rss_2.0Acta Chirurgica Latviensis FeedSciendo RSS Feed for Acta Chirurgica Latviensis Chirurgica Latviensis Feed of Postoperative Pain in Nursing<abstract xml:lang="en"><title style='display:none'>Assessment of Postoperative Pain in Nursing</title><p>Introduction. Postoperative pain is a typical form of acute pain and is connected with extensive traumatization of tissue and operation wound traumatic edema, which in its turn, becomes a source of permanent nociceptive impulses. Insufficiently controlled postoperative pain is a factor of risk for the development of various pathologies, postoperative complications, as well as chronic pain. Aim of the study. To study the usage of postoperative period pain intensity and quality assessment scales in the clinical practice of nursing, as well as availability of methods. Materials and methods. Inquiry utilized quantitative research method - questionnaire. The questionnaire embraced 263 patients and 309 nurses, working in surgical profile. Survey was carried out in surgical profile wards in Riga and regional clinics of Latvia. Results. Prevalent method, in our investigation of pain intensity evaluation, is patient's oral subjective and objective assessment of condition. Such method is mentioned by 87% (269/309) of respondents. A conventional and acknowledged method of pain objectivization - verbal descriptor pain intensity scale is applied by 22% (69/309) respondents, but visual analogue scale is utilized only by 5% (15/309) respondents. Assessment of postoperative pains as systematic and planed operation was marked by 41% (126/309) of surgical nurses. Conclusions. Prevailing method in the clinical practice of pain assessment is patient's subjective and objective evaluation of condition. However, this method is insufficiently recorded and objectivizated. Therefore, it is an actual problem in surgical patient care and shows necessity for standards and improvement of postoperative pain management.</p></abstract>ARTICLEtrue Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices<abstract xml:lang="en"><title style='display:none'>The Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices</title><p>Introduction. Health care-associated infections (HAIs) are a major threat to patient safety. The spread of HAIs cases in intensive care units (ICUs) and in surgical units is influenced by the severity of the patients' condition, as well as the number of invasive procedures and the environment of the units. The immune systems of critically ill patients are in a severe state which increases the probability of beneficial conditions for a colonisation by pathogenic microorganisms due to invasive procedures. Furthermore, the action of inserting an invasive device (urinary catheter, peripheral vein catheter) disrupts the natural defence mechanisms by itself. Aim of the study. To determine risk factors of HAIs during invasive procedures: peripheral vein catheter and urinary catheter insertion and care at the time. Materials and methods. The research was performed in the ICUs and in the surgical units of Latvia's regional multi-profile hospitals (n=3), using the quantitative research method: questionnaire (n=188), and qualitative research methods: clinically structured empiric research (n=45) and microbiological tests (n=86): a) with a Count-Tact applicator and a special culture medium, b) with a swab, and c) with catheter sedimentation method. Results. The study results showed that surgical nurses take care of 18 to 40 patients per day, while intensive care nurses take care of 2 to 3 patients per day. A common problem identified in ICUs and in surgical units related to the lack of unified nursing protocols on performing invasive procedures in all cases (100%; 45/45). Microbiological investigations showed a high level of bio-contamination during invasive procedures: the amount of microorganisms on the nurses' hands considerably exceeded the acceptable levels in all cases (100%; 4/4), and medium to high levels of bio-contamination were discovered on patient's changed bed sheets (100%; 2/2) as well as in nurses' hair (85.7%; 48/56) and their work wear (78.5%; 44/56). In 25% of the observed cases Staphylococcus aureus was discovered in the sterile zone of the peripheral vein catheter 72 hours and 96 hours after the catheter's insertion. 72 hours after the catheter's insertion, as well as 7 days after the insertion of a urinary catheter, 100% of the cases revealed the presence of at least one and in some cases several of the following pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli , β haemolytic Streptococcus and fungi, such as Candida albicans and Candida tropicalis. Conclusions. The main risk factors of HAIs in patients' care using invasive devices are: the lack of unified nursing protocols, aseptic and antiseptic mistakes and excessive workload, as well as a high level of bio-contamination in the ICUs and in surgical units.</p></abstract>ARTICLEtrue Bleeding After Cardiac Surgery in Adults: Reasons and Management<abstract xml:lang="en"><title style='display:none'>Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management</title><p>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.</p></abstract>ARTICLEtrue Associated Disease Clinical and Molecular Data<abstract xml:lang="en"><title style='display:none'><italic>Clostridium difficile</italic> Associated Disease Clinical and Molecular Data</title><p>Introduction. A balanced microflora of the gastrointestinal tract plays a significant role in the protection of an organism. Dramatic changes may take place in the composition of normal microflora during antibacterial therapy, because part of sensitive microorganisms die and microflora detrimental to an organism proliferates there causing gastrointestinal tract disorders (7). C. difficile is an important agent causing gastrointestinal tract disorders. It may induce manifestations ranging from asymptomatic colonization of the gastrointestinal tract to severe diarrhea, pseudomembranous colitis, toxic megacolon, intestinal perforation, and death. All these severity levels are included in the term Clostridium difficile associated disease (CDAD). A patient at risk for C. difficile is an elderly person with a severe principal disease, who receives long-term inpatient treatment, has been receiving antibiotics, antacid and antiulcer agents for a long time, has had a gastrointestinal surgical intervention or any organ transplantation, which is always related to immune suppression (11). Aim of the study. Molecular typing of Latvian strains of C. difficile and clinical data analysis. Materials and methods. The research includes data collected during the time period from August 2006 to the end of 2008 from three Latvian hospitals. A pure culture of C. difficile bacteria was isolated and cultured from fecal material. Ribotyping was done by amplification of specific regions of the 16S and 23S RNA genes and amplification products were separated in 1.5% agarose gel. Results. Fecal samples of 500 patients having manifestations of clinical symptoms of CDAD were microbiologically and molecularly studied from August 2006 to the end of 2008. 130 samples were tcdA + tcdB + toxin-positive. Conclusions. All samples were cultured on agar in anaerobic conditions. As a result, 55 pure cultures were obtained. The average age of patients is 65 years. Women get infected more frequently than men. In 95% patients CDAD was induced by antibacterial therapy. In 86% cases, having received a positive response for C.difficile antibacterial therapy is changed. Disease development risk factors are previous antibacterial therapy, previous hospitalization, GIT manipulations and C.difficile infection in anamnesis. The biggest number of CDAD patients was found in Nephrology Department of P. Stradins Clinical University Hospital. A hypervirulent Cl.difficile ribotype 027 was not found in Latvia yet, bat 16 different ribotypes were determined using Bionumerics software. 4 of them are domineering ribotypes with 17, 14, 5 and 4 isolates in every group.</p></abstract>ARTICLEtrue Cardiac Tumours in Infancy and Youth in the Small Population: a Seven Year Review<abstract xml:lang="en"><title style='display:none'>Primary Cardiac Tumours in Infancy and Youth in the Small Population: a Seven Year Review</title><p>Introduction. Primary tumours of the heart are rare in fetuses, neonates and children; the incidence varies from 0.003% - 0.08% (4, 6, 9, 10) up to 0.2% in children referred for cardiac examination (3, 15). Rhabdomyoma is the most common cardiac tumour during fetal life (60-75%). Teratoma is less common (14 to 19%) with fibroma, myxoma, hemangioma also being described (3, 4, 6, 10, 16, and 18). Multiple rhabdomyomas are associated with tuberous sclerosis in up to 90-95% of cases (3, 4, 5, 6, 10, 12, and 16). No previous study was done on this topic in Latvia so our aim was to determine the incidence, the course and the outcome of primary cardiac tumours in children in our small population. Aim of the study. The aim of our study was to determine the incidence of primary cardiac tumours in our paediatric population, to investigate the nature of the pathology, the course and the outcome of the disease in childhood in Latvia and to compare our results with data from the international literature. Materials and methods. We reviewed retrospectively the clinical, echocardiographic, operative, histological and follow-up data on 17 cases of a primary heart tumours detected within the period of January 1, 2000 till December 31, 2006 in the Clinic for Pediatric Cardiology and Cardiac Surgery of the University Children's Hospital in Riga, Latvia. Results. the incidence of primary heart tumours in the paediatric population in Latvia is 2.4+/-1.4 cases per year. 94% (16) of the primary cardiac tumours in children were benign and 6% (1) malignant. Radical excision performed in all 7 cases of surgical treatment. Rhabdomyomas comprise 47% (n=8) of all the benign tumours with tuberous sclerosis present in 88% of the cases. Conclusions. Most primary cardiac fetal tumours tend to appear in the third trimester of pregnancy, a normal early fetal scan might not rule out cardiac tumours. Relatively often (29% of the cases) the cardiac tumours were an incidental finding. The localization, number and visual appearance of the tumours in echocardiography was indicative of the type of tumour. 41% of the patients with primary cardiac tumours were in need of urgent surgical treatment. Almost all benign primary cardiac tumours were not the cause of death and with the exception of tuberous sclerosis there is good overall prognosis, in the case of malignant primary cardiac tumour the prognosis is poor.</p></abstract>ARTICLEtrue, Radiographic and Pathohistological Outcomes of Hydroxyapatite (HAp) Ceramics and Dental Implants in Atrophic Posterior Maxilla<abstract xml:lang="en"><title style='display:none'>Clinical, Radiographic and Pathohistological Outcomes of Hydroxyapatite (HAp) Ceramics and Dental Implants in Atrophic Posterior Maxilla</title><p>Introduction. Implant based prosthodontic rehabilitation of patients with atrophic edentulous posterior maxilla has necessity in reinforcement of alveolar bone using different bone substitutes. It is important to evaluate late outcomes in integration of synthetic HAp as biomaterial in chemical composition close to main natural bone mineral component in elevated maxillary sinus floor and osseointegration of dental implants. Aim of the study. To evaluate clinical and radiological outcomes of one stage maxillary sinus floor augmentation with synthetic HAp granules and dental implant insertion, mineralization degree of residual bone and augmented sinus part, morphological analysis of biopsies from HAp/host tissue hybrid and residual alveolar bone was performed. Materials and methods. One stage maxillary sinus floor elevation with synthetic HAp granules and 147 SEMADOS (BEGO) dental implant insertions in 70 patients were included in this study. Clinical and radiograph analyzes by dental X-rays, digital orthopantomogramms, quantitative radiodensitometry after 3 and 5 years was done. Trephine biopsies of residual alveolar bone and elevated part of maxillary sinus 6 months after implantation was done in 30 cases. Results. During this period 6 implants (4.2%) were lost. We found the decrease of radiodensity in HAp augmentated maxillary sinus area and increase of radiodensity in the area of residual alveolar bone. In biopsies after 6 months biomaterial/host tissue hybrid consisted of small bone trabecules, fibrous tissue and granules of irregular shape without inflammatory cells. Slow degradation of HAp granules by activity of osteoclast like macrophages was observed. Conclusions. Osseointegration was lost in 4.2% of inserted in augmented maxillary sinus implants. Radiodensitometry showed decrease of optical density in augmented sinus part and increase in residual alveolar bone. In biopsies of host tissue/biomaterial hybrid was bone newformation, connective tissue and biodegradation of HAp granules by osteoclast like cells.</p></abstract>ARTICLEtrue New Injury Severity Score: Availability in E valuation of Severity of Polytrauma Patients with Orthopaedic Injuries<abstract xml:lang="en"><title style='display:none'>The New Injury Severity Score: Availability in E valuation of Severity of Polytrauma Patients with Orthopaedic Injuries</title><p>Significant number of patients with multiple injuries are registered every year in Latvia. In 2009 during seven months 298 patients with multiple trauma are registered. In the most of the cases cause of multiple injuries are road accidents (Health Statistics and Medical Technologies State Agency, Latvia). Using of the simple modification of the Injury Severity Score (ISS) - the New Injury Severity Score (NISS) - makes possibility to better assess the patients with multiple injuries, particularly patients with orthopaedic injuries, predict resources for treatment, the outcome and functional results.</p></abstract>ARTICLEtrue Auditory Processing Disorders: Effects of Age and Hearing Loss to Electrophysiological and Behavioral Responses<abstract xml:lang="en"><title style='display:none'>Central Auditory Processing Disorders: Effects of Age and Hearing Loss to Electrophysiological and Behavioral Responses</title><p>Introduction. Central auditory processing involve normal sound perception, speech recognition, ability of cognition and memory. Accordingly speech recognition difficulties may manifest due to changes at any segment of auditory processing. Cortical auditory evoked potentials (CAEPs) and behavioral measures provide insight into the neural mechanisms underlying speech recognition. These disorders are observed both in young and elderly population. Aim of the study. To evaluate central auditory processing for subjects of different age and hearing level through the presentation of noise using CAEPs and behavioral measures of speech discrimination. However due to complicated connectivity in auditory pathway it is difficult to identify the central auditory processing damage. Behavioral tests in conjunction with electrophysiological examination will reveal more complicated information for differenciation between peripheral and central auditory processing disorders. Materials and methods. Three groups of subjects participated: young normal hearing, young hearing-impaired and elderly hearing-impaired subjects. To minimaze subject variables, the CAEPs (wave peaks P1, N1, P2, N2, P3, N3 in miliseconds) was investigated using passive listening paradigme. The CAEPs were elicited by 1,1s change in frequency 1000 Hz and 2000 Hz in pure tones presented at 65, 70 and 75 dB SPL. Sentence recognition tests in quite and noise, Digit Pairs (DP) and Word Pairs (WP) were developed in Latvian language prior to investigation. They were presented to all subjects. Results. The most prominent finding was the increased latency of P3, N3 in elderly and also in younger hearing impaired adults groups and highly differed within groups. More prolonged latencies were find of N1, P2 in elderly hearing impaired group than in younger hearing impaired group adults. Conclusions. During this investigation the CAEPs are performed for the first time in our clinic therefore the main standarts are determined for our laboratory. The speech recognition tests (Sentence recognition test, DD, DW) are developed in Latvian. The present findings suggest patterns of CAEP are variable within individuals however shows that auditory perception and cognitive function is not only a result of aging and must be associated with a general slowing of neuronal processing or decreased neuronal synchrony within the central auditory nervous system. Determination of central auditory processing capacity level is of crucial significance to prognose and evaluate the hearing result after hearing prosthetics and to appraise indications for hearing prosthetics, cochlear and middle ear implantation including.</p></abstract>ARTICLEtrue with Rosette-Forming Glioneural Tumour of the Fourth Ventricle: Case Study of a Rare Tumour<abstract xml:lang="en"><title style='display:none'>Teenager with Rosette-Forming Glioneural Tumour of the Fourth Ventricle: Case Study of a Rare Tumour</title><p>We report the case of uncommon rare tumour of the fourth ventricle in young person. This diagnosis is included to WHO classification only in 2007. Tumour was identified by the MR imaging, later on surgically removed with post-operative MRI control scan. Diagnosis-rosette-forming tumour of the fourth ventricle- was confirmed both morphologically and immunohistochemically.</p></abstract>ARTICLEtrue Pressure in Children After Cardiothoracic Surgery<abstract xml:lang="en"><title style='display:none'>Intraabdominal Pressure in Children After Cardiothoracic Surgery</title><p>Introduction. Intraabdominal pressure (IAP) now is widely recognized as an important variable and its monitoring is used in a variety of critically ill patients. Aim of the study. The aim of this study was to measure and to recognize the influence of various factors on IAP in children after surgical correction of congenital heart disease. Materials and methods. We conducted non-randomized, prospective observational study in Pediatric intensive care unitat a University Children's hospital. Study protocol was approved by Hospital Ethics commision. Measurements of IAP were performed in 15 children with mean body weight 8±5,83 kg, (Range 3,1-28 kg), mean age of 18,01 months (range 8 days-8 years) after cardiothoracic surgery. Cardiopulmonary bypass (CPB) was used in 12 patients. IAP was measured during first 24 hours postoperatively at 12 hour intervals via indwelling urinary catheter with bladder volumes of 1 ml/kg of normal saline. Of the 15 patients, 12 were mechanically ventilated at the time of the IAP measurements. Ventilation pressures: PIP (peak inspiratory pressure), MAP (mean airway pressure), PEEP (positive end expiratory pressure) and central venous pressure (CVP) via femoral vein were recorded. In some patients (6 from 15) amount of fluid evacuated via intraperitoneal drain from peritoneal cavity in first 24 hours was measured. Results. IAP was 12,24±3,54 mm Hg (Range 5,44-20,4 mm Hg), CVP 13±2,19, PIP 20±2,48 cm H2O, MAP 9±2,3 cm H2O, PEEP 5±1,35 cm H2O. Amount of fluid removed from peritoneal cavity during first 24 hours was 0,8±0,54 ml/kg/h (Range 0,04-1,7 ml/kg/h). Conclusions. We find elevated intraabdominal pressure (IAP&gt; 12 mm Hg) in 10 from 15 (66,67%) pediatric patients in the first 24 hours after cardiothoracic surgery. There was a difference in IAP in patients with abdominal paracenthesis versus patients without the drain. The difference between groups was not statistically significant (P=0,4). We did not find a correlation between IAP, MAP and CVP. We, however, did not observe development of abdominal compartment syndrome (ACS).</p></abstract>ARTICLEtrue Anaesthetics: What Can We Expect More than Pain Relief?<abstract xml:lang="en"><title style='display:none'>Local Anaesthetics: What Can We Expect More than Pain Relief?</title><p>This problem - solving article considers positive and negative non-analgesic actions of local anaesthetics, which may play a significant role in patient morbidity and mortality. Direct impact on inflammatory and immune substances and cells leads to antibacterial, anti-inflammatory, immunomodulating and systemic functions of numerous local anaesthetics. Local anaesthetics used perioperatively locally in continuous infusions or in systemic circulation reach and maintain safe and effective rates, but myotoxic and tissue growth inhibiting effect should be taken in account.</p></abstract>ARTICLEtrue Migration of Swedish Adjustible Gastric Band<abstract xml:lang="en"><title style='display:none'>Intragastric Migration of Swedish Adjustible Gastric Band</title><p>Swedish adjustable gastric banding (SAGB) is an operative procedure meant for the treatment of morbid obesity. It is characterised by application of low-pressure, high-volume device upon the stomach. One of the major complications, currently described in 6% of patients, is the intragastric migration of the adjustable gastric band. The removal of the band is the gold standard in these cases and must be performed either urgently or as a scheduled manipulation according to the symptoms. We present a thoroughly documented case of surgical obesity treatment by SAGB complicated by intragastric band migration as well as our experience in settling the complication.</p></abstract>ARTICLEtrue Endarterectomies in Latvia<abstract xml:lang="en"><title style='display:none'>Carotid Endarterectomies in Latvia</title><p>Introduction. Carotid endarterectomy (CEA) is a treatment of choice for significant carotid stenosis, and it has an important role in stroke prophylaxis, that is proved in many trials all over the world. Aim of the study. To evaluate preoperative diagnostic methods, risk factors and co-morbidities, operation results for patients undergoing CEA in Latvia. To analyze used anaesthasia and operation technique in CEA in Latvia. To reflect carotid endarterecomy results that depends from chosen operation technique. Materials and methods. 317 patients were included in the retrospective study from January 1st till December 31st, 2008. Patient charts were evaluated for information about history of disease and other comorbidities, preoperative investigation, operation and early postoperative period followed by protocol. All patients were divided into three groups depending on type of endarterectomy (CEA with primary suture, with patch or eversion CEA). Results. In 59% cases carotid disease were asymptomatic. Computer tomography angiography (CTA) and duplex ultrasound were the most common diagnostic methods to evaluate carotid stenosis. 339 carotid endarterectomies were performed, where CEA with primary suture was used in 56.2% of cases (group 1). There were no significant diferences in patient atherosclerotic risks factors, comorbidities, preoperative investigation methods, time of surgery and complications rate between the groups. Conclusions. In Latvia carotid endarterectomy is carried out mostly in classical conventional tecniques and arteriotomy is being closed with a primary suture.</p></abstract>ARTICLEtrue Long QT Syndrome in an Infant<abstract xml:lang="en"><title style='display:none'>Congenital Long QT Syndrome in an Infant</title><p>Long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by prolonged QT interval on ECG with prevalence close to 1/3000-1/5000. LQTS is characterized by the occurrence of syncopal episodes due to torsades de pointes ventricular tachycardia (VT) and by a high risk for sudden cardiac death among untreated patients (1, 2, 3). In 12% of patients with LQTS, sudden death is the first manifestation of the disease and only in 4% this happens in the first year of life (2). There is consensus that all symptomatic children with LQTS should be treated with β-blockers which are effective in preventing cardiac events and reducing mortality in 70%, but do not protect patients from sudden death completely (1,2,3,4). The prognosis is poor in untreated patients with annual mortality 20% and 10 year mortality up to 50% (1, 2). Here we present a case of relatively rare congenital heart rhythm disorders in an infant which required immediate treatment.</p></abstract>ARTICLEtrue Neoplastic Proliferations and Background Pathologies of Kidneys with Clear Cell Renal Carcinoma<abstract xml:lang="en"><title style='display:none'>Initial Neoplastic Proliferations and Background Pathologies of Kidneys with Clear Cell Renal Carcinoma</title><p>Introduction. Nephrosclerosis and development of renal tumours is desribed in literature. But there is a few dates about correlation between grades of nephrosclerosis and renal tumours. Aim of the study. Aim of our study is to find out and to analyze initial neoplastic proliferation around renal cell carcinoma in case of nephrosclerosis of different degrees. The hypothesis: the initial neoplastic proliferation in renal cell carcinoma is related to the degree of nephrosclerosis. Materials and methods. We investigated 206 surgical removed kidneys with clear cell renal carcinoma (RCCC) cases. To evaluate the correlation between grading of RCCC and its stages with nephrosclerosis we framed 5 macroscopic degrees of its severity. According the expression of nephrosclerosis we analyzed microscopically renal tissue to diagnose initial neoplastic proliferations. Results. In our research we have got weak positive correlation of R = 0.2 (p = 0.01) between nephrosclerosis and grading of renal clear cell carcinoma. Practically the same correlation exists between renal tumor TNM stage and nephrosclerosis degrees. In 62 cases from all 206 examined surgically removed kidneys microscopically and grossly we have diagnosed initial neoplastic proliferations. Histological variations of them were: papillary adenoma, oncocytoma, nephrogenic adenoma and clear cell proliferations. Accordingly the localization of these neoplastic proliferations we can divide them into subcapsular, cortical and medullar both in the tumour capsule and outside it. Around the neoplastic proliferations we have evaluated the intensity of inflammation, arteriosclerosis, glomerulosclerosis, cystic transformations of renal tubules and stromal fibrosis. Conclusions. We have proved that the most marked correlation was between the background pathologies and papillary adenoma (n = 29). More common the diameter of fibrosis was several times larger than the size of adenoma. There was also strong correlation with cystic changes of renal tubules. There is a correlation R = 0.305 (p = 0.01) between the frequency of papillary adenoma findings and of nephrosclerosis stages. The second most common initial neoplastic proliferation was clear cell proliferations (n = 26). But it has less pronounced association with the background changes. We have not proved the correlation between the frequency of renal clear cell carcinoma and severity of nephrosclerosis.</p></abstract>ARTICLEtrue Experience in Quality of Life Analysis After Bariatric Surgery<abstract xml:lang="en"><title style='display:none'>First Experience in Quality of Life Analysis After Bariatric Surgery</title><p>Introduction. The prevalence of obesity has increased markedly in the past 20 years therefore, bariatric surgery plays an important role in obesity treatment. Aim of the study. The aim of this study was to evaluate the efficacy of Laparoscopic adjustable gastric banding (LAGB) and it influence on patients' quality of life (QOL) in the management of morbid obesity. Materials and methods. 18 patients with morbid obesity underwent LAGB procedure at the Paul Stradins Clinical University Hospital, Riga, Latvia. Data collected were: age, sex, weight, height and operation time, body mass index (BMI), excessive body weight (EBW) and comorbidities. Patients fulfilled general Short Form Health Survey with 36 questions before operation (a), 6 month (b) and 12 month (c) after operation. License was acquired for SF-36v2® use in the study. Results. The mean ± SD age of patients was 42.5 ± 11.8 years (25-63) with 83.3% of them female. The mean ± SD weight was 133.7 ± 20.3 kg (104-176), mean ± SD height 168.7 ± 9.4 cm (155-189) and mean BMI 46.2 ± 6.6 kg/m2 (36.8-58.8). The mean ± SD weight at 6 month follow up was 113.5 ± 17.8 kg (p=0.001). The postoperative mean BMI at 6 month follow up was 39.32 ± 6.1 kg/m2 (p=0.001). The mean percentage of excessive body weight (EBW) loss at 6 months was 30.4%. QOL life was higher after operation (b, c) comparing to preoperative data (a), but there were no statistically significant difference in any of the scales Conclusions. The efficacy of LAGB surgery in long-term is still uncertain, but our early results are comparable to other series. To determine the true efficacy of LAGB in weight control and impact on QOL, a longer follow-up period is necessary, more cases to analyze and data from control group of general population. Our findings suggest that life quality questionnaire SF-36v2® is good tool to measure patient's quality of life before and after operation, to discuss effectiveness of operations techniques and to observe quality of life dynamics.</p></abstract>ARTICLEtrue of Oral Health Status and the Need of Surgical and Therapeutical Preprosthodontic measures in the Elderly Living in Old People's Homes in Latvia<abstract xml:lang="en"><title style='display:none'>Evaluation of Oral Health Status and the Need of Surgical and Therapeutical Preprosthodontic measures in the Elderly Living in Old People's Homes in Latvia</title><p>Introduction. Demographic evolution indicates enlargement of the older people proportion and increased life expectancy. The oral health is strongly associated with quality of life. In 1992 the main part of Latvian dental care was excluded from the list of the government paid health service. The rules N. 254 (2006) of the Cabinet of Ministers of the Republic of Latvia establish that customers from social old people's homes have to pay for dental care by themselves and the government will prepay only teeth extractions in cases of acute pain. Thereby, there appeared necessity to conduct comparative evaluation of clinical situation among populations of Latvia and other countries. Aim of the study. The aim of the study was to establish necessary types and ranges of surgical and therapeutical measures before prosthodontical teeth replacement among people who live in old people's homes; to conduct comparative analysis of clinical situation with corresponding groups of age in Latvian population. Materials and methods. There were examined 212 elderly people living in old people's homes of Kurzeme region of Latvia (randomly chosen). The indices of bad odour were established by HALIMETER. Caries incidence was assessed with DMFT index (D-decayed, M-missing, F-filling). This study was done in period from November of 2007 to February of 2009. Results. Out of all examined elderly people living in old people's homes 32.3% of men and 57.3% of women had complete teeth loss. Caries incidence ratio was 28.7 and 28.8, respectively. Untreated dental caries and filling rate were low (4.5; 2.6 and 0.6; 0.7) while the number of lost teeth was high (23.1 and 25.8). Out of the examined elderly 85.7% of men and 76.5% of women needed emergency surgical treatment (extraction of destroyed teeth). In 45.2% and 57.8% of cases were observed oral mucosal lesions, in 2.4% and 1.6% of cases were found oral precancerous conditions. In 14.3% and 18.8% of cases was noted pain in temporomandibular joints. 97.6% and 87.5% of old people's homes inhabitants needed prosthodontical teeth replacement. Conclusions. Oral health care measures for the elderly in old people's homes is insufficient, the ratio of decayed and missing teeth is high, oral hygiene mostly is unsatisfactory and many of them have halitosis. The elderly from old people's homes need vast surgical and therapeutical treatment prior to prosthetics and teeth replacement. The prevalent type of prosthodontics is complete removable dentures. There is need to develop the oral health care conception for the elderly living in old people's homes in Latvia.</p></abstract>ARTICLEtrue Cystic Tumours with Mesenchymal Stroma<abstract xml:lang="en"><title style='display:none'>Biliary Cystic Tumours with Mesenchymal Stroma</title><p>Biliary cystadenoma and cystadenocarcinoma are rare cystic liver tumours arising from the bile ducts proximal to the hilum of the liver. The tumours have unique structure with ovarian-type mesenchymal stroma, leading to challenging considerations about their pathogenesis. The differential diagnosis is wide and further complicated by the lack of awareness about these neoplastic processes due to the rarity of the disease. Radical surgical treatment can be recommended whenever possible as it can result in prolonged survival.</p></abstract>ARTICLEtrue of Salivary Glands after Ligature and Reconstruction of Common Carotid Artery in Rabbits<abstract xml:lang="en"><title style='display:none'>Histomorphology of Salivary Glands after Ligature and Reconstruction of Common Carotid Artery in Rabbits</title><p>Introduction. In occlusive diseases of carotid arteries may be involved salivary glands which play important role in oral and general homeostasis. Aim of the study. The purpose of this study was histomorphological evaluation of rabbit's salivary glands after regional reduction af arterial circulation and reconstruction of ligated common carotid arteries comparing with normal histological sight. Materials and methods. The experiments were authorized by the Animal Ethics Committee of the Latvian Food and Veterinary Service. 20 male Californian rabbits weighing approximately 3 kg were used. Under intravenous general anesthesia and local anesthesia the ligature of a. carotis communis dextra was done. After 28 days 10 rabbits were sacrificed and samples were taken from all major salivary glands and histological measured acinar dimensions and acinar epithelial cell. For rest 10 rabbits under the general anesthesia were performed revascularization of a. carotis communis dextra. After 28 days the rabbits were sacrificed with intrapulmonal injection of T61. The acini dimensions and acinar epithelial cell diameter in microns in all glands were measured except buccal glands were measured. Results. In ischemic conditions all glands react with decrease of acinar epithelial cell diameter and also diametr of functional unit of salivary gland. After revascularisation reestablishment of acini and secretory epithelial cells was observed. Conclusions. Rabbit's salivary glands have potential to recovery in diminished after ligation of ipsilateral common carotid artery size of acini and secretory epithelium after 4 week ischemia if the blood supply is reestabilished.</p></abstract>ARTICLEtrue First Evidence of Familial Lung Cancer in Latvia by Population Screening for Hereditary Cancer<abstract xml:lang="en"><title style='display:none'>The First Evidence of Familial Lung Cancer in Latvia by Population Screening for Hereditary Cancer</title><p>Introduction. Lung cancer is the major worldwide cause of tumour lethality. Recently, the role of heredity in lung carcinogenesis has become an important scientific target. While there is ongoing search for the respective gene mutations, it was suggested that presence of at least 2 first-degree relatives with lung cancer should reveal the familial lung cancer. Aim of the study. We present the first documented evidence of familial lung cancer in Latvia by population screening data in order to improve the planning of early cancer diagnostics. Materials and methods. The investigation was designed as population screening for hereditary cancer. Family cancer history was obtained from 18642 adults in the Valka district (76.6% of the adult population). Data analysis and proband consultations were performed in Hereditary Cancer Institute. Hereditary cancer syndromes were diagnosed by clinical criteria. Results. Familial lung cancer syndrome was diagnosed in 13 probands, but suspected familial lung cancer syndrome (sFLC) - in 93 probands, corresponding to the frequency 0.6% (95% confidence interval (CI) = 0.5-0.7%). The frequency of lung cancer among blood relatives was 25.5% (95% CI = 19.3-32.8%) in definitive and 17.2% (95% CI = 15.0-19.7%) in suspected syndrome groups exceeding significantly the cumulative risk for EU population. Number of affected generations was significant for sFLC. The age of cancer onset did not influence the frequency of cancer. The data about the cancer course are described. Conclusions. The high frequency of lung cancer in the identified pedigrees supports the role of familial factors in the lung carcinogenesis as well as the practical value of our diagnostic criteria helping to identify high-risk group for intervention measures to prevent lung cancer.</p></abstract>ARTICLEtrue