[Quality of life, depression and anxiety symptoms in patients with chronic rhinosinusitis with polyps treated by endoscopic sinus surgery]. / Jakosc zycia oraz objawy depresyjne i lekowe u chorych leczonych metoda endoskopowa z powodu przewleklego zapalenia blony sluzowej nosa i zatok z polipami.

UNLABELLED: Chronic somatic diseases, including chronic rhinusitis, often correlate with symptoms of depression, anxiety and with quality of life deterioration. The aim of the study was to evaluate depression and anxiety symptoms, as well as quality of life of patient with chronic rhinosinusitis before and after surgery. MATERIAL AND METHODS: The group of 20 patients was included into the study. Patients were examined twice: before and 6 months after surgery. Depression and anxiety were assessed by the means of Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Quality of life was assessed by the means of WHOQOL-100 questionnaire. Intensity of somatic symptoms was measured with VAS scale. RESULTS: Before surgery patients demonstrated frequent symptoms of depression and anxiety. Depression and anxiety intensity correlated significantly with somatic symptoms measured with VAS scale. After surgery depression and anxiety rates decreased, BDI and HADS scores significantly decreased as well. Quality of life in WHOQOL-100 scale significantly improved. CONCLUSIONS: Chronic rhinosinusitis coexists with symptoms of anxiety and mild depression. Proper surgical treatment and somatic state amelioration are related with mental state and quality of life improvement.

[Cathepsin D activity in chronic rhinosinusitis with nasal polyps]. / Ocena aktywnosci katepsyny D w blonie sluzowej pacjentów z przewleklym zapaleniem zatok przynosowych z polipami.

UNLABELLED: Nasal polyposis affects about 1 to 4% of the population. Polyps develop in oedematous and inflammated mucous membrane. In spite of the intensive research the pathomechanism of their development is not fully understood. The majority of the theories concerning the development of nasal polyps emphasize the role of the inflammatory process causing the rupture of the epithelium and the basal membrane. Cathepsin D is one of important mediators of inflammatory processes, that may be involved in the pathogenesis of nasal polyposis. THE AIM OF THE STUDY: was to establish the role of the cathepsin D in the pathogenesis of nasal polyps. MATHERIAL AND METHOD: Tissues were taken from 39 patients treated with endoscopic sinus surgery due to chronic rhinosinusitis with polyps. The activity of the cathepsin D was assesed with spectrofotometric method using the specific inhibitor (pepstatin) in tissue of nasal polyps, in oedematous and the inflammated mucous membrane of the nasal conchae and the samples of mucous membrane taken from the nasal septum. RESULTS: Statistically significant difference in cathepsin D activity between polypoid tissue, inflammated mucosa and the mucous membrane of the nasal septum was detected (t-student test, p < 0.05). No difference in the activity of this enzyme was observed between the polypoid tissue and the inflammated mucosa. CONCLUSION: Increased activity of the cathepsin D in nasal polyps and inflammatory changed mucosa confirm the important role of the cathepsin D in inflammatory processes leading to damage and subsequent remodeling of mucous membrane. We believe that further research on the activity of other proteolytic enzymes is necessary to demonstrate the differences between the inflammable changed mucous membrane and nasal polyps.

[Fungal infections of the paranasal sinuses treated by endoscopic sinus surgery in material of Otolaryngology Department of Medical University in Bialystok]. / Grzybice zatok przynosowych leczone metoda endoskopowa w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Bialymstoku.

Over the last years we have observed a high frequency of fungal infections of the paranasal sinuses. Fungal infections can be grouped into invasive and non-invasive forms. Surgical removal of the sinus fungal masses to ensure drainage and aeration is performed using the endoscopic sinus surgery. General or local antifungal drugs are not indicated in the cases of non-invasive forms. For the treatment of invasive fungal sinusitis aggressive antifungal therapy and surgical treatment are the mainstays of management. The treatment results of 18 patients suffering from fungal infections of the paranasal sinuses operated endoscopically during 4 years period (2006-2009) in Otolaryngology Department of Medical University in Bialystok were presented.

[The influence of endoscopic treatment of isolated, small inflammatory lesions of sphenoid sinus on headache sensation]. / Wplyw leczenia endoskopowego niewielkich, izolowanych zmian zapalnych zatoki klinowej na dolegliwosci bólowe glowy.

UNLABELLED: One of the most frequent complaint in patients with isolated sphenoiditis is headache. In large proportion of these patients no pathologic findings are revealed in sphenoethmoidal recess endoscopicaly thus discrimination between sinus originated and primary headache in such cases may be especially difficult. THE AIM OF THIS STUDY: Was the assessment of the influence of endoscopic treatment of isolated, small inflammatory sphenoid sinus lesions on headache sensation. MATERIAL AND METHOD: 13 patients suffering from headache, with CT-diagnosed isolated, small inflammatory lesions of sphenoid sinus such as mucosal thickening, polypoid tissue and cysts were treated endoscopicaly. Headache was assessed on the basis of five-grade scale before surgery, 1 month after surgery and after the observation period that varied between 5 to 40 months. RESULTS: In the first postoperative month the improvement in their headache was declared by 84.6% of patients, but after longer observation the success rate lowered to 61.5%. The improvement was observed both in patient whose the only complaint was headache and in patients with negative endoscopic findings. CONCLUSIONS: Small isolated sphenoid sinus lesions constitute a group of specific pathologies of paranasal sinuses, which is still difficult to diagnose despite of technological advancement. The treatment of these lesions remains controversial. Decision as to operative treatment should be taken cautiously since headache in great proportion of these patient is not sinus originated. Further multicenter studies on the basis of larger group of patients are necessary to delineate the indications for surgical intervention in patients with small isolated inflammatory sphenoid sinus lesions.

[Assessment of olfactory disturbances in the patients with rhinosinusitis and polypi nasi treated by endoscopic sinus surgery]. / Ocena zaburzen wechu u pacjentów operowanych metoda endoskopowa z powodu przewleklego, zapalenia blony sluzowej nosa i zatok z polipami.

UNLABELLED: One of the most common symptoms of chronic rhinosinusitis with polyps is smell deterioration. Polypectomy and mechanical restoration of patency of the nose not always and not to the same degree leads to the sense of smell improvement. THE AIM OF STUDY was to assess the sense of smell and nasal patency in patients with chronic rhinosinusitis with polyps treated endoscopically during the healing period and the process of functional normalization of the nasal mucosa. MATERIAL AND METHODS: 30 patients suffering from chronic rhinosinusitis with polyps treated endoscopically were included in the study. Nasal resistance (anterior rhinomanometry), smell (smell threshold and identification tests) and rhinoscopic findings were assessed and analyzed 1, 3, 6 and 12 months postoperatively. RESULTS: The most conspicuous decrease of mean nasal resistance was observed in the first control examination (1 month postoperatively) and then further slight improvement continued until sixth postoperative month. Restoration of the patency of the nose yielded only inconsiderable improvement of smell in first postoperative month. Significant improvement of smell could be detected as late as in third and sixth month after the operation. In the twelfth postoperative month slight deterioration of the mean results of smell and nasal patency tests was noted. At the same time control endoscopic examination revealed recurrent polyposis in 26.6% of patients whereas the improvement in mean smell test result in comparison to preoperative results was observed in over 66.6% of patients. CONCLUSIONS: The smell improvement in patients with rhinosinusitis with polyps after endoscopic surgery occurs later than the nasal patency improvement what may be attributed to the process of healing and functional normalization of the nasal mucosa. On average after a year in some patients first clinical symptoms of recurrent disease emerges. Taking in to the consideration chronic and complex nature of the disease it seems reasonable to assess nasal resistance and smell during longer follow up period.

[Mold fungi and the role of allergy on fungi in chronic rhinosinusitis]. / Grzyby plesniowe i rola alergii na grzyby w przewleklym zapaleniu blony sluzowej nosa i zatok przynosowych.

AIM: The aim of this work was to assessment the role of mould fungi and the allergy on fungi in chronic rhinosinusitis. MATERIAL AND METHODS: We studied 30 patients with chronic rhinosinusitis with or without polyposis who underwent endoscopic nose and sinuses procedures. Clinical and immunological workup was performed for atopy in all patients. We performed CT of the sinuses, skin-prick testing on 15 fungal allergens, total IgE and fungal-specific IgE levels, eosinophilia level. Specimens were sent for mycology and histopathologic analysis for identification of fungi. RESULTS: Fungal culture from sinuses were negative in all patients. Bacterial culture were positive in 19 cases. There was observed elevated total immunoglobulin E level in 70% of patients. Positive skin test reactivity for fungal allergen was observed in 7 patients--3 for Aspergillus, 2 for Alternaria and 2 for Cladosporium. Fungal specific IgE levels were below 0.35 KU/L in all patients. Nasal polyps were found in 26 patients, they were associated with asthma and aspirin intollerance. No fungal hyphae were found in histopathologic analysis. CONCLUSIONS: Our preliminary study suggest, that allergy for fungi doesn't play a significant role in etiology and pathogenesis of the chronic rhinosinusitis with or without polyps. We did't find any case of the allergic fungal sinusitis in our patients.

[B-cell lymphoma of the nose cavity--case report]. / Rzadki przebieg chloniaka z komórek B jamy nosowej--opis przypadku.

INTRODUCTION: Non-Hodgkin's lymphoma of the nose and sinuses accounts for 5,8-8% of the tumors in that localisation. Large B-cell lymphoma (DLBCL) are frequent in mediastinum, nasopharynx, stomach and retroperitoneal space. On rare occasions it presents with extracutaneous dissemination. AIM: The aim of the study was to show a case of the female patient presented DLBCL-lymphoma of the right nose cavity and cutaneous lymphoma of the right lower leg. MATERIAL AND METHODS: We described a case of the 68-year-old female diagnosed in Otolaryngology Clinic of the Medical University in Bialystok with DLBCL-lymphoma of the right nose cavity. Immunochemotherapy (4 courses of R-CHOP) and radiotherapy were given with full remission of the tumor. One month later two tumors on the skin of the right lower leg was appeared (histological: DLBCL-lymphoma). Now the patient is during chemotherapy. CONCLUSIONS: We present the case of the rare occurrence of a DLBCL-lymphoma of the nose cavity and the skin of the lower leg. Chemotherapy, immunochemotherapy and radiotherapy are suitable treatment fort that type of lymphoma.

[Endoscopic dacryocystorhinostomy in patients with postsaccal stenosis of lacrimal duct]. / Endoskopowa dacryocystorhinostomia u pacjentów z pozaworeczkowym typem niedroznosci dróg lzowych.

UNLABELLED: Dynamic development of the endoscopic treatment of the lacrimal duct obstruction has been observed for the last 20 years. Various causes of the tear outflow disorders, different levels of lacrlmal duct blockage may require different surgical approach and sometimes additional modern equipment. THE AIM of the study was to present the results of treatment of possibly uniform group of patients with lacrimal duct obstruction in whom the same method of endoscopic surgery was applied. MATERIAL AND METHOD: 16 patients with postsuccal level of obstruction were qualified for the study. All of them were treated endoscopically with mucosal flap formation. Patients in whom synechiae in the upper part of the sac or at the orifice of common canalicullus were found during the procedure were excluded from the study, as well as the patients with Wagener's granulomatosis and posttraumatic form of lacrimal obstruction. RESULTS: Release of epiphora and proper patency of lacrimal system corroborated by irrigation test was achieved in 14 (87,5%) patients of the studied group. In 2 (12,5%) patients recurrence of symptoms was observed. In both cases too small osteotomy and lack of surgical technique precision were the cause of failure. No major complications in the studied group were observed. CONCLUSIONS: Endoscopic dcryocystorhinostomy Is low traumatic and effective procedure of surgical treatment of lacrimal duct obstruction. The success is determined by high precision of surgical technique.

[Actinomycosis of sinus maxillaris--case report]. / Aktinomykoza zatoki szczekowej--opis przypadku.

The authors present the case of primary actinomycosis of maxillary sinus. The frequency of the disease, differential diagnosis and treatment we present.

[Progression of larynx and hypopharynx cancer in the last ten years]. / Zaawansowanie raka krtani i gardla dolnego w ostatnim dziesiecioleciu.

Epidemiological analysis of patients with the larynx and hypopharynx cancer, who were treated in the Department of Otolaryngology in Bialystok from 1999 to 2004 was performed. The following aspect were assessed: (1) number of patients, (2) sex, (3) profession and place of living, (4) primary site of the tumour, (5) clinical advancement stage of the disease. The study was of 676 patients. The majority--92.2%--were males but an increase in number of female patients was found. The most common site of the primary tumour was the supraglottic region (56.9%). The analysis showed that the numbers of patients with T3/T4 clinical advancement stage of the tumour was larger (64.9%).

[Cystic fibrosis (CF) of adults--current problem of laryngologists. The role of genetic research]. / Mukowiscydoza (CF) doroslych--aktualny problem laryngologów. Rola badan genetycznych.

INTRODUCTION: The goal of this work is to evaluate DNA in the direction of gene mutation in the patients with nasal polyps and/or recurring inflammation of the sinuses, and who tested negative for allergic basis of those ailments. MATERIAL AND METHODS: 50 patients aged 20-45 have been included in the research by the University Hospital and the Laryngological Outpatient Clinic SPSK in Bialystok. The patients had symptoms of nasal polyps and recurring inflammation of the sinuses. The analysis of DNA samples of the blood according to the PCR method using the ABI Prism 3100 device and testing for finding mutations of cystic fibrosis--The Cystic Fibrosis Assay. RESULTS: We discovered 1 mutation of delta F508 in a 40-year-old patient, with recurring inflammation of nasal sinuses (described in the case of this patient). CONCLUSIONS: The DNA research method can be used for discovering atypical forms of CF in patients with recurring symptoms of the inflammation of the sinuses and nasal polyps, and who tested negative for allergic basis of those ailments. A wide routine screening in the direction of the mutation of CF may lead to an explanation the reason of the nasal polyps and inflammation of the sinuses.

[Assessment of the hearing organ in the patients with allergic perennial and seasonal allergic rhinitis]. / Ocena narzadu sluchu u pacjentów z alergicznym calorocznym i sezonowym niezytem nosa.

We studied 60 patients with allergic rhinitis (30 with seasonal and 30 with perennial rhinitis). Assessment of atopic status was based on medical history, physical examination, skin-prick testing, total IgE levels and nasal smears. Audiometry and tympanometry have been performed. Audiometric conductive hearing loss was found in 26.7% patients with perennial rhinitis and in 10% patients with seasonal rhinitis. Type B tympanogram were found in 20% of the patients with perennial rhinitis and in 3.33% of the patients with seasonal rhinitis. Type C tympanogram were found in 20% of the patients with perennial and in 6.67% with seasonal rhinitis. Secretory otitis media and retraction pockets were more common in patients with perennial rhinitis allergy. Local allergic reaction in the middle ear and dysfunction of the Eustachian tube can be the most responsible for these disorders. Tympanostomy and ventilation tubes were needed in secretory otitis and myringoplasty in the cases of the retraction pockets. Appropriate treatment of allergic rhinitis may decrease the need and frequency of surgical procedures and may reduce costs associated with hospitalization.

[Some aspects of pharmacotherapy of tinnitus. Compound therapy with Xylocaine and directive counseling--long-term results]. / Niektóre aspekty farmakoterapii szumów usznych. Skojarzone leczenie ksylokaina i directive counseling--wyniki odlegle.

29 out of 49 patients, who were treated in 1996-1998 with Xylocaine and directive counselling for their tinitus, were reevaluated. Non of the patients used any other pharmacological treatment of the tinnitus or underwent full tinnitus retraining therapy (TRT) since 10-days treatment with Xylocaine had been completed. Initially 65.3% of patients declared improvement in their tinnitus. After over 5 years of observation success rate decreased to only 41.3%. Since the positive effect of 10-days treatment with Xylocaine and directive counselling was not stable we concluded that tinnitus patients should receive full TRT.

Occurrence of components of fibrinolytic pathways in situ in laryngeal cancer.

Malignancy is characterized by the occurrence of components of coagulation reaction pathways in situ within tumor tissues detectable immunohistochemically. However, tumors vary in the details of this coagulation-cancer interaction. We have previously described tumor cell-associated tissue factor (TF), factor (F) VII, and F X in laryngeal carcinoma tissues. Fibrinogen and F XIIIa were found in the tumor connective tissue. Tissue factor pathway inhibitor (TFPI) occurred in the tumor connective tissue and on microvascular endothelial cells and normal squamous epithelial cells but not in the tumor cells. Fibrin (thrombin-cleaved fibrinogen) existed at the host-tumor interface and the margins of tumor nodules consistent with an active tumor cell-associated clotting pathway in this tumor type. Studies were extended here to detect components of fibrinolytic pathways. Plasminogen and tissue plasminogen activator (t-PA) were detected on laryngeal tumor cells, particularly in more well-differentiated cases. Low-molecular-weight urokinase plasminogen activator (LMW u-PA) was primarily a feature of more undifferentiated laryngeal carcinoma cells. Staining to a lesser extent was found for high-molecular-weight u-PA (HMW u-PA) on tumor cells and various normal cell types in the tumor tissue. Relatively weak and variable tumor cell staining was found for plasminogen activator inhibitors (PAI) 1, 2, and 3. Trace staining was found for u-PA receptor (u-PAR) in differentiated tumor cells. The significance of coagulation and fibrinolytic pathways present in situ to the economy of laryngeal carcinoma remains to be determined.

[Hearing loss in patients with diabetes mellitus type II]. / Zaburzenia sluchu u chorych na cukrzyce 2 typu.

Hearing threshold of 40 patients with diabetes mellitus type 2 and 20 healthy controls were determined using pure tone audiometry of frequencies 500, 1000, 2000, 4000, 6000 and 8000 Hz and evoked otoacoustic emissions (EOAEs). The hypoacusis was bilateral, progressive and neurosensory nature, affecting the higher frequencies. Subjects with diabetes type 2 were more likely to have a hearing loss than were subjects without diabetes (95% vs 65%). This difference was statistically significant. Hearing loss was significantly correlated with age and duration of diabetes. Evoked otoacoustic emissions found out only in 2 patients with normal hearing. The results suggest that EOAEs doesn't show subclinical cochlear damage in diabetic patients because of the significant hearing loss.