Faculty of Medicine

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    Item type:Publication,
    GIANT LEFT HEPATIC CYST WITH GASTRIC OUTLET OBSTRUCTION
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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    Mihajloska Blazhevska, Pandora
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    Jovanovska, Frosina
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    The prevalence of cystic hepatic lesions in the United States is estimated to be 15%-18% and simple hepatic cyst is the most common, found in 2.5%-18% of the population. Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with GOO will often have recurrent vomiting of food that has accumulated in the stomach, but cannot pass into the small intestine due to the obstruction. A 74-year-old patient was admitted to the emergency department due to diffuse abdominal pain, bloating and tenderness in the upper abdomen. In the last month, he had malaise, bloating (especially after a large meal), loss of appetite, regurgitation and a metallic taste in the mouth. Laboratory tests (WBC 12.000, CRP 10) and a CT scan of the abdomen with contrast were performed. We detected a multiple cystic formations on the right liver lobe and larger one on the left liver lobe that compresses the antro-pyloric part of the stomach and D-1 of the duodenum. We performed gastric emptying with a nasogastric tube, serological tests to exclude possible echinococcosis and tumor markers to exclude possible malignancy. Then, we performed a diagnostic gastroscopy and the findings were normal. An indication for laparoscopic intervention has been made and laparoscopic evacuation and excision-reduction of the simplex cyst was performed. The histopathological analysis revealed a simplex cyst. The patient had a normal postoperative course and was discharged home on the third postoperative day. At the examinations after 1 and 3 months, the findings were normal. Large cysts within the liver parenchyma are in contact with the vascular, biliary and digestive systems. The resulting compression may lead to inferior vena cava obstruction, Budd Chiari syndrome, obstructive jaundice, portal hypertension and Gastric Outlet Obstruction.
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    Item type:Publication,
    Ligasure hemorrhoidectomy (LH) with „near base“ technique
    (Springer Science and Business Media LLC, 2021-10)
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    Jovanovska, Frosina
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    Mustafova, Alma
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    Dervisov, Kristijan
    Ligasure hemorrhoidectomy (LH) with „near base“ technique Şenol Tahir*, Martina Ambardjieva, Frosina Jovanovska, Alma Mustafova, Kristijan Dervisov, Nimetula Limani, Berat Dalipi, Petar Markov University Clinic for Surgical Diseases, General and Abdominal departemen – St. Naum Ohridski, Skopje, N. Macedonia Background: In this study we evaluate the use of MilliganMorgan hemorrhoidectomy with Ligasure vessel sealing. Methods: Grades 3 and 4 hemorrhoids are operated with Ligasure by coagulation and cutting of the hemorrhoids at positions 5, 7 and 11 hour. Te patients received premedication, analgesia and intravenous 500 mg metronidazole preoperatively. Under anesthesia, placed in a lithotripsy position, the anoscope is placed with a easy retraction, than a 5 mm V shape incision is made with the scalpel at the anocutaneous border. Te nodule was lifted with an instrument and the LigaSure was placed on the base of the nodule (leaving 2 mm enough mucosa above the sphincter), coagulated and incised. Te control check, 24 hours later and sent home with oral analgesic and metronidazole therapy. Follow-up 7, 14 and 28th day Results: 52 patients undergoing LH surgery, with an average age of 42.5 years. 59 % are women and 56 % are grades III. Average operative intervention 17.0+4.1 minutes, hospital stay 1.2 days, Postoperative pain (VAS1-6) 3. Urinary retention 0.4 %. Minor bleeding 5.6 %. Pruritus in 5.6 %, gas incontinence 7.6 %. No stenosis or incontinence. Conclusions: LH is an efective and safe surgical method and it should be used as a routine.