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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 6 (June 2008)

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Open AccessArticle
Transfusion of autologous blood
Medicina 2008, 44(6), 482; https://doi.org/10.3390/medicina44060063 - 17 Jun 2008
Cited by 2 | Viewed by 200
Abstract
Recently the use of allogeneic (donor) blood transfusion is widely accepted in the clinical practice. Despite of good quality and safety of preparation of allogeneic blood, there are some risks related with transfusion: hemolytic, febrile, and allergic reactions, transfusion related acute lung injury, [...] Read more.
Recently the use of allogeneic (donor) blood transfusion is widely accepted in the clinical practice. Despite of good quality and safety of preparation of allogeneic blood, there are some risks related with transfusion: hemolytic, febrile, and allergic reactions, transfusion related acute lung injury, negative immunomodulatory effect, transmission of infections diseases, dissemination and recurrence of cancer. This is why the indications for donor blood transfusion are restricted, so new safer methods are discovered to avoid or to decrease the heed for allogeneic blood transfusion. Nowadays, there is an increased interest in autologous blood transfusion as the most acceptable alternative to allogeneic blood transfusion. Autologous transfusion is the collection and reinfusion of the patient’s own blood (donor and recipient is the same person). Several types of autologous transfusion can be used: preoperative autologous blood donation, acute normovolemic hemodilution, intraoperative blood salvage, postoperative blood salvage. Neverless, autologous transfusion does not protect from all risks, it still remains the safest type of blood transfusion and is important in the strategy of blood conservation. Full article
Open AccessArticle
Lichen sclerosus et atrophicus in pediatric and adult male patients with congenital and acquired phimosis
Medicina 2008, 44(6), 460; https://doi.org/10.3390/medicina44060060 - 17 Jun 2008
Cited by 10 | Viewed by 258
Abstract
Lichen sclerosus et atrophicus is a chronic inflammatory sclerotic and atrophic disease of unknown cause that predominantly affects male and female genital skin. This study was designed to evaluate histological characteristics of congenital and acquired phimoses among pediatric (n=60) and adult (n=60) male [...] Read more.
Lichen sclerosus et atrophicus is a chronic inflammatory sclerotic and atrophic disease of unknown cause that predominantly affects male and female genital skin. This study was designed to evaluate histological characteristics of congenital and acquired phimoses among pediatric (n=60) and adult (n=60) male patients who were admitted for circumcision to the Clinics of Urology and Pediatric Surgery of Kaunas University of Medicine Hospital between 2000 and 2003 and to determine the rate of lichen sclerosus et atrophicus and other histological diagnoses among them. This study demonstrates that 45.1% of congenital and 62.3% of acquired phimoses show histological signs of lichen sclerosus et atrophicus. The rate of lichen sclerosus et atrophicus was statistically significantly higher among patients with acquired than congenital phimosis. Boys with acquired narrowing of prepuce were statistically significantly 3.9 times more likely to develop lichen sclerosus et atrophicus than those with congenital phimosis. There were no statistically significant differences between rates of lichen sclerosus et atrophicus and other dermatological diagnoses among pediatric and adult male patients if the type of phimosis (acquired or congenital) was considered. Histological features of lichen sclerosus et atrophicus and other histological diagnoses in boys and men with phimosis were detected with equal frequency irrespective the age of the subjects. The rate of lichen sclerosus et atrophicus was similar among all boys (56.7%) and men (53.3%) treated for phimosis. Only the type of phimosis had a statistically significant influence on the rate of lichen sclerosus et atrophicus and other histological diagnoses. Full article
Open AccessArticle
Cystic lymph node metastasis in papillary thyroid carcinoma
Medicina 2008, 44(6), 455; https://doi.org/10.3390/medicina44060059 - 17 Jun 2008
Cited by 15 | Viewed by 222
Abstract
Background. Thyroid cancer, especially papillary carcinoma, metastasizes most often into cervical lymph nodes. Cervical ultrasound and ultrasound-guided fine-needle aspiration biopsy are the most sensitive modalities in detecting locoregional neck recurrence. Objective. The aim of this study was to illustrate the ultrasound spectrum [...] Read more.
Background. Thyroid cancer, especially papillary carcinoma, metastasizes most often into cervical lymph nodes. Cervical ultrasound and ultrasound-guided fine-needle aspiration biopsy are the most sensitive modalities in detecting locoregional neck recurrence. Objective. The aim of this study was to illustrate the ultrasound spectrum of lymph node metastases from papillary thyroid carcinoma.
Patients and methods. During 1998–2002 years due to suspicion of recurrence of thyroid cancer, 75 ultrasound-guided fine-needle aspiration biopsies of regional lymph nodes were performed. Ultrasound examination of 75 patients with thyroid cancer (56 women and 19 men; mean age of patients was 54.67±12.89 years) was performed. All biopsies were performed on nonpalpable lesions (lymph node short axis £1.5 cm).
Results.
A total of 75 ultrasound-guided fine-needle aspiration biopsies of regional lymph nodes under suspicion of malignancy were performed. Only 5 (6.7%) of the 75 lymph nodes were cystic with internal septation. Other 70 (93.3%) lymph nodes were solid. Cytopathological results of 75 ultrasound-guided fine-needle aspiration biopsies from regional cervical lymph nodes were noninformative in 4 (5.3%) cases, benign – 40 (53.4%), suspicion – 4 (5.3%), and malignant – 27 (36.0%) cases. Eighteen patients underwent surgery for regional lymph nodes. All cystic metastases were confirmed to be papillary thyroid carcinoma on pathologic examination.
Conclusion.
Ultrasound cannot exactly distinguish benign from malign lesions, but sonographic appearance can suggest malignancy and help in selection of the correct lymph nodes to aspirate with ultrasound-guided fine-needle aspiration biopsy. Cystic lymph node metastases may occur in papillary thyroid carcinoma. Cystic neck lesion patients with thyroid papillary carcinoma should always be verified with fine-needle aspiration biopsy. Full article
Open AccessArticle
Helicobacter pylori genotypes in Lithuanian patients with chronic gastritis and duodenal ulcer
Medicina 2008, 44(6), 449; https://doi.org/10.3390/medicina44060058 - 17 Jun 2008
Cited by 17 | Viewed by 223
Abstract
Objective. Clinical outcome of Helicobacter pylori (H. pylori) infection might be associated with specific virulence-associated bacterial genotypes. The distribution of different bacterial genotypes varies geographically. The aim of this study was to assess the relationship between cagPAI, vacA, and iceA [...] Read more.
Objective. Clinical outcome of Helicobacter pylori (H. pylori) infection might be associated with specific virulence-associated bacterial genotypes. The distribution of different bacterial genotypes varies geographically. The aim of this study was to assess the relationship between cagPAI, vacA, and iceA status and severity of the disease in patients from Lithuania, infected by H. pylori. Material and methods. H. pylori from 81 patients (37 with duodenal ulcer and 44 with chronic gastritis) was isolated from gastric biopsy specimens and cultured. Bacterial genotypes cagPAI, vacA (s and m subtypes) and iceA were analyzed by polymerase chain reaction using specific primers.
Results. The cagPAI was identified in 59.3% of Lithuanian H. pylori strains investigated. H. pylori strains cultured from duodenal ulcer (DU) patients more frequently (P<0.01) contained cagPAI and vacA s1 genotypes (75.7% and 75.7%, respectively) in comparison to isolates from chronic gastritis (CG) patients (45.5% and 40.9%, respectively). Evaluation of nucleotide sequence of the vacA middle-region revealed that vacA s2/m2 genotype was more frequent in CG than in DU patients (56.8% and 24.3%, respectively; P<0.05). We have not found any differences in the frequency of iceA1 genotype between the DU and CG patients (46.0% and 40.9%, respectively; P>0.05).
Conclusion
. Our study suggests that cagPAI and vacA s1 genotypes are associated with peptic ulceration in Lithuanian patients infected by H. pylori. Full article
Open AccessArticle
The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients
Medicina 2008, 44(6), 439; https://doi.org/10.3390/medicina44060057 - 17 Jun 2008
Cited by 12 | Viewed by 238
Abstract
Objective. To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology among infertile patients.
Patients and methods. A prospective cross-sectional study in Kaunas University of Medicine Hospital within the period of 18 months was performed. Consecutive infertile women [...] Read more.
Objective. To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology among infertile patients.
Patients and methods. A prospective cross-sectional study in Kaunas University of Medicine Hospital within the period of 18 months was performed. Consecutive infertile women formed the study group according to defined criteria. Hysterosalpingography was performed in the preovulatory phase of the menstrual cycle. Laparoscopy and dye test was performed within one – three months after hysterosalpingography. General tubal pathology, tubal occlusion, and peritubal adhesions detected at hysterosalpingography were compared with general tubal pathology, tubal occlusion, and peritubal adhesions detected at laparoscopy.
Results
. The study population comprised 149 infertile women. The sensitivity of 81.4% and specificity of 47.8% the likelihood ratio of a positive test result of 1.6 and a negative test result of 0.4 for hysterosalpingography while evaluating general tubal pathology was determined. Sensitivity of 84.1% and specificity of 59.1% and likelihood ratios of 2.1 and 0.3, respectively, were calculated, when tubal occlusion was defined as any abnormality of tubal patency. When definition of tubal occlusion was limited to two-sided occlusion, the sensitivity and specificity were 89.5% and 90% and likelihood ratios 9.0 and 0.1, respectively. As a test of peritubal adhesions, hysterosalpingography had sensitivity of 35.5% and specificity of 81.3% and likelihood ratios of 1.9 and 0.8, respectively.
Conclusion. The diagnostic performance of hysterosalpingography in the diagnosis of general tubal pathology and peritubal adhesions is poor. Hysterosalpingography is more accurate in the diagnosis of tubal occlusion. Full article
Open AccessArticle
The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education
Medicina 2008, 44(6), 428; https://doi.org/10.3390/medicina44060056 - 17 Jun 2008
Cited by 17 | Viewed by 266
Abstract
Objective. To determine whether 2-dimensional or 3-dimensional hepatic visualization is better for the medical students to be used while studying the clinical hepatic anatomy.
Material and methods. Twenty-nine patients who underwent surgical intervention due to focal hepatic pathology at the Department [...] Read more.
Objective. To determine whether 2-dimensional or 3-dimensional hepatic visualization is better for the medical students to be used while studying the clinical hepatic anatomy.
Material and methods. Twenty-nine patients who underwent surgical intervention due to focal hepatic pathology at the Department of General Surgery, University of Heidelberg, and at Clinics of Santariškės, Vilnius University Hospital were included in the retrospective cohort study. Before the surgical intervention, the computed tomography (CT) liver scan and 3- dimensional (3D) hepatic visualization were performed. A total of 58 2-dimensional and 3- dimensional digital liver images, mixed up in random sequence not to follow each other with a specially designed questionnaire, were presented to the students of Faculty of Medicine, Vilnius University. Their aim was to determine tumor-affected liver segments, to plan which liver segments should be resected, and to predict anatomical difficulties for liver resection. Results were compared with the data of real operation.
Results. The students achieved better results for tumor localization analyzing 3D liver images vs. CT scans. This was especially evident determining the localization of tumor in segments 5, 6, 7, and 8 (P<0.05). Furthermore, the results of proposed extent of liver resection have been found to be better with 3D visualization (mean±SD – 0.794±0.175) in comparison with CT scans (mean±SD – 0.670±0.200), (P<0.001).
Conclusions. Computer-generated 3D visualizations of the liver images helped the medical students to determine the tumor localization and to plan the prospective liver resection operations more precisely comparing with 2D visualizations. Computer-generated 3D visualization should be used as a means of studying liver anatomy. Full article
Open AccessArticle
Primary health care development in 2002–2006 in Lithuania: Will we achieve the objective set?
Medicina 2008, 44(6), 472; https://doi.org/10.3390/medicina44060062 - 16 Jun 2008
Cited by 2 | Viewed by 175
Abstract
The aim of this study was to identify the changes in the development of primary health care in 2002–2006 and to predict its potential results in 2008, based on various criteria (indicators). Data from the compulsory health insurance system “Sveidra” have been used [...] Read more.
The aim of this study was to identify the changes in the development of primary health care in 2002–2006 and to predict its potential results in 2008, based on various criteria (indicators). Data from the compulsory health insurance system “Sveidra” have been used for the analysis. A share of the private primary health care institutions, the persons enrolled with them, and visits in such institutions from all primary health care institutions during the study period have significantly statistically increased (average annual changes were 6.9%, 22.2%, and 27.2%, respectively). In 2008, this part would make up 61.0%, 30.6%, and 27.2%, respectively. The proportion of persons registered with family doctors and the number of visits to family doctors were significantly increasing (average annual changes were 22.5% and 27.2%, respectively). It is predicted that this part would make up 27.8% and 35.2% in 2008. More detailed analysis has shown that relatively more young and working-age persons (aged 18–44 years) were enrolled in private primary health care institutions. It is in particular evident in Vilnius and Kaunas where the choice of such institutions is high. The number of persons registered with family doctors was increasing in both private and public institutions (average annual changes were 22.5% and 8.3%, respectively; P<0.05). In private institutions, the proportion of persons registered with local district pediatricians was also significantly increasing. The study results have shown significant differences in the developments of primary health care in 2002– 2006 by various indicators. The objective defined in the strategy of restructuring will be achieved in 2008 only in respect of the number of institutions. Assessing by the aspect of services, the results achieved will be approximately two times lower. The practice of the institution of the family doctor is becoming more intensive in both private and public institutions. Full article
Open AccessArticle
Metastatic amelanotic nodular melanoma during pregnancy
Medicina 2008, 44(6), 467; https://doi.org/10.3390/medicina44060061 - 16 Jun 2008
Cited by 3 | Viewed by 236
Abstract
This case report presents a very aggressive course of amelanotic nodular melanoma during pregnancy resulting in death five months after delivery. A 34 year-old Caucasian woman at 19th week of the second pregnancy was diagnosed having amelanotic nodular melanoma (tumor thickness – 2.5 [...] Read more.
This case report presents a very aggressive course of amelanotic nodular melanoma during pregnancy resulting in death five months after delivery. A 34 year-old Caucasian woman at 19th week of the second pregnancy was diagnosed having amelanotic nodular melanoma (tumor thickness – 2.5 mm) with metastases to the regional right inguinal lymph node. Amelanotic nodular melanoma represents malignant melanocytic tumor of the skin, which clinically mimics a variety of benign and malignant skin conditions and therefore commonly leads to delayed diagnosis. Though primary tumor was excised immediately, other treatment procedures as radical lymphadenectomy and chemotherapy were delayed, and immunotherapy was not given totally. At the 29th week of pregnancy, the woman via naturalem delivered a healthy female child, and the chemotherapy was started. Since pregnancy limits the prescription of immunotherapy and chemotherapy, the prognosis for melanoma during pregnancy detected later than in the second stage is poor and can be illustrated by our reported case. Such patients seems to be at higher risk to develop metastasis of melanoma in the internal organs and occasionally even in the fetus; therefore, they should be timely informed about that. Full article
Open AccessArticle
The influence of fluid balance on intra-abdominal pressure after major abdominal surgery
Medicina 2008, 44(6), 421; https://doi.org/10.3390/medicina44060055 - 15 Jun 2008
Cited by 17 | Viewed by 181
Abstract
Objective. The objectives of this study were to determine the incidence of intraabdominal hypertension in patients after major abdominal surgery and to evaluate the correlation of intra-abdominal pressure with fluid balance and systemic inflammatory response syndrome.
Material and methods
. This is [...] Read more.
Objective. The objectives of this study were to determine the incidence of intraabdominal hypertension in patients after major abdominal surgery and to evaluate the correlation of intra-abdominal pressure with fluid balance and systemic inflammatory response syndrome.
Material and methods
. This is a prospective observational study. Patients, admitted to intensive care unit after major abdominal surgery, were included into the study. Intra-abdominal pressure was measured via a urinary bladder catheter twice daily. Twenty-four-hour fluid balance and systemic inflammatory response syndrome criteria met by the patients were collected daily.
Results
. Seventy-seven patients were included into the study. Intra-abdominal hypertension was diagnosed in about 40% of the patients in the early postoperative period. The study showed a significant positive correlation between 24-hour fluid balance and daily changes in intraabdominal pressure. A significant association was also seen between the number of positive systemic inflammatory response syndrome criteria and intra-abdominal pressure, and intraabdominal pressure was significantly higher in patients with systemic inflammatory response syndrome. Besides, patients with intra-abdominal hypertension on the first postoperative day had longer length of stay in the intensive care unit.
Conclusions. Intra-abdominal hypertension occurs commonly in patients after major abdominal surgery, and patients with positive 24-hour fluid balance and/or systemic inflammatory response syndrome are at risk of having higher intra-abdominal hypertensio Full article
Open AccessArticle
Association between cadmium and breast cancer
Medicina 2008, 44(6), 415; https://doi.org/10.3390/medicina44060054 - 15 May 2008
Cited by 13 | Viewed by 223
Abstract
Cadmium is a known human lung carcinogen, although some studies indicate a link between cadmium exposure and human breast cancer. The objective of this study was to assess cadmium concentration in breast tissue samples of patients with breast cancer and benign breast tumor. [...] Read more.
Cadmium is a known human lung carcinogen, although some studies indicate a link between cadmium exposure and human breast cancer. The objective of this study was to assess cadmium concentration in breast tissue samples of patients with breast cancer and benign breast tumor.
Material and methods
. The concentration of cadmium was determined in breast tissue samples of 21 breast cancer and 19 benign tumor patients. Two samples of breast tissue from each patient, i.e. tumor and normal tissue close to tumor, were taken for the analysis. Cadmium was determined by atomic absorption spectrometry (Perkin-Elmer, Zeeman 3030).
Results
. In patients with breast cancer, the mean cadmium concentration was 33.1 ng/g (95% CI, 21.9– 44.4) in malignant breast tissue and 10.4 ng/g (95% CI, 5.6–15.2) in normal breast tissue (P=0.002). In patients with benign tumor, the corresponding values were 17.5 ng/g (95% CI, 8.4–26.5) and 11.8 ng/g (95% CI, 5.1– 18.5) (P=0.3144). There was a statistically significant difference in cadmium concentration between malignant and benign breast tissues (P=0.009).
Conclusion
. The data obtained show that cadmium concentration is significantly higher in malignant breast tissue as compared with normal breast tissue of the same women or benign breast tissue. Further studies are necessary to determine the association between cadmium concentration in malignant breast tissue and estrogen receptor level, and smoking. Full article
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