Acute coronary syndromes hospitalizations and in-hospital outcomes during and after the lockdown of corona virus disease 19 (COVID-19) pandemic outbreak

Funding Acknowledgements

Type of funding sources: None.

Background

Multiple studies documented an important reduction of acute coronary syndromes (ACS) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding the ACS admissions and outcomes during the ongoing pandemic after the initial lockdown.

Purpose

We aimed to study the ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period.

Methods

A retrograde single-center study was conducted. The data for all admissions were collected from March 9th, (first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for three consecutive years from 2019 to 2021. The control period was considered the year 2019 and the study periods were in 2020 (lockdown) and 2021 (ongoing pandemic). ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR [95%CI]) was used to compare all-ACS and subgroups admissions, and risk ratio (RR [95%CI]) to compare the mortality between each study period with the control one.

Results

Were included 550 ACS patients (pts) during 2019, 321 pts during 2020, and 473 pts during 2021 period. The overall-ACS admissions IRR was significantly lower during 2020 lockdown (0.58 [0.44-0.76]), and not significant during 2021 ongoing pandemic (0.86 [0.62-1.18]). During 2020 lockdown, significant reduction for STEMI and UA, the IRR respectively (0.72 [0.56-0.94]) and (0.42 [0.22-0.76]), and not significant during 2021 respectively (0.87 [0.63-1.21]) and (0.86 [0.51-1.46]) were observed. The reduction in NSTEMI admissions was not significant in both periods.

The overall mortality was, importantly increased during the lockdown period (7.45 vs. 3.4 %), RR=2.16 (1.2-3.89). Meanwhile the 2021 mortality was similar (4.2 vs. 3.4%), RR=1.22 (0.66-2.26).

Conclusions

After the initial reduction of admissions in all-ACS, STEMI and UA during the 2020 lockdown period and the increase of all-ACS mortality, the number of admissions and the mortality returned to a similar range during 2021 despite the ongoing COVID-19 pandemic.

Outcomes of ST elevation myocardial infarction (STEMI) hospitalizations during corona virus disease 19 (COVID 19) era

Funding Acknowledgements

Type of funding sources: None.

Multiple studies reports a reduction of STEMI hospitalizations rates during COVID 19 pandemic outbreak. Contradictory STEMI complications rates are reported during COVID 19 pandemic regarding case fatalities rates, cardiogenic shock, life threatening arrhythmias and others.

Purpose. To evaluate the impact of the COVID 19 outbreak on STEMI patient outcomes and complication rates in country with low COVID 19 incidence and mortality and without changes in Cardiology hospital services.

Methods. Was conducted a retrograde study collecting data for STEMI hospitalizations, revascularization procedures and case fatalities and other complications from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center. Incidence rate ratio (IRR) was used to compare STEMI admissions and revascularization procedures and risk ratio (RR) to compare case fatality rate and other complications rate.

Results

Hospital admissions for STEMI declined during 2020 (COVID 19 period) from a total of 217 patients in 2019 to 155 patients hospitalization in 2020 representing IRR 0.72 (p = 0.009). Reduction were observed in the number of primary PCI from 168 procedures in 2019 to 113 in 2020 (IRR 0.67 p = 0.001). Symptom onset to our ICU (including regional transportation) was significantly higher in 2020 than in 2019 (939.97 ± 1122 versus 436.15 ± 383 minutes p <0.0001) The STEMI case fatality was importantly increased during pandemic outbreak (13.55%) compared to 2019 (8.3%) (RR= 1.63 p = 0.001), but a similar a primary PCI-STEMI case fatality 6.2% versus 5.95%. Also an increase was observed for cardiogenic shock (IRR =1.75 p = 0.003).

Results; Hospitalizations and related invazive revascularization procedures for STEMI significantly reduced during COVID 19 pandemic. We identified a substantial increase of STEMI case fatalities and cardiogenic shock during pandemic outbreak. Delayed timely reperfusion by primary PCI has an important impact on infarct related mortality.

Impact of coronavirus disease 19 (COVID 19) pandemic on acute coronary syndrome (ACS) hospitalizations, and related invasive procedures

Funding Acknowledgements

Type of funding sources: None.

Background

  Reports from countries affected by the COVID 19 pandemic demonstrate a reduction in ACS hospitalizations and invasive procedures.

Purpose

We aimed to investigate the impact of the COVID 19 pandemic on ACS patient hospitalizations and related invasive procedures in a country with low COVID 19 incidence and without changes in Cardiology hospital services.

Methods

We conducted a retrograde study collecting data for ACS hospitalizations including ST elevation myocardial infarction (STEMI), non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) and related invasive and revascularization procedures from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center.

Results

Hospital admissions for ACS declined during 2020 (COVID 19 period) from a total of 550 patients in 2019 to 321 patients hospitalization in 2020 representing a 41.6% reduction (p &lt; 0.001). The reduction was observed for all types of ACS, the greatest reduction was for UA 58% (p &lt; 0.001) followed by NSTEMI 32% (p &lt; 0.001) and for STEMI 28% reduction (p &lt; 0.009). Compared to 2019 the proportion of patients presented with STEMI was higher in 2020 (48.6% vs 39.5% p = 0.01) and lower with UA (43.3% vs 31.5% p = 0.0002)

Reduction was observed also in coronary angiography by 43% (p &lt; 0.001) and in percutaneous coronary interventions with 42% (p &lt; 0.001). Compared to 2019 the proportion of patients with 3 vessels coronary disease(CAD)and left main (LM) was higher during COVID 19 pandemic,  respectively 33% vs 40% p = 0.032 and 8% vs 13% p = 0.046

Conclusions

Hospitalizations and related invasive procedures for ACS significantly dropped during COVID 19 pandemic.  Patients admitted to hospital during pandemic presented more with STEMI and had more 3 vessels CAD and LM. Measures should be taken to ensure patients for the safety of health services and encouraged not to neglect cardiac consultations and treatments.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Hospital doors under pressure; policies and trends in the major tertiary care hospital in Albania

OBJECTIVES

Quantification of elective and emergency hospital admissions as a resultant of patients' diagnostic and therapeutic pathways (referral system) and patients' preferences to choose the health-care provider.

DESIGN

Retrospective analysis of routine hospital discharge data. Findings were analyzed with descriptive statistical methods.

SETTING

University Hospital Center, "Mother Teresa", Albania, a secondary and tertiary health care provider to the capital Tirana and tertiary health care provider for the rest of Albania.

SUBJECTS

692,284 hospital admissions during eleven years period, 2006-2016.

MAIN OUTCOME MEASURES

Hospital admission trends measured as Average Annual Percentage Change and standardized admissions by district per 100,000 inhabitants.

RESULTS

Number of hospital admissions increased from 55,528 in the baseline year to 78,130 in the last year of our study. During eleven years ALOS changed from 7.60 to 5.80 days and BOR increased from 83.2% to 91.6%. AAPC total, Average Annual Percentage Change was 3.2% at the ending year, 2006 to 2016. Cramér's V between variables 'year of admission' and 'prefecture' was 0.024, p < 0.001 and between 'year of admission' and 'Tirana University Hospital Center administrative units' was 0.055, p < 0.001. Both relationships are weak but significant. Maps show the exaggerated flow from other districts towards Tirana.

CONCLUSIONS

Patient satisfaction, as a health care quality metric, is a driving force towards the choice of health provider. The satisfied patient chooses again or tells the next patient the preferred provider. The perceived professional difference among health care providers has built a competitive environment. The referral system puts strict rules over patient pathway which in his turn finds ways to bypass it if preferences are not taken in consideration. Commitment to such rules is accepted till forces considered as expression of free choice overcome them, jeopardizing the performance of the whole system. Patient's preferences deserve to be evaluated and incorporated in the patient pathway design.

Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review

We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.

Actual status of preoperative diagnosis of thyroid cancer in Albania

INTRODUCTION

Thyroid cancer is the most common endocrine malignancy and accounts for almost 1% of human cancer. It is well known that the majority of cases occur in women in the middle decades of life. Thyroid cancer is a relatively rare disease; on the other hand clinically apparent thyroid nodules are present in 4-7% of the adult population. Most thyroid nodules are not malignant, with reported malignancy rates from 3-12%. It is important for the surgeon to know beforehand the diagnosis of malignancy, in order to perform a more radical operation on the thyroid gland.

PATIENTS AND METHODS

In our study we have analyzed the preoperative clinical data of 84 patients operated in the First Clinic of General Surgery, UHC "Mother Theresa" in Tirana; all with a positive histopathologic diagnosis of thyroid cancer. The data comprised age, sex, age distribution, blood group, time-lapse from the first endocrinologic visit, clinical examination, signs and symptoms, imaging, functional tests, preoperative FNA, admission diagnosis, associated diseases and preoperative treatment.

RESULTS

From the study emerged that only 9,3% of these patients were diagnosed preoperatively as thyroid cancer. Another related problem is the low percentage of preoperative FNA - only 22%. Among the signs and symptoms related to thyroid cancer we found that 40 and 33% of these patient presented dyspnea and dysphagia, respectively. The physical examination revealed apparent nodular growth of the thyroid gland in 81% and nodular hard consistency in 79% of cases. The proper endocrinologist consultation lacked in 23% of cases.

CONCLUSION

In our opinion, close collaboration between endocrinologists and surgeons in a multidisciplinary frame is the key to correct preoperative thyroid cancer diagnosis and optimal treatment.

Evaluation of patterns and appropriate gastro protection in Albanian primary health care users

Our aim was to assess the prevalence of gastro protection in the Albanian population using non-steroidal anti-inflammatory drugs (NSAIDs). A cross-sectional study, conducted in November-December 2011 in Albania, included 610 NSAIDs users (236 men and 374 women) who visited pharmacies to receive their NSAID medication. A structured questionnaire was administered to all participants including information on age, sex, educational status, pathology being treated with NSAID, presence of gastrointestinal ulcer or related complications, duration of NSAIDs therapy, type of drug used, and gastro protection therapy. Almost all participants (N=599) received NSAIDs to treat rheumatic and/or musculoskeletal disorders. Of these, 475 individuals were on chronic therapy with high daily doses of NSAIDs. Concomitant gastro protective therapy was found in 184 individuals (30 percent of the overall sample). Women and the more educated individuals received more gastro protection than men and the low educated counterparts, respectively (33.4 percent in women vs 25 percent in men; 47 percent in highly educated vs 18 percent in low educated). Appropriate use of gastro protective therapy for NSAID users needs to be promptly implemented in Albania, as its inappropriate use raises ethical and economic concerns. Prescriptions should follow clear guidelines for prevention of gastrointestinal damage following NSAIDs therapy among persons at high risk.

Postoperative pain management at Tirana university hospital center -Mother Teresa-, Tirana, Albania

There is no or little evidence on postoperative pain assessment and treatment in Albanian hospitals. This study is based on our every day work and aims to highlight our experience. We conducted a descriptive drug utilization study which implied data collection over 6 months. Evidence of the enrolled patients was kept by maintaining records and the completed structured questionnaires. Postoperative pain was assessed through a five-category verbal rating scale (VRS). Metamizole was the most prescribed and administered analgesic drug as single therapy and in combination therapy, and acetaminophen was the least prescribed drug. The compliance between the prescribed dosages and those administered was higher in patients treated with a single analgesic compared to multiple therapies. A few patients reported adverse events (4.2 percent). There is much variability in postoperative pain management methods used by medical staff within the Tirana University Hospital. In Albania to date there is no standard protocol for postoperative pain treatment. This study shows that there are no essential differences in patient outcomes in terms of efficacy of analgesic treatment. This leads to the conclusion that a postoperative protocol/guideline for pain management should be prepared, based on our local study findings and also on international experience. Moreover, the guidelines should consider use of balanced analgesia.

Cecal volvulus during pregnancy. Case report

INTRODUCTION

Acute intestinal obstruction in pregnancy is a rare, but life-threatening complication associated with high fetal and maternal mortality.

CASE REPORT

A 20-year old gravida presented with a 24 hour history of several episodes of vomiting, complete constipation and severe crampy abdominal pain. The patient was admitted with the diagnosis of acute abdomen associated with septic shock. On examination echography showed distended intestinal loops and presence of free peritoneal fluid. Abdominal X-ray with shielding of the fetus revealed colonic air-fluid levels. The obstetrician consult diagnosed dead fetus in utero and was decided to operate immediately. On laparotomy was found complete cecal volvulus with gangrene of cecum, part of ascending colon and terminal ileum. A right hemicolectomy was performed with side to side ileotransverse anastomosis. Afterwards a lower segment cesarean section was made and a stillborn fetus was delivered. The patient made an uneventful recovery and was discharged on 9th postoperative day.

CONCLUSION

Cecal volvulus during pregnancy is a rare, but serious surgical problem. Correct diagnosis may be difficult until exploratory laparotomy is performed. Undue delay in diagnosis and surgical treatment can increase the maternal and fetal mortality.

Surgical treatment of the adenocarcinoma of the cardia

Adenocarcinomas of the esophagogastric junction should be classified into adenocarcinoma of the distal esophagus (Type I), true carcinoma of the cardia (Type II), and subcardial carcinoma (Type III) in a pathogenic and therapeutic point of view. During a 15-year period (1995 - 2009), 117 surgical laparotomies for adenocarcinoma of the cardia were performed in elective surgery in the First Clinic of General Surgery UHC "Mother Theresa" in Tirana. The classification was performed by summarizing the information obtained from oral contrast radiography, endoscopy, and intra-operative findings. There were 54 (46%) patients of Type I, 40 (34%) of Type II and 23 (20%) of Type III . Surgical procedures included "subtotal esophagectomy and proximal gastrectomy", "distal esophagectomy and proximal gastrectomy", "total gastrectomy and distal esophagectomy". All anastomoses performed in the above mentioned procedures were hand sewn. Thirty-seven patients (32%) resulted inoperable at the time of laparotomy and 80 (68%) patients were treated with curative intent, those resulting in an operability index of 68%. The overall morbidity and mortality rates of 29% and 4,3% respectively.

Rectal cancer surgery. A ten years experience

Rectal cancer is one of the most common malignancies in the western world population. The management of rectal cancer has changed thoroughly in recent years owing to the rapid advances in surgical techniques, imaging and adjuvant therapy. The present study analyses extensively 152 patients operated for diagnosis of, rectal cancer in the First Clinic of General Surgery UHC "Mother Theresa" in Tirana, Albania, in a ten years period. In the medical and operative records were analysed demographic, diagnostic, clinic, operative, pathology and postoperative patient's data. M : F ratio was 1,5:1. The average age of all patients was 59,8 ± 12,2 (29 - 79) years. 48% of all patients were of the age group 61 - 70 years. The diagnosis interval was 6 ± 4,6 months. The mean distance of tumor from the anal verge was 8,3 ± 4,2 (3,7 - 16) cm. 30% of all patients resulted stage D, according to the Astler - Coller classification. Overall operability index was 97,5%. 30 % of patients were treated with palliative operative procedures. 67,5% of all patients were treated with curative intent. The most common curative operation was low anterior resection with mesorectal excision in 76 patients (51%). The mean postoperative hospital stay was 12 ± 9,7 (3 - 45) days. Overall postoperative morbidity and mortality were 30% and 2,6% respectively. The surgical treatment of rectal cancer has changed radically in recent years in Albania. Relatively new surgical techniques, like low anterior resection and use of adjuvant chemoradiotherapy have improved the outcome, quality of life and survival of our patients.

Current drug-eluting stents in complex patients and lesions

Drug-eluting stents (DES) are playing an increasingly important role in the treatment of coronary artery disease. These new devices work by releasing controlled amounts of pharmacological agents with anti-restenosis properties at the implantation site. Most of them use polymer coating as a drug carrier, but concerns about long-term negative effects of a permanent polymer coating have stimulated the development of non-polymer DES or DES based on bioabsorbable polymers. Several randomized studies with DES have demonstrated their superiority over bare metal stents mostly in selected patients and lesion subsets. Accumulating evidence is showing significant differences in performance between currently used DES. These differences are more pronounced in complex, high-risk subsets of patients and lesions and should be considered during the process of DES selection for the individual patient. Interventional cardiologists have learned that patients who receive DES require a more prolonged antiplatelet therapy, but the optimal length and regimen are still unclear and further investigations are needed. Major advances in interventional cardiology have caused a dramatic shift away from aorto-coronary bypass surgery and an increase in the complexity of percutaneous coronary interventions. Observational and specifically designed randomized studies are currently addressing the issue of the role of DES in complex situations including in-stent restenosis, ostial and bifurcation lesions, chronic occlusions, small vessels, long lesions, saphenous vein grafts, multivessel disease, left main disease, acute myocardial infarction and diabetes mellitus. Although definitive answers are still to come from ongoing research, available data support the use of DES in most of these situations.

The relationship between hospital or operator volume and outcomes of coronary patients undergoing percutaneous coronary interventions

The relationship between volume and outcome in medicine has been intensively investigated in the last few decades. The large amount of accumulated data demonstrates that for many surgical or non-surgical procedures and medical conditions, patients being treated in high-volume hospitals or by high-volume physicians have lower mortality rates and better quality of life compared to those treated by low-volume hospitals or by low-volume physicians. Although the degree of the relationship between high volume and better outcome varies, it is persistent across a wide range of procedures and conditions. Percutaneous coronary interventions (PCIs) have an important impact on public health, given the frequency of coronary heart disease for which these procedures are performed. Studies carried out before and after the advent of stents on the relationship between volume and outcome for PCIs have almost consistently reported that performance of PCIs in high-volume institutions or by high-volume operators is associated with improved outcomes for patients, regardless of the specific indication for PCI. For those procedures for which a relationship between high volume and better outcome has been clearly demonstrated, patients as well as their referring physicians should be informed that patients can benefit both in terms of reduced mortality and improved quality of life if they are treated by high-volume health care providers. Consequently, for these procedures, a health care policy aiming at their concentration in high-volume institutions should be strongly considered.

The Chievitz juxtaparotid organ

The Chievitz juxtaparotid organ represents a macroscopic longitudinal formation, which is developed from oral cavity ectoderm in its lateral wall. As to its function, the organ probably represents a mechanosensor with different qualities of perception. The information coming from its sensors takes part in different activities of the lateral wall of oral cavity during sucking, swallowing, mastication, speech, protecting reflexes and wall tonus. The Chievitz juxtaparotid organ is not only a morphologically interesting structure, but is of great importance also for clinic and surgical pathology of the oral cavity.

[A uterine pecoma: a case report]

The authors describe the first ever reported case of a malignant pecoma of the uterus infiltrating the ovary, the tube and two bowel loops. This extremely rare tumour usually shows a benign behaviour and seems to arise from the perivascular epithelioid cells (PEC).

Thymectomy and multiple sclerosis: ultrastructural study of an experimental model

Transmission electron microscopy was performed on specimens of the thymus of rats induced for acute experimental allergic encephalomyelitis (EAE). The ultrastructural alterations of the thymus were progressive and correlated with EAE development. The thymic disorganization was due to a progressive degeneration of both epithelial cells and thymocytes. These data suggest a direct involvement of the epithelial thymic cells and thymocytes in EAE pathogenesis and may suggest the intriguing therapeutic concept of thymectomy in the management of multiple sclerosis.

Interposition vein cuff in infrainguinal prosthetic bypasses

The Authors describe the interposition vein cuff technique as an adjuvant method to infrainguinal prosthetic bypass grafts. The haemodynamic, mechanical and humoral factors thought to be involved in the beneficial effects of the vein cuff are herein discussed. The results of the main series suggest the use of this method particularly in patients without any available autologous vein conduit requiring a below-knee popliteal or crural reconstruction.

[Surgery of differentiated cancer of the thyroid]

A retrospective study on patients with differentiated thyroid carcinoma operated on at the 3rd Department of General Surgery of the University "La Sapienza" of Rome from 1970 to 1996 was performed. In 709 patients total thyroidectomy was performed as the minimal procedure acceptable, while 19 patients had subtotal thyroidectomy out of necessity. A functional ipsilateral or bilateral lymphnectomy of the neck was performed in 256 cases. This wider operation is indicated in the presence of metastatic lymph nodes and on principle in patients older than forty-five years in which at least another risk factor is present. Long term follow-up (12 years) was assured in 302 patients and the survival rate was 92% independently from the histotype (papillary or follicular). The survival rate of a group of 120 patients (80 with papillary and 40 with follicular carcinoma) was analyzed in relation to the risk factors. This group analysis demonstrated a very low mortality rate in patients with low risk index and an increased rate in patients with a high risk index.

[Parathyroidectomy: our school experience]

The Authors evaluated the results obtained in 145 patients operated on for hyperparathyroidism: 109 patients had primary hyperparathyroidism and 36 patients had secondary hyperparathyroidism. Preoperative localization by ultrasonography was assured in all cases, while only few patients were preoperatively evaluated by arteriography and selected venous sampling of the parathyroid hormone concentration. After surgical resection for primary hyperparathyroidism, transient postoperative hypoparathyroidism occurred in 30 patients (27.5%), recurrent disease occurred in 3 patients (2.7%), while 1 patient experienced persistent hypoparathyroidism (1%). In 3 patients (3%), resection of a solitary adenoma and biopsy of all parathyroid glands resulted in a permanent hypoparathyroidism which required long-term administration of vitamin D and oral calcium. Neither recurrent nor persistent hyperparathyroidism occurred in patients surgically treated for secondary hyperparathyroidism, and no postoperative hypoparathyroidism was registered. The Authors emphasize the importance of an adequate surgical strategy and accurate initial cervical exploration of the parathyroid glands as a necessary step for the correct treatment of this challenging disease.

Radiolabelled monoclonal antibodies in clinical and surgical oncology: a review

Over the past decade, the role of immunoscintigraphy using radiolabelled monoclonal antibodies has been steadily growing in clinical oncology, and in particular, in radioimmunotherapy and radioimmunoguided surgery for the treatment of primary, recurrent, and metastatic colorectal, ovarian, gastric, and prostate cancer. Herein, the authors review the requirements for successful tumour radioimmunodetection and related procedures.

Cholera in the Mediterranean: outbreak in Albania

In the 1990s, an epidemic of cholera caused by Vibrio cholerae 01 El Tor has spread from northern Pakistan to the Mediterranean. In 1993 sporadic cases of cholera, and epidemic foci, were recorded in many countries of the southern part of Eastern Europe.

Cholera in the Mediterranean: outbreak in Albania

In the 1990s, an epidemic of cholera caused by Vibrio cholerae 01 El Tor has spread from northern Pakistan to the Mediterranean. In 1993 sporadic cases of cholera, and epidemic foci, were recorded in many countries of the southern part of Eastern Europe.

Usefulness of the determination of carcinoembryonic antigen (CEA) in the serum of patients with colorectal cancer in Albania

In our work we have studied the value of the determination of serum CEA in patients with colorectal cancer. We have studied 56 patients with colorectal cancer aged 40 +/- 16 years of both sexes, 26 of whom have metastasis and 30 not. The positivity of serum CEA in the patients with colorectal cancer was 66% (37/56) in the patients without metastasis 53% (16/30) and in the patients with metastasis 80.7%. (21/26). The referent values of serum CEA were significantly lower than the values of serum CEA in the patients with colorectal cancer with and without metastasis (p1 < 0.001). Also we noticed that the values of serum CEA of the patients with colorectal cancer with metastasis were considerably higher than those without metastasis (p2 < 0.001). Analysing the values of serum CEA in the patients with colorectal cancer we noticed that all the patients of our work that had serum CEA value 20 ng/ml had metastasis. Relying on our data we conclude that the determination of serum CEA in the patients with colorectal cancer is very useful for the diagnosis and the prognosis of these patients.