Acta Medica Lituanica最新文献

Background: There is strong evidence that alcohol consumption is a significant risk factor for fatal road traffic accidents. It is estimated that the number of alcohol-related road accidents remains high in the past few years in Lithuania. This study aims to examine the prevalence of alcohol in blood samples collected from the autopsy results of road traffic accident victims.

Materials and methods: A retrospective study of 136 road traffic accident victims was performed in State Forensic Medicine Service of Lithuania in the period of 2013 to 2023. We analyzed blood alcohol concentration (BAC) in relation to sex, age, road user type, place and time of the day at death.

Results: 31% of the victims were under influence of alcohol at the time of death, with mean BAC 1.99 ± 0.92‰. The mean BAC was 2.16 ± 0.8‰ in male and 1.18 ± 1.12‰ in female group. By the type of road users, 23% of the pedestrians (mean BAC 2.45 ± 0.71‰), 32% of car drivers (mean BAC 2.13 ± 0.75‰), 41% of vehicle passengers (mean BAC of 1.73 ± 1.19‰), 37% of the motorcycle riders (mean BAC of 1.28 ± 0.53‰), 37% of the cyclists (mean BAC of 1.15 ± 0.75‰) were found to be intoxicated during the time of accident. Highest mean blood alcohol concentration was found during the night time hours (9 p. m. - 5 a. m.) 2.28 ± 0.91, comparing to in afternoon hours (12 p. m. - 5 p. m.) 1.49 ± 0.99, evening hours (5 p. m. - 9 p. m.) 2.10 ± 0.73 and morning hours (5 a. m. - 12 p. m.) 1.94 ± 1.00. The mean BAC in road traffic accidents during summer was 1.48 ± 0.71‰, spring 2.25 ± 0.76‰, autumn 2.12 ± 1‰, winter 2.42 ± 1‰.

Conclusions: Alcohol consumption by road users is a significant contributing factor in road traffic accidents and their outcomes in Lithuania.

Background: Inflammatory bowel disease (IBD) may affect organs outside the intestines, it is called extraintestinal manifestations of IBD. Data on the prevalence of mu-cocutaneous manifestations in IBD patients are very limited, therefore, the aim of this study was to assess the prevalence of skin and mucosal lesions and to determine the relationship with demographic factors, clinical features, and systemic treatment.

Materials and methods: Prospective study included 162 out-patients with IBD who were managed in the tertiary care center. Ulcerative colitis (UC) was diagnosed in 117 patients, Crohn's disease (CD) in 45. Patients completed the questionnaire containing demographic and IBD data, questions about mucocutaneous lesions (in past or present state).

Results: Overall mucocutaneous lesions were reported by 48.1% of IBD patients. Skin lesions were reported by 40.7% of patients, oral mucosal lesions were reported by 16.7%, without significant differences between sexes or IBD types. In 47 (29%) of patients, skin lesions appeared together with IBD or during the course of the disease. The most common skin lesions were psoriasis (8.0%), erythema nodosum (5.6%), pyoderma gangrenosum and acne (3.7% each). UC patients mostly reported about psoriasis (9.4%), while CD patients about erythema nodosum (11.1%). There were more frequent skin lesions in patients with more extensive UC type (p = 0.01), while no difference was noticed between different types of CD. The average duration of IBD in patients with skin lesions was similar to those without lesions (9.3±6.7 vs. 9.4±6.7 years).

Conclusions: Mucocutaneous lesions were reported by 48.1% of inflammatory bowel disease patients. The frequency of mucocutaneous lesions does not differ significantly between UC and CD, and a longer duration of illness is not a predictive factor for the appearance of lesions. More extensive UC is related to higher frequency of skin lesions.

Introduction: Anatomical variations of the brachial plexus and its branches are frequently encountered. Absent musculocutaneous nerve with complete or partial takeover of function by median nerve is known. Such variation creates confusion in the interpretation of a clinical or electro diagnostic test for evaluation of peripheral nerve injury.

Methods: Institutional guidelines for the use of human cadaver were followed. Routine dissection of the upper limbs for undergraduate medical teaching was performed in a 67-years-old male cadaver following standard methods. Relevant gross anatomical features of the variations were photographed.

Results: The musculocutaneous nerve was absent on the left side. A direct small branch arising from the lateral cord supplied the coracobrachialis muscle. Median nerve supplied the biceps brachii and brachialis muscle and further continued as lateral cutaneous nerve of the forearm.

Conclusion: The unilateral absence of musculocutaneous nerve with taking over of its function predominantly by the median nerve observed in the present case is indeed a unique situation to be aware of. Additionally the case exhibited independent supply to the coracobrachialis muscle directly from the lateral cord of the brachial plexus. It is proposed that this variation should be placed in a new subcategory in the existing classification system of the classification for musculocutaneous nerve variations.

Background: Preoperative anxiety affects the majority of surgical patients and has a huge impact on their well-being and recovery. Pharmacological anxiety treatment does not always result in the desired effect and occasionally causes side effects. To address this issue, recent research is focused on inventing and studying nonpharmacological anxiety management techniques.

Objectives: To review the diversity of recent nonpharmacological anxiety-reducing methods for adult and pediatric patients and compare their effectiveness and applicability in real-life clinical practice.

Methods: The search was performed using keywords 'preoperative anxiety', 'management techniques', 'nonpharmacological', 'pediatric' in PubMed and Google Scholar databases. Full-text original articles or reviews that were published during the last 5 years were selected. Anxiety management techniques were identified and further analyzed for advantages and disadvantages.

Results: Patient education, educational videos and music seem to be the most effective and easy to implement in daily practice for adults. While playing rooms and interactive pop-up books are reasonable to manage preoperative anxiety for pediatric patients.

Conclusions: The choice of nonpharmacological anxiety management methods is diverse. However, the availability and application in reality highly depend on numerous variables, such as costs, time availability, motivation of the medical team, cultural background, and preference of the patient.

Introduction: The fibularis quartus (FQ) or peroneus quartus (PQ) is a supernumerary muscle occasionally seen in the lateral compartment of the human leg. It is a weak evertor and has a role in pronation and lateral stabilization of the foot. FQ arises from the fibularis brevis (FB) in most instances and distally gets attached to the lateral aspect of the base of the fifth metatarsal or the cuboid or the calcaneus bone. The muscle has been implicated in a variety of clinical problems ranging from ankle pain to subluxation and tear of peroneal tendons. We report here a rare bitendinous variant of FQ which might provide new insight to clinical problems related to the presence of this muscle and its possible utility as an autograft in reconstruction.

Methods: Institutional guidelines for use of human cadaver were followed. Routine dissection was performed on a 71-year-old male donated cadaver in both the lower limbs. Gross anatomical features were meticulously noted, photographed and measurements were recorded with digital Vernier callipers.

Results: A bitendinous muscle was observed in the lateral compartment of the left leg and identified as FQ. The FQ was proximally attached to the FB and adjacent distal third of the fibula, which then formed a flat fusiform muscle belly and eventually terminated through a rounded tendon via its attachment to the peroneal trochlea of the calcaneus. The dimensions of the proximal tendon, muscle belly and the distal tendon were 4.2 cm x 0.7 cm, 5.6 cm x 1.9 cm and 2.6 cm x 0.3 cm, respectively.

Conclusions: Clinicians should be aware about all possible variants of the supernumerary FQ muscle considering its role in several lateral ankle pathologies. FQ can prove as an excellent autograft for peroneal tendon tear and can be utilized for strengthening weakened peroneal tendons.

Background: Asphyxia within confined spaces, particularly involving plastic bag suffocation and gas inhalation, presents complex forensic challenges. This study explores mechanisms, epidemiology, and forensic considerations of these fatalities, drawing from a comprehensive literature review and analysis of four clinical cases. Plastic bag asphyxia, exacerbated by oxygen depletion and carbon dioxide accumulation, induces rapid loss of consciousness and cardiorespiratory arrest. The method's lethality is increased when combined with inert gases like helium, known for their rapid onset of hypoxia and painless nature. Recent research demonstrates a growing incidence of plastic bag suffocation as a method of suicide. The accessibility of suicide-related information on online platforms contributes to the dissemination of new methods, posing challenges for suicide prevention efforts. Forensic investigations often face obstacles in accurately determining the cause and manner of death, with nonspecific autopsy findings and scene manipulations complicating the diagnostic process.

Materials and methods: A literature research was conducted across PubMed and Google Scholar databases, focusing on articles published in the last 5 years, applying keywords relevant to the topic under consideration and their combinations. 34 pertinent articles were selected, supplemented by data from the Lithuanian State Forensic Medicine Service, involving four clinical cases of confined space asphyxia. Autopsy findings, toxicological analyses, and contextual details were thoroughly examined to determine the mechanism and circumstances of death.

Results: Plastic bag suffocation, often combined with inert gas inhalation, emerges as a common method in suicides. Demographic analyses reveal distinct patterns, with younger age groups demonstrating an increased tendency for gas inhalation suicides. The accessibility and perceived painlessness of helium contribute to its rising usage for suicide purposes. Forensic challenges include nonspecific autopsy findings, manipulations of death scenes, and difficulties in detecting inert gases postmortem. Enhanced surveillance and efforts to restrict access to these tools are crucial in preventing the spread of new suicide methods.

Conclusions: The study highlights the multifaceted nature of asphyxiation deaths within confined spaces and the importance of proactive interventions in suicide prevention. Enhanced surveillance, tailored prevention strategies, and collaborative efforts are essential in addressing evolving suicide methods and reducing their impact.

Introduction: Immunoglobulin A vasculitis (IgAV) is the most common vasculitis in children. Although typically self-limiting, IgAV may result in serious complications. Our objective was to evaluate the incidence, clinical features, laboratory predictors and outcomes of IgA vasculitis with gastrointestinal (GI) and kidney involvement.

Methods: Medical records of patients <18 years of age with newly diagnosed IgAV between 2013 and 2021 in a single center were analyzed. Demographic, clinical, laboratory data, and incidence of GI and kidney involvement data were analyzed. As laboratory predictors, neutrophil, lymphocyte, platelets count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) were calculated.

Results: 240 patients with IgAV were included. GI involvement was in 104 patients (43.3%), whereas kidney involvment in 21 patients (8.8%). Age was the only variable associated with increased odds of kidney involvement (OR 3.5, 95% confidence interval 1.39-8.56, p=0.009). None of the laboratory predictors or other tested variables was associated with kidney involvement in univariable logistic regression. The neutrophil and lymphocyte count, NLR and PLR levels were found to be significantly higher in children with GI involvement. There were no bad outcomes: lethal outcome or chronic kidney disease for the patients with GI and kidney involvement in recent study. During two years of surveillance after IgAV diagnosis, 11 cases (4.6%) had indications for kidney biopsy and were diagnosed with IgAV nephritis.

Conclusions: Older children were more likely to have kidney disease. Easy obtained laboratory parameters such as NLP, PLR could help to predict GI involvement in early disease stage, but had no value for predicting kidney involvement.

The omphalomesenteric canal (OMC) is an important embryonic structure that normally regresses during development. OMC remnant persistance is rare and can lead to complications such as small intestinal obstruction. We report the case of an 18-year-old male with flu-like symptoms, abdominal pain, fever, and a positive McBurney sign. A CT scan raised the suspicion of occlusion, prompting surgery, revealing a fibrous band from the umbilicus to the mesocolon around which the right colon and caecum were wrapped. OMC anomalies are generally encountered in children, with a large spectrum of possibilities causing various problems. Diagnosis is challenging, with symptoms often mimicking other conditions, often necessitating surgery to obtain a definitive diagnosis. Intestinal obstruction is a severe complication, necessitating urgent surgical resection. Radiological imaging mainly serves to prompt surgical intervention as it is limited in directly visualizing fibrous bands, with surgery remaining the best way to obtain a diagnosis, as well as allowing concomitant treatment.

Background: Cysts are called giant when they are >10 cm in diameter. Today the frequency of giant ovarian cysts is decreasing due to good diagnostic methods and regular gynecological examination. These cysts occur more frequently in women of reproductive and postmenopausal age. The most common giant cysts are benign serous cystadenomas. Diagnosing giant cysts can be hindered by nonspecific symptoms, the patient's reluctance to see a doctor and fear of surgery. The purpose of this study is to review the existing literature on this topic and describe three cases of giant cysts found at autopsy.

Materials and methods: A literature review was conducted in the Medline (PubMed) database over a period of 10 years. The information concerning the examination of deceased individuals after their death was sourced from the database of the Lithuanian State Forensic Medicine Service. After the analysis of the deceased persons in the years 2015-2022 in the State Forensic Medicine Service, out of 1638 deceased persons, three cases of giant cysts were identified. These three cases were analyzed retrospectively. During these investigations, the circumstances of finding the scene, the results of the autopsy, and the data of additional toxicological and microscopic tests were evaluated.

Results: A retrospective study of 3 cases confirms the fact that giant ovarian cysts are a rare phenomenon. In case 1, the corpse of a 75-year-old woman was examined, a 30x30x25 cm left ovarian cyst was found, the woman had chronic ischemic heart disease; case 2 was a 65-year-old woman with a 19x25x12 cm right ovarian cyst and deep vein thrombosis with pulmonary embolism; case 3 was a 62-year-old woman with a 40x30x30 cm right ovarian cyst and chronic ischemic heart disease. In all cases, giant ovarian cysts were incidental findings and not the primary cause of death. The described clinical cases corresponded to the characteristics of giant cysts indicated in the literature: appeared in the postmenopausal period, benign course, diagnosed in patients who did not seek medical attention.

Conclusions: Thanks to good early diagnosis, ovarian cysts are diagnosed early, before they reach gigantic size, so giant cysts are extremely rare. Delayed diagnosis is related to reluctance of patients to consult doctors and confusion with ascites and obesity. They are usually benign, and the symptoms they cause are related to mass effect - pressure on nearby organs.

Introduction: The determination of ethyl alcohol concentration in body fluids is an important investigation in forensic practice. To avoid postmortem changes in blood alcohol concentration, the test substance must be transported in special media enriched with sodium fluoride or potassium oxalate. When interpreting changes in concentrations in the body, it is important to assess not only the blood but also other body fluids or tissues.

Materials and methods: A retrospective study was conducted from 2016 to 2023, evaluating data from nonconsecutive 378 autopsies from the State Forensic Medical Service of Lithuania. The study analyzed ethyl alcohol concentrations in blood, urine, muscle and bile. Toxicological data were processed using R commander statistical software. The study aimed to assess the changes, patterns, and correlations of ethyl alcohol concentrations in different body fluids after death.

Results: When the ethyl alcohol concentrations of the different body fluids from the autopsies were evaluated, the urine ethyl alcohol concentration was in 86% cases higher than the blood ethyl alcohol concentration, with a mean difference of 0.51‰. There is a strong correlation between blood and urine ethyl alcohol concentrations, r = 0.93, p < 0.05. The ethyl alcohol concentration in muscle was 75% higher than in blood with a mean difference of 0.06‰. Ethyl alcohol concentration in bile was 90% higher than in blood with a mean difference of 0.14‰. The difference between ethyl alcohol concentrations in bile and muscle was not significant, with a mean difference of 0.07‰.

Conclusions: In addition to blood and urine, muscle and bile samples may be taken at autopsy to detect ethyl alcohol. The results of the study show that there may be differences in the levels of ethyl alcohol in different body fluids after death. These data are therefore important for the assessment of ethyl alcohol concentrations in both clinical and forensic practice.