Gramatnikovski, Nikola

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Gramatnikovski, Nikola

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FEMOROPOPLITEAL BYPASS VS PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENTING IN TREATMENT OF PERIPHERAL ARTERY DISEASES OF INFRAINQUINAL SEGMENT – SHORT-TERM RESULTS
(Macedonian Academy of Sciences and Arts, 2009-06)
Cvetanovski V.
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Blazevski B.
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A b s t r a c t: Critical limb ischaemia is a result of occlusive arterial disease in the infrainquinal segment and is a major indication for arterial revascularization, which implies a femoropopliteal bypass procedure or an interventional procedure – stent grafting of the occluded segment. Although indications for both techniques are clearly defined, there are still controversies. Thus, the aim of this study was to determine shortterm results in patients treated with these two treatment modalities. In the period between 2002 and 2008 a total of 70 patients with occlusive arterial diseases of the low extremity were analysed. In 50 out of 70 patients a femoropopliteal bypass was made. Of these, in 30 (60%) patients PTFE material was used and in 20 (40%) patients an autologous saphenous vein graft was used. The other group comprised 20 patients who underwent stenting. In patients treated with surgical revascularization, the major indication for surgery was occlusive arterial disease in: stage II – in 10 patients (20%), stage III – in 5 patients (10%), stage IV – in 25 patients (50%) and the remaining 10 patients (20%) had subacute ischaemia. Arteriography showed three crural patent tributaries in 18% of the patients, two patent crural tributaries in 40% of the patients and one crural patent tributary in 32% of the patients. There were no significant differences concerning indications and arteriographic findings between the two subgroups. The follow-up period lasted for 6 months and the patency rate was 85% (17) for venous bypass, 11 (64.6%) – short-segment lesions (< 4 cm) and 6 (35.3%) longer segment lesions (> 4 cm) versus 76.5% (23) for PTFE graft (p < 0.05), of which 13 (56.5%) were short-segment (<4 cm) and 10 (43.5%) longer segment lesions (> 4 cm). 106 Cvetanovski M. V., Jovev S. et al. Contributions, Sec. Biol. Med. Sci., XXX/1 (2009), 105–118 The following results were obtained for the second group of patients: initially successful stents in 85%; failure in 15% or 2 patients; technical failure in 1 patient or 5%. After 6 months the patency rate was 75% (15), of which 11 patients (73.2%) had short-segment occlusions (< 4 cm) whereas 4 patients (26,8%) had lesions > 4 cm. The baseline value of the lower limb index (ABI – ankle-brachial index) was significantly increased in both groups, from 0.41 to 0.91 in the group with surgical revascularization and from 0.47 to 0.88 in the second group treated with stenting. The same trend was observed after six months. This study demonstrated a small but significant difference (85% vs 75%, p < 0.05) in favour of the autologous saphenous vein, which should be a preferred graft material in all cases for reconstruction of the femoropopliteal segment. When compared to the overall patency rate of PTFE grafts after 6 months there was no significant difference in patency in the group treated with stent grafting (76.5% vs 75%). However, stenting is a method of choice in the treatment of short-segment occlusions – smaller than 4 cm with good early run off (73.2% vs 64.6%, p > 0.05 p = ns). It is obvious that the results are identical to those in treatment with an autologous great saphenous vein, but in comparison with PTFE the results imply stent usage (73.2% vs 56.5%, p < 0.005). Prosthesis (PTFE) is a graft material of choice when the great saphenous vein is used, damaged or calcified and when the occlusion is longer than 4 cm and is not suitable for stent grafting (43.5% vs 26.6%, p < 0.001).
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Ventricular fibrillation after endoscopic retro-grade cholangiopancreatography in patient with left ventricular assist device – a case report
(Institute of Public Health of the Republic of Macedonia/Scientific Foundation SPIROSKI, 2022-04)
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Janusevski, F
Congestive heart failure is a growing global health problem. Left ventricular assist device (LVAD) is a method used to extend the life of patients with congestive heart failure as a definitive treatment or to “bypass” the period until heart transplantation. Ventricular arrhythmias in patients with LVAD are not uncommon. The aim of this paper is to present the case of a patient with an already implanted LVAD and the need for appropriate interdisciplinary medical treatment. Case report: We present the case of a 54-year old patient, with implanted LVAD - HeartMate 3 due to severe congestive heart failure. The patient was admitted with jaundice at the PHIU Clinic for Gastroenterohepatology with performed endoscopic retrograde cholangiopancreatography (ERCP)) procedure and a stent was placed in the choledochus duct. Immeasurable blood pressure and pulse were recorded in this patient. The ECG was approaching VF (ventricular fibrillation) and it was all asymptomatic by the patient. LVAD mechanical pump leads to continuous blood flow, which means that patients with LVAD not infrequently have no pulse or measurable blood pressure. Also, in patients with LVAD, ECG pulses are with electrical disturbances. VF and ventricular tachycardia (VT) are ventricular arrhythmias that are often seen on ECG in patients with implanted LVAD. Usually these arrhythmias occur with unknown duration and terminate spontaneously. Conclusion: Patients with LVAD are prone to cardiac arrhythmias. The continuous development of medical devices leads to a continuous educational and clinical approach to patients.
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Menagement of Large Carotid Body Tumor: Case Report
(Minerva Medica, 2015)
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Vlado Popovski
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Vjolca Aliji
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Complete arterial revascularization in patients older than 60 years
(2007-05-17)
Cingöz, F
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Tomevski, D
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Günay, C
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Bingöl, H
Objective: The aim of this study was to evaluate the early and mid-term results of total arterial myocardial revascularization in patients older than 60 years. Methods: Sixty-five patients aged 60 years and older (mean 64.8+5.4, range 60–78 years) who underwent total arterial myocardial revascularization between January 2002 and June 2004 were evaluated prospectively. Forty-one patients (63.1%) had three-vessel coronary artery disease, 18 (27.7%) had two-vessel disease and six (9.2%) with left main lesion. Twenty-two patients had an old myocardial infarction (MI) and 11 unstabile angina pectoris. Mean EF was 55%. All patients underwent TAMR. In total 167 distal anastomoses were constructed (2.6 per patient) Pedicled LITA and RITA, free RITA and Radial arter were used as single or composite T- or Y-graft. Results: Patinent were followed-up in a mean period of 17.6+7.3 months (range 1–28 month). One patient died in this period (1.5%) one underwent PTCA (1.5%) two suffered angina pectoris (3.1%), there was no reoperation in this period. There was no occluded grafts in the early postoperative period (<90 days) patency 100%. Late (mean 16+2 month) LITA patency was 98.1% (one graft occluded), RITA patency was 93.4% (one graft occluded) and RA patency was 93.2% (three grafts occluded). Conclusions: This study showed that using only arterial conduits in coronary bypass surgery in elderly (patient aged over 60 years) were clearly evident with respect to higher patency rate, surgical reintervention and freedom from cardiac events.
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Multidisciplinary surgical approach in extensive trauma injury of upper extremity - case report
(Croatian society for pediatric surgery, 2022-09-24)
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Cokleska N
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Racaj A
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Aleksovski Z
Polytraumatized 9 year old patient, in a hemorrhagic and traumatic shock with severe laceration injury of the left upper extremity and early sings for acute critical ischemia, was admitted in our emergency department Surgery was initiated within the first hour of hospital admission. Exploration revealed highly contaminated wound, extensive soft tissue damage, severe muscle laceration, axillary artery lesion, thrombosed axillary vein, neuropraxia of the brachial plexus and open humeral shaft fracture grade III according Gustilo- Anderson classification. The axillary artery lesion was replaced with a reversed saphenous vein interposition graft and the axillary vein thrombus was removed using Fogarty catheter. The open humeral shaft fracture was stabilized with external fixation ostheosynthesis. After meticulous and radical injury zone excision was completed, soft tissue coverage and tension free approximation of the muscle and skin was achieved. Pre-and intraoperative broad spectrum antibiotics were used. Postoperative follow up was satisfactory with acceptable functional and aesthetic outcome. Complete healing of the humeral shaft fracture was noticed after 18 weeks. Rehabilitation program was started after humeral fracture was stable. The treatment of this kind of injuries require multidisciplinary surgical approach that includes traumatology surgeons, vascular surgeons and plastic surgeons.
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Management of large carotid body tumor: Case report
(2014-04)
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Popovski, V
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Aliji, V,
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Introduction. Carotid body tumors (CBT) are slow-growing hypervascular tumors arising from paraganglionic cells of the carotid body. Although the most common form of head and neck paraganglioma, CBT remain rare, with a reported incidence of 0.06 to 3.33 per 100 000 patients. CBT are usually benign. Surgery for young and healthy patients is the first choice of treatment. We present a case of unilateral benign CBT (Shamblin type III) in a 52-year-old male after one-year follow-up. Case Report. A 52-year-old male with 5 years history of slow-growing, asymptomatic, right lateral neck mass. Ultrasonography (US) demonstrated cervical mass beyond the angle of mandible. MRI combined with CT scanning showed large (62x54x41mm) highly vascularized soft-tissue mass completely surrounding the right carotid bifurcation, with compressive effect to larynx and internal jugular vein. Patients underwent surgery under general anesthesia by a multidisciplinary team. During procedure Near-infrared spectroscopy monitoring of the continuous regional oxygen saturation (rSO2) was measured with a cerebral oximeter (Somanetics Invos cerebral oximeter). Through a transverse cervical incision all neurovascular structures were identified and periadventitial. Proximal and distal control established, ECA was ligated and dissected, ICA and CCA cross clamped. Complete and safe tumor resection achieved. CCA to ICA was reconstructed by a termino-terminal anastomosis using ePTFE 6/4 vascular graft. Postoperatively, a transient swallowing difficulties and ipsilateral tongue deviation developed. Concusion. Larger CBT need a multidisciplinary centralized approach as the best choice, including combined competent vascular, maxillofacial, radiology and otolaryngology team.
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Целосна трауматска трансекција на ишијадичниот нерв кај 5-годишно дете - приказ на случај
(Association of Physiatrists of Republic of North Macedonia, 2022-09-27)
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Cokleska Shuntov, Natalija
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Shuntov, Blagoj
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Aleksovski, Zlatko
Вовед: Вообичаени причини за повреди на ишијадичниот нерв се јатрогени повреди предизвикани од оперативен третман на колк, повреда при интрамускулна администрација на лекови, пенетрирачка траума и повреди од огнено оружје. Лезиите на ишијадичниот нерв во горниот дел на бутот се поврзани со болка и парестезии по должината на полето на инервација и изгубена способност за флексија на коленото, дорзална флексија на стапалото и плантарна флексија. Губењето на сензибилитетот го вклучува задниот дел на бутот, страничниот аспект на долниот дел од ногата и целото стапало. Приказ на случај: Презентираме редок случај на 5-годишно дете кое се здобило со голема рана на медијалниот и задниот дел на бутот која се протегала до поплитеалната регија како резултат на повреда од сечење со стакло. Во момент на прием, детето е хемодинамски стабилно. Нема знаци за значителна загуба на крв. На првичната евалуација, раната ја засега кожата, поткожното ткиво, мускулите и целосна трауматска трансекција на ишијадичниот нерв. Пациентот имаше комплетно отсутна функција на двата дела на ишијадичниот нерв при првичната евалуација. По реализирани соодветни предоперативни анализи и подготовка, беше извршен оперативен третман. Интраоперативно, ишијадичниот нерв беше идентификуван, наод за целосна трансекција на нервот. M. semimembranosus, m. semitendinosus и m. biceps femoris, исто така беа повредени. Извршена е реконструкција на мускулите и примарна реконструкција на нервот. Постоперативниот период беше уреден. Првите знаци за враќање на сензибилитетот и некои мали движења на ногата беа детектирани на десетиот постоперативен ден. По завршување на хоспитализацијата на 15 постоперативен ден, пациентот беше трансфериран во локалниот центар за рехабилитација. Редовното следење се вршеше секој месец. Еден месец по повредата е нотирана флексија и екстензија на коленото. Сензибилитетот беше речиси нормален, пациентката можеше да разликува топло, студено, болка и да ја локализира точката на сензација. Движењата во скочниот зглоб беа сè уште слаби. 2 месеци по повредата, таа можеше да стои на ногата со помош. По 3 месеци, таа можеше да оди сама, со мала помош од безбедносни причини. По 5 месеци, таа беше целосно независна, способна да ги извршува секојдневните активности. 6 месеци по повредата беше направена електромиографија на екстремитетот. Резултатот покажува знаци на реинервација и нормална моторна и сензорна амплитудна спроводливост. Заклучок: Повредата на ишијадичниот нерв кај педијатриската популација е релативно ретка и невообичаена повреда. Релативно слабите резултати по реконструкцијата на ишијадичниот нерв во минатото сега брзо се заменуваат со пооптимистички пристап. Напредокот на раната реконструкција на нервите, напредните хируршки техники и добрата постоперативна рехабилитација се клучни за добриот исход. Овој приказ на случај е пример за многу добар исход кај посериозна повреда на долниот екстремитет.
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Compartment syndrome after corrective tibia osteotomy in patient with metaphyseal aclasia – A case report.
(2019)
Samardziski, M
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Аtanasov, N
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Selmani, R
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Dalipi, R
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ЕФЕКТОТ НА ХИПЕРБАРНАТА ОКСИГЕНО ТЕРАПИЈА – КАКО АДЈУВАНТНА ТЕРАПИЈА ВО ЗАЗДРАВУВАЊЕТО НА ХРОНИЧНИТЕ РАНИ
(SHMSHM / AAMD, 2019)
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Ѓорѓеска Андријана
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Преваленцата на хроничните бавно зараснувачки рани во развиените земји е 1-2% од генералната популација и е слична со преваленцата на срцевите заболувања. За жал морбидитетот и трошоците за третман на хроничните рани се често игнорирани од општеството бидејки преставуваат мултидисциплинарен проблем. Според последните податоци во САД за само една година 6,5 милиони луѓе побарале медицинска помош за хронични рани што ја чинело државата 25 милиони долари. Хроничните рани претставуваат рани каи кои редоследот и времето на репаративните процеси се нарушени. Поради тоа е оневозможено воспоставување на анатомски и функционален интегритет на ткивото. Хроничните раниимаат значајно влијание на здравјето и квалитетот на живот на пациентот и нивните семејства предизвикувајќи болка,инвалидитет,депресија,социјалнаизолација,финансиски трошоци,пролонгирана хоспитализација и смртен исход. Материјал и метод -Во студијата беа вклучени 30 пациенти над 18 години со рани кои перзистираат повеќе од 4 недели и кои се поголеми од 1 cm². Резултати - Резултатите покажаа дека во сите три групи беше добиено сигнификантно намалување на површината на раната (по 40 ХБО експозиции во првите две групи) во период од два месеци (p < 0.01). Заклучок- Хипербарната оксигено терапија како адјувантен третман заедно со стандардната обработка на раните овозможува нивно поефикасно зараснување, а со тоа придонесува за намалување на хоспитализацијата, инвалидноста и го подобрува квалитетот на животот на пациентите. Од двата протоколи на ХБОТ подобри резултати во третманот на раните покажа протоколот од 2.2 АТА 90 минути и 40 експозиции.
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Sacrectomy with ilio-lumbar stabilization due to low-grade chondrosarcoma of sacrum and iliac wing. Case report of the first surgery performed in the Republic of North Macedonia.
(Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences, 2021)
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Popovska, D
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Todorova, T
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Rushiti, Q
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Low - grade chondrosarcomas are primary malignant bone tumors that are resistant to chemo- and radiotherapy and are treated surgically. Sacral localization makes surgical resection technically difficult due to position, anatomic structures involved, and large tumor size at detection. The risk of complications is high. We present the introduction of a novel surgical technique in our country, sacrectomy with ilio-lumbar stabilization. This was performed on a 67-year-old man with low-grade chondrosarcoma of the sacrum with sacroiliac joint involvement. The procedure was performed via an antero-posterior approach in two stages. Ilio-lumbar fixation with a mesh cage bridge was used to obtain spinopelvic continuity and stability. Sacrectomy is a technically demanding procedure that requires careful preoperative planning and a multidisciplinary approach, as well as high level of surgical experience.

Gramatnikovski, Nikola

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