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WstępBorelioza z Lyme (Lyme borreliosis – LB) jest najczęstszą chorobą odkleszczową u ludzi. Celem pracy było przeprowadzenie wstępnej analizy występowania zaburzeń słuchu u chorych na LB.Materiał i metodyTesty audiometryczne objęły 66 chorych z rozpoznaną LB, w wieku od 18 do 45 lat. Wszyscy badani (kobiety i mężczyźni) zostali podzieleni na dwie główne grupy: 1 – wczesnej, rozsianej LB i 2 – późnej LB; wśród nich zostały wyodrębnione podgrupy pacjentów z rozpoznaniem neuroboreliozy (Lyme neuroborreliosis – LNB). Diagnostykę narządu słuchu przeprowadzono na podstawie badań audiometrii tonalnej, audiometrii tonalnej rozszerzonej (o wysokiej częstotliwości do 18 kHz), audiometrii impedancyjnej i audiometrii mowy.WynikiNieprawidłowe wyniki testów audiometrycznych stwierdzono u 66,7% badanych, a analiza statystyczna wskazała na istotny związek z zakażeniem Borrelia burgdorferi (p = 0,017). Większość stanowiły osoby z późną LB, zarówno bez, jak i z LNB.WnioskiZaburzenia słuchu różnego stopnia występują u ponad połowy chorych na LB, zwłaszcza w późnych stadiach procesu chorobowego. Uzyskane wyniki wskazują na konieczność prowadzenia dalszych wszechstronnych badań uwzględniających uszkodzenie narządu słuchu i równowagi w przebiegu LB, obejmujących większe grupy chorych.

Penetrating neck traumas are traumas that pass through the platysma muscle, and they account for 5% to 10% of all neck traumas. Penetrating head traumas can damage vital structures such as the airways, esophagus, major nerves and vessels. Thus, patients with penetrating neck traumas should be treated in hospital, and doctors should be careful when deciding on the best treatment. Currently, the need for surgery can be established based on imaging tests, clinical status of the patient, medical history, physical examination, and laboratory tests. Exploratory surgery is not necessary particularly because it is associated with complications. We present two patients with penetrating neck traumas who were treated in our center: a 22-year-old patient with a foreign body that, for two years, mimicked a tumor, and a 45-year-old patient with a stab wound requiring immediate treatment. In the first patient, finding the foreign body earlier would have allowed an immediate removal, which would have prevented subsequent surgery and reduced the risks of leaving the foreign body in the neck. In the second patient, immediate contrast-enhanced computed tomography (CT) of the neck showed a foreign body, its size and position, which helped to plan surgery. Conclusions: In hemodynamically stable patients with penetrating neck traumas, doctors should choose the best treatment based on imaging, medical history, and physical examination.

It is important to identify the clinical indicators of poor prognosis and treatable conditions that might contribute to the progression of heart failure (HF) and pulmonary hypertension (PH) in the group of patients with dilated cardiomyopathy (DCM) and concomitant obstructive sleep apnoea (OSA).To evaluate the influence of OSA on echocardiographic and haemodynamic parameters in patients with DCM, and the outcome in long-term follow-up.We enrolled patients with DCM and severely impaired ejection fraction (EF30%). Each patient underwent polygraphy, echocardiography, and right heart catheterisation. Subjects were divided into groups based on the apnoea-hypopnoea index (AHI):0 and5 (group I), ≥ 5 and ≤ 15 (group II),15 and ≤ 30 (group III), and30 (group IV). We compared the OSA-free (AHI5) subjects with those with OSA (AHI ≥ 5). The evaluated clinical end-points were death and orthotropic heart transplant.The study population comprised 51 patients. Mean EF was 22%; 59% of patients were suffering from OSA. The increased severity of OSA correlated with worse pulmonary haemodynamics. Patients with OSA had higher mean pulmonary arterial pressure and pulmonary vascular resistance than individuals without OSA (p = 0.044, p = 0.032, respectively). The highest chamber diameters assessed in echocardiography were found in group IV (p0.05). A total of 10 end-points occurred during follow-up (8.9 ± 5.1 months), with significant differences observed between groups I-IV and the highest rate in group IV (p0.001).The increasing severity of OSA worsens the prognosis of DCM patients, independently of severe HF and coexistent PH. Systematic OSA screening in patients with HF might facilitate identification of individuals at high risk of progression of pulmonary haemodynamic impairment and end-point rate.

The treatment of snoring and obstructive sleep apnea syndrome comprises preventive behavior, conservative methods (CPAP) and surgical treatment. In the diagnostics procedures the most important aim is to determinate whether the patient is an habitual snorer or OSA patient. Very important thing is also patient's qualification for proper mode of treatment. The aim of the surgical treatment is to remove all the reasons that obturate the upper airways and cause the increasing of respiratory air stream resistance. The most collapsible airway region during sleep is oropharynx involves the soft palate, uvula, tonsils, tonsillar pillars, base of the tongue and pharyngeal muscles.In the study the results of surgical treatment of 138 patients suffer from breathing disturbances during sleep treated at the ENT Department Silesian Medical University in Zabrze in the years 1997 to 2002 were presented. In the evaluated group were 51 habitual snorer and 87 OSA patients. Various type of surgical procedures were performed depend on the airway obturation level (septoplasty, tonsillectomy, LAUP, arytenoidectomy). The postoperative control sleep studies were performed in 68 patients (49.3%) 6 to 12 weeks after the end of the surgical treatment. In all the patients the subjective improvement were evaluated.In 35 from 45 OSA patients (77.8%) RDI decreased after the surgical treatment more then 50% of the preoperative value or was lower then 10 (RDI lower then 10 was in 16 patients, in 19 patients decreased more than 50%). The subjective radical improvement was obtained in 107 patients (77.5%), moderate improvement in 19 cases (13.8%) and no improvement in 12 patients (8.7%).On the base of our results we concluded that surgery is successful method for treatment of selected patients with breathing disturbances during sleep.