Acta Chirurgica Latviensis最新文献

{"title":"Surgical Approach in Congenital Long QT Interval Syndrome Patients","authors":"Diāna Stoldere, Elīna Cimbolineca","doi":"10.2478/chilat-2020-0016","DOIUrl":"https://doi.org/10.2478/chilat-2020-0016","url":null,"abstract":"Summary Long QT syndrome is a genetically determined clinical condition that can lead to sudden cardiac death, life–threatening arrhythmias, typically ventricular tachycardia – Torsades de Pointes in young, otherwise healthy, adults and children. Congenital long QT syndrome is the most common cause of sudden death in young adults with structurally normal heart. There are several studies, which introduce us to gene mutation types, responsible for this disease. At this point 17 types of LQTS gene mutations are recognized, most patients present with the first 3 LQTS gene mutations: KCNQ1, KCNH2, and SCN5A. Secondary factors like electrolyte disbalance, dietary restrictions, and specific drugs may also cause QT interval prolongation. It is important to rule out avoidable causes, before further evaluation of congenital disease. Several treatment options are used in daily practice, which also includes a surgical approach. Although not so often used and seen, surgical technique has positive results – recognized by both doctors and patients.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129605972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Dual Antibacterial Therapy and Effectiveness of Recommendation Criteria as a Diagnostic Tool in Children with Uncomplicated Acute Appendicitis","authors":"Liene Taurina, Z. Liepina, A. Zviedre, A. Eņģelis, A. Petersons","doi":"10.2478/chilat-2020-0008","DOIUrl":"https://doi.org/10.2478/chilat-2020-0008","url":null,"abstract":"Summary Introduction Acute appendicitis (AA) – acute inflammation and infection of the appendix – is one of the most common cause for abdominal surgery in pediatrics. Appendectomy has been the gold standard since 1735, but in recent years there have been several studies that investigate antibacterial therapy for uncomplicated acute appendicitis. In 2016 new recommendations for suspected AA were implemented in emergency department setting of Children's Clinical University Hospital (CCUH). Aim of the Study To evaluate whether diagnostic criteria for patients with a suspected acute appendicitis is effective as a diagnostic tool and to evaluate whether dual antibacterial therapy is safe and effective as first line treatment for children with diagnosis of uncomplicated acute appendicitis in CCUH. Material and methods A retrospective study was made in CCUH from January 2017 to December 2017. Patients aged 7 to 18 with suspected uncomplicated acute appendicitis were identified and data were collected from an internal hospital management system and patients’ medical records. Patients were divided into two groups – A and B. In group A were patients who met the criteria of uncomplicated AA, and in group B – patients who met the criteria of complicated AA. Both groups received ampicillin and metronidazole. For statistical analysis IBM SPSS Statistics 22 program was used. Results From 98 patients majority were boys (51% (n=50)) with mean age 12.6 years. As a result of antibacterial therapy clinical condition improved in 93% (n=89) of patients who were discharged without surgery. 7 patients did not improve and underwent surgery within 48 hours after admission, another 2 had elective appendectomy. There was a significant positive moderate correlation between C–reactive protein (CRP), white blood cell count (WBC), basophil granulocytes (BASO) and appendix diameter at admisson and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.41, p=0.017 vs. r=0.51, p=0.013). In group A (68% (n=67)) there was a significant positive moderate correlation between CRP, WBC and appendix diameter at admission and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.51, p=0.013). In group B (30% (n=31)) 7 patients underwent appendectomy and 2 patients received a broad spectrum antibacterial therapy prior to elective appendectomy. There is evidence of significant association between ALVARADO score (p=0.004), rebound tenderness (p<0.001), WBC (p=0.004), CRP (p<0.001) and stage in which appendicitis has progressed to. Conclusions Antibiotic-alone treatment may be a safe and effective initial management choice in children with uncomplicated acute appendicitis. However, to fully evaluate effectiveness of antibacterial therapy and diagnostic criteria, further follow–up research is needed. A normal C–reactive protein value does not rule out uncomplicated acute appendicitis, therefore it can not act as a single ma","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123850590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Extracorporeal Membrane Oxygenation and Hemadsorber Therapy in Septic Patient with Multiorgan Injury","authors":"Anna Klēšmite, Roberts Leibuss, Baiba Arklina, L. Semčenko, Mārtiņš Kalējs, E. Strīķe, P. Stradins","doi":"10.2478/chilat-2020-0003","DOIUrl":"https://doi.org/10.2478/chilat-2020-0003","url":null,"abstract":"Summary Diagnostic microbiology and management of sepsis have advanced, even though the complication of multiorgan dysfunction remains a significant cause of morbidity and mortality. An estimated incidence of sepsis in 2017 is about 48 million a year, including 11 million sepsis- related deaths, which represents 19.7% of all global deaths.(1,2) Acute respiratory distress syndrome (ARDS) is a devastating complication of sepsis, conventionally, a substantial number of patients require mechanical ventilation (MV) to avert hypoxemia and hypercapnia. However, MV per se can cause lung injury, accelerating the disease progression. The use of extracorporeal membrane oxygenation (ECMO) in the management of ARDS has grown considerably in the past decade. More recently, an increasing popularity of spontaneous breathing and awake patients undergoing ECMO is seen, as well as the use of various types of hemadsorbers for reducing pathologically increased inflammatory response.(3) The purpose of this case report is to review airway and multiorgan support management during ECMO.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134060650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occipital Neuralgia Caused by an Intramuscular Lipoma. A Case Report","authors":"Taluma Agnija, Griskjans Zans","doi":"10.2478/chilat-2020-0014","DOIUrl":"https://doi.org/10.2478/chilat-2020-0014","url":null,"abstract":"Summary Occipital neuralgia is a type of chronic headache disorder in the dermatomes of the greater or lesser occipital nerve. (7) We describe here a rare case of occipital neuralgia caused by an intramuscular lipoma. A 45 year-old man presented with troublesome pain in the occipital area with 3 x 2 cm palpable mass in the right occipital region. Patient was treated by a neurologist. The X ray for cervical vertebrae and computed tomography was performed. Computed tomography revealed a mass reminding intramuscular lipoma. Surgical management was indicated. During the operation stretching of the lesser occipital nerve was detected. After resection of lipoma on postoperative follow – up, the patient reported that the pain had resolved. During the histopathological examination, lipoma was confirmed.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125502986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Complicated Colorectal Cancer Recurrence","authors":"A. Lescinska, Valerija Grakova, A. Malasonoks, A. Sīviņš","doi":"10.2478/chilat-2020-0006","DOIUrl":"https://doi.org/10.2478/chilat-2020-0006","url":null,"abstract":"Summary The case report demonstrates painstaking, one step at a time multitherapy for the third most common cancer and the third cause of cancer death in western countries – colorectal cancer. Multitherapeutic approach at specialized centers for the treatment of colorectal cancer is the cornerstone for reaching favorable treatment results and prognosis.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133151495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Antibacterial Prophylaxis in Vascular Surgery: Analysis of its Parameters Before and After Evaluation of Justification of Chosen Indications","authors":"Edgars Supols","doi":"10.2478/chilat-2020-0012","DOIUrl":"https://doi.org/10.2478/chilat-2020-0012","url":null,"abstract":"Summary In surgical practice, antibacterial prophylaxis (AP) is widely used to reduce the risk of possible infectious complications; it is not always administrated according to evidence-based clinical indications. Administration of AP in cases when its inefficiency for exact situation has been scientifically proven, should be considered as unwarranted. A one-year-long retrospective analysis of AP cases in the Department of Vascular Surgery of Pauls Stradins Clinical University Hospital was performed and the results were broadly analyzed within the local structural unit. It was followed by the development of the local guidelines for administration of antibiotics, as a result, a significant decrease in cases of unwarranted AP has been achieved.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115730440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterisation of Morphology in Musculus Semitendinosus Tendon Used for Anterior Cruciate Ligament Reconstruction: A Pilot Study","authors":"J. D. Osipovs, M. Pilmane, Modris Ciems","doi":"10.2478/chilat-2020-0001","DOIUrl":"https://doi.org/10.2478/chilat-2020-0001","url":null,"abstract":"Summary Introduction Anterior cruciate ligament (ACL) rupture is very common in athletes. In the general population, incidence is approximately 33 per 100 000 people. Aim of the study The aim of the study was the evaluation of morphological changes in the musculus semitendinosus tendon used for the reconstruction of ACL to understand the quality of most common for surgery used material. Material and methods The materials were obtained from four ACL autologous hamstring reconstruction surgeries. The tissue was stained with hematoxyllin and eosin and with immunohistochemical (IMH) staining of PGP9.5, VEGF, collagen I and collagen III. The material was evaluated with semiquantitative method. Results Routine staining showed practically unchanged tendon structure, with one exception when sclerotic blood vessels were observed in endotenon. Collagen III IMH demonstrated moderate to numerous positive collagen fibres in two cases, but in other two there were only few positive structures seen. Collagen I IMH showed few to moderate number of positive collagen fibres in all cases. In two cases, moderate number of PGP9.5 positive nerve fibres was observed and in two other cases occasional to few number of positive structures was detected. PGP 9.5 marked higher number of nerve fibres in peritenon than in endotenon. Numerous VEGF positive endotheliocytes were observed in two cases, but in two other cases VEGF positive endotheliocytes were occasional. Conclusions Tendon of musculus semitendinosus displays two patterns of distribution of tissue ischemia, neuropeptide containing innervation and collagen I and III. Collagen III is thought to be evaluated as a response of tendon to the ischemia and intensive innervation, while increase of collagen I probably is related to the relatively unchanged vascularity and innervation. The pattern of musculus semitendinosus tendon structural changes seems to be connected to the individual homeostasis in patients persisting before the usage of tendon for the reconstruction.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115467087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Incidental Gastrointestinal Stromal Tumor of the Stomach","authors":"Irina Liepina, Sergejs Klimcuks, Jelena Farbere, Ilona Kapeika","doi":"10.2478/chilat-2020-0004","DOIUrl":"https://doi.org/10.2478/chilat-2020-0004","url":null,"abstract":"Summary Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract (3). A 68-year-old male patient was referred to our hospital with complaints about feeling pressure in the thorax and heavy sweating for over 2 years. Abdominal CT showed a pathological formation approximately 21 cm × 15cm × 15 cm in size. The stomach was compressed and dislocated by the tumor. The total gastrectomy Roux modification was performed. The tumor grows from the back wall of the stomach; the tumor is not grew into the mucosa. We made a final diagnosis of an extra luminal GIST of the stomach - pT4N0M0G1R0 stage II. There was no evidence of disease recurrence six months after surgery.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126933178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Peripapillary Choroidal Neovascularization Associated with Age-Related Macular Degeneration: A Case Report","authors":"Dručka Eva, E. Ēriks, Šepetiene Svetlana, Ozoliņš Artūrs","doi":"10.2478/chilat-2020-0005","DOIUrl":"https://doi.org/10.2478/chilat-2020-0005","url":null,"abstract":"Summary A 50-year-old female was diagnosed with significant peripapillary choroidal neovascularization (PCNV) in the left eye (LE). 12 months after a close follow-up, 4 intravitreal injections with bevacizumab and retinal laser photocoagulation were performed to limit the distribution of the lesion. A year after the primary diagnosis in the LE, a tiny PCNV also developed in the right eye (RE). Simultaneous activity was additionally observed in both peripapillary lesions at the time. At the last follow-up, after 43 months, the best corrected visual acuity in the RE was 0.8, but in the LE it was only 0.2. In total, the LE received 6 intravitreal injections with bevacizumab, while the RE received 3 injections. The case report concludes that early diagnosis and intervention helps maintain visual acuity better in the cases of a small lesion than in developed significant PCNV with intense activity characterised with oedema, hard exudates and haemorrhages.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133371900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant Chemoradiotherapy in the Downstaging of Locally Advanced Rectal Cancer and its Impact on Progression–Free Survival","authors":"Tatjana Neško, Arvils Neško, Elīna Sīviņa, G. Purkalne","doi":"10.2478/chilat-2020-0010","DOIUrl":"https://doi.org/10.2478/chilat-2020-0010","url":null,"abstract":"Summary Introduction The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (NACRT) followed by radical surgery, which allows to reduce local recurrence, downsize the tumor and facilitate its R0 resection. Aim of the study The aim of this study was to evaluate the downstaging of LARC after NACRT and to assess the impact of downstaging on progression–free survival (PFS). Materials and methods 65 patients diagnosed with LARC from 2012 to 2018, who received NACRT with subsequent radical surgery were identified in the Pauls Stradins Clinical University Hospital in Riga and included in this retrospective study. Average follow–up period was 31 months. Data were analysed with SPSS Statistics 22.0, Wilcoxon signed–rank test and Kaplan–Meier survival analysis were performed. Results Overall, 66.7% (n=40) of patients experienced a downstaging in response to NACRT, of which 37.5% (n=24, p=0.004) had a downstaging of T and 63.3% (n=38, p=0.0001) of N. 12–month PFS was 87.8%, 24–month PFS – 66.1% and 3–year PFS – 62.7%, median PFS (mPFS) was not met. 3–year PFS of those patients treated with intravenous 5FU/LV boluses was significantly higher (76.5%) than those who received oral tegafur (45.6%, mPFS 32 months), p=0.038. 3–year PFS of patients with downstaged T was 85.9%, compared to 52.1% without it; mPFS not met, p=0.04. Similarly, 3–year PFS of patients with downstaged N was 71.5%, compared to 43.3% without it (mPFS 24 months), p=0.112. Lymphatic and vascular invasion were associated with significantly lower PFS compared to the patients with absent lymphatic and vascular invasion (p=0.0001 and p=0.014, respectively), while perineural invasion did not show any impact on PFS. Age at diagnosis, tumor location, type of surgery and adjuvant chemotherapy did not have a significant impact on PFS. Conclusions Results confirm the efficacy of NACRT in LARC in the downstaging of T and N. Downstaging of LARC, intravenous chemotherapy and absence of lymphovascular invasion are associated with significantly increased PFS.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121551486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}