Układ równowagi - Nowe odkrycia w dziedzinie otoneurologiii
Prof. Nakiela J.: Vertigo. The vestibulo-cerebellar system according to the latest investigations and interpretation of the author

Now I will present the entire opinion by Prof. Bolesław Semczuk

 

Lublin 20 May 1991

To: The Central Commission for Scientific Development and Scientific Degrees,

Warsaw

 

The opinion concerning confirmation of the resolution of conferral of the scientific degree of habilitated doctor on Dr. Jerzy Nakiela, M.D., Ph.D.

 

Jerzy Nakiela, M.D., Ph. D., is 46 years old and obtained the medical doctor's diploma in 1969 in Military Medical Academy (WAM) in Lodz, the degree of Doctor of Science was conferred upon him by The Medical Faculty Council of the Military Medcal Academy (WAM) in 1978 on the basis of his thesis entitled: "Research into the usefulness of the modified Unterberger test in defining the efficiency of the sense of equilibrium". In years 1969-1971 the candidate worked in the Laboratory of Regional and Applied Anatomy in Lodz, and since 1978 he has been the deputy head of the otolaryngological ward (ORL) in Tomaszów Mazowiecki, where he organized an ENG laboratory. he has undergone six training courses from the field of operating techniques of the larynx, ear and salivary glands surgery. In 1988 he stayed for one month in the Otolaryngological Clinic in Oldenburg in West Germany. He is a member of the Polish Laryngologic Association (PTL), the Polish Laryngologic Association (PLOL) and the Head and Neck Surgery, Independent Trade Union "Solidarno¶ć" ("Solidarity").

Dr. Jerzy Nakiela's scientific achievements to date comprise 26 published papers, 4 papers sent for publishing and 1 film,   (31 papers altogether). He is the only author in 17 papers, the first author in 9 while he is a co-author of the remaining papers. Three of his papers were published in foreign journals. The candidate's chief scientific interests concern research into the of the equilibrium system, to which he devoted 25 papers and his doctoral thesis. His scientific achievements are not very numerous, however, in the context of research into the equilibrium system is qualitatively valuable and essential.

The author's essential scientific achievements to date, in my opinion, include:

  • revealing diagnostic mistakes as regards using the Arslan rotation test as the only test to be used in examining the equilibrium organ,
  • revealing in healthy people asymmetrical reactions in the Fitzgerald-Hallpike bi-thermal caloric test, which are no proof of the pathology of the equilibrium organ,
  • revealing the usefulness of the Torok test in the assessment of the efficiency of the treatment of the damaged vestibular organ,
  • the author found statistically higher values of the average amplitude of the maximum angular speed of the free phase in persons with lesions in the cerebellar hemispheres,
  • the author found lack of influence of the central compensation on disappearance of spontaneous nystagmus following injuries of the cerebellar hemispheres,
  • the author revealed /in 76%/ the asymmetry of optokinetic nystagmus in injuries of the cerebellar hemispheres, and also the influence of spontaneous nystagmus on the occurrence and the size of the asymmetry of optokinetic nystagmus,
  • the author's papers of practical significance are those concerning research into the vestibular hyperexcitability in the caloric test and the assessment of the usefulness of the pendulum test for the clinical diagnostics needs,
  • the author found lack of relationships in the occurrence of symmetrical or asymmetrical vestibular reactions with reference to the duration of the carried out neurochirurgical treatment,
  • last but not least, the author discussed observation interesting for clinicians in three casuistic papers.

The issues of disequilibrium and especially their compensations connected with injuries of the cerebellar hemispheres have been relatively little-known and findings obtained by different tests are often divergent. In this context the candidate has broadened information on the still little-known physiological role of the cerebellum in the entire equilibrium system, therefore I think that the candidate's scientific achievements, though modest, entitles him sufficiently to applying for the degree of habilitated doctor. 

Otoneurology issues in Dr.  Nakiela's scientific achievements to date have preceded and determined the concept of the habilitation thesis entitled "Research into the efficiency of the equilibrium system after destruction of the cerebellar hemispheres" in which he tried to determine the value of individual vestibular tests for diagnostics needs. The subjects of the study were a group of 50 healthy persons and a group 58 persons with injuries of the cerebellar hemispheres. All of them underwent the following tests: static-dynamic tests, audiometric examination, otoneurological  examination with electronystagmographic recording, with spontaneous nystagmus and positional nystagmus recording, pendular eye movement examination, kinetic nystagmus examination, rotatory nystagmus examination in the kinetic test, the Fitzgerald-Hallpike test, the Torok differentiating test and the author's own modification of the Unterberger test.

   From among oculomotor disturbances in ill persons with injuries of the cerebellar hemispheres the author observed:

  • dysmetria of saccadic eye movements in the calibration test,
  • disturbances of the smooth tracking test,
  • asymmetry of optokinetic nystagmus.

   What deserves stressing is introducing by the candidate the Torok monothermal differential test, which is sporadically used in domestic labyrinthological laboratories, as well as introducing into research in smooth tracking by means of gonioscope.

  The most essential role of the habilitation thesis is proving by the author that:

  • from among vestibular tests the differentiating caloric test has the greatest value in the diagnostics of injuries of the cerebellar hemispheres, and,
  • that using the author’s own original modification of the Unterberger test can create new possibilities of the diagnostics of injuries of the cerebellar hemispheres. I consider the introduction of this test into the otoneurological diagnostics as the author’s modest contribution to the cognition of the complex cerebellar-vestibulospinal reflexes.

Obviously this test still requires checking in other otoneurological diagnostic centers.

In my opinion, this extensive thesis lacks an analysis of the direction of inclinations or an examination of an ill person and more detailed information concerning locations of lesions found during neurosurgeries /the tumor of the hemisphere or the midline of the cerebellum/ It is known that the cerebellar hemispheres control the static equilibrium to the sides /i.e. to the right and left/, while the vermis controls inclinations forwards and backwards.

Paying attention to this symptom with simultaneous assessment of unilateral or the bilateral vestibular organ destruction is for a clinician an important element, helpful in determining the location of the focus. According to the author, unfortunately there is no unambiguous test allowing proper and unambiguous diagnostics, because a labyrinthologist using a set of tests evaluates first of all the functional state of the equilibrium system, however, locating the lesion usually requires collaboration of a multispecialistic team including radiological tests, which is unnoticed by the candidate, overrating the findings of the set of tests.

In my opinion, the selection of reviewers as follows:

  1. Professor Stanisław Betlejewski, M.D., Ph.D., the Head of the Otolaryngologic Clinic in Bydgoszcz.
  2. Professor Janusza Kubiczkowa, M.D., Ph.D., the Head of the Otolaryngologic Clinic of the Military Aerospace Medical Institute (WIML) in Warsaw.
  3. Associate Professor Andrzej Radek, M.D., Ph.D., the Head of the Neurosurgical Clinic of the Military Medical Academy (WAM) in Lodz

is appropriate and the course of the habilitation degree conferral procedures in accordance with regulations.

To sum up, I consider that both the scientific achievements to date and the habilitation thesis by Dr. Jerzy Nakiela fulfils sufficiently the provisions of law, and therefore I am applying to the Central Commission for Scientific Degrees and Titles for confirming the resolution regarding conferral of the degree of the habilitated doctor of science to the above mentioned candidate.

(The end of the opinion)

After my interventions in Central Commission I finally received the protocol from the session of the Section of Medical Sciences, which I present in its entirety below.

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