[The development of a personalized approach in the treatment of chronic rhinosinusitis with nasal polyps]. / Razvitie personalizirovannogo podkhoda v lechenii polipoznogo rinosinusita.

Due to the high recurrence rate and the variety of complex pathogenesis mechanisms, chronic rhinosinusitis with nasal polyps is difficult to treat. In addition, the disease reduces the quality of life of patients and carries a large financial burden on the healthcare system, therefore, a personalized approach to the treatment of this pathology is becoming popular today. In order to determine which drug route would be most rational for a particular patient, key concepts such as phenotyping, endotyping and genotyping of chronic rhinosinusitis with nasal polyps were introduced. This approach has expanded the understanding of the etiological aspects of the disease and the pathogenetic mechanisms of the formation of nasal polyps. In this regard, immunotherapy of chronic rhinosinusitis with nasal polyps began to develop, consisting in the use of monoclonal antibodies to the substrates of the immune system, which are key figures in the development of certain types of inflammatory reactions of the mucous membrane of the nasal cavity and paranasal sinuses. The use of biological agents represents the first steps in targeted therapy, which is a transition to personalized treatment of patients with chronic rhinosinusitis with nasal polyps. Further studies in the field of immunological mechanisms of the formation of various phenotypes of chronic rhinosinusitis with nasal polyps from the standpoint of proteinomics, transcriptomics and epigenetics give hope for the development of a new drug-based treatment for this disease, which can significantly reduce the need for surgical treatment of patients with this pathology.

[Dynamic monitoring of patients with chronic rhinosinusitis with nasal polyps]. / Dinamicheskoe nablyudenie za bol'nymi polipoznym rinosinusitom.

In connection with the prevalence and tendency to relapse, chronic rhinosinusitis with nasal polyps is an urgent problem not only for otorhinolaryngologists, but also for specialists whose therapeutic activity is somehow related to the respiratory system. Based on clinical observations, 5 phenotypes of this pathology were identified, each of which requires an individual approach to treatment and prevention. As a rule, the first stage is functional endoscopic rhinosinus surgery, the volume of which is determined depending on the phenotype. But even with a carefully performed operation, the result of surgical treatment may be unsatisfactory if there was no adequate care in the early inpatient and outpatient periods. This paper highlights the features of dynamic monitoring of patients with different phenotypes of chronic rhinosinusitis with nasal polyps.

[Experience with treatment of chronic polypoid rhinosinusitis using low doses of clarithromycin in the postoperative period].

A total of 37 patients at the age from 25 to 65 years presenting with chronic polipoid rhinosinusitis (CPRS) were available for the observation. They were allocated to two groups based on the results of endoscopic polyposinusotomy. The patients in group 1 (n=18) were instructed at discharge from the clinic to take 250 mg of clarithromycin daily for 3 months in combination with the local application of a topical corticosteroid. The patients in group 2 (n=19) were prescribed topical corticosteroids alone. It was shown that clarithromycin at low doses caused significant stabilization of CPRS remission and prevented the development of relapses in the majority of the patients (66%). Therapy of CPRS with low doses of clarithromycin was associated with a significant decrease of the frequency of acute retroviral infections (ARVI). The intake of clarithromycin had no effect on the development and/or aggravation of intestinal dysbacteriosis nor did it provoke deviation of blood biochemical characteristics from the normal values both at the onset of therapy and after a follow-up period of 3 months.

[Effects of the size and position of the anastomoses on pathological process in the paranasal sinuses]. / Vliiaiut li razmery i raspolozhenie soustii na kharakter patologicheskogo protsessa v okolonosovykh pazukhakh?

In small anastomoses of the paranasal sinuses blocking in inflammation we observe acute pyo-exudative inflammation; in large anastomoses--chronic productive form with development of the cysts and polyps. By the authors' experience, 8-10% of the population have no maxillary anastomosis in the crescentic fissure. It locates in the posterior part of its medial wall.

[The Hummer Microdebrider--new technology in functional endonasal rhinosurgery]. / Mikrodebraider "Khammer"--novaia tekhnologiia vo vnutrinosovoi funktsional'noi rinokhirurgii.

Microdebrider "Hummer" was used for functional endoscopic sinus surgery (FESS) in 66 patients. Extent of the surgery varied from partial resection of middle turbinate to ethmoidectomy and opening of all sinuses. "Hummer" is the best device for accurate removal of polypoid and hypertrophic tissue from the middle turbinate, posterior end of the inferior turbinate and the nasal septum. Use of "Hummer" makes opening of maxillary and sphenoid sinuses and revision of the frontal and sphenoethmoidal recess much easier and safer. No complications occurred in this group of patients. Further studies are needed to answer the question whether or not use of microdebrider can improve distant results of FESS.

[Main principles of functional intranasal surgery of paranasal sinuses]. / Osnovnye printsipy funktsional'noi vnutrinosovoi khirurgii okolonosovykh pazukh.

The analysis of complications consequent to 200 endoscopic intranasal operations (computed tomography was performed preoperatively in 96 and was not performed in 104 patients) has shown that the incidence of serious complications in both groups was minimal and that of such complications as eyelid hematoma, neuralgia and hemorrhage was similar. Complication-safe operative procedure is described. It is believed that the absence of computed tomograms should not cause the change of functional intranasal surgery for radical surgery by external approach or common polypectomy.

[Intranasal laser coagulation in the therapy of vasomotor rhinitis in elderly patients]. / Vnutrinosovaia lazernaia koaguliatsia v lechenii vazomotornogo rhinita u bol'nykh starshykh vozrastnykh grupp.

Laser coagulation of concha nasalis inferior is essentially atraumatic, bloodless, sterile and causes no edema. The specific effect of a laser beam on microcirculation suggests that laser surgery can be viewed as a pathogenetic method of therapy of vasomotor rhinitis. Laser coagulation of concha nasalis inferior was performed in 74 patients, 42 of which were older than 50 years. The elderly patients suffered from other diseases, e.g. ischemic heart disease or cardiopulmonary pathology, which excluded contact surgery intervention. Laser therapy was well tolerated by all the patients. Good results were recorded in 80% of patients without concomitant sinusitis and in 66.6% of patients with concomitant sinusitis.