Medicina

231 KiB

Open AccessArticle

by Dagmara Reingardienė

Medicina 2008, 44(9), 723; https://doi.org/10.3390/medicina44090093 - 15 Sep 2008

Viewed by 821

In clinical use for over 50 years, heparin is an important and widely used anticoagulant for the prophylaxis or treatment of thromboembolic disease as well as other numerous clinical situations. Ordinarily, heparin prevents clotting and does not affect the platelets, components of the [...] Read more.

In clinical use for over 50 years, heparin is an important and widely used anticoagulant for the prophylaxis or treatment of thromboembolic disease as well as other numerous clinical situations. Ordinarily, heparin prevents clotting and does not affect the platelets, components of the blood that help to form blood clots. However, heparin can also cause heparin-induced thrombocytopenia. Two distinct types of heparininduced thrombocytopenia can occur: nonimmune and immune mediated. Nonimmune heparin-induced thrombocytopenia, which occurs most frequently, is characterized by a mild decrease in the platelet count and is not harmful. The second type, immune-mediated heparin-induced thrombocytopenia, occurs much less frequently but is dangerous. Immune-mediated heparin-induced thrombocytopenia causes much lower platelet count. Paradoxically, despite a very low platelet count, patients who suffer from heparin-induced thrombocytopenia are at risk for arterial or venous thrombosis. In this review article, there are discussed about pathogenesis of heparin-induced thrombocytopenia, other causes of thrombocytopenia, clinical features, laboratory confirmation of diagnosis, and management of patients (direct thrombin inhibitors, other therapies, duration of therapy, and use of oral anticoagulants). Prognosis and prophylaxis of this life-threatening disorder, which can develop from the use of unfractionated or (less commonly) low-molecular-weight heparin, are also discussed. Full article

240 KiB

Open AccessArticle

Inequalities in life expectancy by education and socioeconomic transition in Lithuania

by Ramunė Kalėdienė, Skirmantė Starkuvienė and Jadvyga Petrauskienė

Medicina 2008, 44(9), 713; https://doi.org/10.3390/medicina44090092 - 15 Sep 2008

Cited by 20 | Viewed by 1020

Abstract

Objective. To present changes in life expectancy of males and females by the level of educational achievement and describe different aspects of inequalities in life expectancy over the decade of socioeconomic transition in Lithuania.
Material and methods. This analysis is based on [...] Read more.

Objective. To present changes in life expectancy of males and females by the level of educational achievement and describe different aspects of inequalities in life expectancy over the decade of socioeconomic transition in Lithuania.
Material and methods. This analysis is based on routine mortality statistics and census data for 1989 and 2001 for the entire country. The study included the population more than 25 years of age.
Results. Increasing inequalities in life expectancy by education have occurred due to increasing life expectancy amongst persons with higher educational achievements, and conversely, a declining life expectancy in groups with low levels of education. Cardiovascular diseases were responsible for the greatest number of years lost in life expectancy by all educational categories both in males and females. The numbers of years lost due to cardiovascular diseases decreased in majority of educational categories, particularly in lower secondary educational group. The increase in the years of life expectancy lost was observed due to external causes of death, the higher education being associated with the lower numbers of years lost, especially in females. The greatest impact on the difference in life expectancy between males with university and primary education was caused by external causes both in 1989 and 2001, while the major contribution to the educational differences in life expectancy of females was made by cardiovascular diseases.
Conclusions. Favorable forecast of declining health inequalities by education in Lithuania can hardly be expected in the nearest future. Collective efforts and constructive actions should address the health problems of the least privileged groups in terms of education, as well as promotional efforts directed at young people to complete their education and guarantee of equal opportunities for education. Full article

243 KiB

Open AccessArticle

Effect of Perilla frutescens aqueous extract on free radical production by human neutrophil leukocytes

by Gediminas Žekonis, Jonas Žekonis, Renata Šadzevičienė, Genovaitė Šimonienė and Egidijus Kėvelaitis

Medicina 2008, 44(9), 699; https://doi.org/10.3390/medicina44090090 - 15 Sep 2008

Cited by 23 | Viewed by 1224

Abstract

Objective. The present study was intended to evaluate the antioxidant properties of aqueous extract of the Perilla frutescens (L.) Britton.
Material and methods. The antioxidant properties of Perilla frutescens were analyzed employing neutrophil leukocytes stimulated by the nonopsonized Escherichia coli. The [...] Read more.

Objective. The present study was intended to evaluate the antioxidant properties of aqueous extract of the Perilla frutescens (L.) Britton.
Material and methods. The antioxidant properties of Perilla frutescens were analyzed employing neutrophil leukocytes stimulated by the nonopsonized Escherichia coli. The neutrophil leukocytes were affected by adding an aqueous extract of Perilla. The generation of the reactive oxygen species by neutrophil leukocytes was investigated using assessment of luminol- and lucigenin-dependent chemiluminescence.
Results. We found out that the treatment of neutrophil leukocytes with the Perilla aqueous extract inhibited the release of reactive oxygen species, measured as luminol- and lucigenindependent chemiluminescence, by about 30% and more than 90%, respectively.
Conclusion. The results of this study show that the aqueous extract of the Perilla frutescens inhibits significantly free radical production by neutrophil leukocytes, which was especially obvious when the lucigenin-dependent chemiluminescence assessment method was applied. Full article

235 KiB

Open AccessArticle

The center of the human porta hepatis

by Saulius Rutkauskas, Vytautas Gedrimas, Tomas Čičinskas, Aurimas Savulis and Algidas Basevičius

Medicina 2008, 44(9), 694; https://doi.org/10.3390/medicina44090089 - 15 Sep 2008

Viewed by 940

Abstract

Majority of interventional procedures are made at the porta hepatis, which has a different location on the visceral surface of the liver.
Objective. To describe the location of the porta hepatis in respect of the borders of the visceral surface and separate [...] Read more.

Majority of interventional procedures are made at the porta hepatis, which has a different location on the visceral surface of the liver.
Objective. To describe the location of the porta hepatis in respect of the borders of the visceral surface and separate lobes of the liver.
Material and methods. Sixty-four human livers were obtained at autopsy (mean age, 45 years). We chose the point of the crossing of longitudinal and transversal lines of the porta hepatis, which was considered as center of the porta hepatis. The distances from the center of the porta hepatis to the border of the visceral surface every 10 degrees with protractor and ruler and the angles of anatomical structures were measured. Additionally, the borders of lobes were assessed.
Results. We found that center of the porta hepatis is located approximately 11.6±2.8 cm from the border of the visceral liver surface. The location of center of the porta hepatis was 11.6±1.1 cm from the border of left lobe, 9.7±1.5 cm from the border of quadrate lobe, 12.3±1.2 cm from the border of right lobe, and 7.4±1.0 cm from the border of caudate lobe. All distances were statistically significant (P<0.05). An angle of the fissure for round ligament was 50.5°, of the fossa of gallbladder – 102°, of the groove of vena cava inferior – 266°, and of the fissure for ligamentum venosum – 293°. The borders of the right, left, quadrate, and caudate liver lobe covered 45.6%, 32.6%, 14.3%, and 7.5% of the perimeter of visceral surface border, respectively.
Conclusions. The center of the porta hepatis can help to characterize precisely the position of the porta hepatis on the visceral surface of the liver. Full article

283 KiB

Open AccessArticle

Influence of heating and cooling on muscle fatigue and recovery

by Irina Ramanauskienė, Albertas Skurvydas, Saulė Sipavičienė, Žibuoklė Senikienė, Vitas Linonis, Gražina Krutulytė and Daiva Vizbaraitė

Medicina 2008, 44(9), 687; https://doi.org/10.3390/medicina44090088 - 15 Sep 2008

Cited by 4 | Viewed by 1017

Abstract

The aim of the present study was to establish the influence of muscle heating and cooling on knee flexors and extensors during fatiguing exercise. The participants of the study were 10 healthy males aged 19–23 years. The participants of the study were tested [...] Read more.

The aim of the present study was to establish the influence of muscle heating and cooling on knee flexors and extensors during fatiguing exercise. The participants of the study were 10 healthy males aged 19–23 years. The participants of the study were tested with the isokinetic dynamometer. Control measurements were done before the load as well as 10 min, 30 min, 60 min, and 24 h after the load. The participants performed concentric exercise bouts: 50 knee extensions and flexions at the fixed speed of 180°/s, when femoral muscles before concentric load were of normal temperature, were heated or cooled. Creatine kinase activity in blood serum was estimated 1 h before the load and 24 h after it. Internal temperature of the muscle quadriceps femoris after muscle heating for 45 min increased to 39.5±0.2°C (P<0.001) and after muscle cooling for 30 min decreased to 32.5±0.3°C (P<0.05) as compared to baseline temperature (before heating – 36.9±0.1°C, before cooling – 36.8±0.2°C). Creatine kinase activity in blood serum 24 h after concentric load was significantly increased as compared to control values. Passive muscle warming increased muscle contraction force of knee extensors, but did not cause any changes either in the rate of muscle fatigue or in the rate of muscle recovery. Muscle cooling did not decrease muscle contraction force and did not increase muscle fatigue resistance. The findings of this study showed that both, muscle warming and muscle cooling, brought about a decrease in an indirect parameter of muscle damage – the amount of creatine kinase 24 h after concentric load. Full article

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Open AccessArticle

A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy

by Saulius Grižas, Antanas Gulbinas, Giedrius Barauskas and Juozas Pundzius

Medicina 2008, 44(9), 678; https://doi.org/10.3390/medicina44090087 - 15 Sep 2008

Cited by 24 | Viewed by 943

Abstract

The role of postoperative supplementary enteral nutrition after gastrointestinal surgery is controversial. Therefore, a randomized clinical trial with attempts to address the question of plenitude of routine application of postoperative enteral feeding on rate of postoperative complications following pancreatoduodenectomy was performed. Sixty patients [...] Read more.

The role of postoperative supplementary enteral nutrition after gastrointestinal surgery is controversial. Therefore, a randomized clinical trial with attempts to address the question of plenitude of routine application of postoperative enteral feeding on rate of postoperative complications following pancreatoduodenectomy was performed. Sixty patients undergoing pancreatoduodenectomy were blindly randomized into two groups: 30 patients in the first group received early enteral nutrition (EEN), while 30 patients in the second group were given early natural nutrition (ENN). The complications were evaluated according to definition criteria. All complications were further subdivided into infectious and noninfectious complications. Our data showed that patients in EEN group gained a larger amount of energy in kcal a day during the first five days after surgery in comparison to ENN group. There was a higher rate of postoperative complications in ENN group (53.3% vs 23.3%, P=0.03). This difference occurred mainly due to the higher incidence of infectious complications in ENN group (46.7% vs 16.7%, P=0.025). There were six cases of bacteriemia in this group of patients, while only one case was observed in EEN group (6 (20.0%) vs 1 (3.3%), P=0.1). The overall risk for the development of any type of infectious complication was 1.5 times higher in ENN group. In conclusion, this study suggests that supplementary postoperative enteral nutrition helps to decrease the rate of infectious complications in patients undergoing pancreatoduodenectomy, especially in those with a plasma albumin level of less than 34.5 g/L and/or ASA class III or higher, since natural nutrition is insufficient in this ca. Full article

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Open AccessArticle

Prognostic value of reticulocyte hemoglobin content to diagnose iron deficiency in 6–24-month-old children

by Rosita Kiudelienė, Rasa Griniūtė and Liutauras Labanauskas

Medicina 2008, 44(9), 673; https://doi.org/10.3390/medicina44090086 - 15 Sep 2008

Cited by 17 | Viewed by 831

Abstract

Objective. The aim of our study was to evaluate the prognostic value of reticulocyte hemoglobin content for diagnosis of iron deficiency in 6–24-month-old children.
Material and methods. Children aged 6 to 24 months were consulted for suspected iron deficiency in the [...] Read more.

Objective. The aim of our study was to evaluate the prognostic value of reticulocyte hemoglobin content for diagnosis of iron deficiency in 6–24-month-old children.
Material and methods. Children aged 6 to 24 months were consulted for suspected iron deficiency in the outpatient department in 2006–2007. Criteria for inclusion into the study were normal birth time and weight, no infection during the last two weeks before blood sampling (Creactive protein <5 mg/L), no iron supplements 1 month before the study. Red blood cell, reticulocyte indices and biochemical tests were analyzed. A total of 180 children were enrolled in our study. Iron deficiency was diagnosed when at least two of four parameters (ferritin, transferrin, transferrin saturation, and soluble transferrin receptors) reflected iron deficiency.
Results. According to our criteria of iron deficiency, patients were divided into two groups: 116 had iron deficiency and 64 had normal iron stores. The iron deficiency group had significantly lower hemoglobin, mean corpuscular hemoglobin, mean corpuscular volume, reticulocyte hemoglobin content, ferritin, soluble transferrin receptors, iron and higher red cell distribution width, transferrin, and transferrin saturation (P<0.05) compared with the normal iron store group. Reticulocyte hemoglobin content, ferritin, and transferrin saturation had the highest sensitivity and specificity (76.6% and 78.4%, 81.3% and 81.9%, 85.9% and 87.9%, respectively).
Conclusion. Reticulocyte hemoglobin content is comparable test with ferritin and transferrin saturation and can be used to detect iron deficiency in 6–24-month-old children. Full article

225 KiB

Open AccessArticle

Impact of electrical shock waveform and paddle positions on efficacy of direct current cardioversion for atrial fibrillation

by Giedrė Stanaitienė and Rūta Marija Babarskienė

Medicina 2008, 44(9), 665; https://doi.org/10.3390/medicina44090085 - 30 Jun 2008

Cited by 15 | Viewed by 1060

Abstract

Objective. Direct-current electrical cardioversion is the main method for the conversion of atrial fibrillation. Its success depends on many factors. In several studies, biphasic shock waveforms have been demonstrated to be superior to monophasic shocks for termination of atrial fibrillation; however, information [...] Read more.

Objective. Direct-current electrical cardioversion is the main method for the conversion of atrial fibrillation. Its success depends on many factors. In several studies, biphasic shock waveforms have been demonstrated to be superior to monophasic shocks for termination of atrial fibrillation; however, information about impact of paddle position is controversial. Initial energy level is an object of discussions. The aim of the study was to compare a truncated exponential biphasic waveform with monophasic damped sine waveform and antero-lateral with antero-posterior paddle positions for cardioversion of atrial fibrillation, to determine its impact on early reinitiation of atrial fibrillation.
Material and methods. A total of 224 consecutive patients with atrial fibrillation underwent electrical cardioversion with biphasic (Bi, n=112) or monophasic (Mo, n=112) shock waveform in a randomized fashion. The position of hand-held paddle electrodes was randomly selected in both groups to be anterior-lateral and anterior-posterior. Energies used were 100–150–200–300–360 J (Bi) or 100–200–300–360 J (Mo). If monophasic shock of 360 J was ineffective, we used biphasic shock of 360 J. Early recurrent atrial fibrillation (ERAF) was defined as a relapse of atrial fibrillation within 2 min after a successful cardioversion, acute recurrent – within 24 h.
Results. Two study groups (Bi vs Mo) did not differ with regard to age, body mass index, duration of AF episode (mean 98±147 days for the Bi group and 80±93 days for the Mo group, P=0.26), underlying heart disease, left atrial diameter, left ventricular ejection fraction. In the Mo group, more patients used amiodarone (59.82% vs 41.97%, P=0.002), in the Bi group more patients used propafenone (16.07% vs 8.93%, P=0.033). Cardioversion success rate was 97.32% in the Bi group and 79.46% in the Mo group (P<0.001). After biphasic shock of 360 J in Mo group, the cumulative success rate was 99.11%. Mean delivered energy and mean number of shocks were significantly lower in the Bi group (198.5±204.4 J, 1.5±0.9 shocks vs 489.1±464.2 J, 2.4±1.5 shocks). The efficacy of first shock was 66.96% in the Bi group and 37.5% in the Mo group (P<0.0001). Incidence of ERAF was 4.46% in both groups. Paddle position had no impact on efficacy of cardioversion and ERAF.
Conclusions. For the cardioversion of atrial fibrillation, biphasic shock waveform has a higher success rate than monophasic shock waveform. We did not observe the influence of paddle positions on efficacy of cardioversion. Shock waveform and paddle position had no impact on ERAF. We recommend starting with biphasic energy of 150 J and monophasic of not less than 200 J for cardioversion of atrial fibrillation. Full article

234 KiB

Open AccessArticle

Free radical-scavenging activities of Crataegus monogyna extracts

by Jurga Bernatonienė, Rūta Masteikova, Daiva Majienė, Arūnas Savickas, Egidijus Kėvelaitis, Rūta Bernatonienė, Katerina Dvoráčková, Genuvaitė Civinskienė, Raimundas Lekas, Konradas Vitkevičius and Rimantas Pečiūra

Medicina 2008, 44(9), 706; https://doi.org/10.3390/medicina44090091 - 11 Jun 2008

Cited by 63 | Viewed by 2261

Abstract

The aim of this study was to investigate antiradical activity of aqueous and ethanolic hawthorn fruit extracts, their flavonoids, and flavonoid combinations.
Material and methods. Total amount of phenolic compounds and the constituents of flavonoids were determined using a high-performance liquid chromatography. [...] Read more.

The aim of this study was to investigate antiradical activity of aqueous and ethanolic hawthorn fruit extracts, their flavonoids, and flavonoid combinations.
Material and methods. Total amount of phenolic compounds and the constituents of flavonoids were determined using a high-performance liquid chromatography. The antioxidant activity of Crataegus monogyna extracts and flavonoids (chlorogenic acid, hyperoside, rutin, quercetin, vitexin-2O-rhamnoside, epicatechin, catechin, and procyanidin B2) quantitatively was determined using the method of spectrophotometry (diphenyl-1-picrylhydrazyl (DPPH·) radical scavenging assay and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulphonic acid)(ABTS·+) radical cation decolorization assay). The level of tyrosine nitration inhibition was determined using a highperformance liquid chromatography.
Results. Ethanolic hawthorn fruit extract contained 182±4 mg/100 mL phenolic compounds, i.e. threefold more, as compared to aqueous extract. The antioxidant activity according to DPPH· reduction in the ethanolic extracts was higher 2.3 times (P<0.05). The ABTS·+ technique showed that the effect of ethanolic extracts was by 2.5 times stronger than that of aqueous extracts. Tyrosine nitration inhibition test showed that the effect of ethanolic extracts was by 1.4 times stronger than that of aqueous extracts. The investigation of the antiradical activity of the active constituents in aqueous and ethanolic extracts revealed that epicatechin and catechin contribute to radical-scavenging properties more than other components. Procyanidin B2 only insignificantly influenced the antiradical activity of the extracts.
Conclusion. Both aqueous and ethanolic hawthorn extracts had antiradical activity, but ethanolic extract had stronger free radical-scavenging properties, compared to the aqueous extract. The antioxidant activity of the studied preparations was mostly conditioned by epicatechin and catechin. The individual constituents of both extracts had weaker free radical-scavenging properties than the combination of these substances did. Full article

234 KiB

Open AccessArticle

The alcoholic lung disease: Historical background and clinical features

by Kiriakos Karkoulias, Haralampos Tsitsaras, Dimitrios Patouchas, Fotis Sampsonas, Dimostenis Likouras, Alexander Kaparianos and Kostas Spiropoulos

Medicina 2008, 44(9), 651; https://doi.org/10.3390/medicina44090084 - 22 Oct 2007

Cited by 5 | Viewed by 889

Abstract

The purpose of this review article is to prove the damage that alcohol causes to the respiratory system. We will make a brief review of alcohols history in the course of the centuries till nowadays. The problem of addiction to alcohol (alcoholism) will [...] Read more.

The purpose of this review article is to prove the damage that alcohol causes to the respiratory system. We will make a brief review of alcohols history in the course of the centuries till nowadays. The problem of addiction to alcohol (alcoholism) will be examined for several countries. Alcohol’s metabolism is another topic to be discussed parallel to its pharmacological action. In addition, alcohol’s impact on the respiratory system varies from damaging the mucociliary system to the regulation of breathing and from the sleep apnea syndrome to diffusion disorders. “Alcoholic lung disease” constitutes a syndrome despite the fact that the damage of the lung due to concurrent smoking and drug use is often indistinguishable. Full article

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Medicina, Volume 44, Issue 9 (September 2008) – 10 articles

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