Agnieszka Morawska

Serum zinc level in depressed patients during zinc supplementation of imipramine treatment

BACKGROUND Recurrent major depression is associated with decreased blood zinc concentrations that may be increased by effective antidepressant therapy. Some clinical investigations point to alterations of the zinc level in blood as a potential marker of depression. METHODS A placebo-controlled, double blind study of zinc supplementation to imipramine therapy was conducted on sixty patients fulfilling the DSM-IV criteria for major depression (18-55 years old, 40 females, 20 males). Moreover, a group of 25 healthy volunteers was recruited (16 females, 9 males). Blood samples were drawn for the assay of serum zinc once from the control subjects and four times (before, and then 2, 6 and 12 weeks after the beginning of treatment) from the depressed subjects. RESULTS We report that: 1) the serum zinc level was significantly lower (by 22%) in depressed patients than in healthy volunteers, 2) all groups demonstrated a gradual increase in zinc concentrations over the period of imipramine treatment with or without zinc supplementation, 3) treatment-resistant patients demonstrated lower concentrations of zinc (by 14%) than treatment-non-resistant patients, 4) zinc concentrations were higher in zinc-supplemented patients than in placebo-supplemented patients, 5) zinc supplementation increased zinc concentrations over the period of treatment, and 6) at a 12-week imipramine treatment, a significant negative correlation was demonstrated between the Montgomery-Asberg Depression Rating Scale and the serum zinc level together with a concomitant increase in serum zinc in patients in remission. CONCLUSIONS Serum zinc is a state marker of depression.

Reoperacje w przebiegu otitis media chronica cholesteatomatosa

Summary Introduction Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. Aim This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. Material and methods Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004–2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. Results 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Stahylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. Conclusions The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.INTRODUCTION Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. AIM This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. MATERIAL AND METHODS Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. RESULTS 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. CONCLUSIONS The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

Endoskopowe leczenie olbrzymich kostniaków podstawy czaszki

Summary Introduction Osteomas are relatively common, benign, slow-growing neoplasms. Mainly occurring in frontal and ethmoid sinuses. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim We discuss our experiences in endoscopic treatment of giant osteomas. Results In giant osteomas Draf III or Lothrop approaches are prefered. Periostium of the orbit was intact in all cases. Discharge of cerebrospinal liquid was not observed. Conclusions Size of tumor determines type of surgical aprroach. Endoscopic surgery is more and more popular way in surgical treatment of giant osteomas.

Optymalizacja leczenia chorych z perlakiem ucha środkowego

Summary Background The chronic otitis media is a frequent condition in ENT practice. The presence of cholesteatoma can lead to the destruction of bony structures in the middle ear spaces to a different extent. Aim We discuss the way of the patients’ treatment with the chronic cholesteatoma otitis media that were operated on for the first time. Material and methods We analyze the patients with the chronic cholesteatoma otitis media who were diagnosed, operated on and followed up in our Department between 2006 and 2009. 410 operations on ears were performed in that period of time. We discuss the extent of cholesteatoma, the hearing impairment, the type of otosurgery and the distant results of performed therapy. Results We discuss 44 patients operated on chronic cholesteatomatoma otitis media for the first time. It constitutes ca. 10% of all middle ear operations performed in analyzed period of time and 40% of all individuals operated on cholesteatoma. Conclusions There is a group of patients with the chronic cholesteatoma otitis media that have no hearing improvement after the reoperation. The main aim of the therapy in this group is to remove the pathology and therefore obtain the ‘dry ear’ and prevent against otogenous complications.

Leiomyosarcoma krtani w materiale klinicznym ORL w Krakowie

Summary Introduction Leiomyosarcoma is a malign neoplasm coming from the non-epithelial tissue. It rarely developes in the larynx. 0,5–1% of all of the neoplasm of the larynx is leiomyosarcoma. It usually developes in the age of 40–70 and mostly effects men. Aims Improvement of the therapy of patients with leiomyosarcoma of the larynx. Material and metods The analysis of the medical documentation of the 5 patients with the diagonosis of leiomyosarcoma laryngis treated in Otorhinolaryngologic Clinic UJ in 1996–2006 was performed. The procedures and effects of the therapy were analized. Results In this particular period of time 11 patients was operated because of the sarcoma of the larynx. In this group there were 5 cases of leiomyosarcoma, 4 cases of chodrosarcoma and 1 case of agniomyxofibrosarcoma and 1 case of sarcomy synoviale. Conclusions On the basis of the material of the Clinic the frequency of these tumors was estimated and the therapeutic procedure including widening of the surgical indications for the partial laryngectomy and narrowing the indications for nodular surgery of the neck was proposed.

Pseudomonas i Alcaligenes – patogeny przewlekłego zapalenia ucha środkowego w materiale klinicznym ORL

Summary Introduction Otitis media chronica is the most common disorders encountered in otolaryngology. The great multitude of different bacteria which may couse otitis media constitutes the need for bacteriological diagnostics, especially in cases where classical conservative treatement of the inflammatory process fails. Material and methods Bacterial culture results procured from hospitalized and ambulatory patients which chronic otitis media, admitted from 2003 to 2006 at the otolaryngological department were analyzed. Results In total 47 patients were found to have their middle ear infected with Pseudomonas species and 1 patient with Alcaligenes xylosoxidans rods. Conclusions In cases of ear infection which fails conservative treatment, especially in immunocomprimised can be caused by pathogens which are resistant to most commonly administered antibiotics.

Endoskopowe resekcje guzów złośliwych nosa i zatok przynosowych

Summary Malignant neoplasms of the nose and paranasal sinuses constitute about 3% of head and neck tumors. They are more often observed in males. We discuss clinical appearance and treatment performed in 6 individuals with malignant tumors in the nose and paranasal sinuses that were removed with endoscopic surgery. Successful result in endoscopic treatment patients with malignant tumors in the nose and paranasal sinuses depends on right indications of individuals to this procedure. In some situations it could be alternative to surgery with external approach.

Czynniki prognostyczne u chorych leczonych operacyjnie z powodu perforacji błony bębenkowej przy nieuszkodzonym łańcuchu kosteczek słuchowych

Summary Background Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. Aim This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. Material and methods Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. Results 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. Conclusions The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operators preferences, as well as the availability of given material for transplanting.BACKGROUND Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. AIM This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. MATERIAL AND METHODS Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. RESULTS 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. CONCLUSIONS The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operators preferences, as well as the availability of given material for transplanting.

Analiza wskazań ortodontycznych do leczenia operacyjnego przerostu pierścienia Waldeyera u dzieci w materiale Kliniki Otolaryngologii i Instytutu Stomatologii CMUJ w Krakowie

Summary Introduction The lymphatic system of a childs throat has got a special role to play. It is the first line of contact for a developing organism with antigens in the environment. For a particular group of children Waldeyer ring hyperplasia is much bigger than it is for a usual group of patients. And thats what causes different illnesses Aim The analysis of ortodonthic indications for surgical treatment of adenotomy and tonsillotomy. Material and method The research was conducted on a group of hospitalized children in the Otorhinolaryngologic and in Stomatology Departament of Jagiellonian University Hospital in Krakow. The were treated for pathologic hypertrophy of adenoid and palatine tonsils. The analysis of occlusion disorder was carducted and the assessment of surgical and orthodontic treatment was performed. Results In the years 2002–2006 in the Otorhinolaryngologic and in Stomatology Departament of Jagiellonian University Hospital in Krakow 24 children were being treated for pathologic hypertrophy of adenoid and/or palatine tonsils accompanied by an occlusion disorder. Conclusions Adenotomy with or without tonsillotomy is one of the most frequently performed surgical operations on children. Throughout many years the indications for this procedure were infringed. Nowadays the operation is being performed mainly because of the rhinological and/or otological indications for the pathologic hypertrophy of adenoid and/or palatine tonsils. There is also another indication although it is less frequently used. This indication is an occlusion disorder which needs to be treated orthodontically.

Zasady leczenia niezłośliwych guzów krtani u chorych w wieku podeszłym – amyloidoza krtani

Summary Introduction Amyloidosis’ are the heterogeneous group of diseases characterized by extracellular accumulation of secondary protein structures causing progressive disturbances of the organs. Amyloid deposits are localized mainly in the tissues of parenchymal origin (spleen, kidneys, liver) and as far as otorhinolaryngologic organs are concerned the primary pathological process is rare. Aim The case presentation and the diagnostic and surgical procedure analysis with the assessment of the effects of therapy in patients in elderly age with amyloidosis of larynx. Material and methods A 82-year-old patient with a tumor of the larynx hospitalized in Otorhinolaryngology Clinic in Cracow. The first symptom of the pathologic process in this patient was an increasing laryngeal dyspnoe and the preliminary macroscopic assessment based on indirect laryngoscopy and endoscopy suggested the proliferative process from the group of non-epithelial neoplasm. Results In this case tracheotomy was performed and four days later the pathologic change was endoscopically removed from larynx. The improvement of the local state was achieved which enabled to decannulate the patient. Conclusions The amyloid deposits in otorhinolaryngologic organs are rare. Isolated changes in larynx suggesting malign neoplasm are the benign changes but on account of the specificity of the organ they can be a real threat to life.