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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles 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.

Table of Contents

Medicina, Volume 43, Issue 3 (March 2007)

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Open AccessArticle
Changes in morphometric parameters and function of left ventricle in child and adolescent athletes
Medicina 2007, 43(3), 251; https://doi.org/10.3390/medicina43030031
Received: 8 December 2006 / Accepted: 8 March 2007 / Published: 13 March 2007
Cited by 1 | Viewed by 196 | PDF Full-text (199 KB)
Abstract
The aim of the study was to assess the impact of physical load on left ventricular morphometric parameters and function in child and adolescent athletes.
Material and methods
. A total of 143 trained athletes aged 7–17 years and 54 healthy nonathletic children [...] Read more.
The aim of the study was to assess the impact of physical load on left ventricular morphometric parameters and function in child and adolescent athletes.
Material and methods
. A total of 143 trained athletes aged 7–17 years and 54 healthy nonathletic children and adolescents aged 8–17 years were involved in this study. The participants were divided into four groups according to the duration of physical activity (training hours per week). Two-dimensional, M-mode, and Doppler echocardiography were used to evaluate cardiac dimensions and function. Absolute parameters and parameters corrected for body surface area were calculated. Left ventricular fractional shortening was calculated as an index of systolic function, and E/A ratio was calculated for evaluation of left ventricular diastolic function.
Results
. In 69.9% of athletes, septal and posterior wall thickness, end-diastolic diameter, left ventricular mass, and mass index were statistically significantly higher than in controls. There were no differences in left ventricular end-diastolic diameter and posterior wall thickness corrected for body surface area as well as diastolic E/A ratio between the groups. The fractional shortening in athletes was significantly higher (P<0.01). Interventricular septum thickness, end-diastolic diameter, and left ventricular mass were significantly higher in athletes whose training exceeded 8 hours per week compared to the controls. Left ventricular fractional shortening was significantly higher in athletes training more than 10 hours per week than in controls. Diastolic function index – E/A ratio – did not differ between the groups.
Conclusion
. Our study demonstrated that echocardiographic parameters of child and adolescent athletes statistically significantly exceeded the parameters of untrained controls. These parameters were dependent on the anthropometric data and physical activity (the duration of training expressed in hours per week). Full article
Open AccessArticle
Stents in interventional cardiology
Medicina 2007, 43(3), 183; https://doi.org/10.3390/medicina43030022
Received: 12 December 2006 / Accepted: 5 March 2007 / Published: 10 March 2007
Cited by 3 | Viewed by 218 | PDF Full-text (199 KB)
Abstract
Since the first percutaneous transluminal coronary angioplasty performed by A. Gruentzig in 1977, percutaneous coronary interventions have become the most important treatment modality for coronary heart disease. Coronary angioplasty carried a significant risk of coronary flow-limiting dissections and restenosis during the first six [...] Read more.
Since the first percutaneous transluminal coronary angioplasty performed by A. Gruentzig in 1977, percutaneous coronary interventions have become the most important treatment modality for coronary heart disease. Coronary angioplasty carried a significant risk of coronary flow-limiting dissections and restenosis during the first six months following the procedure. Two main studies comparing percutaneous transluminal coronary angioplasty and coronary stenting (STRESS and BENESTENT) performed in 1994 showed a significant reduction in restenosis rate using stents. Thus, until now stents are the most widely used devices for coronary intervention despite two problems: subacute stent thrombosis (1–2%) and still high restenosis rate (5–40%). Subacute stent thrombosis occurs within the first month after stent placement and can be prevented using the double antiplatelet regimen with aspirin and clopidogrel. Some risk of subacute thrombosis remains beyond the first month when drug-eluting stents are used. This requires prolonged antiplatelet therapy. Drugeluting stents are the most significant innovation in interventional cardiology. They can reduce the incidence of restenosis in native stable coronary arteries to 3–5%. However, the long-term studies comparing bare-metal stents and drug-eluting stents did not show any significant differences in the rate of major adverse cardiac events (death, myocardial infarction), especially in patients with diabetes after the treatment of bifurcational lesions. According to proposed recommendations, drug-eluting stents should be used in small vessels, restenotic lesions, and in saphenous vein grafts. Despite some disadvantages, the results of coronary stenting using drugeluting stents continue to improve. Full article
Open AccessArticle
Electrical injuries
Medicina 2007, 43(3), 259; https://doi.org/10.3390/medicina43030032
Received: 26 August 2006 / Accepted: 1 March 2007 / Published: 6 March 2007
Cited by 11 | Viewed by 238 | PDF Full-text (209 KB)
Abstract
Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can [...] Read more.
Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can vary a lot and range from mild complaints undemanding serious medical help to life-threatening conditions. Lightning causes serious injuries in 1000–1500 individuals every year worldwide. The case fatality rate is about 20–30%, with as many as 74% of survivors experiencing permanent injury and sequela. The primary cause of death in victims of lightning strike or other electrical trauma is cardiac or respiratory arrest. That is why appropriate urgent help is essential. Subsequently electrical burns, deep-tissue and organ damage caused by electricity, secondary systemic disorders often demand intensive care and prompt, usually later multistage surgical treatment; therefore, prevention of electrical trauma, which would help to reduce electrical injuries in children and working-age population, is very actual. The most important is to understand the possible danger of electricity and to avoid it. Full article
Open AccessArticle
The prevalence of type 1 diabetes mellitus among adolescents and adults in Lithuania during 1991–2004
Medicina 2007, 43(3), 242; https://doi.org/10.3390/medicina43030030
Received: 2 March 2006 / Accepted: 13 February 2007 / Published: 18 February 2007
Cited by 2 | Viewed by 164 | PDF Full-text (202 KB)
Abstract
Objective. The goal of this study was to summarize the data on the prevalence of type 1 diabetes mellitus among Lithuanian population aged more than 15 years.
Material and methods.
The data on patients aged more than 16 years were collected with [...] Read more.
Objective. The goal of this study was to summarize the data on the prevalence of type 1 diabetes mellitus among Lithuanian population aged more than 15 years.
Material and methods.
The data on patients aged more than 16 years were collected with the help of general practitioners, endocrinologists, and physicians-internists working in the diabetes care in all towns and regions of Lithuania. The data on patients aged 14 to 16 years were obtained from the National Register of Diabetes Mellitus in Childhood in Lithuania.
Results
. In Lithuania, on December 31, 1991, there were 2179 adolescent and adult patients with type 1 diabetes mellitus or 75.21 per 100 000 inhabitants of the same age group (95% Poisson CI 72.12–78.43), and at the end of 2004 – 3996 or 140.69 (95% Poisson CI 136.40– 145.12), respectively. During a 14-year period, the mean increase in the number of type 1 diabetic patients was 144.85±23.32 persons per year or 4.66±1.17% or 4.04±1.19 cases per 100 000 population (for males 85.54±10.82 or 5.06±1.02% or 6.81±1.57/100 000 and for females 54.23±9.05 or 3.93±0.86% or 3.56±1.05/100 000). Regression-based linear trends showed that the prevalence of type 1 diabetes mellitus among population aged more than 15 years had a tendency to increase. The prevalence rates of type 1 diabetes mellitus among adolescent and adult subjects, adjusted for Lithuanian male and female age groups, were 80.64/100 000 and 70.23/100 000 in 1991 (P<0.05) and 166.52 and 117.63 in 2004 (P<0.05), respectively.
Conclusions
. The prevalence of type 1 diabetes mellitus among Lithuanian females aged more than 15 years was lower than among males. The register provides the possibility of highly precise collection of the data on patients from various medical care units in Lithuania. Full article
Open AccessArticle
Exeter total hip arthroplasty with matte or polished stems
Medicina 2007, 43(3), 215; https://doi.org/10.3390/medicina43030026
Received: 3 October 2006 / Accepted: 13 February 2007 / Published: 18 February 2007
Cited by 2 | Viewed by 202 | PDF Full-text (302 KB)
Abstract
Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stem type.
Material and methods. The first part of the study [...] Read more.
Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stem type.
Material and methods. The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991–1995. Two different designs of Exeter stems were used: matte surface stems during 1991–1995 (matte surface group – 47 cases), and polished stems during 1992–1995 (polished stem group – 71 cases). During the second part of the study, 24 patients (11 in polished stem group and 13 in matte stem group) were prospectively examined with radiography and sonography. Sonography was performed in order to evaluate capsular distension, i.e. the distance between prosthetic femoral neck and anterior capsule. Capsular distension depends on synovitis and/or synovia in prosthetic hip. The relationship between capsular distension, stem type, and radiographic signs of loosening was assessed.
Results
. For the first part of our study, total implant survival was 78% with matte stems and 61% with polished stems 13 years postoperatively (P=0.27). Stem survival was 82% for matte stems, and 88% for polished stems (P=0.54). In the second part of study, a significant relationship between increased capsular distension and cup loosening was determined (P=0.04). We did not find significant difference in capsular distension when compared matte and polished stems.
Conclusion
. Implant survival rates did not differ between the groups. The relationship between capsular distension and cup loosening was statistically significant. Full article
Open AccessArticle
Predicting outcome of treatment with radiotherapy in endocrine ophthalmopathy
Medicina 2007, 43(3), 190; https://doi.org/10.3390/medicina43030023
Received: 24 February 2006 / Accepted: 13 February 2007 / Published: 18 February 2007
Cited by 2 | Viewed by 175 | PDF Full-text (216 KB)
Abstract
Objective. To evaluate if the concentration of C-reactive protein and the level of antibodies to thyrotropin receptors might predict the outcome of retrobulbar irradiation in patients with endocrine ophthalmopathy.
Material and methods
. Patients with moderate endocrine ophthalmopathy received orbital radiotherapy. The [...] Read more.
Objective. To evaluate if the concentration of C-reactive protein and the level of antibodies to thyrotropin receptors might predict the outcome of retrobulbar irradiation in patients with endocrine ophthalmopathy.
Material and methods
. Patients with moderate endocrine ophthalmopathy received orbital radiotherapy. The overall severity of endocrine ophthalmopathy was assessed using the total eye score based on the NOSPECS classification before the treatment and 6 months later. Treatment outcome was evaluated using major and minor criteria recommended by L. Bartalena 6 months after the treatment. Patients who improved in at least one major or in two or more minor criteria were considered responders. Patients in whom no changes occurred or who responded in only one minor criterion or eye status worsened were classified as nonresponders. The active disease was considered present in a patient who responded successfully to retrobulbar irradiation, and the inactive one when a patient did not respond.
Results. The level of antibodies to thyrotropin receptors in responders was 24.0 IU/L (range 2.0–405.0 IU/L) and in nonresponders 23.0 IU/L (range 2.0–405.0 IU/L); P=0.72. C-reactive protein levels in responders and nonresponders were 0.1 mg/L (range 0.1–3.1 mg/L) and 0.1 mg/L (range 0.1–1.5 mg/L), respectively; P=0.92. Although responders and nonresponders differed by proptosis, the severity of endocrine ophthalmopathy, and clinical activity score, but according to the binary logistic regression model, only the clinical activity score could give additional information on the prediction of the treatment outcome. If clinical activity score increased by 1, odds ratio for successful treatment outcome increased 2.4 times.
Conclusions
. 1) At the baseline of radiotherapy, the level of antibodies to thyrotropin receptors and concentration of C-reactive protein in responders did not differ from nonresponders; 2) Responders did not differ from nonresponders to radiotherapy by age, gender, duration of endocrine ophthalmopathy and thyroid disease; 3) The pretreatment clinical activity score, total eye score, proptosis of the responders were higher. Full article
Open AccessArticle
Bimodal recovery of quadriceps muscle force within 24 hours after sprint cycling for 30 seconds
Medicina 2007, 43(3), 226; https://doi.org/10.3390/medicina43030028
Received: 4 September 2006 / Accepted: 12 February 2007 / Published: 17 February 2007
Cited by 6 | Viewed by 214 | PDF Full-text (225 KB)
Abstract
The aim of the study was to investigate the manifestation of potentiation and fatigue as well as the coexistence of these phenomena at different muscle lengths during a 24-hour period after a sprint cycling for 30 s.
Material and methods
. Twelve healthy [...] Read more.
The aim of the study was to investigate the manifestation of potentiation and fatigue as well as the coexistence of these phenomena at different muscle lengths during a 24-hour period after a sprint cycling for 30 s.
Material and methods
. Twelve healthy untrained men (mean age 23.6±1.7 years) took part in the experiment. The contractility of quadriceps muscle was studied before (Initial) and 2, 5, 30, 60 min and 24 h after exercise via the electrically evoked contractions at 1, 15, 50 Hz and maximal voluntary contractions at short and long muscle length.
Results
. 1) In early, fast-recovery phase (within the first 5 min), muscle force evoked by electrical stimulation of 1, 15, 50 Hz was restored at short muscle length, conversely at long length (Initial vs. 5 min: 15 Hz and 50 Hz, both P<0.05), whereas maximal voluntary contraction force was still suppressed at both muscle lengths; 2) in the second phase (from 5 min to 30–60 min), muscle force decreased at low- and high-frequency stimulations and was more expressed at low-frequency stimulation and at short muscle length than that at long length, but the maximum voluntary contraction force recovered to initial; 3) in long-lasting phase (within 24 hours), 15 Hz force was still suppressed at both muscle lengths.
Conclusion
. A bimodal recovery of contractility of the quadriceps following sprint cycling for 30 s is determined by the concomitant complex interaction of mechanisms enhancing (potentiation) and suppressing (fatigue) contractile potential of the muscle. Full article
Open AccessArticle
The diuretic effect of cornflower water extract
Medicina 2007, 43(3), 221; https://doi.org/10.3390/medicina43030027
Received: 21 November 2006 / Accepted: 12 February 2007 / Published: 17 February 2007
Cited by 3 | Viewed by 190 | PDF Full-text (192 KB)
Abstract
The objective of this study was to evaluate and compare the effect of cornflower water extract and hydrochlorothiazide on diuresis, Na+ and K+ excretion, and the changes in the prostaglandin E2 and kinins levels in the blood plasma.
Material and [...] Read more.
The objective of this study was to evaluate and compare the effect of cornflower water extract and hydrochlorothiazide on diuresis, Na+ and K+ excretion, and the changes in the prostaglandin E2 and kinins levels in the blood plasma.
Material and methods. Male Wistar rats were used in all experiments. Animals were divided into nine groups. Diuretic activity was investigated according to the technique proposed by E. B. Berchin; urinary electrolyte contents were analyzed by flame photometry. Prostaglandin E2 content was measured by radioimmunoassay using 3H isotopes, kinins – by enzymatic methods.
Results
. It has been established that in male rats, receiving hydrochlorothiazide, the volume of urine excreted two and four hours after the administration of the drug was by 18% and 17%, respectively, higher as compared to the rats that were given cornflower water extract (P<0.05). The diuretic effect of cornflower water extract was noted in the animal group receiving this extract as compared to the control group: after two hours, the volume of urine excreted increased from 2.03±0.03 mL to 2.44±0.04 mL and after four hours – from 3.88±0.07 mL to 5.35±0.1 mL. Administration of hydrochlorothiazide under the load of salts and water resulted in a higher excretion of sodium and potassium as compared to the effect of cornflower water extract. The highest prostaglandin levels were found in the blood plasma of the animals receiving hydrochlorothiazide. Under the load of salts and water, a 13% and 15% increase, respectively, in the amount of prostaglandins was observed in the animals that were given cornflower water extract compared to the control animals (P<0.05). The greatest increase in the amount of kinins was found in the groups of animals that were given hydrochlorothiazide under the load of salts and water (14% and 22%, respectively). Kinin levels did not differ statistically significantly between the control group and the groups receiving cornflower water extract.
Conclusion. Cornflower water extract possesses diuretic activity, but its effect was lower than that of hydrochlorothiazide. Full article
Open AccessArticle
Bland–Altman analysis as an alternative approach for statistical evaluation of agreement between two methods for measuring hemodynamics during acute myocardial infarction
Medicina 2007, 43(3), 208; https://doi.org/10.3390/medicina43030025
Received: 11 September 2006 / Accepted: 28 November 2006 / Published: 3 December 2006
Cited by 11 | Viewed by 217 | PDF Full-text (198 KB)
Abstract
Background and objective. Evaluation of hemodynamics in patients with acute myocardial infarction is crucial. In clinical practice, the comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace [...] Read more.
Background and objective. Evaluation of hemodynamics in patients with acute myocardial infarction is crucial. In clinical practice, the comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analyzed inappropriately, notably by using correlation coefficients. Our objective is to present an alternative approach, suggested by D. G. Altman and J. M. Bland, based on graphical techniques and simple calculations, for evaluation of the agreement of two methods – intermittent thermodilution (recognized and accepted as a “gold standard” for hemodynamic monitoring) and impedance cardiography (newly introduced method).
Patients and methods
. A total of 34 patients (20 (58.8%) men and 14 (41.2%) women) were investigated according to the study protocol at Kaunas University of Medicine Hospital. A prospective controlled study was designed to compare two different methods – intermittent thermodilution and impedance cardiography – of cardiac output measurement simultaneously in patients with acute myocardial infarction. Statistical analysis was performed with Bland–Altman and linear regression.
Results
. A total of 34 paired measurements were carried out in 34 patients at the initiation of hemodynamic monitoring and 30 paired measurements in 32 patients after subsequent improvement or stabilization of clinical status. Correlation coefficient ranged from 0.37 to 0.98.
Conclusions
. Bland–Altman analysis is an alternative method for assessing the agreement between two methods of clinical measurement. According to our data, noninvasive technique – impedance cardiography – is a reliable method for hemodynamic monitoring in noncomplicated cases of acute myocardial infarction. Full article
Open AccessArticle
Outpatient methadone maintenance treatment program Quality of life and health of opioid-dependent persons in Lithuania
Medicina 2007, 43(3), 235; https://doi.org/10.3390/medicina43030029
Received: 20 April 2006 / Accepted: 15 November 2006 / Published: 20 November 2006
Cited by 22 | Viewed by 297 | PDF Full-text (182 KB)
Abstract
Background. The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being.
Objective
. Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived [...] Read more.
Background. The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being.
Objective
. Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania.
Methods. A total of 102 opioid-dependent patients were recruited in the study. A prospective follow-up study design was used. To assess quality of life, the WHOQOL-BREF 26-item version was used. The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index (OTI).
Results
. Following 6 months of methadone maintenance treatment, significant improvements in physical (P=0.004), psychological (P=0.004), and environmental (P=0.048) components of quality of life were observed; no statistically significant improvements were found in social component of quality of life. Study participants reported lower rates of medical morbidity associated with injection (P<0.001), cardiorespiratory (P=0.034), musculoskeletal (P<0.001), neurological (P=0.013), gastrointestinal (P<0.001), and general health (P<0.001).
Conclusions
. Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients. Full article
Open AccessArticle
Effects of the prolonged thoracic epidural analgesia on ventilation function and complication rate after the lung cancer surgery
Medicina 2007, 43(3), 199; https://doi.org/10.3390/medicina43030024
Received: 30 January 2006 / Accepted: 27 September 2006 / Published: 2 October 2006
Cited by 1 | Viewed by 196 | PDF Full-text (623 KB)
Abstract
Thoracic epidural analgesia has been considered to have a good anesthetic efficacy and to decrease the postoperative complication rate, while its effect upon the ventilation function is still the topic of many clinical studies. The aim of this study was to evaluate the [...] Read more.
Thoracic epidural analgesia has been considered to have a good anesthetic efficacy and to decrease the postoperative complication rate, while its effect upon the ventilation function is still the topic of many clinical studies. The aim of this study was to evaluate the course of early postoperative period using thoracic epidural analgesia.
Material and methods.
A total of 453 patients undergoing the operation due to the non–small cell carcinoma were selected and examined. Their postoperative complications and mortality rate were evaluated. In 79 patients, arterial oxygen saturation (SaO2), forced vital capacity, forced expiratory volume in the first second, and the efficacy of analgesia were analyzed within the first 7 days after the operation. These patients were divided into subgroups according to the type of the operation – lobectomy or pneumonectomy – and the type of analgesia – thoracic epidural analgesia or opiates administered intramuscularly (control group).
Results
. A better statistically significant efficacy of analgesia was observed in thoracic epidural analgesia group than in the control group (visual analog pain scale score 2.5 versus 5.3, P<0.01). There was also a statistically significant lower incidence of postoperative complications (20.5% versus 38.8%, respectively). Thoracic epidural analgesia is a factor decreasing the relative risk of complications (RR=0.53, 95% CI 0.28–0.99, P=0.0233). In the lobectomy group, 24 hours after the surgery, forced vital capacity was 61±12% in the group receiving thoracic epidural analgesia and 45±13% in the control group (P=0.0152); forced expiratory volume in the first second was 56±17% and 41±11%, respectively (P=0.0308). In the pneumonectomy group, 24 hours after the surgery, forced vital capacity was 47±16% in the group receiving thoracic epidural analgesia, 35±8% in the control group (P=0.080). Forced expiratory volume in the first second was 47±15% and 36±7%, respectively (P=0.0449).
Conclusion
. We conclude that analgesia with intramuscularly administered opioids provides unsatisfactory analgesia, especially in the first days after the operation. Thoracic epidural analgesia is a safe method, which provides a better quality of life for the patient, decreases the postoperative complication rate, and improves the ventilation function after the lung operations. Full article
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