[Clinical and radiological classification of otosclerosis]. / Kliniko-rentgenologicheskaya klassifikatsiya otoskleroza.

The article presents various classifications of forms of otosclerosis (OS), which change with the development of diagnostic methods. At the same time, according to the literature, a unified OS classification has not yet been adopted. All existing classifications are imperfect to some extent. The classification of clinical forms of OS according to TPA data makes it possible to determine the indications for surgical treatment and to suggest its possible effect, but not the localization of OS foci. X-ray classifications of localization of OS foci indicate their diversity, distribution, and do not always correlate with the type of hearing loss. At the same time, modern diagnostics of OS should be based on audiological data, localization of foci and their density according to the results of X-ray methods of examination. Based on the examination and treatment of 1532 patients with various forms of OS, a modern clinical and radiological classification of the disease is proposed, based precisely on these provisions. This classification, in our opinion, will improve the quality of diagnosis of various forms of OS, will allow to differentiate the tactics of treating patients with this disease to stabilize hearing loss, indications for surgical treatment, suggest its effectiveness with a reduction in the risk of surgical failures and possible further rehabilitation of the patient.

[Spontaneous otoliquorrhea, complicated by recurrent secondary meningitis, in a 6-year-old child with an abnormality of the inner ear]. / Spontannaya otolikvoreya, oslozhnennaya retsidiviruyushchim vtorichnym meningitom, u rebenka 6 let s anomaliei razvitiya vnutrennego ukha.

Congenital anomalies in the inner ear structures development are one of the reasons for unilateral hearing loss in children. Unilateral hearing loss is predominantly congenital, thus children with this pathology are initially deprived of the ability to hear with both ears, which leads to the formation of a specific «individual hearing norm¼. Due to this, children do not complain of hearing loss, and unsuspecting parents can only guess why their child is poorly studying and lagging behind his peers. Unfortunately, in some situations the detection of malformations of inner ear structures occurs only after the development of complications, namely spontaneous otoliquorrea, leading to bacterial meningitis, and exactly episodes of meningitis (sometimes recurrent) become the cause for examination of patient and diagnosis of this pathology. We present one of this clinical observations.

[Tendoplasty and its effectiveness in the rehabilitation of hearing loss in patients with otosclerosis]. / Tendoplastika i ee effektivnost' pri khirurgicheskoi reabilitatsii patsientov s tugoukhost'yu, obuslovlennoi otosklerozom.

The article briefly presents the physiology of the stapes muscle tendon (SMT), and features in its defeat. Its length was studied using high-resolution multispiral computed tomography of the temporal bones. We also studied the possibility of its restoration using the author's method of tendoplasty using metallized stapes prostheses. Tendoplasty with stapedoplasty was performed in 74 patients with otosclerosis (OS), and 48 patients had stapedoplasty without tendoplasty. As a result of research, the average length of the SMT was 2.38±0.02 mm, which explains the need to use a 3 mm long venous autograft for tendoplasty. The author's method of tendoplasty for stapedoplasty allows restoring the acoustic reflex in 54.1% of OS patients using artificial stapes prostheses. The preservation of the vascular bed in the thickness of the restored tendon can improve the trophy of the long incus process and reduce the risk of its dystrophic changes in the postoperative period. In addition, this fact confirms the importance of the stapes muscle in the acoustic reflex.

[Exudative otitis media as a manifestation of spontaneous otoliquorrhea]. / Ekssudativnyi srednii otit kak proyavlenie spontannoi otolikvorei.

Spontaneous otoliquorrhea (SOL) often mimics the picture of exudative otitis media (EOM), which leads to delayed diagnosis of the underlying disease. PURPOSE OF STUDY: Is to evaluate causes, clinical features and diagnostic algorithm for patients with SOL. PATIENTS AND RESEARCH METHODS: From 2007 to 2018, 33 patients with SOL underwent examination and treatment in the Department of Ear Microsurgery of the Institute. At the preoperative stage, all patients underwent a complete examination, including examination of ENT organs, anthropometric, biochemical, audiological, ultrasound and radiological tests, which made it possible to make the correct diagnosis. RESULTS: SOL was more likely to occur in women over 50 who are obese (69.7%, stage II-III). The disease onset in 51.6% of patients was preceded by conditions accompanied by a short-term or prolonged increase in intracranial pressure. SOL was manifested by the clinical picture of EOM in 72.7% of cases, only in 45.5% of cases was accompanied by release from the ear and nose, was often intermittent and complicated by meningitis in 12.1% of patients. Difficulties in diagnosing the disease are caused by clinical manifestations of exudative or acute otitis media in the absence of a causative factor, which led to the verification of SOL from 1 to 4 years in 81.9% of patients who received long-term treatment for other ENT diseases. CONCLUSION: The master factors in the diagnosis of SOL are otomicroscopy and endoscopy of the nasopharynx, Halo test and screening determination of glucose level in the obtained discharge, as well as high-resolution CT of the temporal bone, which allows to localize the cerebrospinal fluid fistula and to determine the size of the defect.

[The application of stapedoplasty for the treatment of hearing loss in the patients suffering from obliterative otosclerosis]. / Stapedoplastika v lechenii tugoukhosti u bol'nykh obliteriruiushchim otosklerozom.

This article presents the results of analysis of the data obtained during the examination and the surgical treatment of the patients presenting with the obliterative form of otosclerosis and suffering from hearing impairment with special reference to the intraoperative findings, technical aspects of stapedoplasty, and its effectiveness. A total of 14 patients (17 ears) were recruited for the participation in the present study including 10 women at the mean age of 38.8±6.2 years and 4 men (mean age 44.8±3.9 years). The duration of the hearing loss in the period preceding the surgical treatment in 7 (50%) patients was more than 8 years. According to the results of tonal threshold audiometry (TTA), the mean bone conduction (BC) threshold for conductive hearing loss in the frequency range from 0.5 to 4.0 kHz was 24.9±8.1 dB with the mean bone air gap (BAG) equaling 38±5.1 dB. Computed tomography (CT) of the temporal bones revealed grade 1 obliterative otosclerosis in 4 patients, grade II of the same condition in 6 patients, and grade III in 7 ones. These findings were confirmed intraoperatively. In 15 cases, stapedostomy was carried out with the use of the non-contact CO2 laser-based system, in the remaining cases a microdrill was employed. Five patients underwent laser-assisted piston stapedoplasty while in 11 others the stapes prosthesis was placed on the autovein. One patient was treated by the same method with the use of the autocartilaginous prosthesis. The functionally acceptable results within 1 year after the surgical intervention were obtained in all the treated patients with the mean bone air gap equaling 13.2±3.4 dB. The best outcome (the reduction of the BC threshold and BAG by 7 dB and 25.9 db on the average respectively within 1 year after surgery was achieved in the patients with grade III obliterative otosclerosis.

[The fistula of the round window of the cochlea]. / Fistula okna ulitki.

This article presents the data on the frequency, diagnostics, and variants of the surgical treatment of the fistula of the round window of the cochlea. A case of this pathology is reported with the special emphasis placed on the approaches to the diagnostics and surgical management of this condition.

[The current views of the treatment of diffuse external otitis].

The objective of the present study was to evaluate the clinical effectiveness and safety of the local application of triderm for the treatment of diffuse external otitis. The study included 68 patients presenting with bacterial and fungal diffuse external otitis. The treatment in the form of local empiric therapy was continued till the results of microbiological treatment became apparent. The beneficial outcome achieved in 91.2% of the patients was clinically manifest as the regression of the inflammatory process in the external auditory meatus. No complications, such as ototoxic events, either local or systemic allergic reactions, were documented. The authors substantiate the possibility of the application of the medication under consideration for the treatment of diffuse external otitis based on the knowledge of the mechanism of the actin of its constituent components, viz. betamethasone, dipropionate, gentamicin sulfate, and clotrimazole, taking into account the occurrence of the most common causative agents of diffuse external otitis. It is concluded that triderm is a safe medication for the local application and, probably, for the initial empiric therapy of diffuse external otitis to be continued till the results of the microbiological treatment become apparent.

[Event-Related Potentials Accompanying Processing Referentially Ambiguous Pronouns in Russian].

The study is based on the analysis of event-related potentials (ERPs) accompanying processing referentially ambiguous pronouns under condition when disambiguation is necessary for effective task performance. Par- ticipants were asked to match the pronoun in the second sentence with its antecedent (the noun phrase it is related to) in the first sentence in two conditions: experimental (two possible antecedents) and control (only one possible antecedent). Processing referentially ambiguous pronouns as compared to the control condition elicited an Nref effect - a diffuse ERP deflection 300-400 ms poststimulus that was earlier observed in Dutch and Chinese. Moreover, in contrast to previous results, no P600 effect - late positivity associated with ac- ceptability judgment under condition of referential ambiguity - was found. Our data in comparison with re- sults of previous studies indicate that strategies in processing referentially ambiguous pronouns (acceptability judgment) are determined not only by experimental task but also by absence/presence of anomalous trials in the experimental materials.

[ANALGESIC EFFECT OF TROPALGIN ON THERMAL PAIN IN RATS WITH DIFFERENT PAIN THRESHOLDS].

Experiments on rats divided into two groups (with high and low pain sensitivity) were used to assess the effect of tropalgin, a new derivative of tropine, in thermal pain tests (tail-flick and hot plate). Tropalgin was found to possess an analgesic effect comparable to that of reference sodium metamizole. ED50 of tropalgin was 2 mg/kg for intraperitoneal administration. The duration of the analgesic effect of tropalgin in rats low pain sensitivity was longer than in animals highly sensitive to pain. It is suggested that the analgesic effect of tropalgin can be related to the adenosine liberating action of this drug.

[The morphofunctional prerequisites for the development of exudative otitis media in the children presenting with chronic adenoiditis].

The objective of the present study was to elucidate the structural and functional mechanisms underlying disturbances of the protective nasolaryngeal barrier with special reference to the following histological and immunohistochemical characteristics of the pharyngeal tonsils (CD4, CD20, CD68, IgA, P53, BCL2, Ki67, TGF-beta) in the children aged 3-6 years and presenting with complicated (n=20) or uncomplicated (n=20) chronic adenoiditis (CA). It was shown that adenoids of the patients with complicated chronic adenoiditis less frequently exhibit markers of active inflammation, such as hyperemia, intraepithelial infiltration, and hemosiderophages. Also, they have the smaller mean area of lymphoid follicles and the number of functional intrafollicular macrophages suggesting impaired immunological reactivity. Lymphoid follicles of the pharyngeal tonsils in the children with uncomplicated chronic adenoiditis show up enhanced density of B-lymphocytes (CD20) and CD69-positive cells which may suggest functional tension. However, density of IgA-producing lymphocytes responsible for the protection of nasolaryngeal mucosa is identical in the patients with complicated and uncomplicated chronic adenoiditis. Taken together with the decreased number of T-helpers (CG4), this finding indicates the compromised immunological response in the children with this pathology. It is concluded that the structural characteristics of pharyngeal tonsils revealed in the present study may provide a basis for the disturbances of congenital and adaptive immunity; moreover, they can serve as the predictors of complications of chronic adenoiditis.

[Eye movement parameters in reading the sentences with syntactic ambiguity in Russian language].

We studied the eye movement parameters during reading of syntactically ambiguous sentences with feminine relative clause in Russian language. A priori difficulties of sentence structural analysis results in increase of time spent on reading as opposed to reading control sentences (unambiguous). Such a delay is caused by an increase of frequency of regressions (backward saccades) which are executed for rereading an ambiguous fragment ofsentence. This fact in turn leads to an increase in number of fixations and their duration. The total reading time for particular words composing the ambiguous fragment of sentence depended on disambiguation result (relative clause attachment, early/late closure). In case of early closure (when the subject attached relative clause to first noun) the total reading time for this noun exceeded one for second noun. In case of late closure (when the subject attached relative clause to second noun) the total reading time for both nouns didn't differ. Our results indicate that early closure domination in Russian language determines the greater total reading time for first noun of nominal group associated with relative clause.

[Use of mathematical models infrared spectroscopy serum in the differential diagnosis of ulcerative colitis and Crohn's disease in children].

UNLABELLED: RELEVANCE OF RESEARCH: Inflammatory bowel diseases are among the most severe pathologies in pediatric gastroenterology, often lead to disability. Despite the similarity of the clinic, pathogenetic mechanisms, the question of the differential diagnosis of ulcerative colitis and Crohn's disease is relevant in view of their different prognosis and treatment strategy. In recent years, in medical uses infrared spectroscopy of blood serum for the differential diagnosis of various inflammatory diseases, benign and malignant tumors. Besides finding increasing application of mathematical methods for data processing, the so-called mathematical modeling of pathological processes, allowing objectify the survey results for a more accurate diagnosis and prognosis of pathological processes. OBJECTIVE: improving the differential diagnosis of ulcerative colitis and Crohn's disease in children. PATIENTS: 21 children with ulcerative colitis, 56 children with Crohn's disease and 34 healthy children. The method of infrared spectroscopy of serum and mathematical modeling results through multivariate entropy analysis. RESULTS: the obtained spectral characteristics of blood serum in children with ulcerative colitis and Crohn's disease and in healthy children, as well as "images of diseased in these pathologies". CONCLUSION: The use of this medical technology reduced the time of diagnosis, which contributes to the timely choice of rational treatment strategies and provides an opportunity to avoid the development of complications, worsening of the disease.

[Forward-morphological criteria of ulcerative colitis relapse and continuous flow in children].

UNLABELLED: Inflammatory bowel disease is one of the most difficult groups of pathologies in pediatric gastroenterology, due to the steady growth of their prevalence, offset debut at an earlier age, the increase in the incidence of severe complicated forms. Established clinical, genetic, serologic criteria for progression of ulcerative colitis are contradictory, and some--the reach of most medical institutions. PURPOSE: to evaluate the prognostic significance of morphological features of ulcerative colitis relapse and continuous flow. MATERIALS AND METHODS: a retrospective study conducted histological kolonobioptatov 26 children with recurrent, 20--with a continuous flow of ulcerative colitis during their primary treatment in a hospital, the comparison group consisted of 50 children without inflammatory bowel disease. RESULTS: morphological characteristics identified predictors of recurrent ulcerative colitis in the form of severe eosinophilic infiltration of the epithelium, lamina propria of the mucosa. For a continuous flow was characterized: high density cell infiltration of the lamina propria mucosa epithelium predominantly under represented plasma cells, fibroblasts, sclerosis of the basal membrane, the presence of epithelial arcades deformed crypt abscesses. CONCLUSION: the extended study of biopsy material, including assessment of the composition and location of infiltration, fibroblast pool of epithelial-connective relationships in the colonic mucosa of children with ulcerative colitis will not only assess the inflammatory process, but also to predict the course of disease, thereby defining a long-term tactics treatment.

[The diagnostics and treatment of Minor's syndrome].

This publication was designed to describe the clinical manifestations of dehiscence of the superior semicircular canal (Minor syndrome), currently employed methods for its diagnostics, and the first case of this pathology reported in this country with the good outcome of the treatment. Also described are the historical background relevant to the problem, pathomorphological changes in the superior semicircular canal, clinical manifestations of the disease, the patients' subjective complaints, and the methods for diagnostics of dehiscence of the superior semicircular canal (Minor syndrome). The successful diagnostics and treatment of a female patient presenting with the aforementioned case of Minor syndrome is considered in much detail.

[Sanation surgery for the treatment of chronic suppurative otitis media with cholesteatoma].

Results of the surgical treatment of 98 patients presenting with chronic suppurative otitis media (CSOM) and accompanying cholesteatoma. CSOM of large duration turned out to be associated with cholesteatoma in 31.3% of the patients regardless of localization of the tympanic defect. A variety of surgical interventions were undertaken depending on the extension of cholesteatoma including the intrameatal approach (n=75), endaural approach (n=16), postaural approach (n=6), and the combined approach (n=1). Forty two patients presenting with either central or peripheral peroration in the strained part of the tympanic membrane were operated with the use of the intrameatal approach. Perforation in the unstrained part of the tympanic membrane in 56 patients with chronic suppurative otitis media and cholesteatoma extending to the antrum and the cells of the mastoid process was corrected by sanation operation at different stages of the carious process using different surgical approaches. The early surgical intervention during the carious process in the patients presenting with CSOM and cholesteatoma in the phase of remission, taking into account structural peculiarities of the mastoid process and distribution of the inflammatory process, significantly reduced its extension and permitted to reconstruct the structure of the middle ear in 70% of the patients.

[Computed tomography of the temporal bone for the diagnosis of facial nerve neurinoma].

The present retrospective study of 6,200 subjects with temporal bone pathology allowed for the identification of a group of 12 patients aged between 12 and 59 years in whom the presence of facial nerve neurinoma diagnosed by computed tomography was confirmed during surgical intervention and by histological methods. The patients were allocated to three groups depending on the localization of neurinoma. Patients of group 1 (n=8) had neurinoma of the mastoidal segment, those of group 2 presented with neurinoma of the tympanic segment, and patients of group 3 showed combined lesions of the tympanic and labyrinthine segments. Clinical and CT characteristics of each group are presented. CT of the temporal bone is shown to provide a tool of high informative value for the diagnosis of facial nerve neurinoma. It is suggested that CT should be used to examine patients with facial nerve paresis or conductive and mixed hearing loss of unspecified etiology for the early diagnosis of facial nerve neurinoma.

Endogenous Na/K-ATPase inhibitors in patients with preeclampsia.

Although preeclampsia (PE) is a major cause of maternal and fetal mortality, its pathogenesis is not fully understood. Digitalis-like cardiotonic steroids (CTS) are believed to be involved in the pathophysiology of PE, as illustrated by clinical observations that DIGIBIND, a digoxin antibody which binds CTS, lowers blood pressure in PE. Recently we reported that plasma levels of marinobufagenin (MBG), a vasoconstrictor CTS, are increased fourfold in patients with severe PE. In the present study, we tested whether anti-MBG, or anti-ouabain antibodies, or DIGIBIND can reverse inhibition of erythrocyte Na/K-ATPase (NKA) from patients with mild PE (blood pressure, 149 +/- 3/93 +/- 3 mm Hg; age, 28 +/- 2 years; gestational age, 37 +/- 1 weeks). Development of PE was associated with twofold rise in plasma MBG levels (1.58 +/- 0.15 vs. 0.80 +/- 0.11 nmol/L; P<0.01). The activity of erythrocyte NKA in 12 patients with PE was lower than in 6 normotensive gestational age-matched subjects (1.56 +/- 0.18 vs. 3.11 +/- 0.16 micromol Pi/ml/hr; P<0.001). In vitro treatment of erythrocytes from PE patients with anti-MBG antibody fully restored the NKA activity (3.26 +/- 0.41 micromol Pi/ml/hr; P<0.01). The effects of DIGIBIND was marginally significant (2.53 +/- 0.32 micromol Pi/ml/hr), while the anti-ouabain antibody was not effective (2.25 +/- 0.25 micromol Pi/ml/hr, P>0.5). The present observations provide evidence for a role for MBG in the pathogenesis of PE, and suggest that antibodies against MBG may be useful in the treatment of this syndrome.

[Accidental thymic involution in the growing body under the effect of different types of stressors].

Using the quantitative immunohistochemistry, the immunomodulatory effect of different types of stressors (physical and psychoemotional) on the thymus of growing experimental animals was assessed. Sprague-Dawley rats aged 21 day were exposed either to physical (water immersion) or emotional "expectation" stress for 5 hours daily during 7 consecutive days. After the final exposure to stress, animals were sacrificed, thymus was obtained for weighting and was processed for routine histology and immunohistochemistry (CD3, CD8, ED1, PCNA) with subsequent automatic image analysis. The finding obtained have demonstrated severe accidental thymic involution in both groups of experimental animals, which was more prominent under the effect of the physical stressor as compared to "purely" psychoemotional stressor. The major factors of poststress thymic hypoplasia were the increased apoptosis of the cortical thymocytes and inhibition of their proliferation, but not their increased transport to peripheral immune organs.