Piotr Pietkiewicz

The Association between Positional Vertebral and Basilar Artery Flow Lesion and Prevalence of Vertigo in Patients with Cervical Spondylosis

OBJECTIVE: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation. STUDY DESIGN AND SETTING: A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations. RESULTS: We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion. CONCLUSION: Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especially complaining of vertigo. SIGNIFICANCE: Every patient with high-grade cervical spondylosis, especially complaining of vertigo, should be examined by using TCD (transcranial Doppler) with head rotations. In case of positional blood flow reduction during head rotation, further angiographic examination should be undertaken so as to plan suitable treatment.

Zastosowanie testu VHIT (Videonystagmography Head Impulse Test) w diagnostyce uszkodzeń kanałów półkolistych

Summary Introduction The aim of that work was to evaluate the usefulness of VHIT (Videonystagmography Head Impulse Test) in the diagnostics of injuries to the semicircular canals. Material and methods The tests covered 58 patients aged 20–27, including 34 women and 24 men. Any deviations within the vestibular organs was excluded in the interview, otorhinolaryngological examination and full videonystagmographic test. The tests checked functions of the semicircular canals in the following way: in a sitting position and the head leaned forward at 30° the patient was looking at a motionless point while quick movements to the left or right were performed to stimulate a particular lateral semicircular canal. When the vertical semicircular canals were tested the head was inclined laterally to the right side at 45°. Then similar movements were performed forwards (stimulation of the left anterior semicircular canal) and backwards (stimulation of the right posterior semicircular canal). When the head was leaned laterally to the left at 45° the right or left anterior semicircular canal was stimulated respectively. Functions of the canal were determined on the basis of gain (%). Results of the tests In 58 patients the gain value for particular semicircular canals was normal, and the mean values presented as follows: the lateral semicircular canal: 11.9%±10.2, the anterior semicircular canal: 17.5%±11.6 and the posterior semicircular canal: 19.2%±13.5, whereas on the left side: 10.3%±7.9, 18.1%±11.1, 15.1%±12.3 respectively. In one man the gain value for the right posterior semicircular canal was found significantly above the standard value – 71%. Conclusion VHIT showed much more sensitive than a full videonystagmographic test.

Electronystagmography versus videonystagmography in diagnosis of vertigo

ObjectivesVertigo is a very common symptom mainly caused by the lesion of vestibular system (peripheral or central) and often accompanied by some work-related diseases and occupational intoxications. The aim of this study was to assess the value of electronystagmography (ENG) and videonystagmography (VNG) for diagnosing vertigo of various origin.Materials and MethodsThe study included four groups, 25 subjects each, of patients suffering from vestibular disorders of peripheral, central and mixed origin versus healthy controls. All were examined by means of ENG and VNG, using the bithermal caloric test with 30°C and 44°C air irrigations of the ears. The findings (frequency of induced nystagmus FRQ, its slow phase velocity SPV, canal paresis CP, directional preponderance DP, vestibular excitability VE) were analysed and compared.ResultsIn all patients with vertigo due to vestibular neuritis, barotrauma and kinetosis, significant CP, the important sign of peripheral site of vestibular lesion was identified both in ENG and VNG. None of the patients with central origin disorders showed CP in VNG; in the majority of cases DP was observed. However, in ENG we found CP in 5 patients with central origin disorders. There were no essential differences between ENG and VNG in measurements of FRQ and SPV except for higher values in VNG in controls and patients with mixed vertigo.ConclusionsThe results suggest that the VNG should be recommended in preference as the valuable method to assess vertigo and to discriminate between the peripheral and the central vestibular lesions.

Analiza oceny histopatologicznej zmian patologicznych usuniętych w endoskopowych operacjach nosa i zatok przynosowych w materiale własnym

Summary Introduction The work aimed at evaluating results of histopathological examination of postoperative material in endoscopic paranasal sinus surgery in the own material. Material and methods The analysis covered 3,896 results of histopathological examination of routine postoperative material from the Department of Clinical Pathomorphology and Cytopathology Military Medical Academy University Clinical Hospital in Lodz. The study was conducted in hematoxylin and eosin staining according to the principles of this method. The postoperative material included pathological lesions removed by endoscopic surgery of the nose and paranasal sinuses in patients who were treated at Department of Otolaryngology and Laryngological Oncology between 2006 and 2010. The treatment included 1,118 patients, 509 women at the age of 15–79 and 609 men aged 17–77. The material for histopathological examination was sent from merely 1,176 operations because 57 patients were operated twice and one patient was operated three times. Results Polyps within the nose and paranasal sinuses were confirmed by histopathological examination in 705 patients, including 289 women and 416 men. Hypertrophic changes were diagnosed in 404 patients, including 218 women and 186 men. Inverted papilloma was recognised in histopathological examination in 9 patients, including 2 women and 7 men. Hypertrophies were slightly more common in women than in men. Both in men and women unilateral hypertrophic changes within the ostiomeatal complex were predominant, 42.66% in women and 40.86% in men. Conclusion Histopathological examination of postoperative material in patients under endoscopic treatment due to paranasal sinusitis is considerably important for complex evaluation of inflammation type and confirmation of indications for appropriate anti-inflammatory therapy.

The use of videonystagmography head impulse test (VHIT) in the diagnostics of semicircular canal injuries in patients with vertigo

ObjectivesThe aim of the study was to assess the function of semicircular canal in videonystagmography head impulse test (VHIT) in the patients with vertigo and balance disorders.Material and MethodsThe study was performed in 135 patients (86 women and 49 men) aged 22–79 years, who were divided into 2 groups: I (study group) — 73 patients with vertigo of peripheral, central or mixed origin, II (control group) — 62 patients without vertigo (healthy individuals). The function of canal was determined on the basis of GAIN and expressed as DG/RH×100% (where DG is deviation of gaze and RH is rotation of head).ResultsIn the study group the semicircular canal injuries were found in 37 (50.69%) patients, including 24 (32.87%) patients with 1 injury and 13 (17.8%) patients with 2 or more injuries in semicircular canal. The injured anterior semicircular canal was reported 13 times; the lateral — 9 times and the posterior — 31 times.ConclusionsIn the study group, in the VHIT, injuries in semicircular canals were reported in peripheral vertigo, mixed vertigo with non-compensated and compensated function of the labyrinth in 50.68% cases, whereas in the caloric test dysfunction of the labyrinth was found in 58.49% cases.

The effect of metallothionein 2A core promoter region single-nucleotide polymorphism on accumulation of toxic metals in sinonasal inverted papilloma tissues.

Metallothioneins (MTs) are intracellular thiol-rich heavy metal-binding proteins which join trace metal ions protecting cells against heavy metal toxicity and regulate metal distribution and donation to various enzymes and transcription factors. The goal of this study was to identify the -5 A/G (rs28366003) single-nucleotide polymorphism (SNP) in the core promoter region of the MT2A gene, and to investigate its effect on allele-specific gene expression and Cd, Zn, Cu and Ni content in sinonasal inverted papilloma tissue (IP), with non-cancerous sinonasal mucosa (NCM) as a control. The MT2A promoter region -5 A/G SNP was identified by restriction fragment length polymorphism using 117 IP and 132 NCM. MT2A gene analysis was performed by quantitative real-time PCR. Metal levels were analyzed by flame atomic absorption spectrometry. The frequency of A allele carriage was 99.2% and 100% in IP and NCM, respectively. The G allele carriage was detected in 23.9% of IP and in 12.1% of the NCM samples. As a result, a significant association of -5 A/G SNP in MT2A gene with mRNA expression in both groups was determined. A significant association was identified between the -5 A/G SNP in the MT2A gene with mRNA expression in both groups. A highly significant association was detected between the rs28366003 genotype and Cd and Zn content in IP. Furthermore, significant differences were identified between A/A and A/G genotype with regard to the type of metal contaminant. The Spearman rank correlation results showed the MT2A gene expression and both Cd and Cu levels were negatively correlated. The results obtained in this study suggest that the -5 A/G SNP in the MT2A gene may have an effect on allele-specific gene expression and toxic metal accumulation in sinonasal inverted papilloma.

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.

Operacje endoskopowe nosa i zatok przynosowych w materiale własnym

Summary Introduction The aim of the study was to evaluate the results and 4-year own experience in the endoscopic treatment of the nose and paranasal sinuses. Material and methods In the Clinic of Otolaryngology and Laryngological Oncology of the Medical University of Lodz between 2006 and 2009 there were 603 endoscopic operations performed on patients with chronic paranasal sinusitis, including 287 females aged 17–80 and 316 males aged 18–87. The patients were qualified for the operation on the basis of an interview, objective otorhinolaryngological examination, frontal and transverse computerized tomography of the nose and paranasal sinuses, laboratory tests (blood cell count, sedimentation tests, urine tests, electrolytes tests). Moreover, allergological diagnostics (skin prick tests, intranasal provocation tests), a histopathological examination of the removed lesions and a culture of biological material from the paranasal sinuses were done. The 0° and 30° endoscopes of Storz GMBH and Wolf and the video rotation microtome (debrider). Results Possible reasons for paranasal sinusitis were: viral infection (34.8%), anatomical disorders (28.5%), irritating factors like tobacco smoke (17.9%), allergy (13.4%), tumours (3.2%) and gastroesophageal reflux (2.1%). Finally, the following endoscopic operations were conducted: revision surgery of the maxillary sinuses in 680 cases (56.4%), ethmoidectomy in 586 cases (48.6%), polypectomy in 273 cases (22.6%), re-polypectomy in 232 cases (19.2%), sphenoid sinus revision in 229 cases (19.0%), frontal sinus revision in 80 cases (6.6%) and re-ethmoidectomy in 77 cases (6.4%). The average stay in the Clinic lasted 3.2 days. Conclusions Advantages of the complex surgical treatment are found in both post-operative and pharmacological procedures. The FESS surgery should be only a minimally invasive technique, which subsequently could guarantee an effective treatment, slight post-operative complications, a short hospitalization period and a quick return of the patient to work, as it is proved by the own study.

Sensitivity evaluation in air and water caloric stimulation of the vestibular organs using videonystagmography.

INTRODUCTION The aim of the study was to compare air and water caloric stimulation of the vestibular organs using videonystagmography (VNG). MATERIAL AND METHODS The study covered 18 women aged 21-63 and 11 men aged 21-74 years hospitalized at the ENT, without complaints for vertigo and/or balance disorders. The alternate binaural bithermal caloric test with cool 30°C and warm 44°C air or water irrigations (after 2h interval for the recordings) with the use of VNG was done. RESULTS All parameters of air and water vestibular caloric stimulations, assessed in the VNG, differed significantly but were within the normal range. The research showed a statistically significant difference between canal paresis but only for the left ear at 30°C and 44°C. Absolute directional preponderance, relative directional preponderance, vestibular excitability, slow component velocity, frequency were different statistically for both ears at both temperatures. CONCLUSIONS Our study showed that both air and water caloric stimulations were able to distinguish physiological and impaired vestibular function. The obtained results showed statistically higher response for water than air stimulation.

Ocena skuteczności leczenia chorych z zawrotami głowy typu mieszanego za pomocą rehabilitacji ruchowej

INTRODUCTION The aim of this work was to evaluate the efficiency of kinesitherapy in the patients with mixed-type vertigo. MATERIAL AND METHODS The study was conducted on a randomized group of 35 patients, 21 women and 14 men aged 24-75 years (mean age 42.5 years), who were treated at the Department of Otolaryngology and Laryngological Oncology Medical University Teaching Hospital in Lodz for mixed-type vertigo. The inclusion criteria were an interview, physical and otorhinolaryngological examinations, laboratory investigations, complete audiological and otoneurological examinations, including BERA and VNG, USG examination of the blood vessels to the cranium, and CT of the cervical spine. Each patient underwent an individually selected set of habituation exercises, corrective exercises for posture and its orientation in space through 2 months. The efficiency of the implemented therapy was evaluated after two weeks, one month and two months with the use of the complete videonystagmographic test and Silvoniemis criteria. RESULTS The mean excitability of the labyrinths was 25.38 degrees/s before rehabilitation and 22.26 degrees/s after rehabilitation, absolute directional preponderance was 7.62 degrees/s and 1.92 degrees/s respectively, relative directional preponderance was 31.36 degrees/s and 12.57 degrees/s, and unilateral deficit 32.12 degrees/s and 14.34 degrees/s. The subjective evaluation of the vertigo intensification based on the 5 stages of Silvoniemis scale indicates that the mean point-based evaluation reported by the patients at the beginning of the therapy was 3.85 points, whereas after the therapy was 2.91 points after two weeks, 2.35 points after one month, and 1.2 points after two months. CONCLUSIONS Kinesitherapy is an alternative and very effective method for treating mixed-type vertigo.