[Endolaryngeal laser-assisted microsurgery of benign pharyngeal neoplasms: objective evaluation of functional outcome].

A new technique for endolaryngeal microsurgery is proposed. It based on the irradiation of benign laryngeal tumours using Ho:YAG and potassium-titanyl-phosphate (KTP) lasers. A total of 198 patients of either sex aged from 2 to 77 years with a variety of benign laryngeal neoplasms were treated by this method between 2004 and 2007. Its application allowed the results of the treatment to be optimized as confirmed by the statistically significant improvement of the external respiration function, acoustic characteristics of the voice, and positive dynamics of laryngeal endoscopic imaging data.

[Treatment of chronic tonsillitis: prognostic criteria of efficacy].

An original method of wedge dehydration of biological fluids assessing the ability for separation of organic and mineral constituents was for the first time used in patients with different forms of chronic tonsillitis (CT). The method was used in 102 patients aged 8-68 years with chronic inflammation of the palatine tonsils out of exacerbation. A dehydrated drop of tonsillar lacuna discharge (TLD), facia, was studied morphologically under microscope at small magnification (x10--x50). Three types of TLD facia were identified in CT patients. These types characterized severity of the pathological process in the palatine tonsils. Changes of facia type in patients with different CT forms were compared. Basic regularities in the disease progress were determined. This enabled prognosis of a further course of CT in an individual patient and, therefore, planning treatment policy for each case.

[Therapeutic exercise in combined treatment of patients with laryngo- and tracheostenosis].

It is shown that staged individual special respiratory exercises targeted at nervous-muscular apparatus of the pharynx and trachea improve external respiration function, activate blood flow and venous-lymphatic outflow in the neck area with stimulation of reparative processes in combined postoperative treatment of patients with cicatricial stenoses of the pharynx and trachea.

[The problem of treatment in patients with laryngeal and tracheal stenoses, as viewed by an ENT specialist].

Based on their 40 years' clinical experience in treating patients with laryngeal and cervical tracheal stenoses of various etiology, the authors consider that circular trachectomy, by anastomosing laryngeal cartilages, may be performed by highly skilled specialists only at specialized and well-equipped institutions. In cases of chondroperichondritis of cartilages of the larynx or trachea in the presence of paralysis of the vocal folds, it is necessary to make stepwise reparative and plastic operations that can be performed at the ENT clinics having experience in laryngeal surgery.

[Clinico-anatomic characteristics of the tip of the nose].

The anatomy of the tip of the nose is reviewed with description of clinical manifestations in different variants of anatomical structures of the tip of the nose. Thick skin problem and specific features of surgical treatment of nasal tip deformities in thick, porous skin are considered.

[Long-term surgical outcomes in congenital malformations of the floor of the auricle].

The authors analyse long-term outcomes of surgical treatment of congenital defects of the floor of the auricle. They came to the conclusion that surgical techniques used in the correction of the defects need some modification. In the presence of a wide, elastic ascending crus of the helix, when creating the anthelix, the crus should be made finer. In the presence of a large and wide scaphoid fossa it should be made smaller. After reduction of the floor of the auricle the margin of the auricle should be shortened.

[Differentiated approach to medicine phonophoresis in complex treatment of cicatrical deformations].

135 patients aged 18 to 55 years with cicatrical alterations in the larynx were under observation. The treatment included phonophoresis of contractubex, colitin and elastolytin. The study found the necessity to take into account the age of cicatrical deformations when treating them. The most effective in treatment of formation cicatrices (6 to 12 days old) are medicines containing heparin (contractubex), which prevent the formation of pathologic cicatrices (keloid and hypertrophic ones). After the formation of the cicatrice is completed, medicines containing enzymes are more effective, because these "garnet" collagen and thus favor the mechanism of the reversion of pathologic cicatrical formation.

[Clinicofunctional parallels in posttraumatic deformities of the nasal tip].

The analysis of different posttraumatic deformities of the nasal tip gave evidence for a close correlation of internal nose deformities with nasal breathing ranging from common changes in the internal nose (hypertrophy of the inferior turbinated bone) to atresia when nasal breathing is completely blocked. Because of tissue edema, respiration improved and normalized only 1 and 3 months after surgery. It is concluded that functional examinations before and after surgery are beneficial for patients and warrant optimal terms of surgery.

[Interrelations of lysosomal enzymes of leukocytes in patients with cicatricial stenosis of the larynx]. / Vzaimosviazi lizosomal'nykh fermentov leikotsitov u bol'nykh s rubtsovym stenozom gortani.

Activities of acid and alkaline phosphatases, cathepsin B, leucine aminopeptidase, N-acetyl-beta-D-hexosaminidases, beta-D-galactosidase and beta-D-glucuronidase were studied in leukocytes of two groups of patients with normal and pathological healing of wounds after surgical treatment of scar stenosis of larynx. Analysis of the enzymatic activity, calculated by means of Student's test using the data of a single estimation of the activity in leukocytes before surgical treatment, did not exhibit any distinct differences in these two groups of patients. The study of interrelationship between the activities of individual enzymes by means of principles of regression analysis enabled to show that the enzymes studied were in the positive regressive relation. Pattern of enzymatic activity in leukocytes of patients with pathological wound healing was distinctly different from that of patients with normal healing in the shape of regression and, especially, in relaxation of the interrelations between phosphatases and other enzymes. The principle of regression enabled to evaluate the prognosis of postoperative development of wound healing using the preliminary estimation of enzymatic activity in leukocytes of patients with scar stenosis of larynx.

[Post-traumatic rehabilitative treatment of hollow neck organs]. / Puti sovershenstvovaniia vosstanovitelnogo lecheniia posledstvii travm polykh organov shei.

The attention of the reader is focused on the errors and shortcomings in rendering urgent emergency care for patients who underwent traumas of the neck hollow organs. The 30-year experience with 1000 patients managed by the authors convinced him of the necessity to consider more carefully the medical history of the patient, to use more frequently Killian's and Brunings's examinations, microlaryngoscopy, fibroendoscopy, x-rays. Restorative treatment becomes more effective under ultrasound and laser separation of the tissues, laryngochioido plexy, tracheopexy with establishment of the laryngeal patency and that of trachea. The technique is proposed for broadening the lumen of the cervical trachea in cicatricial stenosis and in going-on scarring in the thoracic trachea. The progress in the surgery of the neck hollow organs depends on adequate facilities and treatment policy.

[Contemporary status of the issues in the treatment of children with respiratory papillomatosis]. / Sovremennoe sostoianie problemy lecheniia detei s respiratornym papillomatozom.

For 15 years the authors treated 205 children aged 9 months to 15 years with respiratory papillomatosis. Besides surgical endolaryngeal removal of the papillomas, they applied immunomodulators, plasmapheresis and antiviral drugs. Of different methods of artificial lung ventilation, the best is thought to be transcatheter high-frequency artificial lung ventilation. As shown by the studies of infection resistance, the combined treatment should incorporate such drugs as zovirax and leukomax. Ultrasound disintegration and laser photodestruction with Ho laser were introduced in surgical removal of the papillomas. The combined treatment shortens the treatment duration and prolongs recurrence-free period.

[Surgical treatment of children with cicatricial stenoses of the larynx and trachea]. / Opyt khirurgicheskogo lecheniia detei s rubtsovymi stenozami gortani i trakhei.

The present authors recommend a modification of Ivanov's method suggested by their treatment of 41 children, aged 4 to 15 years; 12 patients suffered from stenosis and 29 patients from atresia of the larynx and trachea, which resulted from surgical intervention required by the complications of extended nasotracheal intubation and subsequent tracheotomy. The modified procedure is as follows. In order to enlarge the laryngeal or tracheal lumen, skin is cut and one or two triangle-shaped skin flaps are dissected; their tops are sutured to the anterior wall of the above organs cut along the median line. In order to distend the larynx, redressment of the cricoid cartilage is needed. He-Ne laser irradiation (of 20 mW/cm2 with a wavelength of 632.8 nm) and collagenase and elastase enzymes stimulate repair and prevent secondary cicatrization of post-operative wound. The lumen is formed using a T-shaped silicon tube. Out of 4 patients followed-up during the last 5 years, 21 were decannulated, 12 developed good laryngotracheostoma, 5 of which required suture of wound. Only 8 patients who had laryngotracheostoma needed surgical intervention due to repeated cicatrization. In 4 of these patients, allogenic cartilage was used for support, and polymer paste Polytel was applied to eliminate laryngeal, tracheal or esophageal fistulas.

[Differential approach to the use of drug ultraphonophoresis for scars]. / Differentsirovannyi podkhod k naznacheniiu lekarstvennogo ul'trafonoforeza pri rubtsakh.

A differential approach to administration of drug ultraphonophoresis (gel contractubex, collitin, elastolitin) in scarry deformations is proposed. The analysis of 82 treatment outcomes has shown that early after trauma (on day 6-12) it is more beneficial to use ultraphonophoresis (UPP) of heparin-containing compounds improving blood rheology, e.g. lidase. This prevents development of pathological scars. Later, when the scar tissues has already formed, more effective is UPP of enzyme medicines with fibrinolytic properties (collitin, elastolitin). Differentiated choice of UPP in scar therapy reduces the time of rehabilitation considerably.

[Assessment of changes in the course of nasal and paranasal inflammation]. / Otsenka dinamiki vospalitel'nogo protsessa v polosti nosa i okolonosovykh pazukhakh.

Direct joulemetry, a method of diagnosis of nasal and paranasal mucosa condition, is based on measurement of electric current work (CW) by electrochemical dissociation of biological fluids on the mucosa of the frontal sinus and its aperture. 27 patients had CW characteristics in three forms of inflammation: purulent, serous-fibrinous, exudative. The effectiveness of the method in follow-up of patients with frontal sinusitis is shown.

[Laser surgical unit "Glasser" (lambda = 1,54 microm) in otorhinolaryngology]. / Primenenie lazernoi khirurgicheskoi ustanovki "Glasser" (lambda = 1,54 mkm) v otorinolaringologii.

The paper describes experimental and clinical results obtained with application of laser radiation (wave length 1.54 microm). The source of the radiation was a new surgical laser unit Glasser. The techniques and advantages of the above radiation treatment are characterized.

[Updated laser technologies in otorhinolaryngology]. / Peredovye lazernye tekhnologii v otorinolaringologii.

Clinical trials have been conducted of a new therapeutic semiconductor laser from the Mustang series which generates laser radiation in red light range (0.63-0.65 mcm) in impulse mode. Laser therapy was given to 75 patients with different ENT diseases with good effect. A surgical laser unit CTH-10 (YAG-Ho laser, 2.09 mcm) has undergone pilot tests with good results in 12 patients with pain maxillofacial syndromes. Photodynamic therapy was used in upper respiratory tract cancer in 27 patients, the results are analysed.

[Improving surgical treatment of children with acquired cicatricial stenosis of the larynx and cervical part of the trachea]. / Ob optimizatsii khirurgicheskogo lecheniia detei s priobretennym rubtsovym stenozom gortani i sheinogo otdela trakhei.

Results of surgical treatment of 144 children with acquired cicatricial stenosis of the larynx and cervical compartment of the trachea were analyzed retrospectively. It was found that a temporizing policy was preferable after the first complaints were voiced. They should be operated no earlier than 18 months after stenosis development. In the case of insignificant cicatricial changes CO2 laser treatment was recommended whereas in the case of concentric large scars plastic surgery with an exterior access was to be used. Therapeutic results also depended on the etiology of the pathology. In children with cicatricial stenosis, that developed after intubation trauma of an intact larynx, the results were better. Repeated surgery of small scars produced a high success rate when CO2 laser was used between months 3 and 7. In the case of concentric scars surgical intervention was indicated during months 7-12 after the first operation, with laryngotracheoplasty being the method of choice.

[Current aspects and prospects of the combined treatment of respiratory papillomatosis in children]. / Sovremennye aspekty i perspektivy kompleksnogo lecheniia respiratornogo papillomatoza u detei.

Treatment methods and outcomes have been analyzed for 313 children aged 9 months-14 years with respiratory papillomatosis (RP) admitted to ENT clinic in 1950-1995. Beginning from 1982 papillomas were removed by means of ultrasonic disintegration. A novel approach included extracorporeal detoxication and immunocorrection. 85% of patients responded to treatment with discrete plasmapheresis and T-activin. It is concluded that best treatment results were achieved in combination of conventional methods with advanced modalities such as extracorporeal detoxication and immunocorrection.

[Use of transcatheter high-frequency artificial ventilation of the lungs in surgical treatment of obturating papillomatosis of the larynx and trachea in children]. / Primenenie chreskateternoi vysokochastotnoi iskusstvennoi ventiliatsii legkikh pri operativnom lechenii obturiruiushchego papillomatoza gortani i trakhei u detei.

Investigations of transcatheter high-frequency artificial ventilation of the lungs (THFAVL) in surgical treatment of obturating papillomatosis in children led the authors to the conclusion that this method is optimal in assisting breathing in operative intervention on the larynx. THFAVL is not feasible unless adequate expiration is provided. Hence, the high-frequency regimen must be acquired gradually under control of blood gases in parallel with reopening of rima glottidis with consideration of individual clinical situation. The most effective parameters of the above surgery are: P-1 kgs/cm 2; heart rate under 80 per minute; inhalation/expiration ratio 1:3, 1:4. The emergence of side effects can be prevented in coordinated actions of the surgeon and anesthesiologist.

[Correction of congenital of the lateral nose deformities]. / Korrektsiia vrozhdennykh deformatsii kontsevogo otdela nosa.

Immediate and remote results of perennial use of most popular correction methods in different types of congenital deformations of nose end (wide end -- according to J. Converse; prolonged end -- according to D. Armstrong and protruded end -- according to F. Burian) were analyzed and their drawbacks disclosed. The authors presented their own new techniques.