Faculty of Medicine

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    Multiseptate gallbladder accompanied by an incomplete annular pancreas in a 19-year male patient: A case report
    (Elsevier BV, 2025-10)
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    Misimi, Shqipe
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    Trpeski, Stanko
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    Atanasov, Zvonko
    Multiseptate gallbladder (MG) is a rare congenital malformation that may occur as an isolated anomaly or in conjunction with other abnormalities of the pancreaticobiliary, urinary, and gastrointestinal systems. The coexistence of MG with an annular pancreas is an exceedingly rare phenomenon. The diagnosis is typically established using abdominal ultrasound; however, further imaging modalities are often required to delineate the detailed anatomy and to identify any associated anomalies within the pancreaticobiliary system. We present a case of a symptomatic MG associated with an incomplete annular pancreas. This case underscores the importance of considering additional congenital anomalies in patients diagnosed with MG, as such associations may influence clinical management and outcomes.
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    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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    Acute Eosinophilic Pneumonia: A Radiological Exploration in a 37-YearOld Patient
    (2024-04)
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    This case report delves into the clinical and imaging features of Acute Eosinophilic Pneumonia (AEP) in a 37-year-old administrative worker. The patient was presented with a persistent and productive cough, fatigue, and peripheral eosinophilia. The diagnostic journey, including chest radiography, HRCT imaging, and broncho-alveolar lavage, aimed to unravel the unique aspects of AEP in this specific presentation. Hypoxemia and diffuse alveolar opacities on chest radiography and HRCT marked the clinical presentation. Broncho-alveolar lavage fluid analysis revealed a remarkably high eosinophil count, confirming the eosinophilic nature of the pneumonia. HRCT imaging unveiled bilateral ground-glass areas, interlobular septal thickening, broncho-vascular bundle thickening, and ill-defined centrilobular nodules. Zonal distribution analysis showcased a random apico-basal pattern, predominantly affecting the lower lobes. Prompt initiation of corticosteroid therapy led to a rapid and complete response, with no relapse after discontinuation. The patient's clinical symptoms improved significantly, aligning with the expected therapeutic response in AEP. This case report underscores the specific HRCT manifestations of AEP in a 37-year-old patient, contributing valuable insights to the understanding of this eosinophilic lung disease. The rapid and favorable response to corticosteroids further supports the accurate diagnosis of AEP. Acute Eosinophilic Pneumonia in this 37-year-old patient demonstrates distinct radiological patterns crucial for diagnosis. The case report enhances awareness among clinicians and radiologists, emphasizing the significance of recognizing AEP in the spectrum of acute respiratory illnesses. Keywords: Acute Eosinophilic Pneumonia (AEP), case report, eosinophilic broncho-alveolar lavage, HRCT imaging, zonal distribution.
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    Laparoscopic fenestration and omentopexy as treatment for large splenic pseudocyst
    (Elsevier, 2021-10-07)
    Zafirovikj Elena
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    Introduction and importance Pseudocysts of the spleen are rare entities with cystic lesions of the spleen being uncommon in general. It is estimated that splenic cysts occur in about 0, 07% of the population1. In general, splenic cystic lesions are discovered incidentally or by mass effect. In the literature, only a limited number of splenic cysts are reported. We report a case of splenic pseudocyst with mass effect where we used laparoscopic fenestration of the pseudocyst with omentopexy as a treatment of choice. Case presentation The patient is a 62-year-old male with no previous history of trauma. He visited his GP for abdominal pain with flaring towards the left shoulder accompanied by early satiety, occasional obstipation, and breathing difficulties. He was referred to our hospital after enhanced computed tomography showed a 15 × 13 cm splenic cyst with displaced stomach and pancreatic tail medially and left kidney downward. Management options were discussed with the patient and he opted for a laparoscopic approach. In this case, we performed laparoscopic fenestration of the pseudocyst with omentopexy. Clinical discussion Until recently splenectomy was the surgical treatment of choice for all large or symptomatic cystic lesions of the spleen2, however with growing knowledge about the protective role of the spleen an approach with spleen protection is advocated. Conclusion There are many advantages to the laparoscopic approach of splenic cystic lesions and it may be the treatment of choice for this uncommon surgical problem.
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    Anti CD20 MOAB (Mabthera) in treatment of Waldenstrom macroglobulinemia (Case report)
    (European Hematology Association, 2003)
    L. Cevreska
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    D. Efremov
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