Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and asthma are the most common chronic respiratory diseases worldwide. At the moment, there is no information about the preferences of Polish specialists as regards the treatment of asthma and COPD or factors influencing the choice of particular treatment regimens. AIM: To determine the treatment options most commonly used by experienced pulmonologists and allergists for asthma and COPD and to identify the factors affecting the choice of a particular therapy. MATERIAL AND METHODS: The survey included 224 doctors (pulmonologists and allergists) across Poland and concerned patients diagnosed with asthma (n = 4358) and COPD (n = 3062). RESULTS: In the case of asthma, the most common therapy applied was inhaled glucocorticosteroids and long-acting ß2 agonists. According to 27.2% of doctors, combination therapy was used in 70-80% of patients while 23.7% declared that the proportion of patients receiving such a treatment exceeded 80%. In the case of COPD, anticholinergics were most frequently prescribed when inhaled glucocorticosteroids and long-acting ß2 agonists had proved insufficient. According to 21% of specialists, the percentage of patients treated so was 41-50%, while 19% declared the use of this treatment in 71-80% of patients. CONCLUSIONS: The most common treatments for asthma and COPD in Poland are inhaled glucocorticosteroids and long-acting ß2 agonists. The main factors influencing treatment decisions are the current GINA and GOLD recommendations as well as patients' age, comorbidities, and price of treatment.

Evaluation of Early and Late Effects of Surgical Treatment of Early Hepatic Artery Thrombosis After Liver Transplantation.

BACKGROUND: Hepatic artery thrombosis (HAT) is the most severe vascular complication after liver transplantation and one of the major causes of early graft loss and mortality after transplantation. The number of retransplantations and recipient deaths can be decreased with an urgent thrombectomy of the hepatic artery. The aim of the study was to analyze the early and long-term outcomes of the surgical revascularization of early hepatic artery thrombosis after liver transplantation. METHODS: Four hundred eleven orthotopic liver transplantations in 380 patients were performed at our center between 2005 and 2020. A Doppler evaluation of the graft vessels patency was performed daily for the first 5 days after transplantation in all recipients. After angio-computed tomography confirmation, most of the cases of HAT qualified for surgical revascularization. RESULTS: Early HAT was diagnosed in 20 cases (4.9%), occurring most frequently between the first and third day after transplantation. Sixteen patients underwent revascularization surgery. Among them, in the early post-transplantation period, 4 died and 2 more had retransplantation. Of the remaining 10 recipients, 2 had no biliary complications, 1 had bile leakage, and 7 had common bile duct stenosis, all treated endoscopically. Among 4 nonoperated patients, 1 died and the other 2 had retransplantation in the early post-transplantation period; the last of these 4 recipients had bile duct stenosis. CONCLUSIONS: The urgent surgical revascularization in liver recipients with early HAT allows the avoidance of early retransplantation. However, these patients require intensified surveillance owing to the high risk of biliary complications that may affect shortened graft and patient survival.

Analysis of surgical outcomes in 102 patients with renal cell carcinoma with venous tumor thrombus: A retrospective observational single-center study.

The aim of the study was to assess short- and long-term results following radical nephrectomy with renal vein and inferior vena cava thrombectomy in patients with renal cell cancer with venous thrombus and to investigate impact of various demographical, clinical and histological factors on overall survival (OS). The medical records of 102 adult patients with renal cell cancer with venous thrombus admitted for surgery in Department of General, Vascular and Transplant Surgery from 2012 to 2019 were retrospectively analyzed. The tumor was more frequently located on the right side compared to the left one (55 vs. 47). According to Neves Zincke classification, the levels of venous thrombus were as follows: 1 to 48 (47%), 2 to 47 (46%), 3 to 6 (6%), and 4 to 1 (1%). Postoperative complications were noted in 16 (15.7%) patients. One (3%) patient (Neves Zincke 2) died of intraoperative pulmonary embolism during hospitalization. Clear cell carcinoma was the most common pathological type reported in 92 (90.2%) patients. Thirty nine (38.2%) patients were alive at the time of last follow-up. The median OS was 21.50 (0-101.17) months. The 1-year OS was 75.5%. Significantly better OS (median 38.03 months) was noted in patients with RCC Neves Zincke 1 compared to OS (median 14.79 months) in patients with Neves Zincke 2-4 VT (P = .008). Higher tumor staging (T3 vs. T4) (P = .038), nodal staging (N0 vs. N1) (P = .0008), Fuhrman histological grading (G1-2 vs. G3-4) (P = .033) were associated with a shorter OS. Patients with renal cell cancer with venous thrombus, with an acceptable perioperative risk, should be treated surgically, because radical nephrectomy with thrombectomy performed in a high volume surgical center is a safe procedure. Neves Zincke 2-4 venous thrombus, higher tumor and nodal staging, as well higher Fuhrman histological grading are associated with a shorter OS.

Left-hemihepatectomy as a method of treatment of locally limited Caroli disease.

The study introduces a case of a 51-year old patient with Caroli's disease of left liver lobe. In 2011 the patient was admitted to Clinic of General, Vascular and Transplantation Surgery. She was after first in her life incident of an acute pancreatitis and subsequent ERCP procedure with left hepatic biliary tract drainage. The lady was qualified to left-hemihepatoctomy, which was successfully conducted in our clinic. The only complication of the procedure was surgical site infection which was properly treated with typical antibiotics. One-year observation occurred no other complications and liver function was fine.