Medicina

176 KiB

Open AccessArticle

Pulmonary edema and hemorrhage as complications of acute airway obstruction following anesthesia

by Irena Agnietė Marchertienė, Andrius Macas and Aurika Karbonskienė

Medicina 2008, 44(11), 871; https://doi.org/10.3390/medicina44110110 - 12 Nov 2008

Cited by 6 | Viewed by 824

Airway obstruction is a quite common complication while its conditioned pulmonary edema – rare. Causes associated with anesthesia are various. Forced inspiratory efforts against an obstructed upper airway generate peak negative intrathoracic pressure. This may cause pulmonary edema and in some cases pulmonary [...] Read more.

Airway obstruction is a quite common complication while its conditioned pulmonary edema – rare. Causes associated with anesthesia are various. Forced inspiratory efforts against an obstructed upper airway generate peak negative intrathoracic pressure. This may cause pulmonary edema and in some cases pulmonary hemorrhage. Last-mentioned is extremely rare. Pulmonary edema may arise soon after airway obstruction as well as later, after some hours. Damage of bronchi is found seldom during bronchoscopy in case of pulmonary hemorrhage, while more often alveolar damage is observed due to alveolar membrane damage. Hemorrhage is conditioned by hydrostatic pressure level, level of hypoxia, damage to bronchi or alveoli (disruption of alveolar membrane). Early diagnosis of negative-pressure pulmonary edema or pulmonary hemorrhage is very important, because this affects postoperative morbidity and mortality of the patients. Two cases of pulmonary edema and hemorrhage after upper airway obstruction as well as literature overview are presented in this article. Pulmonary hemorrhage developed during anesthesia with ketamine, conditioned by increment of hydrostatic pressure, hypoxia, and effects of ketamine on hemodynamics. Full article

183 KiB

Open AccessArticle

Umbilical hernia: Factors indicative of recurrence

by Linas Venclauskas, Jolita Šilanskaitė and Mindaugas Kiudelis

Medicina 2008, 44(11), 855; https://doi.org/10.3390/medicina44110108 - 12 Nov 2008

Cited by 50 | Viewed by 2693

Abstract

Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. The aim of this study was to analyze the [...] Read more.

Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. The aim of this study was to analyze the results of the umbilical hernia repair and to assess the independent risk factors influencing umbilical hernia recurrence.
Materials and methods. A retrospective analysis of patients who underwent surgery for umbilical hernia in the Hospital of Kaunas University of Medicine in 2001–2006 was performed. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. The questionnaire, which involved all these previously mentioned topics, was sent to all patients by mail. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair umbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (onlay technique). Every operation was chosen individually by a surgeon.
Results. Ninety-seven patients (31 males and 66 females) with umbilical hernia were examined. The mean age of the patients was 57.1±15.4 years, hernia anamnesis – 7.6±8.6 years, hospital stay – 5.38±3.8 days. Ninety-two patients (94.8%) were operated on using open suture repair technique and 5 (5.2%) patients – open mesh repair technique. Only 7% of patients whose BMI was >30 kg/m2 and hernia size >2 cm and 4.3% of patients whose BMI was <30 kg/m2 and hernia size <2 cm were operated on using onlay technique (P>0.05). The rate of postoperative complications was 5.2%. Sixty-seven patients (69%) answered the questionnaire. The complete patient’s recovery time after surgery was 2.4±3.4 months. Fourteen patients (20.9%) complained of pain or discomfort in the abdomen, and 7 patients (10.4%) had ligature fistula after the surgery. Forty-five patients (67.2%) did not have any complaints after surgery. The recurrence rate after umbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient’s BMI was >30 kg/m2 (8.6% for < 30 vs 10.7% for >30). There were 5 recurrence cases after open suture repair and one case after onlay technique. Fifty-six patients (83.6%) assessed their general condition after surgery as good, 9 patients (13.4%) as satisfactory, and only 2 patients (3%) as poor.
Conclusions. We did not find any significant independent risk factors for umbilical hernia recurrence. However, based on reviewed literature, higher patient’s body mass index and hernia size of >2 cm could be the risk factors for umbilical hernia recurrence. Full article

206 KiB

Open AccessArticle

Cardiomyocyte remodeling in ischemic heart disease

by Dalia Pangonytė, Elena Stalioraitytė, Reda Žiuraitienė, Danutė Kazlauskaitė, Jolita Palubinskienė and Ingrida Balnytė

Medicina 2008, 44(11), 848; https://doi.org/10.3390/medicina44110107 - 12 Nov 2008

Cited by 13 | Viewed by 1097

Abstract

Objective. The aim of the study was to detect changes in left ventricular cardiomyocyte size and shape in response to chronic ischemia and loss of cardiac tissue (myocardial infarction) during the course of ischemic heart disease (IHD).
Material and methods. Left [...] Read more.

Objective. The aim of the study was to detect changes in left ventricular cardiomyocyte size and shape in response to chronic ischemia and loss of cardiac tissue (myocardial infarction) during the course of ischemic heart disease (IHD).
Material and methods. Left ventricular cardiomyocyte dimensions (diameter and length) were estimated histomorphometrically, and their cross-sectional area and volume were assessed in 85 males who died suddenly out of hospital (within 6 hours of the onset of the terminal event) due to the acute first (preinfarction IHD group, n=53, aged 48.6±2.9 years) or repeated (postinfarction IHD group, n=32, aged 51.7±2.9 years) IHD attack, and had no other causes for the increased heart load. Twenty-nine males of similar age (mean age, 46.0±3.1 years) who succumbed to external causes served as controls.
Results. We have found cardiomyocyte hypertrophy in the preinfarction IHD group already. The cardiomyocyte volume was increased by 32.0% in comparison with the same index in the control group, and cross-sectional area and length – by 17.2 and 12.5%, respectively. In postinfarction IHD group, all studied cardiomyocyte parameters did not differ significantly from the analogous indices in the preinfarction IHD group (P>0.05). Cardiomyocyte hypertrophy was related to the increase in left ventricular cardiomyocyte parameters.
Conclusions. Left ventricular cardiomyocyte hypertrophy occurs before the first myocardial infarction. In postinfarction myocardium, cardiomyocyte dimensions do not differ significantly at least prior to the appearance of congestive heart failure syndrome. Full article

254 KiB

Open AccessArticle

C-reactive protein levels in patients with chronic obstructive pulmonary disease and asthma

by Daiva Urbonienė, Raimundas Sakalauskas and Brigita Šitkauskienė

Medicina 2008, 44(11), 833; https://doi.org/10.3390/medicina44110105 - 12 Nov 2008

Cited by 5 | Viewed by 805

Abstract

Chronic obstructive pulmonary disease (COPD) and asthma are defined as chronic inflammatory airway diseases. There is increasing evidence that systemic inflammation may be involved in their pathogenesis too. We aimed to investigate the C-reactive protein levels in plasma of patients with COPD, asthma [...] Read more.

Chronic obstructive pulmonary disease (COPD) and asthma are defined as chronic inflammatory airway diseases. There is increasing evidence that systemic inflammation may be involved in their pathogenesis too. We aimed to investigate the C-reactive protein levels in plasma of patients with COPD, asthma and control subjects and to evaluate associations of C-reactive protein levels with pulmonary function and smoking history.
Material and methods. We investigated 87 persons: 41 with COPD, 30 with asthma, and 16 controls. Clinical evaluation, pulmonary function tests, C-reactive protein concentration measurement, body mass index and smoking history evaluation were performed.
Results. We determined significantly higher C-reactive protein concentrations in COPD patients compared with asthma patients and controls (8.37±1.14 vs 3.14±0.67 and 2.39±0.59 mg/L, respectively; P<0.001). Creactive protein concentrations in smokers and ex-smokers with COPD were significantly higher than in COPD non-smokers (8.38±1.52 and 10.4±2.22 vs 4.10±0.86 mg/L, respectively; P<0.05). In COPD patients, C-reactive protein level correlated with FEV1 (R=–0.463, P=0.002), FEV1/FVC (R=–0.449, P=0.003), and pack-years (R=0.572, P=0.001). There was no correlation between C-reactive protein level and analyzed parameters in asthmatics and control group.
Conclusions. Our data support the hypothesis that systemic inflammation plays a role in the pathogenesis of COPD, and cigarette smoking might influence this inflammation. Full article

173 KiB

Open AccessArticle

Selected environmental risk factors and congenital heart defects

by Renata Kučienė and Virginija Dulskienė

Medicina 2008, 44(11), 827; https://doi.org/10.3390/medicina44110104 - 12 Nov 2008

Cited by 44 | Viewed by 1609

Abstract

The aim of the article is to review the published scientific literature and epidemiological studies about the effect of selected environmental risk factors on congenital heart defects in infants. According to recent reports, the prevalence of congenital heart defects is around 1% of [...] Read more.

The aim of the article is to review the published scientific literature and epidemiological studies about the effect of selected environmental risk factors on congenital heart defects in infants. According to recent reports, the prevalence of congenital heart defects is around 1% of live births. Congenital heart malformations are the leading cause of infant mortality. Unfortunately, the majority of the causes of heart defects remain unknown. These malformations are caused by interaction of genetic and environmental factors. The article reviews selected environmental risk factors: maternal illnesses and conditions associated with metabolic disorder (maternal diabetes, obesity, phenylketonuria), maternal lifestyle factors (alcohol use, smoking), which may increase the risk of congenital heart defects. Full article

332 KiB

Open AccessArticle

The comparison of patients’ and nurses’ attitudes to health education and nurses’ participation in this process

by Daiva Zagurskienė and Irena Misevičienė

Medicina 2008, 44(11), 885; https://doi.org/10.3390/medicina44110112 - 11 Nov 2008

Cited by 3 | Viewed by 802

Abstract

The aim of the study is to evaluate and to compare patients’ and nurses’ opinion about information given to patients by nurses.
Materials and methods. The study was performed during April–May 2007 in two regions of Lithuania. Eight hospitals were randomly selected [...] Read more.

The aim of the study is to evaluate and to compare patients’ and nurses’ opinion about information given to patients by nurses.
Materials and methods. The study was performed during April–May 2007 in two regions of Lithuania. Eight hospitals were randomly selected for the study. The study included all patients and nurses who were in therapeutic and surgery departments on the day the survey was carried out. A total of 1030 questionnaires were distributed among patients (the response rate was 85.0%), and 436 questionnaires – among nurses (the response rate was 89.0%).
Results. In most cases, patients about their disease are informed by a doctor; this was pointed out by 90.6% of nurses and 90.4% of patients. More than half of patients (65.9%) noted that they knew sufficiently enough about their disease, and 26.4% of nurses agreed. Nurses’ and patients’ opinion on the adequacy of information provided to patients by nurses differed: more patients than nurses indicated that they got enough information on their disease, health status, duration of intended operation and treatment, but nurses noted that they gave more information on nursing procedures, preparation for forthcoming tests, use of administered drugs, preparation for operation, and healthy lifestyle than it was recognized by patients. The patients who were treated in the surgery departments received less information about preparation for forthcoming tests and healthy lifestyle. Patients up to 45 years, city residents, those with higher education, and females were more interested in the above-mentioned information. Nurses who had higher education were more self-critical and more often recognized that they did not provide enough information for patients.
Conclusions. More than half of patients reported that they knew enough about their disease; their awareness depended on their age, sex, place of residence, and education. Physicians were indicated to be the main source of health information in most cases. Nurses more often than patients noted that information provided by them was adequate. The patients who were treated in the surgical departments received less information about healthy lifestyle. Full article

225 KiB

Open AccessArticle

Return to work after coronary artery bypass surgery

by Donatas Vasiliauskas, Rasa Raugalienė, Vytautas Grižas, Jolanta Marcinkevičienė, Lina Jasiukevičienė, Raimondas Kubilius and Vygantas Barsys

Medicina 2008, 44(11), 841; https://doi.org/10.3390/medicina44110106 - 11 Nov 2008

Cited by 4 | Viewed by 824

Abstract

The aim of this study was to assess the possible reasons for not returning to work after coronary artery bypass surgery. A total of 134 patients (aged 65 years and younger) who underwent coronary bypass surgery in 2003 were examined. The analysis was [...] Read more.

The aim of this study was to assess the possible reasons for not returning to work after coronary artery bypass surgery. A total of 134 patients (aged 65 years and younger) who underwent coronary bypass surgery in 2003 were examined. The analysis was performed in three groups of the patients: Group I, patients who were employed before surgery and returned to work after it (n=51); Group II, patients who were employed before surgery but did not return to work after surgery (n=55); and Group III, patients who were unemployed before and remained unemployed after surgery due to health problems (n=28). Number of injured coronary arteries, the extent of operation, postoperative complications, risk factors for ischemic heart disease, clinical status of patients (angina pain and heart failure), physical tolerance, and return to work within one year after coronary bypass surgery were analyzed. It was found that 48.1% of patients who were employed before surgery returned to work after myocardial revascularization. About 30% of patients experienced recurrent symptoms of angina after 12 months. Logistic regression analysis revealed that return to work was significantly influenced by female gender, physical pattern of work, age, and severity of heart failure. Full article

314 KiB

Open AccessArticle

The evaluation of the rehabilitation effects on cognitive dysfunction and changes in psychomotor reactions in stroke patients

by Jūratė Samėnienė, Aleksandras Kriščiūnas and Erika Endzelytė

Medicina 2008, 44(11), 860; https://doi.org/10.3390/medicina44110109 - 09 Nov 2008

Cited by 6 | Viewed by 1063

Abstract

Stroke patients often experience cognitive dysfunctions. One of the parameters assessing cognitive function is the reaction time as it reflects the speed of information processing. The aim of the study was to assess cognitive and psychomotor dysfunctions and the effectiveness of rehabilitation in [...] Read more.

Stroke patients often experience cognitive dysfunctions. One of the parameters assessing cognitive function is the reaction time as it reflects the speed of information processing. The aim of the study was to assess cognitive and psychomotor dysfunctions and the effectiveness of rehabilitation in stroke patients. The subjects of the study were 30 stroke patients who underwent rehabilitation at the Department of Neurorehabilitation. The mean age of patients was 65.33±13.2 years. During the study, the patients’ cognitive functions, the handgrip strength, reaction time, and frequency of movements were assessed. There was a substantial improvement in patients’ cognitive function after rehabilitation. Assessing the results obtained by Mini Mental State Examination, the change was 6.4±2.3 points, and assessing by Neurobehavioral Cognitive Status Examination (Cognistat), the change was 13.3±10 points (P<0.05). Before the early stage of rehabilitation, Cognistat results showed that the majority of the patients experienced memory loss, diminished constructive abilities, and disorientation. After occupational therapy, there was a statistically significant improvement in all cognitive function domains. At the end of the inpatient rehabilitation period, there was a significant change in patients’ reaction time and movement frequency. At the end of early rehabilitation stage, the estimated reaction time in patients with stroke was compared with reaction time in healthy elderly people of the same age. There was no significant difference between these groups; consequently, we concluded that after rehabilitation, improvement of function was achieved. The results of this study showed that at the beginning of early rehabilitation period and after rehabilitation applied, there was a significant moderate correlation between mental state and reaction time in stroke patients. Full article

196 KiB

Open AccessArticle

Acute infectious encephalitis and pathogens coming from animals

by Jean Paul Stahl, Alexandra Mailles, Véronique Vaillant, Daniel Floret and Encephalitis Protocol Group

Medicina 2008, 44(11), 821; https://doi.org/10.3390/medicina44110103 - 12 Oct 2008

Cited by 1 | Viewed by 794

Abstract

Despite better knowledge of pathophysiology and a wider use of new molecular technologies for the diagnosis, the etiological diagnosis of acute encephalitis is not established in most cases. Incidence, prognosis, rate of this disease and severity of sequelae remain unknown. In France, according [...] Read more.

Despite better knowledge of pathophysiology and a wider use of new molecular technologies for the diagnosis, the etiological diagnosis of acute encephalitis is not established in most cases. Incidence, prognosis, rate of this disease and severity of sequelae remain unknown. In France, according to the published data, the incidence of encephalitis is estimated to be 1.9 cases per 100 000 inhabitants in average among non-HIV patients. The etiological diagnosis is established in less than 30% of cases. The more frequent diagnosis is herpetic encephalitis in adults and encephalitis caused by Varicella zoster virus in children younger than 16 years. Despite a difficult diagnosis and the lack of specific treatment for most of these infections, the etiological diagnosis should always be deeply explored to precise the individual prognosis, to allow better management of antibiotic therapy, and to improve epidemiological knowledge. We present the recommendations established by the French Society for Infectious Diseases. First designed to suit the French epidemiology, they take in count the possible exposure of patients to different epidemiological patterns. Three levels of etiological tests are proposed, from the most common infections and those, which required an immediate treatment, to the rarest ones. Full article

227 KiB

Open AccessArticle

Socialization of athletes with disabilities in adapted physical activity

by Laimutė Samsonienė, Rūta Adomaitienė, Jurga Krivičiūtė, Konstancija Jankauskienė, Vilma Jurkštienė and Egidijus Kėvelaitis

Medicina 2008, 44(11), 877; https://doi.org/10.3390/medicina44110111 - 02 Jul 2008

Cited by 3 | Viewed by 879

Abstract

The aim of this study was to determine the impact of the impairment of the body functions on the participation of people with disabilities in sports activities.
Material and methods. The study was carried out in the institutions mostly attended by people [...] Read more.

The aim of this study was to determine the impact of the impairment of the body functions on the participation of people with disabilities in sports activities.
Material and methods. The study was carried out in the institutions mostly attended by people with severe physical disabilities. The participants took a modified Kenny test and answered the questions of a questionnaire. The study sample consisted of 35 persons with severe physical disabilities.
Results. The findings of this study showed that people with disabilities who were not engaged in sports were of much worse opinion about their health condition (P=0.02) and they needed more help from family or friends (P=0.035) compared to the disabled who were not engaged in sports, but in the group of people with disabilities who were engaged in sports, the correlations of those indicators were statistically significant (r=0.59 and r=0.68, respectively). The main motivation of sports participation of people with disabilities (about 80%) was the need for communication and gaining independence. Health improvement was mentioned by less than half of people with disabilities (about 41%) engaged in sports.
Conclusions. The syndrome of movement function impairment, duration of impairment, marital status, the age of persons with disabilities, and objectively determined impairment of biosocial self-service functions did not impact sports participation of people with disabilities. However, subjective sensation of pain and the need of medical aid, which did not match the objective functional impairments, could be the obstacle for people with disabilities to participate in sports. Full article

315 KiB

Open AccessArticle

Lithuanian pharmacists in Russia at the beginning of the 20th century: Their practice and national patriotic activity

by Vilma Gudienė, Almontas Bagdonavičius, Zenona Šimaitienė and Julija Davalgienė

Medicina 2008, 44(11), 895; https://doi.org/10.3390/medicina44110113 - 12 May 2008

Viewed by 802

Abstract

An important role in the formation of modern Lithuanian society was played by pharmacists who at the beginning of the 20th century were one of the most numerous parts of Lithuanian intelligentsia. They chose a job in a pharmacy not as a mission [...] Read more.

An important role in the formation of modern Lithuanian society was played by pharmacists who at the beginning of the 20th century were one of the most numerous parts of Lithuanian intelligentsia. They chose a job in a pharmacy not as a mission of life but due to political, social, and economic reasons. The majority of pharmacists were children of peasants who had refused to obey their parents and study in the seminary of priests. Those people who had been ousted from gymnasiums because of an anticzarist activity or those who had not finished school due to the lack of money also became pharmacists. Young men who had chosen a way of self-support left to the biggest cities of Russia and started the practice of an apprentice in a pharmacy. Later, they took examinations to become an assistant of a pharmacist, and after two years of studies at university, they took examinations of a pharmacist at last. Having got a diploma, they usually did not return to their motherland because there was a large network of pharmacies; thus, business conditions were harder, of course. They established pharmacies in various provinces of Russia most often, and it is supposed that only 10% of Lithuanian pharmacists worked in their native country. Living and working in a Russian environment, however, they enshrined national patriotic ideas, were active participants in social activities, published a Lithuanian professional newspaper “Farmaceutų reikalai” (translation, “Matters of pharmacists“), and attempted to unite all Lithuanians living in czarist Russia to struggle against denationalization, to encourage people to return to their motherland, and to work for its good. This article deals with the path for a career of Lithuanian pharmacists in czarist Russia and their national patriotic activity. Full article

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Medicina, Volume 44, Issue 11 (November 2008) – 11 articles

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