Albanian Journal of Trauma and Emergency Surgery

501-512

Authors: Iordanov E , Uzunova V , Uchikov P, Podnov L, Sakakushev A , Sakakushev B

Colorectal cancer complications are seldom analyzed for occurrence through day and night, working days and weekends, as well as throughout seasons. We hypothesized that information and analysis of high/low complicated colon cancer incidence in the abovementioned terms can improve our preparedness and manage better the resources for superior outcomes. Therefore, we performed a retrospective study during 2010 – 2018 timeframe consisting of 165 patients with complicated colorectal cancer operated on emergently or urgently in the Second Clinic of General and Thoracic Surgery, University Hospital St George, Plovdiv, Medical University Plovdiv, Bulgaria.

525-533

Authors: Kenan Karavdić

Background: Kidney is the most common site of genitourinary trauma. 50% of all urinary injuries is kidney. Kidney is also affected in 8-12% of all blunt and penetrating trauma to abdomen. 80-90% of renal injury is caused by blunt injury GY. Children, compared to adults, have at a higher risk of renal injury from blunt trauma due to a variety of anatomic factors including decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. While there are strong trends toward non-operative management of blunt renal trauma, there are no explicit guidelines for high grade injuries. Organ preservation in children is always a primary goal with solid organ injury. Aim of the work: The aim of the retrospective study is to show the specificity of kidney injury in children as well as the specificity of surgical treatment. Material and Methods: All 19 patients under the age of 18 who were admitted to Clinic for Pediatic surgery in Sarajevo with a diagnosis of renal trauma were retrospectively reviewed .The Echo an CT were used to identify patients with a renal injury. The time period examined was between January 1, 1999- 2019. Inclusion criteria were either a diagnosis of renal trauma or a diagnosis of blunt abdominal trauma and hematuria. Exclusion criterion was death due to an additional traumatic injury. The mechanism of injury (fall, car accident , assault) injury grade (I-V), the presence of hematuria, and demographic data to include age, weight, and sex, were recorded and reviewed. In addition, amount of blood product required, hematocrit nadir prior to transfusion to assist in ascertaining whether transfusion was necessary, surgical interventions performed, and hospital length of stay were also retrospectively analyzed. Due to the low sample size we used descriptive as opposed to inferential statistics in our analysis. Results: Demographics include male to female ratio of 13:6 and the average age of patients was 11.9 + 4.6 years. Of the nineteen patients who underwent review, eleven (57,89%) children presented with a grade III renal injury, five with a grade IV injury and three with grade V injury. Six patients presented with gross hematuria and 3 with microscopic hematuria. Only four patients (22%) required blood transfusions, with the average hematocrit nadir being 31 + 5.3% (24.8-37.8). One of the two patients transfused had a concomitant grade IV splenic laceration with a hematocrit nadir of 24.8% and clinical symptoms consistent with shock. Conclusions: The specificity of the child's anatomy is an aggravating prognostic factor (the kidney is larger in relation to the body cavity than in adults, less protected against the ribs, the muscles of the body and the lower abdomen, the less developed peritoneal and retroperitoneal fatty tissue).It is recommended to initiate conservative treatment (leaching, infusion solution, monitoring) and possibly delayed surgical treatment.Indications for early surgicaly treatment are reserved only for patients with bleeding (absolute) and extravasation (relative).If it is necessary surgical treatment sould be maximally preserve kidney tissue.

542-551

Authors: Isuf Bajrami

Background: Around 1.25 million people die each year due to traffic accidents. Traffic accident injuries are the leading cause of death in the most productive age group – 20-45 years old. If no preventive measures are taken, it is expected that in year 2030 traffic accidents will be the leading cause of death in general. Aim of study: Gathering and comparing the statistics regarding traffic accidents to have a better overview of the problem. To identify the most common factors of traffic accidents. To compare the number of accidents and casualties at local, regional and global level. To evaluate the way traffic accidents are handled from urgent medicine services and the Centre of Urgent Medicine in particular. To improve the quality of handlind traffic accident from medical teams. Material and methods: data for this paper is extracted from QMU and archive protocols. We have cooperated with Emergency Centre of UCCK, and Kosovo Police, Pristina regional unit. Retrospective method of research and afterwards descriptive and analytical method has been applied. Results: Of 604 cases of traffic accidents that have been analyzed, 212 or 35.1 % included persons of age group 16-25. Of the totat number, 411 or 68.04 % were males and 193 or 31,9 % were females. The average time of arriving at the scene of CEM teams was 7.65 minutes. 5150 patients were transported to Emergency Centre in UCCK, 3158 of them or 61.32 % were transported with private vehicles and 1992 or 38.62 % were transported with ambulance. Conclusions: The main factor of traffic accidents remains human factor. Traffic accidents increase the incidence of death and disability in general population. Laws and their obedience, technical condition of vehicles, road infrastructure are also factors that influence the number of traffic accidents. Enforcing Emergent Medical Services, promoting and educating the population, institutional cooperatin, have positive impact in reducing the number of traffic accidnts, decreasing mortality and disability caused by traffic accidents.

564-588

Authors: M. Trajchevska, A. Lleshi, S. Gjoshev, A. Trajchevski

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results:In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364).Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

603-621

Authors: Ledian Fezollari, Gjergj Caushi, Vilson Ruci, Artid Duni, Agron Dogjani, Edvin Selmani, Zamir Demiraj, Guido Bassi

Aims and objectives: This study was done to evaluate the functional and radiographic outcome of PFN in treatment of proximal femoral fracture and more common technical, mechanical complications and intraoperative difficulties during the implant implementation. Materials & Methods: We conducted a retrospective study with ten cases of proximal femoral fractures treated between September 2017 and September 2018, which were accepted at the Department of Orthopedics, the University Hospital of Trauma and the American Hospital in Tirana. Fractures are classified according to classification AO and Boyd-Griffin. The age range of patients taking the study was 20-90 years. Ten cases were followed at regular intervals and the final assessment was made at the end of the 6 month period. In the result, functional clinical assessment according to Harris hip score was done . Results: In our study,mean age was 66 y.o, 7 male and 3 females. Mean of hospitalization time 6 days, mean operation time 120 min. In our study at 6 months follow up, union was achieved in 9 cases, open reduction was performed in 3 cases (10 cases). Technical and mechanical complications were noted in one case. Reoperation rate was 10 % (one case). According Harris hip scoring system excellent results were seen 40 % of cases (4 cases), good results in 50 % cases (5 cases), and poor results in 10% cases (1 case). Conclusions: In our study, in spite of low experience in proximal femoral nailing in cases with unstable trochanteric / subtrocanteric fractures, it was found that PFN is an attractive implant and suitable for proximal femoral fractures and its use in unstable trochanteric / subtrocanteric fractures is very encouraging. This study has also shown that this device can safely be used by an average surgeon to handle common but sometimes tough fractures. Operation is technically not difficult, but gradual learning and great patience is needed to make this method really minimal invasive.

630-637

Authors: Alfred Ibrahimi, Saimir Kuci, Ervin Bejko, Stavri Llazo, Jehona Neziraj, Jacob Zeitani, Edvin Prifti

The occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post-operative heart failure is fairly common. Mechanism of hyperbilirubinemiais still not completely clarified, and there are so few specific therapies available for acute hepatobiliary injury. Post-operative mortality well correlates with increasing total bilirubin values, particularly for bilirubin-associate acute kidney tubular necrosis. The difficulty to reduce mortality is partially a consequence of not completely understood physiopathology. It is obvious that long-lasting CPB plays an important role, in association with hemodilution, hypotension, ischemia-reperfusion, and increasing hematic level of endogenous catecholamine with reduction of hepatic blood flow. Case report. A 68 years old man with severe mitral valve regurgitation and pulmonary hypertension and low EF 30%. Mitral valve replacement and tricuspid anuloplastic was performed. Due to low cardiac output syndrome severe hyperbilirubiemeia was seen (24 mg/dl. and unconjugated fraction 16mg/dl) days after. Phenobarbital (luminal) was started 15 mg/kg daily. Two days later the level decreased until 8 mg/dl with normalization of conjugation/unconjugation ratio.Postoperative hyperbilirubinemia is a multifactorial process caused by both impaired liver function of bilirubin transport. In case of elevated level of unconjugated fraction, we suggest to use Luminal as alternative for decreasing unconjugated fraction.