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BACKGROUND: Colorectal polyps (CP) are common among individuals older than 50 years. Some polyp types can precede colorectal cancer (CRC). This study aimed at describing histopathological characteristics of colorectal polyps in relation to age and gender among symptomatic patients referred for a colonoscopy examination during 2011-2014 in Tirana, Albania. METHODS: Study population included 267 individuals aged ≥ 20 years and diagnosed with ≥ 1 polyp during a colonoscopy examination. A total of 346 polyps were identified, excised and measured, and underwent histopathological examination. RESULTS: Adenomas accounted for 79.8% of all polyps and tubular type was the most frequent one (74.4%). The majority of polyps (42.5%) were small (<1 cm), 38.7% of a medium size (1-2 cm) and 18.8% large (>2 cm). Adenomas were larger than non-adenomatous polyps (p<0.01) There was no gender difference with regard to patient age (p=0.22) or polyp size (p=0.84) Adenomas were more frequent among men compared to women (p=0.02). Age was strongly related to polyp characteristics. The proportion of adenomas increased significantly with age (p<0.01). Within adenomas, the proportion of villous types - a precursor of colorectal cancer - increased remarkably with age (p=0.01). Older age was positively associated with potentially malignant adenomas (defined as adenomas > 1 cm and showing high-grade dysplasia) (p<0.01). CONCLUSION: Adenomas accounted for the majority of polyps. Their morphology, size and malignant potential were related to patient age.

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The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia's safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist.

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Echinococcosis is an endemic zoonosis in the Mediterranean area, with Albania interested actually to a level that is becoming a public health concern. Authors describe preliminary data from the only tertiary (university) medical facility of Albania, positioned in the capital of the country (Tirana), with 333 new cases diagnosed and treated during the period 2005 - 2011. Out of all these 333 new cases an impressive majority of 91% had a surgical treatment right from the first admission, rendering the disease almost a surgical exclusivity. Even more, 80% of all patients from the study group were hospitalized straightforwardly in surgical wards, with options of surgical intervention's percentages outrunning figures from other sources and authors of the same geographical area. Such a situation, together with a very important level of patients' origin from highly urbanized areas such as those of the capital, suggest the necessity of well-organized interventions, among which might be the mandatory notification of all human cases with Echinococcus infection.

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OBJECTIVE: The purpose of this study was to explore the attitudes of cancer patients, their family, and community members in Albania, a post-communist country in Southeast Europe, regarding breaking bad news. METHODS: One hundred and fifty consecutive cancer patients, 150 respective relatives, and an age-sex-residence matched sample of 150 individuals in Tirana district were interviewed from September 2009-January 2010 about attitudes related to diagnosis disclosure. Logistic regression was used to assess the association of diagnosis disclosure with demographic characteristics. RESULTS: Community members were the most in favor, whereas the patients' relatives were the least in favor of diagnosis disclosure. Most of the patients, who were aware of their diagnosis, were not satisfied with the disclosure approach employed by the medical staff. The odds of favoring diagnosis disclosure were significantly higher among younger, male, urban, and more educated patients. CONCLUSION: This survey identified important characteristics of cancer patients, their relatives, and a community-based sample in Albania that could predict the willingness to disclose a fatal diagnosis. Establishment of a formal training of health professionals regarding breaking bad news should be considered in order to ensure a proper approach of communicating diagnosis to cancer patients in transitional Albania.

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OBJECTIVE: To evaluate the efficacy of combined infiltrative bupivacaine with low intraperitoneal pressure insufflation in reducing the post-laparoscopic pain in patients undergoing laparoscopic cholecystectomy (LC). METHODS: This randomized prospective single-blind study included 473 patients undergoing LC. The study took place at University Hospital Center Mother Teresa, Tirana, Albania between January 2006 to September 2009. The patients were divided in 4 groups: Group 1 (n=120) with intra-abdominal insufflation pressure 15 mm Hg and no infiltrative bupivacaine (HPNBG); Group 2 (n=122) with intra-abdominal insufflation pressure 15 mm Hg and with 5 ml infiltrative bupivacaine 0.5% in abdominal minincisions (HPBG); Group 3 (n=110) with intra-abdominal insufflation pressure under 10 mm Hg and no infiltrative bupivacaine (LPNBG); and Group 4 (n=121) with intra-abdominal insufflation pressure under 10 mm Hg and infiltrative bupivacaine (LPBG). RESULTS: There were statistically significant differences (p=0.003) between groups regarding incisional pain intensity, between LPBG and HPNBG (p=0.001), between LPBG and HPBG (p=0.037), between LPBG and LPNBG (p=0.001), as well the shoulder-tip pain intensity (p=0.001); between LPBG and HPNBG (p=0.001), between LPBG and HPBG (p=0.001), and between LPBG and LPNBG (p=0.031). We found statistically significant differences related to pain beginning time (ANOVA test, p=0.027); between LPBG and HPNBG (p=0.041), between LPBG and HPBG (p=0.031), and between LPBG and LPNBG (p=0.05). CONCLUSION: The combination of infiltrative bupivacaine with low intraperitoneal pressure insufflation shows to be more efficient in reducing the post-laparoscopic pain, compared with other regimens.

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