Albanian Medical Journal

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Authors: Vitorino Modesto dos Santos, Lister Arruda Modesto dos Santos

We read the interesting cross-sectional study done by Gjerazi et al. about risk factors of surgical site infections in a general surgery ward, which involved 678 patients with mean age of 52.7±14.5 years. Post-operative skin infections were observed in 41 patients (6%) and 22 of them (53.6%) were males. The authors adequately emphasized the role of these infections on the increased time of hospitalization, the postoperative morbidity and mortality, in addition to significant elevation of medical care costs.

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Authors: Caner ahin1, Ceyhun Varim2, Sena Budak3

Aim: We aimed to investigate body mass parameters using bioelectric impedance measurement in patients who encountered our dietary clinic and, in addition, we aimed to investigate the relationship between these parameters and Epworth Scale. Methods: 156 patients were enrolled in this study which was conducted in Akyazi State Hospital, Sakarya, Turkey, during October 2013 October 2014.Age, gender, height, weight, neck circumference, body mass index, waist circumference, and body mass analysis using Bioelectric Impedance measurement device were examined. Patients were asked to fill Epworth sleep index. Results: 18 of the cases were males and 138 were females. Mean anthropometric indices of the patients were as follows: height: 159.6±7.3 cm; weight: 91.7±63.6 kg; body mass index: 34.2±5.2 kg/m2; neck circumference: 37.3±3.1 cm; waist circumference: 111.3±13.3 cm, and; Epworth Scale: 6.5±5.1. Body mass index and body fat mass exhibited approximately the same magnitude of the correlation with Epworth scale (R=0.628 and R=0.626, respectively). Waist circumference, visceral fat ratio, body fat percentage, correlation values was assessed at the level of medium significance (0.588, 0.573 and 0.526, respectively). Conclusion: Obesity is one of the predisposing factors of Sleep Apnea syndrome. Biolectrical Impedance measurement provides practical, inexpensive method analysis of the body distribution. This can be thought of as a pre-screening test. Patients with excess weight who attend dietary clinics should be referred to the ENT services if body parameters are above certain values in order to prevent their potential morbidity.

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Authors: Artid Duni, Vilson Ruci, Julian Ruci, Leonard Lazaj, Lorenc Murati, Erjon Sejati

Aim: Fractures of the femoral neck, femoral head and trochanteric region are among the most challenging pathologies every orthopedic surgeon has to deal with in the everyday practice, especially in a hectic tertiary trauma center. Their incidence is increasing with ageing of the population and lifestyle changes towards sedentary life and motor vehicle use. Methods: During 2004-2014 we investigated the total number of femoral neck and trochanteric fractures treated in our facility in Tirana, Albania, in order to describe the incidence by the type of fracture (femoral neck, femoral head, transtrochanteric), the annual trend of treatment modality, the age groups affected, the hospitalization, the operability, and the mortality rate. Results: A total number of 2180 femoral neck, femoral head and trochanteric fractures were treated in our facility during the last decade. About 49% were male patients and the mean age was 67.7 years. This constitutes 9.33% of the total number of patients treated for the same period. There were 828 (37.98%) trochanteric fracture cases, 1347 cases (61.79%) were femoral neck fractures and 5 cases (0.23%) were femoral head fractures. The modalities of treatment were as follows: 982 cases or 45% underwent partial prosthetic replacement, 704 cases or 32.29% had ostheosynthesis with different forms of plates and/or screws, 0.73% cases were treated with total hip replacement and 478 cases or 21.93% were treated conservatively. Overall, inpatient mortality was 1.33%. Conclusion: The incidence of femoral neck and trochanteric fractures in the older age groups is increasing every year. The modalities of treatment are oriented towards modern protocols and the operability is increasing year by year. Lower hospitalization and higher operability should be our future goals in Albania.

6

Authors: Mirko Zganjer, Ante Cizmic

In this article we present a rare pathology of the spleen, namely the wandering spleen. Wandering spleen is defined as a spleen without peritoneal attachments, only attached with its pedicle. Wandering spleen is a rare condition in which spleen is located anywhere in the abdomen. The syndrome may be diagnosed during infancy or childhood, but it is not infrequently an incidental finding in adults. In the international literature, there are two methods of treating ectopic spleen - splenopexy and splenectomy. If there are no associated anomalies, surgical treatment of excess spleen is necessary in case of complications, such as torsion or places where there is a possibility of common trauma. We report our three Croatian patients with wandering spleen, and in all of these patients we performed splenectomy. All the three patients had recurrent pains in the lower parts of abdomen. In all patients we found torsion of the ectopic spleen. In one of the patients we performed open splenectomy, in another one we conducted laparoscopy splenectomy, whereas in the other patient we tried to do laparoscopic surgery, which we completed with conversion. Wandering spleen is an uncommon problem with quite rare clinical presentations. Methods of treatment depend on clinical presentation and findings at operative surgery.

7

Authors: Artan Bodeci, Agim Sallaku, Agim Karaj, Euglent Hoxha

Axillary dissection is of great importance in breast surgery. Since the Halsted or Fisher era, the concepts have significantly changed. In the 1990-ies, the concepts evolved considerably. Nowadays, the contemporary sentinel lymph node serves as a modern treatment approach, considering it as an indicator or predictor in the prognosis of breast cancer. This technique can predict the patient s prognosis and of course the radicalism of surgery treatment. It has been recently reported the outcome of this technique in the international literature, but in Albania several issues should be considered in this regard. Nevertheless, the contemporary sentinel lymph node is a worldwide accepted approach, and this review tends to be focused on it, in order to revitalize our surgery treatment. Keywords: breast surgery, complete axillary lymph node dissection, contemporary sentinel lymph node.

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Authors: Aneida Hodo Vevecka, Marinela Serban, Jola Klosi, Elizana Petrela, Ergita Nelaj, Mihal Tase, Carmen Ginghina

Aim: To assess the clinical, echocardiographic and laboratory characteristics of pulmonary hypertension (PH) due to left heart diseases (LHDs), and to assess the prognostic role of PH in patients with LHDs. Methods: This study was conducted at the University Hospital Center Mother Teresa in Tirana and the Institute of Cardiovascular Emergencies Prof. C.C Iliescu , Bucharest. The study population included 208 patients, 53.8% female, average age 63.04±11.26 years. Inclusion criteria consisted of pulmonary artery systolic pressure (PASP) >50 mmHg due to LHDs. Patients were divided into four major groups: patients with left ventricle (LV) systolic dysfunction (N=71), patients with LV diastolic dysfunction (N=35), patients with mitral (N=66) and aortic (N=36) valvulopathies. Anthropometric data, symptoms, blood tests, transthoracic echocardiography, six-minute walking test distance (6MWT), comorbidities and treatment were recorded. Data regarding death were taken from family if death occurred outside hospital. Patients were followed every six months. Average follow-up time was 1.8±1.2 years. Results: PASP correlated will the severity of heart failure (r=0.268, P<0.001) and 6MWT distances (r= - 0.313, P<0.001). There was no significant relationship between PASP and LV ejection fraction (r=0.107, P=0.126). PASP correlated with LV diastolic dysfunction (r=0.206, P=0.034). PASP directly influenced mortality (r=0.348, P<0.001): each unit increase of PASP, increased by 8.5% the probability of death. Conclusion: PH due to LHDs aggravates HF symptoms and reduces physical activity, indifferent of LVEF. PASP is influenced by LV diastolic dysfunction. With its powerful impact on mortality, PH may be considered a marker of primary disease which requires specific treatment.

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Authors: Adriana Ruseva, Lidia Georgieva, Diyan Tochev, Ilko Kosturkov, Zhivka Boneva, Stella Yordanova, Diana Nikolovska

Aim: Physical activity is a main component of energy balance and it is of great importance for the overall health prosperity. There is convincing evidence for the relationship between physical activity and some certain type of carcinomas. Colorectal cancer (CRC) is one of the most important neoplasms in association with physical activity. Our aim was to examine the relationship between recreational physical activity and the risk of developing CRC. Methods: We investigated 540 people, divided into two groups: 270 patients with CRC and 270 healthy controls. A questionnaire, including information about recreational physical activity, was completed from each participant. CRC was diagnosed by fibro-colonoscopy with biopsies. Because of the conflicting data about the risk of colon cancer and rectal cancer, we considered the association of recreational physical activity and colorectal cancer risk in men and women, generally and by sub-site in particular. We selected the last five years of life, as a period of impact. Collected data was statistically processed. Results: There was a relationship between some of the examined types of physical activity and CRC risk, and that performing none of the indicated activities in the questionnaire increased the risk of this carcinoma. Conclusion: Considering the positive role of physical activity in the overall health prosperity, and for the prevention of CRC in particular, we recommend employment of this healthy lifestyle characteristic in the general population.

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Authors: Edite Sadiku, Stela Taci, Arvin Dibra, Ergita Nela, Adriana Babameto

Cholestasis is defined both clinically and biochemically, with varying degrees of jaundice, pruritus, and elevated levels of conjugated bilirubin, alkaline phosphatase, -glutamyl transpeptidase, 5'-nucleotidase, bile acids, and cholesterol. A conventional categorization of cholestatic liver diseases has divided these factors into intrahepatic and extrahepatic causes. Intrahepatic cholestasis may result from hepatocellular functional defects or from obstructive lesions of the intrahepatic biliary tract distal from bile canaliculi. Cholestasis may also be related to mixed mechanisms in diseases such as lymphoma. By convention, cholestasis is considered chronic if it lasts more than months. Most chronic cholestatic diseases are purely intrahepatic, whereas sclerosing cholangitis may affect small and large intrahepatic and/or extrahepatic bile ducts. The differential diagnosis of cholestatic disorders can be wide. The first critical step is to differentiate intra-and extrahepatic cholestasis. A careful patient history and a detailed physical examination are essential in the diagnostic process. Keywords: extra-hepatic cholestasis, hepatology, intrahepatic cholestatic disorders.