[Psychological aspects of treatment of patients with head and neck cancer]. / Psychologiczne aspekty leczenia chorych z nowotworami glowy i szyi.

One of the basic components that describe treatment success in contemporary oncology is patients' quality of life (QL) depending on specificity of the disease, treatment method, side effect of treatment, the medical prognosis and patient expectations. In reality, the QL is determined by the difference between patients' expectations and the actual health condition. The bigger the difference, the worse the evaluation of QL. Solving the crises, stress situation and starting life in a new way are strictly connected with the reshaping of personality and formation of adequate skills. It means it is necessary to create a new "picture of oneself", "self image" appropriate to the actual health condition and find the optimum way of activating personality protecting system (defence mechanisms). This task is not easy to realise; it is often necessary to introduce the psychotherapy to make it work. The main aim of defence mechanisms is the reduction of fear and other negative emotions, typical for oncological patients. However, the immature and poor defence system of "ego" can, at the same time, protect the personality unity and result in harmful behaviours. But when the "new self image" is made real, the newly learnt personality defence mechanisms are more mature, the patient becomes able to fight with the disease, is able to face the reality, which constitutes the main factor in the increase of QL assessment. To estimate the influence of psychotherapy on QL of head and neck cancer patients we have planned the introduction of psychological intervention (meetings of therapeutic groups).

[Usefulness of questionnaire EORTC QLQ C-30 and EORTC QLQ H&N C-35 in assessment of quality of life before surgical treatment in patients with head and neck cancer]. / Zastosowanie ankiety EORTC QLQ C-30 oraz EORTC QLQ H&N35 w okreslaniu jakosci zycia przed rozpoczeciem leczenia chirurgicznego u chorych z rozpoznana choroba nowotworowa w obrebie glowy i szyi.

BACKGROUND: Quality of life (Qob) has become an important issue in head and neck cancer. Nowadays the explanation of factors predicting quality of life after surgical treatment has important role and implications for patient's management. METHODS: We analyzed which pretreatment parameters and factors predicted QoL after surgery of 46 patients with larynx cancer. The patients completed the EORTC Core Questionnaire, the Head and Neck Module. RESULTS: The QLQ H&N35 Core Questionnaire demonstrated acceptable reliability. The instrument was sensitive to the effect of patients' disagreement of quality of life state. Scores were significant associated with total quality of life score. CONCLUSIONS: Results support the sensitivity and applicability of Core Questionnaire. The use of this disease-specific measure to assess quality of life among patients with advanced larynx cancer.

[Laser cordectomy: treatment of precancerous stages of the larynx]. / Chordektomia laserowa w stanach przedrakowych krtani.

UNLABELLED: Diagnostics and treatments of precancerous states of cancer of larynx will demand in select chances the multistages treatment AIM: In work one priced radicality and efficiencies of treatment of precancerous stages of larynx with method of carbone dioxide laser cordectomy. The retrospective examination was executed of years 1991-2000 imicrosurgical interventions of larynx--in talked over period one executed 308 of surgical interventions with use of laser CO2, in number this 41 of interventions were partial laser cordectomies in stages with precancerous changes on the vocal cords. In chances of extensive precancerous changes of vocal cords in sorted chances not one should limit oneself to receiving of specimens from several localization, but change to remove in wholes. Permits this on obtainment radicality of intervention with possibility of obtainment the large material to histopathological investigations.

[The quality of life in head and neck cancer patients: description of randomized examination formula based on standardized questionnaires EORTC QLQ C-30, EORTC QTQ-H-N35 and Kiel Questionnaire]. / Jakosc zycia u chorych z nowotworami glowy i szyi--wstep do randomizowanych badan opartych na standaryzowanych kwestionariuszach EORTC QLQ C-30, EORTC QLQ-H&N35 i Kwestionariuszu Kilonskim.

The notion of quality of life (QL) was first introduced in the US in the 50-ies. This notion is much broader then health, it is a personal, subjective feeling of well-being that comes from actual, widely-meant life experiences. The QL is not a measurable value, however, it may be assessed by means of appropriate indices. In the contemporary holistic attitude to a patient, in modern oncology, QL has become a parameter of equal importance to other values characterizing the treatment success, as important as numbers describing e.g. mean survival, disease free survival, or neoplasm controlled survival. Head and neck neoplasms bring about deterioration of the basic functions of the organism such as: breathing, swallowing, speaking and senses: hearing, taste and smell. Application of treatment may intensify pain, dyspnea, hoarseness or cause any kind of discomfort. It influences directly the patients' family and social life. Comparison of QL of patients treated for larynx, tongue, tonsill, glands, and paranasal sinuses neoplasms depending on localisation of primary foci, advancement of the disease, the applied treatment and its radicality, age, sex, place of living (town/country), and educational level. Correlation between the subjectively assessed QL and the objectively evaluated condition of the patient is measured. In ENT Dept. K. Marcinkowski University of Medical Sciences 46 patients were examined from May to September 2000. EORTC QLQ C-30, EORTC QLQ-Head and Neck and HAD scale were used. Kiel Questionnaire was introduced in September. The main reason for introducing it was the fact, that surgery is the method of choice in the treatment of head and neck malignancies in our Dept. The team composed of a psychologist and an ENT doctor has been working together on objective assessment of each patient. The QL assessment may be of practical importance when trying to improve the model of health care in cases of oncological patients. This knowledge enables us to learn how the accompanying side effects of therapy influence the QL of our patients, and how these problems may be overcome by proper education, advice, and support provided by the qualified staff. The authors are evaluating the QL in the period of 2, 6 months and 1 year after surgery in patients not supported psychologically. Our goal, in the future, is to introduce the psychological treatment, i.e. repetitive meetings in small groups, conducted by a psychologist. We have contacted 4 major ENT centers in Poland in order to coordinate the research on detailed assessment of QL in Head and Neck Cancer Patients in Poland. The results will be presented in the further publications.

[Value of estradiol, progesterone and cortisol binding globulin (CGB) in patients with laryngeal cancer]. / Poziomy estradiolu, progesteronu i globuliny wiazacej kortyzol (CBG) u chorych na raka krtani.

The unique feature of larynx cancer epidemiology is great discrepance between men and women morbidity. This difference may be explained not only by exposition to environmental factors but also to endogenous one, i.e. sex hormone levels. In 67 patients operated for larynx cancer there were simultaneously estimated the value of estradiol (E2), progesterone (Pg) and cortisol binding globulin (CBG) in blood serum. The radioimmunological assay (RIA) with specific antibodies and antigens signed by J125 was used. Value of hormones and binding globulin were examined by Spectria sets by Orion Diagnostica. The high value of estradiol and CBG in blood serum was observed. In meaningful number of patients we noted normal value of progesterone.

Laser arytenoidectomy in the treatment of bilateral vocal cord paralysis.

The introduction of the CO2 surgical laser into laryngeal microsurgery has made resection of the posterior vocal cord together with the arytenoid cartilage possible. Since November 1990, 30 arytenoidectomies, 17 partial cordectomies and 18 bilateral cordectomies as described by Kashima were performed by means of a CO(2) laser in patients with bilateral paralyses of the vocal cords. In this group there were 58 women and 7 men. The patients' ages ranged from 28 to 71 years (mean, 46.7 years). In one case the operation was performed twice: the right arytenoid cartilage was excised initially and the left arytenoid cartilage was removed in the second procedure. Three patients required tracheotomy before being transformed to the ENT Clinic, Poznañ. The etiologies of the vocal cord paralyses were complications arising from thyroid gland surgery (n = 62), trauma (n = 2) and excision of a bilateral glomus caroticum tumor. In all patients except one postoperative recovery was correct and no breathing difficulties were observed after extubation. In the one failure after operation endolaryngeal scar tissue resulted in glottic stenosis.

Extended fronto-lateral laryngectomy with simultaneous reconstruction by means of a mucochondral nasal septum flap.

As treatment for laryngeal cancers the extended fronto-lateral laryngectomy allows tumor to be removed that involves the glottis with the vestibule of the larynx. Since 1979 we have performed 417 extended fronto-lateral laryngectomies with simultaneous reconstruction of the anterior part of the larynx using a mucoperichondral flap from the anterior septum. This operation was indicated for stage T1b cancer (175 cases), stage T2 tumor (231 tumors) and T3 extended operations with epiglottectomy (11 cases). For the total number of 417 patients operated on, 19 cases during the 5-year period of following had local recurrences that required total laryngectomy. In 11 cases, metastases to the cervical lymph nodes required surgical neck dissection. In the remaining 387 cases, a normal air passage and a large laryngeal lumen were found. In 15 cases graft rotation into the larynx made respiration and phonation difficult but without dyspnea occurring. Follow-up to a maximum of 18 years showed that the oncological and functional results after this surgical procedures are encouraging.

[Laser resection of the vocal cord growth of the arytenoid cartilage in the treatment of contact ulcer]. / Resekcja laserowa wyrostka glosowego chrzastki nalewkowatej w leczeniu owrzodzenia kontaktowego.

4 cases of larynx contact ulcer cured with the use of laser resection of vocal process of arytenoid cartilage were presented. Advantages of using laser been in microsurgery of larynx were discussed.

[Jet ventilation as method of the general anesthesia in microsurgery of the larynx]. / Znieczulenie ogólne z zastosowaniem wentylacji dyszowej o duzej czestotliwosci w mikrochirurgii laserowej krtani.

Usefulness of jet ventilation in carbon dioxide laser surgery of the larynx is presented. The authors describe the advantages of that method of general anesthesia in surgery of the larynx.

[Laser aryntenoidectomy in bilateral vocal cord paralysis treatment]. / Arytenoidektomia laserowa w leczeniu obustronnych porazen faldów glosowych.

The method of surgical treatment of bilateral vocal cord paralysis with the use of laser CO2 is presented. This technique was used in 20 patients. The vaporization and extirpation of arytenoid cartilage was performed together with resection of 1/3 of the posterior vocal cord which was removed. Analyzing other methods of treatment of bilateral vocal cord paralysis it was emphasized that with the use of the presented method good results in preserving breathing and phonation of the operated part was archived. It was also emphasized that the fast process of healing and lack of granulation in the operated field allows for the quick recovering patient. This method allows to obtain good wide larynx lumen without the necessity to perform tracheotomy--in 17 out of 20 our patients we could perform laser arytenoidectomy without tracheotomy.

[Smell and taste in patients with neoplastic tumors of palatine tonsils treated by radiation]. / Powonienie i smak u chorych po napromienianiach z powodu choroby nowotworowej midgalków podniebiennych.

The smell and taste investigations were made in group of 47 subjects with neoplasms tumors of palatine tonsils surgical treated with radiation and in group of 7 subjects treated only by radiation. The investigation presents mostly quantitative disturbance of smell in both groups but with temporary character.

The analysis of distribution of karyometric measurements.

The aim of the work was the analysis of distribution of karyometric measurements for semi- and ultrathin sections. The investigation was performed using spheres (diameter 16.2 mm), which were randomly cut using a microtome knife. The diameters of sections were measured with ocular with accuracy 0.1 mm. It has been shown, that the mean value of the measurements does not correspond to the real value of the spheres' diameter, and it is distinctly lower. The theoretical analysis explaining this fenomenon was performed. The obtained results allow for estimation of real diameter of spherical nuclei of the some size.