Henryk Kaźmierczak

Przypadek mnogich powikłań zatokopochodnych w ostrym jednostronnym zapaleniu zatok przynosowych

Summary 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.

Udział białka RCAS1 w tworzeniu supresyjnego profilu mikrośrodowiska raka płaskonabłonkowego gardła środkowego

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.Summary 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

Poszukiwanie patologii słuchowo-przedsionkowej w celiakii☆☆☆☆

Summary The aim of the study was looking for the vestibular or/and auditory pathology in patients with celiac disease. The group of 30 cases aged 6–18 (mean: 9,2) were tested. The results were compared with 30 healthy persons aged 6–18. The tonal audiometry, distorsion product otoacoustic emission, brain stem auditory evoked potentials, electronystagmography and vestibular evoked myogenic potentials were performed. There were no pathological findings on the base of audiological tests (till upper brain stem) in celiac disease. In electronystagmography gaze nystagmus, disordered eye-tracking test and optokinetic nystagmus were observed the most frequently. Gluten-free diet and time of the disease did not influence the results. The electrical conduction through the auditory and vestibular pathways were analyzed as well. No disturbances were noted in celiac disease. The results confirm the hypothesis that neurological signs – vestibular in our study – appeared early, were connected with the histopathological changes of jejunum and remained despite of correct treatment of the disease.

Wartość testu Halamagyi-Curthoysa w diagnostyce neurootologicznej

Summary The aim of the study The goal of the study was to state the usefulness of the Halmagyi-Curthoys’ test in the patients with unilateral vestibular weakness. The influence of the heaviness of the canal paresis, spontaneous nystagmus and compensation on the test results was observed. Material and methods The investigation was performed in 68 patients with unilateral vestibular weakness of the various origin. Halmagyi-Curthoys’ test was done using passive way. Results In healthy subjects the test results were negative. In patients: 47% demonstrated positive test, 44,1% negative proof, in 8,9% test was difficult to estimate. Conclusions The obtained results pointed out that Halmagyi-Curthoys test is useful as orientation, preliminary examination, generally in cases with deep canal paresis (according to Dix- Hallpikes classification).

Assessment of the State of the Natural Antioxidant Barrier of a Body in Patients Complaining about the Presence of Tinnitus

Background Tinnitus is defined as a phantom auditory perception, i.e., sound experience despite the lack of acoustic stimuli in the environment. The aim of this study was to assess the state of the natural antioxidant barrier of a body in patients complaining about the presence of tinnitus. Material and Methods The study included a total of 51 patients aged from 20 to 62 years with diagnosed idiopathic tinnitus and 19 healthy subjects as a control group. All patients underwent the audiometric tone test, speech audiometry, distortion otoacoustic emission product testing, study of evoked auditory potentials of short latency, and biochemical analysis of venous blood concerning values of activity or concentration of glutathione, glutathione peroxidase, S-transferase, glutathione reductase superoxide dismutase, malondialdehyde, and ceruloplasmin as the selected parameters of oxidative stress. Results Disorders of the auditory pathway were not only limited to the cochlea but also covered its further episodes. Mean values of activity or concentration of the selected parameters of oxidative stress in the study and control groups showed reduced effectiveness of the bodys natural antioxidant barrier. Discussion Patients complaining about the presence of tinnitus showed reduced effectiveness of the bodys natural antioxidant barrier compared to the control group. Conclusions The main indication to undertake further research on the functioning of the antioxidant barrier in people suffering from ailments in the form of tinnitus is to determine a suitable therapy aimed at improving the quality of life of these patients, which might be the administration of antioxidant medications.

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 treatments 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 Warthins 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 Toruń 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 Warthins 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 Freys 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 Warthins tumor of the lower pole of the parotid glands superficial lobe. 2. After removal of a cancerous lesion of the parotid gland, every patient requires periodic laryngological monitoring.

An Analysis of the Association between Epilepsy-Related Genes and Vertigo in the Polish Population

Considering the possibility of a common genetic background of vertigo and epilepsy, we genotyped an affected group of individuals with vertigo and an unaffected group, by studying 26 single-nucleotide polymorphisms (SNPs) in 14 genes which were previously reported to be of particular importance for epilepsy. Significant differences were found between the patients and the control group (χ2 = 38.3, df = 3, p = 1.6 × 10–7) for the frequencies of haplotypes consist ing of 2 SNPs located in chromosome 11 (rs1939012 and rs1783901 within genes MMP8 and SCN3B, respectively). The haplotype rs1939012:C-rs1783901:A, consisting of the minor-frequency alleles was found to be associated with a higher risk of vertigo (OR = 5.0143, 95% CI = 1.6991–14.7980, p = 0.0035). In contrast, the haplotype rs1939012:T-rs1783901:A showed a significant association with a decreased risk of the disease (OR = 0.0597, 95% CI = 0.0136–0.2620, p = 0.0002). Our results suggest that the SNPs rs1939012 and rs1783901 may play a potential role of gene regulation and/or epistasis in a complex etiology of vertigo.

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.

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.