Medicina, Volume 47, Issue 3 (March 2011) – 8 articles

The aim of this study was to examine the possibility of the spontaneous eruption of displaced unerupted maxillary canines after the extraction of the deciduous canine and dental arch expansion and to determine the impact of initial canine position on treatment success rate.
Materials and Methods. The study sample included 50 patients (mean age, 13.5 years [SD, 2.2]) with unilaterally displaced unerupted maxillary canines. Deciduous canines were extracted, and the space for displaced canine was created at the beginning of the study. The follow-up period for the spontaneous eruption was 12 months. The initial vertical, horizontal, labio-palatal position and angle of inclination to the midline of the displaced canine were assessed on panoramic radiographs.
Results. Only 42% of displaced canines erupted spontaneously within one-year period (52.9% of labially displaced canines and 36.4% of palatally displaced canines). A significant difference of inclination was determined between spontaneously erupted and unerupted teeth in the labially displaced canine group (P<0.01), with no difference in the palatally displaced canine group. The receiver operating characteristic curve analysis showed that the critical angle of inclination for the spontaneous eruption of the retained canine was 20º (sensitivity 0.759; specificity 0.571; P<0.05). The majority of unerupted canines (75.9%) were inclined more than 20º. The initial height of canine was crucial for spontaneous eruption (sensitivity 0.966; specificity 0.81; P<0.001). This was true for both palatal and labial cases.
Conclusions. The initial vertical position of the labially and palatally displaced canines and the inclination of the labially displaced canines were the most important predictors for spontaneous eruption of the cuspid. Full article

Pacientai, sergantys reumatinėmis ligomis (reumatoidiniu, psoriaziniu artritu, ankilozuojančiu spondilitu) ir vartojantys naviko nekrozės faktoriaus alfa blokatorius (TNF-α), turi didesnę tuberkuliozės riziką. Tuberkuliozės prevencijos ir gydymo rekomendacijos, prieš skiriant TNF-α blokatorius, parengtos atsižvelgus į didelį tuberkuliozės paplitimą, didelį Mycobacterium tuberculosis atsparumą vaistams, visuotinę Bacillus Calmette-Guérin vakcinaciją nuo tuberkuliozės Lietuvoje. Siekiant sumažinti tuberkuliozės riziką, būtinas paciento ištyrimas prieš pradedant gydymą TNF-α blokatoriumi. Tuo tikslu atliekamas išsamus klinikinis ir dviejų krypčių krūtinės ląstos rentgenologinis tyrimas. Tuberkulino odos mėginys pagal Mantoux metodiką naudojant penkis tuberkulino vienetus arba gama interferono išskyrimo mėginys atliekami pacientams, kuriems nėra radiologinių potuberkuliozinių pokyčių. Jei, tiriant radiologiškai, randamas Gono kompleksas, liekamieji negydytos tuberkuliozės pokyčiai, arba Mantoux, arba gama interferono išskyrimo mėginys yra teigiamas, pacientui skiriamas latentinės tuberkuliozės gydymas. Taigi, latentinės tuberkuliozės gydymui skiriamas izoniazido ir rifampicino 3 mėn. kursas, o gydymas naviko nekrozės faktoriaus alfa blokatoriumi pradedamas ne anksčiau kaip 1 mėn. nuo latentinės tuberkuliozės gydymo pradžios. Įtariant aktyvią Mycobacterium tuberculosis infekciją, tuberkuliozė diagnozuojama mikrobiologiškai arba morfologiškai ir skiriamas prieštuberkuliozinis gydymas. Full article

The aim of the study was to determine antimicrobial activity of rhaponticum and shrubby cinquefoil extracts.
Material and Methods. Ethanol extract from the leaves of rhaponticum (Rhaponticum carthamoides D.C. Iljin) and shrubby cinquefoil (Potentilla fruticosa L.) was produced at the Department of Food Technology, Kaunas University of Technology. The antimicrobial activity of the viscous extract or rhaponticum and shrubby cinquefoil was evaluated using standard microorganism cultures (bacteria 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 fungi Candida albicans ATCC 60193). The minimum inhibitory concentration (MIC) of the examined preparations was determined. Results. Both studied preparations – rhaponticum (Rhaponticum carthamoides D.C. Iljin) and shrubby cinquefoil (Potentilla fruticosa L.) – demonstrated similar antimicrobial activity. The highest sensitivity to the studied preparations was observed in microbes with eukaryotic cell structure: Candida albicans, which is a fungus, and a spore-forming prokaryotic bacterium, Bacillus cereus. The highest resistance was observed in Escherichia coli and Klebsiella pneumoniae.
Conclusions. The studied preparations – viscous extracts of rhaponticum and shrubby cinquefoil – are substances with antimicrobial activity against gram-positive (Staphylococcus aureus and Enterococcus faecalis) and gram-negative (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis) bacteria, spore-forming bacteria (Bacillus subtilis and Bacillus cereus), and fungi (Candida albicans). Full article

The aim of this study was to evaluate prospectively the efficacy of different imaging methods in differentiating between chronic pancreatitis and cancer in focal pancreatic lesions and staging of adenocarcinoma.
Material and Methods. Between June 2005 and October 2007, 156 consecutive patients were enrolled into the prospective clinical trial. The patients were randomized into two groups. Ultrasonoscopy and endoscopic ultrasound were performed in both the groups. Group A patients were additionally examined by computed tomography and tumor marker assay, while in the group B, intraoperative ultrasonoscopy with biopsy and urgent histological examination were done. Results of each imaging technique regarding differential diagnosis and cancer stage were compared with the fi ndings of surgical and histological examination.
Results. Chronic pancreatitis and adenocarcinoma were documented in 58 (37.2%) and 78 (50%) patients, respectively. The size of the lesions and clinical presentation were similar in both the groups, but cancer patients were older than patients with pancreatitis (P<0.001). Preoperatively endosonoscopy had the highest accuracy in assessing differential diagnosis (92.1%) and adenocarcinoma (91.8%), whereas computed tomography had the highest accuracy in assessing tumor size (84.5%) and transabdominal ultrasonography in assessing lymph node involvement (78.9%) and distant metastases (88.6%). Intraoperative ultrasound was the most accurate imaging technique in the assessment of differential diagnosis (100%), adenocarcinoma (98.5%), extent of primary tumor (84.8%), lymph node involvement (87.9%), and distant metastases (100%).
Conclusions. In the differential diagnosis between chronic pancreatitis and adenocarcinoma, preoperative ultrasonography and intraoperative ultrasound are the best imaging methods. When ultrasonography is nondiagnostic, computed tomography and endoscopic ultrasound are alternative techniques. Full article

Background. Prostate cancer (PCa) is the second most prevalent malignancy among males, characterized by high mortality rates. Aberrant DNA methylation in promoters of tumor suppressor genes is an early and frequent event during prostate carcinogenesis. Modern techniques allow a sensitive detection of DNA methylation biomarkers in bodily fluids from cancer patients offering a noninvasive tool for PCa monitoring. Our study aimed at the analysis of DNA methylation in urine sediments from PCa patients for the selection of most informative noninvasive biomarkers.
Material and Methods. Real-time methylation-specific polymerase chain reaction was used for the detection of methylated RASSF1, RARB, and GSTP1 genes in catheterized urine specimens from 34 patients with biopsy-proven early or medium stage PCa.
Results. At least one gene was methylated in urine sediments from 28 cases with PCa, with a sensitivity of the test reaching 82%. RASSF1 was methylated in 71% (24 of 34), RARB in 44% (15 of 34), and GSTP1 in 3% (1 of 34) of the specimens. High level of methylation (≥50%) in RARB and RASSF1 genes was detected in 40% and 20% of cases, respectively. A significant association was observed between high level of RARB methylation and Gleason score (P=0.01), while methylation of at least one gene occurred more frequently in urine DNA of older patients (P=0.02).
Conclusions. Results of our study show a high sensitivity of DNA methylation biomarkers, especially RASSF1 and RARB, for the early and noninvasive detection of PCa. Full article

Bacterial resistance to antimicrobial drugs is an increasing health and economic problem. Bacteria may be innate resistant or acquire resistance to one or few classes of antimicrobial agents. Acquired resistance arises from: (i) mutations in cell genes (chromosomal mutation) leading to cross-resistance, (ii) gene transfer from one microorganism to other by plasmids (conjugation or transformation), transposons (conjugation), integrons and bacteriophages (transduction). After a bacterium gains resistance genes to protect itself from various antimicrobial agents, bacteria can use several biochemical types of resistance mechanisms: antibiotic inactivation (interference with cell wall synthesis, e.g., β-lactams and glycopeptide), target modification (inhibition of protein synthesis, e.g., macrolides and tetracyclines; interference with nucleic acid synthesis, e.g., fluoroquinolones and rifampin), altered permeability (changes in outer membrane, e.g., aminoglycosides; new membrane transporters, e.g., chloramphenicol), and “bypass” metabolic pathway (inhibition of metabolic pathway, e.g., trimethoprim-sulfamethoxazole). Full article

Background and objectives. Many previous studies showed clear gender differences in the percentages of adults reporting toothbrushing more than once a day. This study evaluated the factors determining gender differences in toothbrushing among Lithuanian middle-aged university employees.
Material and Methods. A questionnaire survey was anonymously conducted among 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data covered toothbrushing frequency, habitual dental attendance, dental health attitudes and knowledge, and subject’s background information.
Results. Of all respondents, 68% reported brushing their teeth more than once a day (73% of women and 49% of men, P<0.001) and 51% indicated checkup-based habitual dental attendance (54% of women and 41% of men, P=0.012). The majority reported good dental status as being important to them and poor oral health as injurious to general health. Of all respondents, 44% indicated that “Lack of time is the main reason for incomplete oral self-care” (61% of men and 40% of women, P<0.001). Logistic regression models showed that the strongest factor affecting toothbrushing frequency was the importance of good dental health to them (OR, 1.6; 95% CI, 1.1–2.4; P=0.02) among women and statement that “Poor oral health can be injurious to general health” (OR, 2.6; 95% CI, 1.2–5.5; P=0.01) and checkup-based habitual dental attendance (OR, 2.4; 95% CI, 1.0–5.9; P=0.06) among men.
Conclusions. Due to different determinants affecting toothbrushing frequency among men and women, different oral health motivation programs by gender should be developed. Full article

We report the case of a 15-year-old patient who underwent concomitant autologous chondrocyte implantation and osteochondral grafting for the treatment of a massive osteochondritis dissecans defect in the left knee and autologous chondrocyte implantation in the right knee joint. Magnetic resonance imaging showed large osteochondral defects in both the knee joints measuring 8–9 cm2. Both defects were located in the weight-bearing areas of the medial femoral condyles. Therefore, simultaneous autologous chondrocyte implantation (ACI) and osteochondral autograft transplantation (OAT) for the left knee defect and ACI for the right knee joint were performed. Osteochondral plugs were harvested from the patellofemoral joint of the same left knee and grafted into the most dorsal regions of the large osteochondral defect of the left knee. The remaining osteochondral defect was covered with ACI using collagen type I and III membrane and chondrocyte cells. The membrane was implanted into more proximal part of the osteochondral defect of the left knee. Time interval between operations of the left and right knee joints was 6 months. Magnetic resonance imaging at 6 months after each knee surgery showed good preservation of the OAT and ACI grafts. The most recent follow-up examination, performed 12 months after surgeries, has shown excellent results with an International Knee Documentation Committee score of 95.59±4.64 and 96.88±4.69 for the right and left knee joints, respectively, and full range of knee motions with no symptoms.
In this clinical case, the combination of ACI and OAT methods in a one-step procedure produced a good reconstruction of the joint surface with excellent clinical outcomes in the both knee joints of the same patient. Autologous osteochondral grafting and autologous chondrocyte implantation can be combined for the treatment of large osteochondral defects of the knee. Full article