Faculty of Medicine

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Author: search.filters.author.Spirovska, TatjanaHas files: Yes

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    Item type:Publication,
    Drug Induced Acute Pancreatitis
    (SHMSHM - AAMD, 2016)
    Spirovska, Tatjana
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    Mikjunovikj, Ljubica
    Acute pancreatitis is a severe disease with considerable morbidity and mortality. Drug-induced acute pancreatitis is rare, with an estimated incidence of 0.1-2%. More than 100 drugs have been implicated in causing the disease: acetaminophen has been associated with acute pancreatitis in cases where there has been an overdose of drugs; however, the frequency is rare. Based on analysis of the level of evidence, 4 classes of drugs could be identified. We report the case of a 28-year-old man who presented abdominal pain and elevated pancreatic enzymes suggesting acute pancreatitis, severe metabolic acidosis and systemic inflammatory response syndrome after overdosing on a drug containing acetaminophen. He was taking acetaminophen more than 5 g every day two weeks.Workup including an ultrasound,CT scan, microbiological and serological analysis failed to reveal any obvious etiology for the pancreatitis. The possibility of drug-induced pancreatitis was considered and acetaminophen was thought to be the probable etiologic agent and discontinued. A review of the relevant literature is also presented. Drug-induced acute pancreatitis is challenging for clinicians and a detailed mechanism is unknown. It is very important to rule out drug-induced pancreatitis when treating pancreatitis with an unknown etiology.
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    Anesthetic Challenges for Major Hepatectomy
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2022-03)
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    Spirovska, Tatjana
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    Toleska, Marija
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    Rushiti, Kjemal
    Hepatic resection is the treatment of choice for many liver diseases. However, it is a large and complex operation with a high risk of side effects in the patients, and it is a challenge for both surgeons and anesthesiologists. This paper presents a case of successfully performed right hepatectomy in a 45-years-old woman with the finding of a giant liver hemangioma, larger than 10cm, placed near the inferior vena cava and the challenges faced by the anesthesiologists when guiding such a patient during the entire perioperative period. The main concern was the risk of massive blood loss, which might significantly increase the rate of morbidity and mortality. During liver resection, central venous pressure (CVP) was optimally maintained below 5cmH2O to reduce blood loss. The cell salvage technique was used to minimize heterologous blood transfusion. Epidural anesthesia can be safely applied in patients undergoing major hepatic resection, provided that they have corrected perioperative hemostasis. The surgical approach after Belghiti “liver hanging maneuver” performed by the surgeons in our case may involve transient compression of the inferior vena cava that cause profound hypotension. Therefore, a successful outcome requires close collaboration between the anesthesiology and surgical team by sharing decisions throughout the operation and following and implementing the latest evidence-based recommendations.