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Tyrimo tikslas. Ištirti ūminio inkstų nepakankamumo priežastis, inkstų funkcijos atsikūrimo dažnį, pacientų išgyvenimą. Tirtųjų kontingentas. Kauno medicinos universiteto klinikose 1995–2006 m. pakaitine inkstų terapija gydyti 1653 pacientai (584 moterys ir 1069 vyrai), sirgę ūminiu inkstų nepakankamumu. Rezultatai ir išvados. Nuo 1995 iki 2007 m. žmonių, kuriems nustatytas ūminis inkstų nepakankamumas, skaičius išaugo devynis kartus. Vyrų sirgo reikšmingai daugiau nei moterų (p

The objective of this study was to examine the factors affecting quality of life in renal transplant patients and to evaluate the association between depression and quality of life. Material and methods. A study was carried out in 61 renal transplant patients. Health-related quality of life was evaluated using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire. Depression was measured using the Beck’s Depression Inventory (BDI). Results. Twenty percent of the subjects had a BDI score higher than 15. The BDI score correlated inversely with these quality-of-life domains: physical functioning (r=–0.691, P

The aim of the study was to evaluate the causes, prevalence, and grades of chronic renal failure in Lithuanian children and to assess its influence on children's growth. The study was performed in Vilnius University Children's Hospital and Clinic of Children's Diseases, Kaunas University of Medicine. By March 31, 2006, 65 children with chronic renal failure had been registered. The prevalence was 88.3 cases per million children. The mean age was 10.8@4.9 years. The leading causes of chronic renal failure were congenital diseases (37) and obstruction with interstitial nephritis (33.8). At presentation, 23 (35.40) children had mild, 17 (26.15) had moderate, 9 (23.85) had severe renal failure, and 16 (24.6) had end-stage renal disease. Fourteen (21.54) children were below the third percentile in height for their age. Growth failure was observed in one (4.35) child with Grade 1 renal failure. The deterioration of renal function had a significant influence on growth impairment, and 13 (30.95) children with glomerular filtration rate of less than 60 mL/min/1.73 nrand 7 (43.75) with end-stage renal disease had a height below the third percentile. Growth retardation as one of the symptoms of impairment of children's physical development depends on the severity of renal function.

Darbo tikslas. Pateikti suaugusių žmonių gastroezofaginio refliukso ligos laringofaringinės formos diagnostikos algoritmą Lietuvoje. Diagnostikos algoritmas (nuorodos) parengtas remiantis pagrįstos medicinos duomenimis, kitų šalių medicinos organizacijų rekomendacijomis ir Lietuvoje atliktų tyrimų duomenimis, apibendrintais ir įvertintais Lietuvos otorinolaringologų ir gastroenterologų bei šių sričių ekspertų. Straipsnyje pateikiama gastroezofaginio refliukso ligos laringofaringinės formos samprata, etiopatogenezė, klinikiniai simptomai bei morfologinės formos, ligos klinikiniai variantai bei sunkumas. Aptariami diagnostikai naudojami metodai, jų jautrumas bei panaudojimo galimybės Lietuvoje. Gastroezofaginio refliukso ligos laringofaringinės formos diagnostika Lietuvoje turėtų būti pagrįsta: 1) klinikinių simptomų analize; 2) gastroezofaginio refliukso sąlygotų morfologinių pokyčių ryklėje bei gerklose įvertinimu; 3) balso pokyčių diagnostika sprendžiant darbingumo ekspertizės klausimus balsinių profesijų atstovams; 4) patologinio refliukso ar jo padarinių (ezofagito) diagnostika; 5) morfologinių ir funkcinių pokyčių bei refliukso priklausomumo ryšio nustatymu. Diagnostikos algoritmas skirtas otorinolaringologams, gastroenterologams ir šeimos gydytojams siekiant optimizuoti gastroezofaginio refliukso ligos laringofaringinės formos diagnostiką Lietuvoje, sutrumpinti diagnozės nustatymo laiką bei sumažinti klaidų galimybę. The laryngopharyngeal form of gastroesophageal disease represents one of the atypical manifestations of supraesophageal gastroesophageal reflux disease characterized by morphologic and functional changes in the larynx and pharynx with the associated clinical symptoms. The article presents diagnostic algorithm (guidelines) for laryngopharyngeal form of gastroesophageal disease, elaborated by the group of Lithuanian experts in otorhinolaryngology and gastroenterology. The guidelines are based on the data of evidence-based medicine and results of the scientific studies in Lithuania. Diagnostics of laryngopharyngeal form of gastroesophageal disease has to be based on: (1) patient’s complaints (permanent hoarseness, throat itching and clearing, cough, heartburn, “globus” sensation) for more than 3 months; (2) typical laryngoscopic findings (edema, erythema, roughness, hypertrophy of mucosa of the posterior glottis); (3) detection of reflux esophagitis as a subsequence of pathological gastroesophageal reflux; (4) assessment of relationship between reflux and morphological/functional changes. The guidelines are designed for the otorhinolaryngologists, gastroenterologists, and general practitioners.

Apsinuodijimų alkoholio surogatais Lietuvoje nemažėja, todėl pabandėme išsiaiškinti tokių apsinuodijimų eigą. Išanalizuotos 1997–2006 m. Kauno medicinos universiteto klinikų Nefrologijos skyriuje gydytų 94 pacientų, apsinuodijusių alkoholio surogatais, ligos istorijos. Nustatyti 53 nepatikslintais etanoliniais surogatais apsinuodijimų atvejai, nesukėlę ūminio inkstų nepakankamumo, kurie išsamiau neanalizuoti, ir 41 neetanoliniais alkoholio surogatais apsinuodijimo atvejis, iš kurių 34 pacientams pasireiškė ūminis inkstų nepakankamumas. Iš 41 paciento, apsinuodijusio neetanoliniais alkoholio surogatais, 31 taikyta detoksikacinė hemodializė. Iš aštuonių pacientų, kurie pradėti gydyti nuo apsinuodijimo pradžios praėjus ne daugiau kaip 12 val., septyniems pacientams (87,50 proc.) ūminis inkstų nepakankamumas nepasireiškė. Kiti 23 pacientai pradėti gydyti po apsinuodijimo praėjus daugiau kaip 12 valandų, visiems pasireiškė ūminis inkstų nepakankamumas. Po hospitalizavimo praėjus ne daugiau kaip 48 val., nuo sunkaus apsinuodijimo mirė trys pacientai. Išvada. Net 82,9 proc. pacientų, apsinuodijusių neetanoliniais alkoholio surogatais, pasireiškė ūminis inkstų nepakankamumas, tačiau, detoksikacines hemodializes pradėjus iki 12 val. po apsinuodijimo, ši komplikacija pasireiškė žymiai rečiau. Intoxications with alcoholic surrogates are still frequent in Lithuania. The aim of this study was to evaluate the frequency, course, and effectiveness of treatment and outcomes of acute renal failure in patients with alcoholic surrogate intoxication. We have analyzed the case histories of 94 patients with alcoholic surrogate poisoning. Patients were treated in the Clinic of Nephrology, Kaunas University of Medicine Hospital, during 1997–2006. Fifty-three cases of poisoning with unspecified ethanolic surrogates, which did not provoke acute renal failure, were identified, and we did not analyze them in detail. Forty-one cases of intoxication with nonethanolic surrogates were identified, and acute renal failure developed in 34 patients. In 31 of the 41 patients, hemodialysis was started for toxin removal. Among eight patients in whom treatment was started within 12 hours of intoxication, seven (87.5%) patients had no acute renal failure. In the 23 remaining patients, treatment was started later than 12 hours after intoxication, and acute renal failure was diagnosed in all of them. Three patients died within 48 hours after hospitalization because of severe intoxication. Conclusion. Acute renal failure developed in 82.9% of patients poisoned with nonethanolic surrogates. In such cases, when hemodialysis for toxin removal was started up to 12 h after poisoning, acute renal failure developed significantly rarely.

Hemodializių techninė bazė nuolat gerėja, tačiau hemodializėmis gydomų pacientų mirštamumas yra gana didelis. Tai susiję su dializės doze ir jos kokybe. Šio tyrimo tikslas – įvertinti hemodializės procedūros kokybę ir jos pokyčius Lietuvoje 1999–2005 m. 1996–2005 m. gruodžio mėnesiais surinkti duomenys iš visų Lietuvos hemodializės centrų. Užpildyta kiekvieno tuo metu hemodialize gydomo paciento anketa, kurioje užfiksuota informacija apie hemodializės rūšį, skaičių ir trukmę per savaitę, Kt/V – hemodializės efektyvumo žymenį. Tiriamuoju laikotarpiu padaugėjo pacientų, gydomų bikarbonatine dialize (1999 m. – 57,9 proc.; nuo 2001 m. – 100 proc., p0,05). Išvados. 1. 1999–2005 m. Lietuvoje pagerėjo hemodializės procedūrų kokybė: a) nuo 2001 m. taikoma vien bikarbonatinė hemodializė; b) pailgėjo... [toliau žr. visą tekstą] Despite the improvement of hemodialysis technique, mortality of chronic hemodialysis patients remains quite high. It considerably depends on dialysis adequacy. The aim of the study was to evaluate the adequacy of hemodialysis procedure and its changes in Lithuania during 1999–2005. Between 1999 and 2005 in December, all hemodialysis centers in Lithuania were annually visited, and data on the type of hemodialysis, duration of hemodialysis (hours per week), single-pool Kt/V were collected from all hemodialysis patients. The percentage of patients on bicarbonate hemodialysis sharply increased from 57.9% in 1999 to 100% in 2001 (P0.05). Conclusions. 1. The improvement of the quality of hemodialysis was observed in Lithuania during 1999–2005: a) from 2001... [to full text]

1995–2004 m. Lietuvoje ūminiu poinfekciniu glomerulonefritu sirgo 322 vaikai nuo 1–16 metų. Ligos protrūkis užregistruotas 1995 m., kai sergamumas ūminiu poinfekciniu glomerulonefritu buvo 8,3/100 000 vaikų, vėliau mažėjo ir 2003–2004 m. išliko 2,2–2,4/100 000 vaikų. Ligą sukėlė: 28,3 proc. viršutinių kvėpavimo takų infekcijos, po 24 proc. – tonzilitai ir odos infekcijos. Inkubacinis laikotarpis vidutiniškai buvo 14 dienų ir nesiskyrė pagal sukėlusią ligą. Didesnis sergamumas šia liga rudenį (96/322, p

The aim of the study was to determine the changes in bone mineral density in hemodialysis patients and to evaluate their correlation with disorders of calcium-phosphate metabolism. Patients and methods. Data of 82 patients on chronic hemodialysis were analyzed. The patient group consisted of 40 (48.8%) men and 42 (51.2%) women. Clinical and laboratory data were collected from medical records. Bone mineral density was measured by ultrasound (Sahara Hologic densitometer) in the heel area. Results. The mean age of the patients was 60.13±16.02 years. Mean T score was 1.7±1.19, mean Z score was 1.076±1.2, and mean bone mineral density was 0.393±0.0 g/cm2. Women had significantly lower bone mineral density than men (0.361 g/cm2 and 0.425 g/cm2, respectively; P=0.006). Normal bone mineral density, when T score was –1 and more, was observed only in 23 (28%) patients. More than one-third (n=37, 45.1%) of patients were classified as osteopenic (T score between –2.5 and –1) and 22 (26.8%) patients as osteoporotic (T score less than –2.5). Patients with normal bone mineral density were significantly younger than those with decreased bone mineral density (54.7±15.48 years vs. 58.76±15.76 years and 68.09±14.5 years, respectively; P

Tyrimo tikslas. Nustatyti pakartotinių kraštinių sekstantinių prostatos biopsijų reikšmę diagnozuojant prostatos vėžį. Tyrimo metodai. Į tyrimą įtraukti 195 vyrai, apsilankę Kauno medicinos universiteto konsultacinėje poliklinikoje 2003–2007 metais dėl padidėjusios prostatos vėžio rizikos (padidėjusio prostatos specifinio antigeno (PSA) ir (ar) patologinių pokyčių prostatoje, nustatytų digitalinio rektalinio tyrimo metu). Visiems tiriamiesiems atlikta kraštinė sekstantinė prostatos biopsija kontroliuojant transrektiniu ultragarsu. Tiriamiesiems, kuriems pirmoji biopsija buvo neigiama, taip pat nustatyta padidėjusi prostatos vėžio rizika, kraštinės sekstantinės prostatos biopsijos buvo kartojamos. Rezultatai. Prostatos vėžys po pirmosios kraštinės sekstantinės biopsijos histologiškai diagno¬zuotas 30,3 proc. (59/195) pacientų, po antrosios – 13,1 proc. (11/84), po trečiosios – 10,3 proc. (4/39), po ketvirtosios – 7,7 proc. (1/13). Bendrasis kumuliacinis prostatos vėžio nustatymas siekė 38,5 proc. (75/195) ir statistiškai reikšmingai skyrėsi nuo pirmąja biopsija nustatyto prostatos vėžio – 30,3 proc. (59/195)) (p=0,04). Pirmąja kraštine sekstantine prostatos biopsija nustatėme 78,7 proc. (59/75) prostatos vėžio atvejų. Likusius 21,3 proc. (16/75) prostatos vėžio atvejų diagnozavome pakartoję biopsijas. Atlikę antrąją kraštinę sekstantinę biopsiją (TRUG PB2), papildomai radome dar 14,6 proc. (n=11) vėžio atvejų ir kartu su pirmąja biopsija nustatėme 93,3 proc. (70/75) visų... [toliau žr. visą tekstą] Our purpose was to evaluate the relevance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients. Material and methods. Our study included 195 men at high risk for prostate cancer (elevated prostate-specific antigen level and/or abnormal prostate detected by digital rectal examination). We consulted the patients in outpatient department of Kaunas University of Medicine Hospital during 2003–2007. We performed transrectal ultrasound-guided laterally directed sextant prostate biopsy in every patient. For the patients with benign histological findings and increased risk of prostate cancer, laterally directed sextant biopsies were repeated. Results. Prostate cancer was detected in 30.3% of patients (59/195) on the first prostate biopsy, in 13.1% (11/84) on the second prostate biopsy, in 10.3% (4/39) on the third, and in 7.7% (1/13) on the forth biopsy. After all biopsies, prostate cancer was detected in 38.5% (75/195) of patients, and it differed significantly from the percentage of prostate cancer cases detected on the first biopsy (30.3%, P=0.04). We detected 78.7% (59/75) of all prostate cancer cases by the first laterally directed sextant prostate biopsy. The rest 21.3% (16/75) of cases we detected by repeat biopsies. The second laterally directed sextant prostate biopsy revealed additional 14.6% (n=11) of prostate cancer cases and increased the detection of prostate cancer to 93.3% (70/75). At the time of the first... [to full text]

Cockcroft–Gault formula and Modification of Diet in Renal Disease (MDRD) equation are widely used as indirect estimates of renal function. The precision and reliability of these formulas regarding kidney function are still discussed. The aim of our study was to evaluate glomerular filtration rate by different methods and compare the results. Data on patients in whom renal function was evaluated at the Clinic of Nephrology of Kaunas University of Medicine Hospital in 2006 are presented in this article. Glomerular filtration rate was assessed based on 24-hour endogenous creatinine clearance and calculated using three formulas: Cockcroft–Gault, abbreviated MDRD, and complete MDRD. Blood serum creatinine level was measured by the standardized Jaffe assay. Glomerular filtration rate was examined in 125 patients. Their mean age was 58.07±18.962 years. The mean endogenous creatinine clearance was 31.1287±31.14 783 mL/min. The mean glomerular filtration rate calculated by Cockcroft–Gault formula was 34.1220±29.02 967 mL/min, by abbreviated MDRD formula was 29.8212±25.83 866 mL/min/1.73 m2, and by complete MDRD formula was 28.6884±24.99 353 mL/min/1.73 m2. There was no statistically significant difference in mean glomerular filtration rates estimated using all methods in the evaluation of kidney function. When the reliability of formulas was analyzed depending on each stage of chronic kidney disease, it was found that Cockcroft–Gault and MDRD formulas, in contrast to endogenous creatinine clearance, did not precisely reflect kidney function in stages 1 and 2 of chronic kidney disease. Estimates by Cockcroft–Gault and MDRD formulas correctly showed decreased kidney function in stages 3 and 4 of chronic kidney disease. Formulas were not reliable, in contrast to endogenous creatinine clearance, when patients were in end-stage chronic kidney disease. Conclusions[...].

Tyrimo tikslas. Išanalizuoti gydymo gentamicinu stacionare skyrimo indikacijas ir dozavimo principus, įvertinti gentamicinu gydomų ligonių stebėseną dėl galimo nefrotoksinio poveikio. Tyrimo medžiaga ir metodai. Iš archyvo paimta Kauno medicinos universiteto klinikose gentamicinu gydytų 105 ligonių ligos istorijos: 59 chirurgijos ir 46 vidaus ligų profilio. Surinkti duomenys apie gentamicino skyrimo indikacijas, dozavimą, gydymo trukmę, pacientų inkstų funkciją ir jos kitimus gydymo eigoje. Rezultatai. Daugiau kaip trečdalis gydytų ligonių buvo vyresni nei 65 metų. Gentamicino skirta: a) profilaktiškai po operacijos 14 (23,73 proc.) chirurgijos ligonių; b) infekcijai gydyti 45 (76,27 proc.) chirurgijos ir 46 (100 proc.) vidaus ligų profilio ligoniams. Empiriškai gentamicinu gydyti 29 (49,15 proc.) chirurgijos ir 29 (63,04 proc.) vidaus ligų skyrių ligoniai. 87,62 proc. ligonių gentamicino skirta po 240 mg, visiems 105 ligoniams – vieną kartą per parą. Prieš pradedant gydymą gentamicinu inkstų funkcija neištirta 11,86 proc. chirurgijos ir 19,56 proc. vidaus ligų stacionaro ligoniams, o gydymo eigoje inkstų funkcijos rodikliai tirti tik trečdaliui ligonių. Inkstų funkcija 87,62 proc. ligonių vertinta pagal šlapalo koncentraciją kraujyje. Kreatinino koncentracija kraujyje ištirta tik 12,38 proc. pacientų. Chirurgijos skyrių ligonių gydymo gentamicinu trukmės vidurkis – 5,932±2,392 dienos (2–13 d.), vidaus ligų – 8,283±3,344 dienos (3–19 d.). Išvados. Daugiau kaip pusei... [toliau žr. visą tekstą] The aim of the study was to analyze the treatment with gentamicin and possible nephrotoxicity of this antibiotic in patients treated in surgical and internal medicine departments of Kaunas University of Medicine Hospital. Materials and methods. A total of 105 case histories obtained from archive of our hospital were analyzed: 59 case records from surgical and 46 from internal medicine departments. Data were collected regarding indications for the administration of gentamicin, its dosage, duration of treatment, and patients’ renal function at the beginning and during the treatment. Results. There were more than 30% of patients older than 65 years. Gentamicin was administered in 14 (23.73%) surgical inpatients to prevent postoperative infection; 45 (76.27%) surgical and 46 (100%) internal medicine inpatients received gentamicin because of symptoms of infection. Half of the patients were treated empirically. In 87.62% of cases, gentamicin was administered at a dose of 240 mg; all 105 patients received it once per day. Before treatment, renal function was not evaluated in 11.86% of surgical and in 19.56% of internal medicine inpatients, and during treatment, it was examined only in one-third of patients. The duration of the treatment was 5.932±2.392 days (range 2–13 days) in surgical and 8.283±3.344 days (range 3–19 days) in internal medicine inpatients. Conclusions. More than half of patients received empirical treatment with gentamicin. Not enough attention has been paid to... [to full text]

Background. There is no any official renal registry in Lithuania, so in order to know the exact demographic statistics of patients on hemodialysis, we started to collect data since 1996. The aim of the study was to estimate the survival rate of hemodialysis patients and its dynamics, to compare survival in different groups of sex, age, primary renal disease, and to compare to survival of dialysis patients in Europe. Material and methods. We analyzed the data of all patients who started hemodialysis in Lithuania between January 1, 1998, and December 31, 2005. The information was obtained from medical documentation. The total survival rate was estimated using the Kaplan–Maier method. Results. During the study period, 2418 patients started hemodialysis (51.7% of males, 48.3% of females). Their mean age at the beginning of treatment was 56.19±16.12 years. Death occurred in 792 patients. The main cause of death was cardiovascular events, accounting for 32.3%. The total survival rate of hemodialysis patients in Lithuania at 1 year was 79.97%; at 2 years, 69.18%; at 5 years, 49.97%; at 7 years, 38.3%. Males lived longer than females (log rank P

Infekcija yra svarbi hemodializuojamų ligonių sergamumo ir mirtingumo priežastis. Dėl infekcijos ligoniai dažnai hospitalizuojami. Tyrimo tikslas. Įvertinti hemodializuojamų ligonių hospitalizavimo dažnį ir rizikos veiksnius hospitalizuoti dėl infekcijos, remiantis Kauno apskrities hemodializuojamų ligonių duomenimis. Išanalizuotos ambulatorinės kortelės visų 533 negrįžtamosios stadijos inkstų nepakankamumu sergančių ligonių, kurie buvo hemodializuoti Kauno apskrities hemodializės centruose trejų metų laikotarpiu (2001–2004). Duomenys apie ligonio būklę ir laboratorinius tyrimus rinkti 2001, 2002 ir 2003 metų lapkričio mėnesį. Toliau pacientai prospektyviai stebėti 12 mėnesių ir rinkti duomenys apie jų hospitalizavimą dėl infekcijos. Kiekvienais metais tiriami ligoniai vertinti kaip nauji ir atlikta suminė duomenų analizė. Statistinė duomenų analizė atlikta kompiuteriu naudojant statistinius duomenų paketus „SPSS“ ir „STATISTICA“. Atliekant vienfaktorinę statistinę duo¬menų analizę, lygintos ligonių, hospitalizuotų dėl infekcijos, ir nehospitalizuotų ligonių grupės. Reliatyvi hospitalizavimo dėl infekcijos rizika nustatyta taikant daugiafaktorinę Cox regresinę analizę, įvertintas laikas iki pirmojo hospitalizavimo dėl infekcijos. Hospitalizavimo dėl infekcijos dažnis buvo 0,2 hospitalizavimo ligoniui per metus ir sudarė 18 proc. visų hospitalizavimų. Vieno hospitalizavimo trukmės mediana – 11 dienų. Vienfaktorinėje analizėje hospitalizavimas dėl infekcijos buvo susijęs su... [toliau žr. visą tekstą] Infection is an important cause of morbidity and mortality in hemodialysis patients. These patients are frequently hospitalized for infections. The objective of our study was to evaluate hospitalization rate for infections and to determine risk factors for infection-related hospitalizations of hemodialysis patients in Kaunas region, Lithuania. Ambulatory case records of 533 patients with end-stage renal disease, dialyzed in all hemodialysis centers in Kaunas region during the period of 2001–2004, were analyzed. Data on patient’s condition and routine laboratory tests were collected in November of 2001, 2002, and 2003. These patients then were followed up for the next 12 months in order to evaluate infection-related hospitalization rate. All patients were considered new patients every year, and general analysis of three-year data was performed. Statistical analyses were carried out using SPSS (Statistical Package for Social Sciences) and STATISTICA. Univariate statistical analysis was performed comparing the groups of patients that were hospitalized because of infections and were not hospitalized. Relative risk of infection-related hospitalization was estimated using Cox regression evaluating the time to first infection-related hospitalization. The unadjusted infection-related hospitalization rate was 0.2 per patient a year (18% of all hospitalizations). The median length of hospital stay for infections was 11 days. Univariate statistical analysis showed a statistically... [to full text]

Cytomegalovirus infection has been associated with increased morbidity and mortality after transplantation and with diminished graft survival. After transplantation, more than 75% of solid organ transplant patients are newly infected with cytomegalovirus, or latent cytomegalovirus infection may be reactivated. The objective of our study was to evaluate reactivation rate of cytomegalovirus infection after kidney transplantation in Kaunas University of Medicine Hospital and its relation to anticytomegalovirus prophylaxis. A retrospective review of all kidney transplants performed between May 2000 and December 2006 was conducted. We analyzed the prevalence of cytomegalovirus in the groups of donors and recipients, and risk categories were defined for cytomegalovirus infection/disease in transplant patients. During this period, a total of 93 transplantations were performed in 56 men (60.2%) and 37 women (39.8%). The mean age of recipients was 41.04±12.74 years. There were 33 (68.7%) men and 15 (31.3%) women in the group of donors; their mean age was 39.49±14.81 years. Patients at high risk for the development of cytomegalovirus infection/ disease were defined as those who had donor-positive/recipient-negative serostatus (D+/R–), and they made up 5.4% of all patients. Intermediate-risk patients with cytomegalovirus infection (D+/R+ and D–/R+) accounted for 73.1% and 15.1% of all recipients, respectively; 6.4% of patients were at low risk (D–/R–). Anti-cytomegalovirus prophylaxis with i/v ganciclovir was given during the period of hospitalization in all cases, except when there was a D–/R– combination, or when the transplant was removed in the early period after transplantation. The reactivation of cytomegalovirus infection was observed in 23 patients (24.7%). We have observed 41 episodes of cytomegalovirus infection, but during this period, no patient developed cytomegalovirus disease that might cause lethal outcome.

Retrospektyviai išanalizuotos 299 ligos istorijos ligonių, sirgusių galutinės stadijos inkstų nepakankamumu, gydytų Kauno medicinos universiteto klinikose 2005–2006 metais. Jiems buvo suformuota nuolatinė arterinė-veninė jungtis planinėms hemodializės procedūroms atlikti. Analizuoti šių ligonių demografiniai duomenys, indikacijos jungties suformavimui (planuojama pradėti hemodializes, skubiai pradėtos hemodializės, jau buvusios jungties trombozė), laboratorinių tyrimų duomenys bei ligonių gydymo stacionare trukmė. Nustatyta, jog daugiausia jungčių buvo suformuota Kauno miesto ir rajono gyventojams (48,04 proc.). 23,74 proc. ligonių sirgo cukriniu diabetu. Dažniausiai buvo formuojama pirmoji natyvinė kraujagyslinė jungtis – 61,2 proc. ligonių, pakartotinė jungtis suformuota 36,46 proc. ligonių, 2,34 proc. ligonių, nesant galimybių suformuoti jungtį, įstatytas nuolatinis centrinės venos kateteris. 107 (36,1 proc.) ligoniams arterinė-veninė jungtis suformuota ligoniams, kuriems hemodializės procedūros buvo pradėtos skubiai, per centrinės venos kateterį. Ikioperacinis kraujagyslių tyrimas doplerine echoskopija atliktas 18,73 proc. ligonių. Dauguma ligonių buvo gydomi Nefrologijos, Endokrinologijos klinikose. Dalis jungčių suformuotos Chirurgijos dienos skyriuje. Vidutinė gydymo stacionare trukmė, kai formuojama jungtis – 30,61±4,3 dienos, (Nefrologijos klinikoje – 29,05±5,2 dienos, Endokrinologijos klinikoje – 35,53±5,52 dienos). Jungties operacijos ligonis laukė vidutiniškai 16... [toliau žr. visą tekstą] We analyzed case histories of 299 patients with end-stage renal failure, hospitalized in our hospital for the creation of an arteriovenous fistula for chronic hemodialysis. Demographic data, indications for the creation of an arteriovenous fistula, laboratory data, and duration of hospitalization were analyzed. Results. The highest number of arteriovenous fistulas was created in the patients from Kaunas region (48.04%); 23.74% of patients were diabetic. Primary native fistula was created in 61.2% of patients, secondary in 36.46% of cases, and in 2.34% of patients, permanent catheters were inserted. Preoperative Doppler ultrasonography of vessels was performed in 18.73% of patients. The mean duration of hospitalization of all patients was 30.61±4.3 days (29.05±5.2 days in the Clinic of Nephrology and 35.53±5.52 days in the Clinic of Endocrinology). During this period, patients were waiting for operation in an average of 16.78±6.4 days and 14.78±4.87 days for maturation of fistula.

Fabry’s disease is an X-linked inborn error of glycosphingolipid metabolism caused by a deficiency of the lysosomal hydrolase a-galactosidase A. Due to deficiency of this enzyme activity, a progressive lysosomal accumulation of glycosphingolipids, in particular globotriaosylceramide, takes place within endothelial cells and cells of the vascular and nervous systems, myocardial cells, endothelial, and mesangial and epithelial cells of the kidney, eventually leading to organ dysfunction. The degree of renal involvement generally correlates with the progression of glycosphingolipid accumulation and may lead to renal insufficiency and failure. Renal dysfunction can progress to end-stage renal failure, which usually occurs in the third to fifth decade of life. The prevalence of this disease among males on chronic hemodialysis is different in various countries. Screening for a-galactosidase A deficiency by blood spot tests was performed among 536 male dialysis patients in all 42 hemodialysis centers in Lithuania in the period of April–June, 2005. All tests, showed normal galactosidase A enzymatic activity. Conclusion. No patient with suspicion of Fabry’s disease was found by this screening method.

Visame pasaulyje populiacijai senstant daugėja pacientų, sergančių lėtinėmis inkstų ligomis. Gydytojai neretai susiduria su dilema, kaip gydyti gretutines šių pacientų ligas, kad nepasireikštų galimas toksinis vaistų poveikis inkstams. Straipsnyje aptariama suaugusiųjų lėtinių inkstų ligų klasifikacija, diagnostika, įvairių vaistų vartojimo ypatybės.

Priežastys, skatinančios formuotis akmenis, iki šiol lieka hipotetinės. Jei šlapimo sudėtis abiejuose inkstuose vienoda ir nėra šlapimo nutekėjimo kliūties, tai kodėl akmenys turėtų formuotis tik vienoje pusėje? Kodėl jie neslenka žemyn šlapimtakiais tik pradėję formuotis, kol dar yra maži? Kodėl vieniems žmonėms susidaro vienas didelis akmuo, o kitiems – dauginiai smulkūs konkrementai? Šlapimo takų akmenys – polikristalinė visuma, sudaryta iš įvairaus kiekio skirtingų kristalų bei organinių medžiagų.

Sparčiai augant hemodializuojamų ligonių skaičiui, didėja ir išlaidos, skirtos šiems ligoniams gydyti. Darbo tikslas. Surinkti ir išanalizuoti duomenis apie 2005 metais Kauno medicinos universiteto klinikose hemodializuojamų ligonių gydymui ligonių kasų skirtas vidutines metines išlaidas ir ligonio priemoką medikamentams bei palyginti su 2001 metais atlikto analogiško tyrimo duomenimis. Išanalizuotos ambulatorinės kortelės visų 106 negrįžtamosios stadijos inkstų nepakankamumu sergančių ligonių, kurie buvo ambulatoriškai hemodializuoti Kauno medicinos universiteto klinikose vienerius metus: nuo 2004 metų lapkričio 1 dienos iki 2005 metų spalio 31 dienos. Surinkti duomenys apie hemodializių skaičių, hospitalizavimų skaičių, vartojamus medikamentus. Ligoniai vidutiniškai hemodializuoti 2,8±0,4 karto per savaitę. Išlaidos hemodializės procedūroms – 38094,12±5003,17 litų/ligoniui/metams (11041 eurų) ir tai sudarė 63 proc. visos hemodializuojamų ligonių gydymui skirtos sumos. Ligoniai buvo hospitalizuoti 1,4±1,8 karto/ligoniui/metams, hospitalizavimo kaina – 1538,4±1941 litai/metams (446 eurų) sudarė 3 proc. visos hemodializuojamų ligonių gydymui skirtos sumos. Ligoniams vidutiniškai skirta 7,7±2,17 medikamentų, iš jų 2,12±1,6 antihipertenzinių. Ligonių kasų kompensuojamų medikamentų suma vidutiniškai buvo 20639,82±15439,3 lito/ligoniui/metams (5983 eurų). 92 proc. šios sumos sudarė išlaidos eritropoetinui ir intraveniniam geležies preparatui. Apskaičiuotos vidutinės vieno... [toliau žr. visą tekstą] With increasing number of hemodialysis patients, expenditures for the treatment of hemodialysis patients are rising every year. The objective of our study was to collect and analyze the data on estimated average treatment expenditures, which were covered by State Patients’ Fund, for patients undergoing hemodialysis in Kaunas University of Medicine Hospital in 2005 and the costs of medications paid by patient and to compare with the analogical data of the year 2001. We analyzed ambulatory case records of all 106 patients with end-stage renal disease who were hemodialyzed in Kaunas University of Medicine Hospital from November 1, 2004, to October 31, 2005. Data on medications used and number of hemodialysis procedures and hospitalizations were collected. On average, 2.8±0.4 hemodialysis procedures per patient a week were carried out. Expenditures for hemodialysis procedures were 38 094.12±5003.17 litas (11 041 euros) per patient per year, and this accounted for 63% of all expenditures for hemodialysis patient. Hospitalization rate was 1.4±1.8 per patient a year; expenditures for hospitalizations were 1538.4±1941 litas (446 euros) per patient a year (3% of all expenditures for hemodialysis patients). The mean number of drugs prescribed per patient monthly was 7.7±2.17 including 2.12±1.6 antihypertensive medications. The total costs of drugs reimbursed by State Patients’ Fund were 20 639.82±15 439.3 litas (5983 euros) per patient per year, of which 92% was spent on... [to full text]

Hemodializės procedūros metu paciento kraujas kontaktuoja su dializės tirpalu per pusiau pralaidžią membraną. Šiai procedūrai naudojamas vanduo nėra sterilus. Nors mikroorganizmai per dializatoriaus membraną nepatenka, tačiau bakterijų endotoksinai gali patekti į ligonio kraują ir sukelti pirogenines reakcijas, skatinti lėtinį uždegiminį procesą, bloginti ligonių įmitį. Tyrimo tikslas. Ištirti endotoksinų kiekį hemodializei naudojamame vandenyje ir dializės tirpale atsitiktinai pasirinktuose kelių Lietuvos miestų hemodializių centruose. Tyrimo objektas. Endotoksinų kiekis ištirtas trijų Lietuvos miestų šešiuose hemodializės centruose dializei naudojamame vandenyje (n=6) ir dializės tirpale (n=14). Metodika. Endotoksinų kiekis nustatytas LAL (angl. Limulus Amebocyte Lysate assay) testu. Jis atliktas Gento universitetinės ligoninės Nefrologijos laboratorijoje (Belgija). Rezultatai ir išvados. Visuose hemodializei naudoto vandens (n=6) ir dializės tirpalo (n=14) bandiniuose endotoksinų kiekis buvo mažesnis nei 0,25 EV/ml. Tik viename vandens (16,7 proc.) ir dviejuose (14,3 proc.) dializės tirpalo bandiniuose endotoksinų buvo daugiau nei 0,03 EV/ml. Taigi ištirtų hemodializės centrų dializei naudojamo vandens ir dializės tirpalo endotoksinų kiekis atitiko Europos farmakopėjos ir Europos geros praktikos gairių rekomendacijose nurodomus kiekius tirpalams, naudojamiems įprastinei hemodializei. Penkiuose hemodializės centruose dializės tirpalo endotoksinų kiekis atitiko ypač... [toliau žr. visą tekstą] Hemodialysis is a process when the blood of patients contacts with dialysate through a semipermeable membrane. Water used for dialysis is not sterile. Microorganisms cannot pass through the membrane pores, but bacterial endotoxins can diffuse to the blood of patients. Several acute and long-term complications (pyrogenic reactions, silent chronic inflammation, malnutrition) in dialysis patients might be associated with dialysate contamination. The aim of this study was to determine the level of endotoxins in hemodialysis water and dialysate in several hemodialysis centers of different Lithuanian cities. Material and methods. Material was dialysis water (n=6) and dialysate (n=14) from six hemodialysis centers in three different cities of Lithuania. Bacterial endotoxin levels were measured using a sensitive Limulus Amebocyte Lysate (LAL) assay. Results and conclusions. The level of endotoxins was less than 0.25 endotoxin unit (EU)/mL in all hemodialysis water (n=6) and dialysate (n=14) samples. One sample of water (16.7%) and two of dialysate (14.3%) had the level of endotoxins above 0.03 EU/mL. Therefore, the level of endotoxins in hemodialysis water and dialysate in studied Lithuanian hemodialysis centers (n=6) complied with the recommendations of the European Pharmacopoeia and the ERA-EDTA best practice guidelines for conventional dialysis modalities. The level of endotoxins in dialysate of five Lithuanian hemodialysis centers complied with the recommendations of the... [to full text]

Objective. The aim of this study was to estimate the equivalence and correlation between transition zone volume, measured by transrectal ultrasound, and removed prostate tissue weight in surgically treated patients due to benign prostatic hyperplasia. Material and methods. This study involved 168 patients with histologically confirmed benign prostatic hyperplasia. Of these patients, 120 underwent transurethral resection of the prostate and 48 – open prostatectomy. The weights of the specimens were compared with the corresponding volumes of the transition zone. Equivalence and correlation between transition zone volume and removed tissue weight were analyzed. Results. The mean (standard deviation, range) transition zone volume was 25.43 mL (±13.19, 5–61.6) in the transurethral resection group and 76.1 mL (±42.97, 13–275.8) in the open operation group. The mean removed tissue weight was 22.9 g (±13.41, 5–66) and 73.96 g (±44.96, 18– 280), respectively, in the transurethral resection and open operation groups. The correlation between removed tissue weight and transition zone volume was stronger in the open operation group than it was in the resection group (r=0.957, P&lt, 0.001 vs. r=0.878, P&lt, 0.001). There was a significant difference between transition zone volume and resected tissue weight (P=0.001). However, in the open operation group, there was an agreement between transition zone volume and enucleated tissue weight (P=0.263). Conclusions. A significant correlation was detected between removed tissue weight and transition zone volume. There is a significant difference between volume measurement and resected tissue weight while enucleated tissue weight was in agreement with transition zone volume when an open prostatectomy was performed.

Šlapimo takų infekcijos (uroinfekcijos) pasitaiko 40–60 proc. visų ligoninėje įgytų infekcijų. Didėjantis ligonių amžius bei gretutinės ligos sudaro palankias sąlygas šioms infekcijoms rastis. Be to, maždaug 80 proc. hospitalinių uroinfekcijų yra susijusios su šlapimo pūslės kateteriais ir tik 5–10 proc. ligonių jos randasi po invazinių procedūrų šlapimo takuose. Hospitalines infekcijas sukeliantys mikroorganizmai dažnai pasižymi atsparumu antibakteriniams vaistams bei virulentiškumo faktoriais, todėl antibakterinis gydymas gali būti sėkmingas tik pašalinus infekciją sukeliančius veiksnius ar atkūrus normalią urodinaminę funkciją. Antimikrobiniai vaistai komplikuotoms hospitalinėms uroinfekcijoms gydyti turi pasižymėti adekvačiomis farmakodinaminėmis ir farmakokinetinėmis savybėmis: didele vaisto koncentracija šlapime bei antimikrobiniu aktyvumu tiek rūgščiame, tiek ir šarminiame šlapime. Empirinis hospitalinių uroinfekcijų antibakterinis gydymas skiriamas atsižvelgiant į infekcijos lokalizaciją ir sunkumą, įtariamą sukėlėją, skyriaus mikrobiologinę situaciją. Geriausias pasirinkimas gydymo pradžiai – pigiausias siauriausio veikimo veiksmingas uroinfekcijoms gydyti antimikrobinis vaistas, kol bus gauti bent preliminarūs šlapimo pasėlių mikrobiologinių tyrimų duomenys, pagal kuriuos gydymą galima koreguoti. Adekvatus uroinfekcijų gydymas mažina komplikacijų dažnį, antimikrobinių vaistų poreikį ir kartu mikroorganizmų atsparumą jiems, taip pat ekonomiškai naudingas. Urinary tract infections are responsible for 40–60% of all hospital-acquired infections. Increased age of patients and comorbid diseases render hospitalized patients more susceptible to infection. Almost 80% of hospital-acquired urinary tract infections are associated with urinary catheters, and only 5–10% of urinary infections are caused by invasive manipulations in the urogenital tract. Pathogens of hospital-acquired urinary tract infections are frequently multi-resistant, and antibiotic therapy can only be successful when the complicating factors are eliminated or urodynamic function is restored. For treatment of complicated hospital-acquired urinary tract infections, the antibiotics must exhibit adequate pharmacodynamic and pharmacokinetic properties: high renal clearance of unmetabolized form with good antimicrobial activity in both acidic and alkaline urine. For selection of empirical treatment of hospital-acquired urinary tract infections, it is necessary to evaluate localization of infection, its severity, possible isolates, and the most frequent pathogens in the department where patient is treated. The best choice for the starting the antimicrobial therapy is the cheapest narrow-spectrum effective antibiotic in the treatment of urinary tract infection until microbiological evaluation of pathogens will be received. Adequate management of urinary tract infections lowers the rate of complications, requirements for antibacterial treatment, selection of multi-resistant... [to full text]

Value of urodynamic pressure-flow studies in evaluation of bladder outlet obstruction has been recognized. Voiding during these studies is influenced by transurethral catheter, which is used for measurement of vesical pressure. We have investigated the influence of 7 F (2.3 mm) catheter on flow rate during pressure-flow study as a potential cause of misclassification. Patients and methods. Data of free urinary flow and pressure flow from 111 men with symptomatic benign prostatic hyperplasia were analyzed. Inclusion criteria for analysis: age over 45 years, total International Prostate Symptom Score over 8, maximum flow rate in range of 4–20 ml/s, total voided volume of 100 ml or greater. Results. Of all patients, means of maximum free and pressure-flow rate were 9.8 and 9.0 ml/s (p=0.01) with mean voided volume 199 and 212 ml (p=0.03) respectively. Maximum flow rate decreased in 56.8%, increased in 41.4% and was stable in 1.8% of cases. The difference ranged from –8.5 to +10.2 ml/s (‘+’ is indicated when maximum rate of free flow is higher). In the group of obstructed subjects mean maximum flow rates were respectively 8.8 ml/s and 7.9 ml/s (p=0.01). There was no significant difference in maximum flow rate within the group of unobstructed/equivocal subjects. More pronounced mean 1.3 ml/s difference in maximum flow rate was observed also in subgroup of patients with prostate volumes over 60 cc (p=0.01). Conclusions. Catheter of 7 F (2.3 mm) generally slightly diminishes... [to full text] Urodinaminio spaudimo ir tėkmės tyrimo metu matuojamas spaudimas šlapimo pūslėje ir kartu nustatomas šlapimo debitas – tai tiksliausias šlapimo pūslės obstrukciją rodantis tyrimas, tačiau toks šlapinimasis ne visai natūralus, nes esama kateterio uretroje. Atlikta analizė ir tirta 2,3 mm diametro 7 F kateterio įtaka šlapimo tėkmei. Tai svarbu vertinant urodinaminio tyrimo rezultatus. Metodai. Išanalizuota 111 vyrų, atitikusių įtraukimo į tyrimą kriterijus (amžius – vyresni nei 45 metų, vidutiniai ir ryškūs simptomai, maksimalus šlapimo debitas – 4–20 ml/s, šlapimo tūris per 100 ml), laisvo bei spaudimo ir tėkmės tyrimo metu nustatyto maksimalaus šlapimo debito skirtumai. Laisvos šlapimo tėkmės parametrai: maksimalus debitas ir šlapimo tūris palyginti su atitinkamais urodinaminio tyrimo metu nustatytais parametrais. Rezultatai. Maksimalaus šlapimo debito vidurkis – 9,8 ir 9,0 ml/s (p=0,01), šlapimo tūris – 199 ml ir 212 ml (p=0,03) šlapinantis laisvai ir su kateteriu. Maksimalus debitas sumažėjo 56,8 proc., padidėjo – 41,4 proc., nepakito – 1,8 proc. tiriamųjų. Skirtumas svyravo nuo –8,5 iki +10,2 ml/s (‘+’ nurodytas, kai, šlapinantis laisvai, debitas didesnis nei šlapinantis su kateteriu uretroje). Pacientų, kuriems nustatyta obstrukcija, grupėje maksimalaus šlapimo debito vidurkis buvo atitinkamai – 8,8 ml/s ir 7,9 ml/s (p=0,01). Pacientams, kuriems nerasta obstrukcijos, šlapimo debito reikšmingo skirtumo nenustatyta (p=0,4). Kiek didesnis nei 1,3 ml/s maksimalaus debito... [toliau žr. visą tekstą]

Objectives. To determine the incidence and variety of microorganisms of positive urine culture in patients of intensive care units of Kaunas University of Medicine Hospital and to estimate the risk factors for colonization, development of urinary tract infection, and outcome during the period of 2003–2004. Material and methods. We retrospectively reviewed patients with a positive urine culture with or without clinical symptoms of urinary tract infection admitted to an intensive care unit. Results. The growth of microorganisms was determined in urine of 82 (3.9%) patients: urinary tract infection in 64 (78%) and colonization in 18 (22%) patients. Among pathogens of urinary tract infection rods predominated significantly (p0.05). E. coli in urine culture was obtained exclusively in cases of urinary tract infection. All patients with a positive urine culture had catheterized urinary bladder (p0.05). In cases of the same sex, age, and underlying disease of the patients, the risk of urinary tract infection with every day of catheterization significantly increased by 21.7% (p0.05). In cases of the same sex, age, underlying disease, and duration of catheterization, the development of urinary tract infection significantly increased the risk of lethal outcome by 5.5 times (p

Darbo tikslas – įvertinti mažakraujystės įtaką Kauno krašto hemodializuojamų ligonių hospitalizavimui ir mirštamumui. Išanalizuotos ambulatorinės kortelės visų 148 ligonių, kurie 2001 metų lapkričio mėnesį buvo ambulatoriškai hemodializuoti Kauno apskrities hemodializės centruose. Tyrimas atliktas dviem etapais: per pirmąjį etapą surinkti duomenys apie ligonių amžių, lytį, inkstų nepakankamumą sukėlusią priežastį, hemoglobino kiekį 2001 metų lapkričio mėnesį; per antrąjį etapą šie ligoniai prospektyviai stebėti 12 mėnesių, rinkti duomenys apie jų mirštamumą, hospitalizavimo dažnį ir jo trukmę, hospitalizavimo priežastis. Tyrimo pradžioje vidutinis hemoglobinas (Hb) – 101,2±13,8 g/l. Daugiau kaip pusės (59 proc.) hemodializuojamų ligonių hemoglobinas – 100 g/l ir didesnis. Tolesnis ligonių tyrimas 2002 metais parodė statistiškai reikšmingą Hb skirtumą tarp mirusiųjų ir toliau dializuojamų ligonių: mirusiųjų ligonių vidutinis Hb buvo 92,4±18,6 g/l, o ligonių, ku¬riems pakaitinė inkstų terapija tęsiama – 102,81±12,48 g/l, p=0,02. Hb sumažėjimas 1 g/l didina mirštamumo riziką 5 proc. (p=0,027). Ligonių palyginimas pagal hospitalizavimų skaičių per 2002 m. parodė, kad ligoninėje negulėjusių ligonių Hb buvo 104,2±11,1 g/l, hospitalizuotų ligonių Hb – 99±15,1 g/l, be to, šis skirtumas buvo statistiškai reikšmingas (p=0,02). Hb sumažėjimas 1 g/l didina hospitalizavimo riziką 5 proc. (p=0,027). Palyginus ligonius pagal Hb kiekį (Hb mažesnis ir didesnis nei 100 g/l), nustatytas... [toliau žr. visą tekstą] The objective of our study was to evaluate the influence of anemia on hospitalization and mortality in hemodialysis patients of Kaunas region. We analyzed ambulatory case records of 148 patients dialyzed in all 7 hemodialysis centers of Kaunas region in November 2001. The study consisted of two parts: in the first part data on patient age, gender, primary cause of end-stage renal disease, hemoglobin concentration were collected in November 2001 and in the second part these patients were followed up for 12 months in order to evaluate rate and length of hospitalization, reasons for hospitalization and mortality. At the beginning of the study mean hemoglobin (Hb) value was 101.2±13.8 g/l and more than a half of the patients (59%) had hemoglobin value higher than 100 g/l. Further follow-up of the patients during the year 2002 revealed that hemoglobin level of the patients who died was lower from the patients who followed hemodialysis. Mean hemoglobin of dead and alive patients was 92.4±18.6 g/l and 102.81±12.48 g/l, respectively (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk of mortality for every 1 g/l decrease in hemoglobin (p=0.027). Analysis showed that mean hemoglobin value was 104.2±11.1 g/l for the patients who were not hospitalized and 99±15.1 g/l for the patients who were hospitalized during the year 2002 (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk for hospitalization for every... [to full text]

The aim of our study was to evaluate the changes of hemodialysis (HD) service and main demographic characteristics of HD patients in Lithuania during seven years period. From 1996 to 2003 we visited annually all HD centers in Lithuania and collected data about all HD patients. There was a sharp increase in the number of HD centers (from 17 to 37), HD stations (from 25 p. m. p. (per million population) to 87 p. m. p.; p

Per pastaruosius 15 metų (1990–2004) Lietuvoje užregistruota daugiau kaip 80 vaikų hemolizinio-ureminio sindromo atvejų. Atskirais metais sergamumas svyravo – daugiau sergančiųjų užregistruota 1990–1993, 1998–1999 ir 2003–2004 m., tačiau bendrasis sergamumas nepadidėjo. Dažniausiai sirgo vaikai iki dvejų metų amžiaus, be to, mergaitės kiek dažniau negu berniukai. Ne mažiau 80 proc. atvejų liga buvo tipinė, t. y. susijusi su viduriavimu. Šie duomenys iš esmės nesiskiria nuo kitų mokslininkų pateikiamų duomenų. More than 80 cases of the hemolytic-uremic syndrome were registered in Lithuania over the period 1990–2004. The incidence of this syndrome fluctuated annually; higher incidence rates were observed in 1990–1993, 1998–1999 and 2003–2004, however, there was no overall increase in morbidity over the 15-year period. Most cases occurred in the first two years of life; besides, girls suffered slightly more often than boys. At least in 80% of cases the illness was typical, i. e. was associated with diarrhea. In general, the data correspond to the findings of other scientists.

2000–2003 metais Kauno medicinos universiteto klinikų mikrochirurgai iš viso atliko 616 arterioveninių jungčių suformavimo operacijų. Apie 30 proc. jų sudarė radiocefalinės jungtys, po kurių 36,9 proc. ligonių išsivystė (per pirmąjį mėnesį) komplikacija, t. y. trombozė, dėl kurios teko performuoti arterioveninę jungtį. Norint nustatyti radiocefalinių arterioveninių jungčių ankstyvųjų komplikacijų priežastis, retrospektyviai išanalizuotos ligos istorijos operuotų pacientų (n=146), suskirsčius juos į dvi grupes. Pirmą grupę sudarė ligoniai, kuriems suformuota radiocefalinė jungtis funkcionavo gerai (n=94); antrą grupę (n=52) sudarė ligoniai, kuriems suformuota radiocefalinė jungtis trombavosi per pirmąjį mėnesį po operacijos. Lyginant abi tiriamųjų grupes paaiškėjo, kad ligonio lytis, pagrindinė liga, operacijos technika (visos operacijos buvo atliekamos naudojant mikrochirurginę techniką, tačiau jungtis buvo formuojama „galas-galas“ arba „ šonas-galas“ būdu kraujagysles susiuvant 8/0 ar7/0 siūlais) didesnės įtakos ankstyvųjų trombozių išsivystymui neturėjo. Trombozių dažnis statistiškai reikšmingai buvo susijęs su trumpesniu jungties brandinimo laiku: pirmos grupės ligoniams jungtys buvo punktuojamos praėjus vidutiniškai 15,45±2,56 dienos po jų suformavimo, antros – po 12,5±2,42 dienos (p

Darbo tikslas. Įvertinti hemodialize gydomų pacientų kalcio ir fosforo apykaitos sutrikimų dažnio ir jų korekcijos Lietuvos hemodializės centruose pokyčius 1996–2003 m. Visuose Lietuvos hemodializės centruose lankytasi 1996–2003 m. pabaigoje (gruodžio mėnesiais) ir surinkta informacija apie hemodializėmis gydomų pacientų kalcio ir fosforo apykaitos reguliavimą. 51,8 proc. pacientų 1999 m. ir 44,6 proc. 2003 m. nustatyta hiperfosfatemija (>1,8 mmol/l) (p1.8 mmol/l) (p

The aim of the research was to determine causes of acute renal failure in children, their outcome and to define risk factors associated with mortality. 75 children with acute renal failure, who were treated at the Clinic of Children’s Diseases of Kaunas University of Medicine between 1998–2003 years, were included in the study. The age range of patients was 1 month to 16 years. They were divided into two groups. Acute renal failure was diagnosed in 42 (56%) patients (the first study group) and in 33 (44%) patients acute renal failure was together with multiple organ failure (the second study group). In the first study group 69% of cases of acute renal failure were found to be due to renal diseases and in the second study group 97% were because of extrarenal diseases. Sepsis was the most frequent cause of acute renal failure in the second group (p

Treatment method of hemophilia with continuous infusion of clotting factor concentrates is not widespread. We report our experience with the use of continuous infusion of factor VIII in patient with mixed trauma, crush syndrome and acute renal failure. Patient was successfully treated with fasciotomy of left upper arm and forearm, 6 procedures of hemodialysis, 34.500 units of clotting factor VIII concentrate, and 13 red blood cells units. Our experience confirms the safety, efficiency, and economy of the method of the constant infusion of clotting factor concentrates for hemophilia patient requiring replacement therapy, surgical intervention, and hemodialysis.

A multicenter study was performed with the aim to investigate the blood concentrations of zinc (Zn) and aluminum (Al) in hemodialysis patients and to clarify the impact of these metals level on the frequency of infections and the impact of medications on metal concentration in blood of these patients. Material and methods. 265 patients with end-stage renal disease from 7 dialysis centers were enrolled in this study. All patients underwent standard hemodialysis. Venous blood samples were collected from hemodialysis patients before hemodialysis sessions. Atomic absorption spectrophotometry was applied to measure blood levels of Zn and Al. Results and conclusions. The hemodialysis patients with infectious complications had significantly higher mean blood Al than the patients without complications (33.1±38.9 and 24.5±45.9 µg/l, respectively; p

Tyrimo tikslas. Įvertinti apatinių šlapimo organų funkciją 5–18 metų vaikams, sergantiems pasikartojančia šlapimo organų infekcija, ir palyginti rastus pokyčius vaikų, sergančių pasikartojančia ir viršutinių, ir apatinių šlapimo organų infekcija, grupėse. 2004 metais Kauno medicinos universiteto klinikose atlikti 35 urodinaminiai tyrimai 5–18 metų vaikams (3 berniukams ir 32 mergaitėms), sergantiems pasikartojančia šlapimo organų infekcija. 21 jų diagnozuota pasikartojanti apatinių, 14 – viršutinių šlapimo organų infekcija. Urodinaminių pokyčių nustatyta daugumai, t. y. 91,4 proc. vaikų – visiems vaikams, sergantiems pasikartojančia apatinių šlapimo organų infekcija ir 11 (78,6 proc.), sergančių pasikartojančia viršutinių šlapimo organų infekcija. Nestabilus detruzorius rastas 20 (57,1 proc.) vaikų: 14 (66,7 proc.) vaikų, sergančių pasikartojančia apatinių šlapimo organų infekcija ir 6 (42,9 proc.), sergantiems pasikartojančia viršutinių šlapimo organų infekcija. Detruzoriaus susitraukimas po šlapinimosi nustatytas 57,1 proc. vaikų, sirgusių pasikartojančia viršutinių šlapimo organų infekcija ir 28,6 proc. vaikų, sirgusių pasikartojančia apatinių šlapimo organų infekcija. Pakitusi šlapimo pūslės talpa rasta daugumai – 26 (74,3 proc.) vaikams, sirgusiems pasikartojančia šlapimo organų infekcija. Esant nestabiliam detruzoriui, 32 (85 proc.) vaikams rastas nestabilus detruzorius ir pakitusi cistometrinė šlapimo pūslės talpa. Kartojantis šlapimo organų infekcijai, tikslinga... [toliau žr. visą tekstą] The purpose of this article was to evaluate function of lower urinary tract for 5–18 years old children with recurrent urinary tract infections and to compare urodynamic changes in two groups: with recurrent lower urinary tract infections and with recurrent upper urinary tract infections. 35 urodynamic studies in 5–18 years old children (3 boys and 32 girls) with recurrent urinary tract infection were performed at the Clinic of Children’s Diseases of Kaunas University of Medicine in 2004. 21 of these children had recurrent lower urinary tract infections and 14 – recurrent upper urinary tract infections. Changes in urodynamics were present in 91.4% of children: in all children with recurrent lower urinary tract infections and in 11 children with upper recurrent urinary tract infections (78.6%). Detrusor instability was found in 20 (57.1%) children: in 14 (66,7%) with recurrent lower urinary tract infections and in 6 (42.9%) with recurrent upper urinary tract infections. In 32 (85%) children detrusor instability was accompanied by changes in bladder volume. Changes of bladder volume were present for 26 (74.3%) children with recurrent urinary tract infections. Detrusor after contraction was diagnosed in 57.1% of children with recurrent lower urinary tract infections and in 28.6% with recurrent upper urinary tract infections. For children with recurrent urinary tract infections attention for urinary tract dysfunction must be paid.

We analysed ambulatory case records of all patients dialysed in 7 hemodialysis centers of Kaunas region during the year 2002 (n=186). Separate analysis of 42 diabetic patients was performed and compared with non-diabetics. Mortality was higher in diabetic patients in comparison with non-diabetics (22.5% and 7.3%, respectivelly; p

We analyzed data of 383 hemodialysis patients admitted to the hemodialysis center of Kaunas University of Medicine Hospital between 1 January 1994 and 31 December 2004. The aim of the study was to estimate their survival and identify it influencing factors. Demographic data (gender, birth date), cause of renal insufficiency, date of hemodialysis (HD) initiation, blood analyses at the start of HD (hemoglobin, C-reactive protein, serum albumin, creatinine, calcium, phosphate), how HD were started (through central venous catheter or permanent vascular access), time of the first nephrologist consultation before initiating of HD were recorded for each patient in a special form. The total survival rate was estimated using the Kaplan–Maier method. Mean survival of HD patients was only 21.93 months (95% confidence intervals (CI) 18.7–25.16 months). It was influenced by a high early mortality (17.23% of patients died within the first three months from the beginning of HD (36.5% of all dead patients)). The lowest survival rate was of those patients who started HD immediately after the first consultation with a nephrologist. Early referral to nephrologist, normal serum albumin and C–reactive protein concentrations had a positive impact on survival in hemodialysis patients.

The aim of the study was to identify risk factors for secondary hyperparathyroidism at the start and during the first year of hemodialysis. Retrospective analysis of medical records of all patients with end-stage renal disease, dialyzed at the hemodialysis center of Kaunas University of Medicine Hospital on December 2004, was performed. Biochemical data at the start, during the first year and at the end of follow-up (December 2004) were analyzed. At the start of hemodialysis elevated level of parathyroid hormone (PTH) was observed in 46 of 69 patients (67.6%), at the end of the first year – in 27 of 69 patients (39.1%). In 22 of 46 patients (47.8%), who started hemodialysis with elevated PTH levels, the level of PTH decreased to

From 1996 to 2000 in urology department of 2(nd) Kaunas Clinical Hospital, 343 percutaneous interventions were performed, 250 of which was percutaneous nephrostomy. Urinary flowing was disturbed to 171 patients with urinary obstruction and 79 with malignant tumor. Death related to operation was not noticed in all patients. One of the patient had undergone surgery. PCN was successfully performed in 97.5% of all the cases.

Objective. We present our experience in diagnosing, gender assignment, and surgical management of sexual ambiguity in 46,XY mixed gonadal dysgenesis. Material and methods. A retrospective study of five cases treated from 2003 to 2006 was performed. Clinical picture, operative findings, testosterone levels, and immunohistochemistry of gonads for the expression of FOXL2, SOX9, AMH, AMHr, C-kit, and PLAP were analyzed. Results. All patients had ambiguous genitalia, urogenital sinus, uterus, testicle on one side, and a streak gonad on the other. Four patients were reared as male and one as female. Stimulation by human chorionic gonadotropin showed good penile size and testosterone response. All patients underwent laparoscopic gonadal biopsy and/or gonadectomy. Histological studies showed the presence of sparse primordial follicles surrounded by embryonic sex cords in the streak portion of gonads. Germ cells were C-kit positive in all and PLAP positive in four patients. FOXL2 expression was detected in four streak gonads and in none of testes. AMH expression was found only in testes. SOX9 expression was found in both investigated testes and in three out of four streak gonads investigated. Conclusions. 46,XY mixed gonadal dysgenesis should be differentiated from ovotesticular and other types of 46,XY disorders of sexual differentiation by the typical gonadal histology and internal genital structure. High testosterone level after stimulation and good response to testosterone treatment in 46,XY mixed gonadal dysgenesis could orient toward male sex assignment. There are different patterns of gene expression in testicular and streak gonads with a switch to FOXL2 positivity in streak gonads. Early gonadal and genital surgery is recommended.