Acta Medica Lituanica最新文献

Pott's Puffy Tumour (PPT) is an inflammation and swelling of the forehead secondary to osteomyelitis of the frontal bone. Multiple aetiologies are associated with this condition, predominately involving a prior sinus surgery or a direct trauma to the frontal bone. There can be intracranial extension with an epidural, subdural as well as intracerebral abscess. We present the case of an 8-year-old boy who presented with swelling in his forehead secondary to trauma. His general condition was poor, and further evaluation revealed multiple subdural empyemas. Although PPT is rare in this modern era of antibiotics, it should be kept as a differential for any inflammation of the forehead. Timely diagnosis and the appropriate treatment by a multidisciplinary team are indispensable in reducing the morbidity and mortality associated with this case.

Placental abnormalities significantly contribute to fetal mortality. Maternal vascular underperfusion emerges as the prevailing diagnosis. At the same time, genomic alterations within the placenta might play a role in the development of placental dysfunction. We present a case report of a 24-year-old primigravida with an uneventful medical history, admitted at 21 weeks and 2 days gestation. Despite a low risk for typical trisomies, a high risk for preeclampsia and fetal growth restriction (FGR) was recognized in the first trimester. Anhydramnios, abnormal placental morphology, retrochorial and retromembranous hematomas were observed, prompting the termination of pregnancy (TOP). Histological examination revealed multiple placental abnormalities, while the fetus displayed normal anatomy and phenotype. Discussion encompasses the varied manifestations of histopathological findings, and potential associations with adverse pregnancy outcomes. Our case underscores the importance of meticulous evaluation and multidisciplinary collaboration in managing pregnancies with placental anomalies. Further research is crucial to discern the intricate relationship between placental cytogenetics, morphology, and pregnancy outcomes, thus facilitating better clinical management and counseling strategies.

Background: The aim of this retrospective cohort study was to investigate the possibility of optimizing the calculation of integral indicators of the metabolic status and filtration function of the kidneys in patients with combat mine-explosive injuries who have lost significant body weight due to limb amputation.

Methods: Data from 81 servicemen (all males) with combat mine-explosive limb injuries, including those with isolated severe limb injuries (Group 1, n=34) or traumatic amputations (Group 2, n=47), were analyzed. We assessed demographic indicators and the glomerular filtration rate (GFR), calculated according to the generally accepted formulas with correction for lost body parts in the amputees.

Results: The proportion of amputees with obesity as measured by the body mass index in Group 2 without correction for the lost body parts was significantly lower than that in Group 1 and Group 2 adjusted for the lost body parts (2.12% versus 17.65% and 21.28%, respectively, p<0.05 and p<0.01), but it was similar in Group 1 and Group 2 after body weight adjustment for the lost body parts of the amputees (p>0.05). The mean level of serum creatinine in the patients in Group 2 was significantly lower than that in Group 1 (75.19±11.62 vs. 90.93±37.12 μmol/L, respectively, p=0.0206). The estimated GFR according to the Cockcroft and Gault formula (CGF) with adjusted for the lost body part body weight was significantly greater in Group 2 than that in Group 1 (143.63±42.58 and 123.92±26.34 mL/min/1.73m², respectively, p=0.0379) as well as GRF according to CGF corrected for the body surface area (BSA) (131.59±39.94 and 106.17±21.88 mL/min/1.73m², respectively, p=0.0040). Only a few individuals had a moderate decrease in GFR according to CGF or CGF adjusted for BSA, but glomerular hyperfiltration was suspected in a significant number of patients, specifically, 23.53% and 17.65% of the patients in Group 1, respectively, and in 29.79% and 36.17% of the patients in Group 2, respectively (even 51.6% according to CGF corrected for BSA in Group 2 adjusted for the lost body parts).

Conclusions: In amputees, it is necessary to calculate their body weight considering the lost body part for an adequate assessment of their metabolic status. To calculate GFR, it is advisable to use CGF considering the lost body parts with or without adjustment for BSA to avoid the possibility of underestimating GFR calculated by other formulas. Special control is necessary for patients with hyperfiltration suspected by CGF, since this sign can be a predictor of future metabolic disorders.

Background: Cleft lip palate is one of the most common craniofacial birth defects in humans. Multiple defense factors have been described to have possible involvement in the failure in palatal shelve elevation, migration and fusion, most importantly, the role of chronic inflammation. A widespread presence of Gal-10 in different local inflammatory processes has been discussed before, however, knowledge of its involvement in local tissue inflammation in the postnatal cleft palate and tissue regeneration is scant. This study focuses on the detection of appearance and a possible role of Gal-10 in the cleft-affected facial tissue regarding its ontogenetical aspect.

Materials and methods: Craniofacial cleft tissue material was obtained from 21 children aged 8 months to 12.7 years undergoing veloplastic or uranoplastic procedure with non-syndromic craniofacial cleft diagnosis in milk or mixed dentition. Control groups for milk dentition were 5 subjects without orofacial defects for milk dentition and 3 subjects with plastic of superior lip frenula for mixed dentition. The number of factor positive cells in the control group and the patient group tissue was evaluated by using the semiquantitative counting method. The data were evaluated with the use of nonparametric statistical methods.

Results: Elevated levels of Gal-10 were found in the epithelium in correlation with age, from milk to mixed dentition, as well as in both the control and the patient samples. Notable differences in expression can be seen by comparing the milk and the mixed dentition patient muscle tissue, where the milk dentition palate shows a more elevated factor expressed in comparison to the mixed dentition palate.

Conclusions: The nearly total absence of Gal-10 in the healthy palate with an increase of its expression in the palatal epithelium from the milk to mixed dentition age of cleft-affected children suggests the possible role of this factor in providing the local defense function and the epithelium barrier function. The palatal muscles are not the main place for Gal-10 expression either in healthy or in cleft condition-affected individuals. The sporadic and insignificant appearance of Gal-10 only in the healthy milk dentition age and the mixed dentition age cleft-affected palatal connective tissue prove individual changes in the palatal tissue which does not depend on the specific disease.

Background: Lyme disease can lead to neuropsychiatric symptoms like depression, anxiety, and cognitive issues, often mimicking primary psychiatric disorders. This paper examines the connection between Lyme disease and neuropsychiatric outcomes to improve diagnosis and treatment.

Materials and methods: The PubMed database was searched for scientific literature sources. Publications published in English in 2019-2024 were selected. All psychiatric symptoms and disorders found to be associated with Lyme disease were included. For neurological symptoms, the analysis focused on studies addressing cognitive dysfunction.

Results: Acute neuroborreliosis may have minimal effects on the cognitive function and typically resolves well with treatment. However, some studies suggest that Lyme disease can affect the patients' cognitive abilities, leading to impairments in verbal fluency, attention, and memory, with a few isolated dementia-like cases highlighting the need for careful diagnosis. Nevertheless, recent large-scale studies show no increased risk of dementia. Regarding psychiatric symptoms, findings are also inconsistent, with some studies suggesting an increased risk of depression, anxiety, sleep disturbances, and other mental health conditions, while others find no such association.

Conclusions: There is no strong evidence supporting Lyme disease's role in long-term cognitive or psychiatric disorders. However, an early diagnosis and timely antibiotic treatment remain crucial in minimizing long-term consequences and improving patient outcomes.

Neurocysticercosis (NCC), a parasitic infection of the central nervous system caused by Taenia solium larvae, is a leading cause of acquired epilepsy in endemic regions. This case describes a 40-year-old male who presented with chronic headache, dizziness, and a recent seizure episode. He had no prior history of systemic illness, tuberculosis, or neurological disorders. Magnetic Resonance Imaging (MRI) of the brain revealed multiple ring-enhancing lesions with an eccentric scolex in the cerebral and cerebellar hemispheres, accompanied by surrounding edema, confirming the diagnosis of neurocysticercosis. Additional lesions in extraocular, facial, and tongue muscles were consistent with myocysticercosis, an uncommon but clinically significant manifestation that may mimic inflammatory or neoplastic processes. Spinal imaging demonstrated degenerative changes, including diffuse cervical disc bulges at multiple levels (C3-C7) and lumbar disc pathology at L4-L5, causing anterior thecal sac indentation but without cord compression or myelomalacia. While the spinal findings were incidental, they were clinically relevant as contributors to chronic pain and potential neurological deficits. The coexistence of disseminated neurocysticercosis with muscular involvement and early degenerative spinal disease highlights the importance of comprehensive evaluation in patients presenting with seizures and persistent headache. Treatment included albendazole-based antiparasitic therapy, corticosteroids to reduce perilesional edema, antiepileptic medications, and conservative management for disc disease. This case underscores the role of MRI in identifying pathognomonic features of cysticercosis, emphasizes the need for systemic evaluation, and demonstrates the significance of recognizing coexisting pathologies for tailored multidisciplinary management.