Bezsenność można zdefiniować jako subiektywną skargę na kłopoty z zasypianiem, trudności z utrzymaniem ciągłości snu, zbyt wczesne budzenie lub złą jakość snu. Bezsenność jest chyba najczęściej występującym zaburzeniem snu. W patogenezie bezsenności podstawową rolę odgrywają czynniki predysponujące, wyzwalające i utrwalające. Czynniki predysponujące, takie jak wrażliwa osobowość, poziom wzbudzania, sztywny rytm okołodobowy czy inne, indywidualne cechy zwiększają podatność na bezsenność. Czynniki wyzwalające to czynniki, które bezpośrednio zakłócają sen. Do najpowszechniejszych czynników wyzwalających należą stresy psychospołeczne i zaburzenia rytmu snu i czuwania. Czynniki utrwalające bezsenność, takie jak niewłaściwe zachowania okołosenne, przenoszenie do łóżka zachowań związanych z czuwaniem i zamartwianie się bezsennością, stanowią główny cel terapii bezsenności. W leczeniu bezsenności stosuje się strategie farmakologiczne i niefarmakologiczne. W przypadku rozpoznania bezsenności przygodnej lub krótkotrwałej, podstawową metodą leczenia jest informacja o zasadach higieny snu i doraźne podawanie krótko działających leków nasennych. W bezsenności przewlekłej podstawową metodą leczenie jest terapia poznawczo behawioralna (CBT), którą można wspomóc podawaniem leków przeciwdepresyjnych o działaniu uspokająco-nasennym lub tylko doraźnym podawaniem krótkodziałających leków nasennych.
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Insomnia generally is defined as a subjective report of difficulty falling sleep, difficulty staying asleep, early awakening, or nonrestorative sleep. It is one of the most common health complaints among the general population. In pathogenesis of insomnia predisposing, precipitating, and perpetuating factors play an important role. Predisposing factors include arousal-prone personality, elevated baseline physiologic arousal, rigid circadian system, and other individual characteristics that make one vulnerable to or set the stage for the development of insomnia. Precipitating factors are the events or conditions that trigger the insomnia. Common examples include life stressors and change of sleep-wake schedule. The perpetuating factors, such as conditioning of bedtime cues with arousal, maladaptive sleep-wake habits and worries over sleeplessness, then should become the focus of the treatment. Pharmacologic and non-pharmacological methods of treatment are used in the management of insomnia. In the case of the diagnosis of transient or short-term insomnia, a basic method of treatment is usually administrating the right hypnotics and information on the sleep hygiene. In chronic insomnia, a basic treatment is cognitive-behavioral therapy (CBT), which can help pharmacologically by regular use of "sedative and hypnotic" antidepressant medication in the evening only "as needed" taking hypnotics drugs (no more than 2-3 times a week).
The aim of the study was the analysis of the results of liver resection in the treatment of patients with hepatocellular carcinoma, taking into consideration the selected factors based on the department's material.Material and methods. Data of 122 patients subject to liver resection due to hepatocellular carcinoma at the Department of General, Transplantation and Liver Surgery, Medical University of Warsaw, were subject to retrospective analysis.The influence of selected factors on the long-term treatment results was determined, and the patient survival depending on the tumor stage as per the TNM scale was compared. The statistical significance threshold was set at p = 0.05.Results. 1- and 3-year overall survival and recurrence-free survival in the whole patient group was 82.1% and 56.3%, and 57.7% and 20.1%, respectively. The perioperative mortality rate was 1.6%. The neoplasm advancement exceeding the first stage on the TNM scale was associated with lower values of overall survival (p = 0.001, HR = 3.7) and recurrence-free survival (p = 0.00008, HR = 3.8). Elevation of AFP was the only independent prognostic factor for overall survival (p = 0.04, HR = 1.04 at alpha-fetoprotein levels > 1000 ng/ml), while the presence of neoplastic emboli in small blood vessels was an independent risk factor for HCC recurrence (p = 0.02, HR = 2.24).Conclusions. The alpha-fetoprotein levels and presence in the histopathological examination of neoplastic emboli in small blood vessels are independent prognostic factors for outcome of patients operated for hepatocellular carcinoma. The diagnosis of neoplasm at stage 1 as per TNM significantly improves long-term results of resective treatment.
The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide. The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT. Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models. Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS. Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.
Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). Material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). Conclusions. Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.
The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.
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