[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx]. / Rehabilitacja pacjentów leczonych fonochirurgicznie z powodu zmian obrzekowo-przerostowych krtani.

UNLABELLED: Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation. AIM: The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically. MATERIALS AND METHODS: The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice. RESULTS: Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases. CONCLUSIONS: HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.

Heterotopic ossification of the elbows in a major petrol burn.

A case of a young man who developed heterotopic ossification (HO) in his elbows following an accident where he sustained petrol burns to over 60% of his body. His injuries necessitated intubation, escharotomies and a protracted intensive care unit stay that was complicated by septicaemia. Several weeks after the injury, he was diagnosed with HO in his right elbow, followed by the left elbow a week later. He was commenced on an non-steroidal anti-inflammatory drug, a long-term course of a bisphosphonate and regular physiotherapy. He is now waiting for the HO bone to mature before having definitive excision of his lesions in 12-18 months time.