A comparative study of cefaclor vs. amoxicillin/clavulanate in tonsillopharyngitis.

BACKGROUND: Acute pharyngotonsillitis (APT) is one of the most common inflammatory processes of adults and children in an outpatient setting. Increasing failure rates, hypersensitivity to penicillin, the required multiple daily doses and common side effects lead to poor patients compliance and thus inadequate treatment duration, providing therefore ground for considering alternative antimicrobial agents. MATERIAL AND METHODS: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor (375 mg BID) and amoxicillin/clavulanate (625 mg BID) in 10 days treatment regiment of ambulatory patients with APT. A total of 200 patients (age range between 12-65 years) with symptoms of APT and positive antigen strep test were enrolled into the study. Clinical and bacteriological responses were assessed after the end of treatment (14th-18th day) and at the follow-up visit (38th-45th day). All GABHS strains, isolated from throat cultures, were tested for in vitro sensitivity to the antibiotics used in the study and no strain was found resistant to both antibiotics. RESULTS: The results indicated that both antibiotics had high--almost 99% effectiveness at the post therapy visit. On the follow up visit an increased tendency of relapses was observed in the amoxicillin/clavulanate treated group, compared to cefaclor treated group (8.33% vs 3.29%). Relative risk of relapse in patients treated with amoxicillin/clavulanate was 2.6 greater compared to cefaclor. There were significantly higher rates of gastrointestinal adverse events in group treated with amoxicillin/clavulanate (29/97 patients; 29.89%) compared to cefaclor (16/95 patients; 16.84%) - p< 0.03. Frequency of other adverse events did not differ significantly between the groups. CONCLUSIONS: Cefaclor and amoxicillin/clavulonate provide a clinically and bacteriologically effective treatment for patients with pharyngotonsillitis caused by GABHS, but cefaclor treatment is significantly safer in regard to gastrointestinal side effects.

[Detection of human papillomavirus type 16 and 18 in laryngeal cancer using PCR methods]. / Wykrywanie obecnosci wirusa brodawczaka ludzkiego HPV 16 i 18 w raku krtani z zastosowaniem metody PCR.

Human papillomavirus (HPV) is a small DNA virus. HPV is can be divided into two groups: mucosal and cutaneous. HPV have various oncogenic potential. The correlation between presence of high oncogenic type of HPV and carcinogenesis was confirmed in human anogenital tract and cervical carcinoma. The latest studies suggest HPV infection involvement in benign and malignant lesions of aerodigestive tract. The aim of our study was to determine the presence of the HPV genes E6/E7. The specimens were taken after total laryngectomy from 20 patients with squamous cell carcinoma. The fresh tissue specimens were frozen at -70 degrees C until DNA extraction and HPV detection. The presence of HPV DNA was assessed by polymerase chain reaction using specific primers for HPV 16 and 18 E6/E7. There were 7 (35%) HPV positive specimens in our group. 5 (25%) specimens were HPV 16 positive, 4 (20%) specimens were HPV-18 positive. In two cases HPV 16 and HPV 18 was present. The results suggest that high oncogenic types of HPV may play a role in pathogenesis of laryngeal carcinoma.

Short- and long-term results of stapedectomy in children.

Otosclerosis in children and teenagers is very uncommon. Typical otosclerosis presents as a slowly progressive conductive hearing loss and tinnitus in the third to fourth decade of life. Stapedectomy is a well-established procedure for correction of conductive hearing loss in adult patients with otosclerosis. The aim of this work is to assess short- (6 months) and long-term (7 years) results after stapedectomy performed in 10 patients under 20 years of age. In 1 patient cochlear otosclerosis was diagnosed and in 1 patient incus anomaly was found during the operation. Pure tone audiograms obtained 6 months after stapedectomy showed air-bone gap closure to 10 dB in 6 patients, to 15 dB in 8 patients and in all patients to 20 dB. Average air conduction threshold improved by 26.5 dB and average bone conduction threshold by 5.9 dB. 7 years after stapedectomy air-bone gap was similar to the one measured 6 months postoperatively. Stapedectomy in children provides good and stable hearing results.

[Complications of three methods of stapedectomy]. / Powiklania trzech metod stapedektomii.

In a group of 270 partial stapedectomies performed by one surgeon using teflon-piston prosthesis it was assessed whether incidence of complications depended on sequence of surgical steps. In group I of 50 ears classical stapedectomy was performed: 1. removal of stapes superstructure, 2. making a hole in the footplate, 3. placing the prosthesis on the incus. In group II of 167 ears the hole in the footplate was made before removal of stapes arch. In group III of 53 ears: 1. the hole in the footplate, 2. placing the prosthesis on the incus, 3. removal of stapes arch, was performed. Total deafness had one patient of the whole group. No patient had perilymphatic fistula and facial nerve palsy. Floating footplate developed in 4 patients of group I, in one patient of group II and in none patient of group III. Subluxation of incus developed in 3 patients of group I, in 12 patients of group II and in none patient of group III. Comparison of three stapedectomy methods showed that making the hole in the footplate before removal of stapes arch prevents floating footplate and placing the prosthesis on the incus before removal of stapes arch prevents subluxation of the incus.

[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.

[Free forearm skin flap with microvascular anastomosis for oral cavity reconstruction]. / Wolny plat skóry przedramienia z mikrozespoleniem naczyn do rekonstrukcji jamy ustnej.

Free forearm skin-fascia flap was used in 8 patients for intraoral reconstruction. Tissue defect was located in anterior part of the oral cavity in three patients and in lateral part in 5 patients. In the first three patients microvascular anastomosis was performed first and the flap was sutured in the oral cavity later on. In one of these patients the whole flap and in two patients about half of the flap necrotised. In the next 5 patients oral defect was closed first and then microanastomosis was done with good result in all the patients. We advise the last type of reconstruction. Free forearm skin-fascia flap provides good anatomical and functional result of reconstruction in the oral cavity.

[Operations of parotid malignant tumors]. / Operacje nowotworów zlosliwych slinianek przyusznych.

In a group of 64 patients with malignant tumours of the parotid gland the most common type was adenoid cystic carcinoma (20%) and malignant pleomorphic adenoma (14%). A group of 33 patients with follow-up from 4 months to 18 years was analyzed. The overall 5-year survival rate was 45%.

[Free forearm skin flaps with microvascular anastomosis for pharyngeal reconstruction]. / Wolny plat skóry przedramienia z mikrozespoleniem naczyn do rekonstrukcji gardla.

Free forearm skin flap with microvascular anastomosis was used for tissue defect reconstruction in 4 patients after resection of the oropharynx, base of the tongue and ramus of the mandible. The vascular pedicle of the flap contained the radial artery and the cephalic vein. For microvascular anastomosis the facial artery was used in all the patients, the facial vein in 2 patients, the internal jugular vein in one patient and the external jugular vein in the other one. Good healing of the graft was obtained in 3 patients. In one patient partial necrosis developed. No patient had fistula.

[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.

[Diagnosis of temporal bone paraganglioma]. / Rozpoznanie klebczaka kosci skroniowej.

On the basis of 7 cases of temporal bone paraganglioma diagnosis of this tumor is presented. Apart from aural symptoms cranial nerves palsy may appear. Computer tomography, magnetic resonance imaging and subtraction angiography are essential investigations.

[Surgical approach to the atlas and axis]. / Dojscie chirurgiczne do kregu szczytowego i obrotowego.

On the basis of three operated patients a posterior, lateral and antero-lateral approaches to the atlas and axis are presented. The type of approach depends on location and extent of a lesion in the vertebra.

[Face deformation and function defects after maxillectomy]. / Znieksztalcenie twarzy i ubytki funkcji po maksylektomii.

In the group of 42 patients after maxillectomy face deformation and function defects were assessed. The best cosmetic and functional result was observed after maxillectomy without orbital exenteration, with preservation of lateral part of the zygomatic bone and at least a half of nasal skeleton. Severe face deformation developed after orbital exenteration, resection of the palpebrae, cheek and external nose.

[Platysma myocutaneous flap in intraoral reconstruction]. / Plat miesnia szerokiego szyi w rekonstrukcji jamy ustnej.

Plastyma myocutaneous island flap was used in 13 patients to reconstruct tissue defect after oral cancer surgery. Necrosis of the skin island in the oral cavity occurred in 3 patients. A fistula developed in one patient with a large defect of the tongue, pharynx and mandible. In 12 patients wound healing on the neck was good. Plastyma myocutaneous flap is very useful to close defects of the floor of the mouth and up to the half of the tongue width.

[Degree of utilization of hearing aids by adults]. / Stopien uzywania aparatów sluchowych u doroslych.

The amount of use of hearing aids was assessed in 190 adults and 22.6% of them used the aid always, 23.7% most of the day, 22.6% every day a little, 20.0% sometimes and 11.1% never. The hearing aids were used more by patients with profound hearing loss than by patients with moderate loss and more by younger and working subjects than by elderly and non-working ones.

[Diagnosis of cerebello-pontine angle tumors]. / Rozpoznawanie guzów kata mostowo-mózdzkowego.

History and results of investigations in 34 patients with cerebello-pontine angle tumours are presented. Tumour was diagnosed in the first, audiological stage of the disease only in 4 patients. In 7 more patients additional symptoms of central nervous system focal disorders occurred. The remaining 23 patients were in the third stage of the disease with symptoms of increased intracranial pressure. The main reason for such a late diagnosis of the tumour was neglecting of the early audiological symptoms of the disease by patients and by general practitioners as well.

Sternocleidomastoid myocutaneous flap for intraoral reconstruction.

The results of healing of the sternocleidomastoid myocutaneous flap in 22 patients operated upon because of cancer of the tongue and floor of the mouth are presented. An inferiorly based island flap was used in 5 patients. Although total or partial cutaneous necrosis occurred in 4 of the patients, the wound healed without fistula formation in all cases. A superiorly based compound flap was used in 17 patients and in 5 of them the oral part of the skin underwent total or partial necrosis.

Problems of the hearing impaired in Poland.

Auditory disability was studied in a group of 140 Polish hearing aid candidates using an oral presentation of the problem questionnaire of Barcham and Stephens (1980). The overall pattern of problems reported by Polish hearing-impaired patients was similar to that found among English respondents. Some difference in the prevalence of the problems emerged which may result from the different socio-economic situations in the two countries.

Serum iron and total iron binding capacity in larynx cancer patients treated with surgery.

A decrease in serum iron and total iron binding capacity (TIBC) has been seen in patients with various malignancies. Similar iron level and TIBC alterations we have found in patients with larynx cancer. Estimation of TIBC reflects the quantity of transferrin which is the iron carrier in serum. The serum iron and transferrin changes cannot be used for diagnostic purposes because they are not specific to malignancies. Such alterations have been also seen in inflammatory and infectious diseases, heart infarct and anaemias. However, it is of interest whether elimination of neoplastic tissue from an organism brings back the decreased serum iron and TIBC to normal values.