Ewa Osuch-Wójcikiewicz

Association of Polymorphic Variants of miRNA Processing Genes with Larynx Cancer Risk in a Polish Population

Laryngeal cancer (LC) is one of the most prevalent types of head and neck cancer. An increasing interest has been focused on the role of microRNA (miRNAs) in LC development. The study group consisted of 135 larynx cancer patients and 170 cancer-free individuals. Nine polymorphisms of pre-miRNA processing genes, DROSHA (rs6877842), DGCR8 (rs3757, rs417309, and rs1640299), RAN (rs14035), XPO5 (rs11077), DICER1 (rs13078 and rs3742330) and TARBP2 (rs784567), were performed by TaqMan SNP Genotyping Assay. It was found that the frequency of the GT and the TT polymorphic variants of XPO5 gene were higher in LC patients than in controls (p < 0.0001 and p = 0.000183, resp.). In turn, the frequency of the CT genotype of RAN gene was higher in controls than in LC patients (p < 0.0001). The TT and the AG of DICER1 gene (p = 0.034697 for rs13078 and p = 0.0004 for rs3742330) as well as the AG and the GG genotypes of TARBP2 gene (p = 0.008335 and p < 0.0001, resp.) were associated with higher risk of LC occurrence. Our data suggested that polymorphisms of miRNA processing genes might be useful as predictive factors for the LC development.

Recommendations for the diagnosis of human papilloma virus (HPV) high and low risk in the prevention and treatment of diseases of the oral cavity, pharynx and larynx. Guide of experts PTORL and KIDL

The role of human papilloma viruses (HPV) in malignant and nonmalignant ENT diseases and the corresponding epidemiological burden has been widely described. International head and neck oncology community discussed growing evidence that oral HPV infection contributes to the risk of oro-pharyngeal carcinoma (OPC) and recommended HPV testing as a part of the work up for patients with OPC. Polish Society of ENT Head Neck Surgery and National Chamber of Laboratory Diagnosticians have worked together to define the minimum requirements for assigning a diagnosis of HPV-related conditions and testing strategy that include HPV specific tests in our country. This paper briefly frames the literature information concerning low risk (LR) and high risk (HR) HPV, reviews the epidemiology, general guidance on the most appropriate biomarkers for clinical assessment of HPV. The definition of HPV-related cancer was presented. The article is aiming to highlight some of major issues for the clinician dealing with patients with HPV-related morbidities and to introduce the diagnostic algorithm in Poland.

Adaptation and Validation of the Voice-Related Quality of Life Measure Into Polish.

OBJECTIVES The purpose of the study was to translate and adapt the original V-RQOL (Voice-Related Quality of Life) instrument into Polish and to evaluate the psychometric properties of the Polish version of the V-RQOL Measure such as internal consistency, reliability, and construct validity in different groups of dysphonic patients. METHODS A total of 214 patients with voice disorders were assessed using the V-RQOL Measure, the Voice Handicap Index, and the World Health Organization Quality of Life, short version. RESULTS The Polish version of the V-RQOL Measure showed strong internal consistency with the Cronbach alpha coefficient: 0.92 for the total score, 0.90 for the social-emotional domain, and 0.86 for the physical functioning domain, and a good test-retest reliability (r-Spearman correlation coefficient: r = 0.8852 for the total score of the V-RQOL Measure). Construct validity was demonstrated with a strong correlation to the Voice Handicap Index (r = -0.843, P = 0.000*) and a weak positive, statistically significant correlation between the V-RQOL-physical functioning domain, V-RQOL-social-emotional domain, and the Q1, Q2, and Domain 1-Domain 4 of the World Health Organization Quality of Life, short version (0.2 < r < 0.4). CONCLUSIONS The Polish version of the V-RQOL Measure is a valid and reliable instrument to evaluate the patients perception of his or her own voice disorders and the impact it can have on the patients life. The V-RQOL Measure is easy to perform in clinical practice.

Rak gruczołowato-torbielowaty głowy i szyi – doświadczenie 10 lat

Summary Introduction Adenoid cystic carcinoma (ACC) was first described in 1853 and 1854 by three french scientists, Robin, Lorain and Laboulbene. ACC is a rare cancer of the head and neck (about 1%) and it comprises from 6% to 10% of all malignant tumors of the salivary glands. 15%–30% of these tumors are located in submandibular gland, 30% occur in small salivary glands (in the palate, tongue, mouth, nose, sinuses, mucous membrane of the cheeks) and about 6% in parotid gland. Because of its specificity ACC is a challenge for the doctor – it is usually recognized at an advanced stage, spreads along the nerves, it has a high propensity for recurrence, often gives distant metastases, 10-year survival are very small. Aims Aim of this study is the epidemiological and clinical analysis of patients with adenoid cystic carcinoma. Material and methods Includes a retrospective analysis of 21 cases of patients with ACC of the head and neck were hospitalized at the ENT Clinic of the Warsaw Medical University between 2001 and 2011. Data from medical records contain information about the location of the tumor, symptoms and clinical signs, diagnostic methods, method of treatment and local recurrences and distant metastases. Results most cases ACC occurred in the large salivary glands (14 cases), in 5 cases in the nasal cavity and maxillofacial region, in 2 cases in the tongue. In order to accurately determine the extent of the tumor, its relationship to adjacent structures was performed computed tomography and magnetic resonance imaging. Most of patients before treatment have been made biopsy of the tumor or download tissues by forceps for histopathological examination. Reported symptoms depend on the location of the tumor. In 20 cases the patients were treated by surgical therapy and followed by radiotherapy, in one case because of the extent of the tumor was sent to radiotherapy. Conclusions Surgical treatment of ACC requires a wide margin of healthy tissues; For the risk of local recurrences affected positive surgical margins, scull base locations of primary tumor and perineural invasion; Because of unpredictable nature of the tumor (local recurrences, distant metastasis), observation of patients after treatment should be carried out permanently, along with periodic imaging studies.

Postępowanie w przypadkach wznowy brodawczaka odwróconego nosa i zatok przynosowych po leczeniu operacyjnym w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego

Summary Introduction Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5–4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. The aim of study was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. Material The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. Results Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. Conclusions 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing

OBJECTIVES The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice. DESIGN This is a prospective, randomized study. METHODS Forty singers (29 females and 11 males, mean age: 24.6 ± 8.8 years) with MTD were enrolled in the study. The study group consisted of 20 singers who underwent combined functional voice therapy (10-15 individual sessions, 30-40 minutes each). Singers who did not opt for vocal rehabilitation consisted of the control group. Effects of rehabilitation were assessed with videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index. RESULTS After combined functional voice therapy in the study group, great improvement was noticed in palpation of the vocal tract structures (P < 0.001), perceptual voice assessment (P < 0.001), phonetograms (P = 0.002), and singing range obtained from acoustic analysis of glissando (P < 0.001). In the control group, no statistically significant differences were found between the first and the second assessments. CONCLUSIONS Combined functional voice therapy proved to be an efficacious treatment method in singers with MTD in singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics.

Endoscopic transnasal management of sinonasal malignancies - our initial experience

Introduction Malignant tumors of the paranasal sinuses are traditionally managed through external approaches. Advances in endoscopic transnasal surgery have allowed for the endoscopic treatment of some of these tumors. Aim To present the results of treatment of a series of patients with paranasal sinus malignancies treated with an endoscopic approach at a single institution. Material and methods The data on tumor type, operative technique, perioperative complications and postoperative course were analyzed. Results Eleven patients meeting the inclusion criteria were identified. The histopathology was as follows: malignant melanoma in 3 patients, squamous cell carcinoma in 2, adenocarcinoma in 2, poorly differentiated carcinoma in 1, hemangiopericytoma in 1, adenoid cystic carcinoma in 1 and fibrosarcoma in 1. There were no severe perioperative complications with the exception of 1 case of cerebrospinal fluid leak, which was successfully closed. The mean observation period was 13.5 months. One of the patients died of disease, another was lost to follow-up, and one was reoperated on due to recurrence. The remaining 8 patients are alive with no signs of recurrence. Conclusions Our initial experience seems to confirm results obtained by other authors indicating that in selected cases endoscopic surgery of sinonasal malignancies is similarly effective as external approach surgery.

Videolaryngoscopic and videostroboscopic evaluation following laser CO2 and conventional cordectomy of Tis and T1 glottic carcinoma

Introduction This paper is an analysis of long-term functional results, observed on videolaryngoscopic and videostroboscopic examination, of two different types of surgical intervention for Tis and T1 glottic carcinoma: laryngofissure conventional cordectomy and endoscopic laser CO2 cordectomy, with or without additional radiation therapy (using 60Co). Material and methods A total of 46 patients with Tis and T1 glottic carcinoma, 43 men (93.48%) and 3 women (6.52%), served as subjects. All were treated surgically with laryngofissure conventional cordectomy (15 patients, 32.61%) or endoscopic laser CO2 cordectomy (31 patients, 67.39%). The procedures were performed in the Department of Otolaryngology at the Medical University of Warsaw between November 1990 and February 2004. Videolaryngoscopic and videostroboscopic examinations were conducted a minimum of 3 years after the surgery, between January 2006 and February 2007. The appearance of the neocord (the scar after cordectomy), scar or synechia formation in the anterior commissure, movements of the vocal folds on respiration and phonation, difference in level between the neocord and the normal vocal fold, glottic closure, phonation type, and ventricular folds hyperfunction were examined. The symmetry of vocal fold vibrations, regularity of vibrations, glottic closure, amplitude of vibrations, and mucosal wave were also evaluated. Results In our study, the videolaryngoscopic and videolaryngostroboscopic examination showed a significantly higher occurrence of the following findings in patients after endoscopic laser cordectomy: phonation at the glottic level, complete glottic closure, and a tendency to vibration of the neocord on phonation. Conclusions Ventricular hyperfunction on phonation and scar or synechia formation in the anterior commissure were observed statistically more frequently in patients after laryngofissure conventional cordectomy.

Multiparametric Assessment of Voice Quality and Quality of Life in Patients Undergoing Microlaryngeal Surgery—Correlation Between Subjective and Objective Methods

The aim of the study was to estimate voice defect and the quality of life deterioration in patients with different laryngeal pathologies qualified for microsurgery treatment. The results of videolaryngostroboscopy (VLS), perception, aerodynamics, acoustics, Dysphonia Severity Index, Voice Handicap Index (VHI), and the World Health Organization Quality of Life Scale Brief Version before microsurgery were analyzed. There were 151 patients enrolled in the study. There were 86 patients in group 1 (benign lesions), 34 in group 2 (premalignant conditions), and 31 in group 3 (malignant neoplasms). Significant differences were found in the mean values of VLS between group 1 and group 3 (P = 0.001), maximum phonation time between group 1 and group 2 (P = 0.001), and between group 2 and group 3 (P = 0.04), mens fundamental frequency between group 1 and group 2 (P = 0.03), and between group 1 and group 3 (P = 0.01), and shimmer between group 1 and group 3 (P = 0.01). The correlation between the methods was analyzed, and there was a strong to moderate correlation between VLS and perception (r = 0.57-0.73) in group 1 and group 2. The jitter and shimmer correlated moderately with perception in group 1: grade of hoarseness (G) (r = 0.52 and r = 0.57, respectively), breathiness (B) (r = 0.58), and asthenia (A) (r = 0.57 and r = 0.53, respectively). In group 3, the strongest correlation was observed between maximum phonation time and phonation quotient and G (r = 0.52; 0.58), B (r = 0.54; 0.55), and strain (S) (r = 0.63; 0.72). The VHI results and life quality outcomes were not significantly different between the groups. The VHI did not correlate with any voice measure method.

Evaluation of polymorphisms in microRNA biosynthesis genes and risk of laryngeal cancer in the Polish population

MicroRNAs are the largest group of short regulatory RNAs. They regulate genes participating in many physiological and pathological processes. The role of micro RNAs in cancer development is also considerable. Therefore, the aim of this study was to evaluate the relationship between DROSHA (rs6877842) and DGCR8 (rs417309, rs1640299) gene polymorphisms with risk of occurrence of laryngeal cancer. The study included 100 patients and 100 healthy subjects. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissues. Analysis of the gene polymorphisms was performed using TaqMan SNP Genotyping Assay. The rs417309 AA genotype was found to be correlated with increased risk of larynx cancer. The rs1640299 TG and rs6877842 CG heterozygotes were significantly inversely associated with the presence of larynx cancer. Additionally, rs417309 AA genotype increased the risk of larynx cancer in the T1 stage, and the rs1640299 TG heterozygote occurred more frequently in the control group than those in the T3 and T4 stage. The rs417309 and rs1640299 polymorphisms of the DGCR8 gene as well as rs6877842 of the DROSHA gene might be associated with a risk of laryngeal cancer occurrence in the Polish population.