletin of the Russian Military Medical Academy. 2018;20(1):245-249
245-249
Continuous medical education and topical issues in teaching of microbiology
Abstract
The situation and revealed problems of a continuous medical education of experts of various specialities are characterized and ways of their decision are offered. The terms, which let a continuous medical education abroad to become a basic educational system are analyzed. Also, limitations, which have not allowed the continuous medical education to replace traditional formation with study on cycles of licensed departments in the Russian Federation are analyzed. It is established that the basic problem of a continuous medical education is economic. Problems of education of a bacteriologist are reflected in detail. It is shown that such specialities as bacteriologist and virologist require stationary training on profile departments for professional skill improvement, and elements of a continuous medical education can be considered only as additional. Recommendations of elimination of these limitations, which were generated in the course of optimization of educational process, are offered. Also, variants of complex educational process which carries elements of the continuous one are offered. As prominent aspects of optimization of educational process for bacteriologists it is offered to return such a kind of training as specialization on a workplace that will allow to receive necessary specific practical skills. The authors conclude that in connection with the revealed problems it is necessary to consider training on profile departments as the main and variants of a continuous medical education existing at the moment - as additional.
Bulletin of the Russian Military Medical Academy. 2018;20(1):250-253
250-253
Gazenko O. G. - the founder of the cosmic biology and medicine (to the 100th anniversary of the birth)
Abstract
Gazenko Oleg Georgievich - an academician, one of the founders of space biology and medicine, deputy head of the state Research and Experimental Institute of Aviation and Space Medicine of the Ministry of Defense of the Union of Soviet Socialist Republics (1963-1969), director of the Institute of Medico-Biological problems (1969-1988), president of the Russian society named after I.P. Pavlov (1983-2004), advisor to the Russian Academy of Sciences at the State Scientific center of the Russian Federation - Institute of Medico-Biological Problems of the Russian Academy of Sciences (1988-2007). He was immediate participant of the preparation for the flight of Yuri Gagarin. He was the author of Monographs «Animals in Space», «Life and Space», «Man in long Space flight», «Space Cardiology», «Humanity and space». He was in charge as an editor-in-chief of a number of magazines - «Successes of Physiological Sciences», «Space Biology and medicine», as well as large serial monographs - «Scientific results of researches in space missions», «Problems of space Biology». O.G. Gazenko represented Russia at the sessions of the United Nations Scientific and Technical Committee on Outer Space. International recognition of his merits in this field was marked by numerous awards, honorary ranks and titles. The most significant result of the creative path of academician Oleg Georgievich Gazenko was in creation of a new direction - space biology and medicine, which his students and followers still continue to develop.
Bulletin of the Russian Military Medical Academy. 2018;20(1):254-256
254-256
To the 140th anniversary of the legendary Professor of surgery V.F. Voyno-Yasenetsky (Archbishop Luka)
Abstract
The main milestones of life and professional path of an outstanding surgeon of the 20th century Voyno-Yasenetsky (Archbishop Luka) are considered. In 1915, Voino-Yasenetsky published a book «Regional anesthesia» in Staint Petersburg with his own illustrations, and in 1916 he defended his doctoral dissertation in Moscow University on regional anesthesia: the thesis was awarded the prize of the University of Warsaw. In 1917-1930s he worked in Tashkent - the first doctor-surgeon of the city hospital, and from March 1917 - a chief doctor. Since 1920 Voyno-Yasenetsky became a Professor of topographical anatomy and operative surgery at newly established Turkestan University. Voyno-Yasenetsky made great contributions to practical surgery. In his honor several operation were named: resection of affected by purulent process in the sacroiliac joint, the posterior part of the Ilium (pelvic resection by Voyno-Yasenetsky), operation of excision of the affected skin and fatty tissue of the axillary fossa when multiple hidradenitis (Voyno-Yasenetsky operation), incision in the popliteal fossa, supplementing arthrotomy purulent chase (cut by Voyno- Yasenetsky). Also he worked on other problems of clinical surgery. Voyno-Yasenetsky invented the original closure method of the wound located on the periphery of the diaphragm (Voyno-Yasenetsky method). He proposed a new method of spleen mobilization and ligation of blood vessels during splenectomy (Voyno-Yasenetsky method). He described important for surgeons topographic- anatomical landmarks - the projection of the sciatic nerve on the skin back of thigh (Voyno-Yasenetsky line) and the place of exit of the sciatic nerve under the gluteal folds (Voyno-Yasenetsky point). For the books «Sketches of purulent surgery» (1943) and «Late resections of infected gunshot wounds of the joints» (1944) in 1946 he was awarded the Stalin prize of the first degree. Since 1946, in connection with the illness, he departed from surgical activity and before the end of his life he lived in Simferopol (Crimea).
Bulletin of the Russian Military Medical Academy. 2018;20(1):257-260
257-260
Professor T.Ya. Aryev. The first experience of the management of the clinical department (to the 110th anniversary of his birth)
Abstract
The work presents little-known facts of the service of Professor T.Ya. Arieva in the post of the head of theDepartment of Military Surgery of the Military Medical Faculty S.M. Kirov at the Saratov Medical Institute in the period1951-1958. Arriving to a new duty station as a member of the staff of teachers from the Military Medical Academy, hesupported the command of the faculty of medical institute in a short time was able to staff the cathedral team and begin thecurrent work. Possessing significant personal scientific and pedagogical experience and the technique of performing complexsurgical interventions, he was able to effectively organize on a scientifically grounded principles the methodology of teachingdiscipline on the basis of a city clinical hospital. In his work he successfully used the rational distribution of study time, theoptimal schedule of the day of medical and nursing staff. As the head of the department T.Ya. Aryev paid much attentionto the professional growth of the teaching staff, regularly summarized in the press the accumulated experience, shared anddiscussed with colleagues promising ways to improve the pedagogical process. Scientific and clinical work complementedeach other, allowed not only to find answers to urgent questions and problems of medical science, improve the effectivenessof treatment of patients, but also to identify the most gifted listeners and teachers of the department. Such students are T.Ya.Aryev, as M.I. Lytkin and N.E. Povstyanoy, working under his leadership, became later known physicians and scientists, headsof surgical departments in large universities, created their own scientific schools. Service in Saratov allowed to accumulateT. I Aryev considerable experience in the management of the surgical department. It was this factor, combined with personalqualities, that enabled him to lead the first in our country chair of thermal defeats of the Military Medical Academy S.M.Kirov. Under his leadership, the team created a well-known clinic not only in our country but also abroad, a large scientificand educational center, which became a real school of professional skill for a large number of specialists.
Bulletin of the Russian Military Medical Academy. 2018;20(1):261-267
261-267
Organization of the soviet armed forces medical supply in 1970’s and 1980’s
Abstract
The activity of the Soviet Army medical services on the troops medical equipment provision organization in the 1970-1980s is described. Principal schemes for medical equipment provision to the Soviet Army in accordance with the troopslogistical support principles in various conditions are also shown. General accumulation and summarization of the positiveexperience gathered during the local wars (Afghanistan), armed conflicts and in the liquidation of peacetime emergencysituations medical and sanitary consequences (Chernobyl, Armenia, etc.) is taking place in the medical supply system. Theresults of the military pharmacy legal framework development are presented. New progressive approaches to the guidancedocuments development have been established through the introduction of computer facilities based modeling processes fortroops medical equipment provision. The reasons for creating a separate discipline «Organization of military medical supply»and its role in the training of military pharmacists are considered. The role of the Military Medical Supply and PharmacyDepartment of the Military Medical Faculty at the Tomsk Medical Institute, where students of pharmaceutical faculties andpharmaceutical universities were called upon to study after finishing their third year, is exposed. The Military Medical Supplyand Pharmacy Department of the S.M. Kirov Military Medical Academy activity on the troops (forces) medical supply systemimprovement, on the administrative staff training in the resumption of two-year full-time specialists education in the troops(forces) medical supply organization sphere, including additional professional education programs is shown.
Bulletin of the Russian Military Medical Academy. 2018;20(1):268-279
268-279
Pravila dlya avtorov
Bulletin of the Russian Military Medical Academy. 2018;20(1):280
280