Tatjana Chepreganova-Changovska, Dragana Petrovska-Cvetkovska, Marija Srceva-Jovanovski and Venko Filipce
Background and objectives: The main aim of this study is to prove the association of seizure types with the MRI findings of the brain (etiological factor). Also, to prove which type of lesion is mostly represented in which age-group, and with which type of seizure.
Methods: A total of 100 patients with symptomatic epilepsy, aged from 16 to 80 years, were hospitalized at the Neurology Clinic or in its Outpatient Unit, in the period from 2009 to 2012. They were neurologically examined and the seizure type registered. All patients underwent MRI of the brain.
Results: (56%) men and 44 (44%) women were examined. The represented type of epileptic seizures were 41.0% with SPC + CPC, followed by 15.0% GTCC, and 14.0% CPC with secondary generalization, 12,0% CPC, 10,0% SPC and 8.0% with absences. The epileptic lesions of 25.0% were hippocampal sclerosis, 20.0% post-traumatic injuries, 19.0%, post-vascular and brain tumours, and the lowest percentage of 17.0% with post-infectious lesions.
Conclusions: Post-traumatic lesions occur more frequently in the elderly population with the accent on the male, while hippocampal sclerosis occurs in the adolescent and younger population with higher frequency in the female.
Darko Sazdov, Marija Jovanovski Srceva and Zorka Nikolova Todorova
Central venous catheterization is performed by the landmark method and ultrasound guided method. The purpose of the study was to compare the success, average number of attempts, average time to return of blood, and complication rate between the two methods.
Material and Methods:
This was a prospective study done in the Intensive Care Unit of the Acibadem Sistina Clinical Hospital, in Skopje. There were 400 patients in need of central venous catheter and they were prospectively randomized in two groups. The patients randomized in the examined-ultrasound group underwent real-time ultrasound-guided catheterization and the patients randomized in the control-landmark group were catheterized using the landmark method. Internal Jugular, Subclavian and Femoral vein were catheterized in both groups. The Overall success, success on the first attempt, time to the return of blood, number of attempts and complications at the moment of catheterization such as arterial puncture, pneumothorax and hematoma formation were the main outcome measures.
The catheterization using the landmark method was successful in 90.5% of patients, 60.5% of which during the first attempt. The cannulation using real-time ultrasound guidance was successful in 98% of patients with a first pass success of 77%. The complication rate with the landmark method was 14.5% versus 4% with real-time ultrasound guidance p<0.05(p=0.0008).
Real-time ultrasound guidance improves success, decreases number of attempts, decreases average time to the return of blood and reduces mechanical complications rate.
Marina Temelkovska-Stevanovska, Vesna Durnev, Marija Jovanovski-Srceva, Maja Mojsova-Mijovska and Sime Trpeski
Introduction: Systemic postoperative analgesia is inefficient in most patients with hip fracture, which is the reason for pain, especially during leg movement. Peripheral and plexus nerve blocks are an efficient option for postoperative pain relief.
The aim of this study was to compare the effect and duration of continuous FNB versus a single FIC block as a postoperative analgesia in patients with hip fracture.
Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: FNB group – patients with continuous femoral nerve block; and FIC group –patients with a single fascia iliaca compartment block. In all patients, pain intensity was measured at rest and in passive leg movement by using VDS (0–4) at several intervals: 1, 2, 12, 24, 36 and 48 hours after intervention. The amount of supplemental analgesia was measured, together with the time when the patient needed it for the first time, as well as the side effects.
Results: The values of VDS were significantly lower in patients with FNB block versus patients with FIC block in rest and movement at the 24-hour intervals (46.67% vs 0% felt moderate pain), after 36 hours (43.33% vs 0% felt moderate pain) and 48 hours after intervention (46.67% vs 3.33% felt moderate to severe pain) for p < 0.05. Patients with FNB block received a significantly lower amount of supplemental analgesia, 23.3% of the FNB group vs 50% of the FIC group (p < 0.05). Registered side effects were were nausea, dizziness and sedation, and they were statistically significantly more frequent in the FIC group (p < 0.05).
Conclusion: Pain relief in the postoperative period was superior in the FNB group versus the FIC group at rest and in movement in patients with hip fracture.
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Marija Tolevska, Filip Naumovski, Marija Srceva, Aleksandra Panovska Petrusheva, Rexhep Selmani and Atanas Sivevski
Background: Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of morphine dose over 24-hours.
Results: There were statistically significant differences in VAS scores between the groups I and II at all postoperative time points - 2hr, 4 hr, 6 hr, 12 hr and 24 hr. (P < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in the group II (mean = 3.73 ± 1. 41) than the group I (mean = 8.76 ± 2.41). This difference was statistically significant (p = 0.00076).
Conclusion: The ultrasound guided rectus sheath block used for umbilical hernia repair could reduce postoperative pain scores and the amount of morphine consumption in 24 hours postoperative period.
Aleksandra Gavrilovska-Brzanov, Zorka Nikolova, Nikola Jankulovski, Mirjana Sosolceva, Gordana Taleska, Maja Mojsova-Mijovska, Marija Jovanovski-Srceva, Darko Angusev, Darko Sazdov and Nikola Brzanov
Aim: The aim of the study was to evaluate the effect of different grades of increased intraabdominal hypertension (IAH) on the respiratory mechanics.
Material and Methods: In this prospective observational clinical study, the influence of intaabdominal pressure (IAP) on respiratory parameters was assessed in 20 patients requiring mechanical ventilation with IAH grade I, 20 patients with IAH grade II, and 20 patients with grade III IAH. Respiratory parameters were measured and recorded by a computerized system incorporated into the mechanical ventilator.
Results: A statistical difference was noticed between IAP and the dynamic respiratory parameters among the groups. Regarding the respiratory parameters positive correlation between the IAP on one hand, and peak airway pressure and resistance on the other hand was notable: IAP increased and so did pressures and the resistance in the respiratory pathways. Also the correlation between IAP, on one hand and the compliance and peripheral saturation with oxygen on the other hand, was negative. Referring the mean pulmonary pressure there wasn’t correlation among IAP and mean pulmonary pressure in the groups.
Conclusion: IAP leads to impairment of the respiratory mechanics. An increase of the level of IAP is followed by an increase in the altering effects upon the respiratory system.
Margarita Peneva, Elizabeta Zjogovska, Sasho Dohchev, Sotir Stavridis, Aleksandar Josifov, Marija Jovanovski Srceva, Anton Damevski, Josif Janchulev, Jelka Masin Spasovska and Goce Spasovski
Kidney transplantations have become common surgical procedures that are associated with high success rates. Nevertheless, the detection, accurate diagnosis and timely management of the perioperative surgical complications sometimes require multidisciplinary team approach for some of the complications may result in significant morbidity, risk of graft loss and/or mortality of the recipient.
A case of a 24-year old male patient that developed a number of different surgical complications is reported. The complications included venous graft thrombosis, urinary fistula, wound infection, wound dehiscence and a completely exteriorized transplanted kidney. Despite the various complications and, accordingly, a couple of revisions, finally the patient was discharged with a regular kidney function.
Goran Kondov, Borislav Kondov, Marija Jovanovska Srceva, Goge Damjanovski, Imran Ferati, Ivan Karapetrov, Irena Kondova Topuzovska, Nikolina Tanevska and Anita Kokareva
The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity where a dominant part of the cyst was present. The cyst was full with 2.5 liters of transparent fluid, and compressed surrounding structures – heart and both lungs, especially the right one which was partially collapsed.
The patient was a 52 years old woman, without any clinical symptoms. Accidentally, on the screened chest X-ray a shading in the distal third of the right chest was detected.
The case was well documented with a CT of the chest, and an indication for surgical treatment was made. The surgery was done successfully in general anesthesia according to the small right anterior thoracotomy from which a giant part of the cyst was mobilized, which was in the right pleural cavity, but, also, the thymus with the origin of the cyst in the anterior and superior mediastinum was completely removed. In the end, a part of the cyst which was in the left pleural cavity was removed.
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Tatjana Spirovska, Aleksandra Panovska Petrusheva, Marija Tolevska, Marija Srceva, Vesna Durnev, Gjorgji Jota, Redzep Selmani and Atanas Sivevski
Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone.
Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours.
Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001).
Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).
Marija Jovanovski-Srceva, Biljana Kuzmanovska, Maja Mojsova, Andrijan Kartalov, Mirjana Shosholcheva, Marina Temelkovska-Stevanoska, Aleksandra Gavrilovska, Sotir Stavridis, Zoran Spirovski, Borislav Kondov, Anita Kokareva, Risto Todorov and Tatjana Spirovska
Introduction: Surgical stress response, results in elevated levels of anti-insulin hormones and reduced insulin secretion. This hormonal state may be detrimental for surgical patients due to the presence of insulin resistance and hyperglycemia. Additionally, pre-operative fasting favors this conditions. The aim of this study is to analyze the impact of pre-operative caloric load, with 440kJ from amino acid infusions on the levels of glucose, cortisol and insulin resistance in surgical patients.
Material and Methods: The study included 20 female patients scheduled for mastectomy, aged 30-60 years without diabetes and BMI < 30 m2, divided into two groups. The study group A, the evening before the surgery, received 1000 ml amino acid infusions, while the control group B didn′t receive any infusion. In both groups glucose, C-peptide and cortisol levels were determinate preoperatively and postoperatively. From the obtained C-peptide and glucose values, with the help of computer model (HOMA2*), the insulin resistance (IR), functionality of beta cells (BETA) and insulin sensitivity (IS) were calculated.
Results: Postoperative values of insulin resistance (0.94 ± 0.12 vs 1.13 ± 0.2; p = 0.02) and glucose (4.79 ± 0.5 vs 5.77 ± 0.6; p = 0.002) were lower in the study group compared to control group. Postoperative cortisol levels in both groups were higher than the preoperative, but no significant difference was found. The study group showed higher values for BETA and IS. Percentage changes between the groups were significant for all parameters.
Conclusion: Pre-operative caloric load (amino acids) reduces the level of insulin resistance and glucose in the presence of elevated cortisol levels.