Hepatic portal vein branching patterns according to different liver assessment methods and classifications of branching type.

BACKGROUND: It is known that there are varying frequencies of hepatic portal vein branching patterns found in the literature. Studies use different methods and classifications to evaluate the anatomy of the portal vein, which limits accurate comparison between studies and the determination of true frequency of branching patterns in different populations. The aim of the present study was to investigate the intrahepatic branching of the portal vein in corrosive samples using different methods - somatoscopic and computed tomography (CT) and compare with similar studies as well as compare the reclassified data according to the most popular classifications used in the literature. METHODS: A total of 105 liver corrosion specimens from the 1960-1980 period (51 male and 54 female individuals; min-max age variation - 21-90 y., M=59,46 y.) were investigated. The branching patterns of the hepatic portal vein (HPV), left (HPV-LB) and right branch of hepatic portal vein (HPV-RB), and their segmental branches were examined and scanned by CT. Standard HPV ramification was considered, when HPV divided into HPV-LB and HPV-RB, HPV-RB bifurcated to the anterior and posterior branches, and further segmental ramification into the superior and inferior branches was considered standard. We compared the HPV main branch length and diameter measurements between manual and CT method. A review of the literature was performed on portal vein branching variations. RESULTS: The standard HPV ramification pattern was detected in 85.7% of the cases in both somatoscopic and CT evaluation. Variations related to the main branches were HPV trifurcation - 7.6%, posterior branch of right branch of hepatic portal vein from HPV - 4.8% and 5.7%, HPV quadrifurcation 1.9% and 1% respectively, in somatoscopic and CT evaluation. There was a significant difference between HPV-LB length and diameter in CT and manual measurements. According to the literature, more variations are seen using the CT method versus somatoscopic corrosion cast evaluation. The varying frequency in studies may be explained by a lack of one unanimous classification of branching patterns (some authors do not consider segmental variations as standard HPV ramification) and different evaluation methods. CONCLUSION: Somatoscopic evaluation of the branching patterns of the hepatic portal vein in corroded specimens and their CT reconstructions did not differ significantly (which allows relatively accurate comparison of old specimens with newer data). However, the ability to evaluate the reconstructed 3D images of the specimens allowed a more accurate assessment of segmental branching and measurements of lengths and diameters. Standard HPV branching (according to a self-developed classification) in this study was 85.7%. Depending on the classification, the rate of standard branching in the same corrosive samples varied from 63.8% to 84.8% of all cases, indicating that the lack of a unified and stable classification makes it difficult to compare the results of different studies. Deviations from standard branching are very important in surgical procedures and liver transplantation.

Changes in physical activity and mortality risk among an adult Lithuanian urban population: results from a cohort study.

OBJECTIVES: The purpose of this study was to investigate changes in physical activity and the association of these changes with the risk of all-cause mortality and mortality from cardiovascular disease (CVD) among an adult and elderly Lithuanian urban population. STUDY DESIGN: Prospective cohort study. METHODS: Data from four surveys are presented. In total, there were 2416 participants (1071 men and 1345 women) who took part in one of the initial three surveys in the framework of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study since 1986 and also in the follow-up survey in 2006 (with follow-up over 15 years). Study participants were followed-up for mortality events from 2006 until 31 December 2017. The mean duration of the follow-up for endpoints period was 10.55 (standard deviation 2.33) years. RESULTS: Over 15 years of follow-up, 50.9% of men and 56.7% of women were physically active at initial and follow-up surveys, and approximately 10.0% of respondents were physically inactive. Over this period, 22.8% of men and 24.8% of women increased their physical activity level, and 14.1% of men and 10.1% of women decreased their physical activity level. The findings from the Cox proportional hazards regression multivariable analysis showed that a decrease in physical activity level during the follow-up period was related to a higher risk for all-cause mortality and mortality from CVD risk in women (hazard ratio [HR] = 1.82, P = 0.039; and HR = 5.40, P = 0.014, respectively). In men, a clear association of physical inactivity was ascertained only to all-cause mortality risk and only for non-smokers (HR = 2.07, P = 0.013). CONCLUSIONS: A decrease in physical activity levels in women is a strong predictor for all-cause mortality risk and mortality from CVD risk. Physical inactivity in male non-smokers is a strong predictor for all-cause mortality risk.

Traditional risk factors of acute coronary syndrome in four different male populations - total cholesterol value does not seem to be relevant risk factor.

Cardiovascular diseases are the most common cause of mortality and morbidity in most populations. As the traditional modifiable risk factors (smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity) were defined decades ago, we decided to analyze recent data in patients who survived acute coronary syndrome (ACS). The Czech part of the study included data from 999 males, and compared them with the post-MONICA study (1,259 males, representing general population). The Lithuanian study included 479 male patients and 456 age-matched controls. The Kazakhstan part included 232 patients and 413 controls. In two countries, the most robust ACS risk factor was smoking (OR 3.85 in the Czech study and 5.76 in the Lithuanian study), followed by diabetes (OR 2.26 and 2.07) and hypertension (moderate risk elevation with OR 1.43 and 1.49). These factors did not influence the ACS risk in Kazakhstan. BMI had no significant effect on ACS and plasma cholesterol was surprisingly significantly lower (P<0.001) in patients than in controls in all countries (4.80+/-1.11 vs. 5.76+/-1.06 mmol/l in Czechs; 5.32+/-1.32 vs. 5.71+/-1.08 mmol/l in Lithuanians; 4.88+/-1.05 vs. 5.38+/-1.13 mmol/l in Kazakhs/Russians). Results from our study indicate substantial heterogeneity regarding major CVD risk factors in different populations with the exception of plasma total cholesterol which was inversely associated with ACS risk in all involved groups. These data reflect ethnical and geographical differences as well as changing pattern of cardiovascular risk profiles.

Evidence of probable tuberculosis in Lithuanian mummies.

Tuberculosis has affected Europe for millennia and continues to be a burden upon modern society. It is estimated that one-third of the world's population is infected with Mycobacterium tuberculosis, the causative agent of this condition. Despite the introduction of control strategies, the disease continues to be one of the most common causes of death globally. Within the framework of the Lithuanian Mummy Project, seven spontaneously mummified human bodies from a church crypt in Vilnius, dating from the 18th and 19th century, were CT-scanned to assess the presence of tuberculosis or other lung diseases. We encountered pulmonary lesions suggestive of cases of pulmonary tuberculosis. In addition, one case might have been affected by extra-pulmonary tuberculosis. This report replicates the image findings from previous studies on ancient mummies that provided evidence of tuberculosis in soft tissues, thus helping reconstruct the history of this disease over time.

[The effect of stroke on health and daily activities].

The purpose of this survey was to compare quality of life between survivors of stroke and the general population with regard to daily activities, health and emotional state. We surveyed a random group of 508 Kaunas residents, aged between 25 and 84 years, who survived the first stroke. The control group was made up of 508 sex- and age-matched stroke-free residents of Kaunas. We used the SF-12 quality of life questionnaire. Logistic regression was applied to evaluate the subjects for quality of life with regard to health, daily routine and mental state. Health was rated as very good by 1% of patients and 24,4% of controls (p = 0,001) and as poor by 78,9% and 26,4%, respectively (p = 0,001). The activities of 35,2% of patients and 3,5% of controls were impaired by their health (p = 0,001). State of health or emotional problems restricted social relationship in 19,3% of patients and in 1,6% of controls (p < 0,05). Social activities were mostly impaired in patients after cerebral stroke (odds ratio (OR = 36,7). Stroke also caused depression (OR = 16) and limited domestic activities (OR = 15,5).

Relation between cataract and metabolic syndrome and its components.

PURPOSE: To estimate the prevalence of cataract in the middle-aged urban population and the relation between cataract and metabolic syndrome and metabolic syndrome components. METHODS: The survey was carried out in Kaunas City, Lithuania, from 2001 to 2002, according to WHO MONICA study protocol. The ophthalmologic investigation was performed for 1282 respondents (573 men and 709 women) aged 35-64 years. Cataract was defined at slit lamp using LOCS III method. Metabolic syndrome was defined by ATP III criteria. RESULTS: Cataract was found in 17.6% of men and 19.0% of women (p>0.05). Metabolic syndrome was detected in 19.5% of men and 25.7% of women (p<0.05). After distribution of persons into 10-year age groups (35-44, 45-54, 55-64), the prevalence of cataract and metabolic syndrome among men and women significantly increased with age. A relation between cataract and metabolic syndrome was found for men aged 55-64 years and for women aged 45-64 years: the prevalence of cataract in men with metabolic syndrome was 1.3 times higher (43.8% vs 32.9%; OR=1.59 [95% CI, 0.77-3.26]) and in women with metabolic syndrome 1.4 times higher (31.8% vs. 22.6%; OR=1.60 [95% CI, 1.03-2.49]) than in persons of the same age and sex without metabolic syndrome. For men aged 4-64 years cataract was significantly related to central obesity (OR=1.80 [95% CI, 1.01-3.20]) and for women aged 45-64 years cataract was significantly related to higher arterial pressure (OR=1.98 [95% CI, 1.21-3.25]), central obesity (OR=1.54 [95% CI, 1.01-2.35]), and elevated level of serum triglycerides (OR=1.86 [95% CI, 1.20-2.90]). CONCLUSIONS: The results of this study show that the prevalence of cataract in urban women 45-64 years of age with metabolic syndrome was significantly higher than in women of this age without metabolic syndrome.

Primary heart angiosarcoma detected by magnetic resonance imaging.

We present a case of primary heart angiosarcoma in a 38-year-old male. The patient presented with severe dyspnoe and arrhythmia. Echocardiography showed multiple solid masses in the pericardium and pericardial effusion. Chest radiography revealed left-sided pleural effusion and suspicion of a mass projected on the right atrium. Non-enhanced chest computed tomography raised the suspicion of a pericardial neoplasm projected on the right atrium adjacent to ascending aorta with markedly thickened pericardium and multiple round-shaped masses around the heart. Cardiac-gated magnetic resonance imaging demonstrated an inhomogeneous mass in the free wall of the right atrium adjacent to ascending aorta and multiple pericardial masses. Biopsy performed through thoracoscopy confirmed the diagnosis of a primary heart angiosarcoma.

Early age-related maculopathy and risk factors of cardiovascular disease in middle-aged Lithuanian urban population.

PURPOSE: To assess the prevalence of age-related maculopathy (ARM) in a middle-aged urban population and the relationship between ARM and the main risk factors of cardiovascular disease (CVD). METHODS: The survey according to the WHO MONICA study protocol was carried out in Kaunas city, Lithuania, from 2001 to 2002. A total of 1403 persons aged 35 to 64 years were screened (626 men and 777 women: response rate 62.4%). Ophthalmologic investigation was performed for 1337 respondents (594 men and 743 women). Analysis of the relationship between ARM and risk factors of CVD was performed in case-control subdivision matching for sex, age, and education level. RESULTS: Early ARM was diagnosed in 7.4% of men and 5.4% of women. Rate of current smoking in case and control groups did not differ in men but in case group of women it was greater than in control group. Mean systolic and diastolic blood pressure and body mass index (BMI) in male case group and mean fasting blood glucose concentration in female case group were higher than in corresponding control groups. Frequency of diastolic hypertension (diastolic blood pressure > or = 90 mmHg) and obesity (BMI > or = 30 kg/m2) in male case group was higher than in control group. ARM was not associated with cholesterol and triglyceride levels in men and women. CONCLUSIONS: Early ARM in middle-aged Lithuanian urban population was associated with current smoking in women but not in men; it was associated with diastolic blood pressure and BMI in men and with fasting glucose level in women.

[Trends of main risk factors of coronary heart disease in Kaunas population during 20 years (the data of the MONICA study)]. / Dinamika osnovnykh faktorov riska ishemicheskoi bolezni serdtsa sredi naseleniia Kaunasa za 20 let (po dannym programy MONIKA).

MONICA (Multinational MONItoring trends and determinants of CArdiovascular diseases) study was carried out in Kaunas in 1983-2002 in four random samples of population aged 35-64 years (overall 3292 men and 3548 women - response rate 65.1%). Over the 20-year period, mean levels of systolic blood pressure (BP) (in men and women), diastolic BP (in women), body mass index (in men and women) decreased while mean levels of total serum cholesterol increased (in men and women). In the final survey as compared with initial survey arterial hypertension (AH) (BP > 140/90 mm Hg) became less prevalent in women (39.4% and 51.3%, p<0.001) and mild hypertension - less prevalent in men (25.9% and 33%, p<0,001). Over the study period, prevalence of mild hypercholesterolemia (total cholesterol 5.0-6.49 mmol/l) decreased and prevalence of severe hypercholesterolemia (total cholesterol =7.8 mmol/l) increased both in men and women. The prevalence of excessive weight increased in men and the prevalence of obesity increased in women. No statistically significant changes were detected in the prevalence of smoking in men during the study period while in women the prevalence of regular smoking increased (from 4.1% to 11.3%, p 0,001). The observed levels and trends of main risk factors of coronary heart disease require intensification of implementation of primary prevention measures in the studied population.

Prognostic value of body mass index in the development of cardiovascular diseases among Kaunas male population.

The paper presents the results of a primary medical examination and of a prospective, on the average 14-year follow-up study of the male population of Kaunas aged 45-59 years (n = 2452). The prevalence of overweight, according to the WHO criteria, was 48.7%, that of obesity 20.5%. With increasing body mass index (BMI) there occurred a statistically significant increase of main risk factors of ischaemic heart disease (IHD) and of IHD itself. The results of the prospective study showed a U-shaped relationship between BMI and mortality from all cardiovascular diseases, and a J-shaped relationship between BMI and mortality from IHD and morbidity of acute myocardial infarction, respectively. The same relationship held true even after standardization of the level of all other risk factors using the multiple logistic function. Thus, the overweight was confirmed as an independent IHD risk factor in the given population.