Simultaneous treatment of intracranial complications of paranasal sinusitis.

PURPOSE: The objective of this study was to analyse 51 patients with intracranial complications of sinusitis treated in the Department of Otolaryngology and Laryngeal Oncology at Poznan University of Medical Sciences from 1964 to 2016. MATERIALS AND METHODS: Males made up a significant portion of study participants at 70.5%. Treatment included simultaneous removal of inflammatory focal points in the paranasal sinuses and drainage of cerebral and epidural abscesses and subdural empyemas under the control of neuronavigation preceded by the implementation of broad-spectrum antibiotics continuously for 4 weeks. Seventy-three intracranial complications were found among 51 patients. Of the 51 patients, 25 had frontal lobe abscesses (including multiple abscesses). Other complications included the following: 16 epidural abscesses, 9 subdural empyemas, 15 meningitis cases, 3 intracerebral abscesses, 3 sinus thrombosis cases and 2 patients with cerebritis. Co-occurrence of these complications worsened the state of the patient and increased the duration of treatment. Patients with frontal lobe abscesses had a better prognosis and less pronounced neurological symptoms in recent years versus earlier treatment approaches. CONCLUSIONS: Simultaneous treatment of intracranial complications of sinusitis is an effective treatment method that has minimal burden for the patient. From 1964 to 1978, three deaths (17%) were reported among patients with these complications. Since 1978, no deaths were reported in the clinic.

Intracranial complications from sinusitis.

INTRODUCTION: Despite increasingly better diagnostic and therapeutic methods intracranial sinogenic complications, invariably pose a direct threat to the lives of patients and a challenge for otolaryngologists. AIM: The aim of the study was to analyze patients with intracranial sinogenic complications treated at the Department of Otolaryngology and Otolaryngological Oncology of Poznan University of Medical Sciences in the years 2000-2013. MATERIAL AND METHODS: Analysis covered the period from January 2000 to December 2013. Twenty-one patients with intracranial sinogenic complications were treated at the Department of Otolaryngology in Poznan during that time. RESULTS: Material mainly included young men. Brain abscesses were the most common complications. Intracranial complications of sinusitis rarely occurred in isolation, often coexisting with other intracranial pathologies. A significant increase in the incidence was recorded in 2013. Treatment involved concurrently alleviating inflammation in the sinuses through implementation of broad-spectrum antibiotics for several weeks and decompressing the organized intracerebral abscesses, empyema, epidural and/or subdural abscesses under control of neuronavigation. There were no patient deaths recorded in the analyzed period. CONCLUSIONS: The risk of developing intracranial sinogenic complications is low but invariably present and should be included in the differential diagnosis. Since the incidence of intracranial complications may increase in the course of prevailing viral infection, it should raise diagnostic vigilance.

[Anterior commissure status in patients with larynx cancer]. / Stan spoidla przedniego u chorych na raka krtani.

AIM OF THE WORK: Assessment of directions and ways of cancer spreading in the anterior commissure of the larynx, depending on the tumor location, age, sex of patients in a clinical trial and in microscopic serial section study. MATERIALS AND METHODS: The study included 50 larynx preparations obtained from open partial and total laryngectomies (F-7; M-43). For the assessment of larynx anterior commissure microscopic status 28 larynx preparations with macroscopic free anterior commissure were used. For study of the directions and ways of tumor spreading in the anterior commissure served 22 larynx with macroscopic infiltration of anterior commissure. Anterior Commissure (AC) and TNM classifications was used to determine the location and tumor stage. Larynx anterior commissure was extracted and divided into 3 subregions: supraglottic, glottic and subglottic. RESULTS: The direction and the way of cancer propagation in larynx anterior commissure structures is dependent on morphological changes that occur with aging. Cancer spreads in the anterior commissure along the fibers anchoring voice muscle within the Broyles ligament and is seen in tumor cells microembolism. CONCLUSIONS: In patients with cancer of the larynx without macroscopically visible neoplastic lesions in the anterior commissure, cannot be excluded its microinfilration. Changed with age anterior commissure' Broyles ligament by the process of neovascularization and ossification is not an effective protection against the spread of cancer. Directions and the ways of cancer spread in the anterior commissure is similar in men and women. AC classification can be important in qualifying patients for organ preservation surgery and should be supplemented by an additional AC4 degree, taking into account subglottic changes in the anterior commissure of the larynx.

PRAME expression in head and neck cancer correlates with markers of poor prognosis and might help in selecting candidates for retinoid chemoprevention in pre-malignant lesions.

OBJECTIVES: PRAME (Preferentially Expressed Antigen in Melanoma) is a tumor-associated antigen recognized by immunocytes, and it induces cytotoxic T cell-mediated responses in melanoma. PRAME expression in tumors interferes with retinoic acid receptor (RAR) signaling thus promoting tumor progression. Here, we study PRAME expression in head and neck squamous cell carcinoma (HNSCC) to determine its potential clinical significance. MATERIALS AND METHODS: PRAME expression in HNSCC was evaluated by immunohistochemistry in tissue microarrays of primary tumors (n=53), metastatic lymph nodes (n=8) and normal oral mucosa (n=11). Biopsies of dysplastic oral lesions (n=12) were also examined. PRAME expression levels in tissues were correlated with markers of poor prognosis in HNSCC. PRAME mRNA in HNSCC cell lines and in normal immortalized human keratinocytes (HaCaT cell line) was measured by qRT-PCR, and the protein expression by flow cytometry and western blots. RESULTS: PRAME was expressed in HNSCC cell lines and HNSCC lesions. PRAME expression in dysplastic mucosa was variable. No or only weak expression was found in normal cells or tissues. PRAME expression levels significantly correlated with the tumor grade, size, nodal involvement and the clinical status of HNSCC patients. CONCLUSIONS: Elevated PRAME expression associates with clinicopathologic markers of poor outcome in HNSCC and might identify potential candidates with pre-cancerous lesions for chemoprevention with retinoids.

Head and neck squamous carcinomas with exophytic and endophytic type of growth have the same prognosis after surgery and adjuvant radiotherapy.

Head and neck squamous cell carcinomas (HNSCC) are characterized by exophytic or endophytic growth. We hypothesized that the growth pattern predicts outcome and associates with distinct clinical and immunological profiles. Tumors obtained from 60 HNSCC patients treated with surgery and adjuvant radiotherapy were identified as exophytic or endophytic. Recurrence-free survival (RFS) at 42 months was determined. In a subsets of 30 patients (22 exophytic and 8 endophytic) tumor stroma and parenchyma were evaluated for infiltrating CD4(+) and CD8(+) T, dendritic, myeloid and FOXP3(+) regulatory T cells (Treg) and expression of immunosuppressive cytokines by immunohistochemistry. The localization and frequency of positive cells were determined microscopically and analyzed by hierarchical clustering to distinguish exophytic versus endophytic tumors. 34/60 patients had exophytic and 26/60 endophytic tumors. No differences in clinicopathologic data, disease progression or RFS were seen between the two cohorts. Infiltrates of CD3(+)CD8(+) T cells were larger in endophytic than exophytic tumors, while FOXP3(+) Treg, TGF-ß(+), IL-10(+), Arg-1(+), CD11b(+) cells were equally prominent in both. FOXP3(+) Treg accumulated in endophytic tumor nests, while the exophytic tumor stroma was enriched in IL-10(+) cells (both at p < 0.05). Hierarchical clustering based on immunophenotyping failed to identify different clusters in these two tumor types. However, CD68(+) macrophages and FOXP3(+) Treg showed a distinct distribution. The HNSCC growth pattern did not predict RFS. Although higher numbers and differences in localization of immunosuppressive cells in endophytic versus exophytic tumors were observed, no significant relationship was established between the growth pattern and the immune profile of infiltrating lymphocytes.

[The role of surgical treatment for nasopharyngeal carcinoma]. / Miejsce leczenia chirurgicznego w rakach czesci nosowej gardla.

AIM: Presentation of experiences and results of surgical treatment of nasopharyngeal carcinoma. MATERIAL AND METHODS: 4 patients with nasopharyngeal carcinoma operated in Department of Otolaryngology and Laryngological Oncology of Poznan University of Medical Sciences between 2006 and 2011. In one case operation was performed via transpalatal approach and in other three cases via transfacial approach (via lateral rhinotomy). In all cases operation was supported by endoscopy and in advanced tumors (T4) also by navigation. RESULTS: We have not observed any important intraoperation and postoperation complications. Two patients with T2 tumor are disease free (observation time 5 years and 1 year). One patient with T4 tumor developed local recurrence and after few months died. Second patient with T4 tumor refused further control. CONCLUSIONS: 1. Instead of that nasopharyngeal carcinoma is typically treated by radiotherapy or in advanced stages by radio-chemotherapy, in some cases surgical treatment should be used. 2. The main indication to surgical treatment are residual and recurrent tumors after radiotherapy or radio-chemotherapy--both in nasopharynx and in cervical lymph nodes. It can be also used in primary, limited, radio-resistant tumors. 3. Appropriate surgical approach and using of endoscopy and navigations are important factors which influence the radical and safe excision of tumor. 4. The results of treatment of residual and recurrent tumors of nasopharynx depend on stage of disease and complexity of excision of the tumor and the worst prognostic factor is intracranial extension of tumor.

Evolution in management of otogenic brain abscess.

OBJECTIVE: To present the therapeutic results related with treating 103 patients with cerebral abscesses of otogenic origin during 3 various time frames (1953-1977, 1978-1989, and 1990-2011). PATIENTS: A total of 103 patients with cerebral abscess of otogenic origin. INTERVENTIONS: Diagnostics and treatment. MAIN OUTCOME MEASURES: Analysis of mortality rates, abscess location and its basis, coexisting complications, neurological condition at admittance, bacteriological tests, and presentation of the results of abscess treatment with the use of neuronavigation. RESULTS: Mortality rates dropped systematically from the initial value of 35% observed between 1953 and 1977, to 14% between 1978 and 1989, and finally reached 3% between 1990 and 2011. Abscesses were mainly located within the temporal lobe. They predominantly resulted from chronic inflammation of the middle ear. A wide panel of complications was associated with them. Strong concurrence between results of cultures taken from the ear and the abscess was noted. CONCLUSION: Cerebral abscesses remain one of the most severe complications related with inflammation of the middle ear. Both the operative methods and the postoperative care evolved (introduction of surgical microscope, new generation of antibiotics), the preoperative diagnostics facilitating the diagnosis and localization of the abscess progressed; nonetheless, the principles underlying the operative treatment remained unchanged. Neuronavigation constitutes a very important and supportive element in the management of otogenic brain abscesses.

[Results of treatment of 101 otogenic brain abscesses--56-years experience]. / Wyniki leczenia 101 usznopochodnych ropni mózgowia na przestrzeni 56 lat.

INTRODUCTION: Inflammatory process in the areas of the middle ear creates a possible danger related with the development of extratemporal and intratemporal complications. The most dangerous of those include meningitis and cerebral abscesses, which are still present. AIM: The aim of the work is to present 101 patients with cerebral, in temporal lobe, and cerebellar abscesses of aural origin throughout the period of 56 years, namely between 1953 and 2009. MATERIAL AND METHOD: Data concerning the patients have been obtained retrospectively on the basis of medical files. The analysis covered otolaryngological and neurological examinations, as well as method related with diagnosing abscesses. The thesis distinguished three periods of diagnosing otogenic brain abscess, depending on available diagnostic techniques. The first period covers the years 1956-1978, when constituted the basis of diagnosis. During the second period, falling between 1979 and 1989, the diagnosis was based on computed tomography of the head, while within the third period, including the years between 1990 and 2009, diagnosis focused on nuclear magnetic resonance. During the last two years neuronavigation was utilized for puncturing abscesses. CONCLUSIONS: The survival rate equalled 65% between 1953 and 1978, reached 86% between 1979 and 1989, and 91% after the year 1990, however, it is worth mentioning that after the year 1995 there were no fatal cases.

Triggering of Toll-like receptor 4 expressed on human head and neck squamous cell carcinoma promotes tumor development and protects the tumor from immune attack.

Toll-like receptors (TLR) expressed on inflammatory cells play a key role in host defense against pathogens, benefiting the host. TLR are also expressed on tumor cells. To evaluate the role of TLR in tumor cells, we investigated TLR4 signaling effects on human head and neck squamous cell carcinoma (HNSCC). Tumor tissues were obtained from 27 patients with laryngeal and 12 with oral cavity cancers. Normal mucosa was obtained from 10 patients with nonneoplastic disorders. Smears for bacteria were taken from all patients during surgery. TLR4 expression in tumors and HNSCC cell lines (PCI-1, PCI-13, and PCI-30) was detected by reverse transcription-PCR and immunohistochemistry. Cell growth, apoptosis, nuclear factor-kappaB (NF-kappaB) translocation, and MyD88 and IRAK-4 expression, as well as Akt phosphorylation were measured following tumor cell exposure to the TLR4 ligand lipopolysaccharide (LPS). Tumor cell sensitivity to NK-92-mediated lysis was evaluated in 4-hour (51)Cr-release assays. Cytokine levels in HNSCC supernatants were measured in Luminex-based assays. TLR4 was expressed in all tumors, HNSCC cell lines, and normal mucosa. The TLR4 expression intensity correlated with tumor grade. LPS binding to TLR4 on tumor cells enhanced proliferation, activated phosphatidylinositol 3-kinase/Akt pathway, up-regulated IRAK-4 expression, induced nuclear NF-kappaB translocation, and increased production (P<0.05) of interleukin (IL)-6, IL-8, vascular endothelial growth factor, and granulocyte macrophage colony-stimulating factor. TLR4 triggering protected tumor cells from lysis mediated by NK-92 cells. TLR4 ligation on tumor cells supports HNSCC progression.

[Paratracheal lymph nodes in patients with larynx and hypopharynx cancer in radiological and clinical examination]. / Wezly chlonne przytchawicze u chorych na raka krtani i gardla dolnego w ocenie radiologicznej i klinicznej.

INTRODUCTION: Paratracheal lymph nodes receive the lymph from the larynx, hypopharynx, esophagus, thyroid gland and trachea. It is evaluated, that metastases to these nodes occur in about 10-30% of patients with cancer of the larynx, hypopharynx or cervical esophagus. These metastases can lead to the most tragic complication after total laryngectomy, which is the stomal recurrence, Paratracheal lymph nodes are not accessible to examine by palpation or ultrasonography. AIM: The aim of this study was to estimate the usefulness of CT, MRI and clinical intraoperative investigation in the search for enlarged paratracheal lymph nodes. MATERIAL AND METHODS: The investigation was performed in 15 patients with advanced larynx and/or hypopharynx cancer. In all the patients we carried out palpation and ultrasonography of the neck, in 7 cases CT and in another 8 cases MRI of the neck. In all the patients who were operated (14 cases) the exact search for enlarged paratracheal lymph nodes during operation was performed. RESULTS: Palpation and ultrasonography of the neck did not found any enlarged paratracheal lymph nodes in anybody of the patients. CT showed one enlarged prelaryngeal lymph node in one patient. MRI showed one enlarged pretracheal lymph node in another one patient. During operation we found one enlarged paratracheal lymph node, which was not seen in MRI. All these nodes were pathologically not metastatic. CONCLUSIONS: The analysis of the state of paratracheal lymph nodes is very important in prophylaxis of stomal recurrence after total laryngectomy. However preoperative estimation of these nodes is very difficult and limited. It seems to us, that the best way of estimation of the state of paratracheal lymph nodes is intraoperative exploration of the area between trachea and esophagus and excision even loose tissue to pathological examination.

[Experiences with treatment of extended laryngo-tracheal stenosis with employment of transversal resection of trachea]. / Doswiadczenia w leczeniu rozleglych zwezen krtaniowo-tchawiczych z zastosowaniem metody poprzecznej resekcji tchawicy.

UNLABELLED: The aim of this study is to evaluate the results obtained in Department of Otolaryngology et Oncology with transversal resection of trachea acc. to Pearson technique for postintubation stenosis. METHODS: from January 2000 to January 2008 ten patients with subglottic postintubation stenosis underwent surgical treatment, using Pearsons method of operation with preservation of recurrent nerves and no postopereative tracheostomy. Mean stenosis length was 2 cm, the length of of airway resection was 1,5-4 cm. RESULTS: There was no surgical or postoperative complications, all the patients get totally health, no restenosis was observed. The results confirm that the Pearsons method of operation is an adequate treatment for subglottic stenosis.

[Antiplatelet therapy can unmask an inherited bleeding disorder. Aspirin-like defect of platelets does not protect against atherosclerosis]. / Leczenie przeciwplytkowe moze ujawnic wrodzona skaze krwotoczna. Aspirynopodobny defekt plytek krwi nie chroni przed miazdzyca

Some inherited platelet disorders may be revealed late, as in the presented case of a 68-year-old-man. Recurrent epistaxis following peri-interventional antiplatelet therapy (after three elective percutaneous coronary interventions) and an episode of upper gastrointestinal haemorrhage required aspirin withdrawal and less frequent clopidogrel use. Platelet studies showed an aspirin-like defect resulting in a lack of arachidonate-induced platelet aggregation. During dose-reduced (2-3 times a week) clopidogrel administration ADP-induced platelet aggregation was effectively inhibited and neither important bleeding nor stent thrombosis occurred. The inherited defect of cyclooxygenase-1, responsible for platelet thromboxane synthesis, did not protect the patient against coronary and extra-cardiac atherosclerosis.

[Scared atrophy of the cervical part of trachea as an effect of prolongated intubation]. / Bliznowaty zanik odcinka szyjnego tchawicy w nastepstwie przedluzonej intubacji.

Tracheal intubation is presently one of the basic medical procedures. It is connected with many different complications. One of them is tracheal stenosis, which occurs in 6-21 percent of patients after intubation of the trachea. In contrast to this high frequency of tracheal stenosis we didn't find any publications about complete atrophy of a big part of trachea after prolongated intubation and we describe a first case of such complication. The reasons and the possibilities of treatment in such situation are discussed.

[Stomal recurrence after total laryngectomy]. / Wznowa wokól tracheostomy po calkowitym usunieciu krtani.

UNLABELLED: Stomal recurrence after total laryngectomy is a very serious complication, in general with dismal prognosis. There are only a few possibilities of treatment, so stress should be put on prevention. MATERIAL: In the ENT Department Poznan University of Medical Sciences between 1997-2004 829 total laryngectomy were performed, because of advanced laryngeal cancer (T3, T4). In this group until may 2005 37 cases of stomal recurrence were found. AIM: The aim of this study was to analyse the group of patients stomal recurrence. RESULTS: Stomal reccurence developed in 35 men and 2 women. The age of patients was 43-79 years (mean 59 years). The time of lasting the symptoms before laryngectomy was 6-12 months (mean 8 months). The emergency tracheotomy was performed in 16 patients (43%). The time between tracheotomy and laryngectomy was 2 days to 3 weeks (mean 6 days). The subglottic extension was observed in 24 patients (65%). 19 patients (51%) was classified as T3, 18 (49%) as T4. 12 patients (32%) was classified as N0, 5 (14%) as N1, 16 (43%) as N2 and 4 (11%) as N3. 4 patients were earlier treated because of larynx cancer (2 of them has laser chordectomy and 2 fronto-lateral laryngectomy). The time between laryngectomy and radiotehrapy was 4-15 weeks (mean 7 weeks). 22 patients (59%) were classified (due Sisson at al) as type I, 12 (32%) type II, 2 (6%) type III and 1 (3%) type IV. The treatment of stomal recurrences consisted of surgical resection of tumor, chemiotherapy, radiotherapy, brachytherapy or palliative treatment. 34 patients died, 2 are presently treated and 1 is near 5 years free of disease after surgical treatment. CONCLUSIONS: Patients with stomal recurrences begun primary treatment in locally and regionally advanced disease. In more that 60% of patients subglottic extension was observed. Emergency tracheotomy may predispose to stomal recurrence. Limited possibilities of treatment of stomal recurrences are the reason of very poor prognosis in this group of patients. During total laryngectomy paratracheal lymphatic nodes should be looked for and dissect.

[Local changes in the oral cavity in patients after operation of malignant tumours of the tongue and bottom of the oral cavity]. / Stan jamy ustnej u chorych po operacjach nowotworów zlosliwych jezyka i struktur przyleglych.

This study is aimed an objective and subjective evaluation of local changes after operations of malignant tumours of the tongue and the bottom of the oral cavity. THE MATERIAL AND METHODS: we have examined 74 patients (70 men and 4 women) treated in Department of Otolaryngology of the University School of Medical Sciences in Poznan with recognized of malignant tumour of the tongue and floor of the mouth. On the base of subjective and objective ultrasound and x-ray examination with use of contrast and stereognostic test it was evaluated movability, alteration of articulation zones, regularity of swallowing acts, sense of taste and efficiency of stereognosion. In all of the patients we found orders in swallowing, speech and taste dependen on the kind of the operation.

[The impact of paraglottic space for laryngeal cancer spread]. / Znaczenie przestrzeni okologlosniowej dla rozprzestrzeniania sie raka krtani.

INTRODUCTION: Malignant laryngeal cancer is the most common tumor of the head and neck. Radical laryngectomy not only causes the changes in breathing routes and disability to retain the air in the chest during the physical effort, but it also deprives the patient of a possibility to communicate. In order to limit and avoid mutilating surgery i.e. total laryngectomy, precise evaluation of tumor dimensions and spread is indispensable for organ preservation techniques application. AIM: The authors have undertaken the task of estimating the role of paraglottic space in spread of larynx cancer. MATERIALS: The material of 180 patients operated on because of larynx cancer were analysed. 32% patients suffered from epiglottic carcinoma, 26% from glottic, 17% from transglottic carcinoma and 27% from multifocal carcinoma. Subglottic carcinomas was not identified. CONCLUSIONS: The paraglottic space was the most frequently penetrated by advanced tumors invading all three levels of the larynx, next by the transglottic tumors and by glottic localisations of cancer. The difficulties in diagnosing of this anatomical region have been stressed.

[Advances in the diagnosis of unknown primary carcinoma of the neck]. / Postey w diagnostyce przerzutów szyjnych z nieznanego ogniska nowotworowego.

UNLABELLED: The diagnosis of carcinoma of unknown primary is set, when histologically the neck metastases are confirmed but the primary focus is not possible to be found or occurs during the follow-up. The CUP-nodes constitute 2-20% of all neck metastases in laryngological entities. The squamous cell carcinoma or anaplastic carcinoma recognized in the neck nodes suggest, that the primary focus is localised in the head and neck region. AIM: The schedule of diagnostic procedure aiming at finding the primary focus in CUP-syndrome is presented. The knowledge of carcinoma cells spreading paths between particular neck regions is crucial for effective diagnostics of tumor localization in upper aerodigestive tract. RESULTS: Among 3320 oncological patients treated between 1993-2003 in Department of Otolaryngology, Head Neck Oncological Surgery 32 were diagnosed as CUP syndrome. In 17 patients the primary localisation was revealed during the follow-up period in: nasopharynx, palatine tonsil, hypopharynx, testis and breast. In 15 patients the primary focus was never found. The radical neck dissection followed by radiotherapy or chemotherapy was performed in patients with CUP. In cases when primary tumor was found, the radical surgery or radiotherapy was additionally applied.

[Prognostic value of low hemoglobin concentration in adjuvant radiotherapy after total laryngectomy in group of patients with laryngeal cancer]. / Rokownicze znaczenie niskiego poziomu hemoglobiny w uzupelniajacej radioterapii u chorych po calkowitym usunieciu krtani z powodu raka krtani.

PURPOSE: To investigate the impact of hemoglobin concentration (Hb) at the start and end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy on the loco-regional control in postoperative radiotherapy for patients with advanced laryngeal cancer. MATERIALS AND METHODS: Between January 1993 and December 1996, 254 patients with pT3 or pT4 and pN0-pN2 laryngeal cancer were treated with a total laryngectomy and adjuvant radiotherapy (RT). The median age of patients was 56.3 years (range: 30-70 years). The analyzed group consisted of 236 males (92%) and 18 females (8%). In all cases a total laryngectomy was performed. 196 out of 254 patients underwent homolateral neck dissection and 58 out of 254 underwent bilateral neck dissection. The primary tumor bed was irradiated to the median total dose of 61.2 Gy (range: 57 - 64 Gy) and all regional lymph nodes were treated in all patients to a dose of 50 Gy. Indications for postoperative RT were close postoperative margins at the tumor site or pathological status of lymph nodes described as pN1 or pN2. Univariate analyses were used to determine the predictors for locoregional failure. The following factors were studied for prognostic importance of loco-regional outcome: the hemoglobim concentration at the start of radiotherapy, at the end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy, age, sex, pT and pN categories. RESULTS: The actuarial 5-year overall survival was 49%, the actuarial loco-regional control rate was 70%. Univariate analysis, using log-rank test indicated that pN +, Hb level at the end of RT (p = 0.004) and drop during RT (p = 0.038) were predicted for the loco-regional control of postoperative radiotherapy. CONCLUSIONS: Analysis showed that the low level of Hb at the end of radiotherapy and the drop during radiotherapy were correlated with decreasing of the loco-regional control of adjuvant radiotherapy for patients with advanced laryngeal cancer.

[Transversal resection of trachea as the method of treatment of postintubational stenosis]. / Poprzeczna resekcja tchawicy jako metoda leczenia zwezen pointubacyjnych.

We present an experience with transversal tracheal resection with end-to-end anastomosis in 3 patients with extensive subglottic stenosis because of prolonged intubation. All the patients were treated chirurgically based on the Pearson's method. In order to attein the fixation of tracheal stumbs, poroplastic splint was applied into the lumen of the trachea and patency of airways was protected by tracheotomy.There were no major complications during treatment and time of the treatment was significally shortening.

[Structure of the laryngeal anterior commissure and its role in spread of malignant neoplasms]. / Budowa spoidla przedniego krtani i jego znaczenie w rozprzestrzenianiu sie nowotworu zlosliwego.

Since many years anterior commissure of larynx is a field of scientific research. However it is still known as a "X space", or "plane 0", because of lack of its universally accepted anatomical and clinical definition. Authors have made literature survey about development and structure of the anterior commissure of larynx. Analysis of discrepancy and controversy concerning its structure in aspect of direction of neoplasm infiltration has been carried out.