Paweł K. Burduk

Expression of metalloproteinases 2 and 9 and tissue inhibitors 1 and 2 as predictors of lymph node metastases in oropharyngeal squamous cell carcinoma.

The matrix metalloproteinases (MMPs) and their tissue inhibitor of metalloproteinases (TIMPs) can decompose extracellular matrix (ECM) components and brake down basement membranes and, thus, promote tumor local invasion and metastasis.

Nasal foreign body in an adult.

Foreign bodies of the nose in adults are rare, although they are frequently encountered among children and mentally retarded patients. They are often asymptomatic and consequently may remain undetected for many years. We describe a case of an intranasal foreign body mimicking a nasal lesion.

Detection of Helicobacter pylori and cagA gene in nasal polyps and benign laryngeal diseases.

BACKGROUND AND AIMS Helicobacter pylori is the most common etiological factor of chronic infection worldwide. It has also been found in human dental plaques, mouth, saliva, tonsils and adenoid tissue, medial ear or nasal polyps and sinuses mucosa, as well in several benign and malignant lesions of the larynx and pharynx. The aim of the study was to investigate the association of H. pylori colonization in chronic rhinosinusitis and benign laryngeal diseases. METHODS The prospective, controlled study involved a series of 30 patients with nasal polyps and normal nasal mucosa and 30 patients with benign laryngeal diseases. Samples of 10-15 mg obtained from fresh tissues were used for nucleic acid purification. All samples were subjected to H. pylori ureA detection by the PCR H. pylori diagnostic test. Samples that were positive for ureA H. pylori gene were evaluated for cagA H. pylori gene. RESULTS H. pylori DNA (ureA gene) was detected in all patients with nasal polyps, concha bullosa and laryngeal diseases. Presence of H. pylori cagA gene was identified in 7 (23.3%) of 30 patients of H. pylori-positive larynx samples and no positive result was observed in nasal polyps and concha bullosa. CONCLUSIONS Our results reveal the presence of H. pylori DNA in nasal polyps, concha bullosa and benign larynx diseases. cagA-positive H. pylori was observed only in laryngeal tissues. These results may have implications for a possible role of H. pylori in laryngeal diseases.

Episodes of repeated sudden deafness following pregnancies

Sex hormones influence and provoke changes in hearing levels. Sudden deafness is rarely observed in pregnant women. The effective treatment of sudden deafness in pregnant women is a challenging problem. We present a case of repeatable, completely regressed sudden deafness in a woman during her first and second pregnancies.

Chirurgiczna rehabilitacja głosu chorych po laryngektomii całkowitej z zastosowaniem systemu Provox

Summary The aim of study Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation. Material and methods The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients – secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st–3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacles scale. The study showed juxtaposition of early and late complications of patients with voice prostheses. Results 90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency F0 (108 Hz vs. 87Hz) and smaller variability of F0 based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases). Conclusions Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.THE AIM OF STUDY Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation. MATERIAL AND METHODS The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients - secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st-3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacles scale. The study showed juxtaposition of early and late complications of patients with voice prostheses. RESULTS 90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency FO (108 Hz vs. 87Hz) and smaller variability of FO based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases). CONCLUSIONS Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.

Improved quality of surgical field during endoscopic sinus surgery after clonidine premedication—a pilot study

Inadequate surgical field visualization due to intraoperative bleeding during endoscopic sinus surgery (ESS) can cause major complications. The aim of this prospective study was to compare the effect of preoperative administration of clonidine and melatonin on the quality of the surgical field visualization and selected aspects of presurgical premedication.

Chronic, Recurrent, Progressive Osteomyelitis of the Maxilla Caused by Methicillin-Resistant Staphylococcus Epidermidis: A Therapeutic Dilemma

A 28-year-old man was hospitalized more than 15 timesfrom 2005 to 2008 at the Department of Otolaryngology atour institutions because of chronic, recurrent osteomyelitisof the maxilla on the right side. His medical history began in1994 (when he was a healthy 16-year-old boy without anyallergies or medication intake). At that time, a simple dentalprocedure of excision of an epulis located between theupper molar teeth on the right side was performed. Theprocedure was complicated by opening of the maxillarysinus from the oral cavity, which was surgically closed atthat time. Since then, recurrent right-side sinusitis had de-veloped multiple times with several puncture proceduresand empiric antibiotic therapies. In 1995, a Caldwell-Lucprocedure was performed on the right side with bilateralinferior turbinate submucous resection. Histopathologic ex-amination showed a nonspecific chronic inflammation. Af-ter surgery, the patient felt worse and noted an ongoingsensation of pressure around the tooth, swelling of thecheek, purulent discharge from the nose, and recurrentfever. He was hospitalized at the Department of Otolaryn-gologyoftheMedicalUniversityofGdan´sk,Gdan´sk,Poland,from May to August 2001. He was admitted for facial edemaand subfebrile body temperature; the symptoms appeared afew weeks before hospitalization. Computed tomography(CT) scan showed mucous membrane edema in both max-illarysinusesandedemaoftherightcheekandlowereyelid.Bacteriologic investigations of the nose swabs were nega-tive (Table 1). The results of the other laboratory tests wereas follows: white blood cell count, 8,600 L; erythrocytesedimentation rate, 6 mm; and C-reactive protein level, 3.0mg/L. The patient was treated with intravenous empiricantibiotics (600 mg of clindamycin 3 times daily for 14 days,2.0 g of ciprofloxacin 2 times daily for 3 weeks, and 500 mgof metronidazole 3 times daily for 14 days); at the begin-ning, the symptoms ceased, but within the next 2 weeks,the symptoms returned. Bone scintigraphy showed a highmarker concentration in the right maxilla. Next, a CT scanshowed a hypodense, encapsulated lesion inside tissue ofthe thickened cheek and edema of the mucous membraneof the right maxillary sinus (in its lateral-upper recess).Blood tests for perinuclear antineutrophil cytoplasmic anti-bodies (p/ANCA) and cytoplasmic antineutrophil cytoplas-mic antibodies (c/ANCA) were negative. The patient under-went surgical treatment. On the basis of clinical andpathologic findings (inflammatory infiltration), the diagno-sis of zygomatic osteitis was established. The patient re-ceived 20 expositions of hyperbaric oxygen therapy (HBO)(with protocol of a 70-minute time of exposition, 100%oxygen concentration, and 2.5 atmospheric pressure) withgood local outcome. After that treatment, he was healthyfor 4 years with occasional fullness and tenderness in the

Powikłania wczesne i późne po implantacji protezy głosowej Provox 2 u chorych po laryngektomii całkowitej

Summary Introduction Effective communication is an important element of social life. For a long time depravation of the capacity of such communication has been perceived as one of the most aggravating disabilities. It happens when the necessity to remove the larynx in patients with cancer appears. Contemporary methods of speech rehabilitation in patients after total laryngectomy create the possibility to communicate by three methods. One of them is generated speech with the use of voice prosthesis. Material and methods The examination included group of 76 patients (7 women, 69 men) after total laryngectomy with implanted voice prosthesis Provox 2. All the patients were operated on at the Department of Otolaryngology CM UMK. The early and late complication after implantation of voice prosthesis was analyzed. Results In our material we observed more frequentyly late complications. In 97.4% a leakage through or around the prosthesis was observed. In 35 cases we observed leakage through the wide tracheooesophagal fistula with good outcome due to spontaneusly contract of it after removal of the prosthesis. In four cases we used stitches above the fistula and in three patients we did tracheostomal plastic. The granulation tissue from the region of the fistula was removed in 11 patients. Spontaneous falling out of the prosthesis appeared in 6 cases. The late complications as tracheal immflamation, stricture of the oesophagus or occlusion of the fistula were less common. Conclusions The late complications after implantation of Provox 2 prosthesis are more common in this type of patients’ rehabilitation. The leakage through or around the prosthesis required its exchange and generated additional medical costs, which should be reserved in medical insurance policies.

Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study ☆

INTRODUCTION Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs. OBJECTIVE The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS. METHODS In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy. RESULTS A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group. CONCLUSION The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

Przypadek mnogich powikłań zatokopochodnych w ostrym jednostronnym zapaleniu zatok przynosowych

Summary Introduction Intracranial or orbital complications after chronic and acute rhinosinusitis are rare, but could be dangerous. The complications of acute rhinosinusitis more often are observed in young patients. The combination of both intracranial and orbital complications together is found after acute inflammation. Material and methods We present a case of a patient with primary developed orbital complication during acute rhinosinusitis followed by intracranial abscess during the same treatment period. Results One week after intravenous antibiotic therapy with good outcome we observed an aggravated inflammation process with osteitis of frontal bone and brain abscess formation. We performed an external approach for frontal sinus surgery combined with neurosurgical brain abscess evacuation. Swabs taken during surgery were positive for: Streptococcus constellatus and Parvimonas micra sensitive for penicillin and metronidazol. We observed a good recovery after two weeks of treatment. Conclusions We recommend performing a complementary CT of the sinus and CT of the brain with contrast when complications of acute rhinosinusitis are suspected. The coexistence of intracranial and orbital complications could be observed in younger patients mostly after acute sinusitis.