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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 50, Issue 2 (April 2014) – 9 articles , Pages 75-136

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1419 KiB  
Article
Reirradiation for patients with recurrence head and neck squamous cell carcinoma: A single-institution comparative study
by Viktoras Rudžianskas, Artūras Inčiūra, Saulius Vaitkus, Evaldas Padervinskis, Milda Rudžianskienė, Rita Kupčinskaitė-Noreikienė, Lina Saltonaitė, Alius Noreika, Akvilė Statnickaitė and Elona Juozaitytė
Medicina 2014, 50(2), 92-99; https://doi.org/10.1016/j.medici.2014.06.006 - 28 Jun 2014
Cited by 17 | Viewed by 743
Abstract
Background and objective: In the last decade, the number of publications that report on the use of external beam radiotherapy and high-dose-rate brachytherapy (HDR-BRT) in the treat- ment of recurrent head and neck cancer has increased, but no studies compare external beam radiotherapy [...] Read more.
Background and objective: In the last decade, the number of publications that report on the use of external beam radiotherapy and high-dose-rate brachytherapy (HDR-BRT) in the treat- ment of recurrent head and neck cancer has increased, but no studies compare external beam radiotherapy and HDR-BRT. The aim of this study was to evaluate and to compare the efficacy and toxicity of the three-dimensional conformal radiotherapy (3D-CRT) and HDRBRT in the treatment of recurrent head and neck cancer.
Material and methods: A total of 64 patients with head and neck cancer recurrence were randomly assigned at a 1:1 ratio to receive either 3D-CRT (50 Gy/25 fractions) in the control group or HDR-BRT (30 Gy/12 fraction) in the experimental group.
Results: The overall survival rate of patients treated with HDR-BRT at 1 and 2-years was 74% and 67%, respectively, compare to 3D-CRT group – 51% and 32%, respectively (P = 0.002). Local control at 1- and 2-years in patients who received HDR-BRT was 77% and 63% compare with 47% and 25%, respectively, for the patients who received the 3D-CRT (P < 0.001). Most patients developed mild to moderate acute mucositis and dermatitis. In the 3D-CRT group, severe late toxicity was determined in 11 patients (35.5%), and in the HDR-BRT group, in 1 patient (3.1%) (P = 0.001). There was no grade 5 toxicity. Full article
503 KiB  
Article
Prevalence of anterior knee pain among patients following total knee arthroplasty with nonreplaced patella: A retrospective study of 1778 knees
by Vahur Metsna, Sigrid Vorobjov and Aare Märtson
Medicina 2014, 50(2), 82-86; https://doi.org/10.1016/j.medici.2014.06.001 - 28 Jun 2014
Cited by 20 | Viewed by 785
Abstract
Background and objective: : Anterior knee pain (AKP) may compromise the results of total knee arthroplasty in more than quarter of cases. The aim of the current work was to determine the prevalence of AKP and the severity of patellofemoral symptoms among patients [...] Read more.
Background and objective: : Anterior knee pain (AKP) may compromise the results of total knee arthroplasty in more than quarter of cases. The aim of the current work was to determine the prevalence of AKP and the severity of patellofemoral symptoms among patients who received a total knee arthroplasty with non-replaced patella in East-Tallinn Central Hospital from January 1, 2000 to December 31, 2009.
Materials and methods: We carried out a retrospective study involving 1778 consecutive total knee arthroplasties with non-replaced patella. Mean follow-up time was 68 months. We collected data by two patient-reported measures: the knee pain questionnaire and the Kujala score.
Results: We diagnosed AKP among 20.2% of patients, 33.6% had pain in the knee from a source other than patellofemoral joint and 46.2% were pain free. In 87.3% of AKP cases the pain emerged within the first five years of knee replacement. AKP was more prevalent among patients with osteoarthritis compared to rheumatoid arthritis and among patients below 60 years. There was no difference in the prevalence of AKP in terms of gender or mobile and fixed bearing implants. The severity of patellofemoral symptoms in case of AKP was moderate.
Conclusions: AKP is a frequent complication of total knee arthroplasty with non-replaced patella and patients undergoing this procedure should be apprised of the high probability of experiencing pain in the anterior part of the replaced knee. Full article
544 KiB  
Article
The mortality of patients with diabetes mellitus in Latvia 2000–2012
by Santa Pildava, Ieva Strēle and Ģirts Briģis
Medicina 2014, 50(2), 130-136; https://doi.org/10.1016/j.medici.2014.06.005 - 27 Jun 2014
Cited by 12 | Viewed by 590
Abstract
Background and objective: In Latvia, like in other European countries, the incidence of diabetes mellitus is increasing and so it is important to find out what the trends in the mortality of diabetes mellitus in Latvia are. The aim of this study was [...] Read more.
Background and objective: In Latvia, like in other European countries, the incidence of diabetes mellitus is increasing and so it is important to find out what the trends in the mortality of diabetes mellitus in Latvia are. The aim of this study was to calculate the mortality indicators of diabetes patients in Latvia from 2000 to 2012 and compare mortality among diabetes mellitus patients with mortality among the population of Latvia.
Materials and methods: The study was carried out with a quantitative statistical analysis approach. In the study, all the registered patients with diabetes mellitus from 2000 to 2012 were included.
Results: Mortality in a population with diabetes decreased statistically significantly from 57.76 per 1000 py in 2000 to 45.33 per 1000 py in 2012. In the general population of Latvia, there were no statistically significant changes; the mortality in 2000 was 13.56 per 1000 py, in 2012 – 14.24 per 1000 py. The age-standardised mortality ratio of the population with diabetes and the population of Latvia decreased from 1.71 (95% CI = 1.62–1.81) in 2000 to 1.23 (95% CI = 1.19–1.27) in 2012.
Conclusions: In Latvia the mortality of patients with diabetes exceeds mortality in the general population. Mortality rates are higher for men and older patients, however, compared to mortality in the general population, diabetes increases the risk of death; especially for women and for younger patients. There is a tendency that the mortality indicators of patients with diabetes and mortality indicators in the general population are becoming closer. Full article
451 KiB  
Article
A cross-sectional survey of urinary iodine status in Latvia
by Ilze Konrade, Lolita Neimane, Marina Makrecka, Ieva Strele, Edgars Liepinsh, Aivars Lejnieks, Parsla Vevere, Ugis Gruntmanis, Valdis Pīrāgs and Maija Dambrova
Medicina 2014, 50(2), 124-129; https://doi.org/10.1016/j.medici.2014.06.003 - 27 Jun 2014
Cited by 13 | Viewed by 724
Abstract
Background and objective: A nationwide survey of schoolchildren was conducted to detect regional differences in urinary iodine excretion in Latvia and to compare the results with data from the newborn thyroid-stimulating hormone (TSH) screening database as well with the results of a similar [...] Read more.
Background and objective: A nationwide survey of schoolchildren was conducted to detect regional differences in urinary iodine excretion in Latvia and to compare the results with data from the newborn thyroid-stimulating hormone (TSH) screening database as well with the results of a similar study performed in Latvia 10 years ago.
Materials and methods: We conducted a cross-sectional school-based cluster survey of 915 children aged 9–12 years in 46 randomly selected schools in all regions of Latvia. Urine samples, questionnaires on the consumption of iodized salt and information on socioeconomic status were collected. TSH levels in newborns were also measured.
Results: The median creatinine-standardized urinary iodine concentration (UIC) in our study was 107.3 mg/g Cr. UIC measurements indicative of mild iodine deficiency were present in 31.6%, moderate deficiency in 11.9% and severe deficiency in 2.8% of the participants. The prevalence of iodine deficiency was the highest in the southeastern region of Latgale and the northeastern region of Vidzeme. The prevalence of TSH values >5 mIU/L followed a similar pattern. The self-reported prevalence of regular iodized salt consumption was 10.2%. Children from urban schools had a significantly lower UIC than children from rural schools.
Conclusions: Our findings suggest that although the overall median UIC in Latvian schoolchildren falls within the lower normal range, almost 50% of the schoolchildren are iodine deficient, especially in urban schools and in the eastern part of Latvia. The absence of a mandatory salt iodization program puts a significant number of children and pregnant women at risk. Full article
499 KiB  
Article
Gastrointestinal symptoms and eating behavior among morbidly obese patients undergoing Roux-en-Y gastric bypass
by Rūta Petereit, Laimas Jonaitis, Limas Kupčinskas and Almantas Maleckas
Medicina 2014, 50(2), 118-123; https://doi.org/10.1016/j.medici.2014.06.009 - 27 Jun 2014
Cited by 29 | Viewed by 800
Abstract
Background and objective: Roux-en-Y gastric bypass (RYGB) changes anatomy and physiology of the gastrointestinal tract, and is followed by gastrointestinal side effects, changes in bowel function and eating behavior. The aim of the present study was to investigate the severity of gastrointestinal symptoms [...] Read more.
Background and objective: Roux-en-Y gastric bypass (RYGB) changes anatomy and physiology of the gastrointestinal tract, and is followed by gastrointestinal side effects, changes in bowel function and eating behavior. The aim of the present study was to investigate the severity of gastrointestinal symptoms and changes in eating behavior preoperatively and one year after RYGB.
Materials and methods: A total of 180 morbidly obese patients who underwent RYGB were included into the prospective study. Gastrointestinal symptoms were evaluated with Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire and Gastrointestinal Symptom Rating Scale (GSRS), eating behavior with Three-Factor Eating Questionnaire before and one year after RYGB. For all patients routine gastroscopy before surgery was performed.
Results: A total of 99 patients (55%) completed one-year follow-up; 79 (43.9%) patients had no pathological findings on preoperative gastroscopy. GERD-HRQL score and GSRS scores of indigestion, constipation, abdominal pain and reflux decreased significantly after surgery. Male gender (OR = 2.47, 95% CI 1.11–5.50, P = 0.026), GERD-HRQL score (OR = 1.28, 95% CI 1.16– 1.41, P < 0.001) and GSRS diarrhea score (OR = 1.89, 95% CI 1.10–3.17, P = 0.020) were significant predictors of pathological findings on gastroscopy. Eating behavior one year after RYGB changed significantly as compared to baseline. Cognitive Restraint postoperatively has increased from 42.6 to 55.9 (P < 0.001). Uncontrolled Eating and Emotional Eating one year after surgery significantly decreased (59.1 vs. 20.6, P < 0.001 and 28.2 vs. 17.2, P < 0.001, respectively). Full article
475 KiB  
Article
Postoperative complications and mortality after major gastrointestinal surgery
by Triin Jakobson, Juri Karjagin, Liisa Vipp, Martin Padar, Ants-Hendrik Parik, Liis Starkopf, Hartmut Kern, Olavi Tammik and Joel Starkopf
Medicina 2014, 50(2), 111-117; https://doi.org/10.1016/j.medici.2014.06.002 - 27 Jun 2014
Cited by 97 | Viewed by 1633
Abstract
Background and objective: The incidence of postoperative complications and death is low in the general population, but a subgroup of high-risk patients can be identified amongst whom adverse postoperative outcomes occur more frequently. The present study was undertaken to describe the incidence of [...] Read more.
Background and objective: The incidence of postoperative complications and death is low in the general population, but a subgroup of high-risk patients can be identified amongst whom adverse postoperative outcomes occur more frequently. The present study was undertaken to describe the incidence of postoperative complications, length of stay, and mortality after major abdominal surgery for gastrointestinal, hepatobiliary and pancreatic malignancies and to identify the risk factors for impaired outcome.
Material and methods: Data of patients, operated on for gastro-intestinal malignancies during 2009–2010 were retrieved from the clinical database of Tartu University Hospital. Major outcome data included incidence of postoperative complications, hospital-, 30-day, 90-day and 1-year mortality, and length of ICU and hospital stay. High-risk patients were defined as patients with American Society of Anesthesiologists (ASA) physical status ≥3 and revised cardiac risk index (RCRI) ≥3. Multivariate analysis was used to determine the risk factors for postoperative mortality and morbidity.
Results: A total of 507 (259 men and 248 women, mean age 68.3  11.3 years) were operated on for gastrointestinal, hepatobiliary, or pancreatic malignancies during 2009 and 2010 in Tartu University Hospital, Department of Surgical Oncology. 25% of the patients were classified as high risk patients. The lengths of intensive care and hospital stay were 4.4  7 and 14.5  10 days, respectively. The rate of postoperative complications was 33.5% in the total cohort, and 44% in high-risk patients. The most common complication was delirium, which occurred in 12.8% of patients. For patients without high risk (ASA < III; RCRI < 3) in-hospital, 30-, 90-day and 1-year mortality were 2%, 5%, 12.7% and 26.0%. Patients with ASA ≥ III and RCRI ≥ 3 had 2.3% in-hospital mortality, and at 30-, 90 days and 1 year the mortality was 8.5%, 17.8%, and 42.2%, respectively (P = 0.001, P < 0.0001 and P < 0.0001 compared to the lower risk patients). On multivariate analysis, age above 70 years, ASA ≥ III, RCRI ≥ 3, duration of surgery >130 min, and positive fluid balance >1300 mL after the 1st postoperative day, were identified as independent risk factors for the development of complications.
Conclusion: The complication rate after major gastro-intestinal surgery is high. ASA physical status and revised cardiac risk index adequately reflect increased risk for postoperative complications and worse short and long-term outcome. Full article
1954 KiB  
Article
The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia
by Aušrelė Kudrevičienė, Algidas Basevičius, Saulius Lukoševičius, Jūratė Laurynaitienė, Vitalija Marmienė, Irena Nedzelskienė, Jūratė Buinauskienė, Dalia Stonienė and Rasa Tamelienė
Medicina 2014, 50(2), 100-110; https://doi.org/10.1016/j.medici.2014.06.007 - 27 Jun 2014
Cited by 14 | Viewed by 732
Abstract
Background and objective: The aim of the study was to determine the correlation of hypoxicischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at [...] Read more.
Background and objective: The aim of the study was to determine the correlation of hypoxicischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year.
Materials and methods: In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated.
Results: The HI injury groups detected during USG significantly correlated with the mental development groups (r = 0.3; P = 0.01) and the neurological evaluation groups (r = 0.3; P < 0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/ T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quad- riparesis and severe mental development impairment in 1-year-old subjects: sensitivity – 100%, specificity – 93–100%, positive predictive value (PPV) – 60–100%, and NPV – 100%.
In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P ≤ 0.05), and mean resistive index (RI) values were significantly lower (P < 0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development.
Conclusions: Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year. Full article
476 KiB  
Article
First outcome results after total knee and hip replacement from the Lithuanian arthroplasty register
by Šarūnas Tarasevičius, Algimantas Čebatorius, Rasa Valavičienė, Justinas Stučinskas, Linas Leonas and Otto Robertsson
Medicina 2014, 50(2), 87-91; https://doi.org/10.1016/j.medici.2014.06.004 - 27 Jun 2014
Cited by 16 | Viewed by 702
Abstract
Background and objective: In 2010, the Lithuanian Association of Arhtroplasty was established and on January 1, 2011, initiated a national study of all reoperations after total knee (TKR) and total hip replacement (THR) in Lithuania. The aim of the study was to investigate [...] Read more.
Background and objective: In 2010, the Lithuanian Association of Arhtroplasty was established and on January 1, 2011, initiated a national study of all reoperations after total knee (TKR) and total hip replacement (THR) in Lithuania. The aim of the study was to investigate the revision rates after TKR and THR at two years follow-up.
Materials and methods: Lithuanian patients undergoing primary TKR and THR from January 1, 2011, to December 31, 2012, were included in the study. The patient, surgery and prosthetic implantation data were collected via internet database. For reoperations we recorded the reason and type of revision, primary implantation date. We analyzed implant survival rates using any revision as an endpoint on included primary procedures, performed until September 1, 2013.
Results: The completeness of the register verified with state patients fund data reached 85% of all replacements. Out of 3823 primary TKR during the study period 25 revisions were performed with overall implant survival rate 99%. The main reason for knee revision was infections. During the inclusion period we registered 6072 primary THR and 149 revisions with overall implant survival rate 97%. Recurrent dislocation of prosthetic component was the main reason for hip revision. Significantly inferior survival results for femoral neck fracture patients were observed as compared with patients operated for osteoarthritis. Posterior approach as compared to others significantly affected inferior implant survival rates for femoral neck fracture patients.
Conclusions: The overall survival after total knee and hip replacements revealed a high treatment quality of this surgery in Lithuania. Full article
444 KiB  
Article
Concise review of current concepts on nomenclature and pathophysiology of hepatic encephalopathy
by Ilona Savlan, Valentina Liakina and Jonas Valantinas
Medicina 2014, 50(2), 75-81; https://doi.org/10.1016/j.medici.2014.06.008 - 27 Jun 2014
Cited by 11 | Viewed by 687
Abstract
Hepatic encephalopathy is a neuropsychiatric complication of liver cirrhosis the symptoms of which may vary from imperceptible to severe, invaliding, and even lethal. Minimal hepatic encephalopathy is also important because of its tendency to impair patients' cognitive functions and quality of life.
The [...] Read more.
Hepatic encephalopathy is a neuropsychiatric complication of liver cirrhosis the symptoms of which may vary from imperceptible to severe, invaliding, and even lethal. Minimal hepatic encephalopathy is also important because of its tendency to impair patients' cognitive functions and quality of life.
The polyetiological pathogenesis of hepatic encephalopathy is intensively studied. A general consensus exists that not only excess of ammonia but also inflammatory, oxidative, and other processes are significant in the development of hepatic encephalopathy. Full article
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