The review by Prof. Andrzej Radek, M.D., Ph.D.

 Col. Prof. Andrzej Radek, M.D., Ph.D.                                                                     8 October 1990, Lodz

The Head of the Neurosurgery Clinic of Military Medical Academy (WAM)

The assessment of the scientific achievements and the habilitation thesis by Jerzy Nakiela, M.D., Ph.D., entitled "Research into the efficiency of the equilibrium system after the damage of the cerebellar hemispheres".

The doctor of medical science Jerzy Nakiela, born on 25 November 1945 in Małyszyn, the administrative district of Wieluń, obtained the doctor's degree in 1969 as a graduate of the 6th Course of WAM in Lodz. Until 1972 he had fulfilled a professional military service as a military doctor. Just after completing his studies, i.e. during the traineeship after graduation he began his scientific and didactic activity in the Department of Regional and Applied Anatomy in WAM under Gen. Prof. Wiesław Lasiński. This collaboration resulted in several papers on topographic anatomy. Undoubtedly these first scientific relations were very essential for Dr. J. Nakiela from the perspective of getting to know such a superb methodology of medical research. They also affected the formation of his aspirations. In 1972 Dr. J. Nakiela, M.D., Ph.D., left from professional military service and began working in the Health Care Institution (ZOZ) in Brzeziny, and then in the Institute of Occupational Medicine in Lodz. During his work in the Institute of Occupational medicine he led training sessions on the research into the equilibrium system for doctors specializing in laryngology.

The candidate is 2nd degree specialist in otolaryngology and he obtained the degree in 1978, thereby crowning his years of work as a volunteer in the Laryngological Clinic of WAM. In that year he also obtained the degree of doctor of medical science under the direction of Prof. B. Latkowski on the basis his thesis "Research into the usefulness of the modified Unterberger test in defining of the efficiency of the equilibrium sense".

His work in the Otolaryngology Clinic of WAM allowed him, apart from obtaining good professional qualifications, to organize an independent electronystagmographic laboratory in Tomaszów Maz., whose manager he is up to the present time. Working in the hospital of the Health Care Institution (ZOZ) in Tomaszów Maz. he is a consultant of the Neurological Department, which allowed him to develop his otoneurological interests. Analysing the course of the habilitant' work it must also be mentioned that for a year he was the head of the Laryngology Department of the Hospital in Tomaszów Maz. He participated in 6 courses organized by the Medical Postgraduate Education Centre in different otolaryngological clinics in Poland. He completed a monthly training course in the Clinic of Head and Neck Surgery in Oldenburg. He is a member of the Polish Medical Association, the Polish Otolaryngological Association and the Independent Trade Union "Solidarność" of Health Service Workers. In a word, Dr. J. Nakiela, M.D., Ph. D., appears to us as an experienced specialist who has travelled an appropriate way to become an independent scientific worker.

His scientific achievements, which includes 26 published paper, strike with an unusual consequence in the development continuation of his scientific interests. He devoted his doctoral thesis and 20 papers, including 2 sent to be published, 2 scientific articles and 1 film to research into the equilibrium system. This fact is especially worth stressing. Among his publications, he is the only author of 17 papers, the first author in 9, and he published 3 of the mentioned papers in foreign medical journals. So, his scientific achievements, though not very numerous, is qualitatively precious and qualitatively essential in the context of research into the equilibrium system. As a neurosurgeon I wish to stress the value of his papers for practical otoneurology and their usefulness in the assessment of disequilibrium connected with injuries of the cerebellar hemispheres.

It must be stated that despite the well-known development of diagnostic techniques, e.g. the computed axial tomography, searching for simple and universally available methods is worth highest recognition in every respect. Dr. Nakiela, M.D., Ph. D., concentrating his interests on, it must be stressed, a very difficult subject, contributes undoubtedly to the cognition of the essence of vestibulo-cerebellospinal reflexes, which are so complex.

Assessing his habilitation thesis and his scientific achievements to date it must be noticed that Dr. Nakiela is a man who fights with accepted canons, attempting to provide his contribution to clinical otolaryngology. It is already known today that the universally used caloric and kinetic vestibular tests, regarded as the basic methods of research of the equilibrium system, are not absolutely reliable and, though the development of electrodiagnostic methods allows its objectivization, the interpretation of the results is still a very difficult matter because it is known that the entire equilibrium system is a multineuronal complicated structure which consists of a number of nervous tracts and connections.

As a neurosurgeon I would not like to express my opinion on the otologic aspects of Dr. Nakiela's thesis. However, I would like to stress that practical neurosurgery still encounters gigantic tumors of the cerebellopontine angle originating from the nerve VIII whose treatment is one of the most important problems of practical neurosurgery.

On the other hand, it is known that the tumor detected in the otologic period, whose most permanent symptoms are unilateral deafness or also considerable hearing impairment, cancellation or impairment of the reactions of the labyrinth to thermal and rotary stimulation, can be removed completely with the use of the microsurgical technology with impunity for the patient. It must be stressed that otologic symptoms are often misleading and their atypism is frequently found, e.g. the lack of hearing disturbances, the correct excitability of the vestibule, the impairment on the side opposite to the tumor or the bilateral impairment. Therefore, detection of these tumors in the preliminary period is an unusually vital issue. These facts, quoted in the literature and well-known from clinical practice, prove of the importance of the problem, and any research in order to resolve them deserve praise. Dr. Nakiela, combining his anatomical and otologic scientific interests with practical otoneurology, dealt with with the test of the decision of this problem in the very serious manner. Its results are all his scientific achievements crowned with a clinical study, which is his habilitation thesis.

This thesis developed in the Laboratory of the Research into the Equilibrium Systemof the Otolaryngological Clinic (ICH) of WAM in Lodz and the Electronystagmographic Laboratory in Tomaszów Maz. consists of 142 pages of typescript, includes 114 items of Polish and foreign literature and 114 tables containing statistical calculations.

From his thesis the author distinguished 7 conclusions resulting from the carried out research. The research whose aim was to show the usefulnesses of individual tests for detecing the cerebellum defects, universally used in clinical otology in the diagnostics of disequilibrium, was carried out by the author in 108 persons. This group includes 50 healthy persons as a control group and 58 ill persons after surgeries of hemisphere tumors of the cerebellum, treated in different neurosurgical centers in Lodz (the Neurosurgery Clinic of WAM, the Neurosurgery Clinic of Medical Academy (AM), the Neurosurgical Department of the Copernicus Hospital in Lodz). The group of ill persons consists of mainly ill persons with removed hemisphere tumors of the cerebellum among which in 42 cases, as shown by the histopathologic research, they were astrocytomas, in 5 cases - hemangioblastoma (angioblastomas), in 4 cases - cysts of the cerebellum, so they were tumors destroying directly the cerebellar hemispheres. The remaining 7 tumors - 5 neurilemmomas and 2 meningiomas, damaged the cerebellar hemispheres through indirect compression.

In all the examined ill persons, and also in the 50 healthy persons of the control group, the author performed statokinetic, audiometric and electronystagmographic tests. Among the statodynamic tests he introduced his own modification of the Unterberger test which, as shown by his research, presents the greatest diagnostic value.

Dr. Nakiela proves in his thesis that the use of the Unterberger test in his own modification creates new possibilities of the diagnostics of injuries of the cerebellar hemispheres. To prove his clinical observations he created an experimental model which allows checking the reactions of individual parts of the equilibrium organ to an irritant (stimulation) and proving defect changes depending on the damaged place. The description of his modification of the mentioned dynamic Unterberger test, its technique, the interpretation of results in peripheral injuries of the vestibular organ and also its value for the differentiation of peripheral and central injuries were presented by the author in 1983 at the 32nd Congress of the Polish Otolaryngological Association. As shown by the author's research, other tests such as e.g. the Hallpike caloric test and the pendular stimulation test are not fully reliable tests because in most cases they have not shown any essential lateralisation of changes and the only recommendable test, according to the author, is the Torok caloric test. Considering the fact that for the assessment of disequilibrium the author proposes a simple and universally available test which is his modification and which has been thoroughly worked out by him very and, as shown by the thesis, well-tried in clinical practice and confirmed in the experiment, one must stress the unusual significance of his thesis for specific clinical practice. In my opinion, both Dr. Nakiela' scientific achievements and especially his habilitation thesis goes beyond otoneurology, creating perhaps an opportunity of a new look at the neurophysiological interrelations of the components of the equilibrium system, i.e the cerebellum, the vestibular organ, the organ of sight and the spinal cord.

Finishing the review, I would like to emphasize that both the entirety of Dr. Nakiela's scientific achievements, his consistent aspiration to solving the problem and his habilitation thesis, resulting from it, show Dr. Nakiela as a mature clinician and an explorer who, in my judgement, provides an original and precious contribution to clinical otoneurology as well as neurophysiology. The thesis, apart from the cognitive significance, also has a large practical meaning not only for otology, but also for neurology and neurosurgery.

I consider that the candidate fulfils all the conditions essential for an independent scientific researcher, and his achievements and habilitation thesis fully confirm it.

I present my opinion to the High Academic Council of WAM, recommending Dr. Jerzy Nakiela, M.D., Ph. D., for being accepted for further stages of the habilitation procedure.

The Head of the Neurosurgery Clinic

The Clinical Hospital of WAM

Col. Assistant Professor Andrzej Radek, M.D., Ph. D.,

Returning to the opinion by Prof. Janczewski, further in his opinion he writes about the statokinesiometric test. It does not have anything to do with the assessment of my thesis. But if the Professor thinks that drawing a stabilogram by means of the computing technology has a greater value than reflexes which are properly performed and read in the Nakiela's dynamic test, he is seriously mistaken. Anyway, he denies himself - quotation: “It must also be stressed that even the statokinesiometric test performed with the use of the posturograph does not explain fully the relationship between the labyrinth system and the cerebellum." Prof. Janczewski, having at his command my greatest epochal discovery in otoneurology, says in conclusion of his opinion: - quotation: "To sum up, I truly regret to state that neither the scientific achievements nor the habilitation thesis, submitted for my  assessment, by Dr. Jerzy Nakiela, M.D., Ph.D., entitled "Research into the efficiency of the equilibrium system after destruction of the cerebellar hemispheres" do not meet, in my opinion, the requirements for the scientific achievements  of a candidate for the degree of the habilitated doctor of science". Thus, Prof. Janczewski became an executioner of my scientific achievements already in the 3rd Polish Republic. And in this way, on the basis of the "esbeck" (typical of the Soviet security service of PRL) opinion in the Central Commission, like in Stalinist times, sentenced an independent scientist to death, without any possibility of defence. This was a typical kangaroo court. It can be boldly said that this is the greatest communist crime committed on science and as such it does not fall under the statute of limitations.

Prof. Janczewski must have realized that he had been in a continuous scientific conflict with me. If he were a man of honour, he should have refused to write the review. And thus he became a false witness in my cause. In a normal democratic state he should be accountable for those lies in court. My epochal discovery in otoneurology reveals and simultaneously shatters the value of Prof. Janczewski's scientific achievements. Hence his fierce fighting me. Prof. Janczewski was the First Secretary of the Polish United Workers' Party (PZPR) in the Medical Academy in Warsaw, a member of the Central Committee of the Polish United Workers' Party, strenuously supported the evil empire. Therefore, because of such people I could not freely publish my papers and I had to go underground with my scientific activity. After Prof. Janczewski had presented his opinion in the Central Commission, there was no discussion. This is another significant clue. According to the law of 12 September 1990 on scientific titles and degrees announced in the Journal of Laws of the Polish Republic as of 27 September 1990 the Central Commission is to decide about confirmation of the resolution within six months since the date of the receipt of the resolution. One year had passed and I still received no decision. It was not until January 1992 that I received a decision informing me that the Central Commission had refused to confirm the resolution of Medical Faculty Council of WAM in Lodz as of 20 November 1990 on conferring a degree of habilitated doctor on Jerzy Nakiela. The decision was undertaken based on one negative review written by Prof. G. Janczewski. I was sent the information to my home address together with one review written by Prof. Janczewski. Fortunately for me the decision of the Central Commission was against the law in force. Therefore, it had to be regardes as invalid. The Central Commission got confused quite a lot in their criminal activity and broke two times the law of 12 September 1990 on Scientific Degrees and Titles and the Statute of the Central Commission for Scientific Degrees and Titles. The first time was against article 17.1 which states that the Central Commission decides about confirmation of the resolution within six months from the receipt of the resolution. The Central Commission exceeded this time limit twice. The second time when the Central Commission broke the law was in reference to article 34.3 which states that a Section of the Central Commission decides after obtaining an opinion issued by at least one reviewer. If at least one opinion is negative, the section appoints a reviewer from beyond the Central Commission. Because Prof. Janczewski's opinion was negative, the Central Commission, in accordance with article 34.3, should have appointed a new reviewer from beyond the members of the commission. The medical section did not have the right to vote on the basis this one negative review. This provision is also indcluded the internal statute of the Central Commission. Clause 9.4 states that - quotation:"In the advisory conduct of the section. upon receipt of a negative opinion by the reviewer, an additional reviewer is appointed from beyond the members of the commission". This principal condition of the commission statute was not fulfiled by the Central Commission so the decision of 17 December 1991 is illegal and should be considered invalid. I guess why it all took so long. In 1991 there was a changed of the authorities of the Military Medical Academy and it was expected that new authorities of the academy would not appeal from the decision of the Central Commission. And so it was. In 1992 the Dean of the Medical Faculty of WAM informed me that the Medical Faculty Council at the session of 18 February 1992 in the open voting (and not a secret ballot) had adopted a resolution to leave the matter of appeal against the decision of the Central Commission for Scientific Degrees and Titles for assessment of his personal decision. Powerful connections started to work and my Academy became frightened and I was betrayed. Despite the fact that I had it black and white that the decision of the Central Commission was invalid, I decided to appeal from this decision. Before the appeal I decided to personally check in the Central Commission what really happened. I unexpectedly discovered a false bottom in this criminal institution. I will describe it in detail in the appeal to the Central Commission of 10 February 1992