Faculty of Medicine

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FIRST AND SECOND TRIMESTER MEDICAL ABORTION - PILOT STUDY IN REPUBLIC OF NORTH MACEDONIA
(Македонско лекарско друштво = Macedonian medical association, 2021)
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Introduction. Medical abortion is a procedure in which medication is used to end a pregnancy up to 22 weeks of gestation. The aim of this study was to assess the efficiency, safety and acceptance of medical abortion in the first and second trimester using a regimen of medications, mifepristone followed by misoprostol. Methods. In a prospective study, conducted at the University Clinic for Gynecology and Obstetrics in Skopje in the period from March to November 2021, women that came for medical abortion in the first and second trimester were enrolled. They were divided into two groups: Group I (5 to 12 weeks of gestation) and Group II (12 to 22 weeks of gestation). Participants in Group I were given 200 mg mifepristonе for peroral application and after 24 hours instructed for sublingual application of 800 µg misoprostol at home. Participants in Group II were hospitalized and treated with the same regimen. Additional dosage of misoprostol was given to complete abortion. Results. A total of 208 women with medical abortion up to 22 weeks of gestation (173 in the first group and 35 in the second group) were enrolled in the study. In the first group a complete uterine evacuation was achieved in 168 women (97.1%) and in 25 women (71.4%) in the second group. Acceptability of the method was high among both groups (95.14 % in Group I and 82.14 % in Group II). All doctors/clinicians who participated in this pilot study were satisfied with the method. Conclusions. Medical abortion is effective, safe and acceptable option for women in the first and second trimester. Acceptability of the method was high among both groups. All doctors/clinicians who participated in this pilot study were satisfied with the method and would offer it as an option to their patients in the future.
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SMALL INTESTINE INTUSSUSCEPTION DUE TO GASTROINTESTINAL STROMAL TUMOUR IN PREGNANCY: A CASE REPORT
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022)
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Simonovska Paneva, Iva
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Gastrointestinal stromal tumour (GIST) is very rare in pregnancy and only a few cases have been described in the literature. We present a case of a 38-year-old primigravida, presented with non-specific symptoms for the first time in the second trimester. Due to the non-specificity of the symptoms on one hand and the rarity of the tumour on the other, it took a long time for the final diagnosis to be made. Accidentally, on a routine obstetric ultrasound examination, a solid tumour formation was observed, localized under the lower pole of the left kidney. On MRI of the abdomen, in front of the left kidney there was a tubular structure, in close relation with small intestine, suspected for intussusception. At 28 weeks of gestation, an exploratory laparotomy was performed with resection of the involved part of the jejunum and TT anastomosis. Pregnancy was terminated electively, by caesarean section, in 38+6 gestational weeks. The clinical presentation of the GIST depends on the primary location of the tumour. Due to the extremely rare occurrence of these tumours in pregnancy, there is no solid scientific evidence for the most appropriate time of their treatment and the time of termination of pregnancy. The biggest challenge in pregnancy is timely diagnosis and treatment, without impact on the foetus. A multidisciplinary approach is needed. In our case, the severity of the mother’s symptoms outweighed the danger to the foetus from general anaesthesia and surgery itself.
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Rare concomitant myxoid and cystic degeneration of uterine leiomyoma: Case report
(Centre for Evaluation in Education and Science (CEON/CEES), 2021)
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Paneva, Iva
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The uterine leiomyomas are monoclonal tumours of myometrial smooth muscle cells that are oestrogen dependent. A 43-year-old patient was referred by her gynaecologist under a suspected diagnosis of ovarian tumour. She complained of prolonged and profuse, regular menstrual bleeding that leaded to anaemia. The ultrasound examination showed a complex tumour mass with dimensions 68 x 85 mm, with several cystic formations fulfilled with clear fluid, which protrudes from the posterior wall of the uterus. Therefore, the diagnosis of leiomyoma with a cystic degeneration was considered preoperatively. In the case of cystic degeneration of the myoma, the ultrasound shows a combination of cystic and solid components with irregular shape and variable echogenicity. The ovarian malignancy should be ruled out in the presence of a large cystic mass with irregular septa and solid nodular parts filling the small pelvis. Ultrasound characteristics of degenerative myomas should always be considered, so as not to replace it with an ovarian mass, especially if it is subserosal and on the loop.
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An infundibulation for non-medical reasons in North Macedonia
(2023)
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Dimitrovski, Sasho
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Kombinacija mifepristona i misoprostola u izvođenju medikamentoznog abortusa u prvom trimestru trudnoće
(2021)
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APSTRAKT Cilj. Cilj je bio da se utvrdi efikasnost metode i zadovoljstvo pacijentkinja nakon izvođenja medikamentoznog abortusa radi prekida trudnoće u prvom trimestru. Metode. U retrospektivnoj analizi predstavljamo iskustva u izvođenju medikamentoznog abortusa na našoj klinici u periodu od 1. 10. 2020 do 1. 10. 2021 godine. Tablete mifepristona i tablete misoprostola ordinirane su po šemi prilagođenoj protokolu Svetske zdravstvene organizacije. Rezultati. U periodu od godinu dana na našoj klinici tretirali smo 189 pacijentkinja kombinacijom mifepristona i misoprostola sa ciljem prekida trudnoće u prvom trimestru. Instrumentalna revizija zbog rezidualnih masa u materici nakon dve nedelje urađena je kod osam pacijentkinja (4,23%) dok je procedura ponovljena sa uspehom kod dve pacijentkinje (1,06%). Efikasnost metode bila je 95,8%. Imali smo mali broj komplikacija (produženo genitalno krvarenje, tranzitornu febrilnost, povraćanje i sl.). Primenjenom metodom bilo je zadovoljno 91,4% ispitanica. Zaključak. Medikamentozan abortus u prvom trimestru trudnoće je bezbedna, efikasna metoda i posebno korisna zbog pandemije kovida 19, jer se može primeniti bez hospitalizacije u ambulantnoj sredini, uz konsultaciju s ordinirajućim ginekologom.
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PRENATAL DIAGNOSIS OF REPETITIVE ELLIS-VAN CREVELD SYNDROME ACCOMPANIED BY DANDY WALKER MALFROMATION - CASE REPORT
(ScopeMed, 2021-01)
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Todorovska, Irena
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Ellis-van Creveld syndrome is known as chondroectodermal dysplasia or mesoectodermal dysplasia. It is a rear genetic disorder with autosomal recessive inheritance resulting from these patients’ malformations. Case Report: A repetitive syndrome is reported in the present article. Pregnant woman with a fetus with Ellis-van Creveld syndrome is described with a rare concomitant abnormal findings of Dandy-Walker malformation. The aim is to emphasize the importance of the ultrasound differentiation of prenatal diagnosis in patients who have fetuses with congenital anomalies. A 26-year-old pregnant woman was diagnosed with a fetus with congenital anomaly Ellis-van Creveld Syndrome associated with Dandy-Walker malformation. In her history of diseases, previously she has had three indicated abortions due to central nervous system and limbs deformities. She has only one healthy child. The patient was examined clinically, paraclinical, digitally, and has had genetic examinations performed on her, her partner, and fetus. The patient prenatally was diagnosed with caring a fetus with shortening of the long bones, thoracic dysplasia, hexadactyly of the hand, arterial septal defect in addition to Ellis-van Creveld accompanied by Dandy-Walker syndrome. From the results obtained it has been deducted that the pregnancy needs to be terminated. Conclusion: A multidisciplinary approach is needed in prenatal diagnosis and family genetic counselling for the wellbeing of a fetus and the entire family.

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