Albanian Journal of Trauma and Emergency Surgery 2022-07-20T09:06:40+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.</p> <p><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.</p> <p>Under the editorship of <em>Asc.&nbsp;Prof. Dr. Agron Dogjani,&nbsp;MD, Ph.D., FACS, FISS,&nbsp;</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;</p> <p>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> <div dir="auto"><em><strong>Impact Factor Value of 1.131</strong> </em>based on&nbsp;International Citation Report (ICR) for the year 2021-2022</div> <p><strong>ICV - Index Copernicus Value - 2019 =&nbsp;</strong><span style="text-decoration: underline;">77.13</span>; &nbsp;<strong>- 2020</strong> = <span style="text-decoration: underline;">88.13</span> &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</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> Analyzing Mortality in Burned Patients with Lethal Area 50. 2022-07-20T09:06:40+00:00 Bajram Abdullahu Monika Belba <p><strong><em>Background; </em></strong>Clinical outcome is the most measurable of the critical care activity. Although every burn center has its own particular limitations, it is clear that exists a minimum standard of survival after burn injury which is LA50 (Lethal Area 50).</p> <p>The aim of this study is to present demographic and epidemiologic features of severe burns in Albania in the period 2009-2019 and to analyze burn mortality as an important outcome measure analyzing LA 50.</p> <p><strong><em>Material and Methods; </em></strong>The study is retrospective clinical and analytical. Since our burn center is the only one in the country it encompasses all the cases with moderate burns from the capital and severe burns. The data used are obtained by the analysis of the medical records of 1684 patients hospitalized in Burns Service ICU near University Hospital Center in Tirana, Albania during 2009-2019.</p> <p><strong><em>Results;</em></strong> While comparing the decade (2009-2019) with the previous one (1998-2008) there is a progressive decrease of mortality (6.89% versus 10.5%) of our burn patient population although mean BSA (%) burned increased to 25.6±19.1 % (versus 22.8±14.7%). LA 50 for all patients was 80.04%, for children was 77.7%, for adults was 87% and for elderly was 52.28%. The mortality rate of all ICU burns as an average for 2009-2019 was 0.35 cases per 100000 population/year.</p> <p><strong><em>Conclusions;</em></strong> The long-term studies and the comparison of our results with the ones of other burn centers have allowed us to determine the actual level of care and as well as to build up contemporary protocols in order to improve the treatment with the objection decreasing the mortality. Improvements in overall mortality expressed by LA 50 noticed it as an important outcome measure.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Functional Outcome of Arthroscopic Meniscal Root Repair. 2022-07-20T07:41:24+00:00 Nicholas Antao Clevio Desouza <p><strong>Objectives: </strong>The aim of the study was to assess the functional outcome of the knee in patients before and after meniscal root repair.</p> <p><strong>Material and Methods</strong>: This study was a prospective study done on 52 patients with Meniscal Root tear treated by arthroscopic repair. The follow-up period was 6 weeks, 3 months, and 6 months. Functional outcome was assessed using the VAS and Lysholm Knee Score.</p> <p><strong>Results</strong>: The VAS pre-operative was 7.46, the VAS post-operative at 6 weeks was 4.23, the VAS post-operative at 3 months was 3.12 the VAS post-operative at 6 months was 1.19. As compared to preoperative scores at the end of 6 months the difference was statistically significant with a p-value &lt; 0.001. Following surgery there was an excellent outcome in most of the cases with respect to the range of motion, overall, the improvement in the range of motion was statistically significant with a p-value &lt; 0.001. On the evaluation of the Lysholm Knee Score, there was a significant difference between the pre-operative and post-operative scores at each follow-up. The pre-op was 68.52, the Lysholm Knee Score post-op - 6 weeks was 81.72, the Lysholm Knee Score post-op - 3 months was 85.72, and the Lysholm Knee Score post-op - 6 months was 92.23. As compared to preop scores at the end of 6 months the difference was statistically significant with a p-value &lt; 0.001.</p> <p><strong>Conclusion</strong>: In the present study we found that sports-related injuries were commoner, seen more in males and in young. Following meniscus repair, it is possible to get a good range of motion back post-operatively. A fair number of cases get back their knee function if appropriate post-operative physiotherapy rehabilitation protocol is followed.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Success Rate and Complications Associated with the Surgical Treatment of Cervical Spondylosis Myelopathy in Albania. 2022-07-20T07:43:48+00:00 Nehat Halili Artur Xhumari <p><strong><em>Background:</em></strong> Patients suffering from cervical spondylotic myelopathy (SCM) and that do not respond to conservative treatment could benefit from anterior cervical spine surgery. However, surgical intervention is associated with increased risk of complications and therefore the decision to operate should be weighed against benefits. The purpose of this study was to describe the effectiveness and the rate of complications of anterior cervical spine surgery among CSM who do not respond to conservative treatment in Albania. &nbsp;&nbsp;</p> <p><strong><em>Material and Methods</em></strong><strong>: </strong>A total of 100 CSM patients who did not respond to conservative treatment and who showed up at our Service during 2014-2019 were subjected to anterior cervical spine surgery to resolve the CSM related signs and symptoms. The success rate as well as short-term and long-term complication of surgery were evaluated and reported.&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong><em>Results:</em></strong> The mean age of CSM patients (59% males) in the study was 51.5 years. One surgical procedure was employed in 90% of CSM patients whereas two procedures were necessary in the remaining 10%. The overall success rate of anterior cervical spine surgery was 70% (excellent in 40% of CSM patients and good in 30% of patients) whereas in 30% of CSM patients’ surgery did not bring any benefit or there were no changes compared to before the surgery. The overall rate of complications was 16%; no patients died following surgery. Specific complications were rare and varying from 1% of patients (Brown-Sequard syndrome, vocal cord paresis, wound infection) to 3% (subcutaneous hematoma).</p> <p><strong><em>Conclusion:</em></strong> Anterior cervical spine surgery is associated with a relatively high success rate and a low level of post-operative complications and it might be regarded as a safe treatment among these CSM patients who do not respond to conservative treatment.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Some Consideration about Port Site Hernia after Laparoscopic Surgery. 2022-07-20T07:54:18+00:00 Kastriot Haxhirexha Agron Dogjani Aulona Haxhirexha Labeat Haxhirexha Blerim Fejzuli Aferdita Ademi <p><strong><em>Introduction:</em></strong> Port site hernias continue to be a major problem in laparoscopic surgery. The causes of this type of hernia are numerous. The main ones are operative wound infection, obesity, male gender, diabetes, BPH, etc. However, in addition to these factors it seems that in the etiology of post laparoscopic port - site hernias are at least two other factors that have an impact on these complications.</p> <p>Aim of the article is to assess the role of different factors in the occurrence of port site incisional hernias according to our experience.</p> <p><strong><em>Material and Methods:</em></strong>&nbsp; the 187 patients who were operated on at the General Surgery Department of the Clinical Hospital of Tetovo between January, 2017 and June, 2019 on whom the surgical intervention was performed through laparoscopic techniques were included in this study. The reason for the surgical interventions has been various surgical pathologies of the abdomen such as cholecystolithiasis, acute appendicitis, cysts of the liver, ovaries and kidneys, etc. Postoperative complications in these patients, especially port site hernia will be in the focus of our study.</p> <p><strong><em>Results:</em></strong> Out of the total of 187 patients included in this study the occurrence of incisional hernia was recorded in six of them. In five patients the hernia was localized at the site of insertion of the supra-umbilical trocar, while in the other, the trocar was inserted below the xiphoid process. From our records it happened that in all these patients, with postoperative hernia, the insertion of the cannula was done with the cutting trocar. At the same time in all six patients with post laparoscopic hernia the surgical intervention performed was cholecystectomy or appendectomy. Thus, the removal of the gallbladder and appendix, without the use of an Endo-bag, was performed at the site of the hernia presentation. In all these patients the entrance porta infection in which the hernia has occurred, was registered in the early post operative period.</p> <p><strong><em>Conclusion:</em></strong> Of the many factors that increase the risk of incisional hernias, at the site of cannula insertion during laparoscopic interventions, it seems that the type of trocar and the place from which the extruded organ is removed, if it is done without the use of an Endo-bag, are very important.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Characteristics, Effect of Histological Grade and Localization on the Prognosis of Colorectal Cancer. A retrospective Study. 2022-07-20T07:52:53+00:00 Enkelejda Çuedari Majlinda Ikonomi Anila Pema (Kristo) Dhurata Tarifa <p><strong><em>Background:</em></strong> Colorectal cancer is the third most deadly cancer and the fourth most frequent in the world according to GLOBOCAN 2018. The number of new cases is growing up, which may also be related to lifestyle. Many studies have shown a difference in the number of males and females, correlation of localization, stage, and grade with prognosis.</p> <p><strong><em>Material and Methods:</em></strong> In our study were included operated cases with colorectal cancer in University Hospital Center “Mother Theresa” during the period from January 1, 2016, to December 31, 2017.</p> <p>In our study, the total number of patients enrolled is 334. In the end was evaluated the correlation between histological grade, stage, and localization with prognosis.</p> <p><strong><em>Results:</em></strong> From the study resulted that males were affected more than females by colorectal cancer.</p> <p>The average age of diagnosis of colorectal cancer is 63.9 (±12.4) years. Moderately differentiated adenocarcinoma, histological grade II and pathological stage pT3N0Mx after TNM are predominant.</p> <p>The commonest localization is the rectum. Disease-free survival is better in stages I and IIa than in other stages, least favorable in poorly differentiated adenocarcinoma.</p> <p><strong><em>Conclusion:&nbsp;</em></strong>In Albania, patients diagnosed with CRC showed a low survival rate specific to cancer.</p> <p>The type of histology, the stage of cancer, the level of CEA at diagnosis, and the type of treatment a patient received significantly determine the mortality rate.</p> <p>Therefore, cancer screening programs can help to detect the disease at an early stage and initiate timely available treatments in order to extend the life expectancy of CRC patients.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Breast Cancer Disease Burden in Albania 2022-07-20T07:51:00+00:00 Anila Pema (Kristo) Dhurata Tarifa Majlinda Ikonomi Flutura Proko Alketa Ymeri Lindita Shehu Besiana Poga <p><strong><em>Introduction;</em></strong> There are data on an increase in cancer cases in Albania in recent decades, this growing trend of cancer in the Albanian population is due to the rapid increase of habits or unhealthy behaviours such as; smoking, excessive alcohol consumption, unhealthy diet, high levels of obesity, and physical inactivity. However, Albanian men and women show one of the lowest values (in terms of age) in the region of Southeast Europe. In Albania still, we do not have official data regarding the number of breast cancer diagnosed patients either their characteristics, or pathological profile.</p> <p>Our purpose is to conduct retrospective study of number of Breast Cancer patients treated and diagnosed in Albania during 2018.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong><em>Material and Methods; </em></strong>We have recorded and recorded all breast cancer data from the registry of the Oncology Service at University Hospital Center “Mother Teresa “and private clinics in Tirana and from the registries of the district hospitals, during 2018.</p> <p><strong><em>Results;</em></strong> Total number of breast cancer patients treated and diagnosed in 2018, from them 506 patients were diagnosed and treated with breast cancer of all stages in our hospital. Since the registry of cancer is still not untirely functioning the data represents only our hospital not.</p> <p><strong><em>Conclusions;</em></strong> Breast cancer remains a major public health concern worldwide. Trends in the incidence, mortality, and regulated life years of the disabled are varied across regions and countries, suggesting the allocation of appropriate health care resources for breast cancer, which should have the highest level of evaluation.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Characteristics of Patients who Visited the Emergency Department due to self-poisoning Suicide Attempt: A Retrospective Study. 2022-07-20T08:09:08+00:00 Nefise Büşra Çelik Avni Uygar Seyhan Semih Korkut Erdal Yılmaz Nurhayat Başkaya Nurdan Yılmaz Şahin <p><strong>Background: </strong>The aim of this study is to evaluate the sociodemographic characteristics, clinical conditions, and results of patients who were admitted to the emergency department (ED) due to suicide attempts by self-poisoning intentionally.</p> <p><strong>Methods:&nbsp;</strong>This retrospective study was conducted between January 1 and December 31, 2017, in the ED of Istanbul Lutfi Kırdar City Hospital, University of Health Sciences. Patients of only attempted suicide through taking overdose drugs with the intent of self-poisoning and over 12 ages were included in the study, which included 391 cases. Patients who attempted suicide in any different ways than self-poisoning were excluded.</p> <p><strong>Results:&nbsp;</strong>Our study is consisted 69.8% (n=273) of female and 30.2% (n=18) of male patients. The mean age of the total cases was 31.01±12.064, which the youngest case being 14 years old and the oldest being 73 years old. The marital status of the cases is as follows: 140 (35.8%) married, 205 (52.4%) unmarried, 42 (10.7%) divorced, and 4 (1%) widow/widower. Istanbul is covering a major population of patients (93.1%) as a living place. The study has resulted in 58.3% ED discharge, 27.1% hospital leaving, and 10.5% Psychiatry unit admission. It can be stated that elderly people aim for death more than young people via their suicide attempts. The reasons for the suicide of the patients included in the study were grouped as a secondary gain, anger, and death. We found that secondary gain was the reason for teens mostly. We divided into categories clinical results as ED discharge, psychiatrist hospitalization, Intensive care unit (ICU) admission, and discharge against medical advice (DAMA). The patients who attempted suicide with the aim of death were hospitalized in the psychiatry unit, and the attempts caused by secondary gain were discharged from the ED. Patients who had taken paracetamol for suicide, which is contain 70.10% of the total cases, were discharged from the ED, after the examination. It was detected that 39.29% of the cases who had Suicidal ideations again, had a psychiatric disease in their medical history.</p> <p><strong>Conclusions:&nbsp;</strong>Suicidal behavior is a very comprehensive topic when considering its etiology and risk factors, there are many variables as well. Since it is one of the serious public health issues and causes of death, the risk factors must be identified and preventions to be taken should be determined. In addition, when elderly people attempt suicide, more medical care should be taken during ED, since they are more focused to die and fall into the category of severe cases.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Transarterial Chemoembolization in Hepatocellular Carcinoma, Albanian Experience. 2022-07-20T08:11:27+00:00 Ilirian Laçi Alketa Spahiu <p>Liver cancer is the sixth most common cancer worldwide in terms of the number of cases (626,000 or 5.7% of new cancer cases) but due to the very poor prognosis, the number of deaths is nearly similar (598,000). The survival rate is 3% to 5% in cancer registries for the United States and developing countries. The modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the favorite staging system. There are many patients who initially present with the intermediate-stage disease, and in this setting transarterial chemoembolization (TACE) is the treatment of choice.</p> <p>The purpose of this article is to highlight and discuss the role of chemoembolization in the treatment of hepatocellular carcinoma, including the results of recent large studies, and the concept of combined therapies, illustrating our case.</p> <p>The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate the further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process which have shown promising initial results but have failed external evaluation and have not been translated to the clinical aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.</p> <p><strong><em>Conclusion:</em></strong> TACE is a safe method for prolonging patients' survival with unresectable HCC. The correct treatment of HCC is concentrated in cancer centers, and cooperation between multiple specialists is necessary.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Surgical Treatment of Painful Nerve Injury after Knee Arthroscopy. 2022-07-20T07:38:11+00:00 Ridvan Alimehmeti Florian Dashi Arba Cecia Gramoz Brace Mit’hat Demneri <p><strong><em>Background; </em></strong>Pain at the surgical site is an important concern, especially in locations of main joints which may resolve important limitations of movement.</p> <p><strong><em>Materials and Methods</em></strong>; We present the case of painful dysesthesia after knee surgery for traumatic meniscal rupture in a young lady. She presented with painful dysesthesia, limitation of knee flexion, and severe pain in light touch and pressure on the mid-patellar area of the left knee.&nbsp;</p> <p>Tinel’s sign at the site of surgical scar, dysesthetic area (abnormal sensation) corresponded with the medial reticular nerve at surgical exploration under a microscope.</p> <p><strong><em>Results; </em></strong>Microsurgical exploration of the three nerves of medial subcutaneous nerves revealed the branch stack in the scar. The distal end was internalized subfascial inside the muscle fibers of the medial vastus of quadriceps femoris muscle according to Dellon. The other two were released from adherences and found to be in anatomical continuity were left in place. Immediate resolution of dysesthesia was referred by the patient and the amplitude of motion was complete at one-month postoperative control. She remains pain-free 4 months from surgery and the area of dysesthesia remains anesthetic at the center.</p> <p><strong><em>Conclusions; </em></strong>Surgical identification and rerouting of the distal end of sensitive nerves is an efficient treatment after peripheral nerve injury.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Primary Actinomycosis of the Foot in a 37-year-old female Patient: A Case Study and Review of the Literature. 2022-07-20T07:25:45+00:00 Nusret Xhaferi Antonio Gavrilovski Marija Jakimova Fatime Ukaj Dea Dyla Skender Ukaj <p><strong>Abstract:</strong></p> <p>A parasitic disease called actinomycosis occurs when bacteria spread through body tissues, causing abscesses, inflammation, and pain. It affects the skin or deeper parts of the body and can sometimes affect the blood.[1]&nbsp;<sup>&nbsp;</sup>The symptoms of actinomycosis may mimic those of other diseases or even neoplasms. Remission and exacerbation of symptoms occurring in parallel sequence with the initiation and cessation of therapy is a phenomenon that should increase suspicion of actinomycosis in any of its manifestations.<span style="font-size: 11.6667px;">&nbsp;[2]</span></p> <p>Microbiology, histopathology, and MRI revealed the presence of an unusual infectious agent, Actinomyces spp., which is also known as Madura foot [3]<sup>&nbsp;</sup>This implies a serious difficulty in getting a bactericidal concentration of the effective drug into areas of active infection and seriously questions the possibility of restoring the involved tissues [4, 8]</p> <p>The diagnosis was confirmed by isolation of the organisms by anaerobic culture giving typical molar tooth colonies. Final confirmation was done by histopathological examination.</p> <p><strong><em>Case report</em></strong><strong>; </strong>The patient's condition dates back 5 years before the operative treatment when for the first time the patient reported that she was stabbed with a foreign body in the area of ​​the left foot.</p> <p>The patient was treated at home and in the beginning, did not go to the doctor. She occasionally complained of pain and swelling but the pain was not distressing, with no fever and no swelling of the foot…</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Is acute Appendicitis as an extra Pulmonary Manifestation of Covid-19 infection? 2022-07-20T07:48:48+00:00 Ermira Muco Astrit Xhemali Amela Hasa Deniona Nurci Najada Como <p><strong>Background;&nbsp;</strong>Coronavirus disease-19 (COVID-19) is an infectious respiratory disease. The first confirmed case of 2019-nCoV infection in Albania was reported in Tirana on 08 March 2020, when a patient and his adult son who had come from&nbsp;Florence, Italy&nbsp;tested positive. Patients with COVID-19 can be presented with a series of signs and symptoms. Acute abdomen as a presentation of COVID-19 is rare. The diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen.</p> <p><strong>Case presentation:&nbsp;</strong>We report a case of a 42-year-old male who presented with features of acute appendicitis. SARS-CoV-2 polymerase chain reaction test result was positive for COVID-19. Abdominal ultrasonography and his computed tomography of the chest and abdomen showed a perforated appendix and no infiltrates or abnormalities of COVID-19. The diagnosis of our case was appendicitis with COVID-19 without pneumonia. He was admitted and treated with antibiotic therapy and supportive care. He had an improvement in his health condition which made it possible to leave the hospital on the third day of hospitalization.</p> <p><strong>Conclusion:&nbsp;</strong>Based on our clinical case and literature data, we suggest that clinicians should suspect the diagnosis of acute appendicitis in patients with COVID 19. So the case of acute abdomen pain must be completed with a SARS-CoV-2 test. Therefore we recommend additional studies to reinforce the idea of ​​linking SARS COV 2 infection with acute appendicitis.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Acute Esophageal Necrosis. A Case Report. 2022-07-20T07:46:37+00:00 Irgen Tafaj Edite Sadiku Ines Mamaj Qazim Çili Liri Cuko Arvit Llazani Adriana Babameto <p>Acute esophageal necrosis syndrome, is a rare cause of gastrointestinal bleeding. It is characterized by a particular black coloration, mostly of the distal esophagus, which ends abruptly in the gastroesophageal junction. The hemorrhagic manifestation may be hematemesis, melena or both of them. It is a life-threatening condition with significant difference between the two sexes.<br>We report a case of a 67 years old male with schizophrenia, aspiration pneumonia and sepsis who presented with hematemesis. The endoscopic finding was a black, wide linear necrosis of the esophageal mucosa which extended from the middle esophagus to the gastroesophageal junction, compatible with acute esophageal necrosis. The esophageal lesion healed progressively at the same time with the improvement of the general health condition.</p> <p>We must think of acute esophageal necrosis in critically ill male patients, in their sixth decade of life, with multiple comorbidities and gastrointestinal hemorrhage, because early recognition can help reducing the mortality of this rare syndrome.</p> <p><strong><em>In conclusion,</em></strong> we must think of acute esophageal necrosis in critically ill male patients, in their sixth decade of life, with multiple comorbidities and gastrointestinal hemorrhage. The diagnostic is made most of the time only by the characteristic endoscopic findings. Because of the gravity of this affection, the treatment must be quick and aggressive.&nbsp;</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Perioperative Management in a Patient with WPW Syndrome undergoing Plastic Surgery. 2022-07-20T07:57:57+00:00 Merita Zeka Marsela Goga Saimir Kuci Alfred Ibrahimi Ervin Bejko Krenar Lilaj <p>Perioperative management of patients with preexcitation may become quite challenging, especially if there is no time for adequate preoperative investigation and clinical optimisation, as in emergencies, or even worse, in undiagnosed cases. It is possible that the poorly controlled or unknown underlying electrophysiological abnormality will become unmasked during anaesthesia and surgery, giving rise to potentially life-threatening arrhythmias.</p> <p>In the literature, pre-excitation syndromes have been mainly approached from the view of the disease (i.e., presentation, diagnosis, treatment), while anaesthetic data are scarce.</p> <p>This case report aims to focus on the perioperative management of patients with WPW.</p> <p><strong><em>Conclusion;</em></strong> Managing such cases provides an opportunity to revisit important considerations on Wolff-Parkinson-White&nbsp;syndrome Avoiding neuromuscular blockers may make a difference in avoiding arrhythmias when laryngeal mask airway / general anaesthesia&nbsp;is required in patients with Wolff-Parkinson-White&nbsp;syndrome. Sympathetic stimulation should be avoided as it may shorten the refractory period of AP and alleviate life-threatening arrhythmias.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Choledocho-Duodenal Fistula as a Complication of a Chronic Duodenal Ulcer. 2022-07-20T08:01:26+00:00 Kastriot Haxhirexha Labeat Haxhirexha Agron Dogjani Ferizat Dika – Haxhirexha Aferdita Ademi Blerim Fejzuli Teuta Emini <p>Choledocho-duodenal fistulas are rare disorders that can be of various etiologies. Some of the most common causes of these fistulas are neoplastic processes in the extra-hepatic bile ducts, biliary stones or chronic duodenal ulcers. We will present the case of a patient with a choledocho-duodenal fistula who was treated in our clinic due to a severe episode of acute hepatitis. &nbsp;</p> <p>We will present a case report as follow; a 52-year-old man was urgently brought to the abdominal surgery ward of the Tetovo Clinical Hospital due to severe pain in the right epigastric and subcostal region which also appears in the back region. It is accompanied by nausea, vomiting, sub-febrile fever, and weakness.</p> <p>The patient reports that he has long been treated with proton pump inhibitors such as pantoprazole due to a chronic duodenal ulcer…</p> <p><strong><em>Conclusion;&nbsp;</em></strong>Choledocho-duodenal fistulas are very rare disorders and therefore pose a real challenge to surgeons and endoscopists in terms of their timely diagnosis. However, there are authors who prefer a conservative treatment, while some others suggest surgical intervention respectively fistulectomy, in order to prevent complications that may occur as a result of the regurgitation of duodenal contents in the bile duct.&nbsp;&nbsp;</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Endovascular Treatment of post-traumatic Renal Artery Dissection. 2022-07-20T08:04:59+00:00 Ilirian Laçi Alketa Spahiu <p>Blunt renal artery injuries are rare, and no single trauma center has accumulated sufficient experience to draw meaningful conclusions or recommendations about optimal therapeutic strategies.[1]</p> <p>The increased use of CT scans to evaluate blunt abdominal trauma identifies more acute renal artery injuries that may have gone undetected.[2]</p> <p>Patients with renal injury have limited options such as open surgical repair or anticoagulation.[3] The use of endovascular stents to treat trauma is a good option treatment. [4] But not every case is successful.</p> <p>The purpose of this case report is to describe the importance of accurate diagnosis and successful repair in emergency traumatic conditions by means of interventional radiology in cases of intimal damage to the renal arteries.</p> <p>We will present a 38-year-old man who shows on the emergency room because of an accident with abdominal and thoracic trauma. The patient complained of pain in the right side of the abdomen…</p> <p>Through Angiography, an intimal dissection localized in the upper pole of the right kidney was confirmed. We inserted an expandable balloon stent using a transfemoral approach to successfully repair the dissection.</p> <p><strong><em>Conclusion:</em></strong> Blunt renal artery injury is rare. Nonoperative management should be considered an acceptable therapeutic option. Management of blunt renal injuries includes timely evaluation to maximize the preservation of renal function. Recent management trends support the consideration of endoluminal intervention for traumatic renal artery dissections.</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Non-surgical Treatment of Metastatic Liver Tumors with Microwave Ablation. 2022-07-20T08:07:03+00:00 Ilirjan Laçi Alketa Spahiu <p>With all the measures taken, the trend of liver cancer cases has increased worldwide, as a consequence, this is accompanied by an increase in mortality by 43% (10.3 per 100,000 in 2016 (USA)) [1, 2].</p> <p>Liver cancer is also associated with the lowest 5-year survival rate among all types of cancer (19%) [1].</p> <p>Liver cancer (including intrahepatic bile duct cancer) was the ninth leading cause of cancer death in 2000 and rose to sixth in 2016 [3].</p> <p>This shows that the identification of safe and effective treatments for liver cancer is urgent now.</p> <p>Microwave ablation is a thermal ablation modality that has particular applicability in treating hepatic malignancies primary tumors or metastases. Microwaves can generate very high temperatures in short time periods, potentially leading to improved treatment efficiency in larger ablation zones.</p> <p>We will show a patient male 55 years old. Post-surgery of colon cancer 6 months ago. Normal exam. There is e liver metastasis in the right lobe subcapsular 22mm. The patient was a good candidate for MWA.</p> <p>Conclusions</p> <p>MWA is an effective and safe alternative in patients/tumors that are not suitable for resection. Survival and recurrence outcomes after MWA are significantly improved with significantly shorter hospital stays and operative times, with little or no intraoperative blood loss and minor complications. Its use should be extended more and more in the field of treatment of these patients depending on the therapeutic indications</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement## Pleural Lipoma. A case Report. 2022-07-20T07:56:09+00:00 Fadil Gradica Daniela Xhemalaj Rushan Muhameti Alma Cani Lutfi Lisha Fahri Kokici Dhimitraq Argjiri <p>Lipomas are benign tumors from adipose tissue mostly found within the subcutaneous areas of the body such as the upper back, neck, and shoulder, and rarely encountered in the thoracic cavity.</p> <p>Thoracic lipomas are usually located in the bronchial, pulmonary, or mediastinal areas. The finding of a lipoma in the parietal pleura intrathoracic has been sporadically reported in the literature [1].</p> <p>Most patients remain asymptomatic and the lipomas are incidentally found in a chest radiograph or a computed tomography (CT) examination.</p> <p>We present a case of pleural lipomas treated with surgery and the one-year follow-up revealed no changes.&nbsp;</p> <p><strong><em>Conclusion:</em></strong> The majority of patients with pleural lipoma are asymptomatic, and their lesions are incidentally detected on radiograms Important considerations of identifying alarm features in a suspected liposarcoma and when to consider invasive biopsy and/or surgical intervention.&nbsp;</p> 2022-07-20T00:00:00+00:00 ##submission.copyrightStatement##