Instrumental and Non-Instrumental Measurements in Patients with Peripheral Vestibular Dysfunctions.

Vestibular dysfunction is a disturbance of the body's balance system. The control of balance and gait has a particular influence on the quality of life. Currently, assessing patients with these problems is mainly subjective. New assessment options using wearables may provide complementary and more objective information. Posturography makes it possible to determine the extent and type of posture dysfunction, which makes it possible to plan and monitor the effectiveness of physical rehabilitation therapy. This study evaluates the effectiveness of non-instrumental clinical tests and the instrumental mobile posturography MediPost device for patients with unilateral vestibular disorders. The study group included 40 patients. A subjective description of the symptoms was evaluated using a questionnaire about the intensity of dizziness using the Dizziness Handicap Inventory (DHI) and Vertigo Syndrome Scale-short form (VSS-sf). The clinical protocol contained clinical tests and MediPost measurements using a Modified Clinical Test of Sensory Interaction on Balance. All patients underwent vestibular rehabilitation therapy (VRT) for four weeks. The non-instrumental measurement results were statistically significant, and the best was in the Timed Up and Go test (TUG). In MediPost, condition 4 was the most valuable. This research demonstrated the possibilities of using an instrumental test (MediPost) as an alternative method to assess balance.

New Estimators of the Bayes Factor for Models with High-Dimensional Parameter and/or Latent Variable Spaces.

Formal Bayesian comparison of two competing models, based on the posterior odds ratio, amounts to estimation of the Bayes factor, which is equal to the ratio of respective two marginal data density values. In models with a large number of parameters and/or latent variables, they are expressed by high-dimensional integrals, which are often computationally infeasible. Therefore, other methods of evaluation of the Bayes factor are needed. In this paper, a new method of estimation of the Bayes factor is proposed. Simulation examples confirm good performance of the proposed estimators. Finally, these new estimators are used to formally compare different hybrid Multivariate Stochastic Volatility-Multivariate Generalized Autoregressive Conditional Heteroskedasticity (MSV-MGARCH) models which have a large number of latent variables. The empirical results show, among other things, that the validity of reduction of the hybrid MSV-MGARCH model to the MGARCH specification depends on the analyzed data set as well as on prior assumptions about model parameters.

A Locally Both Leptokurtic and Fat-Tailed Distribution with Application in a Bayesian Stochastic Volatility Model.

In the paper, we begin with introducing a novel scale mixture of normal distribution such that its leptokurticity and fat-tailedness are only local, with this "locality" being separately controlled by two censoring parameters. This new, locally leptokurtic and fat-tailed (LLFT) distribution makes a viable alternative for other, globally leptokurtic, fat-tailed and symmetric distributions, typically entertained in financial volatility modelling. Then, we incorporate the LLFT distribution into a basic stochastic volatility (SV) model to yield a flexible alternative for common heavy-tailed SV models. For the resulting LLFT-SV model, we develop a Bayesian statistical framework and effective MCMC methods to enable posterior sampling of the parameters and latent variables. Empirical results indicate the validity of the LLFT-SV specification for modelling both "non-standard" financial time series with repeating zero returns, as well as more "typical" data on the S&P 500 and DAX indices. For the former, the LLFT-SV model is also shown to markedly outperform a common, globally heavy-tailed, t-SV alternative in terms of density forecasting. Applications of the proposed distribution in more advanced SV models seem to be easily attainable.

Acute laryngeal dyspnea as first presentation of granulomatosis with polyangiitis.

Granulomatosis with polyangiitis (GPA) is a multi-organ disease which mostly affects lungs, kidney, and head and neck region. We report a rare case of acute laryngeal dyspnea and rapidly progressive pulmonary changes as first manifestations of disease. A 53 year-old woman presented with symptoms of two-week dyspnea, which aggravated rapidly in the preceding hours. Laryngological examination revealed subglottic infiltrations and vocal fold oedema which required urgent tracheotomy. During few days she developed gingival ulcerations and pulmonary infiltration with negative serum c-ANCA titers. The histopathological examination of subglottic and gingival biopsies and the clinical picture established the diagnosis of GPA. She was treated with prednisone and cyclophosphamide with recovery; however, during over 3 years of follow-up, pulmonary symptoms relapsed and subglottic stenosis persisted. The difficulties in diagnosis and treatment in this unusual presentation of GPA are outlined with conclusion that in patients with subglottic infiltration, which develops rapidly, even when this is a sole presentation of the disease, and when c-ANCA are negative, GPA should always be considered.

The impact of co-morbid factors on the psychological outcome of tinnitus patients.

The study was carried out to determine the impact of some co-morbid otological symptoms and demographic factors on the emotional distress and cognitive functioning in patients with tinnitus. One hundred consecutive patients, complaining of constant idiopathic tinnitus, were enrolled into the study. Four tests were administered: Beck Depression Inventory, Hospital Anxiety Depression Scale (HADS, A--anxiety, D--depression), Mini-Mental State Examination (MMSE) and Trail Making Test (TMT). A multivariate stepwise linear regression analysis was performed to estimate the relationship between the results of each of the tests and following co-morbid factors: age, sex, tinnitus duration, tinnitus laterality, hearing status (normal hearing, unilateral hearing loss and bilateral hearing loss) and vertigo/dizziness. It was found that the scores of MMSE and TMT were negatively correlated with age and with hearing status and the scores of HADS-A were slightly correlated with sex. In regression analysis, in HADS-A, sex and to a lesser extent tinnitus duration, in MMSE and TMT age and to a lesser extent tinnitus laterality were the variables that were comprised in the final model. Demographic factors had contributed more than overlapping otological symptoms to the psychological outcome in tinnitus patients.

Evaluation of biophysical skin parameters and assessment of hair growth in patients with acne treated with isotretinoin.

INTRODUCTION: Treatment of the severe forms of acne vulgaris remains a challenge. Isotretinoin is a drug often used in these cases. Retinoids affect the mechanisms that play a role in the pathogenesis of acne, reduce the production of sebum and sizes of the sebaceous glands. However, isotretinoin appears to have undesirable side effects in the skin, mucous membranes and hair. AIM: THE AIM OF THIS STUDY WAS TO ASSESS THE EFFECT OF ACNE VULGARIS TREATMENT WITH ISOTRETINOIN ON BIOPHYSICAL SKIN PARAMETERS: skin sebum and stratum corneum hydration levels, transepidermal water loss values, pH, erythema and hair growth parameters: total number, density and proportion of anagen hair. MATERIAL AND METHODS: THE STUDY INCLUDED THIRTY PATIENTS WITH ACNE TYPES: papulopustular, conglobata and phlegmonosa. Patients were treated with isotretinoin at a dose of 0.5-1.0 mg/kg/day for a period of 4-7 months. The measurements of skin biophysical parameters were performed before and after the treatment using Sebumeter SM815, Corneometer CM825, Tewameter TM300, MX Mexameter MX18 and Skin-pH-Meter PH908. Hair growth parameters were evaluated with FotoFinder Dermoscope using the TrichoScan Professional V3.0.8.76 software. RESULTS: The results of biophysical skin parameter measurements after the treatment showed a reduction in the severity of seborrhea. However, the skin was dry, which confirmed a lowered degree of stratum corneum hydration and an increase in transepidermal water loss values. Moreover, severity of erythema, an increase in pH value, and variations in selected hair growth parameters: decrease in total count, density and proportion of anagen hair were demonstrated. CONCLUSIONS: The reduction in the skin sebum levels was observed after the treatment. There was dryness of the skin, which was confirmed by biophysical skin parameter measurements. Changes in the hair growth parameters showed telogen effluvium hair loss.

[New insight into medication adherence in chronic skin diseases]. / Nowe spojrzenie na wspólprace pacjenta z lekarzem w chorobach przewleklych skóry.

In everyday medical practice, often even carefully designed treatment plan does not bring the expected results. In such cases, it often tums out that the reason of it is lack of patient compliance to doctor's recommendations (non-adherence). This problem affects up to 50% of patients, it may be the result of many factors, such as their socioeconomic status, knowledge, motivation for treatment, and the availability and quality of medical care. The relationship between doctor and patient, the nature of disease, drug prices and the possibility of adverse side effects are also significant. Lack of involvement of patients in the treatment process is particularly evident in chronic diseases that require prolonged and regular treatment. Interpersonal skills of the clinician and a possibility to establish a good relationship between doctor and patient have strong influence on adherence. In the Internet age, patients often gain on their own information about their disease, which can both positively and negatively affect the healing process. For this reason, one of the factors that increase the compliance is a proper education of patients. In addition, the doctor may use several other useful methods to enhance the therapeutic effect. Patient's preference when selecting medicinal preparations, simplifying treatment regimens and accurate information given to patients regarding the use of drugs also have a significant impact in such cases.

Innovative System for Evaluation and Rehabilitation of Human Imbalance.

<b>Introduction:</b> Mobile posturography is based on wearable inertial sensors; it allows to test static stability (static posturography) and gait disturbances. </br> </br> <b>Aim:</b> The aim of this work was to present the results of research on the innovative MEDIPOST system used for diagnosis and rehabilitation of balance disorders. </br> </br> <b>Material and methods:</b> Fourteen articles published in influenced foreign journals were presented and discussed. The deve-lopment and construction of the device was preceded by a literature review and methodological work. The Dizziness Handi-cap Inventory (DHI) questionnaire was translated and validated. The methodology of posturography with head movements with a frequency of 0.3 Hz was also developed in the group with chronic vestibular disorders. Simultaneous measurements were performed (static posturogrphy vs. MEDIPOST) in the CTSIB-M (Modified Clinical Test of Sensory Interaction in Balance) test in healthy subjects and patients with unilateral peripheral dysfunction.</br> </br> <b>Results:</b> In the posturography with head movements the improvement of sensitivity (67 to 74%) and specificity (65 to 71%) was noted. In the CTSIB-M test the intraclass correlation coefficients for both methods were 0.9. The greatest differences between examinations were observed for the mean angular velocity in the tests on the foam (trials no. 3 and 4), in particular on the foam with eyes closed (trial no. 4 - sensitivity 86.4%, specificity 87.7%). Two functional tests were analyzed: the Swap Seats test and the 360 degree turn test. In the former, the results are studied from 6 sensors - 86% of the true positives and 73% of the true negatives for the fall/ no-fall group classification. The second test differentiates people with vestibular impairment and healthy people. It can be analyzed with 1 (sensitivity 80%) and 6 sensors (sensitivity 86%, specificity 84%). Currently, the MEDIPOST device is in the development and certification phase.

Hearing organ disorders in patients with systemic sclerosis.

In systemic sclerosis (SSc), there may develop hearing and balance disorders as a result of the immune-mediated vasculitis and fibrosis in the inner ear. The objective of the study was evaluation of the hearing organ function in patients with SSc with relationship to duration of the disease and Raynaud phenomenon and also to type and severity of the disease. Twenty unselected, consecutive patients with SSc diagnosed in compliance with the international diagnostic criteria of the American Rheumatism Association (1982), were enrolled into the study. The control group consisted of 26 otologically healthy persons matched to the SSc group for age and sex. Case history was recorded for all patients from questionnaire data. Otolaryngological examination and battery of audiological tests (pure tone audiometry, speech audiometry, impedance audiometry and auditory brainstem response-ABR) were performed. In the anamnesis 60% of patients reported vertigo, 55% headaches, 50% tinnitus, 40% hyperacusis, 40% hearing loss and 30% ear fullness. It was found that patients with SSc had significantly poorer mean hearing thresholds than the control group for 0.5, 1, 6 and 8 kHz. In ABR there were no differences between SSc and control groups although an increase of latency averages in the group of limited patients with SSc compared with the diffuse patients with SSc was observed. In eight patients (40%) sensorineural hearing loss, mostly bilateral and symmetrical was found. Furthermore, no relation was seen between hearing level and duration, type and severity of the disease. Ear involvement is frequent in systemic sclerosis and should be taken into consideration during diagnostic and therapeutic procedures.

[Skin self-injuries in psychodermatological aspect]. / Samouszkodzenia skóry w aspekcie psychodermatologicznym.

Mental disorders are the most frequent cause of self induced injuries (self-injury). Self-mutilation is a form of auto-aggression, which is a manifestation of psychic discomfort. Skin changes, defined as self-induced skin diseases, constitute the secondary problem, and require patients to consult dermatologists. Self-induced skin diseases include Münchhausen syndrome, acne excoriée, trichotillomania, nail biting (onychophagia), dermatitis artefacta, neurotic self-mutilation, self-mutilation when associated with hallucinations and delusions. A knowledge of psycho-dermatological issues among dermatologists, general practitioners, psychiatrists and psychologists facilitates proper diagnosis and the appropriate choice and form of treatment and enables patients to be provided with more complex medical care.

[Vestibular system in patients with systemic sclerosis]. / Stan ukladu przedsionkowego u pacjentów z twardzina ukladowa.

OBJECTIVES: In systemic sclerosis (SSc) there may occur hearing and balance disorders as a result of the immune-mediated inner ear damage, the etiology being vasculitis and fibrosis. The objective is the vestibular organ evaluation in patients with SSc regarding their prevalence and relationship to duration of the disease and Raynaud phenomenon and also to type and severity of SSc. MATERIAL: Twenty unselected, consecutive patients with diagnosed SSc, complying with international diagnostic criteria of the American Rheumatism Association (1982), were enrolled into the study. The control group consisted of 26 otologically healthy persons matched to the SSc group for age and sex. METHODS: In all patients the questionnaire about audiovestibular history, otolaryngological examination, static and dynamic vestibular tests and the electronystsgmography (ENG) were performed. The patients were investigated with the electronystsgmography (ENG) for spontaneous, positional and caloric-induced nystagmus. Also visual ocular-motor tests were performer. RESULTS: In the anamnesis 65% of patients reported vertigo, 55% - headaches, 50% - tinnitus, 40% - hyperacusis, 40% - hearing loss and 30% - ear fullness. Vertigo, dizziness balance disturbance and uncorrect results of Romberg and Utenberger tests were more frequent in patients with vestibular organ lesion. Abnormalities in vestibular organ in SSc patients were fund in 14 (70%) persons - the central type of lesion - 8 (40%), mixed type in 3 (15%) and peripheral in 3 (15%). CONCLUSIONS: Ear involvement is frequent in systemic sclerosis and should be taken into consideration during diagnostic and therapeutic procedures.

The Ototoxicity of Antimalarial Drugs-A State of the Art Review.

This review summarizes current knowledge about the occurrence of hearing and balance disorders after antimalarial drugs treatment. It also examines the clinical applications of antimalarials, their mechanisms behind this ototoxicity and how it can be monitored. It includes studies with larger numbers of patients and those in which auditory function was assessed using audiological tests. Some antimalarials have been repurposed for other conditions like autoimmune disorders, rheumatic diseases, some viral diseases and cancers. While old antimalarial drugs, such as quinoline derivatives, are known to demonstrate ototoxicity, a number of new synthetic antimalarial agents particularly artemisinin derivatives, demonstrate unknown ototoxicity. Adverse audiovestibular effects vary depending on the medication itself, its dose and route of administration, as well as the drug combination, treated disease and individual predispositions of the patient. Dizziness was commonly reported, while vestibular symptoms, hearing loss and tinnitus were observed much less frequently, and most of these symptoms were reversible. As early identification of ototoxic hearing loss is critical to introducing possible alternative treatments with less ototoxic medications, therefore monitoring systems of those drugs ototoxic side effects are much needed.

[Quantitative ocular-motor tests analysis in multiple sclerosis]. / Ilosciowa analiza testów wzrokowo-okoruchowych u pacjentów z SM.

UNLABELLED: Abnormalities in the ocular-motor reflex recorded in electronystagmography may indicate central vestibular system impairment. Multiple sclerosis (MS) is the most common chronic, debilitating disease characterized by focal demyelinization that develops throughout the central nerves system at varying time. The aim of the study was to apply the quantitative analysis of ocular-motor tests to evaluation degree of the central system impairment in MS patients. MATERIAL AND METHODS: The study was carried on 60 MS patients consulted in Balance Division, Otolaryngology Clinic, Medical University of Lodz, from 2002 to 2004, and 50 healthy persons as the control group. Clinical otoneurolaryngological examinations and electronystagmography tests (smooth pursuit, optokinetic, saccades) were performed in all patients. We apply the quantitative Z score analysis for gain in smooth pursuit test, slow phase velocity in optokinetic, maximal velocity of the saccades. Depending on Z score value the patients were qualified into one of three scale dysfunctions. RESULTS: Statistical correlation were found between results of all ocular-motor tests outcome in MS patients and control group. In smooth pursuit test most often second degree (35.0%), in OKN test first degree (28.3%) and in saccades the third degree (31.6%) of dysfunction was observed. The higher the values of Z score, the more abnormal results of ocular-motor reflex were observed. CONCLUSION: Application of the quantitative Z score analysis of the ocular-motor tests results demonstrating the degree of central ocular-motor system dysfunction in MS patients. This method may assist in monitoring the central vestibular system impairment and in evaluation course of the disease and degree of neurological disability.

[Auditory steady-state responses--the state of art]. / Wywolane sluchowe potencjaly stanu ustalonego (ASSR--auditory steady-state responses), dotychczasowy stan wiedzy.

The auditory steady-state responses (ASSR) is quite a new method of electrophysiological threshold estimation with no clinical standards. It was the aim of this study to review practical and theoretical thesis of ASSR and mention recent recommendations and achievements of this technique. The most common application of ASSR is diagnosis of hearing loss in children together with ABR test. In this paper we mentioned information about influence of physiological factors (age, sex, state of arousal, handedness) and type of recording technique (electrodes placement, air and bone stimulation, occlusion effect, amplitude and frequency stimulation, multiple or single frequency stimulation, dichotic and monotic recording technique and type of hearing loss) on ASSR. We conclude that putting ASSR in clinical use as an standardized method it is necessary to do research with numerous groups of patients using the same equipment and parameters of tests.

[Subjective intraoperative hearing self-assessment in patients after stapedotomy comparing to postoperative pure-tone audiometry]. / Subiektywna sródoperacyjna poprawa sluchu u chorych po stapedotomiach w porównaniu z wynikiem kontrolnego badania sluchu w audiometrii tonalnej progowej.

UNLABELLED: In otosclerosis patients the most common procedure followed at Otosurgical Dept. Medical University of Lodz is stapedotomy with insertion of teflon-piston prosthesis. When surgery is finished a whisper hearing test is done from the 1 meter distance for brief intraoperative hearing improvement assessment. There is a number of patient who report subjective intraoperative hearing improvement which is not confirmed by postoperative pure-tone audiometry (2-3rd post-op day). THE AIM OF THE STUDY: was the analysis of factors influencing stapedotomy (teflon-piston procedure) patients in which intraoperative hearing improvement was not confirmed by postoperative pure-tone audiometry. MATERIAL AND METHOD: Retrospective analysis of postoperative hearing results in patients who underwent stapedotomy (teflon-piston operation) at the Otosurgical Dept. Medical University of Lodz from 2005 to 2009. RESULTS: The total number of 142 stapedotomies were analyzed. In 27 ears no hearing improvement was reported (19.1%). Among them 18 reported intraoperative hearing improvement not confirmed on postoperative pure-tone audiometry and 9 cases intraopertively reported no hearing improvement. Patients in Group A (hearing improvement 1-2 month post stapedotomy)--12 cases (44.4%) with hearing improvement confirmed by pure-tone audiometry and Group B--5 cases (55.6%) in which no sign of hearing improvement in pure-tone audiometry was reported. CONCLUSION: In patients who intraopertively reported hearing improvement not supported by the pure-tone audiometry the following factors seem to play a vital role: a) strong suggestion and willingness of improvement after surgical treatment, b) specific condition of the whisper hearing test at the operating room environment, c) patient's stress during the surgery and strong fear of possible revision surgery.

Usefulness of Mobile Devices in the Diagnosis and Rehabilitation of Patients with Dizziness and Balance Disorders: A State of the Art Review.

OBJECTIVE: The gold standard for objective body posture examination is posturography. Body movements are detected through the use of force platforms that assess static and dynamic balance (conventional posturography). In recent years, new technologies like wearable sensors (mobile posturography) have been applied during complex dynamic activities to diagnose and rehabilitate balance disorders. They are used in healthy people, especially in the aging population, for detecting falls in the older adults, in the rehabilitation of different neurological, osteoarticular, and muscular system diseases, and in vestibular disorders. Mobile devices are portable, lightweight, and less expensive than conventional posturography. The vibrotactile system can consist of an accelerometer (linear acceleration measurement), gyroscopes (angular acceleration measurement), and magnetometers (heading measurement, relative to the Earth's magnetic field). The sensors may be mounted to the trunk (most often in the lumbar region of the spine, and the pelvis), wrists, arms, sternum, feet, or shins. Some static and dynamic clinical tests have been performed with the use of wearable sensors. Smartphones are widely used as a mobile computing platform and to evaluate the results or monitor the patient during the movement and rehabilitation. There are various mobile applications for smartphone-based balance systems. Future research should focus on validating the sensitivity and reliability of mobile device measurements compared to conventional posturography. CONCLUSION: Smartphone based mobile devices are limited to one sensor lumbar level posturography and offer basic clinical evaluation. Single or multi sensor mobile posturography is available from different manufacturers and offers single to multi-level measurements, providing more data and in some instances even performing sophisticated clinical balance tests.

[Subdural abscess in course of chronic sinusitis--a case report]. / Ropien podtwardówkowy w przebiegu przewleklego zapalenia zatok przynosowych--opis przypadku.

Subdural empyema is an uncommon and serious complication of sinusitis. Authors reported a case of 34-year-old man without internal loads/ chronic diseases in the course of chronic sinusitis of odontogenic origin. Diagnostic procedures were described. Early employed wide spectrum antibiotic therapy and inflammatory focus removal did not prevent intracranial complications. The patient required two-staged neurosurgical operation.

[Evaluation of apoptosis expression in granulation tissue in chronic otitis media]. / Ocena ekspresji markerów apoptozy w ziarninie w przewleklym zapaleniu ucha srodkowego.

INTRODUCTION: There is a growing evidence that molecular and cellular mechanisms may play a role in pathogenesis in chronic otitis media. THE AIM OF THE STUDY: was to determine the intensity of apoptosis in granulation tissue in chronic otitis media. MATERIAL AND METHOD: Fifty four patients with chronic otitis media, who underwent surgical treatment, were enrolled into the study. The apoptosis was measured in paraffin-embedded granulation tissue specimens by an immunohistochemical methods, by staining with a monoclonal antibody against apo-1/Fas/CD95 and P53 protein. The bacteriological evaluation of middle ear discharges were also done. RESULTS: It was found statistically significant difference in expression of apo-1/Fas antigen between the groups with good clinical course (good healing and without recurrence) than those in the group with poor healing and recurrence (mean percentage of immunopositive cells 1.52 vs 3.34 respectively, p<0.001). The activity of apo-1/Fas antigen was more intense in tissue samples from the group with bacterial infection caused by Pseudomonas aeruginosa/Proteus sp/Staphyloccocus MRSA than those in the group without this infection (mean percentage of immunopositive cells 3.78 vs 1.75 respectively, p<0.001). The differences were also observed for P53 protein expression between the same groups, however they were not significant. There was no differences between the groups of patients with granulomatous and cholesteatomatous chronic otitis media. The significant negative correlation was found between expression of apo-1/Fas antigen and expression of P53 protein (r=-0.64, p<0.001). CONCLUSIONS: In granulation tissue in chronic otitis media different expression of apo-1/Fas antigen was found in relationship to clinical course of disease and bacterial infection caused by Pseudomonas aeruginosa/Proteus sp/Staphyloccocus MRSA. It may suggest that apoptosis mediated by apo-1/Fas mechanism may contribute to pathogenesis of chronic otitis media.

Identification of internuclear ophthalmoplegia signs in multiple sclerosis patients. Saccade test analysis.

BACKGROUND AND PURPOSE: Patients with multiple sclerosis (MS), due to the diverse nature of the disease, have many types of eye movement disorders, particularly internuclear ophthalmoplegia (INO). The aim of the study was to evaluate the usefulness of a quantitative statistical saccade test analysis for identification of INO in MS patients. METHODS: Sixty MS patients and 50 volunteers underwent clinical bedside ocularmotor examination and electrooculographic evaluation in a tertiary referral university hospital. Simultaneous electro-oculography recordings of each eye separately were made. In the saccade test, the versional dysconjugacy index (VDI) for saccades velocity and the Z score analysis were applied. RESULTS: Clinical eye movements disorders were found in 32% of patients. In the MS patients saccades velocity was significantly lower compared with the control group. Based on the results of the control group, we established the cut off values for VDI (1.04) and corresponded Z score (4.46) as the criterion indicated the presence of INO signs in MS patients. We confirmed clinical evidence of different degrees of INO in 15% of patients, and found subclinical INO signs in 20% of patients. CONCLUSION: The EOG registration is a sensitive electrophysiological method for detecting subtle deficits of ocular motility. Saccade test analysis with calculation of the VDI and the Z-test score is a valuable method for identifying subclinical INO signs in MS patients.

[Juvenile angiofibroma in adults]. / Naczyniakowlókniak mlodzienczy u doroslych.

INTRODUCTION: Juvenile nasopharyngeal angiofibroma is a benign lesion which is characterized by three distinctive features: it occurs only in one sex, one period of age and in one location in the organism. MATERIAL AND METHOD: Basing on literature and our series concerning 36 patients treated during 50 years, we present atypical cases of angiofibroma. All of them accomplished patomorphological and clinical criteria of this neoplasm, beside of age and sex. Our study reports three cases of angiofibroma, two of them concerning males aged 34 and 49 years and one case - female aged 68 years. RESULTS: Clinical and radiological investigation revealed tumor in typical location - posterior part of nasal cavity and nasopharynx in all patients, with it's extension to paranasal sinuses in 2 cases. The preoperative supraselective embolisation was performed in two cases. Results of histological examination of our atypical cases were similar as in angiofibromas observed in adolescents. All patients were treated surgically by different approaches according to tumor's extension. A recurrence has occurred in one patient after nearly two years and was treated successfully by reoperation. In two other patients no recurrence was observed during follow-up. CONCLUSION: Our study concerning the occurrence of juvenile angiofibroma in adults, also in female, as the other observations from literature may constitute some remarks in discussion about the pathogenesis and clinics of this tumor.