Acoustic analysis in the diagnosis of voice disorders in children.

The main aim of this study was to describe the changes in acoustic analysis in diagnosing voice disorders in children. The secondary goal was the attempt at differentiation of organic and functional disorders by means of acoustic analysis. The study included 112 children in treated due to laryngeal papilloma, gastro-esophageal reflux, atopic disease and noduli vocales. The following values have been determined: basic frequency F(o), jitter, shimmer, F(o) tremor and the harmonics to noise ratio (HNR). The study results confirmed that the HNR value was the most sensitive indicator of changes in the voice organ.

Evaluation of bcl-2 gene expression in papilloma of larynx in children.

Apoptosis - programmed death of a cell - is a natural mechanism that controls the number of cells in an organism. Neoplastic cells as many types of normal cells, may be the subject of spontaneous apoptosis as well as they may be induced by anti-neoplastic factors. Neoplastic cells' resistance to drugs is often correlated with impossible induction of apoptosis in those cells. Though the process of apoptosis is not fully explained, a possible involvement of many genes in regulation of this process is indicated. One of them is bcl-2 gene and its product - bcl-2 protein, which has the property of apoptosis process inhibition and stimulation of a cell towards outliving (survival). Increased expression of bcl-2 gene is present in many neoplastic cells and it suggests a possible pathogenic role of bcl-2 gene in oncogenesis. In this paper the expression of bcl-2 gene in the cells of papilloma in larynx is defined in six children operated in the Department of Paediatric Otolaryngology of Medical School in Lublin. Papillomas of larynx are neoplasm's of particular resistance to treatment. Complete, cellular RNA was isolated with Chomczynski and Sacchi method using guanidine thiocyanate. Gene expression was defined with the method of reverse transcription by cDNA synthesis and amplification of bcl-2 gene fragment with specific oligonucleotides in reverse transcriptase polymerase chain reaction (RT-PCR). The products were identified on agarose gel. Expression of bcl-2 gene in the investigated cells of laryngeal papilloma was confirmed in all the children. The presence of bcl-2 gene product in these cells may be the cause of apoptosis inhibition and stimulation of cells proliferation of the neoplasm.

ABR disturbances in children with insulin dependent diabetes mellitus.

A number of papers present the research on hearing disturbances in the course of diabetes mellitus. Some authors report the damage of inner ear cells, whereas others maintain that it is located in the retrocochlear part of the hearing pathway. The objective of the paper was to find the location of the auditory pathway disturbances in children suffering from diabetes mellitus. The analysis concerns 37 insulin treated children aged 6-18 years. The following audiometric methods were applied: pure-tone audiometry, impedance audiometry as well as auditory brainstem response (ABR). We observed conduction disturbances within the stem in ABR, in the children without hearing loss in pure-tone audiometry.

Acoustic analysis of voice in children with noduli vocales.

The acoustic tests of voice were carried out on 46 children with noduli vocales before the treatment and after its completion. Acoustic parameters of voice were compared with the control group of children without voice pathology. The results of the investigation were analysed acoustically. It has been proved that jitter, shimmer, Fo tremor and HNR values significantly differentiate the children with noduli vocales from the children without pathological changes in the larynx. These parameters during treatment tend to approach normal values. Therefore, the acoustic analysis of voice may be used in treatment monitoring.

Hearing defects in children born of mothers suffering from rubella in the first trimester of pregnancy.

The investigations concerned women that had suffered from symptomatic rubella in the first trimester of pregnancy. The presence of immunoglobulin G and immunoglobulin M antibodies in mothers and their children was detected, and the hearing organ was examined. In early childhood (up to 3 years of age), hearing loss was confirmed in 50% of the children born of mothers with rubella.

ABR differences before and after dialyses.

The aim of the study was the objective evaluation of the hearing organ in children. Seven children aged 6-17 with end stage renal failure treated by haemodialysis were examined. Four- to five-hour dialyses were performed 2-3 times a week. Pure-tone audiometry was normal in five children. The reactions of brain stem responses (latency and interpeak latency) were analysed before and after haemodialyses. We conclude that the ABR differences were connected with biochemical parameters of uraemia. The present study is a preliminary one and will be continued in the future.

[A nineteen year observation of a boy with branchio-oto-renal syndrome and chronic renal failure]. / Dziewietnastoletnia obserwacja chlopca z zespolem skrzelowo-uszno-nerkowym i przewlekla niewydolnoscia nerek.

Branchio-oto-renal syndrome is a rare autosomal dominant disorder of the first and second embryonic branchial arches and the urinary tract. It is characterized in its full expression by branchial fistulas or cysts, preauricular pits, outer, middle and inner ear defects, hearing loss, lachrymal duct stenosis, facial paralysis and mental retardation. Renal anomalies may range from mild hypoplasia to complete absence. Our report demonstrates the patient with classical BOR syndrome and severe renal insufficiency since infancy up to end stage renal failure at 18 years of age caused by bilateral renal hypoplasia. Although no definitive histological diagnosis was made, the clinical findings in our patients, like mild proteinuria, normal blood pressure, polyuria, polydypsia, hyperchloremic acidosis and typical course of renal failure support the diagnosis of oligomeganephronia in this case.

[Organizational and scientific activities of Prof. Benedykt Dylewski in the field of phoniatry]. / Dzialalnosc organizacyjna i naukowa prof. dr hab. Benedykta Dylewskeigo w zakresie foniatrii.

Prof. dr hab. Benedykt Dylewski was one of the first phoniatrician in Poland. He was working on the fields of diagnosis and therapy of voice and language difficulties in children and school youngsters. The scientific and organizational successes of Dylewski in phoniatrics at the beginning of our century were described.

[Familial occurrence of hearing loss following streptomycin (SM) treatment]. / Rodzinne wystepowanie niedosluchu odbiorczego zwiazanego z leczeniem streptomycyna.

References data indicate the probability of inheritance of predisposition to post-streptomycin hearing loss. Ototoxicity after SM is transmitted by women. It is considered as autosomal dominant inheritance, but the transmission to the next generation is not explained by the Mendelian inheritance rule. The aim of our presentation is showing different kinds of hearing loss after SM occurring in siblings with probable inherited susceptibility to SM.

[Results of the treatment of parotid gland tumors]. / Wyniki leczenia guzów slinianek przyusznych.

During the years 1977-1986 84 patients with the parotid tumor were treated in ENT Clinic in Lublin. 16.6% of tumors were malignant. The surgical procedure was performed in 74 cases (84.5%). There were the removal of tumor with or without the parotid gland resections. In all cases of resection the facial nerve was saved. In malignant tumor cases the radiotherapy followed the surgery. 13 patients with poor health conditions were treated without surgery. The early and late results were described.

[Trace elements in neoplasm tissues of the larynx]. / Pierwiastki sladowe w tkankach krtani objetych choroba nowotworowa.

Trace elements are essential for the proper functioning of the body. Changes in bioelements concentration were observed in numerous pathologic conditions. The aim of this study was evaluation of trace elements concentration in neoplasmatic tissues of the larynx. The study comprised 52 patients operated for cancer of the larynx. Levels of magnesium, zinc and copper in neoplasmatic tissues of the larynx were determined using atomic absorbtion spectrophotometry. The results were compared with the control group. Elevated levels of magnesium were observed in neoplasmatic tissues of the larynx. Zinc and copper levels were lowered in comparison with the control group. The results were statistically analysed.

[Speech disorders in Alajouanine syndrome]. / Zaburzenia mowy w zespole Alajouanine'a.

Alajouanine syndrome includes congenital, bilateral, central facial and abducens nerves palsy and clubfoot. The authors present speech disorders and helpful influence of early rehabilitation.

[The personality of children with repeated nose injuries]. / Cechy osobowosci u dzieci z powtarzajacymi sie urazami nosa.

Clinical observations of children hospitalised due to head injuries made us try to define some features of personality characteristic for this group of children. The examinations of 63 children aged 8-12 were carried out with R.B. Porter and R.B. Cattell test: What do you like doing? and What do you like to think about?. This method facilitates selection of 14 personality traits. The results proved that personalities tested in the group included the following dominating characteristics: aggressiveness, great excitability, and IQ exceeding average.

[Voice disorders in children with gastroesophageal reflux disease]. / Zaburzenia glosu u dzieci z choroba refluksowa.

The study concerns 11 patients with gastroesophageal disease confirmed by pH-metric examination of esophagus. The clinical assessment included lupolaryngoscopy, stroboscopy and acoustic analysis of voice. Basing on the tests there were confirmed inflammatory lesions at the posterior part of larynx (laryngitis posterior) as well as pathological changes of voice acoustic tests.

[Hormonal conditioning of vocal changes in male]. / Hormonalne uwarunkowania mutacji przedluzonej u osobników plci meskiej.

Porophonia pubertum is the change of voice following activation of gonads in puberty. The present paper shows disorders of porophonia pubertum in 3 boys. The objective of the paper was to explain the pathogenesis of these disorders. Basing on clinical and genetic tests, a non-physiological, high position of spoken voice typical for the prolonged porophonia pubertum was proved. The genetic test confirmed the male sex. However, hormonic tests proved a significantly increased level of estradiol. We suppose that excessively increased estradiol level in blood serum caused the porophonia pubertum disorders in our patients.

[Analysis of the causes of failure in surgical treatment of cancer of the larynx]. / Analiza przyczyn niepowodzen leczenia operacyjnego chorych na raka krtani.

In the years 1985-1990 within the group of 2769 patients operated upon for laryngeal cancer in four medical centres (Kraków, Poznan, 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.

[Evaluation of the effectiveness of surgical treatment of metastases of laryngeal cancer to the lymph nodes]. / Ocena wydolnosci leczenia operacyjnego przerzutów raka krtani do wezlów chlonnych.

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.

[Evaluation of complications after surgical treatment of cancer of the larynx]. / Ocena powiklan po leczeniu operacyjnym chorych na raka krtani.

The surgical complications in a group of 1712 laryngeal cancer patients treated during the years 1981-87 in ENT Clinics of Cracow, Poznan, Warsaw and Lublin were described. The most dangerous were bleedings and the most frequent wound and tracheo-+-bronchial infections and pharyngo-cutaneous fistulas++, after radical neck dissection however the paralysis of sublingual and accessory nerves and of brachial plexus. The predisposing factors were: diabetes, lung and heart diseases, late stage of cancer, extent of surgery and tumor infections.

[Evaluation of the causes of lymphatic metastases after surgical treatment of patients with laryngeal cancer]. / Ocena przyczyn powstawania przerzutów do wezlów chlonnych po leczeniu operacyjnym chorych na raka krtani.

During the years 1980-1988 2458 laryngeal cancer patients were operated upon in 4 ENT AM Clinics in Kraków, Poznan, 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.