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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.

Medicina, Volume 45, Issue 4 (April 2009) – 10 articles

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235 KiB  
Article
Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion
by Nerijus Aleksynas, Rytis Kaupas and Aleksandras Antuševas
Medicina 2009, 45(4), 327; https://doi.org/10.3390/medicina45040042 - 08 Apr 2009
Cited by 2 | Viewed by 784
Abstract
Objective. Based on recent literature data, subintimal arterial angioplasty, its indications and contraindications, methods and techniques, treatment results, and perspectives are introduced in this article. During the last two decades, with increasing human lifespan, more and more frequently a combination of progressive chronic [...] Read more.
Objective. Based on recent literature data, subintimal arterial angioplasty, its indications and contraindications, methods and techniques, treatment results, and perspectives are introduced in this article. During the last two decades, with increasing human lifespan, more and more frequently a combination of progressive chronic lower limb ischemia, which is caused by occlusive disease, and severe condition occurs. In such cases, patients cannot be operated on. In Europe and the United States of America, patients undergo subintimal angioplasty. It is a minimally invasive technique for the treatment of lower limb occlusive disease, when without tissue incision, under local anesthesia, blood flow through damaged artery is normalized. Thus, the occlusion is removed without surgery, patient’s quality of life is improved, and survival is increased. Full article
218 KiB  
Article
Assessing needs of families with premature newborns in the Neonatal Intensive Care Unit
by Alina Vaškelytė, Rūta Butkevičienė and David Klemmac
Medicina 2009, 45(4), 320; https://doi.org/10.3390/medicina45040041 - 08 Apr 2009
Cited by 5 | Viewed by 852
Abstract
The aim of this study was to identify needs of families with premature newborns in the Neonatal Intensive Care Unit, perceived by parents and nurses. The study was conducted in the Kaunas Perinatal Center, Neonatal Intensive Care Unit, Hospital of Kaunas University of [...] Read more.
The aim of this study was to identify needs of families with premature newborns in the Neonatal Intensive Care Unit, perceived by parents and nurses. The study was conducted in the Kaunas Perinatal Center, Neonatal Intensive Care Unit, Hospital of Kaunas University of Medicine. The sample consisted of 181 parents and 37 nurses. The NICU Family Needs Inventory was used for data collection. The instrument included five dimensions of needs. Reliability of the scale was identified as 0.94 using Cronbach’s a.
Results. The importance of the needs by parents was prioritized as following: assurance, proximity, information, support, and comfort, and by nurses – assurance, information, proximity, support, and comfort. The needs for assurance, proximity, and information were significantly more important for parents as compared with nurses. Needs for support were significantly more important for nurses. Forty-seven (83.9%) items (out of 56) were identified as important by parents and 49 (87.5%) items – by nurses. Both parents and nurses identified the same 7 items within the group of 10 most important. Parents and nurses identified the same 7 items within the group of 10 least important.
Conclusions
. Both groups of respondents identified needs for assurance as the most important for parents. The needs for comfort were perceived as the least important by parents and nurses. All groups of needs, except the needs for support, were significantly more important for parents as compared with nurses. Both parents and nurses identified the same 44 items (out of 56) as important for parents in the Neonatal Intensive Care Unit. The 10 most important need statements and 10 least important need statements were identified by parents and nurses. Full article
187 KiB  
Article
Characteristics of dental attendance among Lithuanian middle-aged university employees
by Žana Sakalauskienė, Vita Mačiulskienė, Miira M. Vehkalahti, Ričardas Kubilius and Heikki Murtomaa
Medicina 2009, 45(4), 312; https://doi.org/10.3390/medicina45040040 - 08 Apr 2009
Cited by 4 | Viewed by 845
Abstract
Objective. This study aimed to evaluate and describe the dental attendance patterns and to characterize the factors that encourage preventive dental visits among 35- to 44-year-old university employees in Lithuania.
Material and methods
. A questionnaire survey was conducted anonymously among the 35- [...] Read more.
Objective. This study aimed to evaluate and describe the dental attendance patterns and to characterize the factors that encourage preventive dental visits among 35- to 44-year-old university employees in Lithuania.
Material and methods
. A questionnaire survey was conducted anonymously among the 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data on their most recent dental visit, habitual dental attendance, and self-reported dental health were collected. Gender, marital status, education, and income levels served as background factors. Of the respondents, 79% were women, and 82% held a university degree.
Results
. Of all the respondents, 75% reported having their most recent dental visit within the previous 12 months; 19% indicated a preventive check-up as the reason for it (15% – self-decided visit and 4% – dentist’s recall). The most common treatments received were fillings (75%), scaling and cleaning (28%), and endodontic treatment (22%). Analysis of the data about habitual dental attendance showed that preventive check-up as the main reason for attendance was more commonly reported by women (OR=1.7), among those who indicated having lost fewer teeth (OR=1.5), reported higher incomes (OR=1.4), and who indicated a shorter time interval since their most recent dental visit (OR=1.3).
Conclusion
. Dental problem seems to be a dominant reason for dental attendance in Lithuania where both dentists’ and patients’ behavior weakly reflects preventive orientation. Full article
294 KiB  
Article
Nutritional habits of middle-aged schoolchildren from Kaunas town and Raseiniai district
by Lina Škėmienė, Rūta Ustinavičienė, Ričardas Radišauskas, Jolita Kirvaitienė, Robertas Lažauskas and Sandra Sabonaitytė
Medicina 2009, 45(4), 302; https://doi.org/10.3390/medicina45040039 - 08 Apr 2009
Viewed by 731
Abstract
Objective. To evaluate nutritional habits of middle-aged schoolchildren living in a town and district of Lithuania. Material and methods. The 8th–9th-grade schoolchildren were questioned by an anonymous questionnaire. A total of 329 students, 169 from Kaunas and 160 from Raseiniai district, participated [...] Read more.
Objective. To evaluate nutritional habits of middle-aged schoolchildren living in a town and district of Lithuania. Material and methods. The 8th–9th-grade schoolchildren were questioned by an anonymous questionnaire. A total of 329 students, 169 from Kaunas and 160 from Raseiniai district, participated in the study.
Results. Only half of students reported that they had breakfast (61.3% of schoolboys and 47.6% of schoolgirls). More students from the district had dinner in the school canteen as compared to Kaunas students. Only 14.0% of schoolchildren followed nutrition regimen (14.8% of students from Kaunas and 13.1% of students from Raseiniai always had their meal at the same time). Every second schoolboy and schoolgirl consumed vegetables and fruits every day. Whole grain bread was consumed every day similarly frequently by students from Kaunas and Raseiniai, 25.4% and 18.8%, respectively; the students from Kaunas consumed skim milk more frequently, 26.0% and 11.9%, respectively (P<0.05). Confectionery was consumed more frequently by schoolchildren from Kaunas as compared to schoolchildren from Raseiniai district (63.9% vs. 55.0%); however, it was consumed more frequently by boys than girls. Less than one-fourth of Kaunas students (20.7%) consumed potato chips every day, whereas the percentage of the students from Raseiniai district was only 10.0% (P<0.05). Pizzas, kebabs, and hamburgers were consumed more frequently by schoolboys than schoolgirls. Knowledge of healthy nutrition was obtained mainly from media by 48.6% of students; every eighth student got this information from parents, every tenth from physicians, and 7.0% from teachers.
Conclusions
. Middle-aged students from both Kaunas town and Raseiniai district did not follow nutrition regimen; half of them did not have their breakfast before going to school. Fruits and vegetables as recommended foods were consumed by half of the participants; every fourth student consumed skim milk, and every fifth student consumed whole grain bread. The students more frequently consumed such foods as confectionery and smoked meat, which are not recommended (every second student); every fourth had an intake of carbonized drinks (the students from Kaunas more frequently) and potato chips (the students from Kaunas more frequently), and every tenth consumed pizzas and fried potatoes. More than half of students obtained knowledge of healthy nutrition from media, and every tenth – from the physicians. Full article
267 KiB  
Article
Analysis of cardiac and pulmonary complication probabilities after radiation therapy for patients with early-stage breast cancer
by Olga Utehina, Sergejs Popovs, Dace Purina, Ingrida Slosberga, Ilga Vevere, Dzintars Emzins, Juris Berzins, Konstantinas Povilas Valuckas, Ernestas Janulionis and Albert Miller
Medicina 2009, 45(4), 276; https://doi.org/10.3390/medicina45040036 - 08 Apr 2009
Cited by 6 | Viewed by 889
Abstract
Objective. The purpose of this study was to evaluate the radiobiological implications of clinical use of respiratory-gated techniques for postoperative radiation therapy of early-stage left-sided breast cancer after breast-conserving surgery.
Material and methods. Radiation therapy treatment plans of 80 patients with [...] Read more.
Objective. The purpose of this study was to evaluate the radiobiological implications of clinical use of respiratory-gated techniques for postoperative radiation therapy of early-stage left-sided breast cancer after breast-conserving surgery.
Material and methods. Radiation therapy treatment plans of 80 patients with early-stage breast cancer (stage I–II), receiving whole breast irradiation after breast-conserving therapy, were analyzed. The control group consisting of 47 patients received standard radiation therapy, and the respiratory-gated group consisting of 33 patients received deep inspiration-gated radiation therapy. Normal tissue complication probabilities (NTCP) for cardiac mortality and for clinical radiation-induced pneumonitis were calculated for all patients included in present study, using relative seriality model. NTCP data were analyzed for 113 radiation therapy plans, which included free breathing plans for the respiratory-gated groups.
Results
. Pneumonitis probability was 0.6% (range 0.0–2.8%) and 0.3% (0.0–1.2%) for control and respiratory-gated group, respectively. Cardiac mortality was 1.3% (0.0–5.0%) and 0.2% (0.0–2.8%) for control and respiratory-gated group, respectively. Using respiratory-gated radiation therapy, NTCP was reduced in comparison with the control group by 83% (P<0.00001) and by 55% (P=0.01270) for cardiac mortality and for clinical radiation-induced pneumonitis, respectively.
Conclusions. Use of respiratory-gated radiation therapy, for postoperative treatment of earlystage breast cancer, significantly reduces excessive cardiac mortality probability and pulmonary complication probability, as compared to standard radiation therapy techniques. This is especially important from heart complication probability point of view, as cardiac mortality remains one of the important issues of postoperative breast irradiation in patients with early stage breast cance Full article
232 KiB  
Article
Surgical treatment of pressure ulcers: an 11-year experience at the Department of Plastic and Reconstructive Surgery of Hospital of Kaunas University of Medicine
by Kęstutis Maslauskas, Donatas Samsanavičius, Rytis Rimdeika and Vygintas Kaikaris
Medicina 2009, 45(4), 269; https://doi.org/10.3390/medicina45040035 - 08 Apr 2009
Cited by 13 | Viewed by 829
Abstract
The aim of this study was to evaluate morphological characteristics of pressure ulcers, methods of surgical treatment and its effectiveness in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital.
Material and methods
. A retrospective data analysis of [...] Read more.
The aim of this study was to evaluate morphological characteristics of pressure ulcers, methods of surgical treatment and its effectiveness in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital.
Material and methods
. A retrospective data analysis of 139 patients with pressure ulcers treated in the Clinic of Plastic and Reconstructive Surgery, Kaunas University of Medicine Hospital, from January 1996 to January 2007 was performed. Results. A total of 139 patients were surgically treated for pressure ulcers at the Clinic of Plastic and Reconstructive Surgery, Kaunas University of Medicine Hospital, from January 1996 to January 2007. Eighty-one patients were treated repeatedly (from 1 to 7 admissions; M=1). Pressure ulcers were healed completely in 94 patients who underwent surgery during the treatment in the hospital; in 45 patients who underwent surgical treatment, pressure ulcers were partially healed, and on discharge from hospital, only small wounds were left. Pressure ulcers most commonly occur in tuber ischii area (69 cases). The mean age of patients was 42±13.65 years (M=31); pressure ulcers were for 8.9±8.5 months on average (M=31). At admission to Kaunas University of Medicine Hospital, the mean size of pressure ulcers was 42.62±53.27 cm2 (M=10). The results showed that the size of pressure ulcers depends on the duration of paraplegia (P<0.05). In 93 cases, pressure ulcers were treated using myocutaneous flaps; 17 of them were closed with V-Y advancement technique over the sacral area, 35 were closed with m. gluteus rotation flap, and in 41 cases, V-Y advancement technique using hamstring flaps was used.
Conclusions. In patients with paraplegia, the first pressure ulcer occurs after 74.79±61.34 months from the onset of the disease. Pressure ulcers most commonly occur over tuber ischii area. The most effective surgical treatment of pressure ulcers is closure of the wound using myocutaneous flaps (use of the hamstrings); fasciocutaneous flaps were the most commonly used method in patients who underwent surgery for the second time. Full article
201 KiB  
Article
The value of 99mTc-MIBI myocardial perfusion imaging in differentiation of heart failure conditioned by global left ventricular systolic impairment
by Nijolė Ragaišytė, Aušra Kavoliūnienė, Edvardas Vaicekavičius, Ramūnas Navickas, Ilona Kulakienė, Jonė Venclovienė, Jolanta Laukaitienė, Jūratė Janėnaitė and Arnoldas Janavičius
Medicina 2009, 45(4), 262; https://doi.org/10.3390/medicina45040034 - 08 Apr 2009
Cited by 2 | Viewed by 879
Abstract
Objective. The global left ventricular systolic impairment with left ventricular dilatation can manifest due to idiopathic dilated cardiomyopathy or ischemic heart disease and can present a similar clinical picture of severe heart failure. The aim of our investigation was to assess a [...] Read more.
Objective. The global left ventricular systolic impairment with left ventricular dilatation can manifest due to idiopathic dilated cardiomyopathy or ischemic heart disease and can present a similar clinical picture of severe heart failure. The aim of our investigation was to assess a differential diagnostic value of resting 99mTc-MIBI myocardial perfusion defects in evaluation of the etiology of heart failure.
Material and methods
. The data of 2D echocardiography, coronary angiography, and myocardial gated single photon emission computed tomography with 99mTc-MIBI investigation were evaluated in 43 patients with global left ventricular systolic impairment, characterized by left ventricular end-diastolic diameter of ≥65 mm and ejection fraction of £40%. The idiopathic dilative cardiomyopathy was diagnosed in 26 patients (Group 1) and ischemic heart failure – in 17 patients (Group 2). The area and the degree (severity) of myocardial perfusion defects (AMPD and DMPD) at rest in regions supplied by three coronary arteries were evaluated in all the patients.
Results
. The area of perfusion defects in the left anterior descending (LAD) and right coronary artery (RCA) regions in dilative cardiomyopathy patients was smaller than in ischemic heart failure patients (1.43±0.9 vs 2.53±0.53, P=0.001, and 2.19±0.6 vs 2.82±0.56, P=0.02). The degree of perfusion defects was also less severe in the same circulation regions (1.39±0.93 vs 2.59±0.6, P=0.01, and 1.6±0.46 vs 2.71±0.15, P=0.001). We have designed a logistic regression model expressed by formula x=2.52AMPDrca+2.47AMPDlad+2.21DMPDrca. Idiopathic dilative cardiomyopathy was predicted when x was £16 and ischemic heart failure when x was >16. The sensitivity in predicting idiopathic dilative cardiomyopathy was 94.44%, and the specificity was 88.24%.
Conclusion. The difference in the area and degree of 99mTc-MIBI myocardial perfusion defects at rest in patients with heart failure caused by idiopathic dilative cardiomyopathy or ischemic heart failure is measurable and has a predictive value for differentiation of the etiology of global left ventricular systolic impairment. Full article
235 KiB  
Article
Diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block
by Antanas Jankauskas, Jurgita Zaveckienė, Ramūnas Unikas, Rimvydas Šlapikas, Algidas Basevičius and Remigijus Žaliūnas
Medicina 2009, 45(4), 255; https://doi.org/10.3390/medicina45040033 - 08 Apr 2009
Viewed by 742
Abstract
Objective. The aim of present study was to evaluate the diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block.
Materials and methods. Twenty-four patients who underwent both multislice computed tomography coronary angiography and invasive coronary [...] Read more.
Objective. The aim of present study was to evaluate the diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block.
Materials and methods. Twenty-four patients who underwent both multislice computed tomography coronary angiography and invasive coronary angiography were enrolled in the study. Findings of these imaging modalities were compared in order to determine the sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography in identifying hemodinamically significant stenoses (≥50%). All segments ≥2 mm in diameter were visually assessed independently from their degree of calcification and image quality.
Results. In total, 328 segments were analyzed. The Spearman correlation coefficient between multislice computed tomography and invasive coronary angiography was 0.76 (P<0.0001). On a per-segment basis, sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography were 75%, 97.7%, 72%, and 98%, respectively; on a per-vessel basis, these values were 77.8%, 92.3%, 70%, and 94.7%, respectively; on a per-patient basis – 81.8%, 84.6%, 81.8%, and 84.6%, respectively.
Conclusions. Multislice computed tomography coronary angiography provides a high diagnostic accuracy in detecting significant coronary artery stenoses in patients with left bundle branch block. Full article
198 KiB  
Article
Mucinous adenocarcinoma arising in an anorectal fistula
by Linas Venclauskas, Žilvinas Saladžinskas, Algimantas Tamelis, Darius Pranys and Dainius Pavalkis
Medicina 2009, 45(4), 286; https://doi.org/10.3390/medicina45040037 - 07 Dec 2008
Cited by 9 | Viewed by 789
Abstract
Mucinous adenocarcinoma in association with chronic anal fistula is a rare case in clinical practice. The aim of this article was to report a rare case of anal gland mucinous adenocarcinoma in a patient who was treated in the Hospital of Kaunas University [...] Read more.
Mucinous adenocarcinoma in association with chronic anal fistula is a rare case in clinical practice. The aim of this article was to report a rare case of anal gland mucinous adenocarcinoma in a patient who was treated in the Hospital of Kaunas University of Medicine. Case report. A 70-year-old male was treated for anorectal fistula in the surgical department. Four operations were performed for perineal abscess during the period of 15 years. During the period of 15 years, the patient complained of purulent secretion from the perineal abscess. After the last operation, anorectal fistula developed. Multiple biopsies and scrapings of the fistulous track were taken for histological examination. Histological examination revealed mucinous adenocarcinoma, G2. Subsequently, the patient underwent endoanal ultrasound, computed tomography scan, and colonoscopy. The computed tomography scan did not show pathology in the abdomen, but showed soft tissue induration at the site of anorectal fistula. Colonoscopy investigation did not show any pathology in the rectum and bowels. Endoanal ultrasound findings showed soft tissue induration at the site of anorectal fistula, no tumor in the rectum wall. The patient underwent abdominoperineal resection. Histological examination after abdominoperineal resection revealed anal duct mucinous adenocarcinoma pT2 N0 L0 V0 R0, G2. Metastases to the mesenteric lymph nodes were not detected. On the eight day after abdominoperineal resection, the patient was discharged from the hospital for follow-up. Summary. Mucinous adenocarcinoma in anorectal fistula is a rare condition. If surgical treatment for perineal abscess or anorectal fistula is not successful for a long time, mucinous adenocarcinoma should be suspected. Full article
269 KiB  
Article
Prevalence of drug use among students of vocational schools in Klaipėda city, Lithuania, in 2004–2006
by Dalia Jurgaitienė, Apolinaras Zaborskis and Linas Šumskas
Medicina 2009, 45(4), 291; https://doi.org/10.3390/medicina45040038 - 21 Jun 2008
Cited by 3 | Viewed by 730
Abstract
The aim was to evaluate the prevalence and trends of drug use among students of vocational schools in Klaipėda city and to establish the relationships between psychosocial factors and drug abuse.
Participants and methods. Two cross-sectional questionnaire surveys were carried out among [...] Read more.
The aim was to evaluate the prevalence and trends of drug use among students of vocational schools in Klaipėda city and to establish the relationships between psychosocial factors and drug abuse.
Participants and methods. Two cross-sectional questionnaire surveys were carried out among first-year students of vocational schools in Klaipėda. Random samples of 912 and 342 students aged 16–19 years (representatives of Western part of Lithuania) were questioned in 2004 and 2006, respectively. Questionnaires were filled out anonymously in the classroom. Questions have covered information on drugs such as marihuana, club drugs, injectable drugs, and other drugs. Logistic regression was used for evaluation of relationship between drug use and different psychosocial and behavioral determinants of drug use.
Results. In 2004, 56.0% of male respondents and 42.0% of female respondents have reported any drug use during their life. The analysis of standardized data (by the place of residence) showed an increase in the prevalence of drug use during 2004–2006: up to 65.5% in boys (P<0.05) and up to 44.0% in girls (P>0.05). Percentage of club drug users increased significantly in girls (from 21.5% to 29.8%; P=0.040) and exceeded the level of boys. The average number of drugs of different types used by boys changed slightly from 1.57 to 1.63 (P>0.05), but increased significantly in girls (from 1.49 to 1.88, P<0.001). The use of drugs was related to school location (graduates of Klaipėda schools used drugs more frequently), communication with friends who use drugs, participation in the parties where drugs are used, alcohol use, and smoking. In 2006 survey, more significant relationship between drug use and social and behavioral factors was observed.
Conclusion. Several indicators of drug use showed a significant increase in drug abuse among students of vocational schools in Klaipėda during the period of 2004–2006. Multisectorial efforts and integrated preventive measures should be applied for the prevention of epidemics of drug use in Klaipėda city. Full article
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