[Organization and delivery of therapeutic care in modern local wars and armed conflicts].

The system of providing therapeutic care within a united system of staged treatment of wounded and sick and evacuation was established during the Great Patriotic War of 1941-1945 and helped to return 90,6% of casualties to duty. In terms of local wars and armed conflicts the most important task of military field therapy is to improve the provision of therapeutic support through regional and territorial principles, echeloning of forces and facilities, optimization of allocation of medical institutions in accordance with their capabilities, evacuation routes, etc. The organization of therapeutic assistance should be guided primarily by the size and structure of sanitary losses. In modern local wars cannot exclude the occurrence of massive sanitary losses with limited use of weapons of mass destruction, as a result of failure (with a conventional weapon or as a result of sabotage) of nuclear power plants, chemical plants, and transport containers containing toxic chemicals.

[Acute allergy in practice of military physician].

Increasing number of patients with allergy observed in recent years is accompanied with increasing number of health encounters due to acute allergy. The sudden beginning and unpredictable course characterize acute allergy. These factors can be fatal for patient and must be treated immediately. Allergic rhinitis, allergic conjunctivitis, acute urticaria, angioedema and anaphylaxis refer to diseases based on acute allergy. The most dangerous diseases, characterized by fatal conditions, are generalised urticaria, angioedema and anaphylaxis. Knowledge of first aid principles is the most important factor of effective treatment because quickness of allergy progression requires prompt decisions. Use of the whole complex of modern therapeutic possibilities is the most important and durable. Modern methods of first aid for acute allergy, based on recommendations from foreign and domestic publications, are given in the article.

[Prospective concepts of the military field therapy development].

The authors suggested the main problems solved by the military field therapy: development, scientific rationale, systematic improvement and practical application of the organizational form of first aid for the wounded in conditions of combat actions; research on the etiology, pathogenesis and clinical picture of states caused by effect of weapon of mass destruction (nuclear weapon, chemical weapon, etc); development of methods of diagnosis, prophylaxis and treatment of the abovementioned states; research of the pattern, clinical progression and treatment of somatization disorders in conditions of combat and casual activity of troops, analysis of morbidity among the troops and development of prophylaxis;formulation of military-medical questionnaire and development of the system of rehabilitation for the wounded. Searching for innovative methods for solving the problems of military field therapy is the current problem. Modern warfare changed the concept of delivery of health care, effectiveness of evacuative actions, training of medical personnel and medical maintaining. The authors came to conclusion that qualitative technology breakthrough in development of military medicine and military field therapy would not happen without strategic understanding and learning of prospect technologies.

[Modern condition and prospects of improvement of the specialized medical care for acute bone marrow syndrome of radiation etiology].

It is shown, that tactics of treatment of acute marrow failure of radiant etiology is based, first of all, on measures of supporting, replaceable and stimulating therapy. The modern means, used for prophylactic and treatment of infectious complications, are resulted. Opportunities and restrictions of transfusion of donor thrombocytes and granulocytes, erythrocytes and chilled plasma are described. Therapeutic efficiency of transplantation of a bone marrow, cells of embryonic liver and stem cells of peripheral or umbilical cord blood is analyzed. It is shown, that the greatest prospects in perfection of the specialized medical aid at acute radiation syndrome are connected to complex application of interleukin-1beta, interleukin-3, granulocyte or granulocyte/macrophage colony stimulated factor, thrombopoietin and others cytokines.

[Hypoglycemia in patients with type 2 diabetes mellitus: safe solution of the dangerous problem].

The review gives detailed information on the state-of-the-art of hypoglycemia (HG) and the results of its Russian and international trials. It is noted that HG should be now regarded as an extremely undesirable glucose-lowering therapy complication that is closely related to the risk of cardiovascular events and higher mortality rates, worse glycemic control, and poorer quality of life in patients with type 2 diabetes mellitus (T2DM). The priority effective therapy tactics for T2DM is to manage the latter without any risk of HG, which can be implemented by the wide clinical application of incretins, dipeptidyl peptidase-4 inhibitors in particular, which have the glucose-lowering activity comparable with that shown by metformin and sulfonylurea drugs, are practically safe when used as monotherapy and significantly enhance the efficiency of therapy without substantially increasing the risk of severe HG when co-administered with other medications.

[Peculiarities of occupational esophagogastroduodenal pathology in personnel serving at CW disposal and storage facilities].

In a process of medical care and supervision on staff and military personnel, eliminating the chemical weapons, it was revealed that they are more susceptible to esophagogastroduodenal pathology in comparison with the control group. Moreover, the given pathology has an asymptomatic disease course but associated with high contamination of Helicobacter pylori. Marked inflammation changes, atrophic and fibrosis manifestation and microcirculation dysfunction have been confirmed by histological analysis of gastric mucosa. We supposed that the complex of occupational health risk factors, including possible subliminal toxic influence of eliminated CW components determines this pathological dysfunction. Negative influence of shift work and irregular nutrition rhythm are not excluded. The findings of this research are dictating the necessary of revision of military medical expertise principles and the development of the more effective treatment and prophylactic methods.

[Clinical toxicology of the Academy: yesterday, today and tomorrow].

National toxicology school of the Kirov Military Medical Academy, demonstrates the unity of clinical and experimental approaches related to one purpose throughout its history--saving human life and health from exposure to toxic substances of chemical nature. For more than three centuries the russian science of toxicology has been steadily developing, often ahead of the world science. It helped to create the means of protection and develop methods of treatment for chemical lesions. Currently, toxicology departments of military field therapy and military toxicology and medical protection are actively involved in the current study of military medicine, restructuring policy to provide toxicological aid in the Armed Forces, the development and introduction of Innovative methods of diagnosis and treatment of victims of toxicological etiology.

[Formation of therapeutic group of casualties in local wars and armed conflicts].

The necessity of improvement of the therapeutic care organization in the RF Armed Forces is dictated by the existing military threats. Conflicts between states or within a single country along with inefficiency of diplomatic, social and political efforts may lead to armed conflicts or local wars. Analysis of medical support results shows the consistent prevalence of therapeutic group of casualties in the overall structure of medical losses. 35-50% of all sanitary losses is accounted for by somatic diseases. Moreover, their structure is similar to the structure of the army's peacetime morbidity rate. Respiratory diseases head the list of somatic diseases in military personnel. Next--diseases of the digestive and circulatory systems. One of the most important tasks for physicians in wartime is early diagnosis and treatment of visceral pathology in the wounded. An additional point is that the use of tactical nuclear weapons during the armed conflict or local war cannot be completely excluded. There is also a real risk of nuclear and chemical facilities damage, with consequences that are comparable to the use of nuclear or chemical weapons. Thus, in the course of armed conflict or local war, military physicians can meet all possible therapeutic spectrum of pathology: from visceral pathology of peace and wartime to combat related therapeutic pathology.

[The directions of activity of the medical service on prophylaxis and early revealing of tuberculosis in the Armed Forces of the Russian Federation].

The basic directions of system of antituberculous actions in the Armed Forces of the Russian Federation includes: 1) non-admission of citizens, sick of tuberculosis, on military service; 2) allocation of group of persons with the raised risk of tuberculosis among all military servicemen, dispensary dynamic supervision over them and carrying out of chemoprophylaxis; 3) revealing of tuberculosis among military servicemen at preventive medical inspections (including fluorography), and also in case of reference for medical aid with the symptoms specifying on possibility of tuberculosis; 4) carrying out antiepidemic actions in military unit, in case of revealing patient, sick of tuberculosis, well-timed, qualitatively and in full. The major stage of antituberculous actions is a profound medical examination of young reinforcement (recruits under service call and under the contract) after the arrival in army. Preventive actions in group of persons with the raised risk of tuberculosis also are a priority for the medical service of military unit. Final desinfection, controllable emergency chemoprophylaxis and extraordinary fluorography of contact persons under epidemic indications are crucial important for decrease of morbidity in the army focuses of tuberculosis.

[Development of clinical radiology in the Military field therapy Department of the Military Medical Academy (the 90th anniversary of the birth of G. I. Alekseyev)].

On August 18, 2012, 90 years have passed since the birth of the former head of the Military field therapy Department of The Military-Medical Academy named after S. M. Kirov--the main radiologist of the Ministry of Defence of Russian Federation, the corresponding member of the Soviet Union Academy of Medical Science and the Russian Academy of Medical Science, the major- general of a medical service G. I. Alekseyev, who had been working in the department since its foundation till the last day of his life. Being the head of the department for twelve years, G. I. Alekseyev made a considerable contribution to the formation and development of native military radiology, training of medical and scientific skilled specialists. Professor G. I. Alekseyev's scientific ideas and views in the sphere of radiology were realized and developed in further educational, research and medical work of the department. Nowadays the staff of the Military field therapy Department remembers G. I. Alekseyev with special gratitude and appreciation and successfully realizes his ideas and plans in work.

[Modern possibilities of therapeutic aid in the time of mass sanitary losses of radiation profile].

Modern concept of medical-prophylactic measures in the time of mass radiation affection is presented in the present article. Moreover the past changes in organization-regular structure of medical service of the Armed Forces of the Russian Federation and appearance of new time-board equipment were taken into account. Recommendations about the rendering of all types of therapeutic aid on all stages of medical evacuation--first, premedical, medical assistance, qualified and specialized--are given.

[Non-invasive assessment of coronary blood flow in veterans of the Ministry of Defence with ischemic heart disease and age-dependent androgen deficiency].

It was examined 51 pensioners of Ministry of Defence with coronary heart disease (average age 55 [52, 59] years). In 20 patients it was verified age-related androgen deficiency, in 31 patients the level of testosterone was within normal limits. The evaluation of coronary circulation was made on single-photon emission tomography with determination of myocardial perfusion in a rest and after pharmacological loading, bicycle exercise test, holter-monitoring of ECG. It was found in 39% cases in patients with coronary heart disease the androgen deficiency in pensioners of Ministry of Defence, that is exceeded the level of common population. Ishaemic changes were found on exercise test in patients with androgen deficiency more often in comparison with patients with normal testosterone level. During myocardial perfusion scintigraphy with adenosine triphosphate there were no differences among group in area of induced coronary heart insufficiency. It was found the negative correlation between the level of testosterone and the duration of ischaemic ST-depression, and positive correlation between testosterone level and tolerance to physical activity.

[Reclid effects on carbohydrate, lipid metabolism, lipid peroxidation and hemodynamics in patients with diabetes mellitus type 2]. / Vliianie reklida na pokazateli uglevodnogo, lipidnogo obmena, perekisnogo okisleniia lipidov i sostoianie gemodinamiki u bol'nykh sakharnym diabetom tipa 2.

Patients with diabetes mellitus type II have disorders in carbohydrate, lipid and other kinds of metabolism. This increases the risk of cardiovascular complications and atherogenesis. Therefore, it is advisable to use drugs preventing an excessive late phase of insulin secretion with resultant reduction of hyperinsulinemia. Reclid, the drug of this group, improves metabolic processes, insulin resistance, lipid metabolism, hemostasis and microcirculation. 3-month reclid therapy of patients with non-insulin-dependent diabetes mellitus produced a good hypoglycemic effect in 85% of the cases. This effect consisted in reduction of basal and postprandial glycemia, levels of glycosylated hemoglobin, 24-h glucosuria. In patients with diabetes mellitus type II reclid diminished the levels of total cholesterol, triglycerides, glycosylated hemoglobin. In patients with left ventricular diastolic dysfunction, reclid improved transmitral blood flow. Thus, reclid provides a good metabolic control in patients with non-insulin-dependent diabetes mellitus. Moreover, it positively affects mechanisms initiating cardiovascular complications in diabetic patients.