[Evaluation of treating head and neck rhabdomyosarcoma in the Pediatric Institute in Poznan in 1973-1997]. / Ocena leczenia rhabdomyosarcoma glowy i szyi w Instytucie Pediatrii w Poznaniu w latach 1973-1997.

In the paper the authors present the evaluation of head and neck rhabdomyosarcoma (RMS) treatment in 14 children admitted to Pediatric Institute in the past 25 years. The treatment was related to the stage of the neoplasm at the time of diagnosis and consisted in the surgical intervention combined with chemo- and radiotherapy. Embryonal stage was diagnosed in 10 children (71.4%) and alveolar stage in 4 children (28.6%). In the analysed material primary neoplastic changes were found: in 6 cases in the orbit, in 2 cases in the maxillary sinus and nasal cavity, in 2 cases in the mandible. We noted also 1 case in each of the following structures: the nasopharynx, the palate, the pterygoideo-palatal fossa, the neck. In the years 1973-1991--7 children were treated according to the IRS I and II projects. Three of the children presented with the third stage of neoplastic disease and the rest with the second. Between the years 1991-1997--7 other children were hospitalized and underwent treatment based on CWS-91 project. Six of them showed the third stage of neoplasm, and only one--the first. The performed analysis revealed the insignificant improvement in the effectiveness of the treatment after the introduction of the CWS-91 project.

[Monitoring of the inflammation in children before and after tonsillectomy]. / Monitorowanie stanu zapalnego u dzieci przed i po tonsylektomii.

A group of 54 children aged from three to 13 years was qualified to tonsillectomy for laryngological indications. In sera of all children following measurements were performed: the concentrations of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP) and alpha1-antichymotrypsin (ACT) were measured using rocket immunoelectrophoresis according to Laurell, also concentrations of three main immunoglobulin classes (IgA, IgG, IgM) and antistreptolysin titer. The microheterogeneity of both AGP and ACT was investigated, using crossed affinity immunoelectrophoresis according to Bog-Hansen with Concanavalin A (Con A) as a ligand. Results were expressed as reactivity coefficients (RC), being the proportion of all Con A-reacting variants to the non-reacting variant. It is worth mentioning that there was no difference in all investigated parameters as well between groups obtained by categorizing children according to the presence or absence of elevated antistreptolysin titer. It may mean that at least in some cases the chronic inflammation was caused by streptococci non-producing streptolysin O. The results obtained suggest that the absence of the arthritic pain does not exclude the need of antibiotic therapy in children after tonsillectomy. Generally it is postulated that estimation of acute phase proteins concentrations and glycosylation profiles, which were previously shown to be useful in clinical assessment of various diseases may serve as additional marker in laryngology in cases where indications to tonsillectomy are still controversial.

[Congenital laryngomalacia in children]. / Wrodzona wiotkosc krtani u dzieci.

Laryngomalacia is the most common cause of congenital infantile stridor which is respiratory in all cases. It is first noted at birth and usually resolves spontaneously by the age of 2 years. In severe cases it may lead to life-threatening obstructive apnea, cor pulmonale and failure to thrive, and in these patients surgical intervention may be required. This anomaly has been described in the medical literature for over 100 years. The purpose of this study is to review the literature, present terminology, types of laryngomalacia, cause, pathogenesis and relationship with other diseases. Finally, we describe the possible methods of its treatment.

[A case of malignant carcinoma in submandibular salivary gland in a 13-year old girl]. / Przypadek nowotworu zlosliwego slinianki podzuchwowej u 13-letniej dziewczynki.

Of all head and neck neoplasms, 3% are malignant salivary neoplasms. Only 20% of them affect submandibular glands. These tumours vary histologically, which results from the complex embryogenesis of the glands. Malignant submandibular gland tumours are twice as frequent as parotid gland tumours. Simultaneous occurrence of quite different malignant tumours in the same salivary gland is extremely rare. The age range of patients affected with salivary gland neoplasms is wide. However, the occurrence of these neoplasms in children is exceptionally rare. The authors describe a case of a 13-year-old girl with acinose adenoid carcinoma and cystiscarcinoma coexisting in one submandibular salivary gland.

The problem of lower respiratory tract foreign bodies in children.

The authors treat the problem of lower respiratory tract foreign bodies in children on the basis of their own longterm experience. In the years 1972-1991 in the Pediatric E.N.T. Clinic of the Pediatric Institute, Academy of Medicine in Poznan, 147 foreign bodies were removed. A positive history of foreign body aspiration was obtained in 45.7% of the cases. 44.7% of the foreign bodies were removed during the first 24 hours after their aspiration. Broncho-pulmonary complications occurred in 59.1% of the cases.

Nasal septum deviation in newborns.

The patency of the nose is very important for the newborn. Nasal septum deviation (NSD) is one of the most important factors causing disorders of the patency of the nose. It is usually the result of mechanical trauma. The relationship between the course of delivery and deformation, deviation and luxation of the nasal septum is examined. 410 newborns--297 born in natural labour and 113 in Caesarean section, were examined. Also the kind of birth, the position of the fetus during the first and second stages of labour and the weight of the newborns was analyzed. NSD was found in 14.3% of the cases. Follow-up examination of those children was performed 4-6 months after the first check-up. NSD was observed mainly in children born head first.

[Direct laryngoscopy and laryngeal microsurgery in children under general anesthesia]. / Laryngoskopia bezposrednia oraz zabiegi mikrochirurgiczne krtani u dzieci w znieczuleniu ogólnym.

The great local irritability, especially on mechanical agents (giving shock), required the great caution during the laryngeal microsurgery. Local anesthesia lowered the shock risk and assure the safe and precise maneuvers. However, the tracheal tube in the small children larynx limits the visibility. The aim of this work is the description of our experiences in direct laryngoscopy and laryngeal microsurgery in children under general anesthesia, by use of tracheal tube. The significant modification is a metal tube, fixed to the laryngoscope, by which the halothane and oxygen mixture was given constantly. 201 endoscopy and microsurgery maneuvers of the larynx were performed in our Clinic.

[Blood serum cortisol level in children with palatine and pharyngeal tonsil hypertrophy]. / Poziom kortyzolu w surowicy krwi u dzieci z przerostem migdalków podniebiennych i gardlowego.

Because the etiopathogenesis of the Waldeyer's ring hypertrophy is not fully recognized, evaluation of adrenal cortex function in this disorders was made. Serum cortisol level was determined by sulfuric acid fluorescence under resting conditions and 3 hours after ACTH injection. Investigations were performed on 20 children, aged 5-9 years, in all of them a marked hypertrophy of palatine and pharyngeal tonsils was found. These children were divided into two groups, the first one included 11 children with frequent angina and the second group consisted of 9 children with serious difficulties in breathing, but without angina. In these groups serum cortisol levels were estimated before and 3-4 months post tonsilectomy or adenotomy. 11 healthy children of the similar age were included into a control group. It was found that in the first group (hypertrophy and frequent angina) initial resting and ACTH stimulated cortisol levels were statistically significantly higher than in the control group. In the same group 3-4 months post surgery serum cortisol levels were lower and similar to those found in control group. On the contrary, in children of the second group (hypertrophy without angina) the resting and ACTH stimulated serum cortisol levels were lower than in control group and these levels did not change 3-4 months after surgery.

[Cortisol blood level in children with subglottic laryngitis (author's transl)]. / Die Kortisolkonzentration im Blutplasma bei Kindern mit subglottischer Kehlkopfentzündung.

Clinical observations have shown that fear of suffocation aggravates respiratory tract occlusion in children with subglottic laryngitis (s.l.). In similar situations of emotional stress, changes occur in the function of the adrenal glands. The author's observations lead to the conclusion that rapid intravenous injection of glucocorticoids results in the alleviation of symptoms endangering a child's life so that in a majority of cases a tracheotomy is no longer necessary. Cortisol blood level was estimated by the technique of de Moor as modified by Derech and Golebiowska. These levels were then determined in 20 children with s.l. not treated with glucocorticoids before hospitalization and 10 children in a control group. In children with s.l., high levels of cortisol were detected at the time of admission. In a few cases 100 microgram/100 ml. After symptoms of s.l. subsided, levels of cortisol resembled those of the control group as seen on primary examination. Administration of ACTH induced a more pronounced increase in cortisol level in children with s.l. than in children of the control group.