[The modern aspects of the treatment of the patients presenting with bilateral laryngeal paralysis depending on the duration of the disease]. / Sovremennye aspekty lecheniia bol'nykh dvustoronnim paralichom gortani v zavisimosti ot dlitel'nosti zabolevaniia.

AIM: the objective of the present study was to increase the functional effectiveness of the combined treatment of the patients presenting with bilateral laryngeal paralysis on the basis of the development of a medical diagnostic algorithm taking into consideration the peculiar etiological and pathogenic features of the clinical course of the disease. The study included 102 patients suffering from bilateral paralysis of the larynx. The duration of the disease varied from 2 months to 26 years. All the patients underwent the preoperative preparation followed by laryngoplasty surgery for unilateral myoaritenoidchordectomy. The patients who had no tracheostoma at admittance were treated by simultaneous tracheostomy and laryngoplasty. The study made it possible to identify the factors that exerted the adverse influence on the outcome of the operation, such as prolonged cannulation, a protracted course of the disease (for more than 1 year), longer periods of recovery of the external respiration function characteristics, increased duration of the hospitalization and rehabilitation periods that lasted over more than one year, and a rise in the number of the patients carrying the cannulas. Taken together, the proposed algorithm for the examination and treatment of the patients presenting with bilateral laryngeal paralysis, the early diagnostics of the disease, and the differential approach to its treatment made it possible to reduce the frequency of the immediate and long-term postoperative complication and decrease the duration of hospitalization and rehabilitation of the patients.

[The iatrogenic complications of tracheostomy]. / Iatrogennye oslozhneniia trakheostomii.

The objective of the present study was to analyze the complications of tracheostomy associated with bleeding from the brachiocephalic trunk. A total of 13 protocols of the autopsy study of the patients who had died in the intensive care unit were available for the analysis. These patients had experienced heavy external bleeding from the tracheostomy defect shortly before death. The study has demonstrated that all the victims had the tracheostomy hole localized below the level of the standard dissection of the tracheal rings. Nine patients presented with a damage to the brachiocephalic trunk while four others had a pressure injury to the blood vessels. The study included the elucidation of the possible relationship between the anthropometric characteristics of the patients and the variability of the passage of the brachiocephalic trunk in front of the trachea. The length of the neck was found to usually correlate with the length of the body and the brachiocephalic trunk to run in front of the trachea at the level of its 8th-11th rings. The results of the present study may be instrumental in reducing the risk of complications after tracheostomy.

[The diagnostics and treatment of bilateral paralysis of the larynx]. / Diagnostika i lechenie dvustoronnego paralicha gortani.

The objective of the present study was to consider the currently available methods for the diagnostics and treatment of the patients presenting with bilateral paralysis of the larynx of various etiologies. We undertook the analysis of the publications in the domestic and foreign scientific literature concerning diagnosis and treatment of bilateral paralysis of the larynx. It was found that despite the existing modern high-tech diagnostic technologies and the variety of surgical methods for the treatment of this condition, the problem of diagnostics, management, and rehabilitation of the patients suffering from bilateral paralysis of the larynx remains a serious challenge for the researchers and clinicians that requires further investigation of this pathology. For the correct and timely diagnosis of bilateral paralysis of the larynx, the comprehensive evaluation of the functional state of the neuromuscular apparatus of the larynx is necessary. The key prerequisites for the success of the surgical intervention are its timeliness and the choice of the optimal surgical modalities.

[Activity of Retrosplenial Neurons during the First Days and after a Week Following the Learning of the Operant Food-Acquisition Task].

Activity of single neurons in the retrosplenial cortex of rats during realization of the operant food-acquisition behavior was recorded. In the first group of rats the recordings were made in the first six days after learning of the task and in the second group--following a week of a rest after learning. There were no significant differences in proportion of neurons specialized in relation to the learned behavior; however in the first group 40% of these cells had specific activations only in 80-90%, but not in all (100%) realizations of their specific behavioral acts, while in the second group there were much less relative numbers (4%) of such cells. All neurons with not-100% activations on the early stages after the learning were specialized in relation to acts of approaching and pressing the pedal that rats acquired on the last session of learning. It could be supposed that during the first stages of consolidation of the operant skill some variable set of retrosplenial cortex neurons specialized to new behavioral acts can be involved.