Piotr Trojanowski

Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings.

The aim of the study was to evaluate and compare various helical CT display modes [virtual endoscopy (VE)] and multiplanar reformations (MPR), conventional flexible tracheobronchoscopy (FT) and intra-operative (IO) findings in patients with tracheal stenosis and to analyze the advantage of MPR and VE in diagnosis and treatment planning and in postoperative follow-up. Thirty-seven patients with tracheal stenosis underwent standard neck and chest CT followed by MPR and VE. Results were correlated with the results of FT and IO findings. Thirty-three of the 37 stenoses were correctly graded and measured adequately using VE. Complete correlation among CT, fiberoptic tracheoscopy, and surgery of stenosis grading, stenosis length and length of planned resection segment of the trachea was noted between 33 of 37 patients with tracheal stenosis. Correlation between VE and IO was noted in 35 of 37 patients and between FT and VE was noted in 33 of 37 patients with tracheal stenosis. The sensitivity of VE was 94–97%, specificity was 100% with comparison to IO findings. The sensitivity and accuracy of MPR was 86–89% and specificity was 100% with comparison to FT findings. The results of the study indicate that VE is an excellent, consistent, and objective technique. VE with MPR is very useful in diagnostic evaluation and treatment planning in patients with tracheal stenosis.

External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms

ObjectivePathology of the external and middle ear is the most frequent reason to prescribe antibiotics and perform surgery in children and young adults. In the majority of cases imaging studies are not performed; the need for imaging comes when complications are suspected or when treatment is not effective. This paper discusses indications for temporal bone imaging studies and presents the most frequent pathological conditions, together with differential diagnosis, clinical symptoms and methods of treatment.Methods and ResultsThis pictorial review describes major external and middle ear diseases, with special regard to clinical findings and appropriate reporting.ConclusionsApprehension of the complete clinical picture, together with imaging clues, narrows differential diagnosis and helps avoid mistakes. Evaluation of temporal bone pathologies requires close cooperation between the clinician and radiologist.

Head and neck cancer: Value of perfusion CT in depicting primary tumor spread

Summary Background The aim of this study was to assess head and neck squamous cell cancer and surrounding tissue in computed tomography contrast enhanced and perfusion studies, and to examine the role of perfusion imaging in depiction of tissue infiltration. Material/Methods We prospectively evaluated 43 primary malignant head and neck tumors, using standard CT followed by perfusion. Blood flow, blood volume, mean transit time, and permeability values were obtained using regions of interest (ROIs) over lesions and surrounding tissue. Results were compared with histological analysis of resected tissue. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated for both methods. Results We found significant differences between infiltrated and non-infiltrated tissue, especially with regard to muscles. In case of bone and salivary gland infiltration, change in perfusion parameters did not allow proper diagnosis. Conclusions CTP shows promise in depicting malignant infiltration. The combined use of CECT plus CTP results in correct staging of the majority of head and neck tumors.

Application of primary cell cultures of laryngeal carcinoma and laser scanning cytometry in the evaluation of tumor reactivity to cisplatinum

Unsatisfactory effects of treatment of laryngeal carcinoma patients stimulate the clinicians as well as researchers to develop new more effective treatment models and to find new reliable prognostic factors. The aim of the present study was the evaluation of the use of primary cell cultures of the laryngeal carcinoma and laser scanning cytometry (LSC) in the assessment of tumor reactivity to cisplatinum. Nineteen primary cultures of laryngeal carcinoma cells established from fragments of laryngeal carcinoma infiltrations were cultured with or without cisplatin, stained with monoclonal antibodies against P53 and BCL-2 proteins and analyzed by LSC. Cisplatin added to the culture medium leads to the significant increase of P53 expression and decrease of BCL-2 expression. Moreover, changes of P53 and BCL-2 expressions were significantly correlated. Our findings of apoptosis regulatory mechanisms could be useful in patient qualification for the chemotherapeutic follow-up treatment.

Subpopulations of natural killer-T-like cells before and after surgical treatment of laryngeal cancer

Introduction Tumours connected with head and neck comprise about 5% of all tumours. The most frequent histological type of laryngeal carcinoma is squamous cell carcinoma. Different research projects suggest that the role of T lymphocytes might be significant in tumour development. iNKT cells are a new subpopulation of T cells and show cytotoxic activity against tumours. iNKT cells participate in modulating the function of other cells which have anti-tumour properties and secrete cytokines, which have pro-inflammatory and anti-inflammatory effects. In animal models the significance of iNKT cells in various diseases including cancer was shown. Aim of the study The aim of this study was to determine the percentages of iNKT cells, CD161+ cells, CD161– cells, iNKT CD4+ cells, and iNKT CD8+ cells, NK cells, NKT-like cells, and T cells subsets present in peripheral blood of patients with laryngeal cancer before and two months after the tumour resection, in comparison to healthy volunteers. Materials and methods This study included material from laryngeal patients who were treated at the Department of Otolaryngology and Laryngological Oncology (Medical University of Lublin) between 2012 and 2013. A total of 50 patients (40 men and 10 women) aged between 45 and 77 years (median age: 60 years) were enrolled. Based on the TNM classification, the patients were classified as having stage I-IV laryngeal cancer. The control group was composed of 15 healthy volunteers (12 men and three women) aged between 43 and 82 years (median age: 61 years). The protocol of the study was approved by the Local Bioethical Committee at the Medical University of Lublin. Peripheral blood samples (15 ml) from the basilic vein were collected by venipuncture using sterile, sodium heparin-treated tubes (20 units per ml of blood) and used for cytometric analyses. Results iNKT cells were analysed among T CD3+ cells. The percentage of CD3+ and CD3+CD4+ T cells before tumour resection was higher than in the control group, but the increase of CD3+ T cells was not significant. The T CD3+CD4+ / T CD3+CD8+ cell ratio was significantly higher than in healthy donors. After tumour resection a decreased percentage of CD3+CD4+ T cells but an increased percentage of CD8+CD3+T cells was noted. The T CD3+CD4+ / T CD3+CD8+ cell ratio was significantly higher in patients before and after the surgery than in the control group. The amount of NKT-like cells increased after resection and was significantly higher than in the control group. Conclusions Our study exhibited the change in percentage of iNKT, NK, NKT-like cells, and T lymphocytes after tumour resection in patients with laryngeal cancer. The research explains the contribution of those cells in immunological response against tumour.

Dojście przez podniebienie do naczyniakowłókniaka młodzieńczego

Summary Introduction Juvenile nasopharyngeal angiofibromas (JNA) are highly vascular, locally invasive tumours which originate in the sphenopalatine foramen. Several surgical approaches are described for this tumour. The aim of this study was to evaluate the transpalatal approach for juvenile angiofibroma. Material and methods In a group of 22 patients with JNA transpalatal approach was employed. A retrospective patients notes review was done. Extension of tumour, complications of surgery and recurrences were analyzed. Results In 17 patients the tumour was confined to the nasal cavity and the nasopharynx. In 5 patients the tumour invaded the sphenoid sinus. No complications were observed after surgery. Two (9%) patients had recurrence. Conclusion Transpalatal approach is best suited to small tumours (Andrews grade I and II) limited to the nasopharynx, nasal cavity and sphenoid sinus.

The percentage of iNKT cells among other immune cells at various clinical stages of laryngeal cancer.

INTRODUCTION Invariant natural killer T (iNKT) cells constitute a small population of immune cells that share functional and phenotypic characteristics of T lymphocytes and NK cells. Due to their involvement in specific and non-specific immune responses, iNKT cells may represent an important component of antitumor and anti-infectious immunity. MATERIAL AND METHODS Using flow cytometry, we analyzed the percentages of iNKT cells as well as T and B lymphocytes in peripheral blood of 50 laryngeal cancer patients at various clinical stages in comparison to healthy controls (n=15). Moreover, we determined the expression of CD25, CD69 and CD95 antigens on T lymphocytes. RESULTS The percentage of CD4+/CD3+ T lymphocytes in the controls was higher than in laryngeal cancer patients, both with early and late stages of the disease. The percentage of CD8+/CD3+ T lymphocytes in healthy controls was lower than in patients with early and late clinical stages of laryngeal cancer. Patients with advanced laryngeal cancer showed a lower percentage of iNKT cells and higher frequencies of T regulatory cells (Tregs) than the controls. Advanced clinical stages of laryngeal cancer are associated with impaired activation of lymphocytes. CONCLUSIONS Our study confirmed that laryngeal cancer cells exert a strong suppressor effect on the immune system of the host. This is reflected by a decrease in the percentage of iNKT cells that are capable of cancer cell elimination, and a concomitant increase in the percentage of Tregs. However, further studies are needed in order to explain the underlying mechanisms of immunosuppression and understand interactions between immune and cancer cells.

Dermatological manifestations of nervous system diseases

It is a generally accepted principle that the skin is a mirror of human health. Also neurological conditions may be accompanied by characteristic skin changes of significant diagnostic value. Careful and precise examination of the skin can therefore provide important clues in the process of neurological diagnosis. Concise differential diagnoses may be difficult for the nondermatologist, because of the wide range of cutaneous lesions or their spectrum of presentations. Therefore, a multidisciplinary approach may be the key to the right diagnosis. This article covers this particular topic by discussing individual neurological disorders, describing and discussing the various skin manifestations, in correlation with neurological signs and symptoms. Dermatologiczne manifestacje chorób przebiegających z zajęciem układu nerwowego Dermatological manifestations of nervous system diseases Urszula i. zielińska1,2, Monika Łagowska-Lenard2, rafał Lenard3, Agata Smoleń3, Michał rutkowski1, radosław rola1, Piotr trojanowski4, Marcin Wdowiak1, bartłomiej tyzo1 1Klinika Neurochirurgii i Neurochirurgii Dziecięcej Samodzielnego Publicznego Szpitala Klinicznego nr 4 w Lublinie 2Oddział Neurologiczny I Szpitala Neuropsychiatrycznego im. prof. Mieczysława Kaczyńskiego w Lublinie 3Katedra i Zakład Epidemiologii Uniwersytetu Medycznego w Lublinie 4Klinika Otolaryngologii i Onkologii Laryngologicznej Samodzielnego Publicznego Szpitala Klinicznego nr 4 w Lublinie Przegl Dermatol 2016, 103, 77–86 DOI: 10.5114/dr.2016.57749 SŁoWA kLUczoWe: dermatologia, choroby skóry, neurologia. key WorDS: dermatology, skin diseases, neurology. ADreS Do koreSPonDencji: lek. Urszula I. Zielińska Oddział Neurologiczny I Szpital Neuropsychiatryczny im. prof. Mieczysława Kaczyńskiego ul. Abramowicka 2 20-442 Lublin tel.: +48 666 540 545, +48 601 144 013 e-mail: urszula.zielinska@gmail.com

Znaczenie diagnostyki obrazowej unaczynienia miejsca pobrania w planowaniu rekonstrukcji wolnym płatem strzałkowym

Summary Introduction Free fibula flap is widely used in head and neck reconstruction. Imaging studies of the donor site can reveal vascular abnormalities and therefore prevent acute leg ischemia. Aim Evaluation of the role of donor site vascular imaging studies for free fibula flap planing. Material and Methods Out of 35 free flap reconstructions performed in Otolaryngology Head and Neck Surgery Department in Medical University in Lublin in 2011–2012, there were 10 fibula flaps. Each patient had preoperative lower leg subtraction angiography performed. Results Lower leg angiography revealed vascular abnormalities in two out of 10 patients scheduled for free fibula flap transfer. One had dominant peroneal artery and second occlusion of anterior tibial artery. In both cases fibula was harvested from the other leg. Conclusions Imaging studies reveal lower leg vascular abnormalities in 20% of cases thus facilitate surgical plans alternations and prevent serious complications in free fibula flap patients.