Cause of death based on systematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic.

IMPORTANCE: Assessment of the causative association between the COVID-19 and cause of death has been hampered by limited availability of systematically performed autopsies. We aimed to present autopsy-confirmed causes of death in patients who died with COVID-19 and to assess the association between thrombosis and diffuse alveolar damage consistent with COVID-19 (DAD). METHODS: Consecutive forensic (n = 60) and clinical (n = 42) autopsies with positive post-mortem SARS-CoV-2 PCR in lungs (age 73 ± 14 years, 50% men) were included. The cause of death analysis was based on a review of medical records and histological reports. Thrombotic phenomena in lungs were defined as pulmonary thromboembolism (PE), thrombosis in pulmonary artery branches or microangiopathy in capillary vessels. RESULTS: COVID-19 caused or contributed to death in 71% of clinical and 83% of forensic autopsies, in whom significant DAD was observed. Of the patients with COVID-19 as the primary cause of death, only 19% had no thrombotic phenomena in the lungs, as opposed to 38% amongst those with COVID-19 as a contributing cause of death and 54% amongst patients whose death was not related to COVID-19 (p = 0.002). PE was observed in 5 patients. Two patients fulfilled the criteria for lymphocyte myocarditis. CONCLUSIONS: Vast majority of all PCR-positive fatalities, including out-of-hospital deaths, during the SARS-CoV-2 pandemic were related to DAD caused by COVID-19. Pulmonary artery thrombosis and microangiopathy in pulmonary tissue were common and associated with the presence of DAD, whilst venous PE was rarely observed. Histology-confirmed lymphocyte myocarditis was a rare finding.

[Neoplasms of the upper respiratory tract and ear]. / Novoobrazovaniya verkhnikh dykhatel'nykh putei i ukha.

Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.

[The functional outcomes of open vertical resections of the larynx]. / Funktsional'nye rezul'taty posle otkrytykh vertikal'nykh rezektsii gortani.

The early diagnostics of the malignant tumours of the larynx provides a basis for the timely beginning of their conservative treatment and endolaryngeal surgical interventions. However, neither the conservative treatment nor endolaryngeal surgery ensures the sufficiently efficient treatment when the tumour spreads over the anterior commissure, subglottic space, and/or laryngeal ventricles. The open surgical resection of the larynx is indicated for the management of the patients presenting with this condition. Our experience is based on the performance of vertical resection of the larynx in 98 patients including the fronto-lateral and extended fronto-lateral interventions in 63 and 35 of them, respectively. The formation of the malignant tumour is known to result in the alteration of the acoustic characteristics of the patient's voice as compared to the initially normal ones in the preceding period. Specifically, the mean values of the fundamental tone frequency increases, the intensity of the sound signal decreases, and the amplitudes of the fundamental tone harmonics tend to be reduced. At the same time, both the dispersion and the variability of the acoustic characteristics being studied undergo an enhancement in comparison with the normal values. Open resection of the larynx with its simultaneous endoscopic correction made it possible to restore the respiratory and vocal functions in 90.8% and 92.1% of the treated patients respectively.

[Adenoid cystic carcinoma of the larynx: a case report]. / Nabliudenie adenokistoznogo raka gortani.

Adenoid cystic carcinoma is one of the rare pathological conditions affecting the larynx. It is known to develop from the glandula elements present in this organ. The authors report a clinical observation of adenoid cystic carcinoma in the form of an exophytic tumour of the pale pink colour having a smooth surface and the well-pronounced vascular patterns at the base. The neoplasm is localized in the arytenoid and retroarytenoid cartilage regions. Being of 3.5-4 cm in size, the tumour causes the narrowing of the larynx in its posterior portions and restricts its mobility. Bearing in mind the considerable extension of the neoplastic process, we undertook laryngectomy including the resection of the orolaryngopharynx and the cervical portion of the oesophagus, the subtotal resection of the thyroid gland and the simultaneous reconstruction of the orolaryngopharynx.

BASIC PRINCIPLES OF MODELLIND OF FACIAL COMPOSITE TISSUE ALLOGRAFTS.

The article presents the results of anatomical studies aimed to develop modelling of facial allografts taking into account the peculiarities of blood supply. The allografts should meet both aesthetic and functional needs of the recipient for further use in clinical practice. There were selected 3 facial composite tissue allografts out of 50 modifications, which are more suitable for required parameters. On basis of these data, there was successfully performed the facial composite tissue allograft transplantation on the patient.

[Assessment of speech quality in patients with resected larynx].

The organ salving treatment of laryngeal neoplasms including their surgical resection at one of the stages was given to 25 patients. They were further followed up for the assessment of vocal function. Analysis of speech was performed by a group of 5 auditors. They counted how many times each patient heard a consonant as a sonant and vice versa. Based on the analysis of mistakes, the patients were divided into the following three groups: group 1 (many mistakes), group 2 (moderate number of mistakes), an group 3 (practically no mistakes). The most common mistake was devocalization of voiced sounds. Postoperative analysis of speech quality characteristics revealed their dependence on the extent of surgical intervention, the presence of tracheostoma, the type of plastic correction, and the dose of radiation therapy. It was shown that extensive and combined frontal-lateral resection leads to voice impairment. Tracheostoma also have negative effect on speech discrimination.

[Minor surgery in laryngeal cancer].

The article presents the results of conservative surgery in 102 patients with laryngeal cancer T2 and T3. Frontolateral laryngeal resections in different variants (endoprosthesis, extended, an inferior variant) were conducted in 85 (83.3%) patients, horizontal laryngeal resection - in 17 (16.7%) patients (a combined variant -in 2 of them). The treatment resulted in primary healing of a postoperative wound in 92 (90.2%) patients. Complications consisted in development of pharyngeal fistula, suppuration of the postoperative wound, first of all in combined and extended resections, after a total dose of radiotherapy. Minor operations on the larynx enabled decannulation of 98 (96.1%) patients. Four (3.9%) patients continue to carry cannula because of marked scarry alterations.

[Clinical implications of laryngeal echosonography in cancer diagnosis].

Laryngeal echosonography was made in 50 healthy subjects and 186 patients with laryngeal cancer to evaluate efficacy of ultrasound in diagnosis of laryngeal cancer. The study revealed sonographic characteristics typical for laryngeal cancer, endophytic tumors, in particular. Ultrasound can assess involvement of the laryngeal cartilages and severity of their lesion, invasion of the tumor into the underlying tissues and cervical organs. The tumor can be verified by puncture aspiration biopsy using ultrasound monitor. All this allows more effective choice of an optimal treatment method and planning of the scope of surgical intervention.