Management of Massive Hemoptysis: A Single Institution Experience

Introduction: Definition of massive hemoptysis is unclear: criteria range from 100cc /day to 1000cc over a few days. Massive hemoptysis is seen in 1.5 % of all hemoptysis cases. Deaths occurring by exsanguination or asphyxiation from flooding of the alveoli with blood and intractable hypoxemia. The 3 principles of management of hemoptysis consist: 1) maintain airway patency and oxygenation, 2) localize the source of bleeding, 3) control hemorrhage. Consider surgery for lateralized uncontrollable massive hemoptysis unresponsive to other measures or as a definitive therapy in patients whose hemoptysis and general medical condition have stabilized. Objective: Analyses of our experience in treatment of 24 patients with severe hemoptysis for in single thoracic surgery Unit in SU”Shefqet Ndroqi” Tirana, Albania. Material and Methods: In a 5-year period 2009-2013, twenty-four patients were admitted in our hospital with massive hemoptysis. All patients are estimated by: Physical examination, CXR, CT Chest, Bronchoscopy and Arteriography. Fifteen 15 (62%) patients received surgical resection as a definitive therapy. Results: Of twenty-four patients enrolling in the study 18 were males and 6 females, mean age 54.9±13,7 years. The underlying pathology included bronchiectasis (n=5), active tuberculosis (n=9), pneumomycosis (n=7), lung cancer (n=2) and pulmonaryhydatic cyst(n=1). Hemoptysis ceased with conservative management in 9 patients (38%) only. Fifteen 15 (62%) patients received surgical resection. The procedures included lobectomy (n=13), bilobectomy (n=1) and pneumonectomy (n=1). The in-hospital mortality after surgery was 4.1% (1) patient. Redu-thoracotomy and right axillary open window in one patient. Postoperative morbidity occurred in 4 patients, including prolonged ventilatory support, bronchopleural fistulae, empyema and myocardial infarction. Conclusions: The clinical outcome for massive hemoptysis reflects the generalized nature of a destructive disease process involving both lungs and a limited respiratory reserve. Surgery is associated with high risk of morbidity and mortality, and should be performed only in selected patients.Keywords: masive Hemoptysis, Chest, Bronchoscopy and Arteriography, bronchopleural fistulae, empyema and myocardial infarction

On the way to Europe: economic and social developments in Albania

Albania received candidate status for EU membership in 2014, and its political agenda is focused on European integration. This chapter analyses some important aspects of economic and social development in Albania on its road towards the EU. In particular, it focuses on economic growth, governance and the quality of institutions, foreign trade, competitiveness, the labour market, poverty and inequality. Despite high rates of growth, income per capita is relatively low compared with other European countries, and poverty has increased in recent years after a long period of falling poverty levels. Inequality of incomes has widened during the transition and has reached levels similar to other European market economies. Many institutional reforms need to be completed, including an improvement in the quality of institutions, the rule of law being a prominent example. Albania avoided the worst effects of the global economic crisis and the spillovers from the Eurozone crisis but at the expense of a steady increase in public and external indebtedness. In 2014, the country appealed to the IMF for financial support, which was given on condition that a policy of fiscal consolidation would be implemented. This may make it more difficult to expand redistributive social assistance programmes for the relief of poverty in the future. To overcome these limitations, policies should focus on improving the competitiveness of the economy, encouraging a faster rate of technological development and moving towards a path of high value-added production and trade to support the future development of the economy