Kornel Szczygielski

Publications of Kornel Szczygielski

• Use of CMC foam sinus dressing in FESS.

  Authors: Kornel Szczygielski, Piotr Rapiejko, Andrzej Wojdas, Dariusz Jurkiewicz

  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 10/2009;

  Aim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose (CMC) foam dressing in functional endoscopic sinus surgery (FESS) in adult patients. InAim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose (CMC) foam dressing in functional endoscopic sinus surgery (FESS) in adult patients. In the present prospective study, 60 patients with bilateral chronic rhinosinusitis were included. All patients underwent bilateral FESS. Thirty patients had both nasal cavities packed with dissolvable CMC foam (CMCF) and another 30 patients had their nasal cavities packed with routine nasal packing (RNP) in latex glove fingers. The haemostatic effect of the CMCF was assessed during the recovery period, and pain levels were recorded by the patients on a visual analogue scale 24 h after surgery. The prevalence of postoperative middle meatal synechia formation was assessed 1, 2, 4 and 8 weeks after the operation. Four (13.3%) of the patients packed with CMCF had primary postoperative bleeding during the recovery period and required additional dressing. Bleeding appeared in two (6.7%) patients packed with RNP. The mean level of pain was 0.962 (range 0-4) for patients packed with CMCF but was 5.5 (range 3-9) for patients packed with RNP. Four (6.7%) of 26 CMCF patients and 10 (35.7%) of 28 RNP patients developed a synechia in the middle meatus. We found that dissolvable CMC foam dressing is associated with very low levels of localised pain and with low levels of postoperative bleeding and synechia formation.

• [Application of lasers in treatment of larynx diseases].

  Authors: Andrzej Wojdas, Jarosław Kosek, Karolina Dzaman, Kornel Szczygielski, Jan Ratajczak, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):76-9.

  In otolaryngology, CO2 laser is the first and most commonly applied device. Such lasers as Ny:YAG generating visible light having wavelength 532 nm referred to as KTP laser due to the Name of theIn otolaryngology, CO2 laser is the first and most commonly applied device. Such lasers as Ny:YAG generating visible light having wavelength 532 nm referred to as KTP laser due to the Name of the crystal where infrared light is converted to visible light. Such wavelenght, having green colour, due to strong absorption in haemoglobin is applied in treatments on tissues having dense blood vessels. The object of the work is to analyze larynx microsurgery laser treatments performer between 1994-2008 in the Otolaryngology Department of the Military Medical Institute CSK MON in Warsaw. The examination covered 445 patients including 142 women (31.9%) and 303 men (68.1%) aged between 12 and 80 (the average age of 48.2 year olds) who Were qualified in 1994-2003 for endoscopic laser surgery of the larynx. The operations field was watched using OPMI-11 operating microscope (Zeiss, Germany) allowing 4-16 times blow-up. Larynx laser microsurgery was performer using white laser beam: CO2 Illumina 40 (Heraeus LaserSonics, Germany) and green laser beam using KTP AURA XP laser (AMS, USA). The total of 445 larynx laser microsurgeries were performer. In recent years our clinic has seen an increase in the number of operations using this technique. The largest group were patients with recognized precancerous conditions (33.0%) and larynx carcinoma (26.4%). The next group in terms of the number of patients were 114 patients (20.6%) with recognized juvenile papilloma. Complications were observed in 180 patients. Table III show the type of recognized complications. The most commonly observed was swelling of the mucous membrane (48.3%), the rarest type was subcutaneous emphysema (3.3%). It was concluded that larynx laser microsurgery is a safe method and a valuable tool in treatment of larynx diseases, especially precancerous conditions and early forms of larynx carcinoma; that complications following procedure are relatively rare, usually mild, not life-threatening, and most often subsiding after a few days.

• [Endoscopic sinus balloon catheterization--new device in surgical treatment of rhinosinusitis]

  Authors: Dariusz Jurkiewicz, Kornel Szczygielski

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2009; 25(150):443-6.

  Use of new devices in surgical treatment of rhinosinusitis based on balloon catheters it's a hot topic in rhinology. Thanks to minimally invasive set of tools persistent sinus ostium patency withoutUse of new devices in surgical treatment of rhinosinusitis based on balloon catheters it's a hot topic in rhinology. Thanks to minimally invasive set of tools persistent sinus ostium patency without tissue removal is possible that was demonstrated in large multicenter study. This surgical procedure is safe and increases postoperative patients comfort. In this review authors describe experiences reported in world literature and our own highlights connected with use of endoscopic balloon catheter dilation of sinuses devices.

• [The cytokines at maxillary sinuses washings as inflammatory process expression]

  Authors: Andrzej Wojdas, Wanda Stankiewicz, Kornel Szczygielski, Jan Ratajczak, Piotr Rapiejko, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(5):558-60.

  INTRODUCTION: In a pathogenetic chain of chronic sinusitis there is a set of cellular and humoral factors that are accepted as characteristic of a chronic inflammatory process. These include mastINTRODUCTION: In a pathogenetic chain of chronic sinusitis there is a set of cellular and humoral factors that are accepted as characteristic of a chronic inflammatory process. These include mast cells, granulocytes (basophilic and acidophilic), macrophages, lymphocytes, leucotriens (leukotrieny), and some pro-inflammatory cytokines. In the majority of cases these are effector factors that finalise pathogenetic immunological response. By determining concentration of pro-anti-inflammatory and immunoregulatory cytokines present in the place where the disease process is in progress we can distinguish the type of inflammatory condition and thus select the type and duration of treatment. MATERIAL AND METHODS: The subject of the study was a group of 75 patients aged 18-60 with clinically confirmed chronic sinusitis; the diagnosis was made on the basis of history, physical examination as well as otolaryngological and imaging (CT scans) examination. Measurement of cytokines' activity was based on establishing concentration of cytokines in 1 ml (millilitre) of liquid recovered from puncture of maxillary sinus and subjected to centrifugation (lavage of maxillary sinuses) using ELISA (an immuno-enzymatic method) and kits produced by R&D company (Minneapolis, USA.) The following levels were examined: IL-1beta, IL-1ra, IL-4, IL-6, IL-10. RESULTS: Depending on the type of inflammatory process (allergic or bacterial), a difference in the level of IL-1beta/IL-1ra and IL-4 i IL-10 concentration was discovered in patients examined. The static analysis focused on how progression of the disease influenced the results obtained. CONCLUSIONS: Determining the amount of cytokines in maxillary washings allows differentiating chronic sinusitis.

• [A large emphysema as complication of sinus puncture]

  Authors: Ireneusz Kantor, Paulina Antonik, Dariusz Jurkiewicz, Kornel Szczygielski

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):633-6.

  Acute sinusitis including maxillary sinusitis is one of the most common complications of acute upper respiratory tract infections. The "gold standard" in the diagnostics and treatment in cases atAcute sinusitis including maxillary sinusitis is one of the most common complications of acute upper respiratory tract infections. The "gold standard" in the diagnostics and treatment in cases at positive interview, positive results of rhinoscopy, X-ray examination and negative pharmacological treatment is sinus puncture. Method is cheap, simple but charged minimal risk of complications, so, not recommended as method from choice for practice diagnostics of first cast. The paper presents case of intramuscular, subcutaneous, retropharyngeal region and in front of vertebral column regions emphysema in 61-year-old man after maxillary sinus puncture.

• [Bacterial flora in paranasal sinuses of the chronic inflammation]

  Authors: Andrzej Wojdas, Janusz Ratajczak, Agnieszka Syryło, Kornel Szczygielski, Jarosław Kosek

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):595-7.

  OBJECTIVE: To investigate the bacteriological profile in patients with chronic rhinosinusitis. MATERIALS AND METHODS: We enrolled to this trial 100 patients (56 females and 44 males) aged from 18 toOBJECTIVE: To investigate the bacteriological profile in patients with chronic rhinosinusitis. MATERIALS AND METHODS: We enrolled to this trial 100 patients (56 females and 44 males) aged from 18 to 62 (mean 41.3), with chronic rhinosinusitis. Control group were 20 patients (9 females and 11 males) aged from 19 to 44 (mean 29.4). RESULTS: In collected material from 87 patients (87%) growth of bacteria on 89 blood agar were received. In two cases mixed flora was observed. In 13 specimens there was no growth of any bacteria. Comparing results of studied cultures: in 78 patients pathological flora were discovered whereas in 8 patients saprophytic bacteria. In the group of pathological flora 71.57% cultured bacteria was aerobe, among it the commonest were: Staphylococcus aureus (13.73%), Streptococcus pneumoniae (10.78%), Haemophilus influenzae (9.8%), Staphylococcus coagulase negative (9.8%). In anaerobe group most frequently bacteria isolated was Prevotelle sp. (6.86%). CONCLUSIONS: In our trial 15 different bacterial types were identified. In 72% cases aerobic bacteria were cultured. The most commonest pathogens were: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus coagulase negative.

• [Threshold pollen count necessary to evoke allergic symptoms]

  Authors: Piotr Rapiejko, Wanda Stanlaewicz, Kornel Szczygielski, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(4):591-4.

  The purpose of this study was to analyze the relation between clinical picture of allergic disease and the level of pollen count the patients are exposed to. MATERIAL AND METHOD: We analyzed theThe purpose of this study was to analyze the relation between clinical picture of allergic disease and the level of pollen count the patients are exposed to. MATERIAL AND METHOD: We analyzed the severity of allergic rhinitis, conjunctivitis and bronchial asthma in a group of 640 subjects from Warsaw area with hypersensitivity to hazel, alder, grass, mugwort, plantain, nettle, Alternaria and Cladosporium allergens. Aerobiological measurements, patients' symptoms score cards and the results of physical examination were analyzed. RESULTS: First symptoms in patients allergic to grass were visible during exposure to the concentration of 20 pollen grains in 1 m3 of air (25% subjects sensitised to grass pollen). Symptoms were noted in all the subjects sensitized to grass pollen at a concentration of approximately 50 grains/m3 of air. During exposure to the concentration of 65 pollen grains per m3 the symptoms were strengthened. Several hours' exposure to grass pollen concentration exceeding 120 grains/m3 cause dyspnoea in some patients. Similar intensive symptoms occurred after exposure to alder, birch and mugwort pollen. Patients with positive skin prick tests to plantain and nettle pollen allergens experienced symptoms of low intensity or even none symptoms during pollination period. Subjects with hypersensitivity to Alternaria allergens experienced symptoms during exposure to the concentration of approximately 80 spores in 1 m3 of air, while patients sensitised to Cladosporium allergens, during exposure to the concentration of over 2800 spores in 1 m3 of air. The dominant symptom occurring in patients sensitized to fungal allergens was loss of nasal patency, and dyspnoea as well as recurring cough at higher concentrations. CONCLUSIONS: Clinical symptoms of allergic disease were connected to the concentration and the kind of aeroallergen the subjects were exposed to.

• [Comparison of dissolvable sinus dressings in functional endoscopic sinus surgery]

  Authors: Kornel Szczygielski, Piotr Rapiejko, Andrzej Wojdas, Marcin Jadczak, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(5):852-6.

  OBJECTIVES: Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aimOBJECTIVES: Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aim of our study was to compare the pain level, adhessions and haemostatic properties of Stammberger sinus dressing (SSD) with Dissolvable Sinu-Knit (DSK) and routine nasal packing in latex gloves finger (RNP) after FESS in adult patients. METHODS: 45 patients with bilateral chronic rhinosinusitis (CRS) (totally 90 sides) were recruited into our trial. All patients underwent bilateral FESS without septoplasty. Following completion of surgery, every single nasal cavity side was packed with one of the studied dressing chosen randomly. In 41 sides nasal cavities were packed with Stammberger Sinus Dressing (SSD) in 26 sides packed with Dissolvable Sinu-Knit and 23 sides were filled with routine nasal packing in latex gloves finger (RNP). Haemostatic effect was assessed during the recovery period, pain level was recorded by the patients on a visual analogue scale 24 hours after surgery. Tendency to postoperative middle meatal synechia formations was assessed during control visits in the 1, 2, 4 and 8 week postoperatively. RESULTS: Three (7.3%) of sides packed with SSD and four (15.3%) packed with DSK had primary postoperative bleeding that required additional packing. Finally 3D patients were packed with RNP. In patients packed with RNP bleeding didn't appear. Mean pain level for SSD was 0.85 (range from 0 to 3) and for DSK 2.1 (range 0 to 5) whereas for RNP was 5.6 (range from 2 to 9). Five (13.1%) of thirty-eight sides with SSD and five (22.7%) of twenty-two sides with DSK had synechia in middle meatus whereas eight (26.6%) of total thirty sides packed with RNP had synechia at any one of the control visits. CONCLUSION: We found that Rapid Rhino Stammberger Sinus Dressing and Dissolvable Sinu-Knit are associated with very low local pain level and with a good effect in postoperative bleeding and synechia formation control.

• [Evaluation of hyperbaric oxygen and pharmacological therapy in sudden hearing loss]

  Authors: Marcin Jadczak, Piotr Rapiejko, Ireneusz Kantor, Kornel Szczygielski, Jacek Usowski, Jacek Piechocki, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(5):887-91.

  Treatment of idiopathic sudden hearing loss (SHL) is still a big problem for the otolaryngologists, due to the still unexplained etiopathogenesis of the illness. The aim of this study was to evaluateTreatment of idiopathic sudden hearing loss (SHL) is still a big problem for the otolaryngologists, due to the still unexplained etiopathogenesis of the illness. The aim of this study was to evaluate effectiveness of pharmacotherapy combined with the hyperbaric oxygen (HBO) in idiopathic sudden sensorineural hearing loss treatment. Patients who received HBO and medical treatment in the Department of Otolaryngology of Military Institute of Health Service and Warsaw Center for Hyperbaric Therapy and Wounds Treatment were studied. MATERIAL AND METHODS: Nine patients, with idiopathic sudden hearing loss--patients treated in 2007 year were studied. There were 5 women and 4 men involved in our study--mean age: 41 years old. Patients with sensorineural hearing loss of minimum 15 dB at 0.25-8 kHz and tinnitus were included in the treatment group. Improvement of hearing of minimum 10 dB at 0.25-8 kHz in pure tone audiometry and decrease in the intensity of tinnitus was considered as an improvement. RESULTS: Statistically significant difference in Pure Tone Audiometry results obtained before and after the treatment was noted in 500 Hz, 1 kHz, 2 kHz, 3 kHz, 4 kHz and 8 kHz. Statistically significant difference was noted in 500 Hz, 2 kHz, 3 kHz when treatment was started within 6 days since the acoustic trauma. No side effects of therapy were observed. CONCLUSIONS: Hyperbaric oxygen therapy is the unique method of increasing concentration of oxygen in the inner ear fluids thus facilitates the regeneration process. Hyperbaric oxygen therapy combined with steroids is an effective method of sensorineural hearing loss treatment. Important is to start the therapy quickly after hearing loss.

• [Detection of Helicobacter pylori in nasal polyps specimens using urease test GUT plus]

  Authors: Kornel Szczygielski, Dariusz Jurkiewicz, Piotr Rapiejko

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):309-11.

  In patients with nasal polyps the colonisation of nasal polyps tissues by Helicobacter pylori was investigated using urease test (GUT plus). In this prospective clinical trials we enrolled 61In patients with nasal polyps the colonisation of nasal polyps tissues by Helicobacter pylori was investigated using urease test (GUT plus). In this prospective clinical trials we enrolled 61 subjects who had undergone endoscopic nasal polyps surgery and 30 subjects who had undergone septoplasty (control group) were questioned and biopsy specimens of the removed polyps or the mucosal part of inferior turbinate were tested by the urease test GUT plus. In result Helicobacter pylori was not found in the nasal polyps and mucosal part of inferior turbinate tissue of any of patients including the 43 of 61 patients with nasal polyps and 7 of 30 patients with septum deviation who had symptoms of gastroesophageal reflux. In our study using the urease test GUT plus we were not able to confirm presence of Helicobacter pylori in the nasal polyps tissue. However, further epidemiologic studies using different diagnostic methods would be necessary to confirm presence of Helicobacter pylori as potential underlying pathogenetic mechanism of nasal polyposis.

• [Techniques of intranasal drug use]

  Authors: Piotr Rapiejko, Andrzej Wojdas, Jan Ratajczak, Kornel Szczygielski, Dariusz Jurkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):400-2.

  The aim of the study was to assess the incidence of changes in nasal mucosa in patients treated with long term intranasal corticosteroids and to determinate reasonability of intranasal dropsThe aim of the study was to assess the incidence of changes in nasal mucosa in patients treated with long term intranasal corticosteroids and to determinate reasonability of intranasal drops administration in symptomatic treatment of nasal catarrh. The study included the total of 1962 patients. Within this group, 612 patients treated with intranasal corticosteroids underwent full laryngological examination to evaluate the status of nasal mucosa. In the group of 1350 users of web-based Allergologic Courier, who had used intranasal drops because of "runny nose" within last 3 months before the examination, a questionnaire survey was performed. The study results reflect poor knowledge the methods of nasal drops administration among patients, as well as low effectiveness of educational initiatives led by physicians and pharmacists. In 25 persons from 367 examined (6.81%) who used steroid spray locally, and who showed up in laryngological outpatient clinic, nasal mucosal damage was diagnosed for the first time. Mucosal damage was most frequently located in the right nasal septal mucosa--in 21 patients (5.72% of total patients) that was connected with improper nasal inhaler positioning and right hand movements directing it towards septum in the right nasal meatus. Among patients, who have remained under regular laryngological care in outpatient clinic (all of them are instructed of drug administration technique), only 5 persons (2.04%) out from 245 in the study group presented changes in nasal mucosa. No differences between changes occurrence on each side of nasal septum were found. Without proper training, only 8.52% from 1350 examined persons had been taking nasal drops in a proper manner to achieve its effectiveness.

• [Endoscopic sinus balloon catherisation--evolution or revolution in treatment of rhinosinusitis? Our experience and literature review]

  Authors: Dariusz Jurkiewicz, Kornel Szczygielski, Krzysztof Brzozowski

  Otolaryngologia polska. The Polish otolaryngology. 63(2):113-7.

  Sinus ostium patency is a key point in treatment of rhinosinusitis. Thanks to minimally invasive set of tools dilation of ostium without tissue removal is possible that was demonstrated in largeSinus ostium patency is a key point in treatment of rhinosinusitis. Thanks to minimally invasive set of tools dilation of ostium without tissue removal is possible that was demonstrated in large multicenter studies. The aim of our study is to present endoscopic balloon dilatation of sinuses technique under fluoroscopy and asses efficacy and safety in surgical treatment of chronic rhinosinusitis based on own experience (10 cases) and literature data. We concluded that endoscopic balloon dilation of sinus procedure is much more safe than previous techniques and increases postoperative patients comfort.

• [Assesment of haemostatic dressings in endoscopic sinus surgery].

  Authors: Kornel Szczygielski

  Otolaryngologia polska. The Polish otolaryngology. 63(5):452-3.

• [The application of KTP laser in otolaryngology - 3 years experience].

  Authors: Andrzej Wojdas, Kornel Szczygielski, Jarosław Kosek, Jan Ratajczak, Dariusz Jurkiewiczc

  Otolaryngologia polska. The Polish otolaryngology. 65(4):281-4.

  The KTP laser is popularly called the green laser is a type of Nd: YAG laser zawdzięczający its name from the additional element of KTP crystal which is a wavelength of 532 nm. The aim of this paperThe KTP laser is popularly called the green laser is a type of Nd: YAG laser zawdzięczający its name from the additional element of KTP crystal which is a wavelength of 532 nm. The aim of this paper is to present our 3-year experience in the application of KTP laser in otolaryngology. In the Department of Otolaryngology, CSK MON Military Medical Institute in Warsaw from 2008, performed 211 operations using the green laser. The study group was 89 women and 122 men aged 12 to 94 years (mean age 53.2 years). The surgery was performed 15-watt KTP Aura laser. All guestrooms are fibers with a diameter of 0.2, 0.4 and 0.6 mm, and guides for inserting the fiber ends are not. Results: In 3-year period have made a 211 KTP laser surgery including the nasal cavity, mouth, larynx and trachea, and the outer ear. In the procedure adopted one day 76 people, and at least 111 patients stayed in hospital for 4 days. In our material patients after UPPP tonsillectomy and operations, in addition to a negligible bleeding during surgery, rarely also had late bleeding (5%). In our clinic konchoplastyki performed based on the so-called. technique of “cross-hatching”. The laryngeal endoscopic surgery is used micromanipulator, if we are to remove a large tumor of the larynx much better to use the guide laryngeal. The KTP laser is an important tool in the operational procedures in otolaryngology in large part due to the high activity and its complexity hemostatycznemu assistant. Become familiar with the operation of the laser and improvement of surgical techniques allows patients to propose a modern surgical procedures. Improves the possibility of radical treatment of tumors of the larynx endoscopic method.

• [Taste perception in patient with chronic rhinosinusitis with nasal polyps treated with oral glucocorticosteroid therapy]

  Authors: Karolina Dzaman, Piotr Rapiejko, Kornel Szczygielski, Witold Pleskacz, Dariusz Jurkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 63(3):236-41.

  BACKGROUND: Chronic rhinosinusitis with nasal polyps is observed in 1-4% persons during rhinoscopy. While the occurrence of their problems is connected with smell sense, still not enough attention isBACKGROUND: Chronic rhinosinusitis with nasal polyps is observed in 1-4% persons during rhinoscopy. While the occurrence of their problems is connected with smell sense, still not enough attention is paid to the malfunctioning of their taste sense. AIM: The purpose of this study was estimation of taste sense functioning in patients with chronic rhinosinusitis with nasal polyps, treated with oral glucocorticosteroid. MATERIAL AND METHODS: The study included 82 persons. The 31 of them were patients of Otolaryngology Department of Warsaw Military Institute with chronic rhinosinusitis with nasal polyps' diagnosis, who were treated with systemic--oral glucocorticosteroid for three weeks. There were 51 healthy people as a control group. Both prior to the treatment and one month after it was finished, all patients had the taste examination. The taste functioning was examined with two methods: the gustometry by Bornstein and impulse bipolar electrogustometry method. Subjective nasal patency was noted based on analogical scale. The smell function was assessed with the Elsberg-Levy olfactometry in Pruszewicz's modification. RESULTS: Before treatment the taste disturbances were observed, depending on kind of taste, in 6-16 cases (19.4-51.6%) in gustometry and for 10 patients (32.26%) in electrogustometry. Before treatment the taste examination results in chronic rhinosinusitis with nasal polyps' cases were statistically significantly different than in the control group. After treatment with glucocorticosteroid the taste disturbances were observed, depending on kind of taste, in 0-9 cases (0-29%) in gustometry and for 4 patients (12.9%). in electrogustometry. Statistically, glucocorticosteroid therapy also decreased the smell threshold and was effective in restoration of the nose patency. CONCLUSIONS: Statistically, therapy with glucocorticosteroid significantly improved both the taste and smell perception in patients with chronic rhinosinusitis with nasal polyps