Dear Editor, Concerning the article of Bollano E et al. “Surgical treatment of uncomplicated Pilonidal Sinus with a simple closed technique” has been gathering our attention. In this LTE, we would like to critically discuss some of the author's statements. Firstly, the stated pathophysiology of PSD is an outdated theory. Furthermore, primary midline closure, as postulated by the author, is not the surgical procedure of first choice, as several large reviews have shown. The letter discusses the rationale behind adopting the simple closed technique, highlighting its efficacy and potential advantages. By presenting data from our experiences in Albania, we aim to contribute valuable insights to the global discourse on pilonidal sinus treatment. This letter is a noteworthy addition to AJTES, offering fresh insights into the treatment landscape of pilonidal sinus. We trust the editorial team will find the content aligned with the journal's objectives and scope. Your consideration of this submission is highly appreciated, and we look forward to the possibility of contributing to the journal's ongoing dialogue on innovative surgical approaches.
亲爱的编辑，关于 Bollano E 等人的文章 "用一种简单的闭合技术对无并发症的乳头状窦进行手术治疗 "一直是我们关注的焦点。在本 LTE 中，我们想对作者的一些说法进行批判性讨论。首先，PSD 的病理生理学理论已经过时。此外，正如几篇大型综述所显示的那样，作者推测的原发性中线闭合术并非首选手术方法。信中讨论了采用简单闭合技术的理由，强调了其疗效和潜在优势。通过介绍我们在阿尔巴尼亚的经验数据，我们希望为全球有关朝天鼻窦治疗的讨论贡献有价值的见解。这封信为《AJTES》增添了值得关注的内容，为朝天鼻窦的治疗提供了新的见解。我们相信编辑团队会认为内容符合期刊的目标和范围。我们非常感谢您对这篇投稿的考虑，我们也期待着能为杂志就创新手术方法的持续对话做出贡献。
{"title":"Surgical Treatment of Uncomplicated Pilonidal Sinus with the Simple Closed Technique - New Findings of Pilonidal Sinus Treatment from Albania.","authors":"M. Dettmer, Dietrich Doll, Matthias Maak","doi":"10.32391/ajtes.v8i1.330","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.330","url":null,"abstract":"Dear Editor, \u0000Concerning the article of Bollano E et al. “Surgical treatment of uncomplicated Pilonidal Sinus with a simple closed technique” has been gathering our attention. In this LTE, we would like to critically discuss some of the author's statements. Firstly, the stated pathophysiology of PSD is an outdated theory. Furthermore, primary midline closure, as postulated by the author, is not the surgical procedure of first choice, as several large reviews have shown. \u0000The letter discusses the rationale behind adopting the simple closed technique, highlighting its efficacy and potential advantages. By presenting data from our experiences in Albania, we aim to contribute valuable insights to the global discourse on pilonidal sinus treatment. \u0000This letter is a noteworthy addition to AJTES, offering fresh insights into the treatment landscape of pilonidal sinus. We trust the editorial team will find the content aligned with the journal's objectives and scope. \u0000Your consideration of this submission is highly appreciated, and we look forward to the possibility of contributing to the journal's ongoing dialogue on innovative surgical approaches. \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"1 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139524367","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: Kounis Syndrome was first described in 1991 by Kounis and Zavras as “the concurrence of chest pain during an allergic reaction, accompanied by clinical laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult” [1]. The mechanism of Kounis Syndrome most likely involves the release of cytokines through mast-cell degranulation, which leads to coronary vasospasm and atheromatous plaque erosion or rupture following the allergic reaction to an allergen.[2] The treatment is specific to acute coronary syndrome and anaphylaxis, with the added complication that the drugs used, while indicated in each of the two disorders separately, may present contradictions when administered jointly in one patient.[3] The purpose of this review is to briefly revise the existing literature regarding its overlooked diagnosis and contradictory joint management of anaphylaxis and acute coronary syndrome. We will conduct a brief review of the current literature on Kounis Syndrome while describing a suspected case of a female patient presented with both anaphylaxis symptoms and angina pectoris. Conclusions: Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic reaction. Treatment of allergic reactions may be sufficient in type I KS. In contrast, coronary intervention is needed in the other two types, accompanied by vasodilator drugs, including nitrates and calcium antagonists, each of which may have contradictory effects.
{"title":"Allergic Acute Coronary Syndrome: A Case Report and Literature Review","authors":"Mehmet Hoxha, Ester Ndreu, Etleva Qirko Loloçi","doi":"10.32391/ajtes.v8i1.354","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.354","url":null,"abstract":"Introduction: Kounis Syndrome was first described in 1991 by Kounis and Zavras as “the concurrence of chest pain during an allergic reaction, accompanied by clinical laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult” [1]. \u0000The mechanism of Kounis Syndrome most likely involves the release of cytokines through mast-cell degranulation, which leads to coronary vasospasm and atheromatous plaque erosion or rupture following the allergic reaction to an allergen.[2] \u0000The treatment is specific to acute coronary syndrome and anaphylaxis, with the added complication that the drugs used, while indicated in each of the two disorders separately, may present contradictions when administered jointly in one patient.[3] \u0000The purpose of this review is to briefly revise the existing literature regarding its overlooked diagnosis and contradictory joint management of anaphylaxis and acute coronary syndrome. \u0000We will conduct a brief review of the current literature on Kounis Syndrome while describing a suspected case of a female patient presented with both anaphylaxis symptoms and angina pectoris. \u0000Conclusions: Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic reaction. Treatment of allergic reactions may be sufficient in type I KS. In contrast, coronary intervention is needed in the other two types, accompanied by vasodilator drugs, including nitrates and calcium antagonists, each of which may have contradictory effects.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"12 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139523564","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, Andi Lenjani, A. Dogjani, Luljeta Abdullahu, N. Arslani, Dardan Lenjani, Floriana Memedaliu, Ilirian Lenjani
Introduction: Injuries in construction are not a rare occurrence and cause a strain on the health care service. By having education on workplace hazards, trained first aiders, and an effective accident emergency response system, the occurrence of illness/injuries will reduce and hence the number of fatalities. The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained about the construction industry for injury in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival. Solving problems for severe traumas in the health system of Kosovo, such as with professional staff, doctors and nurses, dedicated spaces, medical equipment, drugs, consumables, poor diagnostics, non-decisional consultations, as well as their timely and timely delivery. seeks political health solutions to solve this problem. Material and Methods; In this retrospective study, we researched and analyzed the data of patients with construction-related injuries in ED treated from January-December 2021 Results; During the study period, we analyzed 75,899 ED patients. Of these, 420 cases, or 0.06% were injured. In the research, 420 cases of injuries were investigated, investigating all age groups arising from construction-related activities for 2021. Conclusion; To reduce workplace injuries an organization must carry out regular risk assessments, conduct physical assessments for demanding roles, provide safety and wellness training regularly, train and appoint first aid marshals, hire qualified workers, hire enough workers, keep workspaces clean and walkways clear, post proper signage, Provide adequate lighting, education and training on staff emergency response systems via courses BLS-D BTLS, PHTLS ATLS.
{"title":"Construction Industry Causes of Injuries, Management of EMS and Its Impact on Public Health","authors":"B. Lenjani, Andi Lenjani, A. Dogjani, Luljeta Abdullahu, N. Arslani, Dardan Lenjani, Floriana Memedaliu, Ilirian Lenjani","doi":"10.32391/ajtes.v8i1.378","DOIUrl":"https://doi.org/10.32391/ajtes.v8i1.378","url":null,"abstract":"Introduction: Injuries in construction are not a rare occurrence and cause a strain on the health care service. By having education on workplace hazards, trained first aiders, and an effective accident emergency response system, the occurrence of illness/injuries will reduce and hence the number of fatalities. \u0000The purpose of this research is the evaluation, epidemiology, management, diagnosis, treatment, systematization, and the results obtained about the construction industry for injury in life-threatening cases with trauma, reducing morbidity, disability, and mortality while increasing survival. Solving problems for severe traumas in the health system of Kosovo, such as with professional staff, doctors and nurses, dedicated spaces, medical equipment, drugs, consumables, poor diagnostics, non-decisional consultations, as well as their timely and timely delivery. seeks political health solutions to solve this problem. \u0000Material and Methods; In this retrospective study, we researched and analyzed the data of patients with construction-related injuries in ED treated from January-December 2021 \u0000Results; During the study period, we analyzed 75,899 ED patients. Of these, 420 cases, or 0.06% were injured. In the research, 420 cases of injuries were investigated, investigating all age groups arising from construction-related activities for 2021. \u0000Conclusion; To reduce workplace injuries an organization must carry out regular risk assessments, conduct physical assessments for demanding roles, provide safety and wellness training regularly, train and appoint first aid marshals, hire qualified workers, hire enough workers, keep workspaces clean and walkways clear, post proper signage, Provide adequate lighting, education and training on staff emergency response systems via courses BLS-D BTLS, PHTLS ATLS. \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"6 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139611121","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}
Pub Date : 2023-12-19DOI: 10.32391/ajtes.v7i2.7.365
A. Dogjani, K. Haxhirexha, A. Gjata, K. Subashi
Introduction: The initial assessment of trauma patients is a critical and time-sensitive phase in the realm of emergency medicine. This presentation outlines the fundamental components and principles of conducting an effective initial assessment, which is essential for promptly identifying life-threatening injuries and ensuring timely interventions for patient stabilization. The primary objective of the initial assessment is to swiftly detect and address imminent life-threatening conditions. This process adheres to a structured approach, often following established protocols such as Advanced Trauma Life Support (ATLS). Commencing with the evaluation of the patient's airway, breathing, and circulation (ABCs), healthcare providers prioritize the maintenance of a patent airway, adequate respiration, and a stable circulatory system. Any life-threatening issues identified during this phase demand immediate intervention. Simultaneously, healthcare providers perform a concise yet comprehensive patient history and physical examination, gathering information about the injury's mechanism, the patient's medical background, and any pertinent details. This collected data serves as the foundation for subsequent assessments and treatment plans. The secondary survey, a more detailed and systematic examination, follows the initial assessment. This phase involves a thorough head-to-toe evaluation aimed at detecting injuries that may have been initially overlooked. Diagnostic procedures, including imaging studies and laboratory tests, may be initiated during this phase to further assess and diagnose injuries. The initial assessment places specific emphasis on identifying and managing conditions with rapid and potentially lethal deterioration, such as tension pneumothorax, cardiac tamponade, and massive hemorrhage. Throughout the assessment process, effective communication among the trauma team members is paramount to ensure a coordinated and efficient response. This includes making triage decisions and facilitating swift patient transport to the most appropriate care facility, all of which contribute to optimal trauma patient management. In conclusion, the initial assessment in trauma patients is a dynamic and systematic process designed to swiftly identify and address life-threatening injuries. By recognizing these injuries promptly, initiating timely interventions, and gathering critical patient information, healthcare providers and emergency responders play a vital role in ensuring the best possible outcomes for trauma patients. Training in these procedures is essential to equip healthcare teams with the skills and knowledge needed for successful trauma patient management.
{"title":"Initial Assessment of Trauma Patients","authors":"A. Dogjani, K. Haxhirexha, A. Gjata, K. Subashi","doi":"10.32391/ajtes.v7i2.7.365","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.7.365","url":null,"abstract":"Introduction: The initial assessment of trauma patients is a critical and time-sensitive phase in the realm of emergency medicine. This presentation outlines the fundamental components and principles of conducting an effective initial assessment, which is essential for promptly identifying life-threatening injuries and ensuring timely interventions for patient stabilization. \u0000The primary objective of the initial assessment is to swiftly detect and address imminent life-threatening conditions. This process adheres to a structured approach, often following established protocols such as Advanced Trauma Life Support (ATLS). \u0000Commencing with the evaluation of the patient's airway, breathing, and circulation (ABCs), healthcare providers prioritize the maintenance of a patent airway, adequate respiration, and a stable circulatory system. Any life-threatening issues identified during this phase demand immediate intervention. \u0000Simultaneously, healthcare providers perform a concise yet comprehensive patient history and physical examination, gathering information about the injury's mechanism, the patient's medical background, and any pertinent details. This collected data serves as the foundation for subsequent assessments and treatment plans. \u0000The secondary survey, a more detailed and systematic examination, follows the initial assessment. This phase involves a thorough head-to-toe evaluation aimed at detecting injuries that may have been initially overlooked. Diagnostic procedures, including imaging studies and laboratory tests, may be initiated during this phase to further assess and diagnose injuries. \u0000The initial assessment places specific emphasis on identifying and managing conditions with rapid and potentially lethal deterioration, such as tension pneumothorax, cardiac tamponade, and massive hemorrhage. \u0000Throughout the assessment process, effective communication among the trauma team members is paramount to ensure a coordinated and efficient response. This includes making triage decisions and facilitating swift patient transport to the most appropriate care facility, all of which contribute to optimal trauma patient management. \u0000In conclusion, the initial assessment in trauma patients is a dynamic and systematic process designed to swiftly identify and address life-threatening injuries. By recognizing these injuries promptly, initiating timely interventions, and gathering critical patient information, healthcare providers and emergency responders play a vital role in ensuring the best possible outcomes for trauma patients. Training in these procedures is essential to equip healthcare teams with the skills and knowledge needed for successful trauma patient management.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"102 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959371","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}
Pub Date : 2023-12-03DOI: 10.32391/ajtes.v7i2.7.375
A. Dogjani, K. Haxhirexha, A. Gjata, Kastriot Subashi
Introduction Developing an effective trauma care system is an ongoing challenge in Albania, as it is in many countries. Trauma remains a significant cause of morbidity and mortality, particularly among the younger population in Albania. While the need for a structured trauma system has been recognized, several challenges need to be addressed. Lack of a Formalized Trauma System: Albania lacks a formalized and well-structured trauma system that can efficiently manage trauma cases from the scene of the injury to rehabilitation. The absence of such a system can lead to delays in care and suboptimal outcomes. Inconsistent Data Collection and Quality Improvement: Uniform data collection, quality improvement programs, and trauma verification processes are not consistently implemented. This results in fragmented and inconsistent trauma care, making it challenging to track and improve outcomes. Shortage of Specialized Trauma Care Personnel: The scarcity of healthcare professionals with specialized training in trauma care, including trauma surgeons and emergency medicine specialists, presents a significant hurdle. Trauma care requires a multidisciplinary approach with expertise in various aspects of care, from initial resuscitation to surgical intervention. Infrastructure and Resource Limitations: Many healthcare facilities, especially in rural areas, lack the necessary infrastructure, equipment, and resources to provide optimal trauma care. This includes deficiencies in trauma centers, emergency departments, and pre-hospital care. Challenges in Transportation and Prehospital Care: Efficient prehospital care and transportation of trauma patients are critical for improving outcomes. In Albania, challenges related to transportation and the availability of trained paramedics can hinder the timely delivery of care. Public Awareness and Injury Prevention: Raising public awareness about injury prevention and safety measures is essential. Efforts to reduce the incidence of trauma, especially road traffic accidents, can have a significant impact on overall trauma rates. Coordination Among Healthcare Facilities: Effective coordination among healthcare facilities, from local clinics to major hospitals, is crucial for seamless patient transfer and continuity of care. Advocacy and Government Support: Advocacy efforts by healthcare professionals and organizations are needed to emphasize the importance of a formalized trauma system. Government support and funding are essential for building and maintaining a trauma care infrastructure. Conclusion: establishing a comprehensive trauma system in Albania is a multifaceted challenge that requires collaboration among healthcare stakeholders, advocacy, resource allocation, and a commitment to improving trauma care from the moment of injury through rehabilitation. This ongoing challenge is critical for reducing trauma-related morbidity and mortality in the country.
{"title":"Trauma System in Albania. A challenge that Requires long-term and Sustainable Solutions.","authors":"A. Dogjani, K. Haxhirexha, A. Gjata, Kastriot Subashi","doi":"10.32391/ajtes.v7i2.7.375","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.7.375","url":null,"abstract":"Introduction Developing an effective trauma care system is an ongoing challenge in Albania, as it is in many countries. Trauma remains a significant cause of morbidity and mortality, particularly among the younger population in Albania. While the need for a structured trauma system has been recognized, several challenges need to be addressed. Lack of a Formalized Trauma System: Albania lacks a formalized and well-structured trauma system that can efficiently manage trauma cases from the scene of the injury to rehabilitation. The absence of such a system can lead to delays in care and suboptimal outcomes. Inconsistent Data Collection and Quality Improvement: Uniform data collection, quality improvement programs, and trauma verification processes are not consistently implemented. This results in fragmented and inconsistent trauma care, making it challenging to track and improve outcomes. Shortage of Specialized Trauma Care Personnel: The scarcity of healthcare professionals with specialized training in trauma care, including trauma surgeons and emergency medicine specialists, presents a significant hurdle. Trauma care requires a multidisciplinary approach with expertise in various aspects of care, from initial resuscitation to surgical intervention. Infrastructure and Resource Limitations: Many healthcare facilities, especially in rural areas, lack the necessary infrastructure, equipment, and resources to provide optimal trauma care. This includes deficiencies in trauma centers, emergency departments, and pre-hospital care. Challenges in Transportation and Prehospital Care: Efficient prehospital care and transportation of trauma patients are critical for improving outcomes. In Albania, challenges related to transportation and the availability of trained paramedics can hinder the timely delivery of care. Public Awareness and Injury Prevention: Raising public awareness about injury prevention and safety measures is essential. Efforts to reduce the incidence of trauma, especially road traffic accidents, can have a significant impact on overall trauma rates. Coordination Among Healthcare Facilities: Effective coordination among healthcare facilities, from local clinics to major hospitals, is crucial for seamless patient transfer and continuity of care. Advocacy and Government Support: Advocacy efforts by healthcare professionals and organizations are needed to emphasize the importance of a formalized trauma system. Government support and funding are essential for building and maintaining a trauma care infrastructure. Conclusion: establishing a comprehensive trauma system in Albania is a multifaceted challenge that requires collaboration among healthcare stakeholders, advocacy, resource allocation, and a commitment to improving trauma care from the moment of injury through rehabilitation. This ongoing challenge is critical for reducing trauma-related morbidity and mortality in the country.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"23 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139187366","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}
Pub Date : 2023-12-03DOI: 10.32391/ajtes.v7i2.7.370
A. Dogjani, K. Haxhirexha, A. Gjata, Kastriot Subashi
Introduction; Chest trauma, resulting from both blunt and penetrating mechanisms, poses a significant health threat, and its management demands precise strategies and adherence to established guidelines. This presentation introduces a comprehensive presentation on optimizing chest trauma management, delving into essential strategies and guidelines for healthcare professionals. The presentation begins by outlining the various types and mechanisms of chest trauma, such as blunt and penetrating injuries, with a focus on their significance and prevalence in healthcare settings. Subsequently, the initial assessment of chest trauma patients takes center stage. This involves a primary survey encompassing airway assessment and management, breathing assessment and intervention, circulation assessment and resuscitation, disability assessment, and environmental control. It continues with a secondary survey, including history-taking and a detailed physical examination, accompanied by diagnostic modalities like chest X-rays, computed tomography scans, ultrasound, and arterial blood gas analysis. The presentation then proceeds to address specific chest trauma injuries, including rib fractures, flail chest, pneumothorax, hemothorax, cardiac injuries, pulmonary contusion, and tracheobronchial injuries. The various management approaches are discussed, ranging from pain management, oxygen therapy, chest tube placement, surgical interventions, cardiac tamponade management, to controlling massive hemorrhage. Additionally, it highlights complications and outcomes related to chest trauma, including long-term effects, rehabilitation, and follow-up. The critical role of prevention, pre-hospital care, and guidelines and protocols such as Advanced Trauma Life Support (ATLS) and those from the Eastern Association for the Surgery of Trauma (EAST) are emphasized. Real-life case studies are presented to provide practical insights into chest trauma management, ensuring a comprehensive understanding of the topic. In conclusion, the abstract emphasizes the significance of early recognition, appropriate management, and continuous education and training in chest trauma cases to optimize patient outcomes. This presentation offers a holistic perspective on chest trauma management and equips healthcare professionals with the knowledge and tools to enhance the care provided to patients with chest trauma.
导言：由钝器和穿透性器械造成的胸部创伤对健康构成重大威胁，其处理需要精确的策略和遵守既定的指南。本讲座将全面介绍如何优化胸部创伤管理，深入探讨医护人员的基本策略和指南。 演讲首先概述了胸部创伤的各种类型和机制，如钝器伤和穿透伤，并重点介绍了它们在医疗环境中的重要性和普遍性。 随后，胸部创伤患者的初步评估成为中心内容。这包括初步调查，包括气道评估和管理、呼吸评估和干预、循环评估和复苏、残疾评估和环境控制。接下来是二次调查，包括病史采集和详细的体格检查，以及胸部 X 光、计算机断层扫描、超声波和动脉血气分析等诊断方法。 然后，介绍具体的胸部创伤，包括肋骨骨折、外翻胸、气胸、血胸、心脏损伤、肺挫伤和气管支气管损伤。书中讨论了各种处理方法，包括疼痛处理、氧疗、胸腔置管、外科干预、心脏填塞处理以及控制大出血。 此外，它还强调了与胸部创伤有关的并发症和结果，包括长期影响、康复和随访。本书强调了预防、院前护理以及高级创伤生命支持（ATLS）和东部创伤外科协会（EAST）等指南和协议的关键作用。 文中还介绍了真实的病例研究，为胸部创伤的处理提供了实用的见解，确保了对该主题的全面理解。 最后，摘要强调了胸部创伤病例中早期识别、适当处理以及持续教育和培训对优化患者预后的重要意义。 本讲座提供了胸部创伤管理的整体视角，并为医护人员提供了相关知识和工具，以加强对胸部创伤患者的护理。
{"title":"Optimizing Chest Trauma Management: Strategies and Guidelines","authors":"A. Dogjani, K. Haxhirexha, A. Gjata, Kastriot Subashi","doi":"10.32391/ajtes.v7i2.7.370","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.7.370","url":null,"abstract":"Introduction; Chest trauma, resulting from both blunt and penetrating mechanisms, poses a significant health threat, and its management demands precise strategies and adherence to established guidelines. This presentation introduces a comprehensive presentation on optimizing chest trauma management, delving into essential strategies and guidelines for healthcare professionals. The presentation begins by outlining the various types and mechanisms of chest trauma, such as blunt and penetrating injuries, with a focus on their significance and prevalence in healthcare settings. Subsequently, the initial assessment of chest trauma patients takes center stage. This involves a primary survey encompassing airway assessment and management, breathing assessment and intervention, circulation assessment and resuscitation, disability assessment, and environmental control. It continues with a secondary survey, including history-taking and a detailed physical examination, accompanied by diagnostic modalities like chest X-rays, computed tomography scans, ultrasound, and arterial blood gas analysis. The presentation then proceeds to address specific chest trauma injuries, including rib fractures, flail chest, pneumothorax, hemothorax, cardiac injuries, pulmonary contusion, and tracheobronchial injuries. The various management approaches are discussed, ranging from pain management, oxygen therapy, chest tube placement, surgical interventions, cardiac tamponade management, to controlling massive hemorrhage. Additionally, it highlights complications and outcomes related to chest trauma, including long-term effects, rehabilitation, and follow-up. The critical role of prevention, pre-hospital care, and guidelines and protocols such as Advanced Trauma Life Support (ATLS) and those from the Eastern Association for the Surgery of Trauma (EAST) are emphasized. Real-life case studies are presented to provide practical insights into chest trauma management, ensuring a comprehensive understanding of the topic. In conclusion, the abstract emphasizes the significance of early recognition, appropriate management, and continuous education and training in chest trauma cases to optimize patient outcomes. This presentation offers a holistic perspective on chest trauma management and equips healthcare professionals with the knowledge and tools to enhance the care provided to patients with chest trauma.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":"15 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139187307","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. Muço, R. Osmenaj, R. Bode, Amarildo Blloshmi, Jona Prendi, L. Berdica
Background: The term ‘fever of unknown origin’ (FUO) was first introduced by Petersdorf and Beeson in 1961, and it is defined as recurrent fever >38.3°C, lasting for >3 weeks, remaining undiagnosed after 1 week of in-hospital evaluation. The etiologies of classic FUO include mainly infections, malignancies, non-infectious inflammatory diseases, and miscellaneous causes, while some cases remain undiagnosed. Primary splenic lymphoma (PSL) is a rare malignant lymphoma. In many cases, splenectomy is the treatment of choice for massive splenomegaly. Case presentation: A 54-year-old woman presented with a history of high fever up to 39°C, sweating, fatigue, and weight loss for one month. She had been treated by her family physician with antibiotics (cephalosporin) for 10 days but without improvement. On admission, the patient had palpable splenomegaly but no palpable lymphadenopathy. The patient had increased markers of inflammation. The indicators of autoimmune disease were all negative. Screening for specific infectious diseases and the blood cultures all came out negative. Abdominal computerized tomography (CT) revealed an enlarged spleen. The splenectomy was performed and the spleen was sent for histological analysis. Meanwhile, the patient was subject to a complex treatment. Histological and immunohistochemical analysis confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma with diffuse red pulp infiltration. Afterward, the patient underwent systemic chemotherapy. Conclusion: We strongly suggest that clinicians should have a high index of suspicion for malignancies in cases with FUO. Sometimes splenectomy can be the key to solving the problem.
{"title":"The Key Role of Splenectomy in Fever of unknown Origin which Resulted to be B-cell primary Splenic Lymphoma.","authors":"E. Muço, R. Osmenaj, R. Bode, Amarildo Blloshmi, Jona Prendi, L. Berdica","doi":"10.32391/ajtes.v7i2.338","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.338","url":null,"abstract":"Background: The term ‘fever of unknown origin’ (FUO) was first introduced by Petersdorf and Beeson in 1961, and it is defined as recurrent fever >38.3°C, lasting for >3 weeks, remaining undiagnosed after 1 week of in-hospital evaluation. The etiologies of classic FUO include mainly infections, malignancies, non-infectious inflammatory diseases, and miscellaneous causes, while some cases remain undiagnosed. Primary splenic lymphoma (PSL) is a rare malignant lymphoma. In many cases, splenectomy is the treatment of choice for massive splenomegaly. \u0000Case presentation: A 54-year-old woman presented with a history of high fever up to 39°C, sweating, fatigue, and weight loss for one month. She had been treated by her family physician with antibiotics (cephalosporin) for 10 days but without improvement. On admission, the patient had palpable splenomegaly but no palpable lymphadenopathy. The patient had increased markers of inflammation. The indicators of autoimmune disease were all negative. Screening for specific infectious diseases and the blood cultures all came out negative. Abdominal computerized tomography (CT) revealed an enlarged spleen. The splenectomy was performed and the spleen was sent for histological analysis. Meanwhile, the patient was subject to a complex treatment. Histological and immunohistochemical analysis confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma with diffuse red pulp infiltration. Afterward, the patient underwent systemic chemotherapy. \u0000Conclusion: We strongly suggest that clinicians should have a high index of suspicion for malignancies in cases with FUO. Sometimes splenectomy can be the key to solving the problem.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49387487","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. Darweesh, Amal Al Obaidli, A. Kambal, Hassan A. Aboughalia, W. El Ansari, R. Ramadan, Mohamed Abu Nada, A. Abdelmoneim
Rectal cancer is associated with a high risk of metastases and local recurrence; local recurrence rates after surgical treatment being up to 32%. An accurate local staging at the time of initial diagnosis is therefore very important. Magnetic Resonance Imaging (MRI) is already established as an accurate tool for the preoperative staging of rectal cancer and has resulted in marked improvements in staging accuracy. Material and Methods: This study used MRI in comparing the morphologic features of rectal cancer before and after 8 weeks of chemo-radiation treatment (CRT) and to correlate the post treatment MRI appearances with the histological findings in resected tumors. 45 patients with histo-pathologically proven rectal adenocarcinoma received standardized 8 weeks chemo-radiation therapy and subjected to MRI before and after treatment for clinical staging. A correlation between pathological response and MRI findings was done. Results: The MRI diagnostic accuracy to diagnose T2 is 74.2% with relatively low specificity (64.7%). The diagnostic accuracy of MRI in evaluation of stage T3 and T4, the MRI sensitivity was 96.2% however of low specificity 26.3%. The diagnostic accuracy was 66.7%. Additionally, in evaluation of T2 stage, the sensitivity of MRI was very low 27.3% and specificity relatively high 94.7%. Diagnostic accuracy was 70%. Post RCT, based on downstaging after CRT, the sensitivity of MRI to show no tumor was very low 0% with diagnostic accuracy 88.9%. However, to evaluate stage T2, the sensitivity was 84.6% with low specificity 66.7% and the diagnostic accuracy was 74.2%. Conclusion: MRI had an accuracy average of 81.6% in T stage and 68.9% in N stage in re-staging rectal tumors after CRT. Over-staging results of majority of the inaccuracy. The statistical agreement between post-CRT MRI and the pathologic staging involving T and N stages was not satisfactory. In view of the above, Post CRT, restaging rectal cancer remains a challenge.
{"title":"MRI in Evaluation of Rectal Cancer pre- and post-Chemo-Radiation Treatment.","authors":"A. Darweesh, Amal Al Obaidli, A. Kambal, Hassan A. Aboughalia, W. El Ansari, R. Ramadan, Mohamed Abu Nada, A. Abdelmoneim","doi":"10.32391/ajtes.v7i2.328","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.328","url":null,"abstract":"Rectal cancer is associated with a high risk of metastases and local recurrence; local recurrence rates after surgical treatment being up to 32%. An accurate local staging at the time of initial diagnosis is therefore very important. Magnetic Resonance Imaging (MRI) is already established as an accurate tool for the preoperative staging of rectal cancer and has resulted in marked improvements in staging accuracy. \u0000Material and Methods: This study used MRI in comparing the morphologic features of rectal cancer before and after 8 weeks of chemo-radiation treatment (CRT) and to correlate the post treatment MRI appearances with the histological findings in resected tumors. 45 patients with histo-pathologically proven rectal adenocarcinoma received standardized 8 weeks chemo-radiation therapy and subjected to MRI before and after treatment for clinical staging. A correlation between pathological response and MRI findings was done. \u0000Results: The MRI diagnostic accuracy to diagnose T2 is 74.2% with relatively low specificity (64.7%). The diagnostic accuracy of MRI in evaluation of stage T3 and T4, the MRI sensitivity was 96.2% however of low specificity 26.3%. The diagnostic accuracy was 66.7%. Additionally, in evaluation of T2 stage, the sensitivity of MRI was very low 27.3% and specificity relatively high 94.7%. Diagnostic accuracy was 70%. \u0000Post RCT, based on downstaging after CRT, the sensitivity of MRI to show no tumor was very low 0% with diagnostic accuracy 88.9%. However, to evaluate stage T2, the sensitivity was 84.6% with low specificity 66.7% and the diagnostic accuracy was 74.2%. \u0000Conclusion: MRI had an accuracy average of 81.6% in T stage and 68.9% in N stage in re-staging rectal tumors after CRT. Over-staging results of majority of the inaccuracy. The statistical agreement between post-CRT MRI and the pathologic staging involving T and N stages was not satisfactory. In view of the above, Post CRT, restaging rectal cancer remains a challenge.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49518814","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. Baftiu, Luljeta Abdullahu, Nimet Orgusha, Dardan Lenjani, Zenel Lenjani
Electrical injury is a physiological reaction caused by electric current passing through the body. Electric injuries can be caused by the impact and exposure to electric current or lightning either at home or at work. The injury depends on the density of the current, tissue resistance, and duration of contact. Very small currents may be imperceptible or produce a light tingling sensation. Injuries can range from minor, moderate, to severe, and fatal injuries are just as likely to occur at home as in the workplace, with around 20 Australians dying each year from electric shock. The purpose of this paper is to study how well-trained healthcare professionals in both pre-hospital and hospital settings are in treating patients in the case of electric shock and injuries caused by lightning, including the triage, assessment, monitoring, treatment, and transport with medical care in pre-hospital settings The research was conducted based on data obtained from assessments of health care professionals based on anamnestic data, the status of vital parameters, monitoring, medical procedures, system-level injuries, type of health care delivery, and location. Conclusions; Given the discrepancies found in reporting pathological conditions and injuries pertaining to electrical burn wounds, a standardized system for classifying these pathological conditions is suggested. Although electric shock-related mortality is not the leading cause of death in high-prevalence areas, awareness needs to be raised.
{"title":"Emergency Access and Impact of Injuries Caused by Electrocution and Lightning","authors":"B. Lenjani, A. Dogjani, N. Baftiu, Luljeta Abdullahu, Nimet Orgusha, Dardan Lenjani, Zenel Lenjani","doi":"10.32391/ajtes.v7i2.347","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.347","url":null,"abstract":"Electrical injury is a physiological reaction caused by electric current passing through the body. Electric injuries can be caused by the impact and exposure to electric current or lightning either at home or at work. \u0000The injury depends on the density of the current, tissue resistance, and duration of contact. Very small currents may be imperceptible or produce a light tingling sensation. Injuries can range from minor, moderate, to severe, and fatal injuries are just as likely to occur at home as in the workplace, with around 20 Australians dying each year from electric shock. \u0000The purpose of this paper is to study how well-trained healthcare professionals in both pre-hospital and hospital settings are in treating patients in the case of electric shock and injuries caused by lightning, including the triage, assessment, monitoring, treatment, and transport with medical care in pre-hospital settings \u0000The research was conducted based on data obtained from assessments of health care professionals based on anamnestic data, the status of vital parameters, monitoring, medical procedures, system-level injuries, type of health care delivery, and location. \u0000Conclusions; Given the discrepancies found in reporting pathological conditions and injuries pertaining to electrical burn wounds, a standardized system for classifying these pathological conditions is suggested. Although electric shock-related mortality is not the leading cause of death in high-prevalence areas, awareness needs to be raised. \u0000 ","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42149749","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. Bollano, Krenar Lilaj, Dariel Thereska, A. Dogjani
Fournier's gangrene (FG) is a well known often fatal fasziitis of the pelvic floor following ano-rectal, urologic and gynecologic infections. Although rarely it is described as a complication of operative anal procedures and predisposing factors such as diabetes, alcoholism, immune-defects and consumptive diseases. Current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than expected. This catastrophic complication without a predisposing factor is discussed along with a review of the literature. The objective of this article is to provide updated and relevant information regarding the recognition, diagnosis and management of FG, from the general surgeon to the emergency department. This article refers to two complicated cases of Fournier's gangrene. The patients underwent emergency surgical intervention with the diagnosis of hemorrhoidal prolapse with rectal bleeding and accompanying anemia… Conclusion; The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. The General surgeon must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management.
{"title":"Fournier's gangrene in Patients Operated for Hemorrhoidal Prolapse in the Surgical Emergency Department.","authors":"E. Bollano, Krenar Lilaj, Dariel Thereska, A. Dogjani","doi":"10.32391/ajtes.v7i2.349","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.349","url":null,"abstract":"Fournier's gangrene (FG) is a well known often fatal fasziitis of the pelvic floor following ano-rectal, urologic and gynecologic infections. Although rarely it is described as a complication of operative anal procedures and predisposing factors such as diabetes, alcoholism, immune-defects and consumptive diseases. \u0000Current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than expected. This catastrophic complication without a predisposing factor is discussed along with a review of the literature. \u0000The objective of this article is to provide updated and relevant information regarding the recognition, diagnosis and management of FG, from the general surgeon to the emergency department. \u0000This article refers to two complicated cases of Fournier's gangrene. The patients underwent emergency surgical intervention with the diagnosis of hemorrhoidal prolapse with rectal bleeding and accompanying anemia… \u0000Conclusion; The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. \u0000The General surgeon must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48703798","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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