Vol 19, No 11-1 (2017)
- Year: 2017
- Articles: 11
- URL: https://journal-vniispk.ru/2075-1753/issue/view/4839
Articles
Differential diagnosis of prolonged cough with chronic cough in children
Abstract
Cough is the most common symptom in both outpatient and hospital practice. The multifactoriality of the cough complicates its etiologic diagnosis, especially in the context of primary care. The article presents current data on the different genesis of cough depending on its duration and clinical features, shows the results of our own research, diagnostic algorithms for cough in children are considered. The development of clinical guidelines for the differential diagnosis of diseases accompanied by a prolonged cough in childhood, which determines differential therapy, is particularly relevant and has demand in practice.
Consilium Medicum. 2017;19(11-1):7-16
7-16
Place of the bacterial immunotherapy in the treatment and prevention of inflammatory diseases of the upper respiratory tract
Abstract
Everybody knows the wide prevalence of the upper respiratory tract diseases. It is very common that the main part of patients doesn’t need in prescribed antibiotics. Everywhere the bacterial resistance has been growing up for nowadays. It gets physicians to find a new group of drugs which will prevent the respiratory diseases. The most contradictory and debatable group of the immunomodulators may be interesting at this case. Bacterial lysate represents the most effective group of drugs among the immunomodulators, which reduce the frequency of acute respiratory infections and the exacerbations of chronic respiratory diseases. The necessity of the prescription of this medicines, in particular the OM-85, occurs in group of frequently ill children and patients with the proven secondary immune deficiency.
Consilium Medicum. 2017;19(11-1):17-20
17-20
Clinical characteristics of patients with chronic obstructive pulmonary disease treated in pulmonology departments in the Kazan city
Abstract
Chronic obstructive pulmonary disease (COPD) remains a disease which prevalence in the world is not decreasing, and mortality is increasing. Over the past 10 years, the recommendations for the classification and treatment of COPD have changed many times. The aim of the work was assessing the condition of patients with COPD and the features of their treatment in pulmonology departments of Kazan. Material and Methods. Sixty patients with COPD were examined in a hospital - 59 (98.3%) men and 1 (1.7%) woman, whose average age was 63.8±1.0 years. All patients underwent a physical examination, a survey was conducted on standardized CAT and mMRC questionnaires, and a spirogram of forced expiration was recorded. Result. According to the GOLD 2007 classification, the patients were distributed in the following way: GOLD I - in 5%, GOLDII - 20%, GOLDIII - 51.7% GOLDIV - 23.3%. According to ABCD classification, GOLD 2017 to subgroup C was assigned 1 patient and 59 - to subgroup D. Completely compliant were 28.3% of patients, 65% of patients were well trained by the paramedic for correctly use of their inhalers. Patients preferred short-acting bronchodilators and metered-dose aerosol inhalers among all drugs, they would like to use them only as required. 25% of patients received long-acting beta-adrenoceptor agonist in combination with short-acting drugs, 23.3% of patients mixed a combination of an inhaled steroid with a long-acting bronchodilator and a short-acting bronchodilator as needed, 20% inhaled two long-acting bronchodilators. Conclusion. The study revealed a discrepancy between actual practice and clinical recommendations. The authors linked it with the training of doctors once in 5 years, whereas the recommendations were updated annually. It was suggested that the compliance of patients and their commitment to long-acting bronchodilators would increase with the widespread use of drugs with a rapid start of action.
Consilium Medicum. 2017;19(11-1):21-24
21-24
Resolution of the board of experts on the topic: "New in allergology"
Consilium Medicum. 2017;19(11-1):25-27
25-27
Antibiotic therapy in otorhinolaryngology: aspects use of oral cephalosporins III generation in the ambulatory pediatric practice
Abstract
The article presents information on the relevance of the treatment of infections of ENT-organs in children. The principles of rational prescription of antibacterial drugs taking into account the sensitivity of major pathogens in otorhinolaryngology. The efficiency of the use cefixime - oral cephalosporin III generation, combining a broad range of antimicrobial activity, good pharmacokinetic properties, a favorable profile of tolerability and ease of use (1 per day) in pediatric patients.
Consilium Medicum. 2017;19(11-1):29-36
29-36
The algorithm of examination for patients with unknown etiology unilateral vocal fold paresis in ENT practice
Abstract
Unilateral vocal fold paresis is a common disease in the practice of the otolaryngologist. The causes of the disorders of the laryngeal innervation are very diverse. Paresis of the larynx can be central or peripheral origin. The clinical manifestations are described in the article. According to the phoniatric division of the Saint Petersburg ENT and Speech Research Institute unilateral vocal fold paresis was diagnosed in 178 out of 2667 patients during 2016. Postoperative vocal fold paresis was diagnosed in 150 patients. The most common cause of surgical trauma was thyroid gland surgery - 117 observations. The article presents the results of the laryngeal videostroboscopy and analysis of prognostically favorable and unfavorable to voice features endoscopic characteristics. Described diseases of the larynx, which is also manifested its immobility, such as tumors of the larynx and pathology of the cricoarytenoid joint. Unknown etiology unilateral vocal fold paresis it is necessary to conduct a full comprehensive examination, the purpose of which is the exclusion of pathology of different organs and systems causing a disorder of the laryngeal innervation.
Consilium Medicum. 2017;19(11-1):37-40
37-40
Surgical treatment of maxillary sinusitis in a patient with nasopharyngeal cancer after a gamma-ray and photodynamic therapy
Abstract
In otorhinolaryngologist practice tumors of the nasopharynx occur quite often. Neoplasms are usually asymptomatic and manifest only when choanae obturation and pharyngeal orifice of the auditory tubes squeezing develops. Such patients mainly complain on ears congestion, hearing loss and, more rarely, nasal blockage. When the diagnosis of cancer is confirmed, a course of radiation treatment or chemoradiotherapy is conducted. There are also reports of effective photodynamic treatment. During the course of the therapy, phenomena of post-radiation epithelitis develops, affecting not only the nasopharynx and the oral cavity, but also paranasal sinuses. Most often the maxillary sinuses are affected. Post-radiation sinusitis isn’t sensitive for medical therapy, so surgical treatment is more effective. The article presents a clinical case of patient with nasopharyngeal cancer received a course of radiation and photodynamic therapy. Upon the gamma-ray therapy course (total dose 60 Gr) completed non-sensitive for medical treatment right maxillary sinusitis developed, and so endoscopic antrostomy was performed. After tumor photodynamic therapy session maxillary sinusitis on the left side developed and antrostomy was also performed. In the follow up period complete tumor regression was achieved and no signs of sinus pathology were detected.
Consilium Medicum. 2017;19(11-1):41-44
41-44
Community-acquired infections of the lower respiratory tract: approaches to rational antibiotic therapy
Abstract
Community-acquired infections of the lower respiratory tract (ILRT) is a widespread disease, often with serious prognosis. Currently ILRT, including acute bronchitis, community acquired pneumonia, infectious exacerbations of chronic obstructive pulmonary disease - is one of the leading places in the structure of human morbidity. Not less important problem is the development of approaches to rational antibiotic therapy as AFS, since errors in the prescription of antibiotics in these patients are perhaps the most frequent in the list of medical errors committed in internal medicine and pulmonary practice. This article presents the key diagnostic and differential diagnostic signs of the ILRT and the data justifying the rejection of the use of antibiotics in viral/presumably viral respiratory infections and the purpose of the most effective of them where antibacterial therapy is indicated.
Consilium Medicum. 2017;19(11-1):45-51
45-51
Role of fungi in chronic inflammatory ENT pathology
Abstract
The article describes modern approaches to the diagnosis and treatment of fungal lesions of the ENT organs. Among 5618 patients with chronic inflammatory pathology of ENT organs, fungal infection was established in 1303 (23.2%). Pharyngomycosis was diagnosed in 689 patients (53%), otomycosis in 495 patients (38%), laryngomycosis in 65 patients (5%), mycosis of nose and paranasal sinuses - in 53 patients (4%). Otomycosis was identified in 23% of all otitis cases, pharyngomycosis with chronic pharyngitis was detected in 26%, laryngomycosis with chronic laryngitis - in 17%, and mycosis with chronic inflammation of the nose and paranasal sinuses was found in 7%. Among all patients with otomycosis, fungal infection of the external ear predominates - 67% of patients, fungal otitis media - 17% and fungal infection of the postoperative ear cavity - in 16%. In 97-98% of patients with pharyngomycosis and laryngomycosis, yeast-like Candida fungi are the causative agent. In 65% of patients with external fungal otitis, in 20% of patients with medium fungal otitis, 95% with inflammation of the postoperative ear cavity and in mycosis of nose and paranasal sinuses, we detected mold fungi, most often represented by the genus Aspergillus spp. In 35% of patients with external otitis, 80% of patients with otitis media and 5% of patients with inflammation of the postoperative ear cavity, the fungi Candida spp. where found.
Consilium Medicum. 2017;19(11-1):52-56
52-56
Tumor of the nasal cavity, triggering hormonal changes during lactation. Case report
Abstract
Vascular tumors in the nasal cavity can be presented a variety of pathologies. In this case report, we discuss patient with a large vascular lesion occupying the nasal cavity. According to various authors about 30-45% of women during pregnancy experience nasal problems. The reactivity of the nasal mucosa is caused by an elevated level in the blood of estrogens, which contributes to the dilatation of the vessels and hypersecretion of the mucous membrane of the nasal cavity, especially in the II and III trimesters of pregnancy. This leads to difficulty in nasal breathing and recurrent nasal bleeding. Imaging modalities such as computed tomography (for women in the postpartum period) and magnetic resonance imaging are used for differential diagnostics of vascular lesions of the nasal cavity, what allows the planning of rational surgical treatment. The final diagnosis is established according to histology. And recommended treatment depends on the presenting pathology.
Consilium Medicum. 2017;19(11-1):58-61
58-61
Pathological processes in the paranasal sinuses as predictors of diseases of the bronchopulmonary system and not only of it. Capabilities of radiation diagnostic
Abstract
Pathologic processes in the paranasal sinuses in a large percentage of cases are the cause of inflammatory diseases of the adjacent anatomical structures such as the orbit, middle and inner ear, are the predictor of occurrence of diseases of broncho-pulmonary system. Given the similar clinical picture of diseases of the sinuses, sometimes it is difficult without further research to determine the nature and prevalence of pathological process in such a complex anatomical region. Successfully applied X-ray examination, the choice of which depends on the severity of the process and complexity of clinical manifestations. Traditionally how basic research is widely used classic radiography of the paranasal sinuses in various projections. However, with the advent of computer technologies entered clinical practice techniques such as computed tomography and magnetic resonance imaging.
Consilium Medicum. 2017;19(11-1):62-73
62-73