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    ANTEGRADE ELASTIC STABABLE INTRAMEDULARI NAILING IN TREATMENT OF DISTAL RADIUS DIAPHYSEAL METAPHYSEAL JUNCTION FRACTURES IN CHILDREN
    (University Ss. Cyril and Methodius in Skopje, 2023)
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    Aleksovski, Zlatko
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    Kamiloski, Marjan
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    Racaj, Anila
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    BARDET-BIEDL SYNDROME
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025-03-01)
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    Ljumani Bakiji, Lj
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    Abstract Bardet-Biedl syndrome (BBS) is a genetic and multisystem disease that affects the genitourinary tract, locomotory system, causes eye anomalies, cognitive disorders and characteristic truncal obesity. It is caused by mutations in certain genes, namely: BBS1 to BBS21 gene. The approach to this disease is multidisciplinary. Material and Methods: We present a 3-years-old female child who was referred to the Clinic for Pediatric Surgery due to supernumerary toes on both feet. This is postaxial polydactyly. Intrauterine lobulated kidney structure was observed. The child had problems with her peers and avoids socializing with them. The following examinations were performed: cardiological, ophthalmological and genetic. Genetic examinations confirmed the BBS syndrome. Results: The patient was operated at the clinic for pediatric surgery, the operative and postoperative period were without complications. Conclusion: BBS is a rare autosomal disease that requires timely detection and appropriate multidisciplinary treatment. This allows complications to be reduced and the child to be included in everyday activities.
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    SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
    (Wiley, 2022-01)
    COVIDSurg Collaborative* and GlobalSurg Collaborative*
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    Chokleska, N
    SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
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    PYELOPLASTY IN BIFID RENAL PELVIS WITH OBSTRUCTION OF THE LOWER MOIETY
    (Macedonian Association of Anatomists, 2021-12-27)
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    Zlatko Aleksovski
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    Aleksandar Tanev
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    Abstract Duplications in the urinary collecting system and pyeloureteral junction obstruction (PUJO) are common, but the simultaneous presence of both anomalies is rarely encountered. In duplicate incomplete systems, PUJO usually affects the lower moiety of the kidney. We present a case of a 2- year old boy with left bifid renal pelvis and hydronephrosis of the lower moiety of the kidney.
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    Physical treatment of posttraumatic elbow contractures in children – our experience
    (Scientific Foundation SPIROSKI, 2022-03)
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    The most common complications of elbow trauma are contractures and neurovascular injuries. The complications can be a result of the initial injury, but they can also be a result of a surgical treatment. In addition to orthopedic treatment of elbow fractures, physical therapy and rehabilitation play a significant role in treatment of posttraumatic contractures. To determine the effects of physical therapy and rehabilitation of posttraumatic elbow contractures in children. This was a retrospective cross-sectional study conducted in the University Clinic for Physical Medicine and Rehabilitation, Skopje in the period 01.01.2021 – 01.07.2022. A total of 52 children were included, at the age between 2 and 13 years who had a posttraumatic elbow contracture, limited range of motion, pain and/or limitations in accomplishing daily activities. Depending on the clinical finding, children underwent a relevant physical therapy (kinesitherapy, functional therapy, electrotherapy, thermotherapy, hydrotherapy and magnetotherapy) in duration of three weeks. For assessing the effects of the rehabilitation therapy, the range of motion of the elbow and forearm was examined along with the Flynn’s scale in all children, prior to and after completion of the physical treatment. Applied physical treatment resulted in a significant improvement in all analyzed movements such as: elbow flexion (p=0.00001), elbow extension (p=0.00001), forearm pronation (p=0.00001), forearm supination (p=0.0000) and Flynn’s scale (p=0.0000). After completion of the rehabilitation treatment, excellent results were registered in 41 (85%) children, moderate in 10 (19.23%) and favorable in 1 (1.92%). Timely and adequate application of physical therapy and rehabilitation can significantly improve the final outcome in treatment of posttraumatic elbow contractures in children. A combination of different physical procedures adequately applied and personalized can significantly improve the range of motion of the elbow.
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    Continuous Peripheral Block as a Pain Treatment for Redressment and Physical Therapy in a 7-Year-Old Child - A Case Report
    (Macedonian Academy of Sciences and Arts / Sciendo, 2022-04-22)
    Ljubica Mikjunovikj-Derebanova
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    Ljupco Donev
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    Vesna Cvetanovska-Naunov
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    Vasko Demjanski
    Abstract Continuous peripheral nerve block, also known as "local anesthetic perineural infusion," refers to percutaneous placement of a catheter near a peripheral nerve or plexus followed by administration of a local anesthetic through a catheter to provide anesthesia, or analgesia for several days, in some cases even for a month. This report describes the case of a 7 year old boy with left elbow contracture with limited flexion and extension who was admitted to the Clinic of Pediatric Surgery for redressment of the elbow and physical therapy. An ultrasound-guided axillary brachial plexus block was performed, with placement of a non-tunneled perineural catheter. Redressment of the left elbow was performed twice and before each redressment boluses of local anesthetic were applied through the perineural catheter. Physical therapy was performed painlessly with continuous perineural infusion. On the 5th day of catheter placement, the perineural catheter was removed without any prior complications such as hematoma, infection, catheter dislocation or leakage of local anesthetic. Our goal is to minimize the psychological and physical trauma to the patient, no matter how immature the patient is. Continuous regional anesthesia in children is a safe technique in postoperative pain management that facilitates early mobilization due to its sufficient analgesia and better comfort. It can provide in-home treatment, with adequate education for patients and parents, and improve rehabilitation in children.
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    True left-sided gallbladder (T-LSG) as incidental finding on laparoscopic cholecystomy - case report
    (Macedonian Association of Anatomists, 2021)
    Radomir Gelevski
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    Left - sided gallbladder, located medial ly t o the falciform ligament, between segment III and IV of the liver, has complex embryological development explained by two different concepts: one founded upon f o etal migration of the gallbladder ; and the other founded upon complex f o etal evolution of intrahepatic anatomy. 57 - year - old male was admitted for elective cholecystectomy, and , after pneumoperitoneum was established , a true left - sided gallbladder was identified. The patient wa s positioned in normal position and ports were placed on typical sites. After diligent dissection, cystic artery and duct were clipped as close as possible to gallbladder and dissected. During standard dissection in laparoscopic cholecystectomy, special at tention was dedicated to obtaining posterior critical view of safety, providing adequate exposition of structures of Calot’s triangle. Posterior critical view of safety in left - sided gallbladder exposes cardinal structures of hepatic hilus. Although, duri ng laparoscopy , difficult anatomy is met and there is high probability of bile duct injury, laparoscopic cholecystectomy is the recommended procedure of choice for left - sided gallbladder.
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    INTERCONDYLAR (Y) FRACTURE OF THE DISTAL HUMERUS IN A 8-YEAR-OLD CHILD
    (University Ss. Cyril and Methodius in Skopje, 2021)
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    Kamiloski, Marjan
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    Mikjunovikj, Ljubica
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    Ендоскопски третман на везикоуретерален рефлукс во детската возраст
    (Association of Albanian Medical Doctors from Macedonia (AAMD – Macedonia), 2012)
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    Risto Simeonov
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    Chadikovski, Vladimir
    Апстракт Вовед Везикоуретералниот рефлукс е секојдневен проблем со кој што се соочува детската уролошка пракса. Ендоскопскиот третман на везикоуретералниот рефлукс во детската возраст претставува атрактивна терапевтска опција со која што се избегнува долготрајната антибиотска профилакса и морбидитетот асоциран со отворените хируршки техники. Цел Целта на овој труд е да ги прикажеме нашите резултати од третманот на везико-уретералниот рефлукс по пат на ендоскопска, субтригонална инјекција на кополимерот декстраномер и хијалуронска киселина (Deflux). Материјал и метод Во периодот од 2006 до 2011 година, на Универзитетската клиника за детска хирургија со цистоскопска, субтригонална инјекција на Deflux се третирани вкупно 32 деца, од кои што 21 се женски, а 11 машки на возраст од 1 до 20 години. Третирани се вкупно 49 уретери со рефлукс од II, III и IV степен. Интервенцијата се изведуваше како еднодневна хируршка процедура во општа ендотрахеална анестезија. Децата се следени по протокол (постоперативно, по 6 недели и 6 месеци). Резултати и заклучок Кај 24 деца (32 уретери) беше спроведен целиот протокол на следење. Намалувањето за 2 степени на ВУР го оценувавме како добар резултат. Кај 22 уретери (68.75%) беше постигнат добар резултат. Од останатите 10 уретери кај 4 деца се повтори процедурата, со успешност од 50%. Оваа минимално инвазивна процедура кај децата со ВУР од II-IV степен е супериорна метода на лекување како од медицински, така и од финансиски аспект.
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    Treatment of Pilomatrixoma in Pediatric Population - Our Experience
    (Macedonian Association of Anatomists and Morphologists, 2021)
    Sokolova Rozeta
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    Lumani Bakili Njomza
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    Pilomatrixoma is a type of benign tumor most commonly diagnosed in people under the age of twenty. It usually occurs at the passage of hairy parts of the body and is associated with hair follicles.It accounts for 1% of all benign tumors. The symptomatology varies according to the location of the tumor, however most are isolated and non-symptomatic. Rarely, pilomatrixoma can become malignant after the age of twenty. Tumor size over 10cm increases the possibility of malignant alteration. Complete surgical excision of the tumor is recommended.