[A new variant of choanal polyps]

Seven cases of ethmochoanal polyps, a form of nasal polyps, originating from mucosa of the back ethmoidal labyrinth and lowering into the nasopharynx are described. Such polyps are diagnosed primarily by computed tomography and endoscopy of the nasal cavity. Histologically, ethmochoanal polyps are similar to other polyps from paranasal sinuses. Surgical treatment of ethmochoanal polyps is made under the control of endoscope via approach through the superior nasal passage. The polyp part situated in posterior compartment of the ethmoidal labyrinth was removed with a microdebrider. 1 to 3 year follow-up registered no cases of recurrence.

[Potentials for the endonasal endoscopic surgery in the treatment of maxillary cysts]

To evaluate efficacy of endoscopic surgery in the treatment of maxillary cysts (MC), 152 operations in 134 patients were analysed. Besides MC, 91% of the patients had additional involvement of the nasal cavity and middle nasal passage which required surgery. By computer tomography data, all the cysts were divided into four groups by wall location: posteroinferior, superior, lateral, medial or anterior. Such division is important for the choice of the surgical approach: cysts of the first three locations can be easily removed through the middle nasal passage, in medial and anterior cysts this approach is effective only in half the cases. In the rest cases the sinus was opened through the anterior wall. In all, removal of the cyst by the endonasal approach proved feasible in 73.7%, by the anterior wall--in 26.3% of cases. The algorithm proposed for the choice of optimal intervention implies the initial use of the external approach only in MC located on the anterior and medial walls in the absence of concomitant lesions. In all the other cases, surgery should begin with partial resection of the unciform process and revision of the natural anastomosis of the sinus.

[Choanal polyps: principles of current diagnosis and treatment]

Computed tomography, endoscopic investigation, surgical endoscopic revision of the paranasal sinuses performed in 20 patients with choanal polyps (CP) showed that according to their growth origin, CP may be antrochoanal, sphenochoanal and ethmochoanal (11, 3 and 6 patients, respectively). Thorough preoperative examination prevents opening of unaffected paranasal sinuses. However, when several sinuses are involved, site of CP fixation may be detected at surgery. Endoscopic techniques presented as a good alternative to routine polypotomy and Caldwell-Luc operation. In atypical CP location a differential diagnosis with inverted papilloma must be made.

[The incidence of detecting paranasal sinus pathology based on magnetic resonance and computed tomographic data]

The occurrence of alterations in the paranasal sinuses was investigated by NMR tomography in 107 patients with suspected sinusitis. Though clinical signs of sinusitis were not evident, NMR tomography revealed parietal mucosal thickening or exudate in 39.3% of the examinees. As to involvement of different sinuses, abnormality occurred most frequently in the maxillary sinus, less frequently in anterior ethmoidal cells, posterior ethmoidal bone, sphenoid and frontal sinuses (88.9, 78.6. 58.7, 34.1, 31.7%, respectively). Multisinus lesions were not rare.

[The Hummer Microdebrider--new technology in functional endonasal rhinosurgery]

Microdebrider "Hummer" was used for functional endoscopic sinus surgery (FESS) in 66 patients. Extent of the surgery varied from partial resection of middle turbinate to ethmoidectomy and opening of all sinuses. "Hummer" is the best device for accurate removal of polypoid and hypertrophic tissue from the middle turbinate, posterior end of the inferior turbinate and the nasal septum. Use of "Hummer" makes opening of maxillary and sphenoid sinuses and revision of the frontal and sphenoethmoidal recess much easier and safer. No complications occurred in this group of patients. Further studies are needed to answer the question whether or not use of microdebrider can improve distant results of FESS.

Do laws of biomechanics work in reconstruction of the cartilaginous nasal septum?

"Biomechanical" techniques can be used for correcting C-shaped or S-shaped nasal septum cartilage deformities. These include mucoperichondrium elevation on the concave side, trimming cartilage to its necessary size, incisions to release cartilaginous bends and strip resections. Resection and reimplantation of cartilage are preferable when correcting a difficult post-traumatic septum. While biomechanical principles are applicable to nasal septum surgery, further clinical studies must be devised to provide proper correction of the nasal septum with minimal sacrifice of cartilage.

[Main principles of functional intranasal surgery of paranasal sinuses]

The analysis of complications consequent to 200 endoscopic intranasal operations (computed tomography was performed preoperatively in 96 and was not performed in 104 patients) has shown that the incidence of serious complications in both groups was minimal and that of such complications as eyelid hematoma, neuralgia and hemorrhage was similar. Complication-safe operative procedure is described. It is believed that the absence of computed tomograms should not cause the change of functional intranasal surgery for radical surgery by external approach or common polypectomy.

[Diagnosis of anaphylactic shock caused by antibiotics]

A total of 277 cases with anaphylactic shock due to the use of various antibiotics were analyzed. Anaphylactic shock due to penicillin (38.2 per cent), streptomycin (19.8 per cent), combihation of streptomycin with penicillin (16.9 per cent) or bicillin (15.2 per cent) was most frequent. The causes of the diagnostic mistakes are shown and the clinical signs of the main typical form of the drug anaphylactic shock are descrifed. Four variants of atypical clinical picture of anaphylactic shock, i.e. hemodynamic (collaptoid), asphyctic, cerebral and abdominal were classified. Examples of diagnostic mistakes are presented. It was shown that the drug allergological anamnesis was not always considered in the therapeutic practice.

[Clinical and statistical analysis of the side effects and complications of antibiotic therapy]

A total of 4936 side reactions and complications in 2311 patients subjected to antibiotic therapy were analyzed. The drug allergy was of the allergic nature in 79.9 per cent of the cases, in 6.03 per cent of the cases it was of the toxic nature and in 6.03 per cent of the cases the drug allergy had a toxico-allergic genesis. Dysbacterioses and candidoses were diagnosed in 7.22 per cent of the cases. The complications were lethal in 0.9 per cent of the patients. The complications due to the antibiotic therapy may be arranged in the following descending order: penicillin (51.56 per cent), tetracycline (18.03 per cent), streptomycin (11.5 per cent), levomycetin and sintomycin (11.07 per cent), macrolide antibiotics (5.43 per cent). Affections of the skin and its appendages, nervous system and gastro-intestinal tract were most common. The penicillin side effects were characterized by more frequent skin allergic reactions amd neuro-psychic impairments. Tetracyclines caused more allergic reactions than it was usually considered. Streptomycin was characterized by high shockogenic properties, neurotoxicity and hematotoxicity. The toxic complications were most often caused by aminoglycosides. They were evident clinically from ototoxic and nephrotoxic reactions. General causes of complications due to antibiotic therapy are discussed.