Albanian Journal of Trauma and Emergency Surgery 2021-07-20T13:40:23+00:00 Agron Dogjani Open Journal Systems <p><em><strong>Albanian</strong><strong> Journal of Trauma and Emergency Surgery</strong></em>&nbsp;<strong><em>(AJTES)</em></strong> is the official publication of the Albanian Society for Trauma and Emergency Surgery (ASTES) that comes out two times a year. <em>AJTES</em>&nbsp;is open access, peer-reviewed journal that aims to promote interest, knowledge, and quality of care in emergency and trauma surgery. Under the editorship of <em>Asc.&nbsp;Prof. Dr. Agron Dogjani,&nbsp;MD, Ph.D., FACS, FISS.<strong>&nbsp;</strong></em><em>AJTES</em><em>&nbsp;</em>provides an in-depth, national, and international forum for the most authoritative information on major clinical problems in the fields of trauma and emergency surgery, surgical education, and not only...&nbsp; Contributions are reviewed and selected by a group of distinguished surgeons from across Albania and worldwide as well who make up the Editorial Board.&nbsp;</p> <p><strong><em>ISSN:</em></strong> 2616-4922 <em><strong>(Online)</strong></em>; <em><strong>ISSN:</strong></em> 2521-8778 <em><strong>(Print)</strong></em></p> <p><a href=""><strong></strong></a></p> <p><strong>Impact Factor - 1.022&nbsp;&nbsp;</strong>based on ICR for the year 2020-21</p> <p><strong>Index Copernicus Value - </strong>77.13;</p> <p><strong>ISRA JIF - </strong>2,197;</p> <p><strong>GIF -&nbsp;</strong>2.394;</p> <p><strong>International License.</strong> CC BY-NC 4.0</p> Challenges and Problems Affecting the Development Emergency Medical Services in Kosovo. 2021-07-20T02:44:19+00:00 Basri Lenjani Merima Šišić Verica Mišanović Kenan Ljuhar Dardan Lenjani <p>Emergency medical service is organized as a separate field of health activities in order to provide uninterrupted emergency medical care for citizens who due to illness or injury have directly threatened the life, certain organs or certain parts of the body respectively cut the optimal time of occurrence of the emergency until the start of the final treatment process. Emergence clinic for 2020. Year ED over 100. 000-cases. The emergency health system doesn’t have a consolidated network and integrated emergency medical services.&nbsp; Emergency health services in Europe are being challenged by changes in life dynamics, scientific advancements, which do increase the request to further improve the way of delivering emergency services. Health-system resilience can be defined as the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises, to maintain core functions when a crisis hits, and—informed by lessons learned during the crisis to reorganize if conditions require it. Emergency clinic today at UCCK offers an area of 507m2, with 22 beds in the living room (1 bed per 100,000 population). Compliance with the law on emergency medical care, support, and improvement of EMS creating a special budget for EMS. EMS Independence (Decentralization). Budget, Management, accreditation, initiation of a project of systematization doctors of nurses in an integrated system. Regulation of administrative and legal infrastructure for EMS. The increase in salary (during holidays, weekends), shortening working hours for EMS, beneficial path (stress, risk, complexity, infections, first contact with the patient), the extension of annual leave. Functionalization of the Permanent National Center for Education EMS training, licensing, relicensing (medical staff) Quality control or EMS quality.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Measures of Risk for Sepsis and Mortality in Severe Burned Patients with Stress Induced Hyperglycemia. 2021-07-20T02:44:23+00:00 Albana Aleksi Monika Belba <p><strong><em>Background; </em></strong>Hyperglycemia as a medical condition due to diabetes or other underlying conditions like Stress-Induced Hyperglycemia and sepsis as a life-threatening medical condition are two of the challenges faced during burn treatment.</p> <p><strong><em>The purpose</em></strong> of this study was to evaluate the risk for sepsis and mortality for the patients with critical hyperglycemic values during the disease.</p> <p><strong><em>Material and Methods; </em></strong>This is an observational retrospective cohort study conducted in the Service of Burns of the University Hospital Centre “Mother Teresa” in Tirana (UHCT), Albania from 1st January 2010 to 31st December 2014. Patients were categorized as having euglycemia (mean BG values ranging from 80-120 mg/dl), moderate hyper Sepsis was defined according to the ABA Consensus Panel Publication for Infection and Sepsis glycemia (mean BG values &lt;180 mg/dl) or critical hyperglycemia (mean BG values ≥180 mg/dl). to evaluate the impact of the presence of critical hyperglycemia during the disease in sepsis and mortality, we performed Relative risk, Odds ratio</p> <p><strong><em>Results; </em></strong>Those who had overall hyperglycemia (Moderate and Critical) had 2.6 times the risk for sepsis compared to those who were in the euglycemia group. Analyzing the risk of mortality in patients with overall hyperglycemia during the disease, we observed that the chance of a bad outcome was 2.7 times more likely to occur if the patient had hyperglycemia (RR=2.7).</p> <p><strong><em>Conclusions: </em></strong>Glucose values on admission, as one of the derangement features of burn shock, are prognostic factors in critical hyperglycemia during burn disease and have a close relationship with other outcomes (sepsis and mortality).</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Complications following T-tube & C-tube Drainage of the Common Bile Duct 2021-07-20T02:44:23+00:00 Rovena Bode Klevis Shella Hysni Dede Xheladin Dracini Etmont Celiku <p>The aim of this study is to assess the complications of T-tube (Kehr) and C- tube (Cystic) drainage used for biliary drainage, following biliary surgery.&nbsp;</p> <p>We evaluate all possible complications, related to the tube in situ, during cholangiography and following t- tube removal retrospectively, during a 4- year period 2016-2019.</p> <p>T-tubes were inserted in 48 patients, with 11 (22.8%) patients experiencing complications related to T-tube. A broad spectrum of complications was found, ranging from biliary-specific complications such as a biliary leak, biliary peritonitis, and retained stones, to systemic general complications as wound infection, pulmonary thromboembolism, and internal hemorrhage.</p> <p>Although this retrospective study has underestimated the incidence of T-tube complications, it has demonstrated significant morbidity related to T-tube use, which poses the need for replacement by minimally invasive surgical techniques.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery 2021-07-20T02:44:19+00:00 Alfred Ibrahimi Saimir Kuci Ervin Bejko Stavri Llazo Marsela Goga Ermal Likaj Selman Dumani Ali Refatllari Jacob Zeitani <p><strong><em>Background:</em></strong>&nbsp;Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole&nbsp; &nbsp;for post cardiac surgery pain relief.</p> <p><strong><em>Methods</em></strong><em>;</em> Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation.&nbsp; Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3).</p> <p><strong><em>Results</em></strong><em>;</em> There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group.<strong> <em>Conclusion:</em></strong> Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Endotracheal Intubations in Emergency Department: A Clinical Audit at a Tertiary Health Centre in South India 2021-07-20T13:40:23+00:00 Linu SM Roopasree Sivam Nikhil Paul Mathen P George Suresh Babu <p><strong><em>Background</em></strong><strong>: </strong>Endotracheal intubation in the emergency department is challenging. Hence, regular audits can help us improve our critical airway management skills. Our study aimed to evaluate the practice of endotracheal intubations performed in the emergency department.</p> <p><strong><em>Materials and Methods</em></strong><strong>: A</strong> retrospective cross-sectional study was conducted among the patients intubated in our teaching hospital's emergency department. The study period was from November 1, 2019, to August 31, 2020. We analyzed first attempt success rates, drug use, indication, and complications.</p> <p><strong><em>Results</em></strong><strong>: </strong>We analysed 90 endotracheal intubations, out of which 70(77.8%) were performed by emergency physicians and 20(22.2%) by anaesthetists. The first attempt success rate was 81.11% (n=73) and had significant differences between the both departments. (p value= 0.003, &nbsp;χ2= 7.48). More patients had medical indications compared to trauma for intubation (n=88 vs n=32) among which respiratory failure (n=25, 27.78%) was the most common indication. Rapid Sequence Intubation( RSI) adherence was 82.22% (n=74). Lignocaine (n=16, 19.75%), etomidate (n=35, 43.2%) and succinylcholine (n=65, 80.25%) were the commonly used drugs for premedication, induction and as relaxants respectively. 17(18.89%) out of 90 intubation had complications. Desaturation (n=10, 11.11%), bradycardia (n=1, 1.11%), hypotension (n=4, 44%), dental trauma (n=5, 5.55%) and oesophageal intubation (n=3, 3.33%) were observed in our study.</p> <p><strong><em>Conclusion</em>: </strong>Our study is the first &nbsp;from India which describes the characteristics of endotracheal intubations done in the Emergency Department along with data on RSI adherence. The first attempt success rate, indications, and complications were comparable with other studies in the literature. We recommend future prospective studies to analyze success rates between different specialties and resident doctors to improve the airway management skills in the Department</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients 2021-07-20T02:44:22+00:00 Besnik Faskaj Monika Belba <p><strong><em>Background; </em></strong>Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h.</p> <p>This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids.&nbsp;</p> <p><strong><em>Material and Methods;</em></strong> This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns &gt; 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours.</p> <p><strong><em>Results; </em></strong>The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL.</p> <p><strong><em>Conclusions;</em></strong> Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns &gt; 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Management of Inguinal Hernia in a Tertiary Center, a two-year Retrospective Study. 2021-07-20T13:15:18+00:00 Dritan Cobani Agron Dogjani Arben Gjata Kastriot Haxhirexha Hysni Bendo <p>Background: Inguinal hernia repair remains the most common surgery performed by general surgeons worldwide. There is a lot of published data on the surgical management of inguinal hernias in our country. This study aims to describe our experiences in the surgical management of inguinal hernias and compare our results with those reported in the literature. Material and Method: A descriptive retrospective study was conducted at the University Hospital of Trauma in Albania. From April 2016 - March 2018 were recorded all the data for patients who presented to our hospital and underwent inguinal hernia repair in our hospital, under the conditions of elective surgery. Statistical data analysis was done using SPSS software version 17.0. Results: In this period had a total of 542 patients with inguinal hernias were enrolled in the study. The median age of patients was 46,12 years (range 14 to 92 years old). Males outnumbered females by a ratio of 18.3:1. This gender difference was statistically significant (p = 0.004). Most patients 130 (23.9%) presented late (more than one year of onset of hernia). At presentation, 208 (38.4%) patients had a reducible hernia, 101(18.6%) had an irreducible hernia. The majority of patients 303(55.9 %) had a right-sided inguinal hernia, and 156(28.7 %) had left-sided inguinal hernia with a right-to-left ratio of 1.94: 1. Eighty-three 83(15.3%) patients had bilateral inguinal hernias. 319 (58.8%) patients had an indirect hernia, Conclusion: Inguinal hernias continue to be a source of morbidity and mortality in our center. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Survival Predictors of Preterm Neonates - Single Center Experience. 2021-07-20T02:44:19+00:00 Selma Dizdar Verica Mišanović Refet Gojak Sabina Terzić Duško Anić Hajrija Maksić Elmedina Mrkulić Zijo Begić Basri Lenjani Kenan Ljuhar <p><strong><em>Introduction:</em></strong> Adequate prenatal and postnatal care for preterm neonates not only affects the survival rate, but also the occurrence of chronic diseases, and in the future also affects the quality of life of that children.</p> <p><strong><em>Aim:</em></strong> To examine the influence of independent predictors (weeks of gestation, body weight, sex) on the outcome of the disease and to analyze the influence of the applied ventilatory mode on the final outcome of treatment.</p> <p><strong><em>Material and methods:</em></strong><strong>&nbsp; </strong>The study included neonates (n = 248) born prematurely who were treated in the neonatal intensive care unit for a period of one year due to immaturity-related difficulties.</p> <p><strong>Results: </strong>The mean age of male neonates (n = 119) at birth was 31.13 ± 3.3 weeks of gestation (WG), and females (n = 129) 31.59 ± 3.2 WG. Weeks of gestation have a statistically significant effect on survival (p = 0.0001), for each more week of gestation, the chances of survival increase by 21%. There was no significant difference between birth weight and sex (p = 0.289), and the birth weight of the neonates had a statistically significant effect on survival (p = 0.0001). For every 10 grams of body weight, in our sample, the chance of survival increases by 2%. Ventilation mode showed a statistically significant effect on neonatal survival (p &lt; 0.05), and intubation mode was used as an indicator. If neonates are switched from non-invasive to invasive ventilation mode, the chance of survival in our sample is reduced by 88%.</p> <p><strong><em>Conclusion:</em></strong> Weeks of gestation, birth weight, and the use of a noninvasive mode of ventilation are predictors of a positive outcome for preterm neonates.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Some epidemiological data about Stomach Cancer in Kosovo. 2021-07-20T13:19:19+00:00 Imri Vishi Agron Dogjani Arben Gjata Kastriot Haxhirexha Hysni Bendo <p>Despite the continuing decline in incidence, stomach cancer remains one of the most common and deadly neoplasms in the world [1]. According to the literature, stomach cancer is the third leading cause of cancer deaths worldwide, ranking third after lung cancer and colorectal in global cancer mortality. About 1 in 12 neoplasm deaths can be attributed to stomach cancer, which has 5 times the highest incidence among all cancers, and over one million new cases of stomach cancer are diagnosed each year worldwide.[2]</p> <p>Our objectives were: Evidence and detailed statistical description of demographic, diagnostic, clinical, pathological data of stomach cancer patients are included in this study were hospitalized in two clinical surgery medical centers in the period from January 2009 to January 2019, in University Clinical Center in Prishtina-Department of Surgery, Regional Hospital in Ferizaj-Department of Surgery.</p> <p><strong><em>Material and methods;</em></strong> The study included 115 patients who met the criteria, and the Study variables were obtained from clinical record data that include: Gender (Male, Female); Age; Clinic of the disease: (indigestion Weakness, Weight loss, anorexia, Melena, Abdominal pain, Epigastric pain, Vomiting…); Tumor stage, histopathologic and lesion type...</p> <p><strong><em>Conclusion;</em></strong> Stomach cancer affects both sexes with a preference of men with a ratio of 1.4: 1 (M; F). The most affected age group is 51-70 years which includes about 61.3% of patients. Depending on the localization of gastric cancer, the most affected part of our study was the body of the stomach (46%), the antral part 38%, the cardia part with 15.7%. Typical symptoms in our patients included; Indigestion 46 (40%); Loss of appetite 41 (35.6%); Abdominal pain 70(60.8%); Nausea/ vomiting 35( 30.4%); Postprandial pain 39 (33.9%); Weight loss 56 (48.6%); Melena 19 (16.5%)...</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Diagnosis and Surgical Principles in the Treatment of Acute Injuries of the Flexor Tendons of the Hand 2021-07-20T02:44:24+00:00 Gordana Georgieva Tomislav Jovanoski Zana Aliu Djorgje Djokic <p>Injuries to the flexor tendons of the wrist are a separate chapter in wrist surgery. Flexor tendon injuries still remain a challenge to ensure the patient's optimal outcome.</p> <p>A special problem in the exploration of hand injuries is the accurate assessment of whether there is an injury to one or more tendons, at what height the injury is, and whether it is accompanied by injury to other elements of the hand.</p> <p>On the volar side of the hand, both flexors of the fingers, superficial and deep, or just one of them, maybe injured. If the lesion is in the first zone depending on the severity of the injury, reinsertion or direct tenography is required.</p> <p>In the second zone, there are still ambiguous views on the reconstruction of the deep and superficial flexor, ie. whether the surface flexor needs to be reconstructed. Injury to the flexor tendons in the third zone requires careful exploration for possible injury to the neurovascular elements, and the fourth zone often requires the release of the carpal tunnel.</p> <p>In the most proximal zone of the flexor tendons, the fifth zone, injury to the main blood vessels of the hand and the nerves responsible for sensitive and motor innervation of the hand is possible.</p> <p>Each injury should be approached with careful preoperative examination, appropriate operative technique as well as postoperative rehabilitation in order to fully restore the function of the hand.</p> 2021-03-24T00:00:00+00:00 ##submission.copyrightStatement## Abdominal disturbances in children with Covid-19 2021-07-20T02:44:19+00:00 Ferizate Dika-Haxhirexha Sevdije Koxha Ledia Qatipi Shqiponja Turkeshi Aulona Haxhirexha <p>Covid-19 continues to spread at an unprecedented pace, sparing no country in the world and including almost all ages. Although at the beginning of the pandemic, it was thought that the virus did not affect children, however over time, in different countries, more and more cases of children with Covid-19 begun to appear, though rarely among them were recorded any victims.&nbsp;</p> <p>However, the clinical picture of infections with this virus in children was much more challenging than in adults.&nbsp;</p> <p>In this <span lang="EN-GB">article</span>, we will present the case of three children of ages 4 to 14 years, with signs of acute abdomen, respectively with acute abdominal pain, fever, vomiting, and in whom acute appendicitis was suspected. In all three patients, anamnestic data showed positive family members infected with covid-19.&nbsp;&nbsp;</p> <p>All three children were sent to the surgery ward for follow-up and further treatment.&nbsp;</p> <p>The laboratory analyzes in all of them resulted in increased values ​​of both erythrocyte sediment and CRP, while only in one of them the values ​​of LDH and transaminases (AST, ALT) were also increased.&nbsp;</p> <p>Ultrasonographic examination of the abdomen in two children showed the presence of a small amount of free fluid in the abdomen and mesentery thickening with several packets of enlarged lymph nodes. Radiography of the lungs did not show pulmonary lesions in any of the children. Body temperature ranged from 37.2 to 38.50C, while urine was within the normal range.&nbsp;</p> <p>All children were hospitalized and kept under observation for several consecutive days. At the same time, they were treated with antibiotics of the group of cephalosporins of the third generation, as well as with antipyretics (paracetamol).</p> <p>As their condition improved and the abdominal pain subsided completely, they were released from the hospital with instructions to continue the rest and taking vitamins at home in the form of ready-made preparations for children.</p> <p><strong><em>Conclusion:</em></strong><strong>&nbsp;</strong>While the Covid-19 pandemic is rapidly spreading and not sparing even children, pediatricians and surgeons must be very cautious in treating children with acute abdominal pain since infections with Covid-19, and not surgical diseases, might be the real cause of these concerns.&nbsp;</p> <p>&nbsp;</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Complications of laser Dermatologic Treatments 2021-07-20T02:44:20+00:00 Vladimir Filaj Erisa Kola Ina Kola <p>Over the past three decades, the indications for the use of lasers have increased dramatically. Combined with the interest paid by the media, the volume of laser procedures has progressively increased, as has the number of complications arising from their use.</p> <p>Knowing the principles behind laser surgery can help minimize the potential for complications; however, as with all surgical procedures, in addition to excellent surgical results, undesirable results are inevitable.</p> <p>Laser technologies have evolved effectively these past decades with a broader spectrum of clinical applications accompanied by improved outcomes. Cutaneous lasers and lights are considered safe interventions with an associated rapid healing time. Post-treatment consequences are usually mild and spontaneously resolving, with erythema and edema lasting hours to days. More troublesome while less common adverse events include urticaria, erosions, blistering, infection, hyperpigmentation, hypopigmentation, burns and delayed re-epithelialization [2]. We present some clinical cases with some serious adverse effects of the laser treatments in women and men. There are some treatment options on how to reduce the complications or manage them without long term sequelae, however the clinical experience of the laser operator and the accurate device used influences the safety and the outcomes of the treatment.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## The Complex Femoral injuries after Hippopotamus Bite. 2021-07-20T02:44:22+00:00 Fedor Kovalenko Pantelis Vassiliu Konstantinos Degiannis Dietrich Doll <p>Introduction. Attacks by large animals, which lead to a critical patient condition, have not been systematically and statistically analyzed in the previous literature. Some papers about animal attacks are case reports and address fatal cases. Hippopotamus bite injury is a major trauma associated with complications.</p> <p>Case report. In 2018, an American woman celebrating her 37th birthday in Zimbabwe embarked on a river rafting trip. After the hippopotamus bite, the patient had extensive soft tissue injuries and a comminuted fracture of the right femur. It was undertaken extensive multiple wound debridement and the femur was nailed as the site of entrance of the nail was away from the soft tissue injuries.</p> <p>Conclusion. Usually, hippopotami avoid contact with people. Similar to many wild animals, hippopotami can attack in anticipation of danger, especially when protecting their offspring. In the present case, the inflicted injury is severe and has a combined character.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## A Huge Aneurism of Ascending Thoracic Aorta 2021-07-20T02:44:21+00:00 Andi Kacani Saimir Kuci Arber Aliu Alfred Ibrahimi Aferdita Veseli Arben Baboci <p>Giant Ascending Aorta Aneurysm (AAA) is a rare condition, because of early diagnosis incidence appears to be increasing as a result of routine screening, increased clinical awareness, and improved imaging modalities. The etiology of aneurysms involving the aortic root and ascending aorta can be genetically triggered, degenerative or atherosclerotic, inflammatory, or can result from infectious diseases.&nbsp; According to many studies for ascending aortic aneurysms larger than 6 cm the risk of rupture, dissection, or deaths was 15.6, making it a large life-threatening aneurysm.</p> <p>We present the case of a Giant AAA of about 8,7 cm diameter in a 68 years old man who was successfully operated on for ascending aorta and aortic root replacement under modified Bentall technique using composite mechanical conduit with coronary reimplantation.</p> <p><strong><em>Conclusion; </em></strong>Ascending giant aortic aneurysm is a rare finding, varying from asymptomatic clinical presentation. Surgical treatment remains the standard treatment with very good results. The selection of the operating technique is very individual, depending on the case and the experience of the surgeon.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Isolated Volar Distal Radioulnar Joint Dislocation, a Very Rare and Easily Missed Injury. 2021-07-20T02:44:23+00:00 Dimitar Petrevski Ivo Donevski Antonio Andonovski Radmila Mihajlova-Ilie Simon Trpeski <p><strong><em>Background</em></strong><em>:</em> Isolated distal radioulnar joint (DRUJ) dislocations without associated fracture are very rare entities. A few mechanisms of injury were reported in the literature with dorsal(posterior) dislocation being more common than the volar (palmar, anterior) dislocation.</p> <p><strong><em>Case report:</em></strong> A 26-year-old male, manual laborer presented to our emergency department (ED) 24 hours post-self-inflected injury with right wrist pain, deformity, and decreased range of motion (ROM). The physical examination showed bruising over the dorsal ulnar side of the wrist, loss of the ulnar styloid bony prominence, abnormal volar fullness of the wrist, and gutter deformity on the dorsal aspect of the distal forearm and wrist. The diagnosis was confirmed by comparative radiographs which were followed by closed reduction and immobilization in the below-elbow cast in pronation for 4 weeks.</p> <p><strong><em>Conclusion:</em></strong> Timely accurate diagnosis and conservative treatment with favorable outcome necessitate a proper history on the mechanism of injury with a thorough physical examination, accurate radiographic positioning, and true lateral view.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## A Case Report of Mature Cystic Teratoma in a post-menopausal Woman, a Rare Entity. 2021-07-20T02:44:23+00:00 Ahmed Hassan Abdelmoneim Abdelwahed Abougazia Amal Said Mahan Amal Alobadli Adham Darweesh <p>Ovarian tumours are commonly seen in reproductive age group in women. However, when they occur at extremes of age, the suspicion of malignancy increases. The detection of dermoid cyst at 56 years of age is uncommon, hence proper imaging with CA-125 level monitoring is essential. Awareness of benign tumours or rare possibility of malignant transformation in such age is mandatory for surveillance management or planning the surgical procedure.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Supralevator Abscess Complicated by Necrotic Fasciitis of Peritoneum, Genitalia, Anterior Abdominal Wall and Retroperitoneum. 2021-07-20T02:44:21+00:00 Elena Hadzhieva Dzhevdet Chakarov Evgenii Moshekov Dimitar Hadzhiev Yordan Kalchev Kiril Atliev Boris Sakakushev <p>A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Perioperative Management for Surgical Repair of Ebstein's Anomaly. 2021-07-20T02:44:21+00:00 Marsela Goga Saimir Kuci Alfred Ibrahimi Ervin Bejko Stavri Llazo Ermal Likaj Jacob Zeitani <p><strong><em>Background:</em></strong> Ebstein's anomaly is a rare and complex heart defect that affects the tricuspid valve and is accountable for around 1% of congenital cardiac abnormalities. It is one of the most common congenital causes of tricuspid valve regurgitation. Ebstein's anomaly often is diagnosed prenatally, due to its severe cardiomegaly. Some individuals with this anomaly do not experience complications until adulthood and even then, they have mostly minor complaints like exercise intolerance. An atrial septal defect is most commonly (70-90%) associated with Ebstein's anomaly. However, ventricular septal defect (VSD) can be associated with 2-6% of the cases.</p> <p><strong><em>Case presentation</em></strong><strong>:</strong> This report presents a case of surgical intervention for a 38-year-old female with Ebstein's anomaly symptomatic with moderate-severe pulmonary regurgitation and foramen ovale apertum.</p> <p><strong><em>Conclusions</em></strong><strong>: </strong>Ebstein anomaly is a complicated form of congenital heart disease with variable clinical presentations. The anesthetic plan must also focus on maintenance of RV function and avoidance of increase in PVR. Reversible causes of increased PVR, such as acidemia, hypoxemia, and hypercarbia must be avoided. Agents that lower PVR, such as nitrates, and nitric oxide may be beneficial in patients with severe pulmonary hypertension.</p> <p>With a sound knowledge of the cardiac anatomy, accurate scheming of surgical outcomes, routine follow-ups, multidisciplinary team approach, and better management, an experienced center can ultimately improve the prognosis of such patients.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Disseminated Alveolar Echinococcosis. 2021-07-20T02:44:20+00:00 Liri Çuko Fatmir Bilaj Durim Çela Arlinda Hysenj Borana Bakeri Adriana Babameto Floreta Kurti Irgen Tafaj Etmont Çeliku <p>Alveolar echinococcosis (AE) is caused by the larval form of the tapeworm Echinococcus multilocularis. In humans, E. alveolaris metacestode cells proliferate in the liver inducing a hepatic disorder that mimics liver cancer and can spread to other organs. From 1960 to 1972 mortality was at 70% and 94% after 5 and 10 years of follow-up, respectively. Since then, studies have shown an increasing trend towards improving survival rates [1]. As AE is also spreading to new areas of Eastern Europe, researchers seek to better understand the clinical presentation of pathology, including asymptomatic forms. Clinical case; One 36-year-old woman from Peshkopia has been admitted to the Gastrohephatology department on 20.07.2011 with fatigue, anorexia, dull pain in right hypochondrium, mild epigastric pain, bloating, and weight loss. The epidemiological anamnesis showed that the patient lived in the village and had pets. On physical examination, the patient appeared severely ill with jaundice, massive hepatomegaly, massive mass in the mesogastric area, and anxiety. Laboratory examinations were as follows: Hb 11.1 g/dl, sediment 25 mm/h; leukocytes 6700/mm3; platelets 127000/mm3; prothrombin level 60%, uremia 12.7 mmol/l; creatinine 0.78 mmol /l; ALP 127 U/I; AST 15 U/I; ALT 37 U/I; GGT 131 U/I; bilirubin 3.7 mg/l, albumin 2.8 gr / l, total protein 8.1 gr / l, HbsAg negative, anti-HCV negative. Regarding serology, the titer of anti-echinococcal antibodies was positive (22, n = 11) Conclusions: Clinical presentation and radiologic imaging findings of disseminated alveolar echinococcosis can mimic metastatic malignancy, and diagnosis can be challenging in atypically advanced cases. As the incidence of human alveolar echinococcosis appears to be increasing and, physicians should be aware of alveolar echinococcosis, its epidemiology, and its clinical features.</p> 2021-07-20T00:00:00+00:00 ##submission.copyrightStatement## Ruptured Abdominal Aortic Aneurysm Associated with Left Colon Gangrene and Neurological Disorders, a Very Rare and Life-Threatening Combination. 2021-07-20T02:44:24+00:00 Sokol Xhepa Saimir Kuci Myzafer Kaci Gentian Caco Petrika Gjergo Stavri Llazo Ervin Bejko Alfred Ibrahimi Frenki Vila <p><strong><em>Background:</em></strong> We report the management of a very rare combination of two severe surgical emergencies, ruptured aortic aneurysm with gangrene of the left colon. Both events separately present a high mortality rate in ruptured aortic aneurysms with 48.5%.</p> <p><strong><em>Case report:</em></strong> We present the case of a 59-year-old woman that was admitted to the service of Emergencies at University Hospital Center “Mother Theresa” of Tirana on January 4th of 2013, after being transferred from the Regional Hospital of Durres diagnosed with ruptured aortic aneurysm based on an unclear CT. The patient arrived in a state of profound hypovolemic shock after suffering cardiac arrest and underwent resuscitation at the ICU of Durres Hospital ( no exact information of the anoxic brain time).</p> <p>After a brief volemic compensation in our ICU, the patient was taken to the operating room. Intraoperatively we found an infrarenal r AAA and gangrene of the sigmoid and left colon. Resection and reconstruction by the interposition of a tube graft were performed, followed by a left large hemicolectomy with temporary colostomy realized by the team of general surgeons. Three months later they performed colorectal-anastomosis as a second step operation.</p> <p>Postoperatively the patient had a period of 3 weeks stay in the ICU, mostly due to neurological complications after the ischemic stroke, and on January 29 of 2013, she returned to the Service of Neurology at the Hospital of Durres for further neurological rehabilitation. One year later, in the ambulatory routine check, the patient presented full recovery from surgery and a complete central and peripheral neurological rehabilitation.</p> <p><strong><em>Conclusions:</em></strong> Ruptured aortic aneurysm with gangrene of the left colon is a very rare and severe combination caused by the hypoperfusion of the inferior mesenteric artery in the presence of hypovolemic shock and insufficient collateral circulation. The strategy of treatment includes fast diagnosis, short hypotensive resuscitation, cell-saving and autotransfusion, and the simplest possible surgical reconstruction for both emergencies.</p> 2021-05-20T00:00:00+00:00 ##submission.copyrightStatement##