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Universal newborn hearing screening (UNHS) has become the standard of care in many countries. The aim of this study was to evaluate the results of UNHS after ten years of the program in Poland and to compare them with the results of 2003.In the study, we analyze the results of UNHS in the University Hospital in Poznan, Poland. Between 01.01.2013 and 31.12.2013, 6827 children were examined by means of otoacoustic emissions.Risk factors (RF) were identified in 772 (11.3%) newborns, which is significantly less than 10 years ago (p 0.05). The most frequent RF were: ototoxic medications, treatment in neonatal intensive care unit (NICU) and prematurity 33 weeks of gestation. In 2003, the most frequent were ototoxic medications and prematurity, less frequent was treatment in NICU and more common was low Apgar score. In 51 (6.6%) newborns with RF, the result of OAE was positive either unilaterally or bilaterally. In infants without RF the result was positive unilaterally in 22 (0.4%) and bilaterally in 14 (0.2%) patients. These results are significantly lower than in our former study. The relative risk of positive result was the highest in infants with complex congenital anomalies (RR = 44.99), craniofacial anomalies (RR = 17.46) and mechanical ventilation for 5 days (RR = 10.69). In our previous study, the highest RR of positive test results was in infants with family history, congenital malformations and low Apgar score. We found that most predictive as to the final diagnosis was bilaterally positive OAE test. In most patients, the second check confirmed the diagnosis, independently of RF. The number of false positive tests at the 1st level of screening is significantly lower now than 10 years ago, probably due to better staff training.Long term monitoring and the appropriate management of hearing deficit in children is essential. UNHS seems to be the most efficient way of finding children who require treatment of hearing impairment. The prevalence of most risk factors of hearing deficit has significantly changed over the years. The number of false positive results has significantly decreased over the years thanks to better staff training.

Background and Objectives:Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders; it has a great impact on patient quality of life and is difficult to treat satisfactorily. This study evaluates the efficacy and safety of trimebutine maleate (TM) in patients with FD.Materials and Methods: A multicenter, randomized, double-blind, placebo controlled, prospective study was conducted, including 211 patients with FD. Participants were randomized to receive TM 300 mg twice per day (BID, 108 patients) or placebo BID (103 patients) for 4 weeks. the Glasgow Dyspepsia Severity Score (GDSS) was used to evaluate the relief of dyspepsia symptoms. Moreover, as a pilot secondary endpoint, a substudy (eight participants on TM and eight on placebo) was conducted in to evaluate gastric emptying (GE), estimated using a 99mTc-Tin Colloid Semi Solid Meal Scintigraphy test.Results: of the 211 patients enrolled, 185 (87.7%) (97 (52.4%) in the TM group and 88 (47.6%) in the placebo group) completed the study and were analyzed. the groups did not differ in their demographic and medical history data. Regarding symptom relief, being the primary endpoint, a statistically significant reduction in GDSS for the TM group was revealed between the first (2-week) and final (4-week) visit (p-value = 0.02). the 99 mTc-Tin Colloid Semi Solid Meal Scintigraphy testing showed that TM significantly accelerated GE obtained at 50 min (median emptying 75.5% in the TM group vs. 66.6% in the placebo group,p= 0.036). Adverse effects of low to moderate severity were reported in 12.3% of the patients on TM.Conclusion: TM monotherapy appears to be an effective and safe approach to treating FD, although the findings presented here warrant further confirmation., Galenica A.E. Pharmaceutical Company, This research was funded by Galenica A.E. Pharmaceutical Company.

This study is focused on adaptation of the water stress index to make use of it on bogs and mires of temperate transitional climate zone. Investigated object is located in Janowskie Forest Landscape Park (south-east Poland), area protected within Natura 2000 network and recognized as habitat 7140 (transition mires and quaking bogs). In order to obtain dataset UAV flights with thermal camera and airborne mission with hyperspectral sensor were performed. Field measurements included collection of both meteorological and biophysical parameters. It is shown that CWSI is a promising method for monitoring of water stress on Natura 2000 habitats.

The aim of this study was to analyze infants diagnosed with sensorineural or conductive hearing deficit and to identify risk factors associated with these defects.A retrospective analysis of infants diagnosed with hearing deficit based on the database of the universal newborn hearing screening program and medical records of the patients.27 935 infants were covered by the universal neonatal hearing screening program. 109 (0.39%) were diagnosed with hearing deficit and referred for treatment and rehabilitation. 56 (51.4%) children were diagnosed with conductive, 38 (34.9%) with sensorineural and 15 (13.8%) with mixed type of hearing deficit. Children with sensorineural hearing deficit more frequently suffered from hyperbilirubinemia (p 0.05), while infants with conductive hearing loss were more frequently diagnosed with isolated craniofacial anomalies (p 0.05). The prevalence of other risk factors did not differ between the groups. Sensorineural hearing deficit occurred almost 3 times more often bilaterally than unilaterally (p 0.05). In other types of hearing deficit, the difference was not significant. In children with conductive and mixed type of hearing loss the impairment was mainly mild while among those with sensorineural hearing deficit in almost 45% it was severe and profound (p 0.05). When analyzing the consistency between hearing screening test by means of otoacoustic emissions and the final diagnosis of hearing deficit we found that the highest agreement rate was observed in children with sensorineural hearing loss (p 0.01).The prevalence of most risk factors of hearing deficit was similar in children with sensorineural, conductive and mixed type of hearing loss, only hyperbilirubinemia seemed to predispose to sensorineural hearing deficit and isolated craniofacial malformations seemed to be associated with conductive hearing loss. Sensorineural hearing deficit usually occurred bilaterally and was severe or profound, while conductive and mixed type of hearing deficit were most often of mild degree. Most children with the final diagnosis of sensorineural hearing deficit had positive result of hearing screening by means of otoacoustic emissions.

The mountain chain of the Carpathians is stretching out in the convex bow shape towards the north-east starting from surroundings of Vienna to the Iron Gate. The Carpathians host high geo- and biodiversity and are a homeland for nearly 20 million people who have the rich and diversified both material and spiritual culture. The first ideas being aimed at a protection of the Carpathians' nature are dated on the second half of the 19th century. Further efforts brought the foundation of the first European frontier park of the nature in the Pieniny Mountains (the Western Carpathians) in 1932. After the World War II the Carpathians belonged to the area of the Soviet bloc. During that time several new pretected areas were esablished, often on the both sides of the state boundaries, however the cross-border cooperation was limited. After political changes in 90’ of the XX c., there were some possibilities of establishing the direct working co-operation among boards of frontier protected areas - such a general idea has been already used. The international cooperation in the field of the implementation of the principles of the sustainable development in the area of the Carpathians found the strong support in the Carpathian Convention. The analysis of the example of the Carpathians, the mountain chain that is laid on territories of many countries, lets draw conclusions that not only can be taken back to the Carpathian mountains but to other mountains too. They are included into presented article, Karpat Dağları Viyana yakınlarından kuzeydoğuya doğru başlayarak içbükey şekilde kıvrılarak Iron Gate yakınlarına kadar uzanır. Karpatlar yüksek ölçüde coğrafi ve biyolojik çeşitliliğe sahip olmanın yanısıra zengin bir somut ve soyut kültüre sahip, yaklaşık 20 milyon insana ev sahipliği yapmaktadır. Karpatlar’ın korunması fikri ilk olarak 19. yüzyılın ikinci yarısında ortaya atılmıştır. Daha sonraki çalışmalar 1932 yılında Pieniny Dağları’nda (Batı Karpatlar) Avrupa’nın ilk doğa parkının kurulmasını getirmiştir. İkinci Dünya Savaşı’ndan sonra Karpatlar Sovyet bloğunda kalmıştır. Bu zaman içinde ülke sınırlarının iki tarafında yeni koruma alanları ilan edilmiş ancak sınır ötesi işbirliği kısıtlı olmuştur. 1990 yılındaki siyasi değişimden sonra halen daha önce kullanılan ana fikre bağlı kalınarak öncü koruma alanlarının sınırları boyunca doğrudan sınır ötesi işbirliği kurma olanakları vardı. Karpatlarda sürdürülebilir kalkınma prensiplerine uygun uluslararası işbirliği kurulması Karpat Konferansı’nda güçlü bir şekilde desteklenmiştir. Karpatlar örneğindeki gibi analiz sonuçları sadece Karpat Dağları’nı değil çok sayıda ülkeye ait bölgelerin bulunduğu diğer dağ sıralarının da korunmasını sağlayacaktır. Makalede bunlar da ele alınmıştır

The incidence of sensorineural hearing loss ranges from 1 to 3 per 1,000 live births in term healthy neonates, and 2-4 per 100 in high-risk infants, a 10-fold increase. Early identification and intervention with hearing augmentation within 6 mo yields optimal effect. If undetected and without treatment, significant hearing impairment may negatively impact speech development and lead to disorders in psychological and mental behaviors. Hearing screening programs in newborns enable detection of hearing impairment in the first days after birth. Programs to identify hearing deficit have significantly improved over the two decades, and their implementation continues to grow throughout the world. Initially based on risk factors, these programs identified only 50-75% of infants with hearing loss. Current recommendations are to conduct universal hearing screening in all infants. Techniques used primarily include automated auditory brainstem responses and otoacoustic emissions that provide noninvasive recordings of physiologic auditory activity and are easily performed in neonates and infants. The aim of this review is to present the objectives, benefits, and results of newborn hearing screening programs including the pros and cons of universal vs. selective screening. A brief history and the anticipated future development of these programs will also be discussed.

Electrophysiological recording of neuronal action potentials from behaving animals requires portable, precise and reliable devices for positioning of multiple microelectrodes in the brain. We propose a semi-automatic microdrive system for independent positioning of up to 8 electrodes (or tetrodes) in a rat (or larger animals). Device is intended to be used in chronic, long term recording applications in freely moving animals. Our design is based on independent stepper motors with lead screws which will offer single steps of ~ μm semi-automatically controlled from the computer. Microdrive system prototype for one electrode was developed and tested. Because of the lack of the systematic test procedures dedicated to such applications, we propose the evaluation of the prototype similar to ISO norm for industrial robots. To this end we designed and implemented magnetic linear and rotary encoders that provided information about electrode displacement and motor shaft movement. On the basis of these measurements we estimated repeatability, accuracy and backlash of the drive. According to the given assumptions and preliminary tests, the device should provide greater accuracy than hand-controlled manipulators available on the market. Automatic positioning will also shorten the course of the experiment and improve the acquisition of signals from multiple neuronal populations.

Recent experimental studies have revealed that increased ghrelin levels protect against depressive symptoms of chronic stress in rats. Moreover it was shown that neuropeptide Y (NPY) has an anxiolytic-like effect mediated through both Y1 and Y5 receptors. On the other hand, peptide YY inhibits, while ghrelin stimulates, the release of NPY. The aim of this study was to assess the association between plasma concentrations of ghrelin and PYY and the level of depression in obese women.In forty-five obese women (55 +/- 7 years old) without concomitant diseases, body composition was estimated by bioimpedance method, in addition to anthropometric measurements. Beck's Depression Inventory (BDI) was used for the evaluation of depression levels. Plasma concentrations of ghrelin and PYY were measured in collected blood samples.23 (55.1%) women had severe (22.0 +/- 5.2 pts) and 10 (22.2%) had mild (12.1 +/- 1.9 pts) levels of depression. Obese women with concomitant depression were of similar age and had comparable body mass, BMI, and body composition as those without depression. In addition, there were no differences in plasma ghrelin and PYY levels between the study subgroups. No correlation between BDI and plasma concentrations of ghrelin or PYY was found.Depression in obese women does not seem to be related to the plasma levels of ghrelin and PYY.

Pilocytic astrocytoma (PA) usually occurs in younger patients. It is a benign, generally well-delineated, WHO grade I tumour with favorable prognosis, which makes it different from diffuse astrocytomas, classified as higher grades of malignancy. A case study of PA was presented in a young female patient, observed and treated at the Neurosurgical Department for the period of 10 years, during which time she had frequent surgical procedures due to recurrence and dissemination of the tumour. The initial symptom of the disease was epileptic seizure at the age of 16. Neuroradiological study revealed cerebral tumour in the right temporal lobe, then the first temporal lobe surgery followed by re-operation and radiotherapy was performed. The patient developed hydrocephalus, treated with the ventriculo-peritoneal shunt. After 5 years local recurrence of the tumour appeared in the right temporal region. The patient was operated and the tumour was totally removed. Initially, the histopathological diagnosis of ganglioglioma was suggested for primary tumour, finally the diagnosis of pilocytic astrocytoma for both recurrent and primary tumour was established. During the next years of observation increasing neurological symptoms in lower limbs developed. Subsequently, the patient reported pain syndrome in lumbosacral and perineal area. Consecutive MRI studies revealed a spinal canal tumours localized at the thoracic level and next at sacral level. The spinal tumour was surgically treated in both locations; the last operation was done 10 years after surgery of the primary temporal lobe tumour. Histopathological examinations of the excised foci from spinal canal revealed neoplasm consistent with WHO grade I pilocytic astrocytoma. The presented case indicates that despite the spread of the neoplastic process, a histopathologically benign tumour (WHO I grade) allows for long-term survival and observation period. Unfortunately, multifocal tumour involving midline structures causes major neurological symptoms and deficits. In the presented case we dealt now with the ascending spread process and the occurrence of the new foci in both subtentorial and parameningeal spaces inside the cranial cavity. It is a rare clinical manifestation of a disease ever described in the literature.

In patients with intracerebral haematoma (ICH) secondary to ruptured aneurysm or arteriovenous malformation (AVM), conservative therapy and follow-up without angiographic evaluation is associated with a risk of recurrent bleeding. It is necessary for a clinician to identify a subgroup of patients with spontaneous supratentorial ICH who are likely to harbour high-flow vascular malformations that require specific treatment - neurosurgical or neuroradiological. A new CT-based classification for supratentorial ICH aimed at a close correlation between ICH localization and occurrence of high-flow vascular malformations diagnosed on angiography is presented.According to the proposed classification, supratentorial ICHs are divided into deep and cortico-subcortical. The deep group is further subdivided into striatocapsular, lobar ICH and isolated intraventricular haemorrhage and the cortico-subcortical group into paracisternal and convexity ICH. A new classification was used in a consecutive series of 108 patients with spontaneous supratentorial ICH subjected to angiographic evaluation.Deep ICH in non-hypertensive patients was secondary to AVM rupture in 57.1% (8/14). High-flow vascular malformation was a source of bleeding in 93.6% of patients with paracisternal ICH - aneurysm in most cases (41/47). Convexity ICH was found to be AVM-related in 35.7% of patients (5/14).Our clinical experience shows that the proposed classification appears to be closely associated with angiographic findings. Its clinical application with consideration of other factors such as age and arterial hypertension may help clinicians to identify high-risk ICH patients for angiographic evaluation and further specific treatment to prevent rebleeding.

Background: The aim of the present study was to assess the prevalence of depression in subjects before starting a weight-reduction programme. Methods: The study group involved 173 obese subjects aged 47.0 ± 16.5 years, body mass index (BMI) 36.1 ± 6.3, weight 96.2 ± 18.3 kg. The body weight and height were measured and BMI was calculated. Beck’s Depression Inventory (BDI) was used for the evaluation of depressive symptoms. Results: Severe depression was diagnosed in 84 subjects (mean BMI 37.5 ± 6.3, mean weight 98.1 ± 17.6 kg, age 48.7 ± 16.0, 22.2 ± 1.6 points), mild depression was diagnosed in 65 subjects (mean BMI 34.7 ± 4.8, mean weight 95.3 ± 18.1 kg, age 45.9 ± 16.6; 10.8 ± 2.0 points), and 24 subjects (mean BMI 35.0 ± 8.7, mean weight 92.2 ± 21.1 kg, age 44.0 ± 17.5, 6.5 ± 0.5 points) did not have depression. We observed dif-ferences in BMI between subjects without depression and severe depression ( p < 0.05) and between mild and severe depression. We did not observe differences of age and body mass between these subgroups. Correlations between weight, BMI and BDI score were found in all subjects. Conclusion: Depression often accompanies obesity. The depression levels increased in morbidly obese persons in comparison to moderately obese patients.

Surgical intervention in severe cases of occipital neuralgia should be considered if pharmacological and local nerve blocking treatment fail. The literature suggests two types of interventions: surgical decompression of the greater occipital nerve (GON) from the entrapment site, as a less invasive approach, and neurotomy of the nerve trunk, which results in ipsilateral sensation deficits in the GON innervated area of the skull. Due to anatomical variations in the division of the GON trunk, typical neurotomy above the line of the trapezius muscle aponeurosis (TMA) may not result in full recovery. The present study discusses a case of a female treated with GON decompression as a result of occipital neuralgia unresponsive to pharmacotherapy, who thereafter was qualified for two consecutive neurotomies due to severe relapse of pain.

Adult obesity has been associated with depression, especially in women. Whether depression leads to obesity or obesity causes depression is unclear. Chronic inflammation is observed in obesity and depression. In 63 obese women without additional diseases depression level was assessed with the Beck's questionnaire. After evaluation of depression level study group was divided into groups according to the mood status (A—without depression, B—mild depression, and C—severe depression), and serum concentration of TNF-α, sTNFs, leptin, and IL-6 were measured by ELISA. No differences in age, body mass, BMI, and body composition were observed in study groups. We did not observe differences of serum concentrations of TNF-α, sTNFRs, leptin, and IL-6 between subgroup A and subgroups B and C. It seems that circulating adipokines did not exert influence on depression levels in obese women.

Disturbances of gait and balance are important clinical problems in patients with normal pressure hydrocephalus. A considerable degree of locomotor disability and increased risk of falls are present in many cases. Accordingly, attempts to develop effective evaluation methods of gait and balance disturbances are made. Posturography and the Computer Dyno Graphy (CDG) system appear to be useful in diagnosis and evaluation of treatment in patients with normal pressure hydrocephalus. Both are non-invasive and repeatable methods that enable accurate evaluation of analyzed parameters at time intervals.

Gait disturbances resulting from the normal pressure hydrocephalus (NPH) syndrome significantly restrain locomotion, which in serious cases can lead to a total loss of the ability to move. Hence the need to create an objective method of evaluating gait disturbances described by values of gait parameters and changes of these parameters resulting from neurosurgical treatment. The aim of this project is to create an effective, non-invasive diagnostics method describing movement disorders in patients with NPH before and after surgery.An evaluation of the effectiveness of gait analysis was carried out with Ultraflex, which uses the Computer Dyno Graphy (CDG) system to measure the distribution of forces of reaction on the ground during walking. The control group consisted of 17 healthy individuals (age range 50-65 years) and the treatment group included 17 patients with enlargement of the ventricular system (9 females and 8 males, mean age 58.6 years, range 50-65 years), 8 of whom were qualified for surgical treatment. Analyzed parameters: ground reaction force, single and double support, stance.Changes of parameters reflected gait improvement.The results obtained indicate that gait analysis using the CDG system might be a good method for assessing the effectiveness of NPH surgery.

Tracheotomy as an operation may be connected with many complications. One of them is intra- or postoperative bleeding. A lot of reasons of such bleeding is well known, but we describe a case of bleeding caused by central venous catheter which was inserted into external jugular vein, but dislocated into anterior jugular vein and destructed it's wall. The bleeding observed after tracheotomy was firstly counted as an effect of coagulation defect connected with heparin supply. When few days after tracheotomy the tip of the catheter was seen in the tracheotomy, patient was quickly operated--the destructed anterior jugular vein and external jugular vein were ligated and the central venous catheter was removed.

The aim of the study is to present practical guidelines for the pre-operative management of patients taking commonly applied drugs that affect blood coagulation. In hospital practice it is the responsibility of an internist to evaluate the patient's condition before the patient undergoes surgery. Among the patients consulted by the internist prior to the surgery the number of patients taking the drugs affecting coagulation is on the increase. The surgery performed on these patients carries the increased risk of bleeding that may threaten health or even life of the patient.

The aim of the study is to present practical suggestions of how to prepare a patient for thyroid gland surgery. Widespread distribution of thyroid diseases results in referring the patients for strumectomy. Proper preparation of the patient for the operation decreases the risk of perioperative complications to a minimum. Good co-operation in the team endocrinologist-anaestesiologist-surgeon is very important for the effective treatment.

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 Poznań. 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.

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.

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.

At the ENT Rehabilitation Centre as part of ENT Department University of Medical Sciences in Poznań over 900 patients with tinnitus were diagnosed and treated. Among them were 128 patients over 65 years of age, who in addition to tinnitus, reported hearing loss. After a battery of audiological tests, blood tests and additional specialist consultation, mixed hearing loss was found in 5 patients and senso-neural hearing loss (presbyacusis) was found in remaining 123 patients. For various reasons only 75 patients began treatment. Treatment of tinnitus was threefold: electrostimulation: 40 patients (53%); fitting of hearing aid: 29 patients (39%); TRT according to Jastreboff's model: 6 patients (8%). The authors described results of treatment patients with tinnitus and presbyacusis. The treatment model adopted at the ENT Rehabilitation Centre in Poznań has produced satisfactory therapeutic results.

Permanent or temporary degenerative changes in the internal ear causing tinnitus may occur with particular intensity in patients suffering from systemic disease (diabetes, hypertension, rheumatic diseases, kidney and thyroid gland diseases). Pathomechanisms of hearing impairment and the risk of tinnitus and its character in particular cases are discussed in the paper. The research was carried out on 1200 patients treated in the Laryngological Rehabilitation Centre in Poznań between 1.1.1998 and 04.2001 due to tinnitus. The analysis included the diagnosis of general health condition, general laryngological examination as well as additional tests. In the examined group 34% suffered from systemic diseases. Among them the highest percentage (47%) suffered from hypertension, 41% from hypercholesterolaemia, 22% from rheumatic diseases and 16% from diabetes. 96% of the patients had a long family history of diseases. The additional factor causing damage of the internal ear may be ototoxic drug used in the treatment of many systemic diseases.