[Head and neck phlegmons - diagnosis and treatment - own observations]. / Ropowice glowy i szyi - diagnostyka i leczenie - obserwacje wlasne.

INTRODUCTION: Head and neck phlegmons are rare diseases, however they are associated with high risk of mortality. They can derive from different structures of the described anatomical area. They are often odontogenic. Imaging studies, especially computerized tomography play the greatest role in diagnosis of phlegmons. The treatment is based on surgical incision and drainage as well as analgesia. MATERIALS AND METHODS: A retrospective analysis was conducted on 11 patients from three different ENT centers: ENT Department of the Medical University of Silesia in Katowice, ENT Department of the Municipal Hospital in Sosnowiec and ENT Department of the Hospital No.1 in Bytom. Laboratory results, imaging results, treatment and other factors influencing the course of the disease were analyzed. RESULTS: Most patients were males and the average age was 50.8. In most cases the phlegmons were diffused and localized in different regions of head and neck. The phlegmons were mainly located in the carotid and parapharyngeal space. Streptococci and staphylococci were the most common pathogenes found in the examined material. Antibiotics and metronidasol were effective in all cases. Two types of surgical procedure were performed - either common abscess incision or broad incision along sternocleiodomastoid muscle. CONCLUSIONS: Head and neck phlegmons are rare and they affect patients at any age. The dominating localization of the phlegmons depends mainly on the starting point. Computerized tomography plays the most important role in diagnosis. The treatment is based on surgical procedures and antibiotics.

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery.

Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.

Hadad-Bassagasteguy flap in skull base reconstruction - current reconstructive techniques and evaluation of criteria used for qualification for harvesting the flap.

INTRODUCTION: Cerebrospinal fluid (CSF) leakage is a common consequence or complication in the operations of skull base tumors. The Hadad-Bassagasteguy flap (HBF) is the most common local flap used in the reconstruction of the meninges. It is a nasoseptal flap (NSF) vascularized by the sphenopalatine artery (SPA). Improvement of the already existing techniques is necessary. AIM: To present our experience in HBF and to evaluate the criteria used for qualification (relative and absolute indications) for the NSF reconstructive technique. MATERIAL AND METHODS: The retrospective study included 25 patients who underwent expanded endonasal approach (EEA) operations with the NSF. The correctness of qualification based on our own criteria was assessed. The most important modifications of the original HBF as well as the reasons for failures are discussed. RESULTS: There were 12 relative and 13 absolute indications for NSF harvesting. In 2 cases no anticipated CSF leakage was observed. No complications were reported. CONCLUSIONS: Skull base reconstruction with HBF and its various modifications is a highly effective technique. Absolute indications for NSF harvesting prior to resection are: reoperations in the case of a previous open approach, preoperative CSF leakage, intradural localization of a tumor related to its etiopathogenesis, suspicion of intradural diffusion of a neoplasm in magnetic resonance imaging if the etiopathogenesis cannot clarify the tumor's relation to the meninges. Relative indications concern mostly pituitary macroadenomas of at least 2.5 cm in diameter.

[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.

Glycosoaminoglycans in nasal polyps.

CONCLUSION: The qualitative and quantitative compositions of GAGs were comparable in all the polyps examined. OBJECTIVE: Glycosoaminoglycans (GAGs) are an integral component of proteoglycans, which are constituents of connective tissue. The qualitative and quantitative compositions of GAGs occurring in proteoglycans determine their biological role. In this work, individual fractions of GAGs occurring in nasal polyps were isolated and estimated. MATERIAL AND METHODS: Polyps were obtained over a 2-year period from 31 patients (18 males, 13 females; age range 28-70 years) who underwent polypectomy and evaluated using routine histopathology. RESULTS: The amount of hyaluronic acid in nasal polyps was high, the amounts of dermatane sulphate and chondroitine-6-sulphate were slightly lower and the amounts of chondroitine-4-sulphate, heparin, heparan sulphate and keratan sulphate were the lowest.

[The use of the vocal prosthesis Provox 2 for speech rehabilitation after total laryngectomy]. / Zastosowanie protez glosowych typu Provox 2 w chirurgicznej rehabilitacji glosu u chorych po calkowitym usunieciu krtani.

The authors have presented the application and usage the alloplastic vocal prosthesis Provox 2 to serve for rehabilitation speech after total laryngectomy. Surgical technique of implantation of vocal prosthesis was discussed. The authors estimated in 6 patients following parameters of speech; fundamental frequency, maximum phonation time of vowel "a", maximum intensity and degree of dysphonia. In all 6 cases post-operative course was uncomplicated. Above mentioned parameters of voice were measured in order to comparison quality of oesophageal speech to tracheo - oesophageal speech. The authors assessed speech at 6 patients with voice prosthesis and 6 with good oesophageal speakers as a control group. The results of our investigations showed, that quality of tracheo - esophageal speech obtained with usage vocal prosthesis Provox 2 is more like normal speech than oesophageal speech. Social efficiency and quality of tracheo - oesophageal voice is better than oesophageal voice.

[Disabling positional vertigo (DPV): syndrome of vestibulo-cochlear organ impairment during vascular compression of the vestibulo-cochlear nerve (VCS)]. / Zespól zaburzen narzadu przedsionkowo-slimakowego, disabling positional vertigo (DPV) w przebiegu konfliktu naczyniowo-nerwowego nerwu przedsionkowo-slimakowego (VCS).

In 1984 Jannetta et al. introduced a new term-disabling positional vertigo (DPV). DPV is a term used to describe syndrome of cochleo-vestibular organ impairment during vascular compression syndrome of eight cranial nerve. They introduced this term to distinct this syndrome from other established vertigo syndromes on the basis of recognized in angio - MRI exam compression of VIII nerve by vessel and clinical and electrophysiological criteria. Existence of DPV syndrome is still not universally accepted, because it is difficult to diagnose vertigo as vascular compression syndrome of the eight cranial nerve when there are no specific finding to detect this syndrome. Only Moller proposed specific ABR abnormalities as a criterion in DPV diagnosis (prolongation of I - III interval). The authors performed retrospective analysis of 28 patients (16 female, 12 men, average age 43) with recognized on basis angio - MRI vascular compression syndrome of eight cranial nerve. Contrasted magnetic resonance imaging identified a vascular loop near to cochleo - vestibular nerve in all 28 cases. All patients were performed pure tone audiometry, DPOAE, ABR and ENG exam. The most common symptoms were unilateral tinnitus (89% cases), unilateral hearing loss (86%) and dizziness (61%). The most frequent abnormalities in above mentioned exams were sensorineural hearing loss in pure tone audiometry (92%). ABR data were interpreted with respect to Mollerís criteria and asymmetry of the I - III, III - V and I - V interval and prolongation of V waves in the auditory brainstem response was found in 36% cases. Abnormal changes in electronystagmography were found: absence (10%) or weakness (36%) of caloric response. The differential diagnosis of DPV syndrome are discussed. We could not find any specific clinical findings valuable for DPV diagnosis. There is no significantly more weakness or absence of caloric response of vestibular organ in patients with DPV. Disabling positional vertigo is the syndrome which should be considered in differential diagnosis in every case of vertigo.

Endoscopic approach to the resection of adenoid cystic carcinoma of paranasal sinuses and nasal cavity: case report and own experience.

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that might occur in nasal cavity and paranasal sinuses. It is characteristic for poor prognosis, especially the solid histopathological subtype of the tumor. ACC might spread along nerves and fascias and it is usually diagnosed at advanced stage. Computed tomography and magnetic resonance imaging together with fine-needle biopsy are the gold standards in the diagnostic procedure of the cancer. Surgery with adjuvant therapy are the most common methods of treatment. Among the surgical approaches, the functional endonasal sinus surgery seems to be the most appropriate and favorable way of treatment. In the study, the authors present a case of a 62-year-old patient with T4aN0M0 ACC tumor treated endoscopically at the Department of Laryngology and ENT Oncology, WSS No. 5 in Sosnowiec. The authors indicate the usefulness of FESS procedure in the treatment of malignancies of nasal cavity and paranasal sinuses. They also review the recent publications on endonasal versus open approach in similar cases. In conclusions, the authors favor endonasal approach as a mini-invasive method of surgical treatment of ACC of paranasal sinuses that results in satisfactory oncological outcome and high quality of patient's life.

The results of the interference of nitrates and vitamin E in the metabolism in the connective tissue of rat's liver.

We examined 72 female Wistar rats which were divided into 6 groups. The animals were administered sodium nitrate (V), vitamin E or both compounds at the same time. In order to estimate the interference of nitrates in the presence of vitamin E with the metabolism of rat's liver, we determined the composition and the amount of glycosoaminoglycans (GAGs). It was stated that the total amount of GAGs increased in livers of all rats. Basing on all fractions of the examined GAGs it was determined that the most significant differences between individual groups appeared in the amount of heparane sulphate (HS). The results obtained confirmed the fact of the changes taking place in the picture of liver GAGs in the process of ageing of the examined animals. The results obtained, however, allowed to state the normalising influence of vitamin E on the quantitative composition of GAGs of rats which drank nitrates.

[Malondialdehyde (MDA) as a lipid peroxidation marker]. / Dialdehyd malonowy (MDA) jako wskaznik procesów peroksydacji lipidów w organizmie.

Free radicals generate the lipid peroxidation process in an organism. Malondialdehyde (MDA) is one of the final products of polyunsaturated fatty acids peroxidation in the cells. An increase in free radicals causes overproduction of MDA. Malondialdehyde level is commonly known as a marker of oxidative stress and the antioxidant status in cancerous patients.

Impact of rhinosinusitis symptoms on patients' self-esteem before and after FESS.

INTRODUCTION: Chronic rhinosinusitis (CRS) is one of the most common diseases in Polish society. According to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 the incidence of CRS among European and US citizens varies from 5 to 16%. Its treatment is based on pharmacotherapy or surgical procedure. The aim of the study was to evaluate the correlation between general health condition of the patients with CRS with each symptom of the disease before and after Functional Endonasal Sinus Surgery (FESS) procedure. MATERIALS AND METHODS: The study was conducted on 100 patients, who evaluated symptoms and general health condition twice - before and after FESS, by means of visual analogue scale (VAS). RESULTS: Before FESS the highest severity among all symptoms concerned the nasal blockade and olfactory disorders, while after the procedure this ratio was found to be the opposite. All results were statistically significant (p<0.05). CONCLUSIONS: The authors emphasize a great role of general health assessment in patients with CRS as the element of proper diagnosis and better comprehension of patients' needs. They indicate that the patient's estimation of the disease and its symptoms differs from the clinician's interpretation to much extent.

Cathepsin D activity in nasal polyps.

OBJECTIVES: The aim of the study was to assess the activity of cathepsin D in polyps removed during first-time FESS surgery and in recurrent polyps removed during successive FESS surgeries. DESIGN AND METHODS: The study examined 24 polyps: 11 polyps were removed during first-time surgical procedures (termed primary polyps in the study), and 13 recurrent polyps were removed in successive FESS surgeries (termed polyps after re-polypectomy in the study). The activity of cathepsin D was determined by measuring the tyrosine released from denatured hemoglobin. RESULT: The average cathepsin D activity in polyps after re-polypectomy was 74% higher than the average activity in primary polyps, whereas the difference between the maximum and the minimum cathepsin D activities in polyps after re-polypectomy was twofold greater than the respective difference in primary polyps. CONCLUSION: Differences in cathepsin activity and the protein content, likely to be significant in the process of polyp recurrence, were observed in both groups of polyps.