Sofronievska-glavinov, Maja

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Sofronievska-glavinov, Maja

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msofronievska@yahoo.com

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ENIUS. European Network of multidisciplinary research to Improve the Urinary Stents. COSTS Actions. CA16217. European Cooperation in Science & Technology
(Springer Science and Business Media LLC, 2020-10-28)
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The purpose of this study is to determine the effects of intubation, the impact of complications and to estimate the necessity of improving urinary stents used during pregnancy. Hydronephrosis during pregnancy most commonly develops as a result of compression of the ureters as well as the effect of progesterone on the smooth muscle relaxation. Clinical significance of hydronephrosis lies in the association between ureteral obstruction and the high frequency of ascending urinary tract infection during pregnancy. Most of the cases of symptomatic hydronephrosis in pregnancy resolve with conservative measures with a rare need of stent insertion. When needed, ureteric stents are inserted with local anaesthesia under transabdominal US guidance. Pain and discomfort are common experiences during the procedure. The most common complication of ureteric stents is encrustation which occurs in this population likely secondary to the changes in urinary chemistry during pregnancy, such as hypercalciuria and hyperuricosuria. Ureteric stents placed in pregnant women are generally exchanged every 4–6 weeks in order to avoid encrustation and potential obstruction, necessitating the repeated cost and morbidity of repeated procedures. Infection and migration are other complications of internal stent replacement. In addition, this repetitive procedure can induce rupture of the intrauterine membranes in some cases, or can induce preterm delivery due to invasive and uncomfortable procedure especially in the third trimester of pregnancy. Sometimes for removal of the ureteric stent performing ESWL is inevitable because severe incrustation prevents stent removal after delivery, especially for patients without periodical replacement of the stents. Multiple procedures, morbidities, antibiotics, dietary calcium restriction and pain associated with ureteral stents replacement can all have a negative impact on a pregnancy. For these reasons, biodegradable stents should be preferred and are ideal solution in the properly selected pregnant patient, particularly as this device technology continues to improve.
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INCIDENTAL HEMATOPERITONEUM IN LAPAROSCOPIC APPENDECTOMY IN PREGNANT PATIENT
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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Shurlani, Arben
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Ismaili, Bashkim
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Acute appendicitis is the most common non obstetric emergency in pregnant women and often associated with a late diagnosis and complications such as perforation and fetal loss. We present a case of a 25-year-old primigravida, with epigastric pain radiating to the lower right quadrant that appeared 12 hours before admission, nausea, vomiting, white tongue and foetor ex ore. The laboratory values: WBC 18.000, RBC 4.12, HCT 36.2, CRP 22. Ultrasound examination: fetal biometry corresponded to 7 gestational weeks, positive cardiac activity, a small amount of peritoneal fluid was present in the right paracolic, ileocecal region and in Douglas's space, thickening of the wall of appendix vermiformis, surrounding inflammation of fatty tissue. The patient was observed in the next 6 hours, pain persisted in the lower right quadrant with propagation to the left quadrant. An indication for laparoscopic intervention for acute appendicitis has been made. The patient was placed in the supine position with the first camera and extraction port supraumbilically (10 mm) and the second port (5 mm) suprapubically. On laparoscopic exploration, 200 ml of bloody content was found in the pelvis and the vermiform appendix with reactive changes in the middle part towards the apex. An infundibular paraovarian cyst with a diameter of 20 mm was present on the right fallopian tube. The right ovary was ruptured with bleeding on one side. A third port (5 mm) was placed left pararectally. Aspirated pelvic blood was sent in the laboratory for beta HCG determination and partial resection of the right ovary and appendectomy were performed. After lavage, a Redon drain was placed in the pelvis through the suprapubic port. Postoperative course was normal and the drain was removed on the second postoperative day. Gynecological ultrasound was performed on the third postoperative day, the findings were normal and patient was discharged home.
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Unusual initial presentation of prostate adenocarcinoma with inguinal lymph nodes metastases: a case report
(Oxford University Press (OUP), 2024-04-01)
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Burneski, Jovo
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The presence of lymph node metastases in prostate adenocarcinoma is a poor prognostic sign, and mortality rates are often high. Inguinal lymph node metastases are an unusual presentation of advanced disease, and they can be easily misinterpreted with other diseases. We present a case of a 63-year-old patient with no previous symptoms and signs of prostate disorder with a right-sided inguinal lump and abdominal pain. The CT scan showed right inguinal and retroperitoneal lymphadenopathy. Elevated PSA serum levels, digital rectal examination, and skeletal scintigraphy with 99mTc-MDP favored the diagnosis of metastatic prostate adenocarcinoma. Since the patient denied prostate biopsy, a dissection of the right inguinal nodes was performed. Histopathological findings confirmed metastatic prostate adenocarcinoma. The treatment was hormonal and bisphosphonate therapy, with objective posttreatment improvement. Based on this case, it can be concluded that inguinal and generalized lymphadenopathy are potential initial manifestations of metastatic prostate adenocarcinoma in male patients.
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INCARCERATED INCISIONAL HERNIA: AN UNUSUAL PRESENTATION OF LIPOSARCOMA MYXOIDES METASTATICUM
(Македонско лекарско друштво = Macedonian medical association, 2025-09)
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Frosina Jovanovska
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Bisera Popovska
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Svetlana Jovevska
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Abdominal wall hernia is a common condition seen in the clinical practice of surgery. Soft tissue sarcomas are rare neoplasms, representing less than 1% of tumors in adults. However, recurrent liposarcoma reason for incarcerated incisional are rare and there are limited studies on this subject. We report a case of a 43-year-old female who presented with generalized abdominal pain and vomiting. She was treated for an incarcerated incisional hernia and underwent an exploratory laparotomy, which showed a multiseptated incisional hernia sac, with small bowel loops and the presence of recurrent liposarcoma in the mesentery. Desincarceration with maximal adhesiolysis and total extirpation of the recurrent liposarcoma and abdominal wall hernioplasty were performed. Contrast-enhanced CT is the first-line investigation, complete surgical excision remains the gold standard treatment for primary and even recurrent tumors. Prognosis depends on the histological type and grade. Histopathological examination revealed a liposarcoma myxoides metastaticum. The patient had surgeries for liposarcoma three and one years ago, and appropriate oncological treatment. The operative and postoperative course were uneventful. Postoperatively, she continued with oncological treatment. Follow-up after 6 months remains clean and is ongoing. Conclusion: Liposarcomas are aggressive malignant tumors with frequent recurrences.
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GIANT LEFT HEPATIC CYST WITH GASTRIC OUTLET OBSTRUCTION
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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Mihajloska Blazhevska, Pandora
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Jovanovska, Frosina
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The prevalence of cystic hepatic lesions in the United States is estimated to be 15%-18% and simple hepatic cyst is the most common, found in 2.5%-18% of the population. Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with GOO will often have recurrent vomiting of food that has accumulated in the stomach, but cannot pass into the small intestine due to the obstruction. A 74-year-old patient was admitted to the emergency department due to diffuse abdominal pain, bloating and tenderness in the upper abdomen. In the last month, he had malaise, bloating (especially after a large meal), loss of appetite, regurgitation and a metallic taste in the mouth. Laboratory tests (WBC 12.000, CRP 10) and a CT scan of the abdomen with contrast were performed. We detected a multiple cystic formations on the right liver lobe and larger one on the left liver lobe that compresses the antro-pyloric part of the stomach and D-1 of the duodenum. We performed gastric emptying with a nasogastric tube, serological tests to exclude possible echinococcosis and tumor markers to exclude possible malignancy. Then, we performed a diagnostic gastroscopy and the findings were normal. An indication for laparoscopic intervention has been made and laparoscopic evacuation and excision-reduction of the simplex cyst was performed. The histopathological analysis revealed a simplex cyst. The patient had a normal postoperative course and was discharged home on the third postoperative day. At the examinations after 1 and 3 months, the findings were normal. Large cysts within the liver parenchyma are in contact with the vascular, biliary and digestive systems. The resulting compression may lead to inferior vena cava obstruction, Budd Chiari syndrome, obstructive jaundice, portal hypertension and Gastric Outlet Obstruction.

Sofronievska-glavinov, Maja

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