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Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by high heterogeneity of clinical manifestations and an uncertain prognosis. Although the mortality rate due to SLE has decreased significantly in recent decades, there is still a need to find good tools to measure disease activity for early detection of exacerbations and treatment planning. Over the decades, more than a dozen disease activity scales/indicators have been developed, with the SLE Disease Activity Index (SLEDAI) being the most popular. More recently, the new SLE Disease Activity Score (SLE-DAS) has been introduced. This paper compares the two methods of assessing SLE activity, and presents the relevance of these scales in pregnant SLE patients and their use in formulating definitions of remission and low disease activity. The results show that the SLEDAI and the SLE-DAS are of comparable value in assessing SLE activity and complement each other., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie.)

Unlabelled: High pressure of pharyngo-esophageal segment is the most important factor of impaired development of alaryngeal speech (esophageal speech, tracheoesophageal speech) after total laryngectomy. To prevent pharyngo-esophageal spasm in Department of Otolaryngology in Szczecin are used: pharyngoesophageal plastic surgery with interposition of vascular thyroid flap, two-layer (only mucosa) non-muscular pharyngeal closure and tree-layer closure (mucosa and muscle layer leaving inferior pharyngeal constrictor unsutured)., Aim of Study: The aim of this study was to compare the pharyngo-esophageal pressure between patients after pharyngo-esophageal plastic surgery and following the non-muscular pharyngeal closure., Material and Methods: One hundred eighty two subjects after total laryngectomy were enrolled in this study, and included 108 patients subjected to the pharyngo-esophageal plastic surgery, 44 patients who underwent the two-layer pharyngeal closure, and 30 patients with the tree-layer closure. To evaluate the pharyngo-esophageal pressures manometric tests were performed, and to asses the pharynx morphology videopharyngoscopy was used., Results: The average pharyngo-esophageal pressure in the group after the pharyngo-esophageal plastic surgery was 32 (min.-5, max. 50) mmHg. After the two-layer non-muscular pharyngeal closure mean pressure was 35 (min.-17, max.-40) mmHg, and after the tree-layer non-muscular pharyngeal closure the average pressure was 22,42 (min. 5, max. 40) mmHg. The average pharyngo-esophageal pressure was significantly lower (p < 0.01) among patients after the tree-layer non-muscular closure., Conclusion: The study suggests that the tree-layer non-muscular pharyngeal closure with inferior pharyngeal constrictor unsutured is the preferable method to prevent pharyngo-esophageal spasm after total laryngectomy. However, the efficacy and safety of this surgical procedure should be explored in further multicenter studies.

The review of the literature and some media data referring to chosen methods of unconventional treatment, its history of the development in Poland and around the world has been made in this paper (homeopathy, waxing of ears, bio-energy therapy) and the increasing interest among the treated patients has been shown. It is essential that the doctors (including laryngologists) while carrying out the interview should take the unconventional way of treatment of patients into consideration. This may explain the registering of patients to appropriate treatment in the advanced state of illness, which is particularly unprofitable in cancer-afflicted states.

In the thesis are presented surgical methods of treating larynx and hypopharynx cancer used in the Szczecin Clinic throughout more than 30 years, i.e. between 1970 and 2002. During this period in the Szczecin center 2591 patients ill of larynx cancer underwent surgical treatments. In the analysed period was recorder an increase in: a) the number of patients suffering from larynx and hypopharynx cancer, b) patients' average age, c) percentage of larynx cancer sick rate in females in relation to males and d) the number of patients with advanced stage of disease. Predominant with the patients were supraglottic cancers, however in the recent years there was an increase in the number of glottic cancer patients. In the years 1970-1980 prevailed partial laryngectomies and total laryngectomies were performed sporadically. In the next decade, what became noticeable was a drop in operations with creation of autoplastic vocal shunt and a growth in the number of partial operations with the preservation of respiratory way. In the last decade there was also an increase in the number of operations of total laryngectomies and a decrease in the number of partial operations, whereas the number of performed subtotal operations with the reconstruction of phonatory functions remained at the same level. Oncological and functional results assessed both subjectively and objectively after all kinds of laryngectomies were satisfactory. In the thesis attention was also paid to surgical methods elaborated in the Clinic, which substantially contributed to the progress in surgical treatment of larynx cancer as well as to improvements in revalidation of the phonatory function and its quality with patients after total, subtotal and partial removal of larynx structures.

The results of the surgical treatment of the larynx cancer (glottic-supraglottic) by supracricoid laryngectomy with CHP and CHEP type of reconstruction were presented. Material consists of 160 cases (88 after CHP and 72 after CHEP). 5 years survival rate was obtained in over 71% of cases in all material. Decannulation was possible in 126 (79%) patients. Feeding tube removal before 4 weeks after operation was done in 139 (87%) cases. In subjective assessment all patients had social efficient speech. Favourable results of the treatment encourage wider application of supracricoid laryngectomy.

On the base of 755 cases of glottic cancer, the occurrence and prognostic importance of lymph node metastases were analysed. Metastases of the vocal cord cancer to cervical lymph nodes are rare. In our material amounted 9.13%. Number of metastatic lymph nodes and N factor influenced the lymph node recurrency. It is not, however, dependence statistically. Surgical treatment of the glottic cancer with various degree of advancement secures good oncological results. In our material 3 and 5 years survival rate accounted to 71.33% and 59.31%. The clinical advancement of the glottic neoplasm does not influence in statistically essential way the increase of metastases to regional lymph nodes.

On the base of 1901 cases of larynx and hypopharynx carcinoma treated in ENT Department in Szczecin occurrence of occult nodal metastases was analysed. The frequency of such cases was 21%. Clinical statement and localisation of the tumour was the major factors predicted to occurrence of occult metastases. It was statistically pointed out that nodal recurrences occurred mainly among the patients with occult metastases. Survival rate was significantly better in group with no occult metastases (64.9%--3 year and 50.4--5 year) than in group with occult metastases (37.5%--3 year and 27.9%--5 year).

Eighty-nine patients with hypopharynx carcinoma treated from 1970 to 1997 at the ENT Clinic of Pomeranian Medical Academy were studied retrospectively. There were only IV a stage patients. The treatment consisted of surgery alone (n = 21), radiotherapy and post-radiotherapy surgery (n = 7), a planned combination of surgery and post-operative radiotherapy (n = 61). The 3-year survival was 34.88%, whereas the 5-year disease-free survival was 25.04%. Radiotherapy applied to operative treatment failed to exert any meaningful positive influence on the overall percentage of survivals. 17 patients had local recurrences and 6 node recurrences. Mainly following factors exerted the influence on appearance of nodal recurrence: component N and the number of metastatic nodes. It was pointed out that the results of treatment of hypopharynx carcinoma are still poor and unchanged despite of developing our skills and using new technology of treatment.

Eighty nine patients with hypopharynx carcinoma treated from 1970 to 1997 at the ENT Clinic of Pomeranian Medical Academy were studied retrospectively. There were only IV stage patients. The treatment consisted of surgery alone (n = 21), radiotherapy and post-radiotherapy surgery (n = 7), a planned combination of surgery and post-operative radiotherapy (n = 61). The 3-year survival was 34.88%, whereas the 5-year disease-free survival was 25.04%. The 5-year survival was related to the preoperative nodal staging (N0--52.8%; N1--17.8%; N2--28.3% and N3--0%), the number of lymph nodes metastases (no metastases 45.1%, 1--28.2%, 2-4--23.9%, > 4--0%), and the size of nodes (0 cm--31.6%, 1-3 cm--21.9%, > 3 cm--30.7%). Radiotherapy applied to operative treatment failed to exert any meaningful positive influence on the overall percentage of survivals. 17 patients had local recurrences and 6 node recurrences. Mainly following factors exerted the influence on appearance of nodal recurrence: component N and the number of metastatic nodes. It was pointed out that the result of treatment of hypopharynx carcinoma are still poor and unchanged despite of developing our skills and using new technology of treatment.

The paper presents a 26-year experience of the ENT Clinic of the Pomeranian Medical Academy in Szczecin with 20 patients who underwent reconstruction of the hypopharynx after resection for locally advanced carcinoma. The procedures were carried out in years 1970-1995. The reconstructions included 7 musculomucosal pedicle flaps obtained from the base of the tongue, 5 epiglottis pedicle flaps, 4 tubed pectoralis major musculocutaneous flaps, 1 vascular pedicle submandibular gland flap, 1 deltopectoral flap, 1 skin flap and 1 island pectoralis major musculocutaneous flap. An analysis of the procedures with emphasis on the oncological and functional results indicates that each techniques has advantages in specific circumstances. Guidelines for the application of the techniques are described.

Results of surgery treatment from the external access and radiotherapy in early, stage of vocal cords carcinoma were presented. Clinical material consisted of 94 cases with squamous cell carcinoma of vocal cords with stage T1a and T1b treated in Szczecin University Department of Otorhinolaryngology from 1987 to 1996. 51 cases were operated on (26 by chordectomy and 25 by frontolateral laryngectomy). Radiotherapy was applied in 43 patients. The 3 and 5 years' survival rate in the surgery group was 97% and after radiotherapy 88 to 80%. The functional results were also presented. It was concluded that the mode of treatment in early stages of vocal cord carcinoma should be individualized.

The objective of the paper was the retrospective evaluation of oncological results after dissection radical (RND), modified (MND) and selective (SND) on cervical lymph nodes in laryngeal and hypopharyngeal carcinoma. On the basis of obtained study results, an answer was sought whether and what prognostic factors in metastases to the regional cervical lymph nodes should influence the choice of therapeutic method, and the survival. The study material comprised 986 patients treated during the period 1970-1991 in the Department of Otolaryngology-PAM in Szczecin due to laryngeal and hypopharyngeal carcinoma. In this group, apart from treating the primary changes, the cervical lymph nodes were operated on (Neck Dissection-ND). Data concerning the patients were obtained from: a/ case histories, b/ follow-up, c/ correspondence, d/ USC data. Clinical status of cervical lymph nodes, their histopathological state were assessed postoperatively. The patients' survival period after the treatment of carcinoma was estimated too. The occurrence of neoplastic disease recurrence in cervical lymph nodes was also taken into consideration. All data were collected in Personal Computer memory IBC (PC 386). In processing the data use was made of calculating and data base program Medikus. A linear regression model was elaborated for investigating the degree to which certain factors influence the appearance of nodal recurrence. Hierarchy was established for the factors whose influence on the occurrence of recurrence was the strongest. It becomes apparent from the accomplished studies that metastases to the regional cervical lymph nodes occurred most frequently in hypopharyngeal cancers (81.6%). The clinical assessment is burdened with an error claiming 31% of discrepancy as compared to results of histopathological examination (Tab. 3). Occult metastases were recorded in hypopharyngeal carcinoma about 20%, and in glottic one about 13%. It was revealed that the presence of metastases in lymph nodes, an increase affecting the stage of pT and pN reduced the chances of survival in a significant manner (Tab. 7 and 8). The greatest influence on the appearance of nodal recurrence was exerted by the following factors: number of metastatic nodes, size of nodes, component N, mode of treatment. It has been disclosed that the risk of nodal recurrence increases sixfold with the rise of factor N, twofold with the rise of the number of metastatic nodes, and 1,6 fold when the size of nodes increases by 1 cm. No differences were observed in the percentages of survivals following the operative treatment RND and MND, with the stage being N1-2 (Fig. 1). Radiotherapy applied after MND and RND failed to exert any meaningful positive influence on the overall percentage of survivals (Tab. 4). As compared with therapeutic dissection, better oncological results, scored after prophylactic removal of cervical lymphatic system, provide the basis for elective performance of prophylactic procedures in hypopharyngeal and laryngeal carcinomata.

Original application technology of SBD (Słownikowa Baza Danych) from Szczecin in evaluation of treatment results in larynx and hypopharynx carcinoma was presented. The aim of the report is to present advantages of a system which provides multidirectional date and its particular analysis.

Retrospective assessment of treatment results in larynx and hypopharynx carcinoma treated in ENT department from 1970 to 1991 was undertaken. Linear function and square trend were used in analysis. The patients survival trend after the treatment of carcinoma and recurrence appearance trend were estimated. It was revealed that presence of metastases in lymph nodes, has reduced year by year with 0.235%.

The authors present a report on 62 cases of partial horizontal supracricoid reconstructive laryngectomy, including 28 cases of cricohyoidopexy (CHP) and 34 cases of cricohyoidoepiglottopexy (CHEP). The surgery was carried out in the years 1971 to 1989 in the ENT Clinic of Pomeranian Medical Academy in Szczecin. The indications, surgical technique and oncological results are presented. 78% patients survived after 3 years and 73% after 5 years without recurrence. The reasons of failure and the way of treatment are discussed.