The 6th Albanian Congress of Trauma and Emergency Surgery

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.

Out of Hospital Cardiac Arrest: A Case Report

Introduction: Sudden OHCA (Out of hospital cardiac arrest) is the third leading cause of death in industrialized nations. With more than 60% of cardiovascular deaths resulting from cardiac arrest, it remains the leading cause of death worldwide. Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). VF is the most commonly identified arrhythmia in cardiac arrest patients. Urgent medical treatment includes cardiopulmonary resuscitation and early defibrillation. Material and Methods: Materials for this case report are data collected from the medical records of the Emergency Medical Center of Sarajevo protocol of patients. Case report: Our case report is presented with 59 years old man who had OHCA in his apartment. The initial rhythm was VF, and cardiopulmonary resuscitation was provided due to the Advanced life support guidelines to shockable rhythms. It was delivered 3 DC Shock-s (200J, 300J, 360 J) with the biphasic defibrillator, it was administered 1mg Adrenalin and performed endotracheal intubation. After the third DC shock, we got the return of spontaneous circulation ROSC. The patient was transferred to the University hospital, were he was stabile, and PCI of the LAD was performed as per the standard protocol. Echocardiography performed in the CCU revealed hypokinesia of RV, with preserved systolic function. On hospital day 7 he had a full neurological recovery. He was conscious, oriented, with normal breathing, blood pressure 125/79mmHg, sPO2 99, ECG: sinus rhythm, fr 87/min, without pathological signs. Echocardiography revealed the reduced systolic function of the left ventricle, with mitral regurgitation MR+2. Discussion: Out-of-hospital cardiac arrest (OHCA) is a major health problem in Europe and in the United States. The numbers of patients who have OHCA annually in these two parts of the world have traditionally been reported to be 275,000 and 420,000 respectively. The success of resuscitation depends on many factors: well-organized health care, organization of outpatient emergency services, but primarily when it comes to OHCA, education of the population on Basic life support, and early Cardiopulmonary resuscitation and use of AED (automated external defibrillator).

ACTES 2020 - Abstracts Book; The 4th Albanian Congress of Trauma and Emergency Surgery

The spread of the Corona virus, first identified in China in December 2019, spread to Europe and was recognized as a pandemic by the World Health Organization (WHO) on March 11th.Measures to achieve social distancing have been implemented in different periods and rates of time around the World.The traumatic and non-traumatic emergency patient needs timely and competent care throughout the treatment chain, relying on broad-based competence, multidisciplinary teamwork and communication. In a medical field that is moving towards increasing subspecialization, it is easy to see how the quality of care of these groups of patients can be improvedACTES throughout its topic focuses on these important groups of patients, patients with critical illness and surgical impairment, during the development of ACTES as an online event will try to bring together groups of health professionals to improve, optimize, inspire, and to provide the opportunity for networking and learning from each other.While of course there is a major focus on managing Covid-19 patients at the moment and for a longer period thereafter, the greatest impact on mortality and morbidity is likely to be in those patients who may not have access to care specialized due to lack of resources or due to less attention. We want to take this opportunity to remind everyone that we as traumatic and non-traumatic emergency surgeons have a duty to insure the sick and seriously injured during this period as well.

Influence of gender, ASA physical status, the location of a tumor and stage of the disease on the survival rate in patients with rectal cancer after surgery

Background

There are limited data describing different factors that influence survival rate of patients with rectal cancer.

Aims

Our aim was to determine the influence of patient gender, American Society of Anesthesiologists (ASA) physical status, the location of the tumor and stage of the disease on the patient survival rates after excision of rectal cancer.

Settings and Design

We included 385 patients who were operated between 2004 and 2014 in the University Clinical Center Maribor. The patients were treated due to rectal adenocarcinoma. We assessed survival rates according to gender, ASA physical status, the location of the tumor and stage of the disease with different statistical methods.

Subjects and Methods

To find the extent of correlation between factors and survival rate, we used means and medians, Log Rank test, Breslow test and Tarone-Ware test.

Results

According to patient gender, survival rate did not differ significantly (P > 0.05), however ASA physical status (P < 0.05), location of the tumor (P < 0.05) and stage of the disease (P < 0.05) significantly affected the survival rates.

Conclusions

Our study showed that gender does not have a significant impact on survival rate as oposed to ASA physical status, the location of the tumor and stage of the disease.

Surgical Treatment of Rectal Prolaps in 83 Year Old Patient. A Case Report

Background: Prolapse of the rectum is an uncommon problem. It is defined as a protrusion of the rectum through the anus and can cause disability. There is no concensus in literature which surgical approach is the most appropriate. The aim of our case report is to share our experiance and results of the Altemeier procedure.  Case report: 83 years old female patient was admited to the department for general and abdominal surgery. She was diagnosed with rectal prolapse, which could not be reponated. She felt pain and was incontinent.  Results: We decided that optimal treatment for the patient was operation. Altemeier approach was performed. In our opinion, we achieved a favorable outcome.  Conclusion: As stated above there is no clear concensus on which treatment is the most appropriate for rectal prolaps. In our case after careful consideration, we decided that the Altemeier approach was the best solution for the patient.   

Fournier Gangrene in the 75 Year Old Patient

Aim: The aim of this article is to describe an example of the sick patient with Fournier gangrene and demonstrate the process of his treatment and the solving of problems that had incurred. Case report: The patient is a 70-year-old man who was hospitalized for Fournier gangrene in the perineal region. We performed radical necrectomy, drainage of perianal abscess, and transversostomy. Based on wound culture we prescribed antibiotics Amoksiklav and Ciprobay. Later there was a complication in the form of a decompensated adhesion ileus, which required a re-operative intervention. Conclusion: Fournier gangrene is a rare disease that usually affects males. The disease starts with swelling, cellulitis,higher temperature and odor. Our example describes the successful treatment of the disease with emergency surgery and re-operative intervention.

Road Accidents Management and Emergency Medicine Care

Background:  Traffic accident is when only material damage is caused to the vehicle, track or environment, and there are no casualties. Traffic disaster is such an event in which, besides the material damage, there are human casualties. Traffic disaster is such an event in which, besides the material damage, there are human casualties. Aim:  Provision of emergency medical care in all phases of the management of injured persons in traffic accidents with basic and abnormal trauma support in order to reduce: morbidity, validity and mortality and increasing the quality of EMS. Materials and methods:  Samples of the survey were only injured in traffic accidents and the main causes were; age, sex, place of residence, seasons, weekdays and months, sleepwalking, drug use, alcohol consumption, and medical assessment, poor quality of roads, speed overtaking, car testing, illness, mobile phone use, eating in the car, radio CD player. Results: The research material was obtained from the UCCK - Clinic Clinic in Pristina archive for January - December 2015 and January - October 2016. Research samples were only injured in traffic accidents. In Kosovo, the Emergency Clinic for January-December was 55.294 / 9.32% and 66 injured / 0.11%. Over 3 400 people die in the world's streets every day and tens of millions of people are injured. Conclusions: EMS should be equipped with medical staff, medicines, medical equippment, concrete materials, ambulances with the aim of providing basic and advanced care to the nearest hospital. Educate and train emergency medical professionals with basic and advanced trauma training courses, especially the hospital and prehospital level, and be incorporated as a first class subject at all levels of school.

[ETIOLOGY OF PROSTATE CANCER]

Prostate cancer is now recognized as one of the most important medical problems in male population. Epigenetic regulation of gene expression by promoter methylation and histone acetylation, proinflammatory enzyme cyclooxygenase-2 and somatic mutations in a variety of genes with diverse biological functions has been implicated in prostate cancer development and progression.

Urinary retention presenting as complete bowel obstruction

A 59-year-old male was admitted to hospital for clinical and radiological signs of large bowel obstruction with clinical signs of generalized peritonitis. As such, he was scheduled to undergo emergency exploratory laparotomy. During preoperative preparation, over 2000 mL of urine was obtained after catheterization. We suggested re-evaluation, and after several hours the symptoms resolved. Although rare, pressure from the distended bladder due to urinary retention can cause complete bowel obstruction and signs of peritonitis. If a large volume of urine is obtained during preoperative preparation for mechanical bowel obstruction, it is recommended to re-evaluate the patient to avoid unnecessary surgery and imaging studies.

Aortoduodenal fistula three years after aortobifemoral bypass: case report and literature review

Secondary aortoenteric fistulas (SAEF) are a relatively rare but dangerous complication of aortal reconstructive surgery. We present a patient that underwent aortobifemoral bypass three years before developing the signs of aortoenteric fistula, and we reviewed the literature on the topic. Since the clinical signs are nonspecific, physicians should have a high index of suspicion for SAEF in patients who underwent aortal reconstructive surgery. The most useful diagnostic tools for stable patients are upper gastrointestinal endoscopy and computed tomography scan with contrast that can, in combination with history and clinical signs, enable accurate diagnosis in more than 90% of patients. Unstable patients with suspected aortoenteric fistula should undergo exploratory laparotomy. The treatment of choice is open surgery with graft excision, wide debridement of infected tissue, bowel repair or resection followed by an extra-anatomic bypass or in situ placement of a new graft. Early postoperative mortality remains high, around 30% in most analyses. Currently there are no guidelines for the diagnosis and management of SAEF, so individualized approach is necessary for each patient.

Differential diagnosis and clinical relevance of pneumobilia or portal vein gas on abdominal x-ray

The purpose of the article is to present the differential diagnostic criteria between pneumobilia (air in the biliary system) and portal vein gas on abdominal x-ray. Differential diagnosis is essential because of its influence on patient management. Two patients are presented, one with pneumobilia and the other with portal vein gas on abdominal x-ray, with review of the relevant literature. Pneumobilia is often iatrogenic and even in cases of cholecystitis it is never a sole indication for emergency surgery. Patients with pneumobilia on abdominal x-ray can always be investigated further. On the other hand, the presence of air in portal vein is in most cases a sign of acute mesenteric ischemia. In adults with abdominal pain indicating intestinal ischemia (pain that is 'out of proportion' to clinical abdominal examination findings), it is an indication for emergency exploratory laparotomy. It is vital to act early when intestinal ischemia is suspected.

Melanoma of the glans penis and urethra

Primary melanoma of the glans or male urethra is a rare malignant tumor with high mortality. We searched PubMed and found 129 articles reporting on 220 patients. All articles were case reports or case series. Median patient age was 65 years. Median survival was 28 months, with 5-year survival in approximately 10%. All patients who survived over 5 years had a localized disease (stage I/A) with invasion depth <3-3.5 mm. Wide local excision with sentinel lymph node biopsy is the treatment of choice for patients with localized disease. For advanced disease, the prognosis is poor.

Fournier's gangrene: etiology and outcome analysis of 41 patients

INTRODUCTION

Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area with high mortality.

MATERIALS AND METHODS

A retrospective review included 41 patients diagnosed with FG in our hospitals from 1995 to 2010, divided into survivors and nonsurvivors. We analyzed anamnestic, clinical and laboratory data.

RESULTS

The mortality rate was 36.6% (15/41 patients). Elevated heart and respiratory rates, high serum creatinine, low serum bicarbonate, pre-existing kidney disease, and higher median extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension below 90 mm Hg were also predictive for higher mortality. The median FG severity index (FGSI) score was higher in nonsurvivors (11 compared to 6, p < 0.0001). No cases of testicular necrosis were noted.

CONCLUSION

Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were also positively associated with mortality.

Abdominal pain and two x-rays: spot the difference

We present two patients with air found in the right upper quadrant on standard abdominal x-ray. One was diagnosed with pneumobilia and underwent elective surgery for a bilioenteric fistula. The other was diagnosed with portal vein gas and underwent an emergency exploratory laparotomy at which a superior mesenteric artery embolism was found. The differential diagnostic criteria for pneumobilia and portal vein gas are described. If portal venous gas is found on x-ray in patients with abdominal pain, it is recommended that management is aggressive, meaning an emergency exploratory laparotomy, because mortality in such cases is approximately 75%.

Advantages of new materials in fascia transversalis reinforcement for inguinal hernia repair

PURPOSE

We investigated whether new absorbable materials can be used in the treatment of inguinal hernia with the same efficacy as the traditionally used polypropylene.

METHODS

We compared local tissue inflammation and fibrous reaction, postoperative complications (bleeding, wound haematoma, wound infection) and postoperative recovery time (time of mobilisation) in rats (Fischer strain) after implantation of a polypropylene mesh (PPM) (Prolene, Ethicon, Bracknell, UK) or a dual component fibrin mesh (DCFM) (Tachosil, Nycomed, Marlow, UK), between the muscle layer and the fascia transversalis defect. We further compared direct hernia repair methods using Lichtenstein's operation in humans after implantation of either PPM or DCFM for fascia transversalis reinforcement regarding postoperative pain and complications, time needed for patient mobilisation, and recurrence.

RESULTS

The results show that implantation of DCFM in rats resulted in milder inflammatory response and thicker fibrous tissue formation. Patients implanted with DCFM had significantly lower postoperative pain scores on a visual-analogue scale and lower analgesic use. The overall incidence of postoperative complications was significantly reduced with the use of DCFM. The incidence of recurrence after 24-month follow-up was the same in both groups.

CONCLUSION

This study has shown that DCFM has the same short-term efficacy in hernia treatment as the standard PPM, with a reduction in postoperative pain and analgesic use, and a decrease in overall postoperative complications. In the rat model, DCFM resulted in milder inflammatory response and thicker fibrous plate than the PPM. Further biomechanical testing and longer follow-up is necessary, but initial results are promising.

Surgical treatment of pathologic fractures in patients with metastatic tumors

The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. Proximal femoral fractures were treated with hip arthroplasty or dynamic hip screw. There were 2 amputations performed: one case of pathologic fracture of tibia and one case of humeral fracture. The present study compares results between two group of patients. We noted: age, gender, fracture site, choice of the surgical procedure, hospital stay, need for analgesia after surgery, postoperative complications, and reached level of physical activity after surgery. The mean survival rate was 8.1 months. Seventeen patients experienced postoperative complications. We also found statistically significant improvement in functional scores (MSTS and TESS) in surgically treated patients with pathologic fractures. There are many different techniques of surgical treatment of pathologic fractures caused by skeletal metastases including arthroplasty or a combination of internal fixation combined with polymethyl methacrylate (PMMA) that provides immediate fixation and stability. The present study showed that surgical treatment of pathologic fractures caused by skeletal metastases in vast majority of cases provides bone healing after pathologic fracture, with significant improvement of physical activity and rehabilitation in the investigated group.

[Physiological and clinical outcome of open and closed hemorrhoidectomy compared with stapling method according to long]

AIM OF STUDY

The aim of the study was to evaluate and inaugurate a new method for the treatment of hemorrhoidal disease with the usage of a stapling device (Long's method).

PATIENTS

The study spanning two years (September 1999 to June 2001), included 97 hospitalized patients aged 19-75 years, 42 (43.3%) female and 55 (56.7%) male, exhibiting symptoms and signs of stage III hemorrhoidal disease. The patients were divided into three groups: (a) 35 patients treated with open hemorrhoidectomy for stage II hemorrhoidal disease; (b) 30 patients treated with closed hemorrhoidectomy for stage III hemorrhoidal disease; and (c) 32 patients treated for stage III hemorrhoidal disease by a stapling device, i. e. Long's method.

RESULTS

Study results showed no statistically significant differences between either open or closed hemorrhoidectomy and Long's method in the following parameters: urinary retention, early bleedings during the first 48 hours, late bleedings, incontinence, anal stenosis, and relapses. Statistically significant differences between the groups of patients treated with either open or closed hemorrhoidectomy and those treated with Long's method were recorded in the following parameters: healing time, subjective feeling of pain, pain pro rata to quantity, and use of analgesics.

CONCLUSION

Hemorrhoidectomy by Long's method is an ideal surgical procedure because it allows to realize to goals set on implementing new therapeutic methods: to achieve healing without relapse, to reduce postoperative pain, anal stenosis and incontinence after hemorrhoidectomy, to preserve the physiology of the anal canal, and to familiarize less skilled proctology surgeons with the simplicity of the method.