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Investigation of new stable iron (II) compounds is still an actual problem of today. Therefore we synthesized ferrous oxalate and prepared a stable antianaemic powder Ferosol-1 including copper, zinc and cobalt. We used colour tests, precipitation reactions and paper chromatography for identification of components of this powder. Quantitative analysis of iron and other elements was performed using atomic absorption spectroscopy. We used Lichfield and Wilkinson method modificated by Roth to detect acute Ferosol-1 toxicity. To estimate a local action of this powder we used guinea pigs which were grouped into control and trial ones. We determined bioavailability of Ferosol-1 by giving it to rabbits with experimental posthemorrhagic anemia. Iron resorption was tested on 20-25 days old piglets. We also tried this drug on newborn piglets while atching their weight gain and calculation daily weight gain. This data was used to estimate indirect impact of Ferosol-1 on metabolism of piglets. According to our data Ferosol-1 is of low toxicity (LD50 = 2.25 g/kg), it does not irritate mucosa of duodenum and ventriculus and could be used orally. Iron from Ferosol-1 was found to be well assimilated and to take place in hemopoetic processes of rabbit. After administration of Ferosol-1 to piglets iron concentration in their serum increased from 35.03 +/- 0.66 to 54.88 +/- 6.63 mumol/l, hemoglobin concentration increased to 96.4 +/- 2.5 g/l, erythrocyte number increased to 4.4 +/- 0.14 x 10(12)/l. The same data of control piglets were respectively 83.7 +/- 3.1 g/l and 3.52 +/- 0.3 x 10(12)/l. According to our results Ferosol-1 is an effective drug for prevention of iron-deficiency anemia and causes slight weight gain of piglets.

Unlabelled: Alcohol abuse is considered one of the most important risk-taking behaviors among young people in the world. This paper presents the results of the WHO collaborative cross-national study on Health Behavior in School-aged Children (HBSC) carried out in Lithuania and other European countries also in USA, Canada, and Israel in 1994, 1998, 2002, and 2006., Objective: The aim of this study was to analyze features and trends in alcohol consumption among the samples of 11-, 13-, and 15-year-old adolescents (school-aged children) in Lithuania during 1994-2006., Material and Methods: Representative samples of 5428, 4513, 5645, and 5632 respondents aged 11, 13, and 15 years were included into school-based questionnaire surveys in 1994, 1998, 2002, and 2006, respectively. The standardized research methods were applied. The students have filled in the questionnaires anonymously in the classroom according to the methodology of international HBSC study. The students were asked about lifestyle habits, alcohol consumption, and episodes of drunkenness., Results: The number of students who had been drunk two or more times has increased by 2.5 times (from 9.8%. to 25.6%) during 1994-2006. A significant increase in alcohol consumption was observed among 15-year-old girls - the percentage of girls who have reported alcohol consumption almost approached the percentage of boys (50.3% and 56.8%, respectively; P=0.006). The reported mean age of the onset of first drinking had shifted by 2 years towards younger age during the period of 1994-2006. The comparison of data from 37 countries, participating in this cross-national study, revealed that the prevalence of alcohol consumption among Lithuanian school children is one of the highest (29.0% of boys and 22.1% of girls) and was in the second worst position on a rating scale when comparing with other 36 countries involved in HBSC study. The results suggest that increased use of light alcoholic beverages can cause an increase in the number of drinking teenagers. Ready-to-drink beverages ("alcopops") at least once per week were used by 15.3% of boys and 17.5% of girls (P=0.216); beer - 16.9% of boys and 5.6% of girls (P<0.001)., Conclusions: A significant shift of the onset of drinking alcohol towards younger age was observed in Lithuania during 1994-2006. In recent years, Lithuanian students as compared to peers from other countries are among those who consume alcohol most frequently.

Both traditional and new educational environments, the latter enriched with information and communication technologies, coexist in today's university. The goal of this article is to present the concept of educational environment enriched with information and communication technologies, to reveal the main features of such environment, and to present the results of certain investigation on the application of information technologies in teaching/learning processes at the Faculty of Pharmacy of Kaunas University of Medicine. The discussion object of this paper is the educational environment enriched with information and communication technologies. In designing the environments of this type, positive aspects of traditional teaching models are being developed by integrating them into the new educational environment. The concept of educational environment enriched with information and communication technologies is reviewed in the first part of this paper. The structure and main features of educational environments enriched with information and communication technologies are highlighted in the second part. The results of the study on the application of information technologies in teaching/learning processes at the Faculty of Pharmacy of Kaunas University of Medicine are presented in the third part.

In November 2006, the "Journal of Medical Ethics" published an article where prominent medical specialists stated that medical ethics, as a teaching and a theory, has no practical value. The article was based on the physicians' clinical experience and view that the theory of ethics has little in common with its application in daily practice and provides generalized guidelines for behavior, but is ineffective in decision-making in individual cases. At the same time, when describing conflict situations in healthcare, Lithuanian public press raises the role of ethics to the absolute and states that the lack or violation of ethics is the sole cause of all problems in healthcare, and there would be no problems if physicians behaved morally. From the viewpoint of an ethics professional, both controversial opinions deserve attention, and this paper is devoted to the analysis of these opinions. Ethical collisions and conflicts emerging in providing healthcare are not signs of the helplessness of medical ethics. Both viewpoints - the one disclaiming the role of medical ethics and the one attributing the absolute role to medical ethics - are equally erroneous. Decisions of the society and physicians are aggravated by health policy and the organization of healthcare in the country, as well as by a concrete individual's level of ethical thinking, worldview, and knowledge. Sometimes ethical collisions arise when there is a conflict among ethical principles themselves, and healthcare specialists have to decide which principle should be given priority. There are cases where setting priorities is impossible, and one has to admit that one single specialist is unable to solve the problem without his/her colleagues' assistance. Collective and collegial professionals' work helps to solve such ethical collisions.

The high morbidity and mortality in patients with serious heart failure is a therapeutic challenge for current medicine. The leading cause of left ventricular dysfunction remains ischemic heart disease. Coronary artery bypass surgery is a treatment of choice in moderate-to-severe ischemic cardiomyopathy. The scarcity of completed prospective randomized clinical trials and high surgical risks create significant uncertainty concerning the optimal current treatment strategy. The role of imaging techniques of assessment for myocardial viability based on current guidelines may be very important in clinical decision-making. Present paper reviews some of the relevant literature concerning surgical treatment of ischemic cardiomyopathy and current evidence-based recommendations on this method of treatment. In advanced heart failure, coronary revascularization alone is an insufficient treatment modality. In the presence of moderate-to-severe ischemic mitral regurgitation, mitral valve repair or replacement should be considered at coronary artery bypass grafting surgery. One of the most common mechanisms of ischemic mitral regurgitation is Carpentier's type IIIb dysfunction, in which an undersized mitral anuloplasty might be helpful. Surgery of left ventricular shape and volume restoration leads to improvement of left ventricular function in patients with ischemic cardiomyopathy. When the results from three ongoing prospective randomized studies--the Surgical Treatment for Ischemic Heart Disease trial, Heart Failure Revascularization trial, the PET and Recovery Following Revascularization-2 trial--determining outcome of revascularization versus medical therapy are available, clinicians will have reliable data for making decisions concerning the optimum treatment strategy. At present, the choice of management still remains based on the data obtained from available retrospective trials or the state of art in the field.

The aim of this paper is to reveal tendencies on competence and ability education when realizing undergraduate public health study program in the interaction context of traditional and modern higher education features. Competence is implementation of qualification or the ability to act, conditioned by individual's knowledge, skills, motives, personal characteristics, and values. The integrated competence is necessary for the change of the internal and external work conditions; it is based on the integrity of behavior and knowledge that conditions the essential change of activity. The holistic competence is necessary for a new work development and the transfer of qualification to new situations; it is conditioned by holistic approach toward education. When researching undergraduate public health study program in the context of traditional and modern higher education features at Kaunas University of Medicine, the following problems were stated: insufficient qualities of student's self-analysis, self-directed learning and formation of communication skills; insufficient communication of teachers and students during study process; limited possibilities team work with representatives of other professions when solving problems of public health improvement.

The present paper is dedicated to docent Antanas Adomaitis, anatomist and anthropologist, former member of editorial board of journal "Medicina", on the occasion of his 65th birthday and 40 years of scientific activity. First publications of Antanas Adomatis appeared in the 1960s, and now the list of his scientific publications exceeds 140 in number. The research field of docent Antanas Adomaitis is wide and covers problems from growth and development to physical status of adult people and its changes associated with a particular period. However, his most important scientific works are in the field of clinical anthropology. Antanas Adomaitis investigated growth and maturation under pathological circumstances, body composition of adult people, prevalence of obesity, growth diversity and secular trend: in 1975 he defended his thesis entitled "Physical development and sexual maturation of children with congenital heart defects" for the degree of Doctor of Medicine, later focused on growth and development of children with congenital facial anomalies, also blind and weak-sighted children. Recently docent together with the other scientists of our Department investigates growth variety of children from different towns and rural areas of Lithuania. Antanas Adomaitis collected probably most anthropological data on Lithuanians (children and adults)--this is ponderable contribution to Lithuanian auxology and clinical anthropology, valuable material for the future researches of growth and maturation, also physical status of adult people and secular trend.

On the occasion of 65th birthday of Professor Gintautas Cesnys present paper gives a review of scientific and other activity of this outstanding personality - the expert member of Lithuanian Academy of Science, former Dean of the Medical Faculty (1988-1999) and Head of the Department of Anatomy, Histology and Anthropology (1988-2001) of Vilnius University, prizeman of Lithuanian National Prize of Science (1989) and Estonian State prize (2005). Gintautas Cesnys graduated from Medical Faculty in 1963. His scientific and pedagogical activity developed from problems of auxology (first dissertation "Auxological characteristics of Lithuanians during infancy, longitudinal study, 1970") to ethnic anthropology (second dissertation "Anthropology of ancient inhabitants in Lithuania", 1986). Recently Professor devotes his scientific potentiality for generalizing and summing up of the main historical moments and most outstanding personalities of Lithuanian anthropology.

Background: Clear patient selection criteria and indications for laparoscopic repair of perforated duodenal ulcers are still of relevance. The purpose of our paper is to describe the early outcome results after this operation and to define the risk factors influencing the genesis of postoperative morbidity., Patients and Methods: Fifty-one patients were operated on laparoscopically between October 1996 and October 2003 for perforated peptic ulcers. Out of them, 47 patients with perforated duodenal ulcers entered the final retrospective analysis. Twenty variables were identified, including the duration of acute symptoms before the operation, shock, underlying medical illness, ulcer size, age, Boey score and the predictive value of these variables for morbidity, conversion rates and hospital stay. The univariate data analysis was originally done using the Fisher exact test, t test, Mann Whitney, ANOVA and F tests. The data was reevaluated using multifactorial analysis with logistic and linear regression tests., Results: Patient's age was 32.0+/-12.4 years. Duration of perforation was 8.0+/-10.8 hours. Shock was diagnosed in one patient (2.1%). High surgical risk according to ASA (III-IV) was estimated in 2 patients (4.3%). Laparoscopic duodenography was completed in 36 patients (76.6%). The other 11 patients (23.4%) underwent a conversion to open repair. Seven patients (19.4%) had postoperative complications. Suture leakage was confirmed in 4 patients (11.1%), and other abdominal complications were observed in 3 patients (8.3%). Pneumonia and pneumothorax were diagnosed in 3 patients. Hospital stay was 7.9+/-5.8 (4-45) days. There was no mortality. Ulcer perforation size >4-10 mm is the only significant risk factor influencing the conversion rate. An increase in the suture leakage rate was most significant with delayed presentation of >or=10 hours (p<0.0001). This risk factor influences both the postoperative pneumonia rate (>or=10 hrs., p=0.026) and hospital stay (p<0.05)., Conclusion: Size of duodenal ulcer perforation and duration of ulcer perforation symptoms were found to be risk factors influencing the rates of conversion to open repair and genesis of postoperative morbidity.

The paper presents a review of the scientific publications on Rhodiola rosea L. known for its adaptogenic characteristics. Biologically active substances salidroside, rosin, rosavin, rosarin and tyrosol, which are mainly found in plant rhizomes, demonstrate therapeutic effect. These active components effect the central nervous system by increasing the ability to concentrate, the mental and physical power; they are efficient in the asthenic states and improve general resistance of the cells and the organism against the harmful outer influence. They also prevent the heart system from stress and arrhythmias, and posses some antioxidant activity. Some data confirm that the Rhodiola rosea L. preparations stop the growth of the malignant tumors and metastases in the liver. Some preclinical and clinical data of the golden root preparations are discussed in the survey. The interaction of the herb with other medicines, its usage and effect, recommended doses, and its side effects are also reviewed in the paper.

Today the Institute of Oncology of Vilnius University continues the scientific activities of the former Lithuanian cancer research institutions. The main mission of the Institute is to perform fundamental and applied research in the field of oncology. In addition, the Institute helps Vilnius University to train oncology specialists and researchers as well as provides health care services. The main scientific activities of the Institute of Oncology are the following: development of tumor prevention based on epidemiologic, experimental, molecular and clinical investigations; development of new technologies and methods of early cancer detection and treatment; and improvement of the quality of life of cancer patients. The summary of the most important research and development projects in the Institute of Oncology is presented in this paper.

The intrinsic autofluorescence properties of biological tissues can change depending on alterations induced by pathological processes. In this paper, autofluorescence properties of normal and tumor tissue are presented and possibilities of the application of autofluorescence as a parameter for in situ cancer detection in different organs are discussed. Data obtained during in vivo measurements of normal and pigmented skin autofluorescence are presented. Autofluorescence of experimental tumor (hepatoma A22) was measured to discriminate the optical differences between necrotic, non-necrotic and hemorrhagic areas of tumor and healthy tissue. It was concluded that the uneven distribution of endogenous porphyrins fluorescence in non-necrotic tumor tissue as well as the absence of endogenous porphyrins fluorescence in the small experimental tumors complicated the diagnosis of cancerous tissue based on the autofluorescence measurements.

Despite the appearance in clinical practice of modern treatment modes as thrombolysis and percutaneous coronary intervention, in-hospital mortality from acute myocardial infarction remains an important problem. In this paper we review recently published data concerning risk stratification in the acute phase of myocardial infarction, different factors affecting the prognosis, their dynamics in the course of the disease, and inter-factor relations. We emphasize the prognostic value of three factors: heart rate variability, left ventricular dysfunction and arrhythmias. Changes in heart rate variability are discussed in association to location of myocardial infarction, patency of infarct-related artery, the chosen treatment mode and its timing. Left ventricular diastolic function and right ventricular function are shown to be predictors of morbidity and mortality after myocardial infarction besides left ventricular systolic function. We also present the latest data concerning the prognostic implication of arrhythmias, their relation to left ventricular function and autonomic nervous system balance. Atrial fibrillation and atrial flutter appear to be important factors in predicting mortality after myocardial infarction, especially in the elderly, as well as ventricular arrhythmias - sustained ventricular tachycardia and ventricular fibrillation.

Postoperative lung injury is one of the most frequent complications in cardiac surgery that has a significant impact on health care expenditures and largely has been believed to result from the use of cardiopulmonary bypass. Cardiopulmonary bypass induces the whole body inflammatory response leading to postoperative lung dysfunction. Pulmonary complications after these operations take the first place in morbidity and mortality rates. Despite the modern technologies and new surgical techniques, cases of pulmonary alterations after cardiopulmonary bypass are not rare. Therefore, the prevention of such alterations is an urgent problem worldwide. Still it is not known what is the cause of pulmonary alterations, as well as there are no means to prevent them. In our paper we review the international studies in order to present worldwide practice of prevention of pulmonary alterations using various methods of mechanical lung ventilation.

The flavonoids (rutin, quercetin, and isoquercetin) and hypericin are the main active substances of St. John's wort (Hypericum perforatum). They support regeneration of human body cells, provide disinfection, and act as antidepressant, antiviral, and anti-inflammation tools. Such large spectrum of the applicable functions depends on the quantity of each substance. The objective of this paper is to determine the regularities of the quantitative variation of rutin, quercetin, isoquercetin and hypericin in flowers and leaves of St. John's wort in different habitats and different plant development phases. Plant material for the quantitative analysis was collected in 1998-1999. The high performance liquid chromatography (HPLC) was applied for the quantitative analysis of the active substances in St. John's wort. The flavonoids (rutin, quercetin, and isoquercetin) were identified under the UV waves of 254 nm, and hypericin - under the waves of 590 nm. Larger quantities of rutin were found in leaves, while those of quercetin, isoquercetin and hypericin - in flowers of St. John's wort. The highest accumulation of active substances was observed during the development of flowering buds and in flowering time. The quantitative variation of active substances in different habitats allows the selection of the best plant samples for their cultivation and conservation in field collections.

Objective of the paper was to review the latest scientific reference data on chemoprevention possibilities of lung cancer. Lung cancer is the leading cause of cancer death in Lithuania. The current lung cancer therapy includes surgery, radiation and chemotherapy. These interventions have not produced declines in mortality rates. This overview argues strongly for new approach for controlling this disease. Chemoprevention is the use of specific natural or synthetic substances with the objective of reversing, suppressing or preventing carcinogenic progression to invasive cancer. Whether primary, secondary or tertiary prevention has the potential to improve the dismal statistics associated with this cancer? Several randomized clinical or translational chemoprevention trials have been conducted. All have so far produced either neutral (using retinal, retinyl palmitate, N-acetyl cysteine or isotretinoin) or harmful (using beta-carotene) primary endpoint results showing that lung cancer was not prevented in smokers. Secondary results supporting treatment with isotretinoin in "never" and former smokers and data from prevention trials involving selenium and vitamin E, however, are encouraging and offer a promising direction for future clinical study.

Diabetes is becoming one of the major public health problems because a great proportion of the healthcare expenditure has been spent on the treatment of its associated morbidity and mortality. Diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations as well as long- and short-term disability. In addition, persons with diabetic complications have a lower quality of life compared with persons without diabetes. The goal of this paper is to review the studies on the costs of diabetes, to identify the strengths and limitations of currently available diabetes cost studies, and to identify future research areas that will help us to better understand the economic burden of diabetes. The economic burden of diabetes mellitus is enormous in the world. Cost or illness estimates are often cited as an important element in the choices made regarding diabetes care and management. Studying these economic aspects presents several challenges, such as collecting the appropriate epidemiological and cost data, determining the diabetes attributable factors for premature morbidity and mortality, and determining methods to account for premature morality, disability, and reduced quality of life. The cost to care for diabetes puts a tremendous burden on both the patient and the payer. The direct cost of diabetes increased from 1.7 billion US dollars in 1969 to 44.4 billion US dollars in 1997. Several studies over the years have found that indirect costs related to diabetes are higher than direct. Indirect costs during 28 years increased 33 times, from 1.6 billion US dollars in 1969 to 54.1 billion US dollars in 1997. The expenses of one diabetic patient highly vary in different countries: from 13 US dollars in Bangladesh to 11,157 US dollars in USA per one year. Most of diabetes expenditure is used to pay for inpatient services (60-85%); the biggest part of it is incurred because of late diabetes complications (70%). Diabetes accounted to 3-12% of total healthcare expenditure in different countries. In this era of limited resources and escalating costs, it is critical to have an understanding of the economics of diabetes in order to develop and implement sound public health and prevention policies.

Randomized controlled trials that compared primary percutaneous transluminal coronary angioplasty with thrombolysis have shown that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction. Three large myocardial infarction registries - MITI, NRMI-2 and French registry - failed to show an advantage of primary angioplasty compared with thrombolysis. One of the latest trials mentioned in this paper restored the place of primary angioplasty as superior to thrombolysis in acute myocardial infarction. Data of patients treated with primary percutaneous transluminal coronary angioplasty in Clinic of Cardiology of Vilnius University are presented.

Unlabelled: The aim of this paper was to analyze and to evaluate women's opinion on hormone pills and the influence on hormone pill usage and reveal the main sources of information., Material and Methods: Women who came for pregnancy termination (Group A) and women who came for consultation on further usage of contraception (Group K) have been interrogated. Interrogation according the special questionnaire has been performed at four consultation centers and three gynecologic clinics of Kaunas city. It was find out that due to the wrong information 25.1% of women in group A and 35% of women in group K thought that hormone pills cause irregular bleeding (p=0.01). Another myth - the possibility to become pregnant when taking pills - was indicated by 17% of women in group A and 32.4% of women in group K (p=0.01). Nine percent in group A and 12% in group K were confident that when taking hormone pills for some period of time one will not be able to become pregnant in the future. Seventy three percent of group A women and 80% of group K women indicated that the use of hormone pills increases the body weight (p=0.01). This research showed that the women that used hormone pills were properly informed about their treatment and side effects. Fifty four percent of group A women and 36% of group K women indicated that hormone pills were not suitable in case of several diseases (p=0.01). Eighty three percent of group A women and 71% of group K knew that hormone pills did not protect from cervical cancer (p=0.01). This information was mainly obtained from medical workers. The main reason why women of fertile age who took part in our research used little of hormone pills was false information received from insufficiently skilled persons and accordingly the negative opinion about hormone pills., Conclusions: Women's opinion on hormone pills is a very important factor for its usage. This opinion depends on sources of information, whether women received correct or false information on hormone pills. The most reliable source of information indicated by investigated women was medical personnel.

Gliomas are the most common type of primary intracerebral neoplasm. They carry a dismal prognosis. The main prognostic factors are patient age, performance status and malignancy grade. Because patients with the same histologic diagnosis have variable outcomes, there is a need to develop better prognostic markers with the aim of predicting tumor behaviour and response to therapies. This paper reviews different morphological, genetic, molecular factors and their association with survival. Tumor associated morphological features such as predominant cell type, cellularity, cytological atypia, proliferation activity, microvascular proliferation, necrosis and apoptosis are discussed in some detail.

Arthritis, following infection caused by group A beta-hemolytic streptococcus, is classically attributed to acute rheumatic fever. However, a new clinical syndrome, called poststreptococcal reactive arthritis, as a distinct entity from acute rheumatic fever, was described recently. The purpose of this paper is to provide a summary of published information on poststreptococcal reactive arthritis. The paper outlines its clinical description and proposed diagnostic criteria. Similarities and differences between poststreptococcal reactive arthritis and acute rheumatic fever are discussed. Information regarding long-term risk of carditis following poststreptococcal reactive arthritis is provided, and therapeutic recommendations are outlined.

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 = 14 kg/m ( 2 ) - the underweight, 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.

Bronchiolitis is the most common lower respiratory tract infection in infants and is responsible for the majority of pediatric hospital admissions in winter. Respiratory syncytial virus has been identified as the main causative agent, causing 50-90% of the cases of bronchiolitis. Despite significant advances in pharmacotherapy, the management of infants with bronchiolitis has changed little over the years from supplemental oxygen and good fluid management. Approaches to therapy vary widely all over the world and are controversial. This paper reviews current treatment options for bronchiolitis, including the use of bronchodilators, epinephrine, steroids and ribavirin. Most recent advances, including immunotherapy and intensive care, are discussed.

Growing numbers of morbidity and mortality due to the Coronary Heart Disease (CHD) is recognized as the more increasing challenge in the world. The initial stage of atherosclerosis, early diagnosis and treatment of CHD are the main objectives of current research. Endothelium dysfunction, the earliest expression of the atherosclerotic process is associated with subtle biochemical changes that gradually are transformed into the structural changes of the arterial wall. The theory of free radicals is the most common among the atherosclerosis explanations. Overproduction or impaired neutralization of the free radicals accounts for oxidative stress that is causing substantial damage to the low density lipoproteins, nitric oxyde (NO), endothelium cells, tissue cells and finally leads to the endothelium dysfuction. Pathophysiology of oxidative stress and its role in the endothelium dysfunction are discussed in this paper. Positive role of various medications (statins, angiotensin converting enzym inhibitors, aldosteron antagonists, estrogens, antioxidants, b-blockers with vasodilatative properties) to the oxidative stress and consequently to the endothelium dysfuction are discussed as well.

The objective of this work is to produce chewable tablets out of Echinacea purpurea liquid extract (1:1) and ascorbic acid: to create the technology, to select methods of analysis and to examine stability. The paper describes the technology of tablets: a method of condensation is chosen; the influence of additional substances over tableting is established; pressing characteristics of tableting mixtures are examined. The quality of tablets is evaluated in terms of appearance and technological rates: average tablet mass, hardness against pressure, hardness against wearing, time of disintegration, and speed of ascorbic acid secretion. The identity of ascorbic acid, ferments and hydroxycinamon acid was established. Quantities of ascorbic and chicory acids were defined. The tablets produced were named "Askoeziuofito" tablets. The name consists of abbreviated terms of ascorbic acid, Echinacea plant and phytochemical preparation.

This study presents the results of analysis of 134 lung cancer patients treated with radiotherapy in 1999-2002. The objective of the paper was to evaluate the importance of some prognostic factors on survival of lung cancer patients. We have analyzed influence of patient's age, stage of the disease, tumor size, lymphnodes status, histological type and radiotherapy dose to the survival of lung cancer patients. Among analyzed patients 87% were males and 73.9% were more than 60 years old. Locally advanced lung cancer was diagnosed in 65.6% of cases. The non-small cell lung cancer was diagnosed in 83.8% of cases. During the study period 58.2% of patients died. Statistically significant prognostic factors in our study were: stage, locally advanced lung cancer, involvement of the lymphnodes, III B and IV of the disease. The survival of the patients depends on the radiotherapy dose in our study. The better survival was associated with the bigger than 50 Gy dose (p<0.001).

Experiments with piglets showed good assimilation and metabolism of iron (II) in antianaemic powder Ferosol-1. In order to improve this drug, manganese, calcium (Ferosol-2, 1 composition) and ascorbic acid (Ferosol-2, 2 composition) were added. Manganese and ascorbic acid stimulate erythropoiesis and being strong reductants stabilize iron (II) on storage and in gastrointestinal tract. Components of Ferosol-2 were identified using colour, precipitation- and extraction tests, as well as paper chromatography and absorption spectroscopy. Quantitative analysis of microelements and ascorbic acid was performed using absorption spectroscopy, extraction photometry and iodometric titration methods. Ferosol-2 proved to be more stable than Ferosol-1. Lichfield and Wilkinson method modificated by Roth was used for detection of acute toxicity of Ferosol-2. A local action was estimated on quine pigs. Iron resorption was on 20 days old piglets. Antianaemic effectiveness of Ferosol-2 was evaluated on newborn piglets watching their weight. Experiments with white mice showed low toxicity of Ferosol-2 (LD50 = 4.3 g/kg, for 1 composition and 4.6 g/kg for 2 composition). It does not irritate mucosa of duodenum and ventriculus. Iron in Ferosol-2 was found to be well assimilated in gastrointestinal tract of piglets, easily gets into blood and joins albumen of plasma. After administration of Ferosol-2 to piglets increased iron concentration in blood serum was observed for 3 hours (1 composition) and 6 hours (2 composition). Experimental data showed increased resorption of iron in Ferosol-2, 2 composition due to ascorbic acid. Components of Ferosol-2 are well assimilated and join erythropoetic processes. Ferosol-2 leads to quicker weight gain as well as significantly higher amount of hemoglobin and red blood cells in piglets.

The aim of present paper is to analyze immunological changes due to Ross operation. Cellular immune response as well as incidence of antibodies directed against human leukocyte antigens were studied in patients who received cardiac valve allografts. Standard microlymphocytotoxicity test was used to determine the percentage of panel reactive antibodies. Activated lymphocyte response to Pokeweed mitogen was revealed in patients after Ross operation. The panel reactive antibodies became positive in 3 out of 6 recipients tested. This production of donor specific anti-HLA antibodies can contribute to graft failure in case of subsequent cardiac transplantation.

The article overviews the summarized published data concerning determination of brain death in different countries. The paper is based on some foreign guidelines, as well as recent literature. Brain death has been discussed extensively for the last 30 years. Brain death is defined as cessation and irreversibility of all brains function, including brain stem. Brain death is equivalent to death of the individual, even though the heart continues to beat and spinal cord functions may persist. There are no internationally accepted guidelines for diagnosis of brain death. Different sets of criteria, based on the Harvard Medical School criteria (1968), are used in different countries, and have been revised and updated in the recent years. The exact identification of the preconditions is among the most important requirements. The cause of coma has to be known and sufficient to account for the irreversible loss of all brain functions. Coma and apnea must coexist as well as absence of brainstem function. Cultural differences can lead to fundamentally different approaches to brain death determination. Moral, ethical, religious as well as educational factors, including mass media are important in the determination brain death in different countries. Brain death is both a medically and legally important event. In some Western countries, the legal and medical systems have cooperated, while in others only the medical system is working. There are no medical criteria and no legal support in Egypt, many Islamic and African countries. Brain death can usually be diagnosed reliably by clinical criteria alone. However, there are special circumstances when these are not suitable and cannot be applied and confirmatory instrumental test is required for the diagnosis of brain death. In the paper is presented algorithm of the brain death determination developed according to the some foreign guidelines, as well as literature.

Unlabelled: The objective of our paper was to show the data of our treated patients with malignant pleural mesothelioma. In the Department of Thoracic Surgery of Oncology Institute at Vilnius University from 1980 till 01.06.2002, 33 patients (pts), to whom diagnosis of pleural mesothelioma was confirmed by pathologist, were treated in the Clinic. A malignant pleural mesothelioma was diagnosed in 31 pts, two pts had a non-malignant form of mesothelioma. Among patients were 19 men and 14 women. The distribution of pts according to the stage of the disease was: I stage - 3, II - 1, III - 17, IV - 10. Videothoracoscopy is the best method for diagnosing pleural mesothelioma. Radical operations were performed only in 17 cases: 6 - pulmonectomy with pleuroectomy, 1 - lobectomy, 3 - atypical segmentectomy, 4 - pleuroectomy, 4 - tumorectomy. Thoracotomy was performed in 9 cases. Insufflation of talc was performed in 6 pts. Adjuvant therapy (chemotherapy or radiotherapy) was given to 10 pts., Results: Nineteen pts died of the progression of disease. Median survival of pts was 15.7 months., Conclusions: 1. Diagnosis of malignant pleural mesothelioma is difficult and confirmation of the disease is possible only after histological examination of tumor. 2. The best results of treatment were achieved after combined treatment: surgery, after chemotherapy and radiotherapy. 3. In cases of pleural effusion of diffuse pleural mesothelioma insufflation of talc or other chemical substances into pleural cavity is recommended.

Apoptosis or programmed cell death is genetically determined process to destroy cells for the maintaining of cellular homeostasis in the tissue. This paper reviews the current knowledge on the molecular mechanisms of apoptosis. Activation of cysteine proteases called caspases plays a major role in the execution of apoptosis. These activated caspases selectively cleave cellular proteins, which result in apoptotic morphology (internucleosomal fragmentation of DNA into 180-200 base pair pieces, shrinkage of the cell and the nucleus as well and fragmentation of the cell into apoptotic bodies) and death of the cell. Now two pathways of caspase activation are reported. The first through triggering of cellular death-receptor superfamily. The second is mitochondrial pathway induced by the changes of the expression of pro- and anti-apoptotic genes in the cell. It leads to release of cytochrome c and apoptosis inducing factor from mitochondria. The paper reviews also currently used methods of detection of apoptotic cells in tissue samples, causes of false-positive or false-negative results of ISEL and TUNEL in situ reactions.

The paper describes prevalence, mechanisms of development, clinical features of osteoporosis, its complications and the principles of treatment. It includes an overview of the universally accepted diagnostic methods and criteria and discusses the diagnostic value of laboratory and instrumental investigations. The significance of radiological methods of the diagnosis is emphasized with regard to the problems related to differential diagnosis and appropriate evaluation of the risk factors for osteoporosis and fractures. Contemporary methods of both, prevention and treatment of osteoporosis, depending on the bone mineral density and risk factors for osteoporosis, are presented. Possible problems of tolerance and common adverse drug reactions are discussed.

The material of this publication is dedicated to the memory of Professor Vladas Lasas, honored scientist of Lithuania, member of Lithuanian Academy of Sciences and corresponding member of the Academy of Medicine of the USSR. V. Lasas was born on January 13th, 1892, on a farmstead in Rokiskis region, Lithuania. He died on January 2nd, 1966 in Kaunas. V. Lasas studied medicine at the Faculty of Medicine of Tartu (Dorpat) University and graduated from it in 1918. In 1921 he was invited to deliver lectures on physiology at the newly organized Higher Courses in Kaunas. During 1920-1924 he attended higher educational establishments of Prague, Berlin, Lausanne and Paris. In 1924 V. Lasas worked on probation in Lausanne under supervision of famous scientist M. Arthus, the founder of experimental allergy--anaphylaxis, in the field of experimental anaphylaxis, desensibilization, enteral sensibilization and resorption of native albumins, transfer of allergic state from mother to fetus, the role of interoceptors and biologically active substances in the formation and development of anaphylaxis. Over 40 scientific papers were published and 12 doctoral these were maintained, dealing with these problems. From 1924 to 1940 and from 1944 to 1946 V. Lasas acted as dean of the Faculty of Medicine at Kaunas University. During this period he displayed great organizational talent, and on his initiative three basic clinical buildings were built for the Faculty of Medicine. In 1946 V. Lasas was elected as academician and appointed as secretary-in-charge of natural mathematical and applied science of the Academy of Sciences of Lithuania. V. Lasas was the founder and longstanding chairman of the Lithuanian Physiological Society. Alone and with coauthors he has published 16 original textbooks. The list of his bibliography accounts to 229 publications.

In 2002 phthisiologist J. Runkevicius turned 100 years of age. Associate professor doctor J. Runkevicius (1902-1966) was the first in midwar Lithuania to commence epidemiological investigations of tuberculosis and continued them all his life. Having graduated from the Vytautas Magnus university, from 1933 to 1937 he worked as a physician at the Kaunas Red Cross tuberculosis sanatorium and in 1937-1940 as a head physician at dr. K. Grinius sanatorium of the Society for the fight against tuberculosis. In 1938-1939 he improved his skills at the tuberculosis treating institutions in Switzerland and Finland. In 1940-1941 and 1944-1945. J. Runkevicius was a head physician of the Alytus national tuberculosis hospital and in 1944-1945--chief of the health care department in the Alytus district, too. After his studies J. Runkevicius began his scientific researches. The object of his research was teachers of primary schools, their infectiosity with tuberculosis, and the dependence of morbidity with tuberculosis on the living conditions. Dr. J. Runkevicius generalized his researchers in his thesis "Tuberculosis in bourgeois Lithuania according to clinical roentgenelogical examination data of consecutive groups", maintained at the Faculty of Medicine of Vilnius university in 1949. Since 1945 up till his death in 1966, Dr. J. Runkevicius has been working at the Faculty of Medicine of Vilnius University, chair of therapy. In 1945-1946 concurrently he headed the Department of Tuberculosis of the Ministry of Health. In 1947-1949 he was a deputy dean of the Faculty of Medicine. While being a lecturer of Vilnius university, Dr. J. Runkevicius also worked as head of the organizational-methodic department of the National scientific research institute of tuberculosis. Doc. Dr. J. Runkevicius was one of the first phthisiotherapists in Lithuania who made every effort in the organization of preventive roentgenelogical examination of teachers and students with the view of diagnosing the cases of tuberculosis. Dr. J. Runkevicius supervised the scientific research work of physicians, he was written more than 30 papers. While working at the National scientific research institute of tuberculosis and Vilnius university, Dr. J. Runkevicius has done a lot in the fight against tuberculosis in Lithuania.

Unlabelled: The objective of the paper was to evaluate the importance of maternal social factors, health behavior (smoking, alcohol drinking and drug abuse) and working conditions on incidence of low birth weight (LBW)., Material and Methods: Statistical analysis was performed utilizing database of Medical Birth Registry for the years 1995-1998 using the indicators of maternal social factors, health behavior and working conditions. Statistical analysis was carried out using statistical package SPSS 10.0., Results: During 1995-1998 the incidence of LBW (< 2500 g) was 3.6 per cent. Young (< 20 years) and older (> or = 35 years) maternal age, low (primary or basic) education and "lone mother" status (single, divorced or widowed) increased the risk of delivering LBW baby. The odds ratio of smoking mothers to deliver LBW baby was 3.3. Odds ratios of LBW newborns associated with alcohol drinking and drug abuse were 10.3 and 6.1 respectively. The odds ratio of mothers physically abused during pregnancy to deliver LBW baby was 2.7. However, the harmful working conditions were not associated with the higher odds of LBW. Young and older age was attributable for 22.2 and 49.3 per cent LBW cases in the exposed group respectively. While attributable fraction in exposed due to the low educational level and unfavourable marital status accounted to 38.9 and 52.9 per cent LBW cases respectively. Smoking was attributable for 68 per cent LBW cases, alcohol drinking--87.2 per cent, drug abuse--80.5 per cent LBW cases among exposed mothers. Preventable population attributable risk for unfavourable marital status was 11.7 per cent, low education--9 per cent, smoking--8 per cent, older age--6.9 per cent. Drug abuse and hard manual work had minimal association while harmful working conditions were not associated with higher risk to deliver the LBW baby in the total population., Conclusions: Maternal health behavior peculiarities and hard manual work are related to newborns' birth weight, and medical professionals should encourage quitting the hazardous habits and regulation of workload for expectant mothers. Adverse social factors contribute to the higher incidence of LBW. The solution of social problems should become the priority of State health policy.

The qualitative and quantitative method of determination of amitryptilin, codeine and fluoxetine in the mixture using high-pressure liquid chromatography is described in this paper. Chromatogram is presented which shows, that preparations are fully separated and do not interfere each others analysis. Tables with chromatographical separation characteristics are also presented. Proposed calibration curves of quantitative analysis and calculated medium relative error of quantitative ascertainment for every preparation of the mixture are shown. Final conclusion: method is applicable for qualitative and quantitative analysis of amitryptiline, fluoxetine and codeine in the mixture in hasty poisoning cases.

Alfonsas Kaikaris (1922-1997) was a professor of pharmacy at the Kaunas Medical Institute (now University), historian, museologist, founder of the Lithuanian Pharmacy Museum and of the field of pharmacy history in Lithuania. A. Kaikaris was born in Zagare in 1922. He received his pharmacy diploma in 1947 and began work at the university. Following the reorganization of the university into two institutes, he went to work in the Medical Institute, where he served as the vice dean of the Pharmacy and Stomatology Department from 1957 until 1963. He began to collect pharmaceutical artifacts in 1957. In 1973, the Institute provided a small room in the attic for these objects and so a small pharmacy museum, the first in Lithuania, was born. Thanks to the hard work of A. Kaikaris and others, today this museum has grown into the Pharmacy and Medical History Center of Lithuania, whose work is widely known throughout Europe. A. Kaikaris was also a member of the board of the Lithuanian Scientific Society and head of the Society's Pharmaceutical History Section from 1964 until he retired in 1987. He is the author of 67 scholarly papers and numerous popular articles and conference presentations. In 1988, he received the Paul Stradins Award from the Paul Stradins Medical History Museum in Riga, Latvia, and until his death in 1997 worked as a consultant to the Lithuanian Museum of the History of Medicine and Pharmacy.

The paper describes the typical clinical features of rheumatoid arthritis and principles of its treatment. It includes an overview of the universally accepted diagnostic criteria and discusses the diagnostic value of laboratory and instrumental investigations. The significance of correct diagnosis in an early stage of the disease is emphasized with regard to the difficulties related to differential diagnosis. Appropriate evaluation of the inflammatory activity of rheumatoid arthritis and of the functional state of the patient is discussed. Contemporary principles of complex and individual treatment of rheumatoid arthritis, depending on the course of disease are presented, placing special emphasis on the importance of disease--modifying treatment. Possible side effects of NSAIDs and glucocorticosteroids and methods of their prevention are discussed, as well as indications for new biological medications.

The paper presents data on the prevalence of health affecting behavior factors--tobacco smoking and alcohol consumption in the region of Northern Lithuania (the districts of Birzai, Pasvalys and Pakruojis). In 1997-98, 1580 residents of this region were surveyed using the questionnaire prepared according to the recommendations of the WHO experts. Analysis of the study--patterns in tobacco smoking and consumption of alcoholic beverages--showed that 51.3% of males and 12.5% of females smoked every day. More male smokers were found in the countryside, while more female smokers--in towns. Most smokers were found in 30-39 year--old group (14.6% and 6.1%, respectively). Single women smoked more often than married ones or widows (p < 0.05). Irrespective of the marital status, the greatest proportion was of those who consumed alcohol at least once a month. There were 3.6 times more married women who never consumed alcoholic beverages compared to married men (p < 0.05). The prevalence rate of risk factors depended on education: men with higher education smoked more seldom than those with lower education; there were no men consuming alcohol every day among those with higher education; women with higher education smoked more often than those with lower education; with education getting higher, the number of women who never consumed alcohol was decreasing. In all age groups the highest proportion was of those who consumed alcohol once a month; somewhat lower was the proportion of those who consumed alcohol once a week.