Wojciech Gawron

Are there any disturbances in vestibular organ of children and young adults with Type I diabetes

AbstractAims/hypothesis. The aim of the work was to evaluate the vestibular organ condition in children and young adults suffering from Type I (insulin-dependent) diabetes mellitus. Methods. The group examined consisted of 95 children and young adults aged from 6 to 28 years with Type I diabetes diagnosed. The diabetic group was divided into subgroups according to duration of the disease, compensation of the disease, and presence and character of hypoglycaemic incidents, and presence of diabetic complications. The control group consisted of 44 healthy children and young adults aged 6 to 28 years. After collecting detailed medical history in each case an electronystagmographic test was performed using the computed two-canal electronystagmographer. Results. Within the diabetic group 6 patients complained about vertigo and balance disorders. Spontaneous nystagmus occurred in 10 cases, positional one in 21 cases. Impaired optokinesis occurred in 36 cases and impaired eye tracking test in 33 cases. In caloric tests there was partial canal paresis in 4 cases and directional preponderance in 7 cases. Conclusion/interpretation.Metabolic disturbances present in Type I diabetes cause disturbances in different parts of vestibular organ but mostly in its central part. Comparing disturbances in the vestibular organ with clinical and biochemical parameters characterising diabetes, the range of vestibular organ impairment in diabetes mellitus type 1 seems to depend mainly on the presence and character of hypoglycaemic incidents and the duration of the disease and to some extent on the compensation of diabetes.

Evaluation of hearing organ in patients with Turner syndrome

UNLABELLED Hearing loss and middle ear diseases are often reported in some of Turner patients. In most of the reports hearing organ was evaluated with the use of subjective methods. The aim of the work was subjective and objective evaluation of hearing organ with an attempt to set the correlation between the results and the genotype of the patients with Turner syndrome (Ts). MATERIAL 51 Ts patients aged 14.3 years on average. There were 29 girls with monosomy X and 22 having mosaicism. A detailed medical history was taken in each case with attention given to the hearing loss risk factors. METHOD Physical ENT examination, hearing evaluation: pure tone audiometry, impedance audiometry, distortion products otoacoustic emissions (DPOAEs), brain auditory evoked potentials (BAEP). The control group consisted of 30 healthy patients. RESULTS Recurrent acute otitis media was reported by 19.6% of Ts patients. Pure tone audiometry was improper in 36.3% ears; conductive hearing loss was present in 11.7% ears, mixed hearing loss in 5.9% ears and the moderate sensorineural hearing loss in 18.6% ears. Impedance audiometry was impaired in 14.7% of the cases. DPOAE disturbances were present in 41.4% of Ts patients, BAEP was improper in 52.0%. The percentage of the disturbances in DOPAEs and in BAEP in patients with mosaicism was 45.4 and 40.9% while in patients with monosomy 68.9 and 62%. CONCLUSIONS Ts patients present predisposition to hearing disturbances. The disturbances seem to be connected with middle ear infections and with sensorineural hearing losses. Hearing loss in Ts women is not clinically apparent in most of the cases; this fact reflects the need of early evaluation and further monitoring of hearing organ in those patients. Sensorineural hearing loss seems to prevail in patients with 45,X genotype, so perhaps attention should be paid to this subgroup of Ts patients.

Sudden hearing loss as a first complication of long-standing Type 1 diabetes mellitus: a case report

The term ‘sudden hypoacusis’ describes a hearing loss of a rapid onset and unknown origin that can progress to severe deafness. Its pathophysiology is still unknown, the proposed aetiological mechanisms being vascular disease or autoimmune reaction. We present the case of a 19‐year‐old woman with Type 1 diabetes mellitus who experienced sudden hearing loss on her right side. She had no complications related to diabetes. After being referred to the hospital she was diagnosed with sudden sensorineural right‐sided hearing loss accompanied by high frequency tinnitus. After administration of vasoactive drugs, there was partial improvement after 7 days, followed by gradual improvement over the next 4 weeks to 5 months. The tinnitus did not disappear completely. We conclude that hearing organ disturbances can be present in Type 1 diabetes and represent an early complication.

Stan czynnościowy narządu słuchu w zespole nerczycowym w przebiegu pierwotnej glomerulopatii u dzieci

Summary Nephrotic syndrome (NS) is connected with an increase of glomeral permeability. It generates numerous, reversible electrolic and biochemical disturbances. The aim Of the work was complex evaluation of hearing organ in children in the course of NS. Material 28 children aged from 7 to 17 years suffering from primary glomerulopathy, without renal failure and 28 healthy children in the relative age (control group). Method In children with NS hearing tests (pure tone audiometry, impedance audiometry, BAEP, DPOAE) have been performed twice: in acute phase and in non-symptomic phase. Such parameters as total protein, albumines, globulins, cholesterol, sodium, potassium, calcium, magnesium were evaluated. Results In oedematous stage the concentration of total protein, albumines and calcium were significantly decreased and the concentration of cholesterol was increased. Children with NS presented much worse hearing than healthy subjects, even after the symptoms dissapeared. In acute phase such parameters of BAEP as peak III latency and interpeak I–III interlatency were elongated and DPOAE values were decreased. In normal phase BAEP parameters were similar to those in normal group but DPOAE parameters were still much worse than in healthy children. Some of the biochemical parameters correlated with hearing results in children with NS. Conclussions Hearing organ in children with NS in the course of chronic glomerulopathy is significantly worse than in healthy children. It is probably connected with repeated biochemical and electrolytic disturbances that cause partly reversible alterations in the cochlea, acoustic nerve and brain stem. It may be also caused by ototoxic drugs.

Zróżnicowanie polipów nosa w badaniach techniką mikromacierzy oligonukleotydowych

UNLABELLED Nasal polyps, according to many authors, generate as a result of chronic inflammation process with activation of cytokines, immunological reaction mediators that regulate proliferation, differentiation and cell apoptosis. Clarifying molecular mechanisms present in those disturbances may have diagnostic and prognostic value in evaluation of recurrence, dynamics and differentiation of nasal polyps as well as in their therapy. AIM The aim of the work was an analysis of nasal polyps on the basis of molecular, histopathological and clinical picture as well as comparing differentiated genes transcription in nasal polyps and proper nasal mucosa. MATERIAL AND METHOD Oligonucleotide array with HGU 133A - Affymetrix were used to analyze the expression of 22,283 genes in nasal polyp tissues from 17 patients. The control group consisted of 8 tissue samples from patients after nasal septoplasty surgery. RESULTS All the samples could be classified to nasal polyps group or proper mucosa group, it reflected significant differences in genes profile expression in both groups. The evaluation of 22,283 genes transcriptions showed that in most cases nasal polyps tissue reflect classification connected with dominant inflammation cells infiltration. The data obtained let distinguish subgroups connected with clinical condition of the patients. The subgroup with massive nasal and sinus polyposis, eosinophilia and differentiated lower respiratory airways hyperactivity and the subgroup without eosinophilia infiltration may be distinguished. The data obtained suggest that molecular mechanisms may influence on the promotion and kind of inflammation process as well as the clinical course of nasal polyps.Summary Nasal polyps, according to many authors, generate as a result of chronic inflammation process with activation of cytokines, immunological reaction mediators that regulate proliferation, differentiation and cell apoptosis. Clarifying molecular mechanisms present in those disturbances may have diagnostic and prognostic value in evaluation of recurrence, dynamics and differentiation of nasal polyps as well as in their therapy. Aim The aim of the work was an analysis of nasal polyps on the basis of molecular, histopathological and clinical picture as well as comparing differentiated genes transcription in nasal polyps and proper nasal mucosa. Material and method Oligonucleotide array with HGU 133A – Affymetrix were used to analyze the expression of 22 283 genes in nasal polyp tissues from 17 patients. The control group consisted of 8 tissue samples from patients after nasal septoplasty surgery. Results All the samples could be classified to nasal polyps group or proper mucosa group, it reflected significant differences in genes profile expression in both groups. The evaluation of 22 283 genes transcriptions showed that in most cases nasal polyps tissue reflect classification connected with dominant inflammation cells infiltration. The data obtained let distinguish subgroups connected with clinical condition of the patients. The subgroup with massive nasal and sinus polyposis, eosinophilia and differentiated lower respiratory airways hyperactivity and the subgroup without eosinophilia infiltration may be distinguished. The data obtained suggest that molecular mechanisms may influence on the promotion and kind of inflammation process as well as the clinical course of nasal polyps.

Zespół zaburzeń przedsionkowo-ślimakowych na podłożu konfliktu naczyniowo-nerwowego nerwu przedsionkowo-ślimakowego – problemy diagnostyczno-terapeutyczne☆◊◊◊

Summary Introduction Symptoms encompassing sensorineural hearing loss, tinnitus and vertigo occur in many diseases of various origin. The diagnostics in such cases is especially difficult and often requires interdisciplinary cooperation. Despite of that many cases remain unexplained. Material and method The two cases with above mentioned symptoms (52 year-old woman and 46 year-old man) with differentiated clinical course were presented. The woman for one year experienced left sided, extreme tinnitus with paroxysmal vertigo and dizziness. The man with sudden monolateral hearing loss and tinnitus that disappeared after corticosteroid therapy, complained about recurrence of fluctuating hearing loss and tinnitus accompanied by chronic instability. The diagnostics of hearing and balance organs was performed (pure tone audiometry, impedance audiometry, DPOAE, ABR, ENG) complemented with computed tomography and Nuclear Resonance. Results Female patient presented bilateral mild sensorineural hearing loss, more intensive on the left side, male patient right sided sensorineural hearing loss in the frequencies from 250 to 1500 Hz. The elongation of some peak values in ABR test (with bilaterally proper otoacoustic emissions) as well as partial canal paresis on the hearing loss side suggested primary diagnosis of neoplasmatic process. It was an indication to perform radiological diagnostics. The radiologic findings revealed the contact of vestibulo-cochlear nerve with the loop of cerebellar inferior anterior artery within the internal acoustic canal. Conclusions The course of the disease and diagnostic tests do not provide characteristic data that let diagnose neuro-vascular conflict. One has to be aware of such possibility in patients with intensive vertigo and dizziness that do not improve after treatment when other causes do not justify the symptoms.INTRODUCTION Symptoms encompassing sensorineural hearing loss, tinnitus and vertigo occur in many diseases of various origin. The diagnostics in such cases is especially difficult and often requires interdisciplinary cooperation. Despite of that many cases remain unexplained. MATERIAL AND METHOD The two cases with above mentioned symptoms (52 year-old woman and 46 year-old man) with differentiated clinical course were presented. The woman for one year experienced left sided, extreme tinnitus with paroxysmal vertigo and dizziness. The man with sudden monolateral hearing loss and tinnitus that disappeared after corticosteroid therapy, complained about recurrence of fluctuating hearing loss and tinnitus accompanied by chronic instability. The diagnostics of hearing and balance organs was performed (pure tone audiometry, impedance audiometry, DPOAE, ABR, ENG) complemented with computed tomography and Nuclear Resonance. RESULTS Female patient presented bilateral mild sensorineural hearing loss, more intensive on the left side, male patient right sided sensorineural hearing loss in the frequencies from 250 to 1500 Hz. The elongation of some peak values in ABR test (with bilaterally proper otoacoustic emissions) as well as partial canal paresis on the hearing loss side suggested primary diagnosis of neoplasmatic process. It was an indication to perform radiological diagnostics. The radiologic findings revealed the contact of vestibulo-cochlear nerve with the loop of cerebellar inferior anterior artery within the internal acoustic canal. CONCLUSIONS The course of the disease and diagnostic tests do not provide characteristic data that let diagnose neuro-vascular conflict. One has to be aware of such possibility in patients with intensive vertigo and dizziness that do not improve after treatment when other causes do not justify the symptoms.

Profil ekspresji genów kodujących TGF-β1 i jego receptory TGFβRI, TGFβRII i TGFβRIII w polipach nosa☆☆☆◊◊◊

Summary Background Transforming growth factor β (TGF-β) plays an important role in cells proliferation and differentiation as well as in local immunological response. Objectives An evaluation of genes expression profile for TGF-β1 and its receptors TGF-βRI, TGF-β RII and TGF-β βRIII as well as their potential role in the pathogenesis of nasal polyps in eosynophilic and neutrophilic polyps and in normal nasal mucosa. Material Material consisted of 22 patients. Nasal polyps were removed during standard polypectomy or FESS. In the histopathological evaluation there were 16 eosynophilic polyps and 5 neutrophilic ones. The control group consisted of 8 healthy patients from whom healthy nasal mucosa was taken during nasal septoplasty. Methods The expression of the genes coding TGF-β and its receptors was evaluated with the use of RT-PCR technique. Results TGF-β1 mRNA was present in 10 eosynophilic polyps out of 16. In neutrophilic polyps group (n = 6) mRNA TGFβ-1 was present in 3 samples. TGFβ-1 isoform was present in all the tissues of the control group. It was significantly larger expression of TGFβ-1 gene in normal mucosa in comparison with eosinophilic and neutrophilic polyps (p Conclusions Considering regulative function of TGFβ1 in inflammation processes, its low concentration in nasal polyps tissue may influence on migration and survival of inflammation cells. The high expression of genes coding TGFβRI, TGF-βRII and TGF-βRIII receptors in all the polyps and healthy tissues, show readiness to transduction of TGFβ. It may suggest that, less intensive TGFβ1 expression in nasal polyps may be connected with the presence of other than first TGFβ isoforms. This problem needs further investigations to set precise role of individual TGFβ isoforms and other growth factors in the pathogenesis of NSP as their interactions with local cytokines. It may help to work out more effective and specific therapeutic methods in nasal polyps therapy.