[Pneumomediastinum - a case report]. / Odma sródpiersiowa - opis przypadku.

UNLABELLED: Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed. AIM: The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica). A CASE REPORT: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous. CONCLUSIONS: Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.

[Recurrence in operated patients with laryngeal squamous cell carcinoma]. / Wznowy u pacjentów leczonych operacyjnie z powodu raka krtani.

PURPOSE: The aim of the present study was to investigate the recurrence prevalence in patients with laryngeal squamous cell carcinoma (LSCC) underwent surgery as primary treatment. MATERIAL: The assessed group consisted of 148 patients with operable LSCC underwent surgery as primary treatment between 1999-2002. Surgery was performed in all cases. Total laryngectomy was performed in 107 (72.3%) patients and laser endoscopic tumor resection was performed in 41 (27.7%) patients. RESULTS: Local recurrence occurred in 18 (12.2%) patients, nodal recurrence in 12 (8.1%) and both and/or remote metastases in 6 (4%) patients. Altogether, recurrence was present in 36 (24.3%) patients and 111 (75.7%) patients had no symptoms of recurrence. Recurrence prevalence in 3-year follow-up--prevalence of recurrence significantly increased with tumor's T feature (p=0.04), N feature (p=0.03), progression of clinical stage (p=0.008) and histological malignancy G stage (p=0.01). Recurrence prevalence in 5-year follow-up--prevalence of recurrence significantly increased with tumor's T feature (p=0.02), N feature (p=0.01), progression of clinical stage (p=0.003) and histological malignancy G stage (p=0.002). Tumors localized in glottic area had less recurrences than those localized in supraglottic area (p=0.05). There were no significant dependence between recurrence type (local or nodal) and tumor's clinicopathological features. Multiple factor analysis with logistic regression model did not revealed simultaneous influence of many variables on recurrence's presence and type. Using multiple factor analysis with Cox's regression model it was proved that recurrence presence (p<0.00001) is a significant independent prognostic factor in the analyzed group of patients with laryngeal carcinoma in 3-year follow-up. CONCLUSIONS: Recurrence prevalence depends on localization, systemic progression stage, clinical progression stage, cervical lymph nodes state and histological malignancy stage of tumor. Patients with local recurrence have statistically significantly worse prognosis than patients with no recurrence. Recurrence presence is significant independent prognostic factor in 3-year follow-up.

[Extension of nasal and paranasal sinus malignancies on the basis of computed tomography]. / Rozleglosc nowotworów jamy nosowej i zatok przynosowych na podstawie tomografii komputerowej.

INTRODUCTION: Location and extension of tumour are crucial for results of treatment and prognosis in patients with nasal and paranasal sinus malignancies. The aim of the study was to evaluate the site and extension of nasal and paranasal sinus malignancies using computed tomography (CT). MATERIAL AND METHOD: The group included 124 patients aged 5-83 years. Biopsy confirmed malignant neoplasm in all the patients. Surgery was performed in 92 patients, for 32 inoperable patients palliation was applied. RESULTS: CT revealed that the most common (just above 70%) tumour sites were the nasal cavity, maxillary and ethmoid sinuses. The most common (about 50%) extrasinusal involvements were the orbit, subcutaneous cheek tissue and infratemporal fossa. Only 24.2% of patients had tumour limited to the nose and sinuses. CONCLUSIONS: CT well demonstrates extension of nasal and paranasal sinus malignancies. Vast majority of patients (75.8%) present with tumour extended beyond sinuses.

Granulomatosis with Polyangiitis with Bilateral Facial Palsy and Severe Mixed Hearing Loss.

Granulomatosis with polyangiitis is autoimmune and rare disease. It affects many organs, but the most often affected organs are the nose, lungs, and kidneys. It is part of vasculitis and causes an autoimmune attack by an abnormal type of circulating antibody termed ANCAs against small blood vessels. Disease concerns both men and women with a peak age of presentation in the sixth and seven decades. Typically upper and lower respiratory tract and kidneys are involved. Otitis externa, otitis media, or mastoiditis rarely occurs in granulomatosis with polyangiitis. Deafness is the most dangerous aural complication. Histological examination of biopsy is often not specific. A case of GPA with bilateral otitis media, bilateral deafness, and bilateral facial palsy with fatal course is presented.

[Complications of surgical treatment in patients with laryngeal and hypopharyngeal cancer]. / Powiklania leczenia operacyjnego raka krtani i gardla dolnego.

INTRODUCTION: Surgical treatment of patients with laryngeal or/and hypopharyngeal cancer is combined with potential risk of complications either local and general. The aim of the study was to evaluate the occurrence of them in the large cohort of patients with mentioned localization of cancer. MATERIAL AND METHODS: The group of 447 patients, treated between 2000-2005 in Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin were analyzed retrospectively. There were 412 men and 35 women. 426 patients underwent surgical removal of the tumour without any reconstruction procedure. In 21 (4.7%) patients we performed reconstructions of the pharyngeal defect implementing pectoralis major muscle flap. Complications were classified into general and local. Furthermore, according to the time we classified sequel of the treatment into recent (those during the first 7 days after surgery) and late. Statistical analysis of variables was performed using χ² test. RESULTS: Uncomplicated treatment were accomplished in 78.6% of patients. Local complications occur in 65 (14.5%) and general in 31 (6.9%) individuals. Pharyngo-cutaneous fistula was the most often occurring local sequel which constituted 50.8% of all local complications. Fistula developed in 33 (7.4%) cases. Cardiovascular and pulmonary diseases were the most often among general complications. They occur at the same rate of 25.8% of all general complications cases. Five patients (1.1%) died due to complications developed during the postoperative period. CONCLUSIONS: We noticed 10.6% local complications in our group of patients whereas only 2.5% of treated persons developed general sequel. The pharyngo-cutaneous fistula was the most often occurring local complication. It has been treated surgically in 15 (45.5%) patients. Whereas cardiovascular and pulmonary diseases were the most often general complications and they occur in above half of all cases with general complications.