Acta Medica Lituanica最新文献

Background: Overtly morbid dementing diseases have a prodromal MCI (mild cognitive impairment) phase which is crucial to recognize. Clinical scores provide an easy bedside assessment tool for holistic cognitive evaluation but fail to provide lead time. While routine biomarkers of brain atrophy are late to appear, non-contrast MRI perfusion studies like ASL may serve as a valuable alternative to 18F-FDG-PET for the recognition and classification of the degree of neurodegeneration in individuals with MCI, especially when FDG-PET is not available. Our study adds confidence as we noted brain regions where PET-ASL concordance was most robust and devised concordance with ACE-3 scores.

Material and methods: We conducted a prospective study from Jan 2021 to Jan 2024. Cases were selected based on the inclusion and exclusion criteria, which have objective cognitive impairment. Healthy controls were selected. MRI and PET scans were performed in all cases. Perfusion values of arterial spine labeling, PET, and clinical examination were recorded.

Results: We included 33 patients and 15 healthy controls in the study. We compared ASL and PET for all selected individuals. Our study showed that ASL can detect a hypo-perfusion region with a 91% sensitivity, 85.98% specificity, 89.8% PPV, and 87.62% NPV, with a diagnostic accuracy of 88.9%.

Conclusion: ASL was a dependable replacement for the gold-standard FDG-PET. ASL may serve as a valuable alternative to ¹⁸F-FDG-PET for classifying the degree of neurodegeneration in individuals with prodromal AD, especially when FDG-PET is unavailable.

Hypertrophic cardiomyopathy (HCM) with mid-cavitary obstruction (MCO) is an uncommon condition affecting approximately 10% of HCM patients which is associated with serious outcomes, including sudden cardiac death and heart failure. We present the case of a 43-year-old male with type 2 diabetes mellitus who experienced worsening dyspnea and palpitations, leading to the diagnosis of HCM with MCO without outlet obstruction. Cardiac MRI with gadolinium contrast reveals significant mid-cavitary obstruction without left ventricular outflow tract obstruction with a scar burden of 27% and the absence of other high-risk factors such as apical aneurysm and NSVT runs on Holter monitoring. The patient was treated conservatively with the oral beta-blocker therapy, resulting in symptomatic improvement. Given the high risk of an adverse outcome, it is crucial to recognise MCO early and provide the appropriate treatment. This case report discusses the presentation, diagnosis, and management of a patient with HCM and mid-cavitary obstruction, highlighting the unique treatment considerations associated with this condition.

Take home message: Mid-cavitary obstruction (MCO) in hypertrophic cardiomyopathy (HCM) is associated with high-risk outcomes of sudden cardiac death and heart failure.While beta-blockers can improve symptoms in many MCO patients, treatment should be personalized based on the symptom severity and risk factors.Patients with MCO are at risk of complications like apical aneurysms, thromboembolism, and arrhythmias.

Background: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition characterized by disrupted cerebral autoregulation, often associated with clinical features such as hypertension, encephalopathy, seizures, and visual disturbances. Although it primarily affects females aged 20-65, posterior reversible encephalopathy syndrome can present across diverse demographics. This case underscores the critical importance of identifying uncommon risk factors to facilitate early diagnosis and optimal management.

Clinical case: A 37-year-old male with stage 3 chronic kidney disease secondary to hereditary nephropathy and a history of cocaine and alcohol misuse presented to the emergency department with recurrent seizures, hypertension, hyperthermia and altered consciousness. Imaging demonstrated cortical-subcortical hypodensities on CT and parieto-occipital FLAIR hyperintensities on MRI, consistent with the diagnosis of PRES. A diagnosis of PRES was confirmed based on the patient's history, neurological evaluation, and characteristic radiological findings.

Conclusions: Raising awareness of PRES and its less recognized but increasingly relevant risk factors, such as stimulant drug use - particularly cocaine - remains a critical aspect of improving diagnostic accuracy and management. Although PRES is typically reversible, delayed diagnosis and treatment may lead to permanent neurological complications, including cerebral infarction and hemorrhage.

Background: Transcatheter aortic valve implantation (TAVI) has emerged as an essential therapeutic intervention for patients with severe aortic valve disease, providing a less invasive alternative to traditional surgery, particularly in high-risk individuals. TAVI is also increasingly utilized as a valve-in-valve strategy in cases of a bioprosthetic valve failure. However, data on the efficacy of TAVI in the context of a hemodynamic collapse remain limited.

Methods: This report represents a young, high-risk patient with a failed bioprosthetic valve and cardiogenic shock treated successfully with TAVI.

Results: Emergency TAVI using a Medtronic Evolut Pro+ device achieved rapid hemodynamic stabilization and favorable post-procedural clinical and functional outcomes. Intermittent complete atrioventricular block necessitated the implantation of a permanent pacemaker.

Conclusions: This case highlights the potential of TAVI as a safe and effective intervention in critical clinical scenarios. Emergency TAVI is a viable therapeutic intervention for patients with failed surgical bioprostheses presenting with cardiogenic shock.

Because of its remarkable precision in providing targeted radiation, recent evidence supports Stereotactic Ablative Radiation Therapy (SABR) as a promising non-invasive treatment approach for metastatic renal cell carcinoma, minimizing harm to adjacent healthy tissues. With regards to its heterogeneous nature with diverse clinical presentations, rapid progression and metastatic potential, Renal Cell Carcinoma (RCC) is known to make therapy more challenging, and also to reduce the survival rates. Even though Immune Checkpoint Inhibitors (ICIs) remain the gold standard for treating metastatic RCC (mRCC), certain patients with one or a few distant metastases seem to have a longer survival period if the metastases are surgically removed. However, complete responses are not always the case, with radiation being increasingly incorporated as a component of multidisciplinary care. Moreover, studies proving the immunogenic qualities of hypofractionated SABR and the safety and potential of combining SABR with immune-based and surgical therapy for mRCC are becoming more prevalent in the literature. SABR helps induce local inflammation with the tumour, promoting T cell activation and antigen presentation. Multiple retrospective and prospective reports have also demonstrated that SABR assigned to the metastatic locations of mRCC, while using ablative dosages, achieves high local control rates with a good toxicity profile, thus disproving earlier theories of RCC radioresistance. This review outlines the key evidence favouring SABR being administered to metastatic tumours, including the results of recent prospective phase 2 trials in patients with oligometastatic, oligoprogressive, and unselected mRCC. The body of data that has been gathered points to SABR as a promising indicator that is being utilized more and more in the multidisciplinary management of mRCC.

Background: Pharmacological treatment is one of the most effective ways to help psychiatric patients with depressive disorders. However, prescription of antidepressants to children and adolescents creates controversial thoughts due to possible negative effects on the cardiovascular system. Despite being beneficial in controlling serious illnesses, there is less research done on the side effects of antidepressants which would require periodical checkups and cooperation among medical specialists. This literature review was completed to evaluate effects of antidepressants on the cardiovascular system and the necessity of regular assessment while treating children and adolescents.

Aim: To review the cardiovascular effects of antidepressants prescribed to children and adolescents; to discuss the need for regular patient checkups with a multidisciplinary team: pediatricians, family doctors, cardiologists and children-adolescent psychiatrists.

Methodology: Literature sources were selected from the Pubmed, Google Scholar, Clinical Key, and Research Gate databases by following dates from 2013 to 2024 while using the following keywords and their combinations: antidepressant, cardiovascular, side effects, cardiovascular risk, children and adolescents, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), psychotropic medication, antidepressants in pediatrics, atypical antidepressants, benzodiazepines, lipid metabolism.

Results: Antidepressants, including SSRIs, SNRIs, TCAs, atypical antidepressants and benzodiazepines, are associated with significant cardiovascular risks in children and adolescents. SSRIs, like citalopram and escitalopram, can disturb the heart rhythm by prolonging the QT interval, or increasing the risk of serious arrhythmias. SNRIs have been linked to an elevated blood pressure and heart rate. TCAs are known for their proarrhythmic effects, particularly in overdose situations, posing a high risk of sudden cardiac events. Atypical antidepressants like bupropion can cause cardiovascular disturbances, especially when overdosed. Additionally, less commonly prescribed benzodiazepines contribute to cardiovascular risks when combined with SSRIs during pregnancy, due to increasing the likelihood of congenital heart defects. These risks underscore the importance of careful monitoring, dosage management and thorough cardiovascular assessment when prescribing these medications to children, adolescents, and pregnant women. A team consisting of professional specialists - children-adolescent psychiatrists, cardiologists, pediatricians and family doctors - should detect long-term effects of pharmacotherapy by checking up the young patients regularly.

Conclusions: The use of antidepressants in children and adolescents, though crucial for managing se

Background: A rare but serious complication of heart valve replacement, prosthetic valve thrombosis carries significant risks of morbidity and mortality. Effective management depends on prompt diagnosis and the appropriate treatment, often involving fibrinolytic agents. Protocols using slower infusion rates and lower doses of these agents have led to improved therapy outcomes.

Clinical case: We report a case of a 56-year-old man admitted to the Lithuanian University of Health Sciences Kaunas Clinics due to mechanical mitral valve prosthesis thrombosis complicated by a respiratory failure and atrial fibrillation. The patient was treated with ultraslow thrombolysis with alteplase. The function of the mechanical valve prosthesis became normal, and the patient was discharged from the hospital.

Discussion and conclusions: Managing prosthetic valve thrombosis is challenging due to overlapping clinical features with other diagnoses and the lack of consensus on the treatment methods. Slow-infusion, low-dose thrombolytic therapy with alteplase can be a life-saving intervention with a high success rate.

Hepatic oligometastasis (hOMC) incidence varies from 10-40% in the literature. While the old standard for local treatment was surgical resection, options like TACE, TARE, SBRT with photons and off late protons have come to the fore. The proton beam therapy (PBT) use has gradually started to get adopted in all regions worldwide with increasingly better availability and ever-reducing costs. The role of PBT in hOMC has been studied in many retrospective cohort studies. Although there is a plethora of evidence on photon-SBRT, there are very few analyses on the role of PBT in hOMC. The author intends to analyse the efficacy in terms of the local control (LC) and the overall survival (OS) for PBT and its toxicity profile in this systematic review. LC remains persistently high (76-89% at 1-2 years) across breast, colo-rectum, stomach, and esophagus. Sites like colo-rectum and breast show relatively better survival outcomes, with progression free survival (35-52% at 1-2 years) and OS (33-78% at 1-2 years) than other sites, likely due to disease biology. Breast primary derived hOMCs had the best 3-year OS of 67.6%. Toxicities remain remarkably low with grade 3 plus toxicities ranging from 0-3%, which reflects the ability of proton therapy to deliver beams with precision.

Background: Computed tomography is a highly informative diagnostic tool, but its use poses the challenge of managing potentially high radiation exposure to patients. Children are particularly vulnerable to the harmful effects of ionizing radiation, and the growing use of paediatric Computed Tomography (CT) scans has been linked to an elevated lifetime risk of cancer and an increased mortality. The aim of this study was to evaluate local radiation exposure doses in paediatric thoracic and abdominal-pelvic CT exams, to establish Diagnostic Reference Level (DRL) curves, propose local diagnostic reference levels, and compare them with the existing literature and the European Guidelines on Diagnostic Reference Levels for Paediatric Imaging (PiDRL).

Materials and methods: A dataset of thoracic and abdominal-pelvic CT exams performed on children was analysed. Scan data entries were grouped according to the patient weight in the following intervals: 5 to 14 kg, 15 to 29 kg, 30 to 49 kg, and 50 to 79 kg. In each weight group, the minimum, first quartile, median, third quartile, and the maximum values of Volumetric Computed Tomography Dose Index (CTDI_vol) and the Dose Length Product (DLP) were calculated. The relationship between CTDI_vol, DLP, and the patient body weight was assessed by using exponential curves.

Results: The local DRLs were established for thoracic CT exams, while, for abdominal-pelvic CT exams, the DRL curve was set as a substitute due to limited data. The proposed local DRL values for thoracic computed tomography examinations are 2.0, 2.4, 3.6, and 5.0 mGy for CTDI_vol and 40, 60, 116, and 156 mGy•cm for DLP in the corresponding weight groups of 5 to 14 kg, 15 to 29 kg, 30 to 49 kg, and 50 to 79 kg. The median values of CTDI_vol for paediatric abdominal-pelvic computed tomography were 2.8 mGy in the 5-to-14 kg weight group, 3.6 mGy in the 15-to-29 kg group, 4.8 mGy in the 30-to-49 kg group, and 7.9 in the 50-to-79 kg group. The median DLP values were 81, 127, 203, and 304 mGy•cm, respectively.

Conclusions: The set local DRLs for thoracic and the median dose values in abdominal-pelvic CT exams are generally lower than the European DRLs. The derived DRL curves fulfil the same purpose as weight-group DRLs, serving as benchmarks for dose optimization.