Faculty of Medicine

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Effectiveness of single lumbar periradicular infiltration in patients with sciatica
(Macedonian Association of Radiologists, 2023-11-09)
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Kostova, Masha
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Jovanoska, Ivona
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Neuroimaging, a key role in diagnosis of diffuse axonal injury. CT and MRI patterns every radiologist should know
(EUROPEAN SOCIETY OF RADIOLOGY, 2023-03-01)
Jovanoska, Ivona
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Gjoreski, Aleksandar
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Lombardo, I
Learning objectives - to understand the common mechanisms and pathology of diffuse axonal injury (DAI) - to recognize the radiological appearances on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) - to understand the role and clinical importance of neuroimaging in patients with DAI Read more Background Diffuse axonal injury as the name implies is a traumatic stretch/disruption of axons that occurs with sudden acceleration/deceleration or rotation of the brain. Patients with DAI are most commonly injured in high-velocity vehicle crashes and DAI represents 50% of all primary intraaxial traumatic brain lesions in moderate/severe traumatic brain injury (TBI). It has 80-100% autopsy prevalence in fatal injuries and even occurs in utero if pregnant woman subjected to sufficient force. Typically, patients present with loss of consciousness at the time of accident and often... Read more Findings and procedure details Non enhanced CT is the first-choice neuroimaging tool in all emergency head trauma patients, but MRI is the modality of choice for assessing suspected diffuse axonal injury. It is a potentially difficult diagnosis to make on imaging alone. Some patients with relatively normal CT scans may have significant unexplained neurological deficit, in those cases DAI should be suggestive and confirmed with MRI. On CT the finding can be subtle or absent, but that does not categorically exclude the presence of axonal injury. Contrary to the... Read more Conclusion DAI as a diagnosis should be suggestive in TBI patients with clinical symptoms disproportionate to imaging findings. More than 30% of patients with negative CT have positive MR, so in general it is clinically developed based on clinical manifestations and MRI findings. Neuroimaging plays a significant role, by detecting the location and number of lesions, not only in diagnosis but also in determining the outcome of patients after DAI.
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MINIMALLY INVASIVE APPROACH IN PATIENT WITH EXTRAFORAMINAL DISC HERNIATION
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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Kostova, Masha
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Jovanoska, Ivona
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Nancheva, Andrea
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Dungevski, Gjorgi
Objective: The aim of our study was to evaluate the history, treatment and clinical outcome of a patient with low back pain and radiculopathy caused by extraforaminar disck herniation, after a minimally invasive procedure (PRT) periradicular therapy and physical therapy in order for educational purposes. Clinical features: A 48-year-old patient without comorbidities was presented with 3-week history of lumbar pain with irradiation to the left lower extremity. The patient had difficulty sitting and standing with antalgic movement without being able to assume an upright position.. The pain was intensified by lateral movements dominant left and positioning backwards with propagation to the left side and hip. Dominant symptom was radicular pain with paresis and hypesthesia of the affected dermatoma of lower limb. The diagnosis was confirmed by magnetic resonance imaging with showed exoforaminar disc herniation on the level L4-L5. Intervention and outcome: Advantages of PRT are: minimal invasive procedure, CT guided intervention for exact and precise delivery of the medications, low risk in damage of important local anatomical structures, short recovery time, easy approach and low cost for patient and for the medical institution, respectively. In our study, CT Siemens 16 slice was used for the intervention. The patient was treated with lumbar epidural corticosteroid application and physical therapy. Physical therapy included self-traction and strengthening exercises. Functional status was measured using a Modified Oswestry Questionnaire and numerical pain assessment scale VAS scale. Initially, before intervention, functional status was assessed at 68%, with pain 8/10. After treatment, functional status was 4% and pain was assessed as 1/10. Conclusion: Multidisciplinary approach is needed in patients with extraforaminal disc herniation for better results. In our case study, PRT demonstrated a significant role in treating our patient. As a result of the treatment significant reduction of pain and improvement of functional status was observed. The patient returned to normal life habits and activities in a very short time, which was primary goal.
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RADIOLOGY MODALITESAPPROACH IN ANGIOLEIOMYOMA UTERI.A CASE REPORT
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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Chalcheska, Slavica
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Nancheva Bogoevska, Andrea
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Introduction. Angioleiomyoma uteri, also known as vascular leiomyoma, is a rare benign tumor that arises from uterine blood vessels and smooth muscle cells. Aim of the study was to present the radiological modalities to diagnose the rare disease, the uterine angioleiomyoma. Material and Methods. A case of 25 year old female was admitted to hospital with diffuse abdominal pain and abnormal uterine bleeding. The patient was examined by an ultrasound (US) Siemens, computed tomography (CT) GE 64 slice and magnetic resonance (MR) Siemens Somatom Essenca 1.5 with T1-weighted, T2-weighted, T1 C+ (Gd). Results. A well-defined mass was noticed by US and an additional internal vascularity by doppler. On contrast enhanced CT scan in the arterial and venous phase, the giant mass showed multiple vascular branches. At CT scan the giant mass was found inseparable from uterine corpus and uterine fundus. Due to inconclusiveness of the results, MR was additionally performed, showing well-defined mass, which was incapsulated and accompanied with internal vascular flow voids. Conclusion. Radiology modalities approach is necessary in detection of uterine angioleiomyoma. As it may recur or it may transform into a malignant tumor, although in rare cases, a regular follow-up is obligatory.
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COVID -19 INDUCED AORTIC THROMBUS AND CRITICAL LIMBISHAEMIA
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2023-04-07)
Nancheva Bogoevska, Andrea
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Risteski, Filip
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Gjoreski, Aleksandar
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Jovanoska, Ivona
50 years old male presented with livid redness on both feet, predominantly left, accompanied with severe pain and coldness. Two weeks before, he admitted to hospital due to COVID-19 bronchopneumonia. Urgent abdominal and lower extremities contrast enhanced CT was performed, which showed mural thrombus of the abdominal aorta (AA) extending from below the left renal artery to the iliac bifurcation and total occlusion of the left and partial occlusion of the right crural arteries. Interventional procedures are the first choice for initial emergency management, leaving surgery as a second and anticoagulant therapy as third option for treatment. Endovascular treatment is based on stent grafting. Covered stent graft was used to repair the AA and kissing stenting technique was used in the aortoilical part. The result was complete patency of AA and both iliacal arteries, with improved clinical status. Mural thrombi are likely to occur in large vessels as the heart and descending aorta, and less commonly in the aortic arch or the AA, causing flow reduction. Their occurrence is a rare in the absence of hypercoagulative state or inflammatory, infectious, or familial aortic ailments. In our case, Covid -19 is associate occurrence of thrombus in the AA, which throws out smaller thrombi in the peripheral circulation that causes critical limb ischemia (CLI).CT is the best modality for early diagnosis and endovascular treatment the least invasive treatment. Mural aortic thrombus accompanied by CLI is an urgent medical condition which, if not diagnosed and treated on time, can result in limb amputation or death. Endovascular stenting is first choice of treatment in patients without previous vascular disease.
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ASSOCIATION OF RENAL AGENESIS AND IPSILATERAL SEMINAL VESICLE CYST – ARARE CASE OF ZINNER SYNDROME
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
Chalcheska, Slavica
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Jovanoska, Ivona
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Nancheva Bogoevska, Andrea
Introduction We report a case of Zinner syndrome, a congenital malformation characterized by association of renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Case presentation A 44 years old patient, previously diagnosed with benign prostatic hyperplasia and chronic prostatitis was admitted at our department for puncture of pelvic cyst. Transrectal ultrasound (US) guided puncture and aspiration of the cyst was performed. Few days later, patient presented with septic symptoms and computed tomography (CT) scan was done, which showed large cyst with air inclusions, measuring 13x14cm in diameter in right seminal vesicles and right renal agenesis compatible with Zinner syndrome. An urgent surgical drainage of the cyst was done, followed by improvement of patient’s clinical condition. Discussion Zinner syndrome is one of the rarest congenital anomalies of urogenital tract and is usually discovered and diagnosed after3rd -4th decade of life. Patients are often asymptomatic but they can present with dysuria, recurrent prostatitis or epdidymitis. Radiological modalities have a significant role into detecting and evaluating Zinner syndrome including US, CT and MRI. When symptomatic, most commonly due to its size, surgical excision or transrectal aspirations of the cyst are options of treatment. Conclusion Combination of clinical history and radiological imaging are essential for making the diagnosis and proper management of this rare entity.
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Single-center randomized trial comparing conventional chemoembolization versus doxorubicin-loaded polyethylene glycol microspheres for early- and intermediate-stage hepatocellular carcinoma
(Lippincott, Williams & Wilkins, 2020-10-08)
Gjoreski, Aleksandar
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Jovanoska, Ivona
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Risteski, Filip
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Nedelkovski, Dane
According to Barcelona Clinic Liver Cancer classification, transarterial chemoembolization (TACE) is preferred treatment for stage B and in certain cases for stage A hepatocellular carcinoma (HCC). Conventional TACE (c-TACE) and drug-eluting microspheres TACE (DEM-TACE) are available intraarterial therapies. Screening of patients with cirrhosis is of great importance for early detection of malignant liver nodules. Primary endpoint of this study was to compare DEM-TACE with c-TACE in terms of 12- and 24-month survival. Secondary endpoints were comparison of intensity and duration of the postembolization syndrome (PES) and severe adverse events. We randomized 60 patients with unresectable HCC one-to-one with c-TACE or DEM-TACE and followed them for at least 24 months or until death. TACE was repeated ‘on-demand. Most patients underwent two TACE sessions and the median hospital stay was 3 days for c-TACE and 2 days for DEM-TACE group. The overall 12- and 24-month survival rates were 89.8 and 70.7%, respectively, precisely 85.7 and 63.6% after c-TACE and 90.2 and 75.8% after DEM-TACE, without any significant difference (P = 0.18). Median overall survival was 21.1 months. Significant difference in the overall 12- and 24-month survival was found in patients with Child-Pugh A compared to Child-Pugh B class (P = 0.001). Child-Pugh class, aspartate aminotransferase levels and ascites independently predicted survival (P = 0.003). Both, DEM-TACE and c-TACE showed excellent 12- and 24-month survival rates. No significant difference in terms of adverse events was found. PES was slightly more severe after c-TACE, because of elevated temperature. DEM-TACE requires shorter in-hospital stay.

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