Medicina, Volume 43, Issue 8 (August 2007) – 11 articles

The aim of the study was to evaluate and compare patients’ and physicians’ opinions about the assurance of patients’ right to information about the disease, the results of medical examination, treatment methods and their outcomes.
Material and methods. The study was performed during November 2006 – February 2007 in two counties of Lithuania. Seven hospitals were randomly selected for the study. The participants of the study were all patients who on the day of the inquiry were treated in the departments of internal diseases and surgery and all physicians who worked in these departments on that day. Patients with severe conditions and those who were newly admitted were excluded from the study. In total, 494 questionnaires were distributed, of which 366 were distributed among patients (response rate – 71.3%) and 128 among physicians (response rate – 70.3%).
Results. One-half of the inquired patients (50.9%) did not know what rights they are guaranteed by the Republic of Lithuania Law on the Rights of Patients and Compensation of the Damage to Their Health. However, the majority of patients thought that they were provided information about their disease (86.1%), the results of medical examination (76.2%), the methods of treatment (74.2%), and possible positive and negative consequences (65.2%). The comparison of patients’ and physicians’ evaluation of the provided information revealed certain differences. Physicians were inclined to evaluate themselves better. More than one-half (65.5%) of physicians stated that they provided patients with information concerning the possibility for their participation in treatment-related decision-making, but patients did not participate sufficiently actively (34.5% of positive responses) in making heath-related decisions.
Conclusions. Patients are not very well informed about the Republic of Lithuania Law on the Rights of Patients and Compensation of the Damage to Their Health. The majority of patients in the studied general hospitals stated that they were provided with and understood information about their disease, the results of medical examination, and treatment methods and prognosis. The study showed that only one-third of patients expressed their opinion to the physician when making treatment-related decisions, and their opinion was taken into consideration. Full article

Objective. To study the correlation between adolescents’ psychical disorders and their difficulties of psychosocial adaptation.
Methods and materials. There were 63 adolescent participants in our study (47 girls and 16 boys) who were hospitalized in Department of Children and Adolescent Psychiatry, Kaunas University of Medicine Hospital (Lithuania) during the period from September to December, 2005. Twenty-seven adolescents (19 girls and 8 boys) had suicidal and self-harming behavior. Psychical disorders were diagnosed according to ICD-10 diagnostic criterions. We used Strengths and Difficulties Questionnaire SDQ-lit adapted for Lithuania.
Results. While comparing the mean scores in both sexes of adolescents with diagnoses of depressive, behavioral and adaptation disturbances, we found a statistically significant difference only in emotionally disturbance scale results (P=0.016). Analyzing groups of girls and boys separately, girls showed to be worse psychosocially adapted and had more emotional problems. Girls who tried to commit suicide had more emotional (P=0.006) and psychosocial problems (P<0.001). Girls who were diagnosed with affective disorders had more expressed emotional (P<0.001) and general adaptation (P=0.031) difficulties. Parents noted that those who committed a suicide and had behavior disturbances had more expressed emotional (P=0.007) and general adaptation (P=0.053) problems.
Conclusions. 1. Adolescent girls who were diagnosed depressive illnesses had more emotional and general adaptation problems than girls who were diagnosed behavior or adaptation disorders. 2. Adolescent girls who tried to commit suicide had more expressed behavior problems and difficulties of emotional, general adaptation. 3. Most expressed difficulties of emotional and general adaptation were typical to girls who were diagnosed with depression and who tried to commit a suicide. Full article

The aim of study. To evaluate sociodemographic aspects and risk factors of severe open-globe ocular injuries.
Material and methods. We present data from prospective study of 315 patients with severe open-globe ocular injuries, meeting inclusion criteria.
Results. The patients in our series were predominantly male (92.70%). The male to female ratio was 12.7:1. Almost 27% of the patients were from the age group of 30–39 years. Home (53.65%), streets and highways (19.05%) were the most common place of injury, followed by industrial premises (11.11%), agricultural activities (8.25%), recreation and sports (5.40%); 15.56% of cases were work-related. Sharp objects (43.17%) and hammering on metal (24.44%) were the two major causes of injury. Alcohol intoxication was observed in 13.65% of cases. Severe open-globe eye injuries were classified into four categories: penetrating injuries (56.83%), perforating injuries (2.54%), globe ruptures (12.38 %), and IOFB injuries (28.25%). Males suffered significantly more often than females in the age of 20–29 (OR=1.39±95% CI 1.10–1.75, P<0.01) and 30–39-year (OR=1.75±95% PI 1.45–2.22, P<0.01). Risk factors of severe open-globe eye injuries for male gender were living in urban setting (P=0.001), alcohol use (P=0.001), occupation – unemployed (P=0.001) and retired persons (P=0.011).
Conclusions. Risk factors for male gender to sustain severe open-globe eye injury were living in urban setting, alcohol use, and occupation (unemployed and retired persons). Full article

Until the 20th century fungal infections were rather easy cured, and the need of new antifungal drugs was low. However, low choice of antifungal preparations, their toxicity, limited spectrum of action, and ability to produce resistant strains show the need of new effective medicines for systemic fungal diseases in nowadays. Our goal of research was to synthesize new antimicrobial compounds containing three or more pharmacophores in one molecule. The initial 5-substituted-2-methylmercaptothiazolidin-4-ones were subjected to S-demethylation to yield 2- amino-substituted thiazolidinones. Ethacridine, nitrofuran aldehydes and nitrobenzene aldehyde as pharmacophoric amino or aldehyde group having compounds have been used. Antimicrobial (antifungal) activity of the new compounds was screened in vitro in these bacterial cultures: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Bacillus subtilis ATCC 6633, Klebsiella pneumoniae ATCC 33499 and fungal cultures: Candida albicans ATCC 60l93, Candida glabrata, Candida krusei, Candida kefyr ATCC 86l4, Candida tropicalis ATCC 8302, Candida parapsilosis. Results showed that the new compounds were significantly more effective as antimicrobial agents than initial preparation ethacridine. Ethacridine derivatives were not only effective against numerous gram-positive and some gram-negative bacteria, but the spectrum of action has been discovered against fungi. Minimal fungistatic concentration varies in the range l0.0–750 µg/mL and antibacterial concentration is in the range 62.5–l000 µg/mL. Compound 2a having nitrofuryl substituent in the fifth position of tiazolidine cycle was the most active of synthesized ethacridine compounds. The obtained results gave the opportunity to separate the perspective group of potential antiinfective compounds. Full article

The aim of the study was to compare the prevalence and severity of precancerous condition – gastric atrophy and intestinal metaplasia (IM) between Eastern European (Lithuania and Latvia) and Asian (Taiwan) countries in population older than 55 years.
Methods. Patients aged 55 years and older, referred for upper endoscopy due to dyspeptic symptoms, were included in the study. Gastric biopsies were histological investigated according modified Sydney classification. Helicobacter pylori (H. pylori) was detected if any two of three methods (urease test, histology, and serology) were positive.
Results. Overall 322 patients included: 52 from Taiwan (TW), 171 from Latvia (LV) and 99 from Lithuania (LT). There were 227 (70%) females and 95 (30%) males. The mean age of TW patients was significantly lower (61.0±5.8 years), than of LV (68.1±7.3 years) and LT (66.5±7.5 years) patients. H. pylori was established in 224 (69.6%) patients. H. pylori positivity was established in 43 (82.7%) TW patients, in 112 (65.5%) LV patients, and in 69 (69.7%) LT patients (P>0.05). In H. pylori-infected patients, any atrophy either in the corpus or in the antrum of the stomach was detected in 26 (60.5%) TW patients, in 40 (35.7%) LV patients, and in 36 (52.2%) LT patients (between TW and LV patients P<0.005). Severe atrophy (grade 2 or 3) detected in 8 (18.6%) TW patients, in 17 (15.2%) LV patients, and in 18 (26.1%) LT patients (P>0.05). Intestinal metaplasia was detected in 22 (51.2%) TW patients, in 37 (33.0%) LV patients and in 31 (44.9%) LT patients among countries (P>0.05). There were no significant differences in proportions of different degrees of both atrophy and intestinal metaplasia among countries. Intestinal metaplasia was found in 79 (77.5%) of 102 patients with any degree of atrophy and in 11 (9.0%) of 122 patients without atrophy (P<0.0001). We found strong statistically significant correlations between atrophy and intestinal metaplasia in antrum (r=0.89), P<0.01, and corpus (r= 0.73), P<0.01.
Conclusions. The prevalence of H. pylori in the elderly population is still high in LT, LV, and TW. There are no significant differences in prevalence of gastric atrophy and intestinal metaplasia among TW, LT, and LV. There is a strong correlation between gastric atrophy and intestinal metaplasia. Full article

ß-Glucans are naturally occurring polysaccharides. These glucose polymers are constituents of the cell wall of certain pathogenic bacteria and fungi. The healing and immunostimulating properties of mushrooms have been known for thousands of years in the Eastern countries. These mushrooms contain biologically active polysaccharides that mostly belong to group of ß-glucans. These substances increase host immune defense by activating complement system, enhancing macrophages and natural killer cell function. The induction of cellular responses by mushroom and other ß-glucans is likely to involve their specific interaction with several cell surface receptors, as complement receptor 3 (CR3; CD11b/CD18), lactosylceramide, selected scavenger receptors, and dectin-1 (ßGR). ß-Glucans also show anticarcinogenic activity. They can prevent oncogenesis due to the protective effect against potent genotoxic carcinogens. As immunostimulating agent, which acts through the activation of macrophages and NK cell cytotoxicity, ß-glucan can inhibit tumor growth in promotion stage too. Antiangiogenesis can be one of the pathways through which ß-glucans can reduce tumor proliferation, prevent tumor metastasis. ß-Glucan as adjuvant to cancer chemotherapy and radiotherapy demonstrated the positive role in the restoration of hematopiesis following by bone marrow injury. Immunotherapy using monoclonal antibodies is a novel strategy of cancer treatment. These antibodies activate complement system and opsonize tumor cells with iC3b fragment. In contrast to microorganisms, tumor cells, as well as other host cells, lack ß-glucan as a surface component and cannot trigger complement receptor 3-dependent cellular cytotoxicity and initiate tumor-killing activity. This mechanism could be induced in the presence of ß-glucans. Full article

Objectives. The aim of the study was to study some anatomic and electrophysiological features of the right atrium, related to the presence of atrial flutter.
Materials and methods. A total 23 patients with type I atrial flutter and 22 patients without atrial flutter were studied. Right atrium size was assessed using echocardiography before intracardiac examination and radiofrequency ablation.
Results. Effective refractory periods of coronary sinus, high right atrium, low right atrium were different comparing with the control group (P<0.05). A stimulus–response time between high right atrium and low right atrium positions in anterograde and retrograde ways, an impulse propagation speed along the lateral wall of the right atrium were statistically different comparing both groups (P<0.05). There was a significant correlation among effective refractory periods measured in different sites of the right atrium (r²=0.64, 0.44, 0.44, respectively). All measured effective refractory periods also correlated with stimulus–response time in anterograde way (P<0.05) and impulse propagation speed (P<0.05). Right atrium dimensions were significantly larger in atrial flutter group. There was no correlation between the right atrium dimensions and measured electrophysiological parameters in both groups.
Conclusions. The presence of atrial flutter associates with diffuse alterations of the right atrium, but not the focal or single changes of refractoriness. Full article

Objective. For complete assessment of benefits of the surgical intervention, it is essential to provide evidence of the impact on patients in terms of health status and healthrelated quality of life. In the present study, the preoperative 36-item Short Form (SF-36) Health Survey scores were determined in patients before lumbar microdiscectomy due to better preoperative screening likewise in the control group – almost healthy population taken into account any habitual ailments experienced in an appropriate age.
Patients and methods. In the present study, we investigated a cohort of 100 patients with disc herniation causing low back pain and another hundred of the control subjects, matched by age and gender. The short form 36 general health questionnaire (SF-36) was applied.
Results. Estimation of the SF-36 scores showed that (1) all of the domain values were considerably lower in the preoperative patient group than in the second one (P<0.01); (2) the bodily pain scores were closely correlated to the social function scores (R=0.7, P<0.01), whereas the physical function was less related to the bodily pain (R=0.6, P<0.01). The weakest correlation was observed between bodily pain and mental health and general health (R=0.4, P<0.01).
Conclusion. The present study showed that the generic instrument, SF-36 Health Survey, was optimized paraclinical method for patients predisposed to surgical treatment of the lumbar disc herniation disease likewise for normal population individuals, matched by age and sex, in the assessment of health-related quality of life. Full article

The objective of the study was to identify factors related to the number of solution-focused brief therapy sessions required to solve adolescents’ problems. The study was conducted at the foster care and health care institutions. The sample consisted of 73 adolescents (41% of males, 59% of females), aged 12 to 18 years, who achieved high level of therapeutic progress during solution-focused brief therapy. Respondents from foster care institutions made up 47% and from health care institutions – 53%. The study design included: (1) an initial evaluation, where adolescents’ psychosocial adjustment and personality traits were evaluated as well as information on demographic characteristics and type of referral for therapy was collected; (2) solutionfocused brief therapy was carried out. In the first session, information on the type and severity of the problem presented for the therapy and motivation to solve the problem was collected; (3) the effectiveness of solutionfocused brief therapy was evaluated. Standardized interview for the evaluation of psychosocial adjustment of adolescents was used to evaluate the difficulties of adolescents’ psychosocial functioning. Eysenck Personality Questionnaire was administered to evaluate adolescents’ personality traits. Therapist’s evaluation of improvement was used to evaluate the effectiveness of solution-focused brief therapy. The analysis of results showed that 60.3% of adolescents needed two to three solution-focused brief therapy sessions to solve their problems. Lower number of sessions needed to achieve a solution was related to lower level of psychoticism, lower level of subjectively evaluated problem severity, and living with parents (as the opposite of living in foster care institutions). Ordinal regression analysis revealed that living with parents, self-referral to the therapy, lower level of subjectively evaluated problem severity, and higher self-confidence were significant predictors of lower number of sessions needed to achieve solution. Full article

Objective. Durability of mitral valve repair for ischemic mitral regurgitation remains questionable. The aim of our study was to reveal predictors of recurrent mitral regurgitation following ischemic mitral valve repair.
Material and methods. The study population consisted of 136 patients with ischemic heart disease and ischemic mitral regurgitation. Mitral valve repair was performed at the Kaunas University of Medicine Hospital in 2000–2004. Preoperative echocardiographic examinations were performed two days before surgery, early postoperative examinations 5–10 days after mitral valve repair, late postoperative examinations at 1.89±0.15 years after operation.
Results. Mitral regurgitation increased from 0.78±0.77 at early period to 1.46±0.81 at late postoperative period (P<0.001). At late follow-up mitral regurgitation increased in 13 (9.5%) patients in comparison with preoperative mitral regurgitation and in 69 (50.7%) patients in comparison with early postoperative mitral regurgitation. Left ventricular end-diastolic diameter decreased significantly from 56.44±6.29 mm at early period to 54.44±5.98 mm at late period (P<0.004). Left ventricular ejection fraction increased from 35±10% at early period to 38±10% at late period (P<0.047). Left atrial diameter decreased from 46.12±6.35 mm at early period to 43.95±6.94 mm at late period (P<0.034). Multivariate analysis revealed predictors of late postoperative mitral regurgitation: preoperative left ventricular end-systolic diameter index (P=0.037), left ventricular wall motion score index (P=0.042), mitral regurgitation (P=0.013), and systolic pulmonary artery pressure (P=0.04).
Conclusions. It is possible to predict the progression of mitral regurgitation following ischemic mitral valve repair. Late postoperative mitral regurgitation depends on these preoperative echocardiographic variables: left ventricular end-systolic diameter index, left ventricular wall motion score index, mitral regurgitation, and systolic pulmonary artery pressure. Full article

There are various surgical methods for the treatment of female urinary stress incontinence. According to the opinion of American Association of Urologists, anterior colpoplasty is supposed to be the least effective for the long-term treatment out of four surgical treatment categories (anterior colpoplasty, suburethral sling, colposuspension, and long-needle sling). Nowadays, the open retropubic colposuspension (Burch operation) is considered the most effective and long-term treatment of the female urinary stress incontinence. A first-year postsurgical effectiveness is 85–90% for this operation. Tension-free vaginal tape (suburethral sling) operations are considered as much effective as the above-mentioned surgeries and tend to be very perspective. However, these operations require to be evaluated for their long-term systematic results. Full article