Introduction: Wandering Spleen is a rare condition in which the splenic ligaments are abnormally loose or absent. This makes the Spleen more mobile and increases the risk of torsion. This case report outlines the clinical presentation and management of a 10-year-old female patient who presented at our clinic with acute abdominal pain, vomiting episodes, and a severe fever. Imaging tests, such as abdominal ultrasonography and computed tomography, confirmed the diagnosis of splenic torsion by showing a hemorrhagic infarction and a large spleen. We performed a splenectomy to remove the damaged organ, a partial omental resection to remove the dead tissue and removed the mesenteric lymph nodes for further pathological examination. After the surgical procedure, the intensive care unit carefully observed the patient and treated her with intravenous electrolyte replacement, broad-spectrum antibiotics, pain management, and measures to prevent thrombosis. This case highlights the critical need for early diagnosis and timely surgical intervention in cases of wandering Spleen to prevent serious complications, including splenic infarction. By presenting this case, we seek to elevate awareness of wandering Spleen among healthcare professionals, mainly within pediatric groups. We emphasize the importance of timely diagnosis and appropriate management to optimize patient outcomes. Conclusion: Early detection and prompt intervention are crucial in preventing severe complications in pediatric patients. This case emphasizes the necessity of rapid diagnosis and increased awareness in clinical practice. Due to the Spleen's impaired viability, a splenectomy was required. Following surgery, we provided comprehensive monitoring and pharmaceutical assistance to control pain, prevent infection, and maintain nutritional stability.

Introduction: The demand for reoperation on the aortic valve in Albania is rising, mirroring the increasing average age of the population and the subsequent rise in patients requiring aortic valve surgery. This trend underscores the need for this informative article, which aims to provide insights into the risks and outcomes of aortic valve reoperations, particularly in light of efforts by interventional cardiologists to expand the indications for TAVR to younger and lower-risk patients. Data from the Society of Thoracic Surgeons (STS) National Database reveal results that warrant attention, with concerns over reoperations after TAVR growing, mainly due to the uncertain feasibility of repeat TAVR. This article presents a novel perspective on the risks associated with surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. It underscores the urgent need to develop an optimal strategy for managing these patients and offers fresh insight. Material and Methods: Our research, based on a comprehensive analysis of data from the Society of Thoracic Surgeons in the USA's 10-year database, included individuals who underwent bioprosthetic SAVR following prior TAVR and/or SAVR. Our analyses, which included total and isolated SAVR groups, focused on the primary outcome of operative mortality, ensuring the reliability and thoroughness of our study. Results: The study included 31,106 patients who underwent SAVR. Among them, 1,126 had prior TAVR (TAVR-SAVR), 674 had undergone SAVR followed by TAVR and SAVR (SAVR-TAVR-SAVR), and 29,306 had undergone prior SAVR (SAVR-SAVR). Matched analysis for isolated SAVR cases showed a 1.74-fold higher operative mortality for TAVR-SAVR than SAVR-SAVR (P = 0.020). In our center, 5 cases have been performed in the last two years with excellent results, no losses, and operating times close to the first-time interventions. Conclusions: This study's findings significantly contribute to the field. They could influence clinical practice, particularly for patients with longer life expectancies and anatomy unsuitable for TAVR. They suggest an initial SAVR approach may provide better results even in necessary surgical re-interventions on the aortic valve.

Introduction: Blunt abdominal trauma is the primary cause of morbidity and mortality. Suppose there are no indications of external trauma or changes in the patient's vital signs; blunt abdominal injuries might be complicated to identify at first. It is possible to lose a significant amount of blood without the abdomen appearing significantly different. A direct blow from blunt trauma can result in visceral damage and solid organ rupture, which can cause hemorrhage, peritonitis, and related pelvic injuries. The liver, small bowel, and spleen are the most frequently injured organs. Objectives: To find out the etiology, manifestation, anatomical distribution, diagnostic method, management, and outcome of intestinal injuries from blunt abdominal trauma. Material and Methods: About 59 individuals who had laparotomies during a 3-year period to treat intestine damage from traumatic abdominal trauma were included in the research. In a retrospective analysis, the patients' causes, presentations, anatomical distributions, diagnostic techniques, related injuries, courses of therapy, and deaths were all examined. Results: About 59 individuals with 60 significant bowel and mesentery lesions from blunt abdominal trauma were conducted. The average age was 36.78 years, and the male-to-female ratio was 5.5: 1. About 60 people sustained severe injuries. Furthermore, there were 50 minor intestinal injuries, which included 48 perforations, 12 major seromuscular injuries, and seven mesenteric, eleven colonic, and one duodenal injury. Thirty-three individuals suffered injuries from automobile incidents. The most frequent damage was a perforation at the small bowel's antimesenteric boundary. For colonic perforations, treatment included protective colostomy after resection, anastomosis, and perforation repair. There were 2 (3.38%) documented fatalities, and 10 (16.9%) individuals experienced significant problems. Conclusion: Due to its enormous infectious potential, early detection of intestinal injuries following severe abdominal trauma is crucial, even if it might be challenging. Severe injuries are frequently linked to intestinal perforations and are likely the deciding factors in survival.

Introduction: Approximately 5.8 million people die each year as a result of injuries. Traumatic injury is the leading cause of death under the age of 45 in the U.S. and worldwide. Traumatic injuries represent a significant global health burden, demanding swift and decisive intervention to mitigate morbidity and mortality. The Advanced Trauma Life Support (ATLS) course has emerged as a cornerstone in trauma management, offering healthcare providers a systematic approach to assessment, resuscitation, and definitive care. This article explores the pivotal role of ATLS protocols as the gold standard for safe and effective trauma management. ATLS protocols prioritize a structured assessment methodology, employing the ABCDE approach to rapidly identify and address life-threatening injuries. By adhering to this systematic framework, healthcare providers can promptly initiate time-critical interventions, minimizing the risk of adverse outcomes. Moreover, ATLS protocols promote standardization of care, ensuring consistent management practices across diverse clinical settings. Through multidisciplinary collaboration and continuous training, healthcare teams are equipped to deliver coordinated and efficient care, optimizing patient outcomes. In conclusion, using ATLS trauma management protocols represents more than a guideline; it embodies a commitment to excellence in patient care. By embracing the principles of ATLS, healthcare providers uphold the gold standard for safe, effective, and compassionate trauma management, ultimately saving lives and restoring hope in times of crisis.

Introduction: Maxillofacial trauma presents unique challenges due to the complex anatomy of the face, encompassing vital structures. Beyond physical injuries, these cases significantly impact a patient's appearance and function, necessitating a multidisciplinary approach. Challenges: Maxillofacial trauma often co-occurs with other injuries, particularly head, chest, and extremity trauma. This increases complexity, with head injuries observed in 7.6-8.9% of facial fracture cases, frequently associated with lower Glasgow Coma Scores. Cervical spine injuries and airway obstruction are significant concerns. Management: While trauma management has significantly improved mortality rates, maxillofacial injuries in polytrauma patients remain a challenge. Their proximity to the brain, spine, and airway necessitates modifications to standard ABC assessments. These modifications often incorporate DRSABCDE, a comprehensive evaluation that includes airway clearance with C-spine control, breathing, ventilation, oxygenation, circulation, disability-neurologic status, exposure-environment, and body temperature. Each component of DRSABCDE is crucial in the initial management of maxillofacial trauma. Conclusion: Continuous education and training in triage, communication, and advanced life support (e.g., BLS-AED, ACLS, PHTLS, BTLS, ATLS) are crucial and empowering for healthcare professionals managing maxillofacial trauma in polytrauma patients. This ongoing learning equips them with the necessary skills and knowledge to handle these complex cases effectively.

Introduction: Atrophic posterior maxillary regions pose a significant challenge in dental medicine, where dental implant stability is hard to achieve. The innovative osseo-densification, a new biomechanical technique that aims to solve this problem without removing any bone tissue, is a topic of great interest and potential in our field. Case report: The patient, A.K., a 44-year-old smoking female, was presented to the clinic concerned with the lack of ability to eat from her left side as a result of the extraction of her upper molars. After a 3D radiographic scan was conducted, it was confirmed that there was considerable bone loss in the upper left posterior region and a proximity with the maxillary sinus. As part of the treatment plan, an Osseo-densification technique in crystal maxillary sinus elevation would be used for two implant placements in the first and second molar regions. Conclusions: The osseo-densification technique in crestal sinus lifting was shown to be a dependable and less invasive option for treating considerable posterior maxillary bone loss. However, conclusive findings are still needed for this technique, emphasizing the need for continuous research and learning in our field.

Introduction: Minimally invasive mitral valve surgery (MIMVS) is now a widely accepted and more frequently utilized method for patients needing mitral valve surgery. The promoted advantages are less trauma, less bleeding, less pain, and fewer wound infections, allowing faster postoperative and decreased healthcare costs. Material and Methods: This is a single-center retrospective study. We have collected the records of patients who underwent MIMVS by one team at the Cardiac Surgery Service, UHC” Mother Theresa” Hospital. The patients' data regarding demographic, preoperative, operative, and post-operative variables were collected from the medical records in the hospital. All statistical analyses were performed using IBM SPSS version 24.0 software (SPSS, Inc., Chicago, IL, USA). Results: Surgical technique includes mitral valve repair or replacement through right lateral mini-thoracotomy, through a small 5-7cm incision in the 4th–5th right intercostal space under direct vision Seldinger technique under transesophageal echocardiogram guidance is used for cannulation, first 3 cases of MIMVS was performed with 2 venous cannulas – one percutaneous jugular cannula and femoral one, 8 cases underwent single two-stage femoral venous cannulation for venous drainage, femoral arterial cannulation and vacuum assisted cardiopulmonary by-pass(CPB). Conclusion: Minimal-invasive mitral valve surgery is as safe as the standard approach and allows faster recovery with a shorter length of hospitalization, resulting in decreased healthcare costs. We need a more extensive study to confirm the other advantages, but minimal-invasive should be pushed to become a standard approach for mitral valve surgery. An adequate learning curve is mandatory for all the operative teams to achieve all the benefits for the patients.

Introduction: Traumatic Asphyxia is probably much more common than the surgical literature shows and should always be kept in mind as a possible complication of injuries of the thorax and /or upper abdomen. Traumatic Asphyxia or Perthe’s syndrome is a result of a sudden and severe trauma of the thorax and /or upper abdomen. We report a case of traumatic Asphyxia due to an automobilistic accident. Our patient is a 62-year-old male who was brought to the emergency room due to thorax trauma related to a bicycle accident. He got under a van from one side, and while the shaft of the van rotated, it pulled and crushed the patient between the body of the van and the shaft. There was no direct trauma history on the face and neck area of the patient. In our case, we found associated injuries such as a fracture of the right 7th rib, displaced fracture of the right tibia, and bilateral pulmonary contusion. In our case, supportive therapy and specific treatment for the right tibial fracture were performed. Conclusion: Perthes syndrome should be considered in patients presenting with the associated ecchymoses mask with cutaneous petechial hemorrhages and subconjunctival bleeding as a complication of compression of the thorax. The outcome is variable depending on the severity and duration of compression. When characteristic findings of traumatic Asphyxia are detected in traumatic patients, other organ pathologies should be quickly eliminated, and supportive therapy should be initiated. If any other organ pathology is detected, treatment for the detected pathology should be administered because the prognosis of patients with timely and effective treatment is considerably good.

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV) is a rare group of systemic autoimmune diseases that primarily target small blood vessels. Renal manifestations often present as pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN), which can progress to acute or chronic kidney failure and multiorgan involvement. It is frequently associated with poor outcomes. We report a case of PR3-positive ANCA-associated vasculitis complicated by rapidly progressive glomerulonephritis, acute kidney injury, and diffuse alveolar hemorrhage during the COVID-19 pandemic. This case highlights the diagnostic challenges of differentiating AAV from conditions associated with SARS-CoV-2 infection, as the clinical and radiological presentations of pulmonary-renal syndromes may overlap. The findings underscore the importance of maintaining a comprehensive differential diagnosis in patients with pulmonary and renal involvement, particularly in the post-COVID-19 era, to ensure timely and accurate management of rare autoimmune conditions such as AAV. Conclusion: ANCA-associated vasculitis (AAV) remains a diagnostic and therapeutic challenge, particularly in the post-COVID-19 era, where overlapping clinical and radiological features with SARS-CoV-2 complications can obscure timely identification. This case highlights the critical importance of maintaining a broad differential diagnosis in patients presenting with pulmonary-renal syndromes to differentiate AAV from more common conditions associated with COVID-19.

Introduction: Surgical wound infections (SWIs) remain a significant risk to patients due to their high morbidity and mortality rates. Moreover, they pose substantial economic challenges for both developing and developed countries. The global impact of these infections is staggering, with the World Health Organization (WHO) reporting that millions of patients worldwide are affected by hospital-acquired infections annually, with many succumbing to these infections. This study aims to analyze the incidence of surgical site infections (SSIs) based on the type of surgical intervention, identify the most frequent causes of these infections, and explore effective management strategies. The findings of this study will provide valuable insights into the prevention and management of SSIs, thereby enlightening the medical community and empowering them to improve patient outcomes. Material and Methods: This study, conducted with meticulous attention to detail, focuses on patients operated on in our clinic from January to October 2024. It will reflect the incidence of SSI according to the type of surgical intervention, the most frequent causes of these infections, and the way of their treatment. Results: From January 2023 to June 2024, 788 patients were hospitalized, and 408 were operated on in the Surgery Department of the Clinical Hospital of Tetovo. Three hundred fifty were male, and 438 were female. The ages of the patients included in the study ranged from 21 to 81. Most of the patients were operated on because of cholecystolithiasis, inguinal, ventral, and umbilical hernias, breast cancer, acute appendicitis, and neoplasia of the colon and ileus. From the total number of operated patients (408), the infection of operative wounds was recorded in 49, representing an incidence of 11.76 %. Conclusion: The findings of this study underscore the serious global implications of SSIs, including increased morbidity and mortality rates and the strain on healthcare budgets. Therefore, the prevention and reduction of these infections should be a priority for all countries, irrespective of their economic status.