Volkanovska, Anche
Preferred name
Volkanovska, Anche
Official Name
Volkanovska, Anche
Main Affiliation
Email
ance.volkanovska@medf.ukim.edu.mk
33 results
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Item type:Publication, Cystic pheochromocytoma, a diagnostic challenge: A case report(Bioscientifica, 2020-08); ; We describe a case of cystic pheochromocytoma (PCC) with negative biochemical evaluation, diagnosed on the basis of hypertensive crises during operative management and histopathologic findings. A 57-year-old woman complained of several episodes of stabbing right upper abdominal pain accompanied by tachycardia, headache, lack of breath, elevated blood pressure and vomiting in the preceding three years. At presentation, blood investigations were significant only for mildly elevated transaminases and serum amylase. An abdominal ultrasound was performed and revealed large right adrenal incapsulated and heterogenous mass, 7 × 7 cm in size, with mass effect. Computed tomography imaging confirmed incapsulated adrenal mass with internal septations and unenhanced attenuation of >30 Hounsfield units. Based on imaging appearance and patient’s history, a suspicion of PCC was established, and the patient was referred to endocrinologist. Laboratory exams for Cushing’s syndrome were unremarkable and urinary vanilmandelic acid, metanephrines and serum chromorgranin A were within normal range on several occasions. Further evaluation with iodine-123 (123I)-labeled metaiodobenzylguanidine (MIBG) scintigraphy would have been useful to differentiate the mass, but it was not available at the moment of investigations. Despite negative biochemical diagnosis,strong clinical suspicion for PCC was established and the patient was preoperatively prepared with α-adrenoreceptor and beta blockers. Initial attempt for laparoscopic adrenelectomy was unsuccessful due to early intraoperative occurrence ofhypertensive crises with blood pressure 300/150 mmHg. Three months later a successful open adrenelectomy was performed with nonsignificant intraoperative hemodynamic instability. Histopathologic evaluationconfirmed cystic benign PCC with dominance of multnuclear giant, foamy macrophages, presence of hemosiderin deposition and hemolyzed erythrocytes. Although cystic adrenal lesions comprise several types of non-functionating benign lesions, the differential diagnosis should include cystic form of PCC, an entity that is rarely reported. In cystic PCC the number of cateholamin-producing cells are low, especially when an extensive necrotic cystic regions are present. Furthermore, catecholamines stored in the capsular mass may not be released into the blood circulation until surgical attempt for isolation of PCC is made. Therefore, high clinical suspicion for PCC is necessary since negative biochemical diagnosis is possible. As demonstrated by our case, clinical presentation was crucial in the diagnosis and preoperative management. Preoperative optimization with antihypertensive drugs and blood volume expansion fluids is obligatory in PCC surgery in order to prevent detrimental intraoperative hemodynamic instability. Albeit laparoscopic adrenelectomy is becoming a first line surgical option for PCC, still it’s not always feasible as shown in our case. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Challenging Case of Multisystem Inflammatory Syndrome in a 19- Year Old Female: A Case Report(Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2022); ; Introduction. In comparison to older adults, SARSCoV-2, leads to a mild illness in children and young adults typically manifested with fever, cough and gastrointestinal symptoms. However, the multisystem inflammatory syndrome in children and young adults (MISC) emerged during the coronavirus disease in 2019 pandemic. Case report. We report a challenging case of a 19- year old female patient with signs and symptoms of multisystem inflammatory syndrome and SARS-CoV2 infection, most probably as a post infectious disease with onset between 2 to 4 weeks after the infection. Its clinical symptoms may have overlaped with classical Kawasaki disease (systemic vasculitis) or Kawasakilike syndrome (atypical) with fever, gastrointestinal symptoms, rash, conjunctival injection, hypotension, sore throat, mucosal changes with a relative lack of severe respiratory disease, myocarditis, hypoalbuminemia and elevated inflammatory markers. And indeed, the clinical presentation of COVID-19 in young adults resembles Kawasaki disease with gastrointestinal manifestations to severe inflammation with myocarditis. Conclusion. Timely diagnosis and proper treatment of the multisystem inflammatory syndrome and SARSCoV-2 infection are real challenge requiring multidisciplinary approach and tertiary resources. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MANAGEMENT OF CHOLANGIOHYDATIDOSIS WITH ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY(European Society of Gastrointestinal Endoscopy, 2022); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Adrenal Cyst-Diagnostic Dilemma: Case report(2022); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Management of an adolescent with familial adenomatous polyposis: report of a case(2019); ; ; ; Ana Karadzova Dzambaz - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SERUM D-DIMER IN CIRRHOTIC PATIENTS WITH SPONTANEOUS BACTERIAL PERITONITIS(Macedonian Society of Gastroenterohepatology, 2024-09); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Rare presentation of gastric schwannoma: a case report.(2016); ; ; Mishevski JSchwannomas or neurilemmomas are well-defined benign tumors arising from neural crest cells and surrounding the nerve sheath. These neoplasm’s are rare among the spindle cell mesenchymal tumors of the gastrointestinal tract, and develop most commonly in the stomach representing 0.2% of all gastric tumors. We present a case of 53-years-old female with a history of upper abdominal pain. The physical examination revealed palpable epigastric mass; serum biochemistry and tumor markers were in normal range. Abdominal ultrasound as a first imaging procedure detected 5 cm cystic tumor located between the body and the tail of the pancreas, while upper endoscopy showed sub mucosal mass in the region of cardia. Diagnostic dilemma was resolved by the means of endoscopic ultrasound (EUS), which defined the exact place of the tumor in the gastric wall. Since EUS biopsy was not available procedure, percutaneous biopsy was performed. Histological and immuno-histochemical findings of the biopsy specimen and surgically resected tumor were identical, establishing the diagnosis of schwannoma. Complete surgical resection of the tumor is the treatment of choice, and the prognosis after tumor resection is excellent. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, KRAS MUTATIONS IN PANCREATIC ADENOCARCINOMA IN CORRELATION WITH CLINICAL AND PATHOLOGICAL CHARACTERISTICS(Macedonian Association of Anatomists and Morphologists, 2020); ; ; Pancreatic adenocarcinoma is the seventh cause of death of all malignant tumors worldwide and has the worst prognosis of all solid tumors. In Europe, it is the sixth most common cause of cancer related death and in United States it is the fifth cause of death after lung cancer, prostate cancer, breast and colorectal cancer. Numerous molecular studies have analyzed genetic and epigenetic changes as responsible for the histological variants of this cancer, their correlation with family predisposition, and opportunities for better treatment and survival. This study included 42 patients with pancreatic adenocarcinoma. Tumor tissue samples obtained from surgical specimen were histopathologicaly examined and genetic mutations were determinate. Prior to surgery, patients were diagnosed by imaging modalities (abdominal ultrasound and/or CT), clinical and laboratory examinations. Histopathological analyses included: T category, grade of tumor differentiation, vascular invasion, lymph node involvement and metastasis. We obtained the KRAS and EGFR gene mutations on the Randox investigator diagnostic platform. The aim of the study was to determine the frequency of KRAS and EGFR mutations in pancreatic adenocarcinoma and their correlation with multiple tumor characteristics. No one patient had EGFR mutation. The results showed that more of the patients with KRAS genetic mutations are frequently associated with advanced disease stage and worse prognosis, although the difference was not statistically significant in comparison to patients without KRAS mutations. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Важност на пред и постоперативниот еноректален ултразвук(Macedonian society of gastroenterohepathology, 2023-05); ; ; ; - Some of the metrics are blocked by yourconsent settings
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