Acta Medica Lituanica最新文献

Background: The association between urinary tract anomalies and Müllerian duct anomalies (MDA) is well-known, due to their shared embryonic origin. Disruptions in early development can significantly affect both the kidney and reproductive systems. This article presents two cases illustrating the coexistence of kidney agenesis and MDA in girls, followed by a literature review.

Materials and methods: A literature search was conducted on PubMed, focusing on publications from 2000 to 2024 by using keywords: 'kidney agenesis', 'renal agenesis', 'Müllerian duct anomalies', 'OHVIRA' (obstructed hemivagina and ipsilateral renal anomaly), and 'Herlyn-Werner-Wunderlich syndrome'. The PRISMA guidelines were followed for the study selection. Additionally, two cases managed at Vilnius University Hospital Santaros Klinikos between 2022 and 2024 are presented.

Results: The literature search yielded 32 articles encompassing data on 43 girls with an average age of 11.8 years. In 54% of the cases, the diagnosis of kidney agenesis was concurrent with identifying MDA. In other cases, kidney anomalies were detected earlier, including 6 cases identified prenatally. Type III MDA, as classified by the American Fertility Society, was the most common variety. Premenarche diagnosis of MDA was made in 11.9% of the cases. In more than half of the cases, MDA was identified due to complaints necessitating consultations, mostly leading to urgent surgical interventions. At our hospital, a 9-year-old and a 14-year-old were diagnosed with Herlyn-Werner-Wunderlich syndrome. Kidney agenesis was diagnosed prior to MDA in both cases. For the 9-year-old girl, MDA was found incidentally on ultrasound, while the other required consultation and an urgent surgery due to symptoms.

Conclusions: Unilateral kidney agenesis frequently co-occurs with Müllerian duct anomalies, highlighting the need for comprehensive evaluations in affected patients. An early diagnosis and management of MDA are crucial to prevent complications. An increased clinical awareness and further research are necessary to enhance early detection and patient outcomes.

Background: Hypertrophic CardioMyopathy (HCM) is the most prevalent inherited cardiac disorder, where accurate assessment of Left Ventricular (LV) function and Mitral Regurgitation (MR) is crucial. Cardiac Magnetic Resonance (CMR) imaging is considered the gold standard for evaluating these parameters. Recently, Deep Learning (DL) algorithms have emerged to automate cardiac quantification, but their performance in complex pathologies such as HCM still requires validation.

Purpose: To compare the performance of a fully automated deep learning-based cardiac segmentation software (SW 2) (SuiteHEART) with conventional manual segmentation (SW 1) (syngo.Via) for quantifying crucial cardiac parameters in patients with HCM.

Materials and methods: In this prospective study, 25 consecutive adult patients (mean age 49±12 years) with HCM referred for CMR at our institute were included. CMR examinations were performed by using a 3.0 Tesla scanner (Siemens Vida). The key parameters assessed included Left Ventricular Ejection Fraction (LVEF), End-Diastolic Volume (LVEDV), Stroke Volume (LVSV), Aortic Forward Flow (AoF), Mitral Regurgitation (MR), and Pressure Gradient (PG) across the LVOT. Manual and automated segmentations were performed by using syngo.Via (SW 1) and SuiteHEART software (SW 2), respectively. Statistical analysis included paired t-tests, linear regression, and Bland-Altman analysis.

Results: There was a strong correlation between DL-based and manual measurements for LVEF (r=0.91), LVEDV (r=0.89), LVSV (r=0.87), AoF (r=0.86), MR (r=0.84), and PG (r=0.81) (all p<0.001). Bland-Altman analysis demonstrated acceptable limits of agreement, with no significant bias. Automated segmentation significantly reduced post-processing time compared to manual methods (p<0.001).

Conclusion: Fully automated DL-based cardiac quantification provides accurate and reproducible assessment of the LV function, MR, and flow parameters in HCM patients, closely matching manual segmentation results. Incorporation of DL algorithms can substantially streamline the clinical workflow, although careful validation remains necessary in structurally complex cases such as HCM.

Background: Traumatic Internal Mammary Artery (IMA) pseudoaneurysms can be associated with severe complications, including hemopericardium, pericardial tamponade, diaphragmatic paralysis, hemoptysis, and hemorrhagic shock. Early recognition of this rare condition is essential to reduce the risk of significant morbidity and mortality.

Case details: We present a case of IMA pseudoaneurysm that was promptly diagnosed by using contrast-enhanced CT and successfully managed with endovascular embolization, leading to the patient's complete and uneventful recovery.

Conclusion: This case emphasizes the importance of early recognition and endovascular management of rare but potentially life-threatening internal mammary artery pseudoaneurysms following thoracic trauma.

The bifurcation of the Common Carotid Artery (CCA) is a pivotal anatomical landmark in head and neck surgeries, particularly affecting procedures such as carotid endarterectomy. Typically occurring around the C3-C4 intervertebral disc, variations in its location can complicate surgical access and pose risks of nerve injury. In this case report, three rare bilateral high bifurcations of the CCA at the C2 and C2/3 vertebrae levels are documented. Additionally, an unusual pentafurcation of the External Carotid Artery (ECA) and bilateral superior thyroid artery are observed, arising directly from the CCA. The high bifurcation presents challenges due to its proximity to nerves such as the hypoglossal nerve, potentially leading to complications such as dysphagia or speech impairment. Furthermore, it complicates procedures like carotid endarterectomy, necessitating additional techniques for adequate exposure and increasing risks of Internal Carotid Artery (ICA) thrombosis. Detailed preoperative imaging before surgery is important for effective planning and minimizing the surgical risk. Anatomical variation, such as the vascular structure, can significantly affect surgical and interventional outcomes. Identifying these differences through meticulous evaluation enables surgeons to anticipate potential challenges, reduce complications, and enhance patient outcomes.

Background: Mortality rates between minor (e.g., removal of toes or part of the foot) and major (e.g., below- or above-the-knee) lower extremity amputations (LEA) vary significantly in diabetic patients. Other factors, including survival rates, rehabilitation outcomes, and healthcare burden, are also notably impacted by the type of amputation performed.

Objective: This narrative review aims to analyze and compare mortality rates following minor and major LEA in diabetic patients, by highlighting key risk factors and their impact on patient outcomes.

Methods: A narrative review of existing literature was conducted by using searches of PubMed and Google Scholar. Studies reporting mortality rates, risk factors, comorbidities, functional outcomes, and management strategies among diabetic patients undergoing minor and major LEA were included.

Results: Major LEA is associated with significantly higher short- and long-term mortality rates, with five-year survival ranging from 10% to 48%, compared to 29% to 69% for minor LEA. The key risk factors for mortality include chronic renal disease, peripheral arterial disease, sepsis, and poor glycemic control. While minor LEA offers better survival rates, it carries a higher risk of progression to major amputation if diabetes-related complications persist.

Conclusion: The findings highlight the critical importance of early intervention, strict glycemic control, and multidisciplinary care to improve the survival and quality of life in diabetic patients undergoing LEA. Limb preservation strategies should be prioritised whenever possible, as minor amputations lead to better long-term outcomes. Future research should focus on refining risk stratification and optimizing rehabilitation programs to enhance patient prognosis post-amputation.

Background: Chemotherapy-induced nausea and vomiting (CINV) is a significant concern for patients undergoing highly emetogenic chemotherapy (HEC). This study compares the efficacy of aprepitant and olanzapine in preventing CINV in breast cancer patients receiving Adriamycin and Cyclophosphamide (AC).

Methods: A prospective, comparative, observational study was conducted over one year at the State Cancer Institute, Guwahati, India. 103 chemotherapy-naïve breast cancer patients were enrolled and divided into two groups: aprepitant and olanzapine, both receiving standard therapy with ondansetron and dexamethasone. CINV outcomes were assessed using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool over five days post-chemotherapy. Acute (0-24 hours) and delayed (24-120 hours) nausea and vomiting were evaluated. Side effects were documented and compared between groups.

Results: Olanzapine demonstrated significantly better control of acute nausea compared to aprepitant (p < 0.05). It also showed a trend towards superior efficacy in delayed nausea, though statistical significance was not reached. There was no significant difference between aprepitant and olanzapine in preventing acute or delayed vomiting. The olanzapine group experienced more frequent side effects, but the difference was statistically insignificant.

Conclusion: Olanzapine exhibited greater efficacy in preventing nausea, particularly in the acute phase, compared to aprepitant. However, its higher side effect profile suggests that careful patient selection is necessary. Both agents remain effective options for CINV management, with olanzapine offering an advantage in nausea prevention.

Background: Lymphangioleiomyomatosis (LAM) is a rare neoplastic disorder characterized by the proliferation of atypical smooth muscle-like or epithelioid cells within the lungs and axial lymphatic system. This pathological process leads to the formation of pulmonary cysts and impaired respiratory function. Although the disease primarily involves the lungs, extrapulmonary manifestations can occur in the abdominal cavity, lymphatic system, and retroperitoneum.

Clinical case: A 48-year-old woman presented with abdominal numbness, leading to the discovery of a right ovarian mass. CT and MRI identified non-malignant solid mass in the ovary, as well as thin-walled cysts in the lungs, retroperitoneal pelvis, and upper abdomen, suggesting LAM. The patient was referred for pulmonology evaluation. Genetic testing and lung biopsy were inconclusive. One year later, during laparoscopic hysterectomy for early-stage uterine cancer, a biopsy of a left iliac lesion confirmed LAM. Postoperatively, the patient developed lymphocytic and chylous ascites, requiring further surgical intervention. However, the ascites recurred, and it was managed with diuretic therapy. Following the confirmed diagnosis, Sirolimus therapy was initiated. To date, the patient has not exhibited any significant respiratory symptoms, and follow-up lung imaging has shown no evidence of disease progression.

Conclusions: Due to its rarity, diverse symptoms, and involvement of multiple organs, diagnosis of LAM is challenging. It requires careful clinical observation and a multidisciplinary approach. Early and accurate diagnosis, combined with timely therapeutic interventions, has the potential to significantly improve the patient outcomes in LAM.

Background: : Disulfiram is a type of medication widely prescribed in order to cease alcohol consumption. When used with alcohol, the 'disulfiram-alcohol reaction' occurs, causing nausea and vomiting. Disulfiram blocks alcohol dissolving enzymes thus increasing acetaldehyde concentration and inducing the above-mentioned symptoms. These undesirable symptoms are similar to the side effects that occur to oncological patients after the administration of chemotherapy.

Materials and methods: : Descriptive research method was used. The literature focusing on alcohol, medications and drug consumption was reviewed.

Case report: : The primary abstinence at the beginning of treatment with Disulfiram does not guarantee that alcohol usage will not get manifested again at the further stages of treatment. Alcohol addiction forces patients to search for a way to avoid the unwanted reactions. Sometimes, patients tend to be quite ingenious while trying to suppress the arising side effects. In many cases, it involves the usage of additional medication.

Conclusions: : When alcohol addiction overpowers, the patient tries to reduce the undesirable symptoms and may even die if alcohol is combined with disulfiram. Death may occur due to the cardio and neurotoxic effects of acetaldehyde.

Aim: To compare the outcome of laparoscopic totally extraperitoneal repair versus the open Lichtenstein technique in the treatment of primary bilateral inguinal hernias.

Materials and methods: The study design was comprised of a matched and randomized research: a total of 93 patients were enrolled in the study and operated in clinic "Medikom" from 2015 to 2022. The patients were prospectively randomized and divided into two groups: Group 1 (n=45) underwent TEP repair, whereas Group 2 (n=48) received Lichtenstein repair.

Result: No statistically significant differences were observed between the groups concerning the mean age, sex, body mass index, patient distribution by hernia type, European Hernia Society hernia type, and ASA score (p>0.05).The operating time in Group 1 was on 10.7% more than in Group 2 (p<0.05). At 6 hours post-surgery, the pain score in Group 2 was 1.19-fold significantly higher than in Group 1 (p<0.05). This significant difference persisted at 24 hours post-surgery, with Group 2 exhibiting a pain score 1.27 times greater than Group 1 (p<0.05). The time to resumption of normal activities was 1.5 times longer in Group 2 compared to Group 1, which is a difference that reached statistical significance (p<0.05). No statistically significant difference was observed regarding the incidence of early complications between the two groups (p>0.05 (χ2-test)). Following a 24-month follow-up period, a total of 42 (93.3%) patients from Group 1 and 45 (93.75%) patients from Group 2 were evaluated. Importantly, neither recurrence nor other complications were observed in either group.

Conclusions: The findings of this trial indicate that laparoscopic total extraperitoneal (TEP) hernia repair offers substantial benefits for patients undergoing bilateral inguinal hernioplasty. The duration until resumption of normal activities was 1.5 times significantly longer for patients in the open hernia repair Group 2 compared to those in the laparoscopic hernia repair Group 1.

Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) disrupts phosphorus and calcium metabolism, leading to skeletal disorders such as demineralization, weakened bones, and an increased fracture risk. These disorders, known as renal osteodystrophy, vary widely and are classified into secondary hyperparathyroidism, adynamic bone, and osteomalacia based on bone turnover. Fracture risk increases with the severity of CKD, particularly in advanced stages (creatinine clearance <15-20 mL/min), but even patients with mild to moderate CKD are at risk of fractures. Fractures of the Lesser Trochanter (LT) in adults are rare, and most are caused by underlying malignancies. We present a case of simultaneous avulsion fractures in the left lesser trochanter and bilateral olecranon processes secondary to minor trauma in a young patient with End Stage Renal Disease, which has not been previously reported, and review the literature. This review summarizes the role of imaging (Radiography, US, Computed Tomography, and Magnetic Resonance Imaging) in assessing avulsion fractures in patients with end-stage renal disease. Ultrasound serves as a supportive tool in evaluating the neuromusculoskeletal system; however, in patients with end-stage renal disease, radiography, CT, and MRI remain the primary imaging modalities for assessing avulsion fractures.