Chemometric methods for studying the relationships between trace elements in laryngeal cancer and healthy tissues.

A quick and reliable method for the evaluation and classification of two types of tissues is presented. Several chemometric methods were applied to evaluate multivariate data of the tissue samples with respect to the content of trace elements. The content of Pb, Al, Zn, Cd, Cu, Ni and Co was determined in samples of healthy and cancerous tissue obtained from 26 patients. Determination was done at milligram/kilogram level with inductively coupled plasma optical emission spectrometry (ICP-OES) and atomic absorption spectroscopy (AAS) techniques. Contents of trace metals in studied tissues are not normally distributed; however, normal distribution was confirmed for log values. There is a statistically significant difference in the content of Zn, Cd, Cu and Al (p<0.01) and Ni and Co (p<0.05) when healthy tissue is compared to cancerous one. Correlation between contents of trace elements for studied tissues was positive; the highest was found between Zn and Cu. A chemometric methodology seems to be a promising tool for classifications of the tissue samples.

Squamous cell cancer of hypopharynx and larynx - evaluation of metastatic nodal disease based on computed tomography perfusion studies.

BACKGROUND AND PURPOSE: In patients with squamous cell cancer metastatic disease in lymph nodes still remains the single most important negative predicting factor and when detected, it reduces overall 5-year survival by 50%. The aim of the study was to evaluate contrast-enhanced computed tomography (CECT) with computed tomography perfusion (CTP) examination in order to differentiate malignant from non-malignant cervical lymph nodes in patients with squamous cell cancer of hypopharynx and larynx. MATERIAL/METHODS: This was a prospective three-center study. From November 2007 until March 2010 33 consecutive patients with squamous cell cancer of the hypopharynx and 27 patients with laryngeal cancer underwent computed tomography (CT) examination followed by CTP. During first part of examination 80 ml of contrast was administered, with flow rate 1 ml/s and 100 s delay; standard head and neck examination was performed. Next, perfusion images were acquired with the coverage of 8 cm and different groups of lymph nodes were evaluated - groups II, III, IV and V. Perfusion maps for basic parameters (blood flow [BF], blood volume [BV], mean transit time [MTT] and permeability surface [PS]) were reconstructed for all patients using dedicated software. The long and short axis diameters, the density of the node before and after contrast medium administration and average values of each perfusion parameter were calculated for every node separately. Results were compared with histologic analysis of resected nodes. RESULTS: Out of the total number of 293 nodes evaluated on CECT and CTP it was possible to correlate 208 resected nodes with histologic findings. 125 of them were proven to be malignant and 83 were benign. Malignant nodes showed remarkably higher density and hyperperfusion, comparing to benign ones. The average density values in Hounsfield units (HU) for cervical nodes were: 91.9HU for metastatic comparing to 72.3 HU for non-metastatic, but this difference did not show statistical significance. The average value of BF in malignant nodes was 136.4 ml/100g/min, BV was 7.7 ml/100g, MTT was 4.4s and PS was 19.4 ml/100g/min. The average values for benign nodes were: BF was 80.7 ml/100g/min, BV was 4.7 ml/100g, MTT was 5.6s and PS was 12.8 ml/100g/min. Comparing to non-malignant nodes, malignant ones showed significantly higher BF, BV and PS values (p<0.05). CONCLUSIONS: Although CECT findings may draw our attention, pointing at abnormal morphology of the node, CTP seems to provide additional functional information regarding its possible malignancy. CTP may be useful in differentiation between malignant and benign lymph nodes, based on evaluation of the value of BF, BV and PS.

How to reliably evaluate middle ear diseases? Comparison of different methods of post-processing based on multislice computed tomography examination.

CONCLUSIONS: Multislice computed tomography (MSCT) virtual endoscopy was useful in evaluating mainly post-traumatic and postoperative cases. In other pathological conditions axial images and MPR reformations were most useful. OBJECTIVES: Evaluation of cross-sectional images, multiplanar 2-D reformations, 3-D reconstructions and virtual endoscopy (VE) in assessment of the middle ear in inflammatory diseases, trauma, otosclerosis and tumours. Comparison of each method and correlation with surgical findings. MATERIALS AND METHODS: Investigations were carried out in 80 patients with middle ear pathology. In each case MSCT of the petrous bone was performed. In addition to cross-sectional native scans, frontal and sagittal images were achieved using MPR reconstructions. 3-D volume rendering (VR) and VE images were also generated. The value of native scans information, 2-D, 3-D reconstructions and VE of the tympanic cavity structures was assessed in comparison to intraoperative findings. RESULTS: MPR reconstructions were most useful in the assessment of skull base trauma, skull base tumours and in cases of chronic middle ear inflammation. Highly vascularized tumours, disruption of ossicular chain and stapes prosthesis were best evaluated on 3-D reconstructions. Axial images proved to be the best for otosclerosis interpretation.

Differentiation between cholesteatoma and inflammatory process of the middle ear, based on contrast-enhanced computed tomography imaging.

OBJECTIVE: To assess the usefulness of delayed post-contrast computed tomography (CT) examination for the detection of residual or recurrent cholesteatoma after canal wall up tympanoplasty. STUDY DESIGN AND SETTING: This prospective, non-randomized study, set within an academic medical centre, included 17 consecutive patients who had undergone canal wall up tympanoplasty for cholesteatoma, with possible recurrence. Pre-contrast CT scans and delayed post-contrast images were compared with second look surgical findings. RESULTS: A residual or recurrent cholesteatoma was found in eight of the 17 patients at revision surgery and was correctly diagnosed on post-contrast CT images in six patients (75 per cent). In the two misdiagnosed cases, cholesteatoma pearls smaller than 2.5 mm were not seen on post-contrast CT. The sensitivity of the imaging test was 75 per cent, the specificity was 60.1 per cent, the positive predictive value was 88.1 per cent and the negative predictive value was 81.8 per cent. CONCLUSION: Computed tomography with delayed post-contrast images is a sensitive imaging modality for the detection of residual cholesteatoma. If proven reliable, this method of non-invasive imaging could spare the patient unnecessary revision surgery.

Loss of heterozygosity in laryngeal cancer.

PURPOSE: Head and neck cancers account for about 6% of all human cancers. Molecular changes leading to the disease development and progression still remain not fully explained. Examination of loss of heterozygosity (allelic loss, LOH) using the specific microsatellite markers is a method of choice in assessing tumour suppressor genes (TSGs) localisation in human genome. MATERIAL AND METHODS: The study was performed in a group of 46 male patients, aged 42-77 years. Forty three patients underwent total laryngectomy with lymph nodectomy, two patients--chordectomy and one patient--partial laryngectomy. Tumour tissue specimens and reference peripheral blood samples were obtained during surgical resections. Standard methods were used for DNA isolation. Fluorescent multiplex PCR was used to amplify microsatellite loci included in commercially available human identification kits. RESULTS: LOH was found at the following loci: BAT26, D3S1358, FGA, CSF1PO, D5S818, D8S1179, VWA, D13S317, D18S51. The highest LOH frequency was found in the tumor samples where the neighbouring cervical lymph nodes were affected but the incidence of LOH at BAT26 was statistically insignificant (p = 0.07). CONCLUSIONS: High incidence of LOH is considered an unfavourable prognostic factor accompanying an aggressive nature of the tumour and indicating an involvement of certain genome regions in cancerogenesis. In head and neck cancers LOH was found on the following chromosomes: 3p, 5q, 8p, 9p, 9q, 11q, 17p, 17q, 18p, 18q.

Establishment and preliminary characterization of two cell lines derived from larynx carcinoma.

Two new cell lines, designated as RK-33 and RK-45, have been successfully established by an outgrowth technique from two different larynx tumours obtained from patients after laryngectomy. Both cell lineshave been maintained incultureforover 18 monthsandrecently have reached passage number 220 (RK-33) and 110 (RK-45). The cells display an epithelial morphology and multiply with a population doubling time of about 24 h (RK-33) and about 40 h (RK-45). The epithelial nature of the cells was also confirmed by expression of cytokeratins 8 and 18. Both lines were sensitive to antiproliferative effect of the tested cytostatic agents such as methotrexate. etoposide and thiotepa, with methotrexate being the most effective. We believe that both cell lines: RK-33 and RK-45 could be a suitable model for studying larynx cancer biology, however, further characterization of their properties is needed.

[Epistaxis: causes and management]. / Krwotok z nosa--przyczyny i postepowanie.

Evaluation of 265 patients treated in hospital due to nasal bleeding revealed that almost half of them suffered from hypertension and in about 30% of cases it was impossible to establish the cause of epistaxis. The most frequent way to stop the bleeding was anterior nasal packing and in case of failure posterior nasal packing together with anterior one. Posterior nasal packing with Foley's catheter is relatively simple and effective procedure. Introduction of superselective embolization of maxillary artery and dermoplasty in Rendu-Osler disease was very helpful.

Nucleolar organizer regions in laryngeal cancer.

The purpose of this study was to estimate the prognostic value of the AgNORs count per nucleus in laryngeal cancer. The sections of diagnostic, formalin-fixed and paraffin-embedded specimens from 48 patients with T1-4 tumours were stained with silver nitrate for visualization of NORs (AgNORs). The correlation between AgNORs score and tumour clinicopathological features was estimated. The mean AgNOR number per nucleus was 2.73 +/- 0.87 (range 1.48-4.38). The AgNOR counts did not correlate with the stage of the disease, patient survival rate and N stage. A significant correlation between the mean AgNORs number and various stages of histological differentiation of carcinoma was observed (p < 0.05).

Prognostic value of the expression of p53 and bcl-2 in patients with laryngeal carcinoma.

Previous studies have yielded inconsistent results on the prognostic significance of p53 and bcl-2 in head and neck cancer. The aim of this study was the evaluation of p53 and bcl-2 protein expression in laryngeal squamous cell carcinoma and to clarify the relationship between them. All patients with laryngeal carcinoma were treated during the period 1991-1993. In the present study p53 and bcl-2 expression in paraffin sections from 50 cases of laryngeal squamous cell carcinoma were analysed and correlated with routine clinico-pathological parameters. The expressions of p53 and bcl-2 were examined by immunohistochemical staining. Immunoreactivity for p53 was observed in 45 (90%) of carcinomas and bcl-2 immunoreactivity in 7 (14%). No significant correlation between the p53 or bcl-2 expression and patients' T- or N-stage, histological grading, or overall survival was found.

[Melanoma of nasal cavity and paranasal sinus mucosa]. / Czerniak blony sluzowej jamy nosowej i zatok przynosowych.

In a group of 15 patients with malignant melanoma of the nasal cavity and paranasal sinuses the place of origin was nasal mucosa in 11 patients, the ethmoid cells in 2 cases and the maxillary sinus in 2 cases. Only 5 patients had tumour limited to infrastructure of the nasomaxillary complex, in 10 patients tumour occupied also suprastructure. Total maxillectomy was performed in 4 patients, partial maxillectomy in 8 patients with orbital exenteration in 3 patients. Of 12 patients operated on three patients died one year, two patients two years and one patient 6 years after surgery. One patient is alive 12 years, three patients are alive three years and one patient is alive one year after surgery.

[Expression of Bcl-2 antigen in laryngeal carcinoma]. / Ekspresja antygenu BCL-2 w raku krtani.

The results of immunohistochemical investigations of BCL-2 presence in 50 patients with laryngeal carcinoma were presented. In 14% of all investigated cases presence of BCL-2 protein was observed. In patients with advanced clinical stage of laryngeal carcinoma higher expression of BCL-2 protein comparing with patients with lower clinical stages was more frequently observed--but it wasn't significant. No significant difference in presence of BCL-2 protein among the patients with a different stage of histological differentiation of carcinoma and among the patients with present and absent metastatic changes in regional lymph nodes was observed.

[The use of microsurgery and balneotherapy in the treatment of hyperplastic laryngitis]. / Zastosowanie mikrochirurgii i balneoterapii w skojarzonym leczeniu hiperplastycznych niezytów krtani.

The study aimed at the assessment of the clinical value of using the combined method of laryngeal microsurgery and balneotherapy in the operative treatment and prevention of recurrences of limited hyperplastic changes of the laryngeal mucosa. The study material comprised two groups of patients diagnosed and treated in the years 1991-1997 in the Lublin E.N.T. Department and Laryngological Research-Consulting Center in Iwonicz Zdrój. The I clinical group consisted of 194 patients in whom, on definite indications, micro-surgeries with Kleinsasser's method were performed and the II control group consisting of 165 subjects suffering from chronic simple inflammation of pharyngo-laryngeal mucosa without morphologic hypertrophy. Inhalant treatment was performed by means of an individual method--using inhalant devices by Thomex L-2 producing high density mist of 1-4 mu degree comminution. Isotonic Iwonicz saline-Elin 7 was used. Uniform criteria of assessment were assumed and used of direct and distant therapeutic effect (in control studies) for the whole group of patients in the study period. Obtained results were analysed statistically.

[Pharyngeal closure after pharyngolaryngectomy]. / Zamykanie gardla po faryngolaryngektomii.

Pharyngolaryngectomy was performed in 53 patients. In 36 patients pharynx defect was less than 50% of pharynx circumference and it was closed without reconstruction. Larger pharynx defects were closed using platysma myocutaneous flap (13 cases), pectoralis mayor flap (3 cases) and free forearm flap with microvascular anastomosis (1 case). Healing results are presented in each group of patients.

[Expression of p53 antigen in laryngeal carcinoma]. / Ekspresja antygenu p53 w raku krtani.

The results of immunohistochemical investigations of p53 presence in 50 patients with laryngeal carcinoma were presented. In the whole investigated group the presence of p53 protein in 90% of all investigated cases was observed. In patients with advanced clinical stage of laryngeal carcinoma higher expression of p53 protein comparing with patients with lower clinical stages was more frequently observed--but it wasn't significant. No significant difference in presence of p53 protein among the patients with a different stage of histological differentiation of carcinoma and among the patients with present and absent metastatic changes in regional lymph nodes was observed.

Tumor angiogenesis in patients with laryngeal cancer.

Tumor angiogenesis was evaluated in 60 patients with primary laryngeal cancer by quantitating the microvessel density with antibodies against factor VIII. The microvessel density was then correlated with T stage, N stage, histologic grade and patient survival. A direct correlation was found between increased tumor angiogenesis and T stage, histologic grade and a shorter survival rate.

Expression of bcl-2 protein in lymphocytes of patients with laryngeal carcinoma.

The aim of this study was to evaluate the expression of bcl-2 protein in lymphocytes of the peripheral blood of patients with laryngeal carcinoma. The protein product of the proto-oncogene bcl-2 is a physiological inhibitor of apoptosis or programmed cell death. Since we believe that apoptosis is involved in the regulation of an immune response to a cancer process, we tried to show how this mechanism works in laryngeal carcinoma in comparison with normal peripheral blood lymphocytes of healthy controls. To explain the significance of this molecule's expression, we used flow cytometry to examine the expression of bcl-2 in T lymphocytes from the peripheral blood of 23 patients with laryngeal carcinoma and 20 healthy controls. Our study revealed that the expression of bcl-2 protein in T lymphocytes from the cancer patients was significantly higher than in the controls (P < 0.05). This difference in the expression of bcl-2 protein was found in both CD4 and CD8 subpopulations and was significantly higher than in the control group. In patients with laryngeal carcinoma expression of bcl-2 protein in T lymphocytes was higher in CD4 than in CD8 cells (P < 0.05). These results suggest that bcl-2 protein may interact in the regulation of apoptosis of lymphocytes, taking part in anti-cancer defence.