Faculty of Medicine

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Author: search.filters.author.Chalcheska, Slavica

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    OSMOTIC DEMYELINATION SYNDROME
    (Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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    Risteski, Filip
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    Chalcheska, Slavica
    Abstract. Osmotic demyelination syndrome (ODS) may be observed as a result of a rapid change in serum osmolarity, such as that induced by an overly rapid correction of serum sodium levels in hyponatraemic patients. Case presentation. We report a case of a 40-year-old male, first hospitalization through Emergency center (glucose 6.4 mmol/l. ECG: sinus rhythm, normal axis with SF 70/min.). Patient has electrolyte imbalance ,elevated liver enzymes, high enzyme activity predominantly of CK (6664) in relation to transaminase activity (AST 288, ALT 127), elevated CK, hyponatremia, hypokalemia and extremely low sodium = 95.Main complaints were muscle pain, muscle weakness, slurred speech, weakness, walk inability. Diagnostic findings. The diagnosis was confirmed by MRI 1,5T Simens Magnetom Essenca (brain) that showed large tipical inhomogeneous hypersignal lesion in the central pontine region on T2 weighted and FLER images with restriction of DWI. There is signal intensity of the basal ganglia nucleus lentiformis and and caudate cerebral nuclei on axial T2 weighted images and FLAIR images which were suggestive of CPM. Teaching points. Central pontine myelinolysis is an acute non-inflammatory demyelinating disorder.It is precipitated by the rapid correction of severe chronic hyponatraemia.Electrolyte abnormalities other than sodium should be investigated and rectified.An in-depth neurological examination is mandated to assess the severity and progression of ODS.MRI is the radiological modality of choice for earlier detection of ODS lesions.
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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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    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.