Kireilis, Benas

Background: Hematopoietic stem cell transplantation (HSCT) is a potentially curative procedure that is used in various hematological malignancies. However, among an increasing number of HSCT, the amount of cancer therapy-related cardiac dysfunction (CTRCD) is increasing as well. This study aimed to determine the prevalence of subclinical CTRCD in HSCT patients 12 months after HSCT and to assess the impact of clinical factors on the development of CTRCD. Material and Methods: We included 55 patients who underwent autologous or allogeneic HSCT. The patients were assessed using an echocardiography method before and 12 months after a HSCT procedure. Results: Our study revealed that during the 12-month follow-up period, asymptomatic CTRCD was observed in 15 patients (27.3%), 6 experienced moderate CTRCD, and 9 experienced mild CTRCD. Patients with previous use of anthracyclines tended to have CTRCD more often: nine patients (60%) in the CTRCD group and nine patients (22.5%) in non-CTRCD group. Patients who received the BEAM regimen for conditioning also experienced CTRCD more often: five patients (33.3%) in CTRCD group vs. two patients (5%) in the non-CTRCD group. Conclusions: Our study showed that asymptomatic CTRCD was found in 27.3% of the patients 12 months after HSCT. The BEAM chemotherapy conditioning protocol following prior anthracycline use were identified as factors contributing to the development of CTRCD.

Background: Hematopoietic stem cell transplantation (HSCT) can cause cardiac toxicity of different grade. In this study we aimed to evaluate the impact of mobilization procedure for autologous HSCT process on left and right ventricle sizes and systolic function. Methods: Data of 35 patients undergoing autologous HSCT at the Department of Oncology and Hematology in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from October 2021 till Feb 2023 were analyzed. Bioethics approvement for prospective study was obtained (No BE-2-96). HSCT was performed for various reasons – mostly multiple myeloma, also mantle cell lymphoma, Hodgkin lymphoma, diffuse large B cell lymphoma, Ewing sarcoma. All patients underwent hematopoietic stem cell mobilization with chemotherapy and filgrastim 10 µg/kg/d. Echocardiography was performed before enrolling to the transplantation process and after mobilization before the conditioning regimen. Left ventricular end diastolic diameter (LVEDD), LVEDD index according to body surface area (BSA) (LVEDDi), left ventricular ejection fraction (LV EF), left ventricular global longitudinal strain (GLS), right ventricle (RV) end diastolic diameter (RVEDD, tricuspid annular systolic velocity (S’) using tissue doppler and tricuspid annular plane systolic excursion (TAPSE) were measured before and after mobilization and compared. Statistical analysis was performed using SPSS statistics 20. Qualitative data is presented as an absolute value (N) and percentage (%), quantitative parameters are given as average (m ± standard deviation). We used paired- samples T test to compare quantitative parameters. Statistically significant difference was considered when p<0.05. Results: Out of 35 patients there were 18 men (51,4%) and 17 women (48,6%). Mean age was 57,4±13,15 years, ranging from 18 to 74. 26 (74,3%) patients had multiple myeloma, 4 (11,4%) mantle cell lymphoma, 2 (5,7%) Hodgkin ‘s lymphoma, 2 (5,7%) PCNS diffuse large B cell lymphoma, 1 (2,9%) Ewing sarcoma. Statistically significant difference was observed in the change of RV function. S‘ and TAPSE slightly decreased. Changes of echocardiographic parameters are presented in Table 1. Conclusions: Mobilization procedure in patients undergoing autologous HSCT is associated with reduced RV systolic function. S‘ and TAPSE might be used for early cardiotoxicity evaluation in HSCT patients.

Pheochromocytoma is a rare adrenal gland tumor that produces excessive amounts of adrenaline and noradrenaline, leading to a surge in blood pressure. This condition often goes undiagnosed due to its infrequency and diverse symptom presentation, surgery is considered as the definitive treatment. We report a 65-year-old male patient, initially referred to an endocrinologist for further evaluation of a mass in the right kidney discovered via Magnetic Resonance Imaging (MRI), leading to a diagnosis of pheochromocytoma. Following a successful surgical procedure and peri-operative period, the patient was discharged and advised to return to the hospital 1 month after the surgery and every 1 year for regular follow-ups.

Long QT syndrome (LQTS) is a rare inherited cardiac condition characterized by QT prolongation and T-wave abnormalities on the electrocardiogram (ECG). It is commonly associated with syncope, however, sudden cardiac death can occur due to Torsades de Pointes (TdP). We report the case of a 27-year-old female patient with genetically confirmed LQTS type 2 KCNH2 gene mutation found, who experienced multiple syncopes since a young age. After antipsychotic drugs were removed and ß-adrenoblockers were prescribed, fainting episodes did not reoccur.

Background and aim of the study. Facial nerve palsy, the primary cause of cranial nerve paralysis, induces paralysis in the orbicularis muscle, leading to lower eyelid paralytic ectropion and lagophthalmos, heightening the risk of ophthalmic complications. Surgical interventions, dynamic or static, aim to restore eyelid function or ensure adequate eyelid coverage. This study aimed to evaluate the outcomes of static eyelid reconstruction surgery in facial nerve palsy patients. Methods and materials. In a retrospective analysis, 28 cases with facial nerve palsy were examined, analysing data from a five - year period spanning from January 1, 2018, to December 31, 2022. Results. The study comprised 28 patients, with 16 women (57.1%) and 12 men (42.9%), averaging 50.36 years in age. A significant gender-based observation was noted, with more men presenting left- sided tumors (69.2%), while women exhibited right-sided tumors more frequently (80.0%). Among the surgical cases, 19 patients (67.9%) achieved complete eye closure, while 9 (32.1%) experienced partial closure (lagophthalmos persists). A significant correlation was observed between long-term outcomes and surgical technique. In 21 cases (75.0%), employing gold weight implantation and lateral canthopexy led to reduced lagophthalmos and ectropion in 17 patients (80.9%). Conversely, lagophthalmos persisted in 5 out of 7 surgeries without gold weight implantation (71.42%). Conclusions. Gold weight implantation and lateral canthopexy are effective treatments for facial paralysis, particularly when it hampers full eye closure. Combining these surgical techniques, notably with gold weight implantation, yields optimal outcomes.

Introduction Facial nerve palsy is the most common cranial nerve paralysis, which results in paralysis of the orbicularis oculi muscle [1,2]. This leads to lower eyelid paralytic ectropion and lagophthalmos, which both increase the risk of ophthalmic complications such as corneal exposure, evaporation of the tear film, and subsequent exposure keratopathy [3]. The main causes of facial nerve palsy are tumors, head trauma, viral diseases (Bell's palsy). Facial nerve palsy treatment involves both medical and surgical approaches [4]. Surgical procedures can be dynamic, for example masseterto-facial nerve transfer, cross - face nerve grafting, or static, such as upper eyelid blepharoplasty, ptosis repair and brow lift, and focus on reestablishing eyelid function or eyelid coverage [5]. [...].

Introduction This paper presents a compelling case of a 71-year-old female patient with malfunctioning aortic valve (AV) prosthesis. Admitted for a non ST-elevation myocardial infarction (NSTEMI), computed tomography angiography (CTA) findings led to urgent prosthetic revision. Case presentation A 71-year-old patient with a mechanical AV prosthesis implanted in 2008 due to rheumatic heart disease, was admitted for suspected NSTEMI. [...].

Introduction We report a 65-year-old male with an MRI suspected and SPECT/CT confirmed pheochromocytoma diagnosis. The patient, following a successful surgical procedure, was discharged and instructed for the follow-ups. Case presentation The patient presented with an MRI-confirmed mass in the right adrenal gland. The patient, treated for arterial hypertension, had a highest recorded systolic blood pressure (BP) of 150 mmHg. Further evaluation findings were consistent with pheochromocytoma, surgical treatment was recommended. During pre-operative preparation, doxazosin monotherapy was initiated to reach BP targets of <130/80 mmHg, increasing to a maximum of 18 mg/day. Later, 47.5 mg/day of metoprolol was added to further lower BP and heart rate. For anesthesia induction, 0.2 mg Fentanyl, 300 mg Propofol, 50 mg Atracurium, and 4 mg Dexamethasone were administered.

Introduction Patients who experience chest pain, shortness of breath, atypical outcome of stress testing such as exercise-induced abnormalities often do not show any significant obstructive coronary lesions during coronary angiography [1]. These patients may have structural and functional abnormalities of the coronary microvasculature which refers to the epicardial pre-arterioles, intramyocardial arterioles and capillaries. Coronary microvascular dysfunction (CMD) is a condition where the regulation of blood flow in the coronary vessels is impaired, leading to a reduction in coronary flow reserve and causing myocardial ischemia [2]. As a result, individuals with CMD have an increased likelihood of experiencing cardiovascular events [3]. Aim This study examines whether coronary microcirculatory dysfunction associates with 12 - month cardiovascular events after discharging with confirmed CMD. [...].

Asthma, a chronic condition marked by airway inflam­mation, results from a complex interplay of genetic and environmental factors, including urban pollution. As­thma varies in severity and can be intermittent or per­sistent. Allergic asthma is most common and linked to elevated IgE levels and eosinophilic airway inflamma­tion. Additionally, asthma exacerbations, often triggered by respiratory infections, significantly impact patient’s well-being. Apart from its respiratory impact, asthma has notable implications for the cardiovascular system. Chronic inflammation, common to both asthma and car­diovascular disease (CVD), contributes to atherosclerosis, plaque rupture, and acute CVD events. Studies suggest that persistent asthma is associated with a higher risk of CVD events. While asthma poses challenges in diagno­sis and management, it also underscores the importance of monitoring cardiovascular health in asthma patients, given the clear link between these two conditions. Furt­her research is needed to better understand this complex relationship. Aim: The aim of this article is to highlight the signifi­cance of allergic asthma‘s negative impact on the car­diovascular system.