Faculty of Medicine

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JEJUNAL ADENOCARCINOMA: A CASE REPORT
(2019-06-05)
Bozinovska Beaka, Gordana
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Zdravkovska, Milka
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Eftimovska Rogac, Irena
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Bozinovska, Nadica
<jats:p>Tumors of the small intestine are extremely rare, and clinical signs and symptoms are nonspecific, resulting in prolongation of the diagnosis process and subsequently worsening the outcome of the treatment. In addition to non-specific symptomatology, additional difficulty in diagnosing is the very inaccessibility of the jejunum through endoscopic techniques. The following is a review of the case of a female patient with jejunum carcinoma. CASE REPORT. A 64-year-old patient with nonspecific symptoms of fatigue, weight loss and sore pain in the stomach initially hospitalized due to anemic syndrome. An endoscopic evaluation was performed, and the fining was chronic gastritis. The patient was prescribed with iron supplementation therapy and was sent home. Within a month, the fore mentioned symptoms started to intensify, and the patient was hospitalized at the General Hospital in Skopje, where extensive investigations were conducted. Upper digestive endoscopy was made, and the finding again only showed chronic gastritis. Due to lack of findings, the doctors performed abdominal ultrasonography that indicated only a bolded intestinal segment with a thick wall of 9mm in the projection of the left flexure to the descending colon. The need for additional investigations grew and computed tomography with contrast of the abdomen and small pelvis was performed. The finding of the computed tomography was in favor of an irregular intestinal segment in the projections of the jejunal convolutions, with a thickened heterogenic wall and pathological post-contrast coloring. Due to the need for correlation with other trials, MRI was performed, and its finding was highly suspected of a tumor change in the jejunum, but an inflammatory disease was not excluded. Because of this finding, the patient was sent to the Department of Digestive Surgery at the same facility. From a surgical point of view, the patient was treated with an upper medial laparotomy, which made it possible for the tumor to be released from its surroundings. The surgery and after surgery course and the patient’s condition were all as expected. The patient was in a stable general condition after the surgery, and she was sent home. The pathophysiological finding resulted in jejunal adenocarcinoma (Latin adenocarcinoma intestinijejuni). After the pathophysiological finding was obtained, the patient was referred to an oncologist for eventual adjuvant therapy. DISCUSSION. Small intestine carcinoma is a specific clinical and surgical entity, which is often diagnosed in an already overdue phase. This is due in part to the non-cohesive symptomatology, but largely due to the still insufficiently sophisticated detection methods. Because of this enigmatic nature of these carcinomas, it may be necessary to think of a special team in the digestive surgery departments, which would solely work on this pathology, in order to speed up diagnosis and improve the outcome of the treatment for the patient.</jats:p>
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A Case Report of Intraoperatively Diagnosed Cholangiocarcinoma after Unsuccessful Conservative Treatment of ERCP Complicated with Hemorrhage
(Vilnius University Press, 2018-12-03)
Bozinovska Beaka, Gordana
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Zdravkovska, Milka
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Burova, Blagica
Cholangiocarcinoma is a malignant tumor arising from the epithelium of the bile ducts. Most of these tumors are adenocarcinomas [1]. Intrahepatic cholangiocarcinoma accounts for 10% of all cholangiocarcinomas, hilar cholangiocarcinoma for 25%, and extrahepatic cholangiocarcinoma for 65% [2, 3]. Cholangiocarcinoma can develop in any part of the extrahepatic duct, occurring in 50–75% of reported cases in the upper third of the duct including the hepatic hilum, in 10–25% in the middle third, and in 10–20% in the lower third [4–6]. Approximately 95% of cases show extrahepatic obstruction at the time of diagnosis [7]. In a meta-analysis of 21 prospective trials, the rate of hemorrhage as a complication of ERCP was 1.3% (95% CI, 1.2%–1.5%) with 70% of the bleeding episodes classiﬁed as mild [8]. Hemorrhagic complications may be immediate or delayed, with recognition of occurring up to 2 weeks after the procedure. The risk of severe hemorrhage (ie, requiring >5 units of blood, surgery or angiography) is estimated to occur in fewer than1 per 1 000 sphincterotomies [9]. Despite new and advanced diagnostic methods, sometimes this type of tumor is finally diagnosed from pathological findings on excised tissue.
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Comparative Study for Application of Polypropylene Monofilament Light Mesh, Polypropylene Monofilament Heavy Mesh and Self Gripping Polypropylene Mesh in Patients with Inguinal Hernia Surgically Treated with Lichtenstein Technique
(Vilnius University Press, 2020-12-29)
Bozinovska Beaka, Gordana
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Zdravkovska, Milka
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Kalamaras, Patricija
<jats:p>Background / Objective. In our clinical study we have compared the results of intraoperative and postoperative period in patients with inguinal hernia treated operatively with Lichtenstein technique, where one of three different polypropylene meshes has been applied: polypropylene monofilament light mesh, polypropylene monofilament heavy mesh and self gripping polypropylene mesh. Follow up period have been one year. Methods. This study represents randomized, retrospective-prospective, comparative clinical study where 243 patients have been divided into three groups depends of prosthetic mesh that was applied with Lichtenstein technique. We have evaluated the connection between types of used mesh with some of followed parameters: postoperative pain intensity, postoperative patient mobilization, postoperative surgical site occurrences, duration of hospitalization, chronic pain, filling of foreign body in inguinal area and development of recurrences. Results. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay and lowest duration of surgical procedure than other two groups of patients. In term of chronic pain, only statistically significance we confirmed between the groups of heavy monofilament mesh and self griping polypropylene mesh, where higher number of patients from group with monofilament polypropylene light mesh reported chronic pain. In our study we confirmed that working status and patient age have significant influence on the intensity of postoperative pain in all three patients group. There is no statistical correlation between type of the mesh and surgical site occurrence rate. Conclusion. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay, lowest duration of surgical procedure and less number of patients experienced feeling of “foreign body” in their groin than other two groups of patients.</jats:p>
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METASTATIC CUTANEUS MELANOMA OF THE GALLBLADDER-CASE REPORT
(Association of medical doctors "Sanamed" Novi Pazar, 2019-08-04)
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Nancheva Bogoevska, Andrea
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Bozinovska Beaka, Gordana
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Gjoreski, Aleksandar
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Melanoma is an aggressive malignant tumor that originates from melanocytes and most com- monly occurs on the skin. Dominantly metastasize to regional lymph nodes, in the brain and lungs and rarely in the gastrointestinal (GI) system. The aim of this re- port is to present a rare case of metastasis of cutaneous malignant melanoma in the gallbladder, discovered 10 months after excision of the primary melanoma of the skin. A 45-year-old patient was hospitalized in our hos- pital due to abdominal pain in right upper quadrant and nausea lasting for 7 days. An intraluminal substrate was found in the gallbladder with computed tomogra- phy and later a CT guied biopsy was performed on it, thus proving a metastatic deposit of primary malignant melanoma. Metastatic deposits in the gallbladder are extre- mely rare finding, and 238 cases have been described in the literature.

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