[The formation of the School of Military Neurosurgery of the Military Medical Academy].

The article is devoted to stages of formation of the school of military neurosurgery. Famous pioneers of this school were Vsevolod Galkin and Boris Samotokin. Their scientific works were based on personal experience of treatment for the battle scull and brain injuries during the Great Patriotic War. The main aim of the activity of the talented researcher Vitally Khilko was to develop microneurosurgery, neuroimmunology and fundamental researchers of cerebral blood flow pathology. Boris Gaidar and Valeriy Parfyonov reorganized the echelon neurosurgical care system in a relatively short time. This reorganization formed the basis of the modem principles of specialized neurosurgical care in armed conflicts. At the present time department of neurosurgery is the leading methodological and clinical center of military neurosurgery in Russia.

[Problem of resource supply of medical aid to wounded and damaged persons of neurosurgical profile].

Longstanding complex examination of problems of delivery of medical care to patients of neurosurgical profile, effectuating in Military-medicine academy by Kirov S.M., permitted to observe evacuation and treatment of patients of neurosurgical profile, their social rehabilitation and returning to their work, estimated the advantages of 2-stages evacuation of patients and delivery in hospitals of Center in comparison with multistage one. Were examined questions of rehabilitation, help to families of lost or invalid military servicemen. The authors, observed economical and social questions, made a conclusion: patients of neurosurgical profile have to receive medical care in specialized and equipped institutes of central level of rear of state occurring once and in full volume.

[Single-stage operations for synchronous multiple primary and metastatic cancer of the lung and other organs].

The work presents an experience with the diagnosing of synchronous tumors of double localization in 256 patients. Operations were performed on 146 of them. Single-stage operations were made in 55 cases. When performing single-stage operations, 20 patients were found to have cancer of the lung with distant metastases or cancer of other localization with a metastasis in the lung. In the other 35 patients the diagnosis of true polyneoplasia was made followed by radical operations. Advantages of single-stage operations are shown, performing the first stage of the operation on the lung being substantiated. The five year survival after surgical treatment of multiple primary cancer was 15%.

[Modern medical science and Military Medical Academy].

The article presents the information about the main directions of scientific investigations of Military Medical Academy and their results during the period of 1999-2000. The scientific work was conducted in conformity with demands of orders and directives of RF Ministry of Defense. 12 integrated scientific problems were formed in the annual plans of the Academy's research work. Together with traditional directions the new ones connected with the experience of troops medical support during the armed conflicts, liquidation of consequences of extreme situations, participation of military contingents in peace-making operations were developed. The complex clinical investigations of specific features of combat pathology due to firearms used by the enemy during the military operations in Afghanistan and in the Northern Caucasus are going on. In the most of clinical departments the problems of etiology, pathogenesis and treatment of servicemen' diseases under peacetime conditions are the main directions of scientific investigations. Every year the Academy's rationalizers and inventors produce 60-70 inventions and more than 500 rationalization proposals. Since 1995 the Academy publishes the journal "Clinical medicine and pathophysiology" and since 1999--"Bulletin of Russian Military Medical Academy". The Academy's scientific potential comprises 194 professors, 295 associate professors, 349 Doctors and 894 Candidates of Science, 20 Honoured Scientists of RF, 57 members and corresponding members of academies (Russian Academy of Medical Sciences, Russian Academy of Natural Sciences and other social academies).

[Surgical treatment of lung cancer patients with brain metastases].

The authors present an experience with diagnosing and treatment of 16 patients suffering from lung cancer with solitary metastasis into the brain. The examination performed has shown that in 7 out of 16 patients the surgical treatment was found to be not expedient. This solution was based on the detection of an extensive spread of lung cancer: multiple metastasis outside the thoracic cavity and the brain or inside the brain, and in one case--due to a considerable reduction of indices of the functional and reserve capacities of respiration and blood circulation. Single-step operations were carried out in 9 patients with lung cancer with a solitary metastasis into the brain (resection of the lung with an ablation of the brain metastasis). Out of the 9 patients operated on 6 patients survived for as long as 1.5 to 2 years, one patient lived longer than 4 years. Two other patients operated upon in June 2003 and March 2004 are still alive and feel much better. Satisfactory results of treatment of these patients show such methods to be expedient.

[Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts]. / K voprosu o neobkhodimosti sokrashcheniia étapov meditsinskoi évakuatsii v usloviiakh lokal'nykh voin i vooruzhennykh konfliktov.

The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

[Semiquantitative evaluation of autoregulation of cerebral blood supply in norm]. / Polukolichestvennaia otsenka autoreguliatsii krovosnabzheniia golovnogo mozga v norme.

Elaboration of an informative, noninvasive method for evaluation of the reserve of the cerebral circulation is an urgent problem of angioneurology. The authors propose a method of dopplerographic estimation of the autogerulatory response by hyperthermic changes after short-term period of regional hypotension induced by digital compression of carotid artery on the neck. The indices acceptable in daily clinical practice were calculated. There was determined a range of their values at normal tonus of the resistive vessels, on the background of hypo- and hypertension induced by hypercapnic and hypocapnic loads, respectively. Test of carotid compression with registration of the linear velocity of blood flow in cerebral arteries is safe, significant and reproducible way for a semiquantitative estimation of the reserve of autoregulation. It may be used for evaluation of tonus of resistant vessels of the reservoir of the middle carotid artery as one of the most important index of the functional state of the system of cerebral circulation.

[Dopplerographic assessment of the autoregulation of the blood supply to the brain in neurosurgical pathology]. / Dopplerograficheskaia otsenka autoreguliatsii krovosnabzheniia golovnogo mozga pri neirokhirurgicheskoi patologii.

The development of an informative, noninvasive technique for evaluating the reserve of the cerebral circulatory system is a topical task of clinical angioneurology. The authors developed methods of Doppler evaluation of an autoregulatory response from hyperemic changes after short-term regional hypotension caused by digital compression of the cervical carotid. They calculated the indices acceptable in routine clinical practice, defined the range of their values in health and in typical variants of cerebral circulatory insufficiency in patients with disseminated neurosurgical pathology. The carotid compression test by recording linear blood flow velocity in the cerebral arteries is a safe, valid, and reproducible method of semiquantitative assessment of the autoregulation reserve which may be used to determine the tension of resistive vessels in the middle cerebral arterial bed as an important index of the functional status of the cerebral circulatory system.

[Video endoscopy in neurosurgery]. / Videoéndoskopiia v neirokhirurgii.

The authors present an analysis of their experiences with performing more than 330 video endoscopic operations on the autopsy material and in 172 patients. In 54 of these patients operations were performed for traumatic intracranial convex hematomas, in 21 for adenomas of the hypophysis, in 14--for arterial aneurysms, and 53 patients with discogenic radiculitis, spinal tumors, consequences of severe spinal traumas. In 25 patients the endoscopic videomonitoring was made during excision of the tumors, paratumorous cysts and abscesses of the brain, decompression of the optic nerve, plasty of the anterior cranial fossa fundus with closing the liquor fistulas. Intraoperative angioscopy in carotid endarterectomy was fulfilled in 5 patients. The video endoscopy was proved to result in less traumaticity of the radical surgery. It is a valuable and highly informative method giving optimum results in performing many microsurgical operations.

[The combined use of intraoperative video endoscopy and contact microvascular dopplerography in the surgery of cerebral aneurysms]. / Kompleksnoe ispol'zovanie intraoperatsionnoi videoéndoskopii i kontaktnoi mikrososudistoi dopplerografii v khirurgii anevrizm golovnogo mozga.

The article describes results of an anatomo-clinical investigation using video-endoscopy and contact microvascular dopplerography in surgery of cerebral aneurysms. The endoscopic anatomy of cisterns of the cerebral base was studied in 36 corpses of adult humans. More than 200 video-endoscopic operative interventions were performed on sectional material. Video-endoscopy in combination with contact microvascular dopplerography was conducted in the clinic on 20 patients with aneurysms of the brain. Main advantages of endoscopy used in combination with microvascular dopplerography during clipping the aneurysm are formulated. Complex using the two methods described gives less volume of the access and traumaticity of the intervention but not less radical effect. It is a valuable and highly informative method which optimizes performing the operation and has less amount of postoperative complications.

[The rational choice of antibiotics for the supply of military medical institutions]. / Ratsional'nyi vybor antibiotikov dlia snabzheniia voenno-meditsinskikh uchrezhdenii.

The list of registered in Russia anti-infectious preparations is analyzed and medicinal means of I and II turn are allocated. A set of preparations (total 30 names) is referred to the first turn, completely ensuring needs of the military-medical service, to the second-antibiotics, which should be buy for special purposes in the small amounts. The division was carried out from the point of view of necessity of the antibiotics effective use at treatment of the maximum quantity of the nosological forms of diseases, occurred in the Armed Forces; spreading of resistance to antibiotic of those or other activators; peculiarities of the antibacterial spectrum and Pharmakinetika of preparations; weights and frequencies of the side effects; epidemiological aspects, cost of the course of treatment, but also factor, which in English literature is usually called "compliance" and means convenience in application.