Faculty of Medicine
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Item type:Publication, Divestment–Adventitia Resection in Order to Decrease Morbidity and Mortality and Improve R0/R1 Ratio in Curative Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma(Scientific Foundation Spiroski (publications), 2026-06-14); ; ; Kolari, ArbijonAbstract BACKGROUND: Pancreatic head carcinoma (PHC) is a highly aggressive malignancy associated with substantial morbidity, mortality, and poor long-term survival. Achieving an R0 resection margin during pancreatoduodenectomy (PD) is crucial for improving oncological outcomes. However, in borderline resectable (BRPHC) and locally advanced pancreatic head carcinoma (LAPHC), arterial involvement often necessitates complex arterial resections associated with high perioperative risks. Periarterial sub-adventitial divestment has emerged as a potential alternative to arterial resection, aiming to improve radicality while reducing complications. AIM: To evaluate whether sub-adventitial arterial divestment during curative pancreatoduodenectomy decreases perioperative morbidity and mortality and improves the R0/R1 resection ratio in patients with BRPHC and LAPHC. METHODS: A retrospective study was conducted on 50 consecutive patients with BRPHC or LAPHC treated between 2009 and 2017 following neoadjuvant therapy when indicated. All patients underwent extensive pancreatoduodenectomy with triangle operation, extended lymphadenectomy, and periarterial sub-adventitial divestment of the superior mesenteric, common hepatic, and/or celiac arteries. Clinicopathological data, perioperative morbidity, mortality, length of hospital stay, and R0/R1 resection status were analyzed. RESULTS: Among the 50 patients, 27 (54%) were male and 23 (46%) were female, with a mean age of 63.1 ± 8.97 years. Overall mortality was 8% (4/50). Major complications included postoperative pancreatic fistula (24%), postoperative biliary fistula (2%), postpancreatectomy hemorrhage (4%), reoperation (6%), necrotizing pancreatitis (4%), thromboembolism (4%), cardiac failure (2%), and pulmonary complications (8%). Venous resection was required in 12% of patients. Postoperative pain relief was achieved in 92% of cases. Mean hospital stay was 10.56 ± 6.09 days. Histopathological examination demonstrated R0 resection in 28 patients (56%) and R1 resection in 22 patients (44%). Morbidity and mortality rates were comparable to standard PD and appeared lower than those reported for PD combined with arterial resection. CONCLUSION: Sub-adventitial arterial divestment during pancreatoduodenectomy is a feasible and safe technique for selected patients with borderline resectable and locally advanced pancreatic head carcinoma. The procedure provides acceptable morbidity and mortality rates while achieving favorable R0 resection outcomes, representing a promising alternative to arterial resection in specialized high-volume centers. Keywords Pancreatic head carcinoma Pancreatoduodenectomy Arterial divestment Borderline resectable pancreatic cancer R0 resection - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The role of rapid chromatographic immunoassay tests in acute poisoning: two case reports and literature overview(Edizioni Minerva Medica, 2026-03-22); ; ; ; This report through the presentation of two case studies highlights the common problem with false-positive urine drug screen faced by many physicians to the emergency and toxicology departments. Case 1: a 29-year-old male patient was admitted after acute poisoning with analgesics/antipyretics (Caffetin Cold, Caffetin); diazepam; amlopin. Case 2: a 56-year-old female patient was admitted with impaired consciousness. According to the data obtained from the patient’s family they suspected that she took the following drugs: Zanfexa, Zalasta and Diazepam. A rapid chromatographic immunoassay urine test was performed in both patients for the following substances: opiates, amphetamines, metamphetamine, MDMA (3,4-methylenedioxymethamphetamine), oxycodone, phencyclidine, cocaine, methadone, barbiturates, cannabinoids, benzodiazepines, tricyclic antidepressants, and tramadol. Case 1 was positive for opiates, benzodiazepines and amphetamines. Gas chromatography mass spectrometry and high-performance liquid chromatography were used and confirmed the presence of caffeine, codeine, paracetamol, propyphenazone, pseudoephedrine, dextromethorphan, nordazepam, ramipril and amlodipine in urine sample. Case 2 was positive for tramadol and benzodiazepines. Gas chromatography mass spectrometry was used and confirmed the presence of venlafaxine, its metabolites and nordazepam in serum and urine samples. If a false-positive urine screen result is suspected, nonimmunologic techniques, such as gas chromatography/mass spectrometry or high-performance liquid chromatography, are necessary for confirmation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association between endometrial heterogeneity and endometrial cancer risk stratification in postmenopausal women(Srpsko lekarsko društvo, Beograd, 2026); ; ; ; SUMMARY Introduction/Objective The normal postmenopausal endometrium typically appears thin, homogeneous, and echogenic on transvaginal ultrasonography. In contrast, endometrial carcinoma is often associated with increased thickness, heterogeneous echogenicity, irregular endometrial–myometrial interface, and enhanced Doppler vascularization. The objective of this study was to evaluate the association between heterogeneous endometrial echogenicity and the risk of endometrial malignancy in postmenopausal women. Methods This prospective clinical study included 120 postmenopausal women treated at the University Clinic for Gynecology and Obstetrics in Skopje. Participants were divided into a control group (n = 40) and an examined group (n = 80). The examined group was further stratified according to uterine bleeding status and endometrial thickness (5–8 mm, > 8–11 mm, and > 11 mm). Endometrial echogenicity was assessed by transvaginal ultrasonography and classified as homogeneous or heterogeneous. Binary logistic regression analysis was performed to determine independent predictors of malignancy. Results Heterogeneous endometrial echogenicity was significantly more frequent in the examined group compared with controls (p < 0.001). It was identified as an independent predictor of endometrial malignancy (OR = 4.938; 95% CI: 1.24–19.62; p = 0.023). No statistically significant association was observed between echogenicity and endometrial thickness subgroups (p = 0.49) or uterine bleeding status (p = 0.82). Conclusion Heterogeneous endometrial echogenicity represents a significant independent sonographic predictor of endometrial malignancy in postmenopausal women and should be incorporated into routine ultrasound risk assessment. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Sonographic evaluation of the mechanism of labor - our preliminary experience(Faculty of Medicine, 2026-05-22); ; ; Kijajova IvanaIntroduction: Intrapartum ultrasound evaluation is a contemporary diagnostic tool that provides insight into the process of normal labor and assists in its monitoring. Standardized mathematical parameters are used to assess the relationship between defined landmarks on the fetal head and structures of the soft and bony tissues of the birth canal. Aim: This study was designed to show that intrapartum sonographic parameters, primarily the angle of progression and the distance between the fetal head and maternal perineum, are equally effective in the management of labor progress, as vaginal digital examinations. Material and methods: A prospective cohort study was conducted involving 50 laboring women who were admitted at the delivery department of the University Clinic for Obstetrics and Gynecology in Skopje. They were all in the active stage of labor and were evaluated with intrapartum ultrasound, both transabdominal and transperineal, during the first, second and third hours after admission. Results: An increase in the angle of progression and a decrease in the distance between the fetal head and the maternal perineum can help in predicting the mode of delivery and the time interval to delivery. Conclusion: Introducing intrapartum ultrasound as a complementary tool to the digital vaginal examinations, offers new perspectives in the perinatology, with a unique opportunity for modification and modernization of the traditional protocols for management of labor and delivery, still used across the modern countries worldwide. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ALDOSTERONE SYNTHASE DEFICIENCY FROM HOMOZYGOUS CYP11B2 MUTATION PRESENTING WITH SALT WASTING CRISIS AND FAILURE TO THRIVE IN AN INFANT(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025-12-17); ; Spasevska, SimonidaAbstract Introduction: Aldosterone synthase deficiency (ASD) is a rare autosomal recessive disorder caused by pathogenic variants in the CYP11B2 gene, leading to impaired aldosterone synthesis and life-threatening salt-wasting. We present a case of an infant with failure to thrive, dehydration, and electrolyte imbalance, diagnosed through next-generation sequencing. Material and Methods: mitted with persistent vomiting, constipation, and a10% weight loss. Laboratory evaluation showed severe hyponatremia (116 mmol/L), hyperkalemia (6.5 mmol/L), hypochloremia (87 mmol/L), and metabolic alkalosis. Differential diagnosis included gastrointestinal loss, renal salt-wasting, cystic fibrosis, celiac disease, and congenital adrenal hyperplasia. Normal 17-hydroxyprogesterone excluded classical CAH. Next-generation sequencing was performed. Results: A homozygous pathogenic variant c.554C>T (p.Thr185Ile) in CYP11B2 confirmed ASD. Treatment with fludrocortisone and sodium supplementation resulted in rapid correction of electrolytes and improved growth. Follow-up at 3.5 years showed normal growth (14.5 kg, 103 cm), stable electrolytes, and normal development, with only mild transient hyponatremia during illness. Conclusion: ASD should be considered in infants with vomiting, dehydration, and combined hyponatremia–hyperkalemia when CAH is excluded. Early diagnosis and mineralocorticoid therapy prevent complications and support normal development. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Cerebral infarction due to thrombosis mistaken as dissociative motor disorder(Македонско лекарско друштво = Macedonian Medical Association, 2024-04); ; Nedelkovska, AleksandraPatient history: female patient 33 years old, with sudden loss of consciousness previous day, inability to talk and right-sided motor weakness. Emergency unit doctors found TA-110/70 mmHg, HR= 74/min, glycemia 7,1mmol/L, oxygen saturation- 96%. During several hours of neurologic symptoms were fluctuating with improvement of the motor deficit and speech ability. Computerized tomography (CT) was described without any changes so patient was dismissed with Dg: F44.4 (dissociative motor disorder) Hemiparesis lat.dex (susp. functionalis) and ordered to do electroencephalography, laboratory test and psychiatrist consultation. The next day psychiatrist was consulted, and motor deficit as light right-sided hemiparesis was obvious with right sided drooping mouth, loss of nasolabial fold, with dysarthria (slurred speech). She presented worries about her somatic illness. Electroencephalography was performed that revealed groups and intervals of slow waves over the left frontal-temporal regions. The patient was urgently referred to a neurologist for further investigation and treatment. Initial CT exhibited only mild hypodensity in the left basal ganglia and the left perisylvian region. MRI performed the following day shows a hypointense signal in T1, hyperintense signal in T2, and FLAIR pulse sequences involving the left caudate nucleus, left lentiform nucleus, part of the left frontal, left temporal and left insular lobe. A marked diffusion restriction with low ADC map values exists in the same areas. Findings are consistent with acute ischemic stroke in the left MCA territory. Such cases need to be urgently treated by neurologists and the fluctuating symptoms need to be followed over time. Knowledge about biological markers and neuroimaging is necessary for psychiatrists and close cooperation with neurologists is needed. After performing another CT with angiography with marked hypodense lesions, the patient was admitted and treated at the neurology clinic and dismissed fully recovered. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PREMATURE BIRTH AND COMPLICATIONS OF PREMATURE BIRTH ARE LEADING CAUSES FOR INCREASED NEONATAL MORTALITY(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025-12-17); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, DECREASING OF NEONATAL MORTALITY AT UNIVERSITY GYNECOLOGY AND OBSTETRICS CLINIC IN SKOPJE OUR MATERIAL(Macedonian Association of Anatomists and Morphologists, 2026-02-23); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Pulmonary Thromboembolism Related to Complicated Knee Surgery. Initial Hospital Treatment and 1 Year Follow Up (Case Report)(SASPR Edu International Pvt. Ltd, 2026-08-22); ; Hussain, NazimAbstract Introduction: Pulmonary thromboembolism (PTE) and Deep vein thrombosis (DVT) are common complication following any type of surgery. Orthopedic surgeries have a risk higher than 10% of developing PTE. Therefore, a 2 to 5 weeks is given after the surgical procedure. The aim of this study was to present a case of PTE, preceded by local DVT, preceded by orthopedic surgery despite of prophylaxis with 4000 I.U of LMWH for 21 days and the 1year outpatient follow up afterwards. Materials and methods: A full clinical analysis of a 20 years-old male athlete treated for PTE, DVT and Pleuropneumonia from 22.06.2024 to 05.07.2024 in inpatient setting and a follow up treatment in outpatient setting for 1 year. Results: The patient was admitted with d-dimer count of 3900ng/L, S1Q3T3 ECG pattern highly suspected of underlying PTE. What followed was 2 week long inpatient treatment and stabilization and 1 year-long outpatient treatment, evaluation and finally permanent discontinuation of anticoagulant therapy. Discussion: In an inpatient setting the treatment with LMWH is safer than any other type of anticoagulation for PTE when the right conditions are met and no imminent hemodynamic instability is present. DVT and PTE remain common complications of surgeries especially orthopedic ones. Conclusion: This case highlights the importance of circulatory complications related to surgeries, especially orthopedic ones and how sometimes the given prophylaxis can fail. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Beyond Sodium: Inflammation as the Strongest Predictor of Mortality Among Non-Diabetic Hemodialysis Patients(Macedonian Academy of Sciences and Arts, 2026-06-01); : Standard dialysate sodium concentration (sDNa) may not adequately reflect individual sodium requirements in each hemodialysis patient, potentially contributing to interdialytic weight gain (IDWG), hypertension and inflammation. The aim of this study was to compare clinical and biochemical outcomes between individualized and standard dialysate sodium prescriptions and to assess factors associated with mortality. : This was a prospective interventional study conducted in two phases. In the first phase, patients were treated with standard hemodialysis (HD) using a fixed dialysate sodium concentration of 138 mmol/L. In the second phase, dialysate sodium was individualized based on each patient's pre-dialysis serum sodium concentration. Each patient served as their own control. Outcomes included IDWG, blood pressure, thirst score, dialysis adequacy (Kt/V, URR), nutritional markers, C-reactive protein (CRP), electrolytes, and mortality. : Individualized dialysate sodium prescription was associated with a significant reduction in IDWG (1.93 ± 0.64 vs 2.17 ± 0.79 kg; p = 0.001) and improved dialysis adequacy (Kt/V: 1.50 ± 0.24 vs 1.36 ± 0.22; p < 0.001). Survivors had higher serum albumin levels and lower CRP values compared to non-survivors. Serum and dialysate sodium concentrations were not independently associated with mortality. In logistic regression analysis, CRP >10 mg/L showed the strongest observed association with mortality (OR 10.278; 95% CI 1.709-61.826; p = 0.011). : Individualized dialysate sodium prescription may improve fluid control and dialysis adequacy in selected patients. Inflammation was significantly associated with mortality in this cohort; however, results should be interpreted with caution due to the limited number of events.