Comparison of Hemodynamic Response between Patients with Systolic Heart Failure Differing in Serum Aldosterone Concentrations during and after a 6-Minute Walk Test.

Aldosterone regulates hemodynamics, including blood pressure (BP), and is involved in the development and progression of cardiovascular diseases, including systolic heart failure (HF). While exercise intolerance is typical for HF, neither BP nor heart rate (HR) have specific characteristics in HF patients. This study compares BP and HR profiles during and after standardized exercise between patients with systolic HF with either lower or higher aldosterone concentrations. We measured BP and HR in 306 ambulatory adults with systolic HF (left ventricular ejection fraction (LVEF) <50%) during and after a 6 min walk test (6MWT). All patients underwent a resting transthoracic echocardiography, and venous blood samples were collected for biochemical analyses. The patients were also divided into tertiles of serum aldosterone concentration: T1 (<106 pg/mL), T2 (106 and 263 pg/mL) and T3 (>263 pg/mL), respectively. Individuals from T1 and T2 were combined into T1-T2 as the reference group for comparisons with patients from T3. The individuals from T3 had significantly lower systolic, mean and diastolic BPs at rest, at the end and at 1 and 3 min post-6MWT recovery, as well as a more dilated left atrium and right ventricle alongside a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Higher serum aldosterone concentration in HF patients with an LVEF < 50% is associated with a lower 6MWT BP but not an HR profile.

The serum concentration of brain­derived neurotrophic factor is lower in ambulatory and clinically stable patients with more advanced systolic heart failure.

INTRODUCTION: Brain­derived neurotrophic factor (BDNF) is decreased in heart failure (HF), but whether serum BDNF concentration is related to the severity of HF with reduced left ventricular (LV) ejection fraction (LVEF) below 50% is uncertain. OBJECTIVES: We aimed to compare cardiac structure and function in ambulatory and clinically stable patients with HF and LVEF below 50% for lower and higher BDNF serum concentrations. PATIENTS AND METHODS: A total of 361 ambulatory patients with a compensated HF and LVEF below 50% underwent cardiac evaluation and measurement of serum BDNF and N­terminal pro-B­type natriuretic peptide (NT­proBNP). Patients from the lower (below median) and higher (equal to or above median) BDNF serum concentration groups were compared by analysis of covariance (ANCOVA) adjusted for age, sex, body mass index, resting heart rate, and systolic blood pressure. RESULTS: The patients were at a median age of 63.8 (interquartile range [IQR], 57.7-71.5) years and had a median LVEF of 31.0% (IQR, 23.0-37.4). Individuals with lower BDNF (<23.5 ng/ml) had significantly (P ≤0.05) more dilated right and left atria both before and after emptying, larger right ventricular end-diastolic diameter, LV end-systolic diameter, lower tricuspid annulus plane systolic excursion, shorter pulmonary acceleration time, higher mitral E to A waves ratio and mitral E wave to tissue Doppler e' wave ratio, and higher concentration of NT­proBNP. CONCLUSIONS: HF patients with LVEF below 50% and lower serum BDNF concentration present more advanced cardiac remodeling and dysfunction than individuals with higher BDNF. Potential mechanisms and clinical consequences of these findings require further investigation.

Cardiovascular, anthropometric, metabolic and hormonal profiling of normotensive women with polycystic ovary syndrome with and without biochemical hyperandrogenism.

PURPOSE: Women with polycystic ovary syndrome (PCOS) present with or without biochemical hyperandrogenism (HAPCOS or non-HAPCOS, respectively). Cardiometabolic and hormonal abnormalities have been reported in women with PCOS, particularly those with hypertension. However, no direct comparison between normotensive (blood pressure <140/90 mmHg) patients with HAPCOS and non-HAPCOS has been made. This study compared different cardiovascular (CV), anthropometric, metabolic and hormonal features between normotensive patients with HAPCOS and non-HAPCOS and healthy women. METHODS: We consecutively recruited 249 normotensive patients with PCOS and 85 healthy eumenorrheic women to a case-control observational study. Based on blood androgen concentration, patients with PCOS were divided into HAPCOS (n = 69) or non-HAPCOS (n = 180) groups. RESULTS: Although within normal ranges, patients with HAPCOS had significantly (p < 0.05) higher peripheral and central systolic blood pressure and pulse pressure, C-reactive protein, low-density lipoprotein cholesterol, triglycerides, glucose, and insulin than subjects with non-HAPCOS, and healthy women. They also had lower N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration. In contrast, their body mass index (BMI) was higher of over 4 kg/m2 than patients with non-HAPCOS and nearly 6 kg/m2 than in healthy participants. Except for BMI, statistical differences in the cardiometabolic profile were of little clinical relevance. CONCLUSIONS: Young normotensive women with HAPCOS have a worse cardiometabolic profile but lower NT-proBNP concentration than patients with non-HAPCOS. Features of this profile in both PCOS groups are within ranges typical for healthy women. Increased BMI is the only clinically relevant feature differentiating hyperandrogenic from non-hyperandrogenic patients with PCOS, and healthy women.

Effect of Central Obesity and Hyperandrogenism on Selected Inflammatory Markers in Patients with PCOS: A WHtR-Matched Case-Control Study.

White blood cell counts (WBC), lymphocyte-to-monocyte ratio (LMR), and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) are used as chronic inflammation markers. Polycystic ovary syndrome (PCOS) is a constellation of systemic inflammation linked to central obesity (CO), hyperandrogenism, insulin resistance, and metabolic syndrome. The waist-to-height ratio (WHtR) constitutes a highest-concordance anthropometric CO measure. This study aims to access WBC, LMR, and MHR in PCOS and healthy subjects, with or without CO. Establishing relationships between complete blood count parameters, high-sensitivity C-reactive protein (hsCRP), and hormonal, lipid and glucose metabolism in PCOS. To do this, WBC, LMR, MHR, hsCRP, anthropometric, metabolic, and hormonal data were analyzed from 395 women of reproductive age, with and without, PCOS. Correlations between MHR, and dysmetabolism, hyperandrogenism, and inflammation variables were examined. No differences were found in WBC, LMR, MHR, and hsCRP between PCOS and controls (p > 0.05). PCOS subjects with CO had higher hsCRP, MHR, and WBC, and lower LMR vs. those without CO (p < 0.05). WBC and MHR were also higher in controls with CO vs. without CO (p < 0.001). MHR correlated with anthropometric, metabolic, and endocrine parameters in PCOS. WHtR appeared to strongly predict MHR in PCOS. We conclude that PCOS does not independently influence WBC or MHR when matched for CO. CO and dysmetabolism may modify MHR in PCOS and control groups.

Association between adjunctive metformin therapy in young type 1 diabetes patients with excess body fat and reduction of carotid intima-media thickness.

INTRODUCTION    Lipoprotein-associated phospholipase A2 (Lp-PLA2) and cholesteryl ester lipase (CEL) may oxidize low-density lipoproteins (oxLDL). OBJECTIVES    The aim of the study was to determine the influence of metformin on the metabolism of atherogenic lipid fractions in relation to Lp-PLA2 and CEL levels, as well as assess consequent improvement in the intima-media thickness (IMT) of the common carotid artery in young type 1 diabetes patients with excess body fat. PATIENTS AND METHODS    It was an open-label randomized clinical trial that lasted 6 months. It included a total of 84 people with metabolic decompensation (glycated hemoglobin >7.5%, >58.5 mmol/mol) of diabetes. Adjunctive metformin therapy (in addition to insulin) was administered in 42 patients, and the remaining 42 patients received insulin alone. Glycated low-density lipoproteins (LDLs), oxLDL, Lp-PLA2, and CEL were assessed by commercially available enzyme-linked immunosorbent assay kits. Cartoid IMT was measured using the Carotid Analyser for Research tool. Biochemical analyses were performed using routine laboratory techniques. RESULTS    The reduction of mean carotid IMT was observed in young type 1 diabetic adults treated additionally with metformin (0.6 ±0.1 cm vs 0.53 ±0.1 cm; P = 0.002). This effect was probably due to weight reduction (90 ±16 kg vs 87 ±15 kg, P = 0.054) and the decrease in atherogenic glycated LDL levels (1.5 ±0.5 mg/dl vs 1.6 ±1.046 mg/dl, P = 0.006). No such correlations were observed in patients treated with insulin alone. Additionally, in patients receiving metformin, glycated LDL levels were inversely correlated with Lp-PLA2 levels (r = -0.31, P <0.05). CONCLUSIONS    Additional use of metformin in young type 1 diabetic patients with excess body fat leads to a significant reduction of mean IMT in the common carotid artery. Concentrations of CEL and Lp-PLA2 were significantly increased in both study arms despite improved glucose metabolism.

N­terminal pro­B-type natriuretic peptide as a marker of hypervolemia and predictor of increased mortality in patients on hemodialysis.

INTRODUCTION: N­terminal pro­B­type natriuretic peptide (NT­proBNP) is an established biomarker of heart failure in the general population. However, its diagnostic value is unclear in hemodialysis (HD) patients owing to renal insufficiency. OBJECTIVES: The aim of the study was to establish the usefulness of NT­proBNP for hydration assessment and the relation of NT­proBNP to the nutritional state and prognosis of survival. PATIENTS AND METHODS: In 321 HD patients (206 men; mean age, 65.1 ±21.4 years), we assessed NT­proBNP levels, overhydration (OHBIA), and the indices of the nutritional state (using a bioimpedance analysis [BIA]) in relation to cardiac troponin T (cTnT), hemoglobin, albumin, total cholesterol (TC), and C­reactive protein (CRP) levels. The efficacy of HD was assessed using Kt/V, weekly HD dose, and HD session ultrafiltration. The cohort was divided into NT­proBNP quartiles. Patients with 2 NT­proBNP measurements were categorized also into change­over­time subgroups. A follow­up lasted for a median period of 23.8 ±26.3 months. RESULTS: Relative OHBIA increased across the NT­proBNP quartiles (Q1/Q2/Q3/Q4, 1.31% ±2.56%/2.06% ±2.35%/2.92% ±2.97%/4.62% ±4.22%; P <0.0001). NT­proBNP was also closely associated with other OH parameters. In addition, there was a significant correlation between NT­proBNP and cTnT (r = 0.55; P <0.0001). Body mass index (BMI) and fat tissue index (FTI) decreased across the quartiles (BMI, 28.5 ±7.7/26.0 ±6.6/25.8 ±5.4/23.7 ±5.5 kg/m2; FTI, 14.4 ±9.0/14.1 ±7.3/12.3 ±6.8/11.6 ±6.1; P <0.001). The highest albumin level was present in Q1 (4.10 ±0.63/3.99 ±0.51/3.90 ±0.62/3.97 ±0.78 g/dl; P = 0.006). The TC level was the lowest in Q4 (190 ±60/169 ±56/173 ±51/153 ±56 mg/dl; P = 0.002). The hemoglobin level decreased across the quartiles (11.44 ±1.25/11.15 ±2.50/10.79 ±1.51/10.45 ±1.67 g/dl; P = 0.0006). The differences in CRP levels and HD­related parameters were nonsignificant. During the follow­up, 97 deaths were recorded (11/26/21/39, P <0.0001). CONCLUSIONS: NT­proBNP seems to be a useful biomarker of hypervolemia in HD patients. Nevertheless, it has to be interpreted with regard to the patient's individual residual renal function and cardiovascular status.

Cardiac Troponin T and Hydration Status as Prognostic Markers in Hemodialysis Patients.

This study aimed to assess cardiac troponin T (cTnT) and hydration state as cardiovascular (CV) risk markers in hemodialysis (HD) patients. Two hundred and forty one patients were divided according to HD vintage into two groups: SV (HD ≤24 months) and LV. Water balance was assessed with overhydration (OH%; bioimpedance analysis) and daily diuresis (DD); CV dysfunction with cTnT and heart ultrasound; nutrition with subjective global assessment (SGA), cholesterol (TC) and albumin. SV had lower OH% (2.8 vs. 3.5, p < 0.05) and higher DD (1,161 vs. 637 ml, p < 0.001), while LV had higher cTnT (0.1 ± 0.04 vs. 0.1 ± 0.07 ng/ml, p < 0.05) and lower interventricular septum thickness (IVS; 13.4 vs. 14.5 mm, p < 0.05). Nutritional state as reflected by lower TC was worse in LV (184.7 vs. 169.5 mg/dl, p < 0.05). Mortality was higher in patients in the LV group (15 vs. 27 deaths, p < 0.05). OH% correlated inversely with albumin (r = -0.36, p < 0.001), TC (r = -0.31, p < 0.001) and cTnT (r = -0.4, p < 0.001). cTnT correlated positively with IVS (r = 0.39, p < 0.001), SGA (r = 0.23, p = 0.001) and mortality rate (r = 0.21, p < 0.01), and negatively with DD (r = -0.34, p < 0.001) and albumin (r = -0.25, p < 0.001). Longer dialysis vintage associates with CV dysfunction, overhydration and increased mortality, which may be predicted with OH% and cTnT. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=376603.

Metformin added to intensive insulin therapy reduces plasma levels of glycated but not oxidized low­density lipoprotein in young patients with type 1 diabetes and obesity in comparison with insulin alone: a pilot study.

INTRODUCTION: There are scarce data about the effect of metformin on lipid profile in patients with type 1 diabetes. OBJECTIVES: The present study is the first prospective clinical trial evaluating the effect of combined therapy of metformin and insulin on the pool of oxidized and glycated low­density lipoproteins (LDL) in young patients with type 1 diabetes and concomitant obesity. PATIENTS AND METHODS: A total of 33 obese patients with type 1 diabetes treated with intensive insulin therapy were randomized into a group where metformin was added. The remaining 19 patients continued to receive intensive insulin therapy (control group). In all patients, lipid profile and glycemia were assessed using routine laboratory tests. Oxidized and glycated LDL were measured using commercially available kits. Laboratory tests were performed at baseline and at a control visit after 6 months of treatment. RESULTS: A significant decrease in the levels of glycated hemoglobin, fasting plasma glucose, postprandial glucose, average glucose, triglycerides, glycated LDL, and body mass index was observed in the group receiving combined therapy. A similar decrease was not observed in the control group. The remaining lipid parameters were not changed during follow­up in any of the groups. CONCLUSIONS: Addition of metformin to intensive insulin therapy in young obese patients with type 1 diabetes results in a significant reduction of glycated LDL levels. This can be possibly explained by better glucose control, which improved insulin sensitivity of the peripheral tissues and reduced body mass in this patient group.

Effect of naturally occurring phenolic acids on the expression of glutathione S-transferase isozymes in the rat.

Naturally occurring plant phenols, protocatechuic and tannic acids, have been reported to be inhibitors of chemical mutagenesis and carcinogenesis in experimental models. Our previous studies, have shown that these compounds modulate the activity of phases 1 and 2 enzymes in rodents. The aim of the present study was to investigate whether these compounds affect protein levels of rat hepatic and renal glutathione S-transferase (GST) isozymes. Male Wistar rats were treated intraperitoneally with protocatechuic or tannic acid at 50 mg/kg body weight five times during 14 days. 3-Methylcholanthrene (MC) was administered at 20 mg/kg body weight on day 13 (the last treatment with phenolic compounds) and on day 14. Tissues were obtained from rats terminated 24 h after the last treatment. Western blot analysis with specific antibodies showed significant differences in the effect of the phenolic compounds in the liver and kidney. In the liver, protocatechuic acid significantly increased the constitutive GSTmicro, while tannic acid reduced the GSTalpha protein level by 60%. Both plant phenols decreased all classes of constitutive GST isozymes in the kidney including GSTpi, and also the MC-induced GSTalpha and/or pi protein levels. These results, as well as our previous reports, suggest that protocatechuic and tannic acids interfere with the pathways related to xenobiotic toxicities and carcinogenesis. This effect may be important for chemoprotective activity of these plant phenols.

The effect of plant phenols on the expression and activity of phorbol ester-induced PKC in mouse epidermis.

Protein kinase C (PKC) is thought to be a major intracellular receptor for the mouse skin tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA). The diversity of PKC isoforms, and their central role in many signaling pathways, makes them important targets for potential chemopreventive agents. Our earlier studies showed that the plant phenols protocatechuic acid, chlorogenic acid and tannic acid alter the activity of enzymes involved in carcinogen activation, inhibit the formation of polycyclic aromatic hydrocarbon (PAH)-DNA adducts in mouse epidermis and decrease the level of lipid peroxidation in the epidermal microsomes. In the present study the effects of protocatechuic acid, chlorogenic acid and tannic acid on TPA-stimulated PKC isozymes alpha, beta(1), beta(2), gamma and zeta activity, and their distribution in mouse epidermis, was examined. The application of these phenolics 15 min before a single dose (3.4 nmol) of TPA resulted in significant inhibition of PKC translocation and a subsequent decrease in classical and novel/atypical PKC isoforms in comparison to a group of mice treated with TPA alone. The most potent inhibitor of PKC translocation and activity was tannic acid. This compound increased the levels of PKCalpha, beta(1), beta(2) in the cytosolic fraction by between 127% and 492% in comparison with TPA treated group of mice. Tannic acid decreased the activities of all three PKC classes by approximately 94% in the membrane fraction in comparison with the TPA treated group of animals. The effect of protocatechuic and chlorogenic acids on the distribution and activity of PKC isozymes was moderate. These compounds mostly affected translocation of PKCalpha and subsequently the activity of classical PKC. The enzyme activity in the particulate fraction was reduced by 59% and 43% in comparison with the TPA group, respectively. Thus, the results of these studies suggest that the subcellular distribution of PKC isoforms, and the activity of PKCs, can be modulated by plant phenolic acids, particularly tannic acid, and that such actions represent a part of the anti-promotional activity of these substances in mouse epidermis.

[The dynamics of habituation of perception and reaction in tinnitus patients treated with TRT]. / Dynamika habituacji reakcji i percepcji podczas leczenia przewleklych szumów usznych metoda TRT.

In this paper the authors present the dynamics of habituation of reaction and perception in tinnitus patients. All patient with subjective chronic tinnitus were diagnosed and treated using TRT method according to Jastreboff's neurophysiological model. 110 patients was estimated during last 4 years treated in ENT Rehabilitation Center in Poznan. The authors present the most frequently troubles in every day life caused by tinnitus and also the dynamics regression of complaints during period of treatment. Speed of disappearance of suffering is very important for all patients already in the beginning of cure.

[Patients under 45 years of age "young adults" with head and neck squamous cell carcinoma. Retrospective, multivariable analysis--preliminary report ]. / Retrospektywna, wieloczynnikowa analiza raków plaskonablonkowych glowy i szyi u chorych ponizej 45 roku zycia "young adult"--doniesienie wstepne.

There is a clear tendency to diagnose squamous cell carcinoma of the head and neck more frequently in patients below 45 years of age. These neoplasms in "young adults" seem to be more aggressive with rapid progression, frequent reappearance after treatment and worse prognosis than is observed in older patient population. This preliminary report presents results of retrospective, multivariable analysis of patients below 45 years of age with squamous cell carcinoma of the head and neck. The special focus of the study were: disease progression (T), regional node and distant metastases (N,M), tobacco and alcohol consumption, environmental factors, concomitant diseases, kind of surgical technique and tumour histology.

[Angiofibroma juvenile in the clinical material of Department of Otolaryngology in Poznan in the years 1977-2000 ]. / Wlókniaki mlodziencze w materiale Kliniki Otolaryngologii AM w Poznaniu w latach 1977-2000.

30 patients suffering from angiofibroma juvenile were treated in the Department of Otolaryngology in Poznan in the years 1977-2000. The patients aged from 9-36 years. All the patients were treated surgically and the method of choice was Denker's surgery. 3 patients were reoperated because of local recurrence. On the base of own material good results of full recovery of patients with angiofibroma treated surgically are presented.

Alterations in skeletal protein, distribution of PKCalpha, and level of phospholipids in erythrocyte membranes of women with primary breast cancer.

The aim of our work was to study the influence of primary breast cancer on mature erythrocyte membranes. Blood was sampled from 29 women with primary breast cancer, aged 35-86 years, in different stages of clinical progression of the disease. In red blood cell membranes an increase of phosphatidylinositol-4-phosphate and phosphatidylinositol-4,5-diphosphate levels was observed. These changes were accompanied by a decrease in phospholipase C activity. Simultaneously, a significant decrease in concentration of phosphatidylserine, sphingomyelin, and phosphatidylinositol was found. Quantitative protein evaluation showed an increase in band 4.1 protein content with no changes in the level of constitutive PKCalpha responsible for the phosphorylation of this protein and its affinity to glycophorine C. In parallel a greater increase of PKCalpha translocation after PMA treatment compared to controls was observed. Possible oxidative damage of erythrocyte membranes indicated by an increase in malonyldialdehyde level and decrease in SH-group content as well as by an increase in the w/ ratio was documented. From the results it is concluded that primary breast cancer seems to affect the membranes of mature erythrocytes.

[Prognostic significance of Ki 67 and PCNA expression in laryngeal squamous cell carcinoma (morphometric evaluation of labelling index-L1]. / Ekspresja markerów proliferacji Ki 67 i PCNA jako czynnik prognostyczny w raku plaskonablonkowym krtani (morfometryczne oznaczanie indeksu barwliwosci jader--IB).

There are no certain histological or morphological criteria which would improve the precision of life expectancy and the selection of the most efficient methods of treatment in patients with squamous cell laryngeal carcinoma. The analysis of proliferation activity using immunohistochemical markers such as antigens Ki 67 and PCNA may be helpful to evaluate the aggressiveness of neoplastic cells. The study was conducted in 55 patients (aged 36-86 years, mean 62 years), 52 men and 3 women. Immunohistochemical staining of antigens Ki 67 and PCNA using avidin-biotin method was performed in all cases. Microscopic images were stored, then nuclei of neoplastic cells expressing immunohistochemical reaction were localized using level segmentation method. Next labelling index was calculated. The correlation was observed between the LI for Ki 67 and tumor size (p < 0.00001), stage (p < 0.001), metastases to lymph nodes (p, 0.00001) and site (p < 0.005). A weak correlation was observed between the LI for Ki 67 and presence of distant metastases (p < 0.06). The LI of neoplastic cells for PCNA was correlated with the tumor size (p < 0.00001), stage (p < 0.0001), metastases to lymph nodes (0.0001), site (p < 0.005) and presence of distant metastases (p < 0.03). On the ground of the obtained results both markers can be suggested for the morphological and biological evaluation of the neoplastic cells in laryngeal squamous cell carcinoma.

[Unilateral tinnitus--diagnostics and treatment]. / Jednostronne szumy uszne--diagnostyka i leczenie.

900 patients with tinnitus were treated between January 1998 and August 2000 in ENT Rehabilitation Center in Poznan. Unilateral tinnitus was observed in more than 50% of the patients. In all the patients a history was taken paying a special attention to the loudness estimation by the patient and to the influence of the tinnitus on the everyday life. Laryngological, audiological and neurological examinations and laboratory tests were performed. In some cases endocrinological examination was performed. In the group of patients with unilateral tinnitus a special attention was paid to the possibility of ponto-cerebellar angle tumour. After audiological diagnostics CT or MRI examinations were performed. Authors emphasize, that in patients with unilateral tinnitus a proper observation is required to exclude expansive process within the acoustic nerve.

[Coexistence of choanal polyp and lymph node tuberculosis]. / Wspólistnienie polipa choanalnego i gruzlicy wezlów chlonnych.

The authors present a case of coexistence of choanal polyp and lymph node tuberculosis in patient referred to ENT Clinic of K. Marcinkowski University of Medical Sciences in Poznan with suspicion of nasopharyngeal malignant tumor and lymph node metastases. Performed surgery and histopathological evaluation of obtained tissues revealed lymph node tuberculosis and polyp.

[Effect of ultrasonography on postoperative changes in treatment of neck lymph nodes and improvement of long term results in patients with laryngeal neoplasms]. / Wplyw ultrasonografii na zmiane postepowania chirurgicznego w leczeniu ukladu chlonnego szyi i poprawe wyników odleglych u chorych z nowotworami krtani.

Ultrasonography (US) is a well-known and valuable method of detecting lymph nodes in the neck. It is widely used in the preoperative neck assessment and in follow-up patients treated for head and neck cancer. The aim of the study was to compare the larynx cancer patients in two decades: the 80-ies and the 90-ies and the influence of a single diagnostic tool, i.e. ultrasonography, on therapeutic decisions and final results. Two groups of patients were selected: 737 patients treated between 1981-1985 (before the introduction of US) and 840 patients treated between 1991-1995 (routinely examined with the help of US) in ENT Dept. of Karol Marcinkowski University of Medical Sciences in Poznan. We aimed at analysing the percentages of neck metastases at the moment of diagnosis, the frequency of particular types of primary neck treatment, the percentages of neck recurrences, their advancement at the diagnosis and the methods of secondary treatment. Particular attention to feasibility of salvage was paid. Mean survival time in the group of patients with recurrence and the overall 5-year-long survival rates were analysed. No marked differences were stated between both groups as to epidemiological data, primary tumor advancement and types of the performed larynx surgery. Neck metastases occurred in both groups, 34% and 42%, respectively. Relapse rates were 12.9% and 12.6%, respectively. It was found that the number of elective neck dissections over the period given above became smaller, the number of radical neck dissections was stable, while the number of patients referred to wait and see policy increased. The number of successful neck salvage surgeries markedly increased while the number of patients not qualified for salvage decreased. For the both studied data, the curves on diagrams cross around the year 1992. The turning point situated in this time shows that ultrasound, introduced in 1991, gradually changed the types of primary treatment and possibilities of salvage neck treatment. The statistically significant differences in both groups were shown as to: types of the initial i.e. first neck treatment, relapse rate and the possibility of performing surgical salvage, while the only change was the introduction of a new diagnostic tool, i.e. neck ultrasonography. Survival rate was markedly better in the second group of patients. The methods of qualifying patients for the primary neck treatment and follow-up schedule have been changed since ultrasonography diagnostics was introduced in 1991 for routine assessment of the neck lymphatics in the larynx cancer patients. Strict follow-up schedule allow for early detection and successful treatment in high percentage of relapses.

[Objective audiometry in diagnosis of tinnitus]. / Obiektywne metody badania sluchu w diagnostyce szumów usznych.

During last 3 years there have been 900 tinnitus patients treated at ENT Rehabilitation Center in Poznan. Everyone underwent a thorough laryngological and audiological examination. Diagnostic procedure comprised also neurological and endocrinological consultations with accessory blood tests. Wide group of audiological tests used for diagnosis was divided into objective (BERA, OAE, tympanometry, stapedius reflex) and subjective (pure tone audiometry, speech audiometry, suprathreshold audiometry) methods. Otological diagnostic in tinnitus patients is difficult due to its subjective character. That is why it is so important to have objective methods for its evaluation. In this paper authors present results of BERA tests and impedance conducted on group of 900 patients. Performed objective tests enabled to diagnose otosclerosis, chronic otitis media and pathology in cerebello-pontine angle in patients without any abnormalities on physical examination.