Faculty of Medicine

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    Phyllodes tumor- Case report
    (Macedonian Association of Radiologists, 2023-11)
    Petrovski, Aleksandar
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    Antuleska Belcheska, Gordana
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    Mihajlovska Rendevska, Ana
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    CT Findings in Progressive Xanthogranulomatous Pyelonephritis
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
    Jovanovska, Zlatica
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    Petkovikj, Magdalena
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    Donevska Efremovska, Kristina
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    Kamcheva, Marta
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    Resulting from recurrent subacute or chronic urinary infections, a chronic pyelonephritis develops, which can be represented as several entities. Xanthogranulomatous (XGP) pyelonephritis is one of those entities which has characteristic radiographic features. The inflammatory process following the recurrent infections causes destructions to the parenchymal wall of the kidneys and over time it is replaced with a mass of reactive granulomatous tissue, containing lipid-laden macrophages, which surrounds the typical form of calculi – staghorn calculi. These are the pathognomonic radiological signs. CT is the modality of choice in diagnostic imaging for xanthogranulomatous pyelonephritis for two reasons – in the most of cases it demonstrates a highly specific tirade of findings that allow a confident diagnosis and offers accurate follow-up of the disease which is of great importance for the further surgical treatment. We present the CT findings of a clinical case throughout 6 years long follow up of chronic pyelonephritis which advanced to development of XGP and a complication with purulent collection in the left kidney, which resulted in left sided nephrectomy. This article describes the role of diagnostic imaging and correlates the radiologic findings to the underlying disease process. Additionally, we emphasize the diagnostic importance of CT in treatment, follow-up and preoperative planning.
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    Unveiling the neuropathology tumour landscape: 10-year statistical analysis with global comparison – Single centre experience
    (Macedonian Academy of Sciences and Arts, 2023-12)
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    Introduction: Central nervous system (CNS) tumours represent a significant public health issue worldwide, and their incidence and distribution vary across different populations. Although studies on CNS tumours have been conducted in various countries, there is a lack of information regarding their patterns in Macedonia. Therefore, this study is aimed at investigating the distribution, histopathological types and subtypes and demographic features of CNS tumours in our country. Materials and Methods: A cross sectional study was conducted using the electronic database of the Institute of Pathology – Medical Faculty, University “Ss. Cyril and Methodius” in Skopje which contains data from 3286 received and analysed surgical specimens, mainly from the University Clinic of Neurosurgery in Skopje, and a smaller number of surgical specimens from the University Surgical Centre “St. Naum Ohridski” in Skopje between 2012 and 2022. The collected and analysed data includes patient age, sex and histopathological types and subtypes of the tumours. Results: The majority of CNS tumours were diagnosed in adults aged between 50-70, with a male to female ratio of 1.5:1. The most common location of the tumours was the cerebrum, followed by the pituitary gland and cerebellum. The most frequent histological groups were gliomas, with glioblastoma as the most common diagnosis, followed by meningiomas. Conclusion: Following a detailed and thorough review of the CNS tumours in our study, we can conclude that the R. of Macedonia follows global statistics and trends regarding brain tumours.
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    CONTEMPORARY ASPECTS IN THE PATHOGENESIS OF BRAIN EDEMA IN PATIENTS WITH HEMORRHAGIC CEREBROVASCULAR INSULT
    (2020-07)
    Mihajlovska Rendevska, Ana
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    Aleksovski, B
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    Aleksovski, V
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    Mircevski, M.M
    The worst neurological deterioration after hemorrhagic cerebrovascular insult (H-CVI) occurs due to the formation of perihematomal edema, a proven significant risk factor for poor prognosis. During the last several years, a vast number of studies have been focused on the pathogenesis of the brain edema. The main objective of this review paper was the evaluation of the biochemical and molecular mechanisms involved in the pathogenesis of the edema, with a special focus on the inflammatory and oxidative mechanisms. We believe that this brief review could serve as a motivational boost for designing a comprehensive clinical study, in which the radiological and clinical variables, as well as the proinflammatory mediators and the oxidative stress markers will be simultaneously evaluated for their predictive roles in the formation of brain edema.
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    The role of TNF-α-based models in prognostication of the outcomes after ICH: a pilot study
    (2019-10)
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    Aleksovski, Boris
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    Abstract Introduction: Recently, we have developed TNF-α-based models for prognostication of the 3-month neurological outcome in patients after Intracerebral hemorrhage, ICH (Rendevski et al., 2018). In this pilot study, we aimed to test their utility in the clinical practice for the purposes of identification of the patients who will most likely end up with a poor outcome, as well as to test their utility for clinical decision making between conservative and surgical intervention. Methods: 20 patients with ICH were included initially in this pilot longitudinal study. Their peripheral blood TNF-α levels were screened, and the risk for poor outcome was assessed by using our previously determined cutoff value of > 110.35 pg/mL. The neurological outcome was determined 3 months after the initial hemorrhagic cerebrovascular insult. Another series of 20 threatened patients with TNF-α levels higher than 200 pg/mL were tested for the possibility of lowering the risk of the poor outcome by implementing early craniotomy with hematoma evacuation. Results: The value of > 110.35 pg/mL had fairly identified the patients who later fell into the group with poor outcome, 3 months after ICH (8 out of 9 identified patients with risk for poor outcome have resulted in a poor outcome). In the second series of 20 threatened patients with TNF-α levels higher than 200 pg/mL, early craniotomy and evacuation of the hematoma were shown beneficial; 7 out of 20 patients resulted in a good outcome. Conclusions: TNF-α screening at admission was shown as a useful method for identifying the ICH patients with the highest risk for ending with poor neurological outcome; early craniotomy with hematoma evacuation in the threatened group of patients with the highest TNF-α levels has also shown benefit in lowering the risk for poor outcome and improving patient's neurological state 3 months after ICH.
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    Peripheral glutamate and TNF-α levels in patients with intracerebral hemorrhage: Their prognostic values and interactions toward the formation of the edemal volume
    (VM Media SP. zo.o VM Group SK, 2018-03)
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    Aleksovski, Boris
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    Stojanov, Dragan
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    Aleksovski, Vasko
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    Mihajlovska Rendevska, Ana
    We aimed to evaluate the prognostic values, contribution and interactions of the peripheral blood plasma glutamate and tumor-necrosis factor-α (TNF-α) levels toward the formation of the perifocal edema in patients with intracerebral hemorrhage (ICH).
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    Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage
    (Walter de Gruyter GmbH, 2017-12-01)
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    Stojanov, Dragan
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    Aleksovski, Boris
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    Mihajlovska Rendevska, Ana
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    <jats:title>Summary</jats:title> <jats:p>The aim of the paper was to evaluate the surgical outcome in patients with spontaneous supratentorial intracerebral hemorrhage (ICH) after surgical intervention, in respect to the initial clinical conditions, age, sex, hemispheric side and anatomic localization of ICH. Thirty-eight surgically treated patients with spontaneous supratentorial intracerebral hemorrhage were included in the study. The surgical outcome was evaluated three months after the initial admission, according to the Glasgow Outcome Scale (GOS). The surgical treatment was successful in 14 patients (37%), whereas it was unsuccessful in 24 patients (63%). We have detected a significant negative correlation between the Glasgow Coma Scale (GCS) scores on admission and the GOS scores after three months, suggesting worse neurological outcome in patients with initially lower GCS scores. The surgical outcome in patients with ICH was not affected by the sex, the hemispheric side and the anatomic localization of ICH, but the age of the patients was estimated as a significant factor for their functional outcome, with younger patients being more likely to be treated successfully. The surgical outcome is affected from the initial clinical state of the patients and their age. The treatment of ICH is still an unsolved clinical problem and the development of new surgical techniques with larger efficiency in the evacuation of the hematoma is necessary, thus making a minimal damage to the normal brain tissue, as well as decreasing the possibility of postoperative bleeding.</jats:p>
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    Modeling prognostic factors for poor neurological outcome in conservatively treated patients with intracerebral hemorrhage: A focus on TNF-α
    (Elsevier BV, 2018-09)
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    Aleksovski, Boris
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    Stojanov, Dragan
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    Mihajlovska Rendevska, Ana
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    Aleksovski, Vasko
    Prognostic models for Intracerebral hemorrhage (ICH), mainly based on clinical evaluation, have remained inherently confounded by subjective scoring assessments and limited accuracy. In this study, we aimed at assessing the risk for poor outcome after ICH based on peripheral biochemical markers (TNF-α, glutamate and glucose) and radiological variables (both at admission and five days after patient's care), for modeling purposes of prognostication.
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    Effects of data transformation on multivariate analyses in intracerebral hemorrhage
    (Macedonian Pharmaceutical Association, 2016)
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    Aleksovski, Boris
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    Kolevska, Milena
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    Stojanov, Dragan
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    <jats:p>Multivariate statistical approaches have been increasingly applied in hemorrhagic stroke data analysis. Nevertheless, several aspects regarding their relevance and validity in respect of the application of data transformations have not been studied in details. This paper examines the effects of different data transformations in the standard statistical methods of the multivariate analysis of the intracerebral hemorrhage (ICH) parameters in small group samples. Two different methods for data transformations (log transformation (log(Xi )), square root transformation (√Xi ))have been carried out. The initial volume of the ICH have been studied using several test for skewness, kurtosis, histogram distribution method and different quartile-quartile (Q-Q) and probability-probability (P-P) plots as criteria for normal distribution. Multivariate analyses for the prediction of the perifocal edema was performed using raw and transformed data. Our results indicate that the data transformation operations should be performed very carefully because different analytical outputs lead to different scientific conclusions.</jats:p>
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