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BACKGROUND: Multi-slice computed tomography (MSCT) is becoming an increasingly acknowledged means of visualizing coronary arteries. The accuracy of 64-MSCT is still a subject of clinical evaluation. Our study, performed with a 64-slice scanner, was intended to assess the concordance of coronary artery lumen visualization in MSCT and invasive coronary angiography (ICA), both in post-revascularization and previously medically treated patients. METHODS: We examined data from 73 patients (31 women, 42 men, mean age 59 years) referred to our hospital in 2006 and 2007 who underwent MSCT and subsequent ICA. Twenty two patients had a history of previous revascularization. Of the remaining 51 patients with intermediate coronary artery disease probability, the indication for 64-MSCT was suspicion of coronary artery disease. MSCT coronary angiography was performed with Aquilion 64 scanner (Toshiba, Japan). We evaluated 15 segments of four native coronary arteries (RCA, LM, LAD and Cx in all patients plus 11 arterial and 22 venous conduits). The cut-off value for significant stenosis was the lumen cross section area reduction exceeding 50%, regardless of segment. RESULTS: Regarding native arteries, MSCT and ICA findings were coherent in 80.8% of all patients, 93.8% of vessels, and 98.4% of segments. MSCT coronary stent patency evaluation was 90.9% correct. The by-pass grafts evaluation was entirely concordant in both methods. The respiratory and heart rate variability artifacts hindered the MSCT analysis in ten patients (13.7%). The artifacts occurrence in misinterpreted studies was nearly two-fold higher than in those that were coherent (21.4% vs. 11.9%). CONCLUSIONS: We concluded that a reliable evaluation of the coronaries by means of 64-MSCT is feasible both in patients with suspected coronary artery disease and those with definite coronary artery disease who had previous coronary intervention. Patient selection and co-operation is necessary to avoid respiratory and heart rate variability artifacts that may hinder analysis.

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INTRODUCTION: Carcinoma of the large intestine is a common and relatively well known neoplastic malignancy of the digestive tract. In a very few cases its spread seems unpredictable and can cause a distant metastasis to head and neck region. MATERIAL AND METHODS: A 58 years old patient was admitted to the ENT Department because of an exulcerated tumour mass of the left mental and buccal region. 9 months earlier he underwent anterior resection of rectum due to carcinoma. Histopatological examination of specimen from the facial skin lesion revealed adenocarcinoma cells. Radiological findings suggested isolated character of lesion. The patient was treated by surgery and chemotherapy. Wide excision of tumour mass with partial mandibulectomy was performed and the tissue defect reconstructed with a pectoralis major musculocutaneous flap. A postoperative chemiotherapy with FA and 5-FU followed the surgical procedure. Regardless of the first promising results of the oncological treatment the patient died eight months later. RESULTS AND CONCLUSIONS: We present this case report as an example of an unusual and rare secondary malignancy of head and neck, emphasizing the interdisciplinary character of oncological treatment and the role of oncological vigilance on every step of diagnosis.

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INTRODUCTION: Sarcoidosis is a granulomatous multisystemic disease of unknown origin that can occur in any organ of the body and commonly affects young adults. Pulmonary sarcoidosis is by far the most common manifestation of the disease but occasionally it presents with involvement of the lymph nodes, skin, eyes, liver, spleen, heart, bones, joints, nervous system and the oral organs. The diagnosis of sarcoidosis is complex and includes the presence of noncaseating granuloma in involved tissues, changes in chest x-ray and many other tests. AIM: The aim of the study was to present the rare case of parotid sarcoidosis which was the origin of discussion of diagnostics and treatment of sarcoidosis in ENT field. MATERIAL AND METHODS: The authors present a review of updated opinions on pathogenesis, diagnostics and treatment of sarcoidosis, completed with own experience concerning a case of extrapulmonary sarcoidosis that manifested with isolated parotid gland enlargement. CONCLUSIONS: 1. The incidence of head and neck sarcoidosis is rare, although this etiology should be taken into account in ENT diagnostics. 2. The lesions can occur in many organs, most common manifestation is: lungs, peripherial lymph nodes, skin, eyes, articulations, liver and spleen. 3. Course of sarcoidosis is not characteristic, chest x-ray, biopsy and the analysis of clinical signs are required to settle the diagnosis. 4. In cases of isolated salivary gland sarcoidosis the preoperative diagnosis is difficult, fine-needle biopsy and Doppler ultrasonography can be helpful. 5. The possibility of exacerbations and recidivations makes the long follow-up necessary.

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INTRODUCTION: We present a case of an advanced granuloma eosinophilicum of maxillary location in a 76 years old man who was admitted to our Department with symptoms of chronic pain in right zygomatic region. MATERIAL AND METHOD: We want to lay emphasis on long lasting, low symptomatic development of this kind of tumor and to insist on very carefull otorhinolaryngological and as well radiological examination. RESULTS: According to literature there are many methods used in the therapy of such cases begining with operations, through radiotherapy, the use of steroids or cytostatic drugs and also different combinations of mentioned possibilities. In our case we applied an operation without further radiotherapy and didn't observe any symptoms of recurrence so far. CONCLUSIONS: Granuloma eosinophilicum and its multifocal variety e.i. Hand-Schueller-Christian disease require different patterns of treatment depending on its location, tendency to recurrence and the age of affected person.

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On the base of retrospective analysis of 12,888 cases of carcinoma of larynx and hypopharynx, diagnosed in 19 ENT Departments in Poland from 1991 to 2001, the assessment of basic epidemiological data, including the localization of tumor and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 11 years the trends to change of the mentioned above parameters has been examined. The significant increase of female patients in this period was observed, with average proportion M:F = 8:1. The glottis localization of carcinoma dominated (47.6%), followed by supraglottis (40.8%) and pyriform fossa (7.8%), with significant increase of pyriform fossa tumors in the analyzed period of 11 years. In the majority of cases the carcinoma of larynx and hypopharynx was diagnosed in the advanced stage (T3 + T4) of local disease, with the highest percentage in localization within the pyriform fossa (81.0%), and the lowest percentage in glottis tumors (45.6%). The regional lymph nodes metastases has been diagnosed in 46.7% of the analyzed group, with the highest percentage in tumors localized in pyriform fossa (82.9%), and the lowest percentage in tumors of glottis localization (33.1%). In the 11 years time the significant drop down of N0 cases and tendency to increase of N2 and N3 in the supraglottis localization of tumor. The distant metastases in the analyzed group at the time of diagnosis has been registered in 2.0%, with the highest percentage in posterior pharyngeal wall (7.6%) and pyriform fossa (7.4%). The authors postulate the renewal of prospective study on epidemiology, clinical characteristics and treatment results of larynx and hypopharynx carcinoma in Poland.

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UNLABELLED: The aim of the study was to evaluate the QT dispersion and the severity of arrhythmias in hypertensive patients according to the asymmetry of the left ventricular hypertrophy. The study group consisted of 47 hypertensive patients. In 24 of them the left ventricular hypertrophy was symmetrical (group I) and in 23--asymmetrical (group II). For the evaluation of the left ventricular hypertrophy its thickness was analyzed in 13 segments. The ratio between the maximum and minimum thickness from any location was determined as the asymmetry index (AI). The value of this index 1,3 distinguished between patients with the symmetrical and asymmetrical left ventricular hypertrophy. 20 healthy subjects were examined as a control group (group III). All subjects underwent physical examination, the standard 12-lead electrocardiogram (ECG), twenty-four hour Holter recording and echocardiography. All the results for the QT dispersion (QTd, QTdc, QTdR) were highest in group II, lower in patients from group I and the lowest were observed in the control group. The differences in all parameters between group I and II were statistically significant: for QTd--V p < 0.01, QTdc--p < 0.05, QTdR--p < 0.05. The differences between groups II and III as well as I and III were statistically significant for all QT dispersion parameters: for QTd--p < 0.001 and p < 0.01 respectively, QTdc--p < 0.001, QTdR--p < 0.001 for both groups. We have observed a very distinct positive correlation between the asymmetry index and QTd, QTdc, QTdR (p < 0.001). These values correlated also, but less distinctly with the left ventricular mass index--LVMI (p < 0.05). The frequency and severity of ventricular ectopic beats did not differ significantly between group I and II. The results obtained indicate the lack of connection between the frequency of ventricular premature complexes and (1) all QT dispersion parameters, (2) LVMI, (3) AI. Supraventricular premature complexes occurred significantly more frequently in patients with the asymmetrical left ventricular hypertrophy compared to the group with the regular left ventricular hypertrophy (p < 0.05) and control group (p < 0.01). CONCLUSIONS: The left ventricular hypertrophy in primary hypertension may increase the QT dispersion. It seems that asymmetry of the left ventricular hypertrophy reinforces this increase. The increased QT dispersion in primary hypertension does not influence significantly the occurrence of ventricular arrhythmias.

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Background: Cytokines may play a role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). Methods: We examined serum concentrations of selected pro- (TNFalpha, IL-2) and anti-inflammatory (IL-10) cytokines, and soluble forms of TNF receptors (sTNFR 1 and sTNFR 2) by ELISA in 45 patients with stable exertional angina (group 1), 32 patients with unstable angina (group 2), and 20 healthy subjects (group C). Results: Serum concentrations of both TNFalpha (group 1, 18.3; group 2, 17.2 pg/ml; P<0.001) and IL-10 (group 1, 46.1; group 2, 41.5 pg/ml; P<0.05) were significantly higher in patients with CAD than in group C (8.3 and 14.3 pg/ml, respectively). sTNFR 1 serum level was higher in group 1 (1399.6; P<0.05) than in healthy volunteers (1093.9 pg/ml). In turn, the serum level of IL-2 was significantly higher in unstable patients than it was in groups 1 and C (89.4, 59.8 and 52.8 pg/ml, respectively). In group 1, both TNFalpha and IL-2 correlated with serum lipids. Conclusions: Patients with CAD, irrespective of the form of the disease, have higher serum levels of pro- and anti-inflammatory cytokines than control subjects. Increased concentrations of IL-2 in unstable angina may suggest additional immunologic activation. The pro-inflammatory cytokine levels seem to be related to lipid disturbances.

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BACKGROUND: There is growing evidence that cytokines play a pathogenic role in both heart failure and atherosclerosis. The aim of our study was to assess serum levels of selected cytokines and soluble forms of receptors in patients with coronary artery disease (CAD), and the relation between these concentrations and left ventricular (LV) systolic function. MATERIAL/METHODS: We measured serum levels of TNFalpha, sTNFR 1 and 2, IL-2, and IL-10 in 100 patients with CAD: 70 patients with LV regional wall motion disturbances (group A); and 30 patients with normal LV function (group B). The control group (group C) consisted of 20 healthy volunteers. RESULTS: Mean serum TNFalpha and IL-10 concentrations were significantly higher in groups A (18.3 +/- 3.5; 55.4 +/- 118.5 pg/ml) and B (17.9 +/- 4.9; 45.3 +/- 76.8 pg/ml) than in controls (8.3 +/- 1.4, p<0.001; 14.3 +/- 28.5, p<0.05; respectively). Moreover, in group A serum levels of sTNFR 1 were higher (1367.4 +/- 531.1 pg/ml) than in group C (1093.9 +/- 456.9 pg/ml; p<0.05). No differences were found in the study groups between serum sTNFR 2 and IL-2 levels. In group A, both the LV ejection fraction and motion score index correlated with TNFalpha (r=-0.277; r=0.282; p<0.05), and sTNFR 1 levels (r=-0.258; r=0.280; p < 0.05). CONCLUSIONS: The serum concentrations of TNFalpha and IL-10 are increased in patients with CAD. Additionally, patients with impaired LV contractility have higher sTNFR 1 concentrations. Serum cytokine activation may play a role in the development of heart failure in patients with CAD.

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