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PubMed2002

[Comparison of electrocardiographic parameters during pneumoperitoneum in patients without cardiovascular diseases and in patients with ischemic heart disease].

UNLABELLED: Pneumoperitoneum induces significant pathophysiological changes. Changes in performance of cardiovascular system can be severe in patients with compromised cardiac function. Groups of patients to whom these changes may be deleterious are yet to be identified. Aim of the study was to elucidate the influence of pneumoperitoneum on the electrocardiographic recording. PATIENTS AND METHODS: 35 cardiovascular healthy (ASA I-II) patients (group 1) and 34 patients with underlying moderate ischemic heart disease (ASA II-IV, Goldman's cardiac risk class II-III) (group 2), scheduled for elective laparoscopic cholecystectomy, were included in the study. Premedication included sedatives for all patients and the group 2 received their usual cardiovascular treatment one hour before operation. A standardized protocol of monitoring and anesthesia was followed in the operating room. 12 lead electrocardiograms (ECG) were obtained before and after induction of anesthesia, every 10 minutes during pneumoperitoneum, after the peritoneal desufflation and after extubation. The ECGs were recorded and analysed by the means of computerized system for ECG record and analysis "Kaunas" (UAB "Kardiosignalas", Kaunas, Lithuania). The analysis was performed postoperatively. RESULTS: During pneumoperitoneum a deviation of cardiac electrical axis to the left was observed. There were no marked changes in duration of P wave, P-Q interval, and QRS complex. Following abdominal insufflation a tendency to flattening of T wave was observed returning to the initial position after desufflation. No significant dislocation of ST segment was recorded. CONCLUSIONS: The pneumoperitoneum induced changes of cardiac electrical axis can affect the interpretation of ECG seen on a cardiac monitor during anesthesia. Pneumoperitoneum does not pose patients with moderate ischemic heart disease at additional risk of developing myocardial ischemia.

Anesthesia, Endotracheal↗
PubMed2002

[Some aspects of diagnosis and treatment of cervical intraepithelial neoplasia (review of the literature)].

Cervical cancer has remained close to the forefront of oncologic studies even in our days. The incidence of the disease has changed little, except in those countries with effective screening programs. The morbidity in Lithuania reached 23.9/100,000 in the 2000's, while in comparison the morbidity in the 1994's was 20.4/100,000. The mortality was 13.2 and 11.3/100,000, respectively. Over the last 50 years our understanding of the etiology and pathogenesis of lower genital tract squamous neoplasia has increased enormously and, particularly in the last 15 years, progress in our understanding of the molecular events associated with lower anogenital tract neoplasia has developed rapidly. Cervical cancer is the second most common type of cancer in women worldwide, after breast cancer. Since 1978 it is known that Human Papillomavirus is closely related to genital neoplasia--cervical, vulva, vagina, penis, anus intraepithelial neoplasia and invasive carcinoma. It is also known that cytologic smear is one of the most important way to diagnose cervical intraepithelial neoplasia and cancer as well, because we can not evaluate cervical lesion visually. Cytologic smear remains the main principle of cancer screening because of its simplicity and accessibility, while colposcopy remains the method of examination in choice, when pathologic cytologic findings are determined.

Adolescent↗
PubMed2002

[Relationships between social factors and suicidal attempts of adolescent girls].

This study presents a comparative analysis of family and school situation among adolescent girls, who attempted a suicide and those who did not. The control group was represented by normative sample of school girls of Lithuania. The results indicate that most of the attempters live in incomplete families, with step-father, step-sisters and step-brothers. The results showed that there were more conflicts within families of the attempters than within the other groups of the study. The girls, who completed a suicide attempt more often reported about arguing with their parents. They also appeared to brake the law more frequently and also they experienced abuse more often than girls in the control group. The attempters more frequently reported about financial difficulties of their families. Those girls also reported more problems at school such as truancy. The attempters also evaluated their academic achievements much lower than girls in the control group.

Adolescent↗
PubMed2002

[The assessment of infant motor development disorders in primary health care institutions].

OBJECTIVE: The delay or disorders of infant motor development require early screening and treatment. The objective of this study was to investigate the possibilities to assess infant motor development disorders in primary health care institutions of central part of Lithuania. MATERIALS AND METHODS: The original questionnaires were sent to primary health care institutions of Kaunas district. One-hundred-forty-eight questionnaires with answers of General Practitioners and Pediatricians returned to investigators. RESULTS: Analysing the data we found that one physician in average takes care of 28.8 +/- 18.4 infants, among these infants 3.55 +/- 4.2 have disorders of motor development. Most of the doctors (92.6%) evaluate the infant motor development, but use only the method of routine clinical assessment. Very few physicians (4.8%) use very precise methods of assessment (Munich diagnostic scheme or Bobath method). Among all doctors 66.9% expressed the will to asses infant motor development by themselves in primary health care clinic. CONCLUSIONS: We conclude, that General Practitioners and Pediatricians feel the lack of competence and assistant aids for the assessment of motor development disorders in infants.

Child Development↗
PubMed2002

[Laparoscopic colposuspension - effective, minimally invasive method of treatment of female urinary incontinence].

THE AIM OF WORK: To describe laparoscopic method of treatment of female stress urinary incontinence, indications and contraindications for this operation, to show the first results of this operation in Lithuania, to find out the advantages of this method in comparison with open classical operations. MATERIALS AND METHODS: Ten patients were operated on laparoscopically in the period 1999-2001 due to stress urinary incontinence. The original Burch operation with sutures was performed for two patients, in 8 cases the colposuspension was performed using ligaments (prolene mesh). Transperitoneal colposuspension was performed in 9 cases, extraperitoneal - in one case. Laparoscopic cholecystectomy was performed simultaneously for 3 patients. The average time of hospitalization was 7 days, postoperative stay - 4 days. Catheter in urine bladder was removed after three days, in two cases the remaining urine was observed. RESULTS: Postoperatively in 9 cases the cystocele has disappeared, in one case the recurrence of cystocele was observed. Three months after laparoscopic colposuspension, results as very good were evaluated in 8 cases, good - in one case, satisfactory - in one case (urine continence, imperative urination with minimal urine flow). CONCLUSIONS: Laparoscopic colposuspension - effective method of treatment of stress urinary incontinence, having more advantages in comparison with open operations: shorter time of hospitalization, good postoperative results. The operation is safe, esthetic, with no postoperative hernias. It is an interesting alternative for open operations.

Cholecystectomy, Laparoscopic↗
PubMed2002

[Percutaneous transthoracic fine needle aspiration of lung tumors by computed tomography examination].

Morbidity of lung cancer in Lithuania is increasing. Early diagnostics of this disease is important, difficult and necessary. During 2001, 169 patients with first and second stages of lung cancer were treated in Department of Thoracic Surgery at Kaunas Oncology Hospital. Age of patients was 30-80 years. We have analysed 20 patients with small peripheral lung tumors. Diagnosis was not confirmed by X-ray and fibrobronchoscopic examination. Percutaneous transthoracic fine needle aspiration of small lung tumors was determined by computed tomography (CT) examination. The diameter of tumors were 2.5-4.5 cm. After percutaneous transthoracic fine needle aspiration the diagnosis of lung cancer was confirmed to 15 (70.5 perc.) patients: carcinoma planocellulare - 13, Adenocarcinoma - 2 patients. Metastasis (solitary) from carcinoma renis to 1, abscessus pulmonis (necrotic masses) to 2, tuberculoma (tuberculosis) to 1 patients. After CT examination, percutaneous transthoracic fine needle aspiration and histologic examination diagnosis were confirmed: Carcinoma pulmonis stage I (T1N0M0-T2N0M0) to 5 patients, Carcinoma pulmonis stage II (T2N1M0-T3N0M0) to 9 patients, Carcinoma pulmonis III (T2N2M0) to 1 patient. There were 3 complications after percutaneous transthoracic needle aspiration: hemorrhage in tumor place to 2 patients, local pneumothorax to 1 patient. In all cases when we can not confirm diagnosis of small peripheral lung tumors we have to do CT examination and percutaneous transthoracic fine needle aspiration.

Adenocarcinoma↗
PubMed2003

[Personality correlations with depressiveness among adolescents].

OBJECTIVE: The aim of the study was to assess personality correlates of depressiveness as well as their relationships with the level of depressiveness. MATERIAL AND METHODS: The data on the depressiveness of 954 (452 boys and 502 girls) of ninth grade schoolchildren from 26 secondary schools of one administrative region of Lithuania were analyzed. The methods used in the study were Minnesota Multiphasic Personality Inventory for Adolescents, and Composite International Diagnostic Interview. RESULTS: Twenty two schoolchildren (5 boys and 17 girls) with extremely high scores on Minnesota Multiphasic Personality Inventory Depression scale were found to have depression or dysthymia. It was found that depressive boys and girls (high scores on scores Minnesota Multiphasic Personality Inventory Depression scale) had higher scores on Minnesota Multiphasic Personality Inventory clinical scales (except Mania scale, which was lower) as compared to the non-depressive ones. Girls with depressiveness, which corresponded to the level of depression or clinical dysthymia by Composite International Diagnostic Interview had higher scores on Minnesota Multiphasic Personality Inventory clinical scales (except Mania scale, which was lower), as compared to the other girls (both depressive and non-depressive, as measured by Minnesota Multiphasic Personality Inventory Depression scale). Girls with depressiveness, which corresponded to the level of clinical depression or clinical dysthymia, also had worse psychological adjustment. CONCLUSION: Depressive adolescents, boys and girls, differ from non-depressive ones by worse psychological adjustment. The level of depression did not differ from depressive girls (having high scores on Minnesota Multiphasic Personality Inventory Depression scale) in their non-adaptive personality characteristics, but markedly differed from that of other girls irrespective of theirs Minnesota Multiphasic Personality Inventory Depression scale scores.

Adaptation, Psychological↗
PubMed2003

[Prognosis of chronic renal failure in patients with membranous nephropathy].

Two hundred eighty patients underwent renal biopsy during the period of 1995-1999 in five nephrological centers of Lithuania. All renal biopsies materials were examined in the State Center of Pathology. In 20 patients (7.1%) membranous nephropathy was found. The main clinical presentation at the moment of renal biopsy were nephrotic syndrome (55%) and arterial hypertension (55%). Glomerulosclerosis was found in 30% of patients, interstitial fibrosis--in 40% of patients. The results of analysis showed multiple risk factors for renal failure progression: initial renal failure (p=0.000), systolic and diastolic hypertension (p=0.009 and p=0.009), proteinuria (=1 g/l, =3 g/l) (p=0.026). Membranous nephropathy was found to have a relatively good long-term prognosis - the renal survival rate in 5 years was 84.2%. Kaplan-Meier survival analysis showed that initial renal failure was risk factor (logrank p=0.018, Breslov p=0.032) associated with development of end-stage renal disease in 5 years.

Acute Kidney Injury↗
PubMed2003

[Bartter syndrome and it's neonatal type].

For the first time neonatal variant of Bartter syndrome to 14.5-year old girl is presented in Lithuania. It is a rare genetical disease with autosomal recessive inheritance. The patient was born prematurely, had polyhydramnion, polyuria and polydypsia, a craving for salt, specific outlook and was mentally retarded, had muscle weakness and nephrocalcinosis. Hypokalemia, hyperreninemia and metabolic alkalosis were found. Urine analysis revealed impaired renal concentration capacity, hypercalciuria and hypernatriuria. She had the symptom of systemic disease - osteopenia. Literature review on Bartter's syndrome is done.

Adolescent↗
PubMed2003

[Relationship between lethality of hemodialysis patients, erythropoietin dosage for renal anemia treatment and hemodialysis quality].

In December of 1999 and 2000 we visited all hemodialysis centers of Lithuania and collected data about all hemodialysis patients, using special questionnaires. The aim of the study was to evaluate the relationship between lethality of hemodialysis patients, erythropoietin dosage for renal anemia treatment and hemodialysis quality. The patients with higher Kt/V, higher levels of iron and albumin, normal levels of phosphorus and parathyroid hormone (PTH) requested lower doses of erythropoietin (analysis of the patients who were on hemodialysis in 2000 more than 6 months). So, we can conclude that adequate hemodialysis procedure and good management of hemodialysis patient are leading to the decrease request of erythropoietin doses for anemia treatment. We compared two groups of patients in order to examine relationship between hemodialysis quality and lethality of hemodialysis patients. We selected incident patients registered in December of 1999 and we divided these patients in December of 2000 in two groups: a) 175 patients, who continued hemodialysis treatment and b) 41 patients, who died in 2000. The results revealed, that dead patients were elder, their duration of weekly hemodialysis was shorter, Hb concentration lower, they had worse nutritional status (blood albumin level was lower). Lethality was associated with underlying diseases such as diabetes, hypertensive nephropathy and renal amyloidosis.

Adolescent↗
PubMed2003

[Anti interleukin-2 receptor alpha antibodies (daclizumab) application for the treatment of kidney recipients].

UNLABELLED: Acute rejection is a known risk factor for developing chronic allograft nephropathy, which remains as a major cause of long-term graft loss. Daclizumab (Zenapax), a humanized anti interleukin-2 receptor (IL-2R) alpha monoclonal antibody, is a novel selective immunosuppressive agent for the prophylaxis of acute rejection. Six patients (aged from 32 to 48) after cadaver and living donor kidney transplantation (Tx) have been treated with Daclizumab since 2000 in Lithuania. Daclizumab was prescribed (1.0 mg/kg intravenously before Tx and once every other week afterwards (five dozes in total) for all patients, except one, who received two dozes. The induction therapy was administered due to various immunological risk factors: retransplantated, sensitized and poorly HLA-matched patients, as well as non-immunological risk factors such as patients with diabetes, with kidney from sub-optimal donors, obesity of patients, etc. The maintenance immunosuppression consisted of cyclosporine, mycophenolate mofetil and prednisolon in all patients except one, who was treated without steroids. All the patients have been folloved-up for 5-36 months. Within the observation period in early time after Tx all the patients are alive and have no clinical signs of rejection. The graft function is normal (serum creatinine ranges between 100-120 micromol/l). CONCLUSION: Induction therapy with Daclizumab is safe and efficacious in preventing acute rejection in high risk kidney recipients.

Acute Disease↗
PubMed2003

[Sentinel lymph node biopsy in melanoma patients: methods, indications, and clinical significance].

The incidence of melanoma in Lithuania has doubled over the last decade. Sentinel lymph node biopsy, currently becoming a standard method in the US and Europe, is a minimal invasive and highly sensitive surgical procedure. It can be used for the detection of melanoma micrometastasis in regional lymph nodes in cases when non-invasive methods fail to reveal them. Both disease-free survival and disease-specific survival were significantly better for patients with a negative sentinel lymph node biopsy. A. Breslow thickness, W. H. Clark level, and ulceration of the melanoma were strong predictors, but not as strong as the histological status of the sentinel lymph node. The procedure for sentinel lymph node biopsy is nowadays standardized, including preoperative dynamic lymphoscintigraphy combined with intraoperative gamma probe guidance and blue-dye injection. The aim of this article is to present an update of the sentinel lymph node biopsy method and the prognostic significance of this procedure on the basis of more than 400 sentinel lymph node biopsy's carried out at the Department of Dermatology of the Otto-von-Guericke University, Magdeburg since 1997 and the results of recently published studies in the literature.

Humans↗
PubMed2003

[Molecular factors of pancreatic cancer pathogenesis and prognosis].

There are more than 400 new pancreatic cancer cases in Lithuania each year. More than half of these cases are a stage four diseases. The survival of patients with pancreatic cancer is short (median survival of patients with metastatic disease is about 6 months) and the treatment is not very effective. Analysis of the etiopathogenesis of pancreatic cancer and search for the effective early diagnostic methods, which could predict the response to treatment and increase the survival of these patients, is important. This article is the review of literature about molecular pathogenetic and prognostic factors of pancreatic cancer. Most important of these factors to date are K-ras gene mutation and p53 abnormal protein detection. The detection of K-ras mutation has prognostic value. This mutation could be detected in different human tissues: in the tumor, in regional lymph nodes, plasma, pancreatic juice, stool and other body fluids. Analysis of factors of pancreatic cancer pathogenesis and prognosis will not only help in earlier diagnosis of this cancer, but also will help to apply the current treatment methods more effectively. Research on such factors will be the basis for creation of new treatment modalities like biological therapies.

Codon↗
PubMed2003

[Impact or physiological factors on some dimensions of health-related quality of life of elder men].

The article presents a fragment of the study exploring relations between various factors and health-related quality of life (HRQOL) of elder men. The aim of this article is to describe predictive influence of physiological variables (arterial blood pressure, body mass index (BMI), forced expiratory volume in 1 second (FEV(1))) on several dimensions of HRQOL assessed by "Rand-36 Health Survey" questionnaire. MATERIAL AND METHODS. The study enroled 575 male outpatients aged 59-78 from seven small towns of Lithuania. The study population was based on the original sample, formerly explored by the staff of the Department of Propedeutics to Internal Medicine, Kaunas University of Medicine. Measures of BMI, FEV(1) and blood pressure came from the baseline investigation carried out in 1983. HRQOL was assessed by means of standardized generic questionnaire. The predictive influence of physiological factors on current scores of HRQOL dimensions was determined by logistic regression analysis, controlling for the influence of sociodemographic, lifestyle and other factors. RESULTS. Physiological factors predicted scores of physical functioning, general health perceptions and emotional wellbeing. Systolic blood pressure >129 mmHg was associated with increased odds of relatively poor emotional status (OR=1.79, p=0.047). Diastolic blood pressure >80 mmHg was associated with a twofold increase in odds of poor physical functioning (OR=2.34, p=0.0013). Body mass index >34.9 kg/m(2) predicted poor physical functioning and worse general health perceptions in older age (OR=1.97, p=0.027 and OR=2.38, p=0.009, respectively). Measures of FEV(1) were associated with scores of physical functioning. 10% increase in FEV(1) was associated with reduction in odds of poor physical functioning by 52% (OR=0.48, p=0.045). CONCLUSIONS. BMI>34.9 kg/m(2) among men in adult age was related to poor physical functioning and worse perceptions of health in older age. Systolic blood pressure >129 mmHg and diastolic blood pressure >80 mmHg were predictive of worse emotional wellbeing and physical functioning, respectively. Higher measures of FEV(1) were associated with better physical functioning in later years.

Age Factors↗
PubMed2003

Changing society, changing allergens.

Changes in the political system in Lithuania have been reflected in different allergens. In the paper some changes in the house dust fauna and in the air are presented in relation to the new situation and in comparison to the previous period.

Dust↗
PubMed2004

Three kinds of cosmophysical activity: links to temporal distribution of deaths and occurrence of acute myocardial infarction.

BACKGROUND: The purpose of this study was to check for possible links between mortality statistics in a given month, generally from all causes and specifically from selected causes, and three kinds of cosmophysical activity: solar (SA), geomagnetic (GMA), and cosmic ray (CR). We also compared the results obtained for correlation by gender. MATERIAL/METHODS: 504,243 deaths were analyzed from the National Database of Lithuania (1990-2001); 102,604 OP deaths (1988-2000) were also included in this study and compared with data obtained from neutron monitoring data and other physical sources for the same time period. RESULTS: The total monthly number of deaths for 144 consecutive months was significantly and inversely correlated with SA and positively with CR activity, but not with GMA. The number of deaths from cancer, suicide, motor vehicle accidents, and acute myocardial infarction correlated with all three physical factors. SA and GMA show inverse effects as compared to CR. Ischemci heart disease deaths correlated only with GMA, cardiovascular accidents with SA and CR. Non-cardiovascular and suicide deaths were most strongly correlated to CR activity. CONCLUSIONS: The number of deaths is significantly related to physical activity in the space environment. These relationships show differences between kinds of deaths and significant correlation for the number of acute myocardial infarctions. Gender differences in links with physical activity in space were found in some of the compared groups.

Acute Disease↗
PubMed2004

[Possibilities of diagnosis and treatment of malignant pleural mesothelioma].

UNLABELLED: Objective of our work was to evaluate: incidence, ethiology, diagnostic and treatment methods of malignant pleural mesothelioma. MATERIAL AND METHODS: During period 1992-2001 125 cases of pleural mesothelioma were diagnosed in Lithuania. Conventional X-rays and ultrasound were used in 125 cases (100%), chest CT scans in 57 (45.6%), and chest X-rays and CT scans in 38 (30.4%) cases. In 5 cases (4.0%) we performed chest CT scans and MRI. Various surgical diagnostic methods were used: videothoracoscopy in 35 (28.0%) cases, pleural biopsies 72 (57.6%) cases, diagnostic "mini" thoracotomies - 18 (14.4%) cases. Malignant pleural mesothelioma in all cases was proved morphologically. These operations were performed: pleuropulmonectomies - 62 (60.1%), extended pleuropulmonectomies with resections of pericardium and subtotal diaphragm - 10 (9.7%), parietal pleurectomies without resection of lung and pericardium - 17 (16.5%), partial pleurectomies with resection of pericardium - 4 (3.8%), debulking of tumor (partial resections) - 10 (9.7%). Totally 103 patients were operated (82.4%). Twenty two patients were treated conservatively when diagnosis was confirmed. There were such main postoperative complications: fistulas of bronchial stump - 6 cases (5.8%), chylothorax - 5 cases (4.8%), injury of sympatic ganglion - 2 cases (1.9%), and hemothorax - 10 cases (9.7%); 3 patients (2.91%) died after operation. RESULTS: Mean survival time after combined treatment was 12+/-2 months. After conservative treatment alone - 6.0+/-2 months. In combined treatment group 22 patients (17.6%) had recurrence of disease during 3 years. In conservative treatment group no one survived 3 years. CONCLUSIONS: Combined surgical treatment of malignant pleural mesothelioma is still the most effective. Most of diagnosed cases were found in delayed stage. Mean survival time after combined treatment is 12.0+/-2 months, after conservative - 6.0+/-2 months, and recurrence of the disease during 3 years - 17.6% and 100% respectively.

Biopsy↗
PubMed2004

[Combined treatment of esophageal cancer: a review].

While still relatively uncommon in many countries, esophageal cancer is fatal in the vast majority of cases. In the USA, estimated 13,100 of new cases were diagnosed in 2002. In Lithuania, 163 new cases were diagnosed in 2001. Evidence for an association between environment, diet and esophageal cancer comes from the profound differences in incidence observed in different parts of the world. While the overall outlook for patients diagnosed with esophageal cancer has improved in the last 30 years, most patients are still present with advanced disease and their survival remains poor. Commonly etiology and risk factors of esophageal cancer are: cigarettes and alcohol, diet and other genetics factors. Only in 50% of patients with esophageal cancer clinically localized disease is present. National Comprehensice Cancer Network (NCCN) guidelines state that patients with clinically localized disease may be treated with resection or chemotherapy plus radiation. The overall survival rates for either surgery alone or combined chemotherapy and radiation appear equivalent. Chemoradiation as primary management of localized esophageal cancer has been shown to be superior in radiation alone. A series of randomized trials have demonstrated that adjuvant postoperative chemoradiation does not offer a survival advantage to patients with esophageal cancer. The superiority of preoperative chemoradiation over surgery alone in esophageal cancer has been demonstrated in a prospective trials. Recently published phase I and II studies have demonstrated moderate response rates to taxanes in esophageal cancer. Taxanes and irinotecan in combinations with platinum compounds and fluoropyrimidines are being tested in regimes with radiation.

Adenocarcinoma↗