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    ARTERIALIZATION OF GREAT SAPHENOUS VEIN IN SITU FOR LIMB SALVATION: OUR CLINICAL EXPERIENCES
    (Македонско лекарско друштво = Macedonian Medical Association, 2021)
    V Cvetanovski
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    A Arsovski
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    L Brajevikj
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    A Mitevski
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    Introduction. Critical lower limb ischemia in the ab-sence of distal arterial circulation presents an urgent situation, which must be treated immediately if we want to save the foot or limb from amputation. Approximately 14%-20% of patients with critical lower limb ischemia are unsuited for distal arterial reconstruc-tion and face major distal amputation [1]. Arterializa-tion of great saphenous vein is a unique procedure in which the venous bed is used as an alternative conduit for perfusion of peripheral tissues of lower limb. Methods. We present our clinical experience in 6 patients who underwent in situ arterialization of great saphenous vein for treatment of critical below- and above-knee ischemia. Maintaining the great saphenous vein in situ allows the arterialization with one anastomosis without removing the vein of its original bed. All patients were diagnosed with color Doppler ultrasound and with CT angiography. Results. In all 6 patients we managed to safe the limb or foot from amputation in the first 6 months after the procedure. Postoperative color Doppler ultrasound was performed to assess arterial inflow and arterialized flow in the graft, the anastomosis and venous run-off. In all patients with significant intraoperative reverse flow in upper and below the knee part of great saphe-nous vein the procedures were initially successful. Conclusion. Distal revascularization of the limb with critical ischemia, by creating a reverse flow with in situ saphenous vein arterialization must be seriously considered as an attempt for salvage of the foot or below-knee without distal arterial run-off.
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    Tretman na plevralen empiem
    (Македонско лекарско друштво = Macedonian medical association, 2023-09-21)
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    Cholanceski R
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    Jakupi N
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    Decoupling channel count from field of view and spatial resolution in single-sensor imaging systems for fluorescence image-guided surgery
    (SPIE-Intl Soc Optical Eng, 2022-09-26)
    Blair, Steven
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    Garcia, Missael
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    Zhu, Zhongmin
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    Liang, Zuodong
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    Lew, Benjamin
    Near-infrared fluorescence image-guided surgery is often thought of as a spectral imaging problem where the channel count is the critical parameter, but it should also be thought of as a multiscale imaging problem where the field of view and spatial resolution are similarly important. Aim Conventional imaging systems based on division-of-focal-plane architectures suffer from a strict relationship between the channel count on one hand and the field of view and spatial resolution on the other, but bioinspired imaging systems that combine stacked photodiode image sensors and long-pass/short-pass filter arrays offer a weaker tradeoff. Approach In this paper, we explore how the relevant changes to the image sensor and associated image processing routines affect image fidelity during image-guided surgeries for tumor removal in an animal model of breast cancer and nodal mapping in women with breast cancer. Results We demonstrate that a transition from a conventional imaging system to a bioinspired one, along with optimization of the image processing routines, yields improvements in multiple measures of spectral and textural rendition relevant to surgical decision-making. Conclusions These results call for a critical examination of the devices and algorithms that underpin image-guided surgery to ensure that surgeons receive high-quality guidance and patients receive high-quality outcomes as these technologies enter clinical practice.
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    PRIMARY HYPERPARATHYROIDISM INDUCED BY AN ECTOPIC ADENOMA, INITIALLY PRESENTED AS BROWN TUMOR OF THE TIBIA
    (Department of Anaesthesia and reanimation, Faculty of Medicine, Ss Cyril and Methodious University Skopje, Macedonia, 2020-10)
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    Samardziski, Milan
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    The classic manifestation of unchecked, advanced hyperparathyroidism is the brown tumor, a non-neoplastic giant cell osteomedullary lesion. We report a case of, these days rarely seen manifestation of advanced hyperparathyroidism, brown tumor due to an ectopic mediastinal parathyroid adenoma. A 63-years-old woman presented with an expansile osteolytic lesion of the right tibia on the radiographic images. Because of the suspicion of primary or secondary bone tumor, bone scintigraphy was performed. The bone scan was indicative of metabolic bone disease. Furthermore, laboratory investigations were obtained that revealed hypercalcemia, hypophosphatemia, increased level of alkaline phosphatase, and parathyroid hormone. Subsequently, ultrasound of the neck was performed, but no enlarged parathyroid glands were detected, so the patient underwent dual-phase 99mTc-methoxy-isobu- tyl-isonitrile (MIBI) parathyroid scintigraphy using a hybrid SPECT/CT gamma camera. The MIBI scan showed ectopic hypermetabolic parathyroid tissue in the anterior mediastinum, as well as an additional appearance of focal radiotracer uptake in the sternal end of the right clav- icle, suggesting the presence of a brown tumor. After thorough clinical workup, the diagnosis was in favor of primary hyperparathyroidism and the patient underwent surgical resection of the ectopic parathyroid gland with gamma-probe guidance, later histopathologically confirmed it to be a parathyroid adenoma. Postoperatively her PTH level dropped and the electrolyte status normalized within 6 months. Osteolytic brown tumors can easily imitate bone malignancy and should be evaluated with caution. The use of intraoperative gamma-probe guidance could support the complete removal of the parathyroid adenoma tissue ensuring the surgical and therapeutic success for the patient.
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    Convolutional neural network advances in demosaicing for fluorescent cancer imaging with color-near-infrared sensors.
    (SPIE, 2024-07)
    Jin Y
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    Singhal S
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    Nie S
    Significance: Single-chip imaging devices featuring vertically stacked photodiodes and pixelated spectral filters are advancing multi-dye imaging methods for cancer surgeries, though this innovation comes with a compromise in spatial resolution. To mitigate this drawback, we developed a deep convolutional neural network (CNN) aimed at demosaicing the color and near-infrared (NIR) channels, with its performance validated on both pre-clinical and clinical datasets. Aim: We introduce an optimized deep CNN designed for demosaicing both color and NIR images obtained using a hexachromatic imaging sensor. Approach: A residual CNN was fine-tuned and trained on a dataset of color images and subsequently assessed on a series of dual-channel, color, and NIR images to demonstrate its enhanced performance compared with traditional bilinear interpolation. Results: Our optimized CNN for demosaicing color and NIR images achieves a reduction in the mean square error by 37% for color and 40% for NIR, respectively, and enhances the structural dissimilarity index by 37% across both imaging modalities in pre-clinical data. In clinical datasets, the network improves the mean square error by 35% in color images and 42% in NIR images while enhancing the structural dissimilarity index by 39% in both imaging modalities. Conclusions: We showcase enhancements in image resolution for both color and NIR modalities through the use of an optimized CNN tailored for a hexachromatic image sensor. With the ongoing advancements in graphics card computational power, our approach delivers significant improvements in resolution that are feasible for real-time execution in surgical environments. Keywords: bioinspired sensors; cancer surgery; convolutional neural network; demosaicing; image-guided surgery; near-infrared imaging.
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    Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland
    (Scientific foundation SPIROSKI, 2020-04-25)
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    Tolevska, Natasha
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    Qafjani, Ardit
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    BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase. AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis. METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively. RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%). CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.
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    Impact of Size of the Tumour, Persistence of Estrogen Receptors, Progesterone Receptors, HER2Neu Receptors and Ki67 Values on Positivity of Axillary Lymph Nodes in Patients with Early Breast Cancer with Clinically Negative Axillary Examination
    (2017-12-15)
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    The study aimed to identify factors that influence the positivity of axillary lymph nodes in patients with early breast cancer and clinically negative axillary lymph nodes, who were subjected for modified radical mastectomy and axillary lymphadenectomy.
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    Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/Walter de Gruyter GmbH, 2022-11-01)
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    Mihajlova Ilie, Radmila Mila
    Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.