Joksimovic, Vladimir

Preferred name

Official Name

Joksimovic, Vladimir

Translated Name

Јоксимовиќ Владимир

Alternative Name

Joksimovic V.

Vladimir Joksimovic

Vladimir Joksimovik

vladimir joksimovic

vladimir joksimovik

Vladimir Joksimovikj

vladimir joksimovikj

V.Joksimovic

v.Joksimovic

V.Joksimovikj

v.joksimovikj

Joksimovic V.

V. Joksimovic

V. Joksimovikj

Joksimovikj V

Joksimovikj V.

Main Affiliation

Now showing 1 - 10 of 36

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MORGAGNI HERNIA IN THE ADULT PATIENT: A CASE REPORT
(University of Niš, Faculty of Medicine, Niš, 2020-12-23)
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Stefan Jovic
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The aim of this review paper is to present the state of complementary and alternative medicine in the Republic of Serbia and compare it with other developing and developed countries around the world.In most countries of the world, the legalization and integration of the Complementary and Alternative Medicine (CAM) into the health system went very slowly until the 1970s, when there was an important global change in socioeconomic conditions. WHO estimates that $ 83 billion was spent on traditional medicine in the world market in 2008. Significant variations in financial allocations to CAM across the globe have been observed, however, their direct comparison has been hampered by differences in the definitions and categorization of CAM used, as well as by the use of different currencies in different time periods. The development of CAM in the Balkans, during the 1990s, was hampered by war and transition, and the resolution of CAM was delayed. For the first time, the law regulates the implementation of the CAM in Serbia in 2005 by Article 235 of the Health Care Act.In the Republic of Serbia, evidence of the extent of use of CAM methods is very modest, although worldwide research shows an accelerated upward trend in the use of CAM. This paper is our contribution to the further development and better recognition of CAM methods by both the Ministry of Health of the Republic of Serbia and the professional public.
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INTERMEDIATE UVEITIS AS THE FIRST PRESENTATION OF MULTIPLE SCLEROSIS
(Macedonian Association of Anatomists, 2020-07-16)
Ana Trpeska
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Abstarct Intermediate uveitis is a chronic, relapsing disease of insidious onset in which according to the SUN Working Group, the vitreous is the primary site of inflammation as determined clinically. Intermediate uveitis associated with systemic disease has variable course. Multiple sclerosis is associated with intermediate uveitis. We report a case of multiple sclerosis were intermediate uveitis was the first presentation of the disease. A 33 year old man with a 5 months history of decreased vision in his right eye. Best corrected visual acuity was 0.6 on his right eye and 1.0 on his left eye. Intraocular pressure was 17 mmHg and 15 mmHg on the right and left respectively. He had no signs of ocular surface inflammation, cornea clear, AC without signs of inflammation, lens clear. Right eye 3+ vitreous cells and vitreous condensations left eye 1+vitreous cells. Right eye fundus showed hyperemia of optic nerve head, irregular reflexes in the macula, peripheral retina without signs of retinitis or vasculitis. Left eye fundus showed only optic nerve head slightly hyperaemic. OCT, Indocyanine Green Angiography and fluorescein angiography were performed. We performed the investigations for diagnosing uveitis (angiotensin converting enzyme , serology for Treponema pallidum, Borrelia burgdorferi, Mantoux, neurological investigation) and all turned out to be negative except of MRI Brain and Spine that revealed multiple T2 hyperintense lesions consistent with multiple sclerosis. Multiple sclerosis may present initially with an intermediate uveitis. Multiple sclerosis should be suspected in patients aged 20 - 50 even without any neurological symptoms, noting that intermediate uveitis may precede other symptoms of demyelination.
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DOUBLE, VERY SHORT CYSTIC ARTERY: ANATOMIC VARIATION REVEALED DURING LAPAROSCOPIC CHOLECYSTECTOMY: A CASE REPORT
(Македонско лекарско друштво = Macedonian Medical Association, 2020)
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Marija Toleska
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Introduction. The cystic artery (CA) is the key struc-ture sought to be clipped or ligated during laparoscopicor conventional cholecystectomy.In up to 25% of sub-jects, the superficial and deep branches of the CA have separate origins and Michels called them double CA. Case report. We are presenting a 38-year-old female with one-year history of chronic gallbladder inflamma-tion. During the laparoscopy dissection in the region of the Calot’striangle, we revealed an anatomic va-riation of the cystic artery-a double cystic artery. The more important thing was that both branches were ex-tremely short, or at the lower limit of the publishedlengths of this blood vessel-approximately 3mm each. Bydoing so, the surgicalcourse further took the standardcourse-laparoscopic clips were placed on both branches. Conclusion. The incidence of double CA ranges from 15 to 25%. Such arteries usually arise from RHA and frequently replace the deep branch of the CA. Anatomicvariations in and around Calot’s triangle are frequent. Therefore, careful dissection of Calot’s triangle is ne-cessary for both conventional and laparoscopic chole-cystectomy. Hemorrhage could be a problem during search of the CA if these variations are overlooked and that increases the rate of conversion to open surgery. It also hasto be kept in mind that during laparoscopic visualization anatomical relations are seen differently compared to conventional cholecystectomy
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CASE REPORT: SUPRASPHINCTERIC PERIANAL FISTULA – OPERATIVE TREATMENT WITH BIOGLUE SURGICAL ADHESIVE
(SHMSHM - AAMD, 2025)
Trpeski, Stanko
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Murati, Ndricim
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Ivanovski, Kristijan
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A perianal fistula is a small pus-like channel that can occur between the end of the large intestine and the skin near the anus. It might be: Blind – which has only one open end, Complete - which has both an internal and an external opening and Incomplete – an external opening that does not communicate with an internal organ. They usually occur as a result of a previous history of a perianal abscess and when it is not completely healed. These fistulas arise from the anal glands that are localized between the internal and external anal sphincter and drain into the anal canal. In the following text, a case with a perianal suprasphincteric fistula will be described. A 43-year-old patient comes to Clinic For digestive surgery in Skopje due to pain in the anal region and flow of purulent smelly contents. Physical examination shows a fistulous opening at seven o’clock. A rectal examination was performed with a probe and digital rectal examination - there is communication with the rectum - suprasphincteric. The patient was sent for further investigation – magnetic resonance of the small pelvis. The patient is advised for surgical treatment of the fistula.
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MENAGEMENT OF BUTTONHOLE RECTAL INJURY AFTER VAGINAL DELEVERY - A CASE REPORT
(Македонско лекарско друштво = Macedonian Medical Association, 2020)
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Abstract Introduction. A special form of higher degree perinealtear is a laceration of the anorectal epithelium with in-tact external anal sphincter muscle (“buttonhole tear”). This is very rare but, when not treated, carries the risk of a rectovaginalfistula. Case Report. We present a case of a nullipara, in which a spontaneous vaginal delivery of a fetus in the vertex presentation was complicated by a buttonhole rectal tear with a partial lesion of the sphincters. It was recognized on the 4thpostpartum day, and a recon-struction of the lesion with a diversing colostomy was made soon. Upon returning the colostoma, the patient at 6 months postpartum has good continence and is in a good condition. Discussion. There are very few cases reporting an isolated rectal lesion during parturition. Several factorsmay play a role in the etiology of these lesions, inclu-ding instrumentation, birth weight of more than 4 kilo-grams, midline episiotomy, persistent occipitoposterior presentation, nulliparity, tissue factors, and second sta-ge >1 hour. Obstetric anal sphincter and rectal injuriescan be missed if rectal examination is not carried out asa standard procedure prior to suturing. This can have a devastating effect on the physical and emotional well-being of women.Conclusion. Careful examination of the vagina and the rectum should be performed in all cases of perineal tears following a vaginal delivery. Buttonhole injuries, although rare, should be considered as severe traumas similar to the 4th degree lacerations and managed prom-ptlyby experienced surgeons.
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Perioperative Outcomes of the Laparoscopic Treatment for Colorectal Cancer at the Clinic for Digestive Surgery Skopje, in a 5-Year Interval
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2022)
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Colorectal cancer (CRC) is the third leading cause of cancer related death in the world, and its incidence is rising in developing nations. Taking into account the increase in the incidence of this disease, the purpose of this review was to evaluate perioperative outcomes (in the first 30 days after surgery) for laparoscopic treatment of this malignancy, a treatment that is steadily becoming standard of patient care in the world. Our review showed that at the Clinic for Digestive Surgery, from 2015 to 2019, 115 patients with colorectal cancer were treated laparoscopically. The figures show a growing trend during this period. 10% of all colorectal cancers in 2019 were completed laparoscopically. In most cases (88.7%) tumor staging was pT2 and pT3. Perioperative outcomes showed wound infection in 2 patients, pulmonary complications in 1, anastomotic leakage in 1, bleeding in 1 patient, no readmission, and no mortality. The rate of conversion to open access is 5.7%, the operating time was 198 minutes on average, the average number of hospital stays was 9 days, and the average number of extirpated lymph nodes 13. There was no need for blood transfusion. Perioperative results for laparoscopic treatment of colorectal cancer at our institution show a low morbidity and mortality rate in these patients, with a clearly rising number in laparoscopically operated patients each year. Long term results are yet to be seen. Follow up with these patients will provide results later.
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RELATIONSHIP OF IMMUNOHISTOCHEMICAL EXPRESSION OF MISMATCH REPAIR GENE PRODUCTS AND CLINICOPATHOLOGICAL FEATURES IN PATIENTS WITH LOW-GRADE ENDOMETRIAL CANCER
(Macedonian Association of Anatomists and Morphologists, 2024)
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Ognenoska Jankovska, Biljana
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Background: This study examines the relationship between mismatch repair (MMR) gene expression and clinicopathological features in patients with low-grade endometrial cancer (EC). Methods: A prospective cohort of 40 patients with histologically confirmed low-grade EC underwent immunohistochemical analysis to determine MMR status. Clinical data, including age, body mass index (BMI), menopausal status, parity, and comorbidities, were collected. Histopathological evaluations assessed myometrial invasion,lymphovascular invasion and disease stage. Results: MMR deficiency (MMRd) was identified in 35% of patients, predominantly associated with MLH1/PMS2 loss. No significant associations were found between MMR status and clinical characteristics such as age, BMI, or comorbidities. However, MMRd tumors exhibited a significantly higher prevalence of myometrial invasion over 50% (85.71% vs. 38.46%, p=0.0042) and lymphovascular invasion (71.43% vs. 19.23%, p=0.00114). Additionally, MMRd cases were more frequently associated with advanced disease stages, particularly in stage IIIC (28.57% vs. 7.69%, p=0.078). Conclusion: The importance of MMR status in the biological behavior of low-grade endometrial cancer is highlighted in this study. The strong correlation between MMR deficiency and aggressive histopathological features such as increased myometrial and lymphovascular invasion, highlights the need to integrate MMR testing into clinical practice, even if clinical parameters showed no significant association with MMR expression. These results suggest that MMRd may be a useful prognostic indicator that requires more research to improve patient outcomes and treatment approaches for low-grade endometrial cancer.
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Laparoscopic cholecystectomy in situs inversus totalis: A case report
(Centre for Evaluation in Education and Science (CEON/CEES), 2021)
Gelevski, Radomir
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Todorovich, Lazar
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Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.
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Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery
(Asclepius, 2018)
Milkovski, Daniel
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Acute appendicitis is the most common surgical problem occurring during pregnancy. Its incidence is more common in the second trimester and is confirmed in 1/1000 pregnancies. Clinical manifestations of acute appendicitis in pregnant patients are generally very similar to non- pregnant patients. We present, here, the case of a 29-year-old pregnant patient at 35+4 weeks of gestation with the signs of acute appendicitis. The patient underwent a successful open appendectomy of her perforated appendix, without performing a cesarean section (CS) at the same time. 5 weeks postoperatively, at term, labor was induced with vaginal prostaglandins and the patient delivered a healthy female baby without any complications. Immediate diagnosis of acute appendicitis during pregnancy is recommended and management with the suitable surgical intervention should not be delayed for >24 h as it increases the risk of perforation with its subsequent critical complications. The treatment of acute appendicitis is always surgical, with an appendectomy and perioperative broad-spectrum antibiotics. Except in cases of high maternal and fetal mortality, a CS should not be done simultaneously with the appendectomy in cases of a perforated appendix with diffuse peritonitis, due to the very high risk of dehiscence of the uterus.
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Efficacy and tolerability of hyaluronic acid, tea tree oil and methyl-sulfonyl-methane in a new gel medical device for treatment of haemorrhoids in a double-blind, placebo-controlled clinical trial
(Springer Science and Business Media LLC, 2012-09)
Joksimovic, N
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Zuccari, C
Topical formulations are widely used in anti-haemorrhoidal treatment, but often lacking controlled clinical trials. Here, we report the results from a controlled clinical trial performed with a new gel medical device (Proctoial) containing hyaluronic acid with tea tree oil and methyl-sulfonyl-methane as major components. The total number of 36 haemorrhoidal patients (grade 1-3) was enrolled in a double-blind, placebo-controlled clinical trial and divided into 2 equal parallel groups. The anal pain, pain during defecation, visible bleeding, pruritus and irritation/inflammation were recorded before and after 14-day treatment using a visual analogue scale both by the investigators and by the patients. Safety and tolerability of the treatments were also recorded. The new gel medical device statistically significantly reduced all the symptoms after the treatment compared to placebo. The results indicated also a very good tolerability and safety of the treatments.

Joksimovic, Vladimir

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