Specifics and diagnostic procedure in reflux-related dysphonia.

Voice is a work tool for many professional groups. Currently, cases of dysphonia of multiple origin consist a growing issue. Voice disorders may result from disturbed voice production process, congenital defects, post-traumatic conditions, chronic diseases or hormonal disorders. Chronic diseases causing voice disorders include laryngopharyngeal reflux disease and esophageal reflux disease.The chronic character of reflux causes the formation of numerous morphological changes of the larynx, including: hyperemia of the mucosa limited to arytenoid and intraarytenoid area, edema of the vocal folds, edema of the larynx mucosa. These changes contribute to voice disorders. Among the pathological changes of voice organ etiologically associated with reflux, the following disease units may be distinguished: reflux laryngitis, subglottic edema, contact ulceration, larynx granuloma, larynx and pharynx cancer. Many of disorders in the upper respiratory tract are etiologically related to reflux, e.g. dysphonia, grunting, coughing and dyspnoea.

Serum ß-glucuronidase as a potential colon cancer marker: a preliminary study.

AIM: Colorectal cancer is characterized by high morbidity and mortality in developed countries. The lack of low-cost, easy-to-use screening diagnostic methods is one of the causes of late diagnosis of colorectal cancer. Beta-glucuronidase (GLU) is a lysosomal exoglycosidase involved in degradation of glycosaminoglycans of the cell membranes and extracellular matrix of normal and cancerous colon tissues. The aim of our research was to evaluate the activity of GLU in the serum of colorectal cancer and estimate its potential value in the diagnosis of colorectal cancer. MATERIAL AND METHODS: Blood samples were collected from 21 patients with colorectal adenocarcinoma and 17 healthy subjects. GLU activity was determined by the colorimetric method of Marciniak et al. by measuring the amount of p-nitrophenol released from 4-nitrophenyl-beta-D-glucuronide, at λ = 405 nm. RESULTS: We found significantly greater activity of GLU (p<0.0001) in the serum of patients with colorectal cancer, as compared to the healthy subjects. The serum GLU activity significantly differentiates patients with colorectal cancer from healthy individuals. CONCLUSIONS: Serum GLU activity has diagnostic value and may be used in the diagnosis of colon adenocarcinoma.

Dietetic recommendations after bariatric procedures in the light of the new guidelines regarding metabolic and bariatric surgery.

The frequency of obesity occurrence is constantly increasing all over the world and becoming global epidemic. Facing the lack of the efficiency of conservative treatment, patients with II and III degree of obesity are qualified for surgical treatment; however, the efficiency of surgical treatment is connected with permanent change of nutritional habits and previous lifestyle of the patient. Modification of the way of nutrition, regardless of the type of bariatric procedure, should especially include the lowering of food energetic value and change of type, consistency and size of consumed food. Nutritional treatment after bariatric procedures is multistage. It includes clear liquid diet, full liquid diet, pureed diet, mechanically altered soft diet and regular diet. Gradual expanding of the diet protects gastrointestinal tract from chemical, mechanical and thermal irritation by the food. It also should prevent nutritional deficiencies. Significant influence on the result of surgical treatment of obesity has also regular intake of food, consuming products with high nutritional value, avoiding confectionery and fat products, consuming proper amounts of protein (60-80 g/day) and vitamin-mineral supplementation.

The diagnostics of colorectal cancer.

Colorectal cancer (CRC) is one of the most frequent human malignant neoplasms. CRC has an estimated incidence of more than 1,000,000 new cases annually worldwide. Approximately one out of three people who develop CRC dies from the disease. Furthermore, CRC often affects inhabitants of industrialized countries in comparison to less developed countries. Several markers of colon cancer, including CEA, CA-19-9, TPS, TAG-72 and lysosomal hydrolases, have been identified and are now being adopted in routine clinical practice. Increased values of these markers are often the first signal of recurrence or metastases, which is useful in prediction and prognosis of clinical outcome of patients with CRC. Determination of the activity of lysosomal exoglycosidases in body fluids may bring some hope of improving diagnosis of colorectal cancer. However, it has to be remembered that currently the most effective diagnostic method of CRC is endoscopy.

Presbyphonia as an Individual Process of Voice Change.

OBJECTIVE: The aim of the study was to determine the individual variability of the severity of dysphonia in the population of older women and men using the initial perceptual voice assessment (GRBAS) and objective diagnosis of the clinical form of Presbyphonia with laryngeal visualization technique (High-Speed Digital Imaging [HSDI]) and acoustic voice analysis (Diagnoscope Specjalista). METHODS: The study included 302 elderly women and men. Application of perceptual GRBAS scale allowed to extract 230 subjects with voice disorders (Group I). Remaining 72 elderly subjects without the symptoms of dysphonia consisted Group II. Group III included 50 subjects with euphonic voice. In the assessment of dysphonia, visualization technique (HSDI) as well as acoustic method (Diagnoscope Specjalista). The observation of real vibration of vocal folds using HSDI technique and HS camera allowed to examine symmetricity (Shaw-Deliyski scale), periodicity and amplitude of vibration, Mucosal Wave (MW) morphology, Glottal Closure Type, and value of Open Quotient (OQ). Acoustic analysis allowed to assess value of Fundamental Frequency (F0), Maximum Phonation Time (MPT) as well as Jitter, Shimmer, Noise-to-Harmonics Ratio (NHR) parameters. Narrowband Spectrography was performed. RESULTS: HSDI technique allowed to register in elderly women with voice disorders a mild asymmetry and aperiodicity of vibrations, MW reduction, amplitude increase and glottal insufficiency in the posterior segment of glottis which indicated edematous changes in the larynx. In 90% of men in this group, moderate asymmetry and aperiodicity were observed as well as amplitude decrease, significant limitation of MW and glottal insufficiency in the middle segment of the glottis which indicated atrophic changes in the larynx. In remaining 10% of men, amplitude of vibration was increased which indicated the existence of hypofunctional dysphonia. Objective confirmation of glottal insufficiency in women with edematous changes was high value of OQ in posterior segment of the glottis registered with HSDI technique. In men with larynx atrophy, the value of OQ was the highest in the middle segment of the glottis. Glottal insufficiency, especially in the middle segment, coexisted with the increase of NHR parameter observed in acoustic examination and with numerous nonharmonic components in the scope of high frequencies revealed in narrowband spectrography, especially in men with larynx atrophy. What is more, in men, the increase of F0 and reduction of MPT was registered. In women with edematous changes of the larynx, acoustic analysis revealed decrease of F0 value, increase of Jitter, Shimmer, NHR as well as reduction of MPT. Narrowband sopectrography revealed not only harmonic components but also nonharmonics in the range of low, medium, and high frequencies. CONCLUSIONS: The course of Presbyphonia varies individually in the elderly. In many subjects, the process of aging does not influence the quality of voice. Crucial importance in the diagnosis of Presbyphonia is assigned to High-Speed Digital Imaging technique which confirms the existence of edematous changes in the larynx in women as well as atrophy and hypofunctional dysphonia in men. The acoustic examination of voice confirmed the individual variability of the severity of Presbyphonia in the elderly depending on the clinical form of dysphonia determined by the gender of the diagnosed person.

Multidimentional assessment of voice quality in patients with laryngopharyngeal reflux disease.

<b><br>Introduction:</b> Gastroesophageal Reflux Disease (GERD) is a common disorder in world population. As a result of the regurgitation of acid content from the stomach to laryngopharynx and larynx, secondary damage of laryngeal mucosa occur, which is highly sensitive to hydrochloric acid, and morphological changes are observed. Symptomatology of laryngopharyngeal reflux is varied which makes differential diagnosis difficult.</br> <b><br>Aim:</b> The aim of the study was the assessment of voice quality, morphological changes in larynx as well as etiology of Laryngopharyngeal Reflux Disease.</br> <b><br>Material and method:</b> The severity of dysphonia was classified using perceptual and acoustic methods as well as RSI. Morphological control was performed using HSDI technique and RFS. Etiological factors were examined basing on barofunction of upper esophageal sphincter and 24-hour pH-metry of air exhaled expressed in Ryan score.</br> <b><br>Results:</b> In the majority of patients with Laryngopharyngeal Reflux, dysphonia was recognized, intensified especially in women (G3R2B0A0S3), which was confirmed in Yanagihara classification (type III) and parameters of acoustic analysis. Voice disorders were the most frequently the result of edema and congestion of interarytenoid area, aytenoids and vocal folds. Those symptoms were caused by the decrease of upper esophageal sphincter tension and acidity of exhaled air which was confirmed in 24-hour pHmetry.</br> <b><br>Conclusions:</b> It is important to educate physicians and patients about the possibilty of negative impact of reflux disease on the occurrence of voice quality disorders. Current diagnostic methods for dysphonia guarantee accurate recognition and therapeutic success improving the prognoses of patients with Laryngopharyngeal Reflux.</br>.

Application of the HRES 5562 Camera Using the HSDI Technique in the Diagnosis of Glottal Insufficiencies in Teachers.

OBJECTIVE: Teachers are the largest group of professional voice users with predispositions to functional or organic changes in the larynx. The dysfunction of intrinsic muscles of the larynx frequently occurs which leads to changes in parameters of quality of voice (dysphonia). The aim of the study is the assessment of parameters of vocal folds vibrations, Mucosal Wave morphology, Glottal Closure Type and Open Quotient (OQ) using High Speed (HS) camera and High Speed Digital Imaging (HSDI) technique in teachers with disorders of voice quality classified in GRBAS scale in glottal insufficiencies. MATERIAL AND METHOD: The study included group of 50 teachers of both genders, working in primary and secondary education units for 15 years, without systemic diseases with disorders of quality of voice confirmed by the results in GRBAS scale assessment. Vocal folds vibrations were assessed with HS camera by R. Wolf and HSDI technique. Rigid endoscope with 90o optics by the same company was used in the study. Vocal folds vibrations were registered with the speed of 4000 frames/sec. Regularity, symmetry of vibrations, Mucosal Wave (MW) morphology as well as Glottal Closure Type were assessed. Numerical value of OQ was determined in anterior, middle and posterior segment of the glottis during phonation. RESULTS: Assessment of real vibrations of vocal folds revealed irregularity, mean asymmetry of vibrations, MW reduction as well as glottal insufficiency, the most frequently (96%), in the middle segment - type E according to European Laryngological Society, less frequently (4%) - type E+C. The highest value of OQ (average 0.98) was registered in the middle segment of the glottis. In GRBAS scale, significant dysphonia has been registered, classified as G3R3B3A3 without the features of voice strain - S0. CONCLUSION: In group of teachers with extensive professional experience, glottal insufficiency in the middle segment was registered the most frequently which was confirmed by high values of OQ in this region obtained with HSDI technique. What is more, irregularity, mean asymmetry and asynchrony of vibrations with MW reduction were registered which confirmed the existence of glottal insufficiency in this group. GRBAS scale was useful in preliminary evaluation of dysphonia and its severity, however, the diagnosis of its clinical form was possible only with visualization of the larynx and objective parameters obtained with HSDI.

Application of High Speed Digital Imaging (HSDI) technique in the diagnosis of dysphonia in patients with laryngopharyngeal reflux disease (LPR).

Introduction Gastroesophageal reflux disease (GERD) may cause extra-esophageal complications, including laryngopharyngeal reflux disease (LPR). It is caused by morphological changes in the laryngeal mucosa due to the regurgitation of gastric contents. Laryngopharyngeal reflux has a wide symptomatology. There is no pathognomonic image of the larynx for LPR. In the diagnosis of LPR, the subjective RSI scale is commonly used, which assesses symptoms in conjunction with the laryngoscopic assessment of the larynx on the RFS scale. The aim of the study was to diagnose the clinical form of dysphonia in patients with laryngopharyngeal reflux (LPR) using the HS camera and HSDI technique. Material and methods The study included a group of 72 patients of both genders, age 20 to 65, who obtained more than 13 points in the RSI scale and more than 7 points in the RFS scale. Results Application of HSDI technique with camera in the high speed (HS) and high resolution (HR) mode allowed precise objective diagnosis of organic and functional disorders of a hyperfunctional dysphonia.

Phoniatric, Audiological, Orodental and Speech Problems in a Boy with Cardio-Facio-Cutaneous Syndrome Type 3 (CFC 3) Due to a Pathogenic Variant in MAP2K1 - Case Study.

Cardio-facio-cutaneous syndrome 3 (CFC3) due to variants in MAP2K1 is a rare genetic disorder manifested mainly by short stature, facial dysmorphism, abnormalities of the cardiovascular system, skin changes, and intellectual disability. The aim of the study is the evaluation of the occurrence of pathological changes in the upper respiratory tract, orthodontic disorders, as well as voice, speech and hearing abnormalities in an 11-year-old boy with CFC3 syndrome. The lack of detailed diagnostics of speech, voice and hearing disorders, as well as the degree of their severity was an inspiration to undertake research in this field. Pathological changes in face, oral cavity, upper respiratory tract (nose, nasopharynx, larynx), and hearing organ, as well as voice and speech quality, were assessed in an 11-year-old boy with CFC3 syndrome. Pathologies of the upper respiratory tract (adenoid hypertrophy, narrowing of the nasal passages) and laryngeal asymmetry were found without significant changes in voice quality in the acoustic examination, except for the voice timbre change confirmed in narrowband spectrography. Complex audiological assessment confirmed the existence of bilateral sensorineural hearing loss. Speech pathology assessment revealed abnormalities in the structure of articulation organ, its decreased motor efficiency, imprecision, reduced coordination, as well as the presence of autistic features. Exome sequencing showed the heterozygous variant c.371C>T (p.Pro124Leu) in the MAP2K1 gene, previously described as pathogenic, thus supporting a causative relevance. Phoniatric, audiological, orodental and speech problems should be considered as features of cardio-facio-cutaneous syndrome type 3 (CFC 3) phenotype due to a pathogenic variant in MAP2K1.

Application of High Speed Digital Imaging (HSDI) technique and voice acoustic analysis in the diagnosis of the clinical form of Presbyphonia in women.

<b>Introduction:</b> The aging process of voice begins after the age of 60 and has an individually variable course. Voice quality disorders at this age are called senile voice (Presbyphonia or Vox Senium). Voice pathology is particularly severe in women. The aim of the study was to diagnose the clinical form of Presbyphonia in elderly women using High Speed Digital Imaging (HSDI) and acoustic voice analysis. <br><b>Material and methods:</b> Study included 50 elderly women (average age 69) with dysphonia (Group I). Control group (Group II) included 30 women (average age 71) without voice quality disorders. Visualization assessment has been conducted with High Speed Digital Imaging (HSDI) with High Speed camera (HS). Acoustic evaluation of voice included analysis isolated vowel "a" and continuous linguistic text with Diagnoscope Specialista software. Maximum Phonation Time (MPT) has been determined. <br><b>Results:</b> In Group I, 78% of women revealed vocal folds vibrations asymmetry, vibration amplitude increase, Mucousal Wave (MW) limitation and Type D glottal insufficiency (GTs). Acoustic voice analysis proved decrease in F0, increase in Jitter, Shimmer, NHR. In 22% of women, next to vibrations asymmetry, vibration amplitude reduction and MW limitation, Type E glottal insufficiency (GTs) have been found. Acoustic voice analysis revealed slight decrease in F0 and the presence of numerous non-harmonic components in the glottis region. <br><b>Conclusions:</b> Vocal folds visualization with HSDI showed edema, less often atrophy in elderly women. Both forms of dysphonia were caused abnormal values of F0, Jitter, Shimmer, NHR in the acoustic voice evaluation and significant reduction of MPT.

Perceptual and acoustic voice analysis in patients with glottis cancer after endoscopic laser cordectomy.

<b>Introduction:</b> Treatment of glottis cancer, despite oncological safety, should consider postoperative voice quality. CO₂ laser endoscopic cordectomy allows radical removal of the tumor while maintaining respiratory, defensive and phonatory functions. <br><b>The aim:</b> The aim of the study is perceptual and acoustic evaluation of voice in patients after endoscopic CO2 III-Va laser cordectomy due to glottis cancer. <br><b>Material and method:</b> The study included 30 men after CO₂ cordectomy. 13 (43%) patients underwent type III cordectomy, 6 (20%) - type IV; 11 (37%) - type Va. Voice quality has been assessed 6 months after the surgery. Control group included 30 healthy men of the same age. GRBAS scale has been used in perceptual evaluation of voice. Acoustic analysis has been performed using DiagnoScope Specjalista software. Narrowband spectrography and Maximum Phonation Time (MPT) measure has been performed. <br><b>Results:</b> In study group, voice has been classified as G₁R₁B₀A₀S₀ after type III cordectomy; as G₁R₁B₁A₁S₂ in type IV and as G₂R₁B₁A₀S₃ in type Va. Acoustic evaluation revealed the highest values of F0, Jitter, Shimmer and NHR after Va cordectomy as well as non-harmonic components in narrowband spectrography and reduction of MPT. <br><b>Conclusions:</b> Postoperative voice quality depends on the type of cordectomy. Perceptual assessment indicates that type IV and Va cordectomy cause intensification of voice disorders. Parameters of acoustic evaluation increase with the extent of the procedure. The presence of non-harmonic components in narrowband spectrography increases with the extent of cordectomy, such as the reduction of MPT. Preservation of anterior commissure influences good voice quality in perceptual and acoustic assessment.

The application of High-Speed camera (HS), acoustic analysis and Voice Handicap Index (VHI) questionnaire in diagnosis of voice disorders in elderly men.

OBJECTIVE: The process of ageing begins after 60 years of age and is referred to as presbyphonia (Vox senium). The causes include functional or organic voice disorders, often coexisting with dry upper respiratory tract infection. INTRODUCTION: The aim of the study is the use of high-speed camera and acoustic voice analysis in diagnostics of the clinical form of presbyphonia. M aterials and methods: The study included a group of 50 men, non-smokers, age from 51 to 72, who do not use their voice professionally. High-Speed Digital Imaging and HS camera have been used, allowing evaluation of real vibrations of vocal folds, along with acoustic voice analysis using a software by DiagNova Technologies. RESULTS: VHI questionnaire has been used for self-assessment of voice disability. Visualizations of the larynx enabled recognition of hypofunctional dysphonia or atrophy of vocal folds that cause voice disorders. This was confirmed by parameters of voice acoustic evaluation: F0, NHR, narrowband spectrography. The pathological value of NHR and the presence of nonharmonic components in the range of high frequency levels indicated glottal insufficiency, recorded with the visualization technique of the larynx by HS camera. A significant shortening of maximum phonation time in relation to the control group has also been recorded. DISCUSSION: The objective examination of voice pathology is crucial in diagnosis and rehabilitation, however, subjective assessment of the patient is important in the scope of the procedure used. The patient's subjective self-rating assessment (VHI) confirmed the sense of voice disorders in elderly men, indicating the need for rapid and accurate clinical diagnosis.

Verbal communication disorders in psychogenic dysphonia.

Psychogenic dysphonia is defined as disturbances in voice and speech quality with emotional background with lack of organic changes in the larynx. Mental condition has significant impact on the process of producing voice, functioning of respiratoryphonatory- articulation mechanism and speech prosody. The aim of the study was visual, acoustic, perceptual assessment as well as self-assessment of voice and speech quality using subjective and objective methods in patients with psychogenic dysphonia. The study included 50 patients with psychogenic dysphonia diagnosed in the Department of Clinical Fonoaudiology and Logopedics, Medical University of Bialystok and treated at the Foniatric Outpatient Clinic, University Hospital in Bialystok in 2017-2018. The control group consisted of 30 subjects with euphonic voice. All patients underwent subjective and objective assessment of voice and speech quality. The GRBAS scale, breathing pathway assessment, respiratory-phonatory-articulation analysis, voice and speech intensity evaluation have been performed. Speech prosody has also been examined. Patient selfassessment of voice has been conducted using Voice Handicap Index (VHI). Objective evaluation of larynx included vibrations of vocal folds visualization using High Speed Digital Imaging (HSDI). Acoustic analysis of voice quality has been performed using DiagNova Technologies. The maximum phonation time (MPT) has been determined. Hyperfunctional dysphonia is the most common clinical form of psychogenic dysphonia. Abnormal breathing pathway influence the reduction of MPT and disturbance of respiratory-phonatory-articulation coordination in patients with psychogenic dysphonia. In psychogenic dysphonia intonation and speech rate disorders are observed. Results of voice self-assessment in the majority of examined patients indicates a mild voice disability.

Phonatory compensation in patients with larynx cancer after CO2 laser cordectomy.

INTRODUCTION: CO2 laser endoscopic cordectomy is the method of laryngeal cancer treatment. The type of cordectomy (I-VI) depends on the extent of the tumor. Endoscopic laser surgery provides more satisfactory phonation conditions in comparison to open surgical procedures. THE AIM: The aim of the study was to classify phonatory compensation mechanisms after CO2 laser cordectomy using the HSDI. M aterial and methods: The study included 30 men treated and diagnosed at the Department of Otolaryngology and Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. The control included 30 men with no pathological changes in the larynx. Type III, IV and Va CO2 laser cordectomy have been for glottis cancer treatment. Postoperative evaluation has been conducted 6 months after the surgery. HSDI has been used in larynx visualization. R esults: Type I compensation occurs most frequently in patients after type III cordectomy. Advanced glottis cancer, as an indication for type IV and V cordectomy, leads to epiglottic hyperfunction and phonation involving vestibular folds - type II and III compensation. Type IV compensation is most frequent in type IV cordectomy. C onclusions: The type compensation is connected with the extent of glottis resection. In cordectomy including anterior commissure and the part of opposite fold (type Va), supraglottic hyperfunction with the participation of vestibular folds (type II and III compensation) has been recorded. Transmuscular cordectomy (type III) most often resulted in type I compensation. Type III-Va cordectomy caused reduction or absence of MW, decrease in amplitude and aperiodicity of vibrations in HSDI.

Analysis of voice quality parameters in patients with vestibular voice.

Vestibular voice includes participation of larynx structures which are absent in physiological process. Vestibular phonation may be desired when vocal folds are damaged as in paralytic dysphonia, or undesired in marginal hyperfunction. Vestibular voice may result from psychogenic dysphonia - phononeurosis. The aim of the study is perceptive evaluation of vestibular voice, objective larynx visualization, acoustic and aerodynamic examination. The study included 40 patients: 20 with vestibular voice, 20 with euphonic voice. Voice quality has been evaluated using perceptual GRBAS scale. Endoscopic and stroboscopic larynx examination used Endo-STROB-EL-Xion GmbH with visual tract. High-Speed Digital Imaging (HSDI) and High Speed (HS) camera registered true vocal folds vibrations. Acoustic evaluation of voice with DiagnoScope Specjalista, DiagNova Technologies included analysis of F0, Jitter, Shimmer, NHR, nonharmonic components. MPT has been analyzed. In examined group, hoarseness (95%), roughness (75%) and voice strain (55%) have been recorded. Endoscopy revealed edema of vestibular folds with dilation of vessels covering glottis. Stroboscopy and HSDI confirmed coexistence of hyperfunctional (95%) or paralytic (5%) dysphonia. Acoustic assessment revealed increase in Jitter, Shimmer, NHR and decrease in F0 and MPT. The vestibular voice is observed most frequently in women with hyperfunctional dysphonia (phononeuroses) or in paralytic dysphonia. Visualization techniques confirm the coexistence of vestibular folds hypertrophy and edema with vibration disorders. In the perceptual assessment, vestibular voice was hoarse, rough and strained. Acoustic examination showed increase of Jitter, Shimmer, NHR, presence of nonharmonic components and decrease of F0 and MPT.

Subjective and objective assessment of voice quality in pregnancy.

During pregnancy, voice quality disorders may occur in form of: edema, dryness, nervousness. The aim of the study is subjective and objective evaluation of voice quality in pregnant women. The study included 20 women in the third trimester of pregnancy, age of 20-31 diagnosed at the Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. Subjective assessment has been based on the GRBAS scale. Objective assessment of the vocal organ used the HSDI technique (High Speed Digital Imaging). In the laryngeal visualization, high-speed camera (HS) using rigid endoscope with 90 ° optics has been used. Vibration of vocal folds has been recorded during phonation of vowel "e" at 4000 frames / sec. The glottal closure (GTs), symmetry, regularity and synchronization of vocal folds vibration have been assessed. In estimating the degree of glottal insufficiency, kymography of the larynx has been performed by analyzing the value of Open Quotient (OQ). Objective acoustic evaluation of voice has been also conducted using DiagnoScope Specjalista Program. Hoarseness has been observed in 15 pregnant women, whereas voice fatigability in 20 patients. Using HSDI, the edema of vocal folds in part of the group has been observed. Decreased MPT has been found in all examined women in the third trimester of pregnancy. Hoarseness and fatigability of voice are the most frequent subjective symptoms of voice organ in the third trimester of pregnancy. Decreased MPT is recorded objectively, as well as edema and insufficiency of vocal folds using HSDI technique.

Ectopic Pancreas Imitating Gastrointestinal Stromal Tumor (GIST) In The Stomach.

Ectopic pancreas is a rare congenital disorder defined as pancreatic tissue lacking vascular or anatomic communication with the normal body of the pancreas. Most cases of ectopic pancreas are asymptomatic, but it may become clinically evident depending on the size, location and the pathological changes similar to those observed in case of the normal pancreas. It is often an incidental finding and can be located at different sites in the gastrointestinal tract. The most common locations are: the stomach, duodenum or the proximal part of small intestine. The risk of malignancy, bleeding and occlusion are the most serious complications. Despite the development in diagnostics, it still remains a challenge for the clinician to differentiate it from neoplasm. In this report, we described a case of 28-years old woman who presented recurrent epigastric pain. The upper gastrointestinal endoscopy revealed gastrointestinal stromal tumor on the border of the body and antrum of the back wall of great curvature of the stomach. The histopathological examination after surgery showed heterotopic pancreatic tissue. Ectopic pancreas should be considered in the differential diagnosis of gastric mass lesions.

The impact of bariatric surgery on nutritional status of patients.

INTRODUCTION: Currently, surgical treatment is considered to be the most efficient method of dealing with morbid obesity. AIM: To evaluate changes in nutritional status after surgical treatment of obesity in the early postoperative period. MATERIAL AND METHODS: The study included 50 patients (30 women and 20 men) treated surgically due to morbid obesity. During the preliminary visit and during control visits measurements of body mass, height, and waist and hip circumference were conducted. Also, analysis of body content was performed and blood was taken for biochemical analysis. Statistical analysis was conducted using the program Statistica 10. RESULTS: Six months after the surgery, in the group of women, significant reduction of average body mass, average waist circumference, average hip circumference and average body mass index (BMI) was observed. Also, significant reduction of the percentage of body fat and an increase in the percentage of fat-free body mass were observed. A significant decrease in muscle mass was also noted. Both in women and in men, 6 months after the surgery, a significant decrease in fasting glucose concentration, fasting insulin and triglycerides in blood serum was observed. CONCLUSIONS: Bariatric procedures lead to significant body mass, BMI, waist and hip circumference reduction. Loss of body mass is caused mainly by the reduction of fat tissue. Application of surgical procedures in morbid obesity treatment also allowed us to achieve improvement in insulin, glucose and lipid metabolism.

The activity of N-acetyl-ß-d-hexosaminidase A and B and ß-glucuronidase in nasal polyps and hypertrophic nasal concha.

UNLABELLED: Nasal polyps and hypertrophic lower nasal conchae are common disorders of nasal cavity. The majority of etiopathogenetic theories indicate inflammatory background of polyps and hypertrophic concha. N-acetyl-ß-D-hexosaminidase and ß-glucuronidase are lysosomal exoglycosidases revealing accelerated activity in inflammatory processes. AIM: The aim of the study was to evaluate the catabolism of glycoconjugates in nasal polyps and hypertrophic nasal concha basing on the activity of N-acetyl-ß-D-hexosaminidase (HEX) and ß-glucuronidase (GLU). MATERIAL AND METHODS: Material consisted of nasal polyps taken from 40 patients during polypectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and hypertrophic lower nasal conchae taken from 20 patients during mucotomy. The activity of HEX, HEX A, HEX B and GLU in supernatant of homogenates of nasal polyps and hypertrophic lower nasal concha tissues has been estimated using colorimetric method. RESULTS: Statistically significant decrease has been observed in concentration of the activity (per 1mg of tissue) of HEX (p<0.05), HEX B (p<0.001) and specific activity (per 1mg of protein) of HEX B (p<0.001) in nasal polyps tissue in comparison to hypertrophic lower nasal conchae tissue. CONCLUSIONS: Decrease in the activity and specific activity concentration of the majority of examined lysosomal exoglycosidases (increasing in inflammations) in comparison to hypertrophic lower nasal conchae suggests electrolytes disorders and questions the inflammatory background of nasal polyps.