Assessment of the Willis circle flow changes and the severity of degenerative aortic stenosis and cognitive impairment.

BACKGROUND: Degenerative aortic stenosis (DAS) and cognitive function deterioration frequently coexist in elderly patients, which affects the prognosis. AIMS: We aimed to evaluate the Willis circle intracranial blood flow parameters and cognitive status in patients with DAS. METHODS: Ultrasonography of the Willis circle and the assessment of cerebral blood flow (CBF) volume, acceleration time (AT), pulsatile and resistive indexes (PI, RI), as well as cognition tests (Mini­Mental Status Examination [MMSE] and Montreal Cognitive Assessment [MoCA]) were performed in group 1-41 patients with severe DAS (aortic valve area indexed to the body surface area [AVAi] <0.5 cm2/m2) and group 2-41 patients with moderate DAS (AVAi [range], 0.51-0.99 cm2/m2). The control group comprised 52 patients without DAS. RESULTS: Compared with controls, mean (SD) CBF volume ingroups 1 and 2 was lower (1.37 [0.32] l/min vs 1.5 [0.44] l/min vs 1.71 [0.21] l/min, respectively; P <0.001), while AT (212 [20] ms vs 161 [33] ms vs 86 [21] ms, respectively; P <0.001), RI (0.64 [0.07] vs 0.65 [0.06] vs 0.59 [0.05], respectively; P <0.001), and PI (1.13 [0.21] vs 1.16 [0.17] vs 0.99 [0.12]; P <0.001) were higher. Both MMSE and MoCA scores did not differ according to CBF, RI, PI, and AT. In multivariable regression analysis, age, renal failure, left ventricular ejection fraction, and diabetes, yet not CBF parameters, were independently associated with cognitive function. CONCLUSIONS: Patients with DAS had significantly reduced CBF volume and increased arterial stiffness. However, cognitive impairment may be attributed to concomitant comorbidities rather than CBF parameters.

The patient's readiness to accept the changes in life after the radical lung cancer surgery.

INTRODUCTION: Lung cancer holds the first position as the number of deaths among both the genders and, even if oncological efficient, is related to lasting psychological effects, which may significantly influence further functioning of a patient's professional and social life. The researches objective was to find the level of acceptance of lung cancer and to determine what is the patient's readiness to accept the changes in life after the surgery. MATERIAL AND METHODS: In total, 135 patients suffering from lung cancer were enrolled. To evaluate the readiness to accept the changes in life after the surgery the authors' questionnaire was used and to evaluate of level of acceptance of illness the standardized the Acceptance of Illness Scale (AIS) was used. RESULTS: The awareness of the treatment consequences is high among the patients scheduled for surgery. The acceptance of lung cancer is high (mean = 32.23; SD = 7.53). The level of disease acceptance depends on the evaluation of own health - both currently (it is higher among the patients who consider their health as good) and compared to the previous year (it is higher among the patients who evaluate it as the same or better than a year ago) (p < 0.05). The willingness to accept the life changes depends on a gender, age, marital status, education, employment and health orientation (p < 0.05). CONCLUSIONS: Regardless of the achievements of the recent years in the lung cancer treatment, it remains the biggest oncologic challenge worldwide. Only multidisciplinary actions including prevention and psychological support may contribute to much more efficient treatment.