Volume 2: Number 2 Supplement 2
November 2018
Focus on
" Trauma and Emergency Surgery"
and not only...
Official publication of
ASTES
ISSN: 2521-8778 (print version)
ISSN: 2616-4922 (elect ronic version)
Volume 2 - Number 2 - Supplement2
November 2018
Focus on
“Trauma and Emergency Surgery”
and not only…
official publication of
ISSN: 2521-8778 (print version)
ISSN: 2616-4922 (elect ronic version)
Albanian Journal of Trauma and
Emergency Surgery – AJTES
Official Publication of the Albanian Society for Trauma and
Emergency Surgery - ASTES
Chairman of the editorial board: Prof. Rifat LATIFI, MD, FACS, FICS
(USA)
AJTES Executive Director (CEO): Prof. Asc. Agron Dogjani M D, PhD, FACS (ALBANIA)
Editor in Chief: Edvin SELMANI, MD, PhD (ALBANIA)
Prof. Asc. Rustem CELAMI MD, Ph.D.
Deputy Editor (ALBANIA)
Prof. Lutfi ZYLBEARI MD, Ph.D.
Deputy Editor (Macedonia)
Enver FEKAJ, M.D, Ph.D.
Deputy Editor (Kosovo)
National Editorial Board
Prof. Arben GJATA, MD, PhD,
Prof.Asc. Edmond ZAIMI, MD, PhD,
University of Medicine, Tirana, Albania
University of Medicine, Tirana, Albania
Prof. Xheladin DRACINI, MD, PhD,
Prof.Asc. Ridvan ALIMEHMETI, MD, PhD,
University of Medicine, Tirana, Albania
University of Medicine, Tirana, Albania
Prof. Nikollaq KACANI, MD, PhD,
Prof.Asc. Rudin DOMI, MD, PhD,
University of Medicine, Tirana, Albania
University of Medicine, Tirana, Albania
Prof. Etmont ÇELIKU, MD, PhD,
Prof.Asc. Bajram BEGAJ, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Arben BEQIRI, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Ilia MAZNIKU, MD, PhD,
University “Alexander Xhuvani”, Elbasan, Albania
Prof. Arvin DIBRA, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Skënder TOPI, MD, PhD,
University “Alexander Xhuvani”, Elbasan Albania
Prof.Asc. Agron DOGJANI,MD, PhD, FACS,
University Hospital of Trauma, Tirana, Albania
Prof.Asc. Fadil GRADICA, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Gjergji THEODHOSI, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Jovan BASHO, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Krenar PREZA, MD, PhD,
University Hospital of Trauma, Tirana, Albania
Prof. Tritan SHEHU, MD, PhD,
University of Medicine, Tirana, Albania
Prof. Asc. Besim Boci, MD, PhD,
University of Medicine, Tirana, Albania
Prof.Asc. Skënder BRATAJ, MD,
National Center of Emergency Medicine, Albania
Prof.Asc. Artid DUNI, MD, PhD,
University of Medicine, Tirana, Albania
Artid LAME, MD, PhD,
University of Medicine, Tirana, Albania
Leart BERDICA, MD, PhD,
University of Medicine, Tirana, Albania
Arben RROJI, MD, PhD,
University of Medicine, Tirana, Albania
Myzafer KACI, MD, PhD,
University of Medicine, Tirana, Albania
Shkelzen OSMANAJ, MD, PhD,
University Hospital of Trauma, Tirana, Albania
University of Medicine, Tirana, Albania
Zamir DEMIRAJ, MD, PhD,
Prof. Pirro PRIFTI, MD, PhD,
University Hospital of Trauma, Tirana, Albania
University “Alexander Moisiu”, Durres, Albania
Prof. Maksim ÇELA, MD, PhD,
University of Medicine, Tirana, Albania
Prof.Asc. Sokol BUBA, MD, PhD,
University of Medicine, Tirana, Albania
Gjergj SEMINI, MD, PhD,
University of Medicine, Tirana, Albania
.
International Editorial Board
Prof. Rifat LATIFI, MD, FACS, FICS (USA)
Prof. Selman URANUES, MD, FACS (Austria)
Ass.Prof. Pantelis VASSILIU,MD, PhD, FACS, (Greece)
Ruben PERALTA, MD, FACS, (USA)
Prof.Mauro ZAGO, MD, FEBS, FACS, (Italy)
Prof. Bellal A. JOSEPH, MD, FACS, (USA)
Prof. D`Archivio LAFRANCO, MD, DDS, (Italy)
Prof. Orhan ALIMOĞLU, MD, (Turkey)
Prof. Mehmet Kurtoğlu, MD, PhD, (Turkey)
Ass. Prof. Bogdan DIAKONESKU, MD, PhD, (Romania)
Prof. Ayman El-MENYAR, MD, MRCP, FRCP, FESC,
FACC, (QATAR)
Kastriot HAXHIREXHA, MD, PhD, (Macedonia)
Prof. Mehmet ERYILMAZ,MD, MBAH, (Turkey)
Danny Daphnis,MD, PhD, (Greece)
Basri LENJANI, MD, PhD, (Kosovo)
Skender ZATRIQI, MD, PhD, (Kosovo)
Faton HOXHA, MD, PhD, (Kosovo)
Advisory Expert
Prof. Eliziana PETRELA, MD, PhD, University of Medicine, Tirana, Albania.
Assistant Editors
Admir MUSTAFA, MD
Erion SPAHO, MD
Hysni BENDO
Amarildo BLLOSHMI
Sonja SARACI, MD
Mail Address: Str. Lord Bajron, 1026, Tirana, Albania
Electronic Address: E-mail.: secretary@astes.org.al ajtesjournal@gmail.com
Design & Layout: Hysni Bendo
ISSN: 2521-8778 (print version) ISSN: 2616-4922 (electronic version)
Albanian Journal of Trauma and Emergency Surgery Vol2. No.2 Supplement 2 - 2018
Albanian Journal of Trauma and Emergency Surgery is the official publication of Albanian Society
for Trauma and Emergency Surgery - ASTES
Structure and Format
AJTES is a periodical journal includes editorials, reviews, original articles, case reports, short report,
ideasand opinions, bookreviews, perspectives, seminars, symposium and mini- symposium, ethics and
rights, health care policy and management, practice
guides. The structure of each edition of the publication comprises section categories determined by
Editor and reflects the views of the Editorial Board.
Editorial Expertise
Guidance from Editorial Board consists of leading
authorities from a variety and respective fields of
medical science. Peer review-accomplish by expert
selected for their experience and knowledge of a
specific topic.
Important notice for Author
All manuscript must be submitted to the Editorial
Office through electronic post; e-mail: contact@
astes.org.al. Please check the last page of each edition “Instruction for Author”: The work shall not be
published elsewhere in any language without the
written consent of AJTES. The articles published in
this journal are protected by copyright, which cover
translation rights and the exclusive right to repro-
duce and distribute all of the articles printed in the
journal. No material published in the journal may be
stored on microfilm or videocassettes or in electronic databases and the like or reproduced photographically without the prior written permission of AJTES.
Permissions
For information on how to request permissions to
reproduce articles/information’s from this
journal, please contact Editorial Office.
Advertising policies
The journal accepts displayed and classified advertising. Frequency discounts and special position are
available. The journal reserves the right to reject any
advertisement considered unsuitable according to
the set policies of the journal. The appearance of
advertising or product information in the various
sections in the journal does not constitute an endorsement or approval by the journal and/or its publisher of the quality or value of the said product or of
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Disclaimer
The information and opinions presented in the
Journal reflects the views of the author and not
of the Journal or its Editorial Board or the Publisher.
Publication does not constitute endorsement by
the journal.
Albanian Journal of Trauma and Emergency Surgery 2018
Volume 2, Number 2
ISSN: 2521-8778 (print version)
ISSN: 2616-4922 (elect ronic version)
ht t p:/ / doi.org/10.32391/ajtessupplement.2018.2.2.2
Abstracts
2nd Annual Albanian Congress of Trauma and Emergency
Surgery
ASTES
November 8-10
Ohrid, Macedonia
Congress President:
Agron Dogjani
P resident of Honour :
Rifat Latifi
Official Publication of the Albanian Society of Trauma and Emergency Surgery - ASTES
.
Aims and Scope
Our aim is to promote
interest, knowledge and
quality of care in
emergency and trauma
surgery. ASTES was
formed in 2017, it seeks to
promote best practice in the
provision of emergency and
trauma surgery and acute
care surgery, from prehospital care through
diagnosis, intervention and
intensive care to
rehabilitation. This is
supported by Countrywide
& International
collaboration, scientific
research, development and
delivery of training courses,
and the work of the
specialist sections
(Polytrauma, Visceral &
Chest Trauma, Skeletal
Trauma & Sports Medicine,
Neurosurgical, Anesthesia Reanimation, Acute Care
Surgery, ENT &
Ophthalmology &
Maxillofacial, Radiology,
Nurse service, Disaster &
Military Surgery...etc.)
ASTES holds an annual
scientific meeting – the
Albanian Conference for
Trauma and Emergency
Surgery (ACTES) and
produces a bi-annual
journal – the Albanian
Journal for Trauma and
Emergency Surgery
Contents:
ORAL PRESENTATIONS
7
POSTER PRESENTATIONS
133
INDEX
142
2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
ORAL
PRESENTATIONS
1. The Injury Pattern in Polytrauma.
Distribution of Injuries Based on
the Analysis of more than 500
Patients.
Vilmos VÉCSEI1 , Stephan FRENZEL1
Dept. for Orthopedics and Trauma Surgery,
Medical University Vienna, Austria.
1
Abstract
Introduction:
although
the
term
“polytrauma” has been in use for decades,
no generally accepted definition exists.
Our definition has been until 2010: a
combination of injuries where one, or the
combination where one, or the combination
of injuries
himself is directly life
threatening, in detail is meant: injury to two
body cavities, or injury to one cavity
committed by two long bone fractures,
where spine and unstable pelvis has counted
similarly as an injury to a cavity organ.
Since 2013 a new definition has been
established, the so called Berlin definition.
„A polytrauma means significant injuries of
three or more points (AIS) in two or more
different anatomic AIS regions in
conjunction with one or more additional
variables from 5 physiologic parameters:
Hypotension
(systolic
blood
pressure <= 90 mm Hg),
Level of consciousness (Glasgow
Coma Scale (GCS) <=8,
Acidosis base excess <=-6.0),
Coagulopathy
(international
normalized
ratio
>=
1.4/partial
thromboplastin time >=40 seconds) and
age >=70 years).
This definition fits the reality perfectly.
The Dept. for Trauma Surgery of the
Medical University of Vienna, Austria,
presents itself. A level I trauma center,
located in the General Hospital, as a special
AJTES Vol.2 Nr.2 Supplement 2
unit for the treatment of heavily injured in
the eastern region of Austria.
In a 10-year period 501 polytraumatized
patients have been admitted.
We looked to the injury pattern in two 5year periods (A, B) and compare the
numbers with a group of polytraumatized
10 years later(C).
The injury pattern, the injury severity
follows the cause of the injury and
determines the outcome. AIS-comparison
survivors vs. dead
The pattern of Injury follows local
conditions, has an important function for
accident prevention and is not a factor for a
comparative study.
Key Words: Polytrauma, Definition of
Poltytrauma,
2. Current Management of Complex
Vascular Abdominal Trauma:
Priorities and Techniques
Rifat LATIFI1
1
New York Medical College, School of Medicine
Director, Department of Surgery, Westchester
Health Network, Department of Surgery, New York
Medical College. Valhalla, NY, USA.
Abstract
Vascular trauma is the most common cause
of mortality and significant morbidity of
patient sustaining penetrating or blunt
abdominal trauma. To this end, the ability
to deal with injuries to the vascular tree of
the abdomen in the most expeditious
manner is a must for every trauma surgeon,
as well as for any general surgeon who deal
with trauma patients. Knowledge of
anatomy and surgical techniques that will
provide rapid exposure to aorta and aortic
branches, vena cava, portal vein and their
branches, proximal and distal control
without causing more injury of any vessel,
combined with skillful ability to provide
definitive or temporary revascularization
and establish blood flow to the intestines,
liver and other solid organs, or lower
extremities
is
essential.
There are number of well-established
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
exposures and techniques that have stood
the test of time and will help treating trauma
patients with massive vascular injuries and
should be part of every surgeon’s
armamentarium and trauma center. In most
recent years, however, new techniques such
as temporary shunting, stenting and
embolization of solid organs (liver, spleen
and pelvic embolization primarily) have
become common and have been proven
lifesaving adjuncts to trauma surgery.
While multidisciplinary approach is often
required, the initial approach by the
trauma/general surgeon must be well
focused, planned and systematic, and
should avoid adventuristic moves or
decisions. While damage control surgery
may be part of this armamentarium, the
named vessels should be addressed
surgically. I will describe few of these
techniques during this presentation.
3. Surgical Priorities in The
Treatment of Polytraumatized
Patients with Orthopaedic Trauma
Jordan SAVESKI1, Neda TRAJKOVSKA1, Ilir
HASANI1.
1
Clinical Hospital Acibadem Sistina, Skopje,
MACEDONIA. University Clinic of Traumatology,
Medical Faculty, Skopje, MACEDONIA
Abstract
Introduction: Determination of surgical
priorities, extend of surgery and planning
and optimal timing for fracture stabilization
is essential in the treatment of polytrauma
patients with multiple fracture. For most
patients (hemodynamic stable) the concept
for early total care (ETC) has an advantage.
An unstable and extremis patient should be
resuscitated and adequately stabilized
before receiving definitive treatment.
Damage control orthopaedic (DCO) surgery
increases the chances for survival in patient
at risk, with severe multiple fracture with
chest and head injury. The decision whether
to perform initial temporary of definitive
fixation in the borderline patient is based on
clinical condition.
AJTES Vol.2 Nr.2 Supplement 2
Purpose: The purpose of this study is to
present our principles based on the
treatment experience based on 820
polytraumatized patient with orthopaedic
trauma
Material and method: A total of 820
polytraumatized patients were treated
between 2000 and 2014 year. The severity
of injury (ISS) was 28 range from 16 to 75
years and GCS 9 (range from 3 - 15).The
treatment management was done between 4
different periods: acute or resuscitation (1-3
hours), primary or stabilization (1-72
hours), secondary or regeneration (3-8
days) and tertiary or rehabilitation (after the
8th day). The primary goals in the
resuscitation phase was to establish
adequate ventilation, to maintain the
circulation according ATLS - ABCs
protocol (golden hour) and to access the
global neurological status.
Results: Retrospectively were compared 2
groups of polytraumatized patient with
femoral shaft fractures according the
treatment strategies for femoral shaft
fractures. Gorup A - intramedullary nailing
(IMN) as a ETC and group B - DCO
surgery. In group B ISS was higher (32)
compared to group A (22). The patient in
group B required more fluids (14,21 vs
8,21) and blood (2,2 vs 1,3) compared to
group A in the initial 24 hours. Thoracic,
abdominal, head injuries were present in
significantly higher number in group B
(24,2%) than in group A (12,4%). There
was significantly higher incidence of ARDS
in group A (18,2%) than in group B (8,6%).
Also MOF was significantly lower in group
B (7,4%) than in group A (12,1%). There
were 3 unexpected deaths and 2 conscious
worsening in patients with head injury in
group A.
Conclusion:
Determination of surgical priorities and
time of surgery is essential in the treatment
of polytrauma patients. Early fracture
fixation is respected principle in stable
polytrauma patients with orthopaedic
trauma. DCO surgery is strongly indicated
in unstable and extreme polytrauma patients
with multiple fractures.
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
4. Controversies on definition,
assessment and workflow, with
overview of damage control
modern concept of treatment of
‘real’ polytrauma patient.
1
Ilir HASANI
General Surgeon-Traumatologist, Traumatology
Orthopaedic Surgery, Anesthesy, Intensive Care
and Emergency Centre, Skopje, MACEDONIA.
1
Abstract
Historically, politrauma is associated to
complex and contraverse issues beginning
from definition, assessment, primary and
secondary approach, and also big
controversies on time, type and amount of
treatment, as referred in the literature as
second hit.
We have reviewed the literature on
definition of politrauma and find a lot of
controversies and disagreement between
surgeons. We present the final definition
that is still very hardly implementable in our
routine work.
A lot of work has been done on
standardizing the assessment and approach
of the politraumatized patient on the last
century that has been summarized on very
precise ATLS protocol. Since the
Computerized tomography has became
more available for the politraumatized
patients in the Emergency Room
worldwide, the discussion of favoring the
whole body scan on the Emergency Room
vs. ATLS protocol has attract the attention
of medical society. Arguments of both
statements will be presented.
Recently, withdraw from aggressive
behavior of surgeon and anesthesiologist,
preventing adverse outcome due to inability
of injured body to bear the second
iatrogenic attack, has become a golden
standard on treating seriously multiply
injured patient, so called Damage control
concept on politraumatized patient.
AJTES Vol.2 Nr.2 Supplement 2
5. Organization of Trauma Care
Services in Traumatized Patients
Arben GJATA1
Rector University of Medicine Tirana, Albania.
1
Abstract
Traumas represent one of the most
important
clinical
and
diagnostic
pathologies that often make extreme
emergencies.
In developed countries, under conditions of
peace, trauma constitutes the first cause of
death for under 40s and is a cause for a high
number of permanent disability.
Trauma means a transfer of energy, which
is due to the interaction of physical or
chemical agents with the organism. In this
view, when talking about trauma, we are
talking about different events, such as road
accidents, work or homes, but also burns or
lesions, from cold-fire aggression to those
with firearms.
The role of the surgeon in the trauma team
is
essential.
It
should
provide
multidisciplinary care to reduce diagnostic
time and optimize therapeutic procedures.
In some countries, assistance at the venue is
provided by medical teams, while in the US
from paramedics, who are trained personnel
for this purpose.
The out-hospital phase is as important as the
hospital. The dynamics of the accident, the
injuries sustained by the accident, the vital
parameters and the therapeutic procedures
of primary assessment, basic life support
(BLS) or advanced trauma life support
(ATLS) should be evaluated.
During transport, the patient's condition
should be communicated to the team.
The time of transport is important for the
trauma team because it gives time to
prepare for the accidental reception.
The team besides the general surgeon, the
resuscitator and the imaging may also need
other specialists who are called depending
on the situation.
Transferring the patient from the hospital to
the hospital is an important time to get all
the information that is needed and available.
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Once the hospital team becomes
responsible for the traumatized person, the
primary and secondary examination of the
patient is re-examined, to be passed later in
the diagnostic phase.
The patient is continuously monitored with
the ECG, arterial pressure, oxygen
saturation. Ventilation parameters should
be measured in the case of intubated
patients.
Any deviation from these well-defined
protocols, according to numerous studies, is
associated with significant increases in
morbidity and mortality.
6. Trauma Surgeon vs General
Surgeon in Trauma Management
Mauro ZAGO1
1
General Surgery Dept, Minimally Invasive Surgery
Unit, Head Policlinico San Pietro - BOLOGNA ITALY*
Abstract
As Medicine adapts to the 21st century, new
specialties arise. In the management of
trauma, two models have been opposed in
the past: on one side, a Trauma Surgeon
based system, with specialists fully devoted
to trauma care, often able to fix skeletal
trauma too; on the other hand, blended
systems with General Surgeons dealing
with both elective and emergency surgery
and trauma patients.
The evolution of technology, of the
epidemiology of trauma, and of the trauma
systems and networks entailed the emerging
of the concept of Acute Care Surgery. In
the vast majority of Countries, this new
specialist semms to better fit with the needs
of both patients and health organization.
Who is the Acute Care Surgeon? What is his
minimal educational and technical
background? How can interact with the
other medical specialists playing around a
trauma patient?
AJTES Vol.2 Nr.2 Supplement 2
7. Management of Trauma Patient in
the Hospital Settings.
Agron DOGJANI1
1
General Surgery Service, University Hospital of
Trauma, Tirana, Albania
Abstract
Introduction: Trauma can be defined as a
‘blunt or penetrating external force exerted
on the body resulting in injury’. Traumatic
injury is a leading cause of death globally
among persons under the age of 45 years.
Over 5 million deaths occur each year as a
result of injuries, representing 9% of the
world's mortality. Non-fatal injuries are
among the leading global cause of
emergency department (ED) visits,
hospitalizations and long-term morbidity,
accounting for a large part of health systems
workload. Although road injuries, falls and
self-harm are the top three causes of injury
burden globally, their relative importance
may differ according to the region.
The initial assessment and management of
traumatized patients should take place in a
specialized area of an emergency
department or a specialized trauma center.
The time of injury is the essence of survival
for life-threatening trauma.
Appropriate initial care at the scene affects
the morbidity and mortality of the
traumatized patient. Prolonged transport
time or inadequate hospital care increases
the demand for early restoration of rapid
tissue perfusion before the physiological
changes of the injured patient reach the
hospital. On the other hand, the lack of
medical emergencies in rural areas and the
lack of knowledge of management
protocols by trauma management personnel
increase morbidity and mortality in this
group of patients. This presentation
addresses the management of traumatized
patients after these patients reach an
emergency department at a regional /
municipal hospital or a traumatic center.
Keywords: primary trauma center,
traumatized patients, injured patient, lifethreatening trauma
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
8. History and Current
Epidemiological Profile at UHT,
Tirana, Albania.
Luan NIKOLLARI1 , A. BEJLERI1
1
Statistics Department, University Hospital of
Trauma, Tirana, Albania.
Abstract
Background: Despite advances in
technology, hospital infrastructure, and
human resources, trauma continues to be a
major public health problem not only in
Albania. The purpose of the study is to give
a complete overview of the history of this
institution from the most important in
Albania as well as comparative data of
traumatic epidemiology.
Materials and Methods: This is a
retrospective study conducted in the period
January 2013 - 2017. In this study, data are
analyzed for hospital activity, frequency by
region, age group, incidence, affected body
regions, and mortality.
Results: A total of 173,411 patients with
trauma were presented during this time
frame, about 34,602 patients per year, 95
patients per day. Out of them about 3200
patients (8.7%) in year needed hospital
treatment. 21% of the patients were treated
in intensive care unit and the rest in other
services. Most of the patients were males
(68%) with the mean age 15±65 years. 72%
of injuries were attributed blunt trauma. The
most affected body regions resulted: the
cranial-spinal trauma with 50.3% injuries,
followed by the trauma of extremities and
pelvis 29.4%, and by polytrauma 10.6%.
Mortality in ICU were 18% and in clinics
5.1%. Motor vehicle collisions were the
first cause of death (44%) in 2016 and up to
48% for 2017.
Conclusion: Trauma in Albania has
propensity to rise. Awareness-raising
programs for pedestrian and driver
education, road safety improvement are
necessary. More attention and promote
among
healthcare
professional
to
continuing medical education from the
government is needed.
Keywords: epidemiology, trauma, UHT,
Albania
AJTES Vol.2 Nr.2 Supplement 2
9. Quality Control in Heath Care
and in Trauma Surgery it should
be Our Mission.
Skender ZATRIQI1, Ferat SALLAHU1, Enver
FEKAJ1, Violeta ZATRIQI1
1
Department of Abdominal Surgery, University
Clinical Centre of Kosovo, Pristina, KOSOVO
Abstract
Introduction: All patients are entitled to
good standards of practice and care from
their doctors. Essential elements of this are
professional
competence,
good
relationships with patients and colleagues,
and observance of professional ethical
obligations Health care organizations are
accountable for continuously improving the
quality of their services and safeguarding
high standards of care by creating an
environment in which excellence in clinical
care will flourish.
Aim of the work; we assessed our
institutions for terms quality assurance –
control how much is dispersed this concept
and is there available documentation
Good clinical care must include an adequate
assessment of the patient's condition, based
on the history and clinical signs and, if
necessary, an appropriate examination.
Quality standards must be defined by each
department and provide measurable
endpoints. Departments should ensure that
they are aware of their Trust's risk
management policy and adhere to it on all
occasions
Results; There is capacity and resources in
human and god prepared documentation but
institutional memory was lost and previous
ministers that were developing this
institution new ones do not have any
information about scope and job done
previously. Quality control is for us a new
concept and difficult to implement. A
system of accreditation for specific
interventions should be introduced
guaranteeing
their
state-of-the-art
application. There is urgent need to
implement the QCP in order to meet
standards in need for providing good
services in order to fulfill requirements for
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Licensing accreditation and finally for
gaining and profiting
Keyword: Quality Control, Kosovo
perspective, quality assurance, Trust's risk
10. The Situation of Violence in High
School of Shkodra Region.
Zamira SHABANI1, Irena SHALA1, Vera
GJINAJ1, Emiljano PJETRI1, Kilda GUSHA1
1
University “Luigj Gurakuqi” Faculty of Natural
Sciences, Department of Nursing, Shkoder, Albania
Abstract
Violence is considered 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. Violence
at school includes behavior such as:
victimization of a child and teachers, rape
of a child and / or a teacher, physical and
psychological harassment, victimization
cybernetism, cyber threat and cybernetics,
controversy, bullism, classes of physical
and psychological harm teachers and
students, behavior and activities, which are
derivatives of different cultures, sexual
violence and other border violations, and
the use of weapons in school environments.
The main forms of violence in school are:
teachers towards students, students to
teachers, students to students.
This is a punctual, cross-sectional study. In
this study was used the Standardized
Questionnaire Based on the Global SchoolBased Student Health Study (GSHS) 2003,
Extended Based Questions on Violence and
Injury Module Violence. The survey was
conducted to high school students in
Shkodra Region. Research data are
analyzed through statistical method with
microsoft office 2007. The questionnaire
was administered during January-February
2018.
Key words: violence, teachers, students,
school, Shkoder.
AJTES Vol.2 Nr.2 Supplement 2
11. Managing the Patient Evidence
Base through Trauma Cases in
University Hospital of Trauma,
Tirana, Albania.
Rudina DEGJONI1
Head of Patient Department, Health Care
Insurance Fund of Albania Tirana, ALBANIA
1
Abstract
The level of management of traumatic
health care services in Albania as a service
of the University Hospital of Trauma, 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 University
Hospital of Trauma, Tirana, 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.
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Keywords: trauma, UHT,
epidemiology, patient, evidence
Albania,
12. Devil Stands in Details, when
Colon is not long enough in
Laparoscopic LAR? Tips and
Tricks of a Safe Anastomosis.
Arben BEQIRI1, Antonio CATONA2
1
General Surgery Service, University Hospital
Center “Mother Teresa” Tirana, Albania.
Surgery Service American Hospital, Tirana,
ALBANIA.
2
Surgery Service American Hospital, Tirana,
ALBANIA.
Abstract
Every time you are doing a left colectomy
for a descending colon cancer after taking
down IMA and IMV and mobilizing splenic
flexure you run into some risk of tension on
the low anastomosis. The transverse colon
will not reach the rectum without tension on
the middle colics.
In this lecture we discus all options
available to get through this difficult
situation in colorectal surgery.
Our experience with laparoscopic colorectal
surgery at American Hospital is
demonstrated as well as part of the progress
made in this institution in the last year.
13. Laparoscopic Surgery for
Colorectal Cancer
Nuhi ARSLANI1, Stojan POTRČI1
1
University Clinical Center Maribor, Department
for Abdominal Surgery, University of Maribor,
Faculty of Medicine, SLOVENIA
admitted for colorectal cancer. We analyzed
a variety of data to provide a summary of
their survival rates, local and systemic
complications. For analysis we used data
gathered from preoperative diagnostic tests,
reports gathered during operation, reports
from pathohistologic review, and reports on
complications after surgery and follow up
Results; In the case of 573 (out of 578)
patients (99.1%) we performed resection.
R0 was achieved in 551 patients (96,1%).
R1 was achieved in 8 patients (1,4%).
Local complications were reported in 78
(13.5%)
patients
and
systemic
complications were reported in 68 (11.7%)
Conclusions; Laparoscopic colorectal
surgery for cancer has become the gold
standard. Laparoscopic colorectal resection
for cancer, in experienced hands, can be
performed safely and reliably with many
short-term benefits to the patients while
resulting in at least equivalent long-term
outcomes as open surgery, but less
conclusively demonstrated benefits include
better preservation of cell-mediated
immune function and reduced tumor cell
proliferation. Laparoscopic resection for
rectal cancer can yield the best results in
selected cases by specialists in high volume
centres.
With advances in surgical techniques, with
multimodal-multidisciplinary approach and
with the use of total mesorectal excision we
experienced a significant improvement in 5year survival rate of patients with colorectal
cancer. However there still remains the
question for truly optimal care for each
patient.
Keyword: colorectal surgery, colorectal
cancer, Laparoscopic surgery...
Abstract
Background; Laparoscopic surgery for
colorectal cancer hasundergone a major
paradigm shift in the past two decades: from
a new technique thought inappropriate for
oncologic surgery to one with sufficient
scientific scrutiny to establish itself as a
good alternative, if not the preferred
approach, in suitable cases.
Material and Methods: From 2004 to 2014,
we operated on 578 patients who had been
AJTES Vol.2 Nr.2 Supplement 2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
14. Open Abscesso – Fistulotomy in
Anal Abscesses, Results of
Treatment.
Enton BOLLANO1, Dariel THERESKA1, Krenar
LILAJ2
1
Service of General Surgery, University Hospital
Center “Mother Teresa” of Tirana, Albania
2
Service of Anesthesiology & Intensive Care,
Abstract
Introduction: Perianal abscesses usually
develop from the proctodeal glands which
originate from the inter-sphincteric plane
and perforate the internal sphincter with
their duct. The abscesses may break through
into the anal canal and resolve completely,
but they can also spread by a submucosal,
inter-sphincteric or trans-sphincteric route
and develop into fistulae.
Material and Methods: The study was
extended over a period of three years. There
are 131 patients presenting in the National
Proctology Cabinet at Service of General
Surgery, University Hospital Center
“Mother Teresa” of Tirana, Albania.
The average age of patients was 46.5 years
(26-67 years). Most patients were males
(89).
For reasons of study all cases were
intervened with spinal anesthesia using 2%
lidocaine solution. The intervention was
chosen as a gynecologic position. The
intervention was performed by the same
surgeon.
Diagnosis has been clinically established
and for all cases trans-rectal and perianal
US is performed to evaluate the extent of
abscesses. The average length of complaints
resulted 2.8 days (2 days 4 days)
In 93 patients (Group A) it was possible to
clearly identify the crypto-glandular
abnormal origin and open abscesso –
fistulotomy was performed. In 38 Patients
(Group B) drainage of the abscesses with
ellipsoid incision and passive drainage was
performed.
Postoperative resection resulted 27.8 hours
for Group A patients. All Group B patients
left after 24 hours from hospital. The
reasons for prolonged stay of Group A
AJTES Vol.2 Nr.2 Supplement 2
patients resulted: Pain (14), rectal
hemorrhage (4), temperature (2) and urinary
retention (3).
Postoperative follow-up was performed by
consulting the patients every 15 days up to
two months after the intervention.
Results: From group A two patients were
exposed with anal fistula clinic, a patient
with abscess clinic, two patients with
gastric incontinence clinic, six delayed
wound epithelial patients. From Group B all
patients were presented with an anal fistula
clinic.
Conclusion: The technique of open
abscess-fistulotomy is quite preferred, as
per our results, which also pervade the
contemporary trend of their treatment.
Keyword: Anal Abscesses, fistulotomy,
criptoglandular, transrectal , perianal
abscesses
15. Appendicitis and Meningocele. A
Case Report.
Arvit LLAZANI1, Deniona NUNCI2
1
Surgery Departament, University Hospital Center
“Mother Teresa”, Tirana, Albania
2
Imagery Departament, University Hospital Center
“Mother Teresa”, Tirana, Albania
Abstract
The anterior sacral meningocele is an
anterior sacral defect or a herniation of the
meningeal sac from the sacral foramen to
the anterior. The anterior sacral
meningocele does not regress. Although it
may be asymptomatic, some authors have
reported infectious complications such as
meningitis. Therefore, surgical treatment is
recommended. We present a case with
classic clinical appendicitis who helped in
diagnosing the patient with meningocele.
We performed standard appendectomy
procedure, the patient was discharged
uneventfully. The further evaluation by the
neurosurgeon
concluded
anterior
meningocele. Having appendisitis helped
him to be diagnosed and further followed
for the meningocele pathology. We
presented the case for the rarity of the
associated pathology. Inflammation of the
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
appendix made possible for the patient to be
evaluated and diagnosed for the
meningocele.
Keywords: appendicitis, meningocele,
surgery.
16. Aorto – Jejunal Fistula associated
with an Abdominal Aortic
Aneurysm. A Case Report
Astrit XHEMALI1, Adrian NELAJ1, Eljona
XHELILI1
1
Department of General Surgery, Mother Theresa
Hospital Tirana
Abstract
Primary aorto – enteric fistula is a rare but
serious complication of abdominal aortic
aneurysm, and the outcome of surgical
treatment is poor. With an incidence less
than 1%, according to autopsy studies in
general population. More than 80% of them
involve the duodenum, mainly in the third
and fourth portions. The jejunum and ileum
are only affected in 4% of cases. Mortality
ranges from 33 to 85%, being an early
diagnosis the most important prognostic
factor. The surgical results depend on pre
operative condition of the patient and
degree of contamination of the operative
field. We present the case report of an aorto
– jejunal fistula associated with an
abdominal aortic aneurysm, without GI
bleeding.
Keywords: Aorto-jejunal fistula, abdominal
aneurysm, surgery
17. Colorectal Cancer in Pregnancy:
A Case Report
Drini SHEHI1, Myzafer KACI1, Henri KOLANI1,
Arvin DIBRA1, Etmont CELIKU1
1
General Surgeon – University Hospital Center
“Mother Theresa” Tirana, ALBANIA
Abstract
Introduction: Colorectal cancer in
pregnancy is a very rare finding, with very
few cases reported in the literature and a
reported incidence between 0.002 – 0.005
%, since its clinical presentation with signs
AJTES Vol.2 Nr.2 Supplement 2
and symptoms that mimic those of
pregnancy, it is unfortunately diagnosed too
late, in advanced stages of the disease.
Material and Methods: We report a case of
a 16 yr old primigravida female treated in
the emergency for an intestinal ileus due to
an obstructive rectal cancer.
Conclusion: As there are no guidelines
regarding diagnoses and treatment,
managing these patients remains a
challenge for the clinicians. Herein, we
report this case to increase the vigilance of
our medical system, aiming an earlier
diagnosis and treatment and also a better
multidisciplinary approach to it, within
Obstetricians,
Gastroenterologists,
Surgeons and oncologists.
18. Mesenteric Cysts Associated with
Acute Appendicitis. A Case
Presentations.
Floren KAVAJA1, Miftari F1., Faton HOXHA1,
Shemsedin HASHANI1, Rrustem MUSA1, Arsim
AJETI1, Ali DEVAJA1, Braha B.1, Shahini L1.
1
Department of General Surgery, University
Clinical Center of Kosovo, Pristina, KOSOVO
Abstract
Background: Mesenteries and omentum
cysts are rare in abdominal surgery, which
may also have traumatic background origin,
also known as pseudocysts of mesenteries.
They are asymptomatic or have a noncharacteristically clinic like: nausea,
vomiting, pain, abdominal cramps ore
constipation. While the cystic mass is
affected in the abdomen in 65% of the cases,
therefore cysts are difficult to diagnose in
the early pre-operative course. In the
etiology of these cysts important role have,
lymphatic disorders which are related to the
venous system. In the mesentery of the
intestines appear in 60% of the cases, while
the mesenteries of the colon are rarely
affected according, to some statistics this
happens to 24% of the laundries, while only
25% of cases are in retroperitoneal position.
The adult population hits one case per
140,000 inhabitants, while at the childhood
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
one case per 120,000 inhabitants. The
classification of these cysts according to
Hitti and Sawicki is done in four groups:
cysts of embryonal origin, traumatic,
neoplastic and inflammatory origin. They
can be unilocular and multilocular. A
classification from the immune-histological
aspect was made by author De Perrot.
The case of mesenteric cyst in our hospital,
a 38-year-old patient diagnosed in front of
ultrasonography and pelvic resonance
magnetic with contrast, is shown in the
works, whereas the cyst is located in the
right hemi-abdomen but in it is impossible
to find correlation in the surrounding
organs. After the preoperative preparation
the patient was operated in general
anesthesia with open infra umbilical
incision. The whole cyst extermination was
complete, in addition to appendectomy due
to secondary apathy inflammation with
more coprolite in its space of operation and
postoperative pass smoothly without any
complications in the postoperative posture.
Removal
materials
are
sent
to
histopathological examination. Completely
removed cysts, it is a condition that the
histopathological examination be the exact
that determines the origin and treatment of
the eventuality of it. Other advantages of
removing the total cyst are: recidivist
opportunities are smaller, but the likelihood
of occurring complications during surgery
and postoperative progression is reduced.
Key Words: cysts mesenteric, method of
operations and appendectomy
19. Cranio Facial Fractures and
Injuries, Its Management
Claudio TAGLIA1, Alesio BOCARI2
1
University“La Sapienza” Rome, Italy
2
Nobel Oro-maxillofacial clinic Tirana Albania
Abstract
Patients with severe craniofacial injuries
need a multidisciplinary approach.
In the cases of politraumatic patients the
therapeutic timing, once provided to control
emergencies, such as upper airways
AJTES Vol.2 Nr.2 Supplement 2
obstructions and bleeding, must resolve the
main problem related to the trauma when
possible with an approach involving
different specialties.
Aim of the therapy is the anatomical and
functional recovery.
When diagnosticaliter is completed and the
patient is stabilized the surgical operation
should be performed as soon as possible due
to the fact the delaying could cause
difficulties in reduction of fractures.
Incisions should be performed taking care
of the high aesthetical impact of the face.
The evolutions in imaging and in materials
for internal fixation allowed in the last
decade’s better outcomes.
The author’s report shows the problems
related to the various cranio-facial fractures,
describing the most common complications
and the surgical treatment for each kind of
fracture.
Clinical cases are presented and discussed.
20. Nasal Bone Traumatic Fracture,
Immediate and Long Term
Management
Besim BOCI1, Klevis THOMAI1
ENT Service, University Hospital Centre, “Mother
Theresa” Tirana, Albania
1
Abstract
The nasal pyramid is the most trauma
exposed facial organ, making it prone to all
kind of traumatic fractures such as traffic
accidents, sport trauma, and even household
injuries.
The diagnosis is confirmed through
inspection, palpation, direct rhinoscopy,
and radiology.
The immediate management consists of
bleeding control, stabilization of the bony
pyramid, fixing septal injuries, and closing
skin lacerations.
Long term management had to deal with old
injuries untreated properly. This is achieved
through esthetic and functional rhinoseptoplasty. Best result might require the
use of every potential varieties of rhinoseptoplasty,
including
complete
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bony/cartilaginous
reconstruction
or
rebuilding.
Keywords; nasal trauma, rhinoscopy,
rhino-septoplasty,
cartilaginous
reconstruction
21. Epistaxis Management in
Emergency Settings.
Klevis THOMAI1
ENT Service, University Hospital Centre, “Mother
Theresa” Tirana, Albania
1
Abstract
Introduction: The lifetime prevalence of
epistaxis is approximately 60%, and 6–10%
of the affected persons need medical care.
According to a retrospective study from the
United States, 1 to 2 out of 200 visits to the
emergency department were due to
epistaxis, and about 5% of the patients had
to be admitted for inpatient care. In rare
cases, severe bleeding calls for the rapid
initiation of effective treatment Epistaxis is
a very common situation (50% of the
world's population) and in most cases it is
quite dramatic for both the patient and the
health care provider.
Causes of nose bleeding are varied, ranging
from trauma, cardiovascular and systemic
diseases to the side effects side effects of
medications.
Epistaxis management requires a calm and
sometimes multidisciplinary approach. In
this presentation will address the various
possibilities of rapid stopping of
haemorrhage to reduce the risk of anemia
and create conditions for transport, finding
causes, and its final treatment.
Conclusion: The treatment of severe or
recurrent
epistaxis
requires
the
interdisciplinary collaboration of the
primary care physician, the emergency
physician,
the
practice-based
otolaryngologist,
and
the
hospital
otolaryngology service. Uniform guidelines
and epidemiological studies on this topic
would be desirable.
Keywords; epistaxis, severe bleeding, nose
bleeding…
AJTES Vol.2 Nr.2 Supplement 2
22. Evaluation and Management of
Facial Trauma Patient
Orjada GASHI1, Lorena HAXHIHYSENI1, Jakup
VRIONI1
1
ENT Service, University Hospital Centre, “Mother
Theresa” Tirana, Albania
Abstract
Background: Maxillofacial injuries are
commonly encountered in the practice of
emergency medicine. More than 50% of
patients with these injuries have
multisystem
trauma
that
requires
coordinated
management
between
emergency physicians and surgical
specialists in oral and maxillofacial surgery,
otolaryngology,
plastic
surgery,
ophthalmology, and trauma surgery.
Material and Methods: There are over 238
cases of trauma-related emergency
department (ED) visits in the University
Hospital of Trauma in Tirana, each year.
Results: Average patient age was 30 years
and 76.8% of the patients were male. Sixtyfour percent of injuries were attributed to
fall or blunt trauma. Open wounds
comprised 40% of injuries. The most
common procedure was laceration repair
(70%). The majority of patients (95%) were
discharged home. Mortality rate was less
than 1%. The head, neck and face account
for just 12% of total body surface area, yet
injuries to these areas are disproportionally
represented. Injuries can range from minor
soft tissue lacerations to complex facial
fractures, penetrating neck wounds and
cranial nerve injury. Similar to the range of
injuries, the mechanism of injuries are
broad and may include minor falls to armed
assault and motor vehicle accidents. In
developing countries, motor vehicle
accident (MVA) is the most common cause
of jaw fracture, whereas, in developed
countries, assault is the most common cause
and MVA is the second most common
cause.
Conclusion: Varying from simple,
common nasal fractures to gross
combination of the face, management of
such injuries can be extremely challenging.
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Therefore, trauma to the maxillofacial
region
mandates
special
attention.
Important sensory systems are contained
within
the
face
(e.g.
vision,
auditory,
somatic
sensation, gustatory, olfaction and vestibul
ar). Also, vital structures in the head and
neck region are intimately associated
(airway, blood vessels, nerves and
gastrointestinal
tracts).
Lastly,
the
psychological impact of disfigurement can
be devastating.
Management of maxillofacial trauma is
complex and requires a comprehensive and
accurate diagnostic and treatment plan. It is
also important to consider the biologic,
functional, aesthetic and economic aspects,
as well as the patient’s desire.
Keyword: Maxillofacial injuries, facial
fractures, penetrating neck wounds…
23. Importance of Knowledge and
Attitude of Emergency Physicians
about the Management of
Traumatic Dental Injuries in
Emergency Departments.
Orjada GASHI1, Marion SAKO1, Lorena
HAXHIHYSENI1, Blerina BREGU1
1
Orofacial Surgery Service, University Hospital of
Trauma, Tirana, Albania.
Abstract
Background:
Hospital
emergency
departments are confronted with managing
dental emergencies of both traumatic and
non-traumatic origin. However, the
literature suggests inadequate knowledge of
the management of traumatic dental injuries
among medical professionals. The aim of
the study was to evaluate the knowledge of
ER physicians with different specialties,
experience and hospital sectors for the
management of avulsed teeth in the
emergency rooms of University Hospital of
Trauma in Tirana. It also covers their
attitude towards receiving further education
on tooth avulsion management.
Material and Methods: A cross-sectional
survey was conducted at the emergency
rooms of University Hospital of Trauma on
AJTES Vol.2 Nr.2 Supplement 2
Tirana. A self-administered questionnaire
consisting of 31 multiple choice questions
assessing both knowledge and attitude was
distributed to the physicians who were
working in the ER departments.
Results: Response rate was 81.33%. Data
revealed that 58.9% of the respondents did
not have prior knowledge about avulsion.
70 % of participants showed willingness to
replant the tooth; however, 60% would not
do it by themselves. 40% of the physicians
did not know the importance of extra-oral
time. Saliva was selected as the best
transport media for avulsed tooth by 40.1%
of the participants. Regarding physician’s
attitude, 20% showed interest in receiving
information about the subject.
Conclusion: Dento – alveolar trauma does
not pose a significant morbid risk for the
trauma patient. However, failure to
recognize or obtain appropriate consultation
can result in premature tooth or alveolar
bone loss, resulting in problematic
prosthetic rehabilitation, along with
immediate and long-term emotional and
social impact, especially among young
adults. This study revealed that the majority
of ER physicians lack the knowledge
needed to manage avulsions cases. Hospital
emergency departments are not confronted
with managing dental emergencies of both
traumatic and non-traumatic origin.
Key words: Dental trauma, traumatic
injuries, emergency department
24. Dental Trauma and Its
Management
Erza VOCA MULAJ1, Fatime LENJANI2, Basri
LENJANI2
1
University Dentistry Pristine, Kosovo
2
Emergency Clinic, University Clinical Center of
Kosovo, Pristine, Kosovo
Abstract
Introduction: Traumatic dental injuries
often occur as a result of an accident or
sports injury. Dental injury often occurs in
the context of other trauma. The majority of
these injuries are minor - chipped teeth. It’s
less common to dislodge your tooth or have
it knocked completely out but these injuries
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
are more severe. Assessment and
management should begin with the airway,
cervical spine, breathing and circulation,
including control of major bleeding.
Purpose. Traumatic teeth injuries pose a
challenge to dentistry. The purpose of this
study is to give a classification of dental
trauma based on localization, clinical and
prevalence.
Material and methods; This paper is based
on contemporary literature, the data
obtained from the NCSCU in order to serve
as theoretical and practical scientific
information in dentistry.
Results and Conclusions; Based on the
above objectives, they lead us to the results
which consist in the very important
statistical data. Studies have been selected
in data at range from ages 14 to 18 years males are more at risk than females in ratio
2: 1. Frequent traumas are of the type of
contusion that affects the maxillary and
fracture of the tooth crown. At the end of
this scientific elaboration, we reach the
conclusions which are the essence of
knowledge on dental trauma. Traumatic
dental injuries are treated as emergencies in
dentistry. Prognosis and treatment are in
relations with the treatment of traumatic
dental
pathologies.
Dental
trauma
management remains a problem in dental
practice based on factors that complicate the
treatment. Dental practitioners should have
knowledge in treating and managing dental
trauma.
Keywords;
trauma,
emergency,
management.
25. Management and Emergency
Dental Approach to Periodontal
Abscesses
1
1
Erza VOCA MULAJ, Fatime LENJANI , A.
LENJANI, Berat LENJANI2
1
University Clinical Dentistry Center of Kosovo,
Pristine, Kosovo
2
Stomatological Hospital Pristine, Kosovo
Abstract
Periodontal abscess is the third most
frequent dental emergency, representing 7AJTES Vol.2 Nr.2 Supplement 2
14% of all dental emergencies. The sick
often report to the Department of
Emergencies complaining of a "toothache".
Common causes of toothache are
multifungal. The difference and the type of
abscess can affect the treatment decisions,
prognosis and sickness of the patient. The
correct diagnosis and proper treatment of
these diseases require that the dental
emergency doctor
have
a
basic
understanding
of
dental
anatomy,
pathophysiology and dental treatment
protocols. Many of these conditions can be
managed initially through the Department
of Dental Emergencies. The diligent dental
practitioner should have a clear
understanding that these infections can
become very complex and may require
consultations or referrals on time. Today,
three therapeutic methods are being
discussed in dentistry, involving, drainage
and debridement, systemic antibiotics and
periodontal surgical procedures that are
applied in the chronic stage of the disease.
Keywords. Aspen periodontal, emergency,
tooth, dental
26. Clinical Importance of the Areas
of Cortex, Functional
Lateralization, Dominance and
Asymmetry in the Human Brain!
Sadi BEXHETI1, Selim ÇERKEZI2, Veton
ADEMI3, Jeton SHATRI3
1
Department of Anatomy, Faculty of Medicine,
University of Tetovo, Republic of Macedonia;
2
Institute of Anatomy, Faculty of Medicine,
University of Pristina, Republic of Kosovo;
3
Department of Radiology, Faculty of Medicine,
University of Pristina, Republic of Kosovo
Abstract
The aim of this article is to indicate
functional localization in the areas of
cerebral cortex. The cytoarchitectonic map
of the adult human cerebral cortex, prepared
in the beginning of the 20th century, is one
of
the
greatest
achievements
in
neuroscience.
Here, we want to describe all the versions of
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Brodmann’s map and other authors,
highlighting all the modifications made
especially in the cortex areas related to the
speech and language in the left cerebral
hemisphere. In this paper, are described the
mechanisms of functional localization in
the
visual
cortex,
auditory,
motoric/premotoric area, somatosensoric
and
all
other
functions.
Our results indicate about hemisphere
lateralization (influence of the left and right
hemisphere) and dominance that lead to
microscopic and macroscopic asymmetry of
the
human
brain.
In our work, we used 100 brains that by
their history of disease, were normal brains,
which are fixated with formalin. Certain
areas are put into celoidine patterns.
After that, we used the dyeing methods of
Niessl,
Golgi,
histochemical
and
imunocytochemical. We came to a
conclusion that all of the areas of the
cerebral cortex have their laminar and
columnar
cytoarchitectonic
mostly
dominated by the left side that lead to
functional lateralization and micro and
macroanatomical asymmetry. The left
hemisphere, potentially capable for abstract
thought, would never be able to realise its
task if it would not process the inputs of the
concrete thought that are provided from the
right hemisphere. Functional collaboration
between the two hemispheres of brain,
provides the normal flow of our
psychological activity as a whole.
Keywords: Cytoarchitecture, human brain
mapping,
lateralization,
dominance,
asymmetry.
27. Emergency Treatment of
Spontaneus Subarachnoid
Hemorrhage
Kiril LOZANCHE1, Jovica UGRINOVSKI1,
Ljuzim AGAI1
1
Clinical Hospital, Acibadem Sistina, Skopje,
MACEDONIA
AJTES Vol.2 Nr.2 Supplement 2
Abstract.
The patient with spontaneous subarachnoid
hemorrhage (SAH) belongs to cases of the
emergencies in neurosurgery.
The main cause of SAH is ruptured
intracranial aneurysms with the incidence
of 75-80%.
The outcome of the patients with SAH in
the literature is: 10-15% of patients die
before reaching medical care. Mortality
10% within first few days. Overall mortality
is 45%. Rebleeding is the major cause of
morbidity and mortality, the risk is 15-20%
within two weeks.
Material: In the period between November
2010 to November 2017, we have operated
on 39 ruptured aneurisms in acute stage. All
patients with SAH were investigated within
first 24 hours in the Emergency department:
CT of the brain and MRI or CT
angiography. Those patients with Hunt &
Hess (H&H) grade 2 or more were admitted
to ICU (monitored bed); The surgery
consists of “clipping” of the aneurism neck.
All of the patients were treated with
hyperdynamic therapy (triple H therapy)
and Nimodipine.
Results: 30 patients were admitted in H&H
grade 1 or 2; 9 patients with grade 3, 4 or 5.
30 patients were operated on the first 72
hours from insult (“early surgery”), 9
patients after 12-14 days from insult (“late
surgery”). Poor outcome was in 3 patients.
Coclusion: Our experienced team of:
neurosurgeon, anesthesiologist, neuroradiologist and other staff allow the
patients prompt and safely diagnosis and
treatment with this very dangerous disease.
28. Selection of the Best Surgical
Approach in the Treatment of Sub
Axial Cervical Spine Fractures
Jordan SAVESKI1, Neda TRAJKOVSKA1, Ilir
HASANI2
1
Clinical Hospital Acibadem Sistina, Skopje,
MACEDONIA
2
University Clinic of Traumatology, Medical
Faculty, Skopje, MACEDONIA
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Abstract
Introduction: Clearance, early and correct
diagnoses of cervical spine injurie (CSI) is
still a common problem in traumatology
especially in polytraumatized patients.
Delayed or missed diagnoses leads to
catastrophic consequences. The choice of
the best surgical approach is still
controversial. The aim of this study is to
present our experience in clearance,
assessment and surgical treatment of
subaxial cervical spine injury (SCSI).
Material and methods: From 2000 - 2014
year, 420 pt with SCSI were treated
surgically. There were 62 % male and 38%
female patients. Of all patients 72% were
younger than 50 years and nearly 30% were
in the 3rd decade. The main cause of injury
were MVA in 244 pt (58%), diving in 67 pt
(16%), fall from height 80 pt (19%) and
other injuries 29 pt (7%). Initial evaluation
was done by ATLS and ABCs protocol.
Primary survey included: established
airway, ventilation, maintain blood
pressure>90 and distinguish the type of
shock (hemorrhagic, neurogenic or spinal)
and immobilization of the spine with Ccollar and back board.
Results: Neurologic recovery was as
followed: group A (total 92 pt), from whom
69 pt remained in the same group , 14 pt
group B, 6 pt in group C, 2 pt in group D
and 1 pt in group E; group B (total 59 pt) 9
pt maintain in group B, 18 pt in group C, 22
pt in group D and 10 pt group E; group C
(total 63 pt) 11 pt maintain in the same
group, 40 pt in group D and 12 pt in group
E; group D (total 47 pt) 21 pt maintain in
group D and 46 pt in group E; group E, all
of them maintained in the same level group E. Initial improvement in the
alignment of deformities was achieved in all
patients. Nine pt were re-operated (because
of incomplete reduction, 6 of them primary
treated in another institution). Eleven pt had
postoperative infection (10 pt superficial
and 1 pt deep infection).
Conclusion: Definitive surgical treatment
was determined by the type of injury,
severity of instability and neurological
status. Both anterior and posterior fixation
AJTES Vol.2 Nr.2 Supplement 2
appear to be adequate. Combined approach
was indicated in patient with marked
instability.
29. A Prospective Study for Operative
Treatment of Spine Fractures at
the Clinic of Traumatology,
Skopje, in the Period From 2014
to 2017; Evaluation, Surgical
Approach, Follow ups and
Functional Outcomes
Simon TRPESKI1
University Clinic of TOARILUC, Ss. Cyril and
Methodius University-Medical faculty, Skopje,
Macedonia.
1
Abstract
Introduction: Fractures of the spine
represent a common pathology. They are
represented by 6% of all fractures of the
skeleton and thoracic-lumbar fractures with
90% of the spine fractures. In 20% of
patients with this type of injury there are
neurological outbreaks on the first
examination in the emergency room.
Causes are car accidents (45%), falls (20%),
sports (15%), acts of violence (15%), and
miscellaneous activities (5%) are the
primary causes of spinal fractures.
Materials and methods; At the Clinic of
Traumatology in the period from 2014 to
2017, a prospective study was conducted
for patients with fractures of the spine. In
this study, 157 patients were evaluated after
a trauma event (m: f =102:55), at a median
age of 58 years, all of them operatively
treated. All patients were subjected to
appropriate radiological investigations, AP
and lateral views of the spine, CT and MRI
of the spine.
Results: From 157 patients, complications
occurred in 40 patients, 12 patients had
decubitus wounds of second degree, and 9
dehiscence of the operation wound, in 6
patients urinary tract infections occurred,
and 22 patients had complications as a
result from the polytrauma. In a complete
spinal cord injury (Frankle A) in 12
patients, despite surgery, the changes were
definitive. In these patients, the occurrence
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
of contractures was common. In patients
with complete outbreaks of motility,
Conclusion
The treatment of fractures of spine is a
complex process that requires great
engagement, education and experience and
watchfulness by the responsible surgeon.
Keyword: Fractures of the spine, Frankle
classification…
30. Brain Heart Interaction in Head
Injury
Ayman El-MENYAR1
1
Director of clinical Research in Trauma and
vascular surgery in Hamad General Hospital,
Doha, Qatar
Abstract
Diagnosis of cardiac injury is easily
overlooked in trauma patients. The concept
of brain-heart interaction is an interesting
research field. The neurocardiac axis theory
and neurogenic stunned myocardium
phenomenon could partly explain the brainheart
link.
Several
observational
retrospective studies have demonstrated
worse outcomes in head injury patients who
had positive serum troponin as well. Also,
studies have shown a favorable effect of
beta-adrenergic blockers in patients with
traumatic brain injury in terms of reducing
the overall TBI-related mortality. However,
several questions remain to be answered in
the prospective clinical trials.
31. Brain Tumors after Brain Trauma
Blerim ZEQIRI1, Mentor PETRELA2
1
Neurosurgery Department, Clinic Hospital of
Tetovo, MACEDONIA
2
Neurosurgery Department, University Hospital
Center "Mother Teresa", Tirana, Albania
Abstract
The main purpose of this paper is to present:
diagnosis, clinical reflection, differential
diagnosis, complications and treatment of
head tumors as a consequence of trauma
Material and methods; Data on the
diagnosis of head traumas in children were
collected from patient records and
AJTES Vol.2 Nr.2 Supplement 2
operational data at the Department of
Neurosurgery, Clinical Hospital Tetovo,
including
the
period
01.01.201831.08.2018. The data were analyzed based
on age, sex and type of tumor as a result of
head trauma.
Results; In the Department of Neurosurgery
at the Tetovo Clinical Hospital there were
2167 cases with head trauma for the period
January 2018 to August 31, 2018 of all age
groups. From 0 to 14 years old are 67 cases
Out of the total number of over 3.5% of the
visits are head trauma, aged 0 to 14 years of
whom.
Conclusion: Head traumas are 35.0% of the
incidence of diseases caused in the Tetovo
region, the highest probability of trauma in
males is 65%, while women in females is
35% lower. In most cases it is biased, but
bilateral cases are not excluded.
Key words: Tumors, Trauma, Head, Child.
32. Current Management of
Necrotizing Soft Tissue (NSTI);
Timing of Debridement is
everything.
Rifat LATIFI1
The Felicien Steichen Professor and Chairman of
Surgery. New York Medical College, School of
Medicine. Director, Department of Surgery,
Westchester Health Network. Department
of Surgery, New York Medical College
Abstract
NSTIs, in particular, necrotizing fasciitis,
remain potentially the deadliest form of
surgical infections and require aggressive
resuscitation and surgical debridement.
Early diagnosis, early antibiotic treatment,
and early surgical debridement remain the
cornerstone of care for these patients. Yet,
timely recognition of NSTIs is difficult, but
their clinical presentation is of key
importance. Patients who are thought to
possibly have NSTIs must be seen, as soon
as feasible, by the most experienced
surgeons. Once NSTIs are diagnosed, the
proper interventions must be conducted
immediately. Emergent, timely surgical
debridement remains crucial. Early surgery
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
(within the first 6 h after diagnosis)
improves hospital outcomes in patients with
severe NSTIs.
Early recognition of NSTIs is difficult, but
their clinical presentation is of key
importance. Patients who are thought to
possibly have NSTIs must be seen, as soon
as feasible, by the most experienced
surgeons. Once NSTIs are diagnosed, the
proper interventions must be conducted
immediately. Emergent, timely surgical
debridement remains crucial. Early surgery
(within the first 6 h after diagnosis)
improves hospital outcomes in patients with
severe NSTIs. Further prospective studies
are warranted to support these findings. In
this paper I will outline the current
approaches to NSTI.
33. Failure to Rescue: Measuring our
Setbacks for Improving the Care
of Critical Patients
Mauro ZAGO1
1
General Surgery Dept, Minimally Invasive Surgery
Unit, Head Policlinico San Pietro - Bergamo ITALY
Abstract.
Failure to rescue (FTR) can be defined as
the mortality rate following in-hospital
complications.
There is a growing awareness about the
need to assess and measure the failure to
rescue rate, on institutional, regional and
national basis. Many factors affect failure to
rescue, and all should be individually
analyzed and considered. Rescue surgery is
one of these factors. Rescue surgery
assumes an acute care surgery background.
FTR in trauma could play a paramount role
in the elderly population.
Measurement of failure to rescue rate
should become a standard for quality
improvement
programs. Implementation of all clinical
and organizational items involved is the key
for better outcomes. Preparedness for
rescue surgery is a main pillar in this
process.
AJTES Vol.2 Nr.2 Supplement 2
The rationale for centralization of patients
suffering postoperative complications is
still
debatable.
Centralization
of
management, audit, and communication are
important as much as patient centralization.
34. Current Management of
Abdominal Sepsis by the Open
Abdomen Method.
Boris E. SAKAKUSHEV1
1
Medical University Plovdiv Chair of Propaedeutic
of Surgical Diseases, First Clinic of General
Surgery University Hospital St George Plovdiv,
Plovdiv, BULGARIA
Abstract
Since the beginning of this century the
method of Open Abdomen treatment has
been approved as evidence-based lifesaving approach for abdominal sepsis.
Open Abdomen treatment is indicated in
severe sepsis or septic shock/ and
prevention of Abdominal Compartment
Syndrome. Rezende-Neto et al. already
have defined that there are three basic
indications for Open Abdomen –
anatomical, physiological and logistical.
The main objectives of the Open Abdomen
approach both in severe secondary
peritonitis and severe acute pancreatitis are
sepsis control and expedite subsequent
surgical interventions.
“Planned” or “on demand” re-laparotomy
for Open Abdomen must be done early,
most appropriately until the 48th hour.
Following re-exploration, we focus on early
and definitive closure of the abdomen, in
order to prevent and reduce complications
like entero-atmospheric fistulas, fascial
retraction with loss of abdominal wall
domain, development of frozen/stiff/
abdomen and massive incisional hernias.
Intra-abdominal operations/manipulations
in abbreviated re-laparotomy include
general intra-abdominal procedures aspiration, lavage, necrectomy and specific
ones - suture, resection, anastomosis, stoma
which respond the basic objectives of Open
Abdomen - a) determining the cause of
peritonitis; b) draining fluid collections; c)
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
controlling the origin of the abdominal
sepsis”.
There is no consensus for the optimal type
of temporary abdominal closure technique,
although some benefits of constant negative
pressure devices recently are advocated.
temporary abdominal closure using
negative pressure therapy should ideally
allow the abdomen to be closeed as soon as
possible within 1 week.
The best mode of restitution of the
abdominal wall is progressive closure and
complete adoption of the fascia defect by
primary closure if possible till the 8th day
of inndex operation
The most serious local complication of
Open Abdomen - entero-atmospheric fistula
often requires surgical treatment, depending
on site and size.
Although there is an increasing evidence for
rising rate of life threatening complications
following Open Abdomen treatment,
implying its limitation, it is still method of
choice in severe abdominal sepsis and
septic shock.
Keywords: Open Abdomen, Abdominal
Compartment Syndrome,
Temporary
Abdominal Closure, Negative Pressure
Therapy
35. Timing of Cholecystectomy in
Cases of Biliary Pancreatitis
Orhan ALİMOGLU1
Department of General Surgery, School of
Medicine, Istanbul Medeniyet University, İstanbul,
TURKEY
1
Abstract
Biliary calculi (stone, microlithiasis,
sludge) are the leading cause of acute
biliary
pancreatitis
(ABP).
The
pathogenesis of ABP involves a temporary
obstruction of the ampulla of Vater by a
biliary calculus, causing bile reflux into the
pancreas via a common channel; or the
passage of a stone leading to the temporary
opening of the sphincter allowing
regurgitation from the duodenum into the
pancreatic duct.
AJTES Vol.2 Nr.2 Supplement 2
For the treatment of ABP, although
clearance of the common bile duct and
gallbladder removal are generally accepted
methods for decades, propertiming of the
intervention is still controversial. For
cholecystectomy there are two approaches
that concern propertiming:
(1) interval cholecystectomy: postponing
cholecystectomy for 6 – 8 weeks may
reduce the acute inflammation, making it
easier
to
perform
laparoscopic
cholecystectomy and possibly lowering the
conversion rate;
(2) delayed cholecystectomy (48 hours after
admission): performing cholecystectomy
during the first admission after clinical
improvement may reduce the incidence of
recurrent attacks of ABP, morbidity, and
hospital expenses.
Definitive treatment of mild to moderately
severe ABP can be accomplished
effectively and safely via cholecystectomy
following clinical improvement and
normalized levels of laboratory parameters
during the first admission. Waiting for 6 – 8
weeks to perform cholecystectomy may
result in recurrent biliary pancreatitis (upto
60%), which may increase morbidity and
the length of the hospital stay. On the other
hand, in cases of severe ABP, interval
cholecystectomy may be the preferred
choice in order to diminish possible
complications and morbidity.
Conclusions:
The
timing
of
cholecystectomy in ABP depends of the
severity of the diseases and the clinical
course of the individual patient.
36. Surgery for Acute Cholecystitis:
When?
Ozgur EKINCI1
1
Department of Surgery, School of Medicine,
Istanbul Medeniyet University, Istanbul, Turkey
Abstract
Gallstone disease is one of the most
common problems affecting the digestive
tract. Acute cholecystitis is secondary to
gallstones in 90-95% of cases. Patients who
present with acute cholecystitis are
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
hospitalized with a first line treatment
including I/V fluids, antibiotics, and
analgesia. Ultimately, surgery remains to be
the only definitive therapeutic approach for
patients having been diagnosed with acute
cholecystitis,
and
laparoscopic
cholecystectomy is the preferred surgical
technique. However, in the past and at
present, the timing of cholecystectomy has
been a matter of debate.
“Early cholecystectomy” performed within
96 hours of the illness is preferred over
“interval or delayed cholecystectomy” that
is performed 6-10 weeks after initial
medical treatment and recovery. Current
scientific
evidence
favour
early
cholecystectomy
over
the
delayed
approach, unless the patient is unfit for
surgery, as this approach possesses the
benefits
of
adefinitivesolution
in
onehospitaladmission,
quickerrecoverytimes, and earlier return to
work. Although most surgeons prefer to
perform early cholecystectomy within 96
hours from the onset of symptoms, the
interval approach is still being used for the
management such cases. On the other hand,
for cases having admitted after 96 hours
from the onset of symptoms, interval
cholecystectomy is preferred, yet some
surgeons still choose the option of early
surgical approach. This presentation aims to
discuss the surgical approach for in cases of
acute cholecystitis.
37. The Treatment of Patients with
Cholelithiasis.
Skender VELIU1, Jasmina KRÖPFL2, Dominika
VRBNJAK3
1
Surgeon, Surgical ward, General Hospital dr.
JožePotrč Ptuj, Potrčevacesta 23, 2250 Ptuj,
Slovenia
2
Nurse, General Hospital dr. JožePotrč Ptuj,
Potrčevacesta 23, 2250 Ptuj, Slovenia
3
University of Maribor Faculty of Health Sciences,
Žitnaulica 15, 2000 Maribor, Slovenia
Abstract
Introduction: In the recent years
cholelithiasis has become one of the most
common conditions affecting the digestive
AJTES Vol.2 Nr.2 Supplement 2
system
world-wide.
It
affects
approximately 1/10 of the adult population,
with the higher incidence in women.
Symptoms are present only in 20-30% of
the affected population; in other cases the
disease is asymptomatic. In this article we
present the causes, symptoms, diagnostic
tools available for screening as well as the
current
treatment
guidelines
for
cholelithiasis. The reasons for gallstone
formation are obesity, increased levels of
cholesterol, increased age and certain drugs
especially oral contraceptives. The most
common symptoms are pain in the right
upper abdomen and in the epigastric area.
The diagnosis is made based on the clinical
presentation, laboratory findings and
ultrasound of the abdomen. Current
guidelines for conservative and surgical
management of cholelithiasis are presented
in this article with the emphasis on
laparoscopic cholecystectomy which is the
golden standard for the treatment of
holelithiasis. We present the statistical
figures and results for operative treatment
of patients with cholelithiasis at General
Hospital Dr. Jože Potrč Ptuj, Slovenia for
the period of 2013-2017.
Keywords: Cholelithiasis, conservative
treatment, surgical treatment, laparoscopic
cholecystectomy, guidelines
38. Prophylactic Use of Antibiotics in
the Intensive Care Unit
Hektor SULA1, Rudin DOMI1
Department of Anesthesia & Intensive Care,
1
University of Medicine, Tirana, Albania
1
Abstract
The appropriate use of antibiotics in ICU is
important in ensuring an optimal clinical
outcome, but also in controlling the
emergence of resistance among pathogenic
microorganisms and in containing costs
The polyvalent ICU contains heterogeneous
patients under therapeutic treatment and
prophylactic antibiotics in order to
minimize the infection. The importance of
the prevention of infection in critically ill
patients is therefore based on its potential to
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
reduce both morbidity and mortality. A
clear distinction should be made between
surgical and non-surgical patients.
The antibiotic prophylaxis (ABP) in
emergency surgery seems to be difficult
compared to elected procedures. Sometimes
the difference between prophylaxis and
early treatment is difficult to be done.
Risk factors for ICU infection: The frequent
device utilization in intensive care is
responsible for most nosocomial ICUacquired
infections.
Endotracheal
intubation, mechanical ventilation, central
venous catheter, and urinary catheterization
are most important procedures responsible
for the infections of respiratory tract,
bloodstream, and urinary tract in ICU
patients. The first week of ICU admission is
characterized by impaired host defense
(especially
neutropenic
patients),
contributing in increased infection during
these procedures. The early use of
antibiotics is able to prevent the infection in
these situations.
Antibioprophylaxis
strategy:
Gastrointestinal decontamination. Systemic
Prophylaxis. Preoperative Antimicrobial
Prophylaxis
Common
Misuses
of
Antibiotics:
Prolonged
Empiric
Antimicrobial
Treatment without clear evidence of
infection. Prolonged Prophylactic Therapy.
Excessive Use of Certain Antimicrobial
Agents. Resistance to chlorhexidine
Conclusions; Use of antibiotics for
prophylactic purpose in ICU is an important
maneuver, which needs to be taking into
consideration strict indicators, patient
category kind of ABP, application
modality,
time
length,
possible
complications and economic factors (costs).
39. Extra Corporal Therapies in
Sepsis.
Alfred IBRAHIMI1
Anesthesia and Intensive Care Service University
Hospital Center “Mother Theresa”-Tirana,
Albania.
1
The treatment of sepsis is an ongoing
challenge for clinicians; despite the wide
choice of effective antibiotics to treat
infection, sepsis remains the leading cause
of morbidity and mortality for patients
admitted to an intensive care unit.
Dysregulation of the immune response is
now recognized to be a key factor in
multiple organ dysfunction, yet our therapy
for inflammation remains ineffective. It has
been advocated for more than a decade that
cytokine reduction in blood compartment
could lead to a reduction in mortality in
sepsis. Over the years, multiple
extracorporeal techniques have evolved,
with the intent of influencing the circulating
levels of inflammatory mediators like
cytokines and chemokines, the complement
system, as well as factors of the coagulation
system. These include high-volume
hemofiltration, use of high cutoff
membranes, and systems based on
adsorption, such as coupled plasma
filtration adsorption and the polymyxin – B
column. In addition, new experimental
systems that utilize human phagocytic cells
and immobilized antibodies for targeted
immunomodulation have emerged. In the
context of limited resources and growing
expansion
in
the
availability of
technologies, a better understanding of
these therapies is required before they can
be properly integrated into standard clinical
practice in the hope of influencing major
clinical outcomes.
Keywords: sepsis, therapy, extracorporal
40. Bleeding Complications after
Urgent first time CABG: Impact of
Clopidogrel Loading for
Coronarography
Aleksander HOXHA1, Sokol SHEHU, Rezar
DEVEJA, Thoma QIRJAZI2, Shkelqim
MET’HASANI1, Merita ZEKA
1
Department of Anesthesia & Critical Care,
2
Medical University of Tirana, Albania
Hygeia Hospital, Tirana, Albania
Abstract
Abstract
AJTES Vol.2 Nr.2 Supplement 2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
This study was designed to evaluate the
impact of preoperative clopidogrel on
bleeding and outcomes after coronary artery
bypass graft surgery (CABG).
Background. Excessive bleeding impairs
outcome after coronary artery bypass
grafting
(CABG).
Clopidogrel
in
combination with aspirin, given before
percutaneous coronary intervention, have
become the standard for stent thrombosis
prevention. Some premedicated patients,
however, are found to need surgical
treatment, thus platelet inhibition caused by
clopidogrel becomes a concern for post
operation major bleeding.
Methods. The study represent a
observational retrospective analysis of
collected data. The follow up of 223 treated
with clopidogrel and aspirine and 77
patients not receiving treatment with
platelet antagonist 7 days before CABG are
analysed.
Results. The groups were comparable in
age, gender, body surface area, preoperative
hematocrit, preoperative prothrombin time
and prior myocardial infarction. The
clopidogrel group had higher12h and 24h
mean chest tube output (at 12h mean
519.7ml vs 353.1 ml, p < 0.05, at 24h mean
756.6 ml vs 563.5 ml, p<0.05). Moreover,
reoperation for bleeding was 4.5-fold higher
in the clopidogrel group (5.9% vs. 1.3%, p
<0.01), and more transfusions of red blood
cells (3.23U vs 2.6 U, p<0.05), platelets
(1.53U vs 1.23U, p<0.01) and fresh frozen
plasma (0.84U vs 0.36 U, p<0.01). The
clopidogrel group also showed a longer
mechanical ventilation time (16.9h vs 12.9
h p = 0.03) and trend towards more
prolonged stay in ICU (2.08 days vs 1.7
days p= 0.048).
Conclusions. Clopidogrel in combination
with aspirin before CABG is associated
with higher postoperative bleeding,
exposure to blood products and morbidity.
These findings raise concern regarding the
routine administration of clopidogrel before
anticipated but undecided coronary stent
implantation.
Keywords: Bleeding complications, CABG,
Clopidogrel
AJTES Vol.2 Nr.2 Supplement 2
41. Burns in Elderly Patients. New
Approaches in Treatment of
Combustional Shock Phase. A
case of a Survived Old Patient
with 40% of TBSA.
Albana ALEKSI1
The Service of Burns and Plastic Surgery,
University Hospital Center “Mother Teresa”,
Tirana, Albania.
1
Abstract
Introduction: Nowadays many old people
live and stay home alone, because the young
people go abroad.
The old burned patients represent a growing
number
in
the
total
burned
patient number in our emergency. This
segment of population presents different
features and their survivalfrom the state of
burn depends from the surface and the grade
of damage, the co-morbities and an accurate
treatment to prevent the complications and
to improve the outcomes.
The Case; A male patient 68-yr old was
admitted to our emergency room after he
accidentally found himself within the lime
pit. The place of accident was 35 km from
the burn center. No venous access. No
medication. No medical treatment.
The region affected were the lower
extremities, the low back and the upper
extremities (half of them). After washing
the wounds with NaCl 0.9%, we medically
treated them with petrolatum gauze and
Betadini 7.5% and the patient was
transferred in intensive care. The patient
was fully monitored with central venous
pressure, arterial, urinary catheterization.
The patient suffers from arterial
hypertension and in the last two years he
was subjected a coronary bypass. No signs
of initial necrotomia and the compartment
syndrome. Our attention was paid to
rehydrate the patient as good as possible to
avoid the overloading because he was a
cardiac patient. The fluid resuscitation was
administered guided by Parkland formula
i.e 4ml/kg/%TBSA in order to maintain
a urine output 0.5-1 ml/kg/hour. We gave
him Ringer lactate and after 12 hours
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
post combustio, we gave him colloid
solution (human albumine 20%-50 ml and
2 fresh frozen plazma izogroupizoRhesus).
Keywords:
burned
patients,
initial
necrotomia, petrolatum gauze
42. Thoracotomy and Postoperative
Pain Management
Alma CANI1, Fahri KOKIҀI1, E. SHIMA1, Fadil
GRADICA2, L. AGOLLI1
1
Anesthesiology Service, University Hospital
“Shefqet Ndroqi” Tirana, Albania
2
Thoracic Surgery Service, University Hospital
“Shefqet Ndroqi” Tirana, Albania
1,2
Pneumology Service, University Hospital
“Shefqet Ndroqi” Tirana, Albania
Abstract
Background: Post thoracotomy pain
syndrome (PTPS) is unfortunately very
common following thoracotomy and results
in decreased quality of life. Treatment of
acute post-thoracotomy pain is particularly
important not only to keep the patient
comfortable but also to minimize
pulmonary complications.
The aim of this retrospective study was to
determine perioperative patient, surgical,
and analgesic characteristics associated
with the development of PTPS.
Materials and Methods: In a retrospective
study, 163 patients were randomized to
receive multimodal analgesia including
opioids and non-opioids, delivered through
various routes, neuraxial use of local
anesthetics, either alone or in combination
with
other
drugs,
nerve
blocks,
antihyperalgesics and techniques such as
patient controlled analgesia, prevertebral or
epidural infusion for post-thoracotomy pain
control. Patients were evaluated for
analgesic efficacy and postoperative
complications
Results: Incidence of long-term postthoracotomy pain has been reported to be
80% at 3 months, 20% at 6 months, and 5%
at one year after surgery; incidence of
severe pain is 3–5%, and pain that interferes
with normal life is reported by about 25%
of patients, 5% of the patients with PTPS
AJTES Vol.2 Nr.2 Supplement 2
received treatment for pain. The strongest
predictive factors for the development of
Pulmonary Postoperative Complication
CPP were: thoracic pain for three months
post operatively (odds ratio [OR] = 3.54,
95% confidence interval [CI] = 1.69–
7.40, P = 0.001), thoracic pain for 12
months postoperatively (OR = 2.73, 95%
CI = 1.28–5.83, P = 0.009) Neuropathic
pain was present in 4.8% of patients.
Urinary retention, however, was noted to be
significantly more frequent in patients with
epidural catheter.
Conclusions:
The
introduction
of
multimodal analgesia including opioids and
non-opioids, delivered through various
routes, neuraxial use of local anesthetics,
either alone or in combination with other
drugs, nerve blocks, anti hyperalgesics and
techniques such as patient controlled
analgesia and pre-emptive analgesia have
greatly improved the efficacy of paincontrol while minimizing the side-effects of
any
one
modality.
The
recent
recommendation of planning the pain
services in an organized manner and
implementation of Acute Pain Services
(APS) has proven to be beneficial and
rewarding.
Keywords: thoracotomy, pain, management
43. Fluid Management in Traumatic
Brain Injury and Neurological
Patient
Asead ABDYLI1, Blerim ARAPI1, Gentian HUTI1,
Rudin DOMI1.
1
Anesthesiology and Intensive Care Service,
American Hospital Tirana, Albania
Abstract
Introduction; Maintenance fluids in
critically ill brain-injured patients are part
of routine critical care. Both the amounts of
fluid volumes infused and the type and
tonicity of maintenance fluids are relevant
in understanding the impact of fluids on the
pathophysiology of secondary brain injuries
in these patients. In this narrative review,
current evidence on routine fluid
management of critically ill brain-injured
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
patients and use of hemodynamic
monitoring is summarized. Pertinent
guidelines and consensus statements on
fluid management for brain-injured patients
are highlighted. In general, existing
guidelines indicate that fluid management
in these neuro critical care patients should
be targeted at euvolemia using isotonic
fluids. A critical appraisal is made of the
available
literature
regarding
the
appropriate amount of fluids, hemodynamic
monitoring and which types of fluids should
be administered or avoided and a practical
approach to fluid management is
elaborated. Although hypovolemia is bound
to contribute to secondary brain injury,
some more recent data have emerged
indicating the potential risks of fluid
overload. However, it is acknowledged that
many factors govern the relationship
between fluid management and cerebral
blood flow and oxygenation and more
research seems warranted to optimise fluid
management and improve outcomes.
Keywords: Subarachnoid haemorrhage,
Traumatic brain injury, Fluid management,
Volume
status,
Hypervolemia,
Haemodynamic monitoring
44. Crush Syndrome and Continuous
Renal Replacement Therapy
(CRRT)
Rinard KORTOCI1, Blerim ARAPI1
1
Anesthesiology and Intensive Care Service,
American Hospital Tirana, ALBANIA
Abstract;
Introduction; Mioglobin is a protein based
on iron and enables O2 to be transported to
the muscles. In cases of rabdomiolize
(Crush Syndrome) due to muscle damage,
the myoglobin is thought to be the main
reason for the IRA (through some
mechanisms already confirmed).
Purpose. Evaluation of IRA treatment
modalities in rhabdomyolysis by focusing
mainly on CRRT as well as our experience
in treating a serious septic patient of IRA
(Anorexia).
AJTES Vol.2 Nr.2 Supplement 2
Discussion. In addition to conventional
treatment in Crush Syndrome, CRRT
(CVVH and SHF), hemodialysis, are also of
great importance. The starting point of
CRRT depends on IRA and / or MODS and
not on myoglobinemia or LDH level. In
2014 there have been reports of the use of
SHF (super high flow hemofiltration) which
is carried out with filters with larger pore
sizes than ordinary filters.
Keyword; Crush syndrome, IRA, CRRT,
rabdomiolize, myoglonine, SHF
45. Management of a Iatrogenic
Complete Obstruction of the
Inferior Vena Cava with CRRT
Technique
Saimir KUCI1, Alfred IBRAHIMI1, Ervin BEJKO1,
Stavri LLAZO1, Jonela BURIMI1, Esmerilda
BULKU1.
1
Anesthesia and Intensive Care Service University
Hospital Center “Mother Theresa”-Tirana,
ALBANIA.
Abstract
Introduction: Complete obstruction of the
inferior vena cava is a deadly complication.
Herein we represent a case with a iatrogenic
complete obstruction of the inferior vena
cava treated in the intensive care employing
a bypass between the left subclavian and
left femoral veins.
Case presentation. A 68-year-old male
patient presented an abdominal aortic
aneurysm (6cm). He underwent abdominal
aortic aneurysm repair. During the
operation, the inferior vena cava was
accidentally perforated.
Given
the
emergency
of
this
life-threatening
condition, it was impossible for the surgical
team to stitch the perforation and correct the
complication. Inferior vena cava was
ligated in order to stop the bleeding.
Complete obstruction of the venous flow
found our patient's collateral veins
unprepared, and therefore unable to perform
adequate drainage of the blood from the
lower extremities, resulting in inadequate
preload and the following hypovolemic
shock. We found a practical, off-protocol
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
solution to this critical case. We inserted
central venous catheters in both (left)
subclavian and (left) femoral veins and
connected the two with a simple perfusion
tube. The gradient already present, between
inferior and superior vena cava made
possible a successful transfer of the blood
and a good increase of the pre-load. Clinical
results were almost immediate. Meanwhile
the collateral veins had time to develop a
greater capacity and compensate the venous
obstruction.
Conclusion: We found such a bypass a very
good temporary solution of this deadly
complication and we believe that can be
employed in other similar cases.
46. Helicopter, Excellence Service of
Medical Emergency
Skender BRATAJ1, Erald XHELILI1, Indrit
JAUPAJ1
1
National Emergency Medical Centre, Tirana,
Albania.
47. Modern Triage in the Emergency
Department
Abstract.
Introduction:
Helicopter
medical
emergency service is the best option to cope
with emergency medical emergencies and
in
areas
without
infrastructure.
Modernization and completion, not only
because of modern medical equipment and
devices, but more because of legal
adaptation and new mentality, where every
Albanian or foreign patient in the territory
of the Republic of Albania is guaranteed life
and treated with the same devotion,
devotion and professionalism.
This service is already equipped with onboard medical equipment that is needed to
monitor, defibrillate, immobilize and treat
patients at the scene, during transport, to
more specialized health centers. The
novelty of this topic is about introducing
rigorously prepared medical staff to deal
with the variety of problems encountered
during lifesaving operations.
The purpose of this study is to reflect and
analyse the work done so far by the NCCP
regarding the service, the time of arrival, the
AJTES Vol.2 Nr.2 Supplement 2
difficulties and the problems encountered
during the work.
Accurate
data
analysis,
correct
documentation of events and missions
through the patient's file, receiving predeparture information and completing the
territorial card are essential for assessing the
quality of the service, improving it, and
reducing the disability of the patient. The
Coordination Unit as an Innovation has a
very important role in conducting this
service.
As a Conclusion: Emergency helicopter
service for the natural, structural conditions
of our country is indispensable for life
saving, service improvement, and reduction
of disability.
The current state of affairs aims to improve
this service to be as quality in line with the
standards of international scientific
associations.
Keywords: helicopter; patient's file, followup
Basri LENJANI1, Gani SHABANI1, Esen
UYSAL1, Arber DEMIRI2, Erza Voca MULAJ2,
Dardan LENJANI2
1
Emergency Clinic, University Clinical Center of
Kosovo, Pristin, Kosovo.
2
University Clinical Center of Kosovo, Pristin,
Kosovo.
Abstract
Background: Triage is the process of
determining the priority of treatments for
the sick, injured and poisoned in minor
incidences and to a large extent, based on
the weight and nature of their illness.
Triage system. No uniform triage system
exists in the United States (US), this
creates a wide dilemma of basic
assessment of the injured patients and sick
patients and each region has its own
emergency medical service network.
Aim: The aim of this study is to identify
contemporary triad instruments, evaluation
criteria, validity and reliability reducing
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the overpopulation of the Emergency
Clinic
Materials and Methods: The data were
obtained from the SHSHUK-UCCK
Emergency Clinic's resources for the sixmonth period January-July 2018. Also,
was taken the criteria of assessment and
the examination of triad literature in the
search for the adaptive model for our
country in the three levels of medical care.
Formation of methods that integrate the
field and needs of hospitals will support
EMS that ensures better care continuity.
Results: Emergency Departments around
the world use multiple triad systems to
assess the severity, categorization of the
sick and the injured. Our research
identified adaptable sources and
experiences of the Canadian, Australian,
Finish, German, and TRI triads of the UK,
which systems, resources, can impact on
reducing morbidity, invalidity and
mortality and affecting the level of growth
of reliability in the system.
Conclusions: To regulate the current
situation of the triage system in Kosovo
which functions as an inadequate
synchronous system or does not have any
official document with standards,
normative for triage at state level to
develop standards, of triage norms one of
the five adaptable triad system models, but
adapting to our circumstances and
conditions.
Keywords: Triage, system, emergency, ill,
hurt criteria, assessment, and medical care.
48. Emergency, Legislation, Ethics
and Medical Deontology
Eda LUZAJ1, Skender BRATAJ1, Ertugilda
HOXHAJ1
1
National Emergency Medical Center, Tirana
Albania.
Abstract
Introduction: Over the last few years,
emergency medicine has grown and
impressive changes. Continued medical
AJTES Vol.2 Nr.2 Supplement 2
knowledge and the introduction of
technology in this field have improved the
delivery of first aid in case of medical
emergencies
or
catastrophe.
The
Emergency Medical Service, is responsible
for any Albanian or foreign citizen who is
in the territory of the Republic of Albania in
case of medical assistance.
Purpose: Evidenting of ethical and legal
problems at Emergency Medical Service,
the way of resolving them based on
Albanian legislation and what needs to be
improved!
Medical staff faces patients who refuse
medical care, which pose a hazard as in the
case of psychiatric, alcoholic or drug users.
They also face severe cases: traumatic,
cardio-vascular, respiratory and tumor
patients at the terminal stage. In all these
cases medical personnel are involved in
deontological, ethical and legal issues. Of
particular importance is the preparation,
completion and interpretation of the legal
basis to regulate not only the medicalpatient relationship from the health but also
the ethical - professional deontologic ones
(to fill the legal vacuum regarding medical
violations and relevant disciplinary
measures).
Conclusions and proposals: Adaptation of
Albanian
legislation
to
European
legislation.
The
term
"negligent
medication" Article 96 of the Criminal
Code of the Republic of Albania is
transformed into "neglect in diagnosis and
medical treatment", thus using the same
European terminology and introducing at
the same time the concept of diagnosis
which previously did not exist by allowing
negligence in diagnosis not to be considered
a criminal offense.
49. Nursing Role in Emergency
Edison NDREKA1, Skender BRATAJ1, Gresjeta
VATA1, Hava VANGJELI1
1
National Emergency Medical Centre, Tirana,
Albania.
Abstract
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Introduction; Medical and nursing staff
such as first aid providers are the healthcare
chain (pre-hospital and hospital care).
Purpose: To identify the ethical problems in
the nursing service, their role in the
emergency as well as the differences and
similarities between Albanian Nurse Order
and Albanian Medical Order
In Law no. 147/2014 "On the Emergency
Medical Service", article 20 mentions the
tasks of the emergency nursing staff who
are: to take care of emergency patients,
depending on the sector (primary, triage
reception,
assessment-treatment,
observation) in all their management roles
and work in groups; Accurately implement
emergency service protocols approved by
the ministry responsible for health; to carry
out all duties assigned by the Chief of
Service, Head Nurse and Medical Staff; to
participate in the activities for raising the
technical-professional level in order to
increase the quality of patient care.
Increasing their role in the health service
has added to the various issues related to
their profession.
Ensuring standards to provide a
professional, ethical and deontological
service is regulated by the Statute Albanian
Nurse Order and Albanian Medical Order,
the Code of Ethics and Deontology for
Nurses, the Law No.147 / 2014 "On the
Emergency Medical Service", the Criminal
Code and Civil of the Republic of Albania.
Conclusions; Improving law, ethics and
deontology between the Nurses Order and
the Order of Doctors. Drafting and
implementing a common protocol on group
work among medical staff and emergency
assistants.
Competencies and duties of the nurse in
emergency without the presence of a
doctor!
50. Medical Phone Triage and Ways
of Organizing in the Pre-Hospital
Emergency Coordination Unit.
Skender BRATAJ1, Indrit JAUPAJ1
National Emergency Medical Centre Tirana
Albania
1
AJTES Vol.2 Nr.2 Supplement 2
Abstract
Several years of analysis and experience of
the medical emergency system have shown
some problems: Inability to receive all calls
for medical assistance, lack of triage, lack
of team and ambulance control in real time
via the GPS system, arrival time
unobserved and very long due to traffic and
location at the same ambulance site, lack of
territorial card, lack of communication with
the waiting emergency causing delays in
handing over the patient, assessing the
severity of the disease and receiving the
service.
This work is a new, efficient, fast way of
organizing, as one of the best European
experiences that comes to the aid of the
medical staff of the pre-hospital emergency
service and serves as a unification of the
entire triage system (Selection).
This study is based on the data collected
during the last 16 months of the
Coordinating Unit of the National Centre
for Medical Emergencies.
As a conclusion we can say that this study
highlights the quality of the antecedent
system evaluation with the establishment of
the National Emergency Centre, the current
difficulties faced by the pre-hospital
service, answering and solving all the
requests for assistance, as a result brings
reducing unnecessary flux and waiting in
hospital emergencies; activating and
tracking of available resources in real time,
significantly reducing the time of arrival at
the patient…
This study gives us the opportunity to shed
some light on future challenges for further
service improvements, more efficient use of
resources and resources, better co-operation
between the primary care system and
primary, secondary and tertiary hospital
systems, other co-operatives (firefighters,
police, army in case of emergency),
organizations and NGOs. All this for a
single purpose: life-saving, reducing
invalidity and guaranteeing the quality of
life.
Key words: Medical Emergencies, Dispatch
Life Support, National Emergency Centre
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51. Current Trends in the Clinical
Management of Renal Trauma
Skender SAIDI1
1
University Clinic of Urology, Skopje, Macedonia.
Abstract
Globally, trauma is the sixth leading cause
of mortality, causing for 10% of all deaths
and disability to many millions more. The
kidney is the most frequently injured organ
in the genito – urinary system. The renal
traumatic injuries account for 10% of all
abdominal trauma and up to 5% of all
trauma cases.
Renal trauma is defined as a physical blunt
injury or a penetrating wound of the renal
parenchyma, renal vascular vessels or the
urine evacuation structures induced by a
physical extrinsic agent. Most common
causes of renal trauma includes traffic
incidents, falls, impacts during contact sport
activities (blunt injuries) or knife and
gunshot wounds (penetrating injuries).
The first step of clinical management of
suspect renal trauma consists of evaluation
including patient history collection and
physical examination. The most essential
aspect in the management of renal trauma
involve patient's hemodynamic stability.
For that purpose, it is important that the
vital signs should be permanently
monitored.
The commonly used Injury Severity Scale
system for the kidney trauma is an
anatomic-based description, developed by
the American Association for the Surgery of
Trauma (AAST). According to this system,
the renal injuries are classified into 5
grades.
Treatment options are selected based on the
advanced trauma life support (ATLS)
guidelines, the development of strategies
for controlling the hemorrhage by massive
transfusions, and the use of damage control
surgery procedures.
AJTES Vol.2 Nr.2 Supplement 2
52. Injuries of Renal Artery and Vein
in Abdominal Trauma
Arian HODO1, Astrit MUSTAFA1, Bedri MIHAJ1,
Arben ZENELAJ1
1
Urology Service, University Hospital of Trauma,
Tirana, Albania
Abstract
Pedicle renal vascular trauma are mostly
rare. In trauma associated with laceration of
artery or vein mortality is high. Most cases
of
blunt trauma are caused by
automobilistic accidents and rarely from
penetrating trauma.
Objective: Presentation of our 8 year
experience.
Material and methods: In the study are
encluded cases of automobilistic and
penetrated traumas of renal pedicula
between 2007 to year 2015. In total 9 cases
from which 5 cases resulted trauma of renal
arteria associated with masiv or total
thrombus of renal artery without laceration
and not associated with masive
retroperitoneal hematoma or multiorgan
trauma. Concerning the late diagnoses these
patients are treated conservatively,
monitoring vital signs and urine output.
Examination is done under emergency
conditiones, Abdominal CT scan with
contrast solution and a week after with renal
schintigraphy.
In
DMSA
renal
schintigraphy resulted masive or total
avascularisation. The patients are treated
with antibiotics to prevent retroperitoneal
abcess and in only one case we needed
antihipertensive treatment. In three of the
cases we performed nephrectomy because
of masive retroperitonela hematoma with
vitale failure. One of the cases was
penetrating trauma of renal vein and vena
casa (4 cm). Patient was diagnosed in
Operating Room, it was a multiple organ
trauma encluded pulmonary and hepar
injury. In this patient we used part of renal
vein flaping vena cava and anastomosis
renal vein by transposition of kidney up to
the healthy vena cava parts.
Conclusion: Because of the fact that
patients with thrombus of renal artery where
diagnosed
relatively
late,
surgical
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intervention was not an option. As result,
the patiens were followed up conservativly.
In postoperatory period no complicationes
were noticed.
Key words: trauma, vascular pedicle,
hematoma, thrombus, conservative.
53. Bladder Cancer Initial Approach
in Emergency
Gjergji SEMINI1, Grigorios DALIGAROS2,
Kostandinos ZOTOS3, Athanasios LAZARIDIS4,
Fotios DIMITRIADIS5
1
Urologist, Amerikan Hospital Tirane, Albania
2
Urologist, Ioannina, Greece
3
Urologist, Kozani, Greece
4
Urologist, Arta, Greece
5
Urologist, Aristotle University, Thessaloniki,
Greece
Abstract
The urinary bladder cancer (BC) is the
eleventh most common cancer in both
genders worldwide. About 2,4% of total
population will be diagnosed with bladder
cancer in their lifetime. Men are affected 3
to 4 times more frequently than women,
having also a double mortality rate.
In advanced countries about 90% of bladder
neoplasms are urothelial carcinomas,
occurring at the urothelial cells of the
bladder wall. These lesions can also affect
other areas of the urinary tract, such as the
renal pelvis, ureters and urethra.
The habit of tobacco smoking, with the
presence of polyaromatic hydrocarbons
carcinogens in tobacco products, is the most
important cause of bladder cancer. Other
causative factors are: advanced age, family
history, occupational exposure to types of
organic chemicals (found in textile dyes,
rubber, petroleum products, metals,
processed leather and paints), arsenic
exposure, previous chemotherapy and
pelvic radiotherapy, chronic bladder
inflammation/infections.
Bladder cancer signs/symptoms may
include painless gross or microscopic
hematuria (the most common) and irritative
bladder symptoms {more often in patients
with carcinoma in situ (CIS)}. Rare findings
are pelvic/bone pain, lower extremity
AJTES Vol.2 Nr.2 Supplement 2
edema, flank pain and palpable mass. The
diagnosis depends mainly on cystoscopy
examination.
Initial treatment for most BCs involves
transurethral resection (TUR) in order to
remove all suspected lesions and obtain
material for histological examination.
This article aims to discuss the diagnostic
approach and the treatment modalities of
bladder cancer.
Keywords: bladder cancer, diagnosis,
treatment
54. 12 Years of Experience with
Buccal Urethroplasty for
Traumatic Ruptures of Urethra. A
Review of 95 Cases. Results and
Outcomes.
Gezim GALIQI1, Shpetim YMERI1, Albert PESHA2,
A. KONI3 , Shkelqim FERKO4, Bilbil HOXHA3,
Anton NDOJ4, I. VISHI5, D FERIZI5
1
Regional Hospital of Shkoder, Albania.
2
Regional Hospital of Fier, Albania
3
Amerikan Hospital of Tirana, Albania.
4
Regional Hospital of Durres, Albania
5
Regional Hospital of Ferizaj, Kosovo
Abstract
Background: Posttraumatic reconstruction
of a urethral stricture poses a difficult
surgical problem. The use of buccal mucosa
graft only urethroplasty represents the most
widespread method of bulbar urethral
stricture repair. The graft may be placed on
the ventral or dorsal urethral surface
according to surgeon experience and
preference.
Aim: To represent our experience with
Buccal Mucosa Urethroplasty (BMU) for
substitution of all segments of urethra after
urethral trauma.
Materials and Methods: We repaired 95
urethral strictures with BMU from 2006 –
2018. From them 42 were with traumatic
origin. One stage dorsal or ventral
urethoplasties were: Recurrence rate,
complications
were
analysed
retrospectively. Mean follow up was
minimally 2 years. From one stage BMU in
28 cases was used ventral graft for bulbous
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urethra. In the rest of traumatic origin
especially after obliterated strictures after
pelvic fractures we used dorsal graft.
Patient were evaluated in follow up with
flusometry and when it was less then
10ml/sec the Qmax with flexible
cystoscopy.
Results: Median age of the patient was 49,
mean length of the graf was 4.2. The
success rate was 86 %. In patient with
recurrence we did internal urethrotomies
which resulted conclusive. Only in 5 patient
we did again grafting with BMU.
Conclusion: One stage BMU provides an
excellent result for strictures involving any
segment of anterior and posterior urethra
(1,2) . Even in the case of recurrence most
of the patient are resolved with internal
urethrotomies leaving redo BMU only for
5.2% of cases.
Keywords: Buccal urethroplasty, trauma,
urethra, rupture, results
55. The Use of S-Curved Coaxial
Dilators for Urethral Dilatation.
Experience of a Tertiary
Department.
Gjergji SEMINI3, Panagiotis KALLIDONIS1,
Constantinos ADAMOU1, Adamantia
KOUTAVA1, Panteleimon NTASIOTIS1, Dimitrios
KOTSIRIS1, Evangelos LIATSIKOS1.2
1
Department of Urology, University Hospital of
Patras, Patras, Greece
2
Department of Urology, Medical University of
Vienna, Vienna, Austria
3
Department of Urology, American Hospital,
Tirana, Albania.
Abstract
Background: Urethral strictures can be
treated by urethral dilation, optical internal
urethrotomy or open surgical reconstruction
(urethroplasty). The S-Curved Coaxial
Dilator (SCCD) was designed to facilitate
the passage of the dilator through the
stricture and the urethra because it imitates
the curved anatomy of the male urethra.
Aim: This study presents our experience
with SCCD.
Materials and Methods: We used this kind
of dilation in 310 patients. The technique
AJTES Vol.2 Nr.2 Supplement 2
included the insertion of a hydrophilic
floppy tipped guidewire through the urethra
directly into the bladder under fluoroscopic
control. The SCCDs were then inserted over
the guidewire. Dilators of gradually
increased size from 8F to 20F were used.
The follow-up of the patients includes
uroflowmetry and measurement of post
void residual (PVR) at 4 weeks, 6 months or
in the case of a recurrence of symptoms.
Results: The age of the patients were 69.08
± 15.77 years. The causes of urethral
stricture were iatrogenic (n = 114; 36.8%),
traumatic (n = 35; 11.3%), infectious (n =
22; 7.1%), and of unknown origin (n = 139;
44.8%). The stricture length was 1.62 ±
0.85cm. The mean number of dilations
needed per case was 2 (range 1 – 15) and the
time between the dilations was 212.19 ±
253.9 days. We had 7 failures.
Conclusion: We propose the S-Shaped
Coaxial Dilators for urethral dilation as a
safe and effective technique because of their
similarity to the shape of the male urethra
and because of their hydrophilic coating.
Keywords: SCCD, urethral strictures,
dilation
56. Sachse Laser in PostTrauma
Urethral Stricture: A Valid
Alternative before Urethroplasty.
Astrit MUSTAFA1.3, Evisa ZHAPA1, Francesco
Saverio GROSSI1,2
1
Urology Department, Italo-Albanian, “Salus”
Hospital, Tirana, ALBANIA
2
Complex Structure of Urology, Hospital SS
Annunziata of Taranto. ITALY
3
University Hospital of Trauma Tirana, ALBANIA
Abstract
Introduction: The most commonly used
treatment modality for urethral strictures is
the direct visual internal urethrotomy
method according Sachse cold knife, but
with low long-term success rate. Alternative
method after failure is urethroplasty with
preputial flap or Buccal mucosa. The aim of
this presentation is to report the efficacy of
the Internal Urethrotomy with Holmium
Laser (Sachse laser).
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Material and methods: We report three
cases of urethral stenosis after trauma which
treated with Internal Urethrotomy with
Holmium Laser (Sachse laser) after failure
of multiple treatments with Sachse cold
knife. We evaluated and compared the
uroflowmetry parameters before and after
Sachse laser.
Results: The average of uroflowmetry
parameters before incision were: Q max 4.5
ml/sec, Q med 3 ml/sec. Voided Volume
323 cc, while after incision with Sachse
laser were: Q max 30 ml/sec, Q med 12
ml/sec. Voided Volume 363 cc. No patients
relapsed during follow-up time from 3 to 24
months.
Conclusion: Even though these are only a
few cases, we think that Sachse laser is a
valid alternative after unsuccessful Sachse
cold knife and before. Urethroplasty, even
in patients with urethral stricture after
trauma.
Keywords: Treatment modality, urethral
strictures, alternative method
57. Treatment of Nocturia in BPH
Patients with Tamsulosine 0,4 mg.
Rezart XHANI1, Mustafa XHANI1, Eugen TATA1,
Herion DREDHA1
1
Urology Department, University Hospital Center
“Mother Teresa”, Tirana, Albania
58. SHOCK - What, When, and How
to Treat…
John E. FRANCIS1
Lafayette Surgical Clinic, Chief of Surgery,
Director of Trauma, Lafayette, Indiana, USA
1
Abstract
Shock is poorly understood term which
encompasses a wide range of experiences.
Hemorrhagic shock in particular has its own
particular challenges with regards to
treatment and mitigating effects of therapy.
This discussion will focus on the current
guidelines and recommendations for
identifying, treating, and decreasing the
risks associated with treatment of patient’s
in shock.
Shock is a word we use to describe
inadequate tissue perfusion by oxygenated
blood. In hemorrhagic shock there is a
concomitant loss of fluid to carry oxygen
and ability to remove cell products. This
double-effect compounds the destructive
aspect of decreased perfusion alone. We
will discuss methods and techniques to
reverse these effects as well as prevent
ongoing damage from the initial insult as
well as the effect of the treatment.
59. Trauma and Coagulopathy
Abstract
The use of Tamsulosine is safe and effective
in men affected by BPH who present with
nocturia symptoms. The study was done
during 15 weeks and included 100 patients
aged 55 years or older with 3 or more
nocturia episodes during the night based on
voiding diary. The IPSS was 8 or more
(moderate symptoms) and patients were
treated with Tamsulosine 0,4 mg. The
number of nocturia episodes was reduced
by 1,16 and the IPSS was clearly
ameliorated after 15 weeks of treatment.
The most common adverse effect reported
was retrograde ejaculation (8 % of patients).
Keywords: nocturia, BPH, tamsulosine,
treatment
AJTES Vol.2 Nr.2 Supplement 2
Blerim ARAPI1, Gentian HUTI1, Asead ABDYLI2,
Rinard KORTOCI1
1
Anesthesiology and Intensive Care Service,
2
American Hospital Tirana, ALBANIA
Abstract
Introduction; Hemorrhagic shock from
blood loss is a major cause of mortality in
trauma patients. Bleeding is due to an
intrinsic dysregulation of the blood
coagulation known as trauma-induced
coagulopathy (TIC). TIC is faced in the
presence of both hypoperfusion from blood
loss and tissue injury.
Materia and Methods; We review the
literature, in order to highlight the modern
concepts and mechanisms contributing to
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TIC. Understanding these mechanisms can
improve treatments strategies, morbidity,
and mortality of severe traumatized
patients.
Results; The mechanisms of coagulopathy
in trauma patients have been explained by
close examination of the biochemical and
cellular changes due to tissue injury and
hemorrhagic
shock.
Mechanisms
contributing to TIC include anticoagulation,
consumption, platelet dysfunction, and
hyperfibrinolysis.
Conclusions; The anesthesiologist and
intensivist often are faced with traumatized
patients. The surgical team must be
prepared to promptly treat trauma induced
coagulopathy, and good knowledge about
this complication is the first step.
Keyword: coagulopathy in trauma, blood
coagulation,
hypoperfusion,
platelet
dysfunction
60. Cardiac Arrest in Anesthesia
Pirro PRIFTI1
1
Head of Department of Technical Medical
Sciences, Faculty of Professional Studies
“Aleksander Moisiu”, University, Durres, Albania.
Abstract
Aim of this study is fast Recognition,
Management of situation of Cardiac Arrest
during Anesthesia and treatment of
complications.
Objectives are: Analysis of Causes that
trigger Cardiac Arrest, analysis of risk
factors and prevention of Cardiac Arrest in
Anesthesia.
Is known that Cardiac Arrest occur at 0.5/
10.000 cases of Anesthetized Patients
Between other Causes, Human Mistake is
one of cause of Cardiac Arrests.
Cardiac Arrest can be defined as a physiopathologic situation of acute Cardiac
failure, when the Heart stop and cannot
supply with blood -vital organs, mainly the
Brain.
Causes of Cardiac arrest are multiple and
more important are: Cardiac arrest with
Reflector origins, direct cardiac trauma,
overdose of anesthetic drugs, Ventricular
AJTES Vol.2 Nr.2 Supplement 2
Fibrillation, acute coronary failure, acute
diminished venous reflux, cardiac arrest
from metabolic disorders, massive blood
transfusions, anaphylactic reactions and
cardiac arrest from special surgical
procedures as prosthesis with implanting
cement.
Symptoms during Anesthetized patients are
poor, but Anesthesiologist must be very
careful. Symptoms are, hypotension,
cyanosis,
dysrhythmia,
hypoxia,
hypercarbia, surgeon see `black blood` and
asystole.
Mydriasis occur 45 second after Cardiac
Arrest and is in fact a late symptom of
Cardiac Arrest during Anesthesia
Cardiac Arrest con cause within 2-4 min
irreversible changes that can cause death or
permanent grave neurologic and psychiatric
inabilities.
Treatment must be emergent within 20-40
sec after Anesthetist has diagnosed Cardiac
Arrest and must include Interruption of
surgical Operation, change of position of
patient in surgical bed, interruption of
Narcotic agents, giving of Oxygen 100%,
careful cardiac monitoring, and starting of
CPR.
Therapeutic Principles are: Phase of CPR,
Phase of Patient Ventilation and careful
Monitoring, Faze of Diagnostication and
Intensive Care Therapy.
Key Words. CPR, Anesthesia, Cardiac
Arrest, Monitoring.
61. The Role of Anesthesiologist in
Burned Patients, Our Experience
Nehat BAFTIU1, R. BAFTIU1
1
Anesthesia and Intensive Care Service, University
Clinical Center of Kosovo, Pristine, Kosovo.
Abstract
Introduction; Burns are epidermal tissue
lesions that develop as a result of the
pathological activity of the thermal agent,
electric current, lightning, chemical
substances or radioactive rays on the
surface of the body. Burns are the third
cause of accidental deaths. The treatment of
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burned patients requires in many cases the
involvement of anesthesiologist, where in 4
to 22% of cases these patients are treated in
the Intensive Care Unit (ICU).
The purpose of this presentation is to
highlight the role of the Anesthesiologist in
Burning Patients, Therapy given to the
Intensive Care Unit, and increase the
survival rate in these cases when the
treatment becomes multidisciplinary.
Material and Methods
The data from patient reports in MIQ (ICU)
protocols were collected for a period of 2
years (January 2016-January 2018), from
which data on the treatment of these
patients were obtained, the length of stay in
MIQ and the success rate in the survival of
these patients. Comparisons were also made
with the results of the same cases published
by foreign authors.
Results; It is clear that the success of the
treatment of burned patients requires
teamwork and especially the involvement
of anesthesiologist – reanimator. Parkland's
formula for losing weight compensation
was the basis of treatment for these patients,
both adults and children. Analgesia was
also included in the baseline treatment
group. Prophylaxis from infection, Tetanus
and ulcer stresses will be presented in this
presentation. Given that about 47% of burns
have burns in the face, burning patients'
intubation remains the key to survival.
Conclusion; Anesthetist doctor has a key
role in treating burnt patients. Knowing
fluid loss compensation formulas, MIQ
experience,
timely intubation,
and
prophylaxis for infections increase the
survival potential of these patients.
Keywords; Burning, Anesthesia, Intensive
Treatment, Analgesia, Loss of fluid
62. Epidural Analgesia in Patients
Undergoing Open Abdominal
Surgery, Our Experience
Nehat BAFTIU1, R. BAFTIU1
1
Department of Anesthesia & Critical Care,
University Clinical Center of Kosovo– Pristina,
Kosovo
AJTES Vol.2 Nr.2 Supplement 2
Abstract
Background; Epidural analgesia has been
the reference standard for the provision of
post-operative pain relief in patients
recovering
from
major
abdominal
operations. However, in different studies, a
failure rate of 20-32% has been reported.
The aim of the study was to analyse the
success rates of epidural analgesia and the
outcome in patients who underwent open
major abdominal surgery.
Material and Methods; We collected data
from a prospectively database of 50 patients
who underwent open abdominal surgery
during a period of 2 years (September 2017
to
September
2017).
Anaesthetic
consultants with expertise in anaesthesia for
open abdominal surgery performed the
epidural catheter placement. A dedicated
pain team assessed the post-operative pain
scores on moving or coughing using the
Verbal Descriptor Scale. The outcome was
measured in terms of epidural success rates,
pain scores, post-operative chest infection
and length of hospital stay.
Results: The study group included 33 males
and 17 females, most of them undergoing
liver surgery. The indication for resection
was liver secondaries (70%), primary
tumours (20%) and benign disease (10%).
While major (≥3 segments) and minor
resections (≤ 2 segments) were performed
in 44% and 48% respectively, 8% of
patients were inoperable. Epidural
analgesia was successful in 46 patients
(92%). Bacterial colonisation of epidural tip
was noticed in one patient. However, no
neurological
complications
were
encountered. Five patients (10%) had
radiologically confirmed chest infection.
Three patients (6%) developed wound
infection. One patient died due to liver
failure
following
extended
right
hepatectomy and cholecystectomy for gall
bladder cancer. The median length of stay
was 6 days (3-25 days).
Conclusions: Our experience shows that
epidural analgesia is safe and effective in
providing adequate pain relief following
major open abdominal surgery.
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Keywords: Epiural analgesia; open
abdominal surgery; acute pain; prevention
63. Updating Septic Cascade and
Microbial Resistance
Mihal KËRÇI1, Selim HORESHKA1, Elona
NAQELLARI1
1
University of Medicine, Tirana, ALBANIA.
Continental Hospital, Tirana, ALBANIA
Abstract
Sepsis
represents
the
systemic
inflammatory response and the presence of
the infection. The Consensus Conference of
1992 introduced the term SIRS, which
includes patients with a minimum of two of
the following details:
Sepsis is a life-threatening situation that
occurs when the body's response to the
infection causes damage to tissues and
organs. In the first two consensus, Sepsis 1
and 2 for gravity interpretation used SOFA
score, with a scale from 0 to 4 points, while
the current concepts for patients suspected
to be septic, who have a chance to stay tall
in TI or die in the hospital can be identified
with the Rapid Sequential Organ Failure
Assessment (qSOFA), and the score drops
up to 3 points, referring to mental status
alteration, PAS ≤100 mm Hg, or FR ≥22 /
min.
Temperature> 38 ° C or <36 ° C; FC> 90 in
min; FR> 20 / min or PaCO2 <32 mmHg;
leukocytes> 12000 mm3 or> 4000 mm3
and 10% or more of imatine forms.
Sepsis (SIRS + Infection), Serious Sepsis
(Sepsis + Organ Traumatic), and Sepsis
Coma (Serious Cardiac Vascular Sepsis
which does not respond to the use of lice,
but the need for vasopressors is felt), but the
same concept was that of consensus for
Sepsis 2 in 2001, while Sepsis 3
recommends the clinical use of the above
elements but being limited to the Sepsis
term and the Septic Sniper.
Conclusion; New advances in sepsis and
septic shock have shown improved survival
in these critical patients. Sepsis: "life
threatening from organ dysfunction caused
AJTES Vol.2 Nr.2 Supplement 2
by a disordered response of the recipient to
the infection".
64. Surgical Treatment of Combined
Acetabulum and Pelvic Ring
Fractures
Jordan SAVESKI1, Neda TRAJKOVSKA1, Ilir
HASANI2
1
Clinical Hospital Acibadem Sistina, Skopje,
Macedonia
2
University Clinic of Traumatology, Medical
Faculty, Skopje, Macedonia
Abstract
Introduction: Combined fracture of
acetabulum and pelvic ring fracture
(CAPRF) usually are results of high energy
trauma and occur in polytraumatized
patients.
Hemodynamically
unstable
patients in this injuries present unique
treatment dilemmas and special challenge
for the treating surgeon.
The purpose of this study is to present our
experience with surgical treatment of
CAPRF injuries.
Material and methods: From 1995 to 2014
year, 68 patients (15,1% of 446 pt with
pelvic ring fractures) with CARPF were
surgically treated. Of all of them 72% were
polytraumatized,
32%
were
hemodynamically unstable with average
ISS of 30.6. The most common cause of
injurie was MVA - 69%, fall from height 20% and other - 11%. There were 42 males
and 26 female pt. Pelvic ring fracture (PRF)
were classified by Young-Burgees: APC in
50% (34pt), LC in 45.6% (31 pt), VS in
2.9% (2 pt) and combined in 1,5% (1 pt).
Acetabulum fracture were classified by
Letournel - Judet: TR - 23 pt, TR+PW - 2
pat, ABC - 16 pt, ACPH - 12 pt, TT- 5 pt,
AC - 5 pt, AC+AW - 2pt, PW - 2 pt and PC
1 pt.
Results: Assessment of the X-Rayresults
were done according Matta: excellent - 44
(64%), good - 10 (14%), fair - 8 (12%) and
poor 6 (10%). Final functional results were
done according Poste lD’Aubigne score
system: excellent - 32 (46%), good - 22
(32%), fair - 7 (11%) and poor - 7 (11%).
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Conclusion: CAPRF are results of high
energy trauma and occur in polytraumatized
patient. Incidents of APC and LC of this
injury is similar. Transverse and both
column acetabulum fracture are the most
common fracture patterns.
The high
incidence of associate injuries mandates
multidisciplinary treatment approach. This
injuries should be accessed separately and
the overall treatment strategy should
integrate the independent assessment of the
pelvic ring and acetabulum fracture. The
treating surgeon should strive to achieve the
anatomic reduction of both pelvic ring and
acetabulum fractures for good functional
outcome.
65. Management of Severe Pelvic
Trauma
Fausto CATENA1
1
Professor of general surgery, Chief Department of
Emergency and General Surgery Parma University
Hospital ITALY.
Abstract
Complex pelvic injuries are among the most
dangerous and deadly trauma related
lesions. Different classification systems
exist, some are based on the mechanism of
injury, some on anatomic patterns and some
are focusing on the resulting instability
requiring operative fixation. The optimal
treatment strategy, however, should keep
into consideration the hemodynamic status,
the anatomic impairment of pelvic ring
function and the associated injuries. The
management of pelvic trauma patients aims
definitively to restore the homeostasis and
the normal physiopathology associated to
the mechanical stability of the pelvic ring.
Thus,
the
management
of pelvic trauma must be multidisciplinary
and should be ultimately based on the
physiology of the patient and the anatomy
of the injury. Our aim is to present the
World Society of Emergency Surgery
(WSES) classification of pelvic trauma and
the management Guidelines.
AJTES Vol.2 Nr.2 Supplement 2
66. Anterior Pelvic Approach.
Vilmos VÉCSEI 1
1
Dept. for Orthopedics and Trauma Surgery,
Medical University Vienna, Austria.
Abstract
Introduction; The anterior ilioinquinal
approach introduce by Emil Letournel and
Robert Judet offering the access to the
anterior column of the acetabulum and to
the ala ossis ilei, so fractured. is very well
known. The view to the bony structures
through the 2 windows medial (lacuna
vasorum) and lateral (lacuna musculorum
with the femoral nerv) visualizes the pubic
bone and the anterior column of the
acetabulum. The linea terminalis and the
quadrilateral surface are more palpable than
visible. The preparation for this approach
should not be underestimated. The N.
cutaneus femoris lateralis, the N. femoralis,
the femoral vessels and the corona mortis
require a skilled surgical procedure.
The Stoppa approach opens good access to
the anterior column, the the linea terminalis,
the alla ossis ilei and is suitable to deal with
anterior pathologies. Posterior column
combined with posterior wall fx., transverse
fx. combined with posterior wall fx.,
transverse fx. and posterior wall fracture
require a posterior approach, possibly
combined approaches.
The Stoppa approach offers clear
advantages if you pay meticulous attention
to the protection of vulnerable and
endangered anatomical structures, i.e.
femoral vessels, corona mortis, n.
obturatorius, the urinary bladder.
The incision of the skin performed in
transverse (or longitudinal) direction,
opening of the abdominal wall along of the
linea alba locking for the way
preperitoneally after the disinsertion of the
rectus muscle on his insertion site in the
direction of the linea terminalis. Ligation of
the corona mortis, Incision of the pectineus
fascie and lift up of the iliopsoas muscle. It
is recommended to use special radiolucent
Hohmann hooks with the possibility to fix
them to the adjacent bony structures with Kwires.
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Fracture reduction and fixation are the last
steps.
Training in cadaver labs is recommended.
67. Advances and Challenges in
Anterior Approaches on the
Treatment of Acetabular and
Pelvic Fractures
Ilir HASANI1
General Surgeon – Traumatologist, Traumatology
Orthopaedic Surgery, Anesthesy, Intensive Care
and Emergency Centre, Skopje, MACEDONIA.
1
Abstract
Anterior approaches have made revolution
on the treatment of acetabular fractures in
the middle of the last century with the
scientific work of Letournel.
Anterior Intra-Pelvic Approach has been
promoted at the end of the last century, as
new and alternative approach on treating the
fractures of the acetabulum, involving
anterior structures. Since its promotion
from Hilvensaro and Cole, it has gained a
worldwide reputation of a save and
successful alternative of ilio-inguinal
approach of Letournel, which was a leader
approach after it was Letorunel has
introduced it in traumatology experience.
In the Republic of Macedonia, ilio-inguinal
approach has been routinely used in the
Traumatology Clinic in the last decades
with very good results. In contrary to its
reputation worldwide, the Anterior
Intrapelvic Approach has not been reported
in the Medical literature in the Republic of
Macedonia.
We present our experiences with the fist
intrapelvic approaches and infrapectineal
placement of the plate, challenges, future
development and expectations following
trends refered in the literature.
Key Words: Anterior approach, acetabular
fracture, anterior intrapelvic approach,
modified Stoppa approach
AJTES Vol.2 Nr.2 Supplement 2
68. Unstable Pelvic Ring Injuries Classification and Treatment
Sasa MILENKOVIC1
1
University of Nis, Medical faculty, Orthopaedic &
Traumatology Clinic Nis, SERBIA
Abstract
Introduction: In general, pelvic ring
injuries can be caused by low-energy
trauma in older patients with osteoporosis
and by high-energy trauma in younger
patients. Pelvic ring injuries can be isolated
or accompanied by other injuries of the
locomotory apparatus, injuries of small
pelvic organs, blood vessels and nerves as
part of polytrauma. In accordance with this,
patients can be hemodynamically stable or
hemodynamically.unstable, their lives may
be threatened. Controlling and stopping
bleeding in hemodynamically unstable
patients is achieved by the pelvic clamp,
external skeletal fixation, pelvic tamponade
or embolization. Unstable injuries to the
pelvic ring require stabilisation of the
anterior or anterior & posterior pelvic ring
complex.
Methods In this retrospective study patients
with unstable pelvic ring injuries were
followed between 2013. and 2017.
Hemodynamically unstable patients with
unstable pelvic ring injuries were treated by
external fixation using Malkovich’s
external fixator. Final pelvic stabilization
was
performed
by
pelvic
ring
osteosynthesis.
There
are
several
classification of the pelvic ring injiries:
anatomical (Letournel), Georg Pennal,
Joung& Burgoss, Marvin Tile and AO
classifitaion. We used Tile’s classification,
the final outcomes had been scored using
Majeed scoring system.
Results We presented 31 patients with a
pelvic ring injury (Type B-14, Type C-17).
Primary fixation was performed by external
fixation
or
skeletal
traction
in
hemodynamically unstable patients. Final
stabilization consisted of external fixation
or anterior and posterior pelvic ring
complex osteosynthesis. There were 3
(9,67%) cases of DVT, 1 (3,22%) infection,
2 (6,45%) cases with pelvic nonunion, 1
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(3,22%) fixation failure. Final functional
outcome was excellent in 14 (45,16 %),
good in 13 (41,93%), fair in 3 (9,67%) and
poor in 1 (3,22%) case.
Conclusion Pelvic ring injuries are severe
and its treatment requires a team work.
External fixation has been approved as a
good primary fixation method in
ploitraumatized and hemodynamically
unstable patients. Final surgical treatment
requires stabilization of the anterior pelvic
complex fixation, in type B injuries, and
both anterior and posterior pelvic ring
complex, in type C injuries.
69. Management of Esophageal
Perforations
Carlos MESQUITA1
1
Senior Consultant of General & Emergency
Surgery at Coimbra Central and University
Hospital, COIMBRA, PORTUGAL
Abstract
The esophagus is more vulnerable than the
rest of the alimentary tract, due to the lack
of a serosal layer, and perforation may be
due to several mechanisms. Iatrogeny, due
to a number of procedures as endoscopy and
dilatation of strictures, accounts for almost
75%
of
esophageal
perforations.
Spontaneous rupture of the esophagus, a
dangerous entity known as Boerhaave's
syndrome, accounts for about 15%.
Perforating trauma, foreign bodies and toxic
ingestions make up the bulk of the
remaining causes, around 10%. Because the
esophagus is surrounded by loose stromal
connective tissue, the infectious and
inflammatory response can disseminate
easily to nearby vital organs, thereby
increasing the likelihood of serious
sequelae,
making
the
esophageal
perforations, in general, potentially
devastating conditions. Although rapid
diagnosis and therapy offer the best chance
of survival, delays are common for a
multitude of reasons, resulting in substantial
morbidity and mortality.
AJTES Vol.2 Nr.2 Supplement 2
70. Management of Solid Injured
Organs in Blunt Abdominal
Trauma: NOM vs OM
Mauro ZAGO1
1
General Surgery Dept, Minimally Invasive Surgery
Unit, Head Policlinico San Pietro - Bergamo ITALY*
Abstract.
During the past decades, nonoperative
management of liver, spleen and kidney
injuries has revolutioned the therapeutic
options. The typical patient who underwent
non operative management has to be
haemodynamically stable or rapidly
stabilized following initial resuscitation.
Surgery continues to be considered the gold
standard for haemodynamically unstable
patients. Even if criteria influencing the
risk for failire of NOM are well established,
each patient should be managed on
individual basis. Debatable points concern
the role of angioembolization in both low
and high AAST grade injuries, indications
to NOM with associated injuries, the role of
interventional radiology as rescue tool after
Damage Control Surgery, the ideal followup algorithm. Nonoperative management of
blunt solid organ injuries can be applied
only following strict institutional protocols
and according to the Hospital and trauma
network resources.
71. Management of Liver Trauma
Carlos MESQUITA1
Senior Consultant of General & Emergency
Surgery at Coimbra Central and University
Hospital, COIMBRA, PORTUGAL
1
Abstract
The liver is one of the most frequently
injured organs in abdominal trauma, due to
its anterior location in the abdominal cavity
and a fragile capsule and parenchyma. Any
surgeon who has been confronted with a
patient with a major hemorrhage due to a
liver injury will witness the sense of
weakness brought by this experience. To
improve outcomes in patients with severe
liver injuries, the surgeon needs a deep
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understanding of the pathophysiology, a
knowledge of the anatomy, including the
venous and arterial supply, a full
armamentarium of surgical techniques, not
always conventional, and a trained team, in
an operative and resuscitation environment
with the necessary equipment. Proper
decision making is essential to a successful
outcome. There is a paradigm shift in the
management of liver trauma, due to better
monitoring
and
diagnosis.
In
hemodynamically stable patients, nonoperative management of both low- and
high-grade injuries can be successful. In
hemodynamically unstable patients, direct
suture ligations of bleeding vessels,
vascular isolation with repair of venous
injuries in the context of a damage control
philosophy
improved
outcomes.
Anatomical resections of the liver became
rarely indicated. In general, the most
appropriate technique is the simplest and
quickest technique that can restore
homeostasis. As soon as the patient
becomes cold, coagulopathic and in
irreversible shock, the battle is usually lost.
72. Management of Blunt Abdominal
Trauma in Children.
Emir Q. HAXHIJA1
1
Department of Pediatric and Adolescent Surgery,
University Hospital Graz, Graz, Austria
Abstract
Introduction: Trauma is the leading cause
of death in children. Abdominal trauma,
most commonly blunt in nature, rarely
requires emergent surgical intervention
however at the same time it is the most
common cause of unrecognized fatal injury
in children. High energy accidents such as
motor vehicle crashes and/or children hit by
a car are the most frequent injury
mechanisms. Spleen and liver as the two
superficially lying solid organs are most
commonly injured, followed by injuries to
kidneys, pancreas and bowel. Nonoperative
management for solid organ injuries can be
employed to more than 90% of this patient
population assumed close monitoring in
AJTES Vol.2 Nr.2 Supplement 2
pediatric trauma centers is provided.
Injuries to pancreas are rare and the
indications for surgery more difficult to
meet. Injuries to intestine with suspected
bowel perforation are also less common but
always require operative management.
Intestinal injuries can be overseen on the
initial
Focused
Assessment
with
Sonography for Trauma and/or Computed
Tomography scan but will clinically present
as severe peritonitis usually latest at 6-hrs
post injury. Initial management in shock
includes fluid boluses and transfusion with
packed red blood cells in hypotensive
patients after the second fluid bolus.
Emergent laparotomy is indicated in
patients with hemodynamic instability
despite maximal resuscitative efforts. The
diagnostic laparoscopy as initial surgical
intervention in patients with abdominal
trauma is increasingly applied to rule out a
bowel, mesentery, or diaphragmatic
injuries, especially in cases when emergent
laparotomy is not needed. Laparoscopy has
been shown to prevent unnecessary
laparotomies and increase the postoperative
quality of life.
73. Hollow Viscus Injury due to Blunt
Abdominal Trauma, a
retrospective evaluation.
Agron DOGJANI1, Engjellushe JONUZI1,
Shkëlzen OSMANAJ1, Kastriot HAXHIREXHA2
1
Surgeon in University Hospital of Trauma, Tirana,
ALBANIA
2
Clinic Hospital of Tetovo, MACEDONIA
Abstract
BAT is one of the most common causes of
morbidity in that all age groups. Early
identification of traumatic hollow viscus
injuries (THVI) has been and remains a
challenge to all trauma surgeons, as early
finding and evaluation of their, it present
difficulties of different natures, even with
technological advances is a frightening for
all surgeons because of morbidity and
mortality that it carries. With all the
different varieties of damage mechanisms
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HVI of motor vehicle accidents (MVA)
remain the leading cause1,2.
The first reports date for HVI we must go
back to 1899 by Geille, who reported that
HVI had 11% incidence in a group of
patients who had undergone BAT. There
are studies that said that TII recently ranked
third overall in the standings intraabdominal injuries (IAI) in BAT3.
Objectives: Identification of the mechanism
of injury, the incoming data, the anatomical
distribution of lesions, diagnostic methods,
management and gastrointestinal damage
results from BAT.
Material and Methods: The study includes
patients with BAT in a 2-years period, that
were introduced in the UHT, who
underwent evaluation, treatment and
management of gastrointestinal tract injury.
It is a retrospective study, patients were
analyzed in relation to the mechanism, time
of presentation, in HdSt, anatomic
localization of lesions, diagnostic methods,
the tactics of treatment, complications,
morbidity and mortality.
Results: Are taken into consideration about
21 (8%) patients out of 257 which is the
total number of patients with BAT in the
study which had damage to the HVI, they
occupy 33% of cases treated with BAT
street operators.
Age distribution is such 70 years old range
5-years average 32.8, while such is
distribution by age group; is 14 to 60 years
old (6%) followed by more than 60 years
old (14.2%) and finally by 0-14 years old
(23.8%).
Conclusion: Early recognition of THVI
from BAT is difficult, it's very important is
their dangerousness be recognized because
of its great potential complications affecting
infection that gives directly to their
morbidity and mortality.
Key words; Blunt abdominal trauma,
intestinal injury, colonic injury
AJTES Vol.2 Nr.2 Supplement 2
74. The Selective Ligature of the
Hepatic Artery in a massive trans
Thoracic Hemorrhage.
Dorina SHTJEFNI1, Skender BUCI1
Surgery Service, University Hospital of trauma,
Tirana ALBANIA
1
Abstract
Introduction: The complex thoracoabdominal trauma is rare but life threating
and very difficult to be managed. It is
associated to a high morbidity and
mortality. The goal of this study is to
describe the diagnostic aspects and the
management
of
the
complications
associated to this trauma.
Material and Methods: We will report the
case of a hepatic pseudo aneurysm in a
patient with the thoracic trauma and the
rupture of the right diaphragm complicated
with massive trans-thoracic hemorrhage.
Results: A 44 years old male, the patient
was introduced to the ER after being hit by
a heavy object. The CT evaluation revealed
fractures of the 5-6-7-8-9-10-th ribs with
hemopneumothorax and central hepatic
contusion. The first treatment: drainage of
the right pleural space broad spectrum
parenteral, antibiotic therapy perfusions and
follow up of the patient. The day after the
pleural drain has been removed, we noticed
biliar effusion coming out from the drainage
hole. A new CT evaluation 7 days after the
first one confirmed the presence of
liquidienne multilocular collections in the
right pleural space,the rupture of the right
diaphragm and contusio of the 7-9 hepatic
segments.10 days after trauma was
performed the right thoracotomy and both
organised hemothorax and biliar empyema
was evacuated and the diaphragm was
suturated.16 days after trauma the patient
developed hemobili because of a fissuration
of a pseudo aneurism in the central hepatic
biliary way. The treatment for it was the
administration of the kher drainage. After
many episodes of hemorrhage associated to
the hepatic pseudo aneurism and because
we could not perform the hepatic artery
embolization. The staff decided to perform
the ligature of the right branch of the hepatic
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
artery 4 weeks after trauma. The patient left
hospital healthy 40 days after trauma.
Conclusions: The thoraco -abdominal
complex trauma needs a multidisciplinar
follow up. A very well-trained trauma staff
and the disponibility of all medical
equipments. Beside accurate management
this trauma still has a high morbidity and
mortality.
75. Space – Occupying Cerebellar
Infarction: Complications,
Treatment, and Outcome
Arsen SEFERI1, Artid LAME1, Ridvan
ALIMEHMETI1, Ejona LILAMANI1, Mirel
GRADA1, Arben RROJI1, Mentor PETRELA1
1
Service of Neurosurgery and Neuroradiology,
University Hospital Center “Mother Theresa”
Tirana, ALBANIA.
Abstract
Space-occupying edema is also a common
complication in 17%–54% of patients with
significant cerebellar infarction and may
cause life-threatening conditions such as (1)
obstructive hydrocephalus attributable to
the mass effect in the posterior fossa
resulting in blockage of the fourth ventricle,
(2) direct compression of the mid- brain and
pons, (3) upward herniation of the superior
cerebellum through the tentorial incisura,
and (4) down- ward herniation of the tonsils
through the foramen magnum.
About 50% of patients who has evidence of
mass effect from cerebellar edema showed
subsequent clinical deterioration.
The first step of neurological manifestations
of space-occupying cerebellar infarction is
conservative treatment but a very
meticulous clinical observations of
cerebellar and sings of brain stem
compression
would
determine
the
following surgical treatment. The role of
repetitive radiological image is very
important to choose the type of approach
which consist; DVE, decompressive
suboccipital craniotomy and removing the
cerebellar necrotic issue.
AJTES Vol.2 Nr.2 Supplement 2
We present our experience
with four
patients treated surgically for cerebellar
infarction in posterior inferior cerebellar
artery
76. Epidemology of 1000 Cases
Operated for Traumatic Injuries
of Peripheral Nerves
Ridvan ALIMEHMETI1, Gramoz BRACE1, Ermira
PAJAJ1, Alda KIKA2, Jetmira KERXHALLIU1,
Norik BARDHI1, Myfit SARACI1
1
Department of Neurosciences, University of
Medicine, Neurosurgery Service, University
Hospital Center “Mather Theresa” Tirana, Albania
2
Department of Informatics, Faculty of Natural
Sciences, University of Tirana. Albania.
Abstract
Introduction:
Traumatic
peripheral
nervous system injuries benefit from
surgery at specialized centers. The study
presents the epidemiological data of the
1000 successive cases operated at the
Neurosurgery Service, University Hospital
Center “Mather Theresa” Tirana, Albania.
Material and Methods; Are Revised
clinical files, operating registers and photos
of cases operated for peripheral nervous
system injuries.
A program for recording the main data of
the operated cases has been built, where
computerized data is precisely and in real
time processed according to the categories.
The data collected per 1,000 operated
patients are included and processed to study
epidemiologically.
Results; The characteristics that further
influence the final outcome of the
microscopic surgical repair of the
peripheral nerves following traumatic
lesions such as trauma type, level of injury,
time from injury to final operation,
lymphoid neoplasms, age were studied.
Conclusions; Neuro-surgical repair of
traumatic damages of the peripheral nerves
near the Neurosurgery Service, recognizes
all categories of traumatic damages.
Computerization for data processing and
recording helps greatly in the precision of
epidemiological data and constitutes the
base that, with the help of data mining, also
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
enables predicting the outcome of the
operation in new cases.
Keywords: traumatic Injuries, peripheral
nerve
injurues,
nerve
transplant,
microscopic surgical repair
77. The Role of the Emergency Doctor
in Pacients with Traumatic
Injuries to the peripheral nerves
Ridvan ALIMEHMETI1, Gramoz BRACE1, Ermira
PAJAJ1, Jetmira KERXHALLIU1, Norik
BARDHI1, Mishel QIRINXHI1
Department of Neurosciences, University of
Medicine, Neurosurgery Service, University
Hospital Center “Mather Theresa” Tirana, Albania
Abstract
Introduction; In the hospital and health
care centers of the first aid for the
involuntary involvement of the peripheral
nerves, the assessment of the damaged
structures and the degree of injuries is
done. On this basis, the injured person is
treated in these centers or referred to the
most specialized centers for special
competence to repair damaged peripheral
nervous structures. Traumatic damages to
the peripheral nerves benefit from correct
surgery.
Material and Methods; Based on the
experience of the last 25 years of the
Neurosurgery Service, University Hospital
Center “Mather Theresa” Tirana, Albania.
in the contemporary treatment of traumatic
damage of the peripheral nerves has
studied the time spent by the injury and
processing of the plage until the patient's
arrival in our attention.
We have also studied the time relationship
from damage to recapture at our Service,
with the type of repair needed: end-to-end
neurora, nervous transplant, neurolize.
Results; From the studied cases it turns out
that delayed cases from hospital and
hospital centers for peripheral nervous
system injuries to Neurosurgery Service,
are delayed with the passing of time due to
direct information to emergency physicians
and specialist surgeons during the
neurosurgery cycle.
AJTES Vol.2 Nr.2 Supplement 2
This directly affects the best results at
times treated as due to the shortest time in
favor of muscular atrophy after
denervation as well as for the type of
treatment with less obstruction to nervous
regeneration after repair (direct neurorafe,
transplantation with short).
Conclusions: Treatment of peripheral
nerves requires training in microscopic
surgery of the surgeon who takes charge of
the case, presence of microsurgical
instruments and microscopes (or lupals),
micro suture (10/0, 9/0, 8/0). In the event
of non-occurrence of one of these elements
necessary for the repair of the peripheral
nervous system damaged cases should be
referred immediately after trauma in
centers specialized for microscopic surgery
and the competence to repair the peripheral
nerve damage.
Keywords: peripheral nerves, traumatic
damage, muscular atrophy, denervation...
78. Balloon Kyphoplasty for
Traumatic and Osteoporotic
Compression Vertebral Fractures,
our Experience.
Artid LAME1, Gledion FEJZO1, Erion SPAHO2
Department of Neurosciences, University of
Medicine, Neurosurgery Service, University
Hospital Center “Mather Theresa” Tirana, Albania
2
Neurosurgery Service, University Hospital of
Trauma, Tirana, Albania
1
Abstract
Introduction; We present a review of
patients diagnosed and treated for
osteoporotic thoracic-lumbar compression
fractures.
Materials and methods; There were three
patients diagnosed and treated for
osteoporotic thoracic-lumbar compression
fractures during the year 2018 in a private
hospital. The patients’ clinical data,
imaging studies and operative procedures
were reviewed retrospectively.
Results; There were three female patients
ranging from 34 to 63 years old, (mean age
51.6 years old) identified. All three
patients were diagnosed previously for
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
osteoporosis. Time from symptoms onset
to diagnosis and treatment varies from one
month to three years.
Discussion; Vertebral osteoporotic
compression fractures are almost twice as
common as other fractures typically linked
to osteoporosis, such as broken hips and
wrists. They are located more in the
lumbar and thoracic region.
Conclusion; Treatment with balloon
kyphoplasty remains the gold standard in
the treatment of Vertebral osteoporotic
compression fractures with early
significant improvement of symptoms.
Keywords: osteoporotic fractures,
compression fractures, balloon
kyphoplasty
79. The Repair Surgery of Peripheral
Nerves from Gunshot Injuries
Ridvan ALIMEHMETI1, Gramoz BRACE1, Ermira
PAJAJ1, Arba CECIA2, Thoma KALEFI1, Jetmira
KERXHALLIU1, Norik BARDHI1
1
Department of Neurosciences, University of
Medicine, Neurosurgery Service, University
Hospital Center “Mather Theresa” Tirana, Albania
2
George MassonUniversity, Faifax Virginia, USA.
Abstract
Introduction: Gunshot injuries to the
peripheral nerves has been commonly
encountered in recent years in the practice
of the Neurosurgery Service, University
Hospital Center “Mather Theresa” Tirana,
Albania. Repair of plexusor
peripheralnerveinjurues, represents the
difficultyassociated with the
damagemechanism, the coexistence of
causaligiavascularpreopreatore, bone or
tissueinjuries or otherinvolvedorgans.
Material and Methods; The
retrospectivestudy of the
casesoperatedisbased on clinicalrecords,
operator registers and photos of
casesoperated for
peripheralnervoussystemfrom
gunshotdamage.The
factorsthathavemostaffected the
postoperative progress of the
studycasessuchaspatientage, degree of
AJTES Vol.2 Nr.2 Supplement 2
involvement of damagednerves,
localization of injury, type of
necessaryrepair, presence of
preoperativecausalis, interest in
vascularstructures or
apparatuslocomotor.Therehasbeen a long
follow-up in special cases over 10 years.
Results; Peripheral and brachial nerve
repairs in case of gunshot damage are a
result of a good result if they are carried
out in the near future by trauma, especially
with regard to the treatment of causality
that often accompanies these cases. The
type of repair varies from aderenciolize,
longitudina lepineurotoma,
interferogularneurolize, neurorafi, nerve
transplant. The degree of improvement
depends mainly on the type of reparation
needed and the distance from the damage
to the effectormuscles.
Conclusions: In the perennial peripheral
nervous system repair experience at the
Neurosurgery Service, itturns out
thathealingis more effectiveespecially in
the treatment of pain and
associatedmuscularatrophy.Tracking these
years of ill will allow for regression
blockage findings in distal anatomical
tunnels of gunshot damage, which benefit
from decompression even at a distance of
several years from the time of the injuries.
Keywords: Gunshot Injuries,peripheral
nerve injurues, nervetransplant
80. The Sensation is the Attribution of
our Total Body Water
Apostol VASO1
University Hospital of Trauma, Tirana, ALBANIA
1
Abstract
The sensation results in an unperceivable
event which happens in the sequence
between two smallest units of time,
because the attribution of the total body
water (the ideal sphere) is to be sensitive
even to the smallest particle of matter.
Hence, the sensation is the attribution of
the total body water, but this is the starting
point or the first principle of our perception
too. Since the ideal sphere feels the
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
nothingness, we can’t operate with
empiricism on it, hence the only way is to
speak about it, with the logic or the
Euclidean geometry.
81. Rehabilitation of Patients with
Cerebral Contusion
with 4th degree spasticity at the end of the
12th month. 12 patients (7.18%) died in the
first month.
Conclusions: Early rehabilitation of
patients with CC leads to prevention of
complications and initiation of motor
commands usage.
Keywords: Head Trauma, Disability,
Ashworth scale, rehabilitation.
Manushaqe SARAÇI1 , Luljeta STANAJ1
1
Rehabilitation and Physiotherapy Service,
University Hospital of Trauma, Tirana, Albania
Abstract
Background: Head traumas are one of the
most frequent causes of disability in adults.
Cerebral injuries lead to motor, cognitive
and behavioral deficits. Rehabilitation after
Cerebral Contusions (CC) is an important
part of the treatment strategy.
The aim this study was to evidence the
importance of early rehabilitation of
patients with CC which leads to prevention
of complications and initiation of motor
commands usage.
Material and Methods: This is a
prospective study, including 167 patients,
conducted in timeframe January 2017 to
January 2018. The rehabilitation protocol
has consisted of four phases: rehabilitation
of patients in coma, prevention of
complications, initiation of motor
commands and autonomy or recovery
phase. Ashworth scale is used for
evaluation of spasticity on the first day
(D1) of the month (M 1, 3, 6, 9, 12). The
criteria for progression phase: 1Surveillance of vital parameters (HR, RR,
SBP, SaO2, Temperature), 2-MMT 3rd
degree (full ROM against gravity), 3Associated Injuries.
Results: 167 patients were rehabilitated
with CC, 136 males (81.4%) and 31
females (18.5%), average age of 50±5
years old. 132 patients (79.04%) are fully
rehabilitated within 6 months, 4 patients
(2.39%) remained with 2nd degree of
spasticity according to the Ashworth scale
at the end of the 9th month, 3 patients
(1.79%) remained with 1st degree spasticity
at the end of the 9th month, 16 patients
(9.58 %) (Non-reversible coma) remained
AJTES Vol.2 Nr.2 Supplement 2
82. Results of Pemberton
Acetabuloplasty in Children with
Developmental Dysplasia of the
Hip (DDH).
Gjergji ÇAUSHI1, Blerta HAMOLLI1, Arnel MICI1
Orthopaedic and Trauma Service, University
Hospital of Trauma, Tirana, ALBANIA
1
Abstract
Aim: This study compared results
following Pemberton acetabuloplasty in
late presented children with development
dysplasia of the hip (DDH). We assessed
indications, contraindications, preoperative
planning as well as details regarding
Pemberton technique.
Materials and Methods: We studied 50
cases of children with developmental
dysplasia of the hip presented in our
department over 18 months old. Depending
on the case they were treated with single
stage open reduction and Pemberton
acetabuloplasty or combined with adductor
myotomy, skeletal traction or derotator
osteotomy of the femur shaft.
Results: We present long term results from
literature and also from our department.
We present risks and complications of the
surgical technique. We present indications
of single stage open reduction and
Pemberton acetabuloplasty or combination
with adductor myotomy, skeletal traction
or derotator osteotomy of femur shaft.
Conclusion: Pemberton acetabuloplasty
shows good short term results regarding
correction of the developmental dysplasia
of the hip and also long term regarding
prevention of secondary arthrosis.
However correct indication is crucial.
Pemberton acetabuloplasty is associated
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with high correction potential and low
complication rate.
Keywords: Pembeton, DDH,
acetabuloplasty
83. Internal Fixation vs. Total Hip
Endoprothesis
Aleksandar SAVESKI1, Aleksandar
TRAJANOVSKI1, Teodora TODOROVA1, Rezeart
DALIPI1, Antonio GAVRILOVSKI1, Zoran
BOZHINOVSKI1, Ilir HASANI1, Simon
TRPESKI1
1
University Clinic for TOARILUC, - Skopje,
MACEDONIA
Abstract
Introduction: Femoral neck fractures are
frequent injuries in the patient population
of every trauma center and have a high
incidence in the general population.
Paralleling trends of demographic
forecasts, their incidence will continue to
rise in the future. Especially in the elderly,
femoral neck fractures represent a
significant health care problem and have
enormous impact on health insurance
costs. Therefore, the appropriate treatment
of femoral neck fractures is mandatory.
Aim: To measure the quality of life by SF36 score in patients, with femoral neck
fractures treated with internal fixation and
total hip endoprothesis. QoL of the patients
will include the physical and mental health.
Materials and methods: Retrospectively
we evaluated data of 30 patients with
femoral neck fractures divided in 2 groups
based on the surgical treatment. The first
group (youngsters) was treated with
internal fixation and the second group
(elder population) was treated with total
hip endoprothesis. To measure the QoL of
the patients we used SF-36 score.
Results: The patients treated with
osteosynthesis showed delayed weight
bearing and prevention of the femoral head
comparing with the second group of
patients who was treated with hip
endoprothesis. The patients from the
second group showed better QoL and early
return to their everyday activities.
AJTES Vol.2 Nr.2 Supplement 2
Conclusion: During the years, the outcome
improved significantly due to the
advancement in the osteosynthetic material
and surgical techniques, also to the active
rehabilitation. Many patients with femoral
neck fracture will return in their homes and
their daily activities just like before the
injury.
Key words: femoral neck fractures, total
hip endoprothesis, internal fixation
84. Resolving Fractures of Proximal
Femur in Geriatric Patients with
Subtotal Endoprothesis in a
Period of Two Years Our
Experience
Aleksandar TRAJANOVSKI1, Aleksandar
SAVESKI1, Rezeart DALIPI1, Teodora
TODOROVA1, Antonio GAVRILOVSKI1, Simon
TRPESKI1, Ilir HASANI1, Zoran BOZHINOVSKI1.
1
Univesity Clinic for TOARILUC - Skopje,
MACEDONIA
Abstract
Introduction: Hip fractures are among the
most common type of fractures, especially
in geriatric population. They are major
cause of excess mortality, morbidity,
health and social expenditure in elderly
people.Bone is lost with advancing age in
both men and women, leading to an
increased risk of fractures after minimal
trauma. The primary purpose of treatment
and rehabilitation in the elderly after a hip
fracture is to improve an individual’s
quality of life.
Aim: The management of patients with hip
fractures, the surgical fixation with
endoprothesis of the fracture and
subsequent rehabilitation to allow the
optimal recovery of functional capacity.
Materials and methods: The study was
performed at the University Clinic for
TOARILUC in a two year period. 100
Patients with age over 70, with proximal
femoral fracture were included. All of the
patients were treated surgically with
implantation of subtotal endoprothesis.
Results: The mean age of the patients at
the time of operation was 77.4 years
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(range: 71-84 years). At presentation were
60 female patients with osteoporotic
fractures. All of our patients returned to
their homes after the surgical treatment and
hospitalization in good general condition,
with early weight bearing and
rehabilitation.
Conclusion: Advances in surgical
techniques and instrumentation have
allowed more effective life for the patients.
It is important to underline that the
principles and methods of functional
restoration after a hip fracture should
consider careful planning of the
rehabilitation program for every individual
patient and its implementation with respect
to decisions made by the rehabilitation
team.
Key words: Hip fractures, subtotal
endoprothesis
85.
Cephalo-medullary Nailing of
Inter Trochanteric Hip Fracture
Surgical Technique and Pitfalls to
Improve Results.
Ledian FEZOLLARI1, Gjergji CAUSHI1, Artid
DUNI1, Vilson RUCI1, Ergys CAMI1, Korab
SEJDINI1, Serdi MEMINI1, Edvin SELMANI1,
Zamir DEMIRAJ1, Guido BASSI2. Alfred GEGA1
1
Orthopaedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
2
Orthopeeadic Sevice, American Hospital, Tirana.
Albania.
Abstract
Although the sliding hip screw has an
excellent track record for stabilizing inter
trochanteric hip fractures, more unstable
fractures, especially those with disruption
and comminution of the postero medial
buttress, may be better suited for fixation
with a cephalo medullary nail. Thereverse
obliquity fracture pattern should be
considered a contraindication to use the
sliding hip screw, evidenced by failure
rates. This fracture type should be
stabilized with an intramedullary nail.
Studies by Lindsey et al. and Davis et al.
demonstrated multiple benefits of a
cephalo medullary nail including: (1)
providing stable head and neck fixation,
AJTES Vol.2 Nr.2 Supplement 2
(2) allowing for controlled collapse and
impaction of the fracture site, (3)
decreasing the lever arm on the proximal
fragment compared to the side plate by
virtue of its intramedullary location, (4)
providing excellent axial and rotational
control, (5) allowing for early weight
bearing, (6) allowing minimal dissection
and “percutaneous” insertion, and (7)
serving as a load-sharing implant device.
This article aims to discuss and give a
review of literature concerning cephalomedullary nailing of inter trochanteric hip
fracture surgical technique.
Keywords: cephalo medullary nailing, inter
trochanteric hip fracture, surgical
technique, pitfalls
86. Reverse Osteosynthesis with Distal
Femoral Locking Compression
Plate in Hip Periprosthetic
Fractures
Rezeart DALIPI1, Ilir HASANI1, Milan
SAMARDZISKI1, Aleksandar SAVESKI1,
Aleksandar TRAJANOVSKI1, Kamnar V1, Antonio
GAVRILOVSKI1, Jahja D1, Teodora
TODOROVA1
1
University Clinic for TOARILUC - Skopje,
MACEDONIA
Abstract
Introduction: Periprosthetic fractures (PF)
are considered as fractures associated with
an orthopedic implant, whether a
replacement or internal fixation device.
The global incidence of all types of PF is
constantly increasing due to growing
number of primary joint arthroplasties and
revision surgeries. Most frequently,
periprosthetic fractures are result of low
energy trauma, which has been shown to
account for 75% of the fractures.
Significant comorbidities,
osteoporosis/osteopenia, rheumatoid
arthritis, and revision surgery are all
contributing factors.
Aim: The aim of the report is to deepen the
understanding of the technique in the
surgically treatment of osteosynthesis the
proximal femoral periprosthetic fractures
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
with reverse application of distal femoral
locking compression plate.
Мaterial and methods: This report
presents two cases with periprosthetic
fractures treated with distal femoral
locking compression plate applied in
reverse technique. The surgeries of patients
were performed sn the University Clinic
for Orthopedics Surgery – Skopje. Both
patients had type B1 and type C
periprosthetic fractures according to
Vancouver classification.
Results: The patients were discharged
from the hospital two weeks after the
surgery, in good general condition,
satisfactory movements, both verticalised
and they started weight bearing three days
after the surgery.
Conclusion: Periprosthetic fractures
around the femoral stem after total hip
replacement (THA) are a significant and
growing technical challenge for orthopedic
surgeons, requiring proficiency in both
THA and trauma care. The incidence of
such fractures has a rising trend as the
number of patients undergoing primary and
revision THA increases. In general,
postoperative recovery remains
unpredictable and still there is a high risk
of perioperative and postoperative
complications after periprosthetic fracture
surgery.
Keywords: Periprosthetic fracture, distal
femoral locking compression plate, total
hip replacement.
87. 10 Cases of Total Hip
Replacement for Patients with
Crowe type IV DDH
Ledian FEZOLLARI1, Gjergji CAUSHI1, Artid
DUNI1, Vilson RUCI1, Ergys CAMI1, Korab
SEJDINI1, Serdi MEMINI1, Guido BASSI2
1
Orthopaedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
2
Orthopeadic Service, American Hospital, Tirana.
Albania.
arthritis in early adulthood. Patients
affected by high DDH have a unique and
proper anatomy; both acetabulum and
proximal femur are often associated with
well-defined patterns. Moreover, the
muscles and soft tissues around the hip are
shortened and the capsule is thickened. The
abductors insufficiency leads to a limp or
to a frank Trendelenburg gait. The sciatic
nerve is shortened predisposing to injury in
case of limb lengthening greater than 4 cm.
Appropriate positioning of the acetabular
component during total hip replacement in
patients with hip dysplasia is often
difficult.
In our study, 10 cases of high-level
displacement type IV of Adult DDH
Crowe classification were reviewed.
Acetabulum was performed by
implantation of the AVANTAGE
RELOAD Acetabular Cup in paleoacetabul
dual mobility with and without cement as
the current consensus of acetabulum
reconstruction recommends implantation
of the cup in the true acetabulum in order
to restore the lever arm of the gluteus
medius and reduce hip joint reaction force.
While in the femoral part we performed
subtrochanteric shortening osteotomy
maximally 4 cm, which has been
demonstrated to allow control of leg
length, preservation of the abductor
mechanism, and the correction of
anteversion and implantation of Wagner
Cone Prosthesis Hip Stem. Postoperative
results have been pretty good. Patients
were mobilized the third day after surgery.
Only one case showed neuropraxis of the
sciatica but recovered within 6 months.
Walking balanced within 3 months in 6
cases of study. The study aims to give a
review of literature and present a case
series of total hip replacement for patients
with crowe type iv DDH.
Keyword: Trans trochanteric osteotomies,
Paavilainen osteotomy, Lesser trochanter
osteotomy
Abstract
Introduction: Hip dysplasia is one of the
major conditions leading degenerative hip
AJTES Vol.2 Nr.2 Supplement 2
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89. Damage Control Surgery in
Abdominal Trauma and
Intraabdominal Catastrophes;
Need to New Approaches
88. Catheter-Associated Urinary Tract
Infections in Hip Fractures.
Experience of Durres Regional
Hospital.
Neritan MYDERRIZI1, Shkelqim FERKO2
1
Service of Orthopaedy and Trauma. Durres
Regional Hospital, Albania
2
Service of General Surgery and Urology. Durres
Regional Hospital, Albania
Abstract
Background: Hip Fractures are most
commonly in elderly people with an
incidence that grows with age. These
fractures have an annual mortality of 1833% and hospital mortality of 2.7%.
Catheter-associated urinary tract infection
is a common reality among these patients.
10% develop urinary tract infections.
Materials and Methods: This is a
retrospective study including 210 patients
with hip fractures during 2014-2016
timeframe in the orthopedic service of
Durres Regional Hospital.
Results: The average age of 70.6 years
(21-99 years old). 60 patients were
catheterised before surgery, 150 during
surgery, 45 patients extended the use of
chatheter more than two days after surgery.
Urinary tract infection was seen 15% in the
group A, 8% in group B and 28% in group
C.
Conclusion: Treatment of hip fractures
needs not only a qualified orthopedic
service, but also an intensive care team and
a rehabilitation staff for post operatory
period.
Extended use of indwelling urinary
catheters postoperatively is associated with
poor outcomes. Stable ostheosynthesis and
early ambulation decrease the use of
urinary catheter.
Keywords: hip fractures, urinary tract
infections, catheter-associated
AJTES Vol.2 Nr.2 Supplement 2
Rifat LATIFI1
New York Medical College, School of Medicine
Director, Department of Surgery, Westchester
Health Network, Department of Surgery, New York
Medical College. Valhalla, NY, USA.
1
Abstract
Damage control surgery (DCS) concepts
and techniques have been part of our
clinical armamentarium in trauma for
decades, but recently DCS has expanded to
other surgical disciplines: emergency
general surgery; neurosurgery
(craniectomies); orthopedics surgery,
particularly for trauma; thoracic surgery;
vascular surgery; liver transplant surgery;
and other surgical fields. DCS is
characterized by termination of the surgical
intervention after control of bleeding and
contamination, followed by hemostatic
resuscitation and definitive management.
What technique and approach is used
depends on pathology at hand. It is a
staged approach that takes into consideration the physiologic reserves of the
patient, and it is designed to avoid or treat
the lethal triad of hypothermia, acidosis,
and coagulopathy. The decision to perform
DCS is complex and requires solid
knowledge of physiology of the patient as
well as the associated injuries or comorbid
disease. Moreover, it takes a complete
situational awareness about the patient, his/
her physiology, all end-point resuscitation,
and surgical team dynamics and
skills.Indication for DCS are
hemodynamic instability, hypothermia
(<35 C), coagulopathy, severe metabolic
acidosis (pH <7.2 or base deficit >8),
multiple injuries, massive transfusion
requirements (> 10 units packed red blood
cells), and long operative time (>90 min)
for trauma or emergency are basic
indication for abbreviating the procedure
and some sort of temporal abdominal
closure.
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
90. Management of Abdominal
Vascular Injury
compartment syndrome or LE
compartment syndrome is significant.
Thomas B. WHITTLE1
Vascular Surgeon Heartland Vein & Vascular
Institute, Omaha, NE, Lincoln Surgical Group
Lincoln, NE, USA
1
Abstract
The vast majority of abdominal vascular
injury is penetrating trauma, usually GSW.
There is frequent association of other
intraabdominal injuries. This combination
is often lethal, and less than 50% of
patients survive. Patients often present in
hypovolemic shock with hypothermia,
acidosis, and coagulopathy. Emergency
Department Thoracotomy (EDT) has been
advocated by some, but results are poor.
Others recommend avoiding EDT, and
looking for clues of vascular injury on
physical exam. Injury above or involving
SMA presents with abdominal pain and
distention. Pararenal involvement presents
with hematuria. And injury to the
infrarenal aortoiliac vessels presents with
bilateral or unilateral lower extremity
ischemia. Resuscitation includes IV access,
blood product replacement, midline
abdominal incision, evacuation of
intraperitoneal blood, and intraabdominal
packing. This allows anesthesia time to
catch up. Systematic exploration of the
zones of injury and identifying associated
injuries is then carried out. The decision to
explore a specific vascular hematoma
depends upon location and type of injury
(penetrating or blunt). Prioritizing repair is
important after active hemorrhage is
controlled. Kidneys are most sensitive to
prolonged ischemia, followed by bowel,
and then LE ischemia. Exposure
techniques with proximal and distal control
depends upon the zone of injury. These
include supraceliac or infrarenal aorta
exposures, and left or right medial visceral
rotations. Repair method depends upon
extent of vascular injury, degree of
contamination, time of ischemia, and
patient stability. Ligation or shunting with
return to the OR after stabilization should
be considered. Risk of intraabdominal
AJTES Vol.2 Nr.2 Supplement 2
91. Management of Severe Hepatic
Trauma
Fausto CATENA1
Professor of general surgery, Chief Department of
Emergency and General Surgery Parma University
Hospital ITALY.
1
Abstract
The severity of liver injuries has been
universally classified according to the
American Association for the Surgery of
Trauma (AAST) grading scale. In
determining the optimal treatment strategy,
however, the haemodynamic status and
associated injuries should be considered.
Thus, the management of liver trauma is
ultimately based on the anatomy of the
injury and the physiology of the patient.
Our aim is to present the World Society of
Emergency Surgery (WSES) classification
of liver trauma and the management
Guidelines
92. Management of Anterior
Penetrating Abdominal Injuries.
Physical Examination vs
Radiologic Imaging vs Diagnostic
Laparoscopy
Orhan ALİMOGLU1
1
Department of General Surgery, School of
Medicine, Istanbul Medeniyet University,
Istanbul,Turkey
Abstract
Anterior penetrating abdominal injuries are
frequently encountered conditions in cases
of trauma & emergency surgery. Inthe
1960’s, routine exploratory laparotomies
were widely performed in such cases.The
therapeutic approach has changed over the
years from routine laparotomy to nonoperative treatment.Currently, as elective
conservative treatment for penetrating
anterior abdominal injuries is an
increasingly recognized approach.
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Although emergency laparotomy is still
recommended for patients who either are
hemodynamically unstable, or present with
signs of peritonitis at the initial evaluation,
conservative approach is preferred for the
remaining cases who lack these findings.
However, there’s still controversy in
concern of how the conservative
management should be decided on, or
performed. Three methods are commonly
used for the decision of conservative
treatment which are physical examination
along with necessary laboratory tests,
radiologic imaging techniques including
ultrasonography and computerized
tomography scan, and diagnostic
laparoscopy. It has been reported that the
accuracy for ultrasonography and
computerized tomography scan were 80%
and 77% respectively, whereas this rate for
physical examination was found to be
95%. On the other hand, performing
diagnostic laparoscopy for all patients is
not considered as cost-effective due to the
invasive nature of this intervention and its
probable complications.
In conclusion, a selective conservative
approach based on physical examination,
simple laboratory studies (hemogram, creactive protein) and clinical follow-up in
penetrating anterior abdominal stab
injuries is a simple, cost-effective, reliable
and effective treatment method.
Keywords: anterior penetrating abdominal
injuries, physical examination, radiologic
imaging, diagnostic laparoscopy.
93. The Rate of Success of the
Conservative Management of
Liver Trauma in Albania
Skender BUCI1, Myftar TORBA1, Sokol RUCI1,
Dorina SHTJEFNI1, Elona MARKECI1
General Surgery Service, University Hospital of
Trauma, Tirana, Albania.
Albania. The percentage of success was
58.7%.
Methods: This study was conducted
prospectively from January 2009 to
December 2012. We analyzed 173 patients
admitted to our hospital with liver trauma.
Liver injuries were evaluated according to
the American Association for the Surgery
of Trauma and the World Society of
Emergency Surgery classification, while
the anatomic gravity of the associated
injuries was defined using the Injury
Severity Score system. The potential
mortality was estimated with the Revised
Trauma Score.
Results: Out of the 173 patients with liver
trauma, 83.2% were male. The main cause
of liver trauma was motor vehicle crashes
(50.9%). Blunt trauma was the cause of
liver injury in 129 cases (74.6%), and
penetrating trauma occurred in 44 cases
(25.4%). Initially, the decision was to
manage 88 cases (50.9%) via the
conservative approach.
Of these, 73 cases (42.2%) were
successfully treated with conservative
treatment, while in 15 cases (17.2%), this
approach failed. The success rate of
conservative treatment by grade of injuries
was as follows: grade I (38.4%), grade II
(30.1%), grade III (28.8%), and grade IV
(2.7%). The overall mortality rate of liver
trauma was 13.2%.
Conclusions: The likelihood of success in
using conservative treatment had a
significant correlation with the grade of
liver injury and associated intra-abdominal
injuries. The limited hospital resources and
low level of consensus on conservative
treatment had a negative impact on the
level of success.
Keywords: Liver trauma, Grade of
injuries, Conservative treatment, Success
Abstract
Background: The conservative treatment
of liver trauma has made important
progress over the last 10 years at the
University Hospital of Trauma in Tirana,
AJTES Vol.2 Nr.2 Supplement 2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
94. Emergency System Evolution in
Albania
Skënder BRATAJ1
National Center of Medical Emergency, Tirana,
Albania
1
Abstract
A fully functional integrated system of the
Coordination Unit of the National Center
of Medical Emergency was launched for
the first time in Albania, in 3 April 2017.
A functional emergency system is the first
step towards an advanced health system.
Our mission is to save life and to guarantee
its quality. The Emergency Service
127/112 guarantees immediate response to
any medical emergency throughout the
territory of the Republic of Albania. We
respond at any request for medical help by
arriving immediately after the call at the
scene, where the medical team does the
assessment, treatment, stabilization of vital
parameters and transportation to the
appropriate hospital. This mission is
carried out through a structured
organization and availability of all the
financial, legal, human resources, and the
necessary equipment and tools. We
guarantee the life quality of our patients
only with the professional preparation and
the standardized protocols, the continuous
collaboration with national and
international scientific associations, with a
constant evidence-based verification and
updating. This article aims to describe and
discuss the coordination unit of the
National Center of Medical Emergency, its
role, tasks, purposes and evolution
throughout the years.
Keywords: National Center of Medical
Emergency, Albania, evolution,
emergency, 112, 127
AJTES Vol.2 Nr.2 Supplement 2
95. How to Manage a Case with
Multiple Injuries in Prehospital
and Hospital Premises
Basri LENJANI1, Premtim RASHITI1, Gani
SHABANI1, Esen UYSAL1, Elfije KRASNIQI1,
Erza VOCA1, Berat LENJANI1 , Kledisa HARIZI1 ,
Dardan LENJANI1
1
Emergency Clinic, University Clinical Center of
Kosovo, Pristine, Kosovo.
Abstract
Introduction: In the University Clinical
Center of Kosovo the Tertiary Emergency
Clinic on average require emergency
medical help 1-3 cases of multiple injuries
each day. Of these injured, some come
directly and many of them are referred to
by regional hospitals. Multiple injuries
pose problems, challenges in managing
multiple-injured injuries.
The purpose of this paper is to identify
problems, different complaints, advice and
possible solutions to managing injured
multiple injuries, reducing morbidity,
disability and mortality.
Material and Method: The research is of a
retrospective type for a period of 8 months
from January to August 2018. All data on
multiple injured sufferers have been
studied and researched the problems posed
during the management of multiple injured
injuries ranging from step one to step six.
Results. From the investigated data, the
young age, and especially the males, were
mostly injured by traumas and road traffic
accidents as the main etiologic factor of
multiple injuries. Injuries were more than 2
to 3 system injuries, posing many
problems in managing multiple-injured
seniors.
Conclusions. A well-trained and welltrained medical team is the key to effective
management of multiple injured people,
minimizing the problems encountered
during the management steps.
Words. Multiple injuries, injuries,
emergency clinic, triad.
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
96. The ECG in Emergency Medicine
Skënder BRATAJ1
National Center of Medical Emergency, Tirana,
Albania
1
Abstract
The electrocardiogram is the recording and
graphic reproduction of the electrical
activity of the heart at various stages of its
activity. It is a fundamental and
irreplaceable diagnostic tool, but its
interpretation should be linked to the
symptoms and the history of the patient's
illness. The electrocardiogram (ECG) is
the ideal diagnostic test at the emergency
medicine department. It is non-invasive,
inexpensive, easy to use, and it yields a
wealth of information. All emergency
physicians interpret multiple ECGs every
day and the most critical decisions related
to patients with chest pain, dyspnea, or
even shock, are based on ECG
interpretation at the bedside. However,
although the ‘‘high profile’’ disease states
such as acute coronary syndrome
classically are linked with this
indispensable tool, we use ECG as an
important diagnostic test in other diseases
too.
Although traditionally the ECG is thought
of as a cardiologist’s tool, the possibility of
making real-time assessments of patients,
has converted it into the domain of any
medical practitioner, emergency physician,
internist or family practitioner. All the
physicians and nurses at the Emergency
Department must become very comfortable
with the many facets and subtleties of ECG
interpretation, furthermore they should be
expert in the urgent and emergent
interpretation of the ECG.
In this issue, we examine the ECG in
traditional and nontraditional realms.
Diagnosis of dysrhythmia and acute
coronary syndromes is an obvious focus of
this text. We also discuss
electrocardiographic manifestations of
non-coronary disease, both cardiac and
systemic.
Keywords: ECG, emergency medicine,
diagnostics
AJTES Vol.2 Nr.2 Supplement 2
97. Access to Managing a Case with
Traumatic Cardiac Arrest and
Emergency Treatment in the
Prehospital and Hospital
Environment
Basri LENJANI1, Premtim RASHITI1, Gani
SHABANI1, Esen UYSAL1, Elfije KRASNIQI1,
Berat LENJANI1, Kledisa HARIZI1, Dardan
LENJANI1
1
Emergency Clinic, University Clinical Center of
Kosovo, Pristine, Kosovo.
Abstract
Traumatic cardiac arrest is the
breakthrough of heart work which is
terminated due to open or penetrating
injuries to the chest. Traumatic cardiac
arrest is a medical emergency which will
always result in death if no immediate
medical care is provided and survival
without neurological complications is rare.
There are no definitive protocols on how to
manage traumatic cardiac arrest, but some
victims benefit from emergency
thoracotomy to gain access and repair
damage from chest injuries. Traumatic
cardiac arrest is a complicated form, often
confusing with the Advanced Cardiac Life
Support protocols, in the broadest sense
that the emergency team first needs to
determine the cause of traumatic cardiac
arrest and change, considering
hypovolemic and hemorrhagic shock to
due to penetrating injuries. As all traumas
are treated by a specialized medical team
who are trained using (ATLS). The
survival rate of victims has improved
significantly if the injured gets final
treatment (operation or reperfusion) within
an hour of an accident and this critical time
principle is usually known as the "golden
hour". Medical hospital transport often
becomes inaccessible to the local facility
when the injured party requires advanced
medical care.
Keywords. Traumatic cardiac arrest,
Responder. ACLS. ATLS, medical
emergencies.
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99. Retrospective Study by Bristow
Technique in the Treatment of
Habitual Scapulo-Humeral
Dislocation
98. Emergency Treatment in Himara
Tragic Accident (Albania)
Edlira KUKELI1,2, Valdete KALOSHI1,2, Valbona
ZEKA1,2
1
University Hospital of Trauma, Tirana, Albania
2
University Hospital Center “ Mother Tereza”
Tirane, Albania
Abstract
Background: There is an increasing of
road accidents during recent years. On 21
May 2012 a tragic accident near Visha’s
hill (Himare) happened, when a bus
plunged 80 metres off a cliff. The accident
killed 11 students and injured 22 others.
The ambulances and helicopters rescue
were sent to assist and bring them to
medical resources. The University Hospital
of Trauma provided medical care and
treatment of the wounded and injured.
Aim: This article aims to discuss the
medical response of emergency
department, management and transport of
injured to the tertiary care hospital.
Materials and Method: The retrospective
study was conducted during the period of
time (2012 -2013). It is based on the
obtained hospital data of wounded
(medical records).
Results: 20 (females) of the evacuated
people were treated at the University
Hospital of Trauma. The two remaining
injured were dead during their helicopter
transport. The patients were hospitalized in
intensive care 45%, traumatology 15%,
neurosurgery 22%, general surgery 12%,
and urology 6%. The rescue work was
performed well...
Conclusions: Emergency Departament is
a sensitive area of health care. Triage is the
most important mission of emergency
management. We should provide an
effective strategy of emergency response
improving based in institutional
cooperation and lessons learned.
Keywords: University Hospital of Trauma,
Albania, Himara, accident, management
AJTES Vol.2 Nr.2 Supplement 2
Ilia MAZNIKU1
Faculty of Technical Medical Sciences, University
of Elbasan "A. Xhuvani", Elbasan, Albania
1
Abstract
Aim: To evaluate the functional outcomes
of the Bristow procedure in patients with
recurrent anterior glenohumeral instability.
Materials and methods: Personal clinical
records of 42 patients with 45 operated
shoulders were reviewed retrospectively.
Patient age at time of first dislocation,
injury mechanism, and number of
recurring dislocations before surgery were
recorded. The overall function and stability
of the shoulder was evaluated.
Results: Thirty-five cases or 78% of the
scapulo humeral instability series have
been traumatic. The average number of
repeated dislocations was from 9 to 12
reports A patient, a 25-year-old male, had
17 episodes of shoulder outbreaks in one
day. The average of 46 months of
prosecution. After the surgical procedure
we have not encountered any relapse. In
four patients (9%). A fibrous consolidation
of the corrosion process on the front lip of
glenoidales was observed. Only two had
clinical signs of pain and discomfort. One
of them was reworked for removing screws
with very good postoperative results. The
overall functional end result has been
good. Patients enjoy full functional supine
activity, confidence in using it.
Conclusions: The Bristow procedure is a
very good surgical treatment for recurrent
anterior instability of the glenohumeral
joint. The shoulder function after the
intervention is complete and prominent.
Although there is a limitation on the outer
shoulder curl.
Keywords: Bristow technique, habitual
scapulo-humeral dislocation, treatment
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100.
Clinical Outcomes in
Internal Synthesis of the Humerus
Head Split Fractures, A
Randomized Study.
Dritan TODHE1
Orthopedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
1
Abstract
Background: Humerus head split fracture
is rare and the importance of correct
diagnosis of the type of the fracture is
crucial in order to achieve good result.
The aim of this study is to discuss
theclinical outcomes in internal synthesis
of the humerus head split fractures as well
as to give a review of literature.
Materials and Methods: A retrospective
study of humerus head split fracture
operated during 2014-2015 in Tirana
Albania, classified according the severity
of fracture and age.
Results:We have a series of 15 patients <
50 years, who underwent locking plate
fixation. We noticed that in a mean of 34
months follow up, 12 of them had united.
No osteonecrosis or nonunion was seen in
simple fractures (5 patients). In complex
fractures (10 patients), osteonecrosis was
seen in 4 patients, nonunion in 2 patients,
and gleno-humeral arthritis in one patient.
We concluded that complex fractures are
associated with higher rates of nonunion,
avascular necrosis and inferior shoulder
function. We also considered the RSA in
the failed cases
Conclusion: Although we prefer to
consider internal fixation first, we suggest
that RSA is to be considered in the first
signs of failed, otherwise the postoperative
fibrosis will lead to bad functional results.
Keywords; Humerus head split fracture,
internal synthesis, reverse shoulder
prosthesis
AJTES Vol.2 Nr.2 Supplement 2
101.
Minimally Invasive
Surgical Treatment of Fractures
of the Neck and Head of the
Radius with ESIN Method
Marjan KAMILOSKI1, Lazar TODOROVIC1,
Simon TRPESKI 1, Jetmir ZIBERI1, Lazo
JOVCHESKI 1, Slavica SHUPERLISKA1. Anila
RACAJ1, Zllatko ALEKSOVSKI1.
University Clinic of Pediatric Surgery Skopje,
Macedonia
Abstract
Fractures to the neck and head are
represented by 1-2% of all child age
fractures. These types of fractures were
described for the first time in 1803 yr. This
retrospective study analyses and presents
the results from the treatment of patients
with these fractures in the period from
2010 to 2015. The types of fractures are
classified under the Judget classification.
The goal of our study is to evaluate the
advantage of using the minimal invasive
surgical treatment with fractures of the
head and tne neck of the radius type III and
IV. Two surgical techniques were used: 42
patients were treated with an open and
bloody reposition and transcondylar
fixation, while 32 patients were treated
with the ESIN method. The choice of the
surgical technic was random. This study
has observed the inclusion and exclusion
criteria. For the evaluation and sorting of
the received results we used the “Broberg
and Morrey score system”. The received
results from the two examined groups were
in the scope of expectedly good results.
Following the positive trends in child
traumatology, which prefers the minimal
invasive methods, our study also, showed
better results in this group.
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
102.
Proximal Humerus
Fractures Treatment &
Management
Dorian HABILI1
1
Orthopaedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
Abstract
Proximal humerus fractures are
challenging to treat, as even low-energy
mechanisms of trauma may result into
complex fracture patterns, especially in the
elderly population. They make 5-9 % of all
fractures in our clinical practice. Proximal
humerus fractures have a dual age
distribution, occur either in young people
following high energy trauma or in those
older than 50 years with low velocity
injuries like simple fall.
In the elderly population, most of these
fractures are related to osteoporosis. They
have a bimodal age distribution. Proximal
humeral fractures are the third most
common fracture in elderly patients and
pose an important socioeconomic problem.
More than 70% of the patients with these
fractures are older than 60 years of age,
and 80% are women.
Complex three- and four part fractures
account for >50% of cases in patients older
than 60 years. The major part of these
fracture are treated conservatively, with
approximately 20% of cases requiring
operative management.
Nevertheless, the treatment of choice
remains a matter of controversy. There is
no single method to impose itself as the
gold standard of treatment. Proximal
humerus fractures present a unique
challenge to surgeons as surgical
indications are poorly defined in the
literature. Historically, studies are
complicated by a lack of comparison
groups and nebulous definitions of surgical
indications. At this time, it is not clearly
defined exactly which patient and fracture
type perform better with surgical
intervention. Surgeons should always
consider the patient and their expectations
prior to recommending surgery, as
satisfactory results have been shown from
AJTES Vol.2 Nr.2 Supplement 2
conservative care even in the face of
displacement and comminution. This
article aims to give a review of literature
and discuss the treatment and management
modalities of proximal humerus fractures.
Keywords: proximal humerus fractures,
management, treatment, literature
103.
Multidisciplinary Surgical
Approach in Extensive Trauma
Injury of Upper Extremity - Case
Report
Lazar TODOROVIC1, Ilir HASANI2, Anila
RACAJ 1, Marjan KAMILOSKI, Slavica
SHUPERLISKA1
1
University Clinic of Pediatric surgery, Skopje, R.
Macedonia
2
University Clinic of Traumatology, Skopje, R.
Macedonia
Abstract
Introduction: Polytraumatized an 9-yearold patient, in a hemorrhagic and traumatic
shock with severe laceration injury of the
left upper extremity and early sings for
acute critical ischemia, was admitted in our
emergency department
Material and Methods: Surgery was
initiated within the first hour of hospital
admission. Exploration revealed highly
contaminated wound, extensive soft tissue
damage, severe muscle laceration, axillary
artery lesion, thrombosed axillary vein,
neuropraxia of the brachial plexus and
open humeral shaft fracture grade III
according Gustilo- Anderson classification.
The axillary artery lesion was replaced
with a reversed saphenous vein
interposition graft and the axillary vein
thrombus was removed using Fogarty
catheter. The open humeral shaft fracture
was stabilized with external fixation
ostheosynthesis. After meticulous and
radical injury zone excision was
completed, soft tissue coverage and tension
free approximation of the muscle and skin
was achieved. Pre-and intraoperative
broadspectrum antibiotics were used.
Results: Postoperative follow up was
satisfactory with acceptable functional and
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
aesthetic outcome. Complete healing of the
humeral shaft fracture was noticed after 18
weeks. Rehabilitation program was started
after humeral fracture was stable.
Conclusion: The treatment of this kind of
injuries require multidisciplinary surgical
approach that includes traumatology
surgeons, vascular surgeons and plastic
surgeons
104.
Rehabilitation of Shoulder
after Rotator Cuff Repair
group according to VAS score were in 6
points, while 85% of patients of the second
group were in 3 points in the same phase.
2-There were differences in the VAS
scores of the first phase of rehabilitation
between the two groups. 3-At a later time
functional scores, active motion and
shoulder strength had no differences.
Conclusions: The two groups had
differences in VAS score at first phase of
rehabilitation while functional scores,
active motion and shoulder strength hadn’t.
Keyword: Rotator cuff repair, arthroscopy,
rehabilitation.
Manushaqe SARAÇI 1, Luljeta STANAJ 1
1
Rehabilitation and Physiotherapy Service,
University Hospital of Trauma, Tirana, Albania
105.
Shock Index in Abdominal
Trauma
Abstract
Background: The rotator cuff damage is
the most common cause after road
accidents. Rehabilitation after the
arthroscopy of the rotator cuff is very
important, which leads to: Pain relieving,
ROM recovery, shoulder strength.
Aim: To compare the effect of early versus
delayed motion in clinical outcomes of
patients who have undergone arthroscopic
rotator cuff repair.
Materials and Methods: This is a
prospective study, involving 36 patients
who were treated at our service during
March 2016 –March 2018. Average age
55+-5years old, M/F 14/22 (19 with right
arm and 17 with left arm). 18 patients
started early motion protocol 2-3days after
surgery (First group), 18 patients started
the 28thday after surgery (second group).
The rehabilitation
protocol was applied
with 4 phases: Phase I(weeks 1-6), phase
II(weeks 6-12), phase III(weeks 12+),
phase IV(months 4+). For measurements
we used VAS scale, goniometry, MMT at
the end of each phase of rehabilitation (1st
day, weeks 3,6,12, and months 6, 12).
Criteria for progression in phase: 1Minimal pain, inflammation and swelling
2-Muscular strength ≥ 4/5 throughout.
Results:1-There was significant difference
in pain score. In the first phase of
rehabilitation 89% of patients of the first
AJTES Vol.2 Nr.2 Supplement 2
Ayman El-MENYAR 1
1
Director of clinical Research in Trauma and
vascular surgery in Hamad General Hospital,
Doha, Qatar
Abstract
Shock index (SI), is considered as a rapid
predictable indicator of hemodynamic
instability in trauma patients. Herein, we
aimed to investigate the predictive value of
shock index in patients with abdominal
trauma. Patients were classified into group
I (SI<0.8) and group II (SI ≥0.8). Out of
1199 patients with abdominal trauma
requiring hospital admission, 49% had SI ≥
0.8. In comparison to lower SI group,
patients with SI≥0.8 were significantly 6
years younger, had greater ISS, and
received more blood transfusion and MTP,
and had more exploratory laparotomy and
higher mortality, p = 0.001. After
adjusting for age and sex, ISS, GCS and
abdomen AIS, presence of high SI was
independent predictor for exploratory
laparotomy (aOR 2.25) and MTP (aOR
8.07). A prospective study could be useful
to assess weather higher SI has practical
implications for risk stratification for the
need of early MTP and surgical
intervention for abdominal injuries before
incorporating it as a standard of care
clinical investigation.
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
106.
Management of Spleen
Trauma
Fausto CATENA1
1
Professor of general surgery, Chief Department of
Emergency and General Surgery Parma University
Hospital ITALY.
Abstract
Spleen injuries are among the most
frequent trauma-related injuries. At
present, they are classified according to the
anatomy of the injury. The optimal
treatment strategy, however, should keep
into consideration the hemodynamic status,
the anatomic derangement, and the
associated injuries. The management of
splenic trauma patients aims to restore the
homeostasis and the normal
physiopathology especially considering the
modern tools for bleeding management.
Thus, the management of splenic trauma
should be ultimately multidisciplinary and
based on the physiology of the patient, the
anatomy of the injury, and the associated
lesions. Lastly, as the management of
adults and children must be different,
children should always be treated in
dedicated pediatric trauma centers. In fact,
the vast majority of pediatric patients with
blunt splenic trauma can be managed nonoperatively. Our aim is to present the
World Society of Emergency Surgery
(WSES) classification of splenic trauma
and the management guidelines.
107.
Algorithm Based
Evaluation of Traumatic
Diaphragm Injuries
penetrating abdominal trauma. In the past,
when conservative approach was not
utilized and routine laparotomies were
performed, the evaluation and mangement
of diaphragmatic injuries could generally
be carried out accurately via the
exploration of the diaphragm during
laparotomy. Currently, since conservative
approach for selected cases has widely
been accepted, the diagnosis of
diaphragmatic injuries has become an
important issue.
In blunt trauma patients, diaphragmatic
injury is rarely encountered. Nevertheless,
in cases of blunt trauma, it should always
be kept in mind that the evaluation of the
diaphragm is as necessary as the evaluation
of other organs and structures. Therefore, a
multi-slice computerized tomography scan
focused on the diaphragm is a valuable
diagnostic tool, which also is usually
sufficient for the management of such
cases.
In penetrating trauma patients, left and
right thoracoabdominal injuries are
evaluated as separate entities. For rightsided injuries, the risk of the diaphragm to
be affected is relatively low and follow-up
is usually adeqaute. However, penetrating
left thoracoabdominal injuries are
accompanied by diaphragmatic injuries in
25-30% of cases, about 30% of which later
develop into diaphragmatic hernias. In
suchcases, diagnostic laparoscopy for
evaluating diaphragm injuries is the
preferred diagnostic approach as it also
allows therapeutic measures, as well, when
necessary. This presentation aims to
discuss the algorithm based approach to
traumatic diaphragm injuries.
Keywords: diaphragmatic injuries, trauma,
evaluation, algorithm…
Orhan ALİMOGLU1*
1
Department of General Surgery, School of
Medicine, Istanbul Medeniyet University,
Istanbul,Turkey
108.
Splenic Injuries After
Blunt Abdominal Trauma
Abstract
Diaphragmatic injuries may be en
countered following either blunt, or
AJTES Vol.2 Nr.2 Supplement 2
Rexhep SELMANI1, Goran BEGOVIC1, Zoran
KARADZOV1, Gjorgji JOTA1, Qemal RUSHITI1,
doi.org/10.32391/ajtessupplement.2018.2.2.2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
Andrijan KARTALOV 2, Tatjana SPIROVSKA 2,
Marija ATANASOVA 3
1
University Clinic for Digestive Surgery, Skopje,
Macedonia
2
University Clinic for Anesthesiology and Intensive
Care, Skopje, Macedonia
3
General Hospital Veles, Macedonia
Abstract
Injuries to the spleen are one of the most
common injuries in abdominal trauma.
Unrecognized injury can be a cause of
preventable traumatic death.
We analyzed in our institution the data of
110 cases with blunt abdominal trauma
over a five year period (2013-2017). The
mean age of patients was 55,4. Of the 91
patients (83%) is male. Isolated blunt
abdominal injury with lesions of the spleen
is 6, the other cases is with injuries in
others systems (polytrauma).87 (79%) was
operated and 23 cases was treated
conservative, the 75 cases was operated on
the first day. The mortality was 15 cases
(13%) of the total number.
The blunt abdominal trauma remains one
of the most common causes of spleen
injury. The clinical status of the patient, the
degree of spleen injury and associated
injuries are the guidelines on the type of
approach and treatment in patients with
spleen injury. Today the blunt abdominal
trauma with severe spleen injury is the
most frequent indication for splenectomy.
Keywords: Blunt abdominal trauma,
splenic injury, splenectomy.
109.
The Importance of
Laparoscopy in the Evaluation of
Intraabdominal Traumatic
Lesions
Ymer DURMISHI1, Philippe
KONSTANDINIDIS1, Pascal GERVAZ1, Sami
BYTYCI2, N. ELSHANI2, Adrian HOTI3
1
Surgery Service at Geneva University Hospital,
Switzerland
AJTES Vol.2 Nr.2 Supplement 2
2
University Clinical Center of Kosovo,
Pristine, Kosovo
3
University Hospital Center “Mother Theresa”,
Tirana, Albania.
Abstract
Introduction: The first steps in the use of
laparoscopy for abdominal emergencies
were very slow. Nowadays, with the
standardization of criteria and
methodologies the evaluation by means of
laparoscopy of intraabdominal lesions but
also of their treatment has been accepted as
a sure and efficient technique. Also the
technical progress in the field of
laparoscopy as well as the formation of
teams constituted a significant turn in the
use of these techniques. Even if this
method cannot detect all the lesions, it
helps us generally to evaluate the
importance of traumas and to choose the
type of therapy in a rational way.
Materials and Methods: For the present
study, we have used the data of various
medical centers as well as various medical
reviews which treat this subject. We have
used as well the data bases of different
surgical and scientific associations.
Conclusion: Laparoscopic interventions
for the evaluation and treatment of
traumatic intraabdominal lesions in stable
hemodynamic patients have proved to be a
sure and successful method. According to
the indications found, we consider that in
the future we need more multicentrical and
randomized studies. The numbers show
that more than 50 % of laparoscopic
interventions have not only served as
diagnosis, but also as treatment. Death
occurs in 10-15% of traumatic abdominal
lesions. The benefits of laparoscopy are
largely documented in the treatment of
abdominal emergencies in the field of
evaluation as well as in the field of
consumption of drugs. It decreases the
number of days spent in the hospitals as
well as the number of complications after
surgery and accelerates the return of
patients to work.
Key words: Laparoscopy, abdominal
trauma, abdominal wounds, therapy and
diagnosis
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
110.
Trauma and Endoscopic
Surgery
Ilir SHANI1
1
Surgery Department, Regional Hospital of Durres,
Albania
Abstract
The introduction of laparoscopy has
provided trauma surgeons with a valuable
diagnostic and, at times, therapeutic
option. The minimally invasive nature of
laparoscopic surgery, combined with
potentially quicker postoperative recovery,
simplified wound care, as well as a
growing number of viable intraoperative
therapeutic modalities, presents an
attractive alternative for many
traumatologists when managing
hemodynamically stable patients with
selected penetrating and blunt traumatic
abdominal injuries.
At the same time, laparoscopy has its own
unique complications associated with
diagnostic and therapeutic laparoscopy in
trauma, focusing on practical aspects of
identification and management of
laparoscopy-related adverse events.
Keywords: laparoscopy, trauma,
endoscopic surgery
111.
Imaging Diagnosis and
Follow Up of Traumatic
Pancreatic Injuries
Sonja (Saraçi) BUTORAC1, Vidi DEMKO1, Admir
MUSTAFA1, Kujtim ALIMERI1, Gezim GURI1,
Artan GJIKA1, Xhesika XHETANI3, Natasha
MERKO4, Agron DOGJANI2
1
Department of Radiology, University Hospital of
Trauma, Tirana, ALBANIA.
2
Department of Surgery, University Hospital of
Trauma, Tirana, ALBANIA.
3
Resident of Radiology, University of Medicine,
Tirana, ALBANIA.
4
Nurse Service, University Hospital of Trauma,
Tirana, ALBANIA.
Abstract
Introduction: Pancreatic trauma is a rather
uncommon injury, but if present it is
generally associated with multiple
intraabdominal lesions, thus carrying
significant morbidity and mortality.
AJTES Vol.2 Nr.2 Supplement 2
Prompt diagnosis is therefore crucial, but,
on the other hand, early diagnosis of
pancreatic trauma can be challenging
because of lack of correlation between the
initial clinical features, radiological and
laboratory findings, and the severity of the
trauma. In other cases, specific injury
patterns in the pancreas may have variable
expression at the early 'panscan', especially
as such examination does not include a
dedicated protocol for scanning the
pancreas.
Cases Report: We are going to report five
cases of high-grade pancreatic injury, two
of which upon the imaging diagnosis and
grading underwent surgical intervention
with Roux-en-Y pancreatico-jejunostomy.
Peritoneal lavage and large drainage of the
lesser and greater peritoneal cavity was
performed. In addition to other
examinations, the patients underwent
several CT and/or MRI examinations to
follow-up on the surgical outcomes and
possible morbidities; especially as in
addition to evaluation of parenchymal
injuries, diagnosis of the pancreaticojejunostomy disruption is important in
preventing delayed complications.
Conclusions: We add that imaging plays a
crucial role in the timely diagnosis of
pancreatic injury and its accurate grading,
thus playing an important role in patient's
management. Equivocal findings at initial
abdominal CT should prompt close
clinical, laboratory and imaging follow up,
particularly for suspected occult pancreatic
injuries. In addition, as high grade
pancreatic trauma is associated with
significant morbidity and mortality,
radiology is important in the appropriate
follow-up of these patients, to exclude
further complications and efficient
drainage of the pancreas, with good
outcomes in morbidity and with
maximization of the survival rate of these
patients.
Keywords: Pancreatic trauma, pancreatic
injury, initial abdominal CT
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112.
Computed Tomography as
an Adjuvant Imaging Modality in
Managing of Abdominal Trauma.
Albana SHAHINI1
1
Radiology services American Hospital No 1.
Tirana, Albania
Abstract
Introduction: In our everyday practice in
Radiology Department facing with
abdominal trauma is not a rare condition.
Abdominal computed tomography (CT)
can assist in the decision to perform
surgery or laparotomy in patients
following blunt trauma to the abdomen.
Matherial and Methods: Based on the
data gathered from January 2013December 2017 we evidenced 96 patients
with blunt abdominal trauma underwent
evaluation with CT.
Results: Abdominal injuries were detected
in 24 patients (25%). These included:
traumatic damage of solid viscera in 18
patients (10 splenic, 7 hepatics, 1 renal);
four injuries to hollow viscera (three small
bowel, and one rupture of the urinary
bladder); and 2 skeletal injuries (fractures
of the pelvis). Injury to solid viscera was
categorized as minor in 44 (46%),
moderate in 15 (16%), or severe in 37
(38%) according to an assessment of the
percentage of parenchyma involved.
Hemoperitoneum was detected in 14
patients, and characterized as small in 8
(12%), moderate in three (3.2%), and large
in 13 (3.2%).
Concrusions: CT was useful in
establishing the location and extent of
injuries, and in detecting the presence of
blood or air in the peritoneal cavity.
However, the extent of injury to solid
viscera detected on CT did not correlate
with the need for laparotomy. Of 52
moderate to severe anatomic injuries of the
liver, spleen or kidney, only ten (5.2%)
required surgical intervention because of
persistent bleeding Laparotomy occurred
more frequently in the presence of a large
hemoperitoneum, with moderate to large
hemoperitoneum required surgical
exploration. This analysis confirms the
AJTES Vol.2 Nr.2 Supplement 2
usefulness of CT for detection of location
and extent of injury in patient with blunt
abdominal trauma presented in our
Hospital.
Keyword: laparotomy, abdominal
computed tomography, hemoperitoneum
113.
Role of Ultrasound in
Occult Fractures
Maksim ÇELA1, Erton KARAFILI2
Freelance Professor at Imaging Tirana, Albania
2
Erton Clinic, Tirana, Albania
1
Abstract
Rib fractures are common injuries, which
occur most often following an obtuse nonpenetrating thoracic trauma in car
accidents. It is reported that 10 per cent of
the patients with an obtuse thoracic trauma
have one or more rib fractures. It is
estimated in several studies that fractures
of the first and second rib are of greater
significance and have a poor prognosis
since they are related with more vascular
injuries. Anterior-posterior (A-P) and
latero-lateral (LL) chest radiographs, have
a sensibility of 50%. CT- Scan has a higher
sensibility, but it is time-consuming and
not a bedside procedure. In cases of
calcaneal fractures, radiography is the first
diagnostic tool. This article aims to discuss
and evaluate the role of ultrasound as a
diagnostic tool in occult fractures.
Keywords: ultrasound, fractures, occult
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114.
Errors in Radiology and
Strategy to Reduce them.
Altina XHAFERI1*, Medien XHAFERI2, Ilir
LUMI3
1
Radiologist, University of Medicine, Tirana,
Albania.
2
Angiosurgeon, University Hospital of Trauma,
Tirana, Albania.
3
Radiologist technologists, University Hospital of
Trauma, Tirana, Albania.
Abstract
Introduction: Diagnostic error in medicine
is a major cause of patient harm, with the
rate of missed, incorrect, or delayed
diagnoses estimated to be as high as 10%–
15%. Autopsy studies have identified
major diagnostic discrepancies in up to
20% of cases, suggesting that the working
or final clinical diagnosis may be wrong in
as many as one in five patients overall
Material and Methods; Here is a review
of errors in diagnostic radiology, in an
attempt to explain possible underlying
causes of these errors. The authors also
propose strategies for error reduction in
radiology. On the basis of current
understanding, specific suggestions are
offered as to how radiologists can improve
their performance in practice.
Results: Radiologic errors have been
categorized somewhat differently by
various authors. The topic is made more
complex in that the definition of what
constitutes an error in radiologic
interpretation is subject to debate.
Surgically or autopsy-proven diagnoses are
generally accepted as an objective
reference standard, but these rarely apply.
Conclusion: We hope that future research
toward understanding the underlying
processes of human perception and
overcoming the inevitable cognitive biases
that humans bring to their tasks will
improve the likelihood that radiologist
errors in practice can be reduced. Quality
improvement strategies and information
technology–based solutions may also
provide substantial benefits.
Key words: Error, radiology, radiologist,
diagnose
AJTES Vol.2 Nr.2 Supplement 2
115.
Primary Bone Marrow
Edema Syndromes
Krenar PREZA1 , Almir SKANA2,
1
Chief of the Imaging Department, Continental
Hospital, Tirana. Albania
2
Radiologist, Continental Hospital, Tirana Albania
Abstract
Bone marrow edema is a pattern of marrow
alteration frequently observed at MRI. It is
defined by the presence of an ill-delimited
area of moderate and homogeneous
decrease in signal intensity on SE T1
images that converts to high signal
intensity on fat-saturated proton density or
T2-weighted images. It is non-specific and
may be associated with almost any
abnormal marrow, bone or joint
conditions. Epiphyseal bone marrow
edema can be associated with self-limited
spontaneously resolutive conditions
(overuse, stress insufficiency fractures,
transient osteoporosis), or with evolutive
disorders including chondropathy or
spontaneous osteonecrosis. The main task
of the radiologist is to assess the cause for
bone marrow edema and to highlight
imaging features that contribute to a
specific diagnosis and subsequently a
prognosis (resolutive versus nonresolutive). The current paper aims at
emphasizing imaging features indicative of
bone marrow edema to avoid confusion
with systemic osteonecrosis. We will also
highlight imaging features of prognostic
significance that enable the clinician to
tailor the treatment to the patient’s
condition.
Key words: MRI, bone edema syndrome,
avascular necrosis.
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
116.
Role of Ultrasound with
Color Doppler in Acute Scrotum
Management
Maksim ÇELA1, Erton KARAFILI2
1
Freelance Professor at Imaging Tirana, Albania
2
Erton Clinic, Tirana, Albania
117.
Posttraumatic Pleural
Empiema and Multidetector CT
Findings.
Eni MEHMETI1, Besmir BULKU1, Vidi DEMKO2
University Hospital Center “Mother Theresa”,
Tirana, Albania.
2
University Hospital of Trauma, Tirana, Albania.
1
Abstract
Abstract
Background: Acute scrotum is a common
medical emergency. Doppler Ultrasound
(DU) is a non-invasive diagnostic tool with
high sensitivity in the triage of acute
scrotum. It is the modality of choice to
differentiate testicular torsion and
traumatic testicular rupture from non emergent conditions. This also applies to
B-mode, colour Doppler, spectral Doppler
and power Doppler Ultrasound.
Aim: This article aims to evaluate the role
of ultrasound with color doppler in acute
scrotum management
Materials and Methods: In our study we
evaluated 13 patients aged 7 to 65 years,
presented to our department from year
2014 to 2017. Scrotum was examined by
Toshiba machines EK and GE. The
machine was equipped with high
resolution and colour Doppler linear probe
7-12 MHz Toshiba and 7-12 MHz GE.
Colour Doppler and power Doppler was
used after B-mode and then spectral
Doppler to evaluate the blood flow.
Results: Only 4 patients were selected for
our study: 1 patient with torsion of testis
and 3 patients with different types orchioepididymitis. Other cases were nonemergent conditions. Two of our four
patients were treated surgically and two
others were treated conservatively.
Conclusions: We therefore conclude that
Doppler Ultrasound (DU) is the ideal noninvasive imaging modality in the triage of
scrotal emergencies.
Keywords: ultrasound, colour doppler,
acute scrotum
AJTES Vol.2 Nr.2 Supplement 2
Background: Posttraumatic Pleural
Empiema is a significant complication and
the main cause for 2–10% of victims.
Multidetector CT Findings is increasingly
used. Our study is an analysis focused on
the anatomy of pleura, principles behind
fluid formation/reabsorption and imaging
approach to assessing pleural effusion and
PTPE under-CT evacuation.
Material and methods: The study is
conducted on eight (8) patients with PTPE
at the University Hospital “Shefqet
Ndroqi”, in Tirana, during the period,
January 2015 – June 2018, by using a
MDCT of 128 slice – 64 detector – dual
source, SIEMENS, German machine.
Results and conclusions: The frequency
of post-traumatic pleural injuries with
presence of Hydrothorax is 75.6 % in total;
second after that of Chest wall injuries
(94.2 %). Among the variable forms are
reported Hemothorax – 17.4 % and
Pneumothorax – 7.3 %.
Empyema is rare – 2 %. MDCT is the most
sensitive, specific, and accurate imaging
modality in the assessment of PTPE and
management of patients: demonstrates the
significant disorder in patients with normal
initial radiographs, indicates changing of
management in up to 20% of cases with
abnormal initial radiographs, assists
several micro-invasive procedures in order
to prevents development of empyema,
enables early prediction of respiratory
compromise and limits the severe invasive
interventions.
Keywords: Posttraumatic Pleural Injuries,
Empyema, Multidetector CT
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118.
Percutaneous CT- Guided
Multisampling Core Needle
Biopsy of Thoracic Lesion
Arjana SINA ¹, J. PROFİLİ ², A ARAPİ ³
1
Radiologist, International Turkish Hospital,
Tirana, ALBANIA
2
Anesthesiologist-Intensivist, Onkology Service,
University Hospital Center “Mother Theresa”,
Tirana, ALBANIA
3
Residency, Anesthesiologist-Intensivist, University
Hospital Center “Mother Theresa”, Tirana,
ALBANIA.
Abstract
Objective: The purpose of our study was to
evaluate the diagnostic yield and the
complication rate of percutaneous CTguided coaxial 18-gauge (1.25-mm
diameter) multisampling (five samples)
core needle biopsy (CNB) of suspected
thoracic lesions.
Materials and Methods: The records of
350 consecutive patients (100 women, 250
men; age range, 18–80 years) who
underwent percutaneous CT-guided
adjustable coaxial 18-gauge multisampling
(five samples) CNB of a suspected thoracic
lesion.
Results: Ninety-seven percent (339/350) of
CNB specimens were considered adequate
for a specific diagnosis by the
histopathology staff. There were 330
malignant lesions and 20 benign lesions.
There was no false negative result when
CNB was considered adequate for a
specific diagnosis by the histopathology
staff. Pneumothorax occurred in 8%
(28/350 intrapulmonary lesions). Two
patients required placement of a chest tube.
Minor postbiopsy hemoptysis occurred and
resolved spontaneously in 5% (17/350) of
patients.
Conclusion: Percutaneous CT-guided
coaxial multisampling large CNB of
suspected thoracic lesions, in a mainly
cancer-based population, is an accurate
procedure for a specific histologic
diagnosis and has a low rate of
complications.
Key words: Biopsy, CNB, Needle.
AJTES Vol.2 Nr.2 Supplement 2
119.
Imaging Characteristics
and Prevalence of Pancreatic
Carcinoma in Kosovo During
2011-2015
Kreshnike DEDUSHI HOTI1, Serbeze KABASHI
MUCAJ1, Astrit HOXHAJ1
1
Radiology Department University Clinical Center
of Kosovo, Pristine, Kosovo.
Abstract
Background: Pancreatic cancer is the 10th
most common malignancy and the 4th
largest cancer killer in adults.
The aim of this paper is to evaluate the
number of cases presented with pancreatic
carcinoma during the years 2011-2015, our
experience of the imaging characteristics
of pancreatic carcinoma. We evaluated
prevalence of the pancreatic cancers,
distant metastases and other local
infiltration signs among the total cases of
the pancreatic cancers diagnosed in the
University Clinical Center of Kosovo, with
the aim to compare these research findings
to similar studies made in the developed
countries.
Material and Methods: This is a
retrospective research study done during
the period of 2011-2015.This retrospective
research study includes 362 patients
recently diagnosed with pancreatic cancer,
examined in the period of 2011-2015 at the
University Clinical Center of Kosovo. The
imaging diagnostics are performed with
MSCT Sensation 64 Siemens, MSCT
Emotion 6 Siemens, and 1.5T MRI
Symphony Siemens, biopsy guide with
MSCT Sensation 64 Siemens in the
Radiologic Clinic of UCCK; HP has been
performed in Clinic of Pathology at UCCK
and prevalence is taken from the number of
cases Reported at the Institute of Oncology
Institute of Statistics and NIPH.
Results: Out of a total of the 362 patients
diagnosed with pancreas cancer, results is
female 39.5% (n=143) and male 61.5%
(n=219), report M: F (1: 1.6), 286 cases
resulted in head and neck 79 % (n=286),
76 cases resulted in body and tail cancers
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
(21%), distant metastases in first imaging
modality were found in (n=155).
Conclusion: The prevalence is 19.9:
100,000 inhabitants. Prevalence of
carcinoma of the pancreas for 5 years in
Kosovo has proved to be prevalence is
19.9: 100,000 inhabitants. Seventy-four
percent (74 %, n= 268) of all cancers are
found in Stage III and IV. From an
imaging point of view, these cancers were
presented in an advanced stage, mainly due
to their late clinical symptoms and limited
access to imaging methods in our country.
Keywords: Pancreatic Cancer, MSCT,
MRI, Prevalence, UCCK Pristina, Kosovo
120.
Role of Radiology in the
Management of Traumatic
Injuries to the Abdominal Solid
Organs - with a Focus on Spleen
Sonja (Saraçi) BUTORAC1, Vidi DEMKO1, Admir
MUSTAFA1, Kujtim ALIMERI1, Gezim GURI1,
Artan GJIKA1
1
Department of Radiology, University Hospital of
trauma, Tirana, Albania.
Abstract
Background: The morbidity, mortality and
economic costs resulting from trauma in
general, and blunt abdominal trauma in
particular, are substantial. In the past,
many traumatic abdominal injuries had to
be assessed and treated surgically,and were
therefore associated with the additional
risks and complications of surgery.
Increasing availability and developments
in CT technology, such as multi-detector
CT (MDCT), have enabled rapid nonsurgical assessment of trauma patients in
the emergency room, thereby significantly
reducing the number of exploratory
operations.
Imaging Findings and Procedure Details:
In our practice, US (FAST) has constituted
the initial survey of examination for most
patients, unless patients showed new signs
of declining hemodinamically, in which
case they underwent MDCT urgently,
especially as MDCT is characterized by
AJTES Vol.2 Nr.2 Supplement 2
faster scanning times, increased volume
coverage, and improved spatial and
temporal resolution. However, the initial
survey with US was followed by a more
thorough examination with MDCT, in
most cases contrast-enhanced, which in our
practice constitutes the imaging modality
of choice in the initial emergency
evaluation and triage to different
management strategies in abdominal solid
organ trauma–the spleen, liver and kidney.
Conclusions: Imaging findings, in addition
to the patients’ clinical and haemodynamic
status, have played a crucial role in the
evaluation and management of trauma
patients. CT has a vital role in assessing
the extent of injury to intra-abdominal
organs and assigning an injury grade,
which may affect further the management.
While, CT has virtually replaced
abdominal surgical exploration for the
detection of important injuries; nonsurgical
treatment has become the standard of care
in hemodynamically stable patients with
blunt trauma to solid abdominal organs
such as the spleen, liver and kidneys.
Key Words: Imaging Findings, blunt
abdominal trauma, solid organ injuries
121.
Transport of Injured
Patient. A Nursing Approach.
Daniela BIMI1, Indrit BIMI1
1
University “Aleksander Moisiu”, Durres, Albania
Abstract
The movement of critically injured patients
is potentially hazardous. However,
significant improvements in transport
safety and efficiency have occurred over
the last decade chiefly because of the
advances in resuscitation algorithms,
training, and monitoring technology. On
board resuscitation capabilities and
transport logistics have also progressed.
Because each phase of trauma management
is improving, transport teams are being
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tasked with the transport of increasingly
severe injuries.
Guidelines for transport within the hospital
(intrahospital) and between hospitals
(interhospital) have been formally
developed by the American Society of
Anesthesiologists , the American College
of Surgeons Committee on Trauma , and
the Society of Critical Care Medicine,
among others.
Three common themes emerge with all of
these guidelines: (i) patient transport
always involves some degree of risk, (ii)
the benefits to be realized must outweigh
these potential risks, and (iii) during
transport, the standards of care (especially
monitoring) should be at the same level or
higher than that provided in the setting
from which the patient is being
transported.
The level of care during transport should
be equal to or exceed the level of care the
patient is receiving prior to departure.
Keywords: trauma, injured patient,
transport
122.
Postoperative Pain
Management, the Role of Surgical
Ward Nurses.
Aferdita ADEMI1, 2, Ardita OSMANI1, 2, Blerim
FEJZULI1, 2
1
Clinical Hospital – Tetovo, Macedonia
2
Medical Faculty – University of Tetovo,
Macedonia
Abstract
Introduction; Postoperative pain is the
most undesired consequence after surgical
intervention, and if not managed properly
may delay postoperative recovery.
Objective: To estimate the incidence and
intensity of pain as well as the mode of
treatment and the role of nurses in
management of postoperative pain.
Material and Methods: A total of 365
patients were interviewed in post-operative
period for pain intensity after surgical
intervention. We used the Numerical
Rating Scale (0-10) for evaluation of pain
intensity.
AJTES Vol.2 Nr.2 Supplement 2
Results: from 365 patients included in this
study 195 of them were males and 170
females with an average age of 47.8 years.
The incidence of pain in a postoperative
period was 95 %, whereas the average
level of pain intensity at the time of worst
pain according to Numerical Rating Scale
was approximately 7.1. Treatment of
postoperative pain is accomplished through
NSAIDs, opioids drugs, or combinations
of them. Monitoring by nurse of patient
response to postoperative pain is of great
value and very important in pain
management.
Conclusion: The nurses played an
important role in the management and
treatment of postoperative pain.
Key words: nurses, postoperative pain,
management
123.
Colles’ Fracture and
Rehabilitation
Anxhela AHMATAJ 1, Zamir DEMIRAJ 1
Physical Therapist at University Hospital of
Trauma, Tirana, Albania
1
Orthopedic service at University Hospital of
Trauma, Tirana, Albania
1
Abstract
Colles’ fracture, the fracture of distal
radius, accounts for a high incidence of
fractures in Orthopedics. These fractures
occur mostly in post menopausal women,
due to osteoporosis. In this group, this kind
of fracture follows after a minor trauma.
These fractures rarely happen in young
generation; they require a high energy
trauma, such as car accidents.
Treatments of them varies from
conservative to surgical treatment (ORIF,
fixative extern, etc.).
Complications are seen in most of the
cases. Physiotherapy is an important
procedure to get optimal clinical results,
after conservative and surgical treatment.
The time to start physical therapy is
recommended since the first post surgery
days. Passive ROM of digital articulation
is started to improve ROM and muscles’
strength.
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After ORIF treatment it continues with
Radio-Carpal movements and prono
supinator movements.
For complicated cases, such as
algodistrophy, physical therapy takes an
important role in the treatment of
complications, particularly the MLD
(manual lymphatic drainage).
Based on our experience and according to
evidences in such scientific literatures, it’s
seen a better improvement , measured with
VAS analogue scale, DASH, ROM, and
return to ADL (activity daily life) in the
patients that have been subject of a
rigorous physical therapy protocol,
compared to those who haven’t followed
physiotherapy for different reasons.
Keywords: physical therapy,
rehabilitation, Colles fracture
124.
Nurse Follow-up in Cast
Immobilised Patients.
Arben GJONEJ1, Risida GJONEJ2, Astrit PEKA1
1
Orthopedic service at University Hospital of
Trauma, Tirana, Albania.
2
Lecturer at Faculty of Technical Science, Medical
University of Tirana, Albania.
Abstract
Background: Cast is a material used for
immobilisation of fractures and for
treatment of born and gained orthopaedic
pathologies. It is applied from the
orthopaedic doctor and cast technician.
Earlier these procedures were applied by
non medical professions.
Aim: This study aims to: educate the
patient and his relatives, improve cast
immobilisation by following certain
techniques, avoid further damage and later
complications, etc
Materials and Methods: This is a
descriptive study which evaluates the
whole cast immobilisation process, and in
each moment shows the key points which
have to be considered. There are three
reasons for cast immobilisation; fractures
immobilisation, treatment of orthopaedic
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pathologies and support after an surgical
orthopaedic procedure.
Results: There are three reasons for cast
immobilisation; fractures immobilisation,
treatment of orthopaedic pathologies and
support after an surgical orthopaedic
procedure. There are also three types of
casts; classic cast, plastic cast and bandage
cast.
Conclusions: Cast immobilisation is a non
invasive procedure which if applied
correctly offers very good results for
fractures. Each case should be evaluated
promptly because cast immobilisation has
its limitations. Taking into consideration
the cost – effectiveness ratio, we
recommend the cast immobilisation to be
the first choice in orthopaedic treatment.
Keywords: cast, orthopaedic procedure,
fractures immobilisation
125.
ALARA; Reducing
Radiation Risks from Computed
Tomography Scanning in
Children.
Jona ISAKU ¹, A.SINAJ² , Q .ARAPI 3
¹Radiologic technician , International Turkish
Hospital Tirana, Albania.
²Radiologist, International Turkish Hospital
Tirana, Albania.
3Resident Radiologist, Mother Teresa Hospital
Center, Tirana, Albania.
Abstract
Introduction: Radiation exposure from
computed tomography is associated with a
small but significant increase in risk for
fatal cancer over a child’s lifetime. This
article aims to highlight awareness and
spearhead efforts to reduce unnecessary
computed tomography scans in children.
Materials and methods: In our study 7200
cases are registered that have done a CT in
QSUT for the ages 0 to 14 years old. In our
study population we have taken 42 cases,
in ages between 0-12 years old, residents
in Tirana country. Pediatrics recommend to
do a CT based on the principles of
ALARA only if it is necessary to help in
the diagnostcation of the case .Technical
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staff at Pediatric Hospital applies the
reduced dose radiation system for pediatric
ages. The CT machine in this hospital is
made up of a small number of detectors
affecting the quality of the image .As a
result, 36% of the cases have repeated the
examination. In our patients the radiation
dose in 74% of them (31 cases) is between
0-0.5 Gy, in 12 % the dosage catches the
levels between 0.5- 1.8 Gy. In these
patients in long terms we have diagnosed
slight hemapoetic changes. In 8% of cases
the patients have taken a total dosage
exposure between 2-3.7 Gy.
Conclusions: The effective dose allowed
for the population in one year is 1 m Sv, in
our study the average dose taken by the
population of study is 2.35Gy.This value is
legitimate within the effective permissible
dose. Ongoing education of technician
personal during the last year has been
increased by 30% with the purpose of
minimizing the errors during the CT
examination
To summarize, health policies and
clinicians doctors should stimulate the
implementation of alternative diagnostic
techniques such as Ultrasound and MRI.
Key words: ALARA, diagnose, CT,
radiation, risks, effective dose.
126.
Clavicle Fractures: How
to Avoid Complications from the
Cast Technician
Arben GJONEJ 1, Risida GJONEJ 2, Astrit PEKA 1,
Edvin SELMANI 1
1
Orthopedic service at University Hospital of
Trauma, Tirana, Albania.
2
Lecturer at Faculty of Technical Science, Medical
University of Tirana, Albania.
Abstract
Background: Clavicle fractures are very
frequent in daily practice. They affect
mostly the middle third and mainly male
patients. Factors that contribute are
different for different group ages.
The Aim: The aim of this study is to
evaluate the care and how to avoid
AJTES Vol.2 Nr.2 Supplement 2
complications form the cast technician
prospective in treatment of clavicle
fractures during 2014-2015 in our Service
and to find its incidence during this period.
Material and method: We collected data
form the cast registry of Orthopedic and
Trauma Service in the University Trauma
Hospital during period January 2014December 2015. In our study we excluded
cases that were treated surgically.
Statistical analysis of the data was done
with SPSS version 2.0 packages.
Frequencies and percentages are used to
analyze the categorical variables. P value <
0.05 was considered significant.
Results: 150 cases were treated with
clavicle fracture. They were 5 (3. 3%)
newborns. Age 1-5 years old male patients
were 13 (8.7%), in the group age 6-14
years older there were 8 (5.3%) and male
patients of the group age 15-25 years old
there were 54 (36%). Male patients of
group age 26-50 years old there were 30
(20%) and more than 50 years old there
were 10 patients (6.7%). From our study
the female patients of 1-5 years old there
were 7 (4.7%) , 6-14 years were 7 (4.7%) ,
15-25 years old were 7 (4.7%) , 26-50
years old and more the 50 years old were5
(3.3%). In total there were 115 male and
35 females patients. In 115 male patients
80 (69.6%) were right side and 35 (23.3%)
were left side. In female group 35 (23.3%)
20 were right side and 15 were left side.
The management shows a significant
correlation between the diagnosis and the
type of immobilization with p< 0.05.
Conclusions: Clavicle fractures during
2015-2016 shows a ration of 4.3/1 male /
female the same as international literature.
Treatment according to age groups is
achieved with leucoplast immobilization or
cast or braces. Treatment was successful
without complications.
Keyword: Clavicle, fracture, risk factors,
cast
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127.
The Effect of the Nurses’
Knowledge and Practices in the
Peripheral Intravenous
Catheterization and in The
Development of
Infections/Complications Related
with Catheterization.
Arbëresha GURGURI1*, Fatjona KAMBERI2
1
Public Health Faculty, “Ismail Qemali” University,
Vlora Albania
2
Public Health Study Center, Public Health Faculty,
“Ismail Qemali” University, Vlora Albania
Abstract
Introduction
Peripheral intravenous catheterization is
one of the most common invasive
procedure to provide access of the
administration of drugs ,fluids and
parenteral nutrition in hospitalized
patients.This procedure is associated with a
high relatively risk for complications ,with
serious consequences in patients’ health
and increase the costs of healthcare.Aimed
at assessing the impact of knowledge and
practices of staff nurses on peripheral IV
catheterization and its complications in the
Department of Pathology and Surgery of
Vlora Hospital.
Methods
In the analytical observational study ,54
randomly selected nurses who completed
an anonymus questionnaire for the IV
peripheral catheterization and related
complications , and 14 of them were
observed during the course of the
procedure in 30 hospitalized patients
during the period of conducting the study
.The statistical analysis included the
calculation of averages ,frequencies and
percentages while the Chi-Square test was
used for the relationship between the
variables .
Results
The data collected showed that the
majority of nurses (67%) had average
knowledge and average practice (83%)
about peripheral IV catheterization and the
related complications.There was a
significant relationship between the gender
of the nurses and the level of knowledge
AJTES Vol.2 Nr.2 Supplement 2
(p=0.0236) while there have been observed
some important relationships between
specific questions with demographic
variables of nurses.Regarding nursing
practice,there were significant
relationships between the number of
complications with the number of attempts
and the appearance of the edema , output
of the catheter with the number of
attempts, respectively (p=0.005 and
p=0.003). Complications were observed in
68.97% of the insertions ,with
erythema,pain ,edema,fever being the
commonest (23.81%).
Conclusions
Nurse’s knowledge about peripheral IV
catheterization procedure affects the
occurrence of complications related to the
technique.Increasing knowledge and
focusing on specific measures that are
overlooked in practice are essential to
improving the procedure with a direct
impact on reducing complications,cost of
care and enhancing health care quality.
Key words: Knowledge, practices,
peripheral intravenous catheterization,
nurse,complications, patient .
128.
Obstetric Trauma and
Midwifery.
Daniela BIMI1, Indrit BIMI1
1
University “Aleksander Moisiu”, Durres, Albania
Abstract
Trauma is the most common nonobstetrical
cause of maternal and fetal mortality
affecting 6% to 7% of pregnancies.
Trauma care of the parturient involves
evaluation and resuscitation of two
individuals (mother and fetus) and
occasionally perimortem cesarean section
to promote fetal survival despite mortal
wounding of the mother. The primary
principle in management of the
traumatized parturient is prompt and
sustained resuscitation of the mother,
thereby providing the best opportunity for
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a favorable outcome for both the mother
and the fetus.
Management of the pregnant trauma
patient is challenging because pregnancy
imposes physiologic alterations that
complicate both evaluation and
resuscitation.
Additionally, advanced pregnancy may
influence the pattern of injuries sustained
due to uterine displacement of intraabdominal structures. This paper reviews
the important information that must be
understood by all members of the trauma
team to assure the best possible outcome.
Keywords: trauma, parturient, fetal
mortality, resuscitation
129.
FAST Ultrasound Method
for Trauma
1
Dorian META
1
Faculty of Technical Sciences, University of
Medicine Tirana
Abstract
Background: One of the main problems
regarding trauma (especially the abdominal
ones and not only) is the haemorrhage,
which may be early diagnosed by the
FAST method and a well-trained nursing
staff. An ultrasound made in real time can
be helpful to determine the diagnosis.
Diagnosis and treatment are essential for
optimum results and maintaining the
integrity and patient's life
Aim: The early identification of abdominal
traumas and the real-time determination of
the traumatic event and its consequence
comprise an increasing challenge, both real
and indispensable. The first line of life is
precisely the efficient and professional
response to trauma.
Results: There has been an increase in the
post trauma survival index and even during
the hospitalization phase in 60% of
patients who have received treatment
service with the use of FAST. On the other
hand, in patients, who were not treated
with the FAST method, there has been
observed a drastic decline of 40% in the
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percentage of trauma survival and
complications were encountered while
giving first aid.
Conclusions: The nurse is required to have
some specific ultrasound knowledge in
order to be part of the FAST program, as
the appropriate diagnosis and the high
level of knowledge has a direct effect on
the patient's life. They should be trained
and capable of managing hemodynamic
problems, intensive care techniques and
drug administrations, as well as
manipulations such as, intubation or
pericardiocentesis.
Keywords: trauma, FAST, nurse, early
diagnosis
130.
Radiology Techniques in
Specific Pathologies
Ilir LUMI1, Erjona ZOGAJ1
Msc Radiologist Technician in Trauma University
Hospital of Tirana, ALBANIA
Abstract
Introduction: Radiology is a health
science developed more lately according to
other health sciences. In 1895 Rontgen
discovered the X-ray that opened the door
to other new examination for patients.
Even though, despite this fact, today we
have great technology that brings to us
100% qualified images.
A variety of imaging techniques such as
X ray radiography, ultrasound, computed
tomography (CT), nuclear
medicine including positron emission
tomography (PET), and magnetic
resonance imaging (MRI) are used to
diagnose and/or treat diseases. . We have a
lot of radiology techniques and also
specific one for different pathologies.
Knowing well the pathologies and those
specific techniques brings the Radiologist
Technicians in a different level and also to
a better radiology service. Having a good
collaboration between staff radiologist –
physician is a very important part of the
work in radiology department.
Purpouse: It is important to have
information and to be trained for different
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techniques that improves the quality of
images and also to have a good
collaboration with physician to reduce the
possibility of redoing the examination
again or leading the doctors in a wrong
diagnosis.
Material and Methodology: This study is
a Descriptive research. The database is
taken in Trauma University Hospital of
Tirana. We have selected 10 specific
pathologies that requires specific technique
to be more noticeable in medical image.
Comparing the wrong images with the
right ones is the main format of this study,
opened for discussion.
Conclusion: Informing and organizing
more trainings or conferences to discussed
different techniques is very important. The
importance of the collaboration between
the staff for a better medical service should
be emphasized in every conference.
Key Words: Pathology, radiology, Patient,
communication, ALARA
131.
Amputation Versus
Salvage in Open Tibial Fractures
Grade III
Scoring systems defining objective criteria
for amputation and salvage was discussed.
The goal was to assist the surgeon in
making the initial decision. The final goals
are stable, painless limb and intact
sensation. Indications for primary
amputation: complete traumatic
amputation, severe crush injuries with
warm ischemia time > 6h, irreparable
sciatic/tibial nerve injury, long segment or
multilevel arterial injury and associated
life-threatening injuries. Secondary
amputation is related with higher
morbidity, higher mortality and higher
hospital costs. Recently the Ganga
Hospital Score and the protocol of WTA –
Western Trauma Association provide more
objective criteria to make decision whether
to perform salvage or amputation.
Conclusion: Beside the points, sums,
calculations, when it is not a situation
LIFE OVER LIMB, .when in doubt, even
minimal…..consult a colleague, discuss
with the patient if possible, face the family
with the facts…at least be absolutely sure
that you are doing no harm. Amputation or
salvage is and will be one of the hardest
decisions that a trauma surgeon should
make.
Jordan SAVESKI1, Neda TRAJKOVSKA1, Emilija
STOJKOVSKA-PEMOVSKA 2.
1
Clinical Hospital Acibadem, Sistina, Skopje,
MACEDONIA
2
University Clinic of Traumatology, Medical
Faculty, Skopje, MACEDONIA
Abstract
Introduction: Mangled extremity injury
(MEI) are result of high energy trauma and
are so severe that amputation is possible
outcome. The first decision that must be
made by the surgeon is: whether salvage is
possible at all or not salvage is advisable.
Purpose: The purpose of this presentation
is how decision is made about salvage or
amputation.
Material and methods: From 1997 to
2017 year 360 open tibial fractures were
surgically treated. Of them, grade III was
120 – grade IIIA 50, grade IIIB 46 and
grade IIIC 24. Amputation was done in 18
patients, 8 primary and 10 secondary.
AJTES Vol.2 Nr.2 Supplement 2
132.
Knee Sanguine Effusions
in Sports Trauma (Haemarthrosis)
Ilia MAZNIKU 1
Faculty of Technical Medical Sciences, University
of Elbasan "A. Xhuvani", Elbasan, Albania
1
Abstract
Background: The blood collection in the
athlete’s knee without suffering injuries of
the soft tissues represents a dangerous
potential to the future of the athlete.
Aim: In the following material based on
retrospective data we aim to represent the
cases of competitive athletes who suffered
traumatic knee effusions.
Materials and methods: This is a
retrospective study during the 1980-2015time frame. The patients inculded in the
study were competitive athletes with
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regular activities and training involving a
timeframe from 3 to 12 years.
Results: In overall 16 patients were
included into the study (13 men and 3
women). The average age of the injured
athletes was 23.4 years, the youngest of
them 14 years whereas the eldest 28.7
years. The right knee was injured on 12
cases (75%), whereas the left knee on 4
cases (25%). 7 (44%) cases were
basketball players, 4 cases (25%)
volleyball, 3 cases (19%) athletics 1 case
(6%) and wrestling 1 case (6%). Surgery
was performed in 6 athletes (37.5%).
Conclusions: Traumatic haemarthrosis of
the knee articulation at the sportsmen and
women is only the outer side of the injury.
It has consequences quite severe with the
future of the athlete. An in-depth study of
the accompanying injuries is a primary
duty of the sports team medical doctor, and
a request filled with hope by the sportsmen
to have their problem solved. The
correction of the accompanying injuries,
with or without invasive surgery is a
necessity to the successful continuation of
the sports activity.
Keywords: Haemarthrosis, Sports Trauma
133.
The Masquelet Technique
on the Treatment of Fractures
with Segmental Bone Loss. A Case
Report.
Zamir DEMIRAJ 1,
Orthopedic service, University Hospital of
Trauma, Tirana, Albania
1
difficulties when talking about the
synthesis or the consolidation. We should
also add here the fact that most of them are
open. This is the case that we will present
in our study: Open fracture of the
supercondylare-diaphyseal femuri left,
type III-A fractures according to GustiloAnderson. There are some ways for their
treatment.
The Masquelet technique was presented by
the French surgeon Masquelet. The
interference is done in two phases, the first
stage is the filling of the defect in the bone
with cement and for a period of 2-4
months, around the cement an iterative
membrane (Masquelet’s membrane) is
created; during the second stage we take
off the cement spacer and fill the cavity
with bone grafting (autolog transplant)
while naturally protecting the created
membrane. The membrane acts as a
bioreactor for consolidation. This
technique we have used on the case we are
about to present.
Patient M.D. 35 years old, after a car
accident is presented at the Trauma
Hospital in a state of traumatichemorrhagic shock with the head trauma,
thoraco-abdominal trauma and the left
mandibular fractures, the left forearm
fractures, diaphysis fracture of the left
femur, with the segmental bone loss about
8cm, open type III-A according to
Gustilo-Anderson.
Keywords: Masquelet; fracture; segmental
bone; cement; DCS dynamic condylar
screw;
Abstract
Background: Fractures of the diaphyseal
bones with major bone defects are injured
not very frequently in clinical practice.
They usually occur after a trauma with
high energy (like car accident) and are
accompanied by other injuries like the
trauma of the head and the trauma of the
thoraco-abdominal region, and also other
fractures. These fractures are accompanied
with significant long-term morbidity, this
because their treatment has high
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134.
The influence of Damage
Control Orthopedic Surgery
(DOC) in the Polytrauma Patients
Blerta HAMOLLI1*, Arnel MICI1, Marjola
QATIPI2
1
Orthopedic Surgery Resident, University Hospital
of Trauma, Tirana, ALBANIA
2
Student of University of Medicine, Tirana,
ALBANIA
Abstract
Background:Damage control orthopedics
is a relatively new concept and it occupies
a small proportion of the overall process in
a polytraumatic patient. It necessitates
continuous communication between
surgical, anaesthetic and the whole
multidisciplinary team. The only
randomized study showed a benefit for
borderline patients treated by DCO in
comparison to early total care. The damage
control strategy has been adopted by
traumatologists to treat extremity fractures.
Purpose: The aim of the study is to
evaluate the concept of damage control by
immediate external fracture fixation
(DCO) and consecutive conversion
osteosynthesis in terms of time saving and
safety.
Patients and Methods: For the study we
considered 33 patients (19 Males and 14
Females) from 21 to 50 years old with
severe polytraumatic damages, including
even orthopedic injuries that were
managed with DCO during the period of 6
months (from January 2018 to June 2018)
in University Hospital of Trauma, Tirana.
9 of 33 patients were send to the ICU. The
other patients were subject of surgery in
terms of
DCO, that consisted on:
a) Immediate life-saving surgery, which
was required in 21 cases;
b) Surgery for controlling heavy bleeding,
which was required in 7 cases;
c) Wound bleeding control, infection
control, washing, dressing, and temporally
closing the wound; and
d) Provisional minimally-invasive external
fixation, which was performed in 5
patients.
AJTES Vol.2 Nr.2 Supplement 2
Results: The study demonstrated the
enormous time savings and reduction of
blood loss during initial treatment if
patients with multiple injuries are treated
according to DCO. We feel that DCO is a
safe strategy in severely injured patients
with multiple injuries who are too critically
ill for definitive surgery and for those
patients who cannot be safely assigned to
the clinical pathway of early total care.
Conclusion: The method was adapted to
gain control of an unstable situation until
definitive intervention could be undertaken
Keywords: polytrauma, wounds, external
fixation
135.
Open Fractures of the
Tibial Diaphysis External Fixator
as a Primary Treating Technique
versus Other Treatment Choices
Ilir HASMUCA1
1
Orthopedic Service University Hospital of Trauma,
Tirana, Albania
Abstract
Open fractures of the tibia are more
common than in any other long bone. Rate
of tibial diaphysis fractures reports vary
from 2 per 1000 population to 2 per 10,000
and of these approximately one fourth are
open tibia fractures. Motor vehicle
accidents, skiing accidents, and highenergy falls are the common causes of
open tibial fractures. The mechanism of
injury determines the fracture
configuration (eg, skiing injuries typically
cause spiral fractures). After primary
debridement, the surgical setup should be
changed and the limb redraped without
losing sterility. Today, the indication in the
worldwide literature for treating exposed
tibial shaft fractures, of Gustilo and
Anderson grades I and II, III consists of
immediate fixation using an intramedullary
nail. External fixation is used for types
IIIA and IIIB fractures. The technical
resources or implants for immediate
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treatment of these exposed fractures are
not always available. Thus, temporary
external fixation is the option in such
cases. Monolateral external fixators
generally are preferred for the tibia, though
multiplanar and circular fixators provide
greater stability.
The purpose of this retrospective study was
to evaluate the results and effectiveness of
external fixator as a primary and definitive
treatment in open fractures of the tibial
diaphysis and compare it with other
modalities of treatment.
Keywords: Open fractures, tibial diaphysis,
external fixator
136.
Open Fractures of Tibia
and External Fixationin Injured
Patients. A Case Report
Enkelei BALLA 1
1
Orthopedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
Abstract
Background:The tibia is a subcutaneous
bone and tibias fractures are frequently
open fractures. An open fracture is a
fracture in which there is an open wound
or break in the skin near the site of the
broken bone.
Aim:To provide management of open
fracture of tibia
Methodology:The study was conducted in
the University Hospital Center of Trauma,
Tirana, during the period of time of
January to August 2018.
Case study: A 51 years- old male
slippedwhere is workingand presents with
high energy trauma, an open tibia fracture
with significant soft tissue swelling. Early
treatment for this wasfocused on stopping
hemorrhage, preventing infection at the
site of the injury and the surgery was
performed within 24 h after.External
fixation was placed for initial as a safe and
versatile technique. We provided skeletal
stability, access to the site of injury and
allowed early mobilization.He returned for
follow-up visits at regular intervals and
AJTES Vol.2 Nr.2 Supplement 2
after 6 months he returns to pre-injury
activities.
Conclusions:Management of open
fractures of tibia include the saving the life
of the patient and the limb, to uniting the
fracture, to preventing infections and
restrationing of functions. External fixation
is a safe and versatile technique.
Key words: External fixation, open
fractures.
137.
12 Years Albanian
Experience with Emergent
Surgical Treatment due to Acute
Aortic Dissection Type A.
Edvin PRIFTI1
1
Division of Cardiac Surgery, University Hospital
Center “Mother Theresa” Tirana, Albania
Abstract
Background:The acute aortic dissection
type A is a critical condition requiring
prompt and emergent surgical treatment.
The surgical outcomes are associated with
high mortality and postoperative
morbidity, due to long operation period,
bleeding, neurologic complications etc.
The aim of this study was to investigate
the early and midterm outcome in patients
undergoing surgery due to aortic dissection
representing the single team experience
and to analyze the predictors for poor early
and midterm outcome respectively to the
type of employed surgical technique and
circulatory arrest.
Materials and Methods: This is a
retrospective study including, 100 patients
with acute aortic dissection of the
ascending aorta,that underwent emergent
surgery during 2006-2018. Mean followup was 4 ± 2 years.
Results: Mean age was 53 ± 18 years
varying between 34 and 79 years old.
61(61%) patients were males.The
extracorporeal circulation time was
178±56 minutes and aortic cross clamping
time was 38±41 minutes. The mean
circulatory arrest time was
31 ± 12 minutes. The mean lowest central
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temperature was 23.5 ± 1.1 °C. The mean
ICU stay was 5 ± 7 day. The hospital
mortality was 16 (16%) patients. The cause
of death was massive bleeding in 5, cardiac
problems in 2, neurologic in 4, MOF in 3,
infection in 1, ARDS in 1. 16 patienst
underwent reopening due to bleeding.
Permanent neurologic deficit was
identified in 2 survived patients and
transitory in 10 patients. Continuous
hemofiltration was employed in 16 patients
due to acute renal failure. One patients
underwent surgery due to endocarditis 1
year later. Two other patients died due to
cerebral bleeding at 1 and 0.8 years after
surgery. Another patient had a sudden
death at 2 years after surgery. The actuarial
survival at 3 years after surgery was 74%.
The multivariate analysis reavled the
preoperative renal failure (p=0.03), arch
surgery (p<0.001), age>70years (p=0.04),
and extension of the dissection at the
epiaortic vessels (p=0.02) as strong
predictors for overall mortality.
Conclusion: This initial series of patients
with acute aortic dissection type A
undergoing emergent surgical correction
demonstrate acceptable outcome. The
hospital mortality is comparable with the
eruopean registry. The predictors are
similar to other studies. The multimodal
treatment is required. Such an extreme
presentation can be successfully treated in
Albania.
Keywords: aortics disection, type A, acute,
Albania, Cardiosurgery
138.
Scoring Systems in Blunt
Chest Trauma
Ayman EL-MENYAR1
Director of clinical Research in Trauma and
vascular surgery in Hamad General Hospital,
Doha, Qatar
1
Abstract
Blunt chest trauma (BCT) represents a
significant burden of morbidity and
mortality. We aimed to evaluate the
scoring tools (Chest AIS, ISS, GCS,
TRISS, and RTS) in BCT patients. We
AJTES Vol.2 Nr.2 Supplement 2
conducted a retrospective analysis of BCT
patients hospitalized between 2011 and
2015. Patients with GCS≤8 or penetrating
chest trauma were excluded.
Of the total of 1928 BCT patients admitted
to the level 1 trauma center; 1373 fulfilled
the inclusion criteria. The mean age of
patients was 34.9±15.6 and 90% were
males. There were 229 intubated patients,
197 patients had chest tubes and 30
patients died (2.0%). ICU and hospital
length of stay were significantly associated
with polytrauma, RTS, TRISS and positive
serum troponin. Age-adjusted predictors of
intubation were serum troponin (OR 3.0),
RTS (OR 2.1), ISS (OR 1.10) and
GCS(OR0.64). Age adjusted predictors of
mortality were TRISS (OR 16), serum
troponin (OR 9.3), and ISS (OR 1.2). With
respect to different thoracic trauma scores,
TRISS and serum troponin are found to be
appropriate tools for prediction of inhospital outcomes in patients with BCT.
There is still extensive work needed to set
early, simple scoring tool including
anatomical, physiological and biomarker in
one set.
139.
Innovations in Cardiac
Surgery, Albanian Contribution.
Edvin PRIFTI1
1
Division of Cardiac Surgery, University Hospital
Center “Mother Theresa” Tirana, Albania
Abstract
New surgical techniques have been
recently developed by our team in Albania.
Some of them have been already accepted
in the international surgical
armamentarium, some others are in the
evaluation process.
1. We developed the “peacock tail”
technique is a modification of the
cone reconstruction technique for
Ebstein anomaly and failing right
ventricle, simultaneously to
bidirectional cavopulmonary shunt.
2. The “extroverted cuff” technique
that we have proposed is a novel
modification of the flanged
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3.
4.
5.
6.
technique for the elephant trunk
construction. Such a modification
seems suitable for aortic arch
aneurysm with ragged descending
thoracic aorta that minimizes
bleeding from the distal
anastomosis and potentially
prevents distal embolization of
atheromatous plaque.
The acute ascending aortic
dissection after previous cardiac
surgery, in the presence of large
aortic dimensions very closed to
the sternum, severe aortic
regurgitation, false lumen in the
descending aorta is a very
challenging situation to manage.
Herein we are reporting a
combination of strategies of
perfusion and myocardial
protection based on the Port-Access
technology that allows antegrade
flow into the aorta, endo-clamping
of the ascending aorta,
administration of cardioplegia
before opening the sternum and left
ventricular venting to not allow
ventricular distention.
Tirana 1 technique for total root
replacement consist in the same
principal of Bentall operation but
without coronary ostium
detachment and applying a single
anastomosis with the valve tube.
Tirana 2 technique represents a
modified David operation
consisting in a external tube
wrapping of the aortic root
including the coronary ostiums and
internal implantation of the valve in
a helicoidal form.
Retrograde cellular
cardiomyoplasty through the
coronary sinus according to an
experimental study on swines in
collaboration with the University of
Florence, Italy.Our study provides
data in support of the following
issues: the venous retrograde
delivery route through the coronary
sinus is safe and effective;
AJTES Vol.2 Nr.2 Supplement 2
Celullary cardiomyoplasty
provides a significant improvement
in function and viability.
Keywords: peacock tail, extroverted cuff,
Tirana 1, Tirana 2, Retrograde cellular
cardiomyoplasty, inovations,
cardiosurgery, Albania
140.
Management of Blunt
Thoracic Trauma in Children.
Emir Q. HAXHIJA1
1
Department of Pediatric and Adolescent Surgery,
University Hospital Graz, Graz, Austria
Abstract;
Introduction: Chest trauma in children is
an indicator of injury severity and is
associated with a high mortality rate.
Pulmonary contusions with diffuse
pulmonary bleeding, oedema and
atelectasis are the most frequent thoracic
injuries found. The outcome of pediatric
patients after bluntpulmonary contusion is
presented.
Methods:The patient population, the injury
types, the injury mechanisms, the injury
severity score (ISS), the clinical course of
chest injuries, and the importance of
associated injuries in children less than 19
years of age who were treatedfor
pulmonary contusions from 1986 to
2011have been analyzed. The data from
the time 1986–2000have been compared to
the dataset 2001–2011.
Results: We found a substantial increase in
the number of patients with pulmonary
contusions per year (from 2.73 to 8.27),
increase of injuries in males (from 56% to
70%), reduced need for tube thoracostomy
(from 39% to 12%), and reduced number
of days spent in the hospital(from 25 to 19
days) when the time period 1986–2000
was compared to 2001–2011,with no
significant differences in ISS and
mortality. Whileduring 1986–2000 no
pulmonary contusions were caused by
moped accidents, during 2001–2011
moped accidents have been the second
most common cause of thoracic injury.
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Conclusion:The increased number of
patients with pulmonary contusion per year
and the emergence of moped accidents as
one of the main mechanisms leading to
pulmonary injuries during the 2001–2011
time period may be seen as local
phenomenon, but certainly intrigue for
further more global research.
Keyword; Chest trauma in children,
Pulmonary contusions, thoracic injuries
141.
Outcomes and Treatment
of Traumatic Hemothorax:
Analyses our Cases.
Fadil GRADICA 1*, Agron DOGJANI 2, Lutfi
LISHA 1, Dhimitraq ARGJIRI 3, Alma CANI 4,
Fahri KOKICI 4, Ylber VATA 1, Shkelzen
OSMANI 2, Afron MICI 2, Skender BUCI 2, Ylli
ZIQISHTI 1.
1
Thoracic and visceral Surgery Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
2
General Surgery and Trauma Service, University
Hospital of Trauma, Tirana, Albania.
3
Pneumology Service, University Hospital “Shefqet
Ndroqi” Tirana, Albania.
4
Anesthesie Reanimation Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
Abstract
Background: Guidelines for the
management of traumatic hemothorax are
well established.
The purpose of study: To assess the
management and outcomes of patients with
traumatic hemothorax.
Material and methods: We conducted a
retrospective study of all trauma patients
diagnosed with a hemothorax in University
Hospital of Trauma, and University
Hospital “Shefqet Ndroqi” Tirana Albania
from January 2010 to January 2018.
Results: Sixty-five patients with traumatic
hemothorax were identified, 41 from blunt
mechanism and 24 from penetrating
mechanism. The majority of patients
injured by penetrating mechanisms were
treated with tube thoracostomy and 10
thoracoscopy (VATS) or 17 thoracotomies
two cases Clamschell approach while the
majority of blunt injury patients were
AJTES Vol.2 Nr.2 Supplement 2
observed, pt tube thoracostomy. Among
patients suffering from blunt mechanism,
patients who were managed with chest
tubes had a greater volume of hemothorax
than those who were observed. All patients
who were observed underwent serial chest
radiographs demonstrating no progression
and required no delayed procedures.
Patients with a hemothorax identified only
by computed tomography, after negative
plain radiograph, did not require
intervention. Three patients developed a
delayed empyema one patient and two
patients fibrothorax.
Conclusion: Patients with massive
thoracotomy hemothorax and clamschell
aproach are safety for the survival of
patients with complications and low
mortality whereas a small-volume
hemothorax may be safely observed
without mandatory tube thoracostomy and
with overall low complication rates.
Key Words: Hemothorax, blunt trauma,
penetrant, tube thoracostomy, VATS.
142.
Chest Wall and Sternal
Resectionfor Primary or
Secondary Tumors, our
Experience in Single Unit in
Albania.
Fadil GRADICA1, Lutfi LISHA 1, Dhimitraq
ARGJIRI2, Alma CANI3, Fahri KOKIÇI3, Lutfi
ZHEGU1, Agron MENZELXHIU1, Astrit
KALENJA1, Ibrahim AVDIU 4, Helidon NINA4, A.
PERE4, D. XHEMALAJ4
1
Thoracic and visceral Surgery Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
2
Pneumology Service, University Hospital “Shefqet
Ndroqi” Tirana, Albania.
3
Anesthesia And Intensive Care Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
4
Oncology Service, University Hospital Center
“Mother Theresa“Tirana, Albania.
Abstract
Background: Chest wall resection
involves resection of the ribs, sternum,
costal cartilages and the accompanying soft
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tissues and the reconstruction strategy
depends on the site and extent of the
resected chest wall defect.
Materials and Methods: The study
includes 75 patients (46 male and 29
female, rate M/F 2:1). that underwent
chest wall resection and reconstruction
with prosthetic material at the University
Hospital “Shefqet Ndroqi” ,thorax surgery
division during december 2013 - december
2017 timeframe.The median age was 57
years and ranged from 16 to 73 years. The
indication for resection was primary chest
wall and sternal malignancy in 45 (60%)
patients; 20 (26.6%) patients osteosarcom;
7 (9.3%) patients condrosarcom; 5 (6.7%)
solitary plasmocitoma; 4 (5.3%) desmoidal
tumor; 2 (2.7%) patient liposarcoma; 2
(2.7%) patients Ewing sarcoma; 2 (2.7%)
patient hemangio-pericitoma;
rabdomyosarcoma 2 (2.7%) patients; 1.3%
patient malignant non Hodgkins
lymphoma), secondary (solitary chest wall
metastase )and recurrent chest wall
malignancy in 11 (14.7%) patient,
contiguous lung cancer (NSCLC) in 11
(14.7%) patient, breast cancer recidive in
8 (10.7%) patients.
Results: Skeletal reconstruction was
achieved with prosthetic material alone in
35 (46.7%) patients and with Prosthetic
materials covered by flaps of
myocutaneous or muscle tissue were used
(Prolen mesh and methyl methacrylat
sandwich plastic) in 26 (34.7%) patients,
myocutaneous or muscle flaps alone in 14
(18.7%). Soft tissue coverage was achieved
with transposed muscle in 48 (64%)
patients, local tissue only in 27
(36%) patients...
Conclusions: Our experience demonstrates
that sternal and chest wall resection is a
safe and effective treatment, which may
improve the patient survival and quality of
life.
Keywords: Chest wall resection; primary
and secondary malignancy, reconstruction
AJTES Vol.2 Nr.2 Supplement 2
143.
Culdotomy as a Minimally
Invasive Surgical Procedure with
Tubectomy for Definitive
Sterilisation and in Tubal
Pregnancy.
Arben HAXHIHYSENI1*, Daniela VERCUNI1.
1
Gynecology Service, Durres Regional Hospital,
Albania.
Abstract
Background: Transvaginal surgery is an
earlier surgical procedure than
laparoscopy. In the Regional Hospital of
Durres, Gynaecology Service, it was
applied for the first time in 2007, and since
then it became an usual procedure.
Objectives:To evaluate the efficacy and
safety of definitive transvaginal tubar
sterilisation and tubectomy in tubar
pregnancies (ruptured or not).
Methods: This is a cohort study which
includes 58 cases of definive transvaginal
tubar sterilisation and 37 cases of
tubectomy in tubar pregnancies (23
ruptured and 14 not ruptured). The study
started in January 2007 and ended in
December 2017. In each case the
procedure was explained to the patient and
their approval was mandatory.
Results: Mean time for definive
transvaginal tubar sterilisation was 4.6
min. and for tubectomy 13.9 min. Mean
blood volume lost in unruptured cases was
65 ml and 278 ml in ruptured cases. Mean
time of hospitalisation was between 12 to
24 hours. Only one case with ruptured
tubar preganancy, which was complicated
with hemoperitoneum, was hospitalised for
four days. Total rehabilitation was made in
6 days. There were no complications for a
one year period.
Conclusions: Culdotomy is a safe
procedure to make definive tubar
sterilisation or to make tubectomy in tubar
pregnancies. Based on cost – effectiveness
of this procedure we recommend it to be
used more in Albaninan Gynaecology.
Key words: Culdotomy, Transvaginal
approach surgery, transvaginal tubectomy
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144.
Placental Abruption;
Proper Evaluation and
Management
Genc KABILI1, Rustem CELAMI2, Danny
DAPHNIS3
1
Obstetrician and Gynecologist, American Hospital
of Tirana, Tirana, Albania
2.
Obstetrician and Gynecologist with Hospital
Priveledges at Elbasan Regional Hospital and
American Hospital; Professor at Faculty of Medical
Technical Sciences “Alekander Xhuvani”, Elbasan,
Albania.
3
Scientific Director of the IVF Centre –
Mediterreanean Fertility Institute, Crete, Greece
Abstract
About 1 in 100 pregnant women, or 1 %,
have placental abruption. It usually
happens in the third trimester, but it can
happen any time after 20 weeks of
pregnancy. Mild cases may cause few
problems. An abruption is mild if only a
very small part of the placenta separates
from the uterus wall. A mild abruption
usually isn’t dangerous. Severe placental
abruption, greater separation between the
placenta and the uterus, the baby is at
higher risk for; growth problems,
premature birth, stillbirth, death, or lasting
disabilities. Signs and symptoms of
placental abruption should be weel known
by all medical staff working with
pregnancy care, as early diagnosis is
essential. Such medical problem during
pregnancy poses an emergency and should
be evaluated, diagnosed and propered
managed in order to reduce fetal and
maternal morbidities and mortalities.
Keywords: Placenta, abraption, fetus,
morbidity, mortality, diagnosis,
management.
145.
Arterial catheterization in
post partum hemorrhage (PPH). A
therapeutic alternative in modern
obstetrics.
Avenir BALILI1
1
American Hospital Nr.3, Tirana, Albania
AJTES Vol.2 Nr.2 Supplement 2
Abstract
Intra and post partum hemorrhage are lifethreatening emergencies, a common causes
of maternal mortality-morbidity and still
remain a great treatment challenges in
modern obstetrics. PPH is the first cause of
deaths in developing countries while in
western countries is thromboembolism.
PPH is defined as a blood loss of 500 ml or
more after birth or severe PPH as blood
loss of 1000 ml or more. Another
classification of PPH is time related, into
primary (within 24 hours of delivery) and
secondary (between 24 hours and six
weeks post partum.
At term maternal blood volume is
approximately 7 litres and blood loss may
be life-threatening with unreplaced volume
loss of as little as 30%.
Association of maternal anemia with
postpartum hemorrhages appears to be
important not only as a predisposing factor
for parturient but also reducing resistance
to blood losses.
PPH is closely related to surgical
interventions as episiotomy, operative
vaginal delivery or c-section
Uterine or hypogastric artery
catheterization is a life-saving therapeutic
alternative and preserves future fertility at
the same time. Main indications are post
partum uterine atony, placenta previa,
placenta accreta, persistent bleeding after
cesarean section and hysterectomy, genital
tract trauma, bleeding disorders, ectopic
pregnancy etc.
146.
Title Surgery versus
metotreksat treatment of ectopic
pregnancy in UHC
Queen Geraldine between 2010 and 2015.
Maksim GJONI1
1
“Queen Geraldine“, University Hospital Center,
Tirana, Albania
Abstract
This study can be used as a reference for
the treatment of EP in Albanian population
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according to the equipment we use and the
population profile.
We have been changing gradually from
traditional and the only way of treating EP
to the pharmacological approach in
selected cases. Later on endoscopy was
available and we will include this in a later
approach of the problem.
In this study we followed 228 EP.
Including and excluding criteria were
established for each method of treatment.
Diagnosis and follow up was achieved by
using ultrasound and bHCG, culdocentesis
vaginal bleeding, pain. During the study as
early as possible diagnosis was attempted.
In this study we looked for differences in
the parity, age of the pregnancy, former
surgery, abdominal liquid, operative
technique, hisopathological examination,
cost effectiveness.
We documented soma complication such
as bleeding, pain, future fertility,
Key Words: ectopic pregnancy, surgery,
metotreksat,
147.
Urinary Tract Injury
During Hysterectomy
Leon KAZA1, Rustem CELAMI2
1
Obstetrician and Gynecologist, Lezha Regional
Hospital, Lezha, Albania
2
Obstetrician and Gynecologist, Elbasan Regional
Hospital and American Hospital of Tirana, Tirana,
Albania;
Professor at Faculty of Medical Technical
Sciences, U. of Elbasan “A. Xhuvani”, Elbasan,
Albania
Abstract
Hysterectomy is the most common
gynecologic procedure performed mostly
for benign indication. The reproductive
and urinary tracts in women are closely
related anatomically and embryologically.
Urinary tract injury during hysterectomy is
not uncommon. Injury to the urinary tract
involves injury to the ureters, bladder and
urethra. The combined incidence of lower
urinary tract injury during different modes
of hysterectomy is reported to be as high as
4.8 %. Bladder injury is approximately
three times more common than ureteral
injury. Ureteral injury is one of the most
AJTES Vol.2 Nr.2 Supplement 2
serious complications of gynecologic
surgery associated with significant
morbidity and the potential loss of kidney
function, especially when not recognized
until postoperatively. For these reasons,
injuries to the urinary tract, particularly the
ureter, are the most common cause for
legal action against gynecologic surgeons.
Urological injuries in gynecological
surgeries result due to difficult or careless
surgery and/or associated with active
infection, endometriosis, enlarged uterus,
pelvic adhesions, distorted pelvic anatomy,
previous radiation.
In our presentation we will review how and
why lower urinary tract injuries occur
during hysterectomy. A number of cases of
lower urinary tract injuries during
hysterectomy performed at Lezha Regional
Hospital will be discussed. The question of
training of gynecologist as e pelvic
surgeon will be addressed in our speech.
Gynecologist has to be conscious of the
possibility of urological injuries and take
preventive steps but should not be
frightened and pushed to inaction.
In conclusions, preventing urinary tract
injury during gynecologic procedures
needs a well established strategy which
requires knowledge of anatomy, risk
assessment and intraoperative srcreening
to recognise and repair such injuries.
Keywords: urinary tract injury, urinary
tract fistula, hysterectomy, bladder,
gynecologic surgery
148.
Newborn Trauma: Causes,
Neonatal Management and
Prevention.
Elona GJYLBEGU1, Niketa KOLICI1, Vangjush
LEKGJIKA1, Klodian HYKA1
1
Neonatal Department, American Hospital,
Tirana,Albania.
Abstract
A variety of traumatic lesions can occur
during the neonatal period. Some of those
lesions are clearly birth injuries due to
delivery and others are caused by
necessary procedures during intensive care
in critically ill neonates. As usual patient
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history must be known and knowledge
about the typical complications is
necessary in order to select the appropriate
imaging modality and thus enabling correct
interpretation of those investigations by the
radiologist.
Most birth traumas are self-limiting and
have a favorable outcome. Nearly one half
are potentially avoidable with recognition
and anticipation of obstetric risk factors.
Infant outcome is the product of multiple
factors. Separating the effects of a
hypoxic-ischemic insult from those of
traumatic birth injury is difficult.
Risk factors for birth trauma include the
following:
Large-for-date infants, especially
infants who weigh more than 4500 g
Instrumental deliveries, especially
forceps or vacuum
Vaginal breech delivery
Abnormal or excessive traction
during delivery
Abnormal or excessive action during
neonatal resuscitation
Recognition of trauma necessitates a
careful physical and neurologic evaluation
of the infant to establish whether additional
injuries are present. Symmetry of structure
and function should be assessed, the
cranial nerves should be examined, and
specifics such as individual joint range of
motion and scalp/skull integrity should be
evaluated.
Prognosis; Not all birth injuries will
require surgery. However, in some
instances, severe injuries may require
surgery in order for the infant to have the
best chances of survival. A wide variety of
medications are used to treat birth injuries.
As with surgery, not all birth injuries
require medications. In many cases,
however, medication is prescribed for pain,
seizures, cognitive disabilities, and more.
AJTES Vol.2 Nr.2 Supplement 2
149.
Critical Obstetrical
Emergencies; How Prepared Are
We? A Case Report
Rustem CELAMI1, Leon KAZA2, Genc KABILI3,
Anton MILO3, Zef DELIA4, Agron DOGJANI5
1
Professor in Obstetrics and Gynecology, Faculty
of Medical Technical Sciences, University of
Elbasan “A.
Xhuvani”; Hospital Privileges as Obstetrician and
Gynecologist at Elbasan Regional Hospital and
American
Hospital of Tirana, Tirana, Albania.
2
Obstetrician and Gynecologist at Lezha Regional
Hospital, Lezha, Albania.
3
Obstetrician and Gynecologist, American Hospital
of Tirana, Tirana, Albania
4
Professor in Obstetrics and Gynecology, Faculty
of Technical Medical Sciences, University of
Elbasan “A.
Xhuvani”; Obstetrician and Gynecologist,
American Hospital of Tirana, Tirana, Albania
5
Professor of Surgery, Faculty of Medicine,
University of Medicine of Tirana; General Surgeon
at Trauma
University Hospital, Tirana, Albania
Abstract
Background: Medical emergencies may
occur at any time in any setting,
particularly the inpatient setting. It is
essential that obstetrician gynecologists
prepare themselves by assessing probable
emergencies, establishing early warning
systems, designating specialized first
responders, conducting emergency
simulations, and debriefing staff after
actual events to identify strengths and
opportunities for improvement. Having
such systems in place may reduce or
prevent the severity of medical
emergencies.
Case report; A 28 years old, pregnant
woman, in her third term pregnancy,
comes to Maternity Service, Elbasan
Regional Hospital, in late evening, with
broken waters at home and she came
within few minutes to the hospital. The
admission midwife performs routine
bimanual pelvic examination and detects
the fetal umbilical cord proceeding fetal
head. The midwife calls and informs the
obstetrician and gynecologist on duty,
meanwhile, she had taken the hand out,
and when physician on duty performs
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respective bimanual pelvic examination the
umbilical cord was touched by gloved
fingers – proceeding fetal head, and
immediately a maneuver with two fingers
was tried to push up in a spiral circle the
fetal umbilical cord that was just around
the head, and at the moment the head felt
like was tighten to cervix uteri with
dilation 5-6 cm….
In conclusions, obstetrical emergencies,
and emergent obstetrical surgeries are
present in every day maternity/hospital
practice. Skilled staff can save the fetal and
maternal lives if they are well prepared and
infrastructure is as needed. Emergency
simulations are needed in order to assess
and evaluate the performance in such cases
and prepare for better management of such
emergencies.
Keywords: Obstetrical emergencies,
skilled medical staff, infrastructure,
emergency simulations
150.
Spinal Anesthesia and its
Role in Orthopedic Surgery of the
Lower Extremities
Elona HASALLA1*, Ilia MAZNIKU1, Ilda TAKA1,
Blerta HASALLA1, Sulejman BAHA2
1
Faculty of Technical Medical Sciences; University
“Aleksandër Xhuvani" Elbasan, Albania
2
Department of Pre-Clinic Subjects, Environmental
and Diagnostic Research Center, University of
Florence, Italy
Abstract
Introduction; Spinal anesthesia involves
the use and application of local anesthetic
agents in the subarachnoid space to benefit
from a reversible loss of sensory and motor
function.
The purpose of our study is to underline
the value and guarantee of spinal
anesthesia in creating optimal, painless and
no side effects in patients who need
interventions below Th.5. and to present
our modest experience and encourage its
use in orthopedic operations in the cases of
traumas of lower extremities.
Material and Methods; 800 patients, 720
males (90%) and 80 females (10%) were
AJTES Vol.2 Nr.2 Supplement 2
taken into study, with lower extremity
lesions in the time-period from November
2016 to August 2018. The patients were all
above 18 of age, 40% of patients (320)
were presented in emergency conditions,
with eating and other associated
complications, while 60% of patients (480)
were scheduled operations.
The maximum age was 87 years, the
average age 42 years and the youngest age
14 years. The medicines used were
Lidocaine (2% -3ml), 760 patients (95%),
1.5-2h action time and marcaine (2% 2ml), 40 patients (5%), 2.5h action time.
Conclusions; Finally, we recommend the
use of spinal anesthesia in orthopedic
surgery in the case of inferior traumas, as
the complications are minimal and the
patient's benefits are considerable.
Key words: spinal anesthesia, trauma of
lower extremities,lidocaine, marcaine
151. The Role of the Physiotherapist in the
Emergency Department
Erisa MANE1
1
Department of Diagnostics and Health Rehabilitation,
Faculty of Technical Medical Science, University of
Medicine Tirana, ALBANIA
Abstract
Background: Emergency Department (ED) is the
department of a hospital responsible for the
provision of medical and surgical care to
patients arriving at the hospital in need of
immediate care. ED personnel may also respond to
certain situations within the hospital such cardiac
arrests. The role of advanced musculoskeletal
physiotherapists is still new and evolving.
Aim: The main purpose of the study is to identify
the role of physiotherapist in ED as a necessity of
the future. Specific objectives that were achieved
through this study are: Impact of physiotherapist in
the ED on patients with neck and back pain.
Primary assessment and treatment of patients
with musculoskeletal injuries by
physiotherapists in ED. Comparison of standard
care with physiotherapeutic management
Materials and Methods: The study is a
Systematic Review, meta-analytic type,
consisting of 7 studies of the last ten years,
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which focus on the impact of physiotherapy in
ED. Studies include 1255 patients evaluated and
treated by ED physiotherapist in primary
contact compared to secondary and standard
care. The evalution includes the patient's
condition, disability, pain, waiting time,
treatment, length of stay and patient feedback to
the staff.
Results: The literature used in the study claimed
that physiotherapist in ED reduces pain and
disability 4 times faster than standard care and
reduces length of stay by an average of 40
minutes. Over 82% of patients and 96% of staff
agreed on physiotherapist as primary care in the
Emergency Department.
Conclusions: The new Emergency Care model
includes advanced musculoskeletal
physiotherapist for assessing and treating
patients with minor injuries. Their work is has
proven to be effective in reducing waiting
times, achieving higher patient satisfaction
rates and improving the patient's overall
condition. There is a need for specific training
of physiotherapists and staff reorganization of the
Emergency Department.
Keywords: Emergency Department, Advanced
Musculoskeletal Physiotherapist
152.
Use in Clinical Practice by
Nursing Staff of Proper Body
Mechanics: Cross-Sectional Study
Gentjana HASKJA1*, Fatjona KAMBERI 1
1
Public Health Faculty, “Ismail Qemali” University
of Vlora, Albania
Abstract
Introduction: Musculo-skeletal disorders
are important problems of Public Health
especially for certain occupations
involving the nursing profession. Body
mechanics includes coordinated efforts of
the musculoskeletal and nervous system to
maintain equilibrium the position and
extent of the body during flexion,
movement and activity in everyday life.
Objectives: To determine the knowledge
of nursing staff on the proper practise of
body mechanics in daily clinical practice
and whether there is a link between the
application of physical mechanics in
AJTES Vol.2 Nr.2 Supplement 2
practice and the presence of problems
associated with its non-implementation.
Materials and Methods: This crosssectional study was conducted at the Vlora
Regional Hospital in November 2017 –
February 2018. 53 out of 54 nurses
participated in the study. The nursing
staff's knowledge of body mechanics and
it’s practice was evaluated by a structured
literature questionnaire.
Results: Most nurses were women
(n=38.72%) aged 25-30, while men were
15 (28%) aged 31-35 years. Most of them
had a working experience of 5-10 years (
n=21, 40%). Of the 53 nurses surveyed,
n= 33 (62%) were graduates in a master's
degree. From the analysis of the
connection between the knowledge and the
department where nurses work, there is a
significant statistical difference between
nurses in different departments in relation
to the level of the nurses (p=0.0019,
<0.05).
Conclusion: The results showed that most
nurses had knowledge and practice of
proper body mechanics as well as previous
backache experiences. Educational
programs to increase the awareness of
nursing staff about the importance of
proper use of bodywork mechanics during
work are essential to avoid problems
associated with the lack of proper body
mechanics.
Keywords: knowledge, practice, works
safety, nursing staff, and body mechanic.
153.
Musculoskeletal Disorders
that Appear in Nurses of the
Surgery Department regarding
work Conditions and
Psychological Load
Julian KRAJA1
1
University “Luigj Gurakuqi” Faculty of Natural
Sciences, Department of Nursing, Shkoder, Albania
Abstract
Introduction; The U. S. Bureau of Labor
and Statistics ranks registered nurses the
fifth most hazardous occupation in the
United States resulting in loss days of
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work due to occupational injury and
illness. Muscular-skeletal injuries are
expensive for both individuals and
industry. The American Nurses
Association estimates $7 billion U.S.
dollars annually which are spent in direct
(medical bills) and indirect (worker’s
compensation and staff replacement) costs.
The purpose of this paper is to identify the
muscular-skeletal problems observed in
nurses during their work by linking to
demographic factors, psychological
demand and control over work in the
surgery department.
Material and methodology: This study
was conducted in the district of Shkodra,
were there examined nurses working in the
surgery department, Regional Hospital
Shkodra.
Results In total, 18 nurses working in this
department were interviewed. The
questionnaires used are: Job Content
Questionnaire dhe Nordic Muscularskeletal Questionnaire. The study was
conducted during May-Jun 2018.
Conclusions: Nurses have a considerable
stress level in solving the various problems
they have during their work. This is
reflected in the answers to the questions
they have agreed in order to carry out their
work. They need maximum focus on the
work they do, as well as the high demand
for quick action with great skill. The
results indicate that nurses refer to pain in
different parts of the body affecting their
daily activity.
Keywords: nurse, surgery, psychosocial,
Muscular-skeletal.
154.
Post-Factum Evaluation of
Radius Fractures in the Typical
Place in Relation to Age, Gender,
Osteoporosis Rate, and Treatment
Outcome.
Elona HASALLA1
University Aleksander Xhuvani, Faculty of
Medical and Technical Sciences-Elbasan, Albania
1
Abstract
Introduction:
AJTES Vol.2 Nr.2 Supplement 2
It is well known that the underlying
mechanisms of osteoporosis in older adults
are different than those associated with
estrogen deprivation. Age-related bone loss
involves a gradual and progressive decline,
which is also seen in men. The aim is to
evaluate the influence of the above
fractional on the frequency of radius
fractures in the typical place, particularly
of osteoporosis as the main cause of these
fractures at the age of three. Functional
treatment results.
Patients and Methods; Actually 82
patients with radial fracture in the typical
place of conservative treatment,
implantation and implantation in gypsum,
as well as the respective reactive
rehabilitation procedures were studied. In
the material, they have taken a survey; the
age of the patients, the sex, the rate of
osteoporosis, the technique of
reproduction, how long after the fracture
and eventually the results achieved. They
were 76 women or 92.6% and 6 males or
7.4%. The maximum age of 86 years of
age, the average age of 75 and the
minimum age of 63 In the study, primary
is the rate of osteoporosis as potential
potential for radius fractures in the typical
place.
Results: In our study series, the largest
number of patients was female, eighty-two
cases or 92.6% of the study group, the rest
of 7.6% or 6 cases were mammal. The
study period was 2 years of 2016-2017 all
fractures are in traumatic terrain.
Traumatic trauma in 60% of cases has been
overturned or otherwise reported as a
direct trauma, whereas in 40% of cases
there has been an indirect trauma. pain,
loss of function, different hematoma rates
as well as radiological changes were the
signs of these injuries. Treatment
endpoints were favorable especially when
the implantation period of three weeks was
respected in gypsum and the beginning of
rehabilitation exercises
Conclusion: Typical site radius fractures
are heavily influenced by regional
osteoporosis, age of patients, osteoporosis
rate. Generally, benign fractures tend to
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consolidate. A three-ëeek period is
sufficient for the attachment of bone
fragments and the origin of rehabilitation.
Over-term complications, such as
dysfunctional bone atrophy, are more
difficult to treat than fractures themselves.
Keywords: osteoporosis, aging, elderly,
osteoblast, osteoclast, treatment
155.
Nursing Management of
the Patient with Disability after
Craniotomy
Kimete KADESHA¹, Naime ÇULLHAJ², Irena
TRESA2, Albenc DERVISHI3
1
Chief nurse, Neuroscience Department of UHCT
“Mother Theresa”, Tirana, ALBANIA
2
Head Nurse, Neurosurgery Unit of UHCT
“Mother Theresa”, Tirana, Albania
2
Head Nurse, Neurosurgery Unit of UHCT
“Mother Theresa”, Tirana, Albania
3
Nurse, Neurosurgery Unit of UHCT “Mother
Theresa”, Tirana, Albania
Abstract
There are 20%-25% of the patients
hospitalized in the neurosurgical
department, consequently of brain tumors
and neurovascular disease, they suffer
cranial nerves damage, motor deficits of
the extremities and consciousness´s
alteration, after craniotomy.
These elements make the patients
uncollaborative and depended from the
paramedical staff.
The role of the nursing care is: 1.
Identifying needs, 2. Perform the general
nursing care protocols, 3. Perform the
specific nursing care protocols according
the needs.
When the patient is admitted in the
hospital. it is important, collaboration with
the team of doctors, nurses, rehabilitation
team. We gather the data to know situation
of the patient from the beginning till the
moment. The data serve us to develop
nursing care plan, to prevent
complications .
This is a study toward groups of patients
that have experienced neurological
disability, low karnofsky scale, after
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craniotomy and nursing care according
specific needs of the patients.
Neurosurgery service has a very good
experience that shows the patients after
surgery, life has been saved. The patients
that developed neurological disability after
surgery ,are taken on charge 100% from
the staff to fulfill their needs. A good
education is given to their families.
high level monitoring of the patients and
high level of nursing care, decrease
complication and handicap of them.
Keywords: Disability, daily life activities,
needs priority, Karnofsky scale,
consciousness level, complication
prevention, rehabilitation.
156.
Considerations about
Gestational Diabetes
Natasha MERKO 1, Lindita SAJA 1, Elvi SOTA 1,
Klejdi LATIFI 1
1
Nurse Service, University Hospital of Trauma,
Tirana, ALBANIA.
Abstract
Background: “Gravidanza” is a special
condition of the mother during which a
creature is developing in the body. The
duration of pregnancy is based on the age
of pregnancy which is calculated from the
first day of the last menstruation, accepting
a 28-day cycle. The pregnancy is expressed
in full weeks. A fetus in the term is
considered in the term he born alive in 3840 weeks, premature before 37 weeks and
a fetus serotine or post term is considered a
fetus born alive after week 42 of
pregnancy. Gravidanca manifests itself
with signs and symptoms, combined with
gynecological and imaging examinations,
decide the diagnosis.
Aim: This study is designed to sensitize
and educate all mothers who need to have
a better understanding of the complications
and illnesses that may occur during
pregnancy that endangers two lives, that of
the mother and the fetus.
Materials and Methods: This study is a
retrospective study, in both Maternity "
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Koço Gliozheni" and "The Queen
Geraldine" in Tirana, on cases of patients
diagnosed with gestational diabetes.
Conclusions: Genetic Diabetes is a
complication, a very dangerous metabolic
disorder in pregnancy, endangers both life
and maternal and fetal risk, increases the
risk of neonatal disease and morbidity. In
this study, it is reflected that a special care
of the multidisciplinary team in preventing
it with early diagnosis and good care
during pregnancy at its beginnings, and an
effective treatment of this pathology,
eliminates the risk of Amtaro-fetal, but
also neonatal.
Keywords: Gravidanza, Diabetes, Glucose,
Complications, Prenatal Diagnosis.
157.
How Is Affects Application
of Mezieries Method in Idiopathic
Scoliosis. A Case Study.
Selda VEIZAJ1, Aida LAKO1, Irena KOLA2,
Enkeleda SINAJ2
1
Faculty of Professional Studies, University
“Aleksander Moisiu “, Durrës, Albania,
2
Fakulty of Technical Medical Science, University
of Medicine of Tirana, Albania
Abstract
In this case study for idiopathic scoliosis is
the evaluation of the potential of the
Mezieries Method in a patient with
idiopathic scoliosis, in which he has not
yet finish the maturity skeletal. What
impact does this method have on
stabilization of Cobb's angle?
Clinical Case; One 15-year-old girl, who
was born in October 2003, was diagnosed
with structural scoliosis that presented with
a right thoracic curve of 17.8 degrees Cobb
angle and lumbar curve of 36.9 degrees
Cobb angle. The patient was diagnosed 3
years ago with scoliosis, and just now she
have undergone physiotherapy.
Physiotherapeutic intervention; The girl
was undergone to regular sessions of
physiotherapy for a period to one year and
a half, realizing two sessions a week. For
23 hours of the day she keeps the
personalized brace, which is recommended
by the orthopedic doctor. She has not yet
AJTES Vol.2 Nr.2 Supplement 2
received the recommendation of the
orthopedic doctor for surgery, regardless
the fact that there are some schools in
Germany which advise for surgery even
without reaching the curve of fifty degrees
of scoliosis. For the rehabilitation period,
during clinical and radiological
examinations no one has ever been noticed
improvements of the Cobb angel but not
even any deterioration of it.
Conclusions; Mezieries therapy was
observed in our patient, help not
aggravation of the Cobb angel, despite the
fact that over she has not completed
skeletal maturation. We cannot say it was
effective in reducing the Cobb angel,
however we suggest that a significant
reason to not reduce the Cobb abgel was
the personalized brace shape. In our
opinion, the brace demanded modifications
Keywords; Therapy of Mezieries,
physiotherapy, idiopathic scoliosis
158.
Traumatic and NonTraumatic Injuries. Surgery and
Rehabilitation
Zojë DEMAJ1
1
Nurse, Salus Hospital, Tirana, Albania
Abstract
Aim: This study aims to describe the
traumatic and non-traumatic injuries of
articulations and bones as well as medical
care, surgery and rehabilitation after
surgery. The study accentuates nursing
care and the importance of physiotherapy
in recuperation proccess.
Materials and Methods: Between January
2016 and December 2017 we analyzed a
total of 335 patients treated in the
department of orthopedic surgery of a
private hospital in Tirana. All patients were
16-90 years old. According to our Hospital
protocols (keeping the privacy of all
patients) we analyzed the data of patient
regarding the diagnosis of hospitalization
(cause of injuries), age, gender
distribution.
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Results: All of 335 patients taking the
study result that the largest part are male
(195 of 335) and the others female (140
of 335) .Regarding to the type of injuries
and intervention, result that 82 of the 335
cases presented are for ACL reconstruction
,for a diagnostic artroscopy (knee pain) are
116 cases presented from 335 patients,for
meniscopaty and rupture of menisc are 90
cases presented from 335. The patient
presented in the hospital for hip fracture
were 15 of 335 cases and they had done a
total hip replacement. Other cases
presented were : gonartrosis 27 of 335
cases (total knee replacement surgery) and
artroscopy of shoulder 12 of 335 cases.
Conclusions: At the end of the study, we
found that the most numerous cases
presented to the hospital are due to sports
trauma, home incidents (old age), and
degenerative bone diseases.
Keywords: ACL, trauma, hip fracture,
coxartrosis, gonartrosis, artroscopy,
surgery, meniscopaty, nursing care,
physiotherapy.
159.
Internal Fixation of
Osteoporotic Bone
Jordan SAVESKI 1, Neda TRAJKOVSKA1, Ilir
HASANI2.
1
Clinical Hospital Acibadem Sistina, Skopje,
Macedonia
2
University Clinic of Traumatology, Medical
Faculty, Skopje, Macedonia
Abstract
Osteoporosis is asymptomatic disease;
occurrence of fragility fracture is often its
initial manifestation. This condition which
is characterized by decreased bone density
and thinning of cortical bone is strongly
influenced by complex signaling in both
hormonal and mechanical environments.
Many of the traditional fixation constructs
used for repair of these fractures are not
suitable for use in osteoporotic bone.
Increased use of new implants locking
plates with fix or variable angles,
intramedullary devices and bone
substitutes has greatly improved outcomes
in these patients. The spine, wrist,
AJTES Vol.2 Nr.2 Supplement 2
proximal humerus, hip and distal femoral
and proximal tibial fracture are common
sire of osteoporosis in elderly persons.
Beside the proper choice of the new
implants and tactic in fixation of
osteoporotic bone the surgeon has to
decide about the augmentation of healing
and stability of fracture. The best
augmentation is autogenous cancellous
bone graft (ACBG), which is the best
material for bone grafting because of the
following: Contains all of the ingredient
necessary to stimulate bone healing,
osteoconductive matrix, osteoinductive
signaling molecules and cells capable of
responding to these signals and 80% of the
osteogenic capacity is the result of
mesenchymal stem cells within the
harvested bone. Beside ACBG there are
many bones and substitutes biologic
materials in use for healing of osteoporotic
bone. PMMA cement was first used to
augment fixation of unlocked condylar
buttress plate fixation in supracondylar
femoral fracture However, these methods
are limited in that PMMA induced thermal
necrosis which results in screw loosening
and PMMA cement does not support or
promote new bone formation. PMMA is
not an ideal material for this purpose
because it becomes a permanent implant
and foreign body within bone.
How to make the proper choice of the
fixation construct and augmentation of
fracture healing and stability is the purpose
of this presentation.
160.
Biologically Enhanced
Anterior Cruciate Ligament
Reconstruction
Alan ANDONOVSKI1*, Ilir HASANI 1,
Andonovska B1, Ilir SHABANI1
University Clinic for Traumatology, Orthopedic
Surgery, Anesthesiology and Intensive Care.
Faculty of Medicine, University “Ss Cyril and
Methodius” Skopje, Macedonia.
Abstract
Introduction: Although the improvement
of Anterior Cruciate Ligament (ACL)
reconstruction surgical techniques, ACL
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reconstruction is not a “100%-success”
procedure. Current research is
investigating new methods to biologically
enhance graft tissue healing, providing
superior clinical results with low failure
rate after ACL reconstruction.
Objective: The purpose of this study was
to evaluate the influence of ACL residual
remnant and Plasma Preparation Rich in
Growth Factors (PRGF) on graft healing
and postoperative clinical results after
ACL reconstructive techniques.
Methods: Eight patients (mean age 25)
with ACL rupture and intact ACL residual
remnant with diameter more than 1/3 of the
intact ACL were included in this study.
The patients were equally divided into 4
groups: Group I (control group) with single
bundle ACL reconstruction; Group II with
ACL reconstruction and application of
PRGF; Group III with remnant preserving
ACL reconstruction and Group IV with
remnant preserving ACL reconstruction
and application of PRGF.
Results: Regarding the presence of
synovial fluid at the bone-graft interface,
completed graft integration within the bone
tunnels was seen in 30% of the patients in
group I, 37% in group II, 55% in group III
and 57% in group IV. Regarding the graft
signal, finished graft maturation was found
in 35% of the patients in group I, 57% in
group II, 75% in group III and 85% in
group IV.
Conclusion: Preserved ACL residual
remnants have beneficial effect on graft
maturation and graft integration within the
bone tunnels evaluated on MRI. They
prevent tibia tunnel widening and obtain
better anterior knee stability. PRGF has an
enhancing effect on graft maturation and
showed synergic effect on prevention of
tibia tunnel widening and postoperative
knee stability. This study showed the
importance in preserving ACL residual
remnants and application of PRGF in
patients after ACL reconstruction.
Keywords: ACL reconstruction, ACL
residual remnant preservation, Preparation
Rich in Growth factors, Graft healing,
Clinical results.
AJTES Vol.2 Nr.2 Supplement 2
161.
Post Traumatic Patellar
Absence in Knee Endoprosthesis.
Case Reports
Dritan TODHE 1
Orthopaedic and Trauma Service, University
Hospital of Trauma, Tirana, ALBANIA
1
Abstract
Background: Patients with previous
patellectomy are difficult cases and
reconstruction of the joint with adequate
stability is a challenge to every surgeon.
Patellectomy results in a change in the
alignment of the quadriceps and patellar
tendons and may aggravate anteroposterior
instability if the cruciate mechanism is
damaged or absent.
Case Presentation: We present the cases
of two patients, 55 and 67 years old each,
one man and one woman operated at least
10 (up to 15) years before for knee gunshot
injuries trauma resulting in one total and
one subtotal patellectomy. These patients
were facing knee pain and arthrosis . One
of the patients had severe ankylosis. The
other had a very restricted ROM of 30
degrees (10/10/40). X rays and in one case
MRI were performed to clarify the
anatomical view. The total knee
endoprosthesis with the patellar part was
implanted (in the ankylosis case the
revision endoprosthesis was implanted per
primam). The most difficult point of the
operation was the establishing of the right
patellar-prosthesis point insertion and the
way of insertion.
Outcomes: After the implantation of the
knee prosthesis, we tried to find the old
place of the patella, although the
shortening of the quadriceps muscle has
altered the geometry. It was temporarily
fixed and after the probe of patellar
tracking, it was fixed definitively. The
technique of fixation had to be improvised
with holes on the lateral side or the patellar
part and fixed with ethibond suture nr.5.
Discussion: The CPM and the quadriceps
strengthening with the usual schema (next
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day start, four hours CPM in a day) was
applied. After the first month we had
0/0/60 for both of the patients. We reached
0/0/90 for the man with post ankilosis
patient and 0/0/70 for the other three
months later. After 6 months the post
ankilosis patient was pain free with 0/0/90
and the woman with 0/0/70, complained of
pain. The cause of the pain was due to the
iatrogenic medialization of the patellar
implant .A second operation to performed
a quadriceps plasty by folding the lateral
aspect of the tendon on the patella insertion
was planned.
Keywords: Post-traumatic patellar
absence, Knee endoprosthesis
162.
Acute Traumatic Patellar
Tendon Rupture
Edvin SELMANI1, Fatmir BRAHIMI 1, Leard
DURAJ 1, Valbona SELMANI 1
1
Orthopedic service at University Hospital of
Trauma Tirana, Albania
Abstract
Background: Acute patellar
tendon rupture is easy to diagnose but is
still often overlooked. The aim of this
study was to assess early and late results of
surgical treatment of acute patellar
tendon rupture with Krakow technique.
Material and Methods: A retrospective
study included 4 patients (4 males) . Mean
age was 29.6 ± 9.9 years. Lesions
comprised 4 tendon body ruptures,
Tendon repair was achieved with Krakow
technique. Results were evaluated in 2
steps: on patient files at a mean follow-up
of 7.1 months (range, 3-24 months) to
assess complications and early functional
and radiological results; and by phone at a
mean follow-up of 2.3 years in order to
assess long-term functional outcome on
Lysholm score and patient satisfaction.
Results: Four knees were assessed at a
mean 7.1 months. Mean knee flexion was
128.5° ± 7.5° (range, 85°-150°), extension
-1° (range, -15° to 0°) and CatonDeschamps index 0.96 (range, 0.57-1.29).
All knees were further assessed at a mean
AJTES Vol.2 Nr.2 Supplement 2
2.3 years. Mean Lysholm score was 93.7
points (range, 61-100). All patients were
satisfied or very satisfied with the result.
All had returned to their previous job, and
sports activities.
Conclusions: Patellar tendon rupture has
good prognosis if diagnosis and surgical
treatment is early.
Keywords: Acute rupture; Patellar tendon;
surgical repair
163.
Ankle Fracture with
Syndesmotic Disruption – Effect
on the Functional Outcome.
Marko SPASOV1*,Ilir HASANI1, Oliver
ARSOVSKI1, Ljupco NIKOLOV1, Igor
KAFTANDZIEV1
1
University Clinic of Traumatology, Medical faculty
of Skopje, Macedonia
Abstract
Introduction: It is widely accepted that
reduction of the syndesmosis and
placement of one or more screws across
the distal tibia and fibula restores the
anatomy and allows the syndesmosis to
heal. However, there is no consensus
regarding the specifics of screw placement.
The aim of the present study was to
evaluate the clinical and radiological result
in patients with intact, broken and removed
syndesmotic screw.
Materials and Methods; The study was
conducted at our institution in a period of
two years, and minimum follow up period
of 12 months. Patients who had undergone
open reduction and internal fixation of an
ankle fracture with screw stabilization of
the disrupted syndesmosis were included.
Fracture type was defined using DenisWeber classification system. Functional
result was measured using AOFAS score
and VAS scale was used for pain
assessment. The statistical difference
between the three groups was tested with
non-parametric statistics.
Results; The study population was
separated into three groups regarding the
state of the syndesmotic screw: intact,
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broken and removed. There was no
statistical difference between the
demographics of these groups. There was
statistically significant difference in
AOFAS score among the three tested
groups due to difference between intact
and broken group. Regarding the VAS
scale, the score in intact group was
significantly higher compared to broken
and removed group.
Conclusion; We found no statistical
difference in clinical outcome of patients
who had their syndesmotic screw removed
and those who did not. However, patients
with broken screws fared best of all.
Widening of the syndesmosis was not seen
after removal or breakage of the screw.
Our data do not support the routine
removal of the intact or broken
syndesmosis screw.
Keywords: ankle, syndesmosis, fracture,
surgery, removal
164.
Results of Chronic Achilles
Tendon Ruptures Repaired With
V-Y Tendon Plasty and Fascia
Turndown.
Edvin SELMANI1*, Fatmir BRAHIMI 1, Leard
DURAJ1, Valbona SELMANI1
1
Orthopedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
Abstract
Background: This study aimed to
evaluate the long-term follow-up results of
V-Y tendon plasty with fascia turndown,
for repairing chronic Achilles
tendon ruptures.
Material and Methods: Seventeen
patients (12 males, 5 females), who were
diagnosed with chronic Achilles
tendon rupture and met the inclusion
criteria, were included in the study. These
patients received treatment by means of
V-Y tendon plasty with fascia turndown
from January 2005 to December 2011.
Clinical outcomes of the patients were
assessed by using isokinetic strength
testing, questioning the patient regarding
residual discomfort, pain, or swelling and
AJTES Vol.2 Nr.2 Supplement 2
having the ability to perform heel rises
and using American Orthopaedic Foot &
Ankle Society's (AOFAS's) Ankle-Hind
Foot Scale score. Mean follow-up
duration was 10 years (7-13 years).
Results:Meantime from the injury to
operative treatment was 6 months. Mean
operative defect of Achilles tendon in
neutral position after debridement was 5
cm. During the follow-up, the mean calf
atrophy was 3.4 cm. The mean 30
degrees/s plantarflex and 120 degrees/s
plantarflex peak torques were 89 and 45
Nm, respectively. The mean 30 degrees/s
plantarflex peak torque deficiency was
16%. The mean 120 degrees/s plantarflex
peak torque deficiency was 17%. The
average peak torque deficiency was 17%.
The pre- and postoperative mean AOFAS
Ankle-Hindfoot Scale scores were 64 and
95, respectively. No patient had a
rerupture. Superficial wound infection was
treated with oral antibiotic therapy in 2
patients (11%).
Conclusions: The V-Y tendon plasty with
fascia turn down for
repairing chronic Achilles tendon ruptures
yielded results comparable with the
literature regarding clinical outcomes. This
method did not require synthetic materials
for augmentation and was an economic
alternative compared to other repair
methods.
Keyword: Achilles tendon rupture,
tendon plasty, fascia turndown…
165.
Meniscal Repair of Bucket
Handle Meniscus Tears –
Accelerated or Traditional
Rehabilitation
Alan ANDONOVSKI 1*, Ilir HASANI 1,
ANDONOVSKA B1, Rezeart DALIPI1.
1
University Clinic for Traumatology, Orthopedic
Surgery, Anesthesiology and Intensive Care.
Faculty of Medicine, University “Ss Cyril and
Methodius” Skopje, Macedonia.
Abstract
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Introduction: Post-operative weight
bearing and knee range of motion
after meniscal repair is still debatable
among physicians. There is a lack of
consensus regarding the optimal
postoperative rehabilitation protocol
following meniscal repair.
Purpose: The aim of our study was to
compare the clinical results in patients with
bucket-handle meniscal repair who were
submitted to an
accelerated rehabilitation protocol that
included immediate full range of motion
and weightbearing after the surgery and
those who were submitted to a
traditional rehabilitation protocol with
restricted range of motion and
weightbearing.
Methods: Patients who
underwent meniscal repair of buckethandle meniscal tears using the outside-in
and inside-out technique were included in
our study and divided into two groups:
Group I where an
accelerated rehabilitation protocol that
included immediate knee full range of
motion and weightbearing was performed
and group II where a
traditional rehabilitation protocol with
restricted range of motion and
weightbearing was conducted. The patients
were evaluated postoperatively after an
average of 8 months (range 6-11 months)
by clinical examination, Tegner and
Lysholm scores, measuring sagittal knee
stability with Rolimeter, proprioception
evaluation and MRI imaging.
Results: Twenty-eight patients were
included in our study. Overall, 72% of
patients from group I and 84% of patients
from group II reported clinically good
results. Clinical examination and MRI
imaging showed meniscal retear in 2
patients only from group I. There was not
a significant difference between the groups
regarding the Lysholm (88 vs 80,
respectively; p = 0.3) and Tegner (7.5 vs 7,
respectively; p = 0.97) scores. The results
from the measured sagittal knee stability
and proprioception also did not show
significant differences between the groups.
AJTES Vol.2 Nr.2 Supplement 2
Conclusion: Our study showed that
although the increased rate of meniscal
retears an
accelerated rehabilitation protocol can
obtain comparable clinical results as
traditional rehabilitation protocol in
patients with bucket handle meniscal
repairs. Individual approach and good
coordination with the referent orthopedic
surgeon should be obtained to avoid the
increased rate of meniscal retears.
Keywords: Bucket-handle meniscal repair,
Accelerated or Traditional rehabilitation
protocol, Clinical results.
166.
Osteochondral
Transplantation Technique Pitfalls
in Knee Osteochondral Defects
(MOSAICPLASTY/OATS technique)
Ledian FEZOLLARI 1, Leard DURAJ 1, Ilir
HASMUCA 1, Dorjan HABILI1, Alban
HYSENAJ1, Arnel MICI, A DIZDARI1, Ylber
ZAMA1, Gjergji CAUSHI 1, Vilson RUCI 1, Artid
DUNI 1, Ergys CAMI 1, Korab SEJDINI 1, Serdi
MEMINI 1
1
Ortopedic Service University Hospital of Trauma,
Tirana, Albania
Abstract
The MOSAICPLASTY technique involves
obtaining small osteochondral cylindrical grafts
from the less weight-bearing periphery of the
femur at the patellofemoral joint, and
transporting them to the prepared defect site.
With a combination of 2.7 mm, 3.5 mm, 4.5
mm, 6.5 mm, and 8.5 mm grafts, the site is filled
with 70–90% transplanted hyaline cartilage.
Fibrocartilage “grouting” growing upward from
the prepared cancellous bed will complete the
MOSAICPLASTY graft. Placing the grafts
perpendicular to the surface, at the level of the
original articular surface, is paramount to the
success of the operation. The best candidate for
osteochondral autologous transplantation
(OATS) is the young (20-30 years), thin (<25
BMI) patient who suffers a symptomatic,
traumatic, unipolar, small (<2 cm2), and type IV
outerbridge chondral defect exposing
subchondral bone , confirmed previously with
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an MRI. Cartilage transplantation can be
performed either arthroscopically or open,
including the miniopen technique. Some
surgeons advise that those unfamiliar with the
procedure should begin with the all open
technique and after several cases, move to an
arthroscopic procedure. This article aims to
discuss osteochondral transplantation technique
pitfalls in knee osteochondral defects and to give
a review of literature.
Keywords: MOSAICPLASTY / OATS
technique, knee osteochondral defects, pitfalls
167.
A combination of French and
Ponseti method as treatment for pedes
equinovarus congenitalis – Case report
Anila BELCHISHTA1, Anastasika POPOSKA1, Daniela
GEORGIEVA1
1
University, University Clinic for Orthopedic SurgerySkopje.
Abstract
A case of a 2 weeks old female baby with pes
equinovarus congenitalis bothsides was brought
to our Orthopaedic Clinic. It’s been detected a
breech presentation as a fetus.
We started the treatment with the French
method, a conservative method with daily
physical therapy for the first two weeks, with
daily manipulations of the feet along with
stretching of the feet, followed by taping in order
to maintain the range of motion gains achieved
at the end of each sesion. Another focus was
strengthening the peroneal muscles which is
thought to contribute towards long-term
correction. Afterwards physical therapy sessions
were weaned down to once a week followed by
casting , until the child reached six months old.
Ponseti second method was the following
performed, a percutaneous heel cord release or
tenotomy of Achilles tendon and capsulotomy
with sedation and monitored anesthesia care. A
small dressing is applied and a final clubfoot cast
is applied with the foot in a fully corrected
position. This cast was left in place for 8 weeks,
replaced every 2 weeks.
After correction was achieved with casting,
maintenance of correction started with full-time
(23 hours per day) use of a brace —also known
AJTES Vol.2 Nr.2 Supplement 2
as a foot abduction brace (FAB)—on both feet,
Denis-Browne bar, for 3 months. After 3
months, brace wear was decreased and used
mostly when sleeping for naps and at night-time.
This part-time bracing is recommended until the
child is 4 years of age.
Keywords: Pes equinovarus, French method,
Ponseti II method, Breech presentation
168.
Complex Abdominal Wall
Reconstruction: Practical
Approaches
Rifat LATIFI1
1
The Felicien Steichen Professor and Chairman of
Surgery
New York Medical College, School of Medicine
Director, Department of Surgery, Westchester
Health Network
Department of Surgery, New York Medical College
Abstract
With advances in abdominal surgery and
the use of Damage Control Surgery (DCS)
in the management of major trauma, and
patients with abdominal catastrophes,
complex abdominal wall defects have
become the new surgical disease, and the
need for complex abdominal wall
reconstruction (CAWR) has increased
dramatically. Subsequently, how to
reconstruct these large defects has become
a new surgical question. While most
surgeons use native tissue, whenever
possible, evidence suggests that synthetic
or biologic mesh needs to be added to large
ventral hernia repairs for optimal long-term
outcome. One particular group of patients
who exemplify ‘‘complex’’ are those with
contaminated wounds, enterocutaneous
fistulas, enteroatmospheric fistulas, and/or
stoma(s), where synthetic mesh is to be
avoided if at all possible.
While DCS and open abdomen
management (OAM) in trauma and
critically ill patients or those who have
survived initial catastrophic abdominal
event, has been shown to be lifesaving,
closing the abdomen and regaining
abdominal wall function to avoid severe
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consequences of DCS and OAM has
become modus operando in our
department. I will review our most recent
experience in CAWR in the Acute Phase of
Injury or intra-abdominal catastrophe,
using biologic mesh. Furthermore, most
recently, biologic mesh has become the
new standard in high-risk patients with
contaminated and dirty infected wounds.
While biologic mesh is the most common
tissue engineered used in this field of
surgery, level I evidence is needed on its
indication and long-term outcomes.
Various techniques for reconstructing the
abdominal wall have been described,
however the long-term outcomes for most
of these studies, are rarely reported. In this
presentation, I will outline current practical
approaches to perioperative management
and definitive abdominal reconstruction in
patients with complex abdominal wall
defects, with or without fistulas, as well as
those who have lost abdominal domain and
review our experience in almost 300
patients. In our most recent study
(unpublished data) we have shown that
frailty appears to be a more important
predictor of adverse outcomes after CAWR
with BM than age. In addition to frailty,
other significant independent predictors of
outcomes include open abdomen,
congestive heart failure, transplant and
alcohol use. All future studies should
assess frailty as a potential predictor of
outcomes.
169.
Role and Control of
Infections and Biofilms in
Surgical Wounds
Jasenka ŠKRLIN1
1
Department of Clinical Microbiology and Hospital
Infection, Committee for Infection Control,
Dubrava University Hospital - Zagreb, CROATIA.
Abstract
Despite remarkable developments in the
use of surgical techniques, ergonomic
advancements in the operating room, and
implementation of bundles, surgical site
infections (SSIs) remain a substantial
AJTES Vol.2 Nr.2 Supplement 2
burden, associated with increased
morbidity, mortality and healthcare costs;
80% of SSIs may involve a microbial
biofilm.
Microorganisms routinely contaminate,
colonize, and often infect wounds of all
types. Wound infection and possibly highlevel colonization appear to be major
barriers to healing. The presence and
negative effects of biofilm in chronic
wounds has been increasingly recognised.
Recent studies suggest that biofilmproducing organisms play a significant role
in persistent skin and soft tissue wound
infections in the postoperative surgical
patient population. Biofilm, on an
organizational level, allows bacteria to
survive intrinsic and extrinsic defenses that
would inactivate the dispersed (planktonic)
bacteria. SSIs associated with biomedical
implants are notoriously difficult to
eradicate using antibiotic regimens that
would typically be effective against the
same bacteria growing under planktonic
conditions. This biofilm-mediated
phenomenon is characterized as
antimicrobial recalcitrance, which is
associated with the survival of a subset of
cells including “persister” cells.
An efficient treatment of biofilm infections
needs a well-established multidisciplinary
collaboration, which includes removal of
the infected foreign bodies, selection of
biofilm-active, sensitive and wellpenetrating antibiotics, systemic or topical
antibiotic administration in high dosage
and combinations, and administration of
anti-quorum sensing or biofilm dispersal
agents.
170.
Advances in Complicated
Intra-Abdominal Infections
Management.
Boris E. SAKAKUSHEV1
1
Medical University Plovdiv Chair of Propaedeutic
of Surgical Diseases, First Clinic of General
Surgery University Hospital St George Plovdiv,
Plovdiv, Bulgaria
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Abstract
Sepsis is world problem requiring global
geographical answer in all engaged sectors.
CIAI are common diseases with
considerable morbidity and mortality,
despite progress in management in the last
decades. Key issues in the management of
AS are early diagnosis and patient
resuscitation, timely and adequate control
of the source of infection and antibiotic
treatment.
This is a review of the latest evidencebased recommendations on the critical
issues constituting ES strategy for
treatment of abdominal sepsis, focusing on
the crucial component – liquidating the
source of infection. The fundamental
principles, timing and most common
techniques are envisaged in the light of the
most recent world guidelines on the
problem from the last 3 years.
Future tendenciesof source control focus
on precise risk assessment for operationof
patients with CIAI, wider implementation
of non-operative techniques/percutaneous
drainage/, more organ-saving,
limited/physiological/ operations if
possible.
All these will assure improved patients’
safety, shorter hospitalization and
expenses, lower disability rate and better
QOL.
Keywords:Emergency Surgery,
Abdominal Sepsis, Complicated IntraAbdominal Infections
171.
Management of Abdominal
Compartment Syndrome in Non
traumatic Patients.
Nuhi ARSLANI1*
1
University Clinical Center Maribor, Department
for Abdominal Surgery, University of Maribor,
Faculty of Medicine, Slovenia
organ dysfunction caused by intraabdominal hypertension. Intra-abdominal
pressure is defined as the pressure created
within the abdominal cavity the normal.
IAP for critically ill adults is 5–7mmHg.
Intra-abdominal hypertension is a
sustained or repeated IAP > than 12mmHg
( figure 2).
There are various grades of IAH, Grade 1
IAP 12–15mmHg, Grade 2 IAP 16–
20mmHg, Grade 3 IAP 21–25mmHg and
grade 4 an IAP > 25mmHg.
Patients in the intensive care unit (ICU) are
at risk of developing of intra abdominal
hypertension (IAH) and abdominal
compartment syndrome (ACS).
ACS can be classified as primary or
secondary .
Primary ACS is due to injury or disease in
the abdominopelvic region (eg, abdominal
trauma, hemoperitoneum, pancreatitis);
intervention (surgical or radiologic) of the
primary condition is often needed.
Secondary ACS refers to conditions that do
not originate in the abdomen or pelvis (eg,
fluid resuscitation, sepsis, burns)
ACS can impair the function of nearly
every organ system. Physiologic
consequences include impaired cardiac
function, decreased venous return,
hypoxemia, hypercarbia, renal impairment,
diminished gut perfusion, and elevated
intracranial pressure.
Diagnosis of ACS requires that intraabdominal pressure be measured.
Following surgical decompression, an open
abdomen is maintained using a variety of
temporary abdominal closure techniques .
Keywords:Intra-abdominal pressure, Intraabdominal hypertension, Abdominal
compartment syndrome, Abdominal
perfusion pressure
Abstract
Introduction;Increased intra-abdominal
pressure is called intra-abdominal
hypertension (IAH). Abdominal
compartment syndrome (ACS) refers to
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172.
Acute Mesenteric
Ischemia, Diagnostic and Surgical
Challenges
Rovena BODE1, Etmont ÇELIKU1, Xheladin
DRAÇINI1, Henri KOLANI1, Adrian NELAJ1
1
Department of General Surgery, Mother Theresa
Hospital Tirana
Abstract
In all acute surgical admissions, the
incidence of AMI is estimated at 0.090.2%. Therefore, diligence is always
required because if untreated mortality has
been reported in the range of 50-70%.
Early diagnoses and timely surgical
intervention are the cornerstones of
modern treatment and are essential to
reduce the high mortality of this entity.
Endovascular approaches in parallel with
modern imaging techniques may provide
new options, but what are the outcomes of
surgery in patients with overt peritonitis
signs, where prompt laparotomy is
mandatory? Damage control surgery is an
important option in the AMI patient and
operative management requires adequate
excision of clearly necrotic bowel and a
high index of suspicion of borderline
segments. What about second look
techniques outcomes? Their timing….and
decisions regarding stomas and
anastomosis…What about the open
abdomen techniques indications? What
about our experience, our outcomes?
The aim of this study is to give a glance at
our experience in this high-grade mortality
entity.
A retrospective analysis was performed on
patients who were diagnosed with acute
intestinal ischemia between june 2017 and
july 2018. Patients demographics, clinical
characteristics, risk factors, surgical
procedures and survival were analysed.
Key words: acute mesenteric
ischemia(AMI), damage control
surgery(DCS), endovascular
revascularisation
AJTES Vol.2 Nr.2 Supplement 2
173.
Gastroduodenojejunal
Intussuspection Due to PeutzJeghers Syndrome. A Case Report
Shkelzen OSMANAJ*, Agron DOGJANI. Naim
DIZDARI. Elona MARKECI. Astrit MUSTAFA.
Vidi DEMKO
University Hospital of Trauma, Tirana ALBANIA
Abstract
Peutz–Jeghers syndrome (PJS) is a rare
autosomal dominant disorder occurring in
1 in 150 000 people. It is characterized by
familial mucocutaneous pigmentation
(dark freckles on face, lips, buccal mucosa,
palm and soles)
and hamartomatous polyps in
the gastrointestinal tract.
Gastroduodenojejunal intussusception is
the rarest forms of adult intussusception.
An 27 years- old Albanian male from
Kavaja was admitted to our hospital with
abdominal distension, recurrent abdominal
pain and intermittent non-bilious vomiting
of about 6 months standing. Endoscopy
revealed two huge cauliflower- like polyps
and three small polyps in the stomach, and
the biopsy specimens showed hyperplastic
polyps. Moreover, multiple pigmentation
of the lyps or buccal mucosa and in
perinasal skin. The patient had been mild
anemia due to internal bleeding. In ct
abdominal with contrast was seen
intussusception. We made open surgery to
resolve the case.
Keywords; peutz-jeghers syndrome,
gastro-duodeno-jejunal intussusception,
gastric-outlet obstruction and mucocutaneous pigmentation.
174.
Surgical treatment of a
Ruptured Pancreaticoduodenal
Artery Aneurysm: Case Report
and Review of the Literature
Henri KOLANI1, Ejona CELIKU3, Earta GEGA4,
Etmont CELIKU1,2
1
Surgeon at First Clinic of Surgery- University
Hospital Center “Mother Teresa” Tirana,
ALBANIA
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2
Chief of Surgery Department and Chief Surgeon at
First Clinic of Surgery- University Hospital Center
“Mother Teresa” Tirana, ALBANIA
3
AnatomoPathologist Doctor at University Hospital
Center “Mother Teresa” Tirana, ALBANIA
4
Student of General Medicine at University of
Medicine of Tirana, ALBANIA
Abstract
Introduction: Pancreaticoduodenal artery
(PDA) aneurysm associated with celiac
artery (CA) occlusion or stenosis is
extremely rare and occurs in 2% of all
visceral aneurysms.
Method: We present the case of a 58-yearold female diagnosed with ruptured
pancreaticoduodenal aneurysm. The
bibliography used was taken from
PubMed.
Summary: We report the case of a 58-yearold woman who presented at the Surgical
Emergency Unit with acute abdominal pain
radiating at the back, fatigue, discomfort
with a history of a minor trauma. Physical
examination is relevant for tenderness of
the whole abdomen on palpation. Workup
reveals anemia with Hgb at 8.3 g/dL and
RBC count at 2.8 x 106/mm3. Imaging
studies show retroperitoneal hematoma,
contrast accumulation near the
pancreaticoduodenal arcade but with no
evident relation to the superior mesenteric
artery, peripancreatic, perihepatic and free
peritoneal fluid. The patient was
successfully treated with surgery and was
discharged on the 15th post-operative day.
Conclusion: Rupture of visceral artery
aneurysms, although rare, may be a
relevant differential diagnosis of an acute
abdomen. When the patient comes to the
emergency department with abdominal
pain, a diagnosis of visceral artery
aneurysm rupture should be considered.
175.
Hantavirus Infection
Causative Agent of Acute Renal
Injury
Lutfi ZYLBEARI1, Kastriot HAXHIREXHA1,
Agron DOGJANI2, Sadi BEXHETI1, Ferizate
DIKA-HAXHIREXHA1, Aulona HAXHIREXHA3,
Zamira BEXHETI1, Gazmend ZYLBEARI1
AJTES Vol.2 Nr.2 Supplement 2
1
Faculty of Medical Sciences, University of Tetovo
– Tetovo, R. of Macedonia
2
University Hospital of Trauma, Tirana, Albania
3
University of Medicine, Tirana, Albania
Abstract
Acute kidney injury (AKI) is a rapid
condition occurring within a few hours to a
few days. Early detection of Hantan virus
(HV) induced AKI is the golden standard
for management and treatment of the AKI,
focused on reduction and lowering of the
further kidney injury. Adequate hydration
should begin immediately after diagnosis
of AKI, thus maintaining: haemodynamic
equilibrium of the kidneys, renal perfusion,
correct and equilibrated electrolytes, acidbase equilibrium, overall kidney
homeostasis, proper kidney oxygenation
and prevention of drug induced
nephrotoxicity, and maintenance of renal
function.
Materials and methods: In our scientific
research we report on six patients suffering
from AKI as a consequence of HV
infection, treated in the Department of
Internal Medicine, at the Clinical Hospital
in Tetovo, and the University Nephrology
Clinics in Skopje, during a 5 years period
(2006-2010). The mean ages of the patients
were 35.5 years old (4.6 years) for the 4
male patients, and the 2 female patients
were aged 33 years old ( 2.6 years).
Results: A percutaneous renal biopsy was
performed to all six patients, and
immunofluorescence microscopic
examination afterwards. The results
confirmed the acute interstitial nephritis
diagnosis for four patients, whereas for two
patients the diagnosis of acute proliferative
glomerulonephritis. Luckily the progress
of the disease ended with complete
recovery for all the patients…
Conclusion: We conclude that early
detection of HV infection, full assessment
of the clinical state, early diagnosis of
AKI, immediate onset of treatment (by
following the protocol for AKI treatment)
at the Intensive Care and Reanimation
Unit, remain the keystone for proper and
successful treatment, management, and
prevention of exacerbation of AKI.
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Key words: Hantavirus, Acute Kidney
Injury
176.
Oral and Maxillofacial
Infections as Differential
Diagnosis in Fever of Unknown
Origin.
Ermira MUCO1, Neada HOXHA1, Arta KUSHI1,
Jonida MEHMETI3, Arlind MYFTARI2.
1
The Infectious Disease Service, UHC “Mother
Tereza” Tirana. ALBANIA.
2
Oral and Maxillofacial Surgery. UHC “Mother
Tereza” Tirana. ALBANIA
3
Infectious Disease Service, Hospital of Saranda.
ALBANIA
Abstract
Fever of unknown origin (FUO), refers to a
condition in which the patient has an
elevated fever but despite investigations by
a physician no explanation has been found.
In 1961 Petersdorf and Beeson suggested
the fever of unknown origin criteria: fever
higher than 38.3 °C (101 °F) on several
occasions; persisting without diagnosis for
at least 3 weeks and at least 1 week's
investigation in hospital.
The spectrum of differentials includes
infections, neoplasms, inflammatory
diseases, miscellaneous disorders and
undiagnosed conditions.
In the context of infections, dental disease
is one potential cause of persistent fever.
Therefore, doctors of infectious disease
often require the help of their colleagues of
oral and maxillofacial surgery. Their
intervention and our treatment with the
proper antibiotics bring about the best
solution to the situation. So this
collaboration is a necessity.
Keywords: dental infections, fever of
unknown origin, differential diagnosis
177.
Severe Tricuspid Valve
Endocarditis in a Hemodialysis
Patient. Clinical Presentation and
Outcome.
AJTES Vol.2 Nr.2 Supplement 2
Ermira MUCO1, Neada Hoxha1, Arta KUSHI1,
Jonida MEHMETI1, Vilma CADRI3, Albana
DOKO2
1
Service of Infectious Diseases, University Hospital
Center “Mother Tereza”, Tirana, ALBANIA.
2
Service of Cardiology, University Hospital Center
“Mother Tereza”, Tirana, ALBANIA.
3
Service of Nefrology, University Hospital Center
“Mother Tereza”, Tirana, ALBANIA.
Abstract
Background: Infection is the most
common cause of death in hemodialysis
patients, after cardiovascular disease.
Infective endocarditis is a potentially lethal
complication.
Aim: Our aim was to report clinical and
echocardiographic characteristics,
microbiological profile, management of
hemodialysis patient who presented with
fever of unknown origin and resulted
infective endocarditis.
Results: We present the case of a 38 yearsold woman with 27-days history of high
fever 39°C comes in the emergency of the
Service of Infectious Diseases. She was
with diabet mellitus for 35 years and
hemodialisis patient for three years. She
was blind. Transthoracal and
transesophageal echocardiography
showed one vegetation on the anterior
leaflet of the tricuspid valve, 3.5 cm2.
Blood cultures resulted positive for
candida spp. Chest computed tomography
showed septic pulmonary emboli.
Antibiotic therapy included Vancomycine,
Meropenem, Fluconazol and symptomatic
treatment. After five weeks of antibiotic
therapy, repeat TTE/TEE showed a
resolution of vegetations, 0.2 cm2. The
patient was released
in optimal health condition. The patient is
restarted after a month with high fever.
Transthoracal and transesophageal
echocardiography showed increased
vegetation, 4 cm2 and the repeated
TEEafter a week showed one vegetation, 6
cm2. Because of her health conditions, she
did not undergo a cardiac surgery. The
situation as it came and it became more
difficult. Cardiac and pulmonary problems
were ordered. Anemia became worsening
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and deeper, until after three weeks the sick
person died.
Conclusion: Infective endocarditis is
strongly associated with morbidity and
mortality in hemodialysis patient. If
patients require valve replacement surgery,
mortality is even higher.
Keywords: Infective endocarditis,
hemodialisis patient, blood culture.
178.
Trauma and Management
of Infectious Disease.
Petrit BIBERAJ1*, Shqipe LUTA1, Albana
KRECA1
1
Faculty of Technical Medical Sciences, University
of Elbasan "A. Xhuvani", Elbasan, Albania
Abstract
Accidents and trauma are one of the
world’s mostserious but neglected health
problem. The fast movingtransportation
systems, unprecedented and
unplannedurbanisation and changing social
patterns have contributedto the global
increase in the incidence of trauma to
human body.
Traffic accidents are an endemic disease
which affects mainly the young adults in
the economically productive agegroups
and are the leading cause of death in
persons under 44 years of age. Globally,
26% of all deaths in the agegroup of 15-44
years in 2015 were due to injuries.
Infections in Traumatised Patients
Accidents or violence can result in
penetrating trauma. Contaminated
penetrating foreign bodies introduced at
the time of wounding cause infection,
especially high velocity projectiles, which
result in cavitation. Surgical debridement
reduces potential infection; however,
perioperative antibiotics are usually
indicated owing to studies demonstrating
high rates of sepsis in the pre-antibiotic
era. Open injuries have a potential for
serious bacterial wound infections,
including gas gangrene and tetanus, and
these in turn may lead to long term
disabilities, chronic wound or bone
AJTES Vol.2 Nr.2 Supplement 2
infection, and death. Wound infection is
particularly of concern when injured
patients present late for definitive care or
in disasters where large numbers of injured
survivors exceed available trauma care
capacity. Trauma-associated pathogens
include Gram-positive, Gram-negative and
anaerobic pathogens. Antibiotic resistance
is increasing, and several recent panels
have sought to develop guidelines for
perioperative prevention and empiric
treatment of infection to limit usage and
reduce selective pressure for resistance
The interruption of tissue integrity,
hemorrhage and tissue hypoperfusion,
frequency of invasive procedures, and
impaired host defense mechanisms all have
a major impact on subsequent infection.It
is well known that trauma patients with
hospital-acquired infections (HAIs) are at
increased risk for mortality, have longer
length of stay, and incur higher inpatient
costs.
179.
Cost-effectiveness of
Thyroid Fine Needle Aspiration
Cytology for Diagnosis and
Treatment of Thyroid
Malignant Pathologies in
Pediatric Age
Ilir ALIMEHMETI1, 2, 3*, Myriam HUNINK3, 4
1
Projects and International Affairs Unit, Faculty
of Medicine, University of Medicine, Tirana,
Albania
2
Department of Family and Occupational
Health, Faculty of Medicine, University of
Medicine, Tirana, Albania
3
Department of Epidemiology, Erasmus
University Medical Center, Rotterdam, the
Netherlands
4
Department of Health Policy and Management,
Harvard School of Public Health, Harvard
University, Boston, MA.USA.
Abstract
Background: Thyroid nodules are rare
during pediatric age, affecting 1.7% of
children and adolescents, but the high
malignancy prevalence at presentation has
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
warranted an aggressive clinical approach.
The most frequent surgery technique is
total thyroidectomy, which is followed by
short-term and long-term complications.
Fine needle aspiration (FNA) cytology is
the most accurate tool in the diagnosis of
a thyroid nodule. However, there are
contradictions if it should be used as a
first-line strategy in the pediatric age.
Thus, our aim was to analyze costeffectiveness of surgery, FNA and
observation of thyroid malignant
pathologies in pediatric age.
Material and Methods: A decision model
was created to trade-off between three
different strategies:
- Surgery for all nodules, regardless of
their malignant or benign nature;
- Testing through FNA, and then
perform surgery according to the
FNA result;
- Observation, regardless of their
malignant or benign nature.
Cost-effectiveness was calculated in
terms of costs and quality-adjusted
life years (QALY). All variables were
entered as distributions. Willingness
to pay was set to 50,000$.
Results: In the cost-effectiveness analysis,
surgery was dominated by FNA.
Observation was less effective and cheaper
than FNA, which presented an ICER value
of 46,948.48.
In the 1-way cost-effectiveness
sensitivity analysis for the probability of
malignancy from 0% to 100%, FNA was
always superior to the surgery strategy,
and the threshold of superiority to the
observe strategy was probability of
malignancy = 23.5%. In the probabilistic
sensitivity analysis, FNA resulted
superior to surgery.
Conclusions: FNA is more cost-effective
than the surgery strategy in the diagnosis
and clinical work-up of thyroid nodules in
children.
Keywords: Fine needle aspiration, thyroid
nodule, probability of malignancy, Thyroid
Surgery.
AJTES Vol.2 Nr.2 Supplement 2
180.
Hairy Cell Leukemia After
Sleenectomy with Ascitis In the
Time of The Diagnosis. A Case
Reports.
Eriselda TAULLA¹, Bajram BEGAJ ¹, Ilir KAJO ¹,
Elvina SHABA ¹
¹Department of Internal Medicine, University
Hospital of Trauma, Tirana, ALBANIA.
Abstract
Introduction: Hairy cell leukemia (HCL)
is a unique chronic lymphoproliferative
disorder characterized by cytoplasmic
villous (hairy) projections and diffuse
infiltration of the bone marrow and spleen,
leading to peripheral cytopenia and
splenomegaly.
The aim: How to differentiate a HCL.
HCL is a rare chronic leukemia (B-cell
malignancy). It consistutes2 % of all
leukemias
Case description: A 45-year-old man was
hospitalized with a three months history of
abdominal swelling, dyspnea, weakness,
anorexia, the physical examination showed
cutaneous and conjuctivalpallor,
ecchymosis in the right hipochondria, the
abdomen above thorax level without
collateral circulation and hepatomegaly. In
2011 he had done splenectomy and was
treated with prednisone. (In that time, he
went to the hospital not in Abania with
pancytopenia and massive splenomegaly.)
CBC showed: bicytopenia (anemia and
thrombocytopenia). Serum B12, folates,
A.D. A in serum, 𝛾 interferon,
ceruloplasmin, serum copper, ASMA,
ANA, AMA, CEA, AFP, CA 19-9, LDH,
RCP, total bilirubin 0,7 mg/dl, AST, ALT
and other parameters within the normal
range.total proteins 4,5 g/dl, TP 60%, INR
1.32, sideremi 222.21μg/dl.
The bone marrow biopsy shows:
hypercellularity, reduction of myeloid and
megakariocytar series. IHC: CD20+++,
CD3---, CD5+--, CD8+--, CD15+--,
CD38+--, CD138+--, Glycophorin A++-,
Bcl-2 +++, CD34---, CD117---, MPO---,
CD4---
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Leukocyte Immunophenotyping of
peripheric blood: CD19+83%,
CD20+90%, CD11c+90%, CD25+90%,
FMC7+60%, CD103+90%.
We treat him with Cladribine 0.14mg/kg/d
I.V day1-5. The patient one year after
admission is in remission.
Conclusion: the diagnosis was Hairy Cell
Leukemia
Keyword: Hairy cell leukemia (HCL),
spleenectomy, cytopenia, ascitis…
181.
Dyspepsia in Children
Ferizate DIKA – HAXHIREXHA1, 2, Sevdije
KOXHA1, Ledia KACI1, Aulona HAXHIREXHA2
1
Medical Faculty – Tetove, Macedonia
2
PHO ‘Alba-Med” – Diber, Macedonia
Abstract
Introduction: Dyspepsia is one of the most
common complaint in children.
Disturbances such as upper abdominal pain
and fullness, early satiety, bloating,
paleness, nausea, or vomiting are the
characteristic signs of dyspepsia.
Objectives: the aim of this study is to
show our experience in treating children
with dyspepsia
Methods: in this study are included 58
children aged between for to fourteen years
with signs of dyspepsia. At the admission
laboratory investigation were carried out
for each patient. Additionally, according to
the severity of clinical manifestations,
some diagnostic investigations such as
abdominal ultrasonography, gastroscopy or
microbiological test was performed too.
Results: from 58 children included in this
study 35 of them were females and 23
males. In most of the children
characteristic symptom were epigastric
pain, associated with nausea and vomiting,
while in children with moderate form of
dyspepsia were present signs such as
paleness and bloating. In eight children
with the severe recurrent abdominal pain
gastroscopy is performed but no any sign
of organic disease is registered. In nineteen
children coproculture is performed because
AJTES Vol.2 Nr.2 Supplement 2
of suspicion for intestinal parasits but only
two of them result positive. Fourteen
children with recurrent abdominal pain was
found to be Helicobacter pylori positive.
Children with mild dyspepsia were initially
treated empirically with instructions for
environment improvement and diet
modification, while in those with severe
form empirical treatment associated with
acid reducing drugs sometimes combined
with antibiotics was the treatment of
choice.
Conclusions: dyspepsia is a common
disorder among children of all ages.
Abdominal pain, nausea, vomiting,
bloating and postprandial fullness are
characteristic signs of dyspepsia. Empirical
treatment associated with acid reducing
drugs remains the treatment of choice.
Key words: dyspepsia, recurrent
abdominal pain, children
182.
The characteristics and
clinical outcome of PE in patients
with malignancy.
Dhimitraq ARGJIRI 1, Silvana BALA 1, Fadil
GRADICA 2, Loreta AGOLLI 1, Arjan MEZINI 1,
Viola SELMANI 1, Vasil MIHA 1, Ornela
NUREDINI 1, Jonida TULA 1
1
Pneumology Service, University Hospital “Shefqet
Ndroqi” Tirana, ALBANIA.
2
Thoracic and visceral Surgery Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
Abstract
Introduction: Cancer is a well-known
cause of venous thromboembolism (VTE).
The overall incidence rates of pulmonary
embolism (PE) in cancer patients are
higher than those in patients with other
types of illness and increase rapidly over
time.
Aim: We explored the characteristics and
clinical outcome of PE in patients with
malignancy.
Material and methods: 105 consecutive
PE patients presenting to our tertiary level
care have been separated in two groups:
G1 group of 87 PE patients without
malignancy and G2 group of 18 PE cases
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
with malignancy. Diagnostic tolls: Pretest
PE probability, Wells score, D-Dimmers,
Thoracic CT- scan contrast enhanced.
Variable of interest were; Chemotherapy,
Site of malignancy, Khorana score,
Biomarkers: white cell count > 11.000,
PLT > 350.000, Hb < 10 g%, and
Anticoagulant therapy
Results: of 18 patients enrolled in the
study eleven (110 were male and seven (7)
female. Average age was 63.5± 9.9.
According to the location of malignancy
most of them were lung carcinoma and
metastasis (22.2%), followed by gastrointestinal and urogenitary cancer (16%),
lymph proliferative caners with 11%. Over
fifty percent (55.5%) of patients had
intermediate risk for pulmonary embolism
according to Khorana risk score and 44. %
to high risk. About 1/3 of the patients
(38%) develop PE during chemotherapy
and 62% of patients after chemotherapy. In
56% of patients G1 group the clot was
found in main artery comparing 20.8% in
G2 group (p=0.0206). D-Dimmers in G1
group was significant higher than G2
group (4269.9±230.8 ng/l and 2578.1±
377.2 respectively) p=0.0001
Conclusions: Risk factors for VTE in the
setting of cancer have been well
characterized: Increased age (> 75), solid
tumors, metastasis, and time of cancer
diagnosis, chemotherapy, and
thrombocytopenia. Carefully identify
patients at highest risk of VTE and VTE
prophylaxis. Guidelines and landmark
trials support administration of LMWH in
at risk patients.
Keyword: Low molecular weight heparin,
venous thromb-embolism, pulmonary
embolism
183.
The Relationship Between
Trauma and Tumors
Leart BERDICA1, 2, 3*, Teona BUSHATI1, 2, 3
1
Department of Anatomic Pathology and Forensic
Medicine, Faculty of Medicine, University of
Medicine, Tirana, Albania
AJTES Vol.2 Nr.2 Supplement 2
2 Service of Anatomic Pathology, University
Hospital Centre, “Mather Theresa” Tirana,
Albania
2
Dep. of Pathology of American Hospital of Tirana,
Albania
Abstract
Introduction: Trauma by medical
definition is “an injury to living tissue
caused by an extrinsic agent”.(1)
Generally, we are used to be focused in the
direct damage of the tissues, surgeons are
focused in cleaning the wound to facilitate
tissue repair. But sometimes the process of
healing doesn’t go in the desired direction.
In these cases, the surgeons and
pathologists help each other to find the
reason of the aberrant repair or in
discovering tumors during the medical
exams.
Methods: Pathology results are obtained
from several cases from the Skin, Central
and Peripheral Nervous, Chest and
Thoracic cavity, Abdominal wall and
cavity, Testicles, Bone biopsies.
Results: Patients having history of minor,
moderate or severe trauma had pathologic
exam for different pathology conditions.
There is patient that refer mini trauma with
the comb of skin head which resulted in
hemorrhage and then it was discovered
skin cancer or even Melanoma.
There are patients having cranial trauma
that during a CT scan has been discovered
arterio-venous malformations or various
tumors of the brain or leptomeninges.
Severe trauma of thoracic wall can produce
tumor-like masses in the lung that can be
hard to distinguish from a tumor especially
when there a lot of time passed between
the trauma and diagnostic moment.Trauma
of abdominal cavity may reveal several
tumors of parenchymatic organs or
intestine, or even from the abdominal wall.
There are a number of cases where the
testicular tumors are discovered by trauma
in a football match.
Moderate trauma of the skeleton can
produce pathologic fracture that are hard to
be repaired and the biopsy result is a tumor
or tumor-like condition.
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Conclusions:The “positive” role of trauma
for the patient can be the discovery of a
concomitant disease even tumors. There
some tumors that can be produced by
repeated trauma even when it is of little
intensity.
Keywords; tumor-like masses,
Melanoma,testicular tumors,mini trauma
184.
Basics of Cervical Cytology
&Management of Pap Smear
Result
Teona BUSHATI1, 2, 3 *, Leart BERDICA1, 2, 3
Department of Anatomic Pathology and Forensic
Medicine, Faculty of Medicine, University of
Medicine, Tirana, Albania
2 Service of Anatomic Pathology, University
Hospital Centre, “Mather Theresa” Tirana,
Albania
2
Dep. of Pathology of American Hospital of Tirana,
Albania
1
Abstract
Worldwide, approximately 500,000 new
cases of cervical cancer and 274,000
deaths are attributable to cervical cancer
yearly, making cervical cancer the second
most common cause of death from cancer
in women. Fortunately, the incidence of
cervical cancer has decreased by more than
50% in the past 30+ years, largely due to
the increasing use of cervical cancer
screening with cervical cytology.
The mainstay of cervical cancer screening
for the last 60+ years has been the
Papanicolaou test.
The Papanicolaou test, also known as the
Pap test or the Pap smear, was developed
in the 1940s by Georgios Papanikolaou. It
involves exfoliating cells from the
transformation zone of the cervix to enable
examination of these cells microscopically
for detection of cancerous or precancerous
lesions.
When abnormal cells are detected on the
Pap test, diagnostic testing in the form of
colposcopy is often indicated. This testing
may be followed by diagnosis of dysplasia
via colposcopic biopsies. Subsequent
cervical cancer may be prevented through
AJTES Vol.2 Nr.2 Supplement 2
the diagnosis and treatment of these
cervical cancer precursors. Results from
cervical cytology specimens are reported
according to the 2001 Bethesda System
Classification. Management of abnormal
cytology is done according to 2012
ASCCP Consensus Guidelines.
185.
Pigmentation Disorder and
Dermatology Life Quality
Ardiana SINANI 1, Dorela VASHA 2, Rovena
LICO 3
1
Military Medical Unit at University Hospital of
Trauma, Tirana, Albania
2
Health Inspectorate, Preventive Medicine at the
Ministry of Defense, Tirana, Albania.
3
Speciality Policlinc No 1, Tirana, Albania
Abstract
Introduction: Vitiligo is an acquired
chronic depigmenating disease of the skin.
It causes loss of pigment on effected areas
of the skin or mucosae and is characterised
by milk white, nonscaley with distinct
margins.
Objective: Description of vitiligo.
Different clinical forms, and the most
frequent consequences of the disease in the
social life of the individual.
Results of treatment of simple cases and
complex cases.There is very limited
information available in the textbooks on
vitiligo. This is up-to-date literature
overview of the disease including
definition, classification, aetiology,
histopathology, prognosis, assessment and
treatment There is a current lack of
consensus in the definition and methods of
assessment of this disorder, which makes it
difficult to compare the outcomes of
different studies of the same treatment.
Conclusion: Skin diseases are very
common, affecting over a quarter of the
population. Although usually not lifethreatening, skin diseases have a
significant impact on the quality of life of
patients and cause considerable
psychological distress. Vitiligo, a condition
which results in the loss of pigment from
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the skin and the cosmetic disfigurement of
this seemingly inconsequential skin disease
has a major impact on the quality of life of
patients especially for people with darker
skin. Finally, the aetiology and
pathogenesis of vitiligo remains unclear. It
is still not understood what causes the
destruction of melanocytes.
Keyword: Vitiligo, chronic depigmenating
disease, pernicious anaemia,
those of the therapeutics clinics. The head
of clinics and doctors have a higher level
of burn-out than nurses.
Conclusions: There is a clear need for
adaptation and expansion of a conceptual
framework for a promising approach for
designing interventions to help clinicians
in mitigation, which cause anxiety and
prevent build the flexibility they need to
support themselves in clinical services.
Keyword: fatigue and frustration,
exhaustion, depersonalization…
186.
“BURN-OUT” Syndrome,
in Military Hospital Personnel.
Dorela VASHA 1, Ardiana SINANI 2.
1
Health Inspectorate, Preventive Medicine at the
Ministry of Defense, Tirana, Albania.
2
Military Medical Units at University Hospital of
Trauma, Tirana, Albania.
Abstract
Introduction: “Burn-out” is a phenomenon
characterized by fatigue and frustration,
usually to professionals whose work is
faced with high level of stress that comes
as a result of dedication to a cause or a way
of living that does not match expectations
of the person. Although this appears to be
associated with risk factors derived from
professional environment, this problem can
be present in every person. The aim is to
evaluate the level of “burn-out” in the
military hospital personnel.
Method: This is a cross-sectional study
conducted through the burnout self
administered test to the military medical
personnel. The Maslach Burn-out
Inventory was used as it is the most
commonly used tool to self-assess whether
you might be at risk of burn-out through
three components: exhaustion,
depersonalization and personal
achievement. According to the level of
burn-out it was made a comparison to the
types of clinic (therapeutic, surgical, and
emergency) and to the level of
responsibility.
Results: The study shows that medical
personnel of surgical and emergency
clinics have a higher level of burn-out than
AJTES Vol.2 Nr.2 Supplement 2
187.
Contemporary
Considerations on Pain at
Pediatric Age
Edmond PISTULLI¹, Arian HAMITI¹, A. Nurçe¹,
A. Nake¹, E. Koliçi¹, D. Selmani³, F. Krasniqi²
1
University of Medicin, Tirana, ALBANIA
2
University Hospital Centre, Department of
Neonatology, Pristina-Kosovo
3
University of Medicine Tetovo, MACEDONIA
Abstract
Background: Pain is an important part of
the disease; it’s the first evident symptom.
Recently it is not considered anymore by
the researchers and the doctors as a
symptom, but as a specific disease, defined
as “The Fifth Vital Sign.
Adults are the first persons that benefited
from the recent researches in this direction,
mainly in the last two decades; meanwhile
“uncommonly”, the pain is still untreated
or insufficiently untreated among the
children.
The aim of the study is to recognize the
physiopathological mechanisms behind the
pain and these assessment to pediatric.
Materials and Methods: A 7-months study
from December 1, 2014 to May 31, 2015,
was used to assess the acute pain among
177 children from birth to 13 years old in
Obstetrics and Gynecology Hospital, U H
C, Pediatric Hospital and Outpatient
Services in Tirana.For patients, incapable
to verbalize the pain intensity in a reliable
way (neonates to <4years old), it is used
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the hetero-evaluation. While patients ≥4
years old and < 6 years old are assessed
using the hereto-evaluation and autoevaluation scale according to the Faces
Scale and VAS.
Discussion: According to the study’s
results, the percentage of postoperative
patients with intense pain is 47.62% and
with maximum pain is 52.38%. There are
5.77% non-postoperative patients with
moderate pain, 55.77% with intense pain
and 38.46% with maximum pain.[6][14] In
conclusion, all postoperative patients and
94.23% of non-postoperative children
undergoing painful procedures experienced
intense and maximum pain.
Conclusions: Assessment is the first step
toward the appropriate postoperative and
procedural acute pain management. The
correct usage of assessment scales,
according to a standard protocol ensures to
truthfully measure pain intensity.
Keywords: pain, faces pain scale, pediatric
patients
188.
Comparison of clinical
results between open and
laparoscopic appendectomy in the
treatment of complicated pediatric
appendicitis.
Kenan KARAVDIĆ 1*, Irnis BIŠČO 2
1.
Clinic for Pediatric Surgery, Clinical Center of
University Sarajevo, Bosnia and Herzegovina
2
.Faculty of Medicine, University Sarajevo,
BOSNIA AND HERZEGOVINA
Abstract
Introduction: Approximately 7-10% of
the total population develops appendicitis
during their lifetime, so that
appendectomy is the most often
performed abdominal surgery. For over a
century, the golden standard in the
treatment of patients with complicated
pediatric appendicitis (CPA) was an
open appendectomy. However, today
many polemics among researchers are
guided by whether, in pediatric
AJTES Vol.2 Nr.2 Supplement 2
population, the laparoscopic approach is
superior to an open appendectomy.
Objective: Comparison of the outcome of
treatment of CPA between a group of
patients treated with laparoscopic
appendectomy and a group of patients
treated with open appendectomy.
Methodology: A retrospective, clinical,
comparative study was carried out
covering 293 pediatric patients with an
appendectomy in the period from
November 2015 to April 2018 at the
Clinical Center of the University of
Sarajevo. Patients were divided according
to the treatment method in a group of
patients with open appendectomy and a
group of patients treated by laparoscopic
and compared with demographic and
clinical data and outcomes of treatment.
Results: The average time of anesthesia
was 10 minutes longer in the group of
patients who received laparoscopic
appendectomy compared to the open
appendectomy (p = 0.0086). The average
length of hospitalization was 2 days
shorter in the laparoscopic group of
patients (p <0.0001). Laparoscopically
operated patients had a shorter
application of parenteral analgesia
compared to the patients with the open
appendectomy (p = 0.0061). In patients
with laparoscopic appendectomy the
period of drainage was shorter (p
<0.0001). No statistically significant
difference was found by comparing the
incidence of minor and major
complications between the groups.
Conclusion: Laparoscopic appendectomy
proved to be an effective method and is
increasingly represented in the treatment
of CPA. Children undergoing
laparoscopic treatment are significantly
shorter in the hospital, have a lower level
of postoperative pain, a shorter period of
drainage, however, longer application of
anesthesia compared to children who
have been operated with an open
approach.
Keywords: Appendectomy, complicated,
pediatric, laparoscopic, treatment
outcome.
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189.
Traumatic Abdominal
Trauma, Solid Organ Injury,
Conservative vs Surgical
Treatment
Baton KELMENDI1*, Nexhmi HYSENI1, Dafina
MATOSHI1, Hysni JASHARI1, Gani ÇEKU1,
Alban RUSHITI1
1
Department of Pediatric Surgery, University
Clinical Center of Kosovo, Pristine, KOSOVO.
Abstract
Introduction: Abdominal trauma has
always been one of the major challenges
for pediatric surgeon. Historically the
presence of free lymph in the
intraperitoneal area has been an indication
of aggressive surgical treatment.
The first publication on conservative
treatment for patients thought to have a
limb injury was made by Simpson in 1968.
Initially, the initial treatment was initiated
by Warnsborough, and this treatment was
in 12 patients treated during 1956-1965, it
should be noted that this has occurred in
the period when ECHO or CT diagnosis
was missing.
Material and methods: In the period 2017
to 2018 in our clinic we treated 14 patients
with abdominal injuries. The study
included lysis and heparitis injuries.
Of the 14 injured 4 were subjected to
surgery because of the injury, while 10
were treated conservatively.
Conclusion: Based on the series of cases
that have been treated in our Clinic, we
conclude that conservative treatment is the
selected method of hemodynamically
stable patients. The imperative is dynamic
tracking and 24 hour service.
190.
Assesment on Blunt
Abdominal Trauma in Children
Agron DOGJANI MD, MSc, PhD, FACS1*, Rifat
LATIFI MD, FACS, FICS2, Kastriot
HAXHIREXHA MD, PhD3, Hysni BENDO4.
1
Associate Professor of Surgery, University
Hospital of Trauma, Lecturer at University
Medical of Tirana, ALBANIA
2
Professor of Surgery, Director, Department of
Surgery, Program Director, Surgical Critical Care
AJTES Vol.2 Nr.2 Supplement 2
Fellowship Chief of General Surgery, Westchester
Medical Center, NY. USA
3
Lecturer at State University of Tetovo, General
Surgeon at Clinical Hospital of Tetovo,
MACEDONIA.
4
University Medical of Tirana, ALBANIA
Abstract
Introduction: Trauma is the leading cause
of morbidity and mortality in the pediatrics
age.
Abdominal trauma ranks third for
frequency of trauma injuries in
children.
The purpose of our study is
recognition and description of the
mechanisms that cause Blunt
Abdominal Trauma in pediatrics age,
identify the signs and symptoms that
accompany it.
Material and methods: The study has
retrospectively registered and includes all
patients with Blunt Abdominal Trauma in
pediatrics age who presented to emergency
department at the University Hospital of
Trauma in Tirana, Albania by 01/12/2017 24/06/2018. The sample in the study was
taken randomly without any restriction
study. The Injury Severity Score, Revised
Trauma Score … were used as the
important points for evaluate gravity of
injuries, and mode of treatment…
The data is introduced in absolute and
percentage values, Kendal's tau b
correlation coefficient and the regression
analysis is used to analyze and to see the
connections between the dependent versus
independent variable…The type of study is
control cases, with two components;
descriptive and analytical…
Results: In period under study are
presented about 25200 of these patients
were hospitalized 6.68% cases, and in the
most of the causes was motor vehicle
accidents (35.4%) and the Abdominal
Trauma engaged in 25.8% of cases, in the
pediatric age was 13.7% . We are found
connection between the injury severity
score and complications rate (r = 0.254, n
= 49, p <0.001), and injury severity score
with length of stay in hospital (r = 0279, n
= 49, p <0.001)…
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Conclusions: Blunt Abdominal Trauma in
pediatrics age is a serious threat to the
health of the children. Their treatment
should be carried out not only tertiary
trauma center but in every regional
hospital…The trauma score is very
valuable in the determination the gravity of
the injury, mode of treatment and as a
predictive tool in trauma outcomes.
Keyword: Blunt Abdominal Trauma
pediatrics, abdominal injuries, trauma
score, trauma assessment…
191.
Preventable and Accidental
Trauma in Children
Hysni JASHARI1*, Nexhmi HYSENI1, Salih
GRAJCEVCI1, Baton KELMENDI1, Murat
BERISHA1, Gani ÇEKU1
Department of Pediatric Surgery, Hospital and
Clinical University Service of Pristina, KOSOVO
Abstract
Introduction: traumatic event happened is
a dangerous, violent and intimidating
which poses a threat to the life of the child
or the child's physical integrity.
Experiencing a traumatic event that
threatens the child's life or physical safety
is traumatic for family members too.
Despite the precautionary measures for
child safety, dangerous events occur in
continuity. This risk can occur outside the
family, such as natural disasters, traffic
accidents, violence in communities or
trauma that comes as a result of domestic
violence, sexual or physical violence and
sudden death.
Material and Methods: During our period
2015-2018, our patients are treated with
traumatic injuries of different abdominal
and urological conditions, excluding those
of the locomotor system and neurosurgery
injuries, which are treated in the
Orthopedics Clinic, respectively
Neurosurgery Clinic.
Conclusion: Traumatic experiences put in
motion a cascade of changes in the lives of
children, experiences that can be
challenging and difficult. Systematic
AJTES Vol.2 Nr.2 Supplement 2
access to injured children and adequate
medical care saves the child's life.
Prevention of injuries and adequate
measures to protect children are essential
to reduce the number of injured children.
Preventive injuries have a great financial,
emotional, and social impact on sore
children and their families as well as in
society as a whole.
192.
The Role of Imaging in the
Pediatric Spleen Trauma
Marjeta TANKA1*, Sokol BUBA1, Viola
SHUTERIQI1
1
University Hospital Center “Mother Teresa”,
Tirana, ALBANIA
Abstract
The spleen is the most frequently injured
internal organ after blunt or penetrating
trauma in the abdomen. The clinical
evaluation of the children with blunt
abdominal injury presents a really difficult
and challenging task, therefore imaging
plays an essential role in the diagnosing
and follow up of these patients.
Ultrasonography plays an important
diagnosing role especially on the
hemodynamically unstable patients
because it can be performed at the bedside,
it is fast and noninvasive procedure. It can
also help us stage the lesion, determine
whether laceration or hematoma is present,
determine the presence of free fluid in the
abdomen, provide information of possible
simultaneous damage of other abdominal
organs, also Doppler US and contrastenhanced Us are useful to evaluate splenic
vascularisation. However US has its
limitations especially in providing
information of the injury in the pelvic or
lumbar spine. Therefore the gold standard
in the diagnose and evaluation of
hemodynamically stable patients with
abdominal trauma is contrast-inhanced CT.
It identifies and quantifies the injury of the
visceras, the presence of intra-peritoneal
and extraperitoneal fluid and blood caused
by active hemorrhage, shows possible bone
injury to the ribs and spine. Nowadays the
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most optimal treatment of the children with
splenic injury is non operative, due to the
ability of this organ to stop bleeding
spontaneously. This phenomenon happens
because of some unique pediatric
characteristics: children have smaller blood
vessels with enhanced vasocontrictive
response, thicker splenic capsule, and
higher proportion of myoepithelial cells.
Therefore non operative treatment and
regular ultrasound follow up is the first
line treatment of the hemodinamically
stable pediatric patients after splenic
trauma.
193.
Intercourse between
Trauma and Acute Scrotum
(Torsion of the Test, Twist of the
Epididymal Appendix)
Saimir HETA1
1
Department of Pediatric Surgery, University
Hospital Center “Mother Teresa”, Tirana,
ALBANIA
pediatric age. This element helps to
diagnose as soon as possible the emerging
clinic. As a surgical emergency
intervention, torsion of the test depends
greatly on the duration of torsion, as
success in testicular life depends on the
sooner surgical intervention. From the
daily clinic, it is noticed that in every case
presented - pediatric patient - diagnosed
with torsion test, always in the clinical
history of the patient there is a relationship
that the patient refers to with the presence
of an earlier episode of testicular trauma,
despite the fact that the literature is not that
it supports too much logically. For clinical
significance, it is worth mentioning the
timely approach that clinicians need to
diagnose and treat acute scrotum.
Keywords: Acute scrotum, pain, trauma,
clinical diagnosis
194.
Pediatric Trauma, Triage
of Pediatric Patients in Albania
Marinela KUMARAKU1
Pediatric Service, University Hospital Center
“Mother Teresa” Tirana, ALBANIA
1
Abstract
Acute scrotum pain, accompanied by
swelling, are two clinical elements
indicating the clinical presence of torsion
of the test. The onset of the final diagnosis
is performed after receiving the clinical
history, clinical examination, analysis
(complete urine, imaging), and differential
diagnosis; which in this case occurs
between the conditions: torsion of
testicular appendicitis, epididymitis,
trauma, hernias, hydrocele, varicocele of
the scarring of Schönlein-Henoch. These
clinical conditions do not require any
further surgical intervention, as opposed to
test torsion. In the differential diagnosis,
the pediatric age, the pain and the
explanation of episodes and the gravity of
the pain, referred by the patient, and
reconfirmed by the parents, help greatly.
Pain as a subjective element can even be
minimized by the child. The above
mentioned clinical conditions can be
classified in the age group when they
appear: prenatal, pre-puberty or postAJTES Vol.2 Nr.2 Supplement 2
Abstract
Background: Injury is the leading cause of
death among children older than 1 year.
Each year, approximately 20,000 children
and teenagers die as a result of injury. An
estimated 50,000 children acquire
permanent disabilities each year, most of
which are the result of closed head
injuries.Children present a unique
challenge in trauma care because they are
so different from adults - anatomically,
developmentally, physiologically and
emotionally.
Matherial and Methods: A study
concluded that the risk of death for injured
children is lower when care is provided in
pediatric trauma centers rather than in nonpediatric trauma centers. Emergency
medical technicians must be trained in
rapid pediatric cardiorespiratory
assessment, prompt establishment of
effective ventilation (airway), oxygenation
(breathing) and perfusion (circulation) as
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Abstracts
well as in stabilization and transport of
injured or ill children to a tertiary care
facility. EMTs are the first medical contact
(first responder) that children have
following an injury.
Conclusions: Triage is the process of rapid
assessment of a patient with a view to
define urgency of care & priorities in
treatment. Triage is the first step in the
management of a sick child admitted to a
hospital. Caring for pediatric patients with
trauma is a complex and integrated process
that requires knowledge of the special
considerations of pediatric trauma patients
and understanding of the pathophysiology
and special requirements of the pediatric
population. Approach the treatment of the
injured child with a rational and
meticulous plan of action that not only
leads to expeditious diagnosis and
therapeutic intervention but also provides
efficient and effective care for the patient.
Keywords: Pediatric trauma, injury,
children, triage, emergency.
195.
Emergency Surgery –
Present and Future.
Boris E. SAKAKUSHEV1
Medical University Plovdiv Chair of Propaedeutic
of Surgical Diseases, First Clinic of General
Surgery University Hospital St George Plovdiv,
Plovdiv, BULGARIA
Abstract
This is an overview of Emergency Surgery
concerning its content, understanding,
mission, faith, suffering, challenge and
satisfaction from emergency surgeons’
point of view.
Traumatism is a leading global lethal factor
and emergency surgery compared to
planned one generates 10 to 25 % more
morbidity and mortality.
Terminology, definition and fundamental
contribution of Emergency Surgery in
terms of knowledge and practical
guidelines to all key components of
assessment, investigation, resuscitation and
AJTES Vol.2 Nr.2 Supplement 2
surgical treatment of emergency patients
are discussed.
Current tendencies of Emergency Surgery
development concerning policies, social
impact, resources, management, research
and education are presented.
Future strategies for optimization of
ongoing evolution in Emergency Surgery
and patient care are envisaged.
Keywords; Emergency Surgery, morbidity
and mortality, Trauma injuries…
196.
Higher Number of
Colorectal Cancer Patients in our
Emergency Surgical Units. Why?
Arvin DIBRA 1
1
Department of Surgery, Faculty of Medicine,
University of Medicine, Tirana, ALBANIA
Abstract
Colorectal cancer is the third most
common type of cancer among men and
the second among women. The disease
shows a good prognosis when diagnosed in
the early stages, where mortality is
described as overall 8.5%. But mortality
and morbidity are lower in elective
operated patients, but there is a significant
increase in patients operated in emergency,
as well as a reduction in 5-year survival
rates.
The most common clinical presentation to
the emergency units is obstruction,
followed by bowel perforation. Different
international studies demonstrated that
around 10 to 19% of patients affected by
colorectal cancer will present obstruction
during the natural course of the disease.
The emergency treatment is also a risk
factor for a worse prognosis, with higher
mortality in the short postoperative period.
The difference between the two different
ways of treatment consists in 15 to 30% in
emergency compared to elective patients
where from 1% to 5% is found.
This not only because the patients’
deterioration of the clinical status due to
the obstructive emergency condition, but
also by the advanced stage of the tumor
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found in some cases. Perforation can be the
reason to emergency treatment in 3% to
8% and presents greater postoperative
morbidity and mortality than colonic
obstruction but seems that survival rates
are similar in both situations.
This article aims to discuss our institution
experience and tries to find reasons for the
increasing number of colon cancer patients
surgically treated in emergency regime.
Keywords: colorectal cancer, emergency
surgery
197.
Emergency for
Complicated Gastrointestinal
Cancers
Boris E. SAKAKUSHEV1
1
Medical University Plovdiv Chair of Propaedeutic
of Surgical Diseases, First Clinic of General
Surgery University Hospital St George Plovdiv,
Plovdiv, BULGARIA
Abstract
Gastrointestinal cancer complications
include perforation, bleeding or obstruction
requiring emergency surgery.
Adenocarcinoma of the stomach rarely is
presented in emergency setting, because of
early forthcoming local and systemic signs.
GastrointestinalStromal Tumors are 4760% of all Gastrointestinal tumors is
mainly presented by upper GI bleeding ashematemesisormelena /40-65%
ofpatients/duetoanulceractionofgastricmuc
osaoverlyingthetumor. In
patientswithadvanceddisease, ontyrosinekinaseinhibitortherapystomach GIST
maydeveloptumorrelatedintraluminalorintr
aperitoneal, hemorrhage, rupture,
fistulaorobstructionrequiringemergentsurge
ry. Completeresection (R0)
isperformed,avoidingtumorruptureor
wedgeresectionisadequate,
iftechnicallypossible.Largetumorsnecessita
tesubtotalortotalgastrectomy.
Radicalgastrectomyisnotrequired,
onlycompletetumorresection,
withoutlymhadenectomyand 1 – 2 cm
freeoftumormargin is needed.
AJTES Vol.2 Nr.2 Supplement 2
Almost 1/3 of all CRC cases are
complicated, requiring emergency
treatmentforbowel obstruction, perforation
or bleeding, resulting in considerable
morbidity and mortality. We are often
forced to perform two or even three stage
operations. The emergency complicated
left colon cancer often required the
Hartmann’s procedure, still considered as
the gold standard in patients with severe
performance status. Recently laparoscopic
techniques, as safe and effective alternative
to the conventional Hartmann’s procedure
are more preferred, mainly due to the
better outcomes.
Keywords: Gastrointestinal Stromal
Tumors, Neuroendocrine, Colorectal
Cancer…
198.
Acute Pancreatitis: New
Guidelines of the Management
Enver FEKAJ1*, Rifat BAJRAMI1, Vesel
SKENDERI1, Skender ZATRIQI1, Afrim TAHIRI1,
Bedri BRAHA1, Preveza ABRASHI1
1
Department of Abdominal Surgery, University
Clinical Centre of Kosovo, Pristine, KOSOVO
Abstract
Recently, the original Atlanta classification
of 1992 was revised and updated by the
Working Group using a web-based
consultative process involving
international pancreatic societies. This new
classification addresses the diagnosis,
types of acute pancreatitis (AP), severity,
and definition of pancreatic and peri
pancreatic collections.
The diagnosis of acute pancreatitis
involves a combination of symptoms,
physical examination, and focused
laboratory values. There are two different
types: Interstitial edematous pancreatitis,
and necrotizing pancreatitis. The diagnosis
of infection is based on: ongoing signs of
sepsis, CT findings of extraluminal gas
within the areas of necrosis in the
pancreatic and/or peripancreatic tissue, and
percutaneous fine-needle aspiration. This
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new classification defines 3 degree of
severity: Mild acute pancreatitis,
moderately severe, and severe acute
pancreatitis. There are 2 phases of acute
pancreatitis: early phase, and latephase.
The local complications are classified as:
acute peripancreatic fluid collections,
pseudo cysts, acute necrotic collections,
and walled-off necrosis.
In patients with mild biliary AP, a
cholecystectomy should be performed
before discharge to prevent a recurrence of
AP. In those with necrotizing biliary AP, a
cholecystectomy is to be deferred until
active inflammation subsides and fluid
collections resolve or stabilize. In stable
patients with infected necrosis, surgical,
radiologic, and/or endoscopic drainage
should be delayed preferably for more than
4 weeks to allow liquefactions of the
contents and the development of a fibrous
wall around the necrosis (walled-off
necrosis). In symptomatic patients with
infected necrosis, minimally invasive
methods of necrosectomy are preferred to
open necrosectomy.
Key words: acute pancreatitis, pancreatic
necrosis, pancreatitis treatment
199.
Primary Anastomosis
Versus Hartmann’s Operation in
Emergency Surgery for Acute
Mechanical İntestinal Obstruction
due to Left-Sided Colorectal
Cancer
Ozgur EKINCI1, Aman GAPBAROV1, Cem Ilgın
EROL1, Damla BEYAZADAM1, Tunc EREN1,
Orhan ALIMOGLU1
1
Istanbul Medeniyet University School of Medicine,
Goztepe Training and Research Hospital,
Department of General Surgery İstanbul, TURKEY.
Abstract
Introduction: In emergency surgical cases
of acute mechanical intestinal obstruction
(AMIO) due to left-sided colorectal cancer
(CRC), Hartmann’s operation or primary
anastomosis are alternative surgical
methods. In this study, our aim was to
AJTES Vol.2 Nr.2 Supplement 2
compare the clinicopathologic results and
complication rates between Hartmann’s
operation and primary anastomosis.
Methods: Emergency surgical operations
which were performed for AMIO between
January 2011 and January 2018 were
retrospectively analyzed. Following the
exclusion of obstructive pathologies due to
small intestinal cancer, right colon cancer
and adhesions, left-sided CRC cases were
included in the study. Demographics,
operative indications, postoperative
complications, and the time period
between the primary operation to
colostomy closure were evaluated,
compared and statistically analyzed. A p
value less than 0.05 was accepted as
statistically significant.
Results: Among the 68 patients included
in the study, 48 (70%) were men, and 20
(30%) were women. Hartmann’s operation
was performed to 50 (73.5%) patients
(Group H), whereas primary anastomosis
was carried out in 18 (26.5%) patients
(Group P). Group H consisted of 37 (74%)
men, and 13 (26%) women with a mean
age of 63.8 (range35-89), whereas Group P
consisted of 9 (50%) men, 9 (50%) women
with a mean age of 64.67 (range: 43-82).
The most common complications in the
first 6 months in Group H were surgical
site infections (SSIs) (n=12.24%),
followed by small intestinal fistulas
(n=3.6%), evisceration (n=3.6%),
colostomy revision (n=2, 4%), and
eventration (n=1.2%). In Group P, an end
colostomy was created in 3 (15.7%)
patients due to anastomotic leakage, 2
(10.5%) patients developed SSI, and 1
(5.2%) patient underwent surgical drainage
due to intraabdominal abscess formation.
There were no statistically significant
difference between the two groups
regarding complication rates in the first 6
months. Mean hospital stay was 10.22
(range: 1-65) days in Group H, whereas
this duration was 12.94 (range: 3-61) days
in Group P revealing no significant
difference. Mortality occured in 6 (31.5%)
patients of Group P. Among the 4 (66%)
mortalities which occured in the first
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month, 2 (33%) were due to anastomotic
leakage and the other 2 (33%) were due to
non-surgical reasons. The remaining 2
(33%) mortalities took place in the first
year grading (pN). There were no
significant differences with regard to T
stages. When tumor localizations were
analyzed, tumors were significantly more
commonly located in the descending colon
in Group P, and in the sigmoid colon in
Group H.
Conslusions: There were no statistically
significant differences between the use of
either Hartmann’s operation, or primary
anastomosis with regard to SSIs, other
postoperative complications, or mortality
rates. Therefore, given the advantage of
avoiding the need for a second operation,
primary anastomosis may be preferred to
Hartmann’s operation in cases of AMIO
due to left-sided CRC.
Keywords: Hartmann’s operation,
colorectal cancer, colostomy revision,
primary anastomosis
200.
Evaluation of the BISAP
Score in Assessing Mortality and
Intermediate Markers of Severity
in Acute Pancreatitis
Alma LLUKACAJ1, Etmond ÇELIKU1, Xheladin
DRAÇINI1, Majlinda NAÇO1
1
Department of Surgery, Faculty of Medicine,
University of Medicine, Tirana, ALBANIA
Abstract
This study aims to prospectively evaluate
the ability of the bedside index for severity
in acute pancreatitis (BISAP) score to
predict mortality as well as intermediate
markers of severity in our hospital.
Materials and Methods: The BISAP score
was evaluated among 112 consecutive
cases of acute pancreatitis admitted to our
clinic between January 2011 and
December 2014. BISAP scores were
calculated on all cases using data within 24
h of presentation. The ability of the BISAP
score to predict mortality was evaluated
using trend and discrimination analysis.
AJTES Vol.2 Nr.2 Supplement 2
The optimal cutoff score for mortality from
the receiver operating curve was used to
evaluate the development of organ failure,
persistent organ failure, and pancreatic
necrosis.
Results: Among 112 cases, there were 22
(19.6 %) deaths. There was a statistically
significant trend for increasing mortality (
p < 0.0001) with increasing BISAP score.
The area under the receiver operating
curve for mortality by BISAP score in the
prospective cohort was 0.82 (95 %
confidence interval: 0.70, 0.95), which was
similar to that of the previously published
validation cohort. A BISAP score ≥3 was
associated with an increased risk of
developing organ failure (odds ratio = 7.4,
95 % confidence interval: 2.8, 19.5),
persistent organ failure (odds ratio = 12.7,
95 % confidence interval: 4.7, 33.9), and
pancreatic necrosis (odds ratio = 3.8, 95 %
confidence interval: 1.8, 8.5).
Conclusions: The BISAP score represents
a simple way to identify patients at risk of
increased mortality and the development of
intermediate markers of severity within 24
h of presentation. This risk stratifi cation
capability can be utilized to improve
clinical care and facilitate enrollment in
clinical trials.
Keywords: acute pancreatitis, BISAP
score, mortality, evaluation
201.
BURNS: A Very
Complicated “Simple” Trauma
John E. FRANCIS1
1
Lafayette Surgical Clinic, Chief of Surgery,
Director of Trauma, Lafayette
Abstract
Thermal injuries of all types - hot, cold,
electrical, radiation - irrevocably destroy
tissue to some degree. Timing and
treatment of these injuries is critical to the
life-long complications related to this
trauma. We will discuss current therapies,
the pros and cons of treatment and timing
of treatment, as well as ongoing therapies
to reverse the effect of this trauma on burn
survivors.
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Thermal injuries cover a wide-range of
presentations - from the very simple to
extremely complex. Having a good
understanding of the pathophysiology of
burns if crucial to making good decisions
in the initial treatment of burns, and for
guiding long-term therapy to decrease the
effect of complications associated with
burns. We will discuss the current basic
understanding of burn physiology and how
this relates to current treatment
recommendations.
202.
Advantage of Early
Tangential Necrectomy in
Extensive Pediatric Burns
Kenan KARAVDIĆ1
Clinic for Pediatric Surgery, Clinic Center of
University, Sarajevo BOSNIA AND
HERZEGOVINA
1
Abstract
Introduction: The most common causes of
pediatric burns are fire, hot water,
flammable liquids, gases. More than 2
million inhabitans every year in United
States need help because burns. The burn
wound is the source of all ill effects, local
and systemic. Surgical treatment of
extensive burns involves removal of
necrosis and its transformation into the
uncovered, uncontaminated surgical
wound and covering the region with some
of the grafts. This eliminates necrotic
lactate lactose, improves collagen
synthesis, reduces the activity of
inflammatory mediators and their
contribution to microcirculation and blood
vessel permeability, reduces protein loss,
and reduces the risk of dysthymia.
Aims of study: Determine the optimum
time of operative intervention of
extensively acquired pediatric patients.
Determine efficacy of early tangential
necrectomy in the treatment of extensive
burns in children by comparing clinical
parameters of patients treated with this
method and patients treated with delayed
tangential necrectomy or conservative
(control group) method.
AJTES Vol.2 Nr.2 Supplement 2
Material and methods: We treated 60
patients in period of 10 years. Examined
group: 30 children of both sexes with
extensive burns treated with surgical, early
tangential necrotomy method, ages 6 to 14
years. Control group: 30 children of both
half ages 6 months to 14 years, with
extensive burns treated with a conservative
or surgical method of delayed tangential
necrectomy. In both groups we followed
the next clinical parameters: body
temperature, body weight, diuresis, number
of days in hospital, laboratory parameters(
biochemical and microbiological).
Results: The results showed that the mean
values of the control group temperature (X
+ SEM) were significantly greater than the
mean of the examined group (p <0.001),
significantly lower values of serum
proteins in the control group compared to
the examined group (p <0.001). The result
showed significantly lower values of
hematocrit in the control group compare to
the examined group (p = 0.002), serum
hemoglobin mean values (X + SEM) were
significantly lower in control compared to
the study group (p <0.001). The results
show that the median values (X + SEM) of
hospitalization length are significantly
higher in the control group compared to the
examined group (p = 0.003). The results
showed a significantly higher incidence of
burn wound infection in control compared
to the examined group (p = 0.007)and
significant association between the
duration of hospitalization and the number
of isolated bacteria in the burns (p =
0.002).
Conclusions:
-The method of early tangential
necrectomy of extensively pediatric burn
significantly have en effect on morbidity
and mortality (improves the general
condition of a patient, improves clinical
and laboratory parameters, reduces the
chance of early infection, reduces the
possibility of causing a cause, reduces the
length of hospitalization).
-The most optimal time to perform the
early tangential necrotomy is the period
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between the 4th and 6th days after the
injury.
-For extensively burned children over 30%
of the total body surface, early tangential
necrectomy should be applied on the
surface of about 20% of the total body
surface area as prevention of blood loss
due to necrectomy and autotransplantation.
-For extensively fed children over 40% of
the total body surface, taking
homotransplantation from parents or close
relatives reduces morbidity and mortality.
Key words: pediatric, burn, early
tangential necrectomy
203.
Reverse Sural Island Flap
for Reconstruction of Defects of
the Lower Third of the Leg and
Foot
Sokol ISARAJ1
Service of Burns and Plastic Surgery, University
Hospital Center “Mother Theresa” of Tirana,
Albania
1
Abstract
Background: Defects of the lower third of
the leg and foot pose a challenge to the
surgical team. Introduction of
microsurgery changed the approach to
defects formerly considered even
inoperable, but under conditions when
expertise is missing and the possibility of
free flaps is not an option, surgeons have
to rely on regional solutions for each case.
Aim: This article aims to evaluate the
efficacy of the reverse sural island flap for
reconstruction of defects of the lower third
of the leg and foot and to describe our
experience.
Materials and Methods: In a seven years
period of time (2011-2018) 15 cases were
treated with a reverse sural island flap for
defects located on the lower third of the leg
and foot. Flap dimension varied from
7X4cm to 15X12cm, length of the pedicle
from 6 to 16 cm, two of the flaps were very
close to the distal popliteal crease. In all of
the cases donor area of the flap needed to
be skin grafted.
AJTES Vol.2 Nr.2 Supplement 2
Results: All the cases, except one were
acute trauma cases. The remaining one was
a chronic wound after a burn. In one of the
cases the flap was delayed. In three of
them flap was used to cover defects of the
dorsum of the foot.
Conclusion: Reverse sural island flap is, as
a conclusion, a very useful tool for the
reconstruction of small to moderate defects
of the lower leg and foot, easy to be raised,
with no special needs for complicated
vascular preoperative workup, and with a
very low rate of failure and complications
in carefully selected patients. We have
found the reverse sural flap a consistent
and reliable solution for most of cases with
a few complications and ease of execution.
Keywords: reverse sural island flap,
reconstruction, defects, efficacy
204.
Epidemiology of Burned
Hand in Albania 2012-2016
Gentian ZIKAJ1*, Gjergji BELBA1, Gezim
XHEPA1, Nardi KOLA1, Sokol ISARAJ1
1
Burns and Plastic Surgery Service, University
Hospital Center “Mother Teresa” Tirana, Albania
Abstract
Introduction: Burns are a major cause of
injury worldwide with a high incidence on
the developing country.
Aim: To give an overview of
epidemiologic features and the frequency
of unwanted outcome in post burning
phase.
Material and methods: In this prospective
study were included all patients who had
combustion of the hands solely or hands
accompanied with burns to other areas of
the body, treated and followed up at the
Burns and Plastic Service” clinic of the
University Hospital Center “Mother
Teresa” during the years 2011-2016.
Results: Of the 333 included burn
patients, 64% were males. The median age
of women is 21.8 years, of
men is 27.5 years and the
median age total patients’ population is
25.9 years. About half of patients belong to
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the age group 20-60 years (49.5%) and
only 10.2% belong to the age
above 60 years. In most of the
cases (73.6%), the burn of hands is
associated with burn of the other
anatomical region, mostly forearm.
Conclusion: The surgical treatment is used
for less 30% than of patients.
The undesirable results of the burn
of hands are presented in the 33% of the
patients. The contractures were the
main unfavorable outcome of the burned
hand.
Keywords: hand burn, epidemiology,
treatment outcome
Modern Approaches in the
205.
Treatment of Patients with
Chronic wounds at the General
Hospital DR. JOŽE POTRČ Ptuj,
Slovenia
Skender VELIU1, Jasmina KRÖPFL2, Dominika
VRBNJAK3
1
Surgeon, Surgical ward, General Hospital dr.
JožePotrč Ptuj, Potrčevacesta 23, 2250 Ptuj,
Slovenia
2
Nurse for controlling hospital infection, General
Hospital dr. JožePotrč Ptuj, Potrčevacesta 23,
2250 Ptuj, Slovenia
3
University of Maribor Faculty of Health Sciences,
Žitnaulica 15, 2000 Maribor, Slovenia
Abstract
Introduction: Chronic wounds represent
an enormous health, social and economic
burden in modern society. With the
increasing incidence of diabetes and
obesity as well as the ageing of the
population, we correspondingly expect a
rise in the incidence of chronic wounds.
The latter will reflect in an even heavier
burden for individuals, their families and
the society. At the GH dr. JožePotrč Ptuj
we devote a lot of time todealing with this
issue, because we are aware of the impact
that chronic wounds have on the quality of
life of affected patients.
We have been taking care of patients with
chronic wounds for a number of years in
the ambulatory and hospital setting.
In thisarticle we present our organizational
model in the treatment of patients with
AJTES Vol.2 Nr.2 Supplement 2
chronic wounds at General Hospital dr.
JožePotrč Ptuj.
We present the modern approaches in the
treatment of chronic wounds at our
hospital and our results in the treatment of
chronic wounds supported with clinical
cases.
The key to successful management of
patients with chronic wounds
areprofessional competence, team work
and an individual and holisticapproach to
each patient.
Keywords: Chronic wounds, clinic for the
treatment of chronic wounds, modern
approaches in the treatment of patients,
individualand holistic approach to each
patient
206.
Reconstruction of Post
Trauma Defects in Upper Limbs
Using Perforator and Pedicled
Flaps.
Nardi KOLA1*, Albana ALEKSI1, Sokol ISARAJ1
Service of Burns and Plastic Surgery, University
Hospital Center “Mother Theresa” of Tirana,
Albania
1
Abstract
Introductuion; During our everyday
practice we face a lot of post trauma or
post resection defects and open wounds
with bone exposure etc, in upper limbs that
are not possible treated with skin grafts or
random flaps. Pedicle and perforator flaps
are seen in last year’s in our service as a
good choice in some specific cases in order
to restore length, sensitivity and function
of the limb.
To be successful in such complicated
procedures we should be aware of;
1-Careful planning of the most effective
flap in the area involved
2-Careful selection of the patient [age,
diseases, drug and alcohol abuse]
3-When is possible we can identify the
perforator vessel or the artery of the
supposed pedicle using a hand Doppler
4-In some cases a CT-Angiogram is
important
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5-The consent of the patient is extremely
important
Classification
Flaps are classified according to:
1-Blood supply
2-Tissue to be transferred
3-Donor site location
Our Surgeries
We will present some of our most specific
cases of pedicled and perforator flaps
successfully applied in our theatres. Some
of them are performed for the first time in
our service. Every single flap is raised
respecting a meticulous technique
previesly consulted with most recent
literature in this field of plastic surgery.
We have had our failures and this is
normal but understanding our mistakes we
are performing much better in our days and
we will do better for the future.
Keyword; open wounds, bone exposure,
skin grafts , random flaps.
207.
Inferior Limbs
Amputations in Diabetic Patients
Following Long-Term Artherial
Complications in Vlore’s Regional
Hospital.
Petraq MUSTAQE1
1
Surgeon-angiologist, Vlora regional Hospital,
ALBANIA
Abstract
Introduction: In this article we are
discussing the epidemic spreading of the
“diabetic foot” in diabetic patients because
of the peripheral vascular disease at many
levels of the lower limbs (from femoral
level to the foot). We have recorded 92
amputations in our Hospital from 2000 –
2015. In this study we have recorded 92
cases of lower limb amputations in both
genders with 62 males and 30 females,
varying from 50-80 years old. 42 of these
cases have gone through a femoral
amputation of one limb. 12 cases have
gone through crural amputation of one or
both limbs in18 cases of Lisfranc
amputations and 16 cases of atypical
amputation. In this study we have also
AJTES Vol.2 Nr.2 Supplement 2
included 4 cases of upper limbs
amputations due to microartherial
complications in non-diabetic patients and
patients with Raynaud syndrome.In 4 of
these cases after the crural amputation we
have needed a reintervention that led to the
amputation of the lower limb at a higher
level. Also in 8 cases with Lisfranc
amputation we have needed a
reintervention trying to save the calcaneous
bone and in two cases we went on to
amputate at crural level. In most of the
cases we have performed a histological
exam of tissues and vases. In
Key words: amputation, diabetic gangrene,
atypical amputation, Lisfranc amputation,
femoral amputation.
208.
Chronic and Infected
Wounds Treatment Option with
Acid Acetic
Sulejman SOKOLI1*
1
Orthopedic and Trauma Surgeon, Regional
Hospital of Kukes, Albania
Abstract
Introduction: Chronic wounds are those
wounds that are persistent and failed to
proceed through an orderly and timely
reparative process to produce anatomic and
functional integrity over a period of 3
months, an increase in the number of
patients with chronic wounds has been
reported with the population increasing in
weight, advancing in age and with
comorbidities. In the United States,
chronic wounds affect 3 to 6 million
patients each year.
The current concepts concerning the
treatment of chronic wounds are focusing
on fundamental treatment principles for the
management of venous, arterial, diabetic,
and pressure ulcers.
Material and Methods; A total of 12
patients not responding to traditional
therapy enrolled in the study. A specimen
of wound was isolated before local
application of 1 % acetic acid twice daily
and after completion of treatment and
processed for culture study. None of the
patients received any systemic antibiotics
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during the study period and received twice
daily dressings.
Results; The endpoint of the treatment was
wounds free of P. aeruginosa. The duration
of treatment required to eliminate the
Pseudomonas from the wounds was on an
average 10 days.
Conclusion: Acetic acid 1% is a simple,
safe and effective topical antiseptic that
can be used in the elimination of P.
aeruginosa from chronic infected wounds.
Acetic acid 1% is therefore
recommended for effective elimination of
multiple antibiotic resistant strains of P.
aeruginosa
Keywords; Acid Acetic, Infected Wounds,
Chronic wounds, pressure ulcers.
209.
Do Colorectal Cancer
Patients Diagnosed as an
Emergency Differ from NonEmergency Patients in Their
Consultation Patterns and
Symptoms
Results; Emergency diagnosis occurred in
25% and 10% of the 150 colon and 80
rectal cancers. 'Background' primary-care
consultations (2-3years before diagnosis)
were similar for either group. In the year
before diagnosis, >75% of emergency and
non-emergency presenters had consulted
their doctor, but emergency presenters had
less frequently relevant symptoms (colon
cancer: 38% vs 57% , rectal cancer: 39%
vs 52%) . Alarm symptoms were recorded
less frequently in emergency presenters
(e.g., rectal bleeding. However, about 1/5
of emergency presenters (15 and 19% for
colon and rectal cancers) had 'alarm'
symptoms the year before diagnosis.
Conclusions; Emergency presenters have
similar 'background' consultation history as
non-emergency presenters. Their tumours
seem associated with less typical
symptoms, however opportunities for
earlier diagnosis might be present in a fifth
of them
Keyword: colorectal surgery, colorectal
cancer, Laparoscopic surgery...
Nuhi ARSLANI1*, Jasmina VESELI ARSLANI2,
1
University Clinical Center Maribor, Department
for Abdominal Surgery, University of Maribor,
Faculty of Medicine, Malibor, SLOVENIA.
2
University Clinical Center, Ljubljana, slovenia.
Abstract
Background; Many patients with cancer
are diagnosed through an emergency
presentation, which is associated with
inferior clinical and patient-reported
outcomes compared with those of patients
who are diagnosed electively or through
screening. Emergency diagnosis of cancer
is common and aetiologically complex.
More than 15% of colorectal cancers are
diagnosed following an emergency
presentation
Material and Methods: clinical study of
colorectal cancers diagnosed in aur
hospital 2010 and 2011 using cancer
registration data individually linked to
primary-care data , allowing a detailed
analysis of clinical information referring to
the 3-year pre-diagnostic period.
AJTES Vol.2 Nr.2 Supplement 2
210.
Evaluation of Acute
Pancreatitis
Dariel THERESKA1*, Devid BELALLA1, Nikollaq
KAÇANI1, Arben GJATA1, Enton BOLLANO1,
Inida RULI1, Anisa LIÇO1
1
General and Digestive Surgery Service, University
Hospital Center “Mother Theresa”, Tirana,
ALBANIA
Abstract
The aim of this study is to evaluate the
patients with acute pancreatitis, treated in
the 3rd Service of General and Digestive
Surgery, from demographical, clinical,
diagnostic and treatment point of view.
Material and Methods: This is a
retrospective study. Medical data extracted
from patient files, diagnosed with Acute
Pancreatitis, were used for its realization.
This study involves 94 patients treated in
the 3rd Service of General and Digestive
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Surgery University Hospital Center, from
January 2008 to December 2012.
Results: This study involves 94 patients
diagnosed with Acute Pancreatitis,
deriving from 16 to 89 years old. 54% of
these patients were males and 46% were
females. The most common clinical
presentations were three: abdominal pain,
nausea and vomiting. Abdominal pain and
abdominal sensibility were present in all
patients. To determine the diagnosis
clinical, laboratory and imaging findings
were helpful.
Amylase is the most frequently used test,
with a level higher than three times the
standard in 73% of the patients. This level
has diagnostic significance for this
pathology. To help in determining the
diagnosis were also used blood tests,
biochemical examinations and also
Ultrasound, X-ray, CT-scan.
Biliary form was more evident in females,
whereas alcoholic form was more evident
in males. This difference had a significant
statistic meaning (p=0.0005).
According to Atlanta criteria of gravity:
91% light form, 9% severe form of the
disease, manifested with local
complications and multiple organ
dysfunction syndrome.
93% of the patients were treated
conservatively, whereas 7% were treated
surgically.
Conclusions: Surgical intervention was
indicated in Acute Necrotizing
Pancreatitis, in those cases where the
patient’s condition did not improve,
despite conservative treatment, and in case
of complications as for example Pancreatic
Pseudocysts, etc. Conservative treatment
includes antibiotics, electrolytes,
analgesics, anticoagulants and antisecretory drugs (H2-blocker/PPI).
Keywords: Acute pancreatitis, acute
necrotizing pancreatitis, abdominal pain
AJTES Vol.2 Nr.2 Supplement 2
211.
Surgery in Colorectal
Cancer Emergencies
Devid BELALLA 1, Dariel THERESKA 1, Arben
GJATA 1, Nikollaq KAÇANI 1,
1
General surgeon, 3-rd Clinic, Univesity Hospital
Center” Mother Theresa” Tirana, ALBANIA
Abstract
Background: Because of deficiencies in
population screening, colorectal cancer is
often detected in the advanced stages, with
the first presentation at the surgical
emergency. In these conditions there is an
increased morbidity and mortality,
treatment costs, and prolonged
hospitalization.
Materials and methods: This is a
prospective study of 1254 patient, operated
with colorectal cancer from January 2005 –
January 2018 in the Clinic Visceral
Surgery, at the University Hospital Mother
Teresa.
Results: Of these, 859 patients were
operated with colon cancer and 368 with
cancer of the rectum. 364 patients or 29%
was presented as an emergency as below:
Occlusion, 23% or 287 patients,
perforation / peritonitis patients 51 (4%),
perforation / abscess 26 patients (2%).
62%, or 226 patients was operated in
emergency and had primary resection and
anastomose. 94 (26%) patients with right
colon cancer underwent to resection and
primary anastomose. In 2% of cases, bypass or ileostomy was perfirmed. In 183
(51%) patients, the cancer was localized in
the left colon, sigma and upper rectum,
36% of whom were treated with resection
and primary anastomose, after
intraoperatory preparation of colon. The
rest were treated with lateral colostomy or
Hartman operation. Regarding leaks from
anastomoses, we had 13 patients in 789
cases who underwent to a elective surgery,
and 6 patients among those who had
emergency surgery. There was no
statistical difference between cases with
primary anastomose between the groups of
emergency and elective surgery for the
patients with the tumor localized in right
and left colon (p <0.05). For the rectum the
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data showed a better elective surgery
outcome. The SSI was found higher in the
cases operated as emergency. Mortality
was significantly higher in patients
operated in emergency 16 (4.3%) patients
vs 9(1%). The mortality associated only to
surgical factors was lower.
Conclusions: Although elective surgery
has a better outcome in general, we
recommend the primary anastomose in
patients with colon cancer who need an
emergency operation, whenever his general
condition allows the procedure. The
decision in cases of rectal cancer depends
not only in upper factors, but also
experience of the team, location and prior
radiotherapy.
Keywords: colorectal cancer, emergency
surgery, Albania
patients with an average hospital stay 3.7
days. Patients were treated in 2017.
Results: In group I of the one-day surgery
77.3% were male and 22.7% females,
while in group II were 73.1% male and
26.9% females. nosocomial infections in
the I-st group was recorded at 10.61%,
while in Group II to 44.75%. The most
frequent cause of infections was
Staphylococcus aureus intra-hospital in
79% of cases.
Conclusion: The adoption of modern
trends and shorter stay in hospital prevents
nosocomial infections and reduces use of
antibiotics.
Key words: intra-hospital – nosocomial
infections, one-day surgery
213.
212.
The Advantages of one Day
Surgery in Preventing of IntraHospital Infections
Ilber BESIMI1-2, Ferit MUHAREMI1; Fatmir
SALIU1-2; Ilaz MIFTARI1-2; Rufadije VEJSELI1;
Teuta ABAZI1
1
Clinical Hospital, Department of Surgery, Tetovo,
MACEDONIA
2
SUT, Faculty of Medical Science, Tetovo,
MACEDONIA
Abstract
Introduction: The advantages of one-day
surgery in the prevention of nosocomial
infections are an incentive for health
workers in preventing their surgery. Intrahospital infections defined as disease that
developed 48 hours after hospitalization.
Developed in 5-10% of hospitalized
persons. Adequate and modern treatment
allows reduction intra-hospital infections.
The purpose of this paper lies in the
importance of one-day surgery in the
prevention of intra-hospital infections,
reduce use of antibiotics and provision of
modern treatment.
Material and methods: The study included
133 patients operated. We divided patients
into two groups: group I-66 I have dealt
with one day of surgery and group II 67
AJTES Vol.2 Nr.2 Supplement 2
Groin Pain in Sportsman
Kastriot HAXHIREXHA1, 2*, Agron DOGJANI3,
Lutfi ZYLBEHARI2, Ferizate DIKA –
HAXHIREXHA2
1
Clinical Hospital – Tetovo, MACEDONIA
2
Medical Faculty – University of Tetovo,
MACEDONIA
3
University Hospital of Trauma, Tirana, ALBANIA
Abstract
Introductioin: Groin pain syndrome is
terms used to describe the concern
commonly encountered in athletes. This
syndrome consists of the pain in inguinal
region usually aggravated by athletic
activity and is found mostly in soccer
players.
Purpose: To show our experience in the
treatment of chronic groin pain in
sportsman.
Material and methods: This is a
retrospective review of nine football
players aged between 20 and 32 years
admitted in our hospital because of severe
chronic pain in the region of inguinal
canal.
Results: All the patients included in this
study underwent surgery because of
chronic embarrassing pain. In for patients
we performed reinforcement of the
posterior wall of the inguinal canal using
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Shouldice technique sometimes associated
with neurolysis of ilioinguinal nerve and
resection of the genital branch of
genitofemoral nerve, whereas in five
others patients the tension free hernioplasty
using a prolene mesh was performed.
Patients were discharged from day two to
five after the operation and no any
postoperative complications is observed.
All the athletes returned to sports five to
six weeks after operation and all of them
were satisfied with the results of treatment
Conclusion: groin pain in sportsmen may
be a very annoying problem. In some
patients the pain can be resolved with
hernioplasty sometimes combined with
resection of the genital branch of
genitofemoral and ilioinguinal nerve
(neurolysis).
Key words: Sportsman, groin pain, surgical
procedure
diagnosed for Gastric cancer, are weight
loss and gastrointestinal hemorrhage.
Considering the results of our study, the
symptoms are directly linked to a late stage
of the disease, which are of direct impact
on surgical approach and prognosis. We
conclude that it is of great importance for
our healthcare system to be on alert for an
earlier diagnosis for Gastric cancer
patients.
215.
Terminal Ileum
Endometriosis as a Cause of Acute
Bowel Obstruction: A Case Report
and Review of the Literature.
Myzafer KACI¹*, Drini SHEHI¹, Arvin DIBRA¹,
Etmont CELIKU¹
¹General Surgery Service, University Hospital
Center “Mother Theresa” Tirana, ALBANIA
Faton T. HOXHA1*, Shemsedin HASHANI1,
Rrustem MUSA1, Shpresa HASHIMJA2, Ilir
UKIMERI4, Albulena BALOKU1, Jetlir RASHITI1,
Arsim AJETI1, Ali DEVAJA1, Lulzim Q.
MALOKU5, Ramadan SOPA3, Reshat MATI3
1
Department of Abdominal Surgery, University
Clinical Centre of Kosovo, Pristine, Republic of
Kosovo
2
Department of Anesthesiology, University Clinical
Centre of Kosovo, Pristine, Republic of Kosovo
3
Department of Anesthesiology, University Clinical
Centre of Kosovo, Pristine, Republic of Kosovo
4
Sirona Hospital, Radiology Service, Pristine,
Republic of Kosovo
5
Department of Gynecology and Obstetric,
University Clinical Centre of Kosovo, Pristine,
Republic of Kosovo
Abstract
Introduction: Gastric cancer is one of the
most common cancers and the second most
common cause of cancer deaths
worldwide. Due to its insidious clinical
presentation, it is unfortunately commonly
diagnosed at later stages of the disease,
which is also of prognostic significance.
Material and Methods: This study takes
into consideration the most frequent
clinical findings in correlation to different
stages of Gastric cancer, consisting in data
taken from General Surgery Service,
University Hospital Center “Mother
Theresa” Tirana during the period of time
2015-2017.The data was taken from
preoperative anamnesis of 189 patients
treated for Gastric cancer.
Conclusions: In this survey, the most
frequent reported findings in patients first
Abstract
Background: Small Intestine affected and
obstructed by endometriosis is an
uncommon condition in reproductive
woman years.
Case presentation: We present a case
with acute ileum obstruction caused
secondary by endometrial infiltration
requiring emergency surgery as treatment
of choice. Rare location of endometriosis
in Ileum is diagnostic and therapeutic
challenge as the signs and symptoms in
acute abdominal circumstances. A
pathological examination of the ileum
revealed ileal endometriosis, mainly in
muscularis propria and submucosal
locations.
Conclusions: We should consider the
probability at reproductive female age that
214.
Preoperative Findings and
Surgical Approach in Gastric
Cancer.
AJTES Vol.2 Nr.2 Supplement 2
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the cause of acute bowel obstruction might
be intestinal endometriosis with signs of
obstructions.
Keywords: endometriosis, small bowel,
obstruction, intestinal resection.
216.
Recognition and
Management of Extremity
Vascular Trauma
Thomas B. WHITTLE1
Vascular Surgeon Heartland Vein & Vascular
Institute, Omaha, NE, Lincoln Surgical Group
Lincoln, NE, USA
1
Abstract
Stabilization of the vascular trauma patient
to prevent the lethal triad of acidosis,
coagulopathy, and hypothermia is the
initial step in the management of blunt or
penetrating injury. Use of tourniquets,
shunts, and blood replacement should be
liberally applied. Recognition and
diagnosis of specific vascular injury to the
extremities requires familiarity with hard
and soft physical signs of flow
interruption. Mechanism of injury should
be considered. There should be frequent
use of ankle/brachial and brachial/brachial
pressures when soft physical signs are
present, and more definitive diagnostic use
of MDCTA, angiography, or operative
exploration when hard signs of vascular
injury are present. Timing of intervention
with debridement, hemorrhage control and
revascularization if needed should be
predicated on stability and comorbidities in
the poly trauma patient. Principles for open
repair include proximal and distal control,
exploring the extent of injury/associated
injuries, potential vein harvest for repair,
and finally the repair itself. Selective use
of endovascular intervention with covered
stents and embolization holds future
promise for vascular injuries. However,
many of these patients are young, and the
long-term outcomes relative to open repair
has yet to be adequately evaluated.
Contraindications to endovascular repair
include long segmental injuries, lack of
fixation points, and arterial transection.
Consideration for compartment syndrome
AJTES Vol.2 Nr.2 Supplement 2
should be made especially when there is
prolonged ischemic time, associated
arterial/venous injury, associated
nerve/boney injury, or need for femoral
vein ligation. Open fasciotomy may
prevent significant renal injury or longterm limb disability in many patients.
217.
Surgical Management of
Popliteal Artery Aneurysms in
Albania
Petrika GJERGO1, Albana KENGA1, Denis
KOSOVRASTI1, Sokol XHEPA1, Edmond
KAPEDANI2, Edmond NUELLARI1.
1
Service of Angiology & Vascular Surgery,
University Hospital Center “Mother Teresa”,
Tirana, Albania
2
Faculty of Medicine, Catholic University Our Lady
of Good Counsel, Tirana, Albania.
Abstract
Background: Popliteal artery aneurysm
(PAA) is uncommon, although the
popliteal artery is the second most frequent
location of arterial aneurysms. The aim of
this study was to evaluate the
epidemiology and outcomes of PAA
treated surgically in our clinic.
Methods: From 2008 to 2018, 30 patients
with PAA measuring from 2 to 7 cm were
operated in our department. All data were
collected retrospectively. All patients,
except one, had undergone
ultrasonography examination and
computed tomography angiography before
treatment. Patients had a 30-day follow-up
with clinical and ultrasound examination.
Results: Median age of the patients was 68
years all patients were male. PAA were
asymptomatic in 13 patients (43.3%), 1
patient had intermittent claudication, 1
patient presented with rupture of popliteal
aneurysm, while the other patients (50%)
had acute ischemia due to acute thrombosis
in 11 patients, chronic thrombosis in 2
patients and distal embolization in 2
patients.
From 30 patients, only one patient
underwent thrombolysis with reteplase, all
the others were surgically treated. 26
patients were treated with aneurysmectomy
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with prosthetic graft interposition using a
posterior approach. In 2 patients, distal
ligation of the aneurysm with femoralpopliteal bypass grafting was performed.
Only one patient underwent trombectomy.
During the follow-up period (30 days), no
deaths and no graft thrombosis were
registered. There was only one limb
amputation (the patient who performed
trombectomy) and one fasciotomy (the
patient that underwent thrombolysis). The
limb salvage rate was 96,7%.
Conclusions: PAA are rare, only 30
patients were diagnosed and treated during
the last 10 years in our clinic. The surgical
treatment of PAA had excellent short-term
results with no mortality and a high limb
salvage rate.
Keywords: Popliteal artery aneurysm,
intermittent claudication, aneurysmectomy, trombectomy.
218.
Vascular Access to
Hemodialysis the Creation of
Arteriovenous Fistula for
Hemodialysis is the Best Choice
for People with Advanced Stages
of Renal Disease.
with side by side anastomoses, and 80% of
those with end by side anastomosis were
functionally no problem in the first year.
Within two years, the lateral and lateral
anastomosis rate was 50% and 55%
respectively. In addition, the rate of function
was 90% in FAV made in the brachial artery
with end-to-side anastomosis, whether it was
primary or secondary, at the end of the first
year. However, rapid fastening was observed
at the rate of function during the third year
both in radial arteries and in brachial arteries
based on FAV.
Conclusions: We confirmed that arterial
surface arterial veins in AV primary fistula
were the optimal and rational approach to
hemodialysis, providing a sufficient flow of
blood during this process. In addition, FAV
failure, the primary fistula should be replaced
by FAV, secondary fistula is preferably done
with the brachial artery.
Keywords; arteriovenous fistulas,
hemodialysis, renal disease, Vascular Surgery
219.
Treatment Options of
Crural Pseudo Aneurysms. A
Cases Series
Edmond NUELLARI1*
Service of Angiology & Vascular Surgery,
University Hospital Center “Mother Teresa”,
Tirana, Albania
Edmond NUELLARI1*, Albana KENGA1, Denis
KOSOVRASTI1, Petrika GJERGO1, Edison
HALILI1, Sokol XHEPA1
1
Service of Angiology & Vascular Surgery,
University Hospital Center “Mother Teresa”,
Tirana, Albania
Abstract
Introduction;Primary arteriovenous (AV)
fistulas have been done in patients with renal
disease at the last stages of hemodialysis.
The purpose of the study was to record Fistula
AV for hemodialysis is the first and best
choice in the patients in the open stages of
renal disease.
Materials and Methods: The actual study was
conducted at the Vascular Surgery Service in
Tirana. There was no flux of blood and
persistence and function of fistula during
hemodialysis.All patients were operated
under local anesthesia.
Results:In our study showed that 77% of the
AV fistulas performed in the radial arteries
Abstract
Introduction; Pseudo aneurysms (PAs) of
crural arteries represent rare complications
after vascular interventions or surgery.
Management of crural PAs includes
different treatment options, conservative
treatment as well as open syrgery or
endovascular procedures. We reviewed our
experience.
Material and Methods; We retrospectively
analysed all patients who were diagnosed
with crural PAs in our institution since
2000. We evaluated all PAs for etiology,
treatment and outcome. Endpoints were:
target vessel patency, vascular reintervention and limb loss.
1
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Results.
A total of 30 patients were diagnosed with
crural pseudo aneurysms. Pa was caused
by vascular interventional in 24 patients
(80%): in 22 of them open balloon
thrombectomy had been performed, one
patient had sub fascial endoscopic
perforator vein surgery and one patient
transcutaneous catheter with balloon
assisted. In 6 patients (20%) the PA was
caused by an orthopedic surgical
procedure.
Location of crural Pas: Peroneal artery (n
₌11: 36,7%), posterior tibial artery (n ₌10:
33,3%), anterior tibial artery (n = 5:
16,7%), and tibio-peroneal trunk (n = 4:
13. 3%). Treatment of crural Pas included:
open surgery (n₌13: 43. 3%).endovascular
procedures (n = 6: 20%), and conservative
management (n = 11): 39.7%). After a
median follow-up of 7 months (range: 0-36
months) 5 of 6 endografts were occluded.
None of the surgically, endovascularly and
conservatively treated patients needed reintervention for crural Pas.
1. diameter of the great saphenous vein
(GSV) more than 20 mm,
2. thrombosis of GSV, especially at the
sapheno femoral junction,
3. aneurysm of GSV before sapheno
femoral junction,
4. ruptured primary varicose veins with
huge collaterals.
These cases do not benefit of the
advantages of the Radiofrequency: no pain,
no general or spinal anesthesia, no
recovery in the hospital, 35-40 minutes
procedure in office, next day back to work.
Results: All the patients had no
hemorrhagic, thrombotic or embolic
complications. According to the skin
damages in the presentation, they had
improvements of the quality of the skin.
Conclusions: We should indicate the right
procedure for every case. 70% of cases in
Albania are complicated or with huge GSV
(bigger than 20 mm). If we indicate the
wrong procedure, the bad results will come
back like a boomerang.
Keywords: varicose veins, sapheno femoral
junction, Radiofrequency
220.
Complicated Varicose
Veins Still Need Surgical
Treatment
Sokol XHEPA1, Edmond NUELLARI1, Petrika
GJERGO1, Albana KENGA1, Denis
KOSOVRASTI1, Marsela SOPIQOTI1
1
Service of Angiology &Vascular Surgery,
University Hospital Center “Mother Teresa” of
Tirana, Albania
Abstract
Background: Radiofrequency or Surgical
Treatment?
This is the question today for the
management of the varicose veins. We
think that huge and complicated varicose
veins should be treated surgically.
Patients and Methods: During the period
January 2007 – January 2017 we
performed surgical treatment for all the
patients with:
AJTES Vol.2 Nr.2 Supplement 2
221.
Ruptured Abdominal
Aortic Aneurysm Associated with
left Colon Gangrene and
Neurological Disorders. A very
rare Combination
Sokol XHEPA1*, Gentian CACO1, Petrika
GJERGO1, Myzafer KAÇI2, Stavri LLAZO3, Ervin
BEJKO3
1
Service of Angiology &Vascular Surgery,
University Hospital Center “Mother Teresa” of
Tirana, ALBANIA
2
Service of General Surgery, University Hospital
Center “Mother Teresa” of Tirana, ALBANIA
3
Service of Anesthesiology & Intensive Care,
University Hospital Center “Mother Teresa” of
Tirana, ALBANIA
Abstract
Background: To report the management
of a very rare combination of two severe
surgical emergencies, ruptured abdominal
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aortic aneurysm (rAAA) and gangrene of
the left colon, each of them with a high
mortality (rAAA 48.5%).
Case report: A 59-year-old woman was
presented at the Service of Emergencies at
UHC “Mother Teresa” of Tirana on
January 4, 2013, transferred from Durrës
Hospital with the diagnosis of rAAA based
on an unclear CT. She arrived in a
profound hypovolemic shock after she had
a cardiac arrest and resuscitation at the
ICU of Durrës Hospital (no information
about anoxic brain time).
After a brief compensation of volume in
our ICU, we took the patient in the
operation room. Intraoperatively we found
an infrarenal rAAA and a gangrene of
sigmoid and left colon.
We performed the resection of the
aneurysm and the reconstruction of the
aorta with the interposition of a tub graft.
Immediately thereafter, the general
surgeons performed a large left
hemicolectomy with temporary colostomy
(after 3 months they performed the second
step, colo-rectal anastomose).
Postoperatively she remained 3 weeks in
the ICU, mostly due to neurogical
complications after the ischemic stroke she
had in Durrës Hospital, and on January 29,
2013 she returned to the Service of
Neurology at Durrës Hospital for the
neurogical rehabilitation.
After 1 year the patient come back for
consultation, she was totally healed for
both surgical pathologies and she had a
complete central and peripheral neurogical
rehabilitation.
Conclusions: Gangrene of the left colon
after rAAA is a very rare and severe
combination caused by the acute occlusion
of the inferior mesenteric artery in the
presence of hypovolemic shock and
insufficient collateral circulation. The
strategy of treatment includes: fast
diagnosis, short hypotensive resuscitation,
cell-saving and auto-transfusion, and the
simplest possible surgical reconstructions
for both pathologies.
AJTES Vol.2 Nr.2 Supplement 2
Keywords: Colon Gangrene, temporary
colostomy, peripheral neurogical
222.
Risk Factors Associated
with Severe Carotid Artery
Stenosis in Candidates for Elective
Coronary Artery Bypass Grafting
Surgery
Petrika GJERGO1, A. VESELI1, H. GJERGO1, A.
SIMAKU2, Edmond KAPEDANI3, Edmond
NUELLARI1
1
Service of Angiology & Vascular Surgery,
University Hospital Center “Mother Teresa”,
Tirana, Albania
2
Public Health Institute, Tirana, Albania
3
Faculty of Medicine, Catholic University Our Lady
of Good Counsel, Tirana, Albania.
Abstract
Background: The identification of carotid
artery stenosis in patients with coronary
artery disease prior to coronary bypass
surgery (CABG) can reduce morbidity and
mortality from stroke. Therefore, a
preoperative carotid duplex
ultrasonography, which is simple, noninvasive and inexpensive may be
necessary.
The purpose of this study was to evaluate
the prevalence and risk factors associated
with severe carotid artery stenosis (CAS)
in CABG patients.
Material and methods: 49 patients with
carotid stenosis ≥70% identified by duplex
ultrasound were matched by age and sex to
control patients with carotid stenosis <50%
(n=49). A total of 405 patients hospitalized
for elective CABG were screened to arrive
at these patients’ cohorts. Medical records
of all 98 patients were reviewed for the
presence of a carotid bruit, atherosclerotic
risk factors, history of a prior
cerebrovascular event and extent of
coronary artery disease. Patients with
previous CABG, carotid artery
endarterectomy or stenting were excluded.
Results: Prevalence of severe carotid
artery stenosis was 12.1%. The patients’
cohorts were predominantly male (85.7%)
with mean age 65 years. There was no
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significant difference between groups
regarding the prevalence of atherosclerotic
risk factors or prior cerebrovascular events.
The extent of coronary artery disease
including left main coronary artery disease
did not differ significantly between groups.
Multivariate analysis revealed that the
presence of a carotid bruit (OR 94.72,
95%CI:16.49-543.85, P<0.0001) and
smoking (OR 6.21, 95%CI:1.15-33.58,
P=0.034) were associated with an
increased risk for severe CAS.
Conclusions: This study showed a
significant proportion of severe carotid
artery stenosis in our patients undergoing
CABG. The presence of a carotid bruit and
smoking resulted independent predictors of
severe carotid disease.
Keywords: carotid artery stenosis, coronary
bypass surgery, carotid artery stenosis…
223.
Acute Coronary Syndrome
in the Emergency Department.
Migena ISHMAKEJ1
1
University of Medicine Tirana, ALBANIA
Abstract
Background: Acute coronary syndrome
(ACS) is a major cause of morbidity and
mortality worldwide and common cause of
attendance and admission to emergency
services. It encompasses a group of entities
including acute myocardial infarction with
ST-segment elevation, myocardial
infarction without ST-segment elevation
and unstable angina.
The aim of this study is to provide
epidemiological information of ACS, risk
factors and pain characteristics as a
presenting symptom.
Materials and Methods: This is a hospitalbased prospective study comprising all the
patients who had visited the emergency
department between 1 March and 30 May
2018 (N=895) and 200 patients
hospitalised in the University Medical
Center of Tirana “Mother Teresa”. The
patients were randomly selected and data
was collected based on a form within 48
AJTES Vol.2 Nr.2 Supplement 2
hours of admission in the emergency
department.
Results: Of the total, 73% of the patients
diagnosed with ACS were males and 27%
females. Unstable Angina was observed in
52% of the cases, non-ST elevation
myocardial infarction in 13% and STelevation myocardial infarction in 35% of
the patients. The mean age of the patients
was 65.1 years. Hypertension as a risk
factor for coronary disease was found
among 81% of patients and diabetes in
29% of the cases. 52% of the patients were
smokers and 17% consumed alcohol. The
majority of patients (57%) were
overweight. Dyslipidemia was found in
61% of patients while family history was
positive in 22% of patients. Pain as a
presenting symptom was found among
93,5% of patients with an intensity
evaluated with 7 from males and 9 from
females.
Conclusions: The diagnosis of acute
coronary ischemia depends upon the
characteristics of the chest pain, specific
associated symptoms, abnormalities on
electrocardiogram (ECG), and levels of
serum markers of cardiac injury. A patient
with a possible ACS should be treated
rapidly. Thus, initial management steps
must be undertaken before or during the
time the diagnosis is being established.
Keywords: Emergency Department, Acute
coronary syndrome, diagnosis,
management
224.
Blunt Abdominal Trauma
in Geriatric Patients.
Amarildo BLLOSHMI1, Agron DOGJANI2
University of Medicine Tirana, ALBANIA
2
General Surgery and Trauma Service, University
Hospital of Trauma, Tirana, ALBANIA.
1
Abstract
Background: Third age population (over
65 years old) is continuously increasing in
our country due to increased life
expectancy and improved health care
system. Evidence based studies have
clearly proven that geriatric population
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have a worse prognosis than younger
population after a blunt abdominal trauma
(BAT).
The aim of this study is to make a
complete evaluation of blunt abdominal
trauma in geriatric population and compare
it with blunt abdominal trauma in younger
population.
Materials and Methods: This is a
comparative and retrospective study
conducted in the time frame November
2017 – January 2018, in the University
Hospital of Trauma (UHT). First we
divided patients in two categories, BAT
and nBAT. Everybody who arrived dead to
hospital or died shortly after arriving was
excluded from the study.
Results: BAT patient were than divided
into three categories: BAT in children (014), BAT in adults (15-65) BAT in elders
(>65). Variables analysed are: age, sex,
trauma mechanism, shock index
(ALLGOWER formula), Injury Severity
Score (ISS), Revised Trauma Score (RTS),
hospitalisation time, transportation,
treatment of choice, damaged organs, etc.
Than each variable was compared between
populations to make the changes between
them visible.
Conclusions: Evaluation of BAT in elderly
clearly shows that these patients have
poorer outcome compared to younger
patients. This is linked to physiologic
changes that occur with age and chronic
illnesses that are very common in this age.
Keywords: Blunt Abdominal Trauma,
Geriatric patients, ISS, RTS
225.
Intramedullary Nailing in
the Treatment of Distal Tibia
Fractures
Teodora TODOROVA1, Ajruli B1, Rezeart
DALIPI1, Aleksandar SAVESKI1, Aleksandar
TRAJANOVSKI1, Antonio GAVRILOVSKI1,
Samardziski M1, Simon TRPESKI1, Ilir HASANI1,
1
University Clinic for TOARILUC, Skopje,
MACEDONIA
AJTES Vol.2 Nr.2 Supplement 2
Abstract
Introduction: distal tibia fractures are
common injuries in traumatology, usual by
frequency and often followed with
complications. These injuries are classified
in extraarticular fractures, partial fractures
and complete articular fractures of the
distal tibia. In this study, by following a
group of patients in which these types of
traumas are treated with intramedullary
fixation of tibia, we processed the
outcome, complications, healing and
function retrieval of the injured region of
the extremity after the occurred trauma and
after its surgical correction.
Aim: to evaluate functional results at
patients after their surgical treatment of
distal tibia fractures with intramedullary
nail.
Material and Methods: This clinical
study was performed in the University
Clinic of Traumatology in a two year
period of time and 27 patients were
included. To appraise lower extremity
function at the patients, we used Olerud
Molander score system and we assigned
dorsiflexion.
Results: in our study we included 27
patients with extraarticular fractures of
distal tibia. Average dorsiflexion is
measured 18,96±3,7 degrees, while Olerud
Molander score for distal tibia function is
82,41±16,7. Two complications occurred.
Also an analysis of results based on AO
classification was made.
Conclusion: The surgical as well as the
postoperative treatment of distal tibia
fractures represents a challenge, primarily
because bone and wound healing can be
critical. Intramedullary nailing allows
minimally invasive, symmetric and
dynamic fracture fixation, following the
principles of biological fracture fixation,
and is therefore the treatment of choice in
distal tibial fractures. The obtained results
in this study showed good postoperative
results and low complications rate.
Key words: intramedullary nailing, distal
tibia.
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226.
Considerations and
Evaluations on Abdominal
Trauma in Pediatric Age.
Hysni BENDO2* Agron DOGJANI1,
1
General Surgery and Trauma Service, University
Hospital of Trauma, Tirana, ALBANIA.
2*
University of Medicine Tirana, ALBANIA
Abstract
Background: Trauma is the leading cause
of morbidity and mortality in the pediatrics
age.
Most of the injuries are occupied by
craniocerebral trauma followed by
locomotor trauma. Abdominal trauma
ranks third for the frequency of trauma
injuries in children.
The Aim of our study is to evaluate and
review the mechanisms that cause Blunt
Abdominal Trauma in pediatric age,
identify the signs and symptoms that
accompany it, clarify the importance of
using scoring systems and to discuss
operative or non-operative management
criteria.
Material and methods: The study has
retrospectively registered and included all
patients with Blunt Abdominal Trauma in
pediatric age who presented to emergency
department at the University Hospital of
Trauma in Tirana, Albania by 01/12/2017 24/06/2018. The sample in the study was
taken randomly without any restriction.
Other variables included are: age, gender,
mechanism of injury, the examinations
performed and timing of their treatment
tactics. The level of ISS was used as a
measure for measuring gravity of injuries
in severe cases with ISS> 15.
Results: The study included 49 pediatric
patients of age 1 to 16 years old. Males
consisted of 39 (80%) patients, while 10
(20%) patients were females. The main
reason of trauma were motor vehicle
accidents (55%) followed by falls from
height (33%) and injury by solid objects
(6%).
Pediatric patients comprised 13.7% of all
trauma cases presented at the hospital
during the study period.
AJTES Vol.2 Nr.2 Supplement 2
Conclusions: Blunt Abdominal Trauma in
pediatrics age is a serious threat to the
health of the children. Their treatment
should be carried out not only in national
trauma centre but in every regional
hospital or even in smaller hospitals,
rigorous enough to apply all protocols of
trauma, particulary in children.
Keywords: Blunt Abdominal Trauma,
pediatric, trauma and abdominal injuries,
polytrauma
227.
Management of Blunt
Liver Trauma
Fatjona SHEHU1 Agron DOGJANI2
University of Medicine Tirana, ALBANIA
2
General Surgery and Trauma Service, University
Hospital of Trauma, Tirana, ALBANIA.
1
Abstract
Background: Serious injuries to the nerve,
venous and hepatic portals triad continue
to remain a challenge for surgeons, as
these damages are a leading cause of
mortality. Medicine development in the
field of imaging and surgery has evolved
the thought of hepatic trauma treatment in
terms of conservative treatment.
This study aims to describe the causes of
trauma, the degree of injury, the chosen
method of treatment, the success rate and
the developed complications; comparing
the results of our study with the results of
literature.
Material and methods: The study is of a
retrospective character and includes all
patients with hepatic trauma, presented in
the Emergency of Politrauma in SUT,
Tirana, from December 2017 to May 2018.
The study sample was taken randomly,
without any study restriction.
Results: During the 6 month period, 71
patients with hepatic trauma were reported,
of whom 52 (73.2%) with blunt hepatic
trauma and 19 (26.8%) with penetrating
injuries. Men (67.3%) were more affected
than females (32.7%) with a male female
ratio of 2: 1. The most common cause of
the injuries was car accident, while the
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most affected age group was 16-35 years
old. In 52 patients with blunt hepatic
trauma 53.8% were treated conservatively
and 46.2% surgically.
Conclusions: Conservative treatment is the
chosen method for the management of
blunt hepatic trauma in hemodynamically
stable patients. The conservative method
significantly improves the outcome
compared to surgical management, in
terms of decreased abdominal infections,
decreased transfusions, and decreased
hospitalisation period. However,
hemodynamically unstable patients with
peritonitis should undergo immediate
surgical intervention.
Keywords: Blunt Liver Trauma,
Management, Non-Operative Management
(NOM)
228.
Treatment of Lower Leg
Fractures.
and conservatively in 11% of cases (cast).
Surgical methods of treatment are:
intramedullary nails, osteosintesis with
plates and screws and external fixation.
The most used treatment in SUT is
osteosintesis with plates and screws (62%
of cases).
Conclusions: Most orthopaedic surgeons
agree that treatment has to be
individualized and matched to the patient’s
injury pattern, medical status at the time of
the injury, the cause and severity of the
injury, the presence or extent of soft tissue
damage that surround the tibia. In many
cases, a tibial fracture will be successfully
managed without complications. Recovery
from a tibial fracture varies based on the
severity of the fracture. A person will often
recover within 4 to 6 months. Recovery
time may be longer for a complete break
compared to a partial one and may take
longer if a person has poor health for other
reasons.
Keywords: lower leg fracture, tibia, fibula,
treatment
Ornela ÇELA1
1
University of Medicine Tirana, Albania
Abstract
Background: Tibial fractures are one of
the most common injuries treated by
orthopaedic surgeons. There is a wide
variety in the patterns of injury and
treatment.
The aim of this study is to give a complete
picture of treatment and epidemiology of
lower leg fractures in UHT (University
Hospital of Trauma), Tirana.
Materials and Methods: This is a
descriptive and retrospective study
conducted in the time frame January 2017
– December 2017. We analyzed 100
patients with lower leg fractures diagnosed
in the Orthopaedics Service in the UHT.
Recorded data include aetiology, age,
gender, type of fracture, location of
fracture, treatment of choice,
hospitalisation time and early
complications.
Results: In UHT the treatment of Tibial
injuries is made surgically in 89% of cases
AJTES Vol.2 Nr.2 Supplement 2
229.
General Consierations on
Blunt Abdominal Trauma.
Granit RAMIZI1 , Agron DOGJANI2
University of Medicine Tirana, Albania
2
General Surgery and Trauma Service, University
Hospital of Trauma, Tirana, Albania.
1
Abstract
Background: Trauma or injury has been
defined as damage to the body caused by
an exchange with environmental energy
that is beyond the body's resilience. Blunt
abdominal trauma (BAT) is a leading
cause of morbidity and mortality among all
age groups. Most common causes of blunt
abdominal trauma are automobile
accidents, falls, assaults and industrial
accidents. Identification of serious intraabdominal pathology is often challenging;
many injuries may not manifest during the
initial assessment and treatment period.
The aim of this study is to discuss the
etiology, epidemiology and
pathophysiology of blunt abdominal
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trauma, as well as its clinical presentation,
diagnostic and treatment modalities. We
also aim to give a review of literature
Material and Methods: This is a
retrospective study conducted during May
2017 - June 2018 time frame. The study
included 77 patients with Blunt Abdominal
Trauma admitted to the University
Hospital of Trauma (UHT), Tirana,
Albania.
Results: The study included 16 (20.8%)
females and 61 (79.2%) males of all age
groups. Most common mode of injury was
road traffic accidents comprising 46 cases
(59.7%), followed by fall from heights
comprising 19 cases (24.7%), and hit by
solid objects in 12 cases (15.6%).
Conclusions: Morbidity and mortality can
be prevented by timely initial resuscitation
and correct diagnosis as well as
management (operative or non-operative)
which depend on patient’s hemodynamic
stability and findings of imaging studies.
Keywords: Blunt abdominal trauma, Nonoperative management, Road traffic
accident
230.
Management of Blunt
Splenic Trauma
chosen randomly without any study
restriction. There The medical records of
the traumatized patients at the moment of
their arrival were considered, as well as the
appropriate medical guides and surgical
techniques, comparing them with the
literature records.
Results: 91 patients are included in our
study, from these 76% Males and 24%
Females. Most of them were over 15 years
old (40.44%). Automobile Accidents (AA)
were the cause of 57% of cases, Fall from
Highs (FH) accounted for 26% and Injury
by Solid Objects (ISO) 17%.
Conclusions. It is very important for all
emergency doctors at all cases with BST (
Blunt Splenic Trauma), for its management
to rely primarily on the clinical data, injury
mechanism, time of hospitalization,
examinations like abdominal ECHO, CT
(Computed Tomography), MRI, etc. A
high index of clinical suspicion along with
radiological diagnosis helps to identify and
characterize splenic injuries with high
accuracy and is useful for timely decisionmaking to choose between OM or NOM.
Careful selection of NOM is associated
with high success rate with a lower rate of
morbidity and mortality.
Keywords: Spleen injury, blunt trauma,
management
Liridon NUREDINI1
1
University of Medicine, Tirana, Albania
Abstract
Background: Spleen is the most damaged
abdominal solid organ in Blunt Abdominal
Trauma (BAT) and Toraco-Abdominal
Trauma (TAT) with 60% of damages that
result in increased morbidity and mortality.
The aim of this study is to discuss
epidemiological and physiopathological
elements of the Splenic Trauma (ST) at the
University Hospital of Trauma (UHT), its
management and give a literature review.
Materials and Method: This study has a
combined character (prospective and
retrospective) and includes all the patients
presented in the UHT emergency
department in Tirana, from May 2017 to
June 2018. Patients in the study were
AJTES Vol.2 Nr.2 Supplement 2
231.
Comparison between
Ravitch and Nuss Procedure as
Surgical Treatment Options for
Pectus Excavatum
Doruntina KLENJA1, Anila BELCHISHTA1, Risto
CHOLANCHEVSKI1
1
University Clinic for Orthopedic Surgery- Skopje,
MACEDONIA
Abstract
Pectus excavatum (PE) is the most
common congenital chest wall anomaly.
The deformity is reported to occur more
frequently in males than females. PE is
sporadic and generally asymptomatic.
The Haller index is a mathematical
relationship that exists in a
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human chest section observed with a CT
scan and describes the extent/depth of the
pectus: mild, moderate or severe.
The two most common types of surgeries
used to correct pectus excavatum is the
open repair (Ravitch) or the minimally
invasive repair with a metal bar (Nuss)
procedure.
Aim of this study is to compare results
between Ravitch and Nuss procedure.
The comparison of patients that underwent
repair of a pectus excavatum during
includes a 10-year period from 2005 to
2015. The cases were divided into two
groups, group I operated with Ravitch
procedure and group II with Nuss
procedure.
In our cohort the inclusion criteria were CT
chest with moderate HI > 3.25, bony
deformity distressing the patient
psychologically, Progressive bone
abnormality, bony deformity with
progressive symptoms secondary to
compression either cardiac or pulmonary
with positive finding in EKG,
Echocardiography or pulmonary function
study.
With Ravitch procedure are operated 19
patients and with Nuss procedure 11
patients. Only 45% from Ravitch and 55%
patients operated with Nuss procedure
show better results.
As conclusion wounds infection from
Ravitch are more significant, as for bar
displacement shows better results at Nuss
procedure.
AJTES Vol.2 Nr.2 Supplement 2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Posters
antibiotic should be prescribed and for
what duration.
POSTER
PRESENTATIONS
233.
Pigmentation Disorder and
Dermatology Life Quality
Ardiana SINANI1, Dorela VASHA2, Rovena LICO3
Military Medical Unit at University Hospital of
Trauma, Tirana, Albania
2
Health Inspectorate, Preventive Medicine at the
Ministry of Defense, Tirana, Albania.
3
Speciality Policlinc No 1, Tirana, Albania
1
232.
Procalcitonin value
guided treatment of lower
respiratory tract infections.
Altin HABAZAJ1*, Vrenoz HODAJ 2
1
Pneumology Sevice, University Hospital
of Trauma, Tirana Albania.
2
Emergency Department, University
Hospital of Trauma, Tirana Albania.
Abstract
Introduction;Acute respiratory infections
(ARIs) compriseof a large and
heterogeneous group of infections including
bacterial, viral, and other etiologies. In
recent years, procalcitonin (PCT), a blood
marker for bacterial infections, has emerged
as a promising tool to improve decisions
about antibiotic therapy (PCT- guided
antibiotictherapy). Distinct from CRP and
other acute-phase reactants, existing data
suggest that PCT levels rarely increase in
response to viral infections, indicating that
PCT may be useful for discrimination
between bacterial and viral infections.
Procalcitonin is a precursor to calcitonin.
The final step in the synthesis of calcitonin
is inhibited by cytokines and endotoxin
released during bacterial infections;
therefore, procalcitonin levels are
selectively elevated in patients with
bacterial infections.
The use of procalcitonin to guide initiation
and duration of antibiotic treatment results
in lower risks of mortality, lower antibiotic
consumption, and lower risk for antibioticrelated side effects.
The FDA recently approved a
procalcitonin assay for use in hospitals and
EDs to help prescribers determine if an
AJTES Vol.2 Nr.2 Supplement 2
Abstract
Introduction: Vitiligo is an acquired
chronic depigmenating disease of the skin.
It causes loss of pigment on effected areas
of the skin or mucosae and is characterised
by milk white, nonscaley with distinct
margins.
Objective: Description of vitiligo.
Different clinical forms, and the most
frequent consequences of the disease in the
social life of the individual.
Results of treatment of simple cases and
complex cases.There is very limited
information available in the textbooks on
vitiligo. This is up-to-date literature
overview of the disease including
definition, classification, aetiology,
histopathology, prognosis, assessment and
treatment There is a current lack of
consensus in the definition and methods of
assessment of this disorder, which makes it
difficult to compare the outcomes of
different studies of the same treatment.
Vitiligo is supposed to be an multifactorial
disease in which melanocits are destroyed
and this results in the absence of
pigmentation in affected areas. Even
though most people with vitiligo are in
good general health, they face a greater
risk of having other diseases such as
diabetes, thyroid disease, pernicious
anaemia (B12 deficiency), adrenal gland
disease and alopecia areata.
Conclusion: Skin diseases are very
common, affecting over a quarter of the
population. Although usually not lifethreatening, skin diseases have a
significant impact on the quality of life of
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patients and cause considerable
psychological distress. Vitiligo, a condition
which results in the loss of pigment from
the skin and the cosmetic disfigurement of
this seemingly inconsequential skin disease
has a major impact on the quality of life of
patients especially for people with darker
skin. Finally, the aetiology and
pathogenesis of vitiligo remains unclear. It
is still not understood what causes the
destruction of melanocytes. Also,
uncertainties remain about the natural
history and epidemiology of this disease. A
variety of methods for repigmenting the
skin of people with vitiligo have been tried
in but vitiligo treatment is a major
challenge If a cure for vitiligo is to be
found, further research is required in
understanding the aetiology, epidemiology
and natural history of vitiligo. Current
treatments help to alleviate symptoms for
temporary repigmentation of vitiliginous
patches, but these do not cure the
underlying disease.
Keyword: Vitiligo, chronic depigmenating
disease, pernicious anaemia,
234.
Cerebral Coma as a Rare
but Serious Complication During
Epidural Anesthesia. A Case
Report.
Dritan TODHE 1
Orthopaedic and Trauma Service, University
Hospital of Trauma, Tirana, Albania
1
Abstract
Background: The routine use of epidural
anesthesia has become a standard
procedure during the prosthetic surgery in
hip and knee replacement.
Case presentation: An 80-year-old man
was subject to a double hip replacement
(bilateral) at a single operative procedure.
Epidural anesthesia was used. The
anesthesiologist had some difficulties
penetrating the catheter to the right place.
Naropeine and Phentanyl (2ml-100
gamma) were injected. Fifteen minutes
AJTES Vol.2 Nr.2 Supplement 2
later, the incision took place, first at the
right hip. At that moment the patient falled
in an asleep state (no drugs). The
acetabular component was implanted
within 15 minutes from the incision. Right
at that moment the anesthesiologist called
for attention, since the patient was not
responding to pain stimulus. Intubation
was immediately performed without
relaxing (myorelaxines). The operation
was stopped and the team concluded that
the patient was in deep coma. No laryngeal
reflex, no pupilar reflex, no corneal reflex,
no mydriasis, suggested us a 3 point
Glasgow coma. The monitor displayed us a
BP of 90/65 mmHg, HR of 100 beats in 1`
(80 in 1` at start), PA Oxygen 98%. A
team consult with anesthesiologists,
cardiologist, neurologists, and orthopedic
surgeons was made immediately and
possible different diagnosis were discussed
(cerebral insult through an AVC or
trombembolic incidence from carotis
possible plaque embolisation, chemical
coma- iatrogenic, etc).
Results: One hour after the onset of the
coma, the intubated patient began to move
the left leg with conscious movement. Five
minutes later, the patient was completely
waked up and was extubated. The
neurologic status was perfect with no
damages. We didn`t loose time; we
reintubated the patient under general
anesthesia and the operation went on till
the two hip implants implanted. The
operation succeeded, the patient walked up
without complications, walked the next
day and was released after 7 days from the
hospital.
Discussion: What happened? As a final
analysis we concluded that the deep sleep
was an iatrogenic complication. The
punching of dura mater during the epidural
anesthesia and the penetrating of Phentanyl
in the CS liquor was the hypothetic cause
of the temporarily deep coma. All other
supposed causes were ignored because the
lack of evidence in their favor.
Keyword; epidural anesthesia,
myorelaxines, acetabular, dura mater…
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235.
Breast Calcification and
Final Breast Cancer Diagnosis
Gjok TOSKU1, Islam MAMICA2, Jona ISAKU3,
Afrim PIRRACI1
1
Radiologist at Mother Teresa University Centre;
Lecturer at UMT, Albania
2
Radiologist at Burrel City Hospital, Burrel,
Albania
3
Imaging Technician; Lecturer at FMTS, U of
Elbasan “A. Xhuvani”, Elbasan, Albania
Abstract
Breast calcifications are small spots of
calcium salts. They can occur anywhere in
the breast tissue. They are very small, so
you won’t be able to feel them, and they
don’t cause any pain.
Breast calcifications are very common and
usually develop naturally as a woman ages.
They are usually benign not cancer.
Having benign breast calcifications doesn’t
increase your risk of developing breast
cancer.
Breast calcifications can occasionally be an
early sign of cancer. Because of this, your
doctor or nurse may want you to have
further tests to check what sort of
calcifications you have.
Breast calcifications are usually found by
chance during a routine
screening ultrasound or mammogram or
during an investigation at a breast clinic for
another breast problem. The calcifications
show up on a mammogram as small white
spots.
In many cases, a mammogram may not
give the radiologists enough information.
The mammogram may not be clear or they
may want to check an area more carefully.
However, further tests will give more
information to make an accurate diagnosis.
Further tests are likely to include a more
detailed mammogram which gives a closeup, magnified, picture of the affected area
or even a core biopsy in order to make the
final diagnosis.
In conclusion, final diagnosis of breast
cancer can be challenging and it may take
further examinations, test and procedures.
AJTES Vol.2 Nr.2 Supplement 2
Regular screening programs are referred as
best ones for early diagnosis.
Keywords: Breast, calcifications, cancer,
examinations, screening
236.
Urinary Tract Stones,
Diagnostic Modalities
Islam MAMICA1
1
Radiologist, Burrel City Hospital, Burrel Albania
Abstract
The lifetime incidence of urinary tract
stones is high, seen in as many as 5% of
women and 12% of males. By far, the most
common stone is calcium oxalate,
however, the exact distribution of stones
depends on the population and associated
metabolic abnormalities.
Traditionally, ultrasonography has a lower
sensitivity and specificity than CT, but
does not require use of radiation. However,
when these imaging modalities were
compared in a randomized controlled trial
they were found to have equivalent
diagnostic accuracy within the emergency
department. Kidney, ureter, bladder (KUB)
plain film radiography is most helpful in
evaluating for interval stone growth in
patients with known stone disease, and is
less useful in the setting of acute stones.
MRI provides the possibility of 3D
imaging without exposure to radiation, but
it is costly and currently stones are difficult
to visualize.
In conclusion, developments are
anticipated to enhance each imaging
modality for the evaluation and treatment
of kidney stones in the near future.
Keywords: Uurinary tract, stones,
ultrasound, CT, KUB, MRI
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237.
Begin Tracheal Stenosis
after prolonged intubation. A case
reports.
Rushan MUHAMETI 1
1
Pneumology service, University Hospital of
Trauma, Tirana, Albania
Abstract
Introduction: Prolonged endotracheal
intubation may lead to altered tracheal
blood flow, resulting in mucosal injury and
scarring followed by tracheal stenosis.
Materials and Methods: We report a case
of the tracheal stenosis after prolonged
endotracheal intubation from balloon cuff
pressures. We have provided endoscopic
images and descriptions of the
bronchoscopic findings along with a brief
discussion of the management for this
complication.
Results: (Case History) A 45-year-old man
was admitted in our clinic 2 month after an
accident from mine in border between
Albania -Kosovo. The patient’s hospital
course was complicated by limited
neurologic recovery, aspiration
pneumonitis, and adult respiratory distress
syndrome requiring an extended period of
mechanical ventilation. In first presentation
he has cough, moderate dyspnea and
malaise. Flexible bronchoscopy was
performed, first from above the
tracheostomy revealing leakage of air
bubbles from around an inflated cuff with
underlying granulation tissue. Erosion of
the mucosa overlying the tracheal rings
was visualized in the region where the
balloon cuff had been positioned. After 21
days the patient results with seriously
tracheal stenosis and tracheal dilatation or
stent was indicated. He had severe dyspnea
and stridor and moderate chest pain.
Follow-up bronchoscopy revealed severe
damage of the tracheal lumen associated
with web-like stenosis and he has been
emergency tracheal stend.
Conclusions: Specifically, patients with
cuffed tracheostomy tubes are at a risk for
complications of balloon over-inflation
resulting in elevated cuff pressures. In the
case presented, we hypothesized that the
AJTES Vol.2 Nr.2 Supplement 2
etiology of the complication described was
multifactorial in nature, resulting from
inadequate monitoring of the cuff pressure
over an extended period of time and in the
timeframe after the repair of a traumatic
injury.
Keywords: cuff pressure, tracheomalacia,
tracheal stenosis
238.
Psoriatic Arthritis: What
Ultrasound can provide us?
Leonard MOLLA ¹, Gjok TOSKU2, 3
1
Rheumatologist, University Hospital Center
“Mother Teresa”, Tirana, ALBANIA
2
Radiologist, University Hospital Center “Mother
Teresa”, Tirana, ALBANIA
3
Lecturer University of Medicine, Tirana,
ALBANIA
Abstract
Psoriases are autoimmune mediated
diseases that caused raised, red, scaly
patches to appear on the skin. Like
psoriasis, Psoriatic Arthritis is an
autoimmune disease, meaning it occurs
when the body’s immune system
mistakenly attacks healthy tissue, in this
case the joints and skin. The faulty
immune response causes inflammation that
triggers joint pain, stiffness and
swelling.Ultrasound (US) is a valuable
imaging technique for detection and
characterisation of the inflammatory
process in arthritides. US has widely been
applied to psoriatic arthritis (PsA) in both
clinical and research fields, especially
focusing on enthesitis. US has proven to be
useful to establish a diagnosis of PsA, to
recognise subclinical involvement, (such as
enthesis abnormalities in patients with
PsA, and in patients with only clinically
apparent skin psoriasis despite the absence
of clinical symptoms of arthritis), to
estimate disease activity, and to allow
therapy monitoring showing structural and
inflammatory changes (not only in joints
and tendons, but also in domains not
assessed in usual rheumatology care, such
as the skin and nails).
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Key words: Psoriatic Arthritis, diagnoses,
Ultrasonography, findings.
239.
Enriched Recovery for
Colorectal Surgery: Discussions
and Forthcoming Challenges
Henri KOLANI1
1
Surgery Service, University Hospital Center
“Mother Theresa”, Tirana, ALBANIA
Abstract
Enriched recovery after surgery protocols
are now achieving worldwide diffusion in
both university and district hospitals with
special interest in colorectal surgery. The
optimization of the patient's preoperative
clinical conditions, careful intraoperative
administration of fluids and drugs and
postoperative encouragement to resume the
normal physiological functions as early as
possible has produced results in a large
amount of studies. These approaches
successfully challenged longstanding and
wellestablished perioperative
managements and finally achieved the
status of gold standard treatments for the
perioperative management of
uncomplicated colorectal surgery.Different
Enriched recovery after surgery protocols
are available for colorectal surgery. In
most of them patients receive a
preoperative functional assessment in order
to target the eventual specific postoperative
requirements, therefore, is provided
adequate care organised for respective
necessities. Also, the preoperative visit
would counsel the patients about the
purposes and goals of the enhanced
recovery addressing their expectations
from the surgical recovery and reassuring
them about the purposes of the early
discharge.
In conlusion, various authors feel that
Enriched recovery after surgeryprotocols
ultimately optimized the patient’s medical
fitness for discharge and that nowadays a
further reduction of length of stay must
relate to changes in the organization of
care and not to shorter recovery periods.
AJTES Vol.2 Nr.2 Supplement 2
This could be obtained in example by
evidencing those social factors that can
delay the discharge and therefore
organizing the available resources outside
the hospitals well in advance the operation.
Keywords: Colorectal, surgery, recovery,
protocols
240.
Trend of Implantology
Arben MUCAJ1, Bashkim MURATI1
1
OroMaxilloFacial Surgeon, and University
Lecturer, Tirana Albania.
Abstract
The advancement in implant dentistry has
led to a significant improvement in the
quality of life of our patients; however,
there are still many controversies and
many unanswered questions.
The trend is towards minimally invasive
surgical procedures with cost effective
dental rehabilitations although many of
these therapeutic approaches are still under
scrutiny. For instance, till date, the
scientific community does not have a
definitive answer to the following issues:
short implants or bone reconstructions and
longer implants, the best reconstructive
approach, the ideal implant surface,
systemic factors negatively influencing
implant cluster failures, the most
appropriate treatment for perimplantitis
and the ideal aesthetic materials for
implant prosthesis, to list a few.
Additionally, clinical and ethical issues
including when teeth should be extracted
and implants placed, are also unclear.
Over the years, we have seen in meetings
and congresses, a dramatic increase in the
extraction of teeth that could be saved. A
defined algorithm for such instances has
not yet been presented and the controversy
still remains open.
Translating evidence into treatment
predictability should be the goal in implant
dentistry in the near future, with emphasis
on an open and honest transparent system
that provides the complete financial
disclosure of every author. This is essential
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in a field like implant dentistry where
conflicts of interest could generate
confounding factors and bias.
Keywords: Implant, dentistry, minimally
invasive, surgical procedure
241.
Assessment of Single
Implants in Mandibular Area
Under Immediate Loading
Bashkim MURATI1, Arben MUCAJ1
1
OroMaxillo Facial Surgeon, and University
Lecturer, Tirana, ALBANIA.
Abstract
The aim of this study was to evaluate the
survival of single dental implants subjected
to immediate function. Twelve patients
with edentulous areas in the posterior
mandible were included in the study. All
received at least one regular platform
dental implant (3.75 mm × 11 mm).
Clinical and radiographic parameters were
evaluated. The survival rate after 12
months was 83.3%. The implants showed
no clinical mobility, had implant stability
quotient values (ISQ; Osstell) around 50,
bone loss of up to 2 mm, and a probing
depth of ≤3 mm. Although the posterior
mandible is an area in which the immediate
loading of dental implants should be
performed with caution, this treatment
presented a good success rate in the present
study sample.
Keywords: Dental implants, posterior
mandible, evaluate, treatment
the anesthesiologist. There are differences
between the adult and pediatric
cardiopulmonary systems, the children
have a higher risk for respiratory failure, so
the emergency is immediately.
In our Emergency room is admitted a little
boy about two years old (brought from his
parents) with an acute respiratory failure.
The boy was with a terminal breathing,
with takipnea and superficial breathing,
without conscience, with cyanosis (SpO2
50%). The parent told us that the child is
choked with cherries. Immediately with the
help ofa videolaringoscopy we see a big
cherry in the entrance of the epiglotic that
made difficult the procces of breathing to
the child. To not lose time we decided that
was better to assure first the airways in
putting a tracheal tube and ventilating him,
so we had time to put off the cherry from
the orofaringeal site, then we put off the
cherry with the help of a cleme meanwhile
the child was being ventilates with 100%
of O2. After this we assured an intravenous
route and sedated the child with propofol.
In the CT scanner made to the child we
sow a pneumonia, so we decided to let him
in mechanical ventilation, with PEEP 3cm
H2O, corticotherapy and antibiotherapy.
After 12 hours the child was extubated, he
was quite, conscient without signs of
respiratory failure, He got out from the
hospital after two days.
243.
Femoral Neck Fracture
Zamir DEMIRAJ 1, Anxhela AHMATAJ 2
Orthopedic service, University Hospital of
Trauma, Tirana, Albania
2
Physical Therapist, University Hospital of
Trauma, Tirana, Albania
1
242.
Airways Management in a
Child with Foreign Body Airway
Obstruction. A Case report.
Brikena DAUTAJ1*, Enriketa JAHO1, Rexhina
STURCE1, Bardhyl KURTI1, Esmerilda BULKU1
1
Anesthesia and intensive Care Service, University
Hospital of Trauma, Tirana, Albania.
Abstract
Children may require intubation for unique
reasons, and pediatric intubation in
emergency room can create challenges to
AJTES Vol.2 Nr.2 Supplement 2
Abstract
Background: Neck of femur fractures
(NOF) are common injuries sustained by
older patients who are both more likely to
have unsteadiness of gait and osteoporosis
(reduced bone mineral density). Femoral
neck fracture in this age-group pose a
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Posters
major problem in three aspects: medical,
economy and social.
It is recommended to intervene in the early
48 first hours, naturally if there is no
contraindication, as the result of
comorbidities which can risk even the
patients’ life.
Surgical treatment of neck of femur
fractures is easier in this age-group and it
includes: partial or total prosthesis. The
most important thing is the return of
patient in the ADL (activity daily life) after
surgery.
The femoral neck fractures are common
even in the adult and pediatric age due to
high energy trauma, like falls from height
or car crashes. The main problem for
medical team consists in the chosing of
surgical treatment option. Between
osteosinthesys and prosthesis we would
naturally choose the osteosinthesys in
pediatrics and young adults.
Another problem based on the
classification of these fractures is whether
we always are successfully in our choice,
to avoid two of the complications of
osteosinthesys: pseudoarthrosis and
avascular necrosis of femur.
The difficulty of choosing is higher
between the ages 55-65. A lot of studies
heve been done for this problem. The
importance stands in the fact that the
disruption of blood supply to the femoral
head can be evidented, which is dependent
on the type of fracture and causes
significant morbidity, diagnosis and
classification of these fractures. These
studies are in experimental phases yet. The
article aims to give a review of literature
concerning femoral neck fractures and
their surgical treatment options
Key words: fracture, femoral neck,
osteosynthesis, prosthesis.
AJTES Vol.2 Nr.2 Supplement 2
244.
Congenital Diafragmatic
Hernia: Segment Hepatic
Herniation Through a Diafragm
Defect Simulating Basal Lung
Nodes
Fadil GRADICA1, Lutfi LISHA1, Dhimitraq
ARGJIRI3, Agron DOGJANI2, Alma CANI4, Fahri
KOKIÇI4, Ylber VATA1, Leon SHPATARAKU1,
Dori BOZAXHIU1.
1
Thoracic and visceral Surgery Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
2
General Surgery and Trauma Service, University
Hospital of Trauma, Tirana, Albania.
3
Pneumology Service, University Hospital “Shefqet
Ndroqi” Tirana, Albania.
4
Anesthesia & Intensive Care Service, University
Hospital “Shefqet Ndroqi” Tirana, Albania.
Abstract
Background: Congenital diaphragmatic
hernia is a major malformation
occasionally found in newborns and
babies. Congenital diaphragmatic hernia is
defined by the presence of an orifice in the
diaphragm, more often to the left and
posterolateral that permits the herniation of
abdominal contents into the thorax.
The aim of this case series is to provide
information on the presentation, diagnosis
and outcome of two patients with latepresenting congenital diaphragmatic
hernias. The diagnosis of congenital
diaphragmatic hernia is based on clinical
investigation and is confirmed by plain Xray films and computed tomography scans.
Materials and Methods: We present three
case reports of asymptomatic abdominal
viscera herniation within the thorax. The
first case concerns a rare type of herniation
in the right side of the thorax of the right
hemithorax a part of the liver parenchyma
in a 65-year-old woman and left side liver
abscess. The second case concerns
herniation of the part of liver into the left
hemi-thorax in a 37-years old woman. The
third case concerns herniation of the
stomach and bowel,omentum and spleen
into the left side of the chest with
compression of the left lung in a 55-yearold man. This type of hernia may appear
later in life, because of concomitant
respiratory or gastrointestinal disease, or it
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may be an incidental finding in
asymptomatic adults.
Conclusions: Patients who present with
late diaphragmatic hernias complain of a
wide variety of symptoms, and diagnosis
may be difficult. Additional investigation
and research appear necessary to better
explain the development and progression
of this type of disease. Surgery is treatment
of choice.
Keywords: Congenital diaphragmatic
hernia, surgical treatment, hernioplastics
245.
Management of
Emergency Splenectomies. Our
Experience in the Regional
Hospital of Durres.
Agron DOMI1*, Denis GODAJ1, Shkelqim
FERKO1, Fitim SHINI1, Anton NDOJ1
1
Surgery Department, Regional Hospital of Durres,
Albania
Abstract
Introduction: The aim of this two years
retrospective, monocentric study (held in
Department of Surgery, Regional Hospital
of Durres) is to describe the demographic,
circumstances and etiology, clinical and
diagnostic features, grade of injury as well
as treatment of patients who underwent
emergency splenectomy. The spleen is the
most often injured solid organ in trauma.
Methods and Methods: We conducted the
study in the interval between 01.09.2014
and 01.09.2016. We analyzed 18 clinical
charts of hospitalized patients who
underwent emergency splenectomy in our
hospital.
Results: Demography: 18 patients as 13
Male (72%) and 5 females (28%).Study
group’s average age of patients is 29 (±12)
years old, males 26 (±14) and females 39
(±7). Etiology: car accident (politrauma)
10 patients, closed trauma (falling,
physical attack etc.) 5 patients, blunt
trauma 3 patients. Diagnose: All patients
underwent abdominal CT and US, TBC.
Injury grade was based in the CT and US
examination. Grade I- 4 patients, Grade II
AJTES Vol.2 Nr.2 Supplement 2
– 4 patients, Grade III – 3 patients, Grade
IV – 6 patients, Grade V – 1 patient.
Treatment: 15 patients underwent
splenectomy, 3 patients underwent
splenorrhaphy.
Conclusion: Spleen injury is a common
emergency in our department. Usually it is
not an isolated problem and is included in
the treatment of a politrauma. Mostly
affects young patients in the second and
third decade of life. Considering the
important role of the spleen in the
immunologic system a more careful
evaluation should be made whether to
perform splenectomy in low grade injuries.
Keywords: emergency splenectomies,
management, trauma
246.
Our Experience Using CMac Videolaringoscope Device for
Intubation
Silvana LEKA1*, Rexhina STURCE1, Flutura
BALLA2,
1
Department of Anaesthesiology-Intensive Care,
University Hospital of Trauma, Tirana, Albania.
2
Anaesthetist Nurse, University Hospital of
Trauma, Tirana, Albania.
Abstract
The management of airway is the first
thing to do when you a deal with a trauma
patient. Often, the situation is not easy, not
only because the politraumatized patient
can be a high score Mallampati, but the
mouth full of blood, mandibular- maxillae
fracture, the need for not moving the head
in extension cause of the neck
immobilization are our everyday theatres.
When intubation of this patients is needed,
direct laryngoscopy is not always possible.
From almost one year and a half our
hospital provided the C Mac
videolaryngoscope and all the
anaesthesiologists staff feel more secure in
everyday work.
The device is a portable, battery operated
video laryngoscope that resembles a
standard Macintosh blade. The intubation
technique is identical to conventional
Macintosh laryngoscopy with the
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additional aid of a magnified video view
for the difficult intubations.
From our experience and from a lot of
randomized control trials in the difficulty
intubation is demonstrated that C-MAC
device offers a better laryngeal view, more
successful intubations on the first attempt,
shorter laryngoscopy and intubation times,
decreased needs of adjuncts, exert less
force on maxillary incisors
The C-MAC videolaryngoscope is a very
good tool for tracheal intubation teaching
and as a university hospital we really love
it.
As for every new technology, with
videolaryngoscopy, the main challenges
for the intubator are to become familiar
with the view on the monitor and
coordinate the eyes and hands
appropriately.
As a conclusion in our hospital we have
included this device in the initial step of
difficult airway management.
AJTES Vol.2 Nr.2 Supplement 2
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Index
A Arapi, 68
A Dizdari, 97
A. Bejleri, 11
A. Koni, 35
A. Lenjani, 19
A. Nake, 109
A. Nurçe, 109
A. Pere, 82
A. Simaku, 130
A. Veseli, 130
A.Sinaj, 72
Adamantia Koutava, 36
Admir Mustafa, 64, 69
Adrian Hoti, 64
Adrian Nelaj, 15, 100
Aferdita Ademi, 71
Afrim Pirraci, 139
Afrim Tahiri, 115
Afron Mici, 82
Agron Dogjani, 10, 44, 64, 82, 86, 101, 102,
111, 125, 131, 133, 134, 143
Agron Domi, 144
Agron Menzelxhiu, 82
Aida Lako, 91
Ajruli B, 132
Alan Andonovski, 93, 96
Alban Hysenaj, 97
Alban Rushiti, 111
Albana Aleksi, 28, 121
Albana Doko, 103
Albana Kenga, 127, 128, 129
Albana Kreca, 103
Albana Shahini, 65
Albenc Dervishi, 90
Albert Pesha, 35
Albulena Baloku, 126
Alda Kika, 46
Aleksandar Saveski, 50, 52, 132
Aleksandar Trajanovski, 50, 52, 132
Aleksander Hoxha, 27
Alesio Bocari, 16
Alfred Gega, 51
Alfred Ibrahimi, 27
Ali Devaja, 15, 126
Alma Cani, 28, 82, 143
Alma Llukacaj, 117
Almir Skana, 67
Altin Habazaj, 137
Altina Xhaferi, 66
Aman Gapbarov1, 116
Amarildo Blloshmi, 131
Anastasika Poposka, 97
Andonovska B, 93,96
Andrijan Kartalov, 63
AJTES Vol.2 Nr.2 Supplement 2
Anila Belchishta, 97, 135
Anila Racaj, 61
Anisa Liço, 123
Anton Milo, 86
Anton Ndoj, 35, 144
Antonio Catona, 13
Antonio Gavrilovski, 50, 52, 132
Anxhela Ahmataj, 71, 142
Apostol Vaso, 48
Arben Beqiri, 13
Arben Gjata, 9, 123, 124
Arben Gjonej, 72, 73
Arben Haxhihyseni, 83
Arben Mucaj, 141, 142
Arben Rroji, 46
Arber Demiri, 31
Arbëresha Gurguri, 73
Ardiana Sinani, 108, 109
Ardita Osmani, 71
Arian Hamiti, 109
Arian Hodo, 34
Arjan Mezini, 106
Arjana Sina, 68
Arlind Myftari, 102
Arnel Mici, 49, 77, 97
Arsen Seferi, 46
Arsim Ajeti, 15, 126
Arta Kushi, 102, 103
Artan Gjika, 64, 69
Artid Duni, 51, 52, 97
Artid Lame, 46, 47
Arvin Dibra, 15, 114, 125
Arvit Llazani, 14
Asead Abdyli, 29, 37
Astrit Hoxhaj, 69
Astrit Kalenja, 82
Astrit Mustafa, 34, 36, 101
Astrit Peka, 72, 73
Astrit Xhemali, 15
Athanasios Lazaridis, 34
Aulona Haxhirexha, 102, 106
Avenir Balili, 84
Ayman El-Menyar, 22, 62, 80
Bajram Begaj, 105
Bardhyl Kurti, 142
Bashkim Murati, 141, 142
Basri Lenjani, 19, 31, 56, 57
Baton Kelmendi, 111, 112
Bedri Braha, 115
Bedri Mihaj, 34
Berat Lenjani, 19, 56, 58
Besim Boci, 16
Besmir Bulku, 68
Bilbil Hoxha, 35
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Index
Blerim Arapi, 29, 37
Blerim Fejzuli, 71
Blerim Zeqiri, 22
Blerina Bregu, 18
Blerta Hamolli, 49, 77
Blerta Hasalla, 87
Boris E. Sakakushev, 24, 99, 114, 115
Braha B., 15
Brikena Dautaj, 142
Carlos Mesquita, 43
Cem Ilgın Erol, 116
Claudio Taglia, 16
Constantinos Adamou, 36
D Ferizi, 35
D. Selmani, 109
D. Xhemalaj, 82
Dafina Matoshi, 111
Damla Beyazadam, 116
Daniela Bimi, 70, 74
Daniela Georgieva, 97
Daniela Vercuni, 83
Danny Daphnis, 84
Dardan Lenjani, 31, 56, 58
Dariel Thereska, 14, 123
Deniona Nunci, 14
Denis Godaj, 144
Denis Kosovrasti, 127, 128, 129
Devid Belalla, 123
Dhimitraq Argjiri, 82, 106, 143
Dimitrios Kotsiris, 36
Dominika Vrbnjak, 25, 120
Dorela Vasha, 108, 109
Dori Bozaxhiu, 143
Dorian Habili1, 60, 97
Dorian Meta, 75
Dorina Shtjefni, 45, 55
Doruntina Klenja, 135
Drini Shehi, 15, 125
Dritan Todhe, 59, 93, 138
E. Koliçi, 109
E. Shima, 28
Earta Gega, 101
Eda Luzaj, 32
Edison Halili, 128
Edison Ndreka, 32
Edlira Kukeli, 58
Edmond Kapedani, 127, 130
Edmond Nuellari, 127, 128, 129, 130
Edmond Pistulli, 109
Edvin Prifti, 79, 80
Edvin Selmani, 51, 73, 94, 95
Ejona Celiku, 101
Ejona Lilamani, 46
Elfije Krasniqi, 56, 57
Eljona Xhelili, 15
Elona Gjylbegu, 85
AJTES Vol.2 Nr.2 Supplement 2
Elona Hasalla, 87, 89
Elona Markeci, 55, 101
Elona Naqellari, 40
Elvi Sota, 91
Elvina Shaba, 105
Emilija Stojkovska-Pemovska, 76
Emiljano Pjetri, 12
Emir Q. Haxhija, 44, 81
Engjellushe Jonuzi, 44
Eni Mehmeti, 68
Enkeleda Sinaj, 91
Enkelei Balla, 79
Enriketa Jaho, 142
Enton Bollano, 14, 123
Enver Fekaj, 11, 115
Erald Xhelili, 30
Ergys Cami, 51, 52, 97
Erion Spaho, 47
Erisa Mane, 87
Eriselda Taulla, 105
Erjona Zogaj, 75
Ermira Muco, 102, 103
Ermira Pajaj, 46, 47
Erton Karafili, 66, 67
Ertugilda Hoxhaj, 32
Ervin Bejko, 129
Erza Voca Mulaj, 19,31, 56
Esen Uysal, 31, 56, 57
Esmerilda Bulku, 30, 142
Etmont Celiku, 15,100, 101,117 125
Eugen Tata, 37
Evangelos Liatsikos, 36
Evisa Zhapa, 36
F. Krasniqi, 109
Fadil Gradica, 28, 82, 106, 143
Fahri Kokiçi, 82, 143
Fahri Kokiҁi, 28
Fatime Lenjani, 19
Fatjona Kamberi, 73, 88
Fatjona Shehu, 133
Fatmir Brahimi, 94, 95
Faton Hoxha, 15
Faton T. Hoxha, 126
Fausto Catena, 41, 54, 62
Ferat Sallahu, 11
Ferit Muharemi, 124
Ferizate Dika – Haxhirexha, 102, 106, 125
Fitim Shini, 144
Floren Kavaja, 15
Flutura Balla, 144
Fotios Dimitriadis, 34
Francesco Saverio Grossi, 36
Gani Çeku, 111, 112
Gani Shabani, 31, 56, 57
Gazmend Zylbeari, 102
Genc Kabili, 84, 86
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Index
Gentian Huti, 29, 37
Gentian Zikaj, 120
Gentjana Haskja, 88
Gezim Galiqi, 35
Gezim Guri, 64, 69
Gezim Xhepa, 120
Gjergji Belba, 120
Gjergji Caushi, 51, 52, 97
Gjergji Çaushi, 49
Gjergji Semini, 34, 36
Gjok Tosku, 139, 140
Gjorgji Jota, 63
Gledion Fejzo, 47
Goran Begovic, 63
Gramoz Brace, 46, 47
Granit Ramizi, 134
Gresjeta Vata, 32
Grigorios Daligaros, 34
Guido Bassi, 51, 52
H. Gjergo, 130
Hava Vangjeli, 32
Hektor Sula, 26
Helidon Nina, 82
Henri Kolani, 15, 100, 101, 141
Herion Dredha, 37
Hysni Bendo, 111, 133
Hysni Jashari, 111, 112
I. Vishi, 35
Ibrahim Avdiu, 82
Igor Kaftandziev, 95
Ilaz Miftari, 124
Ilber Besimi1, 124
Ilda Taka, 87
Ilia Mazniku, 58, 76, 87
Ilir Alimehmeti, 104
Ilir Hasani, 8, 9, 21, 40, 42, 50, 52, 61, 92, 93,
95, 96, 132
Ilir Hasmuca, 78, 97
Ilir Kajo, 105
Ilir Lumi, 66, 75
Ilir Shabani, 93
Ilir Shani, 64
Ilir Ukimeri, 126
Indrit Bimi, 70, 74
Indrit Jaupaj, 30, 33
Inida Ruli, 123
Irena Kola, 91
Irena Shala, 12
Irena Tresa, 90
Irnis Biščo, 110
Islam Mamica, 139
J. Profili, 68
Jahja D, 52
Jakup Vrioni, 17
Jasenka Škrlin, 98
Jasmina Kröpfl, 25, 120
AJTES Vol.2 Nr.2 Supplement 2
Jasmina Veseli Arslani, 122
Jetlir Rashiti, 126
Jetmira Kerxhalliu, 46, 47
Jeton Shatri, 20
John E. Francis, 37, 118
Jona Isaku, 72
Jonida Mehmeti, 102, 103
Jonida Tula, 106
Jordan Saveski, 8, 21, 40, 76, 92
Jovica Ugrinovski, 20
Julian Kraja, 89
Kamnar V, 52
Kastriot Haxhirexha, 44, 102, 111, 125
Kenan Karavdić, 110, 118
Kilda Gusha, 12
Kimete Kadesha, 90
Kiril Lozanche, 20
Kledisa Harizi, 56, 58
Klejdi Latifi, 91
Klevis Thomai, 16, 17
Klodian Hyka1, 86
Korab Sejdini, 51, 52, 97
Kostandinos Zotos, 34
Krenar Lilaj, 14
Krenar Preza, 67
Kreshnike Dedushi, 69
Kujtim Alimeri, 64, 69
L. Agolli, 28
Lazo Jovcheski, 59
Leard Duraj, 94, 97
Leart Berdica, 107, 108
Ledia Kaci, 106
Ledian Fezollari, 51, 52, 97
Leon Kaza, 85, 86
Leon Shpataraku, 143
Leonard Molla, 140
Lindita Saja, 91
Liridon Nuredini, 135
Ljupco Nikolov, 95
Ljuzim Agai, 20
Lorena Haxhihyseni, 17, 18
Loreta Agolli, 106
Luan Nikollari, 11
Luljeta Stanaj, 49, 61
Lulzim Q. Maloku, 126
Lutfi Lisha, 82, 143
Lutfi Zhegu, 82
Lutfi Zylbeari, 102, 125
Majlinda Naço, 117
Maksim Çela, 66, 67
Maksim Gjoni, 85
Manushaqe Saraçi, 49, 61
Marija Atanasova, 63
Marinela Kumaraku, 113
Marion Sako, 18
Marjan Kamiloski, 61
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Index
Marjeta Tanka, 112
Marjola Qatipi, 77
Marko Spasov, 95
Marsela Sopiqoti, 129
Mauro Zago, 10, 23, 43
Medien Xhaferi, 66
Mentor Petrela, 22, 46
Merita Zeka, 27
Miftari F, 15
Migena Ishmakej, 131
Mihal Kërçi, 40
Milan Samardziski, 52
Mirel Grada, 46
Mishel Qirinxhi, 47
Mustafa Xhani, 37
Myfit Saraci, 46
Myftar Torba, 55
Myriam Hunink, 104
Myzafer Kaçi, 15, 125, 129
N. Elshani, 64
Naim Dizdari, 101
Naime Çullhaj, 90
Nardi Kola, 120, 121
Natasha Merko, 64, 91
Neada Hoxha, 103
Neada Hoxha, 102
Neda Trajkovska, 8, 21, 40, 76, 92
Nehat Baftiu, 38, 39
Neritan Myderrizi, 53
Nexhmi Hyseni, 111, 112
Niketa Kolici, 85
Nikollaq Kaçani, 123, 124
Norik Bardhi, 46, 47
Nuhi Arslani, 13, 99, 122
Oliver Arsovski, 95
Orhan Alimoglu, 24, 55, 62, 116
Orjada Gashi, 17, 18
Ornela Çela, 134
Ornela Nuredini, 106
Ozgur Ekıncı, 25, 116
Panagiotis Kallidonis, 36
Panteleimon Ntasiotis, 36
Pascal Gervaz, 63
Petraq Mustaqe, 121
Petrika Gjergo, 127, 128, 129, 130
Petrit Biberaj, 103
Philippe Konstandinidis, 63
Pirro Prifti, 38
Premtim Rashiti, 56, 57
Preveza Abrashi, 115
Q .Arapi, 72
Qemal Rushiti, 63
R. Baftiu, 39
R. Baftiu, 38
Ramadan Sopa, 126
Reshat Mati, 126
AJTES Vol.2 Nr.2 Supplement 2
Rexhep Selmani, 63
Rexhina Sturce, 142, 144
Rezar Deveja, 27
Rezart Xhani, 37
Rezeart Dalipi, 50, 52, 96, 132
Ridvan Alimehmeti, 46, 47
Rifat Bajrami, 115
Rifat Latifi, 7, 23, 53, 98, 111
Rinard Kortoci, 29, 37
Risida Gjonej, 72, 73
Risto Cholanchevski, 135
Rovena Bode, 100
Rovena Lico, 108
Rrustem Musa, 15, 126
Rudin Domi, 26, 29
Rudina Degjoni, 12
Rufadije Vejseli, 124
Rushan Muhameti, 140
Rustem Celami, 84, 85, 86
Sadi Bexheti, 20, 102
Saimir Heta, 113
Salih Grajcevci, 112
Samardziski M, 132
Sami Bytyci, 63
Sasa Milenkovic, 42
Selda Veizaj, 91
Selim Çerkezi, 20
Selim Horeshka, 40
Serbeze Kabashi Mucaj, 69
Serdi Memini, 51, 97
Sevdije Koxha, 106
Shahini L, 15
Shemsedin Hashani, 15, 126
Shkelqim Ferko, 35, 53, 144
Shkelqim Met’hasani, 27
Shkelzen Osmanaj, 44, 82, 101
Shpetim Ymeri, 35
Shpresa Hashimja, 126
Shqipe Luta, 103
Silvana Leka, 144
Simon Trpeski, 22, 50, 59, 132
Skender Brataj, 30, 32, 33
Skënder Brataj, 56, 57
Skender Buci, 45, 55, 82
Skender Saidi, 33
Skender Veliu, 25, 120
Skender Zatriqi, 11, 115
Sokol Buba, 112
Sokol Isaraj, 119, 120, 121
Sokol Ruci, 55
Sokol Shehu, 27
Sokol Xhepa, 127, 128, 129
Sonja (Saraçi) Butorac, 64, 69
Stavri Llazo, 129
Stephan Frenzel2, 7
Stojan Potrči, 13
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2nd Annual Albanian Congress of Trauma and Emergency Surgery Index
Sulejman Baha, 87
Sulejman Sokoli, 122
Tatjana Spirovska, 63
Teodora Todorova, 50, 52, 132
Teona Bushati, 107, 108
Teuta Abazi, 124
Thoma Qirjazi, 27
Thomas B. Whittle, 54, 126
Tunc Eren, 116
Valbona Selmani, 94
Valdete Kaloshi, 58
Vangjush Lekgjika1, 86
Vasil Miha, 106
Vera Gjinaj, 12
Vesel Skenderi, 115
Veton Ademi, 20
Vidi Demko, 64, 68, 69
Vilma Cadri, 103
Vilmos Vécsei, 7, 41
AJTES Vol.2 Nr.2 Supplement 2
Vilson Ruci, 51, 52, 97
Viola Selmani, 106
Viola Shuteriqi, 112
Violeta Zatriqi, 11
Vrenoz Hodaj, 137
Xheladin Draçini, 100, 117
Xhesika Xhetani, 64
Ylber Vata, 82, 143
Ylber Zama, 97
Ylli Ziqishti, 82
Ymer Durmishi, 63
Zamir Demiraj, 51, 71, 77, 142
Zamira Bexheti, 102
Zamira Shabani, 12
Zef Delia, 86
Zojë Demaj, 92
Zoran Bozhinovski, 50
Zoran Karadzov, 63
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Organised by
Albanian Society for Trauma &
Emergency Surgery (ASTES)
3rd Annual Albanian Congress of Trauma &
Emergency Surgery
November 7 – 9, 2019
Tirana International Hotel
Tirana , Albania
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