Acute kidney injury (AKI) is a frequent and severe complication in trauma patients, affecting up to 28% of intensive care unit (ICU) admissions and contributing significantly to morbidity, mortality, and long-term renal impairment. Trauma-related AKI (TRAKI) arises from diverse mechanisms, including hemorrhagic shock, ischemia–reperfusion injury, systemic inflammation, rhabdomyolysis, nephrotoxicity, and complex organ crosstalk involving the brain, lungs, and abdomen. Pathophysiologically, TRAKI involves early disruption of the glomerular filtration barrier, tubular epithelial injury, and renal microvascular dysfunction. Inflammatory cascades, oxidative stress, immune thrombosis, and maladaptive repair mechanisms mediate these injuries. Trauma-related rhabdomyolysis and exposure to contrast agents or nephrotoxic drugs further exacerbate renal stress, particularly in patients with pre-existing comorbidities. Traditional markers such as serum creatinine (sCr) are late indicators of kidney damage and lack specificity. Emerging structural and stress response biomarkers—such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), C-C motif chemokine ligand 14 (CCL14), Dickkopf-3 (DKK3), and the U.S. Food and Drug Administration (FDA)-approved tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein 7 (TIMP-2 × IGFBP-7)—allow earlier detection of subclinical AKI and better predict progression and the need for renal replacement therapy. Together, functional indices like urinary sodium and fractional potassium excretion reflect early microcirculatory stress and add clinical value. In parallel, risk stratification tools, including the Renal Angina Index (RAI), the McMahon score, and the Haines model, enable the early identification of high-risk patients and help tailor nephroprotective strategies. Together, these biomarkers and risk models shift from passive AKI recognition to proactive, personalized management. A new paradigm that integrates biomarker-guided diagnostics and dynamic clinical scoring into trauma care promises to reduce AKI burden and improve renal outcomes in this critically ill population.

Objective: Operating room (OR) extubation after adult cardiac surgery with cardiopulmonary bypass CPB is rare. We examined the outcome, factors, and benefits of OR extubation. Methods: We operated on 60 patients in German Hospital Tirana, from January 2019 to September 2020, who had undergone CABG cardiac operations: 52 patients, mitral valve repair 5 patients, aortic stenosis 1patient, Bentall procedure 1 patient, left atrial myxoma 1 patient. The patient's age was from 46-82 years old, there were 24 female patients and 36 male patients, 24 diabetic patients, 36 non-diabetic patients, in all cases we did not apply epidural anesthesia. Anesthesia was used with low doses of fentanyl. in combination with propofol, sevoflurane. In all cases, neostigmine was used for decurarisation. The quality and depth of anesthesia were assessed with obvious signs such as tachycardia, hypertension, sweating. Endogenous stress was also assessed by monitoring glycemia during the intervention. As extubation criteria were assessed the patient's consciousness, respiratory mechanics, hemodynamic stability, diuresis, bleeding from drains. Results: 16 patients were extubated in the OR and 44 patients were extubated 15-20 minutes after the intervention in ICU. There was no reintubation. 2 patients were transferred immediately from OR to the pavilion. 35 patients were transferred to the pavilion 3-4 hours after extubation. 23 patients were transferred to the pavilion the next morning. Patients left the hospital after 5-7 days. Conclusions: Extubation in the OR in the early postoperative period has now become a routine in all specialized clinics. The time spent in the ICU is very low and the day spent in the ward was 5-7 days. The benefit is in the best and fastest activation of patients in the early postoperative period as well as in reduced intervention costs.

Introduction: Wandering Spleen is a rare condition in which the splenic ligaments are abnormally loose or absent. This makes the Spleen more mobile and increases the risk of torsion. This case report outlines the clinical presentation and management of a 10-year-old female patient who presented at our clinic with acute abdominal pain, vomiting episodes, and a severe fever. Imaging tests, such as abdominal ultrasonography and computed tomography, confirmed the diagnosis of splenic torsion by showing a hemorrhagic infarction and a large spleen. We performed a splenectomy to remove the damaged organ, a partial omental resection to remove the dead tissue and removed the mesenteric lymph nodes for further pathological examination. After the surgical procedure, the intensive care unit carefully observed the patient and treated her with intravenous electrolyte replacement, broad-spectrum antibiotics, pain management, and measures to prevent thrombosis. This case highlights the critical need for early diagnosis and timely surgical intervention in cases of wandering Spleen to prevent serious complications, including splenic infarction. By presenting this case, we seek to elevate awareness of wandering Spleen among healthcare professionals, mainly within pediatric groups. We emphasize the importance of timely diagnosis and appropriate management to optimize patient outcomes. Conclusion: Early detection and prompt intervention are crucial in preventing severe complications in pediatric patients. This case emphasizes the necessity of rapid diagnosis and increased awareness in clinical practice. Due to the Spleen's impaired viability, a splenectomy was required. Following surgery, we provided comprehensive monitoring and pharmaceutical assistance to control pain, prevent infection, and maintain nutritional stability.

Aortic arch diseases represent one of the most complex domains in cardiovascular surgery due to the need for cerebral protection, anatomical precision, and durable reconstruction. Their management requires highly individualized strategies that balance cerebral protection, systemic organ perfusion, anatomical complexity, and long-term durability. Over recent decades, antegrade cerebral perfusion has significantly reduced neurological morbidity. In parallel, vascular prostheses have progressed from conventional Dacron grafts to hybrid stent graft systems simplifying arch reconstruction and expanded treatment options in high-risk cohorts. Total endovascular arch repair using branched or fenestrated devices has emerged for selected high-risk patients; however, current data remain limited, with early stroke rates of approximately 5–8% and restricted long-term durability evidence. From both clinical and economic perspectives, open and hybrid approaches remain central to durable arch management.

Introduction: In recent years, contemporary minimally invasive cardiac surgery techniques have been used in many cardiac surgical clinics. With the expansion of minimally invasive operations, ECMO, and some interventional therapies, the current cardiac surgical landscape requires a thorough knowledge of peripheral cannulation techniques. A venous cannulation that is not flawlessly performed can lead to serious life-threatening complications in several steps. The technique we describe step by step is the current gold standard in terms of safety and efficacy: from the use of ultrasound for ultrasound-guided puncture to the safe advancement of super stiff guidewires using a sentinel catheter and concluding with smooth insertion of the venous cannula over the stiff guidewire up to the SVC. Moreover, a list of bailout maneuvers to solve complications and a report of institutional clinical experience since adopting this technique are presented. Conclusion: In our experience, however, the fact is that patients' perceptions and expectations have changed. Patients increasingly ask for a therapeutic approach that leaves the sternum intact. Those doctors who want to meet this new challenge must realize that minimal incisions in cardiac surgery require excellent technical skills. For this reason, doctors should become familiar with current study data.

Acute traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more cammon, early diagnosis of tamponade is important so that life savingtreatement can be started. The classical features of tamponade may a be modified by hypovolemia and the presence of associated injuries. Acute tamponade may also be precipitated by rapid administration of large volumes of fluid. Echocardiography is limited by availability and operator dependence. Pericardiocentesis, while sometimes life saving is dangereous and limited value. A higher deagree of clinical suspincion in patients with chest injuries, together with close monitoring and revaluation, particulary during volume remplancement is essential. This paper describes one patient presented to the emergency department of University Hospital Center “Mother Theresa “ and it discusses the epidemiology and management principles of acute tamponade.