Ramanauskaitė, Aistė

Lejomiosarkoma (LMS) yra reta, bet agresyvi minkštųjų audinių sarkoma, dažniausiai atsirandanti lygiųjų raumenų audiniuose. Ši liga pasižymi ankstyvu metastazavimu ir sudėtinga diagnostika, todėl svarbus ankstyvas ištyrimas ir tikslinis gydymas. Šiame straipsnyje pristatomas 51 metų pacientės klinikinis atvejis, kai LMS pasireiškė dešinės šlaunies ir kirkšnies srityje, sukeldama giliųjų venų obstrukciją. Diagnostikai naudoti UG, KT ir MRT tyrimai bei biopsija, kuri patvirtino aukšto piktybiškumo LMS diagnozę. Dėl išplitimo pobūdžio ir naviko dydžio operacinis gydymas nebuvo galimas, todėl taikyta sisteminė chemoterapija. Aptariamos LMS epidemiologinės, etiologinės ypatybės, šiuolaikinės diagnostikos ir gydymo galimybės, įskaitant naujausius genetinius ir terapinius aspektus.

Sjogreno sindromas (SjS) yra lėtinė autoimuninė liga, kuri pažeidžia egzokrinines liaukas. Labiausiai sutrinka ašarų ir seilių išskyrimo funkcija. Atsiradus šiam sindromui, organizme autoimuniniai procesai aktyvuoja imunines ląsteles, kurios ima atakuoti seilių bei ašarų liaukų epitelį. Akių, burnos sausumas ar seilių liaukų tinimas – varginanti problema, skatinanti pacientus kreiptis į gydytojus. Diagnostikai atliekami tyrimai: seilių liaukų biopsija, Širmerio testas, autoantikūnų kraujyje tyrimas, radiologiniai seilių liaukų tyrimai. Šiuo metu nėra tokio gydymo būdo, kuris visiškai išgydytų SjS, todėl pagrindinis tikslas yra sumažinti simptomų raišką. Akių sausumas gydomas akių lašais arba tepalais. Burnos sausmė gali būti gydoma dirbtinėmis seilėmis, seilių gamybos stimuliatoriais. Vis plačiau gydymui ir diagnostikai yra taikoma sialoendoskopija, kurios metu praplatinami seilių liaukų kanalai ir instaliuojami gliukokortikoidai, atliekama irigacija. Be to, pacientams, sergantiems Sjs, yra 44 kartus didesnė rizika susirgti ne Hodžkino limfoma, ypač su gleivine susijusia limfoidinio audinio (MALT) limfoma.

Introduction. Knee osteonecrosis is a progressive condition that quickly advances to endstage osteoarthritis and is categorized into three types: spontaneous, secondary, and post-arthroscopic. Post-arthroscopic osteonecrosis is the rarest form of osteonecrosis that most commonly occurs in patients over the age of 50. At first, surgical procedures focus on preserving patient‘s natural joint; however, if the disease progresses and conservative treatments does not work, total joint replacement may be necessary for some individuals. The purpose of the case report is to present a case about tibial osteonecrosis after arthroscopic surgery. Case report. In 2023, a 51-year-old heavy smoker female was administered to hospital with right knee instability and pain. Physical examination and MRI confirmed rupture of the anterior cruciate ligament (ACL). Arthroscopic autologous ACL reconstructive surgery under spinal anesthesia was performed by autograft fixation with a TightRope in the femur and with a PullUp XL EndoButton in the tibia side. Rehabilitation was performed after 6 weeks after surgery. Eight months after surgery, in 2024, patient was complaining with pain, swelling, and reduced range of motion in operated knee. MRI was performed and collapse in the tibial proximal part medial condyle was revealed. Non weight bearing, exercises to improve knee mobility, hyperbaric oxygen therapy (HBOT) and NSAID were prescribed as a non-operative treatment of osteonecrosis. A three months later, control MRI revealed no positive signs of treatment in osteonecrosis. The decision to continue performing knee mobility exercises, use NSAIDs and HBOT was made. After 14 months of conservative treatment the patient had no symptoms of the pain and swelling. Patient is under supervision until now. Summary. Case report demonstrates a rare complication after arthroscopic surgery. Conclusions. Arthroscopic surgery is one of the safest ways to repair a knee injury, but it cannot prevent complications such as osteonecrosis.

Introduction. Extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) is a slow-growing type of non-Hodgkin lymphoma that develops in the lymphoid tissue outside the lymph nodes. The purpose of our report is to present a rare case of MALT lymphoma that caused slow growing mass with bilateral involvement of salivary glands for the patient. Case description. A 68-year-old man with Sjogren’s syndrome applied to the hospital of Kauno klinikos due to constant increasing of the parotid salivary glands since 2015. During the examination, bilateral 10 cm enlargement of parotid glands were visible, hard and mobile on palpation. For further investigation, it was decided to perform a core needle biopsy under ultrasound control of the salivary gland due to a possible lymphoproliferative disease. After examining the tissue histologically, it was found that there is a diffuse type of infiltration with small lymphocytes with sparse cytoplasm and relatively large, slightly angular nuclei, which react positively with immunomarkers CD20, Bcl-2, Ki-67. After all, MALT lymphoma was diagnosed based on these findings. The patient continued to be treated in the Hematology department, where VI courses of chemotherapy according to the R-CHOP scheme were prescribed. Also, to assess the effectiveness of chemotherapy, a PET/CT scan was prescribed before and after treatment. Before the treatment, a lymphoproliferative process of moderate metabolic activity was observed in the salivary glands. After the treatment, compared to the previous PET/CT, the dynamics are positive, metabolically active salivary glands are no longer visible. Summary. This case report demonstrates how thoroughly the parotid gland enlargement must be differentiated and that it can be associated with a serious condition – MALT lymphoma. Conclusions. MALT lymphoma is a rare subtype of non-Hodgkin lymphoma, which can affect the salivary glands. It grows very slowly – often doesn’t cause noticeable symptoms.

Introduction: McCune-Albright syndrome (MAS) is a rare condition associated with somatic genetic change in a gene called GNAS and aQects skin, bones and endocrine system. Typical triad of MAS is fibrous dysplasia (FD), precocious puberty, and cafe-au-late spots. Cafe-au-late spots are usually the first sign of MAS. FD can cause various complications, include pain, limp or fractures. Endocrine system disorders may cause precocious puberty especially in girls, thyroid lesions with possible hyperthyroidism, excess growth hormone. Other symptoms may be subcutaneous calcification, osteogenesis, facial bones deformations. In this case report, we describe a 60-year-old woman with MAS and challenges related with surgical treatment of symptoms. Case presentation: Starting since 2013, a 50-year-old woman with MAS, also having bone deformities, subcutaneous calcification spots, short stature was operated. Subcutaneous calcium deposit removal was performed on her right foot. In 2014 she complained of intermittent pain in her right leg after intense walk, sensor disorder below the knee, lack of range of motion. XRay was performed and calcifications on extensor muscles of femoris was noticed and removal operation of vastus medialis muscle was performed. An operation was successful, and the patient was discharged home after post-operative treatment. In 2017, calcium deposit removal of her lower back was performed. In 2019, a woman arrived at the hospital with a pain in her left knee joint and calf, impaired mobility, discomfort while wearing shoes. Decision was made to remove subcutaneous calcifications surgically. The calcifications were removed from subcutaneous tissue and by making an additional incision in patellar projection, the prepatellar bursa and exostosis were removed. In 2024 patient arrived with a pain in her left thigh and right Achilles tendon. X-Ray showed calcifications on the calcaneus and distal part of the Achilles tendon. Due to complains of decreasing life quality calcifications removal operation again was performed. Post-operative physiotherapy and NSAIDs were prescribed, and the patient was discharged home. Conclusions: MAS is a rare disease that worsens the quality of life of the individual and requires constant surgeries. This is a challenge not only for the patient, but also for the surgeon.

Introduction. Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy, can mimic acute coronary syndrome (ACS). In our case report, we will discuss a rare complication of TCM - left ventricular (LV) apical thrombus formation. Casedescription. An 83-year-old woman was admitted to Kaunas Clinics of the Lithuanian University of Health Sciences Hospital with intense shortness of breath, general weakness and pain throughout her body. ECG showed ST elevation in inferior leads, laboratory tests showed elevated troponin I 0.93 µg/l (normal value <0.04), BNP 2225.9 ng/l (normal value <25ng/l). The patient was suspected of having ACS. An urgent coronary angiography was performed and showed no stenosis. Echocardiography showed hypercontraction of the basal segments, akinetic mid-apical segments and a significant decrease in LV ejection fraction (EF) up to 30%. As a result of acute emotional and physical stress and instrumental tests, she was diagnosed with TCM. In addition, after a cardiac magnetic resonance imaging (CMRI) a thrombus was found in the apex of the LV as a complication of TCM. Evidence-based medical treatment was applied, the patient improved and was discharged for further outpatient follow-up. Two months later, the patient underwent a CMRI scan, which showed that LVEF improved to 66% and the thrombus had disappeared. Summary. This is a case report of a patient diagnosed with a complication of TCM and LV thrombus after a stressful event. Conclusions. TCM is a disease with a good prognosis, but it should also be considered a disease at risk of serious complications that can lead to death.

Introduction. An aneurysm is an abnormal bulge in the wall of a blood vessel. A ruptured aneurysm causes bleeding inside the body which is called extravasation. Etiologies that have been reported to contribute to iliac aneurysmal dilatation include atherosclerotic changes, inflammation, wall tension, molecular genetic factors. The purpose of our report is to present a case of an isolated aneurysm of the external iliac artery (EIA) that caused urological complications for the patient. Case description. 73-year-old male was hospitalized in a regional hospital with fever, pain of the left side of waist, anuria. Medical history revealed that patient had been diagnosed with terminal renal failure caused by diabetic nephropathy. Laboratory tests demonstrated high inflammatory indicators and renal dysfunction. The findings in ultrasound of abdominal organs were included hydronephrosis of the left kidney, dilated left ureter, in the left iliac region an inhomogeneous formation, similar to a hematoma. The patient with suspected internal bleeding was transferred to Lithuanian University of Health Sciences Hospital Kaunas Clinics for further investigation and treatment. Upon arrival, it was decided to perform a CT scan of the abdomen and pelvis, and extravasation of the left EIA with aneurysm was observed. Hematoma in the pelvis presses on the left ureter, which is expanded above the hematoma. The patient was consulted by surgeons, and it was decided to prescribed treatment with antibiotics and monitoring of the condition. Consultation with an interventional radiologist is indicated regarding the possibility of embolization and stenting. Summary. This case report demonstrates what urological complications aneurysm of the EIA can cause. Conclusion. Isolated EIA aneurysm and extravasation can cause complications such as ureteric compression and genitourinary system disorders, so it is important to diagnose an aneurysm in time, but it is difficult, because isolated aneurysms often are asymptomatic.

Eight million Ukrainians have taken refuge in the European Union. Many have asthma and/or allergic rhinitis and/or urticaria, and around 100,000 may have a severe disease. Cultural and language barriers are a major obstacle to appropriate management. Two widely available mHealth apps, MASK-air® (Mobile Airways Sentinel NetworK) for the management of rhinitis and asthma and CRUSE® (Chronic Urticaria Self Evaluation) for patients with chronic spontaneous urticaria, were updated to include Ukrainian versions that make the documented information available to treating physicians in their own language. The Ukrainian patients fill in the questionnaires and daily symptom-medication scores for asthma, rhinitis (MASK-air) or urticaria (CRUSE) in Ukrainian. Then, following the GDPR, patients grant their physician access to the app by scanning a QR code displayed on the physician's computer enabling the physician to read the app contents in his/her own language. This service is available freely. It takes less than a minute to show patient data to the physician in the physician's web browser. UCRAID-developed by ARIA (Allergic Rhinitis and its Impact on Asthma) and UCARE (Urticaria Centers of Reference and Excellence)-is under the auspices of the Ukraine Ministry of Health as well as European (European Academy of Allergy and Clinical immunology, EAACI, European Respiratory Society, ERS, European Society of Dermatologic Research, ESDR) and national societies.

Įvadas. Pagrindinė makšties sausumo išsivystymo priežastis - hormonų koncentracijos pokyčiai, ypač estrogenų sumažėjimas. [...].