Simanaitis, Vytautas

Background: Alveolar echinococcosis is a rare but aggressive parasitic disease, and liver transplantation (LT) is considered in selected patients with unresectable hepatic involvement. The last systematic review published in 2018 reported 150 LT cases over 30 years. With advances in surgical technique, imaging, and immunosuppression, the number and complexity of LT procedures for this indication have increased, warranting an updated analysis. Purpose: To conduct a systematic review of liver transplantation for hepatic alveolar echinococcosis and to update previously published outcomes. Method: A systematic literature search was performed in PubMed, ScienceDirect, and Google Scholar following PRISMA guidelines and registered in PROSPERO. Articles published between 2017 and 2025 were included. Extracted data included patient characteristics, prior surgeries, vascular invasion, perioperative antiparasitic therapy, recurrence, and survival outcomes. Result(s): Twenty-three studies reporting 106 LT procedures were included. The mean patient age was 38 years. Prior liver resection had been performed in 45% of patients, and Budd– Chiari syndrome was reported in 23%. Vascular invasion was present in most cases. Living donor LT accounted for 56% of procedures. Albendazole therapy was administered preoperatively in 58% and postoperatively in 87% of patients. Recurrence occurred in 14% of reported cases. One-year and five-year survival rates were 94% and 86%, respectively. Conclusion(s): According to the present data, liver transplantation is a suitable treatment method for unresectable liver echinococcosis in selected patients. The outcomes are comparable to patients who underwent liver transplantation due to liver cirrhosis and other indications.

Įžanga Mitochondrijų funkcija yra labai svarbi kepenų funkcionavimui po transplantacijos. Perfuzija prieš kepenų implantaciją gali padėti apsaugoti mitochondrijas nuo jų pažeidimo reperfuzijos metu ir išemijos [1,2]. Klinikiniai tyrimai rodo, jog mitochondrijų funkcijos išsaugojimas gali padaryti reikšmingą įtaką mitochondrijų kvėpavimo aktyvumui [3,4]. Mitochondrijų pažeidimas gali būti susijęs su ankstyvu transplantato disfunkcijos išsivystymu ir blogesniais klinikiniais rezultatais [5].F Tikslas Įvertinti kepenų perfuzijos įtaką mitochondrijų kvėpavimui po kepenų transplantacijos, palyginant su pacientais, kuriems perfuzija nebuvo taikyta, bei su sveika kontroline grupe. Metodai Tyrimo metu analizuoti mitochondrijų kvėpavimo rodikliai: V2, V3, V4, Respiracinės kontrolės indeksas (RCI), Citochromo c efektyvumas (CytCEff), azido inhibuotas kvėpavimo aktyvumas (Azid), Citochromo c priklausomas kvėpavimo greitis (VCytC). Duomenys surinkti iš trijų grupių: kontrolinė grupė (n=13), transplantuoti pacientai, kuriems taikyta perfuzija (n=6), ir kuriems perfuzija netaikyta (n=20). Neperfuzuoti pacientai buvo papildomai suskirstyti į terciles pagal kiekvieną mitochondrijų rodiklį. Statistinė analizė buvo atlikta naudojant Kruskal– Wallis testą (bendram trijų grupių palyginimui) ir Mann–Whitney U testą (poriniams palyginimams). Tyrimo duomenų statistinė analizė atlikta naudojantis MS Excel 2010 bei SPSS 30.0 programomis. Požymių skirtumai statistiškai reikšmingi, kai p ≤ 0,05. Rezultatai Bendrame grupių palyginime Kruskal–Wallis testas neparodė statistiškai reikšmingų skirtumų (p > 0.05), tačiau kai kurie rodikliai, pvz., VCytC ir V3, rodė reikšmingas ar artimas reikšmingumui tendencijas (p ≈ 0.1). Skirstant neperfuzuotus pacientus į terciles, nustatyta, kad kvėpavimo aktyvumas ir membranos efektyvumas reikšmingai skyrėsi nuo perfuzuotų. Pvz., Azid rodiklis aukščiausioje tercilėje siekė 20.65, palyginti su perfuzuotų 7.59 (p = 0.004), o žemiausioje – tik 4.66. CytCEff, atspindintis membranos vientisumą, žemiausioje tercilėje buvo 1.04, o perfuzuotų 1.26 (p = 0.022). V3, rodantis aktyvų kvėpavimą, žemiausioje tercilėje buvo reikšmingai mažesnis (6.15, lyginant su 12.78; p = 0.035), tačiau aukščiausioje tercilėje V2 viršijo perfuzuotų lygį (16.81, lyginant su 10.66; p = 0.035). Tai rodo, kad perfuzija gali sumažinti žemiausios kokybės transplantatų riziką, bet nepranoksta aukščiausios natūralios funkcijos. Porinių Mann–Whitney testų metu paaiškėjo, kad žemiausios tercilės neperfuzuoti pacientai pagal V2 ir V3 reikšmingai skyrėsi nuo perfuzuotųjų (p<0.05). Aukščiausios tercilės pacientai taip pat reikšmingai (p<0,05) skyrėsi nuo perfuzuotų pagal VCytC, V4 ir Azid. Statistiškai nereikšmingos, bet kliniškai įdomios tendencijos pastebėtos ir kituose rodikliuose, ypač VCytC ir RCI, kurie atspindi membranos vientisumą ir efektyvumą. Perfuzuotų pacientų CytC vidurkis buvo 28.6 ± 5.3, o neperfuzuotų – 38.1 ± 13.5 (p = 0.099). Šis skirtumas nėra statistiškai reikšmingas, bet rodo potencialią tendenciją, kad perfuzija galėjo sumažinti mitochondrijų membranos pažeidimą.

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.

Introduction: Biliary complications are the most frequent cause of post-operative morbidity and mortality following liver transplantation (LT) [1]. Assuming that the mucosa of gallblader reflect changes in bile ducts, we investigated whether gallbladder mitochondrial functions are associated with short and long-term outcomes after LT. Material & Methods: Data from 16 LT patients was compared with 14 controls. Cholecystectomy was performed following implantation and arterial blood supply restoration of the donor liver (LT group) and during pancreaticoduodenectomy (Control).Gallbladder mitochondria were isolated by differential centrifugation.Oxygen consumption rates were measured in freshly isolated mitochondria with an Oroboros oxygraph. Biliary and systemic complications were classified according to the time of onset into early outcomes (up to 2 months after surgery) andlate outcomes (later than 2 months after surgery). Results: We have found that mitochondria of LTgroup present markedly diminished phosphorylating respiration rates compared to the control group. LT group was classified into subgroups according to the respiratory rates in various metabolic states into strong and mild mitochondrial injury. Logistic regression analysis showed that ADP-stimulated respiration with glutamate and malate is significantly associated with early poor outcomes in LT patients. Conclusion: Gallbladder mitochondrial function isa potential prognostic factor for early outcomes after liver transplantation.

Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30-day all-cause mortality. We performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The primary outcome measure was cardiovascular complications as defined by the Standardised Endpoints for Perioperative Medicine-Core Outcome Measures for Perioperative and Anaesthetic Care initiative up to 30 days after surgery. The secondary outcome was 30-day postoperative mortality. This study included 24,203 patients, of whom 611 (2.5%) developed cardiovascular complications. In total, 458 (1.9%) patients died within 30 days of surgery, of which 123 (26.9%) deaths were judged to be cardiac-related. Mortality rates were higher in patients who developed postoperative cardiovascular complications than in those who did not (19.8% vs. 1.4%), which persisted after risk adjustment (hazard ratio (95%CI) 4.15 (3.14-5.48)). We estimated an absolute risk reduction (95%CI) of 0.4 (0.3-0.5) in mortality in the absence of all cardiovascular complications. This would confer a relative risk reduction in mortality of 21.1% if all cardiovascular complications were prevented. Postoperative cardiovascular complications are relatively common and occur early after major abdominal surgery. However, over 1 in 5 postoperative deaths were attributable to these complications, highlighting an important area for future randomised trials.

Background: Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. Methods: This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery. Results: Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16-3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35-3.64)). Frailty and ASA physical status 3-5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12-1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36-1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment. Conclusions: Multimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care.

Objective Parathyroid carcinoma (PC) is considered a rare malignancy which accounts for less than 1% of hyperparathyroidism cases in reported literature. In B. C. James study there were only 348 cases of PC reported in SEER database 2000-2012, which compose 0,36 (per 1 million) incidence rate. PC occurrence is equal in men and women, while benign parathyroid diseases incidence is higher in women with ratio 3-4:1. Diagnostic criteria were established in 1973 by A. Schantz and B. Castleman which include thick fibrous bands, mitotic activity, vascular and capsular invasion in pathomorphological tests. The variations and pathognomic features are debated as there have been reported large series of patients with metastatic tumours of which as many as 50% were initially misdiagnosed as benign tumours, therefore preoperative diagnosis and staging is often incorrect or not available. Imaging techniques such as sestamibi scintigraphy and neck ultrasound are only used in localizing the parathyroid tissue preoperatively and >3cm size mass may raise suspicion of PC as denoted in Cetani study, however these techniques are in no way diagnostic of PC. This lead to diagnostic markers application such as Ki-67, Cyclin D1, which are more specific to PC than parathyroid adenoma. The course of disease is indolent and most deaths occur due to untreated complications of hypercalcemia. Ten cases of PC were treated in our hospital during the period of 17 years. This review focuses on our experience with the diagnosis, treatment and survival of the patients. Our aim was to review the demographics, diagnostics, treatment and outcomes of the patients, who were surgically treated for parathyroid carcinoma in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. As large part of contemporary literature on the topic is referencing the older studies from the year 2000 and before, we think that a more recent standpoint can contribute to better understanding the PC. Methods The model of the study was retrospective. Data on demographics, initial symptoms, preoperative diagnostic blood tests and instrumental procedures, surgical operations, complications, postoperative blood tests, and histology of tumours was collected. The data concerning patients‘ survival was acquired from the Lithuanian National Cancer Institute’s Cancer Registry. Results There were 10 patients who were treated surgically for parathyroid carcinoma. During the study period patients with PC accounted for 2,2 percent of all the patients with parathyroid gland pathology treated surgically in our clinic. Among PC patients there were 7 females, age distribution was from 54 – 74, mean – 64 years. Eighty percent of admitted patients suffered from complications. The most prevalent symptoms were renal function impairment, nephrolithiasis and subsequent pyelonephritis. Three patients had suffered from spontaneous bone fractures. Other common complaints included joint pain and malaise, hoarseness of voice.. Five patients had palpable disease at time of admission. One patient was asymptomatic (Table 1). Preoperative blood tests showed increased serum calcium 2,62-3,4 mmol/l (normal range (NR) – 2,15-2,55 mmol/l), ionized calcium 1,15- 1,57 mmol/l (NR – 0,98-1,13 mmol/l), and PTH 23,91 – 210 pmol/l (NR – 1,2-5,3 pmol/l), which plunged to normal range after surgical treatment. All patients were tested with ultrasound and scintigraphy. Five fine needle aspirational (FNA) punctures of nodules were performed (Table 3). None of the tests were diagnostic of parathyroid carcinoma preoperatively, nevertheless 5 out of 5 cytology showed features of malignancy. En-bloc parathyroidectomies were performed on all patients with various extents of thyroid gland removal. The diagnoses of PC were confirmed with histologic tests. Most prevalent features included vascular invasion (70%), capsular invasion (60%) and presence of fibrous bands (60%). There were no cases with distant metastases at initial surgery and lymphonodectomies were not performed. Data from Cancer registry showed, that 8 out of 10 patients were alive (survivability ranging from 4 months to 16 years postoperatively). Two of the patients have deceased due to carcinoma of pancreas and thyroid gland 2 and 4 years respectively after the operation. Conclusions Parathyroid carcinoma has complex diagnostics and staging because of its rarity and lack of studies. Majority of PC patients present with hypercalcemia and its complications – renal insufficiency, nephrolithiasis. Palpable neck mass is prevalent in half of the patients. Lesser than 3,5 mmol/l values of serum calcium should not lessen the suspicion of PC. The outcome of non-metastasized PC is favourable when en-bloc resection of the tumour is performed. Brief description of the abstract Objective: Review the diagnostics, treatment and outcomes of the patients, who were surgically treated for parathyroid carcinoma in the Hospital of LUHS Kauno klinikos from 2003 to 2019. Conclusions: Majority of PC patients present with hypercalcemia and its complications – renal insufficiency, nephrolithiasis. Lesser than 3,5 mmol/l values of serum calcium should not lessen the suspicion of PC. The outcome of non-metastasized PC is favourable when en-bloc resection of the tumour is performed.

Objectives 1. To identify the main demographic data of the patients (gender, age, number of operations during the period); 2. To evaluate clinical data of the operated patients; 3. To perform the analysis of the results of the surgical treatment and to evaluate the patients' survival. Materials and Methods Retrospective documentary analysis of data of patients who underwent surgical treatment for malignant adrenal tumors at the Hospital of LUHS Kaunas Clinics over the period 1998-2018 was performed. Cases of primary adrenal cancer and metastatic tumors of the adrenal gland were included to the analysis. Patient data were collected from hospital clinical database and case histories. Information collected included demographic (age, gender), anamnestic (type of complaints), instrumental examination data (tumor size), histopathological test results. Survival data were obtained from National Cancer Registry. P values of less than 0.05 were considered significant. Results The study group comprised 62 patients: 32 (51,6 %) females and 30 (48,4 %) males. The mean age at the time of surgical treatment was 55,6 ± 13,33 years (females 54,5 ± 14,15, males 56,7 ± 12,52). The majority of patients had more than one complaint: 44 (71 %) complained of lumbar pain, 31 (50 %) – general weakness, 16 (25,8 %) – high arterial blood pressure, 12 (19,4 %) – weight loss, 7 (11,3 %) – fever, 3 (4,8 %) – the appearance of stretch marks and changes of body composition. Three patients (4,8 %) had no complaints, tumor was found during the preventive health care check-up. An increase in cortisol levels (40 % of patients) and a decrease in adrenocorticotropic hormone (20 % of patients) in blood were found among patients with the adrenal cortical cancer. Patients, diagnosed with malignant pheochromocytoma tended to have an increase in catecholamines (44,4 % of patients). Based on radiological examinations, 43 patients with >5 cm [...].

Objectives: 1. To identify the main demographic data of the patients (gender, age, number of operations during the period); 2. To evaluate clinical data of the operated patients; 3. To perform the analysis of the results of the surgical treatment and to evaluate the patients' survival. Materials and Methods: Retrospective documentary analysis of data of patients who underwent surgical treatment for malignant adrenal tumors at the Hospital of LUHS Kaunas Clinics over the period 1998-2018 was performed. Cases of primary adrenal cancer and metastatic tumors of the adrenal gland were included to the analysis. Patient data were collected from hospital clinical database and case histories. Information collected included demographic (age, gender), anamnestic (type of complaints), instrumental examination data (tumor size), histopathological test results. Survival data were obtained from National Cancer Registry. P values of less than 0.05 were considered significant. Results: The study group comprised 62 patients: 32 (51,6 %) females and 30 (48,4 %) males. The mean age at the time of surgical treatment was 55,6 ± 13,33 years (females 54,5 ± 14,15, males 56,7 ± 12,52). The majority of patients had more than one complaint: 44 (71 %) complained of lumbar pain, 31 (50 %) – general weakness, 16 (25,8 %) – high arterial blood pressure, 12 (19,4 %) – weight loss, 7 (11,3 %) – fever, 3 (4,8 %) – the appearance of stretch marks and changes of body composition. Three patients (4,8 %) had no complaints, tumor was found during the preventive health care check-up. An increase in cortisol levels (40 % of patients) and a decrease in adrenocorticotropic hormone (20 % of patients) in blood were found among patients with the adrenal cortical cancer. Patients, diagnosed with malignant pheochromocytoma tended to have an increase in catecholamines (44,4 % of patients). Based on radiological examinations, 43 patients with >5 [...].