[Resistivity and hemodynamic reactions of essentially healthy pilots to the passive orthostatic test].

The paper analyzes the data of expert tilt testing (-80 degrees, 20 min.) of 66 essentially healthy pilots. Hemodynamic reactions were characterized based on the standard concept of functional classes (FC). Good test tolerance was recorded in 86.4% of cases among which 36.4% were referred to FC-I and 50%--to FC-II. Adequate test tolerance (FC-II) was recorded in 10.6%; reduced and poor test tolerance (FC-IV and FC-V)--in 3%. According to ECG and computerized tachooscillography, the adaptive hemodynamic reactions were optimum in pilots of group FC-I as compared with group FC-II and all the more so when compared with FC-III. The last two groups showed some objective symptoms that had not been looked for in the past (a distinct lability of blood pressure, and incomplete hypertensive and hypotensive reactions) that differentiated these groups from FC-I. Results of the analysis made it possible to put forward additional clinical functional criteria to assess tilt tolerance of pilots with different levels of functional tolerance.

[Prophylactic medicine--a foreground direction of medical support of the air staff of aviation of the Armed Forces of Russian Federation].

The first prophylaxis of chronic not-infection diseases obtains more and more value. Level of these diseases among air staff is rather high and has a tendency of increasing. It's bounded up with defects in the system of the first medical unit, insufficient conducting of ecological and sanitarium-hygiene screening and taking steps on decreasing of the influence of noxious agent on the human organism, improvement of working conditions of air specialists, decreasing of the value of psychoemotional stress and other factors. An important factor during the conducting the first and the second prophylaxis is an early detection of changes in health by the air staff and technical-engineer staff, diagnostics of diseases on early stages, when they conduct without any symptoms, forehanded rehabilitation and treatment.

[Improvement of extracorporeal shockwave cholelithotripsy in the comprehensive treatment of cholelithiasis].

The method of shockwave distant lithotripsy (DL) has been used since 1985. However, many facets of this problem have not been solved yet, because large fragments of the stone remain after its destruction, and focused shock waves (FSW) damage the gallbladder (GB). The aim of this study was to determine possibilities of effective distant destruction of gall stones, to reveal negative consequences of the effects of FSW on the gallbladder (GB) and the surrounding tissues, as well as development and perfection of DL technique. The established parameters of FSW were used to develop the new Lithotriptor Compact. By now, 53 patients with cholelithiasis aged 18 to 55 have been treated by DC. The procedure was performed without general anesthesia. A thousand to 3500 shockwave impulses were applied to each stone. All patients had received litholytic therapy and treatment directed towards metabolic normalization, the functional state of the GB, and prevention of recurrent stone formation, prior to DL. In total, 116 DL sessions (2.2 sessions per a patient) were performed. A positive effect as a result of the complex treatment of cholelithiasis using DL method was achieved in 47 (88.7%) of the patients. There were no complications. In 3 patients (5.7%) recurrence of gallstones was found two years after DL sessions. Correctly selected parameters of FSW and DL technology allow for effective destruction of GB stones, while conservative therapy favors their passage through the biliary tract and fast litholysis of remaining stone fragments.

[Diagnostics, treatment and expert evaluation of air crew members with polypoid growth in the gallbladder].

The article discusses results of diagnosing and treatment of various forms of gallbladder polypoid growth (GBPG) in air crew members in the past 10 yr. period. Growth of polyps was detected in 12.1% of pilots with gallbladder pathologies. Timely and correct diagnostics with the use of radiologic visualization may prevent unwarranted surgery of the hepatobilizry system and thus extend the flying longevity. Ultrasound Doppler investigation is particularly effective in diagnosing early GBPG. High quality of visual differentiation attainable with these techniques made it possible to diagnose the nonneoplastic nature of GBPG in 75% of cases that did not require operational treatment. In most cases the authors' diagnostic and treatment algorithm reduced the amount of surgical activity and prolonged ace careers.

[The risk factors of cerebrovascular disorders in the vertebro-basilar zone in the persons belonging to the flying staff]. / Faktory riska tserebrovaskuliiarnykh rasstroistv v vertebral'no-bazilarnom basseine u letnogo sostava.

The investigation of cerebral hemodynamics in 318 pilots with the use of ultrasonic dopplerography and transcranial dopplerography has shown that the earliest and most frequent manifestations of cerebrovascular disorders are observed in the vertebrobasilar zone (VBZ). The significant indices characterizing the morphofunctional condition of cerebral arteries are the results of triplex scanning of the main vessels. The pathologic changes in VBZ arteries, the variants of abnormal disposition of vertebral arteries, the secondary changes connected with extravasal effect are often detected during the early cerebrovascular disorders. According to the results of cervical vertebra roentgenography the degenerative-and-dystrophic changes, the congenital anomaly and traumatic injuries could play a certain role in the development of early cerebrovascular disorders in VBZ. Most frequently the symptoms of vertebrobasilar vascular insufficiency develop due to the cervical vertebral dislocation, uncovertebral arthrosis, Kimmerle's anomaly and other changes.

[Organization of the methods of early diagnosis and surgical tactics in treatment of nodular thyroid diseases in flying personnel]. / Optimizatsiia metodov rannei diagnostiki i khirurgicheskoi taktiki pri uzlovykh zabolevaniiakh shchitovidnoi zhelezy u letnogo sostava.

Complex analysis of the methods of early diagnostics and tactics of surgery treatment of 340 professional flyers with various forms of nodal thyroid diseases in the 5-yr period (1996-2002) showed effectiveness of a specialized diagnostic program including USI-controlled biopsy, in reliable estimate of structural changes of nodal thyroid formations already at early phases of disease in the majority of patients (83.2%). Organ-preserving and economical operations for removal of benign thyroid knottings led to recovery and professional rehabilitation of 90.3% of the patient-pilots.

[Experience of the 7th Central Military Clinical Aviation Hospital in early diagnostics, treatment, rehabilitation, and expert evaluation of cholelithiasis in flying personnel]. / Opyt raboty 7 Tsentral'nogo voennogo klinicheskogo aviatsionnogo gospitalia po rannei diagnostike, lecheniiu, reabilitatsii i ékspertnoi otsenke kholelitiaza u letnogo sostava.

The Seventh Central military clinical aviation hospital is experienced in performing laparocholecystectomy (LCE) in pilots afflicted with cholelithiasis (CL). In the period from 1990 to 2001, 92 operations were carried out after which 80 patients (87%) were permitted to fly. Medical discharge of 12 patients (13%) was associated not with CL but with some morphofunctional shifts caused by concomitant diseases. Seven to five-yr. follow-up of the 80 pilots who had returned their flying status after LCE showed their good tolerance for the flight loads.

[Distant pulse-wave lithotripsy in the Central Clinical Air Force Hospital ]. / Prioritetnaia distantsionnaia udarno-volnovaia litotripsiia v tsentral'nom voennom klinicheskom aviatsionnom gospitale.

With participation of the specialists from the 7th Central Military Clinical Aviation Hospital 4 pulse-wave complexes "Urat-P", "Urat-P2", "Ulitho", "Cholelithotriptor" were developed and introduced into clinical practice of the hospital. Distant pulse-wave lithotripsy was conducted 3035 patients (358 persons from flying staff). It is the main method of urolithiasis treatment, especially in the flying staff. Its efficiency is more than 96%. The modern models of lithotriptors are effective in destruction of biliary and urinary calculi and the applied parameters of wave impulses don't impact on the organs and tissues. The sphere of use of pulse-wave effect in the clinical practice was extended.

[Current problems in the diagnosis, treatment and prevention of cholelithiasis in flight personnel]. / Nekotorye aktual'nye voprosy diagnostiki, lecheniia i profilaktiki kholelitiaza u letnogo sostava.

In 50% of afflicted pilots, cholelithiasis is asymptotic and develops with the minimum anatomicomorphological changes of the biliary system. An early diagnostics of cholelithiasis in the pilots will enable one to treat them timely with the aim of returning the pilots to flying activity in the future. The introduction of nonsurgical treatment methods into the clinical practice with an application of distance shock-wave cholelithotripsy will elevate the percentage of pilots returning to flying activities. A need for developing domestic special devices for cholelithotripsy is ripe.

[The prospects for the use of a Soviet apparatus for the removal of gallstones with focused shock waves]. / Perspektivy ispol'zovaniia otechestvennoi apparatury dlia udaleniia zhelchnykh kamnei sfokusirovannymi udarnymi volnami.

Clinico-experimental substantiation was conducted for extracorporal crushing of the stones in biliary ducts in patients who suffered from gallstone disease. The "Urat-II" national lithotriptor and "Urat-B" biostand were used to crush in experimental conditions 140 gallstones (0.5-2.5 cm in size) obtained during cholecystectomies. Experimental researches on 56 white rats were conducted to study the liver tissue and adjacent organs. Optimal regimes for the percussive wave generator were found out in which the best crushing effect was obtained (with the dimensions of fractions up to 1.6 mm) and at the same time the minimal disturbing factor was produced. The data obtained during these researches are used in clinical pilot testings on "Urat-II"--a prototype of the national cholelithotriptor.