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Introduction; Rectal cancer is the third leading cancer in the world in terms of incidence and mortality according to GLOBOCCAN. The prognosis of the disease varies according to the stage, being better in the early stages and worse in the advanced and metastatic stages.

Early diagnosis of colorectal cancer made through screening programs is accompanied by an improvement in cancer progression. The introduction of colonoscopy examinations and testing for blood clots has made it possible to diagnose precancerous lesions and colorectal cancer in the early stages when the survival rate is better [1].

The treatment of colorectal cancer has evolved from just surgery before the 1980s to chemotherapy and radiotherapy in the 1980s and improved in later years with the introduction of new cytotoxic drugs that have improved survival. [2].

With advances in molecular biology methods, it is the possible introduction as part of the treatment of new targeting and immunomodulatory drugs based on the results of these molecular tests.

Treatment with these drugs has brought an improvement in the course of the disease of patients with colorectal cancer. [3].

Conclusion; The strategy for treatment for CRC should be assessed with respect to its effectiveness, sensitivity, the number of false positive results, safety, and comfort. Furthermore, the cost and economic factors pertaining to the screening programs should be observed in order to help patients with decision-making, and the prevailing clinical policies should be taken into consideration.

Keywords: rectal cancer, screening, molecular testing, treatment.

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Introduction: Choledocho-duodenal fistulas are rare disorders that can be of various aetiologies. Some of the most common causes of these fistulas are neoplastic processes in the extra-hepatic bile ducts, biliary stones or chronic duodenal ulcers. We will present the case of a patient with a choledocho-duodenal fistula who was treated in our clinic due to a severe episode of acute hepatitis.

We will present a case report as follow; a 52-year-old man was urgently brought to the abdominal surgery ward of the Tetovo Clinical Hospital due to severe pain in the right epigastric and subcostal region which also appears in the back region. It is accompanied by nausea, vomiting, sub-febrile fever, and weakness.

The patient reports that he has long been treated with proton pump inhibitors such as pantoprazole due to a chronic duodenal ulcer…

Conclusion; Choledocho-duodenal fistulas are very rare disorders and therefore pose a real challenge to surgeons and endoscopists in terms of their timely diagnosis. However, there are authors who prefer a conservative treatment, while some others suggest surgical intervention respectively fistulectomy, in order to prevent complications that may occur as a result of the regurgitation of duodenal contents in the bile duct.

Keywords: choledocho-duodenal, fistula, peptic ulcers, ERCP, papillotomy

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Introduction: Port site hernias continue to be a major problem in laparoscopic surgery. The causes of this type of hernia are numerous. The main ones are operative wound infection, obesity, male gender, diabetes, BPH, etc. However, in addition to these factors, it seems that in the etiology of post laparoscopic port-site hernias are at least two other factors that have an impact on these complications.

The aim of the article is to assess the role of different factors in the occurrence of port site incisional hernias according to our experience.

Material and Methods: the 187 patients who were operated on at the General Surgery Department of the Clinical Hospital of Tetovo between January 2017 and June 2019 on whom the surgical intervention was performed through laparoscopic techniques were included in this study. The reason for the surgical interventions has been various surgical pathologies of the abdomen such as cholecystolithiasis, acute appendicitis, cysts of the liver, ovaries, and kidneys, etc. Postoperative complications in these patients, especially port site hernias will be the focus of our study.

Results: Out of the total of 187 patients included in this study the occurrence of incisional hernia was recorded in six of them. In five patients the hernia was localized at the site of insertion of the supra-umbilical trocar, while in the other, the trocar was inserted below the xiphoid process. From our records, it happened that in all these patients, with a postoperative hernia, the insertion of the cannula was done with the cutting trocar. At the same time in all six patients with post laparoscopic hernia the surgical intervention performed was cholecystectomy or appendectomy. Thus, the removal of the gallbladder and appendix, without the use of an Endo-bag, was performed at the site of the hernia presentation. In all these patients the entrance porta infection in which the hernia has occurred was registered in the early postoperative period.

Conclusion: Of the many factors that increase the risk of incisional hernias, at the site of cannula insertion during laparoscopic interventions, it seems that the type of trocar and the place from which the extruded organ is removed, if it is done without the use of an Endo-bag, are very important.

Keywords: Port site hernias, Endo-bag, laparoscopic surgery, incisional hernias

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Introduction: Emergency medical service for patients in emergency situations is the most important aspect of all health systems in the world, as this is the first and most delicate point of confrontation of the patient with the health system of a country. All patients seeking urgent medical care, and the slightest delay in access to this service, by the population, is understood as a matter of "life or death" for them, to which they are quite sensitive. While learning or training during the process of exercising said activity combined with actual study data and comparisons with the results of international emergency medical services remains a challenge of the future. Thus, the evaluation criteria of performance indicators of the emergency service based on scientific research evidence are unified. Ambulance services were basically just small vehicles, some with two stretchers, without the necessary equipment. Managers working as emergency personnel had only a few hours of limited first aid training which were referred to as "suitable personnel". The duties of the ambulance service personnel were two-fold. On the one hand, they transported the sick and planned the so-called regulated ambulance service…

Conclusion: The changes and diversity of medical emergencies including increasing trends of traumatic, mortal, and post-traumatic morbidity emergencies constantly put pressure on medical emergency services. All of these improvements will yield results in increasing efficiency by improving the quality of treatment and reducing the cost of medical care.

Keywords: Education; Trauma; Training; ATLS; Emergency medicine