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Introduction: Spontaneous meningocele or meningoencephalocele of the temporal bone are very rare. Mostly they are result from otologic surgery or head trauma. Spontaneous meningoencephalocele may occur mostly in the epitympanum or mastoid antrum. It could be a result of pathologic obesity. Often it could be misdiagnosed because of less symptomatic. The most expected symptoms could be: unilateral conductive hearing loss with meddle ear effusion, pulsatile tinnitus or CSF leak., Material and Methods: We present a case of 61 year old, obese woman with spontaneous meningoencephalocele of the left temporal bone. The patient presented symptoms of conductive hearing loss with fullness in the left ear and pulsatile tinnitus. The imagine study such as CT scan and MRI showed a dehiscent areas in the tegmen at the right side and meningoencephalocele protruding into the left mastoid cavity on the left side., Results: After complete diagnosis we preformed surgery. A mastoidectomy of the left temporal bone was done and the meningoencephalocele tissue was encountered. The bony defect and CSF leak was closure. The patient was released from pulsatile tinnitus and fullness in the ear, but a component of hearing dysfunction is still present., Conclusions: Spontaneous meningoencephalocele of the temporal bone may occur in an obese patient. The most finding will be a middle ear effusion and conductive hearing loss with pulsatile tinnitus. The combination of CT and MRI will help in proper preoperative diagnosis. The operation include transmastoid, middle cranial fossa repair or combination of both. The multi layer closure of bony defect is very important to avid CSF leak.

Introduction: Multiple primary tumours of the parotid glands are very rare. They may occur unilaterally or bilaterally, synchronously or metachronously. Whartin's tumour is mostly find in bilateral parotid gland tumours., Material and Methods: The authors present an unusual case of 60 years old man with bilateral, multifocal Whartin's tumour of the parotid glands. The tumours have appeared synchronously two years before the diagnosis was done. We performed bilateral superficial partial parotidectomy with removal of the tumours., Results and Conclusion: The multifocal, synchronous bilateral Whartin's tumours of the parotid glands are very rare. Minimal surgery procedures with tumour excision is the method of choice. The recurrence rate is very low.

The authors present a very rare case observed in a 32 year old female with a huge tumor on the left side of the neck in which extensive changes characteristic for cystic lymphangioma in the lower part and for lymphangiomyomatosis in the upper part of the tumor were observed intraoperatively. On the basis of the discussed case the suggestion is put forward that these two rarely occurring diseases may have similar etiological grounds.

The nasocardiac reflex is a little known reaction of nasomucosal origin. The nasocardiac reflex itself may lead to severe bradycardia or can even procure a very dramatic cardiac arrest following irritation or stimulation of the nerves in the nasal cavities or paranasal sinuses. To clarify the rules and mechanisms of the stimulation of the nasal mucosa influencing heart function, 80 healthy volunteers underwent the experiment. After stimulation of the nasal mucosa on the media turbinates by means of 25% ammonia, almost all individuals revealed a significant decrease in the heart rate. In 11 volunteers, disturbances in heart rhythm occurred after a short period of apnoea. Investigations were performed also in 54 persons before and after local anesthesia of the nasal mucosa by means of 2% lignocaine. In 80% of investigated the local anesthesia did not influence the nasocardiac reflex. Analyzing the influence of the preoperative premedication in 26 patients, it was observed, that the reflective reaction after premedication was more expressed than before. Because laryngectomy changes the conditions and physiology of the nose as the first part of the respiratory tract, the nasocardiac reflex in 38 laryngectomized patients was also analyzed. Tests were carried out preoperatively and postoperatively several days, months and years after surgery. Respiratory and heart function were registered synchronically, a flowmeter before operation was placed in one nostril and postoperatively in the tracheostomy tube. May be that such speedy heart reaction on nasal mucosa stimulation is connected with the participation of vagal nerve branches in the spheno-palatine ganglion.

The authors conducted examination of blood flow velocity in medial cerebral artery using Trans Cranial Doppler method and calculated pulsatility index (PI) in 35 patients after neck dissection operation. Similarly 35 patients after neck dissection had duplex Doppler examination of common and internal carotid arteries performed. Pulsatility and resistance indexes and blood flow capacity were estimated. We compared the results with the control group consisted of 15 patients operated on because of chronic otitis. We confirmed a neck dissection operation influence into cranial and cervical blood flow disturbances as well as relationship between postoperative soft tissue oedema and hemodynamical changes. We didn't found connections between cervical and cerebral blood flow and postoperative complications.

Benign cartilaginous tumours of the larynx and trachea are rare. The most common is chondroma, and only 6 cases of osteochondroma of the larynx have been reported in the world literature. We present a case of 74 year's old woman with osteochondroma of the right arytenoid cartilage. This is followed by a review of the literature, diagnostic evaluation and surgical management.

Protein p53 was localized ultrastructurally with 5 nm gold-streptavidin particles in cells of laryngeal carcinoma embedded in Epon 815. Postembedding technique to study p53 protein was used. Protein p53 was found predominantly in nucleus of the cells but the label was also observed in cytoplasm of the cells. Five of 15 samples from patients with laryngeal carcinoma showed positive labeling for p53, (33.3% of all examined samples). Controls of tumor cells incubation with normal mouse serum showed no labeling with gold streptavidin particles.

To evaluate the influence of radical or functional neck dissection on cerebral hemodynamics, pre- and postoperatively TCD sonographic examinations were performed in a group of patients following unilateral radical or bilateral radical/functional neck dissection. Cerebral blood flow velocities (cm/s) and pulsatility index (PI) were studied preoperatively and postoperatively 4, 24 and 48 hours after the operation, using a 2 MHz-pulsed transcranial ultrasonographical system (TCD) with a transtemporal approach to the middle cerebral artery. To exclude the influence of general anaesthesia on cerebral circulation TDC was also performed in a group of patients, following operations under general anaesthesia but not radical nor functional neck dissection. The results of both groups were compared with the data obtained in a control group of healthy persons the same age. The reductions in blood flow velocities and concomitant increases in PI observed during the first postoperative insonation in patients after radical/functional neck dissection reflect a heightened resistance to flow in the arterial cerebral vasculature.

The authors performed epidemiological analysis of malignant neoplasms of the nose, paranasal sinuses, throat, tongue, larynx and salivary glands in Bydgoszcz area. All the patients were treated in the Otolaryngological Clinic of Medical Academy in Bydgoszcz. Patient's sex, age, profession, living and environmental conditions as well as histopathological diagnosis were taken into analysis. The data were referred to various regions of Bydgoszcz province, which were elucidated on the basis of microclimate conditions, industry, soil conditions, density of the forest area, and cultivated agriculture plants. Correlations between occurrence of oral cavity and the upper respiratory tract malignant neoplasms and living conditions as well as kind of profession in different parts of Bydgoszcz province were estimated.

Some data in the literature indicate on the influence of different kind of surgery on the fibrinolytic process. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1)--play important role in regulation of fibrinolysis. The aim of our work was to evaluate the influence of laryngectomy on fibrinolytic potential in the blood of operated patients with larynx carcinoma. Study group consisted of 20 men aged 42-75 years old with larynx carcinoma subjected to total laryngectomy. In the blood of patients we measured the concentration of t-PA:Ag, fibrinogen and FDP levels, PAI-1 activity, and ELT. The increase of t-PA and FDP concentrations, decrease of PAI-1 activity and fibrinogen level with simultaneous ELT shortening indicate on the fibrinolysis activation during the laryngectomy.

Plasminogen activators and inhibitors regulate a variety of physiological and pathological processes involved in tissue morphogenesis, cell differentiation, migration, cancer cell invasion and metastasis. Several reports have shown the decrease of fibrinolytic activity in the blood of cancer patients. In this study we measured the concentrations of tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA), activity of plasminogen activator inhibitor type 1 (PAI-1) and euglobulin lysis time (ELT) in the blood of 20 men aged 42-75 years old with planoepitheliale larynx carcinoma, and 10 healthy persons in similar age. In this study the mean values of t-PA, u-PA concentrations, PAI-1 activity and ELT in the blood of patients with larynx carcinoma were similar to the examination results of healthy persons, but 40% of our cancer patients have increased activity of PAI-1.

A very rare of the osteosarcoma osteolythicum teleangiectaticum of the paranasal sinuses, treated surgically, is reported. The infiltration and destruction of the sphenoid bone caused a haemorrhage from the cavernous sinus. The difficulties in the preoperative evaluation of the extent of the osteosarcoma in the craniofacial bone structures are discussed.

The authors present the surgical technique of stellate ganglion excision as a therapeutic method in patients with the long QT syndrome. The operations were performed through an anterior supraclavicular approach. Discussing the anatomic considerations, the possibilities of complications and side effects, both temporary and permanent, including Horner's syndrome are reviewed. On the base of the review of present literature and the postoperative results in patients treated in the Otolaryngological Department of the Medical Academy in Bydgoszcz, the authors confirm that the results of stellate ganglion excision in patients with the long QT syndrome are encouraging, but the possibilities of complications, including sudden death after stellectomy, must be taken into consideration.