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Introduction; Pneumoperitoneum after cardiac surgery is not usual. It occurs during extended sternotomy, which is sometimes accompanied by the opening of the peritoneal cavity or in cases after previous sternotomies.

A 73-year-old man was operated on two times within one month due to prosthetic mitral valve dehiscence.

The second operation was accompanied by a lot of complications, including blood loss, respiratory failure, massive pleural effusion, sternal infection, pneumomediastinum, and pneumoperitoneum.

The presence of pneumoperitoneum alerted the possibility of intra-abdominal cavitary organ perforation. No surgical approach was chosen because there were no signs of peritonitis. The patient was discharged at home in a good health situation. Sixteen months later, he recovered at the hospital from heart failure, and after abdominal CT, benign pneumoperitoneum was observed in the abdominal cavity again. There was no explanation for this finding, but again conservative treatment was chosen. He was discharged for the third time from the hospital in good condition.

Conclusions Pneumoperitoneum is a rare finding during cardiosurgical operation. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, as the only way to provide objective assessment and adequate treatment, leading to a dramatic reduction in the mortality rate. It is necessary to understand the origin of air in the abdominal cavity, because laparotomy may not always be indicated to deal with a pneumoperitoneum. Clinical data need to be taken into consideration in addition to the radiological data to make the appropriate treatment decision.

 

Keywords: prosthetic valve dehiscence, pleural effusion, heart disease, cardiac surgery, pneumoperitoneum

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Introduction; Postoperative nausea and vomiting (PONV) are disturbing and show adverse events in anesthesia and surgery. These effects prolong recovery time, delay patient discharge, and increase hospital costs. PONV is one of the 2 main disadvantages of general anesthesia after the surgery in the first 24 hours. The origin of postoperative nausea and vomiting after surgery performed under general anesthesia is not entirely clear, but it is probably multifactorial. PONV is influenced by the patient’s own factors (age, gender, obesity, diabetes, pregnancy), preoperative (premedication, anxiety, diet), intraoperative (anesthetics, intubation, aerophagia, intraoperative dehydration, high doses of neostigmine, use of N2O, time of surgery) and using of opiates. The effectiveness of various antiemetics has been studied for the prevention and treatment of PONV in surgical patients. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating, and antiemetic effects. Ondansetron is the most prophylactic serotonin subtype 3 antagonist in our daily clinical practice for the prevention of PONV after surgery.

Keywords: anesthesia, dexamethasone, ondansetron, PONV

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Introduction; Urinoma is an accumulation of urine in the retroperitoneal area. It is caused by injuries to the kidneys, ureters, urinary bladder, or urethra. They may be confined, encapsulated fluid collections, or may manifest as free fluid.

Urine leaks have a variety of appearances.

This case describes a patient 27 years old, female presented at the emergency room with internal diseases with complaints of bloating and abdominal discomfort.

The history of the disease had begun three days before when she presented to the hospital with bloating that came increasing in quantity. She referred that five days ago gave birth to a child through transvaginal delivery.

For the woman was the first birth of a child. According to the patient’s own referral, her pregnancy was without problems but the birth lasted many hours.

There have been no previous health problems (confirmed by laboratory and imaging tests before pregnancy). There was a careful follow-up of the pregnancy. Except for an isolated case of a urinary tract infection, there was no other complication.

Further imaging revealed a large fluid in the pelvis and intraperitoneal. Treatment of this rare phenomenon is crucial for the delay in medical care can lead to an abscess, hydronephrosis, and electrolyte instability.

CT cystography and retrograde urethrographic are the diagnostic imaging studies of choice. In the appropriate setting, the use of these management options may reduce urinoma-related complications and limit or totally eliminate the need for urologic surgery.

Keywords: Urinoma, injuries, hydronephrosis, Childbirth

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Background: Metastatic breast cancer is a burden on healthcare worldwide. Despite the progress made in early diagnosis and adjuvant treatment of breast cancer again about 30% of patients develop metastases in the course of their disease. Also, there is a percentage of patients where the disease presents in the metastatic stage.

Real-world data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients, and third-party payers. Materials and methods: We have collected data from 63 patients at University Hospital Centre “Mother Teresa”, Tirana, Albania, receiving Palbociclib from June 2016 until October 2019. Patients aged≥18 years, diagnosed with ABC and exposed to Palbociclib plus Fulvestrant. Patients were followed-up until death.

RESULTS; A total of 63 patients were included. The median age was 66 years (range 28–78) and 99.05% were female. The Median follow-up time was 26.42 months…

Conclusion: Palbociclib plus Lulvestrant seems an effective treatment for ABC in a real-world context. Compared to registration studies, as in the world practice, these medications are first-line treatments in Albania as well, constituting a significant achievement in the fight against breast cancer.

Keywords: breast cancer, Palbociclib, Fulvestrant, Real-world data, oncology services