[Scoring system for unstable spinal gunshot wounds: the study protocol]. / Ball'naya takticheskaya klassifikatsiya nestabil'nykh ognestrel'nykh ranenii pozvonochnika: protokol issledovaniya.

Morphology of injuries following gunshot wounds requires specific treatment approaches. Currently, there are no similar classifications for assessing fracture stability with subsequent tactical recommendations. Taking into account diagnostic limitations (contraindications for MRI due to implantable metal fragments, limitations of functional radiography of the spine in seriously injured patients), we make decisions considering CT data. In this study, we will determine severity of vertebral damage and effect of these damages on mechanical stability of spinal motion segments. In the future, CT-based assessment of inter-expert agreement will be performed. Finally, we will propose the scoring system for classification of spinal gunshot wounds. OBJECTIVE: To present a research protocol for development of new scoring system for unstable spinal gunshot wounds based on inter-expert agreement assessment. MATERIAL AND METHODS: To create a new tactical classification, we will distinguish and analyze clinical and CT data of patients with thoracolumbar spinal gunshot wounds. The Delphi method will be used to collaborate between several surgeons. A three-stage study will result a questionnaire (for 30 clinical cases). We will develop tactical scoring system and analyze statistical data (kappa). DISCUSSION: Various classifications have been developed for closed spinal injuries. These systems describe the nature of injury and allow one to develop tactical decisions for further actions. Another mechanism of injuries following gunshot wounds does not allow the classification of closed injuries to be adequately applied in some cases. Indeed, spinal structures follow either direct passage of a wounding projectile through the spine or transferring the energy of this projectile in contrast to classical compression, distraction and rotational-translation mechanisms typical for closed trauma.

[Endoscopic treatment of mine-explosive spine injuries: 3 clinical cases and literature review]. / Endoskopicheskoe lechenie minno-vzryvnykh ranenii pozvonochnika: 3 klinicheskikh nablyudeniya i obzor literatury.

Modern warfare is characterized by common mine-explosive injuries. The last ones are accompanied by multiple injuries, large area of damage and severe clinical status of victims. OBJECTIVE: To demonstrate treatment of mine-explosive spinal injuries using modern minimally invasive endoscopic techniques. MATERIAL AND METHODS: The authors present 3 victims with various mine-explosive injuries. Endoscopic removal of fragments from the lumbar and cervical spine was successful in all cases. DISCUSSION: Most of victims with injuries of the spine and spinal cord do not require urgent surgery and can underwent surgical treatment after clinical stabilization. At the same time, minimally invasive techniques provide surgical treatment with minimal risk and earlier rehabilitation, as well as reduce the risk of infectious complications associated with foreign bodies. CONCLUSION: Careful selection of patients for spinal video endoscopy will ensure positive outcomes. Minimization of iatrogenic postoperative injuries is especially important in patients with combined trauma. However, well-experienced surgeons should perform these procedures at the stage of specialized medical care.

[Modern endourological technologies new opportunities in the treatment of patients with urinary tract anomalies and in complex clinical cases].

The clinical examples of the use of modern endoscopic minimally invasive technologies in patients with urinary tract anomalies and in complex clinical cases are presented in the article. The techniques and features of percutaneous nephrolithotomy, retrograde intrarenal surgery (RIRS), antegrade ureteroscopy using f lexible scope in this category of patients are discussed. The paper confirms the efficiency and necessity of further development of endourological methods for the treatment of urolithiasis.

[Road combined trauma of the urinary system organs: organization and clinical tactics in a multidisciplinary hospital].

INTRODUCTION: Damage to the organs of the urinary system (UMS) in road trauma (DT) is 4%, of which multiple and combined - over 70%. The aim of the study is to determine the main organizational and clinical directions for improving the EMC in case of trauma OMS in a trauma center of the 1st level. MATERIAL AND METHODS: For the period from 2017 to 2020. 508 injured with road polytrauma were admitted to the hospital. Of these, trauma and secondary injuries were diagnosed in 108 people (21.3%), which were divided into three groups: the first - 73 (67.6%) victims with the injury of the OMVS, the second - 25 (23.1%) with secondary damage kidney, the third - 10 (9.3%) patients with "neurogenic bladder" with spinal trauma. The assessment of the severity of damage was carried out using the ISS scales and tables of the IH P and IH C. RESULTS: It has been shown that the introduction of an interdisciplinary approach to the organization of in-hospital routing and differentiated algorithms of medical and diagnostic tactics based on the concept of traumatic disease, led to the establishment of a final diagnosis in every third victim in the early stages, as well as to a decrease in the overall mortality rate by 3.7%, the overall mortality rate was 12,2%. The key directions for improving the efficiency and quality of care in case of dominant and concomitant trauma of the urinary system have been identified, based on the tactics of programmed multistage surgical treatment (Damage Control Urological). CONCLUSION: In the FSBI "3CVKG A.A. Vishnevsky "developed, organized and implemented a system and algorithm for the provision of specialized medical care for trauma to the Ministry of Railways, including high-tech assistance to victims of road accidents, associated with the regional and federal services of disaster medicine.

[Clinical efficacy of neurometabolic therapy of dissomical disorders in asthenic syndrome]. / Klinicheskaia éffektivnost' neirometabolicheskoi terapii dissomnicheskikh rasstroistv pri astenicheskom sindrome.

AIM: To analyze the efficacy of cytoflavin in the complex treatment of sleep disorders in asthenic syndrome. MATERIAL AND METHODS: One hundred patients with sleep disorders and asthenic syndrome of various etiology and severity were studied. The patients were divided into three groups depending on the type of therapy: the first group received intravenous infusions of cytoflavin for 10 days; the second group, in addition to cytoflavin, received per os melatonin (3 mg or 5 mg) at bedtime; the third group in addition to cytoflavin received per os zopiclone (7.5 mg) at bedtime. RESULTS: On the 14th day of the study, a decrease in severity or complete relief of asthenia manifestations (according to the SHAS scale) and, accordingly, improvement or normalization of sleep in 97% of patients was found. At the same time, during polysomnographic study, the data obtained are characteristic for improving the quality of sleep phases mainly in the first and second groups of patients and, to a lesser extent, in the third group. CONCLUSION: Cytoflavin effectively suppresses the main manifestations of asthenic syndrome, including sleep disorders.

[Peculiarities of diagnosis and treatment of kidney cancer in the central military hospital].

tumor based on analysis of the treatment of patients with kidney cancer in 1339 received. Studied the characteristics such as the stepwise distribution of patients, incidence of histological types of kidney cancer, and varying degrees of tumor differentiation, the proportion of organ and organ-resecting interventions, methods of drug treatment, adoptive immunotherapy. The information about the features of.

[Branch N 1 of the Vishhnevsky central military clinical hospital N 3 celebrates the 70th anniversary].

On May 2016 the 114th Central aircraft hospital of fighters of air defense troop celebrates the 70th anniversary. Since the establishment of the hospital soldiers took an active part in medical support of the Soviet and later the Russian Air Force. During its existence, the hospital repeatedly reorganized, is now a modern military medical institution, has qualified and specialized medical care to the wounded and sick.

[Assessment of the influence of the balneo-physiotherapeutic procedures on microcirculatory blood flow in patients with occlusive diseases of the great arteries].

Assessment of the influence of the balneo-physiotherapeutic procedures on microcirculatory blood flow in patients with occlusive diseases of the great arteries. A comprehensive program of rehabilitation treatment of patients with atherosclerosis of the arteries of the lower extremities, including over venous laser light, gradient magnetic field on the collar region and calf muscles, dry carbon dioxide baths alternating with baths with horse chestnut. The program is pathogenetically justified the use of its high-performance, regardless of the predominance of a clinical syndrome. This allows recommending it for widespread use in clinical practice, including sanatorium conditions. Some methods that are included in a comprehensive program, in accordance with the proposed algorithm can be used in patients with atherosclerosis of the arteries of the lower extremities with the predominance of individual symptom complex.

[Functional methods of assessment of the blood flow in the lower limbs of the patients with obliterating atherosclerosis during complex conservative treatment].

Have been studied the changes of tissue blood flow in the distal parts of the lower limbs at the capillary level under the influence of the different complexes of rehabilitation. Were obtained the objective results of advantages of the combined use of physical therapy and drug therapy. The study showed that for evaluation of tissue blood flow is preferable to to use the laser flowmetry, and for registration of quantitative indicators of regional blood flow changes--Doppler ultrasound.

[A case of adenovirus infection complicated by gram-negative polymicrobial sepsis: A clinical and morphological observation].

Among respiratory infections, adenovirus infection (ADVI), in the presence of which there may be severe pneumonia that frequently results in a fatal outcome, occupies particular attention. ADVI in patients without immunodeficiency is usually mild and shows a limited extent of injury. At the same time the disease in immunocompromised individuals may be severe, presenting with viremia, evolving sepsis, and high death rates. The paper gives a characteristic example of severe ADVI and its fatal outcome.

[The use of plasma surgery in military medicine].

Scientists have been carrying out plasma energy research with the aim to apply to surgical practice. Domestic plasma devices "SUPR-M", "Fakel-01", "Gemoplaz-VP" and "Plazon" passed tests and were approved not only in clinical practice but also in condition of armed conflicts. Biological influence of air-plasma flows on tissues was examined. Nitrogen oxide (NO) is continuously produced in humans and animals involving enzymatic NO-synthase (NOS), acting as a universal regulator of diverse biological and physiological processes. Comparative analysis of the treatment of gunshot wounds and infectious complications clearly demonstrated the efficacy of using plasma flows at the final stage of surgical treatment. Use in military surgery, oncology, urology and gynecology, thoracic and abdominal surgery should be considered as a promising direction of this technology.

[Formation and development of flight-surgeon examination in the Branch No. 1 of Main Military Clinical Hospital n. a. N.N.Burdenko].

The history of formation and development of branch No. 1 FSI "Main Military Clinical Hospital n. a. N.N.Burdenko of the Ministry of Defense of the RF" is described in the article. The hospital celebrates in this year the 65-years anniversary of scientific and medical activity in the field of military clinical medicine, aviation clinical medicine and a fight-surgeon's examination. The leading historical role of this establishment in support of flight safety, combat readiness and anti-aircraft rocket troops is shown, and then last 10 years and in Air Forces of Russia, and also the basic achievements of branch in successful scientific and medical activity from 1946 till present time are given. Prospects of the further development of this branch are substantially connected to the increase of intensification of research works together with leading military-medical establishments of an aviation profile: Institute of Military medicine of Military-medical Academy, the Central flight-surgeon commission and 3 branch of FSI "3 Central military Clinical Hospital MD RF" etc.,--in solution of the large state problem of decrease of accident rate and rising of a medical flight safety of the RF State aviation.

[Acute mesenteric lymphadenitis: modern approaches to differential diagnostics and a choice of treatment tactics (review of literature)].

The problem of diagnostics acute mesenteric a lymphadenitis is actual and till now not solved. Use laparoscopy techniques in differential diagnostics of acute surgical diseases of an abdominal cavity has opened new prospects. Acute mesenteric the lymphadenitis in clinical practice can be surveyed as a polyetiological syndrome of the enlarged mesenteric/lymph nodes. If acute mesenteric the lymphadenitis is implication of infectious diseases medicament therapy is spent. A biopsy of a lymph node with the subsequent histological research at an infectious disease not informative. At verification of tubercular, oncology and autoimmune diseases is the basic method of diagnostics.

[The role of theoretical and practical conferences in developing the image of curative preventive institution].

In actual conditions, the development of the image of curative preventive institution is one of the major directions of activities of the administrators of medical organizations. Against the background of limited centralized financing the priority in choosing the needed approaches has to be given to the resource-saving technologies, one of which is the organization of theoretical and practical conferences in a proper methodic way. Such an approach provides the information to the superior administration and the stuff of other medical institutions about organized scientific event and demonstrates the endeavor of its team to master the innovative techniques and promotes the experience sharing between colleagues.

[Preparations with fibrino- and mucolytic action in the combined treatment of patients with protracted forms of intestinal infections]. / Preparaty fibrino- i mukoliticheskogo deistviia v kompleksnom lechenii bol'nykh s zatiazhnymi formami kishechnykh infektsii.

A study of 105 patients with distal colitis of torpid and protracted course and of infections genesis indicates that employment of microenemas with fibrinolytics (fibrinolysin) and mucolytics (muciselvin) proved more effective than traditional methods of treatment. The treatment was without any side effects.