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BACKGROUND: Nasal angiofibromas are commonly called juvenile nasal angiofibromas (JNA) because of the almost exclusive occurrence in adolescent males. It is a relatively rare benign fibrovascular tumor originating in the posterior lateral wall of the nasopharynx with only a very few cases diagnosed in females. CASE REPORT: Authors present a case of a 26 y.o. woman with JNA in left nasal cavity with extension to the anterior left ethmoid cells diagnosed and surgically treated at the ENT Department, Medical University of Lodz. Patient presented in past medical history: lymphoma malignum--abdominal location--surgical treatment and chemotherapy (1986) with no clinical signs of recurrence. Diagnosis based on histopathologic examination with immunochemical staining (vimentin, actin, desmin, S-100 protein). CT of paranasal sinuses in frontal and axial plains--left nasal cavity filled with a solid pathologic tissue. In the left anterior ethmoid cells extension of the tumor could be seen. Surgical treatment--tumor has been surgically resected with no complications. In a 12 month follow up patient shows no signs of recurrence. CONCLUSION: Although angiofibroma in females is an extremely rare tumor of a sinonasal tract it should be taken into consideration in the differential diagnosis of all nasal cavity tumors (especially solitary fibrous tumor). It is not possible to make differential diagnosis on physical examination. The only way to confirm the diagnosis is histopathologic examination with immunochemical staining.

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BACKGROUND: Acute pharyngotonsillitis (APT) is one of the most common inflammatory processes of adults and children in an outpatient setting. Increasing failure rates, hypersensitivity to penicillin, the required multiple daily doses and common side effects lead to poor patients compliance and thus inadequate treatment duration, providing therefore ground for considering alternative antimicrobial agents. MATERIAL AND METHODS: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor (375 mg BID) and amoxicillin/clavulanate (625 mg BID) in 10 days treatment regiment of ambulatory patients with APT. A total of 200 patients (age range between 12-65 years) with symptoms of APT and positive antigen strep test were enrolled into the study. Clinical and bacteriological responses were assessed after the end of treatment (14th-18th day) and at the follow-up visit (38th-45th day). All GABHS strains, isolated from throat cultures, were tested for in vitro sensitivity to the antibiotics used in the study and no strain was found resistant to both antibiotics. RESULTS: The results indicated that both antibiotics had high--almost 99% effectiveness at the post therapy visit. On the follow up visit an increased tendency of relapses was observed in the amoxicillin/clavulanate treated group, compared to cefaclor treated group (8.33% vs 3.29%). Relative risk of relapse in patients treated with amoxicillin/clavulanate was 2.6 greater compared to cefaclor. There were significantly higher rates of gastrointestinal adverse events in group treated with amoxicillin/clavulanate (29/97 patients; 29.89%) compared to cefaclor (16/95 patients; 16.84%) - p< 0.03. Frequency of other adverse events did not differ significantly between the groups. CONCLUSIONS: Cefaclor and amoxicillin/clavulonate provide a clinically and bacteriologically effective treatment for patients with pharyngotonsillitis caused by GABHS, but cefaclor treatment is significantly safer in regard to gastrointestinal side effects.

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Angiogenesis as multistage process, which is required for forming of new vessels and is essential for the growth of solid tumors and making metastasis. Sixty patients with laryngeal cancer were analyzed. They were treated in ENT Department of Medical University in Lodz and follow-up period was not shorter than 5 years. Intensity of neovascularisation was examined by means of immunohistochemical techniques carried out on paraffin sections using selected antibody against antigens of vessel cells. The value of the prognostic factors of angiogenesis intensity were evaluated against: dissected nodal metastasis, tumor recurrences and metastasis observed in prospective follow-up and after cancer treatment live time. Morphological properities of tumor or hospital treatment of the patients with laryngeal cancer were analyzed as well. Taking into consideration the results, we can make the conclusion that investigation of angiogenesis can be forthcoming prognostic factor for the laryngeal cancer.

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Kinetics (growth fraction of tumour cell populations), death process of cancer cells (apoptosis and necrosis) and neovascularisation in tumour (angiogenesis) have influence on the growth of cancer. Sixty patients with laryngeal cancer treated in ENT Department of Medical Academy of Lodz were analysed. Proliferation activity of cancer cells was examined by means of selection appropriate antigen (Ki-67) characteristic for cell cycle utilising immunohistochemical techniques carried out on laryngeal cancer paraffin samples. Expression of selected protein connected with apoptosis (p-53) and intensity of angiogenesis were examine using selected antibody (anti-CD34) aimed against epithelial antigens. Above-mentioned markers were correlated with: stage of cancer progression, recurrences and metastasis of laryngeal cancer and follow-up of the patients. The morphological properties were examined as well. The researches on apoptosis, angiogenesis and proliferation of cancer cells can be used as prognostic factors for the patients with laryngeal cancer.

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Apoptosis--the programmed sell death is the process of characteristic events on morphological, biochemical and molecular level which lead consequently to cell death. This process require activation of some genes i.e. p-53, mdm2 and inhibiting others i.e. bcl-2. Sixty patients with laryngeal cancer treated in ENT Department of Medical Academy of Lodz were analysed. Expression of the p-53 and bcl-2 genes' products was examined by means immunohistochemical techniques carried out on laryngeal cancer paraffin samples. Above-mentioned markers were correlated with: stage of cancer progression, recurrences and metastasis of laryngeal cancer and follow-up of the patients. Initial results indicate the possible utilisation of apoptosis as prognostic factors for the patients with laryngeal cancer.

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In the article incidence of pharyngocutaneous fistulas after total laryngectomy was estimated depending on the method of nutritive drain insertion. The study was performed in 464 patients (64% of all laryngectomized) treated surgically in ENT Department of Medical University in Lodz from 1988 to 1997. It was stated that fistulas developed in 114 cases (24.6%). There were compared two groups of patients following laryngectomy: group I was consisted of 279 patients with nasogastric tube and group II numbered 163 subjects with using a different method of nutritive drain insertion by the upper pole of neck wound during laryngectomy. It was found that pharyngocutaneous fistulas developed statistically lower in group with drain inserted by the neck wound than in group with nasogastric tube (17.8% vs 27.9% p < 0.05). Moreover patients in the second group could not suffered from the unpleasant pain in the nose, and easier accepted this manner of nutrition. Satisfactory surgical aspects for the patients and their environment confirm usefulness of different method of insertion of the nutritive drain by the neck wound.

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One of the most important factor in prognosis of the patients with laryngeal cancer is presence of the metastases in lymph nodes of the neck. The main purpose of the paper was the evaluation of CD34 and FVIII antigens as angiogenesis markers, and nm23 protein and CD44 antigen expression as metastasis potential markers and description of their role in the tumour progression and making metastasis in the patients with laryngeal cancer. Paraffin-embedded tissue sections from 89 patients with laryngeal cancer were stained with a monoclonal antibody raised against CD34 and FVIII antigens, against nm 23 protein and against CD44 antigen. Measuring the density of the microvasculature in tumour was investigated. We found significant dependence between intensity of angiogenesis (IA) and pT, nodal metastasis, histological grading and survival. There were also significant correlation between nm23 protein expression and nodal metastasis, and between CD44 antigen expression and pT, nm23 protein expression and FVIII antigen expression. Evaluation of mentioned markers allowed to asses the aggressiveness of tumour cells and anticipate neck metastasis in the patients with laryngeal cancer.

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Evaluation of the biology of laryngeal cancer cell is connected either with many process inside the cell or reactions between cancer cell itself and extracellular matrix. The main purpose in this paper was the evaluation of p53 protein, bcl-2 protein, Ki-67 antigen and CD44 adhesive molecule expressions in comparison to clinical and histopathological features in patients with laryngeal cancer. Paraffin-embedded tissue sections from 89 patients with laryngeal cancer were stained with a monoclonal antibody raised against p53 and bcl-2 proteins, Ki-67 and CD44 antigens using a peroxidase-labelled streptavidin-biotin kit. There were statistically significant relationships between p-53 protein over-expression and pT, histological grading, survival and Ki-67 and CD44 antigens expressions. There were no correlation between bcl-2 protein expression and clinical and histopathological features. We observed statistically significant correlation between Ki-67 expression and pT, histological grading, recurrences and survival. Expression of CD44 statistically significant correlated only with tumour size. We conclude that comparison of data covering mentioned tumour markers expression gives valuable evaluation of biological activity of cancer cells and may allow to create the immunological panel of tumour markers which simplify the prognosis about nodal metastases, recurrences and survival in patients with laryngeal cancer.

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The amount of data in the field of otorhinolaryngology has rapidly increased in proportion to the growing number of patients. It is a very important issue to preserve their records and make them easily available. Authors present a computer-based system for monitoring audiometric data of hearing impaired persons named Audiobase. The main elements of this system as: the personal data, otoscopic and audiometric examination have been described. This system was created to be used by staff without computer skills and therefore is largely "icon-driven". The main functions include patient record creation, update, and retrieval, as well as the generating of reports and graphical presentations. The system has already provided useful research material and is now beginning to fulfill an even more important role in patient follow-up and in evaluation of alternative treatment protocols.

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Observed elderly had general weakness of motor and mental function. The slower reactions to environment stimulus in elderly above 60 years result first of all from weakness of sensory receptors as visible, hearing, smell and taste. In this age group disturbing of balance system function demonstrated vertigo, dizziness, darkness of visible, disequilibrium was more encountered. Up to now there is not specified that "presbyequilibrium" (presbyvertigo, presbyastasis) as physiology ageing process causes this condition or destructive processes, infections, vascular insufficiency and neoplastic processes in inner ear and acoustic tracts and centres. Vestibular symptoms often are related to age by the doctors so for that reason basic and sometimes dangerous disease may be missed. Proposition of this paper is estimation of reflex function of balance system in connection with ageing process. To this end VEMPs were used and latencies and amplitudes of ipsilateral and contralateral VEMP recordings were calculated in young and elderly groups. Lower reflex efficiency in elderly disclosed longer latencies and lower aptitudes of p14 n21 of VEMPs than young people but without significant differences.

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The aim of this paper was assessment of usefulness of MPPW recording in diagnosis of hearing loss. Study of MPPW performed in 65 people, in these 22 cases with normal hearing (44 ears), 20 subjects with sensorineural hearing loss (27 ears), 10 examined with retrocochlear hearing loss (12 ears) and 10 patients with unilateral totally deafness. Differences of latency wave n34 p44 (later response of VEMPs) were stated in sensorineural and retrocochlear hearing loss with reference to latencies this wave in normal hearing subjects. Vestibular organ lesion may be not only diagnosed based on VEMPs results but also cochlear organ lesion can.

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Authors presented possibility of clinical appliance of the M 4128 thermocamera in monitoring thermal changes of the skin and mucosa in upper respiratory tract diseases in patients treated at ENT Department Medical University of Lodz. Basing on the obtained results authors conclude usefulness of thermocamera in diagnosis of the head and neck tumors and inflammatory diseases and monitoring of the photodynamic therapy.

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Bacterial species causing the hospital of the upper respiratory tract and ear were analyzed in this study. Authors evaluated differences in the frequency of various microorganisms on the clinical material. A special attention is paid to the problems of anaerobial species. Microbiological analysis of the isolated bacterial species and the assessment of their drugfastness was conducted.

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In the article incidence of the vertigo and vestibular disorders in 119 patients with sudden sensorineural deafness was evaluated. It was stated, that vertigo and vestibular disorders had 47% of persons, abnormal trace in ENG examination--56% of persons. Furthermore hearing recovery was less frequent in group of patients with sudden deafness and vertigo than in group of patients without vertigo.

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112 patients with larynx cancer underwent ultrasonography of neck lymph nodes to asses their metastatic involvement before surgical treatment. Evaluation of the nodes was also performed by means of simple palpation. Results of palpation and ultrasonographic examination were compared in terms of efficacy in detecting and recognition of metastatic spread within lymphatic system of neck. The final assessment was based on results of intraoperative exploration and histological examination. Results indicate that ultrasonographic evaluation is more efficient in recognition of metastases to nodes of neck then physical examination based on palpation. The authors concluded that ultrasonography as a simple and available method can be effective in detection of metastases of ca larynx to lymphatic system of neck.

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The authors present a new and original method of destroying neoplastic tissues with the use of a laser light. Photodynamic therapy (PTD) requires three components: the photosensitizer, oxygen and light. This method is a promising for treatment on a many specialty including head and neck area. Advantage of PDT ist possibility several times radiation the carcinoma cells. Photodynamic therapy is application for diagnostics and treatment carcinoma and when the conventional therapy is not possible.

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The authors present epidemiology of the cancer in region of Lódz. The region of Lódz contains five provinces. In 1991 in this region were 532 males and 65 females with the cancer of larynx. The authors present coefficient: morbidity, mortality and disease in region of Lódz and in Poland in 1991.

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An analysis of voice rehabilitation was made among 111 patients with cancer who had undergone total laryngectomy. Patients were divided in two/groups: first--67 subjects whose pharynx wound was sutured with purse-string suture and second--41 subjects whose pharynx wound was closed with single sutures. In both groups functional status of the upper esophageal sphincter was compared by means of pressure measurement by Seemman's method. The shape of lower pharynx and the level of development of pseudoglottis were estimated by means of radiological methods and the computer model of vocal tract.

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