[Show abstract][Hide abstract] ABSTRACT: Introduction:
Surgery of the thyroid gland remains the main cause of bilateral vocal cord palsy (VCP). Ventilation problem is the main problem in such situations. There are a couple of corrective surgical procedures in the case of VCP. The aim of our study was to show the possibility of widening of the glottis, and to evaluate the techniques and effects of surgical treatments due to bilateral VCP resulting from thyroid gland surgery.
Material and methods:
Five methods of surgical treatment were used: laser-assisted posterior cordectomy, according to Denis and Kashima; laser-assisted bilateral medial arytenoidectomy, as proposed by Crumley; laser-assisted posterior ventriculocordectomy, as described by Pia; laser-assisted total arytenoidectomy with posterior cordectomy, as presented by Ossoff; and laterofixation, according to Lichtenberger. The postoperative patient's subjective improvement was assessed using visual analogue scale.
Between 1998 and 2014 we operated on 270 patients with bilateral VCP. Paresis occurred as the result of the iatrogenic effect of thyroid gland surgery in 255 patients (94.4%) vs. 15 (7.6%) from other causes. The majority of our patients (77.6%) had undergone laser arytenoidectomy with posterior partial cordectomy, and in 13.7% of them Lichtenberger laterofixation had been performed. Ossoff 's surgery gives good ventilation results: successful decannulation (62.9% after first surgery; 97.6% final rate) and significant subjective ventilation improvement in 96% of patients.
Ossoff 's laser arytenoidectomy with posterior cordectomy is a safe procedure that gives acceptable ventilation improvement. Patients report satisfactory quality of life and the possibility of returning to active professional life. Laterofixation should be considered as an alternative for tracheotomy rather than permanent procedure. (Endokrynol Pol 2015; 66 (5): 412-416).
Preview · Article · Oct 2015 · Endokrynologia Polska
[Show abstract][Hide abstract] ABSTRACT: Low grade inflammation is associated with both chronic spontaneous urticaria (CSU) and atherosclerosis. Data regarding an association between urticarial inflammation and atherosclerosis and subsequent cardiovascular events are scarce. It has been demonstrated that matrix GLA protein (MGP), a biomarker of arterial calcification, is increased in patients with atherosclerosis. Aim: To evaluate circulating levels of markers of arterial calcification and acute phase response (APR) in patients with CSU. Methods: Concentrations of MGP and IL-6 were measured in venous blood samples of patients with long-lasting moderate-severe CSU. Results: There were no significant differences in serum MGP concentration between healthy subjects and CU patients. Serum IL-6 concentration was significantly higher in CSU patients as compared with healthy subjects. Conclusions: The results confirm that CSU is accompanied by a low grade systemic inflammatory state. However, the long lasting urticarial inflammation was not paralleled by an increased circulating level of the calcification marker matrix Gla protein.
No preview · Article · Dec 2014 · European journal of dermatology: EJD
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the effectory mechanisms: vasopressin, renin-angiotensin system and proopiomelanocortin-derived peptides (POMC), partaking in the effects of serotonin through central serotonin 1A receptor (5-HT1A) receptors in haemorrhagic shock in rats. The study was conducted on male Wistar rats. All experimental procedures were carried out under full anaesthesia. The principal experiment included a 2 hour observation period in haemorrhagic shock. Drugs used - a selective 5-HT1A agonist 8-OH-DPAT (5 μg/5 μl); V1a receptor antagonist [β-mercapto-β, β-cyclo-pentamethylenepropionyl(1),O-me-Tyr(2),Arg(8)]AVP (10 μg/kg); angiotensin type I receptor antagonist (AT1) ZD7155 (0.5 mg/kg, i.v.); angiotensin-converting-enzyme inhibitor captopril (30 mg/kg, i.v.); melanocortin type 4 (MC4) receptor antagonist HS014 (5 μg, i.c.v.). There was no influence of ZD715, captopril or blocking of the V1a receptors on changes in the heart rate (HR), mean arterial pressure (MAP), peripheral blood flow or resistance caused by the central stimulation of 5-HT1A receptors (P≥0.05). However, selective blocking of central MC4 receptors caused a slight, but significant decrease in HR and MAP (P<0.05). POMC derivatives acting via the central MC4 receptor participate in the resuscitative effects of 8-OH-DPAT. The angiotensin and vasopressin systems do not participate in these actions.
No preview · Article · Oct 2014 · Journal of physiology and pharmacology: an official journal of the Polish Physiological Society
[Show abstract][Hide abstract] ABSTRACT: Background
There is still controversy regarding the influence of aging on medial olivocochlear (MOC) system function. The main objective of this study is to measure age-related changes of MOC system function in people with normal hearing thresholds.
Bilateral assessment of the MOC effect for click-evoked otoacoustic emissions (CEOAEs; at 70±3 dB peak sound pressure level [pSPL], click at 50/second, 260 repeats, 2.5–20 millisecond window) and for distortion product otoacoustic emissions (DPOAEs; with [frequencies] f2/f1=1.22, [levels of primary tones] L1=65 dB SPL and L2=55 dB SPL; DP-grams for 2f1–f2 were collected for the f1 frequencies varying from 977 Hz to 5,164 kHz, with the resolution of four points per octave) was performed in a group of 146 (n=292 ears) healthy, right-handed subjects aged from 10–60 years with a bilateral hearing threshold from 0.25–4.0 kHz, not exceeding 20 dB hearing level; normal tympanograms; and a threshold of the contralateral stapedial reflex for broadband noise (BBN) of 75 dB SPL or higher. The MOC inhibition was assessed on the basis of changes in OAE level during BBN contralateral stimulation at 50 dB sensation level (mean, 65±3 dB SPL).
Comparative analysis of the MOC effect for CEOAE and DPOAE showed the weakest effect in the oldest age group (41–60 years) at almost all tested frequencies. Moreover, a weak, albeit significant, positive correlation between the level of OAE and the size of the MOC effect was documented.
On the basis of our study, we have found a decrease in the strength of the MOC system with increasing age in normally hearing subjects, as reflected by a decrease of the OAE suppression effects in older individuals and an increase of the number of CEOAE and DPOAE enhancements during contralateral acoustic stimulation in the elderly, especially in the high-frequency range.
Preview · Article · Jun 2014 · Clinical Interventions in Aging
[Show abstract][Hide abstract] ABSTRACT: Chronic spontaneous urticaria (CSU) is an immune-inflammatory disease, characterized by acute phase response (APR) and immune activation. There has been increasing evidence showing that vitamin D deficiency/insufficiency is associated with increased incidence and/or severity of immune-inflammatory disorders.Aim: To assess relationship between vitamin D status and C-reactive protein (CRP), a nonspecific inflammatory marker of CSU activity.
Concentrations of CRP and 25-hydroxyvitamin D [25(OH)D], a biomarker of vitamin D status were measured in serum of CSU patients and compared with the healthy controls.
Serum 25(OH)D concentration was significantly lower in CSU group as compared with the normal subjects. The prevalence of vitamin D deficiency (< 20 ng/ml) was significantly higher in patients with CSU than among normal population. There were no significant differences in prevalence of 25(OH)D insufficiency between the groups. Serum CRP concentrations were significantly higher in CSU patients as compared with the healthy subjects. There were no significant correlations between CRP and 25(OH)D concentrations in CSU patients.
CSU is associated with lower serum 25(OH)D concentration and higher prevalence of its deficiency. The results failed to show any effect of vitamin D status on circulating CRP concentrations in CSU. A potential role of vitamin D in pathogenesis and/or additive therapy of CSU needs to be examined in other cohorts of CSU patients as well as in larger studies.
Full-text · Article · Feb 2014 · Journal of Inflammation
[Show abstract][Hide abstract] ABSTRACT: Chronic spontaneous urticaria (CU) is associated with activation of the acute phase response (APR). Nevertheless, APR-associated proteins have not been well characterized as potential biomarkers of the disease severity. To assess the pattern of complement proteins C3 and C4 -- the acute phase reactants in patients with CU. C3, C4 and CRP concentrations were measured in serum of 70 patients showing different degrees of urticarial severity as well as in 33 healthy subjects. Serum C3 and C4 concentrations were significantly increased in CU patients as compared with the healthy subjects and exceed the normal lab range by about 5% and 10%, respectively. Significant differences were found between patients with mild and increased CU severity. In addition, significant correlations were observed between C3, C4 and CRP concentrations. More severe CU is characterized by higher production of C3 and C4 complements accompanied by parallel changes in CRP concentration.
Full-text · Article · May 2013 · Journal of Inflammation
[Show abstract][Hide abstract] ABSTRACT: The bleeding and haemorrhage is strictly related with accidents and many medical procedures. In some conditions it leads to hypovolaemia and further to hypovolaemic shock. Under conditions of haemorrhagic shock, heart rate and blood pressure critically collapse. Reversing the sympathoinhibitory phase of hypovolaemia could be crucial for clinical management of injured patients after haemorrhage. Systemic administration of 5-HT1A agonists seams to produce resuscitating effects. The aim of this study was to investigate the participation of central serotonin and, in particular, 5-HT1A receptors in cardiovascular regulation in haemorrhagic shock in rats. Intracerebroventricular (i.c.v.) administration of serotonin (5-HT) increased the heart rate (HR), mean arterial pressure (MAP) and implicated that all haemorrhaged animals survived for the whole observation time (2 hours). Similar, although significantly more minor, effects were achieved after selective 5-HT1A activation. Moreover, the i.c.v. administration of selective 5-HT1A antagonist before i.c.v. 5-HT injection partially inhibited 5-HT induced changes. The results of the present work indicate that 5-HT plays an important role in the reversal of the haemorrhagic shock in rats. These effects are at least partially dependent on activation of 5-HT1A receptors.
No preview · Article · Apr 2013 · Journal of physiology and pharmacology: an official journal of the Polish Physiological Society
[Show abstract][Hide abstract] ABSTRACT: Background
Our previous findings showed the importance of analysing the peripheral markers of acute phase response (APR) activation, C-reactive protein (CRP) and IL-6 in the context of urticaria activity and severity. However, these biomarkers do not reliably differentiate between APR to infectious and the disease severity.
In order to investigate a possible association between the immune-inflammatory activation markers CRP and procalcitonin (PCT).
Serum PCT and CRP concentrations were measured in patients with CU of varying severity as well as in healthy subjects.
Serum PCT and CRP concentrations were significantly increased in more severe CU patients when compared to healthy controls and mild CU, and within the CU population there was a significant correlation between concentrations of PCT and CRP. Serum PCT concentrations remained within normal ranges in most CU patients and were only slightly elevated in some severe CU cases.
PCT serum concentration may be only slightly elevated in some cases of severe CU. Upregulation of PCT synthesis accompanied by parallel changes in CRP concentration reflects a low-grade systemic inflammatory response in CU. PCT should be considered as a better marker than CRP to distinguish between APR to infection and an active non-specific urticarial inflammation.
Full-text · Article · Dec 2012 · Agents and Actions
[Show abstract][Hide abstract] ABSTRACT: Background Active chronic urticaria, identified as a mast cell- and basophil-dependent inflammatory disorder of the skin is able to elicit acute phase response (APR). However, systemic inflammatory response in different types of urticaria is poorly characterized. Aim To determine APR pattern in a clearly defined group of patients with acute urticaria and/or angioedema - induced by NSAIDs. Methods Plasma IL-6 and serum C-reactive protein (CRP) concentrations were studied in 17 patients with NSAIDs-induced acute urticaria/angioedema (NSAIDsAU) and in 20 healthy controls. Eleven patients who used NSAIDs were presented at the emergency room with acute urticaria/angioedema while the remaining six manifested the symptoms during the aspirin challenge test. Patients were examined in a dynamic manner: during the acute phase, and next, after subsidence of the symptoms. Results CRP and IL-6 concentrations increased significantly in patients with NSAIDsAU as compared with their asymptomatic period and the healthy subjects. In addition, NSAIDsAU patients showed elevated concentration of the biomarkers following aspirin provocation with the baseline values recovered in the asymptomatic period. Conclusion These results indicate that an acute systemic inflammatory response is activated in patients with NSAIDs-induced urticaria and/or angioedema. The study supports the evidence proving that up-regulation of CRP and IL-6 in urticaria/angioedema does not necessarily reflect any concomitant infection or other inflammatory processes, but may be due to the disease itself.
No preview · Article · Feb 2012 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Delayed pressure urticaria (DPU) is characterized by swelling in the area of sustained pressure on the skin. The reported case was a potentially life-threatening complication due to mucosal edema following esophagogastroduodenoscopy (EGD). A 37-year-old man, suffering from severe DPU and chronic spontaneous urticaria, had undergone EGD due to dyspeptic symptoms. A few hours after the EGD procedure, the patient showed both dysphagia and dyspnea. A physical examination indicated massive tongue base and pharynx edema. We suggest that these symptoms were most likely due to the pressure exerted by EGD. No other apparent origins such as angioedema or late-phase allergic reaction to drugs were identified. One should be aware of the increased risk of developing airway and gastrointestinal obstruction during medical procedures associated with compression, such as EGD or endotracheal intubation, in DPU patients.
[Show abstract][Hide abstract] ABSTRACT: Nitric oxide (NO) may contribute to the mutagenic processes and has been extensively studied as a noninvasive marker of neoplastic processes occurring in the airways. It has been suggested that an increased expression of inducible NO synthase might appear as an important molecular event involved in the early stage of laryngeal carcinogenesis. The aim of this study was to determine NO levels in the exhaled air of patients with early stage glottic carcinoma. Exhaled bronchial NO was measured using a Niox Mino analyzer in 28 patients with squamous cell glottic carcinoma (T1-T2N0M0) and in 30 healthy controls. There were no significant differences in exhaled NO level between the healthy controls and T1-T2N0M0 patients with glottic cancer or between the subgroups (T1 vs. T2). It seems that early glottic cancer is not associated with significant changes in the exhaled NO level. Early diagnosis of cancer is desirable, however this study does not prove that exhaled NO may be a useful biomarker in patients with early stage squamous cell glottic carcinoma.
No preview · Article · May 2011 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
[Show abstract][Hide abstract] ABSTRACT: Hendryk S, Czecior E1, Bażowski P, Misiołek M1.
Subcranial approach in surgical treatment of diffuse pansinusitis
Department of Neurosurgery in Katowice and ENT Department1 in Zabrze Medical University of Silesia, Poland
Purpose: The treatment of diffuse pansinusitis is a challenge for surgeons. Among a many surgical methods the extended subcranial approach creates a good surgical strategy for total removal of the inflammatory changes.
Material and Results: We demonstrate two patients with diffuse pansinusitis that comprising paranasal sinuses and in first case created a clinical image of anterior cranial base tumor and second case had destroyed structures of anterior skull base. In first patient this was Tu gigantocelullarae caused by weak trauma of the frontal region and next had a productive-inflammatory change. In next patient the reason of inflammatory process was aspergillosis. The extended subcranial approach described by Fliss et al. was used in our patients. The essence is to create a wide approach to the whole sinuses via opening the frontal sinus and nasal cavity in one bone piece. No complications were observed after the surgery, and inflammatory changes and accompanying disturbances receded quickly.
Conclusion: Extended subcranial approach creates excellent inspection into whole sinuses and permits the diffuse changes to be radically treated.
No preview · Article · Apr 2009 · Skull Base Surgery
[Show abstract][Hide abstract] ABSTRACT: Hendryk S, Czecior E1, Bażowski P, Misiołek M1.
Strategies and results in surgical treatment of the anterior skull base tumors
Department of Neurosurgery in Katowice and ENT Department1 in Zabrze,
Medical University of Silesia, Poland
Purpose: The final decision on choice of the surgical strategies in anterior skull bases tumors is influenced by possibility of complete tumor removal, difficulty of reconstruction and prediction of the serious postoperative complications.
Material and Results: Our experiences comprised 20 patients. Nine patients were operated on due to malignant tumors. Transcranial approaches were used in 4 cases and craniofacial or subcranial approaches in 5 patients. In 8 patients tumors were resected totally which was confirmed by histopathological tests and by CT and/or MR examinations. The mean survival time in a group with transcranial tumor removal was shorter than in group with en block tumor removal (11 and 17 moths respectively; p<0.01). The CSF leakage (one case) and CNS infection (two cases) appeared only in patients with craniofacial/subcranial approaches. In a group of 11 patients with benign tumors or other lesions of anterior cranial base transcranial or subcranial approaches were used with very good results.
Conclusions: The en bloc removal of the malignant tumors of anterior cranial base via craniofacial/subcranial approach creates a greater chance for a longer patient’s survival. The potential severe complications may be diminished by precise planning of the reconstruction of the skull base lesion. In the benign tumors of the anterior skull base transcranial or subcranial approaches are recommended.
No preview · Article · Apr 2009 · Skull Base Surgery
[Show abstract][Hide abstract] ABSTRACT: Thoracic surgery requires immobilization of the operating area. Usually, this is achieved with one-lung ventilation (OLV), however this may still lead to some movement. High-frequency jet ventilation (HFJV) may be an alternative way of ventilation in thoracic surgery. The purpose of this study was to determine the effectiveness of HFJV as an alternative option to OLV for thoracic procedures.
Sixty patients were randomized to receive either HFJV (n = 29) or OLV (n = 31) during the operation. During the course of the study 10 patients were excluded (4 patients in HFJV group and 6 patients in OLV group). The following haemodynamic and ventilatory parameters were recorded: heart rate, systolic and mean blood pressure, ventricular stroke volume, cardiac index, systemic vascular resistance, peak inspiratory pressure, oxygen saturation, PaO2 and PaCO2. Overall parameters were documented before the initiation of the chosen mode of ventilation every 15 min during the operation.
Patients in both groups showed comparable cardiovascular function. Mean values of peak inspiratory pressure were significantly higher in the OLV group. Oxygen saturation values were statistically higher in the HFJV group. PaCO2 values were similar in both during surgery, but were higher in the OLV group after awakening. Mean values of shunt fraction were lower in the HFJV group. Lower values of peak inspiratory pressure were therefore associated with higher partial pressure of carbon dioxide levels in the HFJV group. In the OLV group, 44% of patients experienced a postoperative sore throat. Operating conditions were comparable.
HFJV is safe option, comparable to OLV and offers some advantages for open-chest thoracic procedures.
No preview · Article · Feb 2008 · European Journal of Anaesthesiology
[Show abstract][Hide abstract] ABSTRACT: The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.
No preview · Article · Sep 2007 · Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde
[Show abstract][Hide abstract] ABSTRACT: The relation between snoring and obstructive sleep apnea as well as hypothyroidism is the object of interest of many authors. The respiratory disturbances during sleep are often observed in patients suffering from hypothyroidism. The relation of snoring to overweight in those patients has not been taken into account. The aim of the study was to evaluate the relations between hypothyroidism and quantitative and qualitative respiratory disturbances during sleep. Additional aim was to establish the relations of sleep apnea syndrome, snoring, hypothyroidism and overweight. The subjects included 15 patients (11 females and 4 males) aged from 28 to 73 (mean 50.3) suffering from hypothyroidism. All of them underwent thyroid testing before and after the hormonal treatment. TSH and fT4 concentrations were determined. At the same time the sleep assessment (PolyMESAM) was performed twice. Data were obtained from sleep studies and questionnaires (Epworth sleepiness scale). After the thyroid hormones stabilization significant decrease of snoring severity was observed. On the contrary, the respiratory disturbance index (RDI), desaturation index (DI), the lowest saturation (LSAT) did not change significantly, however, the Epworth scale score showed significant improvement. The correlations showed the strong relation between loud snoring and TSH (r=0.73, p<0.01) and fT4 (r=-0.66, p<0.003) concentrations before the treatment. The analysis showed no correlation between body mass (BMI) and snoring. The hormonal stabilization in patients suffering from hypothyroidism causes improvement in snoring severity. Based on our investigation the relationship between hypothyroidism and severity of snoring and excessive daytime somnolence was confirmed. It indicates a possible connection between hypothyroidism and upper airway resistance syndrome.
Preview · Article · Apr 2007 · Journal of physiology and pharmacology: an official journal of the Polish Physiological Society
[Show abstract][Hide abstract] ABSTRACT: There is now growing evidence that the reactive oxygen species have an influence on proliferation and antioxidative status of various cell types. The aim of the study was to investigate the effects of different concentrations of leptin, ghrelin, angiotensin II and orexins on proliferation, culture medium malondialdehyde (MDA) levels and antioxidative enzymes activities: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) in 3T3 L1 preadipocytes cell culture. Cell proliferation was measured using [(3)H]tymidine incorporation. In 3T3-L1 cells leptin caused a significant reduction in proliferation (by 36%) compared to control. Ghrelin increased preadipocyte proliferation, and the effect was stronger in higher dose (by 39%), while proproliferatory effect of angiotensin II was stronger in lower doses (by 47%). All used doses of orexin A significantly increased 3T3 L1 cell proliferation (from 21% to 160%), while orexin B caused a marked reduction (from 35% to 70%) of this proliferation. The effects of both orexins were dose-dependent. Leptin and ghrelin increased activity of SOD, CAT, GSH-Px and decreased level of MDA. Angiotensin II treatment stimulated only SOD and CAT activities. Influence of orexins was different on various enzymes. Orexin A increased MDA levels, while orexin B caused a marked decrease in MDA levels. Our results strongly suggest the effects of appetite affecting hormones such as leptin and ghrelin on proliferation and antioxidative enzyme activities of preadipocyte cell lines. Orexin A was found to be the most efficient proliferative-signalling hormone, while orexin B revealed the most significant inhibitory effect on preadipocytes proliferation.
Full-text · Article · Apr 2007 · Journal of physiology and pharmacology: an official journal of the Polish Physiological Society