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Polish Laryngectomy Association Division in Białystok is initiating and organising 5 rehabilitation sessions (3 in Lithuania and 2 in Poland) for people after total laryngectomy caused by cancer. 99 people took part in the above mentioned sessions. This report presents the program and affects of rehabilitation.
OBJECTIVE: To evaluate the effectiveness of prevention measures against dust mite sensitization. DESIGN: European (England, Germany, Greece, Lithuania) multicenter prospective single-blind randomized control trial with a follow-up of 12 months. PARTICIPANTS: Toddlers and preschoolers, with at least 1 parent with atopic symptoms and sensitization, who initially were not sensitized to mite allergens. INTERVENTIONS: A combination of education and a simple preventive measure (mattress encasement) to reduce mite allergen exposure. SETTING: Community-based study. MAIN OUTCOME MEASURES: Sensitization to mite allergens (skin-prick test or specific immunoglobulin E). RESULTS: Of 636 children (mean age, 3.1 years) included in the study, 566 (89%) participated in the first-year follow-up. The incidence of sensitization to mite allergens was 10 (3%) of 330 in the intervention vs 20 (6.5%) of 306 in the control arm, including loss of follow-up (intention-to-treat principle). Allergic symptoms were more common in sensitized than in nonsensitized children and so was the prevalence of physician-diagnosed asthma, eczema, and food allergy. CONCLUSIONS: This simple, harmless, and inexpensive measure can be used in toddlers and preschoolers of parents with atopic disorders to reduce sensitization to mite allergens. With regard to clinical manifestations of atopy, follow-up studies are needed to determine the effectiveness of the intervention.
Ultrasound scans in the mid-trimester of pregnancy are now a routine part of antenatal care in most European countries. Using data from registries of congenital anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of limb reduction deficiencies (LRD) by routine ultrasonographic examination of the fetus. All LRDs suspected prenatally and all LRDs (including chromosome anomalies) confirmed at birth were identified from 20 Congenital Malformation Registers from the following 12 European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries are following the same methodology. During the study period (1996-98) there were 709,030 births, and 7,758 cases with congenital malformations including LRDs. If more than one LRD was present the case was coded as complex LRD; 250 cases of LRDs with 63 (25.2%) termination of pregnancies were identified including 138 cases with isolated LRD, 112 with associated malformations, 16 with chromosomal anomalies and 38 non chromosomal recognized syndromes. The prenatal detection rate of isolated LRD was 24.6% (34 out of 138 cases) compared with 49.1% for associated malformations (55 out of 112; p<0.01). The prenatal detection of isolated terminal transverse LRD was 22.7% (22 out of 97), 50% (3 out of 6) for proximal intercalary LRD, 8.3% (1 out of 12) for longitudinal LRD and 0 for split hand/foot; for multipli-malformed children with LRD those percentages were 46.1% (30 out of 65), 66.6% (6 out of 9), 57.1% (8 out of 14) and 0 (0 out of 2), respectively. The prenatal detection rate of LRDs varied in relation with the ultrasound screening policies from 20.0% to 64.0% in countries with at least one routine fetal scan.
Three extracts, namely hot-water fraction (HWF), water-soluble fraction (WSF), and ethanol-soluble fraction (ESF), were prepared from fresh bee bread imported from Lithuania. The protein and total phenolic contents of these samples were very high. Among them, WSF at 100% concentration showed the highest antioxidative ability and scavenging ability. On the other hand, ESF at 10% concentration possessed the highest ability against 1,1-diphenyl-2-picrylhydrazyl (DPPH) and hydroxyl radicals. Bee bread will apply more and more as health food and medicine due to its functional properties such as antioxidative ability and scavenging activities of reactive oxygen species.
Acrodermatitis enteropathica is rare autosomal recessive disorder characterized by a severe nutritional zinc deficiency. We and others have recently identified the human gene encoding an intestinal zinc transporter of the ZIP family, SLC39A4, as the mutated gene in acrodermatitis enteropathica (AE). A first mutation screening in 8 AE families (15 patients out of 36 individuals) revealed the presence of six different mutations described elsewhere. Based on these results, we have evaluated the involvement of SLC39A4 in 14 patients of 12 additional AE pedigees coming either from France, Tunisia, Austria or Lithuania. A total of 7 SLC39A4 mutations were identified (1 deletion, 2 nonsense, 2 missense, and 2 modifications of splice site), of which 4 are novel: a homozygous nonsense mutation in 3 consanguineous Tunisian families [c.143T>G (p.Leu48X)], a heterozygous nonsense mutation (c.1203G>A (p.Trp401X)) in a compound heterozygote from Austria also exhibiting an already known missense mutation, and distinct homozygous mutations in families from France or Tunisia [c.475-2A>G and c.184T>C (p.Cys62Arg)]. Furthermore, two other potential mutations [c.850G>A (p.Glu284Lys) and c.193-113T>C] were also observed at homozygous state in a French family formerly described. This study brings to 21 the number of reported SLC39A4 mutations in AE families.
Significant changes in the prevalence of tobacco smoking have been observed in many European countries. EU candidate countries have also experienced major changes with respect to tobacco smoking, which have resulted in changes in the frequency of lung cancer. In men in the majority of these countries, a reduction of mortality rates has been observed recently, while in Hungary and Poland a deceleration of mortality increase was observed in the 1990s. The situation is much less favorable in females, where in the majority of countries a continuous increase of mortality rates has been observed, the only exceptions being Latvia, Lithuania and, to a lesser extent, Estonia. In Hungarian women, an acceleration of the increase rate was observed in the 1980s and 1990s (compared with the 1970s). Patterns of lung cancer mortality in analyzed countries are somewhat similar to those observed in EU member states. Recent analyses of time trends of lung cancer in EU countries showed, in general, a decreasing risk in the majority of male populations and an increase in several countries in women. If the decrease of mortality is to be achieved and maintained in the longer term, efforts have to be focused on young generations (entering adulthood now or in the near future). Despite all the difficulties present in reducing tobacco smoking in youth, it seems that one of the most important ways to reduce the future lung cancer burden in current and new EU member states is to strengthen efforts toward changing smoking attitudes in young generations.
The incidence of type 1 diabetes varies markedly between countries. As enterovirus infections have been linked to type 1 diabetes, we determined whether this variation correlates with the frequency of enterovirus infections in different Caucasian populations in Europe. Enterovirus antibodies were examined in the background population (1-year-old and 10-14-year-old children) in seven countries with either exceptionally high (Finland and Sweden) or low/intermediate incidence of diabetes (Estonia, Germany, Hungary, Lithuania, Russia) using EIA and neutralisation assays. Enterovirus antibodies were less frequent in countries with high diabetes incidence compared to countries with low diabetes incidence (P<0.001). This suggests that enterovirus infections are not particularly common in countries with high diabetes incidence. In contrast, there seems to be an inverse correlation between the incidence of type 1 diabetes and enterovirus infections in the background population, which is in line with the previously proposed polio hypothesis according to which the complications of enterovirus infections become more common in an environment with a decreased rate of infections.
Tick-borne encephalitis virus (TBEV) is a severe problem in Estonia. In the present article the first genetic analysis of Estonian TBEV strains is described. In total, seven TBEV strains were isolated from ticks (Ixodes ricinus and I. persulcaus), rodents (Apodemus agrarius and Cletrionomys glareolus), and serum from a tick-borne encephalitis (TBE) patient. The nucleic acid sequences of the viral genome encoding almost the complete E protein (nt 41-1250) and the 3'-NCR-termini of the Estonian TBEV strains were determined by direct sequencing of RT-PCR products. The results showed that all three known TBEV subtypes, Western TBEV (W-TBEV), Far-Eastern TBEV (FE-TBEV), and Siberian TBEV (S-TBEV), co-circulate in Estonia. The Estonian TBEV strains of the S-TBEV and W-TBEV subtypes clustered with the previously reported strains from Latvia and Lithuania. Within the FE-TBEV subtype, however, the Estonian strain Est2546 clustered together with the strain Sofjin, originating from the Far-East of Russia, but not with the strain RK1424, isolated in the neighboring Latvia. This suggests a different evolutionary history for the Estonian and the Latvian strains in the FE-TBEV subtype. The Estonian TBEV strain (Est3535), which belonged to the S-TBEV subtype, had an organization of the 3'-NCR similar to that of strains from the Far-East of Russia (Irkutsk). The 3'-NCRs of Estonian strains of the W-TBEV subtype (Est3051, Est3053, Est3476, and Est3509) were very similar to those of the strain Ljubljana I from the Balkans. In the 3'-NCR sequence of the Estonian strain Est2546, which belonged to the FE-TBEV subtype, a deletion from position 10461 to 10810 extending approximately 10 nucleotides into the core element, was detected.
Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996-1998, 709 030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into 'isolated' when only a cardiac malformation was present and 'associated' when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20-24 weeks for the majority of associated cardiac defects.
The toxicities of copper, chromium, cadmium, nickel, manganese, zinc, and lead ions and various concentrations of mixtures of them were studied using the aquatic plant Spirodela polyrrhiza and the terrestrial plant Lepidium sativum. The composition of the model mixture was based on average analytical data of the annual amounts of representative heavy metals (HM) in wastewater discharged from the Ignalina Nuclear Power Plant (Lithuania) during 1996. The observed and predicted effects of the HM mixture on tested plants were evaluated and compared with the prediction models used in describing the toxic interactions of heavy metals in the mixture. The type of toxic interaction at each tested concentration of the mixture was assessed by a statistical approach that tested the null hypothesis of additive toxicity (Ince et al., 1999) and the mixture toxicity index (MTI; Könemann, 1981). For both plant organisms the effect of the HM mixture calculated using the MTI was synergistic. However, assessment of the HM interaction type at 50% effect concentrations using the hypothesis of additive toxicity showed a synergistic effect for Spirodela polyrrhiza and an additive effect for Lepidium sativum. Though the results obtained using both prediction models for assessing the HM mixture's toxicity were similar, in our opinion, the additive toxicity model is more suitable than the MTI model because the former allows evaluation of the impact of various mixture concentrations, not only those with a 50% effect.
Semipermeable membrane devices (SPMDs) were deployed for 4 weeks in two rivers in Lithuania. The SPMD dialysates were tested in the Microtox assay and, surprisingly, the sample from the relatively clean Ula River exhibited three times more toxicity than the sample from the Vilnia River receiving discharge from several industrial enterprises and municipal waste-water. The whole dialysates were subjected to bioassay-directed fractionation on silica gel columns. Toxicity testing of each fraction revealed that most of the toxicity was contained in fraction 10, which was eluted with 100% acetone. GC/FID, GC/ECD, and GC/FTIR/MS analysis of the fractions indicated that the major component of this fraction was oleic acid. The oleic acid was most likely the hydrolysis product of methyl oleate, the major impurity of the SPMD triolein. It can be inferred that oleic acid was responsible for the toxicity of this fraction in Microtox, as a threefold difference in the toxicity between the two samples was also marked by a threefold difference in their oleic acid content. Toxicity of unsaturated fatty acids in various tests, including Microtox, has been demonstrated elsewhere. Vilnia fraction 2, which was eluted with 100% hexane, exhibited the most toxicity of the remainder of silica gel fractions. The spectral analysis demonstrated that other toxic fractions contained a number of halogenated compounds and PAHs. In general, SPMDs have proved to be a useful way to screen for hydrophobic toxicants in water. However, sample clean-up procedures to remove oleic acid may be required prior to toxicity testing for the estimation of the true toxic potential of the accumulated pollutants.
At the XIth International Brain Oedema Symposium we reported that 208 patients had been randomized in this trial from 65 centres. At the time of submission of this manuscript we have randomized 985 patients from 107 centres including Japan. The trial will continue randomising patients until the end of February 2003. The objective is to determine whether "Early Surgical Intervention" or "Initial Conservative Treatment" is the best option in patients with spontaneous supratentorial Intracerebral haemorrhage (ICH). Patients with trauma, tumours, aneurysms and angiographically proven arteriovenous malformations are excluded. Ascertainment logs from the various centres have revealed substantial variation in the rate of operation for ICH from 2% in Hungary to 90% in Lithuania. The results will remain blinded until all 6 month follow-up information has been obtained. It is anticipated that these results will therefore be known towards the end of 2003. The pooled results have shown that patients with larger Haematomas and depressed consciousness are more likely to end up with a worse outcome.
Following the introduction of routine immunization with diphtheria toxoid in the 1940s and 1950s, diphtheria incidence declined dramatically in countries of the industrialized world. At the beginning of the 1980s many of these countries were progressing toward elimination of the disease. However, since the mid-1980s there has been a striking resurgence of diphtheria in several countries of Eastern Europe. For 1993, WHO received reports of 15,211 diphtheria cases in Russia and 2,987 cases in Ukraine. The main reasons for the return of diphtheria in these countries were: decreasing immunization coverage among infants and children waning immunity to diphtheria in adults, movements of the population during the last few years, and an irregular supply of vaccines. The outbreak spread to neighboring countries and in 1993 cases were reported in Azerbaijan, Belarus, Estonia, Finland, Kazakhstan, Latvia, Lithuania, Poland, Tajikistan, Turkey, and Uzbekistan. Epidemiological patterns of diphtheria are changing in developing countries, and the disease seems to be following patterns seen in industrialized countries 30 to 40 years ago. In developing countries, routine immunization against diphtheria was introduced in the late 1970s with the Expanded Programme on Immunization. In these countries, coverage of infants with 3 doses of diphtheria toxoid reached 46% in 1985, and 79% in 1992. Recent diphtheria outbreaks in Algeria, China, Ecuator, Jordan, Lesotho and Sudan demonstrate a shift in the age distribution of cases to older children and adults. Rapid clinical and public health responses are required to control diphtheria outbreaks. Three major measures are indicated: high immunization coverage of target groups, prompt diagnosis and management of diphtheria cases, and rapid identification of close contacts with their effective management to prevent secondary cases.
The article discusses methodological investigations for the improvement and unification of soil testing in combination with the application of complex physico-chemical methods. An analytical procedure involving different extractions was used in order to determine the total and mobile amount of heavy metals (Cd, Cr, Pb, Ni, Cu, Zn, etc.) by atomic absorption spectrophotometry in soil and its fine-dispersive fraction (< 0.005 mm). The average samples (effected upon by background pollution) of Calcari Epihypogleyic Luvisol, (Lvg-p-w-cc, FAO-Unesco, 1998) has been taken from the rotation field of the experimental station of the Lithuanian University of Agriculture Subsequently, a fine-dispersive fraction was separated by a principle of peptization in distilled water. The investigation results obtained have shown a substantial dependence on the extractor used and the amount of fine-dispersive fraction in soil as well. It was found that the greatest reliability of the mobile heavy metal form is by using 1N CH3 COONH4 extractor and an HCl+HF mixture extractor for their total amount. Additionally, for the first time in Lithuania, the X-ray photoelectron spectroscopy (XPS) it has been applied for the interpretation of soil chemical composition.
The adoption of the Ombrédanne inhaler in Germany is surveyed mainly using the circumstances surrounding its acceptance and distribution. In addition, the figure of Louis Ombrédanne is brought into recollection and expanded. For this purpose historical literature was drawn upon, correspondence with companies was initiated, interviews were carried out and important localities in his life as well as the Académie de Chirurgie itself (Paris) were visited. The "Ombrédanne" reached Germany indirectly via Lithuania and Argentina 19 years after its introduction in France. In the time following, however, it was highly acclaimed in publications and extensively used in civilian and military areas up until World War II. With regard to its adoption and diffusion the question of possible influencing factors arises pertaining to the impediment or furtherance of acceptance outside France. Louis Ombrédanne, the inventor of the apparatus, was a great surgeon, a fascinating personality even today but not an active trailblazer of modern anaesthesiology.
AIMS/HYPOTHESIS: We have previously observed an inverse correlation between the incidence of type 1 diabetes and enterovirus infections in the background population. The aim of this study was to analyse whether maternal enterovirus antibody status, which reflects both the frequency of enterovirus infections and the protection conferred by the mother on the offspring, also correlates with the incidence of type 1 diabetes. METHODS: Maternal enterovirus antibodies were analysed from serum samples taken from pregnant women between 1983 and 2001 in Finland and Sweden using enzyme immunoassay and neutralisation assays. Comparable samples were also taken between 1999 and 2001 in countries with a lower incidence of diabetes (Estonia, Germany, Hungary, Israel, Lithuania, Russia). RESULTS: A clear decrease was observed in maternal enterovirus antibody levels over the past 20 years (p<0.0001). The frequency of enterovirus antibodies was higher in countries with a low or intermediate incidence of type 1 diabetes compared with high-incidence countries (p<0.0001). CONCLUSIONS/INTERPRETATION: These findings are in line with our previous observations supporting the hypothesis that a low frequency of enterovirus infection in the background population increases the susceptibility of young children to the diabetogenic effect of enteroviruses.
Surgical excision of papillomas remains the mainstay of the management of laryngeal papillomatosis, as causal therapy is not yet available. Eighty-nine patients -32 with juvenile papillomatosis (JP) and 57 with adult papillomas (AP)-- underwent endolaryngeal microsurgery (EM) in our department during the last 15 years. The ENT-department in Kaunas serves most of the patients with laryngeal papilloma among the 3.85 million inhabitants of Lithuania. Therapeutic outcome was assessed as both the recurrence rate and the length of time between recurrences of papillomas in the follow-up period lasting at least 2 years. The recurrence rate was 71.9% (23 patients) in the JP group and 22.8% (13 patients) in the AP group. The interval between recurrences of papillomas ranged from 1 month to 10 years (mean 1.9 years) in the JP group and from 6 months to 9 years (mean 3.2 years) in the AP group. The number of EMs per patient ranged from 1 to 18 (mean 3.2) in the JP group and from 1 to 5 (mean 1.35) in the AP group. EM is a minimally invasive and safe technique which provides accurate removal of papillomas, although recurrence is often unavoidable. Prognosis for the disease therefore remains rather unpredictable.
We report a large genomic deletion of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, viz., a deletion that is frequently observed in Central and Eastern Europe. The mutation, termed CFTRdele2,3(21 kb), deletes 21,080 bp spanning introns 1-3 of the CFTR gene. Transcript analyses have revealed that this deletion results in the loss of exons 2 and 3 in epithelial CFTR mRNA, thereby producing a premature termination signal within exon 4. In order to develop a simple polymerase chain reaction assay for this allele, we defined the end-points of the deletion at the DNA sequence level. We next screened for this mutation in a representative set of European and European-derived populations. Some 197 CF patients, including seven homozygotes, bearing this mutation have been identified during the course of our study. Clinical evaluation of CFTRdele2,3(21 kb) homozygotes and a comparison of compound heterozygotes for deltaF508/CFTRdele2,3(21 kb) with pairwise-matched deltaF508 homozygotes indicate that this deletion represents a severe mutation associated with pancreatic insufficiency and early age at diagnosis. Current data show that the mutation is particularly common in Czech (6.4% of all CF chromosomes), Russian (5.2%), Belorussian (3.3%), Austrian (2.6%), German (1.5%), Polish (1.5%), Slovenian (1.5%), Ukrainian (1.2%), and Slovak patients (1.1%). It has also been found in Lithuania, Latvia, Macedonia and Greece and has sporadically been observed in Canada, USA, France, Spain, Turkey, and UK, but not in CF patients from Bulgaria, Croatia, Romania or Serbia. Haplotype analysis has identified the same extragenic CF-haplotype XV-2c/KM. 19 "A" and the same infrequent intragenic microsatellite haplotype 16-33-13 (IVS8CA-IVS 17bTA-IVS 17bCA) in all examined CFTRdele2,3(21 kb) chromosomes, suggesting a common origin for this deletion. We conclude that the 21-kb deletion is a frequent and severe CF mutation in populations of Eastern- and Western-Slavic descent.