Raimundas Lunevicius
University of Liverpool, General Surgery, Department Member
Objective: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy... more
Objective: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe.
Materials and methods: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 ‘‘S’’ and ‘‘T’’ codes
were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers.
Results: The Revised Trauma Score (RTS) mean value was 7.45 +/- 1.04 for the 2007 year arm; it
was 7.53 +/- 0.93 for the 2012 year arm (P = 0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95 min in 2007 vs. 51.6 min in 2012 (P = 0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decisionmaking was reduced by 16.5% in 2012.
Conclusions: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007–2012 period.
Materials and methods: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 ‘‘S’’ and ‘‘T’’ codes
were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers.
Results: The Revised Trauma Score (RTS) mean value was 7.45 +/- 1.04 for the 2007 year arm; it
was 7.53 +/- 0.93 for the 2012 year arm (P = 0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95 min in 2007 vs. 51.6 min in 2012 (P = 0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decisionmaking was reduced by 16.5% in 2012.
Conclusions: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007–2012 period.
Background The purpose of this study was to show whether and how levels, trends and patterns obtained from estimates of premature deaths from adverse effects (AEs) of medical treatment depended on the deprivation level in England over the... more
Background The purpose of this study was to show whether and how levels, trends and patterns obtained from estimates of premature deaths from adverse effects (AEs) of medical treatment depended on the deprivation level in England over the 24-year period, 1990–2013. We provide a report to inform decision-making strategies to reduce the burden of disease arising from AEs of medical treatment in the most deprived areas of the country. Methods Comparative analysis was driven by a single cause-of-injury category—AEs of medical treatment— from the Global Burden of Disease 2013 study. We report the mean values with 95% uncertainty intervals (UIs) for five socioeconomic deprivation areas of England.
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Research Interests: Quality of life, Humans, Female, Male, Jejunum, and 5 moreClinical Sciences, Aged, Middle Aged, Esophagus, and Adenocarcinoma
Summary Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success,... more
Summary
Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is
imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success,
remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world
by underlying cause and age from 1990 to 2015.
Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages
10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and
territories, 11 of which were analysed at the subnational level. We quantifi ed eight underlying causes of maternal
death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIVrelated
maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of
drivers of trends, including the relation between maternal mortality and coverage of specifi c reproductive health-care
services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic
Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.
Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical
disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than
400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the
dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI
quintile improved the most from 1990 to 2015, but also has the most complicated causal profi le. Maternal mortality in
the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion,
ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage
of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled
birth attendance.
Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should
establish or renew systems for collection and timely dissemination of health data; expand coverage and improve
quality of family planning services, including access to contraception and safe abortion to address high adolescent
fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of
more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and
reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine
their own performance with respect to their SDI level, using that information to formulate strategies to improve
performance and ensure optimum reproductive health of their population.
Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is
imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success,
remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world
by underlying cause and age from 1990 to 2015.
Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages
10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and
territories, 11 of which were analysed at the subnational level. We quantifi ed eight underlying causes of maternal
death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIVrelated
maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of
drivers of trends, including the relation between maternal mortality and coverage of specifi c reproductive health-care
services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic
Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.
Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical
disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than
400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the
dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI
quintile improved the most from 1990 to 2015, but also has the most complicated causal profi le. Maternal mortality in
the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion,
ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage
of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled
birth attendance.
Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should
establish or renew systems for collection and timely dissemination of health data; expand coverage and improve
quality of family planning services, including access to contraception and safe abortion to address high adolescent
fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of
more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and
reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine
their own performance with respect to their SDI level, using that information to formulate strategies to improve
performance and ensure optimum reproductive health of their population.
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Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes aff... more
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes aff ecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.
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Global Burden of Disease Cancer Collaboration IMPORTANCE Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE To estimate mortality, incidence,... more
Global Burden of Disease Cancer Collaboration IMPORTANCE Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. EVIDENCE REVIEW Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results.
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Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33... more
Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).
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Background / objective: Translation of the universal Brisbane 2000 terminology of liver anatomy and resections into Lithuanian and Latin languages and pointing out how the translated versions correspond to specific attributes for the... more
Background / objective: Translation of the universal Brisbane 2000 terminology of liver anatomy and resections into Lithuanian and Latin languages and pointing out how the translated versions correspond to specific attributes for the terminology. Material: Terminology of Liver Anatomy and Resections by Terminology Committee of the IHPBA, Brisbane 2000, Australia. Results: The IHPBA Brisbane 2000 terminology of liver anatomy and resections is introduced in the Lithuanian language. The terminology of this nomenclature was translated into and introduced in the Latin language, too. The term hemiliver has no logistic explanation and translation because the right hemiliver and the left hemiliver are not equal in volume. The following terms were translated with difficulty into Lithuanian: hemiliver, right liver, left liver, section, sectionectomy, trisectionectomy. In fact, they are not translatable directly word by word in this national language. The term hemiliver, is not translated into...
Objective To describe and estimate a strangulated (by atypical appendix) closed-loop obstruction of the terminal ileum in an adult. Case report 71-year-old male was admitted because of crampy abdominal pain associated with nausea. There... more
Objective To describe and estimate a strangulated (by atypical appendix) closed-loop obstruction of the terminal ileum in an adult. Case report 71-year-old male was admitted because of crampy abdominal pain associated with nausea. There was no history of previous intraabdominal operations. On examination, the patient had obvious abdominal distention with peritoneal signs localized in the right iliocecal region. Bowel sounds were decreased. X-ray films showed multiple air fluid levels in the small intestine. Small-bowel obstruction was diagnosed and exploratory laparotomy was performed. The small intestine was heavily dilatated, overflowed by fluids and air because of a vermiform appendix wrapped around the terminal ileum and its mesenterium, and by its tip adhered to the ileocecal recessus. An appendectomy was performed, the small bowel was intubated using an enterodecompressive probe. Histopathology confirmed the diagnosis of secondary superficial appendicitis and hemorrhagic peria...
Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal impalement injury associated with major liver and diaphragmatic injuries. We successfully treated the impalement injury with minimally invasive... more
Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal impalement injury associated with major liver and diaphragmatic injuries. We successfully treated the impalement injury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a collection of fluid in the abdominal cavity. The conservative management plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a patient with less invasive techniques yielded a good outcome. This management option may be considered as an alternative for open surgery for hemodynamically stable patients in experienced centres.
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Lithuanian version of recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding based on the International Consensus Recommendations. It was designed for gastroenterologists, general practitioners,... more
Lithuanian version of recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding based on the International Consensus Recommendations. It was designed for gastroenterologists, general practitioners, internists, and endoscopists. Surgical and radiological management, when it is needed, was not taken into account. National version of the recommendations can be announced as a basic project for further development of new recommendations. Two primary references would be an excellent stand for a new start.
The study was aimed to delineate the postoperative morbidity, mortality and long-term follow-up results after R0 subtotal gastrectomy with D2 lymphadenectomy for invasive non-disseminated adenocarcinoma of the distal gastric portion.... more
The study was aimed to delineate the postoperative morbidity, mortality and long-term follow-up results after R0 subtotal gastrectomy with D2 lymphadenectomy for invasive non-disseminated adenocarcinoma of the distal gastric portion. Between January 2005 and December 2007, 228 patients with median age at hospitalisation 66.6 ± 11.4 years underwent the above mentioned surgery for histologically proven distal gastric adenocarcinoma. Postoperative morbidity was documented in 92 (40.4%) of patients within 30 days. An anastomotic leakage was diagnosed in two (0.9%), peritonitis in two (0.9%), anastomositis in five (2.2%), and prolonged ileus in six (2.6%) patients. Nine patients died (3.9%). The overall 1-year survival rate was 83.8%, and the 5-year survival rate was 54.4%. Gender, age, TNM stage, pN, and N ratio were independent factors predicting a long-term prognosis for patients. A R0 type distal subtotal gastrectomy with standard D2 lymphadenectomy for a histologically proven invasive adenocarcinoma of the distal gastric portion without distant metastasis offers acceptable postoperative morbidity and mortality, and considerably high overall cumulative 5-year survival rate. The probability of cumulative survival decreases five times when the ratio between metastatic and examined lymph nodes is > 0.25.
The aim of the present paper was to assess the national burden of colorectal cancer in Lithuania, and to determine the performance of Lithuania for the control of colorectal cancer compared with 45 European nations by ranking. Seven... more
The aim of the present paper was to assess the national burden of colorectal cancer in Lithuania, and to determine the performance of Lithuania for the control of colorectal cancer compared with 45 European nations by ranking. Seven sources of data and information were used. The majority of the findings on disease burden are reported in the present study in the form of the crude and age-standardised incidence, age-specific and age-standardised mortality, disability adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) per 100,000 individuals per year by gender and in the two genders combined between 1990 and 2011. Colorectal cancer was ranked as the 3rd leading cause of disease burden out of all malignancies. Overall, the crude incidence was 35 per 100,000 individuals in 2001 and 51 per 100,000 individuals in 2011 in Lithuania. Incidence and mortality from colorectal cancer varied markedly within Lithuania. The number of DALYs and YLLs slightl...
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Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the... more
Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the patient. We presented the case of a 63-year-old man with chronic coloenteric fistula. Conservative treatment was unsuccessful. The orifice was then closed with two subsequent clips, and the patient recovered well. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.
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Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the... more
Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the patient. We presented the case of a 63-year-old man with chronic coloenteric fistula. Conservative treatment was unsuccessful. The orifice was then closed with two subsequent clips, and the patient recovered well. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.
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Background / objective: To evaluate the results of surgical management of duodenal injuries. Patients and method: A retrospective analysis of all patients with surgically identified duodenal injuries treated over a 22-year period in two... more
Background / objective: To evaluate the results of surgical management of duodenal injuries. Patients and method: A retrospective analysis of all patients with surgically identified duodenal injuries treated over a 22-year period in two emergency health care institutions. Results: In 32 patients studied, there were eight deaths (25%) and an overall complication rate of 53.1%. The morbidity related to abdominal injury was 40.6% (13 patients). Suture dehiscence with fistula formation with or without diffuse peritonitis developed in nine patients (28.1%). There were 58 associated abdominal injuries in 24 patients. The mesenterium, small bowel and pancreas were most frequently injured organs (25%, 21.9% and 21.9%, respectively). The average value of the abdominal trauma index (ATI) was 21.9 (range, 9 to 52). The value of the abdominal trauma index more than 25 was associated with a 1.25 times higher morbidity rate and 1.8 times higher mortality rate (p > 0.05). According to AAST OIS,...