Colorectal cancer complications are seldom analyzed for occurrence through day and night, working days and weekends, as well as throughout seasons. We hypothesized that information and analysis of high/low complicated colon cancer incidence in the abovementioned terms can improve our preparedness and manage better the resources for superior outcomes. Therefore, we performed a retrospective study during 2010 – 2018 timeframe consisting of 165 patients with complicated colorectal cancer operated on emergently or urgently in the Second Clinic of General and Thoracic Surgery, University Hospital St George, Plovdiv, Medical University Plovdiv, Bulgaria.

Background: Control of hemorrhage in major liver trauma constitutes an ongoing surgical challenge even in nowadays, as surgeons often face difficult situations in its management. The goal of this study was to analyze our experience in the control of hemorrhage in major liver trauma. Materials and methods: Our study was performed prospectively covering a period of time from January 2009 till December 2012. 173 patients with liver trauma were included in our study. Results: Temporary haemostasis maneuvers in the setting of urgent laparotomy consisted of: bimanual compression 13 patients (15.3%), Pringle maneuver 23 patients (27%), perihepatic packing 10 patients (11,8%), Foley catheter balloon tamponade 2 patients (2.4%), intrahepatic tamponade in penetrating trauma 4 patients (4.7%). Definitive haemostasis methods used in urgent laparotomy were: electro-coagulation of the liver injury 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic liver resection 1 patient (1.2%), nonanatomic/atypical liver resection 7 patients (8.2%), right hepatic artery ligation 1 patient (1.2%). Surgical techniques in preplanned laparotomies consisted of: left hepatectomy 1 patient (16.6%), right hepatectomy 1 patient (16,6%), nonanatomic/atypical liver resections 4 patients (66.7%). The success of treatment was significantly related to the grade of liver injury (z= 5.2912, p=<0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), amount of blood transfusion received (p=0.03207), and age (p=0.04944). Overall mortality rate was 13%. Conclusion: Perihepatic packing and performing the surgical intervention in two sessions has significantly improved survival rates in major liver trauma from our experience.

Background: The patients with colorectal adenocarcinoma very often developed hepatic metastases. Resection of them still remains the best treatment of disease. Hepatectomy carried about 20% mortality rate. The most important intraoperative factor is major hemorrhage and hypotension and postoperatively the main reasons are hemorrhage, coagulopathy, renal failure, pulmonary, and cardiac disturbance till biliary fistula and liver failure. Anesthesia and perioperative management have resulted in diminished value of mortality and morbidity at the same time. Aim: The aim of this study is to submit our experience in anesthesia and perioperative management in liver resection of hepatic metastases in CRC patients. Material and Methods: In that retrospective study we enrolled 6 patients ASAII- III, from January to July 2019. All patients treated for liver malignancy diagnosis after colorectal carcinoma in elective surgery and received general anesthesia with fentanyl 1-2µg/kg/h, profolol 4.0µg/kg/min via target-controlled infusion and vecuronium 0.001mg/kg/min and sevofluran 2%. All patients are monitored with continuous central venous pressure(CVP). We recorded mean artery pressure (MAP), heart rate (HR), CVP, amount of transfusion, incidence of complications and discharge from intensive care and hospital. Results: Female/male report was 66,6% vs. 33.4%. The ages of patients were 53-72 years with a mean ± SD age of 65.1 ± 9.5 years. CVP was 0-5. Amount of blood was 2.5 unite during intervention. Average of days in intensive care was 3.83. Renal compromised was 3%. Ascites and edema were 50%. All patients were discharged home after 14.66 days. Conclusions: Optimizing hemodynamic and fluid administration and reduced the administration of blood therapy using low CVP (0-5).

Background: Around 1.25 million people die each year due to traffic accidents. Traffic accident injuries are the leading cause of death in the most productive age group – 20-45 years old. If no preventive measures are taken, it is expected that in year 2030 traffic accidents will be the leading cause of death in general. Aim of study: Gathering and comparing the statistics regarding traffic accidents to have a better overview of the problem. To identify the most common factors of traffic accidents. To compare the number of accidents and casualties at local, regional and global level. To evaluate the way traffic accidents are handled from urgent medicine services and the Centre of Urgent Medicine in particular. To improve the quality of handlind traffic accident from medical teams. Material and methods: data for this paper is extracted from QMU and archive protocols. We have cooperated with Emergency Centre of UCCK, and Kosovo Police, Pristina regional unit. Retrospective method of research and afterwards descriptive and analytical method has been applied. Results: Of 604 cases of traffic accidents that have been analyzed, 212 or 35.1 % included persons of age group 16-25. Of the totat number, 411 or 68.04 % were males and 193 or 31,9 % were females. The average time of arriving at the scene of CEM teams was 7.65 minutes. 5150 patients were transported to Emergency Centre in UCCK, 3158 of them or 61.32 % were transported with private vehicles and 1992 or 38.62 % were transported with ambulance. Conclusions: The main factor of traffic accidents remains human factor. Traffic accidents increase the incidence of death and disability in general population. Laws and their obedience, technical condition of vehicles, road infrastructure are also factors that influence the number of traffic accidents. Enforcing Emergent Medical Services, promoting and educating the population, institutional cooperatin, have positive impact in reducing the number of traffic accidnts, decreasing mortality and disability caused by traffic accidents.

Background: ARDS is defined as pulmonary inflammatory process characterized by increased capillary permeability associated with acute severe hypoxemia and bilateral infiltrates on the chest radiograph. Chlinical manifestations of ARDS is associated with a reduction of functional residual capacity and static compliance of the respiratory system.Recently,after experimental models and physiological studies have just established the principles to understand the potential beneficial effects of PEEP and reduction in mortality to 22%. The benefit of PEEP has been demonstrated in terms of preventing cyclic opening and collapsing alveoli in acute respiratory distress syndrome patients (ARDS). Aim of study: To determine the appropriate PEEP level in-patients with ARDS. Objective: By using optimal PEEP:to realize the maximal alveolar recruitment.To avoid the decrease of oxygen delivery (DO2) as result of an unfavourable reduction in cardiac output. Material and methods: Retrospectiv study of 120 patients which only 63 of them are included in study with age 18-70 years old.(2012-2014 ) The entry criteria were clinically (severe dyspnoea, tachypnea, cyanosis); PaO2/FiO2 <200mmHG, the presence of bilateral chest infiltrates. The exclusion criteria were: aged < 18 yrs, COPD in history of diseases, heart attack; PEEP was set the level that provided the greatest improvement in oxygenation. The optimal PEEP came as a result of gradual increase of PEEP from 2-5 cmH2O every 6 hours, depended on gas analyses. The right PEEP level is the PEEP allowing the highest PaO2 value without causing hemodynamic compromise. Results: During this study we conclude that the gradual increase of PEEP improves significantly arterial oxygen tension (PaO2). Per value of PEEP 9.6-15.8, CI 95% is 145.9-191.8. The Pearson test with a significant correlation coefficient of level 0.995 and significance level 0.000 shows also a very important result. It was considered significant statistically the value of P= 0.05. Also, the value of Chi ² of PaO2 and of PEEP, has resulted significant in 0.950 with P < 0.001. Conclusion: Mechanical ventilation using optimal PEEP increases the value of PaO2. As a matter of fact, 88% of cases with PaO2 > 220 mmHg survive. The role of PEEP in clinical practice is still debated but, in selected categories of patients with a careful monitoring, it may play an important role in improving outcome.

Radiologists should suggest what kind of imaging is best suited for a pregnant patient presenting with an acute condition. The type of imaging study is planned in close consultation with the clinical team. Ultrasonography (US) should always be the initial modality for evaluation of a pregnant patient, especially in abdominal emergencies. In other conditions like suspected pulmonary embolism or neurological emergencies ultrasound doesn’t help, so using other diagnostic modalities like CT and MRI will be necessary. A recurring debate in many radiology practices is the concern of radiologists about performing an examination that exposes a fetus to radiation. This literature review aims to identify an optimal imaging strategy for the accurate detection of different acute medical non-traumatic emergencies in pregnant patients.

Aims and objectives: This study was done to evaluate the functional and radiographic outcome of PFN in treatment of proximal femoral fracture and more common technical, mechanical complications and intraoperative difficulties during the implant implementation. Materials & Methods: We conducted a retrospective study with ten cases of proximal femoral fractures treated between September 2017 and September 2018, which were accepted at the Department of Orthopedics, the University Hospital of Trauma and the American Hospital in Tirana. Fractures are classified according to classification AO and Boyd-Griffin. The age range of patients taking the study was 20-90 years. Ten cases were followed at regular intervals and the final assessment was made at the end of the 6 month period. In the result, functional clinical assessment according to Harris hip score was done . Results: In our study,mean age was 66 y.o, 7 male and 3 females. Mean of hospitalization time 6 days, mean operation time 120 min. In our study at 6 months follow up, union was achieved in 9 cases, open reduction was performed in 3 cases (10 cases). Technical and mechanical complications were noted in one case. Reoperation rate was 10 % (one case). According Harris hip scoring system excellent results were seen 40 % of cases (4 cases), good results in 50 % cases (5 cases), and poor results in 10% cases (1 case). Conclusions: In our study, in spite of low experience in proximal femoral nailing in cases with unstable trochanteric / subtrocanteric fractures, it was found that PFN is an attractive implant and suitable for proximal femoral fractures and its use in unstable trochanteric / subtrocanteric fractures is very encouraging. This study has also shown that this device can safely be used by an average surgeon to handle common but sometimes tough fractures. Operation is technically not difficult, but gradual learning and great patience is needed to make this method really minimal invasive.

An abdominal aortic aneurism (AAA) is an enlargement of the lower part of the aorta that extends through the abdominal area.The diameter of the aneurismatic vessel is represented by 3 cm or more in either anterior – posterior , or transverse planes. Aortoenteric fistula (AEF) is defined as a communication between the aorta and gastrointestinal (GI) tract. We report the case of an 84-year-old man presenting with a two-day history of epigastric and back pain. The patient was diagnosed with AAA complicated with primary aortoduodenalfistula. This paper aims to describe the management of AAA and its complications as well as the review the actual literature.

Background: Acute myocardial infarction can result in ischemic, mechanical, arrhythmic, embolic or inflammatory complications. Despite high operative mortality, the lack of an effective and immediate medical alternative makes the surgery repair the mainstay of current management for these patients. Novel surgical approaches are presented to manage these complications. Mechanical complications presented at the Department of Cardiac Surgery-Tirana University Medical Centre consisted in nine cases during the period January 2008-June 2018: two anterolateral papillary muscle rupture cases (22%), one posteromedial papillary muscle rupture case (11%), two ventricular septal rupture cases (22%), one free ventricle wall rupture case (11%), three chordae tendineae rupture cases (33%), four out of nine patients (44,5%) underwent concomitant CABG intervention. Intraoperator mortality is estimated 11% (one out of nine cases). The Department of Cardiac Surgery- Tirana University Medical Centre is limited only in open surgery techniques for repairing the post myocardial infarction mechanical complications. To our personal view key reasons for these results are conditioned from lack of medical devices, trained stuff, reliable short and long outcome data from alternative procedures in order to incorporate thus in our daily practice. Further studies should be undertaken not only to create a precise image of the situation, but also to evaluate the results of the possible changes.

The occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post-operative heart failure is fairly common. Mechanism of hyperbilirubinemiais still not completely clarified, and there are so few specific therapies available for acute hepatobiliary injury. Post-operative mortality well correlates with increasing total bilirubin values, particularly for bilirubin-associate acute kidney tubular necrosis. The difficulty to reduce mortality is partially a consequence of not completely understood physiopathology. It is obvious that long-lasting CPB plays an important role, in association with hemodilution, hypotension, ischemia-reperfusion, and increasing hematic level of endogenous catecholamine with reduction of hepatic blood flow. Case report. A 68 years old man with severe mitral valve regurgitation and pulmonary hypertension and low EF 30%. Mitral valve replacement and tricuspid anuloplastic was performed. Due to low cardiac output syndrome severe hyperbilirubiemeia was seen (24 mg/dl. and unconjugated fraction 16mg/dl) days after. Phenobarbital (luminal) was started 15 mg/kg daily. Two days later the level decreased until 8 mg/dl with normalization of conjugation/unconjugation ratio.Postoperative hyperbilirubinemia is a multifactorial process caused by both impaired liver function of bilirubin transport. In case of elevated level of unconjugated fraction, we suggest to use Luminal as alternative for decreasing unconjugated fraction.