Faculty of Medicine

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Author: search.filters.author.Toleska, NatashaLanguage: search.filters.language.English

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    MANAGEMENT OF A GIANT LIPOMA IN THE AXILLA: A CASE REPORT
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
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    Toleska, Natasha
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    Daskalov, Darko
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    Angjushev, Darko
    Lipomas are the most common benign mesenchymal tumors in adults.Generally,they are less than 5 cm in size but sometimes they can present as giant lipomas.Axillary region is an unusual localization for lipomas in general, especially for giant lipomas.A case of a 62-year-old male with a giant lipoma in the axillary region is presented.The tumor was located in the left axillary region beneath the pectoralis major muscle and extended all along to the scapula. It was adjacent to the axillary vessels and the brachial plexus, but did not invade the neurovascular bundle.A team of a plastic and thoracic surgeon performed the operation.The pathology report confirmed a benign lipoma weighting 454 grams and measuring 13.5x8x7 cm. Follow-up examinations (clinical examination and ultrasound) revealed no recurrence three years after the operation.The mechanism of lipoma formation is not completely clear. It includes twopotential and overlapping mechanisms in which trauma seem to have the major role.The treatment includes surgical excision or liposuction. However,excision of large lipomas can sometimes be a surgical challenge.Giant lipomas in axillary region should beremoved in order to establish the pathohistological diagnosis and to prevent possible compression of the neurovascular structures. In our opinion, surgical excision is a preferred method of treatmentbecause there is less possibility of damaging vital structures and it offers better control against local tumor recurrence.
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    Efficacy of Intraperitoneal Bupivacaine on Pain Relief After Laparoscopic Cholecystectomy
    (Macedonian Academy of Sciences and Arts /Walter de Gruyter GmbH, 2018-07-01)
    Toleska, Marija
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    Panovski, Milcho
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    Patients undergoing laparoscopic cholecystectomy do experience postoperative pain, especially in the abdomen. Postoperative pain management remains a major challenge after laparoscopic procedures. Administration of intraperitoneal local anesthetic (IPLA) after surgery is used as a method of reducing postoperative pain. In this study, we evaluated the effect of intraperitoneal infiltration of local anesthetic (bupivacaine) for pain relief after laparoscopic cholecystectomy.</jats:p> <jats:p><jats:bold>Material and methods:</jats:bold> In this prospective, controlled, and randomized study were included 50 patients aged 25-60 years (35 female and 15 male), scheduled to laparoscopic cholecystectomy with ASA classification 1 and 2. Patients were classified randomly into two groups: group A, which included 25 patients who received intraperitoneal instillation of bupivacaine 0.5% 20 ml; and group B, which included 25 patients who didn’t receive any intraperitoneal instillation. Postoperative pain was recorded using the visual analogue scale (VAS) for 24 hours after laparoscopic cholecystectomy.</jats:p> <jats:p><jats:bold>Results:</jats:bold> There was no significant difference with respect to age, weight, and sex; duration of surgery; and anesthesia time. VAS scores at different time intervals were statistically significantly lower at all times in group A compared to group B. There were statistically significant differences in VAS scores between group A and group B at all postoperative time points - 1hr,4 hr,8 hr,12hr and 24hr (p < 0.00001).</jats:p> <jats:p><jats:bold>Conclusion:</jats:bold> Intraperitoneal instillation of bupivacaine provides good analgesia in the postoperative period after laparoscopic cholecystectomy.</jats:p>
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    Opioid Free Anesthesia for Laparotomic Hemicolectomy: A Case Report
    (Macedonian Academy of Sciences and Arts /Walter de Gruyter GmbH, 2018-12-01)
    Toleska, Marija
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    Opioid free anesthesia (OFA) is deffined as anaesthesiological technique where opioids are not used in the intraoperative period (systemic, neuroaxial or intracavitary). Anaphylaxis caused by opioids (fentanyl) is very rare, and the reaction is presented with hypotension and urticaria. When we have proven allergy to fentanyl, patients' refusal of placing epidural catheter and refusal of receiving bilateral ultrasound guided transversus abdominis plane block (USG TAPB), we must think of using multimodal nonopioide analgesia. The concept of multimodal balanced analgesia is consisted of giving different analgesic drugs in purpose to change the pathophysiological process which is included in nociception, in way to receive more effective intraoperative analgesia with less adverse effects. This is a case report of a 60-year-old male patient scheduled for laparotomic hemicolectomy, who previously had proven allergy to fentanyl. We have decided to give him an opioid free anaesthesia. Before the induction to anaesthesia, the patient would receive dexamethasone (dexasone) 0.1 mg/kg and paracetamol 1 gr intravenously. The patient was induced into general endotracheal anesthesia according to a standardized protocol, with midazolam 0.04 mg/kg, lidocaine hydrochloride 1 mg/kg, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg. Anaesthesia was maintained by using sevoflurane MAC 1 in order to maintain mean arterial pressure (MAP) with a value of +/- 20% of the original value. After tracheal intubation, the patient had received ketamine hydrochloride 0.5 mg/kg (or 50 mg ketamine) in bolus intravenously and a continuous intravenous infusion with lidocaine hydrochloride (lidocaine) 2 mg/kg/hr and magnesium sulfate (MgSO4) 1,5 gr/hr. At the end of surgery the continuous intravenous infusion with lidocaine and magnesium sulfate was stopped while the abdominal wall was closed and 2.5 g of metamizole (novalgetol) was given intravenously. VAS score 2 hours after surgery was 6/10 and 1 gr of paracetamol was given and the patient was transferred to the Department. Over the next 3 days, the patient had a VAS score of 4-6/10 and only received paracetamol 3x1g and novalgetol 3x1 gr daily, every four hours.