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Volume 45, November
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 45, Issue 12 (December 2009) – 11 articles

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Open AccessArticle
Relationship of renal cell carcinoma and hypertension
Medicina 2009, 45(12), 1019; https://doi.org/10.3390/medicina45120130 - 13 Dec 2009
Viewed by 213
Abstract
The morbidity and mortality due to renal cell carcinoma has increased worldwide over the last 30 years. Renal cell carcinoma accounts for about 90–95% of all renal tumors. The mean age of patients with this type of tumor ranges between 50 and 70 [...] Read more.
The morbidity and mortality due to renal cell carcinoma has increased worldwide over the last 30 years. Renal cell carcinoma accounts for about 90–95% of all renal tumors. The mean age of patients with this type of tumor ranges between 50 and 70 years. It is important to note that primary arterial hypertension as well as obesity and smoking are considered as independent risk factors for renal cell carcinoma. The increase in both systolic and diastolic blood pressure as well as the severity of arterial hypertension may have an impact on development of renal cell carcinoma. We describe the case of a 45-year-old male patient with hypertensive crisis. Computed tomography scan revealed renal cell carcinoma, which was confirmed histologically after surgical treatment. Full article
Open AccessArticle
Successful treatment of upper ureteral injury using renal autotransplantation
Medicina 2009, 45(12), 988; https://doi.org/10.3390/medicina45120126 - 12 Dec 2009
Cited by 7 | Viewed by 224
Abstract
Introduction. Ureteral injuries are uncommon. Upper ureteral defect more than 7–8 cm in length is a challenge for urologists, requiring experience and several steps in its management. We report a case of iatrogenic upper urinary tract injury and successful treatment of 8-cm [...] Read more.
Introduction. Ureteral injuries are uncommon. Upper ureteral defect more than 7–8 cm in length is a challenge for urologists, requiring experience and several steps in its management. We report a case of iatrogenic upper urinary tract injury and successful treatment of 8-cm ureteral defect using autotransplantation of the kidney.
Case report
. A male patient underwent surgery due to retroperitoneal tumor. Iatrogenic ureteral injury was recognized 18 days after operation. Three-step management of urinary tract injury was performed. The first step included minimally invasive recovery of the urine flow and treatment of infection. The second step was unsuccessful renal descensus and new formation ureteropyeloanastomosis because of difficulties of kidney mobilization caused by previous surgery. The third step included a successful autotransplantation of the kidney and complete reconstruction of the urinary tract.
Conclusions
. Autotransplantation can be successfully used for the management of long upper ureteral injury in referral urological centers. Full article
Open AccessArticle
Usefulness of assessment of voice capabilities in female patients with reflux-related dysphonia
Medicina 2009, 45(12), 978; https://doi.org/10.3390/medicina45120125 - 12 Dec 2009
Cited by 3 | Viewed by 274
Abstract
Objectives. To analyze vocal capabilities in patients diagnosed with reflux related dysphonia versus controls with healthy voice with selection of the most informative discriminating quantitative parameters and to assess voice changes following treatment.
Material and methods
. Six parameters of voice range [...] Read more.
Objectives. To analyze vocal capabilities in patients diagnosed with reflux related dysphonia versus controls with healthy voice with selection of the most informative discriminating quantitative parameters and to assess voice changes following treatment.
Material and methods
. Six parameters of voice range profile (VRP) and five parameters of speech range profile were taken and analyzed from 60 dysphonic outpatient females with laryngopharyngeal reflux (LPR) diagnosed by reflux-related atypical and typical symptoms, videolaryngoscopic findings, upper gastrointestinal endoscopy, and positive response to empiric 3-month omeprazole treatment. Seventy-six females with healthy voice served as controls.
Results
. All six parameters of voice range profile and three of 5 parameters of speech range profile showed significant differences comparing LPR patients with controls before omeprazole treatment (P<0.05). Logistic regression analysis revealed VRP maximum-minimum intensity range to be the most informative parameter for discrimination between reflux-related dysphonic and healthy voices (overall prediction accuracy, 86.8%). A threshold value of significant parameter was stated using the receiver operating characteristic curve. Treatment with omeprazole significantly improved voice quality showing the greatest changes in the mean scores of majority of voice range profile parameters.
Conclusions. Vocal capabilities, especially evaluated by voice range profile, are restricted in LPR female patients in comparison to subjects with healthy voice. Quantitative voice assessment with voice range profile may add more objective aspect for screening dysphonia and could be used as a criterion of evaluation of treatment efficacy in such patients. Full article
Open AccessArticle
Atrial fibrillation and changes in serum and urinary electrolyte levels after coronary artery bypass grafting surgery
Medicina 2009, 45(12), 960; https://doi.org/10.3390/medicina45120123 - 12 Dec 2009
Cited by 10 | Viewed by 262
Abstract
Objective. Our study was designed to assess the incidence of atrial fibrillation, changes in serum electrolyte concentrations and urinary electrolyte excretion following coronary artery bypass grafting surgery.
Material and methods
. A total of 165 patients who underwent elective coronary artery bypass [...] Read more.
Objective. Our study was designed to assess the incidence of atrial fibrillation, changes in serum electrolyte concentrations and urinary electrolyte excretion following coronary artery bypass grafting surgery.
Material and methods
. A total of 165 patients who underwent elective coronary artery bypass grafting surgery at the Department of Cardiac Surgery (Heart Center) during the period of 2004–2005 were enrolled. Serum K+, Na+, Mg2+, Ca2+, Cl–, and P– concentrations were measured before cardiopulmonary bypass (CPB), on the arrival to an intensive care unit, and 15–18 hours after the surgery. Urinary excretion of K+, Na+, Mg2+, Ca2+, Cl–, and P– was estimated 24 hours before the surgery, during the surgery, and 24 hours after the surgery. Cardiac rhythm was monitored throughout the study. All patients randomly were divided into the group 1 (n=55), which received magnesium sulphate infusion, and group 2 (n=110), which did not receive magnesium sulphate.
Results. The overall incidence of atrial fibrillation was 27.4%. The patients in the group 1 had significantly higher levels of serum magnesium before CPB and serum chloride after the surgery. Urinary magnesium and calcium excretion was significantly higher in the group 1 during and after the surgery. Before the surgery and 24 hours after the surgery, phosphate excretion was significantly higher in the group 1.
Conclusions. The incidence of atrial fibrillation after myocardial revascularization surgery remains high (27.4%). Serum electrolyte concentrations after myocardial revascularization varied within normal ranges. Magnesium sulphate infusion did not decrease the rate of postoperative atrial fibrillation during the early postoperative period in normomagnesemic patients. Full article
Open AccessArticle
Effectiveness of radiologic examination methods in diagnosis of pulmonary tuberculosis
Medicina 2009, 45(12), 952; https://doi.org/10.3390/medicina45120122 - 12 Dec 2009
Viewed by 240
Abstract
Objective of the study. To determine an optimal noninvasive radiologic examination method (computed tomography or roentgenography) in early diagnostics of pulmonary tuberculosis.
Materials and methods
. We have selected 43 patients with diagnosis of pulmonary tuberculosis, who were examined using roentgenography and [...] Read more.
Objective of the study. To determine an optimal noninvasive radiologic examination method (computed tomography or roentgenography) in early diagnostics of pulmonary tuberculosis.
Materials and methods
. We have selected 43 patients with diagnosis of pulmonary tuberculosis, who were examined using roentgenography and computed tomography during 2002–2006. Data were confirmed by biopsy or bacteriological test. Evaluation criteria were anamnesis, prolonged cough productive of sputum, prolonged fever, roentgenologic and laboratory findings (lymphocytosis, monocytosis), antibiotic therapy without response.
Results
. Diagnostic signs of pulmonary tuberculosis were infiltration (89%), lymphadenopathy (63%), calcification in lymph nodes (49%), pneumofibrosis (56%), focus of tuberculosis (54%), foci in lung segments (67%). Other features were as follows: adhesions, pleural effusion, coated pleura, calcified tuberculoma. Biopsy was performed to 25% of patients: in 6 patients during fibrobronchoscopy, in 3 during operation, and in 2 during pleural puncture. Fibrobronchoscopy was done in 70% of patients, and findings were as follows: mucus (31%), blood (2%), bronchial deformations (22%), edema of bronchial wall (18%), and no pathology (31%). Only 8% had acid-resistant cocci.
Conclusions
. Computed tomography is 2 times more efficient than roentgenography in detection of lung alterations, dissemination with focal infiltration in the bronchioles, coated pleura, pleuritis, adhesions and 8 times more efficient in diagnosis of mediastinal lymphadenopathy. In evaluation of pulmonary consolidation, there was no significance difference between diagnostic methods. Full article
Open AccessArticle
Assessment of disease control in patients with asthma
Medicina 2009, 45(12), 943; https://doi.org/10.3390/medicina45120121 - 12 Dec 2009
Cited by 1 | Viewed by 226
Abstract
International guidelines indicate that the main criterion of asthma management is asthma control level. The aim of this study was to assess asthma control and its relation with age, gender, and lung function.
Material and methods
. A total of 106 family physicians [...] Read more.
International guidelines indicate that the main criterion of asthma management is asthma control level. The aim of this study was to assess asthma control and its relation with age, gender, and lung function.
Material and methods
. A total of 106 family physicians and 13 pulmonologists and allergists took part in this study. Each doctor had selected 10–15 asthma patients and had sent invitations to them by post. On the visit day, the patients themselves filled in the Asthma Control Test. The doctors interviewed the patients and filled in a special questionnaire. Pulmonologists and allergists also assessed lung function by performing spirometry. According to the results of the Asthma Control Test, the disease control level was indicated as “totally controlled” (25 points), “well controlled” (24–20 points), and “uncontrolled” (19 points or less).
Results
. A total of 876 asthma patients were examined. Uncontrolled asthma was diagnosed to 56.2% of the patients, 36.5% of patients had well controlled and 7.3% totally controlled asthma. There was no significant difference in asthma control level comparing men and women. A correlation between asthma control level and age was found revealing poorer asthma control in older patients. Ninety-five percent of patients were treated with inhaled steroids; most of them had used inhaled steroids in combination with long-acting β2 agonists. It was found that lung function correlated with clinical symptoms of asthma, the demand of shortacting β2 agonists, and asthma control level.
Conclusion
. The study showed that uncontrolled asthma was diagnosed to more than half of the patients, despite most of them used inhaled steroids. Asthma control was worsening with the age of patients with asthma and it correlated with lung function. We suggest that periodical assessment of asthma control should help to optimize asthma management. Full article
Open AccessArticle
Fluorescence diagnostics of skin tumors using 5-aminolevulinic acid and its methyl ester
Medicina 2009, 45(12), 937; https://doi.org/10.3390/medicina45120120 - 12 Dec 2009
Cited by 2 | Viewed by 252
Abstract
Objective. The incidence of malignant skin tumors is rapidly increasing. Early diagnosis, determining the margins of the tumor, is extremely important to achieve good treatment results. We investigated fluorescence of protoporphyrin IX in skin carcinomas. The study aimed to compare the effectiveness [...] Read more.
Objective. The incidence of malignant skin tumors is rapidly increasing. Early diagnosis, determining the margins of the tumor, is extremely important to achieve good treatment results. We investigated fluorescence of protoporphyrin IX in skin carcinomas. The study aimed to compare the effectiveness of topical 5-aminolevulinic acid and methyl-aminolevulinate in determining the exact margins of skin tumors.
Materials and methods. Fluorescence measurements were performed in 126 patients with malignant, premalignant, and benign skin lesions for detection of the margins of squamous cell carcinoma and basal cell carcinoma. 5-Aminolevulinic acid or its methyl ester was applied to the skin lesion for 2–4 h, and the data of evaluated protoporphyrin IX fluorescence were correlated with the data of morphological tissue examination.
Results
. Malignant tissue shows a specific red fluorescence when illuminated with blue-violet light, whereas no fluorescence was observed in normal skin. In 30% of cases, the delineation of neoplastic lesions excited by 5-aminolevulinic acid was slightly weaker than using methyl-aminolevulinate. A sensitivity of 95.4% and a specificity of 88.6% as well as positive and negative predictive values of 86.1% and 96.3%, respectively, were obtained.
Conclusions. Fluorescence diagnostics can be used for complete visualization of malignant skin lesions after topical application of 5-aminolevulinic acid or methyl aminolevulinate. It has been shown to be highly effective in the diagnostics of malignant superficial skin lesion. This method is applicable for detecting early superficial tumors, margins of tumors, and follow-up after therapy. Topical application of methyl aminolevulinate is slightly superior to 5-aminolevulinic acid in detection of lesion margins. Full article
Open AccessArticle
Nonadherence to medications among pharmacy clients and their attitude toward medications kept a medicine cabinet at home
Medicina 2009, 45(12), 1013; https://doi.org/10.3390/medicina45120129 - 12 Dec 2009
Cited by 3 | Viewed by 223
Abstract
Objectives. To assess self-reported adherence among pharmacy clients and to detect if there are any differences in medication use or storage between genders.
Material and methods
. The data were collected by means of questionnaires. A standard 45-item questionnaire was developed and [...] Read more.
Objectives. To assess self-reported adherence among pharmacy clients and to detect if there are any differences in medication use or storage between genders.
Material and methods
. The data were collected by means of questionnaires. A standard 45-item questionnaire was developed and used to assess adherence and nonadherence to medications. It was distributed to all pharmacy customers who entered pharmacies chosen by us.
Results
. Of the 162 (45 men and 117 women) pharmacy clients participating in the study, 36.42% were considered nonadherent. No significant difference in adherence rates between genders was observed (P>0.05). Women more often named themselves as being responsible for a medicine cabinet at home (P<0.001) and used more sources of information on medications (P<0.05). Women also more frequently checked the expiry date of medications in a medicine cabinet home than men (P<0.05).
Conclusions. The problem of nonadherence to medications exists among pharmacy clients. There is no significant difference in the rate of self-reported adherence between male and female pharmacy clients. Women are the ones named as responsible for a medicine cabinet at home. They also are important health decision makers. Women are more interested in information on medicines and their use; therefore, this demand should be satisfied. Full article
Open AccessArticle
Phenolics and anthocyanins in berries of European cranberry and their antimicrobial activity
Medicina 2009, 45(12), 992; https://doi.org/10.3390/medicina45120127 - 09 Dec 2009
Cited by 24 | Viewed by 375
Abstract
European cranberry is a berry plant rich in biologically active substances, making it valued by both the phyto-pharmaceutical and food industries. The aim of this study was to examine the accumulation of phenolic compounds and anthocyanins in berries of European cranberry and to [...] Read more.
European cranberry is a berry plant rich in biologically active substances, making it valued by both the phyto-pharmaceutical and food industries. The aim of this study was to examine the accumulation of phenolic compounds and anthocyanins in berries of European cranberry and to assess their antibacterial activity.
Material and methods
. Different wild clones of European cranberry were investigated according to berry weight and the amounts of total phenolics and anthocyanins. Anthocyanin profiles of extracts were evaluated by HPLC, whereas the antimicrobial properties were determined by the agar well diffusion method. A strong negative correlation between berry weight and the amount of anthocyanins was found. The amount of total phenolics among different cranberry clones in the field collection ranged from 224.0 mg/100 g to 498.0 mg/100 g, and the amount of total anthocyanins ranged from 40.7 mg/100 g to 207.3 mg/100 g. Quantitative HPLC-UV analysis revealed six anthocyanins in the berries of European cranberry, among which the anthocyanin peonidin-3-galactoside was most prevalent.
Conclusions. Investigation of the antimicrobial properties showed that European cranberry extracts inhibited the growth of wide range of human pathogenic bacteria, both gram-negative (Escherichia coli and Salmonella typhimurium) and gram-positive (Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus, and Bacillus subtilis). Full article
Open AccessArticle
Soluble interleukin-2 receptor and tumor necrosis factor levels in depressed patients in Estonia
Medicina 2009, 45(12), 971; https://doi.org/10.3390/medicina45120124 - 09 Dec 2009
Cited by 21 | Viewed by 257
Abstract
Several studies have reported immune system alterations in depressed patients. Furthermore, correlations between some interleukins and specific depressive symptoms have been found, but results are ambiguous. It might be caused by heterogeneous patient population and concomitant administration of antidepressants. The aim of our [...] Read more.
Several studies have reported immune system alterations in depressed patients. Furthermore, correlations between some interleukins and specific depressive symptoms have been found, but results are ambiguous. It might be caused by heterogeneous patient population and concomitant administration of antidepressants. The aim of our study was to look at differences in the levels of soluble interleukin-2 receptor (sIL-2R) and tumor necrosis factor-α (TNFα) between currently depressed patients with first or recurrent episode of depression, patients in full remission and healthy controls. Secondly, we looked for correlations between sIL-2R and TNFα and different depressive symptoms. A total of 75 medication-free currently depressed patients (76% of females), 17 patients in the full remission phase of major depression (58.8% of females), and 55 healthy controls (58.2% of females) participated in this study. The results showed that the level of sIL-2R was significantly lower in depressed patients in remission phase compared to the healthy controls and subjects with recurrent depression. Drug-naï ve patients with major depressive disorder with recurrent episode had higher levels of sIL-2R than previously treated or patients with the first episode. TNFα levels were higher in drug-naï ve patients with major depressive disorder with recurrent episode compared with previously treated patients. Further analysis of patients revealed that sIL-2R was positively correlated with decreased activity and agitation. TNFα was associated with decreased activity and suicidality. Full article
Open AccessArticle
Associations between mortality and alcohol consumption in Lithuanian population
Medicina 2009, 45(12), 1000; https://doi.org/10.3390/medicina45120128 - 09 Dec 2009
Cited by 14 | Viewed by 278
Abstract
The objective of the study was to assess alcohol-related mortality that potentially might explain an increasing trend in overall mortality of Lithuanian population, which started after 2000 and peaked in 2005.
Material and methods.
An empiric analysis of national mortality and other statistical [...] Read more.
The objective of the study was to assess alcohol-related mortality that potentially might explain an increasing trend in overall mortality of Lithuanian population, which started after 2000 and peaked in 2005.
Material and methods.
An empiric analysis of national mortality and other statistical data as well as their international comparisons.
Results
. An analysis of available data clearly indicates that a decline in mortality in 1998–2000, i.e. during the beginning of the National Programme of Health, as well as its increase in 2001 and 2005 were predominantly determined by cause-specific deaths of two groups: deaths from diseases of the circulatory system (mainly ischemic heart disease) and alcohol consumption-related deaths (liver cirrhosis, accidental poisoning by alcohol, accidents, etc.). A certain proportion of deaths, which were caused by alcohol, were wrongly assigned to the deaths from diseases of the circulatory system due to uncertainties in filling-in death certificates. By approximate estimates, at least one-quarter of increase in all-cause mortality between 2002–2004 and 2005–2007 could be explained by an increase in alcohol consumption, accounting for additional 880 deaths on average per year. In the year 2007, 12.6% (n=5760) of all deaths were somehow related to alcohol consumption. A comparative analysis demonstrated that mortality and alcohol consumption trends were going in parallel over the last decade. The systemic decline in mortality observed in Lithuania from 1995 stopped in 2000 after a decrease in alcohol taxes, which resulted in an increase in alcohol accessibility and consumption. An average annual increase in alcohol consumption over the period of 2001–2004 was 7%; it increased up to 17% in 2005 and accounted for 12% annual increase on average within 2005–2007.
Conclusions
. Negative trends in alcohol-related morbidity and mortality in Lithuanian population most notably registered in 2001 and 2005 were largely influenced by uncontrollable increase in alcohol consumption over the last decade. Economic and commercial arguments in decision-making process that neglected health interest of Lithuanian population (decrease of alcohol taxes in 1999, other factors increasing alcohol accessibility and consumption) were those counteracting the implementation of balanced health policy in the country. Full article
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