Acta Chirurgica Latviensis最新文献

{"title":"Impact of Epidural Analgesia on Labor: Length of Labor, Operative Vaginal Delivery Rate and Occiput Posterior","authors":"Santa Krievina, Jelena Dunaiceva, A. Miskova","doi":"10.1515/chilat-2015-0008","DOIUrl":"https://doi.org/10.1515/chilat-2015-0008","url":null,"abstract":"Summary Introduction.Epidural analgesia (EA) is widely used as labor analgesia. It has been reported that EA can slow down the course of labor and increase the risk of operative vaginal delivery. Slower course of labor can lead to an increased risk of abnormal fetal heart rate (FHR). Some studies have also demonstrated an increase in occiput posterior position of the fetal head at delivery if EA is used. It represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery. Aim of study. To evaluate the impact of EA on the length of labor and the rate of operative vaginal delivery, and to determine whether EA increases the rate of occiput posterior of the fetal head at delivery Material and methods. We carried out a retrospective case-control study based on clinical records from parturients admitted to Riga Maternity Hospital in 2013. Parturients were divided into two groups: case group comprised parturients who had EA, while parturients of control group did not have EA. Groups were further subdivided into primiparas and multiparas and comparisons were made according to parity. We excluded parturients who had obstructed labor, pathological labor, induction of the labor, history of C-section and significant anomaly of the fetus. Results. A total of 832 parturients were included in the study, 304 in EA group (220 primiparas and 84 multiparas) and 528 in control group (257 primiparas and 271 multiparas). Primiparas of EA group had longer latent phase of the first stage of labor in comparison to primiparas of control group (p=0.001), while multiparas of EA group had longer first stage (p=0.031) of labor and longer latent phase of labor (p<0.001) than their respective controls. Vacuum extraction was used in 1.27% of all deliveries with EA. Moreover, vacuum extraction was used only in primiparas an there was no statistically significant difference between EA group primiparas and control group primiparas (1.7% vs. 1.2%, p=0.593). EA did not increase the rate of occiput posterior positon of fetal head. However, primiparas with EA and occiput posterior were more likely to have an abnormal FHR tracing in comparison to primiparas with EA and without occiput posterior position of fetal head (40% vs. 9.8%, p=0.029; RR=4.09, 95% CI 1.3-12.9). There was no statistically significant link between occiput posterior position and abnormal FHR tracing in control group primiparas. Conclusion. EA does not increase the likelihood of operative vaginal delivery. However, parturients with EA have longer latent phase of the first stage of labor. Risk for occiput posterior at delivery is not increased in labor with EA. However, the risk for abnormal FHR among primiparas who receive EA is increased in case of occiput posterior position of the fetal head.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115381045","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":"Chromosomal Aberration in Colorectal Cancer Family","authors":"E. Miklaševičs, Mikko Kupila, D. Kalniete, I. Eglite, D. Bērziņa, M. Ustinova, G. Purkalne, Z. Daneberga","doi":"10.1515/chilat-2015-0002","DOIUrl":"https://doi.org/10.1515/chilat-2015-0002","url":null,"abstract":"Summary Introduction. Lynch syndrome, previously more commonly known as hereditary nonpolyposis colorectal cancer, is a hereditary cancer syndrome with an autosomal dominant inheritance pattern. Usually it is caused by mutations the MMR genes. In 20 – 25% of cases patients are not found to have mutations in any of these genes. Chromosomal aberrations as a cause of the Lynch syndrome were examined in this study. Aim of the study. To identify chromosomal aberrations which may lead to colorectal cancer. Material and methods. Twelve patients, corresponding to either Amsterdam I/II criteria or Bethesda guidelines, which have been tested negative for mutations in Lynch genes have been karyotyped were karyotyped with SNP array chips, in order to determine if they had potentially heritable chromosomal aberrations which could be responsible for increased risk of malignancy. Results. One patient with a 14.7Mbp duplication framed by small deletions was chosen to be the most likely patient to suffer from an inherited carcinogenic chromosomal aberration. The preceding deletion was found to contain the coding region of BRE, encoding a component of the BRCA1-A complex; we believe that this deletion is the most carcinogenic component of the aberration and likely responsible for Lynch syndrome in this case. The larger duplication furthermore contained the coding regions for 83 genes, some of which have been shown to promote malignant disease when overexpressed. Conclusion. Because of the clinically grossly tolerable nature of the aberration it is possible that it was vertically transmitted and contributed to the onset of colorectal cancer in the patient and his mother and maternal aunt.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"344 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116236382","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":"Immunohistochemical Diagnosis of Hirschsprung’s Disease and Allied Disorders","authors":"V. Zuikova, Ivanda Franckeviča, Ilze Strumfa, I. Melderis","doi":"10.1515/chilat-2016-0010","DOIUrl":"https://doi.org/10.1515/chilat-2016-0010","url":null,"abstract":"Summary Introduction. Hirschsprung’s disease accounts for approximately 20% of neonatal bowel obstruction and has a mortality rate of 20 to 25%. As the pathology severely affects a child’s quality of life, quick and precise diagnosis is mandatory. For years, diagnosis relied completely on histopathological analysis of rectal biopsies using haematoxylin-eosin and acetylcholinesterase stains. However, there have been many attempts to find an immunohistochemical marker that would simplify diagnosis of Hirschsprung’s disease. Acceptable markers should be highly sensitive and specific, easy to use and reliable. Aim of the study. The aim is to disclose the full morphological scope of Hirschsprung’s disease and allied disorders by using data available at the Children’s Clinical University Hospital (Riga, Latvia) and to identify the most sensitive and specific immunohistochemical marker for the diagnosis of Hirschsprung’s disease and allied disorders. Material and methods. In a retrospective study, all patients diagnosed with Hirschsprung’s disease and allied disorders at the Pathology Bureau of the Children’s Clinical University Hospital between April 2010 and October 2014 were identified. Immunohistochemical visualisation of calretinin, chromogranin A and synaptophysin was carried out. A conjugated polymer system EnVision was used to detect the bound primary antibodies. The study was controlled by findings in the bowel wall of adults and children lacking aganglionosis. The intensity and pattern of ganglion cell and nerve fibre staining were evaluated semi-quantitatively on a scale of one to three in both submucosal and myenteric plexuses of bowel. The specificity and sensitivity of each immunohistochemical marker were determined with a MedCalc online calculator. Results. During the relevant period, Hirschsprung’s disease (23) and allied disorders (12) were diagnosed in 35 patients. Among these children, 45.7% were diagnosed during the first year of life. Three types of Hirschsprung’s disease were present - short segment disease (73.9%), long segment disease (21.8%) and total colonic aganglionosis (4.3%). Allied Hirschsprung’s disorders were of three different types - hypoganglionosis (75%), zonal aganglionosis (16.7%) and immaturity of ganglion cells (8.3%). After evaluation of the reactivity of immunohistochemical markers, calretinin, synaptophysin and chromogranin showed staining intensity of ganglion cells of 2.47, 0.58 and 0.63, respectively, while nerve plexus staining intensity was 1.84 for calretinin, 2.68 for synaptophysin and 1.79 for chromogranin. Calretinin was characterised by sensitivity/ specificity as high as 90.5%/ 92.9% while these parameters were only 52.4%/ 100.0% for chromogranin A and 33.3%/ 14.3% for synaptophysin. Conclusions. In Latvia, the diagnosis of Hirschsprung’s disease or allied disorder is made later in life than it is in other countries. Hirschsprung’s disease was more frequent than the allied disorders. It can present ","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114804976","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":"Apoptosis, ANUP, Chromogranin A, PGP 9.5, Endothelins and VEGF in Acquired Heart Diseases: Review of Literature","authors":"Edite Kulmane, M. Pilmane, R. Lācis","doi":"10.1515/chilat-2016-0012","DOIUrl":"https://doi.org/10.1515/chilat-2016-0012","url":null,"abstract":"Summary According to the Centre for Disease Prevention and Control of Latvia data, in 2014 16076 latvians died from cardiovascular diseases and it is 57,03% of all deaths. Changes in myocardium of the diseased hearts are complex and pathogenesis is still not fully clear. Morphopathogenesis of cardiovascular diseases are complex molecular cell changes which include apoptosis, homeostasis regulating factors, and innervation and ischemia markers. In this article we wanted to provide an overview about apoptosis, atrial natriuretic peptide, chromogranin A, neuropeptide-containing innervation, endothelins and vascular endothelial growth factor in pathomorphology of acquired heart diseases and their clinical implications.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134498148","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":"Plasma miR-21 and miR-31 as Predictive Biomarkers for Evaluation of Therapeutic Efficacy in Metastatic Colorectal Cancer","authors":"Z. Daneberga, Elza Broka, D. Kalniete, M. Nakazawa-Miklaševiča, M. Ustinova, E. Skuja, G. Purkalne, E. Miklaševičs","doi":"10.1515/chilat-2015-0001","DOIUrl":"https://doi.org/10.1515/chilat-2015-0001","url":null,"abstract":"Summary Introduction. Colorectal cancer (CRC) is the third most common cancer worldwide. Evaluation of patient response to the applied therapy regime is still challenging. Routine laboratory tests during follow-up do not provide necessary information on therapy efficacy. To improve life expectancy and quality of life for patient with CRC ongoing researches is concentrated to discovering new, reliable biomarkers which could contribute to define patients prognosis and choice of therapy. One of topical research field for searching new biomarkers is mi-RNS. Aim of the study. The aim of this study was to analyze relative expression changes of miR-21 and miR-31 as potential biomarkers for evaluation of therapy efficacy in mCRC. Material and methods. In the present study seven patients with mCRC diagnosis were included. After surgery all patients received first line therapy with oxaliplatin. Blood samples for present study were collected every 2-3 weeks. Relative expression of miR-31 and miR-21 assessed with real time PCR. Data analysis carried out by delta delta Ct (ΔΔCt) algorithm. Correlation analysis was performed by R programme ver. 3.1.2 using Pearson correlation coefficient. Results. Our results in the correlation analysis for CEA serum level and relative expression level of miR-21 and miR-31 did not confirm significant correlation. MiR-31 showed increased expression soon after administration of therapy with a drop of relative expression closer to the CDP I. Acquired results revealed trend of increase in relative expression of miR-21 in PFS II compared to PFS I. Correlation analysis for miR-31 and miR-21 did not reach statistical reliability. Conclusions. The relative expression alteration pattern of miR-31 and miR-21 in plasma during the therapy is promising biomarker for evaluation of therapy efficacy. These findings need to be validated in large cohort sample set.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"657 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123047575","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":"Successful Treatment of Pelvic Congestion Syndrome by Percutaneous Embolisation of Left Ovarian Vein","authors":"M. Petrovica, Ilze Strumfa, S. Thora, Andrejs Vanags","doi":"10.1515/chilat-2016-0014","DOIUrl":"https://doi.org/10.1515/chilat-2016-0014","url":null,"abstract":"Summary Pelvic congestion syndrome (PCS) is a frequently undiagnosed pathology, affecting mainly young women. According to literature, about one third of all women have this condition. The main symptoms include chronic pelvic pain, varicose pelvic veins, dysmenorrhea, and dyspareunia. The etiology of PCS is associated with valvular insufficiency in ovarian and pelvic veins. There are four main diagnostic methods: duplex ultrasound evaluation, computed tomography, magnetic resonance angiography including venous phase investigation and digital subtraction angiography. Nowadays percutaneous transcatheter embolization is an effective and safe treatment for ovarian vein reflux and thus PCS. In order to emphasize the need and possibilities to diagnose and treat PCS appropriately, here we present a well-documented case of PCS that was successfully cured by percutaneous transcatheter embolization.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132700354","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":"Tactile Sensibility of Natural Teeth and Osseointegrated Dental Implants to Loading","authors":"Linards Grieznis, P. Apse, Leons Blumfelds","doi":"10.1515/chilat-2016-0011","DOIUrl":"https://doi.org/10.1515/chilat-2016-0011","url":null,"abstract":"Summary Introduction. Dental implant therapy has become a popular method of replacing one or more missing teeth. Osseointegrated dental implants have been studied from histological, microbiologic and biomechanical point of view, but the neurophysiologic integration of the implants and the supported prostheses has received less attention. The sensory mechanism of dental implants is qualitatively different from that of natural teeth. Psychophysiological tests are used to determine the tactile sensibility perceived with the implants and teeth. Aim of the study. The purpose of this study was to compare tactile sensibility of natural teeth and osseointegrated dental implants. Material and methods. Forty-three patients were included in the study. Natural teeth were divided into two groups: non endodontically treated teeth (NETT) and endodontically treated teeth (ETT). Load tests were done by a computer-controlled pressure sensitive device („Power Lab“ Data Acquisition System - model 4/25T, sensor - model MLT003/D; ADInstruments), specially modified for intraoral use. Pushing forces were applied parallel to the vertical axis of teeth and implants. The patient held a signal button which he/she activated as soon as touch was sensed. At this moment the computer registered passive absolute tactile threshold - measured in Newtons. The mean values of passive absolute tactile threshold for natural teeth and dental implants were calculated. Comparison of the mean values was performed by the means of t-test. Results. Passive absolute tactile threshold for osseointegrated dental implants was 2.39 N (SD=1.92), and for teeth - 0.67 N (SD=0.72), for non endodontically treated teeth it was 0.63 N (SD=0.72) and for endodontically treated teeth - 0.73 N (SD=0.69). The differences in mean values were statistically significant (p<0,0001) except for mean values of NETT vs. ETT. Conclusion. This study shows that patients with osseointegrated implants subjectively feel “touch” sensation when greater force is applied compared with natural teeth.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133740696","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":"Medium-Term Outcome after Multidisciplinary Management in Polytrauma Patient: a Case Report","authors":"Vera Kornilova-Filusina, A. Vikmanis, R. Jakušonoka, G. Rusovs, Marija Cistjaka","doi":"10.1515/chilat-2016-0013","DOIUrl":"https://doi.org/10.1515/chilat-2016-0013","url":null,"abstract":"Summary Previously healthy young patients having survived after multiple severe musculoskeletal injuries and undergone trauma-related amputation of lower limb have a long life expectancy. This case shows the role of multidisciplinary approach in severely injured polytrauma patient managed by traumatologists-orthopaedists, anesthetists-resuscitators, radiologists, general surgeons, microsurgeons, thoracic surgeons, urologists, neurologists, physical therapy rehabilitators, physiotherapists, technical orthopaedists, prosthetists. Majeed score demonstrates ability to perform work and to walk. Amputation affects the quality of life with a certain negative somatic and functional impact. Microprocessor controlled knee joint in patients after transfemoral amputation allows more precise adjustment of knee resistance, providing an increased walking velocity, reduction in stumble and falls, however the final outcome depends also on patients’ own motivation and readiness to regain previous quality of life.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123025087","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":"Immunohistochemical Diagnosis of Hirschsprung’s Disease and Allied Disorders","authors":"V. Zuikova, Ivanda Franckeviča, Ilze Strumfa, I. Melderis","doi":"10.1515/chilat-2015-0010","DOIUrl":"https://doi.org/10.1515/chilat-2015-0010","url":null,"abstract":"Summary Introduction. Hirschsprung’s disease accounts for approximately 20% of neonatal bowel obstruction and has a mortality rate of 20 to 25%. As the pathology severely affects a child’s quality of life, quick and precise diagnosis is mandatory. For years, diagnosis relied completely on histopathological analysis of rectal biopsies using haematoxylin-eosin and acetylcholinesterase stains. However, there have been many attempts to find an immunohistochemical marker that would simplify diagnosis of Hirschsprung’s disease. Acceptable markers should be highly sensitive and specific, easy to use and reliable. Aim of the study. The aim is to disclose the full morphological scope of Hirschsprung’s disease and allied disorders by using data available at the Children’s Clinical University Hospital (Riga, Latvia) and to identify the most sensitive and specific immunohistochemical marker for the diagnosis of Hirschsprung’s disease and allied disorders. Material and methods. In a retrospective study, all patients diagnosed with Hirschsprung’s disease and allied disorders at the Pathology Bureau of the Children’s Clinical University Hospital between April 2010 and October 2014 were identified. Immunohistochemical visualisation of calretinin, chromogranin A and synaptophysin was carried out. A conjugated polymer system EnVision was used to detect the bound primary antibodies. The study was controlled by findings in the bowel wall of adults and children lacking aganglionosis. The intensity and pattern of ganglion cell and nerve fibre staining were evaluated semi-quantitatively on a scale of one to three in both submucosal and myenteric plexuses of bowel. The specificity and sensitivity of each immunohistochemical marker were determined with a MedCalc online calculator. Results. During the relevant period, Hirschsprung’s disease (23) and allied disorders (12) were diagnosed in 35 patients. Among these children, 45.7% were diagnosed during the first year of life. Three types of Hirschsprung’s disease were present – short segment disease (73.9%), long segment disease (21.8%) and total colonic aganglionosis (4.3%). Allied Hirschsprung’s disorders were of three different types – hypoganglionosis (75%), zonal aganglionosis (16.7%) and immaturity of ganglion cells (8.3%). After evaluation of the reactivity of immunohistochemical markers, calretinin, synaptophysin and chromogranin showed staining intensity of ganglion cells of 2.47, 0.58 and 0.63, respectively, while nerve plexus staining intensity was 1.84 for calretinin, 2.68 for synaptophysin and 1.79 for chromogranin. Calretinin was characterised by sensitivity/specificity as high as 90.5%/92.9% while these parameters were only 52.4%/100.0% for chromogranin A and 33.3%/14.3% for synaptophysin. Conclusions. In Latvia, the diagnosis of Hirschsprung’s disease or allied disorder is made later in life than it is in other countries. Hirschsprung’s disease was more frequent than the allied disorders. It can present as s","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"195 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114865789","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":"Lactate as a Predictor in Severe Pneumonia","authors":"D. Ose, A. Bērziņš, Krista Grigorovica, A. Klucniks, O. Sabelnikovs","doi":"10.1515/chilat-2015-0006","DOIUrl":"https://doi.org/10.1515/chilat-2015-0006","url":null,"abstract":"Summary Introduction. There are many discussions that one of the mortality risk markers for patients admitted to intensive care unit (ICU) with different etiology shock is admission blood lactate level. It is believed that serum lactate could be used as an early marker of mortality risk determination. We are not aware about research studies regarding admission serum lactate prognostic significance in patients with severe community acquired pneumonia (CAP) in first 24 hours after admission to ICU in Latvia. Aim of the study. To evaluate the prognostic significance of the first lactate level in patients with severe pneumonia. To compare the statistical data of different blood lactate levels (LAC1, LAC2, LAC3, LAC4, LACMAX, LACMIN). To find admission lactate reference level which is attributed to significant increase of mortality. To compare with other markers and scoring systems like: PCT (procalcitonin), CRP (C-reactive protein), CURB-65 (pneumonia severity score), APACHEII (Acute Physiology and Chronic Health Evaluation II). Material and methods. This is a retrospective observational study in which data were collected on all patients admitted to ICUwith pneumonia and sepsis and/or septic shock in two major Hospitals of Republic of Latvia (Eastern Clinical university hospital and Pauls Stradins Clinical university hospital) with primary diagnosis of severe community acquired pneumonia (CAP). We compared the relationship between lactate values that were collected in 24 hour period after admission in ICU and ICU mortality. Results. In this study we analyzed data from consecutive 73 patients with severe CAP and sepsis and/or septic shock and we observed statistically significant difference between the first lactate level (LAC1) in survivors (2.7 [1.9-3.2] (mmol/l) and non-survivors 4.9 [4.3-7.5] (mmol/l); p<0.001). According to data patients with LAC1<3.0 (mmol/l) mortality risk was 0%, patients with LAC1 3.0 – 4.0 (mmol/l) risk was 42.1%, while patients with LAC1>4.0 (mmol/l) mortality risk reached 89.7%. Lactate level measurements in first 24 hours after arrival into the ICU have had high ability to stratify non-survivor patients: LAC1 (0.96), LAC2 (0.98), LAC3 (0.97), LAC4 (0.92), (AUC). Incomparison with other prognostic markers sensitivity and specificity following results were obtained: CRP (0.59), PCT (0.98), APACHE II (0.98), CURB-65 (0.63). Conclusions. Summarizing data on patients with severe pneumonia and sepsis and/or septic shock admission lactate in first 24 hours have significant independent predictive value. In first 24 hours after admission in ICU higher mortality were observed if LAC1 was >3 (mmol/l). Data proves for thepatients with severe pneumonia LAC1 is having similar prognostic ability like APACHEII and PCT, and significantly better prognostic ability than CRP and CURB-65.","PeriodicalId":305046,"journal":{"name":"Acta Chirurgica Latviensis","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129215780","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}