Mieczysław Chmielik

Lower airway papillomatosis in children

Laryngeal papilloma in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. This disease has a tendency to recur and the changes are histologically benign. In some cases papilloma may affect the lower levels of the respiratory tract. In this study, among 90 patients treated for laryngeal papillomatosis, in four children papilloma of trachea, bronchi and lung tissue were detected in endoscopic and radiological examination. This constitutes 4.4% of all patients. Compact nodules and acquired cysts between 5 and 50 mm long were found in chest X-rays and in computerised tomography. These cysts appeared from 4 to 8 years after establishing a diagnosis of laryngeal papilloma, and 1 year after recognising papilloma in the trachea. In all four children the presence of nodules and cysts in the lungs was preceded by recurrent pneumonia, emphysema or atelectasis of the lungs. All children with laryngeal papillomatosis should have a chest X-ray. Detection of acquired cyst-like changes in lung tissue in children with laryngeal papillomatosis is a warning of future papilloma in the trachea and bronchi, with involvement of lung tissue. In differential diagnosis of these changes in the lungs we should take into consideration the presence of papilloma in the bronchi. A prognosis of papillomatosis in the lower airways in children is always serious.

Difficulties in diagnosis of laryngeal cysts in children

INTRODUCTION In larynx cysts may be localized in different regions: glottis, laryngeal pouch, epiglottis, aryepiglottic folds and subglottic area. It is difficult to estimate if the cyst is acquired or congenital. Symptoms of laryngeal cyst depend on the size and localization of the cyst and include: change in the tone of voice, dysphonia, hoarseness, dysphagia, laryngeal stridor and dyspnoea. Cysts of the larynx in infants are rare but the treatment is easy once the diagnosis is made. If mismanaged, the resulting respiratory obstruction can lead to serious complications. OBJECTIVE Analysis of cases of laryngeal cyst in children treated in the Department of Paediatric ENT Medical University of Warsaw. MATERIALS AND METHODS A retrospective analysis of 10 cases of laryngeal cyst in children treated in the Department of Paediatric ENT in Warsaw between 2000 and 2008 was made. RESULTS The authors analyzed indications to directoscopy, endoscopic presentation, problems with establishing the right diagnosis and management. CONCLUSIONS Using a direct laryngoscopy as a golden standard in children with stridor will reduce a number of false diagnosis.

Histological analysis of nasal polyps in children

During 1991-1999, in the Childrens ENT Department of Warsaw Medical University, 39 polypectomies were performed. We analysed the histological structure of all polyps. The most common type of nasal polyp tissue in children was the inflammatory polyp (95% of cases).

Perioperative problems and treatment of a teenager with a juvenile angiofibroma refusing blood transfusion

OBJECTIVES Juvenile angiofibroma is a benign, non-encapsulated neoplasm, consisting of vascular and connective tissue. Its main feature is a local malignancy. In its clinical course it destroys adjoining structures, without metastasizing. It appears rarely, and is mainly found in boys at puberty. Among theories about the aetiology of juvenile angiofibroma, we must consider a haematoma-like lesion, an angioma with an extended fibrous component, or type of inflammatory allergic polyp. In the development of the lesion the participation of hormonal disorders on the pituitary gland-gonad axis is also suggested. According to the latest research, juvenile angiofibroma is regarded as a developmental defect, affecting the embryonic vascular network surrounding the sphenoid bone. METHODS If the patient or his/her parents refuse blood transfusion and use of blood products, it is necessary to apply modifications in the routine perioperative treatment. In the case of the patient refusing blood and blood products transfusion because of their beliefs, it is possible to get consent to use different, highly processed products like albumins or a cryoprecipitate, as well as applying some blood-saving techniques. CONCLUSIONS 1. Removal of juvenile angiofibroma with minimal bleeding is possible. 2. Applying erythropoietin and iron preparations prior to surgery increases erythropoiesis and reduces the risks in transfusion. 3. Applying intraoperative normovolaemic haemodilution is a safe method and allows avoidance of transfusion of blood-derived products.

The endoscopic treatment of postintubation laryngeal stenosis in children, using argon plasma coagulation.

Laryngeal stenosis of the larynx in children is becoming a more frequent problem. Endoscopic dilation of the lumen of the larynx is one of the many methods of treatment. The authors present their own method for the treatment of postintubation laryngeal stenosis by argon plasma coagulation (APC). The investigation was based on ten children with postintubation laryngeal stenosis from I to IV degrees according to the Myer-Cotton grading system. The method of treatment, and the advantages and disadvantages of the new method of endoscopic treatment of postintubation laryngeal stenosis, are discussed in the article.

Body build—is it a factor in acute subglottic laryngitis?

Acute subglottic laryngitis (pseudocroup) is caused by viral infection and usually occurs in children from 6 months to 4 years of age. Obese children are considered to be more susceptible to the disease. In order to evaluate the influence of nutritional status on acute subglottic laryngitis occurrence, an analysis of 193 patients was performed. A group of 70 age-matched healthy children served as the control subjects. The nutritional status of children (body weight and height) was assessed and their percentile positions on the weight and weight-height charts were determined. The recurrence of pseudocroup coexistence of allergy and breast-feeding history were considered in the study. Results of statistical analysis indicate no significant difference in weight and weight-height percentile distribution between patients group and controls. The recent changes in child nutrition might be the explanation of decreased susceptibility to pseudocroup among overfed children.

History and present situation of paediatric ENT surgery in Poland and in other Central East European countries

Abstract One of the first paediatric ENT centres in the world was the research group managed by Jan Danielewicz in Warsaw. It was organised on the basis of progress clinics and paediatric ENT wards, and a programme of specialisation was established. Almost simultaneously, in the sixth decade of the 20th century, centres for paediatric ENT were established in Prague, Berne, Bratislava, Budapest, Bucharest, and Sofia. In the 1970s, these were in touch with the centre for paediatric ENT in Italy, which was the pioneer in this specialty in West Europe. The effect of this contact was the creation of the European Federation of Oto-Rhino-Laryngology Societies and the International Federation of Oto-Rhino-Laryngological Societies (IFOS), and further dynamic progress in this specialisation.

The history of pediatric otorhinolaryngology in Poland

The past few decades have been a time of rapid and constantly-accelerating development in every field of medicine, including pediatrics and laryngology. The first pediatric laryngology unit set up in Poland was in the Warsaw Kopernik Hospital in 1908, and consisted of seven beds in the surgical ward. The actual development of the specialty in Poland began in the nineteen-forties. The first modern department of Pediatric Laryngology was set up in the Mother and Child Institut in 1947, and next in Warsaw University Hospital in 1956. These two were both set up and headed by Associate Professor Jan Danielewicz who is considered to be the father of pediatric otolaryngology in Poland, and one of its co-founders in Europe. The first conference of Polish Pediatric ENT was the result of the efforts of Associate Professor Danielewicz in Zakopane, in 1958. Professors Kossowska and Danielewicz were the joint organisers of the First European Congress of Pediatric Laryngologists in Warsaw, in 1979. At present in Poland exist five Clinic of Pedatric ENT and about 25 ward of this speciality. Pediatric ENT is independent medical specialization.

Guzy twarzoczaszki u dzieci leczonych w Klinice Otolarynologii Dziecięcej w Warszawie

Summary Introduction The tumours of bony face at in children are rare. Among the most commonly found are inflammatory tumours and development anomalies. In histopathology, the most frequent fund are neuroma, fibromas, osteoma, lipomas. In inflammatory tumours there are abscess and inflammatory infiltration. Malignants tumours in this area are rare in children, but are mainly sarcomata or melanoma. Developmental tumours include cyst and fistula. Objective To analyse tumours of the bony face treated in Paediatric ENT Clinic in Warsaw. Material There were thirty cases of bony face tumours treated in Paediatric ENT Clinic in Warsaw between 2005 and 2007. Results One cases (3%) provedto be malignant, and one (3%) locally malignant. Twenty-one cases (70%) were found to be developmental tumours, three cases (10%) of abscesses, and four cases (13%) of benign tumours. Conclusions The most frequently-found tumours of bony face in children are developmental tumours. All tumours must be the subject of histopatological examination. In the case of cancers tumours it has to be established if the tumour is a primary or a metastatic. In the group analysed group the rare tumour were epithelioma, ganglioma.INTRODUCTION The tumours of bony face at in children are rare. Among the most commonly found are inflammatory tumours and development anomalies. In histopathology, the most frequent fund are neuroma, fibromas, osteoma, lipomas. In inflammatory tumours there are abscess and inflammatory infiltration. Malignants tumours in this area are rare in children, but are mainly sarcomata or melanoma. Developmental tumours include cyst and fistula. OBJECTIVE To analyse tumours of the bony face treated in Paediatric ENT Clinic in Warsaw. MATERIAL There were thirty cases of bony face tumours treated in Paediatric ENT Clinic in Warsaw between 2005 and 2007. RESULTS One cases (3%) provedto be malignant, and one (3%) locally malignant. Twenty-one cases (70%) were found to be developmental tumours, three cases (10%) of abscesses, and four cases (13%) of benign tumours. CONCLUSIONS The most frequently-found tumours of bony face in children are developmental tumours. All tumours must be the subject of histopatological examination. In the case of cancers tumours it has to be established if the tumour is a primary or a metastatic. In the group analysed group the rare tumour were epithelioma, ganglioma.