Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review.

We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.

Actual status of preoperative diagnosis of thyroid cancer in Albania.

INTRODUCTION: Thyroid cancer is the most common endocrine malignancy and accounts for almost 1% of human cancer. It is well known that the majority of cases occur in women in the middle decades of life. Thyroid cancer is a relatively rare disease; on the other hand clinically apparent thyroid nodules are present in 4-7% of the adult population. Most thyroid nodules are not malignant, with reported malignancy rates from 3-12%. It is important for the surgeon to know beforehand the diagnosis of malignancy, in order to perform a more radical operation on the thyroid gland. PATIENTS AND METHODS: In our study we have analyzed the preoperative clinical data of 84 patients operated in the First Clinic of General Surgery, UHC "Mother Theresa" in Tirana; all with a positive histopathologic diagnosis of thyroid cancer. The data comprised age, sex, age distribution, blood group, time-lapse from the first endocrinologic visit, clinical examination, signs and symptoms, imaging, functional tests, preoperative FNA, admission diagnosis, associated diseases and preoperative treatment. RESULTS: From the study emerged that only 9,3% of these patients were diagnosed preoperatively as thyroid cancer. Another related problem is the low percentage of preoperative FNA - only 22%. Among the signs and symptoms related to thyroid cancer we found that 40 and 33% of these patient presented dyspnea and dysphagia, respectively. The physical examination revealed apparent nodular growth of the thyroid gland in 81% and nodular hard consistency in 79% of cases. The proper endocrinologist consultation lacked in 23% of cases. CONCLUSION: In our opinion, close collaboration between endocrinologists and surgeons in a multidisciplinary frame is the key to correct preoperative thyroid cancer diagnosis and optimal treatment.

Evaluation of patterns and appropriate gastro protection in Albanian primary health care users.

Our aim was to assess the prevalence of gastro protection in the Albanian population using non-steroidal anti-inflammatory drugs (NSAIDs). A cross-sectional study, conducted in November-December 2011 in Albania, included 610 NSAIDs users (236 men and 374 women) who visited pharmacies to receive their NSAID medication. A structured questionnaire was administered to all participants including information on age, sex, educational status, pathology being treated with NSAID, presence of gastrointestinal ulcer or related complications, duration of NSAIDs therapy, type of drug used, and gastro protection therapy. Almost all participants (N=599) received NSAIDs to treat rheumatic and/or musculoskeletal disorders. Of these, 475 individuals were on chronic therapy with high daily doses of NSAIDs. Concomitant gastro protective therapy was found in 184 individuals (30 percent of the overall sample). Women and the more educated individuals received more gastro protection than men and the low educated counterparts, respectively (33.4 percent in women vs 25 percent in men; 47 percent in highly educated vs 18 percent in low educated). Appropriate use of gastro protective therapy for NSAID users needs to be promptly implemented in Albania, as its inappropriate use raises ethical and economic concerns. Prescriptions should follow clear guidelines for prevention of gastrointestinal damage following NSAIDs therapy among persons at high risk.

Postoperative pain management at Tirana university hospital center -Mother Teresa-, Tirana, Albania.

There is no or little evidence on postoperative pain assessment and treatment in Albanian hospitals. This study is based on our every day work and aims to highlight our experience. We conducted a descriptive drug utilization study which implied data collection over 6 months. Evidence of the enrolled patients was kept by maintaining records and the completed structured questionnaires. Postoperative pain was assessed through a five-category verbal rating scale (VRS). Metamizole was the most prescribed and administered analgesic drug as single therapy and in combination therapy, and acetaminophen was the least prescribed drug. The compliance between the prescribed dosages and those administered was higher in patients treated with a single analgesic compared to multiple therapies. A few patients reported adverse events (4.2 percent). There is much variability in postoperative pain management methods used by medical staff within the Tirana University Hospital. In Albania to date there is no standard protocol for postoperative pain treatment. This study shows that there are no essential differences in patient outcomes in terms of efficacy of analgesic treatment. This leads to the conclusion that a postoperative protocol/guideline for pain management should be prepared, based on our local study findings and also on international experience. Moreover, the guidelines should consider use of balanced analgesia.

Titania nanospheres from supercritical fluids.

Surfactant-coated amorphous titania nanospheres have been synthesised using templating 'water-in-supercritical carbon dioxide' emulsion droplets; the process represents a clean and controlled method for the manufacture of high-purity nanoparticles.