Asociacioni Shëndetësor ProfesionalProfessional Health Association

ACCREDITED B

Y

UEMS -

EACCME

23-25 September 2010, Prizren, Republic of Kosova

Venue:Touristic Complex “Sharri” Prevalla, Prizren, KosovoVendi: Kompleksi Turistik “Sharri” Prevallë , Prizren, Kosovë

PROCEEDINGSPROCEEDINGS

2ND INTERNATIONAL CONFERENCE ON PAIN TREATMENT

1ST NURSES CONFERENCE ON PAIN TREATMENT

and

ofof

Dr.Adem Bytyqi-Executive DirectorProf.Dr.Orhan Kubati

Dr.Fadil Kryeziu Dr.Mehdi Shehu Dr.Armend Spahiu Musa VezgishiFatmir Karabaxhaku Myzafer KalanderiAgron Bytyqi - SecretaryBashkim Sylaj - Vice Secretary

Dr.Sejran Skeraj Prof.Dr.Nexhmi HyseniProf.Dr.Tritan ShehuProf.Dr.Gani BajraktariDr.Nehat Baftiu Dr.Sci Dr.Antigona Hasani Mr.Sci.Prof.ass.Kujtim Shala, MD, DDS, PHD

Dr.Sejran Abdushi Mr.Sci.

Prof.Dr. Orhan Kubati - Chair Dr. Antigona Hasani, Mr.Sci. Prof.Dr. Nexhmi Hyseni Dr.Armend Spahiu

Dr. Sejran Abdushi, Mr.Sci. Ramiz BytyqiAgron Bytyqi

Dr.Adem BytyqiDr. Apostol VasoDr. Nehat Baftiu, Dr.Sci.

This Proceedings is edited by:Dr. Adem BytyqiToN. Agron Bytyqi

General sponzors:1.Bene-Arzneimittel GmbH

www.bene-gmbh.de

Radhitja kompjuterike:Agron BytyqiBashkim Sylaj

Organization committee:

Scientific committee:

ben-u-ronR

Content

1

Welcome by the Conference Chairman..........................................................................3Key-note speakers of the Conference (CV)....................................................................5Presentation .................................................................................................................54Epidemiology of cancer and noncancer pain in Europe ............................................... 55Cronic pain managment ...............................................................................................56The management of postoperativ pain in children ........................................................58Evaluation of pain in strabismus, and cataract surgery with phacoemulsiphication with IOL pre and post operative ...........................................59Implementation of Pain in Albania .........................................................................61The Management of acute postoperative pain in Kosovo ..........................................65The Analgesic effect of clonidine in epidural catheter ...............................................66Management of the pain with the acupuncture: Cephaleae, Migraine.... ....................67Assessment and Treatment of Neuropathic Cancer Pain ...........................................68Postoperative pain management following orthopedic surgery .................................73Role of Radiotherapy in the Management of Cancer Pain ..........................................75Management of cancer pain ...............................................................................76Treatment of Postoperative pain in children in Kosovo ..........................................77Effect intra-operative Magnesium Sulfate on Pain relief and patient comfort after renal surgery..................................................................................79Living Without Pain (Case report of family with HSN type I) ..................................80Use of Epidural anesthesia and risk of acute postpartum urinary retention..............81Does Ketamine reduces Pain on Propofol injection.................................................82Opioid treatment of chronic non cancer pain........................................................83Cancer Pain........................................................................................................84Renal Colic ........................................................................................................85Treatment of Chronic Pain...................................................................................86Postoperative acute Pain Treatment.....................................................................91Pain in general, Treatment of pain in patients with Cancer –supportive and palliative therapy ........................................................................................93Correlation of Elektrocardiographic changes and psychic Depression in Ischemic Heart disease..................................................................................95Terminal and palliative care ................................................................................97Electrophysiological approach to neuropatic pain .................................................99Management of Acute Chest Pain .....................................................................102Acute Pain Treatment .......................................................................................103Predistention of the Epidural Before Catheter Insertion Reduces the incidence of Intravascular Epidural catheter Insertion .........................................104

Fjala përshëndetëse nga Drejtori Ekzekutiv I Konferencës

Të nderuar kolegë,

Asociacioni Shëndetësor Profesional në bashkëpunim me Ministrinë e Shëndetësisë, IASP-në (International Association Study of Pain) dhe me partnerët tjerë kanë kënaqësinë t'ju ftojnë në Konferencën e Dytë Ndërkombëtare për Trajtimin e Dhimbjes dhe Konferemcen e Parë Infermierore për Trajtimin e Dhimbjes e cila do të mbahet në Prizren me 23-25 Shtator 2010.

Trajtimi i dhimbjes ka pësuar një zhvillim të shpejtë në Evropë dhe botë, për rrjedhojë edhe në vendin tonë është parë nevoja për të marrur iniciativa për zhvillimin dhe mbulimin e kësaj hapësire. Objektivat e konferences janë që të senzibilizohet opinioni për dhimbjen, trajtimin e dhimbjes në përgjithësi ku përfshihen dhimbja akute e kronike, dhimbja te sëmundjet e kancerit si dhe ato me etiologji të panjohur.Temat që do të trajtohen janë menagjimi i dhimbjes nga këndvështrimi i përgjithshëm dhe specifik, menagjimi i dhimbjes kundër sëmundjeve kanceroze si dhe dhimbja akute postoperatore. Ne shpresojmë që përmbajtja e temave do të nxisë të menduarit dhe debatet promovuese të cilat do të jenë me interes për të gjithë profesionistët shëndetësor, veçanërisht për anesteziologët, neurologët, kirurgët, neurokirurgët, ortopedët, gjinekologët, fiziatrat, stomatologët, farmacistët dhe profesionistët e tjere, duke mos i anashkaluar infermierët qe jane pjese përbërëse/bashkëpunëtor në ekipin për menagjimin e dhimbjes.

Ne gjithashtu shpresojm që koha e konferencës do të jet e dobishme dhe do të shërbej për krijimin e një rrjeti bashkëpunues ndërmjet profesionistëve shëndetësor në rajon. Shfrytezojm rastin që të falenderojmë Ministrinë e Shëndetësisë, Kuvendin Komunal të Prizrenit, kompanitë farmaceutike si dhe partnerët e tjerë.

Me shpresë se konferenca përveç anës shkencore do të jet e dobishme edhe në shoqërimin ndërmjet kolegëve nga vendet e ndryshme.

Ju dëshirojmë qaste të mira në konferencë dhe qëndrim të këndshëm në qytetin e lashtë të Prizrenit.

Kryetari i Konferencës Dr. Adem Bytyqi – Anesteziolog & IntensivistKryetar i Asociacionit Shëndetësor Profesional (ASHP)

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Welcome by the Executive Director of Conference

Dear Colleagues

,Professional Health Association in cooperation with the Ministry of Health, the IASP (International Association Study of Pain) and other partners have the pleasure to welcome you to the First International Conference for Pain which will be held in Prizren on 09-10 October 2009.Treatment of pain has undergone a rapid development in Europe and the world, therefore in our country has seen a need to take initiatives for development and coverage this gap. The objectives of the conference are to raising awareness of people about pain, treatment of pain in general including acute and chronic pain, cancer pain and those with unknown etiology.Topics which will be treated are pain management from the general and specific perspective, pain management against cancer diseases and acute post-operative pain. We hope that the contents of the topics will stimulate thinking and promote dialogue which will be of interest/benefit to all health professionals, especially anesthesiologist, neurologist, surgeons, neuro-surgeons, orthopedists, gynecologists, physiotherapist, dentist, pharmacists and other professionals, by not bypassing nurses who are part/associate team for pain management.We also hope that the time of the conference will be useful jet and will serve to establish a collaborative network among health professionals in the region.We also want to use this opportunity to thank the Ministry of Health, the Municipality of Prizren, pharmaceutical companies and other partners.We hope that the conference in addition to scientific side of the jet will also be useful in associating between colleagues from different countries.We wish you a pleasant stay in the conference and in the ancient town of Prizren.

Conference ChairmanDr. Adem Bytyqi - Anesthesiologist & IntensivistChairman of the Professional Health Association (PHA)

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Implementimi i dhimbjes në Shqipëri

Prof. Tritan Shehu

Lufta me dhimbje eshte pa dyshim nje nga elementet me te rendesishem te shoqerise njerezore. Ne realitet kjo ka te beje direkt me cilesine e jetes, qofte ne planin e cilesise se ngushte, qofte ne planin e nje jete aktive.

Zhvillimi I shkencave mjekesore, mireqenia ekonomike e sociale, profilkasia aktive, kane bere te mundur zgjatjen e jetes. Mendoj se ne kete menyre shoqeria njerezore ka bere nje hap te madh perpara ne respektimin e individit duke treguar vlerat e saj. Por kjo nuk mjafton perpara shoqerise se viteve 2000. Kjo shoqeri tashme ka nje tipar tjeter dallues per nivelin e ri te saj. Une do te thoja se ndoshta kjo mund te permblidhet ne ate qe quhet cilesia e jetes. Pa dyshim kjo eshte nje shprehje qe ka nje kontekst shume te gjere. Kjo lidhet me shume hapesira e mundesi per jeten, por pa dyshim une ketu do te rendisja ne nje nga vendet e para dhe perpjekejt, qe behen ne lufte me dhembjen fizike, pa te cilen per shume e shume njerez nuk mund te kete cilesi jete, bile jo rralle dhe jeta vete nuk ka kuptim.

Pra lufta me dhimbjen eshte tipar I nje shoqerie te zhvilluaar, jo thjesht ne planin ekonomik, por shume me gjere dhe ne ate moral, etik, social, demokratik, kulturor e arsimor. Ne fund te fundit kjo ka te beje me respektin ndaj qenies njerezore ndaj neve vete, pra kjo nuk eshte vetem nje fushe mjekesore, por dhe politike, sociale, filozofike, eshte nje karakterisitike teorike dhe organizative e sistemit shendetesor e social te nje vendi. Keshtu kjo ka te beje me ekonomine, mentalitetin, vlerat e shoqerise njerezore. Kjo ka te beje me te tashmen dhe me te kaluaren e shoqerise vete. Ka te beje me te drejtat themeltare te njeriut. Si e tille nuk mund te mos influencohet nga rregjimet politike, hapesirat individuale, lirite e te menduarit dhe jetuarit. E pare nen kete plan pa dyshim implementimi dhe zhvillimi I ketij sektori te ri e te gjere te mjekesise ne vendet tona, qe vime nga periudha te gjata diktature, tipari kryesor I te cilave ishte mos rrespektimi I individit, I te drejtave te tij, zhvillimi I ketij sektori ka veshtiresite e veta jo vetem ekonomike.

Ketu ben pjese dhe Shqiperia, qe se bashku me ato qe thashe me lart perballet akoma dhe me shume veshtiresi ekonomike. Pra dhe ecuria e zhvillimit te ketij sektori ka rritmin e vet te ulet, oshilacionet e shoqeruar jo rrralle nga mos kuptimi dhe mos vleresimi i tij. Ne nje vend post komunist, ku per 50 vite ka munguar zeri I vertete I komunitetit, ku vlerat ishin transformuar ne ideologji, ku etika ne dogma, pa dyshim qe keta sektore me kolona te

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Implementimi i dhimbjes në Shqipëri

rendesishme sociale dhe filozofike, nuk e kane te lehte te zhvillohen. Rritja e zhvillimi I tyre do behet ne gradualitet duke ndjekur rritjen e zhvillimin e tere shoqerise. Pa dyshim ketu flas per shoqerine demokratike, te vlerave, te respektit per individin.

Ky sektor te ne filloi te zhvillohej me timiditet vetem mbas vitit 2000. Ai lindi si nje nevoje fizike dhe shpirterore e shoqerise sone ne periudhen e mbas komunizmit. Realisht ai lindi e u zhvillua nga nje grup anestezistesh te rinj, sektor te cilit I perkas dhe une ne karrieren mjekesore, pamvaresisht se qe nga viti 1991 u angazhova ne politike. Pikerisht ne vitin 2000 u themelua ne Tirane Shoqata e Shqiptare e Dhimbjes, si nje organizem jo qeveritar, qe me kohe arriti te kthehet ne nje organizem profesional te vertete, duke luajtur per dite dhe me teper nje aktivitet te rendesishem mjekues, shkencor, didaktik, social dhe emancipues ne nivel vendi. Ne lidhje me kete desheroj te theksoj nje fakt te rendesishem per jeten e kesaj shoqate te re. Forma dhe roli I shoqatave ne vendet post komuniste, per shkak te deformimeve te renda qe krijon kjo ideologji dhe dogme ne te gjitha planet e shoqerise njerezore, shume ngadale marrin fizionomine edhe rendesine e nevojshme te ekzistences se tyre, qe eshte ne perendim. Vecanerisht nje tipar i rendesishem eshte mungesa e komunikimit te ngushme me komunitetin dhe roli i tij. Une do te thoja se kjo shoqate realisht e kuptoi kete mangesi esenziale ne jete ne vendit, duke kerkuar te shtrihet ne komunitet, te afroje mjeke, studente dhe te kombinoje kete qendrim, me nje aktivitet klinik e shkencor te dendur, nepermjet formave te larmishme.

Sidoqofte une mendoj se tashme dhe te ne po konfigurohen shume nga tiparet e nevojeshme per zhvillimin e ketij sektori te mjekesie. Keto elemente jane pjese e studimeve mjekesore universitare dhe pas universitare, I dedikohen konferenca kombetare, nderkombetare te nje niveli te larte, botime periodike cilesore si dhe disa struktura mjekesore.Megjithate dua te theksoj se jemi vetem ne hapat e para te ketij procesi shume te rendesishem mjekesor e social. Jemi ne fillimet e nje rruge te gjate e cila do te zgjatet se bashku me zhvillimet e pergjitheshme ne Shqiperi dhe qe do te jete pjese e reformes shendetesore te ne. Nqs vendi im ne pak vite demokraci ka bere hapa te medha perpara vecanerisht ne planin ekonomik, ka akoma shume per te bere ne planin e sektoreve sociale e vecanerisht ne ate te shendetesise. Ne kete sektor objektivi yne eshte pikerisht te adaptojme politikat sociale me ekonomine e tregut e inisiativen private, sektore qe jane zhvilluar me shpejtesi, duke u bere

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Implementimi i dhimbjes në Shqipëri

jo vetem dominues te ne, por dhe esenciale ne stabilitetin e vendit. Shqiperia ka pasur keto vite nje rritje ekonomike 7-11% duke ruajtur pozitivitetin prej 3-4% dhe ne kete periudhe krize. Ndersa realisht sistemi shendetesor ka ecur me ngadale e osholacione, pikerisht sepse eshte akoma I centralizuar dhe pak I zhvilluar ne drejtim te koncepteve te tregut. Eshte detyra jone qe krahas decentralizimit, instalimit te konceptit spiatli ndermarje, forcimit te sektorit privat si pjese integrale e sistemit, zgjerimit te tregut te shendetit, te zhvillojme dhe politikat sociale e sektoriale. Dhe ketu ka vend per tu perqendruar me teper ne terapine e dhimbjes.

Ne jemi te orientuar te ndertojme nje plen afatmese e afatgjate ambicioz per zhvillimin e kesaj pjese shume te rendesishme te mjekesise. Ketu nje vend si mbeshtetje krijon dhe programi I EFIC per promovimin e dhimbjes si nje problem me vehte, ku ne kemi bere hapa perpara. Sidoqofte dua te theksoj se tashme keto programe duhet te marrin te tjera dimensione shume me te gjera.

Tashme strukturat e nevojeshme per kete aktivitet duhet te shtrihen ne te gjithe vendin dhe jo vetem ne dy tre qytetet kryesore. Per kete ne mendojme te zhvillojme politika nxitese, per te cilat nga ana tjeter mendoj se dhe nje asistence teknike ne planin organizativ do te ishte shume e nevojeshme. Aktualisht ne ne e ofrojme gratis kete sherbim per patologjite trumorale, por kjo nuk mjafton. Ka ardhur koha ta shtrijme shume me gjere qofte neperjet financimeve nga buxheti, qofte nepermjet zgjerimeve te skemes se sigurimeve shendetesore. Sidoqofte me e rendesishmja ngel edukimi I njerezve, sensibilizimi I tyre, ngritja teknikle e operatoreve, dhe zgjerimi I games se tyre.

Ne kete process vetem organizimi I konferencave nuk shte i mjaftushem. Ne kete kuader ne po punojme per te pregatitur programin ri axhornimi te mjekeve ne kete drejtim, duke filluar qe nga mjeku I familjes, I cili eshte mjeku me prane pacientit Ky especialist eshte nje element esencial ne kete drejtim.

Dikush mund te flasi per kosto per keto zhvillime e projekte. Cdo gje ka nje kosto. Por une mendoj se programe te tilla mire te orientuara e zhvilluara me efikasitet do te influencojne pozitivisht ne uljen e invaliditetit rritjen e mobilitetit te ketyre pacienteve. keshtu pervec beneficave mjekesore e sociale mund te krijojme te tilla perfitime dhe ne koston kompleksive per te ekuilibruar shpenzimet zhvilluese ne maksimum.

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Deep Venous Thrombosis: When Lower Leg Pain Is Not

Lester J. Kiemele, Certified Physician AssistantMayo Clinic, Rochester, Minnesota USA

Deep vein thrombosis and pulmonary embolism are two manifestations of venous thromboembolism whose morbidity and mortality are concerning, especially for immobilized patients. Nearly 20% of hospitalized patients who die in hospital do so because of this condition. It is important to have a high index of suspicion for venous thromboembolism whenever lower leg pain, redness and swelling are observed in order to initiate appropriate diagnostic tests and therapy. This basic overview will define deep vein thrombosis, review risk factors and discuss treatment of this potentially serious condition through a case presentation.Objective: 1. Define Deep Vein Thrombosis (DVT)2.Identify common risk factors for DVT3. Identify potential complications from DVT4. Discuss DVT treatment options5. Discuss ways to prevent future DVTs. Materials/Methods: case study. Results/conclusions: DVT is a serious medical condition that must be recognized and treated promptly. This will help minimize the risk of future complications. Once the diagnosis is confirmed, management involves initiating heparin and warfarin simultaneously until the INR is within therapeutic range, then the heparin can be discontinued. The length of treatment depends on the number of occurrences and the patient's comorbidities. Compression is important to prevent post-thrombotic syndrome and other complications later.

References:Clive Kearon, Susan R. Kahn, Giancarlo Agnelli, Samuel Goldhaber, Gary E. Raskob, and Anthony J. Comerota. Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. June 2008 133:454S-545S; doi:10.1378/chest.08-0658. Deep Vein Thrombosis. Mayo Clinic.

. A c c e s s e d J u l y 1 5 , 2 0 1 0 .D e e p v e i n t h r o m b o s i s . N a t i o n a l H e a r t L u n g a n d B l o o d I n s t i t u t e .

. Accessed June 17, 2010.Heit JA. The epidemiology of venous thromboembolism in the community. Atherosclerosis, T h r o m b o s i s a n d V a s c u l a r B i o l o g y . 2 0 0 8 ; 2 8 : 3 7 0 .Landaw SA, et al. Approach to the diagnosis and therapy of deep vein thrombosis.

. Accessed June 10, 2010.

kiemele.lester@mayo.edu

http://www.mayoclinic.com/health/deep-vein-t h r o m b o s i s / D S 0 1 0 0 5

http://www.nhlbi.nih.gov/health/dci/Diseases/Dvt/DVT_All.html

http://www.uptodate.com/home/index.html

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Peripheral Arterial Disease: When Lower Leg Pain Is Not

Lester J. Kiemele, Certified Physician AssistantMayo Clinic, Rochester, Minnesota USA

Atherosclerotic vascular disease is a leading cause of death in the Western world, and is becoming more prevalent in Europe and Asia. Peripheral Arterial Disease (PAD), a common symptom of atherosclerotic vascular disease, is associated with significant morbidity and mortality and is a strong predictor of myocardial infarction, stroke and death. PAD is the least recognized form of atherosclerosis and many patients are not properly diagnosed nor optimally treated. This basic overview will define PAD, identify wound characteristics unique to ischemic ulcers caused by PAD, and describe nursing interventions to optimally care for patients with this serious condition.Objectives: Define peripheral arterial disease (PAD) Identify principles of wound healing Identify factors that affect wound healing Identify wound characteristics unique to ischemic ulcers and PAD Discuss nurses' role in treating ischemic ulcers Materials & Methods: case studyReferences:1. Crowther MA. Pathogenesis of Atherosclerosis. Hematology 2005.

2. de Haro Miralles, J., A. F. Gonzalez, et al. "Onset of peripheral arterial disease: role of endothelin in endothelial dysfunction." Interact Cardiovasc Thorac Surg 10(5): 760-5.3. Duran, N. E., I. Duran, et al. "Coronary artery disease in patients with peripheral artery disease." Heart Lung 39(2): 116-20.4. Jude, E. B., I. Eleftheriadou, et al. "Peripheral arterial disease in diabetes--a review." Diabet Med 27(1): 4-14.5. Maly, R. and V. Chovanec "[Peripheral arterial disease and diabetes]." Vnitr Lek 56(4): 341-6. 6. Meves, S. H., C. Diehm, et al. "Peripheral arterial disease as an independent predictor for excess stroke morbidity and mortality in primary-care patients: 5-year results of the getABI study." Cerebrovasc Dis 29(6): 546-54. 7. Mohler ER. Clinical features, diagnosis, and natural history of lower extremity peripheral a r t e r i a l d i s e a s e .

8. Mukherjee, D. and L. Cho (2009). "Peripheral arterial disease: considerations in risks, diagnosis, and treatment." J Natl Med Assoc 101(10): 999-1008.9. Musaad S, Haynes EN. Biomarkers of Obesity and Subsequent Cardiovascular Events. Epidemiologic Reviews 2007 29(1):98-114.10. Procedure Guideline Assessment of Arterial ulcers VUWHC, Mayo Clinic, Rochester, MN.

kiemele.lester@mayo.edu

http://asheducationbook.hematologylibrary.org/cgi/content/full/2005/1/436

http://www.uptodate.com/patients/content/topic.do?topicKey=~bRhDzg8iotC8ZJ

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Titull i

Prof. Rifat Latifi, MD FACS-Tuson Arizona

9

Pain during and after LASIK surgery

O.Kubati.M.Kubati-Ajeti,B.Zhuriorhankubati@gmail.com

Introduction:LASIK(Laser Assisted Intra-Stromal Keratomileusis) is surgical intervention with eximer laser. The aim of this surgical procedure is to normalize corneal topography thus eliminating the refractive anomaly of the eye such myopia, hypermetropia and astigmatismus. After the intervention patient get relived from any kind of supported devices like spectacles and contact lenses. Aim: Eye is very important human body organ which is used like connection of environment with the brain. Eye is protected by ocular adnexas like eye brow, eye lids and also is supplied by fine sensitive nerve endings. One sensitive nerve fibber cover 1.5 epithelial cells.Patients with refractory disorders have a lot of questions regarding to LASIK. One of them is: “would I have pain during and after LASIK surgery”.Therefore aim of this study is to analyze pain during and after laser surgery in the period of time of three month. Material and methods: LASIK surgery has started 15 years ago. Millions of patient have undergone through that procedure. Every year lasers get more and more sophisticated. Below are data of the laser that we are used in our clinic

ALEGRETO WAVE Eye-Q 400 Hz,Class 4 laserOne dioptre remove for 2 sec. other lasers 4-6 secVery sophisticated tracking systemWave front optimized-the only laser that possesMyopia from -0.25 to -14.0 dpt OZ 4.5-8.0 mmHyperopia +0.25 to +6.0 dpt. OZ 6.0-7.0 mmAstigmatisms up to 6 dpt OZ 6.0-7.0 mm

Before treatment patient undergo the very strict examination. Keratorefactometry is performed first.IOT is measured also. Than corneal topography-amount of atigmatismus, corneal thickness, anterior chamber depth, is performed with very sophisticated device called

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Pain during and after LASIK surgery

PENTACAM.Visual acuity is than check, subjective and objective one.Which eye is dominant is determined.The collected data than we put in to the eximer laser.Before the operation we apply topical anesthesia than 5% povidone iodine in to the conjunctival sac.

We have evaluate 22 patient in the three month period of time.Hypermetropic 4 eyeMyopic 10 eyeAstigmatismus hypermetropicus 9 eyeMyopia late 2 eyeAstigmatismus mixtus 4 eye.Preoperatively all patient have had feeling of burn in the eye. This is because of use of betadine and anesthesia.During the operation no one have had feeling of pain.Postoperatively in the same day patients have had burn and foreign body sensation. NSAID have been used.Postoperatively on day one burn and foreign body sensation was present in all patients but no pain.In 80% of patients foreign body sensation have last up to 6 weeks. Artificial tears are used.

Conclusion: LASIK surgery is very safe and painless procedure. High rate of success, efficiency, painless method are the satisfaction for all treated patients.

Key words: LASIK, pain, refractive disorders

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Titull i

N. Hyseni, S llullakuUniversity Clinical Centre Department of Pediatric Surgery,Prishtina,Kosova

Background: The aim of hypospadias surgery today is to achieve a normal-looking glans and meatus following hypospadias surgery. In pediatric surgical practice, hypospadias is a frequently congenital anomaly of male children with a prevalance of 0,3-0,5 %. In relief of this anomaly numerous techniques have been advenced and in use.We review our experience of different techniques of hypospadias repairMaterial and methods: In this sudy we present the techniques for the correction of hypospadias and their outcomes. Between January 2008 and December 2009, a total of 153 patients were operated for hypospadias at our Department. These patients were divided into two groups. The first group included 134 cases (87, 5%). With distal hypospadias: glanular (13) coronal (24), distal penile (60) and midshaft (32). The surgical methods in this group were used MAGPI (23), TIPU (98), Mathieu (3) and Duckett (5) procedure. The second group included 19 cases (12, 41%) using Bracka's two-stage hypospadias correction. In this group, preputial dorsal skin grafts were used in 3 patients, buccal mucosa in 2 patients and inner preputial skin grafts in a 14 patients. We used the method of cover the neourethra with the tunica vaginalis flap and tunica dartos barrier flap. The age of the patients were 12months to 18 years (with a mean 8,5 years). Postoperative follow up time is (6 months- 1 years)Results:Cosmetic and functional results were satisfactory in the majority of patients. At the first group complications included 23 fistulae (15.0%) and 15 meatal or urethral stenoses (9, 8%). At the second group - 18 of the 19 cases had good graft establishment. In 1 patient with dorsal preputial skin grafts, a keloid scarring developed and was later excised and successfully replaced with buccal graft. One patient had balanitis xerotica obliterans (BXO) and one wide fistula formation, the two Brackas stage procedure was subsequently The fistulae were closed 6 month after the first operation. Meatal stenosis was successfully treated with the help of long catheterization, we used the short urethral stents.

repaired.

12

Titull i

Conclusion: Two stage operations have the best cosmetic result and less number of complications, but there are more operations and more long at times treatment in two times. The use of different techniques on indications allows obtaining the best cosmetic and functional results. A successful repair is measured by the complication rate. Increasing clinical experience by years and minor additions in technique increases the chances of success.

Keywords: hypospadias, surgical techniquesType of presentation: 8 minute oral presentation

13

Current invasive pain management techniques

Dr. Halil ALGAN

Modern Pain Management is a continuously growing -maybe one of the fastest- specialty of medicine. Both in the fields of medical management of pain and invasive management of pain (percutaneous procedures), new and novel therapies and techniques emerged in the last 10 years of time. This rapid improvement is certainly for the best benefits of our patients but on the other hand with the use of these new improvements we might put ourselves and our patients to some degree of risk.

New improvements in the field of Invasive Pain Management might be divided into different groups according to the target of application:

1) Techniques for relieving disc (discogenic) pain (medicines, radiofrequency techniques, laser decompression techniques, mechanical disc removal methods without surgery etc.)

2) Techniques for relieving facet joint pain (multipl electrode radiofrequency etc.)

3) Techniques for relieving nerve root pain (transforaminal catheters, pulsed radiofrequency etc.)

4) Techniques for relieving spinal neuropathic pain (Pasha-cath procedure)

5) Techniques for relieving vertebral compression fracture pain (radiofrequency vertebroplasty etc)

6) Techniques for relieving foot pain (podiothermia)7) Techniques for relieving Zoster infection and Post-Herpetic Neuralgia

pain

14

Modern pain management techniques without high costs and expensive equipments

Dr. Halil ALGAN

Modern medicine is improving continuously and medical industry bringing a wide range of new therapies everyday.

It is impossible to follow these improvements and also most of the times it is impossible implement them to our daily practice because of following reasons:

1) not enough evidence2) not enough education or equipment to use them3) not enough resources to buy them4) not enough reimbursment

But even without fancy medical equipment or modern high end clinics, we as Pain Management specialists, can still help the people in severe and chonic pain.

We have 2 different approach to achieves this:1) Medical management of pain

1. Opioids2. Tramadol3. Paracetamol4. Antidepressants5. Antiepileptics6. Topical agents7. Other

2) Invasive management of pain1. Epidural steroids2. Facet joint injections3. Intradiscal injections4. Sympathetic blocks5. Lytic blocks6. Cryo

15

Pain of muscular origin

Piraye OflazerIstanbul University, Istanbul, TURKEY

Pain in muscle is usually due to extra-muscular pathological conditions, such as vascular pathology, tendinitis, or other reasons. However, pain directly related to muscular conditions is rarer than the pain due to extra-muscular factors and the extent and amount of it is mainly controlled and determined by the nosiceptive nerve endings, muscle spindle and golgi tendon apparatus within the muscle tissue.

The most common muscular causes of muscle pain (myalgia) are trauma and exertion. Trauma is a direct insult to nosiceptors, followed by inflammation. In normal conditions, slight exertion of a muscle may cause disruption of myofibrils. Greater exertion results in rupture of sarcomere or muscle mambrane, which may be repaired by internal abilities of the muscle fiber itself. However, if the exertion or tension exceeds this limit, then the muscle membrane rupture cannot be repaired and a local inflammation occurs. It is this inflammation which causes the disturbance of nosiceptors resulting in pain.

The rupture of muscle membrane, causing pain may also be due to the weakness of the membrane itself in which the membrane ruptur occurs more easily. This is particularly true for dystrophinopathies and some other dystrophies. Patients with Becker muscular dystrophy frequently complain of calf pain on exertion. Rhabdomyolysis, diffuse necrosis of many muscle fibers, is another factor disrupting the muscle membrane and causing myalgia.

In contrast with the common belief, inflammatory muscle diseases do not cause muscle pain frequently. Only 10-15% of patients with polymyositis or dermatomyositis present with pain and this pain is usually due to joint involvement. In contrast, polymyalgia rheumatica, a rheumatological disease, invariably causes myalgia.

Some metabolic diseases, such as carnitine palmityl transferase-II deficiency may cause episodic myalgia. This is due to rhabdomyolysis upon exertion.

16

Pain of muscular origin

Direct effect of hypothyroidism and drug utilisation are other causes of myalgia. It is of importance to check for thyroid hormone levels in a paient with myalgia as the treatment is very easy. Likewise, the history of drug use must be obtained in every patient with muscle pain. At present and due to their frequent use, statins are the major cause of drug induced myalgia.

Muscle pain is a symptom affecting the quality of life and it is important to disclose the cause as it can either be prevented or ceased with a relevant approach.

17

Postoperative Pain and Management

Author: Sarah Shaikoski PA-CMayo Clinic, Rochester, Minnesota, USA

Abstract September 2010 Conference

Postoperative pain management is an important part of perioperative care. A thorough knowledge of the mechanism of pain guides the understanding of effective postoperative analgesia. Discussion will include common alternative and traditional approaches to pain control. A review of new and commonly used modalities and pharmacologic interventions will be presented.

18

Pain Rehabilitation

by John Postier, Physical Therapist

Mayo Clinic, Rochester, Minnesota USA

When people have been dealing with pain in their body for 6 months or more, it can turn into a chronic problem and the traditional techniques used to help people deal with their pain (medication, surgery, heat, ice, electrical nerve stimulation, massage, chiropractor, etc.) many times are no longer effective. The Mayo Clinic in Rochester, Minnesota has a Pain Rehabilitation Center that is a comprehensive program that helps people deal with their chronic pain with the goal of rehabilition. In other words, it helps people move on with their life despite their pain. Many will say they have 'gotten their life back' due to this program. This discussion is given by a Physical Therapist who has worked in this program for 20 years, and will discuss the different aspects to pain rehabilitation, including how physical therapy can be beneficial in helping people cope with chronic pain.

Objectiv:

1. Define new ways of dealing with chronic pain patients

2. Identify how a comprehensive approach to pain enhances function

3. Discuss/introduce the Mayo Pain Rehabilitation Center approach to chronic pain

4. Discuss what a physical therapist has to offer chronic pain patients

Materials:

Mayo Clinic Pain Rehab Center educational materials and statistics

Results/Conclusion:

Chronic pain patients can be very challenging and at times clinicians feel like they run out of options. The Mayo comprehensive Pain Rehabilitation Program approach has been highly affective helping patients return to life activities despite their pain, and a high percentage report less pain upon completion of this program.

Reference:

Evidence-Based Scientific Data Documenting the Treatment and

19

Pain Rehabilitation

Cost-Effectiveness of Comprehensive Pain Programs for Chronic Nonmalignant Pain Robert J. Gatchel* and Akiko Okifuji† Journal of Pain, Vol 7, No 11, November, 2006

A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission Cynthia O. Townsend *, Jennifer L. Kerkvliet, Barbara K. Bruce, Jeffrey D.Rome W. Michael Hooten, Connie A. Luedtke, John E. Hodgson Mayo Clinic, Department of Psychiatry and Psychology, Pain Rehabilitation Center, Generose 2W, 1216 Second Street SW, Rochester, MN 55902, USA, Received 21 February 2008; received in revised form 22 July 2008; accepted 11 August 2008

20

First results from a new approach to the treatment of phantom limb pain

Apostol Vaso (Albania ) , Marshall Devor (Israel)

The idea: New and more effective treatment modalities can come from a deeper understanding of the neurophysiological processes underlying PLP, and particularly from knowledge of the source of the neural impulses that cause painObjectives: The key aim is to identify the source(s) of the pathological impulses responsible for phantom limb painMethods: The study include three phases: In phase 1 we will evaluate the effect of spinal block on phantom pain.In phase 2, of those who experienced pain relief in phase 1, the effect of foraminal blockwas been evaluated in the same way. Eliminating the Tinel sign will require foraminal block at several adjacent levels. Phantom pain relief in this phase will suggest that the origin of pain is in the DRG and/or distally to it (e.g. the neuroma).In phase 3, of those who experienced pain relief in phase 2, the effect of peripheral block (of the neuroma or the proximal nerve, with e.g. brachial plexus block) will be evaluated. again, elimination of the Tinel sign will be the indicator of adequate block. Phantom pain relief in this phase will suggest that the origin of pain is in the neuroma or peripheral nerve between the neuroma and the block. Conclusion: We havee treated 16 amputee patients according to protocol mentioned above and all this patients have been relived temporary from phantom sensation, phantom pain and neuroma pain, at least for the duration of anesthetic action after the perinervose administration of 1 cc liodcain 1% in the vertebral foraminal. All this patient that have responded poistively to adminoistration of lidocain are selected for pPF of the DGR for a longer period of time.

Key wordsPhantom limb pain Neural impuslesNeruoma Vertebral foraminaDorsal root ganglion Spinal foraminal block

21

Antinociceptive and preemptive effect of systemically

administered midazolam

Antigona Hasani, Sadik Llullaku, Marija Soljakova, Muharrem Jakupi, Hasime Terziqi, Adem Bytyqi

Background:

Preemptive analgesia suggests that the application of analgesic in prior to

proceeding of noxious stimuli prevent the sensibility of the central nervous

system which provokes the pain (1). Antinociceptive effects of systemically

administered midazolam have been reported (2,3). The aim of this study we are

to investigate antinociceptive and preemptive effects of systemically

administrated midazolam, before and after acute thermal induced pain, in rats.

Methods:

Sixty four male Sprague Dawley rats were included in the study. The rats are

divided in two groups; Group I, received ip midazolam at 0.1, 1, 5 or 10 mg/kg

(n=8 in each group, per dose), 10 min prior to nociceptive stimulus and Group

II, midazolam at 0.1, 1, 5 or 10 mg/kg (n=8 in each group, per dose) given ip, 10

min after the nociceptive stimulus. Paw movements in response to thermal

induced pain were measured during 60 minutes. Motor disturbances and

behavioural side effects were also recorded.

Results:

Preemptive analgesic effect was significant in small doses (0.1 and 1 mg/kg) of

systematically administrated midazolam, in relation with higher doses (5 and

10 mg/kg) (P<0.001 vs P>0.05, respectively). The ED was 1.84 mg/kg (CI, 50

1.02 – 3.54 mg/kg).

Motor disturbances and behavioural side effects were observed with doses

larger than 5 mg/kg.

Conclusion:

Midazolam applied systematically had antinociceptive effect. This effect was

22

Antinociceptive and preemptive effect of systemically

administered midazolam

observed often when midazolam was administrated before the thermal

induced pain.

1. Kissin I. Preemptive analgesia. Anesthesiology 2000; 93: 1138–43.

2. Nishiyama T. Analgesic effects of systemic midazolam: comparison

with intrathecal administration. Can Journ Anesth 2006;53:1004-

1009.

3. Chiba S, Nishiyama T, Yoshikava M et al. The antinociceptive effects

of midazolam on three different types of nociception in mice. J

Pharmacol Sci 2009; 109: 71-77.

Our results contain the preemptive analgesic effect of systematically

administrated midazolam.

References:

23

Celiac plexus block

Dr. Skender TelakuDepartment of Gastroenterology, CUCK, Prishtina

Celiac plexus neurolysis (CPN) refers to the permanent destruction of the celiac plexus using absolute ethanol while temporary block of the plexus with corticosteroids and long-acting local anesthetic injection is termed celiac plexus block (CPB).Pancreatic pain is predominantly controlled by the celiac plexus. The celiac plexus is situated retroperitoneally in the upper abdomen. It is at the level of the T12 and L1 vertebrae‚ anterior to the crura of the diagram. The celiac plexus is composed of the network of nerve fibers from both the sympathetic and the parasympathetic systems. It consists two large ganglia that receive sympathetic fibers from the three splanchnic nerves. The plexus also receives parasympathetic fibers from the vagus nerve. Autonomic nerves supplying to the liver, pancreas, gall bladder, stomach, spleen, kidneys, intestines, and adrenal glands, as well as blood vessels, arise in the celiac plexus.Neurolitic blocks of the celiac plexus have been used for malignant and chronic nonmalignant pain. CPN using surgical and transcutaneous approaches has been used for many years; however, major complications including paralysis occur in about 1 % of cases, which makes the endoscopic approach a potentially more attractive option.The endoscopic ultrasound technique involves first flushing a 22-gauge needle with normal saline to clear the needle of air followed by insertion of the needle 1 cm cranial and anterior to take off the celiac artery and aspiration to ensure no blood returns. For celiac plexus neurolysis (CPN), 10-20 mL of 0,25% bupivacain is injected followed by 20 mL of 98% absolute ethanol. For celiac plexus block (CPB), 20 mL of 0, 25% bupivacaine is injected followed by 80 mg of triamcinolone. An echogenic ”blush” is typically visualized during injection obscuring needle visibility which is why accurate needle placement pre-injection is critical. This is a safe technique without reported incidences of paralysis. Minor complications include transient diarrhea in 4% to 15%, transient increase in pain in 9%, and transient orthostasis in 1%. Normal saline 500-1000 cc is administered during the procedure and patients should be monitored for 2 hours post-procedure for orthostasis. Major complications include retroperitoneal bleed and peripancreatic abscess.Endoscopic ultrasound celiac plexus neurolysis (EUS-CPN ) in pancreatic cancer reduces pain scores in 78% of patients, which is similar to the results with surgical

24

Celiac plexus block

and transcutaneus neurolysis. The response rates and durability are lower for endoscopic ultrasound celiac plexus block (EUS-CPB) in chronic pancreatitis with 55% response rate at 8 weeks, which decreases at 10% at 24 weeks. Pain reduction lasts about 20 weeks following EUS-CPN in pancreatic cancer compared to 2 weeks for chronic pancreatitis with EUS-CPB.Recent development includes injection directly into the celiac ganglia. With this technique about half the patients experienced pain during or immediately following the procedure with attributed to the initial neural destruction of the ganglia. Long –lasting pain relief was reported in 92% of patients with this initial pain compared to 57% of those without pain. Improved pain relief was reported in 80% of patients with chronic pancreatitis who underwent alcohol injection compared to 38% of patients who received steroids.

25

Morbus Legg-Calve-Perthes in a patient with Sickle Cell Disease

1 2 2Caja T , Rapushi E , Vukatana BService of Hematology Q.S.U.T.Service of Rheumatology Q.S.U.T.

Morbus Legg-Calve-Perthes is the most common osteochondrytys in children between 3-12 years of age but it may acure in children over 12 years old and in some cases in adults.One of this cases is Sickle Cell Disease.Sickle Cell Disease is a genetic disorder that involve the normal production of hemoglobine as a result is producet an abnormal form of hemoglobin (HbS) which is unstable in its structure and cause the erythrocyte to sickle.This abnormal erythrocyte can cause vazzooclusive phenomenon wich is painful.This is known as a sickle cell acute painful crissis and can be precipitated by hypoxia,dehydration,acidosis,infection and fever.Morbus Legg-Calve-Perthes is caused from the reduction of the blood flow in the proximal epiphises of the femur this result in parcieal or total avaskulare necrosis of the femoral head.One of the chronic manifestation of Sickle Cell Disease is Morbus Perthes.The test that confirm the diagnosis when this phenomenon has occured are:X-ray of the pelvis AP,CT scan,MRI,Biopsy of the head of the femurus directed by arthroscopy.The biopsy shows trabeculare necrosis of the bone and bone marrow.MRI is the gold standart of the earlier diagnosis and evaluation of the osteonecrosis of the head of femur.MRI shows the changes in the head of femur before they shows in a X-ray or CT.Conclusion-In young adults the most common are the vassooclusive phenomenon. If this vassooclusive phenomenon occure in osteo-articulare zone and last more than two weeks than you have to do further examinations of this region.MRI is the most accurate test to diagnose the earlier stage of osteonecrosis.It also help to make the differential diagnosis of osteomielitis and osteonekrosis in Sickle Cell Disease.

26

The morphologic changes in neuropathic pain, advantages of the Use of the CT Scanner in the Interventional Procedures

Author(s):A. VASO, Dr. Arben MITRUSHI; Pirro PRIFTI

Institute(s):The Clinique “Galenus: Multidisciplinary Medical Centre for the treatment of the chronic pain and that of the cancer, Tirana, Albania

Introduction: The initation for this study was disabled female patient, 42 years old with undetermined neuropathic pain, since more than 9 years, started after the surgical intervention of laminectomy performed for a discal hernia at the level of the L5/S1 vertebrae.Objectives: Putting into evidence the update treating methods undertaking to a patient with neuropathic pain. Ectopic firing within the dorsal root ganglion (DRG) may play a particularly important role. Based on the above, it is possible that the DRG is a source of abnormal impulses neuropathic painMethods/Results: In the long history of the disease are included consecutively the update methods of the treatment of the neuropathic pain:1. In 2001 the patient performed the operation of the laminectomia at the level of the L5/S1 vertebrae, which resulted unsuccessful for the pain release.2. For 7 - 8 years has been treated by anti-inflammatory drugs and analgesics.3. In the 2008 the patient was presented at the Clinique “Galenus, a multidisciplinary Medical Centre for the treatment of the chronic pain in Tirana. After the first diagnostic evaluation, was done the epidural injection with interlaminated method at the level of the laminectomia.4. After that the patient followed a rehabilitating program not yet with satisfied impact.5. The re-installation of the pain was accompanied by trophic wounds, allodynia, and sudomotore changes. Further examinations suggested the diagnosis of the extensive fibrosis that included the intervenet used zone and epidural area, without concern on paravertebral sympathetic ganglion.6. Lastly a bilateral epidural injection and radiofrequency of the dorsal branch of the concerned spinal ganglion removed the symptoms. 7. This method was used in all neuropathic patients that are treated in our clinic,we have find morphologic changes in the area of the related DGR

27

The morphologic changes in neuropathic pain, advantages of the Use of the CT Scanner in the Interventional Procedures

Conclusions: The therapeutic methods against the neuropathic pain must be associated with periodic diagnostic procedures. The most significant ones are: epidural injections, sympathetic blocks, radiofrequency, rehabilitation.

28

Chest pain syndrome

Neset UzairiHealth Organization ,,EDIAL MEDIKA”_Tetovo/R.M.

Iintroduction: Cardiovascular diseases are in the first place in the statistics of the western countries as the cause of death. Coronary arteries diseases are the main cause of pain in chest known as angina pectoris, a clinical syndrome characterized by retrosternale pain tending to spreading toward the shoulders, left hand, lower jaw, neck and back, often with atypical simptomatology. In addition to aa coronary disease there are other cardiovascular factors such as diseases of aortas., mitrale valve prolaps, kardiomiopatites, pericards, embolia and pulmonal hypertension and other. As neuromuscular, digestive gastrointestinal, pleurites and anxious states . Ischemia of myocard happens because of the inability of coronary arteries to supply the heart muscle with blood and oxygen requirements because of the aa. coronary atherosclerosis that lead to their stenosis or occlusion of the or spasm of a coronary. According to Statistics for 2005 from cardiovascular disease have died 17.5 million, while 7.5 million for heart attack. The Republic of Macedonia is closer to European trends regarding morbidity and mortality of these diseasesAim:Aim of this paper is to present data concerning the appearance of morbidity and mortality of coronary syndrome and to bring a conservative view on the strategy and data along with invasive world authors in this areaMaterials and Methods: There were analyzed 64 patients with heart ischemic disease; 37 men and 27 women aged 25-78 years, the average age for women was 56.5 years and 54.9 years for men who were treated in the above-mentioned institution in Tetovo, clinical hospital and cardiology clinic in Skopje in the last five years. Based on methods used as objective history and examination, monitoring and screening for cardiovascular risk factors of arterial blood pressure, diabetes and hiperlipidemia, ECG with specific changes as omission of ST-T segment and negative T wave, dynamic ECG, coronary stress test Echocardiography, laboratory and enzymatic methods, AST, ALT,, LDH, CK and CK_MB, troponines, invasive methods such as selective coronagraph and myocardium koronarography with TL 201 that was done in the cardiology clinic in Skopje in the doubtful cases.

29

Chest pain syndrome

Results: Judging on this data anamnesis was positive for cardiovascular diseases and risk factors were present in the their overwhelming part. Objective data were scarce almost negative, rapid increase of arterial blood pressure and transitional extra systolic arrhythmia, ECG changes had specific S_T segment and negative T-wave. We found coronography stenotic changes 50-80% of na coronary 13 (20.3%) of cases with dominance of the LAD in 60% of cases, while other branches of RCA, CX-4, with LMCA with less attacks while in 2 (3.1%) cases corography was normal. Scintigrafia of myocardit was in positive correlation with selective coronography in detecting the ischemic disease at 9 (14%) of cases. Most attacked age for men 50-60 years and 60-70 years for females. Discussion and conclusion: Apart from elimination of risk factors mentioned as hypertension, diabetes hiperlipidemia, should look at tireoide glands, anaemia and aortas diseases. Drug therapy started with Nitrates, ASA, Beta blockaders, calcium antagonists, ACE inhibitors, diuretics, antitrombotiket and others. The invasive therapy consisted of , PTCA, stenting, myocard revascularizationJudging by the published data in European centers and in our country, there are two strategies in the treatment of these conditions: the early conservative strategy and early invasive strategy. At patients with elevations of ST segment intervening therapy is first. Patients at risk high, increased enzyme, rhythm disorders, ST segment dispersion to be treated 48-72 hours invasively because of the hemodynamic instability. Despite continuous screening these diseases and risk factors of these diseases are increasing. Litherature:

1) M .Weber.C .Hamm:Myokardinfarkt und instable angina pectoris; Der Internist :Band 48 .Heft 4,april 2007:399-409

2) C.W.Hamm :Akutes koronarsyndrom (ACS);Zeitschrift fur Kardiologioe,Band 93 ,Heft 1(2004)..steinkopf verlag 2004 .

3) U .Sechtem :Therapie der stabilen Angina Pectoris:Der internist Band 49 .Heft 1.januar 2008, pg: 57-68

30

Epidural analgesia for labor and delivery

F. Sada, A. Gecaj-Gashi, M. Hashimi, B. Bruqi, N. Baftiu

University Clinical Center of Kosova, Kosova

Introduction

For most women labor causes severe pain, similar in degree to that caused by complex regional pain syndromes or the amputation of a finger. The maternal stress response can lead to increased release of corticotropin, cortisol, norepinephrine, β-endorphins, and epinephrine.

Clinical Evidence

Randomized, controlled trials of the effects of analgesia administered during labor are difficult to conduct. In a study, a meta-analysis involving 2703 nulliparous women enrolled in five trials conducted at a single institution, the participants had been randomly assigned to either epidural analgesia or intravenous administration of meperidine. On the basis of a visual-analogue pain. scale ranging from 0 to 10 (with 10 representing the worst pain), both the epidural and meperidine groups had a mean preanalgesia score of 9. The mean score fell to 2 in the epidural group and 4 in the meperidine group (P<0.001) during the first stage of labor and rose to 3 and 5, respectively (P<0.001), during the second stage of labor.

Adverse Effects

A Cochrane review of 20 trials involving a total of 6534 women estimated that the relative risk of cesarean delivery with epidural analgesia as compared with other methods or with no analgesia was 1.07 (95% confidence interval, 0.93 to 1.23). Epidural analgesia does increase the duration of the second stage of labor by 15 to 30 minutes and may increase the rate of instrument-assisted vaginal deliveries as well as that of oxytocin administration. 1.37 million women receiving epidural analgesia during labor showed that the risks of epidural hematoma and epidural abscess were 1 case per 168,000 women and 1 per 145,000, respectively; risk of persistent neurologic injury was 1 case per 240,000 women, and the risk of transient neurologic injury was 1 per 6700.40

Two areas of uncertainty related to epidural analgesia are its associations with maternal fever and reduced success in breast-feeding.

31

Epidural analgesia for labor and delivery

Our experience

For a period of 16 month in General Hospital “LINDJA” 26 women received epidural analgesia for labor and delivery. Neither one of these cases has undergone C section nor there a need for the use of vacuum extractor or forceps for delivery. No side effects of epidural analgesia have been recorded in these cases.

Conclusions

In 2002, the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists issued a joint statement indicating that a woman's request for pain relief is sufficient medical indication for its use. Our opinion is that epidural analgesia is a safe, widely used, effective mean of pain relief during labor.

1. Melzack R.The myth of painless childbirth (the John J. Bonica lecture). Pain 1984;19:321-37.

2. ACOG committee opinion #295: pain relief during labor. Obstet Gynecol 2004; 104:213.

3. Eidelman AI, Hoffmann NW, Kaitz M. Cognitive deficits in women after childbirth. Obstet Gynecol 1993;81:764-7.

4. Capogna G, Camorcia M, Stirparo S. Expectant fathers' experience during labor with or without epidural analgesia. Int J Obstet Anesth 2007;16:110-5.

5. Shnider SM, Wright RG, Levinson G, et al. Uterine blood flow and plasma norepinephrine changes during maternal stress in the pregnant ewe. Anesthesiology 1979;50:524-7.

6. Abboud TK, Sarkis F, Hung TT, et al. Effects of epidural anesthesia during labor on maternal plasma beta-endorphin levels. Anesthesiology 1983;59:1-5.

7. Jouppila P, Jouppila R, Hollmen A, Koivula A. Lumbar epidural analgesia to improve intervillous blood flow during labor in severe preeclampsia. Obstet Gynecol 1982;59:158-61.

8. Ramin SM, Gambling DR, Lucas MJ, Sharma SK, Sidawi JE, Leveno KJ. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 1995;86:783-9.

References

32

Dental Pain in Childhood and Its Consequences

Authors: J. Çaushi; E. Shanaj ; V. StathiDental Clinic" New Smile", Tiranë, Shqipërijcaushi@hotmail.com

EntryOur study will discuss the negative effects and adverse relationships found in children before, while, and after they are treated for dental decay accompanied with pain in a dental clinic where the treatment was inadequate and inaccurate.PurposeOur goal is the study of all factors affecting the positive or negative perceptions of pain-at-the-dentist. How do children view tooth-aches and pain? How do they measure the intensity of pain? In our analysis we will attempt to compare the differences found in the standards used by the American Academy of Pediatric Dentistry (AAPD) and the practices in the Albanian pediatric dentistry.Research MethodsThe materials used for this study will include an individual questionnaire from adults who will describe experiences from childhood related to a dental clinic and outside sources and studies pertaining to our theme. Special attention will be devoted to the percentage of interviewed individuals with a positive or negative perception toward childhood tooth-aches and experiencesResultsOur interviewed pool of individuals included 1000 patients, of which half lived in the city of Tirana and the other half in Durrës. Our initial findings showed that the larger group had experienced tooth-aches and pain as difficult moments to have overcome and that in some cases this experience had been aided by careless dentists or their office personnel.ConclusionThe negative effects experienced by the young patients brought as a result irregular dentist's visit when adults and more serious tooth-aches from advanced decay.References: ADA, Pediatric Dentistry, Pinkham, Casamassimo, Fields, McTigue, Nowak.

33

Spinal Anesthesia in children with congenital muscolar dystrophy risk or advantage

Sh. Rexha, District Hospital, Gjakove, Kosovo

BackgroundAnesthesia is a curious blind spot in the perception of many people. Many people seem to just look at anesthesia as a loss of sensation necessary for undergoing an operation. In general, for a visiting anesthesiologist, the time allowed for explaining anesthesia for patients is limited. I performed a questionnaire survey by anesthesia information sheet and evaluated the medical staff's knowledge about the anesthesiology in general.Material and methods The questionnaire comprised 18 questions. 91 people, mainly medical staff, were a part of survey. All of them reported understanding the purpose of the survey for which they were consent to participate. The questionnaire was designed to fulfill the investigation purpose. Data collected have been used to prepare the relevant indicators (also shown in charts). The questionnaire was given to survey administers that ensured high response rate from respondents and were able to give clarification to them in case of need.

ResultsI found the undertaken survey to provide reliable information on knowledge of medical staff about anesthesiology. The survey results helped me to assess the required information so, in future, we could, contribute to improving the general anesthesiology information management system. ConclusionsThe anesthesia information sheet should be developed to explain the anesthesia risks and complications useful to make the patient understand anesthesia. It is important for patient visiting anesthesiologist himself before the operation, which allows building a mutual trust between the patient and the anesthesiologist.

34

BIRADS classification of breast diseases in Radiologic Therapeutic Center ProDiagnostic XS - Prizren.

Dr.Sylejman Krasniqi, Dr.Xhemal Nazifi, Dr.Frederik Çuperjani, Dr.Arta Zhuri, Fisun Rekathati,ass. rad.Radiologic Therapeutic Center “ProDiagnostic XS” – Prizren

Introduction: BIRADS - Breast Imaging Reporting and Data System ® is a system developed by the ACR (American College of Radiology) on standardization of terminology used in reporting of breast disease with imaging methods: mammography, ultrasound and MRI mammography. Founded in 1992 BIRADS is a good initiative for better and quality diagnosis of breast diseases, clear communication between doctors dealing with diagnostic (radiologist) and clinicians that heals the same. Objective: BIRADS prove the value of the detection and classification as early the diagnosis of breast tumors and its importance in predicting the potential malignity and further patient management. Material and methods: In retrospective analysis were included 167 patients examined at 3 month's period from 01/01/2010 to 03/30/2010. Mammography examinations were made with mammography machine "Siemens Mamomat 300”, breast ultrasound with " Siemens G60s "," Aloka 5000 "and biopsies were done with Bard Magnum biopsy set. Results: Data were analyzed from examination of 167 patients and they all were female. The youngest patient was 27 years old and the oldest 78 years old. According to the age group the majority has met aged 40-49 years of age and there were 60 cases (36%), while the smallest number was from age group 20-29 years of age a total of 10 cases (6%). According to BIRADS classification in BIRADS II were 53 cases (32%), BIRADS III - 99 cases (59%) and BIRADS IV - 15 cases (9%). In seven cases biopsy was done and at five of them it was detected breast carcinoma. Conclusion: BIRADS classification helps in standardization of terms that are used for characterization and reporting of breast lesions with even more successful treatment of patients. Use of BIRADS reporting will determine the importance of imaging methods for more efficient and accurate diagnosis of

35

BIRADS classification of breast diseases in Radiologic Therapeutic Center ProDiagnostic XS - Prizren

breast cancer. It is required a draft for breast disease screening program and its implementation as soon as possible.

Keywords: BIRADS, mammography, breast tumors.

36

Nurses opinions and attitudes about pain and pain relief in post-opertive patient

Author: B.Kryeziu-RN&Xh.Ramadani-RN

The presence of pain is one of the main reasons why patients seek health care. Remind yourelf that every person has right to an appropriate assessment and effective pain management. Presence of pain decreases autonomy, the enjoinment and the quality of life and increases psychological and physical suffering of a person.The key components of effective pain management are nurses' knowledge and the appropriate attitudes towards the pain. The treatment of post-operative pain is a problem that was used to be neglected too often. The main goal of the post-operative pain assessment is the recovery of the patient as soon as possible and its release from the hospital.,, The reason for ineffectiveness in management of post operative pain is a complex one. It can be health care system, health care providers and patients and their families. ( Alfhild at all-2005)The barriers to effective post-operative pain management are such insufficient of knowledge about pain, lack of assessment and evaluation of pain. (Manis at all-2005)Best known definition of pain is ,, pain is whatever the patient says it is, and exists whatever the patients says it does;; (McCaffery at all-2002)Objective: This study aims to elicit nurses' knowledge and attitudes towards post-operative pain management in intensive care units and in post operative wards.Methodology: For the purpose of this study has been used the quantitative approach. For the data collection was used the structured questionnaire using 4 and 5 Likerts scale). The questionnaire is composed from 5 main questions and 50 items with closed ended questions.Population: 25 respondentsSetting: secondary care hospitalResults: The nurses showed moderate knowledge in understanding the pain. Less than the half 11(49%) possess sufficient knowledge about the pain. 20(85%) are motivated with regards to the pain relief for the patients. However pharmacological knowledge continues to be unsatisfactory, only 34% of the

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Nurses opinions and attitudes about pain and pain relief in post-opertive patient

respondents are aware about side effects of the opoids. More than n-18 (78%) of the respondents believe that their colleagues communicate with patients, and ask them for their pain, its intensity and about the manner it appears. Only n-6 (24%) trust the patients that they possess pain whenever they say so, they do advise them to afford the pain and do not ignore them by mistrust. About n-14 (62%) believe that their colleagues always care for their patients' comfort. Around n-13 (57%) believe that their colleagues always assess and manage the while ensuring that they are comfortable and that they get the therapy. Conclusion and recommendation: The findings suggested emphases on pain management education as crucial for nursing to ensure adequate knowledge in pain assessment in order to achieve optimum comfort for post-operative patients. An effective interpersonal communication with patients and their families is needed. Pain management should be included in the nursing curriculum as well as the courses for the nurses in the wards. Acknowledgement to: Dr.Halil Basha anesthesiologist and to my colleagues for their contribution to the success of this study.

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Mechanisms of pain and treating chronic pain

Dr Mehdi Shehu, neurologist in Department of Neurology, Regional Hospital „Prim.Dr.Daut Mustafa” Prizren

It is estimated that over one-third of the world's population suffers from persistent or recurrent pain, while in routine medical practice treatment for primary pain fails to achieve adequate relief in at least 40 % of patients. Because many pains persist after an insult is healed, the ongoing pain rather than the injury underlies the patients disability. Untreated pain may become self-perpetuating because pain has immunosuppressive effects that leave patients susceptible to subsequent diseases. Chronic pain is associated with conditions such as back injury, migraine headaches, arthritis, herpes zoster, diabetic neuropathy, temporomandibular joint syndrome and cancer. It results not just from the physical insult but also from a combination of physical, emotional, psychological and social abnormalities. It is now clear that if we can effectively treat the pain despite the underlying cause, it will be possible for patients to regain normal functioning. The key to more successful pain treatment is to understand the mechanisms that generate and maintain chronic pain, pain management with targeting the type of the pain when possible, and knowing the importance of multimodal approach in treatment and managing pain.

Literature:1. International Association for the Study of Pain (IASP Pain

Terminology – homepage on the internet)2. Melzack R, Wall PD. Pain mechanisms: a new theory.

Science 1965 Nov 19; 150(3699):971-93. American Academy of Pain Medicine, American Pain Society. The use of opioids for the treatment of chronic pain: a consensus statement from the American Academy of Pain Medicine and the American Pain Society (Monograph on the internet)4. Cheryl L.S, Michael S.G, Xu Z. Mechanisms of pain

PNAS 2001 Oct 9; 98(21); 11845-11846

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Nursing care of children with pain

Agron Bytyqi - BN, Ramiz Bytyqi - BN, Afrim Avdaj – MD, MrSciRegional Hospital „Prim.Dr.Daut Mustafa” Prizren

Although relief of pain is a basic to every people, treatment is under-appreciated problem in almost all over the world. A large number of children suffer from acute or chronic pain but its intensity and quality we can't determine with complete accuracy, but we can only make a rough assessment of pain on the basis of objective and subjective data. Children also may experience pain from much of the procedure and research conducted by doctors and/or nurses during the examination and treatment of their disease, so they remember the pain, and can leave to future medical care because of painful experiences in the hospital or clinic. Untreated pain experienced in early life can have profound, long-term and sustainable effects in social and physical development, which can cause permanent changes in the nervous system.

Purpose:Identifying the knowledge of nurses to assess and manage pain in children, identification of knowledge for children and families for self-care and compiling the protocol for pain management.

Material and methods: Case study

Results and conclusions:In the Prizren Hospital there isn't a special unit for treating children's pain, but there where children are treated, the status of pain measured by health professionals though subjective data but not from those objective. Regarding to the treating of pain, nurses intervene by giving medicines which are described in the therapy list while they don't implement any another technique for relieving or easing the pain. The education of health professionals (nurses) regarding techniques of evaluation and management of pain which are unique at infants and children is needed and should be a priority for all healthcare professionals.

Recommendations:To put in order the use of nursing care plan for each patient with an administrative

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Nursing care of children with pain

order from MoH, to become professional continuing education of nursing staff, to compile the protocol for the treatment of pain including specifics on children.Health officials should initiate programs to ensure that medicines and needed resources for pharmacological management are possible and that pain is assessed, prevented and treated.

References:Carter B (1994). Child and Infant Pain. Principles of Nursing Care and Managemen.Gaukroger P (1993). Patient Controlled Analgesia in Children in Pain in Infants, Children and Adolescents. Edited by Schecter, Yaster & Berde.Macintyre P & Ready L (1996). Acute Pain Management A practical Guide. Saunders Company Ltd. London.Schecter N, Yaster M, Berde C (1993). Pain in Infants, Children and Adolescents. Williams & Wilkins. U.S.A.Finley, GA and McGrath, PJ (eds). Measurement of Pain in Infants and Children. Progress in Pain Research and Management, vol 10. IASP Press (1998)Children's Pain Matters!, International Association for the Study of Pain, Updated 21 Sep 2009, web access: H. Jaze “Pediatria Infermierore”, 2005, Vlorë Persis Mary Hamilton, R.N.,Ed.D. Former Assistant Professor Napa Valley College, Napa, California. Basic Pediatric Nursing. Sixth edition 1991.M. Qatipi. Neonatologjia, 2002 Tiranë.

http://childpain.org/

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Epidural analgesia

An-Rean:G. Hyska; Obs.-gyn.:S. Cenameri; An.-Rean.: E.Belaj; Obs.-Gyn.: A.Dokle; Head of Infermieristic Department V.Mulliqi; Cheaf Midwife:V.Grori

University Hospital of Obstetric and Gynecology “Koço Gliozheni” Tirana Department of Obs-Gyn. Faculty of Medicine. University of Tirana.

Analgesia is now recognized as a significant contributor to clinical outcomes.

The goal for pain management is to provide the best analgesia with the least amount of side effects. Epidural analgesia is a desirable method of pain relief because it provides true segmental analgesia with little or no contribution from systemic levels of opioids. All of which may lead to excellent analgesia with minimal side effects.

Caring for patients who receive epidural analgesia requires specialized knowledge regarding the placement of the epidural catheter, management of the therapy, and monitoring for potential side effects/complications.

Rreferences:

1. Macintrye, P.E. & Ready,L.B. (1996). Acute pain: significance and assessment. In P.E. Macintrye & L.B. Ready, Acute Pain Management A Practical Guide (pp.1-12). London: W.B.Saunders.

2. VadeBoncouer, T.R. & Ferrante, F.M. (1993). Epidural and subarachnoid opioids. In F.M. Ferrante & T.R. VadeBoncouer (Eds.), Post-operative Pain Management (pp.279-303). New York: Churchill Livingstone.

3. Grichnik, K. & Ginsberg, B. (1992). Epidural analgesic for patients recovering from surgery. In R. Sinatra, A. Hord, B.Ginsberg, & L. Preble (Eds.), Acute Pain Mechanism and Management (pp.243-252). St. Louis: Mosby-Year Book.

4. Pasero C. (1998). Epidural Analgesia For Acute Pain Management. American Society of Pain Management Nurses self directed learning program. ASPMN, Pensacola, FL.

5. Pasero C., & McCaffery M. (1999). Providing epidural analgesia: how to maintain a delicate balance. Nursing, August, 34-40.

6. Naber, L., Jones, G., & Halm, M. (1994). Epidural analgesia for effective pain control. Critical Care Nurse, October, 69-83.

7. Liu S., Carpenter R.L., & Neal J.M. (1995). Epidural anesthesia and analgesia: their role in postoperative outcome.Anesthesiology, 82(6) 1474-1506.

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Palliative care – Centre for palliative care (hospis) - Standardization of palliative care

Mujačić S. Zildžić M.Department for organisation and quality within the Public Health Institution University Clinical Centre Tuzla

Palliative care is a care for patients with active, PH or operative diagnosed, progressive and developed disease, with rather short anticipated age of living, focusing on improvement of the quality of living, relief and prevention of suffering. The key role is management of pain, adequate health care, inclusion of family into health processes and care for patient in terminal phase, as well as several other sociological, psychological and spiritual needs.

Objectives of palliative care are: To ensure relief of pain and other physical symptoms To improve the quality of living to the maximum, without

speeding up or delaying the anticipated death To provide psycho-social and spiritual careTo provide assistance in order to help the patient during the flow

of the disease

Many of crucial aspects of palliative care apply to curative medicine as well; on the other hand, development of palliative care could influence other types of health care, focusing on some of the potential elements, such as spiritual problems.

Palliative care should not be observed as essentially different in relation to other types and fields of health care. Such crucial differences could impede the integration of palliative care in regular career, or even prevent it entirely.Standardised palliative care fulfils the objectives and needs of staff, patients, family and care provider.

Key words: Palliative care, Standardization

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Palliative medicine – A need for overall education

Zildžić M., Mujačić S.Department for organisation and quality within the Public Health Institution University Clinical Centre Tuzla BIH

World Health Organisation (WHO) defines palliative medicine as active and complete care for patient, in times when the disease of patient may not be cured and when the main priority is control of pain or other symptoms, as well as resolution of psychological, social and spiritual problems.

Overall goal of palliative medicine is achievement of the highest possible quality of life for patient and his/her family. To achieve this goal, it is necessary to have well educated health professionals.

According to recommendations of the European Association for Palliative Care (EAPC), palliative medicine should be mandatory and integral part of the curriculum at all faculties of medicine, including final exam in the end of studies.

Palliative medicine should be integrated in specialist and other educational programmes for doctors, medical nurses of family medicine, as well as in programmes of other specializations, including multidisciplinary approach.

Due to enormous clinical and social importance as well as specific approaches and treatment of patients, palliative medicine is a special clinical and academic discipline.

To respond to the defined goals, education in palliative medicine should enable health professionals to gain the appropriate knowledge, skills and competencies through programmes and practical courses during the bachelor studies, specialization and postgraduate studies, as well as a continuous medical education within the associations of doctors and nurses.

In the University Clinical Centre Tuzla, strategic plan for education on palliative medicine has been made at all levels, including the establishment of Hospis, as educational basis for practical training including practicing of palliative medicine as special and equal clinical and academic discipline.

Key words: Palliative medicine, education

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Bone pain as first clinical signe in myeloma patients and psychological affects

T. Nakuci – Caja, J. Caja, E. Rapushi Pal Xhumari the chef of Hematology ServiceUniversity Hospital Center “Mother Tereza” Tirana-Albania Introducion: Bone pain is a frequent sourse of morbidity in patients with Multiple Myeloma. It is known that malignant plasma cells express brain-derived neurotrophic factor (BDNF) and a neurotrophin causes hyperalgia by potentiating the activity of nociceptive neurons. Aim: The aim of the study was to evaluate skeletal pain as first signe in patients with Multiple Myeloma. Material and methods: 40 patients ( 25 males and 15 females) with a mean age 57.43 years with Multiple Myeloma were studied prospectively during 7-years study. Results: 32 patients (80%) resulted with pain at first presentation: scale 0-without pain 8 (20%) patients, scale 1-mild pain no patients, scale 2-middle pain 24 (60%) patients, scale 3-severe pain 8(20%). By localization pain was fond in only a region 11 cases (27.5%), pain in two regions 9 cases(22.5%), pain in three regions 12 cases (30%). 4 patients were followed for reumatological disease, 2 cases for neurological disease and 6 patients followed for specific disease till at their first presentation at our clinic. After three cuorses of chemotherapy the pain was overed in 15 patients, and it was lower in 13 cases. The pain remained same in two patients of stage III of disease. In all cases with osteolytic lesions we used bisphosphonates. In two cases we used local iradiation therapy. Conclusions: The study confirms that bone pain was first clinical signe in 80% of patients with Multiple Myeloma. The patients are consulted in advanced stages of disease ( twenty patients were stage III myeloma at first presentation at clinic of Hematology). Early intervetion with bisphosphonates may play important role in improving outcomes in multiple myeloma patients.It will be explained also that this patients are affected with psychological problems and most of them are pessimists and have negative thoughts that derives in different forms of depression.

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Controlling Pain After Total Hip and Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections

Ervin Priftaj M.D., Albana Daka M.D.,Kenan Bayrakci Ass. Proff., Onder M. Delialioglu M.D.

Improvements in pain management techniques in the last decade have had a major impact on the practice of total hip and knee arthroplasty (THA and TKA).Although there are a number of treatment options for postoperative pain, a gold standard has not been established. However, there appears to be a shift towards multimodal approaches using regional anesthesia to minimize narcotic consumption and to avoid narcotic-related side effects. Over the last 10 years, there are used intra-venous patient-controlled analgesia (PCA), femoral nerve block (FNB), and continuous epidural infusions for 24 and 48 hours with and without FNB. Unfortunately, all of these techniques had shortcomings, not the least of which was suboptimal pain control and unwanted side effects. Multimodal protocols after THA and TKA have been a substantial advance; they provide better pain control and patient satisfaction, lower overall narcotic consumption, reduce hospital stay, and improve function while minimizingcomplications. Although no pain protocol is ideal, it is clear that patients should have optimum pain control after TKA and THA for enhanced satisfaction and function. Rehabilitation after THA and TKA is tied directly to pain and comfort levels. Earlier mobilization, ambulation, and earlier return of normal gait are associated with moreoptimal pain control . In addition, arthrofibrosis and diminished postoperative range of motion are closely related to postoperative pain and related joint splinting and immobilization . Patient perceptions of surgical success are closely matched to residual pain, functional limitations, and speed of recovery

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Dhimbja ne neuropatine diabetike periferike

Dr. Yllka Themeli

Diabeti mellitus eshte nje semundje kronike, pergjate ecurise se te cilit zhvillohen nje sere nderlikimesh kronike. Nje nga ato eshte neuropatia diabetike, e cila perfaqeson nje grup crregullimesh, qe shfaqen si pasoje e demtimit te sistemit nervor qendror dhe atij periferik nga hiperglicemia kronike. Neuropatia periferike konsiderohet me natyre diabetike nese jane te pranishme simptomat dhe/ose shenjat e disfunksionit nervor periferik ne subjekte me paciente diabetike,pasi jane perjashtuar shkaqe te tjera te mundshme.

Dhimbja eshte nje nga simptomat kryesore te neuropatise diabetike periferike, me nje ndikim shume te madh ne cilesine e jetes se pacienteve diabetike, duke dhene efekte direkte negative mbi gjumin, humorin, levizshmerine, aftesine per te punuar, marredheniet interpersonale, vetevleresimin etj. Neuropatia diabetike prek 50 perqind te diabetikeve pas 25 vjetesh diagnostikimi, ndersa dhimbja shfaqet ne 1/3 e pacienteve diabetike ne pergjithesi dhe 40-50% te diabetikeve me neuropati diabetike. Faktori kryesor qe percakton shfaqjen e dhimbjes gjate ecurise se neuropatise diabetike periferike, si dhe gravitetin e saj, eshte niveli i glicemise. Megjithate, nga studimet e fundit ka rezultuar se edhe ne rastet kur glicemia eshte mbajtur ne vlerat normale, mbi 20% e rasteve zhvillojne neuropati periferike te dhimbshme. Faktore te tjere te rendesishem qe ndikojne ne shfaqjen ose jo te dhimbjes ne pacientet diabetike me neuropati periferike jane edhe faktori gjenetik, prania e inflamacionit, si dhe faktori metabolik ne pergjithesi.

Simptomat kryesore te neuropatise periferike diabetike te dhimbshme jane ndjenja e nxehtesise, krampet muskulare, dhimbja e forte, pragu i ulet i dhimbjes, ndjesia e cpimit te gjilperes, mpirje e anesive te poshtme etj. Nga keto, simptoma sinjifikative per dhimbjen neuropatike jane mpirja, ndjesia e cpimit te gjilperes dhe pragu I ulet I dhimbjes.Neuropatia diabetike periferike klasifikohet ne tipin sensor akut,I cili konsiston ne nje discomfort te lehte te rikthyeshem nen nje kontrroll te mire te glicemise,dhe ne tipin sensomotor kronik,qe eshte nje stad me I avancuar ne te cilin shfaqet dhimbja,qe e ben me

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Dhimbja ne neuropatine diabetike periferike

rezistent ndaj mjekimit.Opsionet e trajtimit te dhimbjes ne neuropatine diabetike

periferike konsistojne ne parandalimin ose nderprerjen e humbjes progresive te funksionit nervor si dhe lehtesimin e simptomave me efekte anesore sa me minimale. Ne kete kuader perdoren disa klasa medikamentesh, si antidepresantet triciklike, antikonvulsantet, analgjeziket opioide, antiarritmiket, antgonistet e receptoreve te NMDA si dhe menyra te tjera mjekimi te karakterit lokal me izosorbit dinitrate, capsaicin, acupunctura, stimulimi nervor percutan, fusha magnetike statike, deri tek dekompresioni kirurgjikal ne rastet me simtomatologji te avancuar. Per t'u theksuar eshte roli I acidit alfa lipoik, si nje mjet terapeutik me rol te dyfishte, me efekt te fuqishem si mbi simptomatologjine e neuropatise, ashtu edhe ne lidhje me modifikimin e historise natyrale te saj.

Konkluzione: Neuropatia periferike diabetike e dhimbshme eshte nje nderlikim kronik i shpeshte i DM, ne shume raste mjaft i veshtire per tu menaxhuar. Shenjat dhe simptomat e saj jane evidentuar edhe ne pacientet e sapodiagnostikuar me DM, madje edhe ne stadin e tolerances se demtuar te glukozes. Gjithashtu prania e ketij nderlikimi ka pasoja serioze si ne cilesine e jetes se pacienteve diabetike, ashtu edhe ne koston e menaxhimit te tyre,pasi keto subjekte kane rrisk te larte per te zhvilluar tipe te tjera te neuropative,perfshire polineuropatine demielinizuese inflamatore kronike,deficiencen e vit.B12,hypotireozen dhe uremine. Keto jane argumente me se te mjaftueshme,qe e bejne edhe me te rendesishem diagnostikimin e hershem dhe mjekimin adekuat te saj, ne menyre qe te rritet jetegjatesia e pacienteve diabetike dhe te permiresohet cilesia e jetes se tyre.

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Dhimbja dhe impakti i saj ne trajtimin e Patologjive Reumatizmale

Dr.Ergeta KTONA

Dhimbja eshte nje nga te dhenat klinike me te shpeshta dhe pergjithesisht e para ne patologjite reumatizmale. Pavaresisht karakterit te saj akut ose kronik, degjenerative ose inflamatore ajo prish ne menyre te jashtezakoneshme cilesine e jetes. Dhimbja reumatizmale si nje nocion fizik, organik dhe psikologjik varet jo vetem nga lloji i patologjise qe e shkakton ate por dhe nga niveli socio intelektual i pacientit . Vete organizmi mundohet permes prodhimit te substancave endorfinike (morfin- like) te moduloje dhimbjen, por kur mekanizmat fiziologjik jane te pamjaftueshem atehere nderhyrja farmakologjike dhe jo farmakologjike eshte fondamentale. Nje nder patologjite reumatizmale me te shpeshta e cila prek me shume se 1% te popullsise se gjithe botes dhe qe karakterizohet nga dhimbje shume te forta eshte Artriti Reumatoid.Qe ne stadet e para te kesaj patologjie nevojitet nje plan i detajuar per trajtimin e dhimbjes. Te dhenat me recente te skemave te trajtimit referojne se tek nje pacient mund te perdoren dhe me shume se nje skeme mjekimi deri ne gjetjen e terapise me efikase e varur kjo dhe nga karakteristikat individuale te organizmit per te reaguar ndaj nje lloj terapie te caktuar. Njohja e mekanizmave fizpatologjik te krijimit te patologjive inflamatore si (aktivizimi i TNF, TGF ,rritja e IL1 dhe IL10, rritja e apoptozes se qelizave inflamatore, aktivizimi i makrofageve etj) e ka bere me te sukseseshme trajtimin e tyre duke nderhyre pikerisht ne keto mekanizma . Skemat e kombinuara me preparate inhibuese te dukurive te mesiperme me ane te skemave me preparate tipike” pain killer”si analgjeziket , AINS steroide dhe josteroide, COX1 dhe COX2, tricikliket etj jep rezultate te shkelqyera ne menaxhimin e patologjise ne pergjithesi dhe te dhimbjes ne menyre te vecante dhe duke cuar keshtu sigurisht ne permiresim te dukshem te cilesise se jetes. Pikerisht synimi i referatit do te jete sjellja ne vemendje e skemave me bashkekohore te trajtimeve te kombinuara per menaxhimin e dhimbjes, sigurisht pa synuar qe te ezaurohet gjithcka, por duke u munduar te sjellim sado pak nga informacionet e fundit shkencore ne dobi te pacienteve.

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Rastet me interesante me dhembje akute

Sadri Hulaj , Kujtim Kryeziu , Naser Krasniqi Spitali regjional ,, Prim Dr Daut Mustafa ,, - Prizren

Hyrja:Trajtimi i dhembjeve ne menyre institucionale behet me me sukses ne institucionet adekuate. Qytetaret e semure me patologji te llojellojshme kerkojn ndihme ne institucionet ku kane besim dhe ne institucionet me te aferta. Qendrat Emergjente ne baze te te dhenave statistikore paraqesin vendin me te pershtatshem per nje trajtim te tille.Qëllimi: i punimit eshte te prezentoj rastet me interesante te patologjive te percjella me dhembje e te trejtuara nga ekipet e Emergjences.

Materiali dhe metodat:Materialet jane analizuar ne menyre retrospektive nga te dhenat e librit te Emergjences, te dhenat nga raportet mjekesore dhe materialet didaktike te fotografuara nga personeli I emergjences. Jane

analizuar rastet patologjike qe shkaktojn dhembje nga trauma ,nga

dhembjet viscerale akute ne periudhen e I-re 6 mujore te vitit 2009 te Emergjences se re.

Rezultatet: Jane analizuar raste te llojellojshme te pacienteve qe kane kerkuar ndihme mjekesore per shkaqe te crregullimeve shendetesore dhe te dhembjes

si simptom shoqerues i semundjeve . Nga keto materiale del etilologjia multifaktoriele e patologjive qe shkaktojn dhembje si dhe therapioni i llojellojshem qe eshte dhene nga ekipet mjekesore .Nga 11 953 te semure

e te lenduar qe jane paraqitur ne Q.E. afer 3752 pacient kan pasur dhembje

nga traumat e ndryshme , 2588 pacient qe kan pasur dhembje abdominale , 1346 me dhembje te gjoksit , 486 me dhembje te kokes , 484 dhembjet renale e tj .

Konkluzion: Ne baze te materialeve tona te punes ne Qendren Emergjente konkludojm se dhembja si simptom eshte e ne shumicen e rasteve te trajtuara ne Emergjence mbi 70 % te rasteve ose ne 8456 raste .Jane prezentuar rastet e llojlojshme te cilat perfshine te gjitha sistemet dhe organet e trupit te njeriut dhe jane prezentuar ne menyre figurative .Barnat me te perdorur kan qene Anestetiket dhe Antireumatiket josteroid dhe spazmolitiket ndersa me pak jane perdorur analgjetiket dhe Opijatet .

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The rare case of the great extrarenalis pelvis stone(Case presentation)

Dr.Agim Hazrolli, Dr.Selman Muçaj, Dr.Elvane Maloku, Dr.Bashkim ThaqiDr.Fatos Shukriu, Dr.Afrim RrustemiDepartment of Urology – Regional Hospital "Prim.Dr.Daut Mustafa" Prizren.

Introduction:Stones in urinary tract represent one of the most common pathologies in urology. They encounter various segments of the urinary tract. But their appearance in the pelvis extrarenalis anomaly is rare and not common.

Objective:Demonstrating the localization of such a size stone not common in our modest practice is something extremely rare.

Material and methods: Male patient, 54 years of age, professional driver, comes to the hospital because of chest pains. It CT of thorax and upper abdomen were accidentally discovered great stone on right kidney. Stone was of size 10 X 7 cm. placed in the extrarenal pelvis of right kidney. Then patient is admitted to Urology ward, indications for surgical intervention was bring out after preoperative preparation.

Results:The patient were operated with the right approach lumbotomy. Extrarenal pielon of right kidney were opened, it was very dilatated and warped. After extraction of concrement it was done complete resection of kidney pyelon and plastic surgery according to the author Anderson / Enter. During operation is applied ureteral stent “Double J. Patient feel god through surgery and after surgery. He was freely send home on the VI-th day, in localy good shape and nice generally health conditions..

Conclusion:Since Kosovo is a region of endemic urinary calculosis is useful to think for regular examinations of the urinary tract especially in patients belonging to risk group and that examinations has to be done in systematic way.

KEYWORDS: renal stone, pelvis extrarenalis,

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