Andrzej Wojdas

Publications of Andrzej Wojdas

• Use of CMC foam sinus dressing in FESS.

  Authors: Kornel Szczygielski, Piotr Rapiejko, Andrzej Wojdas, Dariusz Jurkiewicz

  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. 10/2009;

  Aim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose (CMC) foam dressing in functional endoscopic sinus surgery (FESS) in adult patients. InAim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose (CMC) foam dressing in functional endoscopic sinus surgery (FESS) in adult patients. In the present prospective study, 60 patients with bilateral chronic rhinosinusitis were included. All patients underwent bilateral FESS. Thirty patients had both nasal cavities packed with dissolvable CMC foam (CMCF) and another 30 patients had their nasal cavities packed with routine nasal packing (RNP) in latex glove fingers. The haemostatic effect of the CMCF was assessed during the recovery period, and pain levels were recorded by the patients on a visual analogue scale 24 h after surgery. The prevalence of postoperative middle meatal synechia formation was assessed 1, 2, 4 and 8 weeks after the operation. Four (13.3%) of the patients packed with CMCF had primary postoperative bleeding during the recovery period and required additional dressing. Bleeding appeared in two (6.7%) patients packed with RNP. The mean level of pain was 0.962 (range 0-4) for patients packed with CMCF but was 5.5 (range 3-9) for patients packed with RNP. Four (6.7%) of 26 CMCF patients and 10 (35.7%) of 28 RNP patients developed a synechia in the middle meatus. We found that dissolvable CMC foam dressing is associated with very low levels of localised pain and with low levels of postoperative bleeding and synechia formation.

• [The parotid gland's tumours in material of Otolaryngology Department of the Medical Military Institute between 2004-2008].

  Authors: Andrzej Wojdas, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):73-5.

  The parotid gland is the place where benign and malignant tumours may occur. They mostly grow in larger parotid glands. The aim of this work is to analyze operative treatment of parotid gland tumoursThe parotid gland is the place where benign and malignant tumours may occur. They mostly grow in larger parotid glands. The aim of this work is to analyze operative treatment of parotid gland tumours performed in the years 2004-2008. Between 2004-2008, 128 patients underwent surgical procedure caused by parotid gland tumour, including 72 women (56%) and 56 men (44%) aged between 12-80 (the average age was 49.1); the procedures were performed in the Otolaryngology Department of the Medical Military Institute. The initial diagnosis was based on history and physical examination as well as additional examinations including standard ultrasound examination and BAC. The extent of operative treatment was based on medical examination, results of additional examinations and, finally, in special cases, on intraoperative histopathological examination. Our material includes benign tumours diagnosed in 113 patients (88.3%) and malignant ones in 15 patients (11.7%). The most frequent parotid gland tumour is polymorphic adenoma (50%), the second most frequent one is lympho-adenoma (33.6%). The results of fine-needle aspiration biopsy were confirmed in histopathological examination conducted on 101 patients (79%). It was discovered that parotid gland tumours were predominantly benign tumours. The most frequent type of parotid gland tumour was the polymorphic adenoma. The operative method was selected depending on the clinical picture supplemented by the results of additional examinations: BAC, ultrasound examination, computer tomography, MRI. In the event of suspected malignant parotid gland tumour, it is necessary to conduct intraoperative histopathological examination.

• [Application of lasers in treatment of larynx diseases].

  Authors: Andrzej Wojdas, Jarosław Kosek, Karolina Dzaman, Kornel Szczygielski, Jan Ratajczak, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):76-9.

  In otolaryngology, CO2 laser is the first and most commonly applied device. Such lasers as Ny:YAG generating visible light having wavelength 532 nm referred to as KTP laser due to the Name of theIn otolaryngology, CO2 laser is the first and most commonly applied device. Such lasers as Ny:YAG generating visible light having wavelength 532 nm referred to as KTP laser due to the Name of the crystal where infrared light is converted to visible light. Such wavelenght, having green colour, due to strong absorption in haemoglobin is applied in treatments on tissues having dense blood vessels. The object of the work is to analyze larynx microsurgery laser treatments performer between 1994-2008 in the Otolaryngology Department of the Military Medical Institute CSK MON in Warsaw. The examination covered 445 patients including 142 women (31.9%) and 303 men (68.1%) aged between 12 and 80 (the average age of 48.2 year olds) who Were qualified in 1994-2003 for endoscopic laser surgery of the larynx. The operations field was watched using OPMI-11 operating microscope (Zeiss, Germany) allowing 4-16 times blow-up. Larynx laser microsurgery was performer using white laser beam: CO2 Illumina 40 (Heraeus LaserSonics, Germany) and green laser beam using KTP AURA XP laser (AMS, USA). The total of 445 larynx laser microsurgeries were performer. In recent years our clinic has seen an increase in the number of operations using this technique. The largest group were patients with recognized precancerous conditions (33.0%) and larynx carcinoma (26.4%). The next group in terms of the number of patients were 114 patients (20.6%) with recognized juvenile papilloma. Complications were observed in 180 patients. Table III show the type of recognized complications. The most commonly observed was swelling of the mucous membrane (48.3%), the rarest type was subcutaneous emphysema (3.3%). It was concluded that larynx laser microsurgery is a safe method and a valuable tool in treatment of larynx diseases, especially precancerous conditions and early forms of larynx carcinoma; that complications following procedure are relatively rare, usually mild, not life-threatening, and most often subsiding after a few days.

• [Influence of handicapped of patency nose on quality created of voice].

  Authors: Jan Ratajczak, Piotr Rapiejko, Andrzej Wojdas, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):58-63.

  The aim of researches was estimation of quality of voice after operations correcting of the nasal septum deviation. With researches one embraced 40 men in two groups (group I: 20-30 of years old,The aim of researches was estimation of quality of voice after operations correcting of the nasal septum deviation. With researches one embraced 40 men in two groups (group I: 20-30 of years old, group II--above 50 of year old). Voice one priced before operation of corrective nose and 6 of months after executed intervention. In researches one used with scale GRBAS, with estimation laryngostroboskopy of function of vocal folds, with acoustic analysis created of voice, with measurement of maximum phonation time and with Polish version of VHI. Patency of nose priced patients at subjective help of five--gradual of scale. After 6 months all ill favourably priced effect executed of operation improving patency of nose. In scale GRBAS in group I examined voice one priced as normal at 12 ill (60%), instead in group II only at 3 men (15%). Above--regularity refers also of roughness of voice. In stroboscope research executed before operation at almost all ill one ascertained diminution of amplitude of twitches of folds vocal and mucosal wave. After 6 months after operation in group I both amplitude of twitches of vocal folds as and mucosal wave at mostly examined surrendered of normalization. In group II profitable changes we observed only at several of persons. Maximum phonation time of vowel "a" after operation of nose surrendered to extension in both groups examined, however men of group I reached significantly better results, with average value approaching to norms. In acoustic analysis to distinct improvement, but only in group I examined surrendered parameter NHR. In estimation with test VHI six months after operation sense of disturbances of voice in both groups surrendered to diminution, in proportion to qualities created of voice. Operating--restoration physiological air passage at all ill causes diminution or liquidation earlier stepping out of disturbances of voice. From passed researches results, that improvement of health, manifesting itself voice euphonious is in considerable percentage possible only at young persons. At ill in middle age and older to entire liquidation of disturbances of voice will reach in single chances.

• Taste and smell perception among sewage treatment and landfill workers.

  Authors: Karolina Dzaman, Andrzej Wojdas, Piotr Rapiejko, Dariusz Jurkiewicz

  International journal of occupational medicine and environmental health. 01/2009; 22(3):227-34.

  Objectives: The study investigated the functioning of the taste and smell senses in workers employed at a sewage treatment plant and waste landfill. Materials and Methods: The study population wasObjectives: The study investigated the functioning of the taste and smell senses in workers employed at a sewage treatment plant and waste landfill. Materials and Methods: The study population was divided into three groups: sewage workers (group 1), landfill workers (group 2), and laboratory workers (group 3). Smell sensation was assessed using the Börstein gustometry method and taste sensation the Elsberg-Levy olfactometry method. The examinations were performed before and after working hours. Results: Taste disorders were noted in nearly 20% of subjects in each study group examined before work, and in 50% (group 1), 40% (group 2), 28.4% (group 3) of workers examined after work. As regards the sweet taste, a statistically higher value of the mean taste perception threshold (TPT) could be noted in each group examined before work compared to the control group. This referred also to salty taste in groups 1 and 2 and to bitter taste in groups 1 and 3. In the examinations carried out after work, all average TPTs increased and were statistically significant in relation to the sour and bitter tastes in group 1 and to sour taste in group 2. Smell examinations before and after work showed a statistically higher value of the mean olfactory perception threshold (OPT) for each odour than in the control group. The increase in the mean OPT after work was not statistically significant and did not differ between the groups. Before work, the percentage of workers with smell disorders amounted to 31.5% in the group of sewage workers, 6.3% of laboratory workers and 21.7% of landfill workers. After the working hours, these values increased to 40%, 8% and 38.4%, respectively. Conclusions: The study results indicate a higher risk of smell and taste dysfunctions among workers at a sewage treatment plant and waste landfill. The perception of the sour taste appeared to be most sensitive after short-term exposure but this dysfunction is probably reversible in nature. Other tastes were more sensitive to chronic toxic exposure than the sour taste.

• [Results of rehabilitation of voice and speeches after implantation of valve vocal prosthesis at ill after total removal of larynx]

  Authors: Jan Ratajczak, Andrzej Wojdas, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(6):727-30.

  Ill applying with extensive infiltration of new-growth within of larynx will demand radical therapeutic procedure, which is operation completely removals of organ. Aim of work was estimation of voiceIll applying with extensive infiltration of new-growth within of larynx will demand radical therapeutic procedure, which is operation completely removals of organ. Aim of work was estimation of voice and speeches ill with vocal fistula in comparison with oesophageal voice and speech and with physiological. With research one embraced 81 men in age 42-75 of years. Group I--32 ill with cancer of larynx, to which executed total laryngectomy and placed the voice prosthesis Provox 2. Group II--30 ill after operation total removals of larynx, whiches used oesophageal speech. The control group III--19 persons with physiological voice. Research one began from subjective estimation of replacement voices. Then one executed measurements maximum phonation time of vowel "a". To objective estimation of voice one used polish programme "IRIS". One compared: maximum intensities of voices for colloquial speech, F0, Jitter, Shimmer and NHR. In subjective estimation voice of the patients with voice prostheses was greater freedom of production and voice of the patients with voice prostheses appeared to be more loud in relation to oesophageal voice. Greatest statistical essential differences one obtained between maximum phonation times of vowels "a" where clearly is visible, that values obtained for voices of the patients with voice prostheses are to nearer values for physiological voices. Obtained averages values of acoustic analysis: F0, Jitter, Shimmer and NHR did not show statistical of essential differences between voices supplementary, though parameters of voice of the patients with voice prostheses one was to nearer parameters of physiological voice. Characterization perceptive and acoustic speech of the patients with voice prostheses in comparison with oesophageal speech is to nearer characterization of physiological speech. Lack of satisfactory effects of rehabilitation of oesophageal speech, should be effective secondary implantation vocal prosthesis.

• [Role of psychological factors in pathogenesis of disturbances of voice caused with vocal nodules]

  Authors: Jan Ratajczak, Krzysztof Grzywacz, Andrzej Wojdas, Piotr Rapiejko, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(6):758-63.

  INTRODUCTION: Hoarseness is most frequent complaint notified by ill in phoniatric outpatient clinics. Looking of causes notified of disturbances of voice often we ascertain in larynx existence ofINTRODUCTION: Hoarseness is most frequent complaint notified by ill in phoniatric outpatient clinics. Looking of causes notified of disturbances of voice often we ascertain in larynx existence of vocal nodules. Changes these come into being in consequence of excessive or irregular phonations. Single incident of disturbances of voice caused with oedema changes nascent of in consequence of inappropriate work with voice does not wake of our trouble, instead returns this of type of complaint provoke to other researches coexisting of etiological factors this diseases. AIM: Estimation of influence of individual personality trait of ill on formation of vocal nodules. MATERIAL AND METHODS: One examined 20 patients with vocal nodules classified to treatments operating and 20 without disturbances of voice. All patients were subjected to otolaryngological and stroboscopic examinations. Character created of voice one examined at help of scale GRBAS, instead influence of disturbances of voice on quality of life ill at help of test VHI. Psychological examinations one executed using questionnaire State-Trait-Anxiety-Inventory (STAI), questionnaire NEO-FFI and questionnaire of aggression Buss-Perry. RESULTS: Obtained results showed, that persons with returning vocal nodules, both during of research as in different situations everyday lives characterizes with higher level of fear and have greater inclination to worry oneself. Ill from groups examined in greater degree are extroverts, show greater activity and more are contagious socially in comparison to persons of comparative group. Attitude this in situations extorting rivalry will be able to be ruthless, are well organized guided, scrupulous and consistently endeavour to aim. CONCLUSIONS: Wanting efficiently to treat persons with returning vocal nodules we should subject to ill psychological examination and in once of ascertainment of irregularity to correct it, what at simultaneous correct treatment of organic changes should diminish frequency or to eliminate returns of disease. Skill psychological looks on patient by therapists treating disturbances of voice and speeches in case not large emotional instabilities probably would be able to improve results of treatment ill not only with functional disturbances of voice but also with disturbances of voice caused with organic changes in larynx.

• [The cytokines at maxillary sinuses washings as inflammatory process expression]

  Authors: Andrzej Wojdas, Wanda Stankiewicz, Kornel Szczygielski, Jan Ratajczak, Piotr Rapiejko, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(5):558-60.

  INTRODUCTION: In a pathogenetic chain of chronic sinusitis there is a set of cellular and humoral factors that are accepted as characteristic of a chronic inflammatory process. These include mastINTRODUCTION: In a pathogenetic chain of chronic sinusitis there is a set of cellular and humoral factors that are accepted as characteristic of a chronic inflammatory process. These include mast cells, granulocytes (basophilic and acidophilic), macrophages, lymphocytes, leucotriens (leukotrieny), and some pro-inflammatory cytokines. In the majority of cases these are effector factors that finalise pathogenetic immunological response. By determining concentration of pro-anti-inflammatory and immunoregulatory cytokines present in the place where the disease process is in progress we can distinguish the type of inflammatory condition and thus select the type and duration of treatment. MATERIAL AND METHODS: The subject of the study was a group of 75 patients aged 18-60 with clinically confirmed chronic sinusitis; the diagnosis was made on the basis of history, physical examination as well as otolaryngological and imaging (CT scans) examination. Measurement of cytokines' activity was based on establishing concentration of cytokines in 1 ml (millilitre) of liquid recovered from puncture of maxillary sinus and subjected to centrifugation (lavage of maxillary sinuses) using ELISA (an immuno-enzymatic method) and kits produced by R&D company (Minneapolis, USA.) The following levels were examined: IL-1beta, IL-1ra, IL-4, IL-6, IL-10. RESULTS: Depending on the type of inflammatory process (allergic or bacterial), a difference in the level of IL-1beta/IL-1ra and IL-4 i IL-10 concentration was discovered in patients examined. The static analysis focused on how progression of the disease influenced the results obtained. CONCLUSIONS: Determining the amount of cytokines in maxillary washings allows differentiating chronic sinusitis.

• [Case of paraganglioma of the originally numerous location in the 24 year old male].

  Authors: Dariusz Jurkiewicz, Kazimierz Niemczyk, Andrzej Wojdas, Ireneusz Kantor, Bernard Jaroń, Jarosław Kosek

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(2):212-5.

  Paragangliomas, in other words chemodectomas were bening tumors arising from the paragangliomas cells of the parasympathetic system. There are four kinds of paragangliomas: carotic arteryParagangliomas, in other words chemodectomas were bening tumors arising from the paragangliomas cells of the parasympathetic system. There are four kinds of paragangliomas: carotic artery baroreceptors (glomus caroticum), tympanic cavity (glomus tympanicum), internal jugular vein (glomus jugulare) and placed along vagal nerve (glomus vagale). Overall 5-10% of all paragangliomas are malignant. The bening lorms paragangliomas, of the originally numerous location are rare described. The authors describe the rare case of 24 yrs old male, of the bening form paraganglioma of the originally numerous location - glomus tympanicum on the left site, glomus caroticum on the right site. The patient was successfuly treated surgicaly. The first choice of treatment is surgery. The diagnosis of a suspected paraganglioma can be confirmed with USG, CT, Angio CT, Angiography and MRI. Radiation therapy may be usefull in those cases in which the residual tumor was known to be left.

• [Bacterial flora of the tonsillar surface versus tonsillar core in chronic tonsillitis]

  Authors: Agnieszka Syryło, Andrzej Wojdas, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):598-601.

  The purpose of the work was to present the frequency of isolation of particular bacterial species from smear samples obtained from the surface of the palatal tonsils and from aspirates of tonsillarThe purpose of the work was to present the frequency of isolation of particular bacterial species from smear samples obtained from the surface of the palatal tonsils and from aspirates of tonsillar core. The material involved 100 patients, 49 women and 51 men among them, who were qualified to tonsillectomy based on their history, otolaryngological examination and selected laboratory parameters and in whom bacteriological examination of smears taken from the right and left palatal tonsil were performed. The material obtained from superficial tonsillar smears and from tonsillar core aspirates was subject to bacteriological analysis. Frequency of isolation of particular bacterial species was performed. Higher detectability of beta-haemolytic streptococci was found in tonsillar core aspirates, as compared to superficial smears. Bacteriological analysis of palatal tonsil core aspirate was shown to be a good method of isolation of pathogenic microbial strains.

• [Malignant tumors of the nose and paranasal sinuses in the years 1971-2005 in the material of the Otolaryngology Clinic WIM]

  Authors: Dariusz Jurkiewicz, Andrzej Wojdas, Maciej Hermanowski

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):572-5.

  The aim of this study was retrospective analysis of evidence concerning to malignant tumors of the nasal cavity and the paranasal sinuses diagnosed in Otolaryngology Clinic of the Military InstituteThe aim of this study was retrospective analysis of evidence concerning to malignant tumors of the nasal cavity and the paranasal sinuses diagnosed in Otolaryngology Clinic of the Military Institute of the Health Service 1971-2005. The methods of therapy were also discussed. MATERIAL AND METHODS: Material comprised 113 patients (35 females and 78 males) with diagnosis of malignant tumors of the nose and paranasal sinuses. The clinical aspects, sex, age, TNM classification and therapy methods (surgery, radiotherapy, chemotherapy) were analysed. RESULTS: There were 31% females and 69% males (ratio 1 : 2.23). Each year on average 3.23 cases occurred. The highest morbidity was observed in 1997 and 2001 (6 cases each). In 89 subjects (23 females and 66 males) the neoplasm of epithelial origin were diagnosed. The age range of patients was 14-74 years (mean 68.2 years). The most numerous were groups of 60-69 (50 patients) and 70-79 (44 patients). In 82 cases (over 72%) tumors in advanced stages (T3, T4) were revealed. Two subjects (T1) were opera tem on and others 88 (T2, T3, T4) were treated surgically with subsequent radiotherapy. Three of patients did not agree for therapy. CONCLUSIONS: The most frequent of malignant tumors of the nose and paranasal sinuses was cancer. The clinical symptoms of tumor were disclosed most often in age of 60-80 years. The method of choice in treatment is surgery combined with postoperative radiation.

• [Bacterial flora in paranasal sinuses of the chronic inflammation]

  Authors: Andrzej Wojdas, Janusz Ratajczak, Agnieszka Syryło, Kornel Szczygielski, Jarosław Kosek

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):595-7.

  OBJECTIVE: To investigate the bacteriological profile in patients with chronic rhinosinusitis. MATERIALS AND METHODS: We enrolled to this trial 100 patients (56 females and 44 males) aged from 18 toOBJECTIVE: To investigate the bacteriological profile in patients with chronic rhinosinusitis. MATERIALS AND METHODS: We enrolled to this trial 100 patients (56 females and 44 males) aged from 18 to 62 (mean 41.3), with chronic rhinosinusitis. Control group were 20 patients (9 females and 11 males) aged from 19 to 44 (mean 29.4). RESULTS: In collected material from 87 patients (87%) growth of bacteria on 89 blood agar were received. In two cases mixed flora was observed. In 13 specimens there was no growth of any bacteria. Comparing results of studied cultures: in 78 patients pathological flora were discovered whereas in 8 patients saprophytic bacteria. In the group of pathological flora 71.57% cultured bacteria was aerobe, among it the commonest were: Staphylococcus aureus (13.73%), Streptococcus pneumoniae (10.78%), Haemophilus influenzae (9.8%), Staphylococcus coagulase negative (9.8%). In anaerobe group most frequently bacteria isolated was Prevotelle sp. (6.86%). CONCLUSIONS: In our trial 15 different bacterial types were identified. In 72% cases aerobic bacteria were cultured. The most commonest pathogens were: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus coagulase negative.

• [The existence vomeronasal organ in adult humans]

  Authors: Piotr Rapiejko, Beata Zielnik-Jurkiewicz, Andrzej Wojdas, Jan Ratajczak, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):581-4.

  The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveysThe influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

• [Comparison of dissolvable sinus dressings in functional endoscopic sinus surgery]

  Authors: Kornel Szczygielski, Piotr Rapiejko, Andrzej Wojdas, Marcin Jadczak, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(5):852-6.

  OBJECTIVES: Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aimOBJECTIVES: Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aim of our study was to compare the pain level, adhessions and haemostatic properties of Stammberger sinus dressing (SSD) with Dissolvable Sinu-Knit (DSK) and routine nasal packing in latex gloves finger (RNP) after FESS in adult patients. METHODS: 45 patients with bilateral chronic rhinosinusitis (CRS) (totally 90 sides) were recruited into our trial. All patients underwent bilateral FESS without septoplasty. Following completion of surgery, every single nasal cavity side was packed with one of the studied dressing chosen randomly. In 41 sides nasal cavities were packed with Stammberger Sinus Dressing (SSD) in 26 sides packed with Dissolvable Sinu-Knit and 23 sides were filled with routine nasal packing in latex gloves finger (RNP). Haemostatic effect was assessed during the recovery period, pain level was recorded by the patients on a visual analogue scale 24 hours after surgery. Tendency to postoperative middle meatal synechia formations was assessed during control visits in the 1, 2, 4 and 8 week postoperatively. RESULTS: Three (7.3%) of sides packed with SSD and four (15.3%) packed with DSK had primary postoperative bleeding that required additional packing. Finally 3D patients were packed with RNP. In patients packed with RNP bleeding didn't appear. Mean pain level for SSD was 0.85 (range from 0 to 3) and for DSK 2.1 (range 0 to 5) whereas for RNP was 5.6 (range from 2 to 9). Five (13.1%) of thirty-eight sides with SSD and five (22.7%) of twenty-two sides with DSK had synechia in middle meatus whereas eight (26.6%) of total thirty sides packed with RNP had synechia at any one of the control visits. CONCLUSION: We found that Rapid Rhino Stammberger Sinus Dressing and Dissolvable Sinu-Knit are associated with very low local pain level and with a good effect in postoperative bleeding and synechia formation control.

• [The hearing organ men assessment on basis of judgments of committee recruits in 2001-2003 years]

  Authors: Ireneusz Kantor, Jan Ratajczak, Dariusz Jurkiewicz, Piotr Rapiejko, Andrzej Wojdas

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(5):880-3.

  In spite of a considerable progress in research techniques, assessment of health state of large social groups still poses a problem. The most extensive and complete information can be obtained fromIn spite of a considerable progress in research techniques, assessment of health state of large social groups still poses a problem. The most extensive and complete information can be obtained from examinations of recruits. 1 092 506 recruits were examined by medical boards between 2001 and 2003. There were analyzed health certificates with the clause 21 comprising various disorders of the hearing organ (excluding inflammatory illnesses) and defining the recruits' health categories as "D"--unqualified for military service at peace as well as the category "E"--unqualified for military service at peace and in the case of mobilization or at war referring to the level of hearing. 6836 certificates of laryngological illnesses, 5057 certificates with the clause 21, 2684 certificates of the "D" category and 2088 certificates of the "E" category were issued. The certificates given by recruitment commissions refer to a homogeneous group as regards sex and age. They are issued for a short period of time and based on equal criteria. This also refers to laryngological illnesses including estimation of the hearing organ.

• [Application of microsurgery in diagnosis and treatment of larynx diseases]

  Authors: Andrzej Wojdas, Agnieszka Syryło, Dagmara Kenig, Piotr Rapiejko, Jarosław Kosek, Dariusz Jurkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 06/2006; 20(119):519-22.

  THE AIM OF THE STUDY: was analyzing cases of laryngeal diseases and their location that required treatment by surgical procedure as well as analyzing complications resulting from microsurgery of theTHE AIM OF THE STUDY: was analyzing cases of laryngeal diseases and their location that required treatment by surgical procedure as well as analyzing complications resulting from microsurgery of the larynx and their location during surgical procedures and treatment performed in the Otolaryngology Clinic at Military Institute of the Health Services Central Military Hospital in Warsaw (years 1994-2003). MATERIAL AND METHODS: We analyzed 713 patients, of which 248 were women (34.8%) and 465 were men (65.2%) aged between 12 and 80 (the average age was 49.4 +/- 11.8), who were diagnosed as requiring microsurgery of the larynx using the Kleinsasser's set together with operating microscope and CO2 laser in selected cases. RESULTS: The total of 713 microsurgical operations was performed in the larynx area. The largest group were the patients who were diagnosed as having polyps (33.0%), chronic laryngitis (19.6%) and an established diagnosis of laryngeal carcinoma. Complications were observed in 416 patients (58.3%). CONCLUSIONS: Microsurgery of the larynx was the most often applied form of treatment of vocal fold polyps, chronic laryngitis and laryngeal carcinoma; pathological changes that require microsurgical treatment are mostly located in the epiglottis and the central part of the glottis whilst the major complications resulting from the microsurgery of the larynx are limited to superficial damage of the mucous membrane, mostly on the lips.

• [A case report of fibrous dysplasia in right temporal bone]

  Authors: Ireneusz Kantor, Dagmara Kenig, Dariusz Jurkiewicz, Andrzej Wojdas

  Otolaryngologia polska. The Polish otolaryngology. 02/2006; 60(1):89-91.

  The authors describe the rare case of fibrous dysplasia in temporal bone. Dysplasia fibrosa is a benign osseous condition that may involve one or more bones in the cranial and extracranial skeleton.The authors describe the rare case of fibrous dysplasia in temporal bone. Dysplasia fibrosa is a benign osseous condition that may involve one or more bones in the cranial and extracranial skeleton. Temporal bone involvement occurs in 18 per cent of craniofacial diseases. Clinical, radiographic and histologic examinations are essential to confirm the diagnosis of fibrous dysplasia. Treatment of illness depends on the associated symptoms.

• [Immunoregulatory disorders in chronic sinusitis in patients with atopy]

  Authors: Wanda Stankiewicz, Andrzej Wojdas, Marek P Dabrowski, Dariusz Jurkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):269-72.

  Disorders of immunoregulatory activity of T lymphocytes and excessive immunogenic activity of antigen presenting cells are recognised as an important pathogenic elements in allergic diseases.Disorders of immunoregulatory activity of T lymphocytes and excessive immunogenic activity of antigen presenting cells are recognised as an important pathogenic elements in allergic diseases. Successful prevention of development of these pathomechanisms determines the effectiveness of administered therapy. The aim of presented investigations was to assess the kind and the degree of immune disorders in the group of 40 patients with chronic allergic sinusitis (CAS). The range of evaluated parameters comprised the indices of immune competence of T cells in microcultures of mononuclear cells isolated from the blood (response to mitogens PHA and Con A, saturation of IL-2 receptors, T-cell suppressive activity--SAT index), indices of immunogenic activity of monocytes (LM index correlated with the ratio of concentrations of IL-1 beta/IL-1ra, concentrations of IL-1beta, IL-1ra, IL-4 and IL-6 in the culture supernatants). The results were compared with the similar estimations performed in the group of 20 healthy blood donors. RESULTS: The obtained results demonstrated significant deficiency of T cell immune competence in the group of patients suffering from CAS (hyperreactivity of non-matured T cells to Con A, decreased saturation of IL-2 receptors, deficient T-cell suppressive activity and quantitative deficiency of TCD8 cells). In contrast to that, the immunogenic activity of monocytes was significantly elevated in the group of CAS patients as compared to the control group (significantly higher values of LM index, considerable increased concentrations of IL-1b, IL-4 and IL-6). CONCLUSIONS: The observed immunoregulatory deficiency of T-cell population and increased immunogenic activity of antigen presenting cells (monocytes) in CAS patients seem to suggest that the routine antiinflammatory treatment in these patients should be supplemented with the immunocorrective therapy aimed to restore the deficient thymus-dependent immune competence.

• [Techniques of intranasal drug use]

  Authors: Piotr Rapiejko, Andrzej Wojdas, Jan Ratajczak, Kornel Szczygielski, Dariusz Jurkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):400-2.

  The aim of the study was to assess the incidence of changes in nasal mucosa in patients treated with long term intranasal corticosteroids and to determinate reasonability of intranasal dropsThe aim of the study was to assess the incidence of changes in nasal mucosa in patients treated with long term intranasal corticosteroids and to determinate reasonability of intranasal drops administration in symptomatic treatment of nasal catarrh. The study included the total of 1962 patients. Within this group, 612 patients treated with intranasal corticosteroids underwent full laryngological examination to evaluate the status of nasal mucosa. In the group of 1350 users of web-based Allergologic Courier, who had used intranasal drops because of "runny nose" within last 3 months before the examination, a questionnaire survey was performed. The study results reflect poor knowledge the methods of nasal drops administration among patients, as well as low effectiveness of educational initiatives led by physicians and pharmacists. In 25 persons from 367 examined (6.81%) who used steroid spray locally, and who showed up in laryngological outpatient clinic, nasal mucosal damage was diagnosed for the first time. Mucosal damage was most frequently located in the right nasal septal mucosa--in 21 patients (5.72% of total patients) that was connected with improper nasal inhaler positioning and right hand movements directing it towards septum in the right nasal meatus. Among patients, who have remained under regular laryngological care in outpatient clinic (all of them are instructed of drug administration technique), only 5 persons (2.04%) out from 245 in the study group presented changes in nasal mucosa. No differences between changes occurrence on each side of nasal septum were found. Without proper training, only 8.52% from 1350 examined persons had been taking nasal drops in a proper manner to achieve its effectiveness.

• [Subjective and objective assessment of voice quality after surgical treatment of overgrowth changes in vocal folds]

  Authors: Jan Ratajczak, Andrzej Wojdas, Piotr Rapiejko, Dariusz Jurkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):327-30.

  OBJECTIVES: Complex estimation of results of treatment micro surgically of ill larynx with overgrowth changes of vocal folds and comparison of usefulness different methods of research phonationOBJECTIVES: Complex estimation of results of treatment micro surgically of ill larynx with overgrowth changes of vocal folds and comparison of usefulness different methods of research phonation function of larynx, and also estimation of influence disturbances of voice on functional state, emotional and physical ill applying to Clinics. MATERIAL AND METHOD: With researches embraced group 40 ill with hoarseness, of which reason one was organic changes of vocal folds under form of polyps, of vocal nodes, of cyst and of swellings Reincke, attended operational (microsurgery with method Kleinsasser). Voice priced twice before intervention surgical and 3 months after operation. In researches used with scale GRBAS, with estimation laryngostroboscopy of function of vocal folds, analysis acoustic created of voice and Polish version of Voice Handicap Index (VHI). RESULTS: Values p = 0.001 for "G" and p = 0.002 for "B" testify about special usefulness these two values of scale GRBAS in estimation of efficiency used treatments. Value p = 0.0004 obtained in research VHI proves distinct statistical symptomatic between estimation one's own voice and his of influence on life ill before and after operation and about good result of treatment. Statistical analysis examined of acoustic parameters showed on indeed statistical symptomatic difference only in chance of variable RAP (p = 0.03). Greatly usefulness for estimations used treatments showed stroboscope research, where especially character close of glottis (p = 0.003) and changes of mucosal wave (p = 0.008) show distinct dependence statistical difference before and after operation. CONCLUSIONS: In complex estimation of voice ill after operation overgrowth changes of vocal folds greatest usefulness showed research of laryngostroboscopy, Voice Handicap Index (VHI) and qualification of grade-G and breathiness-B in scale GRBAS. Thanks used to method VHI ill oneself priced efficiency effect treatments, and doctor knowing answers of patient on each questions canned properly to steer further treatment.