[20 years of joint research on the carcinoma of the larynx conducted by teams from clinics in Crakow, Poznan, Warsaw and Lublin]. / 20 lat wspólnych badan nad rakiem krtani zespolów klinik krakowskiej, poznanskiej, warszawskiej i lubelskiej.

A twenty-year scientific cooperation has been discussed (1979-1998) between four clinics for laryngology at Medical Universities in Cracow, Poznan, Warsaw and Lublin. The results of research concerning the epidemiology, diagnostics and treatment of the carcinoma of the larynx are presented.

[The development of concept of partial surgery of the larynx due to supraglottic cancer]. / Rozwój koncepcji zastosowania operacji czesciowego usuniecia krtani z powodu raka o pierwotnej lokalizacji w pietrze nadglosniowym.

It has been shown the conception of partial surgery of the larynx due to cancer primary develops in the supraglottic. The evolution of this method which is a consequence of progress in anatomical and embryological knowledge as well as technical possibilities of surgeons has been introduced. The modern methods of partial removal of larynx let resume physiological function of larynx with oncological security.

DNA analysis of laryngeal carcinoma cells by flow cytometry: the histoclinical factors and their significance.

In patients suffering from several types of malignant tumours, changes in deoxyribonucleic acid (DNA) content are usually associated with poorer survival prognosis. In the present study, DNA content and clinical and histopathologic features were analyzed in patients suffering from laryngeal carcinoma, with a view to establishing the crucial prognostic factors. In the 5-year follow-up study, flow cytometry was used to analyze DNA content in the paraffin-embedded samples of laryngeal carcinoma tissue obtained from 90 patients who had undergone surgical treatment in the Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Cracow, Poland, in 1987 and 1988. The group consisted of 59 and 31 patients with T3 and T4 tumours, respectively. In each case, neck dissection was carried out either on one or both sides. Metastases in regional lymph nodes were found in 26 patients. The disease-free 5-year survival rate was 55.6%. Among the investigated cases, there were 14 aneuploid and 76 diploid tumours. The treatment yielded the worst results, when the S-phase fraction (SPF) and proliferative index (PI) were equal to or higher than 15.8% and 16.0%, respectively. The values of SPF and PI index did not correlate, however, with the frequency of regional metastases. Univariate analysis revealed that tumour size (T stage), presence of lymph node metastases, age of patients (< or = 60, > 60), tumour differentiation, tumour front grading (<15 points, > or = 15), mode of infiltration, SPF, and PI were positively correlated with the actual survival rate. Presence of lymph node metastases (p = .0001) and the PI (p = .0067) were found to be the only independent prognostic factors when the Cox multivariate analysis was applied. The assessment of the PI by flow cytometry may effectively facilitate the selection of patients recommended for a more aggressive treatment.

The use of nuclear morphometry for the prediction of survival in patients with advanced cancer of the larynx.

We examined retrospectively whether the quantitative morphometric analysis of nuclear shapes in patients with advanced cancer of the larynx could be used as a prognostic factor. In all, specimens were taken from 90 patients treated by surgery in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The follow-up period was no shorter than 5 years. In the group examined there were 59 patients with T3 tumors and 31 with T4 tumors. A neck dissection was performed on one or both sides in each case. Metastases in regional lymph nodes were found in 26 patients. Histologic grading was assessed in all cases. Fourteen parameters of nuclear shape were studied using a computer-assisted system of image analysis. Morphometric data were compared with patients' survival rates. The worse survival rates were found to be linked with a nuclear area (NA) > or = 64.82 micron 2 and its standard deviation (SDNA) > or = 20.10 micron 2, a nuclear perimeter (NP) > or = 32.45 microns and its variation (SDNP) > or = 4.77 microns, nuclear density (ND) > or = 22,215.63 and its variation (SDND) > or = 6930.85 and nuclear roundness (NR) > or = 0.76. By using multivariate Cox regression analysis the SDND, presence of metastases in lymph nodes and low tumor differentiation were found to be independent prognostic factors. No statistically significant correlation was found between the parameters examined, lymph node status and tumor differentiation.

Acoustic assessment of voice signal deformation after partial surgery of the larynx.

OBJECTIVE: The main objective of the present study was to assess the degree of voice signal impairment among patients who had undergone partial surgery of the larynx due to cancer of this organ. Such on evaluation may be helpful in the selection of the optimal surgical technique for the treatment of tumors displaying a varying degree of local advancement. METHODS: A prospective examination was carried out among 128 patients. Additionally a comparative study of the control group consisting of 36 healthy males was carried out. Acoustic tests were carried out in an echo-free chamber. The temporal changes in the value of acoustic pressure of the uttered text were registered. The 'distance' between the normal speech signal and the pathological voice has been established. RESULTS: The values of the fundamental frequency increase together with an increase of the range of resection of anatomical structures. The biggest differences in the value of results describing the distance from the standard were observed after hemilaryngectomy. The shortest distance from the acoustic standard was observed after chordectomy. No significant differences in the degree of voice signal impairment among patients who had undergone extended chordectomy and hemilaryngectomy were observed. CONCLUSION: The above findings can be of help in arriving at an optimum solution in cases of partial surgery of the larynx. The problem is particularly important in situations where there is the choice between different types of surgery.

Studies on swallowing in patients operated by subtotal laryngectomy.

A series of 39 patients with problems of deglutition after total laryngectomy was studied by X-ray screening and manometry. The importance of the retropulsive movement of the tongue on the quality of deglutition has been demonstrated, as has the function of the superior oesophageal constrictor, the effect of a reduced relaxation time, and of the force of suction in reducing its quality.

[The correlation of Doppler's blood flow distempers in vertebral arteries with degenerative cervical spine changes of patients undergoing treatment for tinnitus]. / Ocena korelacji zaburzen przeplywu krwi tetnicami kregowymi badanego metoda dopplerowska ze zmianami zwyrodnieniowymi kregoslupa szyjnego u chorych leczonych z powodu szumów usznych.

120 patients aged 20-81 years were treated at the Otolaryngology Clinic of the CM UJ in years 1994-1996 for tinnitus. The radiological method showed degenerative changes of the cervical spine in 100 of them. The otolaryngological and neurological methods excluded any reason of tinnitus other than distempers of vertebrobasilar arterial system. The ACUSON 128 XP/10 (Duplex Scan + Color Doppler) was used during examination of blood flows in vertebrobasilar arterial system. The correlation index was calculated as a proportion between the number of patients with pathological vertebral artery blood flow and the total number of patients. For all patients aged 20-81 it was 45.0%. The correlation index for the subsequent age groups grew proportionally to the age of patients, reaching values from 0% to 73.7%.

[Analysis of causes of the parotid pleomorphic adenoma recurrence]. / Analiza przyczyn nawrotów gruczolaków wielopostaciowych przyusznicy.

Out of the total number of 173 patients who had undergone surgery for pleomorphic adenoma of the parotid gland, 19 had to be treated owing to the recurrence of the tumor, following earlier surgery 12 patients were reoperated on by means of the enucleation technique; 5 underwent superficial parotidectomy; in 2 cases the recurrence took on the form of tumor of the parapharyngeal space, which was removed through the cervical-parotid approach. The causes of the recurrences were analyzed taking into consideration the operation technique applied in the first surgery. A serious consequence of pleomorphic adenoma recurrence is the possibility of its becoming malignant, which took place in 2 cases (10.5%), as well as a permanent paralysis of facial nerve during the reoperation, which occurred in 4 cases (21%).

The prognostic value of proliferating cell nuclear antigen (PCNA) in the advanced cancer of larynx.

It was retrospectively examined whether the tumor growth fraction determined by PCNA score in the advanced cancer of larynx could be used as a prognostic factor. There was used immunohistochemical method to evaluate the PCNA score of positive cells in paraffin embedded tissues of laryngeal carcinoma obtained from 90 patients. They were treated by surgery in the Department of Otolaryngology at the Medical University in Cracow, Poland in 1987 and 1988. The follow-up period was not shorter than 5 years. In the examined material there were 59 patients with tumor T3 and 31 with T4. Neck dissection on one or on both sides was performed on patients. The metastases in regional lymph nodes was found in 26 patients. Histologic grading (G1 = 18, G2 = 52 and G3 = 20 patients) and number of mitosis was assessed. The PCNA score was defined by counting positive cells and presented as percentage of a cells. It ranged from 2.1 to 73.0% with the average value of 34.5%. The PCNA score below this level was defined as a low PCNA score (49 patients) and above this level as a high PCNA score (41 patients). There was a correlation between PCNA score and survival of the patients. 35 patients (71.4%) with low PCNA score survived and 15 (36.6%) with high PCNA score (P < 0.05). Similarly the high PCNA score influenced the number of metastases in lymph nodes. They occurred in low and high PCNA score respectively at nine (18.4%) and 17 patients (41.5%) (P < 0.05). There was not found any correlation between PCNA score and tumor differentiation, its size and mitosis number. The PCNA may be a prognostic factor for the patients with advanced cancer of larynx.

[The results of surgical treatment of patients with laryngeal carcinoma in years 1988-1989 in four departments of otorhinolaryngology]. / Wyniki operacyjnego leczenia chorych na raka krtani w latach 1988-1989 w czterech osrodkach klinicznych.

In a group of 579 patients with laryngeal carcinoma treated surgically in years 1988-1989 in four departments of otorhinolaryngology of the Medical Academies in Poznan, Warsaw, Cracow and Lublin, 72% survived 3 years without recurrence and 59% survived 5 years. Similar results were obtained in years 1986-1987. The authors discuss in detail the reasons for failures of the surgical treatment, i.e.: supraglottic localization of the cancer, its extensiveness in the larynx, the stage of clinical development, general condition of the patient, effectiveness of the operation, regularity of postsurgical examination, the degree of histological malignancy, blood transfusion during the operation, distant metastases, little efficiency of medical service in early diagnosis of laryngeal cancer, avoiding postsurgical radiation, subjective factors of the patients and the choice of the optimal method of the treatment. Few patients can be cured if the initial treatment fails.

Effectiveness of classical chordectomy in the treatment of cancer of the glottis.

From 1980 to 1992, 85 patients diagnosed with tumour of the glottis, localized exclusively in the vocal cord area, had undergone surgery. A 90% 5-year survival rate without recurrences had been obtained. Taking into account the cases of life-saving surgery, the percentage of the 5-year survivals amounted to 94%. Considerably better results were obtained by the excision of the entire vocal cord and not just one of its sections (1/2, 2/3 etc.). The degree of deformation of the voice following chordectomy was assessed by means of acoustic and laryngographic methods (Laryngograph Processor PCLX). A 13% rate of irregularity in the functioning of the neoglottis, following surgery, was observed. The Jitter-Shimmer co-efficients were established. The results of the deformation of the voice following chordectomy were presented on the J-S scale and compared with other partial surgeries performed on patients with tumours of the glottis. All of the acoustic and laryngographic findings were presented in the from of mean values most representative of chordectomy.

[Rare forms of non-neoplastic tumors of the lacrimal gland]. / Rzadkie postacie nienowotworowych guzów gruczolu lzowego.

Out of the total number of 20 patients who in years 1982-1996 underwent surgery of the lacrimal gland in the Otolaryngological Clinic of the CM UJ, in 2 cases a rare form of tumor was diagnosed. They turned out to be: amyloidosis and sarcoidosis. Case histories, diagnostic difficulties, as well as methods of surgery, taking into consideration the latest views on the subject, were presented.

Microvasculature of the human fetal laryngeal anterior commissure.

The vascular pattern of the injected with Mercox human fetal larynges, especially of the anterior commissure and surrounding it area, was analysed within the horizontal and frontal sections under a light microscope. The main result of our study was confirmation of existence of the avascular "plane zero" situated above the anterior commissure, which separates that structure from the supraglottic tier. That finding i.e. avascular separation between teh middle and upper laryngeal compartments, already present in the fetal period, has clinical implications as far as the spread of neoplastic process within the larynx is cancerued.

[Efficiency of surgical treatment in patients with laryngeal cancer depending on age]. / Wydolnosc operacyjnego leczenia chorych na raka krtani w zaleznosci od wieku.

In the group of 578 patients with larynx cancer that underwent surgical treatment in four clinics of Medical Academies between 1986-87 a comparable analysis of the efficiency of surgical treatment depending on age of the operated patients was carried out. It was found that the difference between age average and the general state of patients was statistically highly important: Statistically significant was also the dependence between the patients' age and the postoperative complications; close to importance was also the dependence between the age and the survival period of patients. 68% of operated patients up to 65 year of age had five-year survival period without any symptoms; but in the group of patients over 65 years of age the analogical survival value was 51%.

[Changes in vascularization of sternocleidomastoid myocutaneous flaps]. / Badania zmiennosci unaczynienia platów miesniowo-skórnych z miesnia mostkowo-obojczykowo-sutkowego.

Studies of variation in the vascularisation of the sternocleidomastoid myocutaneous flap. An investigation of vascularisation of the sternocleidomastoid myocutaneous flaps was conducted. The research was performed on human cadavers and after injection of arteries 40 myocutaneous flaps of sternocleidomastoid muscle were isolated. The experiment was performed to investigate the origin of the arteries vascularising the muscle and the area of skin, which were used to make the myocutaneous flaps. Changes are characteristic in the lower 2/3 parts of the muscle. These variables may exert an important influence of the outcome of reconstruction treatment in the case of the flaps used from the lower attachment of the muscle.

[Chemodectoma of the nasal cavity and paranasal sinuses]. / Klebczak jamy nosowej i zatok przynosowych.

A rare case of chemodectoma of the nasal cavity and paranasal sinuses is presented. Chemodectoma are unusual tumours arising in specialized tissue probably of neural cres origin. The patient underwent surgery with total removal of the tumour. The presence of such a tumour raises questions as to the origin of such specialized tissue within the nose and paranasal sinuses.

[Primary orbital tumors in children]. / Pierwotne nowotwory oczodolu u dzieci.

We present the incidence, diagnosis and clinical picture of the primary orbital tumors in children. They were treated in ENT Clinic CM UJ in Kraków between 1981-1990 years. Discovered was preponderance of primary non malignant tumors. The most frequently encountered tumors were dermatomas, angiomas and among the malignant tumors-rhabdomyosarcoma.

[Surgeries of the orbit]. / Operacje oczodolu.

Krönlein was the first ophthalmologist to carry out orbital surgery. He described the temporal approach. The purpose of this paper is to report the earliest findings and results in tumors of the orbit in 101 patients who was treated with surgery in ORL CM UJ Clinic in Kraków. Retrobullar tumors of the orbit require a bone orbitotomy.