Medicina

289 KiB

Open AccessArticle

Two Unusual Clinical Presentations of Broad-Ligament Leiomyomas: A Report of Two Cases

by Pınar Yıldız, Hüseyin Cengiz, Gazi Yıldız, Aslı Demir Şam, Ali Yavuzcan, Bilal and Levent Şahin

Medicina 2012, 48(3), 23; https://doi.org/10.3390/medicina48030023 - 15 Apr 2012

Cited by 9 | Viewed by 849

Abstract

We report on two unusual clinical presentations of broad-ligament leiomyomas. The first case was a combination of broad-ligament leiomyoma and ectopic gestational sac at the same location. The other case was a broad-ligament leiomyoma presenting as an ovarian malignancy. The differential diagnosis of [...] Read more.

We report on two unusual clinical presentations of broad-ligament leiomyomas. The first case was a combination of broad-ligament leiomyoma and ectopic gestational sac at the same location. The other case was a broad-ligament leiomyoma presenting as an ovarian malignancy. The differential diagnosis of broad-ligament leiomyoma should be considered in cases of an adnexal mass. Additionally, a broad-ligament leiomyoma could be the reason for an ectopic pregnancy. Full article

275 KiB

Open AccessArticle

The Impact of Complex Cardiac Rehabilitation on Manifestation of Risk Factors in Patients with Coronary Heart Disease

by Raimondas Kubilius, Lina Jasiukevičienė, Vytautas Grižas, Loreta Kubilienė, Edita Jakubsevičienė and Donatas Vasiliauskas

Medicina 2012, 48(3), 24; https://doi.org/10.3390/medicina48030024 - 04 Apr 2012

Cited by 15 | Viewed by 1139

Abstract

Background. Each year more than 4.3 million people in Europe will die of cardiovascular disease. Therefore, the implementation of simple interventions such as smoking cessation, weight loss, improved diets, and increased exercise is the top priority in prevention and rehabilitation programs. The [...] Read more.

Background. Each year more than 4.3 million people in Europe will die of cardiovascular disease. Therefore, the implementation of simple interventions such as smoking cessation, weight loss, improved diets, and increased exercise is the top priority in prevention and rehabilitation programs. The aim of this study was to evaluate the impact of complex rehabilitation on the manifestation of risk factors and cardiac events in patients with coronary heart disease. Material and Methods. A total of 140 patients with coronary heart disease and NYHA functional class II–IV ischemic heart failure were recruited to the study. The patients were divided into 2 groups: 70 patients who underwent a 6-month complex rehabilitation course (rehabilitation group) and 70 patients who received drug treatment only (control group). Smoking, dietary, and physical activity habits were documented using the questionnaires. Blood pressure (BP), body weight and height, and total serum cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (Tg), and blood glucose levels were measured. Measurements were repeated after 3 and 6 months. Results. After 6 months, significantly reduced systolic BP was observed in both the groups as compared with the baseline values (P<0.05). A significant decrease in the diastolic BP; total cholesterol, LDL-cholesterol, triglyceride and blood glucose levels; body mass index, and percentage of patients with the metabolic syndrome as compared with the baseline data was documented only in the rehabilitation group (P<0.05). All the patients quitted smoking as well as all the patients in the rehabilitation group changed their dietary habits (P<0.05). Fewer patients were excluded from the rehabilitation group because of cardiac events as compared with the control group (7.1% vs. 11.4%, P<0.05). Conclusions. Complex long-term rehabilitation of cardiovascular patients significantly reduced the manifestation of major cardiovascular risk factors and the rate of cardiac events. Aerobic exercise must be the most important part of training but well-done resistance training must also be encouraged. Full article

267 KiB

Open AccessArticle

Correlations Between Digital Planimetry and Optical Coherence Tomography, Confocal Scanning Laser Ophthalmoscopy in Assessment of Optic Disc Parameters

by Dovilė Buteikienė, Alvydas Paunksnis, Valerijus Barzdžiukas, Dalia Žaliūnienė, Jūratė Vilma Balčiūnienė and Darius Jegelevičius

Medicina 2012, 48(3), 21; https://doi.org/10.3390/medicina48030021 - 04 Apr 2012

Cited by 3 | Viewed by 819

Abstract

Objective and Aim. In routine clinical practice, laser methods for the evaluation of optic disc parameters are expensive and not accessible for all ophthalmologists; therefore, there is a need for less expensive technique. The aim of this study was to assess correlations [...] Read more.

Objective and Aim. In routine clinical practice, laser methods for the evaluation of optic disc parameters are expensive and not accessible for all ophthalmologists; therefore, there is a need for less expensive technique. The aim of this study was to assess correlations between the parameters of the optic disc measured by digital planimetry (DP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy (CSLO) in healthy and glaucoma patients with the normal biometric parameters of the eye.
Material and Methods. This case-control study enrolled 40 patients with glaucoma and 32 healthy patients with the normal biometric parameters of the eye. All subjects underwent full ophthalmologic examination, digital color optic disc photography, OCT, and CSLO at the same visit. The optic disc was morphometrically analyzed by DP, OCT, and CSLO. Seven optic disc parameters were evaluated.
Results. In the glaucoma group, the optic disc and cup areas (r=0.7–0.8, P<0.001) and cup-tooptic disc and rim-to-optic disc area ratios (r=0.7, P<0.001) measured by DP were strongly correlated with those measured by OCT and CSLO, while the horizontal and vertical cup-to-optic disc diameter ratios were found to be moderately correlated (r=0.6–0.7, P<0.001). In healthy patients, the optic disc and cup areas were strongly correlated (r=0.7–8.0, P<0.001). Significant differences in all optic disc parameters, except for the optic disc area, measured by DP, OCT, and CSLO were found between glaucoma and healthy patients.
Conclusions. Strong correlations between the parameters of the optic disc measured by DP, OCT, and CSLO were found. There were significant differences in the parameters between healthy and glaucoma eyes measured using DP; therefore, this technique may be used for diagnosis, management, and screening of glaucoma. Full article

239 KiB

Open AccessArticle

Mortality After Femoral Neck Fractures: A Two-Year Follow-up

by Jaunius Kurtinaitis, Jolanta Dadonienė, Giedrius Kvederas, Narūnas Porvaneckas and Tomas Butėnas

Medicina 2012, 48(3), 20; https://doi.org/10.3390/medicina48030020 - 04 Apr 2012

Cited by 11 | Viewed by 1013

Abstract

Background and Objective. To identify the survival and standardized mortality ratio with respect to gender, age, and treatment method of patients treated for femoral neck fractures.
Material and Methods. A retrospective review of medical records of 736 patients treated for femoral [...] Read more.

Background and Objective. To identify the survival and standardized mortality ratio with respect to gender, age, and treatment method of patients treated for femoral neck fractures.
Material and Methods. A retrospective review of medical records of 736 patients treated for femoral neck fractures at Vilnius University Emergency Hospital during 2004–2006 was carried out.
Results. The overall 1- and 2-year survival rates were 77.4% and 67.1%, respectively. Lower survival rates were observed in the internal fixation group than in the primary and secondary total hip arthroplasty groups (63.2% vs. 72.0% and 75.1%). Cox proportional hazards model analysis showed patient age to be a significant risk factor for survival (hazard ratio, 1.05; 95% CI, 1.04– 1.07; P<0.001). The overall standardized mortality ratio was 2.50. The standardized mortality ratios for men and women were 3.07 and 2.27, respectively, but the difference between these groups was not significant.
Conclusions. Standardized mortality and survival rates decreased with increasing patients’ age. Significantly lower survival rates were documented in the internal fixation group as compared with primary and secondary total hip arthroplasty groups. There was a trend toward a higher standardized mortality ratio in men than women, but the difference was not significant. Full article

223 KiB

Open AccessArticle

Referral Pattern, Management, and Long-Term Results of Laparoscopic Bile Duct Injuries: A Case Series of 44 Patients

by Giedrius Barauskas, Saulius Paškauskas, Žilvinas Dambrauskas, Antanas Gulbinas and Juozas Pundzius

Medicina 2012, 48(3), 19; https://doi.org/10.3390/medicina48030019 - 04 Apr 2012

Cited by 11 | Viewed by 826

Abstract

Background and Objective. The incidence of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is higher than after open cholecystectomy, and the management of these lesions is still controversial. This study analyzed diagnostic and management strategies as well as long-term outcomes after [...] Read more.

Background and Objective. The incidence of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is higher than after open cholecystectomy, and the management of these lesions is still controversial. This study analyzed diagnostic and management strategies as well as long-term outcomes after BDI.
Material and Methods. A prospective database of patients with BDIs at the Clinic of Surgery was maintained during the 8-year period (2000–2007). The long-term results were evaluated during 2008–2010, after 36- to 120-month follow-up (median, 84 months).
Results. In our series, 21 patients (48%) presented with minor and 23 (52%) with major BDIs. The overall incidence of BDIs was 0.24%. In 92% of cases in the minor BDI group, endoscopic stenting resulted in a good outcome. Major BDIs were treated by immediate, early, or delayed surgery depending on the timeliness of diagnosis and presence of biliary sepsis and/or cholangitis. The mean estimated time to failure after the initial treatment in the minor BDI group was significantly longer when compared with the major BDI group (114.3 vs. 81.8 months, log-rank test P=0.048). The hazard ratio of initial treatment failure after major versus minor BDIs was 6.06 (95% CI, 1.01–17.59). The mean estimated time to develop a biliary stricture after immediate, early, and delayed reconstructions was not different (P>0.05 in pairwise comparisons by log-rank test).
Conclusions. Minor BDIs are best served by endoscopy, while surgical repair may be an efficient option when injury is diagnosed intraoperatively. The timing of reconstruction after major BDIs does not portend a different outcome; consequently, every attempt to achieve infection control should be warranted. Referral to a tertiary care center should be encouraged to facilitate a proper classification of preoperative injuries and multidisciplinary approach Full article

269 KiB

Open AccessArticle

Differentiation of Acute Myocarditis and Acute Myocardial Infarction by the Regional Distribution of Myocardial Irreversible Injury Using Cardiovascular Magnetic Resonance Imaging

by Nomeda Valevičienė, Žaneta Petrulionienė, Birutė Petrauskienė, Gediminas Lauraitis, Sigita Glaveckaitė, Darius Palionis, Algirdas Tamošiūnas and Aleksandras Laucevičius

Medicina 2012, 48(3), 18; https://doi.org/10.3390/medicina48030018 - 04 Apr 2012

Cited by 3 | Viewed by 866

Abstract

Background and Objective. In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction.
Material and Methods. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern [...] Read more.

Background and Objective. In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction.
Material and Methods. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance were investigated.
Results. The subendocardial LGE pattern was much more frequent in the myocardial infarction group (76.7%) than myocarditis group (10.0%) (P<0.001). Meanwhile, midmyocardial LGE was much more typical of myocarditis (65.0%) than acute myocardial infarction (1.1%) (P<0.001), and epicardial LGE was also much more typical of myocarditis (55.0%) than acute myocardial infarction (0.0%) (P<0.001). Midmyocardial and epicardial LGE patterns were defined as a nonischemic LGE pattern more typical of myocarditis. Logistic regression analysis revealed that the subendocardial and midmyocardial LGE locations played the greatest role in differentiation between acute myocarditis and acute myocardial infarction. A statistical model based on midmyocardial LGE distribution and age showed a sensitivity of 90% and a specificity of 93.3% in differentiating between acute myocarditis and acute myocardial infarction.
Conclusion. Our findings suggest that in clinical practice, differentiation between acute myocardial infarction and acute myocarditis can be done based on the subendocardial and midmyocardial LGE location. The presence of subendocardial LGE was found to be strongly associated with acute myocardial infarction; meanwhile, the presence of midmyocardial LGE indicated acute myocarditis. However, other clinical factors should also be taken into account when making the final diagnosis. Full article

180 KiB

Open AccessCase Report

Cesarean Delivery in Severe Pulmonary Hypertension: A Case Report

by Kęstutis Rimaitis, Asta Aliuškevičienė, Dalia Adukauskienė, Marius Rimaitis and Andrius Macas

Medicina 2012, 48(3), 22; https://doi.org/10.3390/medicina48030022 - 29 Feb 2012

Cited by 4 | Viewed by 925

Abstract

Pregnancy in a woman with pulmonary hypertension carries a prohibitively high risk of maternal mortality, and pregnancy is contraindicated in such patients. Some women decide to continue with their pregnancy despite being aware of possible fatal maternal outcome. The management of pulmonary hypertension [...] Read more.

Pregnancy in a woman with pulmonary hypertension carries a prohibitively high risk of maternal mortality, and pregnancy is contraindicated in such patients. Some women decide to continue with their pregnancy despite being aware of possible fatal maternal outcome. The management of pulmonary hypertension in pregnancy is a challenge and requires a multiprofessional approach. We report the case of a patient with severe pulmonary hypertension, who successfully underwent elective cesarean section under epidural anesthesia at 38 weeks of gestation and discuss major issues associated with the obstetric and anesthetic management of pregnant patients with pulmonary hypertension. Full article

261 KiB

Open AccessReview

A Meta-Analysis of the Relationship Between NAT 2 Polymorphism and Colorectal Cancer Susceptibility

by Hong Liu, Zhong-xue Fu, Chun-yi Wang, Jiang Qian, Lei Xing and Yi-wu Liu

Medicina 2012, 48(3), 17; https://doi.org/10.3390/medicina48030017 - 18 Feb 2012

Cited by 7 | Viewed by 990

Abstract

Background and Objective. Although the association between N-acetyltransferase 2 (NAT2) polymorphism and colorectal cancer (CRC) susceptibility in humans has been extensively investigated, the results are contradictory. The aim of this study was to conduct a meta-analysis of published studies to quantitatively summarize [...] Read more.

Background and Objective. Although the association between N-acetyltransferase 2 (NAT2) polymorphism and colorectal cancer (CRC) susceptibility in humans has been extensively investigated, the results are contradictory. The aim of this study was to conduct a meta-analysis of published studies to quantitatively summarize the association between NAT2 polymorphism and risk of CRC.
Material and Methods. Relevant studies that had investigated NAT2 polymorphism and CRC susceptibility were identified through a comprehensive search of Pubmed, EMBASE, Medline, Biosis, Wiley-Blackwell, ISI Web of Knowledge, CNKI, and Chinese Biomedicine Database until October 2011. After selection based on the inclusion and exclusion criteria, the relevant data were extracted from each study, and finally a meta-analysis was performed.
Results. Eight phenotype studies (791 cases and 1158 controls) and 45 genotype studies (13 875 cases and 18 879 controls) were included in the present meta-analysis. The pooling of phenotype studies showed no significant association between the NAT2 acetylator status and CRC susceptibility (rapid acetylator, OR, 1.32; 95% CI, 0.92–1.89, P=0.14; slow acetylator, OR, 0.76; 95% CI, 0.53–1.09, P=0.14). The combined ORs for rapid and slow acetylator status and CRC risk in genotype studies were 1.01 (95% CI, 0.94–1.08; P=0.86) and 0.99 (95% CI, 0.93–1.06; P=0.86), respectively. In the subgroup analysis by regions, no increased risks were found in Asians, Europeans, Americans, or Australasians. Pooling studies were also conducted on the groups of gender, specific tumor sites, and smoking status, but no significant association in genotype distribution between CRC and control was found as well.
Conclusions. These results of our meta-analysis suggest that there is no overall association between NAT2 polymorphism and CRC susceptibility. Full article

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Medicina, Volume 48, Issue 3 (March 2012) – 8 articles

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