Acta Medica Lituanica最新文献

Iatrogenic femoral artery pseudoaneurysms (IFAPs) are not uncommon due to the increase in various minimally-invasive endovascular procedures. Percutaneous thrombin injection is an established technique for large pseudoaneurysms. When ultrasound-guided compression of an aneurysmal neck is not feasible, percutaneous thrombin injection can be combined with endovascular balloon occlusion to prevent leakage of thrombin into the parent artery. We describe a large IFAP following the removal of the femoral dialysis catheter after an inadvertent arterial puncture, which was managed with percutaneous ultrasound-guided (USG) thrombin injection with simultaneous balloon occlusion at the level of the aneurysmal neck without any complications. Follow-up imaging showed thrombosed IFAP without any recurrence.

Background: The solitary fibrous tumor is a rare soft tissue mesenchymal tumor which typically arises from the pleura but may be found anywhere in the body. Abdominal localizations are very rare. The solitary fibrous tumor is classified into two forms, pleural and extrapleural, and morphologically they resemble each other. The diagnostics of the tumor is usually accidental because usually there are no clinical symptoms. The main treatment of the solitary fibrous tumor is the surgical removal of the tumor while radiotherapy treatment and chemotherapy outcomes remain unclear due to the rarity of the tumor and lack of data.

Case presentation: We report the case of the 32-year-old man who was diagnosed with the solitary fibrous tumor of the peritoneal cavity. Laparotomy was performed. A grayish-white, stiff, coarse-grained tumor about 11 cm in diameter of the greater omentum was found and radical omentectomy with tumor removal were performed. Postoperative course was uneventful and the patient is well with no signs of recurrence on the CT scan of the chest and abdomen and MRI of the pelvis at 6 months after surgery.

Conclusions: The solitary fibrous tumor is a rare condition. It is a borderline-malignant tumor but may cause serious complications if not treated. Due to the absence of clinical symptoms, the tumor is usually detected accidentally. The radical surgical removal of the tumor is the most optimal treatment.

Purpose: Our aim was to see the possible effect of the first COVID pandemic wave in Lithuania on colorectal cancer (CRC) preventive, diagnostic and treatment procedures.

Methods: A retrospective analysis was performed using the database of the National Cancer Institute, Lithuania. We have divided patients into two groups: group 1 - patients treated during the nonpandemic period (2019 January 1 to 2019 July 31) and group 2 - the pandemic period (2020 January 1 to 2020 July 31). We analyzed numbers of screening, therapeutic colonoscopies performed, and treated patients for CRC during two periods.

Results: In general, 1318 lower gastrointestinal endoscopic procedures were performed in the first group and 862 procedures in the second group, which was 34.6% less compared to the first group. The first group included 672 (51%) colonoscopies, 172 (13%) day surgeries and 474 (36%) CRC screening programmes. In group 2, 456 (34.6%) less patients underwent CRC diagnostics and treatment: 141 (21%) less colonoscopies, 93 (54%) less day surgeries, 222 (47%) less CRC screening programmes, and 26 (13%) less patients were hospitalized for surgical treatment (196 vs 170).

Conclusion: Our study reveals worrying changes in the timely access to diagnostic procedures during the COVID-19 pandemic that possibly provoked rise in cases with the advanced stage CRC. However, despite numerical difference between groups existed, the difference between groups do not reach statistical significant level.

Introduction: Although most hemodialysis patients (HDP) exhibit an initial seroresponse to vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), studies have shown this response to be lower compared to healthy subjects. This fact raised concerns regarding the durability of the immune response and effective protection against severe Coronavirus disease 2019 (COVID-19) in this vulnerable population. The aim of our study was to evaluate the change in antibody levels over time in HDP population.

Materials and methods: We performed a prospective multicenter study, evaluating antibody response among HDP at 2 and at 6 months after complete two-dose vaccination course with the mRNA-BNT162b2 (Pfizer-BioNTech) vaccine. The study was performed in 14 hemodialysis units of a private dialysis provider in Lithuania. The serum samples of 189 HDP were tested for SARS-CoV-2 IgG against the Spike glycoprotein.

Results: 189 HDP participated in the study. Patients were 64.3±15.7 years of age, 116 (61.4%) were males and 73 (38.6%) were females. Among them, 183 (96.8%) were seropositive for anti-S IgG at 2 months after the second immunization dose. Six months after the second dose only 145 (76.7%) of study participants had positive anti-S IgG titers. The median level of anti-S IgG titers after 2 months was 383.1 BAU/mL (166.2-995.6) and after 6 months this level significantly decreased to 51.4 BAU/mL (22.0-104.0) (p<0.001). Seroresponses at both time points inversely correlated with increasing patient's age. Risk factor for absent response after 2 months included oncologic disease. Systemic autoimmune disease and a history of myocardial infarction increased risk to be seronegative 6 months after the second vaccine dose.

Conclusions: The majority of hemodialysis patients seroresponded after BNT162b2/Pfizer vaccination, but vaccine-induced humoral immunity wanes over time.

Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders characterized by peripheral blood eosinophilia of 1.5 × 10⁹/L (1,500/μL) or greater, with evidence of end-organ damage attributable to eosinophilia (e.g., heart, liver or lung) with no other cause for the end-organ damage [1]. Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disorder that may affect multiple organ systems (lungs, heart, kidneys, or the nervous system). The disorder is characterized by hypereosinophilia in the blood and tissues, inflammation of blood vessels (vasculitis), and the development of inflammatory nodular lesions called granulomatosis [2]. We report a case with a 9-year-old girl presenting with severe hypereosinophilia, ischemic stroke, right-sided hemiparesis and myocarditis treated with methylprednisolone, enoxaparin, rivaroxaban and carvedilol. The patient recovered successfully from myocarditis and stroke but manifested with right-sided orbital involvement as pre- and post-septal orbital cellulitis 10 months later with necrotizing granulomatous perivascular chronic infiltration with eosinophilic infiltration treated with methylprednisolone and subsequent mepolizumab with successful remission of orbital involvement, but severe exogenous Cushing's syndrome and myocardial fibrosis.

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are the most frequent cystic pancreatic neoplasm. They derive from the main pancreatic duct or branch ducts.

Aim: This narrative review aims to present and compare the current guidelines on the management of IPMNs.

Materials and methods: We reviewed the most important scientific literature on the management of IPMNs.

Discussion: The clinical presentation of IPMNs is usually nonspecific; common symptoms are abdominal pain, weight loss, and jaundice. There are no sex differences, and the incidence increases with age. It is considered a premalignant lesion associated with synchronous or metachronous carcinomas. Multifocal sites within the pancreas and the presence of solid components, like mural nodules, are predictive factors for developing malignancy. Magnetic resonance imaging (MRI) is the imaging technique of choice. However, computed tomography (CT) and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) can also contribute to the diagnosis. Resection is the optimal treatment for IPMNs that arise from the main duct, while several indications are suggested for the surgery on IPMNs of branch ducts.

Conclusion: The decision on surgery is not always a simple task and should be based on high-risk features of the neoplasm. In any case, re-examination and follow-up are highly recommended.

Background: Regular physical activity helps in independent living, prevention of chronic health problems and quality of life in the elderly. The aim of the study is to determinewhether physical fitness is associated with multiple dimensions of well-being in the community dwelling elderly.

Materials and methods: A community-based cross-sectional study was undertaken to assess the physical fitness and perceived wellness in 400 elderly (≥65 years) subjects. The Senior Fitness Test (SFT) for assessing functional/physical fitness and Perceived Wellness Survey (PWS) were used to assess their well-being. Bivariate correlation analysis was used for individual testsand multiple linear regressions were used to analyze relationship of wellness composite score with physical fitness test.

Results: 284men and 116 women (mean ages 69.80±3.82 and67.25±2.57 years, respectively) were assessed for physical fitness tests and perceived wellness.'Arm-curl' and 'chair-sit' testsshowedlinear decrease in strength with increasing age. In 'back-scratch' and 'chair-sit and reach' tests lower limb flexibility was better than upper limb in all except the 65-69 year sub-group. Maximum time to perform the '8-feet up-and-go' test increased progressively with age, whereas '2-minute step' test showed a linear decrease in mean score with advancing age. Wellness composite score (14.54±2.31) inmaleswas maximum in the 75-79 year age-group, while in females it (15.26±2.29) was maximum in the 70-74 year age-group. Correlation analysis of physical fitness test with perception of wellness (composite score) showed significant association of 'arm-curl' test (p=0.012), 'back-scratch' test (p=0.0002), '8-feet up-and-go' test (p=0.005), '2-minute step' test (p=0.005) with the composite wellness score in the male participants, whereas in the females such significance was observed only in the '2 minute step' test (p=0.007) with the wellness score.

Conclusion: Screening of physical fitness and wellness are important measures in assessing wellness of community dwelling elderly, and in predicting theiroverall state of well-being, including age-specific comparison of fitness performance and wellness score.

Background: When conducting a forensic examination of burnt bodies, it is important to determine whether the victim was exposed to fire while alive or after death. The differential diagnosis between antemortem and postmortem burning is difficult and often cannot be made based on information obtained solely from the autopsy. The aim of the study is to review current literature on this topic and present clinical cases that illustrate how challenging the determination of vitality during the fire and manner of death can be.

Materials and methods: We present four cases of burnt homicide victims, illustrating the complexity of forensic determination of the cause of death in the fire and the importance of differential diagnosis of antemortem and postmortem exposure to flames.

Results: In the forensic assessment autopsy is a fundamental to determine the cause of death. When death is related to fire, particular findings during autopsy can help to suspect that the victim was alive. One of the main antemortem signs is the deposition of soot in the respiratory tract. Another important test is the toxicological analysis, which determines the level of carboxyhaemoglobin in the blood: a concentration of more than 50% indicates that the person died in the fire.

Conclusions: Forensic examination of burnt bodies requires a comprehensive and detailed assessment of all available data. The autopsy, together with additional diagnostic forensic methods, including histological examination, toxicological analysis and postmortem computed tomography, allows the exact cause of death to be determined.

The case of a 42-year-old female patient with pronounced itching and exanthema, mainly in the area of the trunk and lower limbs, is presented. Previously, the patient took antihistamines without effect, was treated for scabies, but the itching remained pronounced and led to rash and excoriations. From the anamnesis, it was found that the patient has a high level of stress. According to the Hospital Anxiety and Depression Scale, the anxiety of the patient reached 14 points, and depression 1 point. Functional (psychogenic) itching was suspected. Since the patient refused dermatologist consultation, therapy with the anxiolytic temgicoluril, topical antipruritic agents and nonpharmacological methods of treatment were recommended at the initial stage. The patient felt a significant relief of itching symptoms on the first day of anxiolytic usage, she withdrew topical antipruritic agents after 5 days of anxiolytic treatment, in 15 days she began to reduce the dose of temgicoluril, and at the end of the third week she stopped treatment with anxiolytic due to a significant positive effect. In three weeks, practically all elements of the rash, except for the largest wounds from scratching, disappeared. The peculiarity of the case is that functional itching was completely eliminated during anxiolytic therapy without other systemic medications, which emphasizes the importance of eliminating the component of stress and anxiety in the treatment of such patients.

Purpose: In the Emergency Departments (ED) the current triage systems that are been implemented are based completely on medical education and the perception of each health professional who is in charge. On the other hand, cutting-edge technology, Artificial Intelligence (AI) can be incorporated into healthcare systems, supporting the healthcare professionals' decisions, and augmenting the performance of triage systems. The aim of the study is to investigate the efficiency of AI to support triage in ED.

Patients–methods: The study included 332 patients from whom 23 different variables related to their condition were collected. From the processing of patient data for input variables, it emerged that the average age was 56.4 ± 21.1 years and 50.6% were male. The waiting time had an average of 59.7 ± 56.3 minutes while 3.9% ± 0.1% entered the Intensive Care Unit (ICU). In addition, qualitative variables related to the patient's history and admission clinics were used. As target variables were taken the days of stay in the hospital, which were on average 1.8 ± 5.9, and the Emergency Severity Index (ESI) for which the following distribution applies: ESI: 1, patients: 2; ESI: 2, patients: 18; ESI: 3, patients: 197; ESI: 4, patients: 73; ESI: 5, patients: 42.

Results: To create an automatic patient screening classifier, a neural network was developed, which was trained based on the data, so that it could predict each patient's ESI based on input variables.The classifier achieved an overall accuracy (F1 score) of 72.2% even though there was an imbalance in the classes.

Conclusions: The creation and implementation of an AI model for the automatic prediction of ESI, highlighted the possibility of systems capable of supporting healthcare professionals in the decision-making process. The accuracy of the classifier has not reached satisfactory levels of certainty, however, the performance of similar models can increase sharply with the collection of more data.