The venous system of the human foetal spinal cord. Scanning electron microscope of vascular corrosion casts.

The investigation was carried out on 16 human foetal cadavers at the age of 17-23 weeks from the time of conception. The foetal vascular system was injected with the synthetic resin MERCOX CL-2R and analysed in scanning electron microscope.The vascular system of the foetal spinal cord was studied. The foetal vascular system was characterised by high variability concerning the number, course and localisation of blood vessels. It contained numerous anastomoses with the internal spinal venous plexuses, which included anterior and posterior radicular veins. Large arteries running on the surface of the spinal cord are accompanied by the homoname veins. The venous system of the investigated foetuses was divided into 2 categories of veins: internal veins responsible for the drainage of blood from the central area, that is central and peripheral veins coming radially to the surface of the spinal cord and external veins, which form the venous system of the surface of the spinal cord. The venous system of the foetal spinal cord was also examined as to the presence of the valves.

Transnasal endoscopic treatment of cerebrospinal fluid leaks: 10 years' experience.

The endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine procedure. This study describes the endoscopic closure of CSF leaks in a large series (36 patients) at the Jagiellonian University over 10 years (1999 to 2009). We describe the aetiology, defect location, graft material, presence of encephalocele, history of meningitis, intracranial pressure, recurrence, and follow-up. In our studies the aetiology of CSF leak was spontaneous in 4 cases, traumatic in 9, and iatrogenic in 23. The defect was most commonly located near the ethmoid and sphenoid bones. Our initial success rate after transnasal endoscopic treatment was 88.9% (32/36). However, the overall success rate of 97.2% (35/36) and the low morbidity in this series support the endoscopic approach as the standard of care for CSF leak closure. Follow-up ranged from 3 months to 5 years. Importantly, this high success rate can be achieved without the use of intrathecal fluorescein or a lumbar drain.

A case of respiratory epithelial adenomatoid hamartoma of the sinonasal tract.

Respiratory epithelial adenomatoid hamartoma is a rare, non-neoplastic tumour characterised by an abnormal mixture of tissues that are indigenous to the region. REAH are shiny, polypoid, exophytic masses with a rubbery to firm texture. They may arise and co-exist in the setting of inflammatory polyps. We present a case of a 49-year-old patient who was referred to the department with a clinical diagnosis of chronic nasal sinusitis. Results of post-op histopathological examination show a mild change of the respiratory epithelium requiring, among others, differentiation from inverted papilloma and adenoid carcinoma.

The structure of acquired aural cholesteatoma as revealed by scanning electron microscopy.

The structural features of cells, their surfaces and the extracellular matrix were investigated in acquired aural cholesteatoma. Cholesteatomas surgically removed from 30 patients were examined by a scanning electron microscope (SEM). The predominant part of a cholesteatoma was composed of stratified squamous epithelium, showing extensive chaotic desquamation. The surface sculpture of the keratinocytes and corneocytes varied from parallel ridges, irregular microplicae and mirovilli, to flat grooves and pits and a completely smooth surface. Sheetlike lamellar structures, probably representing an intercellular lipid-forming permeability barrier, were also observed. Small crystals located in the perimatrix were observed in one case. According to the SEM observations, cholesteatoma epithelium is characterised by abnormal and uncoordinated keratinisation, with a predominance of the advanced stages of the process.

Sphenoid sinus pyocele with intracranial extension managed under endoscopic guidance: a report of an extremely rare case.

OBJECTIVES: Sphenoid pyoceles with intracranial extension are extremely rare lesions that can mimic tumours and usually cause ophthalmological symptoms. Their infectious nature mandates urgent surgical decompression since pyoceles can cause intracranial and orbital complications. CASE REPORT: A 16-year-old male presented with intense headache and dizziness lasting three days. On admission, the patient gave a five-year history of chronic rhinitis, nasal congestion, and progressively worsening headaches. Ophthalmological examination was normal. CT and MR scans disclosed distension of the sphenoid sinus by a pyocele 55 mm in diameter, extending to the presellar region through the eroded cribriform plate. The patient underwent an endoscopic transnasal sphenoethmoidectomy. After surgery he reported improvement in all preoperative symptoms and was asymptomatic at 3-months follow-up. CONCLUSIONS: A huge sphenoid sinus pyocele with intracranial extension may cause no ophthalmological symptoms. It can be safely managed using endoscopic techniques.

Profile of laryngological abnormalities in patients with amyotrophic lateral sclerosis.

Few studies have described laryngological evaluation of patients with amyotrophic lateral sclerosis. We assessed the laryngological abnormalities of 35 such patients (24 bulbar onset and 11 limb onset). In nine limb onset patients, we discovered signs of early vagal nerve dysfunction, prior to any clinical presentation of bulbar failure. However, in all bulbar onset patients studied, we noticed changes in the uni/bilateral position of the vocal folds and in the voice quality.

Metallothionein stroma reaction in tumor adjacent healthy tissue in head and neck squamous cell carcinoma and breast adenocarcinoma.

INTRODUCTION: An accumulation of genetic alterations forming the field of cancerization is an important event for the transformation from normal to cancer cell in multistep carcinogenesis. Histopathologically healthy tumor adjacent tissue might be considered as a cancerization field which is typified by genetic changes required for the development of cancer. Metallothionein (MT) is considered to be a protective and anti-apoptotic protein. The aim of our study was to evaluate the MT expression in head and neck squamous cells carcinoma and breast adenocarcinoma and their histologically healthy adjacent tissue. MATERIALS AND METHODS: We have sampled 29 tissue samples in total derived from head and neck cancers and 29 samples of their clear surgical margins, 33 breast adenocarcinomas and 33 clear surgical margins. Antibody recognizing MT-1 was used for immunohistochemical analysis. RESULTS: MT expression was revealed in 85,7% of head and neck cancers and 94% of breast adenocarcinomas. It was found in all tumor adjacent tissue. MT expression was statistically significantly higher in tumor adjacent tissue than in cancer tissue in cases with the presence of lymph node metastases in both, breast adenocarcinoma and head and neck squamous cell carcinoma. Generally stroma seems to respond to the presence of cancer by the expression of MT, even in tissues which normally do not express MT. CONCLUSIONS: MT might be a normal or protective reaction of healthy adjacent tissue to the presence of tumor.

Endoscopic removal of air gun pellet in the sphenoid sinus.

THE OBJECTIVE: The presence of an isolated foreign body in the sphenoid sinus is a rare finding, and a retained projectile in this sinus is even more uncommon. CASE REPORT: The authors report the case of a 15-year-old male that was shot in the face with an air gun but was nevertheless able to seek for medical help. The anatomical considerations of the gunshot injury are made, and radiological assessment of the foreign body is presented. THE RESULT AND CONCLUSION: The projectile could be successfully removed with an endoscopic technique, no short or long term sequelae occurred.

Surface structures of aural polyps: a scanning electron microscopic study.

Surfaces of aural polyps collected from 30 patients were examined by scanning electron microscopy. In the polyps not associated with cholesteatoma, the epithelial lining showed individually variable metaplasia towards cuboidal 'cobblestone'-type and squamous epithelium covered with microvilli of various shapes and sizes. Squamous epithelium was present on the surface of all polyps with underlying cholesteatoma, with superficial cells possessing elongated microvilli, microplicae of different sizes, grooves and pits. Such surface structures reflect different stages of the keratinization process that seems to be characteristic for the epithelial lining of polyps with underlying cholesteatoma. Incomplete epithelium accompanied by granulation tissue was found in several polyps; in two cholesteatoma-associated polyps plate-like cholesterol crystals were observed.

Evaluation of cervical lymph node metastasis of 1400 patients with cancer of the larynx.

OBJECTIVE: The main goal of the paper was to evaluate the results of surgical treatment of patients with laryngeal carcinoma, among whom cervical lymph node metastases were observed. The results of treatment were assessed after prior analysis of the following factors localization of laryngeal carcinoma, local and regional advancement, number of lymph nodes affected by metastases, the incidence of 'occult metastases', the presence of metastases in the pre-laryngeal node, the regions of the neck which were most frequently affected by metastases and supplementary irradiation treatment. METHODS: An analysis of a group of 1400 patients who underwent surgery for laryngeal carcinoma in the period 1948-1992, was carried out. In all of the cases, a partial or total laryngectomy accompanied by a unilateral or bilateral surgery of the cervical lymph node system was performed. The results of the above treatment were assessed over a 5-year survival period. RESULTS: In patients among whom metastases to the lymph nodes were observed, it is the following factors that exert an influence on survival chances: supraglottic and glottic localization of the tumor, an increase of regional and organ advancement of the tumor, number of lymph nodes affected by metastases, the presence of metastases in the 'pre-laryngeal' node and the level of the neck affected by metastases. CONCLUSION: The incidence of metastases in regional lymph nodes is a prognostic factor in the treatment of patients suffering from laryngeal carcinoma.

[Video-roentgen cinematographic evaluation of pharyngeal phase disorders during swallowing in patients after partial laryngectomy due to localized supraglottic cancer]. / Wideorentgenokinematograficzna ocena zaburzen fazy gardlowej aktu polykania u chorych po operacjach czesciowego usuniecia krtani z powodu raka o lokalizacji nadglosniowej.

Videorentgenocinematographic examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of videorentgenocinematographic examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

Morphological and clinical characteristics of antrochoanal polyps: comparison with chronic inflammation-associated polyps of the maxillary sinus.

OBJECTIVES: to compare morphological and clinical features of antrochoanal polyps and chronic inflammation-associated polyps of the maxillary sinus. STUDY DESIGN: histological and scanning electron microscopic examination of ten antrochoanal polyps and ten chronic inflammation-associated polyps of the maxillary sinus; comparison of clinical data in both groups of patients. METHODS: following surgical removal, the polyps were halved, the halves being processed for routine light microscopy (formalin fixation, paraffin embedding, HE staining) and scanning electron microscopy (formaldehyde/glutaraldehyde fixation, critical point drying, gold coating), respectively. Clinical data were retrospectively reviewed, tabulated and compared. RESULTS: the antrochoanal polyps differed from chronic inflammation-associated polyps of the maxillary sinus only in a few minor features; slightly longer duration of the process, lower incidence of maxillary ostial obstruction, higher incidence of frequent headaches, persistent nasal obstruction, presence of cysts in the polyp stroma, thickened basement membrane, lower incidence of squamous cell metaplasia, and higher proportion of migratory cells in nasal smears. In two cases, allergy was diagnosed but it seemed not to influence the polyps, which did not show morphological features typical of allergy-associated (eosinophilic) polyps. CONCLUSIONS: In spite of minor differences, antrochoanal polyps can be regarded as chronic inflammation-associated polyps with cystic origin and peculiar localization.

[Objective evaluation of the influence of the tongue base reconstruction on the swallowing disorders]. / Obiektywna ocena wplywu rekonstrukcji nasady jezyka na zaburzenia aktu polykania.

Laryngographic, manometric and videorentgenocinematographic examinations of swallowing were conducted on 54 patients after partial laryngectomy and on 35 subjects being a control group. Resection of a part of the base of the tongue is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of manometric and videorentgenocinematographic examinations indicate that the shape and mobility of the tongue has the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Both manometric and videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a graft of angio-pedunculated submandibular gland. The study of effectiveness of glottis or neoglottis performed with the use of laryngograph showed no relation between glottis/neoglottis occlusion effectiveness index and intensified swallowing disorders. This shows the lack of compensating option in swallowing disorders with the help of a mechanism based on an efficient glottis or neoglottis occlusion alone.

[Drug allergy among patients suffering from nasal polyps]. / Alergia na leki wsród chorych z polipami nosowymi.

The study was performed in order to evaluate quantity and morphology of nasal polyps in patients with diagnosed drug allergy to aspirin, antibiotics, polocain, procain and other drugs. The study included 60 patients (27 females, 33 males aged between 18-69 years). Nasal polyp morphology was examined under electron microscope and light microscope. Morphological evaluation of epithelial and subepithelial structures was done under light microscope, taking not of inflammatory infiltration type, basal membrane, as well as degree of intestinal edema. Evaluation of epithelial cell type, their relative proportion, as well as area percentage covered by cilium, microvilli and squamous epithelium was done under electron microscope. Polyps in patients with idiosyncrasy to polish aspirin and sodium metamizole (12 patients) featured increased eosinophilic infiltration, thickened basal membrane, with elevated eosinophil percentage differential count. The epithelial percentage area was covered by squamous cells without villi. Polyps associated with idiosyncrasy to polish aspirin differed morphology compared to polyps originality from patients allergic to other medications. On the other hand polyps from patients allergic to other drugs, such as: penicillin, procainamide were morphologically (electron light microscope, light microscope) similar to those polyps caused by inflammatory factors.

[Objective evaluation of the influence of the hyoid bone resection on the disorders in the act of swallowing]. / Obiektywna ocena wplywu resekcji kosci gnykowej na zaburzenia aktu polykania.

Laryngographic, manometric and videorentgenocinematographic examinations of swallowing were conducted on 49 patients after partial laryngectomy and on 35 subjects being a control group. The results of examinations indicate that the mobility of remaining after the surgery parts of the larynx have the great influence on the efficient swallowing. The larynx mobility is closely related to the remaining of the hyoid bone. Resection of the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The study of effectiveness of glottis or neoglottis performed with the use of laryngograph showed no relation between glottis/neoglottis occlusion effectiveness index and intensified swallowing disorders. This shows the lack of compensating option in swallowing disorders with the help of an mechanism based on an efficient glottis or neoglottis occlusion alone.

[Manometric analysis of the oral and pharyngeal phases of the act of swallowing]. / Badania manometryczne fazy ustnej i gardlowej aktu polykania.

Manometric analysis of swallowing was conducted on 35 subjects, aged 44 to 60. The course of physiological changes in pressure during oral and pharyngeal phase of swallowing was analysed. To objectify the evaluation of analysed phenomena, parameters that include both pressure values inside pharynx and oesophagus and time dependences connected with changes in their value were used as proposed by the authors of this paper and as applied by other authors involved with these issues.

[Myoepitheliomas of the palate]. / Gruczolak z komórek mioepitelialnych podniebienia.

The authors present a case of myoepithelioma of the palate. Frequency, treatment and pathologic diagnosis of the disease are discussed. A Polish name of the disease is suggested.

[Videorentgenocinematographic analysis of pharyngeal phase in the act of swallowing]. / Badania wideorentgenokinematograficzne fazy gardlowej aktu polykania.

The course of the pharyngeal phase was analysed in physiological conditions. The mobility of anatomical structures taking part in the phase was evaluated, taking into consideration the time sequence in which the elements of the phase followed. To objectify the evaluation of the analysed phenomena, authors of this paper proposed and used linear and time parameters also used by other authors involved with these issues.

Maxillary sinus polyps secondary to dental extraction.

Polyps of the maxillary sinus were obtained from six patients who had reported upper tooth extraction with oroantral perforation prior to the development of symptoms, from 11 patients with chronic sinusitis, and from 12 patients with allergy. Histopathological features, scanning electron microscopy of the polyp epithelium and clinical data were compared in those groups of patients. The post-traumatic polyps differed from those of other aetiologies by showing the presence of granulomas, less numerous inflammatory cells with very few eosinophils, nearly normal surface epithelium (smaller surface area occupied by nonciliated epithelium, absence of epithelial squamous cells, normal frequence of goblet cells), rapid appearance of symptoms, and shorter duration of the disease. It seems that the specific characteristics of the injury-induced polyps results from a different mechanism of their formation, involving primarily abnormal mucosal repair and to a lesser extent an inflammatory process.