[New opportunities for complex treatment of oropharyngeal candidiasis in HIV-infected patients in the later stages of the disease].

Treatment of recurrent oropharyngeal candidiasis (OPC) in HIV-infected patients is a serious clinical problem due to the emergence of resistant Candida strains, the risk of invasive disease, and high economic costs, which warrants the need for new treatment regimens. AIM: To improve the treatment regimen of OPC in the later stages of HIV infection by combining the complex herbal medicinal product Tonsilgon® N with fluconazole and evaluate the effectiveness of this combination. MATERIALS AND METHODS: A comparative randomized clinical study included 65 patients divided into observation and comparison groups, receiving fluconazole plus Tonsilgon® H and fluconazole monotherapy, respectively, for 7 days. On days 1 and 8, the severity of OPC clinical signs was assessed using a visual analog scale. The secretory immunoglobulin A in saliva was measured as a criterion for changing the level of local mucosal protection of the oral cavity and pharynx. CONCLUSION: This treatment regimen for oropharyngeal candidiasis in patients with HIV infection in the later stages of the disease (IVB-IVC) with fluconazole and Tonsilgon® N is effective, which is confirmed by a significantly more pronounced regression of clinical signs (pM-U<0.01), as well as an increase in the level of secretory immunoglobulin A in the oral fluid (from 0.62±0.33 g/L to 0.81±0.18 g/L; p<0.05).

[Morphological characteristics of Palatine tonsils candidiasis in the late stages of HIV-infection]. / Morfologicheskaya kharakteristika kandidoznogo porazheniya nebnykh mindalin na pozdnikh stadiyakh VICh-infektsii.

Candida lesion of Palatine tonsils was studied in 32 HIV-infected patients in the late stages of the disease using histological and cytological methods. There were used conventional methods during pathomorphological studies of palatine tonsils tissue fragments obtained by biopsy, and smears from the surface of the organ. It was found that micromycetes Candida spp. were located in association with various bacteria (mainly Streptococcus spp.), as well as Cryptococcus spp., with the formation of the biofilms, both on the surface of the Palatine tonsils and in the depth of their parenchyma. We revealed the minimal response cellular protective reaction to the deep introduction of the pathogen. Mycosis proceeded against the background of pronounced follicular lymphoid depletion of the tissue of the Palatine tonsils. The examined patients represent a risk group for invasion of Candida micromycetes into the vascular channel and their dissemination with the development of generalized candidiasis.

[Department of Otorhinolaryngology at the Academician E.A. Vagner Perm State Medical University]. / Kafedra otorinolaringologii Permskogo gosudarstvennogo meditsinskogo universiteta im. akad. E.A. Vagnera.

The present article was designed to describe the history of the Department of Otorhinolaryngology based at the Academician E.A. Vagner Perm State Medical University and overview its research, educational, and therapeutic activities.

[The clinical and microbiological characteristics of oropharyngeal candidiasis in the HIV-infected patients at the late stages of the disease]. / Kliniko-mikrobiologicheskaia kharakteristika orofaringeal'nogo kandidoza u VICh-infitsirovannykh patsientov na pozdnikh stadiiakh zabolevaniia.

Oropharyngeal candidiasis in 512 HIV-infected patients at the late stages of the disease was studied with special reference to the clinical and microbiological characteristics of this condition. The diagnosis was established based on the results of the clinical and microbiological examination of the patients including investigation of the tissue samples taken from the oral cavity and the throat with the use of the device specially developed for this purpose. It was shown that the disease existed in various clinical forms the most common of which were monocomponent pathology represented by pseudomembranous candidiasis in 37.5±2.14% of the patients, the two-component mixed form (pseudomembranous candidiasis with concomitant angular chelitis) diagnosed in 27.5±1.97% cases, and the ternary form (the combination of pseudomembranous candidiasis, acute atrophic process, and angular chelitis) documented in 11.9±1.43% patients. The main clinical features of the disease included the combination of its various forms, multiple localization of the pathological process, and its polymorphous manifestations. Changes in the clinical course of oropharyngeal candidiasis associated with the progression of HIV from the 4A to the 4B stage were detected for the first time. They were shown to be accompanied by variations in the species composition and concentration of fungal flora in the crypts of the palatine tonsils and its sensitivity to fluconazole therapy.

[The differential approach to the surgical treatment of pathologies of the frontal sinus]. / Differentsirovannyi podkhod k khirurgicheskomu lecheniiu patologii lobnoi pazukhi.

The surgical intervention for the management of frontal sinusitis is required in a large fraction of patients presenting with this condition. The treatment of choice for the pathology in question is endoscopic endonasal frontotomy. Whenever the endoscopic technique is impossible to employ, the surgeon has to resort to an extranasal operation on the frontal sinus. The indications for the application of such strategy include the pathological conditions complicated by the intracranial and orbital processes, the presence of large benign tumours, recurrent post-surgical purulent sinusitis and traumatic frontal sinusitis. For the preservation of the functionally competent frontal sinus during extranasal frontotomy, a frontonasal fistula with all bony walls and maximally spared mucous membrane can be created. In order to remove an osteotoma from the frontal sinus, we applied the osteoplastic approach with the formation of the osteo-periosteal flap from the frontal wall of the sinus. In those cases when it was impossible to restore the frontal sinus and there was a closed bone cavity undergoing purulent inflammation we practiced obliteration of the cavity with the use of a porous carbon implant.

[The biomechanical prerequisites for the preservation of stapedius muscle tendon during stapedoplasty].

The objective of the present biomechanical and clinical study was to evaluate the consequences of the preservation of stapedius muscle tendon during stapedoplasty. The biomechanical investigations included mathematical simulation with the construction of the model based on the kinematic approach. The comparative clinical study of the results of stapedoplasty carried out between 2001 and 2010 involved 340 patients (77 men and 263 women) at the mean age of 48.18 years. Twenty patients underwent piston stapedoplasty by the method of Shi, 320 ones were treated by stapedoplasty with the preservation of stapedius muscle tendon. The state of speech hearing and the audiometric air-bone gap (ABG) were deduced from the audiograms. The biomechanical study demonstrated a significant increase in the range of the movements of the long crus of the incus, after the removal of the stapedius tendon muscle and the preservation in part of the acoustic reflex in case of tendon preservation. The preservation of the tendon partly dampened excessive sound vibrations. The clinical study revealed the improvement of speech hearing parameters throughout the three-year postoperative follow-up period; it was especially pronounced within the first year after surgery with the preservation of stapedius muscle tendon. The size of ABG at a the frequencies falling in the 0.5-1 kHz and 6-8 kHz ranges after surgery with the preservation of stapedius muscle tendon was smaller than after the removal of the tendon during the three-year follow-up (p<0.005). The difference was especially well-apparent within the first year after stapedoplasty. The difference in this parameter between the interventions with the preservation of stapedius muscle tendon and with its removal was insignificant (p>0.05).

[Peculiarities of stapes functioning in the patients presenting with otosclerosis from the standpoint of biomechanical modeling].

The objective of the present study was to elucidate, in the framework of a biomechanical model, the biomechanical prerequisites for the development of osteodystrophic changes in stirrup bones in the case of their osteodystrophic fixation. The comparative analysis of the biomechanical models of mobile and ankylotic stapes demonstrated that the mild enough strain-stress state under the normal conditions turns into the rigid state in otosclerosis. The main dampher in case of load application to the adequately mobile stapes footplates is the round ligament. If the stapes footplates are fixed in the oval window of the labyrinth the conditions for the functioning of this bone change drastically. Variations of the strain-stress state of the ankylotic stapes footplates undergoing the acoustic impact promotes the development of dystrophic processes in the bone structures in response to the altered conditions of functioning and the appearance of supraphysiological strains and stresses.