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Prof. Nakiela J.: Vertigo. The vestibulo-cerebellar system according to the latest investigations and interpretation of the author

The Professor J. Nofer institute of Occupational Medicine

 

Lodz, 10 May, 2006

 

THE ASSESSMENT of the scientific achievements of Dr. Jerzy Nakiela, M.D., Ph.D., and his habilitation thesis entitled: "Research into the efficiency of the equilibrium system after injuries of the cerebellar hemispheres (a clinical study)" performed on the candidate's request

 

Jerzy Nakiela M.D., Ph.D. obtained the doctor's diploma in 1969 in the Military Medical Academy (WAM) in Lodz. It was already during the junior position after graduation that he began his scientific and didactic activity in the Department of Regional and Applied Anatomy in WAM under the supervision of Gen. Prof. Wiesław Lasiński. It resulted in several publications from topographic anatomy. This activity influenced the formation of his interests.

In 1974 he obtained the 1st degree of specialization in otolaryngology, and in 1978 he passed the examination of the 2nd degree in otolaryngology, thereby crowning the years of his work as a volunteer in the Otolaryngological Clinic of WAM.

In the years 1974-1975 he worked in the Institute of Occupational Medicine in Lodz, continuing there his interests in otoneurology, taking advantage od the well equipped Electronystagmographic Laboratory, including the swivel chair manufactured by Tönnies with a possibility of performing pendular stimulations. The possibility of precise calculation of suitable parameters of kinetic reactions obtained in the group of healthy and ill persons with the unilateral destruction of the labyrinth, allowed Dr. J. Nakiela to present in future his new theory of the mechanism of formation of reactions in rotation tests. According to him, the rotatory reaction and the post-rotary reaction in healthy persons is caused equally by both labyrinths, thereby undermining LeDoux's theory, which is binding to date.

During his work in the Institute of Occupational Medicine he also led training sessions from the research into the equilibrium system for doctors specializing in laryngology and occupational medicine.

In 1978 he obtained the degree of doctor of medical science under the supervision of Prof. B. Latkowski on the basis of his thesis "Research into the usefulness of the modified Unterberger test in defining the efficiency of the sense of equilibrium".

The habilitation thesis realized in the Laboratory of Research into the Equilibrium System of the Otolaryngological Clinic in WAM in Lodz and the Electronystagmografic Laboratory in Tomaszów Mazowiecki (Dr. J Nakiela is the Head of the Laryngology Ward of the local hospital) contains 142 pages of typescript, including 114 items of the Polish and foreign literature and 114 tables containing statistical calculations. The author distinguished 7 conclusions which claim that from among: static-dynamic tests, the Unterberger test and his own dynamic test have the greatest value in the diagnostics of injuries of the cerebellar hemispheres. According to the author, both the Fitzgerald-Hallpike bi-thermal caloric test and the pendular stimulations test do not have any essential meaning because in most of the examined cases these tests had symmetrical results. Only the Torok caloric test can play an important part in injuries of the cerebellar hemispheres because "vestibular decruitment" was found by the author in 68,9% of the ill persons.

Considering the fact that for assessment of injuries of the equilibrium system the author proposes the simple and commonly available dynamic test, which was worked out thoroughly and checked by him, it must be acknowledged as a significant contribution of the candidate in clinical practice. The test developed by the author also allows diagnosing and differentiating isolated injuries of the labyrinth and the cerebellar hemispheres. It is easy to confirm its reliability in an experiment in healthy people using simultaneously to both ears an asymmetric stimulus with hot water, or cold water in the case of a destruction of the cerebellar hemispheres.

In my opinion, both the scientific achievements of Dr. J. Nakiela and his habilitation thesis introduce an innovative look at the mutual neurophysiological relations of the components of the equilibrium system, i.e. the cerebellum, the vestibular organ, the organ of sight and the core. What is especially interesting and deserving attention is the original interpretations of the rules of formation of the vestibulo-cerebellospinal reaction and vestibulo-cerebello-ophthalmic reaction after using a kinetic and caloric stimulus, the foundations of cooperation of horizontal canals with the cerebellar hemispheres and the mechanisms of such phenomena as habituation, compensation and adaptation determining the functioning of the equilibrium system. This new approach to the pathophysiology of the labyrinth became possible thanks to the investigations carefully carried out by the candidate of ill persons with peripheral injuries of the vestibular organ and ill persons with injuries of the cerebellar hemispheres.

To sum up, I think that the scientific achievements and the habilitation thesis are significant for otoneurology and are an independent contribution to the development and progress of this field of medicine.

I also wish to conclude that, as a previous superior of the candidate in the period of his being employed in the Institute of Occupational Medicine in Lodz, he had always been characterized by a faultless moral attitude and a concern for the patient whereas otoneurology was his life's passion.

Prof. Wiesław Sułkowski, M.D., Ph.D.

Specialist in Otolaryngology, Audiology and Phoniatrics

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