Medicina, Volume 43, Issue 1 (January 2007) – 11 articles

The aim of the study was to investigate the immunostimulatory properties of bigroot geranium.
Material and methods. Possible nonspecific characteristics of bigroot geranium were evaluated by the total leukocyte count in the peripheral blood, and qualitative changes of blood were assessed using Shilling’s formula by evaluating changes in lymphocyte counts. In addition, we also studied changes in the counts of Tcell precursors in the thymus and B lymphocytes in the spleen. Ethanol extract of the leaves of bigroot geranium was produced at the Department of Food Technology, Kaunas University of Technology. Studies were performed on mice Bl 57 (n=21). The control group (n=7) received distilled water at a dose of 1 mL/day. The second and third groups received 1% and 10% extract of bigroot geranium, respectively, as a food supplement. Changes in cell counts were investigated after 4 weeks following the initiation of the trial.
Results. After a 4-week administration of 1% extract of bigroot geranium (1 mL/day) (mice group, n=7), leukocyte count in the peripheral blood increased to 6.1×10⁹ cells/L, and lymphocyte count – to 70%, but changes were not statistically significant. The other case group of mice (n=7) received 10% extract of bigroot geranium for 4 weeks at a dose of 1 mL/day. In this group, leukocyte count in the peripheral blood increased statistically significantly from 4.4×10⁹ cells/L to 7.2×10⁹ cells/L (p<0.01), and lymphocyte percentage – from 52% to 80% (p<0.001), as compared to control. Thymocyte (T lymphocytes) counts in thymus and splenocyte (B lymphocytes) counts in the spleen showed a tendency to increase after the administration of 1% and 10% extracts. After a 4-week administration of 1% extract of bigroot geranium, thymocyte and splenocyte counts increased from 0.342×10⁶ cells to 0.372×10⁶ cells per mg of tissue and from 0.395×10⁶ cells to 0.405×10⁶ cells per mg of tissue, respectively, as compared to control group (p>0.1). After the administration of 10% extract of bigroot geranium, thymocyte count increased to 0.488×106 cells per mg of tissue (p<0.01), and splenocyte count – to 0.504×10⁶ cells per mg of tissue (p<0.01).
Conclusion. The extracts of the leaves of bigroot geranium increased leukocyte count and lymphocyte percentage in the peripheral blood, and after a 4-week administration of 10% extract of bigroot geranium, a statistically significant increase in the counts of T lymphocytes (in the thymus) and B lymphocytes (in the spleen) was observed. The immunostimulatory effect depends on the dose of the extract. Full article

Objective. To evaluate prospectively the impact of various factors on subintimal angioplasty of superficial femoral artery.
Patients and methods. Within a period of 36 months, 44 patients with 45 chronic occlusions in superficial femoral artery were examined. The influence of sex, age, hypertension, diabetes mellitus, smoking, chronic ischemia stage, occlusion length and calcification, flush occlusion of the superficial femoral artery, ischemic cardiac disease, postprocedural medical treatment was evaluated.
Results. Arterial calcification had a significant impact on technical success of subintimal angioplasty (p=0.03). Sex, age, smoking, flush occlusion of the superficial femoral artery, and cardiac disease influenced technical and hemodynamic success (p=0.086–0.295). Hypertension, diabetes mellitus, chronic ischemia stage, occlusion length, and postprocedural medical treatment did not significantly influence technical and hemodynamic success (p>0.05).
Conclusions. Arterial calcification had a significant impact on technical success of subintimal angioplasty. Sex, age, smoking, flush occlusion of the superficial femoral artery, and ischemic cardiac disease influenced technical and hemodynamic success. Hypertension, diabetes mellitus, chronic ischemia stage, occlusion length, and postprocedural medical treatment had no statistically significant impact on technical and hemodynamic success. Full article

Pseudomonas aeruginosa is one of the most common nonfermenting aerobic gramnegative microorganisms identified in clinical specimens of hospitalized patients. The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is a growing concern in hospitalacquired infections. Typing of strains is important for identifying the sources of infection as well as prevention of cross-infections and monitoring of the efficacy of antimicrobial therapy. The aim of this study was to evaluate the antimicrobial resistance and prevalence of Pseudomonas aeruginosa serogroups isolated at Kaunas University of Medicine Hospital, Lithuania.
Material and methods. Minimum inhibitory concentrations of piperacillin, cefoperazone, ceftazidime, cefotaxime, cefepime, imipenem, meropenem, gentamicin, amikacin, tobramycin, and ciprofloxacin for 609 Pseudomonas aeruginosa strains isolated from various clinical specimens between November 2001 and November 2002 were determined by the microdilution method in Mueller–Hinton agar using interpretative guidelines of National Committee for Clinical Laboratory Standards. Serogroups of Pseudomonas aeruginosa strains were identified using serums of Seiken Co. Ltd (Tokyo, Japan), containing antibodies against antigens of Pseudomonas aeruginosa O-group.
Results. Pseudomonas aeruginosa strains were the most sensitive to ceftazidime (78.9%), imipenem (73.6%), meropenem (70.9%) and the most resistant to gentamicin (54.1%) and ciprofloxacin (52.5%). Multidrug-resistant strains made up 9.85% of all Pseudomonas aeruginosa strains investigated. Multidrug-resistant Pseudomonas aeruginosa strains were 1.5–3.5 times more resistant to antibiotics compared to non-multidrug-resistant strains, except to amikacin: multidrug-resistant strains were more sensitive (81.7%) than non-multidrug-resistant Pseudomonas aeruginosa strains (61.0%). Pseudomonas aeruginosa serogroups O:E and O:B were the most common serogroups (34.7% and 29.0%, respectively) followed by serogroups O:I (11.4%) and O:A (10.1%). Pseudomonas aeruginosa serogroup O:E strains were the most prevalent among multidrug-resistant strains (48.3%).
Conclusions. The results of our study show that serogroup O:E was the most prevalent serogroup of Pseudomonas aeruginosa in our hospital, and its resistance to antibiotics was the highest. Full article

Depression is one of the most common problems after stroke. Depression is not only frequently occurring outcome of stroke, but stroke is also a clear risk factor for depression. Depression after stroke can affect anyone regardless of his/her age, sex, background, or the severity of stroke. It can develop immediately after the stroke or weeks or months later. Many people are not routinely assessed for depression after stroke, and only a minority are properly diagnosed and treated. Patients with poststroke depression have lower functional status, increased cognitive impairment, and higher mortality rates than stroke patients without depression. Poststroke depression is also associated with poor psychosocial outcome and poor quality of life; therefore, there is a strong case for the early diagnosis and treatment of poststroke depression. Full article

The objective of this article was to establish the characteristics of depressiveness among adolescents with diabetes. Adolescents aged 14 and 16 years suffering from diabetes, healthy ones, and their parents were enrolled in the study. A total of 260 adolescents (100 adolescents with type 1 diabetes mellitus and 160 healthy ones) were interviewed. To measure adolescents’ depressiveness, a new scale was constructed using different questionnaires (Maastricht, Hamilton, Beck). Parents’ depressiveness was measured with Beck depression scale. This study showed that 16-year-old girls with diabetes were more depressed than the healthy ones. Mothers of 14-year-old adolescents and 16-year-old girls with diabetes are more depressed than the healthy adolescents’ mothers. Results of the study confirmed that depressiveness of 14- and 16-year-old girls with diabetes and that of their mothers were related. The relationship between the depressiveness of mothers of 14-year-old boys with diabetes mellitus and bad glycemic control of their sons was determined. The following peculiarities of depressiveness among adolescents with diabetes were found: 14-year-old girls had more negative attitude toward themselves; 16-year-old girls were very sensitive and had depressed mood; 16-year-old boys complained about lowered daily activity. Full article

After knee anterior cruciate ligament reconstructive surgery, the recovery of the former level of physical activity takes from 3 to 12 months. Such a wide range of recovery period of physical activity suggests that rehabilitation in most cases is not optimal. According to the majority of authors, after the surgery, a patient can resume intensive physical activity, when the difference in muscle strength between the operated lower extremity and another extremity is not greater than 10–15%. The aim of this study was to compare the impact of intensive and normal rehabilitations on the recovery of knee extensor muscle strength after the surgery.
Material and methods. A total of 40 patients were enrolled in this study. The subjects were divided into two groups. Both groups were engaged in physical activity. The mean age of patients (16 men and 4 women) in the first group at the time of surgery was 26.4±8.1 years, mean height – 179.8±8.5 cm, and mean weight – 76.0±14.0 kg. An intensive rehabilitation was applied for the first group of the patients studied. The second group consisted of 13 men and 7 women who were engaged in moderate physical activity. Their mean age at the time of surgery was 27.0±9.3 years, mean height – 173.2±6.2 cm, and mean weight – 71.0±9.0 kg. A traditional rehabilitation was applied to this group. Muscle strength was measured in the patients of both groups studied approximately 5.2 months following surgery using the Biodex isokinetic dynamometer.
Results. The patients undergoing an intensive rehabilitation achieved higher levels of knee extensor muscle strength than those patients undergoing a traditional rehabilitation program. Applying an aggressive rehabilitation program, knee extensor muscles recover more quickly than using a traditional rehabilitation program. The comparison of intensive and traditional rehabilitation programs applied to the operated and unoperated lower extremities has shown that the indexes of knee extensor muscle strength differed by 11.51– 12.74%. Applying a traditional rehabilitation, a 23.68–49.42% difference in knee flexor muscle strength between operated and unoperated extremities was noted.
Conclusions. The effect of intensive rehabilitation aimed at strength recovery of knee extensor muscles after anterior cruciate ligament reconstructive surgery is greater than after ordinary rehabilitation. Full article

Background. At present, ¹⁴C-urea breath test is considered a gold standard for diagnosis of Helicobacter pylori infection, but they are time-consuming, comparably expensive, and usually not portable tests. The aim of our study was to establish the diagnostic value of the novel, inexpensive, quick, and convenient to use ¹⁴C-urea breath test “Heliprobe”, Noster AB, Sweden.
Material and methods. Helicobacter pylori testing using “Heliprobe” was performed in 108 consecutive patients. Helicobacter pylori was also investigated using rapid urease test and Giemsa stained histological specimens according to Sydney system.
Results. The diagnostic values of “Heliprobe” assuming the Helicobacter pylori positivity, if the results of two tests (rapid urease test and histology) are positive, were: sensitivity – 97%, specificity – 87%, positive predictive value – 93%, negative predictive value – 95%, accuracy – 94%. The diagnostic values of “Heliprobe” assuming the Helicobacter pylori positivity, if at least the results of one test are positive: sensitivity – 92%, specificity – 100%, positive predictive value – 100%, negative predictive value – 84%, accuracy – 94%.
Conclusions. The novel, quick, convenient to use ¹⁴C-urea breath test “Heliprobe” is accurate, reliable, and useful for the diagnosis of Helicobacter pylori infection in routine clinical practice Full article

Objectives. To determine the influence of hiatal hernia size and the laparoscopic fundoplication technique on the rate of hernia recurrence.
Patients and methods. The preoperative, operative, and postoperative observational data of 381 patients operated on at the Department of Surgery of Kaunas University of Medicine during the period of 1998–2004 for hiatal hernia complicated with gastroesophageal reflux were analyzed. The surgery technique (Nissen or Toupet operation) was chosen independently of the hernia size. The radiological investigation of the esophagus–stomach using barium contrast as well as esophagogastroduodenoscopy and biopsy was performed for all patients before the surgery. The subjective and objective assessment of the patients’ health status was investigated before and no less than 12 months after surgery. If the disease symptoms remained or new ones (i.e. pain behind the sternum, dysphagia, etc.) occurred after surgery, the hernia recurrence was suspected. The radiological investigation of the esophagus–stomach using barium contrast, as well as esophagogastroduodenoscopy and biopsy were performed at the consultative outpatient clinic. The hernia recurrence was confirmed after performing these two investigations. When analyzing the results, the patients were divided into two groups: Group 1 – patients with small hiatal hernia (grade 1 and 2 hernia according to radiological classification), Group 2 – patients with large hiatal hernia (grade 3 and 4 hernia according to radiological classification).
Results. A total of 272 (71.4%) patients had small hiatal hernia, and 109 (28.6%) patients had large ones. Hernia recurrence was diagnosed in 7 (2.58%) patients in Group 1, while in Group 2, 11 (10.1%) patients had hernia recurrence (P<0.05). Laparoscopic Nissen fundoplication was performed in 287 (75.4%) patients, after which 14 (4.98%) patients had hernia recurrence, while Toupet fundoplication was performed in 94 (24.6%) patients, after which 4 (4.3%) patients had hernia recurrence (P>0.05).
Conclusions. The recurrence rate of hiatal hernia after laparoscopic fundoplications is significantly higher in patients with large hernias (grade 3 and 4 according to radiological classification). The surgery technique (Nissen or Toupet fundoplication) was not a significant factor affecting the recurrence rate of hiatal hernia. Full article

Five years after the last issue of the guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, in 2005 American Heart Association and European Resuscitation Council published new guidelines. In this review, basic life support (BLS) technique, indications for use of an automated external defibrillator (AED), recognition of sudden cardiac arrest, and management of choking (foreign-body airway obstruction) are presented according to the “Resuscitation Guidelines 2005.” Full article

Objective. To evaluate changes in anthropometric and biochemical parameters in pregnancy and their dynamics during last two decades and to determine the association between anthropometric and biochemical parameters, their influence on fetal and neonatal development.
Material and methods. In 1985–2005, anthropometric (height, body mass, weight gain during pregnancy, pelvic measurements, skinfold thicknesses, passive body mass) and biochemical (cholesterol, triglyceride, protein, and iron levels) parameters, their correlation, changes in pregnancy were examined; also the correlations between these parameters and neonatal body mass indices were evaluated. In 1986–1987, 383 pregnant women were examined, in 1998 – 130, and in 2003–2005 – 133.
Results. During 20 years, the height of examined women increased on an average of 2.5 cm; they became thinner; body mass index decreased. The body composition became similar to “cylinder” shape due to decreased thickness of adipose tissue in the limbs. The dimensions of bony pelvis – external conjugate and bicristal diameters – decreased. Primiparous women became older (1995 – 22.5 years of age, 2004 – 27.6). At the beginning of investigation, the weight gain was on an average of 21.9% of body mass before pregnancy (13.3 kg) and at the end – 23.9% (14.2 kg). The values of anthropometric parameters vary in a consistent pattern during pregnancy: the lower body mass and body mass index at the beginning of pregnancy, the higher weight gain at the end of pregnancy. Blood serum levels of cholesterol, triglycerides, and especially iron were decreased during the study.
Conclusions. An inverse correlation between body mass index and lipid metabolism in pregnancy was revealed: the higher body mass index was at the beginning of pregnancy, the lower increase in lipid concentration was during pregnancy. At the beginning of investigation as well as after 20 years, women with low body mass index showed the most significant anthropometric and lipid metabolic changes in pregnancy. Full article

Objective. To determine how knowledgeable pharmacy customers are regarding their own health and information about minor illnesses and over-the-counter medicines.
Methods. A written questionnaire was sent in the period of January to April 2003 to a sample of pharmacies in different regions of Estonia. Questionnaires were then distributed to randomly selected pharmacy customers. Of 886 questionnaires given out, 727 were answered and returned; a response rate was 82%.
Results. Half of the respondents assessed their health as good or excellent. When minor illnesses occurred, most used home remedies or over-the-counter medicines. Their knowledge of such illnesses was better than that of over-the-counter medicines. In both cases, the pharmacist was the most frequently used information source. Drug administration, which preparation should be chosen for which illness, and the drug price were the three most often asked questions in the pharmacy. The information about over-the-counter medicines given in the pharmacies was regarded as sufficient by 51% of the respondents.
Conclusion. Although lay people do know about over-the-counter medicines and especially about minor illnesses, pharmacists play a very important part in providing information about medicines. However, drug communication by healthcare professionals regarding over-the-counter medicines should be given more attention in the future. Full article