Lithuanian University of Health Sciences Student Scientific Society

International Health Sciences Conference’13

Conference thesis book

Kaunas 2013

Conference organizers: LUHS Student Scientific Society

Partners: Lithuanian University of Health Sciences, LUHS Student Union, Lithuanian pharmaceutical

students´ association, Lithuanian Medical Students’ Association, LUHS Academy of Veterinary Students' Association, Lithuanian Dental Students’ Association. Kaunas International Medical

Students Union

Special thanks to: Prof. habil. dr. Remigijus Žaliūnas, Rectors of LUHS

Prof. habil. dr. Vaiva Lesauskaitė, Vice rector for research of LUHS Prof. Vincentas Veikutis, Scientific superviser of LUHS Students Scientific Society

Compilers: Rūta Kinderytė, Jorūnė Šuipytė, Lukas Šemeklis, Viltė Sauliūnaitė,

Aleksandras Petrauskas, LUHS Students Scientific Society

Note: responsibility lays on the authors of the scientific works

ISBN 978-9955-15-278-1

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Contents

Welcome message ...................................................................................................................................... 13  

ANESTHESIOLOGY AND IT SECTION ............................................................................................. 14  

1.   SURGICAL TREATMENT URGENCY OF ACUTE EPIDURAL AND SUBDURAL HAEMATOMAS .................................................................................................................................... 14  

2.   PROTHROMBIN COMPLEX CONCENTRATES INFLUENCE ON COAGULATION DISORDERS .......................................................................................................................................... 17  

3.   THE INFLUENCE OF PERIOPERATIVE HEMODYNAMIC FACTORS ON RECIPIENTS RENAL GRAFT FUNCTION ................................................................................................................ 21  

4.   DELIRIUM: DIAGNOSTIC AND TREATMENT CHALLENGES ............................................ 24  

5.   PERIOPERATIVE OPTIMIZATION OF FLUID STATUS BY MINIMAL VOLUME LOADING TEST (MVLT) IMPROVES OUTCOMES IN PATIENTS UNDERGOING ELECTIVE PRIMARY TOTAL KNEE ARTHROPLASTY SURGERY ................................................................ 26  

6.   CORRELATION OF ALARM SYMPTOMS, PATIENTS‘ AGE AND CLINICALLY SIGNIFICANT ENDOSCOPIC FINDINGS .......................................................................................... 30  

7.   THE EFFICIENCY OF POSTOPERTATIVE PAIN CONTROL USING EPIDURAL ANALGESIA .......................................................................................................................................... 33  

BASIC SCIENCES AND PHARMACOLOGY SECTION .................................................................. 36  

1.   COMPARISON OF MULTIVARIATE ANALYSIS BASED METHODS FOR DETECTION OF ECG T-WAVE ALTERNANS ............................................................................................................... 36  

2.   SYNTHESIS AND EVALUATION OF IN VITRO ACTIVITY OF 4-THIAZOLIDINONE COMPOUNDS AGAINST HL-60 LYMPHOMA CELLS .................................................................... 40  

3.   MORPHOLOGICAL CHARACTERISTICS OF THE BLOOD VESSEL IN THE ATRIOVENTRICULAR NODE AND BUNDLE OF HIS .................................................................... 42  

4.   CYTOTOXICITY AND ANTIOXIDANT ACTIVITY OF LECTIN-ENRICHED PROTEIN FRACTION FROM HERB OF URTICA DIOICA L .............................................................................. 45  

5.   ANTIBACTERIAL ACTIVITY OF LECTIN ENRICHED FRACTIONS FROM URTICA DIOICA L. HERB AND DRY EXTRACT ............................................................................................ 47  

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6.   PRODUCTION AND TESTING OF ANTI-ERBB2 F(AB’)2-S .................................................... 51  

7.   ANALYSIS OF LUNG CANCER BY HISTOLOGICAL TYPE AND LOCATION IN LATVIA 53  

8.   THE EFFECT OF ELECTROLYZED (IONIZED) WATER ON RAT MATERNAL BODY PHYSICAL CONDITION (EXPERIMENTAL SCIENTIFIC WORK) ................................................ 56  

9.   DIGITAL PATHOLOGY IMAGE ANALYSIS APPROACH TO MEASURE THE EXTENT OF KIDNEY FIBROSIS ............................................................................................................................... 59  

10.   JOB SATISFACTION IN VARIOUS SPECIALTIES .................................................................. 62  

11.   PATIENTS WITH AGE-RELATED MACULAR DEGENERATION, A RANDOM SAMPLE OF THE POPULATION AND 3 GENERATIONS OF ONE FAMILY GENETIC TREE EVALUATION ACCORDING TO THE MATRIX METALLOPROTEINASE-3 GENE POLYMORPHISM ................................................................................................................................. 66  

CARDIOLOGY SECTION ...................................................................................................................... 68  

1.   RADIOLOGICAL ASSESSMENT OF CORONARY ARTERY OBSTRUCTIONS BY LOCALISATION IN PATIENTS WITH CORONARY ARTERY DISEASE ..................................... 68  

2.   ASSOCIATION BETWEEN LEFT VENTRICLE FUNCTION AND PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE (sCAD) .................... 70  

3.   CARDIAC SIZE AND FUNCTION IN ELITE FEMALE FITNESS ATHLETES ...................... 73  

4.   GENDER DIFFERENCES IN PROGNOSIS OF HOSPITALIZATION DURING ONE YEAR AFTER MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION .................................. 76  

5.   MITRAL VALVE ANULOPLASTY: SUTURE VS RIGID RING .............................................. 79  

6.   R-R MULTIPLE SCLEROSIS IN LITHUANIA: COMPARISON BETWEEN AMOUNT OF VITAMIN D IN PERIPHERAL BLOOD AND SEVERITY OF MULTIPLE SCLEROSIS ............... 82  

7.   CHRONOTROPIC RESPONSE BY EXERCISE STRESS TESTING ......................................... 85  

8.   CHANGES IN AORTIC DIAMETER AFTER ENDOVASCULAR ANEURYSM REPAIR ..... 88  

9.   THE PROGNOSTIC VALUE OF DIASTOLIC FUNCTION ASSESSMENT IN LEFT VENTRICLE DYSFUNCTION PREDICTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION ........................................................................................................................................ 91  

10.   CLINICAL PROBLEMS IN THE USAGE OF NOVEL AND OLD GENERATION ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION IN LATVIA ...................... 94  

11.   THE EFFICACY OF INTRAHOSPITAL TREATMENT OF HYPERTENSIVE CRISIS IN RIGA STRADINS CLINICAL UNIVERSITY HOSPITAL, 2012 ....................................................... 96  

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12.   THE IMPACT OF UNCORRECTED MILD AND MODERATE ISCHEMIC MITRAL REGURGITATION DYNAMICS ON LEFT VENTRICULAR FUNCTION FOLLOWING CORONARY ARTERY BYPASS GRAFTING .................................................................................. 100  

13.   LONG TERM RESULTS OF CORONARY ARTERY BYPASS GRAFTING WITH UNCORRECTED MILD AND MODERATE MITRAL REGURGUTATION ................................. 103  

14.   ISCHAEMIC MITRAL VALVE REGURGITATION AFTER MYOCARDIAL INFARCTION 105  

ENDOCRINOLOGY SECTION ........................................................................................................... 110  

1.   DHEAS SECRETING ADRENAL INCIDENTALOMA ............................................................ 110  

2.   THE FEATURES OF FIRST DIAGNOSING AND INITIAL TREATMENT OF TYPE 2 DIABETIC MALES THAT DO NOT NEED TREATMENT OF INSULIN ...................................... 113  

3.   REALIZATION AND EFFECTIVENESS OF THE DIABETES PATIENT’S EDUCATION PROGRAM ........................................................................................................................................... 116  

4.   ULTRASONOGRAPHIC FINDINGS IN THYROID GLAND OF MIDDLE-AGED LITHUANIAN MALES AND FEMALES .......................................................................................... 120  

5.   EVALUATION OF MIDLLE AGED FEMALES MENOPAUSAL SYMPTOMS .................... 122  

6.   EVALUATION OF SEXUAL FUNCTION AND SEX HORMONES IN 48-50-YEAR-OLD LITHUANIAN MEN ............................................................................................................................ 125  

7.   SEXUALITY OF 26-36-YEAR-AGED TYPE 1 DIABETICS AND AGE-MATCHED CONTROL MEN .................................................................................................................................. 128  

8.   CORRELATION BETWEEN PITUITARY ADENOMA DIAMETER AND MUNSELL FARNSWORTH 100 HUE TEST ........................................................................................................ 131  

9.   DIABETIC RETINOPATHY AND BLOOD LIPIDS LEVELS' EVALUATION IN DIABETIC PATIENTS ............................................................................................................................................ 134  

10.   DIFFERENCES IN SLEEP QUALITY OF MEN SUFFERING FROM TYPE 2 DIABETES MELLITUS WITH AND WITHOUT DEPRESSION SYMPTOMS .................................................. 136  

11.   DIFFERENTIAL DIAGNOSIS OF HYPERANDROGENEMIA AND ITS CLINICAL RELEVANCE ....................................................................................................................................... 139  

12.   PSEUDOHYPOPARATHYROIDISM: A CASE REPORT OF RARE CAUSE OF HYPOCALCAEMIA ............................................................................................................................ 142  

INTERNAL MEDICINE SECTION ..................................................................................................... 146  

1.   HEMODIALYSIS PATIENT‘S HYPERHIDRATION EVALUATION .................................... 146  

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2.   OBSTRUCTIVE JAUNDICE: EVALUATION WITH RADIOLOGY IMAGING METHODS 148  

3.   SENSITIZATION TO CETEARYL ALCOHOL AMONG DERMATITIS PATIENTS ........... 151  

4.   VAGINAL FLORA TYPES OF PREGNANT WOMEN IN THEIR FIRST TRIMESTER ....... 153  

5.   TRAUMA TEAM ACTIVATION DEPENDENCY ON LUNAR PHASES .............................. 156  

6.   PROBABILITY OF BONE FRACTURE ESTIMATION IN 10 YEAR PERIOD ..................... 159  

7.   THE INFLUENCE OF MOON PHASES ON THE NUMBER OF PATIENTS APPLYING TO THE CARDIOLOGY ADMISSION DEPARTMENT AT KAUNAS CLINICS OF HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES .................................................................. 162  

8.   THE INFLUENCE OF THE TIME OF DAY, WORK AND NON-WORK DAY ON THE FREQUENCY OF PATIENT APPLICATIONS TO THE CARDIOVASCULAR ADMISSION DIVISION ............................................................................................................................................. 165  

9.   HYPOCALCAEMIA COMPLICATIONS AFTER THYROIDECTOMIES .............................. 168  

10.   GENDER DIFFERENCES AND FREQUENCY OF ST-SEGMENT CHANGES OF LEAD AVR IN ACUTE MYOCARDIAL INFARCTION ....................................................................................... 171  

11.   PROGNOSTIC FACTORS OF SHORT TERM OUTCOME IN SEVERE ULCERATIVE COLITIS FLARE .................................................................................................................................. 174  

12.   CONNECTION BETWEEN THE PATIENTS’ COMPLAINTS BEFORE UPPER GASTROINTESTINAL ENDOSCOPY AND ENDOSCOPIC FINDINGS ....................................... 177  

13.   REPLICATION OF GWAS RESULTS ON GASTRIC CANCER IN AN INDEPENDENT COHORT OF PATIENTS OF CAUCASIAN ETHNICITY ............................................................... 180  

14.   RHINOCONJUNCTIVITIS PREVALENCE AND HEALTH-RELATED QUALITY OF LIFE INVESTIGATION AMONG STUDENTS IN LITHUANIAN UNIVERSITY OF HEALTH SCIENCES ............................................................................................................................................ 182  

15.   ANALYSIS OF PROGNOSTIC FACTORS IN MORTALITY DUE TO ESOPHAGEAL AND GASTRIC VARICEAL BLEEDING (DATA COLLECTED BETWEEN 2007 AND 2011 BY THE HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES KAUNAS CLINICS) .... 185  

16.   EPIDEMIOLOGICAL PATTERNS OF PERTUSSIS IN VILNIUS CITY AND COUNTRY .. 188  

17.   SLEEPINESS AND VIGILANCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA ... 192  

18.   FIRST ORAL HEALTH KNOWLEDGE OF THE CHILD : SURVEY IN SCHOOLS OF MONTPELLIER, FRANCE ................................................................................................................. 195  

19.   INFLUENCE OF METEOROLOGICAL FACTORS ON TRAUMA TEAM ACTIVATION .. 200  

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20.   SELF-TREATMENT AND HOME MEDICATION BOX CHARACTERISTICS AND ATTITUDE TO SELF-MEDICATION OF STUDENTS’ FAMILIES’ OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES PHARMACY FACULTY ................................................. 202  

21.   AWARENESS OF TUBERCULOSIS AMONG ROMA PATIENTS IN BULGARIA ............. 205  

22.   LOW BACK PAIN RED FLAG SYMPTOM CHARACTERISATION AND COMPARISON IN PATIENTS AT THE EMERGENCY ROOM AND GENERAL PRACTITIONER ........................... 207  

22.   TERMINAL STAGE CHRONIC KIDNEY DISEASE DEVELOPMENT DEPENDING ON GENDER .............................................................................................................................................. 210  

MAXILLOFACIAL SURGERY SECTION ........................................................................................ 213  

1.   INFLUENCE OF IMMEDIATE DENTIN SEALING ON MARGINAL MICROLEAKAGE OF INDIRECT COMPOSITE RESIN RESTORATIONS ......................................................................... 213  

2.   IMPACT OF GASTROESOPHAGEAL REFLUX DISEASE ON ORAL CAVITY AND DENTAL IMPLANTS: A LITERATURE REVIEW .......................................................................... 215  

3.   EPIDEMIOLOGICAL ASSESSMENT OF PRIMARY ORAL CANCER DIAGNOSTICS ..... 217  

4.   ROUGHNESS OF THE RESTORATIVE MATERIALS INFLUENCED BY DIFFERENT POLISHING MATERIALS FOR PROFESSIONAL ORAL HYGIENE ............................................ 220  

5.   THE INFLUENCE OF CHRONIC STRESS AND DIABETES MELLITUS TYPE II ON BONE REPARATIVE MINERALS AND GROWTH FACTORS ................................................................. 222  

6.   FACIAL AND TRIGEMINAL NERVES ARTIFICIAL AND NATURAL ANASTOMOSIS. LITERATURE ANALYSIS ................................................................................................................. 225  

7. THE CHARACTERISTICS OF ISOLATED AND COMBINED ORBITAL FRACTURES IN ASSOCIATION WITH MIDFACE TRAUMA. INDICATION FOR ORBITAL SURGERY AND SURGICAL APPROACHES: RETROSPECTIVE STUDY ............................................................... 229  

NEUROSCIENCES SECTION ............................................................................................................. 232  

1.   EARLY POST OPERATION RESULT REVIEW BASED ON NERVE CONDUCTION STUDY DATA AFTER SIMPLE DECOMPRESSION OF NERVUS ULNARIS IN THE CUBITAL TUNNEL 232  

2.   AN ASSESSMENT OF NON-MOTOR SYMPTOMS IN PATIENTS WITH IDIOPATHIC PARKINSON'S DISEASE IN COMPARISON TO PARKINSONIAN SYNDROMES .................... 234  

3.   RADIOLOGICAL FINDINGS OF ACUTE ISCHEMIC STROKE BEFORE AND AFTER ENDOVASCULAR THROMBECTOMY, TREATMENT RESULTS .............................................. 237  

4.   VERBAL MEMORY IN TEMPORAL LOBE EPILEPSY SURGERY: THE LINK BETWEEN POSTICTAL AND POSTOPERATIVE MEMORY ........................................................................... 240  

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5.   TREATMENT ANALYSIS OF MIGRAINE ATTACKS IN A RANDOM LITHUANIAN SAMPLE ............................................................................................................................................... 243  

6.   LITHUANIAN PEOPLE’S ATTITUDE TOWARDS MENTAL HEALTH .............................. 246  

7.   RESTLESS LEGS SYNDROME IN DIALYSIS PATIENTS: A PILOT STUDY ..................... 250  

8.   ASSESSMENT OF THE CLINICAL VALIDITY AND STABILITY OF AUSTIN EAR CLINIC DIZZINESS QUESTIONNAIRE LITHUANIAN VERSION ............................................................. 253  

9.   METHANOL OPTIC NEUROPATHY ........................................................................................ 256  

10.   DIFFERENCES OF EMOTIONAL STATE AMONG MEN SUFFERING FROM TYPE 2 DIABETES MELLITUS CONSIDERING PRESENCE OR ABSENCE OF DEPRESSION SYMPTOMS ......................................................................................................................................... 259  

11.   TICK-BORNE ENCEPHALITIS AND LYME DISEASE (LYME BORRELIOSIS) EPIDEMIOLOGICAL, CLINICAL AND LABORATORY ACTUAL NEWS IN RIGA EASTERN CLINICAL UNIVERSITY HOSPITAL “GAIĻEZERS" FROM YEAR 2007 TO 2012 .................... 261  

OBSTETRICS AND GYNAECOLOGY SECTION ........................................................................... 265  

1.   COMPARATIVE STUDY ON SEX EDUCATION AND CONTRACEPTION AMONG STUDENTS IN KAUNAS UNIVERSITIES ....................................................................................... 265  

2.   THE MEANING OF LYMPHADENECTOMY SELECTING POSTOPERATIVE TREATMENT STRATEGY FOR PATIENTS WITH ENDOMETRIAL CARCINOMA .......................................... 268  

3.   LAPAROSCOPIC HYSTERECTOMY VERSUS ABDOMINAL HYSTERECTOMY: A RETROSPECTIVE STUDY ................................................................................................................. 271  

4.   LAPAROSCOPIC AND LAPAROTOMIC HYSTERECTOMY FOR TREATING UTERINE CANCER: SELECTION FACTORS, TREATMENT COURSE AND RESULTS ............................. 273  

5.   MULTIPLE PREGNANCY LABOR CARE TACTICS AND CHANGES IN THE RESULTS DURING THE PERIOD OF 2005-2012 .............................................................................................. 277  

6.   WATERBIRTH AND IT‘S RESULTS ........................................................................................ 279  

7.   GESTATIONAL HYPERTENSION, PRE-ECLAMPSIA, PREMATURE DELIVERY AND INTRAUTERINE GROWTH RETARDATION AMONG ADOLESCENTS IN RIGA MATERNITY HOSPITAL FROM 2008 TILL 2012 ................................................................................................... 281  

ODONTOLOGY SECTION .................................................................................................................. 284  

1.   SEM AND STEREO MICROSCOPE ANALYSIS OF ROOT CANAL WALLS AFTER CALCIUM HYDROXIDE MEDICATION ......................................................................................... 284  

2.   DENTAL STUDENTS KNOWLEDGE OF HEPATITIS B VIRUS INFECTION AND IT’S CONTROL PRACTISES IN LITHUANIAN UNIVERSITY OF HEALTH SCIENCES ................... 286  

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3.   INFLUENCE OF PASSIVE ULTRASONIC IRRIGATION ON FINAL CANAL OBTURATION QUALITY AFTER CALCIUM HYDROXIDE MEDICATION ......................................................... 289  

4.   COMPLETE UNILATERAL CLEFT LIP AND PALATE: DIFFERENT POINT OF VIEW IN EVALUATION ..................................................................................................................................... 291  

5.   THE RISK OF ORTHODONTIC MINI IMPLANTS .................................................................. 293  

6.   A COMPARATIVE STUDY BETWEEN TWO METHODS FOR PERFORMING BOLTON ANALYSIS ON DIGITAL MODELS ................................................................................................. 295  

7.   ORTHODONTIC ANOMALIES PREVALENCE IN PATIENTS WITH MIXED OR PERMANENT DENTITION ................................................................................................................ 299  

8.   THE EFFECT OF BOUNDED EDENTULOUS SIDE SPACES TO ATTACHMENT APPARATUS OF ANTAGONIST AND ADJACENT TEETH ......................................................... 302  

9.   DENTAL EROSION PREVALENCE AMONG 13 – 17 YEARS OLD KAUNAS SPORTSMAN SWIMMERS ......................................................................................................................................... 305  

10.   THE PREVALENCE OF THE USE OF RADIOGRAPHY AND THE APEX LOCATOR IN ENDODONTIC TREATMENT WITHIN THE DENTISTS IN LITHUANIA ................................... 308  

ONCOLOGY SECTION ........................................................................................................................ 312  

1.   GASTRIC LYMPHOMAS. LITERATURE REWIEW AND CLINICAL CASE STUDIES ..... 312  

2.   EFFECTIVENESS OF TUMOR ELECTROCHEMOTHERAPY IN VITRO USING DIFFERENT CHEMOTHERAPEUTIC DRUGS COMBINATION WITH DOXORUBICIN .......... 315  

OPHTALMOLOGY SECTION ............................................................................................................ 319  

1.   IMPACT OF VISUAL IMPAIRMENT ON DAILY LIFE OF THE CARDIAC PATIENTS .... 319  

2.   CLINICAL MANIFESTATION OF IRIDOCYCLITIS ASSOCIATED WITH JUVENILE IDIOPATHIC ARTHRITIS AT CHILDREN CLINICAL UNIVERSITY HOSPITAL, LATVIA .... 321  

OTORHINOLARYNGOLOGY SECTION ......................................................................................... 324  

1.   VISUALIZATION OF THE SIMULATED OSSICULAR CHAIN INJURIES IN THE SHEEP TEMPORAL BONE: RADIOLOGICAL AND ANATOMICAL CORRELATIONS ........................ 324  

2.   MIDDLE EAR DISORDERS OF THE PATIENTS OF VSIA "P.STRADINS CLINICAL HOSPITAL" OTORHINOLARYNGOLOGY CLINIC ....................................................................... 327  

3.   CORRELATION BETWEEN USE OF PERSONAL MUSIC PLAYERS (PMP) AND HEARING TRESHOLD SHIFT .............................................................................................................................. 330  

4.   TUMOR RECIDIVUM WITH TRACHEAL LUMEN COMPRESSION AFTER TOTAL THYROIDECTOMY ............................................................................................................................ 333  

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5.   INCIDENCE OF CLINICAL FEATURES AND QUALITY OF LIFE IN PATIENTS WITH CHRONIC DACRYOCYSTITIS ......................................................................................................... 336  

6.   COMPLICATIONS OF TRACHEOTOMY IN LUHS KC DURING 2006– 2011 YEARS ....... 339  

7.   TRANSLATION, CROSS-CULTURAL ADAPTATION AND VALIDATION OF SINO-NASAL OUTCOME TEST (SNOT) - 22 TO LITHUANIAN PATIENTS ........................................ 342  

PEDIATRIC SECTION ......................................................................................................................... 344  

1.   ULTRASONOGRAPHIC MEASUREMENTS OF SHOULDER AND ELBOW JOINT CARTILAGE THICKNESS IN YOUNG BASEBALL PLAYERS .................................................... 344  

2.   CHILDREN’S ARTERIAL BLOOD PRESSURE MEASUREMENTS AND EVALUATION OF THE RESULTS IN CHILDREN'S CLINICAL UNIVERSITY HOSPITAL IN RIGA, LATVIA. .... 347  

3.   FACTORS OF RISK OF CHILDREN WITH FUNCTIONAL CONSTIPATION ..................... 350  

4.   CLINICAL MANIFESTATION AT THE ONSET OF TYPE 1 DIABETES MELLITUS IN CHILDREN IN LATVIA ..................................................................................................................... 352  

5.   PEDIATRIC AGE BENIGN BONE TUMORS OF LONG BONES – RADIOLOGIC DIAGNOSIS AND DIFFERENTIALDIAGNOSIS ............................................................................. 356  

6.   NON-URGENT CARE AT PAEDIATRIC EMERGENCY DEPARTMENT OF UNIVERSITRY HOSPITAL. WHAT INFLUENCES PARENTS’ DECISIONS? ........................................................ 358  

SURGERY SECTION ............................................................................................................................ 362  

1.   VALIDATION OF D’AMICO CRITERIA FOR LOW-RISK PROSTATE CANCER .............. 362  

2.   MULLERIAN DUCT DEVELOPMENT MALFORMATION'S COMBINATION: EXAMINATIONS DIFFICULTIES ..................................................................................................... 364  

3.   IATROGENIC GALLBLADDER PERFORATION DURING LAPAROSCOPIC CHOLECYSTECTOMY. SERIOUS PROBLEM, OR NOT? ............................................................. 366  

4.   FACTORS INFLUENCING LONG TERM SURVIVAL AFTER MAJOR PANCREATIC SURGERY FOR ADENOCARCINOMA OF THE HEAD OF THE PANCREAS ............................ 368  

5.   BILIARY TRACT INFECTION AFTER PREOPERATIVE BILIARY DRAINAGE FOLLOWING OPERATION FOR PERIAMPULLARY TUMORS OR CHRONIC PANCREATITIS 370  

6.   A PROSPECTIVE ANALYSIS OF PAIN REDUCTION AND IMPROVEMENT OF PHYSICAL FUNCTIONS AFTER OPEN CARPAL TUNNEL RELEASE OPERATIONS ............ 373  

7.   THE ROLE OF MALNUTRITION RISK IN PREDICTING THE INCIDENCE AND SEVERITY OF POSTOPERATIVE COMPLICATIONS IN GASTRO-INTESTINAL SURGERY 375  

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8.   ARTICULAR CARTILAGE SURGICAL TREATMENT EXPEDIENCE WHEN KNEE ARTICULAR CARTILAGE AND OSTEOCHONDRAL DEFECTS WERE FOUND DURING THE KNEE ARTHROSCOPIC AND LIGAMENT RECONSTRUCTION SURGERIES ......................... 378  

9.   THE INFLUENCE OF AGE ONTO THE RESULTS OF ACUTE CHOLECYSTITIS OPERATIVE TREATMENT ............................................................................................................... 382  

10.   CORRELATION BETWEEN HALLER'S INDEX AND LUNG FUNCTION TESTS BEFORE PECTUS EXCAVATUM CORRECTION ............................................................................................. 385  

11.   HYPOCALCAEMIA AFTER TOTAL THYROIDECTOMY .................................................... 387  

12.   AN OBSERVATIONAL STUDY ON CORRELATION BETWEEN SCALDING AND PATIENTS RESIDENTIAL AREA ..................................................................................................... 390  

13.   ANALYSIS OF LATE COMPLICATIONS AFTER INGUINAL HERNIA SURGERY .......... 392  

14.   THE CHARACTERISTICS OF ISOLATED AND COMBINED ORBITAL FRACTURES IN ASSOCIATION WITH MIDFACE TRAUMA. INDICATION FOR ORBITAL SURGERY AND SURGICAL APPROACHES: RETROSPECTIVE STUDY. .............................................................. 394  

15.   CHARACTERIZATION OF DISTAL HUMERUS FRACTURES IN CHILDREN AT LUHS KAUNAS CLINICS IN 2010 AND 2011 ............................................................................................. 397  

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Welcome message

Dear young colleagues,

It is our great honor to organize the scientific event which is designed to promote and encourage

the development and exchange of information in all aspects of basic and practical medicine, new

techniques and methods. Our impressive start two years ago showed high interest in our

conference ant this was a great stimulus for us.

For 2nd International Health Science Conference our Scientific Community received 157

abstracts from 5 countries and regions. We tried our best to cover wide range of topics and make

the program be first-rate scientifically and to offer a unique opportunity to the participants to

share ideas. I hope our conference will be a great platform for your intellectual and social

improvement.

On behalf of our Scientific Committee, I wish you an interesting set of basic and practical

scientific presentations relevant to your role and a good use of time in Kaunas.

Professor Vincentas Veikutis, Scientific superviser of LUHS Student Scientific Society

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ANESTHESIOLOGY AND IT SECTION

1. SURGICAL TREATMENT URGENCY OF ACUTE EPIDURAL AND

SUBDURAL HAEMATOMAS

Authors: Petras Petkevičius, Kęstutis Petniūnas, Ieva Zujūtė

Supervisor of the absract: doc. Tomas Tamošuitis

INTRODUCTION

Epidural and subdural haematomas are rare but serious complications of head trauma. Sources

states that an epidural haematoma is diagnosed for 1-4% patients with traumatic head injury and

for 5-15% are found during autopsy. [1] Acute subdural haematomas, according to research,

occurr for 5-25% patients with acute head injuries. [1] Patients with acute subdural or epidural

haematomas with indications for surgical treatment require immediate surgical intervention.

According to studies, if the surgical intervention is performed up to 4 hours after trauma,

mortality rate is 30-47%, but later than 4 hours after trauma, mortality rate increases to 80-90%.

[3]

AIM

To identify if fixed pre-operative time affects outcomes of patients with severe coma (GCS<9)

who suffered acute subdural or epidural haematoma caused by head trauma, which happened in

the first 24hours till surgery.

OBJECTIVES

1. To determine and compare outcomes of patients who underwent surgeries up to 4 hours

after trauma and later than 4 hours after trauma.

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2. To determine surgery timing range when the difference of outcome becomes statistically

significant for patients in severe coma (GCS<9) caused by acute epidural or subdural

haematoma.

3. To determine, whether time till the surgery could be used as a predictor prognosing

outcomes for patients in severe coma (GCS<9) caused by acute epidural or subdural

haematoma.

METHODS

Retrospective biomedical research, in which 238 cases were reviewed with acute isolated

traumatic brain injury (epidural or subdural haematoma) surgically treated in LUHS KK

Neurosurgery Clinic during 2008-2012 period and postoperative treatments applied in

Neurosurgery ICU. Patients with polytrauma or severe chronic diseases were excluded. Out of

238 cases 129 cases where selected with patients who had GCS <9 estimated before surgery. 40

cases were rejected because patients were treated surgically later than 24 hours after head

trauma. Patients were divided into two groups: up to 4 hours and later than 4 hours from trauma

to surgery. Patients with epidural or subdural haematoma were analysed separately. Last

registred GCS was used for estimating patient's outcome, GOS was registred only in a few cases.

We used SPSS 17.0 Statistics for statistical analysis. Non-parametric Tests were used to

evaluate dependence between groups according GCS (Mann-Whitney Test, Spearman‘s

correlation).

We compared groups of patients who have undergone surgery up to 4 hours, with the groups,

where surgery was performed after 4 hours.

RESULTS

Out of 89 patients, 73 (82%) suffered from subdural haematoma and 16 (18%) from epidural.

Average age in subdural group was 53,34 ± 1,91 years, in epidural group 50,13 ± 2,34. Head

trauma caused death in subdural group 32 (43,8%) cases, in epidural group 6 (37,5%). Among

survivors in subdural group 11 (26,8%) patients had severe outcome (GCS <9), 5 (12,2%) had

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moderate outcome (GCS 9-12) and 25 (61%) had mild outcome (GCS >12), in epidural 1 (10%)

- severe outcome, 2 (20%) - moderate outcome, 7 (70%) - mild outcome. In the 1st group

(surgery performed up to 4 hours after head trauma) among patients with subdural hematoma

average GCS outcome was 7,17 ± 1,04, 13 (54,2%) patients died. In the 2nd group (surgery

performed later than 4 hours after head trauma) average GCS outcome was 8,53 ± 0,77, 19

(38,8%) patients died. However there wasn't statistically significant difference between 1st and

2nd group among cases of subdural hematoma, p > 0,05. In the 1st group among patients with

epidural hematoma average GCS outcome was 11,33 ± 2,2, 1 (16,7%) patients died. In the 2nd

group average GCS outcome was 8,2 ± 1,58, 5 (50%) patients died. However there wasn't

statistically significant difference between 1st and 2nd group among cases of epidural hematoma,

p > 0,05.

According to our data, using pre-operative time 5 hours there was statistically significant

difference among patients with acute subdural hematoma. In the 1st group (surgery performed up

to 5 hours after head trauma) average GCS outcome was 6,75 ± 0,84. In the 2nd group (surgery

performed later than 5 hours after head trauma) average GCS outcome was 9,37 ± 0,87. The

difference between 1st and 2nd group was significantly different, p < 0,05. However average

GCS in 2nd group was higher than in 1st one, so we have compared initial GCSes (GCS

evaluated before surgery by anesthesiologist) to make sure that patients with higher intial GCSes

are being operated later. Initial GCS's average was 3,97 ± 0,14 in the 1st group and 5 ± 0,25 int

the 2nd group. Difference between initial GCSes was significantly different, p<0,05. To get

objective results we have compared the difference between otucome and initial GCSes with the

time till surgery. Delta GCS (difference between outcome GCS and initial) correlated

statistically significantly in 2nd group (p<0,05; Spearman's correlation coeficient -0,330) – this

means that when time till surgery gets higher, delta GCS drops in the 2nd group of patients.

Using 5 hours pre-operative time among patients with acute epidural hematoma, there wasn't

statistically significant difference.

Time till the surgery didn't correlate with outcome GCS statistically significantly (p > 0,05,

Spearman's correlation coeficient 0,170 in subdural group, -0.253 in epidural group).

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CONCLUSIONS

1. Group, where surgery was performed up to 4 hours from head trauma didn‘t have

statistically significantly better outcomes than the group where surgery was performed

after 4 hours from head trauma for patients with acute epidural or subdural haematoma.

2. According to our research 5 hours could be the limit time to perform surgery for patients

with acute subdural haematoma. In addition to this, according to our data, patients with

higher initial GCS are being operated later (after 5 hours) while patients with lower ones

earlier. However, according to correlation, in a group of patients who underwent surgery

later than 5 hours after head trauma outcome GCS decreases while time increases

statistically significantly.

3. Time till surgery didn‘t have statistically significant correlation with the outcome GCS in

our research, so it shouldn't be used as a single factor of prognosis for patient's with acute

epidural and subdural haematoma outcome.

REFERENCES

1. Bullock MR, Chesnut R, Ghajar J et al. Surgical Management of Traumatic Brain Injury

Author Group – „Surgical management of acute epidural haematomas“. Neurosurgery.

2006;58(3 Suppl):S7

2. W. A. van den Brink, M. Zwienenberg, S. M. Zandee. The Prognostic Importance of the Volume

of Traumatic Epidural and Subdural Haematomas Revisited. Acta Neurochirurgica, 1999. 141:

509±514

3. W. McBride MD, J. Biller MD, J. L. Wilterdink MD. Intracranial epidural hematoma in

adults. UpToDate Inc. 2011 Aug 17. 21.4 – C21.44

2. PROTHROMBIN COMPLEX CONCENTRATES INFLUENCE ON

COAGULATION DISORDERS

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Authors: Dominykas Dvylys, Petras Petkevičius, Erika Ruočkaitė

Intensive Care Department

Lithuanian University of Health Sciences, Lithuania

Supervisor of Scientific work: Prof. Vidas Pilvinis

INTRODUCTION

Prothrombin complex concentrates (PCCs) normalize levels of vitamin K dependent clotting

factors and re-establish homeostasis. PCCs contain II, VII, IX, X blood clotting factors in

addition to the vitamin K-dependent coagulation inhibitors protein C and protein S [1]. These

products provide a rapid and effective method for correcting clotting factor deficiency,

particularly in patients treated with vitamin K antagonists (VKAs) and liver dysfunction [2].

However the efficiency and dosage profile of prothrombin complex concentrates in each of the

pathologies are still unclear, especially in Lithuania, where PCCs have been used in recent years

only.

AIM

To determine the Prothrombin complex concentrates (PCCs) influence on coagulation disorders.

OBJECTIVES

1. To determine and compare coagulation meanings before Prothrombin complex

concentrates injection.

2. To determine and compare the efficiency of Prothrombin complex concentrates in

reversing coagulation disorders related with vitamin K antagonists overdose and liver

dysfunction.

3. To determine and compare the efficiency of different doses of Prothrombin complex

concentrates in reversing coagulation disorders related with vitamin K antagonists

overdose and liver dysfunction.

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METHODS

Retrospectively 52 cases of patients were selected who received PCCs therapy in LSMU Clinics

(32 cases) and the Republic Hospital of Panevezys (20 cases). From all the cases coagulograms

before and after PCCs injection (within 24 hours) were selected. 2 cases were rejected because

the 2nd coagulogram wasn’t done after the injection of PCCs within 24 hours. 2 cases were

rejected because after PCCs injection patients gained fresh frozen plasma and only then the 2nd

coagulogram was made. So out of 48 cases left, 37 (77%) were with overdose of VKAs, 11

(23%) were with liver dysfunction. Prothrombin Time (PT) and International Normalized Ratio

(INR) measures were used to determine the activity of PCCs. SPSS 21.0 was used for statistical

analysis. Nonparametric statistic methods were used for calculations (Mann-Whitney Test for 2

independent values or 2 related values). Data were considered statistically significant if value p <

0.05.

RESULTS

Out of 48 cases, 22 (45.8%) were female, 26 (54.2%) were male. Average age was 68.46 ± 12.64

years. Initial PT (PT1) and INR (INR1) between patients with VKAs overdose and liver

dysfunction were analysed. Initial PT mean was 18.6 ± 2.09 and initial INR mean was 3.91 ±

0.38 among patients with VKAs overdose. PT1 mean was 16.45 ± 2.66 and initial INR1 mean

was 3.89 ± 0.61 among patients with liver dysfunction. PT1 and INR1 were not significantly

different between VKAs overdose group and liver dysfunction group, p>0,05.

PT1 and INR1 were compared with PTs and INRs after the PCCs injection (PT2 and INR2). PT2

mean was 51.27 ± 3.46, INR2 mean was 1.52 ± 0.07 among patients with VKAs overdose. PT2

mean was 45.36 ± 7.6, INR2 mean was 2.17 ± 0.56 among patients with liver dysfunction. The

difference between PT1, INR1 and PT2, INR2 was statistically significant in both groups,

p<0,05.

Average dose of PCCs in VKAs overdose group was 1419 ± 109 IU, in liver dysfunction group

1591 ± 211 IU. Doses weren’t significantly different between both groups, p>0,05. The mean of

the difference between PT1 and PT2 was 32.67 ± 3.92 (delta PT), between INR1 and INR2 was

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2.38 ± 0.35 (delta INR) among patients with VKAs overdose. The mean of the difference

between PT1 and PT2 was 28.91 ± 7.58 (delta PT), between INR1 and INR2 was 1.73 ± 0.72

(delta INR) among patients with liver dysfunction. Doses of PCCs correlate significantly with

delta PT, p<0,05 (Spearman‘s correlation coefficient 0,343). However doses do not correlate

significantly with delta INR (p=0,084; Spearman‘s correlation coefficient 0,288) among patients

with VKAs overdose. Correlation between PCCs doses and delta PT, delta INR was not

significant among the patients with liver dysfunction.

CONCLUSIONS

1. There is no significant difference of PT1 and INR1 between VKAs overdose and liver

dysfunction groups.

2. PCCs have statistically significant efficiency for patients with both pathologies – VKAs

overdose and liver dysfunction. PCCs are more effective for patients with VKAs

overdose.

3. Doses were not statistically significant different in both groups. Higher PCCs doses for

patients with VKAs overdose have more effect on coagulation measures. However higher

doses of PCCs in liver dysfunction group were not more significantly effective than

lower one.

REFERENCES

1. Dentali F., Pierfranceschi M. G., Crowther M., Garcia D., Hylek E., Witt D. M., et al.

Safety of Prothrombin complex concentrates for rapid anticoagulation reversal of vitamin

K antagonists. A meta-analysis, Thrombosis and Haemostasis, Schattauer. 2011 Jul,

p.429-436.

2. S Schick K., Fertmann J. M., Jauch K. W., Hoffmann J N. Prothrombin complex

concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal

and treatment of severe bleeding. Department of Surgery, University of Munich. Critical

Care 2009 30 Nov. Available from: http://ccforum.com/content/13/6/R191

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3. THE INFLUENCE OF PERIOPERATIVE HEMODYNAMIC

FACTORS ON RECIPIENTS RENAL GRAFT FUNCTION

Authors: Akvilina Jacunskaitė, Vytautė Kadusauskaitė

Supervisor of the abstract: N. Balčiūnienė MD, PhD, A. Macas MD, PhD, Assoc. Prof.

INTRODUCTION

Despite substantial progress in renal transplant surgery, the risk of perioperative complications

remains.About 25% of all kidney recipients suffer from postoperative delayed graft function,

needing renal replacement therapy, resulting in an increase in mortality of 40%. The quality and

efficient function of the transplanted kidney are determined by many factors that can disrupt

graft function. One of the most important factors of adequate organ function is perfusion. Several

studies over the last 30 years have indicated that the hemodynamic status of the recipient during

kidney transplantation relates to graft function. Therefore diagnosis of these factors in kidney

recipients is important.

AIM

To evaluate the influence of perioperative hemodynamic factors on renal graft function.

OBJECTIVES

1. To evaluate and identify which hemodynamic factors influence the immediate graft

function most.

2. To analyse the impact of perioperative infusion therapy for immediate graft function.

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METHODS

This retrospective study included 95 adult patients who underwent kidney transplantations in

LUHS Kaunas Clinic from 2009 to 2012. 102 transplantations were performed during this period

of time. The kidneys were retrieved from multiorgan brain dead donors, who were treated at

Neurosurgery intensive care unit in LUHS Kaunas Clinic. Based on the function of the kidneys

posttransplantation, all 95 recipients were divided into 2 groups: A) patients with immediate

graft function (IGF), B) patients with delayed graft function (DGF). IGF was defined as there

was no need for dialysis and/or when creatine level was reduced by half during the first week as

compared to the value before transplantation. DGF was defined as the need for dialysis and/or

when creatine level was not reduced by half during the first week after renal transplantation. The

examined perioperative hemodynamic factors were central venous pressure (CVP); systolic,

diastolic, and mean arterial blood pressure (MAP) were recorded at surgery start time, at graft

reperfusion and at awakening. MAP was calculated using the formula: diastolic pressure - 1/3

(systolic pressure - diastolic pressure). The following were also recorded: the amount of

crystalloid, colloid infusions, the use of dopamine, antihypertensive therapy, and urine output.

IGF and DGF recipient groups were compared according to mentioned criteria. Statistical

analysis was performed using SPSS 20.0 programme. Categorical variables were compared using

chi-square (χ2) and continuous variables, the Student t test. Multiple regression analysis is shown

as parameter estimates standard errors, and corresponding P values with P < 0, 05 indicating

statistical significance.

RESULTS

The mean age of 95 patients was 46±1,181 years. Of 95 recipients, 42 (44%) experienced DGF

and 53 (56%) had IGF. Lower CVP before the surgery did not make influence on IGF: in group

A mean CVP before the surgery was 7,4±0,658 cmH2O (n=36), in group B - 9.4±0,742 cmH2O

(n=26), p=0,053. In group A, mean CVP at the time of renal graft reperfusion was 11,5±1,203

cmH2O (p=0,454) and at the time of awakening - 11,3±0,801 cmH2O, p=0,853. There was 2,7

greater risk of IGF among the group with CVP <9,5 cmH2O at surgery start time, p=0,045.

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Systolic, diastolic and MAP did not make influence on IGF at the surgery start time, the time of

renal graft reperfusion and awakening. There was threefold greater risk of IGF among the group

with MAP <120 mmHg at surgery start time, p=0,017. There was 4,3 increase in risk of IGF with

systolic arterial blood pressure <121 mmHg at the time of renal graft reperfusion, p=0,008. There

was 2,6 greater risk of IGF among the group with MAP <106 mmHg at the time of awakening,

p=0,048. According to ROC curve we divided recipients into two groups: with infusion therapy

during operation <2800 ml (n=65) versus infusion therapy ≥2800 ml (n=30). There was no

significant relation between amount of infusion therapy administrated in IGF, p=0.121.

CONCLUSIONS

1. The followings were the risk factors of the IGF: CVP <9,5 cmH2O at surgery start

2. time, MAP <120 mmHg at surgery start time, systolic arterial blood pressure <121

mmHg at the time of renal graft reperfusion, MAP <106 mmHg at the time of awakening.

3. There was no significant relation between amount of infusion therapy and IGF.

REFERENCES

1. Bacchi G, Buscaroli A, Fusari M, et al. The influence of intraoperative central venous

pressure on delayed graft function in renal transplantation: A single-center

experience. Transplant Proceedings. 2010; 42:3387–3391.

2. Campos L, Parada B, Furriel F, Castelo D, et al. Do Intraoperative Hemodynamic Factors

of the Recipient Influence Renal Graft Function? Transplantation Proceedings. 2012;

44:1800-1803.

3. Schmid S, Jungwirth B. Anaesthesia for renal transplant surgery: an update. Eur J

Anaesthesiol. 2012; 29: 552- 558.

4. Zukowski M, Bohatyrewicz R, Krawczyk AA. Influence of selected factors on

occurrence of delayed kidney graft function: A multivariate analysis. Transplant

Proc. 2007; 39:2704–2706

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4. DELIRIUM: DIAGNOSTIC AND TREATMENT CHALLENGES

Authors: Zane Glazniece, Ruta Reca, Riga Stradins University, Faculty of Medicine

Suprevisor: Roberts Stasinskis, MD, Riga Stradins University

INTRODUCTION

Delirium is a common clinical syndrome characterised by disturbed consciousness, cognitive

function or perception (1-4). The occurance of delirium varies widely, but, when high-risk

populations are considered,such as the elderly and mechanically ventilated, delirium may occur

in up to 80% of ICU patients (5). It usually develops over 1–2 days. It is a serious condition that

is associated with poor outcomes. However, it can be prevented and treated if dealt with

urgently. Delirium is associated with increased time of hospitalization, increased costs, greater

risk, that after discharcing patient will be sent to care facility rather than home and greater risk

of death (3,4). Delirium can be hypoactive or hyperactive but some people show signs of both

(mixed). People with hyperactive delirium have heightened arousal and can be restless, agitated

and aggressive. People with hypoactive delirium become withdrawn, quiet and sleepy.

Hypoactive and mixed delirium can be more difficult to recognise (1,2). Althought delirium has

great influence on clinical outcome, it still often remains undiagnosed.

AIM

To analyse diagnostic criteria actually used for detection of delirium and association between

patient’s mental status and provided therapy.

OBJECTIVES

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1. To analyze medical records of patients, who were hospitalized in a toxicological and

sepsis unit and patients who later died, to find out what information is provided about

patient's mental status;

2. To determine whether there is a correlation between information about patients mental

status and provided therapy;

3. Translate Confusion Assessment Method (CAM) scale to adapt it for Latvia.

METHODS

A retrospective study. Was conducted and included data about 212 patients who had any of the

toxicologial diagnosis. Also there were acquired data about 45 patients who lately died. Data

were summarized and analyzed with SPSS software.

RESULTS

The delirium was diagnosed to 12 (4.6%) patients. But, when data about patients mental status

were observed, appeared, that clear consciousness had 88 (41.1%) of patients. In 7.5% of

histories there were no data about patiens mental state. Other patients (46.3%) had some delirium

criteria but didn't fulfil the diagnosis for delirium. Diagnose of delirium, correlates with usage of

haloperidol and benzodiazepines (0.551 and 0,402, p<0.05), but more significant correlation it

has with haloperidol usage. Some of diagnostic criteria for delirium were conneced with use of

bezodiazepines and haloperidol, even if there were no data about diagnosed delirium. Use of

benzodiazepines correlated with prolonged hospitalization time (0.335, p<0.05).

CONCLUSIONS

1. Delirium often remains undiagnosed;

2. The diagnostic difficulties are connected with the lack of unified criteria for evaluation of

patient's mental status in the whole hospital;

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3. Health professionals should avoid benzodiazepines in managing patient with delirium,

except for toxicological patients;

4. More attention should be paid to nonmedicamentous treatment of delirium and

managment of the risk factors.

REFERENCES

1. Adamis D., Sharma N., Whelanc P.J.P., Alastair J.D. Delirium scales: A review of

current evidence Macdonald. Aging & Mental Health, 2010 Jul; 14 (5); 543–555

2. Camus V., Burtin B., Simeone I., Schwed P., Gonthier R., Dubos G.. Factor analysis

supports the evidence of existing hyperactive and hypoactive subtypes of delirium.

International Journal of Geriatric Psychiatry. 2000 Apr; 15 (4); 313–316

3. Devlin J. W., Al-Qadhee N. S., Skrobik Y. Pharmacologic prevention and treatment of

delirium in critically ill and non-critically ill hospitalised patients. Best Practice &

Research Clinical Anaesthesiology. 2012 Sept; Pages 289–309

4. National Collaborating Centre for Acute and Chronic Conditions. Delirium: diagnosis,

prevention and management. London (UK): National Institute for Health and Clinical

Excellence (NICE); 2010 Jul.; (Clinical guideline; no. 103)

5. The DECCA (Delirium Epidemiology in Critical Care) Study Group. Delirium

epidemiology in critical care (DECCA): an international study. [Internet] Critical Care

2010 [Cited on 2012 Dec 27][About 7 lpp.]. Available from:

http://www.biomedcentral.com/content/pdf/cc9333.pdf

5. PERIOPERATIVE OPTIMIZATION OF FLUID STATUS BY

MINIMAL VOLUME LOADING TEST (MVLT) IMPROVES

OUTCOMES IN PATIENTS UNDERGOING ELECTIVE PRIMARY

TOTAL KNEE ARTHROPLASTY SURGERY

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Authors: Indrė Sakavičiūtė, Mantas Radzevičius, Aleksandras Briedis

Supervisor of the abstract: docent Audrius Andrijauskas

INTRODUCTION

Perioperative goal directed fluid therapy improves outcomes of treatment by individually

optimizing the fluid status (1). It implies a stepwise infusion of fluids for optimization of

circulation, but ignores changes in hydration status. Potentially it could save up to 860,000 lives

during high-risk surgery every year (2). The mini volume loading test (mVLT) was recently

proposed for evaluation and optimization of hydration status during goal directed protocols by

monitoring the advance of plasma dilution (3).

AIM

Aim of the study was to test the hypothesis that mVLT applied immediately before elective

primary total knee arthroplasty (TKA) surgery and 24 hours later improves outcomes.

OBJECTIVES

1. Apply perioperative mVLT in the intervention group, and use our institution’s standard

of care in the control group of TKA patients.

2. Determine outcomes of treatment: (a) postoperative mobilization evaluated by the timed

up and go (TUG) test, and (b) the day when the fit-to-discharge criteria are met.

3. Compare outcomes between intervention and control groups.

METHODS

Ethical approval N° 158200-9-071-22 was provided by Vilnius Regional Bioethics Committee

(Chairperson G.Andrulionis) on 2009-09-16. It was a prospective randomized open

interventional study. 47 patients scheduled for TKA were enrolled and randomized to either

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intervention (n=21) or control (n=26) groups. Intervention group received mVLT immediately

before anaesthesia induction and 24 hours later. The mVLT implied administration of mini fluid

challenges consisting of 5 mL·kg-1 bolus of acetated Ringer’s infused over 3–5 min followed by

5 min period without fluid. In each mVLT session, arterial and capillary plasma dilution

efficacies of consecutive mini fluid challenges were immediately calculated on a laptop

computer from bed-side measures of invasive arterial Hb (HemoCue) and noninvasive capillary

Hb (Masimo Radical-7) before the first bolus and after each of the 3 mini fluid challenges.

Minimization of capillary plasma dilution efficacy of a mini fluid challenge associated with

negative arterio-capillary plasma dilution efficacy difference were cut-off criteria to stop

infusing boluses and switch to maintenance infusion. Arterial line was also used for simultaneous

monitoring of deviations in cardiac stroke volume (LiDCOPlus). The cut-off criteria to stop

boluses was stroke volume decrease for >10%. During 24 hours between mVLT sessions

patients received fluid therapy on discretion of the physician routinely responsible for the

patients care. All patients were operated by the same lead surgeon and using the same technique.

Spinal anaesthesia and postoperative multimodal analgesia was managed by the same

anaesthesiologist using the same methodology. Postoperative rehabilitation program was the

standard used in this hospital. Control group patients received fluid therapy during the whole

study period on discretion of the physician routinely responsible for the patients care. Monitoring

of stroke volume and noninvasive measures of Hb were not applied for guiding the fluid therapy

in controls. Overall outcomes of treatment in both groups were evaluated by determining the day

when the fit-to-discharge criteria were met and monitoring the functional recovery - a degree of

postoperative mobilization evaluated by the timed up and go (TUG) test. Kaplan–Meier method

was used to calculate the discharge from hospital rate. The log-rank test was used to detect

differences in the time of discharge from hospital between groups. Statistical analysis was

performed using PASW (PASW Statistic 17, SPSS, IBM Corporation, NY).

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RESULTS

The protocol was part of the on-going larger inter-disciplinary study (4). 47 (40 females and 7

males) completed the study: intervention (n=21) or control (n=26) groups. Groups were

comparable in respect to age and weight.

1. Fit-to-discharge criteria were met significantly more rapidly in intervention group than in

controls (log-rank test, p < 0.01).

2. The functional recovery (TUG test) was better in intervention group than in control group

(log-rank test, p < 0.05).

CONCLUSIONS

Our hypothesis was confirmed. Patients who received optimization of fluid status by the

combined perioperative mVLT and GDT protocols met the criteria for discharge from the

hospital sooner than the controls, and their functional recovery was faster. The simultaneous use

of monitoring fluid responsiveness by haemodynamic parameters and plasma dilution allows for

a better detection of a time point when no more fluid should be given so as to prevent both -

circulation and tissues - from being overfilled. It encourages future research.

REFERENCES

1. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M (2008) A Rational

Approach to Perioperative Fluid Management. Anesthesiology 109:723-740.

2. Hamilton MA, Cecconi M, Rhodes A (2011) A systematic review and meta-analysis on

the use of preemptive hemodynamic intervention to improve postoperative outcomes in

moderate and high-risk surgical patients. Anesth Analg 112 (6):1392-1402.

3. Andrijauskas A, Svensen C, Ivaskevicius J, Porvaneckas N, Kvederas G, Marmaite U

(2012) Goal directed fluid therapy revised: indirect monitoring of interstitial fluid

accumulation during mini fluid challenges with crystalloids. The Open Conference

Proceedings Journal 3:42-51.

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4. Kvederas G, Porvaneckas N, Andrijauskas A, Svensen CH, Ivaskevicius J, Mazunaitis J,

Marmaite U, Andrijauskas P. A randomized double-blind clinical trial of tourniquet

application strategies for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc.

(in press) (Published online 28 September, 2012). DOI 10.1007/s00167-012-2221-1.

6. CORRELATION OF ALARM SYMPTOMS, PATIENTS‘ AGE AND

CLINICALLY SIGNIFICANT ENDOSCOPIC FINDINGS

Authors: Lina Mockutė, Sandra Rimšelytė, Saulius Sriuoginys

Department of Gastroenterology,

Medical Academy, Lithuanian University of Health Sciences

Supervisor of the abstract: Prof. G. Kiudelis, Prof. L. Jonaitis

INTRODUCTION

According to gastroenterologists’ guidelines, esophagogastroduodenoscopy (EGD) should be

performed for patients younger than 45 years old with dyspepsia and alarm symptoms (AS) or

patients older than 45 years old with or without alarm symptoms. Alarm symptoms that are

evaluated as an indication to perform EGD are: dysphagia, anaemia, icterus, fever, bleeding from

upper gastrointestinal tract, newly originated dyspepsia for patients over 45 years, weight loss of

unknown origin, recurrent vomiting.

AIM

The aim of this study was to evaluate the correlation of alarm symptoms, patients’ age and

clinically significant organic pathology found on upper endoscopy.

OBJECTIVES

1. To evaluate the incidence of alarm symptoms in different groups of age.

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2. To evaluate and compare the incidence of clinically significant organic pathology

between 2 groups of patients: younger than 45 years old without alarm symptoms (1’st

grp.) and older than 45 years old with or without alarm symptoms (2’nd grp.).

3. To evaluate the correlation between alarm symptoms and clinically significant organic

pathology found on EGD.

METHODS

1. A perspective study was held in 4 medical centers: in Hospital of Lithuanian University

of Health Sciences (HLUHS), in Kaunas Clinical Hospital, in Panevėžys Hospital and in

Alytus Hospital. The results of outpatient EGD were evaluated from September 2012 till

February 2013.

2. Comparing the overall rate of alarm symptoms manifestation, patients were divided

according to their age into two groups: younger than 45 years old (1’st grp.) and older

than 45 years old (2’nd grp.). Alarm symptoms that were evaluated as an indication to

perform EGD were: dysphagia, anaemia, icterus, fever, bleeding from upper

gastrointestinal tract, newly originated dyspepsia for patients over 45 years, weight loss

of unknown origin, recurrent vomiting.

3. To evaluate the incidence of clinically significant organic pathological findings between

different groups of individuals, patients were also divided into two groups: younger than

45 years old without alarm symptoms (1’st grp.) and older than 45 years old with or

without alarm symptoms (2’nd grp.). As an organic pathology, these findings were

considered: erosive esophagitis (EE) (grades: A, B, C, D), gastric ulcer, duodenal ulcer,

gastric polyp, suspected malignant tumor.

4. Data analysis was accomplished using the SPSS 21.0 program. The statistically

significant difference was considered to be, when p<0,05.

RESULTS

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Data were collected from 502 patients: in HLUHS- 99 (20%), in Kaunas Clinical Hospital- 100

(20%), in Panevėžys Hospital- 151 (30%), in Alytus Hospital- 152 (30%). The study included

204 (41%) males and 298 (59%) females. The mean age of the study sample was 55,6±16,7, the

mean age of men- 54,1±16,3, women- 56,6±16,9 years, p>0,05.

When analyzing the overall rate of alarm symptoms manifestation, alarm symptoms were found

in 22 (15%) of 148 individuals among patients aged less than 45 years and in 117 (33%) of 354

individuals among patients aged more than 45 years, p<0,05.

Clinically significant organic pathological findings in esophagus were diagnosed: among patients

aged less than 45 years without alarm symptoms (1’st grp.)- in 36 (26%) of 138 individuals (EE

A was found in 22 (16%) patients, EE B- in 12 (9%) patients, EE C- in 2 (1%) patients); among

patients aged more than 45 years with or without alarm symptoms (2’nd grp.)- in 81 (22%) of

364 individuals (EE A was found in 51 (14%) patients, EE B- in 25 (7%) patients, EE C- in 5

(1%) patients). There was no statistically significant difference between these groups, p>0,05.

Clinically significant organic pathological findings in stomach were diagnosed in 14 (10,1%)

patients of 138 in 1’st group (gastric ulcer was found in 3 (2,2%) patients, duodenal ulcer- in 9

(6,5%) patients, gastric polyp- in 2 (1,4%) patients, suspected malignant tumor- in 0 (0%)

patients). In 2’nd group, which consisted of 364 individuals, 51 (14%) patients had organic

pathological findings in stomach (gastric ulcer was found in 8 (2,2%) patients, duodenal ulcer- in

6 (1,6%) patients, gastric polyp- in 35 (9,6%) patients, suspected malignant tumor- 2 (0,5%)).

There was a statistically significant difference between these groups, p<0,05.

When analyzing the correlation between alarm symptoms and clinically significant organic

pathology found on EGD, 139 (28%) individuals presented with alarm symptoms and organic

pathology was found in 56 (40,3%) of them; 363 (72%) individuals did not present with alarm

symptoms and organic pathology was found in 131 (36,1%) of these patients. There was no

statistically significant correlation between clinically significant organic pathology and alarm

symptoms, p>0,05.

CONCLUSIONS

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1. Alarm symptoms manifest statistically significantly more often among patients over 45

years.

2. There is no significant difference in the rate of clinically significant organic pathology

found in esophagus between patients younger than 45 years old without alarm symptoms

and older than 45 years old with or without alarm symptoms.

3. Patients older than 45 years with or without alarm symptoms are more often diagnosed

with clinically significant organic pathology in the stomach.

4. Alarm symptoms do not predict clinically significant organic pathology.

REFERENCES

1. Vakil N, Moayyedi P, Fennerty MB, Talley NJ. Limited Value of Alarm Features in the

Diagnosis of Upper Gastrointestinal Malignancy: Systematic Review and Meta-analysis.

Gastroenterology. 2006; 131: 390–401.

7. THE EFFICIENCY OF POSTOPERTATIVE PAIN CONTROL

USING EPIDURAL ANALGESIA

Authors: Artūras Kalniūnas, Sandra Ramanavičiūtė, Erika Ruočkaitė

Anesthesiology Clinic, Lithuanian University of Health Sciences, Lithuania

Supervisor of the abstract: Docent, MD, Aurika Karbonskienė

INTRODUCTION

Epidural analgesia is one of the most effective method to manage postoperative pain. We can

achieve improved early rehabilitation results by using this method postoperatively. Appropriate

care for epidural catheters is important for effective epidural analgesia.

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AIM

To evaluate the efficiency of postoperative pain control using epidural analgesia.

OBJECTIVES

1. To evaluate the efficiency of postoperative pain control using epidural analgesia

assessing pain intensity and requirements of rescue analgesic medications.

2. To evaluate patients’ postoperative mobility and its influence on the dislodgement

of epidural catheter.

3. To evaluate the patients’ requirements for analgesics during their increasing

mobility.

METHODS

Patients who received postoperative epidural analgesia during one month period (07-01-2013 –

07-02-2013) at the departments of Traumatology-Orthopaedics and Surgery (Hospital of LUHS

Kaunas Clinics) were included in the study. The patients were observed during all period of

epidural analgesia delivery. 89 patients were visited daily and postoperative mobility, motor

block (Bromage score), pain intensity by Visual Analog Scale (VAS), requirements of rescue

analgesic were assessed. The statistical analysis was performed by using SPSS 17.0 and

Microsoft Office Excel. Data are presented as means, medians (were appropriate), proportions as

percentages, standard deviations, frequencies. χ2 test was used to check significant association

between variables. P level of significance was p<0,05

RESULTS

The average age of patients was 69,00±13,13 years, average BMI 28,59±6,19 kg/m². Lumbar

epidural catheter was inserted in 91% of patients, thoracic epidural - 9% of patients. Spinal-

epidural anesthesia was performed in 92,1% of patients, general anesthesia and epidural

analgesia - 7,9% of patients. Duration of epidural analgesia was planned for three postoperative

days in 49,4% of patients, four days - 50,6% of patients. Mean pain score (VAS) on the first day

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- 1,86 ±2,44, second day – 1,36±2,37, third day – 1,97±2,67, fourth day – 1,75±2,5. There was

no statistically significant difference between pain scores in those 4 days. Rescue analgesics

(RA) were requested by 60,67% of patients during first postoperative day, 39,77% - during

second day, 38,46% - during third day, 22,22% - during fourth day.

Patients were divided into three groups according postoperative mobility: group 1 (lying in bed

during all period of observation), group 2 (moving within limits of bed: sitting up, turning from

side to side), group 3 (getting out of bed on the second postoperative day and walking). Catheter

was taken out timely in 100% of patients in group 1. No dislodgement of catheter or preterm

removal of it was observed in this group. Group 1 showed no requirement for RA in 39,53% of

patients during first postoperative day and 42,86% during second postoperative day. Catheter

was removed timely in 65,4% of patients in group 2. Catheter dislodgement was observed in

11,5%, preterm removal due to difficult management of blockage in 7,7%, due to ineffective

blockage in 3,9%, post-term removal in 11,5% of patients in this group. Group 2 showed no

requirement for RA in 33,33% of patients during first postoperative day and 59,7% during

second postoperative day. Catheter was removed timely in 84% of patients in group 3. Catheter

dislodgement was observed in 14%, post-term removal in 2% of patients of this group. Group 3

showed no requirement for RA during second postoperative day. There was a statistically

significant difference in requirements of rescue analgesics between group 1 and 2 on first and

second day, p<0,05.

CONCLUSIONS

1. Pain intensity remains unvaried during whole postoperative period in patients with

epidural analgesia. Rescue analgesic requirements are getting lower with

2. Preterm dislodgement of epidural catheters is increased with increasing postoperative

mobility.

3. Rescue analgesic requirements are higher in patients with increased mobility during first

day and it is becoming lower during second day of epidural analgesia.

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REFERENCES

1. Competency in managing care in epidural analgesia. Bird A, Allcock N, Cooper J. Nurs

Times. 2013 Feb 5-11;109(5):18-20.

2. Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and

management. Br J Anaesth. 2012 Aug;109(2):144-54.

BASIC SCIENCES AND PHARMACOLOGY SECTION

1. COMPARISON OF MULTIVARIATE ANALYSIS BASED METHODS FOR

DETECTION OF ECG T-WAVE ALTERNANS

Author: Solventa Krakauskaitė

Institute of Biomedical Engineering, Kaunas University of Technology

Robertas Petrolis

Neuroscience Institute, Lithuanian University of Health Sciences

Renata Šimoliūnienė

Dept. Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences

Supervisor of the abstract: Algimantas Kriščiukaitis

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Dept. Physics, Mathematics and Biophysics, Neuroscience Institute, Lithuanian University of

Health Sciences

INTRODUCTION

ECG T-Wave Alternans (TWA) is reported to be a reliable predictor of ventricular sudden

cardiac death [1], so detection and evaluation of it could reveal a new possibilities for the

clinicians. Numerous methods for detection of and evaluation of non-visible TWA in the

microvolt range are elaborated over the last two decades, however, their results sometimes are

controversial. Multivariate methods despite their need for comparatively high computational

resources reported as giving promissing results, while testing on simulated signals and specially

selected recordings.

AIM

To test and compare results of two multivariate analysis methods based on Principal Component

Analysis (PCA) and Periodic Component Analysis (πCA) for detection and evaluation of T-wave

alternans analyzing synthetic and clinical recordings.

METHODS

1. Periodic Component Analysis was performed using modified method, elaborated on the basis

of described in [2] with additional data pre-processing – time stretching procedure to

normalize in duration analyzed ST-T intervals. Every ordinary QRS-T,T interval was aligned

with the others using bi-cubic spline interpolation, maximizing cross-correlation with the

template, constructed from the first 10 cardio cycles. The method constructs the

transformation:

kTT

k Xwy '' = , (1)

which maximizes periodicity of the analyzed signal at the TWA frequency – 0,5 cycles per

beat. Such measure of periodicity is ratio of squared differences between original sequence of

concatenated S-T,T segments y’k and one cardio cycle right shifted same sequence y’k+m:

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∑∑

−

=

−

= + −= 1

0

2

1

0

2

'

''),( K

k k

K

k kmk

y

yymwε . (2)

As estimate of TWA we used energy of the signal represented in first row of constructed

transformation XY TΨ= , where Ψ is the generalized eigenvector matrix of original sequence

of concatenated S-T,T segments y’k and one cardio cycle right shifted same sequence y’k+m.

2. Principal Component Analysis was performed using algorithm, elaborated during our

previous investigations described in [3], which analyzes extracted and time-normalized S-

T,T segments ensemble after the same time stretching procedure as used in πCA case. The

PCA transforms the original data set into a new set of vectors (the principal components)

which are uncorrelated and each of them involves information represented by several

interrelated variables in the original set. Every vector xi representing ordinary ST-T

complex is then represented by linear combination of the principal components fk

multiplied by coefficients wi,k:

∑=

=p

kkkii w

1, ϕx . (3)

Variation of coefficients wi,k represents variation in shape of S-T,T complexes. Method

uses normalized estimate of power spectral density of the coefficients w at the highest

frequency.

3. Data sets. Firstly, the methods were performed using synthetic ECG with added TWA.

The signal consisted of 10 generated cardio cycles in 6 leads. T-wave alternans and

random noise was added according to the recommendations described in [2]. Each ST-T

complex was modeled as:

x!,! n = s! n + !!a! n ∙ -­‐1

!+ v!,! n  ,

= 0,…   ,𝑁 − 1 , (4)

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where 𝑠! 𝑛 is the background ST-T complex, which is periodically repeated in each beat,

𝑎! 𝑛 is the alternans waveform, and 𝑣!,! 𝑛 is additive random noise.

Secondly, the methods were tested using clinical recordings from subjects with risk factors

for sudden cardiac death as well as healthy controls, lasting approximately 2 minutes,

which we took from “PhysioNet/Computers in Cardiology Challenge 2008” Databank

(www.physionet.org/challenge).

RESULTS

1. PCA and πCA were giving congruous results when analyzing the synthetic signals. Our results

analyzing recordings from “St. Petersburg Inst. of Cardiol. Technics 12-lead Arrhythmia

Database” by means of PCA comply with the reference ranks showing significant Kendall tau

rank correlation coefficient 0.592 (p=0.036). The results obtained by means of πCA did not

show significant correlation. TWA episodes were mostly expected in “Sudden Cardiac Death

Holter Database”. Six out of 10 recordings have significant reference rank given by

PhysioNet. Results of PCA method showed TWA positive results in 8 out of 10 recordings.

πCA method did not show any significant results, because of limited amount of leads in the

recordings.

2. Both methods not only detected the TWA phenomena, but also revealed morphological

features of alternans in shape of S-T,T segment of the synthetic ECG signals. Only PCA

showed significant results on clinical recordings.

CONCLUSIONS

1. Multivariate analysis based method PCA gave significant results in detection of TWA in

clinical recordings while compared with reference ranks from PhysioNet database.

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2. Both methods could be used for monitoring of heart activity in severe cardiac situations and

ordinary examinations collecting morphological features of the signal for future

investigations.

REFERENCES

Ikeda T, Saito H, Tanno K, et al. T-wave alternans as a predictor for sudden cardiac death after

myocardial infarction. Am J Cardiol. 2002;89: 79–82.

V. Monasterio, G.D. Clifford, P. Laguna, J. P. Martinez, Annals of Biomedical Engineering, Vol.

38, No. 8, August 2010 A Multilead Scheme Based on Periodic Component Analysis for T-

Wave Alternans Analysis in the ECG pp. 2532–2541.

R. Simoliuniene, A. Krisciukaitis, A. Macas, G. Baksyte, V. Saferis, R. Zaliunas. Principal

Component Analysis Based Method for Detection and Evaluation of ECG T-Wave Alternans.

Computers in Cardiology 2008, vol. 1-2, p. 757-760.

2. SYNTHESIS AND EVALUATION OF IN VITRO ACTIVITY OF 4-

THIAZOLIDINONE COMPOUNDS AGAINST HL-60 LYMPHOMA

CELLS

Authors: Jonas Salys, Liudas Šlepikas, Eduardas Tarasevičius, Liudas Ivanauskas, Valdas

Jakštas, Mindaugas Marksa, Hiliaras Rodovičius, Jūratė Savickienė

Lithuanian University of Health Sciences, Pharmacy Faculty, Department of Drug Chemistry,

A.Mickevičiaus 9, LT 44307 Kaunas, Lithuania

Lithuanian University of Health Sciences, Pharmacy Faculty, Department of Analitical and

Toxicological Chemistry, A.Mickevičiaus 9, LT 44307 Kaunas, Lithuania

Vilnius University, Institute of Biochemistry, Department of Molecular Cell Biology,

Mokslininkų 12, Vilnius, LT 08662, Lithuania

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Supervisor of the abstract: Jonas Salys

INTRODUCTION

Recent data shows that 4-thiazolidinones possessing a variety of biological effects such as

antifungal, antibacterial, antiviral, anti-inflammatory, antidiabetic. It also has been a favorable

scaffold for developing novel anticancer compounds. Proto-oncogene serine/threonine-protein

kinase (Pim-1), necrostatin-7, B-cell lymphoma 2 (Bcl-2) are promising targets of 4-

thiazolidinones for an anticancer therapeutics. Unfortunately, neither of the 4-thiazolidinone

compounds, possessing an anticancer activity, undergoes clinical trials.

AIM

To investigate how structure modifications affects an anticancer activity in vitro.

OBJECTIVES

1. To synthesize 4-thiazolidinone compounds bearing substituents in 5 and 2 positions.

2. To investigate their anticancer activity against promyelocytic leukemia HL-60 cells.

METHODS

Synthesis. Modifications of a 4-thiazolidinone ring were performed in a 5 position by the

Knoevenagel condensation reaction. To modify a 2 position a nucleophilic substitution reaction

performed, previously incorporating a good leaving group to the 4-thiazolidinone ring. Thin

layer chromatography (TLC) was used to monitor a progress of reaction. Purity of compounds

were analyzed using a high performance liquid chromatography (HPLC). Structures of

compounds were determined using an IR spectroscopy.

Cell culture experiments. The human promyelocytic leukemia HL-60 cells were cultured in a

RPMI 1640 medium supplemented with 10% fetal bovine serum, 100 U/mL penicillin and 100

µg/mL streptomycin (Gibco, Grand Island, NY) at 37°C in a humidified 5% CO2 atmosphere. In

each experiment, logarithmically growing cells were seeded in 4 mL of medium at a density 5 x

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105 cells/mL. Cell survival was assessed by the trypan blue exclusion test. Viable and dead (blue

coloured) cells were counted in a haemocytometer.

RESULTS

All synthesized compounds were greater than 90% pure. Synthesized compounds TSS-1, TSS-3

and TSS-4 inhibited cell growth at a concentration of 50 µM. However TSS-2 and TSS-5 did not

affect cell growth at the 50 µM concentration.

CONCLUSIONS

4-thiazolidinones is a privileged scaffold for drug discovery due to ease and vast possibility of

modifications in 5, 3, 2 positions. More than 60 percent of our synthesized compounds possessed

a micromolar range activity. In this work we used modifications that give possible trends for

further development of compounds with an increased activity.

3. MORPHOLOGICAL CHARACTERISTICS OF THE BLOOD

VESSEL IN THE ATRIOVENTRICULAR NODE AND BUNDLE OF

HIS

Author: Saule Kiaunyte

Supervisor of the abstract: dr. Kristina Rysevaite

INTRODUCTION

Atrioventricular node (AVN) and bundle of His are structures of the conduction system of the

heart. AVN receives heartbeat impulses from the sinoatrial node (SAN) and directs them to the

bundle of His. The areas contain numerous ChAT (choline acetyltransferase) and TH (tyrosine

hydroxylase) positive nerve bundles and fibers [1]. Thus, it is important to understand how the

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structures are supplied with blood. According to the recent research, the classic anatomic concept

is that the atrioventricular nodal artery, also known as the septal branch of the left coronary

artery, is the main vessel supplying the AVN [2]. However, considering the pattern of the blood

vessel, morphological characteristics and the septal branch of the left coronary artery wall

innervation, the more accurate information is needed, especially seeking to find out how exactly

these areas are supplied with blood. The knowledge may also be applied during complicated

heart operations.

AIM

The study was aimed to determine the position, morphological peculiarities and innervation of

septal branch of the left coronary artery that supplies blood to the mouse atrioventricular node

and bundle of His.

OBJECTIVES

1. To examine the morphological characteristics of the septal branch of the left coronary artery

in the areas of atrioventricular node and bundle of His.

2. To analyse the following branching of the examined septal branch of the left coronary artery.

3. To examine chemical phenotype of nerve fibers that are anatomically linked with the mouse

blood vessel of the atrioventricular node and bundle of His.

METHODS

During the research 13 C57BL/6J genetic line mouse hearts were used. 6 of them were used for

immunohistochemical analysis, performing reactions using primary antibodies against

cholinergic (choline acetyltransferase, ChAT), adrenergic (tyrosine hydroxylase, TH) markers

and for alpha smooth muscle actin expression. 7 hearts were used to make the preparation with

gelatin, using Karnovsky and Roots’ (1964) [3] (AChE) acetylcholinesterase histochemical

method for nerve fibers identification. Hearts that were prepared with gelatin were examined

using stereo microscope Stemi 200 CS (Carl Zeiss, Germany). The preparations that were made

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applying immunohistochemical method were examined and their images were acquired by

AxioImager Z1 fluorescence microscope with Apotome (Carl Zeiss, Germany). As the images

were compared, the general scheme of the examined blood vessel was acquired using WACOM

digital drawing tablet.

RESULTS

The results showed that (1) the blood vessel of all the examined mice hearts is the septal branch

of the left coronary artery, leading through the atrioventricular node and bundle of His, dividing

into smaller branches until it reaches Purkinje fibers; (2) the examined septal branch has 4 major

branches: A, B, C and D. The branch A leads through the whole atrioventricular node, dividing

into three smaller branches: a, b and c. The branch a is divided into 2, the branch b is divided

into 6 and the branch c is divided into 7 smaller branches. The branch B is the smallest and is

divided into 2 branches. The branches C and D lead together with His bundle, the branch C is

divided into 6, while the branch D is divided into 3 smaller branches; (3) the examined septal

branch of the left coronary artery wall is innervated by adrenergic and cholinergic nerve fibers.

CONCLUSIONS

The septal branch of the left coronary artery leads through the areas of atrioventricular node and

bundle of His, dividing into 4 major branches: A, B, C and D. The blood vessel wall is

innervated by adrenergic and cholinergic fibers. Having completed the research, the conclusion

may be drawn that the blood vessel supplies blood to the mentioned areas and thus also helps to

supply the areas through which the impulses from SAN lead to the heart ventricles and the apex

of the heart.

REFERENCES

[1] Pauza D.H., Saburkina I., Rysevaite K., Inokaitis H., Jokubauskas M., Jalife J., Pauziene N.

Neuroanatomy of the murine cardiac conduction system, Auton. Neurosci. 2013, 12.

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[2] Saremi F., Abolhoda A., Ashikyan O., Milliken J.C., Narula J., Gurudevan S.V., Kaushal K.,

Raney A. Arterial Supply to Sinuatrial and Atrioventricular Nodes: Imaging with Multidetector

CT. Radiology, 2008, 246: 106.

[3] Karnovsky M.J., Roots L. A "Direct-Coloring" Thiocholine Method for cholinesterases.

Journal of Histochemistry and Cytochemistry, 1964, 12: 219-21.

4. CYTOTOXICITY AND ANTIOXIDANT ACTIVITY OF LECTIN-

ENRICHED PROTEIN FRACTION FROM HERB OF URTICA

DIOICA L

Author: Rasa Staršelskytė

Department of Pharmacognosy, Medical Academy, Lithuanian University of Health Sciences

Department of Physiology and Pharmacology, Sapienza University of Rome

Supervisors of the abstract: Prof. Nijolė Savickienė, Dr. Annabella Vitalone, Prof. Gabriela

Mazzanti, Dr. Antonella Di Sotto

INTRODUCTION

Plant lectins are non-enzymic and non-immune origin proteins that specifically recognize and

bind to various sugar structures and possess the activity to agglutinate cells and/or precipitate

polysaccharides and glycoconjugates. The emerging evidences showed that plant lectins

contribute not only to tumour cell recognition but also to cell adhesion and localization, to signal

transduction, to mitogenic cytotoxicity and apoptosis.

AIM

Evaluation of cytotoxicity and antioxidant activity of lectin-enriched protein fraction from

Urtica dioica L. herb.

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OBJECTIVES

1.To determine cytotoxicity of lectin-enriched protein fraction by the tetrazolium dye (MTT)

colorimetric assay.

2.To evaluate antioxidant activity of lectin-enriched protein fraction against ABTS-free radical

and superoxide-radical.

METHODS

1. Lectin-enriched protein fraction was obtained from the herb of Urtica dioica L by using

homogenisation with fluid nitrogen, extraction in 0.01 M phosphate-buffer saline (PBS),

concentrating, salting and precipitation.

2. Cytotoxicity was determined by the tetrazolium dye (MTT) colorimetric assay in HepG2

human hepatoblastoma cell line.

3. The antioxidant activity was evaluated by ABTS-free radical scavenging activity test

and superoxide-radical scavenger assay.

RESULTS

1. Lectin-enriched protein fraction did not display any significant reduction in the cell viability

of HepG2 cells, neither after 24 h nor after 48 h of treatment.

2. The inhibition of the ABTS radical and the superoxide anion was concentration-dependent and

reached 93.8% scavenger activity at 120 µg/ml, 90.2% scavenger activity at 400 µg/ml,

respectively.

CONCLUSIONS

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1. Lectin-enriched protein fraction did not inhibited the cell proliferation in tumour hepatic

HepG2 cells.

2. Lectin-enriched protein fraction exhibited a remarkable scavenger activity against ABTS

radical and superoxide anion.

REFERENCES

1. Goldstein IJ,Hughes RC, Monsigny M, Osawa T, Sharon N. What should be called a

lectin? Nature. 1980; 285:66.

2. Kim DO, Lee KW, Lee HJ, Lee CY. Vitamin C equivalent antioxidant capacity

(VCEAC) of phenolic phytochemicals. J Agric Food Chem. 2002; 50(13):3713-7.

3. Lis H, Sharon N. Lectins: Carbohydrate-SpecificProteins That Mediate Cellular

Recognition. Chem Rev. 1998; 98(2):637-674.

4. Verma N, Behera BC, Makhija U. Antioxidant and hepatoprotective activity of a lichen

Usnea ghattensis in vitro. Appl Biochem Biotechnol. 2008; 151(2-3):167-81.

5. Vitalone A, Di Giacomo S, Di Sotto A, Franchitto A, Mammola CL, Mariani P,

Mastrangelo S, Mazzanti G. Cassia angustifolia extract is not hepatotoxic in an in vitro

and in vivo study. Pharmacology. 2011; 88(5-6):252-9.

6. Wong BW, Luk JM, Ng IO, Hu MY, Liu KD, Fan ST. Identification of liver-intestine

cadherin in hepatocellular carcinoma--a potential disease marker. Biochem Biophys Res

Commun. 2003; 311(3):618-24.

5. ANTIBACTERIAL ACTIVITY OF LECTIN ENRICHED

FRACTIONS FROM URTICA DIOICA L. HERB AND DRY

EXTRACT

Author: Gabrielė Balčiūnaitė

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Supervisor of the abstract: Prof. Dr. Nijolė Savickienė, Prof. Habil. Dr. A. Pavilonis

INTRODUCTION

Plant lectins are a class of carbohydrate-binding nonimmune origin proteins. In past few decades

a lot of lectins were purified and identifiend (Goldstein et al., 1980; Sharon, 1989; Peumans et al,

2001; de Meija et al., 2003). They have attracted great interest because of their various biological

activities, such as cell agglutination, antiproliferative, antitumor, immunomodulatory, antifungal

and antiviral (Broekaert et al.,1989; Wang et al.,1996; Does et al., 1999; Ye et al., 2001; Wong et

al., 2003; Singh et al., 2004).

There is theoretical possibility for lectins to be applied in diagnostic microbiology. There are a

lot of structures on bacteria surface (peptidoglycans, teichoic acids, lipopolysaccharides, capsule)

that could be specifically binded by lectins. There are a lot of reports of the uses of lectins in

diagnostic microbiology. However, this method is still very expensive (Sifkin et al, 1990; Santi-

Gadelha et al, 2006).

Even though several lectins have the same specificities, it does not means that each of them will

interact with microbial surfaces. It depends on combination of factors such as hydrophobicity.

There are a lot of trials on lectin antibacterial activity, but results are ambiguous (Gomes et al,

2010; Kumakia et al, 2011).

There are earlier reports about Urtica dioica L. rhizome lectins antiviral (Kumakia et al, 2011),

antifungal (Broekaert et al, 1989) and immunomodulatory (Le Moal et al, 1992) properties.

However, antibacterial properties are still unspecified.

AIM

To evaluate the antibacterial activity of lectin enriched protein fractions from Urtica dioica L.

dry and fresh herb and dry extract.

OBJECTIVES

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To evaluate the antibacterial activity of lectin enriched protein fractions from Urtica dioica L.

dry and fresh herb and dry extract to Staphylococcus aureus, Bacillus cereus (Gr+ bacteria),

Escherichia coli, Pseudomonas aeruginosa (Gr- bacteria), Klebsiella (capsular bacteria),

Candida (fungi).

METHODS

1. Lectin-enriched protein fraction was obtained from the dry and fresh herb and dry extract from

Urtica dioica L., (DER: (5-10:1), extraction solvent: water) imported from Poland. Liquid

extract from fresh and dry Urtica dioica L. herb extracted with 0,01 M phosphate-buffer saline

(PBS) and fractonated with Ammonium Sulphate. Dry extract of Urtica dioica L. mixed with

PBS and fractionated in the same way.

2. Bacteria suspensions were standartised with McFahrad standard indicator, mixed with Mueler-

Hinton agar and poured to petri dishes;

3. Extracts were poured in to Peni cylinders, standing on petri dishes with solid Mueler-Hinton

agar mixed with bacteria suspentions;

4. Bacteria were cultivated for 24 hours in 37 ̊C temperature;

5. Antibacterial activity was evaluated by measuring diameter of bacteria growth inhibition area.

RESULTS

After 24 hours of bacteria cultivation bacteria growth was inhibited only in Peni cylinder

diameter and no more.

CONCLUSIONS

No antibacterial activity were found of Urtica dioica L. dry and fresh herb and dry extract lectin

enriched protein fractions.

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REFERENCES

1. Broekaert WF, Parijis JV, Leyns F, Joos H, Peumans WJ. Science. 1989; 245 1100–1102.

2. Goldstein IJ, Hughes RC, Monsigny M, Osawa T, Sharon N, What should be called a lectin?

Nature, 1980; 285: 66;

3. Ye XY, Ng TB, Tsang PWK, Wang J. Purification of chrysancorin, a novel antifungal protein

with mitogenic activity from garland chrysanthemum seeds. Biol Chem. 2001

Jun;382(6):947-51.

4. Kumakia Y, Wanderseea M. K., Smitha A. J., Zhoub Y, Simmonsb G, Nelsona N. M.,

Baileya K. W., Vesta Z. G., Lid J. K.-K., Chane P. K. S., Smeea D. F., Barnarda D. L.

Inhibition of severe acute respiratory syndrome coronavirus replication in a lethal SARS-CoV

BALB/c mouse model by stinging nettle lectin, Urtica dioica agglutinin; Elsevier, Antiviral

Research. April 2011; 90(1): 22–32;

5. Le Moal, M.A., Colle, J.H., Galelli, A. & Truffa-Bachi, P. Mouse lymphocyte-T activation by

Urtica dioicaagglutinin.1. Delineation of 2 lymphocyte subsets. Res. Immunol. 1992; 143 ,

691-700;

6. Meija EG, Bradford T, HasleR C. The anticarcinogenic potential of soybean lectin and

lunasin. Nutr Rev. 2003; 61:239-46;

7. Peumans WJ, Van Damme EJ, Barre A, Rouge P, Classification of plant lectins in families of

structurally and evolutionary related proteins, Adv. Exp. Med. Biol. 2001; 491: 27–54;

8. Santi-Gadelha, T., de Almeida Gadelha, C.A., Aragão, K.S., Oliveira, C.C., Mota, M.R.L.,

Gomes, R.C., Pires, A.F., Toyama, M.H., Toyama, D.O., Alencar , N.M.N., Criddle, D.N.,

Assreuy, A.M.S., Cavada, B.S., Purifi cation and biological effects of Araucaria angustifolia

(Araucariaceae) seed lectin. Biochem. Biophys. Res. Commun. 2006; 350, 1050–1055.;

9. Sharon N, Lis H. Lectins as a recognition molecules. Sciene, 1989 246:227-34.

10. Slifkin M., Doyle L. Lectins and Their Application to Clinical Microbiology; Clin Microbiol

Rev. 1990 July; 3(3): 197–218

11. Wang HX, Liu WZ, Ng TB, Ooi VEC, Chang ST. The immunomodulatory and antitumor

activit ies of lectins from the mushroom Tricholoma mongolicum . Immunopharmacology.

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1996; 31, 205-211.

12. Wong JH, Ng TB. Purification of a trypsin-stable lectin with antiproliferative and HIV-1

reverse transcriptase inhibitoryactivity. Biochem. Biophys. Res. Commun. 2003: 301: 545–

550;

13. Xia B, Kawar ZS, Ju T, Alvarez RA, Sachdev GP, Cummings RD, Versatile X uorescent

derivatization of glycans for glycomic analysis. Nat Methods. 2005; 2:845–850.

6. PRODUCTION AND TESTING OF ANTI-ERBB2 F(AB’)2-S

Author: Gábor Tóth

Supervisor of the abstract: György Vereb, MD, Ph.D

INTRODUCTION

Trastuzumab, a humanized anti-ErbB2 antibody is a specific targeted therapy against ErbB2

positive tumors, with a history of both success and a high rate of therapy resistance. Another

humanized antibody, pertuzumab inhibits ErbB2 heterodimerization. While these antibodies

have been developed based on the in vitro direct cellular effect of their mouse parent antibodies,

there is the possibility that their in vivo mechanism of action could be quite different, such as

antibody dependent cellular cytotoxicity (ADCC) exerted by NK cells.

AIM

Our goal was to ascertain the extent of contribution of the direct cellular effect of the antibodies

and that of the in vivo evoked ADCC to tumor growth inhibition. To eliminate the ADCC

component, we needed to generate the F(ab’)2 fragments of the antibodies lacking the Fc part.

Consecutively, we aimed to compare these fragments to the intact IgG antibodies in terms of

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their binding to the target epitope, ability to generate direct cellular effects, and ability to mediate

ADCC in vitro.

OBJECTIVES

1.To produce F(ab’)2 fragments from the trastuzumab and pertuzumab IgG antibodies

2.To separate the F(ab’)2-s from the IgG antibodies

3.To verify that we obtained the expected bivalent fragments that only differ in the lack of Fc

chain from the parent IgG

4.To assess the effect of the therapeutic agents alone and in combination on in vitro tumor cell

proliferation.

5.To assess the effect of pertuzumab and pertuzumab F(ab’)2 on ErbB2 heterodimerization

6.To verify the ability of the IgG and F(ab’)2 antibodies to evoke antibody-dependent cell-

mediated cytotoxicity in vitro.

METHODS

Whole trastuzumab and pertuzumab antibodies were digested with pepsin-agarose. Separation of

digested fragments was tested with protein A and G and gel filtration. Affinitiy and lack of Fc

fragment on F(ab’)2 was tested with immunofluorescence in flow cytometry. In vitro EC50 was

assessed with an MTT based assay. ADCC in the presence of the whole antibodies or their

F(ab’)2-s was tested in a real time adherence assay.

RESULTS

1. Production of F(ab’)2 from trastuzumab and pertuzumab was optimized with pepsin-agarose

digestion

2. Since protein A and protein G showed binding of cleaved F(ab)2, chromatography optimized

for exclusion size and ionic strength was used to separate F(ab’)2 from IgG

3. Proper F(ab’)2 variants showed intact antigen binding but no Fc region taggable with

polyclonal anti-Fc

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4. The effect on proliferation of in vitro sensitive BT-474 and resistant JIMT-1 cell lines was not

affected by the removal of the Fc region. Based on the EC50 values determined as single

agents on BT-474 cells, isoboles for a range of combination were also measured for both the

whole antibodies and the F(ab)’2 fragments. Enhanced dimerization inhibition by the smaller

pertuzumab F(ab’)2 was identified as opposed to its intact parent antibody1.

5. Intact antibodies mediated in vitro ADCC-based killing, while F(ab’)2 fragments did not

mediate ADCC.

CONCLUSIONS

A set of antibodies and their functional F(ab’)2-s which do not mediate ADCC but exert similar

direct cellular effects are now ready for testing on JIMT-1 and N87 xenografts in SCID mice

which represent in vitro trastuzumab resistant and sensitive cell lines, respectively.

REFERENCES

1. Roszik J, Tóth G, Szöllősi J, Vereb G. Validating pharmacological disruption of protein-

protein interactions by acceptor photobleaching FRET imaging. Methods Mol Biol. 2013;

986:165-78.

ACKNOWLEDGEMENTS

The author was supported by the following grants:

TÁMOP 4.2.4.A/2-11-1-2012-0001

TÁMOP 4.2.2.B/10/1-2010 – 0024

7. ANALYSIS OF LUNG CANCER BY HISTOLOGICAL TYPE AND

LOCATION IN LATVIA

Author: Agita Jukna, Riga Stradins University, Faculty of Medicine, Latvia, Riga

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Supervisor of the abstract: Associate professor Ilze Strumfa, Riga Stradins University, Pauls

Stradins Clinical University Hospital, Latvia, Riga

INTRODUCTION

Lung cancer is the most common cancer in the world today (1). It is more often found in men but

in recent years there has been increasing incidence also among women (1;2). The average age of

the patients is between 60 and 70 years (3). The morphology of tumor has a central role not only

in the diagnosis of the patient, but also for the selection of treatment plan (4). In Latvia, there are

few high-quality data about the histological types of lung cancer.

AIM

To establish the frequency of different histological types of lung cancer, exploring the tissue

material of lung tumors available at the archives of single university hospital.

OBJECTIVES

Defining the incidence of the most common morphological types of tumor, their localization and

gender distribution.

METHODS

Retrospective study included the tissue material of lung tumors available at the Pathological

institute of Pauls Stradins Clinical University Hospital during the period from July 2011 to June

2012.

The following data were analyzed from the pathological reports - gender, age, type of material

acquisition (biopsy and operation), tumor localization and morphological diagnosis by World

Health Organization classification (5).

The research data was analyzed using statistical software (Statistical Package for the Social

Sciences - SPSS) and imaging software KAPPA IMAGE BASE.

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RESULTS

Lung tumors were obtained from 278 cases, of which 204 were males (73.4%) (p<0.00001, 95%

CI=73.4±5.23%) and 74 (26.6%) were females. The average age was 65.5 (SD±10) years for

both women and men. All material showed 29.5% squamous cell carcinoma (95%

CI=29.5±5.4%), 20.1% adenocarcinoma (95% CI=20.1±4.74%), 19.1% small cell carcinoma

(95% CI=19.1±4.65%) and 2.5% large cell carcinoma. Between the genders squamous cell

carcinoma predominanted in males with 36.8% (p<0.001, 95% CI=36.8±6.7%), followed by

19.6% of small cell carcinoma and adenocarcinoma with 15.7%. For women it was 32.4% of

adenocarcinoma (95% CI=32.4±10.9%) and 17.6% of small cell carcinoma (p=0.07, 95%

CI=17.6±8.9%) and 9.5% sqamous cell carcinoma. Peripheral localization was defined in 43% as

adenocarcinoma (95% CI=43.0±11.2%) but for sqamous cell carcinoma 11.4% and small cell

carcinoma 7.6%. On the other hand, central localization more often was found for sqamous cell

carcinoma 38.4% (95% CI=38.4±7.0%) and small cell carcinoma 23.7% (95% CI=23.7±6.1%),

but for adenocarcinoma just 9.5%.

CONCLUSIONS

1.Lung tumors are more common in men. The average age is 65 years.

2.The most common is squamous cell carcinoma, followed by adenocarcinoma and small cell

carcinoma. For males statistically significant more frequently was found squamous cell

carcinoma, but for females adenocarcinoma and small cell carcinoma.

3.Lung tumor centrally localized statistically more likely will be squamous cell carcinoma or

small cell carcinoma, and peripheral tumors more often will be adenocarcinoma.

REFERENCES

1. GLOBOCAN 2008 [Internet]. France: International Agency for Research on Cancer;

2010 [cited 2013 January 19]. Available from: http://globocan.iarc.fr/

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2. Tazelaar, H. D. Pathology of lung malignancies [Internet], September 2011 - [cited 2013

January 24]. Available from: https://www.uptodate.com/store

3. Plausu vezis [Internet]. Riga: ONKO.LV, 2006 – 2009 - [cited 2013 January 26].

Available from: http://www.onko.lv/frames.php?lang=lv&id=3

4. Brambilla, E., Travis, W.D., Colby, T.V., Corrin, B., Shimosato, Y. The new World

Health Organization classification of lung tumours [Internet]. European Respiratory

journal, December 2010 - [cited 2013 January 19]. Available from:

http://erj.ersjournals.com/content/18/6/1059.short

5. Travis, W.D., Brambilla, E., Muller-Hermlink, H.K., Harris, C.C. (Eds). Pathology and

genetics of tumours of the lung, pleura, thymus and heart. World Health Organization

classification of tumours., IARC Press, Lyon 2004. 9 – 121 p.

8. THE EFFECT OF ELECTROLYZED (IONIZED) WATER ON RAT

MATERNAL BODY PHYSICAL CONDITION (EXPERIMENTAL

SCIENTIFIC WORK)

Authors:.Aistė.Audickaitė,.Jolita.Stankevič

Supervisor of the abstract: Associate professor Violeta Žalgevičienė; director of “Vandens

tyrimai” Valdas Šimčikas

INTRODUCTION

People always wanted to improve everything around them, making water one of their targets. It

was filtered, distilled, mineralized. Furthermore, many advertisements try to convince that tap

water is unhealthy and even harmful. On the other hand, an attempt is being made to prove that

water can cure if it is electrolyzed. Small-scale studies are carried out to confirm it. Likewise, we

decided to do an experiment with rats in order to make it clearier. Our purpose was to find out

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the effects electrolyzed (ionized) water has on the maternal body of the rats.

AIM

The aim of the study is to investigate the effects tap and electrolyzed (ionized) water has on rats.

OBJECTIVES

1. To examine the effect electrolyzed (ionized) water has on the weight of rats‘ maternal

body and to compare it to the control group;

2. To measure the urine and blood pH and make a comparison between groups;

3. To ascertain whether rats which drink electrolyzed (ionized) water show any external

changes;

4. To determine open – circuit potential (OCP) in rats’ blood.

METHODS

1. The experiment was carried out by using 30 Wistar line white rats (2 months old);

2. For two months rats were given to drink electrolyzed (ionized) water, which was

prepared by using water ionizator filled up with tap water for 20 min (an appropriate time

for water electrolysis). During the water electrolysis alkaline and acid water was

prepared. It was changed 3 times per week;

3. rats were divided into 3 groups: the first group was experimental and was given to drink

alkaline water (I EG), the other one – acid water (II EG), while the third group, which

was the control group, was given tap water (III EG);

4. rats were weighted one time per week twice (first and second month). “Knick pH meter

Calimatic 766” device was used to measure pH of the urine and blood. The open – circuit

potential in rats blood was measured by using a potential – controlled experiment –

voltammetry, which scans the electric potential and records the current variation. Blood

was taken from rats‘ tales;

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5. the independent samples T-test method was used for the statistical significance analysis

(MS Excel 2007). The difference was statistically significant when p < 0.05.

RESULTS

1. Comparing the weight gain in the beginning and the end of the experiment I EG weight

increased 40,5±18,1 g (from 253,6±52,7 g to 294,1±21,9 g); II EG - 32,4±16,9 g (from

250,3±47,9 to 282,7±23,8 g); III EG – 52,4±17,5 g (from 258,8±51,3 g up to 301,0±20,9

g). I EG and II EG gained less weight than III EG; accordingly, p=0,51 and p=0,26;

2. Analysis showed that: I EG blood pH was 7,78±0,17; II EG blood pH 7,80±0,17 and III

EG blood pH 7,80±0,10. I EG pH of urine 7,10±0,53; II EG – 7,50±0,41 and III EG –

7,50±0,58. Comparing I with III and II with III groups (both blood and urine pH)

statistically reliable differences in the pH value were not set (in both cases p>0,05);

3. Two weeks after the beginning of the experiment the first signs of stress appeared in rats

which were drinking electrolyzed (ionized) water: “bloody tears” and changes in coat

(gray, harsh). One rat from the II EG died (autopsy showed enlarged uterus);

4. OCP in rats‘ blood was without any abnormal changes.

CONCLUSIONS

1. Weight and weight gain of the I EG and II EG rats is less than that of the III EG (p>0,05);

2. EG pH of urine is more acidic comparing to the III EG (p>0,05);

3. I EG blood pH is more acidic than III EG (p>0,05);

4. I and II EG rats were with signs of stress (“bloody tears”, coat changes);

5. One rat from the II EG died. Enlarged uterus was found;

6. Open – circuit potential in rats’ blood was normal (varies within the range of 55 mV).

REFERENCES

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1. Khubutiya M, Evseev A, Kolesnikov V, Goldin M, Davydov A, Volkov A, et al.

Measurements of platinum electrode potential in blood and blood plasma and serum.

Russian Journal of Electrochemistry. 2010, Volume 46, Issue 5, pp 537-541.

2. Watanable T, Kishikawa Y. Degradation of myocardiac myosin and creatine kinase in

rats given alkaline ionized water. Department of Veterinary Physiological Chemistry,

College of Bioresource Sciences, Nihon University, Kanagawa, Japan. 1998

Feb;60(2):245-50. Available from

Medline: http://www.ncbi.nlm.nih.gov/pubmed/9524951

3. Watanable T, Kishikawa Y, Shirai W. Influence of alkaline ionized water on rat

erythrocyte hexokinase activity and myocardium. Department of Veterinary

Physiological Chemistry, College of Bioresource Sciences, Nihon University, Kanagawa,

Japan. 1997 May;22(2):141-52. Available from

Medline: http://www.ncbi.nlm.nih.gov/pubmed/9198011

4. Watanabe T, Shirai W, Pan I, Fukuda Y, Murasugi E, Sato T, et al. Histopathological

influence of alkaline ionized water on myocardial muscle of mother rats. Department of

Veterinary Physiological Chemistry, College of Bioresource Sciences, Nihon University,

Kanagawa, Japan. 1998 Dec;23(5):411-7. Available from Medline:

http://www.ncbi.nlm.nih.gov/pubmed/9922944

9. DIGITAL PATHOLOGY IMAGE ANALYSIS APPROACH TO

MEASURE THE EXTENT OF KIDNEY FIBROSIS

Author: Jurgita Ivanauskaitė

Supervisor of the abstract: Prof. Dr. Arvydas Laurinavičius

INTRODUCTION

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Extent of kidney fibrosis is widely used as a measure of chronic disease in both native and

transplanted kidney biopsies. Current clinical routine is mostly based on semiquantitative visual

evaluation of the area of interstitial fibrosis, usually attributing cases into a few categories

defined by the Banff classification (5) or other scoring schemes. Low reproducibility is the major

limiting factor of this approach (1). Therefore, digital pathology techniques are explored seeking

better reproducibility, accuracy and quantification of interstitial kidney fibrosis (2-4).

AIM

To develop a simple methodology in order to measure the extent of kidney fibrosis based on

digital pathology image analysis (IA).

OBJECTIVES

Set up and validate IA algorithm against stereological reference values. Compare the results of

the IA to semi-quantitative pathologist‘s estimate.

METHODS

1. 91 renal allograft biopsies were stained with Masson’s trichrome and scanned by Aperio

XT. Aperio Genie tool was trained to automatically outline biopsy sections. The

colocalization algorithm was set up to detect fibrous tissue and validated against

stereological point count method (6) in 40 biopsies with manually annotated kidney

cortex areas containing at least 5 glomeruli. These biopsies were also used in the final

analysis.

2. The Genie/Colocalization algorithm was used to analyze the 91 kidney allograft biopsies.

The cortex and medulla were analyzed separately based on manual annotations.

3. No attempt was made to exclude glomeruli or arteries from the analysis for the sake of

simplicity and based on an observation that normal and even sclerosed glomeruli or

arteries do not reveal significant amount of fibrous tissue detected by the IA tool. If some

fibrous material is present in these structures, it can still be regarded a feature of chronic

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change in a biological sense. Therefore, we measured total cortical fibrosis, instead of

pure interstitial fibrosis.

4. Two parameters were tested: “wet fibrosis” defined as a proportion of collagen to the

renal cortex area and “dry fibrosis” defined as a proportion of collagen to the renal cortex

without Bowman’s space, tubular and vascular lumina (unstained area inside renal cortex

not analyzed by the Colocalization algorithm).

RESULTS

1. The average percentage of the “dry fibrosis“ evaluated by the IA and stereology did not

differ (respectively, 7.44 ± 5.71 and 8.35 ± 6.20, p > 0.05) and correlated strongly (r = 0.88,

p < 0.05).

2. The average percentage of the “wet fibrosis” evaluated by IA and stereology did not

differ (respectively 5,19 ± 3,76 and 6,47 ± 4,74) and correlated strongly r = 0,90 (p < 0,05).

3. “Dry fibrosis” measured by IA correlated moderately with the pathologist’s evaluation r

= 0.34 (p < 0,05).

4. “Wet fibrosis” measured by IA correlated moderately with the pathologist’s evaluation r

= 0.42 (p < 0,05).

5. Significant difference between the degree of cortex and medulla fibrosis was found

(respectively, 9,68 ± 6,94 and 17,69 ± 12,05).

CONCLUSIONS

Our IA approach, unlike routine pathology, was designed to measure total fibrosis in renal

cortex. Accuracy of the technique was confirmed by a strong correlation without systemic bias

between algorithm and stereology to quantify the fibrous transformation. It correlated to the

semi-quantitative estimate of interstitial fibrosis and could provide simple and robust method to

quantify the degree of chronic change. Clinical utility of the approach remains to be explored.

REFERENCES

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1. Furness PN, Taub N. International variation in the interpretation of renal transplant

biopsies: report of the CERTPAP Project. Kidney international. 2001;60(5):1998-2012.

Epub 2001/11/13.

2. Meas-Yedid V, Servais A, Noel LH, Panterne C, Landais P, Herve N, et al. New

computerized color image analysis for the quantification of interstitial fibrosis in renal

transplantation. Transplantation. 2011;92(8):890-9. Epub 2011/09/20.

3. Servais A, Meas-Yedid V, Buchler M, Morelon E, Olivo-Marin JC, Lebranchu Y, et al.

Quantification of interstitial fibrosis by image analysis on routine renal biopsy in patients

receiving cyclosporine. Transplantation. 2007;84(12):1595-601. Epub 2008/01/01.

4. Servais A, Meas-Yedid V, Morelon E, Strupler M, Schanne-Klein MC, Legendre C, et al.

[Recent approaches of quantification of interstitial fibrosis in renal transplantation].

Medecine sciences : M/S. 2009;25(11):945-50. Epub 2009/12/03. Apports recents des

techniques de quantification de la fibrose pour l'examen anatomo-pathologique en

transplantation renale.

5. Solez K, Racusen LC. The Banff classification revisited. Kidney international.

2013;83(2):201-6. Epub 2012/12/14.

6. West MJ. Introduction to stereology. Cold Spring Harbor protocols. 2012;2012(8). Epub

2012/08/03.

10. JOB SATISFACTION IN VARIOUS SPECIALTIES

Authors: Greta Bacionytė, Paulina Čėsnaitė Supervisor of the abstract: assoc.prof. Vilma

Brukienė

INTRODUCTION

A significance of job in everyday life is widely reported. Not only it gives people money to

survive, but also it bestows on one a personal identity, self-actualization and social image(1). Job

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satisfaction is defined as comfortable, simple and intelligible herewith meaningful, significant

and challenging(2). The term determines whether employee is happy, contented with trying to

reach his/her goals and has fulfilled needs at work. Job satisfaction depends on motivation,

meeting aims and avoiding creation of stress inducing atmosphere at work. It is also influenced

by position of employer, appropriate aiming, understood commissions, communication and

colleagues. Studies have shown, that people more satisfied with their job endure a burnout stress

syndrome and exhaution less frequently(3). Dentists and medical doctors belong to a risk group

which is more likely to deal with burnout stress syndrome and exhaution. Studies revealed that

among dentists 41% of women and 59% of men were undergoing occupational stress(4) –

Therefore, it is important to find out all conditions and aspects of work which discontent

employee. Subsequently, this will enable to create and maintain working conditions that satisfies

them most and reduce risk of doctors‘ health disorders.

The job satisfaction model, suggested by Hackman and Oldman, demonstrates cohesion between

working place conditions and work performance, including employee job satisfaction(5). It states

that there are five core job characteristics (skill variety, task identity, task significance,

autonomy, and feedback) which impact three critical psychological states (experienced

meaningfulness, experienced responsibility for outcomes, and knowledge of the actual results),

in turn influencing work outcomes (job satisfaction, absenteeism, work motivation, etc.) (6).

A theory presented by J.Holland, suggests that people are more likely to undergo job satisfaction

when their personality and job types match. The following types of job were defined: Realistic,

Investigative, Artistic, Social, Enterprising, and Conventional. As dental and medical

professions reffer to the investigative type, people having the same type of personality will be

more satisfied with their job(7).

The present study aimed to investigate job satisfaction among doctors of different medical

specialties and was performed because there has been no such study which examinated

correlation between medical and dental professions and job satisfaction. Although job

satisfaction of dentists was investigated in Lithuania in 2008 (8), overall doctors job satisfaction

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in Lithuania was not analysed. Moreover, such study is important for future dental and medical

students as popularity of these professions has been increasing and they need to understand

positive and negative features of these professions.

AIM

To evaluate job satisfaction of different medical specialties in Lithuania.

OBJECTIVES

1. To indicate dentists’ and medical doctors’ job satisfaction level in Lithuania.

2. To compare job satisfaction differences between doctors living and working in different

regions of Lithuania.

3. To compare differences of job satisfaction of doctors working in private or/and public

sectors.

METHODS

An epidemiologic study among 272 doctors working in Lithuania in both private and public

sectors was performed. A previously developed and validated instrument adressing three sections

(demografic questionnaire, UWEC and Warr-Cook-Walls scales) and including statements

evaluating doctors‘ atittude to their chosen profession was used. Statistic analysis was performed

using SPSS W20 (descriptive analysis, Student T criteria).

RESULTS

Response rate was 45,33%. The survey revealed that dentists were more satisfied (p=0,004) with

their job – 4,2(±0,7) than medical doctors - 3,95(±0,7). Both dentists and medical doctors

working in capital city notified the same extent of job satisfaction (p=0,103) while in other

Lithuanian regions dentists were more satisfied (p=0,027). The ones working in private practice

were the most satisfied (4,44(±0,6), less satisfied (4,00(±0,7) – working both in private and

public practices and the least satisfied doctors worked in public sector (3,9(±0,76);(df=2;p<0.05).

Gender differences according to objective complex Warr-Cook-Walls scale were not significant

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(p=0,584), but based on their own subjective opinion, men are more critical about their job

(p=0,006). Regarding duration of experience the most satisfied were doctors, who had 10-15

years of work experience (df=2;p=0,032). Both dentists and medical doctors were least satisfied

with their salaries (3,3(±1,17) and 3,11(±1,22), correspondingly). Almost a half (48,7%) of

medical doctors stated not getting enough recognition for a good work. As the most positive

feature in their profession both groups notified the variety of activities and tasks (90,8%).

CONCLUSIONS

1.Dentists were more satisfied with their job that medical doctors.

2.The extent of job satisfaction was associated with area of residence, experience and gender.

3.The most valuable factor was variety of job activities while salary was the least satisfying

factor.

REFERENCES

3. 1. Abdullah M. Al-Rubaish, Sheikh Idris A. Rahim, Mahdi S. Abumadini, Lade

Wosornu. Academic job satisfaction questionnaire: Construction and validation in Saudi

Arabia. J Family Community Med.2011 Jan-Apr

4. 2. Locke, Edwin A. What is job satisfaction? Organisational Behaviour and Human

Performance, 1969,4.4:309-336

7. 3. Pūrienė A.,Aleksejūnienė J.,Petrauskienė J.,Balčiūnienė I.,Janulytė V. Self-

perceived Mental Health and Job Satisfaction among Lithuanian Dentists, Industrial

Health 2008,46,247–252

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11. PATIENTS WITH AGE-RELATED MACULAR DEGENERATION, A

RANDOM SAMPLE OF THE POPULATION AND 3 GENERATIONS OF

ONE FAMILY GENETIC TREE EVALUATION ACCORDING TO THE

MATRIX METALLOPROTEINASE-3 GENE POLYMORPHISM

Authors: Aistė Slavinskaitė, Gintarė Kumžaitė, Ieva Gustaitė, Rasa Čiumbaraitė

Supervisor of the abstract: dr. Rasa Liutkevičienė, prof. Vaiva Lesauskaitė

INTRODUCTION

Matrix metalloproteinase (MMP) - are a family of proteolytic zinc-containing enzymes, which

are responsible for degrading extracellular matrix components. MMP-3 polymorphism could

have influence on retinal vascular remodeling and stiffening and may play a role in age-related

macular degeneration (AMD) development. Ex vivo methods showed that MMP-3 mRNA and

protein activity depends on genotype: 5A/5A shows the highest activity, 5A/6A-the middle

activity and the lowest activity - 6A/6A.

AIM

The aim of our research is to assess the impact of MMP-3 (-1171 5A/6A) gene polymorphism in

patients with age-related macular degeneration, in 3 generations of the one family, and compare

to random sample of the population.

OBJECTIVES

1. MMP-3 genes polymorphism impact to age-related macular degeneration development.

METHODS

We have examined 3 generations of the one family (9 people), 84 patients with AMD, and results

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were compared to a random sample of the population (n=1127). The genotyping test of MMP-3

(-1171 5A/6A) was carried out using a real-time PCR method. Age-related macular degeneration

was classified according to AREDS.

RESULTS

The frequency of 5A and 6A alleles in patients with AMD was 0.5. In the examined family the

frequency of 5A and 6A alleles were 0.72 and 0.28. The frequency of alleles in the random

sample of the population was 0.51 and 0.49. The frequency of 5A and 6A alleles in AMD group

and in the random sample population group were statistically insignificant (p=0.15).

CONCLUSIONS

1.MMP-3 genes polymorphism has no impact to age-related macular degeneration development.

The literature data state that MMP-3 5A allele is a risk factor for myocardial infarction

development. The higher frequency of the 5A allele in the examined family shows the necessity

of prevention for myocardial infarction development.

REFERENCES

1.Švagždys S, Lesauskaitė V. Matrikso metalo proteinazės: piktybinių navikų augimo ir plitimo

mechanizmai (Matrix metalloproteinases: the mechanisms of invasion and metastatic

development of malignant tumours). Medicinos teorija ir praktika 2007;13(2):132-138.

2.Liutkeviciene R, Lesauskaite V, Asmoniene V, Zaliūniene D, Jasinskas V. Factors determining

age-related macular degeneration: a current view. Medicina (Kaunas) 2010;46(2):89-94.

3.Vihinen P, Ala-aho R, Kähäri VM. Matrix metalloproteinases as therapeutic targets in cancer.

Curr Cancer Drug Targets 2005;5(3):203-220.

4.Visse R, Nagase H. Matrix metalloproteinases and tissue inhibitors of metalloproteinases:

structure, function, and biochemistry. Circ Res 2003;92(8):827-839.

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CARDIOLOGY SECTION

1. RADIOLOGICAL ASSESSMENT OF CORONARY ARTERY

OBSTRUCTIONS BY LOCALISATION IN PATIENTS WITH

CORONARY ARTERY DISEASE

Authors: Nauris Zdanovskis, Vladislavs Kopitkovs

Supervisor of the abstract: Vladimirs Osipovs

INTRODUCTION

Coronary artery disease (CAD) is a complex disease that causes reduced or absent blood flow in

one or more of the arteries that encircle and supply the heart. Apart from rare congenital

anomalies (birth defects), CAD is usually a degenerative disease, uncommon as a clinical

problem before the age of 30 years and common by the age of 60 years.1

AIM

The aim of this research was to determine the difference in the localization of obstruction in

coronary blood vessels in patients with coronary artery disease and investigate the effect of sex

and age on that difference.

OBJECTIVES

1. To determine most common localization of obstructions by dividing obstruction localizations

in 18 groups – Left main (LM) artery; Left Anterior Descending (LAD) artery proximal portion;

LAD artery middle portion; LAD artery distal portion; Right Coronary Artery (RCA) proximal

portion; RCA middle portion; RCA distal portion; Left circumflex (LCx) artery proximal

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portion; LCx artery middle portion; LCx artery distal portion; First diagonal (D1) artery; Second

diagonal (D2) artery; Third diagonal (D3) artery; First obtuse marginal (OM1) artery; Second

obtuse marginal (OM2) artery; Third obtuse marginal (OM3) artery; Right posterior lateral

(RPL) branch; Right posterior descending (RPD) branch.

2. To determine distribution of obstructions by gender.

3. To group analyzed cases in 7 age groups (from 21 to 30 years; from 31 to 40 years; from 41 to

50 years; from 51 to 60 years; from 61 to 70 years; from 71 to 80 years; from 81 to 90 years) and

determine in which group coronary artery obstructions are the most common.

METHODS

We analysed 111 cases in patients with coronary artery disease where patients were referred for

coronary angiography. Only hemodynamically significant obstructions were identified

(obstruction of 50% or more). The statistical data was analysed using SPSS 20 and Microsoft

Excel 2010.

RESULTS

Total number of analysed cases is 111. Distribution by gender - 71 (64.0%) males and 40

(36.0%) females. The mean age of patients is 66.2 ± 9.7 years (youngest 42 years, oldest 85

years). Mean age of males is 64.2 ± 9.2 years; females 69.9 ± 9.4 years.

Distribution of coronary artery obstruction by localisation – Left Anterior Descending (LAD)

artery proximal portion 74 (66.7%) cases, Right Coronary Artery (RCA) proximal portion 37

(33.3%) cases, RCA middle portion 28 (25.2%), LAD artery middle portion 23 (20.7%) cases,

RCA distal portion 23 (20.7%) cases, Left main (LM) artery 21 (18.9%) cases, Left circumflex

(LCx) artery middle portion 21 (18.9%) cases, LCx artery proximal portion 17 (15.3%) cases,

First diagonal (D1) artery 14 (12.6%) cases, LCx artery distal portion 13 (11.7%) cases, Second

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obtuse marginal (OM2) artery 12 (10.8%) cases, Right posterior lateral (RPL) branch 8 (7.2%)

cases, LAD artery distal portion 8 (7.2%) cases, First obtuse marginal (OM1) artery 6 (5.4%)

cases, Right posterior descending (RPD) branch 6 (5.4%) cases, Third obtuse marginal (OM3)

artery 1 (0.9%) case.

Coronary artery obstruction distribution by age groups - from 41 to 50 years 5 (4.5%) cases;

from 51 to 60 years 27 (24.3%) cases; from 61 to 70 years 38 (34.2%) cases; from 71 to 80 years

33 (29.7%) cases; from 81 to 90 years 5 (4.5%) cases.

CONCLUSIONS

1. The most common coronary artery obstructions are localized at LAD artery proximal portion,

RCA proximal portion and RCA middle portion.

2. Coronary artery obstructions are more frequent in males than in females.

3. The most number of obstructions were identified in age group from 61 to 70 years.

REFERENCES

1. 1.Pearlman JD. Imaging in Coronary Artery Disease [Internet]. Medscape Reference. Drugs,

Diseases & Procedures: Updated 2012 Nov 13[cited 2013 Jan 14]. Available from:

http://emedicine.medscape.com/article/349040-overview#showall

2. ASSOCIATION BETWEEN LEFT VENTRICLE FUNCTION AND

PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH STABLE

CORONARY ARTERY DISEASE (sCAD)

Authors: Agnė Adukauskaitė, Paulius Orda, Rūta Kuodytė

Supervisor of the abstract: prof. Jolanta Vaškelytė

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INTRODUCTION

CAD has a negative impact on the psychosocial and physical functioning of patients (1). What is

more, negative emotional status, such as anxiety or depression, was found to be independently

associated with left ventricle (LV) systolic function in patients with sCAD, and carries an

increased risk of death among these patients (2).

AIM

To evaluate the relationship among LV function, physical capacity and psycho-emotional status

in patients with sCAD and to calculate the prevalence of anxiety and depression in the same

population.

OBJECTIVES

1. Assessment of LV function by measuring LV ejection fraction.

2. Evaluation of physical capacity.

3. Examination of psychological and emotional condition (including anxiety and depression).

METHODS

From the January 2010 to September 2012, 758 patients with sCAD, who were recently

discharged from the hospital after treatment for an episode of stable angina pectoris, and had no

current history of depressive, cognitive disorders or other severe diseases, were examined in the

Cardiovascular Rehabilitation Clinic at the Behavioral Medicine Institute of Lithuanian

University of Health Sciences. 64,6% of them were men (mean age 60,0±10,3). LV function and

physical capability were assessed using echocardiography and veloergometry, respectively.

Psycho-emotional status was examined using Hospital Anxiety and Depression Scale (HAD) and

36-item Short Form Medical Outcome Questionnaire (SF-36), which measures eight dimensions

of health: physical functioning, social functioning, role limitations due to physical problems, role

limitations due to emotional problems, mental health, energy/vitality, pain, general health

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perception). Statistical data analysis was performed using univariate and multivariate linear

regression.

RESULTS

1. 39,7 % of patients with sCAD had anxiety and 24,4 % - depression.

2. Higher LV ejection fraction was associated with better physical functioning and general

health perceptions (β = -,09 and β = -,07, p<0,05, respectively).

3. Physical capacity mean (W) was positively associated with all SF-36 subscales, the strongest

association - with physical functioning (β = -,549, p<0,001): higher physical capacity (W) was

associated with better physical functioning.

CONCLUSIONS

1.A large number of patients with sCAD suffer from anxiety and depression.

2.In patients with sCAD health-related quality of life is associated with left ventricle function.

3.Worse physical functioning and poorer general health perception are associated with left

ventricle systolic dysfunction.

REFERENCES

1. Watkins LL, Koch GG, Sherwood A, Blumenthal JA, Davidson JR, O'Connor C, Sketch MH.

Association of anxiety and depression with all-cause mortality in individuals with coronary

heart disease. J Am Heart Assoc. 2013;2(2):e000068.

2. Dogdu O, Yarlioglues M, Kaya MG, Ardic I, Akpek M, Senarslan O, Elcik D, Sahin O,

Tulumen E, Calapkorur B, Kalay N. Relationship between psychosocial status, diabetes

mellitus, and left ventricular systolic function in patients with stable multivessel coronary

artery disease. Cardiol J. 2012;19(3):249-55.

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3. CARDIAC SIZE AND FUNCTION IN ELITE FEMALE FITNESS

ATHLETES

Author: Justas Simonavicius, Lithuanian University of Heath Sciences

Supervisors of the abstract: Tomas Venckunas, PhD, Lithuanian Sports University, Jolanta

Elena Marcinkeviciene, PhD, Lithuanian University of Health Sciences

INTRODUCTION

Consistent physical activity could be a sufficient stimulus to induce changes in heart

morphology, which is physiological in nature [1-2]. The type and degree of cardiac adaptation is

dependent on many factors, including gender and the type of sports engaged [3]. Fitness is a

class of physique-exhibition event mostly for women. While bearing a close resemblance to

bodybuilding and demanding muscular symmetry, tone, and extremely lean body composition,

the sport does not require very large muscle mass itself. Therefore, training of fitness athletes

includes lower weights used with more repetitions and large overall strength training volume

together with incorporation of significant amount of aerobic training. Researches have revealed

controversial data about power-training and its influence to heart morphology. Contrary to

previous believes, the latest data show that power-training does not alter cardiac morphology [4].

For today, no data of fitness training on cardiac morphology and function are available while this

type of sport activity consists of both endurance and power-training.

AIM

The aim of the study was to compare cardiac dimensions and function in elite female fitness

athletes and sedentary controls.

OBJECTIVES

1. To measure cardiac morphology of elite female fitness athletes and to compare it with

that of sedentary controls.

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2. To evaluate left ventricular function of elite female fitness athletes and to compare it with

that of sedentary controls.

SUBJECTS

Fitness athletes (n = 11) and sedentary but otherwise healthy age-matched adult females (n = 20)

were recruited into the study. Athletes were at their regular training schedule during the time of

investigation, and all the subjects did not exercise for at least 24 hours and did not consume any

food or drink caffeine-containing beverages at least two hours before the echocardiography.

Athletes had been training and competing in fitness sport for at least two last years.

METHODS

Standard transthoracic two-dimensionally guided M-mode and Doppler echocardiography was

performed with the subjects resting in a left lateral position, by means of an ultrasound device.

LV measurements were made from "frozen" M-mode tracings obtained using two-dimensional

guiding in long axis parasternal view. Internal LV diameter (LVDi) as well as septal (IVS),

posterior wall (PW) thickness, right ventricular internal diameter, were measured at end-diastole,

left and right atrium diameters were taken at end-systole as recommended by the American

Society of Echocardiography [5]. The early (E) and late (A) diastolic peak filling velocities were

measured using the Doppler effect from apical four-chamber view, E/A ratio was calculated. Left

ventricle ejection fraction (LVEF) was calculated by the Simpson method. The same cardiologist

made three measurements and the average for each LV parameter was calculated.

Body weight was measured on electronic scales (Tanita TBF-300, Japan). Harpender's

anthropometer was used to measure body height. Body mass index (BMI) was calculated as

weight (kg)/height squared (m2). Body surface area (BSA) was calculated using the standard

equation.

The relative wall thickness (RWT) was calculated by dividing the sum of IVS and PWT by

LVDi. LV mass (in g) was also calculated using a standard equation. LV mass index was

obtained by dividing LV mass by body surface area.

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Statistical analysis was performed using SPSS 13.0 software, Windows release.

RESULTS

Age was similar between the two groups (24.7 (2.8) and 23.0 (2.3) years (mean (standard

deviation)) for fitness athletes and sedentary controls, respectively). The subjects had similar

height 169.3 (6.3) and 168.6 (5.8) cm, body mass 57.1 (4.8) and 60.0 (6.6) kg as well as BMI

19.9 (1.5) and 21.3 (2.2). Morphological heart characteristics did not differ (p>0.05) when

comparing fitness athletes and sedentary controls, and the values were, respectively: LVDi was

44.2 (2.5) and 44.5 (3.0) mm, IVS was 8.1 (0.7) and 7.9 (0.8) mm, PW was 8.2 (0.6) and 8.0

(0.9) mm, LMV 131.5 (21.3) and 128.9 (27.8) g, RWT was 0.370 (0.030) and 0.358 (0.031),

right ventricular internal diameter was 27.6 (2.4) and 28.9 (4.3) mm, left atrium diameter was

33.4 (3.1) and 33.1 (2.2) mm, right atrium diameter was 35.0 (4.0) and 35.4 (4.3) mm. LVEF

was normal in all subjects and did not differ between the groups (p>0.05). All measured tissue

Doppler indices were similar between fitness athletes and sedentary controls (p>0.05).

CONCLUSION

Elite female fitness athletes have normal cardiac size and function, which do not differ from their

matched sedentary controls; therefore fitness sport training has negligible if any effect on cardiac

adaptation, at least in female athletes.

REFERENCES

1. George KP, Batterham AM, Jones B. Echocardiographic evidence of concentric left

ventricular enlargement in female weight lifters. Eur J Appl Physiol Occup Physiol. 1998

Dec;79(1):88-92. PubMed PMID: 10052666.

2. Lalande S, Baldi JC. Left ventricular mass in elite olympic weight lifters. Am J Cardiol.

2007 Oct 1;100(7):1177-80. Epub 2007 Jul 16. PubMed PMID: 17884384.

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3. Sun B, Ma JZ, Yong YH, Lv YY. The upper limit of physiological cardiac hypertrophy

in elite male and female athletes in China. Eur J Appl Physiol. 2007 Nov;101(4):457-63.

Epub 2007 Jul 28. PubMed PMID: 17661070.

4. Scharhag J, Löllgen H, Kindermann W. Competitive sports and the heart: benefit or risk?

Dtsch Arztebl Int. 2013 Jan;110(1-2):14-24. doi: 10.3238/arztebl.2013.0014. Epub 2013

Jan 7. PubMed PMID: 23450998; PubMed Central PMCID: PMC3561756.

5. Lang RM, et al.; Recommendations for chamber quantification. 2005 Dec;18(12):1440-

63. PubMed PMID: 16376782.

4. GENDER DIFFERENCES IN PROGNOSIS OF HOSPITALIZATION

DURING ONE YEAR AFTER MYOCARDIAL INFARCTION WITH

ST-SEGMENT ELEVATION

Author: Ugne Reinikovaite

Supervisor of the abstract: Lina Bardauskiene

INTRODUCTION

First and recurrent events of acute myocardial infarction (AMI) was markedly reduced in men

over the 20-year observation period, but for women the reduction was seen only for recurrent

infarctions [2]. Gender differences play an important role in the pathophysiology of AMI. It has

been proposed that gender differences on symptoms, awareness, prehospital delay, treatment

responses, and complications may contribute to the different outcome [3]. Women have longer

median delays between symptom onset and call for medical assistance and between admission

and reperfusion; they are receiving significantly less of the recommended treatments at discharge

[1]. Most of studies were analyzing the role of gender on mortality. The present study has been

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designed to clarify the role of gender differences in prognosis of hospitalization with ischemic

heart disease (IHD) during a first year after the first-ever MI with ST elevation (STEMI).

AIM

To determine the significance of gender in the one-year prognosis of hospitalization with IHD

after first-ever STEMI.

OBJECTIVES

1.To determine differences of clinical features, access to hospital according gender in patients

after the first-ever STEMI treated in Hospital of Lithuanian University of Health Sciences

Kaunas Clinics (HLUHSKC) in 2011.

2.To determine laboratory, echocardiographic, angiographic differences according gender in

patients after the first-ever STEMI treated in HLUHSKC in 2011.

3.To determine the role of gender differences in prognosis of hospitalization with IHD during a

first year after the first-ever STEMI in patients treated in HLUHSKC in 2011.

METHODS

All 112 men and 42 women admitted to HLUHSKC in 2011 due to the first-ever STEMI were

enrolled. The following demographic and clinical features were selected for the analyses: age,

height, weight, heart rate, access to hospital (by-self, ambulance, transportation from other

hospitals), STEMI site (inferior, anterior, lateral), thrombolysis before transportation, Killip

class, history of concomitant diseases (stroke, diabetes mellitus, arterial hypertension, obesity,

renal failure, and peripheral artery disease), laboratory of first hospitalization day (leucocytes,

hemoglobin, erythrocytes, thrombocytes, troponin, creatinine, cholesterol), left ventricular

ejection fraction by echocardiography, angiographic findings (diseased coronary arteries, TIMI

grade flow). The hospitalization due to IHD during first year was identified via database and

phone calls to patients. Risk of outcomes from IHD was analyzed in the periods of 0-365 days.

The investigation approved by the local ethics committee. Statistical methods: t-tests were used

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to analyze differences in groups, chi-square (χ2) - for categorical data. Cox proportional hazard

regression was used to determine prognostic factors in recurrent hospitalizations after STEMI. A

p-value < 0.05 was regarded as statistically significant.

RESULTS

Women with STEMI were older (p=0.00), had a higher incidence of diabetes (26.2% vs 9.8%,

p=0.01), arterial hypertension (95.2% vs 71.4%, p=0.00), III and IV degree of renal failure

(11.1% vs 1.0%, p=0.00) than men. III and IV Killip class was more likely in women than in

men (28.6% vs 6.3%, p=0.00). In contrast, men were more often than women treated with

thrombolysis before transportation from other hospitals for coronarography (24.1% vs 2.4%,

p=0.00), they had more anterior STEMI (49.1% vs 31.0%, p=0.04). Women more often call for

ambulance (59.5% vs 37.5%, p=0.01). There were no significant gender differences in other

clinical features, echocardiographic, angiographic findings and hospitalizations. The later

hospitalization, elevated low-density cholesterol significantly increases and one coronary artery

disease significantly decreases the risk of hospitalizations after the one year for both genders.

Factors significantly increasing the risk of hospitalizations from IHD for men were elevated

count of leucocytes (p=0.02), triglycerides (p=0.01), low LVEF (p=0.02); for women were older

age (p=0.00), arterial hypertension (p=0.02), and elevated level of troponin (p=0.02).

CONCLUSIONS

1.Diabetes, hypertension, acute heart failure, renal failure were more prevalent in women than in

men. Women more often call for ambulance; men had more anterior STEMI and in hospitals

without possibility of angiography more often are treated with thrombolysis.

2.There were no significant differences in laboratory, echocardiographic, angiographic findings

and hospitalizations between men and women.

3.Prognostic risk factors for hospitalization with IHD during a first year after the first-ever

STEMI for men and women were later hospitalization, low-density cholesterol, one coronary

artery disease; for men were count of leucocytes, triglycerides, LVEF; for women were age

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arterial hypertension, level of troponin.

REFERENCES

1. Leurent G, Moquet B, Coudert I, Pennec PY, Druelles P, Hacot JP, et al. Are there gender

differences in the management of ST-elevation myocardial infarction? Data from ORBI, a

prospective registry of 5000 patients. Eur Heart J: Acute Cardiovasc Care Abstract

Supplement [Internet]. 2012;S1:103. Available from:

http://spo.escardio.org/SessionDetails.aspx?id=254878

2. Lundblad D, Holmgren L, Jansson JH, Naslund U, Eliasson M. Gender differences in trends

of acute myocardial infarction events: The Northern Sweden MONICA study 1985 – 2004.

BMC Cardiovascular Disorders [Internet]. 2008:[about 10pp.]. Available from:

http://www.biomedcentral.com/1471-2261/8/17

3. Yang HY, Huang JH, Hsu CY, Chen YJ. Gender Differences and the Trend in the Acute

Myocardial Infarction: A 10-Year Nationwide Population-Based Analysis. The

ScientificWorldJournal [Internet]. 2012 Sep:[about 11pp.]. Available from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444858/

5. MITRAL VALVE ANULOPLASTY: SUTURE VS RIGID RING

Authors: Antanas Strazdas, Indrė Beketovaitė, Andrius Strazdas

Supervisor of the abstract: Vytenis Ivanauskas

INTRODUCTION

Mitral valve (MV) prolapse is nowadays the most common cause of mitral regurgitation in

industrialized countries with high risk of morbidity and mortality. Still little is known about the

impact of different surgical techniques on left ventricle (LV) remodeling and contractile function

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at long term follow up after MV repair. The type of surgical intervention can have differential

effects on the distribution of LV stress and mitral annulus. This particular aspect and LV reverse

remodeling after DMR (degenerative mitral valve regurgitation) surgery has been investigated in

the present study.

AIM

To compare the effects of different annuloplasty techniques on mitral annulus dynamics and

(LV) function after MV repair.

OBJECTIVES

1.To compare effect of different methods of annuloplasty to the mitral anulus dynamics and MV

function.

2.To compare suture annuloplasty and rigid ring annuloplasty effects to LV function.

METHODS

Prospective randomized study, started in 2009. The population consisted of 45 patients with

DMR, referred to our institution for MV repair. The participants of the study were prospectively

randomized in 2 groups: suture annuloplasty group and rigid ring annuloplasty group.

Echocardiographic evaluation included conventional measurements and the assessment of LV

global longitudinal, radial and circumferential strain by speckle tracking analysis. Preoperative

echocardiography was performed 1 day before surgery. The same evaluation was repeated within

5 days after operation (short-term follow-up) and after 6 months. Mitral valve repair

(valvuloplasty) was accompanied by suture annuloplasty or rigid ring insertion (randomized

before surgery). The normal distribution of each variable was assessed using the Kolmogorov-

Smirnov test. Comparisons of repeated measurements were performed with the Friedman test.

Wilcoxon signed rank test was performed for comparisons within groups. A p value <0.05 was

considered statistically significant. Statistical analyses were performed using the Statistical

Package for Social Sciences, version 17.0 (SPSS, Chicago, Ill).

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RESULTS

Of the 45 patients, 21 underwent MV repair with suture annuloplasty and 24 repair with rigid

ring. Their mean age was 57,7±8,2 years. MV annulus diameter decreased from 38,7±4,1mm

(before operation) to 25±3,0mm (after 6 months) in Suture group and from 39,6±3,2mm to

26±1,8mm in Ring group, p<0,05. MV regurgitation decreased from 3,45±0,62à0,95±0,3

(Ring) and from 3,33±0,5à0,9±0,3 (Suture), p<0,05. MV annulus diameter (sagittal) after 6

month was smaller in Suture group than in Ring group (38,7±4,1à25±3mm vs

39,6±3,2à26±1,8mm, p<0,05). Significant decrease of left ventricle ejection fraction (LVEF)

was noted immediately after surgical repair (p<0,001), but at 6 month follow-up LVEF showed a

significant improvement (p<0,001), but did not return to baseline values (p<0,001). After 6

month LVEF in Suture group was 47,33±9,27%, in Ring group - 46,58±10,93%. Longitudinal

and Radial strains in septum, lateral, anterior and inferior walls were higher in Suture group then

in Ring group, p<0,05. Mean of longitudinal, radial and circumferential strains in all walls was

also significantly higher in Suture group, p<0,05. ROC analysis – annuloplasty with rigid ring

will worsen contraction of the LV basal segments 6 months after operation (odds ratio 19,0 [95%

PI]).

CONCLUSIONS

1. Different methods of annuloplasty resulted in significant reduction of mitral annulus

diameter and degree of MV insufficiency 6 months after surgery.

2. Suture annuloplasty has less negative effect on LV basal segments contractile function

compared to rigid ring annuloplasty, provides more favorable mitral annulus dynamics and

preserves LV function.

REFERENCES

1. Enriquez-Sarano M, Avierinos J-F, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V,

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et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. The

New England journal of medicine [Internet]. 2005 Mar 3 [cited 2012 Feb

18];352(9):875–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15745978.

2. Witkowski TG, Thomas JD, Delgado V, Van Rijnsoever E, Ng ACT, Hoke U, et al.

Changes in left ventricular function after mitral valve repair for severe organic mitral

regurgitation. The Annals of thoracic surgery [Internet]. 2012 Mar [cited 2013 Feb

18];93(3):754–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22296981.

3. De Agustín JA, Pérez de Isla L, Núñez-Gil IJ, Vivas D, Manzano M del C, Marcos-

Alberca P, et al. Assessment of myocardial deformation: Predicting medium-term left

ventricular dysfunction after surgery in patients with chronic mitral regurgitation. Revista

española de cardiología [Internet]. 2010 May [cited 2013 Feb 18];63(5):544–53.

Available from: http://www.ncbi.nlm.nih.gov/pubmed/20450848.

4. Reisner SA, Lysyansky P, Agmon Y, Mutlak D, Lessick J, Friedman Z. Global

longitudinal strain: a novel index of left ventricular systolic function. Journal of the

American Society of Echocardiography  : official publication of the American Society of

Echocardiography [Internet]. 2004 Jun [cited 2013 Nov 18];17(6):630–3. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/15163933.

5. Pandis D, Grapsa J, Athanasiou T, Punjabi P, Nihoyannopoulos P. Left ventricular

remodeling and mitral valve surgery: prospective study with real-time 3-dimensional

echocardiography and speckle tracking. Journal of Thoracic Cardiovascular Surgery

[Internet]. 2011 Sep [cited 2013 Feb 18];142(3):641-9.

6. http://www.ncbi.nlm.nih.gov/pubmed/21277588

6. R-R MULTIPLE SCLEROSIS IN LITHUANIA: COMPARISON

BETWEEN AMOUNT OF VITAMIN D IN PERIPHERAL BLOOD

AND SEVERITY OF MULTIPLE SCLEROSIS

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Authors: Indrė Beketovaitė; Justina Mikšaitė; Antanas Strazdas

Supervisor of the abstract: Gyd. Lina Malcienė

INTRODUCTION

MS is a chronic,immune-mediated and incapacitating disease.Variety interactions between

genetic factors,and enviroment factors such serum vitamin D level, can be associated with

increased susceptibility to MSAs studies shown, adequate level of vitamin D can give

immunomodulatory protective effect on the brain,by influencing regulatory T lymphocyte cells,

whose role is well known in the pathogenesis of the disease.

AIM

To find out, how Vitamin D status predicts new brain magnetic resonance imaging

OBJECTIVES

To evaluate the associations between poor vitamin D status and: MS cognitive impairment, lower

scores on MS disability tests, regulatory T-cells activity and production of anti-inflammatory

cytokines, changes in MRI.

METHODS

We analyzed 150 Relapsing Remitting (RR) MS patients from 3 MS centers: Klaipėda

University Hospital; East-Tallinn Central HospitalDepartment of and Riga Maritime

center.Blood serum samples were analyzed for total vitamin D by electrochemiluminescence

immunoassay method,( analyser – „Cobas e411“) and foor CD4/CD8, by Flow citometry.

Cognitive functions impairment were analysed using PASAT scale. Disability status was

quantified using EDSS.

RESULTS

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Median disease duration was 9.52±3.54 year.

Vitamin D serum levels were lower in R-R MS patiens (24.99±13.03) in R-R MS patiens during

exacerbation in comparison with remission (25,53±10.89)

Long disease duration with vitamin D levels lower than 15nmol/l were associated with extremly

lower cognitive function disability status (according PASAT test)

Relapse activity has also been related to vitamin D status lower that 75nmol/l: during

relapse,lower serum 25(OH)D levels have been reported, when compared to remission of MS.

Cases with higher disability (EDSS>3) were more likely to have vitamin D level lower than

75nmol/l.

CONCLUSIONS

The results of our study suggest that MS patiens with adequate amount (≥75nmol/l)of circulating

vitamin D level, had better scores on disease activity and disability status (acc EDSS),better

regulated T cells compartment,lower relapse rate (≤1 per year)and better cognition impairment

results (acc PASAT test), compared with MS patiens group with vitamin D levels lower than

75nmol/l.

REFERENCES

1. Mowry EM, Waubant E, McCulloch CE, Okuda DT. Vitamin D status predicts new brain

magnetic resonance imaging activity in multiple sclerosis. Ann Neurol. 2012 Aug;72(2):234-

40.Available from:

http://www.ncbi.nlm.nih.gov/m/pubmed/22926855

2. Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the

pathogenesis of multiple sclerosis. Ther Adv Neurol Disord. 2013 Mar;6(2):81-116. Available

from:

http://www.ncbi.nlm.nih.gov/pubmed/23483715

3.Carlson NG, Rose JW. Vitamin D as a clinical biomarker in multiple sclerosis. Expert Opin

Med Diagn. 2013 Feb 19. Available from:

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http://www.ncbi.nlm.nih.gov/pubmed/23480560\\

4.Pozuelo-Moyano B, Benito-Leon J. Vitamin D and multiple sclerosis. Rev Neurol. 2013 Feb

16;56(4):243-51. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/23400652

5.Zivadinov R, Treu CN, Weinstock-Guttman B, Turner C, Bergsland N. Interdependence and

contributions of sun exposure and vitamin D to MRI measures in multiple sclerosis. J Neurol

Neurosurg Psychiatry. 2013 Feb 5.Available from:

http://www.ncbi.nlm.nih.gov/pubmed/23385850

7. CHRONOTROPIC RESPONSE BY EXERCISE STRESS TESTING

Authors: Jelena Danilenko, Valentina Mihejeva. Riga Stradins University, the faculty of

medicine 6.course

Supervisor of the abstract: habilitated Doctor of Medicine, prof. Andrew Kalvelis

INTRODUCTION

Chronotropic incompetence, or the inability of the heart rate (HR) to increase normally with

exercise, has important diagnostic and prognostic associations. [1] Several measures of

chronotropic response exist, including:

1) Peak HR achieved with maximal exercise stress testing;

2) HR reserve, or the change in HR with exercise (peak HR with exercise minus resting HR);

3) Ability to achieve at least 85% of the maximum age-predicted HR;

4) Chronotropic index. A normal Chronotropic index should be approximately 1.0. An abnormal

Chronotropic index is defined as < 0,80. [3]

AIM

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To evaluate and compare with each other Chronotropic index and heart rate recovery, depending

on the patient’s sex, age, and presence of coronary artery disease (CAD) or CAD risk, BMI.

OBJECTIVES

1. Get acquainted with the literature on stress tests, mainly, Chronotropic response.

2. Compare the HR recovery and Chronotropic index with other stress testing data and patient’s

data.

3. To determine correlation between HR recovery and Chronotropic index with patient’s age,

Robinson index, CAD risk, exercise capacity and BMI.

METHODS

1. The study included 66 patients from 19 to 77 years, (19 women and 47 men) who were

hospitalized due to existing CAD or diagnostic purposes.

2. It was developed a special questionnaire, and were taken into consideration the stress test

data.

3. Heart rate recovery was calculated using the formula: maximal heart rate during exercise

minus 2 minutes after the cessation of stress.

4. Chronotropic index was calculated using the formula: (maximal HR during exercise – HR

rest) / (age-predicted HR – HR rest). Age-predicted HR (for men) = 220 – age. [3] Age-

predicted HR (for women) = 206 - 0.88 (age). [2]

5. Robinson index (RI) was calculated using the formula: RI = max. SF * max. Systolic AS/100.

[4]

6. CAD risk assessment was carried out using the Heart Score tables. [5]

7. Data were collected and statistically processed by Microsoft Excel 2003 and SPSS 20.0. The

Mann-Whitney test, Spearman rank correlation method was used for the comparison. Data are

described using the median, interquartile range (IQR), the confidence indicator - p (p <0.05 is

statistically significant.), R-Spearman's rank correlation coefficient.

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RESULTS

There is strong positive correlation between HR recovery and Chronotropic index (r = 0,608; p

<0,001). There is a negative correlation between recovery heart rate and patient’s age (r= - 0,27;

p = 0,026) and positive correlation with RI (r = 0,292; p = 0,017). HR recovery and Chronotropic

index were correlated with CAD risk by Score table, respectively (r = -0,446; p = 0,02) and (r = -

0,404; p = 0,037). There is strong positive correlation between Chronotropic index and exercise

capacity (MET’s) (r = 0,319; p = 0,009), and BMI (r = -0,343; p = 0,005). There was not

detected any difference in recovery heart rate (p=0,64), Chronotropic index (p=0,96) with CAD

or CAD risk, and also with sex, respectively (p = 0,218; p = 0,185).

CONCLUSIONS

1. Our findings show that recovery heart rate decreases with increasing age.

2. HR recovery was positive correlated with Robinson index.

3. Coronary artery dieses risk increases with decreasing HR recovery and Chronotropic index.

4. Chronotropic index increases with increasing exercise capacity.

5. Chronotropic index decreases with increasing patient’s obesity.

6. It has been found that recovery heart rate and Chronotropic index does not affect CAD

diagnosis or CAD risk group, and patient’s sex.

REFERENCES

1. Adabag AS, Grandits GA, Prineas RJ, et al. Relation of heart rate parameters during exercise

test to sudden death and all-cause mortality in asymptomatic men. Am J Cardiol 2008;

101:1437-43.

2. Gulati M, Shaw LJ, Thisted RA, et al. Heart rate response to exercise stress testing in

asymptomatic women: the st. James women take heart project. Circulation 2010; 122:130-7.

3. Kavita Sharma, MD, Priya Kohli, MD, and Martha Gulati, MD, MS, FACC, FAHA. An

Update on Exercise Stress Testing. Curr Probl Cardiol, May 2012.

4. Mintāle, I., Ērglis, A. Fiziskās slodzes testi. Metodiskie norādījumi, 2008.gads.

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5. http://www.escardio.org/communities/EACPR/toolbox/health-professionals/Pages/SCORE-

Risk-Charts.aspx

8. CHANGES IN AORTIC DIAMETER AFTER ENDOVASCULAR

ANEURYSM REPAIR

Authors: Justina Motiejūnaitė, Milda Dedelaitė

Supervisor of the abstract: dr. Antanas Jankauskas

INTRODUCTION

Computed tomography (CT scan) plays an important role in evaluation of aortic aneurysms

before and after endovascular repair. After endovascular aneurysm repair (EAR) a CT scan

should be performed in order to visualize the position of a stent graft, its integrity, endoleaks and

other complications. It is recommended to perform a CT scan 1, 6 and 12 months after

endovascular treatment (1). One of the criteria of successful EAR is the shrinkage of aneurismal

diameter months after treatment. The diameter should shrink, stabilize or increase less than 0.5

centimeters. One of the major EAR complications is an endoleak. The presence of an endoleak

correlates with aneurysm diameter enlargement as well as increased risk of aneurysm rupture

after EAR (2).

AIM

To evaluate the changes in arterial diameter as well as the presence of endoleaks in abdominal

and thoracic CT scans performed after EAR.

OBJECTIVES

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1. To assess the characteristics of follow – up CT scans (number of patients followed,

number of follow – up CT scans, time interval between CT scans) in the department of

radiology in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics.

2. To evaluate the changes in diameter of suprarenal part of the aorta, common iliac arteries,

internal and external iliac arteries as well as the maximum aneurysm diameter in CT

scans performed after EAR.

3. To evaluate the frequency of endoleaks in CT scans performed after EAR.

METHODS

A retrospective analysis of chest and/or abdomen CT data and case records of 16 patients (pts)

after EAR (collected from January 2010 to February 2013) was performed at the Radiology

department of Hospital of Lithuanian University of Health Sciences Kaunas Clinics. 75% of pts

were males and 25% - females. Mean age of pts was 67 (10,7) years. Analyzed CT scans were

performed with 16-slice or 64-slice multidetector row CT scanner with or without injected

contrast agent. Slice thickness of reconstructed CT images was 2,5-1,25 millimeters (mm). Data

of 50 CT scans were evaluated and maximum aortic diameter, diameters of suprarenal aorta,

common iliac arteries, external and internal iliac arteries were measured by three independent

researchers. Diameter was calculated by measuring the maximum width of a blood vessel as well

as a perpendicular dimension to it, adding the numbers together and then dividing it by two.

Diameter change after EAR was evaluated by mm per time interval of 30 days. P-values <0.05

were considered to be statistically significant.

RESULTS

Emergency EAR was performed for 50% of pts and planned EAR was performed for the other

50%. 18,8% of pts received secondary EAR. Mean number of CT scans performed after EAR

was 3,1 (1,7). Mean follow-up was 13,8 (9,8) months.

During the first CT scan after EAR mean maximum aneurysm diameter was 64,9 (12,5) mm,

mean diameter of suprarenal aorta - 28,4 (2,9) mm, right common iliac artery - 29,4 (14,5) mm,

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left common iliac artery - 27,9 (12,1) mm, right external iliac artery - 14,3 (2,8) mm, left external

iliac artery - 14,2 (3,5) mm, right internal iliac artery - 15,3 (10,7), left internal iliac artery - 12,7

(2,6) mm. Maximum aneurysm diameter increased 0,39 (0,96) mm per month, diameter of

suprarenal aorta - 0,02 (0,57) mm per month, right and left common iliac arteries - 0,09 (0,39)

mm per month and 0,03 (0,34) mm per month, respectively. Diameters of right and left external

iliac arteries decreased 0,02 (0,28) mm per month and 0,13 (0,44) mm per month, respectively.

Diameters of right and left internal iliac arteries decreased 0,01 (0,32) mm per month and 0,05

(0,31) mm per month, respectively.

After EAR maximum aneurysm diameter decreased in 60% of pts, increased – in 33.3% of pts.

Diameter of suprarenal aorta decreased in 33.3% of pts, increased – in 66,7% of pts. Diameter of

right common iliac artery decreased in 80% of pts, increased – in 20% of pts. Diameter of left

common iliac artery decreased in 53,3% of pts, increased – in 33,3% of pts. Diameter of right

external iliac artery decreased in 53,8% of pts, increased – in 46,2% of pts. Diameter of left

external iliac artery decreased in 42,9% of pts, increased – in 57,1% of pts. Diameter of right

internal iliac artery decreased in 42,9% of pts, increased – in 57,1% of pts. Diameter of left

internal iliac artery decreased in 35,7% of pts, increased – in 64,3% of pts. Statistically

significant (p<0,05) reduction of arteries‘ diameter was found in 46,7% of pts, increase - in

53,3% of pts. Reduction of arteries‘ diameter more commonly occured in females than males

(p=0,038).

Endoleaks occured in 43.8% of pts after EAR. 71,4% of pts had type 2 endoleak, 14,3% of pts

had type 1B endoleaks and 14,3% of pts had type 1A and 1B endoleaks. Correlation between

enlargement of the arteries and presence of endoleak was found to be insignificant.

CONCLUSIONS

1.On average, a follow-up CT scan after EAR is performed yearly. Each patient undergoes

averagely three CT scans after EAR.

2.Maximum aneurysm diameter increased after EAR, as well as diameters of suprarenal aorta

and common iliac arteries. However, the diameters of both internal and external iliac arteries

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decreased (as estimated by millimeters per time interval). An overall increase tendency was also

found as estimated by percentage.

3.Endoleak is a frequent complication after EAR.

REFERENCES

1. Harris P. et al. Longitudinal aneurysm shrinkage following endovascular aortic aneurysm

repair: a source of intermediate and late complications. Department of vascular surgery of

Royal Liverpool University Hospital, United Kingdom; 1999.

2. Janušauskas T. Pilvinės aortos aneurizmų chirurginio gydymo rezultatai: gretutinių ligų ir

demografinių bei chirurginių veiksnių įtaka ir vertinimas. [Doctoral dissertation] Vilniaus

universitetas; 2011. 34 p.

9. THE PROGNOSTIC VALUE OF DIASTOLIC

FUNCTION ASSESSMENT IN LEFT VENTRICLE DYSFUNCTION

PREDICTION IN PATIENTS WITH ACUTE MYOCARDIAL

INFARCTION

Author: Simonita Mačiulskytė

Supervisor of the abstract: Diana Žaliaduonytė-Pekšienė

INTRODUCTION

Acute myocardial infarction (MI) results in reduced ejection fraction (EF) which is considered

one of the major determinants of cardiac mortality among survivors of MI. In addition, studies

show an upturn in mortality occurring at EF values of < 45%. Therefore, timely assessment of

left ventricle (LV) dysfunction is a relevant diagnostic tool. Many recent studies imply that

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pulsed wave Doppler imaging and pulsed tissue Doppler echocardiography (TDE) are valuable

techniques for assessment of left ventricle (LV) function.

AIM

To investigate whether LV diastolic function parameters assessed by pulsed wave Doppler

imaging and pulsed TDE can predict LV systolic dysfunction related to the first acute

myocardial infarction.

OBJECTIVES

1.To investigate the relation between echocardiographic parameters of diastolic function

measured by pulsed wave Doppler imaging and impaired LV systolic function within 4 months

after acute MI.

2.To investigate the relation between echocardiographic parameters of diastolic function

measured by pulsed TDE and impaired LV systolic function within 4 months after acute MI.

METHODS

The study covered 155 patients with acute MI. Conventional echocardiography including pulsed

wave Doppler imaging and pulsed TDE was performed within 48 hours of admission and in 4

months after the symptoms of acute MI. Patients were divided into two groups – group 1 with

EF<45%, n= 33; (mean age 60.76±10.23 years) and group 2 EF>45%, n=122; (mean age

57.72±11.11 years). The groups did not differ in age, gender, MI localization, traditional

cardiovascular risk factors (hypertension, dyslipidemia, obesity, smoking, diabetes). No patients

had severe valvular disease and all were on sinus rhythm.

RESULTS

The patients of group 1 had significantly higher leukocytes levels on admission (12.4±4.6 x109/L

vs. 9.9±3.0x109/L; p<0.001) than group 2 patients. No statistically significant difference was

detected of troponin I and CRP levels between the two groups. Patients with EF<45% had a

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significantly higher wall motion score index (1.7±0.4 vs. 1.5±0.3; p<0.001) and end-systolic

volume (46.3±15.1 mL vs. 38.5±12.7 mL; p=0.004) than patients with EF>45%. The other

conventional echocardiographic parameters did not differ between group 1 and group 2. Group 1

patients had a shorter deceleration time (DT) (147±34 ms vs. 179±40 ms, p<0.001) and lower

mitral annular systolic motion velocity (S') (6.3±2.1 cm/s vs. 7.2±2.1 cm/s, p=0.04) than patients

of group 2. Other parameters of diastolic function did not differ between the groups: E wave (65

cm/s±13 vs. 64±15 cm/s, p>0.05), A wave (67±17 cm/s vs. 65±16 cm/s, p>0.05), E/A ratio

(1.01±0.37 vs. 1.04±0.34, p>0.05), E’ (6.6±1.6 cm/s vs. 7.0±1.9 cm/s, p>0.05), A’ (8.3±2.1 cm/s

vs.8.9±1.6 cm/s, p>0.05).

CONCLUSIONS

Shortened deceleration time measured by pulsed Doppler imaging and mitral annular systolic

motion velocity measured by pulsed tissue Doppler imaging might be useful as prognostic

predictors of impaired systolic function after acute myocardial infarction.

REFERENCES

1.Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the Evaluation of Left

Ventricular Diastolic Function by Echocardiography. European Journal of Echocardiography

(2009) 10, 165–193.

2.Dalane W. Kitzman, MD; William C. Little, MD. Left Ventricle Diastolic Dysfunction and

Prognosis. Circulation. 2012;125:743-745

3.Akdemir O, Dağdeviren B, Yildiz M, Gül C, Sürücü H, Ozbay G. Specific Tissue Doppler

Predictors of Preserved Systolic and Diastolic Left Ventricular Function after an Acute Anterior

Myocardial Infarction. Jpn Heart J. 2003 May;44(3):347-55

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10. CLINICAL PROBLEMS IN THE USAGE OF NOVEL AND OLD

GENERATION ORAL ANTICOAGULANTS IN PATIENTS WITH

ATRIAL FIBRILLATION IN LATVIA

Author: Baiba Lurina

Supervisor of the author: Assoc. prof. Oskars Kalejs

INTRODUCTION

Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia, occurring in

1–2% of the general population. (1) The Framingham Study showed AF as an independent risk

factor for stroke. (3) Anticoagulants used for antithrombotic prophylaxis in patients with

nonvalvular atrial fibrillation include old generation oral anticoagulants (OAC) vitamin K

antagonists (VKA) and novel oral anticoagulants (NOAC) direct thrombin inhibitors and oral

factor Xa inhibitors. (2) Old generation OAC have been first line medication for a long time

although the usage of VKA cause a lot of problems for patients and physicians. Novel OAC

promise to solve those problems. Despite large clinical studies and publications implementation

of NOAC is undergoing slowly in Latvia. Therefore it was important to compare and analyse

advantages and disadvantages of both OAC groups from the physicians’ and patients’ point of

view to determine possible benefits and losses of NOAC and their chances to widely enter the

Latvian pharmaceutical market.

AIM

To analyse the main problems of the OAC clinical usage by patients with nonvalvular AF and by

professionals treating them.

OBJECTIVES

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1. To analyse clinical problems associated with OAC side effects and interactions, awareness of

patients, complexity of OAC usage from patients perspective.

2. To find out the main difficulties during the choice of OAC and the beginning of the OAC

therapy, patient care and communication from physicians point of view.

3. To statistically analyse data and compare results between VKA and NOAC groups.

METHODS

The study enrolled 103 patients with nonvalvular AF under OAC therapy at Pauls Stradins

Clinical University Hospital, Riga, Latvia. Second study group included 101 medical practitioner

with clinical experience in treatment and care of nonvalvular AF patients, applying OAC.

Questionnaire was used for primary data collection. Programs used for statistic data analysis-

IBM SPSS Statistics 20.0, Microsoft Office Excel 2007.

RESULTS

In patients group there were 82,5% users of VKA and 17,5% users of NOAC. In NOAC group

100% users were prior cardioversion (p<0,001). Statistically significant (p<0,05) higher

incidence of bleeding and hemorrhage episodes was by VKA users. In VKA group only 20% of

patients followed the interaction of active substances with OAC, 25,9% were informed enough

about this aspect. By VKA users 68,2% had difficulties to keep the INR between 2 and 3 and

31,8% had problems to regularly control the INR. Reasons for the insufficient INR control were

mostly problems with logistics (27,8%) and state of health (25,0%).

In physicians group 48,5% did use NOAC in their practice and 81,3% of physicians who did not

prescribe/prescribed NOAC rarely, were willing to do it more often. High costs (66,3%) and not

sufficient clinical experience (21,8%) were mentioned as main problems for NOAC. According

to physicians the main problems for VKA are lack of understanding and cooperation from

patients (34,7%), poor INR control (28,7%) and difficulties in dose adjustment (26,7%). Before

the beginning of the OAC therapy physicians mostly (>50%) considered thrombembolic events

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in medical history, the age of the patient, vascular diseases, patients’ compliance and financial

situation.

CONCLUSIONS

1.Clinical usage of OAC is more complicated in VKA group due to side effects, complexity of

use and lack of information.

2.Physicians find the usage of NOAC less problematic and they would be ready to use NOAC in

practice more often if the finansial issues were solved.

3.Before the beginning of the OAC therapy among physicians thrombembolic and bleeding risk

factors are not considered enough, preferring social aspects of drug use.

REFERENCES

1. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the

management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of

the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-429.

2. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused

update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010

ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33(21):2719-47.

3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke:

the Framingham Study. Stroke. 1991;22(8):983-8

11. THE EFFICACY OF INTRAHOSPITAL TREATMENT OF

HYPERTENSIVE CRISIS IN RIGA STRADINS CLINICAL

UNIVERSITY HOSPITAL, 2012

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Author: Irina Gultjajeva

Supervisor of the abstract: asoc.profesore Antoņina Sondore

INTRODUCTION

Hypertension has become a serious social and medical problem as its progression is associated

with functional and structural vascular, cardiac, etc. changes affecting primarily the heart,

kidneys, brain and leads to premature morbidity and mortality.

AIM

The aim of study was to evaluate the therapeutic effectiveness of the treatment methods, used in

prehospital stage and in P.Stradins clinical university hospitals’ Cardiology Clinics for patients

with hypertensive crisis.

OBJECTIVES

To investigate the effectiveness of the treatment methods of hypertensive crisis in prehospital

stage; to investigate the clinical characteristic of hypertensive crisis in patients entering hospital

and blood pressure dynamics during continued treatment; to determine the demographic data; to

determine the influence of co-existing disease on the development of hypertensive crisis; to

investigate the methods and guidelines of P.Stradins clinical university hospitals’ cardiology

clinic for treatment of hypertensive crisis.

METHODS

Hospitalized patient’s records analysis, completing and compilation of results. Data processing

and statistical analysis with MS Excel, StatPlus 2009 and SPSS Statistics program.

RESULTS

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The average age of the hospitalized patients were 73 ± 11yrs. for women and 64 ± 15yrs.- for

men. 68% of women and 53% of men regularly were taking antihypertensive therapy, 17% of

women and 8% of men used them occasionally, 15% of women and 39% of men – not used at

all.

During prehospital stage for the treatment of hypertensive crisis nitroglycerin medications were

used in 36% of cases, calcium channel blockers (CCB) – in 12%, MgSO4 – in 12%, the central

antihypertensives – in 37%, beta-blockers (BB) – in 10%, diuretics – in 12%. A good therapeutic

effect was achieved within 1-2 hours in 30% of cases (BP decreased for 25% as compared with

initial level), in 70% of patient BP decreased for more than 25%, which led to transport patients

urgently to the hospital. The average blood pressure (BP) was 203/108 ± 27/16 mm Hg.

The main complaints of patients were headache (21% women, 27% men); chest pain (20%

women, 27% men); the chest discomfort (17% women, 6% of men); nausea (14% women , 7%

of men); the vomiting (4% of women and 5% men); weakness (11% women, 12% men);

dizziness (21% women, 29% men); dyspnea (21% women, 19% men). The most often detected

cardiovascular complications and co-morbidities were chronic heart failure (50%), atrial

fibrillation (10%), cerebrovascular disorders (5%), cardiac asthma (5%), diabetes (25%),

dyslipidaemia (37%), impaired glucose tolerance(6%).

Hypertensive emergency (BP> 180/120mm Hg, maximum BP - 290/170 mm Hg) was in 25% of

pts, diastolic BP reached> 130mmHg in 9% of pts. Hypertensive urgency was in 75% of cases

(average BP 195/101 ± 23/9 mmHg). Treatment was as the following: nitroglycerin medications

– in 19%, CCB – in 32%, MgSO4 – in 8%, the central antihypertensives – in 4%, diuretics – in

12%, BB –in 11% of pts. Hypertensive EMERGENCY (50 patients) was treated by

conventional clinical protocol: as soon as possible (for a maximum during 1 hour) parenteral

drugs were used: S. Enap 1.25mg, 1.0, S.Magnesii sulphate 25% -10.0, 0.1% S.Nitrocini -10.0,

S. Chlophasolini 0.15mg-1.0. The desired therapeutic effect was achieved within 2 hours.

Hypertensive URGENCY(150 patients) were treated (in the accordance with the guidelines and

protocols) during 2-12 hours, usually with oral antihypertensive agents (T.Lusopress 20 mg,

T.Corinfar 20 mg, T.Nitrocor 0.5mg, T.Chlophasolini 0.15mg). BP reduction goal was to reduce

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the average BP>25% from the initial level (<120mmHg). So, the emergency

group patients got the statistically reliable average BP decrease by 21.1% (P <0.05) with

S.Nitrocini i / v, reaching in an average BP 119.5 ± 11 mm Hg; in urgent HC patients group

(n=150) the decrease of BP by 24.9% (P <0.05) with the tablets Lusopress + S. Nitrocini (10

mg i / v with perfusor) was obtained in 18 patients, by 22.8% with T.Lusopress + S.Magnesii

sulphate 25% (5 ml i/v)- in 21 patients.

After the therapy, the average BP decreased to an average level of 159/90 ± 30/16 mmHg, and at

the time of discharge it was in average of 137/81 ± 16/10 mm Hg.

The average hospitalization time was 4.5 ± 2.5 days (from 1 to 14 days).

CONCLUSIONS

1. In the prehospital stage hypertensive crisis was treated mainly with nitroglycerin

medications,calcium channel, MgSO4 ,the central antihypertensives, beta-blockers, diuretics. A

good therapeutic effect was achieved within 1-2 hours in 30% of cases. In prehospital stage

using of parenteral therapy reduced the average BP to 21,41% ,but using of enteral therapy the

average BP was reduced by 19.85.

2. The main complains in patients with the average BP >220/110 mmHg were severe headache,

nausea, vomiting. In patients with BP <200/100 mm Hg clinical signs were less developed.

3. It was found that women suffer from arterial hypertension more than men, and they are

hospitalized two times more with a diagnosis "hypertensive crisis".

4. Hypertensive crisis was associated with the following co-morbidities and pathological

conditions: diabetes, chronic kidney disease, cerebral perfusion disorders, dyslipidemia, impaired

glucose tolerance.

5. Management of emergency HC patients group produced statistically reliable decrease of the

average BP by 21.1%; treatment of urgent HC patients resulted in decrease of BP by 24.9%.

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REFERENCES

1. Rīgas iedzīvotāju sirds un asinsvadu slimības un to riska faktori (izplatība, savstarpēja

saistība, ekonomiskie zudumi). Latvijas Kardiologijas Institūts. Rīga, 2000, lpp. 5-37.

2. Sever PS, Messerli FH. Hypertension management 2011: Optimal combination

therapy. Eur H J, 2011; 32: 2499-2506.

12. THE IMPACT OF UNCORRECTED MILD AND MODERATE

ISCHEMIC MITRAL REGURGITATION DYNAMICS ON LEFT

VENTRICULAR FUNCTION FOLLOWING CORONARY ARTERY

BYPASS GRAFTING

Authors: Vytautas Augustinavičius, Dovilė Rimkevičiūtė, Justina Motiejūnaitė

Supervisors of the abstract: prof. J.J. Vaškelytė, prof. Š. Kinduris

INTRODUCTION

Ischemic mitral valve is the third most common cause of mitral regurgitation (MR). It is possible

to predict the progression of MR following ischemic mitral valve repair. Ischemic mitral valve

surgery is associated with a relatively high perioperative morbidity and mortality, but if it is not

corrected during coronary artery bypass grafting (CABG), it can lead to further left ventricle

remodeling and progression of cardiac insufficiency. Therefore, it is important to reveal the

predictors of mitral regurgitation progression following CABG without mitral valve surgery and

assess the resulting changes of late postoperative left ventricle (LV) morphometric and

functional parameters.

AIM

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To evaluate the influence of uncorrected ischemic mitral regurgitation on left ventricle size,

systolic function, left atrial diameter and pulmonary artery pressure changes.

OBJECTIVES

1. Evaluate LV size and systolic function dependence on mitral regurgitation progression

2. Reveal whether preoperative LV functional and morphometric parameters can help predict

mitral regurgitation progression

METHODS

The study population consisted of 79 patients with ischemic heart disease and ischemic MR (I-II

grade). All patients underwent conventional multivessel CABG without MR correction at

Hospital of Lithuanian University of Health Sciences Kaunas Clinics. CABG was performed

using autoveins or internal thoracic arteries. Study protocol included evaluation of two-

dimensional Doppler echocardiographic preoperative and late postoperative examinations.

Patients were divided into three groups according to mitral regurgitation changes: group 1 – MV

regurgitation grade increased, group 2 – MR grade did not change, group 3 – regurgitation grade

decreased. All data were expressed as mean ± standard deviation and compared with Student’s t-

test. A P-value of <0.05 was considered statistically significant. Multivariate ANOVA was used

to determine the relationships between preoperative and postoperative echocardiographic

variables.

RESULTS

The mean age of patients - 65,77±2,47 years, male – 49 (62,0%), female – 30 (38.0%). The

mean duration of observation – 3,78±0,27 years, at least 2 years. In group 1 (n=27, 34,2%) left

ventricular end-diastolic diameter (LVEDD) increased significantly by 3,611 mm (p=0,007), LV

end-diastolic diameter index (LVEDDi) increased by 1,877 mm/m2 (p=0,006), myocardium

mass index (MI) increased by 4,85 g/m2 (p=0,208), relative wall thickness (RWT) decreased by

0,055 (p=0,009), left ventricle ejection fraction (LVEF) decreased by 5,37% (p=0,013), left

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atrium diameter increased by 5,904 mm (p<0,001), wall motion score (WMS) index increased by

0,017 (p=0,875), mean pulmonary artery pressure increased by 5,837 mmHg (p=0,238).

In group 2 (n=31, 39.2%) LVEDD increased by 1,681 mm (p=0,116), LVEDDi increased by

0,767 mm/m2 (p=0,166), myocardium MI increased by 1,094 g/m2 (p=0,787), RWT decreased

by 0,021 (p=0,224), LVEF decreased by 1,677% (p=0,318), left atrium diameter increased by

2,821 mm (p=0,023), WMS index decreased by 0,07 (p=0,381), mean pulmonary artery pressure

increased by 6,65 mmHg (p=0,140).

In group 3 (n=21, 26.6%) LVEDD increased by 1,824 mm (p=0,244), LWEDDi increased by

1,185 mm/m2 (p=0,115), myocardium MI decreased by 1,73 g/m2 (p=0,761), RWT decreased

by 0,046 (p=0,019), LWEF increased by 2,143% (p=0,28), left atrium diameter increased by

2,535 mm (p=0,04), WMS index decreased by 0,147 (p=0,146), mean pulmonary artery pressure

decreased by 2,755 mmHg (p=0,491).

Comparing preoperative Doppler echocardiographic examination data, there was no statistically

significant difference among all three groups ((LVEDD (p=0,919), LVEDDi (p=0,454),

myocardium MI (p=0,855), RWT (p=0,841), LVEF (p=0,704), left atrium diameter (p=0,136),

WMS index (p=0,625)).

CONCLUSIONS

1.Progression of uncorrected mitral regurgitation impacts left ventricle enlargement and

impairment of left ventricular systolic function.

2.Preoperative left ventricle functional and morphometric parameters cannot predict late

postoperative mitral regurgitation progression.

REFERENCES

1.Sá MP, Soares EF, Santos CA et al. Mitral valve replacement combined with coronary artery

bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation. Rev Port

Cardiol. 2013 Feb;32(2):131-7.

2.Mikuckaite L, Vaskelyte J, Radauskaite G, Zaliunas R, Benetis R. Left ventricular remodeling

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following ischemic mitral valve repair: predictive factors. Scand Cardiovasc J. 2009

Feb;43(1):57-62.

13. LONG TERM RESULTS OF CORONARY ARTERY BYPASS

GRAFTING WITH UNCORRECTED MILD AND MODERATE

MITRAL REGURGUTATION

Authors: Justina Motiejūnaitė, Dovilė Rimkevičiūtė, Vytautas Augustinavičius

Supervisor of the abstract: prof. J.J. Vaškelytė, prof. Š. Kinduris

INTRODUCTION

Ischaemic mitral regurgitation (MR) is a consequence of advanced coronary artery disease

(CAD) with left ventricular (LV) remodeling. There is plenty of evidence that uncorrected MR

can cause greater late postoperative mortality even after successful coronary artery bypass

grafting (CABG). Thus the importance of management of severe MR is evident. However, the

correction of mild and moderate MR is still a debatable question. Uncorrected ischaemic MR

might cause further LV remodeling, as well as pulmonary hypertension and cardiac

insufficiency.

AIM

To evaluate changes of LV and left atrial (LA) functional and morphometric parameters as well

as MR alterations after CABG without MR correction.

OBJECTIVES

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1.To evaluate the changes of LV and LA parameters after CABG in patients with mild and

moderate MR.

2.To evaluate the influence of restored myocardial perfusion on ischaemic MR regression.

METHODS

The study population consisted of 79 patients with CAD and ischemic MR (grade I-II). All

patients underwent conventional CABG without MR correction at Hospital of Lithuanian

University of Health Sciences Kaunas Clinics. CABG was performed using autoveins or internal

thoracic arteries. Study protocol included evaluation of two-dimensional Doppler

echocardiographic preoperative and late postoperative examinations. All data were expressed as

mean and confidence interval and compared using Student’s t-test. Multivariate ANOVA was

used to determine the relationship between preoperative and postoperative echocardiographic

variables. A P-value of <0.05 was considered statistically significant.

RESULTS

The mean age of patients was 65,77±2,47 years, 49 (62,0%) were male and 30 (38.0%) female.

The mean duration of observation was 3,78±0,27 years (at least 2 years). Mean left ventricular

end-diastolic diameter (LVEDD) before CABG was 49,635±1,54 mm, after CABG -

52,014±1,369 mm, mean difference 2,378 mm (p=0,001). LV end-diastolic diameter index

(LVEDDi) before CABG was 24,922±0,831 mm/m2, after CABG - 26,179±1,304 mm/m2, mean

difference 1,257 mm/m2 (p=0,001). Myocardium mass index (MI) before CABG was

114,914±8,216 g/m2, after CABG - 116,543±2,975 g/m2, mean difference 1,629 g/m2

(p=0,516). Relative wall thickness (RWT) before CABG was 0,485±0,014, after CABG -

0,445±0,022, mean difference 0,0396 (p<0,001). Left ventricle ejection fraction (LVEF) before

CABG was 40,87±2,21 %, after CABG - 38,95±3,98 %, mean difference 1,924 % (p=0,088).

Left atrium diameter before CABG was 41,41±1,46 mm, after CABG - 45,24±2,14 mm, mean

difference 3,827 mm (p<0.001). Wall motion score (WMS) index before CABG was 1,66±0,11,

after CABG - 1,599±0,15, mean difference 0,061 (p=0,273). Mean pulmonary artery pressure

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before CABG was 24,26±3,36 mmHg, after CABG - 27,61±4,83 mmHg, mean difference 3,346

(p=0,190). MR grade increased in 27 (34,2 %) patients, remained the same in 31 (39,2 %)

patients and decreased in 21 (26,6 %) patients.

CONCLUSIONS

1.LV and LA functional and morphometric parameters in patients with mild and moderate MR

deteriorated moderately after CABG without MR correction.

2.Restored myocardial perfusion does not influence the regression of MR, as the grade of MR

increased in one third of the patients and did not change in one third of the patients as well.

REFERENCES

1.Sá MP, Soares EF, Santos CA et al. Mitral valve replacement combined with coronary artery

bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation. Rev Port

Cardiol. 2013 Feb;32(2):131-7.

2.Mikuckaite L, Vaskelyte J, Radauskaite G, Zaliunas R, Benetis R. Left ventricular remodeling

following ischemic mitral valve repair: predictive factors. Scand Cardiovasc J. 2009

Feb;43(1):57-62.

14. ISCHAEMIC MITRAL VALVE REGURGITATION AFTER

MYOCARDIAL INFARCTION

Author: Dominyka Urbonaitė

Supervisor of the abstract: Živilė Valuckienė

INTRODUCTION:

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Mitral valve regurgitation (MR) is a frequent Doppler echocardiographic finding in patients after

acute myocardial infarction (AMI) and an independent predictor of long-term cardiovascular

mortality. Reported risk factors include advanced age, prior myocardial infarction. Severity of

MR is associated with larger LV volumes and decreased LV function. The prevalence of

mitral regurgitation varies from 11% to 59%.

AIM:

To evaluate the incidence of mitral valve regurgitation (MR) after acute myocardial infarction

(MI), to determine clinical factors associated with significant MR (SMR) after MI and to

evaluate the impact of MR to in hospital mortality.

OBJECTS:

1) to determine the prevalence and incidence of SMR after MI;

2) to assess the impact of reperfusion therapy on manifestation of MR;

3) determine which risk factor have influence to SMR after MI (repetitive MI, type of MI,

localization of MI, hypertension, age, 3 vessel coronary artery disease (3 VD), sex, time from

the onset of chest pain, reperfusion therapy, left ventricular end diastolic diameter (LV EDD),

LV ejection fraction of (EF), myocardial mass index (MMI), increased troponin I (TnI) and

C-reactive protein (CRP);

4) to determine, if lethal outcomes during the hospitalization period are associated with SMR.

METHODS:

We performed retrospective analysis of medical records of all patients (890) who presented with

acute MI to Lithuanian University of Health Sciences (LUHS) Kaunas clinics from January 1st

2012 to December 31st 2012. 705 of patients were treated for the first ever MI, 185 – for

repeated MI. There were 583 men and 307 women. 46 patients died during the hospitalization

period. The documentation reviewed included discharge summaries, echocardiography

protocols, and coronary angiography ± percutaneous coronary intervention protocols

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wherever applicable. Only the patients with no structural heart valve abnormalities were

included in the study. χ2 (p<0,05) test was used for hypothesis testing.

RESULTS:

The mean age of the patients was 66 years. Significant (II-IV*) MR after MI was found in 200

subjects (22,5%). SMR manifestation after the first MI was 20%, after repeated MI – 32%.

However, the type of MI (transmural/ non transmural, reported on ECG) does not determine

the degree of IMR (Q- 16,6% vs Q+ 22,3%, p=0,07). There were 16,4% of patients with

significant ischaemic MR(SIMR) after anterior MI, 25,3% - after inferior MI, 0% - after

lateral MI, 27,3% - after posterior MI, 47,5% - after not indicated localization MI and 0% -

after anterior and inferior MI. SMR was present in 18,1% of patients treated with

percutaneous coronary interventions compared to 29,1% of patients who received

conservative treatment (p=0,003). Futhermore, IMR has influence on hospital outcomes: 46

patients died during the hospitalization, but we had echocardiographic data only of 35

patients: 63,6% of them had SMR compared with 19,8% - without it. We divided all the

patients into two groups: group I - patients with SMR, group II – without it and determined

risk factors which could have influence to SMR manifestation. Mean age in group I was 72

years, in group II - 63; the mean rank was higher in the first group: 444,95>300,91. The mean

of LV EDD in group I was 50,44 mm, in group II – 48,15 mm; respectively mean rank was:

380,88>312,43. The mean of MMI in group I was 118,87, in the other – 107,06; the mean

rank was higher in the first group: 387,70>295,88. The mean of LV EF in group I was 39%

and 44% - in the other, accordingly the mean rank was 246,78<347,31 (p<0,05). We found

out that 17% of men had SMR compared with 29% of women (p<0,05). There was correlation

between the appearance of SMR and the class of heart failure (HF): HF I class of Killip –

7,5% of patients had significant IMR; HF II cl. – 18,7%; HF III cl. – 52,1%; HF IV cl. –

51,4% (p<0,05). Meanwhile, obesity (17% vs 83%), dyslipidaemia (20% vs 80%), diabetes

(22% vs 78%), hypertension (22% vs 78%), tachycardia (33% vs 67%), increase of TnI (22%

vs 78%), time from the onset of chest pain (<6h – 19% vs 81%; 6-12h – 16% vs 84%; 12-24h

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– 15% vs 85%; >24h – 0% vs 100%) did not differ significantly between significant and non

significant MR groups (p>0,05). However, SMR renal failure significantly increases the risk

of SMR (36% vs 21%; p<0,05). Ischaemic insult also significantly increases the risk of SMR

appearance (41% vs 20%; p<0,05). Increase of CRP cause the SMR to 26% of patients

compared with 18% of those who had normal CRP. The presence of multivessel coronary

artery disease had correlation with SMR manifestation: 29% of patients who had 3 VD had

SMR compared with 19% of those who had 2 or less damaged vessels (p<0,05).

CONCLUSION:

The incidence of MR after MI was 94% (I-IV*). Incidence of significant (II-IV*) MR after MI

was found for 22,5% of patients. Risk factor associated with significant MR are: sex, age, HF,

ischaemic stroke, renal failure, CRP rise, increased LV EDD, increased MMI, decreased LV

EF, repeated MI 3 VD. Prior revascularization and type of MI (transmural/non transmural,

judged by ECG) do not predict the manifestation of IMR. Obesity, dyslipidaemia, diabetes,

hypertension, , tachycardia, increase of TnI, time from the onset of chest pain do no differ

between the 2 groups. With reference to our results, the localization of MI depends on the

degree of IMR, with significantly greater incidence of MR in inferior MI and MI with

unspecified localization. Reperfusion therapy reduces manifestation of significant MR. Lethal

outcomes during the hospitalization period are associated with significant MR.

REFERENCES:

1. Eur Heart J. 2007 Feb;28(3):326-33. Epub 2007 Jan 24.

2. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular

dysfunction, or both: prognostic significance and relation to ventricular size and function.

3. Amigoni M, Meris A, Thune JJ, Mangalat D, Skali H, Bourgoun M, Warnica JW, Barvik

S, Arnold JM, Velazquez EJ, Van de Werf F, Ghali J, McMurray JJ, Køber L,Pfeffer

MA, Solomon SD. Source: Brigham and Women's Hospital, Boston, Massachusetts,

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USA. maria_amigoni@libero.it

4. http://www.ncbi.nlm.nih.gov/pubmed/17251259.

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ENDOCRINOLOGY SECTION

1. DHEAS SECRETING ADRENAL INCIDENTALOMA

Authors: Justina Jureviciute, Indre Matuleviciute

Supervisor of the abstract: Valentinas Matulevicius

INTRODUCTION

An adrenal incidentaloma is a tumor found in adrenal glands accidentally without any clinical

symptoms or suspicion. It’s prevalence is increasing in parallel with visual techniques. Majority

of tumors detected are small and non-secretory, but large and secreting tumors are expected to be

surgically curable. Isolated hypersecretion of catecholamines, aldosterone or corticosteroids

manifest as well known diseases like pheochromocytoma, Conn’s disease and Cushing disease.

In contrast, hypersecretion of another major adrenal secretion product – DHEA– is not

considered a separate entity mainly because DHEAS is not a final secretion, but a precursor of

testosterone and estrogenes (1). Our case report represents that DHEA may be isolately secreted

by an adrenal tumor and is able to produce some clinical symptoms. Surgical removal of the

DHEA – secreting tumor should lead to decrease of DHEAS concentration and disappearance of

clinical symptoms.

AIM

The aim of this study is to find out if DHEA – secreting adrenal incidentaloma is common with

any kind of clinical symptoms.

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METHODS

An adrenal incidentaloma was found accidentally during ultrasound for 38-year-old woman,

enduring weight gain, amenorrhea, hirsutism, epileptic seizures. Hormone levels of ACTH,

cortisol, aldosterone, renin, metanephrine, normetanephrine were monitored, and high levels of

DHEAS and testosterone were found. CT scan showed a formation located in right adrenal

gland. Laparoscopic adrenalectomy was performed. Expecting tumor to be hormonally active

and producing high levels of DHEAS, hormone levels were monitored one day before, 2 hours

and 24 hours after the surgery.

CASE REPORT

A 38-year-old woman complaining of weight gain, amenorrhea, hirsutism, epileptic seizure

episodes was referred for consultation of an endocrinologist in suspicion of pheochromocytoma.

Large 6 – 8 cm right adrenal mass was detected during ultrasound. CT -scan confirmed the

presence of 5,8 x 4,6 cm right adrenal tumor. Blood hormone levels of AKTH, cortisol,

aldosterone, renin, metanephrine, normetanephrine were monitorated, and high levels of DHEAS

(28.7 µmol/l, when normal range was 11,5 µmol/l) and testosterone (20,6 nmol/l) were found.

Laporoscopic adrenalectomy was performed. Expecting tumor to be hormonally active and

producing high levels of DHEA, hormone levels were monitored one day before, 2 and 24 hours

and 1 month after the surgery. So before surgery LH and FSH were decreased (1,72 IU/l and

2,13 IU/l), prolactin, metanephrine, normetanephrine, renin, cortisol, AKTH and estradiol were

at normal level, but increased levels of DHEA-S (25,5 µmol/l), testosterone (20,6 nmol/l),

aldosterone (706 pmol/l) and 17-OH progesterone (4,38 nmol/l) were found. During

laporoscopic adrenalectomy, 137 g. tumor was removed. Blood hormone levels 2 hours after the

surgery showed decrease of DHEAS (6.67 µmol/l) and testosterone (9,96 nmol/l), becoming low

(DHEAS – 1,1 µmol/l, testosterone – 1,11 nmol/l) in 24 hours. Subsequently in 24 hours

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estradiol (141 pmol/l), AKTH (0,5 pmol/l), renin (<0,78 ng/l), cortisol (32 mmol/l) ,

methanephrine, normetanephrine also decreased, the later to the level of adrenal insufficiency. 1

month after surgery general health improved significantly, menses reappeared, seizures have not

appeared any more. DHEA-S, testosterone, estradiol were low normal, ACTH, cortisol,

aldosterone, LH and FSH methanephrine, normetanephrine returned to normal, and prolactin

slightly increased. Pathologic investigation revealed adrenal adenoma.

DISCUSSION

About 85 % of adrenal incidentalomas are non-secretory. Secretory adrenal incidentalomas are

these secreting glucocorticoids (Cushing disease), mineralocorticoids (hiperaldosteronism,

Conn’s disease), and cathecholamins (pheochromocytoma). All of these mentioned conditions

are known to manifest clinically. Although DHEAS is a major product of adrenal secretion,

DHEAS secreting tumors are rare and their clinical manifestations are not clearly defined.

Traditionally, high levels of DHEAS in adrenal incidentalomas are considered to be a sign of

malignancy and low values of DHEA-S in the blood are characteristic of benign tumors –

adrenal adenomas (1). In this clinical case DHEAS secreting tumor is described in a women in

normal reproductive health period with development of a tetrade of clinical symptoms:

amenorrhea, weight gain, hirsutism and epileptic seizures. Amenorrhea and hirsutism develop

because DHEAS is precursor of androgens (high testosterone was found), but epileptic seizures

appear due to central brain effects of DHEAS (2). Disappearance of epileptic seizures and

amenorrhea after adrenalectomy in our patient proves their genesis being directly related with

DHEAS hypersecretion. Today this case seems unique, but trivial presence in clinical practice of

amenorrhea, weight gain and hirsutism opens a new way for faster capture of new cases of

adrenal DHEAS secreting tumors by asking about seizures and adding determination of DHEAS

in these patients.

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REFERENCES

1. Ala A, Angeli A, Osella G, Reimondo G, Pia A, Peretti P, Paccotti P,Terzolo M,. The

value of dehydroepiandrosterone sulfate measurement in the differentiation between

bening and malignant adrenal masses. European Journal of Endocrinology 2000; 142;

611-617.

2. Dong Y, Zheng P. Dehydroepiandrosterone Sulphate: action and mechanism in the brain.

Journal of Neuroendocrinology 2012; 24; 215-224.

2. THE FEATURES OF FIRST DIAGNOSING AND INITIAL

TREATMENT OF TYPE 2 DIABETIC MALES THAT DO NOT

NEED TREATMENT OF INSULIN

Authors: Ilona Banišauskaitė, Justina Jurevičiūtė

Supervisor of the abstract: R. Ostrauskas

INTRODUCTION

The number of people with type 2 diabetes mellitus (T2DM) is increasing worldwide due to

population aging, urbanization, obesity and physical inactivity. The society in Lithuania is also

rapidly aging due to social and economic reasons, emigration of young people and low birth rate.

Epidemiological studies in Lithuania also show the increasing number of patients with T2DM.

T2DM is determined 85-95% of all-type diabetes cases.

AIM

The aim of the study – to assess the features of diagnostics of randomly selected and not treated

with insulin T2DM males.

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OBJECTIVES

1. To set the main circumstances of diagnosis of T2DM among Lithuanian males.

2. To determine the basis on which was appointed first-line therapy for newly onset T2DM

males.

METHODS

The object of investigation - males with newly diagnosed T2DM reported by forms No. 089-2/a

(“Announcement about a new case of diabetes mellitus”) of Lithuanian Ministry of health. The

retrospective study applying a non-repayable simple random sampling was done in 2012. The

789 reports from 800 randomly selected primary announcements (Lithuanian Ministry of Health

Forms No. 089-2/a) about newly detected T2DM males were evaluated. For the evaluation was a

selected case in which as primary treatment after detection of disease was prescribed diet

recommendations and/or treatment with oral hypoglycaemic drugs. The case-forms in which as

primary treatment of diabetes mellitus was administrated insulin were removed from the study.

Data clustering, calculation of frequency and average was performed with formulas recorded in

Microsoft Office Excel cells. Data for the study were processed using Statistica 8 for Windows

software and were analysed by descriptive statistics with frequency distribution and cross tabs

calculation. The significance level of two-sided 0.05 was chosen. The normality of distribution

was tested using the Kolmogorov - Smirnov test. Student‘s (t) criteria were used for comparison

of means for normal distributions. Percentage frequencies and 95% confidence intervals (95%

CI) as well as the means and their standard deviations (±SD) were calculated. The difference

between frequencies was checked using the chi-square (χ2) criterion. Correlations were analysed

using the mathematical model of linear regression analysis.

RESULTS

For analysis were selected 789 filled forms about newly detected T2DM males: 613 urban

(77.7%) and 176 (22.3%) rural inhabitants, p<0.05. The average age of the selected contingent at

the time of primary onset of T2MD was 58.9±10.6, and the average body mass index (BMI) -

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33.2±5.5 kg/m2. According to analysed forms, rural inhabitants were younger than urban

inhabitants (56.6±9.0 vs 59.6±8.5 years) (p<0.01), but the average of the their BMI of the

villagers was higher (34.3±4.1 vs 32.9±4.0 kg/m2) (p<0.002) than citizens. T2DM was most

often diagnosed in the sixth and seventh decade of life. Mathematical model of lineal regression

showed the inverse relation between the age of onset of T2DM and BMI (r= -0.252; p<0.001).

Obesity was recognised in 587 (74.4%; 95% CI 68.6-80.7) of selected males. Family history of

diabetes heredity had 185 or 26.3% 685 (95% CI 22.7-30.4). Information about diabetes

symptoms was found in 516 forms (64.4%; 95% CI 60.-71.3), while in the remaining 273 – this

information was not available. The most common symptoms were polyuria that was remarked in

186 forms (36.1%; 95% CI 31.2-41.6) and polydipsia – 184 (35.7%; 95% CI 30.9-41.2).

Treatment was planned considering to the values of glucose in the blood before meal and after

meal. Only diet was prescribed for 28 T2DM males (20.2%; 95% CI 13.9-29.20), only

biguanides for 180 (38.1%; 95% CI 32.9-44.0), and a sulfonylurea together with biguanides for

28 (54.9%; 95% CI 37.9-79.5).

The highest average of glycaemia, before the meal, was observed in males treated with

biguanides and sulfonylureas together (13.0±4.2 mmol/l). This average was significantly higher

than average of groups with other type of treatment (p<0.001). An average of glycaemia has no

significant difference in males treated only with biguanides or only with sulfanylureas.

An average of glycaemia of males treated only with diet was significantly lower (8.3±1.9

mmol/l) than in males treated only with biguanides (9.6±3.1 mmol/l) (p<0.001) or only with

sulfonylureas (9.7±3.4 mmol/l) (p<0.001).

The highest average of glycaemia after meal was observed in the group treated with biguanides

together with derivatives of sulfanylurea (15.0±3.2 mmol/l) and it is significantly higher than in

other groups (p<0.001 and p<0.01).

An average of glycaemia, of males without medical treatment, after meal 10.5±2.3 mmol/l and it

is significantly lower than in other group treated with only biguanides or only with sulfanylurea,

p<0.01.

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CONCLUSIONS

The initial choice of diagnosis and of primary treatment of type 2 diabetic males was associated

with blood glucose values, disease symptoms and body mass index.

REFERENCES

1. Butnorienė J, Norkus A, Šulcaitė R. The prevalence of type 2 diabetes mellitus, and other

disorders of carbohydrate metabolism in one region of the Republic of Lithuania. Problemy

Endocrinologii 2006;52:17-21.

2. IDF Diabetes Atlas. 5th edition. Diabetes. Available from: diabetes [accessed 21.02.2013 at

http://www.idf.org/diabetesatlas/5e].

3. Lesauskaite V, Macijauskiene J, Rader E. Challenges and opportunities of health care for the

aging community in Lithuania. Gerontology. 2006;52:40-44.

4. Marquess JG. The elderly and diabetes: an age trend and an epidemic converging. Consult

Pharm. 2008;23(Suppl B):5-11.

5. Whiting DR, Guariguata L, Weil C, Shaw J. Global estimates of the prevalence of diabetes for

2011 and 2030. Diabetes Res Clin Pract 2011;94:311-321.

3. REALIZATION AND EFFECTIVENESS OF THE DIABETES

PATIENT’S EDUCATION PROGRAM

Author: Inga Pūre, Riga Stradins University, Faculty of Medicine

Supervisor of the abstract: Ilze Konrāde, MD, Riga Stradins University

INTRODUCTION

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Diabetes is one of most widespread diseases in the world. In 2011 in Latvia were 75775 diabetes

patients, 486 deaths (23,6 of 100000 people) was associated with diabetes. Worldwide these

numbers are significant - 371 million patients and 4,8 million death cases in 2012. At the same

time everyday treatment of diabetes patients for 95% consists of their own work which makes

diabetes patients education program vital part of treatment and complication prevention,

independent of diabetes type or designated treatment and must be done as accurately as possible.

There are many studies in world that shows that diabetes education improves clinical outcome of

diabetes therapy and patient’s life quality, is cost-effective as well. However there are only few

data about practical realization, which identify failures and problems in realization of diabetes

education program which should be corrected.

AIM

The aim of this study is to evaluate diabetes patient’s education program in Latvia.

OBJECTIVES

1. Investigate the practical realization of diabetes patient’s education program and identify

failures.

2. Investigate effectiveness of the diabetes patient’s education program, associated with patient

knowledge about diabetes treatment and monitoring.

METHODS

In study 50 patients were involved (60% women) which were stationed in RAKUS clinic

“Gaiļezers”. Patients were interviewed about diabetes by questions which were made on basis of

diabetes patients training methodology description and principles of training methodology

described in literature in Latvia. Questionnaire contained questions about their education

program practical realization and test of knowledge as measurement of effectiveness in which

patients had a choice to answer questions themselves or with a help of multiple choice. Data was

processed with IBM SPSS Statistics 20 and MS Excel software.

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RESULTS

Average age of patients was 62,50 years but diabetes was diagnosed averagely 10,42 years ago.

Only 56% of surveyed patients at least once has had diabetes training. It is statistically valid that

involvement in training program depends on designated therapy (P<0,001) mostly involving

patients with insulin (88%) or combined therapy (66,7%), per-oral therapy only 14,3%. Mostly

training was conducted once (24%) or twice (12%). There is statistically valid connection

between patient education in program and overview of themes, that are mentioned in theory

(including themes about hypoglycemia and late complications due to diabetes) in time of training

(P < 0,021 in all themes and even less) except theme about lifestyle changes (P=0,441) which

were discussed independently from participation in education program.

Patients who have had training mark it positive – 89,3% think it is understandable, 75% think

that it helped to comprehend the disease and its treatment. Study points that conducting a training

improves patient knowledge (P=0,004 and less) compared to group without training.

CONCLUSIONS

1. Realization of the diabetes patient’s education program is deficient, involving only slightly

more than a half of patients, mostly the ones with insulin therapy and is not conducted

frequently enough.

2. Diabetes patient’s education program is effective, both from patient’s subjective evaluation

and objective assessment of level of their knowledge.

REFERENCES

1. Akermane R., Ārente L., Diabetes nurse specialty. Rīga: Nacionālais apgāds, 2009.

2. American Association of Diabetes Educators. Guidelines for the Practice of Diabetes Self-

Management Education and Training. Chicago: AADE, 2009.

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3. Brownson C.A., Hoerger T.J., Fisher B.E., Kilpatrick K.E. Cost-effectiveness of Diabetes

Self-management Programs in Community Primary Care Settings [Internet]. 2009 [cited 2012

Dec 17]. Available from: http://tde.sagepub.com/content/35/5/761.short

4. Disease prophylaxis and control center. Diabetes Mellitus: statistical data about number of

patients distributed in regions, age, gender, diabetes type, therapy, complication, clinical

investigation results 2007 – 2011. [Internet]. Riga: Disease prophylaxis and control center;

2012 [cited 2012 Dec 16] Available from: http://www.spkc.gov.lv/veselibas-aprupes-statistika

5. IDF Diabetes Atlas, 5th edition, 2012 update [Internet]. 2013; [cited 2012 Dec 16]. Available

form: http://www.idf.org/sites/default/files/5E_IDFAtlasPoster_2012_EN.pdf

6. Konrade I., Diabetes Patients Education program [Internet]. Riga: VMNVD; 2010 [cited 2012

Dec 14] Available from: http://www.vmnvd.gov.lv/lv/datu-bazes/rstniecb-izmantojamo-

medicnisko-tehnoloiju-datu-bze/2-internas-medicinas-un-funkcionalas-diagnostikas-

mediciniskie-pakalpo-jumi/228-pielikumi-izverstie-mediciniskas-tehnologijas-metodes-

apraksti-un-citi-materiali/cukura-diabeta-pacientu-apmaciba

7. Moriyama, M., Nakano, M., Kuroe, Y., Nin, K., Niitani M,. Nakaya, T. Efficacy of a self-

management education program for people with type 2 diabetes: results of a 12 month trial

[Internet]. 2009; [cited 2012 Dec 18]. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/19566639

8. Norris, S.L., Engelgau, M.M, Venkat Narayan, K.M. Effectiveness of Self- Management

Training in Type 2 Diabetes. A systematic review of randomized controlled trials [Internet].

2001; [cited 2012 Dec 18]. Available from:

http://care.diabetesjournals.org/content/24/3/561.short

Pīrāgs V., Rasa I., Dzīvīte I, Freimane G., Gailiša U, Lejnieks A.,. et al., Guidelines of Type 2.

Diabetes Mellitus Prophylaxis, Diagnostics and Therapy. Riga: Latvian Diabetes Association,

Latvian Association of Endocrinologists, 2007.

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4. ULTRASONOGRAPHIC FINDINGS IN THYROID GLAND OF

MIDDLE-AGED LITHUANIAN MALES AND FEMALES

Authors: Evelina Radzevičiūtė, Kipras Kvedarauskas

Supervisors of the abstract: associate prof. Birutė Žilaitienė, Laura Daugintytė-Petrušienė, M.D.

INTRODUCTION

Thyroid pathology is one of the most common problems of public health nowadays. Incidence of

thyroid disease is rapidly increasing. Thyroid alterations are detected in the 28% of Lithuania’s

population.

AIM

Investigate thyroid ultrasonographic findings in 48-50-year-old population of men and women in

Lithuania.

OBJECTIVES

1. To evaluate thyroid volume and gender differences.

2. To evaluate thyroid tissue echotexture and disparity between males and females.

3. To evaluate presence of thyroid nodules, the number, structure and frequency of these

findings between males and females.

METHODS

During the period 2012-2013 412 randomly selected 48-50-year-aged men (171) and women

(241) were enrolled into the study. Thyroid ultrasound examination, concerning thyroid lobes

size, echotexture, number of nodes and their structure was performed. The need for aspiration

biopsy of thyroid nodules was evaluated. Thyroid volume in milliliters was calculated according

to the formula: width x thickness x length x .479. The thyroid gland was considered as enlarged

if its volume was greater than 25 ml for males and 18 ml - for females. Statistical analysis was

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performed using SPSS 20.0 statistical package. Frequencies, means (M) and standard deviations

(SD) were calculated. Chi-square was used to indentify difference between males and females.

Data was considered as statistically significant at a confidence level of p <0.05. Thyroid gland

biopsy was recommended when nodes diameter was bigger than 10mm or it was suspected to be

malignant due to the specific ultrasonographic features.

RESULTS

Thyroid ultrasound examination showed that mean thyroid volume of males and females was

respectively 16.8 ± 6.6 ml and 12,4±5,2 ml, thyroid volume was statistically significantly larger

of males than females (p <0.001). 9.4% (n=16) males and 15.8% (n=38) females had enlarged

thyroid gland. Enlargement of thyroid gland was significantly more common in females than

males (p<0.01).

Hypoechoic echotexture of thyroid gland was significantly more often in females (49.6%,

n=119) than in males (26.6%, n=45), p<0.001. For 23.4% (n=40) males and 32.1% (n=77)

females thyroid was described as slightly non-uniform, for 26.9% (n=46) males and 45.0%

(n=108) – non-uniform and for 0.8% (n=2) females – very non-uniform.

35 thyroid nodes of males and 98 of females were analyzed. 71.4% (n=25) thyroid nodes were

single and 28.6% (n=10) multiples for males and 60.2% (n=59) single and 39.8% (n=39)

multiple for females. In terms of thyroid node echotexture distribution between males and

females was the following: hypoechoic nodes 62.5% (n=20) and 53.1% (n=52), isoechoic 6.3%

(n=2) and 15.3% (n=15), hyperechoic 0% (n=0) and 1,0% (n=1) and various echoicity 31.3%

(n=10) and 30,6% (n=30) respectively. Thyroid aspiration cytology was recommended for 1.7%

(n=3) males and 12.6% (n=30) females, much more common for females (p<0.001). Thyroid

nodes were much more common in females than males (p<0.001). Single nodes were more

common in males and multiple in females (p<0.001). Nodes echotexture did not differ between

genders (p>0.526).

CONCLUSIONS

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1. Thyroid volume was significantly lower in females than males, but females had enlarged

thyroid gland more often than males.

2. Females’ thyroid had hypoechoic echotexture significantly more often than males’.

3. Thyroid nodes were much more common between females than males. Single nodes were

more common between males and multiple between females. Nodes echotexture did not differ

between genders.

REFERENCES

1. Narseta Mickuvienė. Vyresnio amžiaus žmonių skydliaukės audinio pakitimai ir jų

paplitimas. Biomedicina. 2001, 1(2), 123-127.

2. Gharib H. Current evaluation of thyroid nodules. Trends Endocrinol Metab. 1994

Nov;5(9):365-9.

3. Acar T, Ozbek SS, Acar S. Incidentally discovered thyroid nodules: frequency in an adult

population during Doppler ultrasonographic evaluation of cervical vessels. Endocrine. 2013

Apr 8.

4. Brander, A., Viikinkoski, P., Tuuhea, J., Voutilainen, L. and Kivisaari, L. (1992), Clinical

versus ultrasound examination of the thyroid gland in common clinical practice. J. Clin.

Ultrasound, 20: 37–42.

5. EVALUATION OF MIDLLE AGED FEMALES MENOPAUSAL

SYMPTOMS

Authors: Evelina Radzevičiūtė, Kipras Kvedarauskas

Supervisors of the abstract: associate prof. Birutė Žilaitienė, Jonas Čeponis, M.D.

INTRODUCTION

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Although menopause is a physiological period of women’s life around 85% of females suffer

from different symptoms. Early symptoms – hot flushes, depressed mood and lower sexual

desire - last for 3 - 5 years. Severity of these symptoms depends on the ethnicity, health status

and individual predisposition.

AIM

Evaluate intensity of menopausal symptoms in 48-50-year-aged Lithuanian females.

OBJECTIVES

1. To evaluate psychological symptoms in perimenopausal women.

2. To evaluate somatic (physical) symptoms in perimenopausal women.

3. To evaluate vasomotor symptoms in perimenopausal women.

4. To compare menopause related symptoms mean scores of the study subjects with The Greene

Climacteric Scale normative data.

METHODS

During the period 2012-2013 241 randomly selected 48-50-year-aged women were enrolled into

the study. 21 question The Greene Climacteric Scale, GCS was used to survey their menopausal

symptoms. GCS is one of the most popular instruments to investigate menopausal

(psychological, somatic (physical) and vasomotor) symptoms in females. Psychological

symptoms score can be divided to anxiety and depression scales. This questionnaire includes one

sexual function probe. Females are asked to evaluate their symptoms severity during the last

month on scale from Not at all = 0, A little = 1, Quite a bit = 2, Extremely = 3. Scores are

summed in domains to evaluate severity of psychological, somatic (physical) and vasomotor

symptoms of females. Results from our investigational group we compared with normative date

collected in Scotland and presented in official GCS web site.

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Statistical analysis was performed using SPSS 20.0 statistical package. Frequencies, means (M)

and standard deviations (SD) were calculated. Data was considered as statistically significant at a

confidence level of p <0.05.

RESULTS

1. Females’ psychological symptoms mean score was 8.07±5.20, anxiety score mean was

4.70±0.75 and depression score was 3.37±2.64. In 3.9% (n=17) of cases clinical anxiety could be

suspected clinical depression could be suspected in 1.7% (n=7) of study subjects. Total

psychological symptoms score mean did not differ significantly if compare with normative data

mean (7.42±6.41), p>0.05.

2. Somatic symptoms mean score was 4.41±3.34 and was significantly higher than normative

data mean score 3.25±3.64, p<0.05.

3. Vasomotor symptoms mean score was 1.29±1.48 and was significantly lower than normative

data mean score 1.79±1.12, p<0.05.

4. Sexual dysfunctions mean score was 0.61±0.75.

CONCLUSIONS

1. GCS general psychological symptoms mean score in the study group of Lithuanian females -

8.07±5.20.

2. GCS somatic symptoms mean score in the study group of Lithuanian females - 4.41±3.34.

3. GCS vasomotor symptoms mean score in the study group of Lithuanian females - 1.29±1.48.

4. Vasomotor symptoms were less expressed in the perimenopausal women from general

Lithuanian population if compare to GCS Scottish normative data, but somatic symptoms were

more expressed in Lithuanian women. No differences in psychological symptoms between two

samples were detected.

REFERENCES

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1. Greene JG. A factor analytic study of climacteric symptoms. J Psychosomatic Res 1976;

20(5):425-30.

2. Jonušienė G, Žilaitienė B, Adomaitienė V, Aniulienė R. Pažėra D, Andriuškevičienė L, et al.

Moters lytinė funkcija po menopauzės. Lietuvos gydytojo žurnalas. Psichiatrijos aktualijos

2010; 2(4):13-16.

3. Jonušienė G. Moterų lytinės funkcijos pomenopauzės laikotarpiu sąsajos su nerimo ir

depresijos simptomais bei lytiniais hormonais. Disertation. 2012, Kaunas

4. http://greeneclimactericscale.com/

6. EVALUATION OF SEXUAL FUNCTION AND SEX HORMONES IN

48-50-YEAR-OLD LITHUANIAN MEN

Authors: Milda Dedelaitė, Kipras Kvedarauskas

Supervisors of the abstract: associate prof. Birutė Žilaitienė, Jonas Čeponis, M.D.

INTRODUCTION

The biology of sexual function is an integral part of life satisfaction and androgens appear to play

an important role in male sexual function and behavior. There is no generally accepted lower

limit of normal testosterone (T) level. However, there is a general agreement that T levels of less

than 8 nmol/l highly support a diagnosis of hypogonadism whereas levels greater than 12 nmol/l

are likely to be normal. The grey zone between 8 and 12 nmol/l requires further evaluation and

assessment of free testosterone (FT) levels. The Brief Sexual Function Inventory (BSFI) was

developed in 1995 as a validated, brief way to measure male sexual function during the past 30

days in clinical practice and research. The questionnaire covers domains of sexual drive,

erection, ejaculation, perception of problems in each area and overall sexual satisfaction. Despite

the importance of sexual function, limited data are available exploring the associations between

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sex hormones and multiple domains of sexual functioning in nonpatient samples in Baltic

countries.

AIM

The aim of the study was to investigate self-reported sexual function using BSFI questionnaire

and serum T, FT, dehydroepiandrosterone sulfate (DHEAS) and sex hormone binding globulin

(SHBG) levels in 48-50-year-old Lithuanian men.

OBJECTIVES

1. To measure sexual function in 48-50-year-old Lithuanian men using BSFI questionnaire.

2. To measure serum T, FT, DHEAS and SHBG levels in 48-50-year-old Lithuanian men.

3. To determine association between domains of BSFI and hormone levels.

METHODS

Using random sampling, 199 men of Caucasian ethnicity aged 48-50 years completed BSFI

questionnaire and 176 men provided a blood sample for hormone measurements at

endocrinology department of Hospital of Lithuanian University of Health Sciences Kauno

Klinikos. Serum levels of T, FT, DHEAS and SHBG were measured using DiaSource RIA

radioimmunoassay kits (Belgium) according to the manufacturer’s instructions. BSFI

questionnaire has 11 questions measuring 5 aspects of sexual functioning: sexual drive (2

questions), erectile function (3) and ejaculatory function (2), as well as assessing problems with

sex drive, erections or ejaculation (3) and overall satisfaction with sex life (1). Each question is

scored on scale of 0-4, with higher scores indicating better functioning. Statistical analysis was

performed using IBM SPSS Statistics 20. P-values <0,05 were considered to be statistically

significant. Bivariate associations of the five BSFI domains with sex hormones were examined

using Pearson (r) correlation. Descriptive statistics (including frequency in percentage, mean and

standard deviation) were used to describe distributions of various domains’ scores and hormone

levels.

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RESULTS

1. Mean sexual drive domain score was 4,67±1,26. Mean erectile function and mean ejaculatory

function domains scores were 9,15±2,96 and 6,83±1,97, respectively. Mean problem-

assessment domain score was 8,12±3,55. Mean overall sexual satisfaction domain score was

2,8±0,93.

2. Mean serum hormone levels were: T 17,14±6,47 nmol/l, FT 28,34±9,63 pmol/l, DHEAS

6,21±2,38 µmol/l and mean level of SHBG was 28,09±11,83 nmol/l. Serum T levels were less

than 8 nmol/l and between 8 and 12 nmol/l in 4 (2,3%) and 31 (19,3%) participants,

respectively. Serum T levels were above 12 nmol/l in 141 (78,4%) participants.

3. Positive correlations were observed between score of sexual drive domain and serum T level

(r=0,165, p<0,05), serum FT level (r=0,184, p<0,05), serum DHEAS level (r=0,246, p<0,01).

A negative correlation between score of overall sexual satisfaction domain and serum SHBG

level (r=0,173, p<0,05) was observed. Correlations between scores of erectile function,

ejaculatory function, problem-assessment domains and serum hormone levels were found to

be insignificant.

CONCLUSIONS

1. Out of all domains sexual drive domain was scored with lowest scores.

2. Mean serum T levels were found to be within reference range although serum T levels were

less than 8 nmol/l and between 8 and 12 nmol/l in 2,3% and 19,3% of participants,

respectively.

3. The study shows that sexual drive is associated with serum levels of T, FT and DHEAS.

Overall sexual satisfaction is linked to serum SHBG level.

REFERENCES

1. Andersen M. L. et al. The association of testosterone, sleep and sexual function in men and

women. Brain research 2011 Oct 6; 1416: 80-104

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2. Arver S. et al. Current guidelines for the diagnosis of testosterone deficiency. Front Horm

Res. 2009; 37:5-20

3. O’Connor D.B. et al. The relationships between sex hormones and sexual function in middle-

aged and older European men. The Journal of Clinical Endocrinology and Metabolism 2011

Oct; 96(10):E1577-E1587

4. O‘Leary M. P. et al. Distribution of the Brief Male Sexual Inventory in community men.

International Journal of Impotence Research 2003; 15:185-191

7. SEXUALITY OF 26-36-YEAR-AGED TYPE 1 DIABETICS AND

AGE-MATCHED CONTROL MEN

Authors: Indrė Matulevičiūtė, Ilona Banišauskaitė

Supervisor of the abstract: Valentinas Matulevičius

INTRODUCTION

Diabetes mellitus patients frequently and anticipatory were considered impotent. More

comprehensive investigation of their sexuality with proper control groups and better instruments of

sexual functioning was rare until now (1, 5). In our study we compare type 1 diabetics sexual

functions with control group that had their reproductive health investigated in 2003/2004 project

“The reproductive function of Estonian, Latvian and Lithuanian young men” and proved to be

excellent (2).

AIM

The purpose of this study is to establish sexuality of 26-36-year-aged type 1 diabetics of different

diabetes duration groups and control men.

OBJECTIVES

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1. To evaluate type 1 diabetics concern related to sexual dysfunction in comparison with healthy

control men.

2. To determine the duration of type 1 diabetes when sexual dysfunction manifest.

3. To determine the first sign of sexual dysfunction.

METHODS

One hundred and forty-nine 26-36 year-old men completed the self-administered European Male

Ageing Study – Sexual Function Questionnaire (EMAS-SFQ) (4), Lithuanian Version (3). Men

answered 25 questions, three scores were calculated: overall sexual function, sexual function

distress, change of sexual function and 2 questions were evaluated like separate domains:

masturbation and erectile dysfunction (ED) (4).

Eighty-eight 26-36-year-old type 1 diabetics were randomly selected from Lithuanian Diabetes

Register. Sixty-one age-matched controls were participants from a 2003/2004 project “The

reproductive function of Estonian, Latvian and Lithuanian young men”. Reproductive health of

these men was excellent in 2003/2004 when clinical, hormonal and gene investigations were

performed. Diabetics were separated into different disease duration groups: 0-9 years (N=29), 10-19

years (N=26), 20-29 years (N=29). Each group of different diabetes duration was compared with

control group. Statistical analysis was performed using IBM SPSS Statistics 20.0. Mann-Whitney U

Test and chi square test were used with significance level of 0.05.

RESULTS

Five different domains of sexual function resulting from EMAS-SFQ were evaluated:

1. Overall sexual function (OSF) was higher in the age-matched healthy controls than in type 1

diabetics with disease duration of 20-29 years (21.38±5.85 vs. 17.72±7.30 (Mean±Standard

Deviation), p=0.02). There was no difference of OSF between control group and diabetics with

disease duration of 0-9, 10-19 years.

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2. Sexual function distress (SFD) was higher in type 1 diabetics with disease duration of 0-9 years

than in healthy controls (3.28±3.84 vs. 1.64±2.07, p=0.04). No other statistical differences were

observed in this domain.

3. Change of sexual function (CSF) differed insignificantly between control men and men with

different diabetes duration.

4. Masturbation score was higher in healthy controls than in type 1 diabetics with disease duration

of 20-29 years (2.46±1.95 vs. 0.97±1.54, p=0.01). No other differences were observed in this

domain.

5. Ability to keep a good erection (ED) was lower in type 1 diabetics with disease duration of 10-19

years than in control group (2.08±0.89 vs. 2.67±0.51, p<0.01) as well as 20-29-year-duration

diabetics vs. controls (2.32±0.67 vs. 2.67±0.51, p=0.03).

6. Comparing all type 1 diabetics with healthy control group OSF was higher in healthy men

(21.38±5.85 vs. 18.63±6.55, p<0.01) as well as masturbation score (2.46±1.95 vs. 1.16±1.59,

p<0.01), SFD was higher in type 1 diabetics (3,08±3,84 vs. 1,64±2,07, p=0.04). Ability to keep a

good erection was lower in type 1 diabetics than control group (2.25±0.78 vs. 2.67±0.51,

p=0.007).

CONCLUSIONS

1.Diabetics of short (0-9 years) disease duration are most concerned about their sexual function.

2.The difference of overall sexual function between healthy men and diabetics manifest as the

duration of diabetes gets 20-29 years.

3.Erectile dysfunction is the first sign of sexual dysfunction and appears when diabetes duration is

10-19 years.

Acknowlegements. We are thankfull for dr. Rytas Ostrauskas and dr. Bronė Urbonaitė for

providing list of 26-36 years diabetic patients from Lithuanian Diabetes Register and Habil.Dr

Valentinas Matulevičius, Dr. Birutė Žilaitienė and Dr. Romualdas Tomas Preikša for providing

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data from the List of Participants of the project “The reproductive function of Estonian, Latvian

and Lithuanian young men”.

REFERENCES

1. Fedele D, Bortolotti A, Coscelli C, Santeusanio F, Chatenoud L, Colli E, Lavezzari M, Landoni

M, Parazzini F. Erectile dysfunction in type 1 and type 2 diabetics in Italy. International Journal

of Epidemiology. 2000; 29; 524.

2. Grigorova M, Punab M, Poolamets O, Sõber S, Vihljajev V, Žilaitienė B, Erenpreiss J,

Matulevičius V, Tsarev I, Laan M.Study in 1790 Baltic men: FSHR Asn680Ser polymorphism

affects total testes volume. Andrology. 2013 Mar;1(2):293-300.

3. Matulevičius V, Preikša R.T, Žilaitienė B, Nikulina S, Veličkienė Dž, Lašaitė L, Prakapienė E,

Abramavičius S, Adomaitienė V, Verkauskienė R, Sakalauskas R. Translation of European male

ageing study sexual functions questionnaire (EMAS-SFQ) to Lithuanian and the search for

control group of potentially surveyed men (Article in Lithuanian). Lietuvos endokrinologija.2012

20(1,2,3,4): 57-66.

4. O'Connor DB, Corona G, Forti G, Tajar A, Lee DM, Finn JD, Bartfai G, Boonen S, Casanueva

FF, Giwercman A, Huhtaniemi IT, Kula K, O'Neill TW, Pendleton N, Punab M, Silman AJ,

Vanderschueren D, Wu FC. Assessment of sexual health in aging men in Europe: development

and validation of the European Male Ageing Study sexual function questionnaire.J Sex Med.

2008 Jun;5(6):1374-85

5. Penson DF, Wessells H. Erectile dysfunction in diabetic patients. Diabetes Spectrum. 2004; 225.

8. CORRELATION BETWEEN PITUITARY ADENOMA DIAMETER

AND MUNSELL FARNSWORTH 100 HUE TEST

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Authors: Rasa Čiumbaraitė, Ieva Gustaitė

Supervisor of the abstract: dr. Rasa Liutkevičienė

INTRODUCTION

Pituitary adenomas (PA) can be subdivided into functioning and nonfunctioning, micro and

macro adenomas of the pituitary gland. Long-standing chiasmal compression indicates primary

optic nerve atrophy and a poor prognosis for visual functions.

AIM

To determine association between color contrast sensitivity established by Munsell Farnsworth

100 hue test results depending on pituitary adenoma diameter and to compare received results

with healthy age and gender-matched controls.

OBJECTIVES

1. Establish correlation between Munsell Farnsworth 100 hue test and pituitary adenoma

diameter.

METHODS

30 persons (60 eyes) with PA and 45 (90 eyes) healthy controls were tested. Computerized

Munsell Farnsworth 100 Hue test program was used for color discrimination. Test requires

arrangement of colour samples by tone. Majority of samples are of the same brightness and

intensity in colour. The sense of colours may be very high, i.e. the number of mistakes is up to

20, or normal average, i.e. the number of mistakes is up to 100, or disturbed, i.e. the number of

mistakes is more than 100. Pituitary adenoma diagnosis was confirmed by computed tomography

or magnetic resonance imaging scans. Patients were divided into two groups according to the PA

diameter: 1 group – PA ≤1 cm (N 24 eyes) and 2 group – PA diameter more than 1 cm (N 36

eyes).

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RESULTS

The computerized Munsell Farnsworth 100 Hue test results ranged in the healthy controls from

32 to 132 [CI 95%] 74.16-85.95), in patients with PA≤1 cm from 84 to 204 [CI 95%] 110.60-

155.12), and in patients with PA>1 cm results range from 124 to 422 [CI 95%] 201.48-277.52),

p<0.01 between three groups.

CONCLUSIONS

1. There was strong correlation (r=0.744) between Munsell Farnsworth 100 hue test and

pituitary adenoma diameter.

2. Computerized F-M 100 hue test can be one of the methods for early diagnosis of chiasma

damage in patients with PA.

REFERENCES

1.Page RB. Sellar and parasellar tumors. In: Wilkins RH, Rengachary SS, editors. Neurosurgery.

2nd ed. Mc Graw-Hill; 1996. p. 791-804).

2.Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA et al. High Prevalence of

Pituitary Adenomas: A Cross-Sectional Study in the Province of Liège, Belgium. The Journal of

Clinical Endocrinology & Metabolism 2006;91(12):4769-4775.

3.Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T 2001 Prevalence estimates for

primary brain tumors in the United States by behavior and major histology groups. Neuro-oncol

3:152–158.

4.Nistor R. Pituitary tumours. Neuro Rew 1996;57:264-72.

5.Monteiro ML, Moura FC, Cunha LP. Frequency doubling perimetry in patients with mild and

moderate pituitary tumor-associated visual field defects detected by conventional perimetry. Arq

Bras Oftalmol 2007;70(2):323-9.

6.Kovacs K, Scheithauer BW, Horvath E, Lloyd RV. The World health Organization

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classification of adenohypophysial neoplasms. Cancer 1996;78:502-10.

7.Schoemaker MJ, Swerdlow AJ. Risk factors for pituitary tumours: a case-control study. Cancer

Epidemiol. Biomarkers Prev 2009;18:1492-500.

8.Monteiro ML, Zambon BK, Cunha LP. Predictive factors for the development of visual loss in

patients with pituitary macroadenomas and for visual recovery after optic pathway

decompression. Can J Ophthalmol 2010;45(4):404-8.

9. DIABETIC RETINOPATHY AND BLOOD LIPIDS LEVELS'

EVALUATION IN DIABETIC PATIENTS

Author: Jekaterīna Stepičeva, Rīga Stradiņš University, Faculty of Medicine

Supervisor of the abstract: Vitolds Mackēvičs, MD, Rīga Stradiņš University, Department of

Internal diseases

INTRODUCTION

Diabetes mellitus (DM) is one of the common metabolic chronic diseases. The incidence of DM

is increasing [1]. One of the common microvascular complications of DM is diabetic retinopathy

(DR). DR is a major cause of blindness among the diabetic patients [2]. According to WHO data,

4.8% of 37 million blindness cases are due to diabetic retinopathy [3]. Dyslipidemia is one of

recognized risk factors for development and progression of DR.

AIM

To evaluate the blood lipid levels association with diabetic retinopathy.

OBJECTIVES

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1.To make the analysis of case reports of Riga Eastern clinical university hospital “Gaiļezers”,

Endocrinology department for two years period.

2.To determine DR distribution among DR patients.

3.To summarize and analyze data using IBM SPSS 21.0

4.To find out information about studied problem in scientific literature.

METHODS

There were 241 patients’ case reports enrolled in the study. The enrollment criteria were the type

1 or type 2 DM and an ophthalmological finding – DR. The type of diabetes, duration of

diabetes, degree of diabetic retinopathy, sex, age, BMI, blood tests – HbA1c, total cholesterol

level (TC), low-density lipoprotein cholesterol level (LDL), high-density cholesterol level

(HDL), serum triglycerides level (TG), non HDL, TC/HDL were observed.

The patients were divided into two groups, depending on the type of DM. Then patients were

divided by the degree of diabetic retinopathy. The correlation between degree of DR and blood

lipids levels’ were found using Spearman's rho.

RESULTS

There were 104 patients with type 1 DM. Males – 43, females – 61. The average age – 47,32 ±

13,8 years. The DR distribution between patients: mild non proliferative DR – 21 patient,

moderate non proliferative DR – 9, severe non proliferative DR – 32, proliferative DR - 42

patient.

There is no statistical significance found between TC and DR (Spearman's rho (𝜌) = 0,133,

p=0,18), HDL and DR (ρ=0,083, p=0,44), LDL and DR (ρ=0,163, p=0,12), TG and DR (ρ 0,049,

p=0,62).

There were 137 patients with type 2 DM. Males – 44, females – 93. The average age – 66,7±

9,08 years.

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The DR distribution between patients: mild non proliferative DR – 26 patient, moderate non

proliferative DR – 14, severe non proliferative DR – 62, proliferative DR – 35 patient.

There is no statistical significance found between TC and DR (𝜌=0,015, p=0,86), HDL and DR

(ρ=0,131, p=0,16), LDL and DR (ρ=0,016, p=0,87), TG and DR (ρ 0,163, p=0,06).

CONCLUSIONS

1.In the first type DM the most common is severe non proliferative DR, but in the second type

DM – proliferative DR.

2.There was no statistically significant association found between DR and blood lipids levels.

3.There is no consensus in the world’s literature about studied problem. There are several

studies, that confirm study results, and there are studies, which deny them.

4.DR risk factors should be estimated in general, not separately.

REFERENCES

1.Rasa I, Pīrāgs V. 2.tipa cukura diabēta profilakses, diagnostikas un ārstēšanas vadlīnijas. Rīga:

Latvijas Diabēta asociācija; Latvijas Endokrinoloģijas asociācija, 2007. 4-130

2.Ciulla, T.A., Amador, A. G., Zinman, B. Diabetic retinopathy and diabetic macular

edema. Diabetes care.2003, 26(9):2653-266

3.Chistiakov, D. A. Diabetic retinopathy: Pathogenic mechanisms and current treatments.

Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2011;(5):165-172

10. DIFFERENCES IN SLEEP QUALITY OF MEN SUFFERING FROM

TYPE 2 DIABETES MELLITUS WITH AND WITHOUT

DEPRESSION SYMPTOMS

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Authors: Rokas Laurinaitis, Jaunė Andziukevičiūtė, Milda Šileikaitė

Supervisor of the abstract: Lina Lašaite, Ph.D.

INTRODUCTION

Over the past two decades it has been demonstrated that depression is common in persons with

type 2 diabetes mellitus (T2DM) and is associated with worse well-being, poorer glycaemic

control and adverse health outcomes [1, 2].

The relationship between depression and T2DM outcomes is not limited only to those having

clinical depression. Black et al. [3] demonstrated that even in the absence of clinical depression,

depressive symptoms are associated with adverse outcomes of T2DM.

AIM

The aim of the study was to evaluate the quality of sleep in men suffering from T2DM in relation

to presence or absence of depression symptoms.

OBJECTIVES

1.To diagnose if the researched patients with T2DM experience depression symptoms.

2.To determine how patients with T2DM evaluate their quality of sleep (subjective quality of

sleep, falling asleep duration, sleep duration, sleep efficiency, sleep disturbances, use of

sedatives, diurnal activity disorder) in relation of presence or absence of depression symptoms.

3.To compare the quality of sleep of patients suffering from 2DM with depression symptoms

with patients suffering form 2DM without depression symptoms.

METHODS

52 men suffering from T2DM have been recruited for the study.

According to the results of the Mini-International Neuropsychiatric Interview [4], the examined

patients have been stratified into two groups in relation to presence or absence of depression

symptoms.

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Pittsburgh Sleep Quality Index [5] has been applied for the evaluation of sleep quality

determining seven components of sleep quality: subjective quality of sleep, falling asleep

duration, sleep duration, sleep efficiency, sleep disturbances, use of sedatives, diurnal activity

disorder.

Statistical analysis. The study was cross-sectional. The data is presented as average value and

standard deviation. Mann-Whitney Test has been used for the evaluation of significant

differences between samples. The data has been considered as statistically significant when

p<0.05. The analysis of statistical results has been accompished with SPSS 17.0 standard

software package.

RESULTS

Depression symptoms have been diagnosed in 10 (19%) of the examined patients with T2DM

(age 52.6±12.6 years). Sleep quality of patients with depression symptoms were compared with

that of patients without depression symptoms:

subjective evaluation of sleep quality has been statistically significantly worse (1.8±0.8 vs.

1.1±0.5, p=0.002); sleep effectiveness lower (0.8±1.2 vs. 0.1±0.4, p=0.015); use of sedatives

(0.8±1.3 vs. 0.2±0.7, p=0.048) and diurnal activity disorder (1.3±1.1 vs. 0.4±0.5, p=0.002) more

frequent in T2DM patients with depression symptoms than among those who had no depression

symptoms. Falling asleep duration, sleep duration and sleep disturbances in

T2DM patients with depression symptoms and the ones without these symptoms have not

differed significantly.

CONCLUSIONS

1. Subjective sleep quality evaluation in patients with T2DM with diagnosed depression

symptoms is worse, sleep efficiency is lower, use of sedatives and diurnal activity

disorder are more frequent than in T2DM patients without depression symptoms.

2. No differences were detected in falling asleep duration, sleep duration and sleep

disturbances between T2DM patients with and without depression symptoms.

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REFERENCES

1. Lustman PJ, Clouse RE. Depression in diabetes: the chicken or the egg? Psychosom Med

2007; 69(4): 297-299

2. Papelbaum M, Moreira RO, Coutinho W, et al. Depression, glycemic control and type 2

diabetes. Diabetology and Metabolic Syndrome 2011; 3: 26-29.

3. Black S, Markides K, Ray L. Depression predicts increased incidence of adverse health

outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003; 26:

2822-2828.

4. Sheehnan DV, Lecrubier Y, Sheehnan KH, et al. The Mini-International

Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured

diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59:

34-57.

5. Buysse DJ, Reynolds III CF, Monk TH, et al. The Pittsburgh sleep quality index: A new

instrument for psychiatric practice and research. Psychiatry Research 1988; 28: 193-213.

11. DIFFERENTIAL DIAGNOSIS OF HYPERANDROGENEMIA AND

ITS CLINICAL RELEVANCE

Author: Aleksandra Kozlova, Riga Stradins University Faculty of Medicine, year 6; Supervisor

of the abstract: Dr. med. Ilze Konrāde Department of Endocrinology

Riga East Clinical Hospital Clinic "Gailezers".

INTRODUCTION

Hyperandrogenemia is one the most common endocrine disorders in women of reproductive age,

its prevalence is approximately 7% in the population. [1; 2] Hyperandrogenemia or androgen

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excess is characterized by a number of symptoms - menstrual irregularities, hirsutism, acne and

alopecia. [3] Several disorders result in androgen excess, therefore all the differential diagnosis

possibilities should be evaluated in order to select the optimal treatment strategy. The most

common disorders associated with hyperandrogenemia in women of reproductive age are

polycystic ovarian syndrome (PCOS), non-classical congenital adrenal hyperplasia (NCCAH),

androgen-secreting tumors (ovarian or adrenal), hypothyroidism, hyperprolactinemia, Cushing's

syndrome, acromegaly, as well as idiopathic hirsutism, which is a diagnosis of exclusion.

Medications may also cause hyperandrogenemia symptoms, by their inherent androgenic effects.

[4]

AIM

The aim of this retrospective research is to evaluate androgen excess symptoms and possible

differential diagnoses.

OBJECTIVES

1. To determine what symptom is the most common in women with androgen excess;

2. To determine what is the most common cause of hyperandrogenemia in women of

reproductive age;

3. To define if there is a positive correlation between hormone levels and the severity of

hirsutism;

4. To define differences in hormene levels between various diagnostic groups;

METHODS

In this retrospective research data was assembled from Riga East Clinical Hospital Clinic

"Gailezers'' patients' medical records, who were treated in endocrinology department from

February 2010 until December 2012, due to complaints that were potentially associated with

androgen excess. All the patients included in this study complied with selection criteria (Patients

had documented hyperandrogenemia clinical symptoms; Hormone analysis results were

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documented in patients medical records; Patients were not pregnant; Patients were not using any

hormonal treatment). Hormone levels that were analysed during this study are - total

testosterone, free androgen index, androstenedione, prolactin, thyrotropic hormone,

dehydroepiandrosterone, 17-OH progesterone, sex hormone binding globulin (SHBG), cortisol

and somatotropic hormone. According to the study selection criteria, 11 women were excluded

from research. A total of 27 patients were evaluated Results were compared using IBM SPSS 20

software in order to calculate Pearson correlation coefficient (PCC) and to perform Independent

Student T-test.

RESULTS

Among 27 participants included in this study hirsutism was observed in 21 women, grade I in 7

of 21 hirsute women, grade II in 11 and grade III in 3 females. Menstrual irregularities were

observed in 24 study participants, acne in 5 and alopecia in 3. Positive correlation was found

between severity of hirsutism and testosterone level, PCC = 0,54 (p = 0,017), which means that

the correlation is moderate. Of 27 women 16 were diagnosed with PCOS, 4 with NCCAH, 2

with prolactin-secreting pituitary adenoma, 2 with hypothyroidism, 1 with androgen-secreting

ovarian tumor, and in 2 cases diagnosis was not specified. According to T-test statistically

reliably (p = 0,028) testosterone levels in PCOS group (67,8 +/- 19,5 ng/dl) differ from NCCAH

group (39,5 +/- 27,9 ng/dL). Similarly, statistically reliably (p = 0.014) differ SHBG levels in

PCOS group (21,3 +/- 12,1 nmol/L) from prolactin-secreting adenomas' group (47,1 +/- 16,7

nmol/L).

CONCLUSIONS

1. The most common symptom in androgen excess patients included in this study are menstrual

irregularities;

2. The most common androgen excess cause is PCOS;

3. There is positive correlation between testosterone levels and hirsutism, increased

testosterone levels worsen the severity of hirsutism;

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4. Testosterone level in patients with PCO syndrome are higher than in NCCAH;

5. SHBG level in patients with PCO syndrome is significantly higher than in patients with

hyperprolactinemia.

REFERENCES

1. Azziz, R., et al., Androgen Excess in Women: Experience with Over 1000 Consecutive

Patients. The Jornal of Clinical Endocrinology & Metabolism, 2004 February, 89(2): 453;

2. Azziz, R., Woods, K.S., Reyna, R., The prevalence and features of the polycystic ovary

syndrome in an unselected population. The Journal of Clinical Endocrinology & Metabolism,

2004 June, 89(6): 2745-9;

3. Karnath, B.M, Signs of Hyperandrogenism in Women. Hospital Physician Journal 2008

October, 44(4): 25-30;

4. Shlomo Melmed et al., Williams Textbook of Endocrinology, 12th Edition, Philadelphia:

Saunders, 2011, p. 498-500, 618-619, 622-625;

12. PSEUDOHYPOPARATHYROIDISM: A CASE REPORT OF RARE

CAUSE OF HYPOCALCAEMIA

Authors: Valentina Mihejeva, Jelena Danilenko, Riga Stradins University,the faculty of medicine

6.course

Supervisor of the abstract: Dr.Natalja Fokina, Pauls Stradins Clinical University Hospital,

endocrinology department

INTRODUCTION

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Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterized by

hypocalcaemia, hyperphosphataemia, increased serum concentration of parathyroid

hormone(PTH) and insensitivity to biological activity of PTH.[1] In 1942, Fuller Albright first

introduced the term pseudohypoparathyroidism to describe patients who presented with PTH-

resistant hypocalcaemia and hyperphosphatemia along with an unusual constellation of

developmental and skeletal defects, collectively termed Albright hereditary osteodystrophy

(AHO). These features included short stature, rounded face, shortened fourth metacarpals and

other bones of the hands and feet, obesity, dental hypoplasia, and soft-tissue

calcifications/ossifications. [2-3] This is a rare disorder having the prevalence of 3.4 per

million.[4]

AIM

The aim of this case report is to analyze the clinical characteristics, diagnosis and treatment of

pseudohypoparathyroidism and to show, that this disease is rare but important cause of

hypocalcaemia.

METHODS

1. Patient interviewing;

2. Physical examination;

3. Laboratory investigation;

4. Imaging assessment;

5. Treatment consideration.

CASE REPORT

A 39-year-old woman got admitted to Paul Stradins University Hospital in november 2012 with

hypocalcaemic problems. She had the complaints of repeated attack of muscle cramps for 20

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years, occasional cramping pain, muscle tension of both hand and feets, impaired vision

functions, weakness. No PHP-related findings were reported in first-degree relatives. On

examination patient was noted to have round face, short neck, short stature, dental hypoplasia,

obesity and brachydactyly. Her height and body weight were 153 cm and 72 kg. Chvostek’s and

Trousseau’s signs were positive. She also had a bilateral cataract. Laboratory studies revealed

hypocalcaemia (2,0 mmol/l), and hyperphosphatemia (2.2 mmol/l). The parathyroid hormone

level was 21.7pmol/l which was higher than normal. The thyroid function was normal. Her

ultrasound of lower abdomen detected no abnormality. Radiograph of the hands showed

shortening of fourth metacarpals. CT scan of the brain revealed basal ganglia calcification. An

electroencephalogram (EEG) revealed presence of sharp and slow waves suggestive of seizure

disorder.

According to characteristic phenotype of Albright hereditary osteodystrophy, clinical features,

laboratory findings and imaging study we put the diagnosis of pseudohypoparathyroidism 1a

type.

The patient was treated with vitamin D - calcitriol 0.25 mcg daily and calcium carbonate 500

mg three times per day. Two month later the serum calcium and phosporus level normalized and

after correction of hypocalcaemia the complaints of convulsion, muscle tension and weakness

disappeared.

DISCUSSION

The elevated serum concentration of PTH in a patient with chronic hypocalcaemia,

hyperphosphatemia, and normal renal function exclude hypoparathyroidism and suggestive of

pseudohypoparathyroidism. Further investigation of urinary cAMP response to exogenous PTH

infusion test as well as analysis of the GNAS1 gene would be recommended to our patient to

differentiate the type of PHP and identify the specific genetic defect, but unfortunately we didn’t

have such opportunity. So in our case report the diagnosis was based on typical AHO phenotype,

clinical history, biochemical features and imaging investigation despite the absence of family

history.

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From our case report it is suggested, that in all cases of convulsion history it is important to

exclude hypocalcaemia before the ordination an anticonvulsant treatment.

In addition, it is important to stress, that the long term treatment of hypocalcemia in patients

with hypoparathyroidism involves the administration of oral calcium and vitamin D or

analogues. Treatment of PHP is similar to that of hypoparathyroidism, except that the dose of

vitamin D and calcium is usually lower than that required in true hypoparathyroidism.

.

REFERENCES

1. Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL,Jameson JL, Loscalzo J:

Harrison’s Principles of Internal Medicine, 17th ed, McGraw Hill 2008; 2357-2367.

2. Mini R Abraham MD, Romesh Khardori MD:

Pseudohypoparathyroidism.Medscape.Updated Dec. 13,2011

3. Mz Uddin, Mar Howlader, Mr Amin, Mg Morshed:Pseudohypoparathyroidism a case

report of a rare disease with uncommon presentation producing diagnostic dillema. J

Bangladesh Coll Phys Surg 2011; 29: 227-230

4. Nakamura Y, Matsumoto T, Tamakoshi A, et al.Prevalence of idiopathic

hypoparathyroidism and pseudohypoparathyroidism in Japan. J epidemiol. Jan 2000; 10:

29 – 33

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INTERNAL MEDICINE SECTION

1. HEMODIALYSIS PATIENT‘S HYPERHIDRATION EVALUATION

Authors: Ieva Šablinskaitė, Milda Jankauskaitė

Supervisor of the abstract: Dr. R. Vaičiūnienė

INTRODUCTION

Water removal or euvolemia support is one of hemodialysis (HD) purposes. Hyperhidration

in HD patients is closely associated with increased morbidity.

AIM

To asses weight gain of HD patients‘ in between hemodialysis and hyperhidration‘s

relationship with demographic factors, insidence of diabetes mellitus (DM) in hemodialysis

patients.

OBJECTIVES

1. To rate hyperhidration level before hemodialysis in hemodialysis patients;

2. To rate hyperhidration relationship with age, sex, duration of hemodialysis;

3. To rate hyperhidration relationship with diabetes mellitus;

4. To rate hyperhidration relationship with arterial blood pressure (BP);

METHODS

The data about weight gain between HD, BP before and after HD, age, sex, HD duration and

incidence of diabetes mellitus, on all LSMUK 2012 december outpatient dialysis patients

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were collected from medical records. Statistical analysis was performed using the

Kolmogorov-Smirnov, Mann-Whitney, chi-square test and Spearman's correlation

coefficient. The chosen significance level is p ≤ 0.05.

RESULTS

We analyzed 71 patient: 35 female (49.3%) and 36 male (50.7%). Patients' average age - 61.0

± 16.8 m. Most patients were in the 60-74 years age group (45.5%).On average, in between

HD patients gained 2.1 ± 0.8 kg (0.6 - 3.8 kg). We estimated, what percentage of their own

body weight had the HD patients gained in between HD – an average of 3.1 ± 1.1% of body

weight (1-6%).

Patients were divided into two age groups: under 60 years (30 patients) and older than 60

years (41 patients). Hyperhidration rate among age groups were not significantly different: 60

and younger age group, the mean weight gain between HD was 3.0 ± 1.3% of body weight,

over 60 years - 3.0 ± 1.0% (p = 0.075). There was not found hyperhidration dependence on

sex: women on average between HD gained 3.1 ± 1.0% of body weight, men - 3.8 ± 5.2% (p

= 0.5). Among the weight gain and HD-term statistically significant correlation was not

received (p = 0.7).

Out of 71 assesed patients, 12 had DM. There was no statistically significant defference of

weighr gain between DM and non – DM patients: non-diabetic patients gained an average of

3.5 ± 4.0% of body weight among HD, diabetic patients - 3.3 ± 1.4% (p = 0.7).

A significant hyperhidration relationship with systolic blood pressure was found: systolic

blood pressure before hemodialysis is significantly higher in patients who gain more than 3%

of their body weight between HD (p = 0.04). The difference of BP of these patients before

and after HD was higher (p = 0, 01). Systolic blood pressure before HD, adding a layer of up

to 3% of the body weight of 135 ± 21.6 mmHg, over 3% - 147 ± 20.1 mmHg. Diastolic blood

pressure differences between the two patient groups was not observed (p = 0.35), diastolic

blood pressure difference before and after the HD is also independent of the percentage of

body weight gain between the HD (p = 0.182).

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CONCLUSIONS

1. Average hyperhidration among hemodialysis is 3.1% of the patient's body weight.

2. Hyperhidration is independent of hemodialysis patients' age, sex and dialysis duration.

3. Diabetes does not affect hyperhidration level.

4. Systolic blood pressure before HD, systolic blood pressure difference before and after

the HD has a direct relationship with weight gain between hemodialysis. Hyperhidration

relationship with diastolic blood pressure has not been established.

REFERENCES

1. Volker Wizemann, Peter Wabel, Paul Chamney, Wojciech Zaluska, Ulrich Moissl,

Christiane Rode et al. The mortality risk of overhydration in haemodialysis patients.

Nephrol Dial Transplant (2009) May 24: 1574-1579.

2. Petr Machek, Tomas Jirka, Ulrich Moissl, Paul Chamney and Peter Wabel. Guided

optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant (2010)

February 25(2): 538-544.

3. Bernard Charra. Fluid balance, dry weight, and blood pressure in dialysis. Hemodialysis

International 2007; 11:21-31.

4. Arjun D. Sinha, Rajiv Agarwal. Opinion: can chronic volume overload be recognized and

prevented in hemodialysis patients? Seminars in dialysis (September 2009), 22 (5), pg.

492-494.

2. OBSTRUCTIVE JAUNDICE: EVALUATION WITH RADIOLOGY

IMAGING METHODS

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Author: Anastasija Rjabuhina, Riga Stradins University, Faculty of Medicine, 6th year.

Supervisor of the abstract: Evija Brinuma, MD, Riga Stradins University, Department of

Radiology

INTRODUCTION

Obstructive jaundice is a condition in which there is blockage of the flow of bile out of the liver.

The most common causes are the presence of gallstones in extrahepatic ducts

(choledocholithiasis), cancer of the pancreatic head, cholangiocarcinoma and chronic

pancreatitis.

AIM

To analyze medical histories and to evaluate the findings of radiology examinations of the

patients with previously mentioned diagnoses.

OBJECTIVES

1. According to publications analyze the most common causes of obstructive jaundice and

evaluate specific and non-specific findings of radiology examinations.

2. To evaluate the benefits and drawbacks of radiology examination methods in case of

obstructive jaundice.

3. To analyze medical histories of patients with diagnoses: complicated gallstone disease, cancer

of the pancreatic head, chronic pancreatitis and cholangiocarcinoma, who were received

treatment in Riga East Clinical University Hospital Clinic "Gaiļezers" from 01.01.2012. until

30.06.2012.

METHODS

There were analyzed 144 medical histories of patients with diagnoses: complicated gallstone

disease, cancer of the pancreatic head, chronic pancreatitis and cholangiocarcinoma, who were

received treatment in Riga East Clinical University Hospital Clinic "Gaiļezers" from 01.01.2012.

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until 30.06.2012. The criteria of patients’ selection were common bilirubin > 40 µmol/l,

conjugated bilirubin > 3,4 µmol/l. Patients’ data were analyzed with IBM SPSS Statistics 20

software.

RESULTS

There were selected 75 patients - 29 (38,7%) men and 46 (61,3%) women. The mean patients’

age were 68,8±13,2 years. The most common diagnose was complicated gallstone disease - 40

(53,3%), then cancer of the pancreatic head – 19 (25,3%), chronic pancreatitis – 9 (12,1%) and

cholangiocarcinoma - 7 (9,3%). The most common diagnose for women was complicated

gallstone disease - 29 (60,9%) cases, the same diagnose for men - 12 (41,4%). The most common

radiological diagnostic method which was used was US (ultrasound), which was followed by

MRI (magnetic resonance imaging) and ERCP (endoscopic retrograde

cholangiopancreatography) - 19 (25,3%), 14 (18,6%) patients were examined only by US, 9

(125) – by US and MRI, others were used rarely. The most informative diagnostic method for

gallstones was MRCP (magnetic resonance cholangiopancreatography) – 24 successful findings

out of 25 cases (96%), then CT (computed tomography) – 8 findings out of 9 cases (88,8%) and

ERCP – 18 out of 23 cases (78,2%). The most informative diagnostic method for cancer of the

pancreatic head was MRI - whole 5 imaging cases were successful (100%) and CT – 6 out of 8

cases (75%). The most informative diagnostic method for chronic pancreatitis was US – 4

successful findings out of 9 cases (44,4%). The most informative diagnostic method for

cholangiocarcinoma was US – 3 out of 6 cases (50%) and ERCP – 2 out of 3 cases (66,7%).

CONCLUSIONS

1. The most common cause of obstructive jaundice is choledocholithiasis.

2. The most informative diagnostic method which can be used in the first place is US – it is

proved by publications and results of my study.

3. MRCP and ERCP are the most informative diagnostic methods for choledocholithiasis, CT

and MRI are the most informative diagnostic methods for cancer of the pancreatic head – it is

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proved by publications and results of my study.

4. According to publications the most informative diagnostic methods for chronic pancreatitis are

CT, MR and MRCP, for cholangiocarcinoma – MRCP and ERCP.

REFERENCES

1. Ahuja A. T., Griffith J. F., Wong K. T., Antonio G. E., Chu W. C. W., Ho S. S. Y. et al.

Diagnostic Imaging Ultrasound. Amirsys; 2007.

2. American College of Radiology Appropriateness Criteria – jaundice. Reston (VA): American

College of Radiology (ACR), 2012. Available from:

http://www.guidelines.gov/content.aspx?id=37917

3. Bonheur J. L., Ells P. F. et al. Biliary Obstruction. Updated 2012. Available from:

http://emedicine.medscape.com/article/187001-overview

4. Chen M. Y. M., Pope T. L., Ott D. J. Basic radiology. 2nd edition. New York: McGraw-Hill;

2011. p. 289-323.

5. Federle M. P., Brooke Jeffrey R., Woodward P. J., Borhani A.A. Diagnostic Imaging

Abdomen. 2nd edition. Canada: Amirsys; 2010.

6. Longo D.L., Fauci A.S., editors. Harrison’s gastroenterology and hepatology. New York:

McGraw-Hill; 2010.

3. SENSITIZATION TO CETEARYL ALCOHOL AMONG

DERMATITIS PATIENTS

Authors: Laima Gaurilcikaitė, Egle Jankuviene

Supervisor of the abstract: dr. Aiste Beliauskiene

INTRODUCTION

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Cetearyl alcohol – white or yellowish wax like material, composed from cetyl alcohol and stearyl

alcohol. Cetearyl alcohol is widely used as an emulsifier and emollient in cosmetics, personal

care products and topical medicaments.

AIM

The present study was aimed at determining the frequency of sensitization to cetearyl alcohol

among dermatitis patients.

OBJECTIVES

1. To determine sensitization to cetearyl alcohol among dermatitis patients frequency.

2. To evaluate the sensitization of cetearyl alcohol interfaces with sociodemographic and

clinical factors.

METHODS

234 consecutive dermatitis patients in 2007 and 145 – in 2011 were patch tested with cetearyl

alcohol along with other allergens of baseline series. Patch testing was performed following to

the guidelines of the International Contact Dermatitis Research Group. The allergens were

applied for 48 hrs in the back area. Positive reactions between ‘+’ and ‘+++’ at day 3 were

considered positive. Demographic and clinical data on these patients were collected in

accordance with the European Surveillance System of Contact Allergies ‘minimal data set’.

RESULTS

At least one positive patch test reaction was found in 47% of the tested patients. Positive patch

test reaction to cetearyl alcohol was observed in 5 cases (1,32 %, 95 % PI 0,4 – 3,1 %). There

were no differences of sensitization frequencies in age (<40 and >40 years), sex (male, female),

atopic dermatitis (no, yes), occupational dermatitis (no, yes) groups of patients. In regard to the

primary site of dermatitis, higher proportion of patients with leg dermatitis was found among

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sensitized to cetearyl alcohol patients than other tested subjects (60 proc. vs. 12,57proc., p =0,02

using chi-square test).

CONCLUSIONS

1. Based on this study, it can be concluded that cetearyl alcohol is common allergen,

especially when dermatitis is localized in legs. Studies with larger groups of patients

should be performed to determine if cetearyl alcohol should be included to the baseline

series in Lithuania.

4. VAGINAL FLORA TYPES OF PREGNANT WOMEN IN THEIR

FIRST TRIMESTER

Authors: Natalija Berza, Madara Bronica

Supervisor of the abstract: Jana Zodzika, MD

INTRODUCTION

One of the most often reasons why females attend doctor are vaginal infections vaginal flora is

dynamic environment where a great variety of microorganisms exist in homeostasis. The main

normal flora inhabitant is Lactobacillus species who protect from pathogens. A lot of things still

remain unclear about this genteel environment and its interaction.

AIM

Analyze vaginal flora types in pregnant women who were at their first trimester using different

microscopy methods.

OBJECTIVES

1. To analyze vaginal flora types of pregnant female by fresh vaginal smear microscopy.

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2. To analyze vaginal flora of pregnant female by Grams staining method.

3. To compare both microscopy methods.

METHODS

65 pregnant women before 12th week of pregnancy participated in this study from 06.08.2012

till 31.01.2013. All participants were divided in to 2 groups, group A (n=45) normal pH and

group B (n=20) pH ( ≥4,7). Their vaginal fluid were analysed with dark field microscopy,

Nugent score.

RESULTS

34% of all pregnant women had I Lactobacillar degree, 31% IIa, 15% IIb and 19% had III

Lactobacillar degree and were considered as pathological flora. Analyzing samples with Grams

staining by Nugent score 63% of samples were considered as normal flora, 17% as intermediate

flora and 20% as bacterial vaginosis. Both methods showed same results coserning normal and

pathological flora (63% normal and 37% pathology X 2= 0,135; p=0,934).

CONCLUSIONS

1. Most of pregnant women have normal vaginal flora with I and IIa Lactobacillar degree.

2. The majority of pregnant women had 0 to3 Nugent scores and were considered as normal

flora.

3. Fresh vaginal sample microscopy and Grams staining methods are both easy performable

methods, that can be used separately or together, but Nugent score is less specific in aerobic

vaginitis detection.

REFERENCES

1. Berek J.S. Berek & Novak’s Gynecology 14th edition – Philadelphia: Lippincot Williams

& Wilcins, 2007 – p. 542 –548.

2. Rezeberga D. Dzemdniecība – Rīga: Medicīnas apgāds, 2009. – 281.-282. lpp.

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3. Stenchever M.A. Comprehensive Gynecology 4th edition – Philadelphia: Harcourt

Health Sciences, 2001 – p. 615.

4. Vīberga I. Ginekoloģija – Rīga: Nacionālais apgāds, 2006. – 148-151. lpp.

5. Donders G.G.G., Definition and classification of abnormal vaginal flora// Best practice &

Research Clinical Obstetrics and Gynecology – 2007 – Vol.1 – p. 1-18.

6. Donders G.G.G., van Calsteren C, Bellen G. et al. Predictive value for preterm birth of

abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester

of pregnancy// BJOG – 2009 – Vol. 176 – p. 1315-1324.

7. Donders G.G.G., Vereecken A., Bosmans E. et al. Definition of a type of abnormal

vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis// BJOG – 2002 –

Vol. 109 – p. 34-43.

8. Donders G.G.G., Vereecken A., Dekeersmaecker A. et al. Wet mount reflects functional

vaginal lactobacillary flora better than Gram stain// J Clin Pathol – 2000 – Vol. 53 – p.

308-314.

9. Donders G.G.G., Vereecken A., Salembier G. et al. Assessment of lactobacillary flora in

wet mount and fresh or delayed Gram’s stain// Infect Dis Obstet Gynecol – 1996 – vol. 4

– p. 2-6.

10. Gjerdingen D., Fontaine D., Bixby M. et al. The impact of regular vaginal pH screening

on the diagnosis of bacterial vaginosis in pregnancy// The Journal of Family practice –

2000 – Vol. 49 – p. 39-43.

11. Hellberg D., Nilson S., Mardh P.-A. The diagnosis of bacterial vaginosis and vaginal

flora changes// Arch Gynecol Obstet – 2001 – Vol. 265 – p. 11-15.

12. Hiller S.L., Nugent R.D., Eschenbach D.A. et al. Association between bacterial vaginosis

and preterm delivery of a low-birth-weight infant// N Eng J Med – 1995 – Vol. 333 – p.

1737-1742.

13. Holst E., Coffeng S.R., Andersch B. Bacterial vaginosis and vaginal microorganisms in

idiopathic premature labor and association with pregnancy outcome// J Clin Microbiol –

1994 – Vol. 32 – p. 176-186.

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14. Hay P.E., Lamont P.F. et al. Abnormal bacterial colonisaton of the genital tract and

subsequent preterm delivery and late misscariage// BMJ – 1994 – Vol. 308 – p. 295-298.

15. Kurki T., Sivonen A., Renkonen O. et al. Bacterial vaginosis in early pregnancy and

pregnancy outcome// Obstet Gynecol – 1992 – Vol. 80 – p. 173-177.

16. Khan K.J., Shah R., Gahtam M., Patil S. Clue cells// Indian J Sex Transimit Dis – 2007 –

Vol. 28 – p. 108-109.

17. MacDermott R.J., Bacterial vaginosis// BJOG – 1995 – Vol. 102 – p. 92-94.

18. Pastore L.M., Thorp J.M., Royce R.A., Savitz D.A. Jackson T.P. Risc score for antenatal

bacterial vaginosis: BV PIN points// Journal of Perinatlogy – 2002 – Vol. 22 – p. 125-

132.

19. Ronngvist D.J., Forsgren-Brusk U.B., Hakansson E.E. Lactobacilli in the female genital

tract in the relation to other genital microbes and vaginal pH// Acta Obstetrica et

Gynecologica – 2006 – Vol. 85 – p. 726-735.

20. van der Scee C., van Belkum A., Zwijgers L. et al. Improved diagnosis of Trichomonas

vaginalis infection by PCR using vaginal swabs and urine specimens compared to

diagnosis by wet mount microscopy, culture and fluorescent staining// J Clin Microbiol –

1999 – vol. 37 – p. 4127-4130.

21. Witkin S.S., Moreno Linhares J., Giraldo P. Bacterial flora of the female genital tract:

function and immune regulation// BJOG – 2002 – Vol. 109 – p. 1-10.

22. McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in

pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.:

CD000262

5. TRAUMA TEAM ACTIVATION DEPENDENCY ON LUNAR

PHASES

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Author: Julius Vidikas

Supervisor of the abstract: Assoc. Prof. Andrius Macas, Res. Vidas Jankus

INTRODUCTION

Predictable trauma team activation could be a usefull tool for organizing trauma team work,

however there isn`t much data how trauma team depends on lunar phases, therefore our main

purpose is to evaluate trauma team activation during different lunar phases.

AIM

To evaluate relation between lunar phases and trauma team activation.

OBJECTIVES

1. To evaluate if there is statistically signifficant difference between injuries frequency and

different lunar phases.

2. To evaluate if lunar phase does effect specific injuries mechanisms.

3. To evaluate if injuries mechanism depends on dark and bright day time.

4. To evalutae if there is difference of injuries in both gender depending on lunar phase.

METHODS

Research data was collected from Lithianian Health Science University(LHSU) Clinics,

Anestesiology department, trauma team registration journal. In this journal were registered

incoming patients with polytraumas. If there were more than one injured patient at once, to

research was included just one person on purpose to evaluate lunar phase influence for particular

injury occurence. The data was collected from 2011-09-02 to 2013-01-18. For consistent analysis

days of observation were included in purpose of equal lunar phases: I New moon, II First quarter,

III Full moon, IV Last-quarter. Lunar phases were measured in minutes increments, according to

astrologic calendar. Distribution by gender: n=130 males and n=53 females. From injuries

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journal patients divided by trauma`s etiology: patients with punctured wounds, bullet wounds,

beaten. Auto accidents analysed, when pedestrian, cyclist, passenger or driver got injured

compared in both gender. For research analysis also were used injuries on suicide purposes,

injuries at home and work. Frequency of falling from heights was evaluated in both : dark day

time and bright day time. Data were analysed using statistical SPSS packet Chi test and T test

criteria. Differences between groups were considered statistically significant if p<0,05.

RESULTS

Linear relation between trauma team activation frequency and lunar phases Chi-square=18,1

p=0,009. T test between new-moon in last-quarter phases according to trauma team activation: t

= 0,47 ±0,745 (New-moon), t= 0,28±0,548 (last-quarter) Chi-square=31,9 p=0,023.In

Comparison moon sides: Pearson Chi-Square= 21,31 p=0,043.Auto accidents by both gender:

52(40%) males and 33 (62,26%) with statistically significant difference Pearson Chi-Square=

22,8 p=0,006. The difference between injuries of falling from heights and lunar phases was not

statistically significant (n=54) p>0,05. Injuries on suicide purpose n=5, injuries at home and

work n=54, injuries at auto accidents n=85, atvejais Pearson Chi-Square >0,05. However, for

males frequency of falling from heights n=54 depends on daytime light (darkness and

brightness): 64,8%(bright daytime), 35,2%(dark daytime) Pearson Chi-Square p=0,003. Violence

caused injuries n= 32(patients with punctured wounds, bullet wounds, and beaten patients)

frequency statistically significantly for male gender varies in bright daytime and dark daytime.

28, 1 %(bright daytime), 71,9%(dark daytime) Pearson Chi-Square= 32,85 p=0,005. Injuries,

which occurred at home and at work, frequency statistically significantly varied just for male

gender 68,5% (at home) and 29,5%(at work) Pearson Chi-Square= 24,41 p=0,00. Auto

accidents (n=85) statistically significantly varied at bright and dark daytime: 50,5% (dark

daytime) and 49,5% bright daytime Pearson Chi-Square= 3,212 p=0,953.

CONCLUSIONS

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1. There was evaluated statistically significant linear relation between lunar phases and trauma

team activation frequency. The highest frequency of trauma team activation was at new-moon

phase with decreasing frequency to fourth-quarter phase.

2.Frequency of trauma team activation was statistically, but non-significantly higher at new-

moon phase.

3. There was statistically significant higher frequency of trauma team activation at bright

daytime, for patients who got injured by falling from heights and got injuries at home or work.

At the dark daytime trauma team activation frequency is higher for patients injuries related to

violence. Trauma team activation frequency when patients got injuries in auto accidents didn’t

varied statistically significantly according to daytime.

4. Lunar phases have higher effect for males, than females. There is statistically significant

difference between trauma team activation and male’s injuries according to lunar phases. Also,

there is linear relation on trauma team activation frequency decreasing when lunar cycle changes

from new-moon to fourth-quarter.

REFERENCES

1. Trauma team activation can be tailored by prehospital criteria.Claridge JA, Golob JF

Jr, Leukhardt WH, Kan JA, Como JJ, Malangoni MA, Yowler CJ.Available from:

http://www.ncbi.nlm.nih.gov/pubmed/21265356.

2. Delayed trauma team activation: patient characteristics and outcomes.

3. Ryb GE, Cooper C, Waak SM.Available from:

http://www.ncbi.nlm.nih.gov/pubmed/23007017

6. PROBABILITY OF BONE FRACTURE ESTIMATION IN 10 YEAR

PERIOD

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Authors: Žilvinas Pavilionis, Julius Vidikas, Rasita Zamblauskaitė

Supervisor of the abstract: Dr. Rimvydas Juodis

INTRODUCTION

Population adapted measurement tools are novice type of predicting diseases. Therefore we

chosen algorithm, which is based on Lithuania epidemiology and risk predicting factors.

“FRAX” is web based tool, developed by World Health Organization (WHO) Collaborating

Centre for metabolic bone diseases. This centre provides models for assessing man and woman

bone quality. Models are developed from studies in population-based cohorts in Europe, North

America, Asia and Australia. The algorithm uses several values: Age, body mass index, and

dichotomized values (prior fracture, smoking, glucocorticoid use, rheumatoid arthritis). Models

are calibrated to specific countries where the epidemiology of fracture is known. Therefore is

important to assess bone fracture risk in our random sample using FRAX algorithm.

AIM

To measure bone quality in random sample using “FRAX” algorithm focusing on Lithuanian

population model.

OBJECTIVES

1. To evaluate age impact for fracture risk using FRAX algorithm.

2. To evaluate body mass index(BMI) impact for fracture risk using FRAX algorithm.

3. To compare bone fracture probability between A and B groups.

METHODS

Retrospectively random 76 patients were reviewed at department of traumatology from

Kedainiai hospital. Several values were checked: prior fracture, smoking, gluccocorticoid use,

rheumatoid arthritis. Age and BMI values were used from patient histories. Patient`s selection

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was made randomly. Then sample was divided into A and B groups. A group contained patients

who had not fractures earlier, and B group patients who had prior fractures and other risk factors.

Probability of bone fracture was calculated in both groups and compared. For bone quality

assessment FRAX web-based assessment program were used. Sample`s qualitive data was

performed using SPSS 17.0 statistical program. Quantitive data were represented in percents.

Probability of bone fracture output 0-100% was compared with age, BMI using Pearson and

linear regression correlation methods. P value were considered significant when (p <0,05).

RESULTS

Sample totally contained 76 patients (n=76). 26 (34,21%) of patients were male, and 50(

65,79%) female. Overall patients age average 71,3m ± 8, 55 years. Average BMI 27, 21 ± 1,36.

14 (53%) of males used to smoke earlier, and 3 (11,53%) were still smoking. 11 (22%) of

females used to smoke earlier, and 2 ( 4%) were still smoking. 2 ( 2,63%) of females and 0(

0%) of males used to use gluccocorticoids. None (0%) of patients had rheumatoid arthritis

disease. A group contained 16 (47,05%) males and 18 (52.94%) females. B group contained 18

(42,85%) males and 24 (57,14%) females. Correlation between A and B groups bone fracture

probabilities: Pearson r=-0.45 p=0.257. Correlation between BMI and fracture probability r=0.72

p=0.34. Probability of major osteoporotic risk varied from 1, 9% to maximum 25,6% .

Comparing age and probability of fracture linear regression coefficient was R= 0,94. BMI and

probability of fracture: R=0, 87.

CONCLUSIONS

1. Positive statistical correlation was found between age and fracture probability. Correlation

coefficient: 0, 94.

2. Positive correlation between BMI and fracture probability wasn`t statistically significant

(p>0,05)

3. Correlation between A and B group bone fracture probabilities differed in negative

correlation. However, correlation was not statistically significant p=0.257.

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REFERENCES

1. Primary care use of FRAX: absolute fracture risk assessment in postmenopausal women

and older men. Siris ES, Baim S, Nattiv A. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/20107292

2. FRAX® counseling for bone health behavior change in women 50 years of age and

older.Dunniway DL, Camune B, Baldwin K, Crane JK. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/22672490

7. THE INFLUENCE OF MOON PHASES ON THE NUMBER OF

PATIENTS APPLYING TO THE CARDIOLOGY ADMISSION

DEPARTMENT AT KAUNAS CLINICS OF HOSPITAL OF

LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

Authors: Vidas Jankus, Julius Vidikas , Justina Liausaitė

Supervisors of the abstract: Assoc. Prof. Andrius Macas, Assoc. Prof. Dr. Giedre Baksyte

INTRODUCTION

In order to predict incoming patients traffic to Cardiology admission department we considered

to make an statistical analysis.

AIM

To determine possible influence of moon phases on patients applying to the Cardiovascular

Admission Department at Kaunas Clinics of Hospital of Lithuanian University of Health

Sciences due to cardiovascular diseases.

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OBJECTIVES

1. To determine if there is a statistically significant difference between mood phases and number

of patients applying to the Cardiovascular Admission department.

2. To determine if there is a relation between a moon phase and particular groups of diseases;

3. To determine if a moon phase influences the frequency of patients applying without a referral

letter to the Cardiovascular Admission Department.

4. To determine if there is a statistically significant difference between moon phases and further

referral place of patients from the Admission Department

METHODS

Data has been collected from the registration journal of Cardiovascular Admission Department at

Kaunas Clinics of Hospital of Lithuanian University of Health Sciences. Information that has

been registered: arrival time; gender; age; primary diagnosis according to ICD (International

Classification of Diseases). Moon phases have been evaluated with the accuracy of minutes with

reference to the astrology calendar. The period of data collection: from 28/04/12 to 26/07/12 (88

days). The number of registered patients: 1333. By coherent data collection it has been aimed to

obtain equal number of days of moon phases. Total number of days included: 23 new moon

days; 20 first quarter days; 21 full moon days; 24 last quarter days. According to the time of

patient’s arrival to the Cardiovascular Admission Department, the phase has been attributed with

accuracy of minutes with reference to the moon calendar. Patients have been grouped according

to a primary diagnosis of arrival: I20-I24 – ischemic heart disease; I47-I49 – arrhythmias; I10-

I11 – hypertensive diseases; G54; G90; G70 – diseases of peripheral nerves; I50 – cardiac

insufficiency; I44-I45 – disorders of cardiac conduction. A patient with the primary diagnosis

and arrival time has been attributed to an appropriate moon phase with accuracy of minutes. Data

has been analyzed using SPSS statistics software package applying Chi-squared Test as well as

Independent T-Test for the comparison of averages. Differences among groups have been

considered as statistically significant when p<0.05.

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RESULTS

Distribution between both gender: 742 males (55.7%) and 591 females (44.3%). The highest

difference between the last quarter and the first quarter – p=0.599. By applying χ2 Criterion

differences between variables were calculated: In comparison moon phases and the frequency of

applying to the Cardiovascular Admission Department due to ischemic heart diseases, the

difference has not been determined p=0,923; (n=628). Difference between moon phases and the

frequency of applying to the Cardiology Admission Department due to arrhythmias has not been

determined; p=0,982 (n=253). Difference between moon phases and the frequency of applying to

the Cardiology Admission Department due to hypertensive diseases has not been determined

p=0,466 (n=129). Difference between moon phases and the frequency of applying to the

Cardiovascular Admission Department due to cardiac insufficiency has not been determined

p=0,969 (n=49). Difference between moon phases and the frequency of applying to the

Cardiovascular Admission Department due to diagnosing of diseases of peripheral nerves has not

been determined p=0,667 (n=49). Difference between moon phases and the frequency of

applying to the Cardiovascular Admission Department without a referral letter has not been

determined p=0,951. Difference between moon phases and further referral place of patients from

the Admission Department has not been determined; p=0,54 (n=1294).

CONCLUSIONS

1. The daily averages of number of patients applying to the Cardiology Admission Department

given different moon phases have not differed statistically significantly.

2. Statistically significant difference between moon phases and ischemic heart diseases,

arrhythmias, hypertensive diseases, diseases of peripheral nerves, cardiac insufficiency, disorders

of cardiac conduction has not been determined.

3. Statistically significant difference between moon phases and the frequency of applying to the

Cardiology Admission Department without a referral letter has not been determined.

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4. Statistically significant difference between moon phases and further referral place of patients

from the Cardiology Admission Department has not been determined.

REFERENCES

1. Lunar phases, myocardial infarction and hemorrheological character. A Western medical

study combined with appraisal of the related traditional Chinese medical theory. Sha

LR, Xu NT, Song XH, Zhang LP, Zhang Y. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/2517088

8. THE INFLUENCE OF THE TIME OF DAY, WORK AND NON-

WORK DAY ON THE FREQUENCY OF PATIENT APPLICATIONS

TO THE CARDIOVASCULAR ADMISSION DIVISION

Authors: Eglė Jankuvienė, Julius Vidikas

Supervisor of the abstract: Assoc. Prof. Andrius Macas, Assoc. Prof. Dr. Giedre Baksyte, Res.

Vidas Jankus

INTRODUCTION

In order to predict incoming patients traffic to Cardiology admission department we considered

to make an statistical analysis.

AIM

To determine the influence of the time of day as well as work and non-work days on the

frequency of patient applications to the Cardiovascular Admission Division.

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OBJECTIVES

1. To determine at which time of day the highest frequency of patients applying to the

Cardiovascular Admission Division occurs.

2. To determine if there is a connection between the groups of cardiovascular diseases and the

time of day.

3. To compare the time averages of applications given the most frequent primary diagnosis

(ischemic heart disease) arriving to the Admission Division with a referral letter, by the vehicle

of Emergency Medical Services (EMS) from another health institution.

4. To compare the frequency of patient applications on work and non-work days.

5. To compare the frequency of different groups of diseases on work and non-work days.

6. To determine if there is a difference in further referral place on work and non-work days.

METHODS

Data has been collected from the registration journal of the Cardiovascular Admission Division.

Period of data collection: 28/04/12 to 26/07/12. The number of patients: 1319. Only emergency

patients have been registered. Arrival time of patients, primary diagnosis, the type of arrival

(without a referral letter; brought by the vehicle of Emergency Medical Services; brought from

another health institution), and the further referral place (released home, hospitalized to the

Critical Care Division (CCD). Primary diagnoses have been divided into the following groups:

I20-I24 – ischemic heart disease; I47-I49 – arrhythmias; I10-I11 – hypertensive diseases; G54;

G90; G70 – diseases of peripheral nerves; I50 – cardiac insufficiency; I44-I45 – disorders of

cardiac conduction. Data has been analysed by means of SPSS statistics software package.

Quantitative data has been compared by means of Independent T-Test; qualitative characteristics

have been estimated applying Chi-squared Test. The Differences among groups have been

considered as statistically significant when p<0.05.

RESULTS

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The average time of most frequent application of patients is 1:37 p.m., SD 5:24. Time average of

ischemic heart disease (n=621) 1:40 p.m., SD 5:25. Comparing to other groups of diseases

p=0.816. Time average of rhythm disturbances (n=249) 1:32 p.m., SD 5:21. Comparing to other

groups of diseases p=0.766. Time average of arterial hypertension (n=129) 2:01 p.m., SD 5:38.

Comparing to other groups of diseases p=0.38. Time average of diagnosed diseases of peripheral

nerves (n=49) 1:49 p.m., SD 6:17. Comparing to other groups of diseases p=0.793. Time average

of cardiac conduction disorders (n=37) 2:11 p.m., SD 5:20. Comparing to other groups of

diseases p=0.524. Time average of cardiac insufficiency (n=49) 12:35, SD 5:03. Comparing to

other groups of diseases p=0.173. Cardiovascular diseases and work/non-work days: researched

period of time: 62 work and 28 non-work days. The number of patients: 1333. Comparing the

averages of daily application of patients by means of Independent T-Test regarding work and

non-work days, statistically significantly higher frequency of applications has been identified on

work days. Significance level: 0.000. Average number of patients on a work day: 16.85 arrivals

(SD 4.619), on a non-work day: 10.29 (SD 3.867). Work and non-work days: applying Chi-

squared Test statistically significantly higher frequency of application due to arterial

hypertension at weekends than on work days; respectively, 14% with 8.6% of all applications;

p=0.007. Statistically significant difference in other mentioned groups of diseases has not been

determined. After the division of data according to sex, statistically significantly higher

frequency of male applications due to rhythm disturbances on work days than at weekends has

been determined; respectively, 17.9% with 9.9% of all applications. Applying Chi-squared Test

statistically significant difference between work and non-work days and further referral of

patients from the Admission Division has been identified; p=0.000. On non-work days patients

statistically significantly have been referred home more frequently and hospitalized to the

Critical Care Division (CCD); les often patients have been hospitalized to another division.

CONCLUSIONS

1. More frequently patients apply to the Cardiovascular Admission Division approx. at 2 p.m.

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2. Time averages of applications due to different groups of cardiovascular diseases do not differ

statistically significantly.

3. Time averages of arrivals of patients regarding different groups of diseases, arriving without a

referral letter, by the vehicle of Emergency Medical Services or from another health institution

have not differed statistically significantly.

4. The average of number of patient applications is statistically significantly higher on work

days.

5. At weekends, patients statistically significantly more frequently apply due to arterial

hypertension.

6. On work days, males statistically significantly more frequently apply due to rhythm

disturbances. On non-work days, patients statistically significantly more frequently are referred

home, hospitalized to the CCD and are less often hospitalized to another division.

REFERENCES

1. Lunar phases, myocardial infarction and hemorrheological character. A Western medical

study combined with appraisal of the related traditional Chinese medical theory. Sha

LR, Xu NT, Song XH, Zhang LP, Zhang Y. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/2517088

9. HYPOCALCAEMIA COMPLICATIONS AFTER

THYROIDECTOMIES

Authors: Julius Vidikas, Žilvinas Pavilionis, Rasita Zamblauskaitė

Supervisor of the abstract: Dr. Darius Bagdanavičius

INTRODUCTION

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Hypocalcaemia after total tiroidectomia is one of the most common complications after this type

of operation. Acute hypocalcaemia after thyroidectomy causes to increased neuromuscular

irritability. The clinical manifestation is tetany, repetitive neuromuscular discharge after a single

stimulus. Tetany is seen in severe hypocalcaemia (ionized Ca level lower than 1,1 mmol/l).

Chvostek's sign, Trousseau's sign can be positive during acute hypocalcaemia. Calcium

metabolism depends on PTH concentration and effectiveness in serum. Therefore we considered

to evaluate hypocalcaemia frequency in LSMU Clinics thyroidectomic operations, comparing

complications frequency with foreign data sources. Using literature sources this complication

varies from 1% to 2%.

AIM

To analyze hypocalcaemia complications after total thyroidectomia operations, focusing on

pathogenic morphologic structure for this disease and.

OBJECTIVES

1. To evaluate hypocalcaemia complications frequency after total thyroidectomies.

2. To evaluate average hypocalcaemia levels.

3. To find most common morphology of thyroidal gland, which leads to hypocalcaemia after

total thyroidectomia?

4. To compare age relation with complications and hypocalcaemia.

METHODS

Retrospectively 40 total tiroidectomic cases in 2008-2010 years were rewieved in LSMUK. Data

was collected from patient’s histories cards. All operations were based of thyroidal gland

carcinoma and struma diagnosis. Calcium concentration levels were selected from patient`s

history cards. The average concentration, the changes comparing with normal concentration was

calculated. Sample`s characteristics like averages, standard deviation data analyzed using SPSS

statistics 17 program. To compare relation between age, carcinoma morphology, and

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hypocalcaemia frequency we used linear regression analysis. Statistically significant differences

and results were considered when p value is less than 0,05 ( p <0,05). The quantitive data was

performed in percents.

RESULTS

Sample contained 2 male (5,0%) and 38 female (94,73%). Biochemical calcium examination for

all 2(100%) male showed decreased levels (<2,23 mmol/l). 24 (63,15% ) female had decreased

calcium concentration (<2,23 mmol/l). Other 14 (36,84%) female had not decreased calcium

concentration. 2(5,265%) female had increased calcium levels after operation, and 3(7,89%) had

normal calcium concentration. 10(20,40%) of patients hadn’t been tested for calcium changes

after operation. Age varied from 42 to 76 years. Average hypocalcaemia value was 1,97±0,0985

mmol/l of calcium, and ionized calcium was 0,98 ± 0,049 mmol/l. Female which had

decreased calcium concentration differed by thyroidal glands morphology. Most common

morphology was multinodosa 17 (70,82%), less common was diffusa-nodosa 5(20,83%), diffusa

2 (8,33%). Age and decreased calcium concentration didn`t correlated R=0,44 (p>0,05 ).

CONCLUSIONS

1. Overall acute hypocalcemia occurred for 26 (68,42 %) patients p=0,041.

2. Overall average hypocalcemia levels was: 1,97 ± 0,0985 mmol/l of calcium, and

0.9,8±0,049mmol/ l ionized calcium.

3. The most common morphology of thyroidal glands was “multinodosa“ 17 (70,82%) p=0.0031.

4.Age didn`t have significant impact for complication frequency R=0,44 (p>0,05).

REFERENCES

1. Predicting hypocalcemia after total thyroidectomy: parathyroid hormone level vs. serial

calcium levels.Graff AT, Miller FR, Roehm CE, Prihoda TJ. Available from:

http://www.ncbi.nlm.nih.gov/pubmed/20859873

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2.The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a

review of 932 casesEleni I. Efremidou, MD, PhD, Michael S. Papageorgiou, MD, Nikolaos

Liratzopoulos, MD, PhD, and Konstantinos J. Manolas, MD, PhD. Available from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637645/

10. GENDER DIFFERENCES AND FREQUENCY OF ST-SEGMENT

CHANGES OF LEAD AVR IN ACUTE MYOCARDIAL

INFARCTION

Author: Agija Rancāne, Riga Stradiņš University, 6th year student

Supervisor of the abstract: Prof. Andrejs Kalvelis, Riga Stradiņš University, Department of

Internal Medicine

INTRODUCTION

Acute myocardial infarction (AMI) differences of symptom presentation in men and women are

important for timely clinical diagnosis. Electrocardiography (ECG) is the most frequently used

test to diagnose AMI. Lead aVR is often neglected.

AIM

The aim of this study is to find the gender differences in symptom presentation and to evaluate

the frequency of ST segment changes in lead aVR and its correlations with other ECG leads in

AMI patients.

OBJECTIVES

1. Compare clinical symptom presentation of AMI in men and women;

2. Evaluate the frequency of ST segment changes in lead aVR in AMI;

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3. Find associations between clinical symptoms of AMI, biochemical markers and ST-segment

changes in lead aVR;

4. Evaluate associations between ST-segment changes in lead aVR and other ECG leads.

METHODS

This was a clinical prospective study where in total 40 patients with prior AMI, who performed a

12-lead ECG and had their blood troponin and creatinine kinase MB (CK-MB) fraction levels

tested, and underwent coronary angiography, were included. A questionnaire was developed.

The obtained data were processed with IBM SPSS program using independent samples pair t test

and Pearson correlation.

RESULTS

Women were significantly older (p=0,004), had higher body mass index (0,026) and systolic

blood pressure (p=0,032) comparing to men. Also women had more often previously diagnosed

coronary heart disease (p=0,001) and had unstable angina in previous week (p=0,001). Chest

pain in women was more often provoked by emotions (p=0,002) but in men by physical

activities (p=0,025). Ischemic chest pain in men more often presented without pain irradiation

(p=0,009).

In lead aVR there were 10 (25%) ST-segment elevations (≥0,1 mV), 16 (40%) ST-segment

depressions (mV≤ -0,1), and 14 (35%) no significant ST-segment changes (>-0,1 and <0,1 mV)

observed. The average value of ST depression of lead aVR was 0,12 ± 0,04 mV, the mean ST

depression was -0,15 ± 0,14 mV.

Independent samples pair t test showed that changes of ST aVR were reflected in leads ST II

(p=0,027), ST V5 (p=0,018) and ST V6 (p=0,003).

Pearson correlation analysis (PCC - Pearson correlation coefficient) showed a negative

correlation between ST-segment changes in leads aVR and II (p=0,000; PCC=-0,557), leads aVR

and III (p=0,009; PCC=-0,408). A negative correlation between ST-segment changes in leads V5

and aVR (p=0,003; PCC=-0,465), leads aVR and V6 (p= 0,000; PCC=-0,539) was observed.

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Also a negative correlation between ST-segment changes in aVR and CK-MB levels (p=0,046;

PCC=-0,317) were found. No more reliable correlations with aVR ST segment changes were

observed.

CONCLUSIONS

1.Women were significantly older, had higher body mass index and systolic blood pressure, and

had more often previously diagnosed coronary heart disease and unstable angina in previous

week. Chest pain in women was more often provoked by emotions but in men by physical

activities. Ischemic chest pain in men more often presented without irradiation of pain.

2.ST-segment changes in lead aVR were observed in 67, 5% of cases. Relatively rarely ST-

segment elevations and frequent ST-segment depressions were present.

3.There is a negative correlation between CK-MB level and ST-segment changes in lead aVR.

Other significant associations between clinical symptoms, biochemical markers and ST-segment

changes in lead aVR were not observed;

4.aVR ST-segment changes also negatively correlated with ST-segment deviations in leads II,

III, V5, and V6 as reciprocal changes.

REFERENCES

1. Aygul N, Ozdemir K, Tokac M, et al. Value of lead aVR in predicting acute occlusion of

proximal left anterior descending coronary artery and in-hospital outcome in ST elevation

myocardial infarction: An electrocardiographic predictor of poor prognosis. J Electrocardiol

2000.,Vol. 41, p.335–341.

2. Cannon CP et al. The electrocardiogram predicts one-year outcome of patients with unstable

angina and non-Q wave myocardial infarction: results of the TIMI III Registry ECG

Ancillary Study. J Am Coll Cardiol. 1997, Vol. 30., p.133–140.

3. Chen Tien-En et al. Prognostic significance of reciprocal ST-segment depression in patients

with acute STEMI undergoing immediate invasive intervention. American Journal of

Emergency Medicine 2012, Vol. 30, p.1865–1871.

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4. Coventry L. et al. Sex differences in symptom presentation in acute myocardial infarction: A

systematic review and meta-analysis. Heart & Lung 2011, Vol. 40, p.477-479.

5. D'Ascenzo F, et al. Prevalence and non-invasive predictors of left main or three-vessel

disease: evidence from a collaborative international meta-analysis including 22740 patients.

Heart 2012, Vol. 98, p.914-919.

6. Dellborg M, Herlitz J. et al. ECG changes during myocardial ischemia: Differences between

men and women. J of Electrocardiol 1994, Vol. 27, p.42–45.

7. Engelen DJ, et al. Value of the electrocardiogram in localizing the occlusion site in the left

anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll

Cardiol 1999.,Vol. 34, p. 389–95.

8. Gaitonde RS, et al. Prediction of significant left main coronary artery stenosis by the 12-lead

electrocardiogram in patients with rest angina pectoris and the withholding of clopidogrel

therapy. Am J Cardiol 2003., Vol. 92, p.846–848.

9. Hulley SB. Designing Clinical Reasearch. Philadeliphia: Lippincott Williams & Wilkins,

2007, p.92.

10. Riera ARP, et al. Clinical Value of Lead aVR, Ann Noninvasive Electrocardiol 2011.,Vol.

16, p.295–302.

11. Wong, CK. et all. aVR ST elevation: an important but neglected sign in ST elevation acute

myocardial infarction. Eur. Heart J, 2010., Vol. 31, p.1845–1853.

11. PROGNOSTIC FACTORS OF SHORT TERM OUTCOME IN

SEVERE ULCERATIVE COLITIS FLARE

Author: Birutė Kudzinskaitė

Supervisor of the abstract: prof. Gediminas Kiudelis

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INTRODUCTION

Ulcerative colitis is a form of inflammatory bowel disease. Ulcerative colitis is a form of colitis,

a disease of the colon that includes characteristic ulcers, or open sores. Ulcerative colitis has an

incidence of 1 to 20 cases per 100,000 individuals per year, and a prevalence of 8 to 246 per

100,000 individuals.

AIM

Examine the patients who had severe flare of ulcerative colitis and were treated at Lithuanian

University of Health Sciences Gastroenterology Clinic for potential clinical, laboratorial and

demographical parameters that could affect short term outcome of the disease.

OBJECTIVES

1. Compare clinical, laboratorial and demographical parameters of patients who had severe

ulcerative colitis and achieved remission with medical therapy to those who failed to

respond and had emergency colectomy.

2. Identify the clinical, laboratorial and demographic parameters which could lead to a

worse course of illness (emergency colectomy).

METHODS

A retrospective study was held at the Lithuanian University of Sciences Gastroenterology Clinic.

55 patient’s cases with severe ulcerative colitis flare according to Mayo criteria during 2006-

2011 years were analyzed. The first group of patients consisted individuals who achieved

remission with medical therapy, second one included patients who failed to the same treatment

and had to undergo emergency colectomy. Statistical analyzes was performed using SPSS ver.19

software. For qualitative data analysis we used Chi-square parameter and for quantitative -

Student parameter. Nonparametric Mann-Whitney parameter was used for data comparisons.

Along with that we performed logistic regression analysis to identify independent factors leading

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to a different outcome. For verification of statistical hypotheses, the significance level of

(p<0.05) was chosen.

RESULTS

We analyzed 55 patients cases: 18 women (32.73%) and 37 men (67.27%). Most of patients have

achieved remission with medications: 42 (76.4%), 13 (23.6%) had emergency surgery. Average

age of patients who achieved remission was 39-year-old (± 5 years). The average age among the

patients who had surgery was 32 (± 5 years). Female gender gave a worse short-term outcome

results: only 10 (23.8%) females and 32 (76.2%) males achieved remission and 8 (61.5%)

females and only 5 (38.5%) men had a surgery (< 0.05). Need for blood transfusion also resulted

worse outcome: Of patients who achieved remission with medications, only 13 (31.0%) had

undergone blood transfusion, compared to 11 (84.6%) of patients who were operated (p<0.05).

The average hospitalization days of patients who achieved remission were 20.27 days. (±3.45),

while the patients who had surgery were 29.62 days. (±7.44d) (p <0.05). Higher platelets count

was associated with worse short-term outcome (p <0.05). The patients who achieved remission

had average 459.16 (± 51.64) number of platelets and whose had a surgery - 572.53 (±101.66).

Rate of decrease in CRB during 7 day period was also significant factor in diseases short-term

outcome. (Maximum CRB - the lowest level of CRB within 7 days). The higher the CRB

decrease the more favorable short-term solution (p <0.05). The proportion of patients who

achieved remission, CRB difference in the mean was 49.69 mg/l (± 13.62 mg/l). Patients in need

of surgery the average difference in CRB was 77.25 mg/l (± 33.99 mg/l). Results of logistic

regression analysis showed that need for blood transfusion and higher platelets rate are

independent and statistically significant factors leading to poorer disease outcome (colectomy).

Decrease of CRB level was close to significance. The 25 (45.45%) patients received rescue

therapy (Cyclosporine /or Infliximab). From those 25 patients who received this treatment, 19

(76%) achieved remission, 6 (24%) required surgery.

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CONCLUSIONS

1. Female gender, the need for blood transfusion, higher platelet count and longer duration

of hospitalization was statistically significantly associated with poorer disease outcome -

emergency colectomy.

2. Higher CRB decreased in 7 days period was statistically significantly associated with a

favorable short-term outcome of the disease.

REFERENCES

1. Danesen S, Fiocchi C. Ulcerative Colitis. J The New England Medicine. 2011 November 3;

365:1713-1725. Available from: http://www.nejm.org/doi/full/10.1056/NEJMra1102942

12. CONNECTION BETWEEN THE PATIENTS’ COMPLAINTS

BEFORE UPPER GASTROINTESTINAL ENDOSCOPY AND

ENDOSCOPIC FINDINGS

Author: Giedre Kučinskaite, Riga Stradins University, Faculty of Medicine, Latvia, Riga

Supervisor of the abstract: Associate professor Juris Pokrotnieks, Riga Stradins University,

Pauls Stradins Clinical University Hospital, Latvia, Riga

INTRODUCTION

There are a large number and a wide variety of complaints relating to digestive tract problems

and to a greater or lesser extent these serve as an indication or a goal for upper gastrintestinal

endoscopy.(1,2,3,4) Relatively little is known about the link between these complaints and the

upper gastrointestinal endoscopy findings.

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AIM

The aim of the study was to examine possible links between the patients' complaints before

upper gastrointestinal endoscopy and endoscopic findings.

OBJECTIVES

1.Find out whether patients had complaints before upper gatrointestinal endoscopy and whitch of

these complaints was the most common.

2.Examine possible links between the patients' complaints before upper gastrointestinal

endoscopy and endoscopic findings.

3.Find out whether age is associated with upper gastrointestinal endoscopic findings.

METHODS

The questionnaire developed by the director of PSKUS Gastroenterology Centre Endoscopy

department, Ph.D. Linda Sosare, and endoscopic examination reports in the time period between

1st May 2012 and 31st July 2012 were used in a short term retrospective study. Statistical data

analysis was performed using IBM SPSS 20.0, Microsoft Office Excel computer programmes

and multifactor analysis program "Kulbak" with informative criteria, where Î> 1.0 indicates that

the characteristic is informative.

RESULTS

The sample size was 222 patients. Of these, 33 (14.9%) did not have any complaints, 164

(73.9%) indicated that they have one or more complaints and 25 (11.3%) left the section with

complaints empty. The most common complaint was abdominal pain, which occurred in 90

(40.5%) patients. The correlation between complaints and endoscopic findings was extremely

weak: for patients that had abdominal pain a statistically significant endoscopic finding was

anastomositis (p = 0.05 *) and for patients with joint pain a statistically significant endoscopic

finding was scars in the oesophagus (p = 0.05 *). A stronger correlation was found between the

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age of the patient and other characteristics. It was shown that the hyperemic gastropathy is

typical in subjects under the age of 49 years (p = 0.02, I = 2.80), while the erosive gastropathy -

in patients above the age of 50 (p = 0.02, I = 4.55). The age of patients also correlated with the

severity of endoscopic findings. In particular, signs of atrophy in the stomach (p = 0.01, I =

4.01), the condition after stomach resection (p = 0.03, I = 7.73) and anastomositis (p = 0.05, I = 7

22) were all typical in patients that were older than 50years.

CONCLUSIONS

1. Majority of patients had complaints before upper gastrointestinal endoscopy. The most

common complaint was abdominal pain.

2. The correlation between complaints and endoscopic findings was extremely weak.

3. There was a stronger correlation between the age and endoscopic findings compared to the

correlation between the patients’ complaints before the upper gastrointestinal endoscopy and

endoscopic findings. The age of patients also correlated with the severity of endoscopic findings.

REFERENCES

1. Ford AC , Forman D , Bailey AG et al. Who consult with dyspepsia results from a

longitudinal 10-yr follow-up study . Am J Gastroenterol 2007 ; 102 : 957 – 65

2. Maso JM , Delaney B , Moayyedi P et al. Managing dyspepsia without alarm signs in primary

care: new national guidance for England and Wales . Aliment Pharmacol Th er 2005 ; 21 : 1135

– 43

3. Talley NJ , Vakil NB , Moayyedi P . American Gastroenterological Association technical

review on the evaluation of dyspepsia . Gastroenterology 2005 ; 129 : 1756 – 80

4. Zagari RM, Law GR, Fuccio L, Pozzato P, Forman D, Bazzoli F. Am J Gastroenterol.

Dyspeptic symptoms and endoscopic findings in the community: the Loiano-Monghidoro study.

2010 Mar;105(3):565-71

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13. REPLICATION OF GWAS RESULTS ON GASTRIC CANCER IN

AN INDEPENDENT COHORT OF PATIENTS OF CAUCASIAN

ETHNICITY

Authors: Rūta Bartusevičiūtė, Milda Dedelaitė

Supervisors of the abstract: M.D. J. Kupčinskas, Prof. G. Kiudelis, Prof. L. Jonaitis

INTRODUCTION

Gastric cancer (GC) is one of the major malignant diseases worldwide with very high mortality

rates. GC is classified into intestinal and diffuse types. Intestinal type gastric cancer is linked

with H. pylori infection, while the pathogenesis of diffuse type gastric cancer is less understood.

Recent genome-wide association studies (GWAS) reviled a link between GC and single

nucleotide polymorphisms (SNPs) of the genes encoding prostate stem cell antigen (PSCA),

phospholipase C epsilon 1 (PLCE1) and mucin 1 (MUC1) genes. Most of the replication studies

of these GWAS results so far have been conducted in Asian populations, while data in Caucasian

subjects with gastric cancer are highly lacking.

AIM

To evaluate the role of SNPs determined in gastric cancer GWAS studies in an independent

cohort of patients of Caucasian ethnicity.

OBJECTIVE

To evaluate the relationship between SNPs of the genes encoding PSCA (rs2976392,

rs2294008), MUC1 (rs4072037) and PLCE1 (rs2274223) with the risk of developing gastric

cancer.

METHODS

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Gene polymorphisms were analyzed in 498 subjects (GC: n=252; controls: n=246) of Caucasian

origin. DNA was extracted from peripheral blood leukocytes using salting out method. PSCA

A>G (rs2976392), PSCA C>T (rs2294008), MUC1 C>T (rs4072037) and PLCE1 A>G

(rs2274223) SNPs were genotyped by real-time PCR (RT-PCR), using predesigned TaqMan

primers. Statistical analysis was performed using PLINK software for genomic analysis

(http://pngu.mgh.harvard.edu/~purcell/plink/).

RESULTS

Frequencies of genotypes in our study are similar to the data reported on subjects of Caucasian

ethnicity. Analysis of data revealed that the frequencies of all SNP genotypes are in line with

Hardy-Weinberg equilibrium. MUC1 rs4072037 C/C genotype was associated with higher

incidence of GC when compared to controls (32.4% vs. 15.9%, p=0.0002). PSCA rs2294008 T/T

genotype was linked with higher risk of GC when comparing to the control group (40.8% vs.

23.0%, p=7.829e-006). There was a higher frequency of G/G genotype in GC group (41.2%)

than in control group (23.3%, p=1.285e-005) for PSCA rs2976392 SNP. No significant

differences were determined between the frequencies of genotypes for PLCE1 SNPs with similar

distribution of A/A, A/G, G/G genotypes between controls (14.1%, 48.1%, 37.8%) and GC

patients (11.7%, 49.8%, 38.5%), respectively (p=0.73).

CONCLUSIONS

1.SNPs of PSCA (rs2976392, rs2294008) and MUC1 (rs4072037) genes are linked with

susceptibility of developing gastric cancer.

2.No significant association was determined between SNP of PLCE1 (rs2274223) gene and the

risk.of.gastric.cancer.

REFERENCES

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1.Study Group of Millennium Genome Project for Cancer, Sakamoto H, Yoshimura K, Saeki N,

Katai H, Shimoda T. Genetic variation in PSCA is associated with susceptibility to diffuse-

type gastric cancer. Nat Genet. 2008 Jun;40(6):730-40.

2.N. Saeki, H. Ono, H. Sakamoto, T. Yoshida. Genetic Factors related to gastric cancer

susceptability identified using a genome-wide association study. Cancer Sci. 2013 Jan;104(1):1-

8;

14. RHINOCONJUNCTIVITIS PREVALENCE AND HEALTH-

RELATED QUALITY OF LIFE INVESTIGATION AMONG

STUDENTS IN LITHUANIAN UNIVERSITY OF HEALTH

SCIENCES

Author: Kristina Mickeviciute

Supervisor of the abstract: Brigita Sitkauskiene

INTRODUCTION

Rhinoconjunctivitis as an allergic disease has one of the highest prevalence rate among the

world’s population and it tends to be increasing.

AIM

We aimed to investigate the prevalence of rhinoconjunctivitis among students in Lithuanian

University of Health Sciences and to evaluate the impact of rhinoconjunctivitis symptoms’

severity on health-related quality of life.

OBJECTIVES

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1.To assess the prevalence of rhinoconjunctivitis symptoms among students in Lithuanian

University of Health Sciences.

2.To compare the prevalence of rhinoconjunctivitis among students to the general population.

3.To evaluate severity of experienced symptoms and their influence on quality of life by

interpreting RQLQ domain scores.

METHODS

Randomly selected medical students were surveyed by a questionnaire assessing the prevalence

of symptoms related to rhinoconjunctivitis and, in addition, Rhinoconjunctivitis Quality of Life

Questionnaire (RQLQ; ©2003 QOL Technologies Ltd.) for the subjects who indicated

experiencing symptoms. RQLQ is a disease-specific quality of life questionnaire that has been

developed to measure the functional (physical, emotional and social) problems that are

troublesome to adults. The questions are divided into seven domains ( sleep, non-nasal/eye

symptoms, practical problems, nasal symptoms, eye symptoms, activities, emotions) each

domain has a set of questions which are rated on the scale from 0 to 6; 0 being “Not troubled”

and 6 being “Extremely troubled” by the symptoms. Overall quality of life score is estimated

from the mean score or all items1.

RESULTS

Questionnaires were obtained from 211 medical students: 62 males and 149 females; the average

age was 21.4 years. 56.9% of responders stated that they’re not experiencing the most

characteristic symptoms of rhinoconjunctivitis, whereas 43.1% indicated having nasal and/or eye

symptoms related to rhinoconjunctivitis. The prevalence of rhinoconjunctivitis among questioned

                                                                                                                         1 E.F. Juniper, G.H. Guyatt, L. E. Griffith, P. J. Ferrie. Interpretation of rhinoconjunctivitis quality of life questionnaire data. J Allergy Clin Immunol 1996; 98: 844-845.

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students is 10% to 20% higher than the average prevalence in the general population.2

Frequency of nasal symptoms among responders was 64.8%, frequency of eye symptoms –

58.2%, combination of these symptoms was indicated by 73.6 % of responders. Domain scores

among the students experiencing rhinoconjunctivitis symtoms were found in range of: sleep

disturbance domain - 1.5 (SD 1.7); non-nasal/eye symptoms – 1.7 (SD 1.5); the rate of practical

problems - 2.1 (SD 1.6); emotional suppression - 1.6 (SD 1.4); nasal symptoms - 1.8 (SD 1.4);

eye symptoms – 1.3 (SD 1.4). The domain scores did not significantly differ between males and

females. It is worthy to note the RQLQ has shown that reading (50.5%), doing home

maintenance (35.2%), and using a computer (31.9%) were the activities regarded as being most

limited by the symptoms.

CONCLUSIONS

1.The prevalence of rhinoconjunctivitis among the medical students is 43.1%.

2.In comparison to the previously studied general population, the prevalence of questioned

symptoms among students is greater.

3.Symptoms of rhinoconjunctivitis negatively influenced quality of students’ life, especially

practical aspects.

REFERENCES

1. E .F. Juniper, G.H. Guyatt, L. E. Griffith, P. J. Ferrie. Interpretation of rhinoconjunctivitis

quality of life questionnaire data. J Allergy Clin Immunol 1996; 98: 844-845.

2. R. Pawankar, G. W. Canonica, S. T. Holgate, R. F. Lockey. World Health Organization. White

Book on Allergy 2011-2012 Executive Summary: 12.

                                                                                                                         

R. Pawankar, G. W. Canonica, S. T. Holgate, R. F. Lockey. World Health Organization. White Book on

Allergy 2011-2012 Executive Summary: 12.

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15. ANALYSIS OF PROGNOSTIC FACTORS IN MORTALITY DUE TO

ESOPHAGEAL AND GASTRIC VARICEAL BLEEDING (DATA

COLLECTED BETWEEN 2007 AND 2011 BY THE HOSPITAL OF

LITHUANIAN UNIVERSITY OF HEALTH SCIENCES KAUNAS

CLINICS)

Authors: Raminta Macaitytė, Ingrida Rubinaitė, Malvina Vienažinytė

Supervisor of the abstract: Prof. K.Adamonis, Prof. L. Jonaitis

INTRODUCTION

Bleeding from esophageal and gastric varices is a life-threatening condition which often results

in fatal outcome. Data on factors associated with first or re-bleeding is not enough, therefore it is

difficult to predict the risk of bleeding and outcomes.

AIM

To assess mortality and associated factors of the patients hospitalised due to bleeding from

varicose veins of the esophagus and stomach in the Hospital of Lithuanian University of Health

Sciences Kaunas Clinics.

OBJECTIVES

1. To determine treatment outcomes of hospitalised patients from 2007 to 2011.

2. To assess reference to mortality with varices etiology, location and degree.

3. To assess reference to mortality with insufficiency of liver according to Child-Pugh functional

class and system of model of end-stage liver disease (MELD).

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4. To determine methods of medication and endoscopic treatment and to assess the reference to

treatment outcome.

5. To assess whether acute variceal bleeding, during endoscopic examination, determines

increased mortality.

METHODS

The data of 134 case histories collected between 2007 and 2011 by the Hospital of Lithuanian

University of Health Sciences Kaunas Clinics, of patients hospitalised to treat for esophageal and

gastric variceal bleeding were retrospectively analyzed. For all cases included in the study, we

collected the following information: age, varices location, the degree of esophageal varices (F1,

F2, F3), insufficiency of liver by Child-Pugh classification(A, B, C), system of model of end-

stage liver disease (MELD), acute variceal bleeding during endoscopic examination and the

influence of these factors on mortality. We assessed the applied methods of medication,

endoscopic treatment and prophylaxis till the first episode of variceal bleeding. We performed

statistical analysis using SPSS version 20.0. The difference was statistically significant at

p<0.05. Sample signs averages were calculated, using Student t-test for comparing, non-

parametric values - χ2 test.

RESULTS

1. 134 cases of variceal bleeding were analyzed: 77 (57.5%) male and 57 (42.5%) female. Age

average: 59.16 ± 2.15 for female, for male – 53.75 ± 1.58 years, p<0.05. 32 patients died

(23.9%). In 2007, 5 patients out of 24 died (20.8%), in 2008 - 11 out of 30 (36.7%), in 2009 –

6 out of 24 (25%), in 2010 – 4 out of 18 (22.2%), in 2011 - 6 out of 38 (15.8%).

2. Esophageal varicose veins were diagnosed in 105 (78.4%) patients, gastric - 9 (6.7%), both -

20 (14.9%). 30 patients (28.6%) who had esophageal varices, died and 2 patients (10%) who

had a mixed varices, p<0.05. Among the patients who had developed esophageal varices F1

degree, all 9 patients survived, F2 – 8 out of 42 died (19%), F3 - 24 out of 73 died (32.9%).

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3. Variceal bleeding causes: viral B, C cirrhosis - 56 (41.8%), non-viral (toxic, idiopathic)

cirrhosis - 55 (41%), vascular (v. portae, v. lienalis thrombosis) portal hypertension - 23

(17.2%). In viral B, C cirrhosis 14 patients (25%) died, with non-viral - 16 (29.1%), vascular -

2 (8.7%).

4. Insufficiency of the liver by Child - Pugh classification: A - 12 (10.4%), B - 51 (44.3%), C -

52 (45.2%). Patients who died in each functional class were distributed accordingly: A - 2

(16.7%), B - 9 (17.6%), C - 19 (36.5%).

5. After MELD scores were counted, the average score of the dead were 23.52 ± 1.29, and

among the survivors - 14.97 ± 0.52 (p<0.05).

6. During the first endoscopic examination, acute variceal bleeding observed in 57 patients

(42.9%), no signs of acute bleeding were in 76 (57.1%). Among the patients who had acute

bleeding, 19 died (33.3%), and with no signs of bleeding, 13 died (17.1%)(p<0.05).

7. Methods of treatment: endoscopic sclerotherapy or balloon tamponade - 54 (40.3%),

endoscopic sclerotherapy with balloon tamponade - 15 (11.2%), variceal band ligation - 28

(20.9%). Among patients who had endoscopic sclerotherapy or balloon tamponade 24 patients

died (44.4%), by applying both methods - 4 (26.7%), after variceal band ligation - 2 (7.1%)(p

<0.05).

8. Specific medication was applied for 108 (80.6%) patients, from which: somatostatin – 12

(9%), carvedilol - 77 (57.5%), carvedilol with somatostatin - 18 (13.4%), propranolol - 1

(0.7%). No medication was applied for 26 patients (19.4%). Taking at least one of the drugs,

13 patients died (14.4%), while taking carvedilol with somatostatin - 5 (27.8%), without any

medical treatment - 14 (53.8%) (p<0.05).

9. Among all re-bleeding cases (68 patients), 45 patients (66.2%) did not take non-selective

beta-blockers to prevent bleeding, while 14 (20.6%) – took, interventional therapy (variceal

band ligation, transjugular intrahepatic portosystemic shunt (TIPS)) or both of the methods

were applied for 6 patients (8.8%), medication with therapy intervention - 3 (4.4%). Among

patients who received at least one preventive measure 4 died (5.9%), and among these, who

did not receive - 8 (11.8%).

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CONCLUSIONS

1.The mortality of hospitalised patients due to variceal bleeding was 23.9%.

2.The highest mortality was among patients with F3 esophageal varices (p <0.05), due to viral

and non-viral liver cirrhosis.

3.A more severe insufficiency of the liver by Child - Pugh function class and MELD score

system leads to increased patient mortality (p<0.05).

4.The highest mortality was among patients who did not get any medication, and mortality

decrease when endoscopic sclerotherapy with balloon tamponade were applied in acute-phase of

bleeding (p<0.05).

5.Acute variceal bleeding during endoscopic examination leads to increased mortality compared

to patients without acute bleeding (p <0.05).

16. EPIDEMIOLOGICAL PATTERNS OF PERTUSSIS IN VILNIUS

CITY AND COUNTRY

Author: Jadvyga Toleikyte, BSc in Public Health, Vilnius University, Faculty of Medicine.

Supervisor of the abstract: Giedre Aleksiene, Head of Infectious Disease Control and Prevention

in Center of Public Health .

INTRODUCTION

Pertussis – a bacterial disease with a main symptom of paroxysmal cough – is the cause of nearly

300 000 deaths each year worldwide. It is particularly dangerous to infants and leads to many

serious complications. Although it mostly affects infants, teenagers and adults can also have a

disease but symptoms are not that severe.

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By making detailed epidemiological patterns of pertussis in Vilnius city and county we want to

demonstrate that teenagers and adults can play an important role of in transferring pertussis to

infants. If that comes to be true, the important outcome of that would be to vaccinate not only

infants but teenagers as well in order to prevent disease development.

AIM

Describe epidemiological patterns of whooping cough in Vilnius city and county, 2003-2012.

OBJECTIVES

1.Determine structure of incidence in vaccine-controlled infections.

2.Describe territorial distribution of incidence in Vilnius county.

3.Evaluate incidence of pertussis and perennial dynamic.

4.Evaluate incidence in various groups of age.

5.Describe vaccination and booster coverages.

METHODS

1. The type of research is descriptive epidemiology.

2. There is used epidemiological data of 2003-2012 from Center of Public Health,

Infectious Disease and AIDS Center in Vilnius.

3. Extensify and intensify indicators are calculated for evaluation of structure in vaccine-

controlled infections, dynamic of incidence, distribution of territorries and various groups

of age.

4. Analysis of data is used by Microsoft Excel, WinPepi, Stata.

RESULTS

1. Comparative part of pertussis in vaccine-controlled infections increased from 16%- 32%

in Vilnius city and from 18%-41% in Vilnius county.

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2. The highest incidence rates of pertussis were in 2 regions of Svencionys, Salcininkai in in

research by Cartogram of Stata in 2003-2012. The incidence rates were from 0.23-0.35.

The lowest incidence rates of pertussis was in 3 regions of Vilnius, Ukmerge and

Sirvintai, 2003-2012. The incidence rates were from 0.02 to 0.23.

3. The biggests incidence rates (incidence per 10 000 population) of pertussis were in

Vilnius city. They were from 0 in 2003 to 1.40 in 2012 of Vilnius city. The incidence

rates were smaller in Vilnius county. They were from 0 in 2003 to 0.40 in 2012 of

Vilnius County.

4. The biggest incidence rates were registered of children aged 0-1 years in 2003-2007 and

in 2008-2012 of Vilnius city. These rates reached from 1,7 in 2003-2007 to 2,3 in 2008-

2012,Vilnius city. Also high level of incidence rates were of teenagers in Vilnius

city.Rates were 1,1 in 8-15 years, 0,8 in 16-17 years of age in 2003-2007 and 3,5 in 8-15

years, 4,2 of 16-17 years of age in 2008-2012 in Vilnius city. The biggest incidence rates

were in children aged 0-1 years in 3,5 in 2003-2007 to 2,7 in 2008-2012 of Vilnius

county. Also big part takes teenagers of 0-4 incidence rates in 8-15 years of age and 16-

17 years of age 2003-2007, 2,4 to 16-17 years of age in 2008-2012.

5. Vaccination coverage DTP3 and DTP4 for children in 1 and 2 years of age is about 95%

in Vilnius city and county, 2003-2012. There is decreasing of vaccination coverage in

2003-2012. It could be the reason of changed documents of registration in 2011,2012 and

alteration of opinions by people about vaccines.

CONCLUSIONS

There is periodicity and increasing tendency of pertussis in Vilnius city and county, 2003-2012.

Principally, there is changed incidence in various groups of age in searching period and

territories. The highest incidence of whooping cough is not just in the age group under 1 years,

but also of adolescents. Increased incidence of pertussis in teenagers shows that it is necessary to

reconsider the national vaccination programme of pertussis in adolescents.

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REFERENCES

1. Usonis V.Vaccines and immunization. Vilnius: Publishing Office of Homo liber; 2010.

2. Recommended Schedule of immunization in Lithuania by BALTIPA in 2012 years.

Vilnius: Publishing Office of Homo liber; 2012.

3. Narjkeviciute I., Kavaliunaite E. Particularity of Pertussis to Children in Immunized

Public. Vilnius: Children’s Clinic of Vilnius University in Medicine Faculty, Children

Hospital of Vilnius University; 2009.

4. Zagminas K., Kupreviciene N., Morkunas B., editors. Methodical Recommendations of

Pertussis Epidemiological Surveillance, Prevention and Control. Vilnius: Public Health

Institute of Vilniaus University in Medicine Faculty; 2009.

5. Savickiene E., Razmuviene D., Caplinksas S., Pertussis Epidemiology in Lithuania,

2006-2010. EpiNorth. 2012; 13:35-9.

6. Lithuania. Direction For Confirmation of National Programme Immunisation, 2009-2013.

Vilnius: Ministry of Health; 2008.

7. Lithuania. For Immunization Scedule of Children in Lithuania. Vilnius: Ministry of

Health; 2007.

8. European Centre for Disease Prevention and Control (ECDC) Guidance. Scientific Panel

on Childhood Immunisation Schedule: Diphteria-tetanus-pertussis (DTP) Vaccination.

Stockholm; 2009 [cited 2012 08 10]. Available from:

http://www.ecdc.europa.eu/en/publications/Publications/0911_GUI_Scientific_Panel_on

_Childhood_Immunisation_DTP.pdf

9. Grunicheva T., Babura E., Gorbatova Y. Effectiveness and Peculiarities of

Immunoprophylaxis of Pertussis Among Children and teenagers in Kaliningrad Oblast,

Russia. EpiNorth. 2012; 13:40-3

10. Raugale A., Lesinskiene s., editors. Children Diseases. 4th ed. Vilnius: Publishing Office

of Vilnius University; 2005.

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11. Weekly Epidemiological Records. Pertussis Vaccines: WHO Position Paper. Geneva:

World Health Organization; 2010 [cited 2013 04 03]. Available from:

http://www.who.int/wer.

17. SLEEPINESS AND VIGILANCE IN PATIENTS WITH

OBSTRUCTIVE SLEEP APNEA

Authors: Laima Blažytė, Simona Stankevičiūtė

Supervisor of the abstract: Guoda Pilkauskaitė, MD

INTRODUCTION

Obstructive sleep apnea (OSA) is the most frequent sleep related breathing disorder

characterized by repeated pauses of breathing during sleep. It results in repetitive oxygen

desaturations and arousals causing sleep fragmentation. Disrupted sleep is related to excessive

daytime sleepiness and impaired vigilance [1]. OSA is proved to be related to increased risk of

car and work accidents. In clinical practice only sleepiness is used to be routinely evaluated

though impaired vigilance was demonstrated using different vigilance tests in various clinical

trials [2].

AIM

To evaluate sleepiness and vigilance in patients with OSA and to determine possible relations

with polysomnographic parameters.

OBJECTIVES

1. To evaluate possible differences in sleepiness of the OSA patients and controls using SSS and

ESS;

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2. To evaluate possible differences in vigilance of the OSA patients and controls using

Psychomotor vigilance test (PVT) [3];

3. To evaluate if the experience in playing computer games has any influence on PVT results;

4. To establish the relations among PSG data and results of vigilance and sleepiness tests.

METHODS

The study group was formed from the patients with newly diagnosed OSA at Pulmonology and

Immunology Department of Lithuanian University of Health Sciences Kaunas Clinics. OSA was

proved by clinical symptoms and PSG [4, 5]. Exclusion criteria were history of neurological or

psychiatric disease, chronic lung disease, uncorrected visual and hearing impairment, chronic

sedative intake or alcohol abuse [6]. Control subjects were selected by chance from general

population and did not undergo PSG. OSA was excluded using a questionnaire demonstrating the

absence of snoring, sleepiness and other sleep apnea symptoms. None of the controls suffered

from any chronic disease. In this clinical situation the likelihood of OSA has been demonstrated

to be low [7]. Subjects working shifts were excluded. Age and body mass index (BMI) was

evaluated as well.

Participants of the study were asked to fill Stanford and Epworth sleepiness scales. After that

they performed PVT. This test was performed twice with a 5 minutes break. Only the results of

the second PVT were analyzed. PSG was evaluated by a respiratory physician. PSG criteria as

total sleep time (TST), apnea-hypopnea index (AHI), apnea index (AI) and oxygen desaturation

index (ODI) were used.

All the participants were interviewed about their computer gaming habits. According to that two

groups of gamers (G) and non-gamers (NG) were formed. NG group included those who never

play computer games, G group – those who play computer games at least once a month.

Values were expressed as mean + SD. Normality of distribution was tested using Kurtosis and

Skewness test. An unpaired t-test or Mann-Whitney U-test was used to compare control and

patient groups regarding quantitative variables. The Chi-squared test was used for qualitative

variables. Correlation analysis were done using Spearman test (r), if r value is 0.1 – 0.29

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correlation is considered weak, r =0.3-0.49 - moderate correlation, r=0.5-1.0 strong correlation.

A p-value of <0.05 indicated significance in all studies.

RESULTS

1.22 patients with OSA (18 males, 4 females) and 18 control subjects (7 males, 11 females) were

included. The two groups were age matched (the study group 49 ± 2.0 yrs, control group 45.4 ±

2.7 yrs (p = 0.653)). BMI of the study group was 33.6 ± 1.4 kg/m2, control group 24.8 ± 0.64

kg/m2 (p = 0.0001). Mean ESS score of the study group was 11.2 ± 0.9, control group 6.11 ± 0.6

(p = 0.0001). Mean SSS score was 3.3 ± 0.2, control group 1 ± 0 (p = 0.0001). PVT results of

study group were 384.5 ± 18.9 s-1, results of control group were 331.2 ± 7.9 s-1 (p = 0.044).

Out of 40 people 31 were included to the gamers group and 9 in the non-gamers group. PVT

value in the G group was 350.1 ± 72.5 s-1, NG – 396.4 ± 71.4 s-1 (p=0.191).

In OSA patients TST showed negative correlation with ESS score (r = -0.43, p = 0.52), positive

correlation with SSS score (r = 0.14, p = 0.046).

No significant correlations were found among PVT results and PSG parameters (TST r=-0,386,

p=0,076, AHI r=0,033, p=0,885, AI r=0,064, p=0,778, ODI r=0,008, p=0,970).

CONCLUSIONS

1. OSA patients were sleepier compared to control group according to the results of Stanford

and Epworth sleepiness scales.

2. According to PVT results OSA patients demonstrated to be less vigilant than the controls.

3. PVT result did not depend on subjects experience in playing computer games.

4. The connection between TST and Stanford sleepiness scale was found weak, yet statistically

significant. This scale may be used when assessing instantaneous sleepiness. The correlation

between PVT results and PSG data was not found. Results do not indicate the need to use

PVT in clinical practice.

REFERENCES

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1. Iranzo A. Excessive daytime sleepiness in OSA. European Respiratory Monograph 2010. 50,

17–30;

2. Mazza S. et al Most obstructive sleep apnoea patients exhibit vigilance and attention deficits

on an extended battery of tests. European Respiratory Journal 2005, 25: 75–80;

3. American Academy of Sleep Medicine. Sleep Disorders Center Florida. Psychomotor

Vigilance Test. www.sleepdisordersflorida.com

4. Miliauskas S. Kvėpavimo sutrikimų miego metu diagnostika ir gydymas. Kaunas: KMU

leidykla; 2007;

5. The report of American Academy of Sleep Medicine task force. Sleep-related breathing

disorders in adults: recommendations for syndrome definition and measurement techniques

in clinical research. Sleep.1999; 22:667–89.

6. Romola S et al Neurocognitive Function in Obstructive Sleep Apnea – a Meta-Review.

Crawley: Respirology 2012, RES -12-381.

7. Flemons WW et al Likelihood ratios for a sleep apnoea clinical prediction rule. Am J Respir

Crit Care Med 1994; 150: 1279–1285.

18. FIRST ORAL HEALTH KNOWLEDGE OF THE CHILD : SURVEY

IN SCHOOLS OF MONTPELLIER, FRANCE

Author: Dr Samy Dubois

Supervisor of the abstract: Dr Paul Tramini

INTRODUCTION

Dental health of whole populations has been clearly improved thanks to States’ political will and

with efforts made by the dental profession. This success is due to a range of prevention programs

based on an improvement of oral hygiene, optimal use of fluorides and reasonable consumption

of sugar, supplemented by effective services of treatment, restoration and rehabilitation. Since

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the 70’s, we noticed for children of the industrialized countries an important reduction of oral

diseases. There exists indeed high variations between countries and it appears that some

populations of low socio-economic level still present high prevalence of tooth decay. Works of

Featherstone confirm that the prevalence of the tooth decay disease is still an alarming health

problem, as well for adults that for children. Prevention programs consist in examining children

periodically. They allow on the one hand, to follow the evolution of the prevalence of the oral

diseases and, on the other hand, to connect this evolution to the actions undertaken to prevent

these diseases.

AIM

This study aims to evaluate the dental state of children schooled in Montpellier, from 4 to 14

years-old, and their knowledge of oral diseases, then to identify the socio-demographic factors as

well as the oral health behaviors in relation to the presence of decay. The goal will be

secondarily to set up actions for health education by sensitizing and promote oral health at school

by prevention.

OBJECTIVES

1. Measure the effectiveness of a prevention and oral hygiene education program.

2. Identify a defect of information on a precise point in order to refocus our actions.

3. Carry out comparisons with the results of other studies.

4. Confront results of the investigation according to the age of children, type of the school

(public/private).

5. Evaluate knowledge and practices of the families for oral health.

METHODS

It’s an epidemiological investigation, descriptive type. A cross-sectional survey has been applied

to 450 children from 4 to 14 years old in schools. This representative sample was divided into 3

equal groups (G1=12 y-o, G2=9 y-o, G3=6 y-o). It was estimated statistically according to

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variables and their standard deviation, while being based on the previous investigations carried

out. We selected randomly 2 public and one private school. The project comprised 2 phases:

1. “Evaluation using a questionnaire about children’s knowledge as regards oral health” &

“Action of promotion and education for health in the schools”.

2. “Revaluation of children’s knowledge (4 months after our first intervention using the same

questionnaire” & “Evaluation of the oral health status and medical monitoring by oral

tracking actions in the schools”.

Three different self-administered questionnaires (one for each group) aim to standardize the data

to code them more easily. Formulation of the questions was carried out to be simple and clear.

A newsletter was given before to the parents via the children, with a form of assent and a specific

questionnaire in order to collect informations about the parent’s professions, size and weight of

the child, use of fluorinated salt or tablets, dietary and oral hygiene habits, knowledge of sealants

and consultation during pregnancy.

Scoring of decayed, missing, filled teeth (DMFT) and Silness Löe Index (SLI) scores were

measured and computed according to the WHO recommendations.

Data were registered in an Excel file. Fisher’s exact test, Χ2 test, or Wilcoxon signed-rank test

were used, according to the case.

RESULTS

Feedback from parents 25,7% (16% for public ; 48% for private)

Tooth decay prevalence 46,4%

SLI 1,2

DMFT 1,298 (1,88 for public ; 0,45 for private)

DMFS 1,795

Dft 1,18

Dfs 2,24

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In 62% of children who didn’t present disocclusion, we found a DMFT=0.

The 5 highest DMFT indices were found on children whose father were worker/farmer and

jobless mother (noticed too in several other studies).

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CONCLUSIONS

We noticed the importance of the socio-economic factor and the family context: children

schooled in public and of working class parents or jobless have a higher risk of decay.

Moreover some children cumulate a large number of decayed teeth. We noticed an

effectiveness of teaching significantly higher among private schooled children, and some

differences according to the age: effectiveness is higher for the “6 years-old” (G3 group).

It is important to continue and improve sensitizing while insisting on the at risk populations

and try to reach the oral health level of children without decay.

Sealants are really unknown (71% of the questioned parents): it would be necessary to

increase its promotion and it would be judicious to ensure a systematic regular tracking in

order to follow the evolution of the oral health.

REFERENCES

1. Featherstone JD, Young DA, Roth JR «Curing the silent epidemic: caries management in

the 21st century and beyond», 2007

2. Geider EP, Michailesco PM, Dimeglio L «An epidemiologic study of the orodental status of

6-15-year-old children in the Languedoc-Roussillon region», 1989

3. Matulaitiene ZK, Zemaitiene M, Zemgulyte S, Milciuviene S « Changes in dental caries and

oral hygiene among 7-8 year-old schoolchildren in different regions of Lithuania 1983-

2009 », 2012

4. Muller-Bolla M, Bourgeois D, Sixou M, Lupi-Pégurier L, Velly AM, Tramini P,

“L’épidémiologie clinique dans la pratique quotidienne du chirurgien-dentiste”, 2009

5. Schulte A, Rossbach R, Tramini P “Association of caries experience in 12 years old children

in Heidelberg and Montpellier, with different caries measures”, 2001

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6. Tolvanen M, Lahti S, Hausen H « Changes in toothbrushing frequency in relation to

changes in oral health-related knowledge and attitudes among children - a longitudinal

study», 2010

19. INFLUENCE OF METEOROLOGICAL FACTORS ON TRAUMA

TEAM ACTIVATION

Author: Eglė Jankuvienė

Supervisor of the abstract: Andrius Macas MD, PhD, Assoc. Prof. , Vidas Jankus

INTRODUCTION

There are not data in literature about connection between meteorological condition and the

frequency of trauma.

AIM

The Purpose of the work is to determine if there is a connection between meteorological

conditions and the frequency of activated trauma team.

OBJECTIVES

1. To determine if there is a statistically significant difference between the frequency of activated

trauma team and the parameters of meteorological conditions.

2. To determine if there is a connection between the parameters of meteorological factors and

trauma mechanism.

METHODS

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Data for the research has been collected from the registration journal of trauma team of

Anesthesiology Division at Kaunas Clinics of Hospital of Lithuanian University of Health

Sciences. Patients who have possibly suffered a politrauma and arrived to the Admission Room

at Kaunas Clinics of Hospital of Lithuanian University of Health Sciences are registred in this

journal. Period of data collection – 02/09/11 to 30/09/12 (396 days). The number of activated

trauma teams – 139. If there were more than one injured in the same accident only one was

included in the research in order to determine the influence of meteorological factors on a

traumatic accident but not on the number of injured. Meteorological data (air temperature; wind

speed, atmosphere pressure, cloud cover, amount of precipitation, total sunlight) was subscribed

for the research period with the accuracy of three hours. Particular meteorological data was

attributed to a particular patient on the basis of activation time of the trauma team. Patients were

grouped according to trauma mechanism.

RESULTS

Independent T-Test has been used to compare averages of meteorological parameters of the days

when the trauma team was activated and those when it was not activated: daily average of air

pressure p=0.909; daily average of wind speed p=0.373; daily average of cloud cover p=0.666;

daily average of precipitation p=0.834; daily average of air temperature p=0.157; daily average

of total sunlight p=0.961. Applying Independent T-Test statistically significant difference in

atmospheric pressure has been determined comparing averages at the time of violent (n=23) and

non-violent (n=116) injuries. Respectively, 1019 hPa SD 6.5383 ir 1015 hPa SD 10.3805.

Statistically significant difference in averages of cloud cover between traumas suffered with

suicidal purposes and given other conditions has been determined. Average of cloud cover at the

moment of the activation of trauma team given suicide - (n=5) 7.8 oktas SD 0.447; given a

trauma under other conditions - (n=134) 5.4 oktas SD 3.019 p=0.000. By means of Independent

T-Test statistically significant difference in wind speed has been determined between men

trauma mechanism when falling down (n=31) and traumas under other conditions. Respectively,

wind speed 3.395 m/s SD 1.856 and 2.37 m/s SD 1.816. p=0.012. By means of Independent T-

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Test statistically significant difference in averages of diurnal cloud cover between the men

trauma in a car accident (n=41) and a trauma under other conditions. Respectively, cloud cover

5.037 oktas SD 2.0893 and 5.93 oktas SD 1.8831 p=0.029.

CONCLUSIONS

1. Statistically significant difference between the frequency of activated trauma team and the

parameters of meteorological parameters has not been determined.

2. The trauma team is activated more frequently: due to violent injuries, given higher

atmospheric pressure; due to traumas suffered in suicidal purposes, given heavier cloud cover;

due to men traumas falling down, given stronger wind; due to men traumas at the time of a car

accident, given heavier cloud cover.

20. SELF-TREATMENT AND HOME MEDICATION BOX

CHARACTERISTICS AND ATTITUDE TO SELF-MEDICATION OF

STUDENTS’ FAMILIES’ OF LITHUANIAN UNIVERSITY OF

HEALTH SCIENCES PHARMACY FACULTY

Author: Povilas Žukauskas

Supervisor of the abstract: dr. Jurgita Daukšienė

INTRODUCTION

Home medication boxes could be defined as a mirror of good (or bad) medication consumption

habits of every family. A number of problems could appear after patient purchase the medication

while storing them at home. Storage of leftovers, usage them later without clear memory what is

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the medication for, or changing the medication with other members of the family are common

reasons off-label medication consumption. This is a serious problem worldwide and can course

serious health problems for the individuals. Sadly just a few studies about home medicine boxes

have been made worldwide. Results of our research of pharmacy students’ attitude to their home

medication boxes could be useful for further studies of risk patients home medication

consumption. There is a chance to save human‘s life because of appropriate use of home

medication box contents.

AIM

To evaluate Pharmacy Faculty students’ families’ home medication boxes contents and

knowledge about medications.

OBJECTIVES

1.Identify who is responsible for the Pharmacy Faculty students’ families’ home medication

boxes composition.

2.Evaluate drug storage conditions at home, home medication boxes storage places.

3.Rate Pharmacy Faculty students’ families’ home medication boxes contents.

4.Figure out the most popular information sources in making home medication box of Pharmacy

Faculty students’ families’.

5.Compare the first and fifth-year Pharmacy Faculty students’ families’ home medication boxes

contents and self-medication differences.

METHODS

A questionnaire has been chosen as a research instrument. It is carried out in writing.

Questionnaire is prepared for first and fifth course Pharmacy Faculty students’ families. The

study was conducted in 2012-2013. 182 respondents were interviewed. The statistical analysis of

the research was performed using SPSS Statistics 17.0. Descriptive statistics on the sample

characteristics and questionnaire items were computed, including percentages, means, standard

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deviations and frequency distributions. Cross-tabulation methods and the Chi-square test were

used to assess the dependency between different variables. The results of first and fifth course

Pharmacy Faculty students’ families’ questionnaires was compared.

RESULTS

Mothers are taking care of home medication boxes contents of 69.32% of first course and

44.68% of fifth course Pharmacy Faculty students’ families’ (p <0.001). Families of first-year

Pharmacy Faculty students which holds medicines taken out of original packaging more often

have medicines with passed expiration period (50.00%) than fifth-year students’ families’

(37.50%) (p > 0.05). First-year Pharmacy Faculty students’ families of 4 persons usually keeps

every persons medicines in one place (p < 0.001). The first and fifth-year Pharmacy Faculty

students’ families usually stores most of medicines in the original packaging, respectively

44.32% and 54.26% (p >0.05), and home medication boxes are generally kept in kitchens,

respectively 50.00% and 43.62% (p <0.001), as well as the main part of the contents of home

medication boxes are non-prescriptive medicines. The most popular information source in

making home medication box was pharmacist advice (30.22%) (p < 0.001).

CONCLUSIONS

Pharmacy Faculty students’ families’ home medication medicines are kept in original packages,

usually there is no medicines with passed expiration period, every family members medicines are

kept in one place, but sadly without any placement order. The most popular place for the boxes is

a kitchen. The mother is the person who is usually responsible for the home medication box of

Pharmacy Faculty students’ families’ home medication boxes composition. The first and the

fifth-year Pharmacy Faculty students’ families’ home medication boxes mostly contain non-

prescriptive medicines. The most popular source of information for selection the contents of the

home medicine box were pharmacist advice.

REFERENCES

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205  

1.Almasdy D. Sharrif A. Archives of Pharmacy Practice. Self-Medication Practice with

Nonprescription Medication among University Students: a review of the literature. (Vol. 2) 2011.

2.Daukšienė J., Radžiūnas R. Nonadherence to medications among pharmacy clients and their

attitude toward medications kept a medicine cabinet at home. Medicina (Kaunas) 2009; 45(12).

Prieiga per internetą: http://medicina.kmu.lt/0912/0912-10e.pdf žiūrėta 2012-06-08.

3.Fonarow G., Clyde E., Yancy W. , Heywood J. Adherence to Heart Failure Quality-of-Care

Indicators in US Hospitals. Arch intern Med. 2005 (196). Prieiga per internetą:

http://archinte.jamanetwork.com/article.aspx?volume=165&issue=13&page=1469 žiūrėta 2012-

06-14.

4.Tourinho F. S. V., Bucaretchi F., Stephan C., Cordeiro R. Home medicine chests and their

relationship with self-medication in children and adolescents. Jornal de Pediatria. 2008; 84(5):

416 – 422.

21. AWARENESS OF TUBERCULOSIS AMONG ROMA PATIENTS IN

BULGARIA

Author: Pepa Karadzhova (Medical University Of Pleven, Bulgaria, Sevda Hristova, (Trakia

University, Bulgaria ).

INTRODUCTION

Tuberculosis (TB) is a significant health problem in the Roma population in Bulgaria.

Incidence of tuberculosis in Bulgaria (newly registered cases) in 2010 is 30 per 100 000

population, and there is a slight declining trend. The total number of patients with tuberculosis in

2011 is 2407 persons compared to 2649 patients in 2010. In comparison, however, with that in

EU countries (average of 11.5 per 100 000 population) it is about 3 times higher. Our country is

located at an intermediate level compared to the high incidence in Eastern Europe and Central

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Asia and the low prevalence in the European Union. In general, Roma people live in poor

conditions and have more limited access to health services than majority populations. Low

quality of food, limited access to healthy food, increased level of stress are factors persisting in

Roma communities and contribute to TB prevalence.

AIM

This study was performed to investigate the knowledge about the transmission, treatment and

symptoms of TB in patients with TB among the Roma population in the village of Nikolaevo,

Bulgaria.

OBJECTIVES

Investigate the knowledge about the transmission, treatment and symptoms of TB in patients

with TB among the Roma population.

METHODS

The focus-group method was used to investigate the knowledge and beliefs about TB among

Roma patients. A total of 20 Roma people aged 14-45 years participated in the discussion.

RESULTS

70% of the focus group participants knew that TB is a pulmonary disease and can be contagious.

Mouth-to-mouth contact and saliva were the most frequently mentioned methods of

transmission. Among factors contributing to TB, participants mentioned bad living conditions,

low quality and lack of food, and stress. Participants quoted chest pain, cough, haemoptysis, loss

of appetite, loss of weight, weakness and sweating as basic symptoms of TB.

CONCLUSIONS

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We concluded that participants were not aware of the seriousness of TB. They knew some

methods of transmission; however, they had some misconceptions.

Mouth-to-mouth contact and saliva were the most frequently mentioned methods of

transmission. “TB could be contracted if you eat from the plate used by a TB patient.” Some

participants thought, that TB could be transmitted by shaking hands with an infected people. It is

necessary to improve knowledge about TB treatment among the Roma population.

An important finding was the confidence in doctors expressed by the Roma people. Generally,

there is a lack of confidence in healthcare workers among Roma patients; however, our results

indicate the opposite. Communication may be poor when health providers are ignorant of a

patient’s culture. Inadequate communication between patient and provider can delay diagnosis.

From everything said so far it becomes clear why it is important to perform screening study of

risk groups. As the Roma people have a tendency to delay contact with the health service, it is

important that health services provide outreach activities in Roma settlements. Door to door TB

education and symptomatic case finding will be effective.

REFERENCES

1. rzi-pleven.com

2. http://www.who.int/en/

22. LOW BACK PAIN RED FLAG SYMPTOM CHARACTERISATION

AND COMPARISON IN PATIENTS AT THE EMERGENCY ROOM

AND GENERAL PRACTITIONER

Authors: Arvis Freimanis, Madara Lazdāne, Riga Stradiņš University, Faculty of medicine

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Supervisor of the abstract:Prof. InāraLogina, Riga Stradiņš University

INTRODUCTION

Low back pain is the second most often occurring symptom in primary care institutions. It is

estimated, that from low back pain suffer 80% of the adult population and 10-15% of them suffer

severe chronic pain. Low back pain red flag symptoms help to identify specific diseases witch

need special evaluation and urgent diagnosis and treatment.

AIM

Characterize and compare low back pain patient red flag symptoms at the primary care praxis

and the hospital emergency room.

OBJECTIVES

1. Characterise low back pain red flag symptom occurrence in both patient groups.

2. Characterise low back pain episode development, duration, localisation, character in both

patient groups.

3. Asses the neuropathic pain component.

4. All the above mentioned parameters are compared between both groups.

METHODS

50 patients were surveyed with a low back pain episode who came to the primary care doctor

(33) or the emergency room (17). For the assessment two surveys were used: low back pain

complains and patient data survey and Paindetect survey [3] for recognition of neuropathic pain

component. In the Low back pain complain and patient data survey the following parameters

were included: patient age, gender pain development, duration, precipitating factors, pain

character, localisation, number of pain episodes in the past, accompanying symptoms and

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morbidities. The following red flag symptoms were evaluated: age over 50 years, pain

persistence more than 4 weeks, severe pain (visual analogue pain scale 8-10), nocturnal pain,

progressing leg weakness, fever, incontinence, numbness in the perineum, severe movement

limitation in the back, history of weight loss (more than 10 kg in the last 6 month), back trauma

in the past 6 month, infectious disease, diabetes mellitus, osteoporosis, use of hormonal drugs,

nerve blockade procedures, lumbal punctions, oncology, HIV infections.

RESULTS

50 patients were included in the study. 25 men and 25 women. Pain equally frequent (17

patients) developed gradually, slowly progressing over weeks and fast, in a one day period. For

15 patients pain was provoked by lifting heavy weight, 19 patients developed pain after rapid

movement, turning. Pain localisation equally often (25 cases) is defined in the lower back and

with radiation to the legs. Most often precipitating factors for pain was walking and prolonged

standing (19 cases), slight movement (18 cases). Credible neuropathic pain component existence

is observed in 6 cases. Significant numbers of patients note physical overwork (21) and stress,

depression (16).

The following red flag symptoms are observed: age over 50 years (19 patients), severe pain (26),

pain persistence more than 4 weeks (3) recent trauma (16), progressing weakness of legs (13),

nocturnal pain (7), fever (1), incontinence (2), numbness in the perineum (2), severe movement

limitation in the back (30), diabetes mellitus (4), use of hormonal drugs (4), osteoporosis (3),

nerve blockade procedures, lumbal punctions (8), oncology (1).

There is a statistical difference between patients who visited the primary care doctor and who

went to the emergency room in the following categories: Pain length (Mann-Whitney U,

p=0,002), pain nature (Mann-Whitney U , p= 0,021) and pain degree (Mann-Whitney U ,

p<0,001).

CONCLUSIONS

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No significant differnece in low back pain red flag symptom occurrence is oserved between the

patients who came to the primary care doctor or the emergency room.

Patients at emergency room presented with more severe pain. No significant difference between

both groups is determined in low back pain episode development, duration and localisation.

|Neuropathic pain component existence is observed in few cases.

The most often occurring red flag symptoms are age over 50, severe movement limitation in the

back, severe pain, recent trauma and night pain.

REFERENCES

1. Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, et al. (2009) A Novel Tool for the

Assessment of Pain: Validation in Low Back Pain. PLoS Med 6(4):e1000047.

doi:10.1371/journal.pmed.1000047

2. Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, et al. (2009) A Novel Tool for the

Assessment of Pain: Validation in Low Back Pain. PLoS Med 6(4):e1000047.

doi:10.1371/journal.pmed.1000047

3. Freynhagen R, Baron R, Gockel U, Tölle TR., painDETECT: a new screening

questionnaire to identify neuropathic components in patients with back pain., Curr Med

Res Opin. 2006 Oct;22(10):1911-20.

22. TERMINAL STAGE CHRONIC KIDNEY DISEASE

DEVELOPMENT DEPENDING ON GENDER

Author: Arvis Freimanis, Riga Stradiņš University, Faculty of medicine

Supervisor of the abstract: dr. med. asoc.prof. Harijs Čerņevskis, Riga Stradiņš University

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INTRODUCTION

Chronic kidney disease (CKD) is becoming a global mayor public health problem.[2] One of

main treatment methods for end stage renal disease is renal replacement therapy. Worldwide the

prevalence of end stage renal disease is rising. [1] A number of studies have verified the

relationship between gender and the progression of CKD, more often approving that CKD

progress faster in men, so having a higher risk of end stage renal disease development. [3] There

is no data on such coherence in the Latvian population.

AIM

Prove that in the Latvian population end stage chronic renal disease prevalence and incidence is

higher in men, and the risk of progression to end stage CKD is higher in men.

OBJECTIVES

1. Evaluate the patients with end stage renal disease and renal replacement therapy by age

and gender;

2. Calculate the prevalence and incidence of renal replacement therapy for men and women;

3. Calculate the risk of end stage renal disease and renal replacement therapy for men and

women.

METHODS

In a retrospective study patient data of the Latvian CKD registry was analyzed about patients

with end stage renal disease from 2008. – 2011.

The registry contains data of all patients with end stage renal disease and receiving renal

replacement therapy in Latvia. In this study each year’s incident and prevalent patient data was

analyzed (count, mean age, distribution by gender). The prevalence and incidence was calculated

based on each year’s population data provided by the Central Statistical Bureau of Latvia. As

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incidence is a measure of risk, relative risk was calculated comparing the incidence numbers

between men and women.

RESULTS

The mean number of patients recieving renal replacement therapy was 914 per year. More men

(473) than women (441). The mean age for renal replacement patients was 52 for men and 55 for

women

End stage renal disease prevalence in men was significantly higher in men than in women –

mean values for men 483 cases/million, women – 381 cases/ million.

Incidence also was higher in men – mean values for men 107 cases/million/year, women 77

cases/million/year.

The relative risk for end stage renal disease development was 1,41 time higher in men than

women in the analyzed period.

CONCLUSIONS

Renal replcament therapy recieved more men than women during the evaluated period and

comapring the mean age - male patiens were 3 years younger than female patiens.

End stage renal disease prevalence and incidence is higher in men than women and the relative

risk of end stage renal disease is 1.41 times higher in men in the Latvian population.

REFERENCES

1. Andrew S Levey, Josef Coresh, Chronic kidney disease, Lancet 2012; 379: 165–80

2. A Meguid El Nahas, Aminu K Bello, Chronic kidney disease: the global challenge,

Lancet 2005; 365: 331–40

3. J. Neugartner, Gender and the Progression of Renal Disease, J Am Soc Nephrol 13:

2807–2809, 2002

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MAXILLOFACIAL SURGERY SECTION

1. INFLUENCE OF IMMEDIATE DENTIN SEALING ON MARGINAL

MICROLEAKAGE OF INDIRECT COMPOSITE RESIN

RESTORATIONS

Gertrūda Sūdžiūtė, Gabrielė Vilma Balčiūtė

Assoc. Prof. Gediminas Zekonis

INTRODUCTION

Open dentin tubules are pathways for microbial, temperature, chemical and mechanlical stimuli to the

tooth. However, the exposure of tubules while preparing for indirect restorations is inevitable. The

following can cause post-operative sensitivity, post-cementation sensitivity and pulp damage.

Additionally the provisional phase may have negative effects on final result since the dentin is not

protected from the marginal microleakage and provisional restauration failures. For this reason it was

proposed that dentin coating may be beneficial to protect tooth from marginal microleakage. It is

thought that immediate dentin sealing (IDS) does not only prevent post-operative sensitivity,

microleakage but also improves bond strength and retention. The current study focuses on

microleakage comparison between IDS group and delayed dentin sealing (DDS) group since

microleakage could result in hypersensitivity, marginal staining or marginal caries.

AIM

The purpose of this study was to determine whether there was a difference in marginal microleakage

using immediate dentin sealing (IDS) technique compared to delayed dentin sealing (DDS) as well as

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to give clinical recommendations to clinicists on how to proceed after preparation to achieve the best

possible outcome in their daily practice.

OBJECTIVES

1. To examine and measure 280 restoration – tooth margins for microleakage.

2. To compare mean microleakage (µm) using IDS and DDS methods.

METHODS

56 freshly extracted human molars were obtained and randomly divided into 2 equal groups. 2

preparations for inlays were done on each tooth (medially and distally). A total-etch adhesive (Syntac,

IVOCLAR) was used for all groups. First group of specimens were prepared using immediate bonding

technique immediately to the freshly cut dentin, whereas DDS specimens were not treated with dentin

bonding agent. Indirect composite restorations were cemented with Variolink II resin cement. The

teeth were thermocycled 800 times at 5°C to 55°C, isolated and immersed in 2% methylene blue

solution for 6 hours, washed in tap water and sectioned in a bucco-lingual direction. Samples were

observed under Nikon LV150 microscope. The degree of dye penetration was recorded and analyzed

with the Fisher‘s and Student's tests (P<0.05).

RESULTS

In total 280 restoration – tooth margins were examined (140 IDS; 140 DDS). In IDS group

microleakage was absent in 9 teeth, while in DDS group microleakage was present in all

speciments.According to Fisher‘s exact test (p <0,005) there was a significant difference between the

two techniques. In IDS group mean recorded microleakage was 111,7 µm, while in DDS – 275,5 µm.

The difference between two groups was statistically significant (p <0,005).

CONCLUSIONS

Microleakage was present by some means in both groups, however IDS group showed statistically

significant advantage before the DDS group (p < 0,005).

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2. IMPACT OF GASTROESOPHAGEAL REFLUX DISEASE ON

ORAL CAVITY AND DENTAL IMPLANTS: A LITERATURE

REVIEW

Author: Lukas Poškevičius

Supervisor of the abstract: PhD Gintaras Janužis

INTRODUCTION

Gastroesophageal reflux disease (GERD) is an involuntary backflow of the gastric content into

the oesophagus or extra-esophageal structures, causing symptoms or signs. GERD is spreading,

especially in economically developed countries. Atypical forms of the disease without

characteristic symptoms (heartburn and regurgitation) are getting common. Literature lacks

information about the influence of GERD on dental implants.

AIM

To review scientific articles researching GERD effects on oral tissues and dental implants.

OBJECTIVES

1. To evaluate oral manifestations of GERD.

2. To examine pathological effects of GERD on hard and soft oral tissues.

3. To examine impact of GERD on dental implant materials.

METHODS

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A systematic literature search in Medline (PubMed) database was conducted using the following

keywords: gastroesophageal reflux disease, GERD, atypical presentations, extra esophageal, oral

manifestations, oral symptoms, mouth pathology, dental implants, titanium, osseointegration,

periimplantitis, corrosion, surface properties, risk factors, fluorides, microflora changes, wound

healing, saliva flow rate, buffer capacity. The included studies had to meet the following criteria:

to describe GERD symptoms and pathologies in the oral cavity, to describe GERD impact on

dental implant materials or durability. Restrictions were not placed regarding type of study

design. 58 studies that met the required criteria were selected for the final analysis.

RESULTS

Although the diagnosis of typical GERD can be made when both heartburn and regurgitation

symptoms are present, atypical oral GERD forms are diagnosed by oesophago-gastro-

duodenoscopy and 24-h oesophageal pH-metry. Atypical GERD forms are often not identified,

still it can be manifested by these common oral symptoms: dental erosions, mucous membrane

erythema, halitosis. Patients can suffer from mouth burning sensation, a sour and acidic taste in

the mouth, xerostomia, impaired taste (dysgeusia), or myofascial pain.

Dental and oral mucosa pathologies are caused by the retrograde movement of gastric and

duodenal content through the lower esophageal sphincter into the esophagus. The content of

refluxed gastric acid, bile, pepsin, and pancreatic enzymes reaches pharynx and the oral cavity,

including teeth, tongue, oral mucosa. This leads to morphological oral mucosa alterations such as

epithelial atrophy, subepithelial edema, increased number of fibroblasts, vascular engorgement,

hypertrophy of lymphoid follicles. Correlation between GERD and dental caries appears to be

negative. Moreover, there are physiological processes that are affected in the oral cavity: the rate

of saliva secretion, buffering capacity and oral pH decreases. Dilated glandular excretory can

reduce mechanical cleaning, acid neutralization and antimicrobial functions. Oral microflora

changes too since the number of S.mutans CFU increases.

Titanium is a common material for implantation because of its biocompatibility and corrosion

resistance. However, TiO2 protective passivation layer, that guarantees resistance, changes

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depending on pH and electric potential. Multiple studies have shown that titanium corrodes more

in acidic pH saliva rather than neutral. Therefore, reflux content can cause the corrosion of

implants.

Usually, fluoride containing gels or rinses are given for patients in order to protect teeth from

acidic reflux exposure. Nevertheless, this will increase titanium corrosion, the possibility of

fracture and may affect the development of a healthy transgingival epithelial junction on the

titanium surface. Impaired wound healing after insertion of implants is modulated by specific

metal ions, released by corrosion activity.

CONCLUSIONS

1.GERD may be manifested by these common oral symptoms: dental erosions, mouth burning

sensation, halitosis, a sour and acidic taste in the mouth, xerostomia, impaired taste, erythema or

myofascial pain.

2.Refluxed acidic content can cause perimolysis, inflammatory process in mucous membrane

and changes in salivation.

3.GERD accelerates the corrosion rate of titanium implants.

3. EPIDEMIOLOGICAL ASSESSMENT OF PRIMARY ORAL

CANCER DIAGNOSTICS

Authors: Aurimas Sudeikis, Mindaugas Šimas

Supervisor of the abstract: dr. Gintaras Janužis

INTRODUCTION

Dentists and family physicians ability to recognize and diagnose oral cancer as soon as possible

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is of vital importance for the successful diagnostics and further treatment of this disease. At this

time, it is noticed that during the last 5 years the amount of patients who are neglecting

symptoms of oral cancer have increased about 30 percent. It is imperative to find out what causes

problems in initial oral cancer diagnostics. It is hypothesized, that it is not only in the diagnosis

and methodological deficiencies of the treatment but also a significant impact on economic,

social and health care systems.

AIM

Clarify the epidemiology of primary oral cancer diagnostics (POCD).

OBJECTIVES

1. Analize public knowledge of oral cancer and its initial signs.

2. Assess and compare dentists and family physicians knowledge of POCD.

3. Assess oncological vigilance of dentists and family physicians.

4. Explore and compare experiences of family physicians and dental practitioners in POCD.

METHODS

Two questionaires were made. The first qustionnaire consist of 18 questions and was made for

interviewing patients. The second one consisting of 49 questions was made for assessing the

knowledge, experience and oncological vigilance of dentists and family physicians. The study

was carried out with the authorization of LUHS Centre for Bioethics. Statistically reliable

samples were established and the study was based on the data of the Lithuanian health indicators

in information system (2011m.). The survey was carried out in the districts of Vilnius, Kaunas,

Klaipėda, Šiauliai, Panevėžys, Alytus, Utena, Marijampolė, Telšiai and Tauragė. Both private

and public treatment institutions were selected randomly and evenly where family physicians and

dentists were interviewed. General public were in the same treatment institutions. The survey

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data was statistically processed by SPSS 13.0 system. Chi-squared (χ ²) criteria have been

adapted in order to verify the statistical hypothesis about the dependence of the features.

RESULTS

1. 385 patients (114 men, 271 women), 316 dentists and 137 family physicians were interviewed.

2. 39.5% of the patients interviewed believed that the third stage of oral cancer is most commonly

diagnosed.

3. About 50% responded that they don’t have possibility of testing for oral cancer.

4. Staggering 82.1% of respondents don’t know the symptoms of primary oral cancer.

5. 46% of the respondents would refer to their dentist if they had suspicious lesions in their mouth.

6. 80.3% of the family physicians and 79.4% of the dentists feel lack of knowledge in the field of POCD.

7. 78.1% of the family physicians and 86.7% of the dentists claim that there is not enough information

about oncological changes in their studies. However, only 24% of the family physicians and 34.4% of

the dentists took further study to improve their POCD skills.

8. Estimating the oncological vigilance, 63.9% of the dentists and even 94.9% of the family physicians

provide information about negative impacts of tobacco at various frequencies.

9. 82.6% of the doctors don’t make an appropriate examination to diagnose oral cancer during the first

visit. 66% of the dentists almost always estimate the condition of tongue and floor of the mouth, 54.8% of

the family physicians do it rarely or don’t do it at all.

10. About 90% of the family physicians claims that they explore mouth tissues at various frequencies,

even so 42% of the patients say that family physicians don’t examine their oral cavity at all.

11. 50% of the dentists never evaluate their patients’ alcohol use, meanwhile, only 8% of the family

physicians do so.

12. 62% of the family physicians and 89.2% of the dentists don’t know the prevalence of the oral cancer

in their surroundings.

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13. 45.9% of the family physicians and 39.5% of the dentists cooperate in the field of POCD.

14. 47.8% of the dentists who are engaged in private practice deny that the POCD should be a separate

procedure during oral cavity examination, but 42.3% of the dentists and 62.4% of the family physicians

employed in public institutions agree that it should be a separate procedure.

15. The data is statistically reliable (p<0,05).

CONCLUSIONS

1.The patients recognizes that there’s little information about oral cancer and POCD.

2.There is a lack of motivation among the public regarding premature POCD.

3.Dentists and family practitioners feel the lack of knowledge and proper training in university.

4.Family physicians do not focus enough on oral cavity examination and don’t cooperate actively

with other dentists on POCD issues .

5.Neither the doctors nor the dentists are interested in oral cancer and know the prevalence of

this pathology in their surroundings.

6. Results of the research are targeted to improve POCD efficiency.

4. ROUGHNESS OF THE RESTORATIVE MATERIALS INFLUENCED BY

DIFFERENT POLISHING MATERIALS FOR PROFESSIONAL ORAL

HYGIENE

Authors: Gabrielė Vilma Balčiūtė, Gertrūda Sūdžiūtė

Supervisor of the abstract: Adomas Auškalnis

INTRODUCTION

A professional oral hygiene procedure is usually repeated every 3 to 6 months. Dental plaque, calculus

and staining are removed using various air polishing materials and prophylactic pastes. The effect

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these materials have depends on the structure of the affected surface material and the chosen method. It

is known that polishing procedures can not only reduce the amount of plaque and pigmentation but

also produce a rougher surface, which may cause an increased rate of biofilm accumulation, gingival

inflammation, dental caries formation, excessive wear of the opposing teeth as well as impairment of

the strength of the restorative materials.

AIM

1. To assess the influence of air polishing and prophylactic pastes on the roughness of enamel,

two kinds of porcelain, laboratory composite and acrylic teeth.

2. To determine the most beneficial professional oral care technique for each restorative material.

OBJECTIVES

1. To assess the mean values of roughness on different restorative materials.

2. To assess the smoothening effect on restorative materials.

3. To assess the roughening effect each polishing material has on different restorative materials.

METHODS

16 specimens (5x5x2mm) of each material group (enamel, lithium disilicate ceramic (IPS e.max)

(EM), leucite glass ceramic (HEIMERLE+MEULE) (LGC), laboratory composite (LC) and acrylic

teeth (Vita Physiodens) (AT)) were fabricated according to the manufacturer‘s specifications and

randomly divided into four sub-groups (1. air polished with air-flow classic prophylaxis powder (EMS,

Switzerland) (AFC), 2. air-flow soft prophylaxis powder (EMS, Switzerland) (AFS), 3. polished with

soft prophylactic paste (Cleanic Kerr, Switzerland) RDA 27 (SP) and 4. medium prophylactic paste

(Orbis, Finland) RDA 170 (MP)). Initial surface roughness was accessed using contact profilometer

“XP plus stylus”. Then the specimens were exposed to assigned procedure according to the grouping.

The samples were thermocycled for 10 000 times that account for 6 months time of temperature

changes in the mouth. The samples then were investigated with profilometer again to assess the change

in roughness after polishing and thermocycling. The results were then analyzed using IBM SPSS

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Statistics 20. Wilcoxon test was performed for the comparison of the initial and final surface roughness

values. The results were evaluated within the P<.05 confidence level.

RESULTS

1. The mean Ra value (nm) in enamel group (gr.) was 134,614 (±57,93), EM gr. - 387,6225

(±121,23), LGC gr. - 184,59 (±61,52), LC gr. - 1107,5 (±469,43), AT gr. - 184,5 (±61,32).

2. There was a statistically significant smoothing in EM and LGC. AFC had influence on

roughening of LC, AT and LGC. AFS had influence on roughening of LC and AT. MP had

roughening effect on LC, AT, LGC and SP on LGC. AFS had smoothening effect on LGC.

MP, SP and AFS had smoothening effect on EM. SP had smoothening effect on AT.

3. There was a statistically significant increase in mean Ra value (nm) of roughness in LC, AT

and LGC. Increase in mean Ra value (nm) of roughness was also present in enamel however it

was not statistically significant.

CONCLUSIONS

1. According to the results, AFC had negative influence on laboratory composite, acrylic teeth,

leucite glass ceramic restorations, AFS on laboratory composite and acrylic teeth, medium

prophylactic paste on laboratory composite, acrylic teeth, leucite glass ceramic and SP on

leucite glass ceramic.

2. AFS is recommended for prophylactic procedures on leucite glass ceramic and E.max

ceramics. MP is recommended on lithium disilicate ceramic and SP on lithium disilicate

ceramic and acrylic teeth.

5. THE INFLUENCE OF CHRONIC STRESS AND DIABETES

MELLITUS TYPE II ON BONE REPARATIVE MINERALS AND

GROWTH FACTORS

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Authors: Jan Pavel Rokicki, Kristupas Gutauskas

Supervisor of the abstract: dr. Gintaras Janužis

INTRODUCTION

Insulin-like growth factor 1 (IGF-1), also called somatomedin C, along with other growth factors and

minerals such as calcium (Ca) and phosphorus (P) play a major role in bone reparative systems.

Nowadays, many people live a stressful life, which can cause the state of chronic stress. In interplay

with diabetes mellitus stress can have a huge impact on the concentration of minerals and growth

factors. Therefore, it is highly important to determine the decrease of rate minerals and growth factors

in order to know whether people suffering from diabetes mellitus and chronic stress are in risk group

for bone density decrease.

AIM

To evaluate the influence of chronic stress and diabetes mellitus type II on reparative minerals and

growth factors.

OBJECTIVES

1. Examine 100 patients by taking their blood and giving an anonymous questionnaire.

2. To evaluate the rate of Ca and P in blood.

3. To evaluate the rate of IGF-1 in blood.

4. To assess the rate of glycated haemoglobin in blood.

5. To assess whether the patients with diabetes mellitus suffer from chronic stress.

METHODS

A total 100 male and female patients (50 healthy subjects and 50 suffering from diabetes

mellitus) were examined in this study. Those who had obvious renal and thyroid dysfunction

were excluded to avoid possible influence of renal osteodystrophy and retardation of hormone

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excretion. None had taken calcium or phosphor supplementation, drugs to affect bone

metabolism or any vitamin preparation containing vitamin D or K. Circulating levels of glucose,

IGF-1, calcium and phosphorus were assessed in laboratory. All patients were questioned using

hospital anxiety and depression scale (HADS) and mini international neuropsychiatric interview

(M.I.N.I). All subjects were divided into 4 groups: healthy patients with anxiety and depression

symptoms (HS), healthy without stress (HNS), patients with diabetes mellitus and anxiety and

depression symptoms (DMS) and patients with diabetes mellitus but no stress (DMNS).

RESULTS

1. Female patients (60 %) more often suffer depressive and anxiety symptoms than male

(20%) patients.

2. All patients suffering from diabetes mellitus and depressive or anxiety symptoms have

shown reduced values of IGF-1 (reduced 10%), calcium (reduced 8%), phosphorus

(reduced 4%).

3. In patients suffering from diabetes mellitus a group was distinguished that had glycated

haemoglobin (HgA1c) up to 7% (most were about 8.5 to 9.8 %).

CONCLUSIONS

1. Chronic stress, anxiety or depression reduces circulating IGF-1, calcium and phosphorus levels

in blood.

2. Patients with diabetes are more likely to experience anxiety, sleep disorders and depression.

3. Diabetes reduces IGF-1, calcium and phosphorus levels.

4. Patients with diabetes and suffering from chronic stress are more likely to have bone pathology.

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6. FACIAL AND TRIGEMINAL NERVES ARTIFICIAL AND NATURAL

ANASTOMOSIS. LITERATURE ANALYSIS

Authors: Rūta Kinderytė, Lukas Šemeklis

Supervisor of the abstract: dr. G. Janužis

INTRODUCTION

Face palsy is one of the most often disease of face and jaw surgery. It is known that for some

patients function of mimetic muscles regenerates spontaneously, untreated. Reason of recovery

can be naturally formed anastomosis between facial and trigeminal nerves branches. Knowing

naturally formed and artificial created anastomosis would bring more possibilities and better

effectiveness of face palsy regeneration.

AIM

Find out natural and possibilities of artificial anastomosis of facial and trigeminal nerves.

OBJECTIVES

1. Assess anatomical and embryological structure of the facial and trigeminal nerves. Assess

histological structure of the facial and trigeminal nerves, mention similarities and differences

between branches of these nerves.

2. Overview possible branches, which results in trigeminal and facial nerve anastomosis.

3. Analyze the current empirical findings of the facial nerve motor fibers during the takeover of

the nerve function.

4. Overview studies of forming artificial anastomosis between the facial and trigeminal nerves.

METHODS

Medline (PubMed), ScienceDirect, AccessMedicine, Medscape, Metapress databases

search was conducted for articles using the search terms: „facial nerve“, „trigeminal nerve“,

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„facial muscles“, „reinnervation“, „anastamosis“, „reanimation“, „paralyzed facial muscles“. The

terms were used alone and in combinations. In total 128 articles, published from 1990 up to 2013

year. 15 articles, which have been discussed in facial and trigeminal nerve anastamosis, were

selected and analyzed systematically.

RESULTS

Arrangements of the facial nerve motor fibers and trigeminal nerve sensory peripheral

fibers are similar. Facial nerve connections with the trigeminal nerve occur in embryo about 14.5

gestation week. Anastomosis that are described in literature most frequently: n.facialis and

n.massetericus (n.trigeminus); n.temporofacialis, n.zygomaticus, n.temporalis, n.buccalis

(n.facialis) and n.auricotemporalis (n.trigeminus); n.buccalis, n.zygomaticus (n.facialis) and

n.buccalis (n.trigeminus).

Mimic muscles movements recover faster in facial palsy, when masseter muscles were

trained.

One of the most common artificially formed and analyzed trigeminal and facial nerves

anastomosis is anastomosis between n.facialis and n.massetericus (n.trigeminus). Anastomosis

were described in 4 articles and operation were carried out in 24 patients.

CONCLUSIONS

1. Results of the literature review and analysis, of the anatomical facial and trigeminal

nerves arrangement and histological structure, show that nerves are similar.

Histologically significant differences between facial and trigeminal nerves were not

observed.

2. Because of similarities of the anatomical arrangement between n.facialis and

n.massetericus (n.trigeminus) one of the most commonly formed artificial anastomosis is

anastomosis between facial and trigeminal nerves. This anastomosis is the most

appropriate treatment in facial nerve paralysis.

3. In facial palsy patients often recover spontaneously. Recovery is more effective when

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masseter muscles are trained. This may indicate that the trigeminal nerve sensory and

motor branches are located together and trigeminal nerve motor nucleus is activated when

attempting to chew.

4. Studies have shown that making an artificial anastomosis between n.facialis and

n.massetericus (n.trigeminus) n.massetericus function was intact, and the results were

more effective than making artificial anastomosis between other these nerves branches.

REFERENCES

1. Biglioli F, Frigerio A, Colombo V, Colletti G, Rabbiosi D, Mortini P, Toffola ED, Lozza

A, Brusati R. Masseteric–facial nerve anastomosis for early facial reanimation. J Cranio-

Maxillofacial Surgery. 2012 February; 40(2): 149–55.

2. Bout RG, Tellegen AJ, Dubbeldam JL. Central Connections of the Nucleus

Mesencephalicus Nervi Trigemini in the Mallard (Anas platyrhynchos L.). J The

Anatomical record. 1997 Aug; 248(4): 554-65.

3. Coombs CJ, Ek EW, Wu T, Cleland H, Leung MK. Masseteric-facial nerve coaptation –

an alternative technique for facial nerve reinnervation. J Plastic, Reconstructive &

Aesthetic Surgery. 2009 December; 62(12): 1580–8.

4. Diamond M, Wartmann CT, Tubbs RS, Shoja MM, Cohen-Gadol AA, Loukas M.

Peripheral facial nerve communications and their clinical implications. J Clinical

anatomy. 2011 Jan; 24(1): 10-8.

5. Fournier HD, Denis F, Papon X, Hentati N, Mercier P. An anatomical study of the motor

distribution of the mandibular nerve for a masseteric-facial anastomosis to restore facial

function. J Surgical and radiologic anatomy. 1997; 19(4): 241-4.

6. Frydman WL, Heffez LB, Jordan SL, Jacob A. Facial muscle reanimation using the

trigeminal motor nerve: an experimental study in the rabbit. Journal of oral and

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Maxillofacial Surgeons. 1990 Dec; 48(12): 1294-304.

7. Herring SW, Wineski LE, Anapol FC. Neural organization of the masseter muscle in the

pig. J Comparative neurology. 1989 February 22; 280(4): 563-76.

8. Odobescu A, Williams HB, Gilardino MS. Description of a communication between the

facial and zygomaticotemporal nerves. J Plastic, Reconstructive & Aesthetic Surgery.

2012 September; 65(9): 1188–92.

9. Pieper DR, Larouere M, Jackson IT. Operative Management of Skull Base Malignancies:

Choosing the Appropriate Approach. J Neurosurgical focus. 2002 May 15; 12(5): e6.

10. Sanders RD. The Trigeminal (V) and Facial (VII) Cranial Nerves. J Psychiatry (Edgmont

(Pa. : Township)). 2010 Jan; 7(1): 13-6.

11. Sforza C, Frigerio A, Mapelli A, Mandelli F, Sidequersky FV, Colombo V, Ferrario VF,

Biglioli F. Facial movement before and after masseteric-facial nerves anastomosis: a

three-dimensional optoelectronic pilot study. Journal of cranio-maxillo-facial surgery.

2012 Jul; 40(5): 473-9.

12. Sinis N, Horn F, Genchev B, Skouras E, Merkel D, Angelova SK, Kaidoglou K, Michael

J, Pavlov S, Igelmund P, Schaller HE, Irintchev A, Dunlop SA, Angelov DN. Electrical

stimulation of paralyzed vibrissal muscles reduces endplate reinnervation and does not

promote motor recovery after facial nerve repair in rats. J Annals of anatomy =

Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft. 2009 Oct;

191(4): 356-70.

13. Skouras E, Angelov DN. Experimental studies on post-transectional facial nerve

regrowth and functional recovery of paralyzed muscles of the face in ratsand mice. J

Anatomy. 2010 Aug; 4:1-27.

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14. Tohma A, Mine K, Tamatsu Y, Shimada K. Communication between the buccal nerve

(V) and facial nerve (VII) in the human face. J Annals of anatomy = Anatomischer

Anzeiger: official organ of the Anatomische Gesellschaft. 2004 Apr; 186(2): 173-8

15. Uluduz D, Kiziltan ME, Akalın MA. Acute peripheral facial palsy: Is there a trigeminal

nerve involvement? J Neuroscience Letters. 2010 July 26; 479(2): 171-4.

7. THE CHARACTERISTICS OF ISOLATED AND COMBINED ORBITAL

FRACTURES IN ASSOCIATION WITH MIDFACE TRAUMA.

INDICATION FOR ORBITAL SURGERY AND SURGICAL

APPROACHES: RETROSPECTIVE STUDY

Authors: Stud. med. Julianna Kuzņecova, Stud. med. Ilze Smirnova

Supervisor of the abstract: M.D. Ģirts Šalms

INTRODUCTION

An orbital fracture (OF) is a fracture or break in the small bones that make eye socket. Traumatic

OF is classificed as midface (MF) fracture and is commonly seen with MF trauma.

Isolated OF is a rare event, it is usually combined with damage to other facial bones.

AIM

To evaluate the incidence and identify factors that correlate with OF in patients with MF trauma.

Define indications for surgical treatment and main surgical approaches used in Paul Stradins

Centre of Dentistry & Facial Surgery (PSCH CDFS).

OBJECTIVES

1. To define OF incidence in Latvian patients with MF;

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2. To analyze characteristics of the patient cohort and their correlations;

3. To study ophthalmological parameters in OF patients;

4. In cases of surgical treatment, to analyze indications for surgery and surgical approaches used.

METHODS

Retrospective analysis of patient histories with diagnoses - nasal bone fracture, zygoma

bones fracture and orbital floor fracture from 31.10.2011 till 01.11.2012. at PSCH CDFS. The

data were analyzed by Microsoft Excel and IBM SPSS Statistics.

RESULTS

538 relevant patients were admitted to the Paul Stradins Clinical Hospital Centre of

Dentistry and Facial Surgery during the examined period; hospitalization rate showed

considerable monthly variations (from 28 in September to 64 and 66 in November and December

respectively, average – 44.8 patients per month).

There was a significant male prevalence (436 patients or 81%) in the analyzed group,

male patients were significantly younger (average age 30 years vs 37 years in female patients,

p=0.0008), trauma incidence increased with age in women and dropped in men. Male gender

positively correlated with criminal and sport injuries (p<0.001 and p=0.006, respectively), while

female gender was associated with domestic trauma (p<0.001). Older age associated with an

increase of domestic trauma and decrease of criminal and sport lesions. Rate of surgical

treatment and in-patient time decreased with age (p<0.001).

From all cohort - 62% patients had nasal fractures, 28% zygoma, 4% both and 6%

blowout lesion. Orbital fracture was diagnosed in 133 patients (24.7%), the lower wall was most

frequently damaged (81.2%), followed by the lateral (44.3%) and the medial (26.3%) walls, the

upper wall injury being rare (3.8%). Incidence of orbital fractures positively correlated with

injuries of zygomatic bone and negatively – with nasal fractures (p<0.001).

Surgical repair of orbital fracture was performed in 17 patients (12.7% of all orbital

fractures), 14 of them had had a criminal trauma. Analysis of surgical treatment of orbital

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fracture revealed that ophthalmological indications for surgery are double vision, enophthalmus

(>2mm), pronounced disturbance of eye movement and bone dislocation with functional

damage. Titanium grid and fixation with miniplasters were the most commonly used techniques

(in 4 and 6 patients, respectively).

Ophthalmologist’s consultations were provided for 26 patients (4.8% of all patients or

19.6% patients with orbital fracture). Severe ophthalmological symptoms were found in 10

patients, all of whom had eyeball contusion and hematomas of different size and localization.

Two patients suffered from lens subluxation; one patient who had had trauma 9 days before

admission, developed compression of the optic nerve with zero vision before and after surgery.

CONCLUSIONS

3. Orbital lesion is a complicate midface trauma that needs particular attention;

4. It is usually found in younger males with criminal trauma or in older females with domestic

trauma;

5. OF is more common in fractures of zygoma than in fractures of nasal bones;

6. In case of radiologically proven OF, indications for surgical treatment depend on

ophthalmological symptoms;

7. Titanium grid and fixation with miniplasters are the most commonly used techniques;

8. Some patients have no indications for surgery and could be conservatively treated;

9. An ophthalmologist’s consultation should be recommended for all patients with orbital

fracture and ophthalmological symptoms.

REFERENCES

1. Brady S.M., The diagnosis and management of orbital blowout fractures: update 2001.

American Journal of Emergancy Medicine - 2001, Nr. 19, Vol. 2., p. 147-154.

2. Cornelius Carl-Peter, Gellrich Nils, Søren Hillerup, Kusumoto Kenji. Midface fracture.

Updated: 2009 December 3; cited 2012 December 31]. Available from:

https://www.aofoundation.org.

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3. Dobrovăţ B., Popescu R., Nemtoi A., Ladunca O., Orbital trauma: from anatomy to imaging

patterns – a pictorial review. Romanian Neurosurgery (2011) XVIII, Vol 4., p. 525 - 535.

4. Jefrey A. Nerad, Orbital trauma, Techniques in opthalmic and occuloplastic surgery 2009,

Vol.13, p. 355.-358.

NEUROSCIENCES SECTION

1. EARLY POST OPERATION RESULT REVIEW BASED ON NERVE

CONDUCTION STUDY DATA AFTER SIMPLE DECOMPRESSION

OF NERVUS ULNARIS IN THE CUBITAL TUNNEL

Authors: Madara Lazdāne, Artūrs Ancāns Riga Stradiņš University, Faculty of medicine.

Supervisors of the abstract: dr.habil.med., prof. Maija Eglīte, Riga Stradiņš University, dr. med.

Rudīte Dumbere, Health Centre 4

INTRODUCTION

Cubital tunnel syndrome is the second most common peripheral nerve entrapment neuropathy in

the upper limb [1]. Cubital tunnel syndrome is characterized by both sensory and motor

impairment which decreases the quality of life and is a cause of disability of patients [2]. Simple

decompression of n. ulnaris in the cubital tunnel is one of the surgical treatment options of

cubital tunnel syndrome. The surgical release involves incising longitudinally over the cubital

tunnel to release the surrounding retinacular fibres.

AIM

To review the early post-operative nerve conduction study (NCS) data that was acquired 1 to 3

months after surgery with the intent to evaluate the effectiveness of the surgical treatment

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outcome.

METHODS

In a retrospective study NCS data of 60 patients was analyzed from 2008 till 2012 who had

undergone simple n. ulnaris decompression in “Health Centre 4”. The data was gathered before

surgery and 1 to 3 months after surgery. Additionally data on patient gender, age and muscle

hypotrophy was gathered. None of the patients previously have had any operations on their

cubital tunnel.

RESULTS

In the study there were 37 men and 23 women. The mean age was 50,65±11,4 years. There was a

statistically significant difference in the NCS results gathered before and after the operation in

respect to:

Motor nerve conduction velocity (Paired Sample test, 24,64 m/s and 42,15 m/s, p<0,001), 53

patients improved (out of 60);

Sensor nerve conduction velocity (Paired Sample test, 32,24 m/s and 41,60 m/s, p<0,001), 49

patients improved;

Motor nerve conduction amplitude (Paired Sample test, 2,78 µV and 3,93 µV, p=0,001), 44

patients improved.

There was not a statistically significant difference in sensor nerve conduction amplitude (Paired

Sample test, 6,97 and 8,28 µV, p=0,140) with only 32 patients improving after operation.

There was a negative correlation between the level of muscle hypotrophy and motor nerve

conduction velocity after surgery (r=-0,307, p=0,017), motor nerve conduction amplitude (r= -

0,457;p< 0,0001), sensor nerve conduction velocity (r= -0,399;p= 0,002) and sensor nerve

conduction amplitude (r= -0,391;p= 0,002).

CONCLUSIONS

1. After simple decompression of n. ulnaris in the cubital tunnel the early nerve conduction study

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results are positive and based on these results the simple decompression operation is effective.

2. Patients who had more distinct muscle hypotrophy before surgery had poorer nerve

conduction study results after surgery.

REFERENCES

1. Cutts, S. Cubital tunnel syndrome. Postgraduate Medical Journal, 2007, Jan, vol. 83 (975), pp.

28-31.

2. Bartels, R. H. M. A., Verbeek, A. L. M. Risk factors for ulnar nerve compression at the

elbow: case control study. Acta Neurochir, 2007, N 149, 669.–674. lpp.

2. AN ASSESSMENT OF NON-MOTOR SYMPTOMS IN PATIENTS

WITH IDIOPATHIC PARKINSON'S DISEASE IN COMPARISON

TO PARKINSONIAN SYNDROMES

Authors: Birutė Vaidelytė, Gabrielė Dambrauskaitė

Supervisor of the abstract: K. Laučkaitė

INTRODUCTION

The severity of idiopathic Parkinson’s disease (IPD) is evaluated first of all according to classical

signs of progressive motor dysfunction, though non-motor symptoms are common in IPD and

increase together with motor disability over the time (1). They are present already at early and

preclinical IPD stages and their character changes as the disease progresses (2). Therefore, an

assessment of non-motor symptoms could be helpful in diagnosing IPD at early stages and also

in differentiation from Parkinsonian syndromes (PS) (3).

AIM

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The aim of the present study was to assess the value of non-motor symptoms in the differential

diagnosis between IPD and PS.

OBJECTIVES

1.To describe the most prevalent non-motor symptoms in patients at early Hoehn-Yahr (H&Y)

stages of IPD and PS.

2.To determine the most distinguishing non-motor symptoms in IPD and PS patients in

comparison to control subjects.

3.To compare IPD to PS patients according to non-motor symptoms.

METHODS

1. The permission of LUHS Centre of Bioethics was obtained before the initiated study.

2. The investigated subjects were divided in 3 groups:

a. The first group consisted of 57 patients at early stages of IPD (H&Y I and II).

b. The second group involved 14 patients with PS.

c. A control group was comprised of 76 subjects. It consisted of the patients with other

neurological diseases, except for neurodegenerative.

3. The patients were examined by an application of clinimetric scales: the NMSS (IPD n=23,

PS n=14, controls n=49), the SF-36v.2 (IPD n=48, PS n=14, controls n=71), and the HAD

scale (IPD n=41, PS n=13, controls n=70).

4. A statistical analysis of the data was performed using the statistical package IBM SPSS

version 19. A p value less than 0.05 was considered as statistically significant.

RESULTS

1. The investigated three groups did not differ according to age (F=0.31, p=0.73,) and gender

(χ2=1,364, p=0,51).

2. A statistically significant difference was found between the mean scores of the NMSS

Gastrointestinal symptom subscale: in IPD group – 10.00±9.25 (median 7); in PS group -

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3.71±8.51 (median 0); in control group – 3.84±5.65 (median 0) (Kruskal-Wallis test,

χ2=11.74, p=0.003).

3. The significant differences were detected between the mean scores of HAD scale. The mean

scores of depression between the groups distributed in the latter manner: in IPD group -

7.02±4.16; in PS group - 7.77±4.34; in control group - 5.44± 4.38 (Kruskal-Wallis test,

χ2=7.07, p=0.029). The mean scores of anxiety were: in IPD group - 8.32±4.68; in PS group -

10.54±4.39; in control group - 6.86±4.58 (ANOVA; F=4.029; p=0.02). A post hoc analysis

by LSD test revealed statistically significant difference between PS and controls (p=0.009).

4. Some statistically significant differences were found in the SF-36v.2 scores. The Physical

functioning subscale scores were as follows: in IPD group - 48.90±27.01; in PS group -

49.29±36.53; in control group - 61.88±26.61 (Kruskal-Wallis test, χ2=6.61, p=0.037). The

Role-emotional limitation scores were: in IPD group – 41.31±35.48; in PS group –

43.45±29.81; in control group - 56.51±30.18 (Kruskal-Wallis test, χ2=6.09, p=0.048). The

General health scores were: in IPD group - 30.28±19.13; in PS group - 30.36±16.92; in

control group - 44.38±17.93 (ANOVA, F=10.35, p<0.01). A post hoc analysis by LSD test

detected a statistically significant difference both between IPD and control groups (p<0.01),

and between PS and control group (p=0.01).

CONCLUSIONS

1.The most prevalent non-motor symptoms with reference to the results of the scales according

to diagnosis distributed as follows: a) in IPD patients: anxiety, depression, urinary symptoms,

and gastrointestinal dysfunction; b) in PS patients: severe anxiety, urinary dysfunction, attention

and memory deficits.

2.The higher level of depression and anxiety, worse self-evaluation of physical functioning and

general health, as well as stronger limitation because of emotional state were the symptoms,

which distinguished IPD and PS patients from controls.

3.Only the gastrointestinal symptoms in IPD patients credibly differed from PS, therefore their

assessment would be highly recommended in every patient with suspected IPD.

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REFERENCES

1.Erro R, Picillo M, Vitale C, Amboni M, Moccia M, Longo K, et al. Non-motor symptoms in

early Parkinson's disease: a 2-year follow-up study on previously untreated patients. J Neurol

Neurosurg Psychiatry 2013; 84:14–17.

2.Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, et al. EFNS/MDS-ES

recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013;20:16–34.

3.Asahina M, Vichayanrat E, Low DA, Iodice V, Mathias CJ. Autonomic dysfunction in

parkinsonian disorders: assessment and pathophysiology. J Neurol Neurosurg Psychiatry 2012;

[Epub ahead of print].

3. RADIOLOGICAL FINDINGS OF ACUTE ISCHEMIC STROKE

BEFORE AND AFTER ENDOVASCULAR THROMBECTOMY,

TREATMENT RESULTS

Author: Arturs Balodis

Supervisors of the abstract: Kārlis Kupčš MD, Evija Miglāne, MD.

INTRODUCTION

The Centre for Disease Prevention and Control (CDPC) of Latvia shows that 7190 patients with

diagnosis - acute ischemic stroke were hospitalized in Latvia during 2010. The biggest part of the

patients were older than 60 years. Mechanical thrombectomy can be used in acute ischemic

stroke patients treatment with large artery occlusion and contrindications for intravenous

thrombolysis or known to have suboptimal outcome. It is available for patients with acute

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ischemic stroke 8 hours from stroke's onset in anterior circulation area and 24 hours in posterior

circulation area. Mechanical thrombectomy is available in Paula Stradins Clinical University

hospital since 2010.

AIM

To analyse radiological findings before and after the treatment, to value endovascular treatment

results.

OBJECTIVES

1. Evaluate safety and efficacy of endovascular thrombectomy using modified Rankine

Scale(mRS) and National Institute of Health Stroke Scale(NIHSS) before treatment, during

discharge and after 90 days.

2. Analyse radiological findings before and after the treatment using data from radiology

department database.

METHODS

This was a retrospective study of acute ischemic stroke patients who were treated by endovascular

thrombectomies due to large artery occlusions. 73 patients with acute ischemic stroke, who were

hospitalized in Paula Stradins Clinical University hospital from 28.12.2010 till 01.09.2012 were included

in this study. Telephone interviews were performed 3 months after thrombectomy using mRS and NIHSS.

The data were analysed using Ms Excel and SPSS 16.0. version. Paired samples T-test was used in order

to compare NIHSS during hospitalization and during discharge from hospital.

RESULTS

There were 40(54,8%) males and 33(45,2%) females within this study. Mean age of the patients

was 66,01±11,05(SD) years. Computed tomography (CT) native scans showed no radiological

findings in 40(55%) cases, hyperdense midle cerebral artery (MCA) symptom in 24(33%) cases

and old cerebral infarct in 9(12%) cases during hospitalization. CT angiography showed that the

majority of thrombs were localised in anterior circulation area MCA – M2 - 55(75,35%), in

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posterior circulation area – vertebrobasilar(VB) - 18(24,7%). CT perfusion showed that

51(69,89%) patient had penumbra, 22(30,11%) penumbra and “core”. CT control scans, after

the mechanical thrombectomy, revealed lacunar stroke in 53(72,6%) cases, widespread ischemia

in15(20,54%) cases, hemorrhage in 5(6,84%) cases. Successful recanalization was achieved in

69 (92%) cases.

Mean time from stroke's onset to mechanical thrombectomy was 274±110,62(SD)min, (95% CI-

244,09-303,91min.) in anterior circulation area and 448,67±247,26(SD)min, (95% CI-365,70-

6111,63min.) in posterior circulation area. Mean NIHSS until thrombectomy was 16,7±6,8 (SD),

(95% CI-15,10-18,30), mean NIHSS after the treatment was 8,8±7,88(SD), (95% CI 6,94-

10,62,). The difference was statistically significant between these groups, p<0,0001. MRS

before thrombectomy - mRS 3 got 1(1,4%) patient who had mild disability, mRS 4-5 got

72(96,8%) patients who had moderately severe and severe disability. At 3 months after

thrombectomy, 25(34,2%) patients had good outcome mRS 2 and less, 14(19,2%) patients had

mild disability, 9(12,5%) patients had severe disability, mRS 4-5. There are no data about

7(9,4%) patients after 3 months. Total mortality after 3 months was 18(24,7%) - mRS 6.

Complications developed in 5(6,84%) patients, they all had intracerebral haemorrhage.

CONCLUSIONS

1. Mechanical thrombectomy is an effective and relatively safe treatment for patients with acute

occlusion of cerebral arteries.

2. It can significantly improve neurological outcome in patients with severe ischemic stroke.

3. CT angiography, CT native are vitally important to perform in order to differentiate the acute

ischemic stroke in anterior circulation area and posterior circulation area, to diagnose the

localisation of thrombs in order to receive endovascular treatment options.

REFERENCES

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1. Choi JH, Betaman BT et. Al. Endovascular recanalization therapy in acute ishemic stroke.

Stroke, 2006, 37, 419-424.

2. Doman GA et al. Stroke, Lancet, 2008, 371, 1612-1623

3. Flynn Rw MacWalter Rs, Doney As. THE cost of cerebral ishaemia. Neuropharmacology,

2008, 55, 250-256.

4. Levandowski CA. Et. Al. Combinated intravenous and intra-arterial r-TPA versus intra-atrial

therapy af acute stroke:Emegersy megenement Bridging Trial Stroke 1999. 30

5. Levy EL et al. Self-expanding stents for recanalization of acute cerebrovascular occlusions.

Am J. Neuroradiol. 2007 May; 28 816-22.

6. Saver JL. Time is brain-quantified. Stroke. 2006 Jan; 37; 263.

4. VERBAL MEMORY IN TEMPORAL LOBE EPILEPSY SURGERY:

THE LINK BETWEEN POSTICTAL AND POSTOPERATIVE

MEMORY

Author: Lukas Sveikata

Supervisors of the abstract: Serge Vulliemoz1, Alan J. Pegna2, Margitta Seeck1, Kęstutis

Petrikonis3. 1EEG and Epilepsy Unit, Neurology Clinic and 2Neuropsychology Unit, University Hospital of

Geneva (HUG); 3Deptartment of Neurology, Hospital of LUHS Kaunas Clinics.

INTRODUCTION

Temporal lobe epilepsy is one of the most common forms of pharmacoresistant epilepsy,

whereas it also has the potential to be effectively cured with surgery in about three fourths of

cases (2). One of the major complications of such intervention is the decline in verbal memory.

In recent studies postictal verbal memory tests demonstrated additional value in lateralizing

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hemispheric (1) side of the seizure focus as well as showed association with postoperative verbal

memory decline (3).

AIM

To evaluate the predictive value of postictal verbal memory in postoperative verbal memory

decline after temporal lobe surgery in patients with pharmacoresistant epilepsy.

OBJECTIVES

1. Evaluate the pattern of postoperative memory decline in left and right temporal lobe

epilepsy patients.

2. Measure the association between postictal verbal memory and postoperative verbal memory.

3. Estimate the predictive value of postictal verbal memory test in predicting a postoperative

verbal memory decline.

METHODS

The subjects were 66 patients with unilateral temporal lobe epilepsy (TLE) at the University

Hospital of Geneva. All patients underwent a routine neuropsychological evaluation, including

Rey verbal learning test. During interictal verbal testing the list of 15 words was presented five

times requiring an immediate recall on each occasion and a verbal delayed recall (VDR) 40 min

after the fifth presentation. The postictal testing required shorter tasks (10 words presented 3

times and VDR after 30 min). It was performed once the patient had recovered orientation in

time and space and was able to understand commands. The interictal examination was repeated

3-9 months after the intervention. Surgery outcome was evaluated according to Engel class.

A repeated-measures analysis of variance (ANOVA) was performed to compare interictal,

postictal and postoperative VDR scores, with post hoc Bonferroni test. Postictal decline and

postoperative decline were built as new variables to assess the VDR score change when

compared to preoperative interictal scores. The relationship between postoperative decline as

dependent variable and postictal decline, presence of hippocampal sclerosis and focus as

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explanatory variables were assessed using a multiple linear regression. The proportion of

variance explained by the regression model was estimated using the determination coefficient

adjusted for the number of variables (aR2).

For the predictive value we estimated the sensitivity (Sn), specificity (Sp), positive predictive

value (PPV), negative predictive value (NPV) and Youden’s index (J) of the postictal test. We

considered the test as positive when a 20% or greater decline was observed. The quantitative

variables are presented in median with range. The significance level was set at 0.05.

RESULTS

We included 33 male, 33 female, aged 29.0 (12 – 57), age at onset 11.5 (1-38), duration of the

disease 14.0 (0-53) years. Left TLE (L-TLE) was diagnosed in 36 patients and right TLE (R-

TLE) in 30 patients. Surgery outcome was Engel class I in 58 patients (87.9%) and Engel class II

in 6 patients (12.1%).

Multiple measures ANOVA revealed a significant decrease in postictal and postoperative VDR

(p<0.001). The decrease was still significant when taken into account the focus lateralization

(p=0.04). The difference in postictal VDR between the two groups was not significant (p=0.06),

though there was a significant difference in postoperative VDR between the groups (p<0.001).

Postictal decline (p=0.01) and focus lateralization (p=0.03), but not the presence of hippocampal

sclerosis (HS) (p=0.46), were significantly associated with postoperative decline (aR2 = 0.17). If

only the patients with HS (n=40) were included, postictal decline (p=0.02), focus lateralization

(p=0.002) and interictal VDR (p<0.001) were significantly associated with postoperative decline

(aR2=0.52).

The postictal decline of 20% was moderately sensitive to predict a greater than 33%

postoperative decline in VDR (Sn=70%, Sp=56%, PPV=24.1%, NPV=90.3%, J=0.26). For

subjects with HS the greatest predictive value was achieved when predicting a greater than 26%

postoperative decline (Sn=77.8%, Sp=71.0%, PPV=37.5%, NPV=91.7%, J=0.49).

CONCLUSIONS

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1. There is a significant postoperative verbal delayed recall decline in left temporal lobe

epilepsy patients compared to right temporal lobe epilepsy patients.

2. Postoperative verbal delayed recall decline is related to postictal verbal delayed recall decline

and focus lateralization. This relationship explains half of the variance in the group of subjects

with hippocampal sclerosis.

3. Postictal memory decline may have predictive value in planning the surgical strategy of

temporal lobe epilepsy patients, especially in the group of patients with hippocampal

sclerosis.

REFERENCES

1. Pegna AJ, Qayoom Z, Gericke CA, Landis T, Seeck M. Comprehensive postictal neuropsychology

improves focus localization in epilepsy. Eur. Neurol. 1998 Nov;40(4):207–11.

2. Sheybani L, Sveikata L, Spinelli L, Lascano AM, Vulliemoz S, Korff C, et al. Presurgical evaluation

in pharmacoresistant epilepsy: the Geneva-Lausanne experience. Schweiz Arch Neurol Psychiatr.

Forthcoming 2013.

3. Vulliemoz S, Prilipko O, Herrmann FR, Pollo C, Landis T, Pegna AJ, et al. Can postictal memory

predict postoperative memory in patients with temporal lobe epilepsy? Epilepsia. 2012 Jun

12;53(10):e170–3.

5. TREATMENT ANALYSIS OF MIGRAINE ATTACKS IN A

RANDOM LITHUANIAN SAMPLE

Authors:.Laura.Šinkūnaitė,.Lukas.Sveikata

Supervisor of the abstract: Prof. Antanas Vaitkus1

1Department of Neurology, Hospital of LUHS Kaunas Clinics

INTRODUCTION

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Migraine affects about 12 % of people in occidental countries. An estimated prevalence in US

population is 18 % in females and 6 % in males (1). Despite the fact that migraine is associated

with serious headache and disability, the American Migraine Study II found that 85 % males and

72 % females, who had migraine, were not diagnosed or received inadequate treatment (2). A

Lithuanian study carried out in the year 1998 showed that only 12.6 % patients used migraine-

specific therapy and only 2.2 % received 5-HT1 receptor inhibitors, also known as triptans that

have become currently the treatment of choice for acute migraine attacks (3).

AIM

Assess the current choice of medications for management of acute migraine attacks and the

change in treatment strategy in Lithuanian clinical practice over 15 years.

OBJECTIVES

1. Identify the most frequently used antimigraine drugs and their combinations.

2. Evaluate the effectiveness in pain reduction of each medication and compare it between

different drug types.

3. Compare the choice of treatment used for acute migraine attacks nowadays with the results of

the study published in 2001.

METHODS

Study included patients in several Lithuanian hospitals and primary health care centers who

filled in our questionnaires in January through April 2013. All of the respondents had a

confirmed diagnosis of migraine. We collected data regarding patients’ age, sex, duration of the

disease, frequency of migraine attacks, their choice of treatment with multiple answers possible,

and the intensity of pain before and after administering the drugs. Pain intensity was measured

using Numeric Analog Scale (NAS).

The quantitative variables are given in means with minimum and maximum values. The

difference in pain intensity before and after the treatment was assessed using Wilcoxon signed-

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rank test. The differences of pain reduction between different treatment options were assessed

using one-way analysis of variance (ANOVA) with post-hoc Bonferroni test. The significance

level was set at 0.05.

RESULTS

We have collected filled questionnaires from 94 patients, aged 43.7 (20-68). Eighty-six patients

(91.5 %) were female and 8 (8.5 %) male. The mean disease duration was 11.7 (0.5 – 40.0),

mean frequency of migraine attacks per month 2.0 (0.15 – 8.0), mean pain intensity before and

after administering antimigraine medications was 8.5 (5.0 – 10.0) and 3.27 (0 – 10.0)

respectively, mean reduction of pain intensity was 5.24 (0 – 10.0).

Triptans were used by 55 (58.5 %) patients, of whom 38 (40.4 %) as monotherapy and 17 (18.1

%) in combination with either NSAIDs, combination analgesics (Solpadein, Citramon,

Neocitramon) or both. Thirty-five (37.2 %) patients administered NSAIDs and/or combination

analgesics, of whom 26 (27.7 %) used only NSAIDs, 5 (5.3 %) administered both NSAIDs and

combination analgesics and 4 (4.3 %) used only combination analgesics. NSAIDs were overall

mentioned by 44 (46.8 %) patients and combination analgesics by 16 (17.0 %) patients. One

patient administered unspecified vasodilatating drug while another patient mentioned per oral

prednisolone in addition to sumatriptan. Four (4.3 %) patients did not use any treatment for acute

migraine attacks.

Patients who used only triptans demonstrated significant pain reduction in mean NAS values

from 8.4 to 2.1 (p<0.001), triptans in combination with NSAIDs and/or combined analgesics

from 9.1 to 4.3 (p<0.001), NSAIDs from 8.5 to 4.0 (p<0.001), combined analgesics from 8.8 to

4.8 (p=0.02). Triptans used in monotherapy have reduced pain levels by 2.2 (p=0.002) points

more than when used in combination with other drugs. Respectively, using triptans in

monotherapy has decreased pain levels by 2.0 (p=0.001) points more than treatment with

NSAIDs and/or combination analgesics alone.

CONCLUSIONS

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1. Triptans were the most commonly administered antimigraine treatment, used by more than

half of respondents, while NSAIDs were used by a little less than half and combination

analgesics by less than one fifth of respondents.

2. Administration of triptans in monotherapy was more effective in reducing pain levels than

other types of therapies.

3. The usage of triptans has risen times twenty-six in a random sample of migraine patients in

Lithuanian hospitals and primary healthcare centers.

REFERENCES

1. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of

migraine in the United States: data from the American Migraine Study II. Headache. 2001

Jul;41(7):646–57.

2. Noack H, Rothrock JF. Migraine: Definitions, Mechanisms, and Treatment. Southern Medical

Journal. 1996;89(8):762.

3. Vaitkus A., Vilionskis A, Salokas R. Analysis of medicines used for migraine attack

treatment. Lietuvos bendrosios praktikos gydytojas. 2001;5(1): 46-49

6. LITHUANIAN PEOPLE’S ATTITUDE TOWARDS MENTAL

HEALTH

Author: Sandra Vaitkevičiūtė

Supervisor of the abstract: Assoc. prof. Eugenijus Laurinaitis

INTRODUCTION

According to the 2010 Eurobarometer data, Lithuanians are quite passive in taking care of their

mental health1. Prevalence of mental disorders grew by 13% from 2005 in our country2 Although

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the situation is getting worse, limited information is available about Lithuanians‘ attitude

towards mental health.

AIM

To figure out the attitude of Lithuanian citizens towards mental health and its connection with

demographic characteristics.

OBJECTIVES

1.To compare answers of women and men;

2.To find differences between different age groups;

3.To compare different marital status and education people’s attitude;

METHODS

An internet survey of Lithuanian people was carried out in January 2012. People had to answer

anonymously to 14 questions of the created questionnaire. The statistical analysis was performed

with SPSS program. The difference was considered statistically significant when p≤0.05.

RESULTS

1. In overall, 353 questionnaires were collected, 341 of them were involved into the analysis.

54.3% women and 45.7% men participated.

2. Age groups: 18-28 years 222 (65.1%); 29-39 years 69 (20.2%); >39 years 50 (14.7%). 89

(26.1%) respondents had secondary education; 24 (7%) - vocational education; 45(13.2%) -

higher non-university education; 183 (53.7%) - university education. According to

occupation: unemployed 57 (16.7%); physical worker 59 (17.3%); mental worker 163

(47.8%); managerial worker 41 (12%); other 21 (6.2%). According to marital status: single

123 (36.1%); having partners 116 (34%); married 96 (28.2%); single parents 6 (1.8%).

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According to living place: city 265 (77.7%).

3. According to mental health self-evaluation: perfect 43 (12.6%), good 173 (50.7%), average

71 (20.8%), satisfactory 25 (7.3%), bad 11 (3.2%). About mental health 129 (37.8%)

respondents know enough; 163(47.8%) are not sure; 49(14.4%) know insufficiently.

Information about mental health 258 (75.7%) respondents seek in the internet, 120 (35.2%) in

the popular press, 113 (33.1%) in the scientific literature, 69 (20.2%) ask friends, 47(13.8%)

ask their personal psychologist.

4. Help would seek 104 (30.5%) if deterioration of mental health appeared; 180 (52.8%) only if

the symptoms were severe; 44 (125.9%) are not sure; 13 (3.8%) never. Would consult friends

45 (13.2%), a pharmacist 7 (2.1%), a family doctor 85 (24.9%), a Mental Health Centre

professional, 156 (45.7%) a private psychologist/psychotherapist/psychiatrist. 29 (8.5%)

respondents know about Mental Health Centre and have been there, 141 (41.3%) know but

never been there, 122 (35.8%) do not know it, 49 (14.4%) never heard of it. The respondents

would recommend their family member to seek help if he/she mentioned at least one

symptom 160 (46.9%); only if the symptom was very severe 171 (50.1%); would not

recommend 10 (2.9%).

4. If mental health deteriorated, help would seek (the percentage in a group is indicated in the

brackets) women 69 (37.3%), men 35 (22.4%); if the symptoms were severe: women 95

(51.4%), men 85 (54.5%); not sure: women 17 (9.2%), men 27 (17.3%); never: women 4

(2.2%), men 9 (5.8%) à(p<0.05).

5. Would consult with friends 18-28 years 16.7%, 29-39 years 7.2%, >39years 6%; with a

pharmacist 18-28years 1.8%, 29-39years 1.4%, >39years 4%; with a family doctor 18-

28years 21.2%, 29-39 years 30.4%, >39years 34; with a Mental Health Centre professional

18-28 years 13.5%, 29-39 years 10.1%, >39 years 22%, a private

psychologist/psychotherapist/psychiatrist 18-28 years 46.8%, 29-39 years 50.7%, >39 years

34% à(p<0.05).

6. 63,2% women and 48,8% men would seek for help due to addictions, 38,4% and 23% due to

mourning, 26,5% and 14,1% due to professional burn-out à (p<0.05). 58,5% of managerial

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workers, 81,7% of mental workers, 60,7% of physical workers would seek for help due to

hallucinations à(p<0.05).

7. 16,7% of respondents of 18-28 years old would consult their friends and 21,2% a family

doctor, oldest respondents 6% and 34% à(p<0.05).

8. About mental health think know enough 13 (22.8%) unemployed, 17 (27.9%) physical

workers, 75 (44.4%) mental workers, 19 (46.3%) managerial workers, 5 (38%) others; have

doubts 32 (56.1%) unemployed, 39 (63.9%) physical workers, 68 (40.2%) mental workers, 17

(41.5%) managerial workers, 7 (53.8%) others; know insufficiently 12 (21.1) unemployed, 5

(8.2%) physical workers, 26 (15.4%) mental workers, 5 (12.2%) managerial workers, 1

(7.7%) others à (p<0.05).

CONCLUSIONS

1. More than half of the respondents would seek for help only if the symptoms were severe.

2. Having mental health deteriorated, women are more prone to seek for help than men.

5. Least managerial workers would consult about hallucinations.

6. Having mental health deteriorated, most respondents would consult a private mental health

specialist.

7. Younger respondents are more prone to consults their friends rather than PCP (primary care

physician).

8. People working mental and managerial jobs best evaluate their knowledge about mental

health.

REFERENCES

1. Eurobarometer.2010.http://www.efsa.europa.eu/en/riskcommunication/riskperception.ht

m Accessed April 10 2013

2. National.Lithuanian.Health.Service.Announcement.2012.http://www3.lrs.lt/pls/inter/w5_sho

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w?p_r=697&p_k=1

3. Norm Kelk at all. Attitudes toward depression in Australia law students and legal

practitioners. http://sydney.edu.au/bmri/research/mental-health-clinical-translational-

programs/lawreport.pdf Accessed April 10 2013

4. NHS. UK. Attitudes to mental Illness 2011 survey report. http://data.gov.uk/dataset/attitudes-

to-mental-illness-2011-survey-report-ns Accessed April 10 2013

5. Marie-Josee Fleury at.all. Typology of adults diagnosed with mental disorder based on socio-

demographics and clinical and service use characteristics.

http://www.medscape.com/viewarticle/745057_2 Accessed April 10 2013

7. RESTLESS LEGS SYNDROME IN DIALYSIS PATIENTS: A PILOT

STUDY

Author: Donatas Zailskas

Supervisor of the abstract: prof. Inga Arūnė Bumblytė, doc. Kęstutis Petrikonis

INTRODUCTION

Restless Legs Syndrome (RLS) is a sensorimotor sleep disorder, characterized by an urge to

move legs due to unpleasant and uncomfortable sensations. RLS diagnosis is made if the patient

satisfies all four diagnostic criteria (DC) approved by International RLS Study Group (1). RLS

remains a highly underdiagnosed condition and one of the main reasons of lower quality of life

in patients on hemodialysis, occurring up to 20% (3). Some studies find that serum calcium (2)

and phosphorus (2,4) concentrations, age (2,7), body-mass index (BMI) (7) or dialysis length

(2,7) do not differ significantly between RLS and non-RLS patient groups. Other studies (6,7),

on the contrary, show a difference.

AIM

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Our main goal was to compare physical, dialysis and laboratory measures between RLS and non-

RLS patient groups.

OBJECTIVES

1. To determine the occurrence of RLS in LSMU KK dialysis department outpatient group.

2. To compare the mean serum calcium and phosphorus concentrations between RLS and non-

RLS patient groups.

3. To compare the mean age, BMI, dialysis length and ultrafiltration amount between RLS and

non-RLS patient groups.

METHODS

We surveyed outpatients, dialyzed in the LSMU KK dialysis department from 2012 12 12 to

2013 04 12. The main inclusion criteria were: 1) 18-80 years old; 2) The ability and agreement to

participate in the study depending on their health status; 3) At least one serum calcium or

phosphorus concentration in the same time interval. Permission to perform the study was granted

by the LSMU Bioethics center. After signing a consent form and agreeing to participate in the

study, patients were checked for the number of RLS DC they satisfy. Epidemiological, medical

history and additional nephrological information from the patient records was collected

afterwards. The mean age, BMI, dialysis length, ultrafiltration amount, serum calcium and

phosphorus concentrations were compared between RLS and non-RLS patient groups. Due to

low sample size, differences between RLS and non-RLS patient groups were determined using

the non-parametric Mann-Whitney criterion; the differences were considered to be statistically

significant if p<0.05.

RESULTS

Out of 79 outpatients on dialysis, 54 (68.35%) patients were surveyed; the others did not satisfy

the main inclusion criteria. 28 outpatients (51.9%) were male and 26 (48.1%) were female, the

mean age was 56.59±15.395 years old, with the youngest being 22 years old and the oldest – 80

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years old. 4 (7.4%) patients were still working, 5 (9.3%) were unemployed, 26 (48.1%) had a

limited ability to work due to illness and 19 (35.2%) were retired. The mean outpatient BMI was

24.463±4.99 kg/m2 with the lowest being 13.99 kg/m2 and the highest – 42.75 kg/m2. 34 (63%)

did not satisfy any RLS DCs, 1 (1.9%) satisfied one, 5 (9.3%) satisfied two, 4 (7.4%) satisfied

three and we found 10 (18.5%) outpatients, satisfying all four RLS DCs. The mean phosphorus

concentration (n=54) between RLS (n=10) and non-RLS (n=44) outpatient groups together with

the mean serum calcium concentration (n=53) between RLS (n=10) and non-RLS (n=44)

outpatient groups did not differ significantly (p=0.379, U=180.5 and p=0.176, U=155.5

accordingly). There was a difference between RLS (n=10) and non-RLS (n=44) outpatient

groups comparing the mean age (n=54) and it was statistically significant (p=0.01, U=105); RLS

patients had a mean age of 47 years and non-RLS patients – 59 years. The mean BMI (n=52)

between RLS (n=10) and non-RLS (n=42) outpatients did not differ significantly (p=0.781,

U=198). The dialysis length (n=51) between RLS (n=9) and non-RLS (n=42) outpatient groups

did not differ significantly (p=0.553, U=165). The mean ultrafiltration amount (n=54) between

RLS (n=10) and non-RLS (n=44) patients did not differ significantly (p=0.815, U=209.5).

CONCLUSIONS

1.Less than a fifth of the LSMU KK dialysis department outpatiens satisfied all four RLS DCs.

2.There were no differences between RLS and non-RLS outpatient groups comparing the mean

serum calcium and phosphorus concentrations.

3.There were no differences between RLS and non-RLS outpatient groups comparing the mean

BMI, dialysis length and ultrafiltration amount, but we found a difference comparing the age.

RLS patients were younger and this finding is consistent with some other studies (4).

REFERENCES

1.Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special

considerations, and epidemiology. A report from the restless legs syndrome diagnosis and

epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19.

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2.Goffredo Filho GS, Gorini CC, Purysko AS, Silva HC, Elias IE. Restless legs syndrome in

patients on chronic hemodialysis in a Brazilian city: frequency, biochemical findings and

comorbidities. Arq Neuropsiquiatr. 2003 Sep;61(3B):723-7.

3.Juliane Winkelmann, Anette Stautner, Walter Samtleben, Claudia Trenkwalder. Long-term

course of restless legs syndrome in dialysis patients after kidney transplantation. Mov

Disord. 2002 September; 17(5): 1072–1076.

4.Kawauchi A, Inoue Y, Hashimoto T, et al. Restless legs syndrome in hemodialysis patients:

health-related quality of life and laboratory data analysis. Clin Nephrol 2006;66(6):440-6.

5.Malaki M, Mortazavi FS, Moazemi S, Shoaran M: Insomnia and limb pain in hemodialysis

patients: what is the share of restless leg syndrome? Saudi J Kidney Dis Transpl; 2012

Jan;23(1):15-20

6.Takaki J, Nishi T, Nangaku M, et al. Clinical and psychological aspects of restless legs

syndrome in uremic patients on hemodialysis. Am J Kidney Dis 2003;41(4):833-9.

7.Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease.

Am J Kidney Dis 1996;28:372-378.

8. ASSESSMENT OF THE CLINICAL VALIDITY AND STABILITY

OF AUSTIN EAR CLINIC DIZZINESS QUESTIONNAIRE

LITHUANIAN VERSION

Authors: Indrė Beketovaitė, Antanas Strazdas, Justina Mikšaitė

Supervisor of the abstract: prof. A. Vaitkus

INTRODUCTION

The most common reasons that frequently cause dizziness occurs up to 40% as a result of

peripheral causes, but any dizziness has to be distinguished from threatening condition - Central

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vertigo (dizziness), which can be the first symptom of more serious diseases, such as

cerebrovascular disorder.

So far any dizziness assessment questionnaire for a brief and fast peripheral and central vertigo

differentiation has not been adopted and approved in Lithuania, while the classic research takes a

long time and it uneconomical.

AIM

To evaluate the diagnostic value of Austin Ear Clinic Dizziness Questionnaire (AECDQ) in

patients with symptoms or signs indicating the presence of vertigo

OBJECTIVES

1.To evaluate sensitivity (Sen) and specificity (Sp) of different estimates of AECDQ.

2.Set the internal consistency of the questionnaire.

METHODS

110 participants with moderate or severe dizziness were examined at Hospital of Lithuanian

University of Health Sciences Kaunas Clinics primary care department during the period

2012/05–2013/02. Accurate diagnosis of each respondent, which caused dizziness, was

established during the treatment period .All participants were comprehensively interviewed using

Lithuanian version of AECDQ.Sum of positive and negative answers indicates the probability to

be central or peripheral origin of dizziness. Sensitivity and specificity of different questionnaire

estimates were evaluated for each disease. Separately were evaluated questions which describes

the duration of dizziness, time of duration and provoking factors. Internal coherence of

questionnaire was calculated by the coefficient of Cronbach's alpha

Statistical analyzes were performed using SPSS 17.0 software package. Chi - square test and

Pearson's correlation coefficient were used. Differences considered statistically significant at

p<0.05.

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RESULTS

110 patients were analyzed, 47 pts were men, average age 58,98±17,1 and 63pts were women,

average age 58,48±13,2. 50 (45%) of all patiens fulfilled the diagnostic criteria for

vertebrobasilar insufficiency and in this case 63% of them isolated vertigo was the first

symptom; 10 (9%) for Meniere's disease; 21 (19%) for Vestibular Neuronitis; 22 (20%) for

Benign Paroxysmal Positional Vertigo (BPPV); 5(n=4,5) for Multiple Sclerosis and one patient

had psychogenic origin of vertigo.Vestibular neuronitis, BPPV and Meniere's disease were

combined into a single peripheral origin of dizziness diagnosis.

Different estimates of questionnaire senitivity and specificity were evaluated for each disease.In

central origin, the largest value had issues Nr2 -Sen 88%, Sp 86% (p=0,001); Nr4- Sen 64%, Sp

58% (p=0,023); Nr13- Sen 68%,Sp 71% (p=0,001); Nr36 –Sen 74%, Sp 64% (p=0,001);

In Meniere's disease: Nr37- Sen 68%,Sp 92% (p=0,001); Nr38- Sen 100%, Sp 69% (p=0,001);

Nr39- Sen 100%, Sp 69% (p=0,013); Nr45- Sen 100%, Sp 92% (p=0,001); Nr46- Sen 100%, Sp

95% (p=0,001); At Vestibular neuronitis: Nr14- Sen 76%,Sp 58% (p=0,004). At BPPV: Nr27-

Sen 60%, Sp 68% (p=0,03); Nr32- Sen 70%,Sp 61% (p=0,001); Nr33 –Sen 84%, Sp 65%

(p=0,001);

Focal neurological deficits evaluation: possitive matches were found in 23 (46%) of patients with

central cause of vertigo and at 2 (3,8%) with peripheral cause. Statistically significant

correlation was found between existing focal deficits and central cause of vertigo (p=0,001; r=

0,47).Pathological reflexes were found in 17 (34%) of patients with central cause of vertigo and

only at 2% (3,5) with peripheral cause.There was no statistically significant correlation between

diagnosis and pathological reflexes (p>0,05)In central origin dizziness, nystagmus occurred with

38 (76%) In peripheral origin - 50 (94%) of the patients.Statistically significant correlation was

found between the focal symptomatic and existing pathological reflexes (p = 0.001, r = 0.43).

Correlation between the current focal symptoms and nystagmus, and nystagmus and existing

pathological reflexes were not obtained (p> 0.05).Assessing the duration of dizziness: at central

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origin 21 (42%) noted that dizziness lasted longer than 10 minutes, 17 (34%) - lasted several

hours. In Meniere's disease -100% of the patients indicated that dizziness lasted a few hours and

longer. At Vestibular neuronitis - mostly, 38% of subjects noted that the dizziness lasted several

days and BPPV 19 (86%) - for a few minutes. Before dizziness episode in central origin of

vertigo, warning unpleasant feelings felt 42% of participants; in peripheral dizziness- only 5%.

86.8% pts with peripheral dizziness noted that postural changes may reinforce or provoke

dizziness; with central vertigo -28%. The Austin Ear Clinic Dizziness Questionnaire Cronbach's

α=0,704).

CONCLUSIONS

1.Lithuanian version of Austin Ear Clinic Dizziness Questionnaire has been used, the sensitivity

and specificity of different questionnaire estimates were evaluated for each disease. According to

Sen and Sp, central causes had less nausea and vomiting, but more pronounced imbalance than

peripheral causes.

2. Internal coherence of questionnaire was calculated by the coefficient of Cronbach's alpha, and

according to that - The Austin Ear Clinic Dizziness Questionnaire has sufficient reliability for the

application in clinical practice.

REFERENCES

1.Sloane P. Dizziness in primary care.Results from the National Ambulatory Care Survey. J Fam

Pract 1989;29(1):33-38

2.Karena Hanley, Tom O’ Down, Niall Considine. A systematic review of vertigo in primary

care. British Journal of General Practice, 2001,51,666-671

9. METHANOL OPTIC NEUROPATHY

Authors: Jekaterina Varlamova, Riga Stradins University, faculty of medicine, 6-th year;

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Jekaterina Skitecka, Riga Stradins University, Ophthalmology resident.

Supervisor of the abstract: Dr.Kristine Baumane, Pauls Stradins Clinical University Hospital.

INTRODUCTION

Methanol poisoning is a rare but potentially life-threatening intoxication and its dangers are not

always easily diagnosed and recognized1. Methanol is the basic of many commercially available

organic solvents and alcohol surrogate component2. Methanol metabolites formic acid and

formaldehyde are very toxic. Typical poisoning effects are metabolic acidosis, neurological

complications, including vision loss, and even death3. Methanol toxicity remains a common

problem in many developing countries, especially among persons of lower socioeconomic

classes2.

AIM

To study carefully an unusual, rare medical case and share with others an experience.

METHODS

1. To study the patient`s disease history.

2. To make all required examinations.

3. To control the further development of the disease.

CASE REPORT

A 33-years-old man entered Department of Ophthalmology in Pauls Stradins Clinical University

Hospital with complaints about progressive vision loss in both eyes that started four days ago.

The anamnesis shown that ten days ago the patient used an alcohol which wasn`t purchased in

the store, and smoked marijuana. He also had an amputation of the testicle due to seminoma six

years ago. On admission the visual acuity in the right eye was hand movements and in the left

one the patient counted fingers from the 20 cm distance, he had the wide pupils with poor

response to light. The examinations made: external examination, visual acuity test, tonometry,

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slit-lamp biomicroscopy, fundus oculi evaluation. The additional examinations: head Computed

Tomography – with no significant changes; optic nerve Optical Coherence Tomography –

thickness of the retinal nerve fiber layer; Pattern – Visually Evoked Potentials – considerable

changes in N75-P100. The fixed diagnosis after the detailed examination was – Toxic Optic

Neuropathy, the possible reason – Methanol Poisoning. The treatment included: hyperbaric

oxygen therapy and drug therapy, directed on detoxification and inflammation reducing. Extra

examination needed for the differential diagnosis: blood testing for mitochondrial

Deoxyribonucleic Acid assessment to exclude Leber`s hereditary optic neuropathy and head

Magnetic Resonance Imaging to exclude seminoma`s metastases in the brain.

DISCUSSION

1.Methanol poisoning is still present today.

2.Unfortunately, toxic neuropathy results in permanent optic nerve damage that leads to the optic

nerve atrophy and the hard visual disability of the patient.

3.In this particular case the patient asked for help too late and after the treatment the vision

wasn`t corrected.

REFERENCES

1.Orphanet [Internet]. Orphanet – the portal for rare diseases and orphan drugs; 2007 [updated

2007 June]. Available from: http://tinyurl.com/d6zn2ds

2.Kalyani Korabathina, MD. Methanol Toxicity [Internet]. 2012 [updated 2012 Feb 3]. Available

from Medline: http://emedicine.medscape.com/article/1174890-overview

3.Yong Woon Shin, Ki Bang Uhm. A Case of Optic Nerve Atrophy with Severe Disc Cupping

after Methanol Poisoning [Internet]. 2011 April; 25(2): 146-150 [published online 2011 March

11].Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060395/

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10. DIFFERENCES OF EMOTIONAL STATE AMONG MEN

SUFFERING FROM TYPE 2 DIABETES MELLITUS

CONSIDERING PRESENCE OR ABSENCE OF DEPRESSION

SYMPTOMS

Author: Eglė Jankuvienė

Supervisor of the abstract: dr. Lina Lašaitė

INTRODUCTION

Distress and depression experienced are recognized as the risk factors of Type 2 Diabetes

Mellitus (2DM). Depression could affect behaviour peculiarities; consequently, it may influence

the compliance with treatment regimen as well as increase the risk of complications.

AIM

Aim of the work is to evaluate peculiarities of emotional state among men suffering from Type 2

DM considering presence or absence of depression symptoms.

OBJECTIVES

1. To evaluate tension-anxiety experienced by men suffering from 2DM considering

presence or absence of depression symptoms.

2. To evaluate depression-dejection experienced by men suffering from 2DM considering

presence or absence of depression symptoms.

3. To evaluate anger-hostility experienced by men suffering from 2DM considering

presence or absence of depression symptoms.

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4. To evaluate vigor-activity experienced by men suffering from 2DM considering presence

or absence of depression symptoms.

5. To evaluate fatigue-inertia experienced by men suffering from 2DM considering

presence or absence of depression symptoms.

6. To evaluate confusion-bewilderment experienced by men suffering from 2DM

considering presence or absence of depression symptoms.

METHODS

1. 42 (81%) men suffering from 2DM without determined depression symptoms (age:

55.4±10.00 years) and 10 (19%) men suffering from 2DM with determined depression

symptoms (age 52.6±12.6 years) have participated in the research.

2. For the determination of depression symptoms the Mini-International Neuropsychiatric

Interview (M.I.N.I.) has been applied, whereas the Profile of Mood States has been

applied for the evaluation of emotional state that determines six aspects of emotional

state: tension-anxiety; depression-dejection; anger-hostility; vigor-activity; fatigue-

inertia; confusion-bewilderment.

3. The data has been considered as statistically significant when p<0.05. The analysis of

statistical results has been accompished with SPSS 17.0 standard software package.

RESULTS

Statistically higher tension-enxiety (9.8±4.0 vs. 3.0±4.3, p<0001), depression-dejection

(12.3±6.3 vs. 5.7±3.7, p=0.001), anger-hostility (12.6±4.8 vs. 7.7±3.8, p=0.007), decrease in

vigor-activity (10.9±3.5 vs. 16.8±3.3, p<0.001), fatigue-inertia (9.5±3.4 vs. 3.6±3.3, p<0.001)

and confusion-bewilderment (5.7±3.0 vs. 1.0±3.1, p<0.001) have been expressed among men

suffering from 2DM with determined depression symptoms compared to those without

determined depression symptoms.

CONCLUSIONS

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1.Men suffering from 2DM with determined depression symptoms experience higher tension-

anxiety than those without determined depression symptoms.

2.Men suffering from 2DM with determined depression symptoms experience higher depression-

dejection than those without determined depression symptoms.

3.Men suffering from 2DM with determined depression symptoms experience higher anger-

hostility than those without determined depression symptoms.

4.Men suffering from 2DM with determined depression symptoms experience higher decrease in

vigor-activity than those without determined depression symptoms.

5.Men suffering from 2DM with determined depression symptoms experience higher fatigue-

inertia than those without determined depression symptoms.

6.Men suffering from 2DM with determined depression symptoms experience higher confusion-

bewilderment than those without determined depression symptoms.

REFERENCES

1.Ali S, Stone MA, Peters JL, et al. The prevalence of comorbid depression in adults with type 2

diabetes: a systematic review and meta-analysis. Diabetic Med 2006; 23: 1165-1173.

2.Fisher L, Chesla CA, Mullan JT, Skaff M, Kanter RA. Contributors to depression in Latino and

European-American patients with type 2 diabetes. Diabetes Care. 2001;24:1751–1757.

11. TICK-BORNE ENCEPHALITIS AND LYME DISEASE (LYME

BORRELIOSIS) EPIDEMIOLOGICAL, CLINICAL AND

LABORATORY ACTUAL NEWS IN RIGA EASTERN CLINICAL

UNIVERSITY HOSPITAL “GAIĻEZERS" FROM YEAR 2007 TO

2012

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Authors: Tatjana Sidorčika, Dana Zeme, Faculty of Medicine, Rīga Stradiņš University

Supervisor of the abstract: Angelika Krūmiņa, Associate Professor, Infectology Department,

Rīga Stradiņš University; Guntis Karelis, Medical Doctor, Neurology Department, Rīga

Stradiņš University

INTRODUCTION

According to World Health Organization (WHO) data calculations around 3000 new tick-borne

encephalitis are diagnosed every year in Europe, and 85 000 cases of Lyme disease, of which 10-

12% manifested by neurological form. They are transmitted natural foci of infectious disease that

affects mainly the central nervous system and is still there Latvian public health problem, despite

the preventive measures.

AIM

The aim of research was to clinical hospital "Gaiļezers" patients with a clinical diagnosis of

"Tick-borne encephalitis " and "Lyme disease" (Lyme borreliosis) epidemiological, clinical and

laboratory data analysis on the five-year period from year 2007 – 2012 and analyze the impact of

various factors on the duration of hospitalization of patients neurological infections.

OBJECTIVES

1. Literature review and analysis of the current Latvian neurological infections such as tick-

borne encephalitis and Lyme disease (Lyme borreliosis).

2. Summarizing clinical hospital "Gaiļezers" patients with clinical diagnosis - tick-borne

encephalitis and Lyme disease (Lyme borreliosis) epidemiological, clinical, laborotoric data

in a five-year period between June 2007 and October 2012.

3. Summarizing clinical hospital "Gaiļezers" patients with clinical diagnosis - tick-borne

encephalitis and Lyme disease (Lyme borreliosis) neurological condition questionnaire results

in a five-year period between June 2007 and October 2012.

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4. Analyzing which of the tick-borne encephalitis and Lyme disease (Lyme borreliosis) factors

(patient age, clinical form, severity, laboratory parameters) affect patients' duration of

treatment in hospital.

METHODS

1. For study used clinical hospital "Gaiļezers" statistics electronic database and archive medical

records. Additional material was collected clinical hospital "Gaiļezers" neurology department

patients with a diagnosis of “Tick-borne encephalitis” and “Lyme disease” neurological form

– for this objective neurological disease detection.

2. The study used a descriptive, comparative and analytical statistical methods.

RESULTS

1. During the period from June 2007 and October 2012 were hospitalized 93 patients with a

clinical diagnosis of tick-borne encephalitis.

2. In general, summarizing data on 93 patients, of whom 42 were women (46,5%) and 51 men

(53,5%). The average age of patients with diagnosed disease was 51,0 ±17,8 years (p< 0,05).

3. Analyzing clinical hospital "Gaiļezers" diagnosis syndrome and severity (mild,

moderate,severe) ratio of the length of hospitalization, it is found, that the syndrome has no

direct effect on the number of bed days, but the severity affects patient's length of stationary

treatment (p <0.01).

4. Lumbar punctures cytological parameters has no effect on the tick-borne encephalitis and

hospital duration (p=0.765).

CONCLUSION

1. Summarizing available data, showed, that the tick-borne encephalitis and Lyme disease

(Lyme borreliosis), are still the most frequent Latvian neurotrophic natural infection with an

annual increase in incidence trends in endemic areas in Europe and the Latvian territory.

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2. Analyzing clinical hospital "Gaiļezers" patients epidemiological data with a clinical diagnosis

of " Tick-borne encephalitis" and "Lyme disease" (Lyme borreliosis) show that since 2008

there has been an upward trend in both (tick-borne encephalitis and Lyme borreliosis)

neuroinfection disease groups in clinical hospital "Gaiļezers", which is consistent with all

Latvian trends.

3. Analyzing clinical hospital "Gaiļezers" clinical data indicates that the neurological infections -

tick-borne encephalitis and Lyme disease (Lyme borreliosis) - there is no drastic difference in

clinical and neurological symptoms, which would set a precise diagnosis of the disease at an

early stage without the use of serological tests.

REFERENCES

1. Aeby, Ch., Tsai, Th. Tickborne encephalitits. In: Textbook of pediatric infectious disease.

Cherry, J., Sheldon, L., Kaplan., Gail (eds). Sixth edition, 2009; 2367-2375.

2. Cerar, T., Ogrine K., Cimperman, J., Lotrič-Furlan, S., Strle, F., Ružič-Sabljie, E. Validation

of cultivation and PCR methods for diagnosis of Lyme neuroborreliosis. Journal of Clinical

Microbiology, 2008 Oct., 46(10); 3375-9.

3. Christen, H.J., Hanefreld, F., Eiffert, H, Thommsen, R. Epidemiology and clinical

manifestations of Lyme borreliosis in childhood. A multicenter study with special regard to

neuroborreliosis. Acta paediatrica. Supplementum. 1993; 386, 1-75.

4. Oschman, P, Kraiczy, P., Halperin, J., Brade, V. (ed.). Lyme Borreliosis and Tick-Borne

Encephalitis. UNI-Med Vertrag AG, Bremen, Germany 1999; 144.

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OBSTETRICS AND GYNAECOLOGY SECTION

1. COMPARATIVE STUDY ON SEX EDUCATION AND

CONTRACEPTION AMONG STUDENTS IN KAUNAS

UNIVERSITIES

Authors: Eglė Bikauskaitė,Miglė Sirgedaitė

Department of Obsetrics and Gynecology, Medical Academy, Lithuanian University of

Health Sciences Head of the Scientific work: Dr.V.Abraitis

INTRODUCTION

Nowadays there is a great emphasis on sexual life, schools and universities organize sex

education programs, There is a lot of information on how to prevent pregnancy. Nevertheless, in

2010 there were 6989 registered abortions in Lithuania and the highest abortion rate was among

women aged 20-24 years old, many of them are students. There are not many studies on young

people sexual knowledge. Knowing the biggest gaps in the field would help to provide

suggestions for universities to improve sex education.

AIM

To investigate and compare students' knowledge about sex education and contraception in

universities of Kaunas city.

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OBJECTIVES

1. To investigate Kaunas universities students common knowledge about sex education and

contraception.

2. Compare the data between the different universities and determine on which subjects

their knowledge was the best / worst.

3. Compare male and female knowledge.

METHODS

The study conducted in Kaunas universities between January and March 2013. A total of 758

anonymous questionnaires containing 23 questions about sexuality and contraception were

distributed.They were distributed before or during lectures.Of these, 733 questionnaires were

completed and returned, for a response rate of (96,7%). statistical analysis of the data was

performed by using IBM SPSS Statistics 19 program, using level of significance when p <0.05

RESULTS

There were 733 (96.7%) fully answered questionnaires. 499 female (68.1%), 234 male (31.9%)

students aged 18-45 years old, the average of age was 20.9 ± 2.6 m . KK 135 (18.4%), KUT 109

(14.9%), LSU 190 (25.9%), LUHS 122 (16.6%), VMU 139 (19%), A.Stulginskio 38 ( 5.2%)

students.

The results showed that 378 (75.8%)of women and 200 (80%)of men had sex and 139 (19%)

did not, 16 (2.2%) did not respond. 361 (62.5%) are sexually active. The average of first sexual

intercourse was 17.4 ± 1.4 m.The highest rate of sexually active students was among LSU

students, there 118 (62.1%) had permanent sexual activity.

In response to the individual questions, the biggest differences were : Students did not know

what the biggest chance to get pregnant is during woman‘s mid-cycle 372 (50.8%). In KUT

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knowledge was the worst 69.7% ,the best knowledge in LUHS 26.2%. If KUT students did not

know which contraceptive measures were the most effective , they also did not know when is the

biggest chance to become pregnant (p = 0.014). That after giving birth, a woman can not get

pregnant before she has her first period thought 313 (42.7%). The highest rate stating this was

in LSU 47.4% and 45.9% in KUT. That washing vagina after sexual intercourse may help to

protect against pregnancy was said by 168 (22, 9%). 32.6% in KK thought so, the best

knowledge in LUHS 16.4%. Male more often than female thought that washing the vagina after

sexual intercourse may help to protect against pregnancy (p = 0.002). Women who did not know

that the greatest chance of becoming pregnant is in mid-cycle, thought that after giving a birth

there is no possibility to become pregnant again before her first period (p=0,032)3).444(60,6%)

prefered using condoms. Mostly condoms were used by KUT students 68,8%,OCPs by VMU

23,8%. That OCPs is the most effective method of birth control was said by 260 (35.5%). 47,5%

students from VMU thought so, worst knowledge was at KUT 28,4%. That OCPs is the most

effective protection against pregnancy was told by 26.9% of men and 40% of women. 149

(20.3%) thought that if they forget to take OCP’s few days in a row it would still protect against

pregnancy . 94 (12.8%) did not know how to protect from the sexually transmitted diseases ,

22.9% students were from KUT and only 3.3% students from LSMU. That there is a need to

take a break from using OCPs every couple of years thought 515 (70.3%).The highest rate, who

stated this was in KK 77% and the lowest in VMU 64%. 515(70,3%) thought that if woman uses

OCPs or other hormonal methods she is likely to gain weight, mostly it was said in KUT 74.7%,

in LSMU 68.7% the percentage was the lowest. That using OCPs increases the risk of

developing serious diseases such as cancer is claimed by 380 (51.8%). If students though that

using OCPs caused at least one side effect, they also thought that is causes other side effects

(p<0,001) 4) 149 (25%) had unsafe sexual intercourse during three months period . The highest

rate in LSU 27,9%, the lowest in LUSH 13,1%. Male had more unsafe sexual intercourse than

female (p=0,006).

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CONCLUSIONS

1. The level of knowledge about contraceptive measures is problematic, many students do not

understand a woman menstrual cycle uncertainties, and therefore unplanned pregnancy options

and do not know the effectiveness of contraceptives.

2. The best knowledge was at LUSH, the worst in KUT. LSU students were the most sexually

active, but this did not correlate with knowledge about menstrual cycle change as well as

knowledge about contraceptive measures. The highest rate in using OSPs was in VMU, female

using OCPs did not relate it with the weight gain, mood swings, or serious diseases like cancer.

The fear of OSPs side effects made an influence to low hormonal contraceptives use among

other universities students.

3. Women's knowledge about birth control, menstrual cycle was statistically significantly higher

than men’s (p <0.001).

2. THE MEANING OF LYMPHADENECTOMY SELECTING

POSTOPERATIVE TREATMENT STRATEGY FOR PATIENTS

WITH ENDOMETRIAL CARCINOMA

Authors: Justina Mikšaitė, Ilona Subotinaitė, Indrė Beketovaitė

Supervisor of the abstract: m.m.dr. V. Abraitis

INTRODUCTION

Endometrial carcinoma surgical treatment includes totally hysterectomy, pelvic and para-aortic

lymph nodes removal. The elimination of regional lymph nodes is associated with prolonged

duration of surgery, intraoperative, early (deep vein thrombosis, febrile fever, wound infection),

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late (lymphocele, intra-abdominal adhesions), postoperative complications and prolonged

hospitalization.

AIM

Evaluate whether the removal of lymph nodes significantly affects the following postoperative

treatment of patients with endometrial carcinoma.

OBJECTIVES

1. To calculate in which part of operations lymph nodes were removed.

2. To calculate cases when cancerous changes were found in removed lymph nodes.

3. To evaluate how changes in regional lymph nodes influence the strategy of postoperative

treatment.

METHODS

A retrospective study was done using Obstetrics and Gynecology clinic computer registry data.

In this study, 64 cases of women hospitalized from 2010 till 2012 for operative treatment of

endometrial carcinoma were analyzed. Statistical analysis was performed using SPSS 17.0 and

findings were considered statistically significant at p<0.05.

RESULTS

For 24 (37.5%) out of 64 operated patients regional lymph nodes were removed. In all of the 24

removed lymph nodes cases the cancerous changes were not found. Furthermore, one out of 24

aforementioned cases had to be excluded, because in the final diagnosis the record Nx remained.

46 (71.9%) operated women had a tumor ingrowing in myometrium less than ½, and the rest

eighteen (28.1%) – ingrowing to myometrium more than ½. According to the tumor

differentiation, 33 (51.6%) of all the tumors were well differentiated (G1), nineteen (29.7%) -

medium differentiated (G2), eleven (17.2%) - poorly differentiated (G3), and one (1.6%) -

undifferentiated tumor (G4). Based on this tumor differentiation all patients were divided into

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two groups: medium/high risk (G2/G3/G4) group with 31 (48.4%) patients assigned, and the rest

33 patients with the well-differentiated tumors. For the fifteen patients from the medium/high

risk group regional lymph nodes were removed. While 26 (78.8%) out of 33 patients with the

well-differentiated tumors were statistically significant and were not treated with radiation

therapy (p<0.05). For the thirteen (54.2%) out of 24 patients with removed lymph nodes

postoperative radiation therapy was not devoted. Furthermore, 34 (73.9%) out of 46 patients with

the tumor ingrowing less than half myometrium postoperative were also statistically significant

and the radiation therapy was not devoted (p<0.05). From 24 patients with removed lymph nodes

in four (16.7%) of the cases with tumor ingrowing to myometrium more than a half postoperative

radiation therapy was not devoted either.

CONCLUSIONS

1.Regional lymph nodes were removed for the one third of the patients with histologically

verified endometrial cancer.

2.No cancerous changes in removed regional lymph nodes were found after surgical treatment.

3.The strategy of postoperative radiation therapy between the patients with removed and not

removed regional lymph nodes was not significantly different. Removing regional lymph nodes

helps physicians to determine the need of postoperative radiation therapy but does not guarantee

any statistically significant reliability.

REFERENCES

1.Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant Radiotherapy for Stage I

Endometrial Cancer: An Updated Cochrane Systematic Review and Meta-analysis. J Natl Cancer

Inst. 2012 Nov 7; 104(21): 1625-34.

2.Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, Sessa C. Endometrial

cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol.

2011 Sep; 22 Suppl 6:vi35-9.

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3. LAPAROSCOPIC HYSTERECTOMY VERSUS ABDOMINAL

HYSTERECTOMY: A RETROSPECTIVE STUDY

Author: Olga Boka, Faculty of Medicine, Riga Stradins University, Riga, Latvia

Supervisor: Associate professor Dace Rezeberga, Head of Department of Obstetrics and

Gynaecology, Riga Stradins University, Riga, Latvia

INTRODUCTION

Hysterectomy is the second most common gynecological surgery after Caesarean section. There

are three main surgical approaches to hysterectomy – abdominal (AH), laparoscopic (LH) and

vaginal hysterectomy. Recently in Latvia the number of LH is surpassing AH.

There have been several randomized trials (1-3) comparing LH with AH. Laparoscopic

hysterectomy compared to abdominal hysterectomy is associated with less blood loss, less post-

operative pain, fewer wound or abdominal wall infections, fewer febrile episodes or unspecified

infections, smaller drop in haemoglobin and earlier discharge from hospital. The disadvantages

are longer operating time and more urinary tract injuries.

AIM

The aim of the study is to determine preferable surgical approach to hysterectomy between

laparoscopic and abdominal in Latvia.

OBJECTIVES

1. Analyze medical charts of patients who underwent laparoscopic hysterectomy or abdominal

hysterectomy.

2. Compare age, postoperative diagnoses, hospital stay, urgency of the surgery, extent of the

surgery, uterine size, estimated blood loss, frequency of bilateral salpingo-oophorectomy,

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complications, use of postoperative analgesics and antibiotic medication between LH and AH

patient groups.

3. Draw conclusions and proposals.

METHODS

Retrospective study included 216 patients who underwent abdominal hysterectomy or

laparoscopic hysterectomy in Riga East Clinical University Hospital Gynecology clinic in 2011.

One hundred twenty two patients underwent abdominal hysterectomy (group I) and 94 patients

underwent laparoscopic hysterectomy (group II).

Patient medical records were analyzed using study protocol.

The data were statistically processed with MS Excel and SPSS v. 20.0

The study was coordinated with the Riga Stradins University Ethics Committee.

RESULTS

There was no significant difference between age, general medical diseases, extent of the surgery

or frequency of bilateral salpingo-oophorectomy in both groups.

In patients with a uterine size above 14 gestational weeks AH was performed more often than

LH (41 vs. 8, p <0,001). Acute and subacute hysterectomy was performed more frequently by

abdominal approach than laparoscopic (57 vs 18, p <0,001).

Group I patients had longer hospital stay 8,5 ± 2,5 days vs. 6,5 ± 1,7 days (p = 0,002), greater

blood loss during surgery – 178,9 ± 112,8 ml vs. 146,1 ± 81,2 ml) (p = 0,009), more

complications - 30 versus 8 (p = 0,002), including postoperative infection 14 vs. 3 (p = 0,025).

Group I patients were given higher average doses of antibiotics compared to Group II:

Ceftriaxone 6,1 ± 4,2 g vs. 4,7 ± 3,6 g (p = 0,007) and Cefazolin 6,6 ± 3,9 g vs. 2,9 ± 1,9 g (p =

0,004). Analgesics were given more frequently and in higher doses after AH than LH:

Trimeperidine hydrochloride was administered to 119 vs. 76 patients (p <0,001), Tramadol to 48

vs. 16 patients (p <0,001).

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CONCLUSIONS

1. Laparoscopic hysterectomy has major advantages over abdominal hysterectomy:

1) patients spent less time in hospital;

2) patients use a lower dose of antibiotics and analgesic medication;

3) patients have fewer perioperative complications.

2. These factors reduce health care costs and provide faster patient mobilization in postoperative

period. Therefore laparoscopic hysterectomy deemed to be the preferable surgical approach.

3. It is essential for young doctors to practice in performing laparoscopic hysterectomy.

REFERENCES

1. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW,

Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane

Database Syst Rev, 2009; (3):CD003677

2. Vaisbuch E, Goldchmit C, Ofer D, Agmon A, Hagay Z. Laparoscopic hysterectomy versus

total abdominal hysterectomy: A comparative study. Eur J Obstet Gynecol Reprod Biol, 2006;

126(2):234-8

3. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total

laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol Reprod

Biol, 2009; 144(1):3-7

4. LAPAROSCOPIC AND LAPAROTOMIC HYSTERECTOMY FOR

TREATING UTERINE CANCER: SELECTION FACTORS,

TREATMENT COURSE AND RESULTS

Authors: Ieva Butkutė, Miglė Gedgaudaitė

Supervisor of the abstract: Arnoldas Bartusevičius

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INTRODUCTION

The developments of new technologies in medicine influence the growing number of minimally

invasive surgeries in gynecology. The tendency is observed to use laparoscopic approach versus

laparotomy for treating uterine cancer.

AIM

To determine factors that influence the selection of laparoscopic or laparotomic approach for

hysterectomy in treating uterine cancer and their impact for the course of treatment.

OBJECTIVES

1.To determine the characteristics of the patients that influences the selection of surgery type.

2.To assess the features of the disease that can influence the choice of surgery.

3.To compare the time of hospital-stay.

4.To evaluate features and outcomes of different surgical approaches.

5.To determine whether there is a correlation between the type of the surgery and surgeon.

METHODS

The retrospective analysis of 117 uterine cancer patients’ data was done. All the patients

underwent total hysterectomy in the Gynecology department of LSMU KK during period

between January and December of 2012. Women were divided into two groups depending on the

type of the performed surgery: group I – laparoscopic hysterectomy (82 women); group II –

laparotomic hysterectomy (31 women). We excluded 4 women: 3 who had the vaginal

hysterectomy performed and for 1 woman laparoscopic hysterectomy had not been successful

and laparotomy was done. Patients’ age, body mass index (BMI), comorbidities, stage of the

underlying disease, whole hospital stay and the duration of the postoperative period,

postoperative complications, lymphadenectomies and correlation between surgeon and surgery

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type were evaluated. Significance of the data was evaluated using χ2 test, Mann-Whitney test and

Stjudent’s t-test. Results were considered statistically significant when p value was < 0,05.

RESULTS

The mean age in the I group was 62 years (SD=11,4 years) compared with 68 years (SD=11,9

years) in the II group (p<0,05). The difference in BMI between groups was not substantial:

Median=30,3, Q1=27,0, Q3=35,8 in the laparoscopic group versus Median=31,3, Q1=27,3,

Q3=37,2 in the laparotomic group. Most of the patients in both groups were overweight or obese

(89,0% and 87,1%, respectively). Cardiovascular pathology was the most common additional

disease: 60 (73,2%) patients had hypertensive heart disease and 12 (14,6%) patients had

ischemic heart disease in the I group, 20 (64,5%) patients had hypertensive heart disease and 4

(12,9%) patients had ischemic heart disease in the II group. Diabetes was found in 14 (17,1%)

and 3 (9,7%) women, respectively. Although laparoscopic hysterectomy was performed more

often for the I stage of the disease (85,4% and 67,7%, respectively) and laparotomic

hysterectomy was more popular for the III stage of the disease (8,5% and 22,6%, respectively),

the difference was not significant. Compared with the I group, the II group was associated with a

longer hospital stay (Median=7 days, Q1=5 days, Q3=9 days and Median=11 days, Q1=8 days,

Q3=15 days, respectively; p<0,05). In addition to this, there was a significant difference in

postoperative hospitalization time (Median=5 days, Q1=4 days, Q3=7 days and Median=9 days,

Q1=7 days, Q3=13 days, respectively; p<0,05). It took longer to perform laparoscopic

hysterectomy than laparotomic hysterectomy (Median=175 minutes, Q1=120 minutes, Q3=195

minutes and Median=135 minutes, Q1=105 minutes, Q3=180 minutes, respectively; p<0,05).

Half of the women underwent lymphadenectomy. Intraoperative complications were found only

in the I group (2 lesions of the bladder, 1 lesion of the intestine; p>0,05). Compared with the I

group, the II group included more blood transfusions (1 and 4, respectively; p<0,05). There were

2 cases of postoperative peritonitis in the laparoscopic group and 1 case in the laparotomic

group. 1 woman of the I group was hospitalized for the second time due to a postoperative hernia

and a vaginal defect. Although bigger uterus more often was found performing laparotomic

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hysterectomy (Median=204,0cm3, Q1=148,8cm3, Q3=375,0cm3 and Median=255,9cm3,

Q1=112,5cm3, Q3=504,0 cm3, respectively), the difference was not significant. There was no

significant difference between the chosen type of surgery and different types of gynecologists

(p>0,05), however there was a significant correlation between the surgery type and

oncogynecologists (p<0,05).

CONCLUSIONS

1.The frequency of laparoscopic hysterectomy is higher among younger patients.

2.Laparoscopic surgeries more frequently were performed when treating stage I disease while

laparotomic approach was used to treat stage III uterine cancer.

3.The choice of laparoscopic hysterectomy determines shorter hospital stay and postoperative

period.

4.The duration of laparoscopic surgeries was longer and the perioperative complications were

observed, however laparotomic approach determined higher incidence of blood transfusions.

5.There was a correlation between the type of surgery and the surgeon.

REFERENCES

1. Juhasz-Boss I, Haggag H, Baum S, Kerl S, Rody A, Solomayer E. Laparoscopic and

laparotomic approaches for endometrial cancer treatment: a comprehensive review. Arch

Gynecol Obstet 2012; 286: 167-172.

2. Tae Wook Kong, Kyung Mi Lee, Ji Yoon Cheong, Woo Young Kim, Suk-Joon Chang,

Seung-Chul Yoo, et al. Comparison of laparoscopic versus conventional open surgical

staging procedure for endometrial cancer. J Gynecol Oncol. 2010; 21(2):106-111.

3. Bijen C, Briet J, H de Bock G, JG Arts H, A Bergsma-Kadijk J, JE Mourits M. Total

laparoscopic hysterectomy versus abdominal hysterectomy in the treatment of patients with

early stage endometrial cancer: a randomized multi center study. BMC Cancer 2009; 9:23.

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5. MULTIPLE PREGNANCY LABOR CARE TACTICS AND

CHANGES IN THE RESULTS DURING THE PERIOD OF 2005-2012

Author: Vaiva Dabravolskaite

Supervisor of the abstract: dr.V. Abraitis

INTRODUCTION

Other the last two decades it is registrated the increase of the labors performed by s/c. PSO

entitle this as one of the biggest problems worldwide. The clinics of Lithuanian Health Science

University is following these tendencies and demonstrates these results: s/c increased from

27,9% to 31,4% during the period of 2005 – 2012. Many clinics show statistics that s/c

increment is closely related to multiple pregnancy, moreover, in some medical institutions the

incidence of s/c in the cases of multiple pregnancy is 100% .

AIM

Evaluate the ways of the labor in the cases of multiple pregnancy and the dinamics of perinatal

rate in the clinic of Lithuanian University of Health Science.

OBJECTIVES

1. Determine the proportion of the labor ways (s/c and natural labor) in the case of the multiple

pregnancy during the years of 2005-2012.

2. Evaluate perinatal mortality rates of the delivered twins during the mentioned period of time.

3. Define if the augmentation of s/c is related to the multiple pregnancy.

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METHODS

There were 397 retrospectively sifted woman , (2005m – 73, 2007m – 104, 2009m – 116, 2012m

– 104), who delivered their newborns in the clinic of Lithuanian University of Health Science.

Equally the perinatal mortality rates of the same period of time were analysed (total (T), full –

term (FT), premature babies (P)). The information was sorted from the informational system of

the obstetrics – gynecology clinic. This research doesn‘t include triplets and monoamniotic

twins, because in all of these cases the only option performed was s/c. The analysis of the

statistics was prepared by using the programs of Microsoft Excel 2003 and SSPS. The results

are considered statistically weighty when chi square (p) is less than 0,05.

RESULTS

The results of the research showed that, in 2005 there were 73 cases of multiple pregnancy in our

clinic. S/c was performed in 45 of the cases (27 consisted of DC/DA and 18 of MC/DA) and it

reaches 61,6%, meanwhile 28 of the woman labors were natural (18 of these these cases were

DC/MC and 10 of them MC/DA) and it reaches 38,4%. In 2007 there were registrated 104 cases

of multiple pregnancy, the results vary on this way: s/c was performed in 63 of the cases (36 of

these cases of DC/DA and 27 of MC/DA), it composes 55,3%, and 51 of the woman labors were

natural (34 of these these cases were DC/MC and 17 of them MC/DA), it composes 44,7%. In

2009 the clinic of obstetrics – ginecology notifies 116 cases of multiple pregnancy, the results

shows that: s/c was performed in 66 of the cases (42 of these cases of DC/DA and 24 of

MC/DA), it composes 56,9%, and 50 of the woman labors were natural (40 of these these cases

were DC/MC and 10 of them MC/DA), it composes 43,1%. Finally in 2012 the clinic of

obstetrics – ginecology notifies 104 cases of multiple pregnancy, the results shows that: s/c was

performed in 56 of the cases (35 of these cases of DC/DA and 21 of MC/DA), it reaches 53,8%,

and 48 of the woman labors were natural (33 of these these cases were DC/MC and 15 of them

MC/DA), it composes 46,2%. The research indicated that in 2012 natural labors were more

statistically weightly than in 2007 (p>0,05). Perinatal mortality rate during the period of 2005-

2012 didn‘t show any statitical difference (p<0,05): in 2005 total mortality rate (T) - 51,1; full –

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term (FT) – 30,6, premature babies (P) – 191,4; in 2007 (T) -31; (FT) –16,9; (P) –100,4; in 2009

(T) -31; in 2009 (T) -26,6; (FT) –6,4; (P) –131,8; in 2012 (T) -40; (FT) –7,8; (P) –129,1;

CONCLUSIONS

1. During the years of 2005 – 2012, the ways of labor in the cases of multiple pregnancy showed

that: in 2012 statistically weightly natural labor was elected more, than in 2007 (p<0,05);

2. In 2005-2012 the perinatal mortality rates in the cases of multiple pregnancy didn‘t show any

statistically weightly difference.

3. The increase of s/c in 2005- 2012 in the clinic of Lithuanian Helath Science University didn‘t

indicate it‘s growth with multiple pregnancy.

6. WATERBIRTH AND IT‘S RESULTS

Author: Kristine Purvinska

Supervisor of the abstract: Dr.med. Natalija Vedmedovska

INTRODUCTION

There are many conflicting facts about waterbirth’s (WB) positive influence on mother and less

positive influence on newborn[1].

AIM

To assess waterbirth influence on mother and newborn in first and second labour period.

OBJECTIVES

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1. To assess positive influence of waterbirth on mother and newborn

2. To assess the possible risk of waterbirth on mother and newborn

3. To make arecomendations for waterbirth management in Latvia

METHODS

Descriptive retrospective case-control study in Rigas maternity Hospital, including standardized

medical records from archives data base.

RESULTS

In our research we included 138 pregnant women, 48 of them made research group, who gave

birth in Rigas maternity Hospital from 2010 until 2012 year. 92 pregnant women made control

group who gave birth subsequently to a waterbirth (WB) group.

Results for a first period of labour didn’t show a statistically significant difference (P=0,151)

between groups in using pharmacological analgesia (6/46 WB group versus 21/88 control

group), but it showed statistically significant less need in WB group (P=0,029) in using epidural

analgesia(0/46 WB group versus 9/88 control group). Also we didn’t find statistically significant

difference between groups according to the length of the first period of labour (383 minutes WB

group versus 370 minutes control group), according to second period of labour (55 minutes

versus 30,4 minutes), and third period of labour (10 minutes versus 10, 5 minutes).

We didn’t find statictically significant difference (P=0,285) according to mode of delivery-

spontaneous vaginal delivery (WB group 40/46 versus 74/92 control group), inducted labour

(6/46 WB group versus 12/92 control group), assisted vaginal deliveries (0/46 WB group versus

2/92 control group), caesarean sections (0/46 WB group versus 4/92 control group).

We found statistically significant difference(P<0,0009) between groups regarding to first degree

tears which were more often in WB group (29/46 WB group versus 30/88 control group).

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There were no significant difference (P>0,05) between groups according to other perineal

traumas: second degree tears (0/46 WB group versus 2/92 control group), first degree tears of

cervix uteri (1/46 WB group versus 6/92 control group), second degree tears of cervix uteri (0/46

WB group versus 1/92 control group), episiotomia (7/46 WB group versus 19/92 control group).

We didn’t find statistically significant difference between groups regarding five-minute Apgar

score below <7, newborns admission to the neonatal intensive care unit (2/46 WB group versus

1/92 control group), newborns morbidity– respiratory distress syndrome (2/46WB group versus

0/92 control group), sepsis (0/46 WB group versus 1/92).

CONCLUSIONS

Evidence suggests that immersion in water during the first stage of labour reduces the use of

epidural analgesia, but doesn’t reduce the use of intramuscular and inhaled analgesia. The rate of

perineal trauma is similar in both groups, but severity of perineal trauma in WB group is lower.

Also in WB is reduced need after surgical interventions. The newborns born in water have higher

Apgar scores in the first minute after birth and they rarely need admission to the neonatal

intensive care unit for further treatment or observation.

REFERENCES

1. Royal college of obstetricians and gynaecologists/Royal College of midwives. Immersion

in water during labour and birth. Joint statement No.1

7. GESTATIONAL HYPERTENSION, PRE-ECLAMPSIA,

PREMATURE DELIVERY AND INTRAUTERINE GROWTH

RETARDATION AMONG ADOLESCENTS IN RIGA MATERNITY

HOSPITAL FROM 2008 TILL 2012

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Authors: Ilze Smirnova, Julianna Kuznecova

Supervisor of the abstract: Inara Miltina

INTRODUCTION

Teenage pregnancy has been associated with maternal hypertensive disorders, fetal growth

restriction, preterm birth and other complications. These could be due to biological immaturity,

lifestyle factors or inadequate attendance to maternity care.

AIM

The aim of this study was to assess the relationship between young age of the mother and

pregnancy risk factors and adverse pregnancy outcome.

OBJECTIVES

Find out whether in the Riga Maternity Hospital adolescent pregnancy are more frequently

observed in hypertension, pre-eclampsia, premature birth and IGR compared with the control

group (20-29 years old woman).

METHODS

The study was designed as a retrospective cohort study. The data were derived from 1279

adolescent medical charts of the Riga Maternity Hospital archive from January 2008 till

December 2012. The first group (focus group) of 1279 medical charts contained information

about the pregnancy and birth outcome of 14-19 year old women. The second – control group

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also had1279 medical charts containing the same information about women aged 20-29 years. In

each group the prevalence of preeclampsia, gestational hypertension, IGR(intrauterine growth

retardation) and preterm labor was calculated and compared between first time labor and

repeated labor.

RESULTS

In the focus group preeclampsia was diagnosed in 28(2.2%), gestational hypertension in

12(0.9%), IGR in 7(0.5%) pregnancies and 58(4.5%) were preterm labor. Preeclampsia was

equaly prevalent in both age groups. IGR was equaly prevalent in control and study group

(0.5%) and IGR was observed more often among first pregnancy. Gestational hypertension and

preeclampsia in focus group more often-91.6% and 96.4%- were observed in first pregnancy.

CONCLUSIONS

In the focus group preeclampsia, gestational hypertension, preterm labor and intrauterine growth

restriction were not observed more often than in the control group.

There was statistical significance between preeclampsia and first time labor in the focus group.

Gestational hypertension and preeclapsia in adolescents are observed more often in first labor.

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ODONTOLOGY SECTION

1. SEM AND STEREO MICROSCOPE ANALYSIS OF ROOT CANAL

WALLS AFTER CALCIUM HYDROXIDE MEDICATION

Author: Aušra Dembinskaitė

Supervisors: Rita Vėberienė, DDS; Julius Maminskas

INTRODUCTION

Calcium hydroxide remnants could negatively affect the quality of final obturation. Researchers do not

agree which sequence for Ca(OH)2 removal is the most effective.

AIM

To evaluate the most effective sequence of Ca(OH)2 removal.

OBJECTIVES

1. To determine effectiveness of: chelating agents, canal reshaping, passive ultrasonic irrigation for

Ca(OH)2 removal and to compare efficiency of 10% citric acid and 17% EDTA;

2. To combine findings and to recommend the most effective Ca(OH)2 removing sequence.

METHODS

60 mandibular canine roots were standardized to 15mm length. Canals were instrumented with

Protaper Universal sequence till F2. 55 canals were obturated with Ca(OH)2 using Lentulo 25N.

Cavities were closed with temporary filling. Specimens were stored for 7 days at 37⁰C in 100%

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relative humidity. Five techniques were used for Ca(OH)2 removal: Group1 (n=10) canals were

irrigated only with NaOCl; Group2 (n=10) NaOCl followed by 10% citric acid; Group3 (n=10) NaOCl

followed by 17% EDTA; Group4 (n=10) NaOCl, EDTA and canal was reshaped using Protaper F3;

Group5 (n=10) NaOCl and EDTA + ultrasonic activation; Group6 (n=5) Ca(OH)2 was not removed;

Group7 (n=5) Ca(OH)2 was not applied. Roots were separated along their longitudinal axis and

examined with OLYMPUS SZX16/SZX-ILLD stereomicroscope (0.3x5) and analyzed with Cellsens

Dimension 2010 program. Proportion of Ca(OH)2 remnants on the canal wall surface (CaS/CS) area

was calculated in each third of root. 3 samples from each of 1-5 groups were examined by SEM (FEI

Quanta 200 FEG). Areas covered by Ca(OH)2 remnants were detected, examined and characterized.

Density of calcium hydroxide remnants and amount of obturated dentin tubules were determined in

investigated study field. Blind test was applied for two independent examiners. Statistical analysis was

applied using SPSS 19.0 program.

RESULTS

Group1– the biggest part of canal walls covered with Ca(OH)2 remnants were identified (p<0.001).

Ca(OH)2 layer was dense, dentin tubules were 100% obturated. Difference between Group2 and

Group3 was not found (p=1.000). In both groups about 50% of dentin tubules were obturated. There

was no statistically significant difference between Group4 and Group5 (p=1.000), though their CaS/CS

was significantly lower than in 1-3 groups (p<0.05). In Group4 obturation of dentin tubules was only

20-25%, even so large amount of smear layer was revealed. In Group5 only 10-15% dentin tubules

were found obturated. Group4 had the lowest amounts of Ca(OH)2 remnants in the apical third

(p<0.05) and Group5 in the coronal third (p<0.05).

CONCLUSIONS

Chelating agents significantly reduced the amount of Ca(OH)2 remnants. There was no difference

between 10% citric acid and 17% EDTA effectiveness. Canal reshaping was the most effective in the

apical area, and PUI-in the coronal part of the root. For the most effective procedure of Ca(OH)2

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removal from shaped root canals, we should reshape canals with bigger instrument, irrigate with

NaOCl followed by chelating agents and use ultrasonic activation.

2. DENTAL STUDENTS KNOWLEDGE OF HEPATITIS B VIRUS

INFECTION AND IT’S CONTROL PRACTISES IN LITHUANIAN

UNIVERSITY OF HEALTH SCIENCES

Authors: Faculty of odontology 5th year students; Akvilė Drakšaitė and Valdonė Voveraitytė

Supervisor of the abstract: Doc. G. Žekonis

INTRODUCTION

With more than two billion infected people, and 350 to 400 million suffering from chronic

infection, hepatitis B virus (HBV) is still a major health problem worldwide. As dental treatment

makes both dentists and patients at a higher risk of HBV infection, dentists can play an important

role in preventing HBV transmission in dental settings.

AIM

The aim of this study is to assess Lithuanian university of health sciences dental students

knowledge of HBV, infection control on practice and to provide recommendations.

OBJECTIVES

1.To assess dental students knowledge of HBV, pathways and routes of its transmission during

dental treatment. Compare different academic years student data.

2.To evaluate dental students knowledge of infection control and its use on practice.

3.To make recommendations.

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METHODS

Bioethics Commission permission was received. The anonymous questionnaire was distributed

among Lithuanian University of Health Science third-, fourth-, fifth-year dental students. The

questionnaire consisted of three sections. First, sociademographic status: age, gender, academic

year. Second, section consisted of 16 questions on student’s knowledge about HBV. Third

section consisted of questions regarding students infection control on practice. Statistical analysis

was performed using frequency, chi-square, and Fisher exact tests. The software used was

Statistical Package for Social Sciences (SPSS, Chicago, IL, USA), version 15. The level of

statistical significance was defined as p<0.05.

RESULTS

Out of 200 students invited to participate in the study, 192 returned questionnaires for a response

rate of 96 percent. 37 were male (19.27 percent) and 155 were female (80.73 percent). The

average age of students was 22.40 ±3.63. Study year: 77 (40.10 percent) students were in their

third year, 51 (26.56 percent) in the fourth year, 64 (33.34 percent) in the fifth year.

For the sixteen items evaluating students’ knowledge of HBV, a mean correct answer of 10.27

(third course 10.15; fourth course 10.26; fifth course 10.42) per student was obtained.

All students answered correctly only one knowledge question: “HBV can be transmitted

from patients to dentists”. Even 116 (60.42 percent) students do not know, that HBV can

be transmitted through the saliva. Assessing student infection control application in

practice, 32.81 percent of students have never used face shield. 134 (69.79 percent)

students have been injured by needle stick. 82 (42.70 percent) students are not vaccinated

against HBV. Study showed statistically significant difference between fifth course

students and other courses. Fifth year student were less vaccinated than third or fourth. It

was not observed statistically significant difference between vaccinated male and female.

55 students (28.65 percent) would not prefer to treat infected patients. Statistically

significant difference between academic year and gender was not observed.

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185 (96.35 percent) students would like to be vaccinated at the university. 152 (79.16

percent) students agree that infectious diseases subject at the university would be

required.

CONCLUSIONS

1.The results of our study indicate that students have no appropriate knowledge of HBV

infection.

2.Students must complete an infection control and prevalence workshop before they start their

clinical education.

3.Dental students knowledge level about HBV doesn’t depend on student academic year.

4.Study shows importance to promote vaccination campaigns and improve students knowledge

REFERENCES

1. Abigail L. Carlson, Trish M. Perl. Health Care Workers as Source of Hepatitis B and C Virus

Transmission. Clinics in Liver Disease Volume 14, Issue 1, February 2010, Pages 153–168.

2. Alessandro R. Zanetti, Daniel Shouval. The global impact of vaccination against hepatitis B:

A historical overview. Vaccine Volume 26, Issue 49, 18 November 2008, Pages 6266–6273.

3. Fariba S. Younai. Health Care–Associated Transmission of Hepatitis B & C Viruses in Dental

Care. Clinics in Liver Disease. Volume 14, Issue 1, February 2010, Pages 93–104.

4. Guido François, Johannes Hallauer, Pierre Van Damme. Hepatitis B vaccination: how to

reach risk groups. Vaccine Volume 21, Issues 1–2, 22 November 2002, Pages 1–4.

5. James A. Cottone, Goebel WM. Hepatitis B: The clinical detection of the chronic carrier

dental patient and the effects of immunization via vaccine. Oral Surgery, Oral Medicine, Oral

Pathology Volume 56, Issue 4, October 1983, Pages 449–454.

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6. Seyed-Moayed Alavian, Hussain Akbari, Masoud Ahmadzad, Majid Kazem, Amir Davoudi.

Concerns regarding dentists' compliance in hepatitis B vaccination and infection control.

American Journal of Infection Control Volume 33, Issue 7, September 2005, Pages 428–429.

7. Stefano Petti, Messano GA, Polimeni A. Dentists’ awareness toward vaccine preventable

diseases. Vaccine. Volume 29, Issue 45, 19 October 2011, Pages 8108–8112.

3. INFLUENCE OF PASSIVE ULTRASONIC IRRIGATION ON FINAL

CANAL OBTURATION QUALITY AFTER CALCIUM HYDROXIDE

MEDICATION

Authors: Aušra Dembinskaitė, Gertrūda Sūdžiūtė

Supervisors: Rita Vėberienė, DDS; Giedrė Juknevičienė

INTRODUCTION

It is identified, that calcium hydroxide cannot be removed completely from root canals system. These

remnants could compromise bond strength of permanent endodontic obturation materials. Researchers

reported, that passive ultrasonic irrigation is the most effective at the removal of Ca(OH)2. However,

there is no accurate data, if it results in better permanent canal obturation.

AIM

To evaluate the impact of different Ca(OH)2 removing sequences for the final canal obturations

quality.

OBJECTIVES

1.To evaluate the quality of final root canal obturation after removing Ca(OH)2 by two different

techniques.

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METHODS

30 mandibular incisors roots were standardized to 15mm length. Canals were instrumented with

ProTaper Universal rotary instruments to size F2 and irrigated with 2.5% NaOCl after each instrument.

Smear layer was removed by etching canal walls with 1 ml of 17% EDTA solution for 1min. Roots

were divided into 3groups: Group1 (n=10) Ca(OH)2 was not applied; Group2 (n=10) and Group3

(n=10) canals were obturated with Ca(OH)2 using Lentulo 25N. Cavities were closed with temporary

fillings. Specimens were stored for 7 days at 37⁰C in 100% relative humidity. Two different

techniques were used for Ca(OH)2 removal: Group2-passive irrigation with 2.5% NaOCl (10ml/canal),

Group3-irrigation with NaOCl (10ml/canal, 2.5%), saline water (10ml/canal), etching with 1ml 17%

EDTA (for 1min) and ultrasonic activation for 30s for each solution separately. Canals of all groups

were dried with paper points and filled with gutta percha using vertical condensation technique and

„AH Plus Jet“ resin sealer. All specimens were stored for 24hours at 37⁰C and 100% relative humidity.

Roots were fixed in metal tubes, positioned in universal cutting machine and sectioned horizontally at -

3mm, -6mm and -9mm from the apex using diamond disc (thickness 20µm, 2500 rotations/min, under

constant air-cooling). Specimens were investigated under optical microscope Nikon LV 150. The

dentin wall - sealer/gutta-percha margin was focused and adaption of the obturating material was

evaluated. Digital images of investigated specimens were captured and the images were valued: "1"-

good adhesion, "2"- adhesion failure. Blind test was applied for two independent examiners. Statistical

analysis was applied using SPSS 19.0 program.

RESULTS

The highest amount of adaptation failures was recorded in Group2. There were statistically significant

lower amount of failures in Group1 (p=0.001) and Group3. Statistically significant difference (p>0.05)

between Group1 and Group3 was not detected.

CONCLUSIONS

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Passive ultrasonic irrigation for calcium hydroxide removal has significantly reduced the amount of

adhesive failures between the final obturation materials and dentin walls.

4. COMPLETE UNILATERAL CLEFT LIP AND PALATE:

DIFFERENT POINT OF VIEW IN EVALUATION

Author: Marius Svedas

Supervisor of the abstract: Linas Zaleckas, Laura Linkeviciene, Olga Svediene

INTRODUCTION

Cleft lip, alveolus and palate are the most common congenital maxillofacial pathology. Patients

with visible facial scars and deformities are perceived by others as less employable, less

attractive. Aesthetic surgical outcome is very important to the patients as well as doctors.

It is not clear whether persons with limited clinical experience have the same subjective opinion

as medical professionals while evaluating the appearance of cleft patients.

AIM

The aim of the study was to compare the aesthetic evaluation of patients after a cleft lip repair by

persons with different level of medical education and clinical experience.

OBJECTIVES

1.To determine whether the aesthetic evaluation of patients after a cleft lip surgery depends on

the level of clinical experience of evaluators.

2.To determine whether repeated evaluations increase the estimation score of patients after a

cleft lip surgery.

3.To determine which group showed the greatest increase in the evaluation score between the 1st

and 2nd evaluation.

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METHODS

Pictures of patients with complete unilateral cleft lip, alveolus and palate were taken in

standardized manner. For evaluation pictures of 40 patients were selected. Three groups of

evaluators were participated in the study. The 1st group consisted of 1st and 2nd year volunteer

dentistry students without any clinical training (n=39), the 2nd group consisted of 4th and 5th year

volunteer dentistry students (n=35) who already have had 2-3 years of clinical experience. The

3rd group consisted of 12 oral and maxillofacial surgeons. Evaluation of the pictures was

performed two times with an interval of 2 weeks. Evaluators were asked to give a subjective

rating from 1 to 5 (5 being the best).

The parametric independent samples T-test and one –way ANOVA with Post-hoc tests for

multiple comparisons were used for statistical analysis with 0,05 level of significance.

RESULTS

The highest evaluations were given by experienced doctors, following the students of the 4th and

5th year of odontology and the lowest evaluations were obtained from the 1st and 2nd year

students. During the 1st time evaluation scores were 2,29, 2,82, 3,46 in the 1st, 2nd and 3rd group

respectively. During the 2nd time evaluation scores were 2,77, 3,23, 3,71 in the 1st, 2nd and 3rd

group respectively. Differences between each of the groups for both evaluations were

statistically significant (p<0,001).

Comparing 1st and 2nd evaluations, the scores increased by 0,49, 0,41 and 0,25 in the 1st, 2nd and

3rd group respectively. The 2nd evaluation was significantly higher than the 1st evaluation in each

of the groups (p<0,001).

CONCLUSIONS

1.The aesthetic evaluation of patients after a cleft lip plasty depends on the level of clinical

experience of evaluators.

2.Repeated evaluations change the evaluation score of patients after a cleft lip plasty.

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3.The greatest increase in the evaluation score between the 1st and 2nd evaluation was observed in

the 1st group without any clinical experience, followed by the 2nd group consisting of students

with moderate clinical experience.

5. THE RISK OF ORTHODONTIC MINI IMPLANTS

Authors: Ieva Bumblytė, Paulius Petravičius

Supervisor of the abstract: Doc. Kristina Lopatienė

INTRODUCTION

Orthodontic treatment is often faced with the need of anchorage. There are cases where, in order

to carry out teeth displacement, skeletal anchorage is required, it protects against unwanted tooth

movement. In order to create this anchorage, mini-implants were suggested, and their

applications range are increasing till now. However, this treatment needs certain time interval

that may affect the duration and quality of treatment.

AIM

To review the latest scientific literature, evaluating mini-implants caused complications and their

characteristics.

OBJECTIVES

1. To emit the most common complications during mini-implants screwing.

2. To overview the most common complications occurring, after the mini-implants are placed.

3. To investigate the frequent complications during mini-implants removal.

METHODS

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Scientific literature search conducted in PubMed, ScienceDirect and Google Scholar databases,

selecting publications in English, published in 2005 - 2012. Using the keywords: "mini

implants", "complications of mini-implants, "the risk of mini-implants“, „the stability of mini-

implants“, „the time of implantation“, and various combinations of these words. In this study, we

used the articles of research and reviews.

RESULTS

1. Mini-implants - orthodontic appliances, which creates a skeletal anchorage, to support

orthodontic forces.

2. Complications of using mini-implants can be divided into the following two groups: 1)

occurring during implantation (eg. periodontal ligament or root injury, mini implant slippage

and etc.) and 2) complications after orthodontic implantation (eg. stationary anchorage

failure).

3. Loss of orthodontic mini-implants stability is one of the most important complication during

treatment and it generally depends on bone density, surrounding mini-implant soft tissue

condition, mini-implant design, surgical intervention, and the use of the force during

acceleration.

4. Oral hygiene is the main factor to patient's orthodontic implantation treatment time. These

complications may develop as periimplantitis, epithelial infiltration, bleeding, drainage of pus,

bone loss, loss of stability, and ultimately - loss of implant.

CONCLUSIONS

1. The most common complications during implantation are: trauma to the periodontal

ligament or the dental root, the surrounding mini-implant bone microcracks, mini-

implant slippage, nerve injury, air subcutaneous emphysema, nasal and maxillary sinus

perforation, mini-implant fracture and torsional stress.

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2. After orthodontic mini-implant placement possible complications such as stationary

anchorage failure, mini-implant migration or soft tissue complications, might occur.

3. Complications during mini-implant removal: mini-implant fracture and partial

osseointegration. It depends not only on dentist‘s competence and skills, but also on

patient's anatomical structures properties, oral hygiene status, addiction and systemic

diseases in the body.

REFERENCES

1. Kravitz ND, Kusnoto B. Risks and complications of orthodontic miniscrews. Am J

Orthod Dentofacial Orthop 2007;131:00.

2. Lee NK, Baek SH. Effects of the diameter and shape of orthodontic mini-implants on

microdamage to the cortical bone. Am J Orthod Dentofacial Orthop 2010;138:8.e1-8.

3. Melsen B, Verna C. Miniscrew implants:the Aarhus anchorage system. Semin Orthod

2005; 11:24 – 31.

4. Motoyoshi M, Uemura M, Ono A, Okazaki K, Shigeeda T, Shimizu N. Factors affecting

the long-term stability of orthodontic mini-implants. Am J Orthod Dentofacial Orthop

137, 588.e1-5.

5. Nagarathna KN, Kamath P, Prasad R, Kumar A, Thomas M. Factors affecting success of

mini implants – a review. Orthod Cyber J. 2012.

6. A COMPARATIVE STUDY BETWEEN TWO METHODS FOR

PERFORMING BOLTON ANALYSIS ON DIGITAL MODELS

Author: Ayman Ghanem

Supervisor of the abstract: Dr. Arūnas Vasiliauskas

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INTRODUCTION

Dental study models are a cornerstone in the armamentarium used by orthodontists to both classify

malocclusion and formulate treatment plans. Recent technological advances have allowed the generation

of digital dental models that can be saved, digitized, measured with software tools, viewed three

dimensionally, and retrieved with a computer. The digital orthodontic models are as reliable as traditional

stone models and probably will become the standard for orthodontic clinical use.

There are many advantages of using digital models in place of stone casts:

1. The ease of portability. Indeed, a digital model can be sent instantly via e-mail, which can be very

useful when collaborating with other professionals;

2. Physical cast replication is not necessary, therefore saving time and materials;

3. Also, stone casts require a relatively large amount of physical storage space, whereas digital

models offer an acceptable digital substitution for cast archival;

4. Durability is not an issue with digital models. Digital models can be virtually manipulated (e.g.,

cross-sectioning or virtual trimming and segmenting) without being permanently altered;

5. Measuring mesial-distal tooth widths on digital models has been shown to be faster than using a

digital caliper on a stone cast.

Accurate measurement of the mesial-distal tooth widths is a very helpful tool for determining if any

modifications in tooth size are necessary for a favorable treatment outcome. An ideal measurement

technique should be accurate, precise, and able to be completed in a timely manner.

AIM

The aim of this study is to emphasize the benefit of identifying tooth longitudinal axis as a

method to measure mesio distal tooth width and perform Bolton analysis accordingly.

OBJECTIVE

1. To determine which program is more time consuming perform Bolton analysis, Dental 3D or

Ortho 3D;

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2. To distinguish the better and more precise method for performing Bolton analysis on digital

models between two different mesio distal tooth width measuring techniques used by two

different programs Dental 3D (Lithuanian variant) and Ortho 3D (Polish variant).

MATERIALS

Materials used consisted of 14 casts (10 on Dental 3D program, 4 on Ortho 3D program), which were

equipped according to these selection criterion:

1. Full permanent dentition regardless the third molars;

2. All teeth having normal morphology, no gross dental abnormalities like talon cusps, no enamel

hyperplasia and peg shaped lateral incisors;

3. The teeth displayed no visible attrition, caries, or restorations affecting the mesio-distal or

buccal–lingual diameter of the crown;

4. A data-recording sheet has been prepared containing specific information for each cast (cast

number and name, tooth number, number of trial, total sum).

Instruments and supplies used – laptop, digital 3D programs (Dental 3D,Ortho 3D), 14 scanned

casts.

METHODS

The individual mesial-distal tooth widths were measured (first molar to first molar, maxillary and

mandibular) on 14 different casts using 2 digital 3D programs. Teeth within all casts on each

program were measured for 7 repetitions each with a time interval of 1 hr between each trial,

using 2 different techniques. First, on Ortho 3D program, teeth sizes were measured, with a

standard computer mouse to draw the distances from point to point on the computer models (by

activating two points for each tooth) for posterior teeth from occlusive view and the anterior

teeth viewed from the facial view. For ease and accuracy of measurements, the images were

enlarged on-screen 2 or 3 times using the built-in magnifying tool. Second, on Dental 3D

program, teeth sizes were measured with a standard computer mouse to draw the longitudinal

axis of each tooth (by activating 3 points for each tooth). Accordingly 2 planes are presented

parallel to longitudinal axis, when placed in their correct tooth contact positions the mesio-distal

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tooth width will be recorded. Measures are in units of mm. Time for each measurement was

recorded using a stop watch, units of minutes. Bolton analysis was performed for each trial for

all pairs (maxillary and mandibular) of casts according to following equations:

Equation for 12 teeth: %3.91100 teeth12maxillary of Sum teeth 12 mandibular of Sum

=⋅

Equation for 6 teeth: %2.77100 teeth6maxillary of Sum teeth 6 mandibular of Sum

=⋅

The descriptive statistics including standard deviation was calculated for repeated individual

mesio distal tooth width measurements, total sum of mesio distal teeth width within dental arch,

and for Bolton analysis of both 12 and 6 teeth equations results, using SPSS 20 program.

RESULTS

Recording the time consumed for each trial, on Dental 3D program, showed an interval between

10 and 7 min. On Ortho 3D program it showed interval between 4 to 5 min. Time in a range of 5

min more, if needed to improve the measurement’s precision, will be a point of advantage rather

than weakness. On the Dental 3D program the highest standard deviation value between all

values of repeated measurements for individual mesio distal tooth width was lower than that on

Ortho 3D program (0.13-0.89 respectively). The highest standard deviation value between all

values of total mesio distal teeth width within dental arch on Dental 3D was as well lower than

on Ortho 3Dprogram (0.32-0.89 respectively). Similar were the results for Bolton analysis with

lower standard deviation on Dental 3D than Ortho 3D program for both 12 teeth (0.002-0.01

respectively ) and 6 teeth (0.004-0.012 respectively).

CONCLUSION

1. Dental 3D program is more time consuming than Ortho 3D;

2. The method of identifying the longitudinal axis of the tooth for measuring its mesio-distal width

is more accurate and precise than the method of identifying two contact points on the tooth.

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7. ORTHODONTIC ANOMALIES PREVALENCE IN PATIENTS

WITH MIXED OR PERMANENT DENTITION

Authors: Ieva Bumblytė, Paulius Petravičius

Supervisor of the abstract: Doc. Kristina Lopatienė

INTRODUCTION

Orthodontic anomalies (OA) are commonly prevalent, and various studies had shown that the

percentage of OA is from 29.3% to 93%. There is no data about OA prevalence among patients

with mixed and permanent dentition.

AIM

To analyze prevalence of various orthodontic anomalies between LUHS orthodontic clinic

patients with mixed and permanent dentition

OBJECTIVES

1. To rate mixed and permanent dentition type distribution of LUHS orthodontic clinic patients

between genders.

2. To set the mixed or permanent dentition type prevalence among LUHS orthodontic clinic

patients.

3. To compare the size and shape dental anomalies in the prevalence of mixed and permanent

dentition.

4. To analyse Angle classes according to the first molars and canines, in different sides of the

dental arch and compare these data between patients with mixed and permanent dentition.

5. To evaluate the horizontal (OJ) and vertical (OB) re-covers in the mixed and permanent

dentition.

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METHODS

A retrospective analysis was performed, a random sample of 141 patients, who came for

treatment in LUHS orthodontics clinic. We have studied ambulatory cards, orthopantomograms

and diagnostic models. Anamnestic data, bite type, teeth size and shape of the anomalies, Angle

class by the molars and canines, teeth position in transversal direction were rated. Statistical

analysis was performed using SPSS 17.0 (IBM), USA.

RESULTS

We have studied 141 pat.: 93 girls (65.95%) and 48 boys (34.05%). 54 patients had mixed

dentition (including 28 girls and 26 boys), 87 patients - permanent dentition (65 girls and 22

boys).

Teeth size anomalies. Microdontia observed in 2 children, macrodontia - 7 patients, needle-

shaped teeth - 3 patients in mixed dentition. In the permanent dentition microdontia observed in

six children, macrodontia - 6 children, needle-shaped teeth unnoticed. No statistically significant

difference in size between the teeth and bite-type anomalies were observed (p>0.05).

Teeth size anomalies (in distribution of dental arch segment). Teeth size anomalies in mixed bite

at the front segment observed in 10 children, at the side segment - 2 children. In the permanent

bite in front segment - 5 patients, side segment - 7 patients. A statistically significant correlation,

between teeth size anomalies, in distribution of dental arch segments and bite type was observed.

χ² = 4.9 / 21 =1; p<0.05.

Angle’s classes by the first molars on the right side: Mixed dentition Angle I class observed in

25 children, Angle II - 28 children, Angle III - 1 child. In the permanent dentition Angle I class

observed in 31 children, Angle II - 43 children, Angle III - 12 children. Statistically significant

correlation, between dentition type and Angle's classes was established. χ² = 6.1 / 140 = 2;

p<0.05

Angle’s classes by the first molars on the left side: Mixed dentition Angle class I observed in 25

patients, II class – 29. Patients with Angle III - unnoticed. In the permanent dentition Angle I

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class noticed in 29 patients, class II - 44 patients, III - 13 patients. Angle by the first molars was

not detected in one patient who had permanent dentition. Statistically significant relation was

noticed between the type of dentition and the Angle’s classes. χ² = 9.6 / 140 = 2; p<0.01.

Dental crowding. In mixed dentition Slight crowding (1-4 mm) was observed in 25 patients,

medium (4-10 mm) crowding in 15 patients, large (> 10 mm) - 1 patient. In the permanent

dentition slight crowding observed in 35 patients, medium - 15 patients, large - 3 patients.

Among dental crowding and dentition type statistically significant relationship was observed.

(p<= 0.05). Space excess observed in 7 patients with mixed occlusion and 13 patients with

permanent occlusion.

CONCLUSIONS

1. In most cases women apply the LUHS orthodontic clinic.

2. There were more patients with permanent dentition than with the mixed dentition.

3. The most common teeth size anomaly - macrodontia observed in patients with mixed

dentition, in the front arch segment. There are an equal numbers of patients with

microdontia and macrodontia in permanent dentition.

4. The most common Angle‘s class in permanent dentition, according to first molars, was

Angle class II.

5. The most noticeable is the slight lack of space (1-4 mm) in mixed and permanent

dentition.

REFERENCES

1.Baubinienė D. Ortodontinių anomalijų paplitimas ir gydymo reikalingumas tarp Lietuvos

moksleivių. 2010.

2.Lopatienė K. Ortodontinių anomalijų atsiradimo ir kvėpavimo pro nosį funkcijos surikimų

ryšys. 2002.

3.Profitt WR, Fields HW. Contemporary orthodontics. 2000.

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8. THE EFFECT OF BOUNDED EDENTULOUS SIDE SPACES TO

ATTACHMENT APPARATUS OF ANTAGONIST AND ADJACENT

TEETH

Authors: Dalia Zarankaitė, Algirdas Balčiūnas

Supervisor of the abstract: doc. Nomeda Basevičienė, doc. Rita Plančiūnienė

INTRODUCTION

The single bounded edentulous side space (BES) is common situation found in patients dental

arches. Usually this kind of arch defect is left untreated because it is functionally and esthetically

acceptable to the patient. However dentist can see changes like migration of unopposed and

adjacent teeth, dental recession and bone resorption, during clinical examination. BES causes

loss of 2 interproximal teeth contacts and one pair of antagonists. These changes cause higher

load on attachment apparatus of residual teeth.

AIM

To evaluate changes in teeth attachment apparatus (probing depth, bone resorbtion, gingival

recession, plaque retention) for patients with BES.

OBJECTIVES

1. Evaluate the relation between BES time and antagonist/ adjacent teeth migration

(angulation, unopposed teeth extrusion).

2. Evaluate the relation between BES time and residual teeth migration with probing depth

and plaque retention.

3. Evaluate the relation between BES time and residual teeth migration with bone resorbtion

and gingival reccesion.

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4. Evaluate the difference of dental sulcus colonization with pathogenic anaerobic bacteria

in adjacent to BES teeth and posterior teeth group with all interproximal contacts in the

same dental arch.

METHODS

Clinical examination of 30 patients (age 21-64 years) with BES and cast analysis. Exclusion

criteria: periodontal disease (chronic periodontitis), systemic diseases, BES exceeding 2 teeth,

missing more than 4 teeth. Clinical evaluation consisted of finding increasement on probing

depth in BES adjacent teeth gingival sulcus (UNC 15 probe), bleeding on probing and plaque

retention on BES adjacent teeth and overall mouth bleeding on probing and plaque retention.

Evaluation of gingival recession of teeth adjacent to BES and 3 antagonists of BES (UNC 15

probe). Cast analysis was completed using model photography with included millimeter scale

(Sony Alpha Nex-7 camera, E 2.8/15-200 lens, 30cm range). Photo analysis was completed

using Adobe Photoshop CS5. Spee curve was drawn in photos, teeth angulation and extrusion

was evaluated by measuring the migration of cusps from its possible normal position (when both

cusps are in contact with Spee curve).

From gingival sulcus of 10 participants 2 samples for microbiological analysis was taken: one

from mesially tilted distal to BES located tooth, another- control- from gingival sulcus of

corresponding tooth, located in another side of dental arch. Samples were grown in plates with

blood agar under anaerobic conditions. All colonies and black pigmented colonies were counted

after 6 days.

Statistical analysis completed using SPSS 17. Evaluation of hypothesis was completed using

Student‘s (t) test. Statistical significance was evaluated using χ2 method, statistically significant

level p<0.05.

RESULTS

No increasement of probing depth was found in gingival sulcus of teeth, adjacent to BES and it‘s

antagonists, comparing to overall probing depth.

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Average angulation of BES adjacent teeth is 6,4º. Teeth with biggest angulation were in lower

jaw, located distally to BES (average 14.6 º). Average antagonist extrusion is 1.53 mm

(SD=1.26) in 11.5 years (SD=7,3 ).

Average bone resorbtion in BES is 2,14 mm (SD=0,978) in 11.5 years (SD=7,3).

Average gingival recession of teeth adjacent to BES is 1.12mm (SD=0.51) in 11.5 years

(SD=7,3). Statistically significant relation between bone resorbtion in BES and gingival

recession of teeth, adjacent to BES was found (average 1.12 mm recession with average 2,14 mm

resorbtion). Higher gingival recession of antagonist teeth, located distally to BES was found

(average 1.11 mm (SD= 0.79) in 11.5 years), compared to recession of other antagonists (average

0.41mm, SD=0.54).

No statistically significant relation between BES time or angulation and plaque retention of teeth

adjacent to BES was found. All patients with plaque and bleeding on probing in BES had overall

bleeding on probing and plaque retention.

Gram negative anaerobic microorganisms, potential pathogens, are prone to colonize gingival

sulcus of distally to BES positioned teeth 46,6 times more than gingival sulcus of control teeth

with all interproximal contacts. An average number of black pigmented anaerobic colonies

(including P.gingivalis) from distally to BES positioned teeth is 110,7x103, while no growth of

black colonies was observed in gingival sulcus of teeth with all interproximal contacts.

CONCLUSIONS

1. Bounded edentolous side spaces causes angulation of distaly to BES located tooth and

extrusion of antagonist tooth.

2. BES does not initiate increasement of probing depth or plaque retention for patiens who

does not have periodontal disease (periodontitis), regardless of BES time and angulation

of adjacent teeth.

3. BES causes bone resorbtion, but statisticaly significant relation between BES time and

bone resorbtion was not found. Gingival recession of teeth, surounding BES is related to

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the level of bone resorbtion in BES. BES causes gingival recession of antagonist tooth,

located distaly to BES.

4. BES causes colonization of potentialy pathogenic microorganisms in gingival sulcus of

teeth, adjecent to BES.

REFERENCES

1. Lamont RJ, Jenkinson HF.Life below the gum line: Pathogenic mechanisms

of Porphyromonas gingivalis. Microbiol Mol Biol Rev. 1998;62:1244–1263.

2. Craddock HL, Youngson CC. A study of the incidence of overeruption and occlusal

interferences in unopposed posterior teeth. Br Dent J. 2004 Mar 27;196(6):341-8.

3. Yamamoto T, Kita M, Yamamoto K, Akamatsu Y, Oseko F, Kanamura N. Mechanical

stress enhances production of cytokines in human periodontal ligament cells induced by

Porphyromonas gingivalis. Archives of oral biology.10/2010; 56(3):251-7.

5. Faggion CM Jr., Giannakopoulos NN, Listl S. How strong is the evidence for the need to

restore posterior bounded edentulous spaces in adults? Grading the quality of evidence

and the strength of recommendations. J Dent. 2011; 39: 108-16

6. Newman G, Takei HH, Klokkevold PR, Carranza FA. Periodontal response to external

forces. Carranza‘s Clinical periodontology 11‘th edition. California; 2011. p. 151-165.

7. Lindskog-Stokland B, Hansen K, Tomasi C, Hakeberg M, Wennström JL. Changes in

molar position associated with missing opposed and⁄or adjacent tooth: a 12-year study in

women. J Oral Rehabil. 2012 Feb;39(2):136-43.

9. DENTAL EROSION PREVALENCE AMONG 13 – 17 YEARS OLD

KAUNAS SPORTSMAN SWIMMERS

Authors: Dovile Zemgulyte, Skaiste Ramanauskaite

Supervisor of the abstract: Egle Bendoraitiene

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INTRODUCTION

Dental erosion is irreversible loss of hard dental tissue. The pathogenesis mechanism of dental

erosion is concerned with acids. Even dental erosion is becoming more and more prevalent

among young people in the modern world due to acidogenic nutrition tendencies and lifestyle,

many dentists do not consider erosion wear as a symptom of dental disease. The factors, which

are considered to make influence to erosion wear, are as following: soft drinks, juice, sweet-and-

sour sauces, alcohol consumption, some diseases such as asthma or bulimia nervosa. Some

researcher state, that swimming in the gas chlorinated pools can also make influence to the

development of erosive dental wear.

AIM

To examine oral health of 13 – 17 years old teenagers attending local swimming pools in Kaunas

town, Lithuania.

OBJECTIVES

1.To estimate the prevalence of dental erosion among the participants of the research;

2.To evaluate the severity of the erosive wear lesions.

3.To identify relations between risk factors and dental erosion development.

METHODS

The present study was initiated in three swimming pools in Kaunas where a total of 46 children

(20 girls, 26 boys) between ages 13-17 years old were examined. Data were obtained by

questionnaire about eating habits and clinical examination based on WHO criteria, using light

source and examination instruments – mirror, probe. All the teeth were examined, dental erosion

was registered using basic erosive wear examination system (BEWE), registering the most

affected lesion in sextant. BEWE system classify erosion lesion into 0 point – no lesion, 1 point

– superficial enamel surface lesion, 2 points – enamel and dentin lesion, 3 points – deep dentin

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and/or pulp lesion. Data collected were analysed using SPSS Version 17.0. The chi-square test,

logistic regression, model summary tests were carried out.

RESULTS

1) The prevalence of dental erosion 30,4%. At least one affected sextant in the dental arch with

signs of erosion was found in 14 children.

2) All of the registered lesions were scored 1 point. The most frequently affected sextant was left

mandibular sextant.

3) The significantly higher erosion development was observed among those children, who often

drink citrus juice (> 3 times per day).

CONCLUSIONS

1.One third of the participants had mild erosive lesions.

2.According to the research soft drinks, alcohol or sauce consumption does not make influence to

erosion development.

3.High consumption of citrus juice and fruit in case with other mentioned earlier nutrition habits

and presens of medical disease is significantly higher risk factor for development of dental

erosion.

REFERENCES

1. Anderson T. Hara, Adrian Lussi, Domenick T. Zero Biological Factors Monogr Oral Sci.

Basel, Karger, 2006, vol 20, pp 88–99

2. Bardsley P. F.The evolution of tooth wear indices Clin Oral Investig. 2008

March; 12(Suppl 1): 15–19

3. Buczkowska-Radlińska J, Łagocka R, Kaczmarek W, Górski M, Nowicka A Prevalence

of dental erosion in adolescent competitive swimmers exposed to gas-

chlorinated swimming poolwater Clin Oral Investig. 2013 Mar;17(2):579-83.

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4. Dukić W, Dobrijević TT, Katunarić M, Milardović S, Segović S. Erosive lesions in

patients with alcoholism. J Am Dent Assoc. 2010 Dec;141(12):1452-8.

5. Dental caries : the disease and its clinical management / edited by Ole Fejerskov and

Edwina A.M. Kidd, with Bente Nyvad and Vibeke Baelum. Oxford : Blackwell

Munksgaard, 2008.

6. Gupta M., Pandit I.K. , Srivastava N. et al. Dental Erosion in Children. JOHCD

September 2009;3(3)

7. Jaeggi T., Lussi A. Prevalence, Incidence and Distribution of Erosion Monogr Oral Sci.

Basel, Karger, 2006, vol 20, pp 44–65

8. Jahangiri L, Pigliacelli S, Kerr AR. Severe and rapid erosion of dental enamel

from swimming: a clinical report. J Prosthet Dent. 2011 Oct;106(4):219-23

9. Johansson A. K, Omar R., Carlsson G. E., Johansson A. Dental Erosion and Its Growing

Importance in Clinical Practice: From Past to Present Int J Dent. 2012; 2012: 632907.

10. Lussi A., Jaeggi T. Dental Erosion in Children Monogr Oral Sci. 2006;20:140-51.

11. Oral pathology : clinical-pathologic correlations / Regezi J. A., Sciubba J. J., Jordan

C.K. R.. St. Louis (Mo.) : Saunders Elsevier, 2008.

12. Shaw L., Smith A.J. Dental Erosion – the problem and some practical soluctions

13. Vaikų dantų gydymas ir profilaktika/ Milčiuvienė S. [et al] KMU Profilaktinės ir vaikų

stomatologijos klinika, Kaunas, 2002.

10. THE PREVALENCE OF THE USE OF RADIOGRAPHY AND THE

APEX LOCATOR IN ENDODONTIC TREATMENT WITHIN THE

DENTISTS IN LITHUANIA

Authors: Vladislava Burkova, Ieva Tunkevičiūtė

Supervisor of the abstract: dr. Rita Vėberienė

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INTRODUCTION

Dental radiology is an essential diagnostic tool in endodontic and one of the key indicators of the

success or failure of the treatment. One of the most remarkable innovations in root canal

treatment has been the development and production of electronic devices for detecting the canal

terminus. Using both methods doctor can reduce the appearance of treatment failures to

minimum. Both of them can be found in Lithuanian dental sectors: public dental sector (PuDS)

and private dental sector (PrDS). Even people choose more often PuDS rather than PrDS, last-

mentioned is considered to be more qualitative.

AIM

To investigate the attitudes of dentists working in Lithuania in the use of radiography and apex

locator during root canal treatment and to see if use was related to respondent’s working sector

and experience.

OBJECTIVES

1. To estimate the relation between dental working sectors and the use of radiography

during different stages of the root canal treatment.

2. To evaluate the usage of the electronic apex locator (EAL) and radiography within the

dentists in different dental sectors.

3. To estimate the relation between the time of the patient’s observation after endodontic

treatment and the experience of the doctor.

METHODS

The research project had received ethical approval. An electronic questionnaire was sent to

randomly selected dentists working in Lithuania. The latter were selected from the

list of GDPs registered in dental organisation „Practical dentistry“. All rights reserved. Statistical

data analysis was performed by using SPSS 20.0.0. Chi-squared tests were used to compare the

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groups at the P<0,05 level of significance. For nonparametric data, the Mann-Whitney U test was

employed.

RESULTS

The overall number of respondents was 172 (Vilnius – 37,2%, Kaunas – 31,4%, Klaipėda –

8,7%, Šiauliai – 3,5%, Panevėžys – 7,0%, other cities – 12,2%). There was significant difference

between the doctors of PuDS and PrDS in the working length (P=0,04) and postoperative

(P=0,01) radiograms. Survey shows that PuDS doctors use preoperative and cone-fit radiograms

less than PrDS ones, but there was no significant difference (P=0,086, P=0,139). For

determination of the working length of single-rooted tooth 73,3% of the doctors used combined

approach of EAL and radiograph. There was significant difference between the doctors of PuDS

and PrDS in the working length determination for single-root (P=0,045). For multi-rooted tooth

this combination was used by 78,5% of respondents. More experienced doctor are keen on

observing their patients longer time than younger dentists, but no signicant difference was found

(P=0,361).

CONCLUSIONS

1. Dentists of PrDS use radiography more often than PuDS what makes their treatment

more accurate.

2. Most part of Lithuanian dentists use the most accurate measuring of working length by

combining EAL and radiograph, however dentists working in PrDS determine it more

accurate in single-rooted tooth than PuDS doctors.

3. More experienced doctors are keen on observing their patients longer time than younger

dentists.

REFERENCES

1. Evans SJ. Good surveys guide. British Medical Journal 1991 302, 302-303

2. Orafi I, Rushton VE. The use of radiography and the apex locator in endodontic treatment

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within the UK: a comparison between endodontic specialists and general dental practitioners.

International Endodontic Journal 2013 Apr; 46(4):355-364

3. Pūrienė A., Petrauskienė J., Balčiūnienė I., Janulytė V., Kutkauskienė J., Musteikytė M.

Privati ar valstybinė odontologinė gydymo įstaiga? Lietuvos pacientų nuomonė ir patirtis.

Medicina 2008; 44(10):805-811

4. Tugnait A, Clerehugh V, Hirschmann PN. Radiographic equipment and techniques used in

general dental practice. A survey of general dental practitioners in England and Wales.

Journal of Dentistry 2003 31, 197–203

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ONCOLOGY SECTION

1. GASTRIC LYMPHOMAS. LITERATURE REWIEW AND

CLINICAL CASE STUDIES

Author: Olga Jegorova1

Supervisor of the abstract: Prof. Dace Baltina2

1Riga Stradinš University Faculty of Medicine 6th year 2Riga Stradinš University Department of Internal medicine

INTRODUCTION

In recent years, the concepts of lymphopoesis had broadened with fundamental immunological

studies. Special place among large morphological and immunological pathologies has

NonHodgkin lymphomas (NHL), especially diffuse large B cell lymphoma (DLBCL) and

mucosa associated lymphoid tissue (MALT) lymphomas. NHL incidence is going to became

higher, therefore, with patient age decrement. In clinical practice most popular gastric NHL are

DLBCL (30-40%) and MALT lymphomas (8 %). Both diseases have similar symptoms, but

different therapy and prognosis.

AIM

Gastric lymphomas are rare malignancies and they have been never researched before in Latvia,

which is why this topic was selected. The aim of the study was to explore gastric lymphomas’

clinical features, diagnostics and therapy tactics, complications and efficiency.

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OBJECTIVES

1. Create detailed literature review on gastric DLBCL and MALT lymphomas’ epidemiology,

etiology, pathogenesis, diagnostics and therapy.

2. Analyze medical histories’ data about gastric DLBCL and MALT lymphoma course from

archives of hospitals “Linezers” and “Latvijas Onkoloģijas Centrs”.

METHODS

During the work process 1000 medical histories were surveyed from hospitals “Linezers” and

“Latvijas Onkoloģijas Centrs” archives in time period from January 2010 until November 2012,

12 of which (eight DLBCL and four MALT lymphomas) were appropriate to the study theme.

Patients were selected according to histological and immunochemistry findings in biopsies,

based on pathologist’s conclusion. Collected information has indicative meaning and is possible

to estimate only tendencies, not regularities. Data analysis were done by Microsoft Office Excel

program and presented in numbers and percentage. Therapy choices were summarized using

comparative analysis method.

RESULTS

An average patient age was 68 years (± 15 years). Moreover, was found patients’ average age

decrement in relation with year: in 2010 average age was 78 years, in 2012 – only 54 years. Male

and female relation was 1.4 : 1. Average illness duration until diagnostics in MALT lymphoma

was six months, in DLBCL – 2.25 months. The most common patients’ complaints were

epigastric pain (seven patients – 58%), weakness (five patients – 42%), weight loss, lack of

appetite, nausea and vomiting (three patients – 25%), heartburn (two patients – 17%). Specific

complaints for each type of lymphoma were not distributed.

Macroscopic stomach changes, biopsy and operation material morphological and

immunochemistry studies matches to literature data. Data about H. pylori infection were not

present.

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In case of MALT lymphoma mass (“bulk”) was found once, DLBCL – in three cases. Previous

therapy had two MALT lymphoma and three DLBCL patients. Gastrectomy was done to three

MALT lymphoma and seven DLBCL patients, including three MALT lymphomas and two

DLBCL without indications. According to European Society for Medical Oncology (ESMO) and

National Cancer Institute (NCI) guidelines, adequate therapy got three MALT lymphoma and six

DLBCL patients.

Gastric lymphoma therapy can’t be separated from complications, that’s why drug side effects

should be controlled. During chemotherapy patients received antiemetics, to avoid reaction for

rituximab – analgesic and antiallergic medicines. Tumor lysis syndrome prophylaxis was taken

to the patients with large tumor mass in late lymphoma stages. Frequent steroid’s side effect –

weight gain, was difficult to measure because of gastrectomies, which are reason for weight loss.

One patient during steroid therapy had insomnia and mood disorders. Surgical treatment result

with two anastomositis.

CONCLUSIONS

Summarizing the most important data following conclusions was made:

1. According to literature review:

1.1. Gastric NHL is rare disease in patients’ age 50-70 years with tendency of age decrement.

1.2. In clinical practice most popular gastric NHL are DLBCL and MALT lymphomas.

1.3. The course of the disease is long-drawn with non-specific signs. Average illness duration

until diagnostics in MALT lymphoma was six months, in DLBCL – 2.25 months.

1.4. H. pylori infection increases gastric NHL development risk.

1.5. The most common patients’ complaints were epigastric pain, weakness, weight loss, lack

of appetite, nausea and vomiting, heartburn. Specific complaints for each type of

lymphoma were not distributed.

1.6. Gastric NHL diagnostics has a huge of opportunities. However, to get a diagnosis is

enough with endoscopy associated with targeted biopsy and sample’s morphological and

immunochemical analysis.

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1.7. Therapy of gastric lymphomas is conservative. Operative therapy is significant in acute

surgical cases.

2. According to 12 medical histories’ of the patients those treated in hospitals “Linezers” and

“Latvijas Onkoloģijas Centrs” from January 2010 until November 2012, analysis, were

found:

2.1. In some cases therapy tactics wasn’t appropriate to ESMO and NCI guidelines

recommendations.

2.2. Acute complications during the conservative therapy are rare mostly because of targeted

side effects prophylaxis.

2.3. The study discovered the need for suggestion to therapeutists to assess necessity of

gastrectomy in each case individually using latest ESMO or NCI guidelines versions.

REFERENCES

1. Tilly H., Vitolo U., Walewski J., Gomes da Silva M., Shpilberg O., André M., Pfreundschuh

M., Dreyling M. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice

Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2012, vol. 23

(Supplement 7): vii78–vii82.

2. Zucca E., Bertoni F., Roggero E., Cavalli F. The gastric marginal zone B-cell lymphoma of

MALT type. BLOOD, 15 JULY 2000., VOL. 96, N. 2, p. 410-417.

3. Zucca E., Dreyling M. Gastric marginal zone lymphoma of MALT type: ESMO Clinical

Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2010, vol. 21

(Supplement 5), p. 175 – 176.

2. EFFECTIVENESS OF TUMOR ELECTROCHEMOTHERAPY IN

VITRO USING DIFFERENT CHEMOTHERAPEUTIC DRUGS

COMBINATION WITH DOXORUBICIN

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Author: Greta Žindžiūtė

Supervisor of the abstract: Saulius Šatkauskas

INTRODUCTION

Exposure of the biological cells to high intensity electric fields can result to cell electroporation

that leads in an increase of permeability of plasma membrane to various anticancer drugs. Such

electroporation has been exploited for treatment or so called electrochemotherapy of superficial

tumors in clinical trials.

AIM

To investigate effectiveness of electrochemotherapy on cell in vitro using bleomycin, cisplatin,

carboplatin, doxorubicin preparations and their combination.

OBJECTIVES

1. To evaluate the anti-cancer agents (bleomycin, cisplatin, carboplatin and doxorubicin)

combination of impact performance MH22A (hepatoma) cell viability, combined with

electrochemotherapy.

2. To evaluate the anti-cancer agents (cisplatin, carboplatin and doxorubicin) combination

of impact performance MH22A (hepatoma) cell viability, combined with

electrochemotherapy.

METHODS

The effectiveness of electrochemotherapy on cell using bleomycin, cisplatin, carboplatin,

doxorubicin and their combination was performed on MH22 hepatoma cells in vitro. It was

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firstly assessed cell viability in dependence of different concentrations of bleomycin(0,1mM -

0,1nM), cisplatin(16µM - 0,01nM), carboplatin(0,26mM - 0,1nM) and doxorubicin (100µM –

0,1 nM) used separately or in combination without any application of electric pulses. The

second research phase was performed to evaluate efficiency of electrochemotherapy using drug

concentrations that were only minimally toxic when used without application of electric pulses

(bleomycin (100nM), cisplatin (100nM), carboplatin (100µM) and doxorubicin (100 nM).

Electrochemotherapy was performed adding defined concentration of the drug to cell

suspension and exposing cell high voltageshort-durationpulse (HV 1200 V/cm, impulse

duration about 100 µs).Since it is assumed that bleomycin is most efficient drug in combination

with electric pulses, to eliminate bleomycin effect electrochemotherapy was also performed

with drug combination that do not contains bleomycin. Cell viability was assessed using cell

colony formation test. For statistical analysis statistical package SPSS 20.0 and Microsoft

Office Excel 2007was used. Data were considered statistically significant if value p< 0.05.

RESULTS

Experiments showed that the larger concentration of chemotherapeutic drugs (bleomycin,

cisplatin, carboplatin, doxorubicin and their combination) is used the lower percentage of viable

cells is obtained. Combination of bleomycin, cisplatin, carboplatin and doxorubicin increased

cytotoxic effect of electrochemotherapy. MH22A cells were exposed to bleomycin, cisplatin, and

carboplatincombination in concentrations without electroporation has had a positive impact of 50

percent cells. Exposed this combination with HV pulses efficiency increased up to 90

percent.Using the same concentration of cisplatin, carboplatin and doxorubicin effect was

smaller: exposed with HV pulses efficiency increased up to 70 percent.

CONCLUSIONS

1.The chemotherapeutics drugs in combination caused an enhanced response of

electrochemotherapy on MH22A cells in vitro.

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2.When using drug in combination with electric pulses highest cytotoxic effect was observed for

combination with bleomycin.

REFERENCES

1. Long Z., Yao C., Li C., Mi Y., Sun C., 2010. Focusing properties of picosecond electric

pulses in non-invasive cancer treatment. Sheng Wu Yi Xue Gong Cheng XueZaZhi

27(5): 1128-32.

2. M. S. Venslauskas, S. Šatkauskas, R. Rodaitė- Riševičienė, 2009. Efficiency of the

delivery of small charged molecules into cells in vitro. Bioelectrochemistry, article in

press.

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OPHTALMOLOGY SECTION

1. IMPACT OF VISUAL IMPAIRMENT ON DAILY LIFE OF THE

CARDIAC PATIENTS

Author: Alina Aligera, Riga Stradins University

Supervisor: Oskars Kalejs, assist.prof., Riga Stradins University, Department of Cardiology

INTRODUCTION

Physiological changes in the eyes impair the vision of elder people in a way that significantly

disable them and prevent from living an independent life style [1; 2; 3]. Elder people more often

visit a cardiologist or a family doctor, sometimes without paying much attention

to visual problems.

AIM

The aim of our study was to develop a screening algorithm to detect the patients with visual

changes, to assess their quality of daily life, as well as to find out which visual paremetres

disturb elder people most of all.

METHODS

The study was done at Latvian Cardiology Center of Paul Stradins Clinical University Hospital,

Riga, Latvia. A screening algorithm was designed as a questionnaire which contained 30

questions based on 7 visual parametres: visual acuity, stereoscopic vision, peripheral vision,

color vision, light/dark adaptation, glare disability, visual processing speed as well as contained

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questions about quality of daily life and activities of elder people with complaints about visual

impairment. Data statistical analysis was performed with MS Excel and SPSS 20.

RESULTS

The patients were devided into two groups. 74%(n=78) patients who regularly attended

a cardiologist, a family doctor, but didn’t visit an ophthalmologist, and 26%(n=27) who regularly

visited a cardiologist, a family doctor and an ophthalmologist. Statistically significant difference

(p<0,0001) among the groups was found between all the visual paremetres. The most common

visual disorder of patients who were not visiting an opthalmologist was associated with visual

acuity and visual processing speed. None of the patients from the first group considered the

overall health status as a good one (48,1% in the second group considered). 100% of patients

from the first group had difficulties with reading a medication guide, and just 18,5% in the

second one experienced them. 60,3% of patients all the time were in a constant need of help due

to visual impairment (0% in the second one).

CONCLUSIONS

1.The majority of cardiac patients experience the visual impairment that restrics them in

conducting daily activities thus reducing the quality of daily life.

2. Focusing on specific eye parametres determined by screening algorithm makes it useful in

revealing the patients with visual problems.

3. A small proportion of cardiac patients visit an ophthalmologist.

4. Cardiologist and family doctor could be a starting point at the screening algorithm for patients

with complaints about vision problems.

5. The screening algorithm is a reliable and an easy way of assessing the quality of life.

REFERENCES

1. David, A., Quillen, M.D., Pennsylvania State University College of Medicine, Hershey,

Pennsylvania Am Fam Physician. 2009 Jul 1;60(1):99-108.

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2. Evans, B.J., Rowlands G. Correctable visual impairment in older people: a major unmet

need. Institute of Optometry.

3. Hayman, K.J., Kerse, N.M., La Grow, S.J., Wouldes, T., Robertson, M.C., Campbell,

A.J.Depression in older people: visual impairment and subjective ratings of health.

Optom Vis Sci. 2007 Nov;84(11):1024-30.

2. CLINICAL MANIFESTATION OF IRIDOCYCLITIS ASSOCIATED

WITH JUVENILE IDIOPATHIC ARTHRITIS AT CHILDREN

CLINICAL UNIVERSITY HOSPITAL, LATVIA

Autor: Alina Aligera

Supervisor of the abstract: Sandra Valeiņa, MD, Department of Ophthalmology, Children

clinical university hospital, Marija Klindžāne, MD Department of Ophthalmology, Riga Stradins

university

INTRODUCTION

Iridocyclitis with known association with juvenile idiopathic arthritis (JIA) is characterized by a

chronic course of the ocular disease [1; 2; 3]. The delayed diagnosis of iridocyclitis can lead to

the development of severe ocular complications and in some cases even result in a significant

visual impairment or even in a complete loss of vision [4; 5]. Routine ophthalmologic screening

is essential for early diagnosis and timely treatment.

AIM

The aim of this study was to analyse the clinical manifestations of iridocyclitis associated with

JIA and to determine the predisposing factors for an adverse visual outcome.

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METHODS

This was a retrospective study and it was was done at Children clinical university hospital, Riga,

Latvia. A data base of medical records in the period from 2000 to 2012 was used to accomplish it.

Inclusion criteria involved: diagnosed iridocyclitis and confirmed JIA. Statistical data analysis

was performed by IBM SPSS Statistics 20.0. Mann Whitney U test, Pearson Chi-square test,

Fisher's exact test was used, as well as Spearman rank correlation was performed.

RESULTS

Iridocyclitis in association with JIA was detected among 27 patients: 19 (70.4%) girls and eight

(29.6%) boys. In seven (25.9%) patients iridocyclitis antedated joint manifestations and in 20

(74.1%) developed after them. Girls had an earlier manifestation of iridocyclitis, correlation with

sex was quite significant (rs=-0,568, p=0,002). Positive HLA-B27 was confirmed for six boys

and one girl, the correlation was strong (rs=-0,727, p<0,0001), associated with an oldest patient’s

age, no specific correlation with a course of the disease was determined (rs=-0,356, p=0,064).

ANA positive screening was detected for 15 girls and three boys, it was associated with an earlier

onset of iridocyclitis (rs=-0,550, p=0,003), the major ocular complications (rs=0,687, p<0,0001)

and a chronic course of it. The following complications occurred in 33 eye: posterior synechia –

90.9% (n=30), complicated cataract – 51.5% (n=17), band keratopathy – 15.5% (n=5), secondary

glaucoma – 6%(n=2). High and very high degree amblyopia was detected in four (12%) eyes.

Surgical treatment was acquired for four (14,81%) patients. There was determined a statistically

significant correlation between the patient’s age when the first iridocyclitis appeared and a

number of ocular complications (rs=-0,564, p=0,002), and a strong statistically significant

correlation between the duration of iridocyclitis and a number of ocular complications (rs=0,787,

p<0,0001).

CONCLUSIONS

Iridocyclitis in association with JIA more often was characterized by an asymptomatic onset, an

incidental finding and a chronic course followed by the development of vision-threatening

complications. An early age of the onset of iridocylitis and positive ANA were the predisposing

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factors for an adverse course of an ocular disease. The correlation between HLB-27 and a course

of iridocyclitis was not established.

REFERENCES

1. BenEzra, D. Uveitis and juvenile idiopathic arthritis: A cohort study. Clin. Ophthalmol. 2007

December; 1(4): 513–518.

2. Kotaniemi, K. A population-based study on uveitis in juvenile rheumatoid arthritis. Clin Exp

Rheumatol. Jan-Feb 1999;17(1):119-22.

3. Kotaniemi, K. Uveitis as a cause of visual loss in arthritides and comparable conditions. J.

Rheumatology. 2001;28:309–12.

4. Miltiadis, A. Juvenile idiopathic arthritis-associated uveitis: Data from a region in Western

Greece.

5. Clinical ophthalmology (Auckland, N.Z.). April 20, 2010, p.343.Ozdal, P.C. Visual outcome of

juvenile rheumatoid arthritis-associated uveitis in adults. Ocul Immunol Inflamm. 2005

Feb;13(1):33-8.

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OTORHINOLARYNGOLOGY SECTION

1. VISUALIZATION OF THE SIMULATED OSSICULAR CHAIN

INJURIES IN THE SHEEP TEMPORAL BONE: RADIOLOGICAL

AND ANATOMICAL CORRELATIONS

Author: Aistė Marija Giniūnaitė; Medical Faculty of Vilnius University

Supervisor of the abstract: Irina Arechvo; Department of Ear, Nose and Throat Diseases,

Republican Vilnius University Hospital

INTRODUCTION

Head trauma patients with or without the temporal bone fractures might have hearing disorders

which are caused by the damages of middle ear structures during a trauma. Although, computed

tomography imaging is used for the diagnosis of trauma, middle ear structures usually are not

evaluated properly because of the lack of experience in choosing appropriate visualization planes

and usage of specific post-processing techniques such as maximal intensity projections (MIP).

This complicates the choosing of an optimal treatment strategy.

AIM

The aim of this work is to gather experience of using high-resolution computed tomography

(HRCT) for imaging of posttraumatic middle ear structures by focusing on the visualization of

the separations, dislocations and fractures of the auditory ossicles.

OBJECTIVES

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The main objective of the research was to assess the surgical and radiological correllations of the

ossicular injuries in a sheep temporal bone model. The second objective of this work was finding

of an optimal HRCT visualization planes and appropriate MIP for ossicular chain imaging in the

sheep temporal bone model with simulated injuries. We also aimed to estimate the limits,

advantages and disadvantages of computed tomography imaging for ossicular chain injuries.

METHODS

The temporal bones of four fresh sheep were dissected. The postauricular approach was used.

The most common traumatic ossicular chain injuries (1): dislocations and fractures were

simulated. The images of the temporal bones were obtained using 64-row CT scanner (Toshiba

Aquilion 64; slice thickness 0.5mm) and the images were processed with Osirix 32 bit version

software for Mac. Values of the dislocations were measured from the obtained CT imaging data

as well as in temporal bones of sheep using callipers. Two observers: one experienced and

another with minimal experience evaluated the images with respect to ease of distinguishing fine

structures of auditory ossicles (handle of malleus, head of malleus, neck of malleus, anterior

process of malleus, lateral process of malleus, incudomalleolar joint, body of incus, long process

of incus, short process of incus, incudostapedial joint, lenticular process of incus, head of stape,

anterior crus of stapes, posterior crus of stapes, footplate of stapes). Readers used a score from 1

to 5 on which 5 corresponds to excellent; 4, to good; 3, to adequate; 2, to marginally acceptable;

and 1, to an unacceptable. Paired t test was used to determine images quality difference. Data

analysis was performed with Microsoft Excel 2010.

RESULTS

Optimal imaging planes and MIP for the sheep middle ear structures were delineated. Simulated

ossicular injuries correlated well with the corresponded radiological images. The assessing of

ossicles chain structures identity revealed high interobserver agreement (p<0.05).

CONCLUSIONS

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The sheep temporal bone is a suitable model for studying ossicular dislocations. HRCT with

different postprocessing techniques provides accurate evaluation of the traumatic ossicular

injuries. MIP reformations more precisely revealed subtle ossicular injuries.

REFERENCES

1. Bin Z, Jingzhen H, Daocai W, Kai L, Cheng L. Traumatic Ossicular Chain Separation:

Sliding-Thin-Slab Maximum-Intensity Projections for Diagnosis. J Comput Assist

Tomogr. 2008; 32(6):951-4.

2. Cordero A, del Mar Medina M, Antonio A, Labatut T. Stapedectomy in Sheep: An

Animal Model for Surgical Training. Otology & Neurotology 2011; 32:742-7.

3. Lane JI, Ritte RJ. The Temporal bone. An Imaging Atlas. Springer, Heidelberg; 2010; p.

75-82.

4. Schnabl J, Glueckert R, Feuchtner G, Recheis W, Potrusil T, Kuhn V et al. Sheep as a

Large Animal Model for Middle and Inner Ear Implantable Hearing Devices: A

Feasibility Study in Cadavers. Otology & Neurotology 2012; 33:481-489.

5. Hollinger A, Christe A., Thali MJ, Kneubuehl BP, Oesterhelweg L, Ross S, Spendlove

D, Bolliger SA. Incidence of auditory ossicle luxation and petrous bone fractures detected

in postmortem multislice computed tomography (MSCT). Forensic Science International

2009; 183: 60–66.

6. Jingzhen H, Cheng L, Bin Z, Guangbin W, Daocai W, Junping Z. Value of Sliding-Thin-

Slab Maximum Intensity Projections in Imaging of the Auditory Ossicles. J Comput

Assist Tomogr 2008; 32:141-145.

7. Henrot P, Iochum S, Batch T, Coffinet L, Blum A, Roland J. Current Multiplanar

Imaging of the Stapes. AJNR Am J Neuroradiol 2005; 26:2128–2133.

8. Meriot P, Veillon F, Francois Garcia J,Nonent M, Jezequel J, Bourjat P,Bellet M. CT

Appearancesof Ossicular Injuries. RadioGraphics 1997; 17:1445-1454.

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2. MIDDLE EAR DISORDERS OF THE PATIENTS OF VSIA

"P.STRADINS CLINICAL HOSPITAL"

OTORHINOLARYNGOLOGY CLINIC

Author: Jelena Semjonova

Supervisor of the abstract: Gints Tominsh

INTRODUCTION

The most common middle ear pathology is otitis media. Basically, it is seen in children and

infants, but it can be seen in the adult population too. Practically every person at least once in

their life had otitis media. Unfortunately, epidemiological data about the adult population are

poorly. However, available information suggests that the incidence of otitis media in adults is

lower than in the pediatric population. Besides, according to literature data older adults are

susceptible to middle ear disease associated with trauma and to neoplastic tumors. Of all middle

ear disorders, persons over 65 years of age are most prone to developing one of the many

infectious diseases of the middle ear.

AIM

Aim of the this work is to investigate the pathology of middle ear in the patients of VSIA

"P.Stradins Clinical Hospital" otorhinolaryngology clinic.

OBJECTIVES

1. Collect data about patients of VSIA "P.Stradins Clinical Hospital" otorhinolaryngology

clinic with middle ear disorders.

2. Clarify the diagnosis of patients.

3. Explore the possible clinical manifestations of the disorders in those patients.

4. Evaluate the possible risk factors for the patients concerned.

5. Process the acquired data using MS Exel 2007 and SPSS 19.0 2010.

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METHODS

1. Patient selection with middle ear disorders diagnosis using manipulation pages of VSIA

"P.Stradins Clinical Hospital" outpatient department

2. Data collection using the data registration form about patients diagnosis, age, sex,

symptoms, otoscopic examination data, risk factors from patients outpatient department

cards.

3. Perfomed data analysis and processing using MS Excel 2007 and SPSS 19 Statistics

program.

RESULTS

The study included 283 patients with middle ear disorders being treated VSIA "P.Stradins

Clinical Hospital" otorhinolaryngology clinic outpatient department during the period from

01.01.2012 to 31.12.2012. 39 % (110) of patients were male and 61% (173) were women.

Minimum age of patients was 18 years, the maximum age was 67 years, the average age of the

patients - 52 years. Secretory otitis media was diagnosed in 56% of the cases. But chronic otitis

media in 42% of the cases. Such diagnosis as cholesteatoma, paraganglioma and acute myringitis

occurred in less than 1% of cases.Was not found significant differences of the age structure

compared to patients with secretory otitis media and chronic otitis media. The highest number of

visits in relation to middle ear pathology was during the winter and autumn months. The most

common patients complained of decreased hearing. In addition, 6% complained of pain in the

ears, 14% complained of fullness in the ear, 12% tinnitus, 21% difficulty breathing through the

nose, and 11% - rhinitis. Unilateral middle ear disorder was found 67%, but both ears were

affected - 33% of the patients. Approximately 29% of the patients were found perforation of the

eardrum. 27% of the patients were found perforation of the eardrum in only one ear and 1,5% in

both. Approximately 5% of the patients were found placed tympanostomy tubes. 4% of the

patients tympanostomy tube was in one ear, in both - 1.5%. 10% of the patients had a purulent

discharge and 11% serous discharge from the ear. According to audiometric data, 35% of

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patients had a mixed hearing loss, 19% - sensorineural and 13% - conductive deafness, 33%-

audiometric changes were not found. According to history data, 27% of patients had chronic

rhynosinusitis, 21% had deviation of the nasal septum, 24% had a history of frequent infections

of the middle ear. Allergies and nasal polyps were found in 4% of patients, gastroesophageal

reflux disease was only 1% and 2% of bronchial asthma. Overall 19% of patients were

previously performed a variety of ear surgery. Radical surgery was performed in 8% of patients,

tympanostomy as well as tympanoplasty in 6%.

CONCLUSIONS

1. According to VSIA "P.Stradins Clinical Hospital" otorhinolaryngology clinic

outpatient department data the most common diagnosis is secretory otitis media

and chronic otitis media.

2. The majority of patients have the unilateral disorder of the middle ear.

3. The most common complains related to middle ear disorder are hearing loss in

one or both ear and almost one third of patients have perforation of the eardrum,

but ear pain and fever, which may indicate an acute process, are found rarely.

4. One-third of patients have a mixed hearing loss.

5. The most common possible risk factors among patients are chronic rhynosinusitis,

deviation of nasal septum and history of frequent infections of the middle ear.

REFERENCES

1. Daniel, M., Imtiaz- Umer, S., Fergie, N., Birchall, J.P., Bayston, R. Bacterial

involvement in otitis media with effusion. International Journal of Pediatric

Otorhinolaryngology .2012,(76) 1416.–1422.p. 2. Evidence-based Practice Center Systematic Review Protocol. Otitis Media With Effusion: Comparative Effectiveness of Treatments,

2012. Pieejams: http://effectivehealthcare.ahrq.gov/ehc/products/387/1013/OME_AmendedProtocol_20120807.pdf

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3. Flint, P.W., Haughey, B.H., Lund, V. J., Richardson, M. A., Robbins, K.T., Regan

Thomas, J. Cummings Otolaryngology Head & Neck Surgery Fith Edition.2010, 2771.-

2187., p.

4. G Browning, G., J Burton, M., Clarke, R.,Hibbert, J., S Jones, N., J Lund, V., M Luxon,

L., C Walkinson, J. Scott- Brownʹ′s Otorhinolaryngology, Head and Neck Surgery 7th

edition. 2008, Vol.3., 3389.- 3394p.

5. Glue ear. Pieejams: http://www.bapo.org.uk/Glue%20Ear2.pdf

6. Thrasher, R.D. Otitis Media With Effusion. October, 2011. Pieejams:

http://emedicine.medscape.com/article/858990-overview#aw2aab6b2b3aa

3. CORRELATION BETWEEN USE OF PERSONAL MUSIC

PLAYERS (PMP) AND HEARING TRESHOLD SHIFT

Authors: Armands Rīders, Anzelika Lepehina, Riga Stradins University(RSU) Faculty of

Medicine, year 6;

Supervisor of the abstract: prof. Ligija Kise, head of Clinic of Otorhinolaryngology at Pauls

Stradins Clinical University Hospital, RSU Department of Otorhinolaryngology.

INTRODUCTION

Exposure to excessive noise is a major cause of hearing disorders worldwide. Mostly it is

attributed to occupational noise. Besides noise at workplaces loud sounds at leisure times may

reach excessive levels as well, especially using PMP with headphones (HP). It is estimated that

over two decades the numbers of young people with social noise exposure has tripled (to around

19%) since the early 1980s, whilst occupational noise had decreased. Noise-induced hearing loss

is a function of sound level and duration of exposure. Excessive noise can damage several cell

types in the ear and lead to tinnitus, temporary or permanent hearing loss. Extent of PMP use

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increases especially among youth what rises a concern about growth of hearing loss incidence in

the future. (2)

AIM

The aim of this study was to investigate the possible role of PMP with HP including music

playing mobile phones in etiology of mild hearing loss in healthy young people.

OBJECTIVES

1.To screen the group of young people for hearing loss using audiometry;

2.To investigate the correlation between HTS and various factors characterizing habits of use of

PMP with HP such as duration of daily and total use and habitual loudness level;

3.To compare HTS between young people who have different music listening habits and

experience with PMP with HP.

METHODS

This is a cross-sectional study, which was carried out at RSU and Pauls Stradins Clinical

University Hospital in Latvia. Study consisted of 2 parts: firstly screening for hearing loss and

secondly correlation analysis between use of PMP and hearing threshold shift (HTS). 66

university students at the age of 18- 24 took part the study. Inclusion criteria for the study were:

participants had to be healthy from side of ENT during the audiometry (respondents with ARVI,

with massive ear wax were not included); and without any chronic diseases (respondent with

Diabetes mellitus type 1 was excluded as well as hearing child of deaf parents). The tonal

threshold audiometries using clinical audiometer AC 40 were carried out to each participant in

order to determine HTS at 4 or 6 kHz. Audiometries were carried out concerning the

recommended procedure by British Society of Audiology. (1) Additionally 20 questions

concerning music listening habits, general health and ENT-associated issues were answered by

everybody. Each participant also had to listen to one identical music fragment using headphones

and to determine his or her habitual loudness level, which afterwards was calibrated into dB

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using decibelometer “Bruel & Kjaer noise 2238”. It’s important to mention that loudness level

exposed to tympanic membrane is higher than measured because HP are inserted in external

auditory canal. Each respondents selected loudness level in dB was used to calculate daily noise

exposure from headphones. Individuals were divided into various groups according to their

music listening habits and use of HP. Average HTS of each group’s individuals were compared

using SPSS 20,0 software in order to perform Independent Student T- test and to determine

Pearson correlation coefficient(PCC).

RESULTS

HTS at 4 or 6kHz was at least 20dB high 15% of respondents unilaterally and 17% of

respondents- bilaterally. Statistically significant medium-strong correlation between HTS and

daily noise exposure from HP (PCC=0,58, p<0,01), between HTS and loudness level

(PCC=0,50, p<0,01), between HTS and average duration of HP use daily (PCC=0,43, p<0,01),

between HTS and total duration of HP use in years (PKK=0,38, p<0,01). Statistically valid

(p<0,05) were differences of HTS between: participants who mainly listened to music using HP

(18,0±5,8dB) and those using loudspeakers (14,5±4,1dB); average duration of HP use daily up to

1,5h (14,4±4,3dB) and over 1,5h (17,5±5,5dB); use of HP up to 3 years long (12,9±4,2dB) and

over 3 years (19,6±4,1dB); usually listening to music using HP at up to 55 dB loud (13,2±3,7dB)

and over 55 dB loud (17,8±5,2dB); participants whose favorite music style was pop

(15,2±4,9dB) and metal (21,5±8,9dB).

CONCLUSIONS

1. 15% of youth tested had unilateral and 17%- bilateral mild hearing loss;

2. HTS statistically significantly medium-strongly correlates with daily noise exposure from

HP, loudness level, duration of daily and total use of HP;

3. Young people who usually use HP to listen to music had 3,5 dB higher HTS compared to

those who mainly use loudspeakers;

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4. HTS of students who use HP only up to 1,5 h daily was 4,6 dB lower compared to those who

use HP over 1,5h daily;

5. HTS of respondents who have used HP up to 3 years was 4,7 dB lower compared to those

who have used them over 3 years long;

6. Fans of metal tend to listen to music louder and their HTS was 6,3 dB higher compared to

fans of popmusic.

REFERENCES

1.British Society of Audiology. Recommended Procedure: Pure-tone air-conduction and bone-

conduction threshold audiometry with and without masking; Berkshire: British Society of

Audiology; 2008

2.Scientific Committee on Emerging and Newly Identified Health Risks [Internet]. Potential

health risks of exposure to noise from personal music players and mobile phones including a

music playing function; Brussels: European Commision; 2008 [cited 2012 March 30]. Available

from:

http://ec.europa.eu/health/scientific_committees/consultations/public_consultations/scenihr_cons

_08_en.htm

4. TUMOR RECIDIVUM WITH TRACHEAL LUMEN COMPRESSION

AFTER TOTAL THYROIDECTOMY

Author: Kristaps Dambergs, 6th year medical student, Riga Stradins university

Supervisor of the abstract: Dr.Juris Tārs, Head of the Otolaryngology – Head and Neck Surgery

department, Latvian Oncology Center (LOC)

INTRODUCTION

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Around 20% of patients after total thyroidectomy with well differentiated thyroid carcinoma are

found locoregional recurrences [3]. Tracheal lumen compression is very rare and incidence is

from 0.4%-1.6%. Most commonly it is caused by large goiter, thyrotoxicosis or thyroid cancer

[1-3,5,7,9]. This is follow-up case report on a patient after total thyroidectomy, it was found that

there is residual tissue, which structurally corresponds to the thyroid tissue and causes tracheal

lumen compression.

AIM

This case can serve as a lesson that residual tissue after total thyroidectomy can cause

postoperative complications such as tracheal lumen compression.

METHODS

• Analysis of patient history;

• Surgery and patient monitoring;

• Analysis of literature.

CASE REPORT

1. Female, 28 years old. Patiet reports that she has a thyroid nodule for 7 years (since year

2005.);

2. 10.12.2012 – Total thyroidectomy was made. Histology – Hashimoto thyreoditis in both

lobes, follicular carcinoma in left lobe (1.7x1.4x1.7cm), one lymphnode without metastatic

process;

3. 08.01.2013 – 16.01.2013 – Therapy with I131 (Dosage 3705 MBq);

4. 14.01.2013 - Scintigraphy with I131 – postoperative thyroid gland residual tissue above

fossa jugularis, no data about dissemintation;

5. 18.02.2013 – MRI Colli – Undiagnosed formation in trachea, which structurally

corresponds to the thyroid tissue. Significant tracheal lumen compression. Patient has no

dyspnea during rest period, but has dyspnea during mild physical activities;

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6. Two times ORL specialist consilium was assembled – 22.02.2013 and 08.03.2013.

Following examinations were done;

7. 26.02.2013 – CT Colli – undiagnosed right-sided paratracheal formation. 27.02.2013 –

Bronchoscopy with biopsy – follicular ephitelial cells and groups of cells;

8. Diagnosis: Tu trachei anuli I-IV maligna suspecta. Stenosis trachei compensata. CA

folliculare glandula thyreoideae (T1BN0M0) Stadium I. Status post thyreoidectomiam

(10.12.2012). Status post I131 therapiam. Thyreoiditis chronicum autoimmunis. Operative

therapy is indicated;

9. 19.03.2013 – Extirpatio Tu colli paratrachealis. Final diagnosis: CA folliculare glandula

thyroideae. Status post thyreoidectomiam totalis (10.12.2012). Tu paratrachealis sinistra

cum deviatio tracheae et propagatio tracheae suspecta. Recidivum;

10. After repeated endoscopic examination data, reoperation is indicated – Extirpatio

cartilago cricoidea et cartilagines tracheales I,II.

DISCUSSION

1. Tracheal lumen compression is a rare complication and mostly patients with these risk factors

– (1) 5 year duration of the goiter, (2) n.laryngeus reccurens palsy, (3) tracheal narrowing or

deviation, (4) is there a retrosternal extention, (5) difficulty of endotracheal intubation, (6)

thyroid cancer, (7) is there a gigant goiter, (8) is there recurrence – are at the risk to develop

respiratory complications after total thyreoidectomy [4,6,8,10].

2. At least 4 of 8 risk factors should alert the managment team [4].

REFERENCES

1. Abdel Rahim AA, Ahmed ME, Hassan MA. Respiratory complication after thyroidectomy

and the need for tracheostomy in patients with a large goiter. Br J Surg. 1999;86:88–90

2. ElBashier EM, Widtalla ABH, Ahmed ME. Tracheostomy with thyroidectomy: indications,

management and outcome. A prospective study. Int J Surg. 2008;6:147–50.

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3. Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi R. Diagnosis of neck

recurrences in patients with differentiated thyroid carcinoma. Cancer 2003; 97:90–96

4. Ganiyu A. Rahman. Possible risk factors for respiratory complications after thyroidectomy:

An observational study. Ear, nose and throat journal. 2009;88

5. Green WER, Shepperd HWH, Stevenson HM, Wilson W. Tracheal collapse after

thyroidectomy. Br J Surg. 1979;66:554–7.

6. Gyoh SK, Emery JG. Coping with respiratory obstructionafter thyroidectomy for gigant

goitres in Northern Nigeria. Ann R Coll Surg Engl 1988; 70: 99±104.

7. Kadhim AL, Sheahan P, Timon C. Management of life-threatening airway obstruction

caused by benign thyroid disease. J Laryngol Otol. 2006;120:1038–41.

8. Lactose L, Gineste D, Karayan J, Montaz N, Lehuede M, Girault M et al. Airway

complications In thyroid surgery. Ann Otol Rhinol Laryngol 1993; 102: 441±6.

9. Ratnarathorn B. Tracheal collapse after thyroidectomy: case report. J Med Assoc Thai.

1995;78:55–6.

10. Wade JSH. Respiratory obstruction in thyroid surgery. Ann R Coll Surg Engl 1980; 62:

15±24

5. INCIDENCE OF CLINICAL FEATURES AND QUALITY OF LIFE

IN PATIENTS WITH CHRONIC DACRYOCYSTITIS

Author: Aistė Kurpiūtė

Supervisors of the abstract: doc. S. Vaitkus, dr. E. Padervinskis, rez. N. Rimkūnas

INTRODUCTION

Dacryocystitis is an inflammation of the nasolacrimal sac, frequently caused by nasolacrimal

duct obstruction or infection. Chronic dacryocystitis almost always dictates surgery for

correction of symptomatology. Endonasal dacryocystorhinostomy (EDCRS) is a lacrimal duct

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opening surgery through nasal cavity. EDCRS is the most frequent surgery that ir performed in

Hospital of Lithuanian University of Healt Sciences (LUHS) Kaunas Clinics

Otorhinolaryngology clinic to patients with chronic dacryocystitis.

AIM

To evaluate the incidence of clinical features and quality of life in patients with dacryocystitis

before EDCRS.

OBJECTIVES

1.To evaluate the incidence of clinical features in patients with chronic dacryocystitis before

EDCRS.

2.To determine the quality of life in patients with chronic dacryocystitis.

METHODS

A prospective analysis was made of 25 patients, who were hospitalized in Hospital of LUHS

Kaunas Clinics Otorhinolaryngology clinic with a diagnosis of chronic dacryocystitis in a period

of 2011 04 - 2013 04. The day before a surgery clinical features were signed in and evaluated in

prospective questionnaire with visual analogical scales (VAS). SF-36 questionnaire was used to

evaluate health related quality of life: physical and mental health. The SF-36 questionnaire

comprises 36 questions divided into 8 different dimensions: physical functioning, role limitation

due to physical problems, role limitation due to emotional problems, vitality, mental health,

social function, pain and general health. All dimensions are scored on a scale ranging from 0

(poor health) to 100 (good health). Data was analyzed using MS Excel 2013, SPSS 21. Pearson’s

χ2 and ANOVA tests were used. The statistical significance level was set at p<0, 05.

RESULTS

Out of 25 patients, 19 (76%) were females, 6 (24%) males. Average age was 58,24 (±15,4) years.

Chronic dacryocystitis of a left eye were to 32%, right 56%, both eyes 12% of patients.

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Incidence of clinical features: only tearing 16%, only suppuration 4%, tearing and suppuration

80%. Due to VAS an average intensity of tearing before surgery was 7,16 (±2,34), an average

intensity of suppuration was 6,5 (±2,48), an average impact to a vision was 5,8 (±3,5), an

average impact to reading was 5,28 (±3,48), an average impact to driving was 4,08 (±2,93) and

an average impact to the mood was 6 (±3,03). Anamnesis of polyposis, sinusitis and gender had

no influence to evaluation of visual analogical scales (p>0, 05). Evaluation of intensity of

suppuration with a visual analogical scale depends on age of a patient: older patients tend to give

higher points in VAS (p<0, 05). Due to SF-36 instrument:

1. Physical health: average points of physical activity were 68, 2 (±24, 15), role limitation due to

physical problems 79 (±35, 12) points, bodily pain 47, 2 (±30, 12) points, general health 49,

6(±18, 59) points. (Max 100 points)

2. Mental health: average points of vitality was 52, 2 (±11, 28), social functioning 23, 56(±19,

59) points, role limitation due to emotional problems 76 (±40, 28) points, mental state 50, 56

(±9, 65). (Max 100 points).

CONCLUSIONS

1.Incidence of clinical features: only tearing 16%, only suppuration 4%, tearing and suppuration

80%. Evaluation of intensity of suppuration with a visual analogical scale depends on an age of a

patient: older patients tend to give higher points in VAS (p<0, 05).

2.Due to evaluation of SF-36 questionnaire dacryocystitis has a negative impact to quality of life

(physical and mental health).

REFERENCES

1.Massegur H, Trias E, Adema JM. Endoscopic dacryocystorhinostomy: modified technique.

Otolaryngol Head Neck Surg. 2004; 130:39–46.

2.M. Staniūtė. Su sveikata susijusios gyvenimo kokybės vertinimas naudojant sF-36 klausimyną.

Biologinė psichiatrija ir psichofarmakologija. t. 9, nr. 1, 2007 m. rugpjūtis.

3.John E. Ware, Jr., Ph.D. SF-36® Health Survey Update. [Internet] http://www.sf-

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36.org/tools/sf36.shtml

6. COMPLICATIONS OF TRACHEOTOMY IN LUHS KC DURING

2006– 2011 YEARS

Authors: Indrė Beketovaitė, Erika Ruočkaitė

Ear, Nose and Throat Department

Supervisor of the abstract: dr.T.Balsevičius

INTRODUCTION

Tracheotomy is one of the most frequently performed surgical procedures in the critically

ill patients treated at Intensive care unit due to secretive respiratory failure and prologed

intubation to ensure long-term ventilation. Better comfort of patient, unnecessary sedation and

more effective respiratory airway cleaning are the advantages of tracheotomy compared with

endotracheal intubation. Although tracheotomy is an ordinary procedure, incidence of

complications rate varry by authors.

AIM

To examine the incidence of intra-operative and post-operative complications in Intensive Care

Unit patients of Lithuanian University of Health Sciences Kaunas Clinics (LUHS KC).

OBJECTIVES

1. To assess the frequency and types of intra-operative, early and late post-operative

complications.

2. To identify the main factors that predispose the complications of tracheotomy.

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3. To determine the influence of the tracheotomy complications on patients‘ outcomes:

decannulation or permanent double-tube cannula.

METHODS

320 medical records of patiens who had tracheotomy operation and were treated at LUHS

KC Intensive Care Units in 2006-2011 years were analysed retrospectively. Medical records

from bronchoscopy were checked in Pulmonology and Imunology clinics due to estimate late

tracheotomy complications (tracheal/subglotic stenosis). Data analysis was performed using

statistical package SPSS 17.0. Means, standard deviation, frequencies and other descriptive

statistics were counted. Data were considered statistically significant if value p < 0,05. ANOVA

test was used to compare the means. χ2 (Chi square) was used to check significant association

between variables. Z - test with Bonferroni correction was used to compare probabilities.

RESULTS

The mean age of the patients with tracheotomy was 64,3±15,8 years, body mass index

(BMI) 29,2±7,9 kg/m2. 56,25% of the patients were treated at Intensive Care Unit (n=180),

36,35% in Neurosurgical Intensive Care Unit (n=116) and 7,5% in Cardiosurgical Intensive Care

Unit (n=24). The mean surgeons‘ experience was 3,25±3,2 years. The mean operation duration

was 42,3±14,8 min. and the mean of hospitalization length was 44,6±34,9 days. 49,9% of

tracheotomy patients had CNS pathology, 41,6% - developed respiratory failure, 5% - developed

shock or multiple organ disfunction and 4,1% had upper airway stenosis.

The main indications of tracheotomy were prolonged mechanical ventilation (95,9%).

3,1% of tracheostomy was performed due to laryngeal stenosis and 0,9% due to tracheal stenosis.

The mean of mechanical ventilation duration until tracheotomy operation was 12,9±9,2 days.

The inferior tracheostomy was performed in 97,2% of patients. Intraoperative complications rate

was 2,8%, early complications rate was 4,1% and late complications rate was 2,2%.

Intraoperative bleeding occured in 2,8% of patients, early postoperative bleeding in 2,8% of

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patients, tracheotomy tube obstruction in 1,2% of patients. During the late period, tracheal

stenosis occurred in 1,6% of patients with tracheotomy and tracheoesophageal fistula in 0,6% of

patients. Postoperative pneumonia was diagnosed in 18,4%, sepsis in 4,1% of patients with

tracheotomy.

Evaluating complications and factors that can predispose complications rate (surgeons’

experience, type of tracheotomy, duration of mechanical ventilation and body mass index)

statistically significant differences were not determined (p>0,05). Endotracheal intubation time

until tracheotomy operation had no influence on patients’ outcomes in present series. The greater

incidence of permanent double-tube cannula was presented in patients with developed post-

operative pneumonia.

CONCLUSION

1. Most common complications of tracheotomy were bleeding and tracheotomy tube

obstruction.

2. Factors liable to complications of tracheotomy were not defined.

3. Post-operative pneumonia increases possibility of permanent double-tube cannula. Post-

operative bleeding and tracheotomy tube obstruction had no influence on patients‘

outcomes.

REFERENCES

1. Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF, Postma GN et al. A

multi-institutional analysis of tracheotomy complications. Laryngoscope. 2012

Jan;122(1):38-45.

2. Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ

Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck

Surg. 2000 Oct;123(4):495-500.

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7. TRANSLATION, CROSS-CULTURAL ADAPTATION AND

VALIDATION OF SINO-NASAL OUTCOME TEST (SNOT) - 22 TO

LITHUANIAN PATIENTS

Author: Justinas Vaitkus

Supervisor of the abstract: Evaldas Padervinskis M.D

OBJECTIVE

To perform translation, cross-cultural adaptation and validation of the SNOT-22 to Lithuanian

language.

STUDY DESIGN

Prospective case – control study.

SETTING

University clinic.

SUBJECTS AND METHODS

The Sino-Nasal Outcome Test 22 (SNOT-22) was translated into Lithuanian language, in pilot

study we involved 34 patients, test-retest group 34 patients with CRS, control group 115

patient with no CRS complains, 36 patients group before surgery and after surgery 3 months.

RESULTS

The results showed a good internal correlation with a Cronbach’s alpha: in the initial test 0.89

and 0.93 in the retest; both values suggesting good internal consistency within SNOT-22.

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Pearson’s correlation coefficient was 0.72 (p < 0.001), revealing good correlation between the

initial scores and the retests scores. Our sample of healthy individuals had a median score of 12

points, and instrument was capable to differentiate healthy and patients group , demonstrating its

validity (p<0.0001).The statistically significant reduction in the postoperative scores, vis-à-vis

preoperative values, demonstrates the instrument’s responsiveness. Minimally important

difference was 13 SNOT-22 scores.

CONCLUSION

The Lithuanian version of the SNOT-22 is a valid instrument to assess patients with CRS. It

demonstrated good internal consistency, reproducibility, validity and responsiveness.

KEYWORDS

SNOT-22; Health-related qualify of live questionnaires; chronic rhinosinusitis with/without

nasal polyps.

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PEDIATRIC SECTION

1. ULTRASONOGRAPHIC MEASUREMENTS OF SHOULDER AND

ELBOW JOINT CARTILAGE THICKNESS IN YOUNG BASEBALL

PLAYERS

Author: Taura Nešokocaitė

Supervisor of the abstract: Saulius Rutkauskas

INTRODUCTION

The prevalence of osteochondropathies, related to repetitive overhead throwing motion and

valgus extension overload (1), is high among individuals who have played baseball actively since

childhood (2, 3, 4). Researchers suggest ultrasound as a highly sensitive detection method for

early changes in cartilaginous structures for young athletes (3, 4), beneficial for being non-

invasive, easily repeatable, painless and avoiding ionizing radiation (3, 5). Early detection of

such alteration could lead to timely initiation of relevant therapies and therefore influence long-

term outcomes (5).

AIM

The aim of the study was to evaluate cartilage thickness in shoulder and elbow joints in young

baseball players.

OBJECTIVES

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1. To compare articular cartilage thickness of the humeral head and cartilage thickness of

the humeral capitellum between the throwing and non-throwing arms.

2. To find correlations between cartilage thickness of the humeral head and cartilage thickness

of the humeral capitellum in left and right arms in different age groups.

METHODS

The study included 19 pitchers, all of which were right-handed and had no history of elbow

surgeries or comorbidities. Shoulder and elbow ultrasound using a General Electric ultrasound

machine (Logiq 7) with 12-MHz linear array transducer was performed on each participant.

Articular cartilage thickness of the humeral head was assessed 1 cm laterally from the

intracapsular part of the long tendon of biceps brachii muscle placing the arm posteriorly.

Cartilage thickness of the humeral capitellum was evaluated in stretched elbow, according to

technical guidelines issued by European Society of Musculoskeletal Radiology. Data analysis

was performed using Spearman rank correlation coefficient, Mann-Whitney and Kruskal-Wallis

tests.

RESULTS

The sample consisted of 38 joints evaluated in 19 baseball pitchers, all of which were boys. The

mean age of participants was 12.6±1.5 years; the mean pitching time was 3.1±1.8 years.

Cartilage thickness of the humeral head was 1.7±0.05mm in the throwing arm and 1.7±0.05mm

in the non-throwing arm (P=0.77), cartilage thickness of the humeral capitellum – 2.1±0.5mm

and 2.1±0.4mm, respectively (P=0.66). Strong negative correlations between age and right

humeral head cartilage thickness (r =-0.595, p=0.0072), right humeral capitellum cartilage

thickness (r =-0.595, p=0.0072) and left humeral capitellum cartilage thickness (r =-0.499,

p=0.0297) were found. Additionally, positive correlations between right humeral head cartilage

thickness and left humeral head cartilage thickness (r =0.745, p=0.0003), right humeral

capitellum cartilage thickness (r =0.545, p=0.0159) and left humeral capitellum cartilage

thickness (r =0.554, p=0.0138), between right humeral capitellum cartilage thickness and left

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humeral capitellum cartilage thickness (r =0.804, p<0.0001) and between left humeral head

cartilage thickness and left humeral capitellum cartilage thickness (r =0.499, p=0.0297) were

observed. However, Kruskal-Wallis test for articular cartilage thickness in different age groups

was not statistically significant. Only one osteochondropathy (0.03%) in the throwing elbow

(Panner’s disease) was detected.

CONCLUSIONS

1.Articular cartilage thickness is not related to the hyperactive movements and is similar in both

throwing and non-throwing arms.

2.Cartilages of the right and left arms develop symmetrically through the skeletal maturation.

REFERENCES

1.Hurd WJ, Kaufman KR. Glenohumeral rotational motion and strength and baseball pitching

biomechanics. J Athl Train. 2012; 47(3): 247-56.

2.Dick R, Sauers EL, Agel J, et al. Descriptive epidemiology of collegiate men’s baseball

injuries: national collegieate athletic association injury surveillance system, 1988-1989 Through

2003-2004. J Athl Train. 2007; 42(2): 183-193.

3.Takahara M, Shundo M, Kondo M, Suzuki K, Nambu T, Ogino T. Early detection of

osteochondritis dissecans of the capitellum in young baseball players. Report of three cases. J

Bone Joint Surg Am. 1998; 80(6): 892-7.

4.Crowther M. Elbow pain in pediatrics. Curr Rev Musculoskelet Med. 2009; 2(2): 83-7.

5.Cassas KJ, Cassettari-Wayhs A. Childhood and adolescent sports-related overuse injuries. Am

Fam Physician. 2006 Mar 15;73(6):1014-22.

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2. CHILDREN’S ARTERIAL BLOOD PRESSURE MEASUREMENTS

AND EVALUATION OF THE RESULTS IN CHILDREN'S CLINICAL

UNIVERSITY HOSPITAL IN RIGA, LATVIA.

Author: Una Beldava, Rīga Stradiņš University, Faculty of Medicine (Pediatrics) 6th year

Supervisor of the abstract: doc.Ingūna Lubaua, Rīga Stradiņš University, Department of

Pediatrics, Children’s Clinical University Hospital

INTRODUCTION

Hypertension is widely found for 2-5% of children and its prevalence increases based on the

growing spread of overweight and that is why a hypertension screening is vital. Blood pressure

should be measured for every child older than 3 years, and for children under 3 years – if there is

a risk factors for hypertension. Although, in pediatricians’ praxis the blood pressure is not being

often measured.

AIM

The aim of this work was to evaluate methods for measuring arterial blood pressure,

measurements frequency and results.

OBJECTIVES

1. Evaluate for how many patients blood pressure was measured.

2. Evaluate in what patient age group blood pressure was more often measured.

3. Evaluate blood pressure measurements frequency.

4. Evaluate in which patient group blood pressure was more measured (with or without risk

factors for hypertension), compare it between two study groups (year 2007 group and year 2012

group).

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5. Compare hypertension occurrence between two study groups (year 2007 group and year 2012

group).

6. Evaluate what kind of hypertension risk factors was found for patients which had high blood

pressure.

METHODS

Information used in this work was obtained from Children’s Clinical University Hospital (Riga,

Latvia) disease history archive of patients who were hospitalized by randomization in selected

dates – 15.03.2007 and 15.03.2012. Data analysis, statistic analysis was accomplished using

Microsoft Excel 2007, SPSS 17. In this work was analyzed – frequency of measuring blood

pressure.

RESULTS

Study included 155 children. There where two groups – year 2007 group and year 2012 group.

Year 2007 group included 76 children, from which 90.8% (69) where at the age or had risk

factors when the blood pressure should be measured, in year 2012 group where 79 children,

91.1% (72) blood pressure should be measured.

In year 2007 group the blood pressure was measured for 29% of children who had indications

and in year 2012 group for 23.6%.

More often blood pressure was measured for children aged 12-18 years (50% of year 2007 group

and 47.1% in year 2012 group). And more often blood pressure was measured 1 time – 31.3% in

year 2007 group and 50% in year 2012 group.

Such hypertension risk factors as overweight and obesity in year 2012 group (28.5%) was found

more often than in year 2007 group (5.3%). In year 2007 group 6.6% (5) children had disease

that could cause high blood pressure, in year 2012 group – 7.6% (6). In year 2007 group 57.9%

(44) children received medication that could elevate blood pressure, in year 2012 group – 51.9%

(41).

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In year 2007 group, from 29 children who had risk factors for hypertension, blood pressure was

measured for only 37.9% (11), in year 2012 group, there were 18 children with risk factors and

blood pressure was measured for 50% (9), and there was a statistically significant difference in

the measurement of blood pressure for children with risk factors and for those without (p=0.002,

OR 6.6, 95% CI:2-21.7).

For no patients it was mentioned with what kind of method blood pressure was measure. In year

2007 group for 2 children blood pressure was measured on left arm, in year 2012 group for 1

child blood pressure was measured on right arm.

In year 2007 group normal blood pressure was found for 75% children (15), prehypertension –

20% (4), stage 1 hypertension – 5% children (1). In year 2012 group normal blood pressure was

found for 70.6% children (12), prehypertension – 5.9% (1), stage 1 hypertension – 17.6%

children (3), stage 2 hypertension – 5.9% (1).

Of all patients whose blood pressure was elevated (10), 2 received in therapy glucocorticoids, 3

patients received nonsteroidal anti-inflammatory drugs, 2 had overwight, 1 had a disease that

could cause secondary hypertension and 2 patients didn’t have any risk factors.

CONCLUSIONS

1. Blood pressure was measured only for 29% in year 2007 group and for 23.6% in year 2012

group.

2. More often blood pressure was measured in older school aged children (12-18 years).

3. Blood pressure more often was measured 1 time.

4. In year 2012 group blood pressure more often was measured in children with hypertension risk

factors.

5. In year 2012 group hypertension and overweight was found more often than in year 2007

group.

6. High blood pressure was found for children with overweight and who received

glucocorticoids, nonsteroidal anti-inflammatory drugs.

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REFERENCES

1. Anderson Robert H., Baker Edward J., Penny Daniel J., Redington Andrew N., Rigby Michael

L., Wernovsky Gil. Paediatric Cardiology 3rd edition. Philadelphia: Churchill Livingstone

Elsevier, 2010.

2. Gundogdu Zuhal. Relationship between BMI and blood pressure in girls and boys. Public

Health Nutrition, 2008;11(10):1085-1088

3. National Institute of Health A Pocket Guide to Blood Pressure Measurement In Children. NIH

Publication 2007.

4. Podoll Amber, Grenier Michelle, Croix Beth, Feig Daniel I. Inaccuracy in Pediatric Outpatient

Blood Pressure Measurement. Pediatrics, 2007;119(3):538-543

5. Shapiro Daniel J., Hersh Adam L., Cabana Michael D., Sutherland Scott M., Patel Anisha I.

Hypertension Screening During Ambulatory Pediatric Visits in the United States 2000-2009.

Official Journal of the American Academy of Pediatrics 2012;130(4):603-611

6. Stabouli Stella, Papakatsika Sofia, Kotsis Vasilios. The Role of Obesity, Salt and Exercise on

Blood Pressure in Children and Adolescents. Expert Rev Cardiovasc Ther. 2011;9(6):753-761

3. FACTORS OF RISK OF CHILDREN WITH FUNCTIONAL

CONSTIPATION

Authors: Anna Goncarova, Julija Maksimova

Supervisor of the abstract: dr. Ieva Eglite

INTRODUCTION

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Constipation is a common health problem among children. More than 90% of all constipations

are functional. It is very important to minimize factors of risk that foster the development of

functional constipation, to prevent the disease.

AIM

The aim of this study is to find the most popular lifestyle, and also to determine the development

of factors of risk of children with functional constipation.

OBJECTIVES

1. To identify the most common factors of risk in children with functional constipation.

2. To identify how often there are some factors of risk in children with functional constipation.

3. To determine witch factors are not so important in functional constipation promoting.

METHODS

We had done the parents inquiry, information gained was processed with MS Excel and SPSS

Statistics programs (descriptive statistics). We questioned the parents, whose children suffer

from functional constipation. Parents were inquired after being consulted by gastroenterologist.

We have got 81 filled inquiry forms from parents about their children’s lifestyle and

development.

RESULTS

37 (45.7%) of all children with functional constipation were girls and 44 (54.3%) were boys.

Two children were less than one year old, 13 (16.0%) were from 1 to 3 years old, 47 children

(58.0%) were from 3 to 7 years old and 19 children were older than 7 years. 21 children (25.9%)

do not attend any institution, 43 children (53.1%) attend a kindergarten and 17 children (21%)

attend a school. 49 children (60.5%) have certain day mode, but 32 children (39.5%) do not have

it. 35 children (43.2%) consume sufficient amount of fruits and vegetables per day, but 46

children (56.8%) eat less fruits and vegetables than they should. 46 children (56.8%) get less

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fluid per day than they should at this age, but 35 children (43.2%) get enough of fluid per day. 27

children (33.3%) have positive family anamnesis for the constipation, but 54 children (66.7%) do

not have it. 41 children (50.6%) had problems with “pot training”, but 40 children (49.4%) do

not have it. 37 children (45.7%) have insufficient physical activity per day, but 44 children

(54.3%) do not have problems of this matter. 80 children have one or more factors of risk and

only 1 child do not have any of these.

CONCLUSIONS

1.There are no specific factors of risk that appear in most cases of functional constipation.

2.Almost all children have one or more factors of risk.

3.All factors are individual for every child, but all of them can promote functional constipation.

REFERENCES

1.Abraham M. Rudolph. Robert K. Kamei. K. J. Overby. Rudolph‘s Fundamentals of Pediatrics.

Third edition. 2002. Pages 475-477.

2.Edited by Joseph J. Zorc. Clinical Handbook of Pediatrics. fourth edition. 2009. Pages 263-

271.

3.Edited by Osborn DeWitt First Zenel. Pediatrics. 2005; Pages 634-636.

4.Edited by Steven M. Altschuler, Stephen Ludwig. Pediatric at a Glauce. 1998. Pages 72-76.

5.Kliegman. Behrman. Jenson. Stanton. Nelson Textbook of Pediatric. 18 th edition. 2007;

Section 4.

4. CLINICAL MANIFESTATION AT THE ONSET OF TYPE 1 DIABETES

MELLITUS IN CHILDREN IN LATVIA

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Author (authors): Jeļena Jakovļeva, Rīga Stradiņš University

Supervisor of the abstract: Iveta Dzīvīte-Krišāne, University Children's Hospital, Rīga Stradiņš

University

INTRODUCTION

Diabetes mellitus type 1 is the most common chronic metabolic disease in children and young

people with characteristic persistent hyperglycemia and the potential risk of early and late

complications development. Every year, on average, 65 Latvian children’s manifest by diabetes

mellitus type 1. Timeous detection of the symptoms is important for disease diagnose and

starting treatment as soon as possible, thus reducing the risk of ketoacidosis development in

child.

AIM

To determine the most distinctive diabetes mellitus type 1 symptoms manifestations, it’s

frequency and duration, the average age of diagnosed children and the incidence of disease in

Latvian children.

OBJECTIVES

1. To determine the incidence of diabetes mellitus type 1 in Latvian children.

2. To determine an average children’s age, gender and age differences with diabetes mellitus

type 1 manifestation onset.

3. To determine characteristic symptoms of disease manifestation (polydipsia, polyuria, nocturia,

polyphagia, weight loss), frequency and duration; to compare it between different gender and age

groups.

4. To determine the ketoacidosis incidence in children with diabetes mellitus type 1

manifestation.

METHODS

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Retrospectively was reviewed 380 patients in 0-18-years-old of type 1 diabetes mellitus onset,

who were observed in University Children’s Hospital advisory clinic, their outpatient cards and

medical records from previous hospitalization, in the period 2005-2011. Information about

symptoms and duration of symptoms was based on history data. Other indicators - the results of

laboratory examinations.

All children with manifest of diabetes mellitus type 1 are hospitalized in the University Children

Hospital in endocrinology ward. Disease incidence was calculated per 100,000 children per year,

divided the number of the patients by the total children number aged from 0-18 year in each

year. Information about total number of children in Latvia provided by Latvian Central Statistical

Bureau data. The data has been analyzed using SPSS software.

RESULTS

The study included 380 children with diabetes mellitus type 1, 170 girls and 210 boys aged from

0 to 18 years, over period 2005 - 2011. The case number of type 1 diabetes mellitus in 2005 year

is 40, 2006 – 57, 2007 – 59, 2008 – 47, 2009 – 63, 2010 – 43, 2011 – 71. Type 1 diabetes

mellitus higest incidence was in 2011 year, about 20/100 000 cases in children. The average age

of children's illness is 9.3 years. The highest number of children (n = 138) is in the age group 10

to 14 years. The most marked symptoms are polydipsia and polyuria, a little less weight loss.

The most commonly it was observed in children aged 15-18 years (71.7%, p <0.001), less

frequently (37.1%, p <0.001) within 0-4 years age group. Nocturia noted less than half of the

patients, the most commonly observed in the 10-14 year old patients (53%, p = 0.09). Polyphagia

less than 1/10 children, most commonly occurs in the age group 10-14 years (p = 0432). The

average glycemia is 23 mmol/L. The average glycated hemoglobin is 12.01%. The average

symptom duration is 4.62 weeks. Ketoacidosis developed in 37.8% of children. Correlation

between age and duration of symptoms (p = 0.232), glycated hemoglobin and age (p = 0.265),

glycaemia and glycated hemoglobin (p = 0.07) is statistically insignificant.

CONCLUSIONS

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1. The incidence of diabetes mellitus type 1 in 2011 rates of 20/100’000 children that is very

high ratio. Morbidity tends to increase.

2. The most common type 1 diabetes mellitus manifestation clinical symptoms in children are

polyuria, polydipsia, weight loss and nocturia. There is no gender difference in symptoms. There

are differences between age groups. Negative weight dynamics is typical of children in the age

group 15-18 years, nocturia in 10-14, ketoacidosis in 0-4 years, which coincides with the

literature data. The average duration of symptoms before hospitalization is 4.62 weeks.

3. The average patients’ age at onset of disease is 9.34 years, with peak during puberty. This

coincides with the literature, where it is stated highest incidence peak during puberty and the

second highest peak in 4-6 years old children. Boys have diabetes mellitus type 1 more often

than girls (1:1.24).

4. Ketoacidosis is manifested in 38.7% of children. Diagnosis of type 1 diabetes mellitus in

Latvian children is dilatory.

REFERENCES

1. Formosa N, Calleja N, Torpiano J., Incidence and modes of presentation of childhood type 1

diabetes mellitus in Malta between 2006 and 2010. Pediatric Diabetes. 2012 Sep;13(6):484-8

2. Global IDF/ISPAD Guideline for Diabetes in Childhood and Adolescence

3. Louis F. Amorosa, Esther J. Lee, and David E. Swee. Diabetes Mellitus 2011: 735.

4. Neu A., Willasch A., Ehehalt S., Hub R., Ranke MB on behalf of the DAIRY group Baden-

Wuerttemberg. Ketoacidosis at onset of type 1 diabetes mellitus in children – frequency and

clinical presentation. Pediatric Diabetes 2003: 4: 77 – 81

5. Sarah E Lawrence S.E., Diagnosis and treatment of diabetic ketoacidosis in children and

adolescents, Pediatric Child Health. 2005 January; 10(1): 21–24

6. The DIAMOND Project Group. Incidence and trends of childhood Type 1 diabetes worldwide

1990-1999. Diabet Med 2006; 23(8): 857-866

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7. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the

Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care

20:1183–1197, 1997

8. Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, Lee W, Rosenbloom A, Sperling M,

and Hanas R. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatric Diabetes

2009: 10 (Suppl. 12): 118–133

5. PEDIATRIC AGE BENIGN BONE TUMORS OF LONG BONES –

RADIOLOGIC DIAGNOSIS AND DIFFERENTIALDIAGNOSIS

Author: Aija Vancane

Supervisor of the abstract: Dr. Ojars Smitins

INTRODUCTION

Despite the availability of advanced imaging methods such as CT and MR imaging, with their

ever increasing number of detectors and strength of the magnetic field, the diagnosis still

depends on the conventional radiograph. By paying attention to the age of the patient, the

location and the radiographic features of the lesion, the radiologist will be led to a short

differential, if not the single correct, diagnosis in order to avoid unnecessary and invasive

investigation methods (1).

AIM

To find out which are the most common pediatric age benign bone tumors.

OBJECTIVES

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1.To analyze long bone radiographs those were taken in University Children’s Hospital (Latvia)

during year 2012.

2.To find out the most common pediatric age benign bone tumors.

3.To determine gender and age gap.

4.To define the most common locations.

5.To evaluate pathologic fracture occurrence.

METHODS

It was a retrospective research. There were analyzed approximately 5000 long bone X-rays

which were taken in University Children’s Hospital (Latvia) during year 2012 with characteristic

signs of benign bone tumor or tumor-like lesion. Data analysis was made with MS Excel and

SPSS programs.

RESULTS

There were selected 58 X-rays with characteristic finding of benign long bone lesion, which is

approximately 1%. The most common diagnosis were fibrous cortical defect (18), which was

followed by bone cyst (9 unicameral and 9 aneurysmal) and osteochondroma (6 on the wide base

and 5 with bony spur). These results are similar to literature data. The most frequently

represented age group was teenagers (43). According to localization - more often benign bone

tumors were localized in lower extremities (42); affected bones were Femur (20), Tibia (18) and

Humerus (16); mostly in metaphysis (52). Often complication was pathological fracture (14).

CONCLUSIONS

1.The most common radiological diagnoses were fibrous cortical defect, bone cyst and

osteochondroma.

2.Gender differences were not pronounced.

3.The dominant age group was teenagers. These tumors they stop to increase in sizes after

growth plate closure.

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4.Twice as often pathologies were lower limb-localized. But analyzing separately long bones in

similar numbers affected were Femur, Tibia and Humerus. More precisely majority in

metaphysis.

5.Pathologic fractures were diagnosed in 14 out of 58 cases, which is one third.

REFERENCES

1.Miller TT. Bone Tumors and Tumor-like Conditions: Analysis with Conventional Radiography

[Internet]. [New York]. 2006 [updated 2007, cited 2012 Dec]. Available from

http://radiology.rsna.org/content/246/3/662.full

2.Tis JE. Overview of benign bone tumors in children and adolescents [Internet]. [Place

unknown]: Tis and Associates; 2012 [cited 2012 Dec]. Available from

http://www.uptodate.com/contents/overview-of-benign-bone-tumors-in-children-and-adolescents

3.Van der Woude HJ. Bone Tumors – Differential Diagnosis [Internet]. [Amsterdam]: Van der

Woude and Associates; 2010 [cited 2013 Jan]. Available from

http://www.radiologyassistant.nl/en/p494e15cbf0d8d

6. NON-URGENT CARE AT PAEDIATRIC EMERGENCY

DEPARTMENT OF UNIVERSITRY HOSPITAL. WHAT

INFLUENCES PARENTS’ DECISIONS?

Author: Emilija Markuškytė

Supervisor of the abstract: MD, PhD student Sigita Burokienė

INTRODUCTION

Emergency department (ED) crowding prevents efficient and effective use of health services and

compromises quality. Over the past decade the number of non-urgent visits in children hospital

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ED increased 2.7 times. There are more patients coming without physician‘s referral, seeking

care that could have otherwise been provided in a primary care setting. The appropriate use of

ED services and resources could result in improved care and outcomes: patients with emergent

conditions would likely receive more timely care with less crowding in the ED, and patients with

non-urgent conditions would experience more continuity of care and preventive services in

primary care. It is important to find out the reasons why parents choose ED for non-urgent health

problems.

AIM

This study aims to provide a better understanding of the motivations and actions of parents of

children with non-urgent injury or illness who attend university hospital emergency department.

OBJECTIVES

1. To explore if the accessibility of primary care service during non-working days has influence

on ED crowding.

2. To identify influence of geographical distances to ED.

3. To find out the main health problems for which patients attend ED and how parents rate them.

4. To explore the connection between parents’ individual characteristics, child’s age and

evaluation of child’s health.

METHODS

A prospective questionnaire-based survey of parents attended ED for non-urgent health problem,

whose children were not hospitalized or assigned to 1st or 2nd urgent care group.

The survey collected data of 512 parents who visited ED on January 2013.

The questionnaire collected information showing demographic, socioeconomic, psychological

factors, which could have influence on parents' choice to visit ED.

Statistical analysis was made using MS Excel and SPSS21.0 statistic program. Results were

analyzed using descriptive statistics methods, T test and chi square test.

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RESULTS

One third of the parents marked fever as the main clinical reason to attend ED (37%), every fifth

indicated pain (21%), trauma (20%) or respiratory (20%) disorders. The most frequent reason of

ED attendance in children younger than 2 years group is fever (52%), comparing to 13–17 year

group, where only 13.3 % of patients mentioned this reason. School age children usually

presented to ED because of trauma. Two thirds of parents who indicated fever or respiratory

symptoms as the main clinical reason rated their child's condition as serious or very serious (64

% and 66% respectively). Trauma more often was indicated as easy or moderate condition

(71.8%). Parents of children younger than 2 years old rated their child's condition as serious 1.5

times more frequently compare to older age. Also mothers rated their child condition as severe

1.5 times more often compared to fathers (51.2% and 35.9% respectively). Every third parent

with lower income and 2/5 of parents in lower education group rated their child‘s health as

severe or very severe. In high income and education groups these rates were half as high (18.4%

and 19.5%). One of every two respondents decided to arrive to ED without physician’s referral.

Only 46% of patients visited their family doctor before coming to ED, every fourth of them were

not satisfied with primary care service. During weekends parents statistically significantly more

often attended ED on their decision, when they could not get help in primary care service. The

distance to the hospital ED had no significant impact on frequency of attendance.

CONCLUSIONS

1. Parents choose hospital ED on weekends, when the child's family doctor does not work or

they cannot admit on the same day.

2. The distance to the hospital ED had no significant impact on frequency of attendance.

3. Child's age and the reason of attendance to the hospital ED significantly influenced subjective

evaluation of severity of the child's disease.

4. Parents in lower education and lower income groups significantly more frequently rated

child's condition as severe and very severe.

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REFERENCES

1. Afilalo, J., Marinovich, A., Afilalo, M. Nonurgent emergency department patient

characteristics and barriers to primary care. Acad Emerg Med, 2004. 11(12): p. 1302-1312.

2. Brousseau, D.C. Nimmer, M. R., Yunk, N. L. Nonurgent emergency-department care:

analysis of parent and primary physician perspectives. Pediatrics, 2011. 127(2): p. e375-381.

3. Zimmer, K.P., Walker, A., Minkovitz, C.S. Epidemiology of pediatric emergency department

use at an urban medical center. Pediatr Emerg Care, 2005. 21(2): p. 84-9.

4. Williams, A., P. O'Rourke, S. Keogh, Making choices: why parents present to the emergency

department for non-urgent care. Arch Dis Child, 2009. 94(10): p. 817-20.

5. Burokiene, S., Raistenskis, J., Strička M., Usonis, V. Pagalba vaikams priėmimo-skubios

pagalbos skyriuose Lietuvos ligoninėse: ligonių srautai ir naudojimosi paslaugomis

tendencijos. Sveikatos mokslai, 2012. 22(3(82)): p. 4.

6. Brousseau, D.C., Hoffmann, R. G., Nattinger, A. B. Quality of primary care and subsequent

pediatric emergency department utilization. Pediatrics, 2007. 119(6): p. 1131-8.

7. Gawronski, O., Ceruli Ch. Non-urgent use of Emergency Department of the Bambino Gesu

Hospital: a cross sectional survey of parents‘ motivation. Paediatrics and Child Health, 2009.

19(10):p.S90-S93.

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SURGERY SECTION

1. VALIDATION OF D’AMICO CRITERIA FOR LOW-RISK PROSTATE

CANCER

Author Arnas Rakauskas

Supervisor of the abstract Prof. Daimantas Milonas

INTRODUCTION

During the last three decades, the detection of low stage prostate cancer (PCa) has changed

dramatically because of the introduction of the prostate-specific antigen (PSA) test and more

detailed prostate biopsy schemes. Active surveillance for such patients becomes popular

treatment modalities. The D’Amico criteria represent one of the most widely used models for

predicting low-risk PCa associated with a low probability biochemical recurrence after radical

treatment of PCa. The definition of PCa with good prognosis – “low-risk cancer” – was

suggested by D’Amico in 1998, and included patients with biopsy Gleason score ≤6, PSA up to

10 ng/mL, and clinical stage cT1c – T2a. There are few data that low risk PCa detected using

D’Amico criteria can harbour more aggressive disease and these criteria are not properly useful

when active surveillance strategy is planned.

AIM

To evaluate if D’Amico criteria may underestimate aggressive prostate cancer in men who had

“low-risk cancer” before radical prostatectomy (RP).

OBJECTIVES

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1. To identify overall and 3-, 5- and 8-year biochemical progression free-survival (BPFS)

after RP in patients with low-risk PCa detected by D’Amico criteria before surgery.

2. To analyze and identify predictive parameters in BPFS.

3. To identify the risk of unfavourable disease (stage ≥T3 and/or Gleason score ≥7) after RP in

patients with low-risk PCa detected by D’Amico criteria before surgery.

METHODS

Between 2004 and 2007, 690 men underwent prostate biopsy and RP at a single university

hospital. Of those, 248 patients (35.9%) had the D’Amico criteria. The end points of the study

were detection of low-risk (stage pT2 and Gleason score ≤6) or unfavourable (stage ≥T3 and/or

Gleason score ≥7) PCa, and BPFS. The risk of progression was analyzed using the multivariate

Cox regression model, and BPFS was established using Kaplan-Meier analysis.

RESULTS

The mean duration of follow-up was 40.5 (1-101) months. pT3 was detected in 14.1%, and

Gleason score ≥7 - in 32.7% of patients. Unfavourable PCa was detected in 37.5% of the cohort

men. Overall biochemical relapse rate was 10.9%. The estimated probability of 3-, 5-, and 8-year

BPFS for all study patients was, accordingly, 89.8, 85.9, and 78%. Eight-year BPFS was 89.3%

for low-risk PCa, and 64.7% - for unfavourable PCa (log rank p=0.02). Positive surgical margins

(p=0.003, HR 0.249, 95.0%CI 1.01-0.616) and post-operative Gleason score (p=0.006, HR 2.76,

95.0%CI 1.344-5.647) were the most significant predictors of biochemical relapse in Cox

regression analysis.

CONCLUSIONS

1. Overall biochemical relapse rate was 10.9%. The estimated 3-, 5-, and 8-year BPFS for

all study patients was, accordingly, 89.8, 85.9, and 78%. Patients with unfavourable PCa

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had higher biochemical relapse rate and worse (64.7%) 8-year BPFS.

2. Positive surgical margins and post-operative Gleason score were the most significant

predictors of biochemical relapse.

3. The D’Amico criteria may underestimate aggressive prostate cancer in up to 37.5% of

patients. Consequently, caution is recommended when the decision concerning the active

surveillance is based on D’Amico criteria alone.

2. MULLERIAN DUCT DEVELOPMENT MALFORMATION'S

COMBINATION: EXAMINATIONS DIFFICULTIES

Authors: Jekaterina Stankevica, Riga Stradins University, Faculty of Medicine, 6th year;

Anastasija Rjabuhina, Riga Stradins University, Faculty of Medicine, 6th year.

Supervisors of the abstract: Marite Puksta, MD, PhD, Riga East Clinical University Hospital

Clinic "Gaiļezers", Gynecological Clinic; Janis Upmalis, MD, PhD, Riga East Clinical

University Hospital Clinic "Gaiļezers", Department of Diagnostic Radiology.

INTRODUCTION

Most of Mullerian duct’s developmental abnormalities are sporadic or multifactorial. They are

present in 1% of women in fertile age. During development Mullerian ducts merge, forming

isthmic part of uterus and continue in cranio-caudal direction. If the caudal fusion is disrupted,

there are two cervices and vaginal septum, but the development of the uterus is not affected.

Longitudinal septum is formed by lateral fusion of Mullerian ducts too.

AIM

To detect approriate radiologic examinations for better diagnostic and therapeutic approach of

the pathology.

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METHODS

There was analyzed one patient’s history, her complaints, diagnostic and therapeutic approach of

pathology.

CASE REPORT

A 37-year-old woman with undetermined bleeding from genital tract was admitted to Riga East

Clinical University Hospital Clinic "Gaiļezers". During the gynecological examination there

were found vaginal septum and cystic mass of unknown etiology in the left side of vagina.

Therefore MRI (magnetic resonance imaging) was used with US (ultrasound) gel and there were

opacification of right side of vagina. During the radiologic examination there were found

longitudinal vaginal and cervical septum, pathologic mass in the left side of vagina with contrast

agent accumulation in the capsule and dynamic changes of mass’s size after mechanic exposure.

Vaginal septum resection using the vaginal approach was performed. During the operation there

was found rudimentary uterine cervix which was located in the left side of vagina behind the

septum. Both cervices were connected among themselves. Cystic mass 5.0 x 4.0 cm with

purulent sanguineous content was detached from the rudimentary cervix. This mass had a

pedicle. The mass was cut off. Patient was discharged in mild condition for gynecological

observation in the outpatient setting. At present patient feels good, sexual life and reproductive

function are not disturbed.

DISCUSSION

1.This combination of congenital malformations is rare, difficult to diagnose with standard

examinations.

2.In this case it was necessary to combine MRI with US gel contrast enhancement to detect

abnormalities of the development and to plan therapeutic approach.

REFERENCES

1.Celik N. Y., Mulayim B. A mullerian anomaly ‘‘without classification’’: Septate uterus with

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double cervix and longitudinal vaginal septum. Taiwanese Journal of Obstetrics & Gynecology

51 (2012) p. 649-650.

2.Hoffman B. L., Moschos E., Griffith W., Beshay V., Rahn D. Williams gynecology. 2nd

edition. New York: McGraw-Hill; 2012. p. 494-503.

3.Jordan J. A., Singer A., editors. The Cervix. 2nd edition. Oxford: Blackwell Publishing; 2006.

p. 6-10.

4.Pilmane M., Šūmahers G. H. Medicīniskā embrioloģija. Rīga: Preses nams; 2006. p. 216-236.

5.Schoenwolf G. C., Larsen W. J., editors. Larsen’s human embryology. 4th edition.

Philadelphia: Churchill Livingstone; 2009. p. 518-521.

6.Troiano R. N., McCarthy S. M. Mullerian Duct Anomalies: Imaging and Clinical Issues.

Radiology 2004; 233:19–34.

3. IATROGENIC GALLBLADDER PERFORATION DURING

LAPAROSCOPIC CHOLECYSTECTOMY. SERIOUS PROBLEM, OR

NOT?

Authors: Mariusz Ligocki, Joanna Ligocka, Sylwia Gajda, Marcin Morawski

Supervisor of the abstract: Oskar Kornasiewicz MD, PhD

INTRODUCTION

Laparoscopic cholecystectomy is accepted as the treatment of choice for acute cholecystitis.

Perforation of the gallbladder may occur during cholecystectomy and leads to spillage of bile and

gallstones. Because of spreading contamination, the influence on morbidity may be expected.

AIM

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The aim of this study was to compare laparoscopic with open cholecystectomy technic by

assessing the morbidity and mortality rates, with a special consideration of the incidence of the

gallbladder perforation.

METHODS

1013 cholecystectomies between January 2004 and March 2013 were included in this

retrospective examination. The rate of gallbladder perforation was established on the basis of the

operative charts data. Gender, age, type of cholecystectomy, postoperative complications and

duration of hospitalization were collected. Statistical analysis was performed.

RESULTS

689 of 1.013 (68.02%) patients underwent laparoscopic cholecystectomy. Morbidity and

mortality rates in laparoscopic and open cholecystectomy were 1.31% vs. 8.64% (p<0.01) and

0% vs. 1.23% (p<0.01) respectively. Median duration of hospitalization in laparoscopic and open

cholecystectomy were 2 and 7 days (p<0.01). Compared to laparotomy, gallbladder perforation

occurred more often during laparoscopic cholecystectomy (8.27% vs. 1.85%; p<0.01). Wound

infection and fever were observed more frequently in the group of patients with gallbladder

perforation (8.56% vs. 1.85%; p<0.01). No incidence of biliary peritonitis or sepsis were

observed.

CONCLUSIONS

Gallbladder perforation may occur more often during laparoscopic cholecystectomy. Although

the overall complication rate in laparoscopic is less than the open approach, complications that

occur with greater frequency during it is iatrogenic gall bladder perforation. It can be associated

with increased risk of fever and wound infection. However comparing overall morbidity and

mortality rates, laparoscopic cholecystectomy is associated with better treatment results. IGBP is

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not a direct indication to a conversion. Moreover the incidence of perforation probably

decreases with learning curve, what would improve the results more.

REFERENCES

Full retrospective research.

4. FACTORS INFLUENCING LONG TERM SURVIVAL AFTER MAJOR

PANCREATIC SURGERY FOR ADENOCARCINOMA OF THE HEAD

OF THE PANCREAS

Authors: Rimantas Melnikas, Vytautas Aukštakalnis

Supervisor of the abstract: K.Urbonas, A.Gulbinas, G. Barauskas

INTRODUCTION

Pancreatic cancer is a disease with a poor prognosis and one of the most frequent causes of death

from cancer in Europe and North America. Although the cancer death rates of most malignancies

have declined over the last 10 years due to improvements in early detection and treatment, death

rates for pancreatic cancer showed only minimal improvement. Operation is the only curative

treatment for patients with a localized pancreatic cancer.

AIM

To determin the factors influencing long term survival after major pancreatic surgery for

Pancreatic Adenocarcinoma.

OBJECTIVES

1.To find out postoperative mortality, overall survival and actual five year survival.

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2.To identify independent factors influencing long term survival following major pancreatic

surgery.

METHODS

The data of 254 patients who underwent major surgery for adenocarcinoma of the head of the

pancreas was prospectively collected and analyzed. Overall survival and postoperative mortality

was calculated. Analyzing factors were: tumor related factors - tumor size and differentiation

grade (according to TNM classification), positive lymph nodes, perineural spread, vascular

infiltration, curative resection; and other factors- sex, age, preoperative biliary drainage and

bilirubin level, surgical and non-surgical complications. Survival rates were summarized using

the Kaplan-Meier method, and the log-rank test was used to compare differences in survival

between groups. Cox proportional hazard model was applied to indentify prognostic factors that

were independently associated with survival. Differences was considered significant at p<0.05.

Hazard ratio(HR) with 95% confidence intervals.

RESULTS

Postoperative mortality was 7%. The median of the overall survival were 15±1,117 moths.

Actual five year survival was 12%. Univariate analysis showed that positive lymph nodes,

perineural spread, vascular infiltration, patients age more than 70years, tumor size and poor

differentiation grade (according to TNM classification), curative resection are factors influencing

long term survival. Multivariate analysis revealed that positive lymph nodes (HR - 1,928 [1,285;

2,891]), perineural spread (HR - 1,73 [1,195; 2,505]), poor differentiation grade (HR - 1,596

[1,127; 2,258]),patients age more than 70 years (HR-1,563 [1,121;2,179]) were the independent

factors associated with worse survival. Factors that were not statistically significant: sex,

preoperative biliary drainage and bilirubin level, tumor size, vascular infiltration, curative

resection, surgical and non-surgical complications.

CONCLUSIONS

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1. Postoperative mortality was 7%. The median of the overall survival were 15±1,117 moths.

Actual five year survival was 12%.

2. Positive lymph nodes, perineural spread, poor tumor differentiation grade, and patient’s age

more than 70 years were independent factors associated with worse survival.

REFERENCES

1. N.P.Jarufe, C. Coldham, A.D. Mayer, D.F. Mirza, J.A.C. Buckels, S.R. Bramhall. Favourable

Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas

and Periampullary Region. Dig Surg 2004;21:202–209

2. Thomas Schnelldorfer, MD, Adam L. Ware, BS, Michael G. Sarr, MD, Thomas C. Smyrk,

MD, Lizhi Zhang et al. Long-Term Survival After Pancreatoduodenectomy for Pancreatic

Adenocarcinoma Is Cure Possible? Ann Surg 2008;247: 456–462

3. Chandrajit P. Raut, MD, Jennifer F. Tseng, MD, Charlotte C. Sun, PhD, Huamin Wang, MD,

PhD, Robert A. Wolff, MD et al. Impact of Resection Status on Pattern of Failure and Survival

After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma. Ann Surg 2007;246: 52–60.

5. BILIARY TRACT INFECTION AFTER PREOPERATIVE BILIARY

DRAINAGE FOLLOWING OPERATION FOR PERIAMPULLARY

TUMORS OR CHRONIC PANCREATITIS

Authors: Rimantas Melnikas, Vytautas Aukštakalnis

Supervisors of the abstract: prof. A. Gulbinas, prof. G. Barauskas

INTRODUCTION

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Preoperative biliary drainage (PBD) are often used in patients with benign and malignant biliary

obstruction. Biliary decompression has been advocated in an attempt to reduce postoperative

complications. However routine PBD remains controversial because of its effect on increased

chance of bacterial colonization and complications following surgical treatment.

AIM

Find out the role of PBD in bactibilia and postoperative complications.

OBJECTIVES

1. Find out the biliary tract infection association with PBD.

2. Compare pathogens and their sensitivity to antibiotics(a/b) between PBD and non-PBD

groups.

3. Find out PBD association with postoperative complications.

METHODS

The data of 201patients who underwent surgery for malignant and benign periampullary tumors

or chronic pancreatitis were retrospectively analyzed. Patients were divided into groups: ERCP

with stenting (ERS), percutaneus transhepatic cholangiostomy (PTC) and surgery without PBD

(NP). Groups were compared by bile culture (bile duct culture was collected immediately after

bile duct dissection), postoperative complications- surgical (pancreatic and biliary fistula,

hemorrhage, eventration), infectios complications (wound infection, peritonitis, pneumonia,

sepsis), non-surgical complications; mortality rates, hospital stay. Microorganisms were held

sensitive if they were sensitive to empiric antibiotic therapy (ampicilin, gentamicin,

metronidazole). Continuous variables were expressed as median or mean ± standard deviation

and were compared using an independent samples T test. Categorical variables were compared

using a χ2 test. Differences was considered significant at p<0.05.

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RESULTS

There were 53.2% (n=107) men and 46.2% (n=94) women. The main causes of operations were:

pancreatic cancer 69.7% (n=140), cancer of p.Vattery 12.4% (n=25). Type of operation: classic

Whipple resection (PDR) 14.9% (n=30), pylorus preserving PDR 42.3% (n=85),

hepaticojejunostomy 42.8% (n=86). 60.7% (n=122) had surgery without PBD, 34.8% (n=70)-

ERS, 4,5% (n=9)- PTC. 26.2% (n=32) patients had positive bile culture in NP group. Bile

infection was more often in patients who had ERS- 92.9% (n=65), p=0.0001; PTC- was not

statistically significant. Most common pathogens causing bile infection did not differ

significantly between groups and distributed respectively: ERS; NP; E.Coli- 17.8%; 23.4%,

K.oxytoca- 14.2%; 12.8%, K.pneumoniae- 13.6%; 14.9%, Enteroccocus spp- 26%; 21.3%,

Enterobacter spp- 6.5%; 4.3%. Multiple species (3 and more different microorganisms) were

commonly detected in ERS group compared to NP: 52.3% (n=34) vs 15.6% (n=5) p=0.001. ERS

was not significantly associated with postoperative complications( ERS vs NP, surgical

complications- 24,3% vs 16,4%, p=0,18; therapeutic complications- 8,5% vs 7,3%, p=0,77;

wound infections-4,7% vs 3,3%, p=0,46), hospital stay (ERS- 15,2± 12 days vs NP- 15± 15,6

days, p=0,92) or mortality (ERS-7,14%, NP-7,3%, p=0,95). Also sensitivity to empirical a/b

therapy ( ampicillin+ gentamicin+ metronidazole) did not statistically differ between ERS

(83,1% ) and NP (83,8%) groups, p=0,92 .

CONCLUSIONS

1.PBD significantly increases bacterial colonization of biliary tract.

2.Most common pathogens were: Enteroccocus spp, E.coli, K.pneumoniae, K.oxytoca,

Enterobacter spp. Also pathogens and sensitivity to a/b did not differ between ERS and NP

groups. However multiple species were commonly detected in ERS group.

3.PBD does not prolong hospital stay nor increases mortality or postoperative complications rate.

REFERENCES

1.Vic Velanovich, Tariq Kheibek, Muhammad Khan. Relationship of Postoperative

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Complications from Preoperative Biliary Stents after Pancreaticoduodenectomy. A New Cohort

Analysis and Meta-Analysis of Modern Studies. J Pancreas (Online) 2009 Jan 8; 10(1):24-29.

Muhsin Kaya, Remzi Beştaş, Fatma Bacalan, Ferhat Bacaksız, Esma Gülsun Arslan, Mehmet Ali

Kaplan. Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic

2.retrograde cholangiography patients. World J Gastroenterol 2012 July 21; 18(27): 3585-3589.

3.Saulius Grižas, Miglė Stakytė, Marius Kinčius, Giedrius Barauskas, Juozas Pundzius. Etiology

of bile infection and its association with postoperative complications following

pancreatoduodenectomy. Medicina (Kaunas) 2005; 41(5): 386-391.

6. A PROSPECTIVE ANALYSIS OF PAIN REDUCTION AND

IMPROVEMENT OF PHYSICAL FUNCTIONS AFTER OPEN

CARPAL TUNNEL RELEASE OPERATIONS

Authors: Karolina Venslauskaitė, Gediminas Samulėnas

Department of Plastic and Reconstructive surgery, Lithuanian University of Health Sciences

Supervisor of the abstract: prof. R. Rimdeika, V. Donec

INTRODUCTION

Carpal tunnel syndrome is the predominant type of compression neuropathies. It develops due to

increased pressure on the median nerve in the carpal tunnel, caused by chronic tenosynovitis.

Open carpal tunnel release (OCTR) is the standard treatment method of carpal tunnel syndrome.

The aim of OCTR is to cut the transverse carpal ligament ant release the pressure on the median

nerve.

AIM

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To evaluate changes of pain intensity and physical functions after open carpal tunnel release

operations.

OBJECTIVES

1.To evaluate pain intensity and physical functions before OCTR operations;

2.To evaluate pain intensity and physical functions after OCTR operations;

3.To compare data of preoperative and postoperative examinations.

METHODS

A prospective analysis was performed, involving patients, who underwent OCTR operation in

the Department of Plastic and Reconstructive surgery in the time period of 2011-11 – 2012-12.

Severity of pain was measured by Numeric Pain Rating Scale and changes of physical functions

were evaluated by DASH questionnaire. Data of these characteristics were collected before

OCTR, in the early post-operative period (2-3 weeks after OCTR) and in the late post-operative

period (3-4 months after OCTR). Data analysis was performed using SPSS 21 package. Repeated

measures ANOVA test was used to evaluate changes of qualitative measurements. Significance

level of 0,05 was chosen for testing statistical hypotheses.

RESULTS

A total of 26 patients ( 88,5% (23) female, 11,5% (3) male) were included in the study, mean age

53,73 ± 15,06 years. Early post-operative results were evaluated 20,65 ± 8,5 days after the

operation and late post-operative results – 112,12 ± 35,13 days after the operation. There was

significant reduction of pain in the early and late post-operative periods compared to

preoperative pain (respectively 2,54 ± 0,57; 1,31 ± 0,47; 5,5 ± 0,44; according to Numeric Pain

Rating Scale, p<0,001). According to the results of DASH questionnaire, physical disability

decreased from 50,79 ± 2,87 (preoperative) to 37,77 ± 4,16 in the early post-operative period and

13,7 ± 3,46 in the late post-operative period (p<0,005).

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CONCLUSIONS

OCTR is an effective treatment method of carpal tunnel syndrome, which singnificantly reduces

pain and improves physical functions.

7. THE ROLE OF MALNUTRITION RISK IN PREDICTING THE

INCIDENCE AND SEVERITY OF POSTOPERATIVE

COMPLICATIONS IN GASTRO-INTESTINAL SURGERY

Authors: Miglė Gedgaudaitė, Aistė Kurpiūtė, Eglė Vaitkutė

Supervisor of the abstract: Dr. Olegas Deduchovas

INTRODUCTION

Malnutrition is a recognized risk factor for postoperative complications. It disrupts the functions

of immune system, delays wounds healing and weakens strength of the muscles. These reasons

increase the risk of postoperative complications, prolong the time of hospitalization and increase

treatments costs

AIM

To evaluate malnutrition risk and its influence on the incidence and severity of postoperative

complications of the patients who were treated in the surgical department of Klaipėda University

Hospital.

OBJECTIVES

1. To evaluate patients nutritional status and to determine which of the patients are at

malnutrition risk before the gastro-intestinal surgery, using NRS-2002 scale.

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2. To evaluate oncological patients malnutrition risk and compare it with benign diseased

patients.

3. To ascertain malnutrition risks influence on the incidence and severity of postoperative

complications.

4. To identify which factors have the influence on postoperative complications.

METHODS

The prospective analysis was done of the patients in Surgical Department of Klaipeda University

Hospital during the period of November 2012 and January 2013. The assessment of the

malnutrition risk was carried out using the NRS-2002 scale .The postoperative period was

evaluated using patient’s charts. The postoperative complications were divided into two groups,

depending on the therapy used to correct them: easy complication – when treatment needed

analgesics, antipyretics, diuretics, electrolytes; severe – when treatment took other drugs or

interventional procedures. All data were analyzed using SPSS 17 statistical analysis program.

Significance of the data was evaluated using Stjudent’s t-test, chi-square and Pearsons R. Results

were considered statistically significant when the p-value was <0,05. LSMU Bioethical Board

approved this study (approval Nr. BEC-MF-68).

RESULTS

87 patients were analyzed. There were 49 (56,3%) females and 38 (43,7%) males. Their age was

between 23 and 80 and average 56 ±13,4 years. The body mass index (BMI) was 24,5 ± 3.2 (19

– 38.4).

87 surgeries were done: 29 cholecystectomies, 26 colorectal surgeries, 21 hernia repairs, 7

gastric resections, 2 gastroenterostomies and 2 laparoscopic adhesiolysies. 53 (60.9%) open-

surgeries were done and 34 (39.1%) were laparoscopic.

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There were 35 (40,2%) oncological patients and 52 (59,8%) operated because of the benign

diseases.

There were 26 (29.9%) patients at malnutrition risk, according to NRS-2002 scale. The highest

prevalence was found in patients undergoing colorectal surgery (53.8%) and gastric resection

(19.2%). Incidence of malnutrition risk for patients undergoing minor surgeries was lower than

10%.

20 (23,0%) postoperative complication was observed. 9 (45.0%) of them were infectious: 4

(20,0%) pneumonias and 5 (25.0%) wound infections. Other complications were: pain and fever

8 (40.0%), 2 (10.0%) deep venous thrombosis and 1 (5.0%) anastomotic leakage. There were 9

(45.0%) severe complications (pneumonias, deep venous thrombosis, anastomotic leakage and

two wound infections). Most of the complications were documented after colorectal surgery – 11

(55.0% of all observed) and 4 (20.0%) after gastric resection.

There was a significant correlation between malnutrition risk and malignant disease (R=0,59,

p<0.05). The malnutrition risk was significantly more common among oncological patients

(62.9%, p<0,05), while benign diseased patients had lower malnutrition risk incidence (7.7%,

p<0.05). The prevalence of postoperative complications was higher among patients with

malnutrition risk (70.0%, p<0,05) versus patients without it (30.0%, p<0,05). There was a weak

correlation between malnutrition risk and the severity of complications: severe complications

were more frequent in patients at-risk (50.0%) versus patients with no-risk (33.3%). But it was

not significant (R=0,15, p=0.49). The incidence of malnutrition risk was significantly higher in

open-surgery group (32.1%, p<0.05). Postoperative complication also were significantly more

frequent in this group (41.5%, p<0.05).

Multiple logistic regression analysis was performed to count odds ratio for postoperative

complications. Patients’ age, gender, malnutrition risk and disease type were evaluated. There

was no significant difference for patients’ age and gender. The odds ratio to develop

postoperative complication was 10.7 in at-risk patients group (p<0.05). In oncological patients

group odds ratio for complications was 15.4 (p<0.05). Both these results were significant

(p<0.05).

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CONCLUSIONS

1. Using NRS-2002 scale, malnutrition risk was detected on 26 (29,9%) patients. Most of

them underwent colorectal surgery (53,8%).

2. Malnutrition risk was significantly more frequent in oncological patients (62,9%) versus

benign diseased patients (7,7%, p<0.05).

3. The frequency of postoperative complications was significantly higher for patients at-risk

(70,0%, p<0.05), also there was a weak correlation between the severity of complications and

malnutrition risk, but it was not significant (R=0,2, p=0.38).

4. Odds ratio for at-risk patients to develop postoperative complications were 10,7 and for

oncological patients odds ratio was 15,4 (p<0.05).

REFERENCES

1. Schiesser M, Muller S, Kirchhoff P, Breitenstein S, Shafer M, Clavien P. Assessment of a

novel screening score for nutritional risk in predicting complications in gastro-intestinal

surgery. Clinical Nutrition 2008; 27: 565-570.

2. Schwegler I, von Holzen A, Gutzwiller J, Schlumpf R, Muhlebach S, Stanga Z.

Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery

for colorectal cancer. British Journal of Surgery 2010; 97: 92-97

8. ARTICULAR CARTILAGE SURGICAL TREATMENT

EXPEDIENCE WHEN KNEE ARTICULAR CARTILAGE AND

OSTEOCHONDRAL DEFECTS WERE FOUND DURING THE

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KNEE ARTHROSCOPIC AND LIGAMENT RECONSTRUCTION

SURGERIES

Author: Lukas Arnas Indičianskis, Kęstutis Subačius, Eimantas Spitrys

Supervisor of the abstract: prof. Rimtautas Gudas

INTRODUCTION

Traumatic knee cartilage and osteochondral injuries can be one of osteoarthritis (OA)

development reasons. In practice, not in all cases of damaged joint orthopaedists performs

appropriate procedures of restoring articular cartilage integrity and chooses only debridement

instead. This study represents the number of patients who would benefit from restoring articular

cartilage or osteochondral defects surgical treatment.

AIM

Identify and select patients with knee articular cartilage and osteochondral defects which would

need reconstructive knee cartilage treatment.

OBJECTIVES

1. Count knee arthroscopic and ligament reconstruction surgeries during 2012 year performed

in LUHS hospital Kaunas Clinics orthopaedic-traumatology department.

2. Analyze performed knee arthroscopies and ligament reconstruction surgeries according to the

"International Cartilage Repair Society" (ICRS) knee articular cartilage evaluation form and

classify found defected areas into degrees.

3. Divide patients by gender and place them into four different age groups.

4. Assess the most common defected knee articular cartilage areas using knee articular cartilage

damage map.

METHODS

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There was performed a retrospective analysis according to LUHS hospital Kaunas Clinics

orthopaedic – traumatology department 2012 year surgeries registry book data. Total 1848

arthroscopic and ligament reconstruction surgeries were performed by orthopaedic-traumatology

department in 2012 year. Of all these surgeries the study included 1430 (77.4%) patients who

had knee arthroscopic and ligament reconstruction surgeries during one-year period. All cases

were analyzed using "ICRS" knee evaluation form (from I to IV degree) and knee articular

cartilage damage map, identifying the place of defected area of the knee articular cartilage.

Cartilage defect repair is indicated as a first line treatment for a focal ICRS grade III and IV

lesions. III degree cartilage lesion according to ICRS is cartilage defects extending down >50%

of cartilage depth, as well as down to calcified layer and down to, but not through the

subchondral bone. IV degree cartilage lesion according to ICRS is erosion of cartilage down to

subchondral bone. Due to missing and corrupted data 111 cases (7.7 percent) were excluded.

Statistical analysis was performed using a standard statistical package “SPSS for Windows 20.0”

and results were valued in decimal accuracy.

RESULTS

1. Totally (n=1319) knee arthroscopic and ligament reconstruction surgeries were analyzed

during the research;

2. Knee articular cartilage defects were found in 59.4% (n = 784) knees;

3. In women group (n=599) knee articular cartilage defects were found in 74.1% (n=444);

4. In men group (n=720) knee articular cartilage defects were found in 47.2% (n=340);

5. Chondromalation was divided in four men different age groups: under 25 years – 14.9%,

from 25 to 45 years - 44.0%, from 45 to 65 years - 72.2% , above 65 years - 90.3%;

6. Chondromalation was divided in four women different age groups: under 25 years – 31.7%,

from 25 to 45 years – 60.6%, from 45 to 65 years – 85.6% , above 65 years – 83.9%;

7. Localized articular cartilage I degree lesions were found in 11.7% different areas of woman

(10.2%) and men (14.0%) knees;

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8. Localized articular cartilage II degree lesions were found in 44.7% different areas of woman

(45.2%) and men (43.7%) knees;

9. Localized articular cartilage III degree lesions were found in 28.9% different areas of woman

(30.2%) and men (27.0%) knees;

10. Localized articular cartilage IV degree lesions were found in 14.7% different areas of woman

(14.4%) and men (15.3%) knees;

11. Affected areas of the knee articular cartilage of both genders: F1 1.3%, F2 1.8%, F3 13.5%,

F4 13.0%, F5 6.3%, F6 6.1%, F7 0.8%, F8 0.9%, F9 2.0%, F10 1.9%, P1 2.5%, P2 3.0%, P3

7.7%, P4 7.8%, P5 2.2%, P6 2.3%, T1 0.8%, T2 0.9%, T3 1.4%, T4 7.4%, T5 7.1%, T6

1.1%, T7 0.7%, T8 0.7%, T9 3.4%, T10 3.2%;

12. Affected areas of the knee articular cartilage in men : F1 1.4%, F2 1.7%, F3 13.3%, F4

12.9%, F5 6.1%, F6 5.9%, F7 0.9%, F8 1.2%, F9 2.5%, F10 2.3%, P1 2.1%, P2 2.7%, P3

7.6%, P4 7.6%, P5 1.7%, P6 1.9%, T1 1.1%, T2 1.1%, T3 1.7%, T4 7.7%, T5 7.4%, T6

1.1%, T7 0.8%, T8 0.9%, T9 3.2%, T10 3.1%;

13. Affected areas of the knee articular cartilage in women : F1 1.3%, F2 1.9%, F3 13.6%, F4

13.0%, F5 6.4%, F6 6.2%, F7 0.7%, F8 0.8%, F9 1.6%, F10 1.6%, P1 2.8%, P2 3.2%, P3

7.7%, P4 7.9%, P5 2.5%, P6 2.6%, T1 0.7%, T2 0.8%, T3 1.2%, T4 7.2%, T5 7.0%, T6

1.2%, T7 0.7%, T8 0.6%, T9 3.4%, T10 3.3%;

CONCLUSIONS

1. The most common affected areas of knee articular cartilage are: F3 13.5%, F4 13.0%, P3

7.7%, P4 7.8%, T4 7.4%, T5 7.1%.

2. According to the results of chondromalation frequency in age groups, we can maintain that

age is one of the risk factors in developement of chondromalation.

3. Based on the results, during the knee arthroscopies and ligament reconstruction surgeries, III

and IV grade (according to ICRS knee articular cartilage grading scale) cartilage defects

compromised 43.7% out of all defected areas. In these cases, most of patients received

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articular cartilage reconstruction procedures.

REFERENCES

1. “ICRS Cartilage Injury Evaluation Package”

www.cartilage.org/_files/contentmanagement/ICRS_evaluation.pdf

2. LUHS Orthopaedic – Traumatology department registry log books of 2012.

3. LUHS Orthopaedic – Traumatology Microsoft Access database.

9. THE INFLUENCE OF AGE ONTO THE RESULTS OF ACUTE

CHOLECYSTITIS OPERATIVE TREATMENT

Authors: Gediminas Brazaitis, Karolis Černauskis.

Supervisor of the abstract: Doc. dr. Adomas Mickevičius

INTRODUCTION

Gallbladder is second only to appendix in order of frequency of acute abdominal situations

requiring surgical intervention. Invention of ultrasound has allowed rapid diagnosis and

assignment of operative treatment: either laparoscopic or laparotomic (open). Unfortunately,

even with the proper conduct of the procedure, independent factors determine a part of overall

success. One of them, age of the patient, has been thoroughly examined in this work.

AIM

Was to determine the influence of patient age on the cholecystitis treatment outcome,

independently of the chosen operative method.

OBJECTIVES

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1. To determine if increasing age increases the number of hospital-stay, duration of surgery

2. To determine whether there is a significant difference between the patient groups: younger

than 65 years or 65≤ years in the aspects of: a) hospital-stay b) duration of surgery c)

additional chronic diseases d) postoperative complications e) choice of treatment methods.

METHODS

The research encompassed 93 patients (50 men and 43 women) that underwent operative

treatment (laparoscopic, open), curing acute cholecystitis in LUHS clinics during 2009-2012.

They were divided into two groups according to age: 1) <65y. and 2) the 65≤ y. The research has

been performed retrospectively, analyzing the documentary records about patients. The

following data has been recorded: age, hospital-stay, duration of surgery, number of additional

chronic diseases, complications (gallbladder perforation, infection, bleeding). Data has been

analyzed using SPSS statistical program, using: 1) the paired sample t-test 2) cross-tab (chi-

square, linear association), and 3) the Mann-Whitney analysis.

RESULTS

1. The age – hospital-stay relationship revealed a significant factor (p = 0.009), and

therefore, indicated that increasing age increases the number of hospital-stay.

2. Between age and duration of operation the factor was (p = 0.60), indicating that there

is no statistically significant relationship.

3. <65 years group analysis: women - 24 (55.8%) men - 19 (44.2%)., hospital-stay avg.

6.53 d. , avg. age. 46.8 y., Avg. duration of operation 84.7 min., Wound healing

(primary 42 (97.7%), secondary (2.3%)), additional chronic diseases (<1-32 (74.4%),

2-3 - 7 (16.3 %), 4 ≤ - 4 (9.3%)), postoperative. infections. (7 (16.3%) were reported,

36 (83.7%) had none) gallbladder perforation (6 (14%) – occurred, 37 (86%) – did

not occur) treatment procedure choice (laparoscopic 39 (90.7%), laparotomy - 4

(9.3%).

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4. <65 years group analysis: women - 19 (38.0%) men - 31 (62.0%)., avg. hospital stay

9.22 d. , average age 74.8 m., average duration of operation 90.23 min.; Wound

healing (primary 46 (96.0%), secondary 2 (4.0%)), additional chronic diseases (<1-28

(56.0%), 2-3 - 14 (28.0 %) ≤ 4 - 8 (16.0%)), postoperative. infections. (10 (20.0%)

were reported, 40 (80.0%) did not occur) gallbladder perforation (11 (22.0%) were

reported, 39 (78.0%) did not occur) treatment procedure (laparoscopic - 43 (86.0%),

laparotomy (open) - 7 (14.0%)).

5. Hospital-stay of <65y. and 65≤ y. groups was compared: p = 0.072 (not a stat.

significant difference)

6. Duration of operation was compared (between <65 y. and ≤ 65 y. groups): p = 0.765

(not a stat. significant difference)

CONCLUSIONS

1. Increasing patient age significantly increases the hospital-stay (p=0,009), although it does

not have a statistically significant relation with the duration of operation (p=0,06)

2. There is no statistically significant difference (p>0,05) between the patient groups: younger

than 65 years or 65≤ years in the aspects of: a) hospital-stay (p=0,12) b) duration of surgery

(p=0,09) c) additional chronic diseases (p=0,22) d) postoperative complications (p=0,35) e)

choice of treatment methods (p=0,11).

REFERENCES

1. Strasberg, S. M. (2008). "Acute Calculous Cholecystitis". New England Journal of

Medicine 358 (26): 2804–2811.

2. Velanovich, V. (2000). "Laparoscopic vs open surgery: A preliminary comparison of quality-

of-life outcomes". Surgical endoscopy 14 (1): 16–21.

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10. CORRELATION BETWEEN HALLER'S INDEX AND LUNG

FUNCTION TESTS BEFORE PECTUS EXCAVATUM CORRECTION

Author: Vita Monkevica

Supervisor of the abstract: prof. Aigars Petersons

INTRODUCTION

Pectus excavatum is a depression in the anterior chest wall and is the most frequent chest wall

deformity, occurring from 1 in 400 to 1 in 1,000 children. In mild and moderate cases, the

patients are usually asymptomatic, but in severe cases there is significant cardiac compression

and pulmonary restriction leading to dyspnoea on exertion, limited exercise tolerance and chest

pain. Although the physiologic and psychological consequences vary for a large proportion of

patients, the defect is troublesome enough to perform corrective surgery.

AIM

To evaluate the correlation between Haller's index and lung function tests before pectus

excavatum correction.

OBJECTIVES

To assess the correlation between Haller's index and lung function tests in pectus excavatum

patients.

METHODS

For the research work the information from medical histories of patients who were treated

in Children's Clinical University Hospital with the diagnoses pectus excavatum in the period

from January 2004 to April 2012 and undergone through lung functional tests, was used. There

is presented information about the patients who were hospitalized for treating pectus excavatum

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from April 2012 to February 2013, whom the author made lung functional test. The patients

selection criteria were – made lung functional test (spirometry) and CT made Haller index. Data

was analized by SPSS program..

RESULTS

32 pectus excavatum patients were examined. 23 were male and 9 were female. Children were

hospitalized from 13 till 28 years, the median age of patients was 15.

20 patients had normal height, increased hight by 1SD in 8 cases, by 2SD in 8 cases, by

3SD in 4 cases. sixteen patients had normal weight, increased weight by 1 SD in 11 cases,

decreased weight by 1 SD in 4 cases, by 2 SD in 1 case.

Minimal Haller index was 2.4, maximal 6.9 and the median was 3.6.

Mean FVC was 86%, maximal – 121%, minimal 61%. Mean FEV1 was 87%, maximal –

122%, minimal 65%. Mean FEF25 was 86%, maximal – 110%, minimal 63%. Mean FEF50 -

101%, maximal – 132%, minimal 75%. Mean FEF75 was 120%, maximal – 156%, minimal

88%.

13 had normal ECG. Most common was sinus bradycardia (5 cases), ventricular prevalence

(5 cases), atrial conduction disorders (3 cases), ventricular conduction disorder (3 cases), atrial

prevalence (3 cases).

Echocardiography was found to be normal in 18 cases. Most common was mitral valve

prolapse in 8 cases out of them with mitral regurgitation in 5 cases, tricuspid regurgitation in 2

cases, aortic regurgitation in 2 cases and heart compression also in 2 cases.

16 patients were found to have comorbidities: 5 had bronchial asthma, 3 had allergies and 3

had scoliosis. Chronic bronchitis, syndactyly, cystic lung malformation, diaphragmal hernia and

somatoform disorder were present in 1 case each.

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Results of pulmonary function tests have statistically significant correlation with Haller’s

index (Haller index and FVC (correlation coefficient: -,707), Haller index and FEV1 (correlation

coefficient: -,655), Haller index and FEF25 (correlation coefficient: -,447)).

CONCLUSIONS

The results of pulmonary function tests have statistically significant correlation with Haller’s

index.

REFERENCES

1. Keith W. Ashcraft, George W. Holcomb, J. Patric Murphy. Pediatric Surgery-4. edition.

New York: Copyright 2005;

4. Mark Davenport, Agostino Pierro Oxford specialist handbooks in surgery-Pediatric

surgery. New York: Oxford university press, 2009;

5. Dakshesh H. Parikh, David C.G. Grabbe, Alexander W. Auldist et.al. Pediatric thoracic

surgery New York: Springer 2009;

6. Prem Puri, Michael Hollwarth Pediatric surgery: diagnosis and management. New York:

Springer 2009;

7. Zacharias Zachariou Pediatric Surgery Digest. New York: Springer 2009;

11. HYPOCALCAEMIA AFTER TOTAL THYROIDECTOMY

Authors: Eglė Vaitkutė, Aistė Kurpiūtė, Miglė Gedgaudaitė

Supervisor of the abstract: dr. A. Šlepavičius

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INTRODUCTION

Postoperative hypocalcaemia is a frequent complication after total thyroidectomy. This

complication needs to be treated with calcium and vitamin D. Symptoms of hypocalcaemia:

cramps, paresthesia, and depression, irritability, in severe cases- seizures, laryngospasm,

disorientation, vision problems, and eczema. That is why the concentration of calcium must be

measured the next day after total thyroidectomy. The next step is to decide whether treatment

with calcium and vitamin D is needed.

AIM

To evaluate an incidence of hypocalcaemia after total thyroidectomy in Klaipėda University

Hospital and to find out the impact of clinical diagnosis and degree of goiter.

OBJECTIVES

1. To evaluate an incidence of hypocalcaemia after total thyroidectomy.

2. To find out the impact of clinical diagnosis to incidence of hypocalcaemia.

3. To determine if there is correlation between degree of goiter and incidence of hypocalcaemia.

METHODS

A total of 79 patients who had a total thyroidectomy in Klaipėda University Hospital formed the

basis of this prospective study. Serial serum calcium measurements next day after a surgery were

recorded as well as details of a surgery, degree of a goiter, pathology, indications for surgery,.

Associated with clinical symptoms hypocalcaemia starts at calcium level of < 2.0 mmol/l.

Results were analyzed with MS Excel 2013 and SPSS 17.0. Pearson’s r correlation and χ2 test

were used. The statistical significance level was set at p<0, 05.

RESULTS

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Out of 79 patients, 67 (84%) females and 12 (16%) males. An average of age was 51, 85 (±11,

67) years. Hypocalcaemia was found in 31 cases (39, 24%), 74, 19% were females and 25, 8%

were males. Thyroid cancer was diagnosed to 19 (24, 05%) of all patients of whom 7 (36, 84%)

had postoperative hypocalcaemia. The incidence of thyroiditis was 2 (2, 53%), both patients had

postoperative hypocalcaemia. Struma nodosa was found in 54 (68, 35%) cases of whom 18 (33,

33%) had postoperative hypocalcaemia. Postoperative hypocalcaemia was found in all cases of

struma nodosa retrosternalis - 4 (5, 06%). Hypocalcaemia was more frequent with the diagnosis

retrosternal goiter (100%) than carcinoma (36, 8%) or struma nodosa (33, 3%), (p<0, 05). There

were no patients with I0 goiter who developed postoperative hypocalcaemia, II0- 8 (33, 33%),

III0- 12 (50%), IV0 - 4 (16, 7%). There was weak correlation (R=0,232) between incidence of

hypocalcaemia and degree of goiter, but it was not statistically significant (p>0, 05).

Lymphadenectomy was performed to 9 (11, 39%) patients, 4 (44, 44%) of them postoperative

hypocalcaemia was established.

CONCLUSIONS

1. Prevalence of hypocalcaemia after total thyroidectomy in Klaipėda University Hospital is 39,

24%.

2. Hypocalcaemia was more frequent with the diagnosis retrosternal goiter than carcinoma or

struma nodosa (p<0, 05).

3. There was no correlation between incidence of hypocalcaemia and degree of goiter.

REFERENCES

1.Ag. Peleiderer, N. Ahmad, Mr. Draper, K. Vrotsou, W. Smith. The timing of calcium

measurements in helping to predict temporary and permanent hypocalcaemia in patients having

completion and total thyroidectomies. Ann R Coll Surg Engl 2009; 91 : 140–146

2.H. Gonzalez-Botas J., Lourido Piedrahita D. Hypocalcaemia after total thyroidectomy:

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incidence, control and treatment. Acta Otorrinolaringol Esp. 2013 Mar;64(2):102-107

3.Pisanu A., Saba A., Coghe F., Uccheddu A. Early prediction of hypocalcaemia following total

thyroidectomy using combined intact parathyroid hormone and serum calcium measurement.

Langenbecks Arch Surg. 2013 Mar;398(3):423-30

12. AN OBSERVATIONAL STUDY ON CORRELATION BETWEEN

SCALDING AND PATIENTS RESIDENTIAL AREA

Authors: Jolanta Gribauskaitė, Karolina Venslauskaitė

Supervisor of the abstract: dr.Darius Kubilius

Department of Plastic and Reconstructive surgery, Lithuanian University of Health Sciences

INTRODUCTION

On the basis of world literature, it is known that people of lower socioeconomic status have a

greater risk for burns. According to classical J.Delgado article, people who do not have tap water

and electricity more often suffer from scalding and burns. Lithuanian statistic departament shows

that almost 37% people who live in village do not have hot tap water. In this case, passive

control of water used for household duties can not be accomplished, and this situation increases

the risk of scalding. In order to decrease the frequency of scalding in society, not only an

effective treatment, but also the prevention is important.

AIM

The aim of our retrospective observational study was to determine and evaluate the residential

area influence on prevalence of scalding in Lithuania.

OBJECTIVE

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Evaluate and compare prevalence of scalding in different residential areas of Lithuania.

METHODS

The retrospective correlative research was made. During this research data of patients treated

from burns in Department of Plastic and Reconstructive Surgery in Hospital of Lithuanian

University of Health Sciences Kaunas Clinics was analyzed. Analysis was based on patients who

suffered from scalding in years 2001-2010. Patients were divided to three groups: those who

were from city, those who were from town and those who were from village. The correlation

between scalding and residential area was determined and evaluated. Data was processed using

SPSS 21.0 software package, applying Pearson’s correlation coefficient, chi square and Z test.

Significance level of 0,05 was chosen for testing statistical hypotheses.

RESULTS

During 2001-2010 years, 1239 patients, who suffered from burns, were treated in Department of

Plastic and Reconstructive Surgery in Hospital of Lithuanian University of Health Sciences

Kaunas Clinics. There was 392 out of 1239 patients from city (31,6%), 374 patients from town

(30,2%) and 473 from village (38,2%). 295 out of 1239 patients (23,76%) suffered from

scalding. 155 of them were men and 140 were women. The mean of age between those patients

were 48,97 ± 0,49 years old. The correlation between prevalence of scalding and different

residential area was statistically significant (chi square 7,658, p=0.022): 96 out of 392 patients,

who were from city, suffered from scalding (24,5%), 71 who were from town (19%) and 128

who were from village (27,1%).

CONCLUSION

Patients from village were more likely to suffer from the trauma of scalding in comparison with

those patients who were from city and town.

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REFERENCES

1. J Delgado, M E Ramírez-Cardich, R H Gilman. Risk factors for burns in children: crowding,

poverty, and poor maternal education. Inj Prev 2002;8:38-41 doi:10.1136/ip.8.1.38..

2. Edelman L. S., Social and economic factors associated with the risk of burn injury. Burns.

2007; 33: 958–65.

3. Mock Ch., Michael Peck M., Juillard C., Meddings D., Gielen A., McKenzie L. Burn

prevention: success stories and lessons learned WHO. 2011

4. Peck M. D. Epidemiology of burns throughout the World. Burns. 2011; 37:1087–1100.

5. Nele Brusselaers, Stan Monstrey, Dirk Vogelaers. Severe burn injury in Europe: a systematic

review of the incidence, etiology, morbidity, and mortality. Critical Care 2010, 14:R188.

13. ANALYSIS OF LATE COMPLICATIONS AFTER INGUINAL

HERNIA SURGERY

Authors: Domantas Juodis, Marius Slabada, Mindaugas Stravinskas

Supervisor of the abstract: Prof. Mindaugas Kiudelis

INTRODUCTION

Surgical treatment of inguinal hernia has many different techniques. Each surgery has its own

advantages and disadvantages. In order to achieve best results, surgeon has to analyze the

outcomes of different surgical treatment techniques.

AIM

To analyze the late results of different inguinal hernia surgical treatment techniques.

OBJECTIVES

1. To find out if late surgical complications depend on a type of surgical treatment technique.

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2. To find out how do patients evaluate their physical activity after more than three years after

the surgery.

METHODS

1. Patients were classified into three groups according to the surgery type: open surgery without

flat mesh - Shouldice (Group A), open surgery with flat mesh - Lichtenstein (Group B),

laparoscopy - TAPP (Group C).

2. In order to evaluate the late results of the inguinal hernia surgeries, we have contacted 660

patients who went through surgery during 2006 – 2010 years. Patients were given two

questionnaires: one questionnaire was used to evaluate physical activity in patients after surgery,

another questionnaire was used to evaluate late complications.

3. Statistics were evaluated using χ² and Mann Whitney tests. Material was processed using

standard SPSS - 18 statistical program. Significance level was chosen p<0.05.

RESULTS

660 patients were operated, 52 women (7.9%), 608 men (92.1%).

378 patients were in group A (57.3%), 125 patients were in group B (18.9%), 157

patients were in group C (23.8%).

37 women (9.8%) and 341 men (90.2%) were in group A, 4 women (3,3%) and 121 men

(96,8%) were in group B, 11 women (7,0%) and 146 men (92.9%) were in group C.

Late chronic pain: 158 patients (23.9%): 86 patients in group A (13.0%), 30 patients in

group B (4.6%), 42 patients in group C (6.4%) (p = 0.581).

Hyperesthesia: 67 patients (10.15%): 41 patients in group A (6.21%), 11 patients in group

B (1.7%), 15 patients in group C (2.7%) (p = 0.809).

Hypoesthesia: 2 patients (0.3%): 1 patient in group A (0.2%) and 1 patient in group B

(0.2%) (p = 0.209).

Purulent complication: 1 patient in group C (0.2%) (p = 0.940).

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Recurrence: 13 patients (1.9%): 6 patients in Group A (0.9%), 3 patients in group B

(0.5%), 4 patients in group C (0.6%) (p = 0.950).

Strong discomfort: 7 patients (1.0%): 4 patients in Group A (0.6%), 2 patients in group B

(0.3%), 1 patients in group C (0.2%).

Discomfort during rest: 91 patients (13.8%): 52 patients in Group A (7.9%), 17 patients

in group B (2.6%), 22 patients in group C (3.3%).

Discomfort during work: 92 patients (13.9%): 52 patients in Group A (7.9%), 14 patients

in group B (2.1%), 26 patients in group C (3.9%).

Absolutely healthy: 470 patients (71.2%): 270 patients in Group A (40.9%), 92 patients

in group B (13.9%), 108 patients in group C (16.4%) (p = 0.967).

CONCLUSIONS

1.There is no statistically significant dependence between the type of complication and the type

of surgery.

2.The majority of patients were feeling well after the surgery and it doesn’t depend on the type of

surgery.

REFERENCES

1.Robert M. Zollinger, Jr., MD, FACS, E. Christopher Ellison, MD, FACS. Zollingers atlas of

surgical operations 2011; 444-464.

14. THE CHARACTERISTICS OF ISOLATED AND COMBINED

ORBITAL FRACTURES IN ASSOCIATION WITH MIDFACE

TRAUMA. INDICATION FOR ORBITAL SURGERY AND

SURGICAL APPROACHES: RETROSPECTIVE STUDY.

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Authors: Stud. med. Julianna Kuzņecova, Stud. med. Ilze Smirnova

Supervisor of the abstract: M.D. Ģirts Šalms

INTRODUCTION

An orbital fracture (OF) is a fracture or break in the small bones that make eye socket. Traumatic

OF is classificed as midface (MF) fracture and is commonly seen with MF trauma.

Isolated OF is a rare event, it is usually combined with damage to other facial bones.

AIM

To evaluate the incidence and identify factors that correlate with OF in patients with MF trauma.

Define indications for surgical treatment and main surgical approaches used in Paul Stradins

Centre of Dentistry & Facial Surgery (PSCH CDFS).

OBJECTIVES

1. To define OF incidence in Latvian patients with MF;

2. To analyze characteristics of the patient cohort and their correlations;

3. To study ophthalmological parameters in OF patients;

4. In cases of surgical treatment, to analyze indications for surgery and surgical approaches used.

METHODS

Retrospective analysis of patient histories with diagnoses - nasal bone fracture, zygoma

bones fracture and orbital floor fracture from 31.10.2011 till 01.11.2012. at PSCH CDFS. The

data were analyzed by Microsoft Excel and IBM SPSS Statistics.

RESULTS

538 relevant patients were admitted to the Paul Stradins Clinical Hospital Centre of

Dentistry and Facial Surgery during the examined period; hospitalization rate showed

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considerable monthly variations (from 28 in September to 64 and 66 in November and December

respectively, average – 44.8 patients per month).

There was a significant male prevalence (436 patients or 81%) in the analyzed group,

male patients were significantly younger (average age 30 years vs 37 years in female patients,

p=0.0008), trauma incidence increased with age in women and dropped in men. Male gender

positively correlated with criminal and sport injuries (p<0.001 and p=0.006, respectively), while

female gender was associated with domestic trauma (p<0.001). Older age associated with an

increase of domestic trauma and decrease of criminal and sport lesions. Rate of surgical

treatment and in-patient time decreased with age (p<0.001).

From all cohort - 62% patients had nasal fractures, 28% zygoma, 4% both and 6%

blowout lesion. Orbital fracture was diagnosed in 133 patients (24.7%), the lower wall was most

frequently damaged (81.2%), followed by the lateral (44.3%) and the medial (26.3%) walls, the

upper wall injury being rare (3.8%). Incidence of orbital fractures positively correlated with

injuries of zygomatic bone and negatively – with nasal fractures (p<0.001).

Surgical repair of orbital fracture was performed in 17 patients (12.7% of all orbital

fractures), 14 of them had had a criminal trauma. Analysis of surgical treatment of orbital

fracture revealed that ophthalmological indications for surgery are double vision, enophthalmus

(>2mm), pronounced disturbance of eye movement and bone dislocation with functional

damage. Titanium grid and fixation with miniplasters were the most commonly used techniques

(in 4 and 6 patients, respectively).

Ophthalmologist’s consultations were provided for 26 patients (4.8% of all patients or

19.6% patients with orbital fracture). Severe ophthalmological symptoms were found in 10

patients, all of whom had eyeball contusion and hematomas of different size and localization.

Two patients suffered from lens subluxation; one patient who had had trauma 9 days before

admission, developed compression of the optic nerve with zero vision before and after surgery.

CONCLUSIONS

1. Orbital lesion is a complicate midface trauma that needs particular attention;

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2. It is usually found in younger males with criminal trauma or in older females with domestic

trauma;

3. OF is more common in fractures of zygoma than in fractures of nasal bones;

4. In case of radiologically proven OF, indications for surgical treatment depend on

ophthalmological symptoms;

5. Titanium grid and fixation with miniplasters are the most commonly used techniques;

6. Some patients have no indications for surgery and could be conservatively treated;

7. An ophthalmologist’s consultation should be recommended for all patients with orbital

fracture and ophthalmological symptoms.

REFERENCES

1. Brady S.M., The diagnosis and management of orbital blowout fractures: update 2001.

American Journal of Emergancy Medicine - 2001, Nr. 19, Vol. 2., p. 147-154.

2. Cornelius Carl-Peter, Gellrich Nils, Søren Hillerup, Kusumoto Kenji. Midface fracture.

Updated: 2009 December 3; cited 2012 December 31]. Available from:

https://www.aofoundation.org.

3. Dobrovăţ B., Popescu R., Nemtoi A., Ladunca O., Orbital trauma: from anatomy to imaging

patterns – a pictorial review. Romanian Neurosurgery (2011) XVIII, Vol 4., p. 525 - 535.

4. Jefrey A. Nerad, Orbital trauma, Techniques in opthalmic and occuloplastic surgery 2009,

Vol.13, p. 355.-358.

15. CHARACTERIZATION OF DISTAL HUMERUS FRACTURES IN

CHILDREN AT LUHS KAUNAS CLINICS IN 2010 AND 2011

Authors: Martynas Jurenas, Kipras Pribuisis, Ritauras Rakauskas

Supervisor of the abstract: E. Cekanauskas, MD Ph.D.

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INTRODUCTION

Fractures of elbow, especially distal humerus fractures (DHF), account for 10% of all fractures in

children. They are most common in children younger than 10 years of age. DHF are dangerous in

terms of complications. Up to 5-19% of DHF produce neurovascular injury. Gathered data

characterizes patients with DHF treated in The Children‘s Department of Orthopedics and

Trauma (CDOT), circumstances of the injury, course of hospitalization and variation in treatment

modalities.

AIM

To organize characteristics of children with DHF treated at CDOT of LUHS Kaunas Clinics.

OBJECTIVES

1. To determine age and gender distribution, leading type, circumstances and seasonality of

DHF in children.

2. To examine features of preadmission period: average length, admission type, rate of

primary immobilization and preoperative neurovascular complications.

3. To evaluate impact of primary immobilization on preoperative neurovascular

complications rate.

4. To assess distribution of treatment methods (open or closed surgery) and relation with

postoperative hospitalization length.

METHODS

Case-records of 103 children with DHF were analyzed. All of them were treated at CDOT from

January 1st 2010 to December 31st 2011. The research includes patients with: supracondylar

humerus fracture, medial enpicondyle fracture of the humerus or fracture of the capitulum

humeri. All of the patients were from 0 to 18 years of age at that time.

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Variables used in this study: age, sex, circumstances of the injury, type of the fracture, primary

immobilization, preoperative neurovascular complications, preadmission period (h,min),

preoperative hospitalization period (h,min), treatment method, type of anesthesia, length of the

surgery and length of hospitalization (d).

SPSS 19.0 software package was used for statistical analysis. To evaluate distribution χ2

technique was used. Significance level p<0.05 was chosen.

RESULTS

The group consisted of 67.96% boys (70) and 32.04% girls (33). Their age ranged from 1 to 17

years with a mean of 7.8 ± 3.7 years. In most injuries left hand was affected 60.2% (62).

Dominance of supracondylar humerus fracture in 65.0% of the patients (67) was statistically

reliable (p=0.001). The rest were diagnosed with medial enpicondyle fracture of the humerus-

20.4% (21) or fracture of the capitulum humeri - 10.7% (11). 62.1% (64) of patients sustained

injuries at home. Most injuries 78.6% (81) happened during the warm season (March-August)

(p=0.001). 90 3% (93) patients were hospitalized within 24 h after the injury. Time preadmission

period ranged from 30 min to 18 h (mean of 3 h 40 min). 9.7% of patients (10) got to CDOT

after 24 h period ranged from 24 h to 10 days with a mean of 3 d and 18 h.

Preoperative neurovascular complications occurred in 14.6% (15) of cases as follows: 5 (4.9%)

with radial nerve neuropathy, 1 with median nerve neuropathy, 8 (7.8%) had unspecified

sensation disorder and one patient was diagnosed with radial artery injury at first presentation.

Primary immobilization was used in 50.5% (52) of cases. 7.7% (4) of them suffered from

neurovascular complications. 49.5% (51) of children had no primary immobilization. In this

group neurovascular complications with statistical significance more frequent and occurred in

21.5% (11) of cases (p=0.001). Preoperative hospitalization period ranged from 30 min to 25 h

(mean of 3 h 18 min). Average preoperative hospitalization period when the patient came to the

CDOT himself or was brought by an ambulance was 4 hours and 45 min. Meanwhile, patients

forwarded by other hospitals arrived in average after 21 h and 58 min.

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Open surgery was performed on 69.9% (72) of the patients and closed surgery was selected for

the rest - 30.1% (31). Percutaneous pinning with K-wire was performed on 50.5% (52) of

children. 19.4% (20) were treated by open reduction and fixation with K-wire. 15.3% (16) of

children were treated by closed reduction and splint immobilization. Other 14.6% (15) of

patients had closed reduction and splint immobilization by Blount. In most cases endotracheal

anesthesia was selected – 73.8% (76). Length of the surgery ranged from 30 min to 2 h and 30

min (mean - 69.9 ± 32.7 min). Length of postoperative hospitalization ranged from 1 to 14 days

with a mean of 5.3 ± 2.3 days. There was a statistically significant difference in average length of

postoperative hospitalization between those who received open surgery (5.9 ± 2.3 days) and

those who received closed surgery (3.9 ± 1.9 days).

CONCLUSIONS

1. Boys at age from 7 to 8 years old were dominant among children with DHF treated at

CDOT of LUHS Kaunas Clinics in 2010 and 2011. Injury was more often during Spring

and Summer months, mostly domestic.

2. Supracondylar humerus fracture was predominant. Most of the children arrived to CDOT

within 4 hours when they came themselves or were brought by ambulance. Half of them

had primary immobilization.

3. Preoperative neurovascular complications occurred in 14.6% of all cases. The frequency

of those complications was with statistical significance lower in children with primary

immobilization.

4. Average postoperative hospitalization length was 5 days. Two thirds of all patients

received open surgical treatment. Their postoperative hospitalization time was longer

than those who received closed surgical treatment.

REFERENCES

1.Campbell CC, Waters PM, Means JB, Kasser JR, Mills HB. Neurovascular hilary and

displacement in type III supracondylar fractures. J. Pediatr.Orthop 1995;15:47-52.

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2.Otsuka NY, Kasser JR. Supracondylar Fractures of the Humerus in Children. J Am Acad The

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Organising Committee of IHSC

Mindaugas Vieželis, Chairman of IHSC

Vytautas Augustinavičius

Kazys Butkus

Edgaras Diržius

Jorūnė Šuipytė

Agnė Čiurilaitė

Giedrius Juodelis

Akvilina Krasauskaitė

Gabrielė Mačionytė

Laura Navasaitytė

Petras Petkevičius

Simona Stankevičiūtė

Justas Žilinskas

Eugenijus Žvykas

Viltė Sauliūnaitė

Lukas Šemeklis

Rūta Kinderytė

Justas Ovsianas

Rokas Liubauskas

Rasa Mačernytė

Birutė Vaidelytė

Domantas Juodis