Sensorineural Hearing Loss in Patients with Long-COVID-19: Objective and Behavioral Audiometric Findings.

Introduction: The symptoms of COVID-19 are primarily respiratory system disorders. Sensorineural hearing loss can be caused by COVID-19, as other symptoms in the nervous system. Hearing loss may also be the only symptom or complication of this disease or the symptoms of long COVID-19. The study aimed to assess hearing in patients after COVID-19 infection. Material and Methods: The study conducted ENT and full hearing assessment in COVID-19 infection. All patients underwent complete audiological diagnostics, including threshold tonal audiometry, tympanometry, otoacoustic emissions, and auditory brainstem evoked potentials (ABR) tests. The study group included 58 patients aged 23 to 75 years who were diagnosed with COVID-19 infection six months before inclusion in the present study and reported post-COVID-19 hearing impairment. Results: There were statistically significant differences between the control and study groups. Sensorineural hearing loss was found in 65.5% of the tonal audiometry test. The stapes reflex was absent in almost 20% of post-COVID-19 patients. The analysis of ABRs demonstrated longer latencies of wave III, V, and time intervals I-III, I-V in post-COVID-19 patients. Conclusion: COVID-19 can damage the inner ear as well as the auditory pathway. Hearing loss may be the only symptom of COVID-19 or be a late complication of the disease due to postinfectious inflammation of the nerve tissue as a symptom of long COVID-19. Prolonged conduction of the auditory pathway shows the affinity of the virus to the nervous system as a symptom of long COVID. It is advisable to perform hearing diagnostics in patients after COVID-19 and provide them with specialist care.

The Microbiome's Influence on Head and Neck Cancers.

PURPOSE OF REVIEW: Head and neck tumors (HNC) rank sixth among cancers worldwide. Due to their late diagnosis and poor prognosis, they are a clinical challenge. However, recent years have seen a dynamic development of science on the microbiome. The aim of the study is to discuss the role of the microbiome in HNC, the impact of the microbiome on oncogenesis, the course of the disease, as well as on treatment, and its toxicity. RECENT FINDINGS: The microbiome's influence on oncogenesis, the course of the disease, and the effectiveness of oncological treatment have been confirmed in cancers of the colon, pancreas, lungs, and prostate. There is no solid literature on HNC. Many studies indicate disruption of the oral microbiome and periodontal disease as potential cancer risk factors. Disruption of the microbiome increases radiotherapy's toxicity, intensifying radiation reactions. The microbiome plays an important role in cancer. It is a new target in research into new therapies. It may also be a prognostic marker of cancer development. Changes in the composition of the microbiome modulate the effectiveness of oncological treatment. More research is needed on the microbiome and its effects on HNC.

Human Papillomavirus-Associated Head and Neck Cancers. Where are We Now? A Systematic Review.

Background: Human papillomavirus targets the skin and mucous membranes, producing benign hyperplastic lesions and precancerous and cancerous lesions. An increasing number of head and neck cancersin particular, oropharyngeal squamous cell carcinoma, laryngeal squamous cell carcinoma, and oral squamous cell carcinoma, are attributable to HPV infection. HPV-induced HNCs typically affect younger, nonsmoking patients with no prior history of heavy alcohol use, more extensive sexual history, and higher socioeconomic status. Aim: The purpose of the review is to present the most recent and well-established findings concerning HPV-induced head and neck cancers and consequently to provide medical specialists with essential information regarding the epidemiology, the role of HPV in HNC cancerogenesis, prevention, diagnosis, and treatment. Material and Methods: All authors independently have searched The EMbase, Medline/Pubmed, and Cochrane databases by using the following keywords "head and neck cancer", "human papillomavirus", "HPV", "HPV biology", "oropharyngeal squamous cell carcinoma", "carcinogenesis", "transoral surgery", "robotic surgery". The last search was conducted in March 2022. The references of the publications of interest were also screened for relevant papers. There were no limitations in regard to the publication date. Conclusion: Aiming to avoid the epidemic of HPV-induced HNC, it is paramount to improve the access to vaccination as well as resolve parental concerns regarding vaccine safety. Physicians should rely on reduced-dose radiation and aim to reduce the overall treatment time. Thanks to a more elaborate understanding of the genomic background of HPV-induced HNC, precision medicine could become a relevant part of patients' management. In comparison to traditional techniques and non-operative treatment, transoral robotic surgery (TORS) offers similar oncologic and functional outcomes, with a possible benefit on long-term quality of life. However, more research is needed to establish clear guidelines indicating when TORS resections should be supported with adjuvant therapy.

Vestibular disorders in patients after COVID-19 infection.

Introduction: The COVID-19 clinical symptoms are primarily related to the respiratory system but may also be involved in many others, including the nervous system. Recently, vertigo or dizziness has been described as one of the clinical manifestations and possible complications of COVID-19. Materials and methods: This clinical study was designed to describe the otorhinolaryngological evaluation and videonystagmographic (VNG) findings in patients with an antecedent of COVID-19 infection in the last 6 months. In this study, we sought to investigate the presence of persistent vestibular damage in healed COVID-19 patients and to determine the origin of vertigo by conducting a comprehensive vestibular examination. To evaluate the association precisely, an otoneurological assessement was conducted on all participants. The study group included 58 patients aged 23-75 years with vertigo, who were diagnosed with COVID-19 infection 6 months before the examination. Each participant was submitted to an evaluation consisting of anamnesis, otorhinolaryngological evaluation, and VNG. Results: Spontaneous nystagmus with closed eyes was reported in 8 patients (13.8%). Positional nystagmus was observed in 15 patients (24.1%). Asymmetrical optokinetic nystagmus was observed in 18 patients (31%). A distorted record in the tracking pendulum test was present in 23 patients (39.7%). Square waves were observed in 34 COVID-19 patients (58.6%). Unilateral weakness (UW) was observed in 23 subjects (39.7%); among those with UW, 22 patients (95.7%) also demonstrated directional preponderance contralateral to the UW. Another 16 patients (27.6%) presented only directional advantage. The post-caloric recruitment was present in 38% patients. Conclusion: Patients who had been diagnosed with COVID-19 seem to be more likely to suffer from vertigo/dizziness and to compensate more slowly. COVID-19 infection may cause inner ear damage and lead to vestibular dysfunction. The role of the central nervous system in the onset of equilibrium disorders should be considered. The presence of vertigo of central origin may indicate the neurotropic effect of SARS-CoV-2 following COVID-19. Imbalance may be the only symptom of COVID-19 and may also be a late complication of the disease due to post-infectious inflammation of the nervous tissue. Comprehensive studies are needed to investigate whether COVID-19 can cause long-term vestibular deficits.

A Comprehensive Approach to Facial Reanimation: A Systematic Review.

PURPOSE: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. METHODOLOGICAL APPROACH: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. CONCLUSIONS: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.

Prevalence and Associated Factors of Cigarette Smoking Among Medical Students in Wroclaw, Poland.

Objective: The study aimed to evaluate the nicotine addiction syndrome among students of the medical university of Wroclaw. Materials and Methods: The anonymous self-administered online questionnaire regarding tobacco and e-cigarettes smoking was sent to 5616 students. A total of 407 students from Wroclaw Medical University who fulfilled the questionnaire were enrolled. Results: One-fourth of the surveyed medical students smoke or have smoked cigarettes in the past. About 75% of students report that there is no information about the harmfulness of smoking and its consequences in the course of teaching in medical studies. The majority of students, 74.5% of women and 62.8% of men, agree that nicotine dependence syndrome should become part of the curriculum of medical universities. Conclusion: The proportion of smokers among medical students is very high, and their knowledge of smoking is insufficient. It seems necessary to implement urgent education for medical students about the consequences of smoking and the treatment of nicotine dependence syndrome. The knowledge of future doctors about the harmfulness of smoking in the future will allow reducing the number of patients suffering from smoking-related diseases and may help reduce the number of smokers among students. It seems necessary to intensify the antismoking campaigns in Poland and worldwide.

A Systematic Review of Cancer of Unknown Primary in the Head and Neck Region.

BACKGROUND: Despite the vivid progress in molecular and genetic profiling, extensive diagnosis and multiple therapeutic modalities, cancers of unknown primary in the head and neck region continue to be a formidable challenge. AIM: The purpose of the review is to present the most recent and well-established findings concerning cancers of unknown primary (CUPs) in the head and neck patients and consequently to provide medical specialists with essential information regarding the biology, pathology, histology, diagnosis and treatment of CUP in the head and neck region. MATERIAL AND METHODS: The Medline/PubMed database was searched by using the following keywords "CUP", "cancer of unknown primary", "CUP biology", "head and neck". The references of the publications of interest were also screened for relevant papers. There were no limitations in regard to the publication date. CONCLUSION: Unique biology and pathophysiology prompt the management of CUP to be demanding. The vivid rise in HPV-related CUPs during the last 20 years has put more focus on this phenomenon. New findings concerning the enigmatic biology of CUP provide fundaments for targeted therapy. Despite the availability of various diagnostic methods, the diagnosis of CUP continues to be a time-consuming, strenuous process that eventually provides answers. It remains controversial as to what combination of treatment methods is the most effective. There is no consensus on the value of combining chemotherapy with radiotherapy. Highly specific surgical treatments for particular histological types of CUP produce more satisfactory results. It is paramount to establish reliable guidelines concerning the diagnosis and treatment of CUP patients.

Doxycycline in the Coronavirus Disease 2019 Therapy.

Acute respiratory syndrome, associated with coronavirus 2 (SARS-CoV-2), is the most important medical and epidemic problem of today. The biggest challenge is to find an effective treatment and to reduce the need for hospitalisation. In the article, the patients with mild to moderate coronavirus disease 2019 (COVID-19) treated with doxycycline with significant improvement have been discussed. Doxycycline is a known antibiotic, but also an anti-inflammatory and immunomodulatory drug, so it seems to be ideal for the treatment of COVID-19. Doxycycline, as an easily available and low-cost medication, should be considered as a COVID-19 therapy in all patients in the first days of the symptoms of a SARS-CoV-2 infection. Due to its immunomodulatory, anti-inflammatory, cardioprotective and antiviral effects, it seems to be an ideal drug for patients with mild, moderate and severe disease. A large multicentre study is needed to evaluate the effects of this medication.

Comparison of Perfusion Pressure in Aorta Using High-Pressure Perfusion and Gravity Perfusion During the Kidney Transplant Procedure.

Organ perfusion is an element of organ donation aimed at cooling the organ, washing out morphotic elements, and creating favorable conditions for the storage and transport of organs. Depending on the method used, perfusion is performed under gravity perfusion (GP) or perfusion under high pressure (HPP). This study aimed to measure the pressure of the perfusion fluid in the abdominal aorta during the use of GP and HPP. The study was performed during 35 organ procurements from deceased donors. The direct proportional increase of pressure in the aorta, depending on the applied perfusion method, was observed. GP was on average 37.8 mm Hg; using a pressure of 50 mm Hg in the HPP, an average of 57 mm Hg was obtained, and using a pressure of 200 mm Hg, 99.4 mm Hg was obtained. The study found that during the application of GP, the pressure generated in the abdominal aorta is low, which may lead to inadequate perfusion of organs. HPP is a faster method that leads to a proper perfusion of the procured organs and is also a safe method because, despite the use of high pressure, no damage to the transplanted kidneys was observed.

Impact of Estrogens Present in Environment on Health and Welfare of Animals.

Nowadays, there is a growing interest in environmental pollution; however, knowledge about this aspect is growing at an insufficient pace. There are many potential sources of environmental contamination, including sex hormones-especially estrogens. The analyzed literature shows that estrone (E1), estradiol (E2), estriol (E3), and synthetic ethinyloestradiol (EE2) are the most significant in terms of environmental impact. Potential sources of contamination are, among others, livestock farms, slaughterhouses, and large urban agglomerations. Estrogens occurring in the environment can negatively affect the organisms, such as animals, through phenomena such as feminization, dysregulation of natural processes related to reproduction, lowering the physiological condition of the organisms, disturbances in the regulation of both proapoptotic and anti-apoptotic processes, and even the occurrence of neoplastic processes thus drastically decreasing animal welfare. Unfortunately, the amount of research conducted on the negative consequences of their impact on animal organisms is many times smaller than that of humans, despite the great richness and diversity of the fauna. Therefore, there is a need for further research to help fill the gaps in our knowledge.

Concurrent Squamous Cell Carcinoma and Leiomyosarcoma in the Larynx at Relapse 15 Years Post-radiation for Primary Laryngeal Cancer.

Malignant tumours of the larynx account for 50% of all head and neck neoplasms. Squamous cell carcinoma is the most common malignancy of the larynx and accounts for 95-98%. Leiomyosarcoma (LMS) originating in larynx is a very rare malignant tumour derived from the smooth muscle tissue. The authors present a case of a 75-year man with coexistent squamous cell carcinoma and leiomyosarcoma in the larynx 15 years after radiation therapy for promany laryngeal cancer. Two cases of the synchronous presence of these neoplasms have been reported so far in English literature. This paper presents the clinical picture, radiological and histopathological diagnoses, and treatment of this case. Key Words: Squamous cell carcinoma, Leiomyosarcoma, Larynx.

The assessment of the balance system in cranial artery stenosis.

INTRODUCTION: Vertigo and balance disorders are a significant clinical problem, especially in elderly patients. The narrowing of cranial vessels may be asymptomatic or produce neurological symptoms. Very often nonspecific signs of ischemia occur, such as headache, vertigo, or dizziness. OBJECTIVE: The objective of the study was to assess the effect of carotid and vertebral arteries stenosis on the function of the equilibrium organ on the basis of electronystagmography and posturography. MATERIAL: The study was conducted in 63 patients, presenting with carotid and vertebral arteries stenosis. The control group consisted of 32 healthy persons. METHODS: All patients were subjected to precise audiological and otoneurological diagnostic examinations. Prior to being qualified for the study, patients were subjected to the assessment of arteries by means of Doppler ultrasonography. The vestibular organ was assessed by means of physical examination as well as by electronystagmography and posturography testing. RESULTS AND CONCLUSIONS: The study revealed statistically significant reduction in the results of the equilibrium organ assessments in patients with carotid and vertebral arteries sclerosis as compared to the control group. Abnormal ENG records in the study group patients were observed particularly in the pendulum test, optokinetic test, and the assessment of positional nystagmus, possibly indicating disturbances within the central part of the equilibrium system. Disturbed blood flow in arteries had also an important impact on spinovestibular reflexes and resulted in disturbed postural stability control. On the basis of the conducted studies, it is concluded that diagnostic examinations for carotid and vertebral artery stenosis should be performed in patients with equilibrium system disorders.

Single median maxillary central incisor syndrome and variant in SMO gene associated with SHH pathway.

Solitary median maxillary central incisor syndrome (SMMCI) is a rare congenital oronasal-dental midline anomaly. The aim of this paper is a presentation of a patient with SMMCI without other visible dentofacial anomalies, with a potentially new molecular etiology consisting of a gene-gene reaction and conservative therapeutic approach to nasal obstruction. Potentially pathogenic variants in the SMO gene (p.Gly422Glu) and in P2RY13 gene (p.Trp205*) inherited from the probant's father, and in the PLD2 gene (p.Gln319fs), inherited from the mother were found. A multidisciplinary approach is necessary for the management of patients with SMMCI, including a genetic consultation with genetic tests.

The impact of the patient's condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients.

INTRODUCTION: Carcinoma of unknown primary site (CUP) refers to 1-5% of all head and neck neoplasms. Very often, the primary site remains difficult to determine. Squamous cell carcinoma is the most frequent histopathological type diagnosed in the head and neck region. According to statistics, a primary site is usually located in the oropharynx. STUDY OBJECTIVE: The study presents diagnostic difficulties and the methods of diagnosing and the therapy of CUP and primary sites in patients treated in the region of Lower Silesia and Silesia. The aim of the study was to show a retrospective analysis of 233 CUP patients to assess how clinical features, diagnosis and treatment affect the survival of patients. MATERIAL AND METHODS: The diagnostics of patients included panendoscopy with specimen collection (nasoendoscopy, laryngoscopy, esophagoscopy, brochoscopy), computed tomography examination of the neck, chest, abdomen and pelvis minor, as well as positron emission tomography examination. Tonsilletomy was performed in 37 patients. Neck dissection was carried out in 109 subjects and 165 patients were treated bt radiotherapy, and 135 by chemotherapy. CONCLUSIONS: Tonsillectomy is required in CUP patients with the negative results of biopsy and imaging tests. It gives a possibility of detecting the primary site and improves the results of treatment and survival of CUP patients.Combination therapy, including surgical treatment and chemoradiotherapy, gives the best therapeutic results in CUP patients. The general condition of patient and younger age have an impact on prognosis and survival.

The evaluation of the sense of hearing in patients with carotid artery stenosis within the extracranial segments.

Stenosis of arteries that supplies blood to the brain is one of the main causes of ischemic stroke which is the third most common cause of deaths in Europe. Atherosclerosis of carotid and vertebral arteries is responsible for 20% of the ischemic stroke cases. Stenosis may be either asymptomatic or manifested with typical neurological symptoms including motor and sensory disturbances as well as disturbances in vision and speech. However, discrete non-specific symptoms of ischemia, including headaches and vertigo, tinnitus and hearing loss, are also quite common. These symptoms may be indicative of a clinically significant stenosis of carotid and vertebral arteries, particularly within the internal carotid artery region, as well as of a risk of ischemic stroke. To date, research reports were unable to provide exact explanation of correlations between impaired hearing and the stenosis of carotid and vertebral arteries. Despite this, numerous articles list these symptoms as one of the first non-specific symptoms of this disorder. The ischemic mechanism within the inner ear region may lead to early symptoms of atherosclerosis of large vessels. However, no evidence of relationship and no explanation could be provided with this regard. The objective of the study was to assess the effect of carotid and vertebral artery stenosis on the function of the hearing and equilibrium organ on the basis of diagnostic audiological examinations including pure-tone threshold audiometry, impedance audiometry, otoacoustic emission tests and brainstem auditory evoked potential tests. The study was conducted in 63 patients (32 males, 31 females) aged 45-75 years, presenting with carotid and vertebral artery stenosis and treated at the Vascular Surgery Clinic of the University Clinical Hospital in Wroclaw. Patients were stratified into two subgroups according to their age (45-60 years, 61-75 years). Patients were also divided into subgroups according to the stenotic arteries and to the symptomatic/asymptomatic status of the disorder. All patients were homogeneous in terms of the degree of artery stenosis. The control group consisted of 32 healthy persons (14 males, 18 females) aged 48-75 years. Patients qualified to the control group reported no history of middle or inner ear disorders, disturbed hearing, vertigo and balance disorders, as well as cardiovascular diseases; they also presented with unremarkable ultrasound scans of the arteries. All patients were subjected to precise audiological examinations. Prior to being qualified for the study, patients were subjected to the assessment of arteries by means of Doppler ultrasonography. The hearing organ function was assessed by means of pure-tone threshold audiometry, impedance audiometry, otoacoustic emission tests and brainstem auditory evoked potential tests. Reduction of the flow through the carotid arteries causes problems in the organ of hearing; abnormalities are reported especially in tone threshold audiometry, examinations of the stapedius muscle reflexes and brainstem auditory evoked potentials, which prove the presence of receptive cochlear-extracochlear hearing damage. Disturbances of the organ of hearing have similar severity in stenosis of the internal carotid artery and vertebral artery. Abnormalities found in audiologic examinations in patients with carotid artery stenosis are not always explicitly clinically expressed in patients with hearing loss; we should consider diagnostics for carotid artery stenosis.

The role of 1,25(oh)2d3 and its analogs in proliferation and differentiation of squamous cell carcinoma of the head and neck ­ literature review

Epidemiological studies correlate sun or UV light exposure with a lower incidence of a variety of malignancies, including breast, colon and prostate cancer. The biologically active 1,25(OH)2D3 and its analogs have been shown to have antiproliferative and differentiating effects in a variety of malignant and non-malignant cells. The effects of 1,25(OH)2D3 are mediated by the binding of calcitriol to a specific intracellular receptor, vitamin D receptor [VDR]. The aim of this study is to review the literature concerning the role of 1,25(OH)2D3 and its analogs in squamous carcinoma cell lines of the head and neck (SCCHN).

Carotid artery stenting versus endarterectomy for the treatment of both symptomatic and asymptomatic patients with carotid artery stenosis: 2 years' experience in a high-volume center.

BACKGROUND: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the 2 current standard treatments for carotid artery stenosis. There is still no well-defined consensus with regard to their superiority. However, the minimally invasive nature of endovascular treatment makes CAS increasingly popular among vascular surgeons. OBJECTIVES: The aim of the study is to compare the safety and efficacy of CEA and CAS in patients with symptomatic and asymptomatic carotid artery stenosis. MATERIAL AND METHODS: A single-center, retrospective analysis of patients who were treated for carotid artery stenosis using CAS or CEA between January 2014 and December 2015 was carried out. There were 471 patients (266 CEA and 205 CAS) who were eligible for inclusion. The vast majority of the patients had significant (>70%) stenosis of the internal carotid artery (92.1% of CEA and 87.8% of CAS). The occlusion of the contralateral carotid artery was observed in 9.8% of all cases (2.6% of CEA vs 17.7% of CAS). RESULTS: The occurrence of complications, such as stroke, myocardial infarction (MI) and death, did not vary statistically between the groups. There were 9 events of stroke in the CEA group (3.4%) and 8 in the CAS group (3.9%), 3 of which were fatal. There were no significant differences between the 2 groups (χ2 = 0.76; p > 0.05). There was no higher risk of mortality in any group (Fisher's exact test; p = 0.08). Symptomatic patients had a higher incidence of stroke than asymptomatic patients across both groups (χ2 = 6.36; p < 0.05; hazard ratio 3.03 (1.26-7.33)). CONCLUSIONS: Carotid endarterectomy is equally effective as CAS in stroke prevention, but is associated with a higher incidence of cranial nerve palsy, access site hematoma and other non-stroke complications. Symptomatic patients had a higher incidence of stroke, regardless of the treatment method.

Quality of life after carotid endarterectomy: a review of the literature.

Strokes are one of the leading causes of death, morbidity, and disability worldwide, mainly among elderly people. It is also the third most common cause of years of life being lost, indicating a high risk of premature mortality. Revascularisation with endarterectomy (CEA) is effective in reducing the risk of death and strokes in patients with carotid artery stenosis, but the effect of invasive treatment on quality of life (QoL) still needs attention. To shed more light on the patients' perspective on this health condition, we carried out a review of the literature which aimed to analyze the level of health-related QoL among stroke survivors, with special attention to patients who had been treated with CEA. Strokes significantly reduce the level of QoL, which may subsequently be improved in the course of treatment with CEA. Patients experience a reduced level of QoL in the early postoperative period, but at 1 year following CEA, the level of QoL remains stable and is similar to that of chronically ill patients. The domains of QoL which are most affected are physical and emotional functioning, which also serve as markers for decreased QoL in the long term. Older age and comorbidities are predictors of worse QoL. Stroke survivors require proper care both immediately after a stroke happens and during the long-term rehabilitation. Measurement of QoL and of the determining factors that contribute to a reduced level of QoL, as well as focusing on determinants of QoL in stroke survivors may help to reduce patients' disability and improve their daily functioning in society as well as reducing the cost of health care.

Diagnostic and Therapeutic Difficulties in Carotid Body Paragangliomas, Based on Clinical Experience and a Review of the Literature.

BACKGROUND: Paragangliomas are rare neuroendocrine tumors, representing 0.03% of all tumors. Half of them develop in the head and neck, and among these 50% are sporadic cervical tumors. OBJECTIVES: The aim of the study was to carry out an epidemiological and clinical analysis of paraganglioma patients diagnosed and treated at the authors' clinics between 1985 and 2014. MATERIAL AND METHODS: The medical data of 47 patients were analyzed. All the patients were qualified for surgery. In 43 cases (88%), simple resection of the tumor was performed, including 11 cases (22%) that additionally required vascular suturing, and 5 (10%) that required reconstruction of the internal carotid artery. Carotid vessel repair was performed by shortening the internal carotid artery in 3 cases (6%), using a saphenous vein graft in 2 cases (4%), and by creating an anastomosis between the external carotid artery and the distal portion of the internal carotid artery in one case (2%). RESULTS: In 40 cases (82%), the course of treatment was uneventful. Three patients (6%) were reoperated because of symptoms of cerebral stroke. Palsy of the hypoglossal nerve occurred in 3 cases (6%), and facial nerve palsy in 2 patients (4%). Six patients (12%) developed postoperative hematomas in the wound. In all the cases, histopathological examinations confirmed carotid paraganglioma. CONCLUSIONS: Cooperation with an otolaryngologist and vascular surgeon during surgery is recommended due to frequent damage to carotid vessels by carotid paragangliomas. Detection of the tumor in the early stages improves surgical treatment outcomes and reduces the number of complications. Regular postoperative check-ups are necessary due to possible occurrences of multiple tumors.