Medicina

157 KiB

Open AccessArticle

Factors determining age-related macular degeneration: a current view

by Rasa Liutkevičienė, Vaiva Lesauskaitė, Virginija Ašmonienė, Dalia Žaliūnienė and Vytautas Jašinskas

Medicina 2010, 46(2), 89; https://doi.org/10.3390/medicina46020013 - 10 Feb 2010

Cited by 25 | Viewed by 1114

Abstract

Age-related macular degeneration affects the macula and is the leading cause of significant and irreversible central visual loss. It is the most common cause of visual loss in people older than 60 years. The pathogenesis of age-related macular degeneration is complex and not [...] Read more.

Age-related macular degeneration affects the macula and is the leading cause of significant and irreversible central visual loss. It is the most common cause of visual loss in people older than 60 years. The pathogenesis of age-related macular degeneration is complex and not completely understood. It is thought that age-related macular degeneration has a multifactorial etiology, the development of which may be caused by interrelation of environmental and genetic factors and body characteristics. In this article, risk factors such as age, gender, cigarette smoking, color of the iris, nutrition, body mass index, oxidative stress, and genetic factors (complement factor H gene, Apo E gene, and others) are reviewed. Here, choroidal neovascularization process, in which hypoxia, inflammatory process, and proteolytic enzymes play a determinant role, is discussed. Considerable attention is paid to genetic polymorphism of matrix metalloproteinases, especially to matrix metalloproteinases 2 and 9, respectively gelatinases A and B, also to matrix metalloproteinase 9. Full article

231 KiB

Open AccessReview

Radiofrequency ablation of liver tumors (II): clinical application and outcomes

by Tomas Vanagas, Antanas Gulbinas, Juozas Pundzius and Giedrius Barauskas

Medicina 2010, 46(2), 81; https://doi.org/10.3390/medicina46020012 - 10 Feb 2010

Cited by 14 | Viewed by 947

Abstract

Radiofrequency ablation is one of the alternatives in the management of liver tumors, especially in patients who are not candidates for surgery. The aim of this article is to review applicability of radiofrequency ablation achieving complete tumor destruction, utility of imaging techniques for [...] Read more.

Radiofrequency ablation is one of the alternatives in the management of liver tumors, especially in patients who are not candidates for surgery. The aim of this article is to review applicability of radiofrequency ablation achieving complete tumor destruction, utility of imaging techniques for patients follow-up, indications for local ablative procedures, procedureassociated morbidity and mortality, and long-term results in patients with different tumors. The success of local thermal ablation consists in creating adequate volumes of tissue destruction with adequate clear margin, depending on improved delivery of radiofrequency energy and modulated tissue biophysiology. Different volumes of coagulation necrosis are achieved applying different types of electrodes, pulsing energy sources, utilizing sophisticated ablation schemes. Some additional methods are used to increase the overall deposition of energy through alterations in tissue electrical conductivity, to improve heat retention within the tissue, and to modulate tolerance of tumor tissue to hyperthermia. Contrast-enhanced computed tomography, magnetic resonance imaging, ultrasound or positron emission tomography are applied to control the effectiveness of radiofrequency ablation. The long-term results of radiofrequency ablation are controversial. Full article

314 KiB

Open AccessArticle

Kūno sandara ir policistinių kiaušidžių sindromas

by Lina Zabulienė and Janina Tutkuvienė

Medicina 2010, 46(2), 142; https://doi.org/10.3390/medicina46020021 - 10 Feb 2010

Cited by 9 | Viewed by 1094

Abstract

Policistinių kiaušidžių sindromas (PKS) yra viena svarbiausių reprodukcinio amžiaus moterų endokrininių metabolinių ligų, lemianti androgenų perteklių, mėnesinių ciklo sutrikimus, nevaisingumą, nutukimą ir kitus organizmo pokyčius. Įvairių autorių duomenimis, PKS pasitaiko 2–28 proc. reprodukcinio amžiaus moterų. Dažniausi klinikiniai policistinių kiaušidžių sindromo požymiai yra susiję [...] Read more.

Policistinių kiaušidžių sindromas (PKS) yra viena svarbiausių reprodukcinio amžiaus moterų endokrininių metabolinių ligų, lemianti androgenų perteklių, mėnesinių ciklo sutrikimus, nevaisingumą, nutukimą ir kitus organizmo pokyčius. Įvairių autorių duomenimis, PKS pasitaiko 2–28 proc. reprodukcinio amžiaus moterų. Dažniausi klinikiniai policistinių kiaušidžių sindromo požymiai yra susiję su hiperandrogenemija, anovuliacija, mėnesinių ciklo bei kitais metaboliniais sutrikimais. PKS sunku identifikuoti, nes iki šiol diskutuojama dėl konkrečių ir visuotinai priimtų diagnostikos kriterijų. Mažai nagrinėta ir PKS fenotipinė raiška, kūno sandaros ir PKS sąsajos, taip pat sąsajos su moters augimo ir brendimo ypatybėmis bei su daugeliu išorinių veiksnių (mityba, fiziniu krūviu, stresu ir kitais veiksniais). Stinga žinių apie PKS raidą ir prognozę atsižvelgiant į individualius bei išorinius veiksnius. Žmogaus kūno sandaros įvairovės ribos yra labai plačios: daugelis fizinės būklės rodiklių (ūgis, svoris, kūno sandara ir proporcijos) yra žmogaus evoliucijos ilgo proceso, prisitaikymo prie aplinkos rezultatas. Tad akivaizdu, kad morfologiniai kūno parametrai, fiziologiniai ir biocheminiai rodikliai yra sudėtingais ryšiais susijusi sistema. Literatūros duomenimis, daugiau kaip pusė PKS sergančių moterų turi antsvorį arba nutukimą. Jeigu PKS sergančių moterų juosmens apimtis bei juosmens ir klubų rodiklis didėja, tai moters reprodukcinė būklė ir medžiagų apykaita sutrinka labiau nei tais atvejais, kai nėra šių rodiklių minėtų pokyčių. Tiriant riebalinio audinio topografiją – stipriausią lytinio dimorfizmo požymį, nustatyta, kad PKS sergančių moterų vidaus organų, juosmens srities ir rankų riebalinio audinio masė yra didesnė nei kontrolinės grupės moterų. Tam tikri lytinio dimorfizmo požymiai gali būti vertinami kaip hiperandrogenizacijos morfologiniai rodikliai – tai rankų jėga, pečių ir dubens pločio santykis, plaštakų ir pėdų dydis, antrojo ir ketvirtojo piršto ilgio santykis (2P:4P), veido bruožų savitumai. Tačiau tarp PKS sergančių moterų tirtas tik 2P:4P santykis. Ankstyvieji fizinės būklės morfologiniai pokyčiai padėtų numatyti ir tam tikras medžiagų apykaitos savybes, taip pat PKS raidą ir šio sindromo pasekmes. Full article

271 KiB

Open AccessArticle

Severe early childhood caries and behavioral risk factors among 3-year-old children in Lithuania

by Eglė Slabšinskienė, Simona Milčiuvienė, Julija Narbutaitė, Ingrida Vasiliauskienė, Vilija Andruškevičienė, Eglė-Aida Bendoraitienė and Kristina Saldūnaitė

Medicina 2010, 46(2), 135; https://doi.org/10.3390/medicina46020020 - 10 Feb 2010

Cited by 47 | Viewed by 1515

Abstract

The objective of the present study was to investigate the prevalence and severity of early childhood caries (ECC) and severe early childhood caries (S-ECC) in 3-year-old Lithuanian children. The impact of selected behavioral risk factors on the development of S-ECC was investigated.
Material [...] Read more.

The objective of the present study was to investigate the prevalence and severity of early childhood caries (ECC) and severe early childhood caries (S-ECC) in 3-year-old Lithuanian children. The impact of selected behavioral risk factors on the development of S-ECC was investigated.
Material and methods. A total of 950 children were examined in kindergartens. Diagnosis of dental caries followed the WHO criteria. Questionnaires were delivered to mothers of the children with S-ECC and caries-free children. The questions were related to the children’s dietary habits, temperament, oral hygiene, and the use of fluoride toothpaste.
Results. The prevalence of ECC was 50.6% with a mean dmft of 2.1 (SD, 0.1) and a mean dmfs of 3.4 (SD, 0.2). The prevalence of S-ECC was 6.5% with a mean dmft of 7.8 (SD, 0.1) and dmfs of 18.1 (SD, 0.6). A significantly higher percentage of children developed S-ECC when they were breast-fed for a period longer than one year, were sleeping with a bottle containing carbohydrates during the night, or were allowed to sip from a bottle either going to sleep or during the day. A significantly higher percentage of mothers having caries-free children knew about risk factors of S-ECC and started tooth brushing after the eruption of the first tooth. There was no significant difference between the groups regarding the use of fluoride toothpaste.
Conclusions. Improper infant bottle-feeding habits and no tooth brushing were found to be significant for the development of S-ECC among 3-year-old Lithuanian children. Full article

155 KiB

Open AccessArticle

Aerobic exercise-induced changes in body composition and blood lipids in young women

by Arvydas Stasiulis, Asta Mockienė, Daiva Vizbaraitė and Pranas Mockus

Medicina 2010, 46(2), 129; https://doi.org/10.3390/medicina46020019 - 10 Feb 2010

Cited by 20 | Viewed by 1480

Abstract

The objective of the study was to assess changes in body composition, blood lipid and lipoprotein concentrations in 18–24-year-old women during the period of two-month aerobic cycling training.
Material and methods. Young, healthy, nonsmoking women (n=19) volunteered to participate in this study. [...] Read more.

The objective of the study was to assess changes in body composition, blood lipid and lipoprotein concentrations in 18–24-year-old women during the period of two-month aerobic cycling training.
Material and methods. Young, healthy, nonsmoking women (n=19) volunteered to participate in this study. They were divided in two groups: experimental (E, n=10) and control (C, n=9). The subjects of group E exercised 3 times a week with intensity of the first ventilatory threshold and duration of 60 min. The group C did not exercise regularly over a two-month period of the experiment. The subjects of group E were tested before and after 2, 4, 6 and 8 weeks of the experiment. The participants of group C were tested twice with an eight-week interval.
Results. Body weight, body mass index, body fat mass, and triacylglycerol (TAG) concentration decreased and high-density lipoprotein cholesterol (HDL-ch) concentration increased after the 8-week training program in the experimental group (P<0.05). Blood total cholesterol (Tch) and low-density lipoprotein cholesterol (LDL-ch) concentrations did not change significantly. Body weight and body mass index started to decrease after 2 weeks of the experiment, but significant changes were observed only after 6 and 8 weeks. Body fat mass was significantly decreased after 2 and 8 weeks of aerobic training. A significant increase in HDL-ch concentration was observed after 4, 6, and 8 weeks. A significant decrease in TAG concentration was observed after 2-week training. No significant changes in all the parameters except TAG (it was slightly increased) were seen in the control group.
Conclusions. The two-month aerobic cycling training (within VT1, 60-min duration, three times a week) may induce significant changes in the parameters of body composition – body weight, body mass index, body fat mass, and blood lipids – in young women. The following significant changes were observed: TAG level decreased after 2 weeks, body mass and body mass index decreased after 6 weeks, body fat mass decreased and HDL-ch level increased after 8 weeks. Peak oxygen uptake increased after 4 weeks. Full article

162 KiB

Open AccessArticle

Type III longitudinal deficiency of the tibia and outcome of reconstructive surgery in a female patient

by Radivoj Brdar, Ivana Petronic, Dusan Abramovic, Marija Lukac, Dragana Cirovic, Tatjana Knezevic and Dejan Nikolic

Medicina 2010, 46(2), 125; https://doi.org/10.3390/medicina46020018 - 10 Feb 2010

Cited by 2 | Viewed by 872

Abstract

Type III longitudinal deficiency of tibia according to Kalamchi and Dawe denotes the presence of distal hypoplasia of the tibia with diastasis. We report a case of type III longitudinal deficiency of the tibia in a female patient who later underwent reconstructive surgery. [...] Read more.

Type III longitudinal deficiency of tibia according to Kalamchi and Dawe denotes the presence of distal hypoplasia of the tibia with diastasis. We report a case of type III longitudinal deficiency of the tibia in a female patient who later underwent reconstructive surgery. The first reconstruction of the leg was done when child turned 4 months of age. Surgical procedures included foot reconstruction and ankle stabilization with twice lengthening by the Ilizarov method (14 cm in total). During the follow-up, both the tibia and fibula of the affected leg showed the same lengthening and regression due to preserved distal growth zone cartilage. After surgical correction, the acetabulum was satisfactorily configured with an acetabular angle of 23 degrees. Explanation for surgical success was that osteotomy and distraction were done in the proximal part of the crural region where the growth potential was better. The tibia remained lean and hypoplastic while the fibula was incrassated. The function in the area of the knee joint was preserved, while the distal part of the leg served as good stand on. When the child was 18 years old, on check-up, the acetabular angle was 23 degrees while the Wiberg angle was 24 degrees. Full article

705 KiB

Open AccessArticle

Late-onset nocturnal intractable seizure during sleep: what is the origin?

by Skaidrius Miliauskas, Vanda Liesienė, Marius Žemaitis and Raimundas Sakalauskas

Medicina 2010, 46(2), 120; https://doi.org/10.3390/medicina46020017 - 10 Feb 2010

Cited by 1 | Viewed by 776

Abstract

A 54-year-old man was admitted to the Sleep Laboratory, Hospital of Kaunas University of Medicine, for assessment of nocturnal seizures of unknown origin during sleep. This patient complained of increasing daytime sleepiness, morning headaches. Before the admission to the Sleep Laboratory, the treatment [...] Read more.

A 54-year-old man was admitted to the Sleep Laboratory, Hospital of Kaunas University of Medicine, for assessment of nocturnal seizures of unknown origin during sleep. This patient complained of increasing daytime sleepiness, morning headaches. Before the admission to the Sleep Laboratory, the treatment with depakine and clonazepam had been prescribed. Despite the treatment, the frequency of nocturnal seizures and daytime sleepiness increased. Full night polysomnography was performed. Ten central apneas were registered during all night. Two central sleep apneas with deep desaturation followed by generalized tonicclonic seizures were documented. First sleep apnea lasted for 180 seconds and was terminated by epileptic tonic-clonic seizures. The second central sleep apnea with oxygen desaturation of 65% was detected 20 minutes later. It lasted for 200 seconds and was also terminated by epileptic tonic-clonic seizures. The conclusion was drawn that the patient had epileptic seizures caused by central sleep apneas with deep oxygen desaturation. The treatment with nasal continuous positive airway pressure device was started. The seizures disappeared completely. Clonazepam was stopped. Depakine was gradually withdrawn during the two weeks. One-year follow-up showed very good compliance, no seizures, and diminished daytime sleepiness. Full article

216 KiB

Open AccessArticle

Identification of predictors of inhospital postreperfusion mode of death in patients with acute ST-elevation myocardial infarction

by Edvardas Vaicekavičius, Ramūnas Navickas, Leonas Survila, Vytautas Štuikys, Arnoldas Janavičius and Kęstutis Valančius

Medicina 2010, 46(2), 104; https://doi.org/10.3390/medicina46020015 - 10 Feb 2010

Cited by 1 | Viewed by 798

Abstract

Objectives. The aim of this study was to identify the predictors of the postreperfusion mode of death using the distinctions in clinical characteristics of patients who died and survived after reperfusion therapy, treated due to ST-elevation myocardial infarction (STEMI).
Material and methods [...] Read more.

Objectives. The aim of this study was to identify the predictors of the postreperfusion mode of death using the distinctions in clinical characteristics of patients who died and survived after reperfusion therapy, treated due to ST-elevation myocardial infarction (STEMI).
Material and methods. This consecutive study has involved 36 patients: 18 patients who died from progressive heart failure (PHF) (group 1, n=13) or from cardiac rupture (CR) (group 2, n=5) after primary coronary intervention. The control group consisted of 18 randomly selected patients who survived inhospital period (group 3). The initial and postreperfusion heart rate (HR), systolic and diastolic arterial pressures (SAP and DAP), maximal ST elevation (max ST) and depression (max ST¯), ST score, TIMI flow grade, coronary score (CS), and their perireperfusion changes were assessed for each patient. The complex prognostic predictors – TIMI Risk Score and TIMI Risk Index – were also assessed. The data analysis was performed by standard statistical and machine learning approach methods.
Results. The comparison of three patients’ groups according to simple ECG or circulatory characteristics showed that more significant differences were seen in postreperfusion characteristics or their perireperfusion changes. Herewith, the major part of significantly different characteristics (baseline SAP, DAP, and HR, postreperfusion SAP, DAP, ST score, and TIMI flow grade, resolution of ST score) was observed comparing both the groups of dead patients with survivors (control group). The differences in the complex predictors (TIMI Risk Score and TIMI Risk Index) were similar. However, the smallest number of significantly different characteristics was seen comparing both the groups of dead patients. The baseline DAP (P=0.045), postreperfusion SAP (P=0.04) and DAP (P=0.03), and ST score (P=0.0025) were higher in the patients who died from CR. The postreperfusion ST score and SAP were also identified as necessary components in the assessment of informative prognostic sets according to feature selection methods used in data mining field.
Conclusion. The postreperfusion ST score, SAP, and DAP could be useful for the prediction of inhospital postreperfusion mode of death in patients with STEMI; evidently more clinical predictors could be useful for the prediction of general occurrence of postreperfusion deaths. Full article

221 KiB

Open AccessArticle

The relationship between panoramic radiomorphometric indices of the mandible and calcaneus bone mineral density

by Eglė Jagelavičienė, Ričardas Kubilius and Aurelija Krasauskienė

Medicina 2010, 46(2), 95; https://doi.org/10.3390/medicina46020014 - 09 Feb 2010

Cited by 14 | Viewed by 959

Abstract

Objective. The aim of the study was to determine the relationship between bone mineral density in the calcaneus measured using the dual x-ray and laser osteodensitometry technique and bone mineral density in the mandible calculated using the panoramic radiomorphometric indices obtained by [...] Read more.

Objective. The aim of the study was to determine the relationship between bone mineral density in the calcaneus measured using the dual x-ray and laser osteodensitometry technique and bone mineral density in the mandible calculated using the panoramic radiomorphometric indices obtained by applying linear measurements in panoramic radiograms of postmenopausal women.
Material and methods. The participants of this study were postmenopausal women (n=129) aged 50 and more. The subjects underwent panoramic radiography of the mandibles, followed by the calculation of the panoramic radiomorphometric indices indicating bone mineral density of the mandible. The dual x-ray and laser osteodensitometer DXL Calscan were used for the measurements of bone mineral density in the calcaneus. Statistical analysis was preformed to find the relationship between bone mineral density measurements in the two anatomically different bones.
Results. Following the diagnostic criteria for osteoporosis recommended by the World Health Organization (1994), the subjects were distributed according to the calcaneus bone mineral density T-score into the normal bone mineral density (group 1), osteopenia (group 2), and osteoporosis (group 3) groups. Mean bone mineral density in the calcaneus in the general studied population was 0.38±0.07; the mean value of bone mineral density of the calcaneus in the group 1 (n=34) was 0.47±0.04 (g/cm²), in the group 2 (n=65) was 0.37±0.03 (g/cm²), and in the group 2 (n=30) was 0.29±0.03 (g/cm²). Differences in bone mineral density between the groups were determined using the analysis of variance (ANOVA) F=285.31; df=2; P<0.001 (T1 vs. T2, P<0.001; T1 vs. T3, P<0.001; T2 vs. T3; P<0.001). A statistically significant correlation was found in the general group between the mental index and bone mineral density in the calcaneus (r=0.356, P<0.001), and between the panoramic mandibular index and bone mineral density in the calcaneus (r=0.397, P<0.001).
Conclusion. Bone mineral density in the calcaneus and the mandible measured using dual energy x-ray and laser osteodensitometer DXL Calscan and by applying panoramic radiography reflect general changes in the mineralization of these bones, characteristic of the postmenopausal period. Full article

205 KiB

Open AccessArticle

Pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastys ir rizikos veiksniai

by Rolandas Zablockis, Rūta Petruškevičienė and Remigijus Valdemaras Nargėla

Medicina 2010, 46(2), 113; https://doi.org/10.3390/medicina46020016 - 09 Feb 2010

Cited by 10 | Viewed by 929

Abstract

Tyrimo tikslas. Išnagrinėti pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastis ir rizikos veiksnius.
Tirtųjų kontingentas ir tyrimo metodai. Ištirta 120 ligonių, sirgusių pleuros empiema (n=67) ir komplikuotu parapneumoniniu pleuritu (n=53). Pleuros empiema diagnozuota radus pūlingo pleuros skysčio. Komplikuotas parapneumoninis pleuritas diagnozuotas ultragarsiniu [...] Read more.

Tyrimo tikslas. Išnagrinėti pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastis ir rizikos veiksnius.
Tirtųjų kontingentas ir tyrimo metodai. Ištirta 120 ligonių, sirgusių pleuros empiema (n=67) ir komplikuotu parapneumoniniu pleuritu (n=53). Pleuros empiema diagnozuota radus pūlingo pleuros skysčio. Komplikuotas parapneumoninis pleuritas diagnozuotas ultragarsiniu tyrimu, aptikus inkapsuliuoto skysčio pleuros ertmėje, pleuros skysčio pH<7,0 bei pleuros skystyje nustačius neutrofilų daugiau kaip 50 proc. visų leukocitų. Tyrimo tikslas – įvertinti tiriamųjų amžių, lytį, gretutinę patologiją, nustatyti laikotarpį, per kurį ligoniai kreipėsi į gydytoją, įvertinti, kokiais antibiotikais ligoniai buvo gydomi iki diagnozės nustatymo.
Rezultatai. Pleuros empiema ir komplikuotu parapneumoniniu pleuritu sirgo vidutinio amžiaus tiriamieji (53 metų), vyrai du kartus dažniau nei moterys. 46 proc. ligonių nustatytas bent vienas rizikos veiksnys, dažniausiai neoplazija (37 proc.), imunosupresuojamųjų vaistų (15 proc.) ir nesaikingas alkoholinių gėrimų vartojimas (15 proc.). Atsiradus ligos simptomams, tiriamieji į gydytojus kreipėsi vidutiniškai po 12 dienų. Ligoniams, kuriems buvo diagnozuota pleuros empiema, rizikos veiksniai buvo dažnesni (pleuros empiemos – 50,75 proc., komplikuoto parapneumoninio pleurito – 39,62 proc. atvejų), į gydytojus jie kreipėsi vėliau (21±28,6 dienos) nei sirgusieji komplikuotu parapneumoniniu pleuritu (9,5±9,8 dienos, p=0,0052). 75 proc. tiriamųjų buvo gydyti antibiotikais, daugelis gydyti monoterapija (86 proc. atvejų). Dažniausiai buvo skiriama penicilinų (29 proc.), cefalosporinų (25 proc.), aminoglikozidų (20 proc.), makrolidų (10 proc.). 25 proc. tiriamųjų dažniausiai dėl klaidingai diagnozuotos tarpšonkaulinės neuralgijos antibiotikų neskirta.
Išvada. Pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastys yra daugialypės: tiriamieji, atsiradus ligos simptomams, per vėlai kreipiasi į gydytoją, beveik pusei tiriamųjų nustatytos imunosupresinę būklę galinčios sukelti patologijos, daliai ligonių neskirta antibiotikų arba jų buvo skiriama netinkamai. Full article

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