Medicina, Volume 43, Issue 2 (February 2007) – 10 articles

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome.
Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively.
Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died.
Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common. Full article

The aim of this work was to assess the quality of pharmacological treatment in patients within one year after acute myocardial infarction.
Material and methods. We performed a prospective survey of 985 consecutive patients with acute myocardial infarction who were treated in the Clinic of Cardiology of Kaunas University of Medicine Hospital in 2004. About half of patients were hospitalized from different regions of Lithuania. According to the follow-up protocol, an information on 514 patients and their used treatment within 13.8±3.2 months after myocardial infarction were collected by letter with questionnaire.
Results. Beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotic drugs were the most drug used (76%, 74%, and 76%, respectively) in patients following myocardial infarction. Most of the patients used a three-drug combination (36.8%), more rarely – two-drug (24.1%) or four-drug complex (19.8%). One drug was used only in 12.1% of cases; 7.2% of patients did not use any cardiac drugs. Betaadrenoblocker with angiotensin-converting enzyme inhibitor was the most common (40.3%) used drug combination in patients on two drug complex. The combination of beta-adrenoblocker, angiotensin-converting enzyme inhibitor, and antithrombotics was more frequently used in patients on three drug complex. The combination of two or three cardiac drugs with statin was used in several cases (1.6–10.3%).
Conclusions. These findings underscore that the use of beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotics was high (about 75%) in patients during the first year after myocardial infarction, and the combination of these three drugs was used more commonly. The discordance between existing guidelines for statin use after myocardial infarction and current practice was determined in patients following myocardial infarction. Full article

Increasing alcohol consumption becomes more relevant social and health problem among youth. There is no reason to believe that this problem will decrease or be solved in the future. In such situation, it is necessary to build on the experience and conclusions of research performed by other countries. In this article, the risk factors for alcohol consumption among youth and preventive programs, in which family, school, and community play the main role, are analyzed. Such programs may attract the attention of public health specialists and public health politicians and can be not only declared, but also really implemented. Full article

Objective. The aim of this study was to determine atrial structural remodeling during the development of ischemic heart disease.
Material and methods. Quantitative histomorphometric parameters of interstitial collagen network (the percentage volume, perimeter, number of fibers per field and collagen–cardiomyocyte volume ratio) of the atria of 132 autopsied men (mean age 49.7±8.9 years) who had died suddenly (within 6 hours since the onset of terminal heart attack symptoms) due to the first (no postinfarction scars) and repeated (postinfarction scars present) acute “pure” ischemic heart disease were investigated.
Results. The main remodeling feature of the wall of the both atria among ischemic heart disease subjects is hypertrophy of cardiomyocytes and hyperplasia of interstitial fibrillar collagen network with the maintenance of the same proportion of contractile myocardium and fibrillar collagen network volume. This proportion in the case of the left atrium persists in both pre- and postinfarction ischemic heart disease groups, while myocardium of the right atrium in preinfarction group subjects is characterized by an excess increase of collagen network as compared to cardiomyocyte hypertrophy, which levels again with that of the control in postinfarction group.
Conclusions. At preinfarction stage of ischemic heart disease, remodeling of both atria develops and progresses in the left atrium at postinfarction stage in the relationship with increase of left ventricular dysfunction. Full article

The objective of this study was to evaluate and compare operative and postoperative results and differences among laparoscopic, vaginal, and abdominal hysterectomies performed at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital.
Methods. A retrospective review of medical histories was performed for women who had undergone three different types of hysterectomies (laparoscopic, vaginal, and abdominal) at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital during 2004–2005.
Results. A total of 602 hysterectomies were performed: 51 (8.5%) laparoscopic, 203 (33.7%) vaginal, and 348 (57.8%) abdominal. The lowest complication rate occurred in patients who underwent laparoscopic hysterectomy (n=5, 9.8%) and the highest – abdominal hysterectomy (n=88, 25.2%) (P<0.05). More complication occurred after abdominal as compared to vaginal hysterectomy (n=88, 25.2% vs. n=20, 9.9%, respectively; P<0.05). There was no statistically significant difference in complication rate comparing laparoscopic and vaginal hysterectomies (P=0.26). The amount of blood loss depended on the type of hysterectomy – less blood was lost during laparoscopic and more during abdominal hysterectomy (123.4 vs. 308.5 mL, respectively; P<0.01). A significantly higher blood loss was observed during abdominal hysterectomy as compared to vaginal (195.3 mL) and vaginal as compared to laparoscopic hysterectomy (P<0.01). The mean length of hospital stay differed comparing all three types of hysterectomies: the shortest stay of 8.6 days was after laparoscopic, the longest of 13.7 days – after abdominal hysterectomy. The mean hospital stay was statistically significant shorter for vaginal hysterectomy compared to abdominal hysterectomy (9.1 vs. 13.7 days, P<0.01). The difference in mean length of hospital stay was insignificant comparing laparoscopic and vaginal hysterectomies (P>0.05). Conclusions. Abdominal hysterectomy was the most common procedure performed. The type of hysterectomy influenced the rate of complications – the lowest complication rate was after laparoscopic and vaginal hysterectomies. The amount of blood loss depended on the type of hysterectomy – the lowest was during laparoscopic hysterectomy. Abdominal hysterectomy required on average a longer hospital stay compared with laparoscopic and vaginal hysterectomies. Full article

Cerebral edema is a life-threatening condition that develops as a result of an inflammatory reaction. Most frequently, this is the consequence of cerebral trauma, massive cerebral infarction, hemorrhages, abscess, tumor, allergy, sepsis, hypoxia, and other toxic or metabolic factors. At present, the following types of cerebral edema are differentiated: the vasogenic cerebral edema resulting from an increased permeability of the endothelium of cerebral capillaries to albumin and other plasma proteins; the cytotoxic cerebral edema resulting from the exhaustion of the energy potential of cell membranes without damage to the barrier; the hydrostatic cerebral edema resulting from disturbance of the autoregulation of cerebral blood circulation; the osmotic cerebral edema resulting from dilution of blood; and the interstitial cerebral edema resulting from acute hydrocephaly. Some authors also differentiate ischemic cerebral edema. At present, when various traumas and traumatic cerebral injuries are frequent causes of death in young people, treatment strategy for cerebral edema is of utmost importance. Monitoring of the patient’s condition in the intensive care unit is a necessity. It is important to ensure proper positioning of the patient – the head should be tilted at 30o in order to optimize the cerebral perfusion pressure and control of the increase in intracranial pressure. Hyperventilation should be applied. Controlled hypothermia decreases the rate of metabolism in the brain. Slightly positive fluid balance should be maintained using crystalloid or colloid (hypertonic–hyperoncotic) solutions, at the same time maintaining cerebral perfusion pressure exceeding 70 mmHg. The treatment includes administration of antihypertensive medications, nonsteroidal antiinflammatory drugs, and barbiturates. Steroids decrease the permeability of capillaries and the hemato-encephalic barrier, promoting the movement of Na+/K+ ions and water through the main endothelial membrane, and therefore they are used in the treatment of vasogenic cerebral edema as well as edema caused by a cerebral tumor. Glutamate and N-methyl-D-aspartate receptor antagonists improve cerebral microcirculation and metabolism. Trometamol corrects cerebral acidosis. Extended cerebral edema is treated surgically via a bilateral decompressive craniotomy, sometimes including craniotomy of lateral and posterior fossae. The treatment of cerebral edema is complex, and positive results may be expected only if the diagnosis and the provision of assistance are timely. Full article

Objective. To assess parental attitudes and knowledge about children’s vaccination. Methods. In this study, 20 day-care centers, 25 schools, and 6 health centers were randomly selected in Vilnius, and an anonymous survey of 2743 parents was conducted. Females made up 85.2% of all respondents, males –14.8%; the mean age was 35.7 years.
Results. Two-thirds of respondents (66.7%) agreed that vaccines for children’s immunization are safe; 80.7% stated that vaccination is more beneficial than harmful. Only 16.9% of parents indicated that vaccines cause adverse events more frequently than other medical treatment, 62.7% that vaccines are amongst the most effective and least costly forms of medical treatment, and 35.9% that vaccines always warrant protection. Majority of parents agreed that children’s vaccination is essential (89.0%), and children should be vaccinated regularly according schedule (88.6%). Only 30.1% of respondents agreed with the idea of taking a newly developed vaccine even if it has been carefully tested for safety; 42.3% of respondents could afford to pay for nonreimbursed vaccines. On an average, 38.0% of respondents know that they should be revaccinated every 10 years against diphtheria and tetanus, 61.3% have never been vaccinated against influenza. The main sources of information on vaccination are medical institutions (92.2%), print media (38.1%), and broadcast media (38.2%).
Conclusions. While most of respondents can be characterized as having a positive opinion about vaccination, 20–40% of respondents indicated insufficient knowledge on this issue. For implementing the new vaccines, communication efforts should focus on clarifying correct parental beliefs about immunization. Vaccines for child should be reimbursed on the same basis as other medical treatment. Vaccination of adult and risk groups should be emphasized in the national vaccination program. Full article

The aim of the study was to determine the prevalence and the frequency of the usage of alcohol (ethanol), tobacco, and other addictive substances and the amounts of such substances consumed among male and female students. The study was performed by applying a questionnaire consisting of 26 standard questions for the evaluation of the respondents’ health and health-related behavior (A. Goštautas, 1999). This article analyzes students’ answers to the questions related to their attitude towards smoking, consumption of alcoholic beverages, the consumed amounts of addictive substances, and the frequency of the usage of such substances. One question was dedicated to the consumption of addictive substances other than tobacco or ethanol. The study included 1475 first- through fourth-year students (713 males and 762 females) from five faculties of the Lithuanian University of Agriculture. This comprised 70% of all students targeted for the inquiry. The obtained results showed that more males, compared to females, used ethanol (89.7% and 79.7%, respectively), smoked (54.7% and 29.1%, respectively), and had tried other addictive substances (35.0% and 16.7%, respectively). More males than females every day or several times per week used ethanol (45.7% and 18.2%, respectively), smoked (43.5% and 29.2%, respectively), and had tried other addictive substances more than once (22.8% and 6.3%, respectively). The prevalence of the usage of ethanol, tobacco, and other addictive substances changed little throughout the four years of studies. The indices of the usage of addictive substances among students were similar to those in the general population. Full article

Objective. To reveal the peculiarities of medical sociology introducing the application of social theories in analyzing public health and medicine. Methods. Comparative and descriptive analysis of scientific references found and current situation.
Results. During the last decade of the 20th century, the discussions about the sociology of health and medicine as separate discipline and its practical applications became more active. Main factors determined the growing importance of discipline were institutionalization of medicine and health care, changing patterns in doctor-patient relationships, different health perceptions, understanding of the influence of social factors on health, cardinal changes in the area of health technologies, consumeristic attitude towards health, appearance of market relationships within health care, and other global phenomena. In sociology, usual social theories such as structural functionalism, conflict, symbolic interaction, poststructuralism, feminist often attempt to explain the changes within health care. There is a relation of medical sociology and other types of sociology having common areas with medicine and health being analyzed in the article; social theories and their application in the field of health and medicine are being introduced attempting to explain the ongoing social changes in both Lithuania and the world.
Conclusions. More and more attention in various areas of medical activities is being paid to the social aspects (both individual and society levels) of these activities, and there is a shift from applied sociology towards medical one. Despite the cessations of the development of medical sociology as separate branch of sciences, the researches of recent years are demonstrating obvious approaching modern research issues and methods, which do exist in contemporary world. Such tendencies show the prompt approaching of the academic community of Lithuania the general scientific standards which are dominating in the globalization-effected world. Full article

The article reviews the recent scientific literature and the authors’ studies on this topic. Occupational conditions and psychological factors have been shown to play an important role in the etiopathogenesis of cardiovascular diseases. Their effect is often indirect, through damage to the central nervous, respiratory, and neuroendocrine systems. Hot climate in the workplace and intense infrared radiation cause the water and electrolyte imbalance and chronic hyperthermia and manifests as neurovegetative dystonia. The long-term effects of low temperatures condition ischemic lesions in circulatory system, trophic organ destruction. The influence of ultrahigh-frequency electromagnetic radiation on the cardiovascular system is directly related to the central nervous system and neurohumoral lesions. “Microwave disease” often manifests as polymorphic dystonia. Exposure to occupational vibration causes “white finger” syndrome or Raynaud’s phenomenon together with cerebral vascular lesions. Recent studies have confirmed that noise as a chronic stressor causes the imbalance in the central and vegetative nervous systems and changes in homeostasis. Noise increases catecholamine and cholesterol concentration in blood, has an effect on plasma lipoprotein levels, increases heart rate, arterial blood pressure, and risk of myocardial infarction. Psychophysiological changes caused by long-term stress influence constant pathological changes in the central nervous system, endocrine and cardiovascular systems. The long-term effect of psychogenic stressors is very important in the etiopathogenesis of psychosomatic diseases. Full article