[20 years of joint research on the carcinoma of the larynx conducted by teams from clinics in Crakow, Poznan, Warsaw and Lublin]. / 20 lat wspólnych badan nad rakiem krtani zespolów klinik krakowskiej, poznanskiej, warszawskiej i lubelskiej.

A twenty-year scientific cooperation has been discussed (1979-1998) between four clinics for laryngology at Medical Universities in Cracow, Poznan, Warsaw and Lublin. The results of research concerning the epidemiology, diagnostics and treatment of the carcinoma of the larynx are presented.

[A rare case of adenoid cystic carcinoma of the larynx]. / Rzadki przypadek oblaka krtani.

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.

[The use of benzydamine Hcl -- Tantum Verde -- in otolaryngology]. / Zastosowanie chlorowodorku benzydaminy--Tantum Verde--w otolaryngologii.

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.

[Treatment results of patients with adenoid cystic carcinoma in the Otolaryngology Department at the University School of Medical Sciences in Poznan between 1958-1999]. / Wyniki lecznia chorych na raka gruczolowato--torbielowatego w Klinice Otolaryngologii AM w Poznaniu w latach 1958-1999.

In the years 1958-1999 the ENT Department at the University School of Medical Sciences in Poznan 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.

[Laser cordectomy: treatment of precancerous stages of the larynx]. / Chordektomia laserowa w stanach przedrakowych krtani.

UNLABELLED: Diagnostics and treatments of precancerous states of cancer of larynx will demand in select chances the multistages treatment AIM: In 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.

[Oral cavity and oropharyngeal carcinomas in the materials of the University of Medical Science, ENT Department, in Poznan, in years 1980-1999]. / Rak jamy ustnej i czesci ustnej gardla w materiale Kliniki Otolaryngologii Akademii Medycznej w Poznaniu w latach 1980-1999.

624 patients with malignant neoplasms of the mouth and the oropharynx treated in the ENT Department K. Marcinkowski University of Medical Sciences in Poznan 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.

[Latent otogenic cerebellar abscess]. / Usznopochodny ropien mózdzku o skrytym przebiegu klinicznym.

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.

[Comparison of DNA adducts between oral, pharyngeal and larynx cancer]. / Porównanie zachowania sie poziomu adduktów kancerogen: DNA w rakach jamy ustnej, gardla i krtani.

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.

[Practical significance of the 6 level neck classification in cancers of the aerodigestive tract]. / Znaczenie praktyczne podzialu ukladu chlonnego szyi na VI regionów w nowotworach górnych dróg oddechowych i pokarmowych.

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.

[Neck metastases from unknown primary neoplasms (CUP syndrome)]. / Przerzuty w ukladzie chlonnym szyi z nieznanego ogniska nowotworowego (carcinoma of unknown primary--CUP syndrom).

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 Poznan, 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.

[Reconstructive surgery in larynx cancer]. / Operacje rekonstrukcyjne w raku krtani.

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.

[Value of intraoral ultrasonography in diagnosis of tonsillar tumors]. / Wartosc endoskopowego badania ultrasonograficznego w diagnostyce guzów migdalka podniebiennego.

UNLABELLED: 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. CONCLUSION: 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.

[Analysis of aromatic DNA adducts in oral cavity and pharyngeal cancer]. / Analiza aromatycznych adduktów kancerogen: DNA w rakach jamy ustnej i gardla.

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]. / Pierwotny czerniak zlosliwy krtani.

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.

Analysis of aromatic DNA adducts in laryngeal biopsies.

Epidemiological studies have confirmed the correlation between tobacco smoking, environmental pollution and the incidence of cancers of the respiratory tract. The occurrence of laryngeal cancer in Poland is relatively high compared to other European countries. Since 1969 the mortality related to larynx cancer appears to be increasing. Tobacco smoke contains an abundance of such carcinogenic compounds as polycyclic aromatic hydrocarbons (PAH), aromatic amines and N-nitrosoamines, which can react with DNA and form adducts. We analyzed aromatic DNA adducts in laryngeal tissues from patients with primary laryngeal, which was confirmed histopathologically to be squamous cell carcinoma. The group consisted of 33 patients (5 women and 28 men). Total laryngectomy was performed in patients. A detergentphenol method was used for DNA isolation. Aromatic DNA adducts were analyzed by a 32P-postlabelling technique with butanol extraction and high performance liquid chromatography. The presence of aromatic DNA adducts was demonstrated in all tissues. Large interindividual differences of DNA adduct levels were seen in each tissue studied. There was a higher mean level of DNA adducts in interarytenoid area non-tumors (51.96/10(8) +/- 91.71 NN) than in non-tumor tissue elsewhere (46.91/10(8) +/- 46.36 NN) and tumor tissue (43.52/10(8) +/- 45.88 NN). Adduct levels were correlated with age, sex, cigarette smoking and TNM stage.

[Diagnostic difficulties in nasopharyngeal tumors]. / Trudnosci diagnostyczne w rozpoznawaniu guzów czesci nosowej gardla.

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 Poznan were described.

[Ultrasonographic intraoperative evaluation of neoplastic changes in the tongue, tonsil, larynx, salivary and neck masses--preliminary report]. / Ultrasonograficzna ocena sródoperacyjna zmian nowotworowych jezyka, migdalka, krtani, slinianek i guzów szyi--doniesienie wstepne.

UNLABELLED: 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 Poznan 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. MATERIAL: 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.

[A case of neuroma in the sublingual region]. / Przypadek nerwiaka okolicy podjezykowej.

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.

Carcinogen: DNA adducts in tobacco smoke-associated cancer of the upper respiratory tract.

Mortality connected with tobacco smoke-associated laryngeal cancer in Poland markedly exceeds the relevant epidemiological data from other European countries. The main groups of genotoxic agents considered as potential carcinogens present in tobacco smoke are polycyclic aromatic hydrocarbons, aromatic amines, N-nitrosoamines and reactive oxygen species. Aromatic DNA adducts, N7-alkylated guanosines and oxidative DNA damage derived from tobacco smoke exposure were detected in laryngeal and oral (tumour and non-tumour) biopsies, and white blood cells of cancer subjects. Further, DNA lesions were analysed to estimate the significance of such confounders as intensity of smoking, subject's sex, age, topography of larynx, cancer staging and genetic factor. The number of cigarettes smoked per day was found to be the main determinant of an individual's DNA adduct level. The occurrence of DNA lesions was established as a reliable marker of former exposure to tobacco smoke genotoxicants. On the other hand, a comparison of DNA lesion levels in various regions of larynx indicates limited usefulness of DNA adduct analysis as an estimate of cancer risk. For a better risk estimation one has to take into account DNA lesions in proto-oncogenes and tumour suppressor genes and the efficacy of DNA repair. Altogether, DNA adducts formation and removal has to be considered as a single stage in the multistep carcinogenesis.