Evaluation of vestibulo-ocular reflex in patients with damage to the central nervous system (GCS score 5-3).

PURPOSE: The aim of our study was to evaluate the vestibulo-ocular reflex (VOR) in patients with severe damage to the central nervous system (CNS) in the diagnosis of brain death and survival prognosis. MATERIAL AND METHODS: The study was conducted in 20 patients with extensive primary central nervous system damage against spontaneous intracranial haemorrhage or craniocerebral trauma and secondary central nervous system damage as a result of cardiac arrest with Glasgow Coma Scale (GCS) score from 3 to 5 treated in the Intensive Care Unit, University Hospital in Bialystok. For labyrinth stimulation we used water at 30°C, recording the reactions with ENG appliance. Records were analyzed in Nathanson-Bergman four-level scale. The first assessment was performed on the second day after the trauma and subsequently the assessments were repeated at 2-day intervals. RESULTS: Of the 20 patients studied, the reflex was recorded in nine, which accounted for 45%. In the remaining 11 (55%) patients the reflex was not reported in any test and all of them died. Among patients with recorded VOR, five died and four survived. CONCLUSIONS: The results of our study show the usefulness of performing the vestibulo-ocular test in patients with severe brain injury to predict their survival.

[Epidemiology of laryngeal and hypopharyngeal cancer in the period 1988-2012 in the material of the Otolaryngology Clinic of the Bialystok Medical University]. / Epidemiologia raka krtani i gardla dolnego w latach 1988-2012 w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Bialymstoku.

UNLABELLED: Malignant tumour is the second cause of death in Poland, behind cardiovascular disease. 26% of men and 23% of women die of it. Head and neck tumours are the fifth most frequent group of malignant tumours. These are mostly squamous cell carcinomas. The carcinogenic factors of tobacco smoke play an indisputable role in the pathogenesis of these tumours. AIM OF WORK: Analysis comprising: number of patients, sex and age, site and stage of the primary tumour (T), clinical assessment of neck lymph nodes (N). The results underwent statistical analysis. MATERIALS AND METHODS: The study involved 1313 patients who underwent surgery in the period 1988-2012 in the Otolaryngology Clinic in Bialystok (1199 men and 114 women, aged 32-86 years). RESULTS: In the study group the proportion of men was 91.3% and women 8.7%. Histopathological verification confirmed squamous cell carcinomas in 99%. The primary tumour was most often located in the supraglottic area of the larynx (48.0%) and its clinical stage was T3 (33.5%). T1 tumours were statistically significantly more frequently found in the glottis and T4 tumours - in the hypopharynx and in the transglottic area. Swollen lymph nodes in the neck were found in 52.4% of the patients, most often N2 (37.4%). The highest percentage of patients with lymph node reaction was found in the youngest group (76.6%) and the lowest - in the eldest group (30.0%). Swollen lymph nodes were statistically relevantly more frequent in patients with supraglottic or hypopharynx tumour.

[Embolization of carotid arteria branch in stanching of nasal bleeding]. / Embolizacja galezi tetnicy szyjnej zewnetrznej w tamowaniu krwawien z nosa.

BACKGROUND: Epistaxis is a common clinical problem, especially in otolaryngology. This disorder affects equally both genders. Most cases manifest as spontaneous nasal bleeding. It can also appear as a result of trauma, high blood pressure, Osler-Rendu-Weber disease. When the bleeding is massive it can be potentially life-threatening. A great majority of epistaxis can be treated conservatively, if not it sometimes requires endovascular treatment. It is specially reserved for extensive, dangerous epistaxis. Angiography with selective embolization has become an accepted method of treating epistaxis that is not controlled with conservative methods. MATERIAL AND METHODS: Authors analyzed the efficacy of selective embolization treatment of epistaxis. 61 patients treated in the Department of Otolaryngology in Bialystok in years 1999-2011 were examined. There were 39 men and 22 women aged 24-48 years. Patients were referred for endovascular treatment when primary management was ineffective. Arteries suspected of bleeding were embolized superselectively. RESULTS: Immediate, complete control of bleeding was achieved in 100% patients. After few hours recurrent nasal bleeding occurred in 4 (7%) patients who underwent successful reembolization. There were no severe complications after procedure. Nine patients experienced few days lasting mild headache which disappeared after medicament treatment. Five patients suffered from unaided removing facial oedema. Out of 61 patients, 56 were available for 12-month follow-up evaluation. No neurological or otolaryngological complications were certified. There was also no relapse of epistaxis. CONCLUSIONS: Selective angiographic embolization is an effective method that should be considered in the treatment of refractory epistaxis. It is safe and not traumatic for patients.

Palliative embolization of hemorrhages in extensive head and neck tumors.

BACKGROUND: A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. MATERIAL/METHODS: Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. RESULTS: Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. CONCLUSIONS: We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers.

HIV infections in otolaryngology.

HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer.

Possible role of α-mannosidase and ß-galactosidase in larynx cancer.

BACKGROUND: Lysosomal exoglycosidases, such as α-mannosidases (MAN) and ß-galactosidases (GAL), are found in different glycoside hydrolase sequence-based families. Considerable research has proved plays the role of MAN, which play a key role in the modification and diversification of hybrid N-glycans, processes with strong cellular links to cancer. Therefore the study aim was to investigate the activities of MAN and GAL in larynx cancer compared to controls. MATERIAL AND METHODS: Larynx cancer (n = 21) and normal healthy tissue (n = 21) were collected from patients during total laryngectomy. A biopsy of macroscopically healthy tissue in the area of the lower 1/3 of omohyoid muscle was taken for frozen sections in each case and these served as controls. The release of p-nitrophenol from p-nitrophenol derivatives of MAN and GAL was used. RESULTS: In all specimens we observed significantly higher activity of investigated enzymes in larynx cancer compared with controls. The mean release of MAN from activated cells was 3.702 ±1.3245 nkat/g wet tissue compared to controls (1.614 ±0.8220 nkat/g wet tissue). The mean release of GAL from the activated cells was 3.383 ±2.1980 nkat/g wet tissue compared to controls (2.137 ±1.3685 nkat/g wet tissue). Differences in observed activity were statistically significant. CONCLUSION: The present data indicate that MAN and GAL are significantly and consistently elevated in larynx cancer growth. It also means that catabolic reactions involving glycoproteins, glycolipids and proteoglycans may play a role in larynx cancer. Further research should also evaluate the relative importance of these particular exoglycosidases in indicating the progress of the disease in considering the spectrum of identified marker mediators.

[Activity of vestibular organs in women with postmenopausal osteoporosis]. / Czynnosc narzadu przedsionkowego u kobiet z osteoporoza pomenopauzalna.

Osteoporosis is a systemic disease characterized by low bone mass and alterations in the microstructure of the skeleton. It is a worldwide disease, most prevalent in women over the age of 70. It is estimated that approximately 15-18% of women over 50 years of age are affected by osteoporosis and further 37-50% of women have decreased bone mass. The percentage of men suffering from this disease is about 40-50% lower. Untreated osteoporosis causes pathologic bone fractures, in particular fractures of the femoral neck, deformations and pain. THE AIM OF THIS WORK: was to evaluate the activity of the vestibular organ in people with advanced osteoporosis, and then to compare the results with a group of people of the same age, not suffering from osteoporosis, and a group of young healthy people. THE STUDY: involved 196 women qualified into the following study groups: I group (control group)--100 healthy women aged 50-61 without osteoporotic symptoms, II group (study group)--96 women aged 51-63 with postmenopausal osteoporosis. METHODS: The study included evaluation of the character and intensity of vertigo, Romberg, Mann test, static and dynamic posturography, ENG with eyes open and closed, Fitzgerald-Hallpike caloric test in all the women. CONCLUSIONS: It was found that postmenopausal osteoporosis tends to have central nervous system disorders, peripheral vestibular disorders occur sporadically.

[Activity of vestibular organs in menopausal women non-users hormone replacement therapy (HRT)]. / Czynnosc narzadu przedsionkowego u kobiet w okresie menopauzy niestosujacych hormonalnej terapii zastepczej (HTZ).

UNLABELLED: Menopause affects women most commonly after 40 years of age. At this time there is higher risk of myocardial infarction, hypertension, high cholesterol level, diabetes, overweight, osteoporosis as well as balance disorders and vertigo. THE AIM OF THIS WORK: was to evaluate the activity of the vestibular organ in menopausal women not using Hormone Replacement Therapy, and then to compare the results with a group of young healthy women. The study involved 100 women aged between 18 and 55 years, qualified into the following study groups: I group (control group)--50 healthy women aged 18-23, II group (study group)--50 menopausal women aged 45-55, not using Hormone Replacement Therapy. METHODS: The study included evaluation of the character and intensity of vertigo, Romberg and Mann test, static posturography, ENG with eyes open and closed, Fitzgerald-Hallpike caloric test, eye-tracking test and optokinetics in all the women. CONCLUSIONS: It was found that menopausal women tend to have central nervous system disorders, peripheral vestibular disorders occur sporddically.

[The quality of life after the surgery of laryngeal or hypopharynx neoplasms]. / Jakosc zycia po operacji nowotworu krtani lub gardla dolnego.

UNLABELLED: The number of diagnosed instances of larynx and laryngopharynx cancer is systematically increasing in Poland, especially in men. Advanced stage of the primary tumour and metastases to the lymph nodes result in the necessity of total laryngectomy. Serious disease, disability connected with extensive surgery and uncertain prognosis influence further professional career and personal relationships of the patients. The aim of this paper is to assess the life of patients after surgery for larynx or laryngopharynx cancer. MATERIAL AND METHODS: The analysis involved 92 patients after total laryngectomy due to squamous cell carcinoma. A significant majority of the patients (59%) judged their lifestyle before surgery as reprehensible. They attributed it to alcohol abuse (95%), heavy smoking (94%), exposure to harmful environmental conditions (73%) and to harmful conditions at workplace (51%). RESULTS: After treatment, which was accepted by over 95% of the patients, many of them quit using alcohol (57%) and quit smoking (75%). Because of serious health condition and difficult economic situation, only a few of them decided to change their working or living conditions. 46% of patients judged that after undergoing complete treatment, the quality of their life deteriorated. However, their awareness of the health-threatening factors grew. CONCLUSIONS: Total laryngectomy in patients with larynx and laryngopharynx cancer deteriorates quality and working or living conditions. The disease causes patients' criticism of their lifestyle before operation. Only 16% of treated did not changed life style after larygectomy.

Hexosaminidase as a new potential marker for larynx cancer.

OBJECTIVES: Larynx squamous cell carcinoma is one of the most common forms of cancer in the area of the neck. The aim of our study was to investigate the activities of N-acetyl-beta-D-hexosaminidase (HEX) in larynx cancer compared with the specimens from the healthy space of the tumor that served as controls. DESIGN AND METHODS: Larynx cancer (n=15) and normal healthy tissue around the tumor (n=15) were collected from the patients during total laryngectomy. Specimens were immediately frozen in -80 degrees C. To assess hexosaminidase activity, release of p-nitrophenol from p-nitrophenol derivatives was used. RESULTS: We observed a significantly higher activity of the investigated enzyme in all laryngeal cancer specimens compared with that in healthy tissue homogenates. The differences were statistically significant. CONCLUSIONS: It could be assumed that HEX may release particular sugars from the ends of oligosaccharide chains of glycocalyx proteins, changing adhesive forces binding together cells, and the communication between cells and elements of extracellular matrix.

[Activity of vestibular organ in people using mobile phones professionally]. / Czynnosc narzadu przedsionkowego u osób zawodowo poslugujacych sie telefonem komórkowym.

UNLABELLED: Mobile phones emit radio frequency radiation from 800 to 2200 MHz. Such radiation is considered to provoke negative reactions in the human body. The radiation dose depends mostly on the exposure time, i.e. telephone connection time, and technical parameters of the devices. Clinical and experimental studies so far have not provided us with a clear statement about the consequences of this radiation on humans. MATERIAL AND METHODS: Taking into account the possibility that radiation may have an impact on the nervous system, the authors conducted an assessment of labyrinth (vestibular organ) reaction in 50 subjects exposed to mobile phones for periods of many years. The results were compared to a group of 100 subjects not experiencing such exposure. CONCLUSION: No statistically significant differences pointing to a negative impact of radiation on labyrinth reaction in humans were observed.

[Vestibular rehabilitation of vertigo and dizziness]. / Rehabilitacja ruchowa w leczeniu zawrotów glowy i zaburzen równowagi.

UNLABELLED: THE AIM OF THE STUDY was to assess the effectiveness of kinesitherapy in vertigo and dizziness. MATERIAL AND METHODS: One hundred thirty two patients with vertigo and dizziness, aged 19-71, treated by kinesitherapy and pharmacotherapy were examined. The control group consisted of 126 patients treated by pharmacotherapy alone. The effects of therapy were assessed by patients' self-control cards and electronystagmography (ENG) examinations. CONCLUSION: Kinesitherapy is an effective complementary method of treating patients with vertigo and dizziness.

[Pathologies of the cervical spine anatomy as a possible cause of young patients vertigo]. / Nieprawidlowosci odcinka szyjnego kregoslupa jako mozliwa przyczyna zawrotów glowy u mlodych osób.

Vertigo occurs in many diseases, especially in older people. It is a specific diagnostic problem in young people. In the paper, 86 young patients with incidental vertigo were clinically assessed. Electronystagmography, eye-tracking pattern test, optokinetic test and cervical spine X rays were used in examination. The results were compared with the control group of young and healthy people and also with the older patients group with degenerative changes of the cervical spine. In the examined group the disturbances of physiologic cervical lordosis were found in 33.8% and positional nystagmus in 23%. The vestibular tests and hearing were frequently normal. These results suggest that disturbances of physiologic cervical lordosis may be the cause of balance disturbances.

[Salivary gland neoplasms in the years 1991-2006 in the material of the Department of Otolaryngology, Medical University in Bialystok]. / Nowotwory zlosliwe gruczolów slinowych w latach 1991-2006 w materiale Kliniki Otolaryngologii AM w Bialymstoku.

Complex structure of salivary glands, histological diversity of malignant salivary gland neoplasms and heterogeneous clinical image make therapeutic strategy difficult and controversial. The aim of this work was an epidemiologic analysis of 86 salivary gland tumour cases (in years 1991-2000) and 82 cases treated at the Otolaryngological Clinic of the Medical University of Bialystok (in years 2001-2006). Epidemiologic researches were conducted retrospectively. Age, sex, histological structure, location and local progression of tumour were analysed. The relationship between histological type, local progression and the presence of metastases to the cervical lymph nodes as well as remote metastases was also examined. The study was based on TNM Tumor Classification: large salivary glands (1977). It was found that malignant epithelial salivary gland tumours affect most commonly the parotid gland in men aged over 50 years. Adenoid cystic carcinoma was the most frequently represented histological type. Remote metastases were observed most commonly in patients with polymorphic adenoma.

[Otoneurological aspects of the early forms of sclerosis multiplex (SM)]. / Aspekty otoneurologiczne wczesnych postaci stwardnienia rozsianego (SM).

Sclerosis multiplex (SM) is characterized by multifocality of neurological changes and polyphasic course. The disease is caused by indefinite factors in the circumstances of genetically determined immune disorders. The aim of study. An attempt was made to identify otoneurological symptoms accompanying the early stage of sclerosis multiplex (SM). Material and research methods. 103 patients (diagnosed with uncharacteristic otoneurological symptoms, in further clinical observation defined as SM prodromes) were retrospectively examined. The following factors were taken into consideration: character and intensity of dizziness, results of static and dynamic tests, electronystagmography (ENG), caloric test, eye tracking and optokinetic nystagmus. Conclusion. Disorders of: vestibulospinal reflexes, eye tracking, optokinesis, time and regularity of caloric nystagmus occur in the very early stages of SM.

[Second primary tumors development in head and neck region. Case report]. / Pierwotne mnogie nowotwory glowy i szyi. Opis przypadku.

Tumours of head and neck present 12.2% of the pernicious tumours' morbidity rate in Poland. Annually, the number of new cases is around 6500. The authors of this work present a case of a 65-year-old farmer who has been smoking for 40 years and occasionally abusing alcohol. The medical history of the patient includes: arterial hypertension, ureterolithiasis, obesity. The patient's brother suffered from knee cancer. In 1998 the patient underwent ablation of carcinoma (2x2 cm) from the left auricle. The result of histopathological examination was Carcinoma planoepitheliale keratodes. In 2003, due to Carcinoma planoepitheliale laryngis, horizontal surgery of the larynx was performed. In the same year the patient had superficial lobe of the left parotid gland removed (due to Carcinoma planoepitheliale glandulae parotis sinisti). After the surgery, supplementary treatment was introduced (irradiation Co60; dose--60Gy on the treated area). Currently the patient is under systematic supervision. He is in a good clinical condition. There have been no features of local growth in the treated organs nor any remote metastasis reported.

[Progression of larynx and hypopharynx cancer in the last ten years]. / Zaawansowanie raka krtani i gardla dolnego w ostatnim dziesiecioleciu.

Epidemiological analysis of patients with the larynx and hypopharynx cancer, who were treated in the Department of Otolaryngology in Bialystok from 1999 to 2004 was performed. The following aspect were assessed: (1) number of patients, (2) sex, (3) profession and place of living, (4) primary site of the tumour, (5) clinical advancement stage of the disease. The study was of 676 patients. The majority--92.2%--were males but an increase in number of female patients was found. The most common site of the primary tumour was the supraglottic region (56.9%). The analysis showed that the numbers of patients with T3/T4 clinical advancement stage of the tumour was larger (64.9%).

[Quality of life for patients with laryngeal cancer]. / Jakosc zycia chorych na raka krtani.

The number of diagnosed instances of larynx cancer is systematically increasing, especially in men. Treatment, in the majority of cases, is undertaken at an advanced stage of the disease. This is the major factor determining the outcome of therapy and the patients' quality of life. The aim of this paper is to estimate the environmental and occupational risk factors as well as to evaluate the quality of life of patients before they were diagnosed with larynx cancer and after the treatment was completed. The analysis involved 82 patients after total laryngectomy due to squamous cell carcinoma. A vast majority of the patients (96%) abused alcohol and were heavy smokers (95%). 76% were exposed to harmful environmental conditions and 56%--to harmful conditions at workplace. After treatment, which was accepted by over 96% of the patients, many of them quit using alcohol (57%) and quit smoking (73%). Because of difficult economic situation only few of them decided to change their working or living conditions. 47% of patients judged that after the diagnosis and consequently after undergoing complete treatment, the quality of their life deteriorated. Their awareness of the health-threatening factors had however grown.

[Multiple meningioma in 53 years old woman manifested only by unilateral hearing loss]. / Mnogie oponiaki u 53-letniej kobiety objawiajace sie jednostronnym niedosluchem odbiorczym.

Meningioma is the most common intracranial tumour and comprises over half of extramedullar tumours of spinal canal. The causes of meningiomas occurrence are mostly unknown. Genetic factors, hormonal disorders, injuries, viral induction and ionizing radiation may play certain role in its developing. There are several histological types of meningiomas; endothelial or syncytial--the most common form (64%), fibrilplastic--12%, anaplastic--11%, transitory--7%, angioplastic--%, psammoma--3%, angiomatous--1%, warty--very rarely. Authors have presented the case of a 53-year-old farmer treated in the Department of Otolaryngology Medical Academy in Bialystok due to lipoma located behind the ear. The lipoma was removed surgically under local anaesthesia. Post-operative course was uncomplicated. During laryngologic examination sensorineural hearing loss of left ear was established. Broaden audiologic and otoneurologic diagnostics revealed sensorineural hearing loss of left ear ranged between 20 to 80 dB when impedance was normal. Constant latent polydirectional nystagmus, pathologic vibratory test and asymmetric optokinetic nystagmus were confirmed in ENG exam. Magnetic resonance was performed as the central nervous system pathology was suspected. During the exam, 4 tumours of similar morphology located paracerebrally were fond. The tumours were bounded by wide base with dura matter and corresponded to meningiomas. After neurosurgical consultation, the patient was classified to surgical treatment. Frontotemporal dextral craniotomy was performed and partial meningiomas were removed. Post-operative course was uncomplicated. Transiently, narrowed visual field was observed. Audiologic parameters did not undergo change for the worse.

[Delayed treatment of laryngeal and hypopharynx cancer in the North-Eastern part of Poland in years 1986-1999]. / Przyczyny opóznien w leczeniu raka krtani i gardla dolnego w regionie pólnocno-wschodnim Polski w latach 1986-1999.

The authors estimated larynx and hypopharynx cancer in patients treated in the Department of Otolaryngology Medical Academy in Bialystok between 1996-1999 and compared the observed state to the data from 1986-1995. At the same time, we tried to determine the causes of delayed treatment based on patients' reports and medical case histories divided according to patients and medical procedures. As in years: 1986-1995, a significant percentage of tumour progression as also observed in the present day. The T3 and T4 tumour comprised about 65% of all larynx and hypopharynx cancers in particular five-year periods. The T1 and T2 tumours included only 34% of the cases. Clinical evaluation of the lymph nodes showed that high grade of tumour progression was accompanied by unilateral or bilateral lymph node metastases (N2 and N3--about 67%). Among the causes of the delayed treatment, patients' ignorance of the first symptoms (43-51%) and ignoring follow-up visit (30-32%) are being still the most dominant ones. According to medical procedures the delay ensued mostly because the effect of apparent improvement after the treatment (36%) and, unfortunately, due to wrong diagnosis (30-31%). Nowadays, it seems to be more difficult to obtain medical advice, specifically as far as specialists are concerned.