Vilnius University Hospital Santariskiu Klinikos Research Articles

Adenomų radimo dažnis atliekant prevencines kolonoskopijas: vieno centro patirtis

Įvadas Prevencinių kolonoskopijų kokybė vertinama apskaičiuojant adenomų radimo dažį (ARD). Mūsų tyrimo tikslas – apskaičiuoti prevencinių kolonoskopijų (storosios žarnos vėžio ankstyvosios diagnostikos programa) ARD ir kitus išvestinius kokybės ro­diklius bei palyginti jų skirtumus tarp Vilniaus universiteto ligoninės Santariškių klinikų endoskopuotojų (VUL SK).Metodai Retrospektyvusis 2009–2012 metais VUL SK (Vilnius, Lietuva) atliktų prevencinių kolonoskopijų duomenų tyrimas.Rezultatai Į analizę buvo įtrauktos 1633 kolonoskopijos, kurias atliko 5 endoskopuotojai. Bendras aklosios žarnos intubacijos dažnis buvo 96,8%. Žarnynas tyrimui buvo paruoštas gerai 65,2% atvejų, vidutiniškai 28,1 % atvejų ir blogai 6,7 % atvejų. Polipai dažniau rasti vyrams nei moterims: adenomos 40,4 % vs. 24 % (p<0,001), hiperplaziniai polipai 11,1 % vs. 6,6 % (p=0,001), daugybinės adenomos 6,4 % vs. 1,9 % (p<0,001). Storosios žarnos vėžys buvo rastas 76 pacientams (4,6 %) ir statistiškai reikšmingai nesiskyrė tarp vyrų ir moterų grupių (p=0,76). Bendras ARD buvo 31,5 % ir jis statistiškai reikšmingai buvo dides­nis vyrų nei moterų grupėje: 40,4 % vs. 24 % (p<0,001). Tarp endoskopuotojų ARD svyravo nuo 26,8 % iki 36,5 % (p=0,007). Bendras daugybinių adenomų radimo dažnis buvo 4 % ir tarp endoskopuotojų svyravo nuo 1,7 % iki 6,7 % (p=0,03). Vidutinis adenomų skaičius procedūros metu buvo 0,5, o vidutinis adenomų skaičius teigiamos procedūros metu – 1,59.Išvados Adenomų radimo atliekant prevencines kolonoskopijas VUL SK dažnis yra didelis ir atitinka rekomenduojamus kokybės stan­dartus.

P1.03-082 18F-FDG PET/CT Value Staging NSCLC Extension to the Lymph Nodes, Single Center Experience

Non small-cell lung carcinoma (NSCLC) is the most common type of lung cancer. Correct clinical and pathological lymph node (N) staging is critical for choosing the best treatment. Positron emission tomography/computed tomography (PET/CT), being non-invasive pre-operative diagnostic method is becoming increasingly popular. Therefore, we aimed to evaluate the accuracy same as false-negative and false-positive results of PET/CT when compared to histopathological diagnoses at Vilnius university hospital Santariskiu klinikos (VUL SK). A retrospective analysis included 15 NSCLC patients who underwent preoperative PET/CT scan and postoperative histopathological analysis for the N staging at VUL SK. PET/CT N stage was compared with gold standard histopathological N stage to assess the sensitivity, specificity, positive and negative predictive values for N staging of NSCLC. There were 15 patients (11 men (73,3%), 4 women (26,7%)) with average age of 66,1±10,2 years included into the study. Ten patients (66,7%) were staged N>0 by PET/CT, histopathological analysis confirmed 4 diagnoses (40%), other 6 diagnoses (60%) were considered false positive. Five patients (33,3%) were staged N0 by PET/CT, histopathological analysis confirmed 3 diagnoses (60%), other 2 diagnoses (40%) were false negative. Estimated specificity of PET/CT for N staging of NSCLC was 25%; sensitivity – 57,14%, positive predictive value – 40%, negative predictive value – 60%. Despite many advantages, PET/CT still has limited value staging NSCLC. Significant number of inaccuracies in N staging may occur evaluating inflammatory lymph nodes. The necessity of histologic confirmation of N stage in stage I-IIIa NSCLC is crucial as these patients may have surgical treatment combination and better outcomes.

Laparoscopically assisted colonoscopic polypectomy - viable option for curative surgery in elderly patients.

IntroductionColorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas.AimTo overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure.Material and methodsA retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee.ResultsTwenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0–Is, 0–Ip, and 0–IIa, except one, which belonged to 0–III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication – bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery.ConclusionsThe LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.

Metals Are Important Contact Sensitizers: An Experience from Lithuania.

Background. Metals are very frequent sensitizers causing contact allergy and allergic contact dermatitis worldwide; up-to-date data based on patch test results has proved useful for the identification of a problem. Objectives. In this retrospective study prevalence of contact allergy to metals (nickel, chromium, palladium, gold, cobalt, and titanium) in Lithuania is analysed. Patients/Methods. Clinical and patch test data of 546 patients patch tested in 2014–2016, in Vilnius University Hospital Santariskiu Klinikos, was analysed and compared with previously published data. Results. Almost third of tested patients (29.56%) were sensitized to nickel. Younger women were more often sensitized to nickel than older ones (36% versus 22.8%, p = 0.0011). Women were significantly more often sensitized to nickel than men (33% versus 6.1%, p < 0.0001). Younger patients were more often sensitized to cobalt (11.6% versus 5.7%, p = 0.0183). Sensitization to cobalt was related to sensitization to nickel (p < 0.0001). Face dermatitis and oral discomfort were related to gold allergy (28% versus 6.9% dermatitis of other parts, p < 0.0001). Older patients were patch test positive to gold(I) sodium thiosulfate statistically significantly more often than younger ones (44.44% versus 21.21%, p = 0.0281). Conclusions. Nickel, gold, cobalt, and chromium are leading metal sensitizers in Lithuania. Cobalt sensitization is often accompanied by sensitization to nickel. Sensitivity rate to palladium and nickel indicates possible cross-reactivity. No sensitization to titanium was found.

Tiesiosios žarnos iškritimo chirurginis gydymas – vieno centro patirtis

ĮvadasDėl vienos tiesiosios žarnos iškritimo gydymo strategijos nesutariama. Mes apžvelgėme tiesiosios žarnos iškritimo gydymą Vilniaus universiteto ligoninėje Santariškių klinikose.Pacientai ir metodaiRetrospektyviai tirti pacientai, operuoti dėl tiesiosios žarnos iškritimo 2005–2016 metais. Pacientai suskirstyti į dvi grupes – viso storio iškritimo (CRP) ir vidinio iškritimo (IRP). Buvo palyginti perioperaciniai grupių duomenys. Duomenys apdoroti statistinio duomenų paketo SPSS 20.0 versija. Skirtumas tarp grupių lygintas remiantis chi kvadrato testu, vertintas kaip reikšmingas,jei p vertė buvo &lt; 0,05.RezultataiMinėtu laikotarpiu operuoti 89 pacientai. Dėl vidinio iškritimo – 52 (58,4 %), dėl viso storio iškritimo – 37 (41,6 %). Vyrų ir moterų santykis buvo 1/6,4, vidutinis amžius – 58,3 ± 15,2 metų. Defekografija atlikta 29 (32,6 %) IRP grupės ir 12 (13,5 %) – CRP grupės pacientams (p &lt; 0,001). Septyni (7,9 %) CRP grupės pacientai praeityje buvo operuoti dėl tiesiosios žarnos iškritmo, o IRP grupėje anksčiau operuotų pacientų nebuvo (p=0,02). IRP grupės pacientai buvo operuoti šešiais būdais, o CRP – trimis būdais (p = 0,003). Vidutinė IRP grupės pacientų hospitalizacijos trukmė buvo ilgesnė (p = 0,014) (9,78 ± 4,6 dienos) negu CRP grupės (7,58 ± 3,7 dienos). Mirštamumas buvo 0 %. Vidutinė 14 pacientų stebėjimo trukmė buvo 20,93±17,21 mėnesio.IšvadaIki šiol nesutariama dėl to, kuri operacija tinkamiausia sergantiesiems tiesiosios žarnos iškritimu. Laparoskopinė ventralinė rektopeksija tinkleliu šiuo metu yra populiariausia operacija šiai ligai gydyti.

Clinical features and three-year outcomes of Takotsubo (stress) cardiomyopathy: Observational data from one center

ObjectiveThe natural history, management, and outcome of Takotsubo (stress) cardiomyopathy (TTC) is not clear. The aim of this study was to investigate clinical features, define prognostic predictors, and assess the clinical course and outcomes of patients with TTC. MethodsWe analyzed 64 patients (52 women) meeting the proposed Mayo Clinic diagnostic criteria for TTC. All patients were treated at Vilnius University Hospital Santariskiu Klinikos from 2001-01-01 to 2014-11-27. Data were collected on the basis of medical records and follow-up data was collected by phone. ResultsThe mean age of analyzed patients was 63.4 ± 14.6 years; the mean follow-up was 2.9 years. More than half of the patients (52%) did not have any clear stressful triggers. During admission, symptoms such as chest pain (64%) and general weakness (45%) were reported more often than other symptoms. Almost all patients (94%) had the classical TTC form; the remaining 6% of patients had “inverted” TTC. The mean left ventricular ejection fraction (LVEF) on admission was 37.7% (± 8.2%). A pseudonormal or restrictive pattern of LV filling, moderate to severe mitral regurgitation (MR), and right ventricular involvement were uncommon in the patients. The in-hospital course showed cardiogenic shock in 23% of the cases, resulting in the death of 5 (8%) patients. We discovered that only peak concentration of troponin I was a significant predictor of in-hospital mortality (HR 1.067, 95%CI 1.022–1.113, p=0.003). At the end of the follow-up period, 45 (87%) women and 8 (67%) men were alive. This makes the overall observed mortality at 3 years approximately 17.2%. Using multivariate analysis, elevation of BNP (HR for increase by 10 ng/l 1.002, 95%CI 1–1.003, p=0.022) and cardiogenic shock on admission (HR 8.696, 95%CI 1.198–63.124, p=0.032) were significant predictors of overall mortality. Other prognostic factors assessed on admission were nonsignificant predictors of overall mortality. ConclusionsOur analysis shows that in-hospital mortality is influenced by the peak concentration of troponin I, and overall mortality is affected by cardiogenic shock and the elevation of BNP during admission. The assessment of troponin I and BNP can help with the prognostication of TTC patients in our daily clinical practice.

Assessment and optimisation of staff radiation exposure in nuclear medicine at Vilnius University Hospital Santariskiu Klinikos

Introduction The assessment of occupational exposure in Nuclear Medicine (NM) is constant and mandatory process. Radiation protection safety culture, quality assurance programme, different protective measures and acquired automated infusion systems, which affect the doses of optimization, were implemented in NM department. It is important to evaluate NM staff doses and influencing factors especially in PET/CT facilities. Purpose To assess external and internal exposure doses of NM workers during SPECT and PET/CT procedures using different protective measures, automatic dispenser and injection systems and to estimate the important factors for radiation exposure optimisation. Materials and methods The study was performed at NM department of Vilnius University Hospital Santariskiu Klinikos during 2008 - 2015. More than 200 dose measurements were performed with TLD (whole body, rings). In April 2014, PET/CT facilities were installed and 195 measurements were performed by electronic dosimeters (POLIMASTER PM1610B-01) during procedures, such as activity preparation, dispensing, injection, patient positioning and discharge. IMBA software was used for internal dose assessment. For direct measurements of internal exposure, the whole body (HP Ge) detector and thyroid counters (Nal(Tl)) were used. Results Annual doses of NM workers in most cases were Conclusion The estimated dose values are far below established dose limits. Staff doses can be reduced by implementing radiation safety culture and using a properly shielded system.

Transanalinė totalinė mezorektalinė ekscizija (taTME): pirmoji mūsų patirtis

Transanalinė totalinė mezorektalinė ekscizija (taTME) yra naujas endoskopinis natūralių angų chirurgijos būdas, susidedantis iš trijų tiesiosios žarnos chirurginių metodų. Šiame straipsnyje detaliai aprašoma taTME chirurginė technika bei pristatomos pirmosios trys taTME procedūros, kurios buvo atliktos Vilniaus universiteto ligoninėje Santariškių klinikose.

Is acute appendicitis still misdiagnosed?

ObjectiveThe optimal diagnostics and treatment of acute appendicitis continues to be a challenge. A false positive diagnosis of appendicitis may lead to an unnecessary operation, which has been appropriately termed negative appendectomy. The aim of our study was to identify the effectiveness of preoperative investigations in preventing negative appendectomy.MethodsA retrospective study was performed on adult patients who underwent operation for suspected acute appendicitis from 2008 to 2013 at Vilnius University Hospital Santariskiu Klinikos. Patients were divided into two groups: group A underwent an operation, where appendix was found to be normal (non-inflamed); group B underwent an appendectomy for inflamed appendix. Groups were compared for preoperative data, investigations, treatment results and pathology findings.Results554 patients were included in the study. Preoperative laboratory tests results of hemoglobin, hematocrit concentrations and white blood cell count were significantly higher in group B (p<0.001). Ultrasonography was performed for 78 % of patients in group A and 74 % in group B and did not provide any statistically significant results. Comparing Alvarado score results, there were more patients with Alvarado score less than 7 in group A than in group B. In our large series we could find only four independent risk factors, and they could only account for 24 % of cases.ConclusionsIn summary, acute appendicitis is still often misdiagnosed and the ratio of negative appendectomies remains rather high. Additional investigations such as observation and computed tomography should be used to prevent this.

Evaluation of intraocular pressure, choroidal and retinal thickness measurements using optical coherence tomography in non‐diabetic haemodialysis patients

PurposeThe purpose of this study was to evaluate the ocular findings in non‐diabetic patients with chronic renal disease undergoing haemodialysis (HD).MethodsWe performed a pilot study in Vilnius University Hospital Santariskiu Klinikos departments of Nephrology and Ophthalmology. In this study 7 patients (14 eyes) with chronic renal disease undergoing haemodialysis underwent an ophthalmic examination including visual acuity (VA), intraocular pressure (IOP), central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) measurements using high‐definition optical coherence tomography (OCT, Spectralis; Heidelberg Engineering) line scans with the activated enhanced depth imaging mode, (central corneal thickness (CCT) and endothelial cell density (CD). Each patient underwent examination 30 minutes before and 30 minutes after a HD session.Results14 eyes of 7 patients with chronic renal failure (CRF) undergoing HD were included. 5 males (35.5 %) and 2 females (14.3 %) participtated. Patients mean age was 72.71 ± 7.67 years. The mean VA was 0.83 ± 0.16. The mean IOP increased from 12.28 ± 1.89 to 14.14 ± 4.75 mmHg (p = 0.1). The change was statistically insignificant. The mean central foveal thickness decreased statistically insignificant from 227.07 ± 15.71 to 225.57 ± 14.10 μm (p = 0.69). The mean subfoveal choroidal thickness before HD was 207.57 ± 50.71 μm, after HD – 194.85 ± 55.39 μm (p = 0.016). There was a statistically significant decrease in the choroidal thickness before and after haemodialysis (p = 0.016). The mean CCT was 529.77 ± 32.12 μm. The mean CD 2777.11 ± 380.15 cells/mm2.ConclusionsHaemodialysis with a high ultrafiltration volume did not alter the retinal thickness and IOP but caused a significant choroidal thinning in non‐diabetic end‐stage CRF patients.

Vaikų perforavusių skrandžio ir dvylikapirštės žarnos opų diagnostika ir gydymas

ObjectivesPerforated peptic ulcer (PPU) is a rare but life-threatening surgical emergency in childhood. The aim of our study was to analyse the clinical features, diagnosis and management of PPU in children.MethodsThe data of children diagnosed with gastroduodenal PPU at Children’s Surgery Department, Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos from 1994 to 2012 were reviewed. The patients’ age, sex, anamnesis, clinical features, examination results, operative findings and methods, medication therapy and outcomes were assessed. Statistical analysis was performed using MS Excel.ResultsThere were 14 (93.3%) males and one female aged 14 to 18 years (16.3 ± 1.3) included in the study. Twelve patients (80%) were diagnosed with gastric and 3 (20%) with duodenal PPU. Eleven patients (73.3%) had dyspepsia before PPU, of them 4 had a history of peptic ulcer disease. Most patients (46.6%) arrived to the hospital within 6 hours of symptom onset. All presented with severe epigastric pain, 8 (53.3%) with nausea and vomiting. Only one patient (6.6%) complained of melena. One (6.6%) suffered from epigastric pain radiating to the left shoulder. Physical examination revealed positive peritoneal signs in 13 patients (86.6%). Subdiaphragmatic free air was detected in 12 patients (80%). The mean duration of perforation was 34.47 ± 57.41 hours (2–178). Thirteen patients (86.6%) underwent laparotomy, 2 laparoscopic repair. The anterior wall of the prepyloric gastric region was the commonest perforation site (80%). Eight patients (53.4%) had a course of H. pylori eradication therapy. The average hospital stay was 10.6 ± 6.3 days (4–32). Fourteen patients (93.3%) had an uneventful postoperative period, one developed nephrotic range proteinuria. All recovered fully.ConclusionsGastroduodenal PPU should be suspected in adolescent boys with a sudden onset of severe abdominal pain, positive peritoneal signs, and confirmed by pneumoperitoneum in the plain X-ray. Simple closure and eradication of H. pylori (when infection confirmed) are mandatory for a complete recovery.

Vaikų perforavusių skrandžio ir dvylikapirštės žarnos opų diagnostika ir gydymas

Darbo tikslasSkrandžio ar dvylikapirštės žarnos opos perforacija yra reta, tačiau gyvybei pavojinga vaikų būklė. Darbo tikslas – išanalizuoti vaikų perforavusių skrandžio ir dvylikapirštės žarnos opų kliniką, diagnostiką ir gydymą.Tyrimo medžiaga ir metodaiAtlikta retrospektyvi ligonių, 1994–2012 m. gydytų Vaikų ligoninės VUL SK filialo Vaikų chirurgijos skyriuje, duomenų analizė. Vertinta ligonių amžius, lytis, anamnezė, klinika, fizinio ir instrumentinio ištyrimo duomenys, operacijos radiniai, metodai ir trukmė, medikamentinė terapija ir ankstyvosios komplikacijos. Statistinė duomenų analizė atlikta MS Excel programa.RezultataiBuvo tirta 15 vaikų: 14 (93,3 %) berniukų ir 1 (6,6 %) mergaitė. Vidutinis ligonių amžius buvo 16,3±1,3 metų. Dvylikai (80 %) ligonių diagnozuota skrandžio, 3 (20 %) – dvylikapirštės žarnos opos perforacija. Iki perforacijos pilvo skausmais skundėsi 11 (73,3 %) ligonių, iš jų keturiems buvo diagnozuota opaligė. Dauguma ligonių (46,6 %) atvyko į ligoninę per 6 valandas nuo simptomų pradžios. Visi vaikai skundėsi labai stipriu skausmu pakrūtinio srityje, 8 (53,3 %) – pykinimu ir vėmimu. Tik 1 (6,6 %) vaikui buvo melena. Vienas (6,6 %) skundėsi pakrūtinio skausmu, plintančiu į kairį petį. 86,6 % tiriamųjų nustatyti pilvaplėvės dirginimo požymiai. Apžvalginėje pilvo rentgenogramoje 12 (80 %) ligonių rasta laisvo oro po diafragma. Ligoniai iki operacijos vidutiniškai sirgo 34,47 ± 57,41 valandas (nuo 2 iki 178). Laparotomija buvo atlikta 13 (86,6 %) ligonių, laparoskopija – 2 (20 %). Net 12 (80 %) vaikų perforavusios opos rastos skrandžio prepiliorinės dalies priekinėje sienoje. Aštuoniems ligoniams (53,4 %) skirta H. pylori eradikacinė terapija. Vaikai ligoninėje gydyti vidutiniškai 10,6 ± 6,3 dienas (nuo 4 iki 32). Pooperacinė eiga buvo sklandi 14 (93,3 %) ligonių, 1 (6,6 %) vaikui nustatyta nefrozinio lygio proteinurija. Visi ligoniai pasveiko.IšvadosSkrandžio ir dvylikapirštės žarnos opos turėtų būti įtariamos paaugliams berniukams, kurie kreipiasi dėl ūminių stiprių pakrūtinio skausmų ir kuriems nustatytas pilvaplėvės dirginimas. Laisvas oras po diafragma apžvalginėje pilvo rentgenogramoje – itin svarbus požymis diagnozuojant ligą. Ulcerorafija ir H. pylori eradikacija (kai infekcija patvirtinta) yra būtini, kad pacientas visiškai pasveiktų.

Dešiniosios hemikolektomijos vieno pjūvio laparoskopinė operacija: dviejų atvejų aprašymas

Vieno pjūvio chirurginės procedūros vystosi kaip minimaliai invazinės chirurgijos dalis. Dešinioji hemikolektomija, atlikta SILS būdu, pirmą kartą aprašyta 2008 metais. Mes aprašome pirmąsias dvi laparoskopines transumbilikalines vieno pjūvio dešiniąsias hemikolektomijas, atliktas Vilniaus universiteto ligoninėje Santariškių klinikos.

Implant and spinal mobility influence on the spinal curvature correction in adolescent idiopathic Lenke I type scoliosis

Background and objectiveThere are still a few researches accomplished to evaluate the advantages and disadvantages of screw, hybrid, and hook techniques in the treatment of adolescent idiopathic scoliosis. As the results are controversial, researchers still look for optimally safe, least traumatizing and economically reasonable methods to treat spinal deformities. The aim of this study is to analyze postoperative spine deformity correction results for Lenke type 1 dependent on fixation type and preoperative bending films.Patients and methodsA retrospective study was performed. Patients admitted to the Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos Orthopedic Department in the period of 1994–2013 were included; 74 cases were analyzed. Three groups according to spine implants were generated. The first included patients treated with pedicle screw fixation, the second – hybrid, and the third – hook fixation. Inclusion criteria: the adolescent age group (10–18), idiopathic scoliosis Lenke I type who undergone posterior spinal fusion with pedicle screws; hybrid fixation and hook application were evaluated in order to compare curve correction dependence on fixation type and curve flexibility. Thoracic and lumbar curve measurements on the coronal plane were performed using the Cobb technique applied on anterior posterior radiographs taken before and two days after surgery. Also, to measure curve flexibility, preoperative passive standing bending films were analyzed. Curve degrees in preoperative passive bending films were compared with the remaining postoperative spinal curves in groups separately. The remaining postoperative curves were compared respectively. ResultsIn total, 74 cases met the inclusion criteria, of them 67 (90.50%) girls and 7 (9.50%) boys. The mean preoperative thoracic Cobb angle was 51.07º (±6.20) in the screw group, 52.88º (±7.26) in the hybrid and 55.45º (±10.94) in the hook group. To compare the preoperative stiffness of the curves, the flexibility % was calculated, with no difference in the groups (p &gt; 0.05). The mean postoperative thoracic Cobb curve angle was 15.81º (±5.28), 21.63º (±6.89), and 27.55º (±8.25), respectively. The mean correction of the thoracic curve was 68.87% in the screw group, 58.76% in the hybrid and 50.27% in the hook group. The mean preoperative lumbar curve Cobb angle was 32.07º (±5.73) in the screw group, 32.50º (±12.33) in the hybrid and 34.74º (±7.50) in the hook group. The mean postoperative lumbar curve Cobb angle was 7.59º (±6.63), 10.94º (±7.52), and 16.06º (±6.89), respectively. The mean correction of the lumbar curve was 75.58% in the screw group, 66.27% in the hybrid and 53.53% in the hook group. The fixation level according to groups: screw Th4-L1, hybrid Th3-L3, hook Th3-L3. ConclusionsThe thoracic curve tends to recover more than the curve remaining in the lateral bending film. Only screw fixation is able to correct the lumbar curve for the Lenke type 1 as it is expected in the remaining lateral bending curve. Thoracic and lumbar deformity using screw fixation recovers on the average by 20% more than hook and by 10% more than hybrid application. The pedicular screw construct is shorter and is able to correct the thoracic curve whatever the modifier type (A, B or C); however, the lumbar curve correction drops when the modifier type is B or C. The other operative methods are less effective to correct both thoracic and lumbar curves whatever the modifier type and also tend to lose the correction % for types 1B or 1C.

EFFICACY OF TREATMENT WITH PEGYLATED INTERFERON AND RIBAVIRIN IN PATIENTS WITH CHRONIC HCV INFECTION “UNDER REAL LIFE“ CONDITIONS

Objective. To investigate the outcomes of combined therapy of hepatitis C (HCV) patients with peginterferon and ribavirin in ”real life” practice, to compare them with data obtained in randomized clinical trials (RCT) and to evaluate possible predictors of sustained virological response (SVR). Material and methods. The retrospective study of HCV patients routinely examined and treated in the Vilnius University Hospital Santariskiu Klinikos (2003−2009 yrs) was carried out. They had undergone the treatment with combination of peginterferon alfa and ribavirin according to the Lithuanian guide. Overall 203 patients were enrolled. SVR was evaluated in 179 patients. Results. The overall rate of SVR was 43 %: in 51,3 % of naives (genotype 1 − 38,8 %, genotype 2 – 100 %, genotype 3 − 82,6 % cases) and in 28,1 % of experienced patients (genotype 1 – 17 %, and genotype 3 – 64,3 % cases). Significant relations of SVR and HCV genotype was observed: 68,9 % having genotype1 were non-responders, whereas 80 % and 75,7 % ones with genotype 2 and 3 achieved SVR (p 0.005 and p = 0.01, respectively). The inverse relation with the age (p 0.01), degree of fibrosis (p = 0.039) and previous unsuccessful treatment was confirmed by multivariate analysis. Conclusions. Data of SVR obtained „on real life“ conditions are non unambiguous: SVR of naive and experienced patients overall and those with genotype 1 were similar or slightly lower, while for patients with genotype 3 significantly higher than results presented in clinical trials. Genotype 1, previous unsuccessful antiviral treatment, older age, and advanced fibrosis were strongest negative predictors for SVR.

The efficacy and safety of intravitreal bevacizumab in the treatment of diabetic macular oedema

AbstractPurpose to evaluate the efficacy and safety of 1.25 mg intravitreal bevacizumab (IVB) in the treatment of diabetic macular oedema at Vilnius University Hospital Santariskiu Klinikos, Centre of Eye Diseases from July, 2012 to May, 2014.Methods Clinical data (best corrected visual acuity (BCVA) and OCT findings at baseline and at the end of the follow‐up) of 52 patients (76 eyes) were reviewed retrospectively. Patients who received only one intravitreal bevacizumab injection or whose medical data were missing were excluded.Results 76 eyes were treated with 1.25 mg intravitreal bevacizumab every 4 weeks at least with two injections for one eye and then continued if needed. The mean BCVA in patients with diabetic macular oedema at baseline (Snellen) was 0.31 (SD ±0.24). The mean number of intravitreal bevacizumab injections per eye was ‐ 3 (range 2‐8). Patients were observed for an average of 36 weeks. At the end of the follow‐up the mean BCVA increased to 0.4 (SD±0.31) and the central macular thickness detected on OCT decreased significantly (mean 325 (SD±228ϻm)). Four patients with resistant diabetic macular oedema underwent combined IVB and laser treatment. One case of endophthalmitis was observed.Conclusion Intravitreal bevacizumab seems to be effective and safe in the management of diabetic macular oedema in this short term retrospective study.

Drug hypersensitivity syndrome induced by Beta–lectam and “Cold3” for the same patient

Drug hypersensitivity syndrome is difficult to diagnose, as many of its clinical features could imitate systemic disorders. The aim of our study is to present the case of patient with drug hypersensitivity syndrome induced by two different kind of drugs in one year period. A 65-year female took amoxicillin due to viral bronchitis. The second day 6-8 hours after applying the drug she developed generalized maculopapular egzanthema with itchiness. She was hospitalized in Vilnius University Hospital Santariskiu Klinikos because of progressive symptoms. The elevation of liver enzymes and discrasia were found. Specific IgE to amoxicillin, ampicillin, penicillin G, penicillin V were negative. Symptoms completely disapeared after one month of treatment. After three months patch test with amoxicillin was carried out. 72 hours later the test was positive. Six months later patient was treated with COLD3 (paracetamol, pseudoephedrine, dekstrametorfan), a cedar oil and homeopathic medications because of respiratory viral infection. The same day similar clinical picture appeared. Three month later we performed patch test withCOLD3, cedar oil and homeopathic drugs. Patch test with COLD3, after 72 hours was positive and others - negative. Herpes simplex, EBV, CMV, and HBV, HCV were investigated and were negative.

Anaphylactic reactions induced by NSAID according to data of Vilnius University Hospital Santariskiu Klinikos

group, 10 (17%) in the alternative medication group. Immediate reactions were observed in 6 (10%) of all tested patients: anaphylaxis in 3 (5%), bronchospasm in 3 (5%). Two cases of anaphylaxis were observed in the first group, and only one in the second. Conclusions Most frequent adverse reactions were observed using ASA, while ketorolac and acetaminophen took the second place. True hypersensitivity was diagnosed for one fifth of the patients. Anaphylactic reactions to NSAID hypersensitivity appeared on 10% of them.

Beta‐lactam and CMV induced drug hypersensitivity syndrome

Beta-lactam antibiotics are one of the most common causes of drug allergic reactions. These reactions may be manifested by a concomitant viral infections caused by HIV, CMV, HHV6 or EBV, especially in children and less common in adults. The aim of our study is to present the case of adult patient with drug hypersensitivity syndrome caused by beta-lactams and manifestation of viral infection. A 45 years female was hospitalized in Vilnius University Hospital Santariskiu Klinikos with a fever over 38.5°C, dry cought and generalized maculopapular rash with diffuse itchiness. One week before she took amoxicilline for seven days. The symptoms appeared 24 hours after the last dose of antibiotic intake. The elevation of liver enzymes was found. A blood test was without eosinophilia. CMV-G and CMV-M were positive. Diagnosis of drug hypersensitivity syndrome induced by CMV infection and beta-lactam was made. Symptoms disappeared after a few weeks of treatment. Four months later drug provocation tests were performed. Patch test with amoxicillin was negative, as well as intradermal test with ampicillin, amoxicillin, penicillin G and cefuroxime. OPT with amoxicilin was without immediate reaction, however, generalized erythema appeared 7 hours later. Additionally, OPT with cefuroxime was without immediate reactions, however, generalized maculopapular rash and itchiness appeared 7-8 hours post OPT. The present case is an example of adult patient with CMV induced acute infection and the manifestation of true allergic reaction to beta-lactam antibiotics at the same time. Authors’ details Vilnius University, Lithuania. Vilnius University, Center of Internal Medicine, Lithuania. Vilnius University, Center of Pulmonology and Allergology, Lithuania.

Solid Pseudopapillary Neoplasm of the Pancreas: Analysis of Seven Cases

Background: The purpose of this study was to describe as well as compare our surgical treatment experiences of solid pseudopapillary neoplasms (SPN) of the pancreas and to provide a review of the literature. Methods: A retrospective analysis of data from Vilnius University Hospital Santariskiu Klinikos (VUH SK) and of the literature, which was researched using Karger Publishers, Springer Science, BioMed Central, and disserCat databases, was conducted. Results: From 2001 to 2012, seven cases were identified with pathologically confirmed SPN diagnosis. A precise preoperative diagnosis was made by computertomography and magnetic resonance imaging. The median diameter of the tumors was 6.36 cm (range 1.5-12 cm). Surgical treatment was undertaken for all patients. Results of the immunohistochemical analysis confirmed a nuclear accumulation of β-catenin. The Ki-67 level was 1-2% in all of the cases. According to our collected data, all types of histological analysis revealed decent prognostic behavior with low mitotic activity (1-2 mitoses per 50 high power fields). Besides, angioinvasion, perineural invasion, and outside capsule invasion were not detected. Conclusions: There was no correlation between more aggressive types of SPN and tumor size, localization, age, and gender.