Volume 3 Number 2 Supplement 3 November 2019

Focus on "Trauma and Emergency Surgery" and not only...

Official publication of

ASTES

ISSN: 2521-8778 (print version) ISSN: 2616-4922 (electronic version)

Volume 3 - Number 2 - Supplement 3 November 2019

Focus on “Trauma and Emergency Surgery” and not only…

official publication of

ISSN: 2521-8778 (print version) ISSN: 2616-4922 (electronic version)

M & B publications

Albanian Journal of Trauma and Emergency Surgery AJTES

official Publication of the Albanian Society for Trauma International Editorial Board Advisory Expert and Emergency Surgery -ASTES Prof. Fausto CATENA MD, PhD FACS () Chairman of the editorial board: Prof. Andrew BAKER MD, PhD, FACS (South Africa) Prof. Eliziana PETRELA, MD, PhD Asc. Prof. Agron Dogjani MD, PhD, FACS FISS () Prof. Joakim JORGENSEN MD, PhD, FACS (Norway) University of Medicine, , Albania Prof. Selman URANUES MD, FACS () EditorEditor in in Chief Chief Prof. Dietrich DOLL MD, PhD, FACS () Prof. John E. FRANCIS MD, PhD, FACS (USA) Asc.Prof. Rustem CELAMI MD, PhD (Albania) Asc.Prof. Rustem CELAMI MD, PhD (Albania) Prof. Thomas B. WHITTLE MD, PhD (USA) Assistant Editors Deputy Editors Prof. Sadi BEXHETI MD, PhD (Macedonia) Deputy Editors Prof. Vilmos VECSEI, MD, PhD (Austria) Prof. Lutfi ZYLBEARI MD, PhD (Macedonia) Asc.Prof. Pantelis VASSILIU MD, PhD, FACS (Greece) Hysni BENDO MD Amarildo BLLOSHMI MD Prof.Asc.Prof. Lutfi Rudin ZYLBEARI Domi MD, MD, PhD PhD (Albania) (Macedonia) Prof. Massimo SARTELI MD, PhD, FACS (Italy) Ilir ALIMEHMETI MD, PhD (Albania) Prof. Jordan SAVESKI MD, PhD (Macedonia) Erion SPAHO MD Asc.Prof.Edvin SELMANI Rudin Domi MD, MD,PhD PhD(Albania) (Albania) Artan Bano MD, (Albania) Sonja SARACI MD Edvin SELMANI MD, PhD (Albania) Prof. Carlos MESQUITA MD, PhD (Portugal) Prof. Mauro ZAGO MD, FEBS, FACS (Italy) IlirNational ALIMEHMETI Editorial MD, BoardPhD (Albania) Prof. Boris SAKAKUSHEV MD, PhD () Asc.Prof. Majlinda Naço, MD, PhD. (Albania) Prof. Kenan FERATI MD, PhD (Macedonia) Prof. Arben GJATA MD, PhD Asc. Prof. Rudin DOMI MD, PhD Asc.Prof. Sasa MILENKOVIC MD, PhD () NationalUniversity Editorialof Medicine, Board Tirana, Albania University of Medicine, Tirana, Albania Prof. Bellal A. JOSEPH MD, FACS (USA) Asc. Prof. Besim BOCI MD, PhD Prof. Claudio TAGLIA MD, PhD (Italy) Prof. Xheladin DRAÇINI MD, PhD Asc. Prof. Bajram BEGAJ MD, PhD Prof. Arben GJATA MD, PhD UniversityUniversity of Medicine,Hospital of Tirana, Trauma, Albania Tirana, Albania Asc. Prof. Basri LENJANI MD, PhD () UniversityUniversity ofof Medicine,Medicine, Tirana,Tirana, Albania Albania Prof. Nikollaq KAÇANI MD, PhD Asc.Prof.Asc. Prof. Fadil Besim GRADICA BOCI MD, MD, PhD PhD Prof. D`'Archivio LAFRANCO MD, DDS (Italy) Prof. Xheladin DRAÇINI MD, PhD University of Medicine, Tirana, Albania UniversityUniversity of Medicine,of Medicine, Tirana, Tirana, Albania Albania Prof. Orhan ALIMOĞLU MD, PhD (Turkey) UniversityProf. Etmont of Medicine, ÇELIKU Tirana,MD, PhD Albania ArtidAsc.Prof. LAME Fadil MD, GRADICA PhD MD, PhD Prof. Mehmet KURTOĞLU MD, PhD (Turkey) University of Medicine, Tirana, Albania Prof. Mehmet ERYILMAZ MD, MBAH (Turkey) Prof.University Nikollaq of Medicine, KAÇANI Tirana, MD, PhD Albania University of Medicine, Tirana, Albania UniversityProf. Arben of BEQIRIMedicine, MD, Tirana, PhD Albania ArsenAsc. Seferi Prof. ArbenMD, PhD HAXHIHYSENI MD, PhD Prof. Kenan KARAVDIC MD, PhD (Bosnia Herzegovina) Prof.University Etmont of Medicine,ÇELIKU Tirana,MD, PhD Albania UniversityUniversity of Medicine,of Medicine, Tirana, Tirana, Albania Albania Asc. Prof. Bogdan DIACONESKU MD, PhD () (Macedonia) UniversityProf. Ilia MAZNIKUof Medicine, MD, Tirana, PhD Albania SokolArtid ISARAJ LAME MD, PhD Kastriot HAXHIREXHA MD, PhD University of Medicine, Tirana, Albania Ilir HASANI MD, PhD Prof.University Arben “Alexander BEQIRI MD, Xhuvani”, PhD , Albania (Macedonia) UniversityArsen Seferi of Medicine, MD, PhD Tirana, Albania Rexhep SELMANI MD, PhD (Macedonia) UniversityProf. Arvin of DIBRA Medicine, MD, Tirana, PhD Albania AlfredUniversity IBRAHIMI of Medicine, MD, PhD Tirana, Albania Asc. Prof. Nehat BAFTIU MD, PhD (Kosovo) Prof.University Ilia MAZNIKU of Medicine, MD, Tirana, PhD Albania University of Medicine, Tirana, Albania Prof. Skënder TOPI MD, PhD Sokol ISARAJ MD, PhD Asc.Prof. Nuhi ARSLANI MD, PhD () University “Alexander Xhuvani”, Elbasan, Albania Marsida Krasniqi, MD, PhD University “Alexander Xhuvani”, Elbasan Albania University of Medicine, Tirana, Albania Floren KAVAJA MD, PhD (Kosovo) Prof. Arvin DIBRA MD, PhD University of Medicine, Tirana, Albania Prof. Edvin PRIFTI MD, PhD Alfred IBRAHIMI MD, PhD Hysni JASHARI MD, PhD (Kosovo) University of Medicine, Tirana, Albania Dritan TODHE MD, PhD University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Shqiptar DEMACI MD, PhD (Kosovo) Asc. Prof. Edmond NUELLARI MD, PhD UniversityDritan TODHE of Medicine, MD, Tirana, PhD Albania Asc. Prof. Edmond NUELLARI MD, PhD UniversityUniversity ofof Medicine,Medicine, Tirana,Tirana, Albania Albania GëzimUniversity GALIQI of Medicine, MD, PhD Tirana, Albania Asc.Prof.Asc.Prof. SokolSokol XHEPA MD,MD, PhD ShkodraGëzim Regional GALIQI Hospital, MD, PhD Albania Shkodra Regional Hospital, Albania UniversityUniversity ofof Medicine,Medicine, Tirana,Tirana, Albania Albania Leart BERDICA MD, PhD Leart BERDICA MD, PhD Asc.Prof.Asc.Prof. AleksanderAleksander HOXHAHOXHA MD,MD, PhDPhD University of Medicine, Tirana, Albania

University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Myzafer KAÇI MD, PhD Asc.Asc. Prof.Prof. Ridvan ALIMEHMETI MD, MD, PhD PhD Myzafer KAÇI MD, PhD UniversityUniversity of Medicine,of Medicine, Tirana, Tirana, Albania Albania UniversityUniversity ofof Medicine,Medicine, Tirana,Tirana, AlbaniaAlbania ShkëlzenShkëlzen OSMANAJ OSMANAJ MD, MD, PhD PhD Prof.Prof. PirroPirro PRIFTI MD, PhD University Hospital of Trauma, Tirana, Albania University “Alexander Moisiu”, Durres, Albania University Hospital of Trauma, Tirana, Albania Mail Address: Str. Lord Bajron, 1026, Tirana, Albania University “Alexander Moisiu”, Durres, Albania Zamir DEMIRAJ MD, PhD Asc.Prof. Sokol BUBA MD, PhD Zamir DEMIRAJ MD, PhD Electronic Address: E-mail.: [email protected] [email protected] Asc. Prof. Edmond ZAIMI MD, PhD University of Medicine, Tirana, Albania UniversityUniversity Hospital Hospital of Trauma,of Trauma, Tirana, Tirana, Albania Albania University of Medicine, Tirana, Albania Asc. Prof. Edmond ZAIMI MD, PhD HenriGjergj Kolani SEMINI MD, MD,PhD PhD Design & Layout: Hysni Bendo Asc.University Prof. Rudinof Medicine, DOMI Tirana, MD, PhD Albania GjergjAmerican SEMINI Hospital MD, Albania,PhD Tirana, Albania Printed: M&B Publications University of Medicine, Tirana, Albania American Hospital Albania, Tirana, Albania ISSN: 2521-8778 (print version) ISSN: 2616-4922 (electronic version)

Albanian Journal of Trauma and Emergency Surgery AJTES International Editorial Board Assistant Editors

Prof. Fausto CATENA MD, PhD FACS (Italy) Hysni BENDO MD official Publication of the Albanian Society for Trauma InternationalProf. Andrew BAKER Editorial MD, BoardPhD, FACS (South Africa) AdvisoryBlerjana Expert Shqepa MD and Emergency Surgery -ASTES Prof. Joakim JORGENSEN MD, PhD, FACS (Norway) Prof.Prof. Fausto Selman CATENA URANUES MD, MD,PhD FACS (Italy)(Austria) Chairman of the editorial board: Prof.Prof. Andrew Dietrich BAKER DOLL MD, MD, PhD, PhD, FACS FACS (South (Germany) Africa) Prof. Eliziana PETRELA, MD, PhD Asc. Prof. Agron Dogjani MD, PhD, FACS FISS (ALBANIA) Prof.Prof. Joakim John JORGENSENE. FRANCIS MD, MD, PhD, PhD, FACS FACS (USA)(Norway) University of Medicine, Tirana, Albania Prof.Prof. Selman Thomas URANUES B. WHITTLE MD, FACS MD, PhD(Austria) (USA) Editor in Chief Prof.Prof. Dietrich Sadi BEXHETI DOLL MD, MD, PhD, PhD FACS (Macedonia) (Germany) Prof. John E. FRANCIS MD, PhD, FACS (USA) Asc.Prof. Rustem CELAMI MD, PhD (Albania) Prof. Vilmos VECSEI, MD, PhD (Austria) Prof.Asc. Thomas Prof. Pantelis B. WHITTLE VASSILIU MD, MD,PhD PhD,(USA) FACS (Greece) Assistant Editors Deputy Editors Prof.Prof. Sadi Massimo BEXHETI SARTELI MD, PhD MD, (Macedonia) PhD, FACS (Italy) Prof. Vilmos VECSEI, MD, PhD (Austria) Prof. Carlos MESQUITA MD, PhD (Portugal) Prof. Lutfi ZYLBEARI MD, PhD (Macedonia) Asc.Prof. Pantelis VASSILIU MD, PhD, FACS (Greece) Hysni BENDO MD Prof. Mauro ZAGO MD, FEBS, FACS (Italy) Amarildo BLLOSHMI MD Asc.Prof. Rudin Domi MD, PhD (Albania) Prof. Massimo SARTELI MD, PhD, FACS (Italy) Ilir ALIMEHMETI MD, PhD (Albania) Prof. Boris SAKAKUSHEV MD, PhD (Bulgaria) Erion SPAHO MD Edvin SELMANI MD, PhD (Albania) Prof. Jordan SAVESKI MD, PhD (Macedonia) Artan Bano MD, (Albania) Prof.Prof. Carlos Bellal MESQUITA A. JOSEPH MD, MD, PhD FACS (Portugal) (USA) Sonja SARACI MD Prof.Prof. Mauro Claudio ZAGO TAGLIA MD, FEBS, MD, PhD FACS (Italy) (Italy) National Editorial Board Prof.Asc. Boris Prof. SAKAKUSHEV Basri LENJANI MD, MD, PhD PhD (Bulgaria) (Kosovo) Prof.Prof. Kenan D’Archivio FERATI LAFRANC MD, PhDO (Macedonia) MD, DDS (Italy) Prof. Arben GJATA MD, PhD Asc. Prof. Rudin DOMI MD, PhD Asc.Prof.Prof. Mehmet Sasa MILENKOVIC ERYILMAZ MD, PhDMBAH (Serbia) (Turkey) University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Prof.Prof. Bellal Kenan A. JOSEPHKARAVDIC MD, MD, FACS PhD (USA) (Bosnia Herzegovina) Prof. Claudio TAGLIA MD, PhD (Italy) Prof. Xheladin DRAÇINI MD, PhD Asc. Prof. Bajram BEGAJ MD, PhD Asc. Prof. Bogdan DIACONESKU MD, PhD (Romania) University Hospital of Trauma, Tirana, Albania University of Medicine, Tirana, Albania Asc.Kastriot Prof. Basri HAXHIREXHA LENJANI MD, MD, PhD PhD (Kosovo) (Macedonia) Asc. Prof. Besim BOCI MD, PhD Prof. D`'Archivio LAFRANCO MD, DDS (Italy) Prof. Nikollaq KAÇANI MD, PhD Ilir HASANI MD, PhD (Macedonia) University of Medicine, Tirana, Albania Prof. Orhan ALIMOĞLU MD, PhD (Turkey) University of Medicine, Tirana, Albania Asc. Prof. Nehat BAFTIU MD, PhD (Kosovo) Prof. Etmont ÇELIKU MD, PhD Asc.Prof. Fadil GRADICA MD, PhD Prof. Mehmet KURTOĞLU MD, PhD (Turkey) University of Medicine, Tirana, Albania Prof.Asc. Mehmet Prof. Nuhi ERYILMAZ ARSLANI MD, MD, MBAH PhD (Turkey)(Slovenia) University of Medicine, Tirana, Albania Asc. Prof. Basri Lenjani MD, PhD (Kosovo) Prof. Arben BEQIRI MD, PhD Asc. Prof. Arben HAXHIHYSENI MD, PhD Prof. Kenan KARAVDIC MD, PhD (Bosnia Herzegovina) University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Asc. Prof. Bogdan DIACONESKU MD, PhD (Romania) Prof. Ilia MAZNIKU MD, PhD Artid LAME MD, PhD Kastriot HAXHIREXHA MD, PhD (Macedonia) University “Alexander Xhuvani”, Elbasan, Albania University of Medicine, Tirana, Albania Ilir HASANI MD, PhD (Macedonia) Arsen Seferi MD, PhD Rexhep SELMANI MD, PhD (Macedonia) Prof. Arvin DIBRA MD, PhD University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Asc. Prof. Nehat BAFTIU MD, PhD (Kosovo) Prof. Skënder TOPI MD, PhD Sokol ISARAJ MD, PhD Asc.Prof. Nuhi ARSLANI MD, PhD (Slovenia) University “Alexander Xhuvani”, Elbasan Albania University of Medicine, Tirana, Albania Floren KAVAJA MD, PhD (Kosovo) Alfred IBRAHIMI MD, PhD Hysni JASHARI MD, PhD (Kosovo) Prof. Edvin PRIFTI MD, PhD University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Shqiptar DEMACI MD, PhD (Kosovo) Dritan TODHE MD, PhD Asc. Prof. Edmond NUELLARI MD, PhD University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Asc.Prof. Sokol XHEPA MD, PhD Gëzim GALIQI MD, PhD Shkodra Regional Hospital, Albania University of Medicine, Tirana, Albania Leart BERDICA MD, PhD Asc.Prof. Aleksander HOXHA MD, PhD

University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Myzafer KAÇI MD, PhD Asc. Prof. Ridvan ALIMEHMETI MD, PhD University of Medicine, Tirana, Albania University of Medicine, Tirana, Albania Prof. Pirro PRIFTI MD, PhD Shkëlzen OSMANAJ MD, PhD University “Alexander Moisiu”, Durres, Albania University Hospital of Trauma, Tirana, Albania Mail Address: Str. Lord Bajron, 1026, Tirana, Albania Asc.Prof. Sokol BUBA MD, PhD Zamir DEMIRAJ MD, PhD Electronic Address: E-mail.: [email protected] [email protected] University of Medicine, Tirana, Albania University Hospital of Trauma, Tirana, Albania Asc. Prof. Edmond ZAIMI MD, PhD Gjergj SEMINI MD, PhD Design & Layout: Hysni Bendo University of Medicine, Tirana, Albania American Hospital Albania, Tirana, Albania Printed: M&B Publications ISSN: 2521-8778 (print version) ISSN: 2616-4922 (electronic version)

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts Book

Albanian Journal of Trauma and duce and distribute all of the articles printed

Emergency Sur-gery is the official in thejournal. No material published in the publication of AlbanianSociety journal may bestoredon microfilm or for Trauma and Emergency Surgery - ASTES videocassettes or in electron-ic databases and

the like or reproduced photograph- ically without the prior written permission Structure and Format ofAJTES. AJTES is an open access, peer reviewed periodical journal that includes editorials, Permissions re-views,original articles, case reports, For information on how to request short report,ideasand opinions, permissions toreproduce bookreviews, perspectives,sem-inars, articles/information’s from this symposium and mini- symposium, ethics journal, please contact Editorial Office. andrights, health care policy and management, practiceguides. The structure of each edition of the publi-cation Advertising policies comprises section categories determined by The journal accepts displayed and classified Editor and reflects the views of the Editorial adver-tising. Frequency discounts and

Board. special position areavailable.The journal

reserves the right to reject anyadvertisement

Editorial Expertise considered unsuitable according tothe set policies of the journal. The appearance of Guidance from Editorial Board consists of leadingauthorities from a variety and advertising or product information in the respective fields ofmedical science. Peer varioussections in the journal does not review-accomplish by expertselected for constitute an en-dorsementor approvalby their experience and knowledge of a the journal and/oritspub-lisherofthequality specific topic. or value of the said product or of claimsmade for it by its manufacturer.

Important notice for Author All manuscript must be submitted to the Disclaimer EditorialOffice through electronic post; The information and opinions presented in e-mail: [email protected]. Please check the theJournal reflects the views of the author last page of each edi-tion “Instruction for and notof the Journal or its Editorial Board Author”: The work shall not bepublished or the Pub-lisher. elsewhere in any language without the Publication does not constitute written consent of AJTES. The articles endorsement bythe journal. published inthis journal are protected by copyright, which covertranslation rights and the exclusive right to repro-

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts Book

Albanian Journal of Trauma and duce and distribute all of the articles printed

Emergency Sur-gery is the official in thejournal. No material published in the

journal may bestoredon microfilm or publication of AlbanianSociety videocassettes or in electron-ic databases and Albanian Journal of Trauma and Emergency Surgery 2019 for Trauma and Emergency Surgery - ASTES Volume 3, Number 2, Supplement 3 the like or reproduced photograph- ISSN: 2521-8778 (print version) ically without the prior written permission Structure and Format ISSN: 2616-4922 (electronic version) ofAJTES. AJTES is an open access, peer reviewed periodical journal that includes editorials, Permissions re-views,original articles, case reports, For information on how to request short report,ideasand opinions, permissions toreproduce bookreviews, perspectives, sem- inars, articles/information’s from this Abstracts symposium and mini- symposium, ethics journal, please contact Editorial Office. andrights, health care policy and management, practiceguides. The structure 3rd Annual Albanian Congress of Trauma and Emergency of each edition of the publi-cation Advertising policies comprises section categories determined by The journal accepts displayed and classified Surgery Editor and reflects the views of the Editorial adver-tising. Frequency discounts and

Board. special position areavailable.The journal

reserves the right to reject anyadvertisement

ASTES Editorial Expertise considered unsuitable according tothe set policies of the journal. The appearance of Guidance from Editorial Board consists of leadingauthorities from a variety and advertising or product information in the respective fields ofmedical science. Peer varioussections in the journal does not November 8- 9 review-accomplish by expertselected for constitute an en-dorsementor approvalby their experience and knowledge of a the journal and/oritspub-lisherofthequality Tirana, Albania specific topic. or value of the said product or of claimsmade for it by its manufacturer.

Important notice for Author Congress President: All manuscript must be submitted to the Disclaimer Agron Dogjani

EditorialOffice through electronic post; The information and opinions presented in theJournal reflects the views of the author P resident of Honour: e-mail: [email protected]. Please check the Carlos Mesquita last page of each edi-tion “Instruction for and notof the Journal or its Editorial Board Author”: The work shall not bepublished or the Pub-lisher. elsewhere in any language without the Publication does not constitute written consent of AJTES. The articles endorsement bythe journal. published inthis journal are protected by copyright, which covertranslation rights and the exclusive right to repro-

official Publication of the Albanian Society of Trauma and Emergency Surgery - ASTES . Aims and Scope Contents: Our aim is to promote interest, knowledge and quality of care in emergency and trauma surgery. ASTES was formed in 2017, it seeks to ORAL PRESENTATIONS 7 promote best practice in the provision of emergency and trauma surgery and acute care surgery, from pre- hospital care through POSTER PRESENTATIONS 128 diagnosis, intervention and intensive care to rehabilitation. This is supported by Countrywide INDEX 140 & 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 (AJTES). ASTES also

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

ORAL PRESENTATIONS Abstract This presentation reflects the author's OP - 001 involvement in internationally recognized education and training models, as ATLS, Direct Peritoneal Resuscitation in Open ETC and DSTC, and in the Portuguese and Abdomen Management UEMS Boards of Emergency Surgery Do different countries need very different Hayato KURIHARA things? I don’t think so, for the simple reason that in Europe and about the challenges we Authors Information: face, with regard to trauma and other medical Humanitas Research Hospital, Head, Emergency and surgical emergencies, similarities are Surgery and Trauma SectionDepartment of much greater than differences. General Surgery,Rozzano, Milan, ITALY • We all agree on the need for a trauma system “to assure that patients (…) Abstract seamlessly receive the proper care, in the Introduction:Damage control surgery is a proper locations, with proper staged approach to the trauma patient in interventions and, if necessary, transfer extremis that improves survival, but leads to to a hospital able to provide the best and open abdominal wounds that are difficult to most appropriate care” (www.aast.org). manage. We evaluated whether directed • We all agree that teamwork is necessary peritoneal resuscitation (DPR) when used as a for prehospital care, transportation, resuscitation strategy in severely injured emergency room care, intensive care, trauma patients with hemorrhagic shock surgery and in/post-hospital requiring damage control surgery would rehabilitation. affect the amount of and timing of • We all agree on the need for trauma resuscitation and/or show benefits in time to registries with, as much as possible, abdominal closure and reduction of intra- global follow-up of patient's course. abdominal complications. • And finally, we all agree that it is Open a abdomen strategy is new standard of necessary to educate, how to prevent and care for many acute surgical and traumatic how to treat. abdominal injuries. One of the main This is also apparent from the challenges is related to delayed abdominal recommendations of the European Trauma closure and fascial retraction. Direct Course Organization (ETCO) about peritoneal resuscitation is associated with equipment and facilities: complete trauma improved outcomes in these patients. team, trauma admission bay close to the The damage control strategy shortens the ambulance entrance, enough space and interval to definitive fascial closure without adequate lighting, adjacent operating room to affecting overall resuscitation volumes. As a allow emergency procedures, standard result, this mitigates intra-abdominal equipment for the initial management of complications associated with open abdomen major trauma, immediate availability of and damage control surgery and affords better additional equipment as difficult airway patient outcomes. equipment, X-ray, ultrasound machine, surgical instruments, readily available blood OP - 02 products and massive transfusion equipment, co-located CT scanner to allow immediate Training in Trauma Surgery, imaging and access to angiography and Challenges and Impact on Survival interventional radiology, 24 hours a day within 30-60 minutes of request. Carlos MESQUITA OP - 003 Author Information: General and Emergency Surgery Departments – Trauma Center, Coimbra Central and University Preperitoneal Pelvic Packing in Pelvic Hospital, PORTUGAL Fractures: When and How?

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Hayato KURIHARA but the new European residency rules in the Nineties compelled the University system to Authors Information: cancel it. As a consequence, the emergency Humanitas Research Hospital, Head, Emergency surgeon has been traditionally considered as Surgery and Trauma Section, Department of “a general surgeon somehow dealing with General Surgery, Rozzano, Milan, ITALY emergency” and therefore treating on a part- time basis, and without specific training, Abstract patients admitted to the Emergency Introduction: Severe pelvic trauma is one of Department for acute surgical illness or the most severe injury in trauma. A trauma, who not only deserve specific multidisciplinary approach and local surgical attention under a technical point of algorithm should be mandatory in any view, but also show a peculiar institutions accepting injured patients. physiopathology deserving an “intensive Preperitoneal pelvic packing is part of a care” approach usually not fully addressed by “pelvic trauma protocol” and represent a good a general surgeon. alternative or complementary adjunct to the Recently, specific attention has been given in bleeding control pathway. Patients with Italy to an increasing peculiar workload for hemodynamic instability due to pelvic the emergency surgeon, especially after the fracture-related bleeding can have life- new laws introducing the emergency and threatening hemorrhage. Management options trauma network as a core part of the National for hemorrhage control in complex pelvic Health Service. Thus, this specialty, based on fractures include bony stabilization, the concept of Acute Care Surgery introduced angioembolization, and preperitoneal pelvic in the USA with its five pillars (trauma, non - packing (PPP). The indications for PPP as traumatic emergency, intensive care, elective well as the operative technique and outcomes surgery, rescue surgery), is gaining a new will be described in this review. PPP directly recognized role and specific emergency and addresses the bony and venous bleeding of trauma wards are increasingly introduced at complex pelvic fractures, which results in the least in the most important Emergency and majority of blood loss in exsanguinating trauma centers. patients. As such, PPP should be considered Keywords:general surgeon, Emergency for pelvic fracture patients who remain Department, emergency surgery, trauma hemodynamically unstable despite red cell transfusion. OP - 005 Keywords: Hemodynamically unstable;

Hemorrhage; Pelvic fracture; Pelvic packing. An Organisation of Trauma Departments in

OP - 004 Slovenia, A view from a Regional Hospital

Present and Future of Emergency Teodor PEVEC,Simona KALŠEK Surgery as Independent Specialty in Italy: Is the Rescue Surgery Turning the Authors Information: Underdog into A Hero? General Hospital Ptuj, SLOVENIA

Antonio La GRECA Abstract Public health service is organized in such a Author Information: manner so as to ensure all the inhabitants of Department of Emergency Surgery, Catholic the Republic of Slovenia the emergency University of the Sacred Heart, School of medical assistance available at all times, Medicine, Rome, ITALY including emergency transport and provision

of emergency medicinal products as soon as Abstract possible and as close to the date of their Introduction: Early in the Eighties, Italy was manufacture as possible and during transport. a pioneer country in teaching emergency Emergency medical assistance means the surgery as an independent specialty. At the implementation of necessary measures by time, a specific residency program was active,

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts doctors and their teams with persons whose transport time and therapy during transport life is imminently threatened due to illness or has made it possible to improve PT outcomes. injury and persons, respectively, who could Discussing the epidemiology and mechanism be affected by such a risk in a short period of of injury in polytrauma and principles of time according to the symptoms. Emergency evaluating policy at all levels; during calls are received and processed by the transport, in the emergency department, in the emergency medical assistance service which intensive care unit, in the operating room, forms an integral part of the public health postoperative care until the patient leaves the service network. hospital. Slovenia, officially the Republic of Slovenia, Identification of evaluation criteria for trauma is a sovereign state located in southern patient such as: primary, secondary and Central Europe at a crossroads of important tertiary assessment. European cultural and trade routes. It covers Examine the elements of hospital 20,273 square kilometers and has a management related to accident time, mode population of 2.07 million.We can see a great of transport (ambulance, car accident, progress in the care of trauma patients.A airway), transportation time etc and their basic-measures with which we have made impact on the performance of PT. better results than in past are: better Emergency Assessment Techniques of trauma prehospital treatment, a network of hospitals, patient in Emergency department… an ATLS concept, a score evaluation Keywords:Trauma, management, trauma systems.Challenges for the futures are: assessment. dispatchers centers, even better prehospital treatment and better interhospital OP - 007 transmissions. Keywords:Trauma, patients, prehospital ATLS® Course Albania Brunch Step by Step treatment. Agron DOGJANI1, Arben GJATA2, Xheladin 2 2 OP - 006 DRACINI , Arvin DIBRA ,Kastriot HAXHIREXHA3; Alfred IBRAHIMI4, Fadil 5 6 Polytrauma Trauma score Challenges in GRADICA , Rustem CELAMI , Skender BRATAJ7, Basri LENJANI8, Hysni BENDO7, Management 1 8 Edvin SELMANI , Erjona ZOGAJ .

Agron DOGJANI 1General Surgeon, University Hospital of Trauma, Tirana, ALBANIA. Author Information: 2Lecturer at University of Medicine of Tirana; General Surgeon, University Hospital of Trauma, General Surgeon, Tirana, ALBANIA. Tirana, ALBANIA 3General Surgeon at HospitalofTetovo, RN of Abstract MACEDONIA. INTRODUCTION: Trauma is the leading 4Anesthesia and Intensive Care Service,” Mother cause of death for the population of 1-44 Theresa” Tirana, ALBANIA. 5 years old and occupies the third place after Lecturer at University of Medicine of Tirana; cancer and cardiovascular disease in all age University Hospital “Shefqet Ndroqi” Thoracic Surgery Service Tirana, ALBANIA. groups. As a result of the improvement of the 6 treatment strategy for traumatized patients, Head of Medical Lab & Imagery Department, ALDENT University, Tirana, ALBANIA we have a reduction in post-traumatic 7Director of National Center of Medical morbidity and mortality from 40% in the Emergency, Tirana, ALBANIA. 1970s to 10% in the new century. These 8Director of Emergency Clinic, University achievements consist mainly of improving Clinical Center of Kosovo, ,KOSOVO trauma treatment standards by defining pre- 9General Physician, National Center of Medical and in-hospital treatment algorithms that are Emergency, Tirana, ALBANIA. 10 ® already applied in most countries. ATLS Coordinator Albania Branch; Imagery Implementation of the concept for transport Service; University Hospital of Trauma, Tirana, time of trauma patient which reduces ALBANIA.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract Abstract For more than 20 years, following the Introduction: Acute cholecystitis (AC) is the changes that took place in Albania in 1992, most frequent complication of cholelithiasis we receive information from trauma patients and one of the most common conditions in the media about the delivery of trauma services. Police records are worthy of a war requiring emergency surgery in the elderly. balance report. Trauma is estimated to be the Cholelithiasis accounts for 90%–95% of all cause of deaths in 13.7% / 100,000 people. causes of AC, while acalculous cholecystitis Every two days three Albanian Citizens die accounts for the remaining 5%–10 because of Automobile Accidents… Changes The elderly is at high risk to present an have already taken place, but the question arises, who cares about the trauma and its episode of AC, and up to 6% of elderly management? Formerly and now the state ... patients will experience severe AC. ok ... but? Is this enough? Laparoscopic cholecystectomy (LC) is The Ministry of Health should have a currently the gold standard for the “Trauma Committee” if yes… is it active? management of acute calculous cholecystitis, Already of the three years at the heart of these medical emergency management networks is with preference for early intervention. In the a National Center of Medical Emergency elderly, however, disease characteristics, (NCME). comorbidities, and poor functional status The trauma service delivery is now evolving augment the risks associated with surgical along the lines of a central and spoken model intervention, which may result in increased with a concentration of expertise and morbidity and mortality. Most literature specialization in the center surrounded by smaller units that feed from the center. The consider as elderly patients those whose age study showed a 19% increase in the chances is equal or greater than 65 or 75 years, of survival since the Introduction of these though these thresholds may not be the most changes. Another 1,600 trauma victims are appropriate from the practical point of view. alive today due to developments in the In the present aging society with frail administration of trauma patients in England patient’s acute cholecystitis represents an over the past six years. everyday challenge in most surgical teams. In this system or mode of organizing what is A correct stratification of frailty in the elderly today the NCME or organizing the transport patient is therefore mandatory. of traumatized from the scene to the Multidisciplinary approach and alternative University Hospital of Trauma... by medical surgical and endoscopic techniques are staff who have done a substantial part of the ® helpful to obtain the best possible outcome PhTLS course ... How is educational status for these population of patients. of personal in other regions far from Capital? ® KEYWORDS: Acute calculous cholecystitis, ATLS student courses in our country have Elderly, Frailty, High-risk patients, been implemented by few and individually… Diagnosis, Surgery, Antibiotics ASTES, by default rules, has acquired the ® right to organize ATLS in Albania… OP - 009

OP - 008 Duodenal fistulas surgical strategies and the role of negative pressure wound therapy Acute Cholecystitis in Frail Patient Antonio La GRECA Hayato KURIHARA Authors Information: Authors Information: Assistant Prof and Senior Staff General, Emerg. Humanitas Research Hospital, Head, Emergency Trauma, Rescue, Acute Care Surgery; Vascular Surgery and Trauma SectionDepartment of Access, Advanced Ultrasound, Rome, ITALY General Surgery,Rozzano, Milan, ITALY

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract Abstract Introduction:Duodenal fistulas usually INTRODUCTION: Acute appendicitis is a follow the breakdown of a previous suture. very common emergency surgery disease. All They have a deep anatomical location, over the world as well as in our emergency consent the transit of enteric fluid rich in hospital the question of surgical options activated enzymes, have a very high output remains. and present problems of skin care1. Mortality The aim is to determine the dependence and rates range from 7 to 40%. Their treatment intensity of post-op pain for acute appendix usually consists in multiple surgical patient. interventions, often by means of damage Materials&Methods: The following criteria control procedures due to local and systemic were used while assessing the pain; Patient’s adverse conditions. Damage control means assessment of pain on a scale from 1 to 10 avoiding new sutures on the duodenum or any during post-op care prior to taking painkillers; intestinal anastomosis and allowing duodenal The frequency of painkillers injection in 24 output to exit the abdomen in an easy and hours; Surgical options: appendectomy, direct way in order not laparoscopic appendectomy, appendectomy to contaminate the peritoneal cavity. Tubes with drainage of the abdominal cavity, inside or in the proximity of the duodenal laparoscopic appendectomy with drainage of hole usually serve this purpose. the abdominal cavity. The study has been Good drainage in complex, infected or also undertaken by Surgery Department #1, deep wounds can be achieved by negative Cherkasy Emergency Hospital, since pressure wound therapy (NPWT), removing March 2019 till August 2019… from every site of the wound with the use of Results: We have 39 patients so far: 22 gauzes and/or open cell polyurethane foam women and 17 men with acute appendicitis and a suction device. Moreover, the sealed diagnosis (phlegmonous, catarrhalis, wound care improves infection control and gangrenous) who required surgical treatment. patient management. Previous The average age of women is 31.6 years contraindications to NPWT in case of (between 19 and 68 years). The average age exposed bowel (such as in an entero- of men is 29,3 years (between 18 and 48 atmospheric fistula) have been replaced by an years). The average days of receiving extensive peri-visceral use thanks to newly inpatient care-3.3 days…. designed foams and suction techniques. Conclusions:Pain intensity and the frequency However, specific descriptions of NPWT for of painkillers injection for acute appendix the treatment of duodenal fistulas are not patients depend on the surgical options. reported. We designed an effective NPWT Laparoscopic appendectomy gives better application after reporting three clinical cases result in pain reduction during post-op care in of successful duodenal breakdown fistula comparison to common appendectomy which treatment in the context of rescue surgery. causes considerable pain during post-op care. Alternative techniques, such as endoscopic Drainage has almost impact on pain intensity drainage with special prosthetic and suction Keywords:Pain Acute appendicitis, approaches, including endoluminal NPWT, phlegmonous, catarrhalis, gangrenous… might also be effective. Keywords:Duodenal fistulas, Good drainage, OP – 011 Damage control Synchronous Colorectal Cancer, a Concern OP –010 of Diagnosis and Treatment, our Case Series

1,2 1 Impact of Acute Appendicitis Surgical Faton T. HOXHA , Rrustem MUSA , Shemsedin 1 1 4 Options on Intensity of Pain at post-Op HASHANI , Floren KAVAJA , Arb F. HOXHA , Ali DEVAJA1, Ferdinand KOMANI1, Shpresa Care 1 1 HASIMJA , Arsim AJETI , Fisnik KURSHUMLIU3 SerhiiMITSUK1, Ihor HAIDA1, Borys BILYK1

Authors Information: Authors Information: 1University Clinical Hospital Service of Kosovo, 1Cherkasy Emergency Hospital, UKRAINE Surgery Clinic, Pristina, KOSOVO; 11 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

2University of Gjakova “Fehmi Agani”, Medical Authors Information: Faculty, Gjakova, KOSOVO 1Surgeon, Surgical ward, General Hospital dr. 3 Institute of Anatomic Pathology, Medical Jože Potrč Ptuj,SLOVENIA Faculty, University of Pristina, KOSOVO 2 Nurse for controlling hospital infection, General 4Trakya University, Medical Faculty,Edirne, TURKEY Hospital Ptuj SLOVENIA 3Ass. Professor, University of Maribor Faculty of Abstract Health Sciences, Maribor, SLOVENIA Introduction: Synchronous colorectal cancers, defined as two or more lesions in the Abstract same patient at the same time at diagnosis, In the recent years cholelithiasis has become are rare and deed a great challenge for one of the most common conditions affecting treatment. the digestive system worldwide. It affects Materials and Methods: In five years, 375 patients underwent different colonic approximately one tenth of the adult resections for colorectal cancer at the population, with the higher incidence in Department of General and Abdominal women. Symptoms are only present in 20- Surgery at the University Clinical Center of 30% of the affected population. In the article Kosovo. In the same group of surgically we present the causes, symptoms, diagnostic treated patients in elective end emergency, tools available for screening as well as the 1.07%, 2 males and 2 females, were current treatment guidelines for cholelithiasis. diagnosed intraoperatively with synchronous colorectal cancers (SCRCs). One of them The reason for gallstone formation is in previously treated for Ulcerative Colitis. obesity, increased levels of cholesterol, Importance of preoperative diagnosis such as increased age and certain medications barium enema which may failed at the especially oral contraceptives. The most presence of annular carcinoma or inadequate common symptoms are pain in the right upper bowel preparation and retained feces failure abdomen and in the epigastric area. The to inadequate bowel preparation and retained diagnosis is made based on the clinical feces, or failure to perform completion colonoscopy at annular carcinoma, may be presentation, laboratory findings and crucial intraoperatively to palpate the entire ultrasound of the abdomen. Current colon carefully before the end of the guidelines for conservative and surgical operation for CRC so that a misdiagnosis of management of cholelithiasis are presented SCRCs can be avoided. Full modern with the emphasis on laparoscopic radiological investigations are precondition cholecystectomy being the golden standard prior to the operation especially when the tumor is at an earlier histological stage. for the treatment cholelithiasis. Statistical Failure to diagnose leads to errors in figures and results of operative treatment of treatment and poor prognosis. patients with cholelithiasis at General Conclusions: Palpation of the entire colon Hospital dr. Jože Potrč Ptuj, Slovenia for the carefully before the end of the operation for period of 2013–2017 are presented as well. CRC may reduce the risk of maltreatment of Keywords:Cholelithiasis, conservative Synchronous colorectal cancers. treatment, surgical treatment, laparoscopic Keywords: Colorectal cancer, synchronous, surgery. cholecystectomy, guidelines.

OP –012 OP –013

Treatment of Patients with Symptomatic The Influence of Ursodeoxycholic Acid in Cholelithiasis Liver Functional Restoration in Patients with Obstructive Jaundice after Endoscopic Skender VELIU1, Jasmina KRÖPFL2, Dominika Treatment 3 VRBNJAK

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Enver FEKAJ¹*, Preveza ABRASHI¹, Vesel OP –014 SKENDERI¹, Afrim TAHIRI¹, Besim SERMAXHAJ¹ The National Emergency System and its Extension throughout the Territory of the Author Information: Republic of Albania. ¹Department of abdominal surgery, University Clinical Centre of Kosovo, Skender BRATAJ Pristina, KOSOVO Author Information: Abstract Director of National Center for Emergency Introduction:The most common causes of Medicine, Tirana, ALBANIA. obstructive jaundice are choledocholithiasis, strictures of the biliary tract, Abstract cholangiocarcinoma, carcinoma of pancreas, INTRODUCTION: Saving people’s lives, pancreatitis, parasites and primary sclerosing guaranteeing their life quality, reducing cholangitis. patients’ disabilities, alleviating the suffering Materials and Methods:In this prospective, of patients with chronic diseases and randomized, open-labeled, and controlled preventing morbidity and mortality is the goal study, 62 patients were enrolled. After of the National Emergency System. Our diagnosis, eligible patients with obstructive mission is accomplished through proper jaundice who met inclusion criteria were organization, discipline, ethical, deontological randomly divided in the investigation group and professional working standards, (n= 31) in which has been administered standardized protocols, national and UDCA, and in the control group (n= 31). international guidelines, evidence-based UDCA administration started twenty-four medicine and continuous updating of hours after endoscopic treatment. contemporary scientific information. The Results:The difference of the average values once fragmented, chaotic, not organized pre- of total and direct bilirubin, between the hospital emergency system was sporadic, groups, was statistically significant at day 0 uncoordinated, and the dispatcher who (p<0.05), but at other evaluation days was not received the calls for medical help was the statistically significant, while the difference same who would go and give medical help. of the average values of ALT, AST, GGT, There were no control mechanisms, no ALP, N/L ratio, urea, glucose, and creatinine, protocols and no possibility of registering between the groups, was not statistically phone calls or patient medical records. significant (p>0.05). The difference of the Thereupon it was impossible to do scientific average values of albumin, between the research, data collection, time to time groups, was statistically significant at the evaluation in order to improve the service. days 5, 10, and 15 (p<0.05). Today we are talking about an integrated Conclusions:UDCA has accelerated reducing system, well organized and based on modern the level of total bilirubin, direct bilirubin, standards. How does this system really work? GGT, and neutrophil/lymphocyte ratio, but The Coordination Unit to the National did not decrease the level of ALT, AST, and Emergency Center is the brain, the command, alkaline phosphatase, and did not induce and the control center. It is composed of increasing of albumin level. UDCA had several functional units or operating rooms greater impact on GGT than in other that are: Evaluation, Management, Control, functional liver parameters. The effect of and Maxi Emergency Unit. In the UDCA did not depend on the gender and the Coordination Unit, each call for medical age of patients, but did depend on the assistance is evaluated via telephone triage etiology of obstructive jaundice. It was more into the following steps: the location of the effective in patients with choledocholithiasis citizen at the time he/she is seeking help, the than in patients with malign stenosis of disease classification, the worsening code, biliary tree. and where the citizen is calling from. All this Keywords:obstructive jaundice, ursodeo- procedure is done electronically through an xycholic acid, treatment with UDCA integrated program where every call is registered under the law, with the possibility

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts of its immediate hearing, archiving and 1283 traffic accident interventions in 2918. collecting data and statistics for scientific The largest number was in August – 198 Research. cases (15.4 %) while the lowest number was Keywords:National Emergency System, 127, in May – 69 (5.4%). Emergency Care, National Centre for Emergency Medicine (NCEM). CONCLUSION: The main factor of traffic accidents remains human factor. OP –015 Traffic accidents increase the incidence of death and disability in general population. Safety in Road Communication and Role of Laws and their obedience, technical condition pre-Hospital Emergency Service of vehicles, road infrastructure are also factors tha influence the number of traffic Isuf BAJRAMI¹, Bujar ², Avdyl accidents. PACOLLI², Haki DRAGUSHA², Amire DRAGUSHA², Muhamet PETROVA ², Norik Enforcing Emergent Medical Services, HOXHA² promoting and educating the population, institutional cooperatin, have positive impact Authors Information: in reducing the number of traffic accidnts, Centre of Emergency Medicine, Pristina, decreasing mortality and disability caused by KOSOVO traffic accidents. Abstract Keywords: traffic accident, medical urgency, Introduction:Around 1.25 million people die fatality, security. each year due to traffic accidents. OP - 016 Traffic accident injuries are the leading cause Telephone Basic Life Support (BLS-T). of death in the most productive age group – 20-45 years old. 20 to 50 million people end Skender BRATAJ up with injueries, disability because of traffic accident injuries. Half of those who lose their Author Information: life in road accidents are active participants in Director of National Center for Emergency traffic – pedestrians, cyclists, bikers. If no Medicine, Tirana, ALBANIA. preventive measures are taken, it is expected Abstract that in year 2030 traffic accidents will be the Introduction:Saving a patient's life is the leading cause of death in general. medical art as well as ancient and beautiful as Material And Methods:data for this paper is difficult and that requires dedication. Saving extracted from QMU and archive protocols. I people’s lives and guaranteeing their life have cooperated with Emergency Centre of quality is the mission of the National UCCK, and Kosovo Police – Pristina regional Emergency System. Our mission is accomplished through proper organization, unit.Retrospective method of research and discipline, ethical, deontological and afterwards descriptive and analytical method professional working standards, standardized has been applied. protocols, national and international RESULTS: According to Police statistics, guidelines, evidence-based medicine and the largest number of accidents in traffic in continuous updating of contemporary Kosovo have taken place in year 2013 - 5541 scientific information. The phone call toward 112/ 127 and the voice of the doctor or nurse cases. The lowest number was registered in that answers are the first hope of every citizen 2003 – 5541 cases. The largest number of that his life is safe. Hello, emergency service, accidents with casualties have taken place in how can I help you? This is the first moment year 2009 with 176 casualties, while 2016 that the medical professional takes over your had the lowest number – 110 casualties. The life! Centre of Urgent Medicine in Pristina had This is where the protocol of telephone cardiopulmonary resuscitation, the battle

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

against time, the battle against the disease, the a short Introduction. Primary successful battle against death begins. The brain is the outcome was a correct placement of the pen main organ that suffers from lack of oxygen. The brain damage begins after 6 minutes of barrel and was determined by the thoracic cardiac arrest and after 10 minutes the lifting in a mouth-to-pen resuscitation. damage becomes irreversible. This is why the Results: Eight (80%) participants performed immediate start of resuscitation maneuvers a successful approach to the upper airway means buying time and stopping it at the moment these maneuvers are started. The with a thoracic lifting at the end. Five lifesaving maneuvers will be continued by the participants performed a cricothyroidotomy medical team that arrives at the destination. and three performed an unintentional After the CPR is adequately executed and the tracheotomy. Injuries to muscles and cartilage patient follows all the chain of survival, he will not only be saved but he can also have a were common, but no major vascular damage normal life otherwise he will die or never was seen in the post-procedural autopsy. wake up. The Telephone CPR protocol However, mean time in the successful group provides for a series of actions coordinated by was 243 s. emergency medical professionals…. CONCLUSION: In this cadaveric model, Keywords:first aid, BLS-T, National Centre for Emergency Medicine (NCEM) bystanders with variable medical knowledge were able to establish an emergency OP –017 cricothyroidotomy in 80% of the cases only using a pocketknife and a ballpoint pen. No Bystander Cricothyroidotomy with Household Devices major complications (particularly injuries of arterial blood vessels or the oesophagus) Haqif GASHI occurred. Although a pocket knife and ballpoint pen cricothyroidotomy seem a very Author Information: Head of Anesthesia, Intensive Care and extreme procedure for a bystander, the results Paintherapy RoMedKlinik Bad Aibling, of our study suggest that it is a feasible option GERMANY in an extreme scenario. For a better outcome, Abstract the anatomical landmarks of the neck and the Introduction:In various motion pictures, incision techniques should be taught in medical TV shows and internet chatrooms, emergency courses. non-medical devices were presented as tools Keyword:Bystander, Cricothyroidotomy, for life-saving cricothyroidotomies. However, Anästhesie, Intensivmedizin, there is uncertainty about whether it is Schmerztherapie. possible for a bystander to perform a cricothyroidotomy and maintain gas exchange OP – 018 using improvised household items. This study examines the ability of bystanders to carry Intraosseous Access as Part of Reanimation out an emergency cricothyroidotomy in fresh in Emergency Setting human cadavers using only a pocket knife and a ballpoint pen. Haqif GASHI Materials and Methods: Two commonly Author Information: available pens and five different pocket Head of Anesthesia, Intensive Care and knives were used. Ten participants with no or Paintherapy RoMed Klinik Bad Aibling, GERMANY only basic anatomical knowledge had to choose one of the pens and one of the knives Abstract and were asked to perform a Introduction:Intraosseous access or cricothyroidotomy as quickly as possible after Intraosseous infusion is a form of application in which infusions or medications are

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts administered intraosseous (into the bone organize a prehospital system, specifically marrow cavity). For this purpose, a steel tourist health centers, that would function cannula is pierced into the bone, over which only during the summer season. The planning the substances can be administered due to the and organization processes were based on the good blood circulation of the bone marrow territory, the number of visitors, the distance cavity. from regional and municipal hospitals and the infrastructure. In 2015, 22 tourist health Intraosseous access is often used in child centers were opened, which followed 25 in emergencies, as it is sometimes difficult to 2016, 26 in 2017-2018 and reaching 28 in puncture the small veins with a vein cannula. 2019. All health centers were provided with a In principle, however, it can be used at all telephone number available to the ages and is increasingly used in adults. Coordination Unit for medical coordination. Intraosseous access is a comparable The National Emergency Center, in order to alternative to the venous catheter in the further improve the medical service in these infusion of fluid, drug administration and areas, but mostly to shorten the time of arrival blood collection. In an emergency, all to the patient decided to place an ambulance common medications and blood products can near these centers, so it was possible to cover be applied, and blood samples are also the medical needs in all tourist areas. In 2015 possible. Advantages of intraosseous there were 19,000 visits, in 2016 the number puncture are the rapid application and high of visits increased by almost 37% (26,000 success rates (>80%) with a low risk of visits), in 2017 the number of visits almost complications. The disadvantages are the doubled (about 40,000). In the last two years, higher cost of material and a limited flow rate this number has grown at a very large of puncture needles in some systems. percentage leading to 49,921 visits in 2018 OP – 019 and a record of 69,850 visits in 2019.The new organization of this service puts us in front of Health Care Centers During Tourist Season, a new challenge to meet the increasing Challenges and Innovations in Managing demands from year to year. Planning means Medical Emergencies preventing, so it's good that new challenges come with an already proven to be successful Skender BRATAJ service. Keywords:tourist care, seasonal health Author Information: centers, national emergency medical centre Director of National Center for Emergency Medicine, Tirana, ALBANIA. OP – 020

Abstract Helicopter, Excellence Service of the Introduction:Albania is a coastal country National Center for Emergency Medicine. with a large number of beautiful beaches, frequented by many people. In the summer Skender BRATAJ, Erald XHELILI season in Albanian territory there is an Author Information: increase in the number of local and foreign Director of National Center for Emergency visitors. During this season many citizens Medicine, Tirana, ALBANIA. move from urban areas to coastal towns and beaches, which are often far from major cities Abstract and away from hospitals. 4 years ago, was Introduction:Helicopter medical emergency made evident that with the permanent service is the best option to cope with organization of the health system, the time of emergency medical emergencies and in areas arrival in case of medical emergencies and without infrastructure. Modernization and accidents in the coastal areas, was very long completion, not only because of modern and the risk to citizens' lives was medical equipment and devices, but more considerable. That is why the Ministry of because of legal adaptation and new Health and Social Welfare and the National mentality, where every Albanian or foreign Emergency Center decided to plan and patient in the territory of the Republic of

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Albania is guaranteed life and treated with the prehospital emergency trauma care. The same devotion and professionalism. mission of PHTLS is to promote excellence in This service is already equipped with on- trauma patient management by all providers board medical equipment that is needed involved in the delivery of prehospital care. tomonitor, defibrillate, immobilize and treat PHTLS is developed by NAEMT in patients at the scene, during transport, to cooperation with the American College of more specialized health centers. The novelty Surgeons' Committee on Trauma. The of this topic is about introducing rigorously Committee provides the medical direction and prepared medical staff to deal with the variety content oversight for the PHTLS program. of problems encountered during lifesaving NAEMT's international education activities operations. began in 1991 with the establishment of an The purpose of this study is to reflect and NAEMT training center in Mexico to conduct analyze the work done so far by the NCEM PHTLS. Today, NAEMT education courses regarding the service, the time of arrival, the are taught in many countries worldwide. difficulties and the problems encountered National Centre for Emergency Medicine has during the work. already conducted the second PHTS course in Accurate data analysis, correct documentation Albania. The first Albanian instructors are of events and missions through the patient's already certified and will serve as a faculty that file, receiving pre-departure information and will continue to train the personal that works completing the territorial card are essential within the emergency system in Albania. This for assessing the quality of the service, presentation describes the history of PHTS improving it, and reducing the disability of promulgation in Albania, its mission and the the patient. The Coordination Unit as an role of NCEM in continuing education for Innovation has every important role in emergency medical staff in Albania. conducting this service. Keywords:PHTLS, NCEM, NAEMT As a Conclusion: Emergency helicopter service for the natural, structural conditions OP – 022 of our country is indispensable for lifesaving, service improvement, and reduction of The Role of Neurolysis in the Surgery of disability. Traumatic Lesions of Peripheral Nerve.

The current state of affairs aims to improve 1 1 this service to be as quality in line with the Ridvan ALIMEHMETI , Florian DASHI , Gramoz BRACE1, Ermira PAJAJ1, Arba standards of international scientific 2 1 associations. CECIA , Thoma KALEFI ,Jetmira KERXHALLIU1,Roland PERGJETANI1, Keywords:helicopter; patient's file, followup 1 Arsen SEFERI OP – 021 Authors Information: 1Neuroscience Department, University of Prehospital trauma and the National Medicine of Tirana, Neurosurgery Sevirce, Emergency Center. University Hospital center “Mother Theresa” Skender BRATAJ, Indrit JAUPAJ Tirana, ALBANIA 2 Hunterian Neurosurgical Laboratory, Author Information: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltmore, MD, USA. Director of National Center for Emergency

Medicine, Tirana, ALBANIA. Abstract Abstract Introduction:Neurolysis is the operative Introduction:Prehospital Trauma Life technique of cessation of adhesions and Support (PHTLS) is the global gold standard removal of fibrosis following traumatic in prehospital trauma education and is taught damage to peripheral nerves in the event of in 64 countries. PHTLS is appropriate for preservation of anatomical continuity of the EMTs, paramedics, nurses, physician nerve fascicles. This technique, defined by assistants, physicians, and other prehospital Milles in the 1980s and revised over the providers. It is recognized around the world as years, remains a successful technique in the the leading continuing education program for treatment of persistent traumatic neuroma. 17 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

But the extent of neurolysis remains a subject Abstract of discussion on a macro and microscopic When a spontaneous intracerebral hematoma level in peripheral nerve surgeons around the is disclosed in a CT scan, there are many world. different pathologies to be differentiated, Materials and Methods:Neurolysis related further exams to be ordered and treatment updated world literature is reviewed. Cases options to be taken into consideration. operated at the QSUT Neurosurgery Service Through some latest operated cases we with neurolysis for various traumatic highlight the logical steps to undertake and peripheral nerve injuries have been studied. discuss the pearls and pitfalls of managing Long-term treatment outcomes are reviewed intracerebral hematomas. Metastasis, cerebral to quantify the rate of return to neural aneurysm, hypertensive hematoma, GBM are function after treatment. some of etiologies we will discuss. Results:Several types of peripheral nerve When taken into consideration the age, co- traumatic mechanisms have been operated morbidities, antecedents, anamnestic with the technique of "neurolysis" contusion, elements, then the imaging suggests the next shock wave firing, jatrogenic intra-fascicular steps to take for the etiological diagnosis as nerve injection, birth plexigraft injury, etc. well as surgical or conservative management. The type of repair ranges from aderenciolize, Keywords:Hematoma, intracerebral, longitudinal epineurotomy, interphasicular spontaneous. neurolysis. The degree of improvement depends largely OP – 024 on the degree of fibrotic fascicular injury, the length of the injured nerve segment, the Cranial Emergencies in Neurosurgery distance from the injury to the affected muscles, the time from traumatic injury to Baris SAYGILI surgical treatment, the neurolytic technique used, the competence of performing Author Information: microscopic and knowledge of peripheral nerve pathology. Faculty of Medicine, Ankara, TURKEY Conclusions: In the many years' experience Former Neurosurgeon at American Hospital, of repairing peripheral nerve traumatic Tirana, ALBANIA injuries at the QSUT Neurosurgery Service, it turns out that neurolysis remains a technique Abstract used successfully in selected cases. It has Emergency in Neurosurgery is complicated been applied alone or in combination with and totally different topic in Neurosurgery. direct sutures or transplants of interrupted The emergency cases can be caused generally nerve segments contained in the same after trauma and accidents but although some traumatized peripheral nerve unit. The use of intraoperative neuro-physiological sporadic /spontaneous situations can cause monitoring, in particular NAP (Nerve Action urgent cases in Neurosurgery. Potential), adds to the assurance of obtaining Mostly fractures and haemoragies are the valuable fascicles at the end of the applied common emergency cases in neurosurgical neurolysis. practice due to trauma and accidents. But Keywords: Neurolysis, traumatic, nerve. also, sometimes sporadic /spontaneous cases

OP – 023 like SAH,cerebral abscess or hydrocephalus cases can cause the emergency pattern. Spontaneous Intracerebral Hematoma; Is it We want to remind the general emergency Only Blood? topics in neurosurgery and share some case experiences that we saw and operated by us. Artur XHUMARI

Author Information: Neurosurgeon in the University Hospital Center “Mother Theresa” Tirana, ALBANIA

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

OP – 025 observed and sufficiently enlarged to avoid recurrence with causing spinal cord damage. Late Post- traumatic Siringomyelia Control MRI in May 2019 revealed

1 1 decompression of syrinx in correspondence Ridvan ALIMEHMETI , Florian DASHI , with clinical gradual improvement of Gramoz BRACE1, Ermira PAJAJ1, Arba CECIA2, 1 1 Conclusions:Vertebral deformity after Thoma KALEFI , Jetmira KERXHALLIU , 1 1 traumatic fracture at thoraco-lumbar passage Roland PERGJETANI , Arsen SEFERI treated with decompression without fusion are Authors Information: highly exposed to kyphosis and spinal canal 1 Neursocience Department, University of deformity. Post-traumatic syringomyelia Medicine of Tirana, Neurosurgery Service, extended above traumatic lesion are rare but University Hospital center “Mother Theresa” should be considered in presence of late Tirana, ALBANIA neurological deterioration manifested with 2 Hunterian Neurosurgical Laboratory, irritation of neuraxis (pain, paresthesia) and/ Department of Neurosurgery, Johns Hopkins or deterioration of previous or appearance of School of Medicine, Baltmore, MD, USA. new neurological deficit. Syrinx stomy to the perimedulary space lowers the pressure and Abstract volume of SCF inside syrinx through Introduction; Spinal post-traumatic microsurgical technique, with good resolution syringomyelia is rarely reported on the of spinal cord dysfunction. literature. Traumatic fracture of thoracic Keywords: Syringomyelia, delayed, vertebral column with or without spinal cord post-traumatic, fracture. injury that ends in a kyphosis and vertebral canal stenosis with consequent arachnoid OP–026 adherences are considered factors that may lead to syrinx formation in the portion above Surgical treatment of temporal lobe epilepsy. the fracture. Our experience with 40 patients. Materials and Methods: Retrospective study of a case harboring post-traumatic Arsen SEFERI syringomyelia 16 years after traumatic fracture of L1. This patient was admitted and Authors Information: treated at Service of neurosurgery in UHC. 1Psychiatry Service at University Hospital Center A 41 y.o. female was involved in car accident “Mother Theresa”, Tirana, ALBANIA in 2001 sustaining compressive fracture of 2Sugery Department at University Hospital Center L1, with urinary and anal retension, without “Mother Theresa”, Tirana, ALBANIA any motor or sensitive deficits of the lower extremities. She underwent decompressive Abstract laminectomy without fusion. Patient E. H., age 39, presents to In February 2018 she referred pain at the site Surgical Emergency, with a cut wound: of fracture/decompression, paresthesia and Sinister mammectomy. According to gradually progressive motor deficit of the family and patient referrals, the action right leg.Because of further worsening of came as a result of a suicidal attempt. neurological deficit, she underwent thoraco- Suffers from Epilepsy since the age of 2 lumbar MRI in November 2018. The presence and several years from depression, of syrinx above the level of kyphosis was leading to a suicidal attempt before. documented with extension from L1 to Th10, She has been treated with with considerable amount of cerebro-spinal antiepileptic drugs for years and fluid (CSF). Somato-sensory evoked underwent neurosurgical intervention in potentials were altered. Italy a month ago, which was successful. Results: The patient underwent The patient shows a regular appearance and microsurgical stomy of the syringx with according to the chronological age, posterior opening at the mediaI part of syrinx maintains partial eye contact. Her mimic into the perimedulary space at Th 12 level expresses an apathetic and cold state, without which was followed by SCF flow outside the alterations of her mood. Refers that after syrinx. The two communications were neurosurgical intervention she has had neurological deficit which persist to date. severe headaches for 19 | Page 3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts weeks, pains that did not enable her to sleep case experiences that we saw and operated by or perform normal daily activities. In one of us. these crises the patient has injured herself, by removing her left breast. Communication is OP – 028 apathetic, cold, distant. Thoughts are negative and worrying about her health. Balloon Kyphoplasty for Traumatic and Perception of the environment and reality, Osteoporotic Compression Vertebral cognition and insight damaged. When asked Fractures, our Experience why she chose to damage her breast, refers she had a feeling of emptiness and therefore Artid LAME1, ErionSPAHO2, Gledion wanted to remove it. Her headaches were also FEJZO2 unbearable and this led her to perform this injury. Through communication the patient Author Information: 1 provides a lot of information about psychotic Department of Neurosciences, University of elements responsible for the bizarre action. Medicine, Neurosurgery Service, University Treatment with antipsychotics, Hospital Centre “Mather Theresa” Tirana, antidepressants, mood stabilizers and ALBANIA 2Neurosurgery Service, University Hospital of anxiolytics, brought an improvement in the Trauma, Tirana, ALBANIA psycho-emotional state. Such cases are rarely described in contemporary literature, the Abstract consequences of severe psychotic and Introduction: We present a review of affective disorders. patients diagnosed and treated for osteoporotic thoracic-lumbar compression OP – 027 fractures. Materials and Methods:There were three Spinal Emergencies in Neurosurgery patients diagnosed and treated for osteoporotic thoracic-lumbar compression Baris SAYGILI fractures during the year 2018 in a private hospital. The patients’ clinical data, imaging Author Information: studies and operative procedures were Faculty of Medicine, Ankara, TURKEY reviewed retrospectively. Former Neurosurgeon at American Hospital, Results:There were three female patients Tirana, ALBANIA ranging from 34 to 63 years old, (mean age 51.6 years old) identified. All three patients Abstract were diagnosed previously for osteoporosis. Emergency in Neurosurgery is complicated Time from symptoms onset to diagnosis and and totally different topic in Neurosurgery. treatment varies from one month to three The emergency cases can be caused generally years. after trauma and accidents but although some Discussion:Vertebral osteoporotic spontaneous or sporadic situations can cause compression fractures are almost twice as urgent cases in Neurosurgery. common as other fractures typically linked to Mostly fractures and spinal cord injuries are osteoporosis, such as broken hips and wrists. the common spinal emergency cases in They are located more in the lumbar and neurosurgical practice due to trauma and thoracic region. accidents. But also sometimes sporadic Conclusion:Treatment with balloon /spontaneouscases like acute disc herniations kyphoplasty remains the gold standard in the that can cause cauda equina or conus treatment of Vertebral osteoporotic medullaris syndrome,vertebral infectious compression fractures with early significant abscess or vascular pathologies that causes improvement of symptoms. spinal haemorrhage cases cancause the Keywords:osteoporotic fractures, emergency pattern. compression fractures, balloon kyphoplasty. We want to remind the general spinal emergency topics in neurosurgery and share some

20 | Page 3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

OP – 029 technique for neurorrhaphies with 10/0 nylon is fundamental in obtaining a functional Neurotizations in the C5 - C6 Proximal result. Recently from trauma to operation, Avulsions of the Brachial Plexus there was no effector morbidity in outcome

1 1 and neuroticization. Ridvan ALIMEHMETI , Florian DASHI , Conclusions: Preoperative study of the Gramoz BRACE1, Ermira PAJAJ1, Arba 2 1 viability of paralyzed muscles most important CECIA , Thoma KALEFI , Jetmira for predicting the surgical outcome of KERXHALLIU1, Roland PERGJETANI1, 1 neurotization.The use of techno-vestiges in Arsen SEFERI the neurotization of the anterior (middle and Authors Information: anterior) muscles as well as the berry flexors 1Neurscience Department, University of (biceps and brachialis) provide a more secure Medicine of Tirana, Neurosurgery Sevirce, functional recovery than the technicoseconds. University Hospital center “Mother Theresa” Microscopy of intraoperatories is Tirana, ALBANIA. indispensable in the application of 2Hunterian Neurosurgical Laboratory, neurotization.Post-operative rehabilitation Department of Neurosurgery, Johns Hopkins with electrovascular stimulation andmuscular School of Medicine, Baltmore, MD, USA. bone factor Important in obtaining maxillofacial efficacy of plexigs. Abstract Keywords:Neurotizations, paralyzed Introduction:In the 90s it was widely muscles, surgery. accepted that C5 and C6 were more widely used in neurotransmission techniques than OP – 030 90% in neurotransmitters in 90% of nerve function regeneration, thereby compromising Postoperative Shock; How to Anticipate and extracorporeal function. Manage it Conveniently? At the QSUT Neurosurgery Service, these techniques have been successfully tested in Mauro ZAGO, follow-up for over 15 years, intensifying and updating with intraoperative monitoring Authors Information: techniques. General Surgery, Minimally Invasive Surgery Materials and Methods: In all operated Unit, Head, Policlinico San Pietro - diagnostic cases of C5 and C6 avulsion BOLOGNA - ITALY supported by cervical MRI and ENMG, SSEP preoperatively. Neuro-technical techniques Abstract for C6 and C6 avulsion are applied: Introduction:Postoperative shock is a not so 1. with terminal nerve accessor spinal donor uncommon event and recognize many for resuscitation of the nervesupra-scapular as etiologies, ranging from recipient. intracavitary/intrabdominal hemorrhage, 2. With a n. radial donor, the branch for the pulmonary embolism, septic shock due to medial head of the muscle tricepsbrachi for resuscitation of the nerve-axillary recipient. surgical and not surgical complication, heart 3. With a n. ulnar donor, a muscle-carpi- failure. ulnaris (and median) trunk, as a donor for the It could happen both after elective and resuscitation of the musculoskeletal nerve, a emergency procedures. branch for musculoskeletal (brachialis). Management of a patient with clear or Operational outcomes are reviewed and impending postoperative shock requires a reviewed for trauma to surgical resection (3 high index of suspicion of the surgical team months - 3.5 years). Results: In all modes of operation, slight and of the nursing team too. Ideally, a (M2), medium (M3) and satisfactory (M4) planning of the actions for a safe and improvements in engine function were effective monitoring should be established in observed.The application of intraoperative any surgical ward, possibly with the help of neurophysiology to the microsurgical

21 | Page 3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts telemonitoring systems even in non-high- giant goiters, hematomas and thyroid dependent unit. malignancies, among others. The author The use of check-lists and a wide application underline the need for the surgeon working in acute care setting to be familiar with thyroid of tools like the NEWS score are one of the surgery. most easily way to implement the culture of Three recent cases, in very old patients, of standardized monitoring of critical or acute airway-threatening from thyroid potentially critically ill patient in the diseases are described: postoperative period. It is clear that the goal is 1. A 91-year-old male with known giant to anticipate the need for rescue surgery, right-sided thyroid mass, with a cytologic and/or put a patient requiring interventional or study suggestive of follicular tumor, who had refused thyroid surgery two months surgical repair of a postoperative complication earlier, was hospitalized for acute in the best situation for recovering, decreasing exacerbation of dyspnea and hoarseness. the rate of failure to rescue. Cervical mass extended from the hyoid In the era of acute care surgery, surgeons bone to the upper mediastinum, with left dealing with acute patients (all complicated shift of cervical structures. Right patients after elective and emergency surgery thyroidectomy and istmectomy were are acute patients) have to know the surgical urgently performed. procedure undertaken and to stay close to 2. A 88-yeard-old female with a known physiology, which remains the mainstone for bilateral large cervical mass was admitted any decision. due to stridor. Computed tomography Basic knowledges for a physiological revealed a large retrosternal compressive assessment are mandatory, goal directed fluid goiter with a remaining tracheal lumen of management has a pivotal role too. 2 mm. Surgical risk was significantly aggravated by a severe aortic stenosis. Nowadays, some critical applications of Since there was no place for a classic Ultrasound should enter in the armamentarium tracheostomy and endotracheal intubation of surgeons too. In particular, free fluid could be difficult or impossible, detection (E-FAST), basic lung US everything was prepared in order to semeiology, US evaluation of volume anesthetize the patient under ECMO, replacement and heart function “at a glance”. which, however, did not become It is time to improve skills and organizations necessary. Intubated with the aid of a fiberscope, a total thyroidectomy was for getting better outcomes in critically ill possible, after partial sternotomy. patients. 3. A 78-year-old female complaining of Keywords: fluid resuscitation, mean arterial stridor and dysphagia, from a large right pressure, operation, surgery, cervical mass, with a 4 mm tracheal lumen was admitted. A tracheostomy was OP – 031 performed but, due to airway obstruction not completely resolved by this Acute Airway-Threatening Presentations of procedure, a right lobectomy with Thyroid Diseases in Very Old Patients isthmectomy was performed urgently. Although cytologic study was suggestive Carlos MESQUITA of papillary carcinoma, the degree of local infiltration, evident at the time of Author Information: surgery, first drew attention to the General and Emergency Surgery Departments, possibility of an anaplastic thyroid Trauma CenterCoimbra Central and University cancer. Hospital, PORTUGAL Acute airway-threatening from thyroid diseases is not common. Early recognition of Abstract these conditions and urgent, partial or total Acute airway-threatening from thyroid thyroidectomy may be necessary to alleviate diseases is not common but may occur due to symptoms, when tracheostomy is not an

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts effective option. The surgeon working in an Simona KALŠEK, Jožeta POTRČA acute care environment should be aware of Authors Information: these possible scenarios and be prepared to ¹Department of Surgery, General Hospital,Ptuj, solve them. SLOVENIA

OP – 032 Abstract Introduction: The aim of present study is to Esophageal Trauma from Foreign Bodies. evaluate the role of laparoscopy in blunt and Literature Review and our Experience. penetraiting abdominal trauma. Materials and Methods: We performed a Arvin DIBRA, Etmont ÇELIKU, Inid review of the literature using Pub Med JORGONI, Arvit LLAZANI, Drini SHEHI. database. The key words were laparoscopy and abdominal trauma. In last 10 years there Authors Information: were 785 articles published. ¹Surgery Department, University Hospital Results: Laparoscopy is most useful in Center “Mother Teresa”, Tirana, ALBANIA hemodinamic stable patients with penetraiting abdominal trauma. The sensitivity and Abstract specificity of diagnostic laparoscopy is 99% Introduction:Esophageal trauma from i.e. 100%. In 92% therapeutic laparoscopy foreign bodies, it’s not a rare condition in our was successful. polyvalent emergency. The esophagus is the In blunt abdominal trauma the role of most common site of foreign body laparoscopy is less clear. It is an option in impaction. Food impactions cause most selected patients who are hemodinamic stable esophageal foreign bodies. Large, smooth and have a fluid collection of unknown origin food pieces (e.g. steak, hot dogs) are on CT scans. In selected cases it is also particularly easy to swallow inadvertently optional in patients with bowel perforation, before being chewed sufficiently. Bones, liver and splen trauma. particularly fish bones, may be swallowed if Conclusion: Laparoscopy is a useful the meat in which they are embedded is not diagnostic and therapeutic procedure in stable chewed sufficiently. It can be complicated patiens with abdominal penetraiting wound. with esophageal perforation, so all team in In blunt abdominal trauma it's role is more operating room must be prepared for this limited. condition, especially the surgeons. Keywords: laparoscopy, abdominal trauma. The foreign body, which may be food or dental prosthesis, may cause spontaneous esophageal injury or injury during attempts to OP – 34 remove it. The primary choice to solve this Management of Liver Trauma situation is endoscopic management not only to diagnose but also to treat the complication. Skender BUCI, Dorina SHTJEFNI Emergent endoscopy is required for sharp- pointed objects, disk or button batteries and Authors Information: any obstruction causing significant Surgery Service, University Hospital of symptoms. Esophageal perforation has a high trauma, Tirana, ALBANIA mortality and morbidity and all the Abstract procedures to remove the foreign body Introduction:The hospital Trauma Centers increase the risk for it. We are bringing you could be able to management severe liver and our revision and experience. biliary tract injuried but should have the Keywords:Esophageal trauma, foreign following criteria or pre-condition like; bodies, emergency, fish bones. theTeam of surgeons trained for this purpose, ultrasound installed in the operating room, OP – 033 liver injury assessment with angio-CT, 24- hour operating room equipped, resuscitation, Diagnostic and Therapeutic Laparoscopy in options for arterial embolization. Abdominal Trauma

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Liver injuries have been found in 20% of cases Abstract of polytrauma, according to most reports from Introduction:BAT is one of the most various trauma centers. Car accidents are the common causes of morbidity in that all age leading cause of Blunt Liver injuries. groups. Early identification of traumatic Diagnosis of Liver injury has undergone a intestinal injuries (TInI) has been and remains significant evolution in recent decades, due to a challenge to all trauma surgeons, as early ongoing developments in the field of finding and evaluation of their, it present imaging. difficulties of different natures, even with technological advances is a frightening for all The diagnostic and therapeutic strategy is surgeons because of morbidity and mortality dependent on the hemodynamic status of the that it carries. With all the different varieties traumatized patient. of damage mechanisms InI of motor vehicle Currently, non-operativ management is accidents remain the leading cause. preferred in more than 80% of cases, it is The first reports date for intestinal injuries we combined with continuous clinical monitoring must go back to 1899 by Geille, who reported and, if necessary, an interventional radiology, that intestinal injuries had 11% incidence in a its efficacy is more than 90%. group of patients who had undergone BAT. This treatment fails in about 10-15% of cases, There are studies that said that intestinal most often for extra-hepatic injury and less injuries recently ranked third overall in the frequently for laparotomy standings intra-abdominal injuries in BAT. In the case of NOM hemostasis techniques Identification of the mechanism of injury, the are preferred over hepatic resection. If incoming data, the anatomical distribution of hemostasis is difficult to obtain, we should lesions, diagnostic methods, management and prefer periapical tamponation, rapid surgery gastrointestinal damage results from BAT. to the concept of shorter laparotomy, multi- Material and Methods:The study includes clamping and venous venous shunt, and re- patients with BAT in a 2-years period, that intervention after 48-72 hours, management were introduced in the UHT, who underwent of secondary complications such as biliary evaluation, treatment and management of fistulas or intrahepatic abscesses should be gastrointestinal tract injury. multidisciplinary, whether at the diagnostic or It is a retrospective study, patients were therapeutic level. analysed in relation to the mechanism, time of The overall mortality, with respect to the presentation, in HdSt, anatomic localization gravity of the anatomical hepatic injuries and of lesions, diagnostic methods, the tactics of associated injuries, is 10 to 20%. treatment, complications, morbidity and mortality. Keywords:liver, Trauma, biliary tract Results:Are taken into consideration about injuried, NOM, fistula Biliary, intrahepatic 21 (8%) patients out of 257 which is the total abscesses. number of patients with BAT in the study which had damage to the InI, they occupy OP – 035 33% of cases treated with BAT street operators. Blunt intestinal Trauma a retrospective Age distribution is such 70 years old range 5- assessment. years average 32.8, while such is distribution

1 2 by age group; is 14 to 60 years old (6%) Agron DOGJANI , Kastriot HAXHIREXHA followed by more than 60 years old (14.2%) and finally by 0-14 years old (23.8%). Author Information: Conclusion:Early recognition of TInI from University Hospital of Trauma, General Surgery, Tirana, ALBANIA. BAT is difficult, it's very important is their 2University of , General Surgery, Tetovo, dangerousness be recognized because of its RN of MACEDONIA great potential complications affecting infection that gives directly to their morbidity and mortality. Keywords:Blunt abdominal trauma, intestinal injury, colonic injury

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

OP – 036 1Emergency Clinic, Hospital and University Clinical Service of KOSOVO 2Servise of Anestesia Clinical Service of KOSOVO Do Indicators help in Manage Emergency 3 Departments? Radiolgy Clinic University Clinical eof KOSOVO 2University Medical Centre Maribor, SLOVENIA 2 International project and training cordinator of Elizana PETRELA1, 2, Edmond ZAIMI1, 3, 4 UrlaIzmir Provincial, TURKEY Albana KOÇIAJ

Abstract Author Information: Trauma is a global, multidisciplinary problem 1Faculty of Medicine, University of Medicine Tirana, ALBANIA caused by mechanical, chemical, physical and 2Statistics Department, University Hospital Center thermal factors and radiation. But in most “Mother Theresa” Tirana, ALBANIA cases, they are car accidents, various home 3Emergency Department, University Hospital accidents (minor, major) which can Center “Mother Theresa” Tirana, potentially be life threatening. Trauma is the ALBANIA4Emergency Department, Hospital of sixth leading cause of death worldwide, Kavaja, ALBANIA resulting in five million or 10% of all deaths a year. Tracing injured traumas is a priority for Abstract treatment or transportation, according to their Indicators are usually used to evaluate the severity of injury. BLS in pre-hospital service and to prepare for possible settings (primary, secondary, tertiary) and interventions. They serve as evidence of hospital ATLS requires a very change and form an important part of most multisystematic approach to be managed by systems and approaches in the monitoring and US personnel. In hospital settings, trauma evaluation process. Indicators can be treatment is traditionally divided into two calculated at different levels and defined in secondary, tertiary levels. Implementing a many different ways by different unified trauma algorithm facilitates access to organizations. Indicators are defined as a diagnostics and treatment by carefully quantitative or qualitative factor or a variable avoiding potential complications in order to that provides a simple and reliable tool of reduce morbidity, disability and mortality. A measuring achievement, reflecting changes proper medical trauma management team in associated with an intervention, or helping to pre-hospital, hospital settings educated and 1 evaluate performance . trained with basic and advanced trauma An indicator is considered "as part of the management courses and adhering to standard information that provides evidence of a procedures and algorithms, protocols are key 2 change" . Evidence and change are two to the effective management of minor trauma different things. An indicator is something injuries. and malaria which will affect the that helps evaluate change, but is not change increase of quality of life as well as the itself (even when the result is desired). reduction of morbidity, disability and A good manager should know how to read the mortality. indicators correctly and then take other steps Keywords: Trauma, Injury, BLS, PhTLS, that lead to change (planning-design- ATLS, Emergency department. implementation-re-evaluation). OP –038 OP – 037 Management of Acute Cardiac Failure in Emergency Access and Management in the University Hospital Emergency Settings first 15 Minutes of Life Threats 1 2 Edmond ZAIMI , Albana KOCIAJ . 1* 2 Basri LENJANI , Nuhi ARSLLANI , Esen UYSAL2, Premtim RASHITI2, Nehat BAFTIU2, I 2 3 Author Information: BUNJAKU , GaniSHABANI , M 1 3 3 3 Emergency Department. University Hospital TAHIRI , LENJANI , Erza VOCA Center “Mother Theresa”, Tirana, ALBANIA 2Emergency Department, Kavaja Hospital, Authors Information: ALBANIA

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract adequate medical treatment for each patient's Acute cardiac insufficiency (ACI) is the rapid need. onset or worsening of CI signs and / or Material and Methods:As a source for symptoms. It is a life-threatening clinical completing this scientific work, are used situation that requires immediate evaluation documentation from Emergency Department and treatment, which is generally followed by books, medical reports, didactic photographs urgent hospitalization of patients. were used to make prospective uninterrupted The objective of this presentation is to work clearer and all medical cases describe the novelties in the diagnosis and (approximately 130 of them) were analyzed treatment of ACI, including the use of cardiac that have been seeking medical help for 24 markers to describe the advantages of Cardiac hours. The time of arrival, the time of staying Markers-based therapy for the management respectively in emergency services, of decompensated ACI; the role of different examinations, necessary consultations as well groups of preparations and non-invasive as hospitalized and transferred cases at the ventilation in the rapid treatment and Kosovo Main Emergency Center in Pristina stabilization of the situation, always in the were, they have been examined. light of the latest ESC and AHA clinical Results: One patient was resuscitated, 13 guidelines. people treated cause thy had injuries on road Emergency medical staff attitude from the traffic accidents, 5 cases of physical violence first moment of contact with these patients, one of which was injured by a sharp tool, the order of actions and treatment of these some patients injured by a height fail of patients until their placement, in the current approximately 3 meters , by motorcycle, conditions, based on the recommendations of bicycle, three poisoned patients, one of them clinical guidelines and our experience and with medicaments who attempted to commit experience , will be clarified in the suicide and 2 persons with alcohol overdose, presentation, with the aim of defining the 21 patients were treated with acute injuries, same ACI management protocol. 26 were treated, one was transferred at the OP – 039 Kosovo Main Emergency Center for more advanced treatment… By age patients were of One Working Day in Emergency Center in all ages but dominated by younger age groups Regional Prizren Hospital, Republic of (10-39 years old among the injured), by sex, Kosovo most frequent patients were Male (ratio 3: 1). Time spent in observation (1- 2 h). A number Sadri HULAJ ¹, Afrim JAHAJ ¹ of patients were brought by ambulance, part of them by Kosovo Police (injured in physical Authors Information: conflicts) and some of them brought by ¹Emergency Center, Regional Hospital in family members as well as patients with mild Prizren, KOSOVO disorders… Conclusion: Arrival time in Emergency - Abstract uninterrupted and no obvious night / day Introduction: An Emergency Working Day differences and sometimes several patients at presents more closely the medical services of the same time challenging teams to provide care teams provided to all patients coming in adequate treatment after proper professional or brought by emergency teams, accident treatment with teamwork and adequate rescuers, such as the Kosovo Police, other consultation. rescue teams or from Citizens themselves, in KeyWords:Patient, injury, doctor, treatment, the most frequented hospital facility and of observation, hospitalization strategic importance. The care teams are in constant readiness but as needed increase the OP – 040 readiness and expand it with additional staff from other units of the Prizren Regional Management of Syncope in University Hospital. In such cases the chain of survival Hospital Emergency Settings comes to an end when early calls, immediate basic and advanced treatment provide Edmond ZAIMI1, Enea SERANI2, Adelina XHEMALI3

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Author Information: Relieving Pain in America. The International 1 Emergency Department. University Hospital Association of the Study of Pain (IASP) Center “Mother Theresa”, Tirana, ALBANIA 2 defines pain as an unpleasant sensory and Emergency Department, Regional Hospital of emotional experience associated with actual Gjirokastra, ALBANIA or potential tissue damage or described in 3 Family Physician Tirana, ALBANIA terms of such damage Acute pain is the

expected physiological response to a noxious Abstract chemical, thermal, or mechanical stimulus, Syncope is a clinical syndrome, in which and usually accompanies surgery, traumatic temporary loss of consciousness is caused by injury, tissue damage, or inflammatory insufficient blood supply to the brain, often as processes. It is self-limiting and typically a result of an immediate decrease in systemic resolves over days to weeks, but it can persist arterial pressure (TA). Typical for the longer as healing occurs. Chronic pain is syncope is that this insufficient supply of defined as intractable pain that exists for three blood to the brain occurs for a short time (8- or more months despite adequate treatment. 10 seconds) and recovers spontaneously. For patients 18 years and younger, there do Syncope is a common symptom with which not yet exist specific consensus guidelines on patients present with DU. Syncope is one of prescribing opioids for chronic pain Pediatric the many possible causes of temporary loss of practitioners are advised to use their best consciousness (HPK). Most of these causes judgment when using opioids after are benign and transient, but some are appropriate use of nonopioid alternatives. associated with increased morbidity and Opioids are not usually indicated as a first mortality, especially in old age. line therapy for primary pain disorders [16]. What is the approach to syncopal patients, However, current evidence suggests that what are the opportunities to distinguish the opioid prescriptions should not be curtailed causes of syncope episode, how to distinguish for moderately to severely painful conditions. the true syncope from other causes of HPK, Synchronal with this reconception, there are what are the main tests that help assess them, other new notions like nervous system what are the initial concerns in treatment- hypersensitivity caused by the acute pain and related, how risk is determined and the the rehabilitation, known for their important attitude held in cases of indeterminate role due to major developments in the diagnosis, are the problems that will be multimodal analgesia. Last years the elucidated in this presentation in light of researches are mostly focused on pain recent ESC guidelines. assessments as the main element that

precedes the treatment. OP – 041 Conclusions: Multidisciplinary pain

management, including pharmacological and Pain Management for Pediatric Patients integrative non-pharmacological therapies, Contemporary Considerations has been demonstrated to be efficacious in the

treatment of both acute and chronic pain. Edmond PISTULLI¹, Admir NAKE¹, Faton Pharmacological interventions includeopioids KRASNIQI² and opioid-sparing agents that target specific

aspects of the nociceptive and neuropathic Authors Information: 1 pain physiology. Faculty of Technical Medical Sciences, Keywords:Opioid reduction therapy, non- University of Medicine in Tirana, Albania. pharmacological therapy, cognitive ² Neonatology department,University behavioral therapy, hypnosis, mindfulness- Hospital Center, Prishtina-Kosovo based stress reduction, acupuncture, pain

rehabilitation.

Abstract OP – 042 Acute and chronic pain are common and often debilitating problems among both Temporary and Permanent Pacemaker in pediatric and adult populations according to Acute Coronary Syndrome the Institute of Medicine statement on

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Ormir SHURDHA OP – 043

Author Information: Syncope and Cardiac Arrhythmia in 2Cardiology Department, University Hospital Emergency Department Center “Mother Theresa” Tirana, ALBANIA Indrit TEMALI1* Abstract Author Information: Background:Cardiac arrhythmias and 1Cardiology Department, American Hospital, conduction disorders are relatively common Tirana, ALBANIA. after Acute Coronary Syndrome (ACS). They are the result of autonomic stimulation, Abstract ischemia or necrosis of the conduction Introduction; Syncope is a transient loss of system. Two major factors determine the consciousness due to cerebral globular need for a cardiac output: symptoms hypoperfusion characterized by the first route, associated with brady-arrhythmia or the site duration of Recently Spontaneous where conduction disorder has occurred. Recovery.Situations of patients presenting During the ACS, different types of heart with syncope and cardiac arrhythmias in the transplant surgeries may become apparent; emergency department pose a challenge for sinus node impulse formation or conduction the emergency physician in deciding whether abnormalities, atrioventricular conduction this patient should be hospitalized and if the (AV) disorders, and intraventricular situation presents a high risk, or can be conduction disorders. managed alone to the emergency department Sinus rhythm disorders (sinus bradycardia, and the patient then sent home. sinus arrest, exist sininoatrial) are more Material and Methods; World Literature common, mainly during inferio-posterior and professional experience stroke. Treatment is not necessary unless Results;Arrhythmias are prevalent in people symptoms present; Atropine can be helpful. If of all ages and can occur in the context of a bradycardia is prolonged and severe, or does cardiac disease but also in a heart with normal not respond to atropine, a temporary cardiac structure. Every day we have a significant arrest should be established. AV block occurs number of patients coming to the Emergency in 12-25% of patients with acute ACS. Department. The risk of progression from the first-degree Conclusion;The diagnosis can be achieved block to the high degree AV block differs by the correct implementation of the from the types of site of myocardial European Society of Cardiology (ESC) infarction. High-grade AV block, and guidelines on syncope management. especially after anterior wall infarction, Regarding the prognosis it is necessary to indicates that damage is within the His- stratify patients regarding the risk of short or Purkinje system. Temporary emergency relief long term performance. Furthermore, in the is required in these cases. case of a syncope of undetermined nature it is Modes and temporary cardiac arrest are important to determine the probability that transcutaneous and transvenous. this syncope has cardiac origin. Transcutaneous ligation is done by placing Keywords; syncop , diagnosis, cardia origin, plates on defibrillation apparatus when the Emergency department "Pacer Mode ON" option is selected. The transvenous suction is made through a suction OP – 044 probe placed in the right ventricle through a large vein, which is usually the femoral vein. The suction probe is connected to a transient Treatment of Hydatid Cyst and Bilio- pacemaker. Bronchial and Bilio-Pleuro-Bronchial Keywords:Cardiac arrhythmias, Acute Fistulas via Thoracotomy and Trans- Coronary Syndrome, Pacemaker… diaphragmic Approach from January

2005 to March 2019 in a Single Unit in Tirana Albania.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Fadil GRADICA1, Lutfi LISHA1, Dhimiter radiological results were good with a one- ARGJIRI1, Alma CANI1, Fahri KOKICI1, Endri year follow-up. SHEHU2; Enton BOLLANO2, Dariel Conclusion:Bilio-bronchial and bilio-pleuro- THERESKA2, Ibrahim AVDI2, Helidon bronchial fistulas due to hydatid cyst are rare, NINO2, Flora J. GRADICA3; V S. REXHA3 but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragm- Authors Information: matic and thoracic. A high perioperative 1 Thoracic Surgery Service, University mortality rate was observed. Thoracotomy Hospital "Shefqet Ndroqi" Tirana, ALBANIA with trans- diaphragmic approach is the best 2 Surgery Service University Hospital Centre” approach for surgical treatment at all three Mother Theresa” Tirana, ALBANIA levels. 3Public Pharmacy Service Tirana, ALBANIA Keywords: Bilo pleural fistulae, bilio- bronchial fistulae, Thoracotomy.

Abstract OP – 045 Introduction:The aim of this study was to report the results of surgical treatment of Rib Fracture Fixation a New Era in hydatid bilio-bronchial et bilio-pleuro- Treatment of Chest Trauma in Albania bronchial fistulas via thoracotomy and trans diaphragmic approach. Fatmir ÇAUSHI

Material and Methods:From January 2005 Author Information: to March 2019, 32 cases were observed in the Head of Department of Thoracic Surgery same center. Bilioptysis was the main University Hospital “Shefqet Ndroqi” Tirana, ALBANIA. symptom in 80% of cases. The diagnosis was based on chest radiography, thoracic and Abstract abdominal CT and abdominal Chest wall trauma now days are common, and ultrasonography, Fibro-bronchoscopy; all contributes significantly to morbidity and mortality of trauma patients. Blunt trauma to examinations visualized the cyst, the chest wall and rib fractures are intrathoracic collections, a diaphragmatic remarkably breach and biliary lesions. All patients were frequent and are the basis of considerable treated by one-stage thoracotomy one case by morbidity and possible mortality. Generalized management of multiple rib fractures and flail VATS left lower lobe. The procedures chest in last 50 years consists of adequate consisted of lung resection (lobectomy and/or pain segmentectomy) (n=24) and decortication control, management of pulmonary (n=11) in the chest, cyst dome resection dysfunction by invasive and noninvasive means and in somecases, surgical fixation. (n=32) or part pericystectomy (n=8) in the Rib fractures can be interpreted as signs of abdomen and suture and plastic of the significant trauma. Thegreater the number of diaphragmatic defect in all cases after hepato- fractured ribs, the higher the mortality and diaphragmatic deconnection. An additional morbidity rates. Multiplestudies have shown that patients with flail chest have substantial laparotomy was not necessary in all cases. benefit when they undergosurgery compared Results:There were 3 deaths (10%):no one with nonoperative management. intraoperative death and three postoperative Operative rib fixation has the potential to deaths, mostly related to pulmonary reduce ventilator days and ICU stay and subsequentlyhospital costs in selected patients complications. Postoperative complications with severe traumatic flail chest requiring (14%) were mainly respiratory. Clinical and mechanicalventilation. Rib-specific plating

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts systems have started to be used in the last 10 symptoms, diagnostic and therapeutic methods years. These haveinaugurated in the modern of patients with Delayed Diaphragmatic era of rib repair with chest wall stabilization Rupture. (CWS) techniques thatare safer, easier to Material and Methods: In this retrospective perform, and more efficient. Recent study, we reviewed the data of all patients with consensus statements have sought todefine diagnosis of delayed traumatic diaphragmatic the indications and contraindications, as well rupture in surgical wards of “Shefqet Ndroqi” as the when, the how, and the technicaldetails hospital in Tirana, Albania, between January of CWS. Repair should be considered for 2012 and July 2019. patients who have three or more displaced Results: Patients included in this study, 13 in ribfractures or a flail chest, whether or not total, where 10 (77%) male and 3 (23%) mechanical ventilation is required. female. The age of the patients varied from 30 Meanwhile in Albania, as in other fields, this to76 years old. Traffic accidents were the most protocol is entering so timidly facing common cause of traumatic diaphragmatic prejudiced rupture in our study (46 %). Dyspnea was the thoughts and economic difficulties but with most common symptom in our subjects (68%); very convincing results. During the last 3 Intestinal obstruction in 1 patient and Tension years, 10cases of chest stabilization have gastro thorax in 1 patient. 38.4% of our patients been treated in our clinic by positioning a had right sided traumatic diaphragmatic specific plate systemfor the ribs. The result rupture, and 61.6% had left sided traumatic was excellent in 9 of them. These patients left diaphragmatic rupture. Colon was the most the hospital after 7 days inexcellent condition. herniated organ. Chest x-ray and computed Meanwhile, in one case, three days after tomography scan were used in all of our surgery an acute kidney failure wasinstalled subjects for diagnosis of diaphragmatic rupture. which led to an unpleasant situation. The mean duration between trauma and surgery However, even this separate case raises the was 56.30±92.44 months. The mean duration of issueof equipping our hospital facilities with hospitalization was 8.46±4.05 days. The most the equipment needed to treat complex common surgical method which was used for patients as a trauma patient. treatment of delayed diaphragmatic rupture in Keywords:Ribs, fracture, fixation, surgery, our patients was thoracotomy (92.3%). In our technique. recent study, primary treatment of diaphragm was performed in 12 patients, partial mesh in 1 OP –046 patient. None of our subjects died. Conclusion;Diagnosis of diaphragmatic Post Traumatic Diaphragmatic Hernia. A rupture is difficult and has a clinical suspicion Retrospective Study Based on Cases in high risk patients. So, using of radiological Between January 2012 - June 2019 modalities for diagnosis and treatment of it is necessary. Moreover, delayed diaphragmatic Ilir SKENDULI rupture and diaphragmatic hernia should be considered in patients with recent blunt trauma Authors Information: and gastrointestinal or respiratory complaints. Thoracic Surgeon, University Hospital “Shefqet Keywords: Diaphragmatic rupture; Mesh; Ndroqi” Tirana, ALBANIA Hernia;Traumatic.

Abstract Background: Diaphragmatic rupture is a life- OP – 047 threatening condition, which may be due to severe penetrating or blunt trauma to the chest Traumatic Pneumothorax, Challenges of or abdomen. Considering that delayed The Treatment (10-Year Study in Vlora diaphragmatic rupture has no clinical Regional Hospital) symptoms, results of diagnostic methods are restricted to the case report studies, also lack of Petraq MUSTAQE1, Lorenc GJOKA2 early diagnosis of it in patients with multiple trauma and diversity of therapeutic methods, Authors Information: we decided to investigate the clinical

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

1General Surgeon at Regional Hospital of Vlora, ALBANIA Abstract 2Anesthesiologist at Regional Hospital of Introduction:There is general agreement Vlora, ALBANIA that, with proper selection of patients with giant bullous emphysema (GEB) it is Abstract possible, using surgical methods, to improve A common surgical disease is Pneumothorax lung function and consequently the quality of which involves the Introduction of a quantity life. of air into the pleural cavity. Other patients may, sometimes, benefit from This pathology is, in most cases, traumatic surgery in the management of specific and only in a small number comes from complications such as pneumothorax or diseases of the pulmonary or mediastinal infection. This study was undertaken to assess structures or organs. the safety and efficacy of a VATS approach Thoracic traumas are coming to light in our for GBE. hospitals, this I owe more to motor vehicles Material and Methods: From January 2006 than accidents that are not uncommon on our to July 2019 we treatedthrough thoracotomy, roads. 44 patients with giant bullous emphysema On the other hand, pneumothorax like the (GEB), and 12 patients through VATS. complication or the most common 17 female patients and 39 male consequence of thoracic trauma is a common patients,were with mean age 50 years old, nosology that is often traumatic. (range 14- 72 years). Our hospital Hospitalizes about 80 traumas Results:We experienced 41 patients were involving thorax in one year, with a good presented with PNX and treated with proportion of tires after tension pleurodesis. Two patients underwent a second pneumothorax, hemothorax, rib fractures, operation by open thoracotomy because of a wounds in this region, hematomas…. prolonged air leak.We have no operative At 10 Years 2007-2017 Diagnosis 204 with death. Follow-up was 16 months range (1- Pneumothorax, to the scanning examinations 36). In one patient we had prolonged that has improved to a good diagnostic extent aerorrhae and bilateral PNX. and accurate. One case with pleural empyema, a thoracic The treatment of pneumothorax has been window was performed, from failure of combined with hemothorax and / or open or lung.In three patients was done reoperation blunt damages, whereas in two cases we have because of the receive. also been associated with chylothorax. Conclusions: Thoracotomy may be KEYWORDS: Pneumothorax traumatic, considered a suitable surgical technique and tension Pnx, hemothorax, chylothorax. treatment of choice in GBE.VATS may be considered in nowadays as a suitable surgical OP – 048 technique as a mini-invasive surgery and in most of the cases it is more effective. Treatment by Thoracotomy and VATS of Keywords:Giant Bullae,Thoracotomy, Giant Bullous Emphysema VATS.

Fadil GRADICA¹, Lutfi LISHA¹; Daniela OP – 049 XHEMALAJ ¹; Dhimitraq ARGJIRI¹; Alma CANI¹; Fahri KOKICI¹; Sali GRADICA¹, Bilateral Chylothorax, after Blunt Chest S.Rexha¹; Aishe R LALA¹; Zef Trauma. A case Report PERDUKA², Dorina SHTJEFNI 1*, Skender BUCI1, Sami Authors Information: KOCEKU1, Gjovalin BUSHI1, Sokol RUCI1, ¹Department of Surgery, Service of Thoracic Kastriot SUBASHI1 Surgery, University hospital of Lung Disease Tirana, ALBANIA. Authors Information: ²Pneumology Service Rreshen Hospital, 1 Surgery Service, University Hospital of ALBANIA Trauma, Tirana, ALBANIA

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract KEYWORD; Traumatic, chylothorax, Introduction:Traumatic bilateral chylothorax milk color versament, nutrition parenteral. is a very rare occurrence. About 80% of chylothorax es are unilateral, in two-thirds of OP – 050 cases in right hemithorax. Appears with an inexhaustible pleural effusion in milk color, Metamorphosis of a multicameral cyst of the in abundance. humerus We will report the management of bilateral traumatic chylothorax as a very rare Gjergj ÇAUSHI occurrence. Material and Method: We present a patient Authors Information: with thoracic trauma. Fracture of thoracic University Medical of Tirana, Faculty of vertebrae 8-th to10-th, with bilateral Medicine, Tirana, ALBANIA chylothorax. An Overview of diagnostic Head of Service orthopedic Surgery, University basis, treatment and evolution Hospital of Trauma, Tirana, ALBANIA.

Résults:A 36-year-old man has been the Abstract victim of a car accident, hospitalized in Introduction:Multicameral bone cysts are surgery with diag. Compressive fractures fluid-filled benign cavities that expand over Th to Th andminimal pleural versament 8 10 time, resulting in bone thinning. Usually, in the right side. Two days after the trauma these cysts are reported in metaphysical areas on the scanning examination results, large of long bones with open physics. 85% of amount of liquid in the right hemithorax them occur almost exclusively in children and and minimal liquid in the left hemithorax. adolescents, and are more aggressive in the From the drainage tube into the right first decade of life, and respectively, the pleural cavity flow about 1000 ml of liquid recurrence rate for these patients is four times with a milky appearance. Biochemical higher than for adolescents. Humerus and analysis of pleural fluid confirmed proximal femur make up almost 90% of these chylothorax. cases, they are classified as active when they We have performed Non- Operative are within 1 cm of the physique and latency Management, the first 10 days with a zero- as they progress to a diaphysis site. oral feeding, only parenteral nutrition, Differential diagnoses for them include electrolyte, vitamins, plasma and albumin, aneurysmal bone cyst, fibrous dysplasia, followed by a fat-free diet. In CT re- enchondroma and intraosseous ganglia. examination 6 days after trauma resulted in By the time skeletal maturity, most of them an increased in the amount of fluid in the tend to resolve themselves. Non-operative left pleural cavity, a drainage tube is treatment can be a valuable option for many inserted into the cystic pleural cavity from patients with minor or symptomatic lesions. which approximately 700ml of milky- Interventions include steroid injection, open colored fluid is drained. twisting and bone grafting, decompression The drainage tube in the cystic pleural and percutaneous injection of marrow or graft cavity is removed after 5 days. The fluid substitutes. flow into the right pleural cavity persisted KEYWORDS: Unicameral bone cyst, in an amount ranging from 150-300ml at Current concepts 24h for about 3 weeks. After this period for about 1 week the pleural effusion was in an OP – 051 amount of less than 100ml in 24 hours. In the fifth week, the drainage tube is removed after the leaks have been reduced to about Indication, Technique, Available 20-30ml. The patient leaves the stabilized Implants as Well as Alternative hospital. Therapies for Periprosthetic Bone CONCLUSIONS: The treatment is based Fracture Reconstruction. on a fat-free diet. Chiral ligation of the thoracic ductus is indicated in a debit over Arjan MULLAHI 500 ml at 24 hours, after 2 to 3 weeks Author Information:

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Chef of Surgery, Ortopedy and Trauma Abstract Department St. Josef- Hospital Linnich, Introduction:Long-bone fractures are Rurdorfer Straße 49,52441 Linnich, common in children related with sportive GERMANY activities or vehicular accidents and nearly one third of them involve the growth plate or Abstract physis. Isolated distal femoral physeal Introduction: Reconstruction of fractures fractures are rare injuries accounting about and bone defects with traumatic and non- 5% of all physeal injuries, and 50 % of them traumatic origin, with femuro-diapherese result in some form of growth disturbance, Strut Grafts represent a special And Great and that increase with severity. Treatment. Fractures involving the physis fall into three Materials and Methods: We will represent main categories: fractures causing separation our revizion and personal results and a of the epiphysis, crossing the epiphyseal plate literature review. and injuries that crush the plate. The zone of Results: In literature is prescribed survey provisional calcification and recently formed after Reconstruction with femuro diaphysere bone are the weak areas and are frequently Strat Grafts, in a pursue within ten years, the sites of injury. from the beginning of this technique at the Stable, truly nondisplaced fractures can be 1991. A direct comparison of publication treated nonoperatively with long leg casting. results it’s difficult due to small number of There is a general consensus that displaced cases in every publication, different types of fractures should be operatively stabilized with implants that are used and heterogen patients. internal fixation. Another alternative treatment, different from Late complications are more common than Reconstruction with femuro diaphysere Strat acute complications, and growth arrest is the Grafts is Tumorose Prosthesis, Gidlestone - most commonly observed complication. Situacion, ostheosynthesis with Locking A physeal bridge may develop after either Platte, alloplastic reconstruction and operative or nonoperative treatment. individual prosthesis=3D printers. Physeal bar excision is recommended when Conclusion: Results of fractures and bone less than 50 % of the physis is involved, and defects reconstruction with Femuro there is adequate growth remaining (at least 2 diaphysere Strut Grafts in short and long cm or at least 2 years). Traditionally, fat has periods, are very satisfying and its advantage been used for interposition, but is for reconstruction stability, immediately polymethylmethacrylate may be utilized as an immobilization of patients. Due to high alternative. requests in operating room about Physeal bar resection in isolation can lead to organization, long experience as a orthopedic incomplete correction as the injured physis surgeon this technique, unfortunately isn’t as may still cease growing earlier than a healthy usual as we want to be. physis. A contralateral hemi epiphysiodesis or Keywords: Femuro diaphysere strut Graft, ipsilateral osteotomy may be needed later on. periprosthesic fracture, allogene transplantate, Therefore, patients must be followed closely bone banks, bone defects. in the years leading up to skeletal maturity. Keywords: physeal fractures, physeal bridge, OP – 0052 polymethylmethacrylate

Physeal Bridge/Bar. A Serious Complication OP – 053 of the Distal Femoral Physeal Injury Surgical Management of Metastatic Lesions Onder Murat DELIALIOGLU1, Ledian of the Proximal Femur with Pathological FEZOLLARI MD2, Kenan BAYRAKCI1 Fractures Using Intramedullary Nailing or Endoprosthetic Replacement. Authors Information: 1Orthopedic Services, American Hospital, Rezeart Dalipi1, Milan Samardziski1, Ilir Tirana, ALBANIA. Hasani1, Antonio Gavrilovski1, Dalip Jahja1, 2Department of Orthopedic, University Aleksandar Saveski1, Aleksandar Hospital of Trauma Tirana, ALBANIA. Trajanovski1, Teodora Todorova1.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

quality of life. Advances in surgical Authors Information: techniques and instrumentation have allowed 1 University Clinic for TOARILUC, Skopje, more Republic of effective life for the patients. Keywords:proximal femur, pathological Abstract fractures, metastases. Introduction:Metastatic neoplasms of bone are the most frequently observed malignant OP – 054 destructive bone lesions in adults. The proximal femur is the most commonly The “day - after” surgery: physiopathology affected bone with metastatic disease in the after total hip replacement appendicular skeleton. The orthopedic surgeon is often the first physician to see the Flamur VELLKU patient with a pathologic fracture. The surgeon must be aware of the indications for Author Information: intramedullary nailing (IMN), endoprosthetic Orthopedic Surgeon, Orthopedic Services, replacement (EPR), as well as options for University Hospital of Trauma, Tirana, reconstruction, which are the two most Albania. commonly applied surgical methods used to treat the proximal femoral metastatic Abstract pathological fractures. Introduction:In a total hip replacement (also Purpose: The aim of the present reaview was called total hip arthroplasty), the damaged to evaluate the clinical, functional and bone and cartilage is removed and replaced oncological outcomes for the better quality of with prosthetic components. The damaged life at the patients after surgically treatment femoral head is removed and replaced with a of metal stem that is placed into the hollow proximal femur metastases with pathological center of the femur. fractures. Areas of concern in prevention and treatment Material and Methods: Retrospectively of hip arthroplasty infection are presented, were evaluated data of 28 patients with focusing on the pathophysiologic process pathological fractures secondary to metastatic involved. A review of the patient risk factors tumors of the proximal femur, treated at the and the pathophysiologic action potentiating Clinic of Orthopedic surgery in Skopje, in a risk for infection include host immunity, period between April 2015 and June 2019. nutritional status, diabetes, age, use of Results:The mean age of the patients at the steroids or immunosuppressive drugs, time of operation was 59.3 years (range: 43- rheumatoid arthritis, and urinary tract or other 76-years). A total of 16 patients were treated infections. with EPR and 12 patients were stabilized with Recovery after surgery of total cochlear IMN. The overall survival of patients with femoral prostheses improve outcomes and metastatic lesion and pathological fracture of reduce hospital length of stay. This pre- and proximal femur was dependent of the general post-quality improvement study was designed condition and the amount of the metastases. to determine whether adding "non-surgical" EPR is recommended for patients with components, to "existing" surgical relativelygood general condition and components, in a healthcare setting, would prognosis. IMNis best indicated when the improve patient recovery after total hip patient’s life expectancy is extremely limited. replacement. Conclusion:Postoperative external beam In our study we have recorded the Total hip irradiation can significantly reduce disease prothesis on the first 400 patients during progression and subsequent loss of fixation. period from October 2010-June2018in A multidisciplinary approach to this patient Orthopedic Services, University Hospital of group will help optimize prognosis as well as Trauma. function. The treatments are palliative but Keywords:Femoral, prostheses, surgery. goals include stabilize fractures, improve function and pain relief in an effort to achieve a better

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

OP – 055 KEYWORDS: Glenohumeral joint, dynamic stabilization, neuromuscular control. Rehabilitation of Patients with Instability Glenohumeral post Traumatic(non- OP – 056 operative) Nasal Fractures and Rhino-septoplasty. Manushaqe SARAÇI1, Luljeta STANAJ1 Besim BOCI Authors Information: 1Rehabilitation and Physiotherapy Service, Authors Information: University Hospital of Trauma, Tirana, Department of ENT Surgery, University Hospital ALBANIA. Centre “Mother Teresa” Tirana, ALBANIA

Abstract Abstract Introduction: The shoulder is composed of 3 Introduction:The nose is the most prominent bones and 4 articulatory surfaces, Gleno- part of the face, and thus, most affected by humeral Joint is the main one. Only 25% of facial trauma. Nasal bone fractures are the head surface of the humeral makecontact reported to be the most common facial with the glenoid. Glenohumeral joint fractures and the third most common fractures instability is a common pathology often in the in the human body. orthopedic. There are several factors to Techniques for treating a nasal bone fracture consider during the rehabilitation :1-Degree are closed or open repositioning; of instability, 2-Direction of instability Closed repair is usually recommended within (anterior, posterior, multidirectional), 3- 3 weeks of injury is usually recommended. Concomitant pathologies, 4-Age and activity This is also because closed repository is a level of patient, 5-Arm dominance, 6-Rang of relatively simple procedure that can be neuromuscular control. performed in outpatient, under local Material and Methods: This is a prospective anesthesia and is thus cost effective studyinvolving16 patients(13M,3F), that have However, results after closed repositioning been rehabilitated in our service during are difficult to predict, and the ratios of January 2018—June 2019. 12(75%) patients external nasal deformity from post reposition had damaged right arm and 4(25%) patients vary from 9% to 50%. Furthermore, some + cases require open-label rhinoplasty at early left arm. Average age 35 -- 6 years old. The rehabilitation protocol was applied in 4 stage. phases: I - Acute phase (0-3 weeks), II- Even a simple fracture can lead to a nasal Intermediate phase (4-6 weeks), III - deformity, and inadequate treatment can Advanced strengthening (8-12 weeks), IV- cause aesthetic and functional issues. External Return to daily activities 12+. For nose deformity prior to nasal trauma can lead measurements we used VAS scale, to unexpected results. Therefore, the initial goniometer, MMT at the end phase of treatment should be carefully planned. In the rehabilitation(1st day, weeks 3,6,12,months present study, we aimed to analyse clinical 6,12). features in cases where concurrent RESULTS: 16 patients were taken into rhinoplasty and open landing were performed study. 6 patients were fully rehabilitated for 6 as primary treatment, after nasal bone weeks. 8 patients were fully rehabilitated for fracture. Furthermore, we focused on patients 12 weeks.2 patients were rehabilitated for who had external nasal deformity prior to more than 12 weeks: 1 patient was with nasal bone fracture. injured Rotator cuff and the other patient was Keywords:Nasal Fractures, Rhino- neuro-muscular contracture. septoplasty, outcomes, retrospective study. Conclusions: It is very important to design a comprehensive program to establish full OP – 057 range of motion, balance capsular mobility along with maximizing muscular strength, Ocular Globe Injuries in Children, a endurance, proprioception, dynamic stability Retrospective Study in Albania. and neuromuscular control.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Marsida KRASNIQI1, 2 *, Katerina KASA3 Ophthalmology Department, University Hospital of Trauma, Tirana, ALBANIA Authors Information: 1University “Aleksander Moisiu” Durres; Abstract ALBANIA Lower canal laceration is a pathology that is 2International Eye Clinic, Tirana. ALBANIA 3 not rare in ocular trauma. Although periocular Universitary Trauma Hospital Tirana. ALBANIA injuries may involve the canal, the localization and extent of the injury they are Abstract not always evidenced at the first emergency Introduction:Eye injuries are the leading examination. Complete examination includes cause of monocular blindness in children. At damage assessment and canalicular test. The present, however, only limited follow-up case in question is laceration of the lower studies exist. The aim of this study is to palpebral canaliculus, a consequence of a car evaluate the clinical characteristics, visual accident. This article will discuss the outcome and prognostic factors of open globe technique used in the treatment of canalicular injuries in children. injury. Material and Methods:The files of 38 Keywords: laceration, canal, trauma, injury. patients aged 16 years or younger who had been treated for open globe injuries were OP – 059 examined. The type of injury was classified and the severity of injury was categorized in Reconstructive Surgery with free and four grades. Pedunculated Flap for Oral Cancer Defects: Results:Our series included 5 eyes (13%) with a rupture, 30 (79%) with a penetrating Our Personal Experience and 3 (8%) with a perforating injury. Follow – up varied from 3 days to 7 years (mean 15.5 1 1 months). The macula was attached at the last Alfred AGA *, Emirjona VAJUSHI MD , 1 2 follow-up in all eyes. The final visual acuity Armida KABA MD , Rezarta KAPAJ ranged between 1.0 and light projection. In 47% of cases (18 eyes), the visual acuity was Authors Information: 0.5; 74% (28 eyes) achieved at least 0.1. 1ENT Department, American Hospital Tirana, Eighteen of 38 eyes (47%) had severe injury ALBANIA with posterior segment involvement. Visual 2Plastic Surgery Department, American Hospital acuity of at least 0.5 was achieved in 44% Tirana, ALBANIA (8/18) of these. Eyes with grade 2-4 injury treated with early vitrectomy had a final Abstract visual acuity of 0.5 in 58% of cases (7/13). Introduction:The aim is to report our Twenty -one (55%) of 38 children were 8 experience of using free and pedunculated years of age and eight of them (38%) had a flaps to repair intraoral defects, their final visual acuity of 0.5. reliability, reconstructive outcome and to Conclusion:Saving the eye with an attached macula was possible in all eyes. Even in assess the associated donor-site morbidity. severely injured eyes good visual acuity can Material and Methods: The medical records be established in about 50% of cases. of patients who had undergone a free Keywords:Children, open globe, Albania, flap reconstruction after radical resection of retrospective. oral cancer between January 2014 and August 2019 at the American Hospital in Tirana were OP – 058 evaluated, to analyze morbidity of the

Lower Canal Laceration Treatment surgery, hospitalization stay and the success rate of the flap vitality. Bledar KRUJA, Elvis VELIU, Leodita Results: In this period, 13 patients with oral GJANA, Johana VRUHO cavity defects resulting from tumor resection underwent reconstruction with free flap. In Authors Information: four cases a radial forearm free flap was used

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts for reconstruction of the lateral wall of the and mandible injuries are more common pharynx and base of the tongue after among adolescents. Although bony squamous cell carcinoma (SCC) resection. In craniofacial trauma is relatively uncommon among the pediatric population, it remains a another case, after resection of big tongue substantial source of mortality, morbidity and tumor that involves the floor of the mouth, we hospital admissions. Continued efforts toward use anterolateral thigh flap. One scapular flap injury prevention are warranted. was used for reconstruction of hard palatal Trauma in the maxillofacial region in defect after total right maxillectomy for children are a frequent clinical reality. Due to adenoid cystic carcinoma (ACC). physiological, anatomical, psychological Conclusions: A free flap, in our experience, features, etc., their treatment is relatively different from that of adults. These changes is ideal to repair intraoral defects. It is consist in details related to the elements of straightforward and reliable and has an fixing the way of its realization, acceptable reconstructive outcome. It might modifications of standard methods and be a suitable procedure for patients that are follow-up of cases. that in most cases closed inoperable before applying this technique in non-surgical conservative treatment is our country. The pedunculated flaps are effective. Tracking of cases in progress is useful and easy to harvest but we noticed that important to ensure the best anatomical development in both the dimensional and the reliability and the complication rate was functional aspects. Physiotherapy remains an higher. Proper essential component of the treatment of intraoperative and postoperative care of the patients in this group. donor site can result in minimal morbidity. Keywords:Oro maxillofacial, trauma, Keywords:Free flap, reconstruction, radical Physiotherapy, treatment. resection, pharynx. OP – 061

OP – 060 Management of Traumatic Dental Injuries in Emergency Departments. Trauma Management of the Oro Maxillofacial Region in Children. Orjada GASHI1, Lorena HAXHIHYSENI1

Esat BARDHOSHI Authors Information: Orofacial Surgery Service, University Hospital of Author Information: Trauma, Tirana, ALBANIA Department of Oro-Maxillofacial Surgery, Faculty of Dental Medicine Abstract University of Medicine, Tirana, ALBANIA Introduction:Hospital emergency departments are confronted with managing Abstract dental emergencies of both traumatic and Introduction:Pediatric Oro maxillofacial trauma involving the bones of the face is non-traumatic origin. However, the literature associated with severe injury and disability. suggests inadequate knowledge of the Although much is known about the management of traumatic dental injuries epidemiology of facial fractures in adults, among medical professionals. The aim of the little is known about injury patterns and study was to evaluate the knowledge of ER outcomes in children. The most common physicians with different specialties, facial fractures were mandible, nasal and experience and hospital sectors for the maxillary/zygoma. The most common mechanisms of injury are motor vehicle management of avulsed teeth in the collisions, violence and falls. These fracture emergency rooms of Trauma University patterns and mechanisms of injury varies with Hospital of Tirana. It also covers their attitude age. Cranial and central facial injuries are towards receiving further education on tooth more common among toddlers and infants, avulsion management.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Materials and Methods: A cross-sectional and are evidenced by relevant examinations survey was conducted at the emergency (anterior rhinoscopy, fibro-endoscopy and CT rooms of Trauma University Hospital of scanner) Tirana. A self-administered questionnaire With all developments that have been made consisting of 31 multiple choice questions in physiopathology over the last two decades, assessing both knowledge and attitude was the exact etiology remains unclear because distributed to the physicians who were the causes are related to the subject and working in the ER departments. Results: environmental factors. Response rate was 81.33%. Data revealed that Treatment consist in improving muco-ciliary 58.9% of the respondents did not have prior clearance, treating infections and knowledge about avulsion. 70 % of inflammation, improving sinus discharge and participants showed willingness to replant the eliminating etiological factors. This treatment tooth, however, 60% would not do it by compromises a series of local, systemic and themselves. 40% of the physicians did not surgical therapies. know the importance of extra-oral time. Keywords: rhinosinusitis, inflammation, Saliva was selected as the best transport treatment. media for avulsed tooth by 40.1% of the participants. Regarding physician’s OP – 063 attitude,20% showed interest in receiving information about the subject. Complex Bilateral Eye Conclusion:Dentoalveolar trauma does not TraumaManagement, a Case Report. pose a significant morbid risk for the trauma patient. However, failure to recognize or Katerina KASA¹, Marsida KRASNIQI ², obtain appropriate consultation can result in Etleva GJURASHAJ ³ premature tooth or alveolar bone loss, resulting in problematic prosthetic Authors Information: rehabilitation, along with immediate and ¹ University Hospital of Trauma, Tirana, long-term emotional and social impact, ALBANIA especially among young adults. This study ² University Aleksander Moisiu, Durres, ALBANIA revealed that the majority of ER physicians ³ Policlinici Nr. 9, Tirana, ALBANIA lack the knowledge needed to manage Abstract avulsions cases. Hospital emergency A 52 years old man was presented to the departments are not confronted with ophthalmic emergency room with a firework managing dental emergencies of both facial and eye trauma, on 31 December 2018. traumatic and non-traumatic origin. He presented multiple, small facial cutaneous Keywords: Dental trauma, traumatic abrasions and burn (Fig 1). His visus on the injuries, emergency department. left eye was light perception and in the right

eye was finger counting in 5cm. The clinical OP – 062 presentation of both eyes was lid and

conjunctival burns, chemosis and Chronic Rhinosinusitis conjunctival hemorrhage, corneal punctiform

perforation, multiple corneal foreign bodies, Fatmir GUNI hyphemia of 3mm, traumatic cataract (Fig 2).

USG (A+B scan) revealed extended vitreous Author Information: hemorrhage and a single foreign body. No ENT Service, University Hospital of Trauma, irido dialysis was seen. The patient had no Tirana, ALBANIA. retinal detachment or optic nerve injury. After

suturing and debriding the cornea, washing of Abstract the anterior chamber he underwent cataract Chronic rhinosinusitis is persistent surgery with scleral fixation intraocular lens, symptomatic inflammation of the nasal vitrectomy and silicone oil tamponade on mucosa and paranasal sinuses. The clinic is both eyes (Fig 3). After 3 months' follow-up, dominated by 2 of 4 major signs: pain, facial his visual acuity on his right eye was 20/200 pressure, hypo/anosmia, leakage and nasal and his left eye was 20/400. The causes of congestion, which last more than 12 weeks

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts poor vision were corneal scar, astigmatism the half year period in 2018., and whose after corneal repair, vitreous hemorrhage, and diagnosis was contusion injuries of the eye. macular edema. Fireworks-related eye The material used for this study included injuries constitute an important cause of patient records, disease histories and hospital preventable blindness worldwide. As ocular release forms. firecracker injuries result in significant Results:The study results proved that there morbidity, public education regarding proper were more men 68 (82,26%), than women 16 use of fireworks may help in reducing the (17,74%), with the most frequent age 40-59 incidence of ocular injuries. regardless the gender. Most frequent injuries Keywords:Eye trauma, fireworks, vitreous occured in workers 22 (26,61%). Wood was hemorrhage, traumatic cataract. the mean of injury in 39 (30,95%). Almost equally, both the right (53,57%) and left eye OP – 064 (44,04%) were injured, while in 2 patients (2,38%) both eyes were injured at the same Analyzing Complications of Posterior time. Of complication we found: Segment of the Eye after Contusion Injuries haemophthalmus (21,43%), ablatio retinae of the Eye (13,09%), commotio retinae (20,24%), Purtscher retinopathy (3,57%), blow-out Kenan LJUHAR, Aida GAVRANOVIĆ, Adem fracture (3,57%). Astigmatisms were found in ZALIHIĆ, Mujo SUBAŠIĆ, Aner DURAKOVIĆ, 3 patients, as strabismus. Our research shown Emir SMAJIĆ that 15 (17,85%) patients needed surgical intervention. Percent of 66,67% patients were Author Information: cured. Emergency Medical Service Center Sarajevo, Conclusions: Eye traumatism is still one of BOSNIE HERZEGOVINA the leading causes of vision loss. Contusion

injury of the eye can result in serious Abstract morphological and functional impact in eye Introduction: One third of all eye injuries tissue structures and often causes a visual are contusion injuries. The most common loss. Proper examination and appropriate causes of contusion eye injuries are approach are essential in successfull objectives, a traffic accident. Complications treatment and saving the visual functions. of the eye injuries on posterior part are: Keywords: contusion injuries of the eye, eye haemophthalmus, ablatio corporis vitrei, traumatism, haemophthalmus, ablatio, optical nerve injuries, injuries of retina. vitrectomy. Contusion injuries of the eye often causes a visual loss despite advance in diagnostic and surgical treatment. Treatment are proper OP – 065 examination and observation, curing with medicines, and VPP. Role of Ultrasound in Scrotal Emergencies The Aims of this work are directed to identifying the most frequent cause of eye Adham DARWEESH¹; Maysa MOHAMED injuries; establish if there is a correlation between age, gender, occupation and Authors Information: complications of contusion injuries of the ¹Senior Consultant RadiologistHead of Body eye; establish if there is a correlation between Imaging, HGH,Associate Program Director, type injury and complications of contusion A/Professor of Clinical Radiology, Weill injuries of the eye, finally, estabilish if there Cornell Medical College, Hamad Medical is correlation between visual acuity status and Corporation, Doha, QATAR. complication of contusion injuries of the eye.

Material and Methods: The study is Abstract retrospective, epidemiological, descriptive Introduction: The purpose of the and analytical. The study included 84 presentation is to demonstrate the role of examinees of both genders, hospitalized at the Ultrasound (US) in the evaluation of patients Department of Ophthalmology Clinical with acute scrotum, especially in cases where Center of the University of Sarajevo during immediate surgical intervention is crucial as

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts in testicular torsion and scrotal trauma. In charts and studied different cases, by such clinical situations, US can provide anamnesis, medical reports and evaluated accurate diagnosis and testis can be saved. positive and negative findings in the Scrotal US is regarded as the imaging radiological report. modality of choice for evaluation of acute scrotum in both pediatric and adult Results: Files of 163 patients were gathered population. It plays important role in triage of during a 5year period. Of these, 58.9% were patients presenting to the Emergency females and 41.1% were males. Department with scrotal pain and offers Of the requested ultrasound examinations, timely and accurate diagnosis of these cases. less than 45%, contained any conclusive Materials and Methods: Review of scrotal information. Abdominal ultrasound was the ultrasound in Emergency Department setting most likely to be ordered by physicians and based on our own experience and the available literature. also to be reported as normal after the scan. Results: We discuss proper techniques of Conclusions: These findings suggest that it is scrotal ultrasound (gray scale & color of great importance to educate primary care Doppler), anatomy, normal and abnormal physicians about imaging referral. The main findings relating to different scrotal problem faced during everyday practice, pathologies, with special emphasis on trauma, when it came to ultrasound referral remained torsion, orchitis and tumors. the need to satisfy patients request to undergo Conclusion: Clinical history along with color Doppler ultrasound help to achieve accurate this imaging modality, because it was and timely diagnosis of scrotal pathologies perceived as a safe, radiation free, easy and allowing for rapid intervention to salvage the fast modality. testis, particularly in cases of torsion and KEYWORDS: Ultrasound, family physician, trauma. radiological report. Keywords: ultrasound, scrotum, emergency, diagnosis. OP –067 OP –066 Errors in Imaging of Patients with Family Physicians and Ultrasound Trends Traumatic Injuries in Everyday Practice Admir MUSTAFA1*, Vidi DEMKO1, Kujtim ALIMERI1, Sonja BUTORAC (SARACI) 1, Erinda KOSTURI¹, Aurora KRASNIQI. Gëzim GURI1, Artan GJIKA1, Najada 1 1 KALLASHI , Bardhyl VEIZI

Authors Information: Authors Information: ¹Family Physician Polyclinic No 3, Tirana, 1Department of Radiology, University ALBANIA. Trauma Hospital, Tirana, ALBANIA.

Abstract Abstract Introduction:Ultrasound examination is one Introduction: The advent of multi-detector of the most common adjuvant examinations computed tomography hasdrastically improved the outcomes of patients with often required in primary care practice by multiple traumatic injuries. Emergency and family physicians. But is it always trauma care produce a “perfect storm” for appropriately ordered? Should it be radiological errors: uncooperative patients, performed in their offices rather than in other inadequate histories, time-critical decisions, facilities? Would it help if primary care concurrent tasks and often junior personnel physicians were educated on imaging working after hours in busy emergency departments. modalities? However, there are still diagnostic challenges Materials and Methods:In collaboration to be considered. A missed or the delay of a with family physicans we reviewed clinical

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts diagnosis in trauma patients can sometimes injury where CT findings can be subtle. be related to perception or other non-visual Computed Tomography (CT) is generally cues, while other errors are due to poor used as first line imaging modality for technique or poor image quality. The main detection of visceral injuries in polytrauma cause of diagnostic errors in the emergency department is the failure to correctly interpret patients. Several direct and indirect CT signs radiographs, and the majority of diagnoses can be seen in patients with blunt pancreatic missed on radiographs are fractures. injury. The purpose of the presentation is to Missed diagnoses potentially have important review CT findings in blunt pancreatic consequences for patients, clinicians and trauma, highlight the value of repeated CT radiologists. Radiologists play a pivotal role scan in these cases, and correlate CT findings in the diagnostic assessment of polytrauma with endoscopic retrogradecholangio- patients and of patients with non-traumatic cranium - thoracic - abdominal emergencies, pancreatography magnetic resonance and key elements to reduce errors in the cholangiopancreatography ultrasound (US), emergency setting are knowledge, experience laboratory and surgical findings. and the correct application of imaging Materials and Methods: Data was protocols. retrospectively collected covering a period of In order to avoid any serious complications, it eight years and analyzed. A total of 21 is important for the practicing radiologist to patients (17 males and 4 females) with blunt be cognizant of some of the most common types of errors. pancreatic injury were identified. All cases The objective of this presentation is to review had CT on admission, and 15 had follow up the various types of errors in the evaluation of CT performed between 24 hours and 14 days patients with multiple trauma injuries or later. 9 cases had US, 8 cases had ERCP and polytrauma and the spectrum of diagnostic MRCP was performed for one case. Serum errors in radiography, ultrasonography and amylase level was obtained on admission in CT in the emergency setting. Keywords: Imaging, errors, all cases. trauma,diagnostic. Results: Initial CT performed on admission was positive in 17 patients (81.0 %); and OP –068 diagnosis was missed in 4 patients (19.0 %). In these four cases, a repeated CT scan was Imaging of Blunt Pancreatic Trauma: The found positive. ERCP demonstrated rupture Value of Initial and Sequential CT of the main pancreatic duct in 7 cases. One Examinations MRCP was positive. Elevated serum amylase was found in 14 cases (66.7%). Specific CT Adham DARWEESH¹, Maysa MOHAMED, features depicted on the initial and repeated Wojciech SZMIGIELSKI examinations were organ fracture 33.3%, swelling - 38.1%, haematoma/contusion – Authors Information: 38.1%, fluid between splenic vein and pancreas – 19.0%. ¹Senior Consultant RadiologistHead of Body Conclusion: Proper CT technique and Imaging, HGH,Associate Program Director, accurate interpretation of CT findings are A/Professor of Clinical Radiology, Weill Cornell Medical College in Qatar Hamad essential for diagnosis of pancreatic injury. Medical Corporation, Doha, QATAR CT also plays important role in following up and managing complications in these cases. If Abstract initial CT on admission was negative in a Introduction: Blunt traumatic pancreatic symptomatic patient with elevated serum injury is uncommon, frequently associated amylase, follow up CT preferably within 24- with other injuries and can pose diagnostic 48 hours should be performed. challenge particularly in early pancreatic

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Keywords:pancreatic, blunt, trauma, CT Conclusion: Multi-detector CT is an scanner. excellent diagnostic modality for the evaluation of bowel and mesenteric injury. OP – 069 Knowledge of the CT findings of bowel and mesenteric injury would improve detection Role of Multi-detector Computed rate and allow for accurate diagnosis and Tomography in Bowel and Mesenteric management. Administration of oral contrast Injury agent is not mandatory for initial evaluation of patients with such injuries. Parambath Arif NELLIYULLA ¹; Maysa Keywords:CT scanner, bowel, mesenteric, MOHAMED, Adham DARWEESH ² injury.

Authors Information: OP – 070 ² Senior Consultant RadiologistHead of Body Imaging, HGH,Associate Program Director, The Accuracy of Imaging Techniques in A/Professor of Clinical Radiology, Weill Early Detection of Breast Disorders Cornell Medical College in Qatar Hamad Medical Corporation, Doha, QATAR Albana SHAHINI

Abstract Author Information: Introduction: Bowel and mesenteric injury Radiologist, Americal Hospital, Tirana, ALBANIA (BMI) is the third most common type of injury resulting from blunt abdominal trauma Abstract (BAT), seen in approximately 5% of BAT INTRODUCTION:Screening is key to early patients undergoing laparotomy. Multi- detection and treatment of breast cancer in detector Computed Tomography(MDCT) is women.To assess the accuracy of imaging considered the diagnostic modality of choice techniques in early detection of breast for the evaluation of hemodynamically stable disorders (benign or malign) and the importance of follow-up protocols. patients who sustained blunt abdominal MATERIALS AND METHODS: This is a trauma. These injuries are however frequently cross-sectional study that brings evidence on missed on CT and diagnosis remains the sensitivity (SN), specificity (SP) and challenging. accuracy (ACC) of mammography (MM) and The aim of this presentation is to evaluate ultrasound (US) examinations, as compared role of Multi-Detector Computed to the biopsy findings (gold standard). Some Tomography (MDCT) in bowel and 254 women underwent MM and US examinations, and biopsies were taken for 39 mesenteric injury following blunt abdominal women with BIRADS 4 and 5. trauma and highlight CT findings and Results: We found a decrease (100% to 90%) potential pitfalls. in the SN for US benign findings as the breast Materials and Methods: Radiological density increased and an uneven variability reports of MDCT examinations of patients on US SN for malign findings. The SP for all with bowel and mesenteric injury over a US findings was 100%. The US ACC decreased for benign findings and increased three-years period were retrospectively for malign findings.If a woman has malign identified and relevant data were collected findings in MM, odds to have a positive and analyzed. malignant finding in biopsy increase 20 times Results: Different specific and less specific (p=0.008). This increase is 12 times for CT findings of bowel and mesenteric injury women with an US positive malignant finding were illustrated, without the use of oral (p=0.005). The odds for having a biopsy contrast. positive malignant finding increase 24 times for women that have at least one malignant

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts finding in either MM or US. The odds for This presentation will be an approach to having a biopsy malignant finding increase 18 imaging diagnoses of patients with acute times if the lesion is 1.5 cm or larger abdominal pain, where computed tomography (p=0.018). If women have both a malign will be emphasized. finding (in either MM or US) and the lesion is Key imaging data of cases of acute over 1.5 cm then odds to have a biopsy appendicitis will be mentioned. positive malignant finding increase to 21 A systematic evaluation of the imaging data times more for malign lesions over 1.5 cm and explanation of the examination protocols. (p=0.027) and 8 times (p=0.027) for MM or KEYWORDS: Imaging, abdominal pain, US findings. examination, protocol. Conclusion: Out study confirms the crucial importance of using MM and US to early OP – 072 detect breast cancer on women, enabling so the early treatment and saving lives. Benefits Acute Epiploic Appendagitis an unusual are higher if these examinations are used in cause of Abdominal Pain combination annually for women aged 40-50 years old and biannually for those over 50. Dorina SHQALSHI Confirmations using biopsy should come for all those women BIRADS 4 and 5 as well as Author Information: for BIRADS 3 with lesion that increased Radiologi service, Salus Hospital, Tirana, since last check-up. Especially for women ALBANIA with denser breasts (ACR 3 and 4), it is vital to have both examinations (MM and US) Abstract used in combination as US has a higher ACC Inttroduction:Primary epiploic appendagitis in this group and is irreplaceable for ages 51- is a rare condition that occurs after either 55 years old. torsion or spontaneous venous thrombosis Keywords:Breast, cancer, imaging. with subsequent development of infarct and inflammation. OP – 071 It is determined by a benign, self-limiting inflammatory or ischemic damage of the Role of CT in Acute Abdomen Especially in epiploic appendages, or it may be secondary Appendicitis Acuta to other inflammatory conditions affecting adjacent abdominal organs. The condition Behar TOCILLA, Bledi CEKREZI, Arben most commonly manifests in the 4th to 5th DHIMA, Albana SHAHINI, Adriatik DAKU, decades of life, predominantly in men. Fjorda TUKA. The diagnosis of epiploic appendagitis has a clear clinical relevance and significant Authors Information: implications in patients’ management. In case Radiology Service, American Hospital, of acute abdominal pain, this entity is Tirana, ALBANIA considered a clinical mimicker of other conditions, such as acute appendicitis and Abstract diverticulitis, that usually require a surgical This segment of the presentation will go over evaluation. Imaging plays an essential role in the optimal imaging approach for patients the diagnosis of epiploic appendagitis, presenting with acute abdominal pain. CT allowing the appropriate detection and findings will be emphasized. Key imaging differential diagnosis, in order to avoid findings of non-traumatic relevant misdiagnosis. causesof acute abdominal pain including Before the use of the CT scan, most of the gastrointestinal like appendicitis will be cases were diagnosed during surgery. explained. A systematic approach for the Once the diagnosis of epiploic appendagitis is imaging evaluation of patients made, conservative treatment must be with abdominal emergencies will be initiated to avoid unnecessary surgery. illustrated and explained including proper Surgical treatment is reserved for patients in scan protocols and analysis of imaging whom conservative treatment fails or for findings. patients whose signs and symptoms worsen.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Keywords:appendagitis, torsion, venous Intubated with the aid of a fiberscope, a total thrombosis, Abdominal Pain thyroidectomy was possible, after partial sternotomy. OP – 073 A 78-year-old female complaining of stridor

Acute Airway-Threatening Presentations of and dysphagia, from a large right cervical Thyroid Diseases in very old Patients mass, with a 4 mm tracheal lumen was admitted. A tracheostomy was performed but, Carlos MESQUITA due to airway obstruction not completely resolved by this procedure, a right lobectomy Author Information: with isthmectomy was performed urgently. General and Emergency Surgery Although cytologic study was suggestive of Departments – Trauma Center papillary carcinoma, the degree of local Coimbra Central and University Hospital, infiltration, evident at the time of surgery, PORTUGAL first drew attention to the possibility of an anaplastic thyroid cancer. Abstract Acute airway-threatening from thyroid Acute airway-threatening from thyroid diseases is not common. Early recognition of diseases is not common but may occur due to theseconditions and urgent, partial or total giantgoiters, hematomas and thyroid thyroidectomy may be necessary to alleviate malignancies, among others. The author symptoms, when tracheostomy is not an underlines the need for the surgeon working effective option. The surgeon working in an in acute care setting to be familiar with acute care environment should be aware of thyroid surgery. these possible scenarios and be prepared to Three recent cases, in very old patients, of solve them. acute airway-threatening from thyroid OP – 074 diseases are described:A 91-year-old male with known giant right-sided thyroid mass, Cold nodules of Thyroid Glands. with a cytologic study suggestive of follicular tumor, who had refused thyroid surgery two Myzafer KAÇI, Arvit LLAZANI, Arvin months earlier, was hospitalized for acute DIBRA, A. HOXHA, Astrit XHEMALI, exacerbation of dyspnea and hoarseness. Artan BODEC, Ilir SKENDULI, Armir DAMZI. Cervical mass extended from the hyoid bone to the upper mediastinum, with left shift of Authors Information: cervical structures. Right thyroidectomy and 1 General Surgeon, University Hospital istmectomy were urgently performed. Center “Mother Theresa” Tirana, ALBANIA A 88-yeard-old female with a known bilateral large cervical mass was admitted due to Abstract stridor. Computed tomography revealed a Introduction: A cold nodule is a thyroid large retrosternal compressive goiter with a nodule that does notproduce thyroid hormone. This type of nodule may be malignant or remaining tracheal lumen of 2 mm. Surgical benign. In older women the cold nodules have risk was significantly aggravated by a severe a chance of 15% to be malignant but this aortic stenosis. Since there was no place for a percentage increases in children and men classic tracheostomy and endotracheal especially if they have been in contact with intubation could be difficult or impossible, ionizing radiation. On scintigraphy cold everything was prepared in order to nodules do not show but are easily shown on ultrasound. The levels of calcium and the anesthetize the patient under ECMO, which, thyroid hormone in blood are used to however, did not become necessary. diagnose the nodules. To verify the nature

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts and the probability of malignance the best 3Radiologist at University Hospital Center preoperative testing method is cytopuncture “Mother Theresa”, Tirana, ALBANIA of the nodule. The final result is given by the 4Torakal Service, at University Hospital “Shefqet postoperative biopsy. Ndroqi”, Tirana, ALBANIA Materials and Methods:A prospective study 5Pneumology Service, at University Hospital is conducted in 80 selected patients who do “Shefqet Ndroqi”, Tirana, ALBANIA not have any other pathology and have been under medical treatment for the thyroid Abstract nodules. The age of the patients varied from Introduction: Pneumomediastinum is caused 25 to 65 years old. 48 patients (60%) were by an injury in lungs level, trachea or females and the other 32 (40%) were males. esophagus. If there isn’t a clear cause then All the preoperative testing methods are used probably is a spontaneouspneumo- such as Thyroid Gland Ultrasound; mediastinum. It’s very rare (1 in 7.000- Scintigraphy of the gland; Thyroid hormones 35.000) and it is found more in males then and calcium levels in blood and also females. Age 20-40 and patients with lungs Cytopuncture of the nodules. The authors diseases or asthma have higher risk. attempted to emphasize the comparison Materials and Methods: We present a case between the preoperative data and report, treated in First Clinic at Surgery intraoperative findings and the biopsy results Service at University Hospital Center of the cold nodules of thyroid gland. “Mother Theresa”. Results: The Calcium blood level had no Results:It is a female patient, 5 years old, changes in testing preoperative and with diagnosis: Multinodular Struma. A total postoperative. Preoperative testing diagnosed thyroidectomy was realized, with bilateral 100% of the patients under study with cold recurrent nerve conservation. 40 hours post nodule of thyroid gland. The most affected operation, the patients represent with age is 35-54 and females have a higher progressive edema of face, neck and upper probability of disease. Postoperative testing part of chest. After CT scanner, we noticed a resulted in 2.5% of the patients with papillary pneumomediastinum. The treatment was with thyroid carcinoma. drain chest tube, that was placed in operation Conclusions: Interventions in early ages are wound, antibiotics and anticoagulants. Patient necessary to prevent goiter and the use of discharge hospital after 15days. iodine salts. It is necessary to know the Conclusions:Pneumomediastinum is a rare prevalence of the disease so that proper health condition and has serios consequences. policies can be developed for the future. The Conservative treatment and observation are best way to diagnose Thyroid Gland necessary to ensure patient improvement. Carcinoma is the postoperative biopsy. Keywords:pneumo-mediastinum, thyroid, Keywords:cyto-puncture, Ultrasound; surgery, bronchoscopy, fibrogastroscopy. Scintigraphy, gland Thyroid OP – 076 OP – 75 Strangulated Giant Para-oesophageal PneumomediastinumAfter Thyroidectomy A Hernias Case Report. Carlos MESQUITA Alma LLUKAÇAJ1, Etmont ÇELIKU1, 2 3 Majlinda NACO , Maksim BASHA , Ilir Author Information: SKENDULI4, Fatmir CAUSHI4, Ilir 5 General and Emergency Surgery Departments, PEPOSHI Trauma Center, Coimbra Central and University Authors Information: Hospital, PORTUGAL 1Sugery Department at University Hospital Center “Mother Theresa”, Tirana, ALBANIA Abstract 2Anestesiologist at University Hospital Center Paraoesophageal hernias (PEH) are mediastinal displacements of abdominal “Mother Theresa”, Tirana, ALBANIA organs andoccur due to a lax diaphragmatic hiatus and phreno-esophageal 45 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts membrane.PHEoccurrence and size increase On physical examination, she was found to be with age. They account for approximately 5– dyspneic and tachypneic and having dullness 10% of to percussion with decreased breath sounds diaphragmatic hernias. If symptomatic they on the left hemithorax. Chest X-ray, can present with intermittent computed tomography and magnetic nonspecificsymptoms, including epigastric resonance imaging demonstrate the existence pain, postprandial fullness, chest pain, of a multilocular lesion in the left hemithorax nausea, iron region that compresses the mediastinum and deficiency anemia, gastro-esophageal reflux pushes it to the right position, pancreas with or dyspnea. In patients without prohibitive calcium zones and a liquid zone that can operative risk they should be surgically correspond to a pancreas pseudocyst. The corrected, avoiding the risk of an acute and patient was successfully treated with potentially life-threatening complication combined operative (thoracotomy), invasive (incarceration, strangulation, volvulus, (percutaneous puncture of pseudocysts of ischemia, perforation or gangrene), when pancreas) and conservative therapy. emergent surgical repair is required. The risk Conclusion:Pancreato-pleural Fistula (PPF) of developing these complications is less than is an uncommon complication of chronic 2%/year and the mortality rate associated is pancreatitis leading to large and recurrent approximately 5%. pleural effusion. The condition is diagnosed To highlight the need of a high suspicion with very high pleural fluid amylase, Rtg and index in uncommon clinical conditions and CT. We recommend a conservative treatment the value of an experienced team, a case of an of chronic pancreatitis in combination with acute complication in a misdiagnosed percutaneous drainage of pseudocysts of the incarcerated giant PEH is presented. pancreas, thus reducing the accumulation of An 86-year-old female with multiple medical fluid in the thorax. conditions, including hypertension, chronic KEYWORDS: Pancreato-pleural Fistula; renal failure on hemodialysis, diabetes Pseudocyst; Pancreas mellitus and a previously known large PEH, was admitted in our emergency department OP – 078 due to acute abdominal pain, vomiting and hypotension. Blood results revealed an Open Fractures of Cruris and Treatment isolated white cell count of 18.0x109/L. CT- with External Fixator. angio was performed and ruled out mesenteric ischemia. Ilir HASMUCA*, Zamir DEMIRAJ

OP – 077 Author Information: ¹Orthopedic Service, University Hospital of Acute Liquid Thorax as a Result of the Trauma, Tirana, ALBANIA Pancreato-pulmonary Fistula. A Case

Report. Abstract

Inroduction: Open fractures of the ankle are Kenan KARAVDIĆ fractures caused by high-energy forces and

observed in the young population. They Author Information: Clinic for Pediatric Surgery, Clinic Center of constitute the backbone of all open fractures. University Sarajevo, BOSNIAHERZEGOVINA The incidence is 1 per 5000 fractures and 23 cases per 100,000 persons. Men are the most Abstract affected by open fracture of the ankle. These Introduction:Pseudocyst formation and fractures are highly susceptible to infections pancreato-pleural fistula are a rare and delays in bone healing and therefore complication of acute and chronic require rigorous and very careful treatment. pancreatitis. Material and Methods: This is a case- Case Presentation: A 10-year-old girl was control study on cases and controls for admitted to our pediatric emergency selection over a 3-year period 2016-2018. department with an acute onset of dyspnea. Only the cases treated by Orthopedic Clinic 1

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts at the University Trauma Hospital for the perception that ACL reconstruction is a period January 2016-December 2018, with routine surgical procedure that can be Diagnosis: Aperta Cruris Fracture, were performed even by orthopedic surgeons studied. Data on both cases and controls were performing less than 10 procedures in a year obtained from the University Trauma or poorly defined parameters of healing and Hospital of Tirana. In this study we defined rehabilitation needed to successfully return (operational definition) cases as "Open patients to pre-injury levels of function. fractures treated with external fixator" and as The solution can be in the individualization of controls "Open fractures treated with other or the surgery and rehabilitation to meet each untreated techniques". patient’s needs. That means that no single Results:Open fractures of the ankle are more surgical technique can address all needs or common in males than in females where the situations successfully and that different average age is 41 years. 95.3% of invoices are variables like: timing of surgery, the type of type I, II Gustilo / Anderson and 4.7% are used graft material, the number of grafts, type III Gustilo / Anderson. graft fixation and additional extra-articular Hospital stay and post op a day higher in surgery should be customized to address the cases of external fixator use. Meanwhile, needs of the patient. New methods able to timing operation has no significant enhance tissue healing, speed up recovery differences between operating techniques. time, and decrease the risk of ACL graft Conclusions: The use of an external fixator failure are also investigated. facilitates better management of your wounds We want to present our thirty-five years’ and facilitates the design of the ultimate experience with ACL reconstruction, starting treatment arm, but this does not mean that from year 1984 since today. We tried other surgical techniques are ineffective. The different ACL reconstruction surgical use of other surgical techniques is effective in techniques, we kept what was good and Gustilo / Anderson type I / II fractures, while changed what gave bad results. A La Carte the use of the fixator is very effective in type surgery or individualize each surgery for each III Gustilo / Anderson fractures. patients the main principle for us today. Keywords: Open fractures of the ankle, Keywords:Anterior cruciate ligament external fixator reconstruction, Different ACL surgical techniques, Thirty- five years’ experience. OP –079 OP – 080 Anterior Cruciate Ligament Reconstruction our Thirty-Five Years’ Experience. Dilemmas in the Decision-Making Process in the Treatment of Proximal Femur 1* 1 Alan ANDONOVSKI , Ilir SHABANI , Fractures - Metanalysis of Papers Done at 1 BiljanaANDONOVSKA, Ilir HASANI Several Different Centers

Authors Information: Antonio GAVRILOVSKI1, Rezeart DALIPI 1*, 1 University clinic for orthopedic surgery, Aleksandar TRAJANOVSKI1. Aleksandar traumatology, anesthesiology and intensive SAVESKI1, care, Skopje, Republic of North MACEDONIA Authors Information: 1 Orthopaedic Surgeon University Clinic for Abstract TOARILUC, - Skopje, RN of MACEDONIA Introduction: Anterior cruciate ligament (ACL) reconstruction is a common operative Abstract procedure which is not predictably successful Proximal Femur Fractures are frequent in restoring the patients pre-injury state. Only injuries in the patient population of every 60–70% of patients resume their previous trauma centre and have a high incidence in level of activity in 20.6% after 10 and 51.7% the general population. Paralleling trends of after 20 years of the patients with ACL demographic reconstruction, knee osteoarthritis is forecasts, their incidence will continue to rise developed. Reasons can be either the wrong in the future.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Due to the still undefined views and assessed at a mean 2.3 years. Mean Lysholm controversies regarding the treatment of score was 93.7 points (range, 61-100). All proximal femur fractures, there is a need for patients were satisfied or very satisfied with meta-analysis of published papers. the result. All had returned to their previous The aim is to draw conclusions that will help form an appropriate decision about the type job, and sports activities. of treatment for these fractures and thereby Conclusion: Patellar tendon rupture has provide the most appropriate treatment for good prognosis if diagnosis and surgical each patient. treatment is early. We list 7 metanalyses with a significant Keywords: Acute rupture; Patellar tendon; number of cases covered and an appropriate Surgical repair. follow-up period, as well as our own experience in our center. Keywords:Fracture, femur, type of treatment. OP – 082 Chronic Achilles Tendon Tear Treatment OP – 081

Patellar Tendon Tear Treatment in Athletes. Edvin SELMANI1, 2, Ylber ZAMA2, Valbona 1, 2 2 Edvin SELMANI , Ylber ZAMA , Valbona SELMANI2, Gjergji CAUSHI1, 2 SELMANI2, Gjergji CAUSHI1, 2 Author Information: Authors Information: 1Faculty of Medicine, University of Medicine 1 Faculty of Medicine, University of Medicine Tirana, ALBANIA. Tirana, ALBANIA. 2Department of Orthopedic, University 2 Department of Orthopedic, University Hospital of Trauma Tirana, ALBANIA. Hospital of Trauma Tirana, ALBANIA. Abstract Abstract Introduction: This study aimed to evaluate Introduction: Patellar tendon tear is easy to the long-term follow-up results of V- diagnose but is still often overlooked. The Y tendon plasty with fascia turndown, for aim of this study was to assess early and late repairing chronic Achilles tendon tears. results of surgical treatment of acute patellar Matherial and Methods: Seventeen patients tendon rupture with Krakow technique. (12 males, 5 females), who were diagnosed Material and Methods: A retrospective with chronic Achilles tendon rupture and met study included 5 patients (5 males) . Mean the inclusion criteria, were included in the age was 29.6 ± 9.9 - years. Lesions study. These patients received treatment by comprised 4 tendon body ruptures, means of V-Y tendon plasty with fascia Tendon repair was achieved with Krakow turndown from January 2005 to December technique. Results were evaluated in 2 steps: 2011. Clinical outcomes of the patients were on patient files at a mean follow-up of 7.1 assessed by using isokinetic strength testing, months (range, 3-24 months) to assess questioning the patient regarding residual complications and early functional and discomfort, pain, or swelling and having the radiological results; and by phone at a mean ability to perform heel rises and using follow-up of 2.3 years in order to assess American Orthopaedic Foot & Ankle long-term functional outcome on Lysholm Society's (AOFAS's) Ankle-Hind Foot Scale score and patient satisfaction. score. Mean follow-up duration was 10 years Results: Four knees were assessed at a mean (7-13 years). 7.1 months. Mean knee flexion was 128.5° ± Results: Mean time from the injury to 7.5° (range, 85°-150°), extension -1° (range, operative treatment was 6 months. Mean -15° to 0°) and Caton-Deschamps index 0.96 operative defect of Achilles tendon in neutral (range, 0.57-1.29). All knees were further

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts position after debridement was 5 cm. During fractures during sport injuries, treated at our the follow-up, the mean calf atrophy was 3.4 Clinic in the period between 2005 and 2014. cm. The mean 30 degrees/s plantarflex and Material and Methods:One hundred and eight patients, aged from 14 to 18 years were 120 degrees/s plantarflex peak torques were treated with primary intramedullary nailing 89 and 45 Nm, respectively. The mean 30 for a tibial shaft fracture. The functional degrees/s plantarflex peak torque deficiency outcome was assessed by the Karlstrom- was 16%. The mean 120 degrees/s Olerud scoring system at 16 weeks after the plantarflex peak torque deficiency was 17%. surgical intervention. The average peak torque deficiency was Results:Seventy-two (78%) patients had 17%. The pre- and postoperative mean excellent result, eleven (16%) good and six (6%) patients had acceptable functional AOFAS Ankle-Hindfoot Scale scores were outcome. 64 and 95, respectively. No patient had a Conclusion:Flexible intramedullary nailing - rerupture. Superficial wound infection was ESIN for tibial fractures, enables early weight treated with oral antibiotic therapy in 2 bearing, provides good functional results and patients (11%). is accompanied with a low rate of Conclusions: The V-Y tendon plasty with postoperative complications. It is a method of fascia turndown forrepair chronic Achilles choice for irreducible and unstable tibial fractures during sports injuries, especially in tendon ruptures yielded results comparable teen athletes. with the literature regarding clinical Keywords:Sport injuries, tibial shaft outcomes. This method did not require fractures, ESIN, functional outcome, teen synthetic materials for augmentation and was athletes. an economic alternative compared to other repair methods. OP – 084

Keywords:Achilles Tendon,Tear,Treatment, Anterior Interosseous Nerve Syndrome tendon plasty. Following Paediatric Supracondylar Humeral Fracture: Case Report

OP –083 Teodor PEVEC1, Simona KALŠEK1

Minimally Invasive Treatment ESIN of Authors Information: Tibial Fractures During Sport Injuries 1General Hospital Ptuj, SLOVENIA 1* Lazar TODOROVIC , Marjan KAMILOSKI1, Anila RACAJ1, Slavica 1 1 Abstract LITAJKOVSKA , Natalija COKLESKA , INTRODUCTION: Anterior interosseous Zllato ALEKSOVSKI1 nerve (AIN) is a motor branch of the median Authors Information: nerve that runs deep into the forearm. It 1University Clinic of Pediatric Surgery, innervates three muscles of the forearm. Their Medical Faculty, University of St. Cyril and isolated palsy is known as the AIN syndrome. Methodius, Skopje, Republic of North Distal forearm fractures are some of the most MACEDONIA. common fractures in children, associated with

frequent neurovascular complications. The Abstract Introduction:The fractures of tibial shaft are paper describes a relatively rare complication common during some sports. Their treatment in our everyday medical practice: an AIN is primarily conservative, but certain types of syndrome following a supracondylar fracture. fractures require operative stabilization. CASE PRESENTATION: A 5-year-old boy The aim of this study was to present our fell off a swing and broke his forearm. It was experience and results from the flexible a supracondylar fracture. No neurological intramedullary nailing of unstable tibial disorders were described. Manual reduction

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts and K-wire fixation were performed. At a and columns of stellar neurons are basic follow-up visit, the mother pointed out that morphological properties of the entorhinal the child was unable to flex the thumb of the area. It was established that regional differences exist in the distribution, shape and treated arm. We recognized the AIN density of cytoarchitectonic units (columns syndrome. and cell bands). Significant differences were Discussion: The AIN syndrome was most found between individual bands and columns likely a consequence of the injury to the in width, length as well as in the numeric elbow itself. Due to our focus on more density of cells within individual bands. Such frequent neurological disorders, especially a complex picture of cytoarchitectonic those of the ulnar nerve, the AIN syndrome modules may be called a modular “mosaic”. One of the most interesting findings of this was detected relatively late. work was the existence of statistically Conclusion:In the preoperative and significant differences in the numerical especially in the postoperative care of density of stellar neurons and the area of children with distal forearm fractures, precise columns between the right and left assessment of the patient's neurological status hemispheres. All these findings indicate the is required for an early detection of associated existence of the three-dimensional mosaic of injuries. cytoarchitectonic modules in the human entorhinal area. The study and the change of Keywords:Nerve injury, child, distal the modular mosaic in various neurological humerus fracture, complication, treatment. diseases, particularly those accompanied by memory disorders, enable a new approach to OP – 085 the path neurobiology of the brain cortex. Keywords:cytoarchitectonic, brain cortex, The Human Entorhinal Cortex stellar neurons

Sadi BEXHETI, Jeton SHATRI, Veton OP – 086 ADEMI, Dijon MUSLIU Anatomical Variations of Posterior Part of Authors Information: the Circle of Willis in Kosovo Medical Faculty – University of Tetova, RN of MACEDONIA Agon TURKAJ1, Antigona KABASHI2, Jeton 3 1 Abstract SHATRI , Sadi BEXHETI Introduction: The aim of this work was the cytoarchitectonic analysis of the modular Author Information: organization of the entorhinal area of the 1Faculty of Medicine, University of Pristina, human cortex. Investigations were carried out Pristina - KOSOVO out postmortem material, on both 2Clinic of Radiology, University Clinical Center of parahypocampal gyruses obtained from the Kosovo, Pristina – KOSOVO 3 brains of 22 adult people aged between 25 Clinic of Radiology - University Clinical Center and 85 years. All the brains were of Kosovo, Institute of Anatomy at the Faculty of physiologically normal, without any signs of Medicine, University of Pristina, Pristina - KOSOVO neuropathologic diseases. Firstly, the brains were fixed in 10% neutral formalin, lasting from 30 to 45 days. Then the parahypocampal Abstract gyruses were embedded in celloidin, cut in Introduction: The posterior cerebral artery- series along the tangential plan and stained P1 (PCA-P1) and posterior communicating according to the Nissl method. Graphic cerebral artery (PCoA) has been noted in reconstruction of cytoarchitectonic units of literature to have anatomical the II layer was carried out on 12 brains. A variations. Variations and anomalies of the total of 520 sections was analyzed. PCA-P1 and PCoA have several The results show that the existence of cytoarchitectonic units in the form of bands clinical implications; including assisting in

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts understanding the clinical signs of a stroke. known cause in most cases, and stressful life The aim of this study was to describe the events can make it worse. But that doesn't anatomy and anomalies of the PCA- mean it isn't real. Pain is an invisible problem that others can't see, but that doesn't mean it's P1 and PCoA. all in your head. There are countless options Materials and Methods: This is for pain relief. They include relaxation an observative descriptive study performed at techniques, exercise, physical therapy, over- the University Clinical Center, Clinic of the-counter and prescription medications, Radiology in Kosovo. A randomized sample surgery, injections (into muscle, joints or your of 454 angiographic examinations in adult back), and complementary treatments such as patients of both sexes without clinical acupuncture and massage. It may not always be possible to completely get rid of your pain, manifestations for cerebrovascular disease but you can use many techniques to help who were instructed to exploration is manage it much better. Health careproviders included. begin with a conservative approach to pain Results: In the present study posterior part relief and prescribe non-narcotic pain-relief had a complete structure in 26.6% of the medications, which are not addictive. Doctors cases. More completed is presented in female may prescribe narcotics, such as codeine and (30.7%) than males (22.55%) and variant E in morphine, if pain becomes severe, such as when treating cancerpain. Many people fear 45.8%. While absence of either the ACOP or that they will become addicted to narcotics. the two sides (type D, E, G, H) is represented Physical dependence is not the same thing as in 62% of the examined patients. addiction. And, physical dependence isn't a Conclusion: Anomalies of the PCA- problem as long as you do not stop taking the P1 and PCoA have a great significance since narcotics suddenly. Addiction to narcotics is it forms a link between two major arterial not usually a problem, unless you have a history of recreational drug or alcohol systems the internal carotid and addiction. the vertebrobasilar system. The knowledge of Keywords:Pain, objective, subjective, this variation is very important treatment. during surgical and radiological interventions. Keywords: variations of posterior OP – 088 part, arteries, posterior cerebral artery-P1. Principles in Treating Neonatal Meningitis Albi ARKAXHIU1*, Desli SHAHINI2 OP – 087 Author Information: Pains Problems, Pain as a Notion. 1 Neonatolog, Kavaja Municipal Hospital, ALBANIA Pirro PRIFTI 2 General Physician, Medical Researcher,

General Health Coordinator at WHO, Author Information: Faculty of Technical Medical Sciences, ALBANIA European University of Tirana, ALBANIA Abstract Abstract INTRODUCTION: Newborn babies are at a Pain is a subjective symptom and evaluation much higher risk of developing meningitis is subjective. We also can evaluate pain in than any other age group, as their immune objective way, in acute pain where it can system is weaker and more susceptible to compromise vital signs, such as arterial pressure, pulse, oxygen saturation and viruses and illnesses. Since the bacteria that respiratory frequency. Pain is associated with causes meningitis can be transferred from emotional and physiological response. Pain is mother to baby, prenatal care and virus a complex problem, involving both the mind screening for the disease is extremely and the body. For instance, backpainhas no important. Meningitis happens when a viral

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts or bacterial infection spreads to the spinal Authors Information: 1 fluid and the brain fluid. Whereas viral Internist, Emergency Department Trauma meningitis can typically resolve on its own University Hospital of Trauma, Tirana, ALBANIA without treatment, bacterial meningitis is a 2 General Physician, Medical Researcher, serious illness that can lead to brain damage, WHO health coordinator, Tirana, ALBANIA hearing loss, and even death. Materials and Methods:During our study in Abstract the Maternity Hospital “Koco Gliozheni”, in Introduction: Post-traumatic stress disorder the period 2017-2019 we have used three (PTSD) is a chronic and disabling entity, categories in classifying: Clinical symptom of which negatively impacts health and quality of life. It occurs after events that are newborn baby, gender, laboratory analyses. perceived as life-threatening and has a Difference between clinical symptom of lifetime rate of 7%. Anaphylaxis is an acute newborn and mum is also important. In systemic reaction with symptoms of an continue of those categories we have immediate-type allergic reaction which can proposed treatment starting from the behavior involve the whole organism and is potentially and procedure of neonatology and all the life-threatening. The relation in between specific fight against microorganism that had PTSD and anaphylaxis is one of the main challenges in emergency department. caused it. Effective interventions and Materials and Methods: Specific patient documentation of responses to these subgroups—including different ages and interventions will receive increased scrutiny. genders, trauma presentations with Conclusion: Most mothers do not know that anaphylaxis correlated with. Also, the they have Group B Strep. In fact, doctors say anaphylactic shock increases one’s risk of that 40% of women carry Group B Strep in developing PTSD, and for this we did the survey in causes of reactions. Also, we have the lower intestines, anus, and vagina without surveyed the symptoms in both genders, ages even knowing it –there are no symptoms that and different trauma presentation. Also, the indicate that the mother has the bacteria in her treatment is going to be evaluated for each system. group symptoms. This is a study made in the By testing anywhere between weeks 35 and emergency department University Hospital of 37 of pregnancy, the doctor should be able to Trauma. There are 190 cases taken for the identify whether the mother has Group B study during the 2017-2019. Effective treatment and documentation of responses to Strep and to be able to put her on safe and this process are recorded for our study. It is a pregnancy-friendly antibiotics in enough time great result to see positive results on patients that the bacteria may be gone in time for that were suffering from both syndromes. delivery. Results:A total of 190 subjects were enrolled The combination of a good therapy before with an average age of 48 yrs. The cases are with an experienced neonatology that know all PTSD related with anaphylaxis. 52% of better the way of treat a baby that comes from them are verified in our study that PTSD has strong relation with anaphylaxis and is the an infected mother may lead us to less cases main risk factor of its development. 98 % of of infected neonatal babies. them had been well recovered after the KEYWORDS: neonatal meningitis, treatment, but all of them had the same symptoms and laboratory, treatment, symptoms, that affect breathing system, blood emergency. circulation and heart. Males after 50 years old and women during menopause had the most aggressive symptoms. Anaphylaxis is well OP –089 presented in mostly females, and it is life

threating event that has been present even Anaphylaxis Related Posttraumatic Stress before in their life. It is our duty as doctors to Disorder be sure that such events are going to happen Vrenos HODAJ 1, Desli SHAHINI2 less, in future.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Conclusions:Retrospective studies suggest followed up closely with physical that up to 1 % of patients present to the examination by the same physician and by emergency department of a maximum care imaging methods. Informed consent was hospital because of an anaphylactic reaction. obtained from all patients. Blunt abdominal It is specially represented in female, in trauma patients who were hemodynamically comparison with males. stable and without any signs of peritonitis One to three anaphylaxis-induced fatalities were followed nonoperatively. Patients were per year per 1 million inhabitants are operated if deterioration of hemodynamic estimated. Our study suggests that PTSD stability and/or lesion (hematoma, etc.) rates are increased in individuals with a progression on imaging was detected. In history of anaphylaxis. Therefore, routine addition to this, additional methods such as follow-up of these individuals should include diagnostic laparotomy or diagnostic surveillance for this disorder. laparoscopy were used for diagnosis and Keywords: PTSD, anaphylaxis, treatment, monitoring, especially in noncooperative survey, emergency. patients due to various reasons, including cranial trauma or alcohol. Patients with OP –090 suspicion of hollow organ injuries were also operated. Abdominal Trauma and Conservative Keywords: Abdominal injury, abdominal Follow Up trauma, nonoperative treatment

Akgün ÇELIK OP –091

Author Information: Management Penetrating Abdominal Stab General Surgeon, Istanbul, TURKEY Wounds

Abstract. Engin GÖÇMEN Introduction;Injuries within the abdominal cavity and abdominal organs continue to be a Author Information: problem for general surgeons. Abdomen is General Surgeon, Istanbul, TURKEY the most common region to be injured Abstract following the head and extremities Injuries To review the results of our treatment may be in the form of blunt abdominal approach to penetrating abdominal stab trauma, stab wounds or gunshot wounds. The wounds and to reduce unnecessary hospital majority of blunt abdominal trauma is seen stay. after motor vehicle accidents. There have Material and Methods: Admission files and been major changes in the approach to surgery notes of 87 patients with penetrating abdominal trauma in the last 20 years. abdominal stab wounds, who had applied to Gureba Bezmialem Valide Sultan Hospital Non-operative treatment strategies are Emergency Clinic between 2008 and 2010, becoming more common. Conservative were reviewed retrospectively. The results treatment experience is based more on physical examination of the abdomen, and experience in blunt abdominal trauma. laboratory findings, such as amylase level, However, recent publications suggest that leukocyte count and hematocrit value, were nonoperative (conservative) treatment can be evaluated. Comparison of the data was made performed in gunshot and stab wounds in by Fisher’s exact test for categorical data and selected patients. Most of the abdominal t-test was used for continuous data. Results: trauma patients are younger than 40 years, A total of 87 patients were treated in our and it remains to be an important cause of emergency clinic with the diagnosis of morbidity-mortality in this population penetrating abdominal trauma and 48 of them In our clinics, hemodynamically stable were operated on. 19 of 36 patients with patients without any signs of peritonitis positive laparotomy findings had a high white underwent conservative treatment for their blood cell count, hematocrit value decreased abdominal injuries. These patients were in 16 patients, and only 2 patients had high

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts amylase values. Out of the surgically treated playing games with friends. He was evaluated 48 patients, 9 patients had hypotension and and proved to have splenic rupture and tachycardia. Negative laparotomy findings hemoperitoneum. He was offered were found in two of them. conservative treatment. Conclusion:Our negative laparotomy rate Keywords: Pediatric,spleen, injury, blunt could have been 59% instead of 33% if the trauma. patients would have been operated on just because of penetrating abdominal wounds. OP –093 KeyWords:Stab wounds, conservative, laparotomy Total Rupture of the Caput Pancreas after Blunt Abdominal Trauma. A Case Report OP – 092 and Review of the Literature.

Nonoperative Management in Pediatric Skender BUCI1, Dorina SHTJEFNI1, Sami Splenic Injury. A Case Report KOCEKU1, Gjovalin BUSHI1, Sokol RUCI1

Elona MARKECI1, Admir MUSTAFA1, Authors Information: Afron MICI1, Skender BUCI1 1 Surgery Service, University Hospital of Trauma, Tirana, ALBANIA Author Information: 1Department of Surgery University Hospital Abstract of Trauma – Tirana, ALBANIA Introduction:Isolated pancreatic lesions are rare, often difficult to identify, they account Abstract for 0.2 -6% of abdominal trauma. The The risk of overwhelming post splenectomy treatment strategy is related to the integrity of infection (OPSI) prompted the evolution the Wirsung Canal. The purpose of this paper toward preservation of the injured spleen. is to report the management of a pancreatic Nonoperative management (NOM) of blunt trauma with rupture of the major pancreatic injury to the spleen in adults has become the duct standard of care in hemodynamically stable Material and Methods:We present a patient patients. This modality of treatment began in with complete rupture of the pancreas without the 1970’s in pediatric patients. It is highly duodenal injury from a closed abdominal successful with overall failures rates from 2% trauma. A 41-year-old man has been the to 31% (average 10.8%) - with the majority victim of multiple aggressions with his fists of failures occurring in the first 24 hours. and legs, in the abdomen, with echoes in the The spleen is one of the most commonly epigastric region. The patient is hospitalized injured organs in the body after blunt for trauma surgery 4 hours after the abdominal trauma. Our objective is to present aggression with abdominal pain. Examination a case of pediatric splenic injury in found, hemodynamically stable, a sensible hemodynamically stable patient was managed abdomen, lipazemia and amilazemia were non-operatively. In the past splenectomy was normal. The scanner has shown a rupture in the standard procedure for traumatic blunt the pancreatic head region (Class III Lucas), splenic injury, when bleeding of the spleen liquid in the omental and periapical bursa. occurred. The patient was admitted to the operating Since the spleen performs important block 6 hours after trauma. Surgical immunological functions the advantage of a exploration has shown hemoperitoneum, spleen-saving approach is preservation of complete rupture of the pancreatic head, immunological functions. Especially in the rupture of the major pancreatic duct, pediatric population splenic preservation is an duodenum and other abdominal organs had a important objective. The risk of preserved integrity of major pancreatic duct, overwhelming post splenectomy infection hemostasis and suturing at the level of the (OPSI) prompted the evolution toward injured area of the pancreas, a wash and preservation of the injured spleen. We abdominal drainage. Post-operative evolution present a case of a 12 –year-old male with a was favorable and without complications. On history of falling down on his left flank

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts the 10th day after the intervention the patient In our study patients with blunt Liver trauma was removed from the healing hospital. 62% were treated NOM and 38% OM. Conclusion:Imaging has an essential role in CONCLUSIONS: NOM is the chosen the evaluation of pancreatic damage before method for the management of blunt liver the onset of clinical and biological signs. The trauma in hemodynamically stable patients. treatment of pancreatic trauma associated NOM significantly improves the outcome with major pancreatic duct injury is surgical. compared to OM, in terms of decreased The prognosis depends on a rapid diagnosis abdominal infections, decreased transfusions, and surgical intervention. and decreased hospitalisation period. Keywords:pancreatic lesions, abdominal However, hemodynamically unstable patients trauma, major pancreatic duct with peritonitis should undergo immediate surgical intervention. OP –094 Keywords:liver injuries, injured abdominal, Blunt, penetrating… Abdominal trauma and Liver some Management Considerations after a OP –095 Retrospective Study. Assessment of Trauma Patient in the Agron DOGJANI1, Kastriot HAXHIREXHA2 Tertiary Centre for Trauma

Author Information: Agron DOGJANI 1General Surgery Service, University Hospital of Trauma, General Surgery, Tirana, ALBANIA. Author Information: 2University of Tetovo, General Surgery Service, General Surgeon, University Hospital of Tetovo, RN of MACEDONIA Trauma, Tirana, ALBANIA

Abstract Abstract Introduction:The liver is the most frequently Introduction:Trauma can be defined as the injured abdominal organ. Most of liver organism's reaction to the action of an injuries are relatively minor and heal external agent. Traumatic injury is a leading spontaneously with nonoperative cause of death globally among persons under management, which consists of observation the age of 45. Over 5 million deaths occur and possibly arteriography and embolization. each year as a result of injuries, representing Purpose to describe the causes of trauma, the 9% of the world's mortality. degree of injury, the chosen method of Non-fatal injuries are among the leading treatment, the success rate and the developed global causes of emergency department visits, complications; comparing the results of our hospitalizations and long-term morbidity, study with the results of literature. accounting for a large portion of the burden Material & Methods:The study is of a on health systems. retrospective character and includes all Initial evaluation and administration of patients with abdominal trauma, presented in traumatized patients after being brought to a the Emergency Department to University third level trauma centre should be done in a Hospital of Trauma, Tirana, from May 2016 specialized area of an emergency department to May 2018. The study sample was taken that is already designed in trauma randomly, without any study restriction. management. Time of injury is the essence of Results:During the two years, 228 patients survival for a life-threatening trauma. with liver trauma were reported, of whom 177 Proper initial care at the scene affects the (78%) with blunt liver trauma and 51 (22%) morbidity and mortality of the traumatized with penetrating injuries. Men (72%) were patient. more affected than females (28%) with a Prolonged transportation time or inadequate male female ratio of 7: 3. The most common hospital care increases the demand for early cause of the injuries was car accident, while restoration of rapid tissue perfusion before the the most affected age group was 16-35 years physiological changes of the injured patient old. reach hospitalization.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

On the other hand, the lack of recognition of Testing through FNA, and then perform management protocols by trauma surgery according to the FNA result; management personnel increase morbidity Observation, regardless of their malignant or and mortality in this patient group. This benign nature. presentation addresses the management of traumatized patients as these patients arrive at Cost-effectiveness was calculated in terms of an emergency department at a hospital or costs and quality-adjusted life years (QALY). tertiary trauma centre. All variables were entered as distributions. Keywords:tertiary trauma centre, traumatized Willingness to pay was set to 50,000$. patients, injured patient, life-threatening Results: In the cost-effectiveness analysis, trauma surgery was dominated by FNA. Observation was less effective and cheaper than FNA, OP – 096 which presented an ICER value of 46,948.48. In the 1-way cost-effectiveness sensitivity Cost-effectiveness of Thyroid Fine Needle analysis for the probability of malignancy Aspiration Cytology for Diagnosis and from 0% to 100%, FNA was always superior Surgical Treatment of Thyroid Malignant to the surgery strategy, and the threshold of Pathologies in Paediatric Age superiority to the observe strategy was probability of malignancy = 23.5%. In the Ilir ALIMEHMETI1,2,3, Myriam HUNINK3,4 probabilistic sensitivity analysis, FNA resulted superior to surgery. Author Information: Conclusions: FNA is more cost-effective 1Projects and International Affairs Unit, Faculty than the surgery strategy in the diagnosis and of Medicine, University of Medicine, Tirana, clinical work-up of thyroid nodules in ALBANIA children. 2Department of Family and Occupational Health, KEYWORDS: Thyroid nodules, FNA, Faculty of Medicine, University of Medicine, thyroidectomy, malignant or benign nature. Tirana, ALBANIA 3 Department of Epidemiology, Erasmus University OP – 097 Medical Center, Rotterdam, The NETHERLANDS 4 Department of Health Policy and Management, Spontaneous Fracture of the left Proximal Harvard School of Public Health, Harvard University, Boston, MA, USA 1/3 Humerus Shaft in a Female Patient with Multiple Myeloma. A Case reports. Abstract Introduction:Thyroid nodules are rare during Eriselda TAULLA pediatric age, affecting 1.7% of children and adolescents, but the high malignancy Authors Information: prevalence at presentation has warranted an Military Medical Unit, University Hospital of aggressive clinical approach. The most Trauma, Tirana, ALBANIA frequent surgery technique is total thyroidectomy, which is followed by short- Abstract term and long-term complications. Fine Introduction: Spontaneous fractures are needle aspiration (FNA) cytology is the most common in patients diagnosed with multiple accurate tool in the diagnosis of a thyroid myeloma and when happens the risk of death nodule. However, there are contradictions if it in those patients is increased. In this case a 65 should be used ad a first-line strategy in the years old female diagnosed with Multiple paediatric age. Thus, our aim was to analyze myeloma, developed a spontaneous fracture cost-efectiveness of surgery, FNA and of the proximal 1/3 humerus shaft while observation of thyroid malignant pathologies dressing, during the induction therapy. in paediatric age. A 65-year-old caucasian female with a Material and Methods: A decision model medical history of six month of lumbago, was created to trade-off between three presented to the hospital complaining fatigue, different strategies: reduced appetite and severe immobilizing Surgery for all nodules, regardless of their bone pain. She reported no other disease. Laboratory findings demonstrated Hb 12g/dL, malignant or benign nature; 56 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts calcemia 11,4mg/dl, proteinemia 10,0 g/dL, Infants receiving hospital attend 2 to 12% (on IGA 2870 mg/dL, Kappa 1920 mg/dL, average 5%) of the patients. IS have mortality creatinine 0,6mg/dL. Bone marrow aspiration of about 1% and contribute to a 3% mortality showed 56% plasma cells. MRI showed increase in other diseases. Causal pathogens, multiple osteolytic lesions in the scull, ribs, gram-negative bacilli occupy the bulk of the pelvic bones and vertebral compression list of pathogenic germs of IS fractures. Knowing the protective measures for IS The diagnosis was "Multiple Myeloma IGA reduces the risk of occurring nosocomial Kappa stage II/A”. She started the induction infections in the patients and the health therapy with Bortezomib. The day 6th, while worker. Minimizes the rate of nosocomial dressing up, she developed a fracture of the infection and protects the health personnel left proximal 1/3 humerus shaft. She was and visitors from the risk of infection. These treated with sling immobilization. She is still infections are very problematic Because they on therapy with Bortezomib. are very risky around the globe, awareness, Conclusion: All the patients with multiple implantation of the prisons on the recognition myeloma should be considered at high risk of and protection of hospital infections, and risk mortality during the induction therapy. The management, their reporting indeterminacy at fractures during this time worse the prognose. the right time of the incidents, the evaluation Keywords:Spontaneous fractures, multiple of the working conditions increase sharply myeloma, humerus, Bortezomib Staff orientation in hospital care by implementing specific guidelines. OP – 098 Conclusion: From the observation, ISs in hospitals are present and problematic, but that Hospital Infections Management much work and care by staff can be eliminated. More information is available Esma SHARKA, Natasha MERKO from the staff. Awareness and engagement in all structures for this classroom Author Information: Keywords:infection, contamination, tubes, University Hospital of Trauma, Tirana incubation, sterilization ALBANIA OP – 099 Abstract Introduction:Awareness of professionals, Radioactive Processes in Food Consumer relatives, relatives and visitors to Hospital Products, Positive and Negative Effects Infections. The infection bites are all hospital facilities that serve to spread the infection, Esma SHARKA¹, Natasha MERKO¹ just as medical staff Infectious Infections (IS) or nosocomial infections are circulating and acquired in the hospital During the Authors Information: hospitalization of patients, therefore, ¹University Hospital of Trauma, Tirana, receiving another infection plus during ALBANIA hospital stay. There are no incubation periods either at the Abstract incubation time or at the time of laying. Introduction: The importance of evaluating Infection begins with the onset of temperature on the third day after laying (48 hours to 72 the effective dose in the human body from hours) Nosocomial infection is an indicator of ionizing radiation is wide and quite complex. the quality of service! The source of infection It requires ongoing study and evaluation. is all hospital facilities that serve the spread Materials and Methods:In this paper we of infection, as well as medical personnel. For used the Retrospective study method, which the reduction of morbidity, mortality in presents data on the two main contributors to hospital beds, IS reduces the quality of life If indoor radiation, the activity of Po-210 in they are poor and are also very costly High nosocomial infections are indicators of the mussel specimens in the Lagoon, quality of service studied during spring and autumn and radon

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts concentration. Rn-222 indoors in some major Results:1758 individuals who come in cities of Albania. Military Hospital Tirana, Albania in RESULTS: showed twice as high values of Dermatology Service in period October 2014 - March 2015 was examined having or not Po-210 activity in mussels during spring Vitiligo. 39 Cases with Vitiligo were compared to activity values found in autumn diagnosed through the physical standard season, due to different physical and examination. In these 39patients diagnosis biological factors. These results are with Vitiligo were applied DLQI comparable to other studies and do not pose questionnaire: any significant risk to public health in From 39 patient taken in consideration in this Albania. On the other hand, the study research study 22 (56.4%) were females and 17 (43.6%) were males, it was noticed that presents measurements of radon gender was influential in the degree of concentration indoors using the passive concern that brings Vitiligo (p=0.01,), and method and the work begun to create a radon in the degree of embarrassed and anxiety concentration map in our country. The due to this skin disease (p=0.01), where measurements cover 10% of the entire females were proven to be the most sensitive territory of the country and will serve to category.Resulted that age group was identify Radon Risk Areas in the Republic of determinant in the skin disease (vitiligo) impact on social activities (p=0.007), in the Albania for which an action plan will be skin disease impact for the selection of prepared to reduce Radon concentrations in clothes (p=0.007)…. these areas. Conclusion:Skin diseases are very common, Conclusions: It is important to note that such affecting over a quarter of the population. studies should inform the public about the Vitiligo is not life-threatening skin diseases problems that alpha radiation brings and but have a significant impact on the quality of life of patients and cause considerable mainly the high concentration of Radon in the psychological distress. Finally, the etiology workplace, schools, homes, etc., where we and pathogenesis of vitiligo remains unclear. each spend 80% of our time. . It is still not understood what causes the Keywords:Natural Radioactivity, Po21 0 in destruction of melanocytes. Also, mussels, Annual Effective Dose, Radon. uncertainties remain about the natural history and epidemiology of this disease. A variety of OP – 100 methods for re-pigmenting the skin of people with vitiligo have been tried in but vitiligo Pigmentation Diseases, with Negative treatment is a major challenge If a cure for Impact on the Quality of Life in Individuals vitiligo is to be found, further research is Affected. required in understanding the etiology, epidemiology and natural history of vitiligo. Ardiana SINANI1, Dorela VASHA1, Eriselda Current treatments help to alleviate symptoms TAULLAJ1, Artan OSMENLLARI1, Suzana for temporary re-pigmentation of vitiliginous CAKONI1. patches, but these do not cure the underlying disease. Authors Information: Keywords:Skin, pigmentation, vitiligo. 1Military Medical Unit, University Hospital of Trauma, Tirana, ALBANIA OP – 101

Abstract COPD and Lung Cancer, the Coexistence

Introduction:Vitiligo is an acquired 1 2 dermatological pigmentation disorders of the Jolanda NIKOLLA , Daniela XHEMALAJ , Hasan HAFIZI2 skin. It causes loss of pigment on effected areas of the skin or mucosae and is Author Information: characterised by milk white, non-scaley 1 lesions with distinct margins. American Hospital 3, Department of Internal Medicine, Pulmonology, Tirana, ALBANIA.

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2University Hospital of Lung Diseases The most effective lung cancer prevention “Shefqet Ndroqi” Tirana, ALBANIA. measure is smoking cessation. Keywords:Lung cancer, Chronic obstructive Abstract pulmonary disease. Introduction:Chronic obstructive pulmonary disease (COPD) is a significant risk factor for OP – 102 lung cancer already well known. Approximately 1% of COPD patients develop A Serious Self-Injury Attempted Case, lung cancer every year, which may be following a Neurosurgical Intervention, on associated with genetic susceptibility to a Patient with Epilepsy in Comorbidity with cigarette smoke. Chronic inflammation Major Depressive Psychotic Disorder (A caused by toxic gases can induce COPD and Case Report) lung cancer. Low-dose computed tomography (LDCT) is an effective procedure for the Fatbardha MYSLIMAJ1, Henri KOLANI2, early detection of lung cancer in high-risk CAKO1, Ermira TOTRAKU1 patients. Materials and Methods: We retrospectively Authors Information: reviewed the medical records of patients who 1Psychiatry Service at University Hospital Center were diagnosed as COPD, based on “Mother Theresa”, Tirana, ALBANIA Spirometry and LDCT findings from January 2Sugery Department at University Hospital Center 2010 through March 2016 in our hospital and “Mother Theresa”, Tirana, ALBANIA in some of the lung health centers in Tirana. Lung cancer was an incidental finding in Abstract them. Chest HRCT images were analyzed by Patient E. H., age 39, presents to Surgical two pulmonologists and radiologists Emergency, with a cut wound: Sinister independently. Biopsy examinations were mammectomy. According to family and also evaluated by two independent patient referrals, the action came as a result of pathologist specialists a suicidal attempt. Suffers from Epilepsy Results: In total 18 (N=18) cases with since the age of 2 and several years from COPD, 11 (61%) males and 7 (39%) females. depression, leading to a suicidal attempt All patients are current or ex heavy smokers, before. She has been treated with predominates males. Lung cancer was present antiepileptic drugs for years and underwent in 4 (22%) COPD male patients. They all had neurosurgical intervention in Italy a month peripheral primary lung cancers and as e ago, which was successful. result the biopsies was obtained by trans The patient shows a regular appearance and parietal fine needle aspiration procedure. The according to the chronological age, maintains distribution of the histological types was: 3 partial eye contact. Her mimic expresses an cases with squamous cell carcinoma and 1 apathetic and cold state, without alterations of case with small cell carcinoma. Two patients her mood. Refers that after neurosurgical with lung cancer have died. Their meantime intervention she has had severe headaches for of survival was 2 years. These 4 patients had weeks, pains that did not enable her to sleep higher unit pack-years (UPY) smoking or perform normal daily activities. In one of values, lower pulmonary functional state and these crises the patient has injured herself, by higher values of pulmonary hypertension removing her left breast. Communication is (HTP) than the other COPD patients. apathetic, cold, distant. Thoughts are Conclusions: Lung cancer in patients with negative and worrying about her health. COPD patients represents a specific entity Perception of the environment and reality, with a poor prognosis, that further poses the cognition and insight damaged. When asked most characteristic and severe model of why she chose to damage her breast, refers tobacco-related diseases. The prognosis of she had a feeling of emptiness and therefore lung cancer patients with COPD is worse than wanted to remove it. Her headaches were also the prognosis of patients without COPD, unbearable and this led her to perform this because of inadequate cancer treatments, and injury. Through communication the patient poorer pulmonary function and quality of life. provides a lot of information about psychotic elements responsible for the bizarre action. 59 | Page

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Treatment with antipsychotics, taper medications as symptoms improve. antidepressants, mood stabilizers and Chronic pain assumes a baseline level of pain anxiolytics, brought an improvement in the that is best treated with a consistent approach psycho-emotional state. Such cases are rarely to minimize baseline discomfort and described in contemporary literature, the minimize the adverse effects of both pain and consequences of severe psychotic and pain treatment on the patient’s lifestyle. affective disorders. Optimal acute pain management is patient specific and pain syndrome targeted when OP – 102 feasible, using a multimodal approach that includes pharmacologic and Pain Treatment in Emergency Department nonpharmacologic interventions. Base the assessment of pain and need for therapy on an Hektor SULA overall accounting of patient status, including functional assessment, rather than solely on Authors Information: patient-reported pain scores. Faculty of Medicine, University of Medicine Conclusion: Pain is the most common Tirana, ALBANIA complaint in the ED. Having a consistent, integrated, and well-planned approach will Abstract optimize the experience for patients as well as Introduction: Acute pain is defined as an medical providers unpleasant sensory and emotional experience Keywords:Pain, emergency, treatment. associated with actual or potential tissue damage as well as activation of OP – 104 neurochemical receptor and mediator responses. The Obese (Emergency-) Patient: Pain is the presenting complaint for up to Business as Usual? 70% of visits to the emergency department (ED). There is a myriad of strategies to treat MarkusKONERT and diagnose pain. The effective strategies are those with adequate and timely pain relief Authors Information: without adverse effects. ¹ Anestesi Sevices at RoMed-Klinik Bad An accurate recognition and assessment of a Aibling, GERMANY patient’s pain is the central aspect of effective pain management and is essential to any Abstract effective analgesic strategy. The prevalence of significant obesity Acute pain follows injury and usually continues to rise in both developed and resolves as the injury heals. Acute pain may developing countries and is associated with be, but is not always, associated with an increased incidence of a wide spectrum of objective physical signs of autonomic medical and surgical pathologies. Thus, nervous system activity such as tachycardia, experienced anaesthetic and surgical staff hypertension, diaphoresis, mydriasis, and should manage obese patients. pallor. When the cause of acute pain is The variety of comorbidities and the uncertain, establishing a diagnosis is the pathophysiological changes of the priority of the emergency physician. respiratory and cardiovascular system Symptomatic treatment of pain should be lead to a significantly increased risk of initiated while the diagnostic evaluation is complications. To master these risks, proceeding. In general, it is inappropriate to special processes and treatment delay analgesic use until a diagnosis has been management are necessary, in which made. knowledge of (patho-) physiological The treatment of acute and chronic pain is alteration of the obese is essential. different, and confusion between the two Obese patients require specially trained leads to poor management of patients. Acute hospital and rescue personnel, suitable pain should be approached with the intention equipment and adequate structural equipment, of providing relief to a limited degree, which should be provided by all hospitals and individualized to each patient, with a plan to health care institutions.

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In my talk I would like to share my conditions respecting trauma guidelines as experience in the treatment of obese well. A multidimensional team must be patients from an anesthesiologist's always available in order to improve the point of view. prognosis. KeyWords:trauma, pregnancy, fetus. OP – 105 OP – 106 Trauma in Pregnant Women Treatment of Traumatic Hemorrhagic Rudin DOMI ¹,Gentian HUTI ¹, Asead Shock in Intensive Medicine ABDYLI ¹

Nehat BAFTIU ¹, R.BAFTIU¹ Authors Information: ¹Department of Anesthesia and Intensive Care Medicine, American Hospital 3, Tirana, Authors Information: ALBANIA ¹University Clinical Center of Kosovo – Pristina, KOSOVO Abstract Introduction: Trauma in pregnancy is a great Abstract concern in modern era. The pregnant women INTRODUCTION: The shock represents a make more challenging the anesthetic and state of inadequate tissue perfusion as a result ICU care due to both organisms the women and the fetus. of circulatory insufficiency. Hemorrhage is Materials and Methods:Regarding the most common cause of shock in injured epidemiology of trauma in pregnancy, several patients. The goals of this paper are as data come from policy, from national services follows: Analysis of the epidemiological of different states, and some of them are also characteristics of traumatic - hemorrhagic reported in literature as well. It is recently shock in Kosovo, for the period July 2016 - reported that the incidence is evaluated 6-7%, and car crush is the major reason over passing December 2018. physical assaults and falling. This kind of Material and Methods: As material we used trauma is also the major cause of mother non the stories of patients with traumatic- obstetrical death. hemorrhagic shock, treated in the Intensive Results:Pregnant women have some Care Unit of the University Clinical Center of physiologically features. Pregnancy related Kosovo, during the period July 2016 - cardiovascular changes are increased cardiac December 2018. The sample consisted of 155 output, vasodilatation, increased heart rate, increased blood volume, decreased blood patients treated during the specified period, cells concentration, and decreased central with verified diagnosis of traumatic- venous pressure. These changes can mask the hemorrhagic shock. severity of hypovolemia, the severity of Results: We established the study to shock states, and can mimic myocardial demonstrate the efficacy of therapy in the ischemia. Respiratory changes include hemodynamic stabilization of traumatized, reduced functional residual capacity due to shocked patients in the first 12 hours of weight gain, increased respiratory rate and volume in minute. These changes can induce intensive care treatment. We categorized the increased oxygen consumption and can lead patients according to the classes of to rapid desaturation. The pregnant woman hemorrhagic shock. The classification was can be presented with full stomach, decreased performed according to the criteria set by the sphincter tone and increased risk to aspirate, American College of Surgeons. Parameters may have difficulties in ventilation and were assessed: respiratory rate, respiratory intubation, and may have airway edema too. Conclusions:To conclude we must be focus load, systolic blood pressure (TAS), capillary on mother condition because improving refill and Glasgow Coma Scale (GCS). mother conditions can improve baby

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Conclusions: Traumatic-hemorrhagic shock breathes/minute, blood pressure 120/80 is a life-threatening emergency due to the mmHg and oxygen saturation 86%. Three development of multiple organ dysfunction weeks earlier she had been operated on for a right-sided hip fracture and had received low syndrome, which may be due to molecular weight heparin prophylaxis symptomatology and changes in vital postoperatively… parameters. Conclusion; Pulmonary embolism is a life- Keywords: Hemorrhage, shock, injured threatening condition that should be prompty patients, recognized. Surgical patients are at increased risk of developing a PE, especially after OP – 107 orthopaedic hip and knee surgery, because of Bilateral Pulmonary Embolism after Hip positioning during surgery and mainly Surgery: A Case Report immobility after surgery, that contributes to a increase venous stasis. Albert LLESHI1*, Ilir HASANI1, Ana Keywords: pulmonary embolism, activated STOJKOVSKA1, Bijana POPOSKA1, Angela clotting time,heparin. TRPOSKA1, Filip NAUMOSKI1, Andzela VITANOVA1 OP – 108

Authors Information: Trauma and Coagulopathy 1University Clinic for Traumatology, Orthopaedic Diseases, Anaesthesia, Asead ABDYLI ¹, Rudin DOMI ¹, Gentian Reanimation, Intensive Care and Emergency HUTI ¹ Centre in Skopje, RN of MACEDONIA. Authors Information: Abstract Introduction: Pulmonary embolism (PE) ¹Department Anesthesia and Intensive Care, ranges from incidental, clinically unimportant American Hospital 3, Tirana, ALBANIA occurrences to causing sudden death. Virchow’s triad of local trauma to the vessel Abstract wall, hypercoagulability and stasis of blood Introduction: Hemorrhagic shock from leads to thrombus formation in the veins of blood loss is a major cause of mortality in the legs which may dislodge and embolize to trauma patients. Bleeding is due to an the pulmonary arteries with potentially intrinsic dysregulation of the blood serious consequences (1). Prompt diagnosis coagulation known as trauma-induced and treatment reduces the risk of coagulopathy (TIC). TIC is faced in the complications and death. presence of both hypoperfusion from blood Pulmonary embolisms is a potentially life- loss and tissue injury. threatening condition where a dislodged Materials and Methods: We review the thrombi most commonly from the legs travels literature, in order to highlight the modern to the lungs and blocks one of the pulmonary concepts and mechanisms contributing to artheries. The combination of the nonspecific TIC. Understanding these mechanisms can symptoms, patient medical history and the improve treatments strategies, morbidity, and risk factors should stear us into taking in mortality of severe traumatized patients. consideration the pulmonary embolismus Results: The mechanisms of coagulopathy in diagnose. trauma patients have been explained by close Heparin constitutes the cornerstone of examination of the biochemical and cellular management of PE. In this report we present changes due to tissue injury and hemorrhagic a case od pulmonaryembolisms in a 70-year- shock. Mechanisms contributing to TIC old female that occurred three weeks after hip include anticoagulation, consumption, platelet surgery, was presented to the emergency dysfunction, and hyperfibrinolysis. department with chest pain and shortness of Conclusions: The anesthesiologist and breath. Her vital signs were as follows: heart intensivist often are faced with traumatized rate 80 beats/minute, respiratory rate 18 patients. The surgical team must be prepared to promptly treat trauma induced

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts coagulopathy, and good knowledge about this radius fractures in the typical place, complication is the first step. particularly of osteoporosis as the main cause Keywords: Hemorrhagic shock, trauma, of these fractures at the age of three. coagulopathy. Functional treatment results.

OP – 109 Materials and Methods:Actually 82 patients with radial fracture in the typical place of The fascia Iliaca Compartment Block in the conservative treatment, implantation and Emergency Department implantation in gypsum, as well as the respective reactive rehabilitation procedures Markus KONERT¹ were studied. In the material, they have taken a survey; the age of the patients, the sex, the Authors Information: rate of osteoporosis, the technique of reproduction, how long after the fracture and ¹Anestesi Sevices at RoMed-Klinik Bad eventually the results achieved. They were 76 Aibling, GERMANY women or 92.6% and 6 males or 7.4%. The maximum age of 86 years of age, the average Abstract age of 75 and the minimum age of 63 In the A regional nerve block with long acting local study, primary is the rate of osteoporosis as anaesthetic can provide effective analgesia potential potential for radius fractures in the for patients with fractured neck of femur and typical place. may reduce the need for opiate analgesia. Results:In our study series, the largest The Fascia Iliaca Compartment block is as number of patients was female, eighty-two effective as a 3:1 block targeting the femoral cases or 92.6% of the study group, the rest of nerve, obturator nerve and lateral cutaneous 7.6% or 6 cases were mammal. The study nerve, and can be achieved easily using period was 2 years of 2016-2017 all fractures ultrasound guidance. are in traumatic terrain. Traumatic trauma in As the site of the local anaesthetic injection is 60% of cases has been overturned or distant from the neurovascular bundle it has a otherwise reported as a direct trauma, low complication rate. whereas in 40% of cases there has been an We did cadaver studies with dyed water to indirect trauma. pain, loss of function, gain information about the ideal puncture site different hematoma rates as well as and to visualize the spread of the local radiological changes were the signs of these anesthetic along the fascia. injuries. Treatment endpoints were favorable KEYWORDS: Fasca iliaca, block, especially when the implantation period of emergency department. three weeks was respected in gypsum and the beginning of rehabilitation exercises OP – 110 CONCLUSION:Typical site radius fractures Post Factum Evaluation of Radius are heavily influenced by regional Fractures in the Typical Place in Relation to osteoporosis, age of patients, osteoporosis Age, Gender, Osteoporosis Rate, and rate. Generally, benign fractures tend to Treatment Outcome. consolidate. A three-week period is sufficient for the attachment of bone fragments and the Elona HASALLA¹, Ilda TAKA¹, Ilia MAZNIKU¹, origin of rehabilitation. Over-term 2 Blerta HASALLA¹, Sulejman BAHA , Elona complications, such as dysfunctional bone DYBELI ¹. atrophy, are more difficult to treat than Authors Information: fractures themselves. 1Lecturer in Nursing Department, Faculty of KEYWORDS: Radius, osteoporosis, Medical Technical Sciences, University of "Aleksander Xhuvani" Elbasan, ALBANIA. fracture, rehabilitation. 2University Hospital Center “Mother Theresa”, Tirana, ALBANIA OP – 111

Abstract Ambulatory Treatment of Upper Limb Introduction: To evaluate the influence of Trauma and Nurse Engagement the above fractional on the frequency of 63 | Page

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Elona HASALLA¹, Ilda TAKA¹, Ilia MAZNIKU Specialist in forensic medicine and clinical ¹, Blerta HASALLA¹, Sulejman BAHA2, Elona physiology.Physiotherapist at FIZIO-TRAUMA, DYBELI¹. Tirana, ALBANIA. Authors Information: 1Lecturer in Nursing Department, Faculty of Abstract Medical Technical Sciences, University of Introduction:Frequently the problems of "Aleksander Xhuvani" Elbasan, Albania. patients / sportsmen who have a lack of 2University Hospital Center “Mother interpretation of information are collected Theresa”, Tirana, ALBANIA especially in the training area, where the information is related to the systems used. Abstract One major problem in the Sports Trauma INTRODUCTION: Outpatient treatment of aspect covers physiotherapists member locomotor injuries in general and upper sports, in real time, determine an immediate extremity trauma in particular represents a diagnosis after an emergency or observation medical, economic, social and scientific of the traumatic event. interest. Upper extremity traumas are injuries RESULTS: 60% of patients with immediate that are more and more common nowadays post-traumatic stress disorder recovered and are still a serious concern for individuals immediately after trauma or long-term who suffer, their loved ones, and society. hospitalization. In patients who were not Materials and Methods:Our study included treated at around 40%, it was found to be an 92 traumatized individuals, of whom 60 are emergency rate of recovery rapidly following male and 32 are female. 56 persons or 61% ophthalmic surgery, as well as an emergency were from Tirana and 36 - 39% were from application in the emergency room. districts. The study covers the period January CONCLUSIONS: Physiotherapists are 2018 to the end of May 2019. required by the specialist to diagnose all types Results:Males were 60 individuals or 65.2% of sports trauma and the way that the patient of the whole series, while females occupied is presented during an activity or during a 32 individuals or 34.8% of the whole series or probationary traumatic event, the knowledge just over 1/4 of all affected. The age most of which has a direct impact on recovery and affected by traumatic injuries in our study is recovery. Eighty-three trained to manage up to in 40 year olds, who make up 59% of problems related to traumatic events and post- cases. traumatic events. Conclusions: Keywords:Sports trauma, training area, 1- Upper partial injuries cause significant physiotherapist, management. functional loss and occupy an important place in the case of traumatic injuries. OP – 113 2-It is important to diagnose and treat these injuries in a timely manner. Rehabilitation for Patients Following ACL 3. The provision of first aid at the scene is of Reconstruction the utmost importance and plays an important Anxhela AHMATAJ1, Viktor MARKU2 role in the further treatment of this pathology. Keywords: trauma, upper extremity,day Authors Information surgery, ambulatory treatment. 1 Physiotherapist, San Vitale Clinic, Tirana, Albania. OP – 112 2 Orthopeadic Surgeon, University Hospital of Sports Trauma and Their Management Trauma, Tirana, Albania.

Dorian META Abstract In our clinic, “San Vitale”, patients are Author Information: routinely referred for physiotherapy after University of Modena and Reggio Emilia, ITALY. ACL reconstruction. Assistant Professor at Faculty of Technical However, to date the role and amount of Medical Sciences, Tirana, ALBANIA. supervised physiotherapy required has not been clearly established.We follow a model,

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts which has been developed by clinical Results: From all articles reviewed there observation, patient interaction, and by have been effective results ofneuro- analyzing outcome measures derived from stimulation techniques, aerobic fitness and prospective follow-up patients. video games in cortical reorganization The best outcome scores occurred in patients with combined program: ROM + Strength, a inducing neural plasticity toward motor group who attended physiotherapy regularly recovery, improvement of executive functions after ACL reconstruction, comparison with and transfer of spatial knowledge. those who attended only infrequently. Conclusion:Rehabilitation through locomotor 100 % of patients achieved normal knee training and neurostimulation extension and 97 % of patients achieved techniques, improves mobility in subjects normal knee flexion. after a cerebrovascular accident due to Keywords:ACL, reconstruction, rehabilitation cortical reorganization. Also, through aerobic fitness and video games there have been OP – 114 improvements of cognitive functions. This way, rehabilitation dedicated to the promotion Review Role of Rehabilitation in Neural of well-being and health urges beneficial Plasticity neuroplastic changes in brain corresponding

in functional improvement. Andromeda KECI ¹*, Klejda TANI, Joana XHEMA Keywords: Cortical reorganization, neural plasticity, aerobic fitness, video Authors Information: games, rehabilitation. Physiotherapy Department, Faculty of Technical Medical Sciences, University of OP – 115 Medicine Tirana, ALBANIA This abstract has been withdrawn. Abstract Introduction: Verifying if physical therapy, neurostimulation techniques, aerobic fitness OP – 116 and video games can induce neural plasticity Case Study, Impact and Efficacy of making it possible for cortical reorganisation, Physiotherapy in Anterior Gleno-Humeral motor recovery in patients, improvement of Dislocation on the Geriatric Age. cognitive functions and transfer of spatial knowledge in everyday living environment. Selda VEIZAJ1*, Endrit MONE2, Erisa 2 1 Methods:There have been revised scientific MANE , Aida LAKO articles respectively focused in the role of Authors Information: pain, the role of physical therapy, 1 University “Alexander Moisiu” Faculty of neurostimulation techniques and video games Professional Studies, Durres, ALBANIA in cortical reorganization. Articles related to 2 University of Medicine, Faculty of Technical the role of pain have taken in the study Medical Sciences, Tirana, ALBANIA subjects with pain, to obsverve its role in cortical reorganization. Studies related to Abstract physical therapy and neurostimulation Background;Dislocation anterior of gleno- humeral joint is when the head of the techniques after cerebrovascular accident humerus is out of the shoulder jointdue to consisted on the involvement ofthese subjects direct or indirect forces. This is the most which exposed to different neurostimulations. frequent dislotaion, among all human joints. Also, related to cogniniton and video games About 1.7%of people have anterior gleno- subjects exposed to these interventions for humeral dislocation during their cognitive benefits. lifetime.PurposeEvaluation of the efficacy of

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts physiotherapy in the treatment of anterior Introduction;Diagnostic Radiology includes gleno-humeral dislotacion ingeriatric patients. general radiography, CT, CBCT, Material and Methods.Case study, a patient mammography, tomosynthesis, dental 82-years old treated at University Hospital of radiography (intraoral, panoramic and Trauma Where initially the Orthopedic doctor CBCT), bone densitometry (DXA) and has restored the head of the humerus into the fluoroscopy. All these diagnostic procedures shoulder joint through the Kocher method, use ionizing radiation (radiation that interacts it’s recommended a tutor for a month. The with matter) – X-rays. Latest reports suggest patient underwent physiotherapy for 2 that there are made about 4 billion X-ray months. examinations per year worldwide. Does the The following tests were used: VAS, increasing demand for X-ray imaging Apprehension Test, Relocation Test, Anterior procedures has implications for radiation Instability Test. protection of medical staff? The increase in Results;Based on physiotherapeutic uses of these procedures presents a challenge treatment that included 3 stages of treatment to ensure appropriate radiation protection of 1, 4 and 8 weeks. VAS rate at the beginning medical staff, patients and public members. of treatment the patient reported vas values = Material and Methods;World literature, 7-8; in week four Vas values were reported = practice and work experience. 4-5; and in week 8 vas = 3. While based on Results;Radiation protection in medicine is Apley’s Scratch test results unable to reach important and unique for a number of the physician- defined targets that meant poor reasons. Medical uses of radiation represent mobility of the upper limb. In the second more than 99.9% of man-made radiation phase of rehabilitation this test results in exposure and there are billions of these difficulty performing the function of flexion / procedures occurring annually in all regions extension; internal / external rotation or of the globe. Medical uses also result in the abduction and adduction. At week 8 the largest number of occupationally exposed patient was able to perform all required workers and represent the largest movements. occupational collective dose. This is the main Conclusions:By physiotherapy we achieved reason why health professionals should be the stabilization of articular ROM, improved known with radiation protection and safety in muscular strength andmobility, improved medical uses of radiation, including roles and neuro-muscular control, and patient responsibilities, education, training, preparation for functional recovery in qualification and competence, and the activities ofdaily living. management system for protection and Keywords;Physiotherapy, Dislocation safety. anterior of gleno-humeral, Apley’s Scratch Conclusions;Medical uses of ionizing Test radiation involve a number of health professionals performing radiological OP – 117 procedures such as diagnostic examinations. Radiation protection in Diagnostic Keywords;X-rays, radiation protection, Radiology ALARA principle, medical exposure, dose SEJDINI1*, Ina UZUNI2 limits, shielding design, quality assurance.

Authors Information: OP – 118 1Student at Medical University of Tirana, ALBANIA Scoring Tool for Massive Transfusion in Abdominal Trauma Abstract The aim is to emphasize the importance of Ayman EL-MENYAR, radiation protection in medicine, to explain radiation protection protocols in Diagnostic Author Information: Radiology, focused in occupational exposure, ¹Chef of Trauma and Vascular Surgery, medical exposure and public exposure. Hamad General Hospital, Doha, QATAR.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract Shock index (SI), is considered as a rapid Abstract predictable indicator of hemodynamic Trauma continues to be the leading cause of instability in trauma patients. Herein, we mortality in young population. Truncal sought to assess SI in patients with abdominal hemorrhage is associated with high trauma. prehospital fatalities in comparison to fatality We conducted a retrospective analysis for rate in the extremity injuries due to the trauma patients between 2014 and 2017 in a difficulty in controlling the bleed. The role of Level 1 Trauma center. endovascular evolved rapidly in resuscitation, Patients were classified into group I (SI<0.8) diagnosis and management stages of trauma and group II (SI ≥0.8). Out of 1199 patients patients. The endovascular management with abdominal trauma requiring hospital seems specifically promising in abdominal admission, 49% had SI ≥ 0.8, 40% received injuries, especially in the setting of others blood transfusion, 14% received massive concomitant injury. In the resuscitation phase blood transfusion (MTP), and 27% had the Introduction of Resuscitative exploratory laparotomy. In comparison to Endovascular Balloon Occlusion of the Aorta lower SI group, patients with SI≥0.8 were (REBOA) is an alternative to open significantly younger (28±14 vs. 34±13), had resuscitative thoracotomy with aortic cross greater ISS (22±13 vs. 15±10), and had more clamping to support the circulation until positive FAST (36 vs 24%). SI≥0.8 group had definitive interventions. The availability of more retroperitoneal hematomas (6.0 vs hybrid operating rooms with angiographic 2.9%), splenic injury (31 vs. 25%), more radiology capabilities offers opportunities for blood transfusion (58 vs 23%), MTP (25.8 vs the diagnostic and management of 3.1%), exploratory laparotomy (32.6 vs hemodynamic unstable patients by either 22.2%), splenectomy (8.4 vs 2.8%), longer temporary control of the devastating bleeding hospital stay, and higher mortality (10.8 vs. using endovascular balloon or with 2.6%), p=0.001. embolization and stenting. This presentation Liver and bowel injuries were comparable reviews current literature and our experience between the 2 groups. SI was significantly with regard to the endovascular management correlated with ISS (r=0.35) and GCS (r=- in abdominal trauma. 0.314). After adjusting for age, sex, ISS, GCS, and abdomen AIS, high SI was OP – 120 independent predictor of exploratory laparotomy (aOR 2.25, p=0.001) and MTP Solid organ injuries (aOR 8.07, p=0.001). ROCs and Area under the curve (AUC) showed that SI ≥ 0.80 Hassan AL-THANI predicted the need for MTP (AUC=0.83) with 85% specificity, 65% sensitivity, 28% PPV Author Information: and 96.7% NPV. Senior Consultant, Chef of Trauma and Shock index ≥0.80 on admission is associated Vascular Surgery, Hamad General Hospital, with worse outcomes and can predict the need Doha, QATAR for MTP and exploratory laparotomy in abdominal trauma. Abstract Solid organ injury includes the liver, Spleen, OP – 119 kidneys and pancreas in isolation or combination. They are known to be highly Endovascular Management in Abdominal vascular and thus represent a major source of Trauma bleeding post trauma especially with blunt mechanisms. This fact makes them important Hassan AL-THANI determinants of mortality and morbidity and a challenge for care giver facing significant Author Information: poly-trauma in trauma centers regardless of Senior Consultant, Chef of Trauma and age or gender. The management is Vascular Surgery, Hamad General Hospital, multidisciplinary. Doha, QATAR

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Those who are hemodynamically unstable abdominal and ongoing massive transfusion with positive FAST will have an immediate and to a greater less use in acute care for exploration laparotomy to control the septic abdomen with septic shock, mesenteric bleeding accordingly; some cases need a ischemia and acute severe pancreatitis. damage control approach in resuscitation and Nowadays, it is used rarely for controlling operatively and often a postoperative CT scan abdominal compartment syndrome not and angio-embolization if suspected ongoing responding to aggressive medical treatment. bleeding, pseudo-aneurysm or AV fistula is Advances in resuscitation have impacted the identified before return to OR for definitive frequency of utilizing this technique and completion and fascial closure. some novel interventions like direct On the other hand Non Operative peritoneal resuscitation have impacted also it Management (NOM) is recommended is use and the expedite closure course as well treatment for those who are hemodynamically as advanced open abdomen dressing stable or respond to initial resuscitation and techniques. that represent the standard. The advantages Those cases are prone to a multitude of local decrease LOS, blood transfusion. NOM take and systemic complications both in short and place in ICU with close observation long term and thus it is demanding condition clinically, laboratory and imaging repetition with high associated morbidity (30%), cost within 48-72h with or without the addition of and mortality (ranged 11-39%). angio-embolization which help to increase the The concept of total management of opened success of NOM and control early abdomen is “key”, and represents a posttraumatic pseudo-aneurysm development multidisciplinary team of highly motivated eliminating risk for delayed bleeding by health professionals to enhance and optimize blocking bleeding damaged vessels. Failure the management of these vulnerable and sick rates are variable for different organs; renal patients with open abdomen in a global and (0-10%), Hepatic (1-15%), Splenic (2-52%). inclusive model of care. Well-designed Important management controversies remain protocols and prospective research trials is in where to admit, when to determine failure, high demand to further clarify the problem role of angio-embolization, how long should and inform clinician decision making and best you keep those patients? Timing for thrombo- practices. prophylaxis, post-splenectomy vaccination timing, vaccination after angio-embolization, OP – 122 follow up and needed rest. The Challenges in Diagnosis and OP – 121 Management of Blunt Bowel Injury

Revisiting Open abdomen Ismael Yousif Mahmood ALOMAR

Husham ABDELRAHMAN, MD, FRCSI, CABS Author Information: Associate Consultant, Trauma Surgery, Author Information: HMC, Assistant Professor, Weill Cornell Senior Consultant Trauma Surgery, Director of Medicine -QATAR Trauma Resuscitation Unit, Hamad trauma center. Hamad General Hospital, Hamad Medical Corporation, Doha, QATAR Abstract Blunt abdominal trauma causing bowel Abstract injuries are uncommon and found in about Open Abdomen remains a life-saving 1% of patients undergoing CT evaluation. procedure in selected patients and a potential Clinical signs of bowel injuries such as source of morbidity and mortality. Data suggest that it is over-utilized and there is abdominal tenderness, rigidity, absent bowel generally low compliance to published tones are present in less than 50% of patients. guidelines. It is main use in critically injured Clinical evaluation is more difficult in patients with massive bleeding often polytrauma patients especially those with

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts head and spinal cord injuries. An absence of period of January 2015 until December the specified CT findings was encountered in 2016.All data were collected and analyzed 9.1 % with surgically proven bowel injuries. according to package SPSS version 20. Frequencies and percentages are used to The presence of free fluid in the abdomen evaluate variables. We considered significant without solid organ injuries: Mesenteric tear p values less than 0.05. which may or may not require repair, missed Results:During 2017-2018 there are 77 cases solid organ injury. Fluid leaking from with complete tear of Achilles tendon treated retroperitoneal hematoma associated with a in our Institution. 7 Cases (9.1%) were pelvic fracture. Postoperative complication of females and the age group were 25-35 years intestinal anastomosis after blunt abdominal old. 5 Cases out of 9 females were right side and 2 were left side. 70 cases (90.9%) were trauma. We reviewed all intestinal injuries in males and out of these 7 cases (10 %) were in adult patients who underwent laparotomy for the age group 25-35 years old and 50 patients blunt abdominal trauma between January (71.4%) are in the group age 35-45 years old 2008 and December 2015.One hundred sixty and 13 patients were above 45-year-old. From patients with intestine injuries were these patients 55 patients were tendon identified. The overall incidence of ruptures of the right side and 15 were left abdominal complication was 17.5%. Wound side. All patients were treated surgically first and then with cast. 70 cases were acute tears infection 10%. Intra-abdominal abscess 8.1%. and 7 cases were chronic tears with the later Anastomotic leak 3.8%. There were two having prolonged rehabilitation time. deaths occurred because of the complication Correlation of variables of initial time of from the bowel injury. Based on finding, it treatment and rehabilitation is significant can be argued that patients, who have blunt p<0.05. small or large bowel injuries, even if operated Discussion:Complete tear of Achilles tendon patients reported in our Trauma center treated early, have significant morbidity and surgically followed by cast treatment have mortality. Blood transfusion, high lactate been 77 cases during period of 2017- level and number of re-laparotomies were 2018.Male gender has dominance. Type of found to be significantly related to intra- treatment is surgical repair of tendon. Time of abdominal complication. surgery is crucial in rehabilitation outcomes. Preferred treatment should be surgical repair OP – 123 followed by cast immobilization. Keywords: Achilles tendon tear, cast Cast Treatment of Achilles Tendon Tear immobilization. After Surgical Repair. Cast Technician Perspective. OP – 124

Arben GJONEJ¹, Risida GJONEJ¹, Astrit PEKA¹, Urinary Tract Infections in Women During Edvin SELMANI ¹, Vilson RUCI¹ Hospitalization

Authors Information: Afërdita ADEMI ¹Service of Orthopedic, University Hospital of Trauma. Tirana, ALBANIA. Author Information: Medical Faculty - University of Tetovo, RN of Abstract MACEDONIA. Introduction: The aim of this study is to Department of Urology, Clinical Hospital – show the results of cast treatment of Achilles Tetovo, RN of MACEDONIA. tendon tear patients treated surgically during 2017-2018 from the cast technician’s Abstract perspective. Introduction:A urinary tract infection (UTI) Materials and Methods: We studied all the is caused by different types of bacteria which cases with complete tear of Achilles tendon multiplying in urine. When the infection treated surgically in our Institution during affects the lower part of urinary tract it is

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts known as a cystitis or bladder infection. 1 Lecture, Faculty of Medical Technical Science, Nurses in urology department must be able to University of Medicine of Tirana, ALBANIA. treat uncomplicated low urinary infection in women. Abstract Material and Methods:in this retrospective Introduction:According WHO, a birth is study are included 125 women treated in our premature when it happens before 37 department during a period between January 2017 - 2019, which were catheterized during gestational weeks calculated from the first hospitalization. Catheterization was day of the last menstrual period. Risk factors performed with siliconized Foley catheters that affect in this pathology are classified in while during catheterization we followed all two groups: 1) spontaneous, 2) fetal/maternal antiseptic and disinfection rules. reasons or both. Results:in 125 women aged between 20 - 70 Materials and Methods: This is a years old hospitalized in our department in a period between June 2017-2019, the risk of retrospective study. The information is urinary tract infections in the first three days collected from the clinical charts for the was very low, respectively, only in one of the period January 2018 till December 2018. patients (0.8 %) contamination of the urinary Demographic data of the mother were also tract with bacteria was recorded. With the taken into consideration (which are expressed extension of catheterization time, the risk of in frequency and percentage) and how they developing urinary tract infections increased affect premature birth as well as the risk progressively, so one week after catheterization the lower urinary tract factors how they affect premature birth too. infection was recorded in seven women Data processing was performed by SPSS 20.0 (5.6%), whereas teen days after package. We used chi- square test for the catheterization in eleven patients was categorical variables and the p value 0.05. registered the presence of urinary tract Results:For the period January 2018 till infection. Most of the patients with urinary December 2018 have born 6620 babies of tract infections were over thirty-five years which 515 (7.7%) are premature births. The old. Urine culture showed that the most common cause of urinary infections was E. age group of mothers are: 17-24 years old coli, while the patients were treated with 35.7%, 25-30 years old 26.3%, 30-35 years old more frequent replacement or sometimes with 22% and over 35 years old 16%. The complete removal of the urinary catheter and correlation between the age variable and the the administration of antibiotics according to diagnoses is significant and the p value is 0.01. the antibiogram results. The rate of the mother which deliver for the Conclusion:in patients hospitalized in the urology department the most common risk first time (primipare) was 292 cases (56.7%) factor for the development of lower urinary and pluripare 223 cases (43.3%). The most tract infection are duration of catheterization, dominant influencing factor was high blood age and female sex. Nurses play an important pressure with 241 cases (46.8%). The role in early detection and follow-up of correlation between diagnoses and risk factors patients with urinary tract infections. variables was significant with p value 0.001. Keywords: low UTI, women, nurses. 78% of the mothers delivered by

OP – 125 caesariansection. 139 patients (27%) used tocolytics. Premature Birth and the Contribution of the Conclusions:From 6620 babies that have Midwives born, 515 of which are premature births. The most dominant influencing factor in this Risida GJONEJ1, AlbanaPOLOSKA1, Etleva diagnose was high blood pressure and 78% of SMAKAJ1, Valbona BEZHANI1, Flora the babies have deliverd by cesarean section. 1 ZYBERAJ The young age of the mother but also the age

Authors Information: of 35 and over affects the premature birth.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

The low use of tocolytics are due to the low conditions. These findings indicate a high cases of membrane premature ruptures. burden of trauma exposure in low-income Midwives' contribution is seen in the proper countries and in post-conflict settings, where access to trained health professionals is care and implementation of the tocolytics usually low. described. The midwife helps the mother Keywords:Epidemiology, Post Traumatic identify early signs of premature birth activity Stress Disorder. as well as helps her identify and minimize risk factors. OP – 127 Keywords:Premature birth, tocolytics, caesarian section. Nursing Care in Patients with Ocular Trauma

OP – 126 Violeta ZANAJ1*, Arben TUSHA 2

Post-traumatic stress syndrome, in hospital Authors Information: ward settings Lecturer at Department of Medical Technical Sciences, Faculty of Professional Studies Natasha MERKO¹, Hasije DURAKU¹, Etlleva “Aleksander Moisiu” University Durres, RAMALIU ¹ ALBANIA.

Authors Information: Abstract ¹Nurse Service University Hospital of Introduction: Eye trauma is one of the most Trauma, Tirana, ALBANIA. popular causes of vision loss in the developed world. Open or penetrating eye trauma can Abstract lead to vision loss through cataract or Introduction:This Reference discusses recent glaucoma. The etiologies of eye injury vary in findings from epidemiologic surveys of urban areas compared to other settings, and traumatic events and posttraumatic stress vary from place to place, between different disorder (PTSD) in the workplace, including regions of the world and between different prevalence, risk factors and consequences, demographic or socioeconomic classes. It risk associated with specific traumatic events, consists in recognizing the features of this and on morbidity and comorbidities pathology, recognizing and preventing its associated with these events. etiological factors before it occurs and Materials and Methods:We have had a appearing and aggravating it. descriptive study in voters, presentation of Treat every person, patient affected by ocular 100 Nurses. On tire exams you score points trauma based on anamnesis, diagnosis, for exposure, PTSD, Look in survey sheets medical therapeutic treatment. Nursing staff calling the terms 'trauma' and 'post traumatic assist with physical assessment, possible stress disorder' in in combination with nursing diagnoses, planning, nursing 'prevalence', 'distribution', we have limited interventions to reduce the time for recovery. SUT statistics between 2013 -2017, and therapies and advice on avoiding its dealing with comprehensive tire exposures etiological factors. and traumatic service. MATERIAL & METHODS: The clinical Resuls: Recent community studies show that signs of ocular trauma are widely recognized; trauma exposure is higher in low-income Prescribing and correctly applying the five countries compared to high-income countries. stages of nursing to the patient: To accurately The highest rates found in post-conflict describe the imaging diagnostic tool for settings. Trauma, PTSD risk factors are ocular trauma; Data on persons, patients, distributed differently in low-income when they are most affected by ocular countries than in high-income countries, trauma, and how they experience it. which contribute most to this risk. Care is Conclusions: The nurse manages to either very low or not at all. accomplish the 5 stages of nursing in a patient Conclusions:Trauma exposure is also with ocular trauma. He / she manages to associated with some chronic physical identify the characteristic signs of ocular

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts trauma and formulate his or her nursing OP – 129 diagnoses. Perform and applies treatment safely as prescribed by the physician. Advises Nursing Ethics in Trauma Patients the sick patient on what to do and what not to do. Keywords;Eye trauma, ocular trauma, Deonada ÇOKU¹, Natasha MERKO¹, Hasije DURAKU¹, Odeta MISHO¹, Etleva RAMALIU¹ nursing diagnoses.

OP – 128 Authors Information:

Nurse Service, University Hospital of Trauma, Managing Patients in Trauma Emergency Tirana, ALBANIA. Department

Natasha MERKO, Deonada COKU Abstract (HYSKO) INTRODUCTION: The word ethics is derived from the ancient Greek ethos - habits, Authors Information: customs and ethics – i moral: Ethics is the ¹Nurse Service University Hospital of Trauma, science of morality (no, moris- the Latin word Tirana, ALBANIA. for habit, adet). The purpose is to give a clear description of the concepts and terms of Abstract ethics in the field of nursing. Ethics is a very Background:Emergency Admission Service broad field, and has been a key pillar of has been nationwide since 1993 with three medicine in all periods of history around the Ministries, Education, Health, Defense. world, whose recognition and study it is Where he also received the appointment much needed while practicing the profession S.U.Q.U. In 2013 with DCM I switch to SUT. for all health staff this paper has emphasized Me 2015 with decisions onThe Government the importance of ethics in general, which has is also integrated into the Military Sp. On the an impact on staff performance health, the urgency of admission there are an average of aim is to evaluate the knowledge, attitudes 50-70 cases per 24 hours, of these 4-5 cases and experiences of nurses in relation to with with politrauma every day. Some come healthcare ethics and legal rules in the field of directly and many more from district nursing: delivery of ways to formulate hospitals. Emergency patient management answers to questions and guide actions. often faces times with different problems. Offers one a framework for resolving issues, This reference aims to highlight various problems and conflicts. An essential issue of complaints, suggestions and possible this paper is the ethical nursing attitude solutions to the urgency of SUT has been towards patients at SUT around for almost 23 years and is the only Materials and Methods: The study is of a one in the National range. qualitative nature, included in the study Material and Methods:A sectional study total 24 nurses of Reception, Consultation, was performed on over 300 patients in trauma Emergency at SUT, and is done their emergency for a period of 2 months, questionnaire survey consisted of 10 from1.11.2016.to 31.12.2017 questions. Results;Men are mostly the main victims, Results: Nurses with regard to knowledge and road accident are the leading causes. about ethics have claimed that according to Injuries include more than 2 specialties, the belief coordination between different specialties in they possess high knowledge of ethical patient management in a timely manner. responsibilities in the field of nursing, and Conclusion:A well-trained team specializing that they have gained this knowledge from in trauma management with a standard work experience, university studies and procedure, standard protocols well, are the attendance at training, courses, conferencing, keys to an effective management of poly ethics plays an important role in the trauma patients. professional work of health care personnel, Keywords: Polytrauma, selection, but must always respect and work ethically. Emergency admission, triage.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

In this paper, we place special emphasis on Conclusion: Acute severe asthma carries a knowledge, experience and high morbidity and mortality. It may be ethical attitudes of Nursing care classified as mild/moderate/severe or life professionals. The importance and the threatening. Peak Expiratory Flow rate is a irreplaceable role of health care professionals good indicator of severity of the attack. B2 in care for patients, a skilled, motivated, agonists by nebulization are the first line of aware staff is a condition for development therapy for acute severe asthma. Nebulization and with anticholinergics is an adjunct and has no the proper functioning of their internships in role as the sole medication in an acute health care institutionsthe necessary patient asthmatic attack. Steroids are to be given in services while always adhering to ethical all patients, but antibiotics to be prescribed norms. only where indicated. Keywords:communication, conflict, Keywords: Asthma, mechanical ventilation, solutions, nursing ethics, the role of nurses. pneumomediastinum, acute respiratory failure. OP – 130 OP – 131 Management of Hypoxemia in Severe Asthmatic Status in ICU. A Case Report. Anesthesia and Perioperative Management in Liver Resection, our Experience. Alma CANI¹, Fahri KOKIҀ I¹, Eliana SHIMA¹, Loreta AGOLLI ² Majlinda NAÇO ¹, Haxhire GANI ¹, Etmont ÇELIKU², Nertila KODRA¹, Anna MANDI ¹, Authors Information: Henri KOLANI², Eden NAÇO ³. ¹Anesthesiologist and Intensive Care Service, University Hospital “Shefqet Ndroqi”, Tirana, Authors Information: ALBANIA ¹Departament of Anesthesia and Intensive Care in ²Pneumologi Service, University Hospital General Surgery, University Hospital Center “Shefqet Ndroqi”, Tirana, ALBANIA “Mother Theresa”, Tirana, ALBANIA. ²Department of General Surgery,University Abstract Hospital Center “Mother Theresa”, Tirana, Introduction:Acute asthma is an episode of ALBANIA. progressive increase in shortness of breath, ³Medical student of Catholic University “Our lady cough, wheezing, or chest tightness, or some of good counsel”, Tirana, ALBANIA. combination of these symptoms. If not treated immediately there will occur increase in flow Abstract resistance causing increased work of Introduction:The patients with colorectal breathing, gas exchange inefficiency, adenocarcinoma very often developed hepatic respiratory muscle exhaustion and finally metastases. Resection of them still remains hypercapnic and hypoxemic respiratory the best treatment of disease. Hepatectomy failure. Acute severe asthma carries a high carried about 20% mortality rate. The most morbidity and mortality. important intraoperative factor is major Case Report: A 24-year-old female hemorrhage and hypotension and presented to the hospital emergency room postoperatively the main reasons are with breathing difficulty. The patient was a hemorrhage, coagulopathy, renal failure, known case of bronchial asthma since years. pulmonary, and cardiac disturbance till biliary The patient presents one-day history of fistula and liver failure. Anesthesia and shortness of breath, cough, chest pain. perioperative management have resulted in At the beginning presented to the hospital diminished value of mortality and morbidity emergency room of UHC “Mother Teresa”. at the same time. After CT thorax, results Pneumediastinitis Materials and Methods:In that retrospective and transferred to the hospital UH "Shefqet study we enrolled 6 patients ASAII- III, from Ndroqi". The patient has a history of 5 years January to July 2019. All patients treated for with regularly spotted bronchial asthma… liver malignancy diagnosis after colorectal carcinoma in elective surgery and received general anesthesia with fentanyl 1-2μg/kg/h,

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts profolol 4.0μg/kg/min via target-controlled For nine consecutive months 10 cases of infusion and vecuronium 0.001mg/kg/min acute cardiac tamponade due to and sevofluran 2%. All patients are monitored hemopericardium was recovered in ICU of with continuous central venous pressure cardiac surgery. All the patient were in (CVP). We recorded mean artery pressure (MAP), heart rate (HR), CVP, amount of cardiogenic shock and immediately 9 of them transfusion, incidence of complications and was performed median sternotomy and one discharge from intensive care and hospital. pericardiocentesis with insertion of central Results:Female/male report was 66,6% vs venous catheter. In 9 nine cases perforation of 33.4%. The age of patients were 53-72 years coronary artery was founded. One patient with a mean ± SD age of 65.1 ± 9.5 years. died due to heart failure after CABG. CVP was 0-5. Amount of blood was 2.5 unite Conclusion: In the era of increasing numbers during innervation. Average of days in intensive care was 3.83. Renal compromised of cardiac invasive procedures and the was 3%. Ascites and edema were 50%. All numbers of complication such an acute patients were discharged home after 14.66 cardiac tamponade also increases. Aggressive days. treatment in ICU and immediate drainage of Conclusion:Optimizing hemodynamics and pericardium are lifesaving procedure for the fluid administration and reduced the patients. administration of blood therapy using low Keywords:Cardiac tamponade, intensive care CVP (0-5). Keywords:blood transfusion, CVP, liver unit, peri cardiocentesis, surgical surgery, perioperative management. pericardiotomy.

OP – 132 OP – 133

Management of Acute Cardiac Tamponade Pneumoperitoneum after open Heart Following Cardiac Procedures. Surgery.

Alfred IBRAHIMI ¹, Saimir KUCI ¹, Ervin Alfred Ibrahimi¹, Saimir Kuci¹, Ervin Bejko¹, BEJKO ¹, Stavri LLAZO ¹, Selman StavriLlazo¹, Esmeralda Bulku¹, Jonela DUMANI¹ Burimi¹ Authors Information: Authors Information: ¹Anesthesia and intensive care service, in ¹Anesthesia and intensive care service, in cardio-vascular clinic “Mother Theresa” cardio-vascular clinic “Mother Theresa” Hospital, Tirana, ALBANIA Hospital, Tirana, ALBANIA Abstract Abstract Introduction:Because of the close anatomic Cardiac tamponade is defined as a relationship of the pericardium, diaphragm, and peritoneal cavity, a benign hemodynamically significant cardiac pneumoperitoneum may occur following compression caused by pericardial fluid. The median sternotomy incision and cardiac number, specific type, and complexity of surgery. The pneumoperitoneum results from percutaneous cardiac procedures continue to inadvertent opening of the peritoneal cavity evolve, most common causes of acute cardiac during the initial surgical incision or during tamponade are: rupture of aortic dissection, the subsequent cardiac surgery. It is generally coronary laceration during PCI procedure and of no significance to the patient, although it must be distinguished from massive hemopericardium after pneumoperitoneum occuring secondary to pericardiocentesis. Tamponade is an absolute intraabdominal pathology or to retrograde indication for urgent drainage, either by dissection of extra alveolar air in patients on pericardiocentesis or surgical pericardiotomy. ventilatory support. One illustrative case is

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts presented. Patient after reoperation for mitral facilitate intubation. When being weaned on valave repalacement in decompesation cardiopulmonary bypass, the patient situation massive ascites in abdominal cavity experienced VS, hypotension during an was seen. After that massive bilateral pleural immediately following CPB. The patients’ efusion was removed for 4 consecutive days. blood pressure did not increase after the Pneumoperitoneum, without, peritoneal signs administration of a high dose of vasopressor and pneumomediastin was diagnosed. Air use, epinephrine vasopressin and passes from open sternal wound to norepinephrine. Therefore, he was initiated mediastinum and peritoneal cavity through on a dose of methylene blue 2mg/kg but his normal anatomic ways. After closure of blood pressure didn’t reach the normal range. sternal wound, air was absorbed in thoracic In conclusion the decision was made to and abdominal cavity administer intravenously hidroxocobalamina Keywords:pneumoperitoneum, sternotomy, 5 g through the CPB circuit and within 20’ of cardiac surgery, pneumomediastin administration the patient was separated successfully from CPB in a stable condition OP – 134 with a low dose of vasopressor support. On arrival to the ICU the patient was token off Hydroxocobalamina is a Rescue Treatment completely from vasopressor for Refractory Methylene Blue Resistant (norepinephrine) and did not require Vasoplegic Syndrome During Cardiac additional vasopressor boluses. On Surgery A Case Report. postoperative day 3 the patient was transferred to the cardiac step-down floor in a 1 2 Marjeta BILAJ(Miraka) ; B BARRIC good hemodynamic condition. Conclusion: This is the case of VS on CPB Authors Information: 1 unresponsive to vasopressor support and Dept of Anesthesia and Critical Care at methylene blue whereas responsive to American Hospital, Tirana, ALBANIA. hidroxocobalamina which potentially 2Dept of Anesthesia, Cardiothoracic division at indicates that the effect of hidroxocobalamina UNC, Chapel-Hill, NC USA is significant or that the two drugs have Abstract synergic effects with one another in one or Introduction: Vasoplegic syndrome (VS) is multiple mechanisms. a complication during cardiopulmonary Keywords: Hidroxocobalamina, vasoplegic bypass (CPB) (25%) and has a significant syndrome, CPB, vasopressor. morbidity and mortality especially in the 5% of these patients non-responsive to OP – 135 conventional vasoconstrictor therapy. In such refractory vasoplegia manifests with Anesthesia Challenges in Sleeve Resection hypotension, low systemic vascular resistance in Thoracic Surgery and normal or increased filling pressures. Conventionally methylene blue has been the Rinard KORTOCI1*, Safet BEQIRI2, Blerim drug of choice and effective as rescue ARAPI1, Roland KAZA1, A BAKO1, Marjeta therapy. It may not be effective in all patients. BILAJ1, A CANE1, A JAUPI1. Recently hidroxocobalamina is effective and an alternative method of managing refractory Authors Information: vasoplegia even in methylene blue resistant 1 Anesthesia Department American Hospital, VS. We report a case of VS during CPB and a Tirana, ALBANIA. successful managing Treatment. 2 Case Report: We describe a young male Thoracic Surgery Department, Kerckhoff patient, in chronic hemodialysis with Clinic Bad Nauheim GERMANY. infective endocarditis undergoing tricuspid valve repair and aortic valve replacement Abstract surgery. Standard ASA monitoring and Introduction: Sleeve resection and especially general anesthesia was induced with propofol, tracheal reconstruction requireexperienced fentanyl, midazolam and cistracurium to team and good skills. Most of the cases are

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts non-small cell lung tumour and sleeve Success in replantation depends on lobectomy is performed when is possible appropriate and time-sensitive care of the tosave pulmonary tissue, patient during the initial presentation to a health care facility, usually the emergency Material and Methods: During 2018-2019 department (ED). It is the responsibility of the have been done 5 patients, and all are emergency care provider to know how to males’non-smallcell pulmonary carcinoma. manage amputations and initiate proper care Mean age 63 +- 6 year. that will lead to a satisfactory outcome The Four were sleeve lobectomy (one was post adage "life over limb" accurately describes stenotic abscess and post chemotherapy) and the priorities in the prehospital care of 7,8 one of them was right pulmonectomy with traumatic amputations. The prehospital care provider is tasked with caring for not only the tracheal reconstruction. Postern-lateral injured patient but also the amputated part. thoracotomy was used for all patients and Stabilization of life-threatening injuries, “compartment lymphadenectomy”. We use control of hemorrhage, and appropriate double lumen tubes (one lung ventilation), storage of the patient's arrival at the ED is total intravenous anesthesia (TIVA) propofol usually chaotic, as patients with an + remifentanyl amputation can be distraught. They may be All patients are extubated in OR. Monitoring agitated and combative, flailing a partial amputation around and, thus, making their includes: Respiratory rate, capnometry, injury worse. Surgical Invasive blood pressure, ECG, SpO2, Techniques:Depending on the type and temperature, urine output. location of the amputation and the length of Results: All are discharged at 8th time since it occurred, the patient may be a postoperative day (except the patient with candidate for replantation. The amputated pulmonary abscess 15days). We have part suffers similar physiologic derangements as the patient in shock. The goal of documented all the anastomosis after four replantation is to provide a functional part weeks under the flexible bronchoscopy. with reasonable sensation and mobility. Conclusions: Most challenged moments are: Conclusion:Traumatic amputations are correct position of the tube under flexible devastating and debilitating injuries. The bronchoscopy, apnoeic hyperoxygenation, results of replantation are rarely perfect, but lung protection ventilation, ventilation from with a time-efficient and pragmatic approach the surgical field and emergency extubating. to management, satisfactory cosmetic and functional outcomes can be achieved. Keywords:Sleeve resection, carinal Keyword: injury, trauma, reconstruction, TIVA, apneic amputation,replantation. hyperoxygenation. OP – 137 OP – 136 The First Dorsal Metacarpal Artery in the Preservation of Fingers Length after Treatment of the first Web Space Burn Traumatic Amputations Wounds of the Hand

Sokol ISARAJ1*, Nardi KOLA1, Albana Gentian ZIKAJ1*, Gjergji BELBA1, Sokol ALEKSI1, Olivia SHABANI1, Ina KOLA1 ISARAJ1, Gezim XHEPA1, Nardi KOLA1.

Authors Information: Authors Information: 1Service of Burns and Plastic Surgery UHC 1Burns-Plastic Service, University Hospital “Mother Teresa” Tirana, ALBANI Center “Mother Teresa” Tirana, ALBANIA. Abstract Introduction: Traumatic amputations rarely Abstract occur in scenarios other than combat Introduction:Electrical injury often causes situations; however, when they do occur, they deep burns involving underlying soft tissue are emotionally and physically debilitating. and bone. Other associated complications 76 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts include vascular and neurologic injuries, diagnosis: “Pathologic tibial fracture, from fracture, subluxation of joints. Rapid the bone exposition in an abandoned burn resurfacing of the wound inessential to enable wound region”. The patient is transferred to early mobilization and optimum recovery of us from the Orthopedic Clinic of the Durrës hand function. Description: A 34-year- Regional Hospital, to cover the exposed bone oldright-hand-dominant man sustained an with soft tissue for the healing of the tibial electrical injury to his left hand. He bone. presentedwith deep burns to the firstweb The patient had suffered a pathologic fracture space and the dorsalaspect of the index finger. 3 weeks ago, after a ten months period of the Theexcision of the escharresulted in exposure exposition of the distal ⅓ of tibia in an of baretendons. FDMA flap wasdone. Around abandoned burn wound, for which was three monthslater, the patient had normalhand treated with external fixation device. In the function. conditions of a aerobic devitalization of the Discussion: If the resultingtissue is limited to bone segment, our college asked the transfer superficialsoft tissue loss, a skin graftmay be of the patient in our clinic, to cover fractured sufficient forcoverage. However, if there bone with vital well vascularized soft tissues. isexposure of the deeperstructures including Although, in our experience, the random loss ofperitenon, the resulting defectshould be adapt and safety reconstructive technique, in closed with local orregional flaps or free this case would be the reverse sural flap, the tissue undertaking of the therapeutic decision was transfer. Island FDMAF is areliable option very difficult, because of the split skin graft with many advantages. It does not involve application in the whole crural region with sacrifice of any majorvessel. It provides the accompanied pathologic fibrotic tissue in acceptablefunctional and cosmeticoutcomes the donor and recipient flap region. regarding skinmatch, elasticity, durabilityand The flap was outlined in the form of the sensitivity. So, it may be considered & novel traumatic defect and slightly larger in size. use. The flap pedicle was calculated to cover the Conclusion:The FDMA flap is a versatile defect after the rotation. The axis of the flap flap for coveringfirst web space defects rotation was calculated about 150 to ondorsal or volar aspects. Thisflap can facilitate the venous drainage. perform with a minimal donor site morbidity The flap was elevated respecting the standard⁰ which provides sensation, length, stability, technique in the subfascial plane, under the mobility as well as aesthetics. gastrocnemius fascia propria, with a 4 cm Keywords:Hand burn, epidemiology, wide pedicle in a length till 7 – 8 cm over the treatment, outcome. lateral malleolus. The patient was transferred after 3 weeks for OP – 138 the further treatment in the Orthopedic Clinic of Durrës Hospital. The Reconstruction of the Crural Soft As conclusion, we can say, that the reverse Tissues with Reverse Sural Flapafter the sural flap is one of the most safety flap in the Pathologic Tibial Fracture in the post correction of the defect of the distal third of Combustional Abandoned Wound - A Case the leg, and in pathologic local condition of Report. the subcutaneous fibrotic alteration, after the burn trauma. Gëzim XHEPA, Gentian ZIKAJ. OP – 139 Author Information: Department of Plastic and Burn Surgery, at Management of Auricular Traumas in The University Hospital Center “Mother Emergency Setting Theresa”, Tirana, ALBANIA 1 1 Rezarta KAPAJ* , Albiona SALIAJ , 1 Abstract Mariola NDRECKA The patient H. A., 57 years old, from Durrës, is hospitalized in the “Clinic of Plastic and Authors Information: Burn Surgery” on January of 2018, with

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

1 Plastic Surgery Department, American OP – 140 Hospital, Tirana ALBANIA Pia Flap in Hand Trauma Defects Abstract Reconstruction Introduction: The external auricle has a high potential for injury due to its exposed and Nardi KOLA *1, Sokol ISARAJ1, Albana unprotected position alongside the head. A ALEKSI1 retrospective study by Bardsley and Mercer looking at hospital records in auricular injury Authors Information: cases revealed that human bites constitute the 1Service of Burns and Plastic Surgery UHC most common cause of injury (42%). This “Mother Teresa” Tirana, ALBANIA was followed by falls (20%), automobile accidents (16%), and dog bites (14%). The Abstract most common injury observed was Introduction:Soft tissue reconstruction of the incomplete amputation of the ear, usually dorsum of the hand is always a complex helical rim tissue loss. Untreated open problem to deal with because of the auricular injuries invariably result in involvement of muscle, tendon and bone. infection, ensuing deformities, and further There are different flaps at our disposal that tissue loss. can be used to cover these soft tissue defects. Auricle avulsion or amputations may present This flap includes local perforator-based with the complete involved segment or a flaps, reverse flow forearm flaps, distant flaps portion thereof available for reconstruction. like the groin and abdominal flaps and free Isolated traumatic ear amputation is an flaps. Each of these flaps has their advantages uncommon event and frequently occurs in and disadvantages. conjunction with major systemic or head and The reverse posterior interosseous artery neck trauma. (PIA) flap is based on reverse flow through Material and Methods: We present three the PIA via anastomosis with the anterior cases we have treated in our setting interosseous artery and the dorsal carpal presenting with partial or near total ear arches near the wrist. The distal reach of the amputation. The etiology of the laceration PIA flap is also limited to the MCPJ of the was: cut with a glass, cut with a knife and fingers and the IPJ of the thumb. This work sports injury. All three patients were male. presents our experience with the use of The average age of the patients was 20 years reverse posterior interosseous artery flap for old. Two of them arrived at the hospital reconstruction of post trauma soft-tissue within hours of the accident while the third defects the dorsum of the hand. arrived 40 hours after partial total ear Material and Methods:5 distally based amputation and restore of the amputated reverse flow posterior interosseous flap flaps segment. The management of the cases and were performed for hand reconstruction final results are presented. between 2010 and 2015. Each patient Results: Satisfactory to excellent results were received a full surgical explanation and a achieved in the two cases presented written consent was obtained. All patients immediately after the injury. The final result were males. Their ages ranged from 35 to remains to be seen in the third case. 57 years old. The reconstructed areas Conclusions: Ear lacerations present a included the dorsum of hand 4 cases and the challenge for the reconstructive surgeon first web space in one case. Two of the cases because of the intricate anatomy and the were post electrical burn sequelae, two other visibility of the ear. Final results depend on road accidents and one of them gun related the degree of laceration, timing and type of injury. We measured in all of them the the primary care and the general status of the pedicle length, the artery diameter and the patients. as such education of the primary defect length. We decided to establish a one - care personnel is mandatory. year period of follow-up for all the patients to Keyword:Auricle injury, restore, Bardsley see the flaps conditions after time passing. and Mercer, plastic. Results:We had complete survival of the flap in four of the cases and only one partial survival. We had to deal with flap bulking in

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts one of the cases after six months. The patients Abstract satisfaction varied from 7 to 9 in a scale from Introduction: Burns are one of the common 5 to 10. injuries of childhood. Because of the potential Keywords: Reconstruction, soft tissue, hand. severity of their residual deformities, burn injuries in infants justify an early OP – 141 management in specialized centers when they cover more than 5% of body surface and in Indications of Lasers Treatment for every case when hands, face, or external Lymphatic Malformations genitalia are concerned. The risk of death from a major burn is associated with Vladimir FILAJ *, Gjergji BELBA increased burn size, decreased age, the presence of a full-thickness burn, the Authors Information: presence of inhalation injury. Service of Burns and Plastic Surgery” Material and Methods: The current article is Mother Theresa” of Tirana. ALBANIA a case report and will review the management Abstract. of ongoing effective treatment of the first The main therapeutic phase: the resuscitation. This article is e part optionsfor treating a lymphatic of a large study about the challenge of malformation are percutaneous drainage, treatment in the phase of burned shock with surgery,sclerotherapy, laser therapy, colloids and plasma for a good judgment of a radiofrequency ablation, or medical therapy. good resuscitation and in final of a good Cutaneous dermatologic lesions of lymphatic outcome. malformation, in type of superficial, Conclusions:Management of this age of translucent, localized or diffuse vesicles, are pediatric burn patients remains a difficult accessible to laser treatment. The useful challenge for clinicians from clinical, social lasers are essentially laser CO2, and rarely and ethical perspectives. General treatment pulsed dye laser and the Nd: YAG. includes fluid and electrolyte therapy, Treatment by laser allows to obtain the temperature control, appropriate nutrition and ablation of vesicles by limiting pain suppression. Pain suppression is a major aftereffects(scare) and so to dry up the part of the treatment and morphine must be transcutaneous lymphatic liquid. largely used. Chemical or electrical burn, However, laser has no action on the deep radiation, associated CO intoxication or constituent of the lymphatic malformation multiple trauma, as well as burn injury in and it’s why medium and long-term infants, raise specific problems. recurrences are inevitable. Keywords:Burns, burned shock, colloids, Finally, the indication of the laser must be resuscitation. retained only as a supplement to the surgery and has to be done by experimented persons. OP – 143 Keyword: lymphatic malformation, laser treatment. Inguinodinia in Young People

OP – 142 Kastriot HAXHIREXHA ¹*, Sadi BEXHETI ¹, Lutfi ZYLBEHARI ¹, XheladinELEZI ¹, Burns in Infants.Modern Trends Ferizat DIKA – HAXHIREXHA ¹, inManagement of Fluids During the Resuscitation. Authors Information: ¹Department of Surgery, Clinical Hospital – Albana ALEKSI1*, Adriatik LAJÇI2 Tetovo, RN of MACEDONIA. Authors Information: 1The Service of Burn and Plastic Surgery, UHC Abstract Tirana, ALBANIA Introduction: Groin pain syndrome usually 2 Resident of Surgery, University Clinical Center of describe the concern which is frequently Pristina, KOSOVO encountered among young people. This concern is characterized by onset of pain across the inguinal canal region and

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts sometimes is aggravated by physical activity. 3General Surgeon at Kukës Regional Hospital, Purpose is to represent our experience with ALBANIA the treatment of long-term inguinal pain in young people. Abstract Material and Methods:This is a Achalasia is characterized by impaired LES retrospective study in which we have relaxation and by the lack of peristalsis in the included eighty-nine young people aged distal esophagus it is accompanied by the loss between 12 and 18 years. All of them of myenteric ganglion of the distal esophagus. complained of long-term pain along the it is not yet known why myenteric plexuses inguinal region. degenerate. is supposed to be an autoimmune Results:All the patients included in this study process driven by a viral infection on a were treated because of chronic embarrassing genetically vulnerable subject. pain. In seventy of them the treatment was Heller myotomy achieves a significant conservative with administration of minor improvement in patient signs but 5-year analgesics of NSAID groups. In the seventeen barium surveillance shows relapse is not others we performed hernioplasty sometimes uncommon and goes up to 90% for the third followed by ilio- inguinal nerve neurolysis type. 69% of patients after surgery have at and resection of the genital branch of least one symptom after myotomy. The study genitofemoral nerve, whereas in two patients reviewed the literature for 2013 to 2019 and because of the size of the hernia the tension assessed the role of Redo Heller. Botox Poem free hernioplasty using a prolene mesh was and esophagectomy. There are few studies of the method of choice. Patients were reintervention after Heller myotomy in discharged from day one to five after the patients with achalasia. Therapeutic operation and no any serious postoperative Dilemma: What to Do After a Heller complications were observed. All the patients Myotomy? Balloon? Botox? , Poem? were discharged from the hospital two to four Esophagectomy? 69% of patients after days after operation and no one complained surgery have at least one symptom after of any other pain or distress. The patients myotomy. Reintervention in some studies were observed long-term after surgery over 5 years goes up to 62% for the first type, Conclusion:inguinodinia in young people 74% for the second type, and 87% for the may be a very distressful problem. In some third type. After reintervention the chances of patients the pain can be resolved reintervention are 50% for the next 2 years. conservatively with NSAID group analgesics, An annual barium survey is recommended. whereas in most of them hernioplasty Keywords:Achalasia, myotomy, balloon, sometimes combined with resection of the esophagotomy. genital branch of genitofemoral and ilioinguinal nerve (neurolysis) is the best OP – 145 treatment procedure. Keywords:young people, inguinodinia, The Surgical Treatment of Secondary hernioplasty, neurolysis Hepatic Metastases from Colorectal Carcinoma.

OP – 144 1* 2 Henri KOLANI ; Frenki VILA ; Eriol BRAHOLLI2; Eljona XHELILI3; Bledi Recurrent Achalasia 3 3 4 MASATI ; Asfloral HAXHIU ; Etmont CELIKU Ilir SHANI, Aldi SHANI2, Frenki VILA2, 3 Authors Information: Eljona XHELILI . 1General Surgeon, University Hospital Center “Mother Theresa” Tirana, ALBANIA Author Information: 2 Resident in General Surgery, University Hospital 1General Surgeon at Durrës Regional Hospital, Center “Mother Theresa”, Tirana, ALBANIA ALBANIA 3General Surgeon in University Hospital Center 2Resident in General Surgery at University “Mother Theresa”, Tirana, ALBANIA Hospital Center “Mother Theresa”, Tirana, 4General Surgery in University Hospital Center ALBANIA “Mother Theresa” Tirana, ALBANIA

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract General Surgery, Oncologic Surgery, Introduction:Colorectal cancer is the third Oncology Center, Istanbul, TURKEY most common cancer and the third leading cause of mortality among men and women in Abstract our country, and is represented by a vast Acute colonic obstruction is a number of cases diagnosed and treated in our medical/surgical emergency because of the clinic slightly second to gastric cancer. More potential for bowel ischemia, perforation, and than 50% of the patients with colorectal sepsis with peritonitis if not rapidly and cancer (CRC) have or will develop appropriately treated. There are numerous metastasis, with a quarter having distant causes of acute colonic obstruction, which metastatic disease at the time of diagnosis, must be differentiated from colonic pseudo- most frequently in the liver. obstruction, which also is considered a Liver metastasis is the leading cause of medical emergency. Management options cancer-related morbidity and mortality in include medical therapy, surgical therapy, colorectal cancer. The only potentially curative treatment for liver metastasis is liver endoscopic therapy, and interventional resection, but only 15% to 20% of the radiologic therapy. Self-expandable metal patients are suitable for surgical resection. stents (SEMS) have gained acceptance for Regardless the early diagnosis and the alleviating acute malignant colonic treatment strategy the survival rarely exceeds obstruction and in some situations for the 3-year period. preoperative relief of acute benign colonic Treatment: Surgical resection remains one obstruction. In this talk I will review the of the major curative treatment options approach to the patient who has acute colonic available to patients with colorectal liver obstruction. metastases. Surgery and chemotherapy form the backbone of the treatment in patients with OP – 147 colorectal liver metastases.This article provides an overview of the surgical Fasciitis necrotic, morbus Fournier is it a management of colorectal liver metastases. surgical emergency? Conclusions: According to the data from 1 1 retrospective and comparative studies the Astrit XHEMALI *, Arvit LLAZANI , 1 surgical resection remains the best choice of Myzafer KAÇI , A. MASKA, L. Laci, L. treatment followed by higher rates of BYLYKBABSHI survivability. Our experiences with cases Authors Information: operated with synchronous and metachronous Department of Surgery, University Hospital liver metastases secondary to colorectal Center “Mother Theresa” Albania cancer, shows an increase in survivability by 25 to 50%, and in the meantime, there is no Abstract positive data in the conservatory treated cases INTRODUCTION:The authors report their limited to chemiotherapy. experience in diagnosis and treatment of one Keywords: Hepatic metastases; Colorectal case of Fournier's gangrene; recent cancer; Surgical resection. international literature review. Complete clinical report. Diagnostic, clinical OP – 146 and prognostic indication, evaluation of effectiveness of surgical treatment Acute Colonıc Obstructıon (debridement and necrectomy) and follow- up; comparison between indications and multidisciplinary approach proposed by Sadık Yıldırım Özgeçmiş international literature. Surgical treatment previous multimodal Author Information: approach, according to international guide- lines. Fournier's gangrene is an uncommon 81 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts and aggressive synergistic fasciitis of the high level of tumor markers CEA 16.3 ng/ml perineum and genital organs, which may and Ca 19/9 77 U/ml. Abdominal computed bring the patient to death; it is a true surgical tomography showed the presence of a large emergency.The disease can no longer be mass in the cecum which adhered to a portion considered to be idiopathic; in most cases a of the small intestine and extending to the urologic, colorectal or cutaneous source abdominal wall. Laparotomy through the canbe identified. Despite antibiotics and inferior midline incision was undertaken and aggressive debridement, the mortality rate a large malignant cecal mass adherent to the remains high, particularly in the elderly, in terminal ileum was found. The tumor also patients with renal failure, and in patients affected the abdominal wall in the RLQ with extensive disease. region. A right hemicolectomy and resection The presentation is highly variable, of terminal ileum was performed including a necessitating a high index of suspicion. High small portion of the abdominal wall infiltrated risk patients include diabetics, alcoholics and by tumor mass. Ileostomy with abdominal debilitated and immunosuppressed wall reconstruction was successfully individuals. Broad spectrum antibiotics and performed and the patient had a satisfactory aggressive debridement remain the hallmarks recovery. After the recovery the patient of treatment. The surgical operation has to be continued treatment at the oncology clinic performed in emergency to avoid a rapid Conclusion:locally advanced colon cancer spread of tissue necrosis and a possible presents a real challenge for the surgeon, development towards septic shock. whereas a multimodal approach is a necessary Keywords:Fournier's gangrene, condition to improve the patient's condition debridement, anaerobic, surgical emergency. and survival.

OP – 148 OP – 149

Unusual Abdominal Wall Abscess as a Serious Postoperative Complication after Consequence of Cecal Adenocarcinoma. A Anterior Intrapelvic Approach on the case reports. Treatment of Pelvic and Acetabular Fractures Kastriot HAXHIREXHA ¹*, Sadi BEXHETI ¹, Lutfi ZYLBEHARI ¹, Ferizat DIKA – 1 1 HAXHIREXHA ¹, Aulona HAXHIREXHA¹ Ilir HASANI , Rezeart DALIPI , Igor 1 1 KAFTANDZIEV , Neda TRAJKOVSKA , 1 1 Authors Information: Simon TRPESKI , Aleksandar SAVESKI , 1 1 ¹Department of Surgery, Clinical Hospital – Oliver ARSOVSKI , Marko SPASOV , Anila 1 1 Tetovo, RN of MACEDONIA. RACAJ , Jordan SAVESKI .

Abstract Introduction: In old people the right lower Authors Information: abdominal pain must be suspected for right 1 colonic and cecal tumor especially if the University Clinic for TOARILUC - Skopje, anamnestic data point to other complications Republic of North MACEDONIA such as anemia, weight loss and duration of illness for several months. In very rare cases Abstract this form of cancer can be complicated by Introduction:Anterior Intrapelvic Approach abdominal parietal abscess and a presence of has been promoted as new and alternative enterocutaneous fistula. approach on treating the fractures of the Case Presentation:65 years old women acetabulum. The intrapelvic approach was presented in our department with severe right originally described by Hirvensalo in the quadrant pain. On examinationa large tender early 90ies and a further comparable warm mass in the RLQ regions sized about 15 description was published shortly thereafter x 15 cm draining purulent discharge was by Cole. Since then, various modifications detected. Laboratory analysis revealed the have been described. Whereas the ilioinguinal WBC 14600 Hemoglobin level 5.5 g/dl and approach was used until then to treat

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts acetabular fractures with relevant anterior approaches, except post-operative column involvement from an extra pelvic complications. view, the intra pelvic approach was Keywords: Anterior intrapelvic approach, developed to address the often-accompanied acetabular fractures. central hip dislocation in these fracture types with relevant fractures of the quadrilateral OP – 150 surface. Since we have started to use this approach, we have never used nomore the Transfer of Trochanter Major Bone Flap B B classical Letournells approach on the for Treatment of Stage II -III of Femoral treatment of acetabular fracture, eventually Head Osteonecrosis. the anterior pelvic ring fractures. With this 1* 2 approach a completely different view to the Ervin JONUZI , Dmitry ILYIN antero-medial acetabular pathology was Author Information: possible. This approach has its specifics, on 1 the fixation technique, instruments, implants, Ortopedic Surgeon, Trauma and Orthopedic but also the intraoperative riscs and Department, German Medical Policlinic, Tirana, ALBANIA. complications. 2 Ortopedic Surgeon, ECSTO Clinic, Moscow, Мaterials and Methods: Consecutive group RUSSIA. of 27 patients were treated by using the AIP approach in the period between Abstract December 2017 and May 2019.The surgeries Introduction:Femoral head osteonecrosis or of patients were performed at the University Avascular Necrosis is a condition caused by a Clinic for Traumatology – Skopje. Fracture compromise of the blood supply as a result reduction and treatment outcomes were characterized by the death of osteocytes and assessed by clinical and radiological bone marrow. examination. In our experience, there was no Osteonecrosis of the femoral head (ONFH) intra operative complication, only 2 patients usually affects young adults in the third and had postoperative complication. fourth decades of life. There has been an Results: We present two serious increasing trend in its diagnosis and treatment postoperative complications in the group of in latest years in Albania. Every year about 27 patients with acetabular fractures. No 15,000 - 18,000 new cases are diagnosed in complication occurred intraoperatively. One the . According to the literature, of the complications was damaged of small about 5%-12% of hip arthroplasties are intestine during wound closure, on an old performed for the treatment of this condition patient with unstable pelvic fracture. Three every year. It starts with one femoral head weeks after surgery appeared feces in the being affected first; bilateral involvement wound. After sutured the wall of small occurs in two years in 72% of cases. intestine, washed and sutured the wound, the The goal of a vascularized bone flap transfer patient was stable. Second postoperatively is to replace the necrotic bone of the femoral complication is an undisciplined psychiatric head, restore the blood supply, and provide patient, pelvic fracture C type, with polyuria new bone and mechanical support for the (cca 30 l/per day), due to failure of the femoral head. osteosynthesis material, the plate has late Results:We are using the anterolateral postoperatively damaged the urinary bladder approach to the hip. The incision is made 30- with derivation massive amount of urine in 50 mm. The interval between the rectus the wound. The plate has been removed, femoris and vastus lateralis is split and the urinary vesicle sutured, catheterization and transverse branch of the lateral femoral cystostomy were performed. circumflex artery is identified. Carefully the Conclusion: The AIP approach seems to be pedicle is isolated and protected. The safe method of treating acetabular fractures vascularized bone flap is harvested from the that allows good visual access and allows greater trochanter. Necrotic bone is debrided excellent fracture reduction. Our preliminary through a bone window made at the junction results revealed a much lower incidence of of the femoral neck and head. The cancellous complications during surgery than traditional bone from the greater trochanter is implanted,

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts and the vascularized bone flap is positioned Results: Dash (Disabilities of the Arm, and fixed. Patients are partial weight bearing Shoulder and Hand) and VAS (Visual for 6 weeks. Full weight-bearing is allowed Analogue Scale) scores were evaluated after 3 months postoperatively. preoperatively and postoperatively. The Conclusion:Patients with symptomatic ON DASH questionnaire was used as an indicator with small lesions should be treated with of the impact of an impairment on the level head-sparing procedures. Patients with large and type of disability. lesions in pre-collapse hips should be treated Conclusions: The technique proved to be with head-sparing procedures if the patients effective in treating acute AC dislocations are young or have THA in older patients. For (Rockwood type III or IV) with a high degree patients with a collapsed femoral head, THA of excellent and good functional results. is the recommended option. Keywords:Dislocation, acromioclavivular, Keyword:Femoral head, osteonecrosis, injury, technique. avascular necrosis. OP – 152 OP – 151 Prediction of the Fractured Femur by using Surgical Treatment of Acromioclavicular Quantitative Gait Analysis Dislocation Grade III or IV with thigh Rope System, a retrospective study on the Clinic of Kenan BAYRAKCI1, Onder M. Traumatology-Skopje in the period of 2015 DELIALIOGLU1, Ledian FEZOLLARI2 to 2018. 1 1 Authors Information: Valentin VEJSELI , M. ILIE MD , S. 1 KRSTEVSKI1, Ilir HASANI1, Igor Orthopedic Services, American Hospital, KAFTANDZIEV1 Tirana, ALBANIA. 2Department of Orthopedic, University Authors Information: Hospital of Trauma Tirana, ALBANIA. University Clinic of Traumatology, Medical

Faculty, Skopje, MACEDONIA Abstract Abstract INTRODUCTION: Femoral shaft fractures Introduction: Acromioclavicular (AC) during childhood cause femoral torsion dislocation is a common injury with incidence abnormalities and significant deviations of of 3 to 4 per 100 000 in the general gait characteristics. Majority of the survivors population. It is more common in younger achieve an independent ambulation by the athletic patients. In 1984, Rockwood help of various compensations. However, modified Tossy et al and Allman there is no study investigating the primary classification to include types IV, V, and VI gait deviations causing these compensations. and we use that classification. The aim of our Our premise was that the parameters used in study is to evaluate surgical treatment of AC compensation can be the predictors of the dislocation grade III or IV with Tight Rope fractured femur. system and functional results. Materials and Methods: We examined both Materials and Methods: On the Clinic of femora of fifteen children admitted to our Traumatology, Skopje in the period of 2015 hospital for unilateral femoral fracture in to 2018 year were treated 32 patients with twelve, and bilateral in three. Eight were male type III (14 patients) or IV AC dislocation (18 and seven were female. The average age was patients) with female to male ratio 0.45 9.56 years (5-15 years). We treated five of (f:m=10:22). Inclusion criteria were applied eighteen fractured femora by open reduction to all patients. Three radiographic views were and plate-screw, eight by closed reduction used: AP view, true axillary view and stress and retrograde titanium elastic nail and five view of both sides of the AC joint and CC with spica cast. They were followed up with ligament. Surgical technique for thight rope an average period of 22.94 months (9-48 technique was performed. months). At the final assessment we evaluated each patient with computerized

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts tomography, radiographies and quantitative the radius head with or without an ulnar gait analysis. Kinematics and kinetics fracture, treated at our clinic. parameters were collected for the both Material and Methods: In this study, we femora. used cases treated from2009-2014, 9 patients Results: Logistic regression analysis showed that fractured femora could be predicted with with this condition were treated on the a correctness of estimation of 86.7 % University Clinic of Pediatric Surgery in (p=0.006). The model used 3 parameters out Skopje, Macedonia. Operative procedure of 16 (foot and hip abduction moment, pelvic contains open reposition of the dislocated excursion in coronal). Sensitivity and radial head with ulnar osteotomy and annular specificity of prediction was found to be ligament reconstruction. 4 weeks nearly equivalent. immobilization is indicated after the surgical Discussion: This study showed that the fractured femora can be estimated using gait treatment in order to achieve neutral rotation. analysis parameters. Uncorrected femoral RESULTS: During the 24 months follow up torsion and angulation effect gait parameters period, clinical and radiological but there are upward and downward investigations were performed. Good radial compensation mechanisms to restore the head position was noticed in 7 patients and significant deviations of gait characteristics. anterior subluxation in 2 patients. Full flexion One of the compensation mechanisms of the and extension elbow movement were detected excessive femoral torsion is open kinetic chain pronation and so foot abduction power in 6 patients in our study, the pronation and is the most predictive value of the femoral supination were acceptable and valgus torsion. Pelvic excursion is the main upward position was corrected. compensation mechanism and so it is in the Conclusion: After the evaluation of the model. Changes in hip abduction moment is presented cases, we can conclude that the the result of femoral ante torsion’s effect on open reduction and corrective ulnar the lever arm dysfunction. osteotomy, fixed with the plate, shows good OP – 153 results in the overlooked antero-lateral luxation of the head of the radius with or Treatment of Antero Lateral Head without ulnar fracture in children. Dislocation Associated with Monteggia Fracture OP – 154

Lazar TODOROVIC1*, Marjan.KAMILOSKI1, Surgical Treatment of Orthopedic Shoulder Slavica SHUPERLISKA1, Anila RACAJ1, Ljubica Pathologies under Arthroscopic Route MIKJUNOVIKJ2, Natalija COKLESKA1, Zllato ALEKSOVSKI1 Viktor MARKU1

Authors Information: Authors Information 1University Clinic of Pediatric surgery, Skopje, 1Orthopeadic Surgeon, University Hospital of RN of MACEDONIA 2University Clinic of Anesthesiology and intensive Trauma, Tirana, Albania. care, Skopje, RN of MACEDONIA Abstract Abstract Introduction:The majority of shoulder pain problems involve the muscle, ligament, Introduction: Treatment of chronic radial cartilage and tendons. In particular, athletes head dislocation is still controversial. Radial and skilled workers are especially head open reposition combined with ulnar susceptibile to issues involving shoulder osteotomy and correction is the best solution blade pain or shoulder joint pain. Because of in these cases. repetitive, intensive routines, shoulder pain The aim of our study is to show the patients can develop over time. This way, the patients with overlooked antero-lateral dislocation of

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts expect a short recovery in time from surgical weaker abdominal muscles, and a less treatment. ossified thoracic cage. While there are strong Materials and Methods: This study included trends toward non-operative management of 64 patients from 2015 to 2019 aged 20 to 74 blunt renal trauma, there are no explicit years who were all undergoing surgical guidelines for high grade injuries.3-5 Organ treatment for calcified subacromial bursa, preservation in children is always a primary impingement syndrome, tendon rupture, goal with solid organ injury. tenopathy and of scapulohumeral resection of Material and Methods: All patients under biceps, all in arthroscopic route. In this study the age of 18 who were admitted to Clinic for group, the operative time, hospital stay, Pediatric surgery in Sarajevo with a diagnosis rehabilitation and recovery period were of renal trauma were retrospectively monitored. reviewed. Echo and CT were used to identify Results: patients with a renal injury. The time period - Operator time of 40 min for pathologies examined was between January 1, 1999- only with calcifications of subacromial bursa 2019. Inclusion criteria were either a and up to 1 hour 50 min of scapulo humeral diagnosis of renal trauma or a diagnosis of luxation. blunt abdominal trauma and hematuria. -58 cases with one day hospital stay,6 cases Exclusion criterion was death due to an with two days hospital stay. additional traumatic injury. - The beginning of rehabilitation in the days Result:Demographics include male to female before post-operative and in the second week ratio of 13:6 and the average age of patients for rotator cuff and that of scapulo-humeral was 11.9 + 4.6 years. Of the nineteen patients luxation with the onset of limited passive who underwent review, eleven (57,89%) movements. children presented with a grade III renal - Rapid recovery from the first weeks to the injury, and eight (42,11%) with a grade IV 3rd month for rotary cuff and that of scapulo injury. Six patients presented with gross humeral luxation. hematuria and 3 with microscopic hematuria. Conclusions: Arthroscopic minimally Only four patients (22%) required blood invasive surgical technique helps us to transfusions, with the average hematocrit quickly heal patients and reduce hospital nadir being 31 + 5.3% (24.8-37.8). One of the costs in short duration hospital stay. two patients transfused had a concomitant Keywords:Shoulder, pathologies, surgical grade IV splenic laceration with a hematocrit treatment. nadir of 24.8% and clinical symptoms consistent with shock. OP – 155 Conclusions: The specificity of the child's anatomy is an aggravating prognostic factor Pediatric Blunt Renal Trauma: A Single (the kidney is larger in relation to the body Institution 20 Years’ Experience cavity than in adults, less protected against the ribs, the muscles of the body and the Kenan KARAVDIĆ lower abdomen, the less developed peritoneal and retroperitoneal fatty tissue). Author Information: It is recommended to initiate conservative Clinic for Pediatric Surgery, Clinic Center of treatment (leaching, infusion solution, University Sarajevo, BOSNIE HERZEGOVINA monitoring) and possibly delayed surgical treatment Abstract Indications for early surgically treatment are Introduction:Kidney is the most common site reserved only for patients with bleeding of genitourinary trauma. 50% of all urinary (absolute) and extravasation (relative) injuries is kidney and is also affected in 8- If it is necessary surgical treatment sould be 12% of all blunt and penetrating trauma to maximally preserve kidney tissue abdomen. 80-90% of renal injury is caused by Keywords: Kidney, pediatric, blunt, trauma blunt injury GY. Children, when compared to adults, are at a higher risk of renal injury from blunt trauma due to a variety of anatomic factors including decreased perirenal fat,

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

OP – 156 and achived to do a successful self- intermittent catheterisation Application of the Monti Procedure in Adult Conclusion:The Monti tunel is a valid option Continent Cutaneous Urinary Diversion. for continent intermittent catheterisation. Is

an alternative to Mitrofanoff procedure. We GezimGALIQI,2, *, Artan KONI2, Bledar used it when the appendix was not SHEGA1, Albert PESHA3 Luan BAJRI4 appropriated to use as a tunel or when it is missing. It has a good continent percentage. Authors Information: Of course, ours is a small serie of cases to 1 Urology Service, Regional Hospital of Shkodra, represent more important conclusions ALBANIA. Keywords: Monti Procedure, Urinary 2Urology Service, American Hospital of Tirana, Diversion, urethral stricture, vesico-vaginal ALBANIA. fistula. 3Urology Service, Regional Hospital of Fieri, ALBANIA 4Anesthesi Service, Regional Hospital of OP – 157

Shkodra, ALBANIA. Influence of Drugs on Urological Diseases

Abstract Gjergji SEMINI1, Rustem CELAMI2 Introduction:Monti and co. described in 1997 a continent catheterize conduit using Authors Information: 1 short segments of the ileum (1). The use of University of Ioannina, University Hospital of this technique allows to obtain 2 to 2.5 cm Ioannina, GREECE 2 Professor at University of Aldent, American segment of the ileum to achieve a tabularized Hospital of Tirana, ALBANIA segment of 7-8 cm. The caliber of such a tube allows catheterization with a 16F to 18F Abstract catheter, and the mucosal folds of the ileum Introduction: Induced urological symptoms are aligned with its longitudinal axis. as side effects of prescribed treatment for various diseases. Materials and Methods:From 2007 to 2019 Materials and Methods: A systematic we treated 5 patient with different condition search of the PubMed of numerous articles. with these procedure .First case was a middle Results:Antihypertensive drugs, age women with a big vesico-vaginal fistula predominantly alpha blockers, result in stress unappropriated to close the fistula Second incontinence, while selective serotonin case a posterior urethral stricture due to reuptake inhibitors – SSRI, may cause urge pelvic fracture in a 60 years old patient incontinence. Commonly used combination of calcium and vitamin D supplementation for unwilling to redo a urethroplasty after the prevention of osteoporosis may be an failed first attempt Two cases of primary underdiagnosed cause of renal calculi. Drug- urethral tumors in womens where excision of induced sexual dysfunction is a frequent side urethra was performed with subsequent effect of antihypertensive treatment, urethroplasty. The fifth one was a 20 years particularly with beta adrenoceptor blockers boy with spina bifida where an augmentation and diuretics. The SSRI and some neuroleptics can also impair sexual function. bladder procedure (2) was performed with a Mesalazine for ulcerative colitis, urinary continent Monti diversion. The subsequently presented recurrent renal colic patient were monitories for several years. due to mesalazine urinary stones. Drug- Results: The continence rate of our patient induced nephrolithiasis is a rare condition in was good in all of them during day time and children. Drug-induced calculi represent 1- night time. All the patient where continent 2% of all renal calculi. Conclusions: Adverse influence of drug reactions may be hard to forecast and link to

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts specific drugs and symptoms. Urological Conclusions: ESWL and URS are highly illnesses can be caused by drugs, and a effective in treatment of proximal ureteral careful drug history, and drug interaction stones less than 1,5cm. ESWL is safer and filter together with timeline of symptoms will less invasive but URS is more effective help to minimize such side effects. especially in distal ureteralstones and has a KEYWORDS: Drugs, symptoms, side lower retreatment rate. effects, urological, diseases. Keywords: Shock wave lithotripsy, semirigid ureteroscopy, ureteral calculi. OP – 158 OP – 159 Shock Wave Lithotripsy Versus Semirigid Ureteroscopy for Proximal and Distal A Review of Dietary Treatment in Patients Ureteral Calculi less than 1,5 cm with Renal Stone.

Rezart XHANI1, MustafaXHANI 1, Gjergji SEMINI1 Rustem CELAMI2 RudinDOMI1, Erion DREDHA1

Author Information: Authors Information: Department of Urology, University Hospital 1 University of Ioannina, University Hospital “Mother Teresa”, Tirana, ALBANIA of Ioannina, GREECE 2 Professor at University of Aldent, American Abstract Hospital of Tirana, ALBANIA Introduction: We compare the efficacy of shock wave lithotripsy and ureteroscopy as Abstract well as complications related to these BACKGROUND; The aim of this study was procedures. to review the studies reporting the effects of Materials and Methods: This is a different dietary on urinary stones. prospective randomized study comparing two Materials and Methods:A systematic search groups of patients with a single radiopaque of the Pubmed for studies, (2010 – 2015), on upper or distal ureteral stone less than 1,5 cm dietary treatment of urinary risk factors for treated by ESWL and ureteroscopy between urinary stone formation was conducted January 2014 – January 2018. ESWL was according to a methodology developed a performed as an outpatient procedure using priori. Studies were screened by titles and the electromagnetic lithotripter (Dornier abstracts for eligibility. Lithotripter S and Storz Modulith_SLX_F2 Results:It remains a state of fact that diet has lithotripter). Ureteroscopy was performed a tremendous effect in urinary stone using an 8,5F semirigid ureteroscope. formation, and calcium stones persist to be Intracoporeal lithotripsy with pneumatic or the most common ones, followed by acid uric electro-hydraulic stones. However, according to recent studies: energy was used when needed. An analysis in hypercalciuria; dietary calcium restriction was performed using four parameters (sex, is not recommended for stone formers with stone size, degree of hydronephrosis and nephrolithiasis. moderate dietary salt urinary infection). The success rates, restriction and a low-normal protein intake is complications, retreatment rates and auxiliary useful in limiting urinary calcium excretion procedures were compared for each and thus may be helpful for primary and group. secondary prevention of nephrolithiasis. Results: A total of 327 patient were treated Omega-3 fatty acids and bran of different for upper and distal ureteral stones . The origin maybe help but the impact is uncertain. success rates were 73,7 % for ESWL and 88, In hyperoxaluria: a diet low in oxalate and/or 4 % for ureteroscopy. The complication rate a calcium intake normal to high (800-1200 was higher in the ureteroscopy group (16 %) mg/day for adults) reduce the urinary than in the ESWL group (5 %). The excretion of oxalate, conversely a diet rich in retreatment rate was higher in the ESWL oxalates and/or a diet low in calcium increase group (57 %) than the URS group (3 %). urinary oxalate.

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Conclusions:General measures: Each patient a period of one year. Materials obtained for with nephrolithiasis should is the forced Biopsy were examined under light increase in fluid intake to achieve a daily microscopy for final evaluation and diagnosis. All PSA values were recorded for urine output of 2 liters. all patients before the procedure was initiated. In children: Moderate dietary salt restriction Statistical analysis was done using tables and implementation of potassium intake are containing data distribution in different useful in limiting urinary calcium excretion. formats and arithmetic mean ... A balanced consumption of fruit and Results:About 59% of the subjects studied vegetables and a low consumption of were in the 55-70 age group. maximal PSA chocolate and cola according to general value ranging from 0 to 7 ng / ml benign prostatic hyperplasia was the predominant nutritional guidelines. lesion (58.75%) in the study population, In elderly: A restriction of sodium intake in while P <0.01 indicating a positive association with a higher intake of potassium, association between levels in increased PSA magnesium and citrate is advisable in order to and chances of adenocarcinoma, results were reduce urinary risk factors for stone formation statistically significant. but also to prevent the loss of bone mass and Conclusion:The results showed that the the incidence of hypertension. chances of finding prostate malignancy are in direct proportion to the trend of increasing

PSA values, but not always a rule, but it Keywords:Diet, fluid intake, stone, urinary makes the histopathologic assessment very system. detailed.

Keywords:Benign prostatic hyperplasia, OP – 160 prostate, prostate specific antigen.

Correlation between Prostate Specific OP – 161 Antigen and Prostate Biopsy

Congenital Injuries Amniotic Band Herion DREDHA SINDROM

Author Information: Arben LLOJA 1 Department of Urology, University Hospital Center “Mother Theresa” Tirana, ALBANIA Author Information: University Hospital Center “Mother Abstract Theresa“ Tirana, ALBANIA. Introduction:Prostate specific antigen (PSA) is a protein produced by prostate gland cells. Abstract PSA is increased in diseases such as prostatitis, hyperplasia and malignancy. Focal ring constrictions of the extremiteties The correlation between different pathologies and atual loss a digit or limb are rare affecting the prostate gland and their complication. Their gebesis is debated. corresponding elevation in PSA values is not Strecer (1930) and others since, maintain that constant, and exceptions may occur. localized failure of germ plasm usually is The purpose of this study is to identify the responsible for the abnormalities. Torpin range and distribution of different prostate lesions affecting men, their association with (1968) and others contend that the lesions are age and evaluation of the association between the consequence of early rupture of the total serum PSA and histological findings. amnion which ten forms adherent tochs bands Materials and Methods:This study included that costrict and at times actually ampute an a total of eighty specimens (both transurethral exteremity of the fetus. Occasionally, the resection of the prostate and prostate biopsy) amputated part may be found within the taken at the histopathology laboratory, in the urology service of the University Hospital uterus. Center “Mother Theresa” Tirana, Albania, for

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Congenital POSTURAL DEFORMITIS: modalities may affect clinical outcomes.In Mechanical factors arsing from chromically this sistematic review, we highlighted the low volumes of amniotic fluid imposed by magnitude of the problem .Efforts must be directed to improving recognition of at-risk the small size and inappropriate of deformity, patients, development of preventative including talipes or clubfoot, scoliosiss, and strategies,and surveillance of long-term hip dislocation. Hipoplastic lung also can clinical consequences. results from oligohydramnios. Keywords:Acute kidney injury , major trauma , treatment , mortality.

OP – 162 OP – 163 Acute Kidney Injury After Major Trauma: A Sistematic Review Post-Traumatic Renovascular Hypertension

Matilda IMERAJ Lutfi ZYLBEARI1, Ferizate HAXHIREXHA- DIKA, Sadi BEXHETI, Aulona HAXHIREXHA, 2 Zamira BEXHETI, Kastriot HAXHIREXHA Authors Information: Authors Information: Department of Nephrology, UHC "Mother ¹State University of Tetova, RN of MACEDONIA ¹Department of Surgery, Clinical Hospital – Theresa" Tirana , ALBANIA Tetova, RN of MACEDONIA. Abstract Abstract Introduction: There is documented evidence Acute kidney injury is a frequent that after renal trauma (open or closed) after a complication following major trauma, it is different period of time we have arterial accompanied by a high mortality rate and hypertension manifestations with renal survivors are at increased risk for chronic vascular hypertension (HTARV) that is kidney disease and late death .In published similar to that of Goldblatti who discovered researches ,the incidence of post-traumatic in 1934 during autopsy of patients who acute kidney injury (AKI) is at a range that suffered from HTA as a result of renal artery varies widely from 0.1 to 8.4% . The causes stenosis. of post-traumatic acute kidney injury (AKI) To verify his hypothesis, he artificially are multifactorial. The shock associated with occluded the renal artery in dogs to reduce major trauma may result in inadequate renal blood perfusion (apparently caused by perfusion, rhabdomyolysis, direct kidney hypoperfusion and ischemia) during which blunt or penetrating trauma,sepsis , the experiment began to increase the blood hypothermia, abdominal compartment pressure in the dog as a result of increased syndrome, or exposure to nephrotoxins such hypoperfusion. renal hypertension causing as contrast material vasoconstriction and increased arterial andantimicrobials. Demographic patient pressure. In most cases, the mechanisms of characteristics such as male gender, older renal hypertension are manifested as a result age,preexisting CKD, higher incidence rates of traumatic perirenal hematoma, of pre-existing comorbidities (hypertension, intracapsular hematoma with renal artery cardiovascular disease, diabetes, chronic injury and renal parenchyma causing obstructive pulmonary disease, metastatic hypoperfusion and renal hypertension and cancer, hypoalbuminemia) use of (ACEI) or renal hypertension. ARB have been implicated as predisposing to Injury treatment was conservative (grade I- AKI . III, and surgically-grade IV-V according to Numerous strategies and techniques have the American Society for Surgery and been used from time to time for prevention of Trauma, 1989 renal injury classification) and acute renal during major trauma. Dialysis is HTA reversal in normal condition are proofs initiated for the usual indications, including of the concept of HTARV. volume overload, hyperkalemia, severe The purpose of the study: was to verify the acidemia, and uremia, but it is possible that increase in arterial pressure (unusual and rare variations in the timing of initiation,

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts cases of possible port) as a result of traumatic Abstract kidney injury. Introduction:COPD is the fourth leading Material and Methods: As a retrospective cause of death worldwide. Exacerbation study material, a database of admissions to episodes are a hallmark of this disease. COPD the Surgery and Intern ward was used as a exacerbation is characterized by a change in retrospective study over a two-year period, the patient’s baseline dyspnea, cough, and/or identifying 10 patients, of whom 6 were sputum beyond day-to-day variability males and 4 females with identical mean ages sufficient to lead to a change in medication. of 24.00 ± 6.00 years as a result of traffic Infectious causes (bacteria, viruses, and trauma. Diagnosis of renal trauma is atypical pathogens) and non-infectious causes performed by screening: urine, imaging (environmental exposure and poor methods, glomerular filtration rate with the compliance with medications) have been Tn99 DTPA and formula to the Cocrroft & described. GOLD recommend antibiotics for Gault formula; ultrasound, computed the treatment of exacerbations. tomography, intravenous pyelography; COPD exacerbation and Systemic and airway Angiography. inflammation play roles in the pathogenesis Results:Of the total number (10 patients), 3 of COPD exacerbation. We hypothesized patients had grade IV-V injuries and were whether increased serum inflammatory surgically treated 1 with nephrectomy and 2 biomarkers are associated with the clinical days of revascularization) while 7 had grade outcomes of COPD exacerbation caused by I- kidney injury. III and were treated different infectious pathogens. conservatively. All patients treated surgically Materials and Methods: COPD patients had an immediate decrease in their with exacerbation were recruited from a hypertension. All patients had HTA observed Clinical Hospital in Tetovo internal- after a 2-week pre-treatment period until 7-8 department during januari juli–2019. C- months. After treatment, their condition was reactive protein (CRP) were measured. reabsorbed and arterial pressure normalized Dyspnea, eosinopenia, consolidation, to normal values. Only 3 patients showed the acidemia, and atrial fibrillation score was need for antihypertensive treatment with ACE calculated for predicting mortality. Multiplex inhibitors within two years which showed polymerase chain reaction was carried out for high positive effects and arterial pressure respiratory viral assay from nasopharyngeal normalized to normal values. swabs, and sputum bacterial culture was also Conclusion: Due to the serious complications performed, length of hospital stay were of arterial hypertension after major renal evaluated, and serum biomarkers were trauma we prefer that it should be evaluated examined. with a very serious approach and Results: A total of 51 COPD patients were management as soon as possible by enrolled. These patients were classified as determining the degree of injury and (GOLD) stage 2, 3, and 4 in 13.2%, 8.6%, according to the method of treatment and 78.2% of cases, respectively. Isolated (conservative or surgical). bacterial exacerbation was recovered in Keywords: Renal trauma, renovascular 30.6% of exacerbation episodes: Klebsiella hypertension. pneumoniae was the most commonly identified bacteria. Viral pathogens and OP – 164 coinfections were noted in 9.6% and 16.1% of exacerbated patients, respectively. Circulating Inflammatory Biomarkers and Influenza was the most commonly detected Clinical Outcomes in COPD Caused by viral pathogen. Serum biomarkers and Biological Pathogens. (Dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation) score for Ruzhdi REXHEPI viruses, bacteria, coinfection, and noninfectious causes of exacerbations were Author Information: similar. Neither (Dyspnea, eosinopenia, Clinical Hospital in Tetovo-Internal Disease, consolidation, acidemia, and atrial Tetovo, RN of MACEDONIA fibrillation) score nor serum biomarkers were able to differentiate patients with and without

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts mortality. Increased serum CRP was noted in screening examination was undertaken in all patients with LOS ≥7 days when compared patients. It can detect with great accuracy the with those with LOS <7 days (0.38 ng/mL vs kidneys hematomas and can give us accurate 0.1 ng/mL; P=0.035). information on whether CT should be Conclusion: CRP and (Dyspnea, performed. The initial management of all eosinopenia, consolidation, acidemia, and patients involve basic resuscitation and atrial fibrillation) score play limited roles in dynamic monitoring of patients' general predicting clinical outcome and lack an condition. association with causes of exacerbation. Results: from fifty for patients included in Keywords: biomarkers, inflammation, this study 35 of them was male and 19 viruses, bacteria, COPD exacerbation. females with an average age of 38.6 years. The most common cause of acute renal injury OP – 165 were traffic accidents in 39 patients, then lesions due to physical attacks in 7 patients, Diagnosis and Treatment of Kidney Injuries fall from great heights in 6 of them and accidental injuries in sports in two cases. Lutfi ZYLBEARI, Sadi BEXHETI, Kastriot After admission in our department laboratory HAXHIREXHA, Sihana AHMETI-LIKA,Aulona investigation (urine and blood count) as well HAXHIREXHA, Zamira BEXHETI as abdominal ultrasound was done in all patients. Abdominal CT was performed in 28 Authors Information: patients due to suspicions of more serious Medical Faculty – University of Tetova, Clinical injuries. According to the data from Hospital –Tetova, PHO “VITA”–Tetove, ultrasonography and CT and based on the MACEDONIA classification of AAST scale in 34 patients

the injury was classified as mild (grade I), in Abstract 18 others as a grade II, while only in two of Introduction: Kidneys trauma represents them as a grade III. All the patients were about 1 to 10 % of all intraabdominal injuries. treated conservatively which includes It is estimated that more than one third of supportive care with bed-rest and observation patients with polytrauma they also have renal along with carefully followed up of patients lesions. The most common causes of this until macro haematuria resolves. lesions are blunt injuries such as road traffic Conclusion: Recovery of traumatic kidney accident, powerful strokes in the lumbar injury requires time and good monitoring of region, fall from great heights, contact sports the patients until their full recovery, which etc., while penetrating trauma of the kidneys can last from 2 to 6 weeks. represent only a small percentage of this Keywords:trauma, kidney injury, injuries. In most cases kidney trauma is conservatively. harmless and can be treated conservatively, so the patients do not require surgical OP – 166 intervention. However, in cases of major injuries, or in the case of pre-damaged Exercise Induced Rhabdomyolysis with kidneys a more serious treatment should be Acute Kidney Failure. A Case Report taken. One of the most characteristic signs of kidney damage is the presence of blood in the Vilma CADRI urine, whether as micro or macroscopic haematuria. Authors Information: Material and Methods: in a period between Department of Nephrology, UHC "Mother January 2016 - 2019 fifty for patients have Theresa " Tirana, ALBANIA been treated at our clinic because of mild renal trauma-grade I to III according to the Abstract AAST. After admission in our department a Introduction: Rhabdomyolysis is a clinical urine sample was taken from each patient for syndrome caused by damage to skeletal investigation of micro or macro haematuria. muscle fibers with disruption and release of At the same time a complete blood count was their contents into the circulation. done. Ultrasound as a useful and accurate

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Its etiology can be highly varied. Exercise General Hospital –Debar, RN of induced rhabdomyolysis is an uncommon MACEDONIA cause of severe rhabdomyolysis and a very rare cause of acute kidney failure. We report Abstract a case of acute kidney failure following heavy Introduction: Bronchiolitis is an acute exercise during exposure under extreme disease of the lower respiratory tract temperatures of 42°C in a healthy young characterized by obstruction of small airways. adult. Usually It is provoked by infection of the Case report, a 26 years old boy was admitted respiratory tract from some viruses whereas at Nephrology department due to acute the most common is respiratory syncytial kidney failure. He had a three-day history of virus (RSV). In the treatment of this myalgia, weakness and dark color urine. condition, are used various drugs such as β2 During last 36 hours showed anuria. agonists and nebulised adrenaline. A day before his complaints, he referred Material and Methods: Forty-five children stenous exercise (raising bags of 50kg) under aged between one to teen yearswith first temperature of 42°C the hole day. He attacks of acute bronchiolitis were included in suffered from headaches for a year that he this study. All the patients were treated in our treated with ibuprofen 400 mg one tablet e institution in a period between January 2017- week. 2019. After admission and detailed At the time of presentation, he had urea examination by the paediatrician fifteen 94mg/dl, creatinine 9.8 mg/dl, ck 3085U/l, children were treated with the mixture of potassium The initial treatment consisted of salbutamol 0.15 mg/kg (max. 5.00 mg) fluid replacement and forced diuresis. whereas thirty other children with adrenaline Patient received daily sessions of dialysis for (0.1ml/kg/dose in 1;10,000) in 3 ml saline the first ten days and then three times a week solution, administered via nebuliser. for 7 days. On 28-th day he manifested Results: According to our results the best prolonged polyuria for 9 days with the urine respiratory enhancement was recorded in output in excess of 7 l/day at children after administration of adrenaline via maximum. Complete recovery was observed nebuliser. The respiratory rate had fallen from after two months of follow up. 75 breaths per minute to less than 50 breaths Conclusions: Rhabdomyolysis is not an per minute, whereas the heart rate was uncommon condition. It is a life-threatening significantly increased. In all these children condition but a completely curable ore. was registered a significant improvement in Depending on severity of renal impairment SpO2 - from 91 to 98. In children treated with some patients may need long term dialysis salbutamol, the rate of respiratory support. improvement was lower, respectively Therefore, early diagnosis and prompt referral respiratory rate had fallen from 75 breaths per to appropriate center is crucial to save life. minute to less than 60 breaths per minute Keywords: Rhabdomyolisis, acute kidney whereas arterial SpO2 from 90 to the level of failure, heavy exercise, dialysis. 96. Conclusion:L-adrenaline is a very effective OP – 167 drug in improving oxygenation and support of infants with bronchiolitis in comparison with The Efficacy of Nebulised Adrenaline in the β2 agonists. Treatment of Children with Acute Keywords: Adrenaline, bronchiolitis, Bronchiolitis children.

Ferizat DIKA – HAXHIREXHA, Sevdije OP – 168 KOXHA, Ledia QATIPI, Aulona HAXHIREXHA C3 Glomerulonephritis in post Transplanted Authors Information: Patient with monoclonal gammopathy of Medical Faculty - University of Tetovo, RN of renal significance (MGRS). A Case Report MACEDONIA PHO "Alba-Med" –Debar, RN of MACEDONIA

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Arjeta DEDEJ1, Leart BERDICA2, Sotiraq Conclusions: Monoclonal gammopathy of LAKO3, Fiona NASTO3, Arjana renal significance MGRS is a term to describe STRAKOSHA1 a group of hematological disorders associated with kidney disease that fail to meet the Author Information: standard definitions for MM or lymphoma. In 1Hemodialysis and Renal Transplant Service, at such cases, the renal impairment is often University Hospital Center “Mother Theresa”, linked to the underlying hematological Tirana, ALBANIA 2 disorder. The intention was to make a clear Head of the Department of Anatomy-Pathology distinction between MGUS, a benign American Hospital Tirana, ALBANIA asymptomatic condition, and MGRS, which 3Hemodialysis and Renal Transplant Service, American Hospital Tirana, ALBANIA may be associated with significant morbidity and mortality. Abstract Keywords: C3 glomerulopathy, complement, Introduction: C3 glomerulopathy includes MGRS, renal disfunction several rare forms of glomerulonephritis withunderlying defects in the alternative OP – 169 pathway of complement cascade. It is characterized by predominant C3 deposition Influencing Factors in the Evolution of in glomeruli due to abnormal activation of the Renal Transplant Patients. alternative pathway of complement system. 1 1 C3 GN has been reported to be associated Arjana STRAKOSHA , Nevi PASKO , Vilma CADRI1, Fiona NASTO2, Arjeta DEDEJ2, Nestor with several systemic diseases 2 1 THERESKA , Myftar BARBULLUSHI . Material & Methods; We will describe a case presenting C3 GN in a patient with Author Information: monoclonalgammopathy of renal significance 1Hemodialysis and Renal Transplant Service, at (MGRS) University Hospital Center “Mother Theresa”, Results:A 61 years old man patient presented Tirana, ALBANIA with gross hematuria, anemia, renal 2Hemodialysis and Renal Transplant Service, disfunction (creatinemia 2,4 mg/dl), American Hospital Tirana, ALBANIA proteinuria 814 mg/24 h. The patient was transplanted two years ago and he was taking Abstract corticosteroids, MMF, tacrolimus and Introduction: Currently kidney entecavir for hepatitis B. Serum protein transplantation is the treatment of choice for electrophoresis; hypogammaglobulinemia patients with Chronic Renal Disease in with a small homogeneous spike-like peak. advanced stage when GFR <15ml / min / 1.73 Serum Kappa free light chains 32,4 mg/dl, sq.m2. Despite new treatment regimens with serum Lambda free light chains 9.3 mg/dl. immunosuppressive drugs and new Ratio 3,4. Autoimmune tests ANA, ANCA, supportive therapies, the task of the clinician Anti ds DNA C3 and C4 were negative. Urine following these patients remains difficult due Kappa Light Chains 26,4 mg/24 h, urine to the high morbidity and the increasing Lambda Light Chains 6,6 mg/24h.Urine number of concomitant diseases. Also in Kappa/Lambda ratio 4. After consultation recent years new medications and treatment with hematologist results of bone narrow schemes have been associated with new biopsy came for monoclonal gammopathy, complications that may affect the transplanted and FISH conclusion is presence of t (11,14) organ recipient by significantly altering their (q13, q32) which originated from IgH / outcomes and clinic. CCND1 retraction and 1q21 acquisition. Renal biopsy is C3 glomerulopathy with Our study through multivariable analysis mesengial and diffuse endocapillary identified some of the major factors affecting proliferation under light microscope and graft and patient life expectancy such as diffuse deposition of C3 and no dyslipidemia, hypertension, proteinuria, immunoglobulin under immunofluorescence anemia, but all of these factors combined with microscope. donor and recipient age, with hemodialysis pre-transplant duration. , from severe or mild

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts infections passed on by recipients, like many of the esophageal mucosa occurred. In one of these factors we cannot disconnect from case was proceeded with the resection of the treatment with immunosuppressive drugs that distal esophagus because of the long stenosis make these risk factors more influential. of the lower esophagus, after previous Heller myotomy performed 20 years before the In this respect, this study is of value because presentation. All the cases had a good post – in this complex situation of combining many operative recovery. On the 3rd. day of influential factors, we may intervene in some hospitalization, patients underwent of them to improve the prognosis of the graft radiographic studies with oral digestion of and recipient. contrast (Barium), following a specific diet Keywords: kidney transplantation, after the procedure and follow up (in 1 ,3,6 immunosuppressive, supportive therapies months) in the subsequent months showing improvement not only clinically but also in OP – 170 radiologic studies. Conclusion:Heller Cardio myotomy with An Albanian Experience in Laparoscopic Door Fundoplication resulted in various Treatment of Esophageal Achalasia clinical improvements; Reducing gastro esophageal reflux (GERD) and dissolving Arben BEQIRI dysphagia (Major part of the patients had dysphagia for more than 5 years). There are Author Information: significant results in reducing the lumen of General Surgeon, University Hospital Center dilated esophagus (in the radiographic studies “Mother Theresa”, Tirana, ALBANIA obtained months later). Laparoscopic approach for esophageal achalasia is the most Abstract effective surgical technique that provides Introduction:Achalasia is a rare primary both short and long-term symptomatic relief motility disorder of the esophagus that affects with released hospitalization time and less one person in 100,000 per year and is complication rate. It is the intervention of characterized by the absence of esophageal choice especially in patients who have not peristalsis and incomplete relaxation of a responded to other methods, like prior frequently hypertensive lower esophageal endoscopic interventions. sphincter (LES) in response to swallowing. Keywords:Achalasia, Heller, laparoscopy. Treatment of the pathology include; Non- surgical 1. Medicaments such as Nifedipine OP – 171 and Nitrates, 2. Endoscopy (Balloon dilatation, use of botulinum toxin type A) and Tips and Tricks for Minimally Invasive the most innovated POEM and 3. surgical Management of Acute Intestinal methods (Heller myotomy with Door Obstruction. Fundoplication). Heller myotomy with fundoplication is considered worldwide the Nuhi ARSLANI ¹, Basri LENJANI ¹, Rok golden standard for the treatment of patients KOLARIĆ ² with achalasia. Materials and Methods:A retrospective Authors Information: survey was conducted between 2016-2019, ¹Department of Abdominal and General Surgery, including 19 cases diagnosed with: University Clinical Center, Maribor, SLOVENIA Esophageal achalasia who have undergone ²Faculty of Medicine, University of Maribor, the procedure: Extra-mucosal Heller cardio- SLOVENIA myotomy with Door Fundoplication in laparoscopy (15 cases were performed in the Abstract American Hospital and 4 cases were INTRODUCTION: Main limitations of the performed in University Hospital center laparoscopic procedure are visualization of ``Mother Theresa`` Tirana, Albania.) the abdominal cavity and complications Results:Related to the surgery procedure, related to blind placements of laparoscopic only in 2 cases, during the interventions with tools. There are few selection criteria to be Heller myotomy in laparoscopy, a perforation used for laparoscopic treatment of intestinal

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts obstruction such as suspicion of partial Abstract intestinal obstruction and suspicion of Introduction: proximal intestinal obstruction. Some clinical TheepidemicofobesityintheWorldis a major parameters can predict the success of public health issue and more than a third of laparoscopic treatment, including adults are now considered obese (body mass improvement after nasogastric tube placement index > or = 30 kg/m2). Surgery for morbid and no fixation of obstructed bowel segments obesity, bariatric surgery, is the most durable to the retroperitoneum. Emergency surgeries treatment for this disease. are done without prior staging work up and Primary bariatric surgery has been proven to therefore hold great risk for mortality. Self- be effective in weight loss and improvement expandable metallic stents (SEMS) provide of weight-related metabolic co-morbidities. time for preoperative evaluation of the Materials and Methods: Thisconstitutes a patient's condition and allow the possibility of prospectivestudycarriedoutin a patient's medical condition to improve. tertiarycareCityHospitalinSkopje “8th Materials and Methods:3 patients who September” and included 8 morbidly obese underwent minimally invasive treatment of patients who underwent LSG. The operation acute intestinal obstruction are presented; was performed through one 15, one 12 mm "patient 1" with acute small-bowel and two 5 mm ports, using the Endo-GIA obstruction due adhesions who underwent stapler to create a lesser curvegastrictubeover diagnostic laparoscopy, "patient 2" acute a 36-Fr bougie. small-bowel obstruction due to Results:Operativetime, complicationrates, intussusception and "patient 3" with acute hospitallengthof stay, Body Mass Index large-bowel obstruction due to carcinoma of (BMI), % of Excess Weight Loss (EWL) and sigmoid colon who have had SEMS placed. appetite were evaluated. There were 3 Results:In patient 1, diagnostic laparoscopy females and 5 males, aged (mean+/-SD) eliminated mechanical obstruction as a cause 35.5+/-10.5 yrs and preoperative BMI 47.8+/- of symptoms and adhesiolysis was performed. 7.5 kg/m2. Three of them had Diabetes In patient 2, diagnostic laparoscopy led to mellitus type 2 (8 mmol/L +/- 3 mmol/L), finding of two invaginations at jejunoileal Sleep apnea all of the patients, Hypertension transition which were desinvaginated during four of them (140/90 mmHg +/- 20/15 the procedure. In patient 3, colonic stent was mmHg). The operative time was 110.7+/-30 positioned in patient's sigmoid colon which min. relieved obstruction due to luminal stenosis. Conclusions: Conclusion:Minimally invasive operative Althoughthenumberofpatientsisrelatively treatment of intestinal obstruction is chosen small, the data of this study indicate that according to the discussed selection criteria, laparoscopic sleeve gastrectomy is effective where indications, contraindications, in weight reduction, normalization of diabetes advantages and limitations of such procedure mellitus type 2, loss of sleep apnea and are carefully considered. normalization of blood hypertension. A Keywords:intestinal obstruction, higher number of patients and longer follow- laparoscopy, exploration, desinvagination, up period will be necessary to evaluate long- stenting. term efficacy. Keyword: Morbid, obesity, laparoscopic OP – 172 sleeve gastronomy.

Treatment of Morbid Obesity with OP – 173 Laparoscopic Sleeve Gastrectomy Non- Surgical Weight Loss Procedures Gazmend ELEZI1*, Lindita SEJFULLAHU- (Gatsric Batox, Intragastric Balloon) 1 1 ELEZI , Merita RUSTEMI-ELEZI , Burim 1 ELEZI Selim Birol

Authors Information: 1 th Author Information: City General Hospital 8 September-Skopje, General Surgery, Maltepe C.I.K State Republic of North MACEDONIA Hospital, Istanbul, TURKEY

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Manegement of obesity includes medical, Abstract endoscopic and surgical interventions. Obesity is an epidemic worldwide and its Laparoscopic Vertical Sleeve Gastrectomy is incidence is continuing to grow up. Today considered as the primary or the first step more people die from obesity and its results surgical intervention to those with than from hunger in the world. Being number morbid obesity or heavier stage. Thanks to one preventible death cause, obesity deserves the advances in stapling technology and to be prevented or treated. vascular energy devices, Laparoscopic Sleeve Else than certain steps and measures to Gastrectomy has become a very effective and prevent obesity from begining, which actually safe surgical treatment for obesity today. should be another subject, there are many Approach to an obesity patient, the decision options for its treatment as well. Medical for Laparoscopic Sleeve Gastrectomy (LSG), therapy, endoscopic bariatric interventions the steps to prevent complication and the the and bariatric surgery are the main treatment technic will be the main topics in my talk. options. Bariatric surgery has its well-known specific OP – 175 risks which may prevent the patient from surgery and direct him or her to non-surgical Standardized Laparoscopic Sphincter treatments. Also there is another group of preserving total mesorectal excision for patients who are overweight or obese without rectal Cancer meeting the criteria of bariatric surgery. No matter what the reason is, there are and Burak KOZA will be an important number of patients who would seek for non-surgical weight loss Authors Information: 1 procedures. Using Type A Botulinum Toxin General Surgery Department, American for weight loss is relatively new method. Hospital, Tirana ALBANIA My talk will include the technic of endoscopic gastric botulinum toxin injection, Abstract possible adverse effects and the results Introduction:Current laparoscopy surgeries according to our experience. are not new in the treatment of rectal cancer in everyday practice, our goal is to describe a OP – 174 standard surgical technique of laparoscopic interventions in this region. Bariatric and Metabolic Surgery There are many descriptions of the surgical (Laparoscopic Vertical Sleeve Gastrectomy, technique used for, total mesorectal excision Transit Bipartition, Ileal Interposition) laparoscopic as well as manual assistance, direct laparoscopy, hybrid laparoscopy Dr. Hasan Vedat OFLUOĞLU including sphincter-saving procedure and abdominoperineal resection. The efficacy of Author Information: laparoscopy for rectal cancer is still General Surgery, Maltepe C.I.K State controversial due to the lack of data regarding Hospital, Istanbul, Turkey long-term oncologic outcomes, patient selection bias, and technique of use. This Abstract study was designed to evaluate the impact of The fast increase in the incidence of obesity a total mesorectal excision standard makes it an almost worldwide epidemic. The laparoscopic sphincter preservation technique health risks caused by obesity alone or as for rectal cancer neoplasia on the long-term being a major component of the "Metabolic outcome of an unselected cohort of patients. Syndrome" are mainly Type 2 Diabetes, This was a prospective study, and data were Cardio-vascular events, Stroke, Articular extracted from a prospectively maintained problems, PCOS, Hypertension and Socio- database. Consecutive patients with psychologic problems. As well as being a histologically proven rectal cancer underwent major health treat, obesity and its results total mesorectal excision standard bring a considerable burden to the economies. laparoscopic surgery.

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Patients with previous conventional repair of the primary/unilateral inguinal abdominal surgery defined as other than herniaPotential benefits of the laparoscopic cholecystectomy or appendectomy and approach include quicker postoperative patients with morbid obesity defined as body recovery and possible decreased incidence of mass index, tumors…were not excluded. The long-term groin pain conclusion of the study was the long-term oncological outcome after a total mesorectal OP – 177 excision standard laparoscopic technique. The long-term oncological outcome includes the Dislocation of Total Hip Arthroplasty, following variables: operative time, distal and Current Concepts Review lateral removal margins, KEYWORDS: laparoscopy, total mesorectal Ledian FEZOLLARI1*, Ilir HASMUCA1, Alban excision, rectal cancer HYSENI1, Arsel DIZDARI1, Ylber ZAMA1, 1 1 Armand STAFUKA , Gjergj CAUSHI , Vilson

RUCI1, Artid DUNI1, Ergys CAMI1, Alfred OP – 176 GEGA1, Gezim BIBA1, Onder DELIALIOGLU2, 2 2 Laparoscopic Inguinal Hernia Surgery Kenan BAYRAKCI , Guido BASSI (TEP - Sils TEP) Authors Information: Selim BIROL ¹Orthopedic Service, University Hospital of Trauma, Tirana, ALBANIA- Author Information: 2Orthopedic Service, American Hospital Tirana, General Surgery, Maltepe C.I.K State ALBANIA Hospital, Istanbul, TURKEY Abstract

Most of dislocations occur within the first 3 Abstract. Laparoscopic inguinal hernia repair months following surgery 50%-70% of originated in the early 1990s as laparoscopy dislocations occur within the first 5 week to 3 gained a foothold in general surgery. Inguinal months postoperatively, and more than 3/4 th hernias account for 75% of all abdominal of dislocations occur within the first year wall hernias, and with a lifetime risk of 27% following surgery. in men and 3% in women. Repair of these The cumulative risk of dislocation does not hernias is one of the most commonly remain constant following THA, increasing performed surgical procedures in the world laparoscopic hernia repair is similar to other with time due to trauma, polyethylene wear, laparoscopic procedures. General anesthesia increased pseudocapsule laxity and is given, and a small cut (incision) is made in deteriorating muscle strength. The cumulative or just below the navel. The abdomen is risk of dislocation within the first inflated with air so that the surgeon can see postoperative month is 1% and within the the abdominal (belly) organs. first year approximately 2%. Thereafter, the A thin, lighted scope called a laparoscope is cumulative risk continuously increases by inserted through the incision. The instruments to repair the hernia are inserted through other approximately 1% per 5-year period and small incisions in the lower abdomen. Mesh amounts to approximately 7% after 25 is then placed over the defect to reinforce the years.Late dislocations are caused by belly wall. progressive improvement in motion after Laparoscopic inguinal hernia repair has surgery become a valid option for repair of an Late dislocations are more likely to become inguinal hernia, although the primary indication for the use of laparoscopic inguinal recurrent and require surgical intervention. hernia repairs has been for bilateral and Among all causes of revision hip surgery, recurrent inguinal hernias. As more dislocation is the most frequent, accounting experience has been gained with the for 22% of total hip revisions in US Medicare laparoscopic techniques, it is now used for the

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts data.Dislocation is also a relatively common Murat Onder DELIALIOGLU1, Ledian 2 1 complication, occurring in approximately FEZOLLARI , Kenan BAYRAKCI 0.3% to 10% of all primary procedures. Understanding the causes of hip dislocation Authors Information: 1 can help the surgeon to identify factors Orthopedic Services, American Hospital, related to the patient, the implant, and Tirana, ALBANIA. 2 surgical technique which contributes to this Department of Orthopedic, University complication. Hospital of Trauma Tirana, ALBANIA. With this understanding, most dislocations can be avoided. Abstract Introduction:Accurate placement of the

distal screws into the interlocking nails is a

demanding procedure secondary to OP – 178 inaccuracy of the targeting device supplied

with the system and to deformation of the nail Periprosthetic Fractures after Total Knee during insertion. Distal locking can be time Replacement consuming and expose the patient and

operation team to unnecessary increased AntonioGAVRILOVSKI1, RezeartDALIPI 1*, ionizing radiation. We describe a new AleksandarTRAJANOVSKI1, Aleksandar protocol for the insertion of the distal screws SAVESKI1 into femoral and tibial interlocking nails by

using only another same length nail without Authors Information: an image intensifier. 1 Orthopaedic Surgeon University Clinic for Material and Methods:Twenty patients TOARILUC, - Skopje, RN of MACEDONIA (eight tibiae and 12 femora), among those

attended to our institution during the last Abstract three years treated with reamed, locked Total knee replacement is one of the most intramedullary nailing were included. After common procedures in the today’s orthopedic placement of the nail in a tibia or femur, a surgery. With the annual increasing number second interlocking nail at the same length is of total knee replacements done in the world, placed along the surgical limb. Using the there is an increase in the number of proximal insertion jig provided with the complications. system, proximal holes of the internal nail are Periprosthetic fractures are one of the most locked with long screws passing through the difficult and challenging complications in nail-mounted outrigger to the far cortex. After orthopedic practice even for the most avoiding the outrigger motion of the external experienced surgeons. nail, distal screws are locked successfully in There are few proposals for classification all cases. systems and treatment algorithms but still Results:In 20 consecutive distally locked there are no gold standard guidelines. nailing, the technique was easily mastered, In our clinic annually around 100 total knees helped to decrease the roentgenogram are implanted. exposure and minimize the operating time We present our experience in the treatment of when compared to freehand techniques. these fractures in the period 2009-2019. Conclusions:This technique can be a safe Keywords: Knee, fracture, surgery, alternative to the common distal targeting orthopaedic. techniques. It is simple, safe, universal,

reproducible, rapid and inexpensive, avoiding OP – 179 the use of distal targeting guides. It can be

used without an image intensifier. Keywords;interlocking nails, distal screws, Inserting Distal Screws into Interlocking image intensifier Nails without Image Intensifier

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OP – 180 mean difference of FPA was 0.48º despite high femoral torsion differences. Torsional Deformity and Foot Progression Keywords:femoral shaft fractures, femoral angle following Pediatric Femoral Shaft torsions, foot progression angles. Fractures. 1, 1 Kenan BAYRAKCI Onder M.DELIALIOGLU , Ledian FEZOLLARI2 OP – 181

Authors Information: Patella Fractures and their Treatment 1Orthopedic Services, American Hospital, Tirana, (Retrospective Study)

ALBANIA. Alban HYSENAJ 2Department of Orthopedic, University Hospital of

Trauma Tirana, ALBANIA. Author Information: Orthopedic Resident, University Hospital Abstract Center “Mother Theresa”, Tirana, ALBANIA Introduction:Our study aimed to determine the frequency and degree of torsional Abstract deformity following femoral shaft fractures to A patellar fracture is a serious injury that can relate them to clinical complaints using foot make it difficult or even impossible to progression angles (FPA) obtained from gait straighten your knee or walk. Some analysis. simple patellar fractures can be treated by wearing a cast or splint until the bone heals. Material and Methods: We examined both In most patellar fractures, however, the pieces femora of seventeen children admitted to our of bone move out of place when the injury hospital for unilateral femoral fracture in occurs. Fractures make up about 1% of all fourteen, and bilateral in three. Nine were fractures. Patella plays an important role in male and eight were female. The average age knee extension. was 9.4 years, ranging from 5years to 15 Depending upon your specific fracture, you years. The cases were followed up with an may be allowed to bear weight on your leg average period of 23 months (6-48 months). while wearing a cast or brace. With some We evaluated each patient with computerized fractures, however, weight bearing is not gait analysis and computerized tomography. allowed for 6 to 8 weeks. Your doctor will Our premise was that foot progression angle talk with you about restrictions on weight may give insight about how subjects with bearing. uncorrected femoral antetorsion adapt. Study of four-year prospective fracture from Results: The mean femoral torsions for 2015 - August 2019, at University Hospital of injured and sound side femora were 6.88º ± Trauma, study of fracture patterns, correlation 18.21º (mean ±SD, range -20º- 44º) and 11.28º with injury mechanism and age. Study the ± 16.57 (-20º- 38º) respectively. The mean whole method of surgical treatment. foot progression angles for injured and sound How long it takes to recover after a patellar side were 12.85º ± 5.72º (4.20º - 26.40º) and fracture will depend upon a number of 12.27º ± 3.98 (3.80º -18.90º) respectively factors, including: The severity of your The Pearson correlation coefficient of the injury; Whether your treatment was surgical relation was 0.454 (p=0.044) between or nonsurgical; The time needed for femoral torsion value of the injured and FPA rehabilitationMost patients will be able to of the sound side and 0.465 (p=0.039) return to their normal activities within 3 to between femoral torsion value of the sound 6 months. For patients with severe and FPA of the injured side. fractures, the return to activity may take longer. Your doctor may suggest some Conclusion: None of the cases and their lifestyle changes to help protect your knee parents had complaint. We observed femoral and prevent future problems. This may torsion differences of up to 40.3º without any include avoiding activities that involve clinical symptoms. It has been seen that the repetitive deep knee bending or squatting.

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Climbing stairs or ladders should severely injured patients with multiple beavoided, as well. injuries who are too critically ill for definitive Keywords:Fracture, patella, extension, surgery and for those patients who cannot be surgery. safely assigned for early total care treatment. CONCLUSIONS: The method was adapted OP – 182 to gain control of an unstable situation until definitive intervention could be undertaken. The Influence of Damage Control KEYWORD: Damage control, orthopedics, Orthopedic Surgery in the Polytraumatic Surgery, extremity fractures Patient OP – 183 Dritan TODHE1, 2, Blerta HAMOLLI2, Alban HYSENAJ2, Rezart ÇIPI2 Benign Bone Tumors, a Descriptive Study in 10 Years. Authors Information: 1Hygeia Hospital Tirana, ALBANIA 2 Blerta HAMOLLI ¹, Arnel MICI ¹, Sokrat University Hospital of Trauma, Tirana, BERDUFI ¹ ALBANIA.

Abstract Authors Information: Introduction:Damage control orthopedics is ¹Orthopedic Service, University Hospital of a relatively new concept and it occupies a Trauma, Tirana, ALBANIA small proportion of the overall process in a Abstract polytraumatic patient. It necessitates Introduction:Benign bone tumors are benign continuous communication between surgical, lesions that compromise the quality of life of anesthetic and the whole multidisciplinary team. Our randomized study in a first-level the affected patients. As they are more Trauma Center showed a benefit for common in younger people and they are borderline patients treated by DCO in mostly asymptomatic lesions, the importance comparison to early total care. The damage given to diagnose and treat them is vital to the control strategy has been adopted by potential morbidity (potential fractures) that traumatologists to treat extremity fractures. these lesions carry. By correctly establishing Material & Methods:For the study we the diagnosis with the relevant histological considered 33 patients (19 Males and 14 Females) from 21 to 50 years old with severe typology, we can prevent aggravation of the polytraumatic damages, including even affected bone structure, regardless of orthopedic injuries that were managed with anatomical location. The purpose of this DCO during the period of 6 months (from study is to show that diagnostic orientation January 2018 to June 2018) in University leads to efficient surgical treatment and Hospital of Trauma, Tirana. 9 of 33 patients reduction in the number of patients presenting were send to the ICU. The other patients were with relapses. subject of surgery in terms of DCO, that consisted on: Immediate life-saving surgery, Material and Methods:This is a study based which was required in 21 cases; Surgery for on 292 cases (from 1700 bone biopsies) and controlling heavy bleeding, which was their histopathological examination data required in 7 cases;Wound bleeding control, presented not only at Trauma University infection control, washing, dressing, and Hospital but also at other hospitals, thus temporally closing the wound; and having a heterogeneity in the distribution of Provisional minimally-invasive external fixation, which was performed in 5 patients. variables such as age, sex and anatomical Results:The study demonstrated the locations. It is a retrospective study of both enormous time savings and reduction of diagnosis and treatment. The evaluation was blood loss during initial treatment if patients performed on the basis of clinical, with multiple injuries are treated according to radiological and histological criteria. DCO. We feel that DCO is a safe strategy in

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Results:The study found that the most We report a rare case of 26-year-old male common benign bone tumor was with an infected femoral pseudoaneurysm of Osteochondroma (39.6%), Aneurysmal Cyst the left leg, presented with a 10-day history (12.6%) Simple Cyst (13.8%) TGJC (21.2%) with mild pain and tenderness of the lower Osteoid Osteoma (8.9%) Male Female Ratio left extremity, in the inguinofemoral area. male predominance. These tumors most affect The patient is known to have a history of I.V children and adolescents (29.9 ± 15.7). Most drug abuse. The IPA ruptured while the affected bone: Femoral (87 cases) and 6% of patient was being prepared for surgery. Due cases had relapses. Most patients come from to its location, the patients clinical state, urban areas. Clinical and histopathological physical parameters and anatomical state of framework not always consistent with the damaged vessel, emergency surgery was significant p <0.001. required. As the reconstruction of the Keywords:Tumor, bone, histopathological common femoral artery was not an option, an examination. external iliac – superficial femoral artery bypass was performed. The presentation, the OP – 184 diagnostic evaluation, and the surgical management of the aneurysm are further Ruptured and Infected Pseudoaneurysms of discussed in our presentation. The patient had the Femoral Artery in a Drug Addict an optimal postoperative course and a 10-day

hospital stay. Albana KENGA1, Ervin BEJKO2, Frenki Discussions:A high rate of limb loss occurs VILA3; Sokol XHEPA1 and many patients with retained lower

extremities suffer unreported incidences of Authors Information: residual claudication or rest pain, resulting 1 Service Of Vascular Surgeon, University from pseudoaneurysm resection and sole Hospital Center “Mother Theresa” Of Tirana, ALBANIA artery ligation. There is no level I evidence to 2 Anesthesiologist, University Hospital Center support that ligation alone; excision of the PA “Mother Theresa” Of Tirana, ALBANIA and eradication of local sepsis is the best 3 Resident Of General Surgery, University methods of treatment of infected Hospital Center “Mother Theresa” Of Tirana, pseudoaneurysms from substance abuse. The ALBANIA mandate is to devise treatment that reduces the rate of amputation and the incidence of Abstract chronic ischemic symptoms, with a low risk Introduction:FAPs in I/V drug users are of graft infection. usually caused by punctures of the femoral Keywords:Femoral artery, pseudoaneurysm, artery. Iatrogenic pseudoaneurysms (IPA) rupture, infected. form when an arterial puncture site fails to seal, allowing arterial blood to jet into the OP – 185 surrounding tissues and form a pulsatile hematoma. These lesions lack a fibrous wall Retroperitoneal Hematoma Related to and are contained by a surrounding shell of Spontaneous Rupture of Thrombosed Iliac Vein. – Two Cases and Review of Literature. hematoma and the overlying soft tissues. It can present as a new thrill or bruit, pulsatile Gentian CACO1,2, Petrika GJERGO2, Lordian hematoma, or marked pain or tenderness. NUNCI3. Complications of pseudoaneurysms include rupture, distal embolization, local pain, Authors Information: neuropathy and local skin ischemia. 1Vascular Surgeon UHC “Mother Theresa”, Tirana, ALBANIA.

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2Service of Vascular surgery, UHC “Mother There were different treatment strategies, Theresa”, Tirana, ALBANIA. surgical, endovascular and conservative. 3 Central Intensive Care Unit, UHC “Mother Conclusion:Rupture of thrombosed iliac vein Theresa”, Tirana, ALBANIA. is a rare complication of deep vein thrombosis. Its presentation is dramatic. Abstract Clinical suspicion and CT scan should lead Introduction: Spontaneous rupture of fast diagnose and treatment to lower the high thrombosed iliac vein is a rare event with mortality rate of such a complication. only a few reported cases. It may be life Keywords:Retroperitoneal Hematoma, threatening because of the combination of rupture, vein thrombosis. both thrombosis and hemorrhage, two situations whose treatment seems OP – 186 contradictory. We report two cases diagnosed and treated in our hospital and we also make A Very Rare Complication of an Abdominal a review of the literature. Aortic Aneurysm:Primary Case Presentation: Two women,58 and 65 Aortoduodenal Fistula without Gastrointestinal Bleeding years old respectively, presented in emergency with collapse and acute swelling 1∗ 2 Sokol XHEPA , Ervin BEJKO , Denis of left lower limb. Both patients had no KOSOVRASTI1, Marsela SOPIQOTI1, Stavri important previous medical history. They had LLAZO2; Astrit XHEMALI3, Frenki VILA3, complained acute lumbar or abdominal pain Eljona XHELILI3 at the very beginning of their illness. Severe Authors Information: 1∗. anemia and signs of hemorrhagic shock were Service of Angiology & Vascular Surgery UHC present at presentation. CT scan showed “Mother Teresa” of Tirana, ALBANIA 2. Service of Anesthesiology & Intensive Care retroperitoneal hematoma on the left side and UHC “Mother Teresa” of Tirana, ALBANIA occlusive thrombus of ipsilateral iliac veins 3. Service of General Surgery University Hospital on both cases. Center “Mother Teresa” of Tirana, ALBANIA The first case was operated at emergency. Abstract After retroperitoneal clot removal a rupture of Introduction: To report the management of a the lateral wall of the thrombosed common very rare combination, Abdominal Aortic iliac vein was found. The vein was legated Aneurysm (AAA) with Duodenal Fistula, but and the patient treated with anticoagulation. without upper gastroduodenal bleeding, The second case had been considered because a massive wall aortic thrombus kept pulmonary embolism at presentation and no closed the communication between aortic lumen and duodenum. CT scan of abdomen had been performed Case Report:A 84-year-old man was because of severe hemodynamic instability. presented at the Service of Emergencies at She was treated conservatively with repeated UHC “Mother Teresa” of Tirana on August blood transfusions and anticoagulation at low 21, 2018, with epigastric and back pain and doses. The next morning a CT scan was without anemia.There was no history of performed and diagnose confirmed. Since the analgesic abuse, peptic ulceration, alcohol patient was stable conservative treatment excess, weight loss or gastrointestinal bleeding. The abdomen was soft and below continued.Both patients had slow but good the epigastric region was a pulsatile mass. recovery. They were treated with long term A computed tomography detected a 6.5 × 10 anticoagulation.A search for the condition at cm abdominal aortic aneurysm with a Pubmed revealed 38 publications with 46 massive anterior mural thrombus and no signs patients. The majority were women over 60 of a leak. Inside of the right side of the mural years of age with left leg vein thrombosis. thrombus was seen air, which was a suspicion for an aortoenteric fistula.

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This suspicion led to immediate surgical cases, the source of paraganglioma was exploration and an aortoduodenal fistula was identified through histological and confirmed. Both, the aorta and the duodenum intraoperative methods. Nevertheless, our were successfully repaired by aortobiiliac example is non-identical because the tumor synthetic graft replacement and was located near hypoglossal nerve. The duodenostomy, respectively. tumor was later removed. The patient had no The patient made an uneventful recovery. He difficulties in speech articulation, only in remains well and 17 days later he left hospital swallowing. After 5 days of tumor removal, with the duodenostomy catheter closed and the condition beganimproving. After 3 normal oral nutrition. months, the situation went back to normality. Conclusions:Primary aorto duodenal fistula Conclusions: Paraganglioma is a rare without gastrointestinal bleeding is a very neuroendocrine tumor that originates in rare and “lucky” complication because the neural creste. It is a tumor mass of the neck patient can be operated without severe anemia visually indistinguishable from other and hypovolemic shock. The strategy of commoner body tumors, such as carotis or treatment includes: fast diagnosis, immediate vagus. Full recovery without functional surgical treatment and the simplest possible defects of any kind can be possible through surgical reconstructions for both pathologies. surgery of nerve preservation. Although, in Keywords:AAA, aorto-duodenal fistula, some examples the elimination of cranial aorto biiliac graft, duodenostomy. nerve XII is a necessity. Keywords:Paraganglioma of hypoglossal nerve, swallowing, contrastive Angio OP – 187 Scanner.

Neurovascular Tumors, Paraganglioma of OP – 188 the Hypoglossal Nerve. A Case Report Subclavian Artery Atherosclerotic Disease Edmond NUELLARI (SAAD)

Marsela SOPIQOTI1, Edmond NUELLARI1, Author Information: 3. 2 1 Frenki VILA , Ervin BEJKO , Sokol XHEPA Angiosurgery Service, University Hospital Center “Mother Theresa”, Tirana, ALBANIA Authors Information: 1.Service of Angiology & Vascular Surgery UHC Abstract “Mother Teresa” of Tirana, ALBANIA 2. Paraganglioma is a rare neuroendocrine Service of Anesthesiology & Intensive Care UHC “Mother Teresa” of Tirana, ALBANIA tumor that originates in neural crest. There 3. are a few instances mentioned of Service of General Surgery University Hospital paraganglioma of the hypoglossal nerve even Center “Mother Teresa” of Tirana, ALBANIA in worldwide scientific literatures. Abstract Paraganglioma of the hypoglossal nerve near Introduction: Clinical presentation of the arteria carotis cannot be determined subclavian and innominate artery peripheral beforehand without a surgical operation. It is arterial disease (PAD) varies from hand a tumor mass of the neck visually claudication to cerebral hypoperfusion to indistinguishable from other commoner body distal embolization and digital ischemia. tumors, such as carotis or vagus. Full Upper extremity PAD could manifest as recovery without functional defects of any coronary steal or lower extremity claudication kind can be possible through surgery of nerve in patients who have had CABG or extra- preservation. Although, in some examples the anatomic axillary to femoral bypass. Physical elimination of cranial nerve XII is a necessity. examination is significant for weak pulses on Our medical case has similar symptoms an ipsilateral extremity, a systolic blood described in scientific literatures. Images pressure difference of more than 10mmHg taken with contrastive Angio Scanner and compared to contralateral extremity. angiography of ACI, ACC and vena jugularis Sometimes the affected hand may feel cool to interna reveal a hyper vascular mass in carotid bifurcation. As in previous reported

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts touch, and in severe cases, digital ischemia Authors Information: has also been described. 1Service of vascular surgery, University Hospital Case: We report a rare case of a 54-year-old Center “Mother Theresa “, Tirana, ALBANIA man with subclavian atherosclerotic disease, 2anesthesiologist, Cardiovascular Surgery, Uhc presented with a 4-day history with mild pain “Mother Theresa”, Tirana, Albania and tenderness of the upper left extremity. 3resident Of General Surgery, University Hospital His past surgical history was significant for Center “Mother Theresa”, Tirana, Albania an aorto-bifemoral bypass grafting 5 years 4service Of Vascular Surgery, University Hospital ago for aortoiliac occlusive disease. After Center “Mother Theresa”, Tirana, Albania taking in consideration the location of the 5 department Of Cardiology University Hospital stenosis, the patients clinical state, physical Center “Mother Theresa”, Tirana, Albania parameters and the state of the occluded vessel surgical intervention was required, consisting in carotid – subclavian by-pass. Abstract Clinical and radiologic tests suggest Introduction: Antiphospholipid syndrome atherosclerotic occlusive disease. We (APS) is an acquired autoimmune disorder therefore discuss in our presentation the that can be manifested clinically as a surgical management of the disease, along recurrent venous or arterial thrombosis. with the post operatory course of the patient. Case: We present a 26-year-old woman, with Discussions: Endovascular repair with or without stenting has been proposed as a first a 7year history of Diabetes Mellitus (DM line treatment by many authors, especially for type 1), that was firstly hospitalized in the patients of higher surgical risk. Concluding, Endocrinology department as a destabilized Open and endovascular treatments of patients DM. She had a history of 3 spontaneous with atherosclerotic subclavian artery disease abortions. During her stay in Endocrinology show similar early outcomes, although open the patient complained of chest pain repair was more frequent in their study in associated with changes in ECG (negative T patients with subclavian artery occlusion. In the long term, open repair shows a waves at V1-V4), and elevation of troponin significantly higher primary patency, without I.2D echo revealed an apical dyskinesia and any difference in overall survival or symptom left apical ventricle thrombus measured recurrence. Therefore, even in cases formerly 3cm2.She was diagnosed as an anterior addressed as high risk, open repair could be a NSTEMI and underwent a coronarography safe and durable strategy, although hospital procedure that showed one vessel disease, stay seems to be longer and randomized data are lacking. Novel endovascular techniques, thrombotic material in proximal LAD. Triple such as the use of covered stents or drug- therapy was started (IV heparin, aspirin, eluting devices, may alter outcomes in the clopidogrel…) future. During her hospitalization in ICU the patient Keywords: Atherosclerosis, subclavia artery, complained of pain and paresthesia in the bypass. right leg. An angio –CT of the chest,

abdomen and the peripheral extremities OP – 189 revealed: lineal infarction, bilateral Multidistrectual Thromboembolic Events parenchymal renal infarction and thrombotic with Myocardial Infarction, and Acute occlusions of the right and left popliteal Ischemia of both Legs in a young Woman arteries. Bilateral embolectomy with Fogarthy Diagnosed with Antiphospholipid Syndrome probe was performed permitting vascularization of both occluded vessels. Denis KOSOVRASTI1, Frenki VILA3, Another angio-CT showed no evidence of Daniela TEFERIÇI5, Petrika GJERGO1, Ervin thrombus in both popliteal arteries. BEJKO2, Sokol XHEPA4 Discussion:The antiphospholipid syndrome is a rare disease. The clinical criteria for its diagnosis were: evidence of thrombosis and 105 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts repeated fetal loss. Close collaboration with Keywords:laser, endovenous laser ablation, vascular surgeons should be always possible phototherapy, K laser. in order to perform revascularization interventions during the acute phase of the OP – 191 thrombotic event. Ruptured Abdominal Aorta Aneurysms

OP – 190 Petrika GJERGO1, Ervin BEJKO2, Stavri

LLAZO2, Edmond NUELLARI1, Sokol Laser Treatment in the Management of XHEPA1 Chronic Venous Disease 1Clinic of Vascular Surgery, UHC Mother 1 2 Skender VELIU , Jasmina KRÖPFL , Theresa, Tirana, ALBANIA Dominika VRBNJAK3 2Service of Anesthesiology and Reanimation, UHC Mother Theresa, Tirana, ALBANIA Authors Information: 1Surgeon, Surgical ward General Hospital dr. Abstract Background: Abdominal aortic aneurysm Jože Potrč Ptuj Potrčeva Ptuj, SLOVENIA (AAA) is a common and life 2Nurse for controlling hospital infectionGeneral threateningdisease that affects 5–9% of the Hospital dr. Jože Potrč Ptuj SLOVENIA 3 population over the ageof 65 years. AAA is Assistant Professor University of Maribor more common in male smokers with a Faculty of Health Sciences Žitna Maribor, positivefamily history of aortic aneurysms. SLOVENIA Most patients with AAAare asymptomatic unless they develop a complication. Abstract Rupture,the most common complication of Shortly after 1960, laser became an AAA, is one of the most fatalsurgical indispensable tool in the field of medicine. emergencies; it has an overall mortality rate Due to continuous development of laser of approximately90%. Most clinicians know that patients with ruptured AAA presentwith technology and optical systems, the use of a classical triad of back pain with or without laser in medicine has been a constantly abdominalpain, hypotension, and a pulsatile advancing. In medicine, the laser is mainly abdominal mass. used in the field of ophthalmology, surgery, The purpose of this study was to present our dentistry and aesthetic skin treatments.In 3-year experience regarding the ruptured General hospital dr. Jože Potrč Ptuj laser is AAA. 22 patients with ruptured infrarenal used in the field of surgery for surgical abdominal aortic aneurysm presented in our treatment of varicose veins and a supportive clinic since january 2017, 19 males and 3 treatment of chronic wounds. The paper females, mean age 74.3 years. All patients presents the basic characteristics of the had an acute presentation with abdominal and minimally-invasive thermal ablation back pain and collapse. 7 patients presented techniques – Endovenous laser ablation within 6 hours from the beginning of (EVLA), experiences and results of treatment symptoms, 9 patients presented within 12 hours and 6 patients after 12 hours. Patients using this method in General hospital dr. Jože were diagnosed using angio-CT scan, they all Potrč since 2016 are presented. The basic had a retroperitoneal hematoma. 15 patients characteristics of the K laser, experiences and underwent emergent surgical treatment of the K laser outcomes of phototherapy ruptured AAA, while for the other 7 patients, treatment of patients with chronic wounds of their relatives refused the surgical different etiologies are presented as well. K intervention. From the 15 treated patients, laser is used as a supportive therapy in only 2 patients died, one because of an aortocaval fistula, discovered during surgery, hospital since 2018. and the other one due to cardiac arrest.

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In conclusion, patients with ruptured AAA walls of the vase in a rigid structure. The should be treated immediately through vases are occluded (from 85% of the lumen to surgical intervention, despite the operative 100%) in all of the cases. The muscular tissue risks. The early diagnosis enables the surgical below the amputation line were necrotic, treatment with an acceptable mortality. denaturated, non-vital and we have been obliged a few times to go above the amputation line in order to find vital and OP – 192 conserved tissue. Keywords:amputation, diabetic gangrene, Inferior Limbs Amputations in Diabetic atypical amputation, Lisfranc amputation, Patients Following Long-Term with femoral amputation. Artherial Complications in Vlore’s Regional Hospital. OP – 193

1 2 Petraq MUSTAQE , Edmond BRESHANI Difficult Vaginal Delivery: The Need to

Remodeling Postgraduate Program Focus in Authors Information: 1Surgeon-Angiologist At Regional Hospital Of Obstetrics and Gynecology in Albania and Vlora, ALBANIA not Only 2Anesthesiologist At Regional Hospital Of Vlora, 1 2 ALBANIA Zef DELIA , Rustem CELAMI

Abstract Author Information: 1 Introduction:In this article we are discussing Professor at University of UET, Obst - the epidemic spreading of the “diabetic foot” Gynecologist, American Hospital of Tirana, ALBANIA in diabetic patients because of the peripheral 2 vascular disease at many levels of the lower Professor at University of Aldent,Obst - Gynecologist, American Hospital of Tirana, limbs (from femoral level to the foot). We ALBANIA have recorded 92 amputations in our Hospital from 2000 - 2015, in a city that counts Abstract 150,000 inhabitants. Introduction:Vaginal delivery is a In this study we have recorded 92 cases of lower limb amputations in both genders with physiological and natural process of birth, 62 males and 30 females, varying from 50-80 when happens within normal parameters of years old. 42 of these cases have gone definitions well recognized by respective through a femoral amputation of one limb. 12 national and international professional official cases have gone through crural amputation of one or both limbs. 18 cases of Lisfranc organizations. amputations and 16 cases of atypical With the trend of increase rate of Cesarean amputation. In this study we have also included 4 cases of upper limbs amputations section, worldwide, and in Albania together due to micro arterial complications in non- with lack of focus, and lack of mentorships in diabetic patients and patients with Raynaud clinical skills of post graduate programs in syndrome. obstetrician gynecologist specialty, we face In 4 of these cases after the crural amputation we have needed a reintervention that led to and will face even more problems in the amputation of the lower limb at a higher managing normal and especially abnormal level. Also, in 8 cases with Lisfranc vaginal deliveries. amputation we have needed a reintervention trying to save the calcaneous bone and in two According to latest data, only shoulder cases we went on to amputate at crural level. dystocia accounts up to 1 % (with median In most of the cases we have performed a values of 0.5 -0.7%). The diagnosis of histological exam of tissues and vases. In all cases we have observed the formation of dysfunction of three main elements like calcific deposits that have transformed the dynamics, mechanic and plastic one should

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be done on time and with professional include; inflammation, epithelialization, objective in order to minimize to risks to fetus fibroplasia and maturation. Mechanical and mother. Shoulder dystocia occurs when failure or failure of wound healing at the surgical site, may lead to disruption of wound anterior fetal should, most commonly, and closure and it is followed by seroma, posterior fetal shoulder, less commonly, hematoma, wound dehiscence or hernia. impacts on symphysis or sacral promontory. Abdominal wound dehiscence is a rare post- Morbidity and mortality associated with this operative complication of total hysterectomy, dysfunction of normal delivery is significant. but vaginal cuff tear is very rare. Evisceration This presentation purpose is to bring through vaginal opening, is life-threatening surgical emergency. In this presentation will awareness of the fetal and maternal trauma be reviewed, the risk factors, symptoms, that can occur on difficult delivery and to precipitating events and symptoms, and bring attention of remodeling academic treatment. postgraduate programs in order to more It is imperative to maintain a high index of medical professionals of respective field to suspicion in patients who underwent profit from clinical skill and offer e better laparoscopic or robotic hysterectomy more medical care to this subgroup of patients frequent nowadays. Keywords:Hysterectomy, complication, Keywords:Difficult, vaginal delivery, vaginal cuff, dehiscence remodel, postgraduate, program

OP – 196 OP – 194 This abstract has been withdrawn. This abstract has been withdrawn. OP – 197

OP – 195 Deep Infiltrating Endometriosis – The gynecologist Challenge Vaginal Cuff Dehiscence as Cuff Tear, Separation, Rupture; Our Experience Leon KAZA

1 1, 2 Author Information: Avenir BALILI , Rustem CELAMI Obstetrician and Gynecologist, Lezha Regional Hospital, ALBANIA Author Information: 1 Obstetrician-Gynecologist, American Abstract Hospital of TIRANA, ALBANIA Introduction;Endometriosis is a chronic 2 Professor at University of Aldent, TIRANA, gynecological disorder that affects ALBANIA approximately 10-15% of women in reproductive years being the second most Abstract common benign disease in the female Introduction:Most common post population. The heterogenic clinical picture hysterectomy complications can be of endometriosis with varies symptoms can categorized, such as; bleeding, infections seriously compromise the physical, thromboembolic event, urinary or intestinal psychological and quality of life of patients. Deep Infiltrating Endometriosis is defined as injury, nerve lesions and lastly vaginal endometriosis penetrating more than 5 mm dehiscence. beneath the peritoneal surface. It is estimated In general, all surgical wounds in normal, that 10% of cases of endometriosis will have healthy individuals heal through an orderly deeply infiltrating lesions. This form of the sequence of physiologic events which disease remains the most difficult to treat and

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts needs highly skilled surgeon. Surgery must be performed by surgeons who are dedicated to endometriosis and treatment should be based on a collaborative multidisciplinary approach. In Albania deep infiltrating endometriosis remains still unknown, so much more must be done in order to diagnose this condition that affects seriously women quality of life. In our speech we will talk about some features of deep infiltrating endometriosis and especially on preoperative diagnosis of the disease. Keywords:Endometriosis, gynecologic, disorder, infiltrating, diagnosis, treatment

OP – 198

This abstract has been withdrawn.

OP – 199

This abstract has been withdrawn.

OP – 200

This abstract has been withdrawn.

OP – 201

This abstract has been withdrawn.

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POSTER EXHIBITIONS & PE &P – 4 PRESENTATIONS Innovation in Radiology PE &P – 1 Najada KALLASHI (JAHIQI)1, Erjona ZOGAJ2 This abstract has been withdrawn.

Authors Information: PE &P – 2 1Radiologist, University Trauma Hospital, Tirana, ALBANIA. This abstract has been withdrawn. 2Imaging technique, University Trauma Hospital, Tirana, ALBANIA.

PE &P – 3 Abstract Innovations in radiology have led to essential Drowning and the Importance of CPR First and irreplaceable developments in the field of Aid. medicine by improving the quality of patient care and reducing mortality rates. Various Studim HYSA. imaging modalities have brought about revolution in the field of medicine over the years. Hybrid imaging is one of the latest Author Information: innovations being widely used and bringing University "Aleksander Xhuvani", Faculty of major developments in radiology. Medical Sciences, Elbasan ALBANIA. Radiology is a medical field that works the practice of imaging to both analyze and treat Abstract disease imagined within the body. Introduction:Drowning is the experience of Radiologists use a collection of imaging being unable to breathe as a result of strained technologies such as X-ray radiography, and uncontrolled immersion in ultrasound, computed tomography (CT), water.According to the WHO (World Health nuclear medicine, positron emission Organization), 500,000 deaths per year or tomography (PET) and magnetic resonance 0.7% of deaths are caused by accidental imaging (MRI) to analyze or treat diseases. drowning.Brainenergyconsumption drops by Interventional radiology is the usually 5% for every 1 degree below 37 degrees, in minimally invasive medical procedures with the range of 37 to 20 degrees.After the guidance of imaging technologies. identifying and taking the person out of the Innovations are new idea, device or process. danger zone: laying a person on a strong Innovations are the application of better plinth. We place the closest First Aid box on solutions that meet new requirements, in our arm to look at the person if he or she articulated needs or existing market needs. It responds to painful speech, congestion or is proficient through more effective products, nflammatorystimulants. We release the processes, services, technologies, or new Breathing Paths from the garment and do the ideas that are readily available to markets, head extension with 2 fingers on the chin and governments and society. Innovations are hands on the forehead by raising the head something original and novel, as a significant, which allows the air to circulate freely.We new that breaks into the market or society. examine the mouth cavity for foreign bodies, Keywords:Radiology, medicine disipline, we remove the dentures and fluids and innovation, hybrid imaging. cleanse the mouth. controlling Inspiration: Listening, observing, feeling. The first helper PE &P – 5 holds his/her cheek and ear close to the person's mouth and eyes toward his chest to Emergency Trauma Management, see his movements. Epidemiology of Trauma Keywords: Drowning, breathe, examination, resuscitation. Natasha MERKO¹, Deonada ÇOKU ¹, Hasije DURAKU ¹, Etleva RAMALIU ¹

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Materials and Methods: Socioeconomic Authors Information: data for each patient was extracted by a ¹Nurse Service University Hospital of Trauma, questionnaire(short generic set of questions Tirana, ALBANIA. on health-related quality of life, educational level and achievement, occupation) and medical cartels of patients. (Dental Clinic Abstract “Parisi") Introduction: In our Emergency Department, DMFT Index was categorized as: DMFT >10 at University Hospital of Trauma, everyday and DMFT <10 come approximately 50-70 patients whom we Results: The study concluded that the offer our service. Many of them are from prevalence of DMFT was found more (DMFT different accidents and came to the hospital > 10) in lower socioeconomic status when immediately, and others from regional compared to uppers socioeconomic status hospitals. On average 4-5 patients are (DMFT < 10) polytraumatized patients. Management of Keywords: DMFT, Socioeconomic Status, patients at Emergency Department has many Adult Patients. challenges. Being the only Trauma Center, it deserves a special attention for all the PE &P – 7 problems that may have the Emergency

Department. First Aid in Management of Trauma Materials and Methods; A sectional study Patient. was performed on 200 patients in trauma emergency for a period of 2 months from 1.11.2013 to 31.12.2014. Natasha MERKO ¹, Albana NDOJ ¹ Results : Males are the main victimes, and the road accident are the main causes. Authors Information: Damages more than 2 specialties, ¹Nurse Service University Hospital of coordination between specialties for diffèrent Trauma, Tirana, ALBANIA. choices in managing patients in their delivery. Conclusions: The key of success for a good Abstract management is a special trauma team and standart protocols. Only this way we can offer Introduction: September 12, World Aid a great service, and have a decreased Day. Many people are unable to approach an mortality and morbidity. emergency service, act correctly and Keywords; Politrauma,selection, trauma consequently have no loss of life, or center, emergency department. deterioration of health. This requires more

information and concrete action across the PE &P – 6 community in order to enable them to deliver.

first aid according to certain rules, seeking DMFT (Decayed Missing Filled Teeth) Index and Socioeconomic Status in Adult more specialized services in order to avoid as Patients much as possible loss of life and complicating situations Organizing this day by all health Ramona A. PARISI structures in cooperation with other structures, including activities, publications, Author Information: direct community outreach, practical Dentist at Dentale Clinic “Parisi” Tirana, demonstrations in public, or the most diverse ALBANIA forms that can be accomplished for this Abstract purpose is a good opportunity to educate the Introduction:This study was conducted to public on correct behavior and knowledge. evaluate the association between DMFT Materials and Methods:A sectional study Index and socioeconomic and behavior al risk was done on 190 patients in Tirana factors in randomly selected adult patients.

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Emergency on the scene for a 2-month first birth.Complications increase the morbidity time service, from 1.11.2014 to 31.12.2014. and mortality of neonat and mother too. The Results:Out of 210 patients it turns out that complication and the disease to be treated is a men include the main victims of road metabolic disease such as Gestational accidents, 85% men 25% who are female Diabetes or Pregnancy Diabetes. patients. The age of these patients ranged Materials and Methods:.This study is a from 2-85 years for males, and from 3-70 retrospective study, evaluating European and years for females, with an average of 32 years World literature, as well as Albanian. We are old. Most patients with trauma Official and based on two Maternities in Tirana. "SUGJ age groups of 15-30 years of age from 31 to Koco Gliozheni" and "Queen Geraldine" on 45 years old. It is stated that patients come cases of patients diagnosed with Gestational from road: Lushnje-Fushe-Kruja, Tirana- Diabetes. Durres, Kombi road. Conclusions: Gestational diabetes is a Conclusions: A well-trained team complication, a very dangerous metabolic specializing in trauma management with a disorder in pregnancy, it risks two lives, both standard procedure and protocols, well maternal and Fetal, increases the risk for defined are the keys to effective management neonatal morbidity and mortality. This study of polytrauma patients. demonstrates that a special care by the Keywords: emergency, emergency, multidisciplinary team in preventing it with ventilation, rating, transfer, selection. an early diagnosis, and good gravid care at its infancy, and a more effective treatment of this PE &P – 8 pathology, eliminates the risk of mother and infant too. Gestational Diabetes Keywords: Gravidance, diabetes, glukosis,

complications,prenatal diagnosis. Natasha MERKO ¹, Yllka BARDHI ¹, Etleva

RAMALIU ¹ PE &P – 9 Authors Information:

¹Nurse Service University Hospital of Trauma, Multiseptated Gallbladder with Recurrent Tirana, ALBANIA. Abdominal Pain. A Case Report and Literature Review. Abstract Xhesika XHETANI2* Vidi DEMKO1 Introduction: Gravidance is a special condition of mother to become wwhere her Authors Information: body is preparing having a child. Pregnancy 1Radiology Department, University Hospital duration is based on the gestational age of the of Trauma, Tirana, ALBANIA. first day of menstruation visit, accepting a 28- 2Radiology Department, University Hospital day cycle A fetus in term listed in the term he Center "Mother Teresa", Tirana, ALBANIA. was born alive at 38-40 weeks, preterm before 37 weeks and a fetal serotonin or after Abstract the term is designated that fetus born alive Introduction:Multiseptated gallbladder is a after week 42 of pregnancy. and me rare congenital malformation of the gynecological and imaging examinations, gallbladder and usually admits to the diagnostics. Gravidancies more normal, likely emergency services with differential or high performance, this classification can be symptoms such as right upper abdominal based on complications, disorders or diseases pain, nause and vomiting, and abdominal may occur at the time of its diagnosis, complaints. duration and until its completion that is

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We present a case of MSG with recurrent emergency care for acute illness, severely and abdominal pain in which laparoscopic multiple traumatized patients. Trauma is a cholecystectomy resolves the complaints of the major cause of death in recent years The patient. Chronic abdominal pain is a common emergency departament use the triage system, disorder in children and adolescents determinate the priority of needs (available worldwide. In attacking this problem, the personnel, equipment), stabilize and transfer pediatrician often concentrates on the the patient under specialised care of trauma gastrointestinal or genitourinary tract as a teams. The goal of emergency care is to source of the pain. Too little attention is paid reduce the mortality and morbidity by to the gallbladder as the cause of pain in this preventing of complications. Actually, the age group. We report a 6-year-old girl who trauma care is the priority of clinical research presented with recurrent abdominal pain in developing countries. and was diagnosed as having a Material and Method:The retrospective multiseptated gallbladder, although rare, study was performed during the period of should be considered in the differential time (2014 -2018). It has thrown interesting diagnosis of patients presenting with statistical data which are collected in medical recurrent abdominal pain and abdominal records of Trauma University Hospital. ultrasonography should form part of the Results: Data collection related with investigation. admitted patients in emergency departament. In Conclusion;multiseptated gallbladder is a There is increasing of (trauma+emergencies) rare congenital anomaly and a rare cause of incidence from 2014 until 2018. The recurrent abdominal pain. Cholecystectomy is incidence resulted 62,8% (2014), 73,5% the choice of treatment in symptomatic (2015), 70,1% (2016), 99,4% (2017), 97,4% patients such in our case. Our patients’ (2018). abdominal pain and gastrointestinal Conclusion:The emergency department is the complaints have resolved after surgery. part of medical polytrauma support.The Cholecystectomy should also be considered training courses are neccessary and avaiable in elderly, asymptomatic patients in whom for trauma medical teams. Improving of he multiseptated gallbladder is incidentally cooperation and coordination between discovered, due to the possibility of facilities is the best way for effective undetected carcinoma of the gallbladder emergency care. Keywords:gallbladder, abdominal pain, ultrasonography. PE &P – 11

PE &P – 10 Hepato Cellular Carcinoma. A case Report

Role of Emergency Department in Etmont ÇELIKU, Manser ÇILI*.

University Hospital of Trauma Authors Information: Edlira LTC KUKELI ¹, Raimonda TRAKO ² Department of Surgery, University Hospital Center “Mother Theresa” Tirana, ALBANIA Authors Information: 1military Medical Unit, Trauma University Abstract Hospital, Tirana, Albania Hepatoma is a tumoral disease that consists in 2american Hospital, Tirana, Albania an abnormal proliferation of the hepatic cells. According to the augmentation of the risk

factors such as smoking, alcoohol abuse, Abstract consuming no healthy food and different Introduction:The emergency department is types of viral and bacterial infections etc. staffed and equiped to provide rapid Nowdays, this disease is becoming more 113 | Page

3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts evident even in the young ages. Here, we Material and Methods: This is a present a 63 old female with this disease retrospective study. In this study we reviewed Hepatoma is malignant disease that is also all patients diagnosed with pancreatic cancer known as hepatocarcinoma (HCC) and is one in Service of Surgery No.1, Surgery of the most expressed tumoral disease of liver. It is seen a strong correlation between Department at University Hospital Centre hepatocarcinoma and other chronic liver “Mother Theresa”, Tirana, Albania in the disease such as Hepatitis B, C, diabetes period between January 1-st 2017 and March mellitus type 2, or chirrosis etc. 31-st 2019. All data were collected from Also is evidenced that being exposed to medical records. harmful factors such as alcohol abuse or Results: Our study shows that pancreatic being malnutried and with hipercaloric diet cancer is a low-incidence pathology that mainly in cholesterol and triglicerides (that cause the fat’s accumulation in liver) can affects men more. The most affected age bring an augmentation of Hepatocellular group is 61-70 years old with an average age carcinoma disease. However, this disease is of 66 years. Our study included 66 patients, very similar in appearance with the metastasis of whom 28 belonged to 2017, 28 to 2019, that origins from the other organs such as and 10 cases to the first 3 months of 2019. colon, stomach etc. The study found that pancreatic cancer was Most cases are treated with surgical resection diagnosed at a later stage and the most and chemotherapy, but the prognosis is not very hopeful. common surgery was 84%, palliative surgery, The hepato-carcinoma disease is very malignant while 8% receive conservative treatment. disease that interests not only the liver, but all Conclusion: Challenges to face are early the physiological reactions processes and has a diagnosis and treatment of Pancreatic high risk to spread metastasis in the other Cancer. organs. Being in front of this situation in this Keywords: Pancreatic Cancer, Pancreatic case, we thought that the most suitable way to proceed is the surgical treatment followed by Ductal Adenocarcinoma, the chemotherapy. The patient today is alive and has an PE &P – 13 improved clinical health. Life Quality of Immobilized Patients PE &P – 12 Zamira SHABANI1, Edona HAXHIJA1, Some Considerations about Pancreatic Donika SHKOZA1 Cancer in Albania Authors Information: Aurela KULLOLLI1,Xheladin DRAÇINI1,2*, 1University of Shkodra “Luigj Gurakuqi” Faculty Etmont ÇELIKU1,2 of Natural Sciences, Department of Nursing, Shkoder ALBANIA Author Information: 1General Surgery Services, UHC “Mother Abstract Theresa” Tirana, ALBANIA Introduction: This is a transversal (cross- 2University of Medicine of Tirana, Faculty of sectional) descriptive study. The aim of this Medicine, Tirana, ALBANIA study is to evidence of quality of life in immobilized patients. Abstract To identify physical skills related to daily Introduction: Pancreatic Cancer is the activities in immobilized patients. Identify the seventh leading cause of cancer-related deaths level of dependence of immobilized patients worldwide and the third most common in the and need for help. Identify the quality of life USA. There are few studies in Albania. The of immobilized patients regarding age group aim of our study is to evaluate epidemiology, and diagnosis. history, diagnostic procedures and surgical Materials and Methods:The data collection treatment of pancreatic cancer in Albania. was carried out in the period from January

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2019 to May 2019. The sample was selected Abstract randomly. In this study were included 85 The association of the gut with other immobilized patients. Initially, we tried to associated pathologies that make up the include 100 patients but 15 of them refused to metabolic syndrome is well known. The gut cooperate. Immobilized patients were has been seen to be associated with obesity. provided with a standardized international Numerous studies have indicated that a large questionnaire administered by us. The percentage of these patients have body weight questionnaire used contains 10 questions above ideal relative to age and body length. through which we obtain the necessary Hyperuricemia is common in diabetic information regarding the immobilized patients, whereas glucose arthritis is rarely patient's ability to perform basic need. encountered. Impaired glucose tolerance tests This questionnaire is called the Bartel Index have been reported in 7-74% of patients with originally created by Florence I. Mahoney and gut, depending on the criteria used. Dorothea W. Barthel; in use since 1955, first Hypertriglyceridemia has been reported in published in 1958). Questionnaires with 75-80% of patients with gut, and patients were conducted at QSUT "Mother hyperuricemia was found in more than 80% Theresa". Before the interview began, patient of patients with hypertriglyceridemia. and family consensus were taken. To analyzed Numerous studies have failed to show a the statistical data was used the SPSS.Vers.19 correlation between urate and cholesterol and Microsoft Office 2010. Was applied the levels. Hypertension has been found in ¼ to Pearson correlation for IC=99%, p<0.01. ½ in patients with gut, but the presence of Results:The average age of the interviewed hypertension is unaccompanied by patients is 62.5 years old when the minimum prolongation of the gut. Many studies have age is 22 years old and the maximum age is seen an association of hyperuricemia with 96 years. 53% of these patients are male (n = atherosclerosis manifestations and 45) and 47% are female (n = 40). hyperuricemia has been proposed as a risk Conclusions: Most patients are unable to factor for coronary disease. Alcohol use is perform such actions as personal grooming associated with hyperuricemia and personal effects, making the shower itself, predisposing persons may have. Based on climbing / lowering the stairs. 1/5 of these facts, we undertook to study with our immobilized patients have complete modest contribution the association of these dependence on their daily activities and conditions with arthritis. present us with a very bad life quality. Keywords:Gut, hyperuricemia, hypertension, Almost half of the immobilized patients have associations with arthritis. severe dependence and are presented with a poor quality of life. Heavy dependence is PE &P – 15 closely related to age increases. The higher the age of patients the higher the dependence Rehabilitation of Polytrauma Patients and and the lower their quality of life associated Tertiary Damage Reduction with daily activities. Keywords:Ability, immobilization, patient, Manushaqe SARAÇI1, Adriatik CEKA1, Geldon dependence. SPIROLLARI1

PE &P – 14 Authors Information: 1Rehabilitation and Physiotherapy Service, Gouty Artheritis, Correlation with Other University Hospital of Trauma, Tirana, ALBANIA. Metabolic Disease Abstract Alban HYSENAJ Introduction: The attitude of polytraumatic patients in Intensive Care extended because Author Information: of the clinical conditions and consequently Orthopedic Resident, University Hospital the occurrence of several aggravation factors, Center “Mother Theresa”, Tirana, ALBANIA by preventing their transfer to rehabilitation facilities. In most cases patients that have respiratory problems, feeding etc.do not make

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts possible the application of a good The fast-movingtransportation systems, rehabilitation program and to leave TI as soon unprecedented and unplannedurbanization as possible. and changing social patterns have Material and Methods: This is a prospective contributedto the global increase in the study, involving 120 patients who were incidence of trauma to human assisted in TI on the second day during body. Traffic accidents are an endemic December 2017- 2018.Average age 35+ disease which affectsmainly the young adults 5years old. M/F 3:1(95M; 25F). Patients are in the economically productive agegroups and presenting the evaluated cranial trauma with are the leading cause of death in persons GCS 3-8 points. Extremity trauma: long bone under44 years of age. Globally, 26% of all and pelvic fractures, patients with thoracic- deaths in the agegroup of 15-44 years in 2015 abdominal and bone fracture poly- were due to injuries. interventional and vertebral column trauma Infections in Traumatized Patientsare second such as: paraplegia, tetraplegia. The only to head injury as the leadingcause of rehabilitation protocol was applied in 3 death beyond the first three to four days of phases: Phase I-Rehabilitation of patients in traumaand are responsible for 80% of late coma (Prevention of complication). Phase II- deaths in adult traumapatients. This is mainly Start of motor commands. Phase III- because the management ofother major Autonomy (Post coma). contributors of mortality like Results: Automobilist trauma was ranked hemorrhage,circulatory collapse and first at 69%. lower limb fractures and poly- respiratory failure has greatlyimproved with intervention surgical: The duration of the application of sophisticated rehabilitation procedures is 4-6 weeks. Up to technicaladvancements. Traumatized patients 80% positive results. Cranial traumas:6 with infectionshave a 5-fold higher mortality patients with depase-coma died during the compared to those withoutinfection. The first week, 10 patient’s irreversible coma. overall incidence of infections Rehabilitation period is 6 months to 1 followingtrauma varies from 9-36%.This is year.60-65% positive results. As a result much higher thanthe rates of nosocomial invalidity is high. infection for general population. The overall Conclusion: Rehabilitation starting on the mortality was 15%, with majorityof death due second day to patients with polytrauma in to infections. ICU we minimized tertiary damages as The financial implication ofinfection and decubitus, paraarticulare calcification, sepsis following trauma are also staggering. muscular hypotrophy, urinary and pulmonary Resource utilization is prolonged in infections, etc, so we reduced disability. traumatized patientswith infections, most of which is spent in the ICUs. Thecost of caring PE &P – 16 for these patients will continue to increase with inflation, newer techniques, more This abstract has been withdrawn. sophisticatedmonitoring and the advent of new therapies. PE &P – 17 PE &P – 18 Trauma Emergency Surgery and Management of Infectious Disease Role of MRI in Cervical Spondylosis Myelopathy with Other Pathological Petrit BIBERAJ, Blerina BAHITI, Florenc Findings PILIGRIU Bardha DERVISHI1, Jeton SHATRI, Agon Authors Information: TURKAJ2, Veton ADEMI Faculty of Medical Technical Sciences, University of"Aleksander Xhuvani" Elbasan, ALBANIA. Author Information: 1 Student of General Medicine, University Clinical Abstract Center of KOSOVO 2 Accidents and trauma are one of the world’s University Clinical Center of KOSOVO mostserious but neglected health problem.

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

Abstract Introduction:Patient satisfaction is an Introduction: Cervical spondylotic important indicator for measuring the quality myelopathy (CSM) is a neck condition that in health care. The purpose of previous studies in this field has always been to assess arises when the spinal cord becomes whether there is an impact on the evaluation compressed due to the wear-and-tear changes of patient satisfaction in improving service that occur in the spine as we age. quality. Already most of the healthcare Case Report: The patient was a 52-year-old industries are more and more concentrated on male, who complains of neck pain, patient centered care and patient satisfaction, paranesthesia in upper extremities, lower back so measuring and analyzing patient pain and bilateral calf pain, muscle weakness satisfaction is an indispensable tool for enhancing and improving service quality. in the lower and upper extremities, fatigue and Health care organizations have been talking general body pain that started four weeks ago about and focusing on patient experience and associated with other clinical manifestation. patient satisfaction for a long time. Health Magnetic Resonance Imaging (MRI) of the systems should use patient satisfaction as a cervical spine revealed canal stenosis and balance measure not a driver for outcomes increased T2 signal within the spinal cord. (Bickmore and Merkley, 2019). CSM is a rare condition there are very few or This paper is based on a questionnaire conducted at the Trauma Hospital, where 180 no cases described in literature when CSM in patients who had been hospitalized for at least C3/C4 is associated with a lack of B12 and two nights were interviewed. The method other pathologies such as and hypoplasia of the used is SERVQUAL, divided into mastoid air-cell with system maxillary sinus demographic data and surveys related to the aplasia. main determinants of service quality Conclusion:The case described in the present assessment. Kaneet et al. (1997) and Marley stated that measuring satisfaction should study suggested that the incidence of CSM incorporate dimensions of technical, may be correlated with VB12 deficiency, interpersonal and moral aspect of care. In this particularly for cases in which the clinical study the determinants used to evaluate manifestations and the imaging do not fully quality by patients were, communication with match. clinicians, responsiveness of hospital staff, Keywords:Cervical myelopathy, clinical cleanliness and quietness of the hospital characteristics, hypoplasia of the mastoid air- environment, pain management, empathy of staff and use of advance technology. The cell purpose was to find out whether patients’ system, MRI, prognostic value. perceptions of service quality were related to their satisfaction, or whether the final PE &P – 19 outcome of treatment mattered to them alone. As a result, we can say that the satisfaction of This abstract has been withdrawn. patients was not only affected by the outcome of the treatment but also positively related to PE &P – 20 the way staff communicated, creating a sense of security and cleanliness and staff Patient Satisfaction and Quality of Service: responsibility. Trauma Hospital Case In evaluating hospital quality and enhancing

patient satisfaction, an important element is Rezarta KALAJA1 not only the latter’s evaluation, but also the Authors Information: communication of the results received to the 1Head of Department of Medical Technical Sciences; University “Aleksandër Moisiu” Durrës staff, in order to take appropriate measures to ALBANIA improve the quality based on experiences and opinions of hospitalized patients. Abstract

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3rd Annual Albanian Congress of Trauma and Emergency Surgery | Abstracts

INDEX TABLE

Amire DRAGUSHA ...... 15 A Ana STOJKOVSKA ...... 70 A BAKO ...... 86 Andzela VITANOVA ...... 70 A CANE ...... 86 Aner DURAKOVIĆ ...... 44 A JAUPI ...... 86 Angela TRPOSKA ...... 70 A. HOXHA ...... 50 Anila RACAJ ...... 55, 94, 97 A. MASKA ...... 93 Anna MANDI ...... 84 Adelina XHEMALI ...... 30 Antigona KABASHI ...... 57 Adem ZALIHIĆ ...... 44 Antonio GAVRILOVSKI ...... 38, 54, 113 Adham DARWEESH ...... 44, 46, 47 Antonio La GRECA ...... 8 Admir MUSTAFA ...... 46, 61 Anxhela AHMATAJ ...... 73 Admir NAKE ...... 30 Arb F. HOXHA ...... 12 Adriatik CEKA ...... 136 Arba CECIA ...... 19, 21, 23 Adriatik DAKU ...... 48 Arben BEQIRI ...... 108 Adriatik LAJÇI ...... 90 Arben DHIMA ...... 48 Afërdita ADEMI ...... 79 Arben GJATA ...... 10 Afërdita KULLURI ...... 74 Arben GJONEJ ...... 79 Afrim JAHAJ ...... 29 Arben LLOJA ...... 102 Afrim TAHIRI ...... 14 Arben TUSHA ...... 81 Afron MICI ...... 61 Arbëresha GURGURI ...... 128 Agon TURKAJ ...... 57, 137 Ardiana SINANI ...... 66 Agron DOGJANI ...... 9, 27, 62, 63 Arjan MULLAHI ...... 36 Aida GAVRANOVIĆ ...... 44 Arjana STRAKOSHA ...... 107, 108 Aida LAKO ...... 75 Arjeta DEDEJ ...... 107, 108 Aishe R LALA ...... 35 Armand STAFUKA ...... 113 Akgün ÇELIK ...... 60 Armida KABA ...... 41 Alan ANDONOVSKI ...... 53 Armir DAMZI ...... 50 Alban HYSENAJ ...... 115, 135 Arnel MICI ...... 116 Alban HYSENI ...... 113 Arsel DIZDARI ...... 113 Albana ALEKSI ...... 87, 89, 90 Arsen SEFERI ...... 19, 21, 23 Albana KENGA ...... 117 Arsim AJETI ...... 12 Albana KOCIAJ ...... 28 Artan BODEC ...... 50 Albana KOÇIAJ ...... 27 Artan GJIKA ...... 46 Albana NDOJ ...... 131 Artan KONI ...... 99 Albana POLOSKA ...... 80 Artan OSMENLLARI ...... 66 Albana SHAHINI ...... 48 Artid DUNI ...... 113 Albert LLESHI ...... 70 Artid LAME...... 22 Albert PESHA ...... 99 Artur XHUMARI ...... 20 Albi ARKAXHIU ...... 58 Arvin DIBRA...... 10, 25, 50 Albiona SALIAJ ...... 89 Arvit LLAZANI ...... 25, 50, 93 Aldi SHANI ...... 91 Asead ABDYLI ...... 69, 71 Aleksandar SAVESKI ...... 38, 54, 94, 113 Asfloral HAXHIU ...... 92 Aleksandar TRAJANOVSKI ...... 38, 54, 113 Astrit PEKA ...... 79 Alfred AGA ...... 41 Astrit XHEMALI ...... 50, 93, 118 Alfred GEGA ...... 113 Aulona HAXHIREXHA ...... 94, 103, 105, 107 Alfred IBRAHIMI ...... 10, 84, 85 Aurela KULLOLLI ...... 134 Ali DEVAJA ...... 12 Aurora KRASNIQI ...... 45 Alma CANI ...... 32, 35, 83 Avdyl PACOLL ...... 15 Alma LLUKAÇAJ ...... 51 Avenir BALILI ...... 124 Altin KUQO ...... 74 Ayman EL-MENYAR ...... 76

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B E B BARRIC ...... 85 Eden NAÇO ...... 84 Bardha DERVISHI ...... 137 Edlira LTC KUKELI ...... 133 Bardhyl VEIZI ...... 46 Edmond BRESHANI ...... 122 Baris SAYGILI ...... 20, 22 Edmond NUELLARI ...... 119, 120 Basri LENJANI ...... 10, 28, 109 Edmond PISTULLI ...... 30 Behar TOCILLA ...... 48 Edmond ZAIMI ...... 27, 28, 30 Besim BOCI ...... 40 Edona HAXHIJA ...... 134 Besim SERMAXHAJ ...... 14 Edvin SELMANI ...... 10, 54, 55, 79 Bijana POPOSKA ...... 70 Eliana SHIMA ...... 83 BiljanaANDONOVSKA ...... 53 Elizana PETRELA ...... 27 Bledar KRUJA ...... 41 Eljona XHELILI ...... 91, 92, 118 Bledar SHEGA ...... 99 Elona DYBELI ...... 71, 72 Bledi CEKREZI ...... 48 Elona GJYLBEGAJ ...... 106,126 Bledi MASATI...... 92 Elona HASALLA ...... 71, 72 Bleona SEJDINI ...... 75 Elona MARKECI ...... 61 Blerim ARAPI ...... 86 Elvis VELIU ...... 41 Blerina BAHITI ...... 137 Emir SMAJIĆ ...... 44 Blerta HAMOLLI ...... 115, 116 Emirjona VAJUSHI ...... 41 Blerta HASALLA ...... 71, 72 Endri SHEHU ...... 32 Borys BILYK ...... 12 Endrit MONE...... 75 Bruna SUBASHI ...... 128 Enea SERANI ...... 30 Bujar GASHI ...... 15 Engin GÖÇMEN ...... 60 Burak KOZA ...... 111 Enton BOLLANO ...... 32 Burim ELEZI ...... 110 Enver FEKAJ ...... 14 Erald XHELILI ...... 18 C Ergys CAMI...... 113 Carlos MESQUITA ...... 7, 24, 49, 51 Erinda KOSTURI ...... 45 D Eriol BRAHOLLI ...... 92 Erion DREDHA ...... 100 Dalip JAHJA ...... 38 ErionSPAHO ...... 22 Daniela TEFERIÇI ...... 120 Erisa MANE ...... 75 Daniela XHEMALAJ ...... 35, 66 Eriselda TAULLA ...... 64 Danny DAPHNIS ...... 124, 125 Eriselda TAULLAJ ...... 66 Dardan LENJANI ...... 28 Erjona ZOGAJ ...... 10, 130 Dariel THERESKA ...... 32 Ermira PAJAJ ...... 19, 21, 23 Denis KOSOVRASTI ...... 118, 120 Ermira TOTRAKU ...... 67 Deonada ÇOKU ...... 82, 130 Ervin BEJKO ...... 84, 85, 117, 118, 120 Deonada COKU (HYSKO) ...... 82 Ervin JONUZI ...... 95 Desli SHAHINI ...... 58, 59 Erza VOCA ...... 28 Dhimiter ARGJIRI ...... 32 Esat BARDHOSHI ...... 42 Dhimitraq ARGJIRI ...... 35 Esen UYSAL ...... 28 Dijon MUSLIU ...... 56 Esma SHARKA ...... 64, 65 Dmitry ILYIN ...... 95 Esmeralda BULKU ...... 84 Dominika VRBNJAK ...... 13, 121 Etleva GJOSHE ...... 127 Donika SHKOZA ...... 134 Etleva GJURASHAJ ...... 43 Dorela VASHA ...... 66 Etleva RAMALIU ...... 82, 130, 131 Dorian META ...... 73 Etleva SMAKAJ ...... 80 Dorina SHQALSHI ...... 49 Etlleva RAMALIU ...... 81 Dorina SHTJEFNI ...... 26, 35, 61 Etmont CELIKU ...... 92 Drini SHEHI ...... 25 Etmont ÇELIKU ...... 25, 51, 84, 133, 134 Dritan TODHE ...... 115

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Hasan HAFIZI ...... 66 Hasan Vedat OFLUOĞLU ...... 111 F Hasije DURAKU ...... 81, 82, 130 Fadil GRADICA ...... 10, 32, 35 Hassan AL-THANI ...... 77 Fahri KOKICI ...... 32, 35 Haxhire GANI ...... 84 Fahri KOKIҀ I ...... 83 Hayato KURIHARA ...... 7 Fatbardha MYSLIMAJ ...... 67 Hektor SULA ...... 68 Fatmir CAUSHI ...... 51 Helidon KLOSI ...... 126 Fatmir ÇAUSHI ...... 33 Helidon NINO ...... 32 Fatmir GUNI ...... 43 Henri KOLANI ...... 67, 84, 92 Faton KRASNIQI ...... 30 Herion DREDHA ...... 102 Faton T. HOXHA ...... 12 Husham ABDELRAHMAN ...... 78 Ferdinand KOMANI ...... 12 Hysni BENDO ...... 10 Ferizat DIKA – HAXHIREXHA .... 91, 94, 107 I Ferizate HAXHIREXHA-DIKA ...... 103 Filip NAUMOSKI ...... 70 I BUNJAKU ...... 28 Fiona NASTO ...... 107, 108 Ibrahim AVDI ...... 32 Fisnik KURSHUMLIU ...... 12 Igor KAFTANDZIEV ...... 94, 96 Fjorda TUKA ...... 48 Ihor HAIDA ...... 12 Flamur VELLKU ...... 38 Ilda TAKA ...... 71, 72 Flora J. GRADICA ...... 32 Ilia MAZNIKU ...... 71, 72 Flora ZYBERAJ ...... 80 Ilir ALIMEHMETI ...... 63 Floren KAVAJA ...... 12 Ilir HASANI ...... 38, 53, 70, 94, 96 Florenc PILIGRIU ...... 137 Ilir HASMUCA ...... 52, 113 Florian DASHI ...... 19, 21, 23 Ilir PEPOSHI ...... 51 Frenki VILA...... 91, 92, 117, 118, 120 Ilir SHABANI ...... 53 Ilir SHANI, ...... 91 G Ilir SKENDULI ...... 33, 50, 51 Gani SHABANI ...... 28 Ilira CAKO ...... 67 Gazmend ELEZI ...... 110 Ina KOLA ...... 87 Geldon SPIROLLARI ...... 136 Ina UZUNI ...... 75 Genc KABILI...... 124, 125, 126 Indrit JAUPAJ ...... 19 Gentian CACO ...... 117 Indrit TEMALI ...... 31 Gentian HUTI ...... 69, 71 Inid JORGONI ...... 25 Gentian ZIKAJ ...... 87, 88 Ismael Yousif Mahmood ALOMAR ...... 78 Gentjana HASKJA ...... 128 Isuf BAJRAMI...... 15 Gezim BIBA ...... 113 J Gëzim GURI ...... 46 Gezim XHEPA ...... 87 Jasmina KRÖPFL ...... 13, 121 Gëzim XHEPA, ...... 88 Jetmira KERXHALLIU ...... 19, 21, 23 GezimGALIQI ...... 99 Jeton SHATRI ...... 56, 57, 137 Gjergj CAUSHI ...... 113 Johana VRUHO ...... 41 Gjergj ÇAUSHI ...... 36 Jolanda NIKOLLA ...... 66 Gjergj SEMINI ...... 125 Jonela BURIMI ...... 84 Gjergji BELBA ...... 87, 90 Jordan SAVESKI ...... 94 Gjergji CAUSHI ...... 54, 55 Jožeta POTRČA ...... 26 Gjergji SEMINI ...... 100, 101, 123 Juxhin GJOSHE ...... 127 Gjovalin BUSHI ...... 35, 61 K Gledion FEJZO ...... 22 Gramoz BRACE ...... 19, 21, 23 K. HYSA ...... 106,126 Guido BASSI ...... 113 Kastriot HAXHIREXHA ..... 10, 27, 62, 91, 94, 103, 105 H Kastriot SUBASHI ...... 35 Haki DRAGUSHA ...... 15 Katerina KASA ...... 40, 43 Haqif GASHI ...... 16 Kenan BAYRAKCI ...... 37, 96, 113, 114

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Kenan KARAVDIĆ ...... 52, 98 Myzafer KAÇI ...... 50, 93 Kenan LJUHAR ...... 44 N Krenar PREZA ...... 125 Kujtim ALIMERI ...... 46 Najada KALLASHI ...... 46 Najada KALLASHI (JAHIQI) ...... 130 L Nardi KOLA ...... 87, 89 L. BYLYKBABSHI ...... 93 Natalija COKLESKA ...... 55, 97 L. Laci ...... 93 Natasha MERKO ...... 64, 65, 81, 82, 130, 131 Lazar TODOROVIC ...... 55, 97 Neda TRAJKOVSKA ...... 94 Leart BERDICA...... 107 Nehat BAFTIU ...... 28, 69 Ledia QATIPI ...... 107 Nertila KODRA ...... 84 Ledian FEZOLLARI ...... 37, 96, 113, 114 Nestor THERESKA ...... 108 Leodita GJANA ...... 41 Nevi PASKO ...... 108 Leon KAZA ...... 125 Niketa KOLICI ...... 106,126 Lindita SEJFULLAHU-ELEZI ...... 110 Norik HOXHA ...... 15 Ljubica MIKJUNOVIKJ ...... 97 Nuhi ARSLANI ...... 109 Lordian NUNCI ...... 117 Nuhi ARSLLANI ...... 28 Lorena HAXHIHYSENI ...... 42 O Lorenc GJOKA ...... 34 Loreta AGOLLI ...... 83 Odeta MISHO ...... 82 Luan BAJRI ...... 99 Oliver ARSOVSKI ...... 94 Luljeta STANAJ ...... 39 Olivia SHABANI ...... 87 Lutfi LISHA ...... 32, 35 Onder M. DELIALIOGLU ...... 96, 113, 114 Lutfi ZYLBEARI ...... 103, 105 Onder Murat DELIALIOGLU ...... 37 Lutfi ZYLBEHARI ...... 91, 94 Ormir SHURDHA ...... 31 M P M TAHIRI ...... 28 Parambath Arif NELLIYULLA ...... 47 M. ILIE ...... 96 Petraq MUSTAQE ...... 34, 122 Majlinda NACO ...... 51 Petrika GJERGO ...... 117, 120 Majlinda NAÇO ...... 84 Petrit BIBERAJ ...... 137 Majlindaj ZAHA ...... 128 Pirro PRIFTI ...... 58 Maksim BASHA ...... 51 Premtim RASHITI ...... 28 Manser ÇILI ...... 133 Preveza ABRASHI ...... 14 Manushaqe SARAÇI ...... 39, 136 Prof. Xheladin DRAÇINI ...... 134 Mariola NDRECKA ...... 89 R Marjan KAMILOSKI ...... 55 Marjan.KAMILOSKI ...... 97 R. BAFTIU ...... 69 Marjeta BILAJ ...... 86 Raimonda TRAKO ...... 133 Marjeta BILAJ(Miraka) ...... 85 Ramona A. PARISI ...... 130 Marko SPASOV...... 94 Rezart ÇIPI ...... 115 MarkusKONERT ...... 68, 71 Rezart XHANI ...... 100 Marsela SOPIQOTI ...... 118, 120 Rezarta KALAJA ...... 139 Marsida KRASNIQI ...... 40, 43, 138 Rezarta KAPAJ ...... 41, 89 Matilda IMERAJ ...... 103 Rezeart DALIPI ...... 38, 54, 94, 113 Mauro ZAGO ...... 24 Ridvan ALIMEHMETI ...... 19, 21, 23 Maysa MOHAMED ...... 44, 46, 47 Rinard KORTOCI ...... 86 Merita RUSTEMI-ELEZI ...... 110 Risida GJONEJ ...... 79, 80 Milan SAMARDZISKI ...... 38 Rok KOLARIĆ ...... 109 Muhamet PETROVA ...... 15 Roland KAZA ...... 86 Mujo SUBAŠIĆ ...... 44 Roland PERGJETANI ...... 19, 21, 23 Murat Onder DELIALIOGLU ...... 114 Roza LUCI ...... 128 MustafaXHANI ...... 100 Rrustem MUSA ...... 12 Myftar BARBULLUSHI ...... 108 Rudin DOMI ...... 69, 71, 100 Myriam HUNINK ...... 63

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Rustem CELAMI .. 10, 100, 101, 106,122, 123, Teodora TODOROVA ...... 38 124, 125, 126 Thoma KALEFI ...... 19, 21, 23 Ruzhdi REXHEPI ...... 104 V S V S. REXHA ...... 32 S. KRSTEVSKI ...... 96 V. LEKA ...... 106,126 Sadi BEXHETI ...... 56, 57, 91, 94, 103, 105 Valbona BEZHANI ...... 80 Sadık Yıldırım Özgeçmiş ...... 93 Valbona S. Rexha ...... 35 Sadri HULAJ ...... 29 Valbona SELMANI ...... 54, 55 Safet BEQIRI ...... 86 Valentin VEJSELI ...... 96 Saimir KUCI ...... 84, 85 Vasilika PRIFTI ...... 128 Sali GRADICA ...... 35 Vesel SKENDERI ...... 14 Sami KOCEKU ...... 35, 61 Veton ADEMI ...... 56, 137 Selda VEIZAJ ...... 75 Vidi DEMKO...... 46, 132 Selim Birol ...... 111 Viktor MARKU ...... 73, 98 Selman DUMANI ...... 85 Vilma CADRI ...... 106, 108 Serhii MITSUK ...... 12 Vilma MEMA ...... 138 Sevdije KOXHA ...... 107 Vilson RUCI ...... 79, 113 Shemsedin HASHANI ...... 12 Violeta ZANAJ ...... 81 Shpresa HASIMJA ...... 12 Vladimir FILAJ ...... 90 Sihana AHMETI-LIKA ...... 105 Vrenos HODAJ ...... 59 Simon TRPESKI ...... 94 W Simona KALŠEK ...... 9, 26, 56 Skender BRATAJ ...... 10, 14, 16, 18, 19 Wojciech SZMIGIELSKI ...... 46 Skender BUCI ...... 26, 35, 61 X Skender VELIU ...... 13, 121 Slavica LITAJKOVSKA ...... 55 Xheladin DRACINI ...... 10 Slavica SHUPERLISKA ...... 97 XheladinELEZI ...... 91 Sokol ISARAJ ...... 87, 89 Xhesika XHETANI ...... 132 Sokol RUCI ...... 35, 61 Y Sokol XHEPA ...... 117, 118, 120 Sokrat BERDUFI ...... 116 Ylber ZAMA ...... 54, 55, 113 Sonila NIKA ...... 128 Yllka BARDHI ...... 131 Sonja BUTORAC (SARACI) ...... 46 Z Sonja SARAÇI ...... 136 Sotiraq LAKO ...... 107 Zamir DEMIRAJ ...... 52 Stavri LLAZO ...... 84, 85, 118 Zamira BEXHETI ...... 103, 105 Studim HYSA...... 129 Zamira SHABANI ...... 134 Sulejman BAHA ...... 71, 72 Zef DELIA ...... 122, 125, 126 Suzana CAKONI ...... 66 Zef PERDUKA ...... 35 Zllato ALEKSOVSKI ...... 55, 97 T Teodor PEVEC ...... 9, 56

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Organised by: Organised by: Albanian Society for Trauma and Emergency SurgeryAlbanian (ASTES) Society for Trauma and Emergency Surgery (ASTES)

www.astes.org.al www.astes.org.al

-th 44-th AnnualAnnualAlbanianAlbanian CongressCongress ofof TraumaTrauma andandEmergencyEmergency SurgerySurgery

NovemberNovember 13-14,13-14, 20202020 Tirana,Tirana, AlbaniaAlbania

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