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The treatment of spontaneous intracerebelar hemorrhages.
(2004-11)
Ivana Paganovska
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Elena Spiroska
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Marija Toleska
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Evaluation of the causes of the neurotrauma
(2004)
Marija Toleska
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Ivica Stefanovski
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R. Todorov
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E. Spiroska
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N. Toleska
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Ischaemic stroke due to Moyamoya disease.
(2004)
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Ana Mihajlovska
;
Viktor Arsov
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Marija Toleska
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EPINEPHRINE AND DEXAMETHASONE AS ADJUVANTS IN UPPER EXTREMITY PERIPHERAL NERVE BLOCKS IN PEDIATRIC PATIENTS
(Macedonian Academy of Sciences and Arts, 2021)
Ljubica Mikjunovikj-Derebanova
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Ljupcho Donev
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Albert Lleshi
ABSTRACT Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric population is still under research. Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral upper extremity nerve blocks in pediatric patients. Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020 until March 2021. Patients were randomized into three groups, and all patients in the groups received analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular, or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of 0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21) received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone with a total volume of 0.5ml/kg. Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours, while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations of both sensory and motor block were prolonged for about 30 minutes on average compared to the first group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer compared with the first two groups (p<0.0001). Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in pe- ripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics in the postoperative period.
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ACUTE APPENDICITIS ASSOCIATED WITH ENTEROBIUS VERMICULARIS –CASE REPORT
(Македонско лекарско друштво = Macedonian medical association, 2020)
Radomir Gelevski
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Marija Toleska
Enterobius vermicularis, typically found in cecum, appendix or terminal ileum, is the cause of the most common helminthic infestation in humans. A 19-year-old female patient, with normal laboratory results, was admitted for urgent appendectomy via McBurney inci-sion. After ligation and division of the inflamed appendixfrom the cecal basis, several viable and mobile enterobiusvermiculareswere identified. A short course of alben-dazole treatment was initiated and was interrupted on the second day as a result of the strong anaphylactic reaction. Contrast enhanced CT of the abdomen iden-tified infundibulum of the gallbladder filled with iregu-larhyperdense liquid indicative for parasitic infestation. One month later, elective laparoscopic cholecystectomywas performed, and the removed gallbladder was sentfor parasitological evaluation confirming non-viable worms. Infestation with Enterobius vermicularisobstructsthe lumen of the appendix, causing contraction of the wall and results in appendicitis-like symptoms without signs of acute inflammation. In minority of cases, with pure pathological signs of inflammation a finding of Eneterobius vermicularisis incidental. There are two possible hypotheses regarding the exact mechanism of gallbladder involvement: hematogenous spread or directmigration through unhealthy intestinal tissue. It is recommended to thoroughly examine all appendiceal specimens for presence of this worm, in order to provideadequate anthelminthic therapy in case of infestation.
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Comparison of benzodiazepines and opoides as oral premedication in pediatric anesthesia
(Македонско лекарско друштво = Macedonian Medical Association, 2017)
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Albert Leshi
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DOUBLE, VERY SHORT CYSTIC ARTERY: ANATOMIC VARIATION REVEALED DURING LAPAROSCOPIC CHOLECYSTECTOMY: A CASE REPORT
(Македонско лекарско друштво = Macedonian Medical Association, 2020)
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Marija Toleska
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Introduction. The cystic artery (CA) is the key struc-ture sought to be clipped or ligated during laparoscopicor conventional cholecystectomy.In up to 25% of sub-jects, the superficial and deep branches of the CA have separate origins and Michels called them double CA. Case report. We are presenting a 38-year-old female with one-year history of chronic gallbladder inflamma-tion. During the laparoscopy dissection in the region of the Calot’striangle, we revealed an anatomic va-riation of the cystic artery-a double cystic artery. The more important thing was that both branches were ex-tremely short, or at the lower limit of the publishedlengths of this blood vessel-approximately 3mm each. Bydoing so, the surgicalcourse further took the standardcourse-laparoscopic clips were placed on both branches. Conclusion. The incidence of double CA ranges from 15 to 25%. Such arteries usually arise from RHA and frequently replace the deep branch of the CA. Anatomicvariations in and around Calot’s triangle are frequent. Therefore, careful dissection of Calot’s triangle is ne-cessary for both conventional and laparoscopic chole-cystectomy. Hemorrhage could be a problem during search of the CA if these variations are overlooked and that increases the rate of conversion to open surgery. It also hasto be kept in mind that during laparoscopic visualization anatomical relations are seen differently compared to conventional cholecystectomy

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