[Clinical applications of photodynamic therapy in the treatment of laryngeal lesions]. / Kliniczne zastosowanie fotodynamicznej terapii w leczeniu schorzen krtani.

Photodynamic therapy (PDT) has been used in the treatment of laryngeal lesions. The disorders comprised primary dysplasia and leukoplakia of the vocal cords. The patients after diagnosis were subjected to the therapy. Six hours prior to the light irradiation the patients received 4% solution of delta-aminolevulinic acid (ALA) during 30 minutes inhalation. After 6 hours all the changes were irradiated using 400 nm wavelength light from 300 W halogen lamp (range: 380-420 nm) in order to visualize them. Next, the wavelength was tuned to 650 nm (range 620-680 nm) and the total dose 120 J/cm2 for all cases. Control examinations in patients revealed complete response of the lesions within 2-3 months after PDT.

Effect of motion on digital nerve repair in a fresh cadaver model.

Information in the literature regarding the postoperative management of digital nerve lacerations is vague, and postoperative immobilization for up to 3 weeks is frequently recommended. In order to define more precisely what, if any, postoperative restrictions are necessary, a fresh cadaver model was designed for digital nerve division, resection, repair, and passive motion. Ten digital nerves were divided at the proximal interphalangeal joint and then repaired, mobilized, and inspected. Intact nerve repairs were serially resected in order to determine the limits of resection that would allow motion without repair disruption. All repairs were resistant to disruption even with hyperextension up to a resection length of 2.5 mm, and all repairs were resistant to disruption if splinted in neutral up to a resection length of 5 mm. There was not 100 percent disruption of repairs until a resection length of 1 cm and range of motion including hyperextension. These results give valuable objective data that can be used to guide early motion and splinting protocols after various degrees of digital nerve injury and repair.

[Pneumocephalus following facial injury]. / Pneumoencephalon jako nastepstwo obrazen twarzoczaszki.

Pneumocephalus or intracranial air its commonly detected following serious head injury and posterior fossa surgery. In laryngology the frequent reason of its appearance is also herniation of air through a break in the wall of skull due to advanced benign and malignant tumors. The pathophysiology involves the presence of craniodural fistula allowing ingress of air. A ballvalve mechanism may allow air to enter not exit the cranium or like in turned upside down bottle leak permit air entrance as fluid leaves the intracranial space. The presence of air is usually asymptomatic but caries a potential risk of increased intracranial pressure or meningitis which require an immediate therapy. Although various ways of treatment were reported prevention and early diagnosis are the most important. We report 3 cases of cerebral air that occurred secondary to the head trauma. The diagnosis every time promptly confirmed by skull roentgenogram or CT.

Latissimus-sparing thoracotomy in the pediatric patient: a valuable asset for thoracic reconstruction.

The traditional posterolateral thoracotomy involves division of the latissimus dorsi muscle (LD). While the division results in no functional disability, it does negate the potential for possible future thoracic reconstruction if required in individual cases (eg, bronchopleural fistula, empyema, etc). A latissimus-sparing thoracotomy (LST) mobilizes the muscle dorsad and does not compromise the operation. Thus, the ipsilateral LD can be used when chest wall reconstruction is required. This option has been used frequently for adults; however, its use in children has not been extensively documented. Microvascular anastomoses for a contralateral LD free-flap may be tenuous in the small vessels of the child; thus, reconstruction using the ipsilateral LD could be beneficial and safer. The feasibility of LST has not been established with regard to the chest of the child. The authors present three pediatric thoracic cases that illustrate the value of this procedure, and discuss different situations in which latissimus-sparing thoracotomy is advantageous.

Enteroclysis in the evaluation of suspected small intestinal bleeding.

One hundred twenty-five consecutive enteroclysis studies performed for the indication of gastrointestinal bleeding were reviewed. The overall yield of positive studies was low (10%) but important lesions were found. Patients with unequivocally normal evaluations of the upper gastrointestinal tract and colon had the highest yield of positive enteroclysis studies (20%). Neither the specific type of bleeding, the presence or absence of abdominal symptoms or physical examination findings, nor the results of laboratory tests were associated with a positive or negative enteroclysis study.