Joanna Urbaniak

Wczesne powikłania tracheotomii przezskórnej metodą Griggsa w materiale własnym

INTRODUCTION The aim of the work was to assess early complications of Griggs percutaneous tracheotomy in the own material. MATERIAL AND METHODS The study covered 155 patients aged 17-88, including 36 women and 119 men. The patients were treated at the Department of Anaesthesiology and Intensive Therapy between 2006-2010. They underwent Griggs percutaneous tracheostomy by a laryngologist or a trained anaesthesiologist. Each surgical procedure was conducted with the use of Portex Blue Line Ultra Percutaneous Tracheotomy Kit (Smiths Medical Co., USA), the trachea was intubated while the patient was under general anaesthesia with propofol, fentanyl and relaxation with atracurium. RESULTS The studied material revealed Griggs percutaneous tracheotomy complications in 26 patients (16.8%), in which 11 patients (7.1%) presented complications within the perioperative period while 15 patients (9.7%) reported early complications. Haemorrhage, usually not very profuse, occurred 7 times (4.6%), mainly in tracheopunction, and was the most often perioperative complication. Moreover, in the perioperative period, 3 patients (1.9%) had trachea identifications difficulties, which required tracheopunction many a time, and 1 patient (0.65%) encountered sudden circulatory arrest with asystolia and effective CPR. In the early postoperative period after Griggs percutaneous tracheotomy, the most common complication was haemorrhage in the operative twenty-four hours, which was noted in 10 patients (6.5%). Among other adverse complications were found: infection of the tissues near the tracheostomal region in 3 patients (1.9%), subcutaneous oedema in 1 patient (0.65%), accidental removing the tube from an unformed tracheostoma in 1 patient (0.65%). CONCLUSIONS In the studied material, complications after Griggs percutaneous tracheotomy amounted to 16.8%, of which 7.1% occurred in the perioperative period while 9.7% were early complications, mainly light bleeding. This may prove good preparation of the surgical team for the surgical procedures.Summary Introduction The aim of the work was to assess early complications of Griggs percutaneous tracheotomy in the own material. Material and methods The study covered 155 patients aged 17–88, including 36 women and 119 men. The patients were treated at the Department of Anaesthesiology and Intensive Therapy between 2006–2010. They underwent Griggs percutaneous tracheostomy by a laryngologist or a trained anaesthesiologist. Each surgical procedure was conducted with the use of Portex Blue Line Ultra Percutaneous Tracheotomy Kit (Smiths Medical Co., USA), the trachea was intubated while the patient was under general anaesthesia with propofol, fentanyl and relaxation with atracurium. Results The studied material revealed Griggs percutaneous tracheotomy complications in 26 patients (16.8%), in which 11 patients (7.1%) presented complications within the perioperative period while 15 patients (9.7%) reported early complications. Haemorrhage, usually not very profuse, occurred 7 times (4.6%), mainly in tracheopunction, and was the most often perioperative complication. Moreover, in the perioperative period, 3 patients (1.9%) had trachea identifications difficulties, which required tracheopunction many a time, and 1 patient (0.65%) encountered sudden circulatory arrest with asystolia and effective CPR. In the early postoperative period after Griggs percutaneous tracheotomy, the most common complication was haemorrhage in the operative twenty-four hours, which was noted in 10 patients (6.5%). Among other adverse complications were found: infection of the tissues near the tracheostomal region in 3 patients (1.9%), subcutaneous oedema in 1 patient (0.65%), accidental removing the tube from an unformed tracheostoma in 1 patient (0.65%). Conclusions In the studied material, complications after Griggs percutaneous tracheotomy amounted to 16.8%, of which 7.1% occurred in the perioperative period while 9.7% were early complications, mainly light bleeding. This may prove good preparation of the surgical team for the surgical procedures.

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

INTRODUCTION The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. MATERIALS AND METHODS In the years 2006-2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed. RESULTS Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found. CONCLUSIONS Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.

Inflammation of the frontal intersinus septal air cell as a cause of headaches

Highlights • Surgery via the external approach appears to be an effective method in some cases.• ISSC is relatively often but rarely associated with pain.• In ISSC inflammation requires surgery as the only method of choice.

Acoustic and capacity analysis of voice academic teachers with diagnosed hyperfunctional dysphonia by using DiagnoScope Specialist software.

OBJECTIVES The aim of the study was to assess the acoustic and capacity analyses of voice in academic teachers with hyperfunctional dysphonia using DiagnoScope Specialist software. MATERIAL AND METHODS The study covered 46 female academic teachers aged 34-48 years. The women were diagnosed with hyperfunctional dysphonia (with absence of organic pathologies). Having obtained the informed consent, a primary medical history was taken, videolaryngoscopic and stroboscopic examinations were performed and diagnostic voice acoustic and capacity analyses were carried out using DiagnoScope Specialist software. RESULTS The acoustic analysis carried out of academic teachers with diagnosed hyperfunctional dysphonia showed enhancement in the following parameters: fundamental frequency (FO) by 1.2%; relative average perturbation (Jitter by 100.0% and RAP by 81.8%); relative amplitude perturbation quotient (APQ) by 2.9%; non-harmonic to harmonic ratio (U2H) by 16.0%; and noise to harmonic ratio (NHR) by 13.4%. A decrease of 2.5% from normal values was noted in relative amplitude perturbation (Shimmer). Formant frequencies also showed reduction (F1 by 10.7%, F2 by 5.1%, F3 by 2.2%, and F4 by 3.5%). The harmonic perturbation quotient (HPQ) was 0.8% lower and the residual harmonic perturbation quotient (RHPQ) 16.8% lower, with the residual to harmonic (R2H) decreasing by 35.1 per cent; the sub-harmonic to harmonic (S2H) by 2.4%; and the Yanagihara coefficient by 20.2%. CONCLUSIONS The capacity analysis with the DiagnoScope Specialist software showed figures significantly lower than normal values of the following parameters: phonation time, true phonation time, phonation break coefficients, vocal capacity coefficient and mean vocal capacity.

Evaluation of selected parameters of the coagulation system during the perioperative period in patients undergoing endoscopic surgery of the paranasal sinuses

Introduction The aim of the study was to evaluate selected parameters of the coagulation system during the perioperative period in patients undergoing endoscopic sinus surgery. Material and methods The study involved 121 patients: group I – 42 patients who did not receive anticoagulatory or antiplatelet medications, qualified for endoscopic sinus surgery under total intravenous anaesthesia (TIVA); group II – 40 patients who received in the perioperative period low-molecular-weight heparins, qualified for endoscopic sinus surgery under TIVA; group III – 39 patients diagnosed according to a schedule, due to vertigo or loss of hearing. All the patients received a full laryngological examination and detailed audiological and otoneurological diagnostics, and examination of selected haemostatic parameters before the surgery/diagnostics. Results The analysis of concentrations of coagulation parameters in groups I and II revealed a statistically significantly higher international normalized ratio value before surgery (I – 1.11; II – 1.08) and 48 h following surgery (I – 1.15; II – 1.10) in group I. The concentration of coagulation factor VII in the study patients was considerably higher in group I for all three measurements (481.93; 443.13; 486.02). The concentration of fibrinogen (coagulation factor I) was significantly lower in group I before surgery (3.2) and at 6 h after surgery (2.84). A significantly lower level of von Willebrand factor was found in group I before surgery (2.94). Comparing test results of groups I and III, who did not receive antiaggregants, statistically significant differences were observed in both tests for factors VII and VIII. Conclusions Concentrations of von Willebrand factor and prothrombin revealed statistically significant differences in between groups.

The influence of the body mass index (BMI) on selected parameters of the coagulation system in patients with disorders of the balance system taking oral contraceptives.

INTRODUCTION The objective of the paper is to evaluate the influence of the body mass index (BMI) on selected parameters of the coagulation system in patients with disorders of the balance system taking oral contraceptives. MATERIAL AND METHODS 105 young women participated in the study who were divided into 2 groups. Group I: 52 women disorders of the balance system taking hormonal contraceptives for at least 2 months, between the age of 20-49; Group II: 53 women with no disorders of the balance system taking hormonal contraceptives for at least 2 months, between the age of 18-40. Patients entering the study underwent full otoneurological examination, detailed laryngological assessment and the examination of selected parameters of the hemostasis system, including the evaluation of fibrinogen and D-dimer levels, APTT and PT, estradiol and progesterone concentrations in the blood serum and evaluation of the body mass index (BMI). RESULTS Central vertigo was the most common type of vertigo in the study group (59,6% of cases). Other vertigo types in this group included compensated vertigo of mixed origin (36,6% of cases) and peripheral vertigo (only 3,8% of cases), which indicates that 40.4% of the cases suffer from damage to the labyrinth. The analysis of the concentration of estradiol in the blood serum revealed, after consideration of a menstrual cycle phase, that estradiol concentration exceeded normative values significantly more often in the study group than in the control group and that estradiol concentration was significantly less frequently below the norm in the study group; the difference was statistically significant (p=0,048). The body mass index (BMI) of women participating in the study significantly correlated with the concentration of D-dimers only in the study group (p=0,35 vs p=0,012). CONCLUSIONS Evaluating the body mass index before administering hormonal contraception can be useful to eliminate other risk factors for thromboembolism. In order to prevent potential thromboembolism episodes, administering hormonal contraception only after lowering the body mass index may also be worth considering.INTRODUCTION The objective of the paper is to evaluate the influence of the body mass index (BMI) on selected parameters of the coagulation system in patients with disorders of the balance system taking oral contraceptives. MATERIAL AND METHODS 105 young women participated in the study who were divided into 2 groups. Group I: 52 women disorders of the balance system taking hormonal contraceptives for at least 2 months, between the age of 20-49; Group II: 53 women with no disorders of the balance system taking hormonal contraceptives for at least 2 months, between the age of 18-40. Patients entering the study underwent full otoneurological examination, detailed laryngological assessment and the examination of selected parameters of the hemostasis system, including the evaluation of fibrinogen and D-dimer levels, APTT and PT, estradiol and progesterone concentrations in the blood serum and evaluation of the body mass index (BMI). RESULTS Central vertigo was the most common type of vertigo in the study group (59,6% of cases). Other vertigo types in this group included compensated vertigo of mixed origin (36,6% of cases) and peripheral vertigo (only 3,8% of cases), which indicates that 40.4% of the cases suffer from damage to the labyrinth. The analysis of the concentration of estradiol in the blood serum revealed, after consideration of a menstrual cycle phase, that estradiol concentration exceeded normative values significantly more often in the study group than in the control group and that estradiol concentration was significantly less frequently below the norm in the study group; the difference was statistically significant (p=0,048). The body mass index (BMI) of women participating in the study significantly correlated with the concentration of D-dimers only in the study group (p=0,35 vs p=0,012). CONCLUSIONS Evaluating the body mass index before administering hormonal contraception can be useful to eliminate other risk factors for thromboembolism. In order to prevent potential thromboembolism episodes, administering hormonal contraception only after lowering the body mass index may also be worth considering.

Brodawczaki odwrócone nosa i zatok przynosowych w materiale własnym

INTRODUCTION The aim of this work was to analyze the occurrence of inverted papilloma within the nose and paranasal sinuses, the extent of lesions and the clinical course in the patients who underwent endoscopic surgery. MATERIALS AND METHODS Between the years of 2006-2012, at the Department of Otolaryngology and Laryngological Oncology, 2295 patients were subjected to surgery due to paranasal sinus diseases. The material was based on their past medical histories. The analysis includes the age and gender of the patients, the type of surgery, and results of histopathological examinations. A surgical procedure covered the paranasal sinuses with lesions diagnosed in CT. The qualified patients had inverted papilloma in histopathological results. RESULTS Among 2295 patients who were operated because of chronic inflammatory changes, inverted papilloma was histopathologically diagnosed in 49 cases. In 16 patients with inverted papilloma, inflammatory changes were present on one side only, while in 33 cases inverted papilloma was confirmed histopathologically on one side. The analysis of age and gender of the study group showed that the highest occurrence of inverted papilloma was in patients over 50 years of age. In the majority of the studied cases, inverted papilloma spread in the middle nasal concha and the maxillary or ethmoid sinus. CONCLUSIONS In surgery, the endoscopic technique allows for an effective removal of inverted papilloma from the nose and paranasal sinuses. According to the authors, endoscopy is the most valuable method for post-operative monitoring of recurrent inverted papilloma.

The effect of oral contraceptives on selected parameters of homeostasis in young women with sudden balance disorders

Introduction The aim of the study was to evaluate the correlation between hormonal contraceptives and sex hormones levels as a possible cause of vertigo related to coagulation disorders and fibrinolyse.INTRODUCTION The aim of the study was to evaluate the correlation between hormonal contraceptives and sex hormones levels as a possible cause of vertigo related to coagulation disorders and fibrinolyse. MATERIAL AND METHODS The study was conducted on 25 female patients aged 23-39, who were treated at the Department of Otolaryngology and Laryngological Oncology, Medical University of Lodz, due to vertigo. The studied patients were divided into 3 groups: I--7 women that used hormonal contraceptives; II--9 women that no used hormonal contraceptives for the last 6 months; III--9 women who never used contraceptives. The methodology included: an otoneurological and audiological examination, blood tests, levels of fibrinogen, D-dimers, APTT, PT, ALAT, ASPAT and BMI, estradiol and progesterone levels. RESULTS In 16 out of the 25 patients the obtained results diverged from normal sex hormones concentration in serum. In each studied group the relation between sex hormones concentration in serum and coagulation and fibrinolyse parameters was proved. The correlation between an increased concentration progesterone and D-dimers was found. CONCLUSIONS An increased concentration of estrogens in serum may have an additional negative effect on a possibility of a thromboembolic episode. In the female patients interested in oral contraception, the prophylactic exclusion of risk factors for a thromboembolic disease seems to be vital.

Artykuł oryginalny/Original research articleWpływ działania doustnych środków antykoncepcyjnych na wybrane parametry układu hemostazy u młodych kobiet z nagłym zaburzeniem czynności układu równowagiThe effect of oral contraceptives on selected parameters of homeostasis in young women with sudden balance disorders

Introduction The aim of the study was to evaluate the correlation between hormonal contraceptives and sex hormones levels as a possible cause of vertigo related to coagulation disorders and fibrinolyse.INTRODUCTION The aim of the study was to evaluate the correlation between hormonal contraceptives and sex hormones levels as a possible cause of vertigo related to coagulation disorders and fibrinolyse. MATERIAL AND METHODS The study was conducted on 25 female patients aged 23-39, who were treated at the Department of Otolaryngology and Laryngological Oncology, Medical University of Lodz, due to vertigo. The studied patients were divided into 3 groups: I--7 women that used hormonal contraceptives; II--9 women that no used hormonal contraceptives for the last 6 months; III--9 women who never used contraceptives. The methodology included: an otoneurological and audiological examination, blood tests, levels of fibrinogen, D-dimers, APTT, PT, ALAT, ASPAT and BMI, estradiol and progesterone levels. RESULTS In 16 out of the 25 patients the obtained results diverged from normal sex hormones concentration in serum. In each studied group the relation between sex hormones concentration in serum and coagulation and fibrinolyse parameters was proved. The correlation between an increased concentration progesterone and D-dimers was found. CONCLUSIONS An increased concentration of estrogens in serum may have an additional negative effect on a possibility of a thromboembolic episode. In the female patients interested in oral contraception, the prophylactic exclusion of risk factors for a thromboembolic disease seems to be vital.

Wpływ działania doustnych środków antykoncepcyjnych na wybrane parametry układu hemostazy u młodych kobiet z nagłym zaburzeniem czynności układu równowagi

Introduction The aim of the study was to evaluate the correlation between hormonal contraceptives and sex hormones levels as a possible cause of vertigo related to coagulation disorders and fibrinolyse.INTRODUCTION The aim of the study was to evaluate the correlation between hormonal contraceptives and sex hormones levels as a possible cause of vertigo related to coagulation disorders and fibrinolyse. MATERIAL AND METHODS The study was conducted on 25 female patients aged 23-39, who were treated at the Department of Otolaryngology and Laryngological Oncology, Medical University of Lodz, due to vertigo. The studied patients were divided into 3 groups: I--7 women that used hormonal contraceptives; II--9 women that no used hormonal contraceptives for the last 6 months; III--9 women who never used contraceptives. The methodology included: an otoneurological and audiological examination, blood tests, levels of fibrinogen, D-dimers, APTT, PT, ALAT, ASPAT and BMI, estradiol and progesterone levels. RESULTS In 16 out of the 25 patients the obtained results diverged from normal sex hormones concentration in serum. In each studied group the relation between sex hormones concentration in serum and coagulation and fibrinolyse parameters was proved. The correlation between an increased concentration progesterone and D-dimers was found. CONCLUSIONS An increased concentration of estrogens in serum may have an additional negative effect on a possibility of a thromboembolic episode. In the female patients interested in oral contraception, the prophylactic exclusion of risk factors for a thromboembolic disease seems to be vital.