Vindžigalskytė, Rūta

Autosominė recesyvinė policistinė inkstų liga (ARPU), įgimta kepenų fibrozė ir Karoli liga yra genetinės inkstų ir kepenų ligos, susijusios su sutrikusia fibrocistino (poliduktino), kurį koduoja PKHD1 genas, funkcija. Sergamumas ARPU yra 1 iš 16 tūkst. gyvų gimusių kūdikių, o kepenų pažaida nustatoma daugiau nei 60 proc. ARPU sergančiųjų. ARPU ir hepatobiliarinių patologijų gydymas yra individualizuotas, parenkamas atsižvelgiant į klinikinę būklę ir komplikacijas. Kepenų transplantacija yra vienintelis radikalus Karoli sindromo gydymo būdas.

Background and aims: In primary biliary cholangitis (PBC), clinically significant portal hypertension (CSPH) may develop even in precirrhotic stages due to a presinusoidal component, potentially limiting the accuracy of Baveno VII (BVII) criteria for predicting esophageal varices (EV). We aimed to evaluate the utility of spleen stiffness measurement (SSM) in predicting EV and varices needing treatment (VNT) in patients with PBC. Method: This multicenter cross-sectional study included patients from 14 centers with PBC fulfilling at least one of the following criteria: Liver stiffness measurement (LSM) ≥8 kPa, splenomegaly, platelet count ≤150 × 109 /L, or ultrasonographic signs of cirrhosis or portal hypertension. LSM and SSM were assessed using transient elastography. Laboratory tests, ultrasound (±6 months from the SSM), and upper endoscopy (±12 m) were collected. Results: We included 126 patients, 87% women, with a median age of 64 years (IQR 58–71). Overall, 82% had a LSM ≥8 kPa, 48% thrombocytopenia, 49% splenomegaly, and 65% cirrhosis. Median LSM and SSM values were 13.6 kPa (IQR 9.1–21.3) and 36.6 kPa (IQR 25.2–48.6), respectively. EV were present in 39% of patients, of whom 28% had VNT. The prevalence of VNT was significantly higher in patients with LSM >15 kPa (24%) compared with those with LSM 8– 15 kPa (4%) or <8 kPa (0%; p = 0.002). For EV prediction, BVII criteria (LSM ≤ 15 kPa and platelet count ≥150 × 109 /L) showed moderate diagnostic accuracy (AUC 0.71), with a sensitivity (Se) of 85%, specificity (Sp) of 55%, and negative predictive value (NPV) of 85%. LSM alone demonstrated comparable performance (AUC 0.74, Se of 94%, Sp 48% and NPV of 93%) at a cut-off of 9.8 kPa. Platelet count also showed moderate accuracy (AUC 0.70, Se 55%, Sp 82%, NPV 74%) using a cut-off of 127.5 × 109 /L. SSM achieved the highest diagnostic accuracy for EV detection (AUC 0.79, Se 78%, Sp 74%, NPV 84%) at a cut-off of 37 kPa. Combining SSM ≥37 kPa with a platelet count <127.5 × 109 /L further improved diagnostic performance (AUC 0.81, Se 45%, Sp 88%, NPV 72%). For VNT prediction, SSM was the strongest predictor (AUC 0.85, Se 93%; Sp 65%; NPV 99%), at a cut-off of 39 kPa, outperforming BVII criteria, LSM, and platelet count (AUC 0.68, 0.74, and 0.77, respectively). Conclusion: SSM showed superior diagnostic accuracy for predicting esophageal varices and varices needing treatment in patients with PBC, improving BVII criteria. Its use may enable more accurate risk stratification, including in precirrhotic stages.

Krono liga yra lėtinė, progresuojanti ir visą gyvenimą besitęsianti liga, kurios galimos komplikacijos yra striktūros, fistulės, abscesai, žarnyno nepraeinamumas ar onkologinės ligos [1]. [...].

Tikslas. Išanalizuoti mokslinėje literatūroje aprašomą mezenchiminių kamieninių ląstelių terapijos panaudojimą Krono ligos komplikacijų gydymui. Metodika. Literatūros apžvalga. Straipsnių atrankai naudotos tarptautinės medicinos duomenų bazės „PubMed“ ir „ClinicalKey“. Pagal raktinius žodžius atrinkta ir išanalizuota 20 mokslinių publikacijų pasirinkta tema. Rezultatai ir išvados. Kamieninės ląstelės yra progenitorinės ląstelės, galinčios diferencijuotis ir įgyti specifinių funkcijų. Žmogaus mezenchiminės kamieninės ląstelės yra perspektyvios gydant sunkias, standartinėmis terapijomis nepagydomas, ligas. Pagrindinis klinikiniam panaudojimui skirtų šių ląstelių šaltinis yra kaulų čiulpai. Perianalinė fistulė ir antrinė žarnos fibrozė yra dažnos Krono ligos komplikacijos. Pastaruoju metu kamieninių ląstelių terapija, turinti imunomoduliacinį, priešuždegiminį ir antifibrozinį poveikį, vis plačiau taikoma gydant minėtas Krono ligos komplikacijas.

Tyrimo tikslas. Atlikti literatūros šaltinių analizę apie ūminės stemplės nekrozės (ŪSN) etiopatogenezę, kli­nikinius požymius, diagnostikos ir gydymo galimybes. Metodai. Remiantis Google Scholar, PubMed ir Clini­calKey duomenų bazių šaltiniais, išanalizuota 16 publi­kacijų pasirinkta tema. Išvados. ŪSN yra daugiaetiologė liga, kliniškai pasi­reiškianti kraujavimo iš viršutinio virškinamojo trakto požymiais, skausmu epigastrio srityje, karščiavimu, sil­pnumu. Pagrindinis diagnostikos metodas yra endosko­pinis tyrimas. Gydymas apima intraveninę hidrataciją, antacidinius vaistus, parenterinę mitybą, nil per os prin­cipą ir komplikacijų valdymą.

Tikslas. Atlikti literatūros šaltinių analizę apie gastroe­zofaginio refliukso rizikos veiksnių pasiskirstymą tarp skirtingo amžiaus grupių. Metodai. Remiantis PubMed ir ClinicalKey duomenų bazių šaltiniais, atrinkta ir išanalizuota 21 publikacija. Išvados. Pagrindiniai kūdikių ir vaikų GERL rizikos veiksniai yra hiatalinė išvarža, neurologiniai vystymosi sutrikimai, cistinė fibrozė, epilepsija, įgimtos stemplės anomalijos, astma ir neišnešiotumas, o paaugliams ir suaugusiesiems − vaikystėje buvusi GERL, blogi mity­bos įpročiai, antsvoris ar nutukimas, rūkymas, alkoholio vartojimas, tam tikrų vaistų vartojimas, psichologinis stresas, prasta miego kokybė.

Objectives. Melanoma, a potentially lethal cancer, has seen a rapid global increase in the last 50 years. It predominantly affects fair-skinned populations, with varying incidence by sex and associated differences in anatomic site. Materials and methods. In a retrospective study, conducted from January 15 to February 15, 2023, at a Dermatology and Venereology Department, two groups of patients were examined: 200 without melanoma (control) and 200 with melanoma (case). Results. Among individuals diagnosed with cutaneous melanoma (CM), statistically significant findings indicate a higher prevalence of CM in women (65.5%, N=131) compared to men (34.5%, N=69) (p<0.01, χ2 =17.818). The age range of participants was from 31 to 90, with a median age of 64.00 years (SD 13.869). The back/lumbar region was the most common site in both genders (21%, N=42). Melanoma on the buttocks was exclusively found in women, representing the least frequent site at 1% (N=2). Across both genders, CM was most diagnosed at Stage I (34.5%, N=69), the least frequently in situ (0.5%, N=1). Individuals with fair skin color are more prone to develop CM (p<0.01, χ2 =23.060). Even 97 patients with melanoma had light skin color. The analysis on eye color’s impact on CM development found that, while the majority (N=136) of patients had blue-gray eyes, it was not statistically significant. The study determined that CM occurs significantly more often in individuals with light hair. Out of 118 patients with melanoma, were blonde or had light brown hair color (p<0.01, χ2 =14.459). Conclusions. Women exhibit a higher prevalence of CM compared to men. The back/ lumbar region is a frequent site of CM diagnosis.

Introduction Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease causing bile duct injury [1]. There is no effective medical therapy and even liver transplantation (LT) might result in recurrence of PSC [2–5]. We present a case of possible recurrent PSC following LT.

Introduction Acute esophageal necrosis is a rare, life-threatening condition, with an unknown etiology [1-3]. It is more common in males, occurring in the general population at a rate of 0,008-0,2% [4]. Aim To analyse clinical cases of acute esophageal necrosis published between August 1, 2013, and August 1, 2023. Methods and Materials Based on Google Scholar, PubMed, ClinicalKey databases, 16 clinical cases were analysed. Discussion Acute esophageal necrosis (AEN) predominantly affected individuals aged 40 to 86, with an average of 63,5 years (SD 13,301). Males had a significantly higher prevalence (93,8%, N=15) than females (6,2%, N=1), with the highest morbidity in the 60-69 age group (31,3%, N=5). Major risk factors for AEN included diabetes, hypertension, kidney dysfunction, sepsis. Certain medications, including aspirin, alendronate, clozapine, olanzapine, can induce ischemic esophageal changes. In one case, psychotropic substances (cocaine and marijuana) were the sole cause of ischemic changes. Common AEN symptoms included gastrointestinal bleeding, epigastric pain, fever, and weakness, less common—syncope, diarrhea, pallor, hypothermia, hypotension, confusion, tachypnoea, tachycardia. Esophagogastroduodenoscopy detected diffuse black circumferential discoloration of the esophageal mucosa, stopping abruptly at the gastroesophageal junction. Suspected complications prompted an esophagogram or CT scan, revealing 5 complicated cases, including 2 with perforations, 3 with strictures. Primary AEN treatment included conservative measures: fluid therapy, proton pump inhibitors, nil per os, and parenteral nutrition. Antibiotics were given to 50% (N=8) of patients for infection, intestinal obstruction, or fever. Three patients required erythrocyte transfusions for anemia correction. Endoscopic methods, including stricturoplasty and balloon dilation, were used to treat esophageal stricture. The perforation case underwent esophagectomy. 19% (N=3) of patients died, posing challenges in determining if AEN directly caused death or resulted from comorbidities. Conclusion AEN, a multi-etiological disease, presents with upper gastrointestinal bleeding, epigastric pain, fever, weakness. Diagnosis involves endoscopy, while primary treatment includes conservative measures.

Short bowel syndrome (SBS) in adults is defined as having less than 180 to 200 cm of remaining small bowel. Many literature sources do not provide precise epidemiological data, and challenges in estimating the prevalence of SBS include its multifactorial etiology and varying definitions. The most common pathologies leading to SBS include Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications.