Ceskoslovenska otolaryngologie最新文献

The author emphasizes new endoscopic trends in otorhinolaryngology, in particular rhinoscopy with microsurgery of the lateral nasal wall, sinuscopy and the use of lasers in microlaryngoscopy. Attention is also drawn to the specific position of endoscopy in otorhinolaryngology, using not only flexible and rigid technique but also possibilities of concurrent examination of the respiratory and deglutition pathways--i. e. so-called double endoscopy. The possibility of a comprehensive endoscopic examination of the deglutition and respiratory pathways led also to the formulation of the principle of panendoscopy the importance of which for oncological diagnosis is already generally accepted.

The authors describe the observation of a localized tissue emphysema of the right cheek, which developed in an eight-year-old child as the early complication of tonsillectomy performed under local anaesthesia. In addition to reflections on the possible pathways of the gas from the tonsillar bed into interstitial spaces of the cheek, the authors draw attention also to possible concurrent penetration into the soft tissues of the neck and mediastinum.

The authors give an account on the therapeutic results of adjuvant polychemotherapy in advanced squamous-cell carcinomas in the ENT region. Based on their conclusions they recommend in these malignities (stage III, IV) comprehensive treatment comprising neo-adjuvant polychemotherapy, surgery supplemented by simultaneous radiopolychemotherapy along with cyclic adjuvant chemotherapy and hyperthermia.

Surgical treatment of six cases of haemangiomas of the larynx. Surgery was used only after all conservative means were exhausted. After complete removal of the tumour after a two-year interval no relapse was recorded. The function of the larynx was not impaired.

The author emphasizes the importance of sialography in the diagnosis of diseases of the salivary glands. By using an intravenous polyethylene cannula it is possible to combine functional examination of the salivary glands (sialometry and sialochemistry) with X-ray examination after filling the glands with contrast substance. In a group of 34 patients sialography contributed to a correct diagnosis in 26 patients, i.e. 76.5%. False positive results were recorded in 1 case (2.9%), false negative results in three (8.8%). From a total of eight tumours of the salivary glands the examination in two cases (25%) did not lead to a correct diagnosis. In 16 instances (47%) the conclusion of the sialographic examination was compared with results of the histological and cytological examination.

The results of the research task revealed that the cause of relapsing otitis were in one third of the children various disorders of the immune system (primary and secondary). In the youngest children without disorders of immunity detectable by laboratory methods most probably retarded maturation of the specific antibody response is involved. In cases of confirmed immunity disorders, immunotherapy proved useful.

The authors draw attention to the urgency of antibiotic prophylaxis of early infection in surgical disciplines and emphasize the main principles of its expedient implementation. In otorhinolaryngology antibiotic prophylaxis proves useful in a number of surgical procedures; the authors submit, however, also examples when they do not consider antibiotic prophylaxis expedient. Among antibiotics used for prophylactic administration they consider at present for the majority of ENT operations cephalosporins of the first generation most useful. Their spectrum is roughly equal to the action of penicillin, oxacillin and ampicillin combined. When selecting an antibiotic, however, always ain individual approach must be used and its selection must be adjusted to the epidemiological situation in different areas and health institutions. The prophylactic use of different types of antibiotics cannot have permanent validity, we have to foresee rotation of antibiotics and the introduction of further new preparations.

The decisive point is the suitable time of antibiotic administration, their combination and possibility to extend the surgical repertoire by prevention in particular of general complications. Wound healing is more rapid, and intended adjuvant treatment can, due to the reduce period of wound healing, be applied much sooner. It is more effective and the attainment of target structures by the administered drugs is not blocked by prolonged processes which are sometimes associated with fibrosis, scars and regressive tissue changes.

The authors proved a tuberculosis origin of lymphadenitis of the cervicofacial area in 16 of 63 children operated on account of this suspected diagnosis. In all instances it was verified by bioptic examination of the removed lymph nodes. However, in no instance acid resistant rods were detected in the microscopic sections. Only in two bacteriological evidence was provided of the presence of mycobacteria tuberculosis in the preoperative punctate from colliquated lymph nodes but not in material obtained from the nodes. The attempt at typing of the causative agent was, however, not successful. In the submitted work the authors paid attention to some aspects of this disease in children, its problems in the area of the parotid gland.

In a previous paper the authors explained, based on statistical analysis, the use of mixed Czech verbal audiometry for the percentage evaluation of auditory losses. In the present work the above problems are discussed and an actual example of calculation of auditory losses is given. Based on statistical processing of more than 200 sound and verbal audiograms a table was prepared where the number is inserted corresponding to the sum of 50% and 100% comprehensibility of a mixed verbal set in dB. A reading of the percentage hearing loss is then taken. In case of discrimination loss in verbal audiometry its value is added to the sum of 50% and maximum attained comprehensibility. If the thus calculated percentage hearing loss in verbal audiometry differs from the hearing loss assessed according to Fowler and Sabine in sound audiometry, in the final evaluation the mean of the two percentage values is used.