Faculty of Medicine
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Item type:Publication, A BILIARY LEAK FROM DUCTS OF LUSCHKA AFTER LAPAROSCOPIC CHOLECYSTECTOMY - IMAGING FINDINGS(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University in Skopje, R.N.Macedonia, 2025-05) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Practicing opioid-free anesthesia for laparoscopic cholecystectomy opioid-free anesthesia(Centre for Evaluation in Education and Science (CEON/CEES), 2019); ; ; Dimitrovski, AleksandarOpioid free anesthesia (OFA) is an anesthesiological technique, which uses non-opioid analgesics, such as paracetamol, dexamethasone, lidocaine, ketamine, and magnesium sulfate instead of opioids. In this case, the report about patient who after previous surgeries experienced opioid side effects is followed by a narrative review; we present the OFA method for laparoscopic cholecystectomy. Case report: We present a case of a 55-year-old woman with a history of controlled hypertension and asthma, planned for laparoscopic cholecystectomy. Previously she underwent two surgical interventions; bilateral radical mastectomy performed separately with a three year gap. Both anesthesias were complicated, postoperatively with nausea, vomiting, dizziness, and respiratory depression. Based on the previous postoperative complications, we hypothesized that nausea, vomiting, dizziness, and respiratory depression were caused by opioids, and we decided to perform OFA. Before the induction the patient received dexamethasone 8 mg and paracetamol 1 gr intravenously, followed by induction with midazolam 3 mg, lidocaine hydrochloride 78 mg, propofol 160 mg, ketamine hydrochloride 39 mg and rocuronium bromide 60 mg. After tracheal intubation, continuous intravenous infusion with lidocaine hydrochloride 2 mg/kg/hr and magnesium sulfate 1.5 gr/hr was started. Anesthesia was maintained by using sevoflurane MAC 0.7–1. At the end of the surgery, 2.5 gr of metamizole was given intravenously. Postoperative recovery was uneventful. Conclusion: In our patient, OFA eliminated opioid-related side effects (nausea, vomiting, dizziness, and shortness of breath), and provided satisfying postoperative analgesia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ACUTE APPENDICITIS ASSOCIATED WITH ENTEROBIUS VERMICULARIS –CASE REPORT(Македонско лекарско друштво = Macedonian medical association, 2020); ; ; Marija ToleskaEnterobius vermicularis, typically found in cecum, appendix or terminal ileum, is the cause of the most common helminthic infestation in humans. A 19-year-old female patient, with normal laboratory results, was admitted for urgent appendectomy via McBurney inci-sion. After ligation and division of the inflamed appendixfrom the cecal basis, several viable and mobile enterobiusvermiculareswere identified. A short course of alben-dazole treatment was initiated and was interrupted on the second day as a result of the strong anaphylactic reaction. Contrast enhanced CT of the abdomen iden-tified infundibulum of the gallbladder filled with iregu-larhyperdense liquid indicative for parasitic infestation. One month later, elective laparoscopic cholecystectomywas performed, and the removed gallbladder was sentfor parasitological evaluation confirming non-viable worms. Infestation with Enterobius vermicularisobstructsthe lumen of the appendix, causing contraction of the wall and results in appendicitis-like symptoms without signs of acute inflammation. In minority of cases, with pure pathological signs of inflammation a finding of Eneterobius vermicularisis incidental. There are two possible hypotheses regarding the exact mechanism of gallbladder involvement: hematogenous spread or directmigration through unhealthy intestinal tissue. It is recommended to thoroughly examine all appendiceal specimens for presence of this worm, in order to provideadequate anthelminthic therapy in case of infestation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, DOUBLE, VERY SHORT CYSTIC ARTERY: ANATOMIC VARIATION REVEALED DURING LAPAROSCOPIC CHOLECYSTECTOMY: A CASE REPORT(Македонско лекарско друштво = Macedonian Medical Association, 2020); ; ;