[Application of new technologies in postgraduate education of otorhinolaryngologists]. / Primenenie novykh tekhnologii v poslediplomnom obrazovanii vrachei-otorinolaringologov.

The article is devoted to one of the urgent problems of modern medical education - postgraduate education, further development of skills and deepening of knowledge among otorhinolaryngologists after training in clinical residency. The long-term experience of training in advanced training cycles for both otorhinolaryngologists beginning their professional path and doctors with a long, decades-long work experience in the specialty is analyzed. The trajectory of professional development is presented, which allows structuring the acquired knowledge, distributing the stages of training over time, taking into account the priorities of students and combining training with the exchange of experience and personal communication with colleagues. The problems and the most promising directions of the development of postgraduate education of otorhinolaryngologists are considered.

[Clinical significance of radiological methods for diagnosing endolymphatic hydrops in Ménière's disease]. / Klinicheskaya znachimost' luchevykh metodov diagnostiki endolimfaticheskogo gidropsa pri bolezni Men'era.

Ménière's disease is a chronic disorder of the inner ear, a permanent sing of which is endolymphatic hydrops. For the diagnosis of Ménière's disease in clinical practice, criteria that are primarily based on the clinical picture. However, instrumental methods for diagnosing Ménière's disease, aimed at identifying endolymphatic hydrops, continue to be developed and improved. Radiation diagnostics contribute significant contribution and aimed at identifying the characteristic signs of Ménière's disease. Recently, it has become possible to visualize endolymphatic hydrops using MRI of the temporal bones. This publication presents an analysis of the current state of this topical aspect of the problem of diagnosing Ménière's disease. The purpose of this review is to conduct a comparative analysis of radiation methods for diagnosing Ménière's disease. MATERIAL AND METHODS: The study included publications in English and Russian found in the PubMed, eLibrary database related to the diagnosis of Meniere's disease. RESULTS: A comparative analysis of computed tomography of the temporal bones, magnetic resonance imaging of the temporal bones and diagnostic possibilities for detecting signs characteristic of Ménière's disease are presented. The most diagnostically significant method of studying Ménière's disease is identified. CONCLUSION: MRI of the temporal bones with contrast enhancement is a promising method that can be used to develop an effective treatment algorithm.

['School of Excellence' in the structure of teaching otorhinolaryngology at the department of diseases of the ear, nose and throat of Sechenov University: experience and perspective]. / Shkola masterstva v strukture prepodavaniia otorinolaringologii na kafedre boleznei ukha, gorla i nosa Sechenovskogo Universiteta: opyt i perspektiva.

We describe our experience of teaching practical skills in Otorhinolaryngology in the Department of Ear, Larynx and Nose diseases of the Sechenov First Moscow State Medical University (Sechenov University) as a part of the rector's project 'School of Mastery' Training is held under the program, specially designed at the department. This program takes into account all the aspects of ENT doctor's practice. During their training in the school students actively participate in the work of the ENT department - they visit the dressing room, operating theater, take part in professors' rounds, and oversee the patients with various ENT conditions. Seminars are held weekly to consolidate learned practical skills. Training sessions are also held in departments of Children's Otorhinolaryngology and emergency ENT department. Results of the 'School of Mastery' were analyzed at the Department of Ear, Larynx and Nose diseases. Future perspectives are also stated.

[The experience with the education based at the clinical residency of the Department of Ear, Throat and Nose Diseases, I.M. Sechenov First Moscow State Medical University (on the occasion of the 260th anniversary of the Sechenovsky University)]. / Opyt obucheniia v klinicheskoi ordinature na kafedre boleznei ukha, gorla i nosa Pervogo MGMU im. I.M. Sechenova (k 260-letiiu osnovaniia Sechenovskogo universiteta).

This publication was designed to report the experience gained by the Department of ear, nose and throat diseases at I.M. Sechenov First Moscow State Medical University in the matters concerning professional medical education in the framework of the clinical residency. The main factors that contribute to the adequate shaping of the future ENT-doctor are considered. These include the continuity of generations and conservation of the traditions in the combination with the development of the leading areas of scientific, clinical and educational work.

[The peculiar features of the psychosomatic status in the patients presenting with the spondylogenic and cochleovestibular disorders]. / Osobennosti psikhosomaticheskogo statusa u bol'nykh s vertebrogennymi kokhleovestibuliarnymi narusheniiami.

The objective of the present study was to elucidate the peculiar features of the psychosomatic status in the patients with chronic vertebrogenic and cochleovestibular disorders The psychosomatic status was evaluated in 117 patients at the age from 21 to 65 years presenting with these conditions using the psychometric tests based on the STAI questionnaire (the state-trait anxiety inventory) adapted for the determination of the level of reactive and personal anxiety. It was shown that the vestibular disorders, tympanophonia, and hearing impairment have a negative influence on the psychogenic status of the patients suffering from cochleovestibulopathy. As many as 92.3% of the patients were characterized by the high or moderately high level of reactive and personal anxiety. The depressive conditions of various severity were diagnosed in 29.1% of the patients. The correction of postural muscular disbalance made it possible to achieve the well apparent reduction of the manifestations of reactive anxiety without prescription of the pharmacotherapeutic treatment and thereby to increase the effectiveness of the management of the patients presenting with the vertebrogenic and cochleovestibular disorders.

[The role of the students' research groups in the formation of the system of values as a personality trait of the future doctor]. / Rol' studencheskogo nauchnogo kruzhka v formirovanii tsennostnykh orientatsii lichnosti budushchego vracha.

This publication was designed to report the experience gained by the Department of Ear, Throat and Nose Diseases at I.M. Sechenov First Moscow State Medical University in the matters concerning the education of the students involved in the activities of research groups. The main causes for which the senior students should be attracted to doing research work in the framework of the university-based scientific societies are considered. Special emphasis is laid on the role of the students' research groups in the formation of the system of values as a personality trait of the future doctor. The experience gained during the recent years with the organization of inter-institutional students' competitions (otorhinolaryngological olympiads) is discussed.

[The role of the vomeronasal system in the formation of the human sexual behaviour]. / Rol' vomeronazal'noi sistemy v formirovanii seksual'nogo povedeniia cheloveka.

This review deals with the structure and function of the vomeronasal system and evaluation of its influence on the sexual sphere of humans and animals. Special attention is given to the role of pheromones in the regulation of the sexual behaviour. The data concerning the function of the vomeronasal organ following surgical interventions in the nasal cavity are discussed.

[The peripheral vestibular disorders encountered in the routine out-patient practical work]. / Perifericheskie vestibuliarnye rasstroistva v ambulatornoi praktike.

The objective of the present study was to elucidate the frequency of causes underlying the development of dizziness and vertigo in the patients seeking advice and care at an outpatient healthcare facility. A total of 590 patients with complaints of dizziness and vertigo were examined. It was found out that the peripheral disorders of the vestibular analyzer were the most frequent causes of dizziness and vertigo in the majority of the examined patients. These conditions were documented to occur in more than 65% of the patients. The most common forms of peripheral vestibular disorders were benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuronitis. The central vestibular disorders occurred considerably less frequently than peripheral ones and were diagnosed only in 10.9% of the patients. The results of the study provided a basis for the development of the algorithm forthe bedside examination of the patients presenting with vertigo and dizziness associated with peripheral vestibular disorders. It is emphasized that such examination should include, besides the standard neurological studies, the neuro-otological tests making it possible to detect the most common forms of peripheral vestibular disorders.

[Tympanophonia as a topical problem of practical medicine].

This paper contains the data suggesting the necessity and importance of the comprehensive treatment of tympanophonia on an individual basis including the rational choice of the combination of pharmacotherapeutic and non-medicamental modalities, such as classical acupuncture and the like. The special emphasis is laid on the importance of compliance with the prescribed hygienic procedures for the organs of hearing and prophylaxis of cochlear disorders.

[The principles of differential diagnostics and combined treatment of tinnitus].

The authors emphasize the importance of the problem of differential diagnostics and combined treatment of tymanophonia with special reference to the widespread, multiple, and diverse causative factors behind this condition as well as the great variability of its clinical signs and symptoms, and difficulty of recoding tympanophonia. The relative significance of various methods in the system of combined treatment of tympanophonia is discussed. It is concluded that the choice of therapy of this condition including the rational combination of pharmacotherapy and non-medicamental modalities, such as classical acupuncture, should be made taking into consideration individual characteristics of the concrete patients.

[The estimation of the efficacy of manual therapy included in the combined treatment of cochlear-vestibular disorders based on the results of computed stabilography].

The objective of the present study was to estimate the efficacy of the combined treatment of spondylogenic cochlear-vestibular disorders with the use of both medicamental and non-medicamental modalities. Computed static stabilometry was applied for diagnostics of postural disbalance and evaluation of the treatment outcomes. It was shown that the application of manual therapy for the management of 56 patients presenting with spondylogenic cochlear-vestibular disorders resulted in the decrease of tinnitus and the improvement of vestibular and cochlear functions.

[Hirudotherapy in the treatment of peripheral cochleovestibular disorders of vascular origin].

Basic therapy of peripheral cochleovestibular disorders of vascular origin consists of the rational combination of medicamentous and non-medicamentous treatments that collectively ensure positive clinical results. The use of hirudotherapy for the management of peripheral cochleovestibular disorders resulted in the substantial decrease of ear noise and the maintenance of the tendency toward further improvement of cochlear and vestibular functions.

[Vestibular disorders in patients with otosclerosis: prevalence, diagnostic and therapeutic options].

A total of 177 patients with otosclerosis were selected for this study. Vestibular disorders were diagnosed in 40 (22.6%) of them. The patients were allocated to 2 groups comprising 11 and 18 subjects respectively. Patients of group 1 were given surgical treatment during the current hospitalization. Patients of group 2 were treated by conservative therapy following stapedoplasty performed 1 year or more earlier. The study included analysis of vestibular symptoms and evaluation of clinical effectiveness of the combined treatment in the form of therapy with betahistine dihydrochloride (betaserk) during 2 months and a course of 10-12 sessions of game exercises at a stabilographic complex. The patients of both groups enjoyed reduced severity of subjective and objective vestibular symptoms and statistically significant improvement of the equilibrium function assessed from statokinesigrams. It is concluded that combined vestibuloadaptive therapy is an effective method of preparation for stapedoplasty and correction of postoperative complications.

[Pulmonary diseases in patients with HIV infection].

AIM: To characterize the spectrum, incidence rate and features of pulmonary pathology in HIV-infected inpatients with reference to a fall in the count of CD4-lymphocytes. MATERIAL AND METHODS: A total of 2370 patients with HIV infection admitted to Moscow infectious hospital N 2 were examined. The protocol of examination included: standard diagnostic tests, bronchoscopy with examination of bronchoalveolar lavage and bronchial biopsies for genetic markers of basic pulmonary disease pathogens, assessment of external respiration function by spirometry. By the count of CD4-lymphocytes in the blood (> 500 cells/mcl; 500-200 cells/mcl and < 200 cells/mcl) the patients with pulmonary pathology were divided into groups 1, 2 and 3. RESULTS: Affection of the lower respiratory tract (LRT) was detected in 1209 (51%) patients. Incidence, etiological spectrum and severity of LRT lesions increased significantly with aggravation of immunological disorders. The patients of group 1 were affected more frequently with bacterial bronchitis, pneumonia (88.2%), group 2 patients - with bacterial pneumonia (67.1%) and pulmonary tuberculosis (28.1%), group 3 - with tuberculosis including generalized forms (53.9%), cytomegalovirus infection (11.2%), pneumocystosis (7.2%). Combined pulmonary pathology was diagnosed in 25% cases. CONCLUSION: Changes in external respiration function were most evident in pneumocystosis and tuberculosis, but they were most persistent in cytomegaloviral lesion of the lungs. Some tuberculosis and CMV infection patients exhibited ventilatory disorders prior to clinical and x-ray symptoms, this suggests prognostic significance of spirometry.

[Seven principles in the treatment of vestibular vertigo and results of the study of VIRTUOSO]. / Sem' printsipov lecheniia vestibuliarnogo golovokruzheniia i rezul'taty issledovaniia.

This article reports the results of the international post-marketing observational program VIRTUOSO aimed at the evaluation of the efficacy of betahistine dihydrochloride at the dose of 48 mg/day for 1-2 months in patients with paroxysmal vertigo of various origins. The clinical response was rated as good, very good or excellent in 74.1% of the patients (p<0.001). Monthly vertigo attack frequency with betahistine decreased in average from 8.0 to 3.0 (p<0.001). Vertigo attack frequency further decreased during the 2-month follow-up after the end of betahistine treatment. No serious adverse effects of betahistine have been reported.

[Posttraumatic neurosensory hypoacusis in forensic medical practice].

Literature data and results of epidemiological examination show that traumas play a significant role in emergence of neurosensory hypoacusis (NSHA) in young healthy population. The diagnosis of NSHA is often missed in forensic-medical examination and this may cause a social problem. Audiometric signs of NSHA were studied in subjects with trauma of the labyrinth. Pure tone audiometry results can be used for differential diagnosis of mechanical and barotraumas and as additional criteria in determination of the harm to health.

[Cytomegalovirus infection of the gastrointestinal tract in patients with HIV-infection].

AIM: To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects. MATERIAL AND METHODS: The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains. RESULTS: CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material. CONCLUSION: CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.

[Objective assessment of the olfactory analyzer function based on recording of olfacto-vegetative and olfacto-vestibular reactions]. / Ob"ektivnaia otsenka funktsii oboniatel'nogo analizatora na osnove registratsii ol'fakto-vegetativnykh i ol'fakto-vestibuliarnykh reaktsii.

To register objectively olfactory defects and to assess them qualitatively and quantitatively, the authors propose to use olfactometric techniques reflecting olfactovegetative and olfactovestibular manifestations. Automatic pupillographic complex APK-OI provides speed, time and amplitude parameters of the pupillary and nyctating reflexes. 600 pupillograms and records of the nictation reflex proved high diagnostic significance of these methods. 104 stabilographic examinations (ST-02 unit) illustrated the changes in 12 vestibular parameters prior to and after olfactory impact. The results give grounds for application of olfactovestibular reactions registration as an objective olfactometric test.

[Finger test as a prognostic criterion in the assessment of the effectiveness of treatment of patients with tinnitus]. / Pal'tse-pal'tsevoi test kak prognosticheskii kriterii éffektivnosti lecheniia bol'nykh s ushnym shumom.

ENT specialists of the Moscow Sechenov Medical University have developed and tried a variant of the pointed test permitting prognostication of the results which could be obtained at treatment of patients with noise in the ears of different etiology. The test was performed in 263 patients with neurosensory, mixed-type and conductive hypoacusis. High informative potential, convenience in performance for physician and the patient who can be taught to conduct in independently make the test valuable in practical otorhinolaryngology.