Faculty of Medicine

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Author: search.filters.author.Risteski, Filip

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    OSMOTIC DEMYELINATION SYNDROME
    (Македонско лекарско друштво = Macedonian medical association, 2023-04-07)
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    Risteski, Filip
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    Chalcheska, Slavica
    Abstract. Osmotic demyelination syndrome (ODS) may be observed as a result of a rapid change in serum osmolarity, such as that induced by an overly rapid correction of serum sodium levels in hyponatraemic patients. Case presentation. We report a case of a 40-year-old male, first hospitalization through Emergency center (glucose 6.4 mmol/l. ECG: sinus rhythm, normal axis with SF 70/min.). Patient has electrolyte imbalance ,elevated liver enzymes, high enzyme activity predominantly of CK (6664) in relation to transaminase activity (AST 288, ALT 127), elevated CK, hyponatremia, hypokalemia and extremely low sodium = 95.Main complaints were muscle pain, muscle weakness, slurred speech, weakness, walk inability. Diagnostic findings. The diagnosis was confirmed by MRI 1,5T Simens Magnetom Essenca (brain) that showed large tipical inhomogeneous hypersignal lesion in the central pontine region on T2 weighted and FLER images with restriction of DWI. There is signal intensity of the basal ganglia nucleus lentiformis and and caudate cerebral nuclei on axial T2 weighted images and FLAIR images which were suggestive of CPM. Teaching points. Central pontine myelinolysis is an acute non-inflammatory demyelinating disorder.It is precipitated by the rapid correction of severe chronic hyponatraemia.Electrolyte abnormalities other than sodium should be investigated and rectified.An in-depth neurological examination is mandated to assess the severity and progression of ODS.MRI is the radiological modality of choice for earlier detection of ODS lesions.
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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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    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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    Ductal Invasive Carcinoma
    (Macedonian Association of Radiologists, 2023-11)
    Vasilevska, Natasha
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    Antuleska Belcheska, Gordana
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    Siljanovski, Hristijan
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    Single-center randomized trial comparing conventional chemoembolization versus doxorubicin-loaded polyethylene glycol microspheres for early- and intermediate-stage hepatocellular carcinoma
    (Lippincott, Williams & Wilkins, 2020-10-08)
    Gjoreski, Aleksandar
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    Jovanoska, Ivona
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    Risteski, Filip
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    Nedelkovski, Dane
    According to Barcelona Clinic Liver Cancer classification, transarterial chemoembolization (TACE) is preferred treatment for stage B and in certain cases for stage A hepatocellular carcinoma (HCC). Conventional TACE (c-TACE) and drug-eluting microspheres TACE (DEM-TACE) are available intraarterial therapies. Screening of patients with cirrhosis is of great importance for early detection of malignant liver nodules. Primary endpoint of this study was to compare DEM-TACE with c-TACE in terms of 12- and 24-month survival. Secondary endpoints were comparison of intensity and duration of the postembolization syndrome (PES) and severe adverse events. We randomized 60 patients with unresectable HCC one-to-one with c-TACE or DEM-TACE and followed them for at least 24 months or until death. TACE was repeated ‘on-demand. Most patients underwent two TACE sessions and the median hospital stay was 3 days for c-TACE and 2 days for DEM-TACE group. The overall 12- and 24-month survival rates were 89.8 and 70.7%, respectively, precisely 85.7 and 63.6% after c-TACE and 90.2 and 75.8% after DEM-TACE, without any significant difference (P = 0.18). Median overall survival was 21.1 months. Significant difference in the overall 12- and 24-month survival was found in patients with Child-Pugh A compared to Child-Pugh B class (P = 0.001). Child-Pugh class, aspartate aminotransferase levels and ascites independently predicted survival (P = 0.003). Both, DEM-TACE and c-TACE showed excellent 12- and 24-month survival rates. No significant difference in terms of adverse events was found. PES was slightly more severe after c-TACE, because of elevated temperature. DEM-TACE requires shorter in-hospital stay.
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    Sarcoidosis of the nervous system MRI - findings
    (2013-10)
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    Risteski, Filip
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    Gjoreski, Aleksandar
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