[Complications in surgical treatment of thyroid diseases]. / Chirurgiczne leczenie chorób tarczycy--powiklania pooperacyjne.

THE AIM: of this study was examination of laryngeal nerve injury, hypoparathyroidism, bleeding and thyroid storm frequency after thyroidectomy. MATERIAL AND METHODS: Retrospective analysis of 847 patients surgically treated from 1985 to 2004 due to thyroid cancer (77) or multinodular goiter (770). We analyzed influence of type of thyroidectomy, diagnosis and reoperation on complication rates. Statistical analysis was performed with Chi2 or Fisher exact test. RESULTS: Unilateral lobectomy was performed in 195 cases (23%)--total unilateral lobectomy in 51% of patients and partial or subtotal lobectomy in rest of them. Bilateral lobectomy was performed in 652 patients--in 20% of cases it was total thyroidectomy and partial or subtotal thyroidectomy in 524 of patients. There was no mortality in operative or postoperative period. Wound exploration due to bleeding was performed in 3 cases (0,4%) and thyroid storm was noticed in 1,6% of all patients. Unilateral permanent laryngeal nerve injury was in 2,1% of patients, in one patient it was permanent bilateral nerve injury and unilateral temporary nerve injury in 3,2%. We noticed statistically significant differences in permanent and temporary nerve injury between total and partial thyroidectomy groups (7,0% vs 1,3% and 8.6% vs 2,2%; p < 0,005) and after primary operation and reoperation groups (8,9% vs 1,7% and 6,7% vs 2,9; p < 0,005). Permanent and temporary recurrent laryngeal nerve injury rates after total thyroidectomy due to cancer or multinodular goiter were not significant (7,8% vs 5,9% and 9,1% vs 7,8%; p = 0,72). Temporary hypoparathyroidism was noticed in 34 cases (4%) and permanent in one case. Again temporary hypoparathyroidism was significantly higher after total thyroidectomy compared to partial (18,0% vs 2,1%; p < 0,005) and after reoperation (17,8% vs 3,2%; p < 0,005). There were no differences in hypoparathyroidism rates after total thyroidectomy due to cancer or multinodular goiter (20,8% vs 13,7%; p = 0,35). RESULTS: Recurrent laryngeal nerve injury and hypoparathyroidism are most common complications after thyroid surgery. Total thyroidectomy and reoperation are risk factors of recurrent laryngeal nerve injury and hypoparathyroidism.

[Primary hyperparathyroidism--case report and review of the literature]. / Pierwotna nadczynnosc przytarczyc--opis przypadku i przeglad literatury.

We present case report of primary hyperparathyroidism treated surgically as well as a review of literature concerning this subject. The disease of not well known etiology presents with elevated parathormon levels and hypercalcemia. Primary hyperparathyroidism which states 85% percent of all kinds of hyperparathyroidism is usually parathyroid adenoma, in 11-15% glandular hyperplasia and in 1-4% parathyroid cancer. Clinical symptoms are muscle weakness and fatigue, nephrolithiasis, occasionally peptic ulcers, pancreatitis, hypertension. Laboratory test reveal increased level of PTH, hypercalcemia, elevated alkaline phosphatase levels and decreased phosphorus levels. Diagnostic imaging techniques such as ultrasonography, MRI or CT have sensitivity about 52-75%. Highest sensitivity in localization of ectopic parathyroid adenoma has sestamibi scintigraphy with technetium-99. Skeleton x-rays show typical changes in distal parts of bones and osteopenia. Treatment of choice is surgical excision of adenoma. Normalization of PTH and calcium levels after surgery and improvement of renal, musculoskeletal and circulatory system function could be achieved in 95%. Most common complications are recurrent laryngeal nerve injury, hypo- or hyperparathyroidism, bleeding or stridor.

US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls.

Ultrasonography (US) is useful for differential diagnosis of diseases of the salivary glands. In acute inflammation, salivary glands are enlarged and hypoechoic with increased blood flow; they may contain multiple small, oval, hypoechoic areas. In chronic inflammation, salivary glands are normal sized or smaller, hypoechoic, and inhomogeneous. Sialolithiasis appears as markedly hyperechoic lines or points with distal acoustic shadowing. Sialosis appears as enlarged hyperechoic glands without focal lesions or increased blood flow. The US features of advanced Sjögren syndrome include inhomogeneous salivary glands with scattered small, oval, hypoechoic or anechoic areas, usually well defined, and increased parenchymal blood flow. Pleomorphic adenomas are usually hypoechoic, well-defined, lobulated lesions with posterior acoustic enhancement that may contain calcifications; Warthin tumors are usually oval, hypoechoic, well-defined lesions that often contain anechoic areas and are often hypervascularized. Malignant neoplasms of the salivary glands may have irregular shapes, irregular borders, blurred margins, and a hypoechoic inhomogeneous structure or may have a benign appearance. Salivary gland cysts have well-defined margins, anechoic contents, posterior acoustic enhancement, and no internal blood flow. However, US appearances of some diseases may overlap, thus producing diagnostic pitfalls.

[Effectiveness of therapeutic (NI, N2) modified radical neck dissection (MRND) in patients with laryngeal cancer]. / Efektywnosc operacji radykalnej zmodyfikowanej w leczeniu klinicznie obecnych przerzutów regionalnych raka krtani.

OBJECTIVE: Efficacy of modified radical neck dissection in treatment of laryngeal cancer with node positive neck. PATIENTS AND METHODS: Retrospective analysis of 311 patients treated with modified radical (86) or radical (225) neck dissection. Recurrence rates, local and regional, after both operations and 5-year disease free survival (Kaplan-Meier method) were analyzed. RESULTS: Regional recurrence rates in N1 group after MRND were 3% and 13% after RND. In N2 group 13% and 16% respectively. 5-year survival after MRND in N1 group was 73% compared with 60% after RND. In N2 group 5-year survival was 56% and 47%. CONCLUSION: We consider MRND as effective treatment method of node positive neck in N1 and N2 stage compared to RND with less morbidity.

[Extracapsular spread as an ominous prognostic sign in laryngeal cancer]. / Objaw naciekania torebki wezla chlonnego jako niekorzystny czynnik rokowniczy.

OBJECTIVE: Impact of extracapsular spread upon survival and recurrence rates in patients with laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of 309 patients with pathologically confirmed regional metastases with and without extracapsular spread (144 and 165 patients respectively). To examine impact of clinical variables upon treatment outcomes we used logistic regression (logit) and Kaplan-Meier method to calculate 5-years disease free survival. RESULTS: Extracapsular spread significantly reduced 5-years survival (40% vs 77%; p = 0.005) and increased regional recurrence rates (33% vs 12%; p = 0.0001). CONCLUSION: Authors suggest use of radiotherapy after neck dissection in presence of extracapsular spread.

[Salvage surgery after failure of radiotherapy in laryngeal cancer]. / Chirurgia ratujaca w przypadkach niepowodzen radioterapii raka krtani.

OBJECTIVE: Efficacy of salvage surgery after radiotherapy failure in patients with laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of 121 patients treated in our clinic between 1980 and 2003 (supraglottis--86 patients, glottis--35). In 70% of patients T-stage was T3 and T4 and regional metastases were present in 56% of cases. We performed statistical analysis of recurrence rates and 5-years survival according to Kaplan-Meier method. RESULTS: Glottic localization (p = 0.02) and extracapsular spread (p = 0.03) were significant factors of final outcome. Local and regional stage was not significant factor of recurrence. Disease free 5-year survival was 53%. CONCLUSION: Salvage surgery is a reasonable method that could save about 50% of patients after radiotherapy failure.

[Stomaplasty for trachoestomal stenosis using rib cartilage--authors method]. / Plastyka zwezenia tracheostomii przeszczepem chrzastki zebra--metoda wlasna.

Authors present surgical procedure for treatment of tracheostomal stenosis after laryngectomy with use of 7th rib cartilage. Procedure is simple, almost without morbidity, provides good ventilatory and cosmetic results and helps in learning esophageal speech.

[Cerebral abscess and ear cancer in the course of chronic otitis media]. / Ropien mózgu i rak ucha w przebiegu pizewleklego zapalenia ucha srodkowego.

Authors are discussing the coexistence of cerebral abscess and the ear cancer in the course of chronic otitis media. They are emphasizing the existing danger of intracranial complications and at the same time the development of cancer with a non-typical course in the middle ear with effusion is more probable.

[Acute suppurative thyroiditis--laryngologic problem]. / Ostre ropne zapalenie tarczycy--problem laryngologiczny.

INTRODUCTION: Authors present four cases of acute suppurative thyroiditis treated in our department. Initial symptoms are similar to acute pharyngitis or laryngitis but could end in fulminant course that could be life threatening. MATERIAL AND METHODS: We present etiology, clinical symptoms and accessory exams as well as new treatment methods. RESULTS: All four patients were cured. In one case pharmacological treatment was sufficient. In second case the patient needed intubation due to stridor. In third one after pharmacological treatment we performed partial thyroidectomy. In last case patient with thyroid abscess needed urgent thyroidectomy due to retropharyngeal and mediastinal multiple abscesses. CONCLUSIONS: Acute suppurative thyroiditis needs hospitalisation. Some patients needed surgical intervention due to life threatening course.

[Haemangiopericytoma of the parotid gland]. / Haemangiopericytoma slinianki przyusznej.

Haemangiopericytoma is a vascular, soft tissue neoplasm with rare occurrence in the head and neck region. On the basis of literature we discuss etiology, symptomatology, histopathology, diagnosis, treatment and prognosis. We present the case of 66-old woman with haemangiopericytoma in the parotid gland treated by surgery.

[Kuttner tumour--review of the literature and report of 3 cases]. / Guz Kuttnera--przeglad literatury i opis 3 przypadków.

We present 3 cases of Kuttner tumour (or chronic sclerosing sialadenitis of submandibular gland) all treated by surgery. In one case we report bilateral involvement. The disease was first described by Kuttner more than 100 years ago. In the new WHO Classification of tumour-like lesions of the Salivary Glands (1992) Kuttner tumour is classified as a distinct clinicopathologic entity. We also present a review of the literature about etiology, pathogenesis, differential diagnosis and treatment of this disease.