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Biomedical subjects

K Niemczyk

Publications and source records attributed to K Niemczyk.

15 recordsLinked to original sources

The anatomy of the tympanic sinus.

The tympanic sinus is one of the most important structures of the human temporal bone. Located in its vicinity are the round window, posterior semicircular canal and facial nerve. The study was performed on 30 temporal bones taken from adult cadavers of both sexes. After the tympanic sinus had been identified, its morphological features were evaluated. The sinus was then measured using a graticule with an accuracy of 0.05 mm. Also measured were the shortest distances from the tympanic sinus to the neighbouring structures (the lateral and posterior semicircular canal, the facial nerve canal and the jugular fossa). The measurements were performed under a surgical microscope with eye-piece graduation of 0.05 mm accuracy. Four main morphological types of fossa of the tympanic sinus and two main developmental forms, a deep sinus and a shallow sinus, were distinguished. The existence of a deep sinus was associated with absence of the bridge and the sinus was shallower when the bridge was prominent. The very deep sinuses were located close to the facial canal, in some cases penetrating deep in its vicinity (in some cases even going beyond two thirds of the canal's circumference), which poses a real risk of facial nerve damage during surgical removal of a lesion located in close proximity to the nerve. In most cases the tympanic sinus is elliptical in shape and its long diameter lies in the vertical plane (mean value: 2.73 x 2.23 mm). The mean distances from the tympanic sinus to the facial nerve canal, lateral semicircular canal, posterior semicircular canal and jugular fossa were 1.5 mm, 2.1 mm, 1.59 mm and 5.5 mm respectively. No correlation was observed between the measurement results and either sex or side.

Adult↗

[Long-term results of stapedectomy in pediatric patients].

Otosclerosis is generally considered as a disease of adults, but the onset of hearing loss can occur in childhood. The purpose of this presentation is to show the effectiveness of stapedectomy in children. Both, short and long-term results are presented. Material is based on 14 pediatric patients, age 7-14 y. 12 of them had bilateral, 2 unilateral hearing loss. Together 26 ears. The diagnostic pattern was as follow: general pediatric and ENT examination, tuning fork testing, pure-tone audiometry (2x), recognition score test, tympanogram and acoustic reflex test, CT scan of the temporal bone. Particular attention was paid to the parents report concerning the episodes of otitis media or frequent upper respiratory tract infections and history of family hearing loss. Average time of hearing loss was noted 3 years before stapedectomy. Pure tone audiometry was performed on frequencies 500, 1000, 2000, 3000 and 4000 Hz. All children had hearing loss with air-bone gap 30 or more dB. 23 ears underwent stapedectomy for otosclerosis with teflon-piston prosthesis insert. Hearing level was based on PTA obtained in 2-3 weeks postoperatively and then 3 and 6 months. PTA hearing improvement was in 22 ears. No hearing loss was noted after operation. A total of 16 ears were available for long-term follow-up (up to 24 months after stapedectomy). The PTA hearing improvement was found to be permanent.

Adolescent↗

[Clinical implications of acoustic neuromas growth rate in volumetric study].

OBJECTIVE: The pattern of neuroma growth is of great importance in choosing the appropriate management. This paper tests the clinical impact of tumor growth rate assessed by volumetry. There is a conviction that some slowly growing tumors could be observed for many years. METHOD AND PATIENTS: Volume measurements were performed on T1- weighted MR images (spin echo sequences) after injection of gadolinium using a special dedicated software. The studied group included 17 patients in whom at least two MRI examinations were carried out and tumor growth was confirmed. The intervals between initial and the first follow-up examination were 14.2 months on the average. In 7 cases tumor evolution was observed in 2 periods (3 MRI studies) and in 4 cases in 3 periods (4 MRI studies). RESULTS: The growth rate depended on tumors volume and clinical stage (P<0.01). Small tumors can be observed more safely than advanced tumors because their increase in mass is lower. CONCLUSION: The observation with the tumoral volume measurements appears to be a useful and accurate tool to estimate the tumor growth rate. The growth rate is a major factor for choosing the appropriate management.

Follow-Up Studies↗

[Extended translabyrinthine approach in treatment of vestibular schwannomas].

Results of removal of vestibular schwannomas using translabyrintine approach were presented. 12 unilateral neuromas were operated. Large neuromas with diameter above 2 cm constituted 75% of all cases. The total resection of tumors was achieved in 10 patients. In all cases anatomical integrity of facial nerve was conserved. In 7 patients facial nerve function was in stage I-III (House Brackmann classification). There were not life threatening complications. Authors underline, that the translabyrintine approach permits to obtain enough wide insight to ponto-cerebellar angle to remove safely, both little and large, vestibular schwannomas.

Adult↗

[Qualification of patients with CPA tumors to translabyrinthine approach based on own experiences].

On the basis of the presented clinical material, the authors present their own observations concerning qualification of the patients with cerebello-pontine angle tumors for surgery utilizing the translabyrinthine approach. The clinical material includes 15 cases of stage II, III and IV cerebello-pontine angle tumors removed through translabyrinthine approach. In view of the fact that there are different opinions concerning the selection of appropriate surgical approach and of a conviction that translabyrinthine approach should be used in case of stage II, relatively small tumors, and that larger, stage III and IV ones should be operated on using the retromastoid approach, we are presenting our views concerning the qualification of patients. In our opinion, the translabyrinthine approach can be used for larger tumors--also for stage IV ones. The translabyrinthine approach was considered only in the cases with total hearing loss and not useful hearing. Of course, in the cases when the tumor penetrates into the middle cranial fossa or into the foramen magnum, the approach may prove rather difficult. As it has been known, the dimensions of the access route are determined by three main anatomical structures: altitude of the bulb of the internal jugular vein, location of the sigmoid sinus and the diameter of the internal auditory meatus. The fundamental advantages of the approach include: no cerebellum retraction required in the case of classic retromastoid approach, easy anatomical and neurophysiological identification of the course of the facial nerve and maintaining its continuity. An approach involving damage of internal ear structures can be performed only if the patient is deaf.

Adult↗

[Indication to translabyrinthine approach to remove of the cerebello-pontine angle tumors--anatomical aspects].

Indication to translabyrinthine approach to removing of the cerebello-pontine angle tumors--anatomical aspects. Translabyrinthine approach was used in surgical procedures performed for stage II, III and IV tumors of the cerebello-pontine angle of various sizes in 15 cases. In order to ensure a correct course of the procedure and successful removal of the tumor, translabyrinthine approach should be carefully planned on the basis of radiological criteria (CT, NMR). Anatomical limitations of the approach are connected with the localization of the sigmoid sinus, the bulb of the internal jugular vein, pneumatization of the mastoid process and the location of the superior petrosal sinus. In approach planning it should be considered whether the bulb of the internal jugular vein is not located high in relation to the internal auditory meatus, what is the meatus diameter (IAC), location of the sigmoid sinus--its shift to the front is a serious limitation for the approach. The pneumatization state of the mastoid process is also important because of the duration of petrosectomy. Taking into consideration the aforementioned conditions allows to plan precisely and perform the approach appropriate for the tumor size.

Adult↗

[Use of intratympanic gentamycin for the treatment of Meniere's disease].

The ablation treatment of Meniere's disease by intratympanic streptomycin applications was first reported by Schuknecht in 1957. Streptomycin and gentamycin are the most frequent aminoglycosides used for the Meniere's disease treatment. Gentamycin is responsible for the damage of vestibular dark cells causing the impairment of endolymph production. This method gives the possibility for the control of the vertigo with a potential hearing preservation. Fifteen patients with unilateral Meniere's disease who had not responded to conventional therapy, were treated by intratympanic gentamycin injections. The hearing status and the caloric test were staged before and after treatment according to the AAO-HNS guidelines. Overall results after minimum 1 year follow-up in this group were as shown below: complete vertigo control--5 patients, substantial vertigo control--8 patients, complete relief of tinnitus--10, relief of aural fullness--12 patients, hearing loss--none. According to presented results, intratympanic injections of gentamycin is the useful alternative to the surgery. This method should be consider in every patient with the unilateral Meniere's disease, who had not responded to the conventional treatment.

Aged↗

Correlation between Ki-67 index and some clinical aspects of acoustic neuromas (vestibular schwannomas).

Evaluation of the proliferation activity of neuromas has a practical meaning when there are doubts about the complete resection of the tumor. Evaluation of the clinical aspects connected with increased proliferation activity may have a much broader application. The aim of this study was to correlate selected clinical and radiologic aspects of vestibular schwannomas with the results of the Ki-67 index. The studied group included 23 males and 20 females. Unilateral neuromas were stated in 38 cases (mean age, 52.2 years) and bilateral tumors in 5 cases (mean age, 44.2 years). The immunohistochemical tests (Ki-67) were performed on the specimens preserved in formalin and stored in paraffin. The Ki-67 index was estimated in a semiquantitative study. The mean value of Ki-67 index was 1.86%. In case of unilateral neuromas (n = 38), the average Ki-67 index was 1.74%. In 5 cases of bilateral tumors, the index amounted to 2.79% (P = 0.278). No significant correlation was found by comparing the value of the Ki-67 index with the age of patients (P = 0.410: r = 0.128). Significant differences in the value of the Ki-67 index were noted in the sub-groups of tumors that were evaluated radiologically as growing and stable. The mean value of Ki-67 index was 3.17% in the first subgroup; in stable neuromas, it was significantly lower, amounting to 1.11% (P = 0.020). Such results may confirm that the growth rate of vestibular schwannomas varies and may explain the difficulties in estimating the growth of neuromas on the basis of clinical aspects only.

Adolescent↗

[Evolution of vestibular schwannoma: radiological evaluation].

Objective evaluation of natural history of vestibular schwannomas can be performed based on the modern radiological investigations, mainly MR. This study included 7 vestibular schwannomas. The average observation period was 28 months. Tumor growth was calculated based on the comparison of volume on the first and subsequent MR image using a special dedicated software. All tumors in this study were growing. The average growth rate was 143 mm3/month. Among 7 primarily observed tumors, 4 schwannomas were already removed surgically. The remaining 3 tumors are still observed. The authors pointed out that longer were the radiological observations of vestibular schwannomas greater was the conviction about progression of majority of these tumors.

Disease Progression↗

The growth of acoustic neuromas in volumetric radiologic assessment.

OBJECTIVE: The volumetric assessments of neuroma were applied for radiologic observation of tumor growth. The hypothesis that most of neuromas are stable or show only slight growth was tested. STUDY DESIGN: This was an observational study. SETTING: The study was performed in the university centers. PATIENTS: The study group included 27 patients with 15 unilateral tumors and 12 bilateral tumors. All patients had at least 2 magnetic resonance imaging (MRI) examinations, and the average interval between initial and control examinations was 11.4 months. MAIN OUTCOME MEASURE: Volume measurements were performed on T1- weighted MRI spin echo sequences after injection of gadolinium using special software. Growth of the tumors was estimated by comparison of the results of three measurements from the initial and control MRI examinations. RESULTS: The growth was confirmed in 17 of 27 tumors (63%). Growth was found in 10 of 12 neuromas of neurofibromatosis type 2 (83.7%). In 15 unilateral neuromas, growth was found in 7 (43%). Unilateral neuromas were observed for a shorter period of time (6.3 months) than bilateral tumors (14.7 months). The correlation between a neuroma volume gain and the follow-up period was statistically significant (p = 0.003, r = 0.544). CONCLUSIONS: The growth of tumors can be confirmed despite a short follow-up period.

Adolescent↗

[The external drainage in chronic exudative otitis media: distant results].

The usage of external drainage in the treatment of chronic exudative otitis media raised as much hope as it did doubts. However this method was not put to common use immediately. The doubts observed by laryngological mele delayed the usage of this method of treatment in many cases. In the Otolaryngological Clinic of the Surgery Institute in Warsaw, the external drainage in chronic exudative otitis media has been in use for several years. The authors of this paper present their own distant observations upon treated patients. They evaluate the efficiency of hearing examination and the lack of recurrence of inflammation of the middle ear.

Acoustic Impedance Tests↗

[First cochlear implant in Poland].

The authors present a 30 year old patient whose hearing was profoundly impaired in the course of meningitis 12 years ago. They present details on the preparation of the patient for the surgery and indications for the implant, consecutive stages of the surgery and the first stage of the rehabilitation process are described. The results of the capability of electrical conductivity of the cochlear nerve as the direct effect of the cochlear implant and the first audiogram illustrating the hearing effect after the first 2 months of rehabilitation are presented as well.

Adult↗

[Cochlear implants: state of knowledge, prospects, indications for implantation].

The authors present the development of totally deaf patients treatment program using cochlear implants. Based on leading Europeans Centers qualification basis and selection criteria are discussed for this method of treatment both for adults and children. Next given are indications for extracochlear and intracochlear implants. Summarizing, they evaluate possible results using the above implants and prospects for the development of this program in our country.

Age Factors↗

[Iatrogenic esophageal perforation].

A total of 213 patients with a foreign body in the oesophagus was treated in our unit between 1980-1990. Most of the foreign bodies were impacted in the cervical oesophagus. Oesophagoscopy were carried out under general anaesthesia in all cases. iatrogenic perforation of oesophagus was encountered in ten cases. Our results suggest that most instrumental perforation of the esophagus should be managed surgically. Drainage and closure of cervical perforations yields good results. Nonoperative management night be entertained in minimally symptomatic patients harboring a late, locally contained perforation without signs of ongoing sepsis.

Adolescent↗