Acta Medica Lituanica最新文献

{"title":"Stereotactic Ablative Radiation Therapy for Metastatic Renal Cell Carcinoma - A Review of Evidence.","authors":"Hima Bora, Gautam Sarma, Partha Pratim Medhi","doi":"10.15388/Amed.2025.32.1.18","DOIUrl":"10.15388/Amed.2025.32.1.18","url":null,"abstract":"<p><p>Because of its remarkable precision in providing targeted radiation, recent evidence supports <i>Stereotactic Ablative Radiation Therapy</i> (SABR) as a promising non-invasive treatment approach for metastatic renal cell carcinoma, minimizing harm to adjacent healthy tissues. With regards to its heterogeneous nature with diverse clinical presentations, rapid progression and metastatic potential, <i>Renal Cell Carcinoma</i> (RCC) is known to make therapy more challenging, and also to reduce the survival rates. Even though <i>Immune Checkpoint Inhibitors</i> (ICIs) remain the gold standard for treating metastatic RCC (mRCC), certain patients with one or a few distant metastases seem to have a longer survival period if the metastases are surgically removed. However, complete responses are not always the case, with radiation being increasingly incorporated as a component of multidisciplinary care. Moreover, studies proving the immunogenic qualities of hypofractionated SABR and the safety and potential of combining SABR with immune-based and surgical therapy for mRCC are becoming more prevalent in the literature. SABR helps induce local inflammation with the tumour, promoting T cell activation and antigen presentation. Multiple retrospective and prospective reports have also demonstrated that SABR assigned to the metastatic locations of mRCC, while using ablative dosages, achieves high local control rates with a good toxicity profile, thus disproving earlier theories of RCC radioresistance. This review outlines the key evidence favouring SABR being administered to metastatic tumours, including the results of recent prospective phase 2 trials in patients with oligometastatic, oligoprogressive, and unselected mRCC. The body of data that has been gathered points to SABR as a promising indicator that is being utilized more and more in the multidisciplinary management of mRCC.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"22-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructed Hemivagina, Uterine Didelphys, and Ipsilateral Renal Agenesis: A Case Report of OHVIRA Syndrome.","authors":"Mehtap Güneş, Sevinç Taşar, Hayriye Nihan Karaman Ayyıldız, İbrahim Kale, Funda Alp Uydu, Murat Muhcu","doi":"10.15388/Amed.2025.32.2.19","DOIUrl":"10.15388/Amed.2025.32.2.19","url":null,"abstract":"<p><strong>Background: </strong>Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital anomaly of the female urogenital tract. This report presents the clinical features, diagnostic approach, and management of an adolescent girl with OHVIRA syndrome.</p><p><strong>Clinical case: </strong>A 14-year-old female was admitted with abdominal pain and irregular menstruation. Ultrasonography and MRI demonstrated uterus didelphys with right-sided hematometrocolpos and ipsilateral renal agenesis. External genital examination revealed an intact hymen with a bluish bulge 2 cm above the hymenal ring. Surgical exploration confirmed an obstructed right hemivagina, which was opened while preserving hymenal integrity. Menstrual blood was drained, and a Foley catheter was placed temporarily to ensure patency. The postoperative course was uneventful, and the patient was discharged on the second day.</p><p><strong>Discussion and conclusions: </strong>This case illustrates successful surgical management of OHVIRA syndrome while preserving hymenal integrity. Early diagnosis and imaging are essential to prevent complications such as hematometrocolpos, endometriosis, and infertility.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"453-458"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Silent Shunt: Traumatic Splenic AV Fistula Revealed and Treated Endovascularly.","authors":"Gulshan Sharma, Resham Singh, Puneet Garg","doi":"10.15388/Amed.2025.32.2.10","DOIUrl":"10.15388/Amed.2025.32.2.10","url":null,"abstract":"<p><strong>Background: </strong>Splenic arteriovenous fistula (AVF) is a rare vascular anomaly that can arise from trauma, aneurysmal rupture, or congenital conditions. Prompt diagnosis and management are crucial to preventing complications such as portal hypertension and high-output cardiac failure.</p><p><strong>Case presentation: </strong>We present the case of a 62-year-old male with a traumatic splenic AVF resulting from a road traffic accident (RTA), associated with a Grade IV splenic injury and multiple pseudoaneurysms. The patient underwent successful endovascular coil embolization and experienced an asymptomatic follow-up.</p><p><strong>Conclusion: </strong>Endovascular coil embolisation is a minimally invasive and effective first-line treatment for traumatic splenic AVFs, particularly in hemodynamically stable patients, providing excellent outcomes and organ preservation.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"393-397"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality Imaging in a Patient with Erdheim Chester Disease with Cardiovascular Involvement.","authors":"Priya Jagia, Vineeta Ojha, Gautam Sharma","doi":"10.15388/Amed.2025.32.2.18","DOIUrl":"10.15388/Amed.2025.32.2.18","url":null,"abstract":"<p><p>We hereby report a 40-year-old woman presenting with chest pain and recurrent pericardial effusion. Cardiac MRI revealed diffuse sheath-like mass involving predominantly the right heart chambers. She also had bony and perirenal involvement. Additionally, she had a pineal gland tumor, a biopsy from which revealed xanthogranulomatous infiltration with foamy histiocytes which were CD 68 positive and CD1a negative, diagnostic of Erdheim Chester disease. Erdheim Chester disease is a rare form of non-Langerhans cell histiocytosis. We highlight the importance of multimodality imaging for comprehensive assessment of all the organ systems to enable prompt diagnosis of this rare condition.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"446-452"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant Prescription to Children/Adolescents and Its Effects on the Cardiovascular System, Comprising the Actual Questions of Periodicity of the Checkups, Cooperation among Pediatricians, Family Doctors, Cardiologists and Children-Adolescent Psychiatrists.","authors":"Reda Montvilaitė","doi":"10.15388/Amed.2025.32.1.15","DOIUrl":"10.15388/Amed.2025.32.1.15","url":null,"abstract":"<p><strong>Background: </strong>Pharmacological treatment is one of the most effective ways to help psychiatric patients with depressive disorders. However, prescription of antidepressants to children and adolescents creates controversial thoughts due to possible negative effects on the cardiovascular system. Despite being beneficial in controlling serious illnesses, there is less research done on the side effects of antidepressants which would require periodical checkups and cooperation among medical specialists. This literature review was completed to evaluate effects of antidepressants on the cardiovascular system and the necessity of regular assessment while treating children and adolescents.</p><p><strong>Aim: </strong>To review the cardiovascular effects of antidepressants prescribed to children and adolescents; to discuss the need for regular patient checkups with a multidisciplinary team: pediatricians, family doctors, cardiologists and children-adolescent psychiatrists.</p><p><strong>Methodology: </strong>Literature sources were selected from the <i>Pubmed, Google Scholar, Clinical Key</i>, and <i>Research Gate</i> databases by following dates from 2013 to 2024 while using the following keywords and their combinations: antidepressant, cardiovascular, side effects, cardiovascular risk, children and adolescents, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), psychotropic medication, antidepressants in pediatrics, atypical antidepressants, benzodiazepines, lipid metabolism.</p><p><strong>Results: </strong>Antidepressants, including SSRIs, SNRIs, TCAs, atypical antidepressants and benzodiazepines, are associated with significant cardiovascular risks in children and adolescents. SSRIs, like citalopram and escitalopram, can disturb the heart rhythm by prolonging the QT interval, or increasing the risk of serious arrhythmias. SNRIs have been linked to an elevated blood pressure and heart rate. TCAs are known for their proarrhythmic effects, particularly in overdose situations, posing a high risk of sudden cardiac events. Atypical antidepressants like bupropion can cause cardiovascular disturbances, especially when overdosed. Additionally, less commonly prescribed benzodiazepines contribute to cardiovascular risks when combined with SSRIs during pregnancy, due to increasing the likelihood of congenital heart defects. These risks underscore the importance of careful monitoring, dosage management and thorough cardiovascular assessment when prescribing these medications to children, adolescents, and pregnant women. A team consisting of professional specialists - children-adolescent psychiatrists, cardiologists, pediatricians and family doctors - should detect long-term effects of pharmacotherapy by checking up the young patients regularly.</p><p><strong>Conclusions: </strong>The use of antidepressants in children and adolescents, though crucial for managing se","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"52-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Mitral Valve Prosthesis Thrombosis: A Case Report.","authors":"Viktorija Pareikaitė, Silvija Makrickaitė, Giedrė Bakšytė","doi":"10.15388/Amed.2025.32.1.13","DOIUrl":"10.15388/Amed.2025.32.1.13","url":null,"abstract":"<p><strong>Background: </strong>A rare but serious complication of heart valve replacement, prosthetic valve thrombosis carries significant risks of morbidity and mortality. Effective management depends on prompt diagnosis and the appropriate treatment, often involving fibrinolytic agents. Protocols using slower infusion rates and lower doses of these agents have led to improved therapy outcomes.</p><p><strong>Clinical case: </strong>We report a case of a 56-year-old man admitted to the Lithuanian University of Health Sciences Kaunas Clinics due to mechanical mitral valve prosthesis thrombosis complicated by a respiratory failure and atrial fibrillation. The patient was treated with ultraslow thrombolysis with alteplase. The function of the mechanical valve prosthesis became normal, and the patient was discharged from the hospital.</p><p><strong>Discussion and conclusions: </strong>Managing prosthetic valve thrombosis is challenging due to overlapping clinical features with other diagnoses and the lack of consensus on the treatment methods. Slow-infusion, low-dose thrombolytic therapy with alteplase can be a life-saving intervention with a high success rate.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"132-137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgG4-related Disease Manifesting as Autoimmune Pancreatitis, Sialadenitis, and Cholangitis: Case Report.","authors":"Augustina Tumelytė, Vytautas Rimkus, Paulina Tekoriutė, Limas Kupčinskas","doi":"10.15388/Amed.2025.32.2.11","DOIUrl":"10.15388/Amed.2025.32.2.11","url":null,"abstract":"<p><p>IgG4-related disease (IgG4-RD) is a rare autoimmune disease which can affect almost any organ. We present a case of IgG4-RD, which manifested as chronic autoimmune pancreatitis with pancreatic insufficiency, severe malnutrition, autoimmune sialadenitis, and cholangitis. After the administration of prednisolone and mycophenolate mofetil, the patient's condition improved significantly.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"398-403"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heavy Chain Disease with Cystic Lung Disease Presenting as Recurrent Spontaneous Pneumothorax in a Young Adult.","authors":"Konstantinos Dodos, Tsampika Vasileia Kalamara, Vasiliki Epameinondas Georgakopoulou","doi":"10.15388/Amed.2025.32.2.15","DOIUrl":"10.15388/Amed.2025.32.2.15","url":null,"abstract":"<p><p>Heavy chain diseases (HCDs) are rare B-cell/plasma cell disorders characterized by secretion of truncated immunoglobulin heavy chains without light chains. Pulmonary involvement has been described but is typically limited to interstitial or infiltrative patterns; whereas, cystic lung disease is exceptionally rare. We report a 23-year-old previously healthy male who presented with recurrent spontaneous pneumothoraces over a two-year period. High-resolution computed tomography revealed numerous bilateral thin-walled cysts with upper-lobe predominance, with several of these abutting the pleural surface. Laboratory evaluation demonstrated a discrete monoclonal spike on serum protein electrophoresis, and immunofixation confirmed an isolated IgG heavy chain without light chains, consistent with γ-heavy chain disease (γ-HCD). Bone marrow biopsy showed a mild increase in plasma cells (5-10%) without overt malignancy, and alternative causes of cystic lung disease, including Birt-Hogg-Dubé syndrome, autoimmune disease, α1-antitrypsin deficiency, and HIV, were excluded. This case highlights γ-HCD as a rare cause of diffuse cystic lung disease with recurrent pneumothorax, expanding the pulmonary spectrum of heavy-chain dyscrasias. The radiographic overlap with light-chain deposition disease emphasizes the need to include monoclonal gammopathies in the differential diagnosis of unexplained cystic lung disease. Recognition of γ-HCD in this context is clinically important, as it may precede lymphoproliferative malignancy and mandates careful longitudinal surveillance.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"424-430"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Proton Beam Therapy in Hepatic Oligometastasis: Review of Evidence.","authors":"Satyajeet Rath","doi":"10.15388/Amed.2025.32.1.25","DOIUrl":"10.15388/Amed.2025.32.1.25","url":null,"abstract":"<p><p>Hepatic oligometastasis (hOMC) incidence varies from 10-40% in the literature. While the old standard for local treatment was surgical resection, options like TACE, TARE, SBRT with photons and off late protons have come to the fore. The proton beam therapy (PBT) use has gradually started to get adopted in all regions worldwide with increasingly better availability and ever-reducing costs. The role of PBT in hOMC has been studied in many retrospective cohort studies. Although there is a plethora of evidence on photon-SBRT, there are very few analyses on the role of PBT in hOMC. The author intends to analyse the efficacy in terms of the local control (LC) and the overall survival (OS) for PBT and its toxicity profile in this systematic review. LC remains persistently high (76-89% at 1-2 years) across breast, colo-rectum, stomach, and esophagus. Sites like colo-rectum and breast show relatively better survival outcomes, with progression free survival (35-52% at 1-2 years) and OS (33-78% at 1-2 years) than other sites, likely due to disease biology. Breast primary derived hOMCs had the best 3-year OS of 67.6%. Toxicities remain remarkably low with grade 3 plus toxicities ranging from 0-3%, which reflects the ability of proton therapy to deliver beams with precision.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 1","pages":"36-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Fifth Metatarsal Fracture or a Rare Anatomical Variant?: A Report of Two Cases of Symptomatic Os Vesalianum Pedis and a Review of the Literature.","authors":"Kristina Petrova, Svetlomir Rangelov, Lyubomir Gaydarski, Boycho Landzhov, Georgi P Georgiev","doi":"10.15388/Amed.2025.32.2.17","DOIUrl":"10.15388/Amed.2025.32.2.17","url":null,"abstract":"<p><strong>Background: </strong>Accessory bones of the foot are common anatomical variants, with <i>Os Vesalianum Pedis</i> (OVP) representing a rare example located near the base of the fifth metatarsal within the peroneus brevis tendon. Although typically asymptomatic, OVP can become painful following trauma and may be misdiagnosed as a fracture, leading to inappropriate management.</p><p><strong>Case presentation: </strong>We present two cases of symptomatic OVP in patients who reported lateral foot pain after acute ankle inversion injuries. Following radiological evaluation at a regional polyclinic, both patients were initially diagnosed with fractures of the fifth metatarsal base and referred to a traumatologist. However, further physical examination and detailed review of previous radiographs, revealing well-corticated, smoothly contoured ossicles, led to the correct diagnosis of OVP. Both patients were treated conservatively with rest, ice, elevation, physiotherapy, and NSAIDs, achieving complete functional recovery within three weeks.</p><p><strong>Conclusions: </strong>These cases highlight the importance of recognizing OVP as a potential cause of lateral foot pain after trauma. Accurate diagnosis based on imaging characteristics can prevent mismanagement. Conservative treatment remains highly effective, and awareness of OVP is essential for appropriate clinical decision-making.</p>","PeriodicalId":34365,"journal":{"name":"Acta Medica Lituanica","volume":"32 2","pages":"438-445"},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}