NK cells in patients with chronic rhinosinusitis show decreased maturity and limited expression of functional receptors

Chronic rhinosinusitis is an inflammatory process of the mucous membrane of the nasal cavity and paranasal sinuses, presenting with two phenotypes that differ in symptoms and inflammatory profiles: either with or without polyps. Natural killer (NK) cells are involved in both the innate and acquired immune response, and their function may be limited under pathological conditions, leading to polyp formation. We determined NK cell involvement and maturity in chronic rhinosinusitis, by determining the percentage of NK cells in polyps, nasal mucosa, and in the peripheral blood. Material was obtained from 49 patients with chronic rhinosinusitis (36 with polyps, 13 without polyps), and 15 control patients. Flow cytometry was used to immunophenotype NK cells, and the expression of selected functional receptors was evaluated. NK cells were found to be increased in polyp tissue versus peripheral blood and nasal mucosa. NK cell maturation differed significantly with predominance of a cytotoxic phenotype (CD11b+/27-) in peripheral blood, compared with a regulatory/tolerogenic phenotype (CD11+/-/ 27+) in tissue material. These findings demonstrate the involvement of NK cells in the inflammatory process of chronic rhinosinusitis. Decreased expression of activating receptors in the analyzed groups may also indicate the presence of modifying agents. Disorders of the maturation process of NK cells may be an important element in the etiopathogenesis of chronic rhinosinusitis with and without polyps.

High frequency of macrophages expressing elevated level of CD80, PD-Ls and TLR1 in nasal polyps of CRS patients

Identification of the association between tissue biomarkers, their surrogates in blood and clinical features, could provide new diagnostic tools and facilitate adequate choices of therapeutic interventions for selected patients suffering from CRS. The aim of present study was the assessment of macrophages in the polyp tissue and monocytes in the peripheral blood in the course of CRSwNP, and their functional immunophenotype. We analyzed 31 patients with CRSwNP. Nasal mucosa tissue was obtained via functional endoscopic sinus surgery (FESS). The control group included 10 patients with deviated nasal septum (DNS). Fluorochrome stained cells were proceed to acquisition using FACS Canto flow cytometer, and the results were analyzed using the software FACS Diva. In our study, we observed a significantly higher level of CD80, CD274, CD273 and TLR1 in nasal polyps compared to blood samples from patients with CRSwNP. This finding may suggest the importance of the PD-1 pathway as a therapeutic target in CRS and an important role for TLR1 in nasal polyp formation and maintenance. Our results may provide some insight into potential future targets of recurrent nasal polyp treatment and contribute to a better understanding of the inflammatory process in Chronic Rhinosinusitis.

Method and basis set dependence of the NICS indexes of aromaticity for benzene

The role of theory level in prediction of benzene magnetic indexes of aromaticity is analysed and compared with calculated nuclear magnetic shieldings of ³ He used as NMR probe. Three closely related nucleus-independent chemical shift (NICS) based indexes were calculated for benzene at SCF-HF, MP2, and DFT levels of theory and the impact of basis set on these quantities was studied. The changes of benzene NICS(0), NICS(1), and NICS(1)zz parameters calculated using SCF-HF, MP2 and several density functionals were within 1 to 3 ppm. Similar deviations between magnetic indexes of aromaticity were observed for values calculated with selected basis sets. Only very small effect of polar solvent on benzene aromaticity was predicted. The ³ He nuclear magnetic isotropic shielding (σ) and its zz-components (σ_zz ) of helium atom approaching the centre of benzene ring from above produced similar curves versus benzene-He distance to NICS parameters calculated for similarly moving Bq ghost atom. We also propose an experimental verification of NICS calculations by designing the ³ He NMR measurement for benzene saturated with helium gas or in low temperature matrices.

[Re-evaluation of 191 larynx cancer surgeries according to the Open Partial Horizontal Laryngectomies classification proposed by European Laryngological Society working committee in 2014]

AIM

of study was to present material of open partial horizontal laryngectomies (OPHL) in T1b, T2 and T3 larynx cancer treatment in single tertiary referral institution.

MATERIAL AND METHODS

Retrospective analysis of operating protocols in patients treated in Poznań ENT University Department between 2000-2012 with glottis (T1b - 185, T2 - 185, T3 - 231) and supraglottis tumors (T1 - 80, T2 - 104, T3 - 206), potentially available for organ preservation treatment. Transoral laser microsurgery, OPHL, radiotherapy and total laryngectomy were treatment options in 210, 191, 271 and 326 patients respectively. OPHL was applied in glottic tumors: 21 - T1b, 103 - T2, 27 - T3 and in supraglottic tumors: 4 - T1, 29 - T2. All procedures were re-evaluated acc. to European Laryngogical Society working committee on nomenclature new classification presented in 2014.

RESULTS

There was no discrepancies in supraglottic laryngectomies (4 cases), classified as OPHL Typ I. All the rest: 84 transglottic, 96 supracricoid with CHEP and 7 supracricoid with CHP laryngectomies were re-classified into Typ II (172) and Type III (15) OPHL. Thus, revision of inferior incision changed classification of procedure into supratracheal laryngectomy in 15 cases. Transglottic laryngectomies, in which upper part of thyroid cartilage was preserved and crito-thyreo-pexy was performed (84 pts), have not been distinguished any more. In 7 cases superior incision included epiglottis; thus 165 patients were distinguished as Typ II a and 7 patients as Typ IIb OPHL. The most pronounced difference was stated in description of structures additionally included into surgical specimen: arytenoid (+ARY) in 24, crico-arytenoid-unit (+CAU) in 5 and piriform sinus (+PIR) in 17 cases; none had the base of tongue (+BOT) resected.

CONCLUSIONS

In 36/191 additional structures and in 15/191 the cricoid ring resection was re-evaluated and pointed out. All these data were available retrospectively in the operating protocols but not pronounced in surgery headlines. Thanks to the univocal, simple new classification all operation details can be included into operation title.

Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome)

Patient: Female, 6

Final Diagnosis: Phenotype-genotype discordance in congenital malformations with communication disorders resembling trisomy 18 (Edwards syndrome)

Symptoms: —

Medication: —

Clinical Procedure: —

Specialty: Otolaryngology

[The role of carbocystein in the treatment of sinusitis]

Chronic sinusitis is one of the most common presenting complaints of all doctor visits in the United States and Europe, with more than 13% of people affected in any given year. This disease has a wide range of impact on communities. Patients with recurrent or chronic sinusitis report a deteriorative sense of general health and vitality, when compared to general population. In our Department we perform about 600 functional endoscopic sinus surgeries (FESS) per year. Chronic rhinosinusitis represents a spectrum of inflammatory and infectious processes concurrently affecting the nose and paranasal sinuses. Among chronic paranasal sinusitis one must single out paranasal sinusitis with and without polyps. In the paranasal sinusitis patomechanism the blockage of natural ostium plays one of the most important roles. The closure of sinus proper ventilation passages leads to the triggering of many pathological occurrences within mucous membrane of this region. The treatment of paranasal sinusitis is diversified and involves a surgical procedure as well as anti-inflammatory and antiallergic drugs (medications) and mucolytics. Its purpose is to clear the nose through the elimination of bacterial infection, liquidating and removal of lying discharge and the restoration of the proper muco-ciliary transportation, and through this the improvement of local condition and faster recovery. In this work the usage of carboxycysteine to treat paranasal sinus conditions has been presented.

Algorithm changes in treatment of submandibular gland sialolithiasis

Our research was conducted to determine the algorithm changes during the treatment of submandibular sialolithiasis. Two time periods were compared between 2004-2008 and 2009-2012. The turning point was December 2008, when sialendoscopy procedure was introduced. In the first period, 48 patients were treated: 31 outpatient duct incisions with stone evacuation and 17 surgical excision of submandibular gland. In the second period, 207 sialendoscopy procedures were performed on 197 patients. Out of this particular group, 158 patients were diagnosed with pathological obstruction of salivary glands and 64 of them were confirmed to have sialolithiasis of submandibular gland. Deposits of calcifications in 40 individuals (62.5 %) affected by sialolithiasis were removed endoscopically; however, in 21 patients, due to the increased circumference of the stone, the intimate association of deposits within the wall of the duct along with its presence inside the deep portions of the gland, double approach (incision of the floor of the mouth in hilar area and sialendoscopy) was performed. Three individuals had their salivary glands totally removed due to the presence of calcified deposits within the glandular parenchyma. Our results allow us to affirm that sialendoscopy is the current treatment of choice for submandibular glands affected by sialoliths. Indication for a complete removal of the gland is becoming uncommon as a first line treatment although still indispensable in chosen cases.

Voice estimation in patients after reconstructive subtotal laryngectomy

Background

Treatment of laryngeal cancers, may include surgery, radiotherapy, chemotherapy, or a combination. Total laryngectomy (TL) has been the standard surgical treatment. Partial laryngectomy procedures were performed, their advantage over TL is preservation of laryngeal functions.

Methods

The investigation was carried out on a group of 20 patients (3 female and 17 male), who underwent surgery according the techniques mentioned above. The methods of investigation were based on perceptual voice estimation (GRBAS), videolaryngostroboscopy, acoustic voice analysis, aerodynamic measure maximum phonation time, voice self-assessment (VHI).

Results and Conclusions

The perceptual voice estimation revealed a good phonation result in only 3 cases after using surgery with the Calearo method as well as the best results of MPT. The VHI reflected severe voice handicap in 2 patients (26 to 40 points). No statistically significant differences were observed between the values of the acoustic parameters in MDVP analysis after following operation -CHEP, Calearo, Sedlacek.

[The systems of classification of laryngo-tracheal stenosis]

Laryngo-tracheal stenosis (LTS) is a relatively rare disease, which develops in very heterogenous group of patients. Careful diagnostics and classification are essential for planning the following treatment and assessing its results. To classify and treat LTS, endoscopic and imaging techniques are required. In this publication basing on the literature review different systems of LTS classifications are described in details. Additionally basing on our clinical experience the probe of choosing the best classification for Polish ENT and thoracosurgery departments was undertaken. In our opinion the use of complex grading systems is unreal in everyday work by Polish ENT surgeons and thoracosurgeons. We suggest to implement the Cotton's system and Medical Research Council dyspnea scale as the optimal way to classify and asses the outcomes of LTS treatment. The former system is well known and widely advocated in Poland, the latter requires a modicum of time from the physician. Both scales, as a combination of subjective and objective parameters show a strong correlation and therefore complement each other.

[Middle ear cancer hidden by chronic otitis media--a case report]

The authors would like to present a rare case of the middle ear cancer which has been developed in postoperative cave in 67 years old patient operated for cholesteatoma 50 years earlier. The patient was admitted to the ENT Department of Poznań University of Medical Sciences because of the ear suppuration and headache occurring for 3 months. CT and MR images suggested granulation tissue filling the postoperative spaces with bone destruction, infiltration of the dura and temporal lobe abscess formation. Intraoperative findings allowed excluding the preliminary diagnosis of intracranial complication in the course of chronic otitis media, revealing the tissue masses resembling neoplastic infiltration. The histopathology examination confirmed the final diagnosis of squamous cell cancer. The patient was directed to radiotherapy. The authors report a case of middle ear squamous cell carcinoma and discuss its diagnostic aspect.

[The importance of postoperative care after functional endoscopic sinus surgery]

INTRODUCTION

In this work we wish to emphasize the importance of postoperative care of patients who underwent FESS in ENT Department Medical University in Poznań. We feel that too little attention is still being paid to this treatment as we mostly focus on surgery.

MATERIAL AND METHODS

Our observation are based on nine year experience in functional endoscopic sinus surgery. The analysis covers patients hospitalized in our Department from January 1998 to August 2007. The schedule of postoperative care has been presented.

RESULTS

1463 FESS operation were carried out in our Department from January 1998 to August 2007. Similar postoperative procedures were used with each patient. Full recovery of mucous membrane depended on a few parameters such as: if the patient underwent FESS for the first time, what kind of changes were observed: polips or chronic infection, as well as the method of surgery ("aggressive" versus "delicate"). Healing time ranged from 6 week to 3 month.

CONCLUSIONS

The scheme of procedures employed comes useful in postoperative treatment after FESS.

Studies of removal of palladium(II) ions from chloride solutions on weakly and strongly basic anion exchangers

Palladium and its compounds find wide application in industry as a catalytic agent in different manufacture processes. Recovery of precious metals from industrial wastes is difficult and time consuming but in spite of these disadvantages it becomes profitable. Palladium(II) ions sorption from various chloride solutions of the composition: 0.1-6.0M HCl-0.00056 M Pd(II), 1.0M ZnCl(2)-0.1M HCl-0.00056 M Pd(II), 1.0M AlCl(3)-0.1M HCl-0.00056 M Pd(II) on the weakly and strongly basic anion exchangers (Varion ATM, Varion ADM and Varion ADAM) was discussed. The sorption research of Pd(II) ions on these resins was carried out by means of static and dynamic methods. The dynamic processes were applied in order to determine the breakthrough curves of Pd(II) ions. Moreover, the working ion-exchange capacities as well as the weight and bed distribution coefficients were determined from the Pd(II) breakthrough curves. The recovery factors of Pd(II) ions (% R) depending on the phase contact time were obtained by means of static methods. The highest ion-exchange capacities for the 0.1-6.0M HCl-0.00056 M Pd(II) systems were obtained for the weakly basic ion-exchange resin Varion ADAM.

[9-years results of the functional endoscopic sinus surgery in ENT department in Poznań--from microscope to four hands technique]

Surgical procedure is used in chronic rhinosinusitis and aims at restoring proper drainage and ventilation. For this reason the surgery of this region is referred to as functional and in English literature is termed as FESS. It supplanted classical method of Caldwell-Luc or Denker. In the study nine years experience in the Department of Otolaryngology, Head and Surgery University of Poznań in the treatment of chronic sinusitis has been presented. 1463 patients treated with FEES were analyzed. Moreover, the method of selecting patients for the surgery, the diagram showing surgeries performed step by step as well as a list of various surgeries and intraoperative complications were presented. This work is the first part of the study. In the other part the results of the treatment based on the questionnaires sent to patients will be presented.

[Horizontal glottectomy--oncological and functional results. Part II. Morphology of the glottis and perceptive-acoustics characteristic of the voice and speech after horizontal glottectomy]

INTRODUCTION

The authors showed findings concerning glottis morphology and perceptual-acoustic characteristics of voice and speech after partial classical (PCGLg) and extended glottic partial laryngectomy (PEGLg).

MATERIAL AND METHODS

10 patients (9 M., 1 F. average age 56 (min. 47 max. 65) were examined. All patients were undergone glottic partial laryngectomy: a) classical (n = 5) b) extended of vocal process (n = 3) with (n = 2) or without (n = 1) the removal of the mucous false folds, c) extended of part of arytenoid cartilage with (n = 2) or without (n = 1) the removal of the mucous of the false folds. The following examinations were executed: phoniatric, videolaryngoscopic and perceptual-acoustic analysis.

RESULTS

After PCGLg and one extended of vocal process, voice and speech has mostly characterized of features of hypofunction dysphonia. Hyperfunction was found in patients after removal of the mucous of the false folds due to leucoplakia. In case of removing of a part of arythenoid cartilage the notable or entire standstill or lack of full phonatory closure were found. The phonetical-acoustic analysis showed that in patients using melodious voice, the character of the source of actuating was periodically-noise, with the component of noise in all range of the course of the acoustic signal of voice. The parameters such as F0, jitter, shimmer does not make coherent conclusions and are less useful in the assessment of the quality of voice.

CONCLUSIONS

In case of the resection of the part of the arythenoid cartilage during glottis laryngectomy, we take into account lack of full phonatory closure and using whisper by the patients. Obtaining the reliable conclusions needs continuations of the investigations and increasing number of patients. These researches are in progress.

[Palliative HDR and PDR brachytherapy in treatment of head and neck cancer relapses]

The preliminary results of palliative HDR and PDR brachytherapy in head and cancer relapses were presented. 47 patients with locoregional recurrenceses were treated by means of HDR and PDR brachytherapy between 05.06.2001 and 31.12.2002 in Great Poland Cancer Center and ENT Dept. K. Marcinkowski University of Medical Sciences. All patients were rejected from salvage surgery or distant field irradiation because of tumor advancement and previous treatment. The mean time of the recurrence after the diagnosing of the disease and first treatment was 9, 7 month. 34 patients were treated by the means of the HDR brachytherapy with the 5 doses of 4 Gy per fraction, 13 patients were treated by the means of the PDR brachytherapy with the one stage treatment (9 doses) or two stage treatment (4 doses) with total dose ranged between 20-40 Gy. The remission after 1, 3, 6 months after treatment and early complications were assessed. In 7 (15%) patients complete remission (CR), in 31 (65.9%) partial remission (PR) and in 5 (10.6) no response for the brachytherapy (NR) were stated; in the other 4 (8.5%) patients there were progression of the tumor. Percentages of remission after 3 and 6 months were as follows: CR - 5 (10.6%) and 3 (6.4%), PR - 25 (53.2%) and 17 (36.2%), NR and Progr - 17 (36.2%) and 27 (57.4)%. In 35 (74.5%) cases superficial necrosis was observed in 6 month time. The both methods had similar percentages of side effects. HDR or PDR brachytherapy are effective method of palliative treatment in head and neck cancer relapses. Early complications are frequent and demands intensive pharmacological treatment.

[Diagnostic difficulties in the laryngeal malignant peripheral nerve sheath tumor (MPNST)]

The malignant tumor deriving from the peripheral nerve sheet, previously described as malignant Schwannoma or neurosarcoma is extremely rare as malignancy localized in the larynx. The half of cases has been developing on the basis of neurofibromatosis in von Recklinghausen disease type I or seldom, type II. The high grade of malignancy end tendency to reccurences and distant metastases is typical for this tumors. The case of 64 year old man with larynx neurosarcoma was presented. The diagnostic difficulties were caused by clinical presentation of the smooth tumor covered by unchanged mucosa and typical histological features of the tumor. The final histological assessment was complemented by positive immunohistochemical reaction (antigens against protein S-100, NSE and PG 9.5).

[Microscopy and endoscopy of the cerebellopontine angle in the retrosigmoid approach]

The retrosigmoid approach is one of the ways to the cerebellopontine angle. It's simple to perform and offers a good view in this difficult to reach area. It's a way to surgical cure of vertigo, microvascular compression syndromes and some kinds of acoustic neuromas. The operating microscopes is a basic tool of the surgeon in otoneurosurgery. For last few years straight rigid microscopes were introduced to have a better visualization without cerebellar mechanical retraction. They are useful complementary tools to existing methods. The authors present their experience on cadaver studies.

[Il-5 and il-6 in pathogenesis of chronic sinusitis: our experience]

The aim of the study was to appraise the level of interleukin 5, 8 in secretion from the nose in etiology of chronic inflammatory state of the nose and nasal sinuses. The group of 32 patients classified as group suffered from the inflammatory state of nasal sinuses described in the International Nose and sinuses Conference in Princeton, New Jersey 1993 was examined. The level of IL-5 and IL-8 with ELISA method was indicated and the cytological examination was carried out. In the material a predominance of neutrophils implying a bacterial etiology of illness was observed. Simultaneously the high level of IL 8 (13-1393 average 2.7 +/- 6.1) was indicated.

[Laser surgery in the treatment of bilateral vocal cord paralysis]

The introduction of surgical lasers into microsurgery of the larynx has made the resection of the posterior vocal cord with or without the arytenoid cartilage possible. This method of surgical treatment allows one to carry out a fast, non-open larynx procedure and practically bloodless operation with minimal postoperative trauma and edema of the surrounding tissues. Since November 1990 at the Clinic of Otolaryngology of the University School of Medical Sciences 48 arytenoidectomies (40 on the right side, 8 on the left side), 19 partial chordectomies and 25 Kashima operations. All surgical treatment were performed by means of CO2 laser in patients with bilateral paralysis of the vocal cords. In all patients postoperative recovery was correct and breathing difficulties were not observed after extubation. Laryngoscopic control examinations were performed a day after operation and a wide lumen of air through the operative field was observed. At the control examination, narrowing of the lumen of the larynx was not observed, the healing process of the operation area was without granulation. Laser arytenoidectomy allows good results of the breathing and phonation function. No changes of granulation proliferation were observed at the side of the CO2 laser treatment. Lack of reaction to laser beam there was possibility to use endoscopic procedures in patients who did not undergo a tracheotomy.

[Enlarged vestibular aqueduct syndrome in patients with hypoacusis and deafness]

In 1978 Valvassori and Clemis have reported that enlarged vestibular aqueduct can cause progressive perceptive hearing loss and finally deafness.

AIM

Analysis of CT scans of patients with cochlear implants. Analysis of radiological data of 120 implanted patients was performed. CT examinations were performed during qualification to cochlear implantation. Most of the CT scans were performed using high resolution computed tomography (HRCT). A special attention was paid to patients with progressive perceptive hearing loss and CT of two patients with "gusher" during CI surgery. In one case (6-years old girl with bilateral profound perceptive hearing loss diagnosed in 2nd year of age) an enlarged vestibular aqueduct was found radiologically. In the second case (16 years old girl with progressive perceptive hearing loss since 1st year of age) no enlarged vestibular aqueduct was detected. Diagnostics and treatment of enlarged vestibular aqueduct syndrome are presented.

[Nonchromaffinic paraganglioma (chemodectoma) of tympanic cavity]

Nonchromaffinic paraganglioma derives from neuroectoderma. It is characterised by plenty vascularisation. Histopathologically it is a benign tumor, and doesn't give any metastasis. Although because of localisation, vascularisation and possibility of bone destruction is clinically malignant. In this paper we present three cases of paraganglioma localised in tympanic cavity treated surgically.

[A case of inverted papilloma of the nose and sinuses]

Two cases of inverted papilloma with unilateral nasal obstruction since 2 years, bleeding from the nose and headache are described. Surgical treatment was applied. Histological examination revealed inverted papilloma.

[Laser cordectomy: treatment of precancerous stages of the larynx]

Diagnostics and treatments of precancerous states of cancer of larynx will demand in select chances the multistages treatment

AIM

In work one priced radicality and efficiencies of treatment of precancerous stages of larynx with method of carbone dioxide laser cordectomy. The retrospective examination was executed of years 1991-2000 imicrosurgical interventions of larynx--in talked over period one executed 308 of surgical interventions with use of laser CO2, in number this 41 of interventions were partial laser cordectomies in stages with precancerous changes on the vocal cords. In chances of extensive precancerous changes of vocal cords in sorted chances not one should limit oneself to receiving of specimens from several localization, but change to remove in wholes. Permits this on obtainment radicality of intervention with possibility of obtainment the large material to histopathological investigations.

[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.

[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.

[Diagnostic difficulties in nasopharyngeal tumors]

Diagnostic possibilities in lethal midline granuloma (Wegener's granulomatosis, angiocentric lymphoma) based on the literature were presented. Results of diagnostic examinations in a case of 34 years old man admitted to the Dept. of Otolaryngology in Poznań were described.

Voice function in patients after extended fronto-lateral laryngectomy

The main purpose of this study was subjective and objective evaluation of voice function before and after extended frontolateral laryngectomy, followed by reconstruction with a mucochondrial graft from the nose. The next aim of this study was analysis of phoniatric and acoustic results depending on: (1) the extent and localization of the neoplastic process; (2) the wound-healing process (including the time of decannulation and effective deglutition); (3) the substitute mechanism of phonation. In all, 40 patients (37 men and 3 women) having T1B (67.5%) and T2 (32.5%) glottic cancers were examined before and after the operation. The ENT investigation included each patient's history from the beginning of illness, a subjective evaluation of the voice by patients before and after the operation, determination of laryngeal mobility of the larynx and indirect laryngoscopy during phonation. Phoniatric examination included voice recordings, average voice pitch, voice range, maximum phonation time, microlaryngoscopy and microstroboscopy. Acoustic analysis covered the harmonic structure of the voice, jitter, shimmer, noise components and basic frequency. Results showed that the extent of the neoplastic process before operation did not affect essential voice quality after operation in stage T1B and T2 disease. The maximum phonation time was shortened in T1B patients from 16.5 s to 9.28 s and in T2 from 16.7 s to 9.8 s. The average voice pitch was decreased in T1B from 177.3 Hz to 111.74 Hz and in T2 from 163.8 to 99 Hz. A correlation between acoustic analysis and phoniatric examinations was found. The value of the first formant decreased by 15.1 Hz, jitter increased 2%, shimmer increased 0.9 dB and basic frequency decreased. The voice quality after operation showed a statistically significant dependence on the mechanism of phonation. The best results were found in patients in whom phonation was the result of removing the vocal fold and postoperative scar vibration. The worst results were found in those patients with a sphincter mechanism of phonation.

[Therapeutic effectiveness of Cedax in the treatment of selected acute upper respiratory diseases]

A group of 66 patients with acute inflammatory upper respiratory tract diseases were examined in the ENT Department of Poznań Medical Academy between November 1996 and November 1997. Specimens for bacteriological cultures were collected from the ear, nose and throat. The subjects were treated with ceftibuten. Clinical improvement was reported in all cases. In 44 patients, ceftibuten treatment eliminated pathogenic bacteria (as evidenced by microbiological analysis).

[The evaluation of ceftibuten (Cedax) effectiveness in the prevention of perioperative infections]

Cedax is the antibiotic drug of the third generation cephalosporin type. In the Department of Otolaryngology of the University Medical School in Poznań tests were carried out on the effectiveness of this drug in the prevention of perioperative infections (tonsillectomy, adenotomy, septoplastics, nasal polypectomy, mucotomy). The experiment comprised 50 patients who were administered Cedax once a day of the period of five consecutive days, beginning on the day of the surgery. Control group compare 50 patients who did not receive the antibiotic cover. For the comparison of both groups the following symptoms were taken into account: general condition of the patient, body temperature in the first few days after the surgery, the healing of the operative wound (the condition of mucosa, healing "per primam" or "per secundam"), the presence and type of nasal discharge. A high degree of efficiency of ceftibuten has observed.