Skull base trauma: Masking, stimulating or neutral factor for the insidious development of angiosarcoma in a 19-year-old

Angiosarcoma is a malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas, uncommonly found in the head and neck region. The etiology is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Presented here is a case of a patient treated due to the skull base trauma and diagnosed with this type of tumor.

DIAPH2 alterations increase cellular motility and may contribute to the metastatic potential of laryngeal squamous cell carcinoma

Low 5-year survival rate in laryngeal squamous cell carcinoma (LSCC) is to large extent attributable to high rate of recurrences and metastases. Despite the importance of the latter process, its complex genetic background remains not fully understood. Recently, we identified two metastasis-related candidate genes, DIAPH2 and DIAPH3 to be frequently targeted by hemizygous/homozygous deletions, respectively, in LSCC cell lines. They physiologically regulate such processes as cell movement and adhesion, hence we found it as a rationale, to study if tumor LSCC specimens harbor mutations of these genes and whether the mutations are associated with metastasizing tumors. As a proof of concept, we sequenced both genes in five LSCC cell lines derived from lymph node metastases assuming there the highest probability of finding alterations. Indeed, we identified one hemizygous deletion (c.3116_3240del125) in DIAPH2 targeting the FH2 domain. Moreover, we analyzed 95 LSCC tumors (53 N0 and 42 N+) using the Illumina platform and identified three heterozygous single nucleotide variants in DIAPH2 targeting conserved domains exclusively in N+ tumors. By combining these results with cBioPortal data we showed significant enrichment of DIAPH2 mutations (P = 0.036) in N+ tumors. To demonstrate the consequences of DIAPH2 inactivation, CRISPR/Cas9 editing was used to obtain a heterozygous DIAPH2+/- mutant HEK-293T cell line. Importantly, the edited line shows a shift from 'proliferation' to 'migration' phenotype typically observed in metastasizing cells. In conclusion, we report that DIAPH2 alterations are present primarily in metastasizing specimens of LSCC and suggest that they may contribute to the metastatic potential of the tumor.

Evaluation of narrow band imaging in the assessment of laryngeal granuloma

Laryngeal granulomas belong to common complications following trans-oral laser microsurgery (TLM). The aim of this study was to evaluate NBI in the differentiation between granuloma-like lesions and local tumor recurrence. 154 consecutive patients after TLM due to early laryngeal cancer were enrolled. In the group, a monthly follow-up including NBI endoscopy was performed. Moderate and severe dysplasia, carcinoma in situ and invasive cancer were defined as positive histology, laryngeal granuloma and other benign laryngeal lesions as negative histology and premalignant lesions as suspicious histology. In 47/154 (31%) cases, granuloma-like lesion (GLL) was found. Patients with GLL were divided into two groups based on the NBI classification. In all patients, the microvascular pattern in NBI was compared with the final histology. In group A, with suspicious, perpendicular vessels, 13/13 (100%) samples were positive. In group B, with normal vascular pattern 3/34 (9%) samples were positive and 31/34 (91%) samples were negative. There was a significant correlation between the positive NBI vascular pattern and the final histology (p = 0.00001). Sensitivity, specificity, accuracy of NBI were as follows: 81%, 100%, 94%, respectively.Based on our results, NBI can reliably differentiate between postoperative laryngeal granuloma and local tumor recurrence. In such a manner, this method is very helpful in the follow-up of tumor patients.

The usefulness of narrow band imaging in the assessment of laryngeal papillomatosis

OBJECTIVES/HYPOTHESIS

Recurrent respiratory papillomatosis (RRP) is a benign disease caused by human papillomavirus 6 and 11. The characteristic feature of this disease are wart-like lesions covering the respiratory epithelium with a predilection for the larynx. There is no curative treatment for the disease. The goal of the treatment is a total surgical removal of the papillomatous lesions in order to reduce the number of relapses. Therefore, a good visualization method of papillomas is crucial during surgery. The aim of the study was to compare the accuracy of narrow band imaging (NBI) to the use of white light alone in detecting RRP.

METHODS

The study was carried out between April 2013 and November 2015 at Poznan University of Medical Sciences, Department of Otolaryngology, Poland. Rigid endoscopy with conventional white light (WL) and NBI (CV-260SL processor and CLV- 260SL light source, Olympus Optical Co. Ltd, Tokyo, Japan) was performed in all patients during direct laryngoscopy. All anatomical sites of the larynx and trachea were assessed using the Dikkers scale and Derkay total site scoring system with WL and NBI. The consensus was reached as to the number of lesions seen in WL compared to NBI.

RESULTS

During 36 microlaryngoscopies, the number of papillomas detected in the larynx (by Derkay total site score) differed significantly between white light endoscopy and NBI (Wilcoxon test p = 0.000655). In endoscopy with NBI, a mean of 1.3 more papillomas in Derkay total site score was detected in comparison to white light endoscopy NBI showed additional areas of diseased tissue in 15/36 (41.67%) patients.

CONCLUSIONS

NBI as an additional tool during microlaryngoscopy can improve the detection of papillomatous lesions.

Alterations in the liver of intrauterine growth retarded piglets may predispose to development of insulin resistance and obesity in later life

Intrauterine growth retardation (IUGR) leads to increased predisposition to metabolic syndrome in adult life but the mechanisms remain obscure. Considering a significant number of functional similarities, IUGR piglets appear to be a good model to study the development of this syndrome in humans. The aim of the present study was to investigate the ultrastructure and proteomic profile of the liver in IUGR pig neonates to discover early markers of predisposition to obesity and insulin resistance. In our study intestine and liver tissue samples were investigated in 7 day old IUGR and normal body weight (NBW) littermate piglets using histometry, mass spectrometry, in-tissue cytometry analysis and confocal microscopy. Compared to NBW, the liver in IUGR neonates was characterized by a significantly enhanced ratio of Kupffer cells to hepatocytes and insulin receptor abundance as well as higher percentages of cells expressing receptors for adipokines (resistin and adiponectin), increased expression of TNF-α (as marker of inflammation), and increased expression of insulin receptor and uncoupling protein 3 (UCP3). Moreover, NBW and IUGR differed in proteomic profile, including protein metabolism (proteasomes, cathepsin D, phermitin, phosphoglucomutase), carbohydrate metabolism (hexokinase 1, phosphoglucokinase, galactokinase, aldolase B, glucose-6-phosphate isomerase), oxidative stress and chromatin organization and DNA uptake (histones, lamin a/c). Reduction of hepatocyte numbers concomitant with significant modifications of expression of key hormones and enzymes for protein and carbohydrate metabolism in IUGR neonates may predispose to insulin resistance and obesity in adult life.

The unexpected racemization and hydrogen–deuterium exchange of the hydrogen at the α-carbon of proline analogs containing the 5-azoniaspiro[4.4]nonyl-group

Herein, we present an unexpected racemization and the hydrogen–deuterium exchange (HDX) at the α-C atom of the proline derivative under basic aqueous conditions (1% water solution of triethylamine).

Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect

Background

It is crucial to find a balance between functional and oncological outcome when choosing an adequate method for the management of vocal fold leukoplakia. Therefore, a detailed examination is a milestone in the decision-making process.

Aim

To examine whether narrow-band imaging (NBI) can be helpful in vocal fold assessment in the case of leukoplakia and how to overcome the “umbrella effect”- understood as the submucosal vascular pattern hidden under the plaque.

Material and methods

Prospective cohort of 41 consecutive patients. Inclusion criteria: vocal fold leukoplakia, no previous procedures (surgery, radiotherapy), and preoperative endoscopy with an optical filter for NBI. Two groups: “suspicious” and “normal”, according to the submucosal microvascular pattern of peripheral regions of the mucosa surrounding the plaque, were distinguished. Patients were qualified for a full-thickness or partial-thickness biopsy, respectively. Criteria defining suspected characters were well-demarcated brownish areas with scattered brown spots corresponding to type IV, Va, Vb, and Vc NI classifications.

Results

In 22/41 (53.7%) patients with “suspected” microvascular pattern, full-thickness biopsy was performed. Moderate and severe dysplasia was revealed in 15 type IV and 7 type Va NI patients. In 19/41 (46.3%) patients with proper NBI vessel pattern treated by partial-thickness biopsy, hyperkeratosis was diagnosed. There was a strong correlation between the NBI pattern and final histology: Chi2 (2) = 41.0 (p = 0.0000).

Conclusion

The results demonstrate that NBI endoscopic assessment of the submucosal microvascular pattern of mucosa surrounding the plaque can be an effective method to categorise the risk in vocal fold leukoplakia prior to treatment.

Recurrent CDK1 overexpression in laryngeal squamous cell carcinoma

In this study, we analyzed the expression profile of four genes (CCNA2, CCNB1, CCNB2, and CDK1) in laryngeal squamous cell carcinoma (LSCC) cell lines and tumor samples. With the application of microarray platform, we have shown the overexpression of these genes in all analyzed LSCC samples in comparison to non-cancer controls from head and neck region. We have selected CDK1 for further analysis, due to its leading role in cell cycle regulation. It is a member of the Ser/Thr protein kinase family of proven oncogenic properties. The results obtained for CDK1 were further confirmed with the application of reverse transcription quantitative polymerase chain reaction (RT-qPCR) technique, Western blot, and immunohistochemistry (IHC). The observed upregulation of CDK1 in laryngeal squamous cell carcinoma has encouraged us to analyze for genetic mechanisms that can be responsible this phenomenon. Therefore, with the application of array-CGH, sequencing analysis and two methods for epigenetic regulation analysis (DNA methylation and miRNA expression), we tried to identify such potential mechanisms. Our attempts to identify the molecular mechanisms responsible for observed changes failed as we did not observe significant alterations neither in the DNA sequence nor in the gene copy number that could underline CDK1 upregulation. Similarly, the pyrosequencing and miRNA expression analyses did not reveal any differences in methylation level and miRNA expression, respectively; thus, these mechanisms probably do not contribute to elevation of CDK1 expression in LSCC. However, our results suggest that alteration of CDK1 expression on both mRNA and protein level probably appears on the very early step of carcinogenesis.

Age of onset of recurrent respiratory papillomatosis: a distribution analysis

OBJECTIVE

Distribution of age of onset of recurrent respiratory papillomatosis (RRP) is generally described to be bimodal, with peaks at approximately 5 years and 30 years. This assumption has never been scientifically confirmed, and authors tend to refer to an article that does not describe distribution. Knowledge of the distribution of age of onset is important for virological and epidemiological comprehension. The objective of this study was to determine the distribution of age of onset of RRP in a large international sample.

DESIGN

Cross-sectional distribution analysis.

PARTICIPANTS

Laryngologists from 12 European hospitals provided information on date of birth and date of onset of all their RRP patients treated between 1998 and 2012. Centers that exclusively treated either patients with juvenile onset RRP or patients with adult onset RRP, or were less accessible for one of these groups, were excluded to prevent skewness.

MAIN OUTCOME MEASURES

A mixture model was implemented to describe distribution of age of onset. The best fitting model was selected using the Bayesian information criterion.

RESULTS

Six hundred and thirty-nine patients were included in the analysis. Age of onset was described by a three component mixture distribution with lognormally distributed components. Recurrent respiratory papillomatosis starts at three median ages 7, 35 and 64 years.

CONCLUSIONS

Distribution of age of onset of RRP shows three peaks. In addition to the already adopted idea of age peaks at paediatric and adult age, there is an additional peak around the age of 64.

Safety of intralesional cidofovir in patients with recurrent respiratory papillomatosis: an international retrospective study on 635 RRP patients

Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients.

Morphological and genetic distinctiveness of metallicolous and non-metallicolous populations of Armeria maritima s.l. (Plumbaginaceae) in Poland

Patterns of morphological, genetic and epigenetic variation (DNA methylation pattern) were investigated in metallicolous (M) and non-metallicolous (NM) populations of Armeria maritima. A morphological study was carried out using plants from six natural populations grown in a greenhouse. Morphological variation was assessed using seven traits. On the basis of this study, three representative populations were selected for molecular analyses using metAFLP to study sequence- and methylation-based DNA variation. Only one morphological trait (length of outer involucral bracts) was common to both metallicolous populations studied; however, the level of variation was sufficient to differentiate between M and NM populations. Molecular analyses showed the existence of naturally occurring epigenetic variation in A. maritima populations, as well as structuring into distinct between and within population components. We show that patterns of population genetic structure differed depending on the information used in the study. Analysis of sequence-based information data demonstrates the presence of three well-defined and genetically differentiated populations. Methylation-based data show that two major groups of individuals are present, corresponding to the division into M and NM populations. These results were confirmed using different analytical approaches, which suggest that the DNA methylation pattern is similar in both M populations. We hypothesise that epigenetic processes may be involved in microevolution leading to development of M populations in A. maritima.

Railway transportation as a serious source of organic and inorganic pollution

Polycyclic aromatic hydrocarbons and heavy metal (Pb, Cd, Cu, Zn, Hg, Fe, Co, Cr, Mo) contents were established in soil and plant samples collected in different areas of the railway junction Iława Główna, Poland. Soil and plant samples were collected in four functional parts of the junction, i.e. the loading ramp, main track within platform area, rolling stock cleaning bay and the railway siding. It was found that all the investigated areas were strongly contaminated with polycyclic aromatic hydrocarbons (PAHs). The PAH contamination of the soil was the highest in the railway siding and in the platform area (59,508 and 49,670 μg kg(-1), respectively). In the loading ramp and cleaning bay, the PAH concentration in soil was lower but still relatively very high (17,948 and 15,376 μg kg(-1), respectively). The contamination in the railway siding exceeded the average control level up to about 80 times. In the soil of all the investigated areas, four- and five-ring PAHs prevailed. The concentrations of PAHs were determined in four dominating species of plants found at the junction. The highest concentration was found in the aerial parts of Taraxacum officinale (22,492 μg kg(-1)) growing in the cleaning bay. The comparison of the soil contamination with PAHs in the investigated railway junction showed a very significant increase of the PAHs level since 1995. It was found that the heavy metal contamination was also very high. Pb, Zn, Hg and Cd were established at the highest levels in the railway siding area, whereas Fe concentration was the highest in the platform area. A significant increase in mercury content was observed in the cleaning bay area. The investigations proved very significant increase of contamination with PAHs and similar heavy metals contamination in comparison with the concentration determined in the same areas 13 years ago.

Comparison of ninhydrin method of detecting amine compounds with other methods of halitosis detection

OBJECTIVES

Halitosis is a result of overactivity of Gram-negative bacteria for which protein amino acids are the major source of energy. Therefore, statistical correlation between concentrations of volatile sulphur compounds (VSCs) and low-molecular-weight amines should be expected.

MATERIALS AND METHODS

Eighty-four patients suffering from halitosis and 40 healthy volunteers aged 20-62 years (average 39.7) participated in the study. In all subjects low-molecular-weight amines were evaluated by the ninhydrin method. Patients with halitosis were randomized into treatment groups. Zinc tablets, tablets and mouthwash containing chlorhexidine or lyophilized lactic acid-forming bacteria were used.

RESULTS

Analysis showed that the level of amines was highest in subjects with halitosis (0.39, s.d. +/- 0.06, P < 0.001) and correlated significantly with results of VSC measurement and organoleptic scores (P < 0.001). Reduction of amine levels after treatment was statistically significant (P < 0.001). Three months following treatment the amine levels began to increase (0.37, s.d. +/- 0.05). The amine levels in healthy controls were lower (0.29, s.d. +/- 0.07) and remained at a stable level.

CONCLUSION

The salivary amine levels significantly correlated with VSC levels and organoleptic scores. Therefore, the ninhydrin method of detecting salivary amines may be an alternative or additional method of diagnosing halitosis. This method may also be used to evaluate treatment efficacy.

[Rare case of the cervical vagal neurinoma]

Neurinoma is the most common tumor of the neurogenic origin. Primary location in the neck with the vagal nerve as a source is very rare clinical situation (less than 100 cases published in the literature). The authors would like to present a case of 35 old men with vagal neurinoma. Main symptoms included painless neck tumor found on palpation. Differential diagnosis included the pedicled cyst and metastatic neck mass. The ultrasound picture was unclear. The intraoperative findings suggested the tumor arising from the vagal nerve. In first day after the surgery hoarseness appeared with paresis of the right vocal cord in the examination. The final histological evaluation revealed neurinoma.

Armeria maritima from a calamine heap--initial studies on physiologic-metabolic adaptations to metal-enriched soil

Plants of Armeria maritima are found both on unpolluted sites and on soils strongly polluted with heavy metals. Seedlings of A. maritima from a zinc-lead calamine heap in ore-mining region (Bolesław population) and from unpolluted area (Manasterz population) were tested to determine the zinc, cadmium and lead tolerance. In hydroponic experiments Bolesław population was more tolerant to zinc, cadmium and lead. Localization of heavy metals in roots was determined using the histochemical method for detecting metal-complexes with dithizone. Their accumulation was found in root hairs, rhizoderma and at the surface of the central cylinder. Glutathione level in plants increased after metal treatment of both populations. However, its high level was not correlated with phytochelatin production. These metal-binding complexes were not detected in plants exposed to zinc, cadmium or lead. Changes of organic acids concentrations in Armeria treated with metals may suggest their role in metal translocation from roots to shoots. The content of organic acids, especially malate, decreased in the roots and increased in the leaves. These changes may be important in Pb-tolerance of Manasterz population and in Zn-, Cd-tolerance of calamine population from Bolesław.

Chromosomal gains and losses indicate oncogene and tumor suppressor gene candidates in salivary gland tumors

The incidence of salivary gland tumor in Poland is growing in the last two decades. Simultaneously a progress in understanding the genetic mechanisms of formation of this tumor was achieved by detecting several genes like PLAG1 involved in its pathogenesis. In this study we perform a whole genome, CGH analysis with the aim to identify recurrent, chromosomal copy number changes possibly indicating novel tumor suppressor gene or oncogene loci. 29 salivary tumor samples: Cystadenolymphoma-warthin (15) and adenoma polymorphum (14) located in the parotid (27) and submandibular gland (2) were collected and CGH was performed. The established copy number profiles were compared in order to asses the smallest common region of gains and losses. The delineated regions were further analyzed with the UCSC Genome Browser on Human Mar. 2006 Assembly to asses their gene content. Altogether, salivary gland tumors presented a different aberration pattern than these reported for head and neck squamous cell carcinoma (HNSCC) but no significant differences were observed between Warthin and adenoma polymorphum tumors. Moreover, several potential tumor suppressor genes and oncogenes were identified in the smallest, common altered regions. We show a frequent deletion of the harakiri gene (12q24.2) in 12/29 tumors and TP53 gene (17p13.1) in 11/29 tumors as potential tumor suppressors in salivary gland cancers. Besides, we detected a frequent amplification of the 13q22.1-22.2 region in 13/29 cases harboring the KLF5 and KLF12 genes. KLF5 regulates the expression of survivin, an oncogene widely expressed in the majority of human cancers. The observed alterations may indicate important genetic events in the formation of salivary gland tumors. Especially the amplification in 13q may be a mechanism contributing to the expression of survivin and tumor progression.

Subjective patients' opinion and evaluation of halitosis using halimeter and organoleptic scores

OBJECTIVES

The aim of the study was to evaluate the level of interest in fetor ex ore among respondents, patients of the Department of Conservative Dentistry in Warsaw.

MATERIALS AND METHODS

A questionnaire was completed by 295 patients, 202 females and 93 males aged 18-74 years (average 38.73 years). Each person was also examined for organoleptic score and volatile sulfur compounds (VSC) by Halimeter. Halitosis was diagnosed if the average level of VSC was > or =125 ppb and the organoleptic measurement using a 0-5 point scale was > or =2. Statistical analysis was performed using chi-square test.

RESULTS

Incidence of halitosis was greatest in age ranges 25-34 years (29.68%) and 45-54 years (24.52%). Sixty-eight (43.87%) persons with diagnosed halitosis frequently reported having a problem with bad breath and only 5.81% persons with halitosis did not notice this problem (P < 0.001). Among 54 healthy persons three (5.56%) reported having a problem with halitosis (P < 0.001).

CONCLUSION

A statistically significant correlation was found between clinical organoleptic diagnosis of halitosis and VSC level by halimeter. Subjective patients' opinion correlated well with objective evaluation of halitosis.

Second primary tumors (SPT) of head and neck: distinguishing of "true" SPT from micrometastasis by LOH analysis of selected chromosome regions

The reason of treatment failures in head and neck tumors is often connected with the appearance of second primary tumors (SPT). Three mechanisms of SPT development of clonal or non clonal secondary tumors were described: 1. via micrometastases (clonal); 2. from a common carcinogenic field - Second Field Tumors (SFT - partially clonal); 3. via independent events (from different carcinogenic fields - "true" SPT - not clonal). Assessing the clonality of diagnosed tumors carries important clinical implications including chemoprevention, radiotherapy and general patient management. In this study a set of 12 microsatellite markers was used to find similarities and/or differences in allelic imbalance patterns between 22 pairs of tumors (the first tumor designate as index and SPT). The aim of the study was to identify a potential clonal origin and progression within given pairs of tumors. The results indicate that within the tumors diagnosed by clinical examination as SPT at least two mechanisms mentioned above should be taken into account as 6/23 (26%) were clonally unrelated ("true" SPT) and 3/23 (13%) carried clonal genetic changes (formation by micrometastasis or SFT). In 14/23 (61%) cases the results were insufficient or ambiguous to determine the clonality status. The final results indicate the complexity of carcinogenesis in these tumors and thus stress that clinical diagnosis of second primary tumors should be considered carefully.

Highly toxic thallium in plants from the vicinity of Olkusz (Poland)

Thallium is a highly toxic metal that plays no role in the metabolism of plants or animals. Recent studies using small mammals and bird feathers as bioindicators demonstrated for the first time that animals from the vicinity of the Bolesław metal works near Olkusz (southern Poland) had large amounts of thallium in their tissues. Because of concern over these reports, four plant species (Plantago lanceolata, Biscutella laevigata, Dianthus carthusianorum, Silene vulgaris) growing wildly in the same area on a 100-year-old calamine waste heap, as well as the waste heap soil, were examined. The average concentration of thallium in the waste heap soil was 43 mgTl/kg dry wt, with the highest value 78 mg Tl/kg dry wt. P. lanceolata accumulated extremely large amounts of thallium (average, 65 mg Tl/kg dry wt; maximum 321 mg Tl/kg dry wt in roots). S. vulgaris and D. carthusianorum accumulated much less (averages, 10 and 6.5 mg Tl/kg dry wt, respectively). On the other hand, B. leavigata accumulated negligible amounts of thallium in its tissues. The concentration of thallium in plants (shoots, roots) from the calamine waste heap was 100-1000 times the level normally found in plants (0.05 mg Tl/kg dry wt). Possible sources of thallium are discussed and the urgent need for large-scale studies on thallium contamination of soils and vegetation in Poland, especially its southern regions, which are the most industrialized, is pointed out.

Adaptation of Biscutella laevigata L, a metal hyperaccumulator, to growth on a zinc-lead waste heap in southern Poland. I: Differences between waste-heap and mountain populations

Biscutella laevigata is an herbal member of the Brasicacae family and a typical mountain species. It has recently been identified as a hyperaccumulator of lead, cadmium and thallium. Its northern reach runs through Poland, where it is found only in the west Tatra Mountains and on calamine waste heaps in the vicinity of Olkusz (Cracow--Silesian Highland). The peculiar distribution of this species in Poland prompted us to undertake studies to identify the traits that allow this typically mountain species to grow so robustly on industrial waste heaps near zinc and lead smelters in the vicinity of Olkusz. Populations of B. laevigata from waste heaps and the Tatra Mountains were compared both under field (natural) conditions and during cultivation of successive generations under laboratory conditions. It was found that the mountain and waste-heap populations of B. laevigata differed significantly. The plants in the mountain population had thicker leaves covered with cutin and a small number of hairs, whereas the plants from the waste-heap population had thin leaves covered with numerous hairs. The difference in leaf thickness between the two populations (0.15 mm on average) was due to increased dimensions of palisade mesophyl cells whereas the number of cells in their leaves remained similar. These traits were hereditary. This indicates that two geographically distant populations of plants followed two different evolutionary paths to adapt to xerothermic conditions. Moreover, it was shown that the waste-heap population of B. laevigata is more tolerant to heavy metals (lead, zinc and cadmium). In the presence of both zinc and lead, growth of the waste-heap plants was stimulated, while under the same conditions, growth of the mountain population was inhibited lower than 50%. This adaptation facilitates the growth of this population on industrial waste heaps. Our studies show that B. laevigata is a valuable species very well-suited for use in the recultivation of areas containing high levels of heavy metals--the waste-heap population of this species is particularly valuable.

[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

Epstein-Barr virus and human papillomavirus infections and oropharyngeal squamous cell carcinomas

Epstein-Barr virus (EBV) and human papillomavirus (HPV) are known to exhibit oncogenic potential. Target cells for both viruses include oropharyngeal elements. The present study investigated whether EBV or HPV infection are associated with palatine tonsil carcinoma (PTC) and/or tongue carcinoma (TC). The study included 28 adult patients with oropharyngeal squamous cell carcinoma, including 14 patients with PTC and 14 patients with TC. The control group included 20 healthy adult volunteers. Sera of all patients and controls were tested for IgG anti-EA antibodies, IgG anti-VCA antibodies, and IgG anti-EBNA antibodies. DNA extracted from the tumors was tested for the presence of EBV DNA and HPV DNA using PCR-ELISA. In parallel, the presence of EBV DNA was tested in the peripheral blood in all healthy individuals and patients. In addition, attempts were made to detect HPV 16 and HPV 18 using other PCR amplification techniques. Serum anti-EBV antibodies were detected in 24 patients (12 patients with PTC and 12 patients with TC). The frequency of detection of the antibodies did not significantly differ between the groups of patients and the control individuals. Most positive patients and controls demonstrated a serological pattern typical for past EBV infection. EBV DNA was identified in 12 cases of PTC and in 12 cases of TC (altogether 86% cases). In 10 PTC patients, 8 TC patients, and only 2 healthy individuals EBV DNA was detected in peripheral blood. HPV DNA was detected in only 3 cases (1 sample of PTC and 2 samples of TC). These results suggest that the etiopathogenesis of oropharyngeal cancers may be associated with EBV infection much more frequently than with HPV infection.

[The quality of life in head and neck cancer patients: description of randomized examination formula based on standardized questionnaires EORTC QLQ C-30, EORTC QTQ-H-N35 and Kiel Questionnaire]

The notion of quality of life (QL) was first introduced in the US in the 50-ies. This notion is much broader then health, it is a personal, subjective feeling of well-being that comes from actual, widely-meant life experiences. The QL is not a measurable value, however, it may be assessed by means of appropriate indices. In the contemporary holistic attitude to a patient, in modern oncology, QL has become a parameter of equal importance to other values characterizing the treatment success, as important as numbers describing e.g. mean survival, disease free survival, or neoplasm controlled survival. Head and neck neoplasms bring about deterioration of the basic functions of the organism such as: breathing, swallowing, speaking and senses: hearing, taste and smell. Application of treatment may intensify pain, dyspnea, hoarseness or cause any kind of discomfort. It influences directly the patients' family and social life. Comparison of QL of patients treated for larynx, tongue, tonsill, glands, and paranasal sinuses neoplasms depending on localisation of primary foci, advancement of the disease, the applied treatment and its radicality, age, sex, place of living (town/country), and educational level. Correlation between the subjectively assessed QL and the objectively evaluated condition of the patient is measured. In ENT Dept. K. Marcinkowski University of Medical Sciences 46 patients were examined from May to September 2000. EORTC QLQ C-30, EORTC QLQ-Head and Neck and HAD scale were used. Kiel Questionnaire was introduced in September. The main reason for introducing it was the fact, that surgery is the method of choice in the treatment of head and neck malignancies in our Dept. The team composed of a psychologist and an ENT doctor has been working together on objective assessment of each patient. The QL assessment may be of practical importance when trying to improve the model of health care in cases of oncological patients. This knowledge enables us to learn how the accompanying side effects of therapy influence the QL of our patients, and how these problems may be overcome by proper education, advice, and support provided by the qualified staff. The authors are evaluating the QL in the period of 2, 6 months and 1 year after surgery in patients not supported psychologically. Our goal, in the future, is to introduce the psychological treatment, i.e. repetitive meetings in small groups, conducted by a psychologist. We have contacted 4 major ENT centers in Poland in order to coordinate the research on detailed assessment of QL in Head and Neck Cancer Patients in Poland. The results will be presented in the further publications.

[The role of Epstein-Barr virus (EBV) infection in carcinogenesis of palatine tonsil carcinoma (PTC)]

OBJECTIVES

Casual link of Epstein-Barr Virus (EBV) and endemically manifesting nasopharyngeal carcinoma has been already well documented. Our study, conducted in Karol Marcinkowski University of Medical Sciences in Poznań, aimed at examining whether EBV infection occurs also in patients with another tumor, palatine tonsil malignant neoplasms.

METHODS

The studies were performed on 20 patients, aged 32 to 80 years, in whom tonsil malignencies was diagnosed by histological methods. The treatment of choice was surgery. Sera of the patients was tested for EBV DNA (Sharp Signal System; Digene), IgM-anti-EBV antibodies (Behring), IgG-anti-EA antibodies (ETI-EA-G; Dia Sorin) and IgG-anti-VCA antibodies (ETI-VCA-G; Dia Sorin).

RESULTS

Serological exponents of reactivated EBV infection (serum IgG-anti-EA and IgG-anti-VCA antibodies) were observed in 12 patients. In parallel, ten of the patients demonstrated EBV DNA. In the remaining 8 patients, three manifested past EBV infection (positive IgG-anti-VCA) and five probed to be EBV negative.

CONCLUSIONS

The results indicated, that tonsil malignancies may be associated with EBV infection.

[Contribution to etiology of otitis media with effusion]

BACKGROUND

Otitis media with effusion is characterized by gathering and retaining of effusion within the tympanic cavity and the structures of the mastoid bone. The aim of this study was to explain the role of immunological reaction in pathogenesis and development of this disease.

MATERIAL AND METHOD

The studied group comprised 6 patients aged between 7 and 14 years. The effusion present within the tympanic cavity was aspired and then the agarare gel immunoelectrophoresis was performed. After 24 hours the precipitation stripes of the IgA and IgG were analysed. Blood serum specimens were also collected in the studied group. After centifrugation, blood serum concentrations of IgA and IgG were evaluated.

RESULTS

IgA and IgG were present in the effusion taken from the tympanic cavity in all examined cases. The level of IgA was higher in older individuals.

[Psychological aspects of treatment of patients with head and neck cancer]

One of the basic components that describe treatment success in contemporary oncology is patients' quality of life (QL) depending on specificity of the disease, treatment method, side effect of treatment, the medical prognosis and patient expectations. In reality, the QL is determined by the difference between patients' expectations and the actual health condition. The bigger the difference, the worse the evaluation of QL. Solving the crises, stress situation and starting life in a new way are strictly connected with the reshaping of personality and formation of adequate skills. It means it is necessary to create a new "picture of oneself", "self image" appropriate to the actual health condition and find the optimum way of activating personality protecting system (defence mechanisms). This task is not easy to realise; it is often necessary to introduce the psychotherapy to make it work. The main aim of defence mechanisms is the reduction of fear and other negative emotions, typical for oncological patients. However, the immature and poor defence system of "ego" can, at the same time, protect the personality unity and result in harmful behaviours. But when the "new self image" is made real, the newly learnt personality defence mechanisms are more mature, the patient becomes able to fight with the disease, is able to face the reality, which constitutes the main factor in the increase of QL assessment. To estimate the influence of psychotherapy on QL of head and neck cancer patients we have planned the introduction of psychological intervention (meetings of therapeutic groups).

[A rare case of adenoid cystic carcinoma of the larynx]

One case of rare laryngeal tumor--adenoid cystic carcinoma in 58 year old woman was reported in this paper. Authors wanted to drew attention to few complaints and only slight dysphagia in comparison to local extensiveness of the neoplasm. Diagnostic difficulties were underline. Epidemiology, clinical course and therapy were demonstrated in laryngeal adenoid cystic carcinoma.

[Ultrasonographic intraoperative evaluation of neoplastic changes in the tongue, tonsil, larynx, salivary and neck masses--preliminary report]

The new diagnostic method, intraoperative ultrasound is presented. There are very few publications in the literature, but they mainly concern the application of transcutaneous ultrasound in localizing the abscesses, their puncture and drainage. Intraoperative imaging of tongue, tonsil, larynx tumors, submandibular and parotid glands and neck masses have been provided by means of a linear 7.5 MHz probe in Poznań ENT Dept. K. Marcinkowski University of Medical Sciences. The application of this method is pioneer and new. The aim of the study was to compare the sensitivity and the specificity of preoperative, transcutaneous ultrasound with the intraoperative one, to assess how the new method influences the extensiveness of the performed procedures and sonographic-surgical correlation of safety margins.

MATERIAL

5 patients with parotid tumors, 4 with tongue, 6 with tonsil and 6 with larynx cancers have been examined. In 13 of them, apart from primary site diagnostics, the neck masses have been assessed. The imaging documentation is presented and the preliminary conclusions concerning the usefulness of this method have been drown.

[Concentration of prothrombin fragments 1+2 (F1+2) and thrombin-antithrombin III complexes (TAT)in patients with primary non-small cell lung cancer, before and after resection]

The aim of our study was to detect the hypercoagulability in patients with lung cancer as well as to search for the marker indicating the effectiveness of tumour resection. Twenty four patients aged: 47-66 years were included into the study. The control group comprised 24 healthy human beings. The plasma concentrations of prothrombin 1 + 2 fragments (F1 + 2) and thrombinantithrombin III complexes (TAT) were measured before and 10 days after the tumour resection. It was shown, that F1 + 2 was a more sensitive hypercoagulability marker in patients with NSCLC, than TAT concentrations. Ten days after tumour resections, 78% of the patients have a normal level of TAT, while only 42% showed normalization of F1 + 2 concentrations. Our data indicate on coagulation activation in patients with different histological types of lung cancer. The risk of thromboembolic disorders still remains 10 days after tumour resection.

[Practical significance of the 6 level neck classification in cancers of the aerodigestive tract]

Lymph node metastases are one of the main reasons of treatment failure in head and neck cancer. Thus, knowledge of lymphatic system anatomy and routs of spreading the metastases in particular primary tumor localisation is of great practical importance. Typical sites of neck metastases in larynx and tonsil cancer were presented. The neck lymphatic system classification according to American Academy of Otolaryngology--Head and Neck Surgery from 1991 was used. The most often site of metastases in larynx cancer was the II and III level, in tongue and floor of mouth cancer--level I and II and in nasopharynx malignancies--level II and V respectively. Knowledge of the neck regions with elevated risk of harbouring metastases was important not only during the surgery but as well before planning of the selective or elective radiotherapy.

[Neck metastases from unknown primary neoplasms (CUP syndrome)]

Carcinoma of unknown primary (CUP-syndrome) is taken into consideration when the patient has histologically confirmed metastases but the primary focus remains unknown or it's diagnosis is delayed. Metastases of unknown origin constitute from 5% to 31% of all neck metastases. Squamous cell carcinoma and anaplastic carcinoma metastases in the neck lymphatics suggest that location of primary focus can be found in head and neck region. Diagnostic procedures applied in detection of primary foci have been described. The knowledge of lymphatic metastases spreading routes is helpful in the primary focus detection. In the material of 1348 patients treated oncologically in the years 1991-1997 in ENT Department of Karol Marcinkowski University of Medical Sciences in Poznań, 22 were diagnosed for CUP syndrome. Primary foci were not found in 7 cases. In the remaining 15 patients the primary was located in nasopharynx, palatinal tonsil, tongue, hypopharynx, testes or breast. The treatment included the radical neck dissection with consecutive irradiation and/or chemotherapy, and in the case of diagnosing the primary one applied it's radical removal or radiotherapy.

[Usefulness of questionnaire EORTC QLQ C-30 and EORTC QLQ H&N C-35 in assessment of quality of life before surgical treatment in patients with head and neck cancer]

BACKGROUND

Quality of life (Qob) has become an important issue in head and neck cancer. Nowadays the explanation of factors predicting quality of life after surgical treatment has important role and implications for patient's management.

METHODS

We analyzed which pretreatment parameters and factors predicted QoL after surgery of 46 patients with larynx cancer. The patients completed the EORTC Core Questionnaire, the Head and Neck Module.

RESULTS

The QLQ H&N35 Core Questionnaire demonstrated acceptable reliability. The instrument was sensitive to the effect of patients' disagreement of quality of life state. Scores were significant associated with total quality of life score.

CONCLUSIONS

Results support the sensitivity and applicability of Core Questionnaire. The use of this disease-specific measure to assess quality of life among patients with advanced larynx cancer.

[Reconstructive surgery in larynx cancer]

Subtotal laryngectomies with larynx reconstruction are an acceptable alternative to the total laryngectomy in T2, T3 larynx cancer treatment. One procedure resection and reconstruction allow for radical oncological treatment with simultaneous preservation of air passage continuity and the function of the neolarynx. In the years 1988-1997 in ENT Dept. of Karol Marcinkowski University of Medical Sciences 38 subtotal laryngectomies with larynx reconstruction were performed. They were: 34 supracricoid laryngectomies with cricohyoidopexy, 2 with epiglotohyoidopexy and 3 supraglotic laryngectomies with reconstruction. The basic criterion of the evaluation of such procedures effectiveness was their oncological radicality. The follow-up period ranged from 2 to 9 years. Local relapse was observed in none of the cases, nodal relapse was started in 2 patients. Another aspect taken into consideration was the function of the neolarynx. In 3 cases two or three laser procedures were performed because of neolarynx lumen structure which were followed by T-dren plasty. In 10 patients temporary swallowing difficulties, especially liquids, were observed in the first three month. Gastrostomy was performed in one case. The authors discuss indications to this type of surgery, operation technique, oncological and functional results. Spirometry results and voice analyses after larynx resection and reconstruction in these patients are presented.

[Desmoid tumor of parotid gland]

Desmoids are rare tumors originating from musculo-aponeurotic soft tissues. Their biologic features placed them between benign fibromas and malignant fibrosarcomas. The rare of parotid gland desmoid tumor is presented. The patient was treated surgically--the tumor was resected with the safety margins. Recurrence was not observed during 12 month follow up.

[Second primary malignant tumor in patients with nasopharyngeal cancer]

Clinical analysis of 90 patients with malignant nasopharyngeal tumors treated in 1985-1996 was performed. The real frequency of second tumors, immunity to second malignant tumor, therapy and genetical factors were described. Second malignant nasopharyngeal tumors occur rarely than in other head and neck tumors (in our material approx. 4%). An attention should be paid to the young age of our patients, mean 46 years.

[Results from the treatment of nasopharyngeal cancer]

Nasopharyngeal carcinoma constitute 0.3% all malignancies in Poland. These tumors still pose a complex diagnostic problem. Intracranial structures and facial skeleton have not been accessible for X-ray imaging so far. Improvement o imaging techniques, fibroscopy, computed tomography, magnetic resonance imaging allows for gathering new data which influence diagnostics and treatment planning in this difficult anatomical localization. Development of radiotherapy techniques allows for decreasing of radio-reaction and neighbouring structure damage. 188 patient were included in this series and divided into two subgroups: I--128 patients treated between 1980-1990 and II--60 patients between 1991-1995. The diagnostics and treatment methods differs in both subgroups. It was connected with new imaging techniques, therapeutic equipment as well as combination of radiotherapy and neoadjuvant chemotherapy. The authors present the latest diagnostic and therapeutic methods which are currently applied in ENT Dept. Karol Marcinkowski University of Medical Sciences and Wielkopolskie Centrum Onkologii with review of literature devoted to the progress in diagnostics, treatment planning and modern radiotherapy techniques.

[Sarcoidosis presenting as isolated nodules of the parotid and submandibular glands]

The authors documented the case of healthy, 50 year old women with a sarcoid lesions of the parotid and submandibular gland without any other manifestations of the disease. The presence of noncaseating granulomas in salivary tissue is a specific feature of sarcoidosis. Primary involvement of the intraglandular lymph nodes with a secondary involvement of the salivary gland parenchyma was detected. Etiopathogenesis, diagnostics and clinical features of sarcoidosis were presented.