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

Medicina, Volume 48, Issue 12 (December 2012) – 8 articles

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Open AccessArticle
Estimation of All-Cause and Cardiovascular Mortality Risk in Relation to Leisure-Time Physical Activity: A Cohort Study
Medicina 2012, 48(12), 93; https://doi.org/10.3390/medicina48120093 - 05 Jan 2013
Cited by 2 | Viewed by 402
Abstract
Background and Objective. Epidemiologists agree that physical activity has a protective role in morbidity and mortality mainly through its positive impact on risk factors. So far, most studies have confirmed that CVD risk decreases with an increasing physical activity level, but it is [...] Read more.
Background and Objective. Epidemiologists agree that physical activity has a protective role in morbidity and mortality mainly through its positive impact on risk factors. So far, most studies have confirmed that CVD risk decreases with an increasing physical activity level, but it is not known what level of physical activity is already sufficient for mortality risk reduction. Thus, the aim of this study was to explore long-term associations between leisure-time physical activity and mortality risk in the Lithuanian urban population.
Material and Methods
. The MONICA study (1992–1993) and the repeated health examination survey in 2001–2002 were organized as a cohort study of 2642 middle-aged inhabitants from the general Lithuanian population of Kaunas. Two random samples aged 35–64 years were examined in 1992–2002. Leisure-time physical activity was assessed by an interview method, asking about physically demanding activities at leisure time measured in hours. The study sample was pooled into 2 groups: inactive (first quartile) and active (second to fourth quartiles). Follow-up was carried out in terms of the endpoints reached from the baseline until December 31, 2010. Mortality data from the National Death Register were obtained.
Results
. Multivariate adjusted Cox proportional hazards analyses revealed an HR of 1.46 (95% CI, 1.15–1.85) for all-cause mortality and 1.73 (95% CI, 1.23–2.45) for CVD mortality in the lowest quartile of leisure-time physical activity compared with the higher ones. As much as 16.2% of all-cause mortality and 22.2% of CVD mortality was attributable to the lowest quartile of leisuretime physical activity.
Conclusions
. This study demonstrated a beneficial effect of leisure time physical activity on predicting all-cause and CVD mortality risk. Full article
Open AccessArticle
Recent Advances in Endovascular Treatment of Aortoiliac Occlusive Disease
Medicina 2012, 48(12), 96; https://doi.org/10.3390/medicina48120096 - 04 Jan 2013
Viewed by 385
Abstract
The rate of endovascular interventions for iliac occlusive lesions is continuously growing. The evolution of the technology supporting these therapeutic measures improves the results of these interventions. We performed a review of the literature to report and appreciate short- and long-term results of [...] Read more.
The rate of endovascular interventions for iliac occlusive lesions is continuously growing. The evolution of the technology supporting these therapeutic measures improves the results of these interventions. We performed a review of the literature to report and appreciate short- and long-term results of endovascular stenting of iliac artery occlusive lesions. The Medline database was searched to identify all the studies reporting iliac artery stenting for aortoiliac occlusive disease (Trans Atlantic Inter-Society Consensus [TASC] type A, B, C, and D) from January 2006 to July 2012. The outcomes were technical success, long-term primary and secondary patency rates, early mortality, and complications. Technical success was achieved in 91% to 99% of patients as reported in all the analyzed articles. Early mortality was described in 5 studies and ranged from 0.7% to 3.6%. The most common complications were access site hematomas, distal embolization, pseudoaneurysms, and iliac artery ruptures. The complications were most often treated conservatively or using percutaneous techniques. The 5-year primary and secondary patency rates ranged from 63% to 88% and 86% to 93%, respectively; and the 10-year primary patency rates ranged from 68% to 83%. In this article, combined percutaneous endovascular iliac stenting and infrainguinal surgical reconstructions and new techniques in the treatment of iliac stent restenosis are discussed. Iliac stenting is a feasible, safe, and effective method for the treatment of iliac occlusive disease. Initial technical and clinical success rates are high; early mortality and complication rates are low. Longterm patency is comparable with that after bypass surgery. Full article
Open AccessArticle
Maternal Request Is not to Blame for an Increase in the Rate of Cesarean Section
Medicina 2012, 48(12), 95; https://doi.org/10.3390/medicina48120095 - 04 Jan 2013
Viewed by 431
Abstract
Background and Objective. The aim of this study was to establish whether Lithuanian women would request an elective cesarean section in a low-risk pregnancy and to compare how the women’s opinion changed during the 5-year period.
Material and Methods.
A study was [...] Read more.
Background and Objective. The aim of this study was to establish whether Lithuanian women would request an elective cesarean section in a low-risk pregnancy and to compare how the women’s opinion changed during the 5-year period.
Material and Methods.
A study was conducted at the Hospital of Lithuanian University of Health Sciences from November 1 to December 31, 2006, and from January 1 to February 28, 2011. A total of 204 and 239 women were enrolled in 2006 and 2011, respectively. Self-administered anonymous questionnaires collected information on women’s knowledge about the advantages of the different modes of delivery and their preferred type of birth in a low-risk pregnancy.
Results. Overall, 82.4% of the participants in 2006 and 74.5% in 2011 thought that women should be able to choose the mode of delivery in a low-risk pregnancy. If they had had such an opportunity, 15.2% of women in 2006 and 14.9% in 2011 would have chosen cesarean section without any medical indication. The most frequently mentioned advantage of vaginal delivery was that it is natural, while safety for the newborn and the possibility of avoiding delivery pain were the mentioned advantages of cesarean section.
Conclusions
. Approximately 15% of Lithuanian women would request an elective cesarean section, and this percentage did not change during the 5-year period. While the national cesarean section rate is increasing with every year, it seems that “maternal request” cannot be blamed for this phenomenon. Despite all the available information about the different modes of delivery, women still lack professional and reliable knowledge about it. Full article
Open AccessArticle
Effect of High Temperatures on Daily Counts of Mortality from Diseases of Circulatory System in Astana, Kazakhstan
Medicina 2012, 48(12), 94; https://doi.org/10.3390/medicina48120094 - 04 Jan 2013
Cited by 1 | Viewed by 375
Abstract
Background and Objective. Associations between hot temperatures and both overall and cardio- and cerebrovascular mortality have been observed in many European, North American, and Southeastern Asian cities. However, the effects varied among the settings with limited evidence from the countries with arid [...] Read more.
Background and Objective. Associations between hot temperatures and both overall and cardio- and cerebrovascular mortality have been observed in many European, North American, and Southeastern Asian cities. However, the effects varied among the settings with limited evidence from the countries with arid and semiarid climates. The aim of this study was to assess the effect of air temperature on deaths from the selected diseases of the circulatory system in the city of Astana, Kazakhstan.
Material and Methods.
The daily counts of deaths from hypertensive diseases (ICD-10 codes, I10–I15), cerebrovascular diseases (ICD-10 codes, I60–I69), and ischemic heart disease (ICD-10 codes, I20–I25) during the warm seasons (April-September) of 2000–2001 and 2006–2010 were obtained from the City Registry Office. The associations between the maximum apparent temperature (average of lags 0–3) and mortality were assessed by a first-order autoregressive Poisson regression with the adjustment for barometric pressure (average of lags 0–3), wind speed, and effects of month, year, holidays, and weekends.
Results. Altogether, there were 282, 1177, and 2994 deaths from hypertensive diseases, cerebrovascular diseases, and ischemic heart disease, respectively. The maximum effective temperature varied between –2.2°C and 44.5°C. An increase in temperature by 1°C was associated with a 1.9% (95% CI, 0.3–3.5) increase in the daily number of deaths from cerebrovascular diseases and with a 3.1% (95% CI, 0.2–6.1) decrease in the number of deaths from hypertensive diseases among women.
Conclusions
. The results suggest a positive association between the maximum apparent temperature and the daily counts of deaths from cerebrovascular diseases and an inverse association between temperature and mortality from hypertensive diseases, but only among women. Full article
Open AccessArticle
Effect of Visual Feedback Information on Isometric Contraction of Forearm Flexor Muscles in Men and Women After Ischemic Stroke
Medicina 2012, 48(12), 92; https://doi.org/10.3390/medicina48120092 - 04 Jan 2013
Viewed by 385
Abstract
The aim of this study was to determine the effect of visual feedback information (VFI) on the isometric contraction of the forearm flexor muscles in men and women after an ischemic stroke when doing a physical load at 20% of strength.
Material and
[...] Read more.
The aim of this study was to determine the effect of visual feedback information (VFI) on the isometric contraction of the forearm flexor muscles in men and women after an ischemic stroke when doing a physical load at 20% of strength.
Material and Methods
. The study included healthy subjects (n=20) and subjects after ischemic stroke (n=20). The study was conducted in Lithuanian Sports University. The measurements of maximum voluntary strength (MVS) and accurate isometric contraction were performed using an isokinetic dynamometer Biodex System Pro 3.
Results
. The absolute errors of isometric contraction of the right arm muscles at 20% of MVS were similar in all the groups during the attempt with visual feedback information. The smallest absolute errors of the healthy subjects were 1.42±0.35 Nm when the task was performed with visual feedback and the greatest absolute errors were 4.69±0.95 Nm (P<0.01) while performing the task without visual feedback. Meanwhile, the smallest and greatest absolute errors of the subjects after ischemic stroke were 1.32±0.45 Nm and 5.05±0.63 Nm, respectively, while performing the task without visual feedback (P<0.01).
Conclusions
. Maximum voluntary strength was greater in all the groups of men. The absolute errors of isometric contractions of the right and left arm muscles tended to increase in both the men and the women when there was no visual feedback information. The women and the men after an ischemic stroke produced greater absolute errors when performing the task with the right and left arm without visual feedback information than the healthy subjects. Full article
Open AccessArticle
Disc Impediment in Medtronic-Hall Aortic Valve Prosthesis Followed by Successful Reoperation
Medicina 2012, 48(12), 91; https://doi.org/10.3390/medicina48120091 - 04 Jan 2013
Viewed by 352
Abstract
This case report describes the diagnostic and treatment challenges of the combined disc impediment caused by pannus ingrowth in combination with thrombus formation in a 21-mm Medtronic-Hall aortic valve prosthesis. A combined obstruction of a Medtronic-Hall prosthesis in the aortic position is a [...] Read more.
This case report describes the diagnostic and treatment challenges of the combined disc impediment caused by pannus ingrowth in combination with thrombus formation in a 21-mm Medtronic-Hall aortic valve prosthesis. A combined obstruction of a Medtronic-Hall prosthesis in the aortic position is a rare, but potentially fatal clinical condition for the first time reported in Vilnius University Hospital Santariškių Klinikos. Despite the difficulties in determining a correct diagnosis, our critically ill patient was clinically stabilized by partially successful thrombolysis and then successfully treated by a surgical thrombectomy together with pannus excision during the rotation of the disc within the valve housing 3 years after the valve implantation. Full article
Open AccessArticle
Comparison of Different Anesthetic Regimens in Patients Undergoing Laparoscopic Adjustable Gastric Banding Operations: A Prospective Randomized Trial
Medicina 2012, 48(12), 89; https://doi.org/10.3390/medicina48120089 - 04 Nov 2012
Viewed by 390
Abstract
Background and Objective. Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The [...] Read more.
Background and Objective. Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations.
Material and Methods
. In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m2), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO2) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO2 in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting.
Results. The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3)
Conclusions
. Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study. Full article
Open AccessArticle
Nonsteroidal Anti-Inflammatory Drug-Induced Severe Hyponatremia
Medicina 2012, 48(12), 90; https://doi.org/10.3390/medicina48120090 - 10 Jun 2012
Cited by 2 | Viewed by 464
Abstract
Hyponatremia (serum sodium level, <135 mmol/L) occasionally may develop in the course of treatment with nonsteroidal anti-inflammatory drugs, which are usually used in daily clinical practice. Nonsteroidal anti-inflammatory drugs diminish the normal inhibitory effect of prostaglandins on the activity of antidiuretic hormone and [...] Read more.
Hyponatremia (serum sodium level, <135 mmol/L) occasionally may develop in the course of treatment with nonsteroidal anti-inflammatory drugs, which are usually used in daily clinical practice. Nonsteroidal anti-inflammatory drugs diminish the normal inhibitory effect of prostaglandins on the activity of antidiuretic hormone and can therefore reduce free water excretion, leading to water retention and induction or exacerbation of hyponatremia. In this report, we present a case of hyponatremia in a 78-year-old man who had received meloxicam, a nonsteroidal anti-inflammatory drug. Full article
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