Vol 20, No 3 (2018)
- Year: 2018
- Articles: 54
- URL: https://journals.rcsi.science/1682-7392/issue/view/778
- DOI: https://doi.org/10.17816/brmma.373
Articles
Endovascular Arterial Embolization in the Treatment of Gastroduodenal Ulcer Bleeding
Abstract
Currently, it is possible to improve the outcome of the treatment of gastroduodenal ulcer bleeding by reducing the mortality, primarily in patients with a persistent high risk of rebleeding against the background of the conservative treatment and high operational risk. Unacceptably high postoperative mortality in high-risk surgical patients reaching 60%, often forces the surgeons to use the conservative treatment for these patients, which often leads to rebleeding, open surgery despite the high risk and unsatisfactory outcome of the treatment. A minimally invasive technique such as transcatheter embolization of the gastric and duodenal arteries in gastrointestinal ulcer bleeding, allowing to affect the source of bleeding by endovascularization with a minimal surgical trauma, made it possible to achieve hemostasis in 60 of 61 patients (98%). Rebleeding after arterial embolization occurred in 3 patients (5%). In 51 patients (85%), endovascular hemostasis was permanent. Additionally, 6 patients (10%) underwent delayed surgery at different times after arterial embolization. Overall mortality in high-risk surgical patients was 9.2% and was not related to arterial embolization, which compares this data favorably with many literary sources. With its impact, arterial embolization with an adhesive composite based on N-butyl-2-cyanoacrylate is an alternative to the surgical treatment of gastroduodenal ulcer bleeding and an operation of choice for high-risk surgical patients.
Bulletin of the Russian Military Medical Academy. 2018;20(3):7-11
7-11
Hormonal status in patients with solitary and multyple cysts of the breast
Abstract
The hormonal status was studied in patients with solitary and multiple cysts of the breast. Sex hormones, being a regulator of the normal physiological processes of most organs and systems, are traditionally considered one of the key factors in the development and progression of tumors in the organs of the reproductive system, including the mammary glands. It was revealed that solitary cysts were most often localized in one mammary gland (42,8%), while multiple cysts were located more often in both mammary glands (57,2%). It was found that in 43,2% of cases the cysts were located in the upper thoracic quadrant of the breast, in 5,6% of cases in the lower, quadrant, 3.2% in the lower inner quadrant, 9,6% in the upper quadrant, and the diffuse the defeat of two quadrants and more was revealed in 38,4% of observations, which is associated with the features of the morphofunctional characteristics of structural units of the breast and the architectonics of the milk ducts. In most cases, cysts with apocrine metaplasia (52,8%) were detected, less common proliferation (32,8%) and squamous metaplasia (14,4%) were less common. Cytological examination of the contents of the cysts of the breast can reveal apocrine metaplasia or hyperplasia of the epithelium - pathogenetically important markers of the risk of breast cancer. It was found that the predominance of cystic changes in the mammary gland at the peri-postmenopausal age correlates with a decrease in the levels of estradiol, progesterone, prolactin, follicle-stimulating and luteinizing hormones, with the exception of the normal values of total testosterone. In groups of early and late reproductive age, there was a tendency to increase the concentration of luteinizing hormone and estradiol in the blood serum. Thus, patients with solitary and multiple cysts of the breast in different age periods against a background of hormonal imbalance need an individual medical-diagnostic approach with echographic semiotics of pathological changes and determination of the hormonal status.
Bulletin of the Russian Military Medical Academy. 2018;20(3):12-16
12-16
The skin test with tuberculous recombinant allergen AT successful treated patients with lung tuberculosis
Abstract
38 patients with newly diagnosed tuberculosis, immediately after the end of the main course of treatment, when they were transferred to the third group of dispensary supervision (6-9 months) and when they were removed from the dispensary supervision (2-3 years later), a skin test with an allergen tuberculous recombinant was made. The positive skin test with tuberculosis recombinant allergen was defined at 20 patients - 13 mm. At the moment of removing to the III group only one skin test with tuberculosis allergen recombinant became negative, 19 (94,5%) patients had positive reactions - 13±2,3 mm. At the time of discharging from dispensary the positive reactions were determined at 16 (80%) cases - 10±2,3 mm, p<0,05. In this group, 13 (65%) patients had normergic skin tests with tuberculosis allergen recombinant and 7 (35%) - hyperergic tests. At the time of removing to the III group at five from seven patients with hyperergic tests the results remained the same, median and at the moment of discharging from tuberculosis service only one patient had the hyperergic skin test with tuberculosis allergen recombinant - 18mm. Among patients with normergic skin tests with tuberculosis allergen recombinant at the time of group III removing median was 11±2,1 mm. At the last dynamic control the normergic results were determined at 15 (75%) patients and the tests median remained almost unchanged - 10±1,8 mm, the differences are reliable compared to the initial data (p<0,05). In group which included 18 patients with negative skin tests with tuberculous allergen recombinant, the skin response stayed negative throughout all examination period except for one patient so patients of this group had not only clinical, radiological and bacteriological, but immunological signs of involution of the tuberculosis process. The study of the influence of clinical, epidemic and social factors to skin reaction showed that first group patients were significantly more likely to be unemployed (30% versus 5,5%; p<0,05) whereas in second group married patients were reliably registered (61,1% versus 25%; p<0,05). Other factors differed unreliably.
Bulletin of the Russian Military Medical Academy. 2018;20(3):17-20
17-20
Dynamics of homeostasis and the outcome of sarcoidosis of the respiratory system in the treatment of corticosteroids
Abstract
The outcome of sarcoidosis of the respiratory system is closely linked to the state of homeostasis and reactivity. Monitoring their status is possible through immunological, biochemical and hormonal studies. Within common medical institutions re-executing these studies is not always possible for a number of reasons. Therefore, the research for the availability and informative criteria of homeostasis and reactivity state was initiated at the end of XIXth century and continues until now. At the Department of Phthisiopulmonology of the First St.-Petersburg state medical University Academy I. P. Pavlov. University, new accessible and informative diagnostic criteria for estimation the state of homeostatic balance of the organism are developed. They are based on research of the general adaptation syndrome and the discovery of antistress types of adaptive reactions of the organism. In this regard, based on the leukogram evaluation following diagnostic criteria were developed and tested: leukocyte-lymphocytic index, types of adaptive reactions, entropy and redundancy of formed elements of white blood cells, extent of disturbance of homeostasis, indices of proliferation and differentiation of monocytes and reactivity types. Unfortunately, in the pulmonology clinics, they are used today only in single cases. The monitoring of homeostasis and reactivity indicators in patients with respiratory system sarcoidosis had a high working performance. It is established that in sarcoidosis the best treatment effect with corticosteroids with minimal residual changes of respiratory system took place in patients with the appropriate type of reactivity and normal range of other indicators. Pathological reactivity of an organism, especially hyporeactive and areactive types, are always accompanied by formation of pronounced residual sarcoidosis changes in the respiratory tract, which is the basis for the subsequent exacerbation (recurrence) of sarcoidosis.
Bulletin of the Russian Military Medical Academy. 2018;20(3):21-26
21-26
The main directions of prevention of noise pathology in the Armed Forces
Abstract
In accordance with the existing Federal sanitary standards, noise and infrasound are considered to be an harmful production factor and in terms of their prevalence they occupy a leading place in the national economy. To prevent the harmful effects of noise and infrasound on the health of members of the armed forces establishes the main lines. For prognostic assessment of harmful influence of production factors on production facilities and transport the special assessment of working conditions is carried out without fail. Hygienic research of workplaces has shown that noise and infra-sound levels correspond to harmful and dangerous classes, that is, risks of professional pathology of acoustic Genesis are created. The presence of acoustic sources in the Armed forces requires constant monitoring of them, the annual special assessment of working conditions development of preventive measures. The impact of noise and infra-sound leads to a decrease in military and professional performance and an increase in General and professional morbidity. The leading place in the structure of morbidity of noise etiology is a sensorineural hearing loss. This requires further improvement of the provision of specialized assistance to military personnel in the presence of noise hearing loss. In the current regulations of the military medical services noise and infrasound are not identified as a harmful factor, and therefore not fully developed the issues of professional selection, monitoring and medical examination of noise pathology. An important place in the system of prevention of harmful effects of noise is given to the means especially individual of protection against noise. Their absence and low efficiency pose a threat to the acoustic safety of military personnel. Provision of personnel with means of individual protection against noise and control of the correctness of their operation are the most relevant measures to reduce the noise pathology of the hearing organ. The existing system of measures to combat the harmful effects of noise in the Armed forces requires revision in accordance with the existing state legislative and legal framework.
Bulletin of the Russian Military Medical Academy. 2018;20(3):26-32
26-32
Features of left ventricular myocardial remodeling associated with state of coronary сollateral arteries in patients with intermediate function of left ventricle and background of acute decompensation of heart failure
Abstract
Features of left ventricular myocardial remodelling depending on the state of collateral coronary flow are presented. Disorders of the left ventricle`s myocardium local contractility in patients with the intermediate function of left ventricle under acute decompensation of heart failure were studied. It was established that in such patients with postinfarction cardiosclerosis the main disorders were more often obtained in the basal and middle parts of lower and posterior walls of left ventricle vascularized by a circumflex branch of the left coronary artery or right coronary artery. It was shown that as blood flow increased in coronary collaterals; increase in left ventricular ejection fraction was 7%. In this case, an improvement in collateral blood flow by 1 point according to the Rentrop’s modified classification was accompanied by an increase in the left ventricular ejection fraction by 2 relative percents. In addition, in patients with intermediate left ventricular function, types of left ventricular myocardial remodelling were determined. Thus, in the pathogenesis of acute decompensation of heart failure, an important link is remodelling of the left ventricular myocardium, that is a complex of changes in structure and geometry that occurred under the action of trigger factor. Determination of qualitative type of remodelling, as well as its relationship with changes in extracellular matrix, is important for assessing the risk of cardiovascular complications and selecting adequate therapeutic tactics. and a volume fraction of interstitial collagen was calculated in patients with intermediate left ventricular function and background of acute decompensation of heart failure.
Bulletin of the Russian Military Medical Academy. 2018;20(3):33-36
33-36
Correlation between heliogeophysical factors and osmotic pressure of blood plasma in patients with arterial hypertension with different temperament
Abstract
The relation between heliogeophysical factors and the osmotic pressure of blood plasma in patients with arterial hypertension with different temperaments is analyzed. It is found that with increasing solar activity (Wolf numbers and radio flux wavelength 10,7 cm), is closely related increase in atmospheric pressure, air temperature and γ-background (within normal limits) in the workplace examinees. It was revealed that in choleric and sanguine patients there is a reliable high inverse correlation relationship between heliogeophysical, meteorological factors and total peripheral vascular resistance, while the phlegmatic and melancholic - the average direct and direct high correlation relationship. Antihypertensive therapy with diuretics with increased solar activity, combined with an increase in the atmospheric pressure, γ-background and the air temperature in the workplace, due a decrease in total peripheral vascular resistance at the choleric and sanguine and increase in total peripheral vascular resistance in healthy individuals and phlegmatic patients and melancholic. The presence of significant and reverse correlation relationship between the total peripheral vascular resistance and osmotic pressure of blood plasma in choleric and sanguine and significant, but a direct correlation - the phlegmatic and melancholic indicates the inclusion of an adaptive process various physiological mechanisms, which determines the need to consider the temperament at solar biospheric relations bonds.
Bulletin of the Russian Military Medical Academy. 2018;20(3):37-40
37-40
Satisfaction of adults with the consequences of gunshot wounds of the maxillofacial area by the results of oral rehabilitation
Abstract
Satisfaction of adults is analyzed with the results of oral rehabilitation with the elimination of the consequences of gunshot wounds in the maxillofacial area, accompanied by a loss of more than 8 teeth on the jaws. It is established that such patients experience serious physical and mental suffering due to loss of teeth and malfunction of chewing, which do not allow them to feel healthy. It was revealed that there were more completely satisfied with the treatment with the use of non- removable or conditionally removable dental prosthesis on artificial supports (dental and zygomatic implants) than among patients who used removable dentures and dentures with restraining or support-retaining clasps. Mainly due to the fact that dental prosthesis based on implants in comparison with removable dental prosthesis largely restore chewing function and cause patients less inconvenience. A week after completion of oral rehabilitation, 6.1% of patients using removable dental prosthesis and dento-facial prosthesis with restorative or support-retaining clasps were satisfied with its results, 61,5% of patients - in part, 10,3% of patients found it difficult to answer this question, and 23,1% of patients were not satisfied with the results of oral rehabilitation. 63,6% of patients who used fixed or conditionally removable dental prosthesis on artificial supports (dental and zygomatic implants) were completely satisfied with the results of oral rehabilitation, 22,7% of patients - in part, 9,09% of patients - were not satisfied and 4,5% of patients found it difficult to answer. In general, the use of modern structures of fixed and conditionally removable dental prostheses on dental and zygomatic implants for oral rehabilitation allows to achieve full satisfaction with the results of dental orthopedic treatment in 81,8% of patients, which indicates the need for widespread use of dental prosthesis on artificial supports in oral rehabilitation wounded in the maxillofacial area.
Bulletin of the Russian Military Medical Academy. 2018;20(3):41-45
41-45
Dynamics of recovery of speech and cognitive impairment in different periods of ischemic stroke
Abstract
The results of the dynamics of speech and other cognitive functions restoration in all periods of ischemic stroke have been established. In the study of speech functions, the motor form of aphasia was more often diagnosed (in 59,1% of cases). In the acute period of ischemic stroke in 80% of cases, speech disorders of severe severity were detected. It was statistically proved that the motor component of speech recovered faster than the touch one. For example, all patients, suffering from sensory aphasia the earlier rehabilitation period ischemic stroke, a volume of understanding speeches sufficiently limited. Parognosia was diagnosed with 50% of patients, in 25% of cases, a violation of phonemic hearing was reviled. At follow-up study there is a positive dynamic in the form of restoration of the impressive component of speech, 75% of patients relatively freely understand human speech. At an in the acute period of ischemic stroke spontaneous speech is changed (lateral and verbal paraphasia is diagnosed in all patients). Polyphasia phenomena had been diagnosed with 50% of patients. Repetitive and dialogue form of speech highly limited. In a late period, polyphasia had been diagnosed with 25% examined. Improvement in the form of a decrease in the number of literal and verbal paraphases was reviled with 75% of patients. 80% of patients were able to dialogue form of speech. In general dynamics of indicators of the degree of speech recovery in women is slightly higher than in men, and does not depend on the age of patients. It was revealed that the most effective speech was restored in the first year after the acute cerebrovascular accident. The restoration of the impressive component of speech was faster in all forms of aphasia. A high level of quality of life was noted in patients with baseline less impaired mobility (an index of Riverbed, Rs=0,68; p=0,01) and less dependent on others (Barthel index, Rs=0,43; p=0,003). Prognostically unfavourable facts for speech restoration include the area of ischemic focus more than 0,8 cm. When assessing cognitive functions in the residual period, 85% of patients were diagnosed with moderate disorders, 15% of patients were diagnosed with mild cognitive impairment. The obtained data substantiate the need to optimize speech therapy assistance in all periods of ischemic stroke.
Bulletin of the Russian Military Medical Academy. 2018;20(3):46-49
46-49
Clinical and instrumental characteristics of traumatic lesions of peripheral nerves of limbs
Abstract
Traumatic injuries of peripheral nerves are caused by domestic, iatrogenic, industrial or military injuries. The estimated frequency of traumatic neuropathies in peacetime in Europe is 1 per 1000, with the highest prevalence among young people of working age. In modern local armed conflicts, the frequency and severity of gunshot injuries increased significantly. In connection with the widespread use of personal protective equipment (helmet, body armor), there is a relative increase in injuries to the limbs. Damage to the peripheral nerve can significantly reduce the patient’s quality of life and lead to severe disability with significant social and personal consequences. A deep understanding of the pathophysiology and molecular basis of damage to the peripheral nerves, achievements in the field of damage topography contributed to the development of microsurgical techniques of treatment. At the same time, there are quite a lot of unresolved issues related to clarifying the mechanisms of degeneration and regeneration in traumatic injuries of peripheral nerves. To determine and select a further tactic for the treatment of traumatic neuropathy, it is necessary to clarify the level, nature and severity of nerve damage. In order to improve the treatment of peripheral nerve injuries, in addition to the clinical-neurological examination, a wide range of additional modern instrumental research techniques are used: electroneuromyography, ultrasound investigation, magnetic resonance tomography.
Bulletin of the Russian Military Medical Academy. 2018;20(3):50-56
50-56
Condition and measures to improve dental care for the population of the Southern Federal district of Russia
Abstract
Рresents information on the level of dental care for the urban and rural population of the Southern FederalDistrict of the Russian Federation, which were obtained based on dental examination data of 3658 adults (1524 men and2134 women) of young and middle-aged (from 21 to 59 years) city and countryside. It was established that urban residentshad significantly lesser untreated carious lesions, including caries of the filled tooth, and removed teeth that were not restoredwith dentures. The main causes of tooth loss, regardless of sex and place of residence, were complicated caries (periodontitis)and periodontal pathology (periodontitis heavier). In men and women living in the city, the intensity of the carious processwas 11,54±0,82 and 9,14±0,67, respectively; while those living in rural areas, respectively, 12,26±0,64 and 11,44±0,68. Thelevel of dental care varied significantly depending on the place of residence and, regardless of gender, the urban populationwas characterized as satisfactory (the index of the level of dental care for men is 53,47%; for women is 60,5%), and ruralresidents as insufficient (the index of the level of dental care for men is 39,07%; for women is 40,12%). The need to improvethe material and technical base of state (municipal) medical and preventive institutions providing dental care to rural residents,as well as the resumption of the work of dental mobile teams or mobile dental offices, based at the regional, regional anddistrict hospitals. It was noted that industrial and agricultural enterprises can help the dental health of villagers greatly byorganizing dental offices with their medical-sanitary units and medical centers.
Bulletin of the Russian Military Medical Academy. 2018;20(3):57-61
57-61
Effectiveness of methods of differential diagnosis of paroxysmal disorders of consciousness in children
Abstract
Abstrast. Clinical, electrophysiological and neuroimaging methods used for differential diagnosis of different forms of epileptic and nonepileptic paroxysms in children in the early stages of the disease are considered. 527 patients aged 1 to 18 years were examined. As a result of a comprehensive survey, taking into account the data of video-electroencephalogram monitoring, 317 patients with epilepsy with a significant predominance of symptomatic forms of epilepsy were revealed, of which 166 (42,37%) patients had focal forms, 36 (11,36%) patients - generalized. A significant number of children were found to have conditionally symptomatic focal epilepsy - 94 (29,65%), only 4 (1,26%) patients - with Landau - Kleffner syndrome and a relatively small group - 17 (5,36%) patients with idiopathic epilepsy. Nonepileptic paroxysms were more common in boys in all age groups except for children from 1 to 3 years, but in this group of children the difference in the frequency of different paroxysms is insignificant (0,48%). In the frequency of nonepileptic paroxysms significantly prevailed in boys aged 3 to 6 years (13,33%) and 6 to 9 years (11,43%). In girls, nonepileptic paroxysms were more common at the age of 3 to 6 years (10,48%) and from 1 to 3 years (9,95%). A comprehensive examination allowed to differentiate children with epileptic and nonepileptic paroxysms and to clarify their diagnoses. With a refined diagnosis of nonepileptic paroxysms, 210 patients were found. The results indicate the need for a thorough comprehensive examination of children suffering from paroxysmal disorders of consciousness to avoid erroneous diagnosis.
Bulletin of the Russian Military Medical Academy. 2018;20(3):62-66
62-66
Morphological substantiation of clinical efficacy of platelet rich plasma in males with androgenic alopecia
Abstract
Morphological substantiation of the clinical efficacy of platelets rich plasma was carried out in the treatment of 22 men with androgenetic alopecia from the 1st to the 4th stage according to the Norwood-Hamilton scale were included. All patients received intradermal injections of platelets rich plasma 0,15 ml per injection. The course of treatment consisted of 4 procedures with an interval of 4 weeks. Clinical efficacy was assessed by the dynamics of morphometric indices of hair growth. Histological examination was carried out on horizontal sections, stained with hematoxylin and eosin, the morphology of the hair was counted at four levels. Evaluation of morphometric growth parameters conducted before treatment and 4 months after the onset of it. It was established that the therapy of platelet-rich plasma has a pronounced clinical efficacy, consisting in a significant (p=0,00025) increase in hair density by 11% and average hair diameter by 10% (p=0,00766), a 14% decrease in the share of hair follicles (p=0,00959). Histologically, the increase in hair density was significant at the level of the bulb of the hair follicles by 148% (p=0,0034) and at the level of the sweat glands by 65% (p=0,0326), and also by the tendency to increase their number at the level of the sebaceous glands. This was combined with a significant decrease in the proportion of telogen hair at 47% (p=0,0153). Thus, the positive clinical effect of plasma-rich plasma therapy in men suffering from androgenetic alopecia is based on reliable morphofunctional changes in the hair follicles.
Bulletin of the Russian Military Medical Academy. 2018;20(3):67-71
67-71
Functional magnetic resonance imaging tomography in assessing the functional state of the brain in patients with opioid addiction
Abstract
The possibilities of functional magnetic resonance imaging in the diagnosis of opioid dependence syndrome are considered. It is known that opioid addiction is one of the leading problems of modern narcology. Despite the fact that the number of researches of the neurobiological effects of opioids is increasing every year, the pathogenetic effects of dependence on this narcotic substance are still not fully understood. Functional magnetic resonance imaging rest allows one to assess the functional connectivity of the remote from each other parts of the brain and makes a great contribution to understanding the mechanisms of development of addictive disorders in general. In patients with opioid dependence, an analysis was made of the neural network of the passive mode of the brain (default mode network). This resting network is associated with the processes of control and thinking, including emotional and cognitive components, and consists of medial frontal regions, posterior cingulate sections, precuneus, lower parietal and temporal divisions. It was found that, in comparison with the control group, in all patients suffering from opioid dependence, weakened functional connections of all structures of the cerebro-spinal cord system (p<0,05). In this case, changes in the medial prefrontal cortex and precuneus are more pronounced in patients who are in the state of opioid intoxication, and in the parietal-temporal regions in patients who are in a state of remission up to 1 month. The correlation of cortical structures responsible for the «behavior control» system (orbitofrontal cortex, prefrontal cortex) with subcortical structures responsible for emotions in the limbic system was also evaluated. In comparison with the control group, in patients with early remission, weakened functional connections between cortical structures and left contiguous nucleus, almond-shaped body from two sides. In patients in a state of intoxication in addition to these changes, the functional relationship between the orbital frontal cortex and the shell on the left has been weakened. The weakening of functional links in the network of the passive mode of the brain in the groups of drug addicts suggests that they have violated the processes of control, thinking and making the right decision. The resulting functional changes can form the basis for creating biomarker maps for patients suffering from opioid dependence, which can be used to guide and evaluate the treatment of this pathology.
Bulletin of the Russian Military Medical Academy. 2018;20(3):72-79
72-79
Features of surgical tactics of treatment of victims with deep burns of the face
Abstract
Data on optimization of tactics of treatment of victims with deep facial burns in 314 patients (194 men and120 women) aged 18-60 years are presented. All patients were treated in the clinic of thermal lesions of the Military medicalAcademy S.M. Kirov in the period from 1991 to 2016 the expediency of using early necrectomy for removal of the studiedcontingent of patients with mild and moderate severity. The result is a reduction in the time of hospitalization and a reductionin the number of scarring. Statistically, the duration of treatment in victims with isolated deep burns was reduced 3 times, inpatients with mild and moderate severity, with extensive thermal lesions, 1.8 times. At the same time, the obtained data indicatethat the terms of removal of the dead skin and restoration of the skin do not affect the mortality of victims with isolated deepburns of the face. In the group of severe and extremely severely burned tactics of treatment of deep burns on the face whenperforming early necrectomy in other areas of the body also has no effect on mortality. It is significant that the shortage ofdonor resources is one of the determining factors in the choice of conservative treatment tactics for this category of patientsin a significant number of observations both at the Academy and in other specialized departments of the Russian Federation.
Bulletin of the Russian Military Medical Academy. 2018;20(3):80-85
80-85
Diagnostic capabilities of electrocardiography systolic heart failure
Abstract
The contractility of the myocardium is determined by the strength and speed of contraction of the ventricles. It can be estimated from the Q-T interval of the electrocardiogram, which is an electrical systole of the ventricles. Set the change in ventricular systole by the deviation of the actual interval of Q-T from the corrected one. Elongation of ventricular systole indicates a violation of myocardial contractility, which causes the development of systolic heart failure. When comparing this indicator with the results of echocardiography, reflecting the contractility of the left ventricle, their direct dependence was established. The greater the degree of breach of myocardial contractility, the higher the percentage of the deviation of the actual Q-T interval from the corrected one. The maximum figures were recorded in patients with a global contractility disorder. This indicator can be used to detect both acute and chronic systolic insufficiency. It was established that in all patients with heart failure there was an increase in the Q-T interval. The magnitude of it depended on the degree of manifestation of heart failure. The increase in the percentage deviation of the actual value from the control occurred in patients with heart failure from I functional class to IV. Only in 1/5 of patients with heart failure of I functional class, the actual value did not differ from the control one, but under physical load, it increased significantly, which indicates the presence of latent systolic insufficiency. It is also found in patients with heart failure with a preserved ejection fraction, the development of which is associated with diastolic dysfunction. Electrocardiography can be used as a method of diagnosing systolic heart failure, which is highly informative and specific.
Bulletin of the Russian Military Medical Academy. 2018;20(3):86-90
86-90
The importance of iron metabolism, hepcidine and soluble transferrin receptor in pathogenesis of anemia in patients with solid tumors
Abstract
A comparative analysis of hemogram parameters, iron metabolism, C-reactive protein, hepcidin, soluble transferrin receptor in patients with malignant neoplasms, accompanied by anaemia and without it. Patients with anaemia compared with non-anaemic patients had lower haemoglobin, erythrocyte, hematocrit, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration, iron, iron transferrin saturation, total iron-binding capacity, and higher levels C-reactive protein, hepcidin, soluble transferrin receptor (p<0,05). Negative correlations of moderate strength between hepcidin and erythrocyte levels (r=-0,41), hemoglobin (r=-0,3), hematocrit (r=-0,35), and total iron-binding capacity (r=-0,51) and transferrin (r=-0,54). In addition, negative correlations of moderate strength were revealed between the soluble transferrin receptor and hemoglobin level (r=-0,57), hematocrit (r -0,49), iron transferrin saturation (r=-0,47), mean corpuscular hemoglobin (r=-0,44), mean corpuscular volume (r=-0,39). A direct correlation of moderate strength was found between the soluble transferrin receptor and transferrin (r=0,41) and total iron-binding capacity (r=0,38), as well as between hepcidin and ferritin (r=0,61), C-reactive protein (r=0,48). In general, the development of functional iron deficiency in patients with anaemia and malignant neoplasms has been established, and the value of hepcidin and soluble transferrin receptor in the genesis of this anaemia has been confirmed.
Bulletin of the Russian Military Medical Academy. 2018;20(3):91-94
91-94
Change in homeostasis of the body and the outcome of tuberculosis in the treatment of antituberculous medicines
Abstract
Fundamental research in the field of physiology revealed the important role of the state of homeostatic balance of the body in the emergence, development and outcome of human diseases, including granulomatous respiratory diseases- tuberculosis and sarcoidosis. To assess the homeostasis of the body in clinical conditions, various research methods are used - immunological, biochemical, hormonal and functional. However, in the daily work they can’t always be performed for technical and economic reasons. Proposed a new available diagnostics criterion of homeostasis based on the study of the quantitative and qualitative characteristics of the leukocytic formula of peripheral blood at the Department of videopornonoelia the First St. Petersburg state medical University Academy I. P. Pavlov. Among them types of adaptive reactions, leukocyte- lymphocytic index, entropy and redundancy of indicators of leukogram, monitorama blood, the degree of homeostasis and types of reactivity of an organism. During their approbation in the clinic high information content was revealed: more than 70% of the examined patients with tuberculosis of respiratory organs had defective types of adaptive reactions (intense), indices of proliferation and differentiation of monocytes were changed, and reactivity of the organism was characterized by pathological types (hyperreactive, paradoxical, hyporeactive and areactive). Treatment of patients with anti-tuberculosis drugs partially improved homeostasis, but its full recovery at the end of the main course of treatment did not occur. For better treatment in complex therapy, it is necessary to activate the body’s protective systems with the use of adaptogens (drugs, medicinal plants, physical factors: ultrasound, ultra-high-frequency inductothermy, alternating magnetic field on the regulatory centers of the suprasegmental apparatus of the autonomic nervous system). Monitoring of the state of homeostasis is most convenient to carry out using the proposed new available criteria for its evaluation.
Bulletin of the Russian Military Medical Academy. 2018;20(3):95-99
95-99
Acupuncture correction of homeostasis in boundary mental conditions of the military personnel and penal system officers in extreme conditions
Abstract
Experimental data about the physiogeny at 603 military men and penal system officers are given in various climatic conditions of Russia, Transcaucasia (Abkhazia, Azerbaijan, Armenia, Georgia) and Afghanistan and at 604 young men entering the military university. Homeostatic ranges of physiogeny adjustment at physiogenic losses in the meridian functional systems of the military personnel, penal system officers in extreme conditions are determined by the electropuncture method. Protective adaptive reactions of eight degrees are revealed by the standardized method of personality research and by the «adaptability»” scale. Discriminant decisive rules on the reference of physiogenic losses to the 1-8th degrees of protective adaptive reactions in boundary mental conditions are applied. Decisive rules establish threshold levels of normal mental state without the loss (the 1st degree), of liminal with latent one (the2nd and 3 degrees) and borderline mental state with obvious (the 4-8th disadaptation degrees) losses. Patients with symptoms are sorted by simple calculation with the use of computer equipment at the reduction of time up to 5 min. for one patient according to eight degrees of protective adaptive reactions for acupuncture performing. Methods of the discriminant analysis are perspective for the solution of diagnostics and medical sorting problems. Reliability of establishment of the correct diagnosis of physiogeny considering physiogenic losses without resorting to other diagnostic methods makes 70-95%. Acupuncture correction of physiogenic losses activates reactions of homeostasis restoration. This physiological correction leads to the transition of physiogeny in limits of the normal mental state of the 1st degree and liminal condition of the 2nd and 3rd degrees of reactions of homeostasis restoration.
Bulletin of the Russian Military Medical Academy. 2018;20(3):100-104
100-104
Features of the acoustic situation in the operation of weapons and military equipment in the Armed Forces
Abstract
Currently, a system of measures to combat the harmful effects of industrial noise on workers has been created in the healthcare of the Russian Federation. However, the level of specific and non-specific morbidity due to industrial noise does not decrease, and the frequency of occupational diseases even tends to increase. This is due to several reasons, including a large number of noise sources, insufficient quality of medical examinations, the absence and low efficiency of the personal noise protection and others. Noise occupies one of the leading places among the harmful physical factors in the Armed forces of the Russian Federation. Therefore, it is necessary to systematize information about acoustic sources of high intensity in the Armed forces, which will reveal several features of the acoustic situation in the workplaces. The features of the noise generated during the operation of weapons and military equipment include high intensity, non-permanent nature, the presence in the spectrum of low and infrasonic frequencies. The presented data show the diversity of sources of noise in the Armed forces, generating noise and infra-sound of sufficiently high levels. The widespread occurrence of noise sources in the military contributes to the high acoustic load of a large number of servicemen. Noise exposure leads to the development of the servicemen of the disease in the first turn of the organ of hearing, increased General and occupational diseases. The direct effect of noise and the development of noise pathology contributes to the reduction of military-professional performance and reliability. Unfavourable acoustic conditions at the workplaces of military personnel require preventive measures. The noise generated by the operation of military equipment creates discomfort for the population and a threat to the environment. Environmental impacts of acoustic oscillations on the natural environment was studied in connection with the training and combat activities of troops in places of permanent deployment and at the sites located near human settlements. It is established that several million people are exposed to noise in our country. Sources of noise affecting the population are industrial and military facilities and road, rail and, especially, air transport. The problem of acoustic pollution of the environment in the operation of weapons and military equipment is one of the priority environmental problems facing the Armed forces.
Bulletin of the Russian Military Medical Academy. 2018;20(3):105-110
105-110
Informative value of various methods used to study fungi in paranasal sinuses` noninvasive mycosis
Abstract
The increase in the number of patients with persistent viral infection, as well as the use of antibacterial drugs, caused the increase in the population of patients with a high risk of developing fungal diseases. In the content of paranasal sinuses, a more than half of the patients with chronic sinusitis showed fungi or fungal-microbial associations. Despite the fact that the epidemiological data in the publications of modern national and foreign researchers on fungal rhinosinusitis are rather discrepant, it is quite decisive that the prevalence of fungal sinusitis has a significant tendency to grow, especially in the last decade. The informativeness of the microscopic, microbiological, and pathomorphological studies of the surgical material with the aim of fungal balls detection. The results contents of paranasal sinuses in 148 patients who had undergone endonasal endoscopic surgical intervention. Computer tomography the maxillary sinus in 113 patients, in the sphenoidal sinus in 25 patients, in the ethmoidal sinus in 7 patients, and in the frontal sinus in 3 patients. With microscopy of native material and preparations stained with white flour white, the presence of fungi is revealed 114 and 136 patients (77 and 91,9%) correspondingly. When sowing the contents of the sinuses onto elective media its cultivation under two temperature conditions (28 and 37оС) revealed growth of filamentous fungi in 26 (17,6%) patients. Histopathological examination confirmed the clinical diagnosis of a fungal ball in 128 (86,5%) patients. The most informative method for detecting the fungal body is the microscopy of preparations stained with white flour white.
Bulletin of the Russian Military Medical Academy. 2018;20(3):111-113
111-113
Clinical characteristics of different nationalities, who committed suicide attempts and were hospitalized in a psychiatric hospital
Abstract
The clinical characteristics of persons of Talysh and Lezghin nationalities who committed suicide attempts and were hospitalized in this regard in a psychiatric hospital are analyzed. It was established that among the suicides of the Talysh nationalities the largest were the shares of people who had suicidal actions in response to severe stress and adaptation disorders, as well as organic mental disorders (32,4% each). Significantly less frequent were patients with personality and behavior disorders - 13,7% (χ2=8,96; p=0,003), schizophrenia, schizotypic and delusional disorders - 8,8% (χ2=15,86; p<0,001). Among the psychiatric disorders, the psychiatric hospital of the Lezghin nationality was dominated by organic mental disorders (27,7%) among suicidal patients. Less common were personality and behavioral disorders at a young age of18,5% (χ2=1,08; p=0,29); schizophrenia, schizotypic and delusional disorders - 15.4% (χ2=2,23; p=0,135) and psychiatric and psychiatric substance abuse disorders - 12,3% (χ2=3,89; p=0,048). Officers of the Talysh and Lezghin nationalities resorted to poisoning with equal frequency - 82,1 and 81,8%, less often - firearms - 13,4% (χ2=92,7; p<0,001) and 13,7% (χ2=89, 9; p<0,001); hanging - 4,5% (χ2=117,5; p<0,001). Talysh rank and file officers often chose hanging and poisoning- 42,9 and 40%; less often they caused gunshot injuries - 17,1% (χ2=4,35; p=0,036). Lezgin’s soldiers used gunshot wounds more often - 42,9%, less often poisoning - 33,3% (χ2=0,1; p=0,75) and hanging - 23,8% (χ2=0,32; p=0,96). In general, the incidence of suicides in mentally ill patients depends on the combination of the following factors: the prevalence rate of suicides in the general population; ethnicity of patients; level of organization and access to psychiatric care. Various combinations of these factors determine the prevalence of suicide among patients with mental disorders.
Bulletin of the Russian Military Medical Academy. 2018;20(3):114-118
114-118
Infringements of colonial resistance of microbiotic skin in patients suffering diseases of an ear, a throat and a nose on the background of diabetes mellitus
Abstract
Infringements of colonial resistance of a microbiota of a skin at the elderly, suffering diseases of an ear, a throat and a nose (an otitis, a tonsilitis, a sinusitis, etc.) are considered on a background of a diabetes. To study changes in quantitative and specific indicators of deep microbiota of the skin, the method of agar prints was used. It is established that the indicators of quantitative changes are associated with a metabolic disorder and may be factors predisposing to the development of other diseases against the background of diabetes mellitus. The revealed changes in the indices of colonial resistance in patients with diabetes mellitus are of interest as adaptive characteristics of the organism in diseases of the ear, throat and nose of various etiologies, and serve as a harbinger of deviations in the clinical and physiological status of patients with diabetes mellitus. Thus, in patients with diabetes mellitus, the composition of the microbiota of the skin corresponds to that of healthy individuals of the same age. Regardless of the type and stage of diabetes mellitus, they showed an increase in the number of colony-forming units of the deep layers of the skin of the forearm, which corresponds to the dysbacteriosis of the third-degree skin. In the structure of biocenoses, in patients of the otolaryngological profile, against the background of diabetes mellitus, changes that correspond to the dysbacteriosis of the skin of the IV degree are revealed. In this category of patients, there is a pronounced secondary immunodeficiency, which is manifested by inhibition of the investigated nonspecific immunity indices, which is a predisposing factor for the onset and development of a purulent infection. It is shown that dysbiosis can manifest itself with clinical local symptoms, and then with general disorders that aggravate the course of the underlying disease and complicate treatment. An integrated approach to this problem can be used for a more differentiated assessment of the prognosis of complications in patients with an otorhinolaryngological profile against diabetes mellitus and increasing the effectiveness of therapeutic and preventive care.
Bulletin of the Russian Military Medical Academy. 2018;20(3):119-121
119-121
Community acquired pneumonia of viral-bacterial etiology in young people: actual aspects of clinical and laboratory diagnostics
Abstract
Community acquired pneumonia is one of the most topical acute respiratory diseases, which is caused by high incidence rate, especially in organized groups of people, constantly changing microbial flora, the increasing resistance of bacteria to antibacterial drugs, difficulties in etiological diagnostics, and the possibility of life-threatening complications and fatalities. An innovative algorithm of etiological diagnostics of community acquired pneumonia is suggested, which includes immunochromatography express-tests of sputum for viruses detection, bacteriological sputum culture, immunoenzyme assay of blood and polymerase chain reaction of sputum and blood serum. It is shown that standard bacteriological sputum culture did not allow us to reveal causative agents of community-acquired pneumonia timely and precisely in most cases, whereas the application of more comprehensive etiological diagnostics enabled us to reveal the causative agent in the majority of the examined patients. And express methods provided an opportunity to verify the infectious agent within 1-2 days and administer early effective etiotropic treatment. It is demonstrated that modern community acquired viral bacterial pneumonia has a number of clinical and laboratory features depending on the revealed viral agents. These features may be used as additional diagnostic criteria of the disease, especially when modern methods of etiological diagnostics are unavailable. The obtained results showed the effectiveness of the use of immunochromatography express-tests of sputum, polymerase chain reaction of sputum and blood serum, and immunoenzyme assay of blood. As a result of statistical analysis, a number of characteristic clinical and laboratory predictors of certain viral-bacterial associations of modern community acquired pneumonia was determined.
Bulletin of the Russian Military Medical Academy. 2018;20(3):122-127
122-127
Evaluation of the effectiveness of single session audiovisual stimulation for the organism functional state’s correction
Abstract
Based on the analysis of the changes in the bioelectrical activity of the brain, the dynamics of cerebral blood flow and the vegetative balance of the body, the efficacy of a single 15-minute session of audiovisual stimulation for the correction of the functional state of the organism was evaluated. It was found that after the audiovisual stimulation session, the mean value of the alpha-rhythm power in the frontal, anterior-parietal and occipital leads of the right and left hemispheres of the brain was statistically significant more than in the background study. Such a change in the power of the alpha-rhythm reflects the level of ascending activation necessary for the organization of adaptive behavior, and can also characterize the intensity of the neuro-emotional stress. Increasing the power of the α-rhythm indicates a decrease in the level of nonspecific cerebral activation and is one of the main characteristics of the state of functional comfort. Statistically significant ifferences in the indices of powers of the β - and β -rhythms inherent in the state of active wakefulness were determined. The decrease1 2in the power index of the electoencephalography delta rhythm was revealed. The revealed dynamics of cerebral blood flow parameters was subject to pronounced individual differences, which made it impossible to determine the direction of the trend. It was established a gradual decrease in the power of the low-frequency component of the cardiorhythm with simultaneous increase in the contribution power of the high-frequency component, reaching a statistically significant difference at the last stage of registration, which leads to a significant decrease in the coefficient of vagosympathetic balance after the audiovisual stimulation session. The revealed changes indicate a decrease in the tone of the sympathetic part of the autonomic nervous system. Thus, it is established that after a single 15-minute audiovisual stimulation session, the value of the α-rhythm power in the frontal, anterior parietal and occipital leads of the right and left hemispheres of the brain increases, the power indices of the beta and delta rhythms of the electoencephalography decrease, the stress index and the vegetative index decrease balance, and also the coefficient of the vagosympathetic balance of the rhythmocardiogram. These changes characterize the optimization of the functional state of the organism and contribute to an accelerated restoration of working capacity.
Bulletin of the Russian Military Medical Academy. 2018;20(3):128-132
128-132
Development of a methodology for obtaining physiologically complete drinking water
Abstract
The current state of the problem of diselementosis in the territory of the Russian Federation is analyzed and a list of elements is identified, the lack of which in food and water has a negative impact on human health. The author substantiates the development of a technique for conditioning drinking water to achieve its physiological usefulness and prevent diselementosis among servicemen who serve in the Arctic zone of the Russian Federation, where snowmelt is the source of drinking water. A salt composition was selected for conditioning low-mineralized water. For this, the initial stream of low-mineralized water is divided into two approximately equal secondary waters, and those mineralizing components that form sparingly soluble compounds are introduced into different secondary streams, which are then combined in a common tank. It is shown that for all the criteria studied, conditioned water meets the requirements of chemical safety Sanitary rules and regulations 2.1.4.1074-01, and also contains essential macro- and microelements in quantities corresponding to the standards of physiological potency of drinking water according to Sanitary rules and regulations 2.1.4.1116-02. The method of conditioning drinking water when it is introduced into the practice of water supply for servicemen of the Ministry of Defense of the Russian Federation will improve the quality of drinking water by enriching with essential macro- and microelements, increasing its physiological usefulness, which will serve as an effective measure to prevent the morbidity of servicemen due to the imbalance of nutrient elements in the body.
Bulletin of the Russian Military Medical Academy. 2018;20(3):133-136
133-136
Efficiency of lithium salt of disulphide of glutathione and inosine in treatment of multiple sclerosis in experiment
Abstract
We studied the possibility of pharmacological correction of neurological disorders in guinea pigs and rabbits with the lithium salt of disulphide of glutathione and inosine medication in experimental allergic encephalomyelitis caused by inoculation of the main myelin protein in Freund’s complete adjuvant. The intradermal test with the main protein of myelin was accomplished in all animals to confirm the autoimmune process at 21st day after sensibilization. The lithium salt of disulphide of glutathione and inosine medication was administered intramuscularly every other day at a single dose of 10 mg/kg for 5 weeks. The symptoms of experimental allergic encephalomyelitis were more pronounced in rabbits and to a lesser extent in guinea pigs. The high therapeutic efficacy of lithium salt of disulphide of glutathione and inosine was established according to the severity and incidence of neurological disorders (dysfunction of the pelvic organs, ataxia, tremor, paralysis and paresis of the limbs) and lethality rate. Early (at 5 days after sensibilization) and subsequent therapeutic use of lithium salt of disulphide of glutathione and inosine prevented the development of experimental allergic encephalomyelitis in 75% of laboratory animals, in the rest 25% of the animals the course of experimental allergic encephalomyelitis was comparatively mild. There were no lethal outcomes in study group compared with lethal outcomes in 70% of animals in control group. Experimental evidence of neuroprotective effects of lithium in brain ischemia and in neurodegenerative diseases highlights new opportunities for the use of lithium-containing drugs in clinical neurology. It has been confirmed that the lithium salt of glutathione and inosine disulfide has a moderate immunosuppressive effect, inhibiting the biosynthesis of antibodies and the delayed-type hypersensitivity reaction.
Bulletin of the Russian Military Medical Academy. 2018;20(3):137-140
137-140
Method for determining the functional state of peripheral nerves after their restoration in an experiment
Abstract
A simple method for assessing the functional state of peripheral nerves after performing experimental reconstructive-plastic interventions on laboratory animals has been developed. It is proposed to evaluate the functional state of the common peroneal nerve reconstructed in an experiment by comparing the amplitude of the animal’s toes spreading in the study of the unconditional statokinetic landing reflex. A reflex response to the preparation for landing from the pelvic limbs is manifested by flexion in hip joints, extension in knee joints, plantar flexion in hocks, and spreading of toes.Spreading of toes in rabbits is caused by the contraction of the external extensor of the toes innervated by the deep branch of the common peroneal nerve.If the conductivity of the common peroneal nerve is impaired, spreading of the toes on the side of the trauma fails to manifest.The advantages of the proposed test are: high speed set up and ease of implementation, as well as clear demonstration when comparing the operated and the intact limbs of the laboratory animal.
Bulletin of the Russian Military Medical Academy. 2018;20(3):141-143
141-143
Quality control of batches of bacteriological examination kits «Selective differential-diagnostic medium for recovery of Bacillus anthracis and closely related bacilli of Bacillus cereus group»
Abstract
Possibilities of quality control of experimental series of a set of reagents for bacteriological studies «Selective differential diagnostic environment for the isolation of the causative agent of anthrax and closely related bacilli of the Bacillus cereus group» is justified. Findings of the investigation of growth properties of the selective medium showed typical colonial morphology of virulent strains of Bacillus anthracis (B. anthracis 81/1, B. anthracis 1(CО), B. anthracis 1193, B. anthracis И-363, B. anthracis 1283) and its vaccine strains B. anthracis CTI-1, B. anthracis Ihtiman, B. anthracis Sterne 34 F2, B. anthracis 55, B. anthracis 71/12 - II Tsenkovsky’s vaccine). The colour of the batches of selective medium and Hottinger’s agar around the Bacillus anthracis colonies was unchanged. Whereas, the colour of selective medium around colonies of closely related saprophytes of genus Bacillus discoloured to bright-yellow, allowing to differentiate colonies of anthracic micro germs and closely related microorganisms. Presence of inhibiting properties of the selective medium was confirmed using heterologous germ cultures (Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Proteus vulgaris HX-19) which showed no growth in all series of the tested medium. Meanwhile, the typical colonial morphology of strains of these microorganisms was observed on Hottinger’s agar.
Bulletin of the Russian Military Medical Academy. 2018;20(3):144-147
144-147
Experimental evaluation of the effectiveness of local treatment of skin burns with сarbopol easier to disperse 2020 hydrogel with human leukemia differentiation factor-6 peptide
Abstract
The results of experimental evaluation of the effectiveness of topical application of the peptide human leukemia differentiation factor-6 in carbopol hydrogel easier to disperse 2020 in thermal burns of skin of III degree are presented. It was found that local application of human leukemia differentiation factor-6 peptide in hydrogel carbopol in concentration from 0,01% to 0,00001% causes acceleration of wound epithelialization processes by 28 days by 71,11% (p<0,01) and reduces the incidence of purulent complications by 62,5% (p<0,05). Histological examination of biopsy specimens of wounds revealed essential features of morphometry, considering the chosen method of treatment and concentration of peptide of human leukemic factor-6 differentiation in carbopol hydrogel. The proposed method of local treatment of burn skin lesions is very promising for optimizing the flow of reparative regeneration processes. The low frequency of purulent complications in the group of animals treated with a minimum peptide content may be due to the combined action of carbopol hydrogel as determinants of wound healing in a wet environment, and the optimal concentration of the peptide human leukemia differentiation factor-6, providing anti-inflammatory effect in a minimum concentration. Analysis of the histological pattern in the studied groups of animals allows us to conclude about the acceleration of the formation of the extracellular matrix, and epithelialization of the wound surface on the background of an application of the peptide human leukemia differentiation factor-6 minimum concentration. On the 14th day of observation the number of microvessels in granulation tissue among animals treated with human leukemia differentiation factor-6 in carbopol hydrogel easier to disperse 2020 with minimum concentration (0,00001%) was 40,6-43,75% more than in the comparison groups. The use of biologically active peptides is one of the promising methods of wound process optimization. human leukemia differentiation factor-6 peptide can selectively stimulate proliferation by enhancing redox processes in cells.
Bulletin of the Russian Military Medical Academy. 2018;20(3):148-152
148-152
Features of adaptation after psychical traumatic stress among servicemen who performed special tasks
Abstract
Features of adaptation after psychical traumatic stress in healthy military men who performed special tasks more than half a year ago were studied. It is shown that 40% of combatants have signs of partial posttraumatic stress disorder, which evidences about negative adaptation after psychical traumatic stress. Signs of partial posttraumatic stress disorder in all manifest as neurotic disorders, and in 7,5% of combatants are associated with signs of psychotic disorders. Among the signs of neurotic disorders, the manifestations of somato-vegetative disorder were encountered in 62,5%, affective tension - in 50%, sleep disorder - in 43,8% and anxiety-phobic disorder - in 43,8%. Among the signs of psychotic disorders, there were mildly pronounced manifestations of social phobia, panic disorder and depression. Soldiers with partial posttraumatic stress disorder have a statistically significant decrease in the self-assessment quality of life in such indicators as «general health», «mental health» and «social functioning». The negative correlation between scores of life quality and signs of partial posttraumatic stress disorder pieces of evidence that namely this disorder impacts on the quality of life in combatants. Comparison of servicemen groups with and without signs of partial posttraumatic stress disorder according to the expert evaluation indicators, exhibited by the unit commanders, and according to the indicators of the operator working, did not reveal a significant difference between them. Thus signs of partial posttraumatic stress disorder in combatants decrease self-assessment life quality but do not have an effect on the professional aspect of social functioning under favourable conditions. This military personnel are needed in medical and psychological correction and rehabilitation to prevent the development of maladaptation in stressful conditions.
Bulletin of the Russian Military Medical Academy. 2018;20(3):153-158
153-158
Experimental assessment of efficiency of new domestic local haemostatic means on the basis of chitosan
Abstract
One of the main reasons for the death of potentially wounded military personnel on the battlefield is ongoing bleeding. In recent years, with the advent of a new group of local hemostatic drugs, the results of prehospital care with external massive bleeding have improved significantly. At the same time, local haemostatic agents based on chitosan showed the greatest effectiveness. The results of the experimental evaluation of the effectiveness of new local haemostatic agents based on chitosan: «Gemohit» (powder, 20 g in the package) and «Hemohit-bandage» (a bandage in the z-fold, 8×150 cm) using the model of external massive arterial bleeding in sheep according to the variant of marginal femoral artery injury. Some of the tests were carried out after 3 years of storage of the preparations (3 samples) and under ambient conditions minus45°C (2 tests). It was found that with external massive arterial bleeding, the use of powder and bandage in the z-fold ensured survival of the animals in 100% of cases, primary and final hemostasis was achieved in 50 and 100% of cases, respectively. Storage for 3 years, as well as use of the drug at low ambient temperature does not reduce its effectiveness. The use of local haemostatic agents «Gemohit» and «Hemohit-bandage» is not accompanied by side effects (local hyperthermal reaction, distal or proximal embolism of blood vessels). Local haemostatic funds «Gemohit» and «Gemohit-bint» showed high efficiency in the experimental model of massive external arterial bleeding. Using the local hemostatic agent «Gemohit» in the form of a bandage is more promising in terms of convenience and effectiveness than the use of powder.
Bulletin of the Russian Military Medical Academy. 2018;20(3):159-163
159-163
The selection of optimal methods for the determining the nutritional status of soldiers
Abstract
In our country and abroad in recent years as one of the main indicators of the status of nutrition, in addition to the body mass index, is the percentage of body fat, which can be determined by a fairly wide range of techniques. In the daily practice of a military doctor, there are often no complex and expensive devices to determine the fat component of the body, such as a widespread bioimpedance analysis of body composition. The article provides many options for determining the fat component of the body. It coliperometric facts technique (the technique of Durnin - Womersley, J. Matiegka in the modification of M. M. Dyakonov, Jackson - Pollock, Gallagher, and others) and circumferential techniques (methods, used in the naval and land forces of the United States of America, the methodology developed in the Y. M. C. A. and its modification). The results were compared with the results of bioimpedance analysis of body composition. To compare the accuracy of the coincidence of the results obtained by the methods used, the method of the mean square error of the model was used. Then the correlation analysis was carried out and regression models were built.The comparative analysis revealed the most informative methods of determining the fat component of the body, which are recommended to use in the practice of a military doctor at different levels of medical care for soldiers. Fat mass can be estimated by the percentage of fat in the body, determined using the caliper-Pollock method, in the presence of calliper- compass, or circumferential technique used in the naval forces of the United States of America.
Bulletin of the Russian Military Medical Academy. 2018;20(3):164-168
164-168
Fundamental life motivations and the prerequisites for their realization in young men in different ethnocultural groups
Abstract
Аbstract. The work deals with fundamental life motivation and preconditions for their implementation in young men of different ethnolinguistic groups in terms of existential fulfilment. It is shown as a similarity (due to a long common history in the groups of «Slavs-Turks» and well-expressed in all nations and nationalities by the concept of freedom), and the difference in scales of methodology by A. Langle and C. Orgler «Scale of Existence», conditioned for Eastern peoples by the commonality of religion and geographical features of residence, values, due to the ethnocultural characteristics of the surveyed persons. Therefore, in the process of medical and psychological support of people of different ethnolinguistic groups, it is necessary not only to pay attention to the evaluation of the characteristics of their personality, but also to take into account certain values (including religious norms) and expectations that are maintained within different cultures, as well as other circumstances, who can make psychological assistance effective or inconclusive. Since in the process of learning the personality is enriched, including by new psychological connections, relying on which and manipulating which it further solves the assigned professional tasks, when working with people, one must proceed from the basic components of self-awareness: self-understanding (cognitive aspect), relations to yourself (the emotional aspect); self-regulation (behavioral aspect). That is, all these tasks can be defined as the formation of new behaviours related to cooperation, mutual assistance, responsibility and autonomy that contribute to optimal adaptation, more successful social functioning in real life, and prevention of recidivism of unconstructive behaviour. However, a generalized view of behaviour and beliefs may not cover the diversity that exists within ethnic groups.
Bulletin of the Russian Military Medical Academy. 2018;20(3):169-174
169-174
Morphological characteristics of the auxiliary elements of the knee joint in normal and deforming arthrosis
Abstract
The results of morphological studies of auxiliary elements (patella, meniscus, cruciate ligament, synovial bags) of 60 knee joints of adult corpses, 30 of which were intact (without signs of deforming arthrosis) and 30 with signs of deforming arthrosis of stages III-IV are presented. It is established that the auxiliary apparatus undergoes significant changes in the progression of deforming arthrosis. In a greater degree degenerative changes prone articular cartilage of the patella and medial condyles of the knee joint. The affected areas were characterized by thinning of the articular cartilage or its complete absence, as well as the presence of osteophytes along the edges of the articular surfaces. The measurements of the relative length, width, and thickness of the meniscus also confirmed the fact of their substantial deformation and degeneration, mainly of the medial meniscus. The posterior part of the body and the horn of the medial meniscus were most susceptible to the destruction of the cartilaginous tissue and were accompanied by the erasure and disintegration of the inner margin. Synovial membranes with deforming arthrosis were thickened, compacted and locally hyperemic, had papillary growths, which indicates the presence of synovitis and fluid accumulation not only in the joint cavity but also in synovial bags, the sizes of which were significantly increased. Intra-articular ligaments are hyperemic, and fragments are noted. Pterygoid folds are enlarged, locally hyperemic, with a vascular pattern, elongated processes are visualized along the edges. Identified morphological changes in the progression of deforming arthrosis lead to trophic and metabolic disturbances of all structures of the knee joint. The results of the study of the auxiliary elements of the knee joint can be used as a control in the diagnosis of deforming arthrosis.
Bulletin of the Russian Military Medical Academy. 2018;20(3):175-179
175-179
Isolated lobar arterio-portal liver perfusion in the experiment
Abstract
The study is devoted to topographic, anatomical and experimental justification of isolated lobar arterio-portal perfusion, the material for which served as liver preparations (n=28), explanted from the corpses of adult men and women who died at the age of 48 to 78 years as a result of injuries and diseases not associated with liver lesions and its major vessels, the data of radiographs of liver preparations (n=10), injected with x-ray contrast solutions, as well as selective angiograms (n=24) obtained with celiac topographic and anatomical features of the main vessels of the left lobe of the liver in relation to the problems of its isolated lobar arterio-portal perfusion are clarified. Based on the analysis of selective angiograms, obtained by clickography shown the absence of functioning vascular anastomoses between lobes of the liver. While further studies conducted on liver preparations (n=8), an experimental model of isolated lobar arterio-portal perfusion of the left lobe of the liver was developed. The approbation of this model convincingly confirmed the results obtained during anatomical studies. The peculiarity of the arterial and portal blood flow of the left surgical lobe of the liver is its isolation from the vascular arterio-portal basins of the right lobe of the liver. The experiment shows the possibility of isolated perfusion of the left lobe of the liver. The developed experimental model demonstrated the validity of the idea of isolated lobar arterio-portal perfusion of the left lobe of the liver and created favorable conditions for further improvement of the concept of retrograde isolated liver perfusion and the possibility of improving its technical aspects for further clinical testing in the complex treatment of patients with multiple bilobar metastatic liver damage.
Bulletin of the Russian Military Medical Academy. 2018;20(3):180-184
180-184
Substantiation and development of rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations
Abstract
Despite the positive changes in the regulation of the accordance of benefits at the federal and regional levels, this problem has not been sufficiently studied so far in the area of organizational and legal interaction between civil and military healthcare. The current order of drug supply to certain categories of citizens attached to military medical organizations results in an unjustified expenditure of resources and an increase in the burden on healthcare, which indicates the irrationality of the existing mechanisms of drug supply. In this regard, it is necessary to develop rational economic and pharmaceutical mechanisms, as a set of methods for managing and interacting the entities that determine the order of drug supply for certain categories of citizens, while optimizing the financial, information and material resources of military and civilian healthcare. Theoretical approaches to the formation of rational economic and pharmaceutical mechanisms of drug supply are presented. Rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations have been substantiated and developed. The characteristic of integration and coordination mechanisms of interaction of military and civil health on drug supply of certain categories of citizens in a single legal space is given. As the basic mechanisms of coordination of interaction are given: information exchange; standardization; direct supervision. The results of an assessment of sound and developed rational economic and pharmaceutical mechanisms of drug supply in the areas of organizational, social and economic efficiency are presented. It is noted that the implementation of the mechanisms of drug supply in the system of preferential drug supply can contribute to the formation of a system of drug supply balanced with the available resources of the country’s population; the formation of economic and social responsibility at each level of decision-making; the optimization of transparency and controllability of financial flows; the optimization of the financial burden on the federal, regional and departmental budgets; the equal access to medicines for all categories of citizens; guaranteed drug supply to socially vulnerable groups of the population.
Bulletin of the Russian Military Medical Academy. 2018;20(3):185-192
185-192
Indicators of disability of the military personnel in able-bodied and retirement age for2015-2016 (territorial aspect)
Abstract
The indexes primary and secondary disability among soldiers working and retirement age because of «military trauma» in dynamics for 2015-2016. From the military in 90% of cases disability is defined in the working age. The socio- hygienic analysis of the data on primary and secondary disability, carried out on a territorial basis, points to the heterogeneous share of disability indicators among military personnel in the Federal districts of the Russian Federation. It is revealed that the North-Caucasus, southern and Central Federal districts are the leaders in the establishment of primary disability and the total number of disabled people. The heterogeneous proportion of persons with disabilities recognized as members of the armed forces in different districts determines the need to analyse the conditions and grounds on which the disability was established. The implementation of the Federal comprehensive program «Accessible environment» and sub-programs aimed at the creation of the subjects of the Russian Federation of rehabilitation centers for patients and disabled people, due to the territorial characteristics of the prevalence of primary disability and the specifics of the category of persons with disabilities. Therefore, the data of the conducted social and hygienic analysis can serve as a basis for making organizational decisions on the creation of complex rehabilitation centers for disabled people from among former servicemen in the territories of the Russian Federation.
Bulletin of the Russian Military Medical Academy. 2018;20(3):193-195
193-195
Optimization of internal quality control system of health care for children needing rehabilitation after neuroinfections
Abstract
The results of the implementation of a three-tier system of internal quality control of medical care for children in need of rehabilitation after neuroinfections are presented. In 2015, a three-tier internal control system was developed at the clinic of the Children’s Research and Clinical Center for Infectious Diseases. The importance of introducing a new approach was determined by the severity of the patients at this clinic. The severity of the condition of children is due to the effects of neuroinfections. In addition, the quality of medical care is an essential element of improving the health care system in modern conditions. After the introduction of this system, the number of examinations carried out at the first level (heads of clinical departments) increased, at the second level (deputy chief physician for medical work and quality of medical care) decreased. The number of detected defects increased, but the quality factor of medical care turned out to be quite high and fell into the group of «insignificant deviations». The main defects are defects in filling in medical documentation and redundancy in laboratory and instrumental research. The leading position in the structure of defects is occupied by defects in filling in medical documentation with a specific weight of 32,4%. With the introduction of a new quality control system, the average length of stay of a patient in the rehabilitation department came close to the one prescribed in medical and economic standards. Revealed quite a large percentage of diagnostic studies that are not included in the medical and economic standards, that is, additional. This fact indicates the need to revise the medical and economic standards in the direction of expansion, taking into account the need. The third level of the internal control system is designed to assess the corrective actions taken as a result of audits at the first two levels of the internal control system. In general, the three-tier system has certainly improved the quality of care.
Bulletin of the Russian Military Medical Academy. 2018;20(3):196-198
196-198
Questions of medical and social examination and rehabilitation of disabled people with the consequences of military trauma
Abstract
The expert characteristics of the clinical and functional status of the military personnel for the first time recognized as disabled in 2016 because of «military trauma» are considered. It is known that the objectification of methods of expert rehabilitation diagnosis in the implementation of medical and social expertise in the establishment of disability and the development of individual programs of rehabilitation/habilitation of disabled people-one of the main objectives of the concept of «Improvement of the state system of medical and social expertise and rehabilitation of disabled people.» In accordance with this provision, clinical and expert indicators are analyzed, confirmed by the data of expert rehabilitation diagnostics, allowing to objectify the impaired functions and structures of the body of soldiers who have received a military injury, when examined in the Bureau of medical and social expertise. The main clinical and functional syndromes that have expert significance and have influenced the adoption of expert decisions in the establishment of disability groups are presented. The article describes in detail the contraindicated and shown factors of the recommended labor activity, which should be guided in the employment of disabled people from among the former soldiers. The use of evidence-based recommendations in practice makes it possible to determine the forms and conditions of employment in normal or specially created working conditions for the rational employment and socialization of servicemen who have become disabled. Referring to the updated normative legal acts, taking into account the principle of inseparability of the medical and social examination procedure from the formation of individual programs of rehabilitation/habilitation of disabled persons, the authors illustrate the possibilities of professional rehabilitation and employment of military personnel who have different groups of disability due to «military trauma».
Bulletin of the Russian Military Medical Academy. 2018;20(3):199-202
199-202
Embolisation of the renal arteries in the treatment of nephrogenic arterial hypertension
Abstract
This review article examines the possibilities of surgical treatment of one of the socially significant diseases of modern society - arterial hypertension. The reasons for the development of parenchymal arterial hypertension have been disassembled. The reasons for the development of renovascular hypertension are discussed. Illuminates the pathogenesis of nephrogenic hypertension, statistical data on its prevalence. The issue of embolization of renal arteries in the treatment of nephrogenic arterial hypertension is considered. The forms of nephrogenic arterial hypertension in which the use of embolization is indicated. The etiology and pathogenesis of arterio-venous fistulas of the kidneys are described. Details of the world literature concerning the treatment of arterio-venous fistula and malformations of the kidneys are considered in detail. A review of literature data on materials used in embolisation of renal arteries in patients with arteriovenous fistula and malformations of the kidney is given. The etiology and pathogenesis of arterio-venous malformations of the kidneys are highlighted. The goal of embolization of the renal arteries in the preparation of patients with terminal renal failure and resistant arterial hypertension to kidney transplantation is described. The issue of preoperative preparation of patients before embolization of the renal arteries, the choice of operative access is considered. Methods of embolization of the renal arteries, possible complications and methods of their prevention are described. The data of the world literature concerning application of selective and superselective embolization of renal arteries in patients with parenchymal arterial hypertension are covered. The issue of potential use of renal artery embolization in other forms of nephrogenic arterial hypertension is also highlighted.
Bulletin of the Russian Military Medical Academy. 2018;20(3):203-206
203-206
Comparative characteristics of the methods for determining the somatic sex of an adult person with the use of a skull
Abstract
The analysis of Russian and foreign literature on the definition of somatic sex on the skull is presented. Cranioscopic and craniometric approaches are considered in carrying out craniological studies and existing traditional and modern methods for their implementation. Cranioscopic studies reveal the advantages and disadvantages of W.M. Krogman, G. Acsadi, J. Nemeskeri and V.N. Zvyagina methods. It is shown that the method of V.N. Zvyagina, which includes 40 descriptive diagnostic signs, is the most informative. Its efficiency is 93,5%. The comparative analysis of the craniometric methods for studying the skull according to R. Martin and H. Welcker in the modification of A.P. Bogdanov and a number of English craniologists is presented. The authors point out that the Russian Forensic Center developed a craniological form, which includes 79 different sizes of a skull, by which is possible to determine not only the sex of a skull, but also the approximate age of a person. A comparative assessment of the Russian (V.I. Pashkova) and foreign (E. Giles) craniometric studies is presented. According to V.I. Pashkova using only craniometric techniques allows one to determine the sex of the skull only in 75-80%, and in the complex approach - in 80-93%. The method of E. Giles, based on the study of regression equations, is objective in 83-86%. Thus, studies of the sex determination by skull in an adult should be comprehensive, including both cranioscopic and craniometric techniques.
Bulletin of the Russian Military Medical Academy. 2018;20(3):207-213
207-213
Labor practices - a promising area of social responsibility for pharmacy organizations
Abstract
The theoretical bases of the social responsibility of business, the search for perspective directions of its development, as well as the historical aspects of the formation of the social responsibility of entrepreneurs abroad and in Russia are considered. The full characterization of external and internal directions of social responsibility is given, its multi- level character, conceptual definitions are shown. Thus, American scientists in their work on management in the United States define social responsibility as the actions of an organization that are undertaken for the benefit of society voluntarily, and not on demand. In modern Russian science, the social responsibility of business is defined as a broad concept that includes the complex responsibility of a business partner, employer, citizen and participant in social relations; as well as social responsibility implies the entrepreneur’s refusal to carry out activities that could harm society, in other words, the business should follow the principle of do no harm, and help. It is noted that in recent years in the Russian Federation the issues of social responsibility of business are considered in relation not only to large, but also to small business. It has been established that the interests of pharmacy workers today are not only in obtaining decent wages, but also in realizing goals such as job satisfaction, respect for the individual, support for education and career, etc. Long-term directions for the development of social responsibility of pharmacy organizations are formulated. A list of socially responsible labor practices is defined, the main ones being: the provision of comfortable and safe jobs; development of labor potential of employees (competence, skills, training, career growth, etc.); building of confidential relations of the employer with employees (truthful informing about the state of affairs in the organization, avoidance of deception and discrimination of employees), etc. Socially responsible labor practices can become the basis of their own social programs of employers, which will not only avoid the turnover of staff, but also attract the best specialists in the market, ensure the growth of the reputation of the organization and improve its image, which in the long run will be a promising advantage in the competition between pharmacy organizations.
Bulletin of the Russian Military Medical Academy. 2018;20(3):214-218
214-218
Review of interactive methods of teaching physics at medical University
Abstract
The article is devoted to the analysis of the literature on the methodology of teaching physics in high school in the section on the application of interactive teaching methods. The review of lecture, practical and seminar forms of contact interactive educational activity of students is presented. Specifically, the actual conceptual approach, based on the principles of the methodology of fundamental disciplines to the organization of educational activity of students, as a research partnership of student-tutor, is presented. The conceptual approach is developed in the context of requirements of modern educational standards of formation of students’ professional competencies. By order of the Ministry of education and science of the Russian Federation, the Federal state educational standard of higher education defines research activity as one of the main types of professional activity, to which graduates who have mastered the speciality program in medical specialities are prepared. Graduates who have mastered the program of the specialty, will have to solve professional tasks of a research sector, which are determined by the Federal state educational standard of higher education including, as an analysis of scientific literature and official statistical surveys, participation in statistical analysis and public presentation of the results, participation in solving individual research and scientific-applied problems in the field of health diagnosis, treatment, medical rehabilitation and prevention. Thus, the role of the educational departments of educational institutions, where students study the sections of such fundamental Sciences as physics and mathematics, the methodology of which is scientific research, increases significantly. Realization of the educational potential of the methodology in basic Sciences is available in the professional research tasks in conditions of a new conceptual approach to the organization of training of students in the sections of these Sciences. The format of the prolonged interactive research partnership student-tutor at all stages of educational activity is considered as effective one for the students’ training for the solution
Bulletin of the Russian Military Medical Academy. 2018;20(3):219-224
219-224
Improving the automation of information support for medical rehabilitation and dynamic monitoring of the health of participants in wars and armed conflicts
Abstract
An analysis of the experience of medical support of troops in the wars and military conflicts shows that their characteristic feature was and remains the constant improvement of the organizational forms of medical support for the troops aimed at optimizing the medical rehabilitation of the wounded and sick. The results of the analysis of medical support of troops during the Great Patriotic War showed that the composition and content of the sanitary minimum level for servicemen should be in constant accordance with the requirements for the level of professional training of servicemen. Organization of medical care for participants of the Great Patriotic War of 1941-1945 and the Afghan conflict of 1979-1989 in the postwar period shows that the basis of all measures to monitor the health of war participants must be a system of active personal dynamic observation. Active dynamic monitoring of the state of health using automated information systems allows to solve the problem of restoring health among participants in wars and military conflicts at the optimal level, provides medical information necessary for assessing the health status of participants in wars, determining the scope and composition of medical and recreational activities. Active invitation of the patient, who is on dispensary supervision, makes it possible to conduct a comprehensive assessment of his health status. However, the effectiveness of the system of medical control over the health of war participants largely depends on the high degree of automation of information processes in the system of dynamic control over the health of a workable and efficient resource on a national scale. The implementation of the principles of dynamic monitoring of the health of participants in wars can be carried out through the practical implementation of Decision 36 of the Plenum of the Academic Medical Council with the Chief of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation (1996). Special attention was paid to the necessity and urgency of the development and operation of an automated information system on the wounded and sick on the basis of the Military Medical Museum. At the same time, it is necessary that its electronic information module is located in the institution where the wounded and sick war veterans are kept in the hospital. At present, such an institution in the Armed Forces of the Russian Federation is an archive of military medical documents of the Russian Military Medical Museum.
Bulletin of the Russian Military Medical Academy. 2018;20(3):225-232
225-232
Role sialic acids in maintenance of an immune homeostasis
Abstract
The role sialic acids in maintenance of an immune homeostasis is considered. It is known, that sialic development both cleanly nonspecific protective effects, and specific, microbes agents providing interaction with specific receptors immunocompetent cells is peculiar to acids. Sialic acids represent components of cellular receptors, which are specific to viruses of family Adenoviridae, Reoviridae, Orthomyxoviridae and for many gram-positive bacteria. The facts reflecting the major role sialic of acids in maintenance of stability of a macroorganism to pathogenes of the various nature, and also in development of a somatic pathology and neoplatic processes are saved up. Concentration sialic acids also increases at sialydosis, a heart attack of a myocardium, oncological diseases, including at tumours of a brain. Especially high growth of this parameter is marked at the active form of a tuberculosis and rheumatism, at parenchymatous to a jaundice. After detachment from protein-carbohydrate complexes of fabrics free sialic acids inactivation many bacterial and virus agents. Therefore, the increase in the maintenance in blood sialoglycoproteines can be display compensatory, protective reaction of an organism. One of many reasons of formation immunology inconsistencies at ageing connect with reduction of concentration sialic acids in an organism. Sialic acids are capable is expressed to change process of recognition of tumoral antigens. The analysis of frequency expression different antigens on cells of various tumors in many cases can be used for an estimation of the forecast and a degree malignant tumoral process, and for reception of vaccines with the purpose immunotherapy.
Bulletin of the Russian Military Medical Academy. 2018;20(3):233-237
233-237
Ethical aspects of modern use of animals in experimental studies
Abstract
Laboratory animals have been widely used in biomedical research for centuries, and there is as much debate about the validity and acceptability of it. Since ancient times there are rules and moral practices, the law fixes the responsibility for the cruel treatment of animals. Currently, developed countries have accepted laws to protect animals, which are implemented through sophisticated mechanisms. Worldwide there is a growing recognition that attention to the observance of animal rights is one of the indicators of the civilization of society. Unfortunately, in Russia, the question of legislative regulation of moral concepts of animal treatment is highly relevant. Currently, in our country, there is no an effective system of control and punishment for violations of the rules of treatment of animals, so that the government cannot effectively influence the institutions in which do not apply ethical and legal norms of work with experimental animals. In addition, in the schools of biomedical and veterinary science, not enough attention is paid to the teaching of bioethics and the ethics of experiment on animals, which makes the level of training of graduates not corresponding to the modern requirements of the civilized countries of the world. It is necessary to develop a new modern documentary base in accordance with the spiritual, scientific and legal guidelines adopted throughout the world, which will determine not only the world recognition of domestic scientific research but also will be a clear indicator of the level of development of morality and civilization of Russia.
Bulletin of the Russian Military Medical Academy. 2018;20(3):238-242
238-242
Some health aspects of the Battle of Stalingrad with elements of philosophical comprehension
Abstract
Presents extensive historical material unparalleled feat of the Soviet people for a liquidation of consequences of the most ambitious in its bitterness of the battle of Stalingrad, where the cost of enormous effort and enormous human sacrifices our country was able to refract the course of historical events in the Great Patriotic war in their favour. Extremely violent confrontation predetermined the loss of troops, where only in the defensive period of the Stalingrad battle a day killed up to 3,000 people and about the same number of wounded. The severe sanitary and epidemiological situation after the battle, where a huge mass of decaying human bodies remained unburied in a relatively small area of hostilities, and what incredible efforts were made to prevent the impending epidemic of dangerous infectious diseases. The contribution of the outstanding scientist-microbiologist Z. V. Ermoleva and the implementation of her bold decisions in the prevention of cholera epidemic are described. The story is about one of the participants of the battle of Stalingrad on the part of the enemy, but played a huge role in the construction of a moral bridge between the fiercely opposing sides of evil and the liberation of Kurt Roiber - a participant in the battle of Stalingrad, who died in a camp for prisoners of war, but left a number of unforgettable drawings, one of which is the «Stalingrad Madonna» - the fruit of observations and a deep understanding of Russian children and mothers, destitute by military actions, calling in their own way to protect the world over their heads. K. Reiber was able to recognize the inhumanity of war, but that he had to himself to go through this hell. Only by relying on these sensitive triggers of our state of mind can we preserve the memory of the tragedy and the role of Russia’s unparalleled feat, which set an example to the whole world, including the enemy of the power of our indomitable Soviet spirit. And, no matter how hard it was, we should know and often remember these days of the hardest struggle and the great victory.
Bulletin of the Russian Military Medical Academy. 2018;20(3):243-253
243-253
Work organization of evacuation hospitals in Saratov during the Battle of Stalingrad
Abstract
The work organization of evacuation hospitals in Saratov during the Stalingrad battle is analyzed. A brief description of the medical issues of the Stalingrad strategic defensive operation is given. The factors that determined the evacuation of a significant number of wounded and sick Red Army soldiers to the medical facilities of the Local evacuation point-45 are indicated. Statistical data are provided on the number of people taken to treatment and sent to other rear hospitals who suffered from the site of the crucial battle of the Great Patriotic and World War II. The importance of using railway, water and motor vehicles for the evacuation of the wounded and sick was noted. The issues of the organization of sanitary and hygienic and antiepidemic work in Saratov and the region in the period of approaching the front, high crowding of the local population and arriving refugees, as well as the constant arrival of ambulance transports are considered. The enormous role of the Saratov Medical Institute staff in medical and consulting work in evacuation hospitals was emphasized. Their high professional training, constant search of non-standard ways of solving complex problems arising in the course of daily clinical activity, allowed to achieve high results in the work of medical institutions, to save the lives of a large number of wounded soldiers and commanders of the Red Army. The contribution and main directions of medical and scientific activity of leading specialists of the medical institute in the considered historical period of time are highlighted.
Bulletin of the Russian Military Medical Academy. 2018;20(3):254-260
254-260
M.I. Astvatsaturov - the founder of the biogenetic concept in the domestic clinical neurology (on the 140th anniversary of his birth)
Abstract
Creative and life path of M.I. Astvatsaturov is exceptionally multifaceted: a fully educated physician and a surprisingly modest and intelligent person; a remarkable clinician and excellent medical teacher; a deep and original scientist and the owner of virtually absolute musical ear; the founder of the national military neurology, a connoisseur of high poetry and classical music of Russian composers. However, the top of his diverse creativity, which brought him fame far beyond the borders of the country, was the formation in the domestic neurology of a new and original scientific direction - biogenetic (evolutionary) analysis of polymorphic clinical phenomena in diseases of the nervous system. I. Ja. Razdolsky argued that «the most original and vivid direction in the development of neuropathology, not only in Leningrad, but also in the Soviet Union over the past 40 years was the introduction of M.I. Astvatsaturov’s evolutionary method in the analysis of clinical phenomena». The first publications on the problematic subject, which served as «the key to understanding a number of phenomena in the pathology of the nervous system, which before had not explanation...», date back to 1913-1916 after M.I. Astvatsaturov’s three-year scientific trip to the best European clinics and laboratories in Berlin, Frankfurt am Main, Hamburg, Heidelberg, Munich, Vienna, Paris, London, Zurich and work for outstanding neurologists and psychiatrists - G. Oppenheim, L. Edinger, M. Nonne, Erba, E. Krepelin, Z. Freud, J. Babinsky, J. Dezherin, P. Marie, V.Manyan, V. Horsley, K. Monakov. Especially widely and vividly the diversity of opinions and scientific hypotheses were presented within the framework of the Astvatsurov’s biogenetic concept in clinical neurology in terms of the formation and improvement of motility, the clinical manifestation of pathological reflexes.
Bulletin of the Russian Military Medical Academy. 2018;20(3):261-266
261-266
Life and work of Henry Ivanovich Turner (on the 160th anniversary of his birth)
Abstract
The main life stages of scientific and practical activities of Henry Ivanovich Turner are presented. It is noted that initially G.I. Turner was interested in problems far from orthopedics: acute purulent processes in the right ileal fossa, the cecum and the appendix. In 1892 G.I. Turner defended his doctoral thesis on «the anatomy of the cecum and the vermiform Appendix in relation to the pathology of perityphlitis». In 1894, Turner was admitted to the degree of assistant Professor of clinical surgery, reading two lectures, he was confirmed in this rank. In 1895, held the appointment of Turner Professor of desmurgy and machineryi Military Medical Academy. He revived the teaching of the subject and translated it into «practical ground». Thanks to the energetic work of Turner as an organizer was revived by the Department of desmurgy and machineryi Military Medical Academy and Surgical Museum of the Academy. Under Henry I. the Museum has been enriched with new type of instruments, dressings, and splints, collection of damaged bones, who helped in the study of desmurgy. This collection has survived to the present day and has more than 800 drugs and has no analogues in the country. A lot of effort and energy gave G.I. Turner to help sick children, handicapped, vocational rehabilitation of crippled children. For many years he supervised the work of an orphanage in St. Petersburg (St. Lachtinskaia, 12), which in 1932 was transformed into the research Institute of child disability in the name of G.I. Turner. This Institute became the organizational and methodical centre of childhood disability in the Soviet Union.
Bulletin of the Russian Military Medical Academy. 2018;20(3):267-271
267-271
The birth of military medical education in the Moscow state
Abstract
The beginning of the formation of military medical education which, first of all, concentrated in Moscow is considered. The role of the pharmacy order and the Russian school of medicine is shown. It is established that the practical traditions in the preparation of the doctor, laid down in the school of medicine were picked up and successfully developed in the hospital school of the Moscow military Imperial hospital. The hospital as the first state medical institution in Russia has actually become the cradle of the national hospital business, medical science and education. The curriculum of the hospital school included theoretical and practical medical disciplines in a larger volume than in the medical faculties of foreign universities. In the past high stands, the role of the famous doctor-Galarza put my whole life on the development of the higher military medical education in Russia - Nicholas bidloo Labertouche. In 1733 the new staff of Medical Office was approved. On the model of the Moscow hospital school (later called the medical-surgical school), established two surgical schools in St. Petersburg at The land and Admiralty hospitals, and one - in Kronstadt. The facts presented in the article convincingly confirm and show the significant role of hospital schools as a centre of formation and development of military medical and General medical education in the XVIII century in Russia. A special role is given to the positive role of «foreign» doctors (Bidloo, Kondoidi), persistently involved in the field of medical support and education of Russia at that time, emphasized the role of progressive public figures in the formation and development of the rudiments of military medical education of the time - B. Godunov, and especially Peter the Great. Attention is drawn to the organizational and methodological support of the educational process - admission to the training of interested representatives of theological seminaries; development of original textbooks based on the most modern theories and views of the medical direction necessarily processed through the prism of the Russian experience of medical care and treatment at the bedside.
Bulletin of the Russian Military Medical Academy. 2018;20(3):272-277
272-277
Professor Pavel Ivanovich Melnichenko (to the70th anniversaru)
Bulletin of the Russian Military Medical Academy. 2018;20(3):278-279
278-279
Pravila dlya avtorov
Bulletin of the Russian Military Medical Academy. 2018;20(3):280-280
280-280