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

The opinion by Prof. Jan Ku¶, M.D., Ph.D.

 

The opinion concerning the confirmation of the resolution about the conferral on Dr. Jerzy Nakiela /appeal from the negative decision of the Central Commission/ the degree of the habilitated doctor of science, issued on the request of the Committee - Re: BCK-IV-0393/92 14.1 year.

Jerzy Nakiela, M.D., Ph. D., born on 25 November 1945, works in the Health Care Institution (ZOZ) in Tomaszów Mazowiecki as senior assistant at the Laryngological Ward and the Head of the Otoneurological Laboratory which he organized. He is 2nd degree specialist in laryngology.

He completed medical studies in the Military Medical Academy in Lodz. He obtained a doctor's diploma in 1969 and in 1978 he was  conferred a degree of doctor of medicine by The Medical Faculty Council of WAM. The title of the doctor's thesis: "Research into the usefulness of the modified Unterberger test in defining the efficiency of the sense of the equilibrium". The conferral of the degree of habilitated doctor of science on Dr. Nakiela was resolved by The Academic Council of The Medical Faculty of Military Medical Academy (WAM) in Lodz on 20 November 1990 after, in accordance with the regulations, completing the habilitation procedure. The Academic Council applied for confirmation of this Resolution to the Central Commission for Scientific Degrees and Titles. From among 88 council members of the Faculty Board, entitled to vote, 48 persons participated in voting.

  • 42 persons voted for the conferral of the title
  • 3 persons voted against
  • 3 persons abstained from voting

The reviewers of Dr.  Nakiela's scientific achievements and his habilitation thesis were selected accurately. The reviewers analysed carefully and presented in detail the candidate's scientific achievements which almost entirely concerns otoneurology. Although they advanced certain content-related reservations concerning certain points of the habilitation thesis, their general assessment of the scientific achievements and the habilitation thesis was positive.

In the extensive discussion during the habilitation colloquium the participants highly assessed the candidate in the field of otoneurology.

The range of the conferred degree and the selection of the scientific unit for the habilitation qualification does not arise any reservations. The thesis was published as a brochure by the Military Medical Academy in Lodz in 1990. The title of the habilitation thesis: "Research into the efficiency of the equilibrium system after destruction of the cerebellar hemispheres /a clinical study/." The aim of the author's thesis was to assess changes in reactions of oculomotor reflexes, vestibulo-ophthalmic reflexes and vestibulo-cerebellospinal reflexes resulting as a consequence of injuries of the cerebellar hemispheres and determine which from the well-known vestibular tests ... have a significant diagnostic meaning in injuries of the central part of the equilibrium system, i.e. the cerebellum. The author examined 58 persons after surgeries of tumor of the cerebellum and 50 healthy persons. All of the subjects, after a detailed interview and basic laryngological examination, underwent static-dynamic tests, audiometric examination and selected otoneurological tests with the electronystagmographic recording of nystagmus. Apart from the battery of classical static-dynamic tests the author used a modification of the Unterberger test /marking time test/ in which the subject performs marking time with one leg moved forward /the right leg first, the left leg later/ The investigations are provided in detail and prepared statistically, their results were included by the author in 7 conclusions which /in short/ are as follows: from among the static-dynamic tests the most valuable in assessment of injuries of the cerebellum is the Unterberger test and especially the author's modification. From among oculomotor disturbances in persons with damaged cerebellar hemispheres the most frequent disturbances are: the dysmetria of saccadic eye movements during calibration, smooth tracking disturbances and optokinetic nystagmus.

From among vestibular tests, the Torok test, showing vestibular decruitment in 68,9% cases, has the greatest diagnostic value in injuries of cerebellar hemispheres.

The habilitation thesis indicates the author's extensive erudition concerning the subject of study and his immense diligence /gathering a large group of ill persons after surgeries of tumors of the cerebellum and a group of healthy persons, performing a huge amount of research with batteries of tests, statistical preparation of results/ Nonetheless, the thesis in principle does not exceed the frames of a contribution thesis. In its large part it is a repetition of many other similar theses whereas the conclusions that the original Unterberger test modified by the author is significant in the diagnostics of injuries of the cerebellar hemispheres is surely not fully evidenced because there are no comparative groups of persons with other injuries of the central nervous system. The clinical value of the test in comparison of today's diagnostic possibilities is also limited. It is difficult to agree with the author's view /p. 76 -of the habilitation thesis/ that the Unterberger test in the author's modification creates new possibilities of the diagnostics of injuries of the cerebellar hemispheres and /p.77/ "allows defining the role of these hemispheres in formation of cerebello-vestibulospinal reflexes". The editor's quality of the thesis is low - but the author is not only to blame. The habilitation thesis is a development of his doctoral thesis concerning research into the modified Unterberger test in peripheral injuries of the equilibrium organ. Most of Doctor Nakiela's scientific achievements is devoted to otoneurological issued and his achievements consist of 27 publications, in which he is the only or the first author. 25 publications published in Polish journals /Polish Otolaryngology - 9, Military Doctor - 4, Medical News - 4, WAM Bulletin - 3, Folia Morph. -3, including 2 in the English version, Polish Neurology-Neurosurgery - 2 and 2 in Russian journals/. The earliest three publications deal with the anatomical issues, including two on the muscular coat of the bottom air passages, one concerning the system of flexion grooves on Poles' feet. One of his publications presents the behavior of the bacterial flora and the antistreptolysin titer in chronic palatal tonsillitis treated with ultrasounds. The next publication deals with the influence of tonsillectomy on the level of immunoglobins in the serum. The remaining 22 publications are devoted to otoneurology /there are really 20 publications because 2 were published twice/. From among these of 22/20 publications 14 is devoted to the assessment of different otoneurologic tests in persons after the surgery of tumor of the cerebellar hemisphere. This is as it were one thesis published in parts. The subject of 5 publications was also the behavior of different tests in peripheral injuries of the organ of balance or in healthy persons. One report presented the results of the treatment of angiogenic vestibular disorders with Cavinton in venoclysises. Apart from the classical modification of the Unterberger test, the publications do not contribute anythins new. They are repetitions or contributions, however, having a high value for popularization of the otoneurologic issues and the diagnostic methods which are sometimes less known /the Torok test/. Inferring from the last paragraph of the summary of the habilitation thesis by Dr. Nakiela, the author shows rather small criticism regarding the value of the Unterberger test modified by him.

I admire the candidate's diligence, his immense willingness to do research work and quite numerous achievements, taking into consideration that, apart from short periods of time, he was not employed in academic centers. Nevertheless, I assess his previous achievements as insufficient for obtaining the degree of the habilitated doctor. It is undoubtedly possible for Dr. Nakiela to increase his scientific achievements and he deserves any assistance in this regard.

(The end of the opinion)

This opinion is not content-related, either. It was written as if under a great pressure or to order. Critical remarks are unjustified which is proved by the results of my research presented earlier. Prof. Ku¶ borrowed the vocabulary and wording from the review written by Prof. Janczewski, writing such a sentence - quotation: "Nevertheless, the thesis in principle does not exceed the frames of a contribution thesis". If an epochal discovery in otoneurology is called a contribution, then I will refrain from any comments. Thanks to these contributions my discoveries will be a part of history.

The first accusation was introduced in the sentence - quotation: "In its large part it is a repetition of many other similar theses whereas the conclusions that the original Unterberger test, modified by the author, is important in the diagnostics of injuries of cerebellar hemispheres, is supplied documentary evidence surely not fully, there are no groups of comparative persons with other injuries of the central equilibrium system".

Well, Dear Professor, the aim of my thesis was research in ill persons with isolated injuries of the cerebellar hemispheres and in this scope my own dynamic test was fully substantiated. This basic one reaction model obtained in my own test can be confirmed by performing in healthy people the Ruttin asymmetric caloric test with cold water. I presented comparative groups with other injuries of the central nervous system in other papers. The main accusation, expressed in the following two sentences - quotation: "The clinical value of the test compared with today's diagnostic possibilities is however limited. With difficulty so to agree with the view of the author /page 76 of the habilitation thesis/. that the Unterberger test in the modification of the Author creates new possibilities of the diagnostics of injuries of the cerebellar hemispheres and /p. 77/ " allows defining the role of these hemispheres in the formation of vestibulo-cerebello-spinal reflexes "- is also fruitless. Introducing computer tomography and magnetic resonance to diagnostic examination does not disqualify the diagnostic values of the own dynamic test. Many times it occurs that in patients suffering from vertigo CT and MR examinations fail to find lesions, and lesions are detected in functional research during the assessment of spontaneous and caused vestibulo-cerebello-ophthalmic reflexes and vestibulo-cerebellospinal reflexes. Everything that I wrote is true and has its justification. When I talked with Prof. Ku¶ on the phone, he advised me to concentrate on questioning the decision undertaken by the Central Commission on 17 December 1991, which was unlawful and should be considered as invalid under the law. Further activities undertaken by the Central Commission after this date should be treated as groundless. I know the names of four Professors who earlier refused to write a negative opinion. It was Prof. Ku¶ who decided to express a negative opinion. I need to remind that Prof. Ku¶ is also an author of a chapter entitled "Vestibular neuronitis" in the textbook "Clinical Otoneurology", edited by Grzegorz Janczewski. Wasn’t it because ranks were closed in defense of one's own scientific position and scientific achievements?

I wondered why Prof. Ku¶ wrote such a false opinion, similar to the opinion by Prof. Janczewski. I knew Prof. Ku¶ earlier and I valued him very much, I considered him one of the best surgeons in head and neck surgery. I participated in development training courses in oncology of salivary glands and the larynx, organized by the Laryngological Clinic led by Prof. Ku¶. I assisted him in surgeries several times, I could admire his composure, self-control and his good command of topographic anatomy. In this clinic I also learnt the splendid technique of thyroid glands surgery. I know all the papers in otoneurology published by Prof. Ku¶ and yet I regret to say that Prof. Ku¶ did not know the foundations of the physiology and the pathology of the labyrinth and the cerebellum, therefore he was not able to assess my scientific achievements and my habilitation thesis in a content-related way. It would have been more honorable for him to refuse to write a review, just like four other Professors had done before.

But this what I saw on Wildstein’s list was food for thought for me and made me sad at the same time. As a rule, the list includes evil people's names. I am asking once again: are the names of the personnel officers of the security police in PRL - Grzegorz Janczewski - IPN BU 0194/1145; - Jan Ku¶ - IPN BU 0891/2025; the same persons who wrote negative opinions about me? I would like to believe that it is not true but this is a task for the National Memory Institute (IPN).

On 1 June 1998, the newspaper "Głos" ("The Voice") published the article entitled "Death of 9 miners without punishment. Kiszczak avoids emotions", which mentions the name of Prof. G. Janczewski as one of the three doctors who signed the medical certificate saying that the state of health of the accused Mr. Kiszczak was an essential obstacle in his participation in the law suit. This article also mentioned the name of Prof. Włodzimierz Januszewicz who took part in the voting of the Medical Science Section of the Central Commission concerning the assessment of my habilitation qualification, and whose name is also mentioned in Wildstein's list. Wildstein's list includes many more names of professors who participated in the Medical Science Section.

I also talked on the phone with Prof. Bolesław Semczuk, who as the superreviewer wrote a positive opinion for me. Prof. Semczuk complained  that during the meeting of the Medical Science Section on 5-6 April 1993 Mr. Janczewski and Mr Ku¶ behaved very unpleasantly towards him. Here I want to express my thankfulness to Prof. Semczuk for presenting this positive opinion, which proves his honesty and independence in scientific research.

Below I present the protocol from the session of the Medical Science Section of 5-6 April 1993.

Prof. Stanisław Betlejewski, who defended the value of my habilitation thesis, participated in the session as a Reviewer of the Faculty Board.

 

General discussion:

 

  • Prof. F. Kokot - stated that he had doubts whether the candidate's habilitation thesis contributes anything more than a doctoral thesis and he saw no scientific novelties in it,
  • Prof. M. Hoffman - stated that according to her the habilitation thesis was a thesis of a contributory character; she added that she had reservations about the reviewers of the Faculty Board, who stress in their opinions the huge "labor intensity" of the contribution to the thesis.
  • Prof. A. Kułakowski -  his reservations concerned the candidate's lack of criticism to his own conclusions.

 

Results of the voting: 1- voted for, 20 - voted against, 3 - abstained from voting.  

I am not going to comment these statements, let the readers draw conclusions themselves on the basis of my previously presented scientific achievements. I can only add that these are other false witnesses and it brings immense discredit to those professors and the Central Commission. This seems to be a kind of a mutual admiration society without rudimentary knowledge from the field of otoneurology.

The decision issued on 26 April 1993 says: "This decision is final. It can be referred due to its unlawfulness to the Supreme Administrative Court, through the mediation of the Central Commission, within 30 days from the date of its delivery"

This I am not going to comment, either, but it explains how democracy and respect for the law looks in the 3rd Polish Republic.

In January 2000 I sent a paper to the laryngological journal "Journal for Oto-Rhino-Laryngology", published by S. Karger AG in Switzerland, entitled "A new theory explaining the mechanism of kinetic stimulation of horizontal canals".                                                          

 The paper was registered under the number of 26947. I prove in the paper that both labyrinths are equally accountable for causing a vestibulo-cerebello-ophthalmic reaction in the physiological conditions in rotation tests. Therefore I undermine LeDoux's theory, binding to date, which claims that rotatory nystagmus is caused by only one labyrinth, the one towards which the rotation takes place. The paper was not accepted for print because of the negative review. The reviewer did not deign to sign and his/her justification said: - quotation: "The main problem is, that the role of the vestibular nuclei is completely disregarded. They are more important for vestibular compensation than the cerebellum, which is not necessary for vestibular compensation".

A transfixing statement that in the compensation process the role of the cerebellum can be omitted. I have never encountered a statement like that since I became involved in otoneurology. Such information is not to be found in basic textbooks on otoneurology. The review is embarrassing and completely not to the point. The paper did not concern the problem of compensation but the mechanisms of formation of vestibulo-cerebello-ophthalmic reactions in kinetic tests. The explanation of this theory is based on the rules of functioning of the vestibulocerebellar system, which was discovered by me. The principles of operation of this system have not been known by now. Reading such a review I completely lost my willingness to exchange correspondence with the editorial office of this publishing house as well as becoming discouraged to send my papers to other foreign journals. The reviewer turned out to be entirely illiterate and I do not discuss with such people because I consider it a waste of time. Also, this reviewer does not have respect to those who, as put by Robert Barany, went before us. Yet, to finish this thread, I must remind that there is no such phenomenon which is called vestibular compensation. The signs of this phenomenon are entirely explained by the phenomenon of habituation, which was earlier described and evidenced by me. So, this is not me who remains in the backwater but the scientists who write such reviews. The truth will defend itself but now I realize how difficult these processes are. All the theories had been invented in the west and then were undermined by me.

In 1993 I sent a letter to the Chief Editor of "Polish Otolaryngology", Prof. Zygmunt Szmeja, informing him about my conflict with Prof. G. Janczewski. I received a reply that I could send new papers. I sent to the Editorial Office of this journal my paper entitled "My own theory of mechanisms of kinetic and caloric stimulations in horizontal canals". To my astonishment this paper was also sent to Prof. Janczewski and was assessed very critically. In order to avoid any discussion with me and prevent me from publishing my papers, the Editorial Office replied to me in short that:

1.  Nowadays there is no place for new theories.

2.  In science, there is no democracy and no discussion.

Such documents speak for themselves and I have them in my collections.

I must remind that some Professors from the Medical University in Lodz also participated in the voting in the Medical Science Section of the Central Commission. They voted against the confirmation of the resolution to confer the degree of habilitated doctor on me. One of them was Prof. H.C. Antoni Prusiński, M.D., Ph.D., a co-author of the textbook "Clinical Otoneurology" ("Otoneurologia kliniczna"), published 8 years after my habilitation qualification. When I insisted on meeting Prof. Prusiński in order to explain the value of my discoveries, he avoided me, refused to meet, excusing himself that he did not have time. Once again I must announce responsibly that the renewal of this textbook 8 years after my habilitation qualification was a deliberate crime and a show of force. At present Prof. Prusiński is the chief editor of the journals Vertigo Profile" and  "Vertigo Forum", where ad nauseam the same people publish their papers in otoneurology based on the knowledge from the end of the 19th century.                                                             

 On 19 March 1993 in the Lodz Journal (Dziennik Łódzki) published the article entitled "A picklock hidden underground" which presents the story of my habilitation qualification. After the publication of this article I experienced numerous losses from the so-called "PRL clique". I described it all in detail in two letters entitled "My experiences with the Central Commission" which appeared in the Independent Academic Forum. Prof. Jan Ku¶ who was the national consultant in the field of laryngology, cancelled me from the function of a regional consultant. This was a really difficult period of time in my professional life.

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