Magdalena Józefowicz-Korczyńska

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

Background and purposePatients 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.MethodsSixty 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.ResultsClinical 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.ConclusionThe 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.

Sudden hearing loss in chronic hepatitis C patient suffering from Turner syndrome, treated with pegylated interferon and ribavirin

Sudden hearing loss is a very rare complication of interferon–alpha treatment. At this time, hearing loss in patients treated with pegylated interferon and ribavirin has only been described in two reports. We present a case of a 27-year-old patient who was diagnosed with Turner syndrome, treated for hepatitis C with pegylated interferon and ribavirin, and suffered from hearing loss during the 10th week of treatment. Audiometric examination revealed a bilateral sensorineural hearing loss (SNHL). Auditory brainstem response (ABR) measures confirmed the diagnosis. We decided to comply with the patients request to continue therapy, which only led to slight further deterioration of the patients hearing ability. However, 18 months after the end of therapy a follow-up audiometric examination disclosed a bilateral SNHL.

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.

Papillary carcinoma in thyroglossal duct cyst with uninvolved thyroid. Case report and review of the literature

The thyroid gland in embryogenesis develops as the first pharyngeal derivative, primarily appearing as an invagination in the floor of the pharynx and then migrating caudally to the trachea. During embryogenic development, it remains attached to the tongue by the thyroglossal duct, which usually undergoes atrophy after birth. If it fails to involute, it can persist as a cyst, a duct, or ectopic tissue, which is localized in the midline between the base of the tongue and the pyramidal lobe of the thyroid gland [1].

The immunoexpression of CD34, Bcl-2, and Ki-67 antigens in sinonasal inverted papillomas.

Background Numerous molecular markers of sinonasal inverted papillomas (IP) were investigated in the past; however, significance of angiogenesis and inhibition of apoptosis were not well documented. This study was designed to determine expression of angiogenic marker CD34 antigen, antiapoptotic marker Bcl-2 oncoprotein, and proliferative marker Ki-67 antigen in the group of patients with IP. We matched up these findings to the group of patients with sinonasal carcinoma (SNC) and used chronic rhinosinusitis (CRS) patients as control group. In addition, we compared expression of the markers among IP patients who displayed distinctly different patterns of clinical behavior. Methods Tissue samples were obtained from 46 surgically treated patients; 18 of them had a diagnosis of IP, 9 had documented SNC, and the remaining 19 patients had CRS. All specimens were stained using immunohistochemistry techniques for CD34 (mean vessel density [MVD]), Bcl-2, and Ki-67 antigens. Morphometry was evaluated by computer image analysis system. Results We noted statistically significant differences in expression of CD34 antigen, Bcl-2 protein, and Ki-67 antigen (for all groups, ANOVA p < 0.001) among the investigated groups. The mean value of CD34 antigen was significantly higher in the IP group than in the CRS group, but it was below the levels of the SNC group. Compared with the cases not complicated by recurrence, the patients with recurrent IP exhibited higher MVD levels, while levels of bcl-2 and Ki67 protein expression did not differ in a significant way between recurrent and nonrecurrent cases. The significant positive correlations were observed between Bcl-2 protein and Ki-67 antigen in IP and SNC groups and between Bcl-2 protein and CD34 antigen in the CRS group. Conclusion Our findings underscore importance of angiogenesis in the development and prognosis of IP and support further investigation of this aspect of IP tumor growth.

Stan układu przedsionkowego u pacjentów z twardziną układową

Summary 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.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.

Treatment of parotid glands cancer

Abstract Parotid glands tumors are relatively uncommon but they diverse and range from less to highly aggressive. Surgery is the primary treatment of choice for most neoplasm of salivary glands. We evaluated the results of parotid gland cancer treatment dependent on clinical data and treatment modality on survival. Results of treatment, clinical stage, types of surgical management and recurrences in 105 patients with parotid gland cancer diagnosed and treated in three clinical centres were presented. The survival rate was calculated according to the Kaplan–Meier method. The patients with parotid gland cancer were treated either with surgery alone, 39 (33.9%), or with surgery and postoperative radiotherapy, 34 (29.6%). In this group, 5-year survival probability was 61%. The worst results of 5-year survival (28%) were radiotherapy alone or combined radio- and chemotherapy. Surgical treatment dominated in I and II tumor stages while in stages III and IV irradiation and chemotherapy were often performed additionally. Probability of survival depending on the operation procedure was the best for patients after subtotal parotidectomy—60%. The worst survival rate was after total parotidectomy—55% and radical total resection—50%. Fifty-one (49.5%) patients underwent a neck dissection. Postoperative complications were observed in 69 (85.2%) patients. Local–regional recurrences occurred in 21 (32.3%) of the patients. Five patients developed distance metastases. Clinical observation and statistic evaluation proved that the best treatment method was a radical surgical procedure and postoperative irradiation.

A clinic-epidemiological study of head and neck tuberculosis — a single-center experience

INTRODUCTION Extrapulmonary tuberculosis (EPTB) accounts for less than 6% of all tuberculosis (TB) cases in Poland, although in other countries (European in particular) this proportion is much higher. The study was undertaken to evaluate the clinical and epidemiological differences in patients hospitalized in one of Otolaryngology Departments in Poland during 36 years. MATERIAL AND METHODS In a retrospective study, 71 patients were identified and divided into three groups according to the study period: I - 1978-1989 (30 patients, 42%), II - 1990-2001 (19 patients, 27%) and III - 2002-2013 (22 patients, 31% of all cases). In each case histological examination of biopsy specimens was available. RESULTS Larynx TB (54.9%) was most common, followed by cervical lymph nodes TB (29.6%) and auris TB (8.5%). In laryngeal TB, glottic region was most often affected (76.9%). Patients with larynx TB were mainly men (87.2%), 10 years older than women in each study period. However, in lymph nodes TB group, women constituted 66.7% of cases and were twice as old as men (64.0 vs. 34.7 yrs). Bacteriological confirmation was made in only one patient. CONCLUSIONS The number of patients diagnosed in our center declined in the first period of 12 years and remained stable over the last 24 years, as were the common sites of head and neck EPTB (larynx and cervical lymph nodes). In patients with head and neck TB the biopsy specimens should be examined not only histologically but also for the presence of Mycobacterium tuberculosis.

Kliniczna ocena zaburzeń ruchowych gałek ocznych w stwardnieniu rozsianym

Summary Otoneurologic bedside examination with testing eye movements gives valuable information about static and dynamic properties of balance system and may give topodiagnostic information about the side of lesion in patients with vertigo, dizziness and disequilibrium. The aim of the study was to present the scheme of otoneurological bedside examination and usefulness of ocular motor disturbances index in evaluation of Multiple Sclerosis patients status. Material and methods Sixty patients with diagnosis of MS, seen in outpatient neurology clinic, Medical University of Lodz, from 2002 to 2004, were enrolled into the study. Patients history of vertigo, dizziness, hearing loss and vision disturbances were evaluated. The clinical bedside ocularmotor examination was performed in all patients. It was composed of seven tests on the basis on which we introduce ocular motor disturbances index – IRZ. Results The most frequent abnormalities were found in clinical saccadic test in 30% and smooth pursuit in 22%. MS patients who had in clinical eye movements examination IRZ bigger than 3 point formed the abnormal clinical examination group’ (ACE) – 31,7%. In u 68,3% the index was less than normal clinical examination group’ (NCE). The longer duration of the disease was observed in ACE group. Comparisons of functional neurological score EDSS and for cerebellar and brainstem subscale were significantly greater in ACE group. Conclusion Otoneurological bedside examinations with dynamic tests and introducing quantitative the ocular motor disturbances index is a valuable method of evaluation of visual-ocularmotor reflex and may be used in monitoring MS course of disease.

Wpływ rodzaju protezki strzemiączka na stopień poprawy słuchu w chirurgii strzemiączka – analiza retrospektywna 350 przypadków

Summary Aim Retrospective analysis of the post-op hearing results in stapes surgery using different types of materials for stapes prosthesis after 12 months follow up. Material and methods The total number of 350 otosclerosis patients who underwent surgical treatment at the Otosurgery Department, Medical University of Lodz from 1980–2002. All patients included in the study were divided into 4 groups: group 1 (N = 54) – Portmanns method interposition, group 2 (N = 160) – stapes replaced with the Shea – type prosthesis, group 3 (N = 60) – platinum wire prosthesis (Zini – type), group 4 (N = 76) – teflon-piston operation (Fisch – type). Results The 12 months post-op mean value for air-bone gap (500, 1000, 2000 Hz) presented the following values: group 1–19 dB, group 2–15.9 dB, group 3–18.4 dB, group 4–13.5 dB. The percentage of patients with the mean air-bone gap value of 15 dB or less (500, 1000, 2000 Hz) has the following values in each group: group 1–75%, group 2–81.3%, group 3–83%, group 4–85%. Conclusions 12 months post-op hearing results compared between the 4 studied groups showed statistically not significant differences. Our experience with teflon-piston prosthesis shows the lowest postop mean value of the air-bone gap.