Gudaitytė, Rita
Item type:Publication, conference output[2026][T1e][M001][2]Introduction Appendiceal intussusception is an exceptionally rare condition, with a reported incidence of approximately 0.01% among appendectomy specimens. It is most often associated with a structural abnormality or a neoplastic lead point in adults [1, 2]. Because clinical presentation frequently mimics acute appendicitis, the diagnosis is commonly made incidentally during surgery. Although malignancy-related appendiceal intussusception has been reported, it remains an uncommon finding [2]. Case Presentation A 76-year-old woman presented with intermittent periumbilical abdominal pain radiating to the right lower quadrant that had persisted for several days. Laboratory evaluation revealed CRP of 12.8 mg/L and WBC count of 6.9 × 10⁹/L. Abdominal ultrasound demonstrated an inflamed appendix measuring 2.1 cm in diameter, with wall thickening and periappendiceal fat infiltration. Laparoscopic appendectomy was performed. Intraoperatively, the appendix was found to be hyperemic, enlarged, and invaginated into the cecal lumen, consistent with appendiceal intussusception. Postoperative recovery was uneventful. Histopathological examination revealed invasive adenocarcinoma (pT3NxMxVLi0RxG1). The tumor infiltrated the submucosa and muscularis propria, without evidence of vascular or lymphatic invasion. Discussion In adults, appendiceal intussusception is frequently associated with a pathological lead point, including both benign lesions and malignant neoplasms such as adenocarcinoma [3]. As described in similar cases, the tumor may act as a mechanical lead point, initiating inversion of the appendix into the cecum and potentially resulting in delayed or missed diagnosis if histopathological assessment is not carefully performed [2]. Because preoperative imaging rarely identifies appendiceal intussusception, routine microscopic evaluation of appendectomy specimens is essential, particularly to exclude malignancy in elderly patients [4]. Conclusions This case demonstrates that appendiceal intussusception should prompt consideration of an underlying neoplastic process, especially in older adults. Thorough intraoperative assessment and mandatory histopathological examination are crucial for the detection of occult malignancy and for guiding appropriate oncologic follow-up.
7 Item type:Publication, research article[2026][S1][M001][11]; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; The Lancet regional health. Europe, 2026-03-01, vol. 62, p. 1-11Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems.
41WOS© Citations 2 Item type:Publication, research article[2026][S1][M001][14]; ; ; ; Minimally invasive surgery is rapidly expanding globally, yet there is insufficient knowledge of how to scale this technology safely and equitably across diverse health systems. We aimed to identify health-system factors associated with safe implementation of minimally invasive surgery globally, using minimally invasive cholecystectomy as a tracer procedure.
65WOS© Citations 2 Item type:Publication, research article[2025][S1][M001,N010][13]; ; ; ; ; ; Frontiers in Physiology, 2025-12-31, vol. 16, p. 1-13Background: Intestinal dysmotility in type 2 diabetes mellitus (T2DM) may involve impaired cholinergic and incretin-mediated regulation. This study compared cholinergic-induced jejunal contractility and evaluated the effects of Glucagon like peptide-1 (GLP-1) and Gastric inhibitory polypeptide (GIP) in relation to the expression of these peptides, their receptors, and Dipeptidyl peptidase 4 (DPP-4) in jejunal muscle of obese patients with and without T2DM.
Methods: Jejunal samples were collected from 32 obese patients undergoing bariatric surgery (14 with and 18 without T2DM). Jejunal muscular tissue was examined for expression of GLP-1, GIP, and for expression and localization of DPP-4 and incretin receptors (GLP-1R and GIPR). In addition, DPP-4 enzymatic activity was quantitatively assessed. Contractility of circular and longitudinal muscle strips was assessed in vitro following bethanechol stimulation, with or without GLP-1 or GIP.
Results: GLP-1 receptors were detected in smooth muscle nuclei and enteric ganglia, while GIP receptors localized to both muscle layers. DPP-4 was present in neural and muscular compartments. In T2DM, GIPR and DPP-4 expression and activity were increased, while GIP protein was reduced. GLP-1 protein levels tended to be higher. Longitudinal muscle contractility independent of neural input was reduced in T2DM. GLP-1 selectively inhibited circular muscle contractions in both groups, whereas GIP had no effect.
Conclusion: This study demonstrates that reduced cholinergic activity in longitudinal muscle, lower GIP, and increased GLP-1 in T2DM indicate a shifted local incretin environment that may collectively suppress jejunal contractility.
34 Item type:Publication, book[2025][K1a][M001][574]; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; Kaunas : Medicininės informacijos centras, 2025-12-31Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]
49 - journal article[2025][S6][M001][6]
; ; Lietuvos akušerija ir ginekologija = Lithuanian obstetrics & gynecology, 2025-03-27, vol. 28, no. 1, p. 67-72Nekrozuojantis fascitas - tai reta, greitai progresuojanti ir gyvybei pavojinga minkštųjų audinių infekcija, dažnai sukelianti septines komplikacijas. Ligos paplitimas įvairiose šalyse svyruoja nuo vieno iki keturių atvejų 100 000 gyventojų, o mirtingumas gali siekti nuo 12,1 proc. iki 76 proc. Šios būklės diagnostika sudėtinga dėl nespecifinių simptomų, todėl gydymo sėkmė priklauso nuo ankstyvos chirurginės intervencijos, plataus spektro antibiotikų terapijos ir intensyvios priežiūros. Šiame straipsnyje aprašomas retas pooperacinio nekrozuojančio fascito atvejis, kai infekcija išsivystė po laparotominės histerektomijos. Klinikinis atvejis rodo šios infekcijos sudėtingumą ir pabrėžia ankstyvos diagnostikos bei agresyvaus gydymo svarbų siekiant išvengti sunkių komplikacijų ir mirtingumo. Pacientės būklė sėkmingai stabilizuota taikant daugiadalykį gydymo metodą, o ilgalaikės sveikatos būklės stabilumas patvirtina taikytų priemonių veiksmingumą. Šis atvejis pabrėžia ankstyvos diagnostikos, tinkamo gydymo ir daugiadalykės priežiūros svarbą valdant nekrozuojančio fascito rizikas.
101 Item type:Publication, research article[2025][S1][M001][17]; ; ; ; ; Background and Objectives: Neuropeptide Y (NPY) family peptides and dipeptidyl peptidase-4 (DPP-4) are involved in gastrointestinal regulation and may contribute to obesity and type 2 diabetes mellitus (T2DM) pathophysiology. This study investigates their expression in jejunal muscular tissue and associations with gastrointestinal symptoms in patients with obesity, with (OB+/DM+) and without T2DM (OB+/DM−). Materials and Methods: This cross-sectional study includes forty-four patients undergoing laparoscopic Roux-en-Y gastric bypass divided based on T2DM status. Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and jejunal tissue samples were analyzed for DPP-4, NPY, peptide YY (PYY), and pancreatic polypeptide (PP) mRNA and protein levels. Results: DPP-4, NPY, PYY, and PP gene expression in jejunal muscular tissue was similar between groups. In the OB+/DM+ group, PP protein was higher, while DPP-4 and PYY were lower compared to the OB+/DM− group. Significant positive correlations between DPP-4 and NPY, PYY, and PP were found in the OB+/DM− group, while only DPP-4 and PYY correlated in the OB+/DM+ group. Gastrointestinal symptoms in the OB+/DM− group showed positive correlations with PP (abdominal pain), DPP-4 (indigestion), and NPY (constipation). Conclusions: The study demonstrates significant differences in DPP-4, PYY, and PP protein expression between patients with obesity, with or without T2DM. Peptide correlations with gastrointestinal symptoms in non-diabetic patients suggest distinct regulatory mechanisms, warranting further research.
16WOS© Citations 2 - conference paper[2025][T1e][M001][2]
; ; International Health Sciences Conference IHSC : Abstract book 2025 : [March 13 - 14, 2025, Kaunas] / Edited by Karina Zerr, 2025-03-13, p. 157-158Introduction Primary malignant melanoma of the esophagus (PMME) is a rare and aggressive cancer, typically originating from the skin, uvea, or retina. Due to its poor prognosis, early detection and intervention are critical. Surgical resection remains the standard treatment for this disease [1,2]. Case Presentation A 69-year-old male was diagnosed with PMME in February 2018, with no evidence of metastasis. Three months later, he underwent minimally invasive esophageal resection (MIE) and gastric conduit formation via a combined laparoscopic and thoracoscopic approach. Histopathology confirmed esophageal melanoma with a 3.23 mm depth of invasion and no lymphovascular involvement. On the second postoperative day, gastric conduit necrosis was diagnosed. The patient was reoperated, and an esophagostomy and gastrostomy were formed. Six months later, the patient underwent reconstructive esophageal surgery with gastric interposition. Although the initial surgery was successful, a fistula developed at the anastomosis site, which was managed with a stent. The patient was discharged with a small residual fistula at the junction. The stent did not fully cover the defect due to its high position, and the patient was readmitted for further management. One month later, the stent was removed, and X-rays confirmed no leakage or fistula. The patient was discharged without further complications. Discussion PMME is an extremely rare entity, accounting for only 0.1–0.2% of all esophageal malignancies [2]. Surgical resection is the most effective treatment but carries significant risks. One such complication is gastric conduit necrosis, which occurs in around 1-10% of patients undergoing esophageal reconstruction with gastric conduit [3,4]. The average survival period of PMME after diagnosis is about 10–14 months, with a 5-year survival rate of 4.2%. Early detection and surgical intervention are crucial to improving long-term outcomes [5]. Conclusions Primary malignant melanoma of the esophagus requires early and aggressive surgical intervention for optimal outcomes [1]. Despite significant surgical challenges and postoperative complications, the patient achieved a stable outcome and remains free of melanoma five years after surgery, demonstrating the importance of timely treatment and effective management of postoperative complications.
19 Item type:Publication, research article[2025][S1][M001][18]; ; ; ; ; ; ; ; ; ; ; ; ; ; ; There is low-certainty evidence on the impact of extended pharmacological prophylaxis on venous thromboembolism-associated morbidity and mortality. The aim of this study was to determine the efficacy and safety of extended prophylaxis after major abdominopelvic surgery for the prevention of clinically relevant venous thromboembolism after hospital discharge.
53WOS© Citations 2 Item type:Publication, conference poster[2024][T1c][M001][1]; ; ; Microbiota in Health and Disease : EHMSG - 37th International Workshop on Helicobacter & Microbiota in Inflammation & Cancer : September 12-14, 2024, Porto, Portugal : Accepted Abstracts, 2024-09-12, vol. 6, p. 160-160Objective: Gastric cancer (GC) is a leading cause of mortality globally, underscoring the urgent need for innovative non-invasive monitoring tools. Molecular profiling indicates that liquid biopsy assays could address many diagnostic and prognostic challenges associated with GC. Materials and Methods: Blood samples from 13 control subjects (CON), 13 atrophic gastritis (AG) patients, and 33 GC patients were collected, with multiple samples from GC patients taken at different time points. Total cfDNA was isolated and very deep targeted sequencing was performed (NovaSeq 6000, Illumina). Results: In the CON, 53.8% of subjects had detectable genetic variants in APC, ERBB2, FAT1, and MUC16 genes, mainly low (60%) or moderate (30%) impact. In the AG, 23.1% had detectable genetic variants in APC, ERBB4, FAT1, KMT2C, MUC16, PIK3CA, and TRRAP genes, most moderate (20.0%) or modifier (53.3%) impact. In the GC, 51.5% of patients had detectable genetic variants in APC, CDH1, EGFR, ERBB2, ERBB4, FAT1, FAT4, KMT2C, KRAS, MUC16, PIK3CA, PTEN, SPEN, TRRAP genes, with high (4.0%), moderate (37.4%), and modifier (58.6%) impact. Mutational cfDNA profiles overlapped by different proportions in GC group comparing the time points: before vs. after the operation – 50.0%, before the operation vs. control visit – 12.5%, after the operation vs. control visit – 12.0%, and all three time points – 12.5%. Detection of somatic plasma cfDNA variants was significantly associated with tumor size (48.3% vs. 82.1%, T1-T2 vs. T3-T4 respectively, p = 0.007). Conclusions: This study illuminates plasma cfDNA dynamics from health to malignancy and links cfDNA mutational profiles with diverse clinical characteristics.
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