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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.

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Medicina, Volume 44, Issue 4 (April 2008)

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Open AccessArticle
Psychometric properties of the Lithuanian version of Sleep Apnea Quality of Life Index (a pilot study)
Medicina 2008, 44(4), 296; https://doi.org/10.3390/medicina44040038 - 23 Apr 2008
Cited by 10 | Viewed by 251
Abstract
Objective. To arrange and test for its psychometric properties Lithuanian version of Sleep Apnea Quality of Life Index and assess quality of life among snoring and obstructive sleep apnea patients before and after the treatment.
Material and methods
. Cross-cultural adaptation of [...] Read more.
Objective. To arrange and test for its psychometric properties Lithuanian version of Sleep Apnea Quality of Life Index and assess quality of life among snoring and obstructive sleep apnea patients before and after the treatment.
Material and methods
. Cross-cultural adaptation of Lithuanian version of Calgary Sleep Apnea Quality of Life Index was accomplished according to generally accepted methodology. In total, 36 (29 males and 7 females) patients (mean age, 41.1±9.7 years) suffering from socially disturbing snoring and obstructive sleep apnea were included into the study. All patients underwent complete full-night polysomnography (mean apnea/hypopnea index, 12.7±11.2) and were treated with two sessions of radiofrequency tissue ablation at the palatal and tong base (if it was necessary) levels. Lithuanian version of the Calgary Sleep Apnea Quality of Life Index was presented before the treatment with radiofrequency tissue ablation and in the period of 2 to 3 months after the treatment. Thirty-five patients repeated the same questionnaire after three weeks to assess the reliability of scores.
Results. The Cronbach’s α coefficients of internal reliability were above the standard (0.7 for groups) in all subdomains and domains. Test-retest correlation coefficients for each domain (ranged from 0.92 to 0.94) were statistically significant (P<0.0001). Lithuanian version of the questionnaire was found to be responsive to clinical change. A statistically significant difference in the mean Sleep Apnea Quality of Life Index scores in the study group patients before and after the surgery was found in all daily functioning subdomains and social interactions domains.
Conclusions. Overall, the results of the present pilot study demonstrate that the Lithuanian version of Sleep Apnea Quality of Life Index is applicable for clinical purposes. Full article
Open AccessArticle
Quality of life and voice in patients treated for early laryngeal cancer
Medicina 2008, 44(4), 288; https://doi.org/10.3390/medicina44040037 - 23 Apr 2008
Cited by 15 | Viewed by 263
Abstract
Objectives. To evaluate quality of life and voice in patients previously treated for early laryngeal cancer versus healthy controls and to assess correlations between demographic and cancer characteristics and posttreatment quality of life and voice.
Material and methods
. A total of [...] Read more.
Objectives. To evaluate quality of life and voice in patients previously treated for early laryngeal cancer versus healthy controls and to assess correlations between demographic and cancer characteristics and posttreatment quality of life and voice.
Material and methods
. A total of 49 patients diagnosed with early (Tis-T2N0) laryngeal carcinoma, treated by radiotherapy or endoscopic surgery at least 6 months before, who were alive and free of recurrence formed study group. Postservice with questionnaires was accomplished. Quality of life was evaluated using Medical Outcomes Study 36-Item Health Survey (SF-36), Hospital Anxiety and Depression (HAD) Scale, voice quality – by Voice Handicap Index (VHI). Normative data were obtained from database or concurrently assessed healthy adult subjects.
Results. Hoarseness was the most frequent complain. Majority of patients consider their health as fair (69.4%), one third – good or excellent. The means of summary of SF-36 scores for physical and mental health differ significantly from normative age-matched population (P<0.001). Emotional distress on HAD scale was found in 40.8% of patients vs. 17.0% of healthy controls. Majority (87.8%) of patients rated their voice abnormal; vast majority of them had slight to moderate dysfunction. Mean VHI scores were slight elevated for patients and differed significantly from healthy ones. Correlation analysis revealed a significant relationship between patients’ physical health and some demographic-clinic factors.
Conclusions. Quality of life in patients previously treated for early laryngeal cancer was worse than healthy subjects. Psychiatric morbidity was indicated in around of one-third of the patients. Voice changes were reported in most patients with low handicap level. Physical health perception was better for patients with higher grade of cancer differentiation, not using alcohol, and treated first. Full article
Open AccessArticle
Diagnostic sensitivity and specificity of laryngoscopic signs of reflux laryngitis
Medicina 2008, 44(4), 280; https://doi.org/10.3390/medicina44040036 - 23 Apr 2008
Cited by 4 | Viewed by 229
Abstract
Objective. To assess the diagnostic sensitivity and specificity of the laryngoscopic signs of reflux laryngitis.
Material and methods.
Using original quantitative evaluation system, the laryngoscopic signs of 108 patients with reflux laryngitis and 90 healthy people were subjected to comparative analysis in [...] Read more.
Objective. To assess the diagnostic sensitivity and specificity of the laryngoscopic signs of reflux laryngitis.
Material and methods.
Using original quantitative evaluation system, the laryngoscopic signs of 108 patients with reflux laryngitis and 90 healthy people were subjected to comparative analysis in this study. Summing up all evaluations of laryngeal changes, laryngoscopic reflux index was proposed.
Results
. Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch were found to be most significant for diagnostics of reflux laryngitis. Presence of mucosal lesions of the interarytenoid notch (roughness, hypertrophy, keratosis, granuloma) increases the odds ratio to attribute the patient to the reflux laryngitis patient group 21 times (OR=21.32, 95% CI 4.38–103.93; P<0.001). Mucosal lesions (hypertrophy, keratosis, granuloma) and edema of vocal cords were determined as the most sensitive and rather specific laryngoscopic signs. Roughness and grade II hypertrophy of interarytenoid notch were found to be the most specific (98%) and sensitive (56%) laryngoscopic signs of reflux laryngitis. Abnormal values of laryngoscopic reflux index (higher than 5 points) reflect a diagnostic sensitivity of 96% and specificity of 97% differentiating patients with reflux laryngitis from healthy persons.
Conclusions.
Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch are found to be the most significant laryngoscopic signs for diagnostics of reflux laryngitis. Laryngoscopic reflux index was found to be the most sensitive and specific diagnostic criterion for reflux laryngitis. Full article
Open AccessArticle
Search for clinical and neurophysiological prognostic patterns of brain coma outcomes in children
Medicina 2008, 44(4), 273; https://doi.org/10.3390/medicina44040035 - 23 Apr 2008
Cited by 4 | Viewed by 201
Abstract
Objective. The aim of the study was to evaluate the possible predictive values of clinical examinations combined with the recordings of electroencephalography and brainstem auditory-evoked potentials in traumatic coma of pediatric patients.
Material and methods. A total of 43 children in coma [...] Read more.
Objective. The aim of the study was to evaluate the possible predictive values of clinical examinations combined with the recordings of electroencephalography and brainstem auditory-evoked potentials in traumatic coma of pediatric patients.
Material and methods. A total of 43 children in coma with severe acute head trauma were included in the study. They were investigated and treated in pediatric intensive care unit using standard evaluation and treatment protocol. Evaluation of coma was performed using Glasgow Coma Scale. Electroencephalography for 35 patients and brainstem auditory-evoked potentials for 24 patients were recorded.
Results. Glasgow coma scale statistic pool median was equal to 4 points as measured in presence of brain edema, meanwhile it was 6 as measured in absence of edema. In case of supratentorial damage, median duration of consciousness recovery was 10 days. In absence of above-mentioned supratentorial damage, recovery of the consciousness was earlier – median was 5 days. Determined duration of artificial lung ventilation was statistically significantly shorter for those who had edema (P=0.048). In 20 patients (57% of all cases), constant or alternating slow wave activity was observed during the first electroencephalographic recording. In other cases, “alpha coma” or low amplitude of arrhythmic activity and local slowing activity corresponding to brain damage seen on computerized tomography were recorded. For 24 patients, brainstem auditory-evoked potentials were recorded. In 9 cases, they were abnormal; in these cases, the consciousness of the patients recovered after 44 days or did not recover.
Conclusions. Glasgow coma scale results alone may have limited prognostic value in absence of other objective neurophysiologic investigation data concerning the coma outcome in children. Prognosis may be worse if pathological brainstem auditory-evoked potentials correlate with pathological dynamic changes in electroencephalography and brain lesions, diagnosed during computerized tomography scan. Full article
Open AccessArticle
Quantitative microlaryngoscopic measurements of vocal fold polyps, glottal gap and their relation to vocal function
Medicina 2008, 44(4), 266; https://doi.org/10.3390/medicina44040034 - 23 Apr 2008
Cited by 7 | Viewed by 242
Abstract
Objectives. The purpose of this study was to quantify the size of vocal fold polyps and to investigate the relationship between the glottal gap and parameters of acoustic voice analysis and phonetography.
Material and methods.
Eighty-one microlaryngoscopic images and digital recordings of [...] Read more.
Objectives. The purpose of this study was to quantify the size of vocal fold polyps and to investigate the relationship between the glottal gap and parameters of acoustic voice analysis and phonetography.
Material and methods.
Eighty-one microlaryngoscopic images and digital recordings of voices (acoustic analysis and phonetogram) acquired from the patients with vocal fold polyps (VFPs) were employed in this study. Vocal fold (VF) images were collected during routine direct microlaryngoscopy using Moller-Wedel Universa 300 surgical microscope, 3-CCD Elmo 768×576- pixel color video camera and a 300 W Xenon light source. Acoustic voice analysis and phonetography were established using Dr. Speech (Tiger Electronics Inc.) software. Microlaryngoscopic images were processed by original software created by ELINTA and displayed on a monitor. The relative lengths and widths of vocal fold polyps as well as percentage area of VFP were calculated. The Pearson’s correlation was applied to reveal the correlation between VFP dimensions and acoustic voice parameters.
Results
. There were no statistically significant differences between the dimensions of left and right vocal folds and VFPs. Statistically significant slight to mild correlations between measured dimensions of VFP acoustic and phonetogram parameters were revealed, with HNR and phonetogram area showing the strongest correlation to the size of VFPs.
Conclusion
. The results of our study confirm that quantitative microlaryngoscopic measurements of vocal fold polyp and glottal gap dimensions may be a useful tool for objective assessment of glottic incompetence and voice impairment. Full article
Open AccessArticle
Association of chronic rhinosinusitis with nasal polyps and asthma: Clinical and radiological features, allergy and inflammation markers
Medicina 2008, 44(4), 257; https://doi.org/10.3390/medicina44040033 - 23 Apr 2008
Cited by 57 | Viewed by 601
Abstract
Chronic rhinosinusitis (CRS) with and without nasal polyps represent different stages of one chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. Coexistence of chronic rhinosinusitis with nasal polyps and asthma and rather similar characteristics of inflammation support assumption [...] Read more.
Chronic rhinosinusitis (CRS) with and without nasal polyps represent different stages of one chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. Coexistence of chronic rhinosinusitis with nasal polyps and asthma and rather similar characteristics of inflammation support assumption that chronic rhinosinusitis and nasal polyps and asthma may be, at least in part, the same disease process. We therefore aimed to evaluate the differences of sinus radiologic findings, systemic inflammation and allergy markers, pulmonary function of chronic rhinosinusitis associated with nasal polyps and asthma. A total of 121 patients with chronic rhinosinusitis referred to tertiary center were evaluated; 23 healthy persons served as controls. Sinus CT scans and nasal endoscopy were performed. Allergic rhinitis was diagnosed according to history and positive skin prick tests to common inhalant allergens. Asthma was diagnosed according to GINA by history and pulmonary function tests. Aspirin intolerance was assessed by history. Total IgE, Aspergillus fumigatus-specific IgE levels, leukocyte and eosinophil count in the peripheral blood were measured. Nasal polyps were detected in 84 patients (69.4%), asthma diagnosed in 48 patients (39.6%), associated with nasal polyps (91.7%) and allergic rhinitis in 45.5% of patients. Forty-four patients with chronic rhinosinusitis and having nasal polyps and asthma were characterized by older age (P<0.01), greater duration of nasal symptoms (P<0.001), higher number previous surgeries (P<0.01), more severe sinus disease on CT scan (P<0.001), greater blood leukocyte and eosinophil count, total IgE level (P<0.01), bronchial obstruction (P<0.05), incidence of allergic rhinitis (P<0.01), and sensitivity to house dust mite D. pteronyssinus (47.7%, P<0.01) and mold allergens (29.5%, P<0.01) comparing to the patients with isolated chronic rhinosinusitis. The extent of sinus CT changes was greater in asthmatics and correlated with greater duration of asthma (P<0.0001), higher number of previous surgeries (P=0.001), leukocyte count in blood (P=0.025), and age (P=0.039).
Conclusion. Our data indicate that patients with chronic rhinosinusitis compose clinically heterogeneous group and when associated with nasal polyps and asthma constitutes the most severe form of unified respiratory tract disease, which is characterized by older age of the patients, greater duration of nasal symptoms, extent of sinus radiological changes, more prominent systemic inflammation markers, greater bronchial obstruction, incidence of perennial allergic rhinitis Full article
Open AccessArticle
Expression of matrix metalloproteinases (MMP-2 and MMP-9) in vocal fold polyps
Medicina 2008, 44(4), 322; https://doi.org/10.3390/medicina44040042 - 20 Apr 2008
Cited by 1 | Viewed by 207
Abstract
Objective. Vocal fold polyps are the most common benign laryngeal lesions. Matrix metalloproteinases (MMP) play an important role in the physiological and pathological remodeling of tissues. The most important subgroup of MMP family consists of gelatinases A and B (MMP-2 and MMP-9). [...] Read more.
Objective. Vocal fold polyps are the most common benign laryngeal lesions. Matrix metalloproteinases (MMP) play an important role in the physiological and pathological remodeling of tissues. The most important subgroup of MMP family consists of gelatinases A and B (MMP-2 and MMP-9). The objective of this study was investigation of the expression of MMP-2 and MMP-9 in vocal fold polyps and normal tissue of vocal folds.
Material and methods. The immunohistochemical expression of MMP-2 and MMP-9 was investigated in specimens taken by endolaryngeal microsurgery from vocal fold polyps (n=30) and normal tissue of vocal fold (n=13, control group). Expression of MMP-2 and MMP-9, both in epithelium and stroma cells, was graded on a semiquantitative scale, ranging from 0 (no expression) to 6 points (high expression).
Results.
A statistically significant increase was observed in the expression of MMP-2 in stroma cells (P=0.0176) of vocal fold polyps compared to control vocal fold group, whereas no significant difference in the expression of MMP-2 was found in epithelium cells (P=0.1487). Comparison of expression of MMP-2 and MMP-9 in epithelium cells revealed a statistically significant increase in MMP-9 expression (P<0.01) in both groups. However, there was no statistically significant difference in the expression of MMP-9 between groups of vocal fold polyps and control vocal folds.
Conclusion
. Expression of MMP-2 in stroma was significantly higher in polyps than in normal tissue of vocal folds. Our data draw attention to the role of MMP-2 in the development of vocal fold polyps and necessity of further investigations to define its function in morphogenesis of laryngeal benign, premalignant, and malignant lesions. Full article
Open AccessArticle
Tympanic membrane changes in experimental acute otitis media and myringotomy
Medicina 2008, 44(4), 313; https://doi.org/10.3390/medicina44040041 - 20 Apr 2008
Cited by 3 | Viewed by 232
Abstract
Objective. The present experimental study explored pathomorphological changes and calcium depositions in the tympanic membrane during experimental acute otitis media caused by nontypeable Haemophilus influenzae in myringotomized and nonmyringotomized ears.
Material and methods
. A rat model of experimental acute otitis media caused [...] Read more.
Objective. The present experimental study explored pathomorphological changes and calcium depositions in the tympanic membrane during experimental acute otitis media caused by nontypeable Haemophilus influenzae in myringotomized and nonmyringotomized ears.
Material and methods
. A rat model of experimental acute otitis media caused by nontypeable Haemophilus influenzae was employed. Sixteen Sprague-Dawley rats were used. Four days following middle ear inoculation, a bilateral myringotomy was performed in six randomly selected animals. Another group of 10 animals was inoculated only. On days 4, 7, 14, and 28 after inoculation, two animals from each group were sacrificed. The temporal bones were removed and the tympanic membranes were dissected, followed by paraffin embedding. Adjacent sections were stained with PAS-alcian blue for basic histopathological observations and by von Kossa method for determination of calcium phosphate depositions.
Results. Particularly intense invasion of polymorphonuclear neutrophil leukocytes was seen on day 4 after inoculation. The highest infiltration of macrophages was observed on day 7. The peak number of lymphocytes was seen on day 14. No difference occurred in the number of polymorphonuclear leukocytes in myringotomized and nonmyringotomized tympanic membranes. The infiltration with lymphocytes and activated macrophages in all parts of the myringotomized tympanic membranes was statistically significantly higher than in the nonmyringotomized animals. The total amount of interstitial calcium phosphate depositions during days 7, 14, and 28 of study was statistically higher in the sections of pars tensa from myringotomized membranes compared to the nonmyringotomized membranes.
Conclusion
. Nontypeable Haemophilus influenzae-induced acute otitis media and myringotomy provoke more extensive inflammatory reaction with microcalcification in the tympanic membranes. Full article
Open AccessArticle
Sinoorbital gunshot injuries Endoscopic diagnostics and management
Medicina 2008, 44(4), 308; https://doi.org/10.3390/medicina44040040 - 20 Apr 2008
Cited by 1 | Viewed by 215
Abstract
Gunshot injuries to the paranasal sinuses and orbita are uncommon. Their severity depends on missile track in tissues. Such injuries can involve the orbit, paranasal sinuses, or brain. This article reports the main clinical criteria and the aspects of surgical management. Functional endoscopic [...] Read more.
Gunshot injuries to the paranasal sinuses and orbita are uncommon. Their severity depends on missile track in tissues. Such injuries can involve the orbit, paranasal sinuses, or brain. This article reports the main clinical criteria and the aspects of surgical management. Functional endoscopic sinus surgery is the most appropriate technique for removing projectiles left. This article also presents one case of airgun injury to the sphenoid sinus with retained missile that was safely removed using endoscopic procedures. Full article
Open AccessArticle
Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas
Medicina 2008, 44(4), 302; https://doi.org/10.3390/medicina44040039 - 20 Apr 2008
Cited by 32 | Viewed by 387
Abstract
Objectives. The aim of the study was to evaluate the frequency and the causes of the intra- and postoperative cerebrospinal fluid (CSF) leaks and to discuss the sella closure methods.
Methods. During the period from 1995 to 2005, 313 patients underwent [...] Read more.
Objectives. The aim of the study was to evaluate the frequency and the causes of the intra- and postoperative cerebrospinal fluid (CSF) leaks and to discuss the sella closure methods.
Methods. During the period from 1995 to 2005, 313 patients underwent 356 transsphenoidal operations for pituitary adenoma. Microadenoma was found in 80 (22.5%) cases, and in 276 (77.5%) cases, macroadenoma was removed. Two different methods to close the sella were used. The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone. In more resent practice, the regenerated oxidized cellulose (Surgicel®) and collagen sponge with human fibrin (TachoSil®) were used to cover the sella membrane defect, followed by packing the sella with autologous fat and covering the dural defect with Surgicel® and TachoSil®.
Results
. Adenoma was totally removed in 198 (55.6%) cases out of 356. Microadenoma was totally removed in 91.3% and macroadenoma in 45.3% of cases, respectively. Postoperative complications were noted in 40 (11.2%) patients. Two (0.6%) patients died after surgery. Intraoperative CSF leakage was observed in 58 (16.3%) cases. Postoperative CSF leakages were observed in 3 cases, when the method of packing the sella with just autologous fat was used, whereas in 29 cases when the sella fat packing was used together with Surgicel® and TachoSil® to cover the sella membrane and dural defects, no postoperative CSF leakages were observed.
Conclusions. The technique of covering the sella membrane and dural defects with Surgicel® and TachoSil® in the presence of intraoperative CSF leakage appeared to be the most reliable one, as no postoperative CSF leakage applying this technique has been observed. Full article
Open AccessArticle
Peripheral arterial disease – an underappreciated clinical problem
Medicina 2008, 44(4), 328; https://doi.org/10.3390/medicina44040043 - 15 Mar 2008
Viewed by 227
Abstract
Peripheral artery disease is a common vascular disorder. In contrast to coronary and cerebral artery disease, peripheral arterial disease remains an underappreciated condition that despite being serious and extremely prevalent is rarely diagnosed and even less frequently treated. Early diagnosis of peripheral artery [...] Read more.
Peripheral artery disease is a common vascular disorder. In contrast to coronary and cerebral artery disease, peripheral arterial disease remains an underappreciated condition that despite being serious and extremely prevalent is rarely diagnosed and even less frequently treated. Early diagnosis of peripheral artery disease and individual assessment of risk factors are important in preventing further cardiovascular complications. The ankle-brachial index is a simple, reliable tool for diagnosing peripheral artery disease. Many studies underscore the importance of using the ankle-brachial index to identify persons with peripheral artery disease, since peripheral artery disease is frequently undiagnosed or asymptomatic. Measurement of the ankle-brachial index is simple enough to be performed in any doctor’s office, and it is one of the most reliable indices of peripheral artery disease. Full article
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