Biomedical subjects
Publications and source records attributed to Maciej Modrzejewski.
Primary poorly differentiated neuroendocrine carcinomas are rare pathological findings in the upper respiratory tract, approximately 650 cases have been reported in the literature. We report a case of 51-year old male with a high grade intermediate cell neuroendocrine epiglottic cancer. The current classification according to the WHO Classification of Tumors published in 2005 is discussed.
On the base of retrospective analysis of 12,888 cases of carcinoma of larynx and hypopharynx, diagnosed in 19 ENT Departments in Poland from 1991 to 2001, the assessment of basic epidemiological data, including the localization of tumor and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 11 years the trends to change of the mentioned above parameters has been examined. The significant increase of female patients in this period was observed, with average proportion M:F = 8:1. The glottis localization of carcinoma dominated (47.6%), followed by supraglottis (40.8%) and pyriform fossa (7.8%), with significant increase of pyriform fossa tumors in the analyzed period of 11 years. In the majority of cases the carcinoma of larynx and hypopharynx was diagnosed in the advanced stage (T3 + T4) of local disease, with the highest percentage in localization within the pyriform fossa (81.0%), and the lowest percentage in glottis tumors (45.6%). The regional lymph nodes metastases has been diagnosed in 46.7% of the analyzed group, with the highest percentage in tumors localized in pyriform fossa (82.9%), and the lowest percentage in tumors of glottis localization (33.1%). In the 11 years time the significant drop down of N0 cases and tendency to increase of N2 and N3 in the supraglottis localization of tumor. The distant metastases in the analyzed group at the time of diagnosis has been registered in 2.0%, with the highest percentage in posterior pharyngeal wall (7.6%) and pyriform fossa (7.4%). The authors postulate the renewal of prospective study on epidemiology, clinical characteristics and treatment results of larynx and hypopharynx carcinoma in Poland.
Dysphagia is frequent in patients after partial laryngectomy for cancer initially located in the supraglottic area. To ensure the best quality of life, establishing how the patient feels after treatment is necessary. Therefore, a self-administered questionnaire was designed to evaluate the dysphagia. 95 patients (75 male and 20 women) who were operated in ENT Department CMUJ between 1998-2004 participated in this study. The MDADI questionnaire in the Polish version was used. The subjective evaluation by the patient of dysphagia is directly related to the size of the tumor and the extent of the partial laryngectomy treatment. Patients, whose tumor was located in supraglottic-glottic area, had subtotal laryngectomy m. Miodoński. Their quality of life was significantly worse due to dysphagia than those with tumors located only in the supraglottic area. Swallowing dysfunctionality was significantly greater after the resection of the hyoid bone. Reconstruction of the base of a tongue by a graft of angiopedunculated submandibular gland diminished the difficulties in swallowing. Moreover, the longer the period after treatment, the higher the quality of life becomes because of the improvement in the swallowing functionality.
INTRODUCTION: In last years we observe more frequently squamous cell carcinoma in patients below 45 years of age. Especially we examined patients with cancer of the larynx. MATERIAL AND METHODS: Estimation of surgical treatment of patients with cancer of the larynx under 45 years age after prior analysis of the following factors: localization of laryngeal carcinoma, local and regional advancement, the incidence of "occult metastases", the presence of metastases in the pre-laryngeal node, the regions of the neck affected by metastases. An analysis of a group of 140 patients who underwent surgery for laryngeal carcinoma in the period 1950-1998 was carried out. In all of the cases partial or total laryngectomy with unilateral or bilateral neck dissection was performed. RESULTS: In patients under 45 years of age, metastases to the lymph nodes were more frequently observed. The incidence of "occult metastases" and metastases to the pre-laryngeal node were more frequently. CONCLUSIONS: The cancer of the larynx in "young adults" is more aggressive and worse prognosis than in older patients population.
Inverted papilloma is a benign neoplasm of uncertain etiology arising from the lateral nasal wall and middle meatus. The tumour is considered locally aggressive. In selected cases inverted papilloma can be associated with squamous cell carcinoma. Computed tomography and magnetic resonance imaging are widely used for diagnosis and preoperative workup to evaluate the degree of sinus involvement. Its tendency to invade adjacent paranasal structures and high recurrence rate causes controversy as to the optimal method of surgical removal. During the past decade, endoscopic surgical approaches have become accepted as standard of care in case of inverted papilloma. Continually increasing skill with the use of the endoscopes and a better understanding of the anatomy of the region have allowed surgeons to extend the applications of sinus endoscopic surgery. The following paper reports clinical outcome of treatment of 20 patients with inverted papilloma of the lateral nasal wall treated in ENT University Department in Kraków, provides review of current literature concerning the subject and discusses indications and contraindications of this method of treatment in comparison with traditional extranasal approaches in order to search for the optimal philosophy of sinus surgery for inverted papilloma.
An Electroglottograph (Fourcin Laryngograph Processor) was used to determine, whether there was a significant difference in degree of Irregularity in vocal fold vibration (% Irregularity) or Contact Quotient (Qx) in the vocal fold vibratory cycle (Lx) between different phonatory tasks and between men and women. The most recent software package, 'Speech Studio', was used to analyse the data. The subjects were 24 healthy subjects, 16 females and 8 males, aged from 22 to 71. The tasks consisted of sustained vowels: a, o, u, short words: Ala, Ola, Ula and a short phrase in Polish, spoken at comfortable pitch and volume. The average age of females and males did not differ significantly on t-testing. The results showed there were no statistically significant differences between mean values of Qx between phonatory tasks on ANOVA testing. However, the differences between mean values of % Irregularity were significantly different between tasks. The % Irregularity obtained for the phrase, was significantly different from the values obtained for the sustained vowels and single words. The values for the latter two did not differ significantly. The difference between male and female Qx and % Irregularity values were not significant on t-testing except for % Irregularity for the word 'Ola', which was greater in men. Our findings show that for calculation of Qx either sustained vowel phonation, single words or phrases may be used. % Irregularity of vocal fold vibration is however task dependent.
Free forearm skin-fascia flap was used at 14 patients for head and neck reconstruction. Tissue defect was located in mesopharynx at 6 patients, in piriformis recessus at 2, in buccal mucosa at 1, in hypopharynx 4 and very large defect embracing mesopharynx, hard and soft palate at one patient. To present moment lives 11 ill in this one from recurrent diseases. Most important element of microvascular junction is correctly executed venous junction. Patients after microvascular flaps showed less percentage of early complications (fistulas, shorter time of staging in Clinic). Connection of partial operation of the larynx with microvascular reconstruction of throat creates chance on good oncological on functional result. Free forearm skin-fascia flap provides good anatomical and functional result after various reconstructions of head and neck region.