Search

Functional endoscopic sinus surgery (FESS) introduced in the recent years by Messerklinger, Stammberger and Kennedy gained undisputable reputation as method of choice in treatment of nose and nasal sinus diseases. The introduction of this method was possible, among others, due to precise radiological diagnostics (CT). Traditional radiological examinations of nasal sinus do not allow for detailed diagnostics and analysis of anatomic anomalies such as: dehiscention in vicinity of carotic artery or ophtalmic nerve which have basic significance while establishing surgical risk. The paper presents 20 cases of nasal sinus CT of patients qualified for functional endoscopic surgery comparative analysis with traditional radiograms were performed.

The first qualification for cochlear implant "Nucleus" was performed on the basis of audiological tests. Next stage was conversation with a patient and his family about motivation of longterm rehabilitation. Then the two very important investigations were carried out--the computer tomography which showed inner ear structure, and electric promotory test. In rehabilitation process original "Nucleus" partially modified and Polish linguistic articulation lists were used.

Ultrasound examination is a fast, easy to carry out and relatively easily accessible one. This examination allows in the first stage to define the character of the change--cyst-like change, solid change, enlarged lymph nodes, and to establish topographic data, especially the relation to main blood vessels of the neck. The examination of 150 patients with neck changes of tumour type was carried out, the characteristic features of changes in case of solid tumours, benign and malignant ones, cyst-like changes, enlarged lymph nodes were presented. The comparison of the results of the ultrasound examination and the results of histopathological tests shows their substantial compliance.

Among host lymphoid cells engaged in anti-tumor defence, tumor infiltrating cells (TIC) are apparently the most suitable for this purpose, due to feasibility of direct contact with tumor cells. The aim of the present study was to evaluate distribution of TIC which express phenotype of cytotoxic cells, in tissues of laryngeal carcinoma. Cryostat sections of surgical tumor samples were subjected to sensitive APAAP immunohistochemistry, following reaction with one of the panel of monoclonal antibodies (MoAbs) vs. several CD antigens and assessed semiquantitatively. It has been found that the content and distribution of potentially cytotoxic cells are quite heterogenous and vary from case to case in examined cancer. CD8+ cells and those bearing NK cell phenotype were the most frequently encountered, mainly within tumor mass. The cells belonging to NK cell subsets, detected by GL183 and EB6 MoAbs could be demonstrated in tumor proximity. TCR-1+ (tau/delta) T lymphocytes were quite a few in part cases. On the other hand, only a scarce number of cells among TIC expressed interleukin-2 receptor. It is concluded that in the vicinity of laryngeal cancer there are fairly large numbers of potentially cytotoxic cells, but at low or nil state of activation.

In 30 patients with chronic renal failure, who were treated by hemodialysis, we investigated smell and taste function. We compared these functions before and up to 6 months following hemodialysis. We also estimated the correlation of the level of urea in the patients' blood with taste and smell. We found a positive (though temporary) influence of hemodialysis upon taste and smell.

The objective evaluation of the character of a change, localized in the area of palatine tonsil and tongue, especially in case of defining the extension of the change may cause many problems. So far the ultrasound examination of the tongue and tonsil was carried out by way of placing the endoscopic head on the skin in submandibular area or just behind the branch of mandibular, which in many cases didn't allow to achieve a satisfactory image of the changed tissues. This paper presents an attempt to use endoscopic head to examine changes localized in the area of tongue, palatine tonsil and nasopharynx and on soft palate. The paper also evaluates the usefulness of 2 types of endoscopic heads to carry out such examinations. The obtained initial results of the examinations point at substantial usefulness of this type of examination to the evaluation of changes localized in the area of tongue and palatine tonsil.

The smell and taste investigations were made in group of 47 subjects with neoplasms tumors of palatine tonsils surgical treated with radiation and in group of 7 subjects treated only by radiation. The investigation presents mostly quantitative disturbance of smell in both groups but with temporary character.

The method of surgical treatment of bilateral vocal cord paralysis with the use of laser CO2 is presented. This technique was used in 20 patients. The vaporization and extirpation of arytenoid cartilage was performed together with resection of 1/3 of the posterior vocal cord which was removed. Analyzing other methods of treatment of bilateral vocal cord paralysis it was emphasized that with the use of the presented method good results in preserving breathing and phonation of the operated part was archived. It was also emphasized that the fast process of healing and lack of granulation in the operated field allows for the quick recovering patient. This method allows to obtain good wide larynx lumen without the necessity to perform tracheotomy--in 17 out of 20 our patients we could perform laser arytenoidectomy without tracheotomy.

There is known a strong association between induction of cancer of respiratory tracts and tobacco smoking. Exposure to polycyclic aromatic hydrocarbons (PAH) present in tobacco smoke can induce DNA lesions including bulky DNA adducts. The studied group consisted of 6 men, aged 46-71 years, all intensive cigarette smokers, without reported occupational exposition to PAH. Treatment did not include radio- and chemotherapy. DNA isolated from surgically removed tumors, surrounding tissue histologically characterized as non-malignant and peripheral blood white cells was analyzed by 32P-postlabelling assay with P1 nuclease enhancement. Both, P1 nuclease digestion and the chromatographic systems used for separation of DNA adducts were established for PAH: DNA analysis. The main adduct was identified as diol-epoxide metabolite of B (a) P. The mean number of adducts in tumor samples, surrounding tissue and white blood cells was calculated, respectively, to 82.3, 59.9 and 41.7 PAH: DNA adducts per 10(8) nucleotides. The only accessible reference was for DNA from white blood cells. The amount of PAH: DNA adducts in white blood cells of larynx cancer patients exceeded that found in healthy blood donors (both: smokers and non-smokers) as well as in workers exposed occupationally to high concentration of PAHs in the ambient air. Hence, it is concluded that carcinogen: DNA adducts as pre-mutagenic lesions can provide a diagnostic information. It concerns the target cells as well as a surrogate tissue. In any case the study has only a preliminary character because of limited number of subjects studied.

The study was on subject of preservation of directional hearing in free auditory field, in horizontal plane in different stages of pathological lesions of the bearing organ with properly fits hearing aid from Viennatone as the behind-the-ear hearing aid (model 116 PAD) and the hearing spectacles (model 90 AN). There were noticed in 50 percentage of subjects improvement in the directional hearing. The best results was obtained in unilateral deafness. The evidently amelioration was observed in front azimuths. The obtained improvement directional hearing was not proportional to the stage of hearing improvement.

On the base of the personal material, comprising 19 patients with glotto-supraglottic cancer, an operative technique on supracricoid reconstructive laryngectomy with CHP and CHEP has been presented. The data achieved within 3 years allowed to evaluation of preliminary oncological and functional results. In the group of 19 operated patients, one case of local recurrence was found. Cervical recurrence was observed in 2 persons in the first year after the operative treatment. No remote metastases and secondary neoplastic++ focus were found in the digestive and respiratory tract. One patient died of massive pneumonia in the course of disturbances in deglutition. The most difficult problem of the postoperative period in the cases of CHP were the disturbances in deglutition. For that reason pneumonia was observed in 4 patients. Nasogastric tube was left in place for a mean time of 20 to 60 days. All CHEP patients were decannulated and 5 ones out of 14 persons group after the operation of CHP remain with tracheotomy tube.

In years 1974-1987 100 patients with malignant neoplasms of the maxilla were treated in the Otolaryngological Department of the Medical Academy in Poznań. Eleven patients carried on a profession concerned with wood dust. The most frequent complaint was unilateral obstruction of the nose. Short history and at the same time a considerable progression of the neoplasm were conspicuous in those cases. The physical examination was completed by tomograms of the paranasal sinuses and in the last four years scanner examination. Unfortunately in majority of patients extensive neoplastic infiltration was found in stage T3 and T4. In spite of such a large infiltrate, changes in the lymph nodes of the neck were observed only in 14% of patients. The treatment included first of all an extensive operational procedure completed by radiotherapy.

In the years 1953-1989 in the Department of Otolaryngology, Medical Academy in Poznań 75 patients were treated for otogenic brain abscesses, among them 19 were children. In the last ten years the number of cases of this complication was not increased significantly in children and adults. In 3 cases abscess was diagnosed in acute otitis media, in the remaining cases it was a complication of chronic otitis media with cholesteatoma. Brain abscesses were situated more frequently in the temporal lobe. In children they developed more frequently on the right side. The survival in temporal lobe abscesses in children was 90%, and in cerebellar abscesses 75%. In adults the survival rate was about 80% for both localizations. In the treatment of these otogenic complications wide radical operation on the middle ear or ++antro-mastoidectomy with exposure of the dura and simultaneous approach to the abscess from the postoperative ear cavity, with puncture of the abscess and replacement of its contents with normal saline with antibiotic is the routine method in the Department.

The evaluation of surgical treatment results was done to 308 oncological patients to whom metastases were formed in lymph nodes between 1980-1984, following the previous surgical treatment of the laryngeal cancer. The evaluation included among others the following: cancer initial localization: T and N traits; the degree of malignancy; surgical radical intervention ; assertion of neoplastic cell plugs in vessels; the time of recurrent lymphatic metastases, etc. The efficiency of surgical treatment of metastases being formed following the previous surgical treatment of laryngeal cancer, measured by the time of 5 years asymptomatic life, equalled 33.4% in the discussed material. Moreover, it was stated that in the studied group of 308 patients the percentage of deaths was increasing in the subsequent years of taking observations (from 1980 to 1984) and depended also on patients overall condition, initial cancer localization, the degree of neoplastic advancement and on the degree of cancer histologic malignancy.

In the years 1985-1990 within the group of 2769 patients operated upon for laryngeal cancer in four medical centres (Kraków, Poznań, Warszawa, Lublin), a clinical analysis on surgical treatment failures was performed. The most significant reasons of failures were: the highly advanced age of patients, coexistent diseases, in particular the cardiopulmonary disease; poor information of neoplastic diseases (carcinomas) and delayed referral to the doctor; lack of consent for surgical treatment; old fashioned diagnostic methods; prolonged period of making diagnosis; increasing number of patients with supra-glottic localization including the hypo-pharynx and piriform recess; a considerable degree of organ ++cancer advancement and substantial clinical advancement; not radical excision of neck glands; intra-surgical blood transfusion; micrometastases to lymphatic glands; immunity collapse; discontinuance of post-surgical radiation on affected parts; lack of lymphadenectomy backward from accessory nerve ; massive cancer metastases to lymph nodes; high histologic malignancy with characteristic carcinous invasiveness; and finally, surgical and post-surgical early and late complications ranginy within our material from 25% to 29% of surgical patients. Basing on the above mentioned analysis, the authors developed indications for surgical treatment of laryngeal cancer.

The authors report one case of the malignant external otitis treated with Ciprobay in 72-year-old diabetic female. They are calling attention to the diagnostic difficulties in the initial period of the disease due to similar clinical manifestations in the chronic otitis. The control examination after 7 months found no recurrence of the Pseudomonas aeruginosa infection.

The late results of the larynx reconstruction by means of the ++muco-septal nasal graft after an enlarged fronto-lateral laryngectomy were described. The analysis of 118 patients shower a satisfying larynx lumen in almost all cases, there were 9 patients with a partial rotation of the graft. A 5-year survival rate was found in 82% of cases.

In comparative study of patients with laryngeal cancer, perioperative prophylaxis with ciprofloxacin was estimated. The drug was administered intravenously 200 mg twice daily, for five days to groups of 95 patients. Bacteriological examinations performed intraoperatively mostly revealed Gram-positive germs. The intravenous form of ciprofloxacin was very effective, resulting in complete healing of the operative wound in shorter time than in control groups. The drug has been well tolerated and no side effects were observed.

During the years 1980-1988 2458 laryngeal cancer patients were operated upon in 4 ENT AM Clinics in Kraków, Poznań, Lublin and Warszawa. 300 (12%) out of them have had the cervical node metastases in 18 months after the surgery. The cause analysis was performed. The primary localizations were in the epiglottic and ++post-cricoid areas. The causes of metastases to the ++lymph nodes were analyzed; the primary epiglottic and ++post-cricoid localization of the tumor, its extensiveness and advanced clinical stage. Twice more often were the nodal metastases stated before the primary treatment, a high degree of histological malignancy, probably insufficient radicality of the surgery and insufficient immunological resistance of the organism were taken in consideration. This group of patients presented a rather high percentage of early unsuccessful results of surgical treatment of the laryngeal cancer; this problem needs further analysis and observations.

The analysis of 191 patients with primary tongue carcinoma treated in ENT Clinic of Medical Academy in Poznań during the years 1963-1987 was presented. Since 1983 there were the dramatic increase in patients number. The patients age was between 20 and 87. Statistically significant was the males number. The half of the patients were in their 6th decade of life. In the last 5 years period the patients were younger of mean 5 years. Their symptoms lasted about 4 months. The earliest was the tongue pain. Tobacco smokers and alcoholics predominated. The localizations were in general on the edge and on the basal part of the tongue. Histologically the most frequent was the planoepithelial cancer in the second clinical stage. The 5 years survival rate was about 20%.

Serum and tissue zinc concentrations in 30 subjects with operable squamous cell carcinoma of the larynx, aged 36-56 were determined by atomic absorption spectrophotometry. The concentration of this cation in cancerous tissues and in unchanged homologous tissues do not differ significantly. Mean zinc serum level was lower before treatment.

The results of lymphnodes examinations in 59 patients operated upon because of the lingual cancer were described. In 39% of cases the metastases were found on the side of lesions. In 31 of patients with palpable lymphnodes the metastases were found in 54.8% of cases. In 28 patients without palpable lymphnodes the metastases were found in 21.4% of cases. Thus 45.2% cases were false positive and 21.4 false negative. In lingual marginal localizations of lesions the metastases were found more frequently as well as in more developed clinical stages. In these patients because of the frequent false positive lymphnodes the radical neck dissection should be performed, in special cases also bilaterally.

Obecnośc ognisk przerzutowych w wezlach chlonnych jest najwazniejszym czynnikiem prognostycznym w przebiegu raka krtani. Kwalifikacja chorych do lymfadenektomii oparta wylącznie na ocenie klinicznej wezlow jest malo dokladna, szczegolnie u chorych z palpacyjnie niewyczuwalnymi wezlami chlonnymi. Nierzadko usuwane są wezly bez zmian nowotworowych, co wskazuje na koniecznośc poszukiwania nowych metod, pozwalających na precyzyjniejszą selekcje chorych, u ktorych obecnośc przerzutow w wezlach jest wysoce prawdopodobna. W ostatnich latach pojawia sie coraz wiecej doniesien wskazujących na powiązania pomiedzy stopniem unaczynienia niektorych nowotworow zlośliwych a ich zdolnością do dawania przerzutow. Zalezności takie opisano m.in. w rakach piersi, gruczolu krokowego, jelita grubego. Dane odnoszące sie do rakow plasko-nablonkowych krtani są skąpe i niejednoznaczne. Celem niniejszej pracy bylo ustalenie, czy nasilenie angiogenezy w rakach plaskonablonkowych krtani, oceniane w wycinkach przedoperacyjnych, wiąze sie z obecnością przerzutow w wezlach chlonnych. Badaniom poddano wycinki przedoperacyjne pochodzące od 40 pacjentow z rakiem plaskonablonkowym krtani, utrwalane w zbuforowanej 10% formalinie. Naczynia uwidoczniono przy pomocy reakcji immunohistochemicznej z przeciwcialami monoklonalnymi przeciwko czynnikowi VIII (von Willebrandta) i liczono je w co najmniej 3 polach mikroskopowych wybranych jako najobfitsze w produkty reakcji przy powiekszeniu 400x. Wyniki sumowano i obliczano średnią arytmetyczną. Liczba naczyn wahala sie od 6 do 38,5. W grupie chorych z przerzutami w wezlach chlonnych (n=18) liczba naczyn wynosila średnio 20, natomiast w grupie chorych bez przerzutow (n=22) 16,7. Roznica ta nie wykazala istotności statystycznej. Uzyskane wyniki wskazują na koniecznośc poszukiwania innych wskaźnikow morfologicznych, ktore moglyby miec zastosowanie w bardziej precyzyjnym określeniu ryzyka przerzutow w wezlach chlonnych u chorych z rakiem plaskonablonkowym krtani.

Mononuclear host cells isolated from primary laryngeal carcinoma were assessed by means of indirect immunofluorescence with a panel of monoclonal antibodies against various lymphocyte subsets and macrophages. Tumours of various staging groups were examined in parallel with cells isolated from patient and donor peripheral blood (PBL). It was found that percentage values of cells bearing T3 and T4 phenotype were reduced both in tumour infiltrating cells (TIC) and in PBL population. The fall in T4+ cells in PBL from cancer patients in T3 and T4 staging groups was statistically significant (p less than 0.01) as compared with donor cells. Corresponding values for T8+ cells from TIC were increased in T1 and T2 staging groups of cancer, but showed a gradual fall in advanced stages. The T4+/T8+ cell ratio was decreased in both TIC and PBL cells. The HNK-1+ (NK) cell pattern in TIC was analogous to that for T8+ cells, i.e. the cell percentage decreased with advance in tumour growth. Corresponding values for OKM-1+ were increased in TIC and in patient blood, though in TIC they grew in proportion to tumour growth. Ia+ (HLA-DR+) cells in peripheral blood were significantly increased in patients versus those of donors (p less than 0.01), but only in T3 and T4 staging groups of examined cancer. These results show that subsets of tumour infiltrating cells in laryngeal carcinoma are a complex phenomenon, associated with growth and progression of tumour.

243 workers occupationally exposed to noise have been examined by pure tone audiometry and impedance audiometry. Hearing disturbance have been diagnosed in 145 cases (62%). Impedance audiometry was performed in 74 subjects. In 47 cases (70%) hearing thresholds were found consistent in both methods whereas the other 21 cases (30%) showed different hearing thresholds. Thirteen individuals of that group exhibited hearing impairment in the cochlea. Hearing loss has been simulated in two cases. The Lüscher-Zawisłocki test revealed 1-1.5 dB in all cases. Objective verification of loudness recruitment phenomenon allowed to state cochlear hearing localization in 31 cases.

The content of magnesium in tissues, erythrocytes and serum was analysed by atomic absorption spectrometry. A higher concentration of magnesium was found in malignant laryngeal tissue and in lymph nodes of the neck compared to homologous pre-cancerous tissue. In pre-cancerous lesions of the larynx the magnesium concentration of the erythrocytes and serum lay at the lower limit of normal. In patients with cancer of the larynx, the magnesium concentration was considerably below the normal levels and continued to decline as the disease progressed.

The fatiguability of m. stupedius was studied in 20 patients with myasthenia and 16 controls determining the reflex of this muscle by means of electroacoustic bridge. In half of the patients group the fatiguability of stapedius muscle was increased and in some cases the reflex threshold of the muscle was raised. The authors suggest continuation of these investigations especially for determination of the clinical importance of these observations.

In der Otolaryngologischen Klinik der Medizinischen Akademie in Poznan begann man 1979 mit einer erweiterten fronto-lateralen Laryngektomie und der Rekonstruktion des vorderen Abschnitts.

The clinic evaluation of the canadian pharmacologic agent "propolis" verified its value known from the literature in common cold infections. 50 persons were treated in ENT Clinic of Marcinkowski's Medical Academy in Poznań during the 1987 year. The observed therapeutic effects were shortening of the disease duration. The regression of symptoms occurred in the first day of the therapy and the complete recovery followed in 1 day in 5 patients, in 2 day in 16, and in 3 day in 3. The placebo group has his full recovery in mean 4.80 days. In the therapeutic group the symptoms lasted 2.5 time shorter than in placebo one.