<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Colorectal cancer is one of the most frequent malignant tumours worldwide. In Latvia, the incidence and mortality from colorectal cancer has increased over the past five years. Surgery is the mainstay of colorectal cancer treatment. However, the prognosis of an individual patient after the operation depends on many factors. Here, we report the prognostically important morphologic factors in potentially radically operated colorectal cancer patients in order to create the “morphologic prognostic portrait” - the basic morphologic characteristics of colorectal cancer in Latvian patients. Such data could be helpful in prognostic estimates.<bold>Aim of the study</bold> was to describe the local tumour spread by pT, to evaluate the occurrence of certain morphologic prognostic factors and to assess lymph node involvement in potentially radically operated colorectal cancer patients.<bold>Material and methods.</bold> In a retrospective study, 173 consecutive patients who underwent a potentially radical operation in a single university hospital within the year 2012 were identified by archive search. The pathology reports that have been created by protocol approach and diagnostic microscopy slides were reanalysed. Tumour morphology and pTN parameters were assessed according to the World Health Organization and the American Joint Committee on Cancer classifications.<bold>Results.</bold> The study included 98 women (56.6%) and 75 men (43.4%). The mean age of patients was 68.5 years [95% confidence interval: 66.9 – 70.1]. Only 4.6% [2.4 – 8.9] of patients were younger than 50 years. The most frequent histological tumour types were colorectal adenocarcinoma in 86.7% [80.8 – 90.9] patients and mucinous carcinoma in 9.2% [5.7 – 14.5] of patients. Evaluating the pT parameter, pT3 was found in 43.2% [36.1 – 50.6] and pT4 in 39.8% [32.8 – 47.2] of cases. Lymphatic invasion was found in 35.1% [25.3 – 46.2] of pT3 and 75.4% [64.0 – 84.0] of pT4 cases; p &lt; 0.001. Perineural cancer invasion in pT3 and pT4 tumours was found in 29.9% [20.8 – 40.9] and 69.6% [57.9 – 79.2], respectively; p &lt; 0.001.<bold>Conclusions.</bold> Colorectal cancer affects both genders with equal frequency. The tumour is mostly diagnosed after the age of 60 years. Adenocarcinoma is the predominant colorectal cancer type in radically operated patients. Perineural and lymphatic invasion in pT4 tumours is statistically significantly more frequent than in less advanced tumours and thus may be pathogenetically linked to wide local tumour spread.</abstract>

Department of Pathology, Riga Stradins University, Latvia

Department of Surgery, Riga Stradins University, Latvia

Frequency of Morphologic Prognostic Factors in Surgically Treated Colorectal Cancer

<abstract xmlns="http://www.w3.org/1999/xhtml"><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>

Heterogeneity of Ki-67 and p53 Expression in Glioblastoma

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Gastric cancer is a frequent malignant tumour worldwide along with lung, colorectal, and breast carcinoma. It is characterised by male predominance and peaks at the age of 70 – 75 years. Gastric carcinoma is also an important cause of oncological mortality. Among the limited treatment options of this tumour, radical surgical intervention is the mainstay and can occasionally result in extended survival. Nevertheless, the 5-year survival of gastric cancer patients nowadays is still low, approaching only 22%, therefore more exact prognostic assessment of the surgically treated patients must be elaborated. Tumour volume has been evaluated in other solid neoplasms. However, the application of this parameter in gastric cancer is still unclear.<bold>Aim of the study</bold> is to measure gastric cancer volume in the surgical material and to assess the results regarding pTN classification in order to develop basic estimates of tumour volume applicability.<bold>Material and methods.</bold> The research was designed as a retrospective study including 88 consecutive potentially radically surgically treated gastric cancer cases. The tumour volume was calculated using the three-dimensional ellipsoid formula. The cases were divided into 5 classes by the obtained volume and characterised by pTN classification and grade. Descriptive statistical analysis was performed. To detect statistically significant differences, the 95% confidence interval was calculated by CIA software and the findings were further confirmed by the χ2 test. Any difference was considered significant, if p value was less than 0.05.<bold>Results.</bold> The largest number of cases presented with the smallest tumour volume not exceeding 5 cm3, namely, 24 cases or 27.3% [95% confidence interval = 19.1 – 38.3]. The pT1 and pT2 carcinomas significantly more frequently were smaller than 5 cm3: 56.5% [36.8 – 74.4] in contrast with 15.4 % [8.6 – 26.1] among pT3 – pT4. There was also notable association between the tumour volume and presence of regional metastases (p &lt; 0.001) as all pN0 tumours invariably were smaller than 10 cm3.<bold>Conclusions.</bold> Smaller tumour volume was statistically significantly associated with a less extensive local spread by pT. The pN0 finding was limited to smaller carcinomas not exceeding the volume of 10 cm3. The association between the tumour volume and pTN parameters indirectly indicates the prognostic value.</abstract>

Department of Surgery, R?ga Stradins University, Latvia

Tumour Volume Assessment in Gastric Cancer

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Trauma is a leading cause of death, particularly among young patients. Spleen is the most commonly damaged organ in blunt abdominal trauma and liver injury is the main cause of death.<bold>Aim of the study.</bold> Review of the literature and recent clinical experience in the management of blunt liver injuries in the Riga East clinical university hospital.<bold>Materials and methods.</bold> Three-year experience in the management of liver traumatic rupture was retrospectively and prospectively analysed. The study included 64 patients over 15 years of age with blunt hepatic injuries. Exclusion criteria were patients with life-incompatible haemorrhagic shock. The Statistical analysis of the data was performed by median and mean of the Microsoft Excel 2010 and SPSS 22 version.<bold>Results.</bold> A total of 64 patients were treated in our institution during the period from November 2010 till November 2013. Isolated liver injuries were diagnosed in 49 cases, combined liver and spleen injuries in 15 cases. Most commonly mechanism ofinjury were road traffic accidents, falls and low energy blunt traumas (criminal beaten, sports injuries);19 patients underwent laparotomy for haemostasis while nonoperative management was used in 45 patients. Haemodynamic stability of the patient and CT confirmed liver injury were the main criteria for nonoperative management. One patient died atthe time of laparotomy from injuries not compatible with life – severe head injury with basal skull fracture, aortic arc rupture, flail chest and liver and spleen injury.<bold>Conclusions.</bold> Conservative management of liver trauma is justified in haemodynamically(HD) stable patients after thorough risk assessment and computed tomography (CT) based injury grading in centres with sufficient expertise and medical resources.</abstract>

Riga East Clinical University hospital Gailezers, General and Emergency Surgery Departament, Latvia

Start of Polytrauma Management in University Hospital: First Experience with Liver Trauma

<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Introduction.</bold> Many medical and conservative surgical treatment options are available but still hysterectomy remains the most common gynecological procedure performed worldwide. These procedures are performed because of actual and possible malignant diseases, and benign conditions including pelvic pain, dyspareunia, uterine myomas, adenomyosis, endometriosis, and menometrorrhagia. The impact of hysterectomy on sexual function has always been a great concern to women and is a major source of preoperative anxiety. Data regarding the impact of hysterectomy on women's sexual functioning are not clear and consistent, many women report improvement of sexual functioning after hysterectomy, which may be due to relief of symptoms, while others complain of sexual dysfunction as a result of hysterectomy. Also discussion about advantages of cervix sparing operations is still controversial.<bold>Aim of the study.</bold> Aim was to assess and compare pre- and post-operative quality of sexual life of gynecological patients undergoing planned hysterectomy, and to find out opinions of patients and their partners about expected impact of operation and changes after surgery.<bold>Material and methods.</bold> Questionnaire method was used to survey gynecologic patients undergoing planned subtotal / total hysterectomy due to benign indication. Sexual Quality of Life Questionnaire – Female (SQoL-F) was used to assess quality of sexual life before and after surgery. Questions about other influencing factors and patients' opinions before and after operation were added. 38 completed questionnaires were used for data analysis.<bold>Results.</bold> Only 55% of subtotal hysterectomy group and 38.9% of total hysterectomy group told their partners completely about planned surgery. Mean period of beginning sexual activities after operation was 5.15 weeks after surgery in subtotal hysterectomy and 5.78 weeks in total hysterectomy group. SQoL-F after three months post-operation period was 6.50 points less in total hysterectomy group, which was not statistically significant. There was a slight statistically insignificant decrease of SQoL-F points within each group after three months observation period: -0.44 points in subtotal hysterectomy group and -2.47 points in total hysterectomy group. Although patients of total hysterectomy more frequently (22.2% vs. 5%) indicated negative impact on sexual function after operation, differences were not statistically significant. There were no differences in co-morbidities, concomitant medications, hormone use history and post-operative complications between groups.<bold>Conclusions.</bold> Patients before hysterectomy are worried about possible negative impact of surgery on their sexual function, they do not talk to their partners candidly about planned surgery. There were no statistically significant changes of sexual quality of life found after subtotal and total abdominal hysterectomy operation after three months observation period.</abstract>

Riga East Clinical University Hospital ‘Gailezers’, Gynecology Clinic, Latvia

Riga Stradins University, Department of Obstetrics and Gynecology, Latvia

Riga Stradins University, Department and Clinic of Psychosomatic Medicine and Psychotherapy, Latvia

Riga Stradins University, Division of Doctoral Studies, Latvia

Quality of Female Sexual Function After Conventional Abdominal Hysterectomy - Three Month' Observation

<abstract xmlns="http://www.w3.org/1999/xhtml">Metastatic tumours in the brain occur more frequently than primary neoplasms. Despite the generally dismal prognosis, neurosurgical resection is indicated in certain patients and can yield prolonged survival. Here we describe an 82-year-old male with a history of neurosurgical resection of a single brain metastasis 6 years ago. Tumour immunophenotype disclosed lung adenocarcinoma with low proliferation fraction. However, the primary tumour remained occult then. At present, 3 new brain metastases were identified by computed tomography. Repeated resection was performed in 2 stages, resulting in removal of 2 metastases. Lung mass was now evident as well. The final diagnosis was lung adenocarcinoma with metachronous brain metastases, stage IV. In conclusion, prolonged survival, in this case 6 years, can be reached even in patients with metastatic cancer by successful selective application of neurosurgical treatment. The biological properties of the tumour including low proliferation also contributed to longer survival and demonstrated surgery as a successful treatment option.</abstract>

Pauls Stradins Clinical University Hospital, Latvia

Prolonged Survival After Neurosurgical Resection of Lung Cancer Metastasis

<abstract xmlns="http://www.w3.org/1999/xhtml"><italic>CDH1</italic> is currently the only gene in which mutations are known to cause hereditary diffuse gastric cancer (HDGC). Hereditary diffuse gastric cancer is defined as a syndrome of inherited predisposition to cancer with autosomal dominant inheritance pattern. Specific criteria are used to identify patients with suspected HDGC and who should be investigated for <italic>CDH1</italic> germline mutations. Accurate screening is mandatory for unaffected carriers of<italic>CDH1</italic> mutations and selected high-risk individuals could be considered for prophylactic gastrectomy.</abstract>

Pauls Stradins Clinical University Hospital, Riga, Latvia

Institute of Oncology, Riga Stradins University, Latvia

<italic>CDH1</italic> Mutation in Two Patients with Hereditary Gastric Cancer

<abstract xmlns="http://www.w3.org/1999/xhtml">Endometriosis is characterised by the presence of ectopic functional endometrial tissue outside the uterus. The disease most frequently affects pelvic tissues and organs but any site can be involved including gastrointestinal tract, lungs and other organs. Extra-pelvic endometriosis mostly occurs in females aged 35–40 years. Here we report a well-documented, morphologically proved and surgically treated case of pulmonary endometriosis in a 50-year-old woman in order to heighten the awareness of endometriosis as the differential diagnosis for nodular lung lesions.</abstract>

Pulmonary Endometriosis - a Rare Differential Diagnosis of Lung Cancer

<abstract xmlns="http://www.w3.org/1999/xhtml">According to current conventional practice 80% to 90% of hepatic injuries can be safely managed without operation. (2) Previously conservative management of the hepatic injuries were recommended for hemodynamically stable patients who did not require blood transfusion and number of trauma centres strongly recommended conservative strategy in alert patient who are able to cooperate with physical examination. However recent experience shows that the key factor in determining whether non-operative management (NOM) can be safely used is hemodynamic stability (HD) of the patient.(5)</abstract>

Riga East Clinical University hospital Gailezers, Departament of Radiology, Latvia

Nonoperative Management of Grade IV Liver Injury for Elderly Patient

<abstract xmlns="http://www.w3.org/1999/xhtml">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

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. 