Ognjenovic, Ljubomir
Preferred name
Ognjenovic, Ljubomir
Official Name
Ognjenovic, Ljubomir
Main Affiliation
18 results
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Item type:Publication, Comparison Between Dunking (Invagination) Pancreaticojejunoanastomosis and Double Layer Duct to Mucosa Anastomosis After Cephalic Duodenopancreatectomy-Whipple Procedure for Pancreatic Cephalic Carcinoma(Walter de Gruyter GmbH, 2020-11-01); ; Gjoshev, Stojan<jats:title>Abstract</jats:title> <jats:p> <jats:bold>Introduction</jats:bold>: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal the risk benefit rationale for dunking either duct to mucosa anastomosis.</jats:p> <jats:p> <jats:bold>Material and method:</jats:bold> In our last series of 25 patients suffering pancreatic head carcinoma we performed a standard dodenopancreatectomy. After the preoperative diagnosis and staging with US, CICT, tumor markers, they underwent surgery. Invagination-dunking anastomosis was performed in 15, whereas, duct-to-mucosa, double layer anastomosis was performed in 10. In the first group with dunking anastomosis, we had 6 patients with soft pancreas and 8 with narrow main pancreatic duct, less than 3 mm. In the duct-to-mucosa group there were 5 patients with soft pancreas and 4 with narrow main pancreatic duct. All other stages of surgery were unified, so the only difference in the procedure remained on the pancreatojejunoanastomosis. The onset of the postoperative pancreatic fistula was estimated with revelation of 3 fold serum level of alfa amylases from the third postoperative day in the drain liquid.</jats:p> <jats:p> <jats:bold>Results</jats:bold>: In the duct to mucosa group there wasn’t a clinically relevant postoperative pancreatic fistula, while in the dunking anastomosis group we had 4 postoperative pancreatic fistula B, 26 %. One of these 4 patients experienced intraabdominal collection – abscess, conservatively managed with lavation through the drain. Comparing the groups, there was no significant difference between the groups concerning the appearance of postoperative pancreatic fistula: p>0.05, p=0.125. From all 25 patients, in 21 patients biliary stent was installed preoperatively to resolve the preoperative jaundice. All 21 suffered preoperative and postoperative reflux cholangitis, extending the intra-hospital stay.</jats:p> <jats:p> <jats:bold>Conclusion</jats:bold>: So far, there have been many trials referring to opposite results while comparing these 2 techniques in creation of the pancreticojejunoanastomosis. In our study, the duct to mucosa anastomosis prevailed as a technique, proving its risk benefit rationale. However, further large randomized clinical studies have to be conducted to clarify which of these procedures would be the prime objective in the choice of the surgeon while creating pancreatojejunoanastomosis.</jats:p> - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Tumour Lymphocytic Infiltration, Its Structure and Influence in Colorectal Cancer Progression(Scientific Foundation Spiroski, 2018); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Tertiary Lymphoid Structures in Colorectal Cancers and Their Prognostic Value(ID Design 2012/DOOEL Skopje, 2018-10-25); ; ; Hadzi-Manchev, DraganTumor-infiltrating lymphocytes (TIL) in tumour stroma are considered to be involved in the elimination of malignant cells and prevention of metastasis formation. TIL consist of T lymphocytes including cytotoxic lymphocytes that are a constituent part of the effector mechanism of anti-tumour immunity and B lymphocytes that can form tertiary lymphoid structures (TLS). TLS has been described in several solid tumours and colorectal carcinoma (CRC), and the influence on the local and systemic anti-cancer response. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, IMPLEMENTATION OF FOCUSED ASSESSMENT WITH ULTRASONOGRAPHY IN TRAUMA PATIENTS IN UNIVERSITY SURGICAL EMERGENCY DEPARTMENT(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University in Skopje, R.N.Macedonia, 2023); ; ; Introduction: This article discusses the importance of trauma assessment in healthcare settings and the role of focused assessment with sonography in trauma (FAST) scans as a diagnostic tool. Trauma remains a significant health concern worldwide, leading to high mortality and morbidity rates, particularly in the younger population. Identifying risk factors for death is crucial for improving trauma patient’s outcomes. Objective: The objective of the study is to implement FAST assessments in an inner-city emergency department and examine their impact on the treatment of adult trauma patients. Material and Methods: The study took place in an urban trauma center and included patients over 18 years old who were presented with trauma, excluding pregnant females, unstable patients and those without consent. FAST scans were performed using ultrasound machines, assessing various abdominal and thoracic views. Results: The results revealed a high sensitivity of 94.4% and a specificity of 85.71% for FAST scans, making them a valuable tool for detecting abdominal free fluid in trauma patients. The most of trauma patients in the study were men aged between 25 and 55, with falls, traffic accidents and assaults being the primary causes of blunt trauma. Commonly affected organs included the lungs, liver and spleen. FAST scans were found to be particularly useful for hypotensive patients, helping in triage decisions. While FAST scans demonstrated high sensitivity and specificity, the study suggests that patients with negative results should be observed and may benefit from follow-up scans, as small amounts of free fluid can be challenging to detect. Conclusion: In conclusion, FAST scanning offers several advantages as a diagnostic tool for trauma assessment including its accessibility, affordability, repeatability, noninvasiveness and quick setup. It complements traditional methods like CT scans, especially in cases of hypotensive patients. Despite their limitations, FAST scans play a significant role in improving the management of trauma patients, helping healthcare professionals to make informed decisions about patients’ care. To fully investigate the potential of FAST scans in trauma situations, additional research is required. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery(Asclepius, 2018); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, True left-sided gallbladder (T-LSG) as incidental finding on laparoscopic cholecystomy - case report(Macedonian Association of Anatomists, 2021); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ACUTE APPENDICITIS ASSOCIATED WITH ENTEROBIUS VERMICULARIS –CASE REPORT(Македонско лекарско друштво = Macedonian medical association, 2020); ; ; Marija ToleskaEnterobius vermicularis, typically found in cecum, appendix or terminal ileum, is the cause of the most common helminthic infestation in humans. A 19-year-old female patient, with normal laboratory results, was admitted for urgent appendectomy via McBurney inci-sion. After ligation and division of the inflamed appendixfrom the cecal basis, several viable and mobile enterobiusvermiculareswere identified. A short course of alben-dazole treatment was initiated and was interrupted on the second day as a result of the strong anaphylactic reaction. Contrast enhanced CT of the abdomen iden-tified infundibulum of the gallbladder filled with iregu-larhyperdense liquid indicative for parasitic infestation. One month later, elective laparoscopic cholecystectomywas performed, and the removed gallbladder was sentfor parasitological evaluation confirming non-viable worms. Infestation with Enterobius vermicularisobstructsthe lumen of the appendix, causing contraction of the wall and results in appendicitis-like symptoms without signs of acute inflammation. In minority of cases, with pure pathological signs of inflammation a finding of Eneterobius vermicularisis incidental. There are two possible hypotheses regarding the exact mechanism of gallbladder involvement: hematogenous spread or directmigration through unhealthy intestinal tissue. It is recommended to thoroughly examine all appendiceal specimens for presence of this worm, in order to provideadequate anthelminthic therapy in case of infestation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, AMYAND’S HERNIA–A RARE CASE OF RIGHT-SIDED INGUINAL HERNIA(Macedonian Association of Anatomists and Morphologists, 2023); Amyand’s hernia is the presence of the appendix in the inguinal hernia sac. The prevalence of this type of inguinal hernia is about 1%. Majority of cases of Amyand’s hernia are incidentally diagnosed during surgical treatment of inguinal hernia. Amyand’s hernia typically presents on the right side since right-sided inguinal hernia is more common and the appendix is located in the lower right quadrant of the abdomen. We present a case of a 23-year-old patient hospitalized at the University Clinic for Digestive Surgery in Skopje for elective surgical treatment of right-sided inguinal hernia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Effect of intra-arterial Nimodipine on subarachnoid hemorrhage injured brain(Macedonian Association of Anatomists and Morphologists, 2022-08-31); ; ; Subarachnoid hemorrhage is a pathological condition of the brain, caused by rupture of intracerebral aneurism or arteriovenous malformation, with high morbidity and mortality rate. SAH may conceive permanent brain damage with persistent disability. Vasospasm isthe most characteristic pathological state of the vasculature, whose development coincides with onset of bleeding with asymptomatic presentation. The critical extend as a risk factor presentswith symptom presentation and indication of brain damage development. Early vasospasm treatment is a priority in prevention of brain ischemia and disability. Existing methods of vasospasm treatment are conservative, endovascular and combined, with simultaneous intraarterial vasodilator application.The aimof this study wasto determine whether intraarterial application of Calcium-blocker Nimodipine will generate immediate vasodilation, facilitating endovascular aneurism treatment, resulting in longterm resolution of the condition.Fifteen patients with SAH receivedendovascular treatment in the first 48 hours of hemorrhage onset, with consequent intraarterialNimodipine application if vasospasm was detected. All patients had ruptured aneurism of anterior circulation. Vessel diameter was measured before and after Nimodipine application. The occurrence and degree of vasodilation, as a difference between both diameters,were considered a confirmation of drug effectiveness.Complete spasm relief occurred in 10patients, residual vasospasm persisted in 4 patients, no VS relief occurred in 1 patient.IntraarterialNimodipine application during endovascular brain aneurism treatment effectively relievesvasospasm. Early coiling reduces complication risks and development of postischemic brain damage. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ВЛИЈАНИЕТО НА РАНАТА ПЕРОРАЛНА ИСХРАНА ВРЗ ПОСТОПЕРАТИВНОТО ВОСПОСТАВУВАЊЕ НА ЦРЕВНАТА ФУНКЦИЈА ПРИ ЕЛЕКТИВНА КОЛОРЕКТАЛНА ХИРУРГИЈА(Архиви на јавното здравје, 2018-06-15); ; Наталија ЦоклескаЦелта на трудот беше да го утврди влијанието на раната перорална исхрана врз постоперативното воспоставување на цревната функција и пероперативниот морбидитет кај пациентите оперирани од колоректален карцином. Материјал и методи: Во проспективната рандомизирана студија беа вклуче-ни 100 пациенти со колоректален карцином со стандардна предоперативна и оперативна процедура. Пациентите беа поделени на 2 групи: испитувана и контролна и секоја група вклучуваше по 50 паци-енти. Пациентите од испитуваната група започнаа со внес на течности во текот на првите 24 часа по-стоперативно и продолжија со регуларна диета во следните 24-48 часа во зависност од толерантноста кон истата. Пациентите од контролната група започнаа со внес на течности и храна по повлекување на постоперативниот илеус. Се следеше времето до воспоставување на цревната функција, должината на постоперативниот болнички престој, бројот и видот на пероперативните компликации и евенту-алните реадмисии во болница во првите 30 дена постоперативно. Резултати: Меѓу испитуваната и контролната група пациенти немаше значајна разлика во однос на демографските податоци, лока-лизацијата на туморот и типот на операција (p>0,05). Бројот на денови до воспоставување на перис-талтика беше 1,18±0,39 наспроти 2,14±0,53, добивање на гасови 1,90±0,65 наспроти 3,34±1,06 и столица 3,24±1,33 наспроти 5,28±1,83. Овие резултати се сигификантно пониски кај испитуваната група во од-нос на контролната група (p<0,001). Не постоеше разлика во анализата на поединечните компликации, меѓутоа вкупниот број на постоперативни компликации беше сигнификантно помал во испитуваната група: 3 наспроти 10 (p=0,04). Болничкиот престој во испитуваната 7,48±2,47 дена наспроти 9,88±3,66 дена во контролната група беше исто така сигнификантно пократок [Z= -6,16 и p<0,001(p=0,000)]. За-клучок: Раната перорална исхрана кај пациентите оперирани од колоректален карцином го забрзува воспоставувањето на цревната функција со истовремено значајно намалување на пероперативниот морбидитет и болничкиот престој.