[Etiopathogenetic factors of wound healing in chronic post-intubation cicatricial stenosis of the larynx and trachea]. / Etiopatogeneticheskie faktory zazhivleniya rany pri khronicheskikh postintubatsionnykh rubtsovykh stenozakh gortani i trakhei.

Despite the existing modern high-tech methods of examination and a variety of surgical treatment methods, the problem of diagnosis, treatment and rehabilitation of patients with chronic post-intubation cicatricial stenosis of the larynx and trachea still requires further study. Improving the understanding and correction of cellular, molecular genetic and biochemical disorders in a chronic wound is a key condition for increasing the efficiency of diagnosis, individual prognosis of the clinical course and the conduct of adequate therapeutic and preventive measures for post-intubation cicatricial laryngotracheal stenoses. In this regard, it seemed appropriate to analyze the existing etiopathogenetic factors of pathological wound healing in chronic post-intubation cicatricial stenosis of the larynx and trachea. Our attempt to summarize the available literature data demonstrated that laryngotracheal scars are a fibro-proliferative disease caused by aberrant wound healing after a damaging effect on the tissues of the larynx and trachea. The article describes the most pathogenetically significant healing, repair, and scarring factors in post-intubation laryngotracheal stenoses, including transforming growth factor ß1, vascular growth factor A, type I and III collagen, and matrix metalloproteinases. An assessment of the features of the diagnostic and prognostic significance of these markers will increase the effectiveness of the treatment of patients with chronic cicatricial stenosis of the larynx and trachea, and will also serve as a prerequisite for the development of strategies for diagnostic, treatment, prophylactic and rehabilitation measures that will improve the quality of medical care and the quality of life of patients with chronic cicatricial stenosis of the larynx and trachea.

[Tumor-like amyloidosis of the upper respiratory tract]. / Opukholevidnyi amiloidoz verkhnikh dykhatel'nykh putei.

The paper describes 11 cases of local tumor-like amyloidosis (LTA) of the upper respiratory tract, among which laryngeal amyloidosis was most common. The clinical diagnosis of suspected local amyloidosis was made in only two cases. The diagnosis of local amyloidosis was established at a morphological examination of a distant neoplasm, by using special Congo red staining followed by polarizing microscopy. Attention is drawn to the localization and sequence of amyloid deposition and morphological changes related to the age of patients and the duration of the disease. The paper discusses the nature of local amyloidosis as stromal vascular proteinosis with the deposition of AL amyloid (immunoglobulin light chain amyloid) that are formed apparently by local immunocytes of the mucosa-associated lymphoid tissue (MALT) system. It emphasizes the need for the clinical monitoring of patients with LTA to rule out systemic amyloidosis.

[The application of the modern technologies for the treatment of precancerous diseases of the larynx]. / Primenenie sovremennykh tekhnologii v lechenii predrakovykh zabolevanii gortani.

This article deals with the endolaryngeal methods for the surgical treatment of pre-cancerous diseases of the larynx with the use of up-to-date technologies and anesthetic support. The authors describe the original methods for endolaryngeal interventions based on the use of the CO2-laser. In addition, the results of the analysis of the data obtained during the immediate and delayed postoperative periods are presented.

[The relationship between eosinophilia and parameters of systemic and local adaptive immunity in patients with polypous rhinosinusitis].

Results of the study on adaptive immunity in patients with polypous rhinosinusitis (PRS) proved to depend on the degree of eosinophilia in the peripheral blood. The patients were allocated to two groups, one comprised of those having up to 150 eosinophils per 1 microliter the other of the patients with a higher eosinophil concentration. Patients of the former group had a significantly reduced number of CD3+, CD4+, CD8+, and CD20+cells in the peripheral blood that may indicate the necessity of administering immunotropic agents. The opposite picture is characteristic of the latter group in which a rise in the number of the above cells is associated with the increased amount of IgG- and IgA-positive cells. In this situation, the use of systemic immunotropic agents should be restricted. It is concluded that evaluation of systemic and local adaptive immunity is of importance for the choice of an adequate strategy for the treatment of patients with polypous rhinosinusitis.

[The dependence of Toll-receptor expression on pathomorphological features of nasal polyps in patients with polypous rhinosinusitis].

This work was designed to study expression of Toll 1-10 receptors on the surface of cells present in inflammatory infiltrate from nasal polyps and peripheral blood of the patients with polypous rhinosinusitis. It was shown that the intensity of expression depended on the pathomorphological characteristics of nasal polyps. Tissues removed from the patients with polyps of the oedematous type contained more Toll-10 positive cells and showed enhanced expression of Toll-5 receptors on monocytes and lymphocytes, Toll-3 receptors on monocytes, granulocytes, and lymphocytes, and Toll-9 receptors on granulocytes. In contrast, patients with polypous rhinosinusitis and nasal polyps of the fibroedematous type exhibited suppressed expression of Tol-7 receptors on monocytes and Toll-10 receptors on granulocytes coupled to the reduced number of Toll-6 positive lymphocytes as well as enhanced expression of Toll-1 receptors on monocytes, Toll-4 and Toll-5 receptors on granulocytes, and Toll-5 receptors on lymphocytes. It is concluded that only Toll-1, Toll-3, Toll-4, Toll-5, Toll-7, Toll-9 and Toll-10 receptors of their ten types identified thus far in patients with polypous rhinosinusitis and two pathomorphological variants of nasal polyps undergo modulation of expression. These findings open up prospects for the use of new methods for the management of patients with polypous rhinosinusitis by affecting selected components of congenital immunity.

[Novel methodological approaches to the evaluation of the immune status in sickly children with ENT organ pathology].

Principles of a novel methodology for the combined assessment of the immune function in sickly children with pathological changes in the organs of the otorhinolaringological system are expounded. The new approach includes investigations into local cellular and humoral immunity, evaluation of functional relationships and correlations between its parameters, interpretation of these findings, and the use of the characteristics thus obtained in the development of concrete recommendations for immunotropic and/or anti-inflammatory therapy. This approach is illustrated by examples of variations in the number of CD4(+) and CD20(+) cells and interplay between them. These findings taken together with the data on the levels of serum IgG, IgA, IgM, and percentage of immunohistochemical preparations positive for these immunoglobulins indicate that the proposed method may prove useful for the development of new therapeutic modalities for the treatment of sickly children with ENT organ pathology following adenotomy and tonsilotomy.

[The use of tranexamic acid as an anesthetic component in ENT surgeries in patients with high surgical-anesthetic risk and in hemorrhagic shock intensive therapy]. / Primenenie tranéksaminovoi kisloty v kachestve komponenta anestezii pri LOR-operatsiiakh u bol'nykh vysokogo operatsionno- anesteziologicheskogo riska i pri intensivno'i terapii gemorrhagicheskogo shoka.

Experimental and clinical trials have shown that anesthesia and intensive therapy of shock incorporating tranexamic acid enhance analgesia, hyporeflexia, thus ensuring stable, adequate anesthesia which is safe under reduced doses of standard anesthesiological modalities. Application of tranexamic acid provided more favourable course of postanesthesiological and postoperative periods, decreased the number of complications and lethal outcomes compared to standard anesthesia.

[Use of nonopiate agents for anesthesia in ENT patients at high surgical-anesthesiological risk]. / Primenenie neopiatnykh sredstv dlia anestezii u LOR-bol'nykh vysokogo operatsionno-anesteziologicheskogo riska.

Optimal methods of endotracheal anesthesia using non-opiate drugs of four classes (clofelin, transamine, contrykal, ketanes) have been fundamentally grounded developed and tried in extensive and traumatic operations for ENT malignant and vascular tumors as well as inflammation in patients of high anesthesiological operative risk. The drugs were used in 174 patients including 13 children. 87.9% of the patients had concomitant diseases: blood hypertension, coronary heart disease, chronic nonspecific pulmonary diseases, bronchial asthma, asthmatic bronchitis, diabetes mellitus, anemia. Adequate stable anesthesia was achieved in reduced dosage of conventional anesthesiological agents.