Acta Medica Lituanica最新文献

A male in his early 70s presented with complaints of bilateral flank pain for seven months, hematuria for 2 days along with the passage of clots associated with an increased frequency of urination and nocturia. The patient had a history of deep vein thrombosis and was on anticoagulation. On ultrasound, multiple calculi with posterior acoustic shadowing were seen in bilateral kidneys, corroborated by Computed Tomography (CT) urography. Laser lithotripsy with DJ stent placement was conducted. The follow-up CT urography showed an inferiorly displaced DJ stent within the right distal ureter and the DJ stent herniating through the right obturator foramen. The right-sided DJ stent was removed after a month. For obturator hernia, the patient is being kept in the follow-up. This case report reviewed the literature and discussed the diagnosis and complications associated with the obturator hernia with the ureter as the content.

Nodal Marginal Zone Lymphoma (NMZL) is a rare, indolent subtype of B-cell non-Hodgkin lymphoma. This case report presents a 67-year-old female diagnosed with NMZL, which had transformed into Diffuse Large B-cell Lymphoma (DLBCL) at the time of diagnosis. The patient's initial presentation involved a dry cough and pleural effusion, a symptom rarely reported in NMZL cases. Diagnostic procedures, including cytology and immunohistochemistry, confirmed the presence of monoclonal B lymphocytes and identified markers consistent with NMZL transformation to DLBCL. The findings highlight the diagnostic challenges associated with NMZL due to the lack of specific immunohistochemical markers, emphasizing the need for histopathological analysis to distinguish NMZL from other lymphomas, such as follicular lymphoma. This case underscores the importance of early detection and differentiation in lymphomas presenting with pleural effusion, as transformation to aggressive forms like DLBCL significantly impacts the prognosis and treatment approaches. Despite the rarity of transformation at diagnosis, clinicians must consider it in NMZL cases with atypical presentations.

Background: Anterior cruciate ligament (ACL) injuries are among the most common and impactful musculoskeletal injuries, particularly in athletic populations. A variety of biological and synthetic grafts are used in surgical reconstruction, each offering different biomechanical properties and long-term outcomes.

Materials and methods: This narrative review analyzed 42 original clinical studies published between 1989 and 2024. Articles were retrieved from PubMed and Google Scholar by using terms such as 'ACL reconstruction', 'BPTB', 'hamstring tendon', 'quadriceps tendon', 'LARS', 'Leeds-Keio', and 'GORE-TEX'. Key outcomes included graft failure rates, postoperative knee stability (e.g., KT-1000, Lachman test), and functional outcomes (Lysholm, Tegner, IKDC). Numerical data were pooled descriptively; no formal meta-analysis was performed.

Results: Biological grafts, particularly BPTB and quadriceps tendon autografts, demonstrated the lowest failure rates (as low as 1.2%) and superior mechanical stability (>95% achieving Grade 0-1 laxity) compared to synthetic options. Hamstring tendon autografts were slightly less durable but still reliable. Synthetic grafts, and especially GORE-TEX and Leeds-Keio, were associated with higher failure rates (up to 33%) and complications related to poor biological integration.

Conclusions: BPTB and QT autografts remain the most reliable options for ACL reconstruction, offering excellent long-term outcomes. While synthetic grafts may be appropriate in select patients, they carry a higher risk of failure and complications. Graft selection should be individualized based on the patient activity level, anatomical considerations, and tolerance for donor-site morbidity.

Background: Adrenal adenomas, often discovered during imaging studies for unrelated conditions, pose diagnostic and therapeutic challenges due to their varying presentations and potential for hormone secretion. While surgical management remains the standard approach for hormonally active adrenal tumors, percutaneous ablation techniques - such as microwave ablation - have emerged as promising alternatives, particularly for patients who are not candidates for surgery.

Materials and methods: This report presents a series of clinical cases in which percutaneous microwave ablation was used as an alternative to adrenalectomy. The study focuses on patients with cortisol-producing adrenal adenomas and explores the effectiveness of this minimally invasive procedure in achieving hormonal control and symptom relief.

Results: Microwave ablation was successfully performed in all cases without major complications. Clinical follow-up demonstrated improvement in cortisol levels and relief of symptoms related to hypercortisolism. The procedure was well tolerated, offering an alternative therapeutic option for patients unsuitable for adrenalectomy.

Conclusions: Percutaneous microwave ablation may serve as a safe and effective treatment option for cortisol-secreting adrenal adenomas in patients with Mild Autonomous Cortisol Secretion and ACTH-independent Cushing Syndrome who are not candidates for surgery. This approach may provide significant symptom relief and hormonal control with minimal invasiveness.

Background: Giant descending thoracic aortic aneurysm (GDTAA) is a rare vascular disease characterized by an aortic diameter exceeding 10 cm. GDTAA carries a significant risk of rupture and mortality and requires timely diagnosis and intervention. Despite the clinical severity of the disease, the literature on GDTAA remains sparse, particularly in cases with extreme aneurysmal dilatation.

Case presentation: We present the case of a 68-year-old man with a GDTAA of 14.08 × 10.04 cm, one of the largest ever reported. The patient initially presented with recurrent syncope, chronic cough and fatigue. Imaging studies, including Computed Tomography (CT) angiography, revealed a massive aneurysmal dilatation in the distal post-arch segment of the descending aorta with compression of the trachea and bronchi. The patient underwent a successful open surgical repair with a Dacron graft and simultaneous Coronary Artery Bypass Grafting (CABG). Postoperative complications included respiratory acidosis, emphysema and transient haemodynamic instability, which were effectively treated. The patient was discharged in a stable condition on the tenth postoperative day.

Conclusion: This case highlights the importance of early recognition and surgical intervention in GDTAA in order to prevent catastrophic consequences. Comprehensive preoperative evaluation, careful surgical planning and attentive postoperative care are essential for optimal recovery. Our results emphasise the importance of modern imaging techniques for accurate anatomical assessment and risk stratification in patients with extreme aneurysm growth. Further research is needed to establish standardised protocols for the treatment of GDTAA.

Fetal growth restriction is one of the main factors contributing to neonatal mortality, stillbirth, and cardiovascular dysfunction in a fetus and newborn, where one of the common causes is placental dysfunction; it can occur as a result of placental vascular anomalies, which requires clarification and systematization of existing scientific provisions based on the assessment of morphological patterns of fetoplacental circulatory disorders. The aim of the study was to investigate and evaluate morphological markers of fetoplacental blood flow disorders in late manifestation of fetal growth restriction by pathohistological examination of placental tissue.

Materials and methods: Clinical and anamnestic features were assessed in 80 pregnant women with late manifestation of fetal growth restriction (the main group of research) and in 40 patients with a timely labour and birth of fetuses with normal fetometry parameters for the gestational age. 32 and 10 placental tissue samples were selected in the main group and in the comparison group, respectively, for pathohistological examination, and a postnatal macro-histomorphological assessment of the placenta was performed.

Results: Postnatal macromorphometric characteristics of placental tissue reflect pathological features of its formation, dominated by an abnormal shape (46-57.5%), eccentric umbilical cord insertion (43-53.8%) with main and intermediate types of vascular branching (37-46.2%), and a statistically lower placental weight and diameter. A combination of maternal and fetal vascular malperfusion was noted, with the following most significant markers: infarctions (13-40.6%), distal villous hypoplasia (24-75.0%), increased syncytial nodules as a manifestation of delayed villous maturation as a manifestation of premature maturation (24-75.0%), decidual arteriopathy (13-40.6%). Analysis of histopathological data indicates malperfusion of the fetal vessels, with the proportion of villitis and markers of intrauterine infection verified in one third of the samples (13-40.6%).

Conclusions: In cases of late-onset fetal growth restriction, placental lesions occur with the development of maternal and fetal vascular malperfusion. Pathomorphological criteria of maternal vascular malperfusion are statistically significant in the main group: infarctions, distal villous hypoplasia, decidual arteriopathy, and chorionic villous dysmaturation. Fetal vascular malperfusion is characterized by obliteration and thrombosis of the stem vessels of the anchoring and intermediate villi, avascularization, hyalinosis of the villi, and, less frequently, delayed maturation with the development of stromal-vascular karyorexis. In our study, both Type 1 and Type 2 fetal vascular malperfusion in different placentas with fetal growth restriction were found, but the segmental type was still the most common.

Background: A postmortem brain weight examination can provide valuable diagnostic information on probable causes of death. Deviations from normal brain weight can indicate the presence of different factors such as psychoactive substance use, the presence of neurological conditions, tumours, brain oedema or traumatic brain injury. The aim of this study is to analyse these factors and their role in understanding the underlying causes of death.

Materials and methods: This research was designed as a retrospective study. The study sample consisted of 651 autopsy cases from 2013 to 2023. The brain weight was compared between people who died from traumatic brain injury, by hanging, of other sudden causes, and were intoxicated by alcohol or drugs. The collected data were processed by using R software. P values less than 0.05 were considered significant.

Results: The mean brain weight of the control group was 1274.93 ± 124.74 g. The mean brain weight of males was greater than that of females. The brain weight was lower in children and the elderly, whereas the greatest in adults between the ages 21-30. In the ethyl alcohol-intoxicated group, the mean brain weight was 1344.01 ± 148.69 g, whereas, in the drug-intoxicated group, it measured 1418.45 ± 125.45 g. The mean brain weight of subjects with strangulation asphyxia was 1372.13 ± 128.83 g, while for those with traumatic brain injury it was 1358.27 ± 150.42 g. The highest brain weight was observed in subjects with epidural hematoma and with subarachnoid haemorrhage. The most frequent complications in patients who died after brain injury were cerebral herniation and pneumonia. The mean brain weight of subjects with cerebral herniation was 1376.95 ± 164.29 g. After traumatic brain injury, skull fractures, brain surgery and cerebral herniation were associated with a higher brain weight. There was a negative correlation between the brain weight and the Glasgow Coma Scale score.

Conclusions: A greater brain mass was observed in subjects with ethyl alcohol and drug intoxication, in the groups with strangulation asphyxia and traumatic brain injury compared to the control group. In the traumatic brain injury group, a greater brain weight was observed in men, in those with skull fractures, with epidural haemorrhage, with herniation signs, and after brain surgery.

Introduction: This study investigates the bioanthropological and paleopathological features of the late Blessed Giuseppe Benedetto Dusmet, a revered 19^th-century archbishop of Catania. Dusmet's remains were examined during the most recent canonical recognition in 2021, providing an opportunity to study the skeletal characteristics that may reflect his lifestyle and health.

Materials and methods: Paleopathological analysis focused on degenerative changes using macroscopic inspection to identify osteoarthritic conditions. Historical records were also consulted to understand the potential connection between his devout religious practices and his physical health.

Results: Significant degenerative and osteoarthritic changes were observed, particularly in the knees. These changes are hypothesized to be linked to Dusmet's frequent practice of kneeling in prayer, a physical activity historically associated with knee osteoarthritis.

Conclusion: This study highlights how bioanthropological and paleopathological analysis can provide insights into the health and lifestyle of historical figures. The observed knee osteoarthritis in the Blessed Giuseppe Benedetto Dusmet's remains suggests a possible link between his behavior and the development of joint degeneration. This research adds to our understanding of the physical impact of religious practices and contributes to the study of health in historical figures.

Background: The Artery of Percheron (AOP) is a vascular variant supplying both sides of the thalamus, present in up to one-quarter of the general population. AOP occlusion is a rare cause of ischemic stroke, resulting in bilateral thalamic infarction. It typically manifests as altered consciousness, gaze abnormalities, and cognitive impairment. Neuroimaging of AOP stroke is challenging, as head CT is often unremarkable. However, a diagnostic 'V' sign can be identified on MRI. AOP stroke is treated as other types of ischemic stroke.

Case description: We present a case of a 61-year-old male with a history of alcohol abuse, diagnosed with ischemic AOP stroke. He presented with sudden loss of consciousness, third nerve palsy, and vertical gaze palsy. MRI revealed bilateral paramedian thalamic infarction with midbrain involvement. Despite conservative treatment, his condition showed minimal improvement, leaving him lethargic and dysarthric. He was discharged to palliative care after two weeks.

Conclusions: AOP infarction, though rare, should be considered in patients with altered consciousness. Early MRI is essential for accurate diagnosis and timely treatment, highlighting the importance of physician awareness of this condition.

Introduction: The increasing popularity of Amanita muscaria, driven by its hallucinogenic properties, has raised significant public health concerns, particularly as it remains largely unregulated across most European Union countries. The mushroom contains muscimol, a compound that induces euphoria, altered perception, and hallucinations, and its precursor, ibotenic acid, converts to muscimol when dried or heated, reducing toxicity while preserving psychoactive effects. The growing trend in intentional consumption of A. muscaria reflects evolving patterns of intoxication despite its known toxicity risks. The European Food Safety Authority has flagged A. muscaria as an emerging risk, highlighting concerns over its increasing availability and potential for misuse.

Materials and methods: Four cases of Amanita muscaria consumption and subsequent intoxication have been documented in Lithuania in 2023. To further investigate this topic, a systematic search was conducted using the PubMed database with the following keyword combinations: 'Amanita muscaria', 'Amanita muscaria toxicity', 'muscimol', 'ibotenic acid', 'psilocybin', and 'hallucinogenic fungi'. After screening for relevance and eligibility, a total of 27 publications met the inclusion criteria and were incorporated into the final analysis.

Case reports: In 2023, four cases of intentional A. muscaria poisoning were reported in Lithuania, linked to recreational consumption. Symptoms included tremors, respiratory failure, dizziness, and paranoia. All patients were male and required hospitalization, but all were discharged in stable condition.

Conclusion: The unregulated status and increasing accessibility of A. muscaria pose significant public health concerns. While A. muscaria remains largely unstudied in medical contexts, its toxicity risks are well-documented. Misleading online information contributes to uninformed consumption, especially among younger individuals. Further research is needed to elucidate its chemical composition, therapeutic potential, and health effects to inform regulatory policies.