The visual-ocular and vestibulo-ocular reflexes in vestibular migraine.

Vestibular migraine is a disease from the border of neurology and otoneurology. The diagnosis depends on patient history. There are no valuable laboratory or imaging tests, therefore the examination of visual-ocular and vestibulo-ocular reflexes is very useful in this group of patients. The material was collected from patients diagnosed due to dizziness at the Department of Otolaryngology and Oncology with the Subdepartment of Audiology and Phoniatrics, CM UMK in Bydgoszcz in 2019-2021. We considered patients with vestibular migraine and analyzed videonystagmographic tests in this study. The most common VNG abnormalities in patients suffering from vestibular migraine were an increased labyrinthine response, increased time constant of the rotational response and abnormal optokinetic response. There was not a single case of canal paresis in the group of patients with vestibular migraine.

To Eat or Not to Eat: A Review of the Relationship between Chocolate and Migraines.

Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.

Risk factors of tympanoplasties in long-term observation.

OBJECTIVES: The aim of the study was to evaluate risk factors influencing the results of tympanoplasties on the base of material taken from the Department of Otolaryngology and Laryngological Oncology Collegium Medicum of Nicolaus Copernicus University in Bydgoszcz between 2004-2009. In this period 98 operations were done. The time from operation to hearing examination was 3 to 7 years, mean 5,43. Tympanoplastic operation were divided according to Tos classification. Measuring hearing results, tonal audiometry was done and mean air bone gap on four frequencies was assesed (500, 1000, 2000, 3000 Hz), according to AAO-HNS guidelines (1995). This parameter was compared between groups separated according to risk factors, that could potentially affect the results. Those risk factors were: disfunction of the Eustechian tube, localisation and size of the perforation of the tympanic membrane, damage of the ossicles, the state of the mastoid process, the number of operations, the presence of the cholesteatoma or granulating tissue, chronic otitis media in the opposite ear, smoking cigarettes, mastoidectomy, canal wall down technique. The results were analysed using statistical test. RESULTS: The most impotant risk factor affecting treatment's results (besides discharge from the ear) is damage of the ossicles, especially the malleus and stapes. Well done operation ensures good hearing results irrespectively of the presence of cholesteatoma or granulating tissue, and also in case of reoperation. For all types of tympanoplasties neither the localisation, nor the size of perforation do not influence on hearing results in long term observation.

Results of cystadenolymphoma treatment of superficial parotid gland.

Introduction Warthin's tumor is a non-malignant tumor that occurs in major salivary glands. Diagnostics include an interview and physical examination as well as additional tests - ultrasonography, magnetic resonance tomography, fine-needle aspiration biopsy. Surgical tumor resection remains the method of treatment, the scope of which includes techniques from extracapsular tumor resection to a full range of parotidectomy. Material and methods A retrospective analysis was conducted for available medical records of 53 patients treated surgically at the Department of Otolaryngology and Laryngological Oncology at the Collegium Medicum of the Nicolaus Copernicus University in Torun in 2009-2016. Each patient underwent an interview, physical examination and a routine ultrasound examination. Results of treatment of 57 tumors were analyzed. Results The study showed that in the case of extracapsular tumor excision in 57 patients in the treatment of Warthin's tumors of the lower pole of the parotid lobe, there were no complications in the form of: permanent paralysis or facial nerve palsy, mucocele, symptoms of Frey's syndrome or cosmetic facial defect. Ultrasound examination in 8 (14%) patients revealed changes requiring further diagnostics or periodic ultrasound monitoring. Conclusions 1. Extracapsular tumor excision appears to be an accurate surgical technique in Warthin's tumor of the lower pole of the parotid gland's superficial lobe. 2. After removal of a cancerous lesion of the parotid gland, every patient requires periodic laryngological monitoring.

Is immunohistochemical evaluation of p16 in oropharyngeal cancer enough to predict the HPV positivity?

AIM: Our goal was to determine the expression levels of p16 in the cohort of the OPSCC patients and evaluation of the pathological and clinical differences between these two groups including patients' survival. BACKGROUND: HPV infection is the main causative factor of oropharyngeal cancer (OPSCC). Identification of HPV status in OPSCC requires positive evaluation of viral DNA integration into host cell however, p16 accumulation in the proliferating cell layers has been accepted as an alternative marker for HPV infection. MATERIAL AND METHODS: The IHC staining for p16 has been performed in tumor tissue from 382 OPSCC patients. The sample was considered positive based on more than 70% of carcinoma tissue showing strong and diffused nuclear and cytoplasmic immunostaining. The clinicopathological characteristics of the patients including site, age, gender, tumor grade, tumor stage, the nodal status, smoking and survival have been analyzed when comparing p16 positive and p16 negative tumors. RESULTS: Out of our cohort in 38.2% cases positive staining for p16 has been recorded. Our analysis did not indicate significant differences in the distribution of the p16 positive patients and age of the patients, stage of the disease. Among the patients who have presented with the N+ neck, there were significantly more p16 positive tumors than in the group with N0 neck (p = 0.0062). There was highly significant correlation between the expression of p16 and smoking (p < 0.0001). The significant difference in survival (p < 0.0001) with more favorable prognosis in the p16 positive group has been observed. CONCLUSIONS: Overexpression of p16 is accepted as a surrogate diagnostic marker for detecting HPV infection in oropharyngeal cancer. However, one should remember about existence of the small subgroups of p16 positive but HPV negative tumors, with relatively worse prognosis. Immunostaining for p16, however useful on everyday basis, should be complemented with other techniques in terms of reliable identification of the HPV infection.

Lyophilized Cyclamen europaeum tuber extract in the treatment of rhinosinusitis.

Nasal and sinus mucositis is a significant health problem associated with significant organizational and financial burden for the health care system. In recent years, several important guidelines and positions of expert groups and scientific associations have been published with regard to the diagnostics and treatment of rhinosinusitis, including European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2012) [1] and Polish Standards for the Treatment of Rhinitis (PoSLeNN 2013) [2]. The management of viral and postviral rhinosinusitis involves systemic treatment including administration of plant origin products. The goal of this article is to present the current knowledge on the use of intranasal preparations containing natural saponin fractions from the rhizomes of Alpine cyclamen (Cyclamen europaeum). Saponins contained in the extract of Alpine cyclamen (Cyclamen europaeum) rhizomes are surface-active compounds that reduce the surface tension on the nasal mucosal cells while simultaneously stimulating the trigeminal nerve receptors leading to increased production of seromucous secretion and extensive drainage of the nasal and sinus cavities. The analysis of published studies on the efficacy and safety of intranasal products containing lyophilized extracts from Cyclamen europaeum tuber warrants the conclusion that these products are useful in the management of nasal and sinus mucositis due to their beneficial impact on the course of the treatment of acute rhinosinusitis. When used in patients with acute rhinosinusitis, an intranasal preparation containing lyophilized extracts from Cyclamen europaeum tuber efficiently reduces the symptoms, particularly the feeling of pressure and pain in the face. According to the authors of PROSINUS study, single-agent treatment using Cyclamen europaeum extracts is more efficient (in terms of the percentage of success) than other monotherapy or combination regimens.

Evaluation of fully biodegradable nasal packings in functional endoscopic sinus surgery ­ a multi-centre study.

THE AIM: This work was to compare an innovative solution, i.e. a fully biodegradable nasal packing Nasopore®, with a traditional one, in the aftercare of patients subjected to functional endoscopic sinus surgery. MATERIAL AND METHOD: Prospective, blinded study with sequential enrollment conducted at three study centres. One of the investigators evaluated during surgery the level of bleeding in each of the nasal cavities and at the end of surgery he applied the test packing, the biodegradable dressing Nasopore®, to one randomly chosen nasal cavity, and a control packing to the other one. The other investigator removed during aftercare the control packing and conducted the follow-up. During the control visits (24-48 hours, 10 and 30 days post-op.) the subjects evaluated their headache, pain in the nose, pressure in the forehead as well as their nasal obstruction. RESULTS: A total of 39 women and 44 men at the age of 47 years on average (min. 19, max. 82) were qualified for the study. The largest differences between different types of nasal dressings were observed with regard to reduction of nasal obstruction in the fist 10 days after surgery (P<0.005). In relation to the pain in the area of the head and nose as well the pressure in the forehead on every visit, better outcomes were observed for the test dressing. Statistical difference (P<0.05) was observed on the fist follow-up visit for the headache and pressure in the forehead as well as on the fist and second visit for the pain in the nose. CONCLUSION: The fully biodegradable nasal dressing Nasopore® may constitute significant improvement and facilitation of aftercare in functional endoscopic sinus surgery while increasing the patients' satisfaction and lowering the postoperative discomfort.

[Treatment of lip cancer, material from the Department of Otolaryngology and Laryngological Oncology, Medical College of Bydgoszcz, Nicolaus Copernicus University, Torun]. / Leczenie raka wargi w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej Collegium Medicum w Bydgoszczy Uniwersytetu Mikolaja Kopernika w Toruniu.

The subject of this study is methods and results of treatment of 21 cases of lip cancer between 2007 and 2012, which included 15 men and 6 women, aged 48-63. In 18 cases it was squamous cell carcinoma, in other 3 basocellulare carcinoma. Of the hospitalized patients the following clinical stages were found: T1 - five, T2 - five, T3 - seven, T4 - four. We operated with several techniques, we performed: V-incision and surgery according to the Webster - one patient, Rutkowski - four, Estlander - four, Karpandzic - three; in the treatment of cancer of upper lip the frontal flap was used. Fourteen patients underwent selective or modified lymph node operation. Five patients appeared local recurrence, 3 of them died due to metastases to multiply organs. Six operated patients did not continue oncological treatment, their subsequent fate is unknown. The remaining 10 patients remained under observation. The results indicate the need of extensive resection of the limph node in case of recurrence and the necessity of implementing selective or radical nodal surgery in the early stages of cancer.

Multiple metastases of renal clear cell carcinoma to the organs of the head.

Metastases of renal clear cell carcinoma to the organs of the head are rare. Single cases show that they can appear either shortly after or many years after radical surgery. The diagnosis of this cancer is difficult because of its insidious course; therefore, it is often diagnosed too late. Late diagnosis is associated with a high risk of distant metastases and increased mortality. The paper presents a case of a patient whose kidney tumour was diagnosed during hospitalisation at the Department of Rheumatology. Further diagnosis and surgical treatment were performed in the Department of Urology, where a left-sided nephrectomy was carried out. After two years, the patient was hospitalised in the Department of Otolaryngology due to dysphagia. The patient was subjected to fine-needle biopsy, surgical biopsy, CT, and ultrasound. Metastases of renal clear cell carcinoma were diagnosed based on a histopathological examination and the results of imaging studies. Due to the extent of the tumour, diagnostics were extended to magnetic resonance imaging. The patient was qualified for tracheotomy, cytoreductive surgery, and chemoradiation. The patient was referred for further treatment at the Centre of Oncology in Bydgoszcz.

[The treatment of malignant neoplasms of the external ear canal and temporal bone in the Department of Otolaryngology and Oncological Laryngology in Bydgoszcz]. / Leczenie nowotworów zlosliwych przewodu sluchowego zewnetrznego i kosci skroniowej w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej CM UMK w Bydgoszczy.

INTRODUCTION, MATERIAL AND METHODS, AIM OF THE STUDY: Evaluation of the methods and results of treatment of 19 cases of malignant tumors of the external auditory meatus and/or temporal bone was performed. RESULTS: In 10 cases planoepithelial carcinoma was diagnosed; in 7 cases basocellulare carcinoma; in 1 case rhabdomyosarcoma; and in 1 case malignant peripheral nerve sheath tumor were histopathologically established. In stage T1 were 8 cases, in T2 - 7, in T3 - 1 and in T4 3 patients were stated based upon clinical and radiological (HRCT and MRI) examination. Three patients in T4 stage were qualified to palliative therapy. In 2 cases radical mastoidectomy was performed, 8 patients underwent partial temporal bone resection. In 6 cases removal of cartilaginous and osseous external auditory meatus was done. In 9 cases local recurrence of tumor was observed during 2 years after surgery. The last 7 cases are under oncological observation. CONCLUSIONS: In conclusion we stressed that patients with malignant tumors of this region are treated in late stages of the disease; it is a main cause of poor diagnosis.

[The involvement of RCAS1 in creating a suppressive tumor microenvironment in patients with pharyngeal squamous cell carcinoma]. / Udzial bialka RCAS1 w tworzeniu supresyjnego profilu mikrosrodowiska raka plaskonablonkowego gardla srodkowego.

INTRODUCTION: Tumor microenvironment makes up the stroma of the neoplasm and is the tissue that determines the growth and progression of the tumor and its ability to create metastases. THE AIM OF THE PRESENT STUDY: has been to evaluate the potential role of RCAS1 protein in creating the suppressive tumor microenvironment in pharyngeal squamous cell carcinomas. The immunoreactivity of RCAS1, CD3, CD25, CD68, CD69 and Foxp3 was assessed in the tissue samples of the tumor, in tumor microenvironment and in the reference samples of palatine tonsils in chronic inflammation. RESULTS: A statistically significantly higher RCAS1 antigen immunoreactivity was identified in pharyngeal cancer samples than in the stromal samples, the presence of RCAS1 positive macrophages infiltrating the tumor and its stroma was also noticed. The statistically significantly higher RCAS1 antigen immunoreactivity level was identified in the pharyngeal cancer samples in patients with the presence of lymph node metastases in comparison to patients without metastases. The infiltration of CD68 positive cells (macrophages) was significantly higher in the stromal tissue samples than in cancer samples and it was in both, the tumor and the stroma, significantly higher in patients with the presence of lymph node metastases than in patients without metastases. Additionally the presence of CD3 positive TILs was noticed in the tissue of the tumor and in its stroma, the cells were activated, typified by CD69 immunoreactivity which was higher than in the reference samples, and impaired cytotoxicity with low CD25 antigen immunoreactivity. This observation confirmed the presence of selective immune suppression within the tumor and the stroma. CONCLUSION: RCAS1, an active factor secreted by the tumor and present in its stroma may play an important role in the phenomenon of tumor escape from host immunological surveillance and in creating the immune tolerance for the tumor cells, as well as in the tumor microenvironment remodeling with creating its suppressive profile enabling the further tumor growth and metastases.

[Multiple complications of acute unilateral rhinosinusitis--a case report]. / Przypadek mnogich powiklan zatokopochodnych w ostrym jednostronnym zapaleniu zatok przynosowych.

INTRODUCTION: Intracranial or orbital complications after chronic and acute rhinosinusitis are rare, but could be dangerous. The complications of acute rhinosinusitis more often are observed in young patients. The combination of both intracranial and orbital complications together is found after acute inflammation. MATERIAL AND METHODS: We present a case of a patient with primary developed orbital complication during acute rhinosinusitis followed by intracranial abscess during the same treatment period. RESULTS: One week after intravenous antibiotic therapy with good outcome we observed an aggravated inflammation process with osteitis of frontal bone and brain abscess formation. We performed an external approach for frontal sinus surgery combined with neurosurgical brain abscess evacuation. Swabs taken during surgery were positive for: Streptococcus constellatus and Parvimonas micra sensitive for penicillin and metronidazol. We observed a good recovery after two weeks of treatment. CONCLUSIONS: We recommend performing a complementary CT of the sinus and CT of the brain with contrast when complications of acute rhinosinusitis are suspected. The coexistence of intracranial and orbital complications could be observed in younger patients mostly after acute sinusitis.

[Neurootological symptoms in Bruns' syndrome]. / Objawy neurootologiczne w zespole Brunsa.

The aim of the study was to present clinical neurootological symptoms in the case of early stage of the fourth ventricle tumor diagnosed finally on the base of MRI. Visual-oculomotor, vestibular-oculomotor, vestibulo-spinal and other electrophysiological signs of the vestibular damage of the brainstem were: paresis of the sixth nerve unilaterally, prolonged latency of III-V waves on brain stem audiological responses (BERA), asymmetry of the fusion limit of optokinetic nystagmus, bilateral areflexia of the caloric and kinetic labyrinth reaction, abnormal Unterberger's test in craniocorpography, the presence of gaze nystagmus. The study stressed the value of the widen and careful neurootological examination in such cases.

The value of the examination of visuooculomotor reflexes in diagnosis of posterior cranial fossa lesions.

The aim of this study was to compare the frequency of pathological types of smooth-pursuit and saccadic movements in different localizations of vestibular lesions. We tested 112 patients using videonystagmography. The smooth pursuit was appreciated qualitatively on the basis of Malecki's patterns. We analyzed the saccadic movements taking three parameters into consideration: latency, velocity, and accuracy. The patients suffered from posterior cranial fossa lesions, supratentorial damage, and peripheral vestibular disorders. We discovered that testing of smooth pursuit and saccades was very helpful in pointing to the localization of the damage in the posterior fossa. The frequency of the pathological saccadic and eye-tracking movements was similar for the different sites of deficit inside the posterior fossa, so recognizing the precise localization of lesion in this anatomical region was difficult.

[Rotation suction-knife (shaver) in otorhinolaryngological surgery]. / Zastosowanie noza obrotowo-ssacego (shaver) w chirurgii otorynolaryngologicznej.

INTRODUCTION: Rotation suction knife (shaver or microdebridor) was developed in beginning 1985 in orthopedic surgery. In the field of otolaryngology it was used in 1992-1994. Shaver is a combination of suction and cutting round knife working together. Knives of different shapes are put into handpiece. They have outer sheath with window, which protect the inner rotating blade. The blade is connected to suction and cutting tissue is removed from the operation field. In otolaryngology surgery we mostly used the oscillation cutting mode which is the most sufficient. Shaver surgery is precise in soft tissue resection, so the most advantages to powered the system is in rhinosurgery, polypectomy with extension to pansinus surgery. Microdebridor can be also used for nasopharynx-adenoidectomy, chonanal atresia surgery, turbinoplasty, dacryocystorhinostomy, sella turcica tumor resection or laryngeal surgery. MATERIAL AND METHODS: We used the Storz's shaver system with a handpiece with a motor in the vertical part of the T-shaped handle. Suction and transport of rejected material does not pass through the motor system. The suction channel is straight and clogging is minimized. We performed shaver surgery during functional endonasal endoscopic surgery (FESS) for polypectomy in 15 cases, medial antrostomy (uncinectomy for "swinging door" procedure) in 10 cases, nasopharyngeal-adenoidectomy in 3 cases and turbinoplasty (inferior turbinectomy) in 10 cases. RESULTS: In our material we did not observe any complications during and after surgery. The healing process is very good without obstruction and crusting. The shaver system has an excellent protection for surrounding tissue and minimalized the tissue destruction. CONCLUSIONS: Shaver is an excellent powered instruments for rhinosurgery especially massive polyps of nose and sinuses. It is very sufficient to prevent normal tissue and remove pathological one, this can be achieved in no bleeding area.

[Influence of the cerebellum on the postural labyrinth reflex--experimental and clinical data]. / Wplyw mózdzku na poprawczy odruch blednikowy--badania doswiadczalne i kliniczne.

The subject of the study was to estimate the influence of the cerebellum and the postural labyrinth reflex. The pigeons after hemicerebellectomy or vermis ablation this reflex was analysed during body rotation around sagittal and transversal axis. In the clinical part of observations, stabilometric measure of head motion during balance on the movable platform was performed in patients with supratentorial and cerebellar tumors. The results showed the greatest reflex disturbances in vermis ablation and vermis tumors. In hemispheric tumors of the cerebellum these disorders were slighter, but greater in comparison with supratentorial lesions. The authors stressed the role of the vermis in controlling of the reflex.

[Vestibular peripheral organ in chronic otitis media]. / Receptor otolitowo-grzebieniowy w przewleklym zapaleniu ucha srodkowego.

The aim of the study was to estimate the function of the vestibular peripheral end organ in patients with chronic otitis media. In the group of 60 cases, 31 female, 29 male, in the age from 27 to 49 years, the electronystagmographic and stabilometric analysis of vestibular-oculomotor and vestibular-spinal reflexes was performed. The results showed that inner ear dysfunction was mainly observed in cholesteatoma cases. The otolith apparatus disturbances were not often present in comparison with the lesion of the ampullar receptor.