[Features of thermal effect at high-frequency laser impact on biological tissue (experiment). Technique of laser ablation of a pharyngeal tonsil]. / Osobennosti termicheskogo éffekta pri vysokochastotnom lazernom vozdeistvii na biologicheskuiu tkan' (éksperiment). Metodika lazernoi abliatsii glotochnoi mindaliny.

In the conditions of the experiment the peculiarities of thermal influence of Ho:YAG on biological tissue in the ablation mode were studied. In the experiment we used: surgical laser system LUMENIS VersaPulse PowerSuite 20, universal thermal imaging camera FLIR SC7000. The biological object (turkey meat) was remotely, at a distance of 5 mm, affected by a Holmium laser (E = 0.9 J and R = 12 Hz) for 6 seconds. The maximum temperature (Tmax, °C) in the ablation zone was measured in real time. As a result, it was found that laser ablation of a biological object is characterized by thermal effects, which largely depend on the state of irradiated tissue: the temperature of the irradiated object rises to critical values equal to 100.07-111.24 ° C, after which the surface layer of biological tissue is charred, and the process of laser "removal" stops; intact biological tissue reaches critical heating after 3.48 s, while under the influence of a high-frequency laser on the previously irradiated biological tissue development period It was also established that in order to continue laser ablation with controlled thermal effect it is necessary to remove charred areas of biological object. On the basis of the obtained data the method of laser ablation of pharyngeal tonsils was developed.

[Isolation of neurospheres and neural progenitor cells from the olfactory epithelium]. / Poluchenie neirosfer i neironal'nykh progenitornykh kletok iz oboniatel'nogo épiteliia.

The olfactory epithelium (OE) is an accessible source of neural stem cells and progenitor cells. The objective of the study was to compare the effectiveness of various biopsy sites to isolate and propagate neural progenitor cells from the olfactory epithelium (OE). The authors assessed OE cell count in OE in different sites of the nasal cavity and showed the possibility of isolation neurospheres from nasal biopsies. In total, 45 inpatinets were included in the study. Biopsy specimens were obtained from 30 patients undergoing septoplasty and/or turbinate surgery. Three areas of OE were biopsied: lower third section of the nasal septum (A), anterior part of the middle turbinate (B), upper third of the nasal septum (C). Immunocytochemistry and fluorescence-activated cell sorting showed that OE cells were NCAM-positive. Mean percentage of NCAM+ cells was 7.8% for A, 42.7% for B and 18.2% for C. The difference was significant between A and B (p=0.0001) and B and C (p=0.01). Therefore, the anterior part of the middle turbinate was an easily accessible and safe site to obtain neural cells. To confirm this, neurospheres were obtained in 15 patients with schizophrenia who underwent in-office endoscopy.

[Identification of the specific topographic features of the neck vessels for the prevention of bleedings during tonsillectomy]. / Identifikatsiia osobennostei topografii sosudov shei v profilaktike krovotechenii pri tonzilléktomii.

The objective of the present work was to study syntopy of the large neck vessels in relation to the capsule of palatine tonsils with the use of the MRI technology. A total of 109 patients (218 palatine tonsils) presenting with chronic tonsillitis were available for the examination including 64 women and 45 men at the age varying from 15 to 54 years. All of them underwent MRI-guided vascular visualization in the paratonsillar region together with the measurements of the vessels extending to the capsule of the palatine tonsils at the level of the upper and lower poles, and also close to the mid-third of each palatine tonsil. The distance from the external carotid artery to the upper and lower poles of the palatine tonsils was found to be 17.1±1.01 mm and 10.3±0.18 mm respectively and in the mid-third the palatine tonsil 10.7±0.12 mm; the distance from the internal carotid artery to the upper and low poles of the palatine tonsil amounted to 14.5±0.84 mm and 16.8±0.77 mm respectively while that to the mid-third of the palatine tonsil was 15.3±0.07 mm. The branches of the external carotid artery feeding the palatine tonsils are the most frequent sources of bleedings; the following measurements were obtained: the maxillary artery 16.4±0.43 mm (17.4%) - the upper pole 9.6±0.02 mm (46.2%), the mid-third of the palatine tonsil 18.5±0.74 mm (29.5%) - the lower pole; the lingual artery 4.7±0.02 mm (6.8%) - the mid-third of the palatine tonsil, 6.2±0.82 mm (56.8%) - the lower pole; facial artery: 4.2±0.01 mm (0.76%) - the mid-third of the palatine tonsil; the occipital artery 25.6±0.12 mm (19%) - the upper pole; 14.8±0.11 mm (18.9%) - the mid-third of the palatine tonsil 9.56±0.12 mm (3.8%) - the lower pole; the tonsillar artery 1.88±0.01 mm (9.8%) - the upper pole; 2.51±0.01 mm (23%) - the mid-third of the palatine tonsil; 2.12±0.01 mm (11%) - the lower pole. The distance from the internal jugular vein to the capsule of the palatine tonsils in the region of the upper pole of the palatine tonsil was 28.3±1.01 mm, in the lower pole region 26.6±1.54 mm, and in the region of the mid-third of the palatine tonsil 22.7±1.24 mm. It is concluded that the results of the present study may be useful for the planning of the surgical strategy for the treatment of the patients presenting with chronic tonsillitis and for the prevention of hemorrhagic complications of tonsillectomy.

[The age-specific features of the pharyngeal tonsil in the adult subjects]. / Vozrastnye izmeneniia glotochnoi mindaliny u vzroslykh.

The authors studied the age-related features of the vascular organization of the adenoid tissue. A total of 46 subjects (n=46) were examined; they were divided into two groups one of which included subjects at the age from 7 to 12 years (n=25) whereas the other group was comprised of 21 subjects at the age from 18 to 42 years (n=21). 29 participants of the study were men (63%) and 17 (37%) women. The histological examination of the adenoid tissue revealed the characteristic changes in the adenoid vasculature in the subjects of either age-group. The subjects above 18 years of age were shown to have developed sclerosis and hyalinosis of the vascular walls with the formation of cavernously dilated plethoric veins having the thickened rigid walls. The morphological changes in the connective tissue (basal) layer were documented responsible for the manifestation of the phenomenon of 'immersion' of the lymphoid tissue with the well developed microcirculatory bed. It is concluded that the results of the histological examination can serve as one of the indicators for the use of electrophysical methods to perform adenotomy in the patients older than 18 years.

[Differential diagnostics of headache associated with pathological changes in the nasal cavity and paranasal sinuses]. / Differentsial'naia diagnostika golovnoi boli pri patologii polosti nosa i okolonosovykh pazukh.

Headache is not infrequently one of the major complaints in the patients visiting the otorhinolaryngologist's office. It was estimated to occur in 24% of the patients presenting with chronic sinusitis. The cause of headache may be pathological processes either in the nasal cavity or in the paranasal sinuses as well as a primary disorder in the nervous system. The present article is concerned with the peculiar features of rhinogenic headache and that of a different etiology. It was shown that the patients suffering from headache are in need not only of the obligatory otorhinolaryngological examination including endoscopy of the nasal cavity, X-ray study and, sometimes, specialized tests but also of neurological counseling. However, the surgical treatment does not always results in the elimination or relief of the rhinogenic headache. Hence, the importance of the evaluation of the risks and benefits of such treatment for an individual patient. The formation of the contact points in the nasal mucosa is considered to be one of the possible causes of rhinogenic headache. However, this opinion needs to be confirmed by the results of large-scale comparative clinical studies.

[Differential diagnostics and the treatment strategy for the management of the nasopharyngeal cystic lesions]. / Differentsial'naia diagnostika i taktika lecheniia kistoznykh obrazovanii nosoglotki.

The nasopharyngeal cystic lesions are quite common (affecting up to 14% of the general population) even though the majority of the cases are asymptomatic. Sometimes this condition is associated with the obstruction of nasal breathing, runny nose, hearing impairment, and other non-specific clinical manifestations. The endoscopic examination of the nasal cavity allows the preliminary clinical diagnosis to be established, however, MRI and CT visualization are necessary for more reliable differential diagnostics of this pathology and adequate planning of its treatment. The nasopharyngeal cysts require the surgical treatment, with endoscopic transnasal marsupialization in the combination with coblation, radiowave or laser irradiation being the main currently available option.

[The original method for the endonasal surgical access to the maxillary sinus through crista conchalis of the maxillary bone]. / Original'nyi metod éndonazal'nogo khirurgicheskogo dostupa k verkhnecheliustnomu sinusu cherez crista conchalis verkhnecheliustnoi kosti.

The objective of the present work was to develop a technique for the endonasal surgical access to the maxillary sinus through crista conchalis of the maxillary bone and to evaluate the effectiveness and safety of the surgical treatment by this method. A total of 210 patients underwent the CT-assisted examination of the paranasal sinuses. The data obtained made it possible to characterize the detailed anatomical structure of crista conchalis of a maxillary bone that forms the anterior part of the medial wall of the maxillary sinus. The syntopy in relation to the distal end of the nasolacrimal canal and the cavity of the maxillary sinus was investigated. The results of the study were used to develop the original technique for endonasal antrotomy that included the 0.5-1.0 cm long vertical section of the mucous membrane at the level of the anterior end of the inferior turbinated bone approximately 1 mm from the edge of the bone aperture of the nose which exposed crista conchalis up to the place of fixation of the inferior turbinated bone. Then, the diamond drill burr was use to carry out trepanation of the medial wall of the maxillary sinus in the region of crista conchalis of the maxillary bone; sanitation of the of the sinus was followed by the apposition of the edges of the incision and their fixation with two sutures. The safety of the proposed surgical technique was confirmed by results of the repeated CT examinations of the paranasal sinus and its effectiveness by the clinical follow-up observations.

[Preoperative MRI diagnostics of the topographic features of neck arteries in the patients presenting with chronic tonsillitis]. / Predoperatsionnaia MRT-diagnostika topografii sosudov shei u patsientov s khronicheskim tonzillitom.

The objective of the present study was to determine the frequency of abnormalities of the major neck vessels and elucidate the specific features of blood supply of palatine tonsil based on the results of MRI performed in the vasculature-targeting regimen. A total of 109 patients presenting with chronic tonsillitis (including 64 women and 45 men at the age varying from 15 to 54 years) were available for the examination. All the patients underwent the MRI diagnostic study of the neck vessels by way of the preliminary evaluation of their condition at the pre-hospital stage. Abnormalities in the internal carotid artery were documented in 11.9% of the cases (including C- and S-shaped tortuosity of internal carotid artery in 6.88%, kinking and coiling of internal carotid artery in 4.13% and 0.92% of the patients, respectively). The majority of the detected abnormalities were located above the upper pole of the palatine tonsil which allowed to avoid the risk of the injury to the main neck vessels and prevented possible hemorrhage. One patient (0.46%) presented with kinking of the right internal carotid artery located in the immediate proximity to the capsule of the palatine tonsil close to its mid-third portion. There was no evidence that the present study gave rise to any malformation of the internal carotid artery and internal jugular vein. The proposed diagnostic method makes it possible to detect a rare anatomical feature of the development of the internal carotid artery discovered in a single patient (0.04%) out of the 2398 operated ones. This finding is of clinical significance and needs to be borne in mind when preparing the planned surgical intervention for the treatment of chronic tonsillitis. The results of the present study should be taken into consideration when prescribing the surgical treatment to the patients suffering not only from chronic tonsillitis but also from other ENT diseases, in the first place pharyngotympanic tube pathology.

[Modern approaches to diagnostics of the diseases associated with chronic tonsillitis].

The objective of the present study was to analyse risk factors and the clinical course of general diseases and disorders associated with chronic tonsillitis. We overviewed domestic and foreign periodicals and present the data thus obtained together with the results of our original investigations. The study permitted to elucidate the risk factors of the complicated clinical picture of chronic tonsillar pathology and substantiate the necessity of the active surgical treatment for the prevention of the development of toxico-allergic forms of this disease. The importance of thorough diagnostics of the diseases concomitant with chronic tonsillitis both for the purpose of identification of its form and for the prevention of the development of serious life-threatening complications is emphasized.

[Certain peculiarities of the clinical course of chronic tonsillitis].

The present review of the literature data demonstrates that the frequency of tonsillectomies has reduced during the last 10 years. The authors consider the possible causes accounting for this decrease. In addition, results of an epidemiological study are presented based on the analysis of medical records of the patients with chronic tonsillitis complicated by paratonsillar abscess who were admitted to the Department of Otorhinolaryngology of No 1 City Clinical Hospital between 2002 and 2010. The severity of the inflammatory process was evaluated from the results of radioautographic investigation of palatal tonsillar biopsies obtained during surgical interventions. These data confirm inflammation of tonsils in patients with chronic tonsillitis including the non-anginous form of this pathology.