Browsing by Author "Petersons, Aigars"

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    BCG-SSI® vaccine-associated lymphadenitis : Incidence and management
    (2016) Engelis, Arnis; Kakar, Mohit; Meikšāns, Roberts; Petersons, Aigars; Department of Paediatric Surgery
    Background and objective There is a high incidence of childhood tuberculosis in Latvia, including children aged less than 1 year, while BCG-associated lymphadenitis is one of the most frequent adverse events requiring surgical treatment. The aim of this study was to analyze the incidence of purulent BCG adenitis through-out the population of Latvia after the introduction of BCG-SSI® vaccine and to evaluate the treatment results. Material and methods The study included 194 patients. All patients had received the BCG-SSI® vaccine during the first week of life routinely or at a later time according to the indications. The indications for surgical treatment were lymph node destruction also affecting the skin. All patients in this study received surgical treatment – the affected lymph node extirpation. Results The mean age of the patients was 5.12 ± 0.96 months. A total of 172 patients had purulent axillar lymphadenitis, 14 had purulent supraclavicular lymphadenitis, 8 patients had lymphadenitis at both localizations. During the whole study period the incidence of BCG adenitis varied from 0.02% to 0.36%, while the mean rate was 0.11% ± 0.08% from 184,068 vaccinated children during the study period. We observed an increasing trend in the incidence of BCG lymphadenitis during the study period. The primary and complete healing rate at the end of period was 99.5% (n = 193) following an affected lymph node extirpation. The mean hospitalization time after the operation was 3.71 ± 0.18 days. Conclusions The incidence of BCG-SSI® vaccine associated purulent lymphadenitis varied widely with an increasing trend, followed by the return to the product characteristic limits. Indications for the surgical treatment should not be changed. Extirpation of the purulent BCG adenitis is a safe treatment method and leads to the primary wound healing in the majority of cases.
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    Case series of variable acute appendicitis in children with sars-cov-2 infection
    (2021-12) Engelis, Arnis; Smane, Liene; Pavare, Jana; Zviedre, Astra; Zurmutai, Timurs; Berezovska, Marisa M.; Bormotovs, Jurijs; Kakar, Mohit; Saxena, Amulya K.; Petersons, Aigars; Department of Paediatric Surgery; Department of Paediatrics; Department of Doctoral Studies
    This case series study consists of six children, aged 5–16 years, admitted to a centralized tertiary paediatric hospital serving a population of 1.9 million with acute appendicitis in the setting of SARS-CoV-2 infection. From the beginning of the pandemic in March 2020 until August 2021, 121 COVID-19-positive children were admitted to the hospital. A total of 49 (40.5%) of these patients presented with gastrointestinal symptoms, of which six were diagnosed with acute appendicitis. Five underwent an appendectomy, while one was treated conservatively. To date, it has been reported that appendicitis may have a plausible association with SARS-CoV-2 infection in children. With COVID-19 cases rising, every medical specialist, including all paediatric surgeons, must be ready to treat common acute diseases with SARS-CoV-2 infection as a comorbidity. Providers should consider testing for this infection in paediatric patients with severe gastrointestinal symptoms. Non-surgical treatment of acute appendicitis in children may gain new importance during and after the COVID-19 pandemic. Further studies are needed to prove the link of causality between COVID-19 and acute appendicitis in children.
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    Choice of the acetabular component placement in dysplastic hip patients
    (2019-08) Zebolds, Silvestris; Petersons, Aigars; Jumtiņš, Andris; Rīga Stradiņš University
    Total hip arthroplasty (THA) in patients with hip dysplasia is a challenging surgical operation. Many orthopedic surgeons concur that the anatomical placement of the acetabular components of endoprostheses (AC-EPs) during THA yields the best result. However, there are advocates of the high rotation center of the hip joint after replacement surgery. In our study, we compared the outcomes of THA based on the placement of acetabular cups to identify the most favorable site for AC-EPs in patients with varying grades of dysplastic osteoarthritis. Our study included 88 patients with dysplastic hip osteoarthritis who underwent 106 THAs during a three-year period using cementless fixation endoprostheses. Functional results were assessed by Merle d'Aubigne and Postel's method and by instrumental gait analysis (IGA). Gait deviation index was calculated based on IGA to compare results in different acetabular component placement groups. Functional assessment of patients by Merle d'Aubigne and Postel's grading method and IGA showed no significant difference in results due to the placement of the acetabular component. Most complications were found in the severe dysplasia patients group with the anatomical placement of the AC-EP. The appropriate location of cementless acetabular cups during THA in dysplastic hips depends on the grade of dysplasia, expected elongation of the leg, and the potential for adequate bone coverage for the AC-EP. In cases of severe dysplasia, the placement of the AC-EP in the secondary socket can provide a good functional outcome and reduce the risk of complications.
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    Diagnostics and treatment of neonatal necrotising enterocolitis in Latvia
    (2019-05-01) Meldere, Ilze; Rucka, Liene; Smilga, Santa; Ābola, Zane; Petersons, Aigars; Department of Paediatrics; Department of Paediatric Surgery
    Necrotising enterocolitis (NEC) is one of the leading causes of neonatal morbidity, mortality and surgical emergencies. As the survival rate of extremely low birth weight (ELBW) infants is rising, so is the risk of NEC. The aim of this study was to compare diagnostics parameters like clinical and radiological findings and laboratory indicators and the treatment and outcome of NEC patients from 2000 till 2007 (Group 1) and from 2008 till 2016 (Group 2) treated in Neonatology Clinic (NC) of Children's Clinical University Hospital (CCUH). In the rectrospective study, 277 newborns were divided among Group I and Group II - 105 and 172 patients, respectively. There were no statistically significant differences between both study groups in mean gestational age and birth weight. In both groups the first signs of NEC appeared on average eight days after birth. Differences in the diagnostic method used in both groups were not statistically significant; specific radiological findings were seen in approximately 1/3 of the cases. There were statistically significant differences in the management of NEC and patient mortality. Conservative therapy was applied in 70.0% of patients in both study groups. Over time, peritoneal drainage (PPD) as the sole surgical treatment decreased by 6.4%, but PPD with following enterostomy decreased by 8.9%. In Group 2 mortality of NEC patients decreased by 17.4%. Mortality among surgically treated NEC patients decreased as well, by 9.0%.
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    Growth factors, their receptors, neuropeptide-containing innervation, and matrix metalloproteinases in the proximal and distal ends of the esophagus in children with esophageal atresia
    (2011) Pilmane, Mara; Ozoliņa, Linda; Ābola, Zane; Petersons, Aigars; Popkovs, Vjačeslavs; Dabužinskiene, Anita; Vetra, Janis; Institute of Anatomy and Anthropology
    Objective: The pathogenesis of esophageal atresia (EA) remains unknown despite a relatively high incidence of this anomaly in population affecting 1 newborn per 3000 live births. The aim of this study was to examine the relative occurrence of growth factors, their receptors, neuropeptide-containing innervation, and tissue-degradating enzymes - matrix metalloproteinases - in the proximal and distal parts of the esophagus with EA. Materials and Methods: A histopathological study was conducted on 15 patients with EA. Tissues were processed for NGFRp75, PGP 9.5, TGF-β, FGFR, VEGF, EGFR and MMP-2 by means of biotin-streptavidin immunohistochemistry. Results: In the control and EA-affected distal esophageal specimens, numerous and abundant NGFR-containing structures were detected, while in the proximal part of the esophagus, a decrease in their number was observed in patients. PGP 9.5 also marked neuronal structures similarly. TGF-β was found only in occasional cells in the EA-affected esophageal specimens, while control material demonstrated moderate to numerous TGF-β-containing structures. Abundance of FGFR and only occasional appearance of VEGF-positive cells were found in both the control and EA-affected material. A moderate number of connective tissue cells in controls contained EGFR. Compared with controls, the number of MMP-2 expressing cells in the EA-affected tissues was decreased in the proximal esophagus. Conclusions: A decrease in PGP 9.5-containing neuronal structures in the proximal esophagus supports insufficient innervation of this part of the organ in EA. A decrease in MMP-2 positive cells in the esophageal atresia-affected proximal esophagus indicates also a possible decrease of tissue adaptive and regenerative reactions. Low expression of TGF-β and almost the absence of EGFR in the EA-affected specimens may result in disturbances of cell growth, proliferation, and differentiation, indicating a significant role of these substances in morphopathogenesis of EA. FGFR and VEGF seem not to characterize EA pathogenesis.
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    Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children
    (2019-08-01) Zviedre, Astra; Eņgelis, Arnis; Tretjakovs, Peteris; Zile, Irisa; Petersons, Aigars; Department of Paediatric Surgery; Department of Human Physiology and Biochemistry; Department of Public Health and Epidemiology
    The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7-18 years) with suspected AA were included in the prospective study (October 2010 - October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C - reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/μL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.
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    Long-term evaluation of the functional and esthetical outcomes for the new method of the toe-to-hand transfer for full-length thumb reconstruction in congenital thumb's hypoplasia in children
    (2019-05-01) Ozols, Dzintars; Zariņš, Jānis; Petersons, Aigars; Rīga Stradiņš University
    Congenital thumb hypoplasia is a rare deformity of the upper extremity. Incidence of thumb hypoplasia type I-V was 2-3 and type IIIb-V was 0.5-1 per 20 000 newborns per year in Latvia. The classification of thumb hypoplasia was created by Blauth in 1967 (type I to V). The base of the metacarpal bone is absent for hypoplasia type IIIb-V; therefore, toe-to hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for successful toe-to-hand transplantation. A technique for toe-to-hand transplantation for thumb hypoplasia type IIIb-V patients has been described in literature but overall results were not better than pollicisation. The aim of this study is to describe a new technique for thumb reconstruction with a second toe transfer with metatarsophalangeal joint arthrodesis, which can provide a 5-digit hand and restore the functionality of the thumb for thumb hypoplasia IIIb-V. Long-term follow up was done to evaluate the functions and aesthetics of the hands. A survey to evaluate aesthetical outcome for the transplantation method and pollicisation method was completed by 290 respondents. The overall population rated the aesthetic outcomes of the new transplantation method significantly higher than for pollicisation (p < 0.0001).
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    Measurement of abdominal circumference in preterm infants
    (2015-11-26) Meldere, Ilze; Urtans, Valdis; Petersons, Aigars; Abola, Zane; Department of Paediatric Surgery
    Background: Body weight, length and head and thoracic circumference are routinely measured in obstetric and neonatal departments. Reference values for these measurements have been established for the neonatal population. Neonatal abdominal circumference is not routinely measured, and no reference values for this measurement have been determined. To evaluate the increase in abdominal circumference in newborns with abdominal pathology such as necrotizing enterocolitis, information about normal abdominal circumference in healthy neonates shortly after birth is needed. The aim of this study was to determine the correlation between abdominal circumference and birth weight by measuring the abdominal circumference of premature neonates soon after birth. Methods: Abdominal circumference was measured within 30 min of birth in 220 neonates born between 23 and 35 weeks' gestation. Results: There was no statistically significant difference in abdominal circumference between boys and girls in the study population. A specific formula for estimating normal abdominal circumference was developed: y = 0.0053x + 14.83 (y = abdominal circumference in cm; x = body weight in g; 0.0053 = regression coefficient; 14.83 = regression constant). Conclusion: A positive linear correlation between abdominal circumference and birth weight was found in infants at birth. The correlation can be summarized as a linear regression equation. Further studies are needed to investigate possible factors associated with abdominal circumference in fed versus unfed preterm infants.
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    One-step lower leg reconstruction with vascularized functional vastus lateralis muscle flap in the treatment of embryonal rhabdomyosarcoma for a six-month-old boy : A case report
    (2020) Ozols, Dzintars; Berezovska, Marisa Maija; Krasts, Janis; Grutupa, Marika; Petersons, Aigars; Department of Paediatric Surgery
    Rhabdomyosarcoma (RMS) is a common soft tissue sarcoma in childhood, however, it is very rare in the neonatal period (0.4–2% of cases). This case depicts a boy, who presented with RMS at two weeks of age, but officially diagnosed at the age of three months. MRI and scintigraphy determined a soft tissue tumor in the soleus muscle, while biopsy confirmed embryonal RMS with high mitotic activity (Ki67 (monoclonal antibodies) ~80%). CWS (Cooperative Weichteilsarkom Studiengruppe)-2012 with I2VA (ifosfamide, vincristine, actinomycin) chemotherapy regimen was administered per protocol. Surgical treatment was performed at age of six months and 18 days. The operation consisted of radical tumor resection and total triceps surae with partial fibula resection. Immediate reconstruction of triceps muscle was accomplished using a vascularized functional musculocutaneous vastus lateralis flap. Functional outcome was measured using the Lower Extremity Functional Scale (LEFS) and the Foot and Ankle Outcome Score (FAOS) with the results of 92.5% and 99% respectively.
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    Prenatal and postnatal diagnostics problems of the most common surgical congenital malformations of newborns in Latvia
    (2009) Abola, Zane; Petersons, Aigars; Pugačevska, Daila; Zviedre, Astra; Lackaja, Jana; Rīga Stradiņš University
    The most common surgical congenital malformations of newborns in Latvia are esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), duodenal atresia (DA) and abdominal wall defects - gastroschisis (G) and omphalocele (O). Survival and quality of life of these patients depend on precise pre- and postnatal diagnosis, timely and qualified treatment, and presence of associated anomalies and prematurity. The aim of our study was to define prenatal and postnatal diagnostic problems of the most common surgical congenital malformations of new-borns in Latvia. Data concerning pre- and postnatal diagnostics from case-records of patients treated in Children's Clinical University Hospital from 1998 till 2008 with esophageal atresia (58 patients), duodenal atresia (20 patients) and congenital abdominal wall defects - gastroschisis (17 patients) and omphalocele (28 patients) were analysed. Results showed that in case of EA prenatal USG was performed in 62% of expectant mothers and in neither case suspicion about. EA was expressed. In all patients after birth diagnostic placement of nasogastric tube was performed. In approximately one-third catheter of bad opaqueness was used. Preoperative bronchoscopy and esophagoscopy in order to exclude upper tracheoesophageal fistula were performed in two patients from the analysed group. In 40% of cases DA was diagnosed in prenatal ultrasonography. G was diagnosed prenatally in 29.4%, O - only in 3.7%.
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    Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children
    (2016) Zviedre, Astra; Engelis, Arnis; Tretjakovs, Peteris; Jurka, Antra; Zile, Irisa; Petersons, Aigars; Department of Paediatric Surgery; Department of Human Physiology and Biochemistry; Department of Public Health and Epidemiology
    Background and objective The diagnostic role of serum cytokines depends on the etiology and pathogenesis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). The aim of this study was to evaluate differences in cytokine levels between AA and AML. Materials and methods Data of 7- to 18-year-old children were collected prospectively from October 2010 to October 2013. There were 31 patients with AA (AA group), 26 with AML (AML group), and 17 with elective non-inflammatory surgical disease (control group). Serum levels of IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, EGF, TNF-α and white blood count (WBC) were measured three times consecutively in each group. Results The level of IL-6 and IL-10 was significantly higher in the AA group than the AML group at the first measurement (8 pg/mL vs. 3.2 pg/mL, P = 0.000; 6.1 pg/mL vs. 3.2 pg/mL, P = 0.005, respectively). There was a significant difference observed in time dynamics of concentration of IL-6 and MCP-1 for AA and AML. The area under the curve (AUC) was 0.77 (95% CI 0.64–0.89; P = 0.001) for IL-6 with a cut-off value of 4.3 pg/mL (67.7% sensitivity and 76.9% specificity) for AA 1 h before surgery. The AUC for WBC was 0.72 (95% CI 0.58.4–0.85; P = 0.005) with a cut-off value of 10.7 × 103/μL (sensitivity 71.0% and specificity 46.2%). Conclusions Serum IL-6 with a cut-off value of 4.3 pg/mL and WBC with a cut-off value of 10.7 × 103/μL assessed together will yield more sensitivity for AA.
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    Serum and Urine Biomarker Leucine-Rich Alpha-2 Glycoprotein 1 Differentiates Pediatric Acute Complicated and Uncomplicated Appendicitis
    (2021-05-11) Kakar, Mohit; Berezovska, Marisa Maija; Broks, Renars; Asare, Lasma; Delorme, Mathilde; Crouzen, Emile; Zviedre, Astra; Reinis, Aigars; Engelis, Arnis; Kroica, Juta; Saxena, Amulya; Petersons, Aigars; Department of Paediatric Surgery; Department of Biology and Microbiology; Statistics Unit
    Purpose: This prospective, single-center cohort study analyzes the potential of inflammatory protein mediator leucine-rich alpha-2 glycoprotein 1 (LRG1) for the early and accurate diagnosis of acute appendicitis (AA), and differentiation of acute complicated (AcA) from uncomplicated appendicitis (AuA). Methods: Participants were divided into the AcA, AuA, and control groups, and their serum (s-LRG1) and urine LRG1 (u-LRG1) levels were assayed preoperatively on the second and fifth postoperative days. Results: 153 patients participated, 97 had AA. Preoperative u-LRG1 with a cut-off value of 0.18 µg/mL generated an area under the receiver operated characteristic (AUC) curve of 0.70 (95% CI 0.62–0.79) for AA versus control (p < 0.001), while the results for AcA versus AuA were not significant (AUC 0.60, 95% CI 0.49–0.71, p = 0.089). The s-LRG1 levels of AA versus the control with a cut-off value of 51.69 µg/mL generated an AUC of 0.94 (95% CI 0.91–0.99, p < 0.001). The cut-off value of s-LRG1 was 84.06 µg/mL for diagnosis of AcA from AuA, and therefore, significant (AUC 0.69, 95% CI 0.59–0.80, p = 0.001). Conclusions: LRG1 exhibited excellent diagnostic performance as an inexpensive, non-invasive, rapid, and accurate biomarker able to reflect the pathogenesis of AA. LRG1 has the potential to replace advanced imaging to diagnose clinically ambiguous AA cases.