Medicina, Volume 47, Issue 9 (September 2011) – 8 articles

The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients.
Material and Methods. The study sample comprised 226 stroke patients at the Viršužiglis Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment.
Results. More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P<0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P<0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P<0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P<0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status.
Conclusions. During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment. Full article

Background and Objective. Many studies have suggested that each hand has a different special talent; however, there is a lack of data in the area of goal-directed bimanual hand coordination and its dependence on gender. The aim of this paper was to investigate gender-dependent bimanual speed-accuracy task performance.
Material and Methods. Twelve healthy young males and twelve healthy young females (all righthanded) performed protractile movements with both arms simultaneously by pushing joysticks toward two targets as quickly and accurately as possible.
Results. Though no significant difference was observed in the reaction time during a unimanual speed-accuracy task between the left and right hands as well as men and women, during a bimanual task, the reaction time of both the hands was significantly longer in women than men. There was no significant difference in the velocity of both the hands during a bimanual speed-accuracy task between men and women, while the accuracy of the left hand was significantly greater in men than women. There was no significant difference in intraindividual variability in the reaction time, maximal velocity, and path of movement between men and women as well as the left and right hands, but variability in the average velocity of the right hand both in women and men was significantly greater compared with their left hand.
Conclusions. Whereas people typically look at the target location for a reaching movement, it is possible that two objects are simultaneously fixated. Full article

A case of successful and prolonged treatment of metastatic non–small cell lung cancer with the epidermal growth factor receptor antagonist erlotinib is presented. A never-smoker female was diagnosed with stage IV lung cancer in December 2005. A chest CT scan showed soft tissue mass 35×34 mm in size in the right lung with metastases in the lymph nodes and in the left lung. A biopsy revealed a poorly differentiated adenocarcinoma. The disease showed poor response to the first-line and second-line chemotherapy. Targeted therapy with erlotinib was started in February 2007. The most severe adverse event observed was grade 3 skin rash. The disease was stable until February 2009 when brain metastases were detected. Erlotinib was continued until May 2009 when disease progression in the lungs was confi rmed. The patient died due to ongoing disease progression in December 2009. Retrospective genetic analysis of a tumor specimen was performed, and no mutations in EGFR exons 18–21 were detected. The patient had a significant clinical benefit for the period of 24 months. These results are consistent with previous reports in literature that clinical characteristics such as female gender, nonsmoker, adenocarcinoma histology, and severe cutaneous toxicity seem to predict good response to erlotinib. In the present case, erlotinib proved to be effective even in heavily pretreated, chemotherapy- resistant lung adenocarcinoma. So far, no exact predictive biomarkers of erlotinib effectiveness have been determined; and their further analyses are essential. Full article

The objective of the study was to evaluate the trends in stroke mortality in the population of Klaipėda aged 35–79 years from 1994 to 2008.
Material and Methods. Mortality data on all permanent residents of Klaipėda aged 35–79 years who died from stroke in 1994–2008 were gathered for the study. All death certificates of permanent residents of Klaipėda aged 35–79 years who died during 1994–2008 were examined in this study. The International Classification of Diseases (ICD-9 codes 430–436, and ICD-10 codes I60–I64) was used. Sex-specific mortality rates were standardized according to the Segi’s world population; all the mortality rates were calculated per 100 000 population per year. Trends in stroke mortality were estimated using log-linear regression models. Sex-specific mortality rates and trends were calculated for 3 age groups (35–79, 35–64, and 65–79 years).
Results. During the entire study period (1994–2008), a marked decline in stroke mortality with a clear slowdown after 2002 was observed. The average annual percent changes in mortality rates for men and women aged 35–79 years were –4.6% (P=0.041) and –6.5% (P=0.002), respectively. From 1994 to 2002, the stroke mortality rate decreased consistently among both Klaipėda men and women aged 35–64 years (20.4% per year, P=0.002, and 14.7% per year, P=0.006, respectively) and in the elderly population aged 65–79 years (13.8% per year, P=0.005; and 12% per year, P=0.019). During 2003–2008, stroke mortality increased by 16.3% per year in middle-aged men (35–64 years), whereas among women (aged 35–64 and 65–79 years) and elderly men (aged 65–79 years), the age-adjusted mortality rate remained relatively unchanged.
Conclusions. Among both men and women, the mortality rates from stroke sharply declined between 1994 and 2008 with a clear slowdown in the decline after 2002. Stroke mortality increased significantly among middle-aged men from 2003, while it remained without significant changes among women of the same age and both elderly men and women. Full article

The process of the restructuring of health care system in Lithuania demonstrates the need to continue the monitoring of changes in avoidable mortality.
Objective. To assess the level of avoidable mortality as well as its changes over time in Lithuania during 2001–2008 and to define the impact of avoidable mortality on life expectancy.
Material and Methods. The mortality data were taken from the Lithuanian Department of Statistics. Twelve avoidable causes of deaths (treatable and preventable) were analyzed. Mortality trends were assessed by computing the average annual percent change (AAPC). The shortening of average life expectancy was computed from survival tables.
Results. During the period 2001–2008, the avoidable mortality was increasing more significantly (AAPC 3.0%, P<0.05) than the overall mortality (AAPC 1.7%, P<0.05) in the population aged 5–64 years. The increasing trend was mainly determined by mortality from preventable diseases (AAPC 4.6%, P<0.05). The avoidable causes of death reduced the life expectancy by 1.77 years (preventable by 1.12 and treatable by 0.63 years). Diversity in trends in mortality of different avoidable causes was disclosed. A declining trend in mortality caused by chronic rheumatic heart disease and lung cancer was observed for males (AAPC –22.6% and –2.1%, respectively; P<0.05). However, the mortality caused by liver cirrhosis was increasing for both genders (AAPC 16.1% for males and 17.6% for females, P<0.01) and that caused by tuberculosis – only for females (AAPC 7.8%, P<0.05).
Conclusions. An increasing trend in avoidable mortality was observed. Deaths caused by the diseases that could have been prevented had the greatest impact on the increasing mortality and decreasing life expectancy. Full article

This article presents the case of a 54-year-old male with evidence of myocardial ischemia at rest. In our case, by means of cardiovascular magnetic resonance, myocardial ischemia at rest in theoretical left anterior descending artery territory was proved, myocardial scar was excluded, and need for revascularization was validated. Full article

Background and Objective. The pattern of contact sensitization among patients with chronic leg ulcers depends on the local practice of wound treatment along with demographic and clinical confounders. The study was aimed at revealing the associations between chronic leg ulcers and contact sensitization.
Material and Methods. Between 2006 and 2008, 35 patients with chronic leg ulcers and surrounding dermatitis and 59 patients with contact dermatitis of the lower leg or foot were prospectively recruited at the Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences. Demographic and clinical data were collected in accordance with the “minimal data set” of the European Surveillance System on Contact Allergy. Patch testing was performed with the allergens of the European baseline series.
Results. At least one positive patch test reaction was found in 28 (80%) of the patients with chronic leg ulcers and in 24 (41%) of the patients with dermatitis of the lower leg or foot (P<0.001). Sensitization to some of the most common allergens, namely colophony, Myroxylon pereirae resin, and methyldibromo glutaronitrile, was prevalent in both the groups of patients, whereas sensitization to benzocaine, p-phenylenediamine, and lanolin alcohol was associated with the presence of chronic leg ulcers. Benzocaine was found to be the leading allergen among patients with chronic leg ulcers (positive patch test reactions in 34.4% of the patients).
Conclusions. Contact sensitization to benzocaine, p-phenylenediamine, and lanolin was found to be associated with the presence of chronic leg ulcers. Full article

Current advances in stem cell research and innovative biological approaches in the field of tissue engineering and regenerative medicine could eventually translate into prospective clinical applications. Various adult organs and tissues harbor stem and progenitor cells that could potentially be used to repair, regenerate, and restore a variety of different tissues following acute injury or tissue destructive diseases. Skeletal muscle is a very convenient and plentiful source of somatic stem cells. It contains several distinct populations of myogenic stem cells including satellite cells that are mainly responsible for muscle growth and regeneration, and multipotent muscle-derived stem cells (MDSCs). Although both cell populations share some phenotypic similarities, MDSCs display a much greater differentiation potential in vitro and are capable of regenerating various tissues in vivo. Furthermore, these cells not only participate in the regeneration process by differentiating into tissue-specific cell types, but also promote endogenous tissue repair by secreting a multitude of trophic factors. In this article, we describe the biological aspects of MDSC isolation and characterization and provide an overview of potential therapeutic application of these cells for the treatment of cardiac and skeletal muscle injuries and diseases, urological dysfunction, and bone and cartilage defects. We also discuss major challenges and limitations currently faced by MDSC-based therapies that await resolution before these techniques can be applied clinically. Full article