Background: An extensive burn is one of the most serious injuries. The conventional methods of local therapy, especially in extensive and deep burns, cannot prevent infection. The fact is that the necrotic burn tissue always gives rise to infection and must therefore be excised. Tangential excision is a diagnostic procedure as well as a surgical preparation of a recipient bed for skin graft. Aim of research: The aim of our research was to demonstrate the efficacy of early tangential necrectomy in the treatment of extensive burns in children as well as in preventing the burn diseases. Material and methods: Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infection, laboratory values. Results: The boys comprised 58.3% of the respondents and the girls were 41,7% of the respondents. The most common cause was the hot liquid of 73.3%, open flame 23.3% and the contact with hot metal 3.3%. The body temperature was significantly higher in control group compared to the examined group (p <0.001) significantly lower hematocrit values in the control group compared to the examined group (p = 0.002). The results show that hospitalization lasted considerably longer in patients in the control group than in the examined group (p = 0.003). The incidence of bacterial infection of the burns is significantly higher in control compared to the examined group of patients (p = 0.007). The most commonly isolated bacteria in the study group was Staphylococcus aureus (15/30 or 50% of all subjects). Acinetobacter spp. was isolated in 9 patients (30% of respondents). Serratia spp. And Enterococcus Foecalis were isolated in 6 patients (20%). Pseudomonas aeruginosa was isolated in 3 patients (10%). Three patients (10%) did not isolate any bacteria during hospitalization Conclusions: The method of early tangential necrectomy of extensively burned children significantly reduce morbidity and mortality (it improves the general condition of the patient, improves clinical and laboratory parameters, reduces the possibility of infection of the wound, reduces the possibility of sepsis, reduces the length of hospitalization).The most optimal time to perform an early tangential necrectomy is the period between the 4th and the 6th day after the injury. In extensively burned children over 30% of the total body surface, an early tangential necrectomy should be performed on an area of about 20% of the total body surface as a prevention of blood loss due to necrectomy and autotransplantation. With extensively burned children over 40% of the total body surface, taking homotransplants from parents or close relatives reduces morbidity and mortality.

Background: Shotgun injuries of the peripheral nerves are presented frequently during the last decades at the Service of Neurosurgery of UHC “Mother Theresa” in Tirana. In such cases the surgical repair of brachial plexus and peripheral nerves constitutes a challenge with relation to difficulties related with mechanism of injury, coexistence of other vascular damage, bone, soft tissue and visceral lesions. Materials and methods: A retrospective study of operated cases with shotgun injuries treated in our Department from 1997 to 2012 was conducted getting information from clinical charts, surgical registries, intraoperative photos and videos of the surgical repair of peripheral nerves. We performed a thorough analysis of the most influencing factors of surgical outcome such as: age, severity of injury, site of injury with relation to the innervated muscles, type of necessary nerve repair, presence of causalgia before operation, concomitant compromise of vascularization and/or locomotor apparatus. Follow-up of the patient was conducted through out-patient visits and phone interviews going back 10 years from surgical repair. Results: 68 cases operated for shotgun injury of brachial plexus or peripheral nerves were revised. There were different ages and both sexes involved. The type of nerve repair went from interfascicular neurolysis to direct end-to-end microsuture and nerve grafting. Timely repair of the nerve injury proved to be yielding better result than late repair in terms of pain relief and sensory motor improvement of the preoperative neurological deficit. The degree and the quality of improvement after surgery is related to the type of repair (neurolysis improves better and faster than grafting), the distance from site of injury to the effector muscle (the longer the distance more time it takes for the function to recover). The recovery of the brachial plexus was followed up for many years and further surgery proved to be necessary and of further improvement. Conclusions: From our long term experience dealing with surgical repair of shotgun injury of peripheral nerves we have learnt that early surgical repair is more efficacious in treating pain and gives better results in terms of motor and sensitive recovery than six months after injury as it was usually done. Long term follow-up is necessary to help with further surgery in case of distal decompressive surgery in anatomical tunnels.

Treatment of chronic ankle instability remains a challenge for orthopedic surgeon. Surgical procedures for this disorder include anatomic direct repair, anatomic reconstruction with an autograft or allograft, and arthroscopic repair. Open direct repair is commonly used for patients with sufficient ligament quality. Reconstruction incorporating either an autograft or an allograft is another promising option in the short term, although the longevity of this procedure remains unclear. Use of an allograft avoids donor site morbidity, but it comes with inherent risks. Arthroscopic repair of chronic lateral ankle instability can provide good to excellent short- and long-term clinical outcomes, but the evidence supporting this technique is limited. Deterioration of the ankle joint after surgery is also a concern. Studies are needed on not only treating ligament insufficiency but also on reducing the risk of ankle joint deterioration.

Background: One of the most severe complication after intestinal resection, often with catastrophic consequence for the patient is leakage from the anastomosis. The severity of complications after anastomotic leak may range from a small localized peritonitis or abscess formation without sepsis, to a development of a four quadrant peritonitis with septic shock. Until now despite the seriousness of this complications, the cause of anastomotic leakage are not yet definitively clear. Aim: The aim of this study is to submit our experience in treatment of patients with anastomotic leakage after intestinal resection and their outcome. Materials and Methods: The study included 63 patients with colorectal cancer operated in the Department of Surgery at the Clinical Hospital of Tetova. In all patients intestinal resection with end to end anastomosis was performed. Conclusions: Anastomotic leak after large bowel resection is a very serious complication with a great impact on patient’s morbidity and mortality. Multiple risk factors are associated with occurrence of this complication whereas the more suspected are: preoperative anaemia, hypoalbuminemia, emergent surgery without adequate preparation of patient, intraoperative blood loss and blood transfusion during surgery etc. Early detection of AL is very important and helpful to improve the outcome of patients and to minimize postoperative rate of morbidity and mortality.

Background: Epidural analgesia is a gold standard in post-operative pain control in patients undergoing large abdominal interventions. Different studies report a failure ratio of epidural analgesia of 20-32%. The aim of this study is to analyze the success rate of epidural analgesia and its consequences in patients that have been subject to large abdominal surgeries. Materials and methods: We have prospectively collected the data of 50 patients that were subject to open abdominal surgeries during a 2 year timeframe (September 2015 – September 2017) at University Clinical Center of Kosovo. Experienced anesthesiologists inserted the epidural catheters. A dedicated team used the Verbal Scale to collect the data regarding post-operative pain during coughing or moving. The success rate of eidural catheter was measured in terms of: the scale of pain, pulmonary post-operative infection and length of hospital stay. Results: The study group included 33 males and 17 females, most of whom were subject to liver surgery. The secondary liver formations (70%), primary tumours (20%) as well as beningn liver disorders(10%) were an indication for liver resection. Large resections (=3 segments) were completed in 44% of patients, small liver resections were (=2 segments) completed in 48% of patients, while 8% of patients were considered inoperative. Epidural analgesia was successful in 46 patients (92%). Bacterial colonisation of the catheter was observed in only one case. There were no neurological complications. 5 (10%) patients showed radiologicalsigns of a pulmonary infection. Three patients (6%) had surgical wound infection. One patient died of hepatic insufficiency after massive right liver resection and cholecystectomy due to gallbladder carcinoma. The average length of hospital stay was 6 days. Conclusions: Our experience concludes that epidural analgesia is a safe and effective way of pain relief after abdominal surgeries.

Background: Cholecystectomy is the standard treatment for patients with acute cholecystitis. On the other hand, percutaneous cholecystostomy (PC) is an alternative for patients at high-risk for surgery. The aim of this study was to evaluate the clinical outcomes of PC. Methods: Surgically high-risk patients with acute cholecystits having undergone PC at our institution between January 2014 – January 2017 were evaluated. Data including the indications for PC, route of insertion, technical success, clinical improvement, length of hospital stay, mortality rates, procedure related complications, subsequent admissions and performance of interval cholecystectomy were recorded and analyzed. Results: The study group consisted of 30 patients with a mean age of 75.3 ( range: 49–99) years. The indications for PC were acute calculous cholecystitis in 28 (93.3%) and acalculous cholecystitis in 2 (6.7%) patients. All procedures were performed via the transhepatic route. Twenty-five PCs (84.4%) resulted in clinical improvement within five days. A repeated PC was performed in two (6.7%) patients. Seven (23.3%) patients underwent a subsequent cholecystectomy after 6 weeks. An emergent cholecystectomy was performed in one (3.3%) patient. Five (16.7%) patients died from underlying comorbid diseases, unrelated to the biliary system, during the follow-up. Conclusions: Patients with acute cholecystitis were promptly relieved from their symptoms following PC. There were only minor complications following the procedure and an interval cholecystectomy was necessary in only 23.3% of the patients. PC is a safe alternative to choecystectomy in high-risk patients with acute cholecystitis with satisfactory results.

Background: Multiple injuries are the second leading cause of morbidity, invalidity and mortality in developed and developing countries in children, young people and the elderly. The most frequent causes are: road traffic accidents, falling from heights, firearms, vehicles, colds and explosive devices. The incidence and prevalence of polytrauma differs from region to region and the largest number of deaths from multiple injuries or polytraumatis occur within the first trauma time, often defined as the "golden hour of trauma". Aim: Provide medical care at all stages of managing the injured with politrauma with basic and advanced support in order to reduce: morbidity, disability and mortality. Materials and methods: The research material was obtained from UCCK Emergency Clinic archive. The research is retrospective, descriptive, qualitative, for the period January-December 2018 In the research only injured with: injuries, sex, type of pathologies, causes, road traffic, firearms, cold vehicles, tools explosives as well as crashes. Results: In 42.16% or 78 cases, problems were also reported in Phase VI because no department was willing to take responsibility for accepting the injured, but was obliged for the injured to stay in the emergency department for several days without any active treatment. Discussion and Conclusions: This research highlights the limitations in the various steps of managing the injured with politrauma and the absence, delays in specialties in standard procedures of operational interventions to manage these injuries. All medical care professionals should be the primary and secondary tertiary and tertiary education and training of emergency medical staff with continuous trending, communication, RKP BLS - AED & PATLS, ALS, ATLS, ACLS and the creation of the national trauma center.

Background: Abdominal pain in children is the most common problem with which the pediatricians faces in their practice. Recurrent abdominal pain is defined as " the presence of at least three episodes of abdominal pain over a period longer than three months and severe enough to affect the activities of the children". Even though it is considered that functional bowel diseases are the most common cause of recurrent abdominal pain several studies have recognized that numerous organic disorder such as intestinal parasitic infections may lead to abdominal pain. Aim: The aim of this study is to observe the prevalence and the type of intestinal parasites in a representative sample of children living in the municipalities of Tetova and Dibra. Materials and methods: Our study was done in a period between January 2018-2019 in the municipalities of Tetova and Dibra. Totally 470 children examined due to recurrent abdominal pain from the pediatrician was subject of this study. Collected stool samples was checked for the presence of intestinal parasites in microbiological laboratories in Tetova and Dibra. Results: 470 children were included in our study. 248 of them were girls and 222 boys with a median age of 8.2 years. 67 of the children were positive (14.25 %) for intestinal parasites. Conclusions: Our study reveals that intestinal parasites were frequent among children in our country. The incidence of intestinal parasitosis is higher among the children who come from families with lower socioeconomic status compared to children who come from families with good conditions. The same situation is related to education, respectively children of educated parents are least vulnerable to intestinal parasitosis.

Background: Chronic abdominal pain is a common disorder in children and adolescents worldwide. In attacking this problem, the pediatrician often concentrates on the gastrointestinal or genitourinary tract as a source of the pain. Too little attention is paid to the gallbladder as the cause of pain in this age group.1 We report a 6-year-old girl who presented with recurrent abdominal pain and was diagnosed as having a multiseptate gallbladder (MSG). MSG, although rare, should be considered in the differential diagnosis of patients presenting with recurrent abdominal pain and abdominal ultrasonography should form part of the investigation.

Background: Health-related infections represent a very important complication of health care treatment. They are associated with high morbidity, mortality, disability and high costs of treatment, care and rehabilitation. The problem is its rising incidence, mainly as pathogens have developed various antimicrobial resistance mechanisms. Enterobacterias that excrete carbapenemases are a significant problem, especially as the treatment options for infections is increasingly limited. Several guidelines dictate measures to prevent their spread and control at different levels of health care. Implementation of guidelines in practice is not easy, as it requires a lot of knowledge, cooperation, consistency, material, environmental and human resources. The role of health care professionals is indispensable in this field. The aim of the article is to present the role of health care professionals in the prevention of Carbapenem-resistant Enterobacteriaceae (CRE) infections and proactive approach of General hospital Ptuj in preventing and controlling CRE.

Background: Amyotrophic lateral sclerosis (ALS) is a serious disease in which some brain and spinal cells die slowly. These nerve cells are called motor neurons and control the muscles that allow the body parts to move. Initially, the disease causes bodily fatigue and muscular weakness through degeneration of the upper and lower motor neurons, leading to loss of ability to initiate and control the voluntary bodily functions. In late stages this disease causes difficulty in the normal swelling and eating that causes the need for PEG in patients with ALS. This clinical picture increases the difficulty and the anesthetic risk used during the PEG application. Case presentation: We are describing our experience in a 56-year-old male patient, ASA III suffering from ALS and being admitted to our clinic to insert PEG. The patient presented BMI =15.6. After the patient provide informed consent, we were monitoring him for detect changes in pulse oximetry, noninvasive blood pressure, heart rate and visual assessment of ventilator activity, level of consciousness and discomfort. We used balanced propofol for moderate sedation (BPS), loading dose 1mg midazolam, 0.1 mg of fentanyl, and 5-15 mg propofol in smaller bolus dose were applied for more precise dose titration. The operation was performed after the patient lost the consciousness and had no pupil reflex. The EGD entered to the stomach. Fistula was localized after the visualization of light from the tube. Local lidocaine was applied and 1cm incision on the abdominal wall gave the possibility for application of fistula and gastro stoma placement. The patient wakes up 10 minutes after the end of the procedure without using antidotes. The patient after treatment went home in two days using gastro stoma for enteral feeding.

Background: Upper extremity soft tissue reconstruction is an extensive topic as a multitude of options exist for diverse soft tissue defects involving shoulder, arm, elbow, forearm, wrist, and hand. Many of the times flap cover is necessary for resurfacing exposed critical structures like tendons, neurovascular structures, bone and to provide supple tissue over joints. Pedicled and perforator flaps are seen in last years as a good choice to restore length, sensitivity and function of the injured upper limb. The aim of this paper is to give an overview of the definitions of as well as to present our experience regarding pedicled and perforator flaps. Materials and methods: A retrospective analysis of 15 trauma patients who underwent pedicled and perforator flaps during the 2012-2016 timeframe period was made. The patients were divided according to their type of injury, as well as the types of flasp that were used. Results: We have performed in total: 7 Foucher’s flaps, 4 Posterior Interosseous Artery flaps, 1 Radial Recurrent Artery flap, 1 Quaba flap, 1 SDMA flap. We had only two cases of partial necrosis of the flaps and all the others survived completely. Conclusions: Every single flap elevated successfully is linked with a meticulous surgical technique. We should take a special care in pedicle positioning because pedicle strangling was the most important negative factor in our two flap partial necrosis. Understanding the mistakes will help us to improve our surgical techniques day after day.

Epidural anesthesia has been used widely as a combination to general anesthesia in cardiac surgery since early seventies. The addition of this technique to general anesthesia may have beneficial effects on clinical outcome. Several clinical trials and experiments have shown that there may be significant benefits using epidural anesthesia in cardiac surgery. Somehow neuroaxial blockade manages to attenuate the response to surgical stress and improve perioperative analgesia. Between august 2014 and September 2018, high thoracic epidural anesthesia was applied to 12 patients as a sole anesthetic technique. Epidural anesthesia was chosen because the patients had relative contraindications to general anesthesia and mechanical ventilation. This paper gives an overview of epidural anesthesia usage and our experience.

Case report: A 27-year-old previously healthy man was admitted to the ICU complaining nausea, vomiting and disorientation, after he ingested 1500 mg paracetamol, but its relatives explained that they possess in the house only metformin (maybe he ingested metformin instead of paracetamol). First blood gas showed moderate, and hours later severe lactic acidosis Ph 7,01, Lac 25 m mol/L, BE -26,4. Aggressive rehydration and hemofiltration was started, until full recovery after 24 hours of hospital admission. He was discharged after three days in healthy condition. Discussion: Lactic acidosis is a common cause of metabolic acidosis at the ICU. Type A is most common and caused by hypoperfusion or hypoxia, whilst type B has other causes including use of the antidiabetic drug metformin. Metformin associated lactic acidosis (MALA) is an important treatment-associated condition, and although rare, it is very serious. Conclusion: MALA should be strongly suspected in patients presenting with wide anion gap metabolic acidosis and high blood lactate concentration. Bicarbonate hemodialysis or continuous renal replacement therapy should be urgently arranged for patients with MALA.

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