Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstructions. It is still a serious problem in developing countries, as our country. We reviewed the morbidity and mortal-ity rates and outcomes of bronchiectasis surgical treatment.
Patients and methods: Between years 2000 and 2016, one hundred and seven (107) patients, sixty nine (69) of whom female and thirty eight (38) male underwent pulmonary resection for bronchiecta-sis. The mean age was 35years (range, 13–66 years). Mean duration of symptoms was 12 years.
Results: Symptoms were copious amount of purulent sputum in 84 patients, expectoration of foul-smelling sputum in 72, haemoptysis in 21 and cough in all patients. The indications for pulmonary resection were: medical therapy failure in eighty two (82) patients, massive haemoptysis in eighteen
and lung abscess in seven (7) patients. The disease was bilateral in twenty seven (27) patients and mainly confined in the lower lobe. Eighty six (86) patients had a lobectomy, 7 had a segmentectomy, two patients right pneumonectomy. Operative morbidity was seen in 47 patients (43.9 %) and mor-tality in two (2) patients. Follow-up was complete in 97 patients with a mean of 5 years. Overall, 78 patients were asymptomatic after surgical treatment; symptoms were improved in 24, and unchanged or worse in 5.
Conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.
Introduction: although the term “polytrauma” has been in use for decades, no generally accepted definition exists. Our definition has been until 2010: a combination of injuries where one, or the combination where one, or the combination of injuries himself is directly life threatening, in detail is meant: injury to two body cavities, or injury to one cavity committed by two long bone fractures, where spine and unstable pelvis has counted similarly as an injury to a cavity organ.
Since 2013 a new definition has been established, the so-called Berlin definition.
"A polytrauma means significant injuries of three or more points (AIS) in two or more different anatomic AIS regions in conjunction with one or more additional variables from 5 physiologic parameters: Hypotension (SBP - Systolic Blood Pressure <= 90 mm Hg); Level of consciousness (GCS - Glasgow Coma Scale) ≤ 8; Acidosis (BE - Base Excess ≤ - 5.0); Coagulopathy (INR - International Normalized Ratio ≥ 1.4; PTT - Partial Thromboplastin Time ≥ 40 seconds, and Age ≥ 70 years).
This definition fits the reality perfectly.
The role of the surgeon in the trauma team is essential. It should provide multidisciplinary care to reduce diagnostic time and optimize therapeutic procedures.
As Medicine adapts to the 21st century, new specialties arise. In the management of trauma, two models have been opposed in the past: on one side, a Trauma Surgeon based system, with specialists fully devoted to trauma care, often able to fix skeletal trauma too; on the other hand, blended systems with General Surgeons dealing with both elective and emergency surgery and trauma patients.
The evolution of technology, of the epidemiology of trauma, and of the trauma systems and networks entailed the emerging of the concept of Acute Care Surgery. In the vast majority of Countries, this new specialist seems to better fit with the needs of both patients and health organization.
Who is the Acute Care Surgeon? What is his minimal educational and technical background? How can interact with the other medical specialists playing around a trauma patient?
The Aim : The aim of the study was to eveluate benefical effect of corticosterides in short treatment of community acquired pneumonia (CAP). Patients and Methods : We enrolled a total of 149 hospitalized patients, for a period of an year (Januay 2011 to Decembre 2011). The diagnose of CAP was made using standard clinical and radiological criteria. Disease severity was scored using Pneumonia Severity Index. Age, antibiotic treatment and PSI adjustement has been done between the groups. Patients received 50 mg prednisolone for 7 days, along with antibiotics. The outcomes were clinical cure at day seven, defervescence, length of stay, time to clinical stability, Results : Mean age of patients enrolled in study was 63±16.7 in prednisolone and 53±18.6 in group without prednisolone Therty (40 %) patients in prednisolone group and 16(22.2%) in without prednisolone group were in Peumonia Severity Index class IV-V. Clinical cure at days 7 was 61/75 (82.6%) in the prednisolone group and 44/72 (61.1%) in other group.[ P Conclusions : In this study we show that Prednisolone (at 50 mg) once daily for a short time, (a week), have a beneficial effects in patients hospitalized with mild to severe CAP, improving outcomes without adverse events.
Rationale: Solitary fibrous tumours (SFT) of the pleura are rare tumours, originated from the mesenchimal tissue, underlying the mesothelial layer of the pleura. This tumors present unpredictable clinical course, probably related to their histological and morphological characteristics. Objective: The aim of the study was to evaluate beneficial effect of surgical treatment of Solitary fibrous tumours (SFT) of the pleura. Material and Patients: Twenty-three (23) patients affected by SFT of the pleura were referred to us for surgical resection in our clinic in SU”Shefqet Ndroqi” from September 1999 to April 2013. Results: Surgical excision required 18 posterolateral thoracotomies, five anterior lateral thoracotomies and no one video-assisted thoracoscopy. Average tumor diameter was 8.5 cm (range, 4.5-25 cm) and weight was 130 g (range 5-2,560 g). In all our patients resections were complete. No intraoperative or perioperative medical or surgical complications occurred. Median chest-drain duration timed 3 (range 2-5) days and median hospital stay was 5 (range 4-7) days. We have no perioperative mortality. Only one patient experienced tumour recurrence. Conclusions: Surgical resection of benign solitary fibrous tumors is usually curative, but local recurrences can occur years after seemingly adequate surgical treatment. Malignant solitary fibrous tumours generally have a poor prognosis. Clinical and radiological follow-up are indicated for both benign and malignant solitary fibrous tumors. Keywords: Solitary fibrous tumor of the pleura, clinical features, imaging, pathology, treatment SFT: Solitary fibrous tumours.
Background: Although rare, thymoma is the most common tumour of the anterior mediastinum. In an effort to assess the clinical and pathologic characteristics of this tumour and to determine whether clinicopathologic stage or histopathologic classification correlates with clinical outcome, in the Thorax Surgery Service at the University Hospital “Shefqet Ndroqi” Tirane Albania. Methods: In 66 patients with a diagnosis of thymoma or thymic carcinoma identified from January 2004–November 2016 we studied the presentation, diagnostic investigations, therapeutic interventions, tumour size, postoperative course, clinical stage, histopathologic classification, disease recurrence and mortality. Results: Of the 66 patients, 14 (21%) were asymptomatic and 22 (33%) had symptoms consistent with myasthenia gravis. Surgical resection is most commonly performed through a median sternotomy and frequently requires en bloc resection of one or more adjacent structures. Local recidive in 4 patients and distant metastasis 2 patients. The overall survival of patients with thymoma was found to correlate with the clinical stage as described by Masaoka and colleagues and with complete tumour resection. A trend to clinicopathologic correlation was observed when applying the histologic classification systems of Suster and Moran and the World Health Organization. Conclusions: Thymoma is a rare tumour with a variable clinical presentation. Clinical outcome correlates with clinical stage and the ability to achieve complete tumour resection.
