[Modern view on the effectiveness of surgical methods for treating obstructive sleep apnea syndrome]. / Sovremennyi vzglyad na effektivnost' khirurgicheskikh metodov lecheniya sindroma obstruktivnogo apnoe sna.

Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.

[Gut microbiota in patients with relapsing-remitting multiple sclerosis]. / Mikrobiota kishechnika u patsientov s remittiruyushchim rasseyannym sklerozom.

Microorganisms in human life play a huge role: in particular, those that coexist with the host organism, inhabiting the skin, upper respiratory tract, external genitalia and especially the digestive tract. The intestinal microbiota, including bacteriome, mycobiome and virome, not only takes part in the digestion process, but also provides the synthesis of a number of vitamins. The intestinal microbiome also serves as the basis for a system of extensive bidirectional neuroendocrine pathways that connect microbiota with various regions of the central nervous system, the hypothalamic-pituitary-adrenal system, and the peripheral parts of the autonomic nervous system. This system of connections has got the name of gut-brain axis and has attracted close attention of scientists over the past two decades, since a targeted impact on the intestinal flora is potentially capable of changing the nature of nervous system regulatory influences on the whole body. It is especially important to study patterns of functioning of the gut-brain axis in patients with the nervous system pathology, namely neurodegenerative and demyelinating diseases. Methods for their treatment continue to improve, and perhaps the correction of the gut microbiotic composition will serve as an additional therapeutic approach. The review article describes current views on the role of the intestinal microbiota, provides the latest data on the composition of bacteriome, mycobiome, and virome in patients with relapsing-remitting multiple sclerosis.

[Cervicogenic vertigo]. / Tservikogennoe golovokruzhenie.

The prevalence of cervical dizziness, still not recognized by the entire medical community, not only does not become less frequent, but even increases today. This phenomenon is facilitated by the widespread computerization of our lives and, in particular, the strain on the neck when working with portable electronic equipment. Despite the fact that criteria that reliably confirming the association of dizziness with cervical pathology have not yet been defined, experimental and clinical evidence of such an association continues to accumulate. This review presents data from studies of the last few years on cervical pathology as a causative factor in some types of dizziness and vertigo. To date, the following variants of cervical vertigo are distinguished: Barre-Lieu syndrome, rotational vertebral artery syndrome, proprioceptive cervical vertigo, migraine-associated cervical vertigo. The paper considers the features of all four cervical vertigo types, as well as methods for diagnosing and the first randomized trials on the treatment of dizziness associated with the pathology of neck structures. The results of own observations of similar cases (diagnosis and treatment) are described; as well as principles of differential diagnosis of some conditions manifested by headache and dizziness in patients with various types of disorders of cervico-cranial region. The similarities of clinical presentation and pathogenetic mechanisms characteristic of skull base and neck anomalies, Meniere's syndrome and cervical vertigo are discussed. In conclusion, an assumption was made about the common origin of a whole group of the diseases associated with the cranio-cervical region.

[Vertical nystagmus]. / Vertikal'nyi nistagm.

The review article provides a definition and classification of different nystagmus types, a comparative description of the central and peripheral vestibular nystagmus. The pathogenetic patterns of up-beating and down-beating nystagmus are accurately described. The features of nystagmus formation in various diseases are discussed, such as Wernicke encephalopathy, Arnold-Chiari anomaly, spinocerebellar ataxia and vestibular migraine. The authors provide their own data on oculomotor disorders in 100 patients with vestibular migraine and migraine with a brain stem aura. This article considers approaches to treatment: surgical and conservative. In conclusion, was noted the possibility of differentiating the central and peripheral vestibular nystagmus by means of clinical study. As well, the differences between vertical nystagmus associated with organic lesions of the brain stem or cerebellum and transient nystagmus with vestibular migraine are highlighted. The authors note the need for in-depth studies of nystagmus in vestibular migraine patients and methods of dealing with it.

[Uvulopalatoplasty with a severe form of obstructive sleep apnea: long-term results]. / Uvulopalatoplastika pri tyazheloi forme obstruktivnogo apnoe sna: otdalennye rezul'taty.

OBJECTIVE: To assess the severity of daytime sleepiness and the level of sleep apnea/hypopnea index (AHI), as well as the possibility of their correction, in the long-term period after uvulopalatoplasty (UPP) in patients suffering from obesity and obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We retrospectively analyzed the data of the patients, who requested a consultation due to nighttime snoring, witnessed sleep apneas and daytime drowsiness. We included men and women of ages 40 to 65 (24 male, 17 female) without cardiac or lung insufficiency. Group 1 consisted of 19 patients, who underwent UPP 3-5 years prior to current consultation. Group 2 consisted of 22 patients, who underwent UPP 6-12 earlier, despite prior diagnosis of severe OSAS. We performed cardiorespiratory sleep monitoring, additionally patients completed the Epworth scale and sleep quality scale. Patients were re-interviewed 2 months after initiation of CPAP therapy and or intraoral device treatment. RESULTS: Group 1 (n=19) displayed obesity (Body Mass Index 34.2±6.1 kg/m2), severe OSAS (AHI 55.2±18.5), high level of daytime drowsiness (Epworth score 18.7±6.3) and low sleep quality (13.0±6.8 sleep quality score). Group 2 (n=22) displayed reduction in AHI level - significant statistically, but not clinically without changes in daytime drowsiness and sleep quality, which were improved in 29 cases out of 41 with the help of CPAP-therapy (18 cases) or intraoral fixation devices (11 cases). CONCLUSION: UPP does not exert a clinically significant affect the severity of sleep disturbance in patients with obesity and severe OSAS. Night sleep study is essential before making a decision about UPP. Clinical state correction of patients in the long-term period of UPP is possible with the help of CPAP therapy or intraoral fixation devices.

[Methods of medical rehabilitation in the complex program therapy for patients with cervicobrachialgia caused by pathological dental occlusion]. / Metody meditsinskoi reabilitatsii v programme kompleksnoi terapii patsientov s tservikobrakhialgiei, obuslovlennoi patologicheskoi dental'noi okklyuziei.

Chronic pain syndromes in the neck and shoulder girdle are one of the important clinical problems due to their high prevalence. In addition, it's of great interest to study the mutual influence of the musculoskeletal system pathology, balance organs and dentoalveolar system due to the possible negative impact of these structures on each other which surely affects the treatment timing and its results. OBJECTIVE: To develop a diagnostic algorithm and a comprehensive program for the treatment and rehabilitation of patients with cervicobrachialgia combined with pathological dental occlusion. MATERIAL AND METHODS: The study involved 90 persons of both genders aged 18 to 55 years consisted of 3 clinical study groups (25 patients) and one control group (15 healthy persons). The clinical groups included 75 patients with chronic myofascial pain syndrome in the neck and shoulder girdle resistant to drug therapy, with temporomandibular joint (TMJ) dysfunction and/or pathological dental occlusion (PDO). The groups were formed depending on the chosen treatment methods: manual therapy was used in the 1st group; in the 2nd group - dental treatment aimed at correcting PDO; in the 3rd group the manual therapy was used together with the correction of the jaws' occlusal relationship. RESULTS: In the study course the most effective algorithm for the diagnosis and rehabilitation of patients with cervicobrachialgia caused by pathological dental occlusion was determined. Positive clinical results were noted in patients of all three groups; however, in the 3- group where manual therapy and complex dental treatment were carried out the results are not differing significantly from the controls. The study showed that in patients with myofascial pain syndrome at the cervical and shoulder levels caused by TMJ dysfunction and pathological dental occlusion it's advisable to include manual and osteopathic diagnostics in the algorithm. Manual muscle testing, posture tests in combination with 3D X-ray imaging and computerized functional studying the maxillofacial region should be used to identify etiology-pathogenesis links between these conditions. These methods are also applicable for quality control of treatment. CONCLUSION: Thus, as a study result the diagnostic algorithm was developed; it allows to determine the relationship of pharmacoresistant pain syndrome of the cervicobrachial region with dental pathology at high degree of accuracy; and a comprehensive interdisciplinary approach to the therapy and rehabilitation of this combined pathology was proposed.

[Positional vertigo variant]. / Variant pozitsionnogo golovokruzheniya.

The article describes case history and multiphase treatment of the patient with attacks of vertigo, initially regarded as the onset of Meniere's disease, but later qualified as secondary positional attacks with combined musculoskeletal pathology of the craniovertebral region and temporomandibular joint. Medicinal, local and surgical treatment led to the perfect result. Thus, the team work of neurologist, otolaryngologist, maxillofacial surgeon and orthodontist led to the successful elimination of vertigo attacks.

[Comprehensive treatment of Costen syndrome]. / Kompleksnoe lechenie sindroma Kostena.

OBJECTIVE: To develop an integrated therapy for the combination of pain syndrome and cochleovestibular syndrome (CVS) in patients with temporomandibular joint (TMJ) dysfunction. MATERIAL AND METHODS: Forty-five patients (42 women and 3 men), aged from 23 to 54 years, with TMJ dysfunction, signs of CVS and complaints of pain in the ear area were stratified into three groups (15 patients each). Patients received pharmacological and osteopathic therapy (group 1); splint therapy followed by orthodontic treatment (group 2) and a combination of the abovementioned methods (group 3). Re-examination was carried out 3 months after completion of treatment. RESULTS: After treatment, complaints of pain, tinnitus, dizziness and nystagmus, the degree of TMJ dysfunction decreased significantly (p<0,05) compared to baseline in groups 1 and 2. In group 3, the most significant and persistent results were obtained, which significantly differed not only from the initial level, but also from the final level of indicators in the first and second groups (p<0,05), including a decrease in the degree of maladaptation associated with vertigo and trait anxiety. CONCLUSIONS: Differential diagnosis of CVS in patients with TMJ dysfunction requires the joint participation of dentist, neurologist and ENT doctor and should be comprehensive, including medical, orthodontic and osteopathic components.

[Migraine and Ménière's disease]. / Migren' i bolezn' Men'era.

The article describes a series of seven cases characterized by a change in the type of attack in the perimenopausal period: migraine attacks before menopause and cochleovestibular paroxysms after the onset of menopause. Clinical data and results of diagnostic tests are presented and the possible link of both attack variants with cervical pathology is discussed. The authors explain this dynamics by stem neural integrator dysfunction during hormonal changes.

[Cervical vertigo: a neurologist's point of view]. / Tservikogennoe golovokruzhenie: vzgliad nevrologa.

Cervical vertigo (CV) hasn't yet been recognized by many neurologists, as it has no specific clinical symptoms and reliable diagnostic criteria. However, over the past 150 years, there has been accumulated numerous experimental and clinical evidence to support the legitimacy of CV allocation as a separate nosology. This review presents data regarding the vertigo associated with neck pathology: possible evidence of CV existence and the description of its type as well. The principles of CV diagnosis and treatment are considered, an attempt to create a unified concept is proposed.