Albanian Journal of Trauma and Emergency Surgery

204-213

Authors: Özgür Ekinci, Tunç Eren, Aman Gapbarov, Mert Gacemer, Tulay Ozkinet, Faik Çelik

Aim: Mechanical jaundice may lead to adverse metabolic effects in surgical patients. Our aim was to investigate the effects of octreotid and allopurinol on liver histology and functions in rats with experimantally created mechanical jaundice. Methods: The subjects were divided into five main groups. The rats in Group I (Control) received no interventions. In Group II, common bile duct ligation (CBDL) was performed. In Group III, the same ligation procedure was performed followed by the administration of octreo tid. In Group IV, the rats received allopurinol following CBDL and in Group V (Sham), the common bile duct was dissected and left intact. After sacrification of each rat on the seventh postoperative day, blood samples were collected for serum hematocrit, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, and albumin measurements in addition to the histopathologic examinations of the collected tissue specimens from the liver, terminal ileum, and pancreas. According to statistical analysis, a value of p<0.05 was considered as significant. Results: The direct bilirubin, AST and ALT levels were detected to be significantly elevated in the groups II, III and IV, in which CBDL was performed (p<0.05). While significant reductions of serum direct bilirubin, AST and ALT levels were detected in the octreotide group, these parameters were significantly elevated in the allopurinol group (p<0.05 and p<0.05, respectively). There was no significant difference of hematocrit and albumine levels among the study groups (p>0.05). Additionally, in the allopurinol group four rats were found to have increased serum amylase levels and the histopathologic evaluations of their pancreatic samples revealed findings of pancreatitis. According to the histopathologic examinations, significant alterations were detected between the control and sham groups (groups I, V) and the CBDL groups (groups II, III, IV). However, these histopathological findings revealed no significant differences within the subgroup of subjects including CBDL alone (Group II), and CBDL along with the administration of either octreotide (Group III), or allopurinol (Group IV). Conclusion: The use of octreotide in mehanical jaundice may have protective metabolic effects. Further studies are considered necessary to be carried to support these findings.

220-227

Authors: Gëzim Galiqi, Artan Koni, Flamur Tartari, Albert Pesha , Shpëtim Ymeri, Luan Bajri, Shkëlqim Ferko, Anton Ndoj

Aim: To represent our data regarding use of buccal mucosa for treatment of recurrent urethral stricture. Evaluating effectiveness of buccal graft for reconstruction of urethral segment both penile and bulbar urethra. Materials and methods: We repaired 95 urethral strictures with buccal mucosa grafts from 2004 to 2015. Mean patient age was 39 years. The etiology of stricture was unknown in 54% of cases in other cases ischemia, trauma, instrumentation waere the reason. 96% had undergone previous urethrotomy or dilation. The buccal mucosa graft was harvested from lower lip mostly. Mean graft length was 3.8 cm. The graft was placed on the ventral and dorsal bulbar urethral surface in 61 and 34 cases, respectively. In pendulous urethra we routinely use the dorsal graft the Asopa inlay graft or Barbagli onlay graft. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean follow-up was 36 months (range 16 to 62). Results: We had a success rate of 77% with dorsal inlay or onlay flap for pendulous urethra inferior than ventral graft used for bulbar urethra which was 81% success rate. Conclusions: In our experience the placement of buccal mucosa grafts into the ventral or dorsal surface of the bulbar urethra showed an acceptable success rates 81% and 77% respectively . Longer times of follow up is need to see if the results deteriorated more.

235-244

Authors: Rovena Bode, Eriol Braholli, Asfloral Haxhiu, Xheladin Draçini, Etmont Çeliku

Background: Cecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. The diagnosis is not always easy and in the majority of cases it is usually made during laparotomy. The aim of the present study is to retrospectively report our experience with solitary cecal diverticulitis, to determine its incidence in patients presenting as an acute abdomen, as well as identify the symptoms and clinical features that may aid in making a pre -operative diagnosis. And to compare this with a review of the literature, focusing on the surgical treatment and also on the indication of appendectomy in the presence of cecal diverticulitis not requiring surgery. Material and methods: Data was collected in patients hospitalized for acute appendicitis or acute abdomen, in the surgical emergency unit of University Hospital Centre "Mother Teresa" Tirana, in a period of 3 years (2015-2017). Sex, age, duration of symptoms, preoperative diagnosis, management, intraoperative findings, histologic examination, length of hospital stay and complications of all patients affected by solitary cecal diverticulitis were reviewed. Results: In the study period, 15 patients presented with a solitary cecal diverticulitis. All patients presented with abdominal pain, additional symptoms were nausea, vomiting and fever. The mean white blood cell count was from 8500-19.200/mm3, while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. Intraoperative findings ranged from localized /circumscript peritonitis to generalised peritonitis due to acute diverticulitis and a normal appendix. Surgery ranged from diverticulum resection accompanied to appendectomy, to ileocecal resection, and right hemicolectomy. Conclusions : Cecal diverticulitis should be included in the differential diagnosis of the cases with pain in the right lower quadrant. Preoperative diagnosis of cecal diverticulitis cannot always be made, since the signs and symptoms are similar to acute appendicitis, but is important in order to decide how to manage this condition. Diverticulectomy and incidental appendectomy are the preferred method of treatment in uncomplicated cases. Right hemicolectomy is a recommended treatment option in complicated patients or those suspicious for tumor during surgery.

256-261

Authors: F. Gradica, D. Xhemalaj, A. Dogjani, L. Lisha, Dh. Argjiri, I Skenduli, S. Buci, A. Mici, Sh. Osmanaj, V. Demko, S. Ruci, A. Cani, F. Kokici, Y. Vata, D. Bozaxhiu

Background: Severe thoracic trauma is the main cause of deaths in US about 10-20%. Causes of severe thoracic Trauma are: Penetrating trauma, Gunshot wounds, Stab wounds; Gunshot wounds on the chest is the most lethal – 50%. Only 7-10% undergoes hospitalization prior to death. Death occurs due to heart & great vessel injuries. Aim of study: Analyses the patients with Severe Thoracic Trauma, Initial Evaluation and Management in the period of time 2004-2017 treated in thoracic surgery service. Material and methods: Patents treated in our hospital during July 2004 - July 2017 are 95. Male to female ratio was 3:1. Age of presentation 9-71 years old, mean age 49 years old. Blunt chest wall trauma 36 (38%) and penetrating chest wall trauma 59 (62%) patients. Ribs and sternal fractures, two or more costal fractures in 15 (15.7%) patients (flail chest 7 patients); unilateral pneumothorax 34 (35.7%) patients, bilaterally pneumothorax 10 (10.5%) patients; massive hemothorax 12 (12.6%) patients, pneumomediastinum et subcutaneous emphysema 6 (6.31%) patients Hamman’s syndrome, lung contusion and parenchymal pulmonary hematoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients, tracheal rupture 1 (1%) patient. Results: Conservative treatment in 22 (23%) patients, unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18 (18.9%) patients; thoracotomy in 29 (30.5%) patients, wedge resection, lung hemostasis and aerostasis from lung lacerations, bronchial lobar rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell incision in 1 (1%) patient; thoraco-abdominal approach 2 ( 2%) patients. flail chest wall stabilization 7 (7.3%) patients by vicryl suture, steel wire suture 3(3%) patients, titanium plate 3(3%) patient. By VATS are treated 2(2.1%) patients. Mean hospital stay was 11 days (average 3-36 days). Morbidity rate in 6 (6.3%) patients, mortality was on 5 (5%) patients. Conclusion: Most common injury locations was lung and chest wall and less common abdominal and cranial trauma. Surgical and intensive treatment are very important and with low mortality rate.

270-275

Authors: Skënder Brataj, Agron Dogjani

Territorial Emergency Service is part of NEMS. It belongs to the only telephone number 127 (112) and it is free of charge. It represents the guarantee of medical emergency service provided by law 147/2014 (For Emergency Medical Service) and with the Council of Ministers Decision (CMD) No.933 date 29.12.2014 on Approval of the Organizational Structure of the National Center of Medical Emergency, CMD. Nr. 250, date 30.3.2016 and aims to guarantee the response to emergencies and medical emergencies, from the moment of receiving the call until their resolution, throughout the territory of the Republic of Albania. This paper aims to give an introduction and to analyse the emergency medical system's mission in Albania.

283-290

Authors: Rexhep Selmani, Zoran Karadzov, Goran Begovic, Qemal Rushiti, Nenad Vrgovic, Dejan Gogovski, Darko Domazetovski

Background: Retroperitoneal sarcomas are neoplasms that occupy only 0.3 – 3% of all solid tumors. Liposarcomas are the most frequent soft tissue sarcomas in adults. Symptoms would only be detected if the liposarcoma infiltrates on the surrounding organs. Case present ation: 58-year-old woman presented with complaints of progressive abdominal distension, loss of appetite, malaise, constipation and weight loss of about 7 kg. Abdominal CT scanning showed the presence of a retroperitoneal tumor that occupied almost the entire right part of abdominal cavity. 16 months earlier, the patient was operated in another surgical facility due to liposarcoma, derived from retroperitoneum (Histopathological finding: Poorly differentiated (G3) liposarcoma pleomorphic cell type). The patient was operated under the diagnosis of retroperitoneal liposarcoma. Conclusions: Treatment of choice is radical surgical procedure including elimination of all the structures and organs involved by the tumour process - RO resection as a basic principle of surgical treatment.

299-304

Authors: Saimir Kuci, Esmerilda Bulku, Alfred Ibrahimi, Ervin Bejko, Stavri Llazo, Jonela Burimi, Ermal Likaj

Acute traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more common, early diagnosis of tamponade is important so that lifesaving treatment can be applied. The classical features of tamponade may be insidious due to hypovolemia and the presence of associated injuries. Acute tamponade may also be precipitated by rapid administration of large volumes of fluids. Echocardiography is limited by availability and operator dependence. Pericardiocentesis, sometimes lifesaving, is dangerous and limited in value. A higher degree of clinical suspicion in patients with chest injuries, together with close monitoring and revaluation, particularly during volume replacement , is essentially. We describe a case with cardiac tamponade which presented in the emergency department of University Hospital Centre “Mother Theresa”, Tirana. The majority of patients who arrive at hospital following a penetrating injury to the heart will have no vital signs. 1 Among those who make it alive, up to 16% will be relatively stable and there will not be any indication of their serious underlying injury. 2 Pericardial tamponade is a life threatening complication of penetrating cardiac trauma that will lead to rapid deterioration in a patient's condition and require emergency treatment. 3 It is important to identify and treat this group of patients before deterioration occurs. Classically the diagnosis is suspected from the presence of hypotension, distended neck veins, and muffled heart sounds, known as Beck's triad. 4 However, these signs are not present in many patients or are attenuated, making recognition more difficult.

315-318

Authors: Nuhi Arslani, Basri Lenjanji

Aim: The aim of this article is to describe an example of the sick patient with Fournier gangrene and demonstrate the process of his treatment and the solving of problems that had incurred. Case report: The patient is a 70-year-old man who was hospitalized for Fournier gangrene in the perineal region. We performed radical necrectomy, drainage of perianal abscess, and transversostomy. Based on wound culture we prescribed antibiotics Amoksiklav and Ciprobay. Later there was a complication in the form of a decompensated adhesion ileus, which required a re-operative intervention. Conclusion: Fournier gangrene is a rare disease that usually affects males. The disease starts with swelling, cellulitis,higher temperature and odor. Our example describes the successful tr eatment of the disease with emergency surgery and re-operative intervention.

327-340

Authors: Edvin Selmani , Agron Dogjani

The aim of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults. Material and methods: A comprehensive study of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed. Results: Two studies found significantly better functional scores after replacement compared with ORIF in Mason type 3 fractures. The third study found no significant differences in functional score or range of motion, but did find that grip strength was better after ORIF. Complication rates were too heterogenous for conclusion. Conclusion: Fixation with good reduction may be attempted in unstable Mason type 3 fractures, and arthroplasty may be considered if this is not possible. Further randomised comparative trials are required to clarify the decision- making between fixation and replacement. Functional outcomes and complications were conflicting in the studies included here. Ideally, treatment decision should take into account elbow stability and degree of comminution.

349-360

Authors: Zamira Shabani, Irena Shala, Julian Kraja, Vera Gjinaj, Emiljano Pjetri

Background: Any behavior or attitude that harms the physical, emotional, and sexual well-being of one or more persons and affects the termination of the individual's normal development is considered as violence. Violence at school includes behaviors such as: victimization of a child and teachers, raping of a child and / or a teacher, physical and psychological harassment, cyber threatening, controversies, bullism, physical and psychological harm, teachers and students sexual violence, using of weapons in school environments. The main violence forms at school are: teachers to students, students to teachers, students to students. This is a punctual, transversal, cross-sectional study. 100 students at high school of Shkodra city participated in this study. The sample selection was randomized. Students of 14-18 years old; 63 females and 37 males were included in the study. The timeframe of the study was January – February 2018. The information was gathered from face to face interviews using standatized questionnaires: Global School-based Student Health Survey (GSHS) 2003, Core-Expanded Questions for the Violence and Unintentional Injury Module Violence (adapted). The information collected by the questionnaires was confident, self-report and with permission of school. All data were calculated with Microsoft Office 2010.