332 article(s) in Acta medica Lituanica

Von Hippel-Lindau Syndrome And Renal Tumours: Radiological Diagnostic And Treatment Options. A Case Report And Literature Review

background. von hippel-lindau disease (vhl) is a rare autosomal dominant syndrome diagnosed for 1 out of 36000–45000 newborns and 90% of the patients have a clinical manifestation before 65 years of age. affected individuals have an increased risk of developing tumours in several organs or their systems. the most common tumours are retinal or central nervous system hemangioblastomas (60–80%) and vhl-associated renal lesions. contrast-enhanced computer tomography (cect) is the gold standard for the diagnosis and characterization of renal tumours. the best treatment option for vhl syndrome-caused renal tumours are nephron-sparing treatment techniques (cryotherapy, radiofrequency, or microwave ablation), which require imaging control. all these innovative treatment techniques are extremely important for vhl patients, because they increase the quality of life by staving off renal dialysis and preventing distant metastases. case report. our case report presents a 16-year-old female with multiple renal cysts observed on ultrasound examination and clinically and molecularly diagnosed with von hippel-lindau syndrome (deletion of the entire vhl gene). after that, for past 11 years multiple renal tumours were removed by cryoablation and patient monitoring on contrast-enhanced magnetic resonance (mri) and cect control scans was conducted. conclusions. active multidisciplinary patient follow-up, routine radiological examinations, and correct treatment tactics allow controlling the progression of renal cell carcinoma and other tumours associated with vhl syndrome, maintaining a normal organ function for a long time, and preventing distant metastases and fatal disease outcomes Show More ... ... Show Less

  • Renal Tumours
  • Case Report
  • Distant Metastases
  • Von Hippel Lindau Syndrome
High-Grade Well-Differentiated Neuroendocrine Tumour Of The Cecum Diagnosed Following Incisional Hernia Repair: A Case Report

high-grade well-differentiated neuroendocrine tumour tumours (nets) of gastrointestinal tract are rare; they can arise in any part of the digestive system and usually present in advanced stages. low incidence and wide heterogeneity in the biological behaviour of such lesions pose a diagnostic and therapeutic challenge. loco-regional nets should be resected whenever feasible, potentially with a curative intent. management of a metastatic disease is often more complex, primarily aimed at the alleviation of symptoms, prevention of further complications, and prolongation of survival. current literature describing the optimal treatment plan for such patients is sparse and further studies are necessary to enhance our understanding of the disease. here we present a case of high-grade well-differentiated cecal net with an associated carcinoid syndrome that was diagnosed following the incisional hernia repair Show More ... ... Show Less

  • High Grade
  • Well Differentiated
  • Incisional Hernia
  • Hernia Repair
  • Neuroendocrine Tumour
Improvement In Childhood Cancer Survival In Lithuania Over Three Decades

background. population-based eurocare-5 studies demonstrated that childhood cancer survival rates in lithuania were 10–20% lower than the european mean. we aimed to analyse the change in the outcome of treatment of paediatric malignancies in lithuania over 30 years. methods. a single-centre retrospective analysis of children below 18 years of age treated for cancer at vilnius university hospital santaros klinikos between 1982 and 2011 was carried out. the minimal requirement of 5-year follow-up after diagnosis was specified for survival estimation. the vital status was assessed using data from the population-based lithuanian cancer registry. to evaluate changes over time, the entire cohort was split into three groups according to the time of diagnosis: 1982–1991, 1992–2001, and 2002–2011. results. a total of 1268 children met the inclusion criteria. the shortest median follow-up was 8.9 (iqr 6.4–11.5) years for patients treated in the third decade. the 5-year overall survival of the entire cohort increased from 37.3% (95% ci 30.2–44.3) in 1982–1991 to 70.7% (95% ci 66.4–74.1) in 2002–2011 (p < 0.0001). the same trend was evident when calculated separately for leukaemia (p < 0.0001), lymphoma (p < 0.0005), and solid tumours (p < 0.004). the percentage of cure rose from zero in the early years of the period analysed to 80% in 2010 and 2011. the improvement in the treatment outcome was attributable to the reduction of treatment-related mortality from 45.8% in 1982–1991 to 12.4% in 2002–2011 and disease recurrence from 30.4% to 19.6% for the same periods, respectively. conclusions. significant progress in the cure rate of children treated for cancer at our institution was observed over 30 years. collaborative national and international clinical and research efforts are crucial to ensure further advances in care and cure Show More ... ... Show Less

  • Childhood Cancer
  • Cancer Survival
  • Follow Up
  • Population Based
  • Entire Cohort
Challenges In The Diagnostics And Management Of Hydrochlorothiazide-Induced Severe Hyponatremia In A Habitual Beer Drinker

introduction. beer potomania is a syndrome of severe hyponatremia caused by excessive beer consumption. the risk of hyponatremia increases in the case of a combination of beer potomania and the use of thiazide diuretics. case report. a 55-year-old male patient with the anamnesis of a long-lasting alcohol use disorder was presented to the emergency department after seizures accompanied by an impaired mental status. he had been drinking beer regularly for ten years. on physical examination, the patient was tachypneic, tachycardic, disorientated, restless, the glasgow coma scale score of 9, observed tremor, and the smell of alcohol from the mouth. laboratory results showed plasma sodium 105 mmol/l, blood urea nitrogen 1.8 mmol/l, the alcohol concentration in the blood 0.06 g/l, and calculated serum osmolality 219 mosm/kg h2o. after a detailed initial evaluation of the patient and labs for hyponatremia, a diagnosis of beer potomania was established. on the third day of hospitalization, the patient’s anamnesis was filled with information about the use of valsartan/hydrochlorothiazide, together with reduced salt intake in the diet for three months for arterial hypertension treatment. it was decided that the combination of heavy beer drinking with the use of diuretic and reduced consumption of salt provoked hyponatremia. the patient was treated with infusion therapy of sodium chloride; plasma sodium level reached 136 on the third day of treatment. conclusions. this case represents an unusual syndrome of beer potomania in conjunction with hydrochlorothiazide usage and reduced salt consumption, which can result in severe hyponatremia that may provoke severe neurologic damage Show More ... ... Show Less

  • Severe Hyponatremia
  • Plasma Sodium
  • The Third
  • Reduced Salt
  • Emergency Department
Initial Experience With Edwards SAPIEN Valve Transcatheter Implantation In Native RVOT In Latvia

transcatheter pulmonary valve implantation has been a well-known method for more than a decade, but there are still many challenging cases when a personalized solution is needed. we report a case of a 15-year-old female patient with tetralogy of fallot, who underwent a surgical correction during infancy. because of progressive pulmonary regurgitation, stenosis, and right ventricle dilatation, transcatheter pulmonary valve implantation in the native right ventricle outflow tract (rvot) using edwards sapien valve was performed. a “landing zone” was created prior to the intervention of stenting the rvot and the right pulmonary artery. the transcatheter approach for pulmonary valve replacement in a native rvot is a reasonable alternative to the surgical approach Show More ... ... Show Less

  • Pulmonary Valve
  • Right Ventricle
  • Edwards Sapien Valve
  • Valve Implantation
Partial Nephrectomy Can Be A Successful Treatment Option For Renal Epithelioid Angiomyolipoma: A Case Report And Literature Review

background. renal epithelioid angiomyolipoma is a rare tumour which involves kidneys in most cases. it is known for its aggressive behaviour as a significant number of cases have been associated with metastatic epithelioid angiomyolipoma. usually, radical treatment with systemic therapy is recommended. only a small number of cases of epithelioid angiomyolipomas have been reported with the standard treatment being radical or partial nephrectomy. we present a case report showing that partial nephrectomy can be a successful treatment option for renal epithelioid angiomyolipoma. this is the first case of this nature in lithuania. case presentation. in this case, a 40-year-old male with epithelioid angiomyolipoma of the left kidney is presented. in 2012, a cystic left renal mass 40 × 41 mm in size was diagnosed incidentally while performing ultrasound and later confirmed by mri. due to the size of the tumour and the possibility of renal cell carcinoma, surgery was scheduled. left partial nephrectomy was performed successfully. final pathology report came back with the diagnosis of renal epithelioid angiomyolipoma. the patient had yearly follow-up for six years by ct scan, and neither recurrence nor progression were observed. conclusion. early detection and diagnosis are crucial for treatment as the tumour tends to have malignancy potential. with early diagnosis, partial nephrectomy can be performed with yearly follow-up and no systemic treatment required Show More ... ... Show Less

  • Epithelioid Angiomyolipoma
  • Partial Nephrectomy
  • Case Report
  • Treatment Option
  • Successful Treatment
Prognostic Value Of Mastora Obstruction Score In Acute Pulmonary Embolism

background. to evaluate the clinical significance of mastora obstruction score in hemodynamically stable patients with acute pulmonary embolism (ape). materials and methods. one-hundred-and-six patients with newly diagnosed ape, confirmed by computed tomography pulmonary angiography (ctpa), were included in the study and prospectively examined. ape severity was assessed by using mastora obstruction score. according to the mastora index, patients were divided into “non-massive” and “massive” groups. the patients’ medical histories and blood laboratory data were collected, and instrumental tests were performed and analyzed. results. eighty-two (77%) of the patients had “non-massive” ape. cough (48%), fever (44%), and pleural effusion (48%) occurred significantly more often in the “non-massive” pe group, while syncope (42%) and right ventricular dysfunction (86%) were more frequent in the “massive” pe group. the probability of the right ventricular dysfunction was significantly higher in the presence of increased pulmonary artery pressure (cramer’s v = 0.410; p < 0.0001) and respiratory failure (cramer’s v = 0.247; p = 0.032). increased crp level was found in the majority of the patients (90%). d-dimer level Show More ... ... Show Less

  • Acute Pulmonary Embolism
  • Right Ventricular Dysfunction
Overview Of Caustic Ingestion Cases At The Children’S Hospital Of Vilnius University Hospital Santaros Klinikos Between 2011 And 2018

background. although not common, caustic ingestion can cause serious injury and sequelae. clinical symptoms do not always represent the depth of lesions of the intestinal tract, which makes management of these patients difficult. materials and methods. between 2011 and 2018, we performed a retrospective one-centre study on ingestion of corrosive agents by children. we used icd-10 codes of x49, x54.x, and t28.2. cases of eye or skin burns were excluded. results. sixty-five cases were found. due to a lack of data, we analysed 56 cases. the majority of them were boys (64%); 41% of patients were between 12 and 24 months old. the median age was one year. in 68% of cases, the corrosive substance was alkali: laundry detergent pods and sodium hydroxide accounting for 25% and 14%, respectively. of the hospitalised patients and all those admitted to the paediatric intensive care unit (picu), 78% had oesophagogastroduodenoscopy (egd), 61% within 24 h after ingestion. the time of egd was not known for 29% of patients. nine (29%) had 2nd- or 3rd-degree burns of the oesophagus or the stomach, one of them did not have any visible changes of the lips and oral mucosa or any symptoms. conclusions. physicians should be suspicious about potential lesions of the gastrointestinal tract when managing caustic ingestion cases. it is recommended to perform egd for symptomatic children within 24 hours after the accident Show More ... ... Show Less

  • Caustic Ingestion
  • Intensive Care Unit
  • Gastrointestinal Tract
  • Hospitalised Patients
Successful Extracorporeal Membrane Oxygenation Assisted Revascularisation In A High-Risk Elderly Patient Refused Surgical Treatment

management of high-risk elderly patients requiring revascularisation remains a clinical challenge. we report a case of extracorporeal membrane oxygenation (ecmo) assisted complex percutaneous coronary intervention in a high-risk octogenarian. an 83-yearold female with signs of worsening heart failure was admitted to the emergency department of a tertiary care facility. transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 20% with severe mitral regurgitation and mild aortic and tricuspid valve insufficiency. three-vessel disease was found during coronary angiography. due to the patient’s frailty, a high-risk surgery decision to proceed with ecmo assisted percutaneous coronary intervention was made during a heart team meeting. following initiation of mechanical support, coronary lesions were treated with three drug-eluting stents. after the procedure, the patient was transferred to the icu on ecmo support, where she was successfully weaned from the device 9 h later. her icu stay was four days. she was successfully discharged from the hospital after uneventful recovery. at one-year’s follow-up, the patient was clinically stable in an overall state of general well-being and with complete participation in routine activities; she had good exercise tolerance and no signs of ischemia. this report highlights the possibility of use of ecmo during pci in high-risk elderly patients Show More ... ... Show Less

  • High Risk
  • Percutaneous Coronary Intervention
  • Elderly Patients
  • Extracorporeal Membrane Oxygenation
A Comparative Analysis Of Mathematical Methods For Homogeneity Estimation Of The Lithuanian Population

background. population genetic structure is one of the most important population genetic parameters revealing its demographic features. the aim of this study was to evaluate the homogeneity of the lithuanian population on the basis of the genome-wide genotyping data. the comparative analysis of three methods – multidimensional scaling, principal components, and principal coordinates analysis – to visualize multidimensional genetics data was performed. the results of visualization (mapping images) are also presented. materials and methods. the data set consisted of 425 samples from six ethnolinguistic groups of the lithuanian population. genomic dna was extracted from whole venous blood using either the phenol-chloroform extraction method or the automated dna extraction platform tecan freedom evo. genotyping was performed at the department of human and medical genetics, institute of biomedical sciences, faculty of medicine, vilnius university, lithuania, with the illumina humanomniexpress-12 v1.1 and the infinium omniexpress-24. for the estimation of homogeneity of the lithuanian population, plink data file was obtained using plink v1.07 program. the past3 software was used to visualize the genotype data with multidimensional scaling and principal coordinates methods. the smartpca from eigensoft 7.2.1 program was used in the principal component analysis to determine the population structure. conclusions. methods of multidimensional scaling, principal coordinate, and principal component for the genetic structure of the lithuanian population were investigated and compared. the principal coordinate and principal component methods can be used for genotyping data visualization, since any essential differences in the results obtained were not observed and compared to multidimensional scaling. the lithuanian population is homogenous whereas the points are strongly close when we use the principal coordinates or principal component methods Show More ... ... Show Less

  • Multidimensional Scaling
  • Principal Component
  • Principal Coordinates
  • Comparative Analysis
  • Genetic Structure
Chemical Peritonitis Resulting From Spontaneous Rupture Of A Mature Ovarian Cystic Teratoma: A Case Report

background. mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10–25% incidence of adult and 50% of paediatric ovarian tumours. the aetiology of dermoid cysts is still unclear, although currently the parthenogenic theory is most widely accepted. the tumour is slow-growing and in the majority of cases it is an accidental finding. presenting symptoms are vague and nonspecific. the main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). prolonged pressure during pregnancy, torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. the diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. materials and methods. we present a report of a clinical case of a 35-years-old female, who was referred to the hospital due to abdominal pain spreading to her feet for three successive days. she had a history of a normal vaginal delivery one month before. abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. transvaginal ultrasound showed a multiloculated cystic mass measuring 16 × 10 cm in the pelvis. in the absence of urgency, planned surgical treatment was recommended. the next day the patient was referred to the hospital again, with a complaint of stronger abdominal pain (7/10), nausea, and vomiting. this time abdominal examination revealed symptoms of acute peritonitis. the ultrasound scan differed from the previous one. this time, the transvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. there was a large amount of free fluid in the abdominal cavity. the patient was operated on – left laparoscopic cystectomy and right adnexectomy were performed. postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of the thromboembolism were administered. the patient was discharged from the hospital on the seventh postoperative day and was sent for outpatient observation. results and conclusions. ultrasound is the imaging modality of choice for a dermoid cyst because it is safe, non-invasive, and quick to perform. leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of the spontaneously ruptured ovarian cyst and thorough peritoneal lavage are required Show More ... ... Show Less

  • Dermoid Cyst
  • Cystic Teratoma
  • Abdominal Pain
  • Ovarian Cyst
  • Ultrasound Scan
Giant Prostatic Hyperplasia And Its Causes

we present a case of a 59-year-old male who was admitted to the emergency department with urinary retention, with a history of lower urinary tract symptoms, with the value of serum prostate specific antigen level of 100 ng/ml and an estimated prostate size of 800 ml, according to magnetic resonance imaging. a prostate biopsy showed benign prostatic hyperplasia. transvesical prostatectomy was performed, following additional procedure of transurethral resection of the prostate. to the best of our knowledge, this is the fourth highest prostate volume reported in medical literature. in this paper, we examine the factors that may have influenced the development of giant prostate hyperplasia Show More ... ... Show Less

  • Prostatic Hyperplasia
  • Magnetic Resonance Imaging
  • Emergency Department
  • Urinary Tract
  • Lower Urinary
Mexican Pregnant Women Show Higher Depression And Anxiety With Rising Age And In The Case Of Being Single

background. pregnancy is an important predisposition period to develop anxiety and depression, with a direct impact on the woman’s offspring. the aim of this study was to report the correlation between depression and anxiety in pregnant women and its association with the marital status and age. materials. a descriptive, retrospective and cross-sectional study was conducted in the outpatient care of the psychology service at the “mónica pretelini sáenz” maternal perinatal hospital (hmpmps), toluca, mexico, from june 2012 to march 2019. as routine, the beck depression inventory (bdi-ii) and the beck anxiety inventory-trait (bait), were applied to all women seeking attention at the hmpmps. only pregnant patients were selected for this study, with the women referred for the first time to the external psychology clinic as inclusion criteria. pearson’s correlation coefficient and the frequency of cases for age, bdi-ii, and bait were obtained using the ibm spss statistics ® v.23 software. results. the study included 2947 pregnant patients with a mean age of 28.6 ± 6.9 years. of these, 2616 (88.8%) presented with mild anxiety, 269 (9.1%) with moderate, and 62 (2.1%) with severe anxiety. on the other hand, 2149 (72.9%) patients presented with minimal depression, 341 (11.6%) mild depression, 268 (9.1%) moderate depression, and 189 (6.4%) had severe depression. the correlations between age and bdi-ii was –0.026 (p = 0.152), between age and bai was –0.038 (p = 0.037), and between bait and bdi-ii 0.650 (p ≤ 0.001). conclusions. the age group with the highest frequency of depression and anxiety was from 20 to 29 years. the absence of a stable partner represented an important risk factor for anxiety and depression during pregnancy Show More ... ... Show Less

  • Depression And Anxiety
  • Pregnant Women
  • Anxiety And Depression
  • Risk Factor
  • Severe Anxiety
Lyme Disease And Heart Transplantation: Presentation Of A Clinical Case And A Literature Review

background. lyme disease, the most common anthropozoonosis, is a transmissible natural focal infection affecting various organs and systems. also known as lyme borreliosis, it is caused by borrelia spirochetes, which are distributed by ticks of the genus ixodes. early diagnosis is difficult due to frequent occurrence of atypical symptoms, unnoticed tick bites, the absence of migratory erythematous lesions, and symptoms occurring during the nontick season. if not diagnosed and treated in time, dissemination of the infection occurs and various complications develop since borrelias damage not only the skin but also the nervous system, joints, and, in rare cases, the heart and eyes. materials and methods. this article presents a clinical case of lyme borreliosis-induced myocarditis, which led to the development of dilated cardiomyopathy and, consequently, urgent cardiac transplantation. according to our data, this is one of the first described cases of this complication in the world. results and conclusions. when diagnosed in time and treated properly, the prognosis of lyme myocarditis is usually good. in most cases, the atrioventricular block disappears within 1–2 weeks of antibiotic treatment and the implantation of a temporary pacemaker is rarely needed. in those rare cases of a chronic borrelia burgdorferi infection, dilated cardiomyopathy may develop; thus if a sudden atrioventricular block occurs, the physician should be vigilant and perform the necessary tests to exclude the diagnosis of lyme disease Show More ... ... Show Less

  • Lyme Disease
  • Dilated Cardiomyopathy
  • Atrioventricular Block
  • Lyme Borreliosis
  • Clinical Case
Changes In The Expression Of Notch And Wnt Signalling Molecules In Human Endometrial Cancer

background. endometrial cancer is the sixth most frequent type of cancer among women worldwide. type i adenocarcinomas account for 80–85% of endometrial cancer cases and sometimes require more aggressive treatment than the remaining part of this group. therefore, molecular markers to stratify adenocarcinomas are needed. materials and methods. in this study, we analysed notch and wnt signalling in human endometrial cancer cases to evaluate these pathway elements as potential biomarkers for type i endometrial cancer. endometrial samples were obtained from 47 women undergoing surgery for stage i–iv endometrial cancer in the national cancer institute (vilnius, lithuania) in 2015–2016. the expression at the mrna level of signalling molecules genes (notch1, notch2, notch3, notch4, jag1, jag2, dll1, hes1, axin2 and ctnnb1) was analysed by the quantitative real-time polymerase chain reaction. relative expression of notch1, notch4, hes1 and β-catenin proteins in endometrioid adenocarcinoma was evaluated by the western blot method. results. the expression level of notch receptors, ligands, and the target gene, as well as ctnnb1 and axin2, was reduced in stage i endometrioid adenocarcinoma if compared to the adjacent non-tumour tissue. the expression of all receptors, ligands, and target molecules was reduced in adenocarcinomas of later stages. the statistically significant correlations between transcript amounts of notch receptors and ligands were found. there was a statistically significant difference in the gene expression of notch signalling pathway components between different tumour differentiation grade samples. a positive correlation between mrna and protein the expression level of notch1, notch4, hes1 was determined in stage i samples. conclusions. analysis of 47 human endometrial cancer samples revealed a reduction in the transcript levels of notch and wnt signalling molecule compared to the adjacent non-tumour tissue. these results suggest tumour suppressor function of notch and wnt signalling in human endometrial cancer. more detailed research on these signalling pathways should reveal their importance as potential biomarkers Show More ... ... Show Less

  • Endometrial Cancer
  • Wnt Signalling
  • Stage I
  • Notch Receptors
  • Potential Biomarkers
Electrocardiographic Changes During Therapeutic Hypothermia: Observational Data From A Single Centre

background. therapeutic hypothermia is recommended to reduce the risk of hypoxic brain damage and improve short-term survival after cardiac arrest. it also temporarily affects the cardiac conduction system. the aim of this study was to evaluate electrocardiographic changes during therapeutic hypothermia and their impact on the outcome. materials and methods. this retrospective analysis involved 26 patients who underwent therapeutic hypothermia after cardiac arrest in vilnius university hospital santaros klinikos from 2011 to 2015. results. during cooling, a significant reduction in the heart rate (p = 0.013), shortening of qrs complex duration (p = 0.041), and prolongation of the qtc interval (p < 0.001) were observed. during the cooling period, five patients had subtle osborn waves, which disappeared after rewarming. the association between electrocardiographic changes during cooling and unfavourable neurological outcome or in-hospital mortality was non-significant. conclusions. therapeutic hypothermia after cardiac arrest causes reversible electrocardiographic changes that do not increase the risk of in-hospital mortality or unfavourable neurological outcomes Show More ... ... Show Less

  • Therapeutic Hypothermia
  • Electrocardiographic Changes
  • Cardiac Arrest
  • Hospital Mortality
  • Short Term Survival
Thrombosis Of The Brachial Artery – A Rare And Devastating Complication After A Simple Closed Posterolateral Elbow Dislocation

dislocation of the elbow joint is the second most common dislocation after the shoulder joint. although this pathology is relatively common, concomitant vascular injuries are rare. we present a case of a patient who sustained a fall on his arm with an outstretched elbow that resulted in a closed simple posterolateral elbow dislocation and delayed thrombosis of the brachial artery followed by two revascularisation surgeries. the physician must always maintain a high index of suspicion for a concomitant vascular injury before and after closed reduction of the elbow joint and have in mind that complete ischemia without any pulsations could be absent because the elbow is surrounded by rich collateral anastomoses. suspicion should be even stronger in the presence of bony lesions or open injuries. a team of trauma and vascular surgeons has to work hand in hand as surgical treatment with a saphenous graft or direct suture is the first method of choice with the prior requirement of a stable elbow joint Show More ... ... Show Less

  • Elbow Joint
  • Brachial Artery
  • Elbow Dislocation
  • Surgical Treatment
  • Vascular Injury
Latvian Experience In Conservative Management Of Abnormally Invasive Placenta: Two Case Reports

background. abnormally invasive placentation (aip) is a clinical term that describes situation when placenta does not separate spontaneously after delivery and its manual removal causes excessive bleeding (1). historically, the treatment of choice for this condition is hysterectomy. lately, the new treatment option, conservative management of the aip, has proven itself an effective alternative to hysterectomy in carefully selected patients (2). however, the use of conservative aip management is limited in many countries, the reasoning being the lack of doctors’ experience in this procedure and concerns regarding a high postpartum infection rate. case reports. we present the first two cases of conservative management of aip in latvia. most of prenatally diagnosed aip cases country-wide are referred to the paul stradinš university hospital, which is a tertiary referral hospital. the annual rate of aip in the hospital varies from five to ten cases. two pregnant women were diagnosed with aip prenatally, both of them refused hysterectomy and therefore went for the conservative management of aip. during caesarean section operation, placentas were left in situ after delivery of the baby. during the follow-up period of 12 and 14 weeks, both women developed infection complications, but complete placental tissue resolution was diagnosed in the end. conclusion. these two cases demonstrate that conservative management of aip can be safely applied in small countries/areas with small aip rate and management experience Show More ... ... Show Less

  • Conservative Management
  • Case Reports
  • Small Countries
  • Rate Case
  • Abnormally Invasive Placenta
Imaging In Pregnancy-Associated Breast Cancer: A Case Report

background. pabc (pregnancy-associated breast cancer) is a rare condition that appears as a malignancy in 1 per 3000 pregnant women and is one of the most common cancers diagnosed during pregnancy or the postpartum period. if a woman who is pregnant or within a year after delivery has complaints of a palpable breast mass, it could undeniably be a malignant mass of the breast. that is why an ultrasound should be performed for all pregnant or lactating women who detect a palpable breast mass that persists for two or more weeks. case report. our case report presents a pregnant 40-year-old previously healthy female at 36 weeks gestational age with a complaint of a palpable left breast mass for two months period. the initial ultrasound showed a breast tumour of irregular shape, solid and hypervascular mass. conclusions. early diagnostics of pabc is of crucial importance in order to offer the best possible outcomes for the patient and foetus Show More ... ... Show Less

  • Case Report
  • Breast Mass
  • Breast Cancer
  • Palpable Breast
  • Malignant Mass
Successful Laparoscopic Living Donor Nephrectomy: First Experience In Lithuania

background. the aim of this paper is to share the initial results of lldn in high-volume university centre that is performing laparoscopic nephrectomies for other indications. materials and methods. during 2017, four lldns were performed. the transperitoneal approach was used in all cases and the kidney was removed using a suprapubic incision. all donors and recipients were prospectively analysed within six-month follow-up. the patients’ clinical, laboratory, and operation-related data were collected from direct interviews with them and from medical records. all patients signed written informed consent. results. one male and three females donated their left kidneys by using the lldn technique. the mean age was 58 ± 9 years; two of them with a history of previous cholecystectomy. all donated kidneys had a single renal artery and renal vein. pre-operative average egfr was 94.2 ± 7.1 ml/min/1.73 m2, immediately after lldn 57.5 ± 10.3 ml/min/1.73 m2, after one month 56.0 ± 9.1 ml/min/1.73 m2. there were no intraoperative complications; surgery duration was 223.75 ± 21.74 min, the cold ischemia time was 77.5 ± 28.77 min, and the warm ischemia time 6.37 ± 3.14 min. there was one postoperative donor complication, one case of acute kidney injury, and one case of prolonged postoperative abdominal pain. the only recipient complication was one case of acute kidney rejection; there were no cases of delayed graft function. conclusions. our initial experience confirms that lldn is an approach that is easy to learn, especially in a high-volume university hospital with expertise in performing laparoscopic nephrectomies for other indications Show More ... ... Show Less

  • High Volume
  • Ischemia Time
  • The Mean
  • Acute Kidney Rejection
Wilms Tumour In Children: 18 Years Of Experience At Vilnius University Hospital Santaros Klinikos, Lithuania

introduction. wilms tumour (wt) is the most common childhood abdominal malignancy, with an average annual incidence of 1 in 10,000 children. the study published in 2002 reported lower survival rates of wt in lithuania in comparison to the data of siop-9 study and the european organization for research and treatment of cancer (eortc). we aimed to assess current diagnostic approach and treatment results of patients with wt treated at our institution and to compare the results with the previously published study. materials and methods. a retrospective single-centre study was performed. 48 patients with wt registered at the institutional database from 2000 to 2018 were enrolled. an estimated 5-year overall survival (os5y) and 2-year event-free survival (efs2y) by stage and risk groups was calculated using ibm spss. a comparative analysis of two time periods – 2000–2008 and 2009–2018 – was carried out. results. forty-two (87.5%) patients presented with localised disease and 6 (12.5%) with primary metastatic disease. the majority of cases were of the intermediate-risk group (77%). the os5yof all analysed children was 86.4%. the efs2y was 88.9% in stage i, 91.7% in stage ii, 83.3% in stage iii, and 50% in stage iv. the efs2y was 100% in the low-risk group, 86.5% in the intermediate-risk group, and 25% in the high-risk group. improvement of outcomes was observed over the analysed period: os5y changed from 81.0% in 2000– 2008 to 92.6% in 2009–2018. among 48 cases, ten patients showed recurrence: eight – early relapse and two – late relapse. six patients died. conclusions. wt was diagnosed at early stages in most cases. the survival was better among the patients diagnosed in earlier stages and with favourable risk group. better survival rates were observed in patients treated in 2009–2018 compared to the 2000–2008 period Show More ... ... Show Less

  • Risk Group
  • Survival Rates
  • Intermediate Risk
  • Wilms Tumour
  • Localised Disease
Intraneural Ganglion Cyst: A Case Report And A Review Of The Literature

background. an intraneural ganglion cyst is a non-neoplastic gelatinous cyst, which can be found within the epineurium of a peripheral nerve and lead to signs and symptoms of peripheral neuropathy. early diagnosis and appropriate surgical treatment of this condition is a key to a successful outcome. materials and methods. we describe a case of a patient with peroneal nerve neuropathy caused by an intraneural ganglion cyst. postsurgically, only partial relieve of the symptoms was achieved because of delayed diagnosis. results and conclusions. the aetiology of intraneural ganglia is controversial and historically different pathogeneses of this condition have been described. diagnosis of these cysts is based on mri. multiple surgical treatment strategies have been developed based on different pathogenesis of the formation of these cysts, but neuropathy is reversible only, if this condition is diagnosed and treated early Show More ... ... Show Less

  • Intraneural Ganglion Cyst
  • Surgical Treatment
  • Case Report
Factors Affecting The Maternal-Foetal Relationship

background. mother’s attachment to her unborn child has a strong impact on a pregnant woman’s attitude towards her health, postnatal attachment, and the child’s physical and emotional growth. the purpose of our study was to identify the factors that impact the maternal-foetal relationship. materials and methods. the study was conducted at the centre of obstetrics and gynaecology of the tertiary-level vilnius university hospital santaros klinikos in vilnius, lithuania. an original questionnaire of nine parts was developed that the questionnaire included information on demographical data, gynaecological and obstetrical history, a relationship assessment scale, the index of happiness, an antenatal depression risk questionnaire, and the maternal-antenatal attachment scale. results. the study included 388 pregnant women. it was found that the level of education, obstetrical issues during pregnancy, and the risk of postnatal depression negatively impacted the maternal-foetal relationship (p < 0.05). mothers who were elder in family birth order, also those whose pregnancy was of a longer duration, who had a better-quality romantic relationship with partner, and whose socioeconomic fulfilment was higher were all found to have a better quality of maternal-foetal bonding (p < 0.05). conclusions. the early recognition of low attachment and right application of various means of psychologic intervention might improve the quality of pregnancy, maternity, and childhood Show More ... ... Show Less

  • Depression Risk
  • Maternal Antenatal Attachment Scale
  • Demographical Data
Rotavirus-Associated Seizures And Reversible Corpus Callosum Lesion

rotavirus is a non-enveloped double-stranded rna virus that causes severe gastroenteritis in children, but complications are rarely reported. some reports have shown that rotavirus can induce diverse complications of the central nervous system, such as seizures, encephalopathy with a reversible splenial lesion, encephalitis, cerebral white matter abnormalities, and cerebellitis. here, we present a 2-year-old patient with seizures, who had an isolated splenial lesion in the corpus callosum on neuroimaging, and the rotavirus antigen detected in faeces Show More ... ... Show Less

  • Corpus Callosum
  • Splenial Lesion
  • Central Nervous System
  • White Matter
Incidence And Features Of Preoperative Anxiety In Patients Undergoing Elective Non-Cardiac Surgery

the study was conducted at the centre of anaesthesiology, intensive care and pain management of vilnius university hospital santaros klinikos. background. due to its implications on postoperative outcomes and patient satisfaction, anxiety evaluation should be incorporated in the preoperative assessment of the patients. materials and methods. a series of consecutive patients undergoing elective surgery were included in the study. preoperative anxiety was evaluated using the hospital anxiety and depression scale (hads), the amsterdam preoperative anxiety and information scale (apais), and the visual analogue (face) scale (vafs). qualitative and quantitative analyses were used to describe features of anxiety. results. 149 patients were included in the study, of whom 40.9% were scheduled for low, 47.7% for intermediate, and 11.4% for highrisk procedures. based on hads, 19 patients (12.6%) were positive for anxiety. vafs revealed that 10.3% of patients experience medium/high intensity of anxiety. patients were mostly concerned about the success (29.3%) and complications (11.4%) of the surgery apais score analysis revealed significantly higher anxiety (p < 0.01) and a need of information (p < 0.01) about surgery compared to anaesthesia. in contrast to age, education, or previous surgery, anxiety was associated with female sex (p < 0.01), surgical risk (p = 0.02), and subjective health evaluation (p < 0.01). patients tended to choose a conversation with the doctor (45.6%) or a relative (44.8%) as a measure to relieve anxiety, and 18.4% would choose medication. praying, music therapy, massage, or even sexual intercourse were among the measures suggested by patients. conclusions. a significant part of patients experience anxiety before surgery, predominantly about the success of the surgery. according to the patients, conversation is the best option to reduce anxiety Show More ... ... Show Less

  • Preoperative Anxiety
  • Patients Experience
  • Cardiac Surgery
  • Intensive Care
  • Face Scale
Effectiveness Of High-Flow Nasal Oxygen Therapy In Management Of Acute Hypoxemic And Hypercapnic Respiratory Failure

background. high-flow nasal oxygen therapy (hfnot) therapy has been increasingly used in patients with acute hypoxemic (type i) respiratory failure (rf). meanwhile indications and clinical effectiveness of hfnot in patients with hypercapnic (type ii) rf remain controversial. the aim of our study was to evaluate the outcomes of primary hftnot in patients with hypoxemic and hypercapnic rf. material and methods. we conducted a retrospective observational study of patients diagnosed with severe community acquired pneumonia (cap), who required hfnc oxygen therapy for hypoxemia. primary end-point was intubation or escalation to niv rate after hfnot. the secondary endpoint was the 30-day mortality after an admission regardless of the cause. results. analysis was conducted on all 51 (n = 51) patients. of these, 32 (63%) were diagnosed with type i rf and 19 (37%) with type ii rf. the partial pressure of arterial carbon dioxide (paco2) in type i rf patients was 34.05 mmhg at admission and decreased to 33.07 mmhg after 1 hour of hfnot. in patients with type ii rf paco2 decreased from 56.47 to 54.97 mmhg. in type i rf successful outcome was achieved in 25 patients (78%) compared to 11 patients (58%) with type ii rf. escalation was required in seven patients with type i rf and eight patients in type ii group. there were no mortalities in our population group. conclusions. our data suggest that hfnot can be effectively used in type i and type ii rf. clinicians should be cautious identifying patients at risk of escalation. a larger population group study is needed to identify predictors of hfnot failure Show More ... ... Show Less

  • Type Ii
  • Oxygen Therapy
  • Respiratory Failure
  • Population Group
Comparison Of Preoxygenation Efficiency With Intersurgical Economy And Intersurgical Quadralite Anaesthetic Face Masks

background. sufficient preoxygenation prevents arterial oxygen desaturation prior to intubation. an optimally sealed facemask is necessary for fast preoxygenation. the study was aimed at comparing the efficiency of preoxygenation using two different face masks. materials and methods. in 2018, a prospective study was conducted. patients were classified into two groups: group a – intersurgical economy face masks, group b – intersurgical quadralite masks. the circuit was flushed with 100% o2 for 30s, preoxygenation started with flow of 8l/min, fio2100. the patients were asked to breathe deeply. fentanyl (1–2 mcg/kg) was administered to increase mask toleration. end-tidal oxygen concentration (eto2) ≥90% was the goal. eto2 was monitored after 30, 60, 90, 120, 180, 210, 240, 270 and 300 seconds. data was analyzed using the independent-samples t-test and the mann-whitney-u test. results. twelve patients were enrolled in group a and 19 in group b. differences in sex, age, bmi and mallampati class in the groups were statistically insignificant (p = 0.13, 0.39, 0.65, 0.43 respectively). patients assigned to asa i – 25.8% (n = 8–>2/6), asa ii – 71.0% (n = 22–>10/12), asa iii – 3.2% (n = 1–>0/1), p = 0.64. the success rate of preoxygenation to eto290 within 5 min was statistically significantly different in the groups, with 33.3% in group a and 94.7% in group b (p < 0.01). mean time to eto290 was 228.3 ± 104.0/164.4 ± 84.3. mean eto2 after: 30s – 56.0 ± 13.5/69.3 ± 11.2 (p < 0.01); 60s – 63.8 ± 15.3/76.1 ± 11.7 (p = 0.02), 90s – 67.8 ± 17.7/80.7 ± 10.1 (p = 0.03); 120s– 69.6 ± 18.2/83.4 ± 10.0 (p = 0.03), 150s–71.1 ± 19.0/87.1 ± 6.5 (p = 0.01); 180s – 72.9 ± 16.8/88.5 ± 5.3 (p = 0.01), 210s – 72.6 ± 18.0/89.2 ± 5.1 (p < 0.01); 240s – 74.17 ± 15.4/90.0 ± 4.3 (p < 0.01), 270s-76.3 ± 16.3/90.2 ± 3.6; 300s – 77.8 ± 14.6/90.2 ± 1.5 (p < 0.01). conclusions. preoxygenation was significantly more efficient and faster with intersurgical quadralite face masks Show More ... ... Show Less

  • Group A
  • Group B
  • Prospective Study
  • End Tidal
  • Mean Time
Metformin Poisoning Treated With High Dose Insulin Dextrose Therapy: A Case Series

purpose. we describe the compassionate use of high dose insulin dextrose (hid) for life threatening metformin associated lactic acidosis (mala) in four patients admitted to intensive care. methods. patients presenting with refractory lactic acidosis believed to be secondary to metformin poisoning were included. high dose insulin dextrose at 0.5units/kg/hour was infused in 50% dextrose. frequent blood gas analysis allowed titration of therapy. all patients also received continuous veno-venous haemofiltration. results. all four patients recovered to normal or near normal lactate and ph between 10 and 24 hours of therapy. two patients had significant separation in time between initiation of hid and haemofiltration to suggest an independent effect of hid on improving ph and lactate. all patients had at least one episode of hypoglycaemia below 4.0 mmol/l with the lowest glucose in any patient during therapy being 3.0 mmol/l. all episodes were corrected with a dextrose infusion without sequelae. conclusions. our study demonstrates that hid therapy appears to be safe in patients with suspected metformin poisoning. it also appears to work to drive down lactate, improve ph and patients’ clinical condition. further evidence is required to assess the effectiveness of hid therapy in the context of mala Show More ... ... Show Less

  • High Dose
  • Lactic Acidosis
  • Intensive Care
  • Clinical Condition
  • Dextrose Infusion
Effects Of Sevoflurane And Desflurane On Early Cognitive Changes After Thyroid Surgery: Interim Results

the study is being conducted at the 1st department of anaesthesiology, the centre of abdominal surgery, the centre of anaesthesiology, intensive care and pain management of vilnius university hospital santaros klinikos. background. these are primary results of a randomized double-blinded study comparing postoperative changes in cognitive functions and the effect of desflurane and sevoflurane on these changes. materials and methods. the study includes patients of ≥40 years of age undergoing elective thyroid surgery under general anaesthesia. patients were randomly allocated to either sevoflurane or desflurane group. cognitive testing (memory, attention, and reasoning tasks) was performed a day before surgery and repeated 24 hours postoperatively. a decrease of 20% in the postoperative score was considered as postoperative cognitive dysfunction (pocd). results. at present 38 patients are included in the study. median decrease in the postoperative score was 2.7% (iqr 16.7). the incidence of pocd was 2.6%. significantly decreased memory scores were observed in 15.8% of patients. both study groups were comparable based on demography, duration of anaesthesia, intraoperative opioids, postoperative pain, and satisfaction. no difference was found in the cognitive score comparing sevoflurane and desflurane groups, except for memory tasks where the sevoflurane group performed worse (p = 0.01). the age or the duration of anaesthesia did not affect postoperative scores. postoperative satisfaction negatively correlated with the memory score (r = –0.35, p = 0.03). postoperative satisfaction correlated with the reasoning score (r = –0.55; p < 0.01) and the total score (r = –0.42; p = 0.03) in the sevoflurane group. likewise, temperature in the sevoflurane group correlated with the memory score (r = –0.58; p = 0.02). conclusions. the desflurane group performs better in memory tasks, but no such advantage is found in the total cognitive score. in contrast to the age or anaesthesia duration, intraoperative temperature and postoperative satisfaction may affect postoperative cognitive performance Show More ... ... Show Less

  • Sevoflurane Group
  • Thyroid Surgery
  • Cognitive Score
  • Memory Score
  • Postoperative Score
Comparison Of Two Continuous Non-Invasive Haemodynamic Monitoring Techniques In The Perioperative Setting

background. the aim of the study was to identify the accuracy of and agreement between two non-invasive haemodynamic monitoring techniques in the perioperative setting – thoracic electrical bioimpedance (teb) and edwards lifesciences clearsight system (cs). materials and methods. the study included ten patients. parametric quantitative data were expressed as mean ± sd. the shapirowilk test was used to test the normality of the distributions. a linear regression model was used to measure the strength of the linear relationship between teb and cs. bland-altman analysis was performed to assess the mean difference, precision, and the limits of agreements (loa). the critchley and critchley method was used to calculate the percentage error (pe), and if Show More ... ... Show Less

  • Haemodynamic Monitoring
  • Monitoring Techniques
  • Non Invasive
  • Linear Regression
  • The Mean
The Correlation Of Post-Operative Acute Kidney Injury And Perioperative Anaemia In Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

background and objective. acute kidney injury (aki) following cardiac surgery with cardiopulmonary bypass (cpb) is polyethiological clinical syndrome. during cpb haemodilution develops, which is useful in reducing the risk of thrombosis; however, haemodilutional anaemia decreases oxygen transfer and provokes tissue hypoxia, which can lead to acute organ damage. the aim of the study was to find out the impact of perioperative anaemia on aki after cardiac surgery with cpb. materials and methods. this prospective study included 58 adult patients undergoing elective cardiac surgery with cpb, without any preoperative chronic renal disease or any systemic autoimmune disease. serum concentrations of ngal had been tested before the surgery, 2 hours, 6 hours, and one day after the surgery. perioperative anaemia was assessed according to the ht value before the surgery, the ht value during cpb, and immediately after the surgery. results. the rate of haemodilutional anaemia is 77.59% in this study. the average of serum ngal concentration before cpb was 63.95 ± 33.25 ng/ml and it was significantly lower than the average concentration 2 hours after the surgery, 6 hours after the surgery and one day after the surgery (respectively 148.51 ± 62.39, 119.44 ± 55, 128.70 ± 59.04 ng/ml, p < 0.05). aki developed in 46.55% of the patients. a significant positive reasonable correlation between the development of perioperative anaemia and aki was determined (r = 0.50, p < 0.05). conclusions. post-operative aki after cardiac surgery with cpb has a moderate positive correlation with perioperative haemodilutional anaemia. a longer cpb time and aortic cross-clamping time were found to be the risk factors for the development of aki Show More ... ... Show Less

  • Cardiac Surgery
  • Acute Kidney Injury
  • Cardiopulmonary Bypass
  • Moderate Positive Correlation
Can The Inferior Vena Cava Collapsibility Index Be Useful In Predicting Hypotension During Spinal Anaesthesia In A Spontaneously Breathing Patient? A Mini Fluid Challenge

the study was performed at the department of orthopaedics and traumatology of the kauno klinikos hospital of lithuanian university of health sciences. background. intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. ultrasound measurements of the inferior vena cava (ivc) and the ivc collapsibility index (ivc-ci) is a non-invasive method to evaluate the intravascular volume status. the aim of the study was to identify the prognostic value of the ivc collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. materials and methods. sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. the diameters of ivcex, ivcin, and ivc-ci were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. the haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. results. severe arterial hypotension was noticed in 18.3% of the patients. no statistically significant differences were detected between changes in ivcex, ivcin, and ivc-ci comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). according to receiver operating characteristic (roc) analysis, ivc-ci is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the roc curve for ivc-ci was 0.05. conclusions. ivc-ci is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. more trials, including different patient subgroups, will be needed Show More ... ... Show Less

  • Spinal Anaesthesia
  • Spontaneously Breathing
  • Collapsibility Index
  • Inferior Vena Cava
  • Severe Hypotension
Prospective Paediatric Intensive Care Registry In Latvia: One Year Outcomes

background. in latvia, there is a single eight-bed paediatric intensive care unit (picu) where all critically ill children are admitted. a recent retrospective audit of the outcomes of paediatric critical care in this unit revealed a high number of unplanned extubations and excess crude mortality. in 2017, our centre joined the uk and ireland based paediatric intensive care audit network (picanet) as a pilot project to investigate the feasibility of developing a paediatric critical care registry in latvia and in the baltic states. methods. riga stradins university ethics committee approved the study. anonymized data on all patients admitted to our unit from 1 june, 2017 to 31 may 2018 were prospectively entered onto the picanet database. results. a total of 774 picu admissions were analysed; 45% of admissions were elective. the median age was 59 months (iqr: 14–149). the highest admission rate was on wednesdays representing the flow of elective surgical patients. the median length of stay was 0.95 days (iqr: 0.79–1.98). twenty-five percent required respiratory support. the expected number of deaths estimated using the paediatric index of mortality 3 (pim 3) 15.16; 15 patients (1.94%) died resulting in standartized mortality ratio (smr) of 0.99 (95% ci 0.57–1.60). the emergency readmission rate within 48 hours after picu discharge was 0.9%. there were 1.8 unplanned extubations per 100 invasive ventilation days. other paediatric intensive care audit networks reported similar adjusted mortality rates but lower rates of unplanned extubations. thirty days after picu discharge, 653 (84.36%) patients were alive and outside hospital, 98 (12.66%) were inpatients, six (0.78%) had died, two (0.26%) were lost to the follow-up. we observed a marked peak of infant emergency respiratory admissions in february. conclusions. this project explored the possibility of prospective paediatric critical care audit in latvia by joining an established international network. this allowed direct comparison of outcomes between the countries. excess mortality was not observed during one-year data collection period, however a high rate of unplanned extubations was revealed. the results allowed a better planning of elective patient flow by spreading elective cases over the week to avoid “rush hours Show More ... ... Show Less

  • Paediatric Intensive Care
  • Unplanned Extubations
  • Paediatric Critical Care
Patient Feedback On Medical Students In Tertiary Health Care: Are Medical Students Accepted In Clinical Practice

background. clinical teaching is central in the training of medical students. although medical studies without practice are hard to imagine nowadays, for most patients this type of learning is still difficult to understand and not always acceptable. materials and methods. a prospective anonymous survey of 150 participants was carried out. participants were patients at the surgery department of the kauno klinikos hospital of the lithuanian university of health sciences. the questionnaire comprised 12 questions: the first two on the patients’ personal information and the rest about the patients’ opinion about medical students. statistical analysis software ibm spss statistics 23.0 was used for statistical data analysis. a statistically significant difference was observed when p < 0.05. results. seventy-eight per cent of patients would allow medical students to be present during their surgery; 78.7% would permit medical students help the anaesthetic team with procedures; 79% responded that students were not introduced, and 21.3% stated that they were informed about students’ involvement for learning purposes. the majority of the respondents (62%) answered that the main advantage was additional practical skills. talking about disadvantages, 25% of the respondents thought that students were not professional enough, 6% were worried about an overcrowded operating theatre, yet the majority of patients (69%) did not worry about this. conclusions. the majority of patients would agree with the involvement of medical students in their surgical operations and induction of anaesthesia. the patients pointed out that the general reason for their concern over surgical operations was that the students were not professional enough and did not have required skills. most patients thought that involving students in their surgical operations did not have negative influence on surgery quality Show More ... ... Show Less

  • Medical Students
  • Surgical Operations
  • Health Care
  • Significant Difference
  • Statistical Analysis Software
Values Of Circulating Molecular Biomarkers (Micrornas) For The Evaluation Of Renal Failure During Urgent Abdominal Sepsis Anaesthesia

background. micro-ribonucleic acids (mirnas) are small non-coding molecules important for gene regulation and management of physiological processes (1). alterations in the expression of mirnas are potential novel biomarkers for many diseases (2). materials and methods. random patients who underwent emergency surgery for abdominal sepsis were enrolled into the study (n = 27). patients were divided into three groups according to the renal function and into two groups depending on the presence or the absence of lethal outcomes during the hospitalization period. relative expression levels of circulating serum mir-30d-5p, mir-23a-3p, mir-146a-5p were assessed with real-time quantitative polymerase chain reaction using the 2–δδct method and compared between the groups. results. expression levels of all three mirnas did not differ significantly between patients with acute renal failure (arf) (n = 8), chronic renal failure (crf) (n = 8), and with a normal renal function (nrf) (n = 11). estimated glomerular filtration rates (egfr) were significantly lower (p = 0.016), the values of urea (p = 0.007) and red blood cell distribution width (rdw) (p = 0.001) were significantly higher in septic patients who died, but no significant correlation between rdw values and expression of mirnas was found. conclusions. the expression levels of serum mir-30d-5p, mir-23a-3p, mir-146-5p did not significantly differ between three groups of patients who developed arf, had crf, or retained nrf. no significant association between the rdw value and expression of mirnas was noted Show More ... ... Show Less

  • Renal Failure
  • Expression Levels
  • Renal Function
  • Abdominal Sepsis
  • Time Quantitative Polymerase Chain Reaction
ECCO2R As A Bridge To A Decision In Type II Respiratory Failure

introduction. end-of-life decisions are often time consuming and difficult for everyone involved. in some of these cases extracorporeal life support systems could potentially be used not only as a bridge to treatment but as a tool to buy time to allow patient’s participation in decision making and to avoid further futile invasive procedures. case report. a previously healthy 53-year-old female patient presented with respiratory failure of unknown cause. in the course of treatment her condition was deemed irreversible and the only option for any chance of long-term survival was a lung transplant. during this whole time the patient’s condition was managed with extracorporeal carbon dioxide removal system (ecco2r). she remained compos mentis and expressed the wish to stop all the treatment as the option of lung transplant was not acceptable to her. treatment was withdrawn and she passed away. discussion. in cases of end-of-life decisions, time can play an essential role. even though extracorporeal life support systems have been conceptualised to be a bridge to treatment, they could be beneficial in a situation when time is needed to make a decision. ecco2r has been used as a treatment method in different settings, however, in this case it served as a tool to maintain the patient alive and conscious for a sufficient time for her to participate in decision making. conclusions. our case report demonstrated that ecco2r could serve as a bridge to decision in situations when time is limited and the decisions that need to be made are difficult Show More ... ... Show Less

  • Decision Making
  • Case Report
  • Respiratory Failure
  • End Of Life
  • Lung Transplant
Pain Management In Intensive Care Unit Patients After Cardiac Surgery With Sternotomy Approach

background. postoperative pain is a common problem among intensive care patients. pain management includes pain assessment and documentation, patient care, and pharmacological treatment. materials and methods. the study used a prospective, cross-sectional design. nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. toronto pain management inventory was used to assess nurses and the 2010 revised american pain society patient outcome questionnaire was used to assess the patients. a research protocol was used to document pharmacological treatment data and visual analog scale (vas) pain measurements. the pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients. results. postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). pain intensity had a tendency to decrease over time, from a mean vas score of 4.66 two hours after extubation to a mean vas score of 3.12 twelve hours after extubation. mostly opioids (100%) and nonsteroidal anti‑inflammatory drugs (nsaids, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses’ pain knowledge was average (x = 60.6 ± 7.3%). conclusions. an individualized pain management plan requires pain documentation and ensures high patient satisfaction. pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high Show More ... ... Show Less

  • Intensive Care
  • Pain Management
  • Cardiac Surgery
  • Patient Satisfaction
  • Pharmacological Treatment
Prophylactic Anti-Coagulation After Severe Burn Injury In Critical Care Settings

background. severely burnt patients are at an increased risk of thromboembolic complications, hence sufficient prophylactic anticoagulation is of paramount importance. local guidelines at the burns centre in the queen elizabeth hospital, birmingham therefore advise increasing the standard dose of low molecular weight heparin in these patients. an audit was carried out to assess the current practice in burns patients to ensure adequate anticoagulation and adherence to guidelines. materials and methods. retrospective data was collected on all burns patients in the burns centre over a two-year period. the main objectives were to assess: • anticoagulation regimes prescribed to severe burns patients • monitoring of anti-factor xa levels • adjustment of dosing based on the results the locally produced trust guidelines were used as the comparator. results. all burns patients were prescribed anticoagulation, but often the dose was not increased as suggested in the guidelines. although most of the severely burnt patients were prescribed adjusted higher doses of anti-coagulation, only 60% of these patients were monitored with anti-factor xa assays. of these assays, 66% showed sub-prophylactic levels. the majority of results led to the adjustment of the dose of anticoagulant. however, often dose changes were made late. discussion and conclusions. the audit confirmed the need for increased doses of prophylactic anticoagulation in severe burns. the better adherence to the guidelines can be achieved by additional training and implementation of decision support via electronic prescribing system Show More ... ... Show Less

  • Factor Xa
  • Severe Burns
  • Prophylactic Anticoagulation
  • Severe Burn Injury
  • Higher Doses
Long-Term Quality Of Life And Posttraumatic Stress Following Elective Cardiac Surgery: Preliminary Findings Of A 5-Year Follow-Up Study

background. heart surgery is a major stressful event that can have a significant negative effect on patients’ quality of life (qol) and may cause long-term posttraumatic stress reactions. the aim of this pilot study was to estimate the longitudinal change and predictors of health-related quality of life (hrqol) dynamics and identify factors associated with pts at 5-year follow-up (t2) after elective cardiac surgery and associations with pre-surgery (t1) qol. materials and methods. single-centre prospective study was conducted after regional bioethics committee approval. adult consecutive patients undergoing elective cardiac surgery were included. hrqol was measured using the medical outcomes study 36-item short-form health survey (sf-36) questionnaire before (t1) and 5-years after (t2) cardiac surgery. posttraumatic stress was assessed using the international trauma questionnaire. results. the pilot study revealed a significant positive change at 5-year follow-up in several domains of sf-36: physical functioning (pf), energy/fatigue (e/f), and social functioning (sf). prolonged postoperative hospital stay was associated with change in sf (p < 0.01), e/f (p < 0.05) and emotional well-being (p < 0.05). the percentage of patients that had the posttraumatic stress disor. der (ptsd) at t2 was 12.2%. posttraumatic stress symptoms were associated with longer hospitalization after surgery (p < 0.01). conclusions. hrqol improved from baseline to five years postoperatively. patients with lower preoperative hrqol scores tended to have a more significant improvement of hrqol five years after surgery. a prolonged postoperative hospital stay had a negative impact on postoperative social functioning, energy/fatigue, and emotional well-being. increased levels of ptsd were found in cardiac surgery patients following five years after the surgery Show More ... ... Show Less

  • Posttraumatic Stress
  • Quality Of Life
  • Follow Up
  • Elective Cardiac Surgery
Association Between Serum Biomarkers And Postoperative Delirium After Cardiac Surgery

background. in cardiac surgery, patients face an increased risk of developing postoperative delirium (pod) that is associated with poor outcomes. neuron-specific enolase (nse) and glial fibrillary acidic protein (gfap) have shown some promising results as potential tools for pod risk stratification, diagnosis, monitoring, and prognosis. methods. prospective single-centre study enrolled 44 patients undergoing elective coronary artery bypass grafting (cabg) and/ or valve procedures using cardiopulmonary bypass (cpb). the patients were assessed and monitored preoperatively, during surgery, and in the early postoperative period. the blood levels of nse and gfap were measured before and after surgery. the early pod was assessed by cam-icu criteria and patients were assigned to the pod group (with pod) or to the npod group (without pod) retrospectively. results. the incidence of pod was 18.2%. after surgery, nse significantly increased in the whole sample (p = 0.002). comparing between groups, nse significantly increased in the pod group after surgery (p = 0.042). δgfap (before/after operation) for the whole sample was statistically significant (p = 0.022). there was a significant correlation between δgfap and the lowest map during surgery in the pod group (p = 0.033). conclusions. our study demonstrated that nse and gfap are associated with early pod. an increase in nse level during the perioperative period may be associated with subclinical neuronal damage. serum gfap levels show the damage of glial cells. further studies are needed to find the factors influencing the individual limits of optimal map during surgery Show More ... ... Show Less

  • Cardiac Surgery
  • Postoperative Delirium
  • Cardiopulmonary Bypass
  • Factors Influencing
  • Increased Risk
Trends Of Basal Cell Carcinoma At The Centre Of Dermatovenereology Of Vilnius University

introduction and objectives. basal cell carcinoma is the most common locally invasive malignant epidermal neoplasm in humans and its incidence has increased over the last decades worldwide, especially among the caucasian population. basal cell carcinoma accounts for about 75% of all skin cancers. incidence data on basal cell carcinoma is sparse because traditional cancer registries often do not register these tumours. in lithuania, patients with skin cancer and melanoma were traditionally treated in centralized oncological institutes. from 2006, the centre of dermatovenereology at vilnius university hospital santaros klinikos (vilnius, lithuania) provides modern diagnostic and treatment facilities to oncodermatological patients. the objective of the study was to evaluate epidemiological and clinical data of basal cell carcinoma at the centre of dermatovenereology during the last 15 years. materials and methods. medical documentation of the cases of histologically-proven basal cell carcinoma diagnosed between 2000 and 2015 was analyzed. epidemiological and clinical evaluation according to the patients’ age, sex, and place of residence, as well as tumour localization, its histological type, and treatment options was performed. results. after the skin lesion biopsy and histopathological examination, a total of 847 basal cell carcinomas were confirmed to 782 patients. during the study period, the total annual number of newly diagnosed basal cell carcinomas rose steadily in our centre: 2.7% between 2000 and 2003, 6.5% between 2004 and 2006, 13.6% between 2007 and 2009, 27.6% between 2010 and 2012, and 49.6% between 2013 and 2015. the biggest part of patients (28.4%) were 70–79 years old, 4.6% – younger than 40, 7.3% – 40–49, 17.1% – 50–59, 27.2% – 60–69, 14.1% – 80–89, and 1.3% ≥90 years old. the average patient age was 66.0 (±13.6). of these patients, 62.0% were female and 38.0% male; 63.6% were from the capital city, 18.3% from other cities, and 18.2% from rural areas. basal cell carcinomas occurred most often in the face region 49.0%, followed by the trunk – 29.4%, the scalp and neck – 10.9%, arms and legs – 7.7%, in 2.9% location was not specified and the whole body – 0.1%. the predominant histological type of basal cell carcinomas was nodular (60.6%), other diagnosed types were superficial (22.9%), infiltrative/morpheaform (8.0%), mixed nodular and infiltrative (1.7%), pigmented (0.2%), rare types (micronodular, infundibulocystic, ductal and mixed) – 0.6%; the type was not specified in 6.0% of cases. nodular, superficial, and infiltrative types were the most common morphological types in all body sites: respectively, in the face – 67.5%, 12.5%, 9.4%; in the scalp and neck region – 77.2%, 14.1%, 5.4%; in the trunk – 49.8%, 37.3%, 7.2%; in extremities – 41.5%, 43.1%, 7.7%. the nodular type was more common among the elderly and its incidence increased with age (p = 0.009), meanwhile, superficial basal cell carcinomas prevailed among younger patients Show More ... ... Show Less

  • Basal Cell Carcinomas
  • Histological Type
Gastric Antral Vascular Ectasia Should Not Be Overlooked In Erythropoietin Resistance: A Series Of Case Reports

background. gastric antral vascular ectasia (gave) is currently recognized as an important cause of upper gastrointestinal (gi) haemorrhage, being responsible for about 4% of non-variceal upper gi haemorrhages and typically presents in middle-aged females. gave, also called “watermelon stomach”, is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum. the pathogenesis is still obscure and many hypotheses have been proposed such as mechanical stress, humoral and autoimmune factors. in the last two decades, numerous therapeutic strategies have been proposed, including surgical, endoscopic, and medical choices, yet successful treatment of gave continues to be a challenge. currently, given the rapid response, safety, and efficacy, endoscopic ablative modalities have largely usurped medical treatments as first-line therapy, particularly using argon plasma coagulation. the actual gave prevalence in patients with end-stage renal disease (esrd) is not clear, yet in difficult cases it should be considered as a cause of erythropoietin resistance. case presentation. we report four clinical cases of gave syndrome patients diagnosed with stage 4 to 5 chronic kidney disease. all patients presented with anaemia and gi haemorrhage, the origin of which turned out to be gave syndrome. conclusions. gave syndrome is a serious condition in esrd patients, especially in those presenting with treatment-refractory anaemia. realization of its aetiology and characteristics is essential to suspect, diagnose, and treat gastric ectasia. only proper diagnosis and well-timed disease treatment can significantly improve a patient’s medical condition and future prognosis Show More ... ... Show Less

  • Gastric Antral Vascular Ectasia
  • Erythropoietin Resistance
  • Difficult Cases
  • Upper Gastrointestinal
Sternal Resection Of A Solitary Renal Cell Carcinoma Metastasis: A Case Report And A Literature Review

background. renal cell carcinoma (rcc) may be metastatic, although solitary sternal metastasis of rcc is a rare medical condition. here we report an unusual case of a 63-year-old male with a solitary sternal metastasis as an initial presentation of clear-cell renal cell carcinoma. materials and methods. a 63-year-old male presented with a small sternal mass. chest computer tomography (ct) and a biopsy from the sternal tumour were performed. histopathological examination revealed the diagnosis of renal clear cell carcinoma metastasis to the sternal bone. on the basis of a subsequently performed abdominal ct the patient was confirmed with a suspicion of a left renal lower pole tumour. treatment with sunitinib was initiated. due to the limited response and a growing sternal mass, the patient was admitted to the national cancer institute after two cycles of sunitinib therapy. open left partial nephrectomy was performed followed by the resection of the sternal metastasis two months later. the chest wall was reconstructed with polypropylene mesh combined with transversal rectus abdominis musculocutaneous flap. results. the postoperative course after the partial nephrectomy was uneventful. the postoperative course of metastasectomy complicated with the right pneumothorax which was successfully treated by insertion of a chest tube. bleeding from the upper digestive tract also occurred on the seventh postoperative day but was successfully controlled by haemostasis with three 20 ml endoscopic injections of 1:10,000 solution of epinephrine. the patient had been followed up after the surgery for 30 months with biannual chest and abdominal ct scans that showed neither local nor distant recurrence of the disease. conclusions. radical surgical treatment of a solitary renal clear cell carcinoma metastasis may offer the best cancer-specific outcomes and improve the quality of life in some patients Show More ... ... Show Less

  • Renal Cell Carcinoma
  • Clear Cell
  • Carcinoma Metastasis
Angina Pectoris And Sinus Of Valsalva Aneurysm: A Rare Manifestation Of An Uncommon Disease

sinus of valsalva aneurysm is an uncommon finding. the present paper describes a case report of a 57-year-old female patient who developed angina pectoris due to the left sinus of valsalva aneurysm. clinical presentation, localization, unruptured status and concomitant coarctation of the aorta make the case presented in this document extremely rare and interesting. current knowledge about the disease is briefly discussed Show More ... ... Show Less

  • Sinus Of Valsalva Aneurysm
  • Angina Pectoris
  • Case Report
  • Left Sinus Of Valsalva
Systemic And Local Inflammation In Colorectal Cancer

background. colorectal cancer (crc) is the third most common cancer in the world. the cornerstone of crc treatment is surgical resection. however, patients in the same tnm stage show different recurrence rates and survival. of patients with a local disease without lymph node or a distant metastasis, 20–25% still develop recurrence. there is evidence that inflammatory reaction is one of the key elements in tumour development. materials and methods. we reviewed literature on colorectal cancer and its relationships with the immune system, with special focus on local and systemic inflammatory reaction. the pubmed and clinicalkey databases were searched using the key words colorectal cancer, local inflammation, systemic inflammation, markers of inflammation. the relevant literature was reviewed and included in the article. results. the immune system has two-sided relationships with cancer, so it not only performs anti-tumour activities, but can also promote tumour growth and spread. research has shown that signs of local inflammation are associated with a better prognosis in crc. systemic inflammation has been associated with more aggressive behaviour and a worse prognosis for patients with several cancers, including crc. conclusions. recent findings in tumour biology have improved our understanding of colorectal cancer and of the natural course of this disease. several markers of local and systemic inflammatory reaction have been identified. the next step is to find the most accurate and applicable marker, so that this promising tool can be used in clinical practice and aid in decision making Show More ... ... Show Less

  • Colorectal Cancer
  • Inflammatory Reaction
  • Local Inflammation
  • Immune System
  • Systemic Inflammation
Uterine Sarcoma: A Clinical Case And A Literature Review

background. uterine sarcomas are rare gynaecologic tumours representing 3–7% of all uterine malignancies. the aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. presenting symptoms are vague and nonspecific. usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. the diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. if there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination. materials and methods. we present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. from a past medical history it was known that previously the patient had been diagnosed with uterine myoma. transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. the patient refused urgent hysterectomy, that was advised to her. the patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. postoperative histological evaluation showed undifferentiated sarcoma uterus pt1b l/v0. imaging modalities were made to evaluate possible dissemination of the disease. in the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors. results and conclusions. uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3–7% of all malignant uterine tumours. imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. it is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. the low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates Show More ... ... Show Less

  • Imaging Modalities
  • Clinical Case
  • Uterine Sarcomas
  • Uterine Tumour
Evaluation Of Quality Of Life After Paediatric Cochlear Implantation

background. cochlear implantation (ci) is the main treatment method for deaf children. ci influences not only communication, but also psychosocial outcomes in children with severe to profound hearing loss. focusing on issues specific to ci (e.g., self-reliance, social relations, education) may provide a more accurate and relative view of functional status of paediatric cochlear implant users. the objectives of this study were to translate into lithuanian and adapt an international questionnaire of the quality of life after cochlear implantation and to evaluate parental perspectives regarding ci and the child’s progress after a minimum of two years after surgery. materials and methods. the parental questionnaire the children with cochlear implants: parental perspectives ccipp was used to evaluate the quality of life following cochlear implantation. the questionnaire includes 74 items covering two main domains: decision-making (26 items) and the outcomes of implantation (48 items). quality of life is estimated according to the scores of eight sub-domains: communication, general functioning, well-being, self-reliance, social relations, education, effects of implantation, and supporting the child. results. the paediatric sample consisted of 11 (39%) girls and 17 (61%) boys, whose mean age at the time of cochlear implantation was 2.41 ± 2.25 years, mean duration of the implant use 3.7 ± 1.3 years. all the grand means in the outcomes of implantation domain exceeded 3 on the 5-point scale, meaning that parents viewed the quality of life of their children as either average or better. parents rated the sub-domains of communication (3.90 ± 0.77 points), social relations (4.05 ± 0.41), and supporting the child (3.89 ± 0.49) most positively. conclusions. according to parents, the quality of life improves after the cochlear implantation, especially in the fields of communication, social relations and supporting the child Show More ... ... Show Less

  • Quality Of Life
  • Cochlear Implantation
  • Social Relations
  • Self Reliance
Is The Trendelenburg Position The Only Way To Better Visualize Internal Jugular Veins

background. a larger cross-sectional area (csa) of the internal jugular vein (ijv) makes catheterization easier and the trendelenburg position is used to achieve this. unfortunately, it is not comfortable for conscious patients. the aim was to evaluate the impact of alternative manoeuvres on the enlargement of the csa of the ijv and to compare these manoeuvres with the trendelenburg position. materials and methods. a prospective study of 63 healthy volunteers was conducted. two-dimensional ultrasound images of right ijv (rijv) and left ijv (lijv) were recorded at the level of the cricoid cartilage in the supine position with and without head rotation by 30 degrees during various manoeuvres. results. the csa of the rijv and the lijv significantly increased using hold of deep breath (mean size (cm2) rijv 1.59 ± 0.82, lijv 1.07 ± 0.64; both p < 0.001) and the trendelenburg position (mean size (cm2) rijv 1.5 ± 0.68, lijv 0.99 ± 0.54; both p < 0.001). the 45-degree passive leg raise increased the csa of only the rijv (mean size (cm2) 1.17 ± 0.61, p = 0.024). these manoeuvres were compared with the trendelenburg position. there was no significant difference in the size of the csa using hold of deep breath on the lijv (p = 0.08) and the rijv (p = 0.203). the passive leg raise had a significantly weaker impact on the size of the csa (p < 0.001 for both sides). conclusions. hold of deep breath and 45-degree passive leg raise (the latter limited for the right side only) are alternative manoeuvres to improve visualization of internal jugular veins for conscious patients. hold of deep breath was as effective as the trendelenburg position Show More ... ... Show Less

  • Trendelenburg Position
  • Deep Breath
  • Mean Size
  • Passive Leg Raise
  • Internal Jugular Veins
Outcomes Of A Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting In Octogenarians

background. the data on long-term outcomes for elderly patients with coronary artery disease who undergo invasive treatment is limited. this study aimed to assess long-term outcomes and risk factors for patients over 80 years of age who underwent revascularisation. methods. this single-centre retrospective study included ≥80-year-old patients who underwent coronary angiography between 2012 and 2014. among 590 study patients, 411 patients had significant angiographic changes and had either a percutaneous coronary intervention (pci) or coronary artery bypass grafting (cabg) performed. baseline patient characteristics, including demographics, comorbidities, survival to hospital discharge, and long term mortality were analysed. three-year mortality was assessed. results. three hundred sixty-nine (89.8%) patients underwent pci and in 42 (10.2%) cabg was performed. significant differences between groups were detected in heart failure (pci – 51.2% vs. cabg – 78.6%; p = 0.001), previous cabg (11.4% vs. 0%; p = 0.014), cardiogenic shock (12.2% vs. 0%; p = 0.008). hospital mortality rate in the pci group – 10.6%, cabg – 7.1%; p = 0.787. a median 3-year survival rate in the pci group – 66.1%, cabg – 66.7%; p = 1.000. chronic heart failure (or 2.442; 95% ci: 1.530–3.898, p < 0.001), atrial fibrillation (or 0.425; 95% ci: 0.261–0.692, p < 0.001), cardiogenic shock (or 0.120; 95% ci: 0.054–0.270, p = 0.001), and lmca stenosis (or 2.104; 95% ci: 1.281–3.456, p = 0.003) were identified as independent 3-year all-cause mortality predictors in multivariate regression analysis. conclusions. there was no significant difference in hospital mortality and survival rates between elderly patients who underwent pci or cagb. the majority of elderly patients underwent a pci and these patients appeared to experience cardiogenic shock more frequently Show More ... ... Show Less

  • Coronary Artery
  • Elderly Patients
  • Cardiogenic Shock
  • Long Term
  • Heart Failure
Survival And Time Interval From Surgery To The Start Of Chemotherapy For Patients With Stage II And III Colon Cancer

background. usually adjuvant chemotherapy is started within 12 weeks of surgery, but the evidence on the commencing time is lacking. our aim was to investigate the association of initiating post-surgery treatment within six weeks vs. six to ten weeks vs. more than ten weeks with survival. methods. we analysed the association of treatment and its timing with survival among patients who were diagnosed and underwent surgery for stage ii or iii colon cancer from 2012 to 2013 at the national cancer institute, lithuania. results. of the 86 patients, 78% were still alive on december 31, 2013. patients who received chemotherapy within six weeks after surgery were more likely to survive. however, those who received chemotherapy 6–10 weeks after surgery had better survival (p – 0.014, hazard ratio 0.80, 95% ci 0.60–0.99) than those who began chemotherapy treatment more than ten weeks after surgery (p – 0.173 hazard ratio 0.55, 95% ci 0.12–0.99) conclusions. the results from this study show that optimal timing of adjuvant chemotherapy for patients with resected colon cancer within six weeks and associated with better survival Show More ... ... Show Less

  • Colon Cancer
  • Adjuvant Chemotherapy
  • Hazard Ratio
  • Stage Ii
  • Post Surgery