Introduction: Abdominal aneurysm is considered a formidable pathological condition that requires prompt treatment. Its progressive increase leads to rupture and massive internal bleeding, which requires the most effective medical care. However, despite the improvement in medical equipment and postoperative care, mortality due to ruptured abdominal aneurysms is still close to 50%, which is primarily related to the severity of the pathology and open surgical intervention. Materials and Methods: 46 patients diagnosed with rupture of the abdominal aorta took part in the study. Selection criteria were a history of abdominal aortic rupture, conservative/operative treatment for the disease, and absence of other complications (acute renal failure, liver infarction) that could affect the results of the study. Results: Since January 2018, 46 cases of ruptured AAAs have been diagnosed. In all forty-six cases, surgical intervention was used: open surgery or endovascular technique. All 100% of patients had a previous history of diagnosed abdominal aortic aneurysm, for which they underwent periodic ultrasound examinations. As a result of the study, it was found that endovascular aortic aneurysm correction is the optimal method for both planned and emergency treatment of aortic aneurysm and its rupture. According to the Cochrane Specialized Register, it was established that endovascular repair is associated with a reduction in early morbidity and mortality after abdominal aneurysm, compared with other methods of surgical treatment. Furthermore, the study found that, unlike open surgery methods, endovascular techniques are associated with a lower risk of complications in the form of intestinal ischemia. Conclusions: Inferior quality studies and lack of information limit the conclusions of this review. From the statistical data shown in this paper, it can be concluded that there is a difference between endovascular and open methods of treatment of abdominal aortic aneurysm rupture. Mortality within the first 30 days after treatment and short-term complications are significantly lower in patients using EVAR. Systemic complications are also more prevalent in patients who were prescribed open surgical treatment.
{"title":"Emergency Treatment of Ruptured Abdominal Aneurysm","authors":"E. Nuellari, Maxim Llambro","doi":"10.32391/ajtes.v8i1.358","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.358","url":null,"abstract":"Introduction: Abdominal aneurysm is considered a formidable pathological condition that requires prompt treatment. Its progressive increase leads to rupture and massive internal bleeding, which requires the most effective medical care. However, despite the improvement in medical equipment and postoperative care, mortality due to ruptured abdominal aneurysms is still close to 50%, which is primarily related to the severity of the pathology and open surgical intervention. \u0000Materials and Methods: 46 patients diagnosed with rupture of the abdominal aorta took part in the study. Selection criteria were a history of abdominal aortic rupture, conservative/operative treatment for the disease, and absence of other complications (acute renal failure, liver infarction) that could affect the results of the study. \u0000Results: Since January 2018, 46 cases of ruptured AAAs have been diagnosed. In all forty-six cases, surgical intervention was used: open surgery or endovascular technique. All 100% of patients had a previous history of diagnosed abdominal aortic aneurysm, for which they underwent periodic ultrasound examinations. \u0000As a result of the study, it was found that endovascular aortic aneurysm correction is the optimal method for both planned and emergency treatment of aortic aneurysm and its rupture. According to the Cochrane Specialized Register, it was established that endovascular repair is associated with a reduction in early morbidity and mortality after abdominal aneurysm, compared with other methods of surgical treatment. Furthermore, the study found that, unlike open surgery methods, endovascular techniques are associated with a lower risk of complications in the form of intestinal ischemia. \u0000Conclusions: Inferior quality studies and lack of information limit the conclusions of this review. From the statistical data shown in this paper, it can be concluded that there is a difference between endovascular and open methods of treatment of abdominal aortic aneurysm rupture. Mortality within the first 30 days after treatment and short-term complications are significantly lower in patients using EVAR. Systemic complications are also more prevalent in patients who were prescribed open surgical treatment.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"27 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139610641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Haxhirexha, A. Ademi, A. Dogjani, Roland Alili, Ferizat Dika – Haxhirexha, Blerim Fejzuli, Teuta Emini – Rushiti
Introduction: Diverticulitis represents a relatively common pathology within the gastrointestinal tract. While diverticula can occur throughout the digestive system, their prevalence is notably higher in the left colon, particularly in the sigmoid region. This condition predominantly affects middle-aged and elderly males. The most effective diagnostic methods for this disease are colonoscopy and computed tomography (CT) with contrast. Although severe complications of diverticulitis are infrequent, the optimal classification of these complications has been described by Hinchey. The article aims to show the case of a young patient with complicated diverticulitis with perforation and generalized peritonitis, classified as stage III-IV, according to Hinchey. Case report: A 43-year-old female patient was urgently admitted to the General Surgery Clinic at Tetovo Clinical Hospital, presenting with severe generalized abdominal pain and signs of peritoneal irritation. Comprehensive diagnostic imaging revealed a large retroperitoneal abscess located above the psoas muscle, accompanied by a significant accumulation of free fluid, suspected to be pus, in the abdominal cavity. Following initial resuscitation, surgical intervention was undertaken. Intraoperative findings included advanced inflammatory changes in the sigmoid colon, characterized by thickened fibrotic walls and a partially constricted lumen. A large abscess was also identified in the retroperitoneal space between the spleen and left kidney. Given these findings, resectioning the distal descending colon and most of the sigmoid colon was considered necessary. The retroperitoneal abscess was incised, its contents aspirated, and a thorough cavity debridement was performed. Subsequently, the Hartmann procedure was executed. Postoperatively, due to the patient's deteriorating condition, she was transferred to the intensive care unit for continued treatment. The patient was discharged from the hospital in stable condition on the tenth day following the surgery. Conclusion: While complications from sigmoid diverticula are uncommon, they can occasionally be extremely severe and pose a significant risk to patient survival.
导言：憩室炎是胃肠道中一种较为常见的病理现象。虽然憩室可发生于整个消化系统，但其发病率明显高于左侧结肠，尤其是乙状结肠区域。这种疾病主要影响中老年男性。该病最有效的诊断方法是结肠镜检查和造影剂计算机断层扫描（CT）。虽然憩室炎的严重并发症并不常见，但 Hinchey 已描述了这些并发症的最佳分类。本文旨在展示一例年轻患者的病例，该患者患有复杂性憩室炎，并伴有穿孔和全身腹膜炎，根据 Hinchey 的分类，患者属于 III-IV 期。病例报告：一名 43 岁的女性患者因全身剧烈腹痛和腹膜刺激症状被紧急送入泰托沃临床医院普外科门诊。综合影像诊断显示，腹膜后巨大脓肿位于腰肌上方，腹腔内有大量游离液体积聚，疑为脓液。经过初步抢救后，患者接受了手术治疗。术中发现，乙状结肠出现晚期炎症病变，纤维化的肠壁增厚，肠腔部分狭窄。在脾脏和左肾之间的腹膜后间隙还发现了一个大脓肿。鉴于这些发现，医生认为有必要切除远端降结肠和大部分乙状结肠。腹膜后脓肿被切开，内容物被吸出，并进行了彻底的空腔清创。随后，实施了哈特曼手术。术后，由于患者病情恶化，她被转入重症监护室继续接受治疗。术后第十天，患者病情稳定出院。结论虽然乙状结肠憩室的并发症并不常见，但偶尔也会非常严重，对患者的生存构成重大风险。
{"title":"Management of Perforated Sigmoid Diverticulitis with Associated Retroperitoneal Abscess and Generalized Peritonitis","authors":"K. Haxhirexha, A. Ademi, A. Dogjani, Roland Alili, Ferizat Dika – Haxhirexha, Blerim Fejzuli, Teuta Emini – Rushiti","doi":"10.32391/ajtes.v8i1.379","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.379","url":null,"abstract":"Introduction: Diverticulitis represents a relatively common pathology within the gastrointestinal tract. While diverticula can occur throughout the digestive system, their prevalence is notably higher in the left colon, particularly in the sigmoid region. This condition predominantly affects middle-aged and elderly males. The most effective diagnostic methods for this disease are colonoscopy and computed tomography (CT) with contrast. Although severe complications of diverticulitis are infrequent, the optimal classification of these complications has been described by Hinchey. \u0000The article aims to show the case of a young patient with complicated diverticulitis with perforation and generalized peritonitis, classified as stage III-IV, according to Hinchey. \u0000Case report: A 43-year-old female patient was urgently admitted to the General Surgery Clinic at Tetovo Clinical Hospital, presenting with severe generalized abdominal pain and signs of peritoneal irritation. Comprehensive diagnostic imaging revealed a large retroperitoneal abscess located above the psoas muscle, accompanied by a significant accumulation of free fluid, suspected to be pus, in the abdominal cavity. Following initial resuscitation, surgical intervention was undertaken. Intraoperative findings included advanced inflammatory changes in the sigmoid colon, characterized by thickened fibrotic walls and a partially constricted lumen. A large abscess was also identified in the retroperitoneal space between the spleen and left kidney. Given these findings, resectioning the distal descending colon and most of the sigmoid colon was considered necessary. The retroperitoneal abscess was incised, its contents aspirated, and a thorough cavity debridement was performed. Subsequently, the Hartmann procedure was executed. Postoperatively, due to the patient's deteriorating condition, she was transferred to the intensive care unit for continued treatment. The patient was discharged from the hospital in stable condition on the tenth day following the surgery. \u0000Conclusion: While complications from sigmoid diverticula are uncommon, they can occasionally be extremely severe and pose a significant risk to patient survival.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"78 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Nuellari, S. Kuçi, Albana Kenga, D. Kosovrasti, A. Ibrahimi, E. Bejko
Introduction: Surgical treatment of abdominal aortic aneurysms poses a significant challenge in the field of vascular surgery, with numerous factors influencing operative technique and surgical outcome. This study aimed to assess the outcomes of open surgical treatment for patients with abdominal aortic aneurysms at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana and provide recommendations for improving outcomes. Material and Methods: A single-center, non-randomized, retrospective study of the results of open surgical treatment of abdominal aortic aneurysms in 206 patients from January 2008 to December 2015 was performed at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana. The study only included patients with a histologically confirmed diagnosis of abdominal aortic aneurysm, while patients with ruptured abdominal aortic aneurysm were excluded. The study evaluated the incidence of abdominal aortic aneurysms, clinical and imaging findings of the disease (ultrasound, tomographic, and arteriographic), frequency of involvement of the iliac artery in the pathological process, and postoperative complications. Transabdominal access was the most commonly utilized, while retroperitoneal access was deemed the safest. No significant differences in recurrence rates were noted between the two approaches. Results: During the study period, 206 patients underwent surgery for AAA and met the inclusion criteria. Of these, 188 (91.3%) were male and 18 (8.7%) were female. The mean age of the patients was 67.8±5.7 years, with 67.7±5.9 years for men and 69±3.1 years for women. There were no statistically significant differences in age between genders (p>0.05). Conclusion: In all other cases of abdominal aortic aneurysms, surgical treatment should be strongly recommended. Finally, given the clinical benefits of using surgical treatment of asymptomatic aneurysms to reduce mortality, it is necessary to conduct an economic assessment of the feasibility of abdominal aortic aneurysms screening in the population over 55 of the age of both sexes.
{"title":"Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study.","authors":"E. Nuellari, S. Kuçi, Albana Kenga, D. Kosovrasti, A. Ibrahimi, E. Bejko","doi":"10.32391/ajtes.v8i1.356","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.356","url":null,"abstract":"Introduction: Surgical treatment of abdominal aortic aneurysms poses a significant challenge in the field of vascular surgery, with numerous factors influencing operative technique and surgical outcome. \u0000This study aimed to assess the outcomes of open surgical treatment for patients with abdominal aortic aneurysms at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana and provide recommendations for improving outcomes. \u0000Material and Methods: A single-center, non-randomized, retrospective study of the results of open surgical treatment of abdominal aortic aneurysms in 206 patients from January 2008 to December 2015 was performed at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana. The study only included patients with a histologically confirmed diagnosis of abdominal aortic aneurysm, while patients with ruptured abdominal aortic aneurysm were excluded. \u0000The study evaluated the incidence of abdominal aortic aneurysms, clinical and imaging findings of the disease (ultrasound, tomographic, and arteriographic), frequency of involvement of the iliac artery in the pathological process, and postoperative complications. Transabdominal access was the most commonly utilized, while retroperitoneal access was deemed the safest. No significant differences in recurrence rates were noted between the two approaches. \u0000Results: During the study period, 206 patients underwent surgery for AAA and met the inclusion criteria. Of these, 188 (91.3%) were male and 18 (8.7%) were female. The mean age of the patients was 67.8±5.7 years, with 67.7±5.9 years for men and 69±3.1 years for women. There were no statistically significant differences in age between genders (p>0.05). \u0000Conclusion: In all other cases of abdominal aortic aneurysms, surgical treatment should be strongly recommended. Finally, given the clinical benefits of using surgical treatment of asymptomatic aneurysms to reduce mortality, it is necessary to conduct an economic assessment of the feasibility of abdominal aortic aneurysms screening in the population over 55 of the age of both sexes. \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"5 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139524225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: One topic still debated in the scientific community and beyond is the influence of genetic or environmental factors on an individual's behavior. The essence of this debate lies in discussing the role and impact of genetic and environmental factors on an individual's behavior, known otherwise as the nature-nurture debate. In a survey-type study, we sought to assess perceptions of the nature-nurture argument among first-year technical medical sciences students at the University of Tirana, Albania. Materials and Methods: A cross-sectional study was conducted using a survey-type questionnaire on a sample of 100 first-year medical university students at the Faculty of Medical Technical Sciences, University of Medicine in Tirana, in April 2023. The questionnaire was based on six specific questions underlying the potential impact of genetic (nature) and environmental factors (nurture) influencing certain types of behavior, such as personality, sexual orientation, and intelligence—or psycho-emotional stress. Results: According to the analysis of the data collected on our sample of students, 84.9% of them perceive that acquired factors (nurture) influence more than innate factors (nature) in forming personality traits, whereas 15.1% perceive the opposite. After adjusting for potential confounders, environmental factors remained statistically significant compared with genetic factors (odds ratio 1.42, 95% CI 0.65 to 0.97). Conclusion: Genetic and sociological research has shown that genetics, life experiences, and environmental factors influence the expression of key traits in shaping behavior. In this study, we confirm the perception of this interaction among medical students. For some aspects of behavior, students are less likely to believe in genetic explanations and more likely to believe in environmental causes.
{"title":"Current Perception of Nature vs.Nurture Debate among Students at the University of Medicine of Tirana","authors":"Ervin Marku, Xhesika Miska, Ledi Neçaj","doi":"10.32391/ajtes.v8i1.361","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.361","url":null,"abstract":"Introduction: One topic still debated in the scientific community and beyond is the influence of genetic or environmental factors on an individual's behavior. The essence of this debate lies in discussing the role and impact of genetic and environmental factors on an individual's behavior, known otherwise as the nature-nurture debate. \u0000In a survey-type study, we sought to assess perceptions of the nature-nurture argument among first-year technical medical sciences students at the University of Tirana, Albania. \u0000Materials and Methods: A cross-sectional study was conducted using a survey-type questionnaire on a sample of 100 first-year medical university students at the Faculty of Medical Technical Sciences, University of Medicine in Tirana, in April 2023. The questionnaire was based on six specific questions underlying the potential impact of genetic (nature) and environmental factors (nurture) influencing certain types of behavior, such as personality, sexual orientation, and intelligence—or psycho-emotional stress. \u0000Results: According to the analysis of the data collected on our sample of students, 84.9% of them perceive that acquired factors (nurture) influence more than innate factors (nature) in forming personality traits, whereas 15.1% perceive the opposite. After adjusting for potential confounders, environmental factors remained statistically significant compared with genetic factors (odds ratio 1.42, 95% CI 0.65 to 0.97). \u0000Conclusion: Genetic and sociological research has shown that genetics, life experiences, and environmental factors influence the expression of key traits in shaping behavior. In this study, we confirm the perception of this interaction among medical students. For some aspects of behavior, students are less likely to believe in genetic explanations and more likely to believe in environmental causes.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"59 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Lenjani, A. Dogjani, N. Arslani, Ilirian Lenjani
Introduction: Patients with life-threatening injuries are a significant concern in the emergency department (ED). These injured people require timely care, as their lives depend on it, and a longer wait can result in organ failure, irreversible damage, and poor survival outcomes. The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained for the injured in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival. Material and Methods. In this retrospective study, we researched and analyzed the data of patients with critical traumatic injuries in DE treated from January-December 2021 Results. During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level. Conclusion. During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level. Also, these critically injured require structured and well-organized care in the DE in the resuscitation room, with educated medical staff, nurses, and support staff trained with the mandatory BLS, BTLS, PHTLS, and ATLS courses, implementing and developing the algorithms standardized for structured care of the critically injured. Keywords: DE, traumatic, life-threatening medical emergency, CPR. monitoring, management,
{"title":"Challenges with Life-Threatening Injuries in the Room of Reanimation.","authors":"B. Lenjani, A. Dogjani, N. Arslani, Ilirian Lenjani","doi":"10.32391/ajtes.v8i1.363","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.363","url":null,"abstract":"Introduction: Patients with life-threatening injuries are a significant concern in the emergency department (ED). These injured people require timely care, as their lives depend on it, and a longer wait can result in organ failure, irreversible damage, and poor survival outcomes. \u0000The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained for the injured in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival. \u0000Material and Methods. In this retrospective study, we researched and analyzed the data of patients with critical traumatic injuries in DE treated from January-December 2021 \u0000Results. During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level. \u0000Conclusion. During the study period, we analyzed 75,899 ED patients. Of these, 627 cases, or 0.83%, were severely injured and traumatically admitted as a life-threatening traumatic medical emergency in the resuscitation room. Attacked age were males 507 cases or 80.87% and females 120 cases 19.13% and over 16 were 46 cases or 6.67%. The main problem in the admission of the sick was the injured with disorders of consciousness, shock, cardiac, and respiratory failure, as well as issues at the systemic level. \u0000Also, these critically injured require structured and well-organized care in the DE in the resuscitation room, with educated medical staff, nurses, and support staff trained with the mandatory BLS, BTLS, PHTLS, and ATLS courses, implementing and developing the algorithms standardized for structured care of the critically injured. \u0000Keywords: DE, traumatic, life-threatening medical emergency, CPR. monitoring, management, \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"39 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139610312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nerses Kyurkchyan, Fabien Masse, Vahe Kharatyan, Khachatur Kyurkchyan
Introduction: Caudal anesthesia is a standard procedure in pediatric anesthesia because of its excellent safety and success rate. Usually, it is administered after general anesthesia, but in selected neonatal populations, awake caudal anesthesia is a method of choice. Prematurely born, low birth weight neonates are more prone to complications from general anesthesia than term neonates, even after simple surgery. Among these complications, post-operative apnea is the most common. Caudal epidural anesthesia in awake neonates is a recognized technique that enables the avoidance of general anesthesia and the complications associated with it. In skilled hands, it is also theoretically easier to perform consistent caudal anesthesia than an awake subarachnoid block. In our case, we report a successful awake caudal anesthesia in an ex-premature baby in the emergency setting for incarcerated inguinal hernia repair. To our knowledge, this case report on this topic has yet to be published in Armenia. Conclusion: Neuraxial (spinal, epidural, caudal) awake anesthesia is the method of choice for lower abdominal surgery in preterm infants. Both spinal and caudal anesthesia are effective methods; awake caudal anesthesia is a method of choice because of the success rate and lower analgesic requirements in the post-operative period.
{"title":"Successful Awake Caudal Anesthesia for Incarcerated Inguinal Hernia Repair in an Ex-Premature Baby at 8 Weeks of Age.","authors":"Nerses Kyurkchyan, Fabien Masse, Vahe Kharatyan, Khachatur Kyurkchyan","doi":"10.32391/ajtes.v8i1.352","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.352","url":null,"abstract":"Introduction: Caudal anesthesia is a standard procedure in pediatric anesthesia because of its excellent safety and success rate. Usually, it is administered after general anesthesia, but in selected neonatal populations, awake caudal anesthesia is a method of choice. \u0000Prematurely born, low birth weight neonates are more prone to complications from general anesthesia than term neonates, even after simple surgery. Among these complications, post-operative apnea is the most common. \u0000Caudal epidural anesthesia in awake neonates is a recognized technique that enables the avoidance of general anesthesia and the complications associated with it. In skilled hands, it is also theoretically easier to perform consistent caudal anesthesia than an awake subarachnoid block. In our case, we report a successful awake caudal anesthesia in an ex-premature baby in the emergency setting for incarcerated inguinal hernia repair. \u0000To our knowledge, this case report on this topic has yet to be published in Armenia. \u0000Conclusion: Neuraxial (spinal, epidural, caudal) awake anesthesia is the method of choice for lower abdominal surgery in preterm infants. Both spinal and caudal anesthesia are effective methods; awake caudal anesthesia is a method of choice because of the success rate and lower analgesic requirements in the post-operative period. \u0000 \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"56 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Likaj, S. Dumani, Alessia Mehmeti, L. Dibra, E. Bejko, Edlira Rruci, A. Veshti
Introduction: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification, a chronic and degenerative mitral valve fibrous ring process. It usually carries a benign prognosis. The prevalence of CCMA is about 0.06%-0.07% of the population. CCMA is generally diagnosed incidentally and can be confused with other intracardiac masses such as cardiac tumors, abscesses, vegetation, or calcified thrombi. Multimodality imaging, including TEE, cardiac computed tomography, and cardiac magnetic nuclear resonance, can easily differentiate CCMA from other masses and help avoid unnecessary surgery. CCMA is typically located in the basal area of the posterior mitral valve, and the calcification seems like a round, large, soft mass with a central echo-dense location. CCMA may have a benign course, but it may sometimes be complicated with mitral valvular dysfunction, systemic embolization, or conduction abnormalities in the scenarios mentioned above, as well as when the diagnosis is unclear, surgery is indicated. Mitral valve replacement should be preferred compared to mitral valve repair. Conclusions: It is important to note that the decision for mitral valve replacement, including CAC cases, should be individualized based on various factors, including the patient's clinical condition, symptoms, severity of valve disease, and associated comorbidities. As scientific understanding and research progress, there may be ongoing developments and refinements in the conservative and surgical management of CCMA.
{"title":"A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve.","authors":"E. Likaj, S. Dumani, Alessia Mehmeti, L. Dibra, E. Bejko, Edlira Rruci, A. Veshti","doi":"10.32391/ajtes.v8i1.372","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.372","url":null,"abstract":"Introduction: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification, a chronic and degenerative mitral valve fibrous ring process. It usually carries a benign prognosis. The prevalence of CCMA is about 0.06%-0.07% of the population. CCMA is generally diagnosed incidentally and can be confused with other intracardiac masses such as cardiac tumors, abscesses, vegetation, or calcified thrombi. Multimodality imaging, including TEE, cardiac computed tomography, and cardiac magnetic nuclear resonance, can easily differentiate CCMA from other masses and help avoid unnecessary surgery. CCMA is typically located in the basal area of the posterior mitral valve, and the calcification seems like a round, large, soft mass with a central echo-dense location. CCMA may have a benign course, but it may sometimes be complicated with mitral valvular dysfunction, systemic embolization, or conduction abnormalities in the scenarios mentioned above, as well as when the diagnosis is unclear, surgery is indicated. Mitral valve replacement should be preferred compared to mitral valve repair. \u0000Conclusions: It is important to note that the decision for mitral valve replacement, including CAC cases, should be individualized based on various factors, including the patient's clinical condition, symptoms, severity of valve disease, and associated comorbidities. \u0000As scientific understanding and research progress, there may be ongoing developments and refinements in the conservative and surgical management of CCMA.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"8 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139524618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Florian Dashi, Mishel Qirinxhi, Aurora Muça, Arba Cecia, N. Bardhi, Denis Qirinxhi, R. Alimehmeti
Introduction: Lipoma is a common benign, slow-growing soft tissue neoplasm. Periosteal lipomas of the proximal radius causing posterior interosseus nerve (PIN) palsy are the rarest. Due to specific anatomical relationships, proximal antebrachial lipomas can easily compress PIN. We present a case report and report on the related literature. Material and Methods: A 55-year-old female was admitted complaining of a progressively growing lump in the anterior-lateral antebrachial region near the left elbow. The recent onset of weakness in finger extension was more evident during manual work. MRI showed a well-defined oval lesion in the dorsal aspect of the proximal radius bone with inter-muscular laying between m. supinator et extensor carpi radialis brevis of 7x5x3 cm in diameter. EMG study confirmed PIN compression syndrome. An en-block extirpation was performed through extensor muscles. PIN and its muscular branches were well preserved. Histological examination confirmed lipoma. The postoperative course was uneventful, and a good recovery was seen within 12 days. We revised three other similar cases operated for the same Clinical diagnosis by our team. Pertinent literature was reported. Discussion: Periosteal radius lipoma related to compression of PIN has rarely been reported in the literature. We say our operative series and the surgical technique. MRI and EMG are the standard diagnostic methods. The intermuscular approach is safe for total tumor removal in experienced hands. Conclusion: Periosteal lipoma compressing PIN is a rare clinical finding. Total removal may be obtained through an intermuscular approach. Intraoperative monitoring can assist in preserving tiny PIN branches
{"title":"Periosteal Lipoma Compressing Peripheral Nerves","authors":"Florian Dashi, Mishel Qirinxhi, Aurora Muça, Arba Cecia, N. Bardhi, Denis Qirinxhi, R. Alimehmeti","doi":"10.32391/ajtes.v8i1.364","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.364","url":null,"abstract":"Introduction: Lipoma is a common benign, slow-growing soft tissue neoplasm. Periosteal lipomas of the proximal radius causing posterior interosseus nerve (PIN) palsy are the rarest. \u0000Due to specific anatomical relationships, proximal antebrachial lipomas can easily compress PIN. We present a case report and report on the related literature. \u0000Material and Methods: A 55-year-old female was admitted complaining of a progressively growing lump in the anterior-lateral antebrachial region near the left elbow. The recent onset of weakness in finger extension was more evident during manual work. \u0000MRI showed a well-defined oval lesion in the dorsal aspect of the proximal radius bone with inter-muscular laying between m. supinator et extensor carpi radialis brevis of 7x5x3 cm in diameter. EMG study confirmed PIN compression syndrome. \u0000An en-block extirpation was performed through extensor muscles. PIN and its muscular branches were well preserved. Histological examination confirmed lipoma. The postoperative course was uneventful, and a good recovery was seen within 12 days. \u0000We revised three other similar cases operated for the same Clinical diagnosis by our team. \u0000Pertinent literature was reported. \u0000Discussion: Periosteal radius lipoma related to compression of PIN has rarely been reported in the literature. We say our operative series and the surgical technique. MRI and EMG are the standard diagnostic methods. The intermuscular approach is safe for total tumor removal in experienced hands. \u0000Conclusion: Periosteal lipoma compressing PIN is a rare clinical finding. Total removal may be obtained through an intermuscular approach. Intraoperative monitoring can assist in preserving tiny PIN branches","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"57 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashwath V. H. Venkataramana, Manjunath Byadigere, Abdul Razack, H. Ranganath, Aeiman Saniya, H. Arish, Suraj Pattar
Introduction: Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss. Aim and Objective: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds. Material and Methods: An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation. Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved. Results: 54 Patients were enrolled, consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm2. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,. Conclusion: The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients.
{"title":"The Lacing Dermatotraction Suturing Technique","authors":"Ashwath V. H. Venkataramana, Manjunath Byadigere, Abdul Razack, H. Ranganath, Aeiman Saniya, H. Arish, Suraj Pattar","doi":"10.32391/ajtes.v8i1.377","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.377","url":null,"abstract":"Introduction: Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss. \u0000Aim and Objective: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds. \u0000Material and Methods: An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation. Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved. \u0000Results: 54 Patients were enrolled, consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm2. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,. \u0000Conclusion: The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients. \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Ademi, Ferizat Dika – Haxhirexha, Aulona Haxhirexha, Blerim Fejzuli, K. Haxhirexha, Teuta Emini – Rushiti
Introduction: Surgical site infections (SSIs) pose a global health concern. While various pathogenic microorganisms can cause SSIs, a predominant causative agent is Staphylococcus aureus, particularly its methicillin-resistant strain (MRSA). MRSA, known for its resistance to multiple antibiotics, significantly complicates treatment options, leading to increased morbidity. In some cases, particularly among patients with pre-existing comorbidities, MRSA infections can prove fatal. Moreover, eradicating MRSA from hospital settings presents a formidable challenge. This study aims to report on two young, otherwise healthy patients who developed MRSA infections in their surgical wounds during hospitalization. Case Descriptions: A 22-year-old female patient developed an MRSA infection following an appendectomy and a 12-year-old male patient exhibited similar complications post-orchiopexy. In both cases, MRSA presence was confirmed through microbiological cultures a few days post-surgery. Repeated cultures indicated successful MRSA eradication after isolation and initiation of targeted antibiotic therapy based on antibiograms. Once their general health stabilized, the patients were discharged and continued outpatient antibiotic treatment for a prescribed duration. Conclusion: These cases emphasize that MRSA infections, typically associated with elderly patients or those with underlying health conditions, can also occur in younger, healthier individuals. Eradicating these infections remains a significant challenge for healthcare facilities encountering MRSA. Keywords: Staphylococcus aureus, Methicillin-resistant, young patients, Surgical site infections.
{"title":"Surgical Site Infections with MRSA in young Patients","authors":"A. Ademi, Ferizat Dika – Haxhirexha, Aulona Haxhirexha, Blerim Fejzuli, K. Haxhirexha, Teuta Emini – Rushiti","doi":"10.32391/ajtes.v8i1.371","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.371","url":null,"abstract":"Introduction: Surgical site infections (SSIs) pose a global health concern. While various pathogenic microorganisms can cause SSIs, a predominant causative agent is Staphylococcus aureus, particularly its methicillin-resistant strain (MRSA). MRSA, known for its resistance to multiple antibiotics, significantly complicates treatment options, leading to increased morbidity. In some cases, particularly among patients with pre-existing comorbidities, MRSA infections can prove fatal. Moreover, eradicating MRSA from hospital settings presents a formidable challenge. \u0000This study aims to report on two young, otherwise healthy patients who developed MRSA infections in their surgical wounds during hospitalization. \u0000Case Descriptions: A 22-year-old female patient developed an MRSA infection following an appendectomy and a 12-year-old male patient exhibited similar complications post-orchiopexy. In both cases, MRSA presence was confirmed through microbiological cultures a few days post-surgery. Repeated cultures indicated successful MRSA eradication after isolation and initiation of targeted antibiotic therapy based on antibiograms. Once their general health stabilized, the patients were discharged and continued outpatient antibiotic treatment for a prescribed duration. \u0000Conclusion: These cases emphasize that MRSA infections, typically associated with elderly patients or those with underlying health conditions, can also occur in younger, healthier individuals. Eradicating these infections remains a significant challenge for healthcare facilities encountering MRSA. \u0000Keywords: Staphylococcus aureus, Methicillin-resistant, young patients, Surgical site infections.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"60 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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