[Mold fungi and the role of allergy on fungi in chronic rhinosinusitis]. / Grzyby plesniowe i rola alergii na grzyby w przewleklym zapaleniu blony sluzowej nosa i zatok przynosowych.

AIM: The aim of this work was to assessment the role of mould fungi and the allergy on fungi in chronic rhinosinusitis. MATERIAL AND METHODS: We studied 30 patients with chronic rhinosinusitis with or without polyposis who underwent endoscopic nose and sinuses procedures. Clinical and immunological workup was performed for atopy in all patients. We performed CT of the sinuses, skin-prick testing on 15 fungal allergens, total IgE and fungal-specific IgE levels, eosinophilia level. Specimens were sent for mycology and histopathologic analysis for identification of fungi. RESULTS: Fungal culture from sinuses were negative in all patients. Bacterial culture were positive in 19 cases. There was observed elevated total immunoglobulin E level in 70% of patients. Positive skin test reactivity for fungal allergen was observed in 7 patients--3 for Aspergillus, 2 for Alternaria and 2 for Cladosporium. Fungal specific IgE levels were below 0.35 KU/L in all patients. Nasal polyps were found in 26 patients, they were associated with asthma and aspirin intollerance. No fungal hyphae were found in histopathologic analysis. CONCLUSIONS: Our preliminary study suggest, that allergy for fungi doesn't play a significant role in etiology and pathogenesis of the chronic rhinosinusitis with or without polyps. We did't find any case of the allergic fungal sinusitis in our patients.

[The laryngological complications of the Gastroesophageal Reflux Diseases]. / Powiklania laryngologiczne choroby refluksowej przelyku.

UNLABELLED: The aim of the study was the quantitative and qualitative assessment of the pathological reflux episodes present in laryngological diseases in relation to GERD. These findings allowed for outlining the relationship between the reported subjective ailments and the disturbances of function and acidic refluxes diagnosed in pH-metric measurements. The study included 40 patients (23 women, 17 men) with clinical laryngological symptoms of GERD (aged 19-63 years, median 42.2): chronic persistent cough, laryngitis, pharyngitis, ulceration of vocal cords, hacking. The patients underwent laryngological check-up (direct laryngoscopy), gastroscopy, 24-hour pH-metry and manometry of the oesophagus. The analysis of the subjective symptoms reported by the patients was done according to the DeMeester's and Likert's scale. The 24-hour abdominal pH-metry was carried out with the use of microDigitrappr MARK III (Synecpol) pH-meter and antymon probe with the reference epidermal electrode. The manometric analysis of the pressure in lower oesophagal sphincter (LES) and the antral function was done with the use of Köenisberg probe integrated with microDigitrapper. RESULTS: In 80% of the patients we observed the presence of pathological acid refluxes and so called high pharyngeal refluxes (the total number of reflux episodes--91 +/- 8.2, the number of reflux episodes lasting longer than 5 minutes--19.6 +/- 4.6, "fraction time" the percentage of pH < 4.0-7.1 +/- 2.9). In this group of patients chronic laryngitis was observed in 50% of cases, chronic hacking--in 31%, persistent pain in the pharynx--in 28.1%, strong cough--in 59.4%. In 18.7% of the patients with the pathological recurrent reflux of gastro-intestinal content to the oesophagus we observed inflammatory changes of various extent in gastroscopy. We found a strong causal relationship between cough and hacking and the pathological GERD (time interval 5 min, Wiener's indicator SI > or = 75%). CONCLUSIONS: 1. The achieved results confirm the significant role of pathological GERDS in the pathogenesis of many laryngological symptoms. 2. On the basis of the achieved data it seems purposeful that the diagnosis should be much more detailed with the use of 24-hour gastroesophageal pH-metry in the patients with persistent laryngological (mainly cough and hacking) symptoms, especially in case of the patients in whom the reported symptoms are not relieved after routine laryngological treatment. 3. Our findings create the possibility for the modification of the so far diagnostic and therapeutical procedures in this group of patients and the relief of the reported subjective ailments.

[Early results of the treatment of chronic sinusitis with functional endoscopic sinus surgery]. / Wczesne wyniki leczenia przewleklego zapalenia zatok obocznych nosa metoda czynnosciowej chirurgii endoskopowej.

In recent years FESS has become a gold standard in the treatment of chronic sinusitis. The results of the treatment depends to a high degree on the thorough preoperative assessment and qualification for surgery, as well as applied criteria reported for success. The aim of the study was to evaluate the early results of FESS in patient with chronic sinusitis after 3 to 12 month of follow up focusing attention on some prognostic factors. In the group 52 patients who underwent FESS in 2003 due to chronic sinusitis particular attention to standardization of pre and postoperative evaluation was paid. Meticulous analysis of the data from SNAQ 11 (sino nasal assessment questionnaire) questionnaire for subjective complaints evaluation, and assessment of the extent of disease according to Friedman, Kennedy and Levine scale revealed no correlation between extent of disease and results of treatment. It was demonstrated, that there is the statistically significant correlation between extent of sinus disease on CT scans and the duration of disease. It applies to the first tree years of disease.

[Assessment of the hearing organ in the patients with allergic perennial and seasonal allergic rhinitis]. / Ocena narzadu sluchu u pacjentów z alergicznym calorocznym i sezonowym niezytem nosa.

We studied 60 patients with allergic rhinitis (30 with seasonal and 30 with perennial rhinitis). Assessment of atopic status was based on medical history, physical examination, skin-prick testing, total IgE levels and nasal smears. Audiometry and tympanometry have been performed. Audiometric conductive hearing loss was found in 26.7% patients with perennial rhinitis and in 10% patients with seasonal rhinitis. Type B tympanogram were found in 20% of the patients with perennial rhinitis and in 3.33% of the patients with seasonal rhinitis. Type C tympanogram were found in 20% of the patients with perennial and in 6.67% with seasonal rhinitis. Secretory otitis media and retraction pockets were more common in patients with perennial rhinitis allergy. Local allergic reaction in the middle ear and dysfunction of the Eustachian tube can be the most responsible for these disorders. Tympanostomy and ventilation tubes were needed in secretory otitis and myringoplasty in the cases of the retraction pockets. Appropriate treatment of allergic rhinitis may decrease the need and frequency of surgical procedures and may reduce costs associated with hospitalization.

Modified neck dissections--efficiency of surgical treatment and clinical observations.

BACKGROUND: The evaluation of affected lymph node number, the site of metastatic lymph nodes, and spread of neoplastic infiltration beyond the lymph capsule is considered useful in prognosis. The aim of the study was to estimate the frequency of neck nodal metastases occurrence depending on the site of origin, the grade of larynx cancer progression, and clinical condition of neck lymph nodes. MATERIAL/METHODS: The study comprised 315 patients with larynx cancer who underwent surgery in 1994-1999. Laryngectomy was the most frequent procedure, performed in 254 patients, while partial laryngectomy was performed in 61 patients. There were 630 bilateral neck dissections; type I of modified radical surgery in 27 cases, type II in 45 cases, and type III in 558 cases. RESULTS: Neck nodal metastases were detected most rarely in cases of glottic cancer (16%), and most frequently in transglottic cancer (56%). Most frequently, the nodal metastases affected the II level of the lymph node groups regardless of the site. Recurrences to the neck lymph nodes were observed in 3.3% of the cases where the removed lymph nodes did not reveal any metastatic changes in histopathological examinations. CONCLUSIONS: Postoperative results of the neck lymph node histopathological examination point to the necessity of lymphadenectomy in the II-V levels. Selective lymphadenectomy is not advisable due to the possibility of metastases to all levels of the neck lymph nodes regardless of the primary tumor site.