Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.5
Abdulhalim Hamlah, Abd Alraouf Tarabishy, Haitham Al-Madhagi
Crush syndrome (CS) is a metabolic disorder whose victims are individuals suffered from natural disasters such as earthquake or man-made conflicts. CS complications include acute kidney injury and cardiac arrhythmia that collectively end with death if untreated immediately. These complications are accounted for the liberation of damaged muscle tissues contents, primarily myoglobin and potassium. The present mini review discusses the biochemical basis of the development of CS. In addition, diagnosis and management and the application of novel experimental therapeutics of CS are also highlighted.
{"title":"Mini Review of Biochemical Basis, Diagnosis and Management of Crush Syndrome","authors":"Abdulhalim Hamlah, Abd Alraouf Tarabishy, Haitham Al-Madhagi","doi":"10.15388/amed.2023.30.2.5","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.5","url":null,"abstract":"Crush syndrome (CS) is a metabolic disorder whose victims are individuals suffered from natural disasters such as earthquake or man-made conflicts. CS complications include acute kidney injury and cardiac arrhythmia that collectively end with death if untreated immediately. These complications are accounted for the liberation of damaged muscle tissues contents, primarily myoglobin and potassium. The present mini review discusses the biochemical basis of the development of CS. In addition, diagnosis and management and the application of novel experimental therapeutics of CS are also highlighted.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135823229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.4
Joana Mikulevič, Karolina Tumelienė, Robertas Kemežys, Augustina Jankauskienė
Background. Nephrotic children may develop thyroid hormone dysfunction due to urinary excretion of thyroid hormones. In contrast to the subclinical hypothyroidism that affects around 30% of children with nephrotic syndrome (NS), the patient in this case had overt hypothyroidism and severe growth retardation.Clinical case. A 5 years and 8 months old girl with steroid-dependent NS was referred from another center due to persistent edema and decreased diuresis, being treated with mycophenolate mofetil (MMF) 250 mg once a day and L-thyroxine 50 mcg daily since 4 months of NS onset because of hypothyroidism. Her albumin was 12.64 g/l, cholesterol 25.64 mmol/l and proteinuria 5 g/l. Severe growth retardation was observed: patient’s height was 93.5 cm (–13 cm <3 percentile), weighted 17.2 kg (15–25 percentile). Her disease vintage was over 3 years. Girl’s growth velocity has slowed down from 3.5 months. The patient received a high cumulative dose of prednisolone (approx. 7800 mg in 1 year and 8 months). Thyroid-stimulating hormone was higher (18.04 mU/L) with reduced FT4 11.43 pmol/l and IGF-1 < 15 µg/L. Kidney biopsy revealed minimal change disease, and genetic testing was negative. Intensive NS treatment with methylprednisolone pulse therapy, enlarged doses of MMF and albumin infusion were started and L-thyroxine dose was increased to 75 mcg. TPOAb was in normal range (12.65 IU/ml). After 3 weeks she was discharged with no edema and after stopping methylprednisolone treatment thyroid function normalized and L-thyroxin was discontinued. Two weeks later standard growth hormone stimulation test with clonidine showed partially insufficient growth hormone secretion. During NS remission with normalization of thyroid function (TSH 6.680 mU/l, FT4 13.85 pmol/l) and normalization of IGF-1 level (132 mcg/l) partial catch-up growth was observed (height velocity increased from 3.5 cm/year to 7.3 cm/year, based on 4-month calculation period).Conclusions. Clinicians should be aware of a risk of developing hypothyroidism and consider thyroid function testing during the treatment of children with NS, as well as actively treat hypothyroidism and evaluate growth.
{"title":"Overt Hypothyroidism and Severe Growth Retardation in a Preschool Girl with Poorly Controlled Nephrotic Syndrome: Case Report and Literature Review","authors":"Joana Mikulevič, Karolina Tumelienė, Robertas Kemežys, Augustina Jankauskienė","doi":"10.15388/amed.2023.30.2.4","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.4","url":null,"abstract":"Background. Nephrotic children may develop thyroid hormone dysfunction due to urinary excretion of thyroid hormones. In contrast to the subclinical hypothyroidism that affects around 30% of children with nephrotic syndrome (NS), the patient in this case had overt hypothyroidism and severe growth retardation.Clinical case. A 5 years and 8 months old girl with steroid-dependent NS was referred from another center due to persistent edema and decreased diuresis, being treated with mycophenolate mofetil (MMF) 250 mg once a day and L-thyroxine 50 mcg daily since 4 months of NS onset because of hypothyroidism. Her albumin was 12.64 g/l, cholesterol 25.64 mmol/l and proteinuria 5 g/l. Severe growth retardation was observed: patient’s height was 93.5 cm (–13 cm <3 percentile), weighted 17.2 kg (15–25 percentile). Her disease vintage was over 3 years. Girl’s growth velocity has slowed down from 3.5 months. The patient received a high cumulative dose of prednisolone (approx. 7800 mg in 1 year and 8 months). Thyroid-stimulating hormone was higher (18.04 mU/L) with reduced FT4 11.43 pmol/l and IGF-1 < 15 µg/L. Kidney biopsy revealed minimal change disease, and genetic testing was negative. Intensive NS treatment with methylprednisolone pulse therapy, enlarged doses of MMF and albumin infusion were started and L-thyroxine dose was increased to 75 mcg. TPOAb was in normal range (12.65 IU/ml). After 3 weeks she was discharged with no edema and after stopping methylprednisolone treatment thyroid function normalized and L-thyroxin was discontinued. Two weeks later standard growth hormone stimulation test with clonidine showed partially insufficient growth hormone secretion. During NS remission with normalization of thyroid function (TSH 6.680 mU/l, FT4 13.85 pmol/l) and normalization of IGF-1 level (132 mcg/l) partial catch-up growth was observed (height velocity increased from 3.5 cm/year to 7.3 cm/year, based on 4-month calculation period).Conclusions. Clinicians should be aware of a risk of developing hypothyroidism and consider thyroid function testing during the treatment of children with NS, as well as actively treat hypothyroidism and evaluate growth.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"243 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135824404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.7
Gintarė Zarembaitė, Gabrielė Žiūkaitė, Sigitas Chmieliauskas, Diana Vasiljevaitė, Sigitas Laima, Jurgita Stasiūnienė
Background: Tuberculosis is one of the most common infectious diseases in the world. 10.6 million people fell ill in 2021 and 1.6 million died from the disease. Lithuania has the third-highest tuberculosis incidence rate per 100,000 and the second-highest mortality rate per 100,000 in EU/EEA countries. During 2015–2021 years, there were 799 deaths of pulmonary tuberculosis in Lithuania. However, the presence of pulmonary tuberculosis is often unknown before death and is only revealed during autopsy. The aim of the study is to review current literature on this topic and present statistical analysis on evaluated socioeconomical, epidemiological indicators, as well as autopsy findings that may suggest pulmonary tuberculosis infection.Materials and methods: This research was designed as a retrospective study focusing on full forensic pathology autopsies between 2015 and 2021. Of these, 100 cases were randomly selected where the cause of death was tuberculosis diagnosed during post-mortem examination and compared to a control group consisting of 415 cases of sudden death.Results: The study revealed that out of 100 pulmonary tuberculosis cases, 90% were male with the mean age of 53.48 ± 11.12 years old. In the case of sudden death where tuberculosis was found, a significant portion of the sample (91%) was not followed up at any medical institution. Regarding socioeconomic factors, a moderate negative correlation between Lithuania’s gross domestic product and tuberculosis distribution was observed, as well as a weak negative correlation between alcohol consumption (l per capita) in the general population and tuberculosis distribution. The lung weight of the pulmonary tuberculosis group was statistically significantly higher than that of the control group.Conclusions: Tuberculosis remains a major problem in Lithuania and the combination of socioeconomic indicators determines the prevalence of tuberculosis in the country. In cases of sudden death, autopsy helps to identify tuberculosis cases that have not been clinically detected and ensures tuberculosis monitoring. Therefore, the person who performs autopsy remains at high risk of contracting tuberculosis. Furthermore, extreme caution is advised if higher lung weight or hardenings are seen during autopsy because of the possibility of tuberculosis.
{"title":"Tuberculosis and Sudden Death in Lithuania","authors":"Gintarė Zarembaitė, Gabrielė Žiūkaitė, Sigitas Chmieliauskas, Diana Vasiljevaitė, Sigitas Laima, Jurgita Stasiūnienė","doi":"10.15388/amed.2023.30.2.7","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.7","url":null,"abstract":"Background: Tuberculosis is one of the most common infectious diseases in the world. 10.6 million people fell ill in 2021 and 1.6 million died from the disease. Lithuania has the third-highest tuberculosis incidence rate per 100,000 and the second-highest mortality rate per 100,000 in EU/EEA countries. During 2015–2021 years, there were 799 deaths of pulmonary tuberculosis in Lithuania. However, the presence of pulmonary tuberculosis is often unknown before death and is only revealed during autopsy. The aim of the study is to review current literature on this topic and present statistical analysis on evaluated socioeconomical, epidemiological indicators, as well as autopsy findings that may suggest pulmonary tuberculosis infection.Materials and methods: This research was designed as a retrospective study focusing on full forensic pathology autopsies between 2015 and 2021. Of these, 100 cases were randomly selected where the cause of death was tuberculosis diagnosed during post-mortem examination and compared to a control group consisting of 415 cases of sudden death.Results: The study revealed that out of 100 pulmonary tuberculosis cases, 90% were male with the mean age of 53.48 ± 11.12 years old. In the case of sudden death where tuberculosis was found, a significant portion of the sample (91%) was not followed up at any medical institution. Regarding socioeconomic factors, a moderate negative correlation between Lithuania’s gross domestic product and tuberculosis distribution was observed, as well as a weak negative correlation between alcohol consumption (l per capita) in the general population and tuberculosis distribution. The lung weight of the pulmonary tuberculosis group was statistically significantly higher than that of the control group.Conclusions: Tuberculosis remains a major problem in Lithuania and the combination of socioeconomic indicators determines the prevalence of tuberculosis in the country. In cases of sudden death, autopsy helps to identify tuberculosis cases that have not been clinically detected and ensures tuberculosis monitoring. Therefore, the person who performs autopsy remains at high risk of contracting tuberculosis. Furthermore, extreme caution is advised if higher lung weight or hardenings are seen during autopsy because of the possibility of tuberculosis.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"64 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135824096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.8
Edoardo Ipponi, Alfio Damiano Ruinato, Leonardo Lombardi, Martina Cordoni, Silvia De Franco, Antonio D'Arienzo, Lorenzo Andreani
Background: Giant cell tumor of the tendon sheath (GCTTS), also termed Tenosynovial giant cell tumor (TGCT), is a locally aggressive tumor which originates from tendon sheaths or bursas. Around 3–5% of these tumors arise from foot and ankle. Localized lesions in this area are often manifested as firm masses or nodules with slow but continuous progression through months and years. Pain associated with weight-bearing, as well as limitations in joint motions, may be reported, depending on tumor’s location. Surgery is the treatment of choice for the definitive removal of GCTTSs with the aim to eradicate the neoplasm and restore the lower limb’s functionality.Methods: Thirteen cases suffering from GCTTS of the foot and ankle underwent surgical resection at our institution between 2017 and 2022. For each case we recorded pre-operative and post-operative symptoms, as well as their pre-operative and post-operative functional status according to both MSTS and AOFAS scores. Eventual complications and local recurrences were reported.Results: Each patient experienced an at least mild pain before surgical treatment. The mean pre-operative MSTS and AOFAS scores were 22.8 and 70.7, respectively. The mean tumor size was 17.7 mm. Each patient received a resection with wide margins. Two cases (15.4%) had local recurrences. None had major complications at their latest follow-up. After the surgery, the mean post-operative MSTS and AOFAS scores increased to 28.3 and 92.2, respectively.Conclusion: Resection with wide margins for foot and ankle GCTTS is effective in restoring the patients’ lower limb functionality and is associated with reasonable local recurrence rates.
{"title":"Outcomes of Surgical Treatment for Localized Tenosynovial Giant-Cell Tumor of the Foot and Ankle: A Case Series","authors":"Edoardo Ipponi, Alfio Damiano Ruinato, Leonardo Lombardi, Martina Cordoni, Silvia De Franco, Antonio D'Arienzo, Lorenzo Andreani","doi":"10.15388/amed.2023.30.2.8","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.8","url":null,"abstract":"Background: Giant cell tumor of the tendon sheath (GCTTS), also termed Tenosynovial giant cell tumor (TGCT), is a locally aggressive tumor which originates from tendon sheaths or bursas. Around 3–5% of these tumors arise from foot and ankle. Localized lesions in this area are often manifested as firm masses or nodules with slow but continuous progression through months and years. Pain associated with weight-bearing, as well as limitations in joint motions, may be reported, depending on tumor’s location. Surgery is the treatment of choice for the definitive removal of GCTTSs with the aim to eradicate the neoplasm and restore the lower limb’s functionality.Methods: Thirteen cases suffering from GCTTS of the foot and ankle underwent surgical resection at our institution between 2017 and 2022. For each case we recorded pre-operative and post-operative symptoms, as well as their pre-operative and post-operative functional status according to both MSTS and AOFAS scores. Eventual complications and local recurrences were reported.Results: Each patient experienced an at least mild pain before surgical treatment. The mean pre-operative MSTS and AOFAS scores were 22.8 and 70.7, respectively. The mean tumor size was 17.7 mm. Each patient received a resection with wide margins. Two cases (15.4%) had local recurrences. None had major complications at their latest follow-up. After the surgery, the mean post-operative MSTS and AOFAS scores increased to 28.3 and 92.2, respectively.Conclusion: Resection with wide margins for foot and ankle GCTTS is effective in restoring the patients’ lower limb functionality and is associated with reasonable local recurrence rates.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135824416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.10
Goda Aleknavičiūtė-Valienė, Linas Černiauskas, Mantas Riauka, Dalius Vitkus
Background. Increased enzyme activity in human blood serum is usually associated with the existence of disease. On the other hand, enzyme activity can also be elevated in the presence of benign conditions, such as macro-enzymes. Macro-enzymes could lead to highly unnecessary and invasive procedures which may cause complications to the patient and an extra cost for the hospital. Therefore, it is important to diagnose this condition in order to avoid unnecessary clinical tests.Case Presentation. We present a case of a 71-year-old asymptomatic female with persistent elevation of AST who was referred to our hospital for additional testing for underlying liver disease. By using polyethylene glycol (PEG) precipitation assay, we were able to identify macro-AST. This helped to avoid the high-risk liver biopsy procedure.Conclusion. In the case of an isolated elevation of AST activity with no clinical indications of liver disease, diagnostic work-up for macro-AST should always be considered by physicians.
{"title":"Macro-Aspartate Aminotransferase and Its Laboratory Detection: A Case Report","authors":"Goda Aleknavičiūtė-Valienė, Linas Černiauskas, Mantas Riauka, Dalius Vitkus","doi":"10.15388/amed.2023.30.2.10","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.10","url":null,"abstract":"Background. Increased enzyme activity in human blood serum is usually associated with the existence of disease. On the other hand, enzyme activity can also be elevated in the presence of benign conditions, such as macro-enzymes. Macro-enzymes could lead to highly unnecessary and invasive procedures which may cause complications to the patient and an extra cost for the hospital. Therefore, it is important to diagnose this condition in order to avoid unnecessary clinical tests.Case Presentation. We present a case of a 71-year-old asymptomatic female with persistent elevation of AST who was referred to our hospital for additional testing for underlying liver disease. By using polyethylene glycol (PEG) precipitation assay, we were able to identify macro-AST. This helped to avoid the high-risk liver biopsy procedure.Conclusion. In the case of an isolated elevation of AST activity with no clinical indications of liver disease, diagnostic work-up for macro-AST should always be considered by physicians.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.9
Deb K. Boruah, Daisy Vishwakarma, Pallavi Gogoi, Navneet R Lal, Arup Deuri
Background: High-resolution Ultrasound (USG) provides good anatomical details of the ocular posterior segment and depicts the various pathological conditions affecting the ocular posterior segment, which helps ophthalmologists for choosing the best treatment options. This study aims to evaluate the utility of High-resolution Ultrasonography in the Evaluation of Posterior Segment Ocular lesions by using Sensitivity and Specificity.Materials and Methods: A hospital-based retrospective study enrolled 81 patients in a tertiary care hospital. Clinical and ophthalmological examinations were performed followed by USG of the orbits. B-mode USG was done with a 7.5–13 MHz linear probe. The final diagnosis was made by correlating the USG findings with clinical and ophthalmological examinations.Statistical analysis: Sensitivity, specificity, the positive predictive value, the negative predictive value, and the accuracy of B-scan USG were compared with the ophthalmological findings by using the Chi-square test.Results: Of 81 patients (n=48 males and n=33 females) with a mean age of 38.98 ± 16.48 [SD] years, posterior segment ocular lesions in association with cataracts were found in 27 (33.3%) patients, whereas 14 (51.9%) patients had posterior vitreous detachment (PVD), 10 (37%) patients had retinal detachment (RD), and 1 (3.7%) patient had choroidal detachment (CD). Posterior segment ocular pathologies were found in 17 (21%) patients with blunt ocular injuries, whereas 8 (47.1%) patients had PVD, 4 (23.5%) patients had RD and 4 (23.5%) patients had CD. The ocular USG had a sensitivity of 87.32%, specificity of 80%, and accuracy of 86.42% with a statistically significant difference between the USG findings and the Ophthalmology diagnosis of the posterior segment ocular abnormalities of a p-value of 0.0005.Conclusion: High-resolution ultrasound is one of the best and an easily available imaging modality for the evaluation of posterior segment ocular pathologies, especially in the presence of opaque ocular media.
{"title":"Utility of High-Resolution Ultrasonography in the Evaluation of Posterior Segment Ocular Lesions Using Sensitivity and Specificity","authors":"Deb K. Boruah, Daisy Vishwakarma, Pallavi Gogoi, Navneet R Lal, Arup Deuri","doi":"10.15388/amed.2023.30.2.9","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.9","url":null,"abstract":"Background: High-resolution Ultrasound (USG) provides good anatomical details of the ocular posterior segment and depicts the various pathological conditions affecting the ocular posterior segment, which helps ophthalmologists for choosing the best treatment options. This study aims to evaluate the utility of High-resolution Ultrasonography in the Evaluation of Posterior Segment Ocular lesions by using Sensitivity and Specificity.Materials and Methods: A hospital-based retrospective study enrolled 81 patients in a tertiary care hospital. Clinical and ophthalmological examinations were performed followed by USG of the orbits. B-mode USG was done with a 7.5–13 MHz linear probe. The final diagnosis was made by correlating the USG findings with clinical and ophthalmological examinations.Statistical analysis: Sensitivity, specificity, the positive predictive value, the negative predictive value, and the accuracy of B-scan USG were compared with the ophthalmological findings by using the Chi-square test.Results: Of 81 patients (n=48 males and n=33 females) with a mean age of 38.98 ± 16.48 [SD] years, posterior segment ocular lesions in association with cataracts were found in 27 (33.3%) patients, whereas 14 (51.9%) patients had posterior vitreous detachment (PVD), 10 (37%) patients had retinal detachment (RD), and 1 (3.7%) patient had choroidal detachment (CD). Posterior segment ocular pathologies were found in 17 (21%) patients with blunt ocular injuries, whereas 8 (47.1%) patients had PVD, 4 (23.5%) patients had RD and 4 (23.5%) patients had CD. The ocular USG had a sensitivity of 87.32%, specificity of 80%, and accuracy of 86.42% with a statistically significant difference between the USG findings and the Ophthalmology diagnosis of the posterior segment ocular abnormalities of a p-value of 0.0005.Conclusion: High-resolution ultrasound is one of the best and an easily available imaging modality for the evaluation of posterior segment ocular pathologies, especially in the presence of opaque ocular media.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.15388/amed.2023.30.2.11
Aikaterini Selntigia, Benedetto Neri, Consuelo Russo, Francesco Giuseppe Martire, Giorgia Soreca, Dario Biasutto, Francesco Maria Di Matteo, Caterina Exacoustos
Background. Schwannomas of the gastrointestinal tract are a rare type of spindle cell tumor of peripheral nerve. Commonly, schwannomas are discovered incidentally, as they are usually asymptomatic.Case. 46-year-old female patient, suffering from secondary amenorrhea and nonspecific intermittent pelvic pain associated with constipation. During gynecological visit an ultrasonographic systematic transvaginal examination was performed. At the sigmoid-rectal level an intraluminal solid mass was described and an urgent colonoscopy was prescribed. Endoscopic submucosal dissection was performed with en-bloc resection. On immunohistochemical analysis, S100 was strongly positive in tumor cells. Finally, a benign schwannoma of the sigmoid colon was diagnosed.Conclusion. Our case highlights the importance of an adequate transvaginal pelvic examination with the evaluation of all pelvic organs. It could be challenging to make diagnosis in an early stage on asymptomatic patients.
{"title":"A Rare Sigmoid-Colon Schwannoma in a Premenopausal Woman: A Case Report","authors":"Aikaterini Selntigia, Benedetto Neri, Consuelo Russo, Francesco Giuseppe Martire, Giorgia Soreca, Dario Biasutto, Francesco Maria Di Matteo, Caterina Exacoustos","doi":"10.15388/amed.2023.30.2.11","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.11","url":null,"abstract":"Background. Schwannomas of the gastrointestinal tract are a rare type of spindle cell tumor of peripheral nerve. Commonly, schwannomas are discovered incidentally, as they are usually asymptomatic.Case. 46-year-old female patient, suffering from secondary amenorrhea and nonspecific intermittent pelvic pain associated with constipation. During gynecological visit an ultrasonographic systematic transvaginal examination was performed. At the sigmoid-rectal level an intraluminal solid mass was described and an urgent colonoscopy was prescribed. Endoscopic submucosal dissection was performed with en-bloc resection. On immunohistochemical analysis, S100 was strongly positive in tumor cells. Finally, a benign schwannoma of the sigmoid colon was diagnosed.Conclusion. Our case highlights the importance of an adequate transvaginal pelvic examination with the evaluation of all pelvic organs. It could be challenging to make diagnosis in an early stage on asymptomatic patients.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.15388/amed.2023.30.2.3
Aleksandra Paņina, Astra Zviedre, Paulis Laizāns, Ilze Apine
Patients with bile duct cysts require careful radiological assessment of the hepatobiliary system prior to surgical intervention. This clinical case is uncommon with an atypical clinical presentation and radiological findings. According to the most widely used classification of choledochal cysts, this case presents a combination of Type I and Type IV of choledochal cyst (CC) combining the form of extra, intrahepatic bile ducts and cystic duct dilations.
{"title":"A Unique Type or Variation of Bile Duct Cyst in a 9-Year-Old Girl:A Remarkable Case Study","authors":"Aleksandra Paņina, Astra Zviedre, Paulis Laizāns, Ilze Apine","doi":"10.15388/amed.2023.30.2.3","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.3","url":null,"abstract":"Patients with bile duct cysts require careful radiological assessment of the hepatobiliary system prior to surgical intervention. This clinical case is uncommon with an atypical clinical presentation and radiological findings. According to the most widely used classification of choledochal cysts, this case presents a combination of Type I and Type IV of choledochal cyst (CC) combining the form of extra, intrahepatic bile ducts and cystic duct dilations.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"119 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135141593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.15388/amed.2023.30.2.2
Ahmed Saad, Roger Chan, Aamer Iqbal, Mark Davies, Steven James, Rajesh Botchu
Introduction. Labral tears (LT) can present with hip or groin pain. Investigation of LT is typically with Magnetic Resonance Arthrography (MRA). The injection of contrast for MRA can lead to fluid signal intensity/oedema on fluid sensitive sequences within the iliopsoas muscle and tendon complex masking the diagnosis of iliopsoas tendinopathy, which may present with similar symptoms. The aim of this study was to identify the presence of iliopsoas oedema in young adult patients being investigated for LT.Material and methods. We performed a retrospective search of our radiology system for the word ‘labral tear’ in the reports of patients who had MRI between 2012 to 2018. Patients under the age of 40 years who underwent high resolution dedicated hip MRI were included in our study. From this database, we then used a keyword search ‘strain and (o)edema’ to identify cases of iliopsoas pathology and analysed the results. Results. We identified 1151 consecutive cases of high resolution hip MRI with a suspected labral tear. 503 patients under the age of 40 years were included in our study with the average age of 27 years. Of the 503 patients within our cohort, searching for the word ‘strain’ identified 48 (9.5%) cases. Of these, 26 (5.3%) patients had iliopsoas oedema with a labral tear. 22 (4.4%) patients had iliopsoas oedema without a labral tear. Conclusion. Our study shows that 4.4% of patients undergoing MRA have no labral tears but iliopsoas oedema. Patients should undergo MRI to exclude iliopsoas strains before MRA.
{"title":"The Incidence of Iliopsoas Tendinopathy and Labral Tears on High Resolution MRI, An Observational Study","authors":"Ahmed Saad, Roger Chan, Aamer Iqbal, Mark Davies, Steven James, Rajesh Botchu","doi":"10.15388/amed.2023.30.2.2","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.2","url":null,"abstract":"Introduction. Labral tears (LT) can present with hip or groin pain. Investigation of LT is typically with Magnetic Resonance Arthrography (MRA). The injection of contrast for MRA can lead to fluid signal intensity/oedema on fluid sensitive sequences within the iliopsoas muscle and tendon complex masking the diagnosis of iliopsoas tendinopathy, which may present with similar symptoms. The aim of this study was to identify the presence of iliopsoas oedema in young adult patients being investigated for LT.Material and methods. We performed a retrospective search of our radiology system for the word ‘labral tear’ in the reports of patients who had MRI between 2012 to 2018. Patients under the age of 40 years who underwent high resolution dedicated hip MRI were included in our study. From this database, we then used a keyword search ‘strain and (o)edema’ to identify cases of iliopsoas pathology and analysed the results. Results. We identified 1151 consecutive cases of high resolution hip MRI with a suspected labral tear. 503 patients under the age of 40 years were included in our study with the average age of 27 years. Of the 503 patients within our cohort, searching for the word ‘strain’ identified 48 (9.5%) cases. Of these, 26 (5.3%) patients had iliopsoas oedema with a labral tear. 22 (4.4%) patients had iliopsoas oedema without a labral tear. Conclusion. Our study shows that 4.4% of patients undergoing MRA have no labral tears but iliopsoas oedema. Patients should undergo MRI to exclude iliopsoas strains before MRA.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135314923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.15388/amed.2023.30.2.1
N. Barabash, Tetiana Tykhonova, Olena Kanishcheva
Background: Along with the presence of the 2011 Endocrine Society Clinical Practice Guidelines and numerous large-scale studies on the treatment of hyperprolactinemia of different origin, there are some unresolved questions, ambiguous and sometimes contradictory points of view regarding the management of patients with prolactinomas. This overview is devoted to the analysis of the results of modern clinical studies and the approaches towards the management of hyperprolactinemia caused by prolactinoma.Materials and methods: A systematic research of the literature for the appropriate keywords published mainly for the last 10 years was done; also, a reference list of each selected article was analysed. We included to our review the articles reporting controversial issues or new data on the treatment of hyperprolactinemia.Results: The review describes various problems arising during the treatment of prolactinoma. The presence of primary and secondary dopamine agonist resistance in each case requires an individual approach, and sometimes may include the use of the antineoplastic agent temozolomide. The side effects of dopamine agonists are discussed, with quite rare ones, including valvulopathy, pathological psychological conditions and cerebrospinal rhinorrhea. The controversial issue of the duration and doses of the drug used to achieve a lasting effect in the treatment of prolactinomas is considered. There are some points connected with the frequency of relapses. Thus, recurrence is correlated to the duration of treatment with dopamine agonists, prolactin levels at diagnosis, and the initial tumor size. Metformin, somatostatin analogues, selective estrogen receptor modulators, tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, epidermal growth factor receptor antagonists are investigated nowadays as potential alternative methods of drug treatment of prolactinomas. Conclusion: Drug therapy with dopamine agonists makes it possible to achieve the desired results in the vast majority of patients. However, despite the proven safety of this group of medicines, the risk of side effects should still be taken into account. The therapy regimen should be determined by the clinical course of prolactinoma and the patient’s response to treatment. Other options of treatment should be considered in patients intolerant to medical therapy, with contraindication or resistance to dopamine agonists, in the case of a malignant tumor. The presence of refractory to any of the applied methods of treatment and aggressive prolactinomas leads to the search for new drugs.
{"title":"Current and Perspective Approaches to the Treatment of Prolactinomas","authors":"N. Barabash, Tetiana Tykhonova, Olena Kanishcheva","doi":"10.15388/amed.2023.30.2.1","DOIUrl":"https://doi.org/10.15388/amed.2023.30.2.1","url":null,"abstract":"Background: Along with the presence of the 2011 Endocrine Society Clinical Practice Guidelines and numerous large-scale studies on the treatment of hyperprolactinemia of different origin, there are some unresolved questions, ambiguous and sometimes contradictory points of view regarding the management of patients with prolactinomas. This overview is devoted to the analysis of the results of modern clinical studies and the approaches towards the management of hyperprolactinemia caused by prolactinoma.Materials and methods: A systematic research of the literature for the appropriate keywords published mainly for the last 10 years was done; also, a reference list of each selected article was analysed. We included to our review the articles reporting controversial issues or new data on the treatment of hyperprolactinemia.Results: The review describes various problems arising during the treatment of prolactinoma. The presence of primary and secondary dopamine agonist resistance in each case requires an individual approach, and sometimes may include the use of the antineoplastic agent temozolomide. The side effects of dopamine agonists are discussed, with quite rare ones, including valvulopathy, pathological psychological conditions and cerebrospinal rhinorrhea. The controversial issue of the duration and doses of the drug used to achieve a lasting effect in the treatment of prolactinomas is considered. There are some points connected with the frequency of relapses. Thus, recurrence is correlated to the duration of treatment with dopamine agonists, prolactin levels at diagnosis, and the initial tumor size. Metformin, somatostatin analogues, selective estrogen receptor modulators, tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, epidermal growth factor receptor antagonists are investigated nowadays as potential alternative methods of drug treatment of prolactinomas. Conclusion: Drug therapy with dopamine agonists makes it possible to achieve the desired results in the vast majority of patients. However, despite the proven safety of this group of medicines, the risk of side effects should still be taken into account. The therapy regimen should be determined by the clinical course of prolactinoma and the patient’s response to treatment. Other options of treatment should be considered in patients intolerant to medical therapy, with contraindication or resistance to dopamine agonists, in the case of a malignant tumor. The presence of refractory to any of the applied methods of treatment and aggressive prolactinomas leads to the search for new drugs.","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139353526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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