Faculty of Medicine

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Modalities of surgical approach in the treatment of lung cancer
(MIT University Skopje, 2024-03)
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Lung cancer is the most common malignancy in men and in the entire human population. It is considered that 2,200,000 new patients are detected annually in the world (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020), of which only 59 patients were surgically treated at the thoracic and vascular surgery clinic in 2022, which is 85% of the total surgically treated in the Republic of North Macedonia.1 Numerous surgical techniques of lung resections are at our disposal in the treatment of lung malignancy, from wedge resection, segmentectomy, lobectomy and pneumectomy, which depends on the stage of the disease, localization of the tumor, involvement of other structures, functional reserves, etc. Lobectomy with lymphadenectomy is still a standard surgical technique in the treatment of early lung cancer (stage I and II non-small cell cancer). The use of oncological drugs before surgical treatment can contribute to the application of surgery in cases where it was not possible, as well as reduce the tumor so that a less extensive surgical procedure can be applied. At the Thoracic and Vascular Surgery Clinic, of 59 patients surgically treated for lung cancer, 49 (83%) were treated with open anterolateral thoracotomy, and lobectomy with lymphadenectomy was most commonly performed in 41 (49.5%).Early diagnosis of lung cancer, using computed tomography screening, would allow the use of less aggressive approaches, such as videothoracoscopic surgery, robot-assisted surgery, and the use of less extensive lung resections such as segmentectomies with lymphadenectomy.
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Evaluation of the surgical treatment of lung cancer
(Department of Anaesthesia and Reanimation, Faculty of Medicine, "Ss. Cyril and Methodius " University, Skopje, R.N. Macedonia, 2024-03)
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Cholanceski R
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Jakupi N
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Bogdanovska M
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Tolevska N
Lung cancer is the most common malignancy in men and in the entire human population. It is considered that 2,200,000 new patients are detected annually in the world (Globcan 2020), 475,000 in Europe (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020). The treatment is multimodal, and several factors influence its choice. Surgical treatment is one of the modalities of treatment and its application depends on numerous factors -histological structure of the tumor, stage of the disease, satisfactory respiratory reserves, satisfactory cardiac reserves, general condition of the patient, etc. At the clinic for thoracic and vascular surgery in 2022, only 59 patients were surgically treated, which is 85% of the total surgically treated in the Republic of North Macedonia. Out of the 59 patients, 44 (74.6%) were men. The average age of the operated patients was 64.22 years, and 37 (62.7%) underwent neoadjuvant chemotherapy preoperatively to reduce the tumor and stage of the disease. Patients who were operated on were mostly in IIIA stage 16 (27.12%). The small percentage of operated patients, 7.7%, and the particularly high percentage of operated patients at an advanced stage indicates that patients are detected at an advanced stage of the disease, which is a contraindication for surgery. Introduction of screening for lung cancer using computed tomography in risk groups will significantly change the therapeutic approach to this group of patients, as well as the outcome of their treatment.
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SURGICAL TREATMENT OF IATROGENIC LESION OF TRACHEA USING “COR MATRIX” PATCH
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2020-04)
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Zdravevska M
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Spasovska K
Injuries of trachea are rare but life-threatening conditions that need urgent and accurate diagnosis and prompt treatment. We present a case of a 29-years old female patient who had two surgical interventions under general anesthesia within a period of four months, in which after the second intervention, subcutaneous emphysema on the neck was detected that was enlarging during the afternoon and therefore an injury of trachea was suspected. CT scan of the neck and thorax was performed that confirmed the subcutaneous emphysema and emphysema in the mediastinum and a suspected lesion of the trachea. Afterword, a bronchoscopy was conducted and a 3 cm long linear lesion of the trachea was visualized 3 cm from the vocal cords and 3,5 cm from the tracheal carina. Then a surgical intervention was performed in general anesthesia, with an approach from the basis of the neck, that led to the dorsal wall of the trachea that was injured, using with PDS suture 000, a part of the lesion was closed, and on the rest part a “cor matrix” patch was placed, which also wrapped the trachea. The patient was extubated the third day after surgery and on the control bronchoscopy the trachea was normal. Early and accurate diagnosis, as well as prompt surgical reparation of tracheal injury provides great morphological and functional results, and prevents further complication.
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Presence of the skip metastasis in axillary pit in patients undergoing surgery of primary breast carcinoma with lymphadenectomy
(Department of Anaesthesa and Reanimation, Ss. Cyril and Methodius University, Faculty of Medicine, Skopje, Macedonia, 2017-11)
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Karapetrov I
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Ferati I
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Ognenovska B
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Ivkovski Lj
Introduction: Axillary status is an important prognostic factor for the breast carcinoma. The axillary pit, can give wrong result for the occupancy at the axillary pit. This can predict condition of the other nodes. Possibility of occurrence of the skip metastasis in biopsy of the sentinel lymph node (SLND), gives us the possibility to remove only one node. introduction of a minimally invasive procedure for determining the axillary status, detection and Aim: Analysis of the 144 patients surgically treated for breast cancer by one surgeon in 2015 in order to assess percentage of skip metastasis. Materials and methods: We analyzed the histopathological results of 144 patients surgically were determined and marked. treated by one surgeon, where level (1-3) of the lymph nodes in axillary pit intraoperatively Results: There were analyzed 144 patients, with mean age of 57.3 years, with an average size of the tumor of 29,54mm + 18.89, with an average removed of 15.45 lymph nodes, and from the third level if there was no positive nodes in the frst and second level). nodes in frst level and positive nodes in the third level, but there was no patient’s positivity in level were 0.37. Only at two patients (1.38%) there were detected skip metastasis (affected 1-2 the third for 2.61. Thus positive for metastatic deposits were 3.76, and positive from the third Conclusion: The percentage of skip metastasis in our study was 1.38%, which is really a small for predicting axillary status and to predict the real situation of the other nodes in the axillary pit. percentage, that gives us right to apply the method for sentinel lymph node detection and biopsy

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