Chemoprevention of Head and Neck Cancers: Does It Have Only One Face?

Head and neck squamous cell cancer (HNSCC) represents a significant burden worldwide. Chemoprevention of HNSCC is a means of cancer control with a use of drugs or natural agents in order to hinder or delay the cancer development. The purpose of this article is to review mechanism of action of different chemopreventive agents' groups and results of most important researches concerning them. The safety issues of HNSCC chemoprevention are also discussed. In case of HNSCC there is currently no agent, which would give positive result in the third phase of clinical trials. Promising results of preclinical trials are not always confirmed by further tests. Main problems are low effectiveness, high toxicity, and lack of highly specificity biomarkers for monitoring the research. New trials concerning many agents, as well as novel technologies for provision of pharmaceutical forms of them, including drug nanocarriers, are currently underway, which gives hope for finding the perfect chemopreventive agent formula.

Bacterial Infections and Osteoclastogenesis Regulators in Men and Women with Cholesteatoma.

One of the most distinct features of middle ear cholesteatoma is bone destruction. Aetiology of cholesteatoma is thought to be multifactorial. Endotoxins produced by bacteria are thought to initiate the inflammation process in the middle ear leading to cholesteatoma. There are physiological differences in bone metabolism between men and women. The aim of our study was the immunohistochemical evaluation of the contents of two key components of the OPG/RANK/RANKL triad-RANKL and OPG in cholesteatoma, to analyse if there are any differences between the sexes and to evaluate the bacteria species isolated from cholesteatoma just before surgical treatment and to evaluate their plausible influence on the expression of OPG and RANKL in cholesteatoma. Twenty-one adult patients with acquired cholesteatoma who underwent surgery were analysed. There were no statistically significant differences in the expression of both regulators of osteoclastogenesis between the sexes. In 38.1 % patients cholesteatoma was not infected, whereas in 61.9 % patients various bacterial infections or mycosis were found. The most frequently isolated species was Pseudomonas aeruginosa (14.29 % infections) followed by Staphylococcus aureus (9.52 % infections). There were no statistically significant differences in expression of both OPG and RANKL between uninfected and infected cholesteatomas.

Fungal colonization of the respiratory tract in allogeneic and autologous hematopoietic stem cell transplant recipients: a study of 573 transplanted patients.

BACKGROUND: Fungal colonization and infections remain a major cause of infection morbidity and mortality following hematopoietic stem cell transplantation (HSCT) in patients with hematological malignancies. The aim of this study was to analyze the spectrum of fungal microflora of the respiratory tract (oral cavity, pharynx, epiglottis, and sputum) in patients undergoing HSCT and to evaluate the relationship between HSCT type and incidence of mycotic colonization and infections. MATERIAL/METHODS: Retrospective analysis of fungal isolates collected from the respiratory tract (oral cavity, pharynx, epiglottis, and sputum) of 573 patients undergoing HSCT was performed. RESULTS: The overall rate of fungal colonization in patients undergoing HSCT was 8.7%. Patients undergoing allogeneic HSCT were statistically significantly more often colonized (12.95%) compared to autologous HSCT recipients (4.7%). Colonizing cultures were mainly C. albicans and C. krusei, and sporadically C. glabrata, C. famata, Aspergillus spp. and Saccharomyces cerevisiae. C. albicans was the most frequent species found in isolates from the pharynx, sputum, and oral cavity collected from patients undergoing HSCT. Aspergillosis was more common after allogeneic than after autologous HSCT. The pharynx was the most frequently colonized site. CONCLUSIONS: Allogeneic HSCT recipients are more susceptible to fungal infections compared to the autologous group. Selection of species during prophylaxis and antifungal therapy requires developing more effective prevention and treatment strategies based on new antifungal drugs and microbe-specific diagnoses.

Primary orbital tumors: a review of 122 cases during a 23-year period: a histo-clinical study in material from the ENT Department of the Medical University of Silesia.

BACKGROUND: The aim of this study was to investigate the distribution of different types of primary orbital tumors, histopathological diagnosis, and postoperative complications. MATERIAL AND METHODS: We analyzed 122 patients (68 women and 54 men) with orbital tumors, hospitalized in the ENT Department of the Medical University of Silesia in Katowice during 1990-2013. The patients were characterized in terms of anatomic, topographical, histopathological, and clinical parameters. The role of diagnostic imagining such as CT, NMR, and fine-needle aspiration (FNB) in preoperative diagnostics is discussed. RESULTS: of FNB, cytological, and histopathological examination of the postoperative specimens were compared. Results There were 56 (46%) patients with malignant tumors, 42 (34%) with benign tumors, 19 (16%) with inflammatory tumors, and 5 patients (4%) had other tumors. In cases of malignant tumors, local recurrence up to 5 years was found in 36 (64.3%) cases. In the other 20 (35.7%) cases of malignant tumors, the patients remained under close follow-up in the outpatient clinic, without signs of local recurrence (follow-up 1-17 years). According to histopathological examination, malignant tumors were detected in 45.9% of patients and non-malignant tumor in 34.4% of patients. In 19.7% of patients, inflammatory and other types of tumors were diagnosed. CONCLUSIONS: We characterized the occurrence and pathological profiles of orbital tumors. The tumor location, histopathological diagnosis, and postoperative complications give us important information for the diagnosis of tumor prior to biopsy or tumor resection and for the determination of the treatment strategy and possible complications after surgery.

Soft tissues sarcomas of the head and neck in adult: histo-clinical analysis of 30-years material in the data of ENT Department of Silesian Medical University.

AIM: The aim of this study was the assessment of efficiency treatment of soft tissues sarcomas in adult in the data of ENT Department of Silesian Medical University in Katowice. MATERIAL AND METHODS: Retrospective analysis has been carried out for 22 patients with the diagnosis of STS in head and neck, treated in the ENT Department of the Silesian Medical University in Katowice, Poland, in the years 1980-2010. Most common histopathological diagnosis was fibrosarcoma. Preferred treatment was surgery combined with radiotherapy. Despite intensive treatment results remain unsatisfactory. RESULTS: The most frequent cause of treatment failure was local recurrence, which was found in 7 cases. In 2 patients, nodal recurrence occurred, while in further 4 patients dissemination of neoplasm occurred. Of the 22 patients in our study, 13 died. Complete 5-year survival in the study group was achieved in case of 3 patients, 4 other patients have survived up to 3 years so far, while 1 patient survived less than 1 year so far. CONCLUSIONS: The application of surgical treatment combined with post-surgical radiotherapy allowed to enhance life quality and to prolong the life of patients. Unfortunately, the percentage of local recurrence cases still remains high. Results of STS treatment are still not satisfactory. The main reasons for it include late for treatment, in relation to the moment of noticing the tumor, in the majority of cases a high malignancy level, as well as technically difficult procedures, along with the strong tendency for local recurrence.

[Device for graphic visualization of pressure course in the opening of sphincter of oesophagus mouth in patients after total laryngectomy]. / Aparat do wizualizacji graficznej cisnienia przebiegu rozwarcia zwieracza ust przelyku u osób po usunieciu krtani.

INTRODUCTION: Oesophageal speech were described for the first time by Gutzmann in 1909. The diagnostic method based upon checking the pressure causing opening of oesophagus mouth was developed by Seeman and Van Den Bergh. In the initial stage, the method was meant to determine the level, to which the patient can master oesophageal speech. In the course of further investigations, an additional element of diagnostics was noted, which enabled early detection of recurrence of the neoplastic process in the oesopagus mouth area. MATERIAL AND METHODS: The material includes 96 patients treated in 2008-2010 at the Department of Otolaryngology, Medical University in Katowice. All patients were classified on the basis of CT of the larynx and the result of histopathological examination to the total laryngectomy. All the patients were subjected to examination by device to visualize the process of opening pressure of the sphincter of the esophagus paragraph. RESULTS: During two years of observation in 28 cases (29%), oesophageal pressure was open his mouth more than 80 mmHg. When performed CT of the neck and histopathology examination recurrence of laryngeal cancer was confirmed in 23 cases (82%). CONCLUSION: This device is used to determine the best method of voice and speech rehabilitation in patients after total laryngectomy and early diagnosis of laryngeal and/or hypopharynx cancer recurrence.

Intraorbital foreign bodies--5 own cases and review of literature.

Five patients were surgically treated for intraorbital foreign body: a 14-year-old girl had a door glass splinter, a 23-year-old man a metallic foreign body--gunshot pellet, a 55-year-old man a splinter from a metallic bar, a 48-year-old patient the splinters of circular saw and 61-year-old man with shot. Two foreign bodies were removed using the Krönlein-Reese-Berk lateral orbitotomy, two others by Sewell medial orbitotomy and one with superior orbitotomy of Dandy-Naffziger. Radiographs and CT scans were used to identify and localize intraorbital foreign bodies. In one case we found coexistence foreign body (shot) and tumor--inflammation pseudotumor of the orbita. It is possible, that in this case long-time occupy foreign body in the orbita was a cause of that tumor. All foreign bodies were successfully removed, and postoperative course was uneventful. The Krönlein-Reese-Berk orbitotomy provides a satisfactory access to the lateral and posterior orbit, which is of particular importance in the case of a deeply penetrating foreign body (metallic or glass). Surgical removal of intraorbital foreign bodies is a classic example of an interdisciplinary therapeutic approach. Best outcome is usually a result of a team of an ophtalmologist, ENT surgeon, maxillary surgeon and possibly also neurosurgeon performing the operation.

[Head and neck phlegmons - diagnosis and treatment - own observations]. / Ropowice glowy i szyi - diagnostyka i leczenie - obserwacje wlasne.

INTRODUCTION: Head and neck phlegmons are rare diseases, however they are associated with high risk of mortality. They can derive from different structures of the described anatomical area. They are often odontogenic. Imaging studies, especially computerized tomography play the greatest role in diagnosis of phlegmons. The treatment is based on surgical incision and drainage as well as analgesia. MATERIALS AND METHODS: A retrospective analysis was conducted on 11 patients from three different ENT centers: ENT Department of the Medical University of Silesia in Katowice, ENT Department of the Municipal Hospital in Sosnowiec and ENT Department of the Hospital No.1 in Bytom. Laboratory results, imaging results, treatment and other factors influencing the course of the disease were analyzed. RESULTS: Most patients were males and the average age was 50.8. In most cases the phlegmons were diffused and localized in different regions of head and neck. The phlegmons were mainly located in the carotid and parapharyngeal space. Streptococci and staphylococci were the most common pathogenes found in the examined material. Antibiotics and metronidasol were effective in all cases. Two types of surgical procedure were performed - either common abscess incision or broad incision along sternocleiodomastoid muscle. CONCLUSIONS: Head and neck phlegmons are rare and they affect patients at any age. The dominating localization of the phlegmons depends mainly on the starting point. Computerized tomography plays the most important role in diagnosis. The treatment is based on surgical procedures and antibiotics.

[Prolongation of Bupivacaine spinal anaesthesia by oral and intramuscular Clonidine]. / Wplyw doustnej i domiesniowej premedykacji klonidyna na czas trwania analgezji podpajeczynówkowej.

The effect of oral and intramuscular clonidine premedication on the duration of sensory and motor blockade and postoperative analgesia during bupivacaine spinal anaesthesia was studied in 102 ASA physical status I-II patients scheduled for lower limbs orthopaedic surgery. In all cases one hour before anaesthesia midazolam (0.1-0.15 mg/kg) was applied orally and isotonic saline solution (10 ml/kg) was infused intravenously. The patients were randomly allocated into one of the following groups: oral (A) or intramuscular (B) clonidine premedication (0.15 mg) (n = 33) and oral or intramuscular premedication by placebo (C) (n = 36). All patients received 10-20 mg of 0.5% hyperbaric bupivacaine intrathecally. Sensory blockade (SB) was evaluated by pinprick and motor blockade (MB) according to Bromage's scale. The following parameters were measured: duration of motor and sensory block, requirement for postoperative analgesia (buprenorfine); systolic, diastolic and mean blood pressures; heart rate; oxyhemoglobin saturation (SpO2) and adverse events. As far as sex, body weight, age, height, ASA grade, dose of midazolam and bupivacaine, the onset of sensory and motor blockade, level of sensory analgesia, type of surgery and its average duration between groups were concerned, no differences were observed (p > 0.05). Both oral and intramuscular premedication with clonidine increased significantly the duration of motor (A--185.9 +/- 59.3; B--190.9 +/- 66.3 min) and sensory (A--216.2 +/- 69.4; B--254.2 +/- 76.8 min) blockade in comparison with placebo (MB--141.9 +/- 56.6; SB--156.7 +/- 62.9 min) (p < 0.01). The effect was more pronounced at the parenteral vs oral administration (p < 0.05). The intramuscular premedication with clonidine intensified the sedative effect of midazolam (p < 0.01). Hypotension, bradycardia and the decrease of SpO2 were significantly greater in B compared to C group (p < 0.05). Dose of buprenorfine applied in the first 24 postoperative hours was in both groups receiving clonidine (A--0.6 +/- 0.2; B--0.5 +/- 0.2 mg) nearly twice as small as than in a control group (1.1 +/- 0.2 mg) (p < 0.01). The authors conclude that prolongation of bupivacaine sensory analgesia may be produced by premedication with 0.15 mg of oral and intramuscular clonidine. The application of clonidine reduces the early postoperative analgesic requirements. The side effects are more pronounced with the intramuscular route of administration.