<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> The adverse effects of hypoxia are well known, especially regarding the brain, and can lead to postoperative cognitive disturbances. On the other hand, the brain is still one of the least monitored organs intraoperatively. Near infrared spectroscopy devices are non-invasive continuous cerebral oxygenation monitoring devices that can also be used intraoperatively.Prone position used during spinal neurosurgery is of particular importance regarding physiological changes that can occur in the human body and can lead to reduced blood and oxygen supply of the brain.<bold>Aim of the Study.</bold> The aim of the study was to determine whether prone position used during spinal neurosurgery impacts cerebral oxygenation and patients’ cognitive performance after the surgery.<bold>Material and methods.</bold> 40 patients were included in the study (32 study group, 8 control group). Patients were scheduled for spinal neurosurgery in prone position. All patients received standard general anaesthesia. In the study group regional cerebral oxygen saturation (rScO2) was continuously monitored using INVOS 4100 near infrared spectroscopy device. During the surgery every 5 minutes in study and control group medium non–invasive blood pressure, heart rate, peripheral oxygen saturation, exhaled CO2 and cerebral oxygenation measurements were fixed. We also fixed intraoperative blood loss and duration of the operation. Cognitive function was assessed in both groups using Montreal - Cognitive Assessment (MoCA) scale before surgery and two days after the surgery.<bold>Results.</bold> We didn’t observe any significant changes in our calculated medium rScO2 intraoperative values. During induction of anaesthesia when patients were lying supine rScO2 above the right cerebral hemisphere was rScO2 72±9.7%, above the left cerebral hemisphere 71± 9.7%. Cerebral oxygen saturation in prone position was rScO2 R 74±10.7% and rScO2 L 74±10.1%. At the end of the surgery when patients were lying supine again rScO2 R was 74±9.3% and rScO2 L was 74±7.9%.We didn’t observe any differences in medium MoCA scores when comparing study and control group. MoCA score before surgery in the study group was 24.1±2.9 points and 24.6±4.1 points in the control group. MoCA performed 2 days after the surgery was 24.6 ±3.2 points in study group and 24.6±2.4 points in control group.<bold>Conclusions.</bold> No significant changes were observed in medium MoCA scores between patients who intraoperatively received noninvasive cerebral oxygen saturation monitoring and patients who did not receive it.Despite medium calculated MoCA scores, individually we observed postoperative cognitive function impairment for MoCA 1-2 points in 5 out of 8 patients in the control group, but in the study group only 1 patient out of 32 showed cognitive dysfunction.Intraoperative regional cerebral oxygen saturation monitoring can help to obviate cerebral desaturation that can lead to postoperative cognitive decline.</abstract>

Riga Eastern Clinical University Hospital, Department of Anaesthesiology

Pauls Stradins Clinical University Hospital, Department of Anaesthesiology

Regional Cerebral Oxygenation Changes Monitored with Near Infrared Spectroscopy Device During Spinal Neurosurgery in Prone Position and Postoperative Cognitive Dysfunction

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Cervical cancer is the fourth most common form of cancer in women [19]. The precancerous stages are divided into three distinctive stages, labelled cervical intraepithelial neoplasia (CIN) I, II and III. One of the aetiological factors is chronic inflammation in cervical tissue, most often induced by Human papilloma virus (HPV). 88,5% of the patients regress from low grade intraepithelial changes to unchanged epithelium [14]. It has been proposed that cytokine balance plays a key role in the development of high grade epithelial changes (CIN I – CIN III) in the remaining 11.5% of patients, however, the exact trigger of this event remains to be found.<bold>Aim of the Study.</bold> The aim of the study was to determine three pro-inflammatory (IL-1α, IL-6, IL-8) and one anti-inflammatory (IL-10) interleukin expression in different CIN <italic>cervix uteri</italic> biopsies.<bold>Material and methods.</bold> 16 biopsies were obtained with different CIN staging: one with CIN I stage, five with CIN II stage and 10 with CIN III stage. The samples were stained with haematoxylin and eosin and immunohistochemistry for IL-1α, IL-6, IL-8 and IL-10. Slides were evaluated semi-quantitatively grading the intensity of positively stained structures in the visual field.<bold>Results.</bold> Examination of the samples yielded the following: IL-1α expression increased from CIN II to CIN III in squamous epithelium, while IL-8 expression decreased. A few IL-1α containing inflammatory cells were found in all CIN stages. IL-8 expression in subepithelium and the number of inflammatory cells decreased from CIN II stage to CIN III, although, it increased in the blood vessel endothelium.<bold>Conclusions.</bold> There was constant moderate expression of both IL-6 and IL-10 during all CIN stages, except for inflammatory cells, where IL-6 expression was high during all stages, yet there were few IL-10 containing cells during CIN. The balanced expression of both cytokines suggests that pro- and anti-inflammatory cytokine balance has an important role in CIN morfopathogenesis. The high expression of IL-6 in inflammatory cells and constant expression trough CIN staging indicates sustentation of chronic inflammation and production of other cytokines, such as IL-8, IL-1α. The variable IL-8 expression and its decrease in CIN III stage suggests the depletion of IL-8 production. The high expression of cytokines in blood vessel endothelium indicates their important role in CIN morfopathogenesis.</abstract>

Interleukin IL-1α, IL-6, IL-8, IL-10 Expression in Different Staging of Cervical Intraepithelial Neoplasia

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Positron emission tomography/computer tomography (PET/CT) is one of the main imaging tests for solid tumor and metastases diagnostic nowadays. However, PET/CT scanning is related to the risk of ionizing radiation exposure, which is especially harmful for children health. Whole-body MRI (WB-MRI) allows exact evaluation of malignant tumor without the radiation exposure.<bold>Aim of the Study.</bold>To compare and evaluate informativity of WB-MRI and PET/CT imaging methods for detection of metastases in children with malignant disease, being treated at Children’s Clinical University Hospital, Riga, Latvia. The gained data were also compared to the world data published before.<bold>Material and methods.</bold> This retrospective study included all patients in whom both PET/CT and WB-MRI imaging examinations were performed between July 2016 and February 2017 in Latvia. Inclusion criteria were: age under 18 years, histological confirmation of a malignant disease. The study included 10 patients (7 males, 3 females, mean age 11 years 7 months). Two patients underwent both examinations 3 times, resulting in a total of 14 cases.<bold>Results.</bold> There were identified three types of tumor: Hodgkin lymphoma (n = 12), non-Hodgkin lymphoma (n = 1), rhabdomyosarcoma (n = 1).PET/CT mean radiation exposure was 263,2 [95% CI: 202.27 - 324.12] mGy.cm, mean radiotracer dosage was 143,5 [95% CI: 114. - 172.52] MBq.There were identified 34 lesions: 24 (70%) lymph nodes, 5 (15%) bone lesions, 5 (15%) soft tissue lesions. 21 malignant lesions were detected by PET/CT. 27 lesions were found by WB-MRI. Out of 34 lesions, eighteen were identified by both imaging methods. Both examinations found absence of residual disease in 2 cases.Eleven lesions were detected by WB-MRI (7 lymph nodes, 1 bone lesion and 3 soft tissue lesions) that were not identified by PET/ CT. 5 lesions could not be identified by WB-MRI (2 lymph nodes, 1 bone lesion and 2 soft tissue lesions) that were detected by PET/CT imaging method.<bold>Conclusions.</bold> WB-MRI examination should be used before and in addition to PET/CT imagining in children with oncological disease. PET/CT examination results interpretation should be done based on WB-MRI imaging results. WB-MRI could not completely replace PET/CT imaging.</abstract>

Comparison Between Whole-Body MRI and PET/CT in Pediatric Oncology

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Unanticipated difficult intubation still exists as a significant problem. El-Ganzouri risk index is a bedside difficult airway evaluation method, which can help determine risk of difficult airways. However, evidence of using of El-Ganzouri risk index in difficult laryngeal visualisation using videolaryngoscopes is limited.<bold>Aim of the Study.</bold> Determine the specificity and sensitivity of El-Ganzouri multivariate risk index to predict difficult laryngeal exposure using Storz C-MAC videolaryngoscope equipped with D type blade.<bold>Material and methods.</bold> We conducted a study of 29 patients, which were examined using El-Ganzouri risk index before induction of anaesthesia. After induction of anaesthesia videolaryngoscopy was performed using Storz C-MAC videolaryngoscope equipped with D-blade and laryngeal visualisation was graded using Cormack-Lehane scale. After laryngeal visualisation grading endotracheal tube insertion was performed and numbers of attempts as well as complications during intubation were recorded. Sensitivity, specificity, positive and negative predictive values were calculated, receiver operating characteristic curve and area under curve was obtained.<bold>Results.</bold> Sensitivity and specificity were 54.2% and 80.0% at El-Ganzouri risk index cut-off value of 2 points. Calculated positive predictive value was 26.7% and negative predictive value was 92.9%. Calculated AUC was 78.3%.<bold>Conclusions.</bold> El-Ganzouri risk index shows moderate sensitivity and specificity when used with Storz C-MAC videolaryngoscope. It can be used to predict difficult laryngeal visualization during videolaryngoscopic intubation.</abstract>

Hospital of Traumatology and Orthopaedics, Department of Anaesthesiology and Intensive care

Prediction of Difficult Tracheal Videolaryngoscopic Intubation Using El-Ganzouri Risk Index

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Although severe root resorption is rare, it is a side effect of orthodontic treatment which affects tooth prognosis. Patients with severe dentofacial deformity, for whom orthodontic treatment and orthognathic surgery was done at the age of 18 and later, had long duration orthodontic treatment and orthognathic surgery, and are at a high risk of root resorption. The impact of orthognathic surgery on root resorption has not been sufficiently studied, and therefore is an interesting topic to research.<bold>Aim of the Study.</bold> To identify the risk factors for apical root resorption of maxillary incisors and canines as a result of orthodontic and surgical treatment of Class III malocclusion involving LeFort I osteotomy.<bold>Material and methods.</bold> The root lengths of upper incisors and canines were measured on cone beam computer tomography (CBCT) scans obtained from a database of orthognathic surgery patients. As a criteria for root resorption was chosen the difference in root lengths between different time points. The measurements were performed using the scans taken before orthodontic treatment (T1), before surgery (T2), and after post surgery orthodontic treatment (T3), of 28 subjects, aged 20.5 ± 3.81 years, with the mean presurgery treatment time of 19.9 ± 8.8 months, and post-surgery time of 7.1 ± 3.1 months. Changes in root lengths during different time spans were correlated with treatment duration, the initial crown/root ratio, and the severity of dentofacial deformity (Wits appraisal, ANB angle, and overjet).<bold>Results.</bold> During T1 - T2 the roots of the lateral incisors shortened by a maximum of 0.78 ± 0.83 mm (p &lt; 0.001), at a rate of 0.04 mm per month. During T2 - T3 the lengths of the central incisor roots decreased most by 0.49 ± 0.52 (p &lt; 0.001) at a rate of 0.07 mm per month. The resorption speed for canines increased from 0.03 mm to 0.1 mm per month before and after surgery. There were statistically significant correlations between the crown-root ratio and the incisor root length (r = 0.319 for lateral and r = 303 for central, both p&lt;0,05) and for canines (r = 482, p&lt;0.01). The associations between the shortened root length, in different time spans for different teeth, and the severity of malocclusion were inconsistent.<bold>Conclusions.</bold> Overall, the shortened root length during combined orthodontic and surgical treatment might not be clinically significant. After surgery, the rate of root resorption (mm per month) increased, especially for canines. The teeth with initially shorter roots showed more resorption during treatment.</abstract>

Apical Resorption of Upper Incisors and Canines During Orthodontic Treatment in Class III Orthognathic Surgery Patients – a Longitudinal Cone Beam Computer Tomography Study

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Uterine rupture is a tearing of uterine wall during pregnancy or delivery. There are two types of uterine rupture described in literature: symptomatic (SUR) and asymptomatic (AUR) uterine rupture. In case of SUR there is a full thickness uterine wall tear which leads to clinical symptoms and high perinatal and maternal morbidity and mortality. In case of AUR the visceral peritoneum remains intact and it is typically diagnosed during Cesarean section. Rupture of previously intact uterus is very rare and is associated with extensive uterine damage, severe hemorrhage and in most cases leads to hysterectomy. Fetal complications include admission to neonatal intensive care unit, hypoxic - ischemic injury and death. Maternal complications include hemorrhage, hypovolemic shock, bladder injury, hysterectomy and maternal death. The incidence and prevalence of uterine rupture as well as the perinatal and maternal rate of complications in Latvia is unknown.<bold>Aim of the Study.</bold> Aim of the study is to analyze clinical cases of SUR and AUR, calculate the incidence and prevalence and detect the risk factors (RFs) and diagnostic difficulties of clinical cases which occurred in Riga Maternity Hospital from year 2010 to 2017.<bold>Material and methods.</bold> A case series study of 41 uterine ruptures which occurred in Riga Maternity Hospital from the 1st of January 2010 until the 31st of December 2016 was performed. An average birth rate for this time period was 6554 live births per year.<bold>Results.</bold> Over the time period 41 women with uterine rupture were diagnosed in Riga Maternity Hospital. AUR was diagnosed in 33 patients during Cesarean section. SUR occurred in seven patients, but in total there were eight cases of SUR, because one of the patients had a uterine rupture twice. SUR incidence in Riga Maternity Hospital is 1.7 per 10000 deliveries (8 per 45875 deliveries) and the prevalence is 0.0175%. In three cases SUR was diagnosed after labor and in five cases - during emergency laparotomy. SUR most frequently manifested with hypovolemic shock and/or acute abdomen. In two cases uterine defect was repaired and in six cases hysterectomy was performed. One patient had acute kidney injury and there was one case of maternal death. Nine babies were delivered and the Apgar score after the 1st minute was ≥ 7 in three cases and &lt; 7 in three cases, but after the 5th minute it was ≥ 7 in five cases and &lt;7 in one case. There were three intrauterine fetal demises. All the patients with either SUR or AUR had multiple RFs for uterine rupture.<bold>Conclusions.</bold> Uterine rupture is associated with multiple RFs. If trial of labor after Cesarean section is the preferred mode of delivery it is necessary to detect all of the RFs. Antenatal measurement of lower uterine segment thickness seems unreliable but further research should be carried out with statistical data analysis. For the safety of patients trial of vaginal delivery in patient with uterine scar should be performed in appropriately equipped and staffed medical facilities.</abstract>

Uterine Rupture – Clinical Analysis of a Case Series in Riga Maternity Hospital

AHEAD OF PRINT

Volume 18 (2020): Issue 1 (June 2020)

Volume 17 (2017): Issue 2 (December 2017)

Volume 17 (2017): Issue 1 (June 2017)

Volume 16 (2016): Issue 2 (December 2016)

Volume 15 (2015): Issue 1 (April 2015)

Volume 14 (2014): Issue 2 (December 2014)

Volume 14 (2014): Issue 1 (December 2014)

Volume 13 (2013): Issue 2 (December 2013)

Volume 13 (2013): Issue 1 (December 2013)

Volume 12 (2012): Issue 1 (December 2012)

Volume 10 (2010): Issue 2 (December 2010)

Volume 9 (2009): Issue 1 (December 2009)

Acta Chirurgica Latviensis

 Acta Chirurgica Latviensis is a journal of a broad spectrum published twice a year. The authors of manuscripts can publish original articles, problem-solving articles and case reports in various branches of surgery and fields associated with surgery. Since 2005 the journal has been published only in English (the articles in the previous volumes had abstracts in English). Acta Chirurgica Latviensis provides an opportunity to publish the results of investigation for both experts in the field and junior specialists. Latvian Academy of Sciences has included Acta Chirurgica Latviensis in the list of scientific publications as a scholarly journal under international review.  Why subscribe and read   Official journal of Riga Stradins University, Latvian Association of Surgeons, Latvian Association of Paediatric Surgeons.  Acta Chirurgica Latviensis is a source of high quality information about all fields of surgery and fields associated with surgery mostly from Latvia, Baltic countries, and eastern Europe.  Why submit   Fast, fair and constructive peer review  All articles are in English  Rejection Rate   45 %   Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 