Buginytė, Roberta

Sklerozinis mezenteritas - lėtinis, nespecifinis žarnyno pasaito riebalinio audinio uždegimas. [...].

Uždegiminės žarnų ligos (UŽL) - tai lėtinių uždegiminių virškinamąjį traktą pažeidžiančių ligų grupė, kuriai priklauso opinis kolitas bei Krono liga. [...].

Background. Sclerosing mesenteritis (SM) is a rare pathology characterized by chronic, nonspecific inflammation of the fatty tissue of the intestinal mesentery. The exact causes are unknown, however abdominal traumas, surgeries, autoimmune disease, tumors may contribute to the development of sclerosing mesenteritis. The main symptom reported by patients is abdominal pain. The gold standard for diagnosing SM is computed tomography (CT). Upon diagnosis, treatment with glucocorticoids combined with other immunosuppressants is prescribed. Case report. In this case report we analyzed a 46-year-old patient who had been complaining of spasmodic abdominal pain for two years. Additionally, an increase in C-reactive protein (CRP) levels was observed alongside the pain. It was decided to perform imaging studies to determine the cause of the abdominal pain. After performing esopgagogastroduodenoscopy (EGD) and a colonoscopy, no pathology was observed. Antibiotic therapy was started, however, with no improvement in the condition, abdominal CT scan and magnetic resonance imaging (MRI) was performed. After imaging studies, inflammation and edema of the small and large intestines were observed, leading to a diagnosis of sclerosing mesenteritis. The patient was prescribed methylprednisolone. During treatment, the clinical condition improved, and abdominal pain disappeared. Conclusion. Sclerosing mesenteritis is a rare pathology that causes chronic abdominal pain. There are many factors that can contribute to this condition. It is important, after conducting the appropriate tests, to identify changes characteristic of sclerosing mesenteritis, determine the factors that contributed to its development, and prescribe treatment.

Introduction Metastatic thyroid tumors are infrequent, accounting for just 3% of all thyroid cancers. Interestingly, 7.8% of these metastases stem from breast cancer. Previous malignancies increase metastatic suspicions when thyroid nodules, possibly accompanied by cervical lymphadenopathy, are discovered. As our case emphasizes, diagnostics can be complex, necessitating specialized treatment and monitoring plans. Case Presentation A 55-year-old female presented with right supraclavicular masses, neck discomfort. She was diagnosed with left breast carcinoma in 2008, with subsequent successful treatments including a right mastectomy, chemotherapy, and radiation. Clinical Examination: A 1 cm nodule was found in the right breast with skin adhesion. Clustered lymph nodes appeared in the left supraclavicular region. Diagnostic Assessments: Ultrasound: 3.8!3 cm tumor in the right breast’s outer quadrant and a hypoechoic mass in the liver. The left supraclavicular area had pathological lymph nodes. Chest X-ray: Identified a 4.7!5 cm mass in the right paratracheal region. Lab. Results: CEA 19, 1-O74 pg/l (0-5, 8); Ca125 8, 8 kU/l (0-35); Ca19-9 5, 5 kU/l (0-37); Ca27.29 129, 8 (0- 31). TSH 1.1 mU/l (0, 4-3, 6), FT4 11, 1 pmol/l (9-21, 07), FT3 5, 1 pmol/l (3, 34- 5, 14), AntiTPO 3, 0 kU/l (0-3, 2), AntiTg 6, 1 kU/l (0-13, 6), calcitonin 1, 24 (0, 12-2, 8). Histopathology: infiltrative ductal breast carcinoma, G2 (ERC), (PRC), (HER2-). Computed Tomography (CT): Highlighted tumor presence in the right breast, pathological lymph nodes, and metastases in renal, hepatic regions, and bones. PET CT: Revealed low metabolic activity neoplastic lesions in the right breast and high metabolic activity lymph nodes suggestive of lymphoma. Thyroid Ultrasound: Several nodules, largest being 0.9!0.7 cm (TI-RADS 4), and a heterogeneous 1.2!0.6 cm zone with microcalcinate-like inclusions (TI-RADS 5) are in the right lobe. The left lobe has zones up to 2.6!1.3 cm with similar inclusions (TI-RADS 5). Pathological-enlarged lymph nodes are present on both neck sides, the biggest being 2.3!1.6 cm on the left. Fine needle aspiration biopsy revealed breast ductal carcinoma metastases in the thyroid gland. Abdominal l/m biopsy result L: infiltrative ductal carcinoma G2 spread, HER2(-), ERC, PR-. Therapeutic Recommendations: A multidisciplinary team recommended chemotherapy with ribociclib and fulvestrant. Given the reducing size of thyroid metastases and no signs of tracheal or esophageal compression, thyroidectomy was deemed unnecessary. Conclusion Metastases in the thyroid often indicate a poor prognosis, negating surgical intervention for some. This case underscores the importance of distinguishing primary thyroid conditions from metastatic incidences due to differing therapeutic approaches and their subsequent impact on prognosis.

Background: Mivacurium is a selective, short-acting, non-depolarising muscle relaxant, which is used to facilitate tracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation. A standard intubating dose of 0.2 mg/kg in children (aged 2–12) causes complete neuromuscular depression in 1.5-2 minutes and spontaneous recovery is 95% complete in approximately 20 minutes. As mivacurium is hydrolyzed by pseudocholinesterase (PCE), a deficiency in this enzyme may result in a prolonged blockage. In this case, we present an unexpected prolonged neuromuscular block in a child after a single dose of mivacurium. Case report: A 7-year-old boy underwent bilateral adenotonsilectomy. The patient had not been anaesthetized in the past and there was no family history of adverse reactions to anesthesia. He did not take any medication and denied drug allergies. Physical examination revealed a healthy 32 kg male. For induction of general anesthesia 0.05 mg fentanyl and a single dose of 3 mg mivacurium were infused, followed by endotracheal intubation 2 minutes later. In this case, only half of the recommended dose (0.09 mg/kg) of neuromuscular blocker was used. Anesthesia was maintained with 1 MAC (minimum alveolar concentration) sevoflurane in oxygen. Surgery lasted 50 minutes uneventfully and anesthesia was continued in the operating room for another 20 minutes. However, complete recovery from anesthesia was complicated by respiratory failure due to residual action of mivacurium. For safe extubation, he was transferred to the intensive care unit. The P-SIMV- Ventilation Mode was continued, and consciousness was additionally sedated with intravenous midazolam 2.5 mg and propofol 50 mg doses. Full spontaneous respiration was restored after 230 minutes after a single bolus of 0.09 mg/kg mivacurium with safe extubation. Conclusions: It is currently not practical to screen for all presurgical cases of pseudocholinesterase deficiency if the patient has no family history of this disorder. Usually, for faster non-depolarising neuromuscular-blockage recovery, neostigmine is used as an antidote. However, the current use of this antidote is still under discussion because it may potentially prolong the mivacurium induced neuromuscular-blockage and should only be used when the majority of euromuscular activity has returned.

Introduction: Mivacurium is a selective, short-acting, non-depolarising muscle relaxant, which is used to facilitate tracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation. A standard intubating dose of 0.2 mg/kg in children (aged 2 – 12) causes complete neuromuscular depression in 1.5 - 2 minutes and spontaneous recovery is 95% complete in approximately 15 to 20 minutes. As mivacurium is hydrolyzed by pseudocholinesterase (PCE), a deficiency in this enzyme may result in a prolonged blockage. In this case, we present an unexpected prolonged neuromuscular block in a child after a single dose of mivacurium. Case report: A 7-year-old boy underwent bilateral adenotonsilectomy. The patient had not been anaesthetized in the past and there was no family history of adverse reactions to anesthesia. He did not take any medication and denied drug allergies. Physical examination revealed a healthy 32 kg male within normal range. For induction of general anesthesia 0.05 mg fentanyl and a single dose of 3 mg mivacurium were infused, followed by endotracheal intubation 2 minutes later. In this case, only half of the recommended dose (0.09 mg/kg) of neuromuscular blocker was used. Anesthesia was maintained with 1 MAC (minimum alveolar concentration) sevoflurane in oxygen. Surgery lasted 50 minutes uneventfully and anesthesia was continued in the operating room for another 20 minutes. However, complete recovery from anesthesia was complicated by respiratory failure due to residual action of mivacurium. For safe extubation, he was transferred to the intensive care unit. The Mechanical Ventilation P-SIMV-Mode was continued, and consciousness was additionally sedated with intravenous midazolam 2.5 mg and propofol 50 mg doses. Full spontaneous respiration was restored after 230 minutes after a single bolus of 0.09 mg/kg mivacurium with safe extubation. Conclusion: In this case report,[...].

Background. Laryngeal tuberculosis is a rare form of tuberculosis that usually develops due to direct spread from a bronchus or hematogenous spread. The most common symptom related to laryngeal tuberculosis is hoarseness which also can be led by dysphagia, odynophagia, cough, or nonspecific symptoms like fever or localized pain. To confirm laryngeal tuberculosis, histopathologic examination is necessary because it can mimic laryngeal cancer. Diagnosis of laryngeal tuberculosis is made through a combination of a comprehensive otorhinolaryngological examination, imaging, laboratory and histological analysis. Case report. We describe the case of a 62-year-old Lithuanian man who presented with the clinical picture of laryngeal cancer, but which turned out to be tuberculosis. We illustrate the difficulty of recognizing laryngeal tuberculosis both clinically and even with radiological examination. Discussion. Laryngeal tuberculosis is a rare condition that can mimic laryngeal cancer. In male patients with a history of smoking and complaining of dysphonia, odynophagia, and cough LT is a diagnosis to be considered.

2020 m. kovo mėn. Pasaulio sveikatos organizacija paskelbė apie COVID–19 infekcijos pandemiją, kurią sukelia SARS–CoV–2 virusas, priklausantis Coronaviriadae virusų šeimai. Patekęs į organizmą SARS-CoV-2 virusas, prisijungia prie specifinių angiotenziną konvertuojančių fermentų 2 (AKF-2) receptorių, esančių ląstelių – taikinių paviršiuje. Dėl plačios AKF-2 receptoriaus ekspresijos, COVID-19 liga pasireiškia įvairaus sunkumo klinikinėmis formomis. Dažniausiai virusas pažeidžia viršutinius ir apatinius kvėpavimo takus, tačiau vis plačiau kalbama apie šio viruso sąlygotą kepenų funkcijos sutrikimą. Tikslas: įvertinti galimus kepenų pažeidimo mechanizmus, simptomus, laboratorinius pokyčius, pažeidimo įtaką pacientų išgyvenamumui bei gydymo ir prevencijos galimybes, sergant COVID-19 infekcija. Metodai: literatūros šaltinių paieška atlikta elektroninėse PubMed, Cochrane, UpToDate ir Medline duomenų bazėse. Analizei atrinkti 2020–2021 metų laikotarpyje anglų kalba publikuoti atsitiktinės imties tyrimai. Paieška buvo atliekama naudojant parinktus raktinius žodžius, išnagrinėta daugiau kaip 30 publikacijų, susijusių su COVID-19 sukeltu kepenų pažeidimu. Rezultatai: virusas kepenis gali pažeisti tiek sveikiems, tiek lėtines kepenų ligas turintiems pacientams. Dažniausiai nustatomi laboratoriniai pokyčiai, esant COVID-19 sukeltam kepenų pažeidimui, yra fermentų alanininės aminotransferazės (ALT) ir asparagininės aminotrasferazės (AST) aktyvumo serume padidėjimas, kuris siejamas su ligos sunkumu. Dėl prastesnių COVID-19 ligos išeičių, kepenų funkcijos sutrikimas yra būklė, kurią svarbu anksti diagnozuoti ir tinkamai gydyti.

Pyogenic liver abscess (PLA) is one of the most common visceral abscesses. The main path of development is retrograde microorganism migration from the biliary tract. Other intra-abdominal infections, haematogenous dissemination or liver trauma can also be one of the reasons for the PLA formation. Nowadays these abscesses are more common between 60-70 years old patients. The main risk factors are diabetes mellitus, liver cirrhosis, biliary tract and pancreatic diseases. Usually abscesses are caused by polymicrobial gastrointestinal flora, which consists of aerobes and anaerobes. The main pathogens are E. Coli and K. pneumoniae. The most common symptoms of liver abscesses are fever and upper abdominal pain. Other symptoms may include chills, night sweats, malaise, nausea or vomiting, right shoulder pain, cough, dyspnoea, anorexia or recent unexplained weight loss. Laboratory tests are usually associated with an increase in liver enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). Other significant laboratory tests may show hyperbilirubinemia or increase of international normalized ratio (INR). The main imaging test to confirm the diagnosis of liver abscess is ultrasonography (US). In order to determine a pyogenic liver abscess and causes of it, it is important to take blood culture and fine needle aspiration. Treatment of the PLA consists of antimicrobial therapy and drainage of the abscess. Cefuroxime and metronidazole or aminoglycoside cover gram-positive and gram-negative microorganisms and are the main antibiotics for PLA. Percutaneous needle aspiration (PNA) or percutaneous drainage (PCD) must be performed when abscesses are larger than 5 cm or patients did not improve clinically under antimicrobial therapy.

Virškinamojo trakto (VT) ligų diagnostikai ir gydymui vis plačiau taikomos endoskopinės procedūros. Jų metu pacientų patiriamą diskomfortą ir nerimą mažina adekvati sedacija ir analgezija. Sedacijai sukelti dažniausiai naudojamas medikamentas yra propofolis. Jis yra trumpai veikiantis, neturintis analgezinio efekto, todėl dažnai naudojamas kombinuojant su opioidais ir (ar) benzodiazepinais. Šiame straipsnyje analizuojami klinikiniai tyrimai, lyginantys monoterapiją propofoliu (MTP) ir kombinuotą sedaciją propofoliu (KTP), kai kartu su propofoliu naudojamas midazolamas, fentanilis ir (arba) ketaminas. Tyrimo tikslas - palyginti abiejų metodų įtaką nepageidaujamų reakcijų pasireiškimui, atsigavimo laiko trukmei po procedūros bei gydytojų ir pacientų pasitenkinimui atlikta procedūra. Tyrimo rezultatai parodė, kad VT endoskopinių procedūrų metu taikant monoterapiją propofoliu hipoksijos ir hipotenzijos rizika yra didesnė, nei taikant kombinuotą terapiją propofoliu. Sedacijos pradžia ir atsigavimo laikas po procedūros yra trumpesnis, kai propofolis naudojamas vienas. Gydytojų ir pacientų pasitenkinimas procedūra nuo pasirinkto sedacijos metodo nepriklauso.