[Treatment and prevention of scleroma].
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Antagonistic activity of approximately 200 Bacillus subtilis cultures vs. Klebsiella rhinoscleromatis clinical strains in experiments on solid and liquid nutrient media, and in experiments on laboratory animals has been studied. 16 B. subtilis strains characterized by a vivid antiscleroma activity in vivo have been selected. Maximum preventive and therapeutical influence of the B. subtilis strain 1119 upon the flow of experimental acute septic and lung scleroma infection has been determined. While co-cultivating the test cultures under study (B. subtilis 1119 and K. rhinoscleromatis 230), a significant titer decline and complete klebsiella's growth suppression on the 8th-12th days provided the certain concentrations of the antagonistic microbes have been shown.
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OBJECTIVE: To study the clinical manifestation and treatment of the laryngeal scleroma METHODS: Forty-three patients with laryngeal scleroma, from May, 1981 to December, 2002, with pathological diagnosed were reviewed retrospectively. The clinical features and the treatment methods of these patients were analysed. RESULTS: All 43 cases had hoarseness and 19 of them manifested dyspnea. In the larynx, the main scleromatous lesions were classified as atrophic stage in 2 cases, as granulomatous in 35 cases and as scarring in 6 cases. The preponderance lesions were located in the glottis in 13 cases, in the subglottis in 1 case, in both supraglottis and glottis in 18 cases, in both glottis and subglottis in 8 cases, and in all the three regions of the larynx in 3 cases. Twenty-four patients were treated with antibiotics, seven patients with surgery and two patients with radiotherapy. Eighteen of 24 patients who were treated with antibiotics were cured, and two of the recurrent patients were cured with a further period of antibiotics therapy. Four of the 24 patients with second or third degree of laryngeal obstruction required prophylactic tracheostomy. One patient in granulomatous stage with the second degree of laryngeal obstruction was cured with the combination of surgery and antibiotics therapy. Six patients in the scarring stage with laryngeal stenosis were cured with reconstruction surgery. One patient treated with radiotherapy recurred in the fourth year after treatment, and one patient failed to antibiotics therapy cured with radiotherapy combined with antibiotics therapy. CONCLUSIONS: Scleroma may involve the larynx and cause dysphonia and laryngeal obstruction. Antibiotics therapy is effective in most cases with laryngeal scleroma, and the long-time follow-up after treatment were necessary. Laryngeal reconstructions were necessary for the patients with cicatrical laryngeal stenosis.