Inguinal hernia repair is one of the most common surgical procedures in the world. Currently, recurrence rates have reduced to less than 5% after mesh repair, but chronic groin pain (CGP) remains a major concern in open hernia surgery. The aim of the study was to detect neuropathic pain associated with iatrogenic nerve damage using the dermatome mapping test (DMT) and to evaluate the preventability of CPG.The study was designed and conducted as a prospective longitudinal observation study in postoperative open hernioplasty patients. The study included 71 adult patients with a primary inguinal hernia, who underwent a standard open surgical procedure for hernia repair using a polypropylene mesh (Lichtenstein's technique). The dermatome mapping classification was performed in each patient, and the test results were recorded. Seven (9.9%) patients with surgery-related pain lasting for three months or longer after surgery were considered to have CGP, and pain was related to iatrogenic nerve damage in two of these cases. Based on the results, we consider that the anatomical location of the nerves can be easily determined using DMT, and CGP can be prevented.

3 cases of pyocephalus (ventricular empyema) in newborn children are described and 16 cases from the literature are analyzed. Half of the previously published cases of pyocephalus are secondary to cerebral abscesses. Neuroradiological findings and especially the necroscopic study of a case demonstrated the existence of membranous blockages inside the ventricles which may make the circulation of CSF impossible. Our treatment of choice consists of repeated punctures and evacuations of purulent content and topic as well as parenteral administration of antibiotics. Further CSF derivative measures are almost always necessary. By these means, we believe the high mortality of these cases could be lowered.

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An abdominal aortic aneurism (AAA) is an enlargement of the lower part of the aorta that extends through the abdominal area.The diameter of the aneurismatic vessel is represented by 3 cm or more in either anterior – posterior , or transverse planes. The developpement of Abdominal aortic aneurysm (AAA) is a complex, multifactorial process involving destructive remodeling of aortic wall connective tissue. Four interrelated factors involved in this process include: (1) chronic inflammation associated with neovascularization and increased proinflammatory cytokine production, (2) increased and dysregulated production of matrix-degrading proteinases, (3) destruction of structural matrix proteins, and (4) decreased medial smooth muscle cell (SMC) presence, resulting in impaired connective tissue repair. This understanding has developed from a characterization of human AAA tissue, as well as the use of different animal models that replicate human disease. The  mortality of ruptured AAA is set between 40 – 70% in patients that manage to arrive alive in the emergency room,  and that of 90% in overall patients confirmed with rAAA in the autopsy results. A ruptured abdominal aortic aneurysm (rAAA) represents a disruption of a dilated aortic wall that leads to blood outside the aortic wall.

Background: We report the management of a very rare combination of two severe surgical emergencies, ruptured aortic aneurysm with gangrene of the left colon. Both events separately present a high mortality rate in ruptured aortic aneurysms with 48.5%. Case report: We present the case of a 59-year-old woman that was admitted to the service of Emergencies at University Hospital Center “Mother Theresa” of Tirana on January 4th of 2013, after being transferred from the Regional Hospital of Durres diagnosed with ruptured aortic aneurysm based on an unclear CT. The patient arrived in a state of profound hypovolemic shock after suffering cardiac arrest and underwent resuscitation at the ICU of Durres Hospital ( no exact information of the anoxic brain time). After a brief volemic compensation in our ICU, the patient was taken to the operating room. Intraoperatively we found an infrarenal r AAA and gangrene of the sigmoid and left colon. Resection and reconstruction by the interposition of a tube graft were performed, followed by a left large hemicolectomy with temporary colostomy realized by the team of general surgeons. Three months later they performed colorectal-anastomosis as a second step operation. Postoperatively the patient had a period of 3 weeks stay in the ICU, mostly due to neurological complications after the ischemic stroke, and on January 29 of 2013, she returned to the Service of Neurology at the Hospital of Durres for further neurological rehabilitation. One year later, in the ambulatory routine check, the patient presented full recovery from surgery and a complete central and peripheral neurological rehabilitation. Conclusions: Ruptured aortic aneurysm with gangrene of the left colon is a very rare and severe combination caused by the hypoperfusion of the inferior mesenteric artery in the presence of hypovolemic shock and insufficient collateral circulation. The strategy of treatment includes fast diagnosis, short hypotensive resuscitation, cell-saving and autotransfusion, and the simplest possible surgical reconstruction for both emergencies.

To the Editor-We read the recent article entitled, "Salvage Surgery with Organ Preservation for Patients with Local Regrowth After Watch and Wait: Is It Still Possible?" by Fernandez et al 1 with great interest. In this study, 257 patients with clinically complete response after neoadjuvant chemoradiation were evaluated. The study patients were followed closely in the "watch-andwait" organ preservation program. Regrowth developed in 28.4% in the first 3 years. I have some concerns with the article.