Acta medica Lituanica
type: channel
description: Founded in 1994. The periodical scholarly journal Acta medica Lituanica is published by the Lithuanian Academy of Sciences in collaboration with the Faculty of Medicine of Vilnius University and the National Cancer Institute. It publishes papers on high quality research, mostly from Lithuania, the Baltic states, and Eastern Europe. Indexed in the Scopus database since 2021.
publisher: Vilniaus universiteto leidykla / Vilnius University Press
language: en
publication name: Acta medica Lituanica
issn: 1392-0138
items: Editorial Board and Table of Contents
items: Antibiotic and Heavy Metal Resistance Profiles of Staphylococcus aureus Isolates from Hospitals
items: Results of Treatment of Hypertriglyceridemia-induced Acute Necrotizing Pancreatitis with the Use of Plasmapheresis
items: Comparative Study of Haemostatic Agents in Tactical Environments and Their Impact on Survival Time before Evacuation
items: Sciatic Nerve Anatomical Variations and Deep Gluteal Syndrome: Clinical Relevance and Current Evidence — A Narrative Literature Review
items: The Impact of Comorbidities on the Effectiveness of Noninvasive Ventilation in Patients with Chronic Obstructive Pulmonary Disease
items: The Impact of Genetic Factors on the Development of Type 2 Diabetes and Possible Pathways for its Correction
items: Type III Fetal Sacrococcygeal Teratoma: Prenatal Diagnosis, Delivery and Postnatal Course
items: The Role of Triglycerides in the Development of Atherosclerosis
items: A Novel RNF216 Variant Causing Gordon Holmes Syndrome in Three Lithuanian Siblings
items: Misdiagnoses of Intracranial Hypotension: A Systematic Literature Review and Case Report
items: Microsurgical Treatment of Cranial Dural Arteriovenous Fistulas: A Case Series and Literature Review
items: Temporal Stability of In-Hospital Mortality in Acute Pancreatitis: A Nine-Year Tertiary Center Cohort Study
items: Gastrointestinal Symptoms in Systemic Sclerosis: Prevalence and Severity across Disease Subtypes and Autoantibody Profiles
items: The Use of Virtual Reality for Pain and Anxiety Reduction: A Literature Review
items: List of Reviewers
items: Pulmonary Artery Thromboembolism (PATE) in Paediatrics: Three Clinical Case Presentations
items: Chronic Kidney Disease in Lithuanian Children: Single Center Experience
items: Stroke and Recurrent Thrombosis of the Coronary Arteries Probably due to Patent Foramen Ovale and Antebrachial Vein Thrombosis in Patient with STEMI – Case Report
items: Embryological Basis and Genetic Considerations of Right Lumbar Undescended Caecum with Paracaecal Appendix and Aberrant Vascular Supply
items: Cement Spacer versus Endoprosthesis as Reconstruction Modality after Limb Salvage for Shoulder Malignancies: Systematic Review and Meta-Analysis
items: An Unusual Case of a Vulva Tumor in an Adolescent: A Case Report and Literature Review
items: Challenges in the Diagnosis of Multiple Sclerosis: A Case Report
items: Teenagers in Face of the War in Ukraine: Experience of Lithuanians
items: The Influence of Meteorological Factors on Osteoarthritis Symptoms and Physical Activity: A Narrative Review
items: Acute Pancreatitis Unmasking an Ectopic Parathyroid Adenoma in MEN1 Syndrome and Cushing’s Syndrome: A Rare Clinical Convergence
items: When Local Beats Systemic: Durable Control of Metastatic Undifferentiated Uterine Sarcoma and Surveillance Uncovering a Second Primary
items: Combined Anatomical Variation of Axillary Artery and Biceps Brachii Muscle: A Case Report
items: Forecasting the Impact of Knowledge of International Humanitarian Law Acquired by Ukrainian Medical Students on Their Practical Activities and the Formation of Humanity in Society

Editorial Board and Table of Contents
type: item
description: -
subject: Front Matter
  topic: section
subject: -
  topic: keywords
creator: Rimantas Jankauskas
rights: Copyright (c) 2026 Authors https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 1
ending page: 5

Antibiotic and Heavy Metal Resistance Profiles of Staphylococcus aureus Isolates from Hospitals
type: item
description: Background: Staphylococcus aureus is a major opportunistic pathogen in hospitals, where sustained exposure to antimicrobial agents and disinfectants promotes the emergence and persistence of resistant strains. In addition, tolerance to heavy metals may facilitate co-selection and long-term survival of resistant S. aureus in clinical settings. Purpose: This study investigated the occurrence of methicillin-resistant S. aureus (MRSA), vancomycin-intermediate S. aureus (VISA), and vancomycin-resistant S. aureus (VRSA), and evaluated antibiotic and heavy metal resistance profiles among S. aureus isolates recovered from hospitals. Materials and Methods: Seventy-nine bacterial isolates were collected from three hospitals. Identification using Gram staining and biochemical tests identified 71 S. aureus isolates. Resistance to antibiotics was determined by disk diffusion, and was quantified using the multiple antibiotic resistance (MAR) index. Resistance to heavy metals was assessed at increasing concentrations, and the multiple heavy metal resistance (MHMR) index was calculated. MRSA, VISA, and VRSA were screened using selective agar containing oxacillin and vancomycin. Cluster analysis was performed based on combined antibiotic and heavy metal resistance profiles. Results: High resistance rates were observed for penicillin and ampicillin (95.8% each), whereas most isolates showed low levels of resistance to chloramphenicol, bacitracin, streptomycin, kanamycin, and methicillin. MAR index values ranged from 0 to 0.88, with most isolates exceeding 0.2. All isolates exhibited resistance to multiple heavy metals, with MHMR values between 0.57 and 0.71, and marked tolerance to chromium and lead. Screening identified 9 MRSA, 3 VISA, and 1 VRSA isolate, including one strain classified as both MRSA and VRSA. Cluster analysis resolved nine major resistance-associated groups. Conclusion: Hospital-associated S. aureus isolates showed extensive antibiotic and heavy metal resistance, su…
subject: Research papers
  topic: section
subject: antibiotic resistance
  topic: keywords
subject: heavy metal resistance
  topic: keywords
subject: Staphylococcus
  topic: keywords
creator: Nitipong Siriwong
creator: Ekachai Chukeatirote
rights: Copyright (c) 2026 Nitipong Siriwong | Ekachai Chukeatirote https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 7
ending page: 7
doi: 10.15388/Amed.2026.33.2.7

Results of Treatment of Hypertriglyceridemia-induced Acute Necrotizing Pancreatitis with the Use of Plasmapheresis
type: item
description: <span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Introduction:<span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;"> Additional risk factors have been identified, and the outcomes of surgical treatment in patients with hypertriglyceridemia-induced acute necrotizing pancreatitis treated with plasmapheresis have been analyzed.<br style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration…
subject: Research papers
  topic: section
subject: hypertriglyceridemia
  topic: keywords
subject: acute necrotizing pancreatitis
  topic: keywords
subject: plasmapheresis
  topic: keywords
subject: laparotomy risk factors
  topic: keywords
subject: surgical treatment
  topic: keywords
creator: Igor Shevchuk
creator: Roman Kuzenko
creator: Volodymyr Pylypchuk
creator: Igor Нalipchak
creator: Sergiy Gedzuk
creator: Sergiy Snizhko
rights: Copyright (c) 2026 Igor Shevchuk | Roman Kuzenko | Volodymyr Pylypchuk | Igor Нalipchak | Sergiy Gedzuk | Sergiy Snizhko https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 4
ending page: 4
doi: 10.15388/Amed.2026.33.2.4

Comparative Study of Haemostatic Agents in Tactical Environments and Their Impact on Survival Time before Evacuation
type: item
description: Aim: Uncontrolled external bleeding remains a leading cause of preventable death in military and civilian tactical environments, necessitating continuous improvement in the means and algorithms for haemorrhage control. The aim of this study was to determine the comparative effectiveness and optimal sequence of application of modern methods for controlling external bleeding in tactical medicine, in order to maximise survival of the wounded until evacuation to hospital. Materials and methods: The study was conducted as a systematic review with a semi-quantitative comparison of efficacy and safety based on registries, clinical cohorts, and severe animal models of coagulopathic haemorrhage. Result: The results demonstrated that new-generation chitosan dressings provide 100% survival for up to 180-240 minutes with minimal blood loss (112-300 ml) in models of severe coagulopathy, outperforming kaolin-based standards (86% survival, blood loss 260-1021 ml). The use of any modern topical haemostatic agent in real combat conditions increases survival by 7%, while the systematic introduction of tourniquets and haemostatic agents reduces preventable mortality from extremity bleeding by 67-87%, saving 1,000-2,000 lives in the conflicts in Iraq and Afghanistan alone. Injectable sponges achieve 100% stable haemostasis for up to 72 hours and are applied three times faster than traditional tamponade, which is critically important for deep, narrow wound channels. Early administration of tranexamic acid (within the first three hours) further reduces the risk of death from bleeding by 10-20%. Under the most challenging conditions, the greatest benefit is achieved through the combined use of tourniquets, new-generation chitosan agents, and specialised devices. Conclusions: The proposed differentiated algorithm enables rapid and reliable haemostasis even in cases of deep traumatic coagulopathy and prolonged evacuation, making it a practical tool for updating tactical medicine protocols a…
subject: Review papers
  topic: section
subject: chitosan dressings
  topic: keywords
subject: tranexamic acid
  topic: keywords
subject: prehospital haemostasis
  topic: keywords
subject: tourniquet
  topic: keywords
subject: traumatic coagulopathy
  topic: keywords
subject: external bleeding
  topic: keywords
creator: Aleksandra Kuliś
rights: Copyright (c) 2026 Aleksandra Kuliś https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 10
ending page: 10
doi: 10.15388/Amed.2026.33.2.10

Sciatic Nerve Anatomical Variations and Deep Gluteal Syndrome: Clinical Relevance and Current Evidence — A Narrative Literature Review
type: item
description: Background: The aim of the study - based on the latest literature, this narrative literature review aims to provide a comprehensive evaluation of deep gluteal syndrome (DGS) and to assess the significance of anatomical variations of the sciatic nerve (SN) in relation to the syndrome. Materials and methods: A review of the scientific literature was conducted using the PubMed, ClinicalKey, and ScienceDirect databases. Publications were selected from 2015 to 2026. All publications were written in English. The following keywords and their combinations were used during the search: “deep gluteal syndrome,” “sciatic nerve variations,” “sciatic nerve entrapment,” and “piriformis syndrome.” Results: The sciatic nerve, characterized by significant anatomical variability in the deep gluteal space, may result in altered biomechanics and predispose the nerve to compression. Anatomical variations of the sciatic nerve, depending on their relationship with the piriformis muscle, are categorized according to the Beaton and Anson classification (types A–F). In recent decades, the term “deep gluteal syndrome” has come into use, encompassing extrapelvic non-discogenic sciatic nerve compressions. The syndrome most commonly manifests as persistent, “shooting” pain that worsens after prolonged sitting and radiates toward the back of the knee, hip, and/or gluteal region, as well as dysesthesia and nocturnal pain. There is currently no gold standard for the diagnosis of DGS. Diagnostic criteria may include compression of the SN in the deep gluteal region, sciatica-like pain, and a non-discogenic origin of symptoms. First-line treatment options include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and rest. In addition, intramuscular injections of a local anaesthetic may be administered to alleviate symptoms. If conservative treatment proves ineffective, surgical nerve decompression should be considered. Conclusions: The most common abnormal sciatic nerve…
subject: Review papers
  topic: section
subject: sciatic nerve
  topic: keywords
subject: deep gluteal syndrome
  topic: keywords
subject: anatomical variations
  topic: keywords
creator: Mantas Leskauskas
creator: Laura Nedzinskienė
rights: Copyright (c) 2026 Mantas Leskauskas | Laura Nedzinskienė https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 11
ending page: 11
doi: 10.15388/Amed.2026.33.2.11

The Impact of Comorbidities on the Effectiveness of Noninvasive Ventilation in Patients with Chronic Obstructive Pulmonary Disease
type: item
description: <span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Background:<strong style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> <span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Noninvasive ventilation (NIV) is a cornerstone treatment for hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the impact of selected comorbidities on the effectiveness of NIV in these patients, and to compare clinical characteristics and outcomes between continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) modalities.<br style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; …
subject: Research papers
  topic: section
subject: arterial pressure
  topic: keywords
subject: chronic obstructive pulmonary disease
  topic: keywords
subject: hypertension
  topic: keywords
subject: hypercapnia
  topic: keywords
subject: noninvasive ventilation
  topic: keywords
creator: Aida Mujaković
creator: Nejra Mlačo-Vražalić
creator: Nejra Prohić
creator: Akif Mlačo
rights: Copyright (c) 2026 Aida Mujaković | Nejra Mlačo-Vražalić | Nejra Prohić | Akif Mlačo https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 2
ending page: 2
doi: 10.15388/Amed.2026.33.2.2

The Impact of Genetic Factors on the Development of Type 2 Diabetes and Possible Pathways for its Correction
type: item
description: Aim: The aim of this study was to investigate the impact of genetic factors on the development of type 2 diabetes in the population of Kazakhstan. Materials and methods: The methodology included the collection of demographic data, the analysis of biochemical parameters, and the application of polymerase chain reaction genotyping for single-nucleotide polymorphisms in genes associated with type 2 diabetes. Result: The main results of the study demonstrated that patients with type 2 diabetes had a 20% higher body mass index (29.5±4.2 kg/m2 versus 24.3±3.1 kg/m2) and 29% lower physical activity (3.2±1.5 hours per week versus 4.5±2.0 hours per week) compared with the control group. Biochemical parameters showed a 50% higher glucose level (7.8±2.1 mmol/L versus 5.2 ± 0.8 mmol/L), insulin levels by 76% (15.3±5.2 microunits per millilitre versus 8.7±2.5 microunits per millilitre), and glycated haemoglobin by 42% (7.5±1.2% versus 5.3±0.5%) in patients with type 2 diabetes. The genetic analysis revealed substantial associations between type 2 diabetes and risk alleles in the TCF7L2 (rs7903146), KCNJ11 (rs5219), FTO (rs9939609), PPARG (rs1801282), and ADIPOQ (rs1501299) genes, which were linked to compromised insulin secretion and metabolic anomalies in the study population. Conclusions: The practical significance of the study lies in the potential application of these findings to develop personalised approaches for the prevention and treatment of type 2 diabetes, including lifestyle modification, the use of modern pharmaceuticals, and anti-inflammatory drugs to improve glucose control in patients.
subject: Research papers
  topic: section
subject: polymorphisms
  topic: keywords
subject: insulin resistance
  topic: keywords
subject: biochemical parameters
  topic: keywords
subject: glycated haemoglobin
  topic: keywords
subject: changes in microbiota composition
  topic: keywords
creator: Zhibek Sembayeva
creator: Oralbek Ilderbayev
creator: Damira Tazhibayeva
creator: Ainur Zhanilova
creator: Aruzhan Ilderbayeva
rights: Copyright (c) 2026 Zhibek Sembayeva | Oralbek Ilderbayev | Damira Tazhibayeva | Ainur Zhanilova | Aruzhan Ilderbayeva https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 8
ending page: 8
doi: 10.15388/Amed.2026.33.2.8

Type III Fetal Sacrococcygeal Teratoma: Prenatal Diagnosis, Delivery and Postnatal Course
type: item
description: Background: Sacrococcygeal teratoma (SCT) is the most common congenital neoplasm in fetuses and newborns. Altman Type III lesions may be difficult to diagnose and manage prenatally because of their marked intrapelvic extension. Materials and Methods: A 24-year-old primigravida woman was referred at 20 weeks of gestation after routine ultrasonography revealed a sacrococcygeal mass extending into the abdomen. Prenatal evaluation included ultrasonography, fetal magnetic resonance imaging, and chromosomal microarray analysis. The pregnancy was managed by a multidisciplinary team with serial fetal surveillance. Results: Imaging demonstrated a predominantly cystic lesion consistent with Altman Type III SCT. During follow-up, bilateral fetal hydronephrosis, gestational diabetes mellitus, and mild polyhydramnios developed. At 38 weeks, an elective cesarean section was performed. On postnatal day 4, total tumor resection with coccygectomy was successfully completed. Histopathology confirmed a mature teratoma. At 6 months, persistent hydronephrosis remained under follow-up, with no documented recurrence. Conclusions: Accurate prenatal imaging, close surveillance, multidisciplinary planning, and timely postnatal surgery are essential for favorable outcomes in Type III fetal SCT.
subject: Case studies
  topic: section
subject: sacrococcygeal teratoma
  topic: keywords
subject: fetal MRI
  topic: keywords
subject: prenatal diagnosis
  topic: keywords
subject: hydronephrosis
  topic: keywords
subject: coccygectomy
  topic: keywords
creator: Orhan Ay
creator: Fethiye Şahin
creator: Pelin Bahçeci
creator: Hasan Madenci
creator: Ali Acar
rights: Copyright (c) 2026 Orhan Ay | Fethiye Şahin | Pelin Bahçeci | Hasan Madenci | Ali Acar https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 9
ending page: 9
doi: 10.15388/Amed.2026.33.2.9

The Role of Triglycerides in the Development of Atherosclerosis
type: item
description: Objective: To review the pathogenesis of triglycerides (TG), triglyceride-rich lipoproteins (TRL) and their remnants as well as their role in the development of atherosclerosis and clinical relevance for assessing residual ASCVD risk. Materials and methods: A literature search was conducted using keywords relevant to the topic and their combinations. A targeted PubMed search prioritized English-language guidelines, consensus statements, randomized clinical trials, cohort studies, and meta-analyses published between 2019 and 2025, with older landmark publications included where necessary. Reference lists of key articles were also manually screened to identify additional relevant studies. Results: The literature shows that elevated TG concentrations are associated with a higher risk of ASCVD, regardless of LDL-C. Given that no clear signal indicates which features of TRL give rise to risk of ASCVD, plasma TG levels remain a reasonable surrogate marker for risk assessment. Evidence suggests that the atherogenicity of TRL is driven primarily by the cholesterol carried within TRL and their remnants rather than TG themselves. TRL remnants may be at least as atherogenic as, and potentially more atherogenic than, low-density lipoproteins (LDL) because they can be taken up by intimal macrophages without prior oxidative or structural modification, persist longer within the intima, are larger in size, and carry more cholesterol per particle. They also more effectively promote foam-cell formation and contribute to low-grade inflammation. Given the conflicting results of large-scale randomized clinical trials, it is not yet possible to conclude that lowering TG concentrations alone reduces the ASCVD risk. Conclusions: Elevated plasma TG concentrations are associated with an increased risk of ASCVD, independent of LDL-C levels. Given the ongoing need to identify the most reliable metric for risk stratification, TG remain a rational surrogate marker for estimating residual ASCVD r…
subject: Review papers
  topic: section
subject: triglycerides
  topic: keywords
subject: triglyceride-rich lipoproteins
  topic: keywords
subject: remnant cholesterol
  topic: keywords
subject: residual risk
  topic: keywords
subject: atherosclerosis
  topic: keywords
creator: Vaida Cerebiejūtė
creator: Živilė Girkantaitė
creator: Egidija Rinkūnienė
creator: Silvija Gimžauskaitė
creator: Jolita Badarienė
rights: Copyright (c) 2026 Vaida Cerebiejūtė | Živilė Girkantaitė | Egidija Rinkūnienė | Silvija Gimžauskaitė | Jolita Badarienė https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 48
ending page: 57
doi: 10.15388/Amed.2026.33.1.4

A Novel RNF216 Variant Causing Gordon Holmes Syndrome in Three Lithuanian Siblings
type: item
description: Background: Gordon Holmes syndrome (GHS) is a rare genetic disorder, usually manifesting as a broad spectrum of neurological symptoms and hypogonadotropic hypogonadism. Only a limited number of cases presenting this congenital disorder have been reported in the literature. Since the genetic and phenotypic heterogeneity of GHS, it is crucial to report novel cases. Case presentation: Here we report a novel homozygous missense variant in RNF216 gene c.1055T>G (p.(Phe352Cys)) in three siblings. Primary concerns were absence of secondary sexual characteristics, and amenorrhea occurred among female patients. Based on laboratory test results and clinical features, hypogonadotropic hypogonadism was diagnosed. Neurological examination revealed no signs of ataxia in siblings. However, brain magnetic resonance imaging revealed pronounced changes in the cerebral white matter for female patients. Due to primary amenorrhea and the absence of secondary sexual characteristics, treatment was initiated. Treatment might be adjusted in the presence of fertility considerations. Conclusions: This case contributes to the limited knowledge of GHS and highlights the importance of hypogonadotropic hypogonadism treatment and close observation of neurological symptoms that may develop over time.
subject: Case studies
  topic: section
subject: Gordon Holmes syndrome
  topic: keywords
subject: RNF216
  topic: keywords
subject: hypogonadotropic hypogonadism
  topic: keywords
creator: Melita Karlonaitė
creator: Ugnė Kanapickaitė
creator: Romena Laukienė
creator: Algirdas Utkus
creator: Birutė Burnytė
rights: Copyright (c) 2026 Melita Karlonaitė | Ugnė Kanapickaitė | Romena Laukienė | Algirdas Utkus | Birutė Burnytė https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 6
ending page: 6
doi: 10.15388/Amed.2026.33.2.6

Misdiagnoses of Intracranial Hypotension: A Systematic Literature Review and Case Report
type: item
description: Background: Despite the difficulties of diagnosing intracranial hypotension (IH), the literature focusing on specific IH misdiagnoses remains scarce. We report on the case of a pediatric patient with spontaneous intracranial hypotension (SIH) caused by thecal sac dilatation due to Marfan syndrome, who was initially misdiagnosed. Additionally, a systematic literature review was conducted, focusing specifically on misdiagnoses of IH. Materials and Methods: The material search for the literature review was performed across PubMed, Scopus, and Web of Science databases. The inclusion criteria were: published within the last ten years, involved human participants, written in English, and included case reports or series with a clear diagnostic pathway, in which a specified initial misdiagnosis was followed by IH as the final diagnosis. Publications were excluded if they did not meet these criteria. Due to the nature of the case reports, reporting bias and certainty assessment were not formally evaluated. Additionally, a single-patient case report was retrospectively analyzed. Results: A 13-year-old woman presented to the emergency department complaining of a severe postural headache, nausea, sleepiness, generalized weakness, dizziness, and loss of appetite. An asymptomatic venous thrombosis and functional headaches were suspected. The patient was transferred to a third-level hospital, where a magnetic resonance imaging scan of the whole spine revealed thecal sac dilatation. SIH was diagnosed, and, after 3 weeks of conservative treatment, the patient was discharged from the hospital with full recovery. In the systematic review, 24 studies containing 28 patients were included in the final report. The most frequent initial misdiagnoses were Chiari I malformation (39.29%) and migraine (21.43%). 75% of studies identified SIH as a cause of IH, 16.67% determined it was iatrogenic, 4.17% - traumatic, and 1 case report did not include the cause of IH. Conclusions: While the case re…
subject: Case studies
  topic: section
subject: intracranial hypotension
  topic: keywords
subject: Marfan syndrome
  topic: keywords
subject: systematic review
  topic: keywords
subject: case report
  topic: keywords
subject: misdiagnosis
  topic: keywords
creator: Gertrūda Kaubrytė
creator: Rūta Samaitienė-Aleknienė
rights: Copyright (c) 2026 Gertrūda Kaubrytė | Rūta Samaitienė-Aleknienė https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 5
ending page: 5
doi: 10.15388/Amed.2026.33.2.5

Microsurgical Treatment of Cranial Dural Arteriovenous Fistulas: A Case Series and Literature Review
type: item
description: <span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Dural arteriovenous fistulas are pathological vascular malformations within the dura mater, characterized by abnormal connections between pial arteries and veins. These are rare lesions that can present with a variety of neurological symptoms, and, when ruptured, can result in a fatal hemorrhage. This disease can be managed by endovascular embolization, surgical resection, and stereotactic radiosurgery. Particularly with the advancement of endovascular techniques, surgery is less frequently used to treat these lesions. However, it remains a viable treatment option in certain cases. In this article, we present a series of 17 patients with dural arteriovenous fistulas treated at a single tertiary neurosurgical center. This study was conducted at São João University Hospital in Porto, Portugal. We retrospectively collected data from all patients who underwent microsurgical or endovascular treatment for dural arteriovenous fistulas between 2014 and 2023. We collected information regarding the patients’ sex, age, and radiological classification of the dAVF, also, the treatment modality chosen, dAVF obliteration rate and information about any complications that have resulted from the treatment. Endovascular treatment had been attempted in 5 patients (29.4%), resulting in partial embolization of the dural arteriovenous fistulas in 3 patients (17.6%). In 2 patients (11.8%), embolization was attempted but deemed technically unfeasible. The remaining cohort, comprising 12 patients (70.6%)…
subject: Research papers
  topic: section
subject: dural AVF
  topic: keywords
subject: surgical resection
  topic: keywords
subject: endovascular embolization
  topic: keywords
subject: case series
  topic: keywords
subject: literature review
  topic: keywords
creator: Domantas Jakštas
creator: Carolina Santos Silva
creator: Pedro Alberto Silva
creator: Antonio Vilarinho
rights: Copyright (c) 2026 Domantas Jakštas | Carolina Santos Silva | Pedro Alberto Silva | Antonio Vilarinho https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 1
ending page: 1
doi: 10.15388/Amed.2026.33.2.1

Temporal Stability of In-Hospital Mortality in Acute Pancreatitis: A Nine-Year Tertiary Center Cohort Study
type: item
description: Background. Acute pancreatitis (AP) is a leading cause of gastrointestinal hospitalization and remains associated with measurable in-hospital mortality despite advances in supportive care. While earlier decades were characterized by declining mortality, contemporary temporal patterns within mature tertiary-care systems remain uncertain. We aimed to evaluate longitudinal trends in admission volume, demographic characteristics, intensive care unit (ICU) utilization, and crude, age-standardized, and adjusted in-hospital mortality in a tertiary academic center. Materials and Methods. We conducted a retrospective cohort study of consecutive adult hospitalizations with a primary diagnosis of acute pancreatitis at a tertiary referral center between 2016 and 2024. Temporal trends were assessed using linear and logistic regression models. Age-standardized mortality rates were calculated using direct standardization to a fixed reference population. Multivariable logistic regression evaluated the independent association between year of admission and in-hospital mortality, adjusting for age and sex. A prespecified sensitivity analysis excluded ICU admissions. Analyses were limited by the lack of reliably recorded etiologic and standardized severity data within the administrative dataset. Results. A total of 1,981 hospitalizations were included. Overall, in-hospital mortality was 5.0%. Annual admission volume, median age, sex distribution, and ICU utilization showed no significant temporal trends. Crude mortality ranged from 1.8% to 6.5% annually and demonstrated no significant temporal association. Age-standardized mortality likewise showed no significant trend. In multivariable analysis, year of admission was not independently associated with mortality, whereas advancing age was the strongest measured independent predictor, with a 34% increase in odds of death per 10-year increment. Exclusion of ICU admissions yielded consistent findings. Conclusions. In this nine-year tertiar…
subject: Research papers
  topic: section
subject: acute pancreatitis
  topic: keywords
subject: in-hospital mortality
  topic: keywords
subject: temporal trends
  topic: keywords
subject: age
  topic: keywords
subject: epidemiology
  topic: keywords
creator: Abdulrahman Al-Dawoudi
creator: Daniil Varlamov
creator: Mujahed Dalain
creator: Davis Freimanis
rights: Copyright (c) 2026 Abdulrahman Al-Dawoudi | Daniil Varlamov | Mujahed Dalain | Davis Freimanis https://creativecommons.org/licenses/by/4.0
date: 2026-07-23
publication date: 2026-07-23
starting page: 3
ending page: 3
doi: 10.15388/Amed.2026.33.2.3

Gastrointestinal Symptoms in Systemic Sclerosis: Prevalence and Severity across Disease Subtypes and Autoantibody Profiles
type: item
description: Background: This study aimed to evaluate the prevalence and severity of gastrointestinal (GI) symptoms in patients with systemic sclerosis (SSc), their impact on social functioning and emotional well-being, and to compare findings between patients with limited cutaneous systemic sclerosis (lcSSc) and diffuse cutaneous systemic sclerosis (dcSSc), as well as between patients positive for anticentromere (ACA) or anti-topoisomerase I (ATA) antibodies. Materials and methods: Forty-two consecutive patients with SSc were included: 31 with lcSSc and 11 with dcSSc. ACA antibodies were detected in 26 patients, and ATA antibodies in 16 patients. The UCLA SCTC GIT 2.0 self-assessment questionnaire was used to assess the severity of GI symptoms across seven subscales: reflux, distention/bloating, diarrhea, fecal soilage, constipation, social functioning, and emotional well-being. Results: Symptoms of reflux (lcSSc/dcSSc = 64.5%/81.8%), distention/bloating (lcSSc/dcSSc = 61.3%/81.8%), constipation (lcSSc/dcSSc = 45.2%/45.5%), and fecal soilage (lcSSc/dcSSc = 6.4%/18.2%) were similarly frequent in lcSSc and dcSSc. Diarrhea was more common in dcSSc (45.5% vs. 16.1%, p = 0.04), with a higher median index value (0.25 vs. 0.00, p = 0.02), thus indicating more severe symptoms. No differences were observed in the prevalence or severity of GI symptoms between ACA- and ATA-positive patients. Median index values for social functioning and emotional well-being did not differ by the disease subtype or antibody status. Conclusions: Diarrhea was more prevalent and more severe in patients with dcSSc, while other gastrointestinal manifestations showed no major differences between subtypes. Symptom prevalence and severity did not differ according to the antibody status, and their impact on social and emotional functioning was similar across the groups.
subject: Research papers
  topic: section
subject: systemic sclerosis
  topic: keywords
subject: gastrointestinal symptoms
  topic: keywords
subject: patient-reported outcomes
  topic: keywords
subject: UCLA SCTC GIT 2.0
  topic: keywords
creator: Marina Vujović Šestakov
creator: Sretko Lukovic
creator: Ivana Pavlovic
creator: Maja Zlatanovic
creator: Predrag Ostojic
rights: Copyright (c) 2026 Marina Vujović Šestakov | Sretko Lukovic | Ivana Pavlovic | Maja Zlatanovic | Predrag Ostojic https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 161
ending page: 168
doi: 10.15388/Amed.2026.33.1.13

The Use of Virtual Reality for Pain and Anxiety Reduction: A Literature Review
type: item
description: <span style="color: #000000; font-family: 'Times New Roman'; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Virtual reality (VR) is being increasingly used as an adjunctive tool to reduce procedural pain and anxiety during various interventional procedures. Forty articles published between 2020 and 2025 were reviewed. The articles reviewed discuss the use of virtual reality to reduce procedural pain and anxiety during various interventional procedures. The results of the literature analysis show that VR can effectively direct patients’ attention and reduce the subjective intensity of pain and fear during procedures across different age groups. VR has been successfully applied to interventional procedures such as vaccination, blood draws, and peripheral vein punctures in children, as well as to a wide range of interventions in obstetrics, orthopaedics, endovascular surgery, cardiology, and dentistry. The studies reviewed confirm that VR is a safe method that rarely causes adverse side effects and can be integrated into clinical practice, contributing to patient comfort, emotional well-being, and the overall satisfaction with the procedure.
subject: Review papers
  topic: section
subject: virtual reality
  topic: keywords
subject: immersive VR
  topic: keywords
subject: procedural pain
  topic: keywords
subject: anxiety
  topic: keywords
subject: interventions
  topic: keywords
creator: Gerda Marčiūtė
creator: Ignas Lapeikis
creator: Greta Kasputytė
rights: Copyright (c) 2026 Gerda Marčiūtė | Ignas Lapeikis | Greta Kasputytė https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 23
ending page: 32
doi: 10.15388/Amed.2026.33.1.2

List of Reviewers
type: item
description: -
subject: Front Matter
  topic: section
subject: -
  topic: keywords
creator: Rimantas Jankauskas
rights: Copyright (c) 2025 Authors https://creativecommons.org/licenses/by/4.0
date: 2025-12-30
publication date: 2025-12-30
starting page: 266
ending page: 266

Editorial Board and Table of Contents
type: item
description: -
subject: Front Matter
  topic: section
subject: -
  topic: keywords
creator: Rimantas Jankauskas
rights: Copyright (c) 2025 Authors https://creativecommons.org/licenses/by/4.0
date: 2025-12-30
publication date: 2025-12-30
starting page: 261
ending page: 265

Pulmonary Artery Thromboembolism (PATE) in Paediatrics: Three Clinical Case Presentations
type: item
description: Background: Pulmonary artery thromboembolism in children is an exceptionally rare condition. Because its clinical presentation and associated risk factors differ from those observed in adults, the condition is frequently underdiagnosed. Case description: We present three cases of paediatric pulmonary artery thromboembolism, each with distinct clinical presentations and differing risk factors. The first case involved a 15-year-old boy who developed fatal massive bilateral pulmonary artery thromboembolism after having spinal trauma, surgery, immobility, and central venous catheter placement. The second case concerned a 17-year-old girl with Prader–Willi syndrome and multiple comorbidities, who presented with severe respiratory failure and laboratory evidence suggesting pulmonary thromboembolism, although imaging to confirm the diagnosis was limited. The third case involved a previously healthy 17-year-old boy with upper-extremity deep venous thrombosis and confirmed pulmonary artery thromboembolism despite the absence of identifiable provoking factors. Conclusions: These cases illustrate the heterogeneity of paediatric PATE presentation, the variability of underlying risk factors, and the diagnostic challenges encountered in clinical practice, underscoring the need for heightened awareness among clinicians.
subject: Case studies
  topic: section
subject: Pulmonary embolism
  topic: keywords
subject: pulmonary artery thromboembolism
  topic: keywords
subject: paediatrics
  topic: keywords
subject: children
  topic: keywords
creator: Gabija Asipauskaitė
creator: Greta Miškinaitė
creator: Algirdas Dagys
creator: Vaidotas Gurskis
rights: Copyright (c) 2026 Gabija Asipauskaitė | Greta Miškinaitė | Algirdas Dagys | Vaidotas Gurskis https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 252
ending page: 259
doi: 10.15388/Amed.2026.33.1.24

Chronic Kidney Disease in Lithuanian Children: Single Center Experience
type: item
description: Background: Chronic Kidney Disease (CKD) in children is relatively rare but carries high burden due to increased morbidity and mortality rates. Unlike adults, where CKD is often secondary to other conditions, pediatric CKD is primarily caused by Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). In Lithuania, data on pediatric CKD are limited, and center-specific patient characteristics and management practices remain underreported in real life settings. This study aimed to assess the current patterns of pediatric CKD in a major Lithuanian tertiary center and evaluate how current practice aligns with guideline recommendations. Material and Methods: A cross-sectional study of children (<18 years) with CKD stages 2–5 at Vilnius University Hospital Santaros Klinikos Pediatric Center was conducted. CKD stages were defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines, and the patients were categorized into seven groups according to CKD etiology. Anthropometric measurements, complications, comorbidities, and ongoing treatments were analyzed. Results: A total of 65 children were included (mean age 11.1 years; male-to-female ratio 1.7:1). CAKUT was the most common etiology of CKD (61.5%), with renal hypoplasia being the predominant variant, followed by cystic kidney diseases (13.9%), glomerulopathies (9.2%), and other or unknown causes (9.2%). The mean estimated glomerular filtration rate (eGFR) was 60.5 mL/min/1.73 m², and most children were in CKD stage 2 (66.2%). Differences in age, sex, eGFR, and the CKD stage across the etiology groups were not statistically significant (all p >0.05). Normal weight remained the predominant category at every CKD stage, with a prevalence of 60.0–66.7%. Nearly half of the patients had CKD-related complications, most commonly CKD-mineral and bone disorder, proteinuria, and arterial hypertension. Most children (76.9%) had received at least one treatment for CKD-related complications. Conclusi…
subject: Research papers
  topic: section
subject: Chronic kidney disease
  topic: keywords
subject: CAKUT
  topic: keywords
subject: children
  topic: keywords
subject: CKD complications
  topic: keywords
creator: Ugnė Rukšėnaitė
creator: Karolis Ažukaitis
creator: Rimantė Čerkauskienė
creator: Dovilė Ruzgienė
creator: Renata Vitkevič
creator: Darija Litvinenko
creator: Augustina Jankauskienė
rights: Copyright (c) 2026 Ugnė Rukšėnaitė | Karolis Ažukaitis | Rimantė Čerkauskienė | Dovilė Ruzgienė | Renata Vitkevič | Darija Litvinenko | Augustina Jankauskienė https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 128
ending page: 140
doi: 10.15388/Amed.2026.33.1.10

Stroke and Recurrent Thrombosis of the Coronary Arteries Probably due to Patent Foramen Ovale and Antebrachial Vein Thrombosis in Patient with STEMI – Case Report
type: item
description: 74- years old woman with history of cryptogenic stroke in 2010 (during hospitalisation at neurological department possible reasons of stroke were excluded at that time), with less than one year history of paroxysmal atrial fibrillation (AF) treated with apixaban, hypertension, diabetes type II, hypothyreotocsicosis and obesity was admitted to our hospital twice. For the first time admitted due to ST segment elevation myocardial infarction (STEMI) and episode of AF. Coronary angiography revealed occlusion of left circumflex coronary (LCX) artery and percutaneous coronary intervention (PCI) with stent implantation was performed. Conversions of AF episodes to sinus rhythm were spontaneous. Patient was discharged home and admitted once again three days after discharge. STEMI of anterior wall and a new episode of AF was diagnosed. Immediate plain old balloon angioplasty (POBA) with implantation of an additional stent in left anterior descending coronary artery (LAD) was performed. Sixty minutes after procedure, the patient developed symptoms of mild right-sided pyramidal syndrome and slight aphasia. Patient’s status was assessed on 3 points according to the National Institutes of Health Stroke Scale (NIHSS) and patient was not qualified for thrombolysis and mechanical thrombectomy of cerebral artery. Four days after symptoms of stroke, CT did not reveal new significant lesions of the brain and 8-th days after stroke aphasia almost completely disappeared. Thrombus in the left atrium appendage was excluded and patent foramen ovale (PFO) with left to right flow was revealed. Due to the risk of reverse flow as a possible reason of strokes (now and 15 years ago) and recurrent thromboembolisation of coronary arteries and presence of thromboembolisation of antebrachial vein the successful occlusion of PFO with Amplatzer Septal Occluder was performed. In good condition, patient was discharged home.
subject: Case studies
  topic: section
subject: stroke
  topic: keywords
subject: myocardial infarction
  topic: keywords
creator: Anna Konopka
creator: Karolina Marzec
creator: Katarzyna Paschalis-Purtak
creator: Marcin Demkow
creator: Joanna Zalewska
creator: Elżbieta Smaga
creator: Ilona Michałowska
rights: Copyright (c) 2026 Anna Konopka | Karolina Marzec | Katarzyna Paschalis-Purtak | Marcin Demkow | Joanna Zalewska | Elżbieta Smaga | Ilona Michałowska https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 184
ending page: 189
doi: 10.15388/Amed.2026.33.1.16

Embryological Basis and Genetic Considerations of Right Lumbar Undescended Caecum with Paracaecal Appendix and Aberrant Vascular Supply
type: item
description: The caecum normally descends to the right iliac fossa during embryogenesis. Disruptions in midgut development may result in its atypical positioning. In a male cadaver, the small, conical caecum and paracaecal appendix were in the right lumbar region. The ileocaecal orifice was on the anterior caecal wall, and the appendicular orifice opened on the medial caecal wall inferior to it. The ascending colon was short and the hepatic flexure was inferior to hepatic quadrate lobe. The right colic artery was absent. The ascending branch of ileocolic artery supplied the caecum, and appendix. The disposition of the rest of the intestinal tract and peritoneum were observed, and measurements taken. Midgut development involves multiple regulatory genes, signalling pathways, transcription factors and mesenchyme-endoderm cross-talk. Mutations in several candidate genes were identified as contributing to midgut malrotation. Awareness of such rare anatomical variation is essential to avoid misdiagnosis of atypical appendicitis or intestinal obstruction.
subject: Case studies
  topic: section
subject: genetic factors
  topic: keywords
subject: malrotation
  topic: keywords
subject: paracaecal appendix
  topic: keywords
subject: undescended caecum
  topic: keywords
creator: Anand Verma
creator: Madhumita Patnaik
creator: Praveen Kumar Ravi
creator: Sayan Biswas
creator: Manisha R. Gaikwad
creator: Aarthi Manokaran
rights: Copyright (c) 2026 Anand Verma | Madhumita Patnaik | Praveen Kumar Ravi | Sayan Biswas | Manisha R. Gaikwad | Aarthi Manokaran https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 245
ending page: 251
doi: 10.15388/Amed.2026.33.1.23

Cement Spacer versus Endoprosthesis as Reconstruction Modality after Limb Salvage for Shoulder Malignancies: Systematic Review and Meta-Analysis
type: item
description: Background: Limb salvage is the mainstay of surgical treatment for primary sarcomas as well as metastatic lesions of the proximal humerus. This involves wide excision of the involved humeral segment followed by a reconstruction of the defect. The purpose of this review was to determine which reconstruction modality offers a better overall functional outcome. Methods: After registering a review with the PROSPERO database (ID No. CRD 42025642215), PubMed and Cochrane Library databases were systematically screened for relevant studies meeting our inclusion criteria. The Methodological Index for Non-randomized studies (MINORs) questionnaire was the primary Risk Of Bias (ROB) assessment tool. The included articles were compared with respect to their intra-operative parameters, functional outcome scores, postoperative shoulder Range Of Motion (ROM), as well as complication rates. Results: A total of eight studies, involving 348 subjects in total, were included in this review, out of which, only four articles were found eligible for meta-analysis. Primary malignancy of the bone was the most common diagnosis (Osteogenic sarcoma followed by Ewing sarcoma). A higher frequency of axillary nerve sacrifice was seen in patients undergoing spacer implantation. Musculoskeletal Tumour Society Scores (MSTS) were used as the chief functional outcome determinant and were significantly better in patients undergoing arthroplasty (73.7+7.9 versus 68.9+8.5). A similar trend was observed with regards to shoulder flexion, extension and abduction. The most common complication noted with a cement spacer was proximal implant migration followed by implant failure. On the other hand, dislocation or subluxation of the prosthesis was the most frequently reported issue with arthroplasty. Overall, the local recurrence rate was 9.5%. Conclusion: Cement spacers are ideally suited for patients with a poor socio-economic background, aggressive lesions and a shorter life expectancy, while joint replacemen…
subject: Review papers
  topic: section
subject: shoulder
  topic: keywords
subject: humerus
  topic: keywords
subject: neoplasm
  topic: keywords
subject: malignancy
  topic: keywords
subject: cement spacer
  topic: keywords
subject: arthroplasty
  topic: keywords
creator: Akshat Gupta
creator: Divesh Jalan
creator: Nishith Gupta
creator: Nupur Aggarwal
creator: Kshitish Behera
creator: Princi Jain
rights: Copyright (c) 2026 Akshat Gupta | Divesh Jalan | Nishith Gupta | Nupur Aggarwal | Kshitish Behera | Princi Jain https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 6
ending page: 22
doi: 10.15388/Amed.2026.33.1.1

An Unusual Case of a Vulva Tumor in an Adolescent: A Case Report and Literature Review
type: item
description: Background: We present the case of a 15-year-old adolescent with swelling in the left vulva that was found to have a tumor measuring approximately 20x15 cm in her vulva. Ewing’s sarcoma/primitive neuroectodermal tumors (ES/PNET) are rare and malignant. Materials and Methods: Preoperative magnetic resonance imaging and computed tomography performed to screen for metastasis were negative. The mass was surgically excised in total. Results: Immunohistochemistry showed the mass to be ES/PNET. The patient underwent positron emission tomography-computed tomography which revealed metastasis to inguinal lymph nodes and bone. While under chemotherapy for stage-4 ES/PNET, the patient was found to have lung metastasis. She died due to recurrent chemotherapy complications during treatment. Conclusions: This rare case highlights that significant of early diagnosis and multidisciplinary approach to treatment of ES/PNET cases.
subject: Case studies
  topic: section
subject: adolescent
  topic: keywords
subject: vulva
  topic: keywords
subject: primitive neuroectodermal tumors
  topic: keywords
subject: extraosseous Ewing’s sarcoma
  topic: keywords
creator: Hayriye Nihan Karaman Ayyildiz
creator: Zekeriya İlçe
creator: İlkay Tosun
creator: Funda Tekkesin
rights: Copyright (c) 2026 Hayriye Nihan Karaman Ayyildiz | Zekeriya İlçe | İlkay Tosun | Funda Tekkesin https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 214
ending page: 221
doi: 10.15388/Amed.2026.33.1.19

Challenges in the Diagnosis of Multiple Sclerosis: A Case Report
type: item
description: Introduction: Multiple sclerosis (MS) may present as a tumor-like, or tumefactive demyelinating lesion, that is indistinguishable clinically and radiologically from a brain tumor. This poses a diagnostic challenge. Case presentation: We present a case report of a 23-year-old woman who was hospitalized in the Neurosurgery Department for biopsy of a brain mass. She had been diagnosed with Hodgkin’s lymphoma at the age of 12, underwent surgery and chemotherapy, and had been in remission ever since. During her annual follow-up a magnetic resonance imaging (MRI) of the brain was performed that revealed a lesion in the right temporal lobe. It was interpreted as central nervous system (CNS) lymphoma. Before arranged neurosurgical intervention, a follow-up MRI scan revealed multiple new small lesions in both hemispheres. Biopsy was not performed, and the patient was referred to the Neurology Department for clarification of the diagnosis. No abnormalities were detected in the tests performed. Cerebrospinal fluid (CSF) was not tested due to the patient’s refusal to repeat the unsuccessful procedure. The patient was discharged from the hospital. Three months later she arrived at the Emergency Department abroad with impaired coordination and hypoesthesia on the right side of the body. Two MRI scans revealed a new lesion in the left posterior periventricular area. CNS lymphoma was suspected again. The patient received treatment with levetiracetam and dexamethasone. Upon her return, an MRI scan was repeated, which revealed an enlargement of the lesion. CSF testing showed indistinct oligoclonal bands. As CNS lymphoma could not be excluded, a lesion biopsy was performed after discontinuation of the steroids therapy. Histological examination excluded malignancy. Later an MRI scan was repeated that showed two new contrast-enhancing lesions. Relapsing-remitting multiple sclerosis (RRMS) diagnosis was confirmed and treatment with disease-modifying therapies (DMTs) was planned. Conclusi…
subject: Case studies
  topic: section
subject: tumor-like multiple sclerosis
  topic: keywords
subject: differential diagnosis
  topic: keywords
subject: CNS lymphoma
  topic: keywords
creator: Kristina Galinytė
creator: Gintarė Butenytė
creator: Gintarė Žemgulytė
creator: Jurgita Makštienė
creator: Renata Balnytė
rights: Copyright (c) 2026 Kristina Galinytė | Gintarė Butenytė | Gintarė Žemgulytė | Jurgita Makštienė | Renata Balnytė https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 222
ending page: 231
doi: 10.15388/Amed.2026.33.1.20

Teenagers in Face of the War in Ukraine: Experience of Lithuanians
type: item
description: Background: The war in Ukraine, starting on February 24, 2022, shocked Lithuanians who actively support Ukraine and who are still experiencing the threat of an extended war. Adolescents are a sensitive group in society. They go through many changes at their age and are in the process of revealing their feelings and forming their worldviews. The study aimed to investigate how war events in Ukraine affected Lithuanian adolescents’ everyday life, relationships, health, attitudes, concentration, and learning. Materials and methods: Adolescents in 6 high schools filled out an anonymous Google Forms survey developed by the authors comprising general data about the respondent, their interest in war events and their involvement in following the news about the war in media, the impact of war events on their physical and mental health, and the feeling of fear about the threats of the war in Lithuania. Results: 395 adolescents aged 16–19 (mean age 17.01±0.97) filled in the questionnaire. This research revealed that adolescents in Lithuania are moderately interested in war events in Ukraine, and 25.3% noted that they follow news about the war once a week. Most teenagers did not note that the ongoing war in Ukraine would affect their communication, ability to concentrate and learn, hobbies, appetite, and sleep. However, 48.9% indicated that war events affected their emotions and mood. Adolescents who talked about the ongoing war with their parents (55.4%, p=0.00006), who were more interested in war events in the media (median=229.7, p<0.001), and girls (53.3%, p=0.008) were statistically significantly more likely to notice that the ongoing war would affect their emotions and mood. 60.8% of the respondents felt fear and threat that war may break out in Lithuania as well. Conclusions: The news in the media and the constant threat of war affect Lithuanian youth, mostly their emotions and mood. Therefore, it is crucial to research and monitor their emotional health, discuss things w…
subject: Research papers
  topic: section
subject: adolescents
  topic: keywords
subject: teenagers
  topic: keywords
subject: war
  topic: keywords
subject: mental health
  topic: keywords
subject: Ukraine
  topic: keywords
subject: Lithuania
  topic: keywords
creator: Sigita Lesinskienė
creator: Augustė Lapinskaitė
creator: Augustė Česnauskaitė
rights: Copyright (c) 2026 Sigita Lesinskienė | Augustė Lapinskaitė | Augustė Česnauskaitė https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 116
ending page: 127
doi: 10.15388/Amed.2026.33.1.9

The Influence of Meteorological Factors on Osteoarthritis Symptoms and Physical Activity: A Narrative Review
type: item
description: Background: Meteorological conditions are suspected to influence osteoarthritis (OA) symptoms, but findings across climates and populations are inconsistent. Understanding how temperature, humidity, and barometric pressure affect pain, stiffness, and physical activity is relevant for clinical counselling and study design. Objective: To synthesize recent evidence on associations between natural weather variation and OA symptomatology, including impacts on physical activity and rehabilitation participation. Methods: We searched PubMed, ScienceDirect, and Google Scholar for peer-reviewed human studies published from January 2010 to May 2024 by using terms related to osteoarthritis and meteorological factors (temperature, humidity, barometric pressure, precipitation, seasonal variation) combined with pain, stiffness, function, or physical activity. Inclusion criteria comprised clinically or radiographically confirmed OA and quantitative outcomes linked to measured meteorological exposures. Interventional artificial heat/cold studies and non-primary data were excluded. Two reviewers independently screened, selected, and extracted data with consensus resolution. Results: Temperature showed the most consistent patterns: colder and more variable conditions were linked to increased pain and stiffness, whereas warmer, stable conditions favored mobility. Humidity and barometric pressure fluctuations showed modest effects, particularly under cool and damp conditions. Precipitation, sunlight, and wind had minimal or inconsistent associations. Adverse weather was associated with a reduced outdoor activity and lower rehabilitation participation. Conclusions: Weather acts as a contextual modifier rather than a primary determinant of OA symptoms. Recognizing meteorological influences may aid patient counselling, season-sensitive rehabilitation planning, and the design of outcome studies.
subject: Review papers
  topic: section
subject: osteoarthritis
  topic: keywords
subject: weather
  topic: keywords
subject: temperature
  topic: keywords
subject: humidity
  topic: keywords
subject: barometric pressure
  topic: keywords
subject: physical activity
  topic: keywords
creator: Karolis Strašunskas
creator: Matas Mikalauskas
creator: Ona Montvydaitė-Kreivaitienė
rights: Copyright (c) 2026 Karolis Strašunskas | Matas Mikalauskas | Ona Montvydaitė-Kreivaitienė https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 33
ending page: 47
doi: 10.15388/Amed.2026.33.1.3

Acute Pancreatitis Unmasking an Ectopic Parathyroid Adenoma in MEN1 Syndrome and Cushing’s Syndrome: A Rare Clinical Convergence
type: item
description: Ectopic parathyroid adenoma within the spectrum of Multiple Endocrine Neoplasia Type 1 (MEN1) is an extremely rare clinical entity. We report a 27-year-old woman who presented with acute pancreatitis as the sentinel manifestation of MEN1, an atypical and intriguing clinical scenario. Initially, her serum calcium levels were deceptively normal, only to surge later, unmasking a deeper endocrine pathology. Subsequent biochemical evaluation established primary hyperparathyroidism (PHPT), and a MIBG scan revealed an ectopic parathyroid adenoma as the culprit lesion. Further endocrine profiling disclosed Cushing’s syndrome (CS), confirmed through a low-dose dexamethasone suppression test, while a positive family history of MEN1-related tumors in her sister solidified the syndromic diagnosis. She was treated with aggressive hydration, analgesia, antibiotics, and supportive therapy, followed by successful parathyroidectomy. This case illustrates a remarkable convergence of conditions ectopic parathyroid adenoma, acute pancreatitis, and MEN1 with the additional complexity of initially normocalcemic presentation during the acute phase of pancreatitis. Although the pathophysiological link between hypercalcemia and pancreatitis remains debated, pancreatitis secondary to hypercalcemia from primary hyperparathyroidism is rare, and its presentation as the first clue to MEN1 is exceptionally uncommon. ACTH-secreting pituitary adenomas causing Cushing’s syndrome are also a rare manifestation of MEN1, and the concomitant presence of an empty sella on MRI further underscores the uniqueness of this case. To the best of our knowledge, this represents the first documented instance in which acute pancreatitis with normocalcemia concealed an underlying ectopic parathyroid adenoma in MEN1, accompanied by Cushing’s syndrome and an empty sella, making this a noteworthy clinical and diagnostic rarity.
subject: Case studies
  topic: section
subject: Multiple Endocrine Neoplasia Type 1 (MEN1)
  topic: keywords
subject: Ectopic Parathyroid Adenoma
  topic: keywords
subject: Hypercalcemia
  topic: keywords
subject: Acute Pancreatitis
  topic: keywords
creator: Asif Dabeer Jafri
creator: Om Prakash Sanjeev
creator: Aftab Hasan Nazar
creator: Ratender Kumar Singh
rights: Copyright (c) 2026 Asif Dabeer Jafri | Om Prakash Sanjeev | Aftab Hasan Nazar | Ratender Kumar Singh https://creativecommons.org/licenses/by/4.0
date: 2026-07-31
publication date: 2026-07-31
starting page: 238
ending page: 244
doi: 10.15388/Amed.2026.33.1.22

When Local Beats Systemic: Durable Control of Metastatic Undifferentiated Uterine Sarcoma and Surveillance Uncovering a Second Primary
type: item
description: Introduction: Undifferentiated uterine sarcoma (UUS) is a rare, aggressive uterine mesenchymal malignancy with poor prognosis, for which, evidence supporting metastasis-directed treatment strategies is limited. Case presentation: A 59-year-old woman underwent total hysterectomy with bilateral salpingo-oophorectomy (R0) for stage IB UUS in 2016, followed by adjuvant doxorubicin–ifosfamide. Three years later, surveillance CT identified bilateral pulmonary metastases. Video-assisted thoracoscopic resection confirmed metastatic UUS, and stereotactic body radiotherapy (SBRT) was delivered to residual and subsequent lung lesions, achieving sustained local control without systemic therapy. The patient remained progression-free for almost three years. In 2024, follow-up imaging showed no active sarcoma but incidentally detected a left breast lesion; biopsy revealed invasive ductal carcinoma with mucinous features. She underwent breast-conserving surgery with sentinel lymph node biopsy (pT1N0(sn)), followed by adjuvant whole-breast radiotherapy and endocrine therapy with tamoxifen. Outcomes: At 8.5 years from UUS diagnosis and one year after breast cancer treatment, the patient remains alive with no evidence of recurrent or metastatic disease and with excellent performance status (ECOG 0). Conclusions: This case demonstrates prolonged, chemotherapy-free control of metastatic UUS using a metastasis-directed strategy combining surgery and SBRT, and highlights the importance of continued surveillance for secondary primary malignancies. It supports considering an oligometastatic treatment paradigm and multidisciplinary management in selected UUS patients despite the absence of prospective data.
subject: Case studies
  topic: section
subject: undifferentiated uterine sarcoma
  topic: keywords
subject: pulmonary metastases
  topic: keywords
subject: oligometastatic disease
  topic: keywords
subject: invasive ductal carcinoma
  topic: keywords
subject: stereotactic radiotherapy
  topic: keywords
subject: secondary primary malignancy
  topic: keywords
creator: Ignas Lapeikis
creator: Vakarė Baranauskytė
creator: Dainius Jančiauskas
creator: Lina Pužauskienė
creator: Erika Korobeinikova
rights: Copyright (c) 2026 Ignas Lapeikis | Vakarė Baranauskytė | Dainius Jančiauskas | Lina Pužauskienė | Erika Korobeinikova https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 204
ending page: 213
doi: 10.15388/Amed.2026.33.1.18

Combined Anatomical Variation of Axillary Artery and Biceps Brachii Muscle: A Case Report
type: item
description: Anatomical variations of the axillary artery and its branches are clinically relevant as they may complicate surgeries in the axilla and shoulder. Accessory heads of the biceps brachii can compress key neurovascular structures. The present report describes these variations observed on the left upper limb of a 79 years old male cadaver during cadaveric dissection. We observed that the usual branches of the 3rd part of the axillary artery as well as the profunda brachii artery originated from the 2nd part of the axillary artery via a common trunk in the left axilla. In addition to that, a small accessory head of the biceps brachii was observed on the left arm originating from the shaft of the humerus. Knowledge about variant branches of the axillary artery is surgically important for establishment of collateral circulation around the scapula following shoulder surgeries. The accessory head of biceps brachii may cause nerve entrapment neuropathy leading to mysterious pain syndrome in the upper limb.
subject: Case studies
  topic: section
subject: axillary artery
  topic: keywords
subject: biceps brachii
  topic: keywords
subject: third head of biceps
  topic: keywords
creator: Dibakar Borthakur
creator: Parul Kaushal
creator: S. B. Ray
rights: Copyright (c) 2026 Dibakar Borthakur | Parul Kaushal | S. B. Ray https://creativecommons.org/licenses/by/4.0
date: 2026-07-31
publication date: 2026-07-31
starting page: 232
ending page: 237
doi: 10.15388/Amed.2026.33.1.21

Forecasting the Impact of Knowledge of International Humanitarian Law Acquired by Ukrainian Medical Students on Their Practical Activities and the Formation of Humanity in Society
type: item
description: Purpose: International humanitarian law (IHL) and the principle of medical neutrality are vital for safeguarding human life and dignity during armed conflicts. This study aimed to evaluate the current state of IHL education in Ukrainian medical institutions and forecast its impact on future healthcare professionals’ professional practice and humanistic orientation. Methods: A mixed-methods design was applied, including content analysis of curricula from 17 higher education institutions across different ministries and an online sociological survey of 174 respondents, primarily medical students and healthcare professionals. Quantitative data were analyzed by using frequency distributions and Spearman correlation, while qualitative analysis explored the respondents’ ethical reasoning in conflict-related scenarios. Results: Only one-third of Ukrainian medical universities included dedicated IHL courses, primarily as electives. Self-reported awareness of IHL was low to moderate, with 23% rating their knowledge as good and 26% as poor. Despite this, 81.4% of medical students agreed with impartial medical assistance to all victims, regardless of affiliation. A weak but positive correlation (ρ=0.15) was found between IHL knowledge and humanitarian attitudes. Female students demonstrated stronger humanitarian orientations compared to males. Conclusion: IHL education in Ukraine remains fragmented and insufficient, yet students display a high ethical potential aligned with humanitarian principles. Structured, value-oriented IHL curricula, including practical training and case-based learning, are needed to strengthen medical neutrality, enhance ethical decision-making, and foster the formation of humanistic values in Ukrainian society.
subject: Research papers
  topic: section
subject: armed conflict
  topic: keywords
subject: medical education
  topic: keywords
subject: humanism
  topic: keywords
subject: international humanitarian law
  topic: keywords
subject: medical students
  topic: keywords
subject: Ukraine
  topic: keywords
creator: Oksana Soroka
creator: Volodymyr Voloshynovych
creator: Yulia Kotsyubynska
rights: Copyright (c) 2026 Oksana Soroka | Volodymyr Voloshynovych | Yulia Kotsyubynska https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 149
ending page: 160
doi: 10.15388/Amed.2026.33.1.12