TIONAL M NA ED R I E C T A L N I

C A O IMCA I N N G A R B ESS IN AL

INTERNATIONAL MEDICAL CONGRESS IN ALBANIA INTERNATIONAL MEDICAL CONGRESS IN ALBANIA “Continuing Education among Health Care Professionists” APRIL 24 - 25, 2015 | TIRANA, ALBANIA APRIL 24 - 25, 2015 | TIRANA, ALBANIA

Organised by: AMERICAN HOSPITAL www.spitaliamerikan.com WELCOME

MESSAGE FROM THE CEO OF AMERICAN HOSPITAL

Patients come to the American Hospital expecting to have the highest standards that medicine can currently offer. The patients and their families consider the American Hospital as the place of care, trust and hope, the last word of medicine, the light in the end of the tunnel.The considerable number of patient, the trust and hopes we have given them speak volumes about us. It speaks of the reputation we have established in eight years of activity of the hospital hard-working team. It also speaks of the high expectations and responsibility we face on a daily basis to support those who have trusted in us.The staff of the American Hospital works constantly to find perfection in the services we provide to you. It is this indisputable professionalism and a technology of highest standards that make two of our most potent tools which make the difference.

Klodian ALLAJBEU, M.D. CEO

Dear Colleagues, It is our great pleasure to invite you to the “ International Medical Congress in Albania”, to be held in Tirana, from April 24-25, 2015. This Congress will be organised by American Hospital, in Tirana, Albania. The main focus of the congress is “Continuing education among Health Care professionals”. The congress will have multi disciplinary clinical sessions, including different aspects of general surgery with the main focus on cancer surgery; head and spinal trauma; transplants surgery; myocardial revascularization procedures and valve surgery;anterior cranial base surgery; current trends on diagnosis and treatment in ophthalmology; minimal invasive esthetic surgery & plastic invasive surgery; intensive care and anesthesia in cardiac and transplants patients; advanced imaging, nuclear medicine and laboratory; IVF and gynecology; joint preservations and orthopaedic injury; prevention and diagnosis in internal medicine and emergency care. Colleagues from all over Albania, Kosovo and abroad will attend and contribute in exchanging knowledge and experience, encourage one another in our efforts against disease, to save lives. We welcome you to the “ International Medical Congress”

Lindita Shosha Mano President IMCA 2015

3 ORGANIZING AND SCIENTIFIC COMMITTEE SPEAKER/CHAIRPERSON INFORMATION

ORGANIZING COMMITTEE OPENING HOURS PREVIEW CENTER

Klodian Allajbeu ( CEO, American Hospital) Friday, April 24 07.30-18.30 Lindita Shosha ( President of IMCA) Saturday, April 25 08.00-14.00 Kenan Bayrakci ( Vc.President of IMCA) Arben Kojqiqi ( General Secretary) Oriela Cano ( PR & Marketing Director) IF YOU ARE A CHAIRPERSON Onejda Ymeraj ( American Hospital 1 Director) • Please locate your session room in due time and be at your session at last 15 minutes Mario Karaj (American Hospital 2 Director) prior of the session Driton Ukmata (American Hospital Pristina Director) Novruz Çaushaj ( American Hospital Fier Director) • We may remind you that speakers need to strictly observe the time schedule. Genti Cako ( American Hospital Durres Director) • Please fill the questionnaire which be handed to you after the respective session. Ilda Jegeni ( Director of Procurement) Stela Mako ( Specialist of PR & Marketing) Dajana Ndreu( Specialist of PR & Marketing) IF YOU ARE A SPEAKER IN SESSION Loren Haxhi ( Webmaster IMCA) • Please locate your session room in due time and be at your session at last 15 minutes prior of the session • For sessions starting at 09.00, the presentations should be delivered the previews day. • In order to avoid any delays, speakers are kindly requested to hand in their presentations SCIENTIFIC COMMITTEE on Cd-Rom or USB

Lindita Shosha Mano (Tirana, Albania) Fatos Olldashi (Tirana, Albania) Kenan Bayrakci (Tirana, Albania) Bekim Jata (Tirana, Albania) IF YOU ARE PRESENTING A POSTER Arben Kojqiqi (Tirana, Albania) Nereida Xhabija (Tirana, Albania) Ugur Gozalan (Pristina, Kosova) Besnik Kojcici (Tirana, Albania) • Each poster will be displayed for the entire duration of the congress. Poster have to be Namik Kemal Duru (Tirana, Albania) Alfred Aga (Tirana, Albania) mounted on Friday, April 24, 2015 or on Saturday, April 25, 2015. Ethem Beskonakli (Tirana, Albania) Novruz Caushaj (Tirana, Albania) • Please attached the poster to the board with the corresponding poster placement Iris Allajbeu (Tirana, Albania) Emiljana Huti (Tirana, Albania) number on Monday 20 April, 2015. Otherwise, the staff will dispose of it. If you have Selim Erekul (Ankara, Turkey) Alfred Aga (Tirana, Albania) any questions regarding your poster(s), please do not hesitate to contact the staff at the Sadik Ersoz (Ankara, Turkey) Andi Kacani (Tirana, Albania) registration desk. Branko Bojovic (Massachusetts, USA) Teuta Haveri (Tirana, Albania) Philip Caushaj (Connecticut, USA) Leart Berdica (Tirana, Albania) Felice Giangaspero (Roma, Italy) Brunilda Zllami (Tirana, Albania) Marco Jacobbi (Torino, Italy) Juxhin Gjoshe (Tirana, Albania) Ugo de Santis (Napoli, Italy) Albana Daka (Tirana, Albania) Ahmet Maden (Izmir,Turkey) Gentian Huti (Tirana, Albania) Rainer Reinmieller (Wien, Austria) Edmond Puca (Tirana, Albania) Baris Saygili (Tirana, Albania) Sotiraq Lako (Tirana, Albania) Kadir Burak Koza (Tirana, Albania) Entela Puca (Tirana, Albania) Onder Delialoglu (Tirana, Albania) Ada Simeoni (Tirana, Albania) Kadir Baykal (Tirana, Albania) Fiona Nasto (Tirana, Albania) Klaus Boeheim, (Austria) Mimoza Meco (Tirana, Albania) Tritan Kalo (Tirana, Albania) Arben Dhima (Tirana, Albania) Agim Sallaku (Tirana, Albania) Arian Hodaj (Tirana, Albania) Mihal Tase (Tirana, Albania) Rezarta Kapaj (Tirana, Albania) Flamur Tartari (Tirana, Albania) Teona Bushati (Tirana, Albania)

4 5 PROGRAM AT GLANCE PROGRAM AT GLANCE

IMCA, INTERNATIONAL MEDICAL CONGRESS IMCA, INTERNATIONAL MEDICAL CONGRESS 24-25 APRIL 2015, Tirana, ALBANIA 24-25 APRIL 2015, Tirana, ALBANIA

PROGRAMME AT A GLANCE FRIDAY 24 APRIL 2015 PROGRAMME AT A GLANCE SATURDAY 25 APRIL 2015

7.30 REGISTRATION 08.00 REGISTRATION

9.00 – 10.00 WELCOME CEREMONY (BALSHA)

ABRET 10.00 – 12.30 PLENARY SESSION (BALSHA) BALSHA Cardiology & METROPOL 09.00 – 11.30 Intern Medicine Ofthalmology Cardiac Surgery 12.30 – 13.00 CORNER CONSULENTS

13.00 – 14.00 BUFFET LUNCH BREAK 11.30 – 12.00 COFFEE BREAK

BALSHA ABRET METROPOL BALSHA 12.00 – 14.30 Cardiology & Plastic Surgery & General Surgery ABRET METROPOL Intern Medicine 14.00 – 16.30 Neurosurgery Transplant & Urology Cardiac Surgery Dermatology Oncology & Pathology

14.30 – 15.00 CLOSING CEREMONY (BALSHA) 16.30 – 17.00 COFFEE BREAK

BALSHA ABRET METROPOL Orthopedics Advanced Gynecology 17.00 – 19.30 Trauma & Intensive Imaging Neonatology & Care Laboratory Pediatrics

WELCOME RECEPTION 20.30 Tirana International Hotel

6 7 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015

7.30 REGISTRATION GENERAL SURGERY & ONCOLOGY & PATHOLOGY

9.00 - 10.00 WELCOME CEREMONY 14.00 -16.30 Chair: Philip Caushaj, Emiljana Huti, Ugur Gonzalan, Leart Berdica Key lecture: “Rectal Cancer- Changing Paradigms of Management, Indications for Pri- 10.00 - 12.30 PLENARY SESSION mary Surgery, Salvage Surgery, Robotic Surgery and non Surgical Management”. “Continuing Education Among Health Care Professionals” Prof. Dr. Philip Caushaj(USA) Chair: Philip Caushaj, Lindita Shosha, Xheladin Dracini, Alfred Aga Key lecture: ”From the Flexner Report to Newer Models of Undergraduate Education” Key lecture: “Extralevator Abdomino Perineal Resection for Rectal Cancer” Prof. Dr. Philip Caushaj (USA) Prof. Dr. Ugur Gonzalan(TURKEY)

Key lecture: ”Continuing Education Among Health Care Professionals” Key lecture: “Surgical Treatment Alternatives of Rectal Cancer” Prof. Ass. Xheladin Dracini (ALBANIA) Prof. Dr. Nikollaq Kacani(ALBANIA)

Key lecture: ”Continuing Education Among Health Care Professionals” Key lecture: “Laparoscopic Surgery: a 25 year Experience” Mr. Klodian Rjepaj (ALBANIA) Prof. Dr. Philip Caushaj(USA)

Key lecture: ”The Revolution in Updating and Medical Communications” Cancer Care in Albania Prof. Dr. Myftar Barbullushi(ALBANIA) Prof. Agim Sallaku(ALBANIA)

Key lecture: ”Open Medical Institute-Medical Education Beyond Borders” Breast Carcinoma, Surgical Treatment in American Hospital,Tirana Dr. Robert Qirko (ALBANIA) Koza B. K., Godaj G, Goga A, Huti E, Murati A, Metaj R.

12.30 - 13.00 Corner Consulents: p16INK4A in Routine Practice as a Marker of Cervical Neoplasia Prof. Dr. Philip Caushaj, Prof.Ass. Xheladin Dracini, Mr. Klodian Rjepaj, Prof. Dr. Kurshumliu F, Thorns CH, Gashi L, Goc G, Hasbajrami A, Binishi J. Myftar Barbullushi, Dr. Robert Qirko Severity Grading and Surgical Management of Acute Cholecystitis Murati A, Shosha Mano L, Koza B, Godaj D, Goga A.

Assesement of ERCP in SPAM, New Techniques and approaches in Treatment of Cho- ledocolythiasis Tmava S, Fezollari L, Dracini XH, Fazlliu I, Vishi I, Abrashi B.

Doppler Guided Dearterialisation “THD” with Mucopecy-an Established Technique for Treating Hemorrhoidal Disease Shosha Mano L, Xhaferi M, Huti G, Miraka M, Popa B, Dhima A, Murati A.

Role of HBME-1 and GALECIN-3 in the Diagnosis of Thyroid Neoplasms Bushati T, Berdica L, Erecul S.

8 9 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015

NEUROSURGERY TRANSPLANT & UROLOGY & NEFROLOGY

14.00-16.30 14.00-16.30 Chair: Ethem Beskonakli, Mentor Petrela,Fatos Olldashi Chairs: Nestor Therecka, Fiona Nasto, Artan Koni, Flamur Tartari Key Lecture: “Pituitary Tumor Surgery” Key lecture:” Live Donor Liver Transplantation” Prof. Dr. Ethem Beskonakli (Turkey) Prof. Dr. Sadik Ersoz (TURKEY)

Key Lecure: “Pathology And Geneticts Of Gliomas” Key lecture:” The Burden of Chronic Kidney Disease in Albania Prof. Dr. Felice Giangaspero, Universita Degli Studi Di Roma “La Sapienza” (Italy) Prof. Dr. Nestor Therecka (ALBANIA)

Key Lecture: “Meningeoma Of Foramen Magnum, Retrocondylar Approchin 28 Cases” A Retrospective Review of Diabetic Nephropathy Patients During Referral to the Nephrol- Prof. Dr. Mentor Petrela, Faculty Of Medicine, Medical University of Tirana (Albania) ogy Clinic Pasko N, Strakosha A, Cadri V, Mumajezi S,Therecka N Key Lecture: Advances In Scull Base Surgery Prof. Ihsan Soraloglu (Turkey) Kidney Biopsy,an Albanian Experience Berdica L, Bushati T Scull Base Surgery, Endoscopic Transnasal Approach Aga A, Shytaj E, Vajushi E, Vasili D, Xhumari A, Petrela M. The Challenge of Doing the First Cases of Percutaneous Nephrolithotomy (PNL) in Kosovo Radiosurgery For Pituitary Adenomas, Our Experience Xhafa A, Kurshumlija F,Shaipi M Xhumari A, Aliraj A, Bregul, Myzeqari B, Mucollari I. “The Kidney, Hypertension and Diabetes” Stereotactic And Functional Neurosurgery At Uhc “Mother Teresa” Idrizi A Alimehmeti, Seferi A, Rroji A, Dashi F, Demneri M, Bushati T, Rakacolli M, Petrela M Malnutrition in Hemodialysis Patients Alpha Internexin Expression In A Series Of 156 Gliomas And Its Relation With Oligoden- Gjyzari A, Veliu SH, Gjyzari I troglial Morphology, Idh1, P53, And Synaptophysin Expression Bushati T, Berdica L, Alimehmeti M, Kaloshi G, Seferi A, Alimehmeti R, Pumo G, Ruka Surgical Treatment of Localy Advanced Prostate Cancer M, Petrela M. Galiqi G, Tartari F, Pesha A, Ymeri SH, Bajri L, Ferko SH, Ndoj A

Temporal Lobe Epilepsy: Surgical Treatmentof Epileptic Patientsin Our Neurosurgical Prevalence and Risk Factor of Anemia after Renal Transplantation. Service During The Last Three Years A Prospective Study in a Single Center in Albania Seferi A, Dashi F, Alimehmeti R, Lilamani E, Rroji A, Ruka M, Petrela M. Strakosha A, Pasko N, Nasto F, Dedei A, Cadri V

Instrumented Spinal Surgery In Albania Biofeedback Therapy, a Simple Method for Treatment of Urinary Disorders Olldashi F, P. Hodo, I Hodo, A. Selaj. Xhafa A, Dayanc M, Shaipi M

Interventional Endovascular Treatments Of Brain And Spine Our Experience Prostate Cancer in Albania,epidemiologic and immunohistochemistry consideration Enesi E, Rroji A, Bilaj F,Rudi I, Demneri M, Petrela M Berdica L, Bushati T,Popi H, Shabani F

10 11 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015

ORTHOPEDICS & EMERGENCY CARE & INTENSIVE CARE ADVANCED IMAGING & LABORATORY

17.00-19.30 17.00-19.30 Chairs: Kenan Bayrakci, Gjergj Caushi, Genti Huti Chair: Iris Allajbeu, Venanzio Valenzia, Albana Daka Key lecture: ”Point preservation surgery of the knee. “MOSAICPLASTY” Key lecture: ”Study of Esophageal-Gastric Transit and Gastro-Esophageal Reflux” Prof. Dr. Kenan Bayrakci (TURKEY) Prof. Dr. Venanzio Valenzia (ITALY)

Key lecture: ”Pemberton’ Osteotomy, a Selection for the Treatment of the Congenital Key lecture: ”Preanalitike Mistakes and Focus in Hemostasis” Hip Dislocation in Albania” Prof. Ass. Etleva Refatllari (ALBANIA) Prof. Dr. Gjergj Caushi (ALBANIA) The usage of CT angiography of coronaries in early Detections of CAD in Comparsion Key lecture: ”The Blast Pelvis & Anorectal injuries the Difficulties and the Great Chal- with Traditional Evaluation Schemes-Our Experience lenge of Treatment” I.Allajbeu, Jata.B, Hajro.E, Xhabija.N, Shahini.A, Nona.A, Meco.S, Temali.I Dr. Sc. Lindita Shosha Mano (ALBANIA) The unique Laboratory Network in Albania with ISO 15189 Standart Key lecture: ”Hip preservation surgery for adult hip: “Safe dislocation technique” Daka A, Marku L, Hyseni B, Marku I Prof. Ass. Onder Murat Delialoglu (TURKEY) Diagnostic Yield of Image Guided Core Needle Biopsy and Fine Needle Aspiration at the Patient Monitoring in Critical Care Setting via Vittal Signs American Hospital, Kosovo During 2013-2015 Panajoti E, Huti G,Arapi B, Miraka Bilaj M Kurshumliu F, Gjikolli B Sciatic nerve injury after THR with anterolateral approach The Importanance of Laboratory Check-Up for the Prevention and Early Diagnosis Duni A, Ruci V, Ruci J. Marku L, Hyseni B, Daka A, Marku I Thoracic Epidural Analgesia in Major Abdominal Surgery Too Many Faces of Liver Hemangioma Jusufi ,I Zeka Z, Hasani A, Gonzalan U, Tmava S. Bilaj F, Rroji A, Enesi E, Leka N, Qirinxhi D, Basho J, Babameto A, Rapi E, Vathi D, Celiku E The Modified SCARF Osteotomy Technique Provides Predictable Correction of Moderate to Severe Hallux Valgus Deformities Biliary Tract Cancers-Clinical Biochemistry, Imaging and Operability Data Ruci J, Gjika E, Selmani E. Duni A, Basho J, Kurti F, Aleksi R, Cekodhima A Transesophageal Echocardiography in the Intensive Care Unit PET/CT Structure and Function Ibrahimi A Dhima A, Tocilla B External Fixation Percy for Comminuted Fractures of the Distal Radius Breast Screening Saves Lifes. American Hospital as a Active Part of Screening in Albania Demiraj Z, Angjeli L, Ibrahimllari Y, Shehu K Shahini A, Allajbeu I, Shahini SH, Kosturi E A Panoramic View of Sepsis Syndrome at Emergency Room The Bone Marrow Biopsy How Do We Perform it and our Experience Pojani A, Hyka K, Lekgjika V, Novaku M, Cara A, Qeraj K, Qose A, Koza B, Puca E. Daku A, Cekrezi B, Ivanaj A, Berdica L,Erekyl S, Allajbeu I, Lako S,Pulluqi P, Xhumari P, Dhima A, Coma B.

12 13 SCIENTIFIC PROGRAM - FRIDAY APRIL 24, 2015 SCIENTIFIC PROGRAM - SATURDAY APRIL 25, 2015

GYNECOLOGY & NEONATOLOGY & PEDIATRICS CARDIOLOGY & CARDIOTHORAXIC SURGERY

17.00-19.30 9.00-11.30 Session 1 Chair: Goksu Goc, Juxhin Gjoshe, Ada Simeoni Chair: Arben Kojqiqi, Alfred Nona, Nereida Xhabija Key lecture: ”Delivery in Multiples-an Overview” Key lecture: ”Minimally Invasive Procedures in Cardiovascular Surgery and the Future Trends” Dr. Dimitrios Saricostas (GREECE) Prof. Dr. Neyyir Tuncay Eren (Turkey)

Key lectures:” New Challenges of Hemoglobinopathies in Albania” Key lecture: ”Timing of Aortic Valve Replacement in Aortic Stenosis” Prof. Dr. Anila Godo (ALBANIA) Prof. Ass. Gani Bajraktari (KOSOVO) Key lectures:”Total Laparascopic versus Abdominal Hysterectomy: Current Trends” Free Style Aortic valve Implantation Dr. Goksu Goc (TURKEY) Prof. Dr. Jurgen Ennker (GERMANY) The Treatment Options of Cervical Insufficiency during Pregnanacy Bajraktari D, Sula A, Delia Z Key lecture: ”Percutaneous Implantation of Aortic valve (TAVI) “ Ulrich Rosendahl MD, FETCS (UK) New Laboratory Biomarkers in Preeclampsia (PE), our Experience Daka A, Bylo A, Barbullushi M, Marku L, Marku I, Hyseni B Contrast Enhanced Cardiac MRI in Evaluation of Myocardial viability after MI– Correlation Between Extent of Nonviable Myocardium and Complications Roma Index and HE4 in the Evaluation of Epithelial Ovarian Mases Allajbeu I, B.Jata, A.Nona, N.Xhabija, S.Meco, E.Hajro, I.Temali, N.T.Eren, Gjoshe J, Daka A, Marku L, Delia Z, Theodhosi GJ. R.Rienmueller

Fetal DNA Fractions Examination-New Test for Fetal Abnormalities Myocardial Revascularisation – Off Pump Technique Qirko R, Gjoni M, Gjoshe J, Koroveshi E, Toma I Kojcici B, Arben Kojqiqi, J. Ganellari, G. Mulla

Early detection of Critical Congenital Heart Disease:Pulse-Oximetry Role Off pump CABG – Anaesthetic and Surgical Considerations Kolici N, Koja A, Simeoni A, Cipi L, Pino B Bilaj-Miraka M, Gentian Huti, Blerim Arapi, Erjon Panajoti, Besnik Kojcici, Arben Kojqiqi

Intermitent stenoses of the duodenum Evaluation of Glycated Hemoglobin Level in Patients with Coronary Artery Disease Preza K, Nano L Gjoshe E, A. Zaka, E. Hajro, E. Dhamo (Gjika) Hematological Changes in Patients Undergoing Coronary Aretery Bypass Surgery Etiologies of Abnormal Uterine Bleeding and its Managment Lako S, Daka A, Nurka T, Dedej T, Ostreni V Hoxhaj O, Gjoni M, Dede E

Intra-Cytoplasmic Injection(ICSI) Outcomes on Women 40 yrs old: A Retrospective study Sula A, Sertecelic Ihsan T, Ferhati B

14 15 SCIENTIFIC PROGRAM - SATURDAY APRIL 25, 2015 SCIENTIFIC PROGRAM - SATURDAY APRIL 25, 2015

OPHTHALMOLOGY INTERN MEDICINE

9.00-11.30 9.00-11.30 Session 1 Chair: Marko Jacobbi, Teuta Haveri Chair: Brunilda Zllami, Albana Shahini Key lecture: ”Retinal diseases,from Diagnosis to Treatment” Key lecture: ”Study of Swallowing and Dysphagia” Prof. Dr. Marco Jacobbi (ITALY) Prof. Dr. Venanzio Valenzia (ITALY)

Refractive Correctionof Moderate and High Myopia with VisianTM. ICL-PCPIOL.A Premium Key lectures: ”Headache in the Emergency” Refractive Options for Potentials Patients Prof. Dr. Jera Kruja (ALBANIA) Pesando P Is the Hashimoto Thyroiditis a Risk Factor for Thyroid Cancer? A Retrospective Study Intrastromal Corneal Ring Segments Puca E, Koza B, Huti E, Bitri S, Daku A, Berdica L, Bushati T, Puca E, Ylli A Ferrara Ring, Pesando P The Map of Prevalence of Allergic Disorders in Albania and Worldwide. A Short Report Keratokonus Disease, Diagnosis and Cross-Linking Treatment from Alb-ISSAC Study Haveri T, Meco M, Qafa N Piluri E, Mesonjesi E, Gupta R, Bregu B, Zoto M, Strachan D, Priftanji A

Excimer Laser Refractive Surgery for Refractive Errors Correction Stroke in Young Adults, Diagnostic Challenge and Prevention Qafa N, Haveri T, Meco M Zllami B, Basha E, Shahini A, Cekrezi B, Saygili B

Phakic IOL Artisan.Artiflex Use for Extreme Refractive Errors Correction The Role of Imaging in the Diagnstification of Vertebral Artery Disease Qafa N, Haveri T, Meco M Shahini A, Zllami, B, Shahini SH, Allajbeu I, Dhima A, Cekrezi B,Kosturi E, Tocilla B

Cataract Surgery in Glaucomatous Eyes Impact of Blood Use on Patients Undergoing Coronary Artery Bypass Surgery. A Pro- Meço M, Haveri T, Qato N spective Study Lako S, Daka A, Nurka T, Memishaj S, Dedej T A Panoramic Overview about Care Improvement and the Challenges of Albanian Ophthalmological Community, in Order to Eliminate the Avoidable and Prevent the Evaluation of Incidence and Clinical Features of Post Soncussion Syndrome (PCS) Blindness in the Future Albania Bardhi N, Mema V, Tandili A Basha E, Zllami B, Pavllo D, Cakonji Z

New Surgical Method for Correcting Diplopia (double vision) Switching to Once of Day Basal Insulin from Twice Daily Doses of Premix Insulin Human Pesando P or Analog Resulted in Greater Improvement in Glycemic Control Patients with type 2 Diabetes Diabetic Retinopathy, Results of may 2013 American Hospital free check up Lumi E, Ylli A, Guri M Haveri T, Meco M, Qafa N

Dealing with Resistant Diabetic Macular Edema Meço M, Haveri T, Qato N

Image Processing Algorithms: a New Method in Evaluation of Posterior Capsular Opacification after Cataract Surgery Halili I, Uka A, Ndreu A

16 17 SCIENTIFIC PROGRAM - SATURDAY APRIL 25, 2015 SCIENTIFIC PROGRAM - SATURDAY APRIL 25, 2015

CARDIOLOGY & CARDIOTHORAXIC SURGERY PLASTIC SURGERY & DERMATOLOGY

12.00-14.30 Session 2 12.00-14.30 Chair: Besnik Kojcici, Bekim Jata, Indrit Temali Chair: Selcuk Isik, Irena Savo, Rezarta Kapaj Key lecture: ”Surgical Treatment of the Ascending Aortic Aneurysm. Specific Technical Key lecture: ”Contour Restoration of the Forehead by Lipofilling: Our Experience” Considerations. Initial Albanian Experience” Prof. Dr. Selcuk Isik (TURKEY) Prof. Dr. Edvin Prifti (ALBANIA) Key lecture: ”Rejuvination by means of Combinations of Minimal Invasive Therapies” Key lecture: ”Pulmonary Hypertension – Diagnosis” Dr. Enrico Guarino (ITALY)

Dr. Roberto Poscia (ITALY) Key lectures: ”Lower Limb Reconstruction, Challenges and Up dates” Dr. Sc. Sokol Isaraj (ALBANIA) Key lecture: ”Pulmonary Hypertension – Treatment” Dr. Roberto Badagilacca (ITALY) Non Surgical Facial Rejuvenation Procedures Savo I, Mishtaku S, Jorgaqi E, Doci XH Pulmonary Hypertension and Right Ventricular Dysfunction as a Prognostic Factor in Acute Decompensated Heart failure Combining Lipofilling in Rejuvenation Procedures, a New Tool Nona A, Carmine Dario Vizza, Robero Badagliacca, Roberto Poscia, Cristina Gambar- Kapaj R, Hoxha S, Isik S della Influence of Sunburn in the Past in the Usage of Protective Behavior Towards Solar Irradiation Surgical Treatment of Heart Failure Doci XH, Savo I, Xinxo S, Vasili E Besik J Skin Resurfacing with Fractional Laser (1550nm) Cardiac Surgery- Are Blood Products Always Needed? Mishtaku S, Savo I Kojqiqi A, Camelia Kojqiqi, Valbona Isufaj, Dritan Agolli, Besnik Kojcici Our Experience in Treating Jawbone Anomalies through Orthognathic Surgery in Alba- Novel oral anticoagulants in prevention of stroke in patients with atrial fibrillation nian Patients , Isufi I, Bregasi A Temali I, Nona A, Jata B Isufi R Comparison of fracture load Between repair materials Neurological Complications after Cardiac Surgery Hysenaj N, Tabaku S, Boriçi D, Shundi E, Bardhoshi M Zllami B, Llazo. S, Basha. E, Huti. G; Arapi. B, Kruja J

Prevalence of Left Ventricular Hypertrophy in Patients with Predialysis Chronic Failure in the Hospital Center Elbasan Zheni GJ

18 19 SCIENTIFIC PROGRAM - SATURDAY APRIL 25, 2015 ORAL PRESENTATIONS

INTERN MEDICINE Continuing Education Among Health Care Professionals Dracini Xh

Continuing medical education (CME) consists of educational activities which serve to 12.00-14.30 Session 2 maintain, develop, or increase the knowledge, skills, and professional performance and Chair: Edmond Puca, Blerim Myftiu relationships that a physician or an other healthcare professional, uses to provide services Key lecture: ”Prophylaxis after Exposure (PPE)” for patients, the public, or the profession. The definition of CME is broad, to encompass Dr.Sc Arben Pilaca (ALBANIA) continuing educational activities that assists physicians in carrying out their professional responsibilities more effectively and efficiently. The content of CME is that body of knowledge and skills generally recognized and accepted Key lecture: ”Causes of Mortality of Cronic Diseases in Albania” by the profession as within the basis medical sciences, the discipline of clinical medicine, and Prof. Dr Enver Roshi (ALBANIA) the provision of health care to the public. CME topics include also management, educational methodology, practice management etc. In practice, CME refer to an event organised by a Survelliance of Infection in Intensive Care Unit in Albania- a Point Prevalence Study in certified and accredited institution to expand the knowledge and skills required by healthcare two University Hospitals professionals. Harxhi A, Nderu A, Cami A, Ohri I, Mehmeti J, Muhametaj J, Gjyzeli M, Kraja DH CME programs are meant for graduated board certified healthcare laureates, who have completed their formal training, and should be designed to change either physicians’ and other Aproach to Alcohol Use Disorders healthcare professionals competence, by teaching them strategies for translating the new Bitri Tivari S, Thoma E, Puca E, Capi R, Sotiri E, Huti E, Puca E acquired knowledge into action, or physicians’ and other healthcare professionals medical practice performance, or patient outcomes. CME accredited providers must also evaluate their programs’ effectiveness in achieving these goals. Sepsis in Department of Infectious Diseases last Years To enhance the overall performance of CME activities is necessary the collaboration among Puca E, Pilaca A, Stroni G, Qyra E, Qato M, Hysenaj ZH, Kalo T, Harxhi A, Pipero P, the appropriate academic groups, professional societies, and health care institutions, in Kraja DH order to define the best teaching protocols and to create a learning system for the lifetime educational development of healthcare professionals. Different Partern of Decompensation in Alcolic Versus non Alcoholic Cirrotic Kristani P, Kurti F, Xinxo S, Babameto A Open Medical Institute-Medical Education Beyond Borders Qirko R Electropsysiological Study of SCA and FRDA Patients Myftiu B, Orhan Kocasoy E, Baslo B Non Invasive Prenatal Test (NIPT) is a new possibility to evaluate the fetal condition for Down syndrome and other abnormalities. This test can detect abnormalities linked with sex Management and Surgical Treatment of Primary Hyperparathyroidism chromosomes and the fetal sex as early as 10 weeks. This test is available in Albania for Bode R, Celiku E, Agolli M, Dracini XH, Kaci M, Domi R pregnant women. Background: NIPT is based on latest technology in sequential evaluation of chromosomes. Systemic Family Therapy as an Advantage in Comparison with Medical Therapy It is safe and easy to get the sample for this test compared to amniocentesis. Other non- Hoxha B, Uka A, Shunjaku F, Jashari R invasive blood tests or ultrasound examinations are safe for the mother and fetus but false positive rate for these tests is up to 5 % and low sensitivity for trisomy 21 up to 30 %. Diagnostic Ultrasound and Family Doctors These tests can result in positive for fetal chromosomal abnormalities in fetuses that are Cela M, Bilja F, Leli D, Hoti A, Zyka E, Ceka E, Qirko R, Shtylla A normal, in a totally normal fetus or vice versus. NIPT will reduce in significant rate false positive and false negative for chromosomal abnormalities. On other side diagnostic tests as amniocentesis or Chorionic Villus Samples have high sensitivity for fetal trisomy, but in both tests is not safe to receive samples because of high rate of fetal abortion. Results: we included in our study 108 women who voluntary completed Non Invasive Prenatal Test. 31 patients or 28.7 % were registered as high risk for trisomy in routine laboratory tests and/or ultrasound evaluations. 42 patients or 38.8 % were older than 35 years. In 0.9 % or one patient resulted in high risk for trisomy 21 or Down Syndrome in NIPT and it was diagnosed by karyotype later on. 78 patients or 72.2 % delivered and are totally normal for chromosomal abnormalities. This test resulted false positive and false negative rate 0 and its sensibility is 100%. Conclusion: Based on our study but even from other reviews new approach for chromosomal abnormality evaluation based on DNA fractions is one of the best non- invasive test because of its accuracy and safety. Soon we will include this test in routine protocols for pregnancy follow up.

20 21 ORAL PRESENTATIONS ORAL PRESENTATIONS

Extralevator Abdominoperineal Resection for Rectal Cancer of patients who underwent breast cancer surgery in our hospital. American Hospital, Prishtina, Kososvo Results: We had more than 100 patients who were operated with breast cancer. 99% of patients Gonzalan U were females but also one male. Age limits range from 22 to 79 years old. Most of them had radical modified mastectomy with axillar dissection. Quadrantectomy (or lumpectomy) is not Introduction:1/3 rectum cancer are located on the distal part of rectum. These rectum cancers preferred massively by us because of the lack of proper radiation therapy in the postoperative are always challenges for surgeons. Lower rectum cancers require APR. In advanced centers period. 10 patients had immediate reconstruction. 7 patients had contralateral prophylactic the rate of APR is less than 10%. Patient and tumor dependent factors effect to the decision mastectomy due to founded suspicion for BRCA mutation. Short terms complications were of APR. Lower rectal cancers are still a problem and APR is associated with poor oncological three patients with wound infection and about 15 patients’ had seromas. No lymph edema has outcome. Standard APR has higher local recurrence rate and poorer prognosis when been seen. No local recurrence has been confirmed until now. compared with AR. Positive circumferential margin 2-3 folds higher in APR group patient. Conclusion: Our surgical team at the American Hospital in Tirana has very good results in Moreover perforation rate 4 folds higher when compared with AR. There are 3 different type of the treatment of breast cancer. The type of operation is decided considering also the patient APR; inter-sphincteric, extra levator and ischio¬anal. Classic APR is the intersphicteric type. desire but always based on sound medical judgment. The short and long term complications The aim: of the extralevator APR is to prevent of the waisting. Indications for the extralevator are very low and local recurrence rate is comparable with good breast cancer centers. APR are tumors extending less than 1 cm from dentate line and, tumors threating circumfer- ential margin. p16INK4A in Routine Practice as a Marker of Cervical Neoplasia Conclusion: Extralevator APR reduce rate of perforation. This also reduce rate of positive Kurshumliu F, Thorns CH, Gashi L, Goc G, Hasbajrami A, Binishi J. CRM. It improves oncological results. Objective. The aim of this study was to validate the role of p16INK4a immunocytochemistry as Key lecture: “Surgical Treatment Alternatives of Rectal Cancer” a marker of cervical epithelial neoplasia in cytology and biopsy samples. Kacani N Methods. During the period of 4 years a total of 501 immunocytochemistry stains in cytology and biopsy samples were performed. The cytology smears were obtained from two independent Colorectal cancer ranks second, for the number of deaths, after bronchial cancer in men, laboratories of women with low-grade squamous intraepithelial lesion interpretation of Pap test and breast cancer in women. We generally diagnose colorectal cancer in advanced stages, or ThinPrep. Additionally, a selection of paraffin blocks from cases diagnosed previously with reducing survival and increasing treatment costs. squamous intraepithelial lesion and cervical cancer were immunostained. During the period 2002-2014, 382 patients with rectal cancer were treated in the Digestive Results. Among 312 cytology samples analyzed byimmunocytochemistry, 36.2% were positive Surgery clinic of Tirana, Q.S.U.T. Cancer location was found as below: in 36.12% of cases the upper rectum, 38.74% in the middle rectum and 25.13% in the lower rectum. for p16INK4a. Negative cases were followed-up with conventional Pap smear and 86.9% Fiber colonoscopy, CT, MRI, Echo endoscopy, preoperatory biopsy was used for diagnostic showed regression. Among positive patients, 14 underwent surgery and 100% exhibited purposes. Not all the diagnostic examination was used at once at all the patients. squamous intraepithelial lesion. In addition al immunohistochemical analysis of selected 81.9% of patients were diagnosed in stage I-II B, and 18.6% in stages IIIC-IVB. Surgical biopsies from our archive, we found that the ratio of positivity for p16INK4a increased from 40% interventions resulted in the upper anterior resection, 32.6%, lower anterior resection, 29.3%, in L-SIL/CIN1 to 69.8% in H-SIL/CIN2 to 100% in H-SIL/CIN3 and squamous cell carcinoma. A abdominoperineal 20.15%, 8.66% with stoma. relatively low number (24%)ofcases with squamous metaplasia revealed focal and/or sporadic Palliative surgery: resection in 7.3% and colostomy in 10.7% staining in the superficial layers of the epithelium. All the cases of cervical adenocarcinoma and 15.9% of patients, in advanced stages, had chemotherapy and radiotherapy before surgery. mesonephric carcinoma were positive for p16INK4a. Surgical operation was performed 6-8 weeks after chemotherapy and radiotherapy. From Conclusion. p16INK4a is a useful additional marker for interpretation of problematic Pap smears these patients, 2 or 18.1% had anterior resection. Stoma was used in 45% of cases. Protective ileostomy was realized in 15.2% while as a solution of anastomotic leaking in 5 and reduces the variability during evaluation of suspicious biopsies of the uterine cervix. patients. Ileostomy was closed 45 days after the first surgery. Early complications were found as below: SSI 4.6%, 2.8% anastomotic leak, bleeding in 1%, Severity Grading and Surgical Management of Acute Cholecystitis ileostomy for the treatment of anastomotic leak was performed in 1.3% of cases. All patients Murati A, Shosha Mano L, Koza B, Godaj D, Goga A. had chemotherapy and radiotherapy after surgery. Recurrence was found in 32 cases or 9.4% of the consulted patients. Recurrent patients had: Objective: A review of TG 07, TG 13 and EAES guidelines for severity and surgical colostomy 28.2%, abdomio-perineal resection in 31.2% and 40.6 % radiotherapy. management of acute cholecystitis. Treatment of rectal cancer is multidisciplinary. Prognosis depends of the stage of tumor, Background: There were no severity assessment criteria for this disease before publication surgical quality related to surgeons experience. in 2007 of the Tokio Guidelines for management of acute cholangitis and cholecystitis. Acute cholecystitis may present a spectrum of disease from a mild self – limited to a fulminant Breast Carcinoma, Surgical Treatment in American Hospital,Tirana lifethreatening disease. Presented with severity assessment criteria acute cholecystitis is Koza B. K., Godaj G, Goga A, Huti E, Murati A, Metaj R. classify into three grades: Severe ( gr. III ) associated with organ disfuncion. Urgent management of organ disfuncion and management of severe local inflammation by Introduction: Breast cancer is nowadays the first killer of women worldwide. Also in Albania we gallbladder drainage should be carried out. are encountering more patients with breast cancer every year. The aim of this retrospective Moderate (gr. II) in which the degree of acute inflammation is likely to associated with study is to present our results in the surgical treatment of breast cancer in the American increased operative difficulty in performing cholecystectomy. Early cholecystecto- Hospital of Tirana. my ( open or laparoscopic) is recommended in experienced centers. Patients with se- Methods: This is a study made in the American Hospital II in Tirana. We analyzed the charts rious local complications emergency surgery should be conducted along with gen-

22 23 ORAL PRESENTATIONS ORAL PRESENTATIONS eral supportive care. Patients that have severe local inflamation, early gallbladder disease. The first THD surgery in the American hospital was performed on December 2009. drainage (percutaneous or surgical) is indicated. Medical treatment and delayed chole- RESULTS: We treated 182 patients from December 2009-February 2015. Mean age 41 yrs cystectomy are necessary; Mild (gr.I) where has no findings of organ dysfunction and (18-73 yrs). Male 58,7%(107), female 41,3%(75). Piles II degree 22,5%(41), III 49%(89), mild disease in the gallbladder, enabling cholecystectomy a safe and low risk procedure. IV 28,5%(52). Hemorrhoidal disease with associated another anal disease was seen in The optimal treatment for ac. cholecystitis is early cholecystectomy: open or laparoscop- 55,4%(101) of patients, respectively with chronic anal fissure in 17%(31), anal polyp in ic. At the moment lap – choly is comprehensively preferred as the surgical treatment. 8,2%(15), perianal condyloma 3,8%(7), anterior mucosal rectal prolaps 23,6%(43),anal From march 2013 – march 2015 we have done cholecystectomy on 27 cases with acute fistula 2,7%(5).In 6(3,2%) cases, the THD was used to control massive bleeding from cholecystitis Gr. I – II, one case Gr III in a total of 134 cases. We did open cholecystetomy hemorrhoids after anticoagulants(post bypass surgery), and 1(0,5%) case massive bleeding in 9 cases, lap choly in 18cases without convertion. We have a case of readmission for a from exteriorization of fecaloma. In 7(3,8%) cases THD was used to stop bleeding after minimal septic collec. previous open hemorrhoidectomy. The evaluation of postoperative pain score by FPS: with pain level IV 7,1%(13), level III 42,9%(78), level II 50%(91) of cases. Postoperative Assesement of ERCP in SPAM, New Techniques and approaches in Treatment of nonsignificant bleeding 17%(31), abundant bleeding 0,5%(1), thrombosed external piles Choledocolythiasis 4,9%(9), skin tags 11,5%(21), urinary retention 20,3%(37), anal itching 4,4%(8). Length of Tmava S, Fezollari L, Dracini XH, Fazlliu I, Vishi I, Abrashi B. stay 2 days. Satisfaction from surgery was very good 96,5%(142), moderately good 2%(3), 1 (0,5%) was not satisfied at all from surgery, activity restarted 6-7 days after surgery. Aim: Endoscopic retrograde cholangiopancreatography (ERCP) as a technique that uses a CONCLUSION: The THD technique is effective in all degree piles, has low complication rate, combination of luminal endoscopy and fluoroscopic imaging to diagnose and treat conditions minimal postoperative pain. Lateral internal sphincterotomy or anoplasty resolves the cases associated with the pancreatobiliary system. This study discusses the outcomes of our cases with associated anal fissure. Rectopexy helps in cases with anterior mucosal rectal prolapse with the quality standards proposed in the literature, new techniques and approaches in and week pelvic floor. Return to normal activity is short, with good satisfaction rate. More time ERCP in American Hospital. is necessary to evaluate long-term results. Patients and methods: In this study, a total of 135 ERCP procedures performed in patients at the endoscopy department of our hospital from 14 february 2012 (date of first ERCP in Role of HBME-1 and GALECIN-3 in the Diagnosis of Thyroid Neoplasms Albania) until december 2012, which were retrospectively evaluated. Bushati T, Berdica L, Erecul S. In two units of ERCP in American Hospital (Tirana/Pristina), retrospective study of the 135 ERCP performed , results obtained and compared them with the quality standards In many cases, the pathologist faces thyroid lesions, in which the difference between proposed in the literature, new techniques and approaches in ERCP in American Hospital. benign and malignant can be quite difficult. The decision that supports one or the Guide – Wire assisted technique is standard protocol used in ERCP performance in our other has clinical implications and means different treatment modalities. On one practice. Conventional canulation in ERCP with injection was never used in American hand one should avoid excessive treatment and patient psychological disorder. On Hospital. The age, gender, complaints, pre-procedure diagnosis, the radiologic and the other hand, in patients with potentially aggressive disease should be guaranteed clinical results, number of procedure repetitions and the final diagnosis were assessed. effective management in the initial stages of disease, when it is still treatable. At our department, pethidine, midazolam and hyoscine-N-butylbromide are used in the Well differentiated, encapsulated tumors of the thyroid gland, with follicular architecture can ERCP procedures for premedication and additionally, cefazolin intravenous is routinely cause diagnostic difficulties. Capsular or vascular invasion controversial may increase the administered for prophyllaxis one hour before the examination. Also, Indometaine 100 possibility of a follicular carcinoma, while inclusions and focal nuclear sulcus may suggest mg supp. Admistrated prior of ERCP in preventing of irritation and reaction of pancreas. the diagnosis of papillary carcinoma. Recently, series of studies are made to describe cases During the procedure, oxygen saturation and heart rate are monitored by pulse-oximeter. with morphological features suggestive but not conclusive for malignancies. The purpose of The patients were those admitted to our hospital or referred from other healthcare centers. this study is the investigate the expression and diagnostic role of HBME - 1 and Galectin - 3, Results: It was 53 patient (n=39.2%) with choledocolythiasis treated with ES (endoscopic two markers associated with malignancies, in well differentiated tumors, or follicular tumors of sfincterotomy) and stone extraction. The age range was 21 to 89 years old and the mean age uncertain malignant potential, we examined in the American Hospital Tirana the later two years. was 58.33. Amoung them, 65.4% of the cases were fema. The data show that HBME-1 and Galectin-3 have heterogeneous immunoreactivity in these borderline tumors, but a strong and diffuse immunoreactivity of HBME-1 and, Doppler Guided Dearterialisation “THD” with Mucopecy-an Established Technique for to a lesser extent of Galectin-3, in the group characterized by nuclear changes which Treating Hemorrhoidal Disease were similar, but less pronounced than those of conventional papillary carcinoma. Shosha Mano L, Xhaferi M, Huti G, Miraka M, Popa B, Dhima A, Murati A Keyword: thyroid; Well differentiated tumor of uncertain malignant potential, follicular tumor of uncertain malignant potential, papillary carcinoma, follicular carcinoma, HBME-1; Galectin-3 INTRUDUCTION: Transanal hemorrhoidal dearterialization is an innovative technique to treat hemorrhoids using a specially designed proctoscope for Doppler-guided trans- “Pituitary Tumor Surgery” anal ligation of terminal branches of the SRA, resulting in decongestion of piles. Beskonakli E PURPOSE: to assess the efficacy of THD & mucopexy and analyze the results ofour experience regarding postoperative pain, complication, patient satisfaction with transanal Pituitary tumor is a neoplastic process in the tissues of the pituitary gland, a pea-sized organ. hemorrhoidal dearterialization device. It is located directly behind the eyes and below the front of the brain. This is the small part METHODS: The THD SLIDE proctoscope was used for identifying and suturing terminal of the brain that regulates the body’s balance of many hormones. Most pituitary tumors are branches of SRA. We included the patients with II-IV degree piles and associated anal benign benign nature and it is a fact that up to 20% of people have pituitary tumors. Many of these

24 25 ORAL PRESENTATIONS ORAL PRESENTATIONS tumors don’t cause any symptoms and are never diagnosed during the person’s lifetime. The semisitting position through a posterior, postero-lateral retrocondylar approach, while causes of pituitary tumors are unknown. Most diagnosed pituitary tumors are functioning and 1 patient was operated in prone position. A Simpson grade resection 1 was achieved in they produce hormones. There are many treatment alternatives depending on the tumor size, 5 patient (19%), a Simpson grade 2 in 20 patients (76,9%), and a Simpson grade 4 was nature and also clinical symptoms. In some cases, medical therapy is used to shrink, destroy performed in 1 case (3.8%). Post-operatively there was 1 death (3.8 %) due to pneumonia, and control the tumor but surgery to remove the tumor is often needed especially if the tumor 1 case (3.8%) with post operative tracheostomy for three months and 3 cases (11.5%) with is pressing on the vital brain structures such as optic nerves and third. Ventricle. temporary lower CN deficits. Most of the pituitary tumors can be removed surgically through the nose (Transseptal- Conclusions: With carefully microsurgical dissection the foramen magnum meningiomas can Transsphenoidal route). If the tumor cannot be removed this way, it can be removed through be safely and completely resected via a posterior or postero-lateral retrocondylar approach, the skull (Transcranial route). Radiation therapy may be used to shrink the tumor for people even those located anteriorly and those in contact with the vertebral artery without causing who cannot have surgery or it can also be used even after surgery. Early diagnosis and craniovertebral instability. treatment is essential, the prognosis after treatment is generally good and this could be associated with the level of skill of the surgeons. In this presentation I’ll present our clinical Key Lecture: Advances In Scull Base Surgery data and show some video examples of our surgical cases. Soraloglu I

Key Lecture: “Pathology And Geneticts Of Gliomas” Skull base tumors are some of the most challenging, complex and technically demanding Giangaspero F tumors to treat due to their close proximity to important neural and neurovascular structures. Patients who had tumors in the skull base and surgeons who ventured into this area faced poor Diffuse gliomas are currently classified as astrocytomas, oligodendrogliomas, or oligo­ prognoses and poor outcomes for many years. But recent advances in diagnostic, anesthetic, and surgical techniques, skull base surgery has undergone rapid advancement. These astrocytomas and range in grade from II to IV. Glioblastoma (GBM), WHO grade IV, is tumors are now routinely resected with reliable results and decreasing morbidity with new the highest grade and most common form of astrocytoma. In the past, the diagnosis of anatomic insights, surgical techniques, endoscopic technology, novel instrumentation, and gliomas was almost exclusively based on histopathologic features. More recently, improved intraoperative image-guidance capabilities. Selection of surgical approaches to the anterior understanding of molecular genetic has led to molecular studies becoming standard for skull base is based upon the nature of the pathology, patient characteristics, and surgeons classification, prognostication, and predicting therapy response. Isocitrate dehydrogenase expertise. A multidisciplinary team (including neurosurgeons, radiologists, anesthesiologists, (IDH) mutations are frequent in grade II and III infiltrating gliomas and secondary GBMs. otorhinolaryngologists, plastic surgeons, and ophthalmologists) approach is particularly Infiltrating astrocytomas and secondary GBMs are characterized by IDH, TP53, and ATRX important in the treatment of skull base pathologies. mutations, whereas oligodendrogliomas demonstrate 1p/19q codeletion and mutations in IDH, CIC, FUBP1, and the telomerase reverse transcriptase (TERT) promoter. Primary GBMs Scull Base Surgery, Endoscopic Transnasal Approach typically lack IDH mutations and are instead characterized by EGFR, PTEN, TP53, PDGFRA, Aga A, Shytaj E, Vajushi E, Vasili D, Xhumari A, Petrela M. NF1, and CDKN2A/B alterations and TERT promoter mutations. Pediatric GBMs differ from those in adults and frequently have mutations in H3F3A, ATRX, and DAXX, but not IDH. Objective: Trauma and surgery (especially the endoscopic sinus surgery performed by In contrast, circumscribed, low-grade gliomas of childhood, such as pilocytic astrocytoma, non expert surgeon) are the most common causes of cerebrospinal fluid (CSF) rhinorhea. pleomorphic xanthoastrocytoma, and ganglioglioma, often harbor mutations or activating Surgical repair is recommended for patients with skull base defect and/or CSF leaks. In the gene rearrangements in BRAF. Neuropathologic assessment of gliomas increasingly relies armamentarium of Otorhinolaryngologist and Neurosurgeons we have different approaches on ancillary testing of molecular alterations for proper classification and patient management. to treat this pathology. The Implementation of the endoscopic transnasal approach of the skull base in countries which have limited resources and economic possibilities was evaluated. Key Lecture: “Meningeoma Of Foramen Magnum, Retrocondylar Approchin 28 Cases” Methods: From June 2013 to November 2014 in the American Hospital and NCH Department Petrela M of Mother Teresa Hospital in Tirana, were operated the first 4 cases of the skull base defect by transnasal endoscopic approach. The major and minor complications, days of hospitalization Purpose: Foramen magnum meningiomas are challenging tumors due the vicinity with and the difficulties for the surgeon in dealing with the lack of appropriate equipment were neurovascular structures. We report a single surgeon experience (MP) with posterior, evaluated. posterolateral retrocondylar approaches in 26 cases. Results: The endoscopic repair of CSF leaks was successful in all the 4 cases; 3 meningocele Methods: From 2004 to 2014, 26 patients (14 women and 12 men) were treated with meningiomas and 1 posttraumatic CSF leaks. The technique and material to repair the defect was different, of the foramen magnum. For all patients the clinical dates were retrospectively reviewed. depending on site and size of the defect. In only 1 case we used glue material such as Bio- Results: The common signs and symptoms were occipital neuralgia (34.6%), gait ataxia Glue, in the other cases we did not have any type of available fibrin-glue material. In 3 cases (34.6%) cranial nerves palsies (27%), spastic tetraparesis (27%) and hemiparesis or we used a Had ad flap and in 1 case we used an ileotibial tract and middle turbinate flap to hemihypoesthesias (7.7%). The preoperative MRI revealed an intradural localization of reconstruct the anterior skull base. The incidence of major complication after surgery was 0% foramen magnum meningiomas in 22 cases (84.6%), intra-extradural localization in 2 cases but the first patient after 15 month had meningitis without rhinorrhea. Till now the origin of this (7.7%) and 2 extradural localization (7.7%). According to the George classification in relation infection and the possibility of spreading of the infection are not clear and is to be evaluated. to the dural insertion there were 2 cases posteriorly inserted (7.7%), 6 cases with purely Conclusion: The endoscopic technique is applicable even in developing countries and it is anterior dural insertion and 7 cases with pure lateral dural insertion, while 11 cases were highly effective, associated with low morbidity. The literature especially in the last 10-years antero-laterally located. In relation to the vertebral artery there were 12 cases located below supports the endoscopic approach using a variety of techniques and materials, but the the VA (46%) and 10 cases above the VA (38.4%). 23 patients were operated on in a surgeon and the supporting staff must have adequate expire.

26 27 ORAL PRESENTATIONS ORAL PRESENTATIONS

Radiosurgery For Pituitary Adenomas, Our Experience Matherial: We studied INA expression in 156 gliomas and correlated it with histology, IDH1, Xhumari A, Aliraj A, Bregul, Myzeqari B, Mucollari I. p53 and SYN expression by immunohystochemestry. Results: INA was expressed in 63.6% of grade II oligodendrogliomas (n = 22), 62.5% of Objective: Primary treatment for functional pituitary adenomas is surgery, except prolactin- grade III oligodendrogliomas (n = 16), 28.6% of grade II oligoastrocytomas (n = 7), 50% of secreting ones. For recurrent and persistent disease treatment options are repeat surgery, grade III oligoastrocytomas (n = 6), 33.3 % of glioblastomas with oligodendroglial component medication and radiation therapy. Radiosurgery has an important role in the management (n = 12), 0% of grade I astrocytomas (n = 14), 0% of grade II astrocytomas (n = 4), 0% of of pituitary adenomas and it is an attractive approach for the treatment of these tumors. grade III astrocytomas (n = 12) and 2.8% of glioblastomas and gliosarcomas (n = 38). INA Methods: We collected data from X-Knife Unit, for patients treated for pituitary adenomas. was expressed by 32 (45.1%) of gliomas with IDH1 mutation (n = 71) versus 13(15.3%) of Results:A total of eight patients were treated, age 26-65 years old, 6 female and 2 male, gliomas without IDH1 mutation (n = 85) , (Cramer’s V was 0.327; p < 0.001) which show a all pituitary adenomas GH- secreting. Prescribed dose 14-16 Gy. Tumor volume 0,11- very strong relationship. INA was expressed by 26 (26.0%) of gliomas with P53 mutation 4,01 ml. 3 cases were planned with 2 isocenter and 5 cases with 1 isocenter, number (n = 100) versus 19(33.9%) of gliomas without P53 mutation (n = 56) , (Cramer’s V was of arcs 1-5 per isocenter. Follow-up was: 4 - 16 months. No Advers Radiation Effects 0.084; p = 0.294) which show a weak relationship. INA was expressed by 30 (49.2%) of as optic neuropathy were seen. It is too early to assess endocrinological response. gliomas with SYN mutation (n = 61) versus 15(15.8%) of gliomas without SYN mutation Discussion; Radiosurgery is indicated in the treatment of well-defined intracranial lesions, (n = 95) (Cramer’s V was 0.360; p < 0.001) which show a very strong relationship. benign or malignant, with a volume up to 15 cc, about 3-5 mm distant from the optic pathways Conclusion: INA expression is a fast, cheap and reliable prognostic marker, which or truncus. In cases where these parameters are not meet, it may be proposed hypofrationated should be used routinely in the pathologic diagnosis of oligodentroglial tumours. stereotactic radiotherapy (1-5 sessions). Conclusions; For the first time in Albania (in the public or private sector) began the treatment Temporal lobe Epilepsy; Surgical Treatment of Epileptic Patients in our Neurosurgical with radiosurgery, an advanced radiotherapy technique. The first cases were successfully Service during the Last Three Years. treated without having acute adverse radiation effects. Arsen Seferi , Florian Dashi, Ridvan Alimehmeti, Ejona Lilamani, Arben Rroji, Maren Ruka, Mentor Petrela. Stereotactic and Functional Neurosurgery at UHC “Mother Theresa” Ridvan Alimehmeti, Arsen Seferi, Arben Rroji, Florian Dashi, Mit’hat Demneri, Teona The prevalence of Epilepsia in developed countries is about 1%. Whereas in developing Bushati, Mira Rakacolli, Mentor Petrela. countries the prevalence is higher and this is dedicated mainly to the level of health service and to the relatively higher number of births. The Service of Neurosurgery, at UHC “Mother Theresa” has introduced the techniques of Farmacologic treatment of epilepsia is successful in 2/3 of cases which means that these stereotactic surgery in March 2006. patients under antiepileptic drugs are seizure free. The remaining 1/3 of cases, called The system of Leksell model D was replaced by the advanced Model G in 2013. It has been farmacoresistent epileptic patients, are subjects that can benefit from surgical treatments. routinely used for deep seated cerebral (28 cases) and cerebellar (lcase) tumor biopsy, The surgical treatment begins with a perioperative diagnostic phase performed by a evacuation of tumoral cysts and thalamic abcesses (2 cases), as well as for implantation of multidisciplinary team: neurologist, epileptologist, neurophysiologist, neuroradiologist, Medtronic DBS electrode (1 case). Intraoperative ex-tempora histological study is available psycologist, neurosurgeon, well-trained technicians and nurses and of course modern to potentiate tumor sampling (Leyca cryotome and microscope). instruments and technology. The manual target calculation has been replaced by Elekta Surgiplan and Franzini’s system In the beginning of 2012, after a long period of staff formation and after implementation of for coordinate calculation. These modern computerized systems allow for image fusion of modern appropriate technology and equipments, in the Neurosurgical Service of University MRI and stereotactic CT for functional targeting in the treatment of movement disorders. Hospital Center “Mother Theresa” of Tirana has began the activity for the surgical treatment The Leksell stereotactic system with Surgiplan and Elekta radiofrequency apparatus which is of epilepsia. available at our Service, will be implemented for deep brain stimulation and lesioning (pallidotomy, During this period about 100 patients have undergone the preoperative diagnostic pathway. thalamotomy) for Parkinson’s D., essential tremor, dystonia. Intraoperative monitoring of basal 80% of them presented lesional epilepsia where the aim of the preoperative study was to ganglia neurophysiological work-out is a supporting mean for precise targetin. evaluate if the lesion itself was in the same time the epileptic zone. The remaining 20% of the patients were studied in the Explorative Functional Unit near Neurosurgical Service, for Alpha Internexin Expression In A Series Of 156 Gliomas And Its Relation With non-lesional epilepsy, and 1/3 of them have undergone surgical treatment. The range of age Oligodentroglial Morphology, Idh1, P53, And Synaptophysin Expression in this group of patients was 8-38 years old. All the patients treated for non-lesioanl temporal Bushati T, Berdica L, Alimehmeti M, Kaloshi G, Seferi A, Alimehmeti R, epilepsy are actually seizure free and, of course follow up is going on. Pumo G, Ruka M, Petrela M. Instrumented Spinal Surgery in Albania Context: Distinguishing glial subtypes based on nuclear and cellular morphology alone is F Olldashi, P. Hodo, I Hodo, A Selaj subjective, with significant interobserver variability. Genetic subtyping of a given histological phenotype and robust biomarkers has improved the prognostic assessment. Recently, IDH1 The beginnings of spinal surgery in Albania are during the Albanian Kingdom years and after mutations have been found in nearly 40% of gliomas and strongly predict better outcome that during the Italian occupation. At that time in Albania foreign doctors working, mainly from The chromosome arms 1p/19q codeletion, wich is tightly related to Alpha-internexin (INA) Austria and Italy. They have treated also patients with the spinal column pathologies. expression, a proneuronal gene-encoding neurofilament interacting protein, characterises After second WW, general surgeon performed some decompresive laminectomies in patients a subtype of oligodendroglial tumours with better prognosis and higher chemosensitivity. with spinal trauma.

28 29 ORAL PRESENTATIONS ORAL PRESENTATIONS

In 1972 spinal trauma patient started to be examined with myelography and laminectomy was Results: A total number of 825 subjects (64.8% M and 35.2% F) treated for end stage-renal performed to those patient with spinal block. disease during 2013 were included in the study. The main RRT modality used in Albania was Spinal instrumentation utilizes surgical procedures to implant metallic or non-metallic hemodialysis (68.5%), followed by kidney transplant (26.1%) and peritoneal dialysis (5.4%). devices into the spine. Instrumentation provides a permanent solution to spinal instability. We found a prevalence of 316 patients/pmp and incidence rate of 77.5/pmp that corresponds Instrumentation maintains spinal stability while facilitating the process of fusion. Medical approximately to 217 new patients every year. Regarding the etiology of CKD, tubulointerstitial implants are specially designed and come in many shapes and sizes. Typically these include diseases were the most frequent cause, affecting (26.1%) of patients followed by chronic rods, hooks, braided cable, plates, screws, and interbody cages. The first spinal ostesinthesis glomerulonephritis (20.4%), diabetes (7.2%) and heritable diseases (4.9%). We observed an important increase of diabetic patients on RRT, 7.2% in 2013 versus 4.3% in 2007. Since was performed in 1973 with spinous processes plates. In 1974 ostheosintesis was performed 2007, we found also a linear increase of prevalence of end-stage CKD on RRT, 316 patients/ pedicular screw with Hegers plate. pmp in 2013 versus 118.5 patients/pmp in 2007. In 2006, we started routinely to perform instrumented spine surgery. First patients we treated Conclusion: This multi centered study has provided for the first time an estimation of the were trauma cases. During this period we performed about 800 instrumented spinal surgeries number of patients with ESRD receiving RRT in Albania. The study shows that the prevalence (550 thoracolumbar region and 250 cervical region). Actually we perform anterior posterior and annual acceptance rate for RRT have increased significantly over the past decade. Renal spinal fixation, cranio cervical fixation, treatment of dens fracture with anterior screw, transplantation remains the preferred therapy for CKD patients but due to the limited number kyphoplasty and vertebroblasty. of donors, dialytic therapies are still the most common modalities that are actually used. The main pathology we treat is trauma. However we have treated degenerative, tumor, infection, deformities, kyphoscoliosis and our results are comparable to other experienced clinic. A Retrospective Review of Diabetic Nephropathy Patients In the perspective we plan to cover all spinal pathologies. The big problem remains the cost During Referral to the Nephrology Clinic of the implants which is still not reimbursed. Pasko N, Strakosha A, Cadri V, Mumajezi S,Therecka N Keywords: Spinal surgery, instrumented, Albania Introduction: The prevalence of diabetes in Albania has increased rapidly in recent years and Interventional Endovascular Treatments Of Brain And Spine Our Experience is likely to continue to increase in the future, with important implications for health policy. The Enesi E, Rroji A, Bilaj F,Rudi I, Demneri M, Petrela M studies have shown that on average, 20–40% of patients with diabetes will develop renal dysfunction. Our local data revealed that 7.5% of patients undergoing dialysis in Albania have BACKGROUND: The importance of imaging technology extends well beyond diagnosis and diabetic nephropathy as a cause of renal failure. The expanding number of diabetic patients on into treatment. Real-time imaging techniques allow specialty-trained clinicians to perform renal replacement therapy it is associated with increase in health expenditure and reinforces minimally invasive procedures for a number of different conditions. These interventional the need to prevent or delay the progression of kidney disease in our diabetic patients. Actually, procedures often require smaller incisions, carry fewer risks of complication, and take less there is no data on renal impairment in diabetics in Albania. As result, the primary aim of the recovery time than traditional surgery. We intent to show our experience in the interventional present study was to assess diabetic patients referred to the nephrology clinic in UHC Tirana. treatment of brain and spine pathologies. Results: A total of 98 diabetic patients (57.2% males and 42.8% females) hospitalized in UHC METHODS: Many times, interventional neuroradiogists can treat conditions that are Tirana from January 2013 to January 2014, were included in this study. Their mean age was otherwise difficult to treat; meaning conditions that are untreatable by open surgery. Patients 60.4 ± 15.8 years. The mean duration of diabetes was 8.2 ± 6.9 years. Among study subject, 92 are evaluated in close consultation with specialists in neurosurgery, neurology, vascular (90.7%) had type 2 diabetes. We found that only a few patients, 24.3% had a blood pressure surgery, otolaryngology and radiology. A multidisciplinary approach is used to determine the of <130/80 mmHg. Mean body mass index (BMI) in type 2 patients was 26.45±0.17kg/m2 best treatment plan for each patient. (male: 25.14±0.8 kg/m2 and female: 28.29±0.35 kg/m2). At the time of presentation in the RESULTS: During a period of 5 years, we have treated 83 intracranial aneurysms with coil clinic, glycated hemoglobin (HbA1c) was 8.1±1.9% and fasting blood glucose of 190.5±38.6 embolisation, 5 embolisations of arteriovenous malformation with ONYX and PHIL (AVM) , 7 mg/dl. We found that HbA1c concentrations and fasting plasma glucose levels were emboisation of intracranial fistula, 8 embolisations of dural spinal fistula, 4 thrombectomy, 5 significantly higher in diabetics with macroproteinuria than in normoproteinuric patientsp ( tumor embolisation with particles. < 0.001). The prevalence of macroproteinuria, microproteinuria and normoproteinuria were 56.4%, 33.8% and 9.8 %, respectively. The prevalence of macroproteinuria was 40.5% in Key lecture: The Burden of Chronic Kidney Disease in Albania males and 41.1% in females. There was no significant difference between males and females Therecka N in the prevalence of macroproteinuria or microproteinuria (p>0.005). We found that 3.3% had CKD stage 1, 5.2% had CKD stage 2, 22.7% had CKD stage3, 26.3% and 42.5% had CKD Background:The chronic kidney disease (CKD) is a common and serious health problem that stage 4 and 5 respectively. The duration of diabetes was higher in both macroproteinuria and places a large burden on the Albanian healthcare system. It is associated with several other microproteinuria groups compared with the groups with no proteinuria. chronic diseases like diabetes and cardiovascular disease and has become the leading cause Conclusions: Duration of diabetes, poor control of glycemia and hypertension, have been of morbidity in Albania. In order to initiate appropriate management of CKD, it is important to have data on incidence and prevalence of the disease. The aim of this study was to evaluate associated with progression of CKD. Therefore, early screening for incipient diabetic the epidemiologic profile of CKD stage 5 patients and associated risk factors for end stage nephropathy and aggressive management of risk factors can prevent the kidney disease renal disease in Albanian population. progression in patients with diabetes mellitus. In this context, it is important to understand Methods: The study was conducted in collaboration with the other centers that provide care the epidemiological aspects of diabetic nephropathy in our country in order to increase for the ESRD patients. Basic demographics data, the clinical and laboratory profile at the time the opportunities for early interventions with effective treatments. The results of this study of initiation of renal replacement therapy (RRT), cause of CKD, and the dialysis modality used emphasis the fact that early diagnoses of diabetic nephropathy is missed due to the lack of were recorded for all patients. screening methods which further enhances the burden on the health care system.

30 31 ORAL PRESENTATIONS ORAL PRESENTATIONS

Kidney Biopsy,an Albanian Experience Material and methods: The study was conducted as a prospective and included 142 boys Berdica L, Bushati T of age 6 months to 7 years, with distal, midshaft, proximal and secondary hypospadias. A preoperative protocol included level of hypospadiac meatus, depth and width of the urethral The implementation of the trucut kidney biopsy in the daily clinical practice has made a big change plate, size of penis, diameter of glans and grade of ventral curvature. The original Snodgrass in the clinical nephrology. Even with the latest technology imaging advances, kidney biopsy technique was performed by a single surgeon, using longitudinal dorsal or lateroventral remains a crucial method of diagnoses, prognosis and orientation of the therapy in many kidney dartos flap, hence covering neourethra. diseases. It is a worldwide used method, especially now that it can be done with automated Results: In 133 cases with distal and midshaft hypospadias, Snodgrass technique was needles ultrasound-guided. This method can be used in the native and transplanted kidney. performed without any technical limitations. The overall success rate of surgery in this group The indications for native kidney: Idiopathic Nephrotic Syndrome, Acute Renal Failure, Rapid was 96.5%. From 14 proximal hypospadias, Snodgrass technique was performed in 10 Progressive Renal Failure, Microscopic Hematuria, Isolated non Nephrotic Proteinuria, cases, whereas in 4 cases, ventral curvature was more than 50º, so it imposed urethral plate Cronic Renal Failure, Diabethic Nephropaty, Lupic Nephropathy. and a two stage procedure with buccal mucosa graft was used. In this group overall success The indications for the transplanted kidney: Acute Rejection, Toxicity from the Calcineurine rate of surgery was 86.3%. From all secondary hypospadias (n=7), in 4 cases the urethral inhibitors, Chronic Allograft Nephropathy, Polyoma virus nephropathy. plate has been conserved without gross scarring and incision, so Snodgrass technique was Nowadays the American Hospital is the only institution in Albania and Kosovo where this considered for reoperation, whereas in 3 secondary hypospadias two stage repair was used. procedure is done. We began to apply it from 2010 with conventional and special stains and Conclusions: a) Snodgrass technique can be preferred to correct different types of also immunofluorescence. hypospadias; b) The major contraindication is ventral curvature more than 50º that leads Keywords: Kidney biopsy, Native kidney, renal transplant, Immunofluorescence. to urethral plate transection for straightening; c) Reoperations can be also performed using Snodgrass technique when the urethral plate has been maintained and is not grossly scarred. The Challenge of Doing the First Cases of Percutaneous Keywords: Snodgrass technique, different hypospadias, ventral curvature. Nephrolithotomy (PNL) in Kosovo Xhafa A, Kurshumlija F,Shaipi M Malnutrition in Hemodialysis Patients Gjyzari A, Veliu SH, Gjyzari I Introduction: PNL is a safe treatment modality that especially in the last decade it is used worldwide for the large and complex kidney stones up to 2 cm. Unfortunately in a part of Background: Malnutrition is a common problem in patients with end stage renal Ballkans countries this procedure still is not the first choice. Because of different reasons most of the patients undergo open surgery instead of PCNL .We evaluated, the first cases in disease (ESRD) undergoing hemodialysis that increases morbidity and mortality rate. our hospital as the first cases published from Kosovo. Objectives: To evaluate the nutritional status of patients undergoing chronic hemodialysis Material and methods: From April 2014-October 2014 10 PNL patients (6 men and 4 women) using BMI scale and assesse probable association between malnutrition in this population were treated with the procedure of PNL. Two patients had one open surgery before. The and demographic, biochemical parameters. stone localization varied in different calyces or kidney pelvis. A 15 year old patient came in Patients and Methods: In this cross sectional study, we evaluated the nutritional status of a septic condition with a stone street in the right distal urether and with a 3,5 cm pelvis stone 72 patients undergoing chronic hemodialysis thrice-weekly for more than six months during and a grade 3 hidronephrosis in the left kidney. He was first treated with right ureterenoscopy 2014. We divided patients in two groups: malnourished patients with a BMI <18.5 and and left nephrostomy and then he was treated with a left PNL. One patient had macroscopic the second group with a BMI ≥18.5. Of 72 patients 46 (64%) were males and 26 (36%) hematuria approximately three week after the operation and an embolisation was required females. Mean age was 52.89±13.02 (21-75) years, time in HD 5.9±3.4 years, 14% had in the lower pole of the kidney. There were some difficulties in treating this patient because these aren’t very often cases in radiology. Patients and stone characteristics, stone-free DM, 86% had arterio venous fistula (AVF) as vascular acess. The biochemical parameters rates (SFR), and complications were evaluated. included hemoglobin, albumin, cholesterol, iron, BUN, and creatinine serum levels. Results: The mean age was 41,6(16-63)) years old. The mean operative time was 141 (60 Results: Among 72 patients, we found 7 (9.7 %) patients with a BMI <18.5 and 65 (90.3%) -290 min). The mean stone burden was 525 mm2.. The stone free rate was 96,7.%. None patients with a BMI ≥18.5. Arm cicumference was significantly lower in the malnourished of the patients needed transfusion during and after the surgery. There was no postoperative group (means 22.86±1.46 vs. 26.23±3.16; p=0.007). We found a statistically significant fever. The nephrostomy tube was pulled after 2 or 3 days. In 7 patients a d-j stent was puted association between female gender and malnutrition. All of the patients with malnutrition during the procedure. were female, Pearson Chi-Square=13.7, p<0.001. In this study malnutrition was associated Conclusion: PNL is a safe procedure with a considerable rate of complications and only if the with younger age: In the malnutrition group mean age was 40.7±18.3 vs. 54.2±11.7 patients have absolute contraindications, surgeon needs to think about open surgery. But to the other group, p=0.008. We found lower values of hemoglobinemia, serum iron, start performing PNL it needs to have other specialities available to manage patients with PNL complications, especially invasive radiology is needed to be developed and advanced. albuminemia in the malnourished group but no statistically significant association was found. Conclusions: Factors predicting malnutrition in our study were female gender and Is Snodgrass Urethroplasty Universal Technique in Correction younger age. Periodic and carefully assessment of nutritional status is needed. of all Types of Hypospadias? Keywords: Hemodialysis; Malnutrition; Body mass index; Biological Markers Izairi A Surgical Treatment of Localy Advanced Prostate Cancer Background: Snodgrass urethroplasty has become the preferred technique for primary and Galiqi G, Tartari F, Pesha A, Ymeri SH, Bajri L, Ferko SH, Ndoj A secondary hyposapdias repair. Objective: The purpose of this study is to evaluate the applicability of Snodgrass technique in INTRODUCTION: Treatment of locally advance prostate cancer is refered to T3 or T4 clinical correction of all types of hypospadias. without evidence of desease in lymph nodes or distant metastasis. In our practice we

32 33 ORAL PRESENTATIONS ORAL PRESENTATIONS routinely recommend RP as primary treatment for locally advance prostate cancer or high Our study aimed to compare semen quality between fertile and sub- fertile men in Kosovo, so risk prostate cancer as to establish normal values for different semen parameters. OBJECTIVE: Evaluating the functional and oncologic result of RP in locally advance METHODS: Sperm analysis data from a population of Kosovar men attending our clinic in prostate cancer.Comparing this data with those obtained from organ confined desease Prishtine, were evaluated in two distinct groups. In the fertile group (n=62) were men having cases.Evaluating the discordance between clinical stage and pathological stage. currently of formerly a pregnant partner with a TTP ≤ 12 months, whereas in the sub- PATIENTS AND METHODS: During years 2007- 2013 we treated 45 patient which were fertile group (n= 95) were men who achieved pregnancy either naturally or via Assisted evaluated to be clinically T3 desease. Local staging was routinely performed by digital rectal Reproduction Techniques, not resulting in live births. Semen analysis were performed examination and transrectal ultrasound. according to the WHO (2010) guidelines except for sperm morphology which was assessed Prostate biopsy was done with 12 core biopsy taken routinely in all patient.CT was done using the Kruger strict criteria. The 5th percentile, as well as the 95% confidence interval only when PSA was more than 20ng/dl according to guidelines of EAU,(nr= 8).Pelvic was calculated for each parameter and cut-off values for single and combined semen bilateral limphadenectomy was routinely done in patients with gleason score more than 7 parameters were determined. in transrectal biopsy and PSA more than 10ng/dl.Perioperative complications and one year RESULTS: Sperm concentration between fertile and sub -fertile men resulted to be sign­ functional results were evaluated also the % of positive margins and oncologic results. ificantly different (57.3 ± 37.3 vs. 39.6 ± 34.0, respectively, p < 0.003), whereas progressive RESULTS: No serious in-hospital complications were noted and no reintervention was motility between the two groups was almost the same (36.7 ± 13.7 vs. 32.7 ± 13.5, respectively, needed. Lymphatic leakage was noted in 6% of patients . Anastomotic stricture occurred p < 0.078). In addition the percentage of morphologically normal spermatozoa showed a in 5% of cases requiring internal urethrotomies. 4% of patients experienced prolonged significant difference between the fertile and sub-fertile men (1.56 ± 1.0 vs. 1.13 ± 1.2, p drainage of urine. At 12 months, complete continence was 79 % and erectile function had <0.02). Using the 5th percentile of the fertile population as the cut - off value the following fully recovered in 5% and 12% of patients who underwent a non-nerve sparing or unilateral results were obtained: 14.1 x106 / ml for sperm concentration, 12.3 % for progressive motility nerve-sparing procedure, respectively.The downstaging from clinical T3 to pathological T2 and for sperm morphology 0.01 %. was observed in 22% of cases. CONCLUSION & DISCCUSION: Results of the present study are not very encouraging, CONCLUSIONS: Our experience with 45 patients confirms the surgical feasibility of RP for they indicate that there is a shift towards abnormality in the sub-fertile population with cT3 PCa, showing complication rates comparable with RP in organ-confined PCa. Further we a very low percentage of normal sperm morphology compared to WHO standards. can optimise the treatment with adjuvant RT and HT. Continence rates were al Moreover, the cut-off values for normality in fertile men were quite different from the Prevalence and Risk Factor of Anemia after Renal Transplantation. WHO 2010 reference value, especially the % of morphologically normal spermatozoa. Thus, this decline in semen quality may impair the fertility rates and further increase the A Prospective Study in a Single Center in Albania need for the assisted reproductions techniques which is evident among Kosovar couples Strakosha A, Pasko N, Nasto F, Dedei A, Cadri V in the last 15 (post war) years.

Introduction: Anemia is common after renal transplantation but its true incidence is not well Biofeedback Therapy ,a Simple Method for Treatment of Urinary Disorders known as it various according to the criteria used in its definition. The purpose of the present Xhafa A, Dayanc M, Shaipi M study was to investigate the evolution of post transplant anemia during the first three years after renal transplantation ,its treatment and possible risk factor. Methods: 150 recipient with a functioning graft at 12 months were included in the study.75% Introduction & Objectives (112 pts)were on CS treatment and 25%(37pts) on tacrolimus treatment. Anemia was defined Wrong acquired voiding habits during toilet training period, lead to different urination disorders following the WHO criteria: Hb concentration <13 gr/dl in man and HB <12 gr/dl in women. in children. Clinical presentation includes enuresis, diurnal incontinence, dysuria or recurrent Results: The Hb concentration increased from 10.5 gr/dl at 1 months to 13 gr/dl at 12 months urinary tract infections. Biofeedback therapy is a simple method of training that makes and 13.5gr/dl to 36 months. The prevalence of post tx anemia decreased from 88% at 1 possible the evaluation of physiological behavioral of pelvic floor muscles. We evaluated month to 29% at 12 months and to 35% to 36 months. There were no differences in age, the first 30 patients that have undergone this therapy in our hospital from April 2014 until gender, dialysis treatment, incidence of acute rejection and of delayed graft function and November 2014. immunosuppressant therapy between anemic and non-anemic recipients. At 12 months only Material & Methods: 30 patients were evaluated (18 boys and 12 girls), from 6 to 22 years 20% of recipient were on treatment with ESA. At 36 months anemia post transplant was associated with higher serum creatinine and lower serum albumin. old (mean age 12). There were different diagnoses: 20 had nocturnal enuresis, 6 had diurnal Conclusion: Anemia post renal transplantation defined according to WHO criteria is common and nocturnal incontinence, 1 voiding dysfunction with nocturnal enuresis, 1 VUR with and its incidence remained stable between 12 and 36 months. Variables associated with dysfunctional voiding, 1 constipation and 1 Giggle incontinence. The diagnosis was made anemia were graft function at 12 months and graft function and malnutrition at 36 months. with laboratory analyses, VDSS, uroflowmetry, VCUG and ultrasound. 7 of the patients have used anticholinergic therapy before without success. Semen paramerres in Fertile Versus Subfertile Population in Kosovo. Results: Some patients unfortunately discontinued the training program after the second A need for Re-evaluation of Sperm Morphology Values week, mostly because of the length to hospital. Although most of the patients continued the Grajqevci M, Goc G, Hasbajrami A,Binishi Hysa J, Xhafa A treatment, the average of VDSS in these patients has changed from 18,4 before training in 7 after the training. The average of residual urine before treatment was 46,58ml and INTRODUCTION: Semen quality is used as an important measure of male fecundity. after treatment 23ml. Patients have undergone biofeedback without using medical therapy. Reference values used for semen analysis were developed by World Health Organization The improvement rate was significant in enuresis patients after two months, evaluated (WHO) and are widely used to evaluate male fertility potential. There were no previous with VDSS, uroflowmetry pattern and decreased residual urine. In voiding dysfunction studies documented that analyzed semen quality and fertility in a post war country of Kosovo. cases electrical stimulation was combined with biofeedback therapy. Also there was a

34 35 ORAL PRESENTATIONS ORAL PRESENTATIONS improvement in vesicourethral reflux surgical treatment was required. Key lecture: ”Pemberton’ Osteotomy, a Selection for the Treatment of the Congenital Conclusions: Biofeedback therapy is a simple method that can be used effectively in the Hip Dislocation in Albania” treatment of many urinary disorders in neurologically normal patients. For a better evaluation Caushi Gj the therapy must continue for at least 6 months. Nëpërmjet përvojës sonë do të shpjegojmë dhe argumentojmë se cilat janë përparësitë e osteotomisë perikapsulare Pemberton. Prostate Cancer in Albania,epidemiologic and immunohistochemistry consideration Kemi marrë në studim 328 raste të intervenuara në klinikën e Ortepedi-Traumatologji Tiranë, Berdica L, Bushati T,Popi H, Shabani F nga viti 1994-2003. Kemi konstatuar që osteotomia perikapsulare Pemberton kur kryhet në mënyrë korrekte me Indtroduction & objectives: It was observed the prostatic surgical pathology within the të gjitha elementet e detajuar në artikull, arin të realizojë qëllimin për të cilin kryhet, madje period of 2003-2014 aiming the calculation of the frecuency, indirect study of the incidence dhe ajo ç’ka duam të theksojmë edhe të vetkorigjojë një anteversion bashkëudhëtar të kësaj and prevalence of the prostate cancer, application of immunohistochemistry methods in patologjie. Por, njëkohësisht edhe pa dashur të përjashtojmë mundësinë ekryerjes së një diagnosing the prostatic carcinoma. osteotomie derotatore në një etapë të dytë në rastet e domosdoshmërisë. Material & Methods: The archive of the Central Service of Pathology of the UHC, American Hospital in Tirana, Glob clinic and Royal Diagnostic Center in Tirana was used determining the variables according to the topics of the pathologic standart report used in the daily Key lecture: ”The Blast Pelvis & Anorectal injuries the Difficulties and the Great routine arranged per year.The variable used are age(divided in groups of 10 years), Bioptic Challenge of Treatment” diagnosis ,Gleason grading system. Data are processed with the SPSS program. Shosha Mano L Results: During the last 12 years in Albania is observed an essential increase of the number of patients with surgical problems of the prostate from 169 cases in 2003 until 561cases in The blast pelvis is complex injury, described as the “signature injury” of the current conflict 2014 of Benign prostatic hyperplasia and from 16 casses in 2002 until 75 cases of Prostate in Iraq & Afghanistan. But we see this trauma also in our civilian hospitals in Albania and for cancer in 2014.Cronologically each year we see the domination of the age group (60-75 the civilian trauma surgeon there is a great challenge in management of the situation. The years). Immunohistochemistry ( CK34BE12, p63, AMACR) is used in the daily routine in the patients often present in extreme conditions, with multiple injuries, including pelvic fracture, trucut biopsy materials especially to detect small foci of cancer. Conclusion: Prostate cancer has relevant figures in the structure of the cancer pathology soft tissue, genitourinary tract, rectum, anal sphincters, vascular and intra-abdominal injury. so more needs to be done in the sense of early detection,minimal invasion procedures of There are significant consequences of surviving severe perineal injury with an increased follow up ad creating a network with the other Balcan countries over the topic. The mean incidence of destructive anorectal injury. There is no significant body of evidence about this frequence of prostate cancer is 10,3% in year with an increasing trend. type of injury on which to base management strategies. There is no evidence to support a move In our country the prostate cancer is more problematic then the uterine cervix cancer in away from the doctrine of the four D’s (diversion, distal washout, drainage and direct repair), female according to the National Cancer Registry for 2010. but sound surgical judgement remains the mainstay of managing these challenging and Keywords: Prostate, Cancer, Benign prostatic hyperplasia ,Gleason, highly morbid injuries. Blast victims are at high risk of developing coagulopathy and deep vein thrombosis. Prophylaxis against DVT is mandatory once the initial hemorrhagic event is controlled. Key lecture:” Joint-Preservation Surgery of the Knee: Mosaicplasty ” Blast pelvic trauma carries high mortality, because most of the patients die in the place of Bayrakci K explosion or during transportation. For the survivors, associated injuries are significant predictors of morbidity. Multidisci- Introduction: Joint preservation is a concept of restoring functions of the joints. It is achieved through the use of multi-modality treatment options that can include medications, plinary team treatment is crucial for managing this type of trauma, Clinicians from general physical therapy, injections, and surgery. and trauma surgery, urology, orthopedics, radiology, rehabilitation, and psychology, along- Articular cartilage is often damaged by injury or normal wear and tear. When it is damaged side experts from anatomy, personal protective equipment and explosive physics will create or worn away, the affected joint becomes painful, stiff, and has limited range of motion. a base how to address these injuries. Surgical repair may be required to stimulate the growth of new cartilage. Articular cartilage These injuries are life threatening, however the advances made by the multidisciplinary restoration relieves pain, improve function and can delay or prevent the onset of arthritis teams have resulted in good outcomes beyond what was previously thought possible. Tra- in the joint. ditionally blast injuries in past were the domain of military surgeons but with phenomenon The most common form of joint preservation surgery for knee is arthroscopy. In this of global terrorism, all surgeons need to be aware of their management. circumstance, a clean out of all the pain mediators in the knee may be indicated. Other forms of joint preservation surgery can be more specific. These include treatment of localized areas of arthritis with a microfracture surgery, Key lecture: ”Joint-Preservation Surgery of the Hip: Safe Dislocation” drilling, abrasion arthroplasty, a autologous chondrocyte implantation, osteochondral Delialioglu M. O autograft transplantation, oste­ochondral allograft transplantation. These can be performed with or without a proximal tibial or distal femoral osteotomy, or Introduction: The use of joint-preserving surgery of the hip has been largely abandoned since a meniscus transplant. the introduction of total hip replacement. In osteochondral auto graft transplantation; healthy cartilage taken from a non-weight- In his description of the detailed anatomy of the blood supply to the skeleton and spinal cord, bearing area is transferred to a damaged area of the knee. The graft is taken as a Crock states that: “Theoretically a method is required by which the human hip joint can be cylindrical plug of cartilage and underlying bone. Then the graft is matched with damaged area and transplanted into place. This leaves a smooth cartilage surface in the joint. dislocated atraumatically in the early phases of disease so that the blood supply of the upper Transplantation may be performed using a single plug or by mosaicplasty where multiple end of the femur can be preserved. This would open the way for the use of new methods plugs are used. This technique is used for patients with small areas of cartilage damage of surface replacement of articular cartilage based on developments in tissue culture and because of the limited availability of the healthy cartilage from the same molecular biology. Rather than relying on prosthetic replacement of the hip to treat significant

36 37 ORAL PRESENTATIONS ORAL PRESENTATIONS intra-articular pathology, a treatment philosophy based on biologic and physiologic principles Hospital in Prishtina. Twenty-seven patients had a right hemicolectomy interventi;10 patients could be more routinely used.” had a left hemicolectomy; 8 patients had total gastroectomy intervention; and 2 patients with In the last years, with the modification of such techniques as pelvic osteotomy, and the introduction rectal carcinoma, and 1 underwent the pancolectomy. After the general anesthesia, the of intracapsular procedures such as safe dislocation and arthroscopy, previously unexpected epidural thoracic catheter is placed, in the levels Th 6-7 or Th 7-8, using the low resistance options for the surgical treatment of sequelae of childhood conditions, including developmental technique. After the test dose with Lidocaine and Adrenaline,a continual administration of dysplasia of the hip, slipped upper femoral epiphysis and Perthes’ disease, have become available. the mixture of Ropivacaine 0.2% and Fentanyl 2.5 µcg/ml, in dosing 4-6ml/h. Perfusion of Moreover, femoroacetabular impingement has been identified as a reason in the development of the mixture continues in the postoperative period in dose 3-8 ml/h, depending of the VAS. osteoarthritis in many hips previously considered to be named as primary osteoarthritis. These All patients have decreased need for additional opioids and hemodynamic stability techniques are potentially preventing or delaying development of osteoarthritis and subsequent occured.The same situations persisted in postoperative period. During the period of need for joint replacement and for instance cartilage transplantation. mobilization the VAS was analyzed, during the first 48 hours every 4 hours and then every 6 hours. The respiratory physiological functions were analyzed during the monitoring Patient Monitoring in Critical Care Setting via Vittal Signs process, administering of additional analgesics, the rapidity of mobilization period and Panajoti E, Huti G,Arapi B, Miraka Bilaj M the scale of anastomosis dehiscence.The results show a high level of perioperative and postoperative analgesia. In the perioperative period,after the initial dose of opioids (2µcg/ ABSTRACT: Medical staff has traditionally relied on five vital signs to assess their patients, kg) was administered to all the patients, and 88% of cases the patients did not need a respectively: temperature, pulse, blood pressure, respiratory rate and oxygen saturation. recurrence of opioid doses. Hemodynamic parameters were stable. In the postoperative Nevertheless, as patients hospitalised nowadays are sicker than in the past, these vital signs period VAS was 0-5, in the first 4 hours after the intervention and 0-3 following hours. may not be adequate to identify those who are clinically deteriorating. This paper aims to All the patients had preserved the standard respiratory functions and were mobilized the describe clinical issues to consider when measuring vital signs as well as proposing additional first day after the intervention.No anastomosis dehiscence or other complications. We assessments such as pain, level of consciousness and urine output, as part of routine patient suggest the placement of thoracic epidural catheters during major abdominal surgery. assessment in critical care. Key words: Vital signs, critical care, patient assessment, medical staff, hospitalisatio. The Modified SCARF Osteotomy Technique Provides Predictable Correction of Moderate to Severe Hallux Valgus Deformities Sciatic nerve injury after THR with anterolateral approach Ruci J, Gjika E, Selmani E Duni A, Ruci V, Ruci J. Intruduction: The modified SCARF osteotomy technique provides predictable correction of Background: Biliary tract cancers are divided into cancers of the gallbladder, the ampulla of moderate to severe hallux valgus deformities. Vater, and cholangiocarcinomas. Distant metastases, extensive regional lymphadenopathy Correction of hallux valgus deformities was achieved using a Z step osteotomy cut to realign and regional vascular encasement or invasion preclude resection. the first metatarsal bone Methods: From 119 patients suffering malignant billiary obstruction there were 66 patients Purpose: To present our experience with a modified SCARF osteotomy with three years (55,4%) with chlangiocarcinoma, 34 patients (28,5%) with ampulomas and 19 patients follow-up, with patients diagnosed and operated in the Universitary Clinic of Orthopaedic and (16%) with gallbladder tumors. There were 62 males or 52% and 57 females or 48% with an Traumatology of Mother Teresa Hospital. average age of 62.5 years old. Material & Methods: A retrospective analysis was undertaken in 38 patients (54 feet), Results: Clinic and metabolic alterations are often observed in biliary obstruction. diagnosed and operated in the University Clinic of Orthopaedic and Traumatology of Mother Imaging: MRI has an advantage over CT because it determines tumor resectabillity. Teresa Hospital, from January 2011-March 2014. Abdominal MRI evidenced the lesion, the tumoral extent in 100% of cases and the vascular Results: Results were analyzed by clinical examination, a questionnaire including the AOFAS invasion in 30,8% of cases. forefoot score,modified, and plain roentgenograms. Hallux valgus and intermetatarsal angle im- Surgery: The resectability was very low, only 3 cases (2,5%). Palliative surgery for treatement proved at mean 19.6° and 6.9°,respectively.Mean forefoot score improved from 50.1 to 91 points of obstuctive jaundice was used in 58 cases (48,7%). out of 100 possible points. Satisfactory healing time was expressed by an average return back to Conclusions: Biochemistry evaluations can only lead towards obstructive biliary disease. their atitude of 6weeks ,without including phisiotherapy. Persistence or recurrence of hallux val- Imaging evaluations are essential for the diagnosis and for to detected distant metastases, gus was seen in 3 patients(8%). The complication rate was 5.4% including post operative pain, lymphadenopathy and regional vascular encasement. Patients need to be diagnosed as soon superficial wound infection,atrophy of the muscles, traumatic dislocation of the distal fragment. as possible, so they can be offered an early palliative treatment and tumor resectability. Conclussion: All of these results are finally included and presented as a new tendence of surgi- Field: Gastro-hepatology, surgery. cal treatment at our clinic for the patients suffering of Hallux Valgus. Key words: Biliary tract cancer, cholangiocarcinoma, CCA, ampuloma, early diagnosis, screening, resectability, palliative treatement. Transesophageal echocardiography in the intensive care unit Ibrahimi A Thoracic Epidural Analgesia in Major Abdominal Surgery Jusufi ,I Zeka Z, Hasani A, Gonzalan U, Tmava S. Transesophageal echocardiography is able to provide relevant and precise information according to the structure and hemodynamic situation of the human heart. It is a minimally In this study, we included 58 patients, both genders, aged 32-74 yr,ASA I-III,which undergone invasive procedure, movable, and diagnoses fast every single hemodynamic change in the major abdominal surgery interventions, from January 2013-January 2015, in American intensive care patients. It provides invaluable and accurate informations about myocardial

38 39 ORAL PRESENTATIONS ORAL PRESENTATIONS disfunction and intracardiac volume. It can diagnose dynamic obstruction of the left ventricle, PaCO2 ≤32 mmHg; leucocytes ≥12 000 μL−1 or ≤4000μL−1 or bandforms >10%. septal myomectomy or mitral valve dysfunction. Transesophageal echocardiography excludes Results: The average age was 50.57 years old and SDV 18.89 years. Males were 55.2% cardiac tamponade and the intracardiac source of embolism. It offers the opportunity for and females 44.7% of cases. At ER all patient presented with fever 38-40°C, complains of visualization of native and prosthetic valves and evaluates their function during postoperative urinary tract in 53.94% and chough in 30.26% of cases. Blood test performed in ER was as period. It helps in the diagnosis of endocarditis and intracardiac masses. In patients with below: white blood cells counts 13.531x103/mm3 (range 4-11x103), C-reactive protein was open chest wounds transesophageal echocardiography provides a faster and safer overview 11.89 mg/dL (range 0-0.5). Hiperleucocitosis resulted in 89.47% of cases. Based on clinical, of ascending and thoracic aorta, of pericardial effusions, facilitating future decisions about laboratory and imagery data we have: patients with urosepsis (34) or 44.73%, pulmonary patient management. It excludes intracardiac shunts in patients with hypoxia during the sepsis (21) or 27.63% of cases, gastrointestinal tract (9) or 11.8%, locomotors sistem (6) or postoperative period. And at the end in heart transplants or in patients with ventricular 7.89%, hepatic abscess (3) or 3.94% and 3 cases or 3.94% without origin. From 76 patients, dysfunction TEE is an important examination that assesses the progress of treatement, or 30.26% of them were nonimmunocompetent patient. Conclusions: Sepsis syndrome is a situation that clinicians in fronted every day. The sex the complications that come from this procedure. doesn’t play any important role in sepsis.

External Fixation Percy for Comminuted Fractures of the Distal Radius Demiraj Z, Angjeli L, Ibrahimllari Y, Shehu K Key lecture: ”Preanalytical Variables in Haemostasis Testing” Refatllari E The fractures of the distal radius are characterized by the frequency and diversity of forms that they submit. According to the statistics they occupy about 1/6 of fractures treated in Laboratory Department, University Hospital Center “Mother Teresa”, Tirana, Albania emergency service. These fractures are 6 times more common in women of menopausal age, The last decades we have seen a decrease in analytical laboratory errors due to advance because of the osteoporosis accompanies this age group. of analytical technique and computer science, with the extra analytical phases becoming Pouteau-Colles in 1814, for the first time made the description of this fracture. more error prone. From all laboratory errors, it is estimated that about 60% are related to pre Although the last two centuries have been passed, still there is not a commune analytical phase. The pre analytical phase includes every steps from specimen collection up international agreement regarding the classification and treatment protocols. to the point of testing. Because of activation of the haemostatic system in the pre analytic There are many classifications for fractures of the distal radius, and in our study we used the phase, coagulation assays are probably more susceptible to outcome variations related to classification by AO group. inadequate sample quality, which have a significant impact on the patients results. There are several ways to treat these fractures starting from the conservative treatment Accurate haemostasis test results depends on all phases of pre analytical process include with gypsum to the surgical treatment with internal osteosynthesis with plate and screws or patient preparation, test prescription, sampling, transportation and centrifugation. Also sample osteosynthesis with external fixation. stability following blood collection is an important part of pre analytical phase. In our study we heave treated the fracture of the distal radiusi with external fixation Pre analytic error prevention requires good communication and cooperation among health care type Percy. This study was organized in two groups of patients: the first group team inside and outside laboratory. It is also strongly recommended the use from laboratory that constitutes a retrospective study conducted on 17 patients who were treated staff of the appropriate posttest guidance to assist clinicians in the interpretation of test results, with external fixator Percy, in the Laverne Hospital (France). In the second group as well as to guide when repeat, confirmatory and follow up testing may be required. of the survey that constitutes a prospective study on 10 patients, in the Albania The error in the pre analytical phase stress the need of continuous education of all the staff National Trauma Center, where we treated them also with the external fixator Percy. involved in this process, to improve quality of the whole patients care. The results of this treatment were really encouraging and makes us use this technique (Percy fix) in the treatment of fractures of the distal Cominutive intra-articulate the radius. The unique Laboratory Network in Albania with ISO 15189 Standart Key words: External fixation. Percy fix, fractures, radius, instable fractures. Daka A, Marku L ,Hyseni B, Marku I

A Panoramic View of Sepsis Syndrome at Emergency Room AIM: Actually the American Hospital is represented with an unique laboratory network in our Pojani A, Hyka K, Lekgjika V, Novaku M, Cara A, Qeraj K, Qose A, Koza B, Puca E. country Certified with ISO 15189 standards since at 2012. The laboratory service is one of the departments of this hospital which offers a great help for any other department since Sepsis is a clinical syndrome characterized by a multi-system response to a microbial 2006. The aim purpose is supporting with laboratory examinations each patient, hospitalized pathogenic. It is a significant public health concern. It is a clinical syndrome commonly at or ambulatory, for every single pathology. emergency room (ER). Methods: The laboratory network of American Hospital consists of: Central Laboratory Objectives: The aim of our presentation is to present a overview of sepsis syndrome (A.H.TR1) and four satellite laboratories,specifically: situation at ER of Amerikan Hospital No2 during period of time January 2013 to Mars 2015 • A.H Laboratory TR2 Material and methods: We conducted a retrospective, observational study at ER • A.H Laboratory Fier of Amerikan Hospital No2, involving 76 critically ill patient diagnosed with sepsis • AMC Laboratory Durres syndrome admitted to the Amerikan Hospital No2 from January 2013 to Marc 2015. • A.H Laboratory Pristina Blood test, Urine analyses and imagery were performed on the admission day. The In each of these laboratories the latest laboratory techniques are performed in order to diagnosis of sepsis is made by: proof of bacteraemia or clinical suspicion of sepsis and achieve accurate and fast results. by criteria of Systemic Inflammatory Response Syndrome: fever ≥38°C or ≤36°C; tachycardia ≥90 beats min−1; tachypnoea ≥20 breaths min−1; respiratory alcalosis Results: Since 2006 the range of services has increased and actually the American Hospital Laboratories offer about 1300 tests in: Biochemistry, Immunology, Hematology & Coagulation,

40 41 ORAL PRESENTATIONS ORAL PRESENTATIONS

Microbiology, Genetics & molecular biology. Biliary Tract Cancers-Clinical Biochemistry,Imaging and Operability Data Conclusion: The laboratory network of American Hospital is accredited by the standard ISO Duni A, Basho J, Kurti F, Aleksi R, Cekodhima A 15189:2007 from the accreditation board ESYD, which constitutes the highest standard of medical managerial the technical aspects in laboratory medicine. Background: Biliary tract cancers are divided into cancers of the gallbladder, the ampulla of Vater, and cholangiocarcinomas. Distant metastases, extensive regional lymphadenopathy Diagnostic Yield of Image Guided Core Needle Biopsy and Fine Needle Aspiration at and regional vascular encasement or invasion preclude resection. the American Hospital,Kosovo During 2013-2015 Methods: From 119 patients suffering malignant billiary obstruction there were 66 patients Kurshumliu F, Gjikolli B (55,4%) with chlangiocarcinoma, 34 patients (28,5%) with ampulomas and 19 patients (16%) with gallbladder tumors. There were 62 males or 52% and 57 females or 48% with an Introduction: Image guided core needle biopsy has been one of key diagnostic procedures in average age of 62.5 years old. oncologic diagnosis for over two decades. Ultrasound (US) and computed tomography (CT) Results: Clinic and metabolic alterations are often observed in biliary obstruction. guided fine needle aspiration (FNA) and core needle biopsy (CNB) can be applied to almost Imaging: MRI has an advantage over CT because it determines tumor resectabillity. any body site, with little variability in technique depending on the organ being investigated Abdominal MRI evidenced the lesion, the tumoral extent in 100% of cases and the vascular and the imaging modality. Advantages of these techniques over surgical excisional biopsy invasion in 30,8% of cases. include time and cost savings, reduction in morbidity and planning for neoadjuvant therapy. Surgery: The resectability was very low, only 3 cases (2,5%). Palliative surgery for treatement Material and methods: During the period of two years we have performed a total of 89 of obstuctive jaundice was used in 58 cases (48,7%). image-guided CNB and FNA procedures from liver, pancreas, lung, kidney, lymph nodes, Conclusions: Biochemistry evaluations can only lead towards obstructive biliary disease. thyroid, breast, peritoneum, retroperitoneum, papilla of Vater, soft tissues and bone. Imaging evaluations are essential for the diagnosis and for to detected distant metastases, Results: The overall diagnostic yield in terms of conclusive diagnosis and conclusive lymphadenopathy and regional vascular encasement. Patients need to be diagnosed as soon description were 47.2% and 76.4%, respectively. as possible, so they can be offered an early palliative treatment and tumor resectability. Conclusion: Image guided core needle biopsy and fine needle aspiration are useful diagnostic Field: Gastro-hepatology, surgery. tools especially in the neoadjuvant setting. Key words: Biliary tract cancer, cholangiocarcinoma, CCA, ampuloma, early diagnosis, screening, resectability, palliative treatement. The Importanance of Laboratory Check-Up for the Prevention and Early Diagnosis Marku L, Hyseni B, Daka A, Marku I PET/CT Structure and Function Dhima A, Tocilla B Background: The importance of laboratory markers such as TPSA, Ca125, Ferritine, Ca19-9, H bA1c in a rutine check-up .The aim of this study is the prevention and early diagnosis for : Adenoma Introduction: Cancer is one of the leading causes of death worldwide. Accurate diagnosis, and prostat Cancer, Anemia, Colorectal cancer,Diabetis , Ovarian cancer and other desease. staging and restaging are essential for the optimal therapeutic management_ of cancer Method: The study was perform with these healthy groups: TPSA (988males from 40-65 patients. Positron emission tomography (PET) with 2-deoxy-2-{fluorine-181fluoro-D-glucose Years), CA125( 393 females 30-50 years ) , Ca19-9 (129 Female and 110 males from 25-60 (18F-FDG), an analogue of glucose, provides valuable functional information based on the years) , Ferritin(1120 female and 352 male from 20-55 Years ),HbAlc (768 females and 861 increased glucose uptake and glycolysis of cancer cells and depicts metabolic abnormalities males from 30-65Years). All the laboratory parameters are analysed using Roche-Elecsys before morphological alterations occur. and Cobas 6000 assay. Results: In the last decade, combined PET/CT scanners have been introduced to facilitate Results: 9.4% of males have High levels of TPSA ,most affected age is 60-65 Years. 7.63% hybrid metabolic and anatomical imaging. Anatomical and functional images are acquired of females have High levels of Ca125, most affected age is 30-35Years. 13%of Females sequentially without moving the patient, giving optimal coregistration of the data for improved and 17%male (50-55Years) have high levels of Ca19-9. 29.2% female (30-35Years)and interpretation . 9.9%males (50-55Years) has Low levels of Ferritin,33.9% females and 43% males(60- Conclusion: The role of PET/CT has expanded in oncology over the last decade and is 65years)has high levels of HbA1c performed as a routine investigation in a number of common cancers. It has proved cost- Conclusion: The performance of periodically analyses according to certain age groups is effective and clinical use will continue to grow with the increased use of new tracers. Different important for prevention and early diagnosis . tracers for different histologic tumors are used in clinical practice .

Too Many Faces of Liver Hemangioma Breast Screening Saves Lifes. American Hospital as a Active Bilaj F, Rroji A, Enesi E, Leka N,Qirinxhi D,Basho J,Babameto A,Rapi E,Vathi D, Celiku E Part of Screening in Albania Shahini A, Allajbeu I,Shahini SH, Kosturi E Abstract: In this presentation, we report our 5 year experience in detection, follow up and mis­ diagnosed of liver hemangioma. We report the US, CT and MRI appearance of liver hemangioma. Breast Ca is one of the most common cancer among women found among every racial and Inspire of detailed cross sectional imaging findings, we emphases the superiority of MRI over ethnic group, Screening and good treatment for breast cancer can lower the risk of dying. US and CT in adequate characterization of these lesions. We report the classical imaging Mammograms can find breast cancer early, when survival is highest,. Have a mammogram findings and many features of atypical liver hemangioma, such as cavernous , sclerosed and every year starting at age of 40 if you are at average risk. Have e clinical breast exam at liver hemangioma with arteriovenous shunting . We also highlight the possible complication of least every 3 years starting age 20 and every year starting age 40. Since 2008 estimates, such lesions, and imaging strategy in diagnosing and follow up of liver hemangioma. breast Ca incidence has increased by more than 20% while mortality has increased by 14%

42 43 ORAL PRESENTATIONS ORAL PRESENTATIONS

Breast Ca is also a leading cause of cancer death in the less developed countries of the world. examination, followed by antibiotic treatment. 2 of them needed replacement of the pessary. This is partly because a shift in lifestyles is causing an increase in incidence and partly because The result was that only 2 of them progressed in early preterm delivery before the 30th week of clinical advances to combat the disease are not reaching women living in these regions. pregnancy. 50 % delivered between 34-37th week of pregnancy and 33 % delivered in full term. Incidence rates remains highest in more develop region but mortality is relatively much in less Results: 83% of the study group with cervical insufficiency confirmed by transvaginal ultrasound developed countries due to lack of early detection and access to treatment facilities. An urgent that was treated with cervical pessary went on beyond the 34th week of pregnancy, only 16% had early preterm delivery. There was not observed any relation between the pessary tr need in cancer control today is to develop effective and affordable approaches to early detection; diagnosis and treatment of breast cancer among women living in less develop countries Roma Index and HE4 in the Evaluation of Epithelial Ovarian Mases We are going to present data about patients at whom American Hospital has contributed for Gjoshe J, Daka A, Marku L, Delia Z, Theodhosi GJ. 5 years in breast screening. Human epididymis protein 4 (HE4) levels and the Risk of Ovarian Malignancy Algorithm The Bone Marrow Biopsy How Do We Perform it and our Experience (ROMA) have recently been shown to improve the sensitivity and specificity of epithelial Daku A, Cekrezi B, Ivanaj A, Berdica L,Erekyl S, Allajbeu I, Lako S,Pulluqi P, Xhumari P, ovarian cancer (EOC) diagnosis. Dhima A, Coma B. ROMA algorithm is an exponential equation combining plasmatic concentrations of HE4 and The pathologies of bone marrow are so much and different including primary or secondary CA125 and classifies patients as being at low or high risk for malignant disease and the marrow biopsy often is needed for evaluating the disease before therapy or after • Cancer Antigen 125 (CA125) and Human Epididymis Protein 4 (HE4) are the most studied specific therapy. Sometimes the laboratory results and myelogram are not enough for final ovarian tumor markers. Their diagnostic performance for identification of ovarian cancer diagnosis and they need the bone marrow biopsy for evaluating the pathologies such as are superior to CA19-9 and CEA, etc. which are no more recommended for the diagnosis anemia, myelodysplasia, Lymphoma etc. The procedure is realized with local anesthesia and of presumed benign ovarian tumor. HE4 (>140 pmol/L) is superior to CA125 (>30 U/mL) under CT and its very helpful and abundantly safe . The clinical information and correlation in terms of specificity and positive likelihood ratio. CA125 and HE4 can be combined with hematologist before procedure is crucial . Also its very important the patient consent into an algorithm ROMA, or associated to clinical information, biological data or imaging. form and information of relatives for any complication depending on patient conditions or ROMA is more sensitive and less specific than HE4 in predicting epithelial ovarian cancer. laboratory results. We discussed here the performing of bone morrow biopsy under CT ROMA is more accurate in post-menopausal women. guided procedure. We have performed a lot of bone morrow biopsy in our American hospital • Premenopausal group: 76% of all epithelial ovarian cancers and low malignant potential with very high success rate and the patients have been evaluated to hematology or other tumors are stratified as high risk and 75% of all bening cases are stratified as low risk clinicist for special therapy and follow-up . • Postmenopausal group: 92% of all epithelial cancers and low malignant potential tumors as high risk and 75% of all bening cases as low risk Gynecology & Neonatology & Pediatrics • Combinated patient groups: 89% of all epithelial ovarian cancers and low malignant Key lecture:”Delivery in Multiples-an Overview” potential tumors as high risk and 75% of all benign cases as low risk HE4 also Saricostas D promises to augment the sensitivity of CA 125 for detecting early-stage ovarian cancer Multiple births currently account for 3% of live births. In 2009, 16 women per 1000 giving birth Fetal DNA Fractions Examination-New Test for Fetal Abnormalities in England and Wales had multiple births compared with 10 per 1000 in 1980. Qirko R, Gjoni M, Gjoshe J, Koroveshi E, Toma I Maternal mortality associated with multiple births is 2.5 times that for single births. Stillbirths and preterm births are common in twins and triplets than in singletons. Non Invasive Prenatal Test (NIPT) is a new possibility to evaluate the fetal condition for Perinatal outcome is perhaps the most important concern when choosing the preferred route Down syndrome and other abnormalities. This test can detect abnormalities linked with sex of delivery for twin gestations. chromosomes and the fetal sex as early as 10 weeks. This test is available in Albania for pregnant women. The Treatment Options of Cervical Insufficiency during Pregnancy Background: NIPT is based on latest technology in sequential evaluation of chromosomes. Bajraktari D, Sula A, Delia Z It is safe and easy to get the sample for this test compared to amniocentesis. Other non- invasive blood tests or ultrasound examinations are safe for the mother and fetus but false Background: According to WHO 7-13% of the pregnancies end preterm. At the American positive rate for these tests is up to 5 % and low sensitivity for trisomy 21 up to 30 %. Hospital Tirana 9.6% of the pregnancies end preterm. Cervical insufficiency is one of the These tests can result in positive for fetal chromosomal abnormalities in fetuses that are reasons for late abortion of the second trimester or early preterm delivery. The main problem of normal, in a totally normal fetus or vice versus. NIPT will reduce in significant rate false the cervical insufficiency in pregnancy remains the correct diagnosis and the proper treatment. positive and false negative for chromosomal abnormalities. On other side diagnostic tests Aim of the study: If the correct diagnosis is concluded, what is the best choice of treatment as amniocentesis or Chorionic Villus Samples have high sensitivity for fetal trisomy, but in and when to start and to determine if the cervical pessary have high success rate. both tests is not safe to receive samples because of high rate of fetal abortion. Methods: Prospective 2 year study in the American Hospital Tirana. 12 pregnant women Results: we included in our study 108 women who voluntary completed Non Invasive were treated with Arabin cervical pessaries for cervical insufficiency in the second trimester of Prenatal Test. 31 patients or 28.7 % were registered as high risk for trisomy in routine singleton pregnancy. The diagnosis was based mainly on the history of previous pregnancies laboratory tests and/or ultrasound evaluations. 42 patients or 38.8 % were older than 35 and the ultrasound examination performed since 16th week of pregnancy and the insertion of years. In 0.9 % or one patient resulted in high risk for trisomy 21 or Down Syndrome in NIPT the pessary was done before the 24th week or pregnancy in all cases. The cases had short and it was diagnosed by karyotype later on. 78 patients or 72.2 % delivered and are totally cervix under 25 mm before 22th week of pregnancy and no other symptoms. 4 of them had normal for chromosomal abnormalities. This test resulted false positive and false negative funneling too. Vaginal cultures were performed every 2 weeks. 10 women referred excessive rate 0 and its sensibility is 100 %. vaginal discharge, but only one of them had vaginal infection confirmed by bacteriological Conclusion: Based on our study but even from other reviews new approach for chromosomal

44 45 ORAL PRESENTATIONS ORAL PRESENTATIONS abnormality evaluation based on DNA fractions is one of the best non-invasive test because Etiologies of Abnormal Uterine Bleeding and its Managment of its accuracy and safety. Soon we will include this test in routine protocols for pregnancy Hoxhaj O, Gjoni M, Dede E. follow up. Background: The multifactorial etiologies of acute AUB are classified by a system approved Early detection of Critical Congenital Heart Disease: Pulse-Oximetry Role by the International Federation of Gynecology and Obstetrics, as “related to uterine struc- Kolici N, Koja A, Simeoni A, Cipi L, Pino B tural abnormalities” and “unrelated to uterine structural abnormalities”, categorized following the acronym PALM-COEIN: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Background: Congenital heart disease is the most common birth defect and represents nearly Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified. 24-40% of all deaths caused by congenital anomalies.1 Critical congenital heart disease This is essential for choosing the most appropriate and effective management for the individu- (CCHD), which encompasses the more severe forms, is present in 2.5 to 3 in 1000 live births.2 al patient and is accomplished by obtaining a history, performing a physical examination and, In general, prenatal ultrasound or physical examination alone can easily miss newborns with when indicated, requesting laboratory and imaging tests. CCHD.3,4 Failure to diagnose CCHD early in life can result in high morbidity and mortality rates, Objective: The two main objectives of managing AUB were: 1- to control the current episode because symptoms frequently present after closing of the pulmonary ductus arteriosus, after of heave bleeding, 2- to reduce menstrual blood loss in subsequent cycles. nursery dis- charge. Pulse-oximetry screening is a low-cost, painless, noninvasive test that Methods: Based on a study of AUB at UHOG “Mbreteresha Geraldine”, during the period increases the ability to identify newborns with CCHD before they clinically decompensate.5–8 2010-2014, including 287 patients, age 9-76 years, with vaginal bleeding as the main com- OBJECTIVE: To develop strategies for the implementation of safe, effective, and efficient plain, was recommended a management algorithm regarding acute, chronic, medical and screening.METHODS:A work group was convened with members selected by the Secretary’s surgical AUB treatment. Advisory Committee on Heritable Disorders in Newborns and Children, the American Academy In conclusion, if clinically appropriate, the medical management should be the initial treatment of Pediatrics, and the American Heart Association.RESULTS: On the basis of published and for most patients, including IV estrogen, multi-dose regimens of OCs or oral progestin and unpublished data, the work group made recommendations for a standardized approach to tranexamic acid. The need for surgical treatment is based on the clinical stability of the patients, screening and diagnostic follow-up. Key issues for future research and evaluation were the severity of bleeding, contraindication to medical management, the underlying medical identified. Many studies show that pulse oximetry screening for CCHD has a less than one conditions of the patient and the desire for future fertility. Once the acute bleeding episode has percent chance of giving false positive results.18 False positive screening results for CCHD can been controlled, is recommended transitioning the patient to long term maintenance therapy. still offer information to doctors: roughly 25% of infants identified as having low blood oxygen Key words: AUB, etiology, algorithm management. without CCHD may be diagnosed with other conditions that require medical intervention. 19 CONCLUSIONS: The work-group members found sufficient evidence to begin screening for Cardiology & Cardiothoraxic Surgery Key lecture:”Minimally Invasive Procedures in low blood oxygen saturation through the use of pulse-oximetry monitoring to detect CCHD in Cardiovascular Surgery and the Future Trends” well-infant and intermediate care nurseries. Tuncay Eren N Key word: CCHD, pulse-oximetry Cardiac surgery as a specialty, probably because of the complexity of the procedures and Intermitent stenoses of the duodenum the possible consequences, has lagged behind other surgeries in the development of mini- Preza K, Nano L mally invasive methods . But the field of cardiac surgery continues to expand with the devel- opment of new techniques and operations, as well as the refinement of established surgical Intermitent stenoses of the duodenum are rare diseases, which are accompanied with ro- procedures. Like in many other medical fields, in cardiovascular surgery also, there are al- tation of the gut anomalies. Clinically they appear at an early age. These diseases are ways many efforts to have better results and to provide patient satisfaction . Less trauma, less accompanied with vomiting and in some cases with biliary vomiting (depending on stenoses morbidity, better cosmesis are the main reasons to seek new tecnologies. Cardiac surgeons level). Often ill patients are directed for ultrasound examination, after suspected for hyper- have made significant strides in developing less-invasive operations over the past 20 years. trophic stenoses of pylori. This kind of examination is important and should not be forgotten. During 2014, two cases were diagnosed with intermitent stenoses of the duodenum, one of Developments in new technology have facilitated these advancements and allowed surgeons them three days old the other two years old. In the first case, the patient had multiple vom- to perform coronary artery bypass graft (CABG) surgery, valve surgery, ablation for atrial iting meanwhile the second case had intermitent vomiting accompanied with biliary vom- fibrillation procedures, and even proximal aortic operations without median sternotomy, which iting. In both cases the ultrasound examination excluded hypertrophic stenoses of pylori. has been the traditional approach for access to the heart. As with any cardiac operation, In the second case first interpretations did not suspect for duodenum stenoses but for careful patient selection and preoperative planning are essential for successful outcome. The expressed gastroesophageal reflux. In both cases for confirmation of diagnoses up- adoption of minimally invasive heart operations by practising surgeons requires a commit- standing abdomen x-ray was conducted, which notes air lobes in duodenum, as well ment to learn new techniques and adopt new technology. The new minimally invasive cardiac as contrast examination. The diagnosis for the first case was duodenum stenoses on surgeon can expect prolonged operating times, a higher conversion rate to sternotomy and papilla-Vater, whereas in second case was under papilla-Vater, accompanied with gut a significant learning curve.. Despite longer CPB times and aortic cross-clamp times, there is malrotation anomalies. Both cases were successfully operated at the pediatric surgical less morbidity in terms of reduced bleeding, shorter hospital stay, added to a superior cosmet- clinic in QSUT. In most cases, ultrasound examination excludes hypertrophic stenoses of pylori but may ic result, and a faster return to preoperative function levels. Driven by market demand, among expose cases when we have expansions of the upper part of the duodenum. Diagnosis other factors, the growing adoption of MIMVS is likely to continue provided results continue to is determined by using contrast examination of gastrointestinal organ. This examination compare well to conventional surgery, which remains the standard for comparing both short- exposes stenoses level and gut malrotation, which are important factors in order to deter- term and long-term results. Endovascular procedures are other successful methods to treat mine surgical treatment plan. critical aortic and vascular pathologies.

46 47 ORAL PRESENTATIONS ORAL PRESENTATIONS

Key lecture:”Timing of Aortic Valve Replacement in Aortic Stenosis” for TAVI is expanding. With the expansion of indications new challenges like vascular access, Bajraktari G TAVI in aortic regurgitation, Valve in valve implantation and TAVI as a bridge to conventional Aortic valve replacement are ever more evolving. We report on the experience of Royal Aortic stenosis (AS) is the most frequent type of valvular heart disease, especially in adults of Brompton hospital TAVI team regarding the contemporary progress in Transcatheter Aortic advanced age (2–7% of the population >65 years). Degenerative AS is the commonest cause Implantation. The first in man Transcatheter mitral valve replacement in the World was of acquired AS in adults, especially in patients older than 70 years old. Echocardiography, performed by Mr Neil Moat and the TAVI team in 2014 at the Royal Brompton Hospital. as the key diagnostic tool in AS, confirms the diagnosis of AS, assesses the degree of valve We will update on the short term results which are promising considering the complexity of calcification, left ventricular (LV) function and wall thickness, detects the presence of other the procedure and the risk profile of the patients concerned. associated valve disease or aortic pathology, and provides prognostic information. A cut-off of valve area 1.0 cm2 or 0.6 cm2/m2 in a patient with AS is considered severe. Patients with Contrast Enhanced Cardiac MRI in Evaluation of Myocardial viability after MI– AS remain asymptomatic for years, particularly in elderly with naturally limited exercise. Aortic Correlation Between Extent of Nonviable Myocardium and Complications valve replacement (AVR) is the only effective treatment for severe aortic AS. Allajbeu I, B.Jata, A.Nona, N.Xhabija, S.Meco, E.Hajro, I.Temali, N.T.Eren, R.Rienmueller Untreated patients, after they become symptomatic, the mortality at 10 years follow-up is 80- 90%, whereas in patients with successful AVR, 10 years mortality 25%. Low flow, defined as stroke volume index (SVI) < 35ml/m2 is a more powerful predictor After myocardial infarction, accurate assessment of myocardial viability is crucial for optimal clinical of subsequent mortality than either ejection fraction (EF) or mean gradient. In patients decision making. Several studies have shown that the transmural extent of infarcion determined with severe AS, low flow with both low and normal EF is associated with increased 2-year by DE-MRI predicts the response of myocardial revascularization in patiens with acute and chronic mortality as compared to normal flow patients. Transcatheter valve replacement improves ischemic heart disease.The correlation of first –pass perfusion defects with the amount of nonvia- survival as compared with medical management and provides a similar outcome compared ble myocardium and incidence of complications in chronic MI is not well established. to surgical AVR. An assessment of flow (SVI) should be included in the evaluation and Method/technique: In 32 patients post MI contrast enhanced MR examination was performed therapeutic decision making of patients with severe AS. Independent conventional predictors with a 1.5 T system. 29 of the patients had a history of anterior MI and 3 of inferior MI with of poor outcome in AS patients are: older age, presence of atherosclerotic risk factors, valve severe stenotic lesions of coronary arteries demonstrated by coronarography. 25 of these calcification, peak aortic jet velocity and left ventricular ejection fraction. patients who had first-pass perfusion defects had also large amount of nonviable myocardium( There are still controversies regarding treatment of asymptomatic patients with severe AS, due to lack of evidence. Most of asymptomatic patients with severe AS, became symptomatic > 70% of wall thickness in more than 4 segments).5 of the patients who had no first-pass in mid-term follow –up period, and they have a risk of rapid functional deterioration. Early perfusion defects also had no large involvement of myocardium by non-viable tissue( >50 elective valve replacement surgery should be considered in these patients. % in 1 and 2 seg.). 2 from the patients of the second group with no perfusion defects and Early surgery in patients with very severe AS is associated with an improved long-term small infarcts underwent a successful revascularization CABG procedure. 6 of the patients survival by decreasing cardiac mortality. AVR improve LV subendocardial function and with large myocardial damage had intraventricular thrombus, 10 of them had aneurysm compensatory twist in these patients. Female sex, peak aortic-jet velocity > 5.5 m/s, and of apex or anterior wall and one had apical anteroseptal VSD as a complication of MI. increased serum B-type natriuretic peptide are independent predictors of outcome in these Conclusion: Previous studies have shown that the presence of microvascular obstruction patients. Transcatheter aortic valve implantation (TAVI) improved survival in patients after acute MI , is related to poor patient prognosis with increased incidence of congestive considered inoperable, as compared with medical therapy. TAVI has similar outcome, as heart failure, recurrent infarction, and chest pain. Our study showed good correlation between compared with AVR in high risk patients. Low flow (independent of LV EF) is independent predictor in these patients. Severity of paravalvular leak is an independent predictor . first –pass rest perfusion and extent of nonviable myocardium in delayed enhancing MR images along with increased incidence of complications. In the setting of complex coronary Free Style Aortic valve Implantation disease and concomitant LV dysfunction, a viability assessment via cardiac MRI can provide Ennker J important diagnostic and prognostic information.

Despite so many years of research, investigations and clinical implantation, finding an ideal Myocardial Revascularisation – Off Pump Technique aortic valve substitute remains elusive. For the last thirty years the most common aortic valves Kojcici B, Arben Kojqiqi; J. Ganellari; G. Mulla implanted are stented bioprosthetic or mechanical valves. Although these valves are ideal in certain circumstances, in some patients they are not. Their stented ring remains a problem, OPCAB is a technique that can be applied in patients with CAD. The aim of this technique as the orifice area is reduced and still some pressure gradients remain, nonphysiologic is to reduce the risks and complications caused by the heart-lung machine.This technique flow pattern is present. Free style aortic valves or stentless aortic xenograft, which first was is ideal for those pateints who have high risks of complications during the traditional CABG introduced in clinic in 1965. Early good results disappeared soon due to structured valve deterioration, mainly due to poor valve preparation. onpump, such as Carotid Artery stenosis,Pulmonary and Renal insufficiency,avoiding The inters for this sort of valves was reintroduced in 1987, with the introduction of a stentless the complications in patients with calcificated Aorta caused by cross-clamp of the Aorta. porcine aortic valve. This valve offers a number of benefits as compared to the stented valves, The benefits of this technique consists in the prevention of the Cerebral Ischemia,complications superior haemodynamics and excellent clinical outcomes. in COPD patients,reducing the incidence of embolism, a faster post operative recovery.

Key lecture:”Percutaneous Implantation of Aortic valve (TAVI) “” Off pump CABG – Anaesthetic and Surgical Considerations Rosendahl U Bilaj M, Huti G, Arapi B, Erjon Panajoti, Besnik Kojcici, Arben Kojqiqi,

Transcatheter aortic valve implantation has become the preferable choice of Aortic valve Abstract: Introduction and background: Off pump cardiac coronary artery bypass graft intervention in patients who are not favorable for conventional surgical procedures. (OPCABG) is performed, to avoid the complications associated with cardiopulmonary bypass Short and intermediate results have been more then satisfactory and as a result the indication (CPB) pump and to minimize aortic manipulation. The term OPCABG encompasses a range

48 49 ORAL PRESENTATIONS ORAL PRESENTATIONS of surgical approaches , the technique that is most commonly performed is OPCABG with and 26 women) who underwent CABG surgery over a 2-year period (2011–2013). Patients a full sternotomy. OPCABG was the primary bypass surgery performed in the world, and with primary hematologic disease were not included in this study. The data is summarized as reached its peak usage at around 25% in 2004 . However, its application is still controversy . average values and Student’s t-test is used to compare it. Values of p≤0.05 were considered Anesthetic management is absolutely critical for a successful program. This review will focus statistically significant. Results: Average values of erythrocytes, hemoglobin and hematocrit declined, to reach lower on benefits and limitations of OPCABG surgery. values on day 3 after surgery (-33.6%, -33.1%, -32.6% respectively from the preoperative Methods and results: This review was accomplished by comprehensive search of literature value, p<0.001) and then gradually increased to reach normal values after one month and published over two decades by pub med and Google scholar. The goal of the inclusion criteria the preoperative values after three months. The average values of leukocytes and neutrophils was to derive information from articles published in major anesthesia and surgical journals. In increased rapidly (neutrophil leukocytosis) to achieve the highest value on day 2 after surgery, this articles describing brief history, evolution of OPCABG surgical and anesthetic technique, while the average value of lymphocytes decreased quickly to achieve lower value on day 1 graft patency, and early and late outcome date were included. Published meta-analyses were after surgery (+74.7%, +127.1%, -52.4% respectively from the preoperative value, p<0.001). compared off pump vs. on pump regarding rate of AF, cognitive deficit. In the last two decades Once these values were reached, the average values of leukocytes and neutrophiles were the technique has evolve, as a result of new surgical devices and increased experience with reduced gradually and the average value of lymphocytes increased gradually to reach the normal levels on day 21 and the preoperative values on day 28. The average platelet count stated techniques. The goal in the majority of modern OPCABG is to achieve complete decreased gradually to reach the lowest value on day 2 after surgery (-26.4% from the revascularization of all the coronary arteries disease. preoperative value, p<0.001), after which gradually increased up to +100.8% of preoperative Conclusion: This review concluded the superiority of OPCABG vs. on pump in the most of value on day 14 (p<0.001) and then gradually decreased to reach normal values on day 21 the studies related to length of stay, operative morbidity , incidence of bleeding especially and preoperative values after three months. when aorta is not manipulated. Also OPCABG will continue to be the indicated technique Conclusions: Average values of the three peripheral blood cells parameters undergo when cannulation of the aorta is contraindicated. important changes after CABG, but not life threatening, and regain normal and preoperative values after 1-3 months from surgery. Evaluation of Glycated Hemoglobin Level in Patients with Coronary Artery Disease Gjoshe E, A. Zaka, E. Hajro, Dhamo E. Retinal diseases,from Diagnosis to Treatment Jacobbi M Background: Glycated hemoglobin has been the key measure of glycemic control in diabetic patients for at last two decades. It is considered to be the gold standard test, You gotten precocious diagnosis setting a lot of attention to the synthomatology reported by and most widely accepted test of glycemic control. The glycated Hb concentration levels the patient goes together with the exact individualization of the detachment pathogenesis. are also more closely related to the risk of chronic complications than random single Fundamental importance have the examination of the ocular fund to locate with extreme or episodic glucose levels. This study tends to investigate the relationship between precision the center of the or the breaks done this last that will give an important indication to glycated hemoglobin (HbA1c) level and coronary artery disease (CAD) severity. the treatment type be performed. Two schools of thought exist for the surgical treatment of the Methods: Observational study was conducted, 200 participants were enrolled and retina detachment: the break surgery and that of the detachment. The surgery of the break baseline characteristics were collected. Clinical presentations in terms of stable angina, (Lincof) has a preference for an episcleral approach with apposition of silicone scleral buckls unstable angina or acute myocardial infarction were diagnosed. All participants were in correspondence of the or the retinals breaks exploiting the ability of the retinal pigmented epithelium to reabsorb the liquid one under the retinal colsed break; the detachment surgery performed coronary angiography to figure out the numbers of coronary artery stenosis departs instead from the principle that at the end of the surgery the retina will have to in terms of none-stenosis (< 50% stenosis), single or multiple vessels stenosis . be necessarily in plain! The choice of one or the other methodic tied up to the form of the All participants were divided into subgroups according to two categories in terms of severity detachment, to the numbers and location of the retinals breaks, to the presence or less than of clinical presentation (stable angina, unstable angina, acute myocardial infarction) vitreo retinals tractions and naturally to the surgeon experience. Today with the mininvasive and the number of coronary artery stenosis (none, single, multiple vessels). Primary surgery, we are able to enter in the posterior chamber (vitrectomy) with tools more and endpoint was to evaluate relationship between baseline HbA1c value and CAD severity. more thin and less traumatic (20, 23, 25 and 27 gauges) even if we havent to forget that the Results: Participants with CAD had more risk factors such as elderly, smoking, low HDL-C. In vitreous as it contributes to the genesis of the retinal detachment, however it constitutes our study, HbA1c levels in the first category were almost similar between subgroups ( stable the good colliding with useful inside to favor the return of the retinal detachment in plain. angina, unstable angina and acute myocardial infarction subgroup). But not the same trend was identified in the second category, in terms of higher HbA1c level corresponding to more vessels Refractive Correctionof Moderate and High Myopia with VisianTM. stenosis. Multivariate regression analyses showed that after adjusted for traditional risk factors ICL-PCPIOL.A Premium Refractive Options for Potentials Patients as well as fasting blood glucose, HbA1c remained strongly associated with the severity of CAD. Pesando P Conclusion: HbA1c may be a useful indicator for CAD risk evaluation. Keywords: Glycated hemoglobin, Coronary artery disease, Diabetes mellitu With this refractive surgical procedure very good outcomes are achieved by a combination of excellent material with high biocompatibility (Collamer™), good preoperative assessment and Hematological Changes in Patients Undergoing Coronary Aretery Bypass Surgery indications, good surgical technique (butterfly surgery), good postoperative evaluations. The Lako S, Daka A, Nurka T, Dedej T, Ostreni V ICL (Intraocular Contact Lens) is foldable, located in posterior chamber sulcus located with a wide range of prescriptions, myopia, hyperopia, astigmatism and in next future presbyopia Objectives: Assessing the hematological changes after artery bypass graft surgery (CABG). and with an excellent quality of vision. Methods: A prospective cohort study included patients in the department of cardiac surgery at the American Hospital, in Tirana, Albania. 164 consecutive patients were studied (138 men The procedure is reversible. The Visian™ ICL Center FLOW, the last model, is the most efficient

50 51 ORAL PRESENTATIONS ORAL PRESENTATIONS phakic IOL, located near the nodal point of the eye, with the optimized efficiency in visual acuity Conclusions: Excimer Laser is the most frequent, effective and safest method for refractive and, resulting in fastest visual recovery. By not disrupting corneal tissue, the Visian™ ICL does errors correction. The successful treatment of these errors could only be completed if all the not induce HOAs and preserve future treatment options while also being easily removable. inclusion criteria would be met. The author was the first to implant a Visian™ ICL in the world in September 1993. Phakic IOL Artisan.Artiflex Use for Extreme Refractive Errors Correction Intrastromal Corneal Ring Segments Qafa N, Haveri T, Meco M Ferrara Ring, Pesando P Purpose: To fully describe the most modern methods of Excimer Laser correction of different The cornea is the most important natural lens of the eye optical system, responsible for refractive errors (myopia, hyperopia and astigmatism). the two thirds of the total refractive power. It has a life-long stability, with its prolate surface Setting: American Eye Centre at American Hospital of Tirana. geometry, a relatively steep center surrounded by a flat periphery, being designed to Methods: Advanced Excimer Laser methods description will give a clear picture on different minimize unwelcome aberrations and to project all rays to a single focus on the retinal plane. types, indications, counterindications, limits, safety profile and clinical results of refractive It is superficial and then easily accessible to any surgical procedure. The Ferrara ring, inert material PMMA CQ Acrylic, addicted in the corneal periphery results in its flattening and, the errors laser correction. rin diameter determines how much the cornea will be flattened, thus the more tissue added, Results: The safety and efficacy of Excimer Laser use in the refractive errors correction will increasing the rin thickness, and the smaller the diameter, the greater will be the myopia be described. Different multicentric studies and our eye center clinical results’ presentation correction obtained (Barraquer – Blavatskaya postulate). The Ferrara Ring are indicated in will fulfill this picture. keratoconus, high irregular astigmatism after corneal transplantation, irregular astigmatism Conclusions: Excimer Laser is the most frequent, effective and safest method for refractive after radial keratotomy, corneal ectasia, pellucid marginal degeneration. errors correction. The successful treatment of these errors could only be completed if all the inclusion criteria would be met. Keratokonus Disease, Diagnosis and Cross-Linking Treatment HAVERI T, MECO M, QAFA N Cataract Surgery in Glaucomatous Eyes Meço M, Haveri T, Qafa N Purpose: To describe the most modern methods of diagnosing keratokonus disease with 3 dimensional comeal topography (Pentacam). To describe the cross-linking method as we Purpose: Our experience and review of the current literature regarding the best approach for apply in our clinic. To present our 5 year experience and results of treating keratokonus with cataract surgery in glaucomatous eyes. cross-linking method. Methods: Seventy eyes of 70 glaucomatous patients were included in this study. Twenty-five Setting: American Eye Centre at American Hospital of Tirana. patients underwent Phaco-Trab, one site surgery ; ,twenty patients underwent sequential Methods: Keratokonus is a degenerative disease of the corneal, starting generally at 14-25 surgery ( separate procedures) ;5 patient with angle closure glaucoma and twenty patient with years old, and causing progressive thinning of the cornea. Because of these thinning, corneal well controlled (on one or two medication) did only cataract surgery . Also literature review shape is reduced into a conical one, causing also distortion of vision. Extrem advancement was consult regarding new glaucoma surgeries combined with phaco. of the keratokonus can cause corneal perforation. Cross-linking is the only procedure used Results: The preoperative mean intraocular pressure (I0P) of 32.6+1-5 mmHg dropped to halt the natural progression of keratokonus. It is based on applying riboflavin drops on the significantly to 14.8+/-3.SmmHg. The mean follow-up time was 20+/- 3 months (range 6-29 cornea (after de-epitelization) and irradiation with UVA 370 nm. This is our experience with months). The reduction of IOP was more pronounced and consistent in the second group this method, applied in our hospital since 2009. (when cataract surgery first and later glaucoma ), but the difference was not significant. Results: After cross-linking, steepest, average and flattest keratometry values reduced In patients that cataract surgery was done after glaucoma surgery , bleb filtration was approximately with 2 D. BCVA improved 2 lines and UCVA remain stable. compromised in 30% The most common complications after combined surgery were fibrinous Conclusions: Cross-linking procedure is a safe and minimally invasive procedure. The exudation (12%) and post-op hypotonia (10%). results shows its efficacy in stabilizing the cornea and therefore halting the progression of Conclusions: According to our results and current literature review :.Consider combined keratokonus. procedure for uncontrolled open angle glaucoma; moderate to advanced glaucoma on multiple medications ; pseudoexfoliative glaucoma.. Glaucoma surgery first on disc at risk. Excimer Laser Refractive Surgery for Refractive Errors Correction Cataract surgery alone in patients with controlled open angle glaucoma and in patients with Qafa N, Haveri T, Meco M closed angle glaucoma

Purpose: To fully describe the most modern methods of Excimer Laser correction of different A Panoramic Overview about Care Improvement and the Challenges of Albanian refractive errors (myopia, hyperopia and astigmatism). Ophthalmological Community, in Order to Eliminate the Avoidable and Prevent the Setting: American Eye Centre at American Hospital of Tirana. Blindness in the Future Methods: Advanced Excimer Laser methods description will give a clear picture on different Bardhi N, Mema V, Tandili A types, indications, counterindications, limits, safety profile and clinical results of refractive errors laser correction. Purpose: To be known and to continue a national compaign , to raise the awarness among Results: The safety and efficacy of Excimer Laser use in the refractive errors correction will peoples, ophthalmological community and albanian government about the societal impli- be described. Different multicentric studies and our eye center clinical results’ presentation cations of vision loss, as well as, to mobilize a strong, long term political and professional will fulfill this picture. commitment to eliminating avoidable blindness .

52 53 ORAL PRESENTATIONS ORAL PRESENTATIONS

Material and method: There are many studing informations about avoidable and preventing one of the main causes of blindness. Early diagnose and regularly check-up every 6 months blindness that will eventually include data from group’s study from International are strongly recommended. Fluorescein angiography and optical coherence tomography are Ophthalmological Study of AAO, on worldwide and from one group’s study that include data the main equipment used to diagnose and classify the stage of diabetic retinopathy. Anti from 16 European Countries VEGF injection and laser photocoagulation are common medical treatments, applied in our Discussion: Blindness know no borders. The prevalence is highest among those in hospital for treating diabetic retinopathy. In advance stages, vitro-retinal surgery is also an developing nations. The number is increasing and expected to double by 2020, as world option for our patients presenting proliferative diabetic retinopathy. populations and life expentancy increase. Causes of adult vision loss and major avoidable causes of adult vision impairment there are: uncorrected refractive error , cataract , Dealing with Resistant Diabetic Macular Edema angle – closure glaucoma and diabetic retinopathy. Cataract is a major health challenge. Meço M, Haveri T, Qafa N Cataract causes nearly half of the world’s vision loss . Unlike Cataract, angle- closure glaucoma and diabetic retinopathy , where 90 % of blindness from these diseases often Purpose: Understanding the different mechanisms of diabetic resistant macular edema and occur due to health care delivery problems in the developing world , where participate evaluating the efficacy of anti -VEGF treatment. and our country. At the same time, avoidable causes of childhood and young adult vision Methods: Thirty eyes of 20 patients with diabetic resistant macular edema were included loss there are: ophthalmia neonatorum , retinopathy of prematurity , vitamin A deficiency , in this study. Visual acuity (VA), fundoscopy, angiography and OCT evaluation was done amblyopia and trauma. during the mean follow-up time of one year (8 months -2 years). Anti VEGF treatment applied Malnutrition and retinopathy, as well as infectious diseases, including trachoma, onchocerci- monthly, with or without focal / pan-retinal Argon Laser treatment. asis ,and keratitis , continue to be major causes of blindness. Results: In fifteen eyes (50%), mean VA improves by 4-5 ETDRS letters; seven eyes (23%) Conclusion: 1. Prevention of blindness from these conditions is deemed feasible and remain stable during the follow-up period and eight (27%) eyes still continue to loos vision by affordable and a high proportion of blindness is preventable. Many other cases are treatable . 3¬4 ETDRS letters .Central Retinal Thickness (CTR) reduced by 30%, 15%, in the first two 2. The prevention and treatment of vision loss should be a public health priority. groups. Vitreo-macular traction, epiretinal membrane, PVR and diabetic papillopathy was mostly seen in the last group, which may need probably surgical treatment. New Surgical Method for Correcting Diplopia (double vision) Conclusions: Understanding the mechanism of diabetic resistant macular edema, is crucial Pesando P toward the strategy of treatment. Anti-VEGF treatment remain still the best choice, excluding the patients that have surgical indications . Binocular diplopia is caused by a neuromuscular anomaly and must be differentiate from monocular diplopia, resulting from defects in the refractive media. The binocular diplopia Image Processing Algorithms: a New Method in Evaluation of Posterior Capsular manifests in a normal retinal correspondence (NRC) or harmonic anomalous retinal Opacification after Cataract Surgery correspondence (AARC) following a pathological or traumatic events. In case of binocular Halili I, Uka A, Ndreu A diplopia one must ask how frequently it is observed, whether it is constant or transient, whether the two images are separated horizontally, vertically or both and, whether the distance between Introduction : Posterior capsular opacification ( PCO ) still remains a major outcome of modern them increases or decreases in different directions of gaze and with different head positions. cataract surgery with intraocular lens implantation. Managing PCO postoperatively is a a big After a complete and detailed diagnosis we can go to a surgical correction that can guarantee burden and in the same time brings a lot of potentially dangerous complication in visual acuity. a perfect functional and cosmetic result. This method consists in moving the position of the Standardizing PCO scoring is still a matter to be discussed between scientists and muscles on the eye ball under topic anaesthesia and under orthoptic control. We use adjustable ophthalmologists. sutures and we do a fine tuning of the sutures and of the position of the muscles until we don’t Purpose: To develop a new method for evaluation of posterior capsular opacification. find the perfect position and the total resolution of the diplopic symptoms, then we close the Materials and Methods : Sixty patients that had undergone uneventful cataract surgery with conjunctive and we discharge the patient without patch the eyes. a posterior chamber intraocular lens implantation between 2007-2012 were included in the retrospective study. Diabetic Retinopathy. Results of free check-up campaign organized from American IOL photographs were evaluated by using image processing algorithms in a computer program. Hospital and Diabetic Association Results : By evaluation of the photographs it was noticed that as the opacification level HAVERI T, MECO M, QAFA N, Nure J increases, the histograms widen and shift toward higher intensity values. Conclusion : Evaluation of posterior capsular opacification with processing algorithms in a Purpose: To report the result of free screening campaign organized from American Hospital computer program may be a new standardized and objective calculation method. and Diabetic Association in May 2013.To describe the most modern equipment like Optical Coherence Tomography, used in our hospital to diagnose and follow diabetic retinopathy. To Key lectures: ”Headache in the Emergency” describe the medical and surgical treatments for its different stages. Kruja J Setting: American Eye Centre at American Hospital of Tirana. Methods: 1077 casual persons participated, aged between 25-70 years old, average 55.1 Headache is pain in the head, face and neck area. It can be sign (symptom) of considerable years old. 59.6% Female 40.4 % male. Blood sugar, HbA1C, fundus oculi were examined. causes that affect these areas; Results: 7% of them resulted with HbA1C > 6.5, 7.5 % resulted with blood sugar level > 126 Anatomical basis: Cerebral tissue itself is not sensitive of pain, because it doesn’t’ have mg/dl and between them 1.2 % presented diabetic retinopathy. sensitive; pain is caused by other affected other structures near brain. Different areas of head, face and neck have structures that are sensitive to pain. These fall in two categories: Conclusions: Diabetic retinopathy is not a rare complication in the diabetic patients, still being Inside the head ( vaclar structures, meninges and cranial nerves)

54 55 ORAL PRESENTATIONS ORAL PRESENTATIONS

Outside the head ( periosteum, muscles, nerves, veins, arteries, subcutaneous tissue, eyes, designated the International Study of Asthma and Allergies in Childhood (ISAAC). Albanian- ears, sinuses and mucous membranes) ISSAC study was conducted in Tirana, during the school year 2011-2012, based on ISAAC Classification: At lecture will be cited other classification, but will be more specified last protocols. This study had been carried out to examine the prevalence of symptoms of classification: asthma, allergic rhinitis, atopic eczema and risks factors among Albanian schoolchildren. The International Classification of Headache Disorders, 3rd edition (beta version); ICDH III, Material and methods: In August 2011, a randomized sample of schools was chosen until Cephalalgia 2013; 33(9) 629–808) a predefined sample of 3000 children for each of three age groups; 6-7, 10-11 and13- Prevalence at emergency: Headache is 4-5% of emergency 14 years old was achieved. Parents (for 6-7 years old and 10-11 years old) and children Is important to know and evaluate headaches that are life threatening from primary benign (for 13-14 years old) responded to a questionnaire containing questions concerning risk headaches (much more prevalent that others) factors, as well as the prevalence, and severity of allergic disorders. Two physician trained Causes of headaches at emergency in allergy field examined all the schoolchildren for visible flexural dermatitis and performed Are cited primary headache and especially secondary headaches (traumatic, vascular) in 1093 of 10-11 years old children, skin prick test, according to the study protocol. In this lecture will be specified some important elements: Results: A total of 9478 schoolchildren from randomly selected schools in the capital of • Diagnosis ( anamnesis datas, neurological examination, other examination) Albania, Tirana were evaluated. In 6-7 years old the frequency of eczema ever was 1.8%, • Treatment asthma ever was 2.8%, and hay fever ever was 5.9%. In 13-14 years old frequency of eczema Will be presented specific algorithms that are related to diagnosis, prevention and treatment ever was 2.5%, asthma ever was 4.4%, hay fever ever was 6.5% and in 10-11 years old the of acute headaches; frequency of eczema ever was 1.7%, asthma ever was 3.0%, hay fever ever was 6.1%. The prevalence of atopy was 23.6%. Is the Hashimoto Thyroiditis a Risk Factor for Thyroid Cancer? A Retrospective Study Conclusion: The prevalence of allergic disorders in different countries varies widely, with an Puca E, Koza B, Huti E, Bitri S, Daku A, Berdica L, Bushati T, Puca E, Ylli A increasing trend in countries in development and in affluent countries. The prevalence of allergic disorders in Albania, in 2011-2012, according to this survey was low. Introduction: Thyroid cancer is the most common endocrine malignancy worldwide, with a significant increase in global incidenc. About 70% to 80% of thyroid cancers are papillary Stroke in Young Adults, Diagnostic Challenge and Prevention thyroid carcinoma (PTC). Despite surgical advances and better long-term results, however, Zllami B, Basha E, Shahini A, Cekrezi B, Saygili B the underlying pathogenesis of PTC remains unclear. Hashimoto’s thyroiditis (HT) has been postulated to have a causative relationship to PTC, being suggested as a possible Strokes in young adult are relatively uncommon. They happen usually in middle and risk factor for developing PTC. advanced age. Up to 10% of strokes may occur in relatively young individuals (under 45 OBJECTIVE: Conflicting data have been reported with regard to Hashimoto thyroiditis (HT) years of age) and represent a challenge in terms of diagnosis and treatment. The classic and risk of Papillary thyroid cancer (PTC). The main objective of our study was to determine risk factors as hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking and the prevalence of PTC and HT coexistence in histopathologic material of thyroidectomized alcohol are also seen in the young age patient with stroke. patients. Cardiac diseases like arrhythmia, valve disease, are also risk factors for stroke. But there Materials and methods: In a retrospective study, the clinicohistopathologic data of 106 are some unusual risk factors. Coagulations defects, hematological disorders pregnancy patients (9 males/97 females), who underwent a total or near total thyroidectomy throughout (eclampsia), vascular malformation, migraneus stroke, mural thrombus, congenital the years 2012 to 2014 for any thyroid pathology at the American Hospital, were analyzed. heart disease, rheumatic heart disease, patent foramen ovale ,vascultis, inflammatory- autoimmune diseases, infectious diseases, cancer, use of illicit drugs, inherited disorder The mean age of the patients was 47.7 years old (range 16-73) We categorized patients (MELAS, CADASIL), moya-moya disease. according to the presence of histopathologically proven HT. Vascular malformations are the main cause of nontraumatic cerebral hemorrhage in RESULTS: Hashimoto Thyroiditis was detected in 21 specimens (19.8%) and PTC in 46 the young (aneurysm, vascular malformation- arteriovenous malformation (AVM); dural (43.3%) of specimens. The prevalence of HT among 46 specimens with PTC was 23.9 arteriovenous fistula (dAVF); cavernous malformation. A significant cause in the young is %.versus 16.6 % in patients without PCT. Among 21 specimens with HT, the prevalence of also the use of illicit drugs. PTC was 52.3%. Patients should undergo through a detailed evaluation including brain imaging, vascular Conclusion: HT was associated with an increased prevalence of PTC suggesting an studies, cardiac evaluations and hematologic assessment, biochemical, immunology and association between HT and PTC. An adequate follow up of patients with Hashimoto’s sometimes very specific screening using the most advanced diagnostic techniques. We thyroiditis may permit an early diagnosis of differentiated thyroid cancer and its appropriate will expose the diagnostic challenge through case reports from our experience, modalities of evaluation, treatment and prevention. Is very important for these patients to have management. More prospective studies are needed to further elucidate this relationship. a complete diagnostic evaluation in order to determine potential causes and effective Key word: Hashimoto Thyroiditis, Papillary Thyroid Cancer, Histopathology secondary stroke-prevention strategies. But unfortunately, even after a careful evaluation for etiology of stroke in the younger patient high percentage (up to 40%) of cases remain The Map of Prevalence of Allergic Disorders in Albania and Worldwide. A Short Report without a known etiology from Alb-ISSAC Study Conclusion: Stroke in young adult is relatively uncommon, but is very import to recognize. Piluri E, Mesonjesi E, Gupta R, Bregu B, Zoto M, Strachan D, Priftanji A Patients often should undergo through a detailed evaluation including brain imaging, vascular studies, cardiac evaluations and hematologic assessment, biochemical, immunology and Background: Allergy is a public health problem of pandemic proportions. Worldwide, the sometimes very specific screening using the most advanced diagnostic techniques. Through rise in prevalence of allergic diseases has continued in the industrialized world for more cases that are hospitalized at American Hospital during five years we will expose the diagnostic challenge and prophylaxis approach. than 50 years. To evaluate the global prevalence of allergic disorders in childhood was

56 57 ORAL PRESENTATIONS ORAL PRESENTATIONS

The Role of Imaging in the Diagnstification of Vertebral Artery Disease without preoperative anemia an average of 1.7 units (p<0.001). Shahini A, Zllami, B, Shahini SH, Allajbeu I, Dhima A, Cekrezi B,Kosturi E, Tocilla B Conclusion: Blood transfusion was required for 79.8% of patients with a mean number of 2 units per patient. Six variables were important factors in the use of blood in patients The diseases of vertebral arteries (stenotic lesions ,dissection, occlusion, fibrous banding, undergoing CABG: using CBP, age≥62 years, BMI≤25, a higher number of grafts, subclavia steal syndrom, vasculitis, trauma impingement, osteophytic compression, giant combined heart interventions, and preoperative anemia. cell arterities etc) especially stenotic lesions are responsible for up to 15-20% of posterior circulation ischemic stroke. Evaluation of Incidence and Clinical Features of Post Soncussion Syndrome (PCS) Albania The second most common site of stenosis after internal carotid artery is the origin of vertebral Basha E, Zllami B, Pavllo D, Cakonji Z arteries .Stenosis of the vertebral artery can occur in either its extra‐ or intracranial portions Thus the early diagnostication of vertebral arteries leads to correct management. Objectives To examine the incidence, duration and clinical course of patients diagnosed with The commonest cause of vertebral artery stenosis is atherosclerotic disease and this is often PCS in Emergency Department. The main outcome measure are the type and duration associated with atherosclerotic plaques in the internal carotid artery at the same time.It is of symptoms assessed by Revermead Post concussion Syndrome Questionnare (RPSQ). considered that the two sites of stenosis mentioned above share a common pathogenesis, Methods Patients presented in emergency department within 6 hours of MTBI initially with stroke resulting from formation of emboli at the site of atherosclerotic plaques. completed a questonaire describing mechanism of injury, associated symptoms, past The initial diagnostication test of choice is ultrasound . As a very accessible ,non invasive, medical history. Serially administrated the RPSQ for 1 week, 1 month and 3 months after l ow cost, without radiation and contrast media it can evaluate 80-90% of vertebral arteries. concussion or until symptoms resolved. For a period of six months were present in ED of Ultrasound combined with colour Doppler Imaging and Power Color Doppler Imaging have Trauma Hospital 723 patients with head trauma. From those 544 patients (75%) with MTBI increased the imaging of the origin of vertebral arteries. But ultrasound is highly user dependent. comleted the RPSQ. Computer Tomography Angiography is able to image the extracranial vertebral artery Results Headache, fatigue, dizziness were the most common symptoms encountered at without the risk associated with catheter angiography. presentation whereas headache, sleep disturbance, frustration, forgetfulness, fatigue and Magnetic resonance Imaging t is best used in combination with Resonance Angiography to dizziness were the symptoms most likely to develop during the follow up period. The most evaluate both intra and extracranial arteries. The gold standart for diagnosing vertebral artery commonly reported symptoms of PCS at first and second follow up (1 week and 1 month) were headache 78%, trouble falling asleep 31%, fatigue 29%, difficulty remembering 18%, stenosis is Digital Substraction Angiography (DSA) although this has a small morbidity and dizziness 17%. associated mortality. In the third follow up (3 months) persists headache 35%, trouble falling asleep 19%, fatigue PTA and stenting is a safe and effective treatment especially at the vertebral artery origin. 16%, difficulty remembering11%, dizziness 11%. Restenosis has been a problem which is thought to diminished by usin diluted stents. There On the analyses the presence of headache post trauma was the most important predictor after have been no major complicatons with this procedure controlling for age, gender, presence of loss of consciousness, alteration of consciousness and post traumatic amnesia. Impact of Blod Use on Patients Undergoing Coronary Artery Bypass Surgery. A Conclusion The result of this prospective study suggest that headache is the most important Prospective Study physical symptom that persist after mild traumatic brain injury. The emotional symptoms tend Lako S, Daka A, Nurka T, Memishaj S, Dedej T to develop later in recovery period. Objectives: Assessing the incidence of blood use and the impact of cardiopulmonary Switching to Once of Day Basal Insulin from Twice Daily Doses of Premix Insulin bypass (CBP), gender, age, BMI, number of grafts, combined cardiac interventions, and Human or Analog Resulted in Greater Improvement in Glycemic Control Patients with hemoglobin level in patients who undergo coronary artery bypass graft (CABG) surgery. type 2 Diabetes Methods: A prospective study included patients in the department of cardiac surgery at the Lumi E, Ylli A, Guri M American Hospital, in Tirana, Albania. 164 consecutive patients were studied (138 men/26 women) who underwent CABG surgery over a 2-year period (2011–2013). 116 patients Background and aims:Many patient failing to achieve blood glucose control on premix were operated on-pump and and 48 patients off-pump. The data is summarized as average insuline,were switched to basal bolus insuline regimen.The safety and efficacy of basal values and values of p≤0.05 were considered statistically significant. insuline treatment for six months,as well as the effect of switching from premix insuline to Results: The average age was 61.8 years. Packed red blood cells (PRBC) were administered basal insuline,were evaluated. to 79.8% of patients. On-pump and off-pump patients received 2.4 and 1.0 unit of PRBC, Materials and methods: The study was conducted in 15 patients 9 female and 6 male with respectively (p<0.001). Female and male patients received 2.2 and 2 units, respectively average age 65 years old. All adult patients with type 2DM in premix insuline regimen were (p=0.35). Patients aged ≥ 62 years received 2.3 units on average versus the average of switched in basal insuline (glargine) (+/- OAD, +/- prandial insulin). Baseline[mean±SD] 1.7 units received by patients aged < 62 years (p< 0.001). Patients with BMI≤25 received HbA₁c 9.94 ± 1.9% ,FPG 13.6± 3.8 mmol/l ,weight 79± 10 kg.Duration of the study was 2.3 units on average versus the average of 1.8 units received by patients with BMI>25 6 months.The primary metabolic measure was glycemic control,as measured by FPG and (p<0.003). Interventions with 4-6 grafts receiced an average 2.5 units, while those with 1-3 HbA₁c change from baseline at 3 months and the secondary at 6 month from the beginning grafts an average of 1.5 units (p<0.001). Results: At the end of the 6-month assessment period, 86.6% of patients who switched from Patients requiring other cardiac surgical interventions received an average of 2.6 units, premix insuline regimen to basal insulin glargine, demonstrated significant improvement in while those without other cardiac surgical interventions an average of 1.8 units (p<0.001). HbA₁c, FPG and weight reduction.In 13.3% of the patients, who do not reach the goal, were Patients with preoperative anemia received an average 2.7 units of PRBC, while patients because of the severe complication of diabetes as proliferative retinopathy and the pure

58 59 ORAL PRESENTATIONS ORAL PRESENTATIONS diet compliance from the patient.Minor hypoglicemia was infrequent and occurred only in and circulatory arrest (p=0.03) as strong predictors for poor overall survival. The same test patients using a concomitant sulphonylurea or prandial insulin. determined the chronic renal failure, dissection, arch procedure and associated procedures Conclusions:Switching to once daily basal insulin (glargine) from twice daily doses of as strong predictors for poor overall free major events survival. premix insulin human or analog resulted in greater improvement in glycemic control in Conclusions: The surgical approach of the ascending aorta is a challenge problem for the patients with type 2 diabetes. cardiac surgeons. Such surgical procedures are now feasible with excellent outcome in Albania. Our early and midterm outcome are excellent and are very promising comparable to Key lecture: ”Surgical Treatment of the Ascending Aortic Aneurysm. Specific Technical other reported series in the literature. Considerations. Initial Albanian Experience” PRIFTI E Key lecture:”Pulmonary Hypertension – Diagnosis” Poscia R Introduction and objectives: Surgical approach of various pathological forms of the ascending aorta is a challenge for the cardiac surgeon. We are presenting the initial experience of the Pulmonary arterial hypertension (PAh) is a clinical syndrome characterised by a progres- surgical approach in Abania. The aims of this study were: (1) to evaluate the early and long- sive increase of pulmonary vascular resistance, ultimately leading to right heart failure term outcome in patients undergoing aortic replacement (2) to identify the predictors for poor and death if left untreated. According to the guidelines published by the european society overall survival in this pool of patients. of cardiology (esc) and the european respiratory society (ers), PAh is characterised by Materials and methods: We included 160 patients undergoing ascending aortic replacement pre-capillary pulmonary hypertension (mean pulmonary arterial pressure [PAP] >25 mmhg, in Tirana, between February 2006 and October 2014. The mean age was 52.9±12.3 years with pulmonary wedge pressure <15 mmhg) in the absence of left heart disease, paren- and 33 were females. The mean NYHA functional class was 2.1±0.8. 33 patients presented chymal lung diseases and thromboembolic disease. PAh includes idiopathic forms, herid- acute aortic dissection type A and 4 chronic aortic dissection and 2 had separated intramural itable forms, or can be associated with systemic diseases such as connective tissue dis- hematoma of the ascending aorta. 8 patients had associated aortic coarctation. Marfan eases, hiV infection, portal hypertension, congenital heart diseases, schistosomiasis and disease was identified in 8 cases and bicuspid aortic valve in 31 patients. 17 patients had haemolytic anemias. associated coronary artery disease and 2 endocarditis. The symptoms of PAh are non-specific and include breathlessness, fatigue, weakness, Results: The in hospital mortality was 6.9% (11 patients). One of them died due to malignant angina, syncope and abdominal distension. ventricular arrhythmias. The other patient died due to intraoperative aortic arch dissection. Three The severity of the disease can be classified by a functional class defined by the World health patients died due to septicemia and two other patients due to renal failure. Two patients died due organization. Symptoms are usually delayed in appearance and progress slowly, with the to severe and uncontrollable bleeding and two other patients due to permanent stroke. Two other result that diagnosis of PAh typically occurs at advanced stages: functional Class III or IV. patients died at 1.5 months and at 3 months after surgery due to renal failure and mediastinitis respectively. 50 patients underwent modified Bentall operation, 4 patients underwent HemiDavid Key lecture: ”Pulmonary Hypertension – Treatment” procedure and 5 patient David procedure. Three patients underwent coronary sinus reconstruction Badagilacca R and replacement due to unruptured non coronary giant Valsalve sinus aneurysm. 17 patients underwent various technique of aortic valve repair. 48 patients required circulatory Endothelial and platelet dysfunction play a key role in PAh pathogenesis, inducing a sus- arrest associated with retrograde cerebral perfusion in 28 and anterograde cerebral perfusion in tained impaired production of vasodilator and antiproliferative agents such as nitric oxide 20 patients. 56 patients underwent aortic valve replacement and ascending aortic replacement and prostacyclin, along with overexpression of vasoconstrictor and promitotic molecules Seven patients required mitral valve replacement and 3 mitral valve repair with a mitral ring. 17 such as endothelin. According to these pathogenetic pathways, three classes of drugs patients underwent associated CABG. 7 patients underwent total aortic arch replacement and have been developed: endothelin receptor antagonists (erA), phosphodiesterase-5 (PDe5) 37 patients Hemiarch procedure. Simultaneous aortic coarctation repair and ascending aortic inhibitors and prostanoids. Although none of these therapies are curative, several ran- aneurysm was performed in sternotomy was performed in 8 patients under sternotomy in four domised controlled trials (rcTs) have demonstrated their clinical efficacy for the treatment and associated left thoracotomy in other 4 patients. The mean aortic cross clamping time was of this deadly disease. 117±47min, the mean circulatory arrest time was 37±23 min. The mean dimension of the aortic Given the availability of several therapies and routes of administration, the selection valve prosthesis dimension was 24.8±2.7mm. The mean postoperative mechanical ventilation and timing of appropriate treatments have become more complex. PAh is a serious and was 31±54 hours and the mean postoperative hospital stay was 12.7±8.4 days. heterogeneous condition requiring careful monitoring and an individualised approach, and Postoperative complications were identified in 62 patients. The reopening due to bleeding treatment should be managed by specialist PAh centres. several therapeutic options are was identified in 15 patients, sepsis in 8 patients. Reintubation was required in 5 patients. available, and advanced prostanoid therapy offers the unique ability to tailor the dose to an Permanent stroke in 4 patients and cerebral edema in 16 patients. Postoperative severe individual. This can present a challenge in terms of monitoring dosage, but the therapeutic renal failure was identified in 17 patients, 6 of them required hemofiltration. 15 patients range is wide and affords the flexibility to achieve a dose that can control symptoms and required readmission into the intensive care unit. The multivariate regression model revealed manage their side effects. the advanced age (p=0.009), preoperative chronic renal failure (p=0.001), arch procedure Despite considerable advances in treatment, the long-term survival of patients with PAh (p=0.027), associated surgical procedure (p=0.036) and circulatory arrest (p=0.0033) as remains unsatisfactory. It is therefore necessary to optimise the usage of the existing therapies. strong predictors for poor early postoperative outcome. The actuarial survival at 1, 3 and The latter may be achieved by initiating prostanoid therapy at an earlier stage during treatment 5 years resulted to be 92%, 88% and 86%, instead the actuarial free reoperation survival and ensuring adequate drug titration to maintain optimum therapeutic response. Future was 90.5%, 83.5% and 79%. The Cox model revealed the chronic renal failure (p=0.0003), research should aim to better elucidate the pathogenesis of PAh, which remains incompletely aortic dissection(p=0.017), arch replacement (p=0.02),associated procedure (p=0.003) understood, with the ultimate aim of developing curative therapies for this debilitating disease.

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Pulmonary Hypertension and Right Ventricular Dysfunction as a Prognostic Factor in mortality. The present study tends to demonstrate that even most complicated cardiac Acute Decompensated Heart failure operations can be performed safely without high blood loss and low use of red blood cell Nona A, Carmine Dario Vizza, Robero Badagliacca, Roberto Poscia, Cristina Gambardella products and fresh frozen plasma but no use of platelets. Methods: This is a single centre retrospective study of 121 patients having undergone all type BACKGROUND: Pulmonary hypertension (PH) and right ventricular (RV) dysfunction have of cardiac operations in the period April 2013 to December 2013. Risk factors for bleeding and been associated with adverse outcome in patients with chronic heart failure. However, data are reoperation were identified by multivariable logistic regression. Medical notes were reviewed lacking in the setting of acute decompensated heart failure (ADHF). We sought to determine to determine blood loss and amount of blood products transfused prognostic significance of PH in patients with ADHF and its interaction with RV function. Result: Patients were divided in two groups, according to the surgical procedure undertaken. METHODS: We studied 170 patients with ADHF. Pulmonary artery systolic pressure (PASP) Eighty patients (66.1%) undergone heart surgery off pump while forty one patients (33.9%) and RV function were determined with the use of Doppler echocardiography, with PH defined undergone heart surgery on pump. Surgical re- exploration for bleeding was performed in as PASP >50 mm Hg. The primary end point was all-cause mortality during 1-year follow-up. two patients (1,65%) in the on pump group. No re-exploration was performed in the off pump RESULTS: PH was present in 68 patients (40%) and RV dysfunction in 39 (23%). The group. In the Off pump group only two patients (2,5%) required platelet transfusion. In the On majority of patients (68%) with RV dysfunction had PH. Compared with patients with pump group platelets were used in four patients (9.75%). normal RV function and without PH, the adjusted hazard ratio (HR) for mortality was 2.40 Conclusions: Bleeding postoperatively is a risk factor for mortality and morbidity. Technical (95% confidence interval [CI] 1.44-4.02; P = .001) in patients with both RV dysfunction reasons are mainly the culprit for bleeding. The major focus of cardiac departments should and PH. Patients with normal RV function and PH had an intermediate risk (adjusted be in improving technical skills in order to minimize the need for re exploration and blood HR 1.77, 95% CI 1.11-2.86; P = .016). Notably, patients with RV dysfunction without products use. PH were not at increased risk for 1-year mortality (HR 1.03, 95% CI 0.43-2.41; P = .94). CONCLUSIONS: PH and RV function provide incremental prognostic information in ADHF. Novel oral anticoagulants in prevention of stroke in patients with atrial fibrillation Thus, the estimation of PASP and RVD may be warranted in the standard assessment of ADHF. Temali I, Nona A, Jata B

Key Lecture: Surgical Treatment of Heart Failure Atrial fibrillation is the most common rhythm disorder and represents a major public health Besik J problem because it carries increased risk of arterial thromboembolism and ischemic stroke. Current european society of cardiology guidelines recommend to stratify atrial fibrillation Heart failure has been singled out as an emerging epidemic. This may be the result of an increased patients according to the CHA 2 DS 2 –VASc score and to administer anticoagulation, incidence, increased survival leading to increased prevalence, or both factors combined. Most preferably with novel oral anticoagulants: that is,dabigatran,rivaroxaban,or apixaban,if the patients with heart failure have symptoms due to impaired left ventricular myocardial function, but CHA 2 DS 2 -VASc score is at least 1. there may be several other reasons for heart failure symptoms. Therefore, once the diagnosis Advantages of new oral anticoagulants over Vitamin K antagonists for thromboembolitic of heart failure is established, further classification requires understanding the parameters of left prevention in patients with non – valvular AF are : predictable effect without need to monitoring ventricular function to grasp the physiology of heart failure syndrome in each patient. Heart failure , fewer food and drug interaction , more predictable half-life ,improved efficacy /safety ratio . may result from disorders of the pericardium, myocardium, endocardium or heart valves. Heart The choice among the novel oral anticoagulants depends on their different pharmacokinetic failure may be surgically treated according to its cause. Coronary artery disease resulting in ischemic profile, patients’ stroke and bleeding risk, comorbidities, drug tolerability and costs and, heart disease is the most frequent cause of heart failure. This can be treated by revascularisation, finally, patients’ preferences. including coronary artery bypass grafting. Heart valve disorders represent another big group which An important aspect is the follow-up of patients receiving NOAC , management of special can be treated surgically. situations as chronic kidney disease and acute coronary syndrome as well as management Heart valve replacement or valve repair may be successfully performed in selected patients. In of bleeding under NOAC treatment . patients with pericardial disorders (most often constrictive pericarditis), surgical pericardiectomy may be performed. Some patients with dilated cardiomyopathy benefit from surgical reduction of left Neurological Complications after Cardiac Surgery ventricular volume. However, despite increasingly improving treatment options, including surgery Zllami B, Llazo. S; Basha. E ; Huti. G; Arapi. B; Kruja J and modern drugs, there is a growing number of patients with end-stage heart failure. For these patients, mechanical circulatory support device implantation and/or heart transplantation may be The neurological complications after cardiac surgery are associated with significantly in- the only option. I will briefly introduce the heart transplantation program at the Institute of Clinical creased morbidity, mortality, disability and higher hospital, personal and social costs. The neurological injury remains important cause of postoperative morbidity and perioperative and Experimental Medicine (a total of 995 heart transplants were performed in our institution deaths. During the years there is an increase of age of patients undergoing cardiac surgery from January 1984 till March 2015) and our experience with mechanical circulatory support and with that even the chronic diseases that are risk factor for neurological complication ( devices (we implanted 237 mechanical ventricular assist devices from April 2003 till March 2015). hypertension, hyperlipidemia, diabetes mellitus, arrhythmia ect); Neurological injuries rates in severity from slight changes in personality, behavior, cognitive function to peripheral nerve Cardiac Surgery- Are Blood Products Always Needed? damage, encephalopathy , stroke with the major deficits and debilities and death ; Kojqiqi A, Camelia Kojqiqi, Valbona Isufaj, Dritan Agolli, Besnik Kojcici Our purpose ( ongoing clinical trial) is to evaluate pre-operatory risk factor ( age, hyperten- sion, diabetes, hiperlipidemia, cigarette use, alcohol, severity of cardiac disease and car- Cardiac operations have a high rate of bleeding. Re-exploration due to blood loss occurs diac function, prior TIA CVA, carotid and vertebral diseases, peripheral artery diseases) , in a region of 2% to 6% of patients undergoing heart surgery. This necessitates, in many intraoperatory ( atheromatous aortic disease, duration of cardiopulmonary bypass, technical problems as hemorrhage, aortic dissection, perfusion problems, temperature and acid base occasions, use of large blood products transfusions, increasing the risk of morbidity and management) type of surgery on pump off pump surgery, early complications after surgery

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(hypoxia, hypoperfuzion, arrhythmia, epilepsy, venous thrombosis) and late neurological out- Key Lecture: Rejuvination by means of combinations of minimal invasive therapies come; Recognition of these risk factors that contribute to neurological morbidity has prompted Guarino E the idea better preoperative evaluation of the patients, neuroprotective interventions during the cardiac surgery( although the pharmacological neuroprotection is still a field to explore) Natural aging is inevitable and an irreversible process. Skin Aging is a complex biochemical prevention and treatment of neurological complications after cardiac surgery. The survey is process due to the depletion of the bodies bio-resources. Long the time we have, reduction in part of ongoing study of neurological complication of cardiac surgery. number and quality of collagen and elastin fibers, reduction in hyaluronic acid and fibrobastis. Conclusion: Neurological complication of cardiac surgery remain still the main concern during the Signs of skin aging are hyperkeratosis of epidermis, dyschromia ptosis and atrophy of these procedures. Is important to evaluate patient carefully pre surgery to chose the right subcutaneous fat, muscles and fascia, and thinning and softening of bone. approach during the surgery, to evaluate perioperative risks and to recognize neurological Premature aging is caused by more subjective factors: lifestyle, nutrition, environmental complication in early and late post surgery. Neuroprotective intervention during the surgery factors, ultraviolet radiation, and a variety of disease processes. remain a field to explore. The rejuvenation program objectives include elimination and smoothing of wrinkles, improving skin color, elasticity, texture and preventing sagging. Prevalence of Left Ventricular Hypertrophy in Patients with Predialysis Chronic Failure Aesthetic Practitioners often use physiological simulators for reparation or revitalization of in the Hospital Center Elbasan skin. Physiological simulators may include: hyaluronic acid, vitamins, amino acids, external Zheni GJ peeling agents & peptides to name a few, but effects are not big, nor long lasting. Although they may indirectly influence fibroblastic activity and other components of regeneration they Background: Cardiovascular disease (CVD) is still the major cause of death in patients with generally don’t produce more than 1.5% new collagen. end stage chronic kidney disease (ES-CKD), with a mortality rate approximately 10 to 30 The aim for a very successful anti aging strategy it’s stimulating the production of new times greater than that of the general population. Advanced cardiomyopathy is caused by left fibroblastic cell, type 1 collagen and endogenous hyaluronic acid. “Today” we have the ability ventricular hypertrophy (LVH) in patients with end stage kidney disease.Multiple factors are to really slow down the aging process with use of the regenerative medicine. involved in the development of CVD in CKD. This kind of treatment is possible with the combined use of platelets rich plasma (PRP), The objective of the study is to determine the prevalence of LVH in patients with CKD and amino acids, small fragment of hyaluronic acid and horse tendon collagen. The PRP are to examine the relations between anemia, pulse pressure(PP), hypertension (HTA) with left rich of growth factor that stimulated the stem cells. The horse tendon collagen use is a ventricular hypertrophy (LVH). very innovative technology, that stimulates the produce of new fibroblasts. Other really bio- Materials and methods: The risk factors and prevalence of Left Ventricular Hypertrophy stimulator of new collagen type 1 is represented by caprolactone acid and polylattic acid. were evaluated in 111 patients with Chronic Renal Failure, presented in ambulatory service. These molecules are available in both injectable and as component of traction wires. Patients excluded from the study were of ischemic heart and valvular heart disease. Objective of this study is evaluate a multi modal treatment for a double-acting bio stimulation Results: LVH was diagnosed in 81,9 % of all patients. The prevalence of hypertension was can really slow down aging, combined with a more natural and enduring aesthetic treatment. 72,6%. Anemia was present in all patients. Of the variables tested lower levels of hemoglobin, In our protocol the patients were subjected to sequential treatment of bio-stimubulation systolic blood pressure (SBP) and PP predicted the occurrence of LVH. with PRP and injective collagen then finish with combined treatment with botox, filler and Conclusions: This study has shown a strong association between chronic kidney disease absorbable suture . (CKD) and LVH in pre dialysis patients. Pulse pressure,SBP and anemia play an important Dal giugno 2013 al gennaio 2014 abbiamo trattato 30 pazienti di qui 28 donne e due uomini role in the development of left ventricular hypertrophy in CKD patients. con una età media di 54 anni (range 44-60). Non venivano riportate complicanze maggiori Key words: Left ventricular hypertrophy; pulse pressure, hypertension, anemia. fatta eccezione per 10 casi di ematomi e 8 di emorragie di grado lieve. Tutti i pazienti completavano il trattamento con risultati buoni e soddisfazione sia per il paziente che per Key lecture:”Contour Restoration of the Forehead by Lipofilling: Our Experience” il medico. Tutti erano pronti a eseguire terapia di mantenimento per allungare l’effetto del Isik S trattamento fatto. From January 2013 to January 2015 we treated 30 patients (28 female 2 male) with average BACKGROUND: A slightly convex forehead without wrinkles adds attractiveness to a age of 54 years (Range 42-60). We have not see serious side effects or compications done woman’s face and to the general perceived image. It is also important for the balance and except for 10 cases of hematomas and 8 of mild bleeding. All patients have make quite the harmony of the face, especially in the lateral and oblique views. We used a new fat injection full treatment with very good results and patient and physician satisfaction. In conclusion we technique for correction of the contours of the forehead. suggest this type of antiaging and very naturaly rejvination treatment for all patient, but with METHODS: In this study fat injection was applied in nine female patients for restoring the better results for 30-50 years. contour and reducing forehead wrinkles, along with a primary rhinoplasty operation. After dissecting all forehead skin from the underlying muscle with a sharp curved-tip epidural Key lectures:”Lower Limb Reconstruction, Challenges and Up dates needle, fat grafts were injected into the newly created pocket until the forehead area looked Isaraj S moderately ballooned and gentle digital pressure was used for feathering. The patients wore hair bandages continuously for 2 weeks after the operation. ABSTRACT: Reconstruction of the lower limb has always been a challenge to the team RESULTS: The minimal follow-up time was 12 months (range=12-48 months) and all the dealing with it, considering the peculiarities of its blood supply, the often scarcity of soft tissue patients were pleased with the results. When we compared the photos before and after the and skin available because of trauma or ablation surgery, and because of need for a stable operation, it was observed that the fat grafts were stable and retained the volume replace- and durable reconstruction which could allow the patient to return to a normal and active life. ment. Patients declared that they had glossy and better quality skin after the operation and Any each of these factors would be the scope of discussion in this key lecture. also had new regenerated contours. We did not observe any complications. We performed Blood supply to the skin on the lower limb is unique: it is mainly done by fasciocutaneous only one additional lipofilling in one patient to obtain an optimal forehead contour. perforators offered by all of the three main axis, contribution to is offered by a few CONCLUSIONS: This technique is easy to perform and effective in reducing forehead musculocutaeous perforators, and one or two direct cutaneous vessels. So the main system wrinkles and correcting the contour. It was also observed that better perceived nasal results of blood supply to the lower limb skin is the fasciocutaneous system of vessels, hence the could be obtained with concomitant forehead lipofilling in rhinoplasty operations. concept of fasciocutaneous flap. The demand for reconstruction of the lower limb is often related to trauma, but not only. Most of

64 65 ORAL PRESENTATIONS ORAL PRESENTATIONS the cases in our practice are trauma cases, constituting more than 70% of lower limb cases. But the solar exposure in the youngsters. Material and methods: The population involved in with advances in cancer treatment, which allow for larger and bolder resections of skin and soft the study was composed of 261 students of the university studying economics, law, and tissue cancer, the number of patients asking for reconstruction is growing constantly. Although nursery. The questionnaire that we used was easily understandable, anonymous, where the role of plastic surgery is not crucial in dealing with vascular diseases of the lower limb, it is we inserted new questions on the knowledge on Malignant Melanoma and skin cancers, becoming important nowadays that plastic surgeons can offer microsurgery procedures. and the influence of previous sunburns on the protective behavior. All statistical tests Most of the flaps used in our practice belong to fasciocutaneous type. But the better were considered significant for p- values < 0.05. The analysis was carried out using SPSS understanding of blood supply, has allowed plastic surgeons to identify specific perforators software, version 16.0. and use them for perforator flaps, which is actually the trend in plastic surgery. The most Results: A very high percentage of the students 93% had good knowledge on skin cancers, useful group of perforators which plastic surgeons is becoming familiar with is that of the and 44.8% thought that ultraviolet exposure was a very important risk factor for Malignant posterior tibial artery. Melanoma and skin cancer, and only 8% did not consider solar exposure as a risk factor. Other types of flaps are the muscle flaps, and very rarely the musculocutaneous flaps. The usage of solar cream as a preventive and protective measure was found to be highly The direct cutaneous system of vessels is represented mainly by the sural artery on which sural influenced from experiences of sunburn in the past. flaps are based. The reverse sural artery flap is vastly used in our practice for reconstruction The usage of solar cream as “sometimes” was referred from 40% of the students that in of the lower third of the leg, and even for reconstruction of defects on the ankle and foot. the past had been sunburned 1-10 times, whereas the students that had been sunburned The advent of microsurgery added a very useful tool in the lower limb reconstruction. The >10 times referred using sunscreen “often” in 57% of the cases. Only 16.9% of the students vast amount of tissue it can transfer, the versatility of flaps it can take advantage of has made “always” used sunscreen. Most of the students didn’t use protective measures because they possible reconstructions, which a few years ago would be considered impossible. Its main wanted to have a suntan, because they were ashamed, or because they considered solar disadvantage is the long hours of operations and the level of expertise that the surgeon and creams as expensive. In 43.1 % of the subjects the source of knowledge were surgical staff must possess. Skin Resurfacing with Fractional Laser(1550nm) Non Surgical Facial Rejuvenation Procedures Mishtaku S, Savo I Savo I. Mishtaku S. Jorgaqi E. Doci Xh. Introduction & Objectives: Fraxional laser (1550 nm) consist in photothermolysis, a concept Introduction: Non surgical facial rejuvenation refers to the application of less or non invasive using arrays of microscopic thermal damage pattern to stimulate a therapeutic response. This cosmetic procedures used to restore the facial features to their previous youthful appearance. process improves the dermal components resulting in wrinkle and age spots reduction (lentigo Often, a combination of different techniques allows individualized treatment with optimal solaris), smoothing of skin texture, and reduction of pore size. Fraxional skin resurfacing laser outcomes. The introduction of these procedures with minimal downtime and natural effect is associated with shorter periods of recovery time in comparison with the ablative technology. has increased acceptance of such treatments. This study aimed to evaluate the clinical effect of 1550 nm fraxional laser treatment in the Objectives: To present procedures of facial rejuvenation applied in the everyday practice, skin resurfacing. to discuss their indications according to age, side effects, and give some clues to the right Material & Methods: Subjects of age 30-55 underwent 3 to 5 sessions of fraxional laser selection of patient. We report the use of a combined approach for facial rejuvenation treatment in an interval of at least 4 weeks. The treatment purpose were rejuvenation in particular with emphasis on botulinum toxin type A, dermal fillers, chemical peels, improvement of hiperpigmentations (age spots , melasma) or acne and surgical scars. All mesotherapy, PRP and lasers. subjects had pre- and post- treatment photographs. The treatment parameters of 15-70 Conclusion: The appropriate evaluation and correct use of these minimally invasive mJ/cm2 energy and 17-25 °A) coverage were applied in every session causing clinically techniques lead to a younger and healthier look for the treatment of facial aging. Finding the erythema and oedema. Deep moisturizing creams and broad spectrum sunscreens were suitable regimen for the patient is the key to success. recommended in the post treatment period. Results & Conclusions: Fraxional skin resurfacing laser (1550 nm) has shown clinical Combining Lipofilling in Rejuvenation Procedures, a New Tool improvement in skin resurfacing, including wrinkles, pigmentation and texture of the skin. Kapaj R, Hoxha S, Isik S Our Experience in Treating Jawbone Anomalies through Orthognathic Fat has been regarded as the ideal filler since many years. It is considered as such because Surgery in Albanian Patients of lack of foreign body reaction, as it is autogenous, Lack of cancerogeneity and abundance Isufi R, Isufi I, Bregasi A in the body. Recently stem cells in the fat tissue have been discovered and the numerous advantages of lipofilling are being used clinically. Fat, not only augments volume, it enhances Orthognathic surgery is a specialist branch of oral and maxilla facial surgery that includes impressively the quality of skin. We will present several rejuvenation procedures which have the surgical treatment of skeletal deformities of the jaws in adult patients .Nowadays the all been combined with fat grafting. We firmly believe lipofilling will add a very efficient tool in desire and the demand of the patients to have a beautiful face and a functional occlusion the armentarium of the plastic aesthetic surgeon. has significantly increased. Orthognathic surgery in the world has its beginnings in the mid-19th century, in Albania it has its origins in the 70s but a great development in this Influence of sunburns in the past in the usage of protective behavior towards solar irradiation field has been taken in the last decade .For better results in orthognatic surgery is Doce XH, Savo I, Dr Sonela Xinxo, Vasili E necessary the cooperation between oromaxillo facial surgeon and other specialist .An ideal team in orthognatic surgery will include OMF surgeon ,orthodontist ,specialised Introduction: Intermittent sun exposure and sunburns in the past especially in young dentist ,psychiatrist or clinic psychologist. age can raise the risk for Malignant Melanoma and the Basocelular form of skin cancer. Pre and post surgery orthodontic treatment is very important in teeth alignment ,incizival Although these pathologies have a raising incidence, the youngsters still continue to like compensation ,stabile occlusion and avoiding relapse. As a relatively new surgery in our recreational activities under the sun and sun tanning, natural or artificial. This means that country ,orthognatic surgery is not very well known by the people so is our duty to inform the the incidence of these pathologies can be reduced if positive protective behavior could be patients for the surgical procedures and also the necessary treatments before during and installed at young age. Objective: To evaluate the influence of sunburns’ experiences in the after surgery . Today the signing of the medical consent in which are described the surgical past and the knowledge on skin cancers on the usage of sun protective measures towards technique ,possible results and complications is very important

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Comparison of fracture load Between repair materials Institute of Public Health date, National Health Report 201W4, World Health Organization data Hysenaj N, Tabaku S, Boriçi D, Shundi E, Bardhoshi M Results: The results show that Cardiovascular disease are responsible for 59% of death in Albania, Tumors diseases such are breast cancer, lung cancer etc are responsible for 20 Abstract.Introduction. In clinic a common problem is complete denture’s fracture. As a result % of death and 11% from accidents . The rest belong to other disease such are undefined it is important to choose the proper material. causes and infectious diseases. Risk factors are responsible for 70 % for the burden of Aim. This study aimed to compare mechanical qualities of materials. chronic diseases in year of 2014.. The data from National Health report shows that in 1990 Methods and Results. 5 different materials for repair were chosen. The 5 types of risk factors were responsible for 30% for the burden of diseases. denture reinforcement that were evaluated in the study included: Autopolymerizing Conclusions: Chronic diseases are responsible for 89% of total death in Albania, and there is PMMA, Heat-activated PMMA, Heat-activated PMMA resin with polyethylene fibers, a tremendous increase of risk factors responsibilities in 2014 compared with the year of 1990. Bis-acrylic resin, Light activated polyether urethane dimethacrylate temporary material. Recommendations: Health promotions, early diagnoses, national chronic diseases, national 25 cuboidal specimens were prepared for three point test bending. They were divided health policy in chronic diseases are the challenge of public health policy in our country. into 5 groups. One group was selected as a control group, the other groups were Key words. Chronic diseases, mortality, burden of diseases, risk factors, health policy repaired with the specified materials. Fracture load was eveluated for all groups. 25 complete dentures mandibular specimens were used to calculate fracture load. Key lecture:”Diagnostic Ultrasound and Family Doctors” Results. The results were tabulated and mean values of the mechanical properties for Cela M, Bilaj F, Leli D, Hoti A,Zyka E, Ceka E, Qirko R, Shtylla A. cuboidal samples calculated. The fracture load values for mandibular denture samples were tabulated. Statistical analysis between groups and within the groups revealed that, among the repaired specimens, heat cure PMMA resin reinforced with polyethylene Summary: Background .A training course in ultrasound was set up for family doctors from june fiber had the best mechanical properties in both cuboidal as well as denture samples. 2012-march 2015 to carry out the ultrasound in primary care. The majority of lectures were Conclusion.Heat cure polymethyl methacrylate with polyethylene fiber was affirmed as material radiologists which were driving force for course as well as the extraordinary help of clinicians ,and of choice based on this study as it accomplishes the most critical norms of requirement. OB-Gynecology doctors.the training course was done off working hours in afternoon in private clinic. AIMS: To assess current impact of ultrasound in the practice of family doctors as well as to Key lecture: ”Prophylaxis after Exposure (PPE)” evaluate the role of ultrasound in improving their performance toward patients. To assess Pilaca A the relation with local radiologists who does perform ultrasound METHOD: The questionnaires was sent through e-mail in 45 doctors who participated the Introduction: Post-exposure prophylaxis (PEP) is effective in preventing illness after potential training (in two cases the interview was done through phone) or documented exposure to a variety of microbial pathogens and in reducing the risk of RESULTS :From total number of trainees only 45 ( 39) 89% returned questionnaires . Only secondary spread of infection. Depending on the type of exposure, different forms of PEP 35 or 85% have direct access in ultrasound facilities in their health centers. From 39 family are available, including vaccines, immune globulins, antibiotics, and antiviral medications. doctors, 30 said were “very pleased” or” pleased” with curriculum of training and only 9 said This presentation tents to highlight the importance of such problematics associated to PEP. Aim: A review about PEP and its practical application in our country. were “enough”. Subject: PEP is routinely recommended following exposure to a wide spectrum of viral and From 35 doctors who have direct access in ultrasound the number of patients were from 3-7 bacterial diseases. Thus, physicians should be familiar with established PEP protocols. patient (average 4) /per day . The total number of patient were enroll for general diagnostic The infectious agent can be transmitted by another person, an animal, or the environment. were 1356 patients or 70%, the rest 30% were for obstetric/gynecology ultrasound the details Although many persons who seek medical care after an exposure visit an emergency of positive results are in Table nr1. department, others go to their primary care physician’s office or, for health care workers, The relation with local radiologist were GOOD in only 5 cases or 15 % , in NOT BAD 13 employee health service centers. The primary goals of the evaluation are to provide PEP cases or 39 % , and BAD in 21 or 59% . if indicated, to allay the exposed person’s anxiety, and to avoid unnecessary interventions CONCLUSION: The primary health doctors are keen to learn the ultrasound. Their and loss of workdays. What we figure out in our medical practice is that there are no national willingness has a good impact in the patient early diagnosis of some life threatening guidelines for vary potential infective agent, the health care workers is not familiar to them and therefore there is no application of these guidelines when they are needed. disease like aortic aneurizm, cr mame,cr thyroid,infantil intesusseption ,apendesitis, Conclusion: PEP is a medical procedure that must not be neglected; in fact it is strongly associated to daily practice. It is very important building national guidelines adapted to the Survelliance of Infection in Intensive Care Unit in Albania- a Point Prevalence Study in economical, political and cultural level of each country. two University Hospitals Harxhi A, Nderu A, Cami A, Ohri I, Mehmeti J, Muhametaj J, Gjyzeli M, Kraja DH Key lecture: ”Causes of Mortality of Cronic Diseases in Albania” Roshi E Introduction: The surveillance of all kinds of infections either community or hospital acquired, along with antibiotic consumption habits in the ICUs is becoming increasingly important not only Background: In most of the developed countries chronic diseases for more than 20 years are for the prevention of infections, but also for rapid and effective management. leading causes of death. In Albania the epidemiological transition has passed and there is a shift Aim: The aim of this study was to determine the properties of ICUs, and the epidemiology from infections disease as main causes of death to chronic diseases as leading cause of death. of infectious diseases, causative microorganisms along with their resistance patterns, and Aim of the presentation: is to give overview of main cause of death in Albanian focusing antibiotics consumptions in the ICUs of 3 different university hospitals in Albania. mainly in chronic diseases stressing particularly in life styles, risk factors early prevention and health policy, Methods: This is a cross-sectional point prevalence study which was carried on a single day on Our objectives: to define causes of mortality by cardiovascular disease especially coronary June 2012. There were two University Hospitals and three ICUs participating in this study: ICU heart disease and stroke, diabetes, tumor diseases, accidents etc. at Infectious Diseases Service and Central ICU at University Hospital Center of Tirana and ICU Material and methods: our results where taken from National Statistical Institute official report, at University Pulmonary Hospital in Tirana. All the patients with an infection were included in the

68 69 ORAL PRESENTATIONS ORAL PRESENTATIONS study. This study was part of a bigger multicenter study which was carried out in the ICUs in a seases during the period January 2009-December 2014, according to the classification of large geographical area ranging from Central Europe to Mid-western Asia. sepsis in1992-2001. Data have been collected from 707 patients during the study period. Results: There were 9 patients with infectious diseases included in the study. Patients Results: The average age in patients with sepsis resulted 50.39 years old with a standard characteristics: Mean age 54 yrs (16- 85); male/female 4/5; 8 out of 9 patients had concomitant deviation of 19.6 years. Females were 52% . diseases; vascular catheters 56% of cases, urinary catheter 67% of cases, invasive mechanical The most affected patients resulted those between 55-75 years old. immunosupressed pa- ventilation 67%; 45% of cases presented hospital acquired infections; All the infectious tients were 15.27% of them where 5.2% suffered from DM and 4.5% of patients had AIDS. disease diagnoses were made clinically, no culture yielded any positive result; Infections type: Hospital sepsis resulted in 2.97% of cases. Most affected systems were the urinary tract and pneumonia 4 cases, VAP 2 cases, surgical site infections 1 case, blood stream infection 1 case. the lungs with a percentage of 36% and 27% respectively. Regarding the etiological aspects Cephalosporins were more preferred antibiotics in 88% of cases, No written antibiotic policy or blood cultures were positive in 12.5% of the cases, urine culture in 7.4% and cultures from surveillance activities were present in all ICUs. wounds in 5.5% of cases. Escherichia coli resulted the most frequent pathogen isolated from Conclusions: A comprehensive evidence-based HAI control, antibiotic stewardship and cultures. The study showed a strong correlation of PCT in patients with sepsis. surveillance program based on local antimicrobial use and resistance problems should be Conclusions: During the last years an increased incidence of sepsis has been noticed. implemented in our hospitals. Key Word: sepsis, infection, immunosupressed

Approach to Alcohol Use Disorders Different Partern of Decompensation in Alcolic Versus non Alcoholic Cirrotic Bitri Tivari S, Thoma E, Puca E, Capi R, Sotiri E, Huti E, Puca E Kristani P, Kurti F, Xinxo S, Babameto A

In our medical practice, we see everyday patients seeking help for their heart and liver BACKGROUND: Liver Cirrhosis is considered to be the twelfth leading cause of death in problems, diabetes, neurologic problems. And many times, they are curing the complications the United States. Ascites is the most common of the three major complications of cirrhosis, of their “hidden-denied problem”-Drug Addiction. followed by variceal bleeding and encephalopathy. Why people get addicted to drugs? Did they lack moral principles or willpower to change their AIM: The aim of the study is to evaluate the different models of decompensation in relation to behavior?! Is there a cure?? Addiction is a chronic, often relapsing brain disease that causes com- the etiology of liver cirrhosis. pulsive drug seeking and use, despite harmful consequences to the addicted individual and their PATIENTS AND METHODS: 200 cirrhotic patients hospitalized during 2011 - 2014 in our environment. As other chronic, relapsing diseases, drug addiction can be managed successfully. clinic, divided in two main groups (alcoholic and non-alcoholic patients), were retrospectively But is not uncoman the relapse. One of the most abused substance in the world, and in Albania, is analyzed. Hepatic decompensation was confirmed as presence of ascites, jaundice, EH, alcohol addiction. Underestimated as a problem or considered “ a male habit”, alcohol abuse has variceal bleeding, SHR, HCC or SPB. caused chronic patients, and many times, fatalities. Asked about alcohol”consumption”, the most RESULTS: We had 172 males (84%) and 28 females (16 %) p<0.05. Mean age of patients frequent answers are: Doctor I only drink wine or beer, or, I dont drink , just 200ml whiskey/per day, was 58 years. I can stop drinking anytime I want to. Do all the alcohol consumers get addicted? In fact the risk According to the etiology: alcoholic cirrhosis was present in 51% of patients. Male for addiction is influenced by a combination of factors that include individual biology, social envi- dominated in alcoholic cirrhosis 98% vs 62% in nonalcoholic group ( HBV; HCV; cryptogenic ronment, and age or development stage. and autoimmune), while female dominated in non-alcoholics (38% vs. 2%), p<0.05. Patients are presented in our facilitties care, often emergency services , with different clinical According complications: We found ascites the main complication in alcoholic cirrhosis (93% panorama. Not rarely they come for visit because of their extremely elevated liver tests or he- vs. 73%, p<0.05), while HCC and death dominated in nonalcoholic group (24% vs. 5.8% and patic insuficiency ( INR 2.57, GGT 1500UI/L). Sometimes, their decision to stop abusing alcohol, 36.7% vs. 23.5%; p<0.05) respectively. comes because of their metabolic problems, diabetes or lipid profil alteration ( TG 3900mg/dl). Patients with alcoholic cirrhosis are younger than non-alcoholic patients with male In rare cases they submit an unplaned detoxification proces, because of a stroke or miokardial predomination , p<0.05 infarction. In Albania ,as alcohol abuse is denied or unaccepted, the number of patients is much Related to Child Classification: alcoholic cirrhosis was present in 51% of cases, where 14.7% lower than the number of abusers. were in Child A; 45% in Child B and 41% in Child C vs. 11.2%; 33.6% and 55.2% respectively As alcohol adiction is a chronic disease, is there a cure? Alcohol is a potent central nervous in non-alcoholic group. In total, patients in Child C dominated in two groups: 47.5% vs. 39.5% system depressant, and its actions are mediated via multiple neurotransmitter systems .There (Child B) and 13% ( Child A), showed poor prognosis and high mortality in non-alcoholic are several aprouved drugs as naltrexone, acomprasate, rarely disulfiram. But alcoholism seek group (36.7% vs. 23.5%). a multidisciplinary approach including pharmacologic ,psychoterapeutic treatment program and CONCLUSIONS: Ascites is the leading initial pattern of decompesation in alcoholic familiar and social suport. cirrhosis whereas hepatocellular carcinoma and high mortality dominates in non-alcoholics. KEYWORDS: Alcoholic, Non-alcoholic liver cirrhosis, Complications, Decompensation. Sepsis in Department of Infectious Diseases last Years Puca E, Pilaca A, Stroni G, Qyra E,Qato M, Hysenaj ZH, Kalo T, Harxhi A, Pipero P, Kraja DH Electropsysiological Study of SCA and FRDA Patients Myftiu B, Orhan Kocasoy E, Baslo B Though the term sepsis is linked closely to modern intensive care, the medical concept is rather older. Sepsis is a disease known since the Antiquity. It remains a major public health problem. OBJECTIVES: The aim of our study is to examine the bioelectrical activity of nerves and Purpose: To highlight the epidemiological, etiological, diagnostic and therapeutic aspects of sepsis muscles in spinocerebellar (SCA) and Friedreichs’ ataxia (FRDA) patients according to a patients in the Department of Infectious Diseases, at the “Mother Theresa” Hospital Center, Tirana. standardized protocol, in order to obtain information about the severity and distribution of Material and methods: Sepsis cases have been studied at the Department of Infectious Di- peripheral nerve involvement.

70 71 ORAL PRESENTATIONS ORAL PRESENTATIONS

PATIENTS AND METHODS: We examined 18 genetically diagnosed, older than 18 years as problematic one, somatic disorders, anxious and depressive disorders. of age SCA and FRDA patients. Control group was formed by 31 age-matched healthy Results: Medicaments in the therapy are completely removed in the therapy of 53 treated individuals. We performed sensory and motor conduction studies, F responses, needle EMG cases through systemic family psychotherapy. Concretely, 23 couples, 19 somatic disorders of proximal and distal muscles, and motor unit number estimations (MUNE) of distal muscles and 11 anxious disorders accompanied with depression. to upper and lower extremities of both groups. First of all medications are modified, decreased and completely removed. Every treated case with the family, previously has assigned the therapeutic contract to which are refrained till Descriptive statistics and group comparisons were done for each recorded parameter. the end. Average number of the sessions of the family psychotherapeutic sessions was 4, 7. FINDINGS: All sensory responses were low in amplitude (p<0.01) in patients as well as All treated cases were outpatient clients (ambulatory treated in the Clinic of Psychiatry). sensory conduction velocity was slow (p<0.05) for ulnar nerve. Median and peroneal motor amplitudes were also low (p<0.01). Median, peroneal (p<0.01), ulnar, and tibial (p<0.05) Study of gastroesophageal transit and the gastroesophageal reflux motor conduction velocities were significantly slow. MUNE in m. abductor pollicis brevis and Valenza V m. tibialis anterior muscles were significantly lower in patient group than healthy individuals (p<0.01). Needle EMG evaluation revealed neurogenic involvement in 1/3 of patients In recent years have greatly improved specificity and sensitivity of the tests used in the RESULTS: Polyneuropathy syndrome is frequent in SCA and FRDA patients. Sensory nerves diagnosis of functional diseases of the esophagus and reflux disease. New methods have in lower extremities were predominantly involved however, signs of motor dysfunction were been added, but no test is able alone to properly define the clinical picture and only the integration of the different exams can come to a correct diagnosis. also notable. MUNE can provide quantitative information about motor nerve fiber and/or motor Esophageal scintigraphy (SE), introduced in 1972 (Kazem) and subsequently implemented neuron involvement. Clinical and electrophysiological findings of peripheric polyneuropathy in 1979 (Tolin), provides morphological and functional and can be used in functional syndrome were more striking in atactic patients with proven genetic defect. disorders as non-invasive, physiological, high “complaiance”, adaptable to the clinical conditions patient, with good correlation with other functional studies (manometry) and Management and Surgical Treatment of Primary Hyperparathyroidism morphological (radiological studies), also, if you have to repeat the study in time to monitor Bode R, Celiku E, Agolli M, Dracini XH, Kaci M, Domi R therapy and / or evolution of the disease, the SE is also preferable for the low radiation dose (0.011 mSv / MBq). Background: Primary hyperparathyroidism is an endocrine disease characterized by a Material And Method: in our service were performed 750 SE 1988-2000 (m58) and more than hypercalcemic state due to hypersecretion of parathyroid hormone. Its clinical profile has 4,500 since 2000 (M325). The SE is based on the administration of a bolus of 10 ml of water labeled with 37 MBq of 99mTc-DTPA and a dynamic acquisition of 480 frames for 60 “. shifted from a symptomatic disease to an asymptomatic hyperparathyroidism. It is usually Are processed and evaluated: 1) images (visualization of the mouth, pharynx and esophagus caused by a single adenoma and multiple gland hyperplasias. to assess the size and shape, presence of diverticula, the way to advance the bolus, Aspi- Objective: The aim of the study is to evaluate the history, diagnostic procedures, surgical ration time of occurrence of the phenomenon: pre intra- or post-swallowing ); 2) curves A / T treatment and complications of patients diagnosed with primary hyperparathyroidism and (en ° slope of peaks) and 3) numeric parameters as transit time and index stagnation oral (<1 admitted in our hospital for surgical treatment during the years 2009-2011. “and <5%), pharyngeal (<1:20” and <5%), esophageal ( <10 “and <10%). Methods: These patients were analyzed retrospectively and all data’s were collected from The SE has been used to study the following diseases: gastroesophageal reflux, achalasia, medical records. diffuse esophageal spasm, diverticula, stenosis-atresia, connective tissue diseases, disor- Results: All patients were symptomatic. In 75% of cases, PHPT was caused by a solitary ders, neuro-degenerative muscle and systemic. adenoma, by hyperplasia in 12.5% of cases and parathyroid carcinoma in 12.5% of patients. Ultrasonography and CT-scans were performed in all patients, RMI in 3 cases (37.5%).In 2 cases the pathological gland was localized ectopically. Conclusion: Surgical treatment of PHPT is based on removal of hormonally active parathyroid tissue. A multidisciplinary team is required for the management of this disease especially endocrinologist, urologist, radiologist, anesthesiologist, surgeon, and pathologist. Keywords: parathyroid gland (PG), primary hyperparathyroidism (PHPT), adenoma of PG, hyperplasia of PG, carcinoma of PG.

Systemic Family Therapy as an Advantage in Comparison with Medical Therapy Hoxha B, Uka A, Shunjaku F, Jashari R

Introduction: Systemic family therapy, referred as a form of psychotherapy, includes families, couples in intimate relations, to nurture change and development. Systemic family therapy tends to make changes in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health. Rather than isolating individuals from the emotional origins of their conflict, problems are addressed at their source. Aim: Offering this form of the psychotherapy, in cases where is indicated and bypassing medication treatment in solving emotional problems. Conclusion: Advantages of systemic family therapy are multiple in corporations with individual psychotherapy in cases of couple problems, problems where the child in a family is identified

72 73 POSTER PRESENTATION INDEX POSTER PRESENTATION INDEX

Perioperative outcomes of total laparoscop- with multi-system infiltrations incidentally Nested variant” of Urothelial Carcinoma of Proko F., Tarifa Dh., Ademi S., Lushi ic hysterectomy versus abdominal hysterec- diagnosed by Cranial MRI renal pelvis and ureter. Case report M., Likmeta M. tomy for benign uterine diseases Daku A.; Puca E.; Saygili B.; Roci E.; Kapaj Alia L., Sergio A. Tripodi Goc G., Hasbajrami A., Hysa J.B. R.; Dedej A,; Koza B,; Cekrezi B.; Lulaj D.; Radiologic finding during leptospirosis Coma B. Management of recurrent visceral Tosku Gj., Melyshi K., Pilaca A., Stroni G., Morbilliform Exanthem – The first manifesta- leishmaniasis in HIV- coinfection Qyra E., Pipero P., Kurti Sh., Kalo T., Muco tion of Cutaneous Non Hodgkin Lymphoma Our experience in patients with postrenal ob- Gjataj A., Mehmeti J., Mehmeti E., Muca E., E., Ramosacaj E., Puca E., Kraja Dh. Qato M., Como N., Ramosaco E., Kolovani struction and drainage with nephrostomies. Shkurti K., Pipero P., Kraja Dh., Harxhi A. E., Pilaca A., Puca E., Kraja Dh. Xhafa A Leishmaniasis at pediatric age. Case report Physical Labor, Hypertension and Male H. Ramadani, A. Vishaj, V. Krasniqi, V. Gashi Congenital choledochal cyst - Case Transvaginal sterilization in Albania is a Fertility presentation new technique applied in routine for the first Cekani M.L., Kabili G. B-cell lymphoma associated with spontan Rashiti I., Shefkiu A., Mustafa S., time at 2007 at Durrës Hospital. perforation of jejunum Poroshtica I., Emini A. Haxhihyseni A.; Haxhihyseni (V.) D. Percutanous closure of an atrial septal Poroshtica I., Mustafa S., Rashiti I., Basha defect in a young patient with stroke H., Toska M. A survey of gastric cancer in Albania at a Cystic nephroma of the renal pelvis with Zllami B., Jata B., Basha E., Huti G. period of time 2012-2013 proximal ureter extension - Case report Adult onset still’s disease (Aosd) mimicking Ademi S., Tarifa Dh., Proko F., Likmeta M. Xhafa A, Kurshumlija F, Shaipi M. Effect of aprotinin on renal function in malaria infection in a person travelling from postoperative cardiac patients E.Guinea Primary mesenteric tumor mimicking Rosai-Dorfman Disease: Cutaneous form, Kojqiqi C., Kojqiqi A., Petko M., Hayward Harxhi A., Muhametaj J., Muco E., Shkurti pancreatic head cancer and successfully case report M., Smith A. K., Meta E., Kraja Dh., Pipero P., Capo R., diagnosed by trans-abdominal ultrasound Berdica L., Erekul S., Bushati T., Alia L., Kokici M. guided thru-cut biopsy Vasili E., Doniku A., Dauti I. Epidemiological data about Congo-Crime Daku A., Koza B, Berdica L, Huti hemorrhagic fever in Kuksi district See-and-treat outpatient hysteroscopy E., Allajbeu I., Dhima A., Lulaj D., Coma B. Multiple Immune Reconstitution Inflamma- Ajdini D., Ajdini A., Puca E. Habibaj J., Mustafaraj K., Koci L. tory Syndrome in a woman after initiation of Is total thyroidectomy enough? Highly Active Antiretroviral Therapy Thyroid incidentalomas. Prevalence Tenofovir – Related Nephrogenic Diabetes Godaj D.; Koza B.; Goga A.; Puca Ermira M., Harxhi A., Pipero P., Puca E., by Ultrasonography Insipidus in a Patient with Acquired Immuno- E.; Murati A.; Metaj R. Qyra E., Dede M., Kraja Dh. Puca E., Koza K.B., Bitri S., Huti E., Daku deficiency Syndrome.The Role of Didanosine A., Coma B., Puca E. Nasto K. Lymphadenopathy at pediatric age as a Primary Aldosteronism of Late Onset in a diagnostic problem. Case report patient with Type 2 Diabetes Mellitus: A Sweet Syndrome, a case report Extrauterine pregnancy, still a medical Ramadani H., Vishaj A., Krasniqi V., Gashi V. Case Report Muco E., Shkodrani E., Cekodhima G., challenge Lumi E., Cakerri L., Pine S., Ylli A. Puca E., Shkurti K., Meta E., Gjyzeli M., Mustafaraj K. The role of MRI in diagnosis, staging, treat- Mehmeti J., Muhametaj J., Dajlani A. ment planning and follow- up of breast cancer Post traumatic headache attributed to mild Ovarian borderline mucinous cystadenoma Allajbeu I., Cekrezi B., Shahini A. , Huti E. , traumatic brain injury in Albania OLD and new techniques or tools for with pseudo-myxoma peritonei Dhima A., Koza B. Entela B., Brunilda Z., Pavllo D., Zana C. rezolving a refractar pupil (miotic) Shosha L., Murati A., Xhaferi M., Dhima Koca E. A., Miraka M., Huti G., Arapi B., Cekrezi B., Concomitant abuse of alcohol and Colon Cancer surgical treatment Berdica L., Daka A., Marku L., Shahini A. Lorazepam Godaj G., Shehi D., Dibra A., Dracini Xh., Age-related Epstein-Barr virus-positive Bitri Tivari S., Thoma E., Puca E. Celiku E. cutaneous ulcer arising after a self-limited The importance of the Myocardial perfusion subcutaneous abscess: a case report scan (MPI) in evaluation of patients after Young female patient presented with giant A case report with ulcerative colitis Kurshumliu F., Sadiku Sh., Krasniqi Xh., Percutaneous Coronary Intervention (PCI) pelvic mass consistent with teratoma mimicking colorectal tumor in CT Brovina A., Kryeziu E., Rrudhani I., Meqa Abdullahu L.; Miftari R., Gërqari I.; Daku A. Sula A, Koza B., Kansiz L., Lulaj Daku A., Dhima A., Allajbeu I., Cekrezi K., Gashi-Luci L, Merz H. Bajqinca A.; Spahiu F.; Bajrami I. D., Allajbeu I., Cekrezi B., Dhima A., Coma B., Coma B., Aliu D., Dedej A., Koza B. B., Shahini A. Efficacy and Tolerability of neoadjuvant Evidence based diagnostic bronchology: Stylohyoid disfunction (Eagle Syndrome) chemotherapy with antracycline and Rapid onsite evaluation (ROSE). A young patient with Tuberous-sclerosis Suma A taxanes in locally advanced breast cancer Alia L.

74 75 POSTER PRESENTATION INDEX POSTER PRESENTATION INDEX

Hepatitis and polytransfused patients ( Beta Metabolic syndrome associated with HIV Daku A., Koni A., Koza B. K., Dedej A., Hiv/Aids and Herpes Zoster Thalassaemia and Sickle Cell Disease) and highly active antiretroviral therapy.( A Nasto F., Dhima A., Coma B., Cekrezi B., Meta E., Pipero P., Harxhi A., Como N., Kreka M., Kurti F., Nastas E., Godo review of clinical aspects) Aliu D., Shahini A. Bino S., Muco E., Puca E., Gjermeni N., A., Kreka B., Gjoni B. Kolpepaj R., Nake A., Harxhi A., Kolici Hajdaraga E., Zllami B., Kraja Dh. E., Xinxo S. Our experience in the performing of Thyroid Psoriasis and Echocardiographic Abnormal- Cytology Gastrointestinal tract metastasis from ities Characteristics in Albanian Patients Pessary Use as Treatment of Choice in Daku A., Cekrezi B., Puca E., Gjoshe E., lobular carcinoma of the breast: a case Vargu M., Vargu P., Konda E., Dajci V., Pelvic Prolapse in Geriatric Patients Berdica L., Koza K.B., Allajbeu I., Shytaj E., report and review of the literature Fida M. Delija Z. Shahini A. Huti E., Koza K.B., Capi R., Daku A., Qeraj K., Huti G., Arapi B., Berdica L., Bushati T., Skin Toxicities Associated with Oral Neoadjuvant Chemoradiation for locally Engineering artificial meniscus for Puca E., Bitri S. Adminstration of Sorafenib and Sunitinib in advanced rectal cancers orthopaedic applications UHC “Mother Teresa”. Ademi S., Tarifa Dh., Sallaku A., Proko F., Ndreu-Halili A., Hasirci V. Prader –Willi Syndrome (PWS) Shkoza A., Tarifa Dh., Ademi Likmeta M, Likmeta M. Demaj E., Hoxha V., Kermaj M., Husi G., S., Proko F., Sallaku A. Complications during Transurethral Ahmeti E., Sinani G., Bele S., Hyseni D., Ylli A. Efficacy of antimicrobial therapy of cerebral Epidemiology, Clinical, Laboratory and Resection of the Prostate (TURP) For abscess Treatment characteristics of bronchiolitis in Benign Prostatic Hyperplasia our hospitalized children Kaci Gj., Meta R., Galiqi G., The role of adjuvant vaginal cuff HDR Dede M., Qyra E., Muco E., Puca E., Pilaca Pesha A., A., Harxhi A. Hasani Sh., Hasani E., Qosaj D. Ferko Sh., Gjerazi K., Cuedari F., Monka brachytherapy in early stage endometrial A., Cala S. cancer Non- coronary cardiac calcifications: A Report of a False-Positive HIV Test Result Hafizi E.,Bardhi G. measurement that predict subclinical and the follow up with Additional Tests in Gastrointestinal Stromal Tumor (Gist): Mas- atherosclerosis? Establishing HIV Serostatus kerading as pancreatic cystic neoplasm Using HDR Brachytherapy as a reirradiation Xhabija N., Allajbeu I., Petrela E., Qeraj K. Qyra Sh., Basho M., Abazi Zh., Qyra B., Alia L., Tripodi S. A. in patients with locally recurrent cervix cancer Bani R. Hafizi E.,Bardhi G. The clinical syndrome of subileus due to Reye Syndrome in adult case report and appendicular artery thrombosis /in child) Breast Ultrasound in Check-up screening review Vitamin D Deficiancy Assessment in Adults Mustaqe P., Cami A. Tivari S. B., Puca E., Huti E., Thoma E., Pilaca A., Ndreu A., Qyra E., Qato M., Patients Daku A. Stroni G., Puca G., Kraja Dh. Puca E., Bitri S., Huti E., Xhabija N., Daka Oncocytic laryngeal cysts: a case report A., Puca E. Vajushi E., Aga A., Shytaj E. Assessment on the level of nourishment of Intraoperatory monitoring of patients children 2-5 years old in the rural areas in undergoing cardiac surgery Wagener vasculitis as a cause of fever with Penetrating Neck Injury. Case Report Albania Abdyli A., Huti G., Arapi B. unknown origin Pollo K., Braho H. Dubare S. Shushari G., Murati A., Daku A., Dedej A., Control measures for diarrhea outbreaks in Capi R., Coma B., Vajushi E., Qosja A., Body mass index and other anthropometric Alternative Medicine, on primal health care child care facilities Qeraj K., Pojani A., Puca E. measures in infants of women with pre- Risto J., Minga Gj., Risto M. Xhixha A., Cipi R., Xhixha A., Cuedari M., gestational and gestational diabetes Mecanaj Xh. Ethical and legal issues in the Assisted Poshi K., Topi G., Nurce A., Xhaferi A., Sever pancreatitis in tuberous sclerosis: Reproductive Technologies. Bio political Kolici E., Rustami E., Cerri P., Qamirani S. Case presentation Cerebral venous thrombisis caused by consequences Isufaj V., Daku A., Saygili B., Capi R., secondary intracranial hypotension Braho H. A very rare case of nosocomial fatal Banushi A., Koza B.K., Kapaj R., Godaj D., Myftiu B., Orhan E. K., Baslo B., Çoban O. necrotizing fasciitis due to Pseudomonas Marku L., Puca E., Berdica L., Puca E. The prevalence of semen bacterial aeruginosa in a immunocompetent subject Parasagital Brain Tumors contamination Kalo T., Zama B., Puca E., Pilaca A., Kurti An overview of our experience in parenteral Zeqiri B, Petrela M Marku I., Daka A., Tartari F., Marku L., Sh., Ndreu A., Kraja Dh. nutrition of the preterm newborn Brunilda H. Simeoni A.; Cipi L.; Kolici N., Caglar M.K. Salivary cortisol and correlations with the The incidence of preterm deliveries and the serum cortisol values in healthy control A case report of severe pancytopenia genital infections during pregnancy The imaging of acute tubular necrosis Dyrmishi B., Olldashi T., Kolici E., Rista E., associated with low-dose methotrexate Izairi P. (ATN) in the transplanted kidney Ylli Z., Ylli A., Fureraj Th. therapy, and hyperleukocytosis after

76 77 POSTER PRESENTATION INDEX POSTER PRESENTATION filgrastim administration to a patient with ERCP experience in American Hospital Complications during Transurethral Resection of the Prostate (TURP) Subacute Cutaneous Lupus Erythematosus Tmava S., Fezollari L., Draçini Xh., for Benign Prostatic Hyperplasia Kuçaj J., Lako S., Marku L., Gjoshe E. Gozalan U., Fazliu I., Vishi I., Hasani A., Pesha A, Kaci Gj, Meta R; Gezim G, Ferko Sh, Gjerazi K, Cuedari F, Monka A, Cala S Jusufaj I., Zeka Z., Dedushaj V. Introduction: The study to be presented has included 283 patients treated with TURP. Aver- Cancer and Chemotherapy age age of patients was 74 years. All the patients have been treated in the Regional Hospital Melyshi K. Skin Recurfacing with fraxional laser (150 nm) in Fier. Mishtaku I., Savo I. Objective of the study was to develop an evidence base for complications and their effective Hematological changes in human management as per contemporary protocols. Further to this study included and prevention brucellosis Inflammatory myofibroblastic tumor of the management for the illness. Methods used were based in the experience of treatment of patients in the hospital where treat- Shkurti K., Kokici M., Kalo T., Muco E., Lung: Case report ments lasted on average for 5 years. After the treatment patients were followed for additional 6 Puca E., Kraja Dh. Borici S., Tanka M., Serbo L. months. Results concluded that no matter the modest number of patients compared with Central Hospital Primary Follicular Dendritic Cell Sarcoma of Langerhans cell histiocytosis ( LHC) in OSUT and taking a reference from EAU (European Association of Urology) we are pleased to the Lung young adults confirm that results were positive. Bleeding occurred during the seizure have included 3, 2% of Berdica L., Caushi F., Bushati T., Taçi P., Pilaca A., Zguri L., Puca E., Qyra cases. Bleeding after conducted seizure have occurred in 4, 9% cases. Patients who received a Kurshumliu F., Xhemalaj D., Alia L., E., Stroni G., Doraci M., Duka E., Hysenaj blood transfusion included 3, 5% cases. Tur syndrome included 1, 8% of cases. Post operation incontinence included 2, 2% of cases. Total incontinence was evidenced at one patient. Urinary Leoncini L., Spina D., Miracco C. Zh., Kraja Dh. retention included 2, 2% of cases. However, we remain without reliable data for the erectile functions. Retrograde ejaculation has taken place in 99% of the cases. Urethral stricture was Initial management of the trauma patient . The overall incidence of testis torsion evidenced at 1, 8% of patients. Vesicle neck contracture happened at 2 patients. Urinary infec- Closed Reduction, Traction, and Casting (TT) in our patients diagnosed as scotum tion has taken place in 60% of cases. Re-TURP has been conducted in 2, 3% of cases. Mortality Techniques acutum suspicious for testis torsion rate remained 0%. Fezollari L., Hasmuca I., Habili D., Duraj L. Cuni Xh., Haxhiu I., Xhani M., Tartari F., Conclusion: TURP is an excellent solution including high standard treatment for HBP. Keywords: prostate, complications, treatment Hyseni S., Ndoj A., Fetahu A., Sejdiu A. Evaluation of blood transfusion effects on Intraoperatory monitoring of patients undergoing cardiac surgery tissue oxgenation,based on lactate level Metachronous testicular seminoma with an ABDYLI A, HUTI G, ARAPI B Nunci L., Ohri I., Sula H., Mjekaj E., Kucaj interval of 8 years from the first seminoma- G., Zeqiri D., Taka A., Gogu B. tous testicular tumor: A Case Report Among the most important roles of the anesthesiologist in operatory room is the continuous Cuni Xh., Haxhiu I., Nuraj P., Mehmeti S., monitoring of the patient. The cardiac patient undergoing surgery needs a specific care due to Participation Helio Pylori bacteria gastritis Sejdiu Amir., Kurshumliu F. the importance of the intervention and the co-existing pathologies. These patients need care- ful monitoring of cardiovascular, pulmonary, renal, cerebral and metabolic systems during and gastroduodenal ulcers and after cardiac surgery. To acquire a good monitoring we should respect some protocols Karemani M as follows: • Standard monitoring according ASA for every type of surgery with: ECG (5 lead and continu- ous lead II and V5) continuous with analyze of ST segment, CF, Sp02, EtCO2, RF and central temperature. Invasive arterial pressure is needed so that we can detect properly and in time the hemodynamic changes. The shape and depth of the arterial curve gives us information regarding the arterial pressure. • Central venous catheter insertion provides us a better way of administration for drugs, liq- uids and CVP measurement (giving us information about the vascular filling and preload) • SVO2 or SCVO2 shows the oxygen consumption in tissues. Normal Sv02 should be 75% with Sa02 95-100%. In a patient with normal Hgb, constant oxygenation, absence of factors increasing metabolism, a decrease in Sv02 is equal to decrease of cardiac. (FICKs law) • Monitoring of cardiac index or cardiac output with a Swan-Ganz catheter provides us a va- riety of measurements in the hemodynamic evaluation of the patient. • TEE (Trans esophageal echo) is being used widely nowadays due to its spectacular results regarding the evaluation of valvular problems, EF and myocardial contractility. Lately this method has replaced the use of Swan-Ganz catheter. • Diuresis should be monitored via a urinary catheter. An acute renal injury or a myocardio- renal syndrome during the perioperatory period is going to prolong the ICU period and the mortality (from 0.9% to 63 %). Early detection of renal problems and the correction of fluid balance is very beneficial for the patient. • Coagulation. These parameters are especially important during on-pump cardiac surgery where the patient is given large doses of heparin. We measure continuously the ACT which gives us quick and reliable results.

78 79 POSTER PRESENTATION POSTER PRESENTATION

• Metabolic system: pH, HCO3, BE, electrolytes, glycemia, lactate levels), blood gas analysis 46.6% had CD4 + levels between 100 to 250 cel / mm3 (P02, PCO2), blood components (especially RBC, HB, HCT, PLT) should be carefully moni- 13.3% had done relapse tored. Oxygenation parameters (Sa02, Sv02, HB) and blood gas analysis are incorporated in Conclusions: Concluded data suggest increased attention on viroses as the first manifesta- the extracorporeal pump providing us quick information. tion of HIV / AIDS. It presents a particular challenge and requires individual decisions and • Cerebral function monitoring with cerebral oxymetry. Cerebral events after cardiac surgery treatment. include stroke (3-6%) and neuro-conjuctive dysfunction 30-50% so the cerebral protection is of extreme importance. Cerebral perfusion and adequate oxygensupply is needed sot that Vitamin D Deficiency Assessment in Adults Patients cerebral oxymetry values are above 55 %. Puca E, Bitri S, Huti E; Xhabija N, A Daka, E Puca. Critical patients need always proper techniques of monitoring and most important the con- tinous care of the anesthesiologist and intensivist. Objective: The purpose of this study was to investigate the 25-hydroxyvitamin (25[01-] 33) levels in general population. Salivary cortisol and correlations with the serum cortisol values in healthy control. Introduction: Vitamin D is important for normal bone health. Vitamin D deficiency is a well- Dyrmishil B, 0lldashi M, Kolici E, Ristal E, Ylli Z, YIli A, Fureraj Th known cause of rickets in children and osteomalacia in adults, and it is also of importance for development of osteoporosis. Beyond this, vitamin D deficiency is suggested as a contrib- Aim: To see the difference between salivary cortisol values in healthy male and female and uting factor in the development of several other diseases and conditions such as diabetes, correlation with the serum some cancer types and immunologic diseases. Methods: The salivary and serum cortisol values are analyzer in 12 healthy control, six female Materials and methods: We targeted 100 cases who participated in an annual health check- nurses and six male. The samples are taken before beginning the work and after finish the up from September 2013 until December 2014. In our evaluation we defined levels of 25- hy- work, at 8:00 h am and 4:00 h pm. The cases respect all the rules for salivary testing of corti- droxyvitamin D3 <25 ng/ml as vitamin D deficiency. sol and the avarege age of participant is the same for both group 28.5 years old. Results: The study consisted of 100 adults 83.4% women) and16.6% men with a mean age Result: Median serum cortisol values in all controls 8:00 am was 157.7 ± 52 nmo1/1 (Normal 49.66 ± 18.22DS, range from 16-76 years, and body mass index 28.5kg/m2. Mean serum range 55-230) and median salivary cortisol values 2.6 ± 1.63 microgidL (normal range 1-11.3) 25(OH) D3 concentration was 15.33 ng/ml. Using a cut-off point of 25 ng/ml, Seventy- two and in the end of work (4:00 pm) values are: serum cortisol values 112.1 ± 53.2 nmo1/1 (Nor- point five (72.5%) of this population had low vitamin D status. The highest 25(OH) D3 concen- mal range 28140) and salivary cortisol values 1.5 ± 0.69 microg/d1 (normal range 0.2-2.7). tration was 47.24 ng/ml. We found vitamin [25(OH) D3 < 10 ng/ml] in 40% of our cases. Mean In male: Serum cortisol 8:00 was 154.1 ±4.2 SD and 4:00 pm 112.2 ± 37.9 nmo1/1. In female serum level of calcium was normal 9.33 mg/dl (normal range 8.4-10.4). The level of calcium serum cortisol 8:00 am 160 ± 65.3 SD and 4:00 pm 112.0 ± 51 nmo1/1. Salivary cortisol; in didn’t correlated with low level of Vitamin D3. male 2.04 ±0.83 micro/dL (8:00 am) and 1.63 ± 0.85 micro/dL (4:00 pm); in female: 3.1 ± 2.1 Conclusion: Vitamin D deficiency was prevalent in our ambulatory patients. Based on our micro/dL (8:00 am) and 1.47 ± 0.56 micro/dL (4:00 pm). There is no difference between male results, we feel that national recommendations for vitamin D intake should be increased in and female controls in the salivary and serum cortisol values. our country. During the study most of the days were sunny. Conclusions: We found the correlation between salivary and serum cortisol values, without The prevalence of semen bacterial contamination. difference between female and male healthy controls, but the study need a bigger group of Dr.Irena Marku ,Dr.Albana Daka,Prof.dr.Flamur Tartari,Dr.Luljeta Marku,Dr.Brunilda Hyseni nurses to have more trustful conclusions. Laboratory Department,” American Hospital” Tirana, Albania University Hospital Center Key words: salivary cortisol, serum cortisol, correlation “Mother Teresa”, Tirana, Albania Backgraund: Identification of the common microorganisms in semen culture in males with genital tract HIV/ AIDS and Herpes Zoster infections.The aim of this study was to investigate the presence of different bacterial species in semen E Meta, P Pipero, A Harxhi, N Como, S Bino, E Muco, E Puca, N Gjermeni, E Hajdaraga, B culture in paient with symptoms of genital system. Zllami, DH Kraja Method: Are selected 100 males,20 — 60 years old.Samples were seeded using a calibrated loop

on agar plates which were incubated over night at 37 °C in normal air with 5 % CO2 The organisms Introduction: Herpes Zoster is known as immunosuppression situation appears in pathology were identified by Gram stains, oxidase, catalase test and other biochemical tests using Biomerieux, or different medications that target the inhibition of immune’s system. He may be one of the VITEK 2. Results: first manifestations one of the major syndromes of immunosuppression that is HIV / AIDS. In • 45 % of males are positive with UREAPLASMA UREALYTICUM+MYCOPLASMA HOMINIS these cases Zosteri characterized by significantly higher incidence than in those seronegative • 1 % of males are positive with STAPHILOCOCCUS AUREUS 1 % of males are positive with for HIV. Aim is to identify Herpes Zoster as first manifestation of HIV/AIDS. STREPTOCOCCUS AGALACTIAE Methods: 372 cases were studied with HIV / AIDS outpatient follow in HIV / AIDS clinic of • 2 % of males are positive with ESCHERICHIA COLT HEMOLITIC 14 % of males are positive with Infection Service UHC, during period 2007 to 2013, age group from 17-71 years old. We GARDNERELLA VAGINALIS stressed the cases where AIDS was demonstrated for the first time with HZ, analyzed the im- • 1 % of males are positive with ENTEROCCOCUS FAECALIS munological stage, the level of CD4 + cells at the time of his appearance; cases where Zoster • 36 % of males are negative. relapse had made during the course of the disease and under HAART therapy Conclusion: Is very important identification of the microorganisms in semen culture in males with gen- Results: 45 cases resulted Zoster as first manifestation of HIV infection from 372 cases. 38 ital tract infection and to take an antibiotic agents to which the microorganism is sensitive to prevent were males and 17 females; from age groups ; 31-40 years old 18 cases, 41-50 15cases, permanent infections that can occurs man’s infertility. 51-60 years old 8 cases, 61-7lyears old 4 cases.Based in immunological stage with CD4 + <100cell / mm3 were 13 cases, CD4 + between 100 - 250cell / mm3 23, CD4 + 250cell / mm3 Medical Education beyond Borders - 350 cell / mm3 6 cases and CD4 + on 350cell / mm3 3 cases. Recurrence by 2 episodes of Qirko R Zoster resulted 6 cases, 3 were during IRIS. 19 of there were hospitalized as a result of grav- ity of viruses, dissemination of dermatomere, eruptions gravity, and post herpetic neuralgia. American Austrian Foundation in cooperation with Open Medical Institute is organizing Conclusions: 12.09% of HIV/AIDS cases, Zoster resulted the primary opportunistic infection. a yearly based medical education program in different medical specialities. This initia- 62% were male. tive started in 1992 and continues including more and more countries. The program is The age group of 31-40 years predominated with 42%, followed by 41-50 years with 33.3% present in Albania in collaboration with Medicine University in Tirana, American Hospital

80 81 POSTER PRESENTATION POSTER PRESENTATION and “Queen Geraldine” Hospital. 11.3 hrs, 48 hrs +/-13.8 hrs, respectively, p = 0.001) and lower postoperative pain scores The goal of this program is to improve the healthcare in countries in transition, promote brain than the abdominal hysterectomy group (4.0 +/- 1.7p, 6.5 +/- 1.6, respectively, p < 0.001). gain and prevent brain drain, provide state of the art postgraduate medical education and CONCLUSION: The proportion of laparoscopic hysterectomies is increasing and rep- training, empower healthcare professionals, rebuild healthcare pyramid. resents approximately more than half of all hysterectomies performed in the Amer- There are in total 118 countries registered to this program. Every year doctors from ican Hospital Kosovo. The present procedure allows the patients to have all the Albania participate in this program and in total there are 584 doctors that visited at least benefits of laparoscopic surgery such as less pain, shorter recovery time,few- once seminars in Salzburg since 1993. This medical education program includes not er complications and less scar tissue. The advantages and potential drawbacks of only one week seminars in the beauty city of Salzburg, Austria, but also observer ship both procedures need to be discussed with women presenting with benign disease. for medical professionals in one of the Austrian hospitals, professorship visit in Albania and satellite symposia. All activities are supported by lectures and other professional Morbilliform Exanthem – The first manifestation of Cutaneous Non Hodgkin Lymphoma materials sent to all alumni doctors. Qato M,Como N, Ramosaco E, Kolovani E, Pilaca A, Puca E, Kraja Dh American Austrian Foundation and other donors cover all expenses for participants in these seminars. Participants need to apply online and the selection process is based on their ex- Introduction: Cutaneous Non Hodgkin Lymphoma is a serious clinical condition that affects pertise. primary the skin without extracutaneous involvement at first place, and accounts for ∼5% of Medical education is a long process and AAF/OMI will help to facilitate it along the doc- all non‐Hodgkin’s lymphomas. tors’ professional life. Objective: To report a 30 year old male that was hospitalized in our service in February 2013, as Morbilliform Exanthem with inguinal lymphdenopathy. Skin resurfacing with fraxional laser (1550 nm) Material and methods: In admition he referred fever, general weakness and anorexia during the Mishtaku S I, Savo 12 last month. Objective examination revealed a bilateral lymphadenopathy (inguinal,cervical and axillary regions ) and erithematous elements, infiltrated in the right pectoral and cervical regions. Introduction & Objectives: Fraxional laser (1550 nm) consist in photothermolysis, a concept Laboratory data had no serious alteration in first place, except for:LDH 548, Total protein was using arrays of microscopic thermal damage pattern to stimulate a therapeutic response. 5.9g/dL and albumin 2.9g/dL. Serologic tests, of suspected infectious diseases, including mea- This process improves the dermal components resulting in wrinkle and age spots reduction sles resulted negative. Ultrasound showed a generalized lymphadenopathy (cervical,axillary (lentigo solaris), smoothing of skin texture, and reduction of pore size. Fraxional skin resur- and inguinal),while CT of head and neck revealed bilateral cervical lymphadenopathy with liquid facing laser is associated with shorter periods of recovery time in comparison with the ablative between the fascia. Biopsy of lymphonode revealed an atypic lymphocyte infiltrate,which ac- technology. cording to immunohistochemical examination, resulted CD3 +,CD4+ and CD30+. This study aimed to evaluate the clinical effect of 1550 nm fraxional laser treatment in the Results: The case was concluded by oncologists, hematologists and histopathologists as a skin resurfacing. Cutaneous Non Hodgkin Lymphoma. Treatment with specific protocols was not sufficient to Material & Methods: Subjects of age 30-55 underwent 3 to 5 sessions of fraxional laser save the life of patient. treatment in an interval of at least 4 weeks. The treatment purpose were rejuvenation im- Conclusion: Cutaneous Non Hodgkin Lymphoma may appear in the first place as a Morbilli- provement of hyperpigmentation’s (age spots, melasma) or acne and surgical scars. All sub- form exanthema. jects had pre- and post- treatment photographs. The treatment parameters of 15-70 mJ/cm2 Keywords: Morbilliform, Exanthem,Cutaneous,Lymphoma energy and 17-25 % coverage were applied in every session causing clinically erythema and edema. Deep moisturizing creams and broad spectrum sunscreens were recommended in A survey of gastric cancer in Albania at a period of time 2012-2013 the post treatment period. Ademi S, Tarifa Dh, Proko F, Likmeta M Results & Conclusions: Fraxional skin resurfacing laser (1550 nm) has shown clinical im- provement in skin resurfacing, including wrinkles, pigmentation and texture of the skin. Introduction: Gastric cancer is fourth most common malignancy in the world. Gas- tric cancer usually affects older individual but it is not rare in younger age groupe. Ad- Perioperative outcomes of total laparoscopic hysterectomy versus abdominal hyster- enocarcinoma gastric is more frequent in men, but it is not determined that have ectomy for benign uterine diseases different clinical and histological features with possible difference in prognosis. Goc G, Hasbajrami A, Binishi Hysa J. Matherial and Methods: We analysed a database of gastric cancer patients treated in our BACKGROUND: The purpose of this study was to compare perioperative morbidity and out- Service of Oncology from january 2012 to December 2013 . Information including patient’s comes of women with benign uterine diseases, undergoing either total laparoscopic (TLH) or age, sex, tumour classification, stage of the disease, type of surgery. Clinical and pathological abdominal hysterectomies (AH). characters of younger patients ( age 40 years or less) were compared with older patients (age METHOD: We performed a retrospective study on 65 patients who under- more than 40 years) went hysterectomy for benign uterine disease at American Hospital, Koso- Results:There were a total of 86 patients treated during the study period.The mean age was vo between January 2013 and December 2014. We compared outcomes be- 50 years with age range of 25 to 75 years. Male to female ratio in younger patients was 1:1, tween the two groups of patients TLH (n=34) vs AH (n=31) in terms of the following: 3 , and in older patients patients was 1:0,6. In younger age group 70% of patients had poorly surgical operation time, post-operative hemoglobin levels, pain level and hospitalization time. RESULTS: The major indications were endometrial hyperplasia, menorrhagia and chronic differentiated adenocarcinoma wich was 50% in older age group. 60% of younger patients pelvic pain. Patients were excluded from our study due to big myoma, (over than 6 cm), had stage IV disease at presentation and curative surgery was not possible .In older patients and poor mobility of enlarged uterus. The total laparoscopic hysterectomy group had 43% had stage IV disease at presentation. Histological features of the women were diffuse slightly longer operative times than the abdominal hysterectomy group but had no statis- type in 13 % , intestinal type 10% signet ring cells in 27% and poorly differentiated 50% tical difference. (85 +/- 13.8 min, and 79 +/- 12.4 min, respectively, p =0.847). Postoper- Conclusions: Gastric cancer is usually considered as a disease of elderly population , but it ative hemoglobin level difference for laparoscopic hysterectomy was significantly low- can occurs in younger patients also.This cancer in young persons has unique characters like er than abdominal hysterectomy (0.9 g/dl +/- 0.7g/dl, 1.5 g/dl +/- 0.6 g/dl, respectively, p female predominance ,signet ring cell ,poorly differentiated , advanced stage at presentation = 0.14). Total laparoscopic hysterectomy group had shorter hospital stays (31.4 hrs +/- with ascites and metastasis to ovaries as the main sites .About 20% of gastric cancer cases

82 83 POSTER PRESENTATION POSTER PRESENTATION occur in patients of 40 years and under with high percentages of poor prognosis factors.They with correct diagnosis. probably have worse survival. The course of patient: Male, 9 year old, from Suhareka, it is been admitted in Infectious Clinic from 20.08.2014 until 08.09.2014 and in the begging it was with admitted diagnosis as Primary mesenteric tumor mimicking pancreatic head cancer and successfully diag- Lymphadenopathy colli. In the Clinic we have done blood work, biochemistry, serology and imagery and in the end we have exclude acute infection. Despite the treatment, the condition nosed by trans-abdominal ultrasound guided thru-cut biopsy didn’t change, we have made FNB (Fine Needle Biopsy) it was negative, also hematologic DAKU A, KOZA B, BERDICA L, HUTI E, ALLAJBEU I, DHIMA A, LULAJ D, COMA B consultation with blood smear was also negative 3 times. Patient it is refers out of country, later it was made the biopsy of the bone marrow in the Hospital Nena Teresa in Tirana, which Although uncommon, mesenteric tumors are encountered in all age groups from infancy to was positive as lymphoblastic acute leukemia from T cell. the very elderly. These tumors should be considered as an explanation for a palpable abdom- Conclusion: Lymphadenopathy at pediatric age it is challenge in every day work wich need inal mass, but they are most commonly brought into the differential diagnosis of abdominal laboratoric infrastructure and cooperation between interdisciplinary specialists in getting the pathology once a suggestive radiologic study or an abdominal operation has been performed. faster way of diagnosis. An increased awareness of neoplastic and nonneoplastic processes that result in mesenteric Key words: Throat pain with edema of neck in both side, difficulty in swallowing, fever, ab- masses aids the clinician in recognizing these diseases. Malignant primary mesenteric tu- dominal pain and hepatosplenomegalia. mors are extremely uncommon, even compared with primary malignancies of the small bow- THE ROLE OF MRI IN DIAGNOSIS, STAGING, TREATMENT PLANNING AND FOL- el. Published reports suggest that one third to one half of all mesenteric masses are malignant LOW-UP OF BREAST CANCER tumors. We described this case with a rarely peri-pancreatic infiltration invading the uncinate Allajbeu I,Cekrezi B, Shahini A, Huti E, Dhima A, Koza B process of pancreas and extending to the mesentery and clinically suspected for pancreatic cancer. After deciding for trans-abdominal throw-cut biopsy we performed it successfully un- Previous studies have shown that Magnetic resonance imaging (MRI) is highly sensitive for der ultrasound and no complication was seen after procedure. Finally the biopsy results was cancer staging, problem-solving, posttreatment surveillance, and other indications. This pre- compatible with primary mesenteric cancer not pancreatic cancer and the patient referred to sentation is a review of the role of MRI in diagnosis, local staging, treatment planning and Oncology for planning chemotherapy. follow-up of Breast cancer based on our own clinical experience and literature . Method and technique: We retrospectively reviewed 57 dinamic breast MRI studies

performed in our clinic between January - December 2014 . The examination was performed Is total thyroidectomy enough? with a 1.5 tesla system(Avanto, Siemens) and dedicated breast coil. Results: 32 of the Godaj D, Burak Koza K, Goga A; Puca E; MuratiA, Metaj R patients were sent either for further evaluation of uncertain lesions found on US Mammography or for screening because of high risk of hereditary breast and/or ovarian Introduction: Total thyroidectomy is nowadays the golden standard in the treatment of Thy- cancer . 15 of the patients were biopsy-proven primary breast carcinoma and were referred roid Cancer. Still, even in the hands of expert surgeons who perform the operation for a long for preoperative evaluation. 8 of the patents had undergone modified breast surgery and time with minimal complication rates, recurrence of cancer happens. The understanding of received radiotherapy and were referred to rule-out local recurrence because of suspicious micro metastasis in the neck lymph nodes and performing neck dissection is our belief will findings in US/Mammography. 2 patients had breast implants and were referred to improve the outcome and lower the recurrence rate. In this paper we will present shortly investigate the integrity of the implant shell and delineate breast cancer around or behind the implant. our experience in the surgical treatment of Thyroid Cancer in the American Hospital II with 14 of the patients from the first group were diagnosed with BI-RADS 4 – proved then by total Thyroidectomy and in specific circumstances with central compartment neck dissection. histopathological findings. We found 5 bilateral breast cancer from the second group and one Methods: This is a study made in the American Hospital II. We analyzed the charts of patients local recurrence from the 3d group, all proved by biopsy. Conclusion:The results of our study who underwent total thyroidectomy in our hospital. supported the previous studies from literature, by demonstrating the superiority of MRI to other Results: 100 total thyroidectomies are performed by our surgical team. Complication rates are modalities in diagnosis, preoperative local staging, and posttreatment follow-up of breast cancer. comparable with the best centers. Laryngeus recurrent nerve damage was permanent only in This was a first experience study because of the limited number of patients ,though with two patients. Transitory nerve edema was found in 5 patients. Hypocalcaemia was present in 12 very promising results supporting the fact that MRI is becoming a very important diagnostic patients. No patient had bleeding after surgery. All patients diagnosed with Thyroid cancer were tool in this field . sent for radioactive iodine ablation. Two patients with anaplastic cancer had local recurrence. Concomitant abuse of alcohol and Lorazepam. Conclusion: Performing total thyroidectomy is safe in the American Hospital II. The surgery Bitri S. Esmeralda Th, E Puca outcome is very good. We believe that neck dissection is necessary in patients who have sus- picious nodes in preoperatory evaluation. During surgery, frozen sections are needed to make Introduction: Multi- drug abuse is a big problem nowadays, even in Albania. Alcoholism re- a proper evaluation of central compartment neck nodes. We have used them in most cases. mains a serious cause of morbidity and mortality, despite all the treatment strategies. When alcohol is combined with anxiety, mood disorders and benzodiazepine dependency, it be- Lymphadenopathy at pediatric age as a diagnostic problem, case report comes life threatening for the patient, but also a familiar and social drama. Withdrawal is the Ramadani H, A. Vishaj, V. Krasniqi, V. Gashi gold standard, but most of time very difficult to be achieved, as the decision and the willing- ness of the patient are crucial. Summary: Diagnostic differentiation of lymphadenopathy at pediatric age present challenge Case presentation: A 54- year-old men with alcohol and benzodiazepine depen- in every day practice in developing country and with limited laboratory resources. dence was referred to our hospital for a detoxification therapy. Daily use of alco- Purpose of the paper hol had started 20 years prior to admission and the daily dose during the last year was Purpose of the paper it is to be presented one case of pediatric age with cervical lymphade- nearly 25-30 Unite / day. In addition he had a history of concomitant Lorazepam nopathy, to reflect epidemiological aspects, clinical, laboratory and the course of the illness, abuse with daily doses 22-30 mg / day. During 20 years of abuse this was the sec- to show the importance of cooperation in between interdisciplinary specialist in order to come ond attempt for abstinence. The first time, he left the addiction unit within 24 hours.

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The communication with the patient was very difficult; he manifested suicidal thoughts, emo- tissue biopsy the result was compatible with neurocutaneous lesions that is frequently present tional lability. What was the main problem at the begging, and what helped us during the and the patient get the right diagnosis. process, was the confidence.. We used Librium to manage the alcohol withdrawal, and in the same time we begun to taper Our experince in patients with postrenal obstruction and drainage with nephrostomies. lorazepam doses, switching them to Librium, respecting the equivalent dose. The benzodi- Xhafa A azepine treatment according to the scheme, finished 3 months from the first day of hospi- talization. About 5 months from the first day of hospitalisation , the patient had one episode Introduction: Postrenal obstruction (PrO) is a common problem that can be caused by dif- of consuming alcohol, but not benzodiazepine. He continued the treatment and, any other ferent diseases. Patients with Pro were likely have elevated values of creatinine, ureas and relapse was referred. sometimes potassium. The main reasons are the lower urogenital systems tumors, urolithia- Conclusion: It is very difficult to treat concomitant abuse of alcohol and benzodiazepine, es- sis, retroperitonel fibrozis and others. We reported 31 patients who had postrenal obstruction pecially in patients with behavioral disorders. In our case, the main difficulty, except the high and was successfully drained with an antegrade nephrostomy. doses of alcohol and lorazepam, was the collaboration of the patient. Finding the best equilib- Material and methods: A series of 31 antegrad nephrostomy patients presenting due to unilater- rium between respecting the protocols, and well treating the patient, remain still a challenge al or bilateral PrO were included from January 2013 and October 2014 at Prishtina`s American in our clinical practice. Hospital in this study. The cause of the obstruction was respectively: infiltrative urothelial car- cinoma (8), metastatic rectal cancer (4), infiltrative cervical cancer of uteri (4), and metastatic Young female patient presented with giant pelvic mass consistent with teratoma prostate cancer (5), and obstructive urolithiasis (5), retroperitoneal fibrozis related to ileopsoas DAKU A, SULA A, KOZA B, KANSIZ L, LULAJ D, ALLAJBEU I, CEKREZI B, DHIMA A, abcess (3), urethral stricture (1), and hidronephrosis after ileal neobladder operation (1). COMA B, Albana SHAHINI A Discussion: The mean age was 62,6 (15-80) years old. 23 patients needed unilateral ne- phrostomy and 8 of them needed bilateral nephrostomy. The mean preoperative urea and Message Body: Teratomas are germ cell tumors commonly composed of multiple cell types creatinine values were 117,4 mg/dl and 4,73 mg/dl respectively. In two patients potassium value was greater than 6,1 mg/dl. The nephrostomy was applied with ultrasound guidance derived from one or more of the 3 germ layers . Teratomas range from benign, well-differen- and the size of nephrostomy was 10-12 Fr. The mean postoperative urea and creatinine and tiated (mature) cystic lesions to those that are solid and malignant (immature). Additionally, values were 91,8 mg/dl and 2,9 mg /dl respectively. In 21 patients the nephrostomy tube was teratomas may be monodermal and highly specialized. Rarely, within some mature teratomas changed every 3-4 months certain elements (most commonly squamous components) undergo malignant transformation Conclusion: In some patients with end stage disease or obstruction of lower urinary tract and sometimes they may cause a acute pelvic pain in the female patients due to the chem- antegrad nephrostomy is a safe procedure and can protect the patients from renal failure. ical reactions to the peritoneum. We have showed a case that came to the Gynecological We reported our experience in these cases as the single center that performs this procedure emergency room because of her acute pelvic pain. After gynecological examinations they in Kosovo. saw a giant pelvic mass and the send to radiology to perform CT for determination and to rule out the acute pain . After performing enhanced CT in the radiology department we de- Transvaginal sterilization in Albania is a new technique applied in routine for the first time at 2007 at hospital of Durres. picted a giant ovarian mass with heterogeneous density that not enhances and additionally Haxhihyseni A, Haxhihyseni(Vercuni) D. the presence of minimal liquid due to the ruptured mature teratoma and we discussed with Gynecology department for operation and histopathologic biopsy to differentiate the subtypes Background: Transvaginal sterilization in Albania is a new technique applied in routine for the of teratomas. The non-enhanced abdominal CT is very helpful to differentiate the types of first time at 2007 at hospital of Durres. female pelvic masses with acute pelvic pain because the presence of fat tissues considers Objective: Application of the new technique in Albania, the study of the realization, safety and the mostly the teratomas and dermoids. advantages of this technique. Materials and methods: Prospective study from 2007 to 2013, in Durres hospital, in 39 wom- A young patient with Tuberous-sclerosis with multi-system infiltrations incidentally en at sexual activity age that had in their medical history more than two willingly abor- tions and has realized the number of children they wanted. All cases fulfilled the prelim- diagnosed by Cranial MRI inary consensus. There were explained to them the details of the operative technique,. DAKU A, PUCA E, SAYGILI B, ROCI E, KAPAJ R, DEDEJ A, KOZA B, CEKREZI B, LULAJ Results: All 39 cases with culdotomic trans vaginal sterilization were selected by excluding pelvis D, Bledar COMA aderences by medical history, vaginal egzamination and ultrasound examination. The average time of culdotomy intervention was 4.6 minutes and for tubectomy was 13.9 min. The average Message Body: Tuberous sclerosis-also called tuberous sclerosis complex (TSC) is a rare, quantity of the blood lost was 65 ml. The average of hospitalisation was one day. The full, com- multi-system genetic disease that causes benign tumors to grow in the brain and on other vital plete rehabilitation for normal vital activity was 6 days. There were no noticed complications. organs such as the kidneys, heart, eyes, lungs, and skin. It usually affects the central nervous Discussion: Transvaginal tubectomy is a new safe,precise technique that has its advantages system and results in a combination of symptoms including seizures, developmental delay, against laparotomic and laparoscopic cistectomy. behavioral problems, skin abnormalities, and kidney disease. We described this case report Conclusion: Transvaginal tubectomia must be spread out in Albania as a simple family plan- ification, costoefectivity. with our young patient that has been accepted to our urgency room with recurrent epilepsy, mental confusion and abdominal pain and discomfort . After performing the cranial MRI we Cystic nephroma of the renal pelvis with proximal ureter extension - case report detected multiple hyperintense tubers and periventricular gliotic changes and a big frontal Xhafa A, Kurshumlija F, Shaipi M. lesion that not enhanced. The radiologic and clinically suspected for neuro-cutanous syndrome therefore we perfomend an thoraco-abdominal CT that showed a multi-system lesions such as Introduction: Cystic nephroma is a rare benign lesion of the kidney. It is classified in mixed multiple hepatic, renal and peripankreatic fibro-lipomatous lesions occupied all the abdomen mesenchymal and epithelial tumours of the kidney according to the World Health Organiza- and some soft tissue on the skin, also pulmonary lymphangiomatosys was present. After soft tion (WHO) classification .We reported a case of cystic nephroma with proximal ureter exten-

86 87 POSTER PRESENTATION POSTER PRESENTATION sion after radical nephroureterectomy headache, confusion, vomits, lethargy. Immediately we realized a CT-scan and RMI of head. Case presentation: We report a 52 year old female patient with complaints of chronic flank According to clinical and image findings and laboratory (Elisa Toxo IgG poz) we defined pain. After examinations with abdominal ultrasound, retrograde pyelography and computed the case as Cerebral Toxoplazmosis. She improved under treatment with Cotrimoxazol with tomography a renal pelvis mass and dilated urether were seen. No lymphadenopathy and CD 4 level CD4 314cell/uL (19.2%). She presented again, 125 days after with dissemi- metastatic disease were noted. Cystoscopy was performed but no pathological changing nated herpes zoster infection with the same level of CD 4. She was treated successfully. were seen in the bladder. Patient was operated with working diagnosis of transional cell carci- Conclusion. This case report shows us two important infective manifestations. noma and open nephroureterectomy was performed. Histopathology has featured diagnosis 1. Immune Reconstitution Inflammatory Syndrome-HIV/AIDS. for mesenchymal-epithelial benign changes with Cystic Nephroma. 2. IRIS was presented with 2 opportunistic infections: Cerebral Toxoplasmosis and Herpes Discussion: Cystic nephroma is a rare benign neoplasm, in international literature only 200 Zoster. cases were reported. Only few cases of cystic nephroma were reported with ureteral extension. Keywords: Immune Reconstitution Inflammatory Syndrome, Highly Active Antiretroviral Ther- The non-specific clinical findings and the poor contribution of imaging examinations make the apy, Cerebral Toxoplasmosis, Herpes Zoster. distinction from other cystic renal neoplasias difficult. On our case proximal ureter extension made the diagnosis more difficult to distinguish from urothelial cancer. Final diagnosis was Primary Aldosteronism of Late Onset in a patient with Type 2 Diabetes Mellitus: established only after histopathological examination of the completely rejected tumor. A Case Report Conclusion: Cystic nephroma with proximal ureteral extension is a rare benign lesion, that E.Lumi ,L.Cakerri, S.Pine, A.Ylli consequently of difficult diagnosis differentiation require surgical extirpation as urothelial can- cer. Diagnostic radiographic imaging does not reliably distinguish malignant from benign le- Key words: PrimaryAldosteronism, Diabetes Mellitus tipe2, Obesity sions, that is why these cases cannot have definitive diagnosis before operation. Introduction Primary Aldosteronism (PA) is the commonest cause of secondary arterial hypertension. PA Rosai-Dorfman Disease: cutaneous form, case report includes adrenal adenomas, unilateral and bilateral adrenal cortex hyperplasia,the familial Berdica L, Erekul S, Bushati T, Alia L, Vasili E, Doniku A, Dauti I. types of the disease and aldosterone secreting adrenal carcinomas. Case report: A 68-year-old male was admitted for hospitalization, due to a strong sense of Background. Rosai-Dorfman Disease is a rare benign systemic histio-proliferative disease with fatigue,headache,and edema of the lower extremities.The patient reported high values of blood massive lymphadenopathy particularly in the head and neck region, and often associated with pressure over the last month,effectively controlled by medication until a month ago. He had been extra nodal involvement [1] . It primarily involves lymph nodes but can affect extranodal sites diagnosed with arterial hypertension 8 years ago.Since then, he was treated with Olmesartan20 such as the skin, where it typically appears as indistinct erythematous papules and nodules. mg qd and Bisoprolol2.5mgbid, reporting an optimal arterial blood pressure control. In rare cases, the disease presentation is only extranodal, as in our case only skin involve- His medical history included DiabetesMellitus type2 and Obesity,for which he was treated with ment, which is found in 3% of patients [2] . On histopathologic examination, emperipolesis is a Glimepiride2mg qd, and Metformin850mg tid. Blood pressure at presentation was 180/100 consistent finding. The etiology is unknown, and treatment is based on clinical manifestations. mmHg,.Normal electrocardiography (ECG) and chest X-ray.Laboratory test were: Pottasi- The patient SH.S. is 48 years old female and she initially presented to the Dermatology De- um=1.6mmol/l,Sodium=140mmol/l,Magnezium=2.61mg/dl,Calcemia=10.2mg/dl.Ph=7.54,P- partment of UHC “Mother Theresa” for the evaluation of the nodular skin lesions she had. co2=46.2mmHg,Po2=70mmHg,HCO3=40.3 mmol/l, normal cortisol levels,24-hour urine She claimed that these nodular lesions were present for 4 years now in different parts of her VanilmandelicAcid( VMA) 1.2 mg (N) <13.6mg,Plasma Aldosterone Concentration (PAC) body; abdominal region, pubic region, arms, finger, forehead and thighs region and no other 30.1 ng/dl (N: 1-16 ng/dl), Plasma Renin Activity (PRA) 0.7 ng/ml/h (N:0.5-1.9ng/ml/h) , PAC/ symptoms were present. She performed surgery removing the lesions located in her finger PRA ratio was 43.VMA levels were within normal range (pheochromocytoma ruled out). The but they kept reappearing in the same site and also in other parts of body as mentioned values were diagnostic of PA,the patient underwent an adrenal (CT), which demonstrated bi- above. The patient did rutine laboratory exams and Diabetes 2 is diagnosed. Total body lateral cortex hyperplasia. Normal finding on Head (CT). He was treated with Spironolactone MRI was performed and no lymphnodes involvement is seen. Then the surgical exsision of (100 mg )added to losartan 50mg qd, achieving an effective control of hypertension. the nodular lesion located in the deltoid region is done. Histopatologic examinations were Conclusion: Diagnostic approach of this case,led us to two interesting specific facts.1-the then performed and concluded the diagnose: extranodal cutaneous Rosai Dorfman disease. patient’s age,since PA usually manifests between 30-50years of age.2-the bilateral ad- Conclusion. Rosai Dorfman Disease usually presents with painless massive cervi- renal cortex hyperplasia and bilateral forms of the disease are treated conservatively. cal lymphadenopathy, rarely the first presentation is with extra nodal manifestations [1]. Post traumatic headache attributed to mild traumatic brain injury in Albania Multiple Immune Reconstitution Inflammatory Syndrome in a woman after initiation of Basha E, Zllami B, Djamandi P, Cakonji Z¹. Highly Active Antiretroviral Therapy Muco E, Harxhi A, Pipero P, Puca E, Qyra E, Dede M, Kraja DH Background Headache is a common result of head injury, occurs in the first seven days after

Message Body: Introduction. Immune Reconstitution Inflammatory Syndrome is a head trauma and it might persist for months and years, is one of the several symptoms of strong inflammatory response after the increase of CD4 level when the antiretrovi- post concussion syndrome. ral therapy is started. The incidence of IRIS in patients initiating HAART is not well de- Objective To evaluate the prevalence and characteristics of acute and chronic post traumatic fined at present, with published estimates ranging from less than 10% to over50%. headache attributed to mild traumatic brain injury Aim. To present Multiple Immune Reconstitution Inflammatory Syndrome in a woman after Methods A prospective, observational study. 544 patients with acute mild head injury pre- initiation of Antiretroviral Therapy. sented to department of trauma underwent a detailed interview (some by phone) between Presentation. A 41-year-old woman presented at our hospital with a febrile situation. She 7-14 days to evaluate acute post traumatic headache (APTH) and 90-100 days to evaluate was diagnosed HIV-infected patient, late presenter according to level of CD4 (34cell/uL chronic post traumatic headache (CPTH) (3.84%), and base line illness (chronic diarrhea; weight loss; oral candidacies). The patient Results The 544 patients fulfilled the criteria of mild traumatic brain injury (Glasgow Coma started Highly Active Antiretroviral Therapy (Zidovudine, Lamivudine, Nevirapine) and symp- tomatic treatment. The situation is improved immunologically and clinically, CD4 174cell/uL scale 13-15 points). The prevalence of APTH occurred 1- 7 days after head injury was in 78 (13.3%). After 36 days she presented with three days history of high grade fever, severe % of patients, lasts for 3-5 days in 42% of them. Characteristics of headache were unilateral

88 89 POSTER PRESENTATION POSTER PRESENTATION in 45%, occipital 35 %, diffuse 10%, aggravation from physical activity 49%, nausea 42%, standard but imaging helps in identifying the abnormally elongated styloid process or the cal- photo/phonophobia in 55% of them. cified ligament. We report three specific cases affected by this disfunction (the classical recur- The prevalence of CPTH (after 90 days) was 35% and 75% of them presented with headache rent form) and assessed and treated by us in the timeframe from 2012 to 2015. Treatment was resembling chronic tension type headache either as the only manifestation as in combination conservative, patient oriented and in two of the presented cases had very good outcomes. with migraine symptoms. Keywords: Eagle, stylohyoid, disfunction Conclussion The pattern of headache after traumatic injury is most commonly related to mi- Nested variant” of urothelial carcinma of renal pelvis and ureter. case report graine type headache (MTH), tension type headache (TTH) and mixed headache with both Alia L, Sergio A. characteristics of MTH and TTH. Message Body: The nested urothelial carcinoma, is a rare histologic variant of inva- Colon Cancer surgical treatment sive bladder carcinoma with a reported prevalence of 0, 3 % and a male predom- Godaj D, Shehi D, Dibra A, Dracini Xh, Celiku E inance. First was described by Stern (1979) as variant of carcinoma of the urinary blad- der. Murphy & Deana (1992), named this neoplasm as the nested variant of urinary Introduction: Colon cancer is today worldwide the fourth cause of cancer death in both male bladder (NVUC) that is included in the latest WHO Classification of Tumours – 2004. and females. In Albania, it also represents a major challenge in the proper treatment from Its histological appaerance is that of a low-grade tumor, composed by islands of discrete the multidisciplinary team including us, the surgeons. In the First Clinic of General Surgery or moderate atypical urothelial cells, that strongly mimicks von Brunn nests and other of the UHC “Mother Theresa” we have operated in the last decade 265 patients diagnosed diseases (cystitis cystica, cystitis glandularis, nephrogenic adenoma, inverted papilloma, with Colon Cancer, both in Emergency room and electively. The aim of this study is to pres- paragonglioma). These confluent small nests invade to the lamina propria or deeper. ent the different clinical situations and the type of surgical approach we have undertaken. NVUC have a very aggressive biologicc behavior, with local recurrences and metastases, so Methods: This is a unicentric, retrospective study developed in the First Clinic of by the WHO reported that 70 % of patients died 4 or 40 months after diagnosis. General Surgery in the period 01.01.2004-31.12.2013. We have analyzed 265 clin- The patient is a 49-year-old woman affected by HCV hepatitis presented with fever, cystitis and ical charts of patients diagnosed with Colon Cancer and who underwent surgery. hypertension, dysuria, loss of kidney fun-ction. Computed tomography showed a sclerosing Results: Gender: Females 129 (48%), Males 136 (52%); Average age F (61,09 yo), M ( 60,9 inflame-matory process involving the connective and adipose tissue of the renal sinus. Renal yo). Hospital stays 11.3 ± 9.5 days. 197 ( 75%) electively, 68 (25%) emergency. Right hemi- scinti-graphy indicated the loss of left kidney function. The diagnosis was incidental during colectomy, extended right hemicolectomy, left colectomy, extended left hemicolectomy with the pathologi-cal examination. colostomy were the most used surgical procedures, based also on the location of the tumor. Microscopically, the urothelium lining of the renal pelvis and the pyeloureteral junction was Conclusions: Colon Cancer is a disease we encounter very often in our daily surgical practice. spared. The subepithelial connective tissue, the fibromuscolar layer and the renal sinus fat The surgical treatment results are obviously better in elective surgery than emergency one. were diffusely infiltrated by small nests of NVUC, sometimes hollowed, always haphazardly The hospital stay is also shorter. In the last decade, the number of surgeries performed has disposed. The nests are composed of medium to large urothelial cells, with abundant increased our experience and confidence in the approach toward colon cancer. eosinophylic or clear cytoplasm and slightly atypical nuclei. These cells infiltrated sparsely the renal interstitium up to the cortex displacing tubules and glomeruli. The deeply infiltrating A case report with ulcerative colitis mimicking colorectal tumor in CT nests appeared irregular and showed significant more nuclear atypia. DAKU A, DHIMA A, ALLAJBEU A, CEKREZI B, COMA B, ALIU D, DEDEJ A ,KOZA B

Ulcerative colitis (UC) is one of the two main forms of chronic inflammatory disease of the Management of recurrent visceral leishmaniasis in HIV- coinfection gastrointestinal tract, called inflammatory bowel disease (IBD). The other form is called Gjataj A, Mehmeti J, Mehmeti E, Muca E, Shkurti K, Pipero P, Kraja Dh, Harxhi A Crohn’s disease. In UC, the inflammation causes loss of the lining of the colon, leading to bleeding, production of pus, diarrhea, and abdominal discomfort and sometimes mimicking Message Body: Introduction:The best way to treat leishmaniasis in HIV-positive patients is colorectal tumor. We presented our case report as a young patient diagnosed before with still the subject of considerable controversy. ulcerative colitis by endoscopic biopsy and due to the recurrent symptoms the gastrointestinal Aim: To present a case with recurrent visceral leishmaniasis in a patient with HIV infection. surgeon suggested abdominal CT . We performed the abdominal CT in our hospital and we Material and methods:Clinical,laboratory,treatment data of a patient with recurrent confection dedicated multisegmental active infiltration of the disease that is more evident in the colorec- of leishmania in HIV-AIDS.A systematic review of the literature regarding management of VL tal region and mimicking colorectal tumors. Therefore we we prescribed all the infiltrated in HIV infected patient. kolonic regions alternating with inflammatory lymph nodes around the colonic adipose tissue. At finally we recommended to the surgery to make a new biopsy guided endoscopy to rule out Results: The patient a 50-year old man,diagnosed with HIV infection in B1 stage in October any possibility of neoplasia that can occur after chronical inflammations . 2011(CD4 511 cells).A year later he started TAR with a decreased CD4 102 cell, and HIV- ARN 3.49x 106 copies/ml.In may 2014 he was hospitalized with high fever up to 39.5oC,low Stylohyoid disfunction (Eagle Syndrome) appetite,weight lost.The laboratory data revealed a bicitopenia(anemia and leucopenia),en- Cases assessed and treated by our clinic from 2012 to 2015 larged liver and spleen (spleen was palpable till the iliac crest),high titer of γ globulinemia.A Suma A bone marrow aspiration resulted positive for leishmania parasite,and the patient was treated with an eight day course with liposomal amphotericine B 150mg/day,and dismissed with a Eagle syndrome is classified as a rare condition (true incidence ~0,16%) and occurs due to negative bone marrow aspirate for parasite.Four months later he was admitted again with the elongation of the styloid process or calcification of the stylohyoid ligament, which then may the diagnosis of VL and treated with liposomal amphotericine B 150mg/day,for five days,and produce recurrent pain sensation due to the pressure exerted on various structures in the head and neck, specifically in the oropharynx and the lateral neck. Two forms of Eagle syndrome dismissed with corticoid therapy.On January 2015 he was admitted again with the same exists: the classic form and the vascular one. As it is recognized as a rare syndrome, patients complains,presence of sappey varicose,enlarged portal vein and the bone marrow aspiration may suffer from several weeks to months or years, especially in recurrent cases, until the due resulted positive for leishmania.He underwent treatment with liposomal amphotericine B for diagnosis can be assessed. When suspected, history and clinical evaluation remains the gold eight days.Bone marrow aspiration after therapy resulted negative for leishmania.

90 91 POSTER PRESENTATION POSTER PRESENTATION

Conclusion: However successful the treatment in terms of initial clinical cure,almost all VL/ Conclusion: Patient who suffered from cryptogenic stroke should be carefully evaluated with HIV cases develop VL relapses.Although the data available on secondary prophylaxis are TEE. PFO and less ASD is one of the causes of cryptogenic stroke. Percutanous closure of limited and often inconclusive,it appears that regular treatment with a pentavalent antimonial ASD is proven to be safe and with mild complication. This was one of the first cases in Albania drug,liposomal amphothericin B or amphotericin B lipid complex can reduce the incidence of that was performed this procedure. leishmanial relapses in HIV-positive. Effect of aprotinin on renal function in postoperative cardiac patients Physical labor,hypertension and male fertility Kojqiqi C, Kojqiqi A, Petko M, Hayward M, Smith A

Cekani M, Kabili K Message Body: Background: One of the most frequent, nevertheless severe risks associ- ated with cardiac surgery is postoperative bleeding as it can lead to a raise in the mortal- Working in a physically demanding job, having high blood pressure, and taking multiple med- ity and morbidity levels. Nevertheless, possible harmful side effects were identified in pa- ications are among health risks that may undermine a man’s fertility, according to a study by tients treated with aprotinin such as an increased risk in saphenous vein graft patency, a us. The study is the first to examine the relationships between workplace exertion, health, and heighten risk of postoperative renal failure and anaphylactic reaction. As a result aprotinin’s semen quality as men are trying to conceive. safety started to be questioned, with the drug being recalled by the manufacturer in 2008. Semen quality is a measure of a man’s ability to achieve fertilization and is based Aims: The scope of the present paper is to assess if treatment with aprotinin is not impairing on the number, shape, and movement ability of sperm, as well as other factors. renal function by raising creatinine levels, controlling for certain demographic variables. We followed more than 50 couples over a yearlong period. The couples were in committed Methodology: The data used in this study were gathered retrospectively, comprising all the relationships and stopped using contraception. All male participants completed preliminary patients that underwent cardiac procedures at the Heart Hospital, over a two years period. Patients’ creatinine levels were measured preoperatively and postoperatively in “high risk of interviews in which they were asked about their reproductive history, health, lifestyle and bleeding“ patients, treated with aprotinin and in those which didn’t receive aprotinin. occupational activity. Most of the men provided a semen sample for analysis. Results: The results obtained suggest that demographic characteristics (age) have a relation- The final study group comprised 50 men with an average age of 31.8 years. It’s found that 13 ship with the incidence of renal impairment in patients that were treated with aprotinin. GLMM percent of the men who reported heavy work-related activity had lower sperm counts, compared results indicate that the probability of having high levels of creatinine is lower for the patients to 6 percent of the men who reported no workplace exertion. In contrast, no other work-related that weren’t treated with aprotinin. Furthermore, females have a lower probability of having exposure, such as heat, noise or prolonged sitting, appeared to influence semen quality. high levels of aprotinin compared to males. The probability of having high creatinine levels, Of the men who reported receiving a physician’s diagnosis of high blood pressure, diabetes, postoperatively, on the first day are the lowest, it increases on second day and decreases or high cholesterol, the researchers found that only those with high blood pressure had a lower again on forth day. Finally, the probability of having a bad outcome increases with age. percentage of normally shaped sperm, compared to men who reported no high blood pressure. Conclusion: This study concludes that aprotinin causes slight increase in creatinine level, however not above the normal range which can impair renal function and lead to poor post- Key words: fertility, man, work, blood pressure. operative outcomes.

Percutanous closure of an atrial septal defect in a young patient with stroke Epidemiological data about Congo-Crime hemorrhagic fever in Kuksi district. Zllami B, Jata B, Basha E, Huti G Ajdini D, Ajdini A, Puca E

Abstract: We describe a 27-year-old right handed girl that came to ER with severe neuro- Message Body: logical condition (coma 5 point GCS); She has abrupt onset of the symptoms with difficulty Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease described in more of speech, right side weakness and then after seizures and vomiting; After radiological ex- than 30 countries in Europe, Asia and Africa. The causative agent is the Crime- amination (MRI): CVA in the middle cerebral artery territory- parietal, frontal, temporal basal an-Congo hemorrhagic fever virus (CCHFV) that is a member of the genus Nairovirus of the family Bunyaviridae. The initial symptoms of CCHF are nonspecific and grad- ganglia. After careful evaluation of risk factors was suspected for patent foramen ovale; Was ually progress to a hemorrhagic phase that can be lethal (case-fatality rate: 10 to 50%). performed transesofageal echo: ASD type ostium secundum with left to right shunt and dila- Objectives: To give some epidemiologic dates about CCHF in Kuksi district. tation of right cavities; Material and methods: We collected the data from Service of Epidemiology of Kuksi district. She is treated for several days in ICU; Has anticoagulation treatment till was performed per- Results: during last ten years were 43 cases. From them 9 cases were females cutanous closure of an atrial septal defect ; In TEE guide is implanted Cera TM Lifetech atrial and 34 males. Most affected age resulted age 20-40 and over then 55 years old. septal defect ocluder; LT-ASD 16mm; Percutaneous closure of ASD is firstly performed at 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 American Hospital. She is treated with Plavix, aspirin after the cardiac procedure and with 8 6 3 3 2 5 14 0 0 2 0 AED for the seizures. Conclusions: Crimean-Congo hemorrhagic fever is an important infection disease. The clini- Atrial septal defect is the most frequently encountered major congenital cardiac disorder in cians and epidemiologist need to take care because some time it me be unreported. Males the adult population, with a prevalence of 0.2 to 0.7 per thousand, most of them ( 75%) are are more affected maybe as a part of daily work activity. ostium secundum defects; Patients often present late in life because symptoms are rare Key words: Crimean-Congo hemorrhagic fever, males, Kukes. until later in life and physical findings may go undetected . Patient that suffered cryptogenic stroke, which has been associated with ASD and PFO are risk for recurrent stroke despite Thyroid incidentalomas. Prevalence by ultrasonography. medical treatment. Patients with hemodynamically significant shunts and/or symptoms who Puca E, Koza K; Bitri S, Huti E, Daku A, Coma B; Puca E meet current criteria should be referred for closure (surgical or percutaneous) of their defect; Message Body:The prevalence of thyroid nodules in the general population varies according At our hospital these procedure is realized safe and without complication. Patient is followed to the method of detection in use. The increased sensitivity of imaging devices raised number for three years now and is treated for secondary Epilepsy. of incidentally discovered lesions in thyroid gland. Reported prevalence of ultrasonographical-

92 93 POSTER PRESENTATION POSTER PRESENTATION ly detected thyroid nodules (incidentalomas) in general population ranges from 5.2 to 67.0%. In hipertrofia of sfincter or sd pseudoxfoliation an old method of incisional equally spaced OBJECTIVE: To assess the presence of thyroid nodule in subjects without a prior diagnosis sphincterotomies with Vannas scissor can be perform.Streching method by two iris hooks in- of any thyroid disorders.MATERIAL AND METHODS: troduced by twoo corneal incision 180 apposed.iris hooks may be of plastic or metal inserted A total of 703 healthy subjects (584 women and 119 men) with a mean age of 45.1 (age in diamond or square configuration EXPANDING DEVICES 5 s Iris ring (Morcher). Perfect range 18 to 77) were submitted to study and thyroid ultrasound were preformed at American pupil, Graether pupil expanding system (Eagle vision) Beehler MAlyugin Ring,some of these Hospital 2 from 1October until 31 December 2014. devices are expansive increase cost of operation and lengthening the time of surgery.a RESULTS: Nodules were detected in 36.2 % (255/703) of subjects by ultrasonographic new standartization of IFIS sindrome. and a new alternativ in these case is MALYUGIN ring examination with ratio female/male 7:1. Multiple nodules were present in 16.2 % of the cases. a foldabil dispozitiv. Solitary nodules under one cm were in 14.5% of subjects, and over one cm were 5.5 %. The prevalence of nodules in women were (31.29) and in men were 4.9 % of subjects. Age-related Epstein-Barr virus-positive cutaneous ulcer arising after a self-limited CONCLUSIONS: The data indicate that thyroid abnormalities are very common incidental subcutaneous abscess: a case report. findings, emphasizing the need for a conservative approach when such lesions are ecoun- Kurshumliu F, Sadiku Sh, Krasniqi Xh, Brovina A, Kryeziu E, Rrudhani I, Meqa K, Gashi-Luci tered incidentally. The pathology was more common in women than in men. L, Merz H

Sweet Syndrome, a case report INTRODUCTION: Epstein-Barr virus-positive mucocutaneous ulcer is a newly recognized Muco E, Shkodrani E, Cekodhima G, Puca E , Shkurti K, Meta E, Gjyzeli M, Mehmeti J, clinicopathologic entity in the spectrum of Epstein-Barr virus-positive lymphoproliferative dis- Muhametaj J, Dajlani A orders. This entity is characterized by a self-limited, indolent course. CASE PRESENTATION:We report the case of a 74-year-old, type 2 diabetic man who pre- Message Body:Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis. It is sented with an ulceroinfiltrative skin lesion on the left side of his neck. Histological examina- a rare skin condition marked by fever and painful skin lesions that appear mainly on your arms, tion showed that the lesion consisted of large atypical cells, some with Hodgkin-Reed-Ster- neck, face and back. It can be associated with malignancies, infections, systemic inflammatory nberg-like morphology, in the midst of reactive lymphocytes, plasma cells, eosinophils and disorders, and medications. The syndrome was first described in 1964 by Robert Douglas Sweet. histiocytes. The atypical cells were partially positive for CD45, CD20, CD79a, CD30, B-cell Objective: To describe a case report with Sweet syndrome. lymphoma 2 and latent membrane protein 1 (CS.1-4), and negative for CD15, B-cell lympho- Clinical case report: A 67-year-old woman was presented at our hospital with a five-day his- ma 6 and CD10. In situ hybridization for Epstein-Barr virus-encoded ribonucleic acid was tory of high fever 39°C, generalized myalgia, headache, sore throat. She also suffered from positive. Two years before, the patient had been diagnosed with a self-limited subcutaneous diabetes mellitus for several years. At the examination we noticed erythematous well-demar- abscess in the same anatomic area that healed after antibiotic therapy. cated papules on the neck, chest, and extremities which were painful at touch. Laboratory CONCLUSION:Older patients with positive Epstein-Barr virus serology may develop B-cell results were as follow: leukocytosis 11700 cells/uL; high platelets level 310000/ uL; HGB 13g/ lymphoproliferations due to age-related immune suppression. Epstein-Barr virus-encoded dl; creatinine level 1.1mg/dL; uremia 23.4 mg/dL; lactate dehydrogenase 203U/L; AST 34U/L; ribonucleic acid testing and clonality analysis, eventually complemented with close clinical ALT 38U/L; fibrinogen 505mg/dL; high level of CRP 54.4mg/dl; protein electrophoresis (albu- follow-up, should be performed for suspicious inflammatory lesions in older patients. min51.4%; β globulin 10.5%; ά1 globulin 3.8%; ά 2 globulin 13.4%; γ globulin 20.9%); elevated ESR level 37mm/h. The serologies for Wright, Widal, Weil Felix, HIV, ELISA for Toxoplas- Efficacy and Tolerability of neoadjuvant chemotherapy with antracycline and taxanes mosis, RPR and VDRL were negative. Abdominal ultrasound showed hepatosplenomegaly. in locally advanced breast cancer. Chest radiography showed bilateral bronchopneumonia. Blood cultures resulted negative. Proko F, Tarifa Dh, Ademi S, Lushi M, Likmeta M Skin biopsy showed a papillary and mild-dermal mixed infiltrate of polymorphonuclear leu- kocytes with nuclear fragmentation and histiocytic cells. Sweet’s syndrome responded rap- Background: Neoadjuvant ( NA) chemotherapy was initially used only as treatment for locally idly at the systemic therapy with Ceftazidime; Levofloxacine and low-dosage of corticoste- advanced breast cancer T3/T4, now the clinical indication is being extended not only to roids. We followed up the patient for another nine months but we didn’t find any other illness. stage T3/T4, but also to some stage T1/T2 tumors. Conclusions: Sweet’s syndrome is not a common disease. Its diagnosis is based on clinical The aim: was to assesss the clinical response and tolerability of neoadjuvant ( NA) chemo- data, the appearance of skin lesions and histological findings. therapy with anthracycline, cyclophosphamide and/or 5 fluorouracil followed by docetaxel or Paclitaxel in locally advanced breast cancer. OLD and new techniques or tools for rezolving a refractar pupil (miotic) Patients and Methods: 28 patients with locally advanced breast cancer (T> 3cm or N>2), from during cataract surgery January 2013 to December 2014, received doxorubicine(60 mg/m2 )/or epirubicine(90-100mg/ Koca E m2) and cyclophosphamide (600 mg/m2) with or no 5 fluorouracil, every 3 weeks for four cycles, followed by docetaxel (75 -100 mg/m2)/ or paclitaxel 175mg/m2 every 3 weeks for four Message Body: OLD and new techniques or tools for rezolving a refractar pupil (miotic) cycles. Age of patients was 36-73 years, 11(39) of them were premenopausal, 9(32%) were during cataract surgery.The choises are pharmacologic agents, ophthalmic viscosurgi- postmenopausal and 8(29%) were perimenopausal. 14 patients were ER+, 3 were triple nega- cal devices (OVD), pupilary streching ,expanding pupilar devices.to perform a safety and tive, 5 were unknown ER, 3 were Her2 +, and KI67 value were 15-80%. All patients underwent good,cataract surgery is necessary a well dilated pupil, but some patology of eyes limit comprehensive physician examination, breast imaging with ultrasound prior to chemotherapy the dilatation or mantainance of it during surgery.these include ,sd pseudoexfoliativ uses, and after four cycles CAF or FEC, and after four docetaxel or Paclitaxel. of chronic miotic therapy in glaucoma patient, trauma or inflamation which cauze syn- Results: There was clinical response in 25 patients (89.3%), 3 patients (10.7%) there was prog- echial scar in some diabetics patient glycogen depozit cause miotic pupil .IFIS sindrome ress disease. Pathological response evaluation revealed 4 complete responses (CR: 14.2% ). in patient receving sistemic alfa 1 antagonist (tamsulosin) for prostatic adenoma.In these Side effects were : febrile neutropenia occurred in 2 patients (7.1% ), 1 patient(3.55) experienced cases is wisely to use a step by step approach to enlarge the pupil to a safe diameter. grade 3 skin toxicity, fatigue 13%, joint pain 12.4%, events attributable to docetaxel. intracameral lidocaine with epinefrine in BSS (EPISHUGARCAINE) OR SHUGARCAINE li- Conclusion: CAF or FEC followed by Docetaxel or Paclitaxel is effective and well-tolerat- docaine 4% with bsss plus for breaking mild to moderate synechial closure and for space ed treatment as NA chemotherapy for locally advanced breast cancer. NA chemother- creating anfd maintaining feature is used viscodispersiv agent of heavy molecular weight apy is used as treatment of patients with operable as well as inoperable breast cancer. (healon GV) OR discoVISC (aLCON) Keywords: breast cancer, antracycline, taxanes, NA chemotherapy.

94 95 POSTER PRESENTATION POSTER PRESENTATION

Radiologic finding during leptospirosis A single-center study (Vaidya and co.)was carried out between 1975 and 2012, included Tosku Gj, Melyshi K, Pilaca A, Stroni G, Qyra E, Pipero P, Kurti Sh, Kalo T, Muco E, Ramo- 1062 patients,showed out that nine percent (92 of 1062) of patients developed a perforation, sacaj E, Puca E, Kraja Dh. 55% out of them (51 of 92) occurred after chemotherapy. Case presentation: Message Body:Leptospirosis is a zoonosis, caused by Leptospira species. The spectrum of The presentation of case admitted to Surgical ward in Regional Hospital , with clinical human disease is extremely wide, from a flu sindrom to the involvement of liver, kidneys and lunch that has a bed prognosis. features of Acute abdomen Purpose: To assess the radiologic data during pulmonary manifestations of leptospirosis. Investigation : abdominal X-ray , Chest X-ray . lab.examinations Intraoperativ diagnosis: Material and Methods: From 107 cases serologically confirmed with positive IgM ELISA for perforation intestine jejuni,ileus adhaessionem ,peritonitis fibro-purulenta leptospirosis during January 2009- December 2014 in our hospital, we included 42.99 (46 Surgery: laparatomia mediana supra et infraumbilicalis,resectio intestine jejuni cc 20 cm. patients) presented with respiratory symptoms. et T-T anastomossis,adhaesiolyssis, Two lymphatic nodes from mesenterium and resected Results: All patients were males. Mean age at the time of diagnoses were 43.8 years old intestine loop were taken for biopsy(PH exam). with 14.8±DS. The time from the first symptoms until they presented to hospital was 6.3 Postop.follow up : Without complication days. Signs and symptoms were: jaundice in 93.47%, conjunctival suffusion in 86.9%, my- PH exam. : Lymphoma malignum algia in 82.6%, oliguria in 71.7%, temperature with average 38.7°C in 67.3% of cases, breathlessness in 54.3%, cough in 45.6%, haematuria in 41.3%, headache in 30.4%, ab- Imunophenotypisation : CD 20 marker : difuse pozitiv(+++) dominal pain in 32.6%, chills in 28.2%, chest pain in 20.6%, vomiting in 21.7%, cough with Pathologist comment : high grade “ Lymphocit B Lymphoma “ (CD 20 + ) hemoptosis in 21.7%, and diarrhea in 10.6% of cases. Acute respiratory distress syndrome Post op. ultrasound: two round-shape formations in the liver ,enlarged inguinal inguinal was presented in 19.5% of cases. In 71.7% were confirmed pathological manifestation by lymph nodes chest X-ray including: bilateral bronchoalveolar infiltrations in 52.1% and infiltrative massive After the Haemoatologist consultation,the patient proceeds with chemiotherapy,according to pneumonia in 19.5%. R-CHOP protocols Conclusion: Pulmonary involvement in leptospirosis was present in 42.99% of patients, so lepto- Ultrasound performed after 2 mounths detected one ,and after 8 mounths has not detected spirosis should be considered in the differential diagnosis of patients with febrile illnesses asso- any focal lesion in liver ciated with pneumonitis and respiratory failure, especially in the presence of hemoptysis or other signs of pulmonary hemorrhage. We can’t explain why all patients with pathologic manifestation were males. Envolvement of lunch in leptospirosis is a prognostic factor for case fatality. ADULT ONSET STILL’s DISEASE (AOSD) MIMICKING MALARIA INFECTION IN A PER- Keywords: leptospirosis, pulmonary, chest X-ray. SON TRAVELLING FROM E.GUINEA Harxhi A, Muhametaj J, Muco E, Shkurti K, Meta K, Kraja Dh, Pipero P, Capo R, Kokici M Leishmaniasis at pediatric age, case report H Ramadani, Vishaj A, Krasniqi V, Gashi V INTRODUCTION: AOSD is a rare systemic inflammatory disease characterized by the classic triad of persist high spiking fever,joint pain and salmon-coloured bumpy rash.The Summary: Leishmaniasis is zoonotic disease which is caused from protozoa from genus diagnosis is considered a diagnosis of exlusion. leishmania with sandflies. Autochthonous leishmaniasis at pediatric age we faced very rare in Malaria is a mosquito-borne infections disease caused by parasitic protozoars belonging our country. The first case in our country was reported after year 2000. Purpose of paper is to present epidemiologic, clinic, laboratory aspects and flow of the dis- to the genus Plasmodium. ease at one child whom was treated in our Clinic, to show even the possibility of autochtho- PURPOSE:To introduce the case of patient presenting with fever who lived and worked nous leishmaniasis in our populate. in E.Guinea and the difficulties in differential diagnosis and management of the situation. Results: Female, from Rahovec, 4 year old, was admitted in our Clinic from 17.07.2014 until Methods & Material:This is a case report presentation.T 26.08.2014, after she was transferred from Pediatric Clinic with diagnosis Leishmania. The he description of epidemiological, clinical and treatment data of the case is followed by illness it was started two weeks before the admission in Pediatric Clinic. In our Clinic she the discussion of differential diagnosis challenges. was treated for one month. We have made laboratory and we have diagnosis from serology Results: 31-years-old male presented at our ID Service with a three days history of fever results which was positive for Leishmania. Patient all the time was in Rahovec and she didn’t 40°C,chills, headache, myalgia, arthralgia. He stayed in E.Guinea for seven months and live the country. After treatment with glucantin we have seen the better condition in clinical aspects and also laboratory. One month later after fishing the therapy, the patient was in good he had two episodes of Malaria.He was treated successfully there,but couldn’t tell what shape and her complains was gone. species of Plasmodium were identified.On physical examination there were no significant Conclusion: Leishmaniasa in our country can be sporadic even in the pediatric age which changes. don’t need to be imported from endemic area. Blood count revealed leukocytosis up to 27000/uL with granulocytosis without changes in RBC and PLT. Inflammatory markers were very high: PCR 236ng/dl,Fib 563ng/dl,Ferritin- B-cell lymphoma associated with spontan perforation of jejunum emia >1200ng/ml.Urine and blood culture were sterile. Parasitological examination of pe- Poroshtica I, Mustafa S, Rashiti I, Basha I, Toska M ripheral blood was negative twice for Plasmodium species .Serology and investigations for infectious agents or causes of fever were all negative. The relatives of the patients Message Body: CASE PRESENTATION were anxious because they feared another malaric episode and didn’t trust laboratory The B-cell lymphomas are types of lymphoma affecting B cells. B-cell lymphomas include findings, so they insisted to upon starting antimalaric drugs empirically. both Hodgkin’s and non-Hodgkins lymphomas. Prognosis and treatment depends on the We came to a consent and started a treatment with Artemether.The situation didn’t improve, specific type of lymphoma as well as the stage and grade. Treatment includes radiation and so we continued exploring for other causes of the fever. Further examinations:Bone chemotherapy. Perforation is a serious life-threatening complication of lymphomas involv- marrow biopsy resulted normal.Complement titer resulted altered with low C3 and ing the gastrointestinal (GI) tract C4,ANA positive;RF normal;antiDNA normal.After consulting rheumatologist the patient

96 97 POSTER PRESENTATION POSTER PRESENTATION

See-and-treat outpatient hysteroscopy gestacional sac in uterus , the yolk sac , embrio and heart beat . Habibaj J, Mustafaraj K, Koci J If there is no gestacional sac after 5.5 weeks , we should rule out an extrauterin pregnancy wich is characterized by an extrauterin adnexial mass .The pregnancy might be intersticial , Message Body: Hysteroscopy is the gold standard for the evaluation of uterine cavity. How- tubal , ovarial , cervical , or abdominal . ever is not generally accepted as a well tolerated outpatient procedure. The technological In any case , what we need to know is the blood level of bhcg , and its pattern during a certain time and the levels of progesteron. advances made in recent years and the introduction of small diameter hysteroscops as well The Treatment will depend on gestacional age : medical o surgical . the simplification of the technique has made hysteroscopy a procedure that can be performed Laparoscopy remains the criterion standard for diagnosis and treatment of extrauterine in outpatient setting. The main indications for hysteroscopy are: abnormal uterine bleeding; pregnancy infertility and intrauterine pathologies, diagnosed by imagery. In most cases the pathology can be treated during the same procedure. Ovarian borderline mucinous cystadenoma with pseudo-myxoma peritonei SHOSHA L, Murati A, Xhaferi M, Dhima A, Miraka M, Huti G, Arapi B, Cekrezi B, Berdica L, Tenofovir – Related Nephrogenic Diabetes Insipidus in a Patient with Acquired Immu- Daka A, Marku L, Shahini A. nodeficiency Syndrome. The Role of Didanosine. Nasto K INTRODUCTION: Ovarian mucinous cystadenoma is a benign tumor, multilocular cyst, bi- lateral 10% of cases, comprise 15% of all ovarian tumors. 80% of mucinous tumours are benign, 10% are border-line , 10% are malignant. The complications of benign ovarian cysts Introduction - Tenofovir disoproxil fumarate, is a nucleotide reverse – transcriptase inhibitor are torsion, hemorrhage,rupture. Its rupture leads to mucinous deposits on the peritoneum with proven anti HIV therapeutic properties. Because of its high antiviral activity, tenofovir has (pseudo-myxoma peritonei,PMP), characterized by the accumulation of abundant mucinous been widely prescribed especially against drug-resistant strains of HIV. material within the peritoneal cavity. Tenofovir presents a tubular nephrotoxicity . It has been found to be responsible for Renal PURPOSE: This study was set out to define the medical strategy in 58 years old woman with Failure, Fanconi syndrome and Neprogenic Diabetes Insipidus. huge ruptured borderline cystadenoma of left ovary & pseudomyxoma peritonei, presented at Didanosine plays a facilitating role in nephrotoxic effect of tenofovir. the American Hospital in Tirana, on 29 February 2012. Aim - Presentation of a clinical case with Nephrogenic Diabetes Insipidus after using Teno- MATERIAL & RESULTS: We collected the data by history-taking, clinical examination, lab- fovir and Didanose for a few years, as part of antiretroviral therapy. Review of literature on oratory investigations, abdominal MRI, histopathological study. The patient presented with abdominal distension & strong pain, vomiting, increased weight, fever 38ºC. On abdominal this topic. examination, a huge ill-defined pelvi abdominal mass was noticed, extended up to xiphister- Methods and materials – A case of a 45 years old male with HIV/AIDS,diagnosed since 2007. num. General examination: tachypnea (Respiratory rate 29/minute), CRP 3mg/dl, sediment He was presented at Infectious Disease Service with seven months history of polyuria , 56mm/h, CA 125 123U/ml, CEA 106ng/ml. Her body weight was 107 kg, her height was 166 polydipsia, dehydration, with weight loss , fatigue. From 2010 he was receiving Tenofovir,- cm and her abdominal circumference was 134 cm.Abdominal MRI showed large ovarian tu- Didanosine and Aluvia. mor & ascites. Extended midline laparotomy was done. Intra operatively 9 liters of fluid were Laboratory: creatinine 1.1, bilirubine 1.4, protein level 1,4 . Sodium 135 mmol/l, Potassium aspirated from the rupture of left ovary mucinous multiloculated cyst. The tumor weighed 7,5 levels 3.1, 2.34, 1.9 mmol/l, Chloride 95. Osmolarity 284 mosm/kg. kg. Left salpingo-oophorectomy was performed & Appendectomy & Meckel diverticulectomy HbA1C 4,8%. & infracolic omentectomy was done. She had a remarkable recovery, discharged on day 6 . CONCLUSION: Conservative surgery of fertility is possible in select cases Different glycemi measurement revealed a glucose level 106 - 108mg/dl before eating and Radical surgery of maximum cytoreduction is the goal of treatment in women with advanced 199 -238 mg/dl 2 h after eating. or recurrent diseases, implants are the main prognostic factors ADH levels normal. The follow-up of patients must be done up to 15 years following the initial diagnosis. Diuresis 8 – 11L/24 h. with a density of 1000. Sodium level in urine 15.9 mmol/l, Potassium level 5.9 mmol/l, Chlorine 19.8 mmol/l. Albuminuria 0,08 gr. The importance of the Myocardial perfusion scan (MPI) in evaluation of patients after Imaging Data: Percutaneous Coronary Intervention (PCI Abdominal ultrasound – normal Abdullahu L, Miftari R, Gërqari I, Bajqinca A, Spahiu F, Bajrami I Cranial CT with contrast – normal Tenofovir therapy was stopped. Hydrochlortiaside and Ibuprophen and later amiloride, were SPECT-G-SPM-has become a routine procedure in nuclear medicine as powerful modality for assessing perfusion and heart function. Very high probability of repeated occlusion of cor- started. Symptoms improved progressively . A few days after starting hydrochlortiaside the onary artery after PCI and occlusion of other coronary arteries raises necessitates for early diuresis was 5.5 l/24h, urine density 1005. detection and timely intervention. Conclusion: Aim of the study was to determine the role of MPI for early detection of re-occlusion of the Since ARV therapy such as TDF,ddI have potential nephrotoxic effect, the ID specialist arteries after PCI or other deteriorations of coronary arteries. Evaluating and comparing the should be aware of these and apply the monitoring protocol accurately. results obtained from coronarogarphy and SPM. Methods: The study included 28 patients undergoing PCI; from them 20 males and 8 females. In all Extrauterine pregnancy , still a medical challenge these patients was made MPI with SPECT-G method (gated) during the exercise and in Mustafaraj K, Habibaj J, Koci L the rest after I.V.administration of radiopharmaceuticals 99m-Tc-MIBI of 8 mCI (296MBq), respectively 24 mCI (888MBq)with a daily study protocol and were compared with data from Message Body: Extrauterine pregnancy, still a medical challenge coronarogarphy. When a woman is presenting with a positive urinary pregnancy test and refers a delay of Results: From the total number of patients undergone coronarogaphy (28), in three of them more then ten days of her menstruation , we have to seek the presense of gestacional sac. the result was proved negative for coronary disease and in 25 of them (89%) during coron- The most accurate way is the tranvaginal examination .The first step is to establish the arography it was found changes in the coronary arteries and were placed stents in order to

98 99 POSTER PRESENTATION POSTER PRESENTATION re-vasculate the affected vessels. and duration of treatment. The standard treatment of infection with hepatitis C realizes with The patients who underwent PCI, 7 of them had multivessels intervention (28%), 19 patients pegylated interferon and ribavirina for 4-12 weeks according to genotype detected. New reg- were only stent in one of coronary artery (72%), 9 patients in the left descending artery (LAD), imen of treatment for hepatitis C infection are implemented during last years. 8 patients in right coronary arterie (RCA) and 1 in ramus intermedius (RIM). At the same time, strategies of vaccination and testing of blood donors for HBsAg, and other In 3 patients who had no affected coronary artery during coronarography, also the PSM has measures of public health, have resulted in a extinct reduction of hepatitis B. Nevertheless resulted with no changes in perfusion. While the patients who had PCI, scintigraphy of myo- hepatitis B remains a big medical problem, mainly in developing countries. Cirrhosis happens cardial perfusion after placement of stents, has improved in 8 patients, worsened in 8 patients in 1- 2,2% per annum. and have had partial improvement in 9 patients. Conclusion: Vaccination against hepatitis B of all patients recently diagnosed with thalassae- Discussion: In assessing the degree of homogenicity of accumulation of radiopharmacs in the mia major and sickle cell d heart muscle during exercise and rest, it was determined a relative degree of abnormality in perfusion of vascular sections and it was evaluated perfusion in all segments those regions. Psoriasis and Echocardiographic Abnormalities Characteristics in Albanian Patients Remaining lesions after placement of stents were assessed for defects in accumulation. This Vargu M, Vargu P, Konda E, Dajci V, Fida M is easier to detect with MPI with 99m Tc-MIBI. Distribution of radio pharmaceuticals in heart is distributed proportionally with circulation of the blood, with the fast cleansing from blood and Message Body: Psoriasis is an inflammatory disease with significant elements in the skin slow cleansing from heart muscle. Preparation is simple and there were no adverse effects As a similar to other inflammatory disorders psoriasis is not confined just to the skin but, rath- Conclusion: According to our data, we have concluded that MPI is an appropriate method for er, considered a systemic inflammatory condition. the early detection, identification and monitoring patients with coronary artery disease (CAD). In this study we investigate the incidence and severity of echocardiographic and clinical ab- Keywords -SPECT-G-SPM, 99m Tc-MIBI, dual head gamma camera Ecam, coronarogarphy. normalities in patients with psoriasis. Materials and Method: In this study took place 100 patients diagnosed clinically and histo- Evidence Based Diagnostic Bronchology: Rapid Onsite Evaluation (ROSE). pathologically with psoriasis and 100 persons as controls. We used a two-dimensional Doppler Marcianò G, Alia L echocardiographic technique to evaluate the condition of left and right heart dimensions, wall thicknesses, wall motion abnormalities, valvular disturbances, and systolic / diastolic functions. Message Body:‘ROSE’ is the acronym frequently employed to indicate Rapid On-Site Evalua- Results: Left ventricular hypertrophy, left ventricular diastolic dysfunction, left ventricular tion of the material obtained by needle aspiration techniques. Today, thanks to the possibility wall motion abnormalities and valvular pathologies, especially mitral and tricuspid valve of targeted sampling of vast bronchial and pulmonary territory and the use of rapid cyto- prolapse, were significantly more frequent in patients with psoriasis compare to controlls. logical and microbiological staining, a diagnosis of the type of disease can be made during Conclusion: Psoriasis also involves the cardiovascular system and heart, and might cause endoscopic examination or shortly after it in a large percentage of cases.(1-8) Four points disturbances such are high blood pressure, left ventricular hypertrophy, regional wall motion are worth emphasizing in the rationale underlying such rapid routine diagnostic approach : abnormalities, diastolic dysfunction, and mitral and tricuspid valve prolapse. 1.Ease of specimen-processing: smearing, fixing and staining. 2. Ease of data processing both in bronchology and sample examination for common diseas- Skin Toxicities Associated with Oral Adminstration of Sorafenib and Sunitinib in UHC es, which represent over 90% of our daily work. “Mother Teresa”. 3. Necessity of evaluation of qualitative and quantitative suitability of the sample, especially Likmeta M, Shkoza A, Tarifa Dh, Ademi S, Proko F, Sallaku A when necrosis is a prominent feature of bronchoscopic findings. 4. Outstanding cost/benefit ratio. Keywords: sorafenib, sunitinib, skin toxicity. MATERIAL, METHODS AND RESULTS: In the last 33 years (1980 - 2015) we performed Objectives: The aim of this study was to assess the coutaneous adverse effecst of MKIs 36.000 bronchoscopies; the diagnostic time, using four sampling techniques (Table A) and in patients treated in the Oncology Department in UHC “ Mother Teresa” between january five staining procedures (Table B), in 89% of cases ranged from 4 to 20 minutes in infectious, 2013-january 2015. inflammatory and neoplastic diseases. Rapid sample examination (RSE), when combined Methode: This observational study was conducted on a group of 29 patients, identified with sampling procedures, is a simple, swift and safe technique; it is the unique approach through pharmacy and hospital records. We reviewed medical records of 18 patients receiv- avoiding the blind work of bronchologists, i.e. to sample without seeing what is there. ing sunitinib, 11 patients receiving sorafenib. Clinical data on skin toxicities were collated. We describe the incidences of skin toxicities and analyse the data statistically. Hepatitis and polytransfused patients ( Beta Thalassaemia and Sickle Cell Disease) Results: We indentified 18 (mean-age 57) patients on sunitinib for the treatment of renal cell Kreka M, Kurti F, Nastas E, Godo A, Kreka B, Gjoni B carcinoma and 11 patients on sorafenib for the treatment of hepatocellular carcinoma and thyroid tumor (mean-age 54). Only 2 patients on sorafenib left the treatment. The most com- Introduction: Patients with haemoglobinopathies and thalassaemia major in particular, suffer mon cutaneous toxicity for sorafenib was rash (50%) and Hand and Foot reaction (HFSR) form iron overload in their organism, due to transfusions, but at the same time as a result of el- (37%). Other cutaneous toxicities included stomatitis/mucositis (12%), pruritis (18%). Edema evated intestinal absorption. Hepatic iron overload is a gold standard for the evaluation of this were identified at 2% of cases, especially feet edema. The most common cutaneous toxicity condition in haemoglobinopathic patients. MRI seems to give exact data of hepatic damage. for sunitinib was stomatitis/mucositis (57%), skin discoloration (hair or face) (30%), HFSR Discussion: About 3% of world population has a chronic infection of HCV, Chronic Hepatitis (20%). Other cutaneous toxicities included edema, especially palpebral edema (12%). C is a major cause of cirrhosis and hepatic-cellular carcinoma. Preventive measures to mini- Conclusions: MKIs are well tolerated, but they are associated with a significant risk of various mize post-transfusion risk of hepatitis C, include careful selection of voluntary donations and skin reactions as adverse events. The commonest and most serious cutaneous toxicity were their tested status. The severity of chronic hepatitis C in patients with haemoglobinopathy rash and HFSR for sorafenib; stomatitis/mucositis and skin discoloration for sunitinib. seems to be greater, because of iron overload, presence of other concomitant viral infections ( like HBV and HIV). It is proved that iron overload and infection from HCV are independent Efficacy of antimicrobial therapy of cerebral abscess. factors, but reciprocally contribute in the development of hepatic fibrosis, thats why patients, Dede M, Qyra E, Muco E, Puca E, Pilaca A, Harxhi A in particular those with poor control of iron overload face a great risk for cirrhosis develop- ment. Detection of HCV RNA in blood, is the method of diagnosing infection with hepatitis Introduction: Despite advances in imaging techniques, laboratory diagnostics, surgical inter- C. Measuring of HCV RNA titer and virus genotype, help to distinguish the type of infection ventions, and antimicrobial treatment, brain abscess remains a challenging clinical problem

100 101 POSTER PRESENTATION POSTER PRESENTATION with substantial case fatality rates. levels, the continuous pain and the last rectal examination showing a liquid content in cherry Objectives: To describe a case of cerebral abscess in an young adult patient treated only color, after an extended consultation, the case was evaluated as an ileocecal invagination with antibiotic therapy. with signs of initial peritonism. However, the laparotomy showed gangrenous acute appendi- Material and methods: Epidemiological, clinical, laboratory, imagine and therapeutical fea- citis (appendicitis acuta gangrenosa) with thrombosis of appendicular artery. The best solu- tures of an 28 years old male patient with cerebral abscess are described. A literature review tion for this case, following a full review of the abdomen, was that of a typical appendectomy. was performed to look for treatment approaches (antimicrobials vs. combined surgery drain- The histological examination confirmed the appendicular artery thrombosis. Enterococcal in- age plus antimicrobial therapy) and sequels. fection. Such complicated clinical cases have been considered even by other others. Results: 28 years old male previously healthy young person, presented with 4 day histo- Key words: subocclusion, arterial thrombosis, appendicitis, rectal examination, enterococcus. ry with strong headache localized in right retro-mastoidien region , difficulty to open the mouth , nausea, vomiting, and 2 day history with fever, chills, numbness of right part of Oncocytic laryngeal cysts: A case report face and superior part of left leg. On PE he looked ill, discrete rigidity, right peripheral facial Vajushi E, Aga A, Shytaj E paralysis, hemi-parestesia of left extremities, kerning and Bruxhinski negative. Lab test were normal. On MRI of brain a ring enhanced 14x7 mm lesion localized at right ponto-mes- Message Body: Oncocytic cysts of the larynx are rare benign, slow growing lesions that are encephalic region with edema was seen. Serology for toxoplasmosis and HIV was nega- lined predominantly or exclusively by oncocytes, They represent a separate clinicopathologi- tive. CSF examination presented lymphocytic reaction (90 cells, 96% lymphocytes, normal cal entity in the group of all laryngeal cystic lesions. glucose). TB gold test was negative. Neurosurgical consultant dismissed surgical drain- The oncocytic change is a phenomenon of metaplasia which occurs frequently in epithelial age. Patient was dismissed after 3 months of antimicrobial treatment with slight right facial endocrine cells with high metabolic activity and it is also associated with inflammation, de- paralysis, disestezia of left extremities, torticollis and paralysis of Dexter abductor ocular. generative process or cellular ageing. In the larynx, oncocytic metaplasia is very uncommon, Conclusion: The management of a patient in whom a brain abscess is present involves co- but it is occasionally seen in the lining of laryngeal cysts, which are found most commonly operation among neurologists, neurosurgeons, and infectious disease specialists. Surgical in the ventricles or in the false vocal cords, where seromucinous glands are more abundant. drainage may be necessary in many patients to ensure adequate therapy and complete res- Oncocytic cysts typically occur in the elderly and are usually solitary, with involvement of an olution of infection. isolated site, whereas diffuse involvement with multiple cysts is extremely rare. The symptom- atology varies from asymptomatic to hoarseness and dyspnea. Non-coronary cardiac calcifications: A measurement that predict subclinical Diagnosis is made by histological examination. Treatment is surgical. Although it is a be- atherosclerosis? nign lesion, follow up is recommended, as recurrence is possible, especially in the case of Xhabija N, Allajbeu I, Petrela E, Qeraj K patients with multiple involvement, since they may show a tendency to develop new cysts. Some 150 cases of oncocytic laryngeal cysts have been published. We report another case Message Body: Multislice Computed Tomography (MSCT) has become widely available in of laryngeal oncocytic cysts with hoarsness and sore throat. Literature was reviewed with detecting coronary artery disease (CAD), even when it was subclinical. We utilized positive special regard to etiology, clinical presentation, imaging, incidence, localization, associated MSCT for atherosclerosis to relate them with evidence of non-coronary cardiac calcification lesions and treatment options. measured by methods of calcium score. This study was performed to determine whether Aortic Valve Sclero-Calcification Penetrating Neck Injury (AVSC) and/or Mitral Annulus Calcification (MAC) are associated with, and has power Pollo K, Braho H to predict atherosclerosis in relatively juvenile population like Albanian population. Methods: In a prospective, cohort study, we identified patients who all underwent both MSCT Introduction: Greater urban violence has resulted in an increased incidence of penetrating and TTE for various clinical indications. neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic di- Purpose: Might the echocardiographic assessment of cardiac calcifications be valuable in lemmas. The evaluation and management of such injuries, however, remains controversial. determining whether a patient who appears to be at low-intermediate coronary risk is actually Factors contributing to these problems are complex anatomy, proximity of vital structures, at high risk of CAD? and potential for rapid deterioration of airway, vascular, or neurologic injuries. Results: The mean age of our study population included 155 patients (109men and 46 Case description: A 16-year-old male was presented to the emergency unit of the Military women) was 57+-11.28 years. These patients were divided in two groups: 91(58.7%) in Central Hospital in Tirana, Albania with a penetrating neck wound. He reported stridor, the AVSC group and 64 (41.3%) in the control group. The AVSC group had a higher prev- tacypnea, subcutaneous emphysema, no active bleeding, significant crepitations in the alence of positive CT for the presence of CAD and a higher incidence rate of multivessel anterior region of the neck and superior thoracic region. disease than the control group (75.8 versus 19%, with p<0.001). MAC also was found to be Physical examination was remarkable for the wound in the left anterior region of the neck, the significantly more prevalent in the AVSC group (92.6 versus 7.4%) with p<0.001.Multivar- subcutaneous emphysema on the right part of the neck and the right armpit, the light edema iate analysis identified only AVSC and age as independent predictors of coronary athero- in the right part of the neck. sclerosis. The sensitivity, specificity, positive and negative predictive values for AVSC in The wound was 3-4 cm long and sutured. He was conscious; cardiovascular, respiratory and diagnosing CAD were 85.1%, 69.8%, 75.8% and 81%, respectively. Conclusion: Presence renal systems were normal. Laboratory findings were normal. of non-coronarycardiac calcification can also predict coronary atherosclerosis and should Radiologic findings consisted of the CT reports, which confirmed the perforation ofthe be added to conventional risk factors. trachea, pneumomediastin, pneumothorax, and subcutaneous emphysema. He was admitted with a diagnosis of penetrating neck wound and injury of the trachea. Medical management The clinical syndrome of subileus due to appendicular artery thrombosis /in child) consisted of intravenous antibiotics, analgesics and bed rest. During hospital stay the patient Mustaqe P, Cami A was improved. He was discharged on day eight. Discussion: This case illustrates that an equal willingness for both conservative and Message Body: This is the complicated case of an 18-month child entering the regional hos- surgical intervention as dictated by serial bedside evaluation with adequate radiological pital of Vlore with signs of intestinal obstruction, initially with abdominal pains, vomits, distinct support can provide the clinician a safe and effective means of managing a potentially meteorism and last defecation with liquid content in cherry color. Considering the medical complex and lethal problem. tests results (leukocytosis 22.000), the abdominal roentgenography with central hydroaeric Conclusion: Tracheal injuries are seen in about 1%-7% of patients with penetrating neck injuries.

102 103 POSTER PRESENTATION POSTER PRESENTATION

Body mass index and other anthropometric measures in infants of women with branes and the genital infection is the most common etiological factor. pre-gestational and gestational diabetes Objective: The aim of the study was to evaluate the incidence of genital infections in preterm Poshi K, Topi G, Nurce A, Xhaferi A, Kolici E, Rustami E, Cerri P, Qamirani S deliveries and spontaneous abortions. Material and methods: The study was carried out as a retrospective and included 80 women Aim: The aim of this study was to evaluate the body mass index (BMI) and other anthropo- of age from 17 to 38 years with gestational age from 16 to 31, in the period from February metric measures in newborn infants of women with gestational diabetes (GD) and pre-gesta- 2014 to March 2015. All 80 women were hospitalized because of spontaneous abortion re- tional diabetes (PGD). spectively preterm delivery symptoms, and in all of them was taken vaginal and cervical Methods: We conducted a cross-sectional study including 110 pregnant women (38 with specimen for microbiological analyses. Just in 3 pregnant women were done microbiological diabetes mellitus and 72 with GD) and their newborn babies, during the period January routine analysis, previously. There was made an comparative analysis of genital infection and 2010-February 2013. All the data for pregnant mothers were taken form medical records spontaneous abortion respectively preterm delivery. of University Hospital Obstetric and Gynecology “Koco Gliozheni” in Tirana. Anthropometric Results: Spontaneous abortion respectively preterm rupture of premature membranes was measures of infants were recorded within 24 hours after birth. All women included in the found in 6 (7.5%) cases, during 16-21 gestational age, in 21-26 gestational age 13 (16.2%) study were pregnant for the first time (primigravidae) and with singleton pregnancies. and in 26-31 gestational age 7 (8.7%). In 26 (32.5%) of pregnant women after the preterm Results: There was no statistically significant difference of PI between infants born from delivery or spontaneous abortion was found positive microbiological result, presence of bac- pre-gestational diabetic mothers and mothers with GD. Infant’s body mass index (BMI) of moth- teria. The most attacked group of pregnant women was gestational age from 21 to 26. ers with PGD was strongly and significantly correlated with infant’s head perimeter (r = 0.635, Conclusions: 1) Genital infections very often can cause preterm rupture of premature mem- p<0.001), thorax perimeter (r =0.676, p<0.001) and abdominal perimeter (r = 0.536, p = 0.001). branes; 2) Taking genital specimen for microbiological analysis in pregnant women, at the be- For infants of mothers with GD, no correlation was found between baby’s BMI and head, ginning of second trimester, have a great importance in saving the baby due to delivery; 3) The thorax and abdominal perimeters. There was no correlation of infant’s PI with pre-pregnancy indication to use this analysis is preferred to all pregnant women firstly after the first trimester. and current maternal BMI, and this was consistent for both women with pre-gestational and Keywords: pregnancy, preterm delivery, genital infections. gestational diabetes. Conclusions: No statistically significant changes were found regarding anthropometric values Metabolic syndrome associated with HIV and highly active antiretroviral therapy.( A such as BMI, PI, head, thorax and abdomen perimeter in newborn infants of long-time diabet- review of clinical aspects) ic mothers and mothers with gestational diabetes. Kolpepaj R, Nake A, Harxhi A, Kolici E, Xinxo S

A very rare case of nosocomial fatal necrotizing fasciitis due to Pseudomonas aerugi- Message Body: Highly active antiretroviral therapy (HAART) improves the longevity and nosa in a immunocompetent subject quality of life of HIV-infected subjects. However, some HAART regimens, especially those Kalo T, Zama B, Puca E, Pilaca A, Shkelqim Kurti, Ndreu A, Kraja Dh including protease inhibitors, have been shown to cause in a high proportion of HIV-infected patients metabolic (dyslipidemia, insulin resistance) and somatic (lipodystrophy/lipoatrophy) Message Body: Necrotizing fasciitis is a rare infection of the superficial fascia and subcuta- changes that are associated with an increased risk of cardiovascular disease (coronary artery neous cellular tissue. It is more frequently polymicrobial and a combination of aerobic and disease and stroke). The pathogenesis of HAART-associated metabolic syndrome and its anaerobic bacteria, often lead in a very quick and severe progression of the disease. Pseudo- atherogenic profile is complex, and several factors are involved, including direct effects of monas aeruginosa may cause soft tissue infections, but it is rarely associated with necrotizing HAART on lipid metabolism, endothelial and adipocyte cell function, activation of proinflam- fasciitis and few reports document such association. matory cytokines, and mitochondrial dysfunction. The purpose of this communication is to report the occurrence of a very rare case of nosoco- The induced metabolic syndrom has cardiovascular consequences and myocardial infarction mial fatal necrotizing fasciitis of both legs caused by Pseudomonas aeruginosa. is the cause of 7% of the HIV-infected deaths in 2000. A careful stratification of the cardiovas- Case presentation: A 49 years old, immunocompetent, smoker, 8 hours after the nail extir- cular risk and cardiovascular monitoring of patients under HAART is needed according to the pation of left toe due to a Perionichia without any antibio-prophylaxie, started to have severe most recent clinical guidelines. pain of the same leg. He started having frissons during the same night, as well as walking These complications are likely to contribute to an increased risk of premature and accelerated difficulties. He was admitted at ICU of Cardio surgery because of a suspicion of thrombosis atherosclerosis with growing concern about potential cardiovascular consequences. of both popliteal arteries. High doses of heparin were promptly started asides of supportive We will emphasize that a better understanding of the molecular mechanisms responsible for therapy because of tissues hypo-perfusion. Than he was transferred at ICU of Infectious this syndrome will lead to the discovery of new drugs and will reduce the incidence of lipodys- Diseases Service for bilateral necrotizing fasciitis and septic shock. He presented cold and trophy and related metabolic complications in HIV-infected patients facing long-term HAART. cyanotic and necrotic elements of inferior extremities covered by bulous elements filled with a Treatment options concern antiretroviral therapy with the search for the least toxic drug (but sero-hemorrhagic liquid, Nikolschi positive, a weak pulse of both popliteal arteries and its ab- with equal antiviral efficacy), symptomatic treatment (statin, fibrates, thiazolidinediones, met- sence at both of dorsum pedis arteries. He was lethargic, anuric, BP=70/30 mmHg, HB=139/ formin) and lifestyle modifications (first of all, stopping cigarette smoking!) min. The rapid fatal course of this case did not allow us to perform any surgical exploration. Key Words: HIV infection, Lipoatrophy, Lipodystrophy, Metabolic complications, HAAR The patient died 24 hours after the initiation of first symptoms of disease. Pseudomonas aeruginosa was isolated in two blood cultures and liquid of vesicles. Pessary Use as Treatment of Choice in Pelvic Prolapse in Geriatric Patients Conclusion: Necrotizing fasciitis leads inevitably towards a severe sepsis and multiple Delija Z organ failure with a high mortality rate (12-57% of cases), which needs an early diagnosis besides of a promptly and aggressive surgical intervention. Message Body: Pelvic organ prolapse is the descent of one or more of the pelvic structures such as bladder, uterus and vagina from the normal anatomic location toward or through the The incidence of preterm deliveries and the genital infections during pregnancy vaginal opening. Although pelvic organ prolapse is a prevalent condition in the older popula- Izairi P tion, effective treatment options are available to improve or manage it. The exact prevalence is unknown; however, according the recent studies it is the most common reason for gyneco- Background: According to the certain studies, 1/3 of the preterm delivery or spontaneous logic surgery in women aged 65 and over. abortions during the second trimester, are as a result of preterm premature rupture of mem- The cause is a loss of pelvic support from numerous factors, including direct injury to the leva-

104 105 POSTER PRESENTATION POSTER PRESENTATION tor ani, as well as neurologic injury from stretching of the pudendal nerves that may occur with Results: A total of 157 patients were included, 68% were male and 30% were female. The vaginal childbirth. Previous hysterectomy for pelvic organ prolapse; ethnicity; and an increase most common age at disease onset was 1 to 6 months old. From January to March were in intra-abdominal pressure from chronic coughing, straining with constipation, or repeated 50% of cases and from October to December were 27% of cases. The most common clini- heavy lifting may contribute. Most patients with pelvic organ prolapse are asymptomatic. A cal signs were cough, wheezing, rhinorrhea, dyspnea, intercostal and jugular retractions. In sense of bulging or protrusion in the vagina is the most specific symptom. Evaluation includes radiologic findings, hyperinflation was the most prevalent finding in 57%, high CRP or ES bimanual pelvic examination. rate together with Leukocytosis were present in 52% and therapy included intravenous infu- Management options for women with symptomatic prolapse include observation, pel- sions in 66%, systemic corticosteroids in 95%, intravenous antibiotics in 88%, O2 therapy vic floor muscle training, mechanical support with pessaries, and surgery. Pessary in 21.66%, inhalation with beta 2 agonist: salbutamol in 69.43% with Ipratropium bromide use should be considered before surgery in women who have symptomatic prolapse. (Atrovent) in 11.46%, with pulmicort in 9.55% and only with solution NaCl 0.9% in 12.10%. In conclusion, most women can be fitted with a pessary regardless of the stage or site of Conclusions: There is no correlation between radiology and laboratory findings in one side predominant prolapse. Surgical procedures are obliterative or reconstructive. There is a re- and treatment with intravenous antibiotics on the other side. We have to prevent inappropriate surgence in conservative therapy using pessaries, as the older population grows and the use of antibiotics in bronchiolitis. imperfection of long-term surgical results becomes more evident. Key words: Bronchiolitis, Pneumonia, inhalation therapy. Keywords: Pelvic organ prolapse, pessaries, management Report of a False-Positive HIV Test Result and the follow up with Additional Tests in Neoadjuvant Chemoradiation for locally advanced rectal cancers Establishing HIV Serostatus Ademi S, Tarifa Dh, Sallaku A, Proko F, Likmeta M Qyra Sh, Basho M, Abazi Zh, Qyra B, Bani R

Introduction: Colorectal carcinoma is the third leading cause of death from cancer in both Message Body: The aim of our report is to describe a case of a false-positive HIV females and males . The overall incidence of colorectal cancers is nearly identical in men and test result and discuss how prolonged follow-up, along with the use of other laborato- women .The incidence of colorectal carcinoma is higher in industrialized regions. Incidence ry tests, such as determination of plasma viral load (PVL), may help identify such cases. and prevalence rates of rectal cancer continuously grow in Albania. REPOA 31-year-old man from Tirana underwent his first serological assay for HIV-1 as part Purpose: The objective of this study was to evaluate the efficacy of neoadjuvant chemo- of testing as a blood donor and the enzyme linked immunosorbent assay (ELISA) showed radiation in locally advanced and unresectable rectal cancer patients , to make them from positive results. The sample was tested with ELISA HIV-1 /2 Ag/Ab at the Laboratory of Im- inoperable to operable after radiochemotherapy treatment and getting a pathologic complete munology at Institute of Public Health and the results were positive while the optic density was response at the majority of the patients. 1,7 and the cut-off 0,3. The results of searching for antibodies were negative. The patient Methods : In this study are included 80 patients with locally advanced rectal cancer ,accord- was informed that he likely had HIV infection. He denied any predisposing risk factor for HIV. ing to the TNM ( T3,T4 ) . All the patients were treated by neoadjuvant chemoradiation with He did not report any condition which can result in a false positive reaction such as: hepatitis 45-50 Gy conventional fractionation external beam radiotherapy (EBRT) and concurrent oral B or influenza vaccination, renal failure, systemic lupus erythematosus, positive rheumatoid capecitabine chemotherapy . All the patients were assessed after 6 weeks of completion of factor, cystic fibrosis, hepatitis, or a sexually transmitted disease. The patient was required chemoradiation by clinical examination , and/or CT/MRI scan pelvis for response evaluation. to do a follow-up testing to determine his infective status. One month after his first test, the The choice of surgery: abdominoperineal resection or anterior resection was depending of patient was retested with ELISA and Western Blot, and a sample of plasma was sent for the response. HIV RNA analysis. This time, the result of optic density was 0,98 and Western Blot was Results:The radiochemotherapy treatment generally was well tolerated by patients . No negative for HIV-1 and HIV-2 antibodies. HIV RNA analysis also showed negative results. significant side effects were seen. 77 patients were ready for surgery and only 3 patients Conclusion: False-positive results in ELISA can occur. The follow-up testing is required were not operable yet. 55% of the patients had a conservative surgery . 41% had an abdom- to determine actual serostatus. A false-positive serological test result may be support- inoperineal resection.The down-staging affects were seen in more than 60% for nodes and ed by normal CD4+ count (CD4/CD8 ratio) and undetectable HIV-1 RNA, but is ultimately 45% for tumours size. Conclusion: The management of rectal cancer should be multidisciplinary.Every patients Breast Ultrasound in Check-up screening should have a personalized treatment from the beginning therapy, surgery, adjuvant chemo- Tivari S. B, Puca E, Huti E, Thoma E, Daku A therapy. Radiochemotherapy in the locally advanced rectal cancer is well tolerated with no side effects , and very effective on downstaging of the primary tumours, making in operable Introduction: Various types of lesion from inflammation to carcinoma can affect breast. the inoperable patients. Some lesions are common in young females while others in elderly age group. Breast cancer ranks as one of the leading cancer type in the number of new cases diagnosed. Epidemiology, Clinical, Laboratory and Treatment characteristics of bronchiolitis in Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic our hospitalized children conditions. That’s why, recently, even in our country, one of the main reason to present Hasani Sh, Hasani E, Qosaj D in our Check-up Department, is due to the concern of having breast cancer. Breast con- trol is part of every clinical visit of our apparently healthy patients presented for a routine Background: Bronchiolitis is an acute inflammatory injury of the bronchioles that is usually check-up in our hospital. As young aged females are more informed about breast problems, caused by a viral infection (most commonly respiratory syntitial virus and human metapneu- breast ultrasound is a frequent examination. During our work we noticed a considerably movirus). prevalence of benign breast finding, even if the most part of patients were asymptomatic. Objectives: The aim of this study was to evaluate the clinical, laboratory and treatment fea- Purpose: The purpose of this study was to profile benign breast problems tures of bronchiolitis in hospitalized children. amongst apparently healthy patients presented for a routine breast ultrasound. Matherial and methods: We studied retrospectively 157 patients, age 28 days - 24 months old Material and methods: This is a retrospective and prospective study performed in our Check- who were hospitalized in Pediatric Clinic, Pulmonology Department in UCC Prishtina, from up department during October 2014-Mars 2015. We analyzed the ultrasound data of the January 1, 2014 to 31 December, 2014. We analyzed also the impact of birth weight, actual patients and we focused on 2 main benign finding :fibroadenoma and cistic/fibrocistic lesion weight, clinical signs and symptoms, radiology and laboratory findings and the treatment with of woman presented for a breast ultrasound. different kind of inhalation therapy. Results : In our study we enrolled 296 patients with a mean age 38.2 +- 12.6 years. Ac-

106 107 POSTER PRESENTATION POSTER PRESENTATION cording to the diagnoses 26% of patients were diagnosed with fibrocystic dysplasia, 20.6% cines, antihomotoxic and complementary). with fi broadenoma and 53.4 % of the patients had findings that were normal. About 7 % • Standardization of traditional and herbal medicines, their involvement in the drug law (safe had both fibroadenoma and cystic lesions. Any breast cancer was diagnosed in our group. ty and efficacy). Discusion. Through this study we had a better overview of breast changes in young females • Regulation of the practice, summarized in alternative and complementary medicine (patient in our country. With greater awareness about breast diseases, the number of patients who safety). present for routine Check-up, can easily increase leading to early diagnosis and treatment. Sever pancreatitis in tuberous sclerosis: Case presentation Assessment on the level of nourishment of children 2-5 years old in the rural areas in Isufaj V, Daku A, Saygili B, Capi R, Banushi A, Koza B. K, Kapaj R, Godaj D, Marku L, Puca Albania, 2013 E, Berdica L, Puca E Dubare S Message Body: Severe acute pancreatitis is characterized by persistent organ failure that re- Background: Malnutrition is the root cause of 35% of the children’s death under 5 in the world. sulting in SIRS. Tuberous sclerosis is a rare, multi-system genetic disease that causes benign The prevalence of stunting under 5 years old came down from 32% in 2000, to 19% in the year tumors to grow in the brain, kidneys, heart, eyes, lungs and skin. It usually affects the central 2008.The percentage of children with low weight kept down from 11% in 2000 to 9% in 2008. nervous system and results in a combination of symptoms including seizures, developmental In 2010 the prevalence of anemia was 19.6% among children of age 6-59 months. Level of delay, behavioral problems, skin abnormalities, and kidney disease. anemia for this age was higher in the perurbane area of Tirana( 26.5%) than Kukes (18,2%) Aim: To present a severe pancreatitis in a male with tuberous sclerosis. and Shkodra(17.9%). Through this study, we aim to give an opportunity NGO-s and health Case presentation: A 32 years old male presented at the emergency room of Amerikan Hospital workers to have a big picture, of the nutrition level among children 2-5 years old in Albania. with fever, disoriented and stupor. Blood tested were as below: WBC (Leukocite) 10.45 x10^3/ Methodology : This is a cross- sectional study, the only one that allows the rating of preva- uL (4.5 – 11), PLT (Trombocite) 262.00 x10^3/uL (150 – 450), CR. Proteina 1.95 mg/dl (0 - 0.5), lence of a phenome. It’s a queasy-experimental, non-random, post-test study. Dates were AST (SGOT) 68.35 UI/L (0 – 38), LDH 785.08 UI/L (135 – 225), Kolesterolemia 352.85 mg/dl (0 analyzed with SPSS version 22 and Who Anthro v3.2.2. 53 women and 610 children 2-5 – 200), Trigliceridet 304.13 mg/dl (0 – 200), LDL cholesterol 265.90 mg/dl (0 – 100), Azotemia years old from perurbane area participated in the study. The sample is a non-probabilis- 141.46 mg/dl (0 – 50), creatinemia 2.66 mg/dl (0.7 - 1.2), amilazemi 2094.66 UI/L (28 – 100), tic, convenient, intentional sample. The data was provided through interviews for breast lipazemia 1696.3 UI/L (0 – 190), kreatine fosfokinaza (CPK) 1978.73 UI/L (39 – 308). Serolo- feeding and nourishment and through the measurement of anthropometric parameters like gy for Toxoplasma, West Nile Virus, influenza and Echinococcus resulted negative to. On im- weight and height for children. The data collection happened during January- May 2013. agery: Multiple multidimensional lesions in liver. Comprimation of pancreatic corpus, surrenal Results: 46.7% of children were (F) and 53.3% (M). The mean BMI for all children was 16.22. glands and hepatorenal area. Same lesions in osseous, subcutaneous tissue and basal-pleura. The lowest child BMI ( 10.77) recorded in Mamurras and the highest in Shirgjan 23.44. The Results: Based on clinical presentation, laboratory, imagery and histological dates this case lowest mean BMI recorded in Maliq 13.37. The mean BMI for F was 16.09 and 16.33 for M. was classified as sever pancreatitis in a patient with Tuberous sclerosis The total stunting prevalence was 10.5% where 2.1% of children had stunting<3 SD and 8.4% Conclusions: Tuberous sclerosis is a rare autosomal dominant neurocutaneous syndrome stunting <2SD.8.6% of boys were stunted and 12.6 of girls. 1.65% of children had wasting characterized by the presence of benign congenital tumors in multiple organs. The diagnosis <3SD and 4.59% of them had wasting <2SD. 22.78% of children (10.52% of all F and 14.46% is usually established on the basis of diagnostic criteria applied to physical or radiologic find- of M) had BMI<15.5kg/m2 - very severe underweight. Only 77 children had a normal BMI. ings. Implication of pancreas is rare in this disease. Key words: pancreatitis, Tuberous sclerosis, benign tumors, Alternative Medicine, on primal health care Risto J, Minga Gj, Risto M An overview of our experience in parenteral nutrition of the preterm newborn. Simeoni A, Cipi L, Kolici N, Caglar M.K Primary health care is focused on people, through the disciplines of Alternative Medicine that offers a holistic approach to health which makes prevention equally important as the Background: All premature infants <35 weeks of pregnancy and most ill term infants require full treatment of diseases. As part of this preventive approach, doctors will address properly, the or partial PN whilst enteral nutrition is gradually introduced .The percentage of PN should be causes of health problems. The trend towards highly specialized health care, is not conducive reduced as quickly as possible by the introduction of enteral nutrition and finally be replaced to a good human relationship between the doctor and the patient. Too often in conventional completely by enteral nutrition in order to minimize any side-effects from exposure to PN. medicine, it turns out that the patient is not treated as a person (subject, social beings), but rather as a tool whose organs are examined and treated separately or as organ-specific Methods: We included in this study babies born from June 2011- June 2014 that during the first groups. Although, specialties , are directed / performed by a specialist, often, highly qualified. days of life needed PN for more than 3 days. We divided them in three groups ELBW; VLBL; The growth of alternative medicine is an option / looking for more personalized health care, and LBW . For each group we analyzed the mean daily weight loss, the mean day of regaining wider and more loving / compassionate. People love primary health care, to be with better of the birthweight; the mean number of days that they took any parenteral nutrition and the health outcomes, lower costs and provide maximum satisfaction to the users. In summary, we mean day of starting the enteral feeding. For the babies that continued follow-up in our clinic (a can say that the viability of alternative medicine (T / CAM) are: total of 23 babies) we also calculated the mean age at which they doubled their birth weight. • Alternative Medicine offers a comprehensive health care. Results: A total of 29 infants which during the first hours of life needed umbilical cathetherisation - Is equal for all layers and entities, affordable but effective. and took total or partial PN were enrolled. For babies ELBW (total of 2 cases) the mean daily - Treats body as a whole. weight loss was 16 g/day; the mean number of days on PN was 9.5 days. They regained - Cooperation in treatment (doctor - doctor and doctor- patient). • Access that makes the prevention equally important as the treatment of diseases. birth-weight after 10.5 days. Both of them were started trophic feeds on day 3 of life. On their • Biological treatment of diseases (homeopathy, homotoxicology, bioregulation). follow up we noticed that they doubled their birth-weight after 2.8 months. For VLBW group • Provides a more personalized health care (doctor-patient) (a total of 9 cases) the mean daily weight loss was 9.6 g/day; the mean number of days on • Limit use of allopathic medicines, due to the effects, side even in some cases giving them parenteral nutrition was 6.5 days; they regained birth weight after 8 days ; enteral feeds unnecessary, especially antibiotics and benzodiazepines. were introduced on 1.4 days of life; On follow up (a total of 8 cases) they doubled their birth • Reducing the cost of treatment (introduction of treatment protocols for homeopathic medi weight after 2.13 months. For babies LBW (a total of 18 cases) the mean daily weight loss

108 109 POSTER PRESENTATION POSTER PRESENTATION was 8.2 g/day; the mean number of days in PN was 4.5 days; enteral feeding was introduced eded with fibrochondrocytes, were implanted in New Zealand rabbits after meniscectomy on day 1 of life; they regained birth weight after 6.2 days; on follow up ( a total of 12 babies) and the microscopical and histological observations have shown that the 3D collagen-based they regained their birth weight after 1.8 months. We have not had any cases of necrotizing construct has a significant potential as a meniscus substitute. enterocolitis. Conclusions: In our experience, short term administration of PN (less than 2 weeks) was GASTROINTESTINAL STROMAL TUMOR (GIST): MASKERADING AS PANCREATIC found to be safe. CYSTIC NEOPLASM. Alia L, Tripodi S. A The imaging of acute tubular necrosis (ATN) in the transplanted kidney Daku A, Koni A, Koza B. K, Dedej A, Nasto F, Dhima A, Coma B, Cekrezi B, Aliu D, Shahini A Message Body: GISTs represent a distinct biological subset of mesenchymal tumours of the

gastro-intestinal tract originated from interstitial Cajal cells (or their precursors). The neoplas- Message Body: Acute tubular necrosis (ATN) is very rare complication but the most common cause of acute kidney after renal transplantation. ATN is usually caused by a lack of oxygen tic cells are characterized by a spindle or epithelioid aspects and by the immunohistochemi- to the kidney tissues (ischemia of the kidneys) but may also occur if the kidney cells are cally expression of c-KIT (CD117). damaged by a poison or harmful substance. Its commonly defined as an abrupt decline in Herein we describe a retroperitoneal GIST, macroscopically evident as a large cystic pancreatic renal function, manifested by acute elevation in plasma blood urea nitrogen (BUN) and se- mass, simulating a cystic pancreatic neoplasia. We speculated about the origin of such neoplasm, rum creatinine, occurring over hours to days to weeks, and usually reversible. We discussed suggesting a subserosal gastric GIST.Histologically, two different architectural pattern were evi- our patient with hiperacute acute tubular necrosis that occurred a few hours after surgery dent: the bulk of the mass was composed by epithelioid cells embedded in a thin reticular stroma. manifested with anuria, high creatinine levels with normal range Doppler ultrasound . We Such cells formed thick digitations in the lumen simulating a papillary pattern. The remaining of discussed here the importance of clinical and radiological examinations during the necrosis neoplasia was composted of spindle cells with a fascicular or storiform arrangement immersed and the evaluating the complications by MRI for further information and differentiating from other pathologies. in a thin reticular stroma focally mixoid. No whorled extracellular collagen fibers, of the type des- ignated as skeinoid fibers, were seen. Mild nuclear atypia and focal cytoplasmic vacuolizations Our experience in the performing of Thyroid Cytology were appreciated. Areas of coagulative necrosis were present. The neoplastic cell were separed Daku A, Cekrezi B, Puca E, Gjoshe E, Berdica L, Koza B. K, Allajbeu I, Shytaj E, Shahini A from the pancreatic parenchyma by a thick fibrous capsule. In a limited area the neoplasia infil- trated the gastric wall . Mitotic index was >5 mitoses/10 high-power field. Immunohistochemical Message Body: The thyroid cytology is a very common procedure and very helpful in the analysis revealed an intense, granular surface and cytoplasmic c-Kit positivity. CD34 expression differentiating disease of different pathologies that infiltrate the thyroid gland. Usually is been was also strong and diffuse. Vimentin and smooth muscle actin were expressed only weakly done under ultrasound guiding with some local anesthesia by radiologist or other clinicists. and focally. Neuroendo-crine markers, cytokeratins, S-100, caldesmon and desmin expression Its a safe procedure and doesnt waste so much time and the patient usually goes home after were completely absent. The morphology and the immunohistochemical features suggested a procedure without any special therapy. We want to presentate our special experience during last 5 years in the performing thyroid cytology and to show the clinical and histopathologic diagnosis of GIST. The size > 10cm, a high percentage of proliferative cells, evidenced by Mib-1 results from our 500 (five hundred) patients. Also we presented our technique, the pitfalls expression, and the mitosis number (> 10/50 hpf) indicated an high risk of aggressive behaviour. and experience how to perform the cytology to get the best results and to give the maximum information to the referring doctor. We discussed here the importance between radiology and Reye Syndrome in adult case report and review referring doctor and the optimal correlation between doctor and patients to get the maximum Pilaca A, Ndreu A, Qyra E, Qato M, Stroni G, Puca E, Kraja Dh outcome form this procedure . Introduction: Reye syndrome is a potentially syndrome that has numerous detrimental effects Engıneerıng artıfıcıal menıscus for orthopaedıc applıcatıons to many organs, especially the brain and liver, as well as causing low blood sugar. The dis- ease causes fatty liver with minimal inflammation and cerebral edema. Here is an association Ndreu-Halili A, Hasirci V between taking aspirin for viral illness such as; influenza B, chickenpox and rotavirus. Here we describe a case of Reye syndrome in an adult, women 35 year old with a good outcome Meniscus is a wedge shaped structure, with a convex base attached to a flat tibial surface, Aim: Presenting of a case report of Reye syndrome in adult and review of the literature. and with a concave femoral surface, on which femur and tibia articulate. The most common Subject: Reye syndrome is a two-phase illness because it is almost always associated with a meniscus problems are meniscal tears and a great interest of researchers has been focused previous viral infection such as influenza, cold, or chicken pox etc. An epidemic of flu or chicken on how to treat these tears. Among the existing methods, tissue engineering seems to be a pox is commonly followed by an increased in the number of cases with Reye syndrome. This ill- promising solution that avoids all the problems associated with the other approaches. In this ness can attack more often child. We are presenting a case; a woman, 35 year old, hospitalized in study, a three dimensional (3D) collagen-based structure was prepared by tissue engineering Intensive Care Unit of Infectious Diseases Hospital, in Tirana. She presented persistent vomiting, to mimic the natural human meniscus. Three different foams prepared under different con- drowsiness, irritability, personality changes, occurring seven days after she was recover from in- ditions were combined and nano/microfibrous layers were placed in between them. Various fluenza. She has used aspirin during influenza attack. The diagnosis of Reye syndrome is based crosslinking procedures were used to increase the mechanical properties of the scaffold. in clinical manifestation, abnormality of some lab test (elevated transaminases, hypoglicemy) and The highest mechanical properties were obtained with the 3D construct. Then all the indivi- differential diagnosis; meningitis, encephalitis, diabetes, poisoning, or psychiatric illness. She re- dual foams and the 3D construct were seeded with human fibrochondrocytes to study cell fused doing the liver biopsy, so our report may have some limitation. She was suspected for Reye behavior such as attachment, proliferation, and extracellular matrix (ECM) and glucosami- syndrome and treated with supportive therapy for about 2 weeks with good out come. noglycan (GAG) production. Conclusions: Reye Syndrome is a potential life-threatening disease which is often encoun- Furthermore, the influence of cell seeding on the compressive properties of wet individual tered in children. Nevertheless we should not neglect its appearance in adults. Clinical man- foams and the 3D construct was observed. As expected, the highest cell proliferation and ifestations of Reye syndrome in adults are similar to those of children, but have their own compressive properties were obtained with the 3D construct. Finally, the 3D constructs, se- specifics with better outcomes. Keywords: Reye, aspirin, influenza, personality changes, outcome

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Control measures for diarrhea es with brain parasagital tumors for the period of 4 years - 2010-2014. Xhixha A, Cipi R, Xhixha A, Cuedari M, Mecanaj Xh Of the total number of males were 10 or 62.5%, whereas females were 6 or 37.5%. The disease is diagnosed at ages 11-30 years old total of 1 case 6.25%, while the age group Message Body: Control measures for diarrhea outbreaks in child care facilities often include of 0-10 years have not encountered. review and examination of feces samples only from symptomatic children. We present evi- Conclussion: Parasagital tumors are brain tumors with a 1.84% incidence of all brain disease dence from an investigation on Escherichia coli (E. coli) O157: H7 in one of the kindergartens with a higher probability in men after age 50 years, while females is sitting, also age after 50 of Tirana in order to implement a policy on mandatory analytical review for all children during years post menopause, and in new age incidence is low. an outbreak. In addition to routine control measures during an outbreak, such as the screening of the cleanliness level of the premises and hands of children and staff, there were collected fecal Gastrointestinal tract metastasis from lobular carcinoma of the breast: a case report samples from all children and staff. We conducted a study using data from epidemiological and review of the literature investigation and questionnaires on parents and staff to verify infection risk factors, and to Huti E, Koza B, Capi R, Daku A, Qeraj K, Huti G, Arapi B, Berdica L, Bushati T,Puca E, Bitri S be informed on parents and staff knowledge related to the causes, sanitary or hygienic rules. Laboratory findings presented 9 cases of E. coli O157: H7 identified and confirmed by the Introduction: Breast cancer is the most common tumor in women. Common sites of breast laboratory; from the 9 cases, 7 cancer metastasis include lungs, liver, bones, soft tissue, brain, and adrenal glands. Metastasis of breast cancer into the gastrointestinal tract happens rarely. The diagnosis of CEREBRAL VENOUS THROMBISIS CAUSED BY SECONDARY INTRACRANIAL HYPO- this kind of disease is difficult because of the nonspecific symptoms and the long interval TENSION between primary manifestations and recurrence. Awareness of this condition may lead to an Myftiu B, Kocasoy Orhan E, Baslo B, Çoban O accurate diagnosis and an earlier initiation of systemic treatment, thus avoiding unnecessary surgical intervention. Message Body: Cerebral venous thrombosis (CVT) cases caused by intracranial hypotension Case report: In this paper, we report a rare case of a patient with lobular carcinoma metastases are very rare. Lumbar punction, epidural anesthesia or intratecal steroid injections are among frequent causes of secondary hypotension. Spontaneous intracranial hypotension is respon- to the colon, presenting with abdominal pain, discomfort, and weight loss. The patient underwent sible for only 2% of CVT cases. radical mastectomy and received postoperative radiotherapy and chemotherapy. Five years later, Following delivery under the epidural anesthesia, a 31-year old patient began to experience she presented with gastrointestinal tract symptoms. headaches, which were aggravating by standing in vertical posture. Mild neck stiffness was Surgery and biopsy of colon lesion was chosen for this patient. Immunohistochemical staining sug- the only pathologic feature of her neurologic examination. Cranial MRI revealed subdural gested a breast origin. The patient was treated with chemotherapy and died nine month after . This effusion on bilateral parietal and frontal lobes, together with dural gadolinium enhancement is the second case report in our hospital.. on bilateral frontal, parietal and occipital lobes. Conclusions: Gastrointestinal tract metastases from breast origin are considered rare in clin- MRV showed diminished calibration of superior sagittal sinus and absence of visualization ical practice. Lobular carcinoma metastasizes mostly to the GI tract.GI tract metastasis from of sinus rectus. Clinical features of headaches (history of epidural anesthesia, headaches breast carcinoma are difficult to be diagnosed.Diagnostic laparoscopy should be considered that followed this procedure and orthostatic feature of them), together with MRI correlation in breast cancer patient with GI symptoms despite Abdominal -CT findings . were supportive that headaches were caused by intracranial hypotension. This situation was thought to have contributed to the development of CVT. LMW heparin treatment was initiated Prader Willi Syndrome (PWS) for this reason. Predisposing etiologies for thrombosis were excluded. Demaj E, Hoxha V, Kermaj M, Husi G, Ahmeti E, Sinani G, Bele S, Hyseni D, Ylli A Occurrence of CVT due to intracranial hypotension is being explained by three mechanisms: 1) Engorgement of cerebral veins due to loss of SCF and slowing of venous blood flow; 2) INTRODUCTION: Prader –Willi Syndrome (PWS) is a complex multisystem genetic disorder Sagging of the brain due to the loss of buoyancy which causes traction of cerebral veins and that shows variable clinical features during a patient`s life.The syndrome is due to the loss sinuses resulting in a mechanical distortion of the vessel wall; and 3) Loss of CSF reduces of expression of several genes encoded on the proximal long arm of chromosome 15.The absorption of CSF into the cerebral venous sinuses resulting in an increase of blood viscosity prevalence of PWS is estimated to be 1 in 10,000 to 25,000.PWS adults are an example of in the venous compartment human obesity related to hypothalamic dysfunction ,with several interacting endocrine and metabolic abnormalities. Parasagital Brain Tumors Complications due to obesity and behavioral problems are major contributors to morbidity and Zeqiri B, Petrela M mortality.Management of PWS,therefore,requires a multidisciplinary professional approach. CASE PRESENTATIONWe report a case of a 20 years girl affected byPWS Introduction: The human brain is the most complex organ in the human body and certainly Clinical history is characterized by hypotonia,poor suck and successively by motor delay.She among the most complex creations in the universe we live. had done only the first year of elementary school.Since the age of 3months she started to It is clear that the greatest wonders of the world made by man are the result of human brain increase her daily caloric intake and become progressively obese . making it the most impressive of a human being. She was refered to pediatric clinic for severe obesity,was diagnosed by the genetist at 8y.old The human brain with its complexity acts as a safe device which keeps the smaller memories (based on clinical evaluation:lowforhead,almond shaped eyes,short stature for age,small- of a person. hands,mentalretardation).Clinical,laboratory and imagery findings show the presence of Purpose: The main purpose of this paper is to present the etiology, pathogenesis, clinical cholelitiasis ,irreversible picture, diagnosis, difernciale diagnosis, complications and treatment of brain tumors Materials and methods: Data for the diagnosis of brain parasagital tumors are collected from The Role of adjuvant vaginal cuff HDR Brachytherapy in early stage endometrial cancer patient records and operating records at the department of Neurosurgery, Clinical Hospital Hafizi E, Bardhi G Tetovo including the time period from January 2010 to December 2014. Data were analyzed according to age, gender and type of tumors. Purpose: To report outcomes following adjuvant High Dose Rate Vaginal Brachytherapy in Result: In the Department of Neurosurgery at the Clinical Hospital Tetovo there were 16 cas- early stage endometrial cancer compared with External Beam Radiation Therapy.

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Methods and Materials: Between May 2009-January 2013, 78 patients with early stage Ethical and legal issues in the Assisted Reproductive Technologies. Bio political con- endometrial cancer(Figo stage IA-IB low or intermediate risk) were treated with ad- sequences juvant Brachytherapy or External Beam Radiation Therapy (after hysterectomy). Braho H 30 patients were treated with Brachytherapy alone,3 fractions with 6Gy in 5 mm depth. 48 patients were treated with External Beam Radiation Therapy alone (cobalt or linear accel- Message Body: The aim of this work is the study of the new “ways” to born connected with the erator) with dose 45Gy in 5 weeks. assisted reproductive technologies. By giving a brief description of the principal techniques Results:The 3-year rates of Loco- regional control,Disease-free survival and Overall survival connected with IVF and motherhood surrogacy, the aim would not be the medical-scientific were without significant difference but patients treated only with description, but the ethical issues and legal-political consequences. In the area of repro- Brachytherapy had less side effects,so Brachytherapy was more acceptable. duction, the progress has been very fast since the birth of the first so-called test-tube baby, Conclusion: Adjuvant Vaginal cuff High Dose Rate Brachytherapy in early stage endometrial Louise Brown, through the pioneering scientist R G Edwards and Patrick Steptoe in 1978. cancer improved Loco-regional control,Disease free survival and Overall survival with less If we consider infertility as a disease, it would when score as the most prevalent disease morbidity than External Beam Radiation Therapy. in the world, as between 10 and 15 percent couples around the world are infertile, but on Keywords:Brachytherapy,endometrial cancer,external beam radiation therapy this point not every body agrees. The technique of in vitro fertilization and other assisted reproductive technologies today make it possible for 85 percent of infertility cases to be tak- Using HDR Brachytherapy as a reirradiation in patients with locally recurrent cervix cancer en care of even if the procedure doesn’t concludes with a baby for the couple. All over the Hafizi E,Bardhi G world is considered to be born over 3 million IVF babies. This achievments have changed our antroplogy and even religious dogma changing our human identity.It seems has given Purpose: To assess the outcome for patients with postradiation locally recurrent cervical can- strong arguments against discrimination based on colour, race, creed, caste, social stra- cer treated with High Dose Rate Brachytherapy. ta, nationality or language and generally of any factor based on circumstances of birth giv- Materials and methods: 19 patients with postradiation recurrent cervical cancer were treated ing us the belief that human problems can be solved only through human effort. apart from with HDR Brachytherapy.All patients were treated with External beam radiation therapy with that, we have on the other side problems from an ethical-social point of view giving to birth dose 45-50.4Gy at least 6 months ago and had biopsy-proven recurrence.They were treated to new areas of studies such as bioethics and biopolitics that with be treatedin this paper. with 4 fractions HDR Brachytherapy with 7 Gy per fraction,one fraction per week. Results: Overall survival was better for patients who had stage II disease before brachyther- A case report of severe pancytopenia associated with low-dose methotrexate therapy, apy than for those who had stage III disease.Grade 3-4 complication were seen in 3 patients and hyperleukocytosis after filgrastim administration to a patient with Subacute Cuta- and were within acceptable limits. neous Lupus Erythematosus Conclusion: Reirradiation with High Dose Rate Brachytherapy in recurrent cervical cancer Kuçaj J, Lako S, Marku L, Gjoshe E can give a good chance of survival with acceptable toxicity. Keywords:Brachytherapy,cercical cancer ,reirradiation. Message Body: Methotrexate is widely drug used in the treatment of autoimmune rheu- matic diseases. Severe pancytopenia associated with low-dose methotrexate therapy is a Wagener vasculitis as a cause of fever with unknown origin potentially serious complication. Only a few cases of severe pancytopenia caused by low- Shushari G, Murati A, Daku A, Dedej A, Capi R, Coma B, Vajushi E, Qosja A, dose methotrexate therapy have been reported. White blood cell counts equal to or greater Qeraj K, Pojani A, Puca E. than 100,000 mm3 (hyperleukocytosis), without evidence of adverse effects, have occurred in approximately 2% of patients using filgrastim (granulocyte colony-stimulating factor). Message Body: Fever of unknown origin (FUO) is a syndrome that a clinician attacks time Case presentation:We present a case of a 39-year-old woman with mucositis and pancy- after time in his daily work. Systemic vasculitis is one of the most causes of FUO. topenia, causing severe neutropenia, cutaneous bleeding, and requiring blood and platelet Symptoms can include fever, weight loss and fatigue, though these are not usually the transfusions, folinic acid, glucocorticoids, granulocyte colony-stimulating factor (filgrastim), primary presenting complaints. antibiotic therapy as a result of low dose weekly methotrexate for Subacute Cutaneous Lu- Aim: To present a case of an 22-year-old Caucasian male who presented primarily with pus Erythematosus. After 5 days with filgrastim treatment, the leukocyte count increased complaints of uncontrollable fever of unknown origin (FUO) for past two weeks. to 26,600 mm3 to reach 115,000 mm3 eight days from filgrastim cessation, and complete Case presentation: A 22 year old male presented to the emergency room with a history recovery after 6 weeks. of 2 weeks with fever (up to 39OC), macroscopic hematuria, melena, diarrhea, nausea, Conclusions;Patients receiving low-dose methotrexate therapy require regularly monitoring vomiting, anorexia, sweat and abdominal disturbations. with complete blood count to identify myelosuppression and avoid pancytopenia, especially Laboratory findings demonstrated WBC 28.84 x10^3/uL (4.5–11), trombocite counts those who have risk factors for possible methotrexate toxicity. 586.00, CRP 14.97 mg/dl (0-0.5), ESR 95mm/hr (0 – 20), hematuria, proteinuria, Ac.anti- Hyperleukocytosis is rare with growth factors, but there is the risk of adverse effects (leu- TPO 91.10IU/ml (0–34), D-dimere 10846.7 ng/mL (0–500), Fibrinogjen 428.8 mg/dl (200– kostasis) and complete blood count should also be monitored after treatment with filgrastim. 400); microcytic normochromic anemia; C3-complementemia 60mg/ml (90 – 180), C4- Keywords: Methotrexate, Pancytopenia, Lupus Erythematosus Subacute Cutaneous, complementemia 6.0 mg/dl (10-40), pANCA 14.80 AU/mL (0 -20), cANCA 228.8 AU/mL (0 -20). On radiologic examinations confirmed; Apical-posterior sinister opaque cavity and Cancer and Chemotherapy miliariforme opaque in apical lobe dexter and spleen infarct. Melyshi K On hospital day 5, based on high levels of cANCA, proteinuria, persistent hematuria and pulmonary involvement, temporary diagnosis of GPA is made which is later confirmed by the The Purpose of this Study: The truth on cancer growth. Vasculogenesis and Avastin biopsy. Therapy with pulse Methylprednisolone 1g/day IV for 3 days is started followed by Literary Material and Results: “Understanding V.E.G.F.” ROCHE 1996 prednisolone 60mg/day PO. Proteinuria is persistent after 3 days so endoxan 1g/day IV is Oncology is based on the idea that cancer just like any other tissue of the body requires blood added to the therapy. After 24 days of hospitalization the patient leaves to be admitted in another vessels (Oxygen + Glucose) in order to grow itself. Cancer needs these new blood vessels hospital (Italy) where he continues with the same treatment and is now in good conditions. (vasculogenesis, V.E.G.F.) so that it can continue this accelerated growth. Following this log- Discussion: Systemic vasculitis is a component of FUO. Interesting in this case was the way ic, in order to stop the cancer from spreading, we interrupt the vasculogenesis, which feeds it. of presentation: fever, melena and abdominal disturbation. The pharmaceuticalanti-vasculogenic Industry (Avastin) is also built on this kind of reason-

114 115 POSTER PRESENTATION POSTER PRESENTATION ing,aiming the death of the cancerous tissue by letting it die due to “hunger”. Experience Macroscopy: The tumor is fleshy, lobulated, whitish with expansile borders 8 cm in the great- shows us that after treating cancer with Avastin, the volume of the tumoral mass reduces. est dimension. This clinical fact justifies the above-mentioned treatment by pretending that it has eased the Microscopy: The tumoral mass and the mediastinal lymphnode demonstrates atypical cells malign symptomatology and that it has extended in some way the lifespan of the patients. organized in fascicles and whorls. DISCUSSION AND CONCLUSION: The feeding with blood of the body tissues, doesn’t lead The tumoral cells are admixed with small lymphocytes and plasma cells. The nuclei are to the growth of these tissues, but rather to the rationalization and setback of it. We can use oval and the nucleolus is evident. A huge panel of antibodies was used CKMNF,CD68,CK7 our pineal gland as an existing proof, which although is the smallest gland in our body, it is at once the most vascularized structure of it . The blood vessels in the skin of our body are ,CD20,CD3,EMA,AE1/AE3,Ki67 (10-15%),Actin, Desmin, Vimentin, CD38, CD34, CD99, so frequent, it looks as though it has a bloody cover wrapped around itself, in which no tissue cl2, p63, CD23, Bcl6, CD10, Kappa, Lambda, S100, CD68, CD21, CD23, AE1/AE3,Cluster- growth can be distinguished, but quite the opposite of it. ina,EGFR,HLA.DR. Same as with the cancerous tissue, we can mention the fetus and how it doesn’t quicken but actually slows down its growth, after being fed by the placental/umbilical vessels. Initial management of the trauma patient To sum it up somehow, I believe that the vasculogenesis should not be considered as a Closed Reduction, Traction and Casting Techniques helper in cancer growth, but rather as an inhibitory factor with the duty of control-rationaliza- Fezollari L, Hasmuca I, Habili D, Duraj L tion-differentiation of the accelerated and uncontrolled malign growth. Avastin, in this case, as the cause of the tissue Hypoxia, cannot possibly be deadly to cancer. In fact it favours the Message Body: All Orthopaedic surgeons that care for trauma patients should have a good creation of new foci of it/metastasis. background in resuscitation and ICU management to discuss the care of these patients with other members of the team based on current academic literature. The Orthopaedic surgeon is Hematological changes in human brucellosis member of the team who should be able to convey the advantages of long bone stabilization Shkurti K, Kokici M, Kalo T, Muco E, Puca E, Kraja Dh and possess the skills to do so in a timely fashion with minimal risk of complications. OBJECTIVES: Identify the correct sequence of priorities in assessing the multiply injured patient Message Body: Brucellosis is an important zoonosis in Albania and its neighbours with vari- Apply the primary and secondary evaluation surveys to assessment of the multiply injured patient ability of clinical symptoms. Laboratory findings in peripheral blood are some times anaemia, Apply guidelines and techniques in the initial resuscitative and definitive--case phase Anticipate normal or low WBC and thrombocytopenia. Pancitopenia is a rare sign; it is caused from gran- the pitfalls associated with the initial assessment and management ( minimize their impact ) ulomas in bone marrow or cytophagocytosis that some times named as Robb-Smith syndrome. Conduct an initial assessment survey on a simulated multiply injured patient. The purpose of the authors is to study the variability of peripheral blood changes and their Regardless of the injuries sustained or the capabilities of the treating facility, the principles described in ATLS should guide the initial assessment, resuscitation, and treatment of the relations with the hepato-lienal syndrome. multiply injured patient.The primary and secondary survey should be continually repeated to The material and methods: We studied 340 patients, hospitalised in the Department of Infec- identify deterioration in the patient’s condition and to make appropriate interventions. tious diseases in the UHC of Tirana, during the period January 2000 – December 2013. The The use of a prioritized and systematic approach to initial management of the trauma pa- patients were diagnosed with brucellosis according to their serological confirmation (Rose tient ensures that optimal care is delivered and the best possible outcome is achieved. Bengal +, Wright >1:160, ELISA IGM, IgG). This is a retrospective and prospective study. Keywords: Preparation, Triage, Primary survey ( ABCDEs ),Resuscitation, Adjuncts to prima- Results: Hepatomegaly was found in 96% of cases, splenomegaly in 62%, and hepatospleno- ry survey and resuscitation, Secondary survey, Adjuncts to the secondary survey, Continued megaly in 62%. Enlarge lymph nodes were found in 11.8 % of cases. The frequence of sple- postresuscitation monitoring and reevaluation, Definitive care. Closed reduction. nomegaly was 65% in the acute Brucellosis, versus 48% in subacute form (p=0.036). WBC was between 2000-17000, less than 4000 were found in 19% and more than Evaluation of blood transfusion effects on tissue oxgenation based on lactate level 10000 in 9.2% of cases. In 91% of cases was found lymphocytosis and in 71% anemia. Nunci L, Ohri I , Sula H, Mjekaj E, Kucaj G, Zeqiri D, Taka A, Gogu B Erythrosedimentation rate > 20 were in 58% of cases. Pancytopenia was observed in 3% of cases. Bone marrow aspiration was made in 15% of With purpose evaluation of red cell transfusion over tissue oxigenation,we perform one anal- cases with normal results, only in one case with co-infection Brucellosis we find Leishmania itic prospective observation on 59 patients.We monitor vital sings at addmision and also was parasite. Hepato-splenomegaly was present in 8% of patients with blood changes. stictly observed lactate level and hemoglobin level at addmision before red cell transfusion Conclusion: Brucellosis has to be considered in differential diagnosis when peripheral blood (pre T), two hours after transfusion (2h post T) and 24 hours after (24 h post T).At first the pa- changes as anemia, thrombocytopenia, low WBC with lymphocytosis, and sometimes tients group based at hemoglobin level, Group I with Hb< 8g/dl and Group II with Hb ≥ 8g/dl. pancytopenia are found. Serological tests are important for diagnostic confirmation. After that the patients group again based at lactate level,Group I lactat level ≥ 2,5 and Group II lactate level <2,5.Statistical evaluation between above mentioned groups shown that lactate Primary Follicular Dendritic Cell Sarcoma of the Lung level are indisputably indicator in measuration of tissue oxygenation.Progressive increase of Berdica L, Caushi F, Bushati T, Kurshumliu F, Xhemalaj D, Alia L, Leoncini L, Spina D, Miracco C hemoglobin level was not accompanying with progressive decrease of lactate level.Another im- portant finding was significant high mortality and morbidity at patient group with lactate level ≥ 2,5. Background: Also called follicular dendritic reticulum cell tumor, follicular dendritic cell sarco- Key words: Red cell transfusion,lactat level, hemoglobin. ma. Reticulum cells are nonlymphoid, nonphagocytic cells that capture and present antigens and immune complexes. Follicular dendritic reticulum cells are found in B cell zones,partic- ERCP experience in American Hospital ularly in germinal centers. Interdigitating reticulum cells are found in T cell zones, and are Tmava S, Fezollari L, Draçini Xh, Gozalan U, Fazliu I, Vishi I, Hasani A, Jusufaj I, Zeke Z, related to Langerhans cells. Dedushaj V Fibroblastic reticulum cells are found in the parafollicular and deep cortex areas. The tumor affect lymph nodes and extranodal sites, including liver, oral cavity, bowel, spleen. Background and aims: we aimed in our study to evaluate the efficacy and safety of the Case report: The patient 52 years old, female, suffered from cough with sputum, fatigue and ERCP, new techniques and approaches for the treatment of common bile duct stones . respiratory difficulty. The imaging exams thought to have Echinococcus cyst in the lung, so a Patients and methods: in two units of ERCP in American Hospital (Tirana/Prishtina), pro- pneumonectomy was performed. spective study of the 135 ERCP, results obtained and compared with the quality standards

116 117 POSTER PRESENTATION POSTER PRESENTATION proposed for common bile duct stones treatment in the literature, new techniques and ap- were negative for hepatitis A, B and C. Brucellosis, typhus and leishmaniasis were excluded proaches in ERCP in American Hospital .Results: In this prospective study, a total of 135 by serology. While EBV IgG was positive with 15.9 UI/L. On bone marrow aspirate 6% immu- ERCP procedures performed in patients at the endoscopy department of our hospital from noblasts were present. The MRI of the abdomen suggested for multiple lesions in spleen, liver 14 february 2012 ( date of first ERCP in Albania), were prospectively evaluated. It was 53 and lesions in sacrum and vertebral bodies. Diagnosis of LCH was confirmed by bone marrow patient (n=39.2%) with CBD stones treated with ES (endoscopic sfincterotomy) and stone biopsy. The patient was treated with supportive therapy while conventional chemotherapy extraction. The age range was 21 to 89 years old and the mean age was 58.33. Amoung them was not administered because of the patient’s poor clinical condition. The patient died from , 65.4% of the cases were females (n=86) while 34.6 % were males (n=46).). Among the all multisystemic LCH and multiple organ failure. of 135 ERCP, failure in 6.6 % of the cases (n= 9).Guide –Wire assisted technique is standard Conclusions: Langerhans cell histocytosis (LCH) in young adults is claimed to be a diag- protocol used in ERCP performance in our practice. Conventional canulation in ERCP with nostic challenge. The clinical presentation with liver involvement initially suggested a sero- injection was never used in American Hospital. Conclusions: the results obtained after per- negative hepatitis. The patient had multiple organ failure making the prognosis very poor. forming 135 procedures of ERCPsupport the ability to practice ERCP in American Hospital It is important to remember that there are still many undiagnosed/ misdiagnosed patients obtaining levels of efficacy and safety in accordance with published quality standards. In suffering from LCH. American Hospital ERCP, with ES and stone extraction found to be safe and effective proce- dure in treatment of primary and secondary choledocolythiasis. The overall incidence of testis torsion (TT) in our patients diagnosed as scotum acu- Keywords: Expert biliary endoscopist; Cannulation; Sphin tum suspicious for testis torsion terotomy; ERCP ; Biliary cannulation; common bile duct. Çuni XH, Haxhiu I, Xhani M, Tartari F, Hyseni S, Ndoj A, Fetahu A, Sejdiu A

Inflammatory myofibroblastic tumor of the Lung: Case report Testis pain or swelling, often referred to as the acute scrotum, can have a number of caus- Borici S, Tanka M, Serbo L es. Testis torsion represents a surgical emergency because the likelihood of testis salvage diminishes with the duration of torsion. Therefore, the family physician must act quick- Summary: Inflammatory myofibroblastic tumor of the lung is a rarely incountered lesion. ly to identify or exclude this condition in any patient who presents with an acute scrotum. Although it is commonly seen in children, the number of childhood cases in the literature Material and methods: We recently reviewed a series of 60 boys who presented to our Emer- is limited. It has a dual nature: it may behave as inflammatory lesion or a tumor which has gency department with an acute scrotum suspicious for testis torsion. Immediate surgical the capacity for recidivism and metastasis. So the syndrome requires careful follow-up. exploration was performed in 27 ptts.(45%); in 33 of cases (55%) the surgery exploration was In this report, we present a case of a 4 year old girl who presented with cough and the chest performed after ultrasound examination. X-ray and CT scan revealed a tumor mass in the right lung. After lobectomy, histological The ptts.have been operated from different surgery team (attendants form Clinic of urology / examination combined with immunohistochemical study discovered an inflammatory myofi- surgery children Clinic in UCCK, Pristina) in cohort study January 2010 to December 2015. broblastic tumor of the lung. Results: After surgical exploration confirmed the testis torsion was in 41 cases (68,4%), torsio cys- Introduction: Inflammatory myofibroblastic tumour of the lung is a rare condition, comprising tae Morgagni in 16 cases (26.7 %) and in 2 (4,9%) of cases the diagnoses was orchiepididymitis. less than 1 percent of all surgically resected lung lesions. Inflammatory myofibroblastic tumor The patients age ranged from 1 month to 24 years (mean age 15 years). (IMT) of the lung includes a spectrum of pulmonary lesions. Nowadays it is still unclear whether The pathology in all cases was unilateral; in 26 of cases (44%) it was in right side and in 34 these lesions represent a primary inflammatory process or a low-grade malignancy with a prom- of cases (56%) it was in left side. inent inflammatory response. Inflammatory tumour may behave as a malignancy and thereby In 32 of cases (78%) with TT, the testis was found with reversible changes and performed pose a diagnostic dilemma for the clinician. We recently managed a case that we describe. detorsion in affected testis and orchidopexy in both testis Case Presentation: A 4-year-old girl was referred for diagnostic evaluation of a non specific In 9 of cases (22%) the affected testis was with irreversible damage (infarcted) and removed. cough.CT scan of the chest confirmed a solid mass in the right upper lobe and middle lobe of In same time ochidopexy was performed in contralateral testis. the lung with an area of central calcification, well contoured , heterogeneous.The patient was Conclusion: When the history and physical examination strongly suggest that testis tor- subjected to surgical removal of the mass. sion is present and the duration of pain is less than 12 hours, urgent surgical interven- The histological and immunohistochemistry characteristics were compatible with an inflam- tion is indicated. No imaging studies are required because they may delay treatment. matory myofibroblastic pseudotumour.The postoperative course was uneventful Conclusion: Inflammatory myofibroblastic tumours of the lung are rare. Surgical excision is Metachronous testicular seminoma with an interval of 8 years from the first seminoma- usually indicated to reach a firm diagnosis and cure.Complete resection, when possible, is tous testicular tumor a case report safe and leads to excellent survival and remains the key to prevent recurrence. Cuni Xh, Haxhiu I, Nuraj P, Mehmeti S, Sejdiu, Kurshumliu F

Langerhans cell histiocytosis (LHC) in young adults Message Body: A case report. A present case was 42-year-old man,who was admitted in our Taçi P, Pilaca A, Zguri L, Puca E, Qyra E, Stroni G, Doraci M, Duka E, Hysenaj Zh, Kraja Dh. Clinic of urology with a complaint of left scrotal swelling. From medical records we notice a past history of right high orchiectomy, 8 years ago. Introduction: Langerhans cell histiocytosis ( LHC) in young adults is a rare disorder of unknown The H.P. report confirm pure seminoma stage IS without spermatic cord invasion. etiology characterized by proliferation of histiocytes. Here we present a case of a young patient with In postoperative treatment he was treated with radi symptoms of hepatitis and multiple lesions in spleen, liver and bones, with a very rapid fatal end. therapy in Oncologic Institute in Skopje (Macedonia). Case: A 18-year-old boy with no past medical history was admitted to our clinic with a week Now, after 8 years he detected one a painless,unilateral mass in the left scrotum so he under- long complaints of chills, high fever, dry cough, loss of appetite, nausea, fatigue and dark went scrotal ultrasonography and lab measurement for serum tumour markers (AFP,B-HC- urine. Physical exam revealed : temperature of 39oC, tachycardia, jaundiced eyes and skin, G,LDH). The tumour size was 3-4 cm. The serum tumour markers levels were in normal lim- hepatosplenomegaly. Laboratory studies showed severe bicytopenia: Leukocyte count: 2 its. After careful discussion of his treatment options, the current patient opted for ‘’biopsy ex 800/ mm3; ( lymphocytes 45.5%) Platelet count: 57 000/ mm3. Liver function tests revealed tempore ‘’ in that testicle.The immunohistochemical H.P. result confirm the presence of ma- high levels of AST 321 U/L, ALT 396 U/L, GGT 144 U/L, LDH 1175 U/ L, total bilirubin 9.5 lignant tissue so we perform the left high orchiectomy. The postorchiectomy AFP and B-HCG mg/dl, low levels of total protein 4.2g and prothrombin time PT HS 30.5% and INR 2.198. High levels in serum were in normal values.Postoperatively the HP result and abdominopelvic CT levels of ferritin 1200 ng/ml and D- dimer 7847. 89 ng/ml were observed. Laboratory results scanning confirm pure seminoma pT1,N0,M0,S0. The patient after two days were admitted in

118 119 POSTER PRESENTATION POSTER PRESENTATION oncologic department for additional treatment and follow-up care. conclusion about its congenital nature. In 1959 Alonso Lej and Co have made up clasification Discussion: According to the data from literature, about 3% or 4% of men who have been of choledochal cysts due to its macroscopic view in three types while describing 2 their cured of cancer in one testicle will eventually develop cancer in the other testicle. A multidis- cases and 94 other cases, based on literature. ciplinary team of urologists, medical oncologists, radiotherapists and a pathologist is the team In 1977 Todon and Co, In 1977 Todon and co, upgrades choledochal cyst clasification due which can have big impact in therapeutic strategy and in the success of cure rates. to cholangiographic finding in five types. Classification: These anomalies have been cathegorised accordingly to Todani and co sys- The importance of the Myocardial perfusion scan (MPI) in evaluation of patients after tem. There are 5 types of ch. Cy, with subclasiffication for type I and IV. Percutaneous Coronary Intervention (PCI) Type I are more common and represent 80-90% of choleochal cysts. They consist in saccu- Abdullahu L, Miftari R, Gërqari I, Bajqinca A, Spahiu F, Bajrami I lar and fusiform dilation of d.ch. Type IA is sacular in shape and involves either choleochus ormost part of it. SPECT-G-SPM- has become a routine procedure in nuclear medicine as powerful modal- Type IB is sacular dhe and affects limited portion of ch. ity for assessing perfusion and heart function. Very high probability of repeated occlusion Type IC is more fusiform in shape and affects major par of e.h b.d. of coronary artery after PCI and occlusion of other coronary arteries raises necessitates Type II – Seems like isolated diverticulum which came up from the choledochus wall . the for early detection and timely intervention. cyst might be united with choledochus through pedonculum. Aim of the study was to determine the role of MPI for early detection of re-occlusion of the arteries Type III – comes from intraduodenal part and has been described as choledochocoele. after PCI or other deteriorations of coronary arteries. Evaluating and comparing the re- sults obtained from coronarogarphy and SPM. Participation Helio Pylori bacteria gastritis and gastroduodenal ulcers Methods: The study included 28 patients undergoing PCI; from them 20 males and 8 Karemani M females. In all these patients was made MPI with SPECT-G method (gated) during the exercise and in the rest after I.V.administration of radiopharmaceuticals 99m-Tc-MIBI Introduction: For the first time in 1990 two Australian authors Waren and Marchal discovered of 8 mCI (296MBq), respectively 24 mCI (888MBq)with a daily study protocol and were and confirmed bacteria Helio B. Pylori, as fundamental factors in the biggest show of disor- compared with data from coronarogarphy. ders gastric and duodenal ulcers, as well as a large impact on the appearance of peptic ulcer. Results: From the total number of patients undergone coronarogaphy (28), in three of them Treatment of this bacteria significantly reduces the number of relapses f gastric ulcer. the result was proved negative for coronary disease and in 25 of them (89%) during coron- Goal:The purpose of this paper is research the HBP participation in gastritis and peptic, sen- arography it was found changes in the coronary arteries and were placed stents in order to sitivity of bacteria to antibiotic therapy, and research of the ailing humanity, the number of re-vasculate the affected vessels. patients who are attacked by gastritis and ulcers, where as the cause of the disease is Heloi The patients who underwent PCI, 7 of them had multivessels intervention (28%), 19 pa- B . Pylori. tients were only stent in one of coronary artery (72%), 9 patients in the left descending Material & Results: The study was conducted at the Clinical Hospital of Tetoves- Department artery (LAD), 8 patients in right coronary arterie (RCA) and 1 in ramus intermedius (RIM). Gastroenterohepatologjise and Polyclinic intern “MEDICUS -LUX” - Tetove. Target research In 3 patients who had no affected coronary artery during coronarography, also the PSM has involved a considerable number of the ailing humanity with gastritis and ulcers, as well as the resulted with no changes in perfusion. number of patients to which it is detect the presence of H B Pylori, as one of the main causes While the patients who had PCI, scintigraphy of myocardial perfusion after placement of .Diagnostic methods applied: ENDOSCOPY with biopsy, namely Ureazes or CLO test -testi. stents, has improved in 8 patients, worsened in 8 patients and have had partial improve- An auxiliary method is also used x-rays with contrast. ment in 9 patients. The study included 200 patients, of whom 130 patients with Gastritis (80 female, 50 male). Discussion: In assessing the degree of homogenicity of accumulation of radiopharmacs With gastric ulcer were studied 50 patients (of which 30 females and 20 males). in the heart muscle during exercise and rest, it was determined a relative degree of ab- Conclusion: From the analysis made is proven that participation Helio B. Pylori infection is normality in perfusion of vascular sections and it was evaluated perfusion in all segments a high frequency of patients with gastritis and gastric ulcer, measures shall be taken with those regions. therapeutic antibioticotherapy & blocking of H2 receptors, as well as protein pump blocking. Remaining lesions after placement of stents were assessed for defects in accumulation. Keyword: gastritis, gastric ulcers, CLO - test. This is easier to detect with MPI with 99m Tc-MIBI. Distribution of radio pharmaceuticals in heart is distributed proportionally with circulation of the blood, with the fast cleansing from blood and slow cleansing from heart muscle. Preparation is simple and there were no adverse effects. Conclusion: According to our data, we have concluded that MPI is an appropriate method for the early detection, identification and monitoring patients with coronary artery disease (CAD). Keywords -SPECT-G-SPM, 99m Tc-MIBI, dual head gamma camera Ecam, coronarogarphy.

Congenital choledochal cyst -Case presentation Rashiti I, Shefkiu A, Mustafa S, Poroshtica I, Emini A

Message Body: Choledochus cysts are congenital anomalies of biliary paths These cystic dilatation may affects either extra or intrahepatic biliary path or both . Incidence: Are rare in western countries (1:100.000-150.000 newborn), but very frequent among asiatic countries . Approax. 33-50 % of reported cases comes from Japonia (1 case in 1000-3000 newborns ) Are more common among female gender. F:M ratio is 3-4: 1 History: Described for first time by Valter and Ezler in 1723. Douglas has done the first clinical publication and description in 1853 while comming up with

120 121 IMPORTANT ADDRESSES GENERAL INFORMATION OF TIRANA

PROFESSIONAL CONGRESS ORGANIZER Tirana is relatively a new city. & SCIENTIFIC SECRETARIAT It was founded in 1614 by Sule- jmen\r\nPashe Bargjini, feudal lord

TIONAL M NA ED R I E C A of that time from this region, who T L N I built\r\nthe first objects (a mosque, C A O IMCA I N N G A R B a bakery and a Turkish sauna) of ESS IN AL the new city. IMCA - International Medical Congress in Albania American Hospital I This settlement has been inhabited Rruga Lord Bajron, Tirana 1001 as early back as the Neolithic\r\npe- Phone +355 (0)42 35 75 35 riod. The ruins of die castle of first century A.D. which is likely\r\nto be Mobile +355 (0)68 200 65 56 the castle mentioned with the name Mobile +355 (0)67 401 76 79 Tirkan by Byzantine historian Procop Fax +355 (0)42 35 76 34 (VI century) have been unearthed in Email [email protected] the foot of Dajti mountain. Web imca.al There are some hypothesis about the origins of the name Tirana: SPONSORSHIP & EXHIBITION First, it is thought that Tirana comes from the word Theranda found in ancient Greek and Latin sources because those living there American Hospital called it Të ranat (“fallen material”), Rr. "Lord BAJRON", pranë S.U.T, because the plain was formed as a result of the strong materials which Laprakë, Tirana were brought by the water from the Sulejmen Pashe Bargjini Tel:+355 42 356 500 surrounding mountains. Fax:+355 42 357 634 Second, Tirana comes from Tirkan. Tirkan was a castle on the face of mount Dajti. E-mail: [email protected] Third, Tirana comes from Teheran, the capital of Iran, in remembrance of the victory by Sule- jman Pasha (founder of the city), head of the Turkish army during the campaign in Persia. CONGRESS VENUE Fourth, an old Tirana tale says that Sulejman Pasha took the name of the city from an old Tirana International Hotel lady whom he had met at the site where he was going to build the city. When Sulejman City Center,Scanderbeg Square, Tirana, Albania Pasha asked the old lady what she was doing she answered “ Po tir an (meaning Tel. +355 4 223 41 85; Fax. +355 4 223 41 88; “spinning silk”)”. E-mail: [email protected] Fifth “Tirana“ comes from old Greek, “Tyros” which means dairy. It is thought that this variant remained, because in the field of Tirana, the shepherds of the nearby areas used to trade dairy products. THE PARTICIPANTS’ REGISTRATION FEE INCLUDES: For the first time, Tirana’s name in the nowadays form was mentioned in 1418 in a Venetian • Admission to all scientific sessions document. • Admission to scientific poster area For the first time the registration of lands was done under the ottoman invasion in 1431- and the commercial exhibition 1432. Tirana had 60 inhabited areas with near 1000 houses and 7300 inhabitants. In the XV -century as Marin Barleti mentions, there was Tirana e Madhe and Tirana e Vogël (Big and • Congress materials (congress bag, final program, badge) Small Tirana). • Certificate of Attendance In the registrations of 1583, the area of Tirana resulted to have 110 inhabited areas, 2900 • Coffee Beaks houses and 20,000 inhabitants. • Simple Lunch The first district in Tirana was Bami. Sulejman Pasha, whose background was from Mullet, estab- • Opening Ceremony & Welcome Reception lished Tirana in 1614. First, he constructed a mosque, a bakery and a hamam (Turkish sauna). • Closing Ceremony

122 123 GENERAL INFORMATION OF TIRANA GENERAL INFORMATION OF TIRANA

Two centuries later, the direction The Tabak Bridge (in front of the of the city went to the family of Albanian parliament) dates back Toptani, from Kruja. The two to the 18th century. The Orthodox oldest neighborhoods of Tirana Church of Saint Prokop was built were that of Mujos and that of in 1780. The Catholic Church of Pazari, situated between the ac- Saint Maria was constructed in tual center and “Elbasani“ street, 1865 with the Austrian-Hungarian in the two sides of Lana. In 1703 expenses of the Emperor, Franc Tirana had 4000 inhabitants. In Josef. Bridge of Tabakëve and 1769 Tirana ‘s area exported bridge of Terzive (actually the 2600 barrels of olive oil and bridge of the “Elbasani” Street) 14.000 stuffed packages of date with the beginning of the XIX tobacco to Venetian trades. century. Kapllan Hysa‘s mosque In 1820 Tirana had 12.000 (near to the monument “Ushtari I inhabitants. In 1901 Tirana had Bazar, Tirana 1900 Panjohur “ (The Unknown soldier) Tabak Bridge 15.000 inhabitants. At the beginning of the XX - century Tirana had 140.000 olive trees, 400 was constructed in 1816. oil mills, while the market numbered 700 shops. In 1838 Tirana had 38.000 inhabitants. In 1945 it had 60.000 inhabitants. The Library was established in 1922 and had 5000 volumes. The Fortress of Petrela, 12 km far from The mosque in the center of Tirana, called the mosque of Ethem Beu began its construction Tirana, dates IV century BC. It took in 1789 by Molla Beu from Petrela. The mosque was finished in 1821 from Molla Beu‘s son, the actual form in the XIII century, Sulejman Pasha‘s grandnephew. The best masters of Albania worked for it. Haxhi Et’hem under the rule of Topiaj and later Beu started the Clock’s Tower around 1821-1822 and it was finished with the help of the passed to the property of Kastriots. richest families of Tirana. The family of Tufina made the restoration of the Clock. In 1928 the Albanian state bought in Germany a modern clock and the Tower was raised in the height of Tirana become the temporary 35 m. During the World War II, the Clock was damaged, but it restarted work in July 1946. capital on 8 February appointed by the Congress of Lushnja Tirana 1929 and finally took this status on December 31, 1925. The Fortress of Petrela Estef Frashëri compiled the first regulatory plan of the city in 1923. “Durrësi“ Street was opened in 1922 and was called “Nana Mbretneshë “(Queen Mother). A lot of houses and yards were demolished for its construction. The existing Parliamentary building was raised 1924 and firstly, it served as a Club of Officers. There, on September 1928, Ahmet Zogu proclaimed the Monarchy. Tirana is the world main center of bektashis from 1925, a year when the bektashis were stopped and expulsed by Turkey. The center of Tirana is projected by well-known Italian architects of Mussolini period, Flor- estano de Fausto and Armando Brasini.

Their works are the Palace of Brigades (the ex-Reigning palace), the ministries buildings, the National Bank and the Municipality. “Dëshmoret e Kombit “ (Martyrs of the Nation) boulevard was constructed in 1930 with the name “Zogu I“ boulevard. In the communism period, the part from “Skanderbeg“ square up to the Train Station was named “Stalin“ boulevard.

The Palace of Culture where the Theatre of Operas and Ballet and the National Library stand was finished in 1963. It was raised on the ex-old Trade of Tirana and the ex- soviet president Nikita Hrushov put on the first brick in 1959.

124 125 GENERAL INFORMATION OF TIRANA

Skenderbeg Square

The monument of Skanderbeg built in 1968 is a work of Odhise Paskali in collaboration with Andrea Mana and Janaq Paço. It was placed there for the occasion of the 500-th anniversa- ry of the death of our national hero.

The monument “Mother Albania” (Nënë Shqipëri), 12 m high was inaugurated in the ceme- tery “Dëshmoret e Kombit “ in 1971.

The Academy of Sciences was finished on April 1972.

The Gallery of Figurative Arts was created in 1976 and it includes around 3200 works of Albanian and foreign authors.

The National Historic Museum was built in 1981 and the ornament on its frontal part is called “Albania“.

The International Cultural Center, the ex- museum “Enver Hoxha“ was inaugurated in 1988. “The Pyramid“ was projected by a group of architects under the direction of Pranvera Hoxha and Klement Kolaneci.

In 1990 Tirana had 250.000 inhab- itants. Actually, the massive over- SERVICE, EXPERIENCE, HEALTH run of inhabitants from all the other parts of the country in the capital has increased the population of American Hospital, Embrace life! Tirana to over 700.000 inhabitants. In 2000 the center of Tirana, from Buildings in Tirana the Central University Corpus and up to the “Skanderbeg“ square was declared as Cultural Assemble with particular values under the state ‘s protection, that same year in this area began a restoring process named “Return to Identity.” 042 35 75 35 126 TIONAL M NA ED R I E C T A L N I

C A O IMCA I N N G A R B ESS IN AL

INTERNATIONAL MEDICAL CONGRESS IN ALBANIA