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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.

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.

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.

624 patients with malignant neoplasms of the mouth and the oropharynx treated in the ENT Department K. Marcinkowski University of Medical Sciences in Poznań between 1980 and 1999 were analysed. Since the middle of the 90-ies a rapid increase of neoplasms incidence of this location has been observed. The most numerous group were tumours of the palatine tonsil (34.8%), tongue (32.5%), floor of the mouth (5.9%), soft palate (5.3%). Advanced neoplasms which encompassed the tongue, oropharynx, mouth floor base was observed in 134 patients (21.5%). The precise definition of their site of origin primary location was not possible to establish. In the analysed group males were dominating. Heavy smoker and alcohol-abuse constitute the majority of risk-factor patients. Poor dental status and mouth hygiene in this population was observed. In the histological examination squamous cell carcinoma was a dominating. Prognosis in patients with malignant neoplasms of the palatine tonsil were better in comparison with tongue cancer.

In the period of 35 years 25 patients with intracranial complications of paranasal sinusitis were treated in the Department of Otolaryngology of the Karol Marcinkowski University School of Medical Sciences in Poznań. In the past 15 years the number of complications decreased annually by half. Intracranial sinusal complications were more frequently present in young men. In 25 patients abscesses of the frontal lobe and epidural abscesses were most often diagnosed. Surgical treatment was carried out in each case when the inflammation process spread into the bony parts or into intracranial space. The method of choice in treatment of frontal lobe abscess and subdural abscesses is elimination of sinuses inflammatory foci with a simultaneous evacuation of the abscess by puncturing of the abscess and gradual exchange of its content into antibiotic solution. Intensive antibiotic therapy was carried out for the period of 4 weeks. Mortality rate in our material concerned patients with the brain frontal lobe abscesses and amounted to 12%. In the last 15 years we succeeded to treat all 17 patients.

In the years 1958-1999 the ENT Department at the University School of Medical Sciences in Poznań treated 125 patients suffering from adenoid cystic carcinoma located in the head and neck area. The aim of this study was to assess treatment results over a span of 41 years. The cases treated included 68 women and 57 men. The highest incidence of the disease was observed in men in their 70's--16 cases and women in their 50's--19 cases. In a majority of cases, the cancer started in major salivary glands, specifically parotid--51, submandibular--11, sublingual--4. Other places included minor salivary glands located in the palate--15, cheek--8, oral cavity--5 and tongue--4. Other glands affected by the tumor were those in the ethmoidomaxillary area--23. The treatment of choice was surgery with subsequent radiation. All patients were subjected to surgical treatment, 89 of them being subsequently radiated. Local recidivation was observed in 12 patients (i.e. 10%), metastases to neighbouring lymph nodes in 9 patients (i.e. 7%). Distant metastases affected the lungs--4 cases, liver--1 and bone--1.

The new diagnostic method, intraoperative ultrasound is presented. There are very few publications in the literature, but they mainly concern the application of transcutaneous ultrasound in localizing the abscesses, their puncture and drainage. Intraoperative imaging of tongue, tonsil, larynx tumors, submandibular and parotid glands and neck masses have been provided by means of a linear 7.5 MHz probe in Poznań ENT Dept. K. Marcinkowski University of Medical Sciences. The application of this method is pioneer and new. The aim of the study was to compare the sensitivity and the specificity of preoperative, transcutaneous ultrasound with the intraoperative one, to assess how the new method influences the extensiveness of the performed procedures and sonographic-surgical correlation of safety margins.5 patients with parotid tumors, 4 with tongue, 6 with tonsil and 6 with larynx cancers have been examined. In 13 of them, apart from primary site diagnostics, the neck masses have been assessed. The imaging documentation is presented and the preliminary conclusions concerning the usefulness of this method have been drown.

Carcinoma of unknown primary (CUP-syndrome) is taken into consideration when the patient has histologically confirmed metastases but the primary focus remains unknown or it's diagnosis is delayed. Metastases of unknown origin constitute from 5% to 31% of all neck metastases. Squamous cell carcinoma and anaplastic carcinoma metastases in the neck lymphatics suggest that location of primary focus can be found in head and neck region. Diagnostic procedures applied in detection of primary foci have been described. The knowledge of lymphatic metastases spreading routes is helpful in the primary focus detection. In the material of 1348 patients treated oncologically in the years 1991-1997 in ENT Department of Karol Marcinkowski University of Medical Sciences in Poznań, 22 were diagnosed for CUP syndrome. Primary foci were not found in 7 cases. In the remaining 15 patients the primary was located in nasopharynx, palatinal tonsil, tongue, hypopharynx, testes or breast. The treatment included the radical neck dissection with consecutive irradiation and/or chemotherapy, and in the case of diagnosing the primary one applied it's radical removal or radiotherapy.

Aim of the study was to establish clinical utility of intraoral ultrasonography in diagnosis of tonsillar tumours in respect to its magnitude, location, histological structure, presence of satellite lesions and furthermore compare results obtained by endoral to transcutaneous ultrasonography. 64 patients with tonsillar tumour entered the study. Endoral ultrasonography was performed by probe UST-937 Convex 5 MHz.Endoral ultrasonography is very efficient in exact tumour localisation and correlation between endoral ultrasonography and intraoperative assessment of T tumor is statistically significant. Ultrasonography is sensitive in recognition of satellite lesions. In the case of planoepithelial cancer, malignant lymphoma and inflammatory process very characteristic features of tumor can be described. Endoral ultrasonography is better then transcutaneous in tonsillar tumours diagnosis.

An exposure to tobacco smoke carcinogens is followed by an interaction of chemical carcinogens with DNA molecule resulted by the formation of carcinogen: DNA adducts. The study subjects were 40 oral and pharyngeal cancer patients with primary tumours diagnosed as squamous cell carcinoma. The biological samples purchased for analysis included tumour biopsy, the surrounding tissue (histopathologically recognised as non-malignant) and peripheral blood leucocytes. For DNA adducts analysis first DNA was isolated using phenol detergent extraction followed by 32P-postlabelling assay including P1 nuclease enhancement. Aromatic DNA adducts were found in all studied tissues. The average levels of DNA adducts in tumour and non-tumour tissues were found higher than in leucocytes. Biopsies from pharynx contained higher levels of DNA adducts than from oral cavities. Confounding effect of tobacco smoking and alcohol consumption on DNA adducts level was observed but it has not reached statistical significance. Formation of DNA adducts was not depended on such factors as patients age, sex, pulmonary tuberculosis, cancer progression (TNM), environmental pollution and mechanical irritation.

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.

Diagnostic possibilities in lethal midline granuloma (Wegener's granulomatosis, angiocentric lymphoma) based on the literature were presented. Results of diagnostic examinations in a case of 34 years old man admitted to the Dept. of Otolaryngology in Poznań were described.

In the years 1958-1997 were surgically treated in the Department of Otolaryngology Karol Marcinkowski University of Medical Sciences in Poznań 365 patients with pleomorphic adenomas. Majority of the tumors originated of the major salivary glands was parotid gland (273 cases). The given materials confirms the viewpoint that enucleation in the pleomorphic adenomas of the parotid salivary gland--based on total removal of the tumor together with the capsule and pouch constitute a completely sure surgical procedure.

A case of 18 years old male with tracheoesophageal fistula as a result of esophageal foreign body (chestnut) is described. Foreign body was removed using esophagoscopy. Bronchofiberoscopy performed because of difficulties with swallowing and frequent airway infections revealed tracheoesophageal fistula. Fistula was closed from intratracheal access. Symptoms of dysfagia disappeared after surgery.

Patient aged 48 with the cyst of the cervical part of thoracic duct was described. Cyst appeared as the result of inflammation. Histopathological examination excluded the cystic lymphangioma.

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.

The paper presents three cases of localised amyloidosis of the larynx. The study was focused on case histories, findings of larynx examination and method of treatment was discussed. Amyloidosis is a disease characterised by gathering of amyloid deposits in extracellular space. The amyloid fibres consist of different kinds of proteins which have the ability of forming laminae. This disease may be secondary to numerous general processes in which amyloid proteins forms. Etiopathogenesis of this disease has not been explained yet. In the following paper the latest theories and classification of amyloidosis are presented.

Pleomorphic adenoma localised in nasal cavity is extremely rare. Authors described a case of mixed salivary gland tumor in the lateral wall of nasal cavity. We are presented, on the base of our experience and literature data, pathogenesis, clinical course and treatment of this tumors situated in atypical places.

In the years 1958-1997 111 patients with adenoid cystic carcinoma in the head and neck of different localization were treated at the Department of Otolaryngology--Head and Neck Surgery. Majority of the tumors originated of the major salivary glands, mainly in the parotid gland (47 cases). The most common location among the tumor of the minor salivary glands was the palate (14 persons). The tumors arising from other mucous glands, most frequently has located in the maxillo-ethmoideal complex (20 cases). The authors stress diagnostic difficulties, the necessity of a proper selection of the surgical method and postoperative radiotherapy, describing the treatment results in the patients. Radial surgical procedure of the adenoid cyctic carcinoma yelds optimal local control and survival rates.

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 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.

1496 patients with foreign bodies of esophagus, reported between 1945-1997 to ENT Department of K. Marcinkowski University of Medical Sciences, were analysed. The age ranged from 0.5 to 95 years, but the most numerous group was under 5 years of age. Men outnumber women. Very detailed anamnesis, oropharynx and hypopharynx examination, neck palpation, chest X-ray were crucial for diagnosis. More than 50% of patients reported within first 10 hours after foreign body wedged. The most often met foreign bodies were: bones, coins, denture, fish bones, fruit-stones, buttons. The most dangerous were supposed to be: needles, pieces of glass, springing anchores, safety razors. Foreign bodies were removed by means of rigid esophagoscopes. In 75.3% foreign bodies occupied the first isthmus. Serious complications met in the analysed material, included: esophageal wall perforation [27], mediastinitis [21], aortal hemorrhage [3], esophagus-tracheal fistula [1]. Intramural abscesses, posteriol pharyngeal wall abscesses were found more often. 98% of esophageal foreign bodies were removed by the same route they had been introduced.

Primary neoplasms of parapharyngeal space are rare. In this location the so called non-malignant tumors occur many times more than the malignant ones. In our paper, employing statistics, objective symptoms and complaints connected with these tumors were ordered according to frequency. In recent five years in ENT Department of Karol Marcinkowski University of Medical Sciences in Poznań 9 persons were surgically treated. The differentiated histopathological picture is discussed and described (6 malignant and 3 non-malignant). It can be claimed that MR is more useful in diagnosis than CT. The treatment is usually surgical; both external and oral approaches are used.

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/c0.8) or with chromosome oversensitivity to mutagens (b/c1) 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.

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, Poznan, 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.

On the basis of cases of their own and the literature the authors review the etiology, pathophysiology and management of rhinophyma.

258 foreign bodies were removed from the lower respiratory tract in ENT Department of Poznań High School of Medical Sciences between 1945 and 1997. The age ranged from 0 to 85 years, but the most numerous group (68%) was found between 0 and 10 years. 86.5% patients were admitted to hospital during first three days after inserting the foreign body. The longest time of foreign body existence inside the bronchus was a period of 18 years. The most often met foreign bodies were: bones, bean seeds, fruit stones, pieces of food, iron nails. Spontaneous evacuation of the foreign body took place in 4% of cases. 98% of foreign bodies were removed by means of rigid bronchoscopy. Bronchofiberoscopy was performed for diagnostic purposes or for taking out foreign bodies located in the peripheral parts of the bronchial tree. 3% of patients were referred to the further toracosurgery treatment.

A case of squamous cell carcinoma of the nose and paranasal sinuses in an 18-year-old male is presented. Carcinoma of the nose and sinuses is not common and accounts for 3-5% of an all malignancies in the head and neck. Peak incidence of the disease seems to occur in the 6th and 7th decade of life. No cases of nasal carcinoma were observed under the age of thirty. The authors discuss the difficulties in setting the diagnosis--nonspecific symptoms mimic those of chronic sinusitis.

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.

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.

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.

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.

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%.

Aggressive fibromatosis in the otolaryngological region is a curious clinical entity, demanding accurate histopathologic interpretation. It is rare connective tissue tumor, which growth infiltratively with a destructive biological behaviour similar to malignant tumours and a high recurrence rate. Morphologically reactive fibromatosis and fibrosarcoma should be considered amongst others in differential diagnosis. CT and MR scans are useful in determining the extent of the tumors and help to distinguish the tumor from nerves, vessels and bone. Surgery is the treatment of choice. Our observations of the course of disease in the maxillary sinus, nasal cavity and nasopharynx confirmed the date in literature.

Cedax is the antibiotic drug of the third generation cephalosporin type. In the Department of Otolaryngology of the University Medical School in Poznań tests were carried out on the effectiveness of this drug in the prevention of perioperative infections (tonsillectomy, adenotomy, septoplastics, nasal polypectomy, mucotomy). The experiment comprised 50 patients who were administered Cedax once a day of the period of five consecutive days, beginning on the day of the surgery. Control group compare 50 patients who did not receive the antibiotic cover. For the comparison of both groups the following symptoms were taken into account: general condition of the patient, body temperature in the first few days after the surgery, the healing of the operative wound (the condition of mucosa, healing "per primam" or "per secundam"), the presence and type of nasal discharge. A high degree of efficiency of ceftibuten has observed.

In the years 1980-1995 60 patients with adenoid cystic carcinoma in the head and neck of different localization were treated at the Department of Otolaryngology. Majority of the tumors originated of the major salivary glands was parotid gland (24 cases). The most common location among the tumor of the minor salivary glands was the palate (5 cases). The tumors arising from others mucous glands, most frequently has located in the maxillo-etmoideal complex (12 cases). The authors stress diagnostic difficulties, the necessity of a proper selection of the surgical method and postoperative radiotherapy, describing the treatment results in the patients. Radical surgical procedure of the adenoid cystic carcinoma yields optimal local control and survival rates.

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.

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.

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.

The paper presents an evaluation attempt af Mucosolvan in the upper respiratory tract diseases. A group of 50 patients underwent observation. They were hospitalized in our Department due to acute and chronic inflammations of respiratory tract, malignant tumours and larynx, and trachea stenosis. In cases of larynx and trachea stenosis there occur disturbances in the cleaning of surface of mucosa. Normally, it is done by means of mucociliary system. In the modern postoperative therapy mucolitic preparations are very useful.

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.

Our examination included 10 male patients in the age of 40-72. Microlaryngoscopic examination revealed smooth prominence of the larynx vestibule always on the left side concealing partly the vocal fold but with its mobility preserved. Our greatest attention was focused on CT since we expected possible explanation of the asymmetry of the larynx vestibule. That examination disclosed: left-side shift of the thyroid cartilage lamina to the larynx, elongation of the thyroid cartilage lamina and measurements of interlaminar angles revealed contraction of that angle to the value 60-78.

Usefulness of jet ventilation in carbon dioxide laser surgery of the larynx is presented. The authors describe the advantages of that method of general anesthesia in surgery of the larynx.

Spirometric, phoniatric and acoustic investigations were performed in 13 patients after laser arytenoidectomy due to bilateral vocal cord paresis. Phoniatric examination included voice recording, average level and voice range, time of phonation, laryngoscopy and stroboscopy. Acoustic analysis covered harmonic structure of the voice, jitter, shimmer, noise component, basic frequency.

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 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.

4 cases of larynx contact ulcer cured with the use of laser resection of vocal process of arytenoid cartilage were presented. Advantages of using laser been in microsurgery of larynx were discussed.