Impact of diabetes mellitus on disease severity and patient survival in idiopathic pulmonary arterial hypertension: data from the Polish multicentre registry (BNP-PL).

BACKGROUND: Recent studies revealed that alterations in glucose and lipid metabolism in idiopathic pulmonary arterial hypertension (IPAH) are associated with disease severity and poor survival. However, data regarding the impact of diabetes mellitus (DM) on the prognosis of patients with IPAH remain scarce. The aim of our study was to determine that impact using data from a national multicentre prospective pulmonary hypertension registry. METHODS: We analysed data of adult patients with IPAH from the Database of Pulmonary Hypertension in the Polish population (BNP­PL) between March 1, 2018 and August 31, 2020. Upon admission, clinical, echocardiographic, and haemodynamic data were collected at 21 Polish IPAH reference centres. The all-cause mortality was assessed during a 30-month follow-up period. To adjust for differences in age, body mass index (BMI), and comorbidities between patients with and without DM, a 2-group propensity score matching was performed using a 1:1 pairing algorithm. RESULTS: A total of 532 patients with IPAH were included in the study and 25.6% were diagnosed with DM. Further matched analysis was performed in 136 patients with DM and 136 without DM. DM was associated with older age, higher BMI, more advanced exertional dyspnea, increased levels of N-terminal pro-brain natriuretic peptide, larger right atrial area, increased mean right atrial pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and all-cause mortality compared with no DM. CONCLUSIONS: Patients with IPAH and DM present with more advanced pulmonary vascular disease and worse survival than counterparts without DM independently of age, BMI, and cardiovascular comorbidities.

Telemedicine in Primary Practice in the Age of the COVID-19 Pandemic-Review.

Background and Objectives: In the era of the COVID-19 pandemic, telemedicine, so far underestimated, has gained in value. Currently, telemedicine is not only a telephone or chat consultation, but also the possibility of the remote recording of signals (such as ECG, saturation, and heart rate) or even remote auscultation of the lungs. The objective of this review article is to present a potential role for, and disseminate knowledge of, telemedicine during the COVID-19 pandemic. Material and Methods: In order to analyze the research material in accordance with PRISMA guidelines, a systematic search of the ScienceDirect, Web of Science, and PubMed databases was conducted. Out of the total number of 363 papers identified, 22 original articles were subjected to analysis. Results: This article presents the possibilities of remote patient registration, which contributes to an improvement in remote diagnostics and diagnoses. Conclusions: Telemedicine is, although not always and not by everyone, an accepted form of providing medical services. It cannot replace direct patient-doctor contact, but it can undoubtedly contribute to accelerating diagnoses and improving their quality at a distance.

Outcomes of Patients with Pulmonary Large Cell Neuroendocrine Carcinoma in I-IV Stage.

Background and Objectives: Large cell neuroendocrine cancer is characterised by poor prognosis. The standard of treatment is still not established. The aim of this study was to assess the predictive factors of overall survival (OS) and progression-free survival (PFS) of pulmonary large cell neuroendocrine carcinoma (LCNEC) and combined LCNEC. Materials and Methods: All patients had confirmed pathology stage I-IV disease recorded between period 2002-2018. Survival curves were estimated by Kaplan-Meier method. Uni- and multivariable analysis was conducted using Cox-regression analysis. Results: A total of 132 patients with LCNEC and combined LCNEC were included. Half of them had clinical stage IIIB/C-IV. Patients were treated with radical (n = 67, including surgery alone; resection with neo-adjuvant or adjuvant chemotherapy, radiochemotherapy, or adjuvant radiotherapy; patients treated with radiochemotherapy alone), palliative (n = 41) or symptomatic (n = 24) intention. Seventeen patients were treated with resection margin R1 or R2. Non-small cell carcinoma (NSCLC) chemotherapy (platinum-vinorelbine; PN schedule) and small-cell lung carcinoma (SCLC) chemotherapy approaches (platinum/carboplatinum-etoposide; PE/KE schedule) were administered in 20 and in 55 patients, respectively. The median (95% Confidence Interval (CI)) OS and PFS were 17 months (9.0-36.2 months) and 7 months (3.0-15.0 months), respectively. Patients treated with negative resection margin, with lower clinical stage, without lymph node metastasis, and with size of primary tumour ≤4 cm showed significantly better OS and PFS. The main risk factors with an adverse effect on survival were advanced CS and positive resection margin. Conclusions: Patients with LCNEC characterized poor prognosis. Independent prognostic factors influencing PFS were initial clinical stage and resection margin R0 vs. R1-2.

Tobacco smoke exposure as a risk factor for obstructive sleep apnea in children.

BACKGROUND: The most common respiratory disturbance in sleeping children is obstructive sleep apnea syndrome (OSAS). Passive smoking is one of factors predisposing to OSAS. The aim of this study was to determine the correlations between exposure to tobacco smoke (passive smoking) and development of respiratory disorders in children during sleep. METHODS: One hundred and sixty school-aged children (6-18 years) were included in the study. The inclusion criterion was exposure to tobacco smoke at home (n = 90). The control group were school-aged children who had had no contact with tobacco smoke at home (n = 70). Exclusion criteria were obesity and children with impaired patency of the nose. Each child had a polygraphic examination performed at home. The children and their parents completed a questionnaire to assess the level of child's exposure to tobacco smoke. The study ran from December 15, 2012 to February 26, 2016. RESULTS: OSAS was observed in 12% of children with an apnea-hypopnea index >1.5 (<13 years of age) and an apnea-hypopnea index >5 (for children >13 years), and with diurnal and nocturnal symptoms. Children exposed to tobacco smoke presented more apnea-hypopnea events (n = 17) than the control group (n = 3; P < 0.001). In the group exposed to tobacco smoke the following issues were noted: concentration problems (38.9%), tiredness/lethargy (46.7%), and irritability/hyperactivity (36.7%). No statistically significant differences were found in waking up, snoring, or sleep apnea. CONCLUSIONS: OSAS occurs more often in children exposed to tobacco smoke and these children demonstrate concentration problems, tiredness, and irritability/hyperactivity to a greater extent than control group.

Psychometric Assessment of Physiologic and Behavioral Pain Indicators in Polish Versions of the Pain Assessment Scales.

BACKGROUND: There is an urgent need to prepare a reliable and accurate tool for pain assessment in patients who are unable to self-report. Translating pain assessment scales into foreign languages requires further validation testing. AIM: The aim of the study was to carry out psychometric assessment of behavioral and physiological indicators of pain included in two Polish versions of pain assessment scales, the Behavioral Pain Scale (BPS) and the original Adult Non-Verbal Pain Scale (NVPS). DESIGN: A prospective repeated-measure descriptive study was conducted. SETTINGS AND PARTICIPANTS: Twenty-eight adult non-communicative mechanically ventilated ICU patients were included in the study. The study took place in five hospitals in Poland, one 15-bed general ICU of a university teaching hospital and four 6-bed medical ICUs of district hospitals. METHODS: Pain assessment was conducted at rest, during non-painful and painful procedures independently by two observers. RESULTS: Internal consistency of the Polish version of the scales was below the expected 0.7 value (Cronbach's alpha for the BPS 0.6883 and NVPS 0.6697). Principal component analysis showed that for the Polish version of the BPS, all three domains formed one separate factor (63.9%), while in the case of the NVPS two separate factors were found, one covering four domains of the NVPS (47.1%) and the other exclusively covering the category of Vital sign (20.2%). There was a significant difference between the pain scores with the NVPS (χ2 = 228.95 p < .001) and the BPS (χ2 = 236.46 p < .001) during three observation phases. There were no significant differences between scores obtained by different raters. The analysis of variance demonstrated a statistically significant difference in the values of physiological indicators of pain (SBP, DBP, MAP) between observation phases. CONCLUSIONS: The Polish version of the BPS has better psychometric properties than the Polish version of the NVPS. It is necessary to define precisely the descriptors used in the scales and to implement a staff training program.

Can Youthful Mesenchymal Stem Cells from Wharton's Jelly Bring a Breath of Fresh Air for COPD?

Chronic obstructive pulmonary disease (COPD) is a major global cause of morbidity and mortality, projected to become the 3rd cause of disease mortality worldwide by 2020. COPD is characterized by persistent and not fully reversible airflow limitation that is usually progressive and is associated with an abnormal chronic inflammatory response of the lung to noxious agents including cigarette smoke. Currently available therapeutic strategies aim to ease COPD symptoms but cannot prevent its progress or regenerate physiological lung structure or function. The urgently needed new approaches for the treatment of COPD include stem cell therapies among which transplantation of mesenchymal stem cells derived from Wharton's jelly (WJ-MSCs) emerges as a promising therapeutic strategy because of the unique properties of these cells. The present review discusses the main biological properties of WJ-MSCs pertinent to their potential application for the treatment of COPD in the context of COPD pathomechanisms with emphasis on chronic immune inflammatory processes that play key roles in the development and progression of COPD.

Foreign Body in the Airway a Female Patient with Myasthenia Gravis.

Aspiration of a foreign body occurs rarer in adults than it does in children. Advanced age and swallowing disorders, often caused by neuromuscular diseases, predispose for aspiration. Symptoms due to aspiration are mainly cough and wheezing. However, clinical and radiological symptoms may mistakenly suggest lung cancer. Making a proper diagnosis could be difficult and time consuming. In this study we report a case of a 73-year old woman who has been diagnosed and treated myasthenia gravis for 10 years. The patient manifested chronic cough for over a year, weight loss, lung lesions on chest X-ray and computed tomography images in the form of atelectasis and inflammatory infiltrations. The results of cytological tests of bronchoalveolar lavage fluid were 'atypical cells' which suggested a lung cancer. Flexible bronchoscopy set the diagnosis as a foreign body in right upper bronchus, which turned out to be a piece of a plant obstructing the bronchus. The patient came down with pneumonia. Laboratory examinations revealed leucocytosis and a high level of C-reactive protein. A complete removal of foreign body took place during rigid bronchoscopy. Concomitantly, but unrelated to the finding of a foreign body in the bronchus, the patient was diagnosed with digestive tract perforation on the basis of X-ray images, which remained otherwise asymptomatic. Explorative laparotomy revealed a perforated colonic diverticulum, which was successfully treated surgically.

[Vitamin D in allergic disorders]. / Witamina D w chorobach alergicznych.

Vitamin D is a factor that plays a significant role in calcium-phosphate balance. It has an effect on bone metabolism and also has modulator and anti-inflammatory activity. It is claimed that vitamin D inhibits immunological reactions with Th1 and Th17 lymphocytes. The influence of vitamin D on Th2 lymphocytes is not clear. The main effect of vitamin D is probably the activation of Treg lymphocytes. It was observed that vitamin D had a beneficial influence on diseases connected with excessive activation of Th1 lymphocytes, such as multiple sclerosis, rheumatoid arthritis, non-specific enteritis, diabetes type 1 or psoriasis. The role of vitamin D in allergic diseases, in which increased activation of Th2-dependent reactions are of great importance, is controversial. However, due to a wide range of vitamin D activity, this view seems to be simplified. A beneficial effect on the course of allergic diseases was observed in up-to-date studies although the role of vitamin D in their pathogenesis has not been explained yet. On the basis of recent studies and well-known mechanisms of vitamin D activity on particular elements of the immunological system, the influence of vitamin D on the course of chosen allergic diseases, such as allergic asthma, atopic dermatitis and allergic rhinitis was presented considering the possibility of contribution of allergen-specific immunotherapy.

[Synchronous multiple primary lung cancers in a 65-year old heavy smoker. Case report]. / Synchroniczne mnogie pierwotne raki pluca u 65-letniego mezczyzny z wieloletnim wywiadem nikotynowym. Opis przypadku.

Here we present a 65-year old ex-smoker with history of recent surgery for vocal cord tumor (histology: moderate grade intraepithelial neoplasia), who reported to the pulmonary outpatient clinic for the nodular lesions in the left lung seen on chest X-ray. Subsequent chest CT scan revealed focal lesion of 18 mm in diameter with spicular margins located in the right upper lobe, another irregular cyst with septa, 62 × 58 mm in the right lower lobe, and calcified nodule in the left lung, no enlarged lymph nodes or pleural effusion was seen. He underwent upper right lobe resection and wedge resection of the lower right lobe. Histological examination revealed adenocarcinoma in the right upper lobe with lymph node metastasis (pT2aN2M0). Examination of the right lower lobe showed squamous cell carcinoma (pT2bN0M0). He was subsequently treated with adjuvant chemotherapy and radiotherapy. During 20 months of the follow-up, he remained in good health with no signs of the disease progression. Patients with synchronous multiple primary lung cancers have significantly less favorable outcome than those with single primary lung malignancies, although it can be considerably improved with radical surgical treatment. Basing on the above case report, we discussed diagnostic and therapeutical scheme in patients with the primary multiple lung cancers, and have analyzed epidemiological data and some aspects of MPM etiology.

Lung Lesions: Differential Diagnoses Beyond Cancer.

BACKGROUND Lung cancer is the most common malignant neoplasm diagnosed worldwide. Early diagnosis and treatment are of great importance for patient's prognosis. A wide variety of pulmonary conditions display clinical and radiological presentation similar to that of lung cancer, and the awareness of their existence can help in making correct diagnoses. CASE REPORT This article presents a description of 4 patients with an insidious type of lesions mimicking pulmonary carcinomas. The first patient was referred to Department with a tumor-like lesion in the right lung. After CT of the chest and core-needle biopsy, the lesion turned out to be an ectopic thyroid tissue. The second patient reported a dry cough and weight loss. A lung nodule mass was revealed in chest CT and the patient was diagnosed with pulmonary tuberculoma. The remaining 2 patients, despite the suspicion of lung cancer, were subsequently diagnosed with a post-traumatic pleural hematoma and diffuse large B cell lymphoma. CONCLUSIONS Low-dose computed tomography of the chest plays a significant role in the diagnosis of newly detected lesions in the lungs. However, due to the similarity of the image of cancer to that of other diseases, the ultimate diagnosis should be based on the interpretation of full imaging diagnostic tests, clinical presentation, and histopathological examination of the material obtained from the lesion. Analysis of cases enables us to expand our understanding of the diseases that need to be considered in differential diagnosis of a patient with a detected tumor-like lesion in the lungs.

Unmasking Pott Disease: A Diagnostic Challenge Mimicking Metastatic Lung Cancer - A Case Report.

BACKGROUND Tuberculosis spondylitis, also known as Pott disease, is a rare form of the ancient infectious disease tuberculosis. It bears a complex clinical and radiological profile, often necessitating an extensive differential diagnostic approach for accurate identification. The disease was named in honor of the first diagnosed patient, highlighting its historical significance. CASE REPORT We report a case involving a 69-year-old male initially admitted to the Pulmonology Department under the suspicion of a left lung tumor, as indicated by a chest X-ray. A subsequent CT scan revealed a tumor-hilar mass, enlarged subcarineal lymph nodes, and a pathological mass at the C6/C7 vertebral level. Despite negative tuberculosis tests, the patient was misdiagnosed with disseminated lung cancer with spinal metastases. Following radiotherapy targeting the cervical and thoracic spine, the definitive diagnosis of spinal tuberculosis was confirmed via histopathological examination from an open biopsy of the C6 and C7 vertebrae. CONCLUSIONS Tuberculosis can present with an insidious and misleading clinical picture, often mimicking other diseases such as cancer. Early and accurate diagnostic processes are crucial for effective treatment. This case underscores the importance of considering tuberculosis in the differential diagnosis, especially when clinical presentations are ambiguous.

Impact of COVID-19 on antibiotic usage in primary care: a retrospective analysis.

The COVID-19 pandemic has contributed to many changes in the medical practice, including a wider access to tele-consultations. It not only influenced the type of treatment but also shed light on mistakes often made by doctors, such as the abuse of antibiotics. This study aimed to evaluate the antibiotic treatment, and the impact of the COVID-19 pandemic on antibiotic prescribing during a GP's visit. The retrospective medical history analysis involved data from a first-contact medical center (Pantamed, Olsztyn, Poland), from 1 January 2018 to 31 May 2023. Quantities of prescribed antibiotics were assessed and converted into the so-called active list for a given working day of adult patients (> 18 years of age). Statistical analysis based on collective data was performed. During the COVID-19 pandemic, a decline in the number of medical consultations has been observed, both remotely via tele-medicine and in personal appointments, compared to the data from before the pandemic: n = 95,251 versus n = 79,619. Also, during the COVID-19 pandemic, there was a decrease in the total amount of prescribed antibiotics relative to the data before the pandemic (2.44 vs. 4.54; p > 0.001). The decrease in the quantities of prescribed antibiotics did not depend on the way doctor consultations were provided. The COVID-19 pandemic has contributed to changing the family doctors' management of respiratory infections. The ability to identify the etiological agent-the SARS-COV2 virus-contributed to the reduction of the antibiotics use.

Spirometry day: a means to enhance social knowledge on respiratory diseases.

The chapter presents the results of pulmonary function tests conducted as part of the Polish Spirometry Day of 2011, an initiative aimed at increasing the awareness of causes, symptoms, and delayed effects of common respiratory diseases, in particular of bronchial asthma and chronic obstructive pulmonary disease, and at demonstrating the role of regular examinations, especially in higher risk groups. The results show that there was a relatively substantial group of persons, 11.2 % of the population sample studied, not being aware of a respiratory disease they had. Furthermore, the results show that quite often, 12.4-16.0 % of the population studied, obstruction was diagnosed in persons who did not have any spirometry tests done before, despite some respiratory symptoms that should raise the attention of general practitioners to perform such tests.

Assessment of the Function of Respiratory Muscles in Patients after COVID-19 Infection and Respiratory Rehabilitation.

OBJECTIVES: The MIP (maximum inspiratory pressure) and MEP (maximum expiratory pressure) are sensitive indicators of respiratory muscle function. The aim of the study was to assess the function of respiratory muscles in patients after COVID-19 infection, before and after hospitalisation at the Pulmonary Rehabilitation Ward. MATERIALS AND METHODS: The study was conducted on a group of 19 people with laboratory-confirmed COVID-19 infection, who, in the period from 1 February to 31 May 2021, were hospitalised at the Independent Public Pulmonary Hospital and underwent respiratory rehabilitation in hospital conditions. A statistical analysis was performed using the STATISTICA package, ver. 10. A respiratory pressure meter (RP Check) was used to measure muscle strength. Measurements were performed twice on each patient-before admission and after hospitalisation in the Pulmonary Rehabilitation Ward. RESULTS: We show that conducting pulmonary rehabilitation contributes to the increase in MIP and MEP, which are associated with increased strength of the inspiratory and expiratory muscles. The average value of MIP increased by 11.95 cmH2O and MEP by 26.16 cmH2O. The improvement was visible in both female and male patients. CONCLUSIONS: Pulmonary rehabilitation contributes to the improvement of respiratory muscle function indicators among patients after COVID-19 infection. Assessment of the MIP and MEP indices is a simple and quick way to reliably assess the function of the respiratory muscles.

The Role of Aquaporin 5 (AQP5) in Lung Adenocarcinoma: A Review Article.

Aquaporins (AQPs) are selective, transmembrane proteins, which are primarily responsible for the transport of water and small molecules. They have been demonstrated to play a key role in the development and progression of cancer. Lung adenocarcinoma is the most common primary lung cancer diagnosed in patients in Europe and the USA. The research done so far has provided firm evidence that some AQPs can be biomarkers for various diseases. The objective of this review article is to present a potential role of AQP5 in the development of lung adenocarcinoma. Original papers discussing the involvement of AQP5 in carcinogenesis and containing relevant clinical data were identified. In order to analyze the research material in accordance with PRISMA guidelines, a systematic search of the ScienceDirect, Web of Science, and Pubmed databases was conducted. Out of the total number of 199 papers identified, 14 original articles were subject to analysis. This article presents the pathophysiological role of AQP5 in the biology of lung adenocarcinoma as well as its prognostic value. The analysis substantiates the conclusion that the prognostic value of AQP5 in lung cancer requires further research. Another aim of this paper is to disseminate knowledge about AQPs among clinicians.

Exploring the efficacy of artificial neural networks in predicting lung cancer recurrence: a retrospective study based on patient records.

Background: Lung cancer remains a significant public health concern, accounting for a considerable number of cancer-related deaths worldwide. Neural networks have emerged as a promising tool that can aid in the diagnosis and treatment of various cancers. Consequently, there has been a growing interest in exploring the potential of artificial intelligence (AI) methods in medicine. The present study aimed to evaluate the effectiveness of a neural network in predicting lung cancer recurrence. Methods: The study employed retrospective data from 2,296 medical records of patients diagnosed with lung cancer and admitted to the Warminsko-Mazurskie Center for Lung Diseases in Olsztyn, Poland. The statistical software STATISTICA 7.1, equipped with the Neural Networks module (StatSoft Inc., Tulsa, USA), was utilized to analyze the data. The neural network model was trained using patient information regarding gender, treatment, smoking status, family history, and symptoms of cancer. Results: The study employed a multilayer perceptron neural network with a two-phase learning process. The network demonstrated high predictive ability, as indicated by the percentage of correct classifications, which amounted to 87.5%, 89.1%, and 89.9% for the training, validation, and test sets, respectively. Conclusions: The findings of this study support the potential usefulness of a neural network-based predictive model in assessing the risk of lung cancer recurrence. Further research is warranted to validate these findings and to explore AI's broader implications in cancer diagnosis and treatment.

A Real-World Multicenter Retrospective Observational Study on Polish Experience with Nintedanib Therapy in Patients with Idiopathic Pulmonary Fibrosis: The PolExNIB Study.

Nintedanib is a disease-modifying agent licensed for the treatment of IPF. Data on Polish experience with nintedanib in IPF are lacking. The present study aimed to describe the safety and efficacy profiles of nintedanib in a large real-world cohort of Polish patients with IPF. This was a multicenter, retrospective, observational study of IPF patients treated with nintedanib between March 2018 and October 2021. Data collection included baseline clinical characteristics, results of pulmonary function tests (PFTs), and a six-minute walk test (6MWT). Longitudinal data on PFTs, 6MWT, adverse drug reactions (ADRs), and treatment persistence were also retrieved. A total of 501 patients (70% male) with a median age of 70.9 years (IQR 65-75.7) were included in this study. Patients were followed on treatment for a median of 15 months (7-25.5). The majority of patients (66.7%) were treated with the full recommended dose of nintedanib and 33.3% of patients were treated with a reduced dose of a drug. Intermittent dose reductions or drug interruptions were needed in 20% of patients. Over up to 3 years of follow-up, pulmonary function remained largely stable with the minority experiencing disease progression. The most frequent ADRs included diarrhea (45.3%), decreased appetite (29.9%), abdominal discomfort (29.5%), weight loss (32.1%), nausea (20.8%), fatigue (19.2%), increased liver aminotransferases (15.4%), and vomiting (8.2%). A total of 203 patients (40.5%) discontinued nintedanib treatment due to diverse reasons including ADRs (10.2%), death (11.6%), disease progression (4.6%), patient's request (6.6%), and neoplastic disease (2.2%). This real-world study of a large cohort of Polish patients with IPF demonstrates that nintedanib therapy is safe, and is associated with acceptable tolerance and disease stabilization. These data support the findings of previously conducted clinical trials and observational studies on the safety and efficacy profiles of nintedanib in IPF.

Nurses' nonverbal methods of communicating with patients in the terminal phase.

AIM: The aim of this study was to ascertain what methods of communication nurses use during interactions with patients nearing the end of their lives, with a particular focus on nonverbal communication. METHODOLOGY: A questionnaire containing 24 questions was completed by 95 nurses working in one of five hospices in Poland. RESULTS: A total of 48% of the sample reported frequently using nonverbal communication consciously and with a certain aim, and a further 37 (39%) reported that they sometimes use it. The sample's responses indicate that for patients the best form of touch is holding hands. In addition, 63% of the respondents stated that they had been educated in communicating with palliative care patients, but only 56% thought that nurses' communication knowledge and skills were satisfactory, and 50% would like to undergo training in communication skills specific to palliative care. CONCLUSION: Most nurses are aware of the importance of nonverbal communication to their interactions with palliative care patients, but a substantial proportion think that they need to be better educated in theoretical and practical aspects of communication.

[Embolotherapy of recanalized symptomatic pulmonary arteriovenous malformations in a patient with Rendu-Osler-Weber syndrome: a case report and review of literature]. / Powtórna embolizacja objawowych przetok tetniczo-zylnych pluc u pacjentki z choroba Rendu-Oslera-Webera: opis przypadku i przeglad pismiennictwa.

Rendu-Osler-Weber disease is a genetic disorder resulting in mucosal and celiac angiodysplastic lesions. We present a case of a 47-year-old woman with Rendu-Osler-Weber disease manifesting with telangiectasias on the skin and mucosa of the face and pulmonary and hepatic arteriovenous malformations (AVMs). Due to cardiovascular and neurological (recurrent brain abscess) complications of pulmonary AVMs, the patient was qualified for the embolization of a recanalized AVM in the right lung. Endovascular embolotherapy is the method of choice in treatment of pulmonary AVMs allowing for avoidance of complications and prolonged survival. Due to the risk of recanalization of embolized AVMs, a long-term follow up is necessary.

Effects of Tobacco Smoking on the Survivability of Patients with Multiple Cancers and Single Lung Cancer.

Lung cancer is the leading cause of death worldwide among men and women. Tobacco smoking is the number one risk factor for lung cancer. The aim of our study was to evaluate the survivability of patients with single lung cancer in relation to the survival time in patients with multiple neoplasms whose last neoplasm was a lung cancer. A retrospective analysis was con-ducted of data from medical histories of patients hospitalized at the Pulmonary Hospital in Olsztyn (Poland) from 2012 to 2017, with a lung cancer diagnosis as the first or subsequent cancer. The total longevity of women with diagnosed multiple cancers was found to be shorter than that of men: 67.60 years (SD: 7.77) and 69.91 years (SD: 7.97), respectively. Among the ex-smokers, the longevity of men (68.93 years) was longer than that of women (66.18 years). Survival time, counted from the diagnosis of both the first and subsequent cancer, was longer among patients with multiple cancers than among patients with single lung cancer (p = 0.000). Women's survivability was worse than men's in the case of multiple cancers and in the group of people who quit smoking (p = 0.037; p = 0.000). To conclude, smoking tobacco affects the survival of patients with lung cancer. Smoking cessation improves overall survival.