Albanian Journal of Trauma and Emergency Surgery

76-83

Authors: Daniel Houser, Mark H. Johnston

Background: The presence of foreign bodies in the digestive tract usually occurs in pediatric, adolescent and psychiatric patients. Current Protocols focus mainly on pediatricians and adults. We present some cases mainly of feminine age. Most swallowed foreign bodies will harmlessly pass through the GI tract, but some will lead to health problems if they become lodged (too big to pass, such as a spoon, or small objects like a pill that adheres to a moist surface); traumatize the mucosa (sharp or pointed object, like a razor blade or pin), or cause burn-like illness (biologically active, such as a button battery or a medication patch) may cause problems. which during X-Ray abdominal exfoliation show varying objects in the digestive tract at different levels. The following examinations highlighted the most accurate localization. Asymptomatic clinical data continued to deteriorate, despite imaging evidence. This article discusses the challenges involved in the management of foreign troops in the digestive tract and the re-evaluation of literature

91-98

Authors: Edvin Selmani, Fatmir Brahimi, Leard Duraj, Valbona Selmani, Gjergji Syko, Igli Karanca

Background; This systematic review aims to illustrate the published results of “minimally invasive” procedures for correction of hallux valgus. Based on former systematic reviews on that topic, the literature search was organised by two independent investigators. MEDLINE was systematically searched for available studies. The keywords used were “hallux valgus”, “bunion”, “percutaneous surgery”, “minimally invasive surgery”, “arthroscopy”, “Bosch” and “SERI”. Studies were assessed using the level of evidence rating. A total of 21 papers were included in this review. These studies described a total of 1,750 patients with 2,195 instances of percutaneous, minimally invasive or arthroscopic hallux valgus surgery. Clinical reports of results after minimally invasive hallux valgus surgery at meetings are common. Published results in peer-reviewed journals are less common and the majority of papers are level IV studies according to the level of evidence ratings. We found one level II and three level III studies. Reported complications seem to be less than one may see in one’s own clinical practice. This possible bias may be related to the fact that most studies are published by centres performing primarily minimally invasive hallux valgus surgery.

105 -112

Authors: Lutfi Zylbeari, Zamira Bexheti, Gazmend Zylbeari, Ferizate Dika Haxhirexha, Kastriot Haxhirexha

Background: Gastrointestinal complications are frequent in patients with renal disease and are responsible for substantial morbidity and mortality among these patients in developing countries. Many times, these patients are subjected to endoscopic evaluation and mucosal biopsies are taken for definitive diagnosis. Long before the routine uses of dialysis, patients dying of uremia were found to have a high incidence of gastrointestinal abnormalities (1). Matherials and methods: The survey included 240 persons; 120 of them were dialysis patients, while the remaining 120 were healthy individuals who served as a control group. 54 (45%) of the patients with hemodialysis were females while 66 (55%) of them were males with mean age: 58.20 ± 18.00 years. These patients had been in dialysis for more than 12 years at the Clinic for Nephrology in Skopje and the Clinical Hospital in Tetovo. Results: Gastrointestinal complications were present in 20 (37.0%) out of 54 females while 26 (39.4%) out of 66 males presented with duodenal bulbar ulcers. 84 patients [(females-38/54 (70.4%) and males-46/66 (85.2%)] of the total number of 120 examined patients were found to have chronic gastritis. In conclusion, we found that the incidence of PUD was more than 10 times higher in CKD patients than in those without CKD over a 3-year period between 2008-2010. CKD patients receiving HD, NSAID, or clopidogrel had an increased risk of PUD, compared to CKD patients not receiving these treatments.

118-124

Authors: Ferizat Dika - Haxhirexha, Agron Dogjani, Ledia Kaçi, Lutfi Zylbehari, Kastriot Haxhirexha

Background: C-reactive protein (CRP) is one of the acute-phase proteins which increases during inflammatory conditions. Nowadays, C-reactive protein (CRP) is a commonly used biomarker especially in emergency department (ED) for diagnostics of febrile and infectious patients. It is almost impossible to distinguish the bacterial from nonbacterial (viral) infection by CRP level only - so the detailed history of onset of disease is very important to establish the diagnosis of bacterial infection as a cause of acute abdominal pain. Objective: The aim of this study was to establish the diagnostic value of leucocyte and CRP count in in diagnosing acute abdominal pain. Material and methods: We retrospectively evaluated 159 patients with acute abdominal pain admitted to the surgical department of the Clinical Hospital of Tetova and PHO “Alba – Med” over a period of 2 years respectively from January 20016 to January 2018. All patients included in this study was aged between five to 15 years old. Results: During the study period there were 158 patients (96 were females and 56 males). All the patients suffered from acute abdominal pain, whereas 45 of them had a surgical condition, respectively in 42 of them acute appendicitis as a cause of pain, Meckel’s diverticulitis, jejunal intussusception and ruptured ovarian cyst in three other patients. In 105 patients nonsurgical condition was the reason of acute abdominal pain. CRP was performed within 24 h after admission in all the patients. In the group of patients with surgical disease in 41 of them (91 %) the value of CRP was more than > 5g/L. Conclusions: According to our experience we conclude that the CRP level is not sufficient to predict patients with acute abdominal pain that require surgical treatment.

136-141

Authors: Leart Berdica, Teona Bushati, Alfred Aga, Erisa Kola, Rustem Celami, Agron Dogjani

Background: The concept of carcinoma in situ was first introduced by Broders in 1932 [1] and has been accepted as a well-established notion and diagnostic category in many organs and systems. However, sebaceous carcinoma in situ (SCIS) has not yet been recognized as a concept and diagnostic entity in general pathology or dermatopathology. Such lesions have been commonly misinterpreted as either a benign neoplasm or sebaceous carcinoma. Tumors that do not necessarily arise in pre-existing sebaceous glands are usually invasive at the time of diagnosis, and like their ocular counterparts, can exhibit pagetoid intraepidermal spread. Cases of purely in-situ extraocular sebaceous carcinoma are extremely rare and yet controversial until now. Recognizing sebaceous carcinoma in situ as a valid concept and diagnostic entity that will certainly help to avoid misinterpretation and subsequently under or over treatment of such lesions. In this article, we provide a case report presentation with histopathological examination and a critical review of the literature.

151-162

Authors: Valon A. Zejnullahu, Rozalinda Isjanovska, Besnik X. Bicaj, Vjosa A. Zejnullahu, Astrit R. Hamza, Viktorija Caloska-Ivanova

Background: Acute appendicitis is one of the most frequent causes of abdominal pain. Early diagnosis is the key to success for the surgeon, followed by the treatment with operation or conservative treatment as a new approach, before the stage of gangrenous appendicitis or perforation occurs. Aim: This study aims to establish he role of hyperbilirubinemia as a laboratory marker in prediction of acute appendicitis in the early diagnosis. Materials and methods: This is a cross-sectional study; it included 201 patients admitted in the emergency ward with suspicion for acute appendicitis. All patients that participated in this study have been subject to appendectomy. The blood samples were taken from all patients in order to analyze the level of total/direct bilirubin. Results: The study samples of 201 patients consisted of 67.7% with complicated appendicitis and 32.3% with non-complicated appendicitis. The sensitivity, specificity, PPV, NPV for laboratory marker, as predictor for complicated vs non-complicated cases of appendicitis was as follows: Total bilirubin; specificity (72.3%), sensitivity (54.4%), PPV (80.4%), NPV (43.1%), Conclusion: Elevation of total/direct bilirubin level in patients with clinical signs of acute appendicitis might predict the stage of acute appendicitis, such prediction may help surgeons to provide accurate treatment of the disease without delay in the diagnosis. This accuracy can be further supplemented by using Alvarado scoring model during the clinical approach.

174-181

Authors: Lutfi Zylbeari,Kastriot Haxhirexha, Nasir Behxheti, Ferizate Haxhirexha-Dik, Gazmend Zylbeari, Zamira Bexheti, Jetnire Jakupi-Alimani, Sihana Lika-Ahmeti, Arbnore Qaili, Hanife Lika

Background: End Stage Renal disease (ESRD) as it was historically termed is a term that encompasses all degrees of decreased renal function, from damaged–at risk through mild, moderate, and severe chronic kidney failure. ESRD is a worldwide public health problem. In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost (see Epidemiology). Material and Methods: The blood sample for routine analysis (lipidogram) and specific analysis was taken at 08 o'clock in the morning with the room temperature that variated from 19 to 24°C, before the hemodialysis session, minimum 12 hours of fasting - with tendency to avoid the absorption effect of food by the intestine as well as avoid absorption of lipids and formation of chilomicrones. In all samples regardless of their group, the concentration of ApoC-II and lipids were analyzed in a period of 12 months in a period of 12 months (the measurements were made every three months, it means we totally made 3 measurements in 9 months). Results: The results from patients and controlling group for Apo-C3 and lipid profile (ChT, TG, HDL-ch, LDL-ch) are given in table number 3. A significant statistical difference with p<0.0001 is found from the results of the lipidic profile and ApoC-III of patients with ESRD treated with HD compared with the results of the controlling group for the same parameters. Conclusion: In this study patients with ESRD treated with HD have high parameters of ApoC-III, TG, LDL-ch but low concentrations of HDL-ch due to impaired catabolism of apolipoproteins in this specific group of patients. In all patients symptoms of CDV (myocardial infarction, angina pectoris, ischemia), acute coronary syndrome were noticed.

189-196

Authors: Rudina Degjoni

Background The level of management of traumatic health care services in Albania as a service of the Military University Hospital in Emergency Care differs in relation to other university hospitals across the country, mainly due to changes in the public health of the population. The article aims to present the management of traumatic patients at the Military Hospital in Albania, providing examples of the number of cases that have been addressed in the spread of this disease as epidemiology in Albania. The literature review and data statistics will be carried out by using the hospital records that will be used for further research in Albania. In addition, there is a study of international reports on Trauma management issues, trauma care and quality in Trauma. Much of the results consider the necessity of adopting a comprehensive traumatic system, focusing on quality management and improving trauma care to increase survival and reduce complications to the wounded. Urban conditions and public health policies are the most important factors in developing and implementing programs to improve emergency trauma care services. The heterogeneity of the population and its geographical distribution, the complexity of road accidents, are challenging factors for quantitative research on trauma management and the effectiveness of its care. Staff training in all areas, combined with the existence of modern vehicles and equipment, means of communication and timely transfer of the ambulance, contribute to the treatment of patients with urgent trauma, life saving and prevention of all types of disabilities.