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.

Comparison of two VHIT software programs in diagnostics of semicircular canals.

INTRODUCTION: The aim of this work was to assess SCC function in VHIT test, using both versions of VHIT ULMER. MATERIAL AND METHODS: The study was performed in 57 subjects aged 22-33 years (48 women and 9 men) without vertigo in anamnesis. Patients did not complain of any "vertigo" ailments or any balance disorder incidents in the past. All tests using either VHIT I or VHIT II were performed by the same person. The function of lateral SCC in VHIT ULMER II was examined similarly like in VHIT ULMER I. In both methods was used the same sensitivity threshold parameters for horizontal and vertical accelerations (horizontal - 2500, vertical - 1600). Each of these sequences enables a parameter, called represented GAIN, to be calculated in form of a point on the canalogram. RESULTS: GAIN represents the deviation of the gaze in comparison to the deviation of the head between the first (t - 0 ms) and the fourth image (t = 120 ms). The calculation formula is: GAIN (in %) =100 x DG/RH. DG is deviation of the gaze ("gaze velocity in space") and RH is rotation of the head ("head velocity or impulse canal paresis"). Normal GAIN value ranges 1-40%. CONCLUSIONS: The examination using VHIT ULMER II appears to be a more sensitive diagnostic method than VHIT ULMER I. Improved software with automated functions such as camera adjustments, examination surface arrangement, of VHIT ULMER II, enables technician to shorten the time of examination, simultaneously providing a range of new information about the condition of oculo-vestibular system.

Own experience in the diagnosis and treatment of elongated styloid process syndrome.

<b>Introduction:</b> The aim of the study was to present selected cases with Eagle's syndrome diagnosed and treated at the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, in the years 2016-2020. <br><b>Material and method:</b> Five selected clinical cases with Eagle's syndrome are presented, including three male patients and two female patients, aged 28 to 42 years. <br><b>Results:</b> The prevalence of Eagle's syndrome was similar for both female and male patients. The carotid artery syndrome, which is characterized by: visual disturbances, unilateral pain located along cervical vessels, headache and migraine, was more common. Lack of proper diagnosis of Eagle's syndrome often significantly delays the implementation of proper treatment and thus exposes patients to long-term struggle with pain. Our observations have shown that the time between the onset of symptoms and correct diagnosis in patients averaged about five years. 3D-CT scan is the gold standard for detecting Eagle's syndrome. An intraoral approach was used in surgical treatment. Although this approach offers shorter treatment time and better cosmetic effect, there is also a greater risk of complications associated with limited visibility of the surgical field and infection. <br><b>Conclusions:</b> Although styloid syndrome usually occurs bilaterally, these patients reported unilateral symptoms. No correlations were found between the prevalence of Eagle's syndrome and sex, the length of the styloid process or age, nor side of the body. The best healing effect is obtained by surgical correction/reduction of the elongated styloid process.

Sequencing of exons 4, 5, 12 of COCH gene in patients with postlingual sensorineural hearing loss accompanied by vestibular lesion.

INTRODUCTION: Mutations at the DFNA9 locus on chromosome 14q12 are the third most common form of DFNA hearing loss, which is clinically characterized by late onset (in adulthood) progressive sensorineural hearing loss accompanied by vestibular dysfunction. The aim of the study was to search for COCH gene mutations (P51S, V66G, G87W, G88E, V104del, I109N, W117R, A119T, M512T, C542Y) in patients with severe or profound sensorineural hearing loss accompanied by a vestibular lesion. MATERIAL AND METHODS: The study was based on a group of 30 patients. Qualification criteria comprised the presence of progressive postlingual, severe to profound sensorineural hearing loss with tinnitus, early age of sensorineural hearing loss onset, before the 40th year of life, and a positive family history of early onset hearing loss. All patients were diagnosed with peripheral vestibular lesions. RESULTS: The authors did not find P51S, V66G, G87W, G88E, V104del, I109N, W117R, A119T, M512T, or C542Y mutations in the COCH gene in the tested group (no differences were found in the nucleotide sequences of exomes 4, 5 and 12 when compared to the published cDNA sequence of the COCH gene). CONCLUSIONS: No cochlin mutations were found in the group of patients with severe to profound sensorineural hearing impairment accompanied by a vestibular lesion. The COCH gene needs further exploration and analysis of genotype-phenotype correlations.

Concurrent ENG and VNG recording in healthy people - preliminary report.

INTRODUCTION: The aim of the study was to evaluate concurrent recording of ENG and VNG measurements in selected diagnostic tests in healthy subjects so as to explore potential sensitivity and applicability of this kind of testing in the diagnostics of vertigo. MATERIAL AND METHODS: The study was carried out in 50 healthy subjects including 24 women and 26 men aged 20-22 (mean age of 20.5 years) reporting no otorhinolaryngological organ-related complaints and no history of any balance disorders or vertigo. Every patient underwent subjective and objective otoneurological tests, electronystagmographic (ENG) examination including calibration, head-tracking test, optokinetic nystagmus test, rotatory chair test, positional tests according to Cawthorne and Rosen, and Hallpike caloric test as well as videonystagmographic (VNG) examination which included calibration, spontaneous nystagmus evaluation, head-tracking test, positional tests according to Cawthorne and Rosen with neck rotation test, and Hallpike caloric test. At first, ENG and VNG examinations were carried out separately at a 24-hour interval. Concurrent ENG and VNG recording was carried out 48 hours following the last test, with calibration being performed again before both evaluations. The concurrent recording included the spontaneous nystagmus evaluation, positional tests according to Cawthrone and Rose with the neck rotation test, and Hallpike caloric test. RESULTS: No negative mutual interference of the conducted tests has been observed. Both in the concurrent and in the separate recordings, the caloric test revealed lower values of the mean velocity of the nystagmus free phase in the ENG test as compared to the VNG test. No signs of spontaneous nystagmus, as well as no signs of optokinetic and positional nystagmus, were detected in any case. CONCLUSIONS: The conducted tests did not reveal any mutual excludability between the selected ENG and VNG diagnostic tests upon concurrent recording. However, the concurrent use of both examinations in the diagnostics of balance disorders and vertigo requires further studies.

Comparative evaluation of the diagnostic value of the VHIT and Dix-Hallpike test in patients with balance system disorders in out-patient healthcare practice and expertise preparation.

INTRODUCTION: The aim of the paper was the comparative analysis of the diagnostic value of the Video Head Impulse Testing (VHIT) Ulmer I and Dix-Hallpike Test in patients with balance system disorders in out-patient practice and expertise preparation. MATERIAL AND METHODS: The examination was performed in 63 patients aged 20-79, including 28 women aged 20-72 and 35 men aged 23-79, divided into two groups: Group I (study group) - 33 patients with mixed cause vertigo (on the basis of the Fitzgerald-Hallpike caloric test during the VNG examination), and Group II (reference group) - 30 healthy patients. After the ENT interview and physical examination, exclusion of pathological lesions in the external acoustic meatus and middle ear, each patient was subjected to a Fitzgerald-Hallpike caloric test during VNG examination, as well as a VHIT test and Dix-Hallpike test, with the evaluation of eyeball reaction during head rotation. RESULTS: In the group of patients with mixed-cause vertigo (Group I), the Fitzgerald-Hallpike caloric test showed unilateral labyrinth deficiencies in 90.9% of the patients (with the average value of 41.8%) and relative directional preponderance with the average value of 19.0%, while in 9.1% of the patients, the detected values of labyrinth excitability were normal. In the examination of patients with vertigo, benign paroxysmal positional vertigo was diagnosed in 9.1% of cases. This diagnosis was based on the positive response to the Dix-Hallpike manoeuvre and indicative of damage to the posterior semicircular canal in the VHIT test (without signs of deficiency in the VNG examination). CONCLUSION: The VHIT test and Dix-Hallpike test enable quick and precise detection of benign paroxysmal positional vertigo in out-patient practice and expertise preparation.

Diagnostic evaluation of neck torsion test in objective examination in patients with vertigo and/or hearing impairment.

INTRODUCTION: The aim of the study was to evaluate the neck torsion test in objective examinations of patients with vertigo and/or hearing loss. MATERIAL AND METHODS: The study was conducted in 100 patients, including 54 women and 46 men aged 17-79 years, who were divided into two groups: I - 50 patients, including 30 women and 20 men aged 17-79 years (mean age 49.92 years) with dizziness and/or hearing impairments, and confirmed asymmetry of intracranial vessels, II - 50 patients - the control group, including 24 women and 26 men aged 20-71 years without dizziness and/or hearing disorders and without disturbance in the construction of intracranial vessels. For each patient, the following tests were carried out: subjective, objective otorhinolaryngological, Doppler ultrasound specifying the diameter of vertebral and carotid arteries and the velocity of blood flow in these vessels, audiological diagnostics, including the examination of latency of waves I, III, V of the auditory evoked potentials of the brain stem, otoneurological diagnostics with used the neck torsion test. RESULTS: It appears from the analysis of the material presented that the application of the neck torsion test in the Doppler ultrasound results in the fact that the difference in the mean systolic velocity of blood flow in vertebral artery is higher on the side opposite to the turning of the neck, and the increase in the average diastolic blood flow velocity in the vertebral artery on the side of the test being performed and its reduction on the opposite side in the study group, when compared to the control group. The value of the wave I, II, V latency in the ABR test during the neck torsion test is extended more in the study group than in the controls, on the side of the performed test. The performed neck torsion test in the VNG test increases the occurrence of both, square waves and nystagmus (much higher in the study group than in the controls). CONCLUSION: The application of the neck torsion test in the Doppler ultrasound, ABR and VNG test in patients with vertigo and/or hearing loss means that these tests become functional, thereby increasing their diagnostic value and may be used to monitor the rehabilitation of inner ear disorders.

Diagnostic evaluation of neck torsion test in objective examination in patients with vertigo and/or hearing-impairment.

INTRODUCTION: The aim of the study was to evaluate the neck torsion test in objective examinations of patients with vertigo and/or hearing loss. MATERIAL AND METHODS: The study was conducted in 100 patients, including 54 women and 46 men aged 17-79 years, who were divided into two groups: I - 50 patients, including 30 women and 20 men aged 17-79 years (mean age 49.92 years) with dizziness and/or hearing impairments, and confirmed asymmetry of intracranial vessels, II - 50 patients - control group, including 24 women and 26 men aged 20-71 years without dizziness and/or hearing disorders and without disturbance in the construction of intracranial vessels. For each patient, the following tests were carried out: subjective, objective otorhinolaryngological, Doppler ultrasound specifying diameter of vertebral and carotid arteries and the velocity of blood flow in these vessels, audiological diagnostics, including the examination of latency of waves I, III, V of the auditory evoked potentials of the brain stem, otoneurological diagnostics with used the neck torsion test. RESULTS: It appears from the analysis of the material presented that the application of the neck torsion test in the Doppler ultrasound results in the fact that the difference in the mean systolic velocity of blood flow in vertebral artery is higher on the side opposite to the turning of the neck, and the increase in the average diastolic blood flow velocity in the vertebral artery on the side of the test being performed and its reduction on the opposite side in the study group, when compared to the control group. The value of the wave I, II, V latency in the ABR test during the neck torsion test is extended more in the study group than in the controls, on the side of the performed test. The performed neck torsion test in the VNG test increases the occurrence of both, square waves and nystagmus (much higher in the study group than in the controls). Conclussion. The application of the neck torsion test in the Doppler ultrasound, ABR and VNG test in patients with vertigo and/or hearing loss means that these tests become functional, thereby increasing their diagnostic value and may be used to monitor the rehabilitation of inner ear disorders.

Diagnosis and treatment of nasal and paranasal inverted papillomas - epidemiology and own experience.

INTRODUCTION: The aim of this study was to analyse the occurrence of inverted papillomas of the nose and paranasal sinuses in patients that underwent endoscopic sinus surgery in our department. MATERIAL AND METHODS: Between 2006 and 2016, 3,574 patients underwent surgery due to paranasal sinus diseases. Patients were qualified for surgery based on medical history, computed tomography, and laboratory tests. Data were gathered from medical files, and they included age, sex, and histopathological diagnosis. RESULTS: Among 3,574 patients that underwent surgery due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 patients, including 31 women (38.75%) and 49 men (61.25%). Most patients were aged 60-70 years (women, 12.5%; men, 15%) or 50-60 years (women, 5%; men, 21.25%). Between 2006 and 2016, the number of surgeries ranged from 264 (7.38%) in 2013 to 355 (9.93%) in 2016, and the number of inverted papillomas ranged from 4 in 2007 and 2015 (1.23%) to 12 in 2014 (3.87%). Over the last 4 years of the study period, the incidence of inverted papillomas increased. CONCLUSIONS: Among 3,574 patients operated on due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 cases (2.23%); thus, all patients qualified for endoscopic surgery due to inflammatory or hypertrophic changes should undergo rhino-fiberoscopy. Recurrence of inverted papillomas was observed in 17.50%, typically in patients with nasal polyps that co-occurred with inverted papillomas. We regard rhino-fiberoscopy as the most valuable method for detecting tumour recurrence in patients after surgery for inverted papillomas.

Acoustic neuroma as first sign of inner ear functional disorders.

INTRODUCTION: The aim of this work was to describe acoustic neuromas as the first signs of inner ear functional disorders. MATERIAL AND METHODS: The study covered 3,456 audiological and otoneurological patients, who were treated in the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics Military Medical Academy University Teaching Hospital in Lodz within the period of 2011-2016. Among the studied subjects, an acoustic neuroma on the vestibulocochlear nerve was diagnosed in 13 cases (5,16%), including 9 women and 4 men. Each patient underwent a medical interview and an objective examination with static and dynamic tests, pure tone audiometry and speech audiometry tests, impedance audiometry tests, characteristics of tinnitus, videonystagmography and auditory brainstem evoked potentials (ABR) in crack. In each case of an incorrect ABR recording, contrast-enhanced MRI was performed. STUDY RESULTS: The conducted tests showed an incorrect ABR recording in 252 patients (7,29%, including 54,37% women and 45,63% men). In the performed contrast-enhanced MRI, 13 patients (5,16%), including 3,57% women and 1,59% men, had an image typical to neuroma of the vestibulocochlear nerve. Each one of the studied patients showed signs and symptoms typical to an acoustic neuroma such as hypoacusia and balance disorders, tinnitus in 12 subjects, headaches in the temporal and occipital area in 4 subjects, trigeminal neuralgia symptoms in 2 subjects and vision problems like scotoma and blurred vision reported by 1 patient. CONCLUSION: Each case of sensorineural hearing loss, particularly unilateral sensorineural hearing loss, requires expanded hearing tests and auditory brainstem evoked potentials tests. An incorrect brainstem evoked potentials recording such as: an elongated latency of the 5th wave, an elongated interlatency of 1-2-3 and 1-2-3-4 waves, requires a contract-enhanced magnetic resonance imaging to diagnose cerebellopontine angle tumours.

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.

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.

The evaluation of the neck torsion test in subjective examinations of patients with vertigo and/or hearing loss.

INTRODUCTION: The aim of this work was to evaluate the diagnostic value of the neck torsion test in VNG, Doppler ultrasonography and brainstem auditory evoked potentials in patients with vertigo and/or hearing loss due to intracranial vascular malformations. MATERIAL AND METHODS: The study covered 47 patients, 30 female and 17 male (mean age, 55.5 years; range, 19-74 years) with vertigo and/or hearing disorders and the asymmetry of vertebral arteries. Each patient underwent a subjective examination, an otolaryngological examination, otoneurological diagnostics, VNG with gaze tracking in the straight ahead position and in the 600 left and right neck torsion, the neck torsion test, audiological diagnostics including I-, III- and V-wave latency of the brainstem evoked potentials in the straight ahead position and the right ear stimulation in the 600 right neck torsion and the left ear stimulation in the neck torsion to the left, Doppler ultrasonography with measuring the diameter of vertebral arteries and the velocity of the blood flow in these vessels with the use of the neck torsion test. RESULTS: In own study, in VNG, the positive neck torsion test was observed in 76.5% of the study patients, while square waves in both directions were found in 46.5% and in one direction in 10.6%. Cervical nystagmus was noticed in 19.1% of these patients. In the auditory evoked potentials test, the differences in I-, III- and V-wave latency time were not statistically significant, either at rest or in the neck torsion. In the Doppler ultrasound examination, the asymmetry of vertebral arteries were present (below 25%) in 7 women (14.9%) and 4 men (8.5%), whereas large asymmetries (above 25%) were observed in 23 women (48.9%) and 13 (27.7%) men (range, 25% - 215%) and was statistically insignificant. The resting blood flow velocity in vertebral arteries of large asymmetries, both in systole and diastole heart phases, was significantly higher in the artery with larger asymmetry. CONCLUSION: The neck torsion test can be diagnostically useful in monitoring the vertebrobasilar system as well as qualify for microsurgical procedures if the vertebrobasilar insufficiency has been diagnosed.

Evaluation of selected indicators of antioxidant status in patients with head and neck cancer.

INTRODUCTION: The aim of the study was to evaluate lipid peroxidation (TBARS) and the antioxidant enzymatic barrier in patients with head and neck cancer and in healthy controls. MATERIAL AND METHODS: Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) were measured by spectrometry in red blood cells of 22 patients and healthy controls. RESULTS: Decreased activity of SOD, CAT, and GPx as well as an increased concentration of MDA was found in cancer patients in comparison to healthy controls. DISCUSSION: Increased lipid peroxidation in red blood cells of cancer patients indicates an intensification of oxidative stress reactions. Measurements of the activity of the antioxidant enzymes point unambiguously to a reduced antioxidant capacity in head and neck cancer patients. However, this was a pilot study with a low number of participants. Moreover, future research should take into account genetic and extragenetic factors.

Metallothionein 2A core promoter region genetic polymorphism and its impact on the risk, tumor behavior, and recurrences of sinonasal inverted papilloma (Schneiderian papilloma).

Inverted papillomas are a unique group of locally aggressive benign epithelial neoplasms in the nasal cavity and paranasal sinuses arising from the Schneiderian mucosa. Metallothioneins are sulfhydryl-rich heavy metal-binding proteins required for metal toxicity protection and regulation of biological mechanisms including proliferation and invasion. The goal of this study was to identify three SNPs at loci -5 A/G (rs28366003) and -209 A/G (rs1610216) in the core promoter region and at locus +838 C/G (rs10636) in 3'UTR region of the MT2A gene with IP risk and with tumor invasiveness according to Krouse staging. Genotyping was performed using the PCR restriction fragment length polymorphism technique in 130 genetically unrelated IP individuals, and 418 randomly selected healthy volunteers. The presence of the rs28366003 SNP was significantly related to the risk of IP within the present population-based case-control study. Compared to homozygous common allele carriers, heterozygosity and homozygosity for the G variant had a significantly increased risk of IP (adjusted odds ratio [OR] = 7.71, 95% confidence interval [CI]: 4.01-14.91, p(dominant) < 0.001). Moreover, risk allele carriers demonstrated higher Krouse stage (pT1 vs. pT2-4) (OR = 19.32; 95% CI, 2.30-173.53; p < 0.0001), diffuse tumor growth (OR = 4.58; 95% CI, 1.70-12.11; p = 0.0008), bone destruction (OR = 4.13; 95% CI, 1.50-11.60; p = 0.003), and higher incidence of tumor recurrences (OR = 5.11; 95% CI, 1.68-15.20; p = 0.001). The findings suggest that MT2A gene variation rs28366003 may be implicated in the etiology of sinonasal inverted papilloma in a Polish population.

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.

Significance of CYCLOOXYGENASE-2(COX-2), PERIOSTIN (POSTN) and INTERLEUKIN-4(IL-4) gene expression in the pathogenesis of chronic rhinosinusitis with nasal polyps.

The purpose of this paper was to evaluate the level of Cyclooxygenase-2 (COX-2), Periostin (POSTN) and Interleukin-4(IL-4) gene expression in patients with chronic rhinosinusitis with nasal polyps, without polyps and with a nasal septum deviation. The tests were performed on 63 patients (24 women and 39 men) with chronic rhinosinusitis and polyps (CRSwP-study group I), with determination of the COX-2, POSTN and IL-4 gene expression; an allergy was diagnosed in 38 cases. The reference groups were patients with chronic rhinosinusitis without polyps--CRS (n = 23, including 14 women and 9 men) and patients with nasal septum deviation--DSN (n = 18, including 9 women and 9 men). The expression level was determined in the polyp tissue and the mucosa of paranasal sinus collected during an FESS. The expression level of studied genes was also evaluated in the material. Immediately after being collected, the tissue fragments were placed in test tubes with 1 ml of RNAlater (Qiagen, Hilden, Germany) preventing the degradation of RNA and frozen at -70 °C. The studies revealed an increased level of POSTN, IL-4 gene expression and a decreased level of COX-2 gene expression that may be associated with the development of chronic rhinosinusitis with nasal polyps. An analysis of the expression level indicates the participation of POSTN and IL-4 in the development of chronic rhinosinusitis with nasal polyps in patients with atopy.

Effects of oral contraceptives on selected parameters of the homeostatic control system in young women having a sudden disorder of the auditory and/or balance system.

The purpose of the paper was to assess the effects of oral contraceptives on selected parameters of the homeostatic control system in women having a sudden disorder of the auditory and/or balance system. The study included 105 young women divided into two groups: Group I--52 women with the disorder of the auditory and/or balance system using hormonal contraceptives for at least 2 months, aged 20-49; and Group II--53 women without any disorder of the auditory and/or balance system using hormonal contraceptives for at least 2 months, aged 18-40. The patients included in the study underwent a full otoneurological evaluation, detailed laryngological diagnostics and an evaluation of selected parameters of the homeostatic control system--fibrinogen level, D-dimer level, evaluation of APTT and PT indicator, plasma estradiol and progesterone with the Roche Cobas analyser by means of chemiluminescence. The vertigo occurring in the study group was most often central (59.6% of cases), mixed with compensation in 36.6% of cases, and peripheral only in 3.8% of cases, indicating labyrinth damage in 40.4% of cases. An analysis of the progesterone level, considering the menstrual cycle phase in the group, showed that its value was abnormal in 51.0% of women in the study group and 47.1% in the control group. In their own studies, the authors observed that the estradiol level in the plasma, considering the menstrual cycle phase in the study group, was abnormal in 41.2% of women and that the differences in its concentration were statistically significant in the study and control groups (p = 0.005), which may have a negative impact on the possibility of a thromboembolic episode.

[Neoplastic tumors in patients with unilateral inflammations qualified for endoscopic surgery]. / Guzy nowotworowe u chorych z jednostronnymi zmianami zapalnymi zakwalifikowanymi do operacji endoskopowych.

INTRODUCTION: The aim of this work was to analyze the occurrence and type of neoplasm in unilateral pathological lesions within the nose and paranasal sinuses in patients who underwent endoscopic surgery, in own material. MATERIAL AND METHODS: Between 2006 and 2012 2295 patients, including 1006 women aged 15-84 and 1289 men aged 17-87, were operated on due to diseases of paranasal sinuses in the Department of Otolaryngology and Laryngological Oncology. The patients underwent surgery after a medical interview, physical examination, 3D CT of paranasal sinuses and laboratory tests. The removed lesions were histopathologically investigated. The studied group included the patients with only unilateral lesions and histopathologically recognized neoplastic lesion. RESULTS: In the studied material, neoplastic lesions occurred in 9.8% cases, out of which 5.4% were inverted papillomas, 3.1% osteomas, and 1.5% malignant tumors. However, in the patients who were operated due to hypertrophic changes within paranasal sinuses, neoplasm was found in 1.3% cases, while inverted papilloma in 0.7%, osteoma in 0.4% and malignant tumors in 0.1%, which altogether amounts to 8 times higher occurrence of neoplastic lesions in unilateral changes. RESULTS: Unilateral changes within paranasal sinuses require highly inquisitive pre-operative diagnostics, peri-operative analysis and histopathological evaluation.

[Internal and external chordectomy via laryngofissure with the use of CO2 laser]. / Chordektomia wewnetrzna i zewnetrzna poprzez rozszczepienie krtani i zastosowaniem lasera CO2.

INTRODUCTION: The aim of this work was to evaluate the therapy results of patients with glottic carcinoma in the T1NoMo advanced clinical stage on internal or external chordectomy via the thyroid cartilage with the use of CO2 laser. MATERIAL AND METHODS: The study was conducted in 110 patients, including 7 women aged 52-68 and 103 men aged 52-73, who were treated in the Department of Otolaryngology and Laryngological Oncology, Military Medical Academy Teaching Hospital in Lodz, during the years 2010-2012, due to laryngeal carcinoma (T1N0M0). RESULTS: The studied material was subjected to external chordectomy via laryngofissure in 51 men (46.4%), and internal chordectomy with the use of CO2 laser in 52 men (47.2%) and 7 women (6.4%). In the patients operated via laryngofissure, the following types of external chordectomy were performed: IV - in 25 cases (49.0%), Vc - in 12 cases (23.6%), and Vb and Vd - in 7 cases each (13.7% each). Internal chordectomy was conducted with the use of the following types: III - in 31 cases (52.5%), IV - in 15 cases (25.4%) and Vd - in 13 cases (22.1%). During the post-operative follow-up of 1-3 years, no recurrence of carcinoma was observed. CONCLUSIONS: The place and size of carcinoma are often dependent on the type of internal and external chordectomy, which is preceded by tracheotomy and is usually dependent on a patient's consent. Too short post-operative follow-up does not allow for the comparison of effective therapies of the two surgical methods.