[C-peptide level as an early diagnostic marker of metabolic syndrome and predictor of cardiovascular disease in patients with diabetes mellitus type 2].

The aim of the present study was to investigate the relationship of C-peptide levels with insulin, resistance; components of metabolic syndrome and cardiovascular disease in patients with diabetes mellitus type 2. The study included 98 patients with diabetes mellitus type 2, who were divided into two groups by the level of C-peptide. The first group consisted of 54 patients with elevated levels of C-peptide; the second group consisted of 44 patients with normal levels of C-peptide. Our study has shown a positive correlation between C-peptide levels and a body mass index (BMI), triglyceride levels and the triglyceride/high-density lipoprotein ratio. Correlation analysis also allowed identifying a statistically significant association of the HOMA-2-IR-C-peptide with a BMI, triglycerides and the triglyceride/high-density lipoprotein ratio. In the group of patients with elevated levels of C-peptide found in practically all components of metabolic syndrome, as well as a high incidence of arterial hypertension and ischemic heart disease. The study shows that the detection of the C-peptide level is preferred in comparison with insulin for assessment of insulin resistance, presence of metabolic syndrome and can be used in type 2 diabetic patients for early detection of cardiovascular risk.

[Telemedical approach to the organization of the advisory dermatologic care].

Considered the introduction to the health practice of the remote medical help by the information and Communication Technologies to improve the quality of diagnostics of dermatological patients in the remote garrisons. Developed the scheme and the map of teleconsultation, and also defined indications for its conduct. Given the example of online consultation resulted in a diagnosis of pathomimics (Munchausen's disease), and in the recommendations for survey and treatment of the patient. It is concluded that the development of remote consultation of the patients needing dermatovenereological medical care from any health care facility will bring closer the highly specialized dermatovenereological assistance to the remote garrisons and will significantly save the cost of such assistance.

[Diagnosis and treatment of peripheral arterial aneurysms in lower limbs].

Authors analyzed a five years experience of the diagnosis and treatment of peripheral arterial aneurysms in the Center of vascular surgery of the multidisciplinary military hospital. Authors give the assessment of different diagnostic instrumental methods and demonstrate results of surgical treatment. The possibility and effectiveness of endovascular-traumatic method of surgical correction of this pathology of lower limb arteries are given.

[Modern capabilities of laparoscopic surgery for kidney cancer treatment].

Retroperitoneal surgical approach is the main component of operative intervention. This approach predetermines quality of surgical operation and the risk of intraoperative complications, an opportunity of their prevention. Lymphadenectomy is the unique method allowing authentically to confirm cancer in the lymph nodes and to evaluate a stage of disease. Endoscopicsurgical nephrectomy is the operation that keeps advantages of minimally invasive surgical approach in the majority of kidneys diseases without loss of quality of surgical treatment.

[Alcoholic liver disease: possibilities of diagnosis, treatment and rehabilitation in multidisciplinary hospital].

Tactics of alcoholic liver disease treatment is defined in accordance with lesion level. Differentiated approach to these patients can significantly improve the efficiency of diagnosis, treatment and rehabilitation. At the stage of cirrhosis it is necessary to focus on prevention and treatment of complications. Patients with compensated cirrhosis and subcompensated improved survival achievable Propafenone S-ademetionine (geptral, Geptor). The article presents the results of our study demonstrating a significant decrease in serum bilirubin in patients on background intravenous S-ademetionine. Practicability of stage system creation of medical rehabilitation of patients with alcoholic cirrhosis is approved.

[Treatment of rupture of abdominal aortic aneurism in multi-field military hospital].

For the last 5 years in the center of vascular surgery of Vishnevskiy 3rd Central Military Clinical Hospital 218 patients with abdominal aortic aneurism were treated, 96 planned surgical operations for abdominal aortic aneurism (post-operative mortality 3.1%) were performed. 11 patients underwent urgent surgical operation because of rupture of abdominal aortic aneurism. 1 of 11 patients died at the stage of laparotomy, the second patient died after clipping of ruptured aneurysm. In other 9 cases surgical operation was performed successfully. But 2 of 9 patients died in a few hours after surgery. In summary, 4 of 11 patients underwent surgical operation for rupture of abdominal aortic aneurism survived. The postoperative mortality was 63.6%. Authors gave an example of successful treatment of patient with rupture of abdominal aortic aneurism. It was concluded that successful treatment of rupture of abdominal aortic aneurism is possible only in case of well-run integration of different treatment and diagnostic departments. CT angiography is crucial for instrumental diagnostics of rupture of abdominal aortic aneurism. Successful surgical operation is impossible without organized blood supply service, refusion and donor blood. Artificial lung ventilation, extracorporal detoxication and adequate pharmacological supply help to avoid severe complications during the postoperative period, even in patients with associated pathology.

[Capabilities of roentgen-endovascular surgery in conditions of the central multi-field clinical hospital union].

Spanning 45 years team of the Vishnevsky Central Military Clinical Hospital N 3 has achieved high results and made the Vishnevsky Central Military Clinical Hospital N 3 one of the best medical centers of Russia providing state-of-the art care for patients with cardiovascular diseases. Nowadays the Center of interventional radiology and treatment provides all methods of roentgen-endovascular interventions on coronary, peripheral, cerebral vasculature, veins and bile ducts. The center has modern diagnostic and treatment equipment: digital angiography system with 3-dimensional angiography, 3D-navigation and CT angiography. Annually, about 1500 diagnostic coronarography and about 500 percutaneous coronary interventions are performed in the hospital. More than a half of peripheral arterial intervention is endovascular. The examples of such operations as single-step iliac artery stenting, inferior vena cava thrombectomy, embolization of a dural arteriovenous fistula of the posterior cranial fossa, percutaneous transhepatic paracentetic cholangiostomy are given.

[Diagnosis and treatment of complications after femoral artery paracentesis].

The authors show that the prophylaxis of local complications after femoral artery cannulation consists of proper technique of puncture, careful site selection for puncture, usage of closure devices and external compression. The authors also underline that it is necessary to pay special attention to patients receiving anticoagulant or antiaggregant therapy. Despite the rarity, occurrence of inguinal canal hematoma after the X-ray contrast angiography and X-ray endovascular surgery is a serious complication that can prolong recovery. For a complete recovery after femoral artery paracentesis it is necessary to provide a bed regime, to apply a compression band and to monitor a medical state during the first day.

[Myocardial revasculization in patients with ischemic heart disease and the end-stage of chronic kidney disease].

Chronic kidney disease (CKD) is independent factor of progression of ischemic heart disease (IHD). In that case, it is important to know the peculiarities of diagnosis and treatment of IHD in patients with CKD. The importance of this problem is increasing due to increase of patients with CKD. Cardio-vascular morbidity in patients with CKD is higher than in patients with other diseases. Myocardial revasculization may lead to significant improvement of survivability in patients with CKD. Among the prevention and treatment facilities the Vishnevsky Central Military Clinical Hospital N 3 is a leader in preforming the myocardial revasculization. The authors gave an example of successful coronary artery bypass surgery in patient with IHD and end-stage of CKD. Development of modem medical technologies, systematization of experience and knowledge allow in XXI century to consider CKD as non-absolute contradiction to elective surgery in case of different forms of IHD, including the end-stage of CKD (dialysis treatment). It is advisable to perform the myocardial revasculization in patients with the end-stage of CKD in specialized multi-field hospital, where can provided not only cardiosurgical and cardiological treatment but also specialized treatment for neurological patients, including haemodialysis and hemofiltration.

[The Vishnevsky Central Military Clinical Hospital N 3 celebrates the 45th anniversary].

The article is dedicated to the history of the Vishnevsky Central Military Clinical Hospital N 3. N.M.Nevskiy, the head of the 2nd Central military clinical hospital n.a. P. V. Mandryka, suggested to groud a military diagnostic and treatment complex in the countryside. It was caused by the exceeding demand for hospitalization for military personnel. The new hospital was built in 4 years and launched on 20 June 1968. The Central military clinical hospital of n.a. P. V.M andryka was transformed to the staff N 27/705 with 925 beds. This staff consisted of main treatment department with 655 beds (Krasnogorsk), branch of the 1st hospital with 120 beds (Moscow), branch of 2nd hospital with 100 beds and sanitary department with 50 beds (Bolshevo, the Moscow Region). In 1970 branch of the 1st 2nd hospitals were excluded from the staff. The name of hospital was changed for "Central clinical military hospital". In 1976 hospital was named after the prominent military surgeon A.A. Vishnevsky. Nowadays hospital is a multi-field medical and preventive treatment facility, one of the highest technological medical centers of the Armed Forces of the Russian Federation. This hospital provides a qualified medical treatment for servicemen, their families and other categories of employee of the Armed Forces. Hospital consists of 18 specialized centers, 110 diagnostic and treatment departments, 1 outpatient hospital and 6 branches.

[Contribution of the Vishnevsky Central Military Clinical Hospital N 3 to the history of combat casualty care and delivery of care to the injured soldiers].

The article is dedicated to the 45-year history of combat casualty care in the Vishnevsky Central Military Clinical Hospital N 3. In the echelon system of medical care the Vishnevsky Central Military Clinical Hospital N 3 ranks the echelon (level) N 3. Specialists of the hospital, along with a medical and preventive activity, practice methodological, educational and innovative activity, participate in different scientific forums. Temporary duty assignment to the combat, human-made disaster and natural disaster areas is a real functional test. 64 physicians have an extreme situation experience. The Vishnevsky Central Military Clinical Hospital N 3 is a clinical base of department of surgery, advanced physician training department, combat casualty care department of the Institute for advanced physician training of Mandryka scientific and educational clinical center. For the purpose of reducing the terms and improving the quality of medical care it was suggested to make the integration connections with leading hospitals of the Ministry of Defense of the Russian Federation.

[Requirements for information about medical parameters in the field of ophthalmology].

The authors came to conclusion that modern concept of medical information systems imply the development of electronic case-record using medical archives, results of laboratory and instrumental researches, based on modern information exchange technologies. The main criterion of realisation of this concept is solving of diagnosis problems. All parameters of diagnosis and treatment can be divided into three groups: measurable, observable and calculable. Measurable parameters -parameters, whose quantitative meanings can be measured with the help of special equipment and procedures of ist application. Observable parameters--parameters that can be observed with the help of biomicroscope, fundus-camera, ophthalmoscope and etc. Specific characteristic of these parametrs is not a qualitative evaluation, but quantative description and high level of subjectivity. The third group--parameters that cannot be measured or observed. These parameters can be received computationally or in the process of simulating. These parameters are result of mechanical and mathematical simulation of physiological and pathologic process of visual organ. The authors suggested requirements for ophthalmological workstation.

[Treatment of purulonecrotic forms of diabetic foot in multipurpose hospital unit].

Results of treatment and inspection of 278 patients with purulonecrotic complications of diabetic foot, treated in septic surgery department of 3rd Central Military-Clinical Hospital n. a. A.A. Vishnevsky during 1999-2009 are analyzed. For patients with purulonecrotic forms of diabetic foot is necessary to perform complex therapy with participation of endocrinologist and angiosurgeon, in specialized departments with the necessary medical equipment and dressing means and having experience of treatment of patients with diabetic foot, characterized with heavy and long-lasting course of disease leading to amputations. At the same time, application of gelling dressing means, iodoforms with ferment drapes for local treatment allowed to lower a level of amputations from 17.1 to12.8%, and also to reduce stay of patients in a hospital to 8 days.

[Primary and secondary prevention of alcoholic liver cirrhosis].

Alcohol--is the main causative factor of cirrhosis among the population in Russia. The primary prevention must be focused on exception of consumption of heavy doses of alcohol hepatitis and B vaccination. There are no healthy doses of alcohol. Secondary prevention means the use of the hepatoprotectors. List of hepatoprotectors and also amount of money spent to the purchase of these hepatoprotectors increase constantly. But, unfortunately, alongside with it, increases the mortality from hepatic disorders. Effectiveness of the most hepatoprotectors (such as Essential phospholipids, milk thistle) equals to the effectiveness of placebo.

[Treatment of vascular implants' infections in aortic position].

Nowadays the infection of a vascular implants in abdominal aorta is the heaviest and terrible complication in vascular surgery. Frequency of suppuration of vascular implants in aortic position is from 1 up to 3,5%, with lethality from 21 up to 80%. Average age is 61,4 +/- 4,3 years. In 6 cases, bifurcated system was infected, in other 3--linear. From methods of tool diagnostics the certain value has fistulography. Visualization of an artificial limb at the given research is pathognomonic its attribute infection. The Most significant, exhaustive method in our supervision was a computer tomography with bolus contrast.

[Organizational and methodological approaches to the medical rehabilitation of the wounded from the consequences of combat trauma in the upper limb in rehabilitation center].

This article discusses the possibility of optimizing the organizational and methodological approaches to the medical rehabilitation of the wounded from the consequences of combat trauma of the upper extremities in rehabilitation center. Clearly the implementation of organizational measures and technologies optimized medical rehabilitation, restoration of function provided the injured extremity: total of 152 (64%) injuries, partial in 26 (11%) injuries, as well as the stability of long-term results. Optimization using the traditional methods of treatment (biomehanoterapiya, chiropractic, massage, acupuncture, integrated technology) has increased the effectiveness of medical rehabilitation at 35%.

[Development of activity of ophthalmological center of multi purpose hospital unit on the basis of IT].

The article explores the potential information technologies have to intensify the diagnosis and treatment process in the ophthalmological centre of multipurpose military hospital unit and examines the present information analysis system that automates the ophthalmologist's workplace. The operation algorithm of the given system in ophthalmology is peculiar and distinct from the ones in other fields.

[Successful treatment of aneurysm of iliac artery in old patient with widespread atherosclerosis of aorta].

Disclosure of aneurysm of abdominal aorta indicates severity and prevalence of atherosclerotic process which means high probability of combined occlusive affections in other arterial circulations. Authors treated the patient with aneurysm of iliac artery with widespread atherosclerosis of aorta taking into account the abovementioned facts. Right stage surgical tactics assured success.

[Development of the rehabilitation system for wounded during the late hospital stage].

The current article deals with the main methods of development of the rehabilitation system for wounded during the late hospital stage. The problems of specialized rehabilitation for injured, patients of cardiology and neurology and the application of the newest rehabilitation techniques used to optimize medical aid in order to promote professional qualities recovery experience are also considered.

[Reconstruction of posttraumatic skull and facial bones injuries with the use of perforated titanium plates and meshes].

The given way of reconstruction of posttraumatic injuries showed predicted, long-term results and can be recommended for application in specialized establishments on bases of hospitals. Use of the data of computer tomography during the preoperative and postoperative period allows to estimate the volume of missing bone tissue. It also allows to define the volume of autogenous bone required for completion. Allows to define parameters of thickness, height, degree of curvature of autogenous bone, and also to select the optimum size of titanium plate or mesh. Application of perforated titanium plates ams meshes, made of high-purity the titan, allows to correct complex defects of maxillofacial area with minimization of complications in the postoperative period.