Andrzej Sieśkiewicz

Ocena korelacji średniego ciśnienia tętniczego z krwawieniem śródoperacyjnym przy wolnej czynności serca w trakcie endoskopowej chirurgii zatok przynosowych

UNLABELLED Induced controlled hypotension is a standard method aimed at decreasing intraoperative bleeding and achieving good operative field conditions. Low hemodynamic parameters during the operation are related to increased risk of brain hypoperfusion and injury to hypoxia-sensitive nerve cells. The purpose of this study was to find the mean arterial pressure (MAP) that preserves good operative conditions at low heart rate (HR) during endoscopic sinus surgery. MATERIAL AND METHOD Twenty eight patients ASA I-II were anesthetized using remifentanil and sevoflurane. The anesthetist was attempting to keep the heart rate around 60 b/min. tried to diminish the MAP gradually until good operative field conditions were achived. The surgeon blinded to the HR and MAP values rated the bleeding in the operative field on the basis of Fromm and Boezzart scale. Spearman rank correlation coefficient was used to assess the statistical dependence between the variables. RESULTS The best operative conditions were achieved in patients with the lowest MAP and HR. By keeping the HR at the level of 60 b/min in about 40% of patients very good and good operative field conditions were achieved at MAP higher than 65 mm Hg. There was a significant and strong correlation between the operative field conditions and MAP (Spearman rank correlation test, R = 0.54 p = 0.003). CONCLUSIONS With the stable low heart rate at the minimal physiological values the bleeding in the operative field depends on MAP. Keeping HR around 60 b/min there is no need to decrease the MAP to dangerously low levels to achieve good operative field conditions in great proportion of patients.Summary Induced controlled hypotension is a standard method aimed at decreasing intraoperative bleeding and achieving good operative field conditions. Low hemodynamic parameters during the operation are related to increased risk of brain hypoperfusion and injury to hypoxia-sensitive nerve cells. The purpose of this study was to find the mean arterial pressure (MAP) that preserves good operative conditions at low heart rate (HR) during endoscopic sinus surgery. Material and method Twenty eight patients ASA I–II were anesthetized using remifentanil and sevoflurane. The anesthetist was attempting to keep the heart rate around 60 b/min. tried to diminish the MAP gradually until good operative field conditions were achived. The surgeon blinded to the HR and MAP values rated the bleeding in the operative field on the basis of Fromm and Boezzart scale. Spearman rank correlation coefficient was used to assess the statistical dependence between the variables. Results The best operative conditions were achieved in patients with the lowest MAP and HR. By keeping the HR at the level of 60 b/min in about 40% of patients very good and good operative field conditions were achieved at MAP higher than 65 mm Hg. There was a significant and strong correlation between the operative field conditions and MAP (Spearman rank correlation test, R = 0.54 p = 0.003). Conclusions With the stable low heart rate at the minimal physiological values the bleeding in the operative field depends on MAP. Keeping HR around 60 b/min there is no need to decrease the MAP to dangerously low levels to achieve good operative field conditions in great proportion of patients.

Chirurgia endoskopowa zatok przynosowych i podstawy czaszki ze wspomaganiem neuronawigacją: porównanie systemów optycznych i elektromagnetycznych

Summary Transnasal endoscopic operative methods became increasingly popular in paranasal sinuses and cranial base surgery. Various types of localization systems are recently used to navigate through and between tangled anatomical structures in this region. The aim of this study was to compare (as basing on our own clinical experience), the advantages and limitations of the optical and electromagnetic neuronavigation systems. Material and method Optical neuronavigation system (Stealth Station Treon plus, Medtronic, USA) and electromagnetic neuronavigation systems (DigiPointeur, Collin, France and Fusion ENT, Medtronic, USA) were used during endoscopic operations of paranasal sinuses, anterior skull base, orbits, parasellar region and clivus. The subject of comparison were precision of both system types and additional time necessary for setting up the system. Also assessed were convenience of navigation and easiness of manipulation with neuronavigated instruments during surgical procedures performed using classical endoscopic technique, bimanual technique and four hand technique. Results The accuracy was high and comparable for both system types and did not deteriorate during the procedure. The time needed to set up of the optical system was somewhat longer. Surgeons comfort during operative procedures was assessed as slightly higher for the electromagnetic systems, especially if four hand or bimanual techniques were used and if constant neuronavigation was indispensible. The optical system allows for navigation of a variety of surgical tools and this was considered a great advantage over the electromagnetic systems in this particular application. Conclusions The additional time spent in the operative theatre for getting a system ready is well paid off by better orientation of a surgeon in the operative field consequently increasing safety and higher accuracy of surgical procedure. What system should a surgeon use depends to a great extent on the type of planed procedure and preferred surgical technique.

Przeznosowy dostęp endoskopowy celem odbarczenia nerwu wzrokowego

Summary Optic nerve decompression is nowadays increasingly performed using endoscopic technique. The aim Of this report is to present a clinical series of 8 patients operated on with this technique due to posttraumatic loss of vision and other visual disturbances. Technical details of this procedure and surgical anatomy will also be discussed. Material and methods Endoscopic optic nerve decompression was performed in eight patients using transnasal transethmoidal approach. The loss of vision was caused by posttraumatic optic neuropathy in 6 patients, optic neuritis in 1 patient and by cystic lesion of the orbital apex and sphenoid sinus in 1 patient. Results Vision acuity improvement was achieved in 4 patients (50%). Complications included intraoperative cerebrospinal fluid leak occurred in 2 patients. In one of them the leak had to be sealed using intracranial approach. Conclusions Endoscopic optic nerve decompression can be used in appropriately selected patients with optic nerve lesions to improve the visual functions. High technical skill, proper endowment and thorough knowledge of surgical anatomy are prerequisites of success. Good interdisciplinary cooperation between the laryngologist and neurosurgeon helps in minimizing the risk of serious complications, especially in posttraumatic cases.UNLABELLED Optic nerve decompression is nowadays increasingly performed using endoscopic technique. THE AIM of this report is to present a clinical series of 8 patients operated on with this technique due to posttraumatic loss of vision and other visual disturbances. Technical details of this procedure and surgical anatomy will also be discussed. MATERIAL AND METHODS Endoscopic optic nerve decompression was performed in eight patients using transnasal transethmoidal approach. The loss of vision was caused by posttraumatic optic neuropathy in 6 patients, optic neuritis in 1 patient and by cystic lesion of the orbital apex and sphenoid sinus in 1 patient. RESULTS Vision acuity improvement was achieved in 4 patients (50%). Complications included intraoperative cerebrospinal fluid leak occurred in 2 patients. In one of them the leak had to be sealed using intracranial approach. CONCLUSIONS Endoscopic optic nerve decompression can be used in appropriately selected patients with optic nerve lesions to improve the visual functions. High technical skill, proper endowment and thorough knowledge of surgical anatomy are prerequisites of success. Good interdisciplinary cooperation between the laryngologist and neurosurgeon helps in minimizing the risk of serious complications, especially in posttraumatic cases.

Endoscopic treatment of adversely located osteomas of the frontal sinus.

Objectives We assess the utility and limitations of an endoscopic technique in the treatment of osteomas that are considered difficult to manage endoscopically, ie, those located superiorly or laterally in the frontal sinus, extending beyond a virtual plane through the lamina papyracea, and we describe the principles of a surgical technique that facilitates removal of such tumors. Methods We performed a retrospective study on 8 patients with symptomatic frontal sinus osteomas, including tumors extending past the commonly recognized limits of endoscopic resection because of their size or site of attachment. Results All tumors were removed by a purely transnasal endoscopic approach. No major complications were observed during or after the operation. All patients experienced improvement or total regression of their symptoms. Conclusions With appropriate instruments and specific endoscopic techniques, it is possible to resect osteomas that not long ago were deemed inaccessible to endoscopic surgeons. The commonly recognized limits of endoscopic treatment of such tumors may be exceeded in some cases; however, favorable anatomic conditions are decisive for a successful operation.

Ocena aktywności katepsyny D w błonie śluzowej pacjentów z przewlekłym zapaleniem zatok przynosowych z polipami

Summary Nasal polyposis affects about 1 to 4% of the population. Polyps develop in oedematous and inflammated mucous membrane. In spite of the intensive research the pathomechanism of their development is not fully understood. The majority of the theories concerning the development of nasal polyps emphasize the role of the inflammatory process causing the rupture of the epithelium and the basal membrane. Cathepsin D is one of important mediators of inflammatory processes, that may be involved in the pathogenesis of nasal polyposis. The aim of the study Was to establish the role of the cathepsin D in the pathogenesis of nasal polyps. Matherial and method Tissues were taken from 39 patients treated with endoscopic sinus surgery due to chronic rhinosinusitis with polyps. The activity of the cathepsin D was assesed with spectrofotometric method using the specific inhibitor (pepstatin) in tissue of nasal polyps, in oedematous and the inflammated mucous membrane of the nasal conchae and the samples of mucous membrane taken from the nasal septum. Results Statistically significant difference in cathepsin D activity between polypoid tissue, inflammated mucosa and the mucous membrane of the nasal septum was detected (t-student test, p Conclusion Increased activity of the cathepsin D in nasal polyps and inflammatory changed mucosa confirm the important role of the cathepsin D in inflammatory processes leading to damage and subsequent remodeling of mucous membrane. We believe that further research on the activity of other proteolytic enzymes is necessary to demonstrate the differences between the inflammable changed mucous membrane and nasal polyps.

Evaluation of tumor microsatellite instability in laryngeal cancer using five quasimonomorphic mononucleotide repeats and pentaplex PCR.

PURPOSE To determine microsatellite instability (MSI) in squamous cell carcinoma of the larynx. MATERIAL AND METHODS The study was performed in a group of 30 male patients, aged 42-47 years. All patients underwent total laryngectomy with lymph nodectomy. Histologically all tumors were squamous cell carcinomas. Detection of MSI was based on comparison of allelic profiles generated from amplification of matching normal and tumor DNA. RESULTS The appearance of novel alleles in the tumor DNA indicated microsatellite instability. MSI analysis showed a microsatellite stable phenotype in 23 cases (77%). CONCLUSIONS MSI may not contribute to the development of squamous cell carcinoma of the larynx.

Minimally invasive transnasal medial maxillectomy for treatment of maxillary sinus and orbital pathologies.

Abstract Conclusion: Minimally invasive transnasal medial maxillectomy with preservation of the nasolacrimal duct may provide an alternative method for surgical treatment of selected maxillary sinus and inferior orbit pathology if more extensive endonasal or external approach procedures are to be avoided. Objectives: To present a modification of the transnasal endoscopic approach to the maxillary sinus leading through its medial wall, anteriorly to the nasolacrimal duct that considerably improves access to the antero-inferior part of the maxillary sinus and entire orbital floor. To discuss indications for the procedure along with surgical outcome after at least 12 months of follow-up. Methods: A total of 22 selected patients with extensive/refractory inflammatory maxillary sinus disease that could not be cleared completely through middle meatal antrostomy or pathologies of the inferior orbit that required uncompromised access to the orbital floor were operated with this method. The effectiveness of the treatment was evaluated through clinical symptomatology and endoscopic examination to confirm eradication of the disease. Results: The presented method allowed for good overall symptom control and eradication of disease confirmed endoscopically in about 90% of cases with an inflammatory type of disease. The visualized reach within the maxillary sinus with commercially available endoscopic instruments was conspicuously improved as compared with middle meatal antrostomy.

Grzybice zatok przynosowych leczone metodą endoskopową w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Białymstoku

Summary Over the last years we have observed a high frequency of fungal infections of the paranasal sinuses. Fungal infections can be grouped into invasive and non-invasive forms. Surgical removal of the sinus fungal masses to ensure drainage and aeration is performed using the endoscopic sinus surgery. General or local antifungal drugs are not indicated in the cases of non-invasive forms. For the treatment of invasive fungal sinusitis aggressive antifungal therapy and surgical treatment are the mainstays of management. The treatment results of 18 patients suffering from fungal infections of the paranasal sinuses operated endoscopically during 4 years period (2006–2009) in Otolaryngology Department of Medical University in Bialystok were presented.

Endoskopowe leczenie płynotoków nosowych

UNLABELLED Endoscopic surgery due to its high efficacy and relatively minor intraoperative trauma became a standard of transnasal csf leak treatment. THE AIM OF THIS STUDY was to present, basing on our own experience, diagnostic and therapeutic methods of treatment of various types of csf rhinorhea. MATERIAL AND METHOD All together 14 endoscopic skull base reconstructions were performed. The bony defect and dural perforations were closed using: fat grafts, septal bone or cartilage, mucosal flaps of the septum or nasal concha, artificial dura and collagen sponge with fibrin glue. The defect was localized by high resolution computed tomography, magnetic resonance cisternography, neuronavigation system and fluorecein test. RESULTS Complete closure of the defect and resolution of the csf leak after the first attempt was achieved in 92,3% of patients. In one case the rhinorhea was successfully stopped after the second reconstructive procedure. No adverse reaction of intrathecal fluorescein administration were noted in our patients. CONCLUSIONS Endoscopic surgeons have a wide variety of diagnostic tools and operative techniques at their disposal for precise localization and management of csf rhinorhea. The key for high efficacy of the treatment is appropriate selection of diagnostic and surgical method depending on cause, type, size and localization of the leak.Summary Endoscopic surgery due to its high efficacy and relatively minor intraoperative trauma became a standard of transnasal csf leak treatment. The aim of this study was to present, basing on our own experience, diagnostic and therapeutic methods of treatment of various types of csf rhinorhea. Material and method All together 14 endoscopic skull base reconstructions were performed. The bony defect and dural perforations were closed using: fat grafts, septal bone or cartilage, mucosal flaps of the septum or nasal concha, artificial dura and collagen sponge with fibrin glue. The defect was localized by high resolution computed tomography, magnetic resonance cisternography, neuronavigation system and fluorecein test. Results Complete closure of the defect and resolution of the csf leak after the first attempt was achieved in 92,3% of patients. In one case the rhinorhea was successfully stopped after the second reconstructive procedure. No adverse reaction of intrathecal fluorescein administration were noted in our patients. Conclusions Endoscopic surgeons have a wide variety of diagnostic tools and operative techniques at their disposal for precise localization and management of csf rhinorhea. The key for high efficacy of the treatment is appropriate selection of diagnostic and surgical method depending on cause, type, size and localization of the leak.

Grzyby pleśniowe i rola alergii na grzyby w przewlekłym zapaleniu błony śluzowej nosa i zatok przynosowych

Summary Aim The aim of this work was to assessment the role of mould fungi and the allergy on fungi in chronic rhinosinusitis. Material and methods We studied 30 patients with chronic rhinosinusitis with or without polyposis who underwent endoscopic nose and sinuses procedures. Clinical and immunological workup was performed for atopy in all patients. We performed CT of the sinuses, skin – prick testing on 15 fungal allergens, total IgE and fungal-specific IgE levels, eosinophilia level. Specimens were sent for mycology and histopathologic analysis for identyfication of fungi. Results Fungal culture from sinuses were negative in all patients. Bacterial culture were positive in 19 cases. There was observed elevated total immunoglobulin E level in 70% of patients. Positive skin test reactivity for fungal allergen was observed in 7 patients – 3 for Aspergillus, 2 for Alternaria and 2 for Cladosporium. Fungal specific IgE levels were below 0,35 KU/L in all patients. Nasal polyps were found in 26 patients, they were associated with asthma and aspirin intollerance. No fungal hyphae were found in histopathologic analysis. Conclusions Our preliminary study suggest, that allergy for fungi doesn’t play a significant role in etiology and pathogenesis of the chronic rhinosinusitis with or without polyps. We did’t find any case of the allergic fungal sinusitis in our patients.