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The article deals with the history of the complex of buildings of the Mandryka Central Military Clinical Hospital located in Moscow's Serebryany and ArivoniKilsply lanes. Famous historical figures, physicians and writers whose names are associated with the buildings of the hospital are listed. In 2014, the Moscow government commission decided to recognize the architectural monuments of the building of the surgical hospital and the income house of MD S.M.Rudnev and the inrnmp hnus of A. R.Lednitskv. currently Dart of the architectural ensemble of the hospital.

The article presents historical data about paediatric health care delivery and escort of children of the Command of the Red Army during their evacuation from Moscow in 1941. Data on foundation of kindergartens of People's commissariat in 1942-1943, their support and foundation of children's department in the hospital is given. Special subdivision governed by the head of child care institutions of the hospital was formed for managing child care institutions.

The article reports results of clinical studies aimed to elucidate the influence of medicines on the size and density of atherosclerotic plaques in the walls of coronary and cerebral arteries. The phenomenon of regression of atherosclerotic lesions in the survivors of Leningrad siege during a long period of starvation is analyzed. The influence of inhibitors of angiotensin-converting enzyme on apoptosis of smooth muscle and foam cells of atherosclerotic plaques in the sanological mechanisms of atherosclerosis is discussed. The concept of natural regression of atherosclerosis is formulated and the necessity of development of the methods for is pharmacological activation are formulated.

A review of documents on the peculiarities of obstetric and gynecological care in besieged Leningrad is presented with special reference to the data about the number of children born during blockade and their health status in the first months of life, the work of maternity hospitals, their number and personnel. The term «military time amenorrhea» coined during blockade is discussed.

The peculiarities of a clinical course, results of pharmacological and interventional treatment in 447 patients with noncoronary cardiac arrhythmias were analyzed. A definition highly curable cardiac arrhythmia is introduced. The high efficiency and safety of the method of radiofrequency ablation in patients with highly curable cardiac arrhythmias that allows soldiers to leave the military service, as well as to enter military service under the contract. Proposed implementation of the control medical examination to conduct endocardial electrophysiological study and the subsequent medical examination to determine the category of fitness for military service not earlier than 6 months after surgery.

The article presents information on the history of the Naval Medical Academy (NMA), the preconditions of its creation, the composition of the faculty of Naval Department of the 1st Leningrad Medical Institute, of the 3rd Leningrad medical Institute andfirst teachers of NMA.

The article is devoted to activity of the Central Military Hospital of the People's Commissariat for Defence during the Great Patriotic War. The research is based on declassified orders of PCD and orders of the chef of hospital. Authors presented the role of the hospital in organization of medical aid for officers of PCD, members of their families, Red Army soldiers, junior and senior Red Army commanders; the role of the hospital in organization of medical facilities for combat army; medical supply for evacuation of family members of PCD's officers ( en route and in evacuation places); delivery of child health care to children of officers of PCD in the hospital and education in kindergartens of PCD.

The article presents the documentary information about the founding, the establishment and early years of the 1st Therapeutic Red Cross Hospital - in the future - Mandryka Central Military Clinical Hospital of the Ministry of Defence of the Russian Federation. Presented the work of the Hospital during the dificult period of the Civil War, typhus epidemic, famine and devastation. Specified its staffing structure, command, medical and administrative staff, travel and accommodation till the moment of the deployment in the Silver Lane in Moscow.

A case of congenital cardiac disorder with multiple defects in the secondary interventricular septum and atrial septum aneurysm in a young serviceman is reported. Plastic surgery of the atrial septum with a good clinical outcome included closure of the defect with a flap harvested from the autopericardium under conditions of artificial blood circulation and warm blood cardioplegia.

Arterial hypertension (AH) is a major challenge facing modern medicine. High frequency of AH patients with excess body mass and disturbances ofcarbohydrate metabolism is attributable to their common pathophysiological mechanisms underlain by insulin resistance and resulting compensatory hyperinsulinemia. The authors review modern concepts of AH development in patients with insulin resistance associated with enhanced blood insulin level and increased production of catecholamines playing an important role in AH pathogenesis mediated through sympathetic stimulation of heart, vessels while kidneys. Insulin resistance contributes to AH largely by activating sympathoadrenal system while increased glomerular filtration of glucose is accompanied by its back absorption together with sodium in proximal tubules. It results in hypervolemia and enhanced content of sodium and calcium in vascular walls which leads to their spasm and a rise in the total peripheral vascular tension (TP VT). Insulin promotes fibroblast proliferation and vascular smooth muscle cells via stimulation of tissue growth factors and collagen synthesis in atherosclerotic plaques. The concomitant narrowing of the vessels further increases TPVT. It in turn decreases renal blood flow and thereby activates renin-angiotensin-aldosterone system and development of AH.

The treatment of patients with neuroendocrine tumours and hormonally active distant metastases traditionally included surgical removal of the primary neoplasm, embolization of metastases in the liver, therapy with somatostatin analogs and interferon-alpha to prevent excessive production of regulatory peptides (carcinoid and other endocrine syndromes). Patients with neuroendocrine pancreatic tumours were also treated with alkylating chemotherapeutic drugs including streptosocin and temozolomide. The results of such treatment are far from being satisfactory. Recent progress in the treatment of such patients is due to radiotherapy using somatostatin analogs. Moreover, large-scale randomized studies demonstrated the effectiveness of targeted preparations acting on receptors of vascular growth factors and ripamycin target inhibitors ofmammals. Results of the studies on comparative effectiveness of targeted drugs for combined therapy of neuroendocrine tumours are presented.

140 patients with paroxysmal supraventricular reciprocating tachycardia were treated with the help of radio frequency ablation; results of treatment were analyzed. First group consisted of 76 patients with atrioventricular nodal reentrant tachycardia, second group--64 patients with atrioventricular reentrant tachycardia accompanied with WPW syndrome and preexcitation syndrome. In first group the operation ended up with success in 94.7%, in the second group--90.6%, after the second operation--100% and 96.1% relatively. Different complications in patients from the first group occured in 3.9%, in the second group--in 6.3%. Taking into account high effectivennes and safety of radio frequency ablation, it is recommended to reconsider principals of categorisation of fitness for service among conscripts and servicemen doing call-up and under the contract military service and also citizens, entering military educational institutions.

Aim: To study peculiar features of daily AP rhythm and profile in men with cardiovascular risk factors residing in the Far North., Materials and Methods: The study included 115 servicemen divided into 3 groups (hypertensive disease (HD), hypertonic type neurocirculatory asthenia (NCA) and risk factor of cardiovascular diseases other than AH). HD was diagnosed based on multiple AP measurements and 24-hr monitoring., Results: HD was associated with elevated mean AP, load indices and AP variability All patients had pathological type of morning dynamics. Normal daily rhythm of systolic AP (SAP) was documented in 66.1% of the patients with HD and in 68% with cardiovascular risk factors without AH. Normal daily rhythm ofdiastolic AP (DAP) was recorded in 63.5% of the patients with HD and in 72% with cardiovascular risk factors without AH. In group 2, normal daily rhythms of SAP and DAP were found in 44 and 56% of the cases respectively., Conclusion: Men residing in the Far North under conditions of anomalous photoperiod need medicamentous correction of AP regardless of AH type. Ambulatory BP monitoring should be preferred for the assessment of the efficacy of antihypertensive therapy.

Atherosclerosis and coronary heart disease are the main causes of disablement and mortality in most developed countries. Clinical studies showed the relationship between coronary calcinosis and atherosclerotic lesions, the calcinosis area accounting for roughly 1/5 of the atherosclerotic plaque area. Calcinosis is quantitatively characterized by the calcium score determined by multispiral and electron-beam computed tomography. High calcium score suggests an increased risk of cardiovascular complications. Their treatment awaits further assessment since a number of studies revealed differential effect of various medicines on coronary calcification.

We analysed the results of the treatment of 4205 patients with different forms of vertebrogenic radiculopathy. They suggest the efficacy of differential application of graduated medicamental therapy, reflexo- and physiotherapy depending on the period of clinical course of the disease.

Morphological criteria for malignant pheochromocytoma remain to be developed According to the WHO recommendations, the sole absolute criteria is the presence of metastases in the organs normally containing no chromaffin tissue. Such signs as cellular and nuclear polymorphism, mytotic activity, vascular invasion, capsular ingrowth are not sufficient to describe a pheochromocytoma as malignant. It is equally dfficult to differentiate between malignant and benign tumours based on histological data since histologically mature neoplasms can produce metastases. Based on the results of original studies, the authors believe that such histological features as vascular and capsular invasion do not necessarily suggest unfavourable prognosis. Therefore, the conclusion of malignancy based on such features can not be regarded as absolute. Probably such neoplasms should be called "pheochromocytomas with morphological signs of malignant growths". They should be referred to the tumours with uncertain malignancy potential based on the known discrepancy between morphological structure and biological activity of neoplasms. Comparative studies of clinical and morphological features of pheochromocytomas showed that their histological type (alveolar; solid, dyscomplexed, trabecular) and morphological signs of malignant growth influence both the clinical picture and arterial hypertension. There are no significant relationship between the above morphological signs, timour mass and clinical manifestations of pheochromocytomas.

Part 1 of this review is devoted to the history of development of temporary and continuous electric stimulation (ES) of the heart. Up-to-date concepts of bradyarrhythmia are considered along with the most important techniques for its management with the use of two-chamber and frequency-adaptive systems. Algorithms for the choice of optimal ES regimes taking account of the type of bradyarrhythmia are discussed. Current concepts of physiological ES of the heart are considered. The authors describe their own experience with the application of ES of the heart.

A rise in the incidence of latent and late forms of neuro- and visceral syphilis significantly complicates diagnostics of the disease in patients admitted to emergency medicine clinics. Syphilis is believed to be a cause of roughly 0.5% of all cardiopathies. Late syphilitic lesions of the cardiovascular system (cardiovascular syphilis) occur in 0.25-0.96% patients in need of therapeutic treatment, 93.4% of them present with mesaortitis but its life-time diagnosis is possible only in 10% of the cases. Syphilitic lesions in the aorta are especially well apparent at the points of its branching into coronary arteries of the heart and aortic arch. One of the main consequences of syphilitic aortitis is the narrowing of coronary arteries frequently complicated by atherosclerosis, coronary thrombosis, and the resulting myocardial infarction. Another severe complication of syphilitic aortitis is progressive aortic valve insufficiency (in 25-50% of the patients) related to dilatation of the valve ring affected by inflammation. Some patients develop bacterial endocarditis of the aortic valve. Close localization of the coronary artery junction and the aortic valve account for a combination of aortic valve insufficiency and coronary insufficiency in patients with syphilitic process in the initial part of aorta. A case report is presented.

At the beginning of December 2011 turns the 90th anniversary of a prominent national physician Alexander Nikolayevich Senenko. He was an educatee of the two academies--Military Medical Kirov (graduated with honors in March 1944) and the Naval Medical (VMMA), where he studied at post-graduate at the Department of Faculty Therapy (1950-1953). The results of the scientific work of the department summarized in the monograph of Gogin E.E., Senenko A.N., Tyurin E.I., "Arterial Hypertension" (1978, 1983). Monograph of Senenko A.N. "Heart and focal infection" (1973) has not lost its scientific and practical importance to this day. Shortly before the death (June 1, 1991), Alexander Nikolaevich completed the major work on the role of focal infection in the pathology of internal organs. In all he published over 250 scientific papers, including one textbook, four monographs and several major textbooks.

To improve differential diagnostics and treatment of coronary heart diseases (CHD) and concomitant climacteric cardiopathy (CCP), we analysed results of clinical examination and laboratory-instrumental studies of 1063 women complaining of chest pain. They were divided in 3 groups: group 1 (817 patients with CHD), group 2 (134 patients with CCP), group 3 (122 patients with CHD+CCP). Peculiarities of laboratory and instrumental diagnostics are described in conjunction with comparative characteristic of multispiral CT coronarography and corononaroangiography.

The authors attribute survival of certain residents of blockaded Leningrad under conditions ofcomplete starvation to activation of natural sanologic mechanisms of the body. Physiological psychoemotional stress is supposed to contribute to the formation of prerequisites for survival during subsequent starvation. Also, the survival is believed to be related to selected activation of apoptosis of renewable cells and utilization of their constituents in endogenous nutrition. The role of priority energetic and trophic support of brain and kidneys and the contribution of the psychosomatic factor are postulated. The mechanisms of rehabilitation after upset of vital activity involve partial reversibility of atrophic and metabolic processes and neural regulation of organs and their systems. The importance of the study of activation of natural sanologic mechanisms in extreme conditions is discussed

A total of 4141 patients complaining of chest pain were divided into 7 groups. They were examined for the analysis of heart pain, cardiac rhythm disturbances, and chronic heart failure. Peculiarities of stable angina of effort in aged and elderly patients are described

The aim of the study was to compare the influence of hypothiazide and indapamide on platelet aggregation in patients with arterial hypertension (AH) and abdominal obesity (AO). 28 and 31 patients were given hypothiazide and indapamide respectively for 16 weeks. The following parameters were estimated: blood lipid spectrum lipid peroxidation in plasma and platelets, platelet aggregation. The data obtained were treated using Student's t-test. Hypothiazide was shown to have beneficial effect on peroxidation syndrome and optimize platelet aggregation. These effects were further promoted by long-term indapamide therapy. Hypothiazide had no effect on the above parameters. It is concluded that a combination of indapamide with non-medicamental factors is needed to reduce body weight in patients with AH and AO.

Clinico-instrumental characteristics of arterial hypertension, liable to the ishemic stroke were studied. The pecularities of clinical, neurological picture of disease and results of instrumental methods of examination were determined. These peculiarities let to educe the course of arterial hypertension, liable to the ishemic stroke. This course appeared because of hypertensional macroangiopathy during 3-5 years, two atherosclerotic stenosis of brachiocephalic arteria, occlusions and stenosis of these arterias, left ventricular hypertrophy of hypodynamic type, circulatory dynamics against the bad daily profile of arterial pressure and/or increased variability of arterial pressure accompanied with ischemic attacks, signs of chronicle heart failure and circulatory encephalopathy. The scheme of the examination of patients with AH during the long-term examination with the goal of prophylaxis IS was offered.

A retrospective analysis of 12 658 records of patients with pain syndrome in the chest was studied. Part of the patients was held multispiral computed tomography of the heart and coronary angiography. Used omeprazole test for differential diagnosis of coronary heart disease and gastroesophageal reflux disease, evaluated the criterion of cost-effectiveness.

The study included 1418 patients with FC I-IV stable angina of effort (42.4% men and 57.6% women, mean age 74.6 +/- 1.2 years). The possibility to supplement standard therapy with myocardial cytoprotectors (trimetasidin, mexidol, qudesan) was estimated in 4 groups of patients from the severity of pain syndrome, chronic cardiac insufficiency, and heart rhythm disturbances.

The study was designed to evaluate effect of trandolapril, an ACE inhibitor, on platelet aggregation in patients with arterial hypertension and impaired glucose tolerance. The drug was given to 38 patients for 12 weeks. The key end points were dynamics of the blood lipid spectrum, lipid peroxidation in plasma and platelets, antioxidative protection of the blood's liquid medium and platelets, platelet aggregation. The data obtained were treated using Student's t-test. They show that trandolapril exerts positive effect on peroxidation syndrome and reduces platelet aggregation.

The aim of the study was to elucidate normalizing effect of candesartan on disturbed thrombocytic hemostasis in patients with arterial hypertension and metabolic syndrome. The drug was given for 16 weeks to 31 patients in whom dynamics of lipid peroxidation in plasma and platelets, the antioxidative potential of candesartan, and parameters of thrombocytic hemostasis were assessed. Treatment with candesartan improved lipid peroxidation and primary hemostasis. It is expected that continuation of therapy following this scheme can stabilize the obtained effect.

During the sleep person is in the state of antiorthostasis, this state provokes vascular cerebral abnormalities (night cerebral hypervolemia). The nature of encephalon blood supply is changing in this horizontal state, in the result there is lowering of hydrostatic blood pressure, rise of the encephalon blood supply and more difficult venous outflow. 60 patients with essential hypertension (1-2 phases) at the age of 64.2 +/- 1.8 years which were in the state of slightly raised upper segment of the head and body during night sleep were examined. By the method of the cerebral venous hemocirculation defined. Conclusion. Cerebral arterial blood flow of examined patients has increased by 25-30% during the sleep, the changes of arterial and cerebral venous hemocirculation have attended hypervolemia. Being in the state of upper (by 10-15 degrees) head of the bed decreases blood redistribution and decreases the extension of cerebral blood circulation's acute abnormalities.

Arterial hypertension (AH) remains a topical problem in modern cardiology. It increases the risk of angina, myocardial infarction, stroke, neurologic and psychic disorders. Causes, symptoms, criteria and method for the correction of AH in patients with metabolic syndrome are extensively investigated. However, disturbances of hemostasis and approaches to their efficacious correction in such patients remains unexplored.

Hypertension is the main disease in Russian Federation--its frequency is 39.2% in men and 41.1% in women. In recent years course of a disease is accompanied by the metabolic derangements which form the metabolic syndrome. In the basis of pathogenesis of hypertension are insulinresistance and compensatory hyperinsulinemia in combination with associated metabolic derangements. Inveterate insulinresistance leads to hypertension.

A group of 830 patients with spondylogenic visceropathies was divided into three with clinical symptoms of bronchial (n = 80), cardiac (n = 530), and abdominal (n = 220) vertebral syndromes. Their clinical features, differential diagnosis and methods of treatment are described.

The aim of the study was to assess effects of irbesartan on disturbed platelet hemostasis in patients with arterial hypertension and metabolic syndrome. 38 patients received this drug for 16 weeks. Dynamics of lipid peroxidation in plasma and platelets, antioxidative protection of liquid blood fraction and platelets were estimated. The data were treated by the Student's t-test. Therapy with irbesartan for 4 months improved lipid peroxidation and primary hemostasis. Its continuation following the same regimen is expected to strengthen the obtained effect.

It was the purpose of this search to announce that elaborating an optimal tactics for patients with coronary heart disease (CHD), complicated with ischemic mitral regurgitation (IMR). There were operated 85 patients with CHD and IMR in the course of 2006-2008. Previously all patients were separated on 3 groups in dependence of severity of IMR, character of damage of coronary race and changing of left ventricle. In the first and the second groups was realized an aorta-coronary shunting with annuloplasty. In the third group was realized an isolated shunting. Mortality in hospital was zero percents. A rudimentary regurgitation was noted by 10% of patients of the 1st group. The maximum period of monitoring was 24 months. Freedom from mitral regurgitation for the 1st and 2nd group was 95%, for the 3rd--93%. So, adequate and mutual estimation of flap-connected factors as well as condition of coronary race by the patients with IMR reduces the risk of by-pass mitral regurgitation and shows good short-term and long-term results.

Under the term amyloidosis is meant a group of diseases with a variety of clinical symptoms characterized by extracellular deposition of insoluble pathologic fibrillar proteins in tissues and organs. A report is presented of a 93-year-old patient admitted to a multifield hospital for the treatment of cerebral vascular disorders and peripheral nervous disturbances; the patient developed signs of myocardial infarction recognized in clinical/instrumental studies and died. Primary amyloidosis with diffuse vascular lesions in internal organs was diagnosed at autopsy. The death was caused by marked dystrophic changes in myocardium, liver and kidneys, hepatic and renal insufficiency.

Aims of the study were to determine main pathophysiologic mechanisms of decreased exercise tolerance in patients with metabolic syndrome (MS); to prove the state of hypoxemia by ergospirometry in patients with MS; to reveal with the help of echocardiography lowering of functional activity of the myocardium in MS; to confirm by electron microscopic techniques the presence of perivascular and interstitial fibrosis and fatty infiltration of the myocardium in patients with MS. In the study we have observed 39 patients with MS and 12 healthy individuals. We have noted the decrease of peak oxygen consumption and carbon dioxide excretion during the ergospirometry at anaerobic threshold in patients with MS. Echocardiographic examination has proven the reduction of left ventricular ejection fraction and cardiac contractile performance. The electron microscopic techniques have shown diffuse-focal interstitial fibrosis, hypertrophy of myocardial cells and fatty infiltration of the myocardium.

Gastrointestinal stromal tumours (GIST) first described in 1983 are the commonest mesenchymal neoplsams of the digestive tract. The main pathogenetic mechanism is hypersecretion of tyrosin kinase receptor c-kit (CD-117) by GIST cells and its hyperactivation. A rare clinical case of GIST measuring 1.2 CM with concomitant stomach cancer (poorly differentiated carcinoma) is reported. The tumours were discovered intraoperatively. To our knowledge, data on such cases are practically lacking in the literature.

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.