Faculty of Medicine
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Item type:Publication, Inflammatory myofibroblastic tumor of the appendix(Serbian Pathologists and Cytologists Association, 2022-05); ; Inflammatory myofibroblastic tumor (IMT), also called inflammatory pseudotumor is a rare disease of mesenchymal origin, first described in 1937. Cases of IMT involving the appendix are exceptional, and they can mimic malignant appendicular tumors. Case report: A 25-year-old woman presented to the emergency department with pain in her right lower abdomen for three days. This was associated with increased body temperature and nausea. Other clinical findings included acute abdomen and laboratory analysis with mildly elevated inflammatory markers. No past history of serious illnesses or abdominal surgery. Because of the lack of specific clinical or imaging signs, IMT still offers a great deal of diagnostic challenge. The macroscopic examination of the appendix revealed a surgical specimen of 5.0x2 cm. The tip of the appendix was distended by mucinous material and had signs of acute appendicitis. Histological examination of the specimen stained with hematoxylin and eosin, revealed a mass showing fibroblastic proliferation accompanied by a dense inflammatory infiltrate in the mucosa and a clear widening of the submucosa. A few areas showed myxoid changes with spindle cells, alternating with polyclonal plasma cells and lymphocytes. Immunohistochemical analysis showed positivity for vimentin and partial positivity for CD68, SMA and desmin. Conclusion: Awareness of this type of tumor in the differential diagnosis of appendiceal masses, avoids overtreatment, and highlights the need of long-term follow-up regarding the tendency for local recurrence and small risk of distant metastasis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CORRELATION OF SCORING SYSTEMS WITH HISTOPATHOLOGICAL FINDINGS AND THEIR IMPORTANCE IN REDUCING THE PERCENTAGE OF UNNECESSARY APPENDECTOMIES(Македонско лекарско друштво = Macedonian medical association, 2019); ; ; ; Markov, PetarIntroduction. Acute appendicitis (AA) is one of the most common emergency surgical conditions, where emergency laparotomy is necessary. However, perforation rates and negative laparotomies during this procedure have not been reduced. The purpose of this paper was to evaluate the importance of the scoring systems in the differenttial diagnosis for setting an indication for appendectomy. Method. Prospective comparisons of the values of 4 scoring systems were performed among 60 patients: Alvarado, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis. Values for the scores were determined in all patients treated with lower right quadrant (LRQ) abdominal pain, under a differential diagnosis of AA. After the appendectomy (open surgery or laparoscopic), a correlation was obtained between the histopathologic findings (HP) and the corresponding latent values. Results. In the study 63.33% of the patients were male. Distribution of patients according to the values of the three different systems (Alvarado, RIPASA and Tzanakis) showed that the largest number of patients had values higher than 8 and AIR values of 7- 8. In the study, 95% of the operated patients were positive for appendicitis compared to the histopathological finding. 80% of the surgeries included on-time appendectomy, 15% delayed diagnosis, and 5% were found to be with an unnecessary appendectomy. According to the HP findings of those with positive findings, 77.2% of the cases had appropriate preoperative ultrasonographic (US) diagnosis. A statistically significant association of the scores with HP findings (promptly phlegmonous, promptly gangrenous, late perforated and unnecessary) was found only for the Alvarado, AIR, Tzanakis, and no statistically significant association was found for the RIPASA score. Conclusion. Scoring systems are useful diagnostic tools for appendectomy indication. Using one or a combination of two or more scoring systems reduces the percentage of unnecessary appendectomies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute appendicitis during the COVID-19 pandemic versus before pandemic period in Republic of North Macedonia(2022-10-13); ; Background: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted the outcomes of acute appendicitis. Aim: The aim of the study was to compare the characteristics of acute appendicitis (AA) in children before and during the COVID-19 pandemic. Methods: A cross sectional study was conducted at the University Clinic for pediatric surgery in Skopje, Republic of North Macedonia, between January 2019 and September 2020. We elaborated children aged ≤14 years diagnosed with AA and treated at our clinic before / during COVID-19 period. The time from the first symptoms to hospitalization, incidence of complications, type of intervention, duration of hospital stay, and postoperative use of antibiotics were compared between the two groups. Results: A total of 328 children with appendectomies were included in the study – 197 (60,1%) before (Group 1) and 131 (39,9%) during COVID 19 pandemic (Group 2). No significant differences was found between the groups related to gender (p=0,341) and age (p=0,475). The time from the first symptoms to hospitalization (p=0,031), complications (p=0,044) and use of antibiotic treatment (p=0,028) were significantly associated with Group 2. No association between the groups and AA type of intervention was found (p=0,191). Conclusion: Even with lower incidence, appendectomies in children during Covid 19 pandemic had increased rate of complications, prolonged hospitalization, and higher antibiotic use. Reason for these findings is important to be investigating, as pandemic conditions should be taken into account in children health interventions. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery(Asclepius, 2018); ; ; Acute appendicitis is the most common surgical problem occurring during pregnancy. Its incidence is more common in the second trimester and is confirmed in 1/1000 pregnancies. Clinical manifestations of acute appendicitis in pregnant patients are generally very similar to non- pregnant patients. We present, here, the case of a 29-year-old pregnant patient at 35+4 weeks of gestation with the signs of acute appendicitis. The patient underwent a successful open appendectomy of her perforated appendix, without performing a cesarean section (CS) at the same time. 5 weeks postoperatively, at term, labor was induced with vaginal prostaglandins and the patient delivered a healthy female baby without any complications. Immediate diagnosis of acute appendicitis during pregnancy is recommended and management with the suitable surgical intervention should not be delayed for >24 h as it increases the risk of perforation with its subsequent critical complications. The treatment of acute appendicitis is always surgical, with an appendectomy and perioperative broad-spectrum antibiotics. Except in cases of high maternal and fetal mortality, a CS should not be done simultaneously with the appendectomy in cases of a perforated appendix with diffuse peritonitis, due to the very high risk of dehiscence of the uterus.