[Modern methods in diagnostics of lacrimal system vertical part obliteration]. / Sovremennye metody diagnostiki obliteratsii slezootvodyashchikh putei.

A review of the literature is devoted to the description of modern diagnostic methods that are directed at detecting lacrimal pathway obstruction. The presented analysis is based on the study of data from Russian and foreign literary sources on both routine and high-tech lacrimal system examination methods, as well as on authors' experience in studying the diagnostic efficiency of imaging methods such as lacrimal scintigraphy, computed tomography with lacrimal pathway contrasting, and also single photon emission computed tomography. The article gives information about the advantages and disadvantages of the presented methods, highlights the questions of the prospects of their usage in practical dacryology.

[Modern methods in treatment of lacrimal system vertical part obliteration]. / Sovremennye metody lecheniya obliteratsii vertikal'nogo otdela slezootvodyashchikh putei.

A review of the literature is devoted to the description of modern methods in treatment of lacrimal system vertical part obliteration. Particular attention is paid to various aspects of the most common surgical intervention - endonasal endoscopic dacryocystorhinostomy.

[Comparative morphological assessment of the damaging effects of cold plasma and radio wave energy on the mucous membrane of the lip in the experiment]. / Sravnitel'naya morfologicheskaya otsenka povrezhdayushchego vozdeistviya kholodnoplazmennoi i radiovolnovoi energii na slizistuyu obolochku guby v eksperimente.

The aim of this study was a comparative morphological assessment of changes in the mucous membrane of the lip in the field of radio wave and cold plasma exposure in the experiment. MATERIAL AND METHODS: Experimental animals removed a portion of the mucous membrane of the inner surface of the lip with a Surgitron radio knife (group 1) and an electrode of the Coblator II cold plasma apparatus (observation group 2). Tissue was taken from the edge of the surgical wound as a trapezoidal flap containing mucous and submucous membranes immediately after the incision and 3 weeks after the surgery. Histological sections were prepared, which were stained with hematoxylin and eosin, as well as according to van Gieson. RESULTS: It was found that, both in cases of using a radio knife and a coblator along the edges and in the depth of the wound, coagulation tissue necrosis was observed, which was more evident in group 1 of observations. In addition, after the radio wave exposure, in the areas close to the defect, the epithelial lining was disrupted to one degree or another, which was not observed when using the coblator. After 3 weeks of the experiment, the stratified squamous non-keratinizing epithelium in both groups had a normal histological structure. At the same time, when using the coblator, the lamina propria of the mucous membrane was completely restored, and in cases with the use of a radio knife, sclerotic processes with the formation of scar tissue took place in the lamina propria of the mucous membrane in some areas. CONCLUSIONS: The use of a coblator should be recognized as a more gentle method, since a comparative analysis of histological changes immediately after the incision showed a more intense damaging effect of the radio knife on the surrounding tissues, which in later stages was accompanied by incomplete regeneration (substitution) of the lip mucosa.

[The development of posttraumatic maxillary sinusitis due to transconjunctival penetration of a foreign body with a fracture of the lower wall of the orbit]. / Razvitie posttravmaticheskogo verkhnechelyustnogo sinusita vsledstvie transkon"yunktival'nogo proniknoveniya inorodnogo tela s perelomom nizhnei stenki orbity.

The article presents a clinical example of the course of posttraumatic acute purulent sinusitis with reactive soft tissue phenomena due to the previous injury of the orbit by a foreign body, the introduction of the latter into orbit and the maxillary sinus result in a fracture of the lower wall of the orbit. A feature of the injury is the penetration of a foreign body through the conjunctiva of the lower eyelid and lower conjunctival fornix, without damaging the skin. This case is professionally interesting for both young doctors and experienced specialists in otolaryngology, ophthalmology, maxillofacial surgery and neurosurgery. Experts, analyzing this clinical example, will be able to correctly diagnose, effectively eliminate the inflammatory process in the maxillary sinus.

[Experience with tafamidis in a patient with transthyretin amyloidosis].

Transthyretin amyloidosis (ATTR) is a threatening and severe genetic disease characterized by damages to organs and systems caused by a pathological protein transthyretin produced in the liver. Clinical manifestations of this disease vary from injuries of the nervous system to injuries of the cardiovascular system. Prognosis for ATTR-amyloidosis remains unfavorable. The absence of pathognomonic symptoms complicates diagnostics of this disease, which tends to simulate other conditions. At present, medicines exist, which are pathogenetic in the treatment of ATTR-amyloidosis. The article describes a clinical case of ATTR-amyloidosis with primary heart injury complicated with functional class III chronic heart failure during the tafamidis treatment.

[Comprehensive treatment of indolent trophic ulcers of venous aetiology]. / Kompleksnoe lechenie dlitel'no nezazhivaiushchikh troficheskikh iazv venoznoi étiologii.

AIM: The study was undertaken to evaluate efficacy of comprehensive treatment with the use of erbium laser radiation in patients suffering from venous trophic ulcers of lower limbs. PATIENTS AND METHODS: The study included a total of seventy-six 45-to-80-year-old patients. Of these, there were 43 (56.6%) women and 33 (43.4%) men. The duration of the disease averagely amounted to 10.8±4.8 years. In 38 patients, the bottom of the ulcerative defect was with pronounced periulcerative inflammation and various degree of purulent discharge. All patients were admitted to the surgical department and underwent meticulous examination. Erbium laser irradiation was carried out with consideration for the ulcer size. Laser irradiation was performed at a wavelength of 2940 nm, pulse duration - 0.3 ms, laser beam diameter - 7 mm with radiation power of 2.19 J/cm2. RESULTS: Efficacy of treatment was assessed in dynamics by the degree of pain syndrome, ulcer size upon completion of treatment, as well as the rate of trophic ulcer epithelialisation. In 15 (19.7%) patients with varicose disease the vertical and horizontal reflux was eliminated with performing phlebectomy and echosclerotherapy. The obtained findings demonstrated that 42 (91.3%) patients of the study group had decreased terms of the beginning of purification of the fundus of the ulcer. After 6 months of rehabilitation and follow up, complete ulcer healing was achieved in 18 (64.3%) patients of the control group and in 39 (86.7%) patients of the study group. CONCLUSION: The obtained findings showed that laser radiation proved to be an effective method of treatment in patients presenting with indolent trophic ulcers. Comprehensive treatment made it possible to effectively influence the microflora and the state of regional lymph drainage, to stimulate the processes of reparative regeneration.

[Experience of the interdisciplinary approach to diagnostics and treatment of patients with bisphosphonate osteonecrosis of the upper jaw]. / Opyt mezhdistsiplinarnogo podkhoda k diagnostike i lecheniiu patsientov s bisfosfonatnym osteonekrozom verkhnei cheliusti.

The article discusses the issues of diagnosis, the clinical course of osteonecrosis of the upper jaw in patients with oncological diseases. The assessment of radiological indicators of bone pathology of the upper jaw, signs of the development of the inflammatory process of the maxillary sinus and other sinuses of the nose. The experience of conservative tactics and surgical treatment of patients in this group is analyzed with the participation of specialists from otorhinolaryngologists and maxillofacial surgeons.

[The multidisciplinary approach to the diagnostics and surgical treatment of the lacrimal passages]. / Mul'tidistsiplinarnyi podkhod v diagnostike i khirurgii sleznykh putei.

The primary objective of the present study was to highlight the current state of research on the pathology of the lacrimal organs based on the results of the analysis of the relevant publications in the domestic and foreign scientific literature. Special attention in this review is given to the problems of diagnostics, indications for the probing, the treatment and stenting strategies. The authors report their original observations contributing to the better understanding of the anatomical features of the nasolacrimal passages. In addition, the data on the principal pathogenic agents are presented together with certain peculiarities of the surgical treatment of the pathology under consideration.

[Topographical and anatomical localization of the lacrimal passages in the nasal cavity]. / Topografoanatomicheskoe raspolozhenie slezootvodiashchikh putei v polosti nosa.

The objective of the present work was to study topographical and anatomical relationships between the lacrimal passages and the walls of the nasal cavity from the standpoint of the rhinosurgeon. The materials for the study were obtained by examining 15 corpses. It was found out that in 91% of the cases, the natural ostium of the maxillary sinus is localized within 11.6 cm from the lacrimal tubercle. In 62% of the cases, the nasolacrimal passage opens in the region of the vault of the inferior nasal passage as an orifice roughly 0.8 mm in size displaced approximately 9.4 mm posteriorly from the edge of the inferior turbinated bone. In 21% of the cases, the ostium of the nasolacrimal passage approximately 2 mm in diameter is situated at the lateral wall of the inferior nasal passage, roughly 6.5 mm above the bottom of the nasal cavity. In 10% of the cases, the nasolacrimal passage opens at the inner surface of the inferior turbinated bone proper at a distance of about 3.4 mm from the site of its attachment. It is concluded that topographical and anatomical localization of the lacrimal passages is of primary importance in terms of endonasal endoscopic interventions on the lateral wall of the nasal cavity including the puncture of the maxillary sinus associated with the potentially high risk of the damage to the nasolacrimal passage and in a lesser extent to the lacrimal sac.

[The surgical treatment of pyocele of the frontal sinus]. / Khirurgicheskoe lechenie piotsele lobnoi pazukhi.

The authors describe a clinical case of pyocele of the frontal sinus in the patient presenting with polypous pansinisitis and pronouncd hypertrophy of the frontal sinuses with special reference to the specific features of diagnostics and surgical strategy for the treatment of this condition.

[451st Military Hospital of the Ministry of Defence Russia celebrates the 90 years anniversary].

451st Military Hospital of the Ministry of Defence Russia celebrates the 90 years anniversaiy. The Military hospital in Dushanbe turns 90 years in September 2016. Some peculiarities of the work of the hospital are remoteness from the other Russian military hospitals and delivery of primary care, including incidental medical service, medical and specialized healthcare takes place in a hot climate and -under condition of :the prevalence of acute intestinal infections. For decades, the hospital distinguishes a high professionalism and cohesion of the team, the pursuit of the development and adherence to traditions.

[The influence of accessory ostia on the development and the course of the inflammatory processes in the maxillary sinuses].

The objective of the present study was to detect accessory ostia in the patients presenting with various diseases of the maxillary sinuses. We undertook the endoscopic examination of the middle meatuses in 250 patients. It was shown that accessory ostia can be especially frequently seen in the patients with chronic maxillary sinusitis and nasal septum deviation.

[The functional conditions of nasal cavity mucosa and paranasal sinuses following radical and minimally invasive surgical interventions].

The data of the literature are presented concerning the state of the mucous membrane of the nasal cavity, nasal turbinates, and maxillary sinus during the postoperative period following various surgical procedures.

[The state of the nasal mucosa and the paranasal sinuses in the late postoperative period following radical and minimally invasive surgery]. / Morfologicheskoe i funktsional'noe sostoyanie slizistoi obolochki polosti nosa i okolonosovykh pazukh posle khirurgicheskikh vmeshatel'stv.

We have investigated the functional state of the mucous membrane of the nasal cavity and maxillary sinus after radical and minimally invasive surgical procedures during the log-term postoperative period, i.e. three and more months after the intervention. The materials for the study were brushings and histological biopsies; in addition, the functional parameters of the mucous membranes of the nose and maxillary sinuses were estimated before and after surgery. It has been found that the type of the surgical intervention on the inferior turbinate bones for the treatment of chronic rhinitis, such as gentle turbinotomy, has no significant influence on the state of the mucous membrane. The study has demonstrated that 48% of the patients presenting with the chronic maxilloethmoidal mixed form of sinusitis experience epithelial metaplasia resulting in atrophic scarring of the mucosa whereas in the remaining 52% the ciliary epithelium becomes either damaged or detached and the ciliary beat frequency (CBF) decreases. In the exudative form of the disease, CBF and some other functional characteristics are improved but the stromal oedema persists and ciliated epithelium integrity gets compromised.

[The role of accessory ostia of the maxillary sinuses in pathogenesis of acute and chronic maxillary sinusitis].

The objective of the present study was to analyze the literature publications concerning the problem of accessory ostia of the maxillary sinuses and their influence on the development and clinical course of acute and chronic maxillary sinusitis. It is concluded that, despite the conflicting opinions of different authors, accessory ostia appear to be involved in pathogenesis of maxillary sinusitis as the factors that provoke chronization of the inflammatory processes.

[The modern strategy for the treatment of the patients presenting with odontogenic maxillary sinusitis and the oroantral fistula].

The objective of the present study was the comparative analysis of various methods for the plastic correction of the oroantral fistula with the use of the mucosal flap and the osteoplastic materials based on the data from the literature and on-line publkations. The characteristics of an ideal material for the plastic correction ot the oroantral fistula and the conditions for carrying out this surgery are discussed.

[Acid-base equilibrium and mucociliary clearance in the nasal cavity in the patients with chronic rhinitis and inflammatory diseases of paranasal sinuses].

The objective of the present study was to measure pH values and mucociliary clearance (MCC) in the patients presenting with chronic rhinitis and pyo- inflammatory diseases o f paranasal sinuses. A total of 100 subjects included into the study were allocated to three groups. Group 1 was comprised of 20 healthy volunteers, group 2 consisted of 40 patients with chronic rhinitis, and group 3 included 40 patients presenting with pyo- inflammatory diseases o f paranasal sinuses (PNS). The study showed that chronic rhinitis was associated with the shift of mucosal pH values towards the alkaline side (pH = 7.5±0.5) accompanied by suppression of mucociliary transport in the intranasal mucous membrane. In the patients with acute and chronic sinusitis, the acid-base equilibrium was shifted towards higher acidity (pH = 6.8±0.13). The results of the study indicate that the inflammatory process exerts negative effect on the functional state of the intranasal mucous membrane accompanied by the shift of the acid-base equilibrium and the suppression of mucociliary transport.

[The assessment of the ventilation function of the eustachian tubes after shunting of the tympanic cavity].

The objective of the present work was to study specific features of the eustachian tube after the insertion of the shunt into the tympanic membrane and to measure the pressure necessary to ensure passive opening of the tube in the patients presenting with exudative otitis medium (EOM). The study included 87 patients with this pathology who underwent shunting of the tympanic cavity following a course of conservative treatment. Threshold audimetry and acoustic impedancemetry were performed in all the patients to estimate the patency of the eustachian tube with the perforated tympanic membrane. It is concluded that the shunting of the tympanic cavity resulted in markedly disturbed dynamic function of the Eustachian tube in the majority of the patients (59%) regardless of the severity of hearing impairment.

[Catheterization of the Eustachian tube in the combined treatment of exudative otitis].

The objective of the present study was to determine the amount of a medicinal agent entering the tympanic cavity during catheterization of the Eustachian tube in 26 patients presenting with exudative otitis and admitted for its treatment to N.I. Pirogov Clinical Hospital No 1, Moscow. The patients were managed by combined therapy in conjunction with catheterization of the Eustachian tube using radiocontrast matter (the iodine containing (76%) preparation trazograf having viscosity identical with that of dexamethasone). The administration of trazograf was followed by multispiral CT of the temporal bones. It was shown that trazograf penetrated into the tympanic cavity during catheterization of the Eustachian tube and accumulated inside it in 19.2% and 77% of the cases respectively. This finding suggests that the therapeutic effect in the patients presenting with exudative otitis is due not only to the direct action of the pharmaceutical product being used on the site of inflammation but also to the restoration of the draining and aerating functions of the course of Eustachian tube catheterization.

[Comparative characteristic of the local application of anti-inflammatory agents for the treatment of otitis externa and otitis media].

The objective of the present work was the clinical study of candibiotic exhibitic antibacterial, antimycotic, anti-inflammatory, and anesthetic properties when applied for the treatment of otitis externa and otitis media. This agent was included together with traditionally used systemic medications in the combined treatment of 26 patients. It was applied in the form of endoaural drops, transtubal administration through a catheter, and transtympanic pumping by the Politzer balloon technique (in case of perforation). In the patients with otomycosys, the preparation was used for the treatment of the external acoustic canal after the removal of fungal masses thrice daily for 1 month. Good clinical effect achieved in all the patients was manifest as the normal otoscopic picture and less frequent complaints on days 8-10 after the onset of therapy. Its maximum duration was 21 days. Positive dynamics (pain relief) was apparent within the first 2 days of the treatment. Fungal mycelium was absent after 14-16 days of the treatment in 100% of the patients initially presenting with yeast-like fungi.