Ūminis skausmas dešinėje klubinėje srityje: ar visada tai apendicitas?

Agnius Juška1, Ieva Žostautienė1, Jonas Pivoriūnas1, Jonas Jurgaitis2, Marius Paškonis2, 3, Vytautas Lipnickas2, Kęstutis Strupas2 1Vilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 Vilnius 2Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika, Vilniaus universiteto ligoninė Santariškių klinikos, Santariškių g. 2, LT-08661 Vilnius El paštas: [email protected] Aklosios žarnos pavienis divertikulas – reta patologija ir pagal požymius beveik neatskiriama nuo ūminio apendicito. Aklosios žarnos divertikulitas gali nesukelti simptomų tol, kol nepasireiškia uždegimas, divertikulas neprakiūra ar iš jo neprasideda kraujavimas. Nors atliekami echoskopiniai ir kompiuterinės tomografijos tyrimai, tikslią diagnozę prieš operaciją vis vien sunku nustatyti ir dažniausiai ji paaiškėja operuojant. Nors ši liga reta Vakarų šalyse, ją reikia turėti omenyje diferencijuojant tuomet, kai pacientas skundžiasi skausmu dešinėje klubinėje srityje. Dėl to į šią retą būklę norime atkreipti ne tik chirurgų bet ir kitų gydytojų dėmesį. Reikšminiai žodžiai: pavienis aklosios žarnos divertikulas, divertikulitas dešinėje, skausmas apatiniame dešiniajame kvadrante, įgimtas aklosios žarnos divertikulas. Acute pain in right iliac fossa region – is it always an appendicitis? Agnius Juška1, Ieva Žostautienė1, Jonas Pivoriūnas1, Jonas Jurgaitis2, Marius Paškonis2, 3, Vytautas Lipnickas2, Kęstutis Strupas2 1Vilnius University Faculty of Medicine, M. K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania 2Clinic of Gastroenterology, Urology and Abdominal Surgery, Vilnius University Hospital Santariškių Clinics, Santariškių Str. 2, LT-08661 Vilnius, Lithuania E-mail: [email protected] Solitary diverticulum of caecum is an uncommon pathological condition almost indistinguishable from acute appendicitis. Caecal diverticulitis can be asymptomatic until it becomes inflamed, perforated or begins to bleed. In spite of routine ultrasonography and computer tomography findings, correct preoperative diagnosis is still difficult and is usually made in the operating theater. Although this condition is very rare in Western countries, it should be considered in the differential diagnosis for patients complaining of right iliac fossa pain. Therefore, the aim of this case report is to improve the awareness of this condition not only among surgical trainees but also among the rest of medical staff. Key words: solitary diverticulum of the caecum, right diverticulitis, right lower quadrant pain, congenital diverticulum of the caecum

Hepatoceliulinės karcinomos prognostinės sistemos

Jonas Pivoriūnas1, Jonas Jurgaitis2, 3, Marius Paškonis2, 3, Agnius Juška1, Janina Didžiapetrienė3, Eugenijus Stratilovas3, Narimantas Evaldas Samalavičius3, Vitalijus Sokolovas3, Gintautas Brimas2, Kęstutis Strupas21 Vilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 Vilnius2 Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika,Vilniaus universiteto ligoninės Santariškių klinikos, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto Onkologijos institutas Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas Hepatoceliulinė karcinoma – tai penktas tarp dažniausių navikų pasaulyje ir trečias pagal mirštamumą. Per pastaruosius dešimtmečius sergamumas šiuo naviku didėja Jungtinėse Amerikos Valstijose ir Europoje. Lietuvoje hepatoceliulinės karcinomos atvejų taip pat daugėja. Manoma, kad kepenų navikų per kitus du dešimtmečius dar padaugės. Hepatoceliulinė karcinoma yra sunkiai įvertinama, heterogoniška liga, dėl to pasaulyje kuriamos prognostinės sistemos, kurios turi padėti gydytojui parinkti tinkamą gydymą ir įvertinti ligos prognozę. Šio straipsnio tikslas – išrinkti ir apibūdinti labiausiai pasaulyje paplitusias hepatoceliulinės karcinomos prognostines sistemas, palyginti jų taikymo rezultatus, parinkti Lietuvai tinkamiausias sistemas. Metodai Pasinaudojus „PubMed“ duomenų baze ir įvedus reikšminius žodžius hepatocellular carcinoma, prognostic scores ir staging system buvo rasti 205 straipsniai, publikuoti nuo 1984 iki 2007 metų. Atrinkti 54 straipsniai, kuriuose minimos 24-ios hepatoceliulinės karcinomos prognostinės sistemos. Rezultatai Išanalizavus sistemas buvo nuspręsta atmesti tas, kurių pritaikyti Lietuvoje nėra galimybių dėl to, kad šalyje neatliekami tyrimai. Plačiau aprašytos devynios sistemos. Išvados Išrinkę plačiausiai pasaulyje naudojamas hepatoceliulinės karcinomos prognostines sistemas ir palyginę jų taikymo rezultatus, manome, kad būtų vertinga atlikti retrospektyvųjį lyginamąjį tyrimą, kad išsiaiškintume, kokia prognostinė sistema geriausiai tinka hepatoceliuline karcinoma sergantiems Lietuvos populiacijos pacientams diferencijuoti pagal išgyvenamumą. Reikšminiai žodžiai: hepatoceliulinė karcinoma, prognostinė sistema, prognostiniai kriterijai, pacientų išgyvenamumas Prognostic scores of hepatocellular carcinoma Jonas Pivoriūnas1, Jonas Jurgaitis2, 3, Marius Paškonis2, 3, Agnius Juška1, Janina Didžiapetrienė3, Eugenijus Stratilovas3, Narimantas Evaldas Samalavičius3, Vitalijus Sokolovas3, Gintautas Brimas2, Kęstutis Strupas21 Vilnius University Faculty of Medicine, M. K. Čiurlionio str. 21, LT-03101 Vilnius, Lithuania2 Clinic of Gastroenterology, Urology and Abdominal Surgery,Vilnius University Hospital Santariškių Clinic, Santariškių str. 2, LT-08661 Vilnius, Lithuania3 Institute of Oncology, Vilnius University, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background / objective Hepatocellular carcinoma is the most common primary liver cancer. It is the fifth most common neoplasm and the third most common cause of cancer-related death in the world. Over the last decade the incidence of this cancer has been rising in the United States of America and in Europe as well as in Lithuania. The incidence of this cancer in the next two decades is expected to rise. Hepatocelullar carcinoma is a difficult and heterogenic disease. Therefore, prognostic scores are being created to help clinicians to choose the best treatment for the patient. The aim of this review is to select and describe the most widely used prognostic systems of hepatocellular carcinoma, to compare results of their usage, applicability and to choose the most suitable scoring systems for the further use in Lithuania. Methods The PubMed data base was used to search for the keywords: “hepatocellular carcinoma”, “prognostic scores” and “staging systems”. 205 published articles were found from the year 1984 though 2007; 54 articles with 24 prognostic systems were selected. Results Upon analysing the prognostic systems, it was decided to reject the scoring systems that are impossible to use in Lithuania because of the absence of related tests. In total, nine prognostic systems were overviewed. Conclusions A retrospective cohort study is advisable to ascertain which prognostic system of hepatocellular carcinoma is most suitable for Lithuanian population. Key words: hepatocellular carcinoma, prognostic score, prognostic factors, survival of the patien

Survival of Patients With Testicular Cancer in Lithuania During 1999–2002

The aim of this study was to evaluate the survival of patients with testicular cancer in Lithuania during 1998–2002 and factors that influenced the survival.Material and methods. The survival rates of testicular cancer patients were evaluated using the data of the Lithuanian Cancer Registry for 1998–2002. The survival was evaluated using the Kaplan-Meier method and log-rank test in order to compare the survival rates. The observed survival rates were calculated.Results. The 5-year observed survival rate in Lithuania was 71.2% (95% CI, 64.4%–77.5%). The survival of testicular cancer patients depended on age at the time of diagnosis, histology of tumor, stage and extent of disease.Conclusions. The survival of patients with testicular cancer in Lithuania was substantially lower than in other European countries. The better survival was associated with younger age and lesser extent of metastases

Susirgusiųjų sėklidžių vėžiu 1998–2002 išgyvenamumas Lietuvoje

The aim of this study was to evaluate the survival of patients with testicular cancer in Lithuania during 1998–2002 and factors that influenced the survival. Material and methods. The survival rates of testicular cancer patients were evaluated using the data of the Lithuanian Cancer Registry for 1998–2002. The survival was evaluated using the Kaplan-Meier method and log-rank test in order to compare the survival rates. The observed survival rates were calculated. Results. The 5-year observed survival rate in Lithuania was 71.2% (95% CI, 64.4%–77.5%). The survival of testicular cancer patients depended on age at the time of diagnosis, histology of tumor, stage and extent of disease. Conclusions. The survival of patients with testicular cancer in Lithuania was substantially lower than in other European countries. The better survival was associated with younger age and lesser extent of metastases

The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education

Objective. To determine whether 2-dimensional or 3-dimensional hepatic visualization is better for the medical students to be used while studying the clinical hepatic anatomy. Material and methods. Twenty-nine patients who underwent surgical intervention due to focal hepatic pathology at the Department of General Surgery, University of Heidelberg, and at Clinics of Santariškės, Vilnius University Hospital were included in the retrospective cohort study. Before the surgical intervention, the computed tomography (CT) liver scan and 3- dimensional (3D) hepatic visualization were performed. A total of 58 2-dimensional and 3- dimensional digital liver images, mixed up in random sequence not to follow each other with a specially designed questionnaire, were presented to the students of Faculty of Medicine, Vilnius University. Their aim was to determine tumor-affected liver segments, to plan which liver segments should be resected, and to predict anatomical difficulties for liver resection. Results were compared with the data of real operation. Results. The students achieved better results for tumor localization analyzing 3D liver images vs. CT scans. This was especially evident determining the localization of tumor in segments 5, 6, 7, and 8 (P<0.05). Furthermore, the results of proposed extent of liver resection have been found to be better with 3D visualization (mean±SD – 0.794±0.175) in comparison with CT scans (mean±SD – 0.670±0.200), (P<0.001). Conclusions. Computer-generated 3D visualizations of the liver images helped the medical students to determine the tumor localization and to plan the prospective liver resection operations more precisely comparing with 2D visualizations. Computer-generated 3D visualization should be used as a means of studying liver anatomy