Aim: Mechanical jaundice may lead to adverse metabolic effects in surgical patients. Our aim was to investigate the effects of octreotid and allopurinol on liver histology and functions in rats with experimantally created mechanical jaundice. Methods: The subjects were divided into five main groups. The rats in Group I (Control) received no interventions. In Group II, common bile duct ligation (CBDL) was performed. In Group III, the same ligation procedure was performed followed by the administration of octreo tid. In Group IV, the rats received allopurinol following CBDL and in Group V (Sham), the common bile duct was dissected and left intact. After sacrification of each rat on the seventh postoperative day, blood samples were collected for serum hematocrit, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, and albumin measurements in addition to the histopathologic examinations of the collected tissue specimens from the liver, terminal ileum, and pancreas. According to statistical analysis, a value of p<0.05 was considered as significant. Results: The direct bilirubin, AST and ALT levels were detected to be significantly elevated in the groups II, III and IV, in which CBDL was performed (p<0.05). While significant reductions of serum direct bilirubin, AST and ALT levels were detected in the octreotide group, these parameters were significantly elevated in the allopurinol group (p<0.05 and p<0.05, respectively). There was no significant difference of hematocrit and albumine levels among the study groups (p>0.05). Additionally, in the allopurinol group four rats were found to have increased serum amylase levels and the histopathologic evaluations of their pancreatic samples revealed findings of pancreatitis. According to the histopathologic examinations, significant alterations were detected between the control and sham groups (groups I, V) and the CBDL groups (groups II, III, IV). However, these histopathological findings revealed no significant differences within the subgroup of subjects including CBDL alone (Group II), and CBDL along with the administration of either octreotide (Group III), or allopurinol (Group IV). Conclusion: The use of octreotide in mehanical jaundice may have protective metabolic effects. Further studies are considered necessary to be carried to support these findings.

Background: Retroperitoneal sarcomas are neoplasms that occupy only 0.3 – 3% of all solid tumors. Liposarcomas are the most frequent soft tissue sarcomas in adults. Symptoms would only be detected if the liposarcoma infiltrates on the surrounding organs. Case present ation: 58-year-old woman presented with complaints of progressive abdominal distension, loss of appetite, malaise, constipation and weight loss of about 7 kg. Abdominal CT scanning showed the presence of a retroperitoneal tumor that occupied almost the entire right part of abdominal cavity. 16 months earlier, the patient was operated in another surgical facility due to liposarcoma, derived from retroperitoneum (Histopathological finding: Poorly differentiated (G3) liposarcoma pleomorphic cell type). The patient was operated under the diagnosis of retroperitoneal liposarcoma. Conclusions: Treatment of choice is radical surgical procedure including elimination of all the structures and organs involved by the tumour process - RO resection as a basic principle of surgical treatment.

Aim: To represent our data regarding use of buccal mucosa for treatment of recurrent urethral stricture. Evaluating effectiveness of buccal graft for reconstruction of urethral segment both penile and bulbar urethra. Materials and methods: We repaired 95 urethral strictures with buccal mucosa grafts from 2004 to 2015. Mean patient age was 39 years. The etiology of stricture was unknown in 54% of cases in other cases ischemia, trauma, instrumentation waere the reason. 96% had undergone previous urethrotomy or dilation. The buccal mucosa graft was harvested from lower lip mostly. Mean graft length was 3.8 cm. The graft was placed on the ventral and dorsal bulbar urethral surface in 61 and 34 cases, respectively. In pendulous urethra we routinely use the dorsal graft the Asopa inlay graft or Barbagli onlay graft. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean follow-up was 36 months (range 16 to 62). Results: We had a success rate of 77% with dorsal inlay or onlay flap for pendulous urethra inferior than ventral graft used for bulbar urethra which was 81% success rate. Conclusions: In our experience the placement of buccal mucosa grafts into the ventral or dorsal surface of the bulbar urethra showed an acceptable success rates 81% and 77% respectively . Longer times of follow up is need to see if the results deteriorated more.

Background: Even that the entire hand represents 4 percent of the TBSA, The American Burn Association, the Advanced Trauma Life Support, and the Advanced Burn Life Support curricula all recognize the severity of hand burns by classifying these as injuries requiring treatment at a burn qualified centre. Hand burns occur commonly both as part of larger burn injuries as well as isolated injuries. Due to damage to the skin and other parts of the hand, burns can lead to open wounds, disability, severe emotional and psychological complications, and economic burden. Aim: To give an overview of epidemiologic features and outcome of burn hand patients who are admitted in our Service. This current study was performed in University Hospital Centre “Mother Teresa” Tirana which is the only tertiary hospital in Albania. Material and methods: In this retrospective study were included all patients who had combustion of the hands solely or hands accompanied with burns to other areas of the body, treated and followed up during the years 2011-2016. Results: Of the 333 included burn patients, 64% were males.The median age of women is 21.8 years, of men is 27.5 years and the median age total patients’ population is 25.9 years. About half of patients belong to the age group 20-60 years (49.5%) and only 10.2% belong to the age above 60 years. In most of the cases (73.6%), the burn of hands is associated with burn of the other anatomical region, mostly forearm. Conclusion: The goal of wound management is to have the skin healed by post-burn in two weeks’ time. In many cases, this will occur nonoperatively with good wound care. The surgical treatment is used for less 30% than of patients. Surgical excision of the burn with split-thickness skin grafting should be undertaken as soon as it becomes obvious that wound healing will not be complete by post-burn day 14. The undesirable results of the burn of hands are presented in the 33% of the patients. The contractures were the main unfavorable outcome of the burned hand.

Background: Cecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. The diagnosis is not always easy and in the majority of cases it is usually made during laparotomy. The aim of the present study is to retrospectively report our experience with solitary cecal diverticulitis, to determine its incidence in patients presenting as an acute abdomen, as well as identify the symptoms and clinical features that may aid in making a pre -operative diagnosis. And to compare this with a review of the literature, focusing on the surgical treatment and also on the indication of appendectomy in the presence of cecal diverticulitis not requiring surgery. Material and methods: Data was collected in patients hospitalized for acute appendicitis or acute abdomen, in the surgical emergency unit of University Hospital Centre "Mother Teresa" Tirana, in a period of 3 years (2015-2017). Sex, age, duration of symptoms, preoperative diagnosis, management, intraoperative findings, histologic examination, length of hospital stay and complications of all patients affected by solitary cecal diverticulitis were reviewed. Results: In the study period, 15 patients presented with a solitary cecal diverticulitis. All patients presented with abdominal pain, additional symptoms were nausea, vomiting and fever. The mean white blood cell count was from 8500-19.200/mm3, while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. Intraoperative findings ranged from localized /circumscript peritonitis to generalised peritonitis due to acute diverticulitis and a normal appendix. Surgery ranged from diverticulum resection accompanied to appendectomy, to ileocecal resection, and right hemicolectomy. Conclusions : Cecal diverticulitis should be included in the differential diagnosis of the cases with pain in the right lower quadrant. Preoperative diagnosis of cecal diverticulitis cannot always be made, since the signs and symptoms are similar to acute appendicitis, but is important in order to decide how to manage this condition. Diverticulectomy and incidental appendectomy are the preferred method of treatment in uncomplicated cases. Right hemicolectomy is a recommended treatment option in complicated patients or those suspicious for tumor during surgery.

Background: Acute biliary pancreatitis (ABP) is one of the most common gastrointestinal events that requires acute admission to the hospital with considerable risks of mortality & morbidity. Laparoscopic cholecystectomy has become the gold standard for the treatment of ABP. Our aim was to determine the safety of cholecystectomy during the first admission by performing a review of the current literature. Waiting for 6 - 8 weeks to perform cholecystectomy may result with an increased incidence of recurrent ABP attacks, which may increase morbidity and the length of the hospital stay. On the contrary, cholecystectomy during the index admission for mild ABP appears to be a preferable and safe approach with better surgical outcomes providing a definitive treatment.

Background: Severe thoracic trauma is the main cause of deaths in US about 10-20%. Causes of severe thoracic Trauma are: Penetrating trauma, Gunshot wounds, Stab wounds; Gunshot wounds on the chest is the most lethal – 50%. Only 7-10% undergoes hospitalization prior to death. Death occurs due to heart & great vessel injuries. Aim of study: Analyses the patients with Severe Thoracic Trauma, Initial Evaluation and Management in the period of time 2004-2017 treated in thoracic surgery service. Material and methods: Patents treated in our hospital during July 2004 - July 2017 are 95. Male to female ratio was 3:1. Age of presentation 9-71 years old, mean age 49 years old. Blunt chest wall trauma 36 (38%) and penetrating chest wall trauma 59 (62%) patients. Ribs and sternal fractures, two or more costal fractures in 15 (15.7%) patients (flail chest 7 patients); unilateral pneumothorax 34 (35.7%) patients, bilaterally pneumothorax 10 (10.5%) patients; massive hemothorax 12 (12.6%) patients, pneumomediastinum et subcutaneous emphysema 6 (6.31%) patients Hamman’s syndrome, lung contusion and parenchymal pulmonary hematoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients, tracheal rupture 1 (1%) patient. Results: Conservative treatment in 22 (23%) patients, unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18 (18.9%) patients; thoracotomy in 29 (30.5%) patients, wedge resection, lung hemostasis and aerostasis from lung lacerations, bronchial lobar rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell incision in 1 (1%) patient; thoraco-abdominal approach 2 ( 2%) patients. flail chest wall stabilization 7 (7.3%) patients by vicryl suture, steel wire suture 3(3%) patients, titanium plate 3(3%) patient. By VATS are treated 2(2.1%) patients. Mean hospital stay was 11 days (average 3-36 days). Morbidity rate in 6 (6.3%) patients, mortality was on 5 (5%) patients. Conclusion: Most common injury locations was lung and chest wall and less common abdominal and cranial trauma. Surgical and intensive treatment are very important and with low mortality rate.

Shock represents a condition of inadequate tissue perfusion due to circulatory insufficiency. Hemorrhage is the most common cause of shock in injured patients. Traumatic hemorrhagic shock presents a lifethreatening condition due to the development of multifunctional organ dysfunction syndrome, which can be diagnosed due to symptomatology and changes in vital parameters. This study aims to analyse the epidemiological characteristics of traumatic - hemorrhagic shock and to demonstrate the efficacy of therapy in hemodynamic stabilization in patients with shock during the first 12 hours of intensive treatment at University Clinical Center of Kosovo.

Aim: Gastrointestinal complications (GIC) following open heart surgery usually are rare but with high morbidity and mortality. The aim of this study was to see the outcome of these patients after complication, compared with a similar study found in literature. Identifying risk factors preoperatively and postoperatively in our patient’s series, for GIC. Materials and methods: Between January 2012 and December 2017 from 1990 operated cardiac patient 34 of them developed GIC, presenting gastro duodenal bleeding due to active ulcer, liver failure, pancreatitis, cholecystitis, or intestinal ischemia. We performed a retrospective analysis. Results: From all consecutive patient only 1.7 % developed GIC. Mortality rate was 55.8%, especially 100 % mortality in intestinal ischemia patient. Regarding risk factors, those were the same found in other similar study (age, atherosclerosis disease, by pass time, postoperative ARF, Low cardiac output syndrome.) Conclusion: GIC after cardiac surgery are rare but when it happens the mortality is very high not even of late diagnosis. In ages patients, diabetes, long by pass time, long hypoperfusion state. It is recommended to be alert for GIC for detection in early phase, and for reducing as much as possible morbidity and mortality.

Background: PTPE is a significant complication and the main cause for 2–10% of victims. MDCT is increasingly used. Our study is an analysis focused on the anatomy of pleura, principles behind fluid formation/reabsorption and an imaging approach to assessing pleural effusion and PTPE under-CT evacuation. Material and methods: The study is conducted on eight (8) patients with PTPE at University Hospital of Trauma, University Hospital Centre “Mother Theresa”, University Hospital “ Shefqet Ndroqi” in Tirana, during the period January 2015 – June 2018, by using a MDCT of 128 slice – 64 detector – dual source, SIEMENS, German machine. Results and conclusions: The frequency of post-traumatic pleural injuries with presence of Hydrothorax is 75.6% in total; second after that of Chest wall injuries (94.2%). Among the variable forms are reported Hemothorax – 17.4 % and Pneumothorax – 7.3 %. Empyema is rare – 2 %. MDCT is the most sensitive, specific and accurate imaging modality in the assessment of PTPE and management of patients: - demonstrates the significant disorder in patients with normal initial radiographs, - indicates changing of management in up to 20% of cases with abnormal initial radiographs, - assists several micro-invasive procedures in order to prevents development of empyema, - enables early prediction of respiratory compromise and limits the severe invasive interventions.

Chronic wounds represent an enormous health, social and economic burden in modern society. With the increasing incidence of diabetes and obesity as well as the ageing of the population, we correspondingly expect a rise in the incidence of chronic wounds. The latter will reflect in an even heavier burden for individuals , their families and the society. At the General Hospital Dr. Jože Potrc Ptuj we devote a lot of time dealing with this issue, because we are aware of the impact that the chronic wounds have on the quality of life of affected patients. We have been taking care of patients with chronic wounds for several years in the ambulatory and hospital setting. In the article we present our organizational model in the treatment of patients with chronic wounds at General Hospital Dr. Jože Potrc Ptuj. We present the modern approaches in the treatment of chronic wounds at our hospital, our results in the treatment of chronic wounds supported with clinical cases. The key to successful management of patients with chronic wounds are good knowledge, team work and an individual approach to each patient.

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

Cirrhosis describes the end stages of chronic inflammation and progressive scarring of the liver and may lead to hepatocellular dysfunction and portal venous hypertension. Liver cirrhosis in itself is a major cause of mortality worldwide, accounting from more than 1 million deaths in 2010. Esophageal varices are common in cirrhosis such that Christensen et al. documented their occurrence in 90% of patients with cirrhosis within 10 years of follow up, 40% experiencing variceal bleeding. Acute hemorrhage from esophageal varices will classically appear as hematemesis and/or melena in patients with a history of cirrhosis. It is most often diagnosed by performance of an EGD which will reveal actively bleeding varices. Because of the high rate of morbidity and mortality associated with esophageal variceal bleeding, one must have a high index of suspicion in any patient with chronic liver disease or cirrhosis. As such, empiric management for variceal hemorrhage should be initiated any time this diagnosis is considered.

Background:Traumatic injury of the peripheral nerves should betreated in specialized centres. Thisstudy presents the epidemiological data of 1368 consecutive patients operated for peripheral nerve injuries beside the Service of neurosurgery, Department of Neurosciences, UHC "Mother Theresa", Tirana. In order to obtain the necessary data for this studywe revisedthe clinical records, surgical registers and pre, intra and postoperativephoto/video of the cases operated for peripheral nervous system injuries. A data recording program of the surgery cases wasbuilt ad hoc, categorizing the cases according to several variables. The data collected from theoperated cases were manually inserted to be processed by the program. Results of informatics elaboration of the datawereobtained,reviewed and categorized by: age, gender, type of trauma,localizationof injuryand type of nerve repair. Future studies to be conducted in this field will focusin determining the level of nerve injury, time from the injuryto intervention, distance from the site of trauma to the effector organ. The data will build necessary information for data mining, which based on these important factors that influence the result of nerve repair, will be useful for the prediction of the result in new patients harbouring peripheral nerve injury beforeundergoing surgery

The aim of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults. Material and methods: A comprehensive study of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed. Results: Two studies found significantly better functional scores after replacement compared with ORIF in Mason type 3 fractures. The third study found no significant differences in functional score or range of motion, but did find that grip strength was better after ORIF. Complication rates were too heterogenous for conclusion. Conclusion: Fixation with good reduction may be attempted in unstable Mason type 3 fractures, and arthroplasty may be considered if this is not possible. Further randomised comparative trials are required to clarify the decision- making between fixation and replacement. Functional outcomes and complications were conflicting in the studies included here. Ideally, treatment decision should take into account elbow stability and degree of comminution

Albania, like all the former communist countries, has inherited in 50 years a large arsenal of weapons and ammunition stockpiles, as shells and projectiles of various calibers, which constituted a negative phenomenon and seriously jeopardized the lives of people and communities throughout the geography of their deployment. After the 1990s, the Albanian Armed Forces embarked on the path of transformation and integration of Albania into NATO. In this framework, the implementation of defense reforms aimed the reduction and modernization of the military. In this context, one of the transformation goals was the getting rid of the remaining excess ammunition that was being destroyed under the programs of the Ministry of Defense and partner countries and the role of the University Hospital of Trauma and the Military Hospital in Tirana, Albania. This paper aims to discuss the security threat that these stockpiles pose to our nation and the wiser region. It also explains how the excess munitions eliminating process was completed in Albania.