The problem-oriented research laboratories of the Military Medical Academy

1. Extending cultural care beyond language enhances the use of mental health services and fosters a mutually agreed-on plan of care. 2. Understanding cultural characteristics facilitates an understanding of behavior, family and social dynamics, and adaptation patterns to stress that can empower clients to work toward their goals and validate the impact of emotions and behaviors on others. 3. Culturally appropriate mental health care reflects a synthesis among communication, space, social organization, time, environmental control, and biological variables.     

The Military Medical Academy on memorial medals and phalerae

When the Texas Legislature convenes in January 1999, managed care certainly will be among its leading issues. And the people and organizations that will influence that debate will come from a wide spectrum of interests including medicine, the insurance industry, business, large employers, and many others. Here is a brief analysis of the key players in the managed care debate.     

The contribution of the scientists of the Military Medical Academy to the development of Russian physiotherapy and health resort science (on the 200th anniversary of the Military Medical Academy and the 70th anniversary of the Department (Course) of Physiotherapy and Health Resort Science of the Military Medical Academy)

The paper deals with the milestones of the space biomedicine advancement, its integration in the system of sciences and the life of humanity, and the role of Oleg G. Gazenko in its evolution.     

Surgeons--the presidents and commanders of the former Medical Surgical Academy--of the Military Medical Academy

BACKGROUND: To examine the prevalence of atrial fibrillation (AF) in cardiopathic patients with hyperthyroidism. METHODS: The data concerning the patients had been derived from registers of the Laboratory of Radioimmunoassay where cardiopathic patients' blood samples were referred from the Cardiology Unit to evaluate thyroid function, consecutively from January 1992 to December 1997. Of the 443 patients, 303 (68.4%) were classified as being euthyroid, 23 (5.2%) hypothyroid, 117 (26.4%) hyperthyroid. Thyroid function was diagnosed clinically and confirmed by serum TSH and free thyroid hormone (FT3, FT4), levels. RESULTS: Among hyperthyroid patients, the more frequent arrhythmia was AF (54.7%). After excluding from the study those hyperthyroid patients with rheumatic disease, hypertension, myocardial infarction, 37 hyperthyroid patients were selected; 18 (48.6%), (mean age 63.4 +/- 10.8 yrs), showed sinus rhythm and 19 (51.4%), (mean age 66.0 +/- 12.1 yrs), showed AF. FT3 and FT4 were higher in patients with AF than in those without AF, whereas TSH was not significantly different between the groups. Left ventricular (LV) mass index was significantly increased in hyperthyroid women with AF compared with hyperthyroid women without AF (109.80 +/- 22.33 g/m2 vs 84.50 +/- 6.20 g/m2; p < 0.005). A significant correlation was found between FT3 levels and LV mass index in the hyperthyroid women with and without AF (r = 0.77; p < 0.001). CONCLUSIONS: In this study the prevalence of AF is 51.4% in hyperthyroid patients. FT3 is higher in patients with AF than in those without AF. Finally, the correlation between FT3 and LV mass index suggests that cardiac hypertrophy is associated with thyroid hyperfunction.     

The 15th anniversary of the Department of Therapy of the Military Medical Faculty in the Russian Medical Academy of Postgraduate Education

The relationship between dose intensity of cytotoxic agents and therapeutic results was examined in a retrospective analysis of 32 patients with non-metastatic high-grade osteosarcoma of the extremities. The average dose intensities of individual agents were 9.8 mg/m2/week for doxorubicin, 1.2 g/m2/week for methotrexate, and 10.5 mg/m2/week for cisplatinum. The dose intensities of doxorubicin and methotrexate were significantly correlated with the clinical results, while that of cisplatinum was not. These results indicate that maximal dose intensification of doxorubicin and methotrexate is an important determinant of treatment outcome for patients with osteosarcoma.     

Medical legal aspects of clinical monitoring

Modern laboratory technology has spawned a plethora of techniques for measuring and monitoring drug concentrations and body constituents; but the availability and frequent over-use of these determinations, some of which are exotic and require specialized personnel and expensive apparatus have further escalated the already high cost of medical care in several ways. The specter of medical malpractice suits has compelled the physician to practice defensive medicine including ordering unnecessary monitoring procedures, particularly for drug levels. Further impetus has been superadded by the courts and state legislatures; for example, phenylketonuria (PKU) determinations are mandatory in almost all states. Court rulings have held that "common knowledge" not expert testimony, may be all that is necessary to hold the doctor culpable for not ordering a test; nor is expert testimony necessarily required if the Physicians Desk Reference (PDR) or drug company insert recommends that certain tests or monitoring procedures be performed and the doctor fails to comply. (PSRO) programs will force further conformity, leave less to the discretion of the physician and place the government in an ever more regulatory role. Professional societies should take cognizance of the impropriety and danger of the government dictating diagnosis and treatment and should launch a vigorous program to scrutinize pending regulatory legislation and to make official and informed representations to appropriate legislators.     

The clinico-hematological indices of the participants in the cleanup of the aftermath of the Chernobyl accident

Clinicohematological investigations and cytogenetic analysis of blood lymphocytes were made 5-7 years after the Chernobyl accident in 201 liquidators who had worked in the radionuclide-contaminated zone. Among the somatic diseases found in the examinees statistically more prevalent were cardiovascular and gastrointestinal affections, asthenic syndrome, thyroid disorders. Hemograms presented a rise in hemoglobin, red cell and eosinophil content, a drop in the number of neutrophils. A tendency to erythrocytosis was observed in 20.3% of the wreckers. Dicenters and rings were abundant in the lymphocytes of 69% of the cytogenetically examined examinees 5-7 years after the exposure to radiation.     

Forty years study of systemic scleroderma (data of Institute of Rheumatology, Russian Academy of Medical Sciences)

The basic stages and the results of 40-year studies of systemic scleroderma (SSD) at the Institute of Rheumatology, Russia Academy of Medical Sciences, are given. The goal-oriented studies of the systemic, peripheral, and visceral manifestations of the disease, which were undertaken in the 1960s basically altered our insight into the disease. Subsequently the diagnostic signs of the disease were developed, which substantially improved the diagnosis of SSD. Long-term studies examined the evolution of SSD and identified three major types of its course: acute, subacute, and chronic, which differ in the rapidity of progression of a pathological process, the pattern of clinical and morphological manifestations and prognosis, as evidenced by survival rates. The identified types of the course (n = 3) and clinical forms (n = 5) formed the basis for the Russia classification of SSD. Studying the pathogenesis of the disease mainly in the context of the mechanisms of formation of fibrosis and impaired microcirculation, as well as its clinical heterogeneity served as the basis for developing pathogenetic therapy regimens by differentially using disease-modifying agents and other therapeutical complexes. At present, the Institute of Rheumatology has accumulated unique experience in studying and following over 1500 patients with SSD and related diseases. There is a rise in the sclerodermal group of diseases, cross-over and combined forms of SSD along with great progress in the diagnosis and treatment, which enhances the quality of life of patients with SSD and prognosis in them.     

Mental processes in schizophrenia (based on data from neuropsychological studies)

Features were studied of brain organization of mental processes in schizophrenic patients during the period of aggravation of the condition, using methods common in neuropsychological diagnosis. Faulty mental functions are analyzed in connection with clinical manifestations. Groups have been identified of patients having particular neuropsychological and clinical characteristics.     

The inference of accident liability from the accident record.

Under the assumption of unchanged liability after the occurrence of an accident, the distributions of accident liability in groups can be broken up into probable component distributions of liability for subgroups with different accident records. It is shown that the component distributions have the same form as the total distribution if the latter is of Type III. Accident records have some validity as indicators of accident liability, but relative certainty that particular persons have high accident liability can be achieved only for that small number of cases whose accident records include a large number of accidents. Quantitative examples are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prognosis in breast cancer based on histopathological findings (based on data from 42 pathology departments)

A model program for breast cancer screening has been initiated in Hungary. This paper evaluates the distribution of tumours on the basis of histopathological parameters in order to describe the baseline situation before the nation-wide introduction of screening. All pathology departments were asked to contribute to the study by sending in the complete anonymous reports of the last 10 breast cancer cases reported in 1997. Reports of different completeness on 419 tumours from 42 institutions (53% participation rate) were analysed. The mean age of the patients was 61.2 years (range 28-89). The mean tumour diameter was 2.64 cm (range 0.3-13). The prognostic profile (histological type, grade, lymph node involvement) of the tumours was generally poor. The information content of the reports is variable. Reports evaluable for the given factor involved prognostic information in the following proportions: tumour size: 87%; histological type: 100%; grade: 59%; skin involvement: 52%; pTNM categories; 40%; oestrogen and progesterone receptors: 37 and 29%, respectively; margins: 53%; (lymph)vascular invasion: 39%; peritumoral lymphocytic reaction: 36%; necrosis; 31%. Investigation of other prognostic markers was rare. Smaller city hospitals tended to document less prognostic factors and mostly from the less costly ones. Short and long reports showed no differences between their information content. Typewritten reports are still very common in Hungary, while computer based reporting systems requiring the filling out of prognostic markers fields are rare. The prognostic information content of these latter is generally higher. The estimated poor prognostic profile demonstrated by this report also urges the introduction of a nation-wide screening program, which should improve the observed parameters. Some degree of standardisation in pathology reporting seems also justified.     

对军队院校非现役文职教员岗前培训的思考

随着我军文职人员制度的全面实施,越来越多的社会优秀人才被聘用到军队院校的教学科研岗位担当非现役文职教员。针对非现役文职教员的特点开展好岗前培训工作是军队院校师资队伍建设工作中的重要环节。目前,军队院校开展的一系列教员岗前培训工作,取得了一些经验和成效,但也存在一些不足。针对这些不足,深入分析其产生的原因,探讨相应的解决措施。     

The main locations of post-stroke cysts in the cerebral hemispheres and the clinical characteristics of the motor deficit (based on computed tomographic data)

Overall eighty-eight patients with hemispheric stroke were examined 3 months following the outset of the disease. Clinical findings and computerized tomography scans showed the cerebral hemispheric cysts to be in posterocapsulolenticular, anterocapsulocaudal, lenticular, thalamic, lobar, frontal, combined, multiple positions. Locations of hemispheric cysts were found out to be associated with polymorphous structure of motor deficit.     

Materials on the morphology departments of the Orenburg Medical Academy

An analysis of the relation among the quantity of focuses of Aedes aegypti, the rains and the temperatures in rainy and dry periods from 1982 to 1992 in 10 de Octubre municipe, at City of Havana, was carried out. No correlation was found between the number of focuses and the rains occurred in both seasons, and it was just the same between the number of focuses and temperatures. Thus, emphasis is made in the need for a strong surveillance along all year.