Hyperbaric oxygen therapy in the treatment of complications of irradiation in head and neck area.

BACKGROUND AND PURPOSE: We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications. MATERIAL AND METHODS: Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months. RESULTS: Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed. CONCLUSION: The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.

The effect of hyperbaric oxygen on nasal mucociliary transport.

Nasal mucociliary transport was measured in a group of 30 adult patients (eight women and 22 men; age range 21-78 years, mean 47.9 years) treated with hyperbaric oxygen (HBO) therapy and in a control group of 32 adult subjects (two women and 30 men; age range 20-50 years, mean 32.0 years) compressed in a hyperbaric chamber without oxygen therapy. The treated patients breathed 100% oxygen at 250 kPa pressure for 60 min. Subjects from the control group were compressed in the hyperbaric chamber at 250 kPa for 70 min. Nasal mucociliary transport was measured with the saccharin clearance test. After exposure to HBO, the nasal mucociliary transport time was significantly decreased by 26% (P < 0.01) and returned to the original value after 24 h (increased by 8.3%, P = 0.25). In the control group, compressed in air, there were no statistically significant changes. This study shows that simultaneous compression and pure oxygen cause an increase in nasal mucociliary transport. The mechanism of activation of mucociliary clearance is probably the increased oxygenation of blood plasma and enhancement of metabolism in ciliated epithelium.

A case of multisymptomatic relapsing polychondritis in a 22-year-old woman.

A case of multisymptomatic relapsing polychondritis in a 22-year-old woman. We report a case of a 22-year-old woman with relapsing polychondritis (RP)--a rare and little known systemic autoimmune disease characterised by episodic inflammation of cartilaginous structures (ear, nose, bronchi, trachea, larynx, ribs, cardiovascular system). This patient presents with a seven-year history, initiated by the saddle nose. The patient developed a multitude of symptoms: auricular chondritis, ocular symptoms, recurrent arthritis, respiratory complications (laryngotracheomalacia, bilateral vocal cord palsy), sensorineural hearing loss and enchondroma of the humeral bone. The examination of an auricle biopsy by an immunofluorescent method and a positive serum reaction from the patient to normal cartilage supported the immunological nature of relapsing polychondritis. Treatment consisted of orally administered prednisone and diaminodiphenylsulfone (Dapsone).

[Primary malignant neoplasms of nasal septum in the material of ENT Department at Medical University in Gdansk]. / Pierwotne nowotwory zlosliwe przegrody nosa w materiale Kliniki Otolaryngologii AM w Gdansku.

The authors presented 25 years experience of ENT Department Medical University of Gdansk in treatment 28 primary malignant neoplasms of nasal septum. The aim of the study was to analyse epidemiological (age, sex, addictions etc.), morphological and clinical data of these tumors, methods of treatment and their results. Histologically the most often recognized neoplasm was squamous cell carcinoma (15 of 28 cases--53.6%) and malignant melanoma (6 of 28 cases--21.4%). Diagnostic and clinical difficulties in this group of patients were presented. The treatment results were compared to the results obtained in the whole group of patients with malignant neoplasms of the nose and paranasal sinuses.

[Unusual history of the chemodectoma of parapharyngeal space]. / Klebczak przestrzeni przygardlowej o nietypowym przebiegu klinicznym.

A case of chemodectoma in 58 year old woman is presented. The tumour was located in the parapharyngeal space. During preoperative arteriography and embolization a hemiparesis was noticed, probably caused by the thrombus in the cerebral medial artery. Early radiological examination of brain arteries allowed to perform specific treatment in only two hours time from the onset of the paresis. The treatment was successful--neurological symptoms have receded after 24 hours. Few days later patient was operated on--the tumour was removed with part of the vagus nerve. No serious postoperative complications were observed.

[Hyperbaric oxygen therapy as a method of treatment of laryngeal and pharyngeal radionecrosis]. / Hiperbaria tlenowa jako metoda leczenia zmian popromiennych gardla i krtani.

The authors described two cases of palatine tonsil carcinoma treated with surgery and subsequent radiation therapy after which occurred severe radionecrosis of the larynx, pharynx and oral cavity. These subjects were treated with hyperbaric oxygen therapy (HBO). Complete resolution of postradiation changes was observed. The authors described: 1) basic changes in the tissues caused by radiation therapy; 2) the mechanisms of healing activity of hyperbaric oxygen.

[Malignant schwannoma of parotid gland. Case report and review of literature]. / Zlosliwy nerwiak oslonkowy slinianki przyusznej. Opis przypadku i przeglad literatury.

The authors described a rare malignant neoplasm of peripheral nerve sheath, sarcomatous neurillemoma, localized in parotid gland in 72-year female. Findings of the computer tomography, nuclear magnetic resonance and Doppler-ultrasound are presented and discussed. A review of world literature, including 14 cases of this tumor, was made.

[Carcinoma of the hypopharynx in the material of ENT Department at the Medical University of Gdansk]. / Rak gardla dolnego w materiale Kliniki Gdanskiej.

The authors presented results of retrospective epidemical and clinical evaluation of 101 patients with carcinoma of hypopharynx. 42 of them were treated surgically or combined method. 29.7% of them survived 3 years and 23.5%--5 years. Radiotherapy was applied in 52 cases--25.6% of them survived 3 years, and 19.9%--5 years. 28.4% of the patients survived 3 years and 21.5%--5 years.

[Merkel cell carcinoma in otolaryngology]. / Rak z komórek Merkela w otolaryngologii.

The authors presented two cases of Merkel cell carcinoma, a rare malignant neoplasm of neuroendocrine origin located in parabasal layer of epithelium. The first described case was 67 year old woman, after resection of primary tumor of eyelid, with metastases in lymph nodes of parotid gland. The second case was 44 year old woman with the primary tumor in retroauricular region. The patient underwent radiotherapy 23 years earlier due to malignant lymphoma. Basing on the available literature the authors discussed clinical and histological features of this malignancy, they stressed the important role of immunohistochemical tests in the diagnosis.

[Osteoma of the maxillary sinus]. / Kostniak zatoki szczekowej.

Osteomas of paranasal sinuses occur mainly in frontal and ethmoid sinus, in maxillary or sphenoid sinus are seen very rarely. The authors present a review of literature and next describe a case of spongioid osteoma in 42-years old female. The clinical features and radiologic assessment of the disease are presented. The tumour was resected by Caldwell-Luc operation with very good long term result.

[Retained teeth in the maxilla]. / Retencja zebów w szczece.

Two cases of retained teeth in maxilla, very rare disease seen in otolaryngological practice, are described. The authors present causes of this pathology, symptomatology, diagnostics and treatment. Diagnosis of retained teeth is made mainly by radiologic investigation i.e. CT and pantomography. A review of literature was made.

[Malignant ameloblastoma of the maxilla as an interdisciplinary problem]. / Szkliwiaki zlosliwe szczeki--problem interdyscyplinarny.

The clinico-pathological assessment of three cases of rare dentogenic tumours of the maxilla was made (including one case described earlier). In two patients primary malignant ameloblastoma was diagnosed. In one patient benign ameloblastoma was treated few times; in this case we have observed the transformation of benign disease to malignant because the occurring lymph node metastases. The authors discussed clinical and morphological characteristics of these tumours, which are under interest of many specialists.

Ventriculosaccular lymphoepithelioma of the larynx: case report and literature review.

BACKGROUND: Lymphoepithelioma is a very rare neoplasm of the larynx. The authors have reviewed the available published literature on the subject and found eight studies on lymphoepithelioma. Lymphoepitheliomas derive from the epithelial and lymphatic tissues of the laryngeal ventricule. The rarity of the occurrence of lymphoepithelioma makes it difficult to define its clinical features and general treatment methods. METHODS: The authors present a description of a lymphoepithelioma located in the left laryngeal sacculus, extending into the pre-epiglottic space and infiltrating the epiglottis with an ulceration of its laryngeal surface. A total laryngectomy and a left radical neck dissection were performed. After surgery, radiotherapy treatment was applied to the left cervical and laryngeal areas. Two years after the initial radiotherapy, the patient died during palliative chemotherapy (for metastases). RESULTS: In patients with lymphoepithelioma of the larynx, the following can be observed: (1) bulging of the laryngeal ventricule, with or without ulceration of the laryngeal surface of the epiglottic mucosa; (2) early lymph node and remote matastases. CONCLUSIONS: In the early stages of lymphoepithelioma, radiotherapy is the method of choice. In advanced cases of lymphoepithelioma, radiotherapy supplements surgical treatment.

[Ocular and orbital symptoms of Wegener's disease]. / Oczne i oczodolowe objawy choroby Wegenera.

Wegener's granuloma occurs most commonly in upper respiratory tract, in lungs and in kidneys. In many cases ocular and orbital disturbances may be accompanied by changes in the nose and sinuses. These disturbances occur as: superior orbital fissure syndrome, orbital apex syndrome or ocular fascicle atrophy. The authors present the symptoms of these disturbances in 3 patients treated at Otolaryngological Clinic, Medical University of Gdansk. On the bases of clinical symptoms and radiological results (CT and MRI) the assessment of pathogenesis of ocular and orbital symptoms was made in each of these cases, with special regard to the mode and result of the treatment.

Benign neoplasms of the larynx.

In a 45-year period (from 1948 to 1992) 291 patients with histologically proved benign neoplasms of the larynx were observed and treated. The most frequently occurring tumors were papillomas, being 95.2% in whole material. In most cases of benign tumors of the larynx intralaryngeal excision of the tumor was used. Clinical data and results of treatment were presented and discussed.

[Malignant tumors of the parotid gland]. / Nowotwory zlosliwe slinianki przyusznej.

The authors presented 72 cases of malignant parotid gland tumors treated in ENT Dept. in Medical University of Gdansk in years 1970-1990. The most frequent tumors were: carcinoma planoepitheliale, adenocarcinoma et carcinoma muco-epidermale. Particular analysis of TNM stage, histopathological findings and therapy of described cases may be helpful in improving the treatment results.

[Extramedullary plasmacytomas of the larynx]. / Odosobnione pozaszpikowe guzy plazmatycznokomórkowe krtani.

The authors present four cases of solitary extramedullary plasmocytoma of the larynx, a very rare laryngeal tumor, seen in ENT Department, Medical University of Gdansk in years 1948-1994. They were 0.16% of all malignant laryngeal neoplasms and 23.5% of non-epithelial neoplasms of the larynx in this period. Characteristics for these tumors, epidemiological and clinical features were discussed.