Vol 21, No 11 (2019)


The role of functional and anatomical disorders of the esophagus and stomach in the development of laryngeal pathology: review article

Starostina S.V., Makhov V.M., Bolshakov A.V.


The increased attention of clinicians to gastroesophageal reflux disease (GERD) is associated with a clear tendency to increase the frequency of the disease, the severity of its course, as well as the possibility of developing serious complications and the presence of a large number of extraesophageal manifestations, significantly reducing the quality of life of the patient. The most versatile extraesophageal manifestations of reflux disease are otorhinolaryngological, of which special attention should be paid to reflux-associated laryngeal pathologies, the symptoms of which are the most numerous and may be the only manifestations of gastroesophageal reflux disease. This article assesses the influence of GERD on the clinical and functional state of the larynx and its dynamics against the background of antireflux therapy, as well as the prognosis of the development and course of benign and precancerous diseases of the larynx.
Consilium Medicum. 2019;21(11):9-14
pages 9-14 views

Possibilities of regenerative medicine in otorhinolaryngology (literature review)

Svistushkin V.M., Starostina S.V., Svistushkin M.V., Pobivantseva A.A., Arkhipov M.V.


During last 30 years the tissue engineering from theoretical area of scientific interest turned into the wide practical field for experiment. Skin, bone tissue, cartilage, blood vessels are just some examples of organs and tissues that, thanks to regenerative medicine, can be created in the laboratory. At the moment it is difficult to find a field of medicine where the development of tissue engineering and cell therapy would not be in demand. Otolaryngology is no exception. Globally for researchers in regenerative medicine, there are 3 areas of interest: the study of cells, the possibility of using native and synthesized bio-scaffolds, the use of various recombinant growth factors and other cellular targets. The possibilities of regenerative medicine in the field of otolaryngology are extremely wide, which is explained by the large variability of diseases. Otiatry, rhinology, laryngology - dozens of promising preclinical and clinical studies are being conducted in each of the areas today, the results of which in the near future will significantly expand the use of minimally invasive treatment methods. One of the few factors holding back even more rapid development of this area remains the imperfection of the regulatory framework and the discrepancy between the quality of preclinical studies and the requirements of ethical committees. Many open questions require immediate solutions, because the promise of continuing research towards the development of regenerative technologies is obvious. The restoration of tissues and their functions in otorhinolaryngology with the methods of regenerative medicine will make it possible to solve problems that previously seemed impossible.
Consilium Medicum. 2019;21(11):15-19
pages 15-19 views

Differentiated approach to the treatment of sore throat

Maltseva G.S.


The article discusses in detail the pathophysiological mechanisms of pain, as well as the most commonly used classification of sore throat in clinical practice. The use of systemic antibacterial drugs based on Centor criteria is recommended. The rationale for the use of topical drugs in the treatment of sore throat is given. The main groups of topical preparations, their advantages and disadvantages are considered. A diagnostic and therapeutic algorithm for the actions of a doctor in a patient with a sore throat is presented.
Consilium Medicum. 2019;21(11):20-23
pages 20-23 views

Features of the microflora of the pharyngeal biotope in the staff of the medical hospital: some aspects

Svistushkin V.M., Nikiforova G.N., Asriyan G.G., Karpova O.I.


The microbiota of the human body - a combination of microorganisms that live on the skin and mucous membrane - is the basis of its microecology and has a direct impact on vital activity, health and quality of life. The normal human microbiota is represented by various organisms, but bacteria are the most significant link. Pharyngeal microbiocenosis is formed from the birth of a child as a result of mixing the flora of the oral cavity and the nasal cavity, due to which it is quite diverse. The species composition of the resident (indigenous, autochthonous) human microbiota is quite constant, however, a number of factors, including professional activity, can influence the number of microorganisms and the structure of the transient (allochthonous) component of the biocenosis. Data on the characteristics of microbiotopes in individuals of various specialties will allow us to assess the risks of a number of pathological processes and develop a set of effective preventive measures. Scientific data on the composition of the microbiota of the pharynx of medical workers is rather scarce, although hospital staff are always involved in the epidemic process of nosocomial infections and are involved in maintaining the circulation of microflora in a medical institution. In this regard, the need to study the characteristics of the microflora of the pharynx in medical personnel of a multidisciplinary hospital is not in doubt.
Consilium Medicum. 2019;21(11):24-27
pages 24-27 views

Pharmacodynamic effects of nicotine mouth spray and cytisine tablet. A study in adult healthy smokers

McCaffrey V., Hansson A., Perfekt R.


The relief of cigarette craving is crucial to increase the success rate of attempts to quit smoking. Temporary relief of cigarette cravings is the therapeutic indication of nicotine replacement therapy. Cytisine is a plant-based alkaloid that is specifically indicated in the management of nicotine dependence. The aim of this open-label, single-dose, randomized, crossover study was to compare the urge-to-smoke in 59 abstinent smokers, who followed an overnight 12-hour nicotine abstinence period, following two consecutive sprays of nicotine mouth spray 1 mg nicotine/spray or one 1.5 mg cytisine tablet on separate treatment days, separated by a washout period of at least 36 hours. Urges to smoke were scored on a visual analogue scale. The results of this study indicate that the onset of relief of urges to smoke following use of nicotine mouth spray 2¥1 mg is substantially and statistically significantly faster than that of cytisine tablet 1.5 mg.
Consilium Medicum. 2019;21(11):28-33
pages 28-33 views

Eosinophilia as a predictor of recurrent course polypoid rhinosinusitis after surgical treatment

Svistushkin V.M., Chichkova N.V., Pshonkina D.M.


Introduction. Respiratory diseases, in particular polypoid rhinosinusitis and bronchial asthma, occupy one of the first places in the overall structure of morbidity. The recurrent course of polypoid rhinosinusitis determines the uncontrolled course of bronchial asthma in patients with combined pathology. Achieving the control of bronchial asthma and polypoid rhinosinusitis is the main goal of maintaining this category of patients. Aim. The objective of this study was to investigate the role of biological markers in predicting the early recurrence of polypoid rhinosinusitis after endoscopic polysinusotomy. Materials and methods. The study involved 73 patients diagnosed with polypoid rhinosinusitis and polypoid rhinosinusitis in combination with bronchial asthma. All patients underwent bilateral endoscopic polysinusotomy followed by dynamic observation during the year. The dynamics of blood eosinophilia and the number of nasal secretion eosinophils were evaluated. A morphological examination of the tissue of distant polyps was performed. Conclusions. It has been shown that the eosinophilic nature of polyps as well as a sustained increase in the number of blood eosinophils and nasal secretions are prognostically unfavorable factors for an early relapse of the polypoid rhinosinusitis.
Consilium Medicum. 2019;21(11):34-37
pages 34-37 views

Using of nasal decongestants in the сomplex treatment of patients with acute rhinosinusitis

Starostina S.V., Selezneva L.V.


The aspects of the clinical use of nasal decongestants in acute rhinosinusitis, in the pathogenesis of which the nasal mucosa plays a key role, are considered. Convincing evidence of the need to use nasal decongestants in the treatment of acute rhinosinusitis is presented. A modern topical nasal therapy of acute rhinosinusitis is presented in the practice of an otolaryngologist.
Consilium Medicum. 2019;21(11):38-41
pages 38-41 views

Adequate pharmacotherapy of allergic rhinitis

Morozova S.V., Keda L.A.


In 2016, the percent of people in Europe suffering from allergic rhinitis is up to 28.5%. The prevalence of allergic rhinitis in the Russian Federation is from 10 to 24%, while allergic rhinitis is among the three most common diseases, after cardiovascular disease and oncology. Allergic rhinitis is characterized by sneezing, itching in the nasal cavity, nasal congestion and rhinorrhea. Intermittent allergic rhinitis is characterized by symptoms less than 4 days a week or less than 4 weeks a year. Persistent allergic rhinitis is characterized by the course of symptoms more than 4 days a week or longer than 4 weeks a year. There are mild, moderate and severe allergic rhinitis, which differ in the severity of symptoms and influence on the quality of life of the patient. Allergy caused by fungal pathogens is also called mycogenic and is divided into 2 classes: exogenous, when the fungal allergen enters the body from the outside and endogenous in the presence of a focus of fungal infection in the body. Ebastin is the optimal drug of the group of H1-histamine receptor blockers of the II generation, has a high safety profile and a convenient dosing regimen. The efficacy of ebastin has been demonstrated in a number of clinical studies and observations.
Consilium Medicum. 2019;21(11):42-46
pages 42-46 views

The use of high-technology methods in surgical treatment of patients with chronic rhinitis

Svistushkin V.M., Sin'kov E.V., Shchennikova E.S., Sobolev V.P., Karpova O.I.


Surgical treatment of patients presented with chronic rhinitis is a current problem in otorhinolaryngology due to it’s high prevalence. Nasal symptoms worsen quality of life considerably and contribute to development of airway pathology. The present paper provides the review of high-energy surgical techniques for treatment of patients with chronic rhinitis along with advantages and disadvantages of every technique.
Consilium Medicum. 2019;21(11):47-49
pages 47-49 views

Actual antibacterial therapy for inflammatory diseases of nose and paranasal sinuses

Karpishchenko S.A., Bolozneva E.V.


The article presents a literature review of the problem in paranasal sinuses inflammatory diseases. Various forms of sinusitis, their diagnostic criteria, management algorithm are considered in detail. Different forms of inflammatory diseases of paranasal sinuses have different etiology and pathophysiology, but the basics of drug therapy are almost identical. The appointment of systemic antibacterial therapy is always justified and is not in doubt due to rhinogenic and to odontogenic rhinosinusitis. Antimicrobials are sometimes not prescribed in posttraumatic changes in the paranasal sinuses. Trauma of the nasal mucosa leads to a rough sharp violation of the microbiota of the nasal cavity, thereby significantly increasing the risk of infection and the development of purulent complications. Appointment of adequate systemic antibiotic therapy has a positive effect on the outcome of the current inflammatory process. Timely prescribed antimicrobials in reasonable required dosages can prevent the risks of intracranial and orbital complications in acute and exacerbations of chronic sinusitis, nasal furuncle. In order to prevent the development of complications in the early postoperative period, patients are also prescribed antibiotics. Drugs of choice are penicillins or cephalosporins. In practice, the combination of amoxicillin with clavulanic acid proved to be good in the practice of ENT hospital.
Consilium Medicum. 2019;21(11):50-56
pages 50-56 views

Possibilities of pathogenetic therapy of patients with inflammatory diseases of the paranasal sinuses

Svistushkin V.M., Nikiforova G.N., Shevchik E.A., Zolotova A.V., Dedova M.G., Karpova O.I.


Rhinosinusitis is one of the most common pathological process in the human population. Principles of treatment of patients with rhinosinusitis are reflected in the Russian and international clinical guidelines, which are regulary revisied. Inflammation during rhinosinusitis causes the block of natural anastomoses of paranasal sinuses, violation of aeration, inactivation of mucociliary clearance and stagnation of fluid in the lumen of the sinuses. In uncomplicated rhinosinusitis the main goal of therapy is the elimination of the inflammatory process and restoring of the sinuses normal functioning. The most effective drugs are intranasal corticosteroids that are recommended as monotherapy in post-viral rhinosinusitis, or in combination with systemic antibiotic therapy in patients with bacterial rhinosinusitis. For the treatment of rhinosinusitis only mometasone is registered in our country. There are several mometasone drugs from different manufacturers, including mometasone nasal spray of the pharmaceutical company TEVA, Dezrinit. Research results confirm that Dezrinit meets the same quality standards as the original drug.
Consilium Medicum. 2019;21(11):57-62
pages 57-62 views

Diagnostic value of magnetic resonance imaging of inner ear in patient with Meniere’s disease: case report

Svistushkin V.M., Morozova S.V., Varosyan E.G., Stepanova E.A., Mukhamedov I.T., Bidanova D.B.


Diagnosis and treatment of Meniere's disease is difficult. There is no gold standard for testing. The diagnosis of Meniere's disease is confirmed on a natural history and audiometric data. Further diagnostic methods include the dehydration test and electrocochleography. Magnetic resonance imaging (MRI) inner ear with intratympanic gadodiamid administration allows to assess the degree and prevalence of endolymphatic hydrops. This study describes a clinical case estimate MRI of endolymphatic hydrops in patients with Meniere's disease before and after surgery. Pertinent data of MRI of inner ear with appropriate correlations with disease patterns.
Consilium Medicum. 2019;21(11):63-66
pages 63-66 views

Advantages of complex treatment in patients with sensorineural hearing loss of vascular genesis

Morozova S.V., Keda L.A., Popova O.I.


According to epidemiological data, sensorineural hearing loss (SHL) is widespread, especially in industrialized countries. SHL has a high prevalence and a large number of etiological factors and is classified according to several indicators: the severity of hearing loss, the time of occurrence, the nature of the course and the side of the lesion. Examination of a patient with complaints of hearing loss includes an audiological examination, the study of the lipid profile, to exclude organic brain damage, magnetic resonance and computed tomography is used. Vascular genesis of SHL is widespread. There is evidence of hereditary predisposition to vascular etiology of acute SHL, as well as a high prevalence of dyslipidemia among this group of patients. Nootropic drug Gliatilin, the active substance of which is choline alfoscerate, is actively used in neurological practice and has a high activity in in restoring cholinergic transmission and stabilizes neuronal membranes. The use of this drug in angiogenic SHL will increase the effectiveness of therapeutic measures in this pathology.
Consilium Medicum. 2019;21(11):67-70
pages 67-70 views

Changes the level of the acute phase proteins during the treatment of patients with pulmonary tuberculosis combined with diabetes mellitus

Abdullaev R.Y., Komissarova O.G., Berezhnaia O.O., Romanov V.V.


Aim. The study of the dynamics of acute phase proteins in the process of complex treatment of patients with tuberculosis, combined with different types of diabetes mellitus, before and during treatment. Materials and methods. We studied 100 patients with pulmonary tuberculosis, which were divided into 2 groups. The first group included 40 patients with pulmonary tuberculosis in combined with type 1 diabetes. The second group consisted of 60 patients with pulmonary tuberculosis in combined with type 2 diabetes. The levels of C-reactive protein, serum amyloid protein A, a1-antitrypsin (a1-АТ), haptoglobin and fibrinogen were determined. Studies were performed prior to and on a monthly basis during the first 6 months of complex treatment. Results. By the end of the 6-month effective treatment, the level of most phase proteins (APPs) in patients with both types of diabetes returned to normal, but a moderate increase in a1-AT remained, indicating that the inflammatory process was incomplete and, possibly, due to activation of limited proteolysis reactions during reparative processes. At the same time, individual indicators changed in patients with different types of diabetes at different rates. Normalization of most acute-phase reactants during effective treatment in patients with type 2 diabetes was slower. The different rates of reduction and normalization of individual APPs in patients with different types of diabetes, apparently, was associated with the peculiarities of the deflation of their protective reactions of the body as they overcome the infectious aggression and resorption of the inflammatory substrate. With ineffective treatment, the positive dynamics of C-reactive protein and serum amyloid protein A was slow and incomplete, and the initially high values of a1-AT and haptoglobin did not change throughout the duration of treatment. Conclusions. It was found that in patients with combined pathology, the dynamics of changes in the levels of the acute APPs was directly related to its effecacy.
Consilium Medicum. 2019;21(11):71-75
pages 71-75 views

Pulmonary infarction combined with nosocomial infection with Klebsiella pneumoniae in a senile patient

Maltseva O.A., Kharitonov M.A., Salukhov V.V., Nikolaev A.V., Bogomolov A.B., Morozov S.L., Shevelev A.A.


A clinical case of successful treatment of pulmonary embolism in an elderly patient is presented. The course of the disease was complicated by nosocomial infection Klebsiella pneumoniae with the formation of a lung infarction and destruction of lung tissue. Infarction-pneumonia proceeded on an unfavorable background, the patient was diagnosed with atrial fibrillation and infectious-toxic nephropathy. The source of thromboembolism in the inferior Vena cava system was established. The combination of lung infarction and pneumonia caused by K. pneumoniae is one of the main features of this observation, since each disease itself can lead to a lung abscess. The importance of bacteriological research aimed at verification of the causative agent of pneumonia was noted. Taking into account the revealed multiresistance of the pathogen, traditional antibacterial drugs at the first stages of treatment were ineffective.
Consilium Medicum. 2019;21(11):76-79
pages 76-79 views

Granulomatosis with polyangiitis (Wegener's granulomatosis): variety of clinical and radiological manifestations

Koroleva I.M., Chichkova N.V., Sokolina I.A., Buncheva A.V.


Currently, the issue of radiation diagnosis of systemic vasculitis, clinical and radiological manifestations of which are very variable, remains relevant. There is a stable opinion about the traditional x-ray imaging of this heterogeneous group of diseases and the sequence of lesions of organs and systems. However, not always typical clinical and radiological symptoms are so "typically consistent" according to generally accepted scientific views, which significantly affects the timing of diagnosis and the appointment of adequate therapy, its results and, as a consequence, the quality of life of patients. Our article presents our own observations of 17 patients, including 7 men, 8 women and 2 children, who underwent a full range of clinical, laboratory and x-ray examinations, including the most modern diagnostic methods.
Consilium Medicum. 2019;21(11):80-85
pages 80-85 views

Pulmonary embolism with "bone cement" during percutaneous vertebroplasty

Sinopal'nikov A.I., Tyurin I.E.


Percutaneous vertebroplasty (PCVP) is a minimally invasive intervention that is currently widely used to treat pain caused by vertebral fractures due to osteoporosis, trauma or tumor. Potentially serious complications of PCVP include pulmonary embolism with "bone cement" fragments that enter the paravertebral venous system and then via v. azygos and inferior vena cava reach the pulmonary arteria. The article provides a description of 2 cases of pulmonary embolism in patients undergoing PCVP due to vertebral hemangioma with severe pain.
Consilium Medicum. 2019;21(11):86-88
pages 86-88 views

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