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Introduction:Physical activity during cancer treatment may reduce resulting side effects(e.g. fatigue) and improve the quality of patient’s life. It is not known, however, which typevof exercise would be the best or what the optimal duration and intensity of training should be. Neoadjuvant chemotherapy enables to evaluate the intervention effects. Young breast cancer patients are more willing to engage in intensive training than older ones. This randomised pilot study (SPORT NATHY TRIAL) evaluates the feasibility and the safety of high intensity interval physical activity during neoadjuvant chemotherapy administered to young women with breast cancer. Possible impact on treatment efficacy will be also evaluated. Methods:Young breast cancer patients (18-40 years old) were randomized to standard neoadjuvant chemotherapy (usual care - UC) or to neoadjuvant chemotherapy with 6 months of supervised high-intensity interval exercise (SHIIE). SHIIE: 2 times per week circuit on uphill treadmill walking/running, cycle ergometry, elliptical trainer from 5 × 1:15 (1st mth), 5 × 1:30 (2nd mth), 5 × 1:45 (3-4th mth) 5 × 2 min (5-6th mth) with 80%-95% HRpeak with 4 min active rest between sets; 10 min warm-up (50-60 % HRpeak) and 5 min cool-down; total time of to 40 min. Additionally once a week 45 min preferred activity (walk, run, cycling, rollerblading) 60-70 % HRpeak. Each time during training max 5 persons SHIIE groups were supervised by a physiotherapist. UC - 90 min (3 × 30min) walks per week (60% HRpeak) and patient physical therapy rules education.Each participant was monitored at all times by Polar activity monitor to measure: the number of steps, calories burnt, length of sleep, general daily heart rate with special attention placed to monitoring the heart rate during training.A biochemical analysis, bone density, cardiovascular evaluation (Digital ECG and transthoracic echocardiography, treadmill exercise test with RAMP protocol designed individually based on the score during 6 min walk test) were performed on all participants before chemotherapy and upon completion of the treatment.Specialized questionnaires and forms were used to estimate emotional status and sexual functioning.Results:We have already enrolled 22 patients. Median age was 35 in both groups. Number of trainings per week was in UC 2,5 and in SHIIE 3,1. All patients in SHIIE participated in min. 90% of supervised trainings.We were surprised to note that patients from the UC group, following the example of SHIIE group patients, increased their activity significantly. This observation was possible thanks to continuous monitoring of all patients with Polar activity monitors.Conclusions:High intensity interval physical activity may be recommended to young breast cancer patients during neoadjuvant chemotherapy and could be part of a valuable support care strategy. Hospital supervised training encourages other patients to be more physically active as well. Citation Format: Joanna Kufel-Grabowska, Slawomir Marszalek, Maciej Gorecki, Marta Malinowska, Maciej Lesiak, Ewa Straburzynska-Migaj, Wiktoria Suchorska, Janusz Dos, Piotr Nowaczyk, Alicja Nowak, Agnieszka Bartczak-Rutkowska, Magdalena Dudek, Andrzej Marszalek, Maria Litwiniuk. Supervised high intensity interval physical exercise of young women with breast cancer during neoadjuvant chemotherapy has also a positive impact on the control group (SPORT NATHY trial) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-10.

Purpose The aim of the study was to evaluate the impact of inertial training on upper and lower extremity strength in the elderly. The study also assessed the influence of inertial training on their independence, balance, and speed and quality of gait. Methods Twenty physically inactive older residents of a nursing home (6 women and 14 men; age, 76.7 ± 8.77 years) were randomized to a training (T; n = 10) or control group (C; n = 10). The T group performed inertial training twice a week for 6 weeks using a Cyklotren inertial device. Each training session included 12 exercise sets involving the elbow and knee flexor and extensor muscles (3 sets per single muscle group). The training loads were 10 and 20 kg for the upper and lower extremities, respectively. Before and after training, the maximum force of trained muscles was evaluated under training conditions. Functional tests were also completed. Results Participants from the T group had significantly increased (37.1-69.1%) elbow and knee flexor and extensor muscle strength. Improvement in upper and lower limb strength in non-specific conditions was also noted; 23.3% and 40.6%, respectively. Functional abilities improved significantly in the T group (Tinetti balance test: 29%, Tinetti gait tests: 18.6%, and gait speed (8-Foot Up-and-Go): 12.8%), while remaining unchanged in C. Conclusion We strongly recommend a daily routine of inertial training for older adults. Benefits from inertial training can reduce the risk of falls and increase the safety and independence of the elderly.

Introduction Cardiotoxic effect of chemotheraphy represents known and challenging problem, thus search for potentially cardioprotective factors plays a key role in the contemporary cardio-oncology. Physical activity may allievate side effects of chemotheraphy and improve quality of live. Myocardial Work is a novel echocardiographic technique and promising tool for cancer patients assesement. Purpose The aim of this randomised pilot study was to assess left ventricle function using speckle tracking myocardial strain (2D STE) with Myocardial Work (MW) module in young women undergoing neoadjuvant chemotheraphy due to breast cancer and the impact of supervised high-intensity interval physical activity on these echocardiographic parameters. Material and methods We evaluated 24 women aged 27–41 (mean 34±4 yrs) with invasive breast cancer undergoing standard neoadjuvant chemotheraphy and randomized them into two groups: control - (CG, 15 pts) and experimental - with 6 months of supervised high-intensity interval exercise (SHIIEG, 9 pts). Every patient underwent echocardiographic examination 2D STE and MW before chemotheraphy and at 6 months follow-up. The following parameters were evaluated: Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Work Efficiency (GWE), Global Waste Work (GWW). Results Following parameters significantly decreased after chemotherapy: EF (65.4±5.7 vs 60.5±7.0%; p=0.003), GLS (20.4±2.5 vs 18.4±2.0%; p=0.001), GWI (1835.4±206.9 vs 1594.1±228.3 mmHg%; p=0.0004), GCW (2240.5±270.8 vs 1884.9±241.3 mmHg%; p=0.0001), GWE (95.9±1.5 vs 94.9±1.7%; p=0.02). No signifficant changes in GWW (78.6±36.4 vs 80.5±32.2 mmHg%; p=0.7) were found. The comparison of control (CG) and experimental group (SHIIEG) at 6 months follow-up revealed no signifficant differences in the following parameters: GLS (p=0.9), GWI (p=0.3), GCW (p=0.2), GWE (p=0.3) and GWW (p=0.5). However analysis of relative percentage change from baseline in GLS and GWW (Δ%GLS, Δ%GWW) almost reached statistical significance [for CG and SHIIEG respectively: Δ%GLS (−15.6 vs −4.4; p=0.07), Δ%GWW (+39.4 vs −7.3; p=0.06)]. Conclusions Neoadjuvant chemotherapy administered in young women with invasive breast cancer impaires the function of left ventricle after 6 month of theraphy, resulting in decrease of GLS, GWI, GCW and GWE. The supervised high-intensity interval physical activity impacts the relative change of GLS (Δ%GLS) and GWW (Δ%GWW), therefore may have cardioprotective effect on left ventricle function. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Greater Poland Cancer Centre, Poznan, Poland

The beneficial effects of exercise are recognized for preventing physical and cognitive decline during the aging process. However, there is still a gap concerning recommended intensity, volume, frequency and mode of exercise especially for older people. The aim of this study was to investigate an appropriate type of physical activity (PA) model for healthy aging. A commentary of the influence of PA and exercise on healthy aging through an online search of the databases Web of Science, PubMed and Google Scholar. Two living groups can be considered as potential references: modern hunter-gatherer small-scale population and master athletes. Greater physical activity is proposed for healthy aging than that recommended by WHO. Additionally, mindfulness meditation techniques during exercise are recommended especially for persons practicing long-duration exercises. Complex and compound exercise and workouts should include challenging exercises adjusted and balanced to provide clients, especially older people, with noticeable changes and progress.

Introduction: One of the very important indicators used in the treatment of postural defects is the relative symmetry of the lower limbs. The selection of a safe and effective therapeutic tool is not an easy task and is particularly important in children. The authors of the experiment have decided to check the effectiveness of two manual techniques, that minimally interfere with patient's tissues. The objective of this study was to evaluate the influence of selected manual procedures: the Ackerman's second phenomenon and mobilization of the sacroiliac joint to hyperextension (Kowtun's grip) on the relative length of the lower limbs in a school-age children. Materials and methods: 70 children aged 8-12 participated in the study. All of them were diagnosed with postural abnormalities: spine defects in the sagittal plane, three-dimensional asymmetry of the torso, knee and / or foot defects and asymmetry of the length of the lower limbs. Qualification of children for a particular group with a postural defects was based on the concept of Sastre Fernandez. In each patient, the manual procedure in order to compensate the leg length, was applied once. In 28 children the applied procedure was the Ackerman's second phenomenon and in 42 it was the Kowtun's grip. The relative length of t h e l o w e r l i m b s w a s m e a s u r e d immediately before and after the manual procedure. Results: The executed experiment indicates the effectiveness of the Ackerman's second phenomenon in compensating the asymmetry of the length of the lower limbs in children with posture defects. The effect of Kovtun's mobilization is less clear. Conclusions: Manual procedure change the relative length of the lower limbs in children with postural defects. The Ackerman's second phenomenon in an effective and yet gentle and safe manual tool that can be used in children in order to compensate the relative length of the lower limbs. The effect of the Kowtun's treatment requires further research.

Phoniatricians usually have the key role when dealing with a voice disorder, supported by logopedists/speech-language pathologists. Cooperation with other medical or non-medical disciplines may contribute when needed. Fundamentals, general goals and the structure of voice therapy are followed by a survey of specific methods and techniques. No matter what kind of technique is used, treatment strategy is inevitably based on pathophysiological mechanisms of a disorder and the patient’s state as a whole. Voice therapy is a dynamic process and not an application procedure for a stable phonatory pattern or a list of exercises for every patient. This integrative model for treatment of voice disorders includes additional skills and knowledge of mechanisms of applications, stages of behavioural treatment, phases of motor learning, stages of voice therapy and steps of a given technique. Functional disorders of the singing voice (dysodia) require additional and specific expertise, especially in emergency situations in the frame of cancellation policy regarding the opera and theatre business. Drug treatment and physiotherapy/osteopathy as more therapeutic approaches to voice disorders are presented, as well as phonosurgical procedures, i.e. functional surgical interventions aiming exclusively, or in part, at improvement, restoration or preservation of vocal function. Methods comprise of phonomicrosurgery (endoscopic microsurgery), laryngeal injection and laryngeal framework surgery that modify the cartilaginous framework of the larynx (laryngoplastic phonosurgery, open-neck surgery). Pacing and reinnervation are also discussed as alternatives in bilateral vocal fold palsies, and vocal rehabilitation after head and neck surgery, including the use of personalised computer speech synthesis for laryngectomised patients, is considered. Indications for tracheostomy and tracheostoma care refer to clinical practice. The prognosis of voice rehabilitation depends on the various factors that are included in voice production and should be considered accordingly.

AIM: The purpose of the study was to publish our experience of salivary gland cancer treatment with large number of patients treated at a single institution. BACKGROUND: Salivary gland cancers are rare tumors of the head and neck representing about 5% of cancers in that region and about 0.5% of all malignancies. Due to the rarity of the disease, most of the studies regarding treatment outcome consist of low number of patients, thus making it difficult to draw conclusions. MATERIAL AND METHODS: 115 patients with primary salivary gland cancer were included in a retrospective study. The subsites of tumor were the parotid gland (58% patients), submandibular gland (19%) and minor salivary glands (23%). All patients underwent primary surgical resection. The following were collected: age, stage of the disease, T status, N status, grade of tumor, perineurial invasion, lymphovascular invasion, extracapsular spread, final histological margin status and postoperative treatment. Details of local, regional or distant recurrence, disease free survival and overall survival were included. RESULTS: The majority (65%) of patients presented in early stage, T1 and T2 tumors. 81% of patients were N0. Free surgical margins were achieved in 18% of patients, close in 28% patients and positive surgical margins in 54% (62) patients. Factors that significantly increased the risk of recurrence: T stage (p = 0.0006); N-positive status (p

Introduction Skin cancer is the most commonly diagnosed cancer type worldwide, and 80 % of skin cancers are basal cell carcinoma (BCC). The main risk factor for developing BCC is exposure to ultraviolet radiation (UVR), particularly high-dose exposure at a young age. Outdoor workers, particularly farmers, are at high risk of developing BCC. However, studies of BCC in this population are scant. Objective To comprehensively evaluate all cases of BCC of the head and neck region treated during the years 2007–2013 at our hospital in Poland, and to compare the tumour characteristics in farmers to non-farmers. Materials and methods Retrospective analysis of 312 patients treated for head and neck BCC during the study period (2007–2013). Results Most patients (198 cases; 63 %) were males, with 114 females (37 %). Median age was 73 years (range 32–96 years). The most common tumour location was the nose and cheek (114 pts; 37 %) followed by the auricle (82 pts; 26 %), lips (54 pts; 18 %), scalp (26 pts; 8 %), and eye (36 pts; 12 %). The most common disease stage on presentation was stage T2 (104 pts, 33 %), followed by stage T1 (79 pts; 25 %), stage T3 (89 pts; 28 %), and stage T4 (40 pts; 14 %). By occupation, farmers accounted for 33 % of all patients (102 of 312 pts). The most common tumour localisations in the farmer subgroup were the nose and cheek (50 pts; 49 %; p

Changes in body posture, musculoskeletal disorders and somatic dysfunctions are frequently observed during pregnancy especially ligament, joint and myofascial impairment. The aim of the paper is to present the use of osteopathic manipulative treatment (OMT) for back and pelvic pain in pregnancy on the basis of a review of the available literature. MEDLINE and Cochrane Library were searched in January 2014 for relevant reports, randomized controlled trials, clinical and case studies of OMT use in pregnant women. Each eligible source was verified and analyzed by two independent reviewers. OMT procedures appear to be effective and safe for pelvic and spinal pain management in the lumbosacral area in pregnant women.

Summary 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 responsible for the voice emission. Physiotherapy enables the normalization of the tension and function of the anatomical structures changed after trauma. The aim of the study Presentation of the results of the physiotherapy and voice rehabilitation treatment established for patient with voice disorders, occurred after cranio-cerebral trauma. Material and Methods 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 Results 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. Conclusions 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.

Summary 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 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.

Summary 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, 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.

Introduction: Basal cell carcinoma (BCC) is the most common type of non-melanoma malignant skin tumors. Eighty-five percent of all cases are located on the skin of the head and neck. The risk of recurrence after surgery is estimated at 5-15%. Aim: To evaluate the selected risk factors for recurrence after surgical treatment of head and neck BCC at the Depart- ment of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences. Material and methods: A retrospective analysis was made of patients treated at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences in 2007-2012 for BCC of the head and neck region. The study covered 312 patients: 198 males (63%) and 114 females (37%), aged 32-96 years. Results: In the study group of 312 tumors, recurrence after initial treatment in this Centre was diagnosed in 18 patients (9%), whereas in patients who were previously operated elsewhere, recurrence was found in 22 cases (17%). The nodular type was the most common BCC type in the study group and concerned 175 patients (56%). The most numerous group (114; 37%) in this study group comprised patients with external nose and cheek tumors. Conclusions: The importance of preoperative biopsy to assess the histological type as a routine treatment of pa- tients with BCC is essential. Ultrasound evaluation to assess the exact size and depth of tumor invasion should also be implemented.

Occupational voice disorders are accompanied by increased tension of the external laryngeal muscle which changes the position of the larynx and consequently disturbs the conditions of functioning of the vocal tract. The aim of the study is to assess the use of osteopathic procedures in the diagnosis and treatment of occupational dysphonia.Study subjects included 40 teachers with chronic diseases of the voice organ (38 women and 2 men) aged from 39 to 59 (mean age: 48.25). Before and after the voice therapy the osteopathic examination according to Libermann's protocol was performed as well as phoniatric examination including laryngovideostroboscopy (LVSS), assessment of the maximum phonation time (MPT) and the Voice Handicap Index (VHI) score. The voice therapy, scheduled and supervised by a laryngologist-phoniatrician and conducted by a speech-language pathologist, was supplemented with osteopathic myofascial rehabilitation of the larynx. The chi-square McNemar test and non-parametric Wilcoxon matched pairs test were applied in the statistical assessment.The applied interdisciplinary treatment including osteopathic and vocal therapy resulted in a statistically significant decrease in tenderness of muscles raising the larynx (cricothyroid ligament, sternocleidomastoid muscles, and pharyngeal constrictor muscles) and in lowering the tonus (geniohyoid muscles, pharyngeal constrictor muscles and sternocleidomastoid muscles). A significant improvement was also observed in the case of dysfunction of the cricothyroid joint examined during glissando and yawning, as well as in asymmetry of the thyrohyoid apparatus. Moreover, the therapy resulted in significantly better normalization of the head position and better control of the centre of gravity of the body. Statistically significant post-therapy improvement was observed in the phoniatric examination, including VHI scores, MPT results and parameters of videostroboscopic examination.The use of osteopathic therapy helps significantly improve the functions of the vocal tract in patients with occupational dysphonia.

Treatment in a health spa with proper infrastructure and professional medical care can provide optimal conditions for intensive voice rehabilitation, especially for people with occupational voice disorders. The most numerous group of people with voice disorders are teachers. In Poland, they have an opportunity to take care of, or regain, their health during a one-year paid leave. The authors describe a multi-specialist model of extensive treatment of voice disorders in a health spa, including holistic and interdisciplinary procedures in occupational dysphonia. Apart from balneotherapy, the spa treatment includes vocal training exercises, relaxation exercises, elements of physiotherapy with the larynx manual therapy and psychological workshops. The voice rehabilitation organized already for two groups of teachers has been received with great satisfaction by this occupational group. The implementation of a model program of extensive treatment of voice disorders in a health spa should become one of the steps aimed at preventing occupational voice diseases.

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 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 rehabilitationAfter 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.

The article presents the role of a physiotherapist and an ostheopath in the multidimensional management of occupational voice disorders. The influence ofbiomechanical characteristics of the musculo-fascial system on vocal apparatus is described. The visual and palpating methods used in physiotherapeutic/ostheopatic diagnostics, including the assessment of joint mobility and ergonomics in dynamic and static situations are also outlined.

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, forming the "mouth of oesophagus", which hinders learning oesophagus speech.The assessment of manual myofascial release techniques influence on the patients' oesophagus pressure after total laryngectomy.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.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.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.The application of myofascial manual techniques decreased an oesophagus pressure which allows patients to obtain faster oesophagus speech.

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 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.

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 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.

After total laryngectomy and after complete treatment (radiotherapy) there are many functional disorders in the range of head and neck. These decrease muscle strength and flexibility of muscles of cervical spine. This causes disorders of physiological range of motions of this area. The introduction of the stretching techniques (postisometric relaxation) to the physiotherapy program allows to decrease negative effects of treatment, mentioned above. The therapy of main cervical muscles was carried out during a two week rehabilitation camp. Biomechanical-kinesiological tests were used to assess the effect of the physiotherapy program. The application of postisometrical relaxation and the massage of the cervical and arm muscles increased the average motor ranges and muscle strength. Cervical muscles disbalance was decreased at the same time.

After total laryngectomy and after complementary treatment (radiotherapy) there are many functional disorders in the range of head and neck. It was observed, that muscles of this area became weakened with simultaneous increase of their rest tension. These changes affect reduction of physiological motor range of the cervical spine. Comparison of function of cervical muscle between patients after total laryngectomy and healthy people allows to characterize defects of neck movements. Detailed estimation of muscle strength and move range in cervical spine after total laryngectomy will enable application of effective physiotherapy program.

Cel pracy W pracy przedstawiono nowy program rehabilitacji ruchowej dla chorych po calkowitym usunieciu krtani, ktory byl realizowany podczas dwutygodniowego turnusu rehabilitacyjnego. Opieral sie on na stosowaniu indywidualnych zabiegow rehabilitacyjnych, podczas ktorych stosowano metody zmniejszające nadmierne napiecie spoczynkowe mieśni okolicy szyi i barkow (poizometryczna relaksacja i masaz okolicy karku). W programie rehabilitacji stosowano takze cwiczenia oddechowe oraz trening ksztaltujący wydolnośc fizyczną. Material i metodyka Badaniami objeto 35 chorych po calkowitej laryngektomii, leczonych operacyjnie z powodu raka krtani. Za pomocą testow biomechanicznokinezjologicznych oceniano wplyw określonych technik manualnych oraz zestawu cwiczen usprawniających na zmiane sil mieśniowych i zakresy ruchow w odcinku szyjnym kregoslupa. Wyniki W wyniku prowadzenia kompleksowej rehabilitacji ruchowej, u chorych wykazano znaczną poprawe funkcji mieśni odcinka szyjnego kregoslupa. Po zastosowaniu poizometrycznej relaksacji oraz masazu mieśni okolicy karku i obreczy barkowej, u chorych zwiekszyly sie średnie wartości badanych sil mieśniowych oraz zakresow ruchow. Wzrosty analizowanych parametrow biomechanicznych odnotowano przede wszystkim w tych badanych grupach mieśniowych, ktore zostaly uszkodzone podczas operacji usuniecia krtani oraz podczas leczenia uzupelniającego (moment sily mieśni wykonujących sklon w przod i zakres ruchu w sklonie w tyl). Prowadzenie powyzszych zabiegow rehabilitacyjnych pozwala na szybsze opanowanie i doskonalenie mowy przelykowej oraz na poprawienie jakości zycia chorych po calkowitym usunieciu krtani.

Cutaneous squamous cell carcinoma (cSCC) accounts for 20 % of all skin malignancies and 20 % of deaths. In contrast to mucosal SCC, treatment results are very good. However, regional metastases are present in 5–20 % of cases, and the prognosis for patients with metastases is 50 % lower. It has been reported that several risk factors are responsible for the head and neck lymph node regional metastasis, such as: poor cell differentiation, local recurrence, immunosuppression, and tumour dimension. Multivariate analysis of metastatic neck lesions in head and neck cSCC. Retrospective analysis of patients treated at our department for head and neck cSCC. The study includes 100 patients: 66 males (66 %) and 34 females (34 %), aged 26–98 years (mean age 74.6). The tumour was evaluated for: sex predilection, local recurrence, stage (according to 7th edition of American Joint Committee on Cancer TNM staging), differentiation, and site. Most patients (79 cases; 79 %) were treated for primary cSCC, while the other 21 patients presented local recurrence of cSCC. Neck metastases were diagnosed in five patients with primary cSCC and in three with recurrent cSCC. No distant metastasis was observed. The most common tumour location was the auricle (29 cases; 29 %). Neck dissection was performed most frequently in patients with lip tumours (17/22 cases; 77 %). Neck metastasis was diagnosed most often in patients with cSCC on the lip (2 patients) and buccal region (2 patients). The most common tumour location in males was the auricle (25/66 cases; 38 %) whereas in females the nasal and buccal regions were the most common locations, with 8 patients each (8/34 cases; 23 %). Neck dissection was performed in 20 of the 66 males (30 %) and in 12 of the 34 females (35 %). Neck metastasis was confirmed in 5 females (15 %) and 3 males (5 %). The most common histopathological tumour stage was G2 (57 cases; 57 %). Of the eight patients with confirmed neck metastasis, four had poorly-differentiated (histopathological stage G3). Thus, 4 of the 24 patients (17 %) with stage G3 tumours experienced metastasis. Our findings suggest that factors such as local recurrence, degree of cell differentiation, tumour dimension and/or location, can increase the risk of neck metastases. For this reason, in patients with such risk factors, neck dissection should be considered to evaluate for metastatic lesions.