LT  |  EN
Search    

(Theory and Practice in Medicine)
 
about the Journal | editorial board | current issue | archive | for authors | contacts

Theory and Practice in Medicine, 2013, Vol. 19, No. 4


TURINYS

Download PDF document

EVALUATION AND SIGNIFICANCE TO SURVIVAL OF PROGNOSTIC FACTORS AFTER RADICAL SURGERY OF PANCREATIC DUCTAL ADENOCARCINOMA

Download PDF document

Audrius Šileikis, Benediktas Kurlinkus, Marius Petrulionis, Dmitrij Šeinin, Saulius Jurevičius, Kęstutis Strupas

Correspondence Address:

Key words: Pancreatic ductal adenocarcinoma, Lymph node ratio (LNR), radical surgical treatment.
Objective. Evaluate survival of patients after radical surgical treatment of pancreatic ductal adenocarcinoma by performing uni-variate and multi-variate survival analysis. Identify variables useful in predicting long-term outcome. Compare results with data from other articles.
Materials and methods. A retrospective research was accomplished in the Center of Abdominal Surgery, Vilnius University Hospital Santariskiu Clinics. Medical data of patients who underwent radical surgical treatment of pancreatic cancer between years 2002 – 2011 was collected. In general, 213 patients entered the research. 107 patients with postoperative diagnosis of
pancreatic head, body, tail ductal adenocarcinoma were included in the final analysis. Patients survival was examined according to their pathological examination variables. Uni-variate and multi-variate survival analysises were performed. Collected data was examined with Microsoft Excel 2003 ir SPSS 17.0 programs by Kaplan-Meier method and Cox Regression analysis. Statistical significance was set at a level of p < 0,05 after performing Log Rank (Mantel-Cox) test.
Results. 107 patients were examined: 65 (60,7 %) males, 42 (39,3 %) females. 3 year survival was 12,5 %. Uni-variate analysis identified average survival (in years). In general: 2.151. In accordance with TNM indexes. T3 (93 % of cases): 2.159; T4 (5 % of cases): 0.610; (p < 0.001). N0 (43 cases): 2.842; N1 (64 cases): 1.430; (p = 0.007). LNR < 0,17 (72 cases): 2.747; LNR
≥ 0,17 (35 cases): 0.923; (p < 0.001). Using multi-variate Cox Regression analysis a G3, R1, LNR ≥ 0,17 and stage III were identified as independent predictors of patient survival.
Conclusions. Indexes of pathological examination T, N, G, R and provide statistically significant information about survival prognosis of patients undergoing radical surgical treatment of pancreatic ductal adenocarcinoma. LNR is the most specific index and can be applied in predicting long-term outcome.


MEASUREMENTS OF RELATIVE HUMIDITY, AIR TEMPERATURE AND CO2 CONCENTRATION IN THE UNIVERSITY LECTURE HALL

Download PDF document
Lina Abaravičiūtė, Genė Šurkienė, Jonas Algis Abaravičius, Rimantas Stukas
Correspondence Address:

Key words: microclimate, humidity, temperature, carbon dioxide, naturally ventilated buildings.
Objective. To analyze the microclimate indicator (air humidity, temperature and carbon dioxide) levels in one lecture hall of a certain university in Lithuania. To check if the obtained indicators are in agreement with the norms.
Methods. Air humidity, temperature and carbon dioxide levels were measured in one lecture hall of a certain university in Lithuania for seven days. The lecture hall has only natural ventilation system. Due to this reason we have recorded every moment of the beginning of the ventilation, its duration and intensity. The number of lectures, students’ attendance, start and end times of lectures were recorded as well.
Results and conclusions. A daily time-weighted average (then lecture hall is occupied) of CO2 concentration statistically significantly exceeded 1500 ppm for all seven days of measurement. This level is set as the limit for high schools in Lithuania. Most obtained values of CO2 concentration were above 1000 ppm limit, which is considered as uncomfortable. We did not
observe any significant deviations from the Lithuanian norms for the air temperature and humidity.


PERITONITIS IN CHILDREN ON PERITONEAL DIALYSIS

Download PDF document
Donata Vaitkūnaitė, Augustina Jankauskienė, Rimantė Čerkauskienė
Correspondence Address:

Key words: children, peritoneal dialysis, peritonitis.
Introduction. Peritonitis remains a major peritoneal dialysis complication in pediatric population. Peritoneal dialysis-associated peritonitis is the most significant cause of patients discontinuing peritoneal dialysis and switching to hemodialysis.
The aim of the study was to evaluate characteristics of peritoneal dialysis-associated peritonitis in children who received peritoneal dialysis in Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos.
Material and methods. Children < 18 years old receiving chronic peritoneal dialysis in the period of 1998 to 2012 were included in the study. Patients’ sex and age at peritoneal dialysis initiation, disease causing final renal function failure, peritoneal dialysis duration, child age at first peritonitis episode, and rate of peritonitis, etiology and outcomes of peritonitis were evaluated.
Results. Twenty-six (11 female, 15 male) patients were enrolled in the study. The mean age of the patients at dialysis initiation was 7.4 ± 5.7 years (2 weeks – 17.2 years), and the mean peritoneal dialysis duration was 24.2 ± 23.7 months (0.5–86 months). There were 72 episodes of peritonitis in analyzed period for an annualized rate of 1.4. Nine children (34.6 %) had no peritonitis during peritoneal dialysis; five children had 1 episode of peritonitis (19.2 %). There were 8 children (30.8%) who had more than three episodes of peritonitis. Younger patients (4.9 ± 4.9 years) had peritonitis more frequently than the older ones (12.2 ± 4.0 years) (p < 0.05). First episode of peritonitis was after 6.5 ± 9.9 month’s peritoneal dialysis initiation (0.3–39.5 months). Gram-positive bacteria were the most common etiologic factor. Full recovery was in 76 % cases, 11 %
patients needed to remove peritoneal catheter. Five times (7 %) peritoneal dialysis was discontinued and hemodialysis started. Two (3 %) patients died, twice (3 %) peritoneal dialysis was stopped for some time.
Conclusions. Peritonitis is still a common complication of peritoneal dialysis with a tendency to lower in recent years. Annualized rate of peritonitis in children on peritoneal dialysis was 1.4 and the most common etiologic factor was Staphylococcus spp. bacteria. Because of appropriate antibacterial therapy and peritoneal catheter exchange full recovery was achieved in 87 % cases.


MEZENCHYMAL STEM CELLS AND THEIR APPROACH FOR THE PERSONALIZED MEDICINE

Download PDF document
Igor Fomčenko, Živilė Gudlevičienė
Correspondence Address:

Key words: mezenchymal stem cells, tissue engineering, regenerative medicine, personalized medicine.
Stem cells therapy for various diseases is being increasingly implemented in the modern world. Most preclinical and clinical studies have been performed to assess the regenerative properties of mesenchymal stem cells (MSC) in treatment of various degenerative diseases and tissue regeneration. However, we still lack knowledge about stem cell properties, their behavior inside the body and abilities of their use. Such lack of knowledge is noticeable not only among the general public, but also in the medical society. Most results of clinical studies of the MSC treatment suggest that stem cells are reasonably effective, but the number of treated subjects is still not enough for a reliable evidence and wide application. Although MSC agents hold great promise, a long time is needed to consider and critically evaluate all options of the advanced cell therapy. Purpose of this article is to provide the medical society with an overview of currently available knowledge found in literature of the properties of MSC and their ability to use in individualized medicine for the treatment of various diseases.


INFUSION THERAPY IN CRITICALLY ILL PATIENTS: LITERATURE REVIEW

Download PDF document
Vytautas Karosas, Jūratė Šipylaitė, Gintautas Kėkštas, Andrius Klimašauskas
Correspondence Address:

Key words: infusion therapy, crystalloids, colloids, hypovolemia.
Infusion therapy is an important part of the treatment of the critically ill patients. The therapy aims to maintain effective circulatory volume and to ensure the perfusion of tissues. Crystalloids and colloids are the main types of fluids used for these purposes. Solutions differ in the efficacy of their circulation of blood volume restoration, safety and price. There is an ongoing discussion in medical publications as to what the most suitable method is to treat criticaly ill patients: crystalloids or colloids, and on what manner of infusion therapy (liberal, conservative or early targeted) results in a better outcome for a patient. Recent randomised, controlled studies involving patients with sepsis proved that the use of colloids leads to an increase in the number of cases of renal impairment, coagulopathy, and anaphylaxis and results in a higher mortality in patients. In light
of this, a European Society of Intensive Care Medicine Task Force presented a written agreement regarding the use of colloid solutions in citically ill patients. The recommendations of the „Surviving Sepsis Campaign” were also updated in 2012. Moreover, the efficacy and indications of natural colloid albumin have been re-assessed in medical publications. This article presents an overview of the different types of solutions and their adverse effects, the choice of solutions available in clinical situations, and new recommendations for their use.


CHURG-STRAUSS SYNDROME: LITERATURE REVIEW AND CASE REPORT

Download PDF document
Žaneta Petrulionienė, Irena Butrimienė, Rita Rugienė, Jolanta Dadonienė, Alma Čypienė, Audronė Milčiūtė, Nomeda Valevičienė
Correspondence Address:

Key words: Churg-Strauss syndrome, pericardial effusion.
Churg-Strauss syndrome or allergic granulomatosis and angiitis, is a multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia. In 1951, Churg and Strauss first described this syndrome. We present a clinical case of 41 years old woman, which for many years suffered from various upper respiratory tract disorders. She was directed to Santariskiu clinics due to decreased exercise tolerance, shortness of breath, resulting from physical exertion, fever, antibiotics in the background, and suspected infective endocarditis. A pericardial effusion was found in the emergency department after cardiac ultrasonography. The patient admitted to the cardiology department, where additional tests suspected Churg-Strauss syndrome. The patient was transferred to the Rheumatology department for further treatment.


ADRENAL INSUFFICIENCY AND PREGNANCY: CASE REPORT AND LITERATURE REVIEW

Download PDF document
Jelena Volochovič, Švitrigailė Grincevičienė, Gražina Drąsutienė
Correspondence Address:

Key words: pregnancy, adrenal insufficiency, corticosteroids substitution.
Adrenal insufficiency is rare condition in obstetrical care. Adequate care of pregnant women is essential for low perinatal mortality and morbidity rates. In this clinical case the maternity care of patient with autoimmune adrenal insufficiency is described. Recommendations from literature review are compared with tactics in this particular case.


EARLY DIAGNOSTICS OF MALIGNANT MELANOMA

Download PDF document
Ingrida Vaišnorienė, Janina Didžiapetrienė, Giedrė Smailytė, Konstantinas Povilas Valuckas
Correspondence Address:

Key words: nevus, melanoma, reflectance confocal microscopy.
Objective: to present literature data on the topic of non-invasive diagnostic methods for distinguishing benign melanocytic skin tumors from malignant melanoma.
Materials and methods. Review of all publications in PubMed database, containing materials for diagnosis of skin tumors. About 40 percent of the publications were published during 2008–2012 years (in the period from 2008 to 2012).
Results and conclusions. According to the clinical trials data, accuracy of non-invasive diagnosis of melanocytic skin lesions varies from 60 percent, when a qualified doctor makes a naked eye examination, up to 90–95 percent, when additionally dermoscopy and reflectance confocal microscopy examinations are applied. Use of more accurate diagnostic methods improves early diagnosis of melanoma and thus contributes to effective treatment and lesser mortality from this disease.


TOXOPLASMIC CHORIORETINIS: LITERATURE OVERVIEW AND CASE REPORT

Download PDF document
Birutė Vėbraitė, Vilma Tamulionytė, Daiva Paulavičiūtė-Baikštienė, Valerijus Barzdžiukas
Correspondence Address:

Key words: ocular toxoplasmosis, chorioretinitis, Toxoplasma gondii.
Toxoplasmic chorioretinitis is an inflammation of retina and choroid caused by a protozoan Toxoplasma gondii. Vision impairment due to this illness may vary from minor to significant depending on location and extent of the lesion. In site of an acute necrosis choroid and the deeper layers of retina are destroyed and replaced by scar and pigmentary tissue. These scars persist for life thus the vision is impaired irreversibly. Moreover, a lack of adequate diagnosis and treatment may lead to complications that can cause even more massive vision deterioration and irreversible changes. The main aim of treatment of toxoplasmic chorioretinitis is control of the infection and prevention of scar tissue formation in the retina and choroid.


ABNORMAL UTERINE BLEEDING IN PRE-MENOPAUSAL WOMEN: EXHAUSTION OF ALL POSSIBILITIES IN ORDER TO AVOID HYSTERECTOMY?

Download PDF document
Agnė Ožalinskaitė, Gražina Stanislava Drąsutienė, Audronė Arlauskienė
Correspondence Address:

Key words: abnormal uterine bleeding, the Levonorgestrel-Releasing Intrauterine System, NovaSure endometrial ablation. Heavy menstrual bleeding is a common concern among women of reproductive age which impedes a woman’s physical, social, emotional and/or material quality of life. The article discuss the importance of abnormal uterine bleeding in pre-menopausal women in daily gynecologists work as well as reviews the most practiced treatment possibilities. The main treatment methods for heavy menstrual bleeding in women without organic pathology are the Levonorgestrel-Releasing Intrauterine System, hormonal therapy and hysterectomy. This article also reviews the second generation endometrial ablation as an alternative to hysterectomy.


PASTEURELLOSIS PRESENTING WITH MENINGITIS AND BRAIN ABSCESS

Download PDF document
Daiva Radzišauskienė, Arvydas Ambrozaitis, Almina Bajoriūnienė, Saulius Ročka
Correspondence Address:

Key words: meningitis, brain abscess, computed tomography of the brain.
Pasteurella multocida is a Gram-negative coccobacillus that colonizes the oropharynx of many domestic animals. It is non – motile, bipolar – staining, aerobic, somtimes facultatively-anaerobic bacillus. The virulent strains produce polysaccharide capsules. The capsule of P. multocida is of importance in the protection against phagocytosis. This pathogen can cause human disease called pasteurellosis. Most human infectious occur post animal bite or scratch injure resulting in local cutaneous infection. Aerosol inhalation of the microorganism can cause human respiratory tract pasteurellosis. Invasive P. multocida infection may cause septicemia, meningitis, septic endocarditis, pericarditis, peritonitis, endophthalmitis. Severe systemic pasteurellosis can develop in patients with diabetes, hepatic cirrhosis, also in immunocompromised and pregnant women. P.
multocida meningitis is a rare clinical  manifestation, but mortality is high, around 30 %. Here we report the case of P. multocida meningitis with the development of brain abscess as a complication. We suggest that patients with predisponding conditions for serious P. multocida systemic infection should avoid contact with animals. The antibiotic treatment active against P.
multocida is recommended after any animal bite for these patients. We also suggest to perform computed tomography after P. multocida meningitis treatment because of possible complication such as brain abscess.


CONTRAVERSAL APPROACH TO OMEGA-6 FATTY ACIDS CONSUMPTION

Download PDF document
Inga Bikulčienė, Arvydas Kaminskas
Correspondence Address:

Key words: omega-6 fatty acids, cardiovascular disease.
This article reviews the scientific studies that suggest the consumption of linoleic acid not always reduces the risk of cardiovascular disease or provides safety and benefit of higer intakes. However, in spite of widespread enthusiasm for increasing PUFA in the diet, linoleic acid is unlikely to provide the intended benefits and may actually increase the risk of cardiovascular
disease and death.

 


HISTORICAL REVIEW OF ANIMAL TESTING IN LITHUANIA (1920–1940)

Download PDF document

Otilija Kutanovaitė, Vilma Kuzminskaitė, Andrej Podkopajev, Vytautas Jonas Sirvydis

 

Correspondence Address:

Key words: animal testing, laboratory animals, surgery, oncology.
This paper reviews the medical experiments performed in Lithuania during the year 1920–1940. Information is provided on the most popular research fields at a given time, experimental methods and laboratory animals used. Aforementioned data is compared between the two major research centers – Vilnius and Kaunas. Also the most interesting and inspiring, on authors choice, articles are observed.


back
Address:
„Medicinos teorija ir praktika”
V.Grybo g. 32/10 - 333
LT-10318 Vilnius, Lithuania
Tel. (8 ~ 5) 247 6309
E-mail:

Programavimas: www.mikrospektras.lt - interneto svetainių kūrimas