Łukasz Borucki

Węzły chłonne przytchawicze u chorych na raka krtani i gardła dolnego w ocenie radiologicznej i klinicznej

INTRODUCTION Paratracheal lymph nodes receive the lymph from the larynx, hypopharynx, esophagus, thyroid gland and trachea. It is evaluated, that metastases to these nodes occur in about 10-30% of patients with cancer of the larynx, hypopharynx or cervical esophagus. These metastases can lead to the most tragic complication after total laryngectomy, which is the stomal recurrence, Paratracheal lymph nodes are not accessible to examine by palpation or ultrasonography. AIM The aim of this study was to estimate the usefulness of CT, MRI and clinical intraoperative investigation in the search for enlarged paratracheal lymph nodes. MATERIAL AND METHODS The investigation was performed in 15 patients with advanced larynx and/or hypopharynx cancer. In all the patients we carried out palpation and ultrasonography of the neck, in 7 cases CT and in another 8 cases MRI of the neck. In all the patients who were operated (14 cases) the exact search for enlarged paratracheal lymph nodes during operation was performed. RESULTS Palpation and ultrasonography of the neck did not found any enlarged paratracheal lymph nodes in anybody of the patients. CT showed one enlarged prelaryngeal lymph node in one patient. MRI showed one enlarged pretracheal lymph node in another one patient. During operation we found one enlarged paratracheal lymph node, which was not seen in MRI. All these nodes were pathologically not metastatic. CONCLUSIONS The analysis of the state of paratracheal lymph nodes is very important in prophylaxis of stomal recurrence after total laryngectomy. However preoperative estimation of these nodes is very difficult and limited. It seems to us, that the best way of estimation of the state of paratracheal lymph nodes is intraoperative exploration of the area between trachea and esophagus and excision even loose tissue to pathological examination.Summary Introduction Paratracheal lymph nodes receive the lymph from the larynx, hypopharynx, esophagus, thyroid gland and trachea. It is evaluated, that metastases to these nodes occur in about 10–30% of patients with cancer of the larynx, hypopharynx or cervical esophagus. These metastases can lead to the most tragic complication after total laryngectomy, which is the stomal recurrence. Paratracheal lymph nodes are not accessible to examine by palpation or ultrasonography. Aim The aim of this study was to estimate the usefulness of CT, MRI and clinical intraoperative investigation in the search for enlarged paratracheal lymph nodes. Material and methods The investigation was performed in 15 patients with advanced larynx and/or hypopharynx cancer. In all the patients we carried out palpation and ultrasonography of the neck, in 7 cases CT and in another 8 cases MRI of the neck. In all the patients who were operated (14 cases) the exact search for enlarged paratracheal lymph nodes during operation was performed. Results Palpation and ultrasonography of the neck did not find any enlarged paratracheal lymph nodes in anybody of the patients. CT showed one enlarged prelaryngeal lymph node in one patient. MRI showed one enlarged pretracheal lymph node in another one patient. During operation we found one enlarged paratracheal lymph node, which was not seen in MRI. All these nodes were pathologically not metastatic. Conclusions The analysis of the state of paratracheal lymph nodes is very important in prophylaxis of stomal recurrence after total laryngectomy. However preoperative estimation of these nodes is very difficult and limited. It seems to us, that the best way of estimation of the state of paratracheal lymph nodes is intraoperative exploration of the area between trachea and esophagus and excision even loose tissue to pathological examination.

Amyloidoza w obrębie głowy i szyi

Summary Introduction Amyloid is a pathological protein which can accumulate in almost every tissue, consequently resulting in illness (amyloidosis). Amyloid has a red color when the slice preparation is stained with Congo red staining and under polarized light exhibits a characteristic apple-green color. Over 26 different proteins, that can form amyloid, have been described. AL, AA and ATTR amyloidosis are the most frequent type of amyloidosis. Head and neck is a rare region for amyloidosis, which can be localized and/or systemic. Early diagnosis and precise classification of the amyloidosis is essential for treatment planning. Various treatment strategies: antinflammatory management, chemotherapy, immunotherapy, surgery, gene therapy, to name just a few, are already readily available or are currently being explored or researched. Material and methods Three cases are presented here: an elderly women with tongue and neck tumor and two patients with laryngeal tumors. The biopsy of the lingual and laryngeal tumor and ultrasonography in the first case have been performed in the ENT-Department and Ambulance. Results In the Internal Medicine Department the patient with lingual and neck tumor, due to symptoms such as: swallowing disorders, dysartria, painful joints swelling and carpal syndrome in anamnesis, previously underwent an examination in order to rule out scleroderma. The investigation appeared to be negative. The histopathology investigation of the lingual tumor identified amyloidosis. USG has not revealed any significant findings. The two patients with laryngeal tumor, except for hoarseness, has not manifested other symptoms suggesting general illness. The biopsy established that there was localized amyloidosis. Conclusion Diagnosis of amyloidosis and its correct classification continue to pose a great challenge. Two factors play a pivotal role in the identification of local or systemic amyloidosis: the local and/or systemic manifestation and Congo red staining as a gold diagnostic standard.INTRODUCTION Amyloid is a pathological protein which can accumulate in almost every tissue, consequently resulting in illness (amyloidosis). Amyloid has a red color when the slice preparation is stained with Congo red staining and under polarized light exhibits a characteristic apple-green color. Over 26 different proteins, that can form amyloid, have been described. AL, AA and ATTR amyloidosis are the most frequent type of amyloidosis. Head and neck is a rare region for amyloidosis, which can be localized and/or systemic. Early diagnosis and precise classification of the amyloidosis is essential for treatment planning. Various treatment strategies: antinflammatory management, chemotherapy, immunotherapy, surgery, gene therapy, to name just a few, are already readily available or are currently being explored or researched. MATERIAL AND METHODS Three cases are presented here: an elderly women with tongue and neck tumor and two patients with laryngeal tumors. The biopsy of the lingual and laryngeal tumor and ultrasonography in the first case have been performed in the ENT-Department and Ambulance. RESULTS In the Internal Medicine Department the patient with lingual and neck tumor, due to symptoms such as: swallowing disorders, dysartria, painful joints swelling and carpal syndrome in anamnesis, previously underwent an examination in order to rule out scleroderma. The investigation appeared to be negative. The histopathology investigation of the lingual tumor identified amyloidosis. USG has not revealed any significant findings. The two patients with laryngeal tumor, except for hoarseness, has not manifested other symptoms suggesting general illness. The biopsy established that there was localized amyloidosis. CONCLUSION Diagnosis of amyloidosis and its correct classification continue to pose a great challenge. Two factors play a pivotal role in the identification of local or systemic amyloidosis: the local and/or systemic manifestation and Congo red staining as a gold diagnostic standard.

Fully endoscopic resection of juvenile nasopharyngeal angiofibroma – Own experience and clinical outcomes

OBJECTIVES The treatment of choice in juvenile nasopharyngeal angiofibroma (JNA) is surgery - nowadays endoscopic techniques. The aim of the study was to present the results of endoscopic treatment in patients diagnosed with juvenile angiofibroma. MATERIALS AND METHODS In this retrospective case series, 10 patients with a diagnosis of JNA treated at the Department of Otolaryngology of the Medical University in Poznań from 2006 to June 2013 were included. The age of patients were between 11 and 19 years old (14.6 on average). In 9 out of 10 patients the treatment was preceded by embolization. The surgery used the endoscopic approach through one nostril and the four-handed technique. RESULTS Total resection was possible in all cases. Blood loss ranged from 100 to 250 ml. Post-operative hospitalization lasted from 3 to 5 days (3.3 days on average). Recurrence was reported in one patient. The observation lasted from six months to seven years (3.55 on average). CONCLUSIONS Endoscopic resection of juvenile angiofibroma is safe for the patient. Moreover, if the evaluation of the tumour size and staging is correct, the ability of total removal of the tumour is very high. It is also connected with small blood loss, short hospital stay and good cosmetic effects.

Technika czterech rąk w operacjach endoskopowych nosa i zatok przynosowych – doświadczenia własne☆

Summary Endoscopic surgery in chronic sinusitis became a gold standard since Stammberger and Kennedy describe there technique in ‘80 s. During last 20 years an enormous progress has been done in that field. Tumors of the nose and paranasal sinuses became a target for endonasal surgery, alternatively to open approaches. This surgery is more bloody, needs more tools, so the next step was to introduce the second surgeon into endoscopic sinus surgery and the four hands technique has born. Three models of four hands technique are present in the literature. Since November 2006 at the ENT department at Medical University in Poznan 24 patients have been operated on with this technique out of wich 12 suffered from tumors and 12 patients have been diagnosed with chronic sinusitis. This paper describes the surgical technique and our experience based on this 24 operations.

Znaczenie angiografii i embolizacji w leczeniu malformacji naczyniowych głowy i szyi w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Poznaniu

Summary Angiography is an invasive, radiological investigation of vascular system. It plays an important role within variety of diagnostic tools in head and neck pathologies. In selected cases with well defined tumor supply vessels, angiography may be combined with intravascular obliteration. This possibility widen indications, which comprise diagnostic arteriographies – visualization of blood supply and extension of vascularization; therapeutic and diagnostic arteriographies – palliative or radical in character, dependent on pathology; and therapeutic angiographies as adjuvant therapy prior to surgical treatment. Authors present their experience with endovascular techniques application in head and neck pathologies. Material comprised 59 angiographies performed in patients treated at Otolaryngology Department at Poznan University of Medical Sciences between 2000–2007. In conclusion authors emphasize advantages and disadvantages, as well as, the role of the endovascular treatment in head and neck surgery.

Ewakuacja ropnia mózgowia pod kontrolą neuronawigacji

Summary Otogenic brain abscess remain a challenge for otosurgeons. The method of choice in treatment, is the operation of the middle ear and drainage of the abscess in one step procedure. Evacuation of the abscess under neuronavigation leeds to decrease the intraoperative injury of the brain and to improve the precision of the puncture. The paper describe the technique of drainage of the otogenic brain abscess under neuronavigation, step by step.

Wyniki leczenia 101 usznopochodnych ropni mózgowia na przestrzeni 56 lat

INTRODUCTION Inflammatory process in the areas of the middle ear creates a possible danger related with the development of extratemporal and intratemporal complications. The most dangerous of those include meningitis and cerebral abscesses, which are still present. AIM The aim of the work is to present 101 patients with cerebral, in temporal lobe, and cerebellar abscesses of aural origin throughout the period of 56 years, namely between 1953 and 2009. MATERIAL AND METHOD Data concerning the patients have been obtained retrospectively on the basis of medical files. The analysis covered otolaryngological and neurological examinations, as well as method related with diagnosing abscesses. The thesis distinguished three periods of diagnosing otogenic brain abscess, depending on available diagnostic techniques. The first period covers the years 1956-1978, when constituted the basis of diagnosis. During the second period, falling between 1979 and 1989, the diagnosis was based on computed tomography of the head, while within the third period, including the years between 1990 and 2009, diagnosis focused on nuclear magnetic resonance. During the last two years neuronavigation was utilized for puncturing abscesses. CONCLUSIONS The survival rate equalled 65% between 1953 and 1978, reached 86% between 1979 and 1989, and 91% after the year 1990, however, it is worth mentioning that after the year 1995 there were no fatal cases.Summary Introduction Inflammatory process in the areas of the middle ear creates a possible danger related with the development of extratemporal and intratemporal complications. The most dangerous of those include meningitis and cerebral abscesses, which are still present. Aim The aim of the work is to present 101 patients with cerebral, in temporal lobe, and cerebellar abscesses of aural origin throughout the period of 56 years, namely between 1953 and 2009. Material and method Data concerning the patients have been obtained retrospectively on the basis of medical files. The analysis covered otolaryngological and neurological examinations, as well as method related with diagnosing abscesses. The thesis distinguished three periods of diagnosing otogenic brain abscess, depending on available diagnostic techniques. The first period covers the years 1956–1978, when constituted the basis of diagnosis. During the second period, falling between 1979 and 1989, the diagnosis was based on computed tomography of the head, while within the third period, including the years between 1990 and 2009, diagnosis focused on nuclear magnetic resonance. During the last two years neuronavigation was utilized for puncturing abscesses. Conclusions The survival rate equalled 65% between 1953 and 1978, reached 86% between 1979 and 1989, and 91% after the year 1990, however, it is worth mentioning that after the year 1995 there were no fatal cases.

Protezowanie tchawicy za pomocą stentów u chorych leczonych z powodu raka krtaniTracheal stenting in patients treated due to carcinoma of the larynx

Summary Introduction Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes. Aim of the study was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma. Material and methods Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia. Results After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life. Conclusions Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.INTRODUCTION Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes. AIM OF THE STUDY Was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma. MATERIAL AND METHODS Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia. RESULTS After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life. CONCLUSIONS Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.

Protezowanie tchawicy za pomocą stentów u chorych leczonych z powodu raka krtani

Summary Introduction Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes. Aim of the study was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma. Material and methods Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia. Results After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life. Conclusions Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.INTRODUCTION Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes. AIM OF THE STUDY Was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma. MATERIAL AND METHODS Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia. RESULTS After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life. CONCLUSIONS Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.