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Aerosolotherapy is a particularly useful method of treatment for otolaryngolgists because it is a procedure of local treatment within the affected region. Advantages of aerosolotherapy as well as indications and contraindications for aerosolotherapy in patients with otolaryngological diseases are described. Among the indications are: precancerous states located on vocal cords; pooperative states in the region of nose, throat and larynx; states after radiotherapy; mycosis of oral cavity, throat and larynx; The importance of additional techniques of aerosolotherapy such as: vibratory aerosols, additional hypertension and electroaerosols is emphasized.

Ultrasonography (US) is a well-known and valuable method of detecting lymph nodes in the neck. It is widely used in the preoperative neck assessment and in follow-up patients treated for head and neck cancer. The aim of the study was to compare the larynx cancer patients in two decades: the 80-ies and the 90-ies and the influence of a single diagnostic tool, i.e. ultrasonography, on therapeutic decisions and final results. Two groups of patients were selected: 737 patients treated between 1981-1985 (before the introduction of US) and 840 patients treated between 1991-1995 (routinely examined with the help of US) in ENT Dept. of Karol Marcinkowski University of Medical Sciences in Poznań. We aimed at analysing the percentages of neck metastases at the moment of diagnosis, the frequency of particular types of primary neck treatment, the percentages of neck recurrences, their advancement at the diagnosis and the methods of secondary treatment. Particular attention to feasibility of salvage was paid. Mean survival time in the group of patients with recurrence and the overall 5-year-long survival rates were analysed. No marked differences were stated between both groups as to epidemiological data, primary tumor advancement and types of the performed larynx surgery. Neck metastases occurred in both groups, 34% and 42%, respectively. Relapse rates were 12.9% and 12.6%, respectively. It was found that the number of elective neck dissections over the period given above became smaller, the number of radical neck dissections was stable, while the number of patients referred to wait and see policy increased. The number of successful neck salvage surgeries markedly increased while the number of patients not qualified for salvage decreased. For the both studied data, the curves on diagrams cross around the year 1992. The turning point situated in this time shows that ultrasound, introduced in 1991, gradually changed the types of primary treatment and possibilities of salvage neck treatment. The statistically significant differences in both groups were shown as to: types of the initial i.e. first neck treatment, relapse rate and the possibility of performing surgical salvage, while the only change was the introduction of a new diagnostic tool, i.e. neck ultrasonography. Survival rate was markedly better in the second group of patients. The methods of qualifying patients for the primary neck treatment and follow-up schedule have been changed since ultrasonography diagnostics was introduced in 1991 for routine assessment of the neck lymphatics in the larynx cancer patients. Strict follow-up schedule allow for early detection and successful treatment in high percentage of relapses.

A twenty-year scientific cooperation has been discussed (1979-1998) between four clinics for laryngology at Medical Universities in Cracow, Poznań, Warsaw and Lublin. The results of research concerning the epidemiology, diagnostics and treatment of the carcinoma of the larynx are presented.

Unlabelled: Diagnostics and treatments of precancerous states of cancer of larynx will demand in select chances the multistages treatment, Aim: In work one priced radicality and efficiencies of treatment of precancerous stages of larynx with method of carbone dioxide laser cordectomy. The retrospective examination was executed of years 1991-2000 imicrosurgical interventions of larynx--in talked over period one executed 308 of surgical interventions with use of laser CO2, in number this 41 of interventions were partial laser cordectomies in stages with precancerous changes on the vocal cords. In chances of extensive precancerous changes of vocal cords in sorted chances not one should limit oneself to receiving of specimens from several localization, but change to remove in wholes. Permits this on obtainment radicality of intervention with possibility of obtainment the large material to histopathological investigations.

The results concerning examination of DNA adducts in oral (23 patients), pharyngeal (23 patients) and larynx cancer (10 patients) subjects are presented. DNA adduct levels were compared in respect to anatomical structure (primary tumour location), number of cigarettes smoked, TNM stage, and age of patients. DNA was isolated from removed tissue (tumour and non-tumour surrounding tissue) using detergent/phenol extraction. 32P-postlabelling assay including nuclease P1-enhancement modification was applied. Aromatic DNA adducts were found in all studied tissues. Total DNA adduct levels (tumour and non-tumour tissues) was lowest in larynx cancer, higher in oral cancer and highest in pharyngeal cancer. There were no influence of age into formation of DNA adducts. The higher level of DNA adducts was found in tumour tissue of oral cancer in the group of smokers with metastasis into lymph nodes.

One case of rare laryngeal tumor--adenoid cystic carcinoma in 58 year old woman was reported in this paper. Authors wanted to drew attention to few complaints and only slight dysphagia in comparison to local extensiveness of the neoplasm. Diagnostic difficulties were underline. Epidemiology, clinical course and therapy were demonstrated in laryngeal adenoid cystic carcinoma.

Subtotal laryngectomies with larynx reconstruction are an acceptable alternative to the total laryngectomy in T2, T3 larynx cancer treatment. One procedure resection and reconstruction allow for radical oncological treatment with simultaneous preservation of air passage continuity and the function of the neolarynx. In the years 1988-1997 in ENT Dept. of Karol Marcinkowski University of Medical Sciences 38 subtotal laryngectomies with larynx reconstruction were performed. They were: 34 supracricoid laryngectomies with cricohyoidopexy, 2 with epiglotohyoidopexy and 3 supraglotic laryngectomies with reconstruction. The basic criterion of the evaluation of such procedures effectiveness was their oncological radicality. The follow-up period ranged from 2 to 9 years. Local relapse was observed in none of the cases, nodal relapse was started in 2 patients. Another aspect taken into consideration was the function of the neolarynx. In 3 cases two or three laser procedures were performed because of neolarynx lumen structure which were followed by T-dren plasty. In 10 patients temporary swallowing difficulties, especially liquids, were observed in the first three month. Gastrostomy was performed in one case. The authors discuss indications to this type of surgery, operation technique, oncological and functional results. Spirometry results and voice analyses after larynx resection and reconstruction in these patients are presented.

Primary malignant melanoma of the larynx is very rare. The case of larynx malignant melanoma in 71-years old men is presented. Hoarseness was the main complaint that encouraged the patient to visit a doctor. The patient was heavy smoker, he had been smoking 40 cigarettes for the last 50 years. He used to drink about 200 ml of pure alcohol per day. In the direct laryngoscopy gluish had cyanotic tumor, extending to the true vocal cord, ventricle, ventricle fold and subglottic space was seen. Enlarged cervical lymph nodes, laterally to the main vessels were found both in palpation and in US examination. Total laryngectomy and neck dissection was performed. The histological examination of surgical specimen revealed; Malignant melanoma. Metastases in the lymph nodes. Neoplastic infiltration of the nodal capsule. The patient was admitted to the complementary radiotherapy. At the moment the follow up in outpatient. The article contains the review of literature concerning the diagnosis, treatment and prognosis in cases of laryngeal malignant melanoma.

Epidemiological studies have confirmed the correlation between tobacco smoking, environmental pollution and the incidence of cancers of the respiratory tract. The occurrence of laryngeal cancer in Poland is relatively high compared to other European countries. Since 1969 the mortality related to larynx cancer appears to be increasing. Tobacco smoke contains an abundance of such carcinogenic compounds as polycyclic aromatic hydrocarbons (PAH), aromatic amines and N-nitrosoamines, which can react with DNA and form adducts. We analyzed aromatic DNA adducts in laryngeal tissues from patients with primary laryngeal, which was confirmed histopathologically to be squamous cell carcinoma. The group consisted of 33 patients (5 women and 28 men). Total laryngectomy was performed in patients. A detergentphenol method was used for DNA isolation. Aromatic DNA adducts were analyzed by a 32P-postlabelling technique with butanol extraction and high performance liquid chromatography. The presence of aromatic DNA adducts was demonstrated in all tissues. Large interindividual differences of DNA adduct levels were seen in each tissue studied. There was a higher mean level of DNA adducts in interarytenoid area non-tumors (51.96/10(8) +/- 91.71 NN) than in non-tumor tissue elsewhere (46.91/10(8) +/- 46.36 NN) and tumor tissue (43.52/10(8) +/- 45.88 NN). Adduct levels were correlated with age, sex, cigarette smoking and TNM stage.

Comparative genomic hybridization was performed on 38 primary laryngeal carcinomas divided into two groups according to the metastatic phenotype. DNA copy number changes were detected in 22 of the 38 cases (57.9%). Gains were most frequently observed at 3q, 8q, and 9q, and losses were found in decreasing order at 18q, 3p, and 4. The mean value of losses was 2.5 times as high in metastasizing primary tumors (23/38) as in nonmetastasizing tumors. The most frequent losses in metastasizing tumors were at 18q, 3p, and 5q.

Tumours of head and neck belong to the most frequent types of cancer world-wide. In Poland, mortality from larynx cancer among males has been continuously increasing during the last decades up to 8.4 deaths per 100,000 men in 1993, which exceeds epidemiological records from other countries. The aetiology of laryngeal cancer is strongly associated with exposure to carcinogens present in tobacco smoke. The review describes a sequence of molecular and cellular events from carcinogenic exposure, DNA adduct formation, detection of mutations in the p53 gene, loss of heterozygosity (LOH) in chromosomal loci encoding the p53 and p16 genes, and loss of control of the cell cycle. The section concerning DNA adducts includes a discussion of the role of such confounders as exogenous exposure, the age and sex of the subject, and disease progression. The significance of genetic factors as individual risk determinants is discussed in relation to bleomycin-induced chromosome instability and in connection with the occurrence of defects in genes encoding detoxifying enzymes. The question concerning the substantial difference between men and women in larynx cancer morbidity and mortality remains open, even when the significantly higher adduct formation in male DNA compared with female material was taken into account. Preliminary experiments suggest a role of the frequently observed loss of the Y-chromosome.

The difficult and complicated mechanism of cancer development with little knowledge about the biology of existing cancers can lead to a permanent search for new examination techniques to improve the precision of life expectancy in patients and the selection of the most efficient methods of treatment. The aim of this study was to analyze certain prognostic factors, i.e., p53, Ki67, proliferating cell nuclear antigen (PCNA), DNA ploidy and cell proliferating activity, as well as the degree of morphological differentiation and cell maturity evaluated on an ultrastructural level in patients with laryngeal cancers in connection with data obtained from follow-up examinations and the clinical course of the disease. Neoplastic tissue was taken from 120 patients with laryngeal cancers. All underwent surgical treatment, radiotherapy and combined treatment in the Department of Otolaryngology. Karol Marcinkowski University School of Medical Sciences, Poznań, Poland, and the Department of Otolaryngology-Head and Neck Surgery, Haukeland University, Bergen, Norway. Before beginning treatment all patients underwent histological verification of their neoplastic tissues. Histopathological examination proved that the majority of cases (95%) had a squamous cell carcinoma. The occurrence of changes within the lymph nodes of the neck (N) was significantly correlated with T, S, Ki67, metastases to lymph nodes, DNA ploidy, site and surgery performed. The degree of clinical progression (S) was intercorrelated with T, N, p53, Ki67, PCNA, DNA ploidy, site and laryngectomy. The occurrence of oncoprotein p53 in neoplastic cells was measured by the staining degree of their nuclei and was correlated with T, S, DNA ploidy, metastases to lymph nodes, PCNA and site. The degree of staining of neoplastic cells for the nuclear antigen Ki67 was correlated to T, N, G, S, DNA ploidy, metastases to lymph nodes and surgical treatment. The proliferative antigen PCNA in the examined population of patients was intercorrelated with T, p53, Ki67, metastases to lymph nodes and surgical treatment. The results obtained from DNA flow cytometry could be associated with N, G, p53, Ki67 and metastases to lymph nodes. On the basis of the results obtained, the techniques suggested for the morphological and biological evaluation of neoplastic cells in cancer of the larynx should include TNM classification + G + DNA + p53 + Ki67.

The span of time between the appearance of the first symptoms of larynx cancer and the moment it is diagnosed in Poland amounts to approximately 6 months. It is the result primarily of the fact that patients tend to consult a doctor late after the symptoms show as they underestimate them due to their lack of knowledge concerning their nature. In some cases the diagnosis may be difficult to give even for a specialist. The paper presents the cases of three patients with an unusual course of larynx cancer.

One of the most common reasons of failure in head and neck cancer treatment are metastases in regional lymph nodes. Preoperative assessment of the neck lymphatic system is an important task, but even more crucial goal is to monitor the patients after initial operation or combined treatment. The frequency of nodal recurrences ranged from 9% to 23%. It constitute nearly 50% of all treatment failures in larynx, tongue and tonsil malignancies. There are different methods of therapy in nodal recurrence treatment, but the most recommended, easily accessible and widely used is surgery. The group of 2134 patients (1580--larynx cancer, 286--tongue and floor of mouth cancer, 268--tonsil cancer) treated between 1987-1997 were operated in ENT Dept. of K. Marcinkowski University of Medical Sciences in Poznań. In 269 patients were detected the nodal recurrence. In 149 cases the recurrence was homolateral, in 48 heterolateral, in 71 patients the neck was not previously treated. 152 patients were irradiated on the neck fields just after primary surgery. The rate of recurrences was 12.6%. Authors analysed and compared the percentage of recurrences for different primary lesions: larynx, tongue and tonsil neoplasms. The period of time from the last control examination to the moment of recurrence detection, its frequency on particular nodal levels, number of recurrences and trends between years 1992-1997 were assessed. 208 patients who developed nodal recurrence had surgical salvage, 59 patients were not qualified to surgery because of the lesion extension. Neck re-operations were divided into 3 main types: selective, modified radical and radical neck dissection. The frequency of particular neck dissection types, curative rates and difficulties of performing the salvage surgery were discussed.

The bleomycin test is a recognised method of evaluation of hidden genetical instability. The concept of the test consists in inducing chromosome aberrations in lymphocytes exposed in vitro to bleomycin and subsequent quantitative analysis of chromosome breaks. The study material was whole venous blood from 61 laryngeal cancer patients and from 30 healthy persons taken as a control. For each patient two parallel cultures where carried out in the standard procedure. Bleomycin was added to one of the cultures to induce chromosome breaks. Then, in microscopic metaphasal plates stained by Giemsa dye, the chromosome instability index estimated as a number of chromosome breaks per cell (b/c) and the percentage of cells with chromosome breaks were calculated. Higher indices of chromosome instability were demonstrated in laryngeal cancer patients in comparison to the controls. The persons with chromosome instability (b/c > 0.8) or with chromosome oversensitivity to mutagens (b/c > 1) were identified only among larynx cancer subjects. Furthermore, it was established that an increased chromosome instability is associated with high aggressiveness recognised by histological grading. The latter finding requires confirmation on an enlarged group of subjects.

As treatment for laryngeal cancers the extended fronto-lateral laryngectomy allows tumor to be removed that involves the glottis with the vestibule of the larynx. Since 1979 we have performed 417 extended fronto-lateral laryngectomies with simultaneous reconstruction of the anterior part of the larynx using a mucoperichondral flap from the anterior septum. This operation was indicated for stage T1b cancer (175 cases), stage T2 tumor (231 tumors) and T3 extended operations with epiglottectomy (11 cases). For the total number of 417 patients operated on, 19 cases during the 5-year period of following had local recurrences that required total laryngectomy. In 11 cases, metastases to the cervical lymph nodes required surgical neck dissection. In the remaining 387 cases, a normal air passage and a large laryngeal lumen were found. In 15 cases graft rotation into the larynx made respiration and phonation difficult but without dyspnea occurring. Follow-up to a maximum of 18 years showed that the oncological and functional results after this surgical procedures are encouraging.

The late results of the larynx reconstruction by means of the mucoseptal nasal graft after an enlarged fronto-lateral laryngectomy were described. The analysis of 460 patients showed a satisfying larynx lumen in almost all cases. In 21 cases due to the neoplasm recurrence a total laryngectomy were performed. The voice after surgery was socially good, and the wide larynx lumen was obtained.

The purpose of this study was to prove the superiority of ultrasound (US) examination of the neck in comparison to palpation, to reveal unpalpable nodes (pN0) before surgery, and to allow for the early detection of nodal recurrences in patients with laryngeal cancers. In all, 1,120 patients with laryngeal cancers were operated on between 1990 and 1997. All underwent palpation and neck US before surgery. In the pN0 group US revealed enlarged lymph nodes in 261/505 cases, of which 63 (24.14%) were confirmed as metastatic by histology. All 1,120 patients underwent regular postoperative US follow-up. Nearly 5,000 US examinations were performed; 136 patients who developed nodal recurrences had surgical salvage procedures. In this group 61 patients had small, nonpalpable lesions, and 46 patients discrete and slight changes in scarred necks. In this latter group of 117 patients with nonpalpable lesions, 105 cases were histologically confirmed as metastatic. In postoperative check-ups, metastases were suspected in sonographically detected subclinical nodes, but the US scans obtained were difficult to interpret. In these cases, because of the dynamics of lesion changes, US was repeated two to three times at 10- to 14-day intervals. This reappraisal enabled us to exclude malignancy in regressing nodes, as well as to obtain the stable picture of scar, and support a diagnosis while the lesion grew larger or a central area of low attenuation or hypoechogenic echos appeared in the nodal capsule. Successful radical reoperation for tumor was done on110 patients; 78 patients underwent successful salvage surgery after an early US diagnosis. The sonographic-surgical correlation was nearly 95% and the sonographic-histological correlation was 90%. The follow-up period was 1-49 months. In all preoperative assessments US was found to be a valuable tool in the staging of laryngeal cancer and planning the extent of surgery. Close follow-up with US after radiotherapy and initial operation was essential for the early detection of tumor recurrences, making surgical salvage still feasible.

The main purpose of this study was subjective and objective evaluation of voice function before and after extended frontolateral laryngectomy, followed by reconstruction with a mucochondrial graft from the nose. The next aim of this study was analysis of phoniatric and acoustic results depending on: (1) the extent and localization of the neoplastic process; (2) the wound-healing process (including the time of decannulation and effective deglutition); (3) the substitute mechanism of phonation. In all, 40 patients (37 men and 3 women) having T1B (67.5%) and T2 (32.5%) glottic cancers were examined before and after the operation. The ENT investigation included each patient's history from the beginning of illness, a subjective evaluation of the voice by patients before and after the operation, determination of laryngeal mobility of the larynx and indirect laryngoscopy during phonation. Phoniatric examination included voice recordings, average voice pitch, voice range, maximum phonation time, microlaryngoscopy and microstroboscopy. Acoustic analysis covered the harmonic structure of the voice, jitter, shimmer, noise components and basic frequency. Results showed that the extent of the neoplastic process before operation did not affect essential voice quality after operation in stage T1B and T2 disease. The maximum phonation time was shortened in T1B patients from 16.5 s to 9.28 s and in T2 from 16.7 s to 9.8 s. The average voice pitch was decreased in T1B from 177.3 Hz to 111.74 Hz and in T2 from 163.8 to 99 Hz. A correlation between acoustic analysis and phoniatric examinations was found. The value of the first formant decreased by 15.1 Hz, jitter increased 2%, shimmer increased 0.9 dB and basic frequency decreased. The voice quality after operation showed a statistically significant dependence on the mechanism of phonation. The best results were found in patients in whom phonation was the result of removing the vocal fold and postoperative scar vibration. The worst results were found in those patients with a sphincter mechanism of phonation.

Mortality connected with tobacco smoke-associated laryngeal cancer in Poland markedly exceeds the relevant epidemiological data from other European countries. The main groups of genotoxic agents considered as potential carcinogens present in tobacco smoke are polycyclic aromatic hydrocarbons, aromatic amines, N-nitrosoamines and reactive oxygen species. Aromatic DNA adducts, N7-alkylated guanosines and oxidative DNA damage derived from tobacco smoke exposure were detected in laryngeal and oral (tumour and non-tumour) biopsies, and white blood cells of cancer subjects. Further, DNA lesions were analysed to estimate the significance of such confounders as intensity of smoking, subject's sex, age, topography of larynx, cancer staging and genetic factor. The number of cigarettes smoked per day was found to be the main determinant of an individual's DNA adduct level. The occurrence of DNA lesions was established as a reliable marker of former exposure to tobacco smoke genotoxicants. On the other hand, a comparison of DNA lesion levels in various regions of larynx indicates limited usefulness of DNA adduct analysis as an estimate of cancer risk. For a better risk estimation one has to take into account DNA lesions in proto-oncogenes and tumour suppressor genes and the efficacy of DNA repair. Altogether, DNA adducts formation and removal has to be considered as a single stage in the multistep carcinogenesis.

The introduction of the CO2 surgical laser into laryngeal microsurgery has made resection of the posterior vocal cord together with the arytenoid cartilage possible. Since November 1990, 30 arytenoidectomies, 17 partial cordectomies and 18 bilateral cordectomies as described by Kashima were performed by means of a CO(2) laser in patients with bilateral paralyses of the vocal cords. In this group there were 58 women and 7 men. The patients' ages ranged from 28 to 71 years (mean, 46.7 years). In one case the operation was performed twice: the right arytenoid cartilage was excised initially and the left arytenoid cartilage was removed in the second procedure. Three patients required tracheotomy before being transformed to the ENT Clinic, Poznañ. The etiologies of the vocal cord paralyses were complications arising from thyroid gland surgery (n = 62), trauma (n = 2) and excision of a bilateral glomus caroticum tumor. In all patients except one postoperative recovery was correct and no breathing difficulties were observed after extubation. In the one failure after operation endolaryngeal scar tissue resulted in glottic stenosis.

A comparison was made of the staining intensities of selected immunohistochemical proliferating antigens (p53, PCNA, Ki67), DNA flow-cytometry and ultrastructures of neoplastic cells from 120 cases of laryngeal cancers. Clinically very advanced tumors were in the majority (T3, 43%; T4, 18%). A 5-grade scale was adopted to evaluate the level of immunohistochemical staining of the carcinoma cell nuclei. Positive staining was obtained in 70% for p53, 57% for Ki67 and 80% for PCNA. Sixty-two percent of the cases were DNA-diploid and 38% DNA-aneuploid. The DNA-diploid carcinomas were accompanied by enlargement of the cell nuclei, preservation of wide margins of nuclear heterochromatin, enlargements of the nuclear areas and increases in the number of nuclei. In the aneuploid-polyploid cancers the nuclei had a substantial polymorphism, with large cleaved nuclei showing significant variations in size and having a nuclear envelope. A frequent finding was euchromatization of chromatin. Dense chromatin appeared in the form of small clumps spread over the whole area of these irregular nuclei. Enlargement and activation of nucleoli were found. There was a positive (chi-square) correlation between T- and N-stage and immunohistochemical staining. There was also a positive correlation in staining intensity between p53, Ki67 and PCNA markers and strong correlation between these markers for proliferative activity and the degree of aggressiveness of a tumor.

Malignant nonepithelial neoplasms of the larynx are rare, and tumors of mesenchymal origin constitute 4-6% of all malignant neoplasms of the larynx. Sarcoma neurogenes vel malignant schwannoma make up 10% of all soft tissue sarcomas. In this paper a case of the extremely rare malignant schwannoma of the larynx is presented. In world literature we have met four case reports describing tumors of this histological morphology and location.

According to epidemiological data concerning laryngeal cancer there is almost ninefold higher morbidity in male population than in females. The aim of this study was to analyse on molecular level the genotoxic effects arising under the same exposure to tobacco smoke in males and females. In biopsies received from laryngectomy material we determined levels of aromatic and alkylated DNA adducts in tumours and in adjacent non-tumour tissue. It was established that levels of DNA adducts found in male DNA samples exceeded those in female DNA samples 1.5-3.8 times, which was recognised as a molecular evidence for epidemiological differences. Next, testosterone and sex hormones binding globulin (SHBG) were determined in male subjects blood serum. The levels of testosterone and SHBG very weakly correlated with DNA adduct levels even when subjects were separated into age groups. It is concluded that levels of testosterone and SHBG are not the proper markers of individual susceptibility to genotoxicity of tobacco smoke carcinogens.

An inter-individual variability in sensitivity to mutagen-induced genotoxicity was studied in respect to an estimation of larynx cancer risk. Bleomycin induced chromosome breaks were analysed in blood lymphocytes proliferating in vitro in a group of 35 larynx cancer subjects and in 18 healthy controls. A significantly higher index of chromosome breaks was found in larynx cancer subjects as compared with the controls. The distribution of individual results indicates that subjects oversensitive to bleomycine were identified only among laryngeal tumour patients. A potential usage of bleomycin test in tumour prognosis is discussed.

In a group of 579 patients with laryngeal carcinoma treated surgically in years 1988-1989 in four departments of otorhinolaryngology of the Medical Academies in Poznań, Warsaw, Cracow and Lublin, 72% survived 3 years without recurrence and 59% survived 5 years. Similar results were obtained in years 1986-1987. The authors discuss in detail the reasons for failures of the surgical treatment, i.e.: supraglottic localization of the cancer, its extensiveness in the larynx, the stage of clinical development, general condition of the patient, effectiveness of the operation, regularity of postsurgical examination, the degree of histological malignancy, blood transfusion during the operation, distant metastases, little efficiency of medical service in early diagnosis of laryngeal cancer, avoiding postsurgical radiation, subjective factors of the patients and the choice of the optimal method of the treatment. Few patients can be cured if the initial treatment fails.

In a group of 42 patients with surgically treated laryngeal carcinoma, who were divided into those before their 50 and after 60 years of age, main lymphocyte subsets of peripheral blood lymphocytes were assessed by means of flow cytometry. In the group after 60 years of age significantly increased percentage and raised total number of NK (natural killer) cells were found. In the whole group increased total number of all lymphocyte subsets was found. These data indicate that older patients despite an increased number of total to lymphocytes NK cells show higher percentage and total number as compared with normal population at that age.

A study of DNA ploidy was carried out including 84 cases of laryngeal squamous cell carcinoma. Material was fixed during 30 min in 3% paraformaldehyde and embedded in low-melting-point paraffin. The histologic studies were done for diagnosis and general view. Results were as follows. The highest percentage of cancers with DNA diploidy was found in well- and medium-differentiated tumors. Among well-differentiated carcinomas there were 18% diploid versus 5% polyploid tumors. In the medium-differentiated cancers there were 23.5% diploid, 6% polyploid, and 6% hyperdiploid tumors. The highest percentage of DNA hyperdiploidy and poliploido-aneuploidy was found in low-differentiated cancers. Additionally, tumor proliferative activity was evaluated in relation to the percentage of cells in phase S of cellular cycle. Special attention was paid to tumors which revealed the phenomenon of DNA poliploidy-aneuploidy beside DNA diploidy.

The purpose of this study was to demonstrate the superiority of ultrasound examination of the neck in comparison with palpation in patients operated on and irradiated because of the larynx cancer. Recurrence is common after laryngectomy, especially for advanced laryngeal cancer. Close ultrasound follow-up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible. Ultrasound also proved to help in the follow-up and control during radiation therapy. In this special group of patients nodal recurrence is more difficult to detect early by clinical examination because of scars and oedema due to prior surgery and radiotherapy. A group of 810 patients operated on between 1990 and 1995 was followed up by means of ultrasound. 3100 US examinations were performed in this group. 102 patients who developed nodal recurrence had surgical salvage. The follow-up of these patients lasted for 1-49 months. A comparison between patients with palpable lesions and lesions detected sonographically was performed regarding: size of the nodes, pattern of recurrence, possibility of performing radical surgery, time from the last control examination. Apart from demonstrating non-palpable nodes US may also depict the size, multiplicity, relation to the surrounding vessels and invasion of the carotid artery, as well as malignant extension in the salivary glands or thyroid.

The analysis of survival of 311 patients after total laryngectomy due to cancer and conventional postoperative radiotherapy was performed. During irradiation in a part of patients were introduced interruptions in treatment and no related diseases. The gap in treatment was taken in account and for this factor all patients were divided into 3 groups; without gap in treatment (A), with short gap--below 7 days (B) and with long gap--over 7 days (C). All groups were comparable. It was concluded that the long gaps increase the failure in treatment for about 30%.

The purpose of this study was to evaluate the superiority of ultrasound examination of the neck in comparison with palpation in patients operated on and irradiated because of the larynx cancer. Close follow up by means of ultrasonography all patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible. Scars, oedema and anatomical changes due to prior surgery and radiotherapy make the clinical examination very difficult. Apart from demonstrating non palpable nodes, ultrasound may also depict nodal size, multiplicity, relation to the surrounding vessels, invasion of the carotid artery and malignant extension in the salivary glands or thyroid. 12 pictures of ultrasound were presented.

In the years 1946-1995 in Karol Marcinkowski University School of Medical Sciences, Department of Otolaryngology, Head and Neck Surgery the long term results on 2223 patients with laryngeal cancer treated surgically according to the age were evaluated. Five year survival rates after total laryngectomy in elderly persons was 44.2%. Five year survival rates (67.7%) after partial laryngectomy justify their application in suitably chosen cases of cancer of the larynx.

In the group of 578 patients with larynx cancer that underwent surgical treatment in four clinics of Medical Academies between 1986-87 a comparable analysis of the efficiency of surgical treatment depending on age of the operated patients was carried out. It was found that the difference between age average and the general state of patients was statistically highly important: Statistically significant was also the dependence between the patients' age and the postoperative complications; close to importance was also the dependence between the age and the survival period of patients. 68% of operated patients up to 65 year of age had five-year survival period without any symptoms; but in the group of patients over 65 years of age the analogical survival value was 51%.

The p53 gene is known as an anti-oncogene that manifests its function by controlling the cell cycle and is responsible for apoptosis of cells with unrepaired DNA. An accelerated p53 protein synthesis is the first response of a cell following DNA damage. However, mutations of the p53 gene can disturb protein synthesis or may be responsible for synthesis of a changed protein unable to control the cell cycle. Laryngeal tissue specimens from 120 patients were tested by immunohistopathological staining to detect mutated wild-type p53 protein. It was found that p53-positive specimens correlated with TNM staging and histopathological grading. Another indication of entering the cell cycle and undertaking an active proliferation by laryngeal cells was shown by detection of proliferating cell nuclear antigen (PCNA) and Ki67 nuclear antigen, which appeared in proliferating cells (late G1, S-G2 and M phase), but was absent in resting cells. Scoring of the staining for p53 protein, PCNA and Ki67 correlated with each other. DNA from 40 specimens was then isolated, amplified by polymerase chain reaction and analysed by single-strand conformation polymorphism and DNA sequencing for mutation in the p53 gene. Fifteen DNA samples were found to be positive, while mutations were detected in exons 5-8 in 13 samples. The majority of mutations were found in tissue specimens from T3 and T4 tumors. A possible explanation is almost half was attributable to genotoxic effects of tobacco smoking. Changes in the p53 gene and its products may also reflect early changes in laryngeal carcinogenesis and be of prognostic value.

The presence of N7-alkylguanine adducts in DNA was analysed in a group of 46 patients with larynx tumours. All patients were subjected to laryngectomy and the tissues accessible for analysis by (32)P-post-labelling assay were larynx tumour, larynx non-tumour and peripheral blood leucocytes. N7-Alkylguanine adducts were detected in all the studied DNA samples. The average level of N7-alkylguanines was 26.2/10(7) nucleotides in tumour cells, 22.7/10(7) in non-tumour cells and 13.1/10(7) in blood leucocytes. There was significantly higher level of N7-alkylguanines in the larynx tissues in males than in females. The effect of tobacco smoking on DNA adduct levels was shown by an increase in the average levels of N7-alkylguanines in the subject groups classified according to their smoking habits. A moderate age-related increase in levels of N7-alkylguanine was demonstrated in larynx tumour tissue. The levels of N7-alkylguanine adducts in larynx cells were compared with that of aromatic DNA adducts. Pearson correlation coefficients (0.28 for tumour tissue and 0.30 for non-tumour tissue) indicate independent formation and removal of N7-alkylguanine and aromatic DNA adducts resulting from tobacco smoke exposure.

264 patients with cancer of larynx, 21 female and 234 male, had a testosterone and sex hormone binding globulin (SHBG) before the treatment in serum estimated. Because of dependence of levels of hormones the group of patients was divided into three following groups: "lower than standard", "standard", "higher than standard". The correlation between these groups and sex, age, localization of tumor, organs' advances, stage of morphological malignancy and type of cancer was reported. Anomalous values of testosterone were in male group more frequently reported. Anomalous values of SHBG were similar in male and female groups, but in the female group there was a significant majority of "lower than standard" values reported. The majority of abnormal values of testosterone and SHBG was described in groups of age higher than 50 years. There were no differences in testosterone and SHBG levels in different localization of tumors in larynx. In advanced stage T3 and T4 there were more frequent lower mean values of testosterone levels and higher values of SHBG levels in comparison to T2 stages. In tumors in G1 and G2 stages of histological malignancy higher levels of SHBG and higher mean levels of testosterone. The tumors in stage G3 the hormone levels were lowers were observed. The levels of SHBG in groups of carcinoma planoepitheliale keratodes were in 66% higher than in a group of carcinoma planoepitheliale akeratodes but in both groups the levels of testosterone were nearing the same. In group of patients with larynx cancer the negative correlation between the levels of testosterone and SHBG was not observed. Higher SHBG levels were not always accompanied by lower testosterone levels.

Cancer is a genetic disease and the development of the techniques of molecular biology in recent 10 years contributed to the new understanding of neoplasmatic process. The mutations of gene p53 became one of the most common abnormality in human cancer. The aim of this research was to mark oncoprotein p53 in 120 cases of larynx cancer and the correlation of its appearance with clinical and histopathological parameters. The evaluate the degree of immunohistochemical staining of cell nuclei a 5 degree scale was adopted. The positive staining of cell nuclei was observed in 70% of cases. Positive correlations based on a chi-square test was observed between p53 and T and N as well as between p53 and the degree of histological differentiation.

Immunohistopathological staining for p53, PCNA and Ki67 was performed in 120 specimens from previously untreated laryngeal carcinomas using the avidin-biotin method with peroxidase as a marker enzyme and diaminobenzidine as a chromogen. A 5-grade staining score system was used. Statistically significant correlations (Chi-square) were seen between T- and N-stage and histopathological grading. p53 and Ki67 scoring correlated with T- and N-stage whereas PCNA with T-stage. All staining correlated with histopathological grading. The score of staining for p53, PCNA and Ki67 correlated with each other. The patients with recurrences within 3 years had mainly carcinomas with higher staining scores. Using Chi-square analysis the p53, PCNA and Ki67 staining scores were also independent prognostic indicators.

In 4 ENT Clinics of Medical Academies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: senility, other concomitant diseases (especially cardiac), prolonged diagnostic procedure, no up to date diagnostic methods, giving up the radiotherapy (38% of cases), upper laryngeal localization of tumors (87%), advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degrees and IV degrees 85%), lack of surgical radicality especially in neck dissection, unsuccessful neck dissection behind the accessory nerve, omittance of taking the specimens to the pathomorphologic examinations from the marginal part of the operational field in 25% of patients. The early recurrences in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.

In a group of 60 patients with surgically treated laryngeal carcinoma blood lymphocyte subsets were assessed on the day of surgery (day 0) and six weeks thereafter by means of flow cytometry. Blood cells at day 0 were also compared to tumor infiltrating lymphocytes (TIL) isolated from surgical specimens. Significant alterations were found in postoperative period as compared to day 0 manifested by the fall of B cells, increase of activated T lymphocytes and NK cells. There were also marked changes between blood cells at day 0 and TIL, evidence in rise of B cells, of activated T lymphocytes and decline of NK cells within the latter. These data suggest that the assessment of lymphocyte subsets may be of value in immunological monitoring of laryngeal carcinoma patients.

A comparison was performed of staining intensity of immunohistochemical proliferating antigens (p53, PCNA, Ki67), DNA flow cytometry and ultrastructure of the carcinoma cells in 120 cases of laryngeal cancer. Clinically very advanced tumors were in majority (T3 - 43%, T4 - 18%). A 5 graded scale was adapted to evaluate the level of immunohistochemical staining of the carcinoma cell nuclei. A positive staining was obtained in 70% for p53, 57% for Ki67 and in 80(2/3) for PCNA. 62% of the cases were DNA diploid and 38% DNA aneuploid. The DNA diploid carcinomas were accompanied by the enlargement of the cell nuclei, preserving of the nuclei's wide margins of heterochromatine, enlargement of the nuclear area and increase of the number of nuclei. In the aneuploid-polyploid cancer the nuclei had a substantial polymorphism with large cleaved nuclei and with significant variation in size, and with nuclear envelope. A frequent finding was euchromatization of chromatine. Dense chromatine appeared in the form of small clumps spread over the whole area of these irregular nuclei. Enlargement and activation of nucleoli occurred. There was a positive correlation (Chi-square) between T- and N-stage and immunohistochemical staining. There was also a positive correlation in staining intensity between p53, Ki67 and PCNA. There is also strong correlation between these markers of proliferative activity and the degree of aggressiveness of the tumour.

A group of 578 patients with larynx cancer underwent surgical treatment in four Otolaryngological Clinics of Medical Universities in Poznań, Warsaw, Cracow and Lublin between 1986-1987. Within this group, 75% of operated patients had a three--year survival rate without symptoms, and 58% of patients had a five-year survival rate. A detailed evaluation of causes of failures in surgical treatment dealt with e.g. the initial placement of the cancer including entrance margins of larynx in a rich net of lymphatic vessels, extensiveness of organs, the degree of clinical progressions, general physical condition of a patient, radicality of treatment, regularity of check-ups after the operation, high degree of histological malignancy unfavourable configuration of TNM feature blood transfusions, the appearance of remote metastases low efficiency in the early diagnostics of larynx cancer, subjective conditions of patients, discontinuation of complementary irradiation.

The metastases in the pre-laryngeal (Delphian) lymph nodes in the course of laryngeal cancer are uncommon. Between 1984 and 1994, 1573 patients with the diagnosis of laryngeal carcinoma were operated at the Department of Otolaryngology of Academy of Medicine in Poznań (Poland). Total laryngectomies were performed in 1069 cases and partial laryngectomies in 504 cases. Pre-laryngeal lymph nodes were identified in 109 patients. Histologically, metastases were found in 8 cases (7.48%). The prognosis of the patients with metastases in these lymph nodes is poor; only 2 patients are alive and free of neoplastic disease.

The basic methods of larynx cancer diagnosis were presented. It included subjective and objective examination, and laboratory examination. The importance of detailed history of cases determined by the tumor localization was underlined. Indirect and direct laryngoscopy have not lost it importance despite the development of modern methods of larynx cancer diagnosis. Microlaryngoscopy provides the most valuable information about the localization and advancement of neoplasmatic change. Its also allows for precise taking of specimen for histopathological examination. Radiological method in larynx cancer diagnosis were also taken into consideration particularly laryngotomography which allows for evaluation of subglottic region, ventrical and recesus piriformis. The histological examination remains a decisive factor in the surgery of larynx cancer. Great diagnostic possibilities of neck lymphatic system and larynx are being provided by the ultrasonographic examinations, computer tomography and magnetic tomography of nuclear resonance which allow for detailed evaluation of neoplasm extend and appearance of recurrence and metastases. The greatest responsibility in diagnosis of larynx cancer is put on a doctor who first advised the patient.

In 4 ENT Clinics of Medical Akademies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: prolonged diagnostic procedure, upper laryngeal localization of tumors, advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degree and IV degree 85%), lack of surgical radicality especially in neck dissection. The early recurrencies in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.

Genotoxical agents as PAH, nitrosamines, aromatic amines located in tobacco smoke are responsible for disorders of structure and function of DNA chromosomes, proteins and also initiation of carcinogenesis. DNA adducts are recognized as measure of the biological effective dose of exposure to environmental genotoxicant. So far most studies on DNA adducts after human exposure to tobacco smoke have ben carried out on white blood cells, lungs and oral cavities tissue. The aim of this work was estimation of relationship between state of neoplastic disease (TNM system) and number of aromatic DNA adducts. The subject were 37 patients with primary larynx tumor. In every case histopathological investigation revealed squamous cell carcinoma. There were 33 total and 4 partial laryngectomies performed. From tumour and nontumour larynx tissue DNA was isolated. Analysis of DNA adducts was performed by the 32P-postlabelling method. The results were characterized by individual differentiation. The highest level of DNA adducts was found in larynx tumour cells. In case of strong smokers (30-40 cigarettes per day) the level of aromatic adducts was higher then in non- or ex-smokers. In both tissues (tumour and non-tumour) the highest level of aromatic adducts was in T3 stage, the lowes in cause of T2 stage. In tissues with T4 stage the level of DNA adducts was intermediate. One has been observed decrease tendency in level of DNA adducts which is connected with increase of TNM stage.

The authors present the advantages of using a micromanipulator of new generation (small working spot) in laser surgery of larynx. This micromanipulator are very usefull in laser surgery of small changes on vocal cords.

The examination was carried out on 32 patients with larynx cancer, before and after fronto-lateral laryngectomy with reconstruction, using cartilage-mucous membrane transplant from the nasal septum. Before and after the surgery the following examinations were carried out: 1. phoniatric evaluation of voice, 2. acoustic analyses of voice, 3. spirometric examination. The phoniatric examination included evaluation of voice characteristics, time of phonation, anatomic mechanism of voice creation and evaluation of voice tiredness with the use of stroboscopy. Acoustic examination included the frequency evaluation of laryngeal sound and its range, jitter shimmer evaluation, harmonic structure of sound and the level of noise. The result obtained allow us to consider the voice and respiratory function as satisfactory.