Showing papers in "Medicina-lithuania in 2003"

Photodynamic therapy: mechanism of action and ways to improve the efficiency of treatment.

Abstract: Photodynamic therapy is treatment modality involving the administration of photosensitizing compound, which selectively accumulates in the hyperproliferative target cells followed by local irradiation with visible light of lesion. Eventually target tissue will be damaged by necrosis and apoptosis. Action of treatment is described from absorption of light till damage of tissue. Several rationale proposals to increase the efficiency of described treatment modality are suggested: to evaluate the antiproliferative activity of new coming photosensitizers, to combine photosensitization with other treatment modalities in molecular level, exploring mechanism of apoptosis, to increase the efficiency of treatment by combination with ionizing radiation, hyperthermia or ligation of peripheral benzodiazepine receptors.

[Role of nitric oxide and other endothelium-derived factors].

Abstract: The endothelial cell layer displays the features of a distributed organ and has a variety of biological functions such as keeping the balance between coagulation and fibrinolysis, expression of adhesion molecules for cells in the immune system, metabolism of noradrenaline and 5-hydroxytryptamine, and conversion of angiotensin I and bradykinin. The endothelium also regulates the underlying smooth muscle layer and vascular tone by release of endothelium-derived relaxing factors such as nitric oxide (NO), prostaglandins, and endothelium-derived hyperpolarizing factor (EDHF) as well as vasoconstricting factors such as endothelin, superoxide (O(2)(-)), and thromboxane. We have reviewed the nature, mechanisms of action, and role of these factors in regulation of vascular tone, with special emphasis on NO. By a process catalyzed by NO synthase, NO and citrulline is formed from the substrates molecular O(2) and L-arginine. The main receptor for NO is guanylyl cyclase leading to formation of smooth muscle cyclic guanosinmonophosphate and relaxation. EDHF is an endothelium-derived factor causing vasorelaxation of the underlying smooth muscle layer by hyperpolarization. The nature of EDHF is still unknown, but several candidates for EDHF have been proposed such as potassium ions, hydrogen peroxide, and epoxyeicosatrienoic acids. Prostaglandins such as prostacyclin and prostaglandin E2 binds to specific receptors followed by increases in cyclic adenosinmonophosphate and vasorelaxation, while contractile prostaglandins constrict vessels by activation of thromboxane and endoperoxidase receptors. Superoxide anions induce contraction of vascular smooth muscles cells by scavenging NO. Endothelin is a potent endothelium-derived contractile factor. The synthesis of endothelin-1 is induced by hypoxia, thrombin, interleukin-1, transforming growth factor-beta1, vasopressin, and catecholamines. Cardiovascular risk factors like age, hypertension, and hyperlipidemia are associated with impaired endothelium-dependent vasodilation either as a consequence of increased inactivation of endothelium-derived vasodilators or increased formation of endothelium-derived contracting factors. This imbalance of endothelium-derived factors plays a role for development of atheroslerosis and ischemic vascular diseases.

Stimuli-sensitive hydrogels in controlled and sustained drug delivery.

Abstract: Recently, controlled and sustained drug delivery has become the standard in modern pharmaceutical design and an intensive research has been undertaken in achieving much better drug product effectiveness, reliability and safety. In this regard, many polymers are very useful with majority of hydrogels, which undergo reversible volume and/or sol-gel phase transitions in response to physiological (temperature, pH and present of ions in organism fluids, blood glucose level) or other external (electric current, light) stimuli. This article reviews the main stimuli-sensitive hydrogels and the use of these hydrogels in parenteral, ocular, peroral, rectal, vaginal, nasal, dermal and transdermal drug delivery.

[Relationship between lower extremity muscle strength and dynamic balance in people post-stroke].

Abstract: Summary. The purpose of this study was to determine how lower extremity muscle weakness is related to post-stroke difficulties in balancing. Methods. Dynamic balance of 30 people post-stroke and 30 neurologically sound people was assessed by the Functional Reach Test and the Timed Up and Go Test. Bilateral lower extremity muscle strength was measured in classical manual muscle testing positions using a Lafayette instrument. Results. There was a weak correlation between lower extremity muscle strength and the Functional Reach Test: from r=0.05 to r=0.53 for the impaired extremity and from r=0.23 to r=0.53 for the sound extremity. Control group results were from r=0.51 to r=0.86. The correlation between lower extremity muscle strength and the Timed Up and Go Test was from r=–0.33 to r= –0.64 for the impaired extremity and from r=–0.35 to r= –0.58 for the sound extremity. Control group results in this testing situation were from r=–0.63 to r= – 0.90. Conclusion. The results of the study indicate that the loss of lower extremity muscle strength as a result of cerebrovascul ar accident has a poor influence on dynamic balance problems in people post-stroke.

Application of controlled arterial hypotension in endoscopic rhinosurgery.

Abstract: Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. In the case of the expanded process, still more numerous interventions are performed with general anesthesia. The objective of research is to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia caused by nitroglycerin and captopril when performing endoscopic operations of accessory nasal sinuses. Fifty-two patients of physical health state 1-2 according to ASA were examined: for 32 the controlled hypotension (Group H) was applied, 20 patients underwent operations in normotension (Group N). All patients on the eve of the operation were premedicated with diazepam; Group H patients on the day of operation received 6.25 mg of captopril. Anesthesia was carried out with fentanyl and halothane steam in the 50:50% mixture of oxygen and laughing gas. In Group H arterial blood pressure was lowered by nitroglycerin infusion. The average arterial blood pressure was maintained in GroupH within the limits of 50-60 mmHg. Hypotension was coordinated with the rising of the head-bed of the operating table at 5 degrees. Hemorrhage was measured by collecting blood with the pump graded with the precision of 25 ml. The visibility of the operative field was evaluated subjectively every 15 minutes according to the scale of 5 points proposed by Fromm. In both groups the average arterial blood pressure values as well as the values of the frequency of heart contractions differed statistically significantly. In the hypotensive group, hemorrhage during operation was less, on the average, (208 ml) than in Group N (349.2 ml). The visibility of the operative field was by one point, on the average, better than in Group H. No anesthetic complications were observed during investigation. In summary, it is possible to state that the controlled arterial hypotension caused by captopril and nitroglycerin reduced significantly intraoperative hemorrhage and improved the visibility of the operative field in endoscopic rhinosurgery.

Role of tissue factor in atherothrombosis

Abstract: Tissue factor is a key enzyme in coagulation process. It is primary known as a cofactor for factor VIIa-mediated triggering of blood coagulation, which proceeds in a cascade of extracellular reactions. Tissue factor forms a catalytic complex with VIIa and intitiates coagulation by activating factor IX and X, ultimately resulting in thrombin formation. Being a transmembranic glycoprotein it takes a signalling information to another cell activity after endothelium or other tissue damage. Tissue factor plays a pivotal role in blood clotting physiology and pathology especialy in atherothrombosis. Thrombogenic tissue factor on cell-derived microparticles is present in the circulating blood of patients with acute coronary syndromes. Tissue factor is found in adventitia of blood vessels and the lipid core of atherosclerotic plaques (but not in vascular cells contacting directly with blood). Although the molecular mechanisms responsible for these phenomena remain unclear, it is thought that they are brought about by the action of intracellular signaling, resulting in gene transcription and subsequent protein synthesis. By expressing on monocyte or macrofage cell membrane surface it is involved in proinflammatory action and plaque destabilisation. This shifted the emphasis to investigations of what happened on the cell surface, and later to the cell biology of tissue factor and its inducibility in monocytes/macrophages and endothelial cells. Recent studies have suggested that tissue factor also plays non-hemostatic roles in blood vessel development, tumor angiogenesis and metastasis, inflamation. Tissue factor upregulates a number of genes involved in regulation of growth, transcription, and cellular motility, as well as cytokines, makes it possible to suggest a link between the formation of the tissue factor / VIIa complex and the cellular processes. Regulation of tissue factor activity by natural tissue factor pathway inhibitor (synthesized by vascular endothelial cells) or by special drugs is a new insight in thrombosis and vessel reocclusion preventive therapy. Tissue factor concentration in circulating blood has a higher informativity comparing to troponine and CRB values.

The complex technology on products of German chamomile

Abstract: The German chamomile is an old herbal medicine, which is widely used in medical practice The water and ethanol extracts of matricaria flowers are mainly used for their anti-inflammatory, antiseptic and spasmolytic properties It is possible to prepare tea of pulverized matricaria flowers with 02 mm sized particles packed in tea bags The investigation of anatomical diagnostical identification, qualitative and quantitative indices showed that matricaria top got after gathering flowers can be recommend as a herb for medical use The thin-layer chromatographic research showed that matricaria top contains 9 flavonoids (2 more than flowers) and it's essential oil--10 components (one more than flowers) The technological study of practical use of matricaria top approved the possibility to prepare the fluid extract of matricaria top for external use The results of investigations showed the possibility of complex use of Matricaria recutita cultivated in Latvia

Quantitative analysis of professionally trained versus untrained voices.

Abstract: The aim of this study was to compare healthy trained and untrained voices as well as healthy and dysphonic trained voices in adults using combined voice range profile and aerodynamic tests, to define the normal range limiting values of quantitative voice parameters and to select the most informative quantitative voice parameters for separation between healthy and dysphonic trained voices. Three groups of persons were evaluated. One hundred eighty six healthy volunteers were divided into two groups according to voice training: non-professional speakers group consisted of 106 untrained voices persons (36 males and 70 females) and professional speakers group--of 80 trained voices persons (21 males and 59 females). Clinical group consisted of 103 dysphonic professional speakers (23 males and 80 females) with various voice disorders. Eighteen quantitative voice parameters from combined voice range profile (VRP) test were analyzed: 8 of voice range profile, 8 of speaking voice, overall vocal dysfunction degree and coefficient of sound, and aerodynamic maximum phonation time. Analysis showed that healthy professional speakers demonstrated expanded vocal abilities in comparison to healthy non-professional speakers. Quantitative voice range profile parameters- pitch range, high frequency limit, area of high frequencies and coefficient of sound differed significantly between healthy professional and non-professional voices, and were more informative than speaking voice or aerodynamic parameters in showing the voice training. Logistic stepwise regression revealed that VRP area in high frequencies was sufficient to discriminate between healthy and dysphonic professional speakers for male subjects (overall discrimination accuracy--81.8%) and combination of three quantitative parameters (VRP high frequency limit, maximum voice intensity and slope of speaking curve) for female subjects (overall model discrimination accuracy--75.4%). We concluded that quantitative voice assessment with selected parameters might be useful for evaluation of voice education for healthy professional speakers as well as for detection of vocal dysfunction and evaluation of rehabilitation effect in dysphonic professionals.

The prevalence of overweight and obesity in relation to social and behavioral factors (Lithuanian health behavior monitoring).

Abstract: The aim of the study is to estimate the trends in the prevalence of overweight and obesity among Lithuanian adult population and to examine the association of social and health behavior factors with overweight and obesity. Since 1994 five cross-sectional surveys have been conducted among adult population aged 20-64 within the international FINBALT HEALTH MONITOR project. An independent national random sample of 3000 inhabitants of Lithuania was drawn from National Population Register for each survey. The data were collected through mailed questionnaires (covering sociodemographic characteristics, health behaviors, and self-reported height and weight). Overweight was defined as BMI>25 kg/m ( 2 ) and obesity - as BMI>30 kg/m ( 2 ). In 2002 the overall prevalence of obesity was 16% and the prevalence of overweight - 49.1%. Since 1994 both indicators have increased in men while in women the prevalence of overweight has decreased. The prevalence of obesity and overweight increased with age. Obesity and overweight were least prevalent among the highly educated women, but most prevalent among the highly educated men. Women living in cities were less obese and overweight than those living in towns and villages. Obesity and overweight were less prevalent among daily smokers and physically active persons. Women drinking beer at least once a week were less obese and overweight than those who consumed beer more rarely. There was no consistent association between nutrition habits and the prevalence of obesity and overweight. The National obesity control program aimed at promotion of healthy nutrition and physical activity should be elaborated in order to decrease the prevalence of obesity and overweight in Lithuanian population.

Preeclampsia and eclampsia

Abstract: Preeclampsia is a multisystem disorder after the 20(th) week of gestation, that is usually associated with raised blood pressure, proteinuria, and pathologic edema. Eclampsia is defined as the occurrence of conculsions in association with the syndrome of preeclampsia. In Europe and other developed countries eclampsia complicates approximately 1 in 2,000 deliveries, while in developing countries estimates vary between 1 in 100 to 1 in 1,700. 44% of seizures occur postnatally, the remainder being antepartum (38%) or intrapartum (18%). Although rare, eclampsia probably accounts for 50,000 maternal deaths a year world-wide. In this review article we discussed conditions, which are associated with a higher incidence of preeclampsia, pathophysiology, findings at physical examination, principles of treatment (blood pressure control, anticonvulsant therapy, and fluid management), post-partum management, complications, maternal morbidity and mortality, as well as prevention.

Mechanisms of nitric oxide synthesis and action in cells

Abstract: Nitric oxide (NO) is a free radical gas, which is a product of reaction between molecular oxygen and L-arginine. Great diffusibility of nitric oxide determines its quick three-dimensional distribution around the cell which is a source of nitric oxide. Single electron makes it into very reactive radical, interacting with metals incorporated in enzyme structure, heme, superoxids, oxygen, etc. The synthesis of nitric oxide is catalyzed by enzyme nitric oxide synthase (NOS) which has three isoforms: endothelial nitric oxide synthase, neuronal nitric oxide synthase, macrophagal nitric oxide synthase. Due to mechanisms of action NOS enzymes are also classified as constitutive nitric oxide synthase and inducible nitric oxide synthase. Constitutive forms are found in cytosol and membranes, they are dependent on Ca(2+)/calmodulin concentration and are extremely important in the regulation of physiological processes. Inducible forms are synthesized in cells after induction by bacterial endotoxins or cytokines, do not depend on Ca(2+)/calmodulin concentration and are being considered as pathological isoforms. It is thought that nitric oxide synthase catalyses transport of electrons for reactions between molecular oxygen and L-arginine. This consideration based on fact that flavine co-enzymes and hem are found as structural units in nitric oxide synthase. Although all isoforms catalyze the same reactions, every one of them has its own unique structure and localization. These features determine differences of activation pathways as well as specificity of inhibitors. The characteristic features of nitric oxide and functional differences among the nitric oxide synthase isoforms determine its different role in regulation of many physiological and pathophysiological processes.

Trends in main cardiovascular risk factors among middle-aged Kaunas population between 1983 and 2002.

Abstract: OBJECTIVE OF THE STUDY To evaluate dynamics in prevalence of main risk factors of cardiovascular diseases among middle-aged Kaunas population between 1993 and 2002. MATERIAL AND METHODS Four independent surveys in 1983-1984, 1986-1987, 1992-1993, and 2001-2002 were carried out in random samples of men and women aged 35-64 involving 2413, 1762, 1231 and 1403 persons respectively. The risk factors were defined within the framework of the WHO MONICA study (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease). RESULTS During the 19 years the mean values of systolic blood pressure decreased among men. Among women decreased both mean values of systolic and diastolic blood pressure, however the prevalence of hypertension has decreased only among women by 11.9%, with no significant changes among men. The prevalence of overweight decreased among men, and the prevalence of obesity declined among women. Among women the body mass index decreased as well. No changes in the prevalence of hypercholesterolemia among men (80.7%) as well as among women (82.7%) have been detected, meanwhile the mean of total cholesterol among men increased from 5.9 mmol/l to 6.1 mmol/l and among women - from 6.09 mmol/l to 6.31 mmol/l (p<0.001). The prevalence of smoking has increased by 7.2% among women and didn't change among men. IN CONCLUSION The decreasing trends in the prevalence of some risk factors have been estimated in Kaunas middle-aged population during 1983-2002 years. However the profile of cardiovascular disease risk factors is still rather high. Programs or strategies targeted to control levels of main cardiovascular disease risk factors are urgently needed.

[Treatment of supracondylar humerus fractures in children, according to Gartland classification].

Abstract: Supracondylar fractures are the most common fractures in the area of elbow in children The purpose of this study was to review and analyze the treatment patterns of supracondylar humerus fractures in childhood There were 93 children with supracondylar humerus fractures treated in the Department of Pediatric Orthopedics within the period from March 2000 till November 2002 Ninety fractures were extension-type injuries, 3 were flexion injuries, these were not included in our study Supracondylar humerus fractures were classified according to Gartland classification Type III fractures were found in 63 patients, type II fractures were seen in 23 patients and 4 patients had type I fractures Indications for treatment were determined according to fracture type Four children were treated with external immobilization alone Twenty-three patients underwent closed reduction and percutaneous pinning by K-wires Sixty-two patients were treated with closed reduction and external immobilization such as a plaster cast or according to Blount Eleven of these 62 children (type III) underwent close or open reduction and internal fixation in follow-up In 1 case of comminutive fracture a patient underwent immediate operation There were no early or late complications All operated patients healed without sequela and had excellent or good results We had noticed that all manipulations should be performed immediately in order to avoid severe swelling and neurological or vascular complications In type I fractures we performed the external immobilization only Type II displaced fractures can be treated satisfactorily with closed reduction and external immobilization Type III displaced fractures should be treated with closed reduction and percutaneous pinning with K-wires under the fluoroscope guidance It is believed to be a safe, reliable and efficient method for treatment of this difficult fracture Indications for open reduction and internal fixation includes open fractures, fractures complicated by vascular injury, unsatisfactory closed reduction due to unstable fracture

Prevalence of dyslipidemias among Lithuanian rural population (CINDI program).

Abstract: The aim of this study is to describe trends in serum total, low and high density lipoprotein cholesterol, triglycerides and nutrition habits in Lithuanian rural population between 1987 and 1999. The article presents the data of three screenings of random samples of the population aged 25-64 of five Lithuanian rural regions. Since 1987 the prevalence of hypercholesterolemia has decreased. The greatest decrease was observed in the proportion of persons with elevated level of low-density lipoprotein cholesterol. The prevalence of low level of high-density lipoprotein cholesterol decreased more significantly among women compared to men. The most remarkable changes in the prevalence of dyslipidemias were observed between 1993 and 1999. The increasing age was strongly correlated with higher prevalence of hypercholesterolemia in both genders. The prevalence of hypercholesterolemia was higher among men with higher education, overweight, hypertension and smokers than among those with low education, normal weight, normal level of blood pressure and nonsmokers. In women hypercholesterolemia was associated only with hypertension. The nutrition habits of Lithuanian rural population have changed, especially over the last five years. The consumption of animal fat has decreased and the usage of vegetable oil and margarine has increased. Women increased consumption of vegetables and fruits. The strengthening of favorable trends in nutrition habits in Lithuanian population should be one of the most important strategies in the implementation of cardiovascular disease prevention programs.

Staphylococcus aureus infection in the surgery of burns.

Abstract: S. aureus causative agent is relatively pathogenic to humans and is found on the skin and mucosa of up to 40% of all population. Burn injuries are infected with S. aureus in 30% of cases; however, in many cases the injuries heal without the antibiotic therapy, solely by applying dressing with antiseptic solutions, early removal of necrotic masses and covering the injury with a skin graft. In 2000, in the Division of Plastic Surgery and Burns of our institution, the frequency of S. aureus infection among patients with burns was 47%, of which methicillin-resistant S. aureus - 45%. The study included 100 patients who had S. aureus grown in the samples of their injuries. The article compares the severity of the trauma and the results of treatment in groups of patients with methicillin-resistant S. aureus and methicillin-sensitive S. aureus.

Diagnostic test with omeprazole in patients with posterior laryngitis.

Abstract: The aim of the study was to evaluate the merit of empiric omeprazole therapy in patients with suspected laryngopharyngeal reflux (LPR), to determine the optimal dose and duration of diagnostic test, to compare the diagnostic value of upper gastrointestinal (GI) endoscopy and omeprazole test (OT). One hundred out-patients with posterior laryngitis and more than one atypical symptom of LPR, aged 14-68 years were treated with omeprazole for 4 weeks (clinical group). According to received omeprazole dose (20 mg, 40 mg, > 40 mg), three clinical subgroups were selected. Twenty patients treated only with life style modifications and diet composed dietary group. At the entry to the study, a symptom questionnaire (5 laryngeal and 3 esophageal scored from 0 to 3 points), well being in general (W-B(VAS) on 100-mm VAS scale), videolaryngoscopy, upper endoscopy, and voice assessment (4 voice range profile parameters and overall vocal dysfunction degree (VDD)) were completed. Total symptom index (TSI) was calculated multiplying sum of symptoms severity score by number of presented symptoms. Normal values of efficacy parameters were obtained from 113 healthy voice subjects (control group). Patients were evaluated twice during the treatment: after 1-2 weeks and after 4-5 weeks. Patients were confirmed as responders, if TSI improved at least 50%, and patients were satisfied with results. According to our data, the 1st control assessment showed significant improvement on symptoms, laryngoscopy scores, VDD, and W-B(VAS) only for clinical group patients (p<0.05). Responders rate also was advantageous for the clinical group patients in comparison to the dietary group (36.0% vs. 15%). The second control assessment showed significantly better results for the clinical group patients in comparison to the 1st (p<0.05 2nd vs. the 1st). Sixty five percent of them (65/100) were classified as responders (p<0.05). The better results were in patients receiving omeprazole more than 20 mg daily. Erosive esophagitis during upper GI endoscopy was found for 21.0% (21/100) clinical group patients, 18 of them were responders to omeprazole 4-week test (accuracy of OT with regard to confirmed diagnosis with upper endoscopy was 85.7%). At week 4, efficacy parameters were not in normal range. We concluded that short-term treatment with omeprazole might be useful in confirming the clinically based diagnosis of laryngopharyngeal reflux.

Overweight and increased blood pressure in preschool-aged children.

Abstract: This paper presents the data on height, weight, body mass index, systolic and diastolic blood pressure of 3-7 year old children. A sample of preschoolers (n=1441) was drawn from the kindergartens in Kaunas city (Lithuania). The 5 ( th ), 10 ( th ), 50 ( th ), 90 ( th ) and 95 ( th ) percentiles were estimated for studied variables and the criteria for the overweight and increased blood pressure were calculated. It was shown that body mass index could be used as an indicator of the child's physical development. Its value 14-18 kg/m ( 2 ) indicates an optimal child's growing, value or =18 kg/m ( 2 ) - the overweight. According to these criteria it was found that 7.4% of 3-7 year old children were underweight, 5.8% overweight. Increased blood pressure (over 90 ( th ) percentile of systolic or/and diastolic blood pressure) had 21.4% of examined children. The prevalence of increased blood pressure was significantly higher in obese than in normal weight children. We conclude that the significant prevalence of childhood overweight and increased blood pressure emerge in preschool aged children. Thus, we recommend investigations of prevention and intervention programs to be used in the preschool setting.

Ultrastructural changes in the remnant kidney (after 5/6 nephrectomy) glomerulus after losartan and atenolol treatment.

Abstract: The aim of our study was to investigate the effect of losartan on the changes in the early stages (at week 4) of experimental chronic renal failure after 5/6 nephrectomy compared with the impact of atenolol. Attention was focused on the ultrastructural changes in the renal corpuscles. Twenty-seven male Wistar rats were divided into three groups: nephrectomized group, nephrectomized losartan-treated group and nephrectomized atenolol-treated group. Rats were kept in a climate-controlled facility, where animals were housed under standard conditions on a 12-hour light/dark cycle and fed with standard rodent chow. Angiotensin receptor antagonist losartan (180 mg/L) or beta-blocking agent atenolol (750 mg/L) was added to the drinking water and treatment was started on the first day after the operation. Systolic blood pressure and 24 hour protein excretion was measured every week. Nephrectomized rats had higher proteinuria and systolic blood pressure than the treated rats. Rats were killed 4 weeks after surgery. Early stage renal disease was characterized by glomerular hypertrophy and focal segmental glomerulosclerosis. The morphological study revealed that ultrastructural changes in the atenolol-treated group were smaller than those in the nephrectomized and losartan-treated groups. Glomerular basement membrane (GBM) thickness was significantly increased in losartan-treated (206.8 nm) and atenolol-treated (198.8 nm) rats compared to nephrectomized (169.2 nm) rats. The podocytes demonstrated hypertrophy and foot process effacement, especially in nephrectomized group. In conclusion, our results show that firstly, treatment with losartan and atenolol significantly increased GBM thickening and secondly, treatment with atenolol reduced ultrastructural changes in the podocytes.

[Programmed cellular death and atherogenesis: from molecular mechanisms to clinical aspects].

Abstract: Numerous recent investigations on the development and morphology of atherosclerotic lesions have shown programmed cell death or apoptosis to be an important factor in atherogenesis. Enzymes known as caspases are essential for completion of the apoptotic program. With regard to the origin of signals inducing apoptosis, there are two ways of initiating caspase activation: (a) cellular death receptor-mediated activation; and (b) activation mediated by mitochondrial permeability and expression of the p53 oncogene. Both of these pathways are involved in atherogenesis. Oxidative stress, angiotensin II and cholesterol overload are the primary factors that induce apoptosis in vascular cells. Considering apoptosis in endothelial cells, exposed phosphatidylserine on the cell membrane activates thrombin increasing the probability of arterial thromboses. Further progression of atherosclerosis is promoted by the formation of apoptotic bodies with oxidized phospholipids exposed on the membrane; these also activate adhesion of monocytes. Apoptosis of smooth muscle cells is usually observed in the fibrous portion of an atherosclerotic plaque in which the cells produce collagen important for plaque stability. As apoptosis occurs in smooth muscle cells, the fibrous cap grows thinner. This can result in both plaque rupture, formation of thrombi as well as calcification of the plaque from apoptotic smooth muscle cells remnants. Smooth muscle cells apoptosis is beneficial in that it offers protection to the walls of arteries against proliferative restenosis induced by invasive procedures. Apoptosis of macrophages contributes to the formation and progression of the lipidic core and promotes thrombosis of atherosclerosis in damaged arteries. By contrast, apoptosis of macrophages diminishes the production of matrix methaloproteinases that decompose collagen fibers. New facts concerning the effects of antioxidants (selenium, vitamin C and vitamin E), inhibitors of angiotensin converting enzyme, beta-blockers, calcium chanel blockers, and statins are also considered in this review.

Comparison of two different methods of analgesia. Postoperative course after colorectal cancer surgery

Abstract: BACKGROUND The purpose of our study is to compare two methods of postoperative analgesia in colorectal cancer patients after resectional operations, and to evaluate advantages and limitations of each method on the postoperative course of these patients. METHODS One hundred patients scheduled to undergo elective colorectal cancer surgery were randomized into two groups; after general anesthesia, one group received epidural analgesia (n=50) and the second one - intramuscular pethidine analgesia (n=50). Visual analogue scale at rest and on coughing was used to compare intensiveness of pain between the two groups during the day of surgery and first three postoperative days. Patients' mood and self-satisfaction were evaluated using self-assessment manikin scale. Side effects of both analgesia techniques were registered. All complications and postoperative hospital stay were also evaluated. RESULTS Visual analogue scale pain scores at rest and on coughing were significantly better in epidural analgesia group as compared to systemic intramuscular pethidine analgesia group (p<0.05). Additional analgesics were needed for 10 (20%) and 28 (56%) patients respectively to keep visual analogue scale pain scores below 5. Adverse effects such as profound sedation, nausea and vomiting were more frequent in systemic intramuscular pethidine group, but pruritus - very uncommon to compare with epidural analgesia group (p<0.05). There were no significant differences between the two groups in respect to complications and postoperative hospital stay. CONCLUSIONS Epidural analgesia has demonstrated significantly better effectiveness than intramuscular pethidine analgesia after colorectal cancer surgery with fewer adverse events. Self-assessment manikin scores showed better self-satisfaction in patients of epidural analgesia group as compared to patients in systemic pethidine group.

Hypericin as novel and promising photodynamic therapy tool: studies on intracellular accumulation capacity and growth inhibition efficiency.

Abstract: In this study we set out to investigate the photodynamic efficacy of hypericin (Hyp), three other photosensitizers and 5-aminolevulinic acid-induced protoporphyrin IX in their ability to block the growth of rather aggressive tumor - Ehrlich ascites tumor in mice. Hypericin was found to exhibit the highest tumor growth inhibiting activity in treating Ehrlich ascites tumor by photodynamic therapy. The different photosensitizers were ranked as follows: Hypericin > hematoporphyrin dimethyl ether > Photofrin II > meso-tetra-(para-sulfophenyl) porphin > 5-aminolevulinic acid. Of importance, just after Hyp-based photodynamic therapy 75% of mice survived a 4-month period, and no recurrence of tumor within this period was detected in 25% of the treated mice. The clear cut correlation observed between tumor dye concentration in the tumor cells and efficiency of photodynamic therapy, supports the idea that the intracellular accumulation of the photosensitizer is one of the most important factors in determining the benefit of photodynamic therapy. Hence, the accumulation of the photosensitizer in the tumor cells should be considered as one of the prognostic factors for the determination of the therapeutic outcome.

Correlation of power Doppler sonography with vascularity of the synovial tissue

Abstract: The purpose of this study was to investigate the intra-articular vascularization of the synovium with power Doppler sonography and correlate these findings with histopathologic al findings of synovial vascularity. Before arthroplasty or arthroscopy with synovectomy the knee joints of 20 patients with osteoarthritis or rheumatoid arthritis were examined with power Doppler sonography. Vascularity of the synovial membrane was classified semi quantitatively. The degree of the synovial vascularity was graded quantitatively using histological method. The strong correlation was found between qualitative power Doppler sonography results with histological findings of vascularity (Spearman's correlation coefficient was 0.85, p=0.0005). Power Doppler sonography may be a valuable tool to detect synovial vascularity and to assist clinicians in distinguishing between inflammatory and non-inflammatory synovium.

The importance of prostatic measuring by transrectal ultrasound in surgical management of patients with clinically benign prostatic hyperplasia.

Abstract: Summary. Objective. To study wheather transrectal ultrasound volume determination of the whole prostate and of the transition zone alone correlates to resected or enucleated weight in patients operated upon with transurethral resection of the prostate and retropubic or suprapubic prostatectomy because of presumed benign prostatic hyperplasia. Material and methods. The study comprised 120 patients with symptomatic benign prostatic hyperplasia. Ninety patients underwent transurethral resection of the prostate and 30 treated using suprapubic or retropubic prostatectomy. The weights of the specimens were correlated with the corresponding volumes of the transition zone and of the whole prostate, respectively, measured by transrectal ultrasound using prolate ellipsoid method. Results. The mean weight of the resected or enucleated specimens was 36.79 g. The mean whole prostate volume in all patients was 63.14 cm 3 . Difference between resected weight and prostate volume was statistically significant (p= 0.0001), whereas the mean transition zone volume was 40.14 cm 3 and difference with resected weight was not significant (p=0.483). Correlation coefficients between measured total prostate volume and weight of resected tissue as well as between measured transition zone volume and weight of resected tissue were calculated and were respectively r=0.925, p< 0.001 and r=0.958, p<0.001. Conclusions. Measurements of the transition zone of the prostate by transrectal ultrasound are more accurate than those for the whole prostate to predict enucleated or resected weight. The assessment of the transition zone volume may be sufficiently reliable to be used in the clinical management of benign prostatic hyperplasia and helpful to choose modality of the surgery.

The effectiveness of physical therapy methods (Bobath and motor relearning program) in rehabilitation of stroke patients

Abstract: The purpose of this study was to examine whether two different physiotherapy regimes caused any differences in outcome in the rehabilitation after stroke. We examined 240 patients with stroke. Examination was carried out at the Rehabilitation Center of Kaunas Second Clinical Hospital. Patients were divided into 2 groups: Bobath method was applied to the first (I) group (n=147), motor relearning program (MRP) method was applied to the second (II) group (n=93). In every group of patients we established samples according to sex, age, hospitalization to rehab unit as occurrence of CVA degree of disorder (hemiplegia, hemiparesis). The mobility of patients was evaluated according to European Federation for Research in Rehabilitation (EFRR) scale. Activities of daily living were evaluated by Barthel index. Analyzed groups were evaluated before physical therapy. When preliminary analysis was carried out it proved no statically reliable differences between analyzed groups (reliability 95%). The same statistical analysis was carried out after physical therapy. The results of differences between patient groups were compared using chi(2) method. Bobath method was applied working with the first group of patients. The aim of the method is to improve quality of the affected body side's movements in order to keep both sides working as harmoniously as possible. While applying this method at work, physical therapist guides patient's body on key-points, stimulating normal postural reactions, and training normal movement pattern. MRP method was used while working with the second group patients. This method is based on movement science, biomechanics and training of functional movement. Program is based on idea that movement pattern shouldn't be trained; it must be relearned. CONCLUSION. This study indicates that physiotherapy with task-oriented strategies represented by MRP, is preferable to physiotherapy with facilitation/inhibition strategies, such the Bobath programme, in the rehabilitation of stroke patients (p< 0.05).

Osteochondral transplantation (mosaicplasty) in the treatment of knee joint cartilage defects

Abstract: Between 1998 and 2001 thirty-five patients underwent osteochondral transplantation (mosaicplasty) and 35 patients (controls) - microfracture procedure for osteochondral or chondral knee joint pathology treatment. Average age of patients was 24.74+/-7.20 years. Patients were evaluated through International Cartilage Repair Society (ICRS) and modified Hospital for special Surgery (HSS) scales, arthroscopically, histologically, with MRI and x-rays. Modified HSS and ICRS evaluation showed statistically significantly better results in the mosaicplasty group 12 months post operation (p=0.005). Last follow-up showed deterioration in microfracture group (p=0.0005).

Narcotic abuse and HIV infection in prisons

Abstract: Number of drug using people in Lithuanian prisons has been growing every year: in the beginning of 2001, 1010 people in total were on a record of dispensary care, which made 8.8% of all imprisoned persons at that time. The same percent has increased in the beginning of 2002 reaching 12.25%, and growing up to 13.3% in the beginning of 2003. Drug availability and unsafe use of illegal drugs, especially sharing of needles and syringes in one of the fourteen country's penal establishments - Alytus strict regime correctional facility - resulted in a rapid HIV outbreak in spring 2002. Three hundred prisoners infected with HIV were identified during the voluntary testing. Though majority of prisoners are quite well informed about HIV, their knowledge does not alter the risky behavior. The well-informed on HIV prisoners, nevertheless, use drugs despite the risk of HIV infection. Furthermore, shortage in treatment of drug use, in rehabilitation and occupation of prisoners provide benevolent conditions for rapid spread of HIV and other blood-born infections in the Lithuanian penitentiaries. Many prisoners are not able to reintegrate into society after their release because of broken social relationships, lack of social services in the country, therefore they do often relapse into a drug use, and endanger not only their close people but also society in whole. HIV and virus hepatitis might be transmitted from them to a general population by a variety of transmission modes.

Prostate-specific antigen and transition zone index - powerful predictors for acute urinary retention in men with benign prostatic hyperplasia.

Abstract: Summary. Objectives. To examine the efficacy of prostate-spec ific antigen and various parameters obtained by transrectal ultrasonography as predictors of acute urinary retention in patients with benign prostatic hyperplasia. Methods. Eighty-nine men with symptoms of benign prostatic hyperplasia were enrolled in this study from February 2002 to June 2003. Among them, 21 patients presented with acute urinary retention. Transrectal ultrasonography was used to calculate the total prostate volume, transition zone volume and transition zone index. Sample of prostatespecific antigen was taken in outpatient clinic or in clinic before first insertion of the catheter into the bladder, because of urinary retention. If the patient presented with inserted catheter, we used latest prostate-specific antigen date from the medical notes of outpatient clinic. To compare the usefulness of the various indexes, the area under the receiver-operator characteristic curve was calculated for each index. Results. There were significant differences between patients with and without acute urinary retention in the total prostate volume (58.16 cm 3 and 44.28 cm 3 , p=0.0028), transition zone volume (36.62 cm 3 and 23.70 cm 3 , p=0.0001), transition zone index (0.62 and 0.51, p=0.00022), prostate-specific antigen (4.96 ng/ml and 2.97 ng/ml, p=0.00069), age and quality of life score, but no significant difference in International Prostate Symptom Score. In patients with acute urinary retention, the area under the receiver-operator characteristic curve was 0.775 for transition zone index, 0.742 for prostate-specific antigen, 0.737 for transition zone volume, 0.696 for total prostate zone volume and 0.633 for International Prostate Symptom Score. Conclusions. The transition zone index and prostate-specific antigen are accurate predictors of acute urinary retention in patients with benign prostatic hyperplasia and may be useful for deciding between surgical intervention and medical treatment.

Congenital genital anomalies. Aspects of diagnostics and treatment

Abstract: Congenital genital anomalies are a very complex pathology. In order to clarify its causes it is important to revert to the genetic conditions and regularities of embriological development. The genital disturbances are mostly determined by chromosomal or endocrinic disorders or by impaired biochemical processes. Clinical problems arise when the genetical sex is in discrepancy with ambiguous genitalia. True hermaphroditism, congenital adrenal hyperplasia, testicular feminization and gonadal dysgenesis are the most common syndromes. Diagnostic criteria applied are similar for all (establishment of karyotype, investigation of hormones and their derivates, genital ultrasound and endoscopy, if needed - radiological examination), but medical and surgical treatment is applied to each patient individually.

Influence of cadmium and zinc on the mice resistance to Listeria monocytogenes infection.

Abstract: UNLABELLED The objective of this study was to examine the effect of chronic exposure to cadmium and zinc on the mice resistance to experimental Listeria monocytogenes infection. MATERIALS AND METHODS At the day beginning of experiment outbred mice were injected with suspension of bacteria and 8 weeks were given the following oral intake treatment: control group (n=28) deionized drinking water, Cd- group (n=37) water containing CdCl2 10 mg/l and Cd+Zn- group (n=33) water containing CdCl2 10 mg/l and ZnSO4 100 mg/l. The delayed type hypersensitivity was evaluated by the inflammatory response during so-called "foot" test. Listerial proteins solution was injected under plantare of lower aponeurosis of rear foot of experimental animals. Survival of L. monocytogenes in organs of experimental animals was evaluated by the presence of bacteria colonies after 30 days incubation of livers homogenates in broth medium at +4 degrees C and inoculation on CASO-agar. Kidneys, liver and spleen were used for metals analysis. Differences were significant if the P value was below 0.05. RESULTS Chronic exposure to Cd or to Cd with Zn for 8 weeks caused influence on survival of mice: Cd- and Cd+Zn groups mice died more rapidly than control group ones. Bacterial growth in organs was observed for all groups until fourth week. From sixth-week, control and Cd+Zn- group's mice more rapidly eliminated bacteria from organs, demonstrating that Zn- treated mice were more resistant to listerial infection than Cd- intoxicated ones. On the other hand, mice from Cd+Zn- group had significantly decreased spleen index (up to 74%, p<0.01) as compared to control group. Chronic poisoning of mice with low doses cadmium and zinc during infection significantly affected (p<0.05) their growth rate from fourth week in both experimental groups. Cadmium and zinc insignificantly decreased the delayed type hypersensitivity response to L. monocytogenes allergens in Cd+Zn- group of mice, and no differences were observed in Cd- group, as compared with control group. CONCLUSIONS 1. Cadmium-exposed mice are more susceptible to Listeria monocytogenes and to other opportunistic infections than not intoxicated mice. 2. Zinc significantly reduces the negative effect of cadmium on the antimicrobial defense of mice. 3. Cadmium and zinc no significantly decrease the delayed type hypersensitivity response to L. monocytogenes allergens as compared with control.

Stability and antioxidant activity of black currant and black aronia berry juices

Abstract: The berries of black currant and black aronia are rich in polyphenolic compounds and especially in anthocyanins, demonstrating antioxidant activity The aim of the study was to evaluate the possible effect of thermal technological processes on the quantity of polyphenols and anthocyanins in berry juice concentrates, and on the antioxidant activity After 8 hour storage of black currant and black aronia berry juice concentrates at 60 degrees C, the amount of polyphenols decreased by 46% and 22%, anthocyanins 31% and 35%, respectively Antioxidant activity decreased by 26% and 56%, respectively The results demonstrated insufficient stability of juice concentrates, and impropriety of application of long lasting drying processes in manufacturing of black currant and black aronia berry dry products Fast and efficient drying methods for liquid products should be applied to preserve qualitative and quantitative composition and their antioxidant activity