Faculty of Medicine

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OUR EXPERIENCY WITH USING THE OMENTAL FLAP FOR THE TREATMENT OF GYNECOLOGIC JATROGENIC VESICOVAGINAL FISTULAS
(SHMSHM - AAMD, 2018)
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Ismaili, Bashkim
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Dalipi, Adelina
Objective: To report our experience with using the omental flap for the treatment of gynecologic jatrogenic vesicovaginal fistulas (VVF). Material and methods: The study evaluated 14 patients who underwent VVS repair with transabdominal approach with omental flap between January 2010 and December 2013. The main causes of VVF in this study cohort were 9 (64.2%) for benign and 5 (35.8%) for malignant conditions. In all cases were used omental flap with sufficient length in delayed surgical repair (after 3 month of gynecologic surgery). Preoperatively the cystoscopi with colposcopy was done to identify the size, site, number of fistulas and relationship with ureteral orifices and sites of vagina. In addition CT urography or intravenous pyelograms were performed to exclude the ureterovaginal fistulas. The dorsal lithotomy position, with infraumbilical laparothomy approach and transvesical O’Connor technique in general anesthesia were used. Before resection of fistulous canal up to fresh and healthy tissue the intubation of ureteral orifices were performed. Further multilayer defect closure beginning from vagina, omental flap interposition, followed by bladder serosa and mucosa. Next 7 days bladder was drained with urinary catheter, cystostoma and ureter stents, which were pulled out one by one next 2 days. At 10th day, before catheter removal was performed cystogram. Results: Operative method is successful in 13 (93%) of patients. After one year follow up it’s no recurrence. The bladder capacity is sufficient. Conclusion: O’conore’s technique for repairing subtrigonal and supratrigonious vesicovaginal fistulas over 10 mm in wide, with the omentum interposition, is a method that promise a high percentage of success in the first repair.
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Covid infection as devastating post-transplant complication
(Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020)
Dohchev, Sasho
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Trifunovski, Aleksandar
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Trajkovski, Dimitar
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Janchulev, Josif
In march 2020 Covid 19 was declared as a pandemic by World Health Organisation. The marked risk group were older patients and patients with comorbidity such as hypertension, DM, obstructive pulmonary disease and chronic kidney disease. Patients on dialysis and kidney transplant recipients are among highest risk groups to be infected with Corona virus. Since the very beginning, Corona virus pandemic have great impact on the transplant program worldwide. There are recommendations for kidney transplant profe- ssionals that suggest the prioritization of patients for kidney transplantation. We present an expanded criteria donor, and recipient with multiple vascular access problems as an indication for kidney transplantation. In the early posttransplant period vascular problems with implication on the graft function were diagnosed and surgically treated, and cholecystecto- my was performed due to an uncalculous cholecystitis. Unexpected Corona virus infection early post transplan- tation occurred as a devastating complication for our kidney transplant recipient.
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INFLUENCE OF CARDIAC RISK PREDICTORS ON SURGERY OUTCOME IN ELDERLY WITH HIP FRACTURE
("Ss Cyril and Methodius"University, Faculty of Medicine, Skopje, R. N. Macedonia, Department of Anesthesia and Reanimation, 2017)
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Mojsova Mijovska, Maja
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ABSTRACT Introduction: Patients with hip fracture are usually older and stress of trauma and surgery may increase cardiac morbidity and mortality. The aim of this study was to compare the influence of cardiac risk factors on surgical outcome in elderly patients with hip fracture. Methods: 120 patients with hip fracture older than 70 years with previously defined high or low per operative cardiac risk according to ACC/AHA guidelines were included and were assigned to two groups of 60 patients: Risk group –patients with high cardiac risk; and NR (non risk) group without or with low cardiac risk. Recipients from the both groups were pain relief with intravenous analgesia: Niflam 2 x 100 mg/iv and Tramadol 50 mg/iv every 8 hours; As an end point of the study were registered the incidence of cardiac events in both groups: cardiac death, myocardial infarction, congestive heart failure, unstable angina and new-onset atrial fibrillation. In all patients was determined pain intensity by using Verbal Descriptive Scale as well as the side effects. Results: Recipients with high cardiac risk has higher incidence of postoperative cardiac events versus patients with low cardiac risk (Risk group 46.6% vs. 15% in NR group) and the same result is with mortality rate (10% in Risk group vs. 0% in NR group). The values of VDS were equal in recipients from both groups. Conclusion: Patients with hip fracture are classified as a high risk patients according the presents of high risk cardiac predictors, and have significantly higher incidence of postoperative cardiac morbidity and mortality.
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POSTOPERATIVE SERUM CREATININ LEVEL IN TWO DIFERENT HYDRATION REGIMES IN LIVING DONOR KYDNEY TRANSPLANATATION
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia, 2017-04)
Mojsova Mijovska, Maja
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Introduction: Early graft function is very important and can be achieved with adequate intraopeartive perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting central venous pressure (CVP) on early graft function. Material and methods: After approval of Ethical committee of the Medical Faculty-Skopje, we obtained inform consent of 60 patients, ASA 2-3 undergoing renal transplantation of livingrelated person in the Clinic of Urology – Skopje. A prospective clinical study was performed in the period of 2 years. Patients were divided into 2 groups of thirty patients : group A receiving normal saline intraoperatively targeting for CVP to 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. We recorded lactate at the end of the surgery, onset of diuresis and total urine output from unclamping the renal vessels to the end of the surgery in both groups and postoperative serum creatinine in 3times (3, 12, 36 hours). Results: The onset of diuresis in seconds was insignificantly longer in group B p>0,05 (p=o,31). The average value of postoperative levels of the lactate showed that in group B the levels of the lactate were significantly higher for Z=-5,79 and p<0,001 (p=0,000). We didn’t find any statistical differences in postoperative serum creatinine in both groups. Conclusion: Our study didn’t show any benefit from targeting CVP to 15 mmHg. We couldn’t find any significant difference on onset of diuresis and urine output after the unclamping the vessels. However, in the constant infusion group (group B) the level of the lactate was higher CVP. In postoperative biochemical parameters we had no statistical difference between the average values of serum cratinine.
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The impact of intraoperative targeting of the central venous pressure on the onset of diuresis in living donor kidney transplantation
(Macedonian Association of Anatomists and Morphologists, 2016)
Mojsova Mijovska, Maja
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Introduction: Early graft function is very important and can be achieved with an adequate intraoperative perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting CVP on the onset of diuresis in kidney transplantation. Material and methods: The patients were divided in 2 groups of thirty patients: group A receiving normal saline intraoperatively, targeting for CVP 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. The hemodynamic changes were recorded as systolic, diastolic and mean arterial pressure in 4 times: T0 before the induction, T1 after induction, T2 before the clamping the vessels and T3 after unclamping. We also recorded the duration of surgery, the duration of cold and warm ischemia, and the amount of normal saline until the unclamping of the vessels, lactates at the end of the surgery and total urine output from unclamping the renal vessels to the end of the surgery in both groups. We were monitoring the administration of plasma expander, dopamine and furosemide (if higher than 40mg) and we were inspecting if any tissue edema occurred. Results: There were no statistically significant differences in intraoperative hemodynamic parameters between both groups. The onset of diuresis in seconds was insignificantly longer in group B p>0.05 (p=0.31). The average value of postoperative levels of the lactate showed that in group B the level of the lactate were significantly higher for Z=-5.79 and p<0.001 (p=0.000). Conclusion: CVP as a guide for volume substitution is still highly recommended in kidney transplantation. The fact that in group B (the constant infusion group) we had 5 (16.7%) patients in whom we didn’t achieved urine output at the end of the surgery and the level of lactate was higher in group B gives us the right to conclude that targeting higher CVP, promotes diuresis and better urine output at the end of the surgery.

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