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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.

Susceptibility to smoking related larynx cancer has been suggested to be associated with genetically determined differences in the ability to detoxify carcinogens present in tobacco smoke. The genetic polymorphisms of glutathione S-transferases, involved in the metabolic inactivation of, for example, tobacco derived carcinogens, have been recognized as potential risk modifiers in various environmentally induced malignancies, including larynx cancer. We employed PCR-based methods to determine the distribution of the GSTM 1 and G STT1 null genotypes in 171 larynx cancer patients and 180 controls to examine further their potential role in individual susceptibility to this neoplasm. The GSTM 1 null genotype was found in 49 1 % of the cases and 57 7 % of the controls and the GSTT1 null genotype in 17 5 % of the cases and 21 7 % of the controls, respectively. Larynx cancer risk associated with the lack of GST M 1 (OR = 0 7; 95 % CI: 0 5-1 1) or GSTT1 (OR = 0 8; 95 % CI: 0 5-1 3) was not significantly affected by age, smoking status, or cancer progression. Although this study thus suggests no role for the G STM 1 and GSTT1 gene polymorphisms in individual susceptibility to smoking-related larynx cancer, due to its relatively small sample size more data are required before any definite conclusions can be drawn.

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.

A case of latent otogenic cerebellar abscess is presented during chronic otitis media with cholesteatoma, in 42-year-old woman. Good results of the treatment were obtained by draining and substituting the content of abscess into antibiotic solution.

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.

Diagnostics and treatments of precancerous states of cancer of larynx will demand in select chances the multistages treatmentIn 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.

Benzydamine HCL--Tantum Verde is a non-steroid drug of anti-inflammatory, pain-killing and antibacterial activity. The preparation is very easy to use in the form of mouth and throat wash, nebuliser or 3 mg lozenges. It is non-toxic and does not have side-effects. It allows the patients to improve their ability to eat foods and reduces throat discomfort and pain. On the basis of literature and own observation it is to be stated that Tantum Verde has substantial usefulness in the treatment of various, inflammatory conditions, radiotherapy induced mucositis in anti-neoplastic induced stomatitis, in angina, in neoplasms with necrosis, after surgical operation of the mouth and pharynx, after intubation and endoscopic surgery in the larynx.

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.

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.

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.

Neuromas are being mesenchymal tumors which are very rare in the mouth. The authors presented the case of the tumour of this localisation of 46-year old female, treated in the Department of Otolaryngology University School of Medical Sciences in Poznan, with suspicion of sublingual cyst.

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.

Lymph node metastases are one of the main reasons of treatment failure in head and neck cancer. Thus, knowledge of lymphatic system anatomy and routs of spreading the metastases in particular primary tumor localisation is of great practical importance. Typical sites of neck metastases in larynx and tonsil cancer were presented. The neck lymphatic system classification according to American Academy of Otolaryngology--Head and Neck Surgery from 1991 was used. The most often site of metastases in larynx cancer was the II and III level, in tongue and floor of mouth cancer--level I and II and in nasopharynx malignancies--level II and V respectively. Knowledge of the neck regions with elevated risk of harbouring metastases was important not only during the surgery but as well before planning of the selective or elective radiotherapy.

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.

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.

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.

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 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.

Biochemical and physiological principles of biological sealing are presented. Various methods of application of biological seal and indications for its use in otorhinolaryngology are discussed.

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.

A case of Wegener's disease is described. In eight years of remission a patient, treated with cyclophosphamid and steroids demonstrated sterosis of the trachea and upper way obstruction. We have performed carbon dioxide laser photoresection of granulotion mucosis and scars with an excellent results.

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.

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.

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.

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.

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 group of 66 patients with acute inflammatory upper respiratory tract diseases were examined in the ENT Department of Poznań Medical Academy between November 1996 and November 1997. Specimens for bacteriological cultures were collected from the ear, nose and throat. The subjects were treated with ceftibuten. Clinical improvement was reported in all cases. In 44 patients, ceftibuten treatment eliminated pathogenic bacteria (as evidenced by microbiological analysis).