Haralds Plaudis | Riga Stradins University (original) (raw)

Papers by Haralds Plaudis

Antibiotics are recognized widely for their benefits when used appropriately. However, they are o... more Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules, " for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.

General Surgery

Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multipl... more Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multiple insulinomas constitute less than 10% of all insulinomas. Surgery is the treatment of choice for insulinoma. The operation can be done with an open or laparoscopic approach, with cure rates ranging from 77% to 100%. Pancreatic resection is recommended for tumours larger than 2 cm in size, while enucleation is advised for lesions smaller than 2cm if the tumour is at least 2—3 mm away from the main pancreatic duct to prevent the formation of a fistula. For better intraoperative localization of lesions, bimanual palpation together with intraoperative ultrasonography (IOUS) is advised. Palpation alone has 70% sensitivity, but together with IOUS, it reaches 85—95% A young female patient in her late 20s with non‑specific complaints and a medical history of epilepsy dating back to the age of 17 underwent a physical examination. Blood test results indicated severe hypoglycemia, and magnetic res...

World Journal of Emergency Surgery

Antibiotics are recognized widely for their benefits when used appropriately. However, they are o... more Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement o...

Hpb, 2020

The applications of color Doppler and power flow imaging for laparoscopic intraoperative ultrason... more The applications of color Doppler and power flow imaging for laparoscopic intraoperative ultrasonography (LIOU) are discussed. Basic principles concerning Doppler, color Doppler imaging (CDl), and power flow (PF) are briefly reviewed, and a number of representative examples of imaging are provided. LIOU is progressively gaining importance, not only for screening of the biliary tract, but in particular, for staging laparoscopy in patients with gastrointestinal cancer. The CDI technology that was developed relatively quickly is now in widespread use in diagnostic ultrasound, particularly for vascular surgery. CD options are no longer restricted to the expensive high-end ultrasound scanners, but are available in the majority of modest duplex systems with limited additional costs. Ongoing developments in ultrasound technology have resulted in the introduction of an alternative option to mean frequency-based CD ultrasound, ie, the PF. There are several advantages that emanate from the combination of B-mode ultrasound with CDI and/or PF. These include (1) rapid identification of anatomical structures, ie, vessels, ducts, tissue spaces, and cysts; (2) detection of small vessels that are difficult or impossible to recognize by B-mode scanning alone; (3) more accurate assessment of vascular encasement/involvement by tumor and a precise display of major vessels anatomically related to the tumor; (4) real-time guidance for safe parenchymal dissection of solid organs with identification and preservation of blood supply; (5) precise guided needle biopsy or puncture; and (6) visualization of bile flow in common bile by PF. This has the potential to enable dynamic flow studies of the function of the papilla of Vater in the near future.

Hpb, Sep 1, 2018

Introduction: Currently, methyl tertiary butyl ether (MTBE) is the only clinically applicable top... more Introduction: Currently, methyl tertiary butyl ether (MTBE) is the only clinically applicable topical agent for gallstone dissolution after having been proven its effectiveness and safety through the worldwide studies. Although generally safe, the widespread use of MTBE is limited by the drawbacks of MTBE, most which is attributed to relatively low boiling point of MTBE and resulting higher evaporation. Method: 2-Methoxy-6-methylpyridine (MMP) is a compound wherein the bulky aliphatic tert-butyl group of MTBE is replaced with an aromatic group, thereby having higher boiling point (156 C). In this study, we were intended to determine the safety and gallstone-dissolving potential of MMP. Results: In the in vitro dissolution test, MMP showed significantly better gallstone-dissolving potential than MTBE, especially at 8 h and 24 h after reaction, respectively (P< 0.05). 24-h incubation with MMP has resulted in 88.2%, 61.5%, and 39.3% dissolubility of cholesterol, mixed, and pigmented gallstones, respectively. The treatment with MTBE did not reduce the viability of human gallbladder epithelial cells nor did increase or decrease the expression of pro-apoptotic marker (Mcl-1) or proliferation marker (PCNA), respectively. In the in vivo dissolution test, MMP exhibited the significantly higher gallstonedissolving potential than MTBE in the both hamster models of cholesterol and pigmented gallstones (P< 0.05). Compared to MTBE. Conclusions: If a clinical trial supports these conclusion, contact litholysis by MMP is expected to be an attractive alternative to laparoscopic cholecystectomy in managing a proportion of patient population with gallstones.

Hpb, 2020

and maintained database. Development of long-term biliary complications, mortality and the costs ... more and maintained database. Development of long-term biliary complications, mortality and the costs of treatment were compared across each of the injury grades. Results: Amongst 120 patients, the majority of injuries were Strasberg grade A (41%), with 11%, 17% and 32% at grades B, C and D, respectively. Rates of surgical repair differed significantly by grade (p<0.001), with 8-20% of grade A-C injuries being repaired surgically, compared to 74% of grade D injuries. A total of 31 patients developed complications of BDI, which gave estimated complication rates of 19%, 23% and 31% at 1, 5 and 10 years respectively. A significant difference in complication rates was detected (p=0.022), with estimated rates at five years of 40% vs. 15% in grade D vs. A injuries (p=0.010). When all treatment costs were combined a significant difference across the BDI grades was detected (p<0.001). Costs were highest in grade D injuries at a mean of £11,048 per patient, but this was closely followed by the grade B group, at £10,612 per patient. Comparisons across the grades of BDI found no evidence of a significant difference in patient survival (p=0.830). Conclusions: Strasberg AD injuries lead to considerable long-term morbidity and cost. Grade D injuries are typically managed surgically and result in the highest complication rate and treatment costs. Grade B injuries lead to a similar complication rate and treatment cost but are often managed without surgery.

Acta Chirurgica Latviensis, Dec 1, 2016

In population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to... more In population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to 19.3% of women with two to three or more pregnancies (7). Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies. Pregnancy induced physiological hormonal changes are associated with a decrease of gallbladder motility and increased cholesterol saturation of bile, leading to biliary stone formation (12,6,8). Surgical approach nowadays is the method of choice in the management of symptomatic gallstone disease during pregnancy, preferably if possible surgery should be postponed to second trimester (7,8). Preoperative radiologic imaging using magnetic resonance cholangiopancreatography is the golden standard for patients with suspected choledocholithiasis, however, its application during pregnancy is limited (9). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be used before, during or after laparoscopic cholecystectomy when it is indicated, but unfortunately, its application during pregnancy is associated with considerable number of complications concerning mother and fetus. Alternative approach has been developed and recommended for patients with the common bile duct (CBD) stones providing laparoscopic common bile duct exploration (LCBDE). Intraoperative cholangiography or intraoperative ultrasound (IOUS) are the methods currently used for detection of the CBD stones during laparoscopic cholecystectomy, however, IOUS can be considered as the method of choice during pregnancy (3). IOUS is a dynamic imaging modality that provides interactive and timely information during surgical procedures. Because the transducer is in direct contact with the organ being examined, high-resolution images can be obtained that are not degraded by air, bone, or overlying soft tissue (1).

General Surgery, 2021

Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic... more Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic duct or directly through the incision in the common bile duct (CBD) are well established methods for restoring biliary drainage function in patients with choledocholithiasis. Although it plays a crucial role in the transcystic approach, transductal approach can be achieved differently. However, it has restrictions in availability due to its expensiveness. Objective — to report efficacy of transductal LCBDE without laparoscopic choledochoscopy. Materials and methods. This is a prospective study of urgently admitted patients who underwent trans‑ductal LCBDE due to confirmed choledocholithiasis. During laparoscopy, clearance of the CBD was achieved in two ways: by choledochoscopy (group CS+, n = 43) and without it (group CS–, n = 34). The data of patient demographics, comorbidities, operative outcomes, morbidity, mortality and long‑term biliary complications were analysed and compared betw...

World journal of emergency surgery : WJES, 2015

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control tech... more The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis...

Frontiers in Surgery

BackgroundAlthough pancreatic neuroendocrine neoplasms (PNEN) are rare, there has been a constant... more BackgroundAlthough pancreatic neuroendocrine neoplasms (PNEN) are rare, there has been a constant increase in incidence. Furthermore, PNEN present unique clinical behaviors and long-term survival can be expected even in the presence of metastases as compared with ductal adenocarcinoma of the pancreas. Determining the best therapeutic approach and proper timing of therapy requires knowledge of reliable prognostic factors. Therefore, the aim of this study was to explore clinicopathological features, treatment, and survival outcomes of patients with PNEN based on Latvian gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) registry data.MethodPatients with confirmed PNEN at Riga East Clinical University Hospital and Pauls Stradins Clinical University Hospital, between 2008 and 2020, were retrospectively analyzed. Data were collected and included in EUROCRINE, an open-label international endocrine surgical registry.ResultsIn total, 105 patients were included. The median age at diagn...

Medicina

Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring su... more Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVI...

Neurourology and Urodynamics, Jun 1, 2017

Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy su... more Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy subjects, and it is strongly associated with postpartum incontinence when the trauma occurs on the dominant side of innervation. Episiotomy is the most common cause of perineal trauma during delivery, and the surgical incision is usually performed on the mediolateral right side episiotomy. Surface electromyography (sEMG) in obstetrics is a novel method for detecting the innervation zones (IZ) of external anal sphincter (EAS). The aim of this study is to locate the IZs of EAS by the means of sEMG, and to analyse their distribution, in order to evaluate the effect of episiotomy on the external anal sphincter muscle activity. In this prospective observational type study, 225 pregnant primiparous women (age 28.4 ± 4.1 years) were involved and EMG was performed to detect the distribution of IZs and amplitude of EMG signals of EAS. The EMG measurements were performed two times: during the 2nd tr...

the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retros... more the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years ’ experience

Antibiotics are recognized widely for their benefits when used appropriately. However, they are o... more Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules, " for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.

General Surgery

Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multipl... more Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multiple insulinomas constitute less than 10% of all insulinomas. Surgery is the treatment of choice for insulinoma. The operation can be done with an open or laparoscopic approach, with cure rates ranging from 77% to 100%. Pancreatic resection is recommended for tumours larger than 2 cm in size, while enucleation is advised for lesions smaller than 2cm if the tumour is at least 2—3 mm away from the main pancreatic duct to prevent the formation of a fistula. For better intraoperative localization of lesions, bimanual palpation together with intraoperative ultrasonography (IOUS) is advised. Palpation alone has 70% sensitivity, but together with IOUS, it reaches 85—95% A young female patient in her late 20s with non‑specific complaints and a medical history of epilepsy dating back to the age of 17 underwent a physical examination. Blood test results indicated severe hypoglycemia, and magnetic res...

World Journal of Emergency Surgery

Antibiotics are recognized widely for their benefits when used appropriately. However, they are o... more Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement o...

Hpb, 2020

The applications of color Doppler and power flow imaging for laparoscopic intraoperative ultrason... more The applications of color Doppler and power flow imaging for laparoscopic intraoperative ultrasonography (LIOU) are discussed. Basic principles concerning Doppler, color Doppler imaging (CDl), and power flow (PF) are briefly reviewed, and a number of representative examples of imaging are provided. LIOU is progressively gaining importance, not only for screening of the biliary tract, but in particular, for staging laparoscopy in patients with gastrointestinal cancer. The CDI technology that was developed relatively quickly is now in widespread use in diagnostic ultrasound, particularly for vascular surgery. CD options are no longer restricted to the expensive high-end ultrasound scanners, but are available in the majority of modest duplex systems with limited additional costs. Ongoing developments in ultrasound technology have resulted in the introduction of an alternative option to mean frequency-based CD ultrasound, ie, the PF. There are several advantages that emanate from the combination of B-mode ultrasound with CDI and/or PF. These include (1) rapid identification of anatomical structures, ie, vessels, ducts, tissue spaces, and cysts; (2) detection of small vessels that are difficult or impossible to recognize by B-mode scanning alone; (3) more accurate assessment of vascular encasement/involvement by tumor and a precise display of major vessels anatomically related to the tumor; (4) real-time guidance for safe parenchymal dissection of solid organs with identification and preservation of blood supply; (5) precise guided needle biopsy or puncture; and (6) visualization of bile flow in common bile by PF. This has the potential to enable dynamic flow studies of the function of the papilla of Vater in the near future.

Hpb, Sep 1, 2018

Introduction: Currently, methyl tertiary butyl ether (MTBE) is the only clinically applicable top... more Introduction: Currently, methyl tertiary butyl ether (MTBE) is the only clinically applicable topical agent for gallstone dissolution after having been proven its effectiveness and safety through the worldwide studies. Although generally safe, the widespread use of MTBE is limited by the drawbacks of MTBE, most which is attributed to relatively low boiling point of MTBE and resulting higher evaporation. Method: 2-Methoxy-6-methylpyridine (MMP) is a compound wherein the bulky aliphatic tert-butyl group of MTBE is replaced with an aromatic group, thereby having higher boiling point (156 C). In this study, we were intended to determine the safety and gallstone-dissolving potential of MMP. Results: In the in vitro dissolution test, MMP showed significantly better gallstone-dissolving potential than MTBE, especially at 8 h and 24 h after reaction, respectively (P< 0.05). 24-h incubation with MMP has resulted in 88.2%, 61.5%, and 39.3% dissolubility of cholesterol, mixed, and pigmented gallstones, respectively. The treatment with MTBE did not reduce the viability of human gallbladder epithelial cells nor did increase or decrease the expression of pro-apoptotic marker (Mcl-1) or proliferation marker (PCNA), respectively. In the in vivo dissolution test, MMP exhibited the significantly higher gallstonedissolving potential than MTBE in the both hamster models of cholesterol and pigmented gallstones (P< 0.05). Compared to MTBE. Conclusions: If a clinical trial supports these conclusion, contact litholysis by MMP is expected to be an attractive alternative to laparoscopic cholecystectomy in managing a proportion of patient population with gallstones.

Hpb, 2020

and maintained database. Development of long-term biliary complications, mortality and the costs ... more and maintained database. Development of long-term biliary complications, mortality and the costs of treatment were compared across each of the injury grades. Results: Amongst 120 patients, the majority of injuries were Strasberg grade A (41%), with 11%, 17% and 32% at grades B, C and D, respectively. Rates of surgical repair differed significantly by grade (p<0.001), with 8-20% of grade A-C injuries being repaired surgically, compared to 74% of grade D injuries. A total of 31 patients developed complications of BDI, which gave estimated complication rates of 19%, 23% and 31% at 1, 5 and 10 years respectively. A significant difference in complication rates was detected (p=0.022), with estimated rates at five years of 40% vs. 15% in grade D vs. A injuries (p=0.010). When all treatment costs were combined a significant difference across the BDI grades was detected (p<0.001). Costs were highest in grade D injuries at a mean of £11,048 per patient, but this was closely followed by the grade B group, at £10,612 per patient. Comparisons across the grades of BDI found no evidence of a significant difference in patient survival (p=0.830). Conclusions: Strasberg AD injuries lead to considerable long-term morbidity and cost. Grade D injuries are typically managed surgically and result in the highest complication rate and treatment costs. Grade B injuries lead to a similar complication rate and treatment cost but are often managed without surgery.

Acta Chirurgica Latviensis, Dec 1, 2016

In population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to... more In population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to 19.3% of women with two to three or more pregnancies (7). Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies. Pregnancy induced physiological hormonal changes are associated with a decrease of gallbladder motility and increased cholesterol saturation of bile, leading to biliary stone formation (12,6,8). Surgical approach nowadays is the method of choice in the management of symptomatic gallstone disease during pregnancy, preferably if possible surgery should be postponed to second trimester (7,8). Preoperative radiologic imaging using magnetic resonance cholangiopancreatography is the golden standard for patients with suspected choledocholithiasis, however, its application during pregnancy is limited (9). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be used before, during or after laparoscopic cholecystectomy when it is indicated, but unfortunately, its application during pregnancy is associated with considerable number of complications concerning mother and fetus. Alternative approach has been developed and recommended for patients with the common bile duct (CBD) stones providing laparoscopic common bile duct exploration (LCBDE). Intraoperative cholangiography or intraoperative ultrasound (IOUS) are the methods currently used for detection of the CBD stones during laparoscopic cholecystectomy, however, IOUS can be considered as the method of choice during pregnancy (3). IOUS is a dynamic imaging modality that provides interactive and timely information during surgical procedures. Because the transducer is in direct contact with the organ being examined, high-resolution images can be obtained that are not degraded by air, bone, or overlying soft tissue (1).

General Surgery, 2021

Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic... more Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic duct or directly through the incision in the common bile duct (CBD) are well established methods for restoring biliary drainage function in patients with choledocholithiasis. Although it plays a crucial role in the transcystic approach, transductal approach can be achieved differently. However, it has restrictions in availability due to its expensiveness. Objective — to report efficacy of transductal LCBDE without laparoscopic choledochoscopy. Materials and methods. This is a prospective study of urgently admitted patients who underwent trans‑ductal LCBDE due to confirmed choledocholithiasis. During laparoscopy, clearance of the CBD was achieved in two ways: by choledochoscopy (group CS+, n = 43) and without it (group CS–, n = 34). The data of patient demographics, comorbidities, operative outcomes, morbidity, mortality and long‑term biliary complications were analysed and compared betw...

World journal of emergency surgery : WJES, 2015

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control tech... more The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis...

Frontiers in Surgery

BackgroundAlthough pancreatic neuroendocrine neoplasms (PNEN) are rare, there has been a constant... more BackgroundAlthough pancreatic neuroendocrine neoplasms (PNEN) are rare, there has been a constant increase in incidence. Furthermore, PNEN present unique clinical behaviors and long-term survival can be expected even in the presence of metastases as compared with ductal adenocarcinoma of the pancreas. Determining the best therapeutic approach and proper timing of therapy requires knowledge of reliable prognostic factors. Therefore, the aim of this study was to explore clinicopathological features, treatment, and survival outcomes of patients with PNEN based on Latvian gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) registry data.MethodPatients with confirmed PNEN at Riga East Clinical University Hospital and Pauls Stradins Clinical University Hospital, between 2008 and 2020, were retrospectively analyzed. Data were collected and included in EUROCRINE, an open-label international endocrine surgical registry.ResultsIn total, 105 patients were included. The median age at diagn...

Medicina

Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring su... more Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVI...

Neurourology and Urodynamics, Jun 1, 2017

Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy su... more Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy subjects, and it is strongly associated with postpartum incontinence when the trauma occurs on the dominant side of innervation. Episiotomy is the most common cause of perineal trauma during delivery, and the surgical incision is usually performed on the mediolateral right side episiotomy. Surface electromyography (sEMG) in obstetrics is a novel method for detecting the innervation zones (IZ) of external anal sphincter (EAS). The aim of this study is to locate the IZs of EAS by the means of sEMG, and to analyse their distribution, in order to evaluate the effect of episiotomy on the external anal sphincter muscle activity. In this prospective observational type study, 225 pregnant primiparous women (age 28.4 ± 4.1 years) were involved and EMG was performed to detect the distribution of IZs and amplitude of EMG signals of EAS. The EMG measurements were performed two times: during the 2nd tr...

the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retros... more the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years ’ experience