Biomedical subjects
Publications and source records attributed to G Janczewski.
Indications and contraindications for tympanoplasty and critical opinion upon results of this operations were presented. Attention has been brought to the role of hearing aids in restoration of social useful hearing in patients after tympanoplasty.
In the years 1985-1990 within the group of 2769 patients operated upon for laryngeal cancer in four medical centres (Kraków, Poznań, Warszawa, Lublin), a clinical analysis on surgical treatment failures was performed. The most significant reasons of failures were: the highly advanced age of patients, coexistent diseases, in particular the cardiopulmonary disease; poor information of neoplastic diseases (carcinomas) and delayed referral to the doctor; lack of consent for surgical treatment; old fashioned diagnostic methods; prolonged period of making diagnosis; increasing number of patients with supra-glottic localization including the hypo-pharynx and piriform recess; a considerable degree of organ ++cancer advancement and substantial clinical advancement; not radical excision of neck glands; intra-surgical blood transfusion; micrometastases to lymphatic glands; immunity collapse; discontinuance of post-surgical radiation on affected parts; lack of lymphadenectomy backward from accessory nerve ; massive cancer metastases to lymph nodes; high histologic malignancy with characteristic carcinous invasiveness; and finally, surgical and post-surgical early and late complications ranginy within our material from 25% to 29% of surgical patients. Basing on the above mentioned analysis, the authors developed indications for surgical treatment of laryngeal cancer.
The evaluation of surgical treatment results was done to 308 oncological patients to whom metastases were formed in lymph nodes between 1980-1984, following the previous surgical treatment of the laryngeal cancer. The evaluation included among others the following: cancer initial localization: T and N traits; the degree of malignancy; surgical radical intervention ; assertion of neoplastic cell plugs in vessels; the time of recurrent lymphatic metastases, etc. The efficiency of surgical treatment of metastases being formed following the previous surgical treatment of laryngeal cancer, measured by the time of 5 years asymptomatic life, equalled 33.4% in the discussed material. Moreover, it was stated that in the studied group of 308 patients the percentage of deaths was increasing in the subsequent years of taking observations (from 1980 to 1984) and depended also on patients overall condition, initial cancer localization, the degree of neoplastic advancement and on the degree of cancer histologic malignancy.
This study was conducted to investigate the differences between auditory brainstem responses--ABR recorded in men with temporary or permanent threshold shifts (TTS or PTS). Behaviorally, the tested ears showed insignificant differences in the hearing thresholds at frequencies in the range 0.25-8 kHz. The latency of waves I, III, V and interwave intervals I-III, III-V, I-V were analysed as functions of stimulus intensity. The comparisons between recordings obtained in groups with TTS and PTS showed significant differences in latencies of wave V at 90 dB nHl only. The latencies of waves I, III and interwave intervals were unaltered.
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During the years 1980-1988 2458 laryngeal cancer patients were operated upon in 4 ENT AM Clinics in Kraków, Poznań, Lublin and Warszawa. 300 (12%) out of them have had the cervical node metastases in 18 months after the surgery. The cause analysis was performed. The primary localizations were in the epiglottic and ++post-cricoid areas. The causes of metastases to the ++lymph nodes were analyzed; the primary epiglottic and ++post-cricoid localization of the tumor, its extensiveness and advanced clinical stage. Twice more often were the nodal metastases stated before the primary treatment, a high degree of histological malignancy, probably insufficient radicality of the surgery and insufficient immunological resistance of the organism were taken in consideration. This group of patients presented a rather high percentage of early unsuccessful results of surgical treatment of the laryngeal cancer; this problem needs further analysis and observations.
The results of laryngeal cancer surgery were assessed in a group of 832 patients treated in four major ENT centers in Poland. Five-year survival rates were as follows: stage I, 86%; stage II, 71%; stage III, 54%; and stage IV, 42%. In experienced hands and for properly selected cases, cure rates after partial (conservation) laryngeal surgery were similar to those after total laryngectomy. For early stages (I and II), the survival after partial surgery was better than that found after radiotherapy.
The surgical complications in a group of 1712 laryngeal cancer patients treated during the years 1981-87 in ENT Clinics of Cracow, Poznań, Warsaw and Lublin were described. The most dangerous were bleedings and the most frequent wound and tracheo-+-bronchial infections and pharyngo-cutaneous fistulas++, after radical neck dissection however the paralysis of sublingual and accessory nerves and of brachial plexus. The predisposing factors were: diabetes, lung and heart diseases, late stage of cancer, extent of surgery and tumor infections.
The effects of auditory fatigue on auditory brainstem responses (ABR) were investigated in 23 normal-hearing subjects. ABR was recorded before and after exposure to fatiguing noise. Behaviourally, the auditory fatigue was tested using a temporary threshold shifts (TTS) paradigm. The latency of waves I, III, V and interwave intervals I-III, III-V, I-V were analysed as functions of stimulus intensity. In post-exposure recordings a threshold elevation, significant increase of all waves latency, increase of interwave-interval III-V at 40,50,60 dB nHL and unaltered intervals I-III, I-V were observed.
The relationship between temporary threshold shift (TTS) and latency changes of auditory brainstem responses (ABR) induced by noise exposure was studied in 23 normal-hearing subjects. Shift in latency wave V at 40 dB nHL of stimulus intensity as a result of auditory fatigue showed no significant correlation with TTS at 4 kHz. The great intersubject variability of shifts in latency wave V as a result of auditory fatigue suggests that this shift may be a useful measure of individual susceptibility to noise.
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