[Spasmodic dysphonia in course of Meige's syndrome--case report]. / Przypadek dysfonii spastycznej, wystepujacej w przebiegu zespolu Meige'a.

INTRODUCTION: The Meige's syndrom is characterized by the presence of bilateral, symmetrical, dystonic cramp of face muscles or muscles of middle line of body, the respiratory muscles and muscles of throat. The etiology of Meige's syndrome is uncertain. The disorders of basal ganglia function and neurotransmitters' imbalance (dopamine and acetylocholine) can be with reason of pronouncement of symptoms presumably. MATERIAL AND METHOD: Our aim was to introduce a case of 71 years old patient in whom we diagnosed spasmodic dysphonia in course of Meige's Syndrom. Patient has been treated by 3 years with Botulin toxin. The spasmodic Dysphonia occurred after over 2 years from appearing of first syndrom's symptoms. RESULTS: Sonorous voice during rehabilitation was got during expressing syllables and short bisyllabic words. Patient stays still under phoniatric care. CONCLUSIONS: Patients with spasmodic dysphonia ought to be examined by a interdisciplinary medical team.

[Expression of adhesive molecules, angiogenesis markers and protein products of suppressor genes in neoplasms of oral cavity and maxillary sinus]. / Ekspresja czastek adhezyjnych, wskazników angiogenezy i produktów bialkowych genów supresorowych w nowotworach jamy ustnej i zatok szczekowych.

INTRODUCTION: Adhesion molecules, angiogenesis markers and protein products of suppressor genes are potential prognostic indicators in different type of tumours. The purpose of this study was to analyze relations between expression of these markers and clinical as well as histological features of oral cavity and maxillary sinus tumours. MATERIAL AND METHODS: Measurements of expression of CD44, TP53, Nm23 oncoproteins and angiogenesis markers were performed. Forty-three patients treated in years 1985-2000 in the Department of Maxillofacial Surgery of the University Hospital in Wroclaw entered our study. Thirty-two of them were treated for oral cavity cancers. Remaining eleven patients were treated for maxillary sinus cancers. RESULTS: We have shown, there was a positive correlation between the number of the vessels and presence of the nodal metastases; between histological grading and VCAM expression; between CD44 expression and total surface area of the blood vessels. There was also correlation between total surface area of the blood vessels and patients' survival time.

[Chlamydia pneumoniae occurrence in children with adenoid vegetations]. / Wystepowanie Chlamydia pneumoniae u dzieci poddawanych adenotomii.

INTRODUCTION: In world literature there is a lack on informations about occurrence frequency of Chlamydia pneumoniae in swabs fromadenoid vegetations. Chlamydia spp. is a group of nontypical pathogenetic bacteria. Initially they were fought a cause of lower respiratory tract. Nowadays they are considered as a pathogenetic factor of upper respiratory tract infections. They can also cause persistant infection. MATERIAL AND METHODS: During 3,5 months at the end of winter and bigining of spring, 110 children qualified to adenotomy (53 girls and 57 boys) were examinated. The average of age carried out 6,11 years. RESULTS: the positive results of direct immunophluorescence test (IFA) of adenoid vegetations swabs were received in 29 children (26.4%). Received results demonstrate chronic infection with Chlamydia pneumoniae. Pneumonia or bronchitis was noted additionally at 3 children (2.7%) in this in one child pneumonia caused by C. pneumoniae was diagnosed, secretory otitis media was diagnosed in 5 children (4,5%), asthma in 3 patients (2,7%). Confirmed infection Chlamydia pneumoniae occurred earlier at 5 children (4.5%). CONCLUSION: Results of direct immunophluorescence test(IFA) of adenoid vegetations swabs do not correlate directly with levels of anty-C. pneumoniae antybodies in blood. But antybody level could be supplementary to clinical symptoms and and swab result or give us information about infection history in patient.

Brain auditory evoked potentials in children with Down syndrome.

UNLABELLED: Researchers have been examining the condition of the auditory organ in people with Down syndrome for many years. The aim of this work was an objective evaluation of the hearing threshold and a functional evaluation of the hearing pathway in children with Down syndrome without any disturbances in the middle ear. MATERIAL: Seventy children with Down syndrome, aged from 2 months to 17 years. Brain auditory evoked potentials (BAEP) were performed. The peak latencies in children who had a normal BAEP pattern at 70 dB sHL were analysed. Peaks I-III and interpeak latencies I-III were significantly shortened in Down syndrome children up to the age of 1 year, as compared to older children with Down syndrome and to the control group. Peak III and interpeak latencies I-III were significantly longer in older children with Down syndrome in comparison to the control group. CONCLUSIONS: Hearing loss in children with Down syndrome is more frequent than in healthy children. The average latency values of BAEP established for healthy children should not be used as a reference for children with Down syndrome. The shortening of the latency values in BAEP results of children with Down syndrome under 1 year of age may be connected with accelerated maturation of the nervous system or anatomical and/or functional disturbances of the central nervous system. BAEP is a valuable method that allows for the objective evaluation of the hearing threshold and functional condition of the hearing pathway in subjects who do not cooperate during testing.

[Rhabdomyosarcoma of nasopharynx and oropharynx in adult--a case report]. / Przypadek rhabdomyosarcoma nosogardla i gardla srodkowego u osoby doroslej.

The authors present the case of rhabdomyosarcoma--a rare malignancy--in the adult patient. The epidemiology, etiopathogenesis, diagnostics and therapeutical options were discussed.

[Analysis of vocal fold paresis in the patient material of the Department of Otolaryngology in Wroclaw from 1993 to 2002]. / Analiza porazen faldów glosowych w materiale Kliniki Otolaryngologicznej we Wroclawiu w latach 1993-2002.

The aim of this paper was analysis of vocal fold paresis in the patients referred to ENT Department in Wroclaw in the years 1993-2002. The study was performed on the base of 304 patients--209 women and 131 men. The average patient's age was 56 years. In all patients phoniatric examination and videostroboscopy were carried out. There were 38% cases of iatrogenic paresis mainly caused by thyroid surgery and cardiosurgery. In 30% causes we found the diseases which caused paresis (mainly infections, cancers, lesions of the central nervous system and injury of head, neck and chest). In about 30% causes we have not found the cause of paresis. Both vocal fold paresis in 98% was caused by thyroid surgery. Left vocal fold paresis was more often then paresis of the right side of vocal fold.

[Autofluorescence laryngoscopy in the diagnosis of laryngeal cancer--early results]. / Laryngoskopia autofluorescencyjna w diagnostyce zmian nowotworowych krtani--doniesienie wstepne.

BACKGROUND: During oncogenesis significant changes in tissue properties occur that result in alteration of fluorescence characteristics of the tissue. The aim of our study was to determine the usefulness of autofluorescence technique in diagnostic of laryngeal epithelium lesions. MATERIAL AND METHODS: 40 patients admitted to the Department of Otolaryngology Wroclaw Medical University due to different laryngeal lesions were included into the study. They underwent white light laryngoscopy followed by autofluorescence videoendoscopy. AF was induced by blue light of xenon short arc lamp and processed by a D-light AF System (Storz). Autofluorescence and white light images were immediately assessed and later compared with to histopathological findings. RESULTS: Normal laryngeal mucosa showed a typical green fluorescence signal. Squamous cell carcinoma displayed a diminished green fluorescence and in some cases presented reddish-yellow color. CONCLUSIONS: We revealed that autofluorescence laryngoscopy is very helpful, supplementary tool in diagnosis of laryngeal pathology. Autofluorescence laryngoscopy is noninvasive technique designed especially for diagnostic of early and premalignant lesions.

[Changes of laryngeal mucosa in the course of pemphigus vulgaris]. / Zmiany na blonach sluzowych krtani w przebiegu pecherzycy.

Blister diseases are chronic autoimmune reactions connected with formation of intraepithelial blisters. Pemphigus vulgaris (PV) change is appear most often, almost 80% of all cases. Erosions on mucosa appear as first symptoms at 50-70% patients. Blisters occurring on the skin are typical for this illness and usually come into with weeks or months with delay in relation to the changes on mucous membranes. In this work we have described character and location of changes on mucous membranes at 5 patients with PV, diagnosed based on clinical symptoms and confirmed in immunofluorescent investigations.

[Nasopharyngeal carcinoma coexistent with lymph node tuberculosis, diagnostic difficulties--case report]. / Rak nosogardla wspólistniejacy z gruzlica wezlów chlonnych szyi, trudnosci diagnostyczne--opis przypadku.

Nasopharyngeal carcinoma occurs about 0.25-0.5% all malignancies in Poland. From the mids of a group more frequent are undifferentiated cancer (about 70%). The authors describe a case of undifferentiated nasopharyngeal cancer in 17-years old woman, which is connected with lymphonodular tuberculosis. They point to precise diagnostics of lymphonodular metastases, looking for primary carcinoma focus and difficulties in diagnosis.

Investigation of normal and malignant laryngeal tissue by autofluorescence imaging technique.

OBJECTIVE: During oncogenesis significant changes in tissue properties occur that result in alteration of fluorescence characteristics of the tissue. The differences in autofluorescence between normal and malignant tissues offer new possibilities in detecting epithelial pathological lesions. AIM: The aim of our study was to determine the usefulness of autofluorescence technique in diagnostic of laryngeal tumors. MATERIAL AND METHODS: Fluorescence in larynxes from 10 laryngectomized cancer patients was induced by excitation light at 360-450 nm wavelength. As a light source, mercury lamp and laser (404 nm) were used. The CCD camera captured the fluorescent light emitted. Normal epithelium and cancer tissue were also analyzed on fluorescence microscopy. RESULTS: Laryngeal carcinoma tissues when excited with ultraviolet or blue light generate attenuated or absent autofluorescence in the green light band compare with normal epithelium where strong signal around 505 nm was detected. Average value of maximal autofluorescence intensities was 26.2V (range 18-35) and 4.4V (range 2-8) in healthy and cancerously changed mucosa respectively. Spectral analysis revealed that autofluorescence signal from unchanged mucosa (around 505 nm) was significantly higher compared to cancer tissue (P=0.005). CONCLUSIONS: It seems that autofluorescence imaging may be a supplementary tool in diagnosis of laryngeal tumors.

Quantitative evaluation of angiogenesis in laryngeal cancer by digital image measurement of the vessel density.

OBJECTIVE: the aim of our study was determination of the relationship between angiogenesis and clinical as well as histological features in laryngeal cancer. METHODS: we used two different methods of estimation of the amount of microvessels in the series of 55 cases, e.g. classical count of endothelial cells group (h-MVD) and digital image measurement of the vessel density (VD). RESULTS: neither h-MVD nor VD correlated significantly with clinical features of the tumour. The results of VD examination correlated significantly with the existence of nodal metastases (P=0.02). The relationship between h-MVD and N status was on the statistical borderline (P=0.07). Multivariate analysis of Cox's proportional hazards model revealed that only N status correlated significantly with patients' survival. CONCLUSION: our results indicate that measurements of angiogenesis in laryngeal cancer may be of some value in predicting N status in laryngeal cancer patients. This issue should be confirmed in prospective studies.

Histological and electron microscopic investigation of Reinke's edema.

Reinke's edema is a benign lesion of vocal fold affecting subepithelial space. This paper describes the histological features of Reinke's edema on the basis of an extensive number of cases (203 women and 58 men). In 10 cases the electron microscopic examination was performed. Edema of subepithelial tissue was present in 138(62%) cases. This phenomenon was observed more frequently in women than in men (p=0.01). In the subepithelial tissue there were a numerous wide vessels with oedematous endothelium. Leukoplakia and dysplasia of epithelium were present in 21(8%) and 16(6%) specimens, respectively. Leukoplakia was detected more often in men than in women. This relation was close to statistical significance (p=0.055). The presence of dysplastic lesions of the epithelium was correlated with the age of the patients and smoking habit (p=0.0042, p=0.0021). Electron microscopic investigations revealed loosened intercellular junctions and widening of intercellular spaces, especially in basal and spinous layers.

Treatment of Reincke's edema among different professional groups: presentation of results.

OBJECTIVES: Reincke's edema is one of the most common voice disorders in adults. The main purpose of our study, was to analyze factors that may influence the development of this disease. We also estimated the results of surgical treatment. MATERIALS AND METHODS: The research was performed on a group of 261 patients with Reincke's edema treated in the ENT Department of the Medical University of Wroclaw in the years 1994--2000. In the study population, women were in a majority and teachers formed the largest occupational group (30%) followed by salespersons (15%). Most of the patients (86%) were tobacco smokers. All of the patients underwent detailed videostroboscopic examination of the larynx and perceptual analysis of the voice quality before and after treatment. RESULTS: The symmetry of vocal cords before and after treatment was found in 75 patients. Lack of symmetry before treatment, and proper symmetry after surgery was observed in 71 subjects. Fifty patients showed less symmetry after treatment, and 65 patients were asymmetric before and after surgery. The difference between the symmetry of vocal folds before and after treatment was at the border of statistical significance (p = 0.069). The number of patients with full vocal cords closure increased after treatment. This difference was statistically significant (p = 0.032). The periodicity of vocal cord movements was significantly higher after treatment (p < 0.001). CONCLUSIONS: The perceptual assessment of voice, before and after treatment, revealed statistically significant post-treatment improvement in voice quality.

[DNA ploidy and DNA index in aneuploid laryngeal cancer]. / Ploidia DNA oraz indeks DNA guzów aneuploidalnych w raku plaskonablonkowym krtani.

UNLABELLED: Abnormal cellular DNA content, a hallmark of malignancy, is known to be an important prognostic factor in many human solid tumors. In laryngeal tumors studies are not as common as in different locations. THE PURPOSE: Of this study was to analyze the prognostic value of DNA content in squamous cell carcinoma of the larynx and relations between aneuploidy and clinical as well as histological features of the tumor. MATERIALS AND METHODS: Sixty-two patients with squamous cell carcinoma of the larynx treated in years 1997-2001 on the ENT department of the University Hospital in Wroclaw were subject of our study. Flow cytometric DNA ploidy, S-phase fraction and index DNA measurements were performed on fresh frozen tumor tissues. RESULTS: Results were compared to histological grading and TNM category. There was a positive relation between DNA aneuploidy, histological grading and with lymph node metastases. This correlation did not reach statistical significance. We also noticed low mean values of index DNA in advanced tumors (G3, T4, N+). CONCLUSIONS: The results of this study suggest that presence of aneuploid cells in laryngeal cancer can be related to lymph node metastases and tumor grading. Studies should be continued to prove results on the major number of patients.

[Two cases of unknown aetiology oedema-hypertrophy changes in the larynx]. / Dwa przypadki zmian przerostowo-obrzekowych krtani o nieustalonej etiologii.

We have described two cases of oedema and hypertrophic changes of the larynx which cause remains unknown. We have shown in our paper diagnostic difficulties connected with these cases. A brief review of the literature is presented. The oedema and hypertrophic changes might be connected with inhalations of marijuana smoke.

[Laryngeal symptoms in patients with gastroesophageal reflux diseases]. / Objawy laryngologiczne u chorych z choroba refluksowa przelyku.

Gastroesophageal reflux disease (GERD) is considered an important etiological factor of numerous larynx dysfunctions. The goal of our study was to describe larynx status of patients with GERD before and after treatment. Forty-five patients with GERD symptoms entered our study. GERD was confirmed in 24-hours pH-metric examination. Patients were treated with proton pump inhibitors in doses chosen accordingly to GERD severity. All patients underwent endoscopic evaluation of the larynx and acoustic voice analysis before and after the treatment. GERD was diagnosed in 35 out of 45 patients. Acoustic voice analysis revealed that voice disorders appeared more often in patients with severe than moderate or mild refluxes (p = 0.023). Laryngeal changes found in endoscopic evaluation also depended on reflux severity (p = 0.05). The voice quality improved (p = 0.031) and the changes in larynx diminished after anti-reflux treatment (p = 0.016).

[S+G2M phase fraction and index of DNA in the aneuploid laryngeal cancer]. / Wspólczynnik proliferacji komórek i wartosc indeksu DNA w aneuploidalnych rakach plaskonablonkowych krtani.

Abnormal cellular DNA content, a hallmark of malignancy, is known to be an important prognostic factor in many human solid tumors. The purpose of the following research was to analyze the prognostic value of DNA index in aneuploid squamous cell carcinoma of the larynx and relations between S+G2M phase fraction and clinical as well as histological features of the tumor. Eighty-six patients with squamous cell carcinoma of the larynx treated in years 1997-2002 in the ENT Department of the University Hospital in Wroclaw were subject of our study. Flow cytometric DNA ploidy, S-phase fraction and index DNA measurements were performed on fresh frozen tumor tissues. Results were compared to histological grading and TNM category. We have shown, there is a positive correlation between the histopathological diagnosis and DNA ploidy, between DNA ploidy and S+G2M phase fraction and between the tumor size and S+G2M phase fraction. We noticed a positive correlation between the DNA index of the tumor and presence of the nodal metastases, there was also correlation between the DNA index of the tumor and S+G2M phase fraction.

Corticosteroid-induced laryngeal disorders in asthma.

BACKGROUND: Inhaled corticosteroids have proven to be the most effective agent available in treating bronchial asthma, and such treatment is believed to be very safe. Concerns regarding side effects of inhaled corticosteroids usually focus on potential systemic effects, where local side effects are often overlooked. The purpose of this study was to analyze and assess the influence of inhaled corticosteroids on the vocal cords of patients treated for bronchial asthma. MATERIAL/METHODS: Fifty patients (mean age: 50 years, range: 22 to 83 years) suffering from asthma and receiving corticosteroidal inhaled agents entered in this study. All of the patients underwent detailed videoscopic examination of the larynx. None complained of any laryngeal disorders or dysfunction before the diagnosis of asthma. All of the patients were non-smokers. RESULTS: Significant changes in the laryngeal status were observed. Changes included atrophy of laryngeal mucosa, vocal fold atrophy, and vocal fold bowing. CONCLUSIONS: Damage to the larynx is an important factor in patients with asthma treated with inhaled corticosteroids, which elicit apoptosis of the epithelium.

Hormonal markers of aging in men with laryngeal carcinoma.

BACKGROUND: Cancer of the larynx, a frequent neoplasm in older people, occurs several times more often in men than in women. Surprisingly, the highest incidence of the disease is observed in the period in which concentrations of a number of hormones (eg, androgens, growth hormone) decrease. Our objective was to look for differences in hormonal markers of aging between men with laryngeal carcinoma and healthy control subjects. METHODS: Seventy-eight men with cancer of the larynx and 51 healthy age-matched controls were recruited for the study. In each of the examined men, serum concentrations of total testosterone, free testosterone, dihydrotestosterone, dehydroepiandrosterone sulfate, steroid-hormone binding globulin, estradiol, and insulin-like growth factor type 1 (IGF-1) were determined. RESULTS: Men with laryngeal carcinoma had lower serum concentrations of IGF-1 (136 +/- 75 vs 318 +/- 141 ng/mL, p < .000001), lower free testosterone (11.95 +/- 5.38 vs 15.48 +/- 4.96 pg/mL, p < .001), and lower dihydrotestosterone/total testosterone ratio (0.07 +/- 0.06 vs 0.09 +/- 0.04, p < .05) than healthy controls had. CONCLUSIONS: Somatopause seems to be more evident in men with laryngeal carcinoma than in age-matched controls. In our observation, low concentration of IGF-1 predicted the presence of laryngeal carcinoma more than low concentration of free testosterone did.