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    RENAL LYMPHANGIECTASIA- AN UNUSUAL MIMICKER OF RENAL HYDRONEPHROSIS
    (Macedonian Association of Anatomists and Morphologists, 2021)
    Tashkova, Zorica
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    Arifi, Njomza
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    Renal lymphangiectasia is a rare malformation of the renal lymphatics. It occurs in both children and adults and can be unilateral or bilateral with no gender predilection. It is a condition characterized by different degrees of dilatation of the lymphatic ducts. Because of the rarity, it can be easily misdiagnosed for other cystic masses, most commonly peripelvic cysts, renal cysts or hydronephrosis. Usually is asymptomatic and incidental finding, but in severe cases can lead to hypertension and renal failure. We report a case of unilateral renal lymphangiectasia in adult male patient with medical history of hydronephrosis and characteristic radiologic CT findings. From imaging methods, we conducted ultrasound (US), contrast enhanced computed tomography (CT) and CT angiography, because they have an important role as diagnostic procedures to recognize renal lymphangiectasia. Kidney cystic lesions revealed on ultrasound and confirmed on CT as hypodense intrarenal multiloculated findings, as well as fluid attenuation collections, not always go in favor of hydronephrosis. Knowledge of the radiological findings associated with renal lymphangiectasia can contribute to better differentiation from other conditions and with the right diagnosis, successful management and treatment can be provided for the patient.
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    PERSISTENT TRIGEMINAL ARTERY - ANATOMICAL FEATURES AND CLINICAL SIGNIFICANCE
    (Macedonian Association of Anatomists and Morphologists, 2023)
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    Persistent trigeminal artery is the most common primitive carotid basilar anastomosis that persists in adulthood. The overall incidence of persistent trigeminal artery is between 0.2 to 0.76%. PTA are known to be associated with a wide range of pathology. The aim of this study was to describe the morphological characteristics of the PTA and to emphasize its clinical significance. We examined radiographs from patients who had CT angiography undertaken for a variety of clinical reasons, performed as a part of their medical treatment at the University Institute for Radiology in Skopje, RN Macedonia. The study population included 234 patients, 130 male and 104 females, mean age 57.8 years. In one patient we found PTA with overall incidence of 0.42%. CTA revealed a left PTA that arise from the internal carotid artery and communicate with the basilar artery between the origin of the anterior inferior cerebellar artery and the superior cerebellar artery. Although anatomically interesting, an awareness of the anatomy and variations of the brain arteries is clinically important for radiologists and surgeons for save performance of procedures, and forensic pathologists since variants may have forensic consequences.
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    Radiological procedures in diagnosis and preoperative staging of testicular malignant tumors
    (SHMSHM - AAMD, 2008)
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    Gligorievski, Antonio
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    Banev, Sasho
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    Evaluation of clinical and magnetic resonance (MR) findings of posttraumatic syringomyelia with results of surgical treatment.
    (2011)
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    Mihajlovska-Rendevska, Ana
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    Mitrevska, Nadica
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    Vrchakovski, Miodrag
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    ARTERIAL THROMBOSIS IN A COVID-19 PATIENT
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2022)
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    Shopova, Zhaklina
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    Vidinic, Ivan
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    Arterial thrombosis is one of the complications descry bed in severe COVID-19. Our presented case had throm bosis of abdominal aorta and left renal artery despite prophylactic treatment with low molecular heparin - enoxaparine. Thrombotic lesions were defined with CT angiography. Treatment consisted of therapeutic doses of low molecular heparin and Bergman solution. After 42 day of hospital treatment, the patient was dischar ged and vascular surgeon consultations were performed. By presenting this case, we want to draw attention to the need for early diagnosis of this complication and to highlight the need for treatment with therapeutic doses of low molecular heparin in patients with severe Covid pneumonia or oxygen dependent patients and in risk for thrombosis.
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    Origin of the right vertebral artery examined with CTA
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/ Sciendo, 2025-12-06)
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    Kordoska, Jovana
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    Background: The vertebral artery arises from the first part of the subclavian artery and provides posterior brain circulation. The abnormal origin of the vertebral arteries is an uncommon finding. The aim of this study was to examine the origin of the right vertebral artery and to discuss its clinical implications. Materials and methods: We examined radiographs of 203 patients who had CT angiography undertaken for a variety of clinical reasons, performed as part of their medical treatment at the University Clinic for Radiology in Skopje, R. N. Macedonia. Results: The study population included 203 patients, 108 male and 95 female, age range from 19-82, mean age 59.6 years. In 202 patients (99.5%) the right vertebral artery originated from the right subclavian artery. In one patient (0.49%) we found atypical right vertebral artery arising from the right common carotid artery in combination with the origin of the right subclavian artery from the aortic arch. Conclusions: The knowledge of the potential vertebral artery origin variants is important for clinicians for safe performance of diagnostic and interventional procedures in radiology and for surgeons during planning and accomplishing surgical interventions.
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    Origin of left common carotid artery examined with CTA
    (Faculty of Medicine, University of Nis Galaksijanis Nis, 2023-09-21)
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    Introduction: The aortic arch usually gives rise to three major branches: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The left common carotid artery is the second and longest branch of the aortic arch; it ascends from the apex of the arch to the left carotid bifurcation in the neck, which typically occurs between the third and fourth midcervical vertebral bodies. The aim of this study was to describe the variations in origin of left common carotid artery and to emphasize their clinical significance. Materials and methods: We examined radiographs of 103 patients who had CT angiography undertaken for a variety of clinical reasons, performed as a part of their medical treatment at the University Clinic for Radiology in Skopje, RN Macedonia. The study population included 103 patients, 58 male and 45 females, age range from 25 - 82, mean age 58.4 years. Results: The left common carotid artery arose from the aortic arch in 88 patients (85.43%). In 15 patients (14.56%) we found atypical arisen of the left common carotid artery from the brachiocephalic trunk. Conclusion: Although anatomically interesting, an awareness of the left common carotid artery anatomy and variations is clinically important. A sound knowledge of left common carotid artery anatomy and variations is important during diagnostic, endovascular and surgical procedures.
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    Size, Localization and Risk Factors in Ruptured and Unruptured Brain Aneurysms
    (SciVision Publishers LLC, 2025-01-06)
    Daskalov, Dejan
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    Brain aneurysm is a pathological focal enlargement of an artery in the brain, that is, of the inner muscle layer of the blood vessels. The vessel expands in the form of a balloon from varying degrees, where the wall of the aneurysm can become thin and rupture without warning. Brain aneurysms can form and not rupture. They are often discovered incidentally during the examination of other pathological health conditions. Aim: To assess the incidence of brain aneurysms in relation to sex and age, as well as in relation to localization, size and type, that is, bleeding and non-bleeding brain aneurysms. The study also analyzes risk factors for the occurrence and outcome of brain aneurysms. Material and Methods: In the study, 80 patients with symptoms of brain aneurysm were analyzed, and diagnostic procedures were performed to prove the brain aneurysm and establish an indication for further treatment. Results: Of the analyzed patients, 48 (60%) were women, and 32 (40%) were men. In terms of age, the patients had an average age of 56.1 ± 10.3 (31-84 years). In patients with ruptured and unruptured aneurysms, there was a statistically insignificant difference in the average age between these two groups of patients 55.8 ± 9.5 vs 56.8 ± 12.3 years. Ruptured aneurysms were significantly more often diagnosed in male patients 84.38% vs 62.5% in the female population. A statistically significant difference was detected in the distribution of small, large, and giant aneurysms between the groups of ruptured and unruptured aneurysms, where it was shown that small aneurysms were insignificantly more often bleeding 77.19% vs 56.52%, large aneurysms were insignificantly more often non-bleeding 26.09% vs 21.05%, giant aneurysms were significantly more often non-bleeding 17.39% vs 1.75%. Aneurysms were non- bleeding, that is, unruptured in 28.75%, bleeding, that is, ruptured aneurysms were diagnosed in 71.25% of patients. Risk factors were present in 69 (86.25%) patients, of which the most common risk factor was hypertension, which was present in 86.25% of the patients. Hyperlipidemia was present in 33.75% of patients, while diabetes was diagnosed in 13.75%. The risk factor of smoking was present in all patients. Conclusion: Timely diagnosis of brain aneurysms is important in determining the type of aneurysm, its localization, size, and the risk of rupture. Given that non-ruptured diagnosed aneurysms carry a high risk of rupture, the establishment of an indication for endovascular treatment is of particular importance. Control of risk factors, especially smoking and hypertension, is an important segment in the prevention of the occurrence and outcome of brain aneurysms.
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    Anatomical features and variations of the vertebrobasilar system
    (Firenze University Press, 2024-09-04)
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    The posterior circulation of the brain constitutes the vertebrobasilar system and its branches, which are responsible for about 20% of the brain blood supply. The aim of this study was to describe the morphological characteristics of the vertebrobasilar system. We examined radiographs of 103 patients, 58 male and 45 females, age range from 25 - 82, mean age 58.4 years who had CT angiography undertaken for a variety of clinical reasons, performed as a part of their medical treatment at the University Institute for Radiology in Skopje, Macedonia. The left vertebral artery arose from the left subclavian artery in 94.17% and the right vertebral artery had origin from the right subclavian artery in 99.02%. Variable origin of the left vertebral artery from the aortic arch was noticed in 5.82% and in one patient (0.97%) we found atypical arisen of the right vertebral artery from the right common carotid artery. The diameter of the vertebral artery was 3.20 ± 0.74 mm on the right side and 3.33 ± 0.76 mm on the left side. The mean length of the basilar artery was 31.60 ± 5.1 mm (from 21.4 mm to 44.1 mm). The mean diameter of the basilar artery was 3.27 ± 0.52 mm (from 2.22 to 4.87 mm). Most of the SCA arise from the basilar artery as a single vessel. The most common variations of the SCA were duplication (frequency 1.94% on right and 0.97% on left) and origin from PCA (frequency 1.94% bilateral). In four patients (3.88%) we found fenestrations of posterior brain circulation, three fenestrations (2.91%) was on the basilar artery and one fenestration (0.97%) was on the vertebral artery. In one patient persistent trigeminal artery was found. A sound knowledge of vertebrobasilar system anatomy and variations is important during diagnostic, operative and endovascular procedures.
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    UNILATERAL INFILTRATION OF THE OPTIC NERVE AND ORBIT REVEALING RELAPSE OF AN ACUTE LYMPHOBLASTIC LEUKEMIA
    (University of Tetova, 2022-05-19)
    Reci, Valvita
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    Kesba, Mahmoud
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    Introduction. Ocular tissue remains a sanctuary for leukemic proliferation because of poor chemotherapy penetration of the blood-retina and blood-aqueous barriers. Thickening and enhancement of the optic nerve in patients with underlying leukaemia should be considered suspicious for leukaemic infiltration and should be differentiated from optic neuritis. The leukaemic infiltration of the optic nerve is more common in children. The chemotherapeutic drugs cannot penetrate the blood-brain barrier and the invasion of leukaemic cells in the small optic canal can interfere with the flow of CSF. Purpose. To describe the clinical presentation and imaging features of a leukemic optic nerve and orbit infiltration. We present a case of unilateral infiltration of optic nerve and orbit revealing a relapse of an acute lymphoblastic leukemia. Methods. A 10-year-old child with past history of treated acute lymphoblastic leukemia 5 years ago, presented to our clinic with decreased vision, eye pain during ocular motility and severe protrusion and exotropia of the left eye. At the moment of our examination, pediatrician confirmed that the child is healthy and no signs of leukemia. Results. At presentation, we noticed very pronounced protrusion and exotropia of the left eye, lagophthalmos and conjunctival hyperemia. Ocular examination revealed normal visual acuity in his right eye and decreased visual acuity in his left eye 20/200. Pain during ocular motility and limited elevation, abduction and adduction as well convergence insufficiency. Ishihara test showed impaired red-green colour vision. Diminished light brightness and contrast sensitivity in his left eye and a relative afferent pupillary defect was present. Fundus examination showed severe hyperaemia and oedema of the optic disc with blurring margins and whitish-yellowish peripapillary leukemic infiltrates, flame-shaped haemorrhages, few dot and blot retinal hemorrhages in the middle periphery of the retina and towards superior and inferior temporal retinal vein, as well as dilated and tortuotic retinal veins. MRI result showed the presence of a perineural lobulated expansive lesion that infiltrates the intraconal fat with loss of its signal as a sign of infiltration. The described mass displaces the eyeball ventral and causes axial proptosis while posteriory extends to the prechiasmatic segment of the left ocular nerve with infiltration of the same; penetrates into the posterior third of the ethmoidal sinus with infiltration of the ethmoidal cells as well as towards the left cavernous sinus, para and suprasellar with dural involvement beside the left middle cranial fossa. The orbital apex is dilated and completely occupied by the described substrate. Size of this mass was about 5.3 cm and 4.5 cm. We diagnosed as relapse of leukemic optic nerve and orbit infiltration and referred to the pediatrician-oncologist for further management. Bone marrow biopsy (myelogram), flow-cytometry and lumbar punction was done and demonstrated blast infiltration and therefore was confirmed ocular relapse of the lymphoblastic leukemia. Conclusion. Isolated optic nerve relapse of leukemic infiltration is of paramount importance to early diagnosis, as vision can be saved if treatment is initiated promptly. Optic nerve leukemic infiltration has a severe prognosis. Ophthalmic assessment is essential in patients with ALL in order to diagnose an early ocular involvement and the patient's vision can be preserved if treatment is initiated promptly.