Medicina, Volume 44, Issue 12 (December 2008) – 11 articles

Malignant biliary obstruction may be caused by cholangiocarcinoma and other nonbiliary carcinomas. At the time of diagnosis, 90% of patients with malignant obstructive jaundice may benefit from palliative treatment only. The objective of palliation is to relieve jaundice-related symptoms, prevent cholangitis, prolong survival, and improve quality of life. Percutaneous transhepatic biliary stenting is a well-established procedure used in patients with malignant obstruction of intra- and extrahepatic bile ducts. Twelve patients (9 women, 3 men; mean age, 68 years; range, 44–88 years) with inoperable malignant biliary obstruction were selected for percutaneous transhepatic biliary stenting with metallic stents in the period from January to December 2007. Technical and clinical success rate in this patient series was 83% and 80%, respectively. Minor and major complications occurred in 17% and 8% of cases, respectively, which is in the range reported by the others. This is our first experience of percutaneous transhepatic biliary stenting at the Hospital of Kaunas University of Medicine and, to our knowledge, the first reported patient series in Lithuania. These first results encourage expanding effective palliation by the employment of the percutaneous transhepatic biliary stenting in patients with nonresectable malignant biliary obstruction or in case of a recurrent disease after curative surgery. The cost effectiveness of percutaneous transhepatic biliary stenting against percutaneous transhepatic biliary drainage has yet to be evaluated in a prospective manner. However, immediate clinical benefits and positive short-term outcomes are unequivocal. Full article

Objective. To evaluate and compare the impact of two sharp-edge optic foldable intraocular lenses (IOLs) of similar design made from different material (hydrophilic acrylic or hydrophobic acrylic) on visual function, anterior and posterior capsule opacification at one-year follow-up after cataract phacoemulsification.
Material and methods. Seventy-two eyes of 72 patients scheduled for cataract surgery were included in a prospective clinical study. Two foldable sharp-edge optic posterior chamber acrylic IOLs of similar design were used. Thirty-nine eyes of 39 patients received a single-piece hydrophilic acrylic (PC 511, Ophtec) IOL and 33 eyes of 33 patients – single-piece hydrophobic acrylic (AcrySof, SA60AT, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsulorrhexis/optic overlapping, and posterior capsule opacification (PCO) were evaluated. The intensity of ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3-mm optic zone were assessed using a photographic image analysis system (EPCO 2000). The patients were examined at one year postoperatively.
Results. There were no significant differences in best-corrected visual acuity and capsulorrhexis/optic overlapping between IOL types at 1-year follow-up after surgery. In the single-piece hydrophilic acrylic IOL group, the grade of ACO density was significantly higher in capsulorrhexis rim area (1.56±0.71 and 1.00±0.75) and in the capsule/optic area (1.62±0.67 and 1.00±0.75) (P<0.05). PCO values of the entire IOL optic area (0.12±0.13 and 0.024±0.02) as well as in the central 3-mm optic zone (0.06±0.11 and 0.001±0.003) was significantly higher in the single-piece hydrophilic acrylic IOL group one year postoperatively (P<0.05). In 33.3% of cases of the single-piece hydrophilic acrylic IOL group, contraction of haptics to IOL optics was present one year postoperatively, which was not present in any case of the single-piece hydrophobic acrylic IOL group.
Conclusions. One-year follow-up after cataract surgery has shown a significant difference in ACO and PCO development comparing single-piece hydrophilic acrylic and single-piece hydrophobic acrylic intraocular lenses. The effect of hydrophobic acrylic foldable lenses on preventing anterior and posterior capsule opacification is mainly a result of the acrylic hydrophobic biomaterial. Full article

Objective. To evaluate efficacy of diagnostic procedures, results of surgery, and complications in malignant pleural diseases.
Material and methods. From 1999 to 2006, 169 patients underwent treatment in the Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. Patients were divided into two groups: group I, patients with primary pleural malignant diseases (93 patients, 55.0%), and group II, secondary pleural tumors (76 patients, 45%). Of the 76 patients, 40 patients (52.6%) were diagnosed with metastatic pleural tumors and 36 patients (47.4%) with tumors invading parietal pleura. We used noninvasive and invasive methods for diagnosis. Noninvasive methods included chest x-ray, chest computed tomography, magnetic resonance imaging, chest ultrasound, positron emission tomography/ computed tomography (performed in Germany), and invasive methods included puncture of pleural effusions, transthoracic pleural puncture, drainage, pleural biopsy and video-assisted thoracoscopic pleural biopsy, pleural resection, and ultrasound-guided needle biopsy of the pleura. The following procedures were performed in group I: pleurectomy in 15 patients (16.1%), pleural pneumonectomy in 42 patients (45.2%), pleural decortication in 12 patients (12.9%), extended pleuropneumonectomy with diaphragm and pericardium resections and plastic surgery in 14 patients (15.0%), pleurectomy with costal resections in 10 patients (10.1%). Procedures performed in group II included video-assisted thoracoscopic pleurectomy in 15 patients (19.7%), pleural biopsy in 10 patients (13.2%), pleurectomy in 15 patients (19.7%), pleural drainage and fenestration in 5 patients (6.5%), lung and pleura resection in 12 patients (15.8%), chest wall and pleura resection in 10 patients (13.2%), diaphragm and pleura resections in 9 patients (11.8%).
Results. Early stage primary pleural tumors were found in 24 patients (25.8%). Metastatic pleural disease was found in 32 patients with early primary tumors (80.0%). In all 36 patients (100.0%) with chest wall tumors, disease of advanced stage was determined. Main surgical complications of the group I were observed in 26 patients (27.9%). Six patients (6.5%) died after surgery. In group II, 23 patients (30.2%) had postoperative complications; 3 patients (3.9%) died.
Conclusions. In noninvasive methods, the highest sensitivity was achieved for chest computed tomography and magnetic resonance imaging (97%); the specificity of chest magnetic resonance imaging was 100%, and the specificity chest computed tomography and magnetic resonance imaging – 98%. The accuracy of chest xray plus computed tomography was 98%. In invasive methods, accuracies of pleural biopsy, video-assisted thoracoscopic pleural biopsy, and pleurectomy were 100%, 90%, and 100%, respectively. In case of primary pleural tumors, the main surgery was extended pleuropulmonectomy (45.2%) with or without mediastinal resection. Mortality rate was 6.5%. In case of metastatic pleural disease, the main surgery was video-assisted thoracoscopic pleurectomy (19.7%). Mortality was rate 5%. In cases of pleural invasion by other thoracic malignancies, the main surgeries were chest wall and pleural resection (13.2%) and lung and pleural resection (15.8%). Mortality rate was 2.8%. After 169 operati Full article

Objective. To determine the changes in platelet function, manifesting as deviations of their aggregation intensity, in persons with acute ischemic stroke and transient ischemic attacks, to evaluate the effect of aspirin on platelet aggregation, dependent upon degree of cerebral blood flow disturbances and patient’s gender, and to compare these changes with those in healthy persons.
Material and methods. We examined 50 patients aged 33 to 98 years (mean age, 63.7±2.1 years; 20 men and 30 women) with cerebral blood flow disturbances during acute period (18 with transient ischemic attacks and 32 with ischemic stroke). The diagnosis was confirmed by computer tomography and other clinical examinations. Adenosine diphosphate-, epinephrine-, and collagen-induced platelet aggregation was assessed in platelet-rich plasma. Twelve patients used aspirin at prophylactic doses (100–150 mg/d), and 38 patients did not use. The control group consisted of 25 healthy persons aged 31–64 years (mean age, 45.4±1.9 years; 17 men and 8 women).
Results. Increased platelet aggregation induced by all three inducers was significantly more frequent in stroke group. Platelet reaction to collagen was more expressed. Aspirin suppressed aggregation, but did not protect against development of ischemic stroke. Higher activity of platelet function during ischemic stroke was observed in platelets from men’s plasma.
Conclusions. During acute period, platelet aggregation in platelet-rich plasma statistically significantly increases in the stroke group, independently of the severity of the disease. A part of patients, using recommended dose of prophylactic aspirin, developed ischemic stroke. The effect of aspirin on platelets was more pronounced in women than men. Full article

Objective. To assess the changes in the prevalence of asthma and allergy in 6–7- year-old schoolchildren in Kaunas, Lithuania, using the International Study of Asthma and Allergy in Childhood (ISAAC) core questionnaire.
Material and methods. Two cross-sectional surveys (1994/1995–2001/2002) according to the ISAAC protocol were carried out. Lithuanian version of the ISAAC core questionnaire was completed by parents randomly selected from Kaunas primary schools. A school-based sample of 1879 participants in the 1994/1995 survey and 2772 participants in the 2001/2002 survey was study population.
Results. The response rates in 1994 and 2002 were 93.95% and 92.4%, respectively. There is a tendency towards an increase in the prevalence of current symptoms and diagnoses for all three conditions, but it was more pronounced in boys. Significant increases in the prevalence of asthma (0.9% vs 2.6%), allergic rhinitis (1.4% vs 2.4%), and atopic dermatitis (1.4% vs 3.5%) were observed comparing two surveys. Still a lot of allergic diseases remain undiagnosed.
Conclusions. Our study shows that the prevalence of symptoms of asthma, allergic rhinitis, and atopic dermatitis is increasing, reflecting the changes in morbidity from these conditions in our country. Full article

The aim of the study was to evaluate the impact of a long-term rehabilitation on chronic fatigue and cardiorespiratory parameters in patients with chronic heart failure.
Material and methods. One hundred seventy patients with class III–IV (NYHA) chronic heart failure were examined. The study population was divided into two groups: long-term rehabilitation group and control group. They underwent cardiopulmonary exercise test and completed questionnaires on chronic fatigue (MFI- 20L, DUFS, and DEFS). Measurements were repeated 3 and 6 months after long-term complex rehabilitation.
Results. According to the data of MFI-20L, DUFS, and DEFS questionnaires, 170 patients (100%) with class III–IV (NYHA) chronic heart failure complained of fatigue. Overall daily fatigue was 56.8±28.5 points on a 100-point scale, and after 6-month rehabilitation, this parameter was statistically significantly reduced on all scales (P<0.05). Physical fatigue and self-care improved in controls. Cardiopulmonary exercise test showed that parameters of hyperventilation, ventilatory equivalents, and pCO₂ were significantly improved in rehabilitation group after 6 months as compared to baseline data (P<0.05), but not in the control group.
Conclusion. Patients with class III–IV (NYHA) chronic heart failure experience chronic fatigue, which reduces their motivation and self-care abilities. Long-term complex rehabilitation programs improve all parameters of chronic fatigue, respiratory efficiency, and prognostic indicator of chronic heart failure – ventilatory equivalent for carbon dioxide. Full article

Objectives. The aim of the study was to evaluate the prevalence of xerostomia among inpatients with rheumatic disorders at the Hospital of Kaunas University of Medicine (HKUM) and its association with age, sex, and xerophthalmia. Determining adequate treatment for xerostomia was also important, because untreated xerostomia may become aggravated and thus significantly impair patient’s quality of life.
Material and methods. The authors designed a special questionnaire for conducting all studyrelated enquiries. Patients for this study were selected according to their case records ranging from 1998 to 2004. In total, there were 483 cases chosen based on prevalent rheumatic diseases, which were most conducive to xerostomia.
Results. The results showed no significant evidence that the prevalence of xerostomia increased with age. Also, women were more susceptible to rheumatic diseases than men (W:M = 10:1) and are more likely to be affected by xerostomia and xerophthalmia (W:M = 2.5:1). A significant correlation was found between xerostomia and xerophthalmia. Only 17.7% of xerostomia-positive patients were treated for xerostomia, in comparison with xerophthalmia-positive patients who were treated for xerophthalmia in 84.8% of cases. It was shown that the modalities of treatment administered for xerostomia were neither sufficient nor up-to-date according to current recommendations found in medical literature.
Conclusions. Xerostomia is closely correlated with xerophthalmia in rheumatic diseases. Xerostomia is more prevalent in older segments of population, especially in women, but we failed to prove statistical significance of older age in prevalence of sicca symptoms. Treatment administered to rheumatic patients for xerostomia in the HKUM is neither sufficient nor adequate. Full article

Objective. To evaluate acute toxic effect of ibogaine and noribogaine on the survival of mice and determine median lethal doses of the substances mentioned.
Material and methods. White laboratory mice were used for the experiments. Ibogaine and noribogaine were administered intragastrically to mice via a stomach tube. Control animals received the same volume of saline. The median lethal dose was calculated with the help of a standard formula.
Results. To determine the median lethal dose of ibogaine, the doses of 100, 300, 400, and 500 mg/kg were administered intragastrically to mice. The survival time of mice after the drug administration was recorded, as well as the number of survived mice in each group. Upon administration of ibogaine at a dose of 500 mg/kg, all mice in this dose group died. Three out of four mice died in the group, which received 300 mg/kg of ibogaine. No mouse deaths were observed in the group, which received 100 mg/kg of ibogaine. The determined LD50 value of ibogaine equals to 263 mg/kg of body mass. In order to determine the median lethal dose of noribogaine, the doses of 300, 500, 700, and 900 mg/kg were administered to mice intragastrically. Noribogaine given at a dose of 500 mg/kg had no impact on the mouse survival. The increase of noribogaine dose to 700 mg/kg of mouse body mass led to the death of three out of four mice in the group. Upon administration of noribogaine at a dose of 900 mg/kg, all mice in this group died. The LD50 value of noribogaine in mice determined on the basis of the number of dead mice and the size of the doses used equals to 630 mg/kg of mouse body mass. The behavior of mice was observed upon administration of ibogaine or noribogaine. Low doses of ibogaine and noribogaine had no impact on the mouse behavior. External effects (convulsions, nervous behaviour, limb paralysis) were observed only when substances were administrated at higher doses.
Conclusions. It has been determined that the median lethal dose of ibogaine and noribogaine equals to 263 mg and 630 mg/kg of mouse body mass, respectively. The toxicity of ibogaine is 2.4 times higher than that of noribogaine. Full article

Background and objectives. There is a need for simple method allowing detection of dehydration and hypovolemia. Based on a new theory of homeostatic blood states, we hypothesized that hemodilution following standardized crystalloid fluid bolus can be used to discriminate between baseline normohydration and dehydration, also normovolemia and hypovolemia.
Methods. Computer simulations based on previously published kinetic data were used to define the best time points for discrimination between baseline normohydration and dehydration, also normovolemia and hypovolemia. Hemodilution was compared at the proposed timing in 20 volunteers who received 40 infusions of Ringer’s solution of 25 mL/kg during 30 minutes.
Results. Simulations indicated that preexisting hypovolemia could be best detected at the end of infusion, while dehydration 20–30 min later. In baseline hypovolemia, the peak reduction of hemoglobin concentration was 16.0% at the end of infusion, while it was only 11.8%, when participants were normovolemic (P<0.004). In baseline dehydration, the residual hemodilution was 8.6%, when measured 30 min after the end of infusion. It was only 3.1% in baseline normohydration (P<0.006).
Conclusions. In response to fluid load, the baseline dehydration exaggerates the lowering of residual hemoglobin in respect to baseline. Meanwhile, baseline hypovolemia exaggerates the lowering of peak hemoglobin concentration. The volume loading test that deploys interpretation of hemoglobin dynamics in response to the test volume load could possibly serve as an easily available guide to indicate an individual patient’s baseline hydration state and volemia. The introduction of continuous noninvasive monitoring of hemoglobin concentration would expand the applicability of the new method. Full article

Objective. To evaluate the antimicrobial activity of soft and purified propolis extracts. Study object and methods. Antimicrobial activity of soft and purified propolis extracts was determined with reference cultures of Staphylococcus aureus ATCC 25923, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Klebsiella pneumoniae ATCC 33499, Pseudomonas aeruginosa ATCC 27853, Proteus mirabilis ATCC 12459, Bacillus subtilis ATCC 6633, Bacillus cereus ATCC 8035, and fungus Candida albicans ATCC 60193. Microbiological tests were performed under aseptic conditions. Minimum inhibitory concentration (MIC) – the highest dilution of preparation (the lowest concentration of preparation) that suppresses growth of reference microorganisms – was determined.
Results. Concentration of phenolic compounds in soft propolis extract that possesses antimicrobial activity against gram-positive (Staphylococcus aureus, Enterococcus faecalis) and gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis) is 0.587±0.054 mg and 0.587±0.054–0.394±0.022 mg (P>0.05) and in purified propolis extract – 0.427±0.044 mg and 0.256±0.02 mg (P>0.05). Klebsiella pneumoniae is most resistant to soft propolis extract when the concentration of phenolic compounds is 1.119± 0.152 mg and to purified propolis extract when the concentration of phenolic compounds is 1.013±0.189 mg (P>0.05). Spore-forming Bacillus subtilis bacteria are more sensitive to soft and purified propolis extracts when the concentration of phenolic compounds is 0.134±0.002 mg and 0.075±0.025 mg, respectively, and Bacillus cereus – when the concentration is 0.394±0.022 mg and 0.256±0.02 mg (P>0.05). Sensitivity of fungus Candida albicans to soft and purified propolis extracts is the same as Bacillus subtilis. Encapsulated bacterium Klebsiella pneumoniae is most resistant to antimicrobial action of soft and purified propolis extracts as compared with gram-positive Staphylococcus aureus and Enterococcus faecalis bacteria (P<0.05), gram-negative Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis (P<0.05), sporeforming Bacillus subtilis and Bacillus cereus bacteria (P<0.05), and fungus Candida albicans (P<0.05). There is no statistically significant difference between antimicrobial effect of soft propolis extract and purified propolis extract on gram-positive bacteria, gram-negative bacteria, spore-forming bacteria, encapsulated bacteria, and Candida fungus.
Conclusions. Soft and purified propolis extracts possess antimicrobial activity. They could be recommended as natural preservatives in the manufacture of pharmaceutical products. Full article

Cancer prevention is a system of various measures devoted to avoid this disease. Primary cancer prevention means the identification, avoidance, or destruction of known risk factors. The main risk factors are smoking, diet, alcohol consumption, occupational factors, environmental pollution, electromagnetic radiation, infection, medicines, reproductive hormones, and lack of physical activity. Approximately onethird of cancers can be avoided by implementing various preventive measures. The aim of this article was to acquaint medical students, family doctors with risk factors of main cancer sites (lung, breast, colorectal, and prostate). Full article