Healing Of Cavities Research Articles

The effect of fascia and free skin graft on the healing of mastoid cavity after canal wall down mastoidectomy.

Post-mastoidectomy delayed cavity healing is a challenge to manage. This study aimed to cut down healing time with a simple technique (fascia with a skin graft) and compared it with controls without this technique. The current study was a prospective non-randomised controlled study, conducted in a tertiary referral hospital. Thirty cases and 30 controls with squamosal type chronic otitis media were studied. By the end of first month, 23.3 per cent of cases had healed compared with 3.3 per cent of controls. At the third month follow up, 83.3 per cent of cases and 53.3 per cent of controls had healed. At the sixth month follow up, 93.3 per cent of cases and 86 per cent of controls had healed. Healing of the mastoid cavity, as evidenced by epithelialisation and formation of a dry cavity, was faster in cases that received the graft when compared with controls without the graft.

Effect of microstructures restoration on high temperature fatigue behavior of DZ125 superalloy

Combination of hot isostatic pressing (HIP) and rejuvenation heat treatment (RHT) technology was used to restore creep-damaged DZ125 directional solidified superalloy, and the influence of microstructure restoration on high temperature fatigue behavior of the samples was explored. The results show that the HIP+RHT process could effectively heal internal cavities and recover the degraded γ′ phase in creep-damaged DZ125 superalloy to cubic particles similar as in as-received sample. After restoration treatment, the stress concentration areas inside the sample eradicated with the healing of the internal cavities, and the fatigue source areas were limited only to near surface than initiating from inside as in the as-received and creep-damaged samples. As a result, the restored sample had higher crack initiation life and lower crack propagation rate compared to as-received and creep damaged samples. The TEM microstructure characterization near fatigue fracture showed that the restoration of the degraded γ′ phase eliminated tangled dislocation in creep damaged sample and produced evenly distributed dislocations in the γ channel with short curved line-like morphology, like the as-received sample, which effectively hindered the dislocations movement during subsequent deformation, and strengthen the fatigue resistant of alloy. Therefore, it can be concluded that the HIP-RHT process, through the combined effect of internal cavities healing and the restoration of the degraded microstructures, renders higher high temperature fatigue life than creep-damaged and even higher than as-received DZ125 superalloy.

Mastoid Obliteration: A Comparison of Two Techniques.

To compare the outcome and efficacy of mastoid obliteration following canal wall down mastoidectomy, using two different materials such as bone pâté and bioactive glass granules. This is a prospective, randomized, single blind comparative study conducted for a period of 2years in a tertiary care center. The patients were divided into two groups A and B. In group A, the mastoid was obliterated with bone pâté and inferiorly based musculoperiosteal flap and in group B, bioactive glass with inferiorly based musculoperiosteal flap. They were assessed post operatively at 4th, 12th and 24th week for cavity healing (merchant et.al., score), subjective satisfaction and at the 24th week the effectiveness of obliteration was assessed visually by oto endoscopy and HRCT was done additionally to assess the volume of external auditory canal. A total of 40 patients with chronic otitis media (Squamosal type) were included and divided into 2 groups. At the end of 4weeks, bioactive glass had better healing, which was statistically significant. At the end of 24 weeks both groups had similar rate of healing. There was no difference in subjective satisfaction at end of 24weeks. The patients in bioactive glass group had statistically better obliteration than Group A and the volume of the EAC was less in this group signifying better obliteration. The cavity healing were similar for both bone pâté and Bioactive glass at end of 24weeks. Bioactive glass had better outcomes for effectiveness of obliteration compared to bone pâté.

The method of coding and quantitative evaluation of tuberculosis lesions in the lungs

To evaluate the degree of tuberculous lesions of the lungs, the method has been developed for coding and quantitative assessment of chest computed tomography results (chest CT) based on the presence of the following signs in each lobe of the lung: infiltrative and/or small focal changes – +1 point, focal formations (tuberculomas) – +2 points, cavitary changes (cavities) – +4 points. If there are all elements in the lobe, the maximum score is given – 7. The X-ray signs of tuberculous changes in the lungs are recorded in the form of a five-digit code "* * * | * *", where * corresponds to the lung lobe and is replaced by a figure corresponding to the total score calculated for this lobe. The arithmetic mean of the numbers in the code allows estimating the dissemination of tuberculosis: the higher the value, the more severe pathological changes in the lungs. The authors experimentally found that in the treatment of multiple and extensive drug resistant pulmonary tuberculosis with, the timing of sputum conversion (r s = 0.442; p < 0.01) and healing of cavities (r s = 0.575; p < 0.05) directly depended on the severity of tuberculous changes in the lungs, revealed by chest CT and evaluated using the proposed method.

Cell therapy: A potential solution for the healing of bone cavities

AimTo Explore whether the use of autologous BMMNCs as a cell therapy technique will improve the healing of bone cavities in vivo. MethodologyAfter achieving proper anesthesia, mononuclear cells were isolated from iliac crest's bone marrow aspirates (BMMNCs). Then access cavity, root canal preparation, and filling were done in third and fourth premolars, followed by amalgam coronal restoration. After that, a flap was reflected and a standardized bone cavity was drilled, the related root-ends were resected and retrocavity was drilled and filled with MTA. Before repositioning the flap, the bone cavity was filled with the desired filling material according to its corresponding group (n = 8): CollaCote group; where collagen scaffold was used, MNC group; in which CollaCote® loaded with isolated BMMNCs were applied, Biogen group; in which BIO-GEN® graft material was applied and finally Control group; where the bone cavities were left empty to heal spontaneously. Evaluations of healing of the bone cavities were done radiographically and histologically. ResultsThe MNC group induced the best healing potential with statistical significant difference from other groups. Conclusioncell therapy utilizing autologous BMMNCs looks to beat the conventional therapies and convey a significant improvement in the healing of the bone cavity in vivo.

Mastoid Cavity Obliteration with Hydroxyapatite Granules

Background: Modified radical mastoidectomy is the mainstay in the treatment of a case of unsafe CSOM. In order to reduce the side effects of an open matoid cavity, many methods to obliterate the cavity have been devised. Aims & Objectives: Cavity obliteration was done to study the efficacy of mastoid cavity obliteration Material and Methods: We carried out cavity obliteration with hydroxyapatite in 20 patients and compared the results with non obliteration. Results: We observed that in addition to reduction in size of cavity, there is better epithelisation and hence faster healing of the mastoid cavity. There is also a significant improvement in hearing status of the patients. Conclusion: Modified Radical Mastoidectomy followed by cavity obliteration with hydroxyapatite granules has numerous advantages compared to leaving the cavity as such.

Effect of appointment of a complex of amino acids on the level of human-beta-defensin-1 and liver function on the background of antituberculosis therapy

Objective — to investigate influence of amino acids appointment on Human-beta-defensin-1 level and liver function in patients with pulmonary tuberculosis who take anti-tuberculosis treatment.Materials and methods. 100 patients with pulmonary tuberculosis were included in the study. 8 of them were subsequently excluded from the study due to treatment interruption, while another 92 patients were divided into 3 groups: 46 patients of Group 1 did not receive additional therapy, 23 patients of Group 2 received essential amino acids in tablet form for 30 days and patients of Group 3 received injectable essential amino acids for 10 days and then amino acids in tablet form for 20 days. Effectiveness of intensive phase was determined basing on cessation of bacterial excretion and appearance of positive X-ray dynamics in form of consolidation of infiltrates and healing of cavities or their size’s decreasing.Results and discussion. Comparison of Human-beta-defensin-1 in groups after 2 months of treatments how edit shighest level inGroup 1 ((45.19 ± 8.67) µmol/L, median — 51.10 µmol/L), the lower one in Group 2 ((9.43 ± 2.97) µmol/L, median — 3.46 µmol/L) and the lowest level in Group 3 ((7.30 ± 1.21) µmol/L, median — 6.04 µmol/L), p < 0.05. Comparison of ALT in groups after 2 months of treatment showed its highest level in Group 1 (1.2 ± 0.2 µmol/L, median — 1.1 µmol/L) and significantly lower level in Group 2 ((0.4 ± 0.1) µmol/L, median — 0.4 µmol/L) and Group 3 ((0.5 ± 0,1) µmol/L, median — 0.4 µmol/L), p < 0.05. Comparison of AST in groups after 2 months of treatment showed its highest level in Group 1 ((0.93 ± 0.13) µmol/L, median — 0,71 µmol/L) and significantly lower level in Group 2 ((0.34 ± 0.04) µmol/L, median — 0.35 µmol/L) and Group 3 ((0.29 ± 0.04) µmol/L, median — 0.30 µmol/L), p < 0.05. Comparison of thymol test in groups showed the lowest result in Group 1 ((4.08 ± 0.44) U, median — 3.25 U), the higher one n Group 2 ((4.38 ± 0.58) U, median — 4.40 U) and the highest result in Group 3 ((5.99 ± 0.79) U, median — 6.30 U), p < 0.05.Conclusions. The inclusion of a complex of amino acids in the pathogenetic therapy of pulmonary tuberculosis increases the effectiveness of the intensive phase of anti-tuberculosis therapy, reduces the hepatotoxic effect of anti-tuberculosis drugs and stimulates the production of Human-beta-defensin-1, which leads to an earlier and balanced immune response. The appointment of a complex of amino acids according to a scheme including the use of an injectable form of the drug has a more pronounced positive effect than the isolated use of a tablet form.

Analysis of treatment outcomes for destructive pulmonary tuberculosis in patients with multiple drug resistance of M. tuberculosis

The objective of the study: to analyze treatment outcomes in patients with pulmonary destructive MDR tuberculosis who completed the intensive phase of treatment and had healed or persisting cavities.Subjects and methods. Treatment outcomes were retrospectively analyzed in 191 patients suffering from destructive pulmonary MDR tuberculosis who underwent the intensive phase of chemotherapy in in-patient settings in 2009-2012 and 2013-2015 (treated by different regime ns); in each of those cohorts, groups were formed depending on persistence/healing of destruction (cavities) during the intensive phase of chemotherapy: (CV-) ‒ the destruction healed, (CV+) – the destruction persisted.Results. In 24 months, treatment was found to be effective only in 19/68 (27.9%) in the (CV+) group versus 31/40 (77.5%) in the (CV-) group, p &lt; 0.05 (cohort 2009-2012); 17/42 (40.5%) versus 29/41 (70.7%), respectively, p &lt; 0.05 (2013-2015 cohort). Within 48 months, treatment outcomes were as follows: clinical cure in the (CV+) group was 38.2% (26/68 people), and in the (CV-) group – 72.7% (29/40 people), p &lt; 0.05 (2009- 2012) and 23/42 (54.7%) and 33/41 (80.5%), respectively, p &lt; 0.05 (2013-2015 cohort).Conclusion. Considering the above, when assessing treatment in the intensive phase of chemotherapy in destructive pulmonary tuberculosis patients, it is necessary to take into account the rate of cavity healing but not being limited to sputum conversion. Patients with persisting cavities should not be transferred to the continuation phase, the surgery or collapse treatment should be considered for such patients.

Efficacy of infusion chemotherapy in patients with pulmonary tuberculosis with treatment failure and malabsorption syndrome

Objective. To investigate the effectiveness of infusion chemotherapy in patients with pulmonary tuberculosis (TB) with treatment failure and malabsorption syndrome.&#x0D; Materials and methods. We observed 52 patients with newly diagnosed pulmonary TB with treatment failure, who were diagnosed with malabsorption syndrome. Patients were divided into two groups: 1st group (main) included 24 patients who received rifampicin and ethambutol intravenously, pyrazinamide and isoniazid orally; 2nd group (control) – 28 patients who received standard therapy orally. The severity of malabsorption syndrome was determined by a violation of intestinal penetration. Intestinal penetration was determined by the concentration of lactulose and mannitol (lactulose-mannitol test) in urine. The concentration of rifampicin, isoniazid, ethambutol in the serum was determined by liquid chromatography on a chromatograph Perkin Elmer (USA).&#x0D; Results and discussion. The examination revealed a violation of the rate of intestinal penetration in all studied patients, compared with healthy donors. The concentration of anti-TB drugs in the serum was significantly lower than the therapeutic average in group 2 compared with group 1 (p&lt;0,05). In patients of group 1 after the intensive phase of treatment, the disappearance of clinical symptoms of the disease was observed in 22 (91.3±5.8 %) and 17 (60.7±6.3 %) patients (p&lt;0.05), cessation of mycobacterial excretion – in 20 (83.3±4.3 %) and 14 (50.4±4.6 %) (p&lt;0.05), resorption of infiltrative changes and healing of destruction cavities in the lungs – in 12 (50.2±5.3 %) and 10 (35.7±4.7 %) (p&lt;0.05) compared with group 2.&#x0D; Conclusions. In patients with malabsorption syndrome with ineffective treatment and low intestinal penetration, which leads to reduced serum concentrations of anti-TB drugs in the intensive phase of treatment, it is advisable to increase the effectiveness of intravenous rifampicin and ethambutol.

PREBIOTICS AND NUTRITIONAL CORRECTION IN INTEGRATED THERAPY OF PATIENTS WITH PULMONARY TUBERCULOSIS AND COMORBID PROTEIN METABOLIC DISORDERS

The purpose of the work is to study the effectiveness of prebiotics and nutritional correction as components of the integrated therapy of patients with pulmonary tuberculosis and protein metabolic disorders. 67 patients with pulmonary tuberculosis were examined and then divided into two groups: I group included 35 patients, who received standard antimycobacterial therapy in the intensive phase of the treatment in combination with prebiotic (lactulose) in a dose of 20 ml 3 times a day plus nutriological correction of metabolic disorders; the II group included 32 patients, who received standard antimycobacterial therapy. The control group consisted of 30 healthy individuals of comparable sex and age. In order to study the protein metabolism state, the content of certain substitutable amino acids (ornithine, aspartic acid, serine, glutamic acid, proline, glycine, alanine, cysteine, tyrosine, glutamine) and essential amino acids (lysine, histidine, arginine, threonine, valine, methionine, isoleucine, phenylalanine, leucine) and their total amount (mg per 100 ml of blood serum) were assessed. Results and discussion. It has been found that all patients in groups I and II, which were under our supervision before the treatment, had symptoms of intoxication and respiratory syndrome, the tuberculosis process in the lungs occupied more than three segments and single decaying and rupturing cavities prevailed. The patients with massive bacterial excretion dominated in both groups. Moreover, before the treatment, protein metabolic disorders were found out in both groups. They manifested by the imbalance of individual amino acids and led to a decrease in the total content of essential amino acids in 1,2 – 1,3 times, total content of substitutable amino acids in 1, 2 times that led to a decrease in total content of substitutable amino acids in patients of both groups in 1,2 – 1,3 in comparison with the control group. A comparative analysis of the effectiveness of prebiotics (lactulose) and nutritional correction of metabolic disorders in combination with antimycobacterial therapy in the TB patientsl with protein metabolic disorders showed that probiotics and dietary modifications contribute to improving protein metabolism.&#x0D; This has been evidenced by a significantly high (p &lt;0,05) level of the total content of essential amino acids in blood serum, total content of substitutable amino acids and total content of amino acids (reliably reaching the level of indicators in healthy individuals) compared with the relevant indicators in the group of the patients receiving only antimycobacterial therapy. Probiotics and nutritional correction promote the rapid dynamics of the disappearance of respiratory syndromes and intoxication, promote cavity healing, and reduce the duration of treatment. Conclusions. The results of our research obtained convincingly suggest that prior to the beginning of treatment; all patients with pulmonary tuberculosis have protein metabolic disorders that require selecting a way to correct these disorders in order to increase the effectiveness of TB treatment. Antimycobacterial therapy during two months contributes to the positive dynamics of protein metabolism correction, but complete normalization of the amino acid composition in blood serum does not occur. Applying prebiotics (lactulose) and nutriological correction of metabolic disorders in combination with antimycobacterial therapy promotes the normalization of protein metabolism and increases the effectiveness of the TB treatment.

Competitive Healing of Creep-Induced Damage in a Ternary Fe-3Au-4W Alloy

Autonomous healing of creep-induced grain boundary cavities by Au-rich and W-rich precipitates was studied in a Fe-3Au-4W (wt pct) alloy at a fixed temperature of 823 K (550 °C) with different applied stresses. The ternary alloy, with two supersaturated healing solutes, serves as a model system to study the interplay between two separate healing agents. The creep properties are evaluated and compared with those of the previously studied Fe-Au and Fe-W binary systems. The microstructures of the creep-failed samples are studied by electron microscopy to investigate the cavity filling behavior and the mass transfer of supersaturated solute to the defect sites. Compared to the Fe-Au and Fe-W alloys, the new Fe-Au-W alloy has the lowest steady-state strain rate and the longest lifetime. The site-selective filling of the creep-induced cavities is attributed to two different categories of precipitates: micron-sized Au-rich precipitates and nano-sized W-rich precipitates. The Au-rich precipitates are found capable to fully heal the cavities, while the W-rich precipitates show only a limited degree of healing. The two types of precipitates show a reluctance to coexistence, and the formation of W-rich precipitates is suppressed strongly. A model is proposed to describe the competitive healing behavior of the Au-rich and W-rich precipitates.

Manuka Honey versus Antibiotic Ear Drops in Healing of Post-Operative Mastoid Cavity: A Prospective Randomized Trial

Background and Objectives This study investigates the role of manuka honey in the healing of postoperative mastoid cavity.Subjects and Method This was a single centre prospective study on 40 consecutive patients of chronic otitis media undergoing canal wall down mastoidectomy. Manuka honey soaked in gel foam was kept in the mastoid cavity for the study group and antibiotic soaked gel foam was kept for the control group. Culture swabs from mastoid granulations were sent at various times from both groups. The healing of the mastoid cavity was assessed in the follow up period.Results Preoperatively 15 out of 20 patients (75%) had a positive aural swab culture in the study group while 11 out of 20 (55%) in the control group had a positive aural swab culture. The most common organism isolated was &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; and &lt;i&gt;Proteus mirabilis&lt;/i&gt;. One month after mastoidectomy only 4 patients (20%) had sterile culture and 16 patients (80%) had grown organisms; in the control group, 7 patients (35%) had sterile culture and 13 patients (65%) had growth on culture. The mean merchant scores for the study group and the control were 2.61 (2-5) and 2.05 (1-4), respectively. At 3 months 13 patients (65%) with sterile culture and 7 patients (35%) had growth on culture; in the control group, 16 patients (80%) had sterile culture and 4 had shown persistent growth on culture (&lt;i&gt;p&lt;/i&gt;=0.28). All positive cultures were aerobic in both groups. The mean merchant scores for the study group and the control were 1.03 (0-4) and 0.7 (0-3), respectively (&lt;i&gt;p&lt;/i&gt;=0.09).Conclusion Healing of mastoid cavity was almost similar in both groups (&lt;i&gt;p&lt;/i&gt;&gt;0.05). Manuka honey exhibited antibacterial activity against &lt;i&gt;Pseudomonas&lt;/i&gt;, &lt;i&gt;Proteus&lt;/i&gt;, &lt;i&gt;Klebsiella&lt;/i&gt;, &lt;i&gt;Escherichia coli&lt;/i&gt;, &lt;i&gt;Staphylococcus&lt;/i&gt;.

Endoscopic Adipofascial Radial Forearm Free Flap Reconstruction of the Skull Base: A Technical Update.

Objective While most defects after endoscopic endonasal resections can be closed with local or locoregional options, rare cases require free tissue transfer. In this setting, while minimally invasive techniques have been described, the essential procedural details are lacking. The objective of this report is to describe several key technical modifications to free flap harvest and endoscopic-assisted inset which decrease morbidity and improve reliability and efficiency. Methods A retrospective chart review was performed of consecutive patients treated at Washington University in St. Louis with endoscopic free flap reconstruction through a Caldwell-Luc/transbuccal approach between January 2016 and September 2019. Results A total of six patients underwent adipofascial radial forearm free flap with this technique, five for recalcitrant cerebrospinal fluid leak or pneumocephalus and one for osteoradionecrosis. All flaps survived and there were no flap-related complications. Five patients (83%) achieved successful healing and separation of the sinonasal cavity and intracranial space. One patient developed recurrent pneumocephalus. Three key technical modifications were identified that improve efficiency and reliability of flap delivery and inset: (1) use of an adipofascial radial forearm flap, without skin paddle; (2) wide resection of the anterior and lateral maxillary face to facilitate flap delivery; and (3) precise defect measurement and flap contouring prior to inset to prevent any need to debulk the flap in situ. Conclusion Endoscopic adipofascial radial forearm free flap delivered to the skull base through a Caldwell-Luc/transbuccal corridor is a feasible option with a high success rate and low morbidity when other reconstructive attempts have failed.

Impact of the wet spinning parameters on the alpaca‐based polyacrylonitrile composite fibers: Morphology and enhanced mechanical properties study

AbstractThe study examined the effect of different wet spinning parameters (e.g., total solid content, coagulation bath concentration, drawing, and stretching) on the morphology and mechanical properties of the wet spun alpaca/polyacrylonitrile (PAN) composite fibers. The alpaca/PAN composite fibers were wet spun using 10, 20, and 30% of alpaca particles along with the PAN polymer. The shear‐thinning or non‐Newtonian flow behavior was observed among the dope solutions with different solid content. The cross‐sectional fiber morphology showed the bean‐shaped characteristic for the control PAN fibers, whereas the alpaca/PAN composite fibers exhibited almost circular shape. “Cavity healing” was observed, where noticeable voids and porous areas were demolished in the cross section of the composite fibers, by changing the total solid content and coagulation bath concentration. Although the control PAN fibers exhibited the highest tenacity with lower fiber diameter, the alpaca/PAN composite fibers showed a gradual deterioration in tenacity while adding alpaca particles into the PAN polymeric matrix. Nevertheless, due to the increment in the total solid content, higher draw ratio, and stretching of the fibers, the tenacity, molecular orientation, and the crystallinity of the composite fibers were increased.

Endobronchial valve in complex treatment of patients with drug resistant fibrous cavernous pulmonary tuberculosis

The objective of the study: to assess the efficacy of complex treatment with endobronchial valve implantation in the patients suffering from drug resistant fibrous cavernous pulmonary tuberculosis.Subjects and methods. Treatment outcomes in 97 patients with limited fibrous cavernous pulmonary tuberculosis were analyzed. Main Group included 42 patients who had bronchial valve block implanted. Comparison Group included 55 patients. Artificial pneumoperitoneum was used in both groups.Results. In Main Group, sputum conversion was achieved in 12 months in 40 (95.2%) patients, and in 32 patients (58.2%) in Comparison Group (p &lt; 0.01). In 12 months after treatment start, positive X-ray changes were observed in 42 (100%) patients of Main Group and 40 (72.7%) patients of Comparison Group. Healing of cavities in 12 months was observed only in the patients from Main Group (26 (61.9%) patients). Upon completion of the study, surgery was still indicated to 4 (9.5%) of patients from Main Group and to 35 (63.6%) patients from Comparison Group.

Outcomes of type III tympanoplasty: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement and healing of cavity in patients who underwent type III tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective chart review of 21 patients who underwent type III tympanoplasty at Bowring and Lady Curzon Hospital from January 2018 to December 2018 was done. In 7 patients autologous incus, 6 tragal cartilage and 8 teflon prosthesis was used for ossiculoplasty. Intra and postoperative events were assessed. Pure tone audiograms done after 3 and 6 months were compared. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 15 patients who underwent canal wall down procedure (CWDP) had a mean hearing gain of 20.33 dB and 26.67 dB while in 5 patients of canal wall up procedure (CWUP) group mean hearing gain was 22.5 dB and 27.5 dB at 3 and 6 months after surgery respectively. Hearing gain was similar in both groups irrespective of the prosthesis used. Autologous materials were used in most of the CWUP with intact stapes and teflon prosthesis was used in majority of CWDP where only mobile stapes foot plate was present. Prosthesis extrusion was not encountered in any of our cases so far in this series.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The post-operative hearing gain with autologous incus, tragal cartilage and teflon middle ear prosthesis are similar. Teflon prosthesis is an effective material for ossiculoplasty, especially useful when incus and stapes are absent while autologous incus or tragal cartilage are preferred in cases with intact stapes head.&lt;/p&gt;

Endobronchial valve block in the treatment of patients with destructive pulmonary tuberculosis and low adherence to therapy with anti-tuberculosis drugs and refusing to stay in hospital

The objective of the study: to analyze the efficacy of endobronchial valve block ( EBV ) during ou t-p atient treatment of patients with destructive pulmonary tuberculosis who refused i n-p atient treatment and therapy with ant i-t uberculosis drugs. Subjects and methods. Treatment outcomes of 129 patients were randomly studied, the patients suffered from destructive pulmonary tuberculosis and demonstrated low adherence to therapy with ant i-t uberculosis drugs and staying in hospital. EBV was used in one group (66 patients), and it was not used in patients from another group (63 patients). Results. The use of EBV in patients with poor adherence to inpatient treatment and chemotherapy allowed achieving sputum conversion in 36 (58.1%) patients and healing of cavities in 43 (65.2%). Among the patients in whom no EBV was used, sputum conversion was achieved in 12 (20.7%) patients ( p = 0.001, χ 2 ) and cavities were healed in 14 (22.2%) patients ( p = 0.001, χ 2 ). Efficacy and safety of EBV was demonstrated when used on the ou t-p atient basis in the above category of patients.

Dried amniotic membrane grafting as an adjuvant to canal wall-down procedure in pediatric cholesteatoma

Purpose To evaluate the effect of dried amniotic membrane grafting on healing of radical cavity after canal wall-down procedure. Patients and methods A total of 24 cases were included. All had canal wall-down surgery done with the use of dried amniotic membrane at the end of procedure to line the radical cavity. According to the course of healing, cases were divided into four groups regarding wideness and dryness of cavity. Results were statistically analyzed. Results Among the 24 patients in the postoperative follow-up period of 6 months, only three (12.5%) patients needed revision meatoplasty for having narrow and wet cavities. Sixteen (66.7%) patients achieved the optimum goal of wide and dry cavity. Two (8.3%) patients had dry but narrow cavities. Three (12.5%) patients had wide but wet cavity, with recurrence of cholesteatoma. Conclusion Dried amniotic membrane graft can be used safely to line the radical cavity. Further comparative studies are needed to evaluate efficacy among other materials used to achieve safe and dry cavities.

Pathogenesis of middle ear acquired cholesteatoma in the light of the research using high-throughput, “omics”, technologies of molecular biology

Cholesteatoma is described as cystic lesion consisting of keratinizing squamous cell epithelium, filed with keratin debris, surrounded by inflammatory fibrous tissue, gradually expanding in the middle ear and causing destruction of neighboring bones. This paper presents brief review of existing hypotheses explaining its etiology in the light of the researches using high-throughput, “omics”, technologies of molecular biology. Classic theories of pathogenesis of acquired cholesteatoma as: immigration, squamous metaplasia, basal cell hyperplasia or invagination theory have not been able to explain fully all pathological processes observed in cholesteatoma tissue. This also concerns the newer concepts that cholesteatoma is a result of mucosal traction generated by interaction of migrating opposing surfaces, a natural attempt by the body to cure the underlying inflammation in the cavity or chronic wound healing process triggered by micro defects in the basement membrane of the epithelium in the retraction pocket. Introduction of high-throughput, “omics”, technologies of molecular biology to the studies under cholesteatoma pathogenesis allowed identification of cholesteatoma-related gene expression signatures using full-genome microarrays as well as proteomic analysis of cholesteatoma. This studies confirmed known pathological processes observed in cholesteatoma tissue such as: high proliferative activity, decreased signal transduction, active immunological response, alterations in the extracellular matrix, increased expression of proinflammatory cytokines, neovascularization and may others. This techniques allow precise and complete view of molecular mechanisms in those processes. However it is still unknown what is the cause that trigger epithelial hyperplasia, inhibited migration and inflammatory response in the preexisting retraction pocket.

Clinical effects of autologous platelet-rich plasma gel in the repair of chronic wounds

Objective: To explore the clinical application effects of autologous platelet-rich plasma gel in the repair of various chronic wounds. Methods: From January 2015 to January 2018, 76 patients with chronic wounds were admitted to our unit, with 39 men and 37 women, aged 28 to 75 (52±6) years. Before the operation, areas of wounds ranged from 2.0 cm×0.5 cm to 17.0 cm×5.0 cm, depths of wounds ranged from 1 to 6 cm, areas of wounds substrate ranged from 3 cm×3 cm to 17 cm×8 cm, and volumes of deep cavities ranged from 7 to 55 mL. All patients received operation 2 to 7 days after admission. Autologous platelet of 220-250 mL was collected from each patient by single extraction to make platelet-rich plasma of 10-50 mL. The cavity was filled completely by injection of platelet-rich plasma gel for 1-3 times. Wounds were sutured directly or covered by local flaps or other materials according to the conditions of wounds, and the unclosed wounds in primary stage were treated by continuous vacuum sealing drainage (VSD). Ultrasound, CT, or magnetic resonance imaging was performed to detect the healing of cavity after the operation. The healing of wound and repair of cavity after the operation and during follow-up were observed. Results: Wounds in 39 patients were closed directly after primary operation. Among them, wounds of 36 patients were healed completely, and wounds of the other 3 patients were healed completely after second debridement and topical filling of platelet-rich plasma gel. The cavities in 35 patients were filled with granulation tissue after treatment of platelet-rich plasma gel for 1-3 times combined with VSD, and the wounds were healed after skin grafting or flap transplantation. The treatment of wounds discontinued in the other 2 patients after treatment of platelet-rich plasma gel for once. Postoperative follow-up was lost in 7 patients. During follow-up of 2 and/or 4 months after the primary operation, wounds were healed well with no recurrence, and cavities were filled with fibrous tissue. Conclusions: Autologous platelet-rich plasma gel has advantages in treating chronic wounds, including a large amount by single extraction, flexible use mode, ability to fully fill the complex cavity, high surgical safety, and mild secondary injury. It's a new choice for repair of chronic wounds in clinic.