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Background: Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer. Method: In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision. Results: DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9). Conclusion: DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries.

In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.

Background: In the last decade, the risk of terrorist attacks has increased largely almost worldwide. In this setting, disaster response personnel must understand the unique physiopathology of injuries as-sociated with explosions and must be prepared to assess and treat the people injured in such tragedies. The ammunition explosion in Gërdec, Vora, just 13 miles from the capital of Albania, Tirana, confronted our country with a real human tragedy with severe casualties. The striking force of the two consecutive explosions resulted in two consecutive earthquakes with respectively an amplitude of 9.2 and 2.5 on the Richter scale. Objective: To explain the classification of explosives and in connection with it to identify the major types of explosive and blast injuries, and the management options in the cases of explosions and blast injuries. Material & Methods: Efforts to dismantle Albania’s stockpiles of obsolete munitions took a catastroph-ic turn on March 15th, when a series of explosions occurred as crews were clearing out a storage depot in Gërdec, on 15th of March 2008, at 12:15 AM hours. Gërdec is located 10 km northwest of the capital of Albania, Tirana; near the national highway Tirana-Durres and at a distance of 3-4 km in air line from National Airport. Data presented here were collected from the patients’ files in our Trauma UHC and from the official reports from the different governmental offices. Conclusion: The explosive and blast injuries now present a true modern epidemic disease that threat-en the very survival of the free world. A thorough understanding of detonation and blast dynamics by the treating teams is required to better correlate the injury patterns presented. This is also critical for revision of current multiple casualty protocols. It is up to the medical establishment to prepare suitable protocols, coordinate manpower and secure medical resources to successfully handle such events.

Background:There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence. Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned. Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy; 2 had a positive DPL and negative laparotomy; 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy. Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

Single isolated jejunal perforation (IJP) due to blunt abdominal trauma is uncommon and most often occurs with road traffic accidents. The diagnosis of traumatic single IJP is challenging as there are minimal clinical features initially. For most favorable results, strict monitoring, a high index of clinical suspicion, and the help of available appropriate diagnostic tools like diagnostic peritoneal lav age (DPL)/focused abdominal sonography for trauma (FAST) are preferable. Here we report a case of IJP following blunt trauma abdomen.

Diagnostic peritoneal lavage (DPL) is considered by many as the most important investigation for the early detection of intraperitoneal injury. The aim of this study is to assess the accuracy of DPL as a diagnostic method in evaluating abdominal trauma. A prospectively maintained database of all DPLs performed in the past 36 months at Sina Hospital was analyzed. Information relative to the type of injury, indication for DPL, DPL and laparatomy results were analyzed in order to evaluate the accuracy, sensitivity and specificity of DPL. Over a 36-month period, 111 (13.9%) DPLs were performed for 800 patients with abdominal trauma at Sina Hospital. Fifty-five (49.5%) patients had negative and 56 (50.5%) patients had positive DPL. Among negative results, laparatomies were performed for 5 (9.1%) patients. Among positive results, 47 patients had organ injuries at laparatomy and 6 (11.3%) did not have any organ injuries (false positive). The overall accuracy, sensitivity and specificity of DPL were 87%, 90% and 85%, respectively, that were comparable to the other reports (p

Diagnostic peritoneal lavage (DPL) is considered by many as the most important investigation for the early detection of intraperitoneal injury. The aim of this study is to assess the accuracy of DPL as a diagnostic method in evaluating abdominal trauma. A prospectively maintained database of all DPLs performed in the past 36 months at Sina Hospital was analyzed. Information relative to the type of injury, indication for DPL, DPL and laparatomy results were analyzed in order to evaluate the accuracy, sensitivity and specificity of DPL. Over a 36-month period, 111 (13.9%) DPLs were performed for 800 patients with abdominal trauma at Sina Hospital. Fifty-five (49.5%) patients had negative and 56 (50.5%) patients had positive DPL. Among negative results, laparatomies were performed for 5 (9.1%) patients. Among positive results, 47 patients had organ injuries at laparatomy and 6 (11.3%) did not have any organ injuries (false positive). The overall accuracy, sensitivity and specificity of DPL were 87%, 90% and 85%, respectively, that were comparable to the other reports (p