Forensic expertise in the Defense Ministry of Russian Federation: modern status and perspectives of development

The article presents a summary of history of creating and elaborating of military forensic medicine, it's now-day condition and perspectives of future evolution. Authors mark necessity of material and technical reequipment of SFE of DF of RF, of improvement of system of preparing of the staff, of uniting of SFE and of agencies of military justice.     

Outpatient care of patients with atherosclerosis obliterans of lower limb arteries

Results of application of complex treatment of patients with atherosclerosis obliterans of lower limb arteries by means of perfection of an out-patient stage of the surgical help are presented. Rendering assistance in the conditions of surgical branch of city polyclinic makes modern methods of conservative treatment for the overwhelming majority of patients with an obliterating atherosclerosis of arteries of the bottom extremities more accessible, promotes improvement of indicators of safety of extremities and survival rate of patients.     

早期胰头－壶腹区肿瘤的影像分析（附40例报告）

目的：探讨早期胰头－壶腹区癌的影像学表现及病理基础。材料与方法：分析４０例早期胰头－壶腹区癌的ＣＴ、十二指肠低张造影表现与超声比较。胰头癌１０例，胰腺段胆总管癌１５例，壶腹癌１５例。结果：ＣＴ检出胰头癌６例，胰腺段胆总管癌１１例，壶腹乳头癌９例，敏感性分别为６０％，７４％，６０％。超声检出胰头癌３例，敏感性４２％，１０例胰腺段胆总管癌和壶腹乳头癌超声未明确诊断。低张十二指肠造影检出壶腹癌１３例，敏感性８７‰。结论：ＣＴ和十二指肠低张造影检查为早期胰头壶腹区肿瘤的最佳影像学检查方法。     

正常人胼胝体膝部及嘴部年龄与性别差异的DTI研究

目的:研究胼胝体膝部和嘴部的DTI参数ADC值、部分各项异性(FA)值及神经密度在年龄及性别方面的差异,并获取其随年龄增长的变化规律。方法:将247例正常人按照年龄段分为10组,行颅脑DTI,测量胼胝体膝部和嘴部ROI的ADC值、FA值及神经纤维数,并计算神经密度。结果:①男性胼胝体膝部和嘴部的ADC值随年龄增长的差异均具有统计学意义;女性则差异均无统计学意义。②男性及女性胼胝体膝部和嘴部的FA值随年龄增长差异均具有统计学意义,其随年龄增长的变化规律基本上符合升高—相对稳定—下降的趋势。③男性及女性的胼胝体膝部和嘴部神经密度随年龄增长差异均无统计学意义。④在>3～6岁组,女性胼胝体嘴部的ADC值显著高于男性(P<0.01);在40岁以上男性,胼胝体膝部的神经密度显著高于女性(P<0.01);胼胝体膝部的ADC值和FA值、胼胝体嘴部的FA值和神经密度在各个年龄段内的性别差异均无统计学意义。结论:①胼胝体膝部和嘴部的ADC值、FA值随年龄增长的变化规律可以反映胼胝体膝部和嘴部生长发育及老化的整个过程。②本研究所获得的胼胝体膝部和嘴部的ADC值、FA值及神经密度可作为以后进一步研究的参考。     

Ultrastructure of the cortex of the cerebellar nodulus in rats after a flight on the biosatellite Kosmos-1514

The ultrastructure of moss fibers and granule cells of the cortex of the cerebellum nodulus of rats flown for 5 days onboard the biosatellite Cosmos-1514 and exposed to 1 g for 6-8 hours upon return to Earth is indicative of an excess excitation of terminals of moss fibers and excitation of granule cells. The excitation of moss fiber terminals reflect the excitatory state of hair cells of the otolith apparatus and neurons of the vestibular ganglion produced by the effect of 1 g after exposure to microgravity. This state can be viewed as evidence of a greater sensitivity of the hair cell of the otolith organ--neuron of the vestibular ganglion system during exposure to microgravity. It is hypothesized that the sensitivity of this system of other mammals may also increase in microgravity.     

动力髋螺钉内固定治疗股骨粗隆间骨折失败因素分析

目的分析动力髋螺钉内固定治疗股骨粗隆间骨折的失败因素。方法对102例股骨粗隆间骨折采用动力髋螺钉内固定失败的19例病例资料进行回顾分析。结果19例失败病例中,9例因内固定松动髋内翻,5例钉穿出,3例钢板拨钉,1例髋螺钉退出,1例钢板折断。失败因素与骨折的严重程度、骨质疏松、忽视内侧结构重建、术中操作不当、康复训练不当等有关。结论骨折严重程度和骨质疏松是导致动力髋螺钉失败的主要因素。术中重视内侧支持结构重建,严格规范手术操作,正确指导康复锻炼及抗骨质疏松治疗,可减少失败发生。     

Deep sea trip of the ship crash Northern Force fleet

A long-termed navy march of crash shupborn group of Northern Navy became a sign-oriented event in the life of the Armed Forces. After more then 10 years cessation this march signed recommencement of permanent Russia navy attendance in strategically important areas of the World Ocean. The authors highlight work of military-navy specialists in conditions of this march. The most important peculiarity of this march was participation of a hard aircraft carrier "Navy Admiral of the Soviet Union N.G.Kuznetsov". Activity of aircraft staff in carrying out the boardings and the deck starts requires the highest mobilization of all psycho-physiological resources. There was effectuated a complex medical-psychophysiological research of functional condition of aircraft and engineer staff of the group during the service. Also there was effectuated an operative recovery of functional condition among sailors and officers of the ship staff. Method of neuronsemantic diagnostics of psychological disadaptation and suicide risk was used during the analyze of groups of risk. The results of the analyze permitted to educe main psychotraumatizing factors, to form recommendations on psycho-correction, organization-educative measures taking into account individual peculiarities of motivation sphere and cognitive sensitivity. There were effectuated different trainings of moralities, communicativeness, strategy of negotiation and stress-managment in cooperation with the psychologist of the ship.     

Fractures of the neural arch and odontoid process of the axis: A study of their causation

Summary The anatomical findings in 43 cases with fractures of the neural arch or odontoid process of the axis have been correlated to the reconstructions of the course of events in the accidents. Bilateral fractures of the neural arch anterior to the inferior apophyseal joints were the result of a violent anteroflexion of the head. Simultaneous traction or compression of the cervical spine were possibly of contributing importance. Considerable non symmetrical fractures of the neural arch were due to oblique anteroflexion of the head combined with traction of the cervical spine. Trauma against the posterior part of the neck resulted in fractures of the neural arch posterior to the inferior apophyseal joints. The fractures of the odontoid process were the result of a violent anteroflexion or retroflexion of the head. Simultaneous compression of the cervical spine and rotation of the head were possibly of contributing importance in some cases.     

Analysis of the structure and causes of acute poisoning of chemical etiology in the Northern Fleet

Data for the incidence of acute poisoning among the personnel of the Northern Fleet in 2002-2010 is analyzed, its dynamics and proportion of primary morbidity of sailors. In the class of clinical entity of "injury, poisoning and certain other consequences of external causes" proportion of poisoning in servicemen of different categories was ranging from 0.5 to 1.8%. Deaths occurred in 23.4% of cases of poisoning. Among the causes of poisoning major were--failure to comply with requirements to ensure safe conditions of military service and safe conduct of work, personal indiscipline of injured. Proposals for the prevention of poisoning in the current conditions of service in the Navy are suggested.     

About the elaboration of the unique informational space of the medical service of the Armed Forces and improvement of informational assurance of system of it's control

The now-day period of development of the medical service of the Armed Forces of the RF and it's system of control is characterized by a growing up need by functionaries of control departments in an actual, authentic, well-timed and all-round information. This information is necessary for qualitative solving of concrete missions. Growing of volume and importance of information stipulates research of new methods and ways of rise of control effectiveness. One of the ways of resolving this problem is elaboration of the unique informational space of the medical service of the Armed Forces of RF. Realization of perspectives of improvement of information acquisition and processing for the control of the medical service permits create the unique informational space of the medical service of the Armed Forces of RF, realize a centralized control, solving missions of building and reforming of system of control and medical supply of Forces.     

Organizational-methodological aspects in optimization of training of future military physicians

There was an effort to create a universal organization-administrative workbench, which, on the one hand, execute the function of primary and dynamical valuation of this process, revelation of difficult situations and, on the other hand, permits identify the causes of theirs rise and the ways of resolving these situations. At that the optimization of training military-medicine personnel is organized by the way of realization it's principles, in the network of correct normatively - juridicial field, on the base of modern agents, forms and methods of professional military education, as well as the realization of peculiarities of system of military-medical education, of multi-criterion diagnostics of activity of military-medicine academy and of teaching of several subjects, of predicting of success of professional education of hearer, of efficient restructuring of educational-methodological complex with the aim of method of branches and frontiers for the purpose of ground and choice such administrative solutions, that are the beast from the point of view of efficiency of result of functioning.     

Adaptation of divers in the European North

The article gives a value of physiological condition of plungers's organisme during the most unfavorable season of the year-- polar night--in condition of based planed readiness (n = 26). Data of researches concluded necessary parameters of anthropometry, homodynamic, respirator functions. Supplementary diagnostic base was made by methods from the program of express-control of functional conditions. The results of the searches gave an opportunity to esteem the examined group of service men as people with tight vegetal nervous system, high level of neurohumoral regularity, which common for the physically strong people. It confirms the effectiveness of existing system of choice of plungers. The authors offer to fix a system of physiological monitoring of the health of all the service men. The purpose of this action is an early revelation of donozoologial conditions.     

The general and local treatment of wounded patients with gunshot fractures at stages in the medical evacuation

The article discusses the pathogenetical approach to an early prophylaxis of local disorders of blood circulation in the cases of gunshot fractures of limbs. The authors emphasize the negative influence of the post-traumatic edema of muscles inside osseous-fascial bursas. On the background of blood losses and centralization of blood circulation edema causes the decompensation ischemia of tissue, which leads to the appearance of centres of secondary necrosis. An early recovery of optimal tissue blood circulation is propounded as one of the goals during the primary surgical management of wounds. A rational sequence of immediate surgery, which was practically tested is proposed. Basic methods of operations on limb segments are enclosed.     

Community-acquired pneumonias, complicated with pathology of the urological system

The article presents the results of studying the characteristics of clinical course, diagnostics and treatment of outhospital pneumonias, combined with pathology of urinary bodies in the interest of optimizing medical-diagnostic ensure this category of patients in an environment of pulmonologikal department of multidisciplinary hospital facility. Optimization of the full survey of patients with pneumonia, combined with diseases and pathological changes of urinary system, in the initial period of their treatment in the pulmonologikal department environment allows to make early, proved correction of etiotropic, pathogenetic and symptomatic therapy of their polimorbidycal pathology, that will reduce their terms of being in hospital without damage to quality of diagnostics and treatment.     

Clinical aspects of the ischemic insult problem in patients of professions associated with danger

The work presents the analyze of the structure of ischemic insult, the clinic course of ischemic insult, the terminations of ischemic insult in neurological department in hospitals. The purpose of researches is optimization of preventive and neurorehabilitation measures of persons of "dangerous" professions. There were 242 cases of acute violation of cerebral circulation in ischemic type according to formalized case records during the period 2004-2006 years. The results of researches demonstrated that the treatment tactic, based on correct evaluation of condition and of prognosis of disease secures lower indexes of lethality of patients with ischemic insult, than the world's ones. A comparatively low percent of invalidation is mainly conditioned by primary prophylactic of insult during the period before hospital and active therapeutic measures during the period of acute insult in hospital. The indexes of lethality in the group with the patients with cardioembolic sub-type were higher. In the bond with this fact it's worth while to reinforce the preventive measures of persons with cardiorhythmic frustrations.     

影响高压氧治疗颅脑损伤患者疗效的常见因素分析

目的探讨高压氧(HBO)治疗颅脑损伤患者疗效的常见影响因素。方法对进行HBO治疗的179例颅脑损伤患者的疗效进行回顾性分析。考察的影响因素包括:性别、年龄、损伤类型、昏迷程度(GCS评分)、损伤部位、病灶数量、气管切开与否、颅脑手术次数、合并损伤、基础疾病、并发症、外伤性脑积水、开始HBO治疗的时间、HBO治疗的次数等,将上述因素对疗效的影响进行统计学分析。分别以"首次HBO治疗的昏迷程度、HBO治疗时是否已行气管切开手术和开始HBO治疗的时间"为分组条件,将患者分为3组,并比较HBO对3组患者的疗效。结果影响疗效的主要因素包括:首次HBO治疗时的昏迷程度、HBO治疗时是否行气管切开手术、开始HBO治疗的时间。GCS评分<9分的患者有效率为58.11%,与其他组比较最低(P<0.01);气管切开术后的患者有效率为46.43%,与对照组比较差异有统计学意义(P<0.01);首次HBO治疗距离外伤时间<1个月的患者有效率为91.35%,与其他组比较最高(P<0.05)。结论HBO治疗颅脑外伤患者疗效显著,排除禁忌证后应尽早行HBO治疗。     

Measurement procedure for further radiologic analysis of bone. A review of the quantitative radiology of the skeleton

The reasons for using measurements of bone density for further analysis of changes in metabolic bone diseases are pointed out. Besides the easy methods of visual comparison of X-ray images and "microradioscopy", the methods of quantitative radiology are discussed. The X-ray morphometry method is presented, including the new results of measurement of various bones of the skeleton. Structural analysis of spongy and compact bone tissue from the X-ray image using opto electronic image transformation is demonstrated. The techniques of X-ray photodensitometry and isotope-densitometry are explained. The importance of a reproducible calibration standard and the special value of reference systems containing a known concentration of hydroxyapatite are shown. Special information is given regarding the present status of the development of the new technique of quantitative computer tomography (QCT) or computer tomometry with the aid of a solid reference system. This new reference system is constructed from various concentrations of hydroxyapatite in "solid water" (a polyethylene mixture) and is demonstrated in detail. The results of comparing measurements of the 2nd lumbar vertebral body are shown. Finally, the clinical importance of measurements of the "apatite value" of vertebral trabecular bone tissue and of various trabecular areas of the skeleton is emphasized.     

外部性脑积水的CT表现与鉴别诊断

目的:获取外部性脑积水的CT特征,并与脑萎缩、硬膜下积脓、积液相鉴别,从而提高其诊断准确性。材料与方法:选择外部性脑积水49例,脑萎缩21例,硬膜下积脓5例,硬膜下积液2例,分析其CT表现特征,并与临床对照。结果:1.外部性脑积水CT特征:额及顶区蛛网膜下腔增宽。前部纵裂及大脑外侧裂增宽,额、顶区脑沟增宽、深陷,其他部正常,侧脑室可轻度扩大或正常,大脑额、顶叶凸面皮质无变薄征象。2.脑萎缩CT特征:大脑沟普遍增宽、深陷,有时小脑沟也增宽及其数目增多(≥4条),第三、四脑室及侧脑室扩大,纵裂增宽且不局限于前部,大脑凸面皮质变薄,蛛网膜下腔增宽且不局限于额顶区。3.硬膜下积脓CT特征:颅内板下方新月形低密度区,密度高于脑脊液,大脑凸面受压,变平、内移,于新月形低密度与大脑凸面之间有一薄膜结构,呈膜状飘浮征象,侧脑室可有受压变窄。4.硬膜下积液CT特征:一侧或双侧新月形低密度影,为脑脊液CT值。脑凸面有受压略变平征象,单侧硬膜下积液可有中线结构移位,侧脑室可有轻度变窄。结论:只要熟悉外部性脑积水、脑萎缩、硬膜下积脓,以及硬膜下积液各自的CT特征,一般不难对它们作出鉴别诊断。     

Community-acquired pneumonia in the elderly: the peculiarities of the clinical picture, diagnosis and treatment

The article presents the results of studying the peculiarities of the clinical picture, diagnosis and treatment for community-acquired pneumonia in the elderly in view of the interaction of combined pathology of respiratory, cardiovascular and urological systems in order to optimize medical-and-diagnostic support of the above-mentioned category of patients in conditions of the pulmonology department of versatile educational establishment. Optimization of all-round inspection of the sick with pneumonia in the advanced age at an initial stage of treatment in conditions of the pulmonology department so as to reveal the aggravation of internal bodies' combined diseases will allow making early correction of aetiotropic, pathogenetic and symptomatic combined pathology therapy available, which reduces the terms of staying at hospital without damage of diagnosis and treatment.     

CTPI对非小细胞肺癌通过抗血管生成治疗的评价研究

目的 探讨CT灌注扫描(computed tomography perfusion imaging,CTPI)对非小细胞肺癌通过抗血管生成治疗的评价效果.方法 选取本院2016年1月～2018年12月收治的100例非小细胞肺癌患者为试验组,均通过抗血管生成治疗;以同期收治的100例通过安慰剂治疗的非小细胞肺癌患者为对照...