Silent Kidney Stones Diagnostic Modalities in Albania

Objective: Silent and not yet discovered stones of the upper urinary tract are potentially dangerous since in due course they may cause infection, obstruction and renal damage. The aim of this study was to determine the incidence of such silent kidney stones in a representative population of Mat region - Albania   Subjects and Methods: There were included in the study 200 consecutive subjects at Radiology Service, Burrel Hospital that underwent an additional kidney screening while undergoing abdominal ultrasound. All these subjects did not have a history or symptoms of urolithiasis.   Results: There were found silent kidney stones in 3% of 200 subjects that went through, 80 % (n=160) of them were from age 20-70 years old. Notably, multiple stones and stones of a considerable size were without symptoms.   Conclusions: In addition to the usual figures of incidence and prevalence of stone disease drawn from patient data, there is an incidence of 3% silent stones that may only be discovered incidentally or by screening. This is part of water elements that is characteristic for the region. Figures for other regions have yet to be determined. There is enough data that show the consequences of kidney stones if neglected. Awareness to the population and regular ultrasound screenings would be beneficial. Keywords: kidney stones, incidence, ultrasoun

Subtotal Esophagectomy-Akiyama Procedure： In a Case with Esophageal Squamous Cell Carcinoma

Adenocarcinoma, typically in the distal third of the esophagus, and squamous cell carcinoma, typically in the proximal two thirds of the esophagus, each make up 49% of cases of esophageal cancer. The remaining cancers in this area include sarcoma (1%), lymphoma (0.5%), cylindroma (0.25%), and primary melanoma (0.25%). Case report We present patient S.G. 62 years old, male, with the following symptoms started 3 months from hospital admission: difficult swalloing mostly for the hard foods and eventually for the liquids too, chest burning, cough and vomiting, throat pain, weight loss. In the laboratory findings only a mild anemia was found, Hemoglobine 10.8 g/dl, and slightly high values of CRP. Patient was hospitalized in the First Clinic of General Surgery, University Hospital Center “Mother Teresa” Tirana, Albania and underwent an upper gastrointestinal tract endoscopy and 28 cm form the incisive teeth and esophageal narrowing was detected which could not allow the scope to go lower for further examination. Biopsy was taken through endoscopy. Patient was planned for a CT scan and tumor markers, CEA and CA 19-9, both later ones came in normal values. CT scan showed an irregular, asymmetric narrowing of the thoracic esophagus, thickening of the esophagus walls with 4 cm of extension without invasion of local periesophageal fat and regional lymphadenopathy. The biopsy resulted; esophageal squamous cell carcinoma G2. In these circumstances patient underwent a feeding jejunostomy and was sent to follow the protocol of neoadjuvant chemo and radiotherapy. Three months later the patient is returned in our clinic, where he underwent the surgical intervention. Postoperatively the patient was treated in the Intensive Care Unit. The next day after the operation, cervical drains were removed and in the fourth postoperative day the thoracic and abdominal drains were also removed. Patient comes in the surgery ward in the fifth postoperative day where is treated afterwards with an excellent postoperative course. In the tenth postoperative day the anastomosis integrity is verified by x-ray swallowing contrast gastrografin, and the next day he was discharged from the hospital. Keywords: Esophageal, squamous cell carcinoma, subtotal esophagectomy DOI: 10.7176/ALST/79-05 Publication date:March 31st 202

Gender Prevalence of Urolithiasis in Albania: Our Data

Urolithiasis remain a problematic nosology in many countries and regions, however, there are studies that bring data on this nosology even in location, size and gender as well. We would like to bring in light our data in respect of gender prevalence of urolithiasis on our population study. In our prospective study from 2011 to 2014, of 200 subjects who were admitted to emergency service, respectively City Hospital of Mat, where 122 subjects were diagnosed with urolithiasis, and 67 % of those subjects where males, or in other words 82 subjects, and 33 % were female subjects, or in other words 40 subjects. In many studies there are data on gender and age as well in respect to urolithiasis. Our data, even in modest population would like to present and compare with literature and bring to the respective state authorities’ attention for any future prospects. Keywords: Urolithiasis, prevalence, gender, Albania DOI: 10.7176/ALST/87-01 Publication date: April 30th 2021

Hepato Cellular Carcinoma: Case Report

Hepatoma is a tumoral disease that consists in an abnormal proliferation of the hepatic cells. According to the augmentation of the risks factors such as smoking, alcohol abuse, consuming no healthy food and different types of viral and bacterial infections. Nowadays, this disease is becoming more evident even in the young ages. Here, we present a 63 old female with this disease. Keywords: Hetapoma, tumoral, disease DOI: 10.7176/ALST/78-06 Publication date: March 1st 202

Early Diagnosing of Urinary Tract Anomalies

Nowadays, with advanced diagnostic technology and accessibility of patients to qualified physician, many anatomical anomalies are diagnosed in uterine life, including urinary tract anomalies in prenatal period, however, even with advanced of technology, many of such anomalies continue to be diagnosed later on, in early stage of life or even later when a medical problem arise as a consequence of these anomalies. In Albania, nowadays, high technology and high definition diagnostic imaging machines are available; however, we do face lack of qualified and experienced medical specialist, especially in peripheral regions - city hospitals throughout Albania. Early diagnosing of anomalies like urinary tract ones, are possible to be diagnosed since the end of first trimester of pregnancy by 14 weeks, and later on during the anatomic ultrasound examination or otherwise called morphologic fetal ultrasound at 18 – 22 weeks of pregnancy, if examination carried out by a qualified medical specialist, should clearly visualize fetal urinary tract. However, this fetal problems undiagnosed during pregnancy, there are often diagnosed in postnatal period. In some countries, many ultrasound examinations during pregnancy are performed by ultrasound technicians and interpreted by radiologist or perinatologist, however, generally these examination are performed by fetal medicine specialist, or obstetrician and gynecologists. In Albania these examination are performed only by obstetrician and gynecologist, since qe do not have a fetal medicine center. Any urinary problem during early age, it is appropriate to perform a general abdominal ultrasound examination as fast, reliable and cost-effective examination tool with no side effect. Keywords: Diagnostic, early, urinary, anomalies, medical specialist DOI: 10.7176/ALST/87-02 Publication date: April 30th 202

Management Approach to Thyroid Cancer in Albania

Thyroid cancer is a cancer that starts in the thyroid gland. In Albania, thyroid cancer is rare disease, according to available data, which are not solid and up to date data, referred to 2014 to a paper named “Actualities in the Diagnosis and Treatment of Thyroid Cancer in Albania” by D. Gjergji et al., data from Clinic of General Surgery, UHC “Mother Theresa” in Tirana and the Registry of the Department of Pathology during the period 2004 – 2011, there were suspected 262 patients with thyroid tumors and only 42 of them or 16 % were diagnosed with thyroid cancer. Treatment depends on the type of thyroid cancer. Surgery is most often done, the entire thyroid gland is usually removed and if is suspected that cancer has spread to lymph nodes in the neck, these will also be removed. Radiation therapy may be done with or without surgery and it may be performed by; aiming external beam x-ray radiation at the thyroid or taking radioactive iodine by mouth. If the cancer does not respond to surgery or radiation, and has spread to other parts of the body, chemotherapy and targeted therapy are applied. The importance of screening, early diagnosis and there proper treatment possess still challenges in Albania, so better national health  programs must be developed in order to offer a better health care service to this medical problem. Keywords: Thyroid cancer, risk factors, diagnosis, treatmen