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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 44, Issue 8 (August 2008)

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Open AccessArticle
Hemodynamic studies for prediction of acute myocardial infarction outcomes
Medicina 2008, 44(8), 640; https://doi.org/10.3390/medicina44080083 - 18 Aug 2008
Cited by 2 | Viewed by 206
Abstract
Prediction of outcomes after acute myocardial infarction was initiated more than 40 years ago. Improvement of the management options significantly reduced mortality of patients with acute myocardial infarction. In the 1960s, the mortality rate of inpatients was around 25–30%, whereas in 2007, according [...] Read more.
Prediction of outcomes after acute myocardial infarction was initiated more than 40 years ago. Improvement of the management options significantly reduced mortality of patients with acute myocardial infarction. In the 1960s, the mortality rate of inpatients was around 25–30%, whereas in 2007, according to the guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes, issued by the European Society of Cardiology, hospital mortality in patients with ST-elevation acute myocardial infarction was 7%, while in patients with non-ST-elevation acute coronary syndrome just 5%, but at 6 months, mortality rates were very similar in both conditions (12% vs. 13%, respectively). There are different criteria for prediction of acute myocardial infarction: demographic, clinical, laboratory, instrumental, and epidemiological. Data of hemodynamic studies are ones of the possible criteria for prediction of outcomes after acute myocardial infarction. Methods and findings of hemodynamic studies used for prediction of the outcomes are presented in this article. Full article
Open AccessArticle
Risk factors for noncommunicable diseases in Lithuanian rural population: CINDI survey 2007
Medicina 2008, 44(8), 633; https://doi.org/10.3390/medicina44080082 - 13 Aug 2008
Cited by 29 | Viewed by 331
Abstract
The aim of the study was to assess the risk profile for noncommunicable diseases in Lithuanian rural population.
Material and methods. Within CINDI program, the risk factor survey was carried out in five rural regions of Lithuania in random sample of population [...] Read more.
The aim of the study was to assess the risk profile for noncommunicable diseases in Lithuanian rural population.
Material and methods. Within CINDI program, the risk factor survey was carried out in five rural regions of Lithuania in random sample of population aged 25–64 years in 2007. The risk factors were defined according to the WHO criteria. A total of 1739 participants were enrolled in the study.
Results. The prevalence of hypertension was considerably higher among men than among women (60.3% and 44.6%, respectively). Hypercholesterolemia was identified in half of examined persons with no gender difference. The proportion of obese female persons was greater than male. Metabolic syndrome was diagnosed in 15.1% of men and in 21.5% of women. The significant gender difference was observed in the prevalence of regular smoking (47.5% in men and 18.1% in women) as well as risky alcohol consumption (26.7% of men and 3.1% of women). The majority of rural population was lacking leisure-time physical activity. The prevalence of hypertension, hypercholesterolemia, obesity, and metabolic syndrome was increasing with age in both men and women. Regular smoking and risky alcohol consumption were more common among younger than older population. Leisure-time physical activity tended to increase with age.
Conclusions
. The prevalence of risk factors for noncommunicable diseases in Lithuanian rural population is high. The obtained data prove that comprehensive and intersectorial preventive actions aimed at the reduction in the risk of noncommunicable diseases are urgently needed in Lithuania. Full article
Open AccessArticle
Nutritional status of elderly surgical patients
Medicina 2008, 44(8), 609; https://doi.org/10.3390/medicina44080079 - 13 Aug 2008
Cited by 3 | Viewed by 185
Abstract
The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it.
Material and methods
. A total of 156 patients aged 45 years and more, treated at the Departments [...] Read more.
The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it.
Material and methods
. A total of 156 patients aged 45 years and more, treated at the Departments of Surgery and Urology of Kaunas 2nd Clinical Hospital, were enrolled in the study. Elderly group (aged 65 years and more) consisted of 99 patients, and middle-aged group (45 to 64 years old) of 57 patients. The following anthropometric measurements were performed: weight, height, mid-arm circumference; hemoglobin, serum albumin level, and total lymphocyte count were determined. Standard assessment scales included Instrumental Activities of Daily Living, Geriatric Depression Scale, and Mini Mental State Exam. Statistical analysis was performed with the help of SPSS 12.0.
Results
. Malnutrition was diagnosed in 53.5% of older patients and in 15.8% of middle-aged patients (P<0.05). Obesity was diagnosed in 32.3% of elderly patients and in 40.4% of middle-aged patients (P<0.05). Among men, obese patients made up 20%, among women – 54.4% (P<0.05). Malnutrition was more prevalent among elderly patients who underwent urgent operations than in patients who underwent planned operations (69.6% and 34.1%, respectively; P<0.05) and among elderly patients with impaired cognitive functions than among those without impaired cognitive functions (in 100% of patients with medium impaired cognitive function, in 59.3% of patients with mild impaired cognitive function, and in 44.4% of patients with unimpaired cognitive function, P<0.05). Malnourished elderly patients had lower functional level than the remaining (IADL score of 3.97 and 4.75 for men, 5.38 and 6.89 for women, respectively; P<0.05). The prevalence of malnutrition did not differ significantly in the groups of older patients with depression, probable depression and not depressed patients – 75.0%, 57.7%, and 46.7%, respectively (P>0.05).
Conclusions
. Malnutrition was diagnosed more frequently in elderly surgical patients than in middle-aged patients. Obesity was more common in women than in men. The prevalence of obesity was not associated with age. Malnutrition in elderly surgical patients was associated with poor functional status, impaired cognitive function, and urgent operation. Full article
Open AccessArticle
Presurgical evaluation of epilepsy patients
Medicina 2008, 44(8), 585; https://doi.org/10.3390/medicina44080076 - 11 Aug 2008
Cited by 5 | Viewed by 243
Abstract
Epilepsy surgery has been established as an effective treatment in pharmacoresistant focal epilepsies. Most candidates for epilepsy surgery are patients with partial epilepsy syndromes refractory to medical treatment. The curative surgery procedure is resection of the epileptogenic zone; therefore, precise detection of the [...] Read more.
Epilepsy surgery has been established as an effective treatment in pharmacoresistant focal epilepsies. Most candidates for epilepsy surgery are patients with partial epilepsy syndromes refractory to medical treatment. The curative surgery procedure is resection of the epileptogenic zone; therefore, precise detection of the site responsible for seizure generation is necessary. Modern structural and functional imaging techniques have made presurgical evaluation less invasive and available for a higher number of patients. Video electroencephalography (EEG) monitoring, high-resolution structural and functional imaging techniques are used widely for presurgical evaluation. When noninvasive evaluation is not sufficient for the detection of the epileptogenic zone, invasive EEG monitoring and intracarotid amobarbital test are used. A classical example of a surgically curable epilepsy syndrome is mesial temporal lobe epilepsy with about 70–80% of patients becoming free of seizures after surgery. Results in extratemporal epilepsies are also satisfactory. Despite worldwide expansion during the recent decade, epilepsy surgery remains underutilized. Better understanding of advances in presurgical evaluation should reduce fears of epilepsy surgery and help to select patients who could achieve complete seizure control or significant amelioration after surgery. Full article
Open AccessArticle
Trends in alcohol consumption among Lithuanian school-aged children in 1994–2006 and new challenges
Medicina 2008, 44(8), 623; https://doi.org/10.3390/medicina44080081 - 06 Aug 2008
Cited by 5 | Viewed by 199
Abstract
Alcohol abuse is considered one of the most important risk-taking behaviors among young people in the world. This paper presents the results of the WHO collaborative cross-national study on Health Behavior in School-aged Children (HBSC) carried out in Lithuania and other European countries [...] Read more.
Alcohol abuse is considered one of the most important risk-taking behaviors among young people in the world. This paper presents the results of the WHO collaborative cross-national study on Health Behavior in School-aged Children (HBSC) carried out in Lithuania and other European countries also in USA, Canada, and Israel in 1994, 1998, 2002, and 2006.
Objective. The aim of this study was to analyze features and trends in alcohol consumption among the samples of 11-, 13-, and 15-year-old adolescents (school-aged children) in Lithuania during 1994–2006. Material and methods. Representative samples of 5428, 4513, 5645, and 5632 respondents aged 11, 13, and 15 years were included into school-based questionnaire surveys in 1994, 1998, 2002, and 2006, respectively. The standardized research methods were applied. The students have filled in the questionnaires anonymously in the classroom according to the methodology of international HBSC study. The students were asked about lifestyle habits, alcohol consumption, and episodes of drunkenness.
Results. The number of students who had been drunk two or more times has increased by 2.5 times (from 9.8%. to 25.6%) during 1994–2006. A significant increase in alcohol consumption was observed among 15- year-old girls – the percentage of girls who have reported alcohol consumption almost approached the percentage of boys (50.3% and 56.8%, respectively; P=0.006). The reported mean age of the onset of first drinking had shifted by 2 years towards younger age during the period of 1994–2006. The comparison of data from 37 countries, participating in this cross-national study, revealed that the prevalence of alcohol consumption among Lithuanian school children is one of the highest (29.0% of boys and 22.1% of girls) and was in the second worst position on a rating scale when comparing with other 36 countries involved in HBSC study. The results suggest that increased use of light alcoholic beverages can cause an increase in the number of drinking teenagers. Ready-to-drink beverages (“alcopops”) at least once per week were used by 15.3% of boys and 17.5% of girls (P=0.216); beer – 16.9% of boys and 5.6% of girls (P<0.001).
Conclusions. A significant shift of the onset of drinking alcohol towards younger age was observed in Lithuania during 1994–2006. In recent years, Lithuanian students as compared to peers from other countries are among those who consume alcohol most frequently. Full article
Open AccessArticle
The incidence of lymph node metastases in prostate carcinoma depends not only on tumor characteristics but also on surgical performance and extent of pelvic lymphadenectomy
Medicina 2008, 44(8), 601; https://doi.org/10.3390/medicina44080078 - 28 Jul 2008
Cited by 4 | Viewed by 193
Abstract
Objectives. The purpose of the present study was to determine whether predictions of the incidence of pelvic lymph node metastases in patients with similar prostate cancer characteristics are influenced by the extent of pelvic lymphadenectomy or surgical performance.
Material and methods.
Data [...] Read more.
Objectives. The purpose of the present study was to determine whether predictions of the incidence of pelvic lymph node metastases in patients with similar prostate cancer characteristics are influenced by the extent of pelvic lymphadenectomy or surgical performance.
Material and methods.
Data from a prostate cancer database were analyzed to investigate associations between incidence of lymph node metastasis and preoperative prostate-specific antigen level, clinical stage, biopsy Gleason score, extent of pelvic lymphadenectomy, and surgical performance. Subgroups of patients with the same characteristics were formed, and a multivariate analysis was performed.
Results
. Data of 668 patients with cT1-T2c prostate cancer who underwent radical retropubic prostatectomy with pelvic lymphadenectomy were analyzed. Lymph node metastases were found in 8.7% of these patients. In the subgroup of patients undergoing limited pelvic lymphadenectomy, 6.3% were affected compared with 14.7% of patients undergoing extended pelvic lymphadenectomy (P<0.0005). In the subgroups of patients with the same tumor characteristics (with only two exceptions), the impact of the extent of lymphadenectomy on the incidence of lymph node metastases was evident. The results of the multivariate analysis corroborated the influence of the extent of pelvic lymphadenectomy (P<0.03) and surgical performance (P<0.04) on the incidence of lymph node metastases.
Conclusions. The incidence of lymph node metastases was dependent not only on preoperative prostate-specific antigen level, clinical stage, and biopsy Gleason score but also to a large degree on surgical performance and the extent of pelvic lymphadenectomy. Our data suggest that a limited and/or not thoroughly performed pelvic lymphadenectomy results in failure to detect a relevant proportion of lymph node metastases. Full article
Open AccessArticle
Staphylococcus aureus prevalence among hospitalized patients
Medicina 2008, 44(8), 593; https://doi.org/10.3390/medicina44080077 - 09 Jul 2008
Cited by 1 | Viewed by 207
Abstract
Objective. To determine the prevalence of Staphylococcus aureus strains among hospitalized patients at the beginning of their hospitalization and during their treatment and the resistance of strains to antibiotics, and to evaluate epidemiologic characteristics of these strains.
Patients and methods. Sixty-one [...] Read more.
Objective. To determine the prevalence of Staphylococcus aureus strains among hospitalized patients at the beginning of their hospitalization and during their treatment and the resistance of strains to antibiotics, and to evaluate epidemiologic characteristics of these strains.
Patients and methods. Sixty-one patients treated at the Department of Cardiac, Thoracic and Vascular Surgery were examined. Identification of Staphylococcus aureus strains was performed using plasmacoagulase and DNase tests. The resistance of Staphylococcus aureus to antibiotics, b-lactamase production, phagotypes, and phagogroups were determined. The isolated Staphylococcus aureus strains were tested for resistance to methicillin by performing disc diffusion method using commercial discs (Oxoid) (methicillin 5 mg per disk and oxacillin 1 mg per disk).
Results
. A total of 297 Staphylococcus aureus strains were isolated. On the first day of hospitalization, the prevalence rate of Staphylococcus aureus strains among patients was 67.3%, and it statistically significantly increased to 91.8% on days 7–10 of hospitalization (P<0.05). During hospitalization, patients were colonized with Staphylococcus aureus strains resistant to cephalothin (17.6% of patients, P<0.05), cefazolin (14.6%, P<0.05), tetracycline (15.0%, P<0.05), gentamicin (37.7%, P<0.001), doxycycline (30.7%, P<0.001), and tobramycin (10.6%, P>0.05). Three patients (4.9%) were colonized with methicillin-resistant Staphylococcus aureus strains, belonging to phage group II phage type 3A and phage group III phage types 83A and 77; 22.6– 25.5% of Staphylococcus aureus strains were nontypable. During hospitalization, the prevalence rate of phage group II Staphylococcus aureus strains decreased from 39.6% to 5.7% (P<0.05) and the prevalence rate of phage group III Staphylococcus aureus strains increased to 29.5% (P<0.001).
Conclusions. Although our understanding of Staphylococcus aureus is increasing, well-designed communitybased studies with adequate risk factor analysis are required to elucidate further the epidemiology of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Surveillance of methicillin-resistant Staphylococcus aureus provides relevant information on the extent of the methicillin-resistant Staphylococcus aureus epidemic, identifies priorities for infection control and the need for adjustments in antimicrobial drug policy, and guides intervention programs. Full article
Open AccessArticle
Legal assessment of current situation on orphan patients in Lithuania
Medicina 2008, 44(8), 571; https://doi.org/10.3390/medicina44080074 - 21 Jun 2008
Cited by 3 | Viewed by 226
Abstract
After Lithuania joined the European Union, the Regulation (EC) No. 141/2000 on orphan medicinal products and Commission Regulation (EC) No. 847/2000 came into force as part of national legislation. Member States must adopt specific measures to increase knowledge on rare diseases and to [...] Read more.
After Lithuania joined the European Union, the Regulation (EC) No. 141/2000 on orphan medicinal products and Commission Regulation (EC) No. 847/2000 came into force as part of national legislation. Member States must adopt specific measures to increase knowledge on rare diseases and to improve their detection, diagnosis, and treatment. The aim of this article was to present and to assess the current legal situation on orphan patients and their treatment in Lithuania, to identify legislation gaps, and to propose some ideas how to facilitate the solution of the existing problems in this field. For this purpose, European Union and Lithuanian legal documents on rare medicinal products are examined using a comparative method. With reference to inventory of Member States’ incentives for rare diseases in national level, the most important issues, which orphan patients face to in Lithuania, are singled out. In Lithuania, the situation of orphan patients in terms of protection of patient rights is insufficiently determined. The access to effective health care services or approved therapies in some cases is restricted. Working relationships between genetic services and various clinical specialists as well as with those in primary care are not legally determined; the number of clinical trials aimed at orphan medicinal products is low. These results suggest a need for awareness raising among Lithuanian Government, health care specialists, patient organizations about the importance to improve practical implementation of European Union legislation and progressive experience of some European countries in this field. Full article
Open AccessArticle
Aorto-caval fistula clinically presenting as left renal colic Findings of multislice computed tomography
Medicina 2008, 44(8), 619; https://doi.org/10.3390/medicina44080080 - 14 Jun 2008
Cited by 4 | Viewed by 193
Abstract
Spontaneous aorto-caval fistula is a rare complication of abdominal aortic aneurysm. A definitive diagnosis is sometimes difficult, as the classic diagnostic signs (pulsatile abdominal mass with bruit, high-output hearth failure, and acute dyspnea) are present in about half of the patients. Diagnosis may [...] Read more.
Spontaneous aorto-caval fistula is a rare complication of abdominal aortic aneurysm. A definitive diagnosis is sometimes difficult, as the classic diagnostic signs (pulsatile abdominal mass with bruit, high-output hearth failure, and acute dyspnea) are present in about half of the patients. Diagnosis may be suspected from clinical symptoms, but sometimes atypical clinical features may obscure the actual situation. Computed tomography findings include early detection of contrast medium in the dilated inferior vena cava, which is isodense with the adjacent aorta, an associated aortic aneurysm, loss of normal anatomic space between aorta and vena cava, and rarely one can even visualize the abnormal communication between aorta and vena cava. Prompt radiological diagnosis is of key importance in the management of these patients. We describe findings of multislice computed tomography of the patient with dissecting aortic aneurysm and aortocaval fistula, clinically presenting as left renal colic. Multislice computed tomography is the imaging modality of choice for diagnosis of abdominal vascular pathology as it is noninvasive, fast and demonstrates a high diagnostic accuracy. Full article
Open AccessArticle
Treatment diets in Estonian health care institutions
Medicina 2008, 44(8), 577; https://doi.org/10.3390/medicina44080075 - 27 Jan 2008
Viewed by 183
Abstract
New system and nomenclature of diets for Estonian health care institutions have been developed in the university hospital based on theoretical and practical experience obtained over several years of cooperation with medical scientists from different fields of specialization. The nomenclature of diets includes [...] Read more.
New system and nomenclature of diets for Estonian health care institutions have been developed in the university hospital based on theoretical and practical experience obtained over several years of cooperation with medical scientists from different fields of specialization. The nomenclature of diets includes ordinary food and eight groups of diet food with subgroups. The normative values of the basic nutrients are in accordance with the Estonian and Nordic nutritional recommendations. The whole system includes the menus and recipes of nutritional food portions. The system of treatment diets helps to optimize proper nutrition in different departments and organize better patient care. Full article
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