[Basic principles of immunocorrective therapy in otorhinolaryngology].

The structural and functional basis of ENT mucosa immunity, leading methods of local immunity assessment in ENT pathology are presented. The experience of the chair and clinic of I.P. Pavlov St-Petersburg State Medical University in the field of immunotropic therapy of ENT pathology is reviewed.

[Efficacy of local use of recombinant interferon alpha-2 preparations in combined treatment of recurrent respiratory papillomatosis].

Clinical-immunological examination of 41 patients with recurrent respiratory papillomatosis (RRP) included determination of phenotype CD3, CD4, CD8, CD16, CD25, CD56, HLA-DR in peripheral blood by flow cytofluorimetry, the levels of IFN-gamma, TNF-alpha, GM-CSF, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13 in the laryngeal secretion by multiplex immunoassay. Interferon inhalation therapy was conducted to prevent recurrence in 23 patients after surgical treatment and in 18 patients as monotherapy. The efficacy of the monotherapy was 45.5%. Treatment with IFN-alpha raised the levels of cytokines modulating an immune response by Th1-type (IFN-gamma, IL-12, IL-2) and GM-CSF, and reduced the levels of IL-4, IL-10 and IL-13. Local treatment with recombinant IFN-alpha is effective in aggressive RRP. As prognostic markers of the treatment efficacy may serve baseline high levels of TNF-alpha and IL-4/IFN-gamma index in laryngeal secretion. Treatment efficacy can be assessed by raise of IFN-gamma, IL-2 and IL-12 in combination with reduction of IL-4/IFN-gamma index.

[Choice of tools for ambulatory uvulopalatoplasty on the basis of experimental and clinical studies].

We studied interaction of a radiofrequency scalpel and a semiconductor laser with the tissue phantom. The heated part of the phantom can be easily removed and measured for size of the coagulated area. We investigated to what extent the width of the coagulation necrosis along the incision is influenced by the power and speed of each instrument used for incision. As for the laser, the width of the coagulation zone increased with rise of power and slowing of cutting velocity. For the scalpel, this relationship between incision velocity and coagulation effect was much weaker but had the same trend. We compared hemostasis efficiency during uvulopalatoplasty with both instruments. Much more potent hemostatic effect was registered in laser uvulopalatoplasty.

[Role of echography in diagnosis of diseases of cervical lymph nodes].

We studied echograms of lymph nodes and clinically similar tumors of the neck in 194 patients. A complex of echographic signs providing the best diagnostic indicators: a minimal size of the node, volume, maximal to minimal size ratio and form. Accuracy of differential diagnosis of benign and malignant lymphadenopathies was 80.4%, sensitivity -- 94.3%, specificity -- 69.4%. In duration of the disease less than 1 month use of computer processing of echograms raised diagnostic accuracy by 9.5%.

High-frequency jet ventilation in endolaryngeal surgery.

STUDY OBJECTIVE: To describe the clinical experience with high-frequency jet ventilation (HFJV) of the lungs during endolaryngeal surgery and its effect on acid-base balance and capillary PO2 (PcO2), PCO2, central hemodynamics, and tracheobronchial mucous membrane. DESIGN: Evaluation of different modalities of HFJV. SETTING: Operating rooms and otolaryngology intensive care unit in a medical institute. PATIENTS: 218 patients undergoing elective endolaryngeal surgery. INTERVENTIONS: Patients receive HFJV through catheters with an inner diameter of 1.4 to 1.8 mm. Catheters were introduced orotracheally, nasotracheally, percutaneously, or through a fenestrated tracheostomy tube. Minute volume was based on body weight times 0.2, corrected for acid-base balance. MEASUREMENTS AND MAIN RESULTS: Intraoperative cardiac output, airway pressure, changes in tracheobronchial mucosa, and acid-base balance were monitored. HFJV changed central hemodynamics slightly and preserved gas exchange: PcCO2 remained within normal limits, while PcO2 increased. Use of thin catheters enhanced largyneal exposure and surgical manipulation. Percutaneous catheterization permitted resumption of HFJV in the event of laryngeal edema and inadequate spontaneous respiration after surgery. CONCLUSION: HFJV leads to optimal conditions for endolaryngeal surgery, reverses constant outflow of the respiratory gas mixture, prevents aspiration of tissue products and blood, and removes smoke from the operative site when using laser surgery.

[Rhinobronchial reflex in patients with bronchial asthma]. / Rinobronkhial'nyi refleks u bol'nykh bronkhial'noi astmoi.

Altogether 229 patients with bronchial asthma and 57 patients with chronic bronchitis (preasthma) were examined. Diseases of the respiratory tracts, mainly of the nasal cavity and accessory nasal sinuses were found in 273 (95.45%) patients. There was correlation of the cell structure of the upper and lower respiratory tracts in patients with bronchial asthma as well as correlation in the status of the nasal and bronchial cavity mucosa. A raised rhinobronchial reflex was revealed in 33.7% of patients with bronchial asthma and a raised olfactobronchial reflex in 46.2%. Latent hyperreactivity of the bronchi was detected in 21.7% of the patients with vasomotor rhinopathy without concomitant pulmonary pathology.

[Clinical efficacy of cefixime (results of multicenter trials)]. / Klinicheskaia éffektivnost' tsefiksima (rezultaty mul'titsentrovykh ispytanii.

Multicentre trials of cefixime (Cefspan, Fujisawa Pharmaceutical Co., Ltd., Japan) were performed in 1992. The trials involved 137 children and 269 adult patients with inflammatory infections of the respiratory organs and urinary tracts and otorhinolaryngologic affections. Positive clinical and bacteriological results of the trials were stated in 76-90 per cent of the cases. The adverse reactions such as skin eruption and dyspepsia were rare and did not require the specific treatment.

[Light-guide instruments for low-intensity laser therapy in ORL practice]. / Svetovodnye instrumenty dlia nizkointensivnoi lazernoi terapii v LOR-praktike.

Manipulators with monofibre light-guides have been specially designed for otorhinolaryngologic instruments commonly used in routine drug therapy for intracavital treatments. Quartz enclosed in a protective polyethylene sheath is used as the monofibre light-guide with a light conductor 400 microns in diameter and 2 to 3 m in length. It can be built in the following instruments: an ear catheter, a maxillary sinus lavage cannula, a subclavian artery catheter, and a laryngeal bougie. The use of monofibres allows considerable widening the application field of the low power laser therapy in otorhinolaryngologic practice. Moreover, in compliance with human engineering requirements it managed to preserve most standard manipulations otolaryngologist makes use in the course of routine clinical practice with conventional instruments.

[Contact laser surgery in the treatment of laryngeal neoplasms]. / Rezultaty kontaktnoi lazernoi khirurgii novoobrazovanii gortani.

YAG-ND laser contact surgery in combination with tracheal puncture jet ventilation of the lungs were used in managing 128 patients with laryngeal cancer (T1-T2) and 129 patients with benign lesions of the larynx. A complete response was achieved in 97.3% of stage I and 94.4% of cancer stage II patients. The recurrences occurred in 7 out of 129 patients with benign lesions.

[Low-intensity laser irradiation in otorhinolaryngology]. / Nizkoénergeticheskoe lazernoe izluchenie v otorinolaringologii.

Low-intensity laser irradiation is a modality widely practiced in otorhinolaryngology. Basing on extensive personal experience and literature data the authors provide ENT specialists with relevant techniques and parameters of the radiation for different otorhinolaryngological diseases.

[Laser surgery and phototherapy of the larynx and laryngopharynx under indirect laryngoscopy]. / Lazernaia khirurgiia i fototerapiia gortani i gortanoglotki pod nepriamoi laringoskopiei.

The authors elaborated the equipment and technique of endolaryngeal laser surgery under indirect laryngoscopy in conditions of local anesthesia as well as phototherapy of the larynx with coherent and noncoherent monochromatic light in the postoperative period. Therapy was conducted and assessment of its efficacy was made in 93 patients with benign tumours, cysts of the larynx and laryngopharynx, cicatricial membranes of the middle regions of the larynx. The efficacy of the given method was assessed on the basis of long-term laryngoscopic studies, stroboscopy and acoustic measurements of the voice. Indications and contraindications to the mentioned therapy have been specified.

[Mechanisms of interactions between different types of nystagmus]. / O mekhanizme vzaimodeistviia razlichnykh vidov nistagma.

Basing on the original and literature data it is suggested that all types of nystagmus are formed by the same complex system. Under combined stimulation, impulses from the sensory systems are integrated not only in the vestibular nuclei, but also in a series of structures at cortical-subcortical level. The integration proceeds with its own polarity (activating or inhibiting) when a signal alters the ability of a structure to respond to another inputting signal. In this way the thresholds are permanently modified in the integrating structures of the system. It results in increasing or decreasing effect of the outputting reaction of the system. Final response of integrating process reaches the effector level of the nystagmus generation, namely paramedial or mesencephalic regions of pontine reticular formation and spreads further to oculomotor nuclei.

[Epidemiology and laser correction of chronic diseases observed in snoring and obstructive sleep apnea]. / Epidemiologiia khronicheskikh zabolevanii, vstrechaiushchikhsia na fone khrapa i sindroma obstruktivnogo sonnogo apnoé, i ikh lazernaia korrektsiia.

Investigations of snoring have been initiated because snoring is associated with obstructive sleep apnea syndrome (OSAS) and some chronic diseases eventuating in invalidity. Questionnaire survey provided evidence on snoring and OSAS incidence among different age groups of male and female population of St-Petersburg. Associated chronic diseases were also evaluated. Snoring and OSAS were corrected by laser uvulopalatoplasty. The correction was conducted in the contact regimen by Nd-YAG laser. As a result of the treatment, snoring and apnea in mild OSAS ceased in all the patients and decreased by at least 60% in severe OSAS. This effect was confirmed by polysomnographic findings.

[The function of the oxidant-antioxidant system in patients with laryngeal cancer]. / Sostoianie oksidantno-antioksidantnoi sistemy u bol'nykh rakom gortani.

Lipid peroxidation and antioxidant system were studied at hospital admission, on postoperative day 1, 3 weeks and half a year after surgery in 86 patients with different stages of laryngeal cancer. A correlation is stated between lipid peroxidation disturbances and the defects in the protective antioxidant system. Low-frequency laser irradiation of autoblood produced a clinically beneficial effect and stabilized biochemically the relations between lipid peroxidation and antioxidant systems.

[Skin tumors of the face: experience in contact laser excision]. / Opukholi kozhi litsa: opyt kontaktnoi lazernoi ékstsizii.

A clinical review is provided of 1558 neoplasm cases of facial skin new growth of different origin and site. The technique of YAG-Nd laser in contact mode application is described. Specific postoperative features are correlated with tumor extension, its histological type and site. In all the cases, except skin papillomatosis, there were no primary recurrences.

[Laser diaphanoscopy for inflammatory diseases of the paranasal sinuses]. / Lazernaia diafanoskopiia pri vospalitel'nykh zabolevaniiakh pridatochnykh pazukh nosa.

After puncture or catheterization of the accessory nasal sinuses, the intensity of helium-neon laser inserted into the cavity under examination was recorded by means of a specially designed manipular. The laser beam intensity that penetrated the wall was found to correspond to the degree of its inflammation. The high level of objective information obtained allows assessment of pathological developments and therapeutic effectiveness.

[Laser surgery of cicatricial laryngeal stenosis]. / Lazernaia khirurgiia rubtsovykh stenozov gortani.

The authors consider possibility of using surgical lasers for treatment of cicatricial laryngostenosis (CL); present classification of stenoses depending on the causes and location; emphasize advantages of high-energy laser vs conventional methods (reduced blood loss, no need in previous tracheotomy or laryngofissure, minimal reactive changes, rapid epithelization); describe the procedure of laser radiation and its variants depending on tumor location in the larynx.

[Computed tomography in the diagnosis of postoperative changes of paranasal sinuses]. / Kompíuternaia tomografiia v diagnostike posleoperatsionnykh izmenenii v okolonosovykh pazukhakh.

Basing on the evidence obtained at examinations of 37 patients within 15-year follow-up after surgery on the maxillary and ethmoidal sinuses, the authors analyse potentialities and techniques of computed tomography in diagnosis of the developments in operated on paranasal sinuses. CT demonstrated advantages in examination of paranasal sinus walls and soft tissue alterations in them.

[Diagnosis of postoperative changes in the frontal and maxillary sinuses]. / Diagnostika posleoperatsionnykh izmenenii v lobnykh i verkhne- cheliustnykh pazukhakh.

The paper specifies x-ray picture of surgically treated frontal and maxillary sinuses in uneventful healing without inflammation relapses (30 cases), in relapse of purulent (21 sinuses), purulent-polypous (15 sinuses), polypous (4 sinuses) sinusitis, in pain syndrome in the region of the operated on maxillary sinus projection (7 patients). X-ray symptoms of postoperative changes in the sinuses, varying in clinical course, are characterized.

[Provision of artificial ventilation of the lungs during endolaryngeal surgical interventions using a high-energy laser]. / Obespechenie iskusstvennoi ventiliatsii legkikh pri éndolaringeal'nykh khirurgicheskikh vmeshatel'stvakh s ispol'zovaniem vysokoénergeticheskogo lazera.

To ensure controlled lung ventilation in endolaryngeal surgical interventions, using a high-energy laser, use was made of normal frequency jet ventilation (NFJV) and high frequency jet ventilation (HFJV) through a non-inflammable fluoroplast catheter supplied at a distal end with a device fixing it in a central position. HFJV seems preferable, as endolaryngeal manipulations become more convenient. The study was performed in 118 patients. Venturi effect was observed only during ventilation through a tracheostomic canule. It has been established that, unlike NFJV, in HFJV gas exchange parameters are much better, though oxygenation in NFJV is satisfactory in all the patients.