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    FOUR YEAR RESULTS OF CONSERVATIVE TREATMENT OF BENIGN STRICTURES OF THE ESOPHAGUS WITH SVARY GILLIARD TECHNIQUE OF BOUGIENAGE: CROSS-SECTIONAL STUDY REPRESENTING FIRST EXPERIENCES IN REPUBLIC OF MACEDONIA
    (Macedonian Academy of Sciences and Arts, 2018-01)
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    Jane Mishevski
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    Background: Benign esophageal strictures are complications that result from various causes. They can be structurally categorized in two groups: simple and complex. Treatment is similar in most of cases that require dilatation and means use of three general types of dilators that are currently in use. However, despite the last guidelines on esophageal dilatation, the therapeutic response, optimal timing of treatment and interval between sessions can vary and there is no strong consensus in the literature regarding this fact. Aims: To analyze, the first 4 year experience of Digestive Endoscopy Unit of the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia, in treating benign esophageal strictures, since the Savary-Gilliard technique of “bougienage” was introduced for the first time in Republic of Macedonia, at our Institution in December 2013, by assessing etiology, length of stricture, number of dilations required to achieve satisfactory therapeutic response, as well as the relationship between the type, extent of stenosis and therapeutic response. Methods: One hundred and forty five dilations, during a period from 20-th December 2013, until March 2017 were analyzed in 31 patients. Results: The caustic strictures were the most prevalent, occurring in 15 (48%) of patients, followed by peptic stenosis presenting 26% of patients. The long and corrosive strictures needed more sessions to the absence of dysphagia. Peptic and short stenoses best answered on treatment and need fewer dilatation sessions per patient. Conclusion: caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long one. Peptic stenosis is the second one cause of benign esophageal strictures and responded well to endoscopic therapy. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage using Savary-Gilliard or American type of technique, irrespective of type and extent of esophageal stenosis is safe and grateful procedure.
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    MANAGEMENT OF CHOLANGIOHYDATIDOSIS WITH ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY
    (European Society of Gastrointestinal Endoscopy, 2022)
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    Nikolovska Trpchevska, Emilija
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    A serious complication of hepatic hydatid disease is intrabiliary rupture (IBR). We present a 19-year-old male patient with acute cholangitis. His abdominal ultrasound (US) revealed multiple liver cystic lesions, two of which large and partially collapsed, and impaction of membranes into common bile duct. Endoscopic biliary drainage resulted in significantly improved patient’s condition, with control US disclosing complete evacuation of one of the large collapsed liver cysts. Endoscopic retrograde cholangiopancreatography as a minimally invasive procedure has become preferred approach of IBR management, with remarkable success rates, and additional advantage of permitting elective surgery, associated with decreased morbidity and mortality.
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    NonHodgkin's Lymphoma with Peritoneal Localization
    (Hindawi Limited, 2014)
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    Misevski, J
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    The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5-20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.
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    СЛУЧАЈ НА ГАСТРИЧЕН МЕТАСТАТСКИ МЕЛАНОМ 2 ГОДИНИ ПО ПОЧЕТНА ДИЈАГНОЗА НА КОЖЕН МЕЛАНОМ
    (SHMSHM/AAMD, 2021-04)
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    Меланомот е најчестиот карцином кој метастазира во гастроинтестиналниот тракт, сепак, метастазите во желудникот е ретка појава. Ние го претставуваме случајот на пациентка со повеќе коморбидитети, дијагностицирана а потоа оперирана од бенка во дел на левото рамо 2 години пред презентацијата на неспецифични гастроинтерстинални симптоми и редукција на крвната слика. На горно дигестивна ендоскопија најдени се нејасно ограничени полипозни формации со васкуларна структура, кои хистопатолошки се потврдени за метастатски меланом во желудникот. Често неспецифични гастроинтестинални симптоми се причина за одложување на дијагностицирање на овој вид тумор, или воопшто не се дијагностицира ниту по обдукција. Заради ова, секој неспецифичен гастроинтестинален симптом заслужува една горно дигестивна ендоскопија во најкраток временски период, со цел рано дијагностицирање, спречување на напредување на болеста а по можност и навреме преземање на соодветен третман.
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    Herpes simplex esophagitis a cause of odynophagia in young patient: case report
    (2020)
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    Objectives: Herpes simplex esophagitis is usually found in immunosuppresed patient, those with malignancy, patient with AIDS, patient treated with immunosupresive therapy and in terminally ill patients. Very rarely it can be found in healthy, immunocompetent individuals. We present a case of a young patient with herpes simplex esophagitis manifested with odynophagia, retrosternal pain and fever. Case presentation: 18 years old patient referred to our clinic because of acute and severe odynophagia, retrosternal pain and fever in the last five days. She had no previous medical conditions. On physical examination the patient had fever up to 39C and tachycardia of 105/min. She had no abdominal tenderness, no palpable masses or hepatosplenomegaly. Laboratory analysis showed normal total white blood cell (WBC) count of 4.7x109/L. The patient underwent an upper gastrointestinal endoscopy. Upper gastrointestinal endoscopy revealed friable and inflamated esophageal epithelium with multiple conflu- ent ulcerations. Several biopsies were taken and patohystological analysis showed inflamamatory infiltrate with acute vas- cular proliferation and presence of lymphoid accumulations and eosinophils. This finding showed acute erosive esophagi- tis. In addition, HSV serology was done and HSV IgM and HSV IgG were positive. Blood serology for CMV IgM was negative. The patient was treated with oral acyclovir 200mg five times a day, for two weeks. Improvement of the symptoms was reported the second day, with complete resolution after completing the 14 days course of antiviral treatment. Conclusion: Herpes simplex esophagitis is a condition associated with immunosuppresd patient. It is typically presented with odynophagia, severe retrosternal pain and fever. Rarely, it can be found in immunocompetant patient and effectively treated with antiviral medications.
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    Bleeding Meckel's Diverticulum in a 33-Year-Old Female Diagnosed with Video Capsule Endoscopy and a Technetium-99 m Pertechnetate Scan with a Favorable Response to H2 Blocker and PPI
    (Hindawi Limited, 2021-12-09)
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    Meckel's diverticulum is a true diverticulum consisting of all three layers of the small intestine resulting from incomplete regression of the vitelline duct. While it is often benign, it can present with serious complications such as intussusception, ulceration, torsion, hemorrhage, obstruction, inflammation, and fistula formation. Although it typically presents in infancy and early childhood, it can also manifest much later into adulthood. We report a case of Meckel's diverticulum complicated by significant bleeding in a 33-year-old female patient. Diagnosis was accomplished with video capsule endoscopy and a technetium-99 m pertechnetate scan. The patient responded well to acid suppression, initially with an H2 blocker and later with a PPI (proton pump inhibitor), and remained asymptomatic for nearly four months in the interim to definitive surgical treatment. Microscopic examination of the resected diverticulum confirmed the presence of ectopic gastric mucosa. A PubMed literature search revealed several similar cases of Meckel's diverticulum complicated by hemorrhage with a favorable response to H2 blockers and PPIs. While surgical resection remains the mainstay of definitive treatment, medications aimed at acid suppression can delay the need for urgent surgery, allow for diagnostic assessment, and optimize conditions for elective surgical treatment.