<abstract xml:lang="en"><title style='display:none'>Diagnosis and Management of Blunt Pancreatic Trauma in Children</title>There are still diagnostics problems and variety of opinions about tactics in the treatment of blunt pancreatic injurys. The methods of surgery treatments are more and more replacing the methods of endoscopy and conservative therapy. There is a remarkable diference in the tactic of treatment between adults and children because of the anatomical physiological reasons. Delayed diagnosis of this wounding is connected with heightened morbidity and mortality. Handlebars injury is the most frequent mechanism of the trauma. The most determinant role in the diagnostics has active examination tactic and arsenal of visual diagnostics methods. Therapy approach must be individualized depending from the hemodynamic status, seriosity of injury, existence of associated injuries and the experience in the institution. After traumatic pseudocysts can be successfully drained in US control or endoscopic to stomach. Children with such injuries must be concentrated if possible in the specialized centers.</abstract>

Riga Stradins University, University Children's Hospital, Riga, Latvia

Diagnosis and Management of Blunt Pancreatic Trauma in Children

<abstract xml:lang="en"><title style='display:none'>Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management</title>Postoperative bleeding is a concern for all patients undergoing cardiac surgery. In patients exposed to cardiopulmonary bypass, bleeding following surgery is excessive in up to twelve percent of patients in whom subsequent re-exploration is required. Several studies have evaluated main reasons, prevention of excessive postoperative bleeding and impact of patients outcomes. This article contains a literature review on excessive bleeding and re-exploration following cardiac surgery, main surgical and medical sources, prevention and management of bleeding.</abstract>

Department of Anesthesiology and Cardiothoracic Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia

Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management

<abstract><title style='display:none'>Abstract</title> Introduction. Neonatal anthropometric measurements, including body weight, length, head circumference and abdominal circumference are routine procedures in obstetric and neonatal departments. Standard values for neonatal population are established for body weight, length, head and thoracic circumference, however there are no reference values for neonatal abdominal circumference, futhermore, this measurement currently is not a routine procedure in every obstetric and neonatal unit. In order to evaluate the increase of abdominal circumference in newborns with a disease of organs of abdominal cavity including necrotizing enterocolitis (NEC), the abdominal girth of newborns soon after birth without pathology in the abdominal cavity should be ascertained. Thereby, the average value of the abdominal circumference of newborns in Latvia could be obtained. Aim of the Study. The aim of our study is to measure the abdominal circumference in premature and term-born neonates soon after birth and to define the correlation between abdominal circuit and birth weight. Materials and Methods. The measurement of waist girth was carried out in 460 neonates within 30 minutes after birth. Newborns were divided into 4 groups according to birth weight: extremely low birth weight (ELBW) - under 1000 g, very low birth weight (VLBW) - 1001 g - 1500 g, low birth weight (LBW) - 1501 g - 2500 g and term neonates with 2501 g - 4590 g birth weight. The abdominal circumference was measured in 2 obstetric units in accordance with the previously established measurement methods. Results. There was no statistical difference between abdominal circumference in boys and girls in ELBW, VLBW and LBW groups (p&gt;0.05). Mean abdominal circumference in ELBW group was 18,70 cm (SD=0,84) in boys and 18,67 cm (SD=1,40) in girls, VLBW group was 22,20 cm (SD=1,42) and 21,94 cm (SD=1,29) in boys and girls, respectively. Mean abdominal circumference in LBW group was 24.47 cm (SD=2.36) in boys, and 24.92 cm (SD=2.23) in girls. Independent Samples Test: Mean abdominal circumference was statistically different in boys and girls in 2500g -4590g birth weight group with median value 30.56 cm in boys, and 33.23 cm in girls (p&lt;0,05). Mean value in girls was 3.33 cm higher than in boys. Dependent Variable linear regression: Specific formula for estimation of normal abdominal circumference was developed as a result of this study: y=0.0044x+16.38 (y - abdominal circumference, cm; x - body weight, grams; 0.0044 - regression coefficient; 16.38 - regression constant). Conclusions. The difference of mean abdominal circumference was not statistically significant in boys and girls in ELBW, VLBW and LBW groups, however, the difference was significant in the term-born neonates group. As a result of this study reference values and specific formula were established, which allows determination of normal abdominal circumference in neonates depending on birth weight.</abstract>

Children`s Clinical University Hospital, Riga, Latvia

Pauls Stradins Clinical University Hospital, Riga

Children`s Clinical University Hospital, Riga, Latvia / Riga Stradins University, Department of paediatric Surgery, Riga, Latvia

Children`s Clinical University Hospital, Riga, Latvia/ Riga Stradins University, Department of paediatric Surgery, Riga, Latvia

Neonatal Anthropometry: Measurement of the Abdominal Circumference in Newborns

<abstract><title style='display:none'>Summary</title>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 short segment disease, long segment disease and total colonic aganglionosis. Calretinin showed the highest reactivity to ganglion cells and proved to be the most specific and sensitive marker for diagnosis of Hirschsprung’s disease and allied disorders. Synaptophysin showed strong staining of myenteric plexuses and can be used for assessment of extrinsic nerve fibres despite its low reactivity to ganglion cells.</abstract>

Children’s Clinical University Hospital, Riga, Latvia

Immunohistochemical Diagnosis of Hirschsprung’s Disease and Allied Disorders

<abstract><title style='display:none'>Summary</title>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.</abstract>

Large Incidental Gastrointestinal Stromal Tumor of the Stomach

<abstract xml:lang="en"><title style='display:none'>Current Aspects of Epidemiology, Pathogenesis and Treatment in Diabetic Macular Edema</title>This problem-solving article reviews the current knowledge on the epidemiology, physiology and treatment principles of Diabetic Macular Edema (DME), a common diabetic complication and leading cause of blindness in working-age individuals. Although some risk factors for DME have been determined, the exact pathogenesis is still unknown. Proven effective and satisfactory therapy is currently not available. Clinical understanding and the major treatments for DME have not changed for several decades. Scientific progress in recent years outlines some new promising therapeutical strategies for treating DME. In addition new non-invasive high resolution imaging methods of the retina provides much deeper information about morphological findings in DME. New treatment and diagnostic options could be beneficial to detect DME in early stages, prevent its progression and to start the most effective treatment at earlier stages.</abstract>

Current Aspects of Epidemiology, Pathogenesis and Treatment in Diabetic Macular Edema

<abstract><title style='display:none'>Summary</title>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.</abstract>

Surgical Approach in Congenital Long QT Interval Syndrome Patients

<abstract><title style='display:none'>Summary</title>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.</abstract>

A Case Report of Extracorporeal Membrane Oxygenation and Hemadsorber Therapy in Septic Patient with Multiorgan Injury

<abstract><title style='display:none'>Summary</title><sec><title style='display:none'>Introduction</title>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.</sec><sec><title style='display:none'>Aim of the study</title>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).</sec><sec><title style='display:none'>Materials and methods</title>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.</sec><sec><title style='display:none'>Results</title>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.</sec><sec><title style='display:none'>Conclusions</title>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.</sec></abstract>

Neoadjuvant Chemoradiotherapy in the Downstaging of Locally Advanced Rectal Cancer and its Impact on Progression–Free Survival

<abstract><title style='display:none'>Summary</title>Acute gastric dilatation is a rare and life threatening disease. The usual symptoms of acute gastric dilatation can vary and be nonspecific, including acute abdominal pain, abdominal distension, nausea and vomiting. Many aetiologies of acute gastric dilatation are described. This article presents a case of a 13 year old girl who presented in our clinic with acute gastric dilatation after an orthopaedic operation. Clinical signs and a diagnostic pathway are presented in the report. In the early treatment of acute gastric dilatation, nasogastric tube insertion was used for gastric decompression. As a surgical approach jejunostomy insertion was used to ensure enteral feeding. Our case study shows that the optimal treatment for this pathology is mainly conservative.</abstract>

Acute Gastric Dilatation in a 13 Year Old Child. A Case Report

<abstract><title style='display:none'>Summary</title><sec><title style='display:none'>Introduction</title>Diabetic retinopathy (DR) is a severe complication that can lead to complete vision loss and still is one of the main blindness-causing reasons among patients with type 1 diabetes mellitus (T1DM). DR as a complication can cause vision loss to people at their working age. More than 90% of patients with type 1 diabetes will develop DR by 20 years post diagnosis <italic>(Leslie R. Dye, 2018).</italic> DR is more likely to develop in patients with T1DM <italic>(Kanski's Clinical Ophthalmology, 2016).</italic> This complication can be very serious speaking of the ability to see. Sometimes vitrectomy plays a vital role in the management of severe complications of DR at its end-stage <italic>(Myron Yanoff et al., 2020).</italic></sec><sec><title style='display:none'>Aim of the study</title>To prove the development severity of DR that depends on the duration of diabetes and metabolic compensation. Additionally, to determine retinopathy's association with other micro and macrovascular diabetes mellitus complications for a better understanding of what are the contributory factors for these complications to develop and which of those may coexist.</sec><sec><title style='display:none'>Materials and Methods</title>A retrospective study was held at the Pauls Stradins Clinical University Hospital (Riga, Latvia). From January 2016 to March 2018, 79 (158 eyes) patient histories were analyzed who have type 1 diabetes mellitus. To obtain more precise research results, almost all patients have done check-up visits to one certain ophthalmologist. The IBM SPSS Statistics version 25.0 was used to process data. Tables were made in SPSS and Microsoft Excel 2016 programs. Statistically significant value (p) was set at &lt; 0,05.</sec><sec><title style='display:none'>Results</title>No statistically significant difference is seen in the mean duration of the disease: in the group of proliferative diabetic retinopathy (PDR): 25.23 (median = 22.0) years and non-proliferative group: 24.68 (median = 23.50) years. Results show that the duration of diabetes mellitus is considerably smaller in a group without DR 11.24 (median = 8.50) years. Metabolic compensation (%) in diabetes mellitus is not statistically different between patients with diverse forms of DR; no association found either. No statistically significant difference in best corrected visual acuity (BCVA) was detected among patients with various forms of DR. Three groups were compared: both types of DR and no DR. It was detected that BCVA in patients without DR was higher in both eyes: 0.83 ± 0.27 dioptres. No statistically significant difference (pχ &gt; 0.05) was detected between the groups of DR and therefore no association was made between the form/existence of DR and arterial hypertension. There is a strong association between DR and microvascular complications (V = 0.40) with the existence of DR and there is an even stronger association (V = 0.61) with the forms of DR. There is no statistically reliable difference (pχ &gt; 0.05) between the groups of DR; therefore, no association with the existence of microvascular complications and also risk factors.</sec><sec><title style='display:none'>Conclusions</title>More than two-thirds of patients included in the research have some signs of DR. Because of the strong association of DR and other microvascular complications, patients with diabetes should be screened regularly for retinopathy, nephropathy, and neuropathy. And likewise, if a patient has at least one microvascular complication, he or she should be tested for the rest possible complications as well. According to data, most of the patients in this study have poor metabolic compensation; consequently, the metabolic compensation screening should be done certainly every three months.</sec></abstract>

Diabetic Retinopathy. Association with Metabolic Compensation, Duration of Diabetes and Other Micro and Macrovascular Complications in Patients with Type 1 Diabetes Mellitus

<abstract><title style='display:none'>Summary</title>Osteoporosis and other pathological bone conditions can impair bone regeneration properties, consuming in increased morbidity and decreased quality of life. Changes of bone healing can result in poor osteointegration and surgical failures if implants are used. To overcome and facilitate bone regeneration, more attempts are made to develop an ideal synthetic scaffold with better biocompatibility, osteoconductivity, bioactivity, osteoinductivity and interconnected porosity. It is considered that strontium, being similar to calcium, can be incorporated into the mineral phase of the bone remodeling. This quality had led strontium to be used as an osteoporotic medication to improve quality of bone and to reduce the risk of bone fractures. Also local application of strontium has been widely used within different biomaterials in tissue engineering researches.In this review authors wanted to provide an overview about strontium, its mechanisms of action in bone tissue and initiated changes of bone remodeling within biomaterials.</abstract>

Does Local Application of Strontium Increase Osteogenesis and Biomaterial Osteointegration in Osteoporotic and Other Bone Tissue Conditions: Review of Literature

<abstract><title style='display:none'>Summary</title>Acute appendicitis is one of the most common surgical diseases during pregnancy. In rare cases, ectopic decidual tissues (deciduosis) can develop in the appendix and cause inflammation. Here we report a well-documented case of appendicular deciduosis presenting with acute abdominal pain and resulting in gangrenous appendicitis.</abstract>

Deciduosis of the Appendix Manifesting as Acute Abdomen in Pregnancy

<abstract xml:lang="en"><title style='display:none'>Apolipoprotein A1 and Transferrin as Biomarkers in Ovarian Cancer Diagnostics</title>Introduction. Advanced technologies such as matrix assisted laser desorption/ionization and surface enhanced laser desorption/ionization mass spectrometry has introduced promising insights into ovarian cancer detection. Several highly sensitive and specific protein peaks have been identified that discriminates ovarian cancer patients from patients with benign ovarian tumors and controls. Aim of the Study. Objective of this study is to evaluate diagnostic accuracy each individual marker and combined serum biomarker assay consisting of apolipoprotein A1, transferrin and Ca125. Materials and methods. A case-control study consisted of 99 women - 37 patients with ovarian cancer, 31 patients with benign ovarian diseases, and 31 age-matched healthy controls. Apolipoprotein A1 and transferrin was measured in sera using immunological turbidimetric assay. Tumor marker CA125 was analyzed by standard enzyme-labeled chemiluminescent immunometric assay. To compare the difference between variables in the study groups, ANOVA test was performed and for correlation Pearson's correlation analysis applied. Sensitivity and specificity of the diagnostic tests was calculated using statistical program Vassarstat. Results. Serum apolipoprotein A1 and transferrin were down regulated, controversially to Ca125, which was up regulated among ovarian cancer patients. Negative correlation between transferrin and Ca 125 (p&lt;0.00), apolipoprotein A1 and Ca 125 (p&lt;0.00) and positive correlation between transferrin and apolipoprotein A1 (p&lt;0.00) was observed. For single biomarker test highest diagnostic sensitivity and specificity for Ca125 was observed. Addition of apolipoprotein A1 or transferrin to serum level of Ca125 with the condition, that both have to overlap the threshold (Ca125 &gt; 21U/ml and apolipoprotein A1 ≤ 139.1 mg/dl or transferrin ≤ 2.3 g/l), yielded test specificity of 96.7%. Addition of apolipoprotein A1 to Ca125 improved test sensitivity up to 94.5% maintaining high sensitivity at the same time 91.1%, respectively, when discriminating controls from ovarian cancer patients. Biomarker test consisting of apolipoprotein A1, transferrin and Ca125 had high specificity at unacceptable sensitivity. Conclusions. Combined biomarker tests discovered using advanced technologies can aid more accurate ovarian cancer detection. Use of apolipoprotein A1 in combination with Ca125 at distinct thresholds can improve ovarian cancer detection.</abstract>

Latvian Oncology Center, Riga Eastern Clinical University Hospital, Riga, Latvia

A. Kirhensteins Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia

Apolipoprotein A1 and Transferrin as Biomarkers in Ovarian Cancer Diagnostics

<abstract xml:lang="en"><title style='display:none'>Internal Fracture Fixation using the Anterior Retroperitoneal Lower Laparotomy Approach in Pelvic Ring and Acetabular Fractures: the First Experience and Outcomes</title>Introduction. The ilioinguinal approach is well established for the treatment of pelvic fractures. As an alternative, the anterior retroperitoneal lower laparatomy (modified Stoppa) approach can be used to expose pelvic and acetabular fractures. We describe our experience with this approach in polytrauma patients with pelvic ring and acetabular fractures. Aim of the Study. The aim of study was to evaluate possibilities and impossibilities of internal fixation of pelvic ring and acetabular fractures using the anterior retroperitoneal lower laparatomy approach. Materials and methods. This retrospective study describes a series of 20 consecutive patients where a modified Stoppa approach was used for pelvic or acetabular fracture fixation. Results. 10 patients with acetabular fractures, six patients with a pelvic ring injury not involving the acetabular joint and 4 patients with a combined fracture were operated through a modified Stoppa approach. Anatomic or satisfactory reduction was achieved in 92% of the acetabular fractures. Pelvic ring fractures had an anatomic (displacement &lt;1 cm) postoperative result in 100%. Conclusions. using this approach may have good the postoperative radiological un surgical results. This is a method of choice for patients with combined trauma with internal organ damage and patients with both side pelvic bone fracture.</abstract>

Clinics "Gailezers", Riga Eastern Clinical University Hospital

Internal Fracture Fixation using the Anterior Retroperitoneal Lower Laparotomy Approach in Pelvic Ring and Acetabular Fractures: the First Experience and Outcomes

<abstract><title style='display:none'>Summary</title><bold>Introduction.</bold> Heterogeneity is a characteristic feature of malignant tumours. It challenges the treatment regimens as well as can impair the diagnostic accuracy. Glioblastoma multiforme (GBM), a high-grade malignant glial tumour, is known for the extreme morphological heterogeneity giving rise also to the term itself.<bold>Aim of the study</bold> was to evaluate heterogeneity of pathogenetically and diagnostically important cardinal tumour features, namely, cellular proliferation and tumour suppressor protein expression in GBMs.<bold>Material and methods.</bold> The study group comprised 101 GBMs, retrospectively identified by archive search. The inclusion criteria comprised validated diagnosis (by World Health Organisation criteria) and lack of prior treatment. Recurrent GBMs as well as other glial and non-glial tumours were excluded from the study. Insufficient tissue materials comprising stereotactic biopsies and tissues affected by widespread necrosis (exceeding 90%) were also excluded. Proliferation activity (by Ki-67) and expression of aberrant p53 protein was detected by immunohistochemical investigation (IHC) of formalin-fixed, paraplast-embedded tumour samples. Polymeric visualisation system was used to detect bound primary antibodies. The expression of each antigen was measured by computed morphometry in at least 200 cells of hot and cold spots in each tumour. The data were expressed as the relative value. Heterogeneity was estimated as the mathematical difference between the highest and lowest expression value in each tumour. Descriptive statistics was applied. The 95% confidence intervals (CI) were determined as well.<bold>Results.</bold> The highest proliferation activity ranged 15 – 95%; mean 43.9% [95% CI = 40.3 – 47.6]. The lowest proliferation activity ranged 2 – 95%, mean 20.1% [16.8 – 23.4]. The mean proliferation heterogeneity was 23.8% [21.5 – 26.2]; range 0 – 67%. The mean heterogeneity of p53 protein expression was 11.7% [8.9 – 14.6], ranging 0 – 75%.<bold>Conclusions.</bold> GBM is characterized by marked heterogeneity regarding proliferation rate and expression of p53 protein that may affect diagnostic accuracy and grading of gliomas in small samples of tissue material as well as survival in case of small residual tumour after surgical treatment.</abstract>

Department of Pathology, Riga Stradins University, Latvia

Department of Surgery, Riga Stradins University, Latvia

Heterogeneity of Ki-67 and p53 Expression in Glioblastoma

Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

 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...

 Acta Chirurgica Latviensis is a journal of a broad spectrum published twice a year. The authors of manuscripts can publish original...

Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

Tutti i volumi ed i numeri in questa rivista