Faculty of Medicine

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Intrafetal Interventional Procedures and Anesthetic Implications
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-05)
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Nancheva Bogoevska, Andrea
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Elenova, Biljana
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Sivakov, Borche
Intrafetal surgery is an operative procedure which is performed on a pregnant mother to treat her baby before it is born. Maternal-fetal surgery can occur either during the middle of pregnancy or at the end of the pregnancy. In all cases, anesthesiologists are involved to provide for the comfort and safety of pregnant mothers and their babies. As these defects and malformations have become more readily identified, the number of innovative therapies has also amplified. Rapid advances in imaging techniques and prenatal diagnosis have allowed for the progressive development of prenatal interventions and surgeries and today they have become an integral part of the management of high-risk pregnancies. In addition, the rapidly growing capability of digital optics and miniaturized instrumentation has now allowed fetoscopy procedures to become a reality. There are 3 basic types of surgical interventions: 1. Minimally invasive midgestational procedures, 2. Midgestational open procedures, 3. Ex-utero intrapartum treatment (EXIT). These procedures require many manipulations and monitoring in both the mother and the unborn fetus. The combination of underdeveloped organ function and usually life-threatening congenital malformation places the fetus at considerable risk. Fetal surgery also leads to enhanced surgical and anesthetic risk in the mother including hemorrhage, infection, airway difficulties and amniotic fluid embolism, so anesthetic management should focus on maintaining adequate uteroplacental blood flow, optimizing surgical conditions, and minimizing maternal and fetal risk.
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RADIOLOGY MODALITESAPPROACH IN ANGIOLEIOMYOMA UTERI.A CASE REPORT
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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Chalcheska, Slavica
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Nancheva Bogoevska, Andrea
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Introduction. Angioleiomyoma uteri, also known as vascular leiomyoma, is a rare benign tumor that arises from uterine blood vessels and smooth muscle cells. Aim of the study was to present the radiological modalities to diagnose the rare disease, the uterine angioleiomyoma. Material and Methods. A case of 25 year old female was admitted to hospital with diffuse abdominal pain and abnormal uterine bleeding. The patient was examined by an ultrasound (US) Siemens, computed tomography (CT) GE 64 slice and magnetic resonance (MR) Siemens Somatom Essenca 1.5 with T1-weighted, T2-weighted, T1 C+ (Gd). Results. A well-defined mass was noticed by US and an additional internal vascularity by doppler. On contrast enhanced CT scan in the arterial and venous phase, the giant mass showed multiple vascular branches. At CT scan the giant mass was found inseparable from uterine corpus and uterine fundus. Due to inconclusiveness of the results, MR was additionally performed, showing well-defined mass, which was incapsulated and accompanied with internal vascular flow voids. Conclusion. Radiology modalities approach is necessary in detection of uterine angioleiomyoma. As it may recur or it may transform into a malignant tumor, although in rare cases, a regular follow-up is obligatory.
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COVID -19 INDUCED AORTIC THROMBUS AND CRITICAL LIMBISHAEMIA
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2023-04-07)
Nancheva Bogoevska, Andrea
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Risteski, Filip
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Gjoreski, Aleksandar
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Jovanoska, Ivona
50 years old male presented with livid redness on both feet, predominantly left, accompanied with severe pain and coldness. Two weeks before, he admitted to hospital due to COVID-19 bronchopneumonia. Urgent abdominal and lower extremities contrast enhanced CT was performed, which showed mural thrombus of the abdominal aorta (AA) extending from below the left renal artery to the iliac bifurcation and total occlusion of the left and partial occlusion of the right crural arteries. Interventional procedures are the first choice for initial emergency management, leaving surgery as a second and anticoagulant therapy as third option for treatment. Endovascular treatment is based on stent grafting. Covered stent graft was used to repair the AA and kissing stenting technique was used in the aortoilical part. The result was complete patency of AA and both iliacal arteries, with improved clinical status. Mural thrombi are likely to occur in large vessels as the heart and descending aorta, and less commonly in the aortic arch or the AA, causing flow reduction. Their occurrence is a rare in the absence of hypercoagulative state or inflammatory, infectious, or familial aortic ailments. In our case, Covid -19 is associate occurrence of thrombus in the AA, which throws out smaller thrombi in the peripheral circulation that causes critical limb ischemia (CLI).CT is the best modality for early diagnosis and endovascular treatment the least invasive treatment. Mural aortic thrombus accompanied by CLI is an urgent medical condition which, if not diagnosed and treated on time, can result in limb amputation or death. Endovascular stenting is first choice of treatment in patients without previous vascular disease.
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ASSOCIATION OF RENAL AGENESIS AND IPSILATERAL SEMINAL VESICLE CYST – ARARE CASE OF ZINNER SYNDROME
(Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
Chalcheska, Slavica
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Jovanoska, Ivona
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Nancheva Bogoevska, Andrea
Introduction We report a case of Zinner syndrome, a congenital malformation characterized by association of renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Case presentation A 44 years old patient, previously diagnosed with benign prostatic hyperplasia and chronic prostatitis was admitted at our department for puncture of pelvic cyst. Transrectal ultrasound (US) guided puncture and aspiration of the cyst was performed. Few days later, patient presented with septic symptoms and computed tomography (CT) scan was done, which showed large cyst with air inclusions, measuring 13x14cm in diameter in right seminal vesicles and right renal agenesis compatible with Zinner syndrome. An urgent surgical drainage of the cyst was done, followed by improvement of patient’s clinical condition. Discussion Zinner syndrome is one of the rarest congenital anomalies of urogenital tract and is usually discovered and diagnosed after3rd -4th decade of life. Patients are often asymptomatic but they can present with dysuria, recurrent prostatitis or epdidymitis. Radiological modalities have a significant role into detecting and evaluating Zinner syndrome including US, CT and MRI. When symptomatic, most commonly due to its size, surgical excision or transrectal aspirations of the cyst are options of treatment. Conclusion Combination of clinical history and radiological imaging are essential for making the diagnosis and proper management of this rare entity.
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"DEVELOPMENTAL HEMOSTASIS" AND PEDIATRIC SURGERY
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023-12)
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Nancheva Bogoevska, Andrea
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Hemostasis can be defined as a physiological process that stops bleeding after injury of blood vessels. It is a complex and highly regulated process to localize the blood clot only to the site of injury. The hemostatic system in the human body is based on the components of Virchow’s triad: 1. vascular injury, 2. change in blood coagulability, 3. disturbance of blood flow (stasis). If the third component (blood flow) is excluded, hemostasis can be defined as an inter-reaction between the blood vessel wall, blood cell components and plasma proteins that maintain the hemostatic balance. The final outcome of hemostasis is coagulation of blood at the site of vascular injury(1,3). Hemostasis can be divided into primary, secondary and tertiary hemostasis. These three independent mechanisms combine to maintain hemostatic balance.
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Placement of central venous access port in the interventional radiology suite – single center experience
(Macedonian Association of Radiologists, 2023-11)
Jovanovska, Ivona
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Gjoreski, Aleksandar
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Dungevski, Gjorgi
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Ramadani, Pranvera
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Nancheva Bogoevska, Andrea
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METASTATIC CUTANEUS MELANOMA OF THE GALLBLADDER-CASE REPORT
(Association of medical doctors "Sanamed" Novi Pazar, 2019-08-04)
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Nancheva Bogoevska, Andrea
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Bozinovska Beaka, Gordana
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Gjoreski, Aleksandar
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Melanoma is an aggressive malignant tumor that originates from melanocytes and most com- monly occurs on the skin. Dominantly metastasize to regional lymph nodes, in the brain and lungs and rarely in the gastrointestinal (GI) system. The aim of this re- port is to present a rare case of metastasis of cutaneous malignant melanoma in the gallbladder, discovered 10 months after excision of the primary melanoma of the skin. A 45-year-old patient was hospitalized in our hos- pital due to abdominal pain in right upper quadrant and nausea lasting for 7 days. An intraluminal substrate was found in the gallbladder with computed tomogra- phy and later a CT guied biopsy was performed on it, thus proving a metastatic deposit of primary malignant melanoma. Metastatic deposits in the gallbladder are extre- mely rare finding, and 238 cases have been described in the literature.

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