Faculty of Medicine

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Evaluation of the surgical treatment of lung cancer
(European Respiratory Society, 2024-09)
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R Cholanceski
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N Jakupi
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M Bogdanovska
Lung cancer is the most common malignancy in men and in the entire human population. It is considered that 2,200,000 new patients are detected annually in the world (Globcan 2020), 475,000 in Europe (Globcan 2020), i.e. 1,135 in the Republic of North Macedonia (Globcan 2020). The treatment is multimodality and several factors influence its choice. Surgical treatment is one of the modalities of treatment and its application depends on numerous factors - histological structure of the tumor, stage of the disease, satisfactory respiratory reserves, satisfactory cardiac reserves, general condition of the patient, etc. At the clinic for thoracic and vascular surgery in 2022, only 59 patients were surgically treated, which is 85% of the total surgically treated in the Republic of North Macedonia. Of the 59 patients, 44 (74.6%) are men, the average age of the operated patients is 64.22 years and 37 (62.7%) underwent neoadjuvant chemotherapy preoperatively to reduce the tumor and stage of the disease. Patients who were operated on were mostly in IIIA stage 16 (27.12%). The small percentage of operated patients, 7.7%, and the particularly high percentage of operated patients at an advanced stage indicates that patients are detected at an advanced stage of the disease, which is a contraindication for surgery. Introduction of screening for lung cancer using computed tomography in risk groups will significantly change the therapeutic approach to this group of patients, as well as the outcome of treatment of this group of patients.
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CT IMAGING OF LIVER CYSTIC ECHINOCOCCOSIS
(Македонско лекарско друштво = Macedonian medical association, 2025-04)
Begu, Aida
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Liver cystic echinococcosis (CE) is a zoonotic disease caused by the accidental infection of humans with the eggs of the tapeworm Echinococcus granulosus. Two-thirds of all cases present with hepatic involvement.
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VERRUCOUS MALFORMATIONS AS A RARE CASE IN THE GROUP OF VASCULAR ANOMALIES WITH SLOW BLOOD FLOW IN CHILDREN
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04-04)
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Kamiloski, Marijan
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Lumani Bakiji, Njomza
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Racaj, Anila
Verrucous venous malformations belong to the group of vascular anomalies. The International Society for the Study of Vascular Anomalies (ISSVA) classifies these changes into two major groups: vascular tumors and vascular malformations. The vascular malformations group includes lymphatic malformations, venous malformations, and their combinations (malformations with slow blood flow), as well as arteriovenous malformations (malformations with fast blood flow). Verrucous venous malformations (VVM) are a rare congenital vascular anomaly first described by Helwig in 1967. They are characterized by varying degrees of hyperkeratosis of the skin and subcutaneous tissue. Clinically, they manifest as dark red solitary or multiple hyperkeratotic plaques, most commonly localized on the extremities. Treatment is combined and includes surgical intervention, electrocoagulation, laser therapy, topical agents, and systemic medications. Materials and Methods: Between 2019 and 2024, two children with suspected verrucous venous malformations were admitted to the Public Healthcare Institution – University Clinic for Pediatric Surgery. The lesions were unilaterally located on the lower extremities. The gender distribution was 1:1 (male to female), with an average age of 10 years. The changes had been present since birth. There was no positive family history in either patient. Clinically, one of the patients presented with inflammation of the lesion, accompanied by pain and serous secretion. Results: Following appropriate preoperative preparation, both patients underwent surgical excision and autologous skin transplantation. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis. After excision, electrocoagulation was applied to residual lesions. A reduction of approximately 90% in lesion size was recorded. Conclusion: Verrucous venous malformations are a rare type of malformation within the group of vascular anomalies, requiring a multidisciplinary treatment approach.
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Our Experience with Surgical Treatment of Scaphoid Fractures with Headless Compression Screw
(Scientific Foundation SPIROSKI, 2024-10-10)
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Merdjanoski, Igor
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Gjorikj-Petrushevska, Magdalena
BACKGROUND: Fractures of the scaphoid bone are quite common, and they come with their own set of challenges due to the specific shape of the fractures and the delicate blood supply to the scaphoid bone. Failing to diagnose and treat acute scaphoid fractures promptly can result in failure of the bone to heal and subsequent development of wrist arthritis. Advances in diagnosis, surgery, and implant materials have led to a growing inclination towards early surgical fixation, even for non-displaced scaphoid fractures that could potentially be treated without surgery. AIM: The study's goal was to assess the effectiveness of headless compression screws for treating acute scaphoid fractures and, in two cases, nonunion following previous conservative therapy. METHODS: Between January 2022 and March 2024 ten patients with scaphoid fractures were surgically treated at the University Clinic of Traumatology Skopje, within twelve months follow-up. All of them were male with mean age of 27,3 years. All were diagnosed with X-rays and CT scans. Six of the fractures were on the right hand and four on the left. RESULTS: All the patients were surgically treated with open reduction and internal fixation with headless compression screw. Volar approach was used in 9 cases and dorsal approach in only one of them. Six of the patients were surgically treated within 4-14 days after injury and four of them were surgically treated due to non union after previous conservative treatment, two of them after three and two of them after seven months of injury. All fractures united after a mean time of 9,5 weeks, without secondary displacement. Throughout the follow-up period, there were no incidences of developing osteoarthritis of the wrist. CONCLUSIONS: It is crucial to understand that achieving a positive result is not guaranteed for every patient and relies on selecting the right patients and fractures. However, our study shows favorable results in sooner surgical treatment with the headless compression screw, rather than delayed treatment of scaphoid fractures. Surgical treatment with headless compression screw showed both functional and radiographic results. While it is beneficial for the screw to be positioned in the subchondral area, it is important to be cautious to avoid cortical penetration, as this will require the screw to be removed later.
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Neglected condition: nodular fasciitis and our case
(Македонско лекарско друштво = Macedonian medical association, 2022)
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Jovanoski, Tomislav
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SURGICAL MANAGEMENT OF DUODENAL GASTROINTESTINAL STROMAL TUMOR IN A YOUNG ADULT FEMALE PATIENT: A CASE REPORT
(Department of Anesthesia, Reanimation and Intensive Care Faculty of Medicine, University ”Ss. Cyril & Methodius” Skopje, R. of N. Macedonia, 2023)
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Panikj Katarina
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. They can arise anywhere in digestive tract in adults and only in fewer than 5% of cases can be located in duodenum. Case presentation: We report on a rare case of duodenal GIST in 32-year-old female patient with several comorbidities (extreme obesity, HTA, glucose intolerance) and previous left adrenalectomy. The tumor mass was located in D2 portion of duodenum involving the papilla of Vater, with diameter of 5 cm. It was diagnosed with upper GI endoscopy, abdominal US and CT scan and confirmed histologically as GIST. The optimal surgical approach in this case was pancreaticoduodenectomy (en bloc resection) due to location and size of the tumor and involving the adjacent anatomical structures. R0 resection was confirmed with negative surgical margins. Postoperative course was prolonged due to respiratory complications and present pancreatic fistula. The patient was discharged from hospital in good health condition. Conclusion: There is lack of consensus about appropriate surgical approach in these tumors, due to its rarity. Optimal surgical strategies for duodenal GISTs remain to be established.
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CARPENTER SYNDROME - CASE REPORT AND TREATMENT
(Македонско лекарско друштво = Macedonian Medical Association, 2016)
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Zogovska E
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Agai Lj
Introduction. Carpenter syndrome is a polymorphic disorder transmitted by autosomal recessive inheritance, caused by mutations in the RAB23 gene [1]. These gene- tic disorders are reflected on the biogenesis of intracra- nial structures. This syndrome was described for the first time in 1900 by the British doctor George Carpenter. It may include congenital heart diseases, mental retarda- tion, hypogonadism, obesity, umbilical hernia, develop- mental disorder, bone anomalies and frequent respiratory infections. Carpenter syndrome has two main features: craniosynostosis and more than five fingers or toes (2-4]. Aim. To present our experience in treatment of an in- fant with Carpenter syndrome including trigonocephaly and polydactyly. Case report. In May 2003, an eleven-month-old male infant with Carpenter syndrome was hospitalized in the Pediatric Department of the University Clinic of Neuro- surgery in Skopje, Republic of Macedonia. The infant was referred to our Department from the University Pediatric Clinic because of trigonocephaly and poly- dactyly with two thumbs on his right hand. The infant had already been twice hospitalized at the University Pediatric Clinic for two recurrent lung infections su- ggestive of Carpenter syndrome. The diagnosis of tri- gonocephaly and polydactyly with two thumbs on the right hand was made by physical examination, X-ray of the right infant's hand and computed tomography of the head. According to Oi and Matsumoto classification from 1986 [5], the infant had a severe form of trigonocephaly. Surgical procedure. Under general endotracheal anesthe- sia, the infant was placed supine on the operating table, a bifrontal skin incision was made and the scalp flap was created. The bifrontal craniotomy was realized into one bony piece succeeded by a modified Di Rocco's "shell" procedure including frontal translation and trans- Correspondence to: Vladimir Mirchevski, University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje, Macedonia, E- mail: neurosurgery skopje @yahoo. position rotating the flap for 180 degrees without /touching the orbital rims. Results. The postoperative period was uneventful ex- cept for the expected forehead swelling. The infant was discharged from the hospital on the 7 postoperative day, neurologically intact. Three months after surgery, the head had excellent esthetic appearance, with regular psychomotor development in line with the age of the patient. Six months after the first surgery the patient underwent a second plastic and reconstructive surgery in order to reduce the number of fingers. Conclusion. The early recognition and multidisciplinary approach could prevent new disabled individuals in the society. Our technique shortens the entire surgical procedure, diminishes the time under anesthesia and its complications, especially in departments where blood saving devices are not available
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Dandy Walker and extreme macrocephaly caused by by enormous occipital encaphalocele
(Македонско лекарско друштво = Macedonian Medical Association, 2016)
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Zogovska E
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Kostov M
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Micunovic M
Introduction. Dandy-Walker syndrome is a congenital brain malformation involving cerebellum with partial and complete vermian agenesis, enlargement of the fourth ventricle and surrounding fluid spaces, cyst formation in posterior cranial fosse pushing tentorium upward [1,2). Hydrocephalus or an increase in the pressure of the fluid spaces may also be present or other malformation as corpus calosum hypoplasia or agenesia, occipital encephalocele, malformation of the heart, face, limbs fingers and toes [3-5]. The symptoms often occur in early infancy and include slow motor development and progressive enlargement of the skull. The diagnostic is done by ultrasound, CT and MRI [6-11]. The treatment of this syndrome may be complex and sometimes includes various experts such as pediatrician, pediatric neurosurgeon, physiatrist, psychologist, sociolo- gist or others. The treatment consists of treating the asso- ciated problems such as hydrocephaly [12-15]. Prog- nosis of Dandy-Walker syndrome is variable and the morbidity and mortality depends on severity of the syndrome and associated malformations [16]. Aim. The aim of this paper was to demonstrate how se- vere spontaneous evolution of Dandy-Walker syndrome may be expressed and the problems and dilemmas which may appear related to its treatment. Case report. A six-year-old boy was referred to the neurosurgeon because of the excessive growth of the skull in anteroposterior axis caused by a wide base occipital encephalocele. Although the psychological de- velopment was near the low limit of the 1Q, the enor- mous head had not allowed verticalization of the child and further progress of his psychomotor development. The head was so heavy that could not be supported by Correspondence to: Vladimir Mirchevski, University Clinic for Neuưosurgey, Clinical Center "Mother Teresa" Skopje, Macedonia: E- mail: neurosurgery.skopje@yaho0.com the child's neck. Surgical procedure. We performed a cranial skull re- duction with primary cranioplasty assisted by a plastic surgeon and Pudentz shunt procedure. Result. The follow-up period lasted two years. The child started to walk, hypotonia and Babinski signs disappeared, communication and his IQ improved. The esthetic results are quite acceptable allowing him better development. Conclusion. The early recognition of anomalies such as Dandy-Walker syndrome with occipital encephalocele using ultrasound may suggest interruption of the preg- nancy on time [6-9). However, the right diagnostic pro- cedure for detecting deformities of the newborn and infant's head at birth is MRI, and the adequate surgical treatment can prevent abnormal and excessive growth of the skull and disorders in the psychomotor develop- ment during child's growth. A multidisciplinary approach may prevent new disabled individuals in the society.
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Surgical correction of strabismus in Graves ophthalmopathy-case report
(SHMSHM / AAMD, 2018)
ABSTRACT The aim of the study is to evaluate long-term results of surgical treatment of strabismus and diplopia associated with Graves ophthalmopathy in the 40-year-old patient. The patient had preoperative diplopia and restricted mobility on the eyes. The patient was prescribed to wear Fresnel prisms prior to surgery. The patient achieved a single binocular vision without prisms after the operation. The muscles surgery of the both vertical recti on the right eye were performed by recession and reattachment of the muscle to the globe. On the left inferior rectus was performed recession with adjustment suture. Standard measures were used for the primary strabismus surgery of rectus inferior and rectus superior on the right eye, and adjustable suture surgery on the rectus inferior on the left eye. Adjustment of the sutures was done the day after the surgery. After two years of post-operative following, no need was observed for any subsequent operation. Conclusion: The operation of the restrictive thyroid ophthalmopathy using recessive standard technique combined with adjustable sutures can provide excellent post-operative results and patient satisfaction.
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Open esophagectomy as a treatment of choice for esophageal cancerand a successful outcome at the University Clinic in Skopje, North Macedonia: a case report
(University Ss. Cyril and Methodius, Medical Faculty in Skopje, 2022)
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Jakupi N
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Karagjozov P
Esophageal cancer is one of the least studied cancers and has high mortality rates, mainly because it is diagnosed at rather late stage. It requires urgent attention and in patients where surgery is feasible, it is immediately performed. There is a considerable variation in terms of the surgical approach in different countries, but open esophagectomy is a treatment of choice. This study describes a case of esophageal squamous cell carcinoma that was successfully treated with open esophagectomy and therefore provides information about the present state of esophageal cancer surgery at the University Clinic in Skopje, North Macedonia. The patient underwent clinical examination after which she was admitted to our department for surgical treatment. Esophagography and CT imaging were done pre- and postoperatively and no complications were noted after surgery. The patient was discharged and a written informed consent was obtained for publication of this case and any accompanying images.

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