Įkurtas 1993 m. Publikuoja chirurgijos srities straipsnius.
Vilniaus universiteto leidykla / Vilnius University Press
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Netrauminis abipusis girnelės savojo raiščio plyšimas: klinikinis atvejis ir literatūros apžvalga
<strong class="boldas" lang="lt-LT" 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;"> <em class="italic" lang="lt-LT" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Įvadas.<span lang="lt-LT" 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;"> Abipusis girnelės savojo raiščio plyšimas – itin reta trauma, mokslinėje literatūroje aprašomi tik pavieniai atvejai. Šios traumos rizika didėja sergant sisteminėmis ligomis, pavyzdžiui, sistemine raudonąja vilklige, taip pat vartojant kortikosteroidus, nes jie sukelia raiščio kolageno skaidulų degeneraciją. Plyšus girnelės savajam raiščiui, sutrinka kelio tiesiamasis mechanizmas, todėl būtinas chirurginis gydymas. <em class="italic" lang="lt-LT" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Klinikinis atvejis. <span lang="lt-LT" 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;">Straipsnyje pristatomas 50 m. pacientės, sergančios sistemine raudonąja vilklige ir periodiškai gydomos kortikosteroidais, atvejis. Moteris kreipėsi į gydymo įstaigą dėl abiejų kelių sąnarių nestabilumo. Klinikinio ištyrimo metu abiejuose keliuose nustatytas tiesiamojo mechanizmo sutrikimas ir aukšta girnelės padėtis. Būklė patvirtinta rentgeno tyrimu – <span lang="lt-LT" 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;">apskaičiuotas Insallio ir Salvati santykis (dešiniojo kelio – 2,11, kairiojo kelio – 1,94). Atlikus magnetinio rezonanso tomografijos tyrimą, diagnozuotas didelio laipsnio abiejų girnelių savojo raiščio dalinis plyšimas. Nustačius chirurginio gydymo indikacijas, atliktas dešiniojo kelio girnelės savojo raiščio kombinuotas vientisumo atkūrimas. Taikytas pirminis susiuvimas ir augmentacija, naudojant vidinio tvirtinimo metodiką. Pasiekta stabili fiksacija, tačiau po mėnesio pasireiškė komplikacija – lateralinio inkaro migracija. Vis dėlto tiesiamasis mechanizmas išliko nesutrikęs. <em class="italic" lang="lt-LT" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Išvados.<span lang="lt-LT" 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;"> Abipusis girnelės savojo raiščio plyšimas turėtų būti įtariamas pacientams, kurie skundžiasi kelio tiesiamojo mechanizmo sutrikimu. Ši trauma diagnozuojama atliekant šoninę kelio sąnario rentgenogramą (30° fleksija), o kilus abejonių dėl diagnozės, atliekama magnetinio rezonanso tomografija. Visiški ir didelio laipsnio daliniai plyšimai turėtų būti gydomi chirurginiu būdu. Tinkamiausia pooperacinė reabilitacija dar nėra pakankamai ištirta.
abipusis girnelės savojo raiščio plyšimas
Autorių teisės (c) 2026 Gustas Jonaitis | Giedrius Petryla | Paulius Kanopa https://creativecommons.org/licenses/by/4.0
Congenital Anterior Urethrocutaneous Fistula: A Rare Case Report
<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;">Congenital anterior urethrocutaneous fistula (CAUF) is an extremely rare penile anomaly which presents despite a normal urethral meatus and intact prepuce. It may present in isolation or with associated anomalies such as hypospadias or chordee. We report the case of a 14-months-old boy with a congenital anterior urethrocutaneous fistula on the ventral penile shaft. A single-stage urethrocutaneous fistula closure with a dartos flap along with torsion correction was performed. The postoperative course was uneventful, and the child remains well on follow-up.
Autorių teisės (c) 2026 Authors https://creativecommons.org/licenses/by/4.0
Hiperplastinis endometriumo polipas ir architektūrinė bei citologinė atipija: klinikinis atvejis ir literatūros apžvalga
<strong class="boldas" 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;"> <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Įvadas.<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;"> Endometriumo polipai yra dažna gerybinė gimdos gleivinės patologija, tačiau daliai jų būdingi architektūrinės ir citologinės atipijos požymiai, susiję su padidėjusia piktybinės transformacijos rizika. Atipinė endometriumo hiperplazija laikoma tikrąja ikivėžine būkle. Šio darbo tikslas – pateikti klinikinį atvejį ir mokslinės literatūros apžvalgą, pabrėžiančią histeroskopinės polipektomijos diagnostinę vertę ir tinkamiausios gydymo taktikos svarbą. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Metodai. <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;">Aprašomas 50 m. moters klinikinis atvejis: atlikta echoskopinė darinio diagnostika, histeroskopinė polipo rezekcija ir histologinis pašalintos medžiagos įvertinimas. Taip pat atlikta mokslinės literatūros analizė, apimanti atipinių endometriumo polipų epidemiologiją, diagnostiką, histologinius požymius ir gydymo rekomendacijas. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Rezultatai. <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;">Histeroskopinės polipektomijos metu pašalintas gimdos kūno polipas, histologiškai patvirtintas kaip hiperplastinis endometriumo polipas, pasižymintis architektūrine ir citologine atipija bei sumažėjusia PAX2 baltymo ekspresija. Mokslinės literatūros duomenys rodo, kad polipo atipija dažnai neatspindi viso endometriumo būklės: iki 30,8 proc. atvejų aplinkiniame endometriume nustatoma karcinoma, o iki 88 proc. histerektomijos preparatuose aptinkami likutiniai ikivėžiniai pakitimai. Taigi endometriumo polipo atipija laikytina didelės endometriumo vė<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;">žio rizikos radiniu. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Išvados.<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;"> Atipinis endometriumo polipas yra ikivėžinė būklė, reikalaujanti tokios pat gydymo taktikos kaip ir atipinė endometriumo hiperplazija. Histeroskopinė polipektomija yra būtinas diagnostikos metodas, leidžiantis patikimai nustatyti lokalizuotą atipiją. Pacientėms, neplanuojančioms nėštumo, rekomenduojama totalinė histerektomija ir abipusis kiaušintakių bei kiaušidžių pašalinimas, o konservatyvi priežiūros taktika, ypač pomenopauzės laikotarpiu, nerekomenduojama dėl didelės piktybinės transformacijos rizikos.
Autorių teisės (c) 2026 Gabija Matuzaitė | Diana Bužinskienė https://creativecommons.org/licenses/by/4.0
Mezenterinė cistinė limfangioma ir dauginės pilvo organų granulomos: klinikinis atvejis
<em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Įvadas.<strong class="boldas" 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;">Mezenterinė cistinė limfangioma – retas, lėtai progresuojantis intraabdominalinis darinys, dažniausiai randamas plonosios žarnos pasaite. Retais atvejais limfangioma gali susidaryti taukinėje, gaubtinės žarnos pasaite ar retroperitoniniame tarpe. Ji susiformuoja dėl neaiškios kilmės limfinės sistemos malformacijų ir dažniau nustatoma vyriškosios lyties pacientams (santykis 5:2). Ši būklė kai kuriems pacientams pasireiškia kartu su imuninės sistemos disfunkcija, todėl dažnai įtariamas ar net patvirtinamas imunodeficitas. Kombinuotas imunodeficitas mažina vakcinų efektyvumą ir gali sukelti gyvybei pavojingą reakciją. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Atvejo aprašymas. <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;">4 m. berniukas atvyko į Vilniaus universiteto ligoninės Santaros klinikų Vaikų priėmimo-skubios pagalbos skyrių dėl padidėjusios šlapimo pūslės. Atlikus pilvo organų ultragarsinį tyrimą, nustatyta normali šlapimo pūslė, tačiau plonosios žarnos pasaite rastas 16x11x12 cm cistinis darinys. Po i<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;">šsamių diagnostinių tyrimų nutarta cistą šalinti. Darinio histopatologinis tyrimas patvirtino mezenterinės cistinės limfangiomos diagnozę. Operacijos metu pilvo ertmės organuose rasta daugybinių granulominių darinių (apie 10 mm skersmens), atliktos jų biopsijos. Išsamūs tyrimai dėl infekcinių ligų (TBC, HCV, HBV, CMV, EBV ir ŽIV) buvo neigiami. Praėjus keliems mėnesiams, paciento kairėje sėklidėje atsirado židininių pakitimų, kurių biopsijose aptikta raudonukės viruso RNR. Įvertinus paciento klinikinę anamnezę, ligos eigą ir laboratorinius rodiklius, nustatytas kombinuotas imunodeficitas, galimai išprovokuotas raudonukės vakcinos ar naujai išsivysčiusios ligos, neturinčios specifinio gydymo. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Diskusija. <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;">Mezenterinė cistinė limfangioma – reta gerybinė būklė ar anomalija, būdinga maždaug 1 atveju iš 250 000, dažniausiai pasireiškianti vaikams, kurie nejaučia simptomų. Ultragarsinio tyrimo metu 58 proc. atvejų nustatomas neskausmingas, minkštas, paslankus darinys. Pilvo ertmėje granulomų randama retai, todėl galima įtarti imuninės sistemos disfunkciją. Asmenims, sergantiems pirminiu imunodeficitu, raudonukės vakcina siejama su lėtiniu granulomatoziniu susirgimu, o imuninės sistemos sutrikimai gali lemti viruso persistavimą ir agresyvų imuninės sistemos atsaką. Raudonukės viruso RNR, rasta sėklidės židiniuose, patvirtina viruso išprovokuotą granulomų susiformavimą, todėl, esant netipinei granulomatozinei reakcijai, svarbu tirti pediatrinius pacientus dėl imunodeficito, ypač tuo atveju, kai įtariamas provokuojantis veiksnys yra virusinė vakcina. Ankstyvoji diagnostika būtina siekiant išvengti komplikacijų ir paskirti tikslingą gydymą. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Išvados.<strong class="boldas" 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;">Mezenterinė cistinė limfangioma – tai intraabdominalinis, gerybinis navikas, dažniausiai nustatomas mažiems vaikams. Veiksmingiausias gydymo metodas, padedantis išvengti recidyvo, yra visiškas šio darinio pašalinimas. Straipsnyje aptariamas klinikinis atvejis rodo, kad svarbu laiku nustatyti imunodeficitą pacientams, kuriems diagnozuotos netipinės pilvo ertmės granulomos. Naujausi tyrimai, atlikti vaikams, sergantiems kombinuotu imunodeficitu, patvirtino sąsają tarp granulomų atsiradimo įvairiuose organuose ir raudonukės viruso RNR ar vakcinos. Dažniausiai granulomų randama po MMR vakcinacijos praėjus 2<span class="CharOverride-3" 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-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">152 savait<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;">ėms (maždaug vieniems metams).
Autorių teisės (c) 2026 Agnė Gudauskaitė | Vytautas Bilius | Arūnas Strumila https://creativecommons.org/licenses/by/4.0
Evaluation of Outcomes from Lower Lip Defect Reconstruction after Wide Excision of Squamous Cell Carcinoma
<em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;"> Lip defects may occure from various etiologies, the most prevalent being invasive malignant processes. The treatment of these lesions involves their surgical removel. The reconstructed mouth, along with the functional, esthetic, and psychological outcomes of the reconstruction, profoundly affect the patient’s quality of life. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Aim.<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;"> The purpose of this paper is to present our clinical experiences with the application of different methods for the reconstruction of lower lip defects, as well as to evaluate the functional, <span lang="ar-SA" 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;">а<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;">esthetic, and psychological outcomes after surgical intervention.<strong class="boldas" 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;"> <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Patients and methods.<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;"> This retrospective study included thirty patients who underwent surgery at the Department<strong class="boldas" 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;">of Maxillofacial Surgery, Clinical Hospital, Stip, during the period from 2021 to 2024. The analysis was performed by gender, age, size of the skin incision, size of the defect, histological margins, and method of reconstruction. A functional, aesthetic and psychological assessment was performed six months after the surgery. Oral competence, speech intelligibility, and lip mobility during movement were evaluated. The esthetic assessment referred to the presence of microstomia and the evaluation of scar visibility. The psychological assessment referred to the patient’s levels of depression and anxiety. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Results. <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;">This study presents our clinical experiences in applying different techniques for lower lip reconstruction. The outcomes of the evaluation, in accordance with the specified parameters, are thoroughly discussed and presented. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Conclusion.<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;"> A combination of various techniques can be effectively applied in the reconstruction of lower lip defects that are larger than 2/3 of its width, thereby achieving optimal functional, esthetic, and psychological outcomes.
functional, aesthetic and psychological outcomes
Effectiveness of Ursodeoxycholic Acid (UDCA) in Preventing Bile Duct Gallstone Recurrence after Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Trial (RCT)
<em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Objective.<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;"> Does ursodeoxycholic acid (UDCA) effectively prevent the recurrence of symptomatic bile duct stones that require intervention in patients who have undergone a<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;"> <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;">cholecystectomy for symptomatic gallstone disease? <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Methods.<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;"> Following successful cholecystectomy for symptomatic gallstone disease, 300<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;"> <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;">patients were randomized (1:1 ratio) to receive a 24-month course of either UDCA (300<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;"> <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;">mg twice daily) or a placebo. The primary outcome was symptomatic bile duct stones diagnosed by imaging (ultrasound, CT<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;"> <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;">scan, or Magnetic Resonance Cholangiopancreatography (MRCP)) requiring treatment (endoscopic retrograde cholangiopancreatography with stone removal or surgery) during the 24-month follow-up. Secondary outcomes included changes in liver function tests and the incidence of adverse events. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Results.<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;"> During the 24-month follow-up, symptomatic bile duct stones requiring treatment were significantly less common in the UDCA group compared to the placebo group. Specifically, stones were found in 8<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;"> <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;">patients (5.3%) taking UDCA, but in 25<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;"> <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;">patients (16.7%) receiving the placebo. This difference was statistically significant, with a Hazard Ratio (HR) of 0.31, suggesting that patients in the UDCA group were about 69% less likely to develop stones. The study also found that liver function tests remained similar between both groups throughout the trial. In terms of safety, the frequency of adverse events was comparable between the two groups. The most common side effects reported were mild, temporary gastrointestinal symptoms. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Conclusion.<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;"> The postoperative administration of UDCA over a 24-month period represents a safe and effective prophylactic measure. It significantly reduces the recurrence of symptomatic bile duct stones requiring intervention in patients who have undergone a<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;"> <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;">cholecystectomy for symptomatic gallstone disease.
Digital Rectal Examination: Current Perspectives and Applications of a Timeless Clinical Art
<em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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.<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;"> Digital Rectal Examination (DRE) is one of the earliest, easiest, and most cost-effective tools in clinical medicine. Its viability in contemporary practice has come under scrutiny due to advancements in imaging. This article revisits its clinical applications in light of the recent literature. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Methods.<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;"> A search of PubMed and Google Scholar was conducted using various MeSH subheadings related to digital rectal examination, and on the basis of available literature, the versatility of the DRE was examined, specifically focusing on its essential role in the initial detection and assessment of prostate disorders, anorectal pathology, and gastrointestinal emergencies. <em class="italic" style="color: #000000; font-family: 'Times New Roman'; font-size: medium; 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;">Conclusion.<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;"> Recent trends show a decrease in the routine performance of DRE, often due to reliance on advanced diagnostics, evolving screening guidelines, and deficiencies in training. DRE is not obsolete but rather a timeless clinical art that can provide immediate and often life-saving diagnostic information cost-effectively, particularly when modern diagnostic facilities are not available. There is a need to improve the training of DRE and use it as per the evidence.
Konferencijos „Vilnius Surgical Symposium for Young Surgeons 2026“ programa