Faculty of Medicine
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Item type:Publication, Divestment–Adventitia Resection in Order to Decrease Morbidity and Mortality and Improve R0/R1 Ratio in Curative Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma(Scientific Foundation Spiroski (publications), 2026-06-14); ; ; Kolari, ArbijonAbstract BACKGROUND: Pancreatic head carcinoma (PHC) is a highly aggressive malignancy associated with substantial morbidity, mortality, and poor long-term survival. Achieving an R0 resection margin during pancreatoduodenectomy (PD) is crucial for improving oncological outcomes. However, in borderline resectable (BRPHC) and locally advanced pancreatic head carcinoma (LAPHC), arterial involvement often necessitates complex arterial resections associated with high perioperative risks. Periarterial sub-adventitial divestment has emerged as a potential alternative to arterial resection, aiming to improve radicality while reducing complications. AIM: To evaluate whether sub-adventitial arterial divestment during curative pancreatoduodenectomy decreases perioperative morbidity and mortality and improves the R0/R1 resection ratio in patients with BRPHC and LAPHC. METHODS: A retrospective study was conducted on 50 consecutive patients with BRPHC or LAPHC treated between 2009 and 2017 following neoadjuvant therapy when indicated. All patients underwent extensive pancreatoduodenectomy with triangle operation, extended lymphadenectomy, and periarterial sub-adventitial divestment of the superior mesenteric, common hepatic, and/or celiac arteries. Clinicopathological data, perioperative morbidity, mortality, length of hospital stay, and R0/R1 resection status were analyzed. RESULTS: Among the 50 patients, 27 (54%) were male and 23 (46%) were female, with a mean age of 63.1 ± 8.97 years. Overall mortality was 8% (4/50). Major complications included postoperative pancreatic fistula (24%), postoperative biliary fistula (2%), postpancreatectomy hemorrhage (4%), reoperation (6%), necrotizing pancreatitis (4%), thromboembolism (4%), cardiac failure (2%), and pulmonary complications (8%). Venous resection was required in 12% of patients. Postoperative pain relief was achieved in 92% of cases. Mean hospital stay was 10.56 ± 6.09 days. Histopathological examination demonstrated R0 resection in 28 patients (56%) and R1 resection in 22 patients (44%). Morbidity and mortality rates were comparable to standard PD and appeared lower than those reported for PD combined with arterial resection. CONCLUSION: Sub-adventitial arterial divestment during pancreatoduodenectomy is a feasible and safe technique for selected patients with borderline resectable and locally advanced pancreatic head carcinoma. The procedure provides acceptable morbidity and mortality rates while achieving favorable R0 resection outcomes, representing a promising alternative to arterial resection in specialized high-volume centers. Keywords Pancreatic head carcinoma Pancreatoduodenectomy Arterial divestment Borderline resectable pancreatic cancer R0 resection - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The role of rapid chromatographic immunoassay tests in acute poisoning: two case reports and literature overview(Edizioni Minerva Medica, 2026-03-22); ; ; ; This report through the presentation of two case studies highlights the common problem with false-positive urine drug screen faced by many physicians to the emergency and toxicology departments. Case 1: a 29-year-old male patient was admitted after acute poisoning with analgesics/antipyretics (Caffetin Cold, Caffetin); diazepam; amlopin. Case 2: a 56-year-old female patient was admitted with impaired consciousness. According to the data obtained from the patient’s family they suspected that she took the following drugs: Zanfexa, Zalasta and Diazepam. A rapid chromatographic immunoassay urine test was performed in both patients for the following substances: opiates, amphetamines, metamphetamine, MDMA (3,4-methylenedioxymethamphetamine), oxycodone, phencyclidine, cocaine, methadone, barbiturates, cannabinoids, benzodiazepines, tricyclic antidepressants, and tramadol. Case 1 was positive for opiates, benzodiazepines and amphetamines. Gas chromatography mass spectrometry and high-performance liquid chromatography were used and confirmed the presence of caffeine, codeine, paracetamol, propyphenazone, pseudoephedrine, dextromethorphan, nordazepam, ramipril and amlodipine in urine sample. Case 2 was positive for tramadol and benzodiazepines. Gas chromatography mass spectrometry was used and confirmed the presence of venlafaxine, its metabolites and nordazepam in serum and urine samples. If a false-positive urine screen result is suspected, nonimmunologic techniques, such as gas chromatography/mass spectrometry or high-performance liquid chromatography, are necessary for confirmation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Late emergence of myasthenia gravis complicating envenoming by Vipera ammodytes(Elsevier BV, 2026-10-01); ; ; - Some of the metrics are blocked by yourconsent settings
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Item type:Publication, PREMATURE BIRTH AS A RESULT OF CONGENITAL ANOMALY IN A UNICORN UTERUS(Walter de Gruyter GmbH, 2025-05-16); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, APGAR SCORE AT THE FIRST AND FIFTH MINUTE AS A PREDICTOR OF SURVIVAL AND INCREASED NEONATAL MORTALITY IN NEWBORNS TREATED IN THE NICU(Walter de Gruyter GmbH, 2025-05-16); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CONTINUOUS INTRAVENOUS NIMODIPINE APPLICATION FOR PREVENTION OF VASOSPASM BEFORE ENDOVASCULAR TREATMENT OF RUPTURED CEREBRAL ANEURISMS(Macedonian Association of Anatomists and Morphologists, 2022); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association between endometrial heterogeneity and endometrial cancer risk stratification in postmenopausal women(Srpsko lekarsko društvo, Beograd, 2026); ; ; ; SUMMARY Introduction/Objective The normal postmenopausal endometrium typically appears thin, homogeneous, and echogenic on transvaginal ultrasonography. In contrast, endometrial carcinoma is often associated with increased thickness, heterogeneous echogenicity, irregular endometrial–myometrial interface, and enhanced Doppler vascularization. The objective of this study was to evaluate the association between heterogeneous endometrial echogenicity and the risk of endometrial malignancy in postmenopausal women. Methods This prospective clinical study included 120 postmenopausal women treated at the University Clinic for Gynecology and Obstetrics in Skopje. Participants were divided into a control group (n = 40) and an examined group (n = 80). The examined group was further stratified according to uterine bleeding status and endometrial thickness (5–8 mm, > 8–11 mm, and > 11 mm). Endometrial echogenicity was assessed by transvaginal ultrasonography and classified as homogeneous or heterogeneous. Binary logistic regression analysis was performed to determine independent predictors of malignancy. Results Heterogeneous endometrial echogenicity was significantly more frequent in the examined group compared with controls (p < 0.001). It was identified as an independent predictor of endometrial malignancy (OR = 4.938; 95% CI: 1.24–19.62; p = 0.023). No statistically significant association was observed between echogenicity and endometrial thickness subgroups (p = 0.49) or uterine bleeding status (p = 0.82). Conclusion Heterogeneous endometrial echogenicity represents a significant independent sonographic predictor of endometrial malignancy in postmenopausal women and should be incorporated into routine ultrasound risk assessment. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ASSOCIATION BETWEEN PREMATURITY AND NEONATAL MORTALITY IN OUR MATERIAL(Walter de Gruyter GmbH, 2025-05-02); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Sonographic evaluation of the mechanism of labor - our preliminary experience(Faculty of Medicine, 2026-05-22); ; ; Kijajova IvanaIntroduction: Intrapartum ultrasound evaluation is a contemporary diagnostic tool that provides insight into the process of normal labor and assists in its monitoring. Standardized mathematical parameters are used to assess the relationship between defined landmarks on the fetal head and structures of the soft and bony tissues of the birth canal. Aim: This study was designed to show that intrapartum sonographic parameters, primarily the angle of progression and the distance between the fetal head and maternal perineum, are equally effective in the management of labor progress, as vaginal digital examinations. Material and methods: A prospective cohort study was conducted involving 50 laboring women who were admitted at the delivery department of the University Clinic for Obstetrics and Gynecology in Skopje. They were all in the active stage of labor and were evaluated with intrapartum ultrasound, both transabdominal and transperineal, during the first, second and third hours after admission. Results: An increase in the angle of progression and a decrease in the distance between the fetal head and the maternal perineum can help in predicting the mode of delivery and the time interval to delivery. Conclusion: Introducing intrapartum ultrasound as a complementary tool to the digital vaginal examinations, offers new perspectives in the perinatology, with a unique opportunity for modification and modernization of the traditional protocols for management of labor and delivery, still used across the modern countries worldwide.