[Deafness and mentality in Francisco Goya's paintings]. / Gluchota a psychika w malarstwie Franciszka Goi.

The famous painter Francisco Goya y Lucientes (1746-1828) suffered during his life one or several diseases, the nature of which has not been determined with certainty. At age of 46, Goya suffered from severe illness that lasted a few months. It caused loss of vision and hearing, tinnitus, dizziness, a right-sides paralysis, weakness and general malaise. Although he recovered from a cerebral stroke which accompanied it, the deafness remained unaltered. The illness divides Goya's artistic life into two great different periods. After in the painter produces his greatest works. The visual experience after the illness was heightened by the exclusion of acoustics stimuli and the artist's talent rose to the highest level. His character became more withdrawn and introspective and his entire vitality was direscted to his painting. Goya's painting became progressively more gloom and satirical during his long convalescence. The artist suffered a stroke at age 73 that again rendered him paralysed on the right side. The precise cause of his illness has long been debated. Ome medical writers have favored the diagnosis of syphilis, some consider the possibility of an exogenous psychosis, and other suggests that the symptoms of the illness are more congruent with heavy metal poisoning, particulary lead. It is interesting to speculate how the Goya's deafness influenced the artist's mentality and the changes of his painting. Interesting is also the problem of the sensory compensation in fact of disturbance of physiological function of one of the senses.

[Joseph Toynbee--otologist, scientist, philanthropist]. / Joseph Toynbee--otolog, naukowiec, filantrop.

Joseph Tonbee's life's work may be summarized in the words of William Wilde: "The labours and investigations of Mr. Toynbee have affected more for aural pathology than those of all his predecessors either in England or on the continent". Some idea of the extent of his researches is given by the fact that he dissected some 2.000 ears. These preparations formed the Toynbee Collection in the Museum of the Royal College of Surgeons of England. He wrote the results of his researches in a catalogue that includes the description of 1,659 human ears. This catalogue forms the basis of modern otology for all time. This purely pathological catalogue was completed in 1860 with the publication of a more clinical book, "The Diseases of the Ear: their Nature, Diagnosis and Treatment". Toynbee appears to have been the first to describe the pathological changes in otosclerosis. In his book "Diseases of the Ear" he described the condition clearly, recognizing "anchylosis of the stapes to the fenestra ovalis" in 136 temporal bones. He also aligned the subjective, visual and ausculatory tests for Eustacchian tubal patency which we use today. Adam Politzer wrote: "Toynbee was the first who realized in otology that therapeutic progress depends on the knowledge of anatomy". But Toynbee was also active on other fields. Politzer, in his lecture in Vienna in 1914 said: "Toynbee was as outstanding a savant as he was a philanthropist. In addition to his scientific activity, he considered it a sacred task to dedicate his spare time to the improvement of living and health conditions of the poorer classes." Tragic enough, Toynbee's zeal for clinical experimentation went too far. Seeking to help his patients by devising a treatment to allay their tinnitus, he conceived the idea of introducing a mixture of chloroform and prussic acid into the tympanic cavity by means of Valsalva maneuver. When he made the first trial on July 7, 1866, with himself as a subject, he was found dead on the couch in his consulting room.

[Science and life--the history of Marquis Alfonso Corti]. / Nauka a zycie--historia markiza Alfonso Cortiego.

Alfonso Corti was born at Gambarana, near Pavia in 1822. A famous friend of Corti's father, Antonio Scarpa, may have kindled his boyhood interest in anatomy and medicine. As a medical student he enrolled first at the University of Pavia. Corti's favorite study there was microanatomy with Bartolomeo Panizza and Mario Rusconi. In 1845, against paternal wishes, Corti moved to Vienna to complete his medical studies and to work in the anatomical institute of Joseph Hirtl. There he received the degree in medicine in 1847 under the supervision of professor Hyrtl, with a thesis on the bloodstream system of a reptile. He was then appointed by Hyrtl to be his Second Prosector. With the outbreak of the 1848 Revolution he left Vienna, and after brief military service in Italy made visits to eminent scientist in Bern, London and Paris. By the beginning of 1850 Corti had received the invitation of the anatomist Albert Kölliker and had moved to Würzburg, where he made friends with Virchow. At the Kölliker Laboratory he began to work on the mammalian auditory system. A short time Corti spent in Utrecht, where he visited Professors Schroeder van der Kolk and Pieter Harting. In Utrecht Corti learned to use methods to preserve several preparations of the cochlea. From Utrecht he returned to Würzburg to complete his study of at least 200 cochlea's' of man and different animals. His famous paper: "Recherches sur l'organe de l'ouïe des mammiferes" appeared in 1851 in Kölliker's journal "Zeitschrift für wissenschaftliche Zoologie". In the same year, after death of his father, he inherited father's title Marchese de San Stefano Belbo and estate and moved back to Italy. In 1855 Corti married the daughter from a neighboring estate, Maria Bettinzoli. His young wife presented him with a daughter Bianca, and a son Gaspare, but in 1861 she died, leaving him with the responsibility of rearing the children. Unfortunately he was gradually developing arthritis deformans. Corti's last 15 years were further darkened by the inexorable progress of his crippling illness. In 1876, on the second of October, he died at Corvino San Quirico.

[The tempestuous history of middle ear operation]. / Burzliwa historia operacji ucha srodkowego.

The paper is a review of primary and secondary historical and scientific literature concerning the surgical treatment of the middle ear diseases. The development of mastoid surgery can be traced through the past 4 centuries. Once used as a means of evacuating a postauricular abscess, it has evolved to become a method for gaining entry into the middle ear to control acute and chronic ear diseases, or for treatment of otogenic complications. Earlier works led the way to the postauricular "Wilde incision", which gave rise to Schwartze mastoidectomy. Oscar Wilde's ultimate demise from an otogenic meningitis appears all the more ironic when one considers the role his father, Sir William Wilde, played as one of the founding fathers of modern otology. The death of baron von Berger after mastoidectomy performed for treatment of tinnitus and hypacusis, stopped the further development of surgical procedures for about hundred years. The Joseph Toynbee's "Diseases of the ear" was the first work about ear diseases on a pathologic anatomical base, and fundamental for otology of the German speaking countries in the nineteenth and early twentieth centuries. Otology was emerging as a specific specialty. Von Tröltsch was the first surgeon, who proposed the antral opening through the external ear canal. When Schwartze and his assistant, Eysell, published their paper: "On the Artificial Opening of the Mastoid Air Cells," a century or so had passed since the few previous attempts to remove the tegmen of the mastoid had been reported. One of the greatest otologists of the 19th century was Adam Politzer, His influence on the 50 years of otology has never been equaled. It is in his honor that the International Society of Otology bears his name.

[The influence of nasal flow aerodynamics on the nasal physiology]. / Wplyw aerodynamiki przeplywu powietrza przez nos na fizjologie nosa.

The ability of the human nose to warm and humidify the respiratory air is important to maintaining the internal environment of the lungs, since ambient air is conditioned to nearly alveolar conditions (body temperature and fully saturated with water vapour) upon reaching the nasopharynx. Because of very short time of the inspiratory phase duration, as well as expiratory phase, only the rich vascularization of the nasal mucosa and specific organization of the submucosal vessels are not able to assure such effective physiological activity. Therefore the type of airflow during the respiration is essential to understanding the functional possibilities of the nasal mucosa. Most studies have investigated the airflow only in steady-flow conditions, where the laminar flow was observed. Anatomically accurate physical models of real nasal cavities and particle image velocimetry allow evaluation of the entire flow field in the nasal cavity. In these investigations a partially turbulent flow was observed even at low air velocities in most part of the nasal cavity. From a physiological perspective, a turbulent flow would seem sensible, since it enhances contact between air and the mucosal layer. By doing so, the nasal physiological functions - humidification, cleaning and warming are optimized.

[Cancer or syphilis laryngis, politics or diagnostic failure--problems of Emperor Frederick's III disease]. / Rak czy kila krtani, polityka czy bledna diagnoza--problem choroby cesarza Fryderyka III.

The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported. In spite of fact, that the German laryngologists the patient's pathologic changes diagnosed as laryngeal cancer in early stage, the ultimate diagnosis was made too late for surgery to have any effect. This delay was due to the differences in opinions between the attending laryngologists; particularly between that of the English prominent laryngologist Morell Mackenzie and the Germans, prof. Gerhardt and prof. Bergmann. The roles of the British Queen Victoria as well as her daughter, the wife of Prince Frederick, the princess Victoria, in decisions about the treatment of the disease, are discussed. The behavior and the personality of Sir Morell Mackenzie played also a very important role in the course of the disease. Some medical facts and symptoms render it probable that syphilis was the underlying reason for the development of cancer. Crown Prince Frederick was a pipe smoker for at least 30 years before he died at the age of 57 years, so it may be possible, that the Emperor's laryngeal cancer was induced by tobacco. There are some suggestions, that the premature death of the King of Prussia and German Emperor Frederick III could be a critical turning point in European's history.

[Microtia: isolated defect of hearing organ, or syndrome forming collection of abnormalities]. / Mikrocja--izolowane zaburzenie rozwojowe narzadu sluchu czy zespól wad?

Congenital malformations of the external ear are relatively rare, however gradual increase in their frequency has been observed in the last years. These defects can occur as isolated congenital malformations, but they can coexist with congenital malformations of facial skeleton and also with congenital defects of distant organs. The purpose of this study was to determine coexisting facial skeleton defects and congenital defects of distant organs in a group of patients with unilateral or bilateral congenital malformations of the external ear. 37 patients age 1 to 30 [mean age 12.4 years] with anotia, microtia or aplasia of external ear canal were part of this study. In 17 examined patients [46.0% of all examined persons] microtia could be treated as an isolated malformation, however hypoplasia of other elements formed from branchial arches, including mandibula, cheek or oral cavity, was found in 15 examined patients [40.5%]. In 11 [29.7%] patients congenital malformations of the external ear were found together with the congenital defects of distant organs (kidney, heart, muscular and skeletal system), and in two patients [5.4%] the defects involved even two different distant organs. Defects of the distant organs were found more frequently in patients with bilateral malformations of the external ear than in patients with unilateral ear malformation. In authors opinion each patient, even with seemingly isolated microtia, should be closely examined in order to exclude probable congenital defects of the distant organs.

[Age and complications after laryngectomy]. / Wiek a powiklania po laryngektomii.

Between 1989-1999, 573 patients (501 male and 72 female) with laryngeal cancer underwent laryngectomy in the Otolaryngological Clinic of the Medical University in Bydgoszcz. The age varied from 32 to 88 years (mean age--56.5 years). The aim of the investigations was the analysis of correlation between age and postoperative complications after laryngectomy. The greatest percentage of fever as a postoperative complication was observed in the youngest group of patients. The least number of pharyngo-cutaneous fistulae occurred in the group of patients older than 65 years. Both relationships were not statistically significant. The numbers of other complications were almost similar in all groups related to age. The results of our investigation suggest, that the advanced age as a sole factor (without additional diseases of circulatory or respiratory organ, or neurological diseases) is not a contraindication for surgical treatment of laryngeal cancer.

[The effect of preoperative irradiation on wound healing after laryngectomy--literature review and own results]. / Wplyw przedoperacyjnego napromieniania na gojenie sie rany po laryngektomii--przeglad pismiennictwa i wyniki wlasne.

We reviewed 573 patients who underwent total laryngectomy between 1989-1999 in the Otolaryngological Clinic of CM UMK. Pharyngocutaneous fistulae occurred in 65 cases (11.3%). In 16 patients who were preoperatively irradiated, the fistulae occurred in 7 cases (43.7%). In the non-radiotherapy group of 557 persons, in 58 cases (10.4%) after total laryngectomy, the wound healing was disturbed and a pharyngocutaneous fistula was observed. The authors reviewed the Polish and the foreign literature concerning the influence of preoperative radiotherapy on wound healing after surgical treatment of larynx carcinomas.

[Post-laryngectomy pharyngocutaneous fistula--a continuing clinical problem]. / Przetoka skórno-gardlowa jako powiklanie po laryngektomii--wciaz aktualny problem kliniczny.

BACKGROUND: Pharyngocutaneous fistula following laryngectomy is a serious complication, and its incidence varies from 4% to 65%. The study's objective was to determine the incidence of post laryngectomy fistulas in patients operated in our department to establish whether specific factors predispose to fistula formation. METHODS: A retrospective study was performed in 573 patients who underwent laryngectomy. RESULTS: Between 1989 and 1999, 835 cases of laryngeal carcinoma were diagnosed, 690 were treated surgically, 573 of them underwent laryngectomy in our department. Of these patients, 545 (95,1%) had total laryngectomy, while 28 (4,9%) partial laryngectomy. In 538 cases the laryngectomy was combined with radical or functional neck dissection. The presence of early postoperative fistula was established in 65 of the 573 patients (11,3%). Our study could not verify reports that any specific factors were significantly related to fistula formation, the only factors that did show statistical significance were the preoperative patient's general health status and the kind of postoperative antibiotic therapy. CONCLUSIONS: On the base of literature review, the authors compare results obtained in the last decade of the 20 century with results obtained earlier. Although the incidence of post-laryngectomy pharyngocutaneous fistulas decreased in comparison with the fistula rate observed earlier, the problem is still unresolved, and the fistulae remain a serious complication of larynx oncology surgery.

[Rehabilitation after total laryngectomy--vision and realization]. / Rehabilitacja chorych po laryngektomii--wizja a realizacja.

Universality, early initiation, complexity and continuity - should be the main attributes of rehabilitation in patients after laryngectomy. The authors discuss the problem of universality and accessibility of rehabilitation in Poland. A great role in realization of this attributes played since 20 years the Polish Society of Laryngectomees. Till now the governmental help and the participation of the National Health Fund for the patients after laryngectomy is very limited. The early rehabilitation should be started before the operation and a particular note must be taken to the patient's changed vital situation after the surgical treatment. The complexity of the rehabilitation must cover the whole spectrum of rehabilitation; it means voice and speech therapy, the improvement of respiratory system function, the problems of respiratory air conditioning and the psychological as well as social psychological aspects. The authors describe a model of such a complex rehabilitation that can be provided in health resorts. In the postoperative period the role of the laryngectomee clubs and associations is very important to assure the continuity of rehabilitation.

[Prospective factors of T1 and T2 glottic carcinoma]. / Czynniki prospektywne raka glosni w stadium zaawansowania T1 i T2.

The aim of our study was to estimate the probability of the neoplasm recurrence in patients with T1 and T2 glottic carcinoma operated with CO2 laser microsurgery. We analyzed the material of 171 patients treated in the Otolaryngology Department of the Collegium Medicum Nicolaus Copernicus University between 1991 and 2003. The statistical method of logistic regression was used to estimate factors disposing the local recurrence of laryngeal cancer. We studied: age, sex, extent and location of the lesion, time up to recurrence, carbon granuloma, smoking cigarettes before and after the operation. We confirmed statistically significant correlation between the local recurrence and anterior commissure involvement.

[Age connected hearing disorders (presbyacusis) as a social problem]. / Niedosluch zwiazany z wiekiem (presbyacusis) jako problem spoleczny.

The data of World Health Organization anticipate very rapid growth of percentage participation of elderly people in the population on the whole world. In Poland, in the year 2005, the percentage of people in the "post productive" age (women over 60 years, men over 65 years) was 15,32% of population, the expected data in 2020 is about 16%. The problem of this group becomes very essential social question. One of very important vital difficulties of that particular age is the problem with verbal communication, caused by the hearing disorders, very often stated in the older population. The hearing disorders (presbyacusis) are characterized by difficulties in speech understanding, the so called "social deafness", which often is a cause of psychical changes and isolation of persons with such hearing impairment. Because of its character, presbyacusis is very difficult in hearing rehabilitation. A new method of selection and fitting of hearing aids, adapted to the specificity of hearing disorders of older people is discussed.

[Estimation of smell sense rehabilitation in patients after total laryngectomy]. / Ocena skutecznosci rehabilitacji wechu u osób po laryngektomii calkowitej.

The loss of sense of smell significantly decreases a quality of life after total laryngectomy. That is why this problem should be considered within a complex rehabilitation of laryngectomized patients. The smell exercises ought to start parallely to the speech rehabilitation. The aim of our study was to estimate the efficacy of smell rehabilitation after total laryngectomy. 59 persons after total laryngectomy attending the fourteen days long rehabilitation camp were examined. All the patients had the examination of three smells identification (lemon, mint and anise) made before the beginning of exercises. All the persons had also the efficacy of air aspiration through the nose measured. The control examination of those parameters was conducted after fourteen days of exercises of making the negative pressure in the throat and nasopharynx directing the air flow into the olfactory area of the nose. We confirmed a statistically significant differences between the smell identification and the force of aspiration before and after rehabilitation. We confirmed that patient's age and the time from laryngectomy have the influence into the efficacy of smell rehabilitation.

[Malignant tumors of the nose and paranasal sinuses in the years 1992-2001]. / Nowotwory zlosliwe nosa i zatok przynosowych w latach 1992-2001.

On the base of retrospective analysis of 927 cases of malignant neoplasms of the nose and paranasal sinuses, diagnosed and treated in 10 clinical centers in Poland from 1992-2001, the assessment of basic epidemiological data, including the localization of tumor, and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 10 years the trends to change the mentioned above parameters has been examined. The index of morbidity in this period was constant and compareable with figures published earlier. In the analyzed material there is a predominance of males and the sex ratio was 1.45. The majority of cases were between 50-69 years (55%). The most common histopathological diagnosis was carcinoma (58%). The majority of cases of malignant tumors of the nose and paranasal sinuses was diagnosed in the advanced stage T3-T4 (72.3%) with the highest percentage in the middle region. 90% of all cases were treated surgically, but in about 30% it was the only treatment (also in cases of stage T2-T4). In 56% of all patients the surgical procedure was completed by radiotherapy. This data suggest that indications for additional irradiation should be extended.

[Carbon granuloma--an unwanted effect of laryngeal laser microsurgery]. / Carbon granuloma--niepozadany skutek mikrochirurgii laserowej krtani.

Over recent twenty years, laser microsurgery has gained great recognition in the treatment of early carcinoma. From 1990 to 2004, more than 800 operations on the larynx were performed using laser microsurgery, including 167 chordectomies for squamous cell carcinoma. In 14 patients who were on the follow-up for 1 to 6 months, we observed a spherical, smooth structure (3-5 mm in diameter) in the middle part of the scar, which imitated local relapse of the neoplastic process. The lesion was removed with CO2 laser. Histopathologic examination revealed, in all cases, the presence of nonspecific, inflammatory process and development of granulation tissue. In only one patient in further follow-up, neoplastic growth recurred. Such lesions were not observed in other than chordectomy laser microsurgical procedures.

[The follicular cyst of the mandibula--case report]. / Torbiel zawiazkowa zuchwy--opis przypadku.

Cyst is a pathological cavity which is surrounded by capsule and filled with matter of different compactness and composition. Cysts may originate in bones and in soft tissues. We are describing the case of the follicular cyst of the mandibula diagnosed for a 55 years old female patient. After diagnosis based on clinical, laryngological examination, computerized tomography, amber-coloured fluid in aspiration biopsy, the cyst and the unerupted tooth were surgically removed. Now the patient is under laryngological care.

[Rhinophyma--diagnosis and treatment]. / Rhinophyma--diagnostyka i leczenie.

The authors present four cases with rare disease--rhinophyma. These disease occurs mainly in males of middle and old age. It results from long-standing rosacea in some patients. Risk factors are blood vessels disorders, endocrinal abnormality, digestive tract disorder. In laryngological practice there are many methods of non-surgical treatment of rhinophyma. The aim of the treatment is to remove deformation and restore function of the nose and prevent the relapse of rhinophyma. Rhinophyma is removed with the epidermis and the wound is realest to self epithelisation in case of small changes, but in more severe cases of rhinophyma the wound needs to be covered by skin scalp.

[Antioxidants enzymes activity and concentration of lipid peroxidation products in chronic tonsillitis before and after surgery]. / Aktywnosc enzymów antyoksydacyjnych i poziom produktów peroksydacji lipidów w przebiegu przewleklego zapalenia migdalków podniebiennych przed operacja i po operacji.

INTRODUCTION: Chronic tonsillitis is one of the most often disease in otolaryngological practice. Free radicals release during chronic inflammation process are responsible for tissue destruction. The aim of the study was to estimate the free radicals production and the activity of antioxidative enzymes during chronic tonsillitis before and after surgery. MATERIAL AND METHODS: The study was performed in group of 60 patients and 32 healthy persons as a control group. We analized the activity of enzymes in blood and serum from the patients before the operation and on 7 day, 4 week and 6 months after the operation. RESULTS: The obtained results shows a lower activity of superoxide dismutase before the operation. After the surgery the activity of the enzyme increased to values observed in control group. The catalase and glutathione peroxidase activity were higher during chronic inflammation, and after the operation the activity decreased, but it was still higher then in control group. Concentration of lipid peroxides products (malondialdehyde) in erythrocytes and serum were higher before the surgery. Then the concentration decreased to values observed in healthy subjects. CONCLUSIONS: The measuring and monitoring the activity of antioxidative enzymes and the concentration of lipid peroxidation products (malondialdehyde) could be useful in proper diagnosis of chronic tonsillitis and in adequately early qualification for surgery.

[Long-term results of treatment in T1, T2 laryngeal cancer with CO2 laser microsurgery]. / Odlegle wyniki leczenia raka krtani T1 i T2 w mikrochirurgii laserowej.

The aim of this study was estimation the long term results of CO2 laser therapy in laryngeal cancer. 36 patients with early glottic cancer-T1 and T2 were treated with CO2 laser microsurgery in 1990-1992. The control laryngological, phoniatric and laryngovideostroboscopic examinations were conducted from six to thirty months after the operation. The next controls were done within three years and then after eight to ten years from microsurgery. The local recurrence was observed only during the first control in seven cases--19%. Four patients underwent total laryngectomy after several laser microsurgery, two were treated only with CO2 laser and one had CO-therapy. The better quality of voice was observed during following control examinations. A scar with smooth surface and marge in 29 persons and a tendency to phonatory vibration of scar in 9 patients were noticed in laryngovideostroboscopy examination during the first control. Following examinations showed a progressive improvement of voice parameters.