Faculty of Medicine
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Item type:Publication, A CASE OF TWIN PREGNANCY WITH CONJOINED TWINS(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023-10); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Effect of intra-arterial Nimodipine on subarachnoid hemorrhage injured brain(Macedonian Association of Anatomists and Morphologists, 2022-08-31); ; ; Subarachnoid hemorrhage is a pathological condition of the brain, caused by rupture of intracerebral aneurism or arteriovenous malformation, with high morbidity and mortality rate. SAH may conceive permanent brain damage with persistent disability. Vasospasm isthe most characteristic pathological state of the vasculature, whose development coincides with onset of bleeding with asymptomatic presentation. The critical extend as a risk factor presentswith symptom presentation and indication of brain damage development. Early vasospasm treatment is a priority in prevention of brain ischemia and disability. Existing methods of vasospasm treatment are conservative, endovascular and combined, with simultaneous intraarterial vasodilator application.The aimof this study wasto determine whether intraarterial application of Calcium-blocker Nimodipine will generate immediate vasodilation, facilitating endovascular aneurism treatment, resulting in longterm resolution of the condition.Fifteen patients with SAH receivedendovascular treatment in the first 48 hours of hemorrhage onset, with consequent intraarterialNimodipine application if vasospasm was detected. All patients had ruptured aneurism of anterior circulation. Vessel diameter was measured before and after Nimodipine application. The occurrence and degree of vasodilation, as a difference between both diameters,were considered a confirmation of drug effectiveness.Complete spasm relief occurred in 10patients, residual vasospasm persisted in 4 patients, no VS relief occurred in 1 patient.IntraarterialNimodipine application during endovascular brain aneurism treatment effectively relievesvasospasm. Early coiling reduces complication risks and development of postischemic brain damage. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MECHANICAL THROMBECTOMY IN STROKE - OUR TEN MONTHS EXPERIENCE(2019-10-24); ; ; ; Bushinoska, JasnaMechanical thrombectomy for stroke patient started in November 2018 in our country. For ten months we have 21 patient with large vessel occlusion. Our center is for now single center that provide mechanical thrombectomy for population of two million people. All stroke patient were with large vessel occlusion on CT and CTA. First patient was directly evaluated and treated in angiography suite on the basis of native CT- hyperdense MCA sign and clinical symptoms. Next patient underwent CT and CTA and one with MR/MRA. Four patient were with T occlusion, two successful recanalization and two failure. Other 17 were M1/M2 occlusion from witch tree tandem lesions ICA and M1. Patients were on age of 25 to 73 years old. We used stent retriever in all patients (solitaire or embotrap) and aspiration together and in most of patient intermediate catheter ( sofia/sofia plus) but we never used balloon guiding catheter. Time window in 18 patient was <6h and 3 of patients with wake up stroke. All patients were with NIHSS >5. TICI 2b was achieved in 8 patients, TICI 3 in 4 patients, TICI 2a in 3 patients, in one patient grade 1 and no reperfusion in 5 patients from witch one with worsening. No major hemorrhage appeared but only 4 patients previously received IV tPA. Till today no national strategy for stroke patient pathway. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Spinal epidural hematoma after lumbar catheter insertion in a patient who underwent TEVAR for an aneurysm of the descending aorta(SciTechnol, 2020-01-29); ; ; Asani, ElmedinaWe present a case of spinal epidural hematoma after Lumbar catheter insertion in a patient who underwent TEVAR for an aneurysm of the descending aorta. Spinal epidural hematoma (SEH) is a relatively rare entity and has been reported to occur in patients who receive anti-coagulant therapy, have bleeding disorders, or after traumatic needle insertion. In our case, the epidural hematoma occurred 4 hours after catheter insertion, in a patient who received anticoagulant and antiplatelet medication. In these cases, early detection of symptoms and rapid diagnosis are an imperative. Our patient’s diagnosis was done 5 hours after symptom development and it consisted of thoracolumbar MRI that showed a spinal hyper-acute epidural hematoma extending from T9-T10 to L4-L5 and the affected segments of the spinal cord and conus medullar showed edema, most significantly at L1-L2 levels. A neurosurgical consult was done immediately after obtaining the results and within six hours after neurosurgical symptoms occurred, the patient underwent spinal decompression, the hematoma was evacuated and the patient regained motor function in her legs. During her stay at the cardiac ICU, the doctors administrated to our patient antiplatelet medication alongside low-molecular-weight heparin (LMWH)–inj. Clexane 40 I.U., against our recommendations. Due to this, our patient developed re-bleeding and we had to perform a second surgery, to do a more extensive spinal decompression and to evacuate the hematoma. Neurologic rehabilitation after the second surgery was difficult, but with extensive physical therapy, we have managed to achieve some improvement, with motor response 2\5 on the left leg and 3\5 on the right leg. Although anticoagulants and\or antiplatelet medication are a must in endovascular procedures and are considered safe to use during epidural analgesia, special attention and care to epidural hematoma should be given, especially in cases when an epidural catheter placement is needed.