Wojciech Golusiński

Publications of Wojciech Golusiński

• Orbital tumors in material of Department of Head and Neck Surgery and Oncological Laryngology of Greater Poland Cancer Center 2007-2010.

  Authors: Piotr Pieńkowski, Michał Wieloch, Wojciech Golusiński, Jakub Pazdrowski, Lukasz Luczewski

  Otolaryngologia polska. The Polish otolaryngology. 01/2012; 66(1):39-42.

  INTRODUCTION: Tumors of the orbit are diagnosed sporadically. Based on the tumor registry of the American Cancer Society the incidence of tumors of the orbit is assessed at fewer than 1 per 100 000INTRODUCTION: Tumors of the orbit are diagnosed sporadically. Based on the tumor registry of the American Cancer Society the incidence of tumors of the orbit is assessed at fewer than 1 per 100 000 persons. Tumors of the orbit can be divided into three groups: primary tumors, tumors penetrating the orbit from neighboring structures, and tumors that are metastases of malignant cancers from distant organs. AIM OF THE STUDY: To present the results of treatment of patients with tumors of the orbit treated in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznań during 2007-2010. MATERIAL AND METHODS: The study group consisted of 26 patients surgically treated during 2007-2010 in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznań. RESULTS: In the postoperative histopathological examination 18 patients (69%) were diagnosed with malignant tumors, 7 patients (27%) with non-malignant tumor and 1 patient (4%) with inflammatory lesion. Among malignant tumors the most frequent was basal cell carcinoma, diagnosed in 7 patients (27%). When removing the tumors of the orbit 4 types of operation were performed: lateral orbitotomy, superior orbitotomy, eye enucleation, and exenteration of the orbit. In 3 patients (12%) cancer recurrences occurred. All patients with recurrences underwent reoperation. In a patient with an extensive recurrence of squamous cell carcinoma the surgery was not radical and the patient died during palliative chemotherapy. CONCLUSIONS: Patients with tumors of the orbit should be treated operatively in appropriately prepared centers. In our material the confirmation of this thesis is the group of patients with recurrences of basal cell carcinoma, operated on many times in the past, who due to the extent of the cancerous process had to have the seeing eye removed. In the case of malignant cancers of the orbit an interdisciplinary approach to the problem and the assurance of psychological care for patients who have lost an orbit are essential.

• Our experience in the use of anterolateral thigh flap for reconstruction of the head and neck neoplasms.

  Authors: Jakub Pazdrowski, Tomasz Synowiec, Paweł Golusiński, Piotr Pieńkowski, Lukasz Luczewski, Paweł Chęciński, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 01/2012; 66(1):51-55.

  INTRODUCTION: Free flaps with vascular anastomosis have been widely used in clinical practice for more than 30 years. They are standard in reconstructive surgery following extensive resections causedINTRODUCTION: Free flaps with vascular anastomosis have been widely used in clinical practice for more than 30 years. They are standard in reconstructive surgery following extensive resections caused by neoplasms of the head and neck. The anterolateral thigh flap (ALT) constitutes very good reconstructive material due to the long vascular pedicle, the appropriate diameter of vessels, the large skin island plane, and thickness depending on requirements. MATERIAL: The own material comprises 5 patients who have had extensive neoplastic infiltrations removed at different anatomic locations within the area of healthy tissue. RESULTS: Reconstructions have been conducted using a microvascular thigh flap (ALT). All of the operated patients are under constant supervision. The observation period ranges from 2 to 3 months. No recurrence of the neoplastic process or graft rejection has been observed in any of the patients.

• [Diagnostic difficulties of the patient with sinonasal tract tumor; therapeutic dilemmas - a case report and up to date review].

  Authors: Ewa Majchrzak, Anna Wegner, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 09/2011; 65(5):377-82.

  Esthesioneuroblastoma (ENB) is a rare malignancy unique to the sinonasal tract. It arises from the olfactory epithelium and has a tendency to originate from one side of the nasal cavity and paranasalEsthesioneuroblastoma (ENB) is a rare malignancy unique to the sinonasal tract. It arises from the olfactory epithelium and has a tendency to originate from one side of the nasal cavity and paranasal sinuses with frequent extension into the cranial cavity and orbit. There is a bimodal age distribution between 11 and 20 years and between 51 and 60 years. ENB accounts for approximately 2-3% of intranasal cancers. Due to the non-specific nature of the initial presentation and slow growth of the tumor, patients often have a long history before diagnosis. Physicians including pathologists are not always aware of distinctive features of ENB especially radiographic, histologic and immunohistochemical characteristics. Additional difficulty can be the fact that Esthesioneuroblastoma can histologically mimic many tumors within the sinonasal tract. We report on a 38-year-old male patient with a Kadish stage C tumor with frontal lobe invasion. The patient underwent a craniofacial resection with a combined head neck and neurosurgeon team. After the surgery postoperative radiotherapy was used. The aim of this study is to present the natural history of the malignancy, the diagnostic process, treatment and prognosis, based on the literature review.

• Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy.

  Authors: Sławomir Marszałek, Anna Zebryk-Stopa, Jacek Kraśny, Andrzej Obrębowski, Wojciech Golusiński

  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 12/2008;

  In patients after total laryngectomy, increased tension in myofascial neck and arm areas might be observed. Via fascial continuity it has an adverse impact on the superior esophageal constrictorIn patients after total laryngectomy, increased tension in myofascial neck and arm areas might be observed. Via fascial continuity it has an adverse impact on the superior esophageal constrictor forming the "mouth of the oesophagus", which hinders learning of esophageal speech. The aim is to assess the effect of manual myofascial release techniques on esophageal pressure in patients after total laryngectomy. Forty patients (12 F, 28 M), aged 43-75 (mean 56.8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node resection, 38 patients (95%) after radiotherapy. Esophageal pressure was assessed using modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limb areas. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. Statistically significant decrease of the mean esophageal pressure was observed after the physiotherapy treatment. The average pressure among the examined patients decreased from 37.9 to 26.6 mmHg. The application of myofascial manual techniques decreases esophageal pressure, thus allowing patients to learn esophagus speech at a faster pace.

• [An influence of myofascial release techniques on the esophagus pressure for patients after total laryngectomy]

  Authors: Sławomir Marszałek, Anna Zebryk-Stopa, Jacek Kraśny, Andrzej Obrebowski, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(6):686-90.

  The increase of patients after total laryngectomy myofascial neck and arms area tension might be observed. Via fascial continuity it has an adverse impact on superior oesophageal constrictor, formingThe increase of patients after total laryngectomy myofascial neck and arms area tension might be observed. Via fascial continuity it has an adverse impact on superior oesophageal constrictor, forming the "mouth of oesophagus", which hinders learning oesophagus speech. THE AIM: The assessment of manual myofascial release techniques influence on the patients' oesophagus pressure after total laryngectomy. MATERIAL: 40 patients (12 F, 28 M), aged 43-75 (middle 56, 8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node's resection, 38 patients (95%) after radiotherapy. METHODS: The oesophagus pressure was checked by modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limbs area. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. RESULTS: A statistical significant decrease of the mean of oesophagus pressure was observed after physiotherapy treatment. The average pressure among the examined group decreased from 37.9 to 26.6 mm Hg. CONCLUSIONS: The application of myofascial manual techniques decreased an oesophagus pressure which allows patients to obtain faster oesophagus speech.

• [Endoscopic decompresion of orbital cavity in the course of the Graves' ophthalmophaty]

  Authors: Wojciech Golusiński, Magdalena Kordylewska, Michałek Krzysztof, Ryszard Waśko, Jerzy Sowiński

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(5):587-92.

  Thyroidorbithopaty is inflammatory disease against the autoimmune reaction. Clinical symptoms are connected within-creasing the volume of retrobulbar tissues. As a result of the autoimmune reactionThyroidorbithopaty is inflammatory disease against the autoimmune reaction. Clinical symptoms are connected within-creasing the volume of retrobulbar tissues. As a result of the autoimmune reaction is reaching to the blow-up, thickening extrabulbar muscles, of appearance of the swelling of the inflammable body of the fat body and tear glands. Heightened retrobulbar pressure is leading to the exophthalmos of the eyeball. He can be a consequence of the exophthalmos insuffiency of eyelids, drying, ulcerations of the cornea. In external eyball muscles changes are leading to eyeball mobility limitation, the double vision, whereas the pressure on the optic nerve can be a reason of injuring it what next serious complications constitute thyroidorbitopathy. In the case active orbithopaty an immunosuppression is an essential way of curing. Disabled advanced form thyroidorbithopaty is a reading for curing applying treatment methods. Outside clinical symptoms among others findings of CT, MR examinations are deciding using it. A treatment is one of methods of operating intranasal curing, of endoscopic decompression of the orbital cavity. Authors are showing the method of operating curing on the basis of the case ill around thyroid orbithopathy in the course of illness Graves- of Basedow with accompanying diabetes.

• [Reconstruction of the hypopharynx and cervical esophagus with gastric pull-up technique in the patient with recurrence carcinoma of the hypopharynx]

  Authors: Wojciech Golusiński, Jakub Pazdrowski, Magdalena Kordylewska, Piotr Pieńkowski, Anna Wegner, Paweł Murawa, Janusz Wasiewicz, Sławomir Marszalek, Maria Kusnierkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(5):616-20.

  Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poorPatient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are, discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.

• Assessment of expression of toll-like receptors 2, 3 and 4 in laryngeal carcinoma.

  Authors: Mirosław Szczepański, Maria Stelmachowska, Lukasz Stryczyński, Wojciech Golusiński, Husam Samara, Iwona Mozer-Lisewska, Jan Zeromski

  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 06/2007; 264(5):525-30.

  Head and neck cancers remain a big challenge for oncology. Among them laryngeal carcinomas predominate. In spite of abundant inflammatory cell infiltrates containing several immunologically competentHead and neck cancers remain a big challenge for oncology. Among them laryngeal carcinomas predominate. In spite of abundant inflammatory cell infiltrates containing several immunologically competent cells, patients with head and neck cancers show markedly suppressed anti-tumor response. In general, cancer cells use strategies to avoid recognition and destruction by the immune system. Toll-like receptors 1-13 (TLRs) are crucial for activation of innate immunity and secondarily for the induction of acquired response. TLRs are mainly expressed on cells of the immune system, but they have been demonstrated on endothelial and epithelial cells. Ligand binding to TLR leads to the activation of several genes, predominantly proinflammatory ones such as IL-1 and TNF-alpha and maturation of professional antigen presenting cells (APC) i.e., dendritic cells. It can cause better tumor antigen presentation by APC. The aim of this study was the evaluation of expression of TLR-2, TLR-3 and TLR-4 in the microenvironment of laryngeal carcinoma. Tumor specimens (n = 20, male patients aged 43-77 years, mean 57 years) from patients subjected to total laryngectomy. Immunohistochemistry and indirect immunoflourescence on frozen tissue sections. Cancer tissue: portion of cancer cells manifested membrane and/or cytoplasmic expression of TLR-2, TLR-3 and TLR-4. The most frequent expression on tumor cells was TLR-2 and the least expression of TLR-4. Inflammatory infiltrates: in all cases inflammatory cell infiltrates of various intensities were present, both in tumor mass and tumor stroma. Expression of all TLRs tested, both, membrane and cytoplasmic ones were shown on inflammatory cells, but distinct in quantitative terms. TLR-4 positive cells were the most frequent. A portion of cells expressed both, TLR and HLA-DR. It is of interest that TLRs tested were expressed not only on cells of inflammatory infiltrate, but also on tumor cells. This fact may be an important factor in tumor escape from immune surveillance. It is notable, that both, TLRs and HLA-DR were shown to be co-expressed, what may favor the role and impact of TLRs in antigen presentation. Further studies are needed to elucidate TLRs function in the course of neoplastic process.

• [The role of immunohistochemical staining (protein p53, cyclin D1) in the prognosis of adenoid cystic carcinoma salivary gland tumors]

  Authors: Anna Wegner, Elzbieta Waśniewska, Donata Jarmołowska-Jurczyszyn, Wojciech Golusiński, Wiesława Biczysko

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):423-7.

  INTRODUCTION: Adenoid cystic carcinoma of the salivary glands (carcinoma adenoides cysticum) is malignant epithelial tumor of rare occurrence. Tumor of this kind has among salivary glands tumorsINTRODUCTION: Adenoid cystic carcinoma of the salivary glands (carcinoma adenoides cysticum) is malignant epithelial tumor of rare occurrence. Tumor of this kind has among salivary glands tumors uncertain prognosis and unpredictable course. The aim of the study was to characterize the patient population and the immunohistochemical analyses (p53 protein, cyclin D1). MATERIAL AND METHODS: The examined group consisted of 30 patients with adenoid cystic carcinoma of the salivary glands. The expression of p53 protein and D1 cyclin in the tumor was evaluated and the correlation between these proteins and the organ and clinical grading was defined. RESULTS: The immunohistochemical studies showed in 70% the positive staining for p53 protein and 90% for cyclin D1. There was not statistically significant difference between the advanced grading of the organic and clinical adenoid cystic carcinoma.

• [Rare case of the Recklinghausen disease in the head and neck region]

  Authors: Wojciech Golusiński, Tomasz Kopeć, Lukasz Borucki, Katarzyna Iwanik

  Otolaryngologia polska. The Polish otolaryngology. 02/2006; 60(3):425-8.

  INTRODUCTION: Neurofibromatosis type I (Recklinghausen disease) is one of the most common genetic disorders. Symptoms in head and neck region are present in nearly 30% of cases, but the most frequentINTRODUCTION: Neurofibromatosis type I (Recklinghausen disease) is one of the most common genetic disorders. Symptoms in head and neck region are present in nearly 30% of cases, but the most frequent are skin café-au-lait lesions or lesions localized in craniofacial region. Neurinomas of the last four cranial nerves are also described. MATERIAL AND METHODS: We discuss a case of a 50-year woman admitted to our department because of chronic pain symptoms localized in the head and neck region. A rare case of neurinoma of the X and XII nerves in the neck region was stated. This patient was successfully treated surgically with removing tumors, which involved vagal and hypoglossal nerve on the right side. CONCLUSIONS: The causal treatment is until now unknown and patients are carefully observed and scan with MRI. The possible treatment for patients are surgery when the lesion become painful or for cosmetic reasons. Also surgery with radiotherapy is require for tumors with malignant transformation which is possible in 5% of cases. The genetic guidance should be proposed to NF1 patients.

• Stent-graft treatment of extracranial internal carotid artery aneurysm.

  Authors: Robert Juszkat, Maciej Wróbel, Wojciech Golusiński, Witold Szyfter, Paweł Checiński, Grzegorz Oszkinis

  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 11/2005; 262(10):826-9.

  Extracranial internal carotid artery aneurysm is not a frequent finding. Although there are a number of methods used for the treatment of this kind of pathology, every approach should be tailored toExtracranial internal carotid artery aneurysm is not a frequent finding. Although there are a number of methods used for the treatment of this kind of pathology, every approach should be tailored to the patient. The authors describe the case of a patient with a large extracranial internal carotid artery aneurysm presenting as a tumor of the parapharyngeal space, treated with a stent-graft. The patient remains asymptomatic at the 2-year follow-up. To our knowledge, this type of successful treatment of a carotid aneurysm has been reported only once so far.

• [The effect of a comprehensive physiotherapy program on the aerobic endurance level of people after total laryngectomy]

  Authors: Sławomir Marszałek, Andrzej Minczykowski, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 02/2005; 59(1):49-54.

  After total laryngectomy and follow-up treatment (including radiotherapy) there are many functional disorders in the head and neck. This restricts the movement of the chest and shoulders, and alsoAfter total laryngectomy and follow-up treatment (including radiotherapy) there are many functional disorders in the head and neck. This restricts the movement of the chest and shoulders, and also decreases the ventilation of the lungs. Consequently the level of endurance in people following total laryngectomy is significantly lower. Many patients also view cancer as physically disenabling, so they don't want to do as much physical activity as they could. However it could be seen that intensive physiotherapy with aerobic training and physical exercises led to a decrease in the negative effects of oncological treatment. The influence of physical exercise on aerobic efficiency was examined on a mechanical track during the aerobic test according to a modified version of Bruce's protocol. In conclusion when aerobic training and physical exercises are included in the physiotherapy program for laryngectomised patients an increase in their physical endurance is visible.

• [Ki67, p53 and cyclin D1 in the squamous cell carcinoma of head and neck]

  Authors: Wojciech Golusiński, Paweł Golusiński, Jakub Stańczak, Jadwiga Kłosin

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(4):777-84.

  The difficult cancer development and the insufficient knowledge of the biology of the existing cancers lead for the constant search for the new techniques of diagnosis. The aim of this study was toThe difficult cancer development and the insufficient knowledge of the biology of the existing cancers lead for the constant search for the new techniques of diagnosis. The aim of this study was to analyze the selected prognostic factors such as p53, Ki67 and cyclin D1 in patients with head and neck cancer in connection with histological differentiation (G), TNM classification and the clinical advancement of the disease (S). The material comprised of the tissue specimens from 32 patients with squamous cell carcinomas of head and neck, who underwent the primary surgery. The immunohistochemical study was performed with avidin-biothin method. A 5-point grading system was adopted to assess the level of the immunohistochemical staining of the carcinoma cells. Through our study we found a statistically significant correlation between the staining intensity of carcinoma cells for p53, Ki67, cyclin D1 and the TNM classification and the clinical advancement of the disease (S). Such correlation for the histological differentiation (G) has not been observed. We think that the immunohistochemical techniques may constitute an important supplement of evaluation of the malignancy in the squamous cell carcinomas of head and neck.

• [2nd Congress of International Federation of Head and Neck Oncologic Societies. Rio de Janeiro 29.11-2.12 2002, Brazil]

  Authors: Tomasz Kopeć, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(3):701-2.

• [Correlation between ultrastructural changes and the presence of metastases in adenoid cystic carcinoma of salivary glands]

  Authors: Wojciech Golusiński, Anna Wegner, Bronisław Kulczyński, Elzbieta Waśniewska, Donata Jarmołowska-Jurczyszyn, Wiesława Biczysko

  Otolaryngologia polska. The Polish otolaryngology. 02/2003; 57(5):685-90.

  Adenoid-cystic carcinoma is a malignant epithelial neoplasm which has different histological types. Still, an open question is, whether adenoid-cystic carcinoma of the salivary glands with metastasesAdenoid-cystic carcinoma is a malignant epithelial neoplasm which has different histological types. Still, an open question is, whether adenoid-cystic carcinoma of the salivary glands with metastases to lympho nodes and specific micro- and macroscopic features, allows us to define their progression. A group of 46 patients with adenoid-cystic cancer of the salivary glands was studied and was subjected to histological and ultrastructural assessment. In analysed group in 12 patient metastases to lympho nodes were confirmed. In 10 cases it was solid type of tumour and in 2 canaliculars type. In tumours with metastases to lympho nodes solid types prevailed and there was no a typical cribriform type. In all cases they were found fields of mixted texture of the tumours structure.

• [Coexistence of choanal polyp and lymph node tuberculosis]

  Authors: Wojciech Golusiński, Jolanta Kaczmarek, Maciej Wróbel, Joanna Bierła

  Otolaryngologia polska. The Polish otolaryngology. 02/2002; 56(3):365-8.

  The authors present a case of coexistence of choanal polyp and lymph node tuberculosis in patient referred to ENT Clinic of K. Marcinkowski University of Medical Sciences in Poznań with suspicion ofThe authors present a case of coexistence of choanal polyp and lymph node tuberculosis in patient referred to ENT Clinic of K. Marcinkowski University of Medical Sciences in Poznań with suspicion of nasopharyngeal malignant tumor and lymph node metastases. Performed surgery and histopathological evaluation of obtained tissues revealed lymph node tuberculosis and polyp.

• [Nonchromaffinic paraganglioma (chemodectoma) of tympanic cavity]

  Authors: Witold Szyfter, Wojciech Golusiński, Małgorzata Leszczyńska, Marcin Kawczyński, Małgorzata Janicka-Jedyńska

  Otolaryngologia polska. The Polish otolaryngology. 02/2002; 56(4):483-7.

  Nonchromaffinic paraganglioma derives from neuroectoderma. It is characterised by plenty vascularisation. Histopathologically it is a benign tumor, and doesn't give any metastasis. Although becauseNonchromaffinic 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.

• [Prognostic significance of Ki 67 and PCNA expression in laryngeal squamous cell carcinoma (morphometric evaluation of labelling index-L1]

  Authors: Aldona Woźniak, Wojciech Golusiński, Elzbieta Kaczmarek, Janusz Kaczmarek, Jolanta Kaczmarek

  Otolaryngologia polska. The Polish otolaryngology. 01/2002; 56(4):437-43.

  There are no certain histological or morphological criteria which would improve the precision of life expectancy and the selection of the most efficient methods of treatment in patients with squamousThere are no certain histological or morphological criteria which would improve the precision of life expectancy and the selection of the most efficient methods of treatment in patients with squamous cell laryngeal carcinoma. The analysis of proliferation activity using immunohistochemical markers such as antigens Ki 67 and PCNA may be helpful to evaluate the aggressiveness of neoplastic cells. The study was conducted in 55 patients (aged 36-86 years, mean 62 years), 52 men and 3 women. Immunohistochemical staining of antigens Ki 67 and PCNA using avidin-biotin method was performed in all cases. Microscopic images were stored, then nuclei of neoplastic cells expressing immunohistochemical reaction were localized using level segmentation method. Next labelling index was calculated. The correlation was observed between the LI for Ki 67 and tumor size (p < 0.00001), stage (p < 0.001), metastases to lymph nodes (p, 0.00001) and site (p < 0.005). A weak correlation was observed between the LI for Ki 67 and presence of distant metastases (p < 0.06). The LI of neoplastic cells for PCNA was correlated with the tumor size (p < 0.00001), stage (p < 0.0001), metastases to lymph nodes (0.0001), site (p < 0.005) and presence of distant metastases (p < 0.03). On the ground of the obtained results both markers can be suggested for the morphological and biological evaluation of the neoplastic cells in laryngeal squamous cell carcinoma.

• [The application of the manual physiotherapy treatment for patient with after trauma dysphonia].

  Authors: Sławomir Marszałek, Anna Zebryk-Stopa, Waldemar Wojnowski, Bożena Wiskirska-Woźnica, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 65(4):285-8.

  As a result of laryngeal injures an abnormal phonation is frequently observed. It is the consequence of structural and functional changes of the laryngeal tissues directly and indirectly responsibleAs a result of laryngeal injures an abnormal phonation is frequently observed. It is the consequence of structural and functional changes of the laryngeal tissues directly and indirectly responsible for the voice emission. Physiotherapy enables the normalization of the tension and function of the anatomical structures changed after trauma. Presentation of the results of the physiotherapy and voice rehabilitation treatment established for patient with voice disorders, occurred after cranio-cerebral trauma. The 47 year old man two years after cranio-cerebral trauma was presented, which voice was hoarse, produced with a strong neck and shoulder girdle muscle tension. Phonation time was significantly shortened. During the manual examination the abnormal of mobility, range of movement and soft tissue tension in neck, head and upper trunk area has been observed. The systematic rehabilitation program was started 2 years after injury and it was continued for four months. The individual program contains physiotherapy, osteopathic and speech therapy treatment. The phoniatric examination was performed before and after rehabilitation After four months of treatment and after self-therapy exercises the significant changes were observed. Patient's voice became no more strain, but stronger and socially effective. The application of an individual therapy which contained osteopathic manual muscle-fascial techniques allows a subjective and objective improvement of voice in a examined patient. This procedure is an effective complement to logopedic and phoniatric therapy for patients after trauma of the larynx.

• [An influence of some factors on the logopedic rehabilitation of patients after total laryngectomy].

  Authors: Wioletta Sokal, Magdalena Kordylewska, Wojciech Golusiński

  Otolaryngologia polska. The Polish otolaryngology. 65(1):20-5.

  The operation of total laryngectomy deprives patients of the ability of voiced communication, causes isolation and loneliness. The loss of voice and speech leads to a predominant cripplehood,The operation of total laryngectomy deprives patients of the ability of voiced communication, causes isolation and loneliness. The loss of voice and speech leads to a predominant cripplehood, disturbs verbal communication in the social and family circle. The best ways of voiced communication of the patients after laryngectomy are an esophageal speech and the speech using voice prosthesis. The aim of the study is to estimate the voice and speech rehabilitation of the patients after total laryngectomy. The study comprised 30 patients who in the years 2007-2009 underwent an operation of laryngectomy at the Department of the Surgery of the Head and Neck and the Laryngological Oncology in the Greater Poland Cancer Center in Poznań. In this group 9 patients used voiced speech after grafting the voice prosthesis, 15 patients (12 men and 3 women) underwent a classical rehabilitation of the esophageal speech, 6 patients (4 men and 2 women) used an electronic voice prothesis. The most important factors which influenced on mastering an esophageal speech were: pressure inside the esophagus, appearing a reverberation, time of training at home, length of time of logopedic rehabilitation, age and education. Necessary time to master a speech in the group of 9 patients with voice prothesis was 4-5 days. Length of time of the classical speech rehabilitation lasted from 3 to 8 months. 3 persons (20%) mastered a very good degree of esophageal speech, 7 patients a good degree (46.67%) and 2 patients (13.33%) - a sufficient degree of esophageal speech despite of low pressure inside the esophagus and appearing a reverberation quickly. 3 patients (20%) used an oral and guttural pseudo-whisper, a voiced reverberation was not obtained during the whole time of logopedic rehabilitation. The surgical voice rehabilitation, in spite of the possibility of complications, enjoys a great popularity among patients. The classical rehabilitation of the esophageal speech was more difficult for the tasted group of patients but mastering a speech to a very good and good degree lets communicate naturally.