[Efficacy of bioregulative drugs in the treatment of otitis media with effusion associated with rhinosinusitis and adenoiditis]

PURPOSE

Improving of otitis media with effusion (OME) with rhinosinusitis (RS) and adenoiditis treatment effectiveness.

MATERIALS AND METHODS

The study included 112 patients 12-18 y.o. with otitis media with effusion, who were divided into 2 groups depending on the treatment scheme. The Group I (the main group) patients treatment included Traumeel S and Euphorbium compositum Nasentropfen S in addition to the standard treatment, and the Group II (comparison), children were prescribed standard therapy. Patients of both groups were divided into 3 subgroups depending on the upper respiratory tract inflammation symptoms: A - patients with adenoiditis; B - with rhinosinusitis and C - combination of adenoiditis and rhinosinusitis. The comparison group (groups IIB and IIC) treatment scheme (children with rhinosinusitis) included topical corticosteroids and the main group patients didn't receive corticosteroids. All patients went through complaints and anamnesis collection, routine otorhinolaryngological and instrumental examination before and after treatment.

RESULTS

Analysis of treatment results demonstrated high efficacy of multicomponent drugs with low doses of active ingredients in the therapy of patients with OME, regardless of comorbid pathology. Significantly better results were obtained in the patients treated with bioregulatory drugs when comparing the outcomes of OME therapy in combination with adenoiditis (groups IA and IIA). Comparable efficacy results were obtained in the treatment group of patients with OME associated with RS (in groups IB and IIB as well as in groups IC and IIC), where GCS was received in the comparison group. The high efficacy and safety of bioregulatory drugs makes the use of these agents a promising treatment for patients with OME, RS and adenoiditis.

[Triggers and predictors of development and formation of sensorineural hearing loss]

The purpose of the study is to review the results of scientific researches in recent years in an expanded interdisciplinary view of the problem of etiopathogenesis of sensorineural hearing loss, as well as the role of comorbidities and triggers in the formation of persistent changes in the audio-receiving part of the auditory analyzer.

[Effects of middle-ear surgical interventions of different types on peripheral audio reproduction part of the acoustic analyzer in patients with otitis media purulenta chronica]

Different operations on the middle ear were performed in 86 patients with otitis media purulenta chronica (OMPC). Mean bone hearing thresholds in the high-pitched area (10,000-16,000 Hz) were determined and suprathreshold tests were made in 86 patients on day 10 and 6 months after surgery. Minimal changes seen only in early postoperative period occurred in canal wall up operations with tympanoplasty of type I-II. Canal wall down type of surgery had a negative effect on the function of the cochlear receptor system in the early postoperative period. All "open" types of ear surgery, even with tympanoplasty, provoked hearing deterioration with maximum elevation of the hearing thresholds in the high-pitched area (10,000-16,000 Hz). Middle ear surgery without forming a new tympanic cavity results in progressive deterioration of the peripheral part of the hearing receptor system.

[A follow-up of patients with anterior optic tract glioma concurrent with type 1 neurofibromatosis]

Fifty-nine patients with anterior optic tract (AOT) lesion concurrent with type neurofibromatosis (NF-1) were followed up for 1 to 36 years (median 5 years). Based on the study, the authors identified several grades of the disease: - stabilization without intervention; - stabilization after treatment; - insignificant negative changes as a slight tumor growth and a further stabilization of the process; - occasionally negative changes irrespective of treatment. The behavior of a tumor is unpredictable. The onset of progression in infancy is a poor predictor. Ophthalmological symptoms are not the criterion that can be used to make a prognosis. The prognosis is largely determined by neurovisualization techniques and primarily magnetic resonance imaging. A uniform slight thickening of AOT structures irrespective of the extent of the process along the AOT should be referred to as a good prognosis. There was no spontaneous tumor regression in any case. By taking into account the beneficial effect of radiotherapy, the authors consider it expedient to use it as monotherapy and in combination with surgery. Bypass surgery on the spinal fluid system frequently fails to entirely solve the problem intracranial hypertension.

[Specific features of manifestation of anterior optic tract gliomas in patients with type 1 neurofibromatosis: ophthalmological and neurovisualizational aspects]

Gliomas of the anterior optic tract (AOT) (optic nerves, chiasms, and visual tracts) are benign slowly growing tumors usually detectable in childhood. These are a rather heterogenic group of tumors. The pattern and course of the disease are frequently affected by the presence of type 1 neurofibromatosis (NF-1) in the patient. The ophthalmological symptoms of AOT lesion in the presence of NF-1 were analyzed in 80 patients aged 1 to 24 years (median 5 years). According to the ophthalmological symptoms and the pattern and extent of lesions to AOT structures, the authors identified 4 groups by the data of neurovisualization techniques (magnetic resonance imaging, computed tomography) and revealed that the ophthalmological pattern reflected the site and degree of lesion to AOT structures. At the same time it is shown that there is a group of silent tumors attending without visual disorders. These tumors have the similar neurovisualization pattern, such as a moderate thickening of AOT structures and they occur in 13.8% of cases, as shown by the authors.

[YAG-Nd laser shunting of the tympanic cavity in patients with exudative otitis media]

A novel method of surgical treatment of exudative otitis media with YAG-Nd laser for shunting of the tympanic cavity has been introduced in therapy of 75 patients. Long-term outcomes of the above treatment characterize it as effective and safe in exudative otitis media.

[Delayed radiation-induced optic neuropathy in patients with tumors in the chiasmal-sellar area after radiation therapy]

Six clinical observations of a rare condition, delayed radiation-induced optic neuropathy (RON) are presented. RON developed in patients with brain tumors treated by radiotherapy and radiosurgery; in the majority of patients the condition developed during exposure to therapeutic doses; its incidence was 0.5% of the total number of patients treated by radiotherapy during this period. Asymmetrical chiasmal syndrome developed rapidly in all the patients. Clinical diagnosis of RON was confirmed by magnetic resonance tomography in all cases, and in one case by morphological analysis. Conservative therapy including hyperbaric oxygenation just stabilized the visual function. Remote period of observation was 42 months.

[Tumor necrosis factor as indicator of endogenic intoxication severity in acute neurosensory hypoacusis]

Pathogenesis of acute neurosensory hypoacusis is considered in terms of endogenic intoxication syndrome as impaired microcirculation and development of hypoxia in the periphery of the acoustic analyser are likely consequences of this syndrome. Measurement of tumor necrosis factor alpha level in the supernatant of cultivated mononuclears from patients with acute neurosensory hypoacusis indicated more active production of this mediator compared to donors. This fact justifies further investigations of this disease pathogenesis in respect to disorders in regulation of nonspecific adaptive-compensatory mechanisms.

[Single-photon emission-computed tomography of the brain in craniopharyngiomas in the late postoperative period]

The paper analyzes tomographic scanning images of 32 patients with craniopharyngiomas in the late postoperative period. Computed tomographic data allowed the patients to be divided into 3 groups: 1) 10 patients without signs of tumor recurrence or hydrocephalus; 2) 14 patients with recurrent cystic craniopharyngiomas; 3) 8 patients with severe hydrocephalus. Single photon emission computed tomography (SPECT) of the brain indicated regional disturbances of brain tissue blood supply in the frontobasal or frontobasotemporal regions of the right hemisphere (the area of an surgical access and of the removed tumor) and revealed them in the distal areas (frontobasotemporal regions of the left hemisphere, parietal and occipital cortices of the cerebral hemisphere or cerebellar tissue). The compensatory reserves of cerebral circulation were assessed by the foci of relative physiological hyperemia of brain tissue (the cerebellum and the medial portions of the occipital regions of the brain). The findings provide evidence for that the vascular factor is involved in the late postoperative pathological picture in patients with craniopharyngiomas.

[Use of YAG-ND laser in the treatment of not healing trepanation cavities after cleansing surgery of the middle ear]

Not healing trepanation cavities after middle ear surgery were exposed to YAG-Nd laser radiation (1.06 and 1.32 mk). Persistent epidermization and discontinuation of the discharge were achieved in 72% of the patients with postoperative otorrhea. Optimal regimens of laser radiation (wave length, exposition, power) are detailed for various forms of the pathological process.

[Ophthalmological symptoms of visual tract lesions in craniocerebral injuries]

Craniocerebral injuries are known to involve the visual tract in 2-5% of cases. Fifty-nine patients aged 5 to 68 with visual tract involvement in craniocerebral injury were examined in N. N. Burdenko Institute of Neurosurgery of the Russian Academy of Medical Sciences. Unilateral optic nerve involvement was found in 48 patients, involvement of the chiasm and/or both optic nerves in 11. Involvement of a single optic nerve was associated with vision acuity reduction, 30 patients becoming blind or virtually blind, and with various defects of the visual field. Traumatic injury to the chiasm manifested as a rule by the asymmetric chiasmal syndrome. Follow-up of the patients in the acute period of craniocerebral injury showed that paling of the optic disc manifested in various periods after the moment of the injury, from 3-4 days to 1 month, this depending on the localization of the injury and its distance from the posterior pole of the eye. Besides visual disturbances and ophthalmoscopic changes, oculomotor disorders were found which were caused by traumatic impairment of the oculomotor nerves (in the orbit or skull) and muscles. Transcutaneous electrostimulation of the injured optic nerves was sufficiently effective, its efficacy directly depending on the period elapsed since the injury, excepting blind or virtually blind patients.

[Epizootiological importance of Frontopsylla hetera (Siphonaptera) fleas in the Gorno-Altai natural plague focus]

Experiments conducted during all seasons have established that F. hetera, one of the mass species of fleas in Mountain Altai, can be infected both by the strain of selective virulence typical to this nidus and by the non-typical non-virulent mountain-altai strain of plague agent. The non-virulent strain does not form in fleas the block of proventriculus and within 1.5-2 months they become free from the microbe. At the infection with the typical strain of the altai subspecies rare transmissions of the agent to Pallas' pika can take place as well as its long preservation in fleas.

[Flea Ceratophyllus fasciatus as the vector of the Altai-mountain strain of plague microbe]

The work was conducted with a typical strain of the plague agent, which is virulent to white mice and little virulent to guinea pigs (subcutaneous infection), and with C. fasciatus. The fleas of this species can be infected, form the block of proventriculus within 4 to 35 days, transmit the agent during bloodsucking to healthy animals and cause the death both white mice and guinea pigs.