Albanian Journal of Trauma and Emergency Surgery

653-660

Authors: Ajmone Troshani, Evda Vevecka

The aim is to investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections Methods: Cohort study with prospectively collected data of all elective Caesarean sections on mothers with a gestational age of 37+0 weeks and more, that were performed in our Hospital from 1 January 2011 to 1 January 2017. Multiple pregnancies, fetuses with congenital anomalies, intrauterine deaths, and emergency Caesarean sections were excluded. Primary outcome measures of neonatal respiratory morbidity included transient tachypnea of newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn. Results: 4290 infants were delivered by elective caesarean section at 37+0 and then after Compared with newborns from vaginal delivery, and emergency cesarean section an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 +0 weeks’ gestation to 37+6 weeks (odds ratio 5.7 95% confidence interval 4.3 to 8.9), 38+0 weeks’ gestation to 38+6 weeks (2.8 , 2.1 to 4.2 ), and 39+0 weeks’ gestation (2.1, 1.5 to 2.8). Also increasing the incidence of admission to the NICU with decreasing gestational age at term birth below the 39 weeks of gestation Conclusions: Compared with newborn delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of respiratory morbidity. The relative risk increased with decreasing gestational age.

665-669

Authors: Ridvan ALIMEHMETI, Florian DASHI, Panajota SINANI, Ermira PAJAJ, Jetmira KERXHALLIU, Arsen SEFERI

Aim:This study analyzes the epidemiological distribution and the clinical-electric co-relation in carpal tunnel syndrome (CTS). Methods:100 consecutive patients referred to our out-patient service for carpal tunnel syndrome were included in this study. The clinical examination of the stage of CTS and electrophysiological study (EPS)wasconducted and the BCTQ questionnaire was administered with an average of 15 minutes for each.The link between the electrical stage and the total points of the questionnaire was analyzed by the Bivariate Correlation analysis by finding the Pearson coefficient and the level of significance according to the Two-Tailed test of significance. Results: It was found that the female-male ratio was 3.5 to 1 with the predominance of the age 51-60 -year-old. 35% were overweight and 17% were obese.The first predominant symptoms were paresthesia, tingling sensation in their fingertips and pain, which prevailed at night.It was seen that the highest percentage was in those with not more than secondary education. There was no significant relation with family history and CTS.The most common comorbidities were arterialhypertension and rheumatoid arthritis. 43% were referred to the neurologist by the family doctor.In the bivariate analysis a statistically significant link was found with p<0.01 with positive correlation r=0.311for the right hand and p <0.01, r = 0.345 for the left hand. Conclusions: There is still a considerable number of patients diagnosed at an advanced stage,with faded opportunity for maximal benefit from timely treatment.This syndrome is more frequent in women with BMI> 25 and in certain professions that request repetitive flexion of the grip. Family doctor should be more alert on diagnosing this common syndrome in an early stage.

679-683

Authors: Gëzim GALIQI, Luan BAJRI, Albert PESHA, Artan KONI, Bledar SHEGA

Introduction: Monti and co. described in 1997 is a continent catheterizable conduit using short segments of the ileum (1). The use of this technique allows us to obtain 2 to 2.5 cm segment of the ileum to achieve a tabularized segment of 7-8 cm. The 15 cm of terminal ileum was not routinely used for this type of procedure. After the reconstruction of a tunnel, anastomosis was performed on the superior part of the posterio-lateral junction of the bladder. Objectives: To report 6 cases using the Monti procedure with ileum for adult continent cutaneous urinary diversion, from different etiologies. Materials and Methods: From 2007 to 2020 we treated 6 patients with different conditions with this procedure.First case was a middle-aged woman with a big vesico-vaginal fistula (fig.3) It was unappropriated to be closed with satisfactory functional results in terms of continence, because a part of the sphincter was destroyed also. The reason of damage was auto mutilation as a result of borderline personality. Discussion: Monti procedure associating Mitrofanoff principle was mainly used in pediatric patients (1,2,3) That’s because of the relatively easy execution of the “Mitrofanoff principle” and the high degree of continence obtained with its use (4). But can we use the same principle to resolve some difficult cases in adult urology also? Conclusion: The Monti tunnel is a valid option for continent intermittent catheterisation. It’s also an alternative to be adjunct with Mitrofanoff procedure when needed. We used it when the appendix was not appropriate to be used as a tunnel or when it was missing. It has a good continent percentage and it can be done rather easily. Of course, ours is a small series of cases to represent more important conclusions.

689-693

Authors: Recep Erçin Sönmez, Muhammet Ali Aydem, Aman Gapbarov, Orhan Alimoğlu

Aim: We aimed to put forward the efficacy of abdominal CT performed for patients diagnosed with acute abdomen and to share our clinical findings in that regard. Methods: 216 patients who had been hospitalized in General Surgery Department due to acute abdomen had been analyzed retrospectively between October 2018- January 2019. Abdominal computerized tomography (CT) results had been discussed in terms of diagnostic accuracy and clinical outcomes. Results: 171 (79.2%) patients (M/F:95/76 (55.6% / 44.4%)) had been evaluated by computerized tomography (CT) due to various causes of acute abdomen. Patients who had been scanned more than once (n=13 (7.6%)) during theirs’ hospitalization period had longer average length of stays compared to those whom had been scanned for only once (n=158 (92.4%)) (multiple scanned:17 days vs single scanned:3 days; p=0.000). Besides, single-scanned patients had showed higher clinical accuracy compared to those with multi-scans (80.4% vs 61.5%, p=0.126). 28 ileus (84.8%) patients had been scanned by non-enteral computerized tomography (CT), and 12 (36.4%) of them had been given false radiological reviews. Conclusion: Improper and redundant use of computerized tomography (CT) may cause prolongation of stays at the hospital, besides performing unnecessary scans do not improve diagnostic accuracy.

699-704

Authors: Basri LENJANI, Nehat BAFTIU, Premtim RASHITI, Ilaz BUNJAKU, Nuhi ARSLLANI, Blerim KRASNIQI, Shpresa MAKOLLI, Dardan LENAJNI

The process of patient referral system at the level of health care is a comprehensive institutional framework with responsible, welldefined competencies, as a network of cooperation with the general goal of maintaining health, treatment, stabilization, transport and medical care up to in the complete recovery of the sick. The process of patient referral system in most countries in Europe and in the world is a challenge for most developing and developed countries. The mechanisms of the referral system function at different national, regional and municipal levels based on national laws and policies and work on the basis of efficient lines of communication by creating clear and simple steps and procedures described. The referral system in Kosovo is disorganized, chaotic, the Ministry of Health must have a national document of the referral system for patients at the health level, and before that all health care professionals are educated, trained on the way of the referral system, which cases must be sent from the primary, secondary and tertiary level. At the national level, the National Coordinating Council with a national plan of the patient referral system can convey the quality; help the health care professionals based on the current health legislation, the harmonization of unique standardized protocols with follow-up guidelines. Patients at the country level.

709-714

Authors: Ermira PAJAJ, Ridvan ALIMEHMETI, Florian DASHI, Aiola STOJA, Arsen SEFERI

Neurogenic Thoracic Outlet Syndrome (NTOS) is a rare, but controversial syndrome in relation to its diagnosis, treatment modality, and approaches in case of surgical treatment. In the English literature, there are sparse studies dealing with these aspects. We conducted a PubMed 2000-2017 literature review and found a total of 3953 cases reported with NTOS. The clinical characteristics, etiology, electrophysiological and radiological work-up and treatment options were reviewed and reported. It seems that, as far as surgical indication criteria are concerned, there is a consensus for NTOS in its motor deficit stage and its techniques are generally well established. This review showed that differential diagnosis, radiological, and electrophysiological criteria for correct diagnosis of NTOS are not controversial. However, surgical indications and types of approaches and techniques reflect the surgeon’s affiliation with specialties dealing with NTOS (vascular, plastic, hand, orthopedic or neurosurgeons), and the surgeon’s experience with this specific and rare syndrome.

721-724

Authors: Saimir KUCI, Alfred IBRAHIMI, Ermal LIKAJ, Marsela GOGA, Ervin BEJKO, Stavri LLAZO, Jacob ZEITANI

Background: Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to device exchange, urgent transplantation, and even death of the patient. Infections with multidrug resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface associated colonization’s of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms. Case presentation: A 48-year-old patient 72 kg, height 172 cm with dilated cardiomyopathy, his course was complicated by pump failure requiring LVAD HeartMate III placement 3 years (Milan Italy). The parameters of the LVAD pump were determined for the patient from the moment of the Pump speed 5300 rpm Flow 4.4 lpm was set. The patient performed moderate activity under normal conditions. The patient regularly took Coumadin to keep the recommended INR levels at the recommended target values 2.5. At the site of the exit of the cavity from the skin in the region of the right hypochondrium, there was an infection that for a long time was treated with various schemes with ambulatory antibiotics Conclusions: In the present case we showed that successful eradication of a chronic LVAD driveline infection was only possible when approached both surgically and conservatively. It is important to note that a good knowledge of the physiopathology of heart failure, the widest possible information on the treatment of heart failure with the help of LVAD implantation is very important in the treatment and survival of these patients.

729-731

Authors: Fadil GRADICA, Daniela XHEMALAJ

Degos’ disease, also known as “malignant atrophic papulosis” is a rare vasculopathy characterized by typical cutaneous lesions with an unknown etiology which was first described by Dego in 1942 (1), but another case, reported in 1941 by Köhlmeier, who interpreted it as thromboangiitis obliterans of the mesenteric vessels (2). It is an occlusive arteriopathy involving small-caliber vessels. Specifically, it is a progressive, small- and medium-size arterial occluding disease, leading to tissue infarction and initially involving the skin. Degos disease occurs both in a limited benign, cutaneous form and in a potentially lethal multiorgan, systemic variant. The disease has a male predominance (3:1), and sporadic cases of familial involvement have been recorded. (3-7). The involvement of the gastrointestinal tract and other organs has been noted in approximately 60% of reported cases (8). There are fewer than 50 living patients presently known worldwide, and fewer than 200 reported in medical literature. However, many individuals may go undiagnosed due to rarity of the disease (9,10). Most individuals develop symptoms between the ages of 20-50; however, cases outside of this age range have been reported as well, even as early as 8 months (1,6).

738-744

Authors: Saimir KUCI, Adriana MISJA, Alfred IBRAHIMI, Ermal LIKAJ, Petrit REXHEPI, Orion GLIOZHENI, Ilir OHRI

Introduction: Nowadays, we need to deal with heart transplanted patients for other medical concerns. So, it is important to see in detail different aspects and modalities of their care during other types of surgery. A transplant team will carefully monitor each heart trans-plant recipient and should be possible to seek information on the patient’s overall status. They will be able to inform on the most recent investigations (ECG to assess graft function, recent biopsy for rejection, angiography for coronaries, etc.). Case report: Our patient, a 65-year-old lady underwent heart transplantation 5 years before. The cardiac situation was stable and she was doing fine. She was recovered in the gynaecological clinic with a diagnosis of vaginal prolapse with surgical indication General anaesthesia was done with fentanyl 7 ml, pavulon 4 mg, propofol 200 mg and sevoflurane 1.5-2.2%. The patient was monitored during surgery with SpO2, ECG, IBP, CVP. The operation technique was open of vaginal plastic repair. Discussion: By 3 months, most recipients of heart transplant came under New York Heart Association (NYHA) I class. The last UK national survey about health-related quality of life after cardiac transplantation indicates that, 1 year after surgery, there is an improvement in quality of life (60% are much better; 28% somewhat better) and there is no deterioration in general health at 3–5 years, except that many of them have symptoms compatible with depression. Conclusion: Perioperative care of heart transplant recipients will entail a greater attention to maintaining an adequate preload and vascular tone, to avoiding infections and to being aware of the multiple side effects of immunosuppressive therapy. References and recommended reading Papers of particular interest, published within the annual period of review, have been highlighted as: of special interest of outstanding interest Additional references related to this topic can also be found in the Current World Literature section in this issue