Assessment of immunomodulation and regulation of cell cycle in epithelium and stroma after Cidofovir injection in patients with recurrent respiratory papillomatosis-Pilot study.

Recurrent respiratory papillomatosis is strictly connected with human papillomavirus (HPV) infection of the epithelium of the upper respiratory tract. The main treatment of lesions located in the larynx or lower pharynx includes microsurgical excision by using a CO2 laser. To decrease the amount of surgical procedures gain in importance combined therapy with antiviral agents. The aim of this study was to investigate the effect of the intralesional application of Cidofovir on the tissue of laryngeal papillomas. We have shown that simultaneous microsurgery with adjuvant therapy of Cidofovir reduces chronic inflammation (by measuring the expression of CD4 and CD8 in tissue samples), cell proliferation, and regulates the cell cycle of HPV-infected cells by reducing the expression of p53 and p63 proteins. In addition, this strategy reduces the multiple surgical procedures and regrowth of the pathology.

Results of CO2 laser surgery in laryngeal papillomatosis.

Recurrent respiratory papillomatosis is medical condition strictly connected with HPV infection of the epithelium of the upper respiratory track. The main treatment of lesions located in larynx or lower pharynx includes microsurgical excision by using CO2 laser. A thorough preoperative assessment of patients is extremely important, which should not only be based on traditional laryngological examination, but also on endoscopy of the larynx and the use of the NBI (narrow band imaging) technique to assess the vascularization of lesions. In patients with recurrent papillomas, neoadjuvant therapy with antiviral agents or agents that inhibit angiogenesis is also often used. Among our group of 31 patients with laryngeal papillomas, 15 people (48%) required repeated surgical intervention and additional antiviral therapy while 10 (33%) people had to undergo the procedure three or more times due to disease recurrence. In this article we will discuss that laryngeal microsurgery with a CO2 laser is an effective method of treating patients with laryngeal papillomatosis and we will present the possibilities of adjuvant therapy.

Voice Rehabilitation After Laryngeal Transplantation: Own Experience.

BACKGROUND AND PURPOSE: Laryngeal transplantation (LT) remains an infrequently performed procedure due to well-defined and limited medical indications. The challenges include a very complicated surgery, continuous immunosuppressive treatment, as well as post-transplant rehabilitation of voice, speech, and swallowing. The aim of this paper is to describe a model of voice and speech rehabilitation after LT, based on our own experience. STUDY DESIGN: Observational study. METHOD: Presented here are the rehabilitation processes of two patients who had previously undergone LT as well as their pre- and postrehabilitation voice outcomes. Both patients underwent voice, speech, and swallowing rehabilitation in the fifth month after LT. RESULTS: One of the patients had a significant improvement in voice quality. While, the other did not regain his natural, sonorous voice, but he scored very high on a voice self-assessment test. CONCLUSION: Voice rehabilitation after LT is a complex and long-term process that requires the involvement of a team of specialists. The optimal anatomical conditions restored during surgery, the patient's motivation and the support of professionals make it possible to return to normal verbal communication.

Bleeding into the Abdominal and Ilio-Lumbar Muscles-A Rare Complication in the Course of COVID-19: Analysis of Four Cases and a Literature Review.

The risk of venous thromboembolic (VTE) complications, mainly in the form of pulmonary embolism (PE) and deep vein thrombosis (DVT), in COVID-19 is well known, necessitating the administration of thrombotic prophylaxis in most patients. With a high risk of VTE complications or their presence, full anticoagulation may be associated with hemorrhagic complications. COVID-19 bleeding is rarely reported. Here, we present four cases of patients with muscle bleeding: two in the iliopsoas muscle, which resulted in death despite the embolization of the bleeding vessel, and two in the oblique and straight abdominal muscles, which were treated conservatively. In the reported cases, the severity of the bleeding coincided with the severity of the course of COVID-19. When observing a sudden drop in hemoglobin (Hb) in a patient with COVID-19, one must always remember the possible complications in the form of muscle bleeding, which can be fatal.

The Effectiveness of Rehabilitation of Occupational Voice Disorders in a Health Resort Hospital Environment.

BACKGROUND: The aim of this study was to present a rehabilitation program of occupational voice disorders for teachers, conducted in the form of health resort stays, and evaluate its effectiveness depending on job seniority. METHODS: The study included 420 teachers who participated in a complex vocal prophylactic and rehabilitation program carried out during a 24-day stay at a health resort hospital. Employment time varied from 4 to 45 years (mean 28.3 years). The participants were divided into three groups: employment time < 21 years (57 teachers), 21-30 years (182 teachers) and > 30 years (181 teachers). All of the subjects underwent maximum phonation time assessment as well as jitter, shimmer and NHR (noise to harmonic ratio) parameters assessment before and after the program; they also underwent perceptual evaluation using the GRBAS scale and voice self-assessment using the VHI-30 scale. RESULTS: The perceptual evaluation using the GRBAS scale and self-report measures of voice function assessed using the VHI scale revealed improvement (p < 0.001). The parameters of jitter, shimmer and NHR improved significantly: jitter p < 0.001, shimmer p < 0.001 and NHR p < 0.003. Maximum phonation time increased slightly but significantly (p < 0.001). For all of the studied groups regardless of their employment time, maximum phonation time increased (p < 0.001). Initially, the lowest values of maximum phonation time were observed in teachers with longer job seniority, which improved after the rehabilitation but remained <15 s. CONCLUSIONS: Voice care for teachers is crucial regardless of their job seniority. Early prophylaxis for voice disorders is effective, as the results of rehabilitation are better in teachers with a shorter employment time.

[Teachers' voice rehabilitation in sanatorium conditions]. / Sanatoryjna rehabilitacja glosu u nauczycieli.

BACKGROUND: Voice diseases occupy the third place among all of the diagnosed occupational disorders in Poland. There still exists the necessity to implement effective and economical methods of the primary and secondary prevention of voice disorders in teachers. The aim of this study was to assess the effectiveness of comprehensive voice rehabilitation in teachers, conducted within a health resort hospital. MATERIAL AND METHODS: The results of comprehensive voice rehabilitation in 100 teachers with job seniority of 10-30 years (M = 17 years), conducted during 24-day-long staying in a sanatorium, are presented in this research. Phoniatrical and laryngological examinations (maximum phonation time [MPT], perceptual assessment of voice in GRBAS scale, laryngovideostroboscopy, and acoustic analysis of voice), self-assessment of voice (the Voice Handicap Index - VHI), logopedical estimation and audiometry were conducted during the first and the last day of the sanatorium stay. The therapeutic program included educational workshops on vocal hygiene, voice therapy, physiotherapy and psychotherapy. The inpatient therapy effects were also described by the teachers using a questionnaire. RESULTS: Improvements of objective acoustic parameters, a perceptual assessment of voice, and a self-assessment of VHI and MPT were observed. Phonation style changes were confirmed in the laryngovideostroboscopic examination. Phonation closure improved significantly in 30% of the examined teachers. Moreover, 97% of the participants confirmed in the questionnaire the effectiveness and purposefulness of periodic recurrence of such rehabilitation courses. CONCLUSIONS: The results of this research as well as the positive feedback from the participants of inpatient rehabilitation confirmed the effectiveness of occupational voice disorder rehabilitation in sanatorium (inpatient) conditions. Treatment and rehabilitation in a stationary form should aim to achieve voice improvement and job continuation. Such a procedure may contribute to reducing the financial outlays related to treatment, health leaves and occupational pensions. Med Pr. 2021;72(4):399-405.

Modulatory effect of laser irradiation on mastoparan-7-induced contraction.

Mastoparan-7 activates guanine nucleotide-binding proteins (G-proteins) and stimulates both apoptosis and increases in cytoplasmic calcium concentration and may induce smooth muscle contraction. The primary aim of the present study was to evaluate the modulatory effect of laser stimulation on vascular smooth muscle contraction induced by direct stimulation of G-protein with mastoparan-7. Experiments were performed on isolated and perfused tail arteries of Wistar rats. Contraction force in the model was measured by increased levels of perfusion pressure with a constant flow. Irradiation treatment was applied directly to the blood vessels. The laser was applied in increasing doses of 10 mW (E=1.8 J), 30 mW (E=5.5 J) and 110 mW (E=19.8 J). Time of exposure was 3 min for each irradiation. In the laser-stimulated arteries, a significant and dose-dependent decrease was observed. The half maximal effective concentration values were 4.43±2.2x10-8, 2.4±0.56x10-7, 3.2±0.72x10-7 and 7.7±0.3x10-7 M/l in the control and 10, 30 and 110 mW laser irradiation groups, respectively. Significant (P<0.001) changes were identified for all laser treatment groups in comparison with the control. When analyzing the function of calcium ion (Ca2+) stores was analyzed, a significant inhibition of influx from both intra- and extracellular Ca2+ stores was observed. The results from the present study suggested that contraction induced by direct activation of G-protein with mastoparan-7 may by effectively inhibited by laser radiation, and that the effect was associated with an inhibition of Ca2+ influx from both intracellular and extracellular Ca2+ stores.

The influence of low level laser irradiation on vascular reactivity.

PURPOSE: The mechanism of action of low level laser irradiation on tissues is unclear. Authors of publications present the positive clinical impact of low and medium power laser irradiation on vascular reactivity. The purpose of this study was to analyze the role of vascular endothelium in laser-induced constricted by endothelin-1 and phenylephrine. MATERIALS AND METHODS: Experiments were performed on isolated and perfused rat tail arteries of weighing 250-350g male Wistar rats. Contractility of arteries as a response to endothelin-1 and phenylephrine was measured after exposure to laser stimulation (10, 30 and 110mW). RESULTS: Laser irradiation inhibits vascular smooth muscle contraction induced by endothelin-1 and an alpha-adrenergic receptor agonist, phenylephrine proportionally to the laser power. Concentration-response curves were shifted to the right with significant reduction in maximal response. Laser irradiation at the power of 10mW, 30mW, and 110mW reduced the maximum response of arteries stimulated with phenylephrine sequentially to 88%, 72%, and 52%. Similar findings were observed during stimulation of endothelin-1. Laser irradiation at the power of 10mW, 30mW and 110mW resulted in maximal response respectively reduced to 94%, 62% and 38%. CONCLUSION: Our results strongly suggest that during low level laser irradiation vascular smooth muscle cells reactivity is reduced, this effect is present in arteries with normal endothelium. The mechanism of action of laser biosimulation on tissues is unclear. Authors of publications present the positive clinical impact of low level laser irradiation on vascular reactivity.

[Prospective factors of T1 and T2 glottic carcinoma]. / Czynniki prospektywne raka glosni w stadium zaawansowania T1 i T2.

The aim of our study was to estimate the probability of the neoplasm recurrence in patients with T1 and T2 glottic carcinoma operated with CO2 laser microsurgery. We analyzed the material of 171 patients treated in the Otolaryngology Department of the Collegium Medicum Nicolaus Copernicus University between 1991 and 2003. The statistical method of logistic regression was used to estimate factors disposing the local recurrence of laryngeal cancer. We studied: age, sex, extent and location of the lesion, time up to recurrence, carbon granuloma, smoking cigarettes before and after the operation. We confirmed statistically significant correlation between the local recurrence and anterior commissure involvement.

[Tracheocoele--a complication after decanniulation]. / Tracheocoele--powiklanie po dekaniulacji.

A case of tracheocoele as a complication after decanniulation in a patient after brain trauma is presented. Within twelve months after decanniulation patient was operated three times to close the tracheocutaneous fistula without good effect. A pretracheal air cyst was recognized after the radiological examinations. Tracheocoele was evacuated with its tract. No recurrences were observed.

Deep venous thrombosis in patients with chronic spinal cord injury.

CONTEXT/OBJECTIVE: Deep venous thrombosis (DVT) is a well-known complication of an acute spinal cord injury (SCI). However, the prevalence of DVT in patients with chronic SCI has only been reported in a limited number of studies. The aim of our study was to examine the prevalence of DVT in patients with SCI beyond three months after injury. DESIGN: Cross-sectional study. SETTING: Rehabilitation Department at the Bydgoszcz University Hospital in Poland. PARTICIPANTS: Sixty-three patients with SCI that were more than 3 months post injury. The patients, ranging in age from 13 to 65 years, consisted of 15 women and 48 men; the mean age of the patients was 32.1 years. The time from injury varied from 4 to 124 months. OUTCOME MEASURES: Clinical assessment, D-dimer and venous duplex scan. RESULTS: The venous duplex scan revealed DVT in 5 of the 63 patients. The post-injury time in four of the patients varied between 4 and 5 months; one patient was 42 months post-injury. CONCLUSION: DVT occurred in patients with chronic SCI, mainly by the 6th post injury month.

Autofluorescence spectroscopy in the differentiation of laryngeal epithelial lesions - preliminary results.

Conclusions Autofluorescence spectroscopy may be a supporting tool for differential diagnosis of changes in laryngeal epithelium. Objectives Early detection and differential diagnosis of proliferative changes in the larynx are still a challenge for laryngologists. The aim of the study was to evaluate the autofluorescence spectroscopy technique to in vitro differential diagnosis of pathological changes in the epithelium of the larynx. Methods Forty-two patients aged 34-79 years were included in the study. The fifty-two tissue specimens, including 10 samples of cancerous lesion, 10 adjacent normal tissue, 10 chronic inflammation, eight cyst, three leukoplakia, four polyp, and seven Reinke's edema, were obtained during laryngological procedures. All tissue samples were independently diagnosed histopathologically. The autofluorescence emission spectra at two excitation wavelengths, 290 nm and 370 nm, were measured for every sample studied. Results The autofluorescence signals of cancerous tissue samples at both excitations exhibited identical emission band shapes of much lower intensities at their maxima as compared to the adjacent healthy tissue samples studied. The autofluorescence spectra intensities of cancerous and normal tissues varied inter-individually. Evident differences in autofluorescence intensities and its band shapes of different pathological laryngeal changes at the 290 nm excitations were demonstrated.

[Long-term results of treatment in T1, T2 laryngeal cancer with CO2 laser microsurgery]. / Odlegle wyniki leczenia raka krtani T1 i T2 w mikrochirurgii laserowej.

The aim of this study was estimation the long term results of CO2 laser therapy in laryngeal cancer. 36 patients with early glottic cancer-T1 and T2 were treated with CO2 laser microsurgery in 1990-1992. The control laryngological, phoniatric and laryngovideostroboscopic examinations were conducted from six to thirty months after the operation. The next controls were done within three years and then after eight to ten years from microsurgery. The local recurrence was observed only during the first control in seven cases--19%. Four patients underwent total laryngectomy after several laser microsurgery, two were treated only with CO2 laser and one had CO-therapy. The better quality of voice was observed during following control examinations. A scar with smooth surface and marge in 29 persons and a tendency to phonatory vibration of scar in 9 patients were noticed in laryngovideostroboscopy examination during the first control. Following examinations showed a progressive improvement of voice parameters.

[Plasmacytoma of the larynx]. / Szpiczak krtani.

Multiple myeloma is a neoplastic proliferation of the plasma cells of clonal character producing similar immunoglobulin or part of the immunoglobulin. Multiple myeloma occasionally occurs as solitary, extramedullary plasmacytoma. The location of plasmacytoma in the larynx is extremely rare. We are describing the case of the larynx plasmacytoma diagnosed for a 79 years old female patient. After histopathologic diagnosis of the laryngeal polyp the patient was examined hematologically in great detail aiming at the investigation of myeloma multiplex. No features of multiple myeloma have been found. Now the patient is under strict laryngological and hematological care.

[Benign osteoblastoma of the frontal sinus]. / Osteoblastoma benignum zatoki czolowej.

The extremely rare case of benign osteoblastoma of frontal sinus was presented. Uncharacteristic clinical symptoms, radiological investigations and differentiation diagnostic were analysed. The operation treatment, which was chosen in that case, was described. It was agreeing with treatment presented by the other Polish and foreign authors.

Long term results of childhood dysphonia treatment.

OBJECTIVE: The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. METHODS: This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. RESULTS: Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. CONCLUSIONS: Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls.

Affective temperament in women with functional aphonia.

OBJECTIVES: The aim of the present study was to assess the affective temperament in women with functional aphonia. STUDY DESIGN: Cross-sectional. METHODS: Forty-one women with functional aphonia underwent an examination of affective temperament by means of the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire. RESULTS: Compared with the reference group, women with functional aphonia show significantly higher rates of depressive and anxious temperament. CONCLUSIONS: The results of the present study are concordant with the previous findings, indicating elevated levels of depressive and anxious symptoms in aphonic patients. Implications for the therapy of functional aphonia as well as considerations for further studies are discussed.

Laryngovideostroboscopy in children--diagnostic possibilities and constraints.

OBJECTIVE: The aim of this study was to report our experience with laryngovideostroboscopy (LVS) in consecutively examined children patients. METHODS: The study included 150 children (2.5-14 years of age) diagnosed with dysphonia. Patients were divided into three age groups: group I - from 2.5 to 6 years of age (n = 31), group II - from 6 to 10 years of age (n = 73), and group III--from 10 to 14 years of age (n = 46). LVS was performed during the second visit. 3.5mg of dormicum were administered orally 30 min prior to LVS in all children from group I and in some patients belonging to group II. Local anesthesia of the pharyngeal mucosa was not needed in any case. RESULTS: In nine out of 150 children, it was not possible to perform LVS during the first attempt. In eight of these children, the examination was performed successfully during another visit with satisfactory LVS images obtained. LVS revealed soft vocal fold nodules in 85 patients along with other organic changes found in five children: congenital laryngeal web (n = 1), vocal fold cysts (n = 3), and vocal fold paralysis (n = 1). Hyper-functional dysphonia was diagnosed in the remaining 60 subjects. CONCLUSIONS: In order to perform successful LVS in children patient, the purpose and methodology of this examination should be explained to parents on the first visit whereas an attempt to perform LVS should be undertaken during the second visit. Oral administration of dormicum 30min prior to the examination is advisable, particularly in younger children, and allows us to avoid the use of local anesthetics.