Medicina

312 KiB

Open AccessArticle

Modern attitude towards management of laryngopharyngeal form of gastroesophageal reflux disease. Lithuanian clinical practice guidelines for adults

by Nora Šiupšinskienė, Virgilijus Uloza, Rūta Pribuišienė, Evaldas Butkus and Limas Kupčinskas

Medicina 2007, 43(10), 832; https://doi.org/10.3390/medicina43100107 - 17 Oct 2007

Cited by 1 | Viewed by 804

Abstract

The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary [...] Read more.

The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary care physicians as well as otorhinolaryngologists and gastroenterologists for the management of adults with uncomplicated laryngopharyngeal form of gastroesophageal reflux disease. Committee composed of experts from Lithuanian Otorhinolaryngological and Gastroenterological Societies developed guidelines based on a comprehensive review of the evidence-based literature related to laryngopharyngeal form of gastroesophageal reflux disease and guidelines of other countries. The guidelines provide description of each medicine groups with emphasis on proton pump inhibitors as the most effective drugs for the treatment of laryngopharyngeal form of gastroesophageal reflux disease. Indications for empirical treatment with proton pump inhibitors are described, as well as duration of treatment, doses, optimal regimen of use, and assessment of treatment efficacy. The therapy should begin with the application of proton pump inhibitors twice daily, before meal for three months. Combined therapy for nonresponders is described. Algorithm for stopping the medication is recommended. These recommendations may provide an efficient and economical approach to the management of this problem. Full article

247 KiB

Open AccessArticle

Health behavior of families having preschool-age children

by Aušra Petrauskienė, Liudmila Dregval and Sandra Petkutė

Medicina 2007, 43(10), 816; https://doi.org/10.3390/medicina43100105 - 17 Oct 2007

Cited by 6 | Viewed by 856

Abstract

The aim of this study is to assess health behavior among families growing up the preschool children. The study was performed in 2007 in Kaunas kindergartens selected randomly. The anonymous questionnaires were filled in by 271 families. Mothers answered to the questions more [...] Read more.

The aim of this study is to assess health behavior among families growing up the preschool children. The study was performed in 2007 in Kaunas kindergartens selected randomly. The anonymous questionnaires were filled in by 271 families. Mothers answered to the questions more frequently than fathers did. Fathers were less educated than mothers. It was estimated that preschool-age children used fresh vegetables and fruits insufficiently. Two-thirds of children ate fresh vegetables at least once a day, and only 1 of 20 – 3 times a day. Children ate fresh fruits more frequently than vegetables: every tenth child used them three times a day. The tendency of relation between parents’ education and frequency of eating fresh vegetables and fruits was established. More frequently they were used in families where parents had university education. Physical activity of examined families was insufficient. Half of the parents have never done their morning exercises, and about half of the preschool-age children did their exercises rarely (12.5%) or never (41.4%). The majority of children exercised every day in families where fathers had incomplete secondary/secondary education. Children spend much time passively watching TV or playing with computer. Harmful habits among parents are spread widely in the families: more than one-third of fathers and every thirteenth mother smoke regularly; alcohol is used in the majority of families. Full article

246 KiB

Open AccessArticle

Anticholinergic effect of 2-aminopyridine and its sulfonylcarbamide derivatives on electromechanical activity in guinea pig atrium

by Vida Gendvilienė, Danguolė Zablockaitė, Irma Martišienė, Herta Gurskaitė and Antanas Stankevičius

Medicina 2007, 43(10), 808; https://doi.org/10.3390/medicina43100104 - 17 Oct 2007

Cited by 3 | Viewed by 700

Abstract

The aim of the study was to investigate an action of 2-aminopyridine and its new sulfonylcarbamide derivatives 2-AP21, 2-AP22, 2-AP26, and 2-AP27 (10^–5–10^–3 M) on carbachol-induced shortening of action potential duration and reduction of contraction force in guinea pig atrial [...] Read more.

The aim of the study was to investigate an action of 2-aminopyridine and its new sulfonylcarbamide derivatives 2-AP21, 2-AP22, 2-AP26, and 2-AP27 (10^–5–10^–3 M) on carbachol-induced shortening of action potential duration and reduction of contraction force in guinea pig atrial muscles. Experiments were carried out using a standard method of myocardium electromechanical activity registration. Under control conditions (perfusion of atrial strips with Tyrode solution), an average of action potential duration, measured at 90% (AP₉₀) and 50% (AP₅₀) of repolarization, were 112.32±6.07 ms and 50.21±3.25 ms, (n=19), respectively, and contraction force was of 1.42±0.28 mN (n=20). Carbachol (10^–6M), an agonist of muscarinic acetylcholine receptor and activator of K_Achchannels, markedly decreased AP₉₀ to 35.31±4.21%, AP50 – to 26.42±2.66% (n=19) (P<0.001), and contraction force – to 24.23±2.0% (n=20) (P<0.001) vs. control. Modification of 2-aminopyridine structure by replacing 2-amino group by 4-toluolsulfonylcarbamide fragment and quaternization of nitrogen in pyridine ring increased anticholinergic effect on action potential duration and contraction force. According to their maximal prolongation of AP at 90% of repolarization, all new drugs ranked as follows: 2-AP27>>2-AP26>2-AP22³2-AP>2-AP21. 2-aminopyridine derivative 2-AP27, containing 4-toluolsulfonylcarbamide fragment and 4-nitrobenzyl radical at quaternized nitrogen of the pyridine, had the most potent anticholinergic effect on AP₉₀ (936.60±178.23%). 2-AP22 and 2-AP26 (containing methyl or allyl radicals at quaternized nitrogen of the pyridine, respectively) showed a much weaker anticholinergic effect (231.39±28.48% and 318.25±63.81%, respectively). The weakest anticholinergic effect (63.59±34.38%) was induced by 2-aminopyridine derivative 2-AP21, which had non-quaternized nitrogen of the pyridine. Full article

603 KiB

Open AccessArticle

Idiopathic ventricular tachycardia in children: curative therapy with radiofrequency ablation

by Dalia Bakšienė, Rima Šileikienė, Vytautas Šileikis, Tomas Kazakevičius, Vytautas Zabiela, Migla Žėbienė and Aras Puodžiukynas

Medicina 2007, 43(10), 803; https://doi.org/10.3390/medicina43100103 - 17 Oct 2007

Cited by 8 | Viewed by 867

Abstract

Idiopathic ventricular tachycardia is a rare condition, and there is a lack of clear guidelines for the necessity and indications for prophylactic antiarrhythmic or curative treatment. The aim of this study was to review the clinical picture of idiopathic ventricular tachycardia and evaluate [...] Read more.

Idiopathic ventricular tachycardia is a rare condition, and there is a lack of clear guidelines for the necessity and indications for prophylactic antiarrhythmic or curative treatment. The aim of this study was to review the clinical picture of idiopathic ventricular tachycardia and evaluate the efficacy and safety of radiofrequency ablation therapy in children.
Material and methods. The subjects of this study were 16 children with idiopathic ventricular tachycardia. The mean age at onset of idiopathic ventricular tachycardia was 12 years. All patients underwent electrophysiological examination. Nonfluoroscopic mapping technology (CartoTM) was used in one case. Radiofrequency ablation was performed in all children (mean duration of follow-up was 46 months).
Results. Six children with idiopathic ventricular tachycardia were free of symptoms. Palpitation was the only complain in four patients, and six patients presented with symptoms of circulatory disorder (the tendency of the higher rate of ventricular tachycardia and more premature contractions and episodes of ventricular tachycardia in one day were noticed in five of them). All children after radiofrequency ablation were alive, and only one complication (complete right bundle branch block) occurred. Success at last follow-up included five children with left and six with right idiopathic ventricular tachycardia.
Conclusions. Catheter ablation seems a promising therapeutic option with the outlook possible of the idiopathic ventricular tachycardia in children. It is safe enough and should be considered as the therapy of choice even in children without of symptoms if they wish to live active social and physical life. Full article

158 KiB

Open AccessArticle

The dependence of successful resuscitation on electrocardiographically documented cardiac rhythm in case of out-of-hospital cardiac arrest

by Nedas Jasinskas, Dinas Vaitkaitis, Vidas Pilvinis, Lina Jančaitytė, Gailutė Bernotienė and Paulius Dobožinskas

Medicina 2007, 43(10), 798; https://doi.org/10.3390/medicina43100102 - 17 Oct 2007

Cited by 6 | Viewed by 810

Abstract

Objective. To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city.
Material and methods. An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in [...] Read more.

Objective. To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city.
Material and methods. An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in Kaunas city with a population of 360 627 inhabitants. In this period, all cases of cardiac arrest were analyzed according to the guidelines of the Utstein consensus conference. Cardiac arrest (both of cardiac and noncardiac etiology) was confirmed in 72 patients during one year. Effective cardiopulmonary resuscitation was performed in 18 patients.
Results. The total number of deaths from all causes in Kaunas during 1-year study period was 6691. Sixty-two patients due to sudden death of cardiac etiology were resuscitated by emergency medical services personnel. Return of spontaneous circulation was achieved in 11 patients. Ventricular fibrillation was observed in 33 (53.2%) patients. Asystole was present in 11 (17.7%) and other rhythms in 18 (29.1%) cases. Patients with ventricular fibrillation as an initial rhythm were more likely to be successfully resuscitated than patients with asystole.
Conclusions. Ventricular fibrillation was the most common electrocardiographically documented cardiac rhythm registered during cardiac arrest in out-of-hospital settings. Ventricular fibrillation as a mechanism of cardiac arrest was associated with major cases of successful resuscitation. Full article

228 KiB

Open AccessArticle

Transition zone volume measurement – is it useful before surgery for benign prostatic hyperplasia?

by Daimantas Milonas, Aivaras Matjošaitis and Mindaugas Jievaltas

Medicina 2007, 43(10), 792; https://doi.org/10.3390/medicina43100101 - 17 Oct 2007

Cited by 8 | Viewed by 776

Abstract

Objective. The aim of this study was to estimate the equivalence and correlation between transition zone volume, measured by transrectal ultrasound, and removed prostate tissue weight in surgically treated patients due to benign prostatic hyperplasia.
Material and methods. This study involved 168 [...] Read more.

Objective. The aim of this study was to estimate the equivalence and correlation between transition zone volume, measured by transrectal ultrasound, and removed prostate tissue weight in surgically treated patients due to benign prostatic hyperplasia.
Material and methods. This study involved 168 patients with histologically confirmed benign prostatic hyperplasia. Of these patients, 120 underwent transurethral resection of the prostate and 48 – open prostatectomy. The weights of the specimens were compared with the corresponding volumes of the transition zone. Equivalence and correlation between transition zone volume and removed tissue weight were analyzed.
Results. The mean (standard deviation, range) transition zone volume was 25.43 mL (±13.19, 5–61.6) in the transurethral resection group and 76.1 mL (±42.97, 13–275.8) in the open operation group. The mean removed tissue weight was 22.9 g (±13.41, 5–66) and 73.96 g (±44.96, 18– 280), respectively, in the transurethral resection and open operation groups. The correlation between removed tissue weight and transition zone volume was stronger in the open operation group than it was in the resection group (r=0.957, P<0.001 vs. r=0.878, P<0.001). There was a significant difference between transition zone volume and resected tissue weight (P=0.001). However, in the open operation group, there was an agreement between transition zone volume and enucleated tissue weight (P=0.263).
Conclusions. A significant correlation was detected between removed tissue weight and transition zone volume. There is a significant difference between volume measurement and resected tissue weight while enucleated tissue weight was in agreement with transition zone volume when an open prostatectomy was performed. Full article

240 KiB

Open AccessArticle

Possibilities of platelet function assays

by Aušra Mongirdienė

Medicina 2007, 43(10), 767; https://doi.org/10.3390/medicina43100098 - 17 Oct 2007

Cited by 2 | Viewed by 816

Abstract

The aim of this article is to review various methods used and started to introduce into practice for determining platelet function, their possibilities, advantages, and disadvantages. Nowadays, in platelet function investigations, devices and their systems with unequal possibilities, operating in different principles, are [...] Read more.

The aim of this article is to review various methods used and started to introduce into practice for determining platelet function, their possibilities, advantages, and disadvantages. Nowadays, in platelet function investigations, devices and their systems with unequal possibilities, operating in different principles, are used. However, because of a wide variety of platelets defects, none of them gives the accuracy of 100%. In order to avoid mistakes, several assays are used. Analysis of platelets function testing is represented in two ways: according to its investigation object and investigation methods and according to the most frequently used platelet function assays. The most important criteria are presented in two different tables. Full article

225 KiB

Open AccessArticle

The activity of the Clinic of Ophthalmology as the subunit of the Faculty of Medicine of the University of Lithuania (Vytautas Magnus University) during 1922–1938

by Asta Lignugarienė, Jadvyga Petrauskienė and Snieguolė Kaselienė

Medicina 2007, 43(10), 757; https://doi.org/10.3390/medicina43100097 - 17 Oct 2007

Viewed by 755

Abstract

The aim of the study was to evaluate the activity and the validity of the expansion of the Clinic of Ophthalmology of the University of Lithuania (since 1930 – Vytautas Magnus University) operating in Kaunas city between 1922 and 1938. The evaluation was [...] Read more.

The aim of the study was to evaluate the activity and the validity of the expansion of the Clinic of Ophthalmology of the University of Lithuania (since 1930 – Vytautas Magnus University) operating in Kaunas city between 1922 and 1938. The evaluation was based on the analysis of changes in inpatient and outpatient flow, the structure of cases of inpatient treatment, and the usage of beds. In the analysis, we used annual reports of the Clinic of Ophthalmology as well as data presented in statistical publications of the Department of Health for the studied period. The changes in the indices of the activity of the Clinic were evaluated using the logarithmic regression coefficient. A more rapid increase in the number of patients discharged from the Clinic of Ophthalmology was observed during 1922–1930 (on the average, by 9% per year). During 1931–1938, only the number of discharged men was increasing. During the studied period, the majority of the cases of inpatient treatment were lenticular diseases (19%), trachoma (16%), and corneal diseases (16%). During 1922–1930, the sharpest increase was observed in the number of inpatients with eyeball diseases and eye traumas (on the average, by 12.3% per year) and during 1931–1938, in the number of patients with trachoma (on the average, by 6.7% per year). The analysis of the indices of the activity of the inpatient unit confirmed the need for the expansion of the Clinic during 1922–1930, but revealed that the expansion of the material basis of the Clinic up to 50 beds during 1931–1938 was not efficient. In the outpatient unit of the Clinic of Ophthalmology, the number of visits per year and the number of admitted patients per year during the studied period increased by 2.5 and 3.5 times, respectively. Full article

222 KiB

Open AccessArticle

Leptin levels at birth and in early postnatal life in small- and appropriate-for-gestational-age infants

by Margarita Valūnienė, Rasa Verkauskienė, Margaret Boguszewski, Jovanna Dahlgren, Danutė Lašienė, Liudvikas Lašas and Kerstin Albertsson Wikland

Medicina 2007, 43(10), 784; https://doi.org/10.3390/medicina43100100 - 09 Oct 2007

Cited by 44 | Viewed by 1102

Abstract

The aim of this study was to evaluate leptin concentration at birth and in early postnatal life in small- and appropriate-for-gestational-age infants and to assess its relationship with infants’ anthropometry at birth and some characteristics of maternal pregnancy.
Materials and methods. A [...] Read more.

The aim of this study was to evaluate leptin concentration at birth and in early postnatal life in small- and appropriate-for-gestational-age infants and to assess its relationship with infants’ anthropometry at birth and some characteristics of maternal pregnancy.
Materials and methods. A total of 367 infants born after 32–42 weeks of gestation were enrolled in the study. Umbilical cord blood samples were collected from 80 small- and 287 appropriate- for-gestational-age newborns. Altogether, 166 venous blood samples were taken from these neonates on days 2–6 of life.
Results. Cord leptin levels were significantly lower in small- compared to appropriate-forgestational- age infants. We observed a positive correlation between cord leptin and birth weight, all neonatal anthropometric parameters, placental weight, and some maternal nutritional factors. In multivariate analysis, cord leptin concentration explained up to 15% of the variation in sum of newborn’s skinfold thickness but only 5% of the variation in birth weight. Postnatally, leptin concentration decreased markedly to the similar low levels in both infant groups and remained so during the first postnatal week.
Conclusions. Significantly lower cord leptin concentration in small-for-gestational-age neonates reflects a lower fat mass content compared to appropriate-for-gestational-age infants. However, an abrupt decrease in leptin levels shortly after birth in both groups suggests that placenta could be an important source of leptin in fetal circulation. The impact of low leptin levels at birth in small-for-gestational-age infants on their postnatal appetite and weight gain remains to be elucidated in future studies. Full article

183 KiB

Open AccessArticle

Clinical cosmobiology: distribution of deaths during 180 months and cosmophysical activity. The Lithuanian study, 1990–2004 The role of cosmic rays

by Elyiahu Stoupel, Ramunė Kalėdienė, Jadvyga Petrauskienė, Skirmantė Starkuvienė, Evgeny Abramson, Peter Israelevich and Jaqueline Sulkes

Medicina 2007, 43(10), 824; https://doi.org/10.3390/medicina43100106 - 07 Oct 2007

Cited by 10 | Viewed by 924

Abstract

The aim of this study is a next step of our previous, initial, publications – to explore the links between monthly death number (total, and for the major death causes and each gender) with levels of monthly cosmophysical activity in a long-term, big [...] Read more.

The aim of this study is a next step of our previous, initial, publications – to explore the links between monthly death number (total, and for the major death causes and each gender) with levels of monthly cosmophysical activity in a long-term, big cohort observation.
Methods. Death number during 180 consecutive months from the National Registry of Lithuania for years 1990–2004 were studied. A total of 630 205 deaths were analyzed (333 035 males). For comparison, monthly indices of solar activity, geomagnetic activity, and cosmic ray activity and year and month (1–12) of the study were used. The cosmophysical data were obtained from space research centers in the USA, Russia, and Finland.
Statistics. Pearson correlation coefficients (r) and their probabilities (P) between compared parameters were calculated. A multivariate model of prediction was designed.
Results. It was a significant correlation between total monthly death number and indices of cosmic ray activity and, inverse, of solar activity; in men stronger than in women. Monthly geomagnetic activity was significantly correlated with traffic accidents, ischemic heart disease/ stroke ratio, suicide victim number. Deaths from stroke, noncardiovascular causes, suicide, traffic accidents were related with cosmic ray activity and, inverse, with solar activity. Relationship of ischemic heart disease/stroke ratio to year of observation showed additional evidence for the growing role of stroke in cardiovascular mortality.
Conclusions. Monthly death number is linked to cosmic ray activity, and inverse, to solar activity. Central place of stroke-related deaths in cardiovascular mortality is emerging. Geomagnetic activity, in monthly account, plays a relatively minor role. We presume that forces antagonistic to cosmic ray activity, like solar activity and geomagnetic activity, can prevent some negative biologic effects of cosmic ray. Full article

226 KiB

Open AccessArticle

Relationship between isolation of extended spectrum beta-lactamase-producing Klebsiella pneumoniae and course of hospital-acquired pneumonia

by Astra Vitkauskienė, Agnė Giedraitienė, Vytis Dudzevičius and Raimundas Sakalauskas

Medicina 2007, 43(10), 778; https://doi.org/10.3390/medicina43100099 - 15 Sep 2007

Cited by 1 | Viewed by 887

Abstract

Aim of the study. To evaluate relationship between isolation of extended spectrum beta-lactamaseproducing Klebsiella pneumoniae strains and course of hospital-acquired pneumonia.
Materials and methods. K. pneumoniae strains isolated from bronchial secretions or bronchoalveolar lavage fluid samples of patients hospitalized at an intensive [...] Read more.

Aim of the study. To evaluate relationship between isolation of extended spectrum beta-lactamaseproducing Klebsiella pneumoniae strains and course of hospital-acquired pneumonia.
Materials and methods. K. pneumoniae strains isolated from bronchial secretions or bronchoalveolar lavage fluid samples of patients hospitalized at an intensive care unit of Kaunas University of Medicine Hospital were analyzed. By means of synergistic two-antibiotics disc method, K. pneumoniae strains producing extended spectrum beta-lactamases were selected for further analysis using E-test (AB Biodisk, Solna, Sweden). Hospitalacquired pneumonia was diagnosed based on standard criteria for the diagnosis of pneumonia if signs of pneumonia occurred after 48 hours following admission. Late-onset hospital-acquired pneumonia was considered if these signs of pneumonia occurred on fifth day of hospitalization or later.
Results. Total of 45 strains of K. pneumoniae were isolated during the study period; 18 isolated strains produced ESBL. Thirty-two patients investigated have developed hospital-acquired pneumonia, 20 of which were cases of late-onset hospital-acquired pneumonia. Thirteen cases of K. pneumoniae isolation were classified as airway colonization. Extended spectrum beta-lactamase-producing K. pneumoniae strains were more frequently isolated from patients with hospital-acquired pneumonia (88.9%, n=16 and 11.1%, n=2, P<0.05) in comparison with non-producing strains. Extended spectrum beta-lactamase-producing strains were more prevalent in late-onset pneumonia group (93.8%, n=15) than in early-onset group (6.2%, n=1, P<0.001).
Conclusions. Extended spectrum beta-lactamase-producing K. pneumoniae strains were more frequently isolated from patients with hospital-acquired pneumonia as compared to colonized patients. Extended spectrum beta-lactamase-producing K. pneumoniae strains were more frequently isolated from patients with late-onset hospital-acquired pneumonia. Full article

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Medicina, Volume 43, Issue 10 (October 2007) – 11 articles

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