What do we know about the epidemiology and the management of human echinococcosis in Albania?

Echinococcosis is a life-threatening neglected zoonotic disease. Cystic echinococcosis (CE) due to Echinococcus (E.) granulosus usually involves livestock and dogs; alveolar echinococcosis (AE) due to E. multilocularis involves rodents and canines such as foxes and dogs. Human hosts are infected accidentally via hand to mouth and/or foodborne/waterborne pathways. Albania is deemed to be endemic for cystic echinococcosis (CE), but there is a scarcity of data to confirm this. A systematic literature search was performed in PubMed, Google Scholar, and in other medical sources. Because of the scarcity of existing information, data confirming CE cases were reviewed from the medical hospital records of Albania's largest Hospital, the Mother Teresa University Hospital (UHCMT) Tirana, and from a large private laboratory in Tirana (Pegasus laboratory). A total of eight eligible publications on 540 CE patients were found. Three hundred forty seven additional cases hospitalized in UHCMT from 2011 to 2020 were confirmed, as well as 36 laboratory cases and 10 Albanian cases notified in Germany. Taking all cases into account and considering 162 overlapping cases, 771 cases were documented from 2011 to 2020. The only case reported as AE was most likely a multi-organic CE. Surgery was the most frequent therapy approach used (84.7%). Autochthonous human CE seems to be widespread, and transmission is ongoing in Albania. CE patients in Albania undergo surgery more frequently compared with CE cases in other European countries. In order to establish a realistic estimate of prevalence and incidence of CE in Albania, mandatory notification should be reinforced. Stage-specific therapy can be used in CE to reduce therapy cost and diminish mortality by avoiding surgical overtreatment.

Corrigendum to 'Ectopic thyroid tissue in the anterior mediastinum along with a normally located gland' (Radiology case reports 16 [2021] 3191-3195).

[This corrects the article DOI: 10.1016/j.radcr.2021.07.064.].

Ectopic thyroid tissue in the anterior mediastinum along with a normally located gland.

Ectopic thyroid tissue is a rare developmental abnormality arising from an aberration in the normal migration of the thyroid gland, from the floor of the primitive foregut to its final position. It is usually asymptomatic, often being diagnosed as an incidental finding. However, it can present with symptoms of compression such as chest pain, cough, stridor, dysphagia, dyspnea and superior vena cava syndrome. Herein, we present the case of a 42-year-old male patient, presenting with dyspnea, chest pain and fatigue. Laboratory tests showed low serum levels of thyroid-stimulating hormone (TSH) and a thoracic computed tomography revealed a heterogeneous mass in the anterior mediastinum. The patient underwent a full surgical resection. The postoperative histopathological examination of the mass demonstrated the presence of benign ectopic thyroid tissue with no evidence of malignancy. This case report emphasizes the importance of taking Ectopic thyroid tissue into account when considering the differential diagnosis of a mediastinal mass, as other common diagnoses including lymphomas, dermoid cysts and thymic tumors, require an entirely distinct treatment approach.

Laparoscopic cholecystectomy: which predicting factors of conversion? Two Italian center's studies.

BACKGROUND: Laparoscopic cholecystectomy represents the gold standard technique for the treatment of lithiasic gallbladder disease. Although it has many advantages, laparoscopic cholecystectomy is not risk-free and in special situations there is a need for conversion into an open procedure, in order to minimize postoperative complications and to complete the procedure safely. The aim of this study was to identify factors that can predict the conversion to open cholecystectomy. METHODS: We analyzed 1323 patients undergoing laparoscopic cholecystectomy over the last five years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome. Among these, 116 patients (8.7%) were converted into laparotomic cholecystectomy. Clinical, demographic, surgical and pathological data from these patients were included in a prospective database. A univariate analysis was performed followed by a multivariate logistic regression. RESULTS: On univariate analysis, the factors significantly correlated with conversion to open were the ASA score higher than 3 and the comorbidity, specifically cardiovascular disease, diabetes and chronic renal failure (P<0.001). Patients with a higher mean age had a higher risk of conversion to open (61.9±17.1 vs. 54.1±15.2, P<0.001). Previous abdominal surgery and previous episodes of cholecystitis and/or pancreatitis were not statistically significant factors for conversion. There were four deaths in the group of converted patients and two in the laparoscopic group (P<0.001). Operative morbility was higher in the conversion group (22% versus 8%, P<0.001). Multivariate analysis showed that the factors significantly correlated to conversion were: age <65 years old (P=0.031 OR: 1.6), ASA score 3-4 (P=0.013, OR:1.8), history of ERCP (P=0.16 OR:1.7), emergency procedure (P=0.011, OR:1.7); CRP higher than 0,5 (P<0.001, OR:3.3), acute cholecystitis (P<0.001, OR:1.4). Further multivariate analysis of morbidity, postoperative mortality and home discharge showed that conversion had a significant influence on overall post-operative complications (P=0.011, OR:2.01), while mortality (P=0.143) and discharge at home were less statistically influenced. CONCLUSIONS: Our results show that most of the independent risk factors for conversion cannot be modified by delaying surgery. Many factors reported in the literature did not significantly impact conversion rates in our results.

Blunt abdominal trauma following gunshot wound Case report and literature review.

Blunt abdominal trauma following gunshot wound. Case report and literature review Introduction: Similarly to blast weapons, every firearm produces explosion at the moment of shooting, which can cause injuries in every region of the body. The aim of this paper is to present the mechanism of blunt abdominal injury following gunshot wounds, bringing this uncommon disease to the clinicians' attention and to review the literature available. CASE REPORT: A patient developed a delayed bowel perforation following a gunshot injury of the abdomen without breaking of the peritoneum. It was clinically suspected eight hours later and confirmed with contrast-enhanced computed tomography scan. The patient underwent immediate laparotomy. Resection, end-to-end anastomosis, and large lavage of the peritoneal cavity was performed. The patient was discharged ten days after operation in good condition. CONCLUSION: Failure to recognize blunt trauma mechanism following firearm wounds increases the risk of missed injuries. Distant injuries should be suspected in all cases after blast wave and firearms exposure and a follow up should be done for many days to make sure such injuries are excluded. CT scan total body is recommended in all such cases. Key words: Blunt trauma, Distant Injuries, Firearm injuries, Pressure Waves.

Delayed diagnosis and treatment of high grade blunt pancreatic trauma. Case report and review of literature.

INTRODUCTION: Despite technological advancement, high grade pancreatic injuries following blunt abdominal trauma continues to remain a disease that is associated with high morbidity and mortality rates, particularly in cases of delayed diagnosis. The aim of this paper was the presentation of delayed diagnosis and treatment peculiarities of high grade pancreatic trauma and a review of literature. CASE REPORT: A 55-years old man, involved in motor vehicle crashes, was referred to our level I trauma center. Hemodynamically stable. Abdominal physical exam, laboratory and focused abdominal sonography for trauma were normal. First total body multidetector CT scan, performed only after 24 hours, showed almost complete left pneumothorax, left third to fifth rib fractures and subcutaneous emphysema. Left chest tube was applied. On the eighth post-traumatic day, the general condition of the patient started to deteriorate. The patient showed abdominal pain, fever, nausea, vomiting, and bilateral flank ecchymosis. Only the third CT scan performed, on twelfth day, after the peritoneal signs, changes in blood and biochemical parameters appear, we revealed linear laceration and hypo-attenuation area of the neck and a part of distal body pancreas. In laparotomy fat necrosis, giant retroperitoneal abscess, necrosis of the neck and distal body of the pancreas, was found. Distal pancreatectomy with splenectomy was performed. Postoperative course with extensive wound infection and necrotic leakage from peripancreatic drain was complicated. The patient was discharged two months after his operation without any events. CONCLUSION: On time diagnosis of pancreatic trauma, especially in polytrauma patients, continues to remain a challenge for trauma surgeons. Main pancreatic duct injury is an important prognostic factor and the major one determining therapeutic approaches. Adequate surgical approaches decrease morbidity and mortality in pancreatic trauma. KEY WORDS: Delayed diagnosis, Distal pancreatectomy, Pancreatic blunt trauma.

Epidemiology of goiter and benign tumors of the thyroid gland in Albania.

AIM: The aim of this study was to describe the demographic characteristics and disease patterns among patients with thyroid nodular abnormalities (goiter) and benign tumors of the thyroid gland in Albania, a transitional country in South Eastern Europe. METHODS: Our study included all patients diagnosed with goiter and/or benign tumors of the thyroid gland who were hospitalized at the University Hospital Center (UHC) "Mother Teresa" in Tirana between 2004 and 2012 (N=2258). All patients underwent the same examination and interviewing procedures. Demographic characteristics included gender, age, and place of residence. Binary logistic regression was used to compare the demographic characteristics between patients with benign tumors of the thyroid gland and those with goiter. RESULTS: Overall, there were 2204 patients with goiter and 54 patients with benign tumors of the thyroid gland hospitalized at UHC over the period 2004-2012. There was no evidence of statistically significant differences in demographic characteristics (age, gender, or place of residence) between patients with benign tumors of the thyroid gland and those with goiter. CONCLUSIONS: Our study provides useful evidence on the epidemiology of benign tumors of the thyroid gland and the thyroid nodular abnormalities (goiter) in the Albanian population. Future studies in Albania should assess the main determinants of thyroid gland disorders and compare them with findings pertinent to other similar populations.

The effect of ursodeoxycholic acid in liver functional restoration of patients with obstructive jaundice after endoscopic treatment: a prospective, randomized, and controlled study.

BACKGROUND: In patients with obstructive jaundice, multi-organ dysfunction may develop. METHODS/DESIGN: This trial is a prospective, open-label, randomized, and controlled study with the objective to evaluate the effect of ursodeoxycholic acid in liver functional restoration in patients with obstructive jaundice after endoscopic treatment. The aim of this study is to evaluate the effect of ursodeoxycholic acid in liver functional restoration of patients with obstructive jaundice after endoscopic treatment. The hypothesis of this trial is that patients with obstructive jaundice, in which will be administered UDCA, in the early phase after endoscopic intervention will have better and faster functional restoration of the liver than patients in the control group.Patients with obstructive jaundice, randomly, will be divided into two groups: (A) test group in which will be administered ursodeoxycholic acid twenty-four hours after endoscopic procedure and will last fourteen days, and (B) control group.Serum-testing will include determination of bilirubin, alanine transaminase, aspartate transaminase, gama-glutamil transpeptidase, alkaline phosphatase, albumin, and cholesterol levels. These parameters will be determined one day prior endoscopic procedure, and on the third, fifth, seventh, tenth, twelfth and fourteenth days after endoscopic intervention. DISCUSSION: This trial is a prospective, open-label, randomized, and controlled study to asses the effect of ursodeoxycholic acid in liver functional restoration of patients with obstructive jaundice in the early phase after endoscopic treatment.