Romuald Krajewski

Publications of Romuald Krajewski

• [Anatomy and surgical approaches to the parapharyngeal space].

  Authors: Maciej Rysz, Bogdan Ciszek, Stanisław Starościak, Romuald Krajewski, Marek Pietras

  Otolaryngologia polska. The Polish otolaryngology. 11/2011; 65(6):428-35.

  Analysis of surgical approaches to primary tumors localized in parapharyngeal space used in Head & Neck Cancer Department, Cancer Center Institute in Warsaw. Description of differences in terminologyAnalysis of surgical approaches to primary tumors localized in parapharyngeal space used in Head & Neck Cancer Department, Cancer Center Institute in Warsaw. Description of differences in terminology used to describe fascial compartments of the neck. Retrospective analysis of medical records of 8 selected patients who had an operation for primary parapharyngeal space neoplasm. Analysis has been done of operation protocols, diagnostic images, tumor size and histopathology. Transcervical, transparotid and transmandibular approaches were used with additional rhinotomy and craniotomy in selected cases. Selection of approach should take into account tumor localization, its size and histopathology. Planning of surgical procedure for parapharyngeal space tumor should be based upon analysis of diagnostic images and selection of the approach depends on tumor localization, size and histopathology. Differences in terminology of superficial and middle cervical fascial compartments can lead to inappropriate clinical decisions.

• [Can we get rid of hospital infections in head and neck surgery?]

  Authors: Marek Pietras, Romuald Krajewski, Hanna Połowniak-Pracka

  Otolaryngologia polska. The Polish otolaryngology. 01/2005; 59(6):919-23.

  Infection rate registered on the basis of clinical symptoms and of microbiological forms in patients treated in Surgery Division, Head & Neck Cancer Department during 2001-2003, was analyzed. TotalInfection rate registered on the basis of clinical symptoms and of microbiological forms in patients treated in Surgery Division, Head & Neck Cancer Department during 2001-2003, was analyzed. Total number of patients treated was 2343. In 664 preoperative microbiological cultures have been obtained from suspected areas and in 52.8% of these a pathogen has been found. Patients undergoing major surgery received a prophylactic antibiotic selected by an infection control team and Microbiology Department. If preoperative cultures showed resistance to standard prophylactic antibiotic, another was selected on the antibiogram basis. Particular attention was paid to all the elements of prophylactic against infection in the ward, examination and dressing rooms, operating theatre. In 48% of patients, mainly those after extensive, prolonged surgery, antibiotics (usually 3rd generation cephalosporins) were used for 5-7 days. During 2001, 2002 and 2003 correspondingly 148, 97 and 58 infections were registered with positive culture and infection with clinical symptoms occurred in 30, 21 and 20 patients (4%, 2,8% i 2,3%). Comparisons of hospital infection rates between different institutions are very difficult, but relatively low rate in our material and decreasing number of infections registered during consecutive years show that persistent and multifaceted prophylactic interventions can result in significant reduction of hospital infections also in patients wits contaminated surgical field.

• [Cancer in branchiogenic cyst--primary focus or metastasis?]

  Authors: Grzegorz Sobczyk, Dorota Kiprian, Mirosława Pietniczka-Załeska, Romuald Krajewski

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(3):505-8.

  The authors report the case of 68 year old male operated upon for the branchial cyst of the neck. Histopathological examination showed carcinoma in the wall of the cyst. Ipsilateral tonsillectomy wasThe authors report the case of 68 year old male operated upon for the branchial cyst of the neck. Histopathological examination showed carcinoma in the wall of the cyst. Ipsilateral tonsillectomy was done and pathology revealed primary focus in the palatine tonsil. Diagnosis of the branchiogenic cancer should be made only when all the criteria defined by Martin in 1950 are met. Patients with carcinoma cells found in branchial cyst should be diagnosed and treated as metastasis from Waldeyer's ring to the lymph nodes of the neck. Ipsilateral tonsillectomy is indicated as blind biopsy. When histopathological examination of the tonsil is negative the patients should be treated as metastasis to the neck from unknown primary focus.

• [Skull base surgery techniques in the treatment of pituitary adenomas]

  Authors: Wiesław Bonicki, Radosław Michalik, Romuald Krajewski, Andrzej Kukwa, Artur Oziebło

  Neurologia i neurochirurgia polska. 36(6):1121-30; discussion 1131-3.

  The giant pituitary adenoma surgery remains a real challenge to any neurosurgeon. Despite an extensive development of transsphenoidal techniques, open craniotomy procedures still are required inThe giant pituitary adenoma surgery remains a real challenge to any neurosurgeon. Despite an extensive development of transsphenoidal techniques, open craniotomy procedures still are required in 5-10% of all cases with pituitary adenoma. The skull base surgery techniques not only allow to minimize the surgery-related trauma of the brain, but also improve the access to the operating field. In the years 1998-2001 the authors operated on the total of 395 pituitary adenoma patients, mostly using the transsphenoidal approach (320 cases), with skull base surgery techniques applied in 75 cases (i.e. in 19% of all patients)--in 67 patients the transbasal-subfrontal approach was applied, and in 2 cases--lateral rhinotomy. There were two indications to the transbasal-subfrontal approach: a large size of the tumor causing visual disturbances, and extension of the adenoma to adherent anatomical spaces. In this group of patients the total removal of the tumour was achieved in 88% of cases. In the remaining patients remnants of the tumor were left in the cavernous sinuses. The skull base surgery techniques are most useful in the treatment of selected patients with pituitary adenoma.

• Combined treatment for tumours of the base of the skull

  Authors: Romuald Krajewski, Andrzej Kawecki, Andrzej Kukwa

  Reports of Practical Oncology & Radiotherapy.

  AimTumours situated in the region of the base of the skull are at the limits of possibility for radical resection and in patients with malignant tumours it is necessary to use combined methods ofAimTumours situated in the region of the base of the skull are at the limits of possibility for radical resection and in patients with malignant tumours it is necessary to use combined methods of treatment. The purpose of this paper is to evaluate the early results of combined treatment tumours of the base of the skull.Materials/MethodsBetween 1994 and 2004 68 patients with malignant tumours of the base of the skull and 10 with benign tumours were treated by an interdisciplinary group. Treatment included surgery, radiotherapy, and chemotherapy.ResultsAfter a period of post operative observation (median length 19 months), 32 patients with malignant tumours were without recurrence of disease, 8 lived with the tumour, 21 died as a result of disease progression and 4 died of other causes. Information was unavailable for 3 patients. Among 10 patients with benign tumours, 5 lived without symptoms of disease and 5 with the tumour.ConclusionsBecause of the limited possibilities regarding radical removal of malignant tumours in the region of the base of the skull, combined treatment using radiotherapy, surgery and, in some cases, chemo therapy is standard. Use of aggressive treatments gave local control in about half the patients though further observation is necessary in order to assess later oncological results.