Faculty of Medicine

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Author: search.filters.author.Andov, MishelLanguage: search.filters.language.English

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    Upper gastrointestinal bleeding from primary aortoesophageal fistula in a patient with aneurism of the thoracoabdominal aorta: Case report and literature review
    (Wiley, 2024-08)
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    Andov, Mishel
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    Kolev, Aleksandar
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    Bundovski, Kristijan
    Upper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option. We present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55‐year‐old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment.
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    MARIJUANA-INDUCED ACUTE CORONARY SYNDROME IN A YOUNG PATIENT
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
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    Jovanoski, Mario
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    Andov, Mishel
    Introduction: Acute coronary syndrome (ACS) is generally a natural consequence of the progression of coronary atherosclerosis. But in minority of cases, it might be developed due to non-atherosclerotic reasons including recreational marijuana use. Possible pathophysiological mechanisms include inflammation, procoagulant state and vasoconstriction (vasospasm) of the coronary arteries. Marijuana adverse effects on cardiovascular system are various and well documented. Case report: We present a 29-years old male who was referred to our Clinic due to chest pain and morphologic ECG changes. The patient has been previously hospitalized in local hospital due to hematochezia. Because of the chest pain, ECG was performed, and blood sample was taken there to determine the troponin level (hs-Tn I). ST-segment elevation and high level of hsTn I were indication for urgent transfer of the patient to our clinic. After admission, the patient underwent coronary angiography and PCI. Thoroughly taken history revealed that the patient was occasionally smoking marijuana in recreational purposes. He was a cigarette smoker, but he had no additional known risk factors for CAD. Conclusion: Recreational marijuana use may be a trigger factor for an acute coronary syndrome. We should always think and suspect marijuana and other recreational drugs as a potential risk factor for adverse cardiovascular events in young patients.
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    Anesthetic Challenges And Management In Patient With Ataxia-Telangiectasia
    (Walter de Gruyter GmbH, 2023-12-01)
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    Louis-Bar Syndrome is a synonym for a very rare complex neurodegenerative disorder ataxia-telangiectasia (A-T). This is an autosomal recessive inherited disease that encompasses abnormalities in the cerebellum, multisystem degeneration, immunodeficiency, increased risk for malignancy and consecutive respiratory insufficiency. Most of the patients are radiosensitive and any exposing to ionization may lead to progression of the disease. Potential risks from anesthesia, mechanical ventilation, and postoperative complications in these patients have been insufficiently discussed in the literature. We present a successful anesthetic and respiratory management with one-lung ventilation in a patient with Louis-Bar Syndrome who underwent video assisted thoracoscopy (VATS) for recurrent pleural effusion.
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    Changes in left ventricular function after coronary artery bypass grafting in patient with left ventricular dysfunction
    (Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2020)
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    Sokarovski, Marjan