Faculty of Medicine

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Author: search.filters.author.Dungevski, GjorgiLanguage: search.filters.language.English

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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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    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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    Placement of central venous access port in the interventional radiology suite – single center experience
    (Macedonian Association of Radiologists, 2023-11)
    Jovanovska, Ivona
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    Gjoreski, Aleksandar
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    Dungevski, Gjorgi
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    Ramadani, Pranvera
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    Nancheva Bogoevska, Andrea
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    Incidental Breast Lesions detected on computed thorax tomography
    (Macedonian Association of Radiologists, 2023-11)
    Andonov, Gorazd
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    Dungevski, Gjorgi
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