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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 9 (September 2009) – 11 articles

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269 KiB  
Article
The scientific heritage of Professor Aron Gutman (Commemorating the 10th anniversary of Aron Gutman’s death)
by Armuntas Baginskas, Gytis Svirskis and Rimvydas Miliauskas
Medicina 2009, 45(9), 732; https://doi.org/10.3390/medicina45090096 - 21 Sep 2009
Cited by 1 | Viewed by 799
Abstract
Aron Gutman started his scientific research when he was a student of the Department of Physics and Mathematics, Vilnius University. At that time, he developed the theory of nonhomogenous vector relations between magnetic moments of electrons in an atom and applied it for [...] Read more.
Aron Gutman started his scientific research when he was a student of the Department of Physics and Mathematics, Vilnius University. At that time, he developed the theory of nonhomogenous vector relations between magnetic moments of electrons in an atom and applied it for explanation of energy spectrum of real atoms. Since 1960, he worked in Kaunas Medical Institute, and his main field of scientific interests was theoretical biophysics and electrophysiology of living tissues and cells. The earlier biophysical works of A. Gutman dealt with problems of the bioelectrical fields that underlie electroencephalogram, electrocorticogram, and electrocardiogram. The most important achievement was a theory of individual potential or postsynaptic field potential of synapses from individual axon (EEG quantum) and its role in shaping of electroencephalogram. In the later works (from 1971), he looked into properties and function of the individual nerve cells. He had created and developed the theory of nonlinear (bistable) dendrites and analyzed functional implications of such dendrites. In the last works, A. Gutman tried to relate the functioning of the nervous system at the cellular and system levels. He made efforts to find connection between the properties of individual neurones and principles (laws) of functioning of the nervous system. He had managed to relate dendritic bistability of neurones and Gelfand-Tsetlin principle of the functioning of the central nervous system (also known as the principle of minimal afferentiation). He explained some regularities in motor control by the dendritic bistability of motoneurones. Full article
192 KiB  
Article
Associations between parental skills and their attitudes toward importance to develop good oral hygiene skills in their children
by Giedrius Vanagas, Žemyna Milašauskienė, Vilius Grabauskas and Aušra Mickevičienė
Medicina 2009, 45(9), 718; https://doi.org/10.3390/medicina45090094 - 9 Sep 2009
Cited by 53 | Viewed by 2640
Abstract
Background. For many years, poor oral hygiene and frequent consumption of sugars is known as key behavioral risk factors for oral diseases, such as dental caries and periodontal disease. Parental attitudes toward children’s oral health could be associated with their own oral [...] Read more.
Background. For many years, poor oral hygiene and frequent consumption of sugars is known as key behavioral risk factors for oral diseases, such as dental caries and periodontal disease. Parental attitudes toward children’s oral health could be associated with their own oral health skills. We aimed to analyze associations between parental skills and attitudes toward caries development and possibilities to control positive oral health behavior in their children.
Material and methods. A cross-sectional study involved 550 parents of 3- to 4-year-old children. A 40-item questionnaire was developed from the Theory of Planned Behavior, Health Belief Model and the Health Locus of Control model, and parental attitudes toward dental caries in their children were analyzed. Results. A total of 397 filled-in questionnaires were collected; the response rate was 72%. Parents with good own oral hygiene skills significantly more often understood the importance of brushing their children’s teeth (χ2=29.8; df=1; P<0.001). Study results highlighted also significant differences in importance to prevent tooth decay (χ2=3.1; df=1; P=0.051), importance to control sugar snacking (χ2=10.6; df=1; P=0.001), and parental perceived seriousness of tooth decay in children (χ2=9.2; df=1; P=0.002) comparing parents with poor and good oral hygiene skills. Differences in parental efficacy to control proper toothbrushing and parental efficacy to control sugar snacking in children were not significant comparing both groups.
Conclusions
. More than half (61%) of the parents have reported appropriate own oral hygiene skills. Parental attitudes toward children’s oral health were significantly associated with their own oral health behavior and understanding the importance of development of oral hygiene skills in their children. Full article
237 KiB  
Article
Analysis of content of phenolic acids in Lithuanian propolis using high-performance liquid chromatography technique
by Kristina Ramanauskienė, Arūnas Savickas, Asta Inkėnienė, Konradas Vitkevičius, Giedrė Kasparavičienė, Vitalis Briedis and Algirdas Amšiejus
Medicina 2009, 45(9), 712; https://doi.org/10.3390/medicina45090093 - 9 Sep 2009
Cited by 15 | Viewed by 1281
Abstract
The aim of the study was to analyze phenolic acids in Lithuanian propolis and to compare it with the composition of propolis in neighboring countries (Latvia and Poland) according to the predominant flora in the collecting places. The study was also aimed at [...] Read more.
The aim of the study was to analyze phenolic acids in Lithuanian propolis and to compare it with the composition of propolis in neighboring countries (Latvia and Poland) according to the predominant flora in the collecting places. The study was also aimed at the evaluation of the effect of the layer thickness (mm) of the harvested propolis on the quality of the raw material in determining the amount of phenolic acids.
Materials and methods.
The object of the study was propolis collected in Lithuania, Poland, and Latvia in late July of 2006 and 2007. The qualitative and quantitative analysis of phenolic acids was performed using the high-performance liquid chromatography technique (HPLC).
Results. The results of the study showed that the quantitative and qualitative composition of phenolic acids in propolis depended on the plants from which the bees in the area collected substances for the raw material of propolis. The predominant phenolic acids were determined to be ferulic and coumaric acids, and they may be among the main indicators of quality in the standardization of the raw material and preparations of propolis.
Conclusion
. We created an HPLC-based analysis method for the identification and quantification of phenolic acids in propolis. The variety of phenolic acids in propolis depends on the vegetation predominating in the harvesting area. Studies have shown that the highest amount of phenolic acids is observed in propolis harvested in areas characterized by the predominance of deciduous trees and meadows. Results have also shown that ferulic and coumaric acids are the predominant phenolic acids in propolis. The thickness of the layer of the collected propolis in the hive also influences its chemical composition. Full article
677 KiB  
Article
Radiological changes after Nuss operation for pectus excavatum
by Artūras Kilda, Saulius Lukoševičius, Vidmantas Barauskas, Živilė Jankauskaitė and Algidas Basevičius
Medicina 2009, 45(9), 699; https://doi.org/10.3390/medicina45090091 - 9 Sep 2009
Cited by 21 | Viewed by 1052
Abstract
The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure.
Materials and methods.
Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after [...] Read more.
The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure.
Materials and methods.
Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated.
Results
. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012).
Conclusions
. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index. Full article
497 KiB  
Article
Evaluation of pituitary imaging in patients with PROP-1 gene mutation
by Natalija Tkačenko, Danutė Lašienė, Silvija Jakštienė, Algidas Basevičius and Rasa Verkauskienė
Medicina 2009, 45(9), 693; https://doi.org/10.3390/medicina45090090 - 9 Sep 2009
Cited by 4 | Viewed by 818
Abstract
The most common genetically determined cause of multiple pituitary hormone deficiency is PROP-1 gene mutation. PROP-1 is a transcription factor involved in the development of pituitary gland and affects hormonal synthesis of anterior pituitary.
The aim of our study
was to evaluate radiological [...] Read more.
The most common genetically determined cause of multiple pituitary hormone deficiency is PROP-1 gene mutation. PROP-1 is a transcription factor involved in the development of pituitary gland and affects hormonal synthesis of anterior pituitary.
The aim of our study
was to evaluate radiological aspects of the pituitary region in patients with PROP-1 gene mutation. Pituitary imaging studies were performed in 12 patients with a confirmed PROP-1 gene mutation. Pituitary hyperplasia was found in 5 (42%) and pituitary hypoplasia in 4 (33%) patients. Changes in pituitary size were not associated with the type of PROP-1 gene mutation. Full article
215 KiB  
Article
Late results of coronary revascularization with saphenous vein and internal thoracic artery grafts
by Šarūnas Kinduris, Juozas Sakalauskas, Raimonda Verseckaitė and Gintarė Kaklauskaitė
Medicina 2009, 45(9), 688; https://doi.org/10.3390/medicina45090089 - 9 Sep 2009
Viewed by 770
Abstract
Objective. To evaluate the patency of saphenous vein and internal thoracic artery grafts by coronary system using angiographies performed in symptomatic patients after coronary artery bypass grafting.
Material and methods
. From 1999 to 2006, 685 patients (mean age, 59.1±11.8 years) had [...] Read more.
Objective. To evaluate the patency of saphenous vein and internal thoracic artery grafts by coronary system using angiographies performed in symptomatic patients after coronary artery bypass grafting.
Material and methods
. From 1999 to 2006, 685 patients (mean age, 59.1±11.8 years) had angiography of 538 internal thoracic and gastroepiploic artery and 1644 saphenous vein grafts. There were 580 (84.7%) males. The mean period from operation to the performance of reangiogram was 73.3±53.5 months. Graft failure was defined as >95% stenosis. The saphenous vein was grafted to the left anterior descending artery in 106 (6.4%), to the diagonal artery in 364 (22.1%), to the obtuse marginal artery in 629 (38.3%), and to the right coronary artery in 545 (33.1%) cases.
Results
. During the study, 1496 (68.97%) grafts were patent, and 686 (31.0%) had failed. Unadjusted 1-, 5-, 10-, and >10-year patency was 91.0%, 89.9%, 90.1%, and 75% for internal thoracic arteries and 79.9%, 68.6%, 57.4%, and 51.0% for saphenous veins, respectively.
Conclusions
. Internal thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed coronary arteries. When bypassing coronary arteries with less than 70% stenosis, saphenous veins may be a better choice. Full article
245 KiB  
Article
Nonpharmacological correction of low back pain by single or integrated means of medical rehabilitation and the evaluation of their effectiveness
by Giedrė Sakalauskienė
Medicina 2009, 45(9), 739; https://doi.org/10.3390/medicina45090097 - 8 Sep 2009
Viewed by 923
Abstract
Low back pain is a global worldwide problem. A great attention is given to correction of this health status by a wide range of rehabilitation specialists. Some single or integrated physical factors, physiotherapy, specific and nonspecific physical exercises, alternative methods of treatment, also [...] Read more.
Low back pain is a global worldwide problem. A great attention is given to correction of this health status by a wide range of rehabilitation specialists. Some single or integrated physical factors, physiotherapy, specific and nonspecific physical exercises, alternative methods of treatment, also the complex of multidisciplinary rehabilitation means are applied in the management of low back pain. The evidencebased data are analyzed in order to identify which nonpharmacological means are effective in pain correction; in addition, the effectiveness of various methods and models of low back pain management are compared in this article.
Conclusions
. Research data evaluating the impact effectiveness of single or integrated means of rehabilitation are very controversial. There are no evidence-based specific recommendations for the correction of this health status objectively assessing advantages of physiotherapy or physical factors and referring the definite indications of their prescription. It is thought that multidisciplinary rehabilitation is most effective in management of chronic low back pain. The positive results depend on the experience of a physician and other rehabilitation specialists. A patient’s motivation to participate in the process of pain control is very important. It is recommended to inform a patient about the effectiveness of administered methods. There is a lack of evidencebased trials evaluating the effectiveness of nonpharmacological methods of pain control in Lithuania. Therefore, the greater attention of researchers and administrative structures of health care should be given to this problem in order to develop the evidence-based guidelines for an effective correction of low back pain. Full article
228 KiB  
Article
School nurses’ contribution to schoolchildren’s future health
by Elvyra Grinienė and Neringa Liutaitė
Medicina 2009, 45(9), 724; https://doi.org/10.3390/medicina45090095 - 8 Sep 2009
Cited by 1 | Viewed by 1001
Abstract
In the changing contemporary society, certain demands for health care system become evident. In recent years, declining health indicators of Lithuanian schoolchildren prompt to analyze the situation of schoolchildren’s health care: whether health care at schools is sufficient and effective and how school [...] Read more.
In the changing contemporary society, certain demands for health care system become evident. In recent years, declining health indicators of Lithuanian schoolchildren prompt to analyze the situation of schoolchildren’s health care: whether health care at schools is sufficient and effective and how school nurses deal with schoolchildren’s health problems on a daily basis.
Objective
. To analyze how school nursing specialists work at school and what problems they encounter while providing health care to schoolchildren.
Material and methods
. A total of 202 school nurses from five main Lithuanian cities participated in the survey in 2005. More than three-fourths (77.7%) of the respondents had been working at school for more than 10 years. For the survey, an original closed questionnaire, consisting of 28 questions, was used.
Results. The survey showed that most of school nurses were approached by schoolchildren with the following health problems: visual impairment, anomalous posture, and scoliosis. More than three-fourths (75.5%) of the school nurses noted that schoolchildren’s health was getting worse over the last five years. School nurses usually provide care to 11–30 schoolchildren per day. Most of their time is spent on schoolchildren’s health check-ups, health education, and documentation. The school nurses noted that the efficiency of health care system at school was reduced by a number of problems, including poor working conditions, the lack of medical equipment, inadequate computer systems. Therefore, the cooperation among nurses, school administration, and parents must be substantially improved.
Conclusions. The competence of school nurses should be maintained through an educational approach by developing their qualification, as well as through a social approach by improving their cooperation with school community and parents. Full article
201 KiB  
Article
Coagulation alterations in treating arrhythmias with radiofrequency ablation
by Vilma Kozlovaitė, Pranas Grybauskas, Jūratė Cimbolaitytė, Aušra Mongirdienė, Vytautas Šileikis, Vytautas Zabiela, Joana Kažanienė and Julius Ptašekas
Medicina 2009, 45(9), 706; https://doi.org/10.3390/medicina45090092 - 8 Sep 2009
Cited by 2 | Viewed by 938
Abstract
Objective. To determine an influence of radiofrequency ablation on changes in coagulation system.
Material and methods
. We investigated 30 patients with cardiac arrhythmias. Platelet aggregation, fibrinogen and D-dimer level were analyzed before, right after, 24 and 72 h after radiofrequency ablation. [...] Read more.
Objective. To determine an influence of radiofrequency ablation on changes in coagulation system.
Material and methods
. We investigated 30 patients with cardiac arrhythmias. Platelet aggregation, fibrinogen and D-dimer level were analyzed before, right after, 24 and 72 h after radiofrequency ablation. Platelet aggregation was explored in whole blood and platelet-rich plasma using adenosine diphosphate (ADP), epinephrine, and collagen for induction.
Results
. Platelet aggregation induced by ADP and collagen in whole blood plasma increased significantly (P<0.01) (by 45% and 43%, respectively) in 24 h after radiofrequency ablation and remained increased in 72 h after radiofrequency ablation (by 11% and 35%, respectively) (P<0.01) as compared with baseline results. Spontaneous aggregation of platelet-rich plasma as well as ADP- and collagen-induced platelet aggregation tended to decrease right after radiofrequency ablation. Epinephrine-induced platelet aggregation significantly decreased by 17.5% after radiofrequency ablation (P<0.01) and started to increase in 24 h after radiofrequency ablation. In 72 h after radiofrequency ablation, platelet aggregation induced by different agonists increased by 7–45% significantly (P<0.05), and values were higher than baseline ones. Fibrinogen level after radiofrequency ablation did not differ from that of the baseline (3.08±0.7 g/L), but D-dimer level increased significantly (from 0.39±0.3 to 1.29±2.4 mg/L, P<0.01). In 24 h after radiofrequency ablation, an increase in fibrinogen level and a decrease in D-dimer level were found. Fibrinogen level increased to 3.32±0.6 g/L significantly in 72 h after radiofrequency ablation (P<0.05). Meanwhile, D-dimer concentration decreased to 0.78±0.8 mg/L, but it was still significantly higher (P<0.05) than the baseline value.
Conclusion
. Despite diminished platelet aggregation and increased D-dimer level right after radiofrequency ablation, a risk of thrombosis increased in the next few days after radiofrequency ablation. Full article
236 KiB  
Article
Results of surgical treatment of aortic root infection
by Palmyra Semėnienė, Arimantas Grebelis, Gintaras Turkevičius, Giedrė Nogienė, Rasa Čypienė and Vytautas Sirvydis
Medicina 2009, 45(9), 683; https://doi.org/10.3390/medicina45090088 - 8 Sep 2009
Viewed by 795
Abstract
Aim of the study. To investigate preoperative status and results of surgery of patients with confirmed diagnosis of aortic root infection.
Materials and methods. We have analyzed data of 21 patients who were operated on at the Heart Surgery Center, Vilnius University, [...] Read more.
Aim of the study. To investigate preoperative status and results of surgery of patients with confirmed diagnosis of aortic root infection.
Materials and methods. We have analyzed data of 21 patients who were operated on at the Heart Surgery Center, Vilnius University, since January 1, 1997, till December 31, 2006. All these patients underwent surgery because of aortic root infection. The patients were aged 25–72 years (mean age, 53±14 years). There were 17 (80.9%) male patients. Sixteen patients (76%) preoperatively were in NYHA class IV. The abscesses of aortic root were confirmed preoperatively by means of esophageal echocardiography in 18 patients (86%). Blood cultures positive for Staphylococcus aureus were found in four patients (19.9%). All the patients underwent replacement of the aortic valve by mechanic prosthesis; one of these patients was reoperated because of persistent sepsis, and replacement of the aortic root with homograft was performed. The duration of follow-up of the patients was 1 to 10 years.
Results. Inhospital mortality rate was 14.3%. The causes of death included sustained heart failure and sepsis. All these patients were in NYHA functional class IV preoperatively; one of these patients had culture positive for Staphylococcus aureus. Inhospital survival was 85.7%, one-year postoperative survival – 80.9%, and both five-year and ten-year survivals were 76.0%. The long-term survival was negatively influenced by recurrent infective endocarditis, heart failure, and age. Death occurred in 1 patient (11.1%) of the 9 patients who at the time of surgery were younger than 50 years and 4 patients (33.3%) of the 12 who were older than 50 years at the time of operation.
Conclusions
. The infection of aortic root is not common pathology; however, it is a complicated disease. Esophageal echocardiography is an informative method while diagnosing aortic root abscesses. The inhospital mortality is increased by the heart failure persisting after the operation and sepsis. The long-term survival is decreased by preoperative infective endocarditis of the prosthesis and heart failure. The mortality rate of patients older than 50 years is 3-fold higher than mortality rate of younger ones. Full article
291 KiB  
Article
The effectiveness of long-term rehabilitation in patients with cardiovascular diseases
by Donatas Vasiliauskas, Lina Jasiukevišiene, Raimondas Kubilius, Ruta Arbašiauskaite, Dovile Dovidaitiene and Loresa Kriaušiuniene
Medicina 2009, 45(9), 673; https://doi.org/10.3390/medicina45090087 - 8 Sep 2009
Cited by 5 | Viewed by 841
Abstract
Background. Screening results of EuroAspire III study have revealed the failure of effective correction of cardiovascular risk factors in all 22 participating EU countries. How long should cardiac rehabilitation programs last to impact motivation for lifestyle change?
Aim and objectives. To [...] Read more.
Background. Screening results of EuroAspire III study have revealed the failure of effective correction of cardiovascular risk factors in all 22 participating EU countries. How long should cardiac rehabilitation programs last to impact motivation for lifestyle change?
Aim and objectives. To compare the impact of long-term (6 months) rehabilitation versus short-term (4 weeks) rehabilitation on the reduction of risk factors and cardiac events, as well as on the use of cardioprotective drugs.
Methods. Study contingent of 150 patients, suffering from functional class III-IV (NYHA) chronic heart failure caused by ischemic and hypertensive cardiomyopathy, was subjected to complex rehabilitation: exercise training, dietary corrections, and smoking cessation. The patients were divided into two groups: long-term rehabilitation group (n=80) and short-term rehabilitation group (n=70). Blood pressure, body mass index, dietary habits, dyslipidemia, sedentary lifestyle, smoking, chronic fatigue, and use of cardioprotective drugs were evaluated in all patients at the onset of study, after 4 weeks, and 6 months. Cardiovascular events were estimated throughout the whole 6-month period.
Results. In the long-term rehabilitation group, there was a significant reduction (P<0.05) in systolic blood pressure (151±9.2 vs. 135±9.7 mm Hg), diastolic blood pressure (92.3±6.5 vs. 75.4±3.8 mm Hg,) body mass index (35.4±3.5 vs. 27.2±4.8 kg/m2), dyslipidemia (56.3 vs. 23.4%), sedentary lifestyle (31.3 vs. 4.7%), and smoking (10.0 vs. 0%). The impact of a short-term rehabilitation was not significant. Because of cardiac events, 13 patients (16.3%) in the long-term rehabilitation group and 26 (16.3%) in the short-term rehabilitation group failed to complete the 6-month study (P<0.05). The following change in drug use pattern was noted in the long-term rehabilitation group: nitrates, 74 vs. 65%; digitalis, 42 vs. 32%; antiarrhythmic agents, 15 vs. 10%; statins, 36 vs. 20% (P<0.05). During 6 months, in both groups, because of better physician monitoring, there was no decrease in the use of major cardioprotective drugs, such as antiaggregants, beta-blockers, and ACE inhibitors.
Conclusions
. Long-term (6 months) versus short-term (4 weeks) rehabilitation of cardiovascular patients significantly reduces manifestation of major cardiovascular risk factors, the rate of cardiac events, chronic fatigue and improves the use of cardioprotective drugs. Full article
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