Abstract Introduction. The complications associated with preterm birth are still the primary cause of death in children below 5 years of age, leading to nearly 1 million death cases in 2013. We performed our study to examine a new non-invasive method for prediction of fetal maturity. Methods. The study was designed asa prospective observational-interventional clinical study, conducted at the University Clinic for Gynecology and Obstetrics, Medical Faculty, University Ss. Cyril and Methodius Skopje, Republic of Macedonia. Ninety pregnant patients were examined, 48 with preterm birth used as examined cases and 42 women above 37 completed weeks of gestation and delivered at term, used as control cases. The investigation was performed before and 72 hours after administration of the therapy protocol for fetal lung maturation. The measurement was done with an ultrasound histogram software, measuring the density of thalamus and surrounding brain tissue. The results were followed up to 72 hours and then compared with the postpartum respiratory distress syndrome (RDS). If the patient was not delivered within 72 hours of measurement, she was excluded from the study. Results. In the first and in the second gestational age group, we noticed significant fetal maturation. All groups according to nationality and religionshowed high significance before and after treatment. The correlation among the thalamus density vs. surrounding brain tissue and postpartum RDS in all three groups according to gestational age, nationality and religion was high. Conclusion. Measuring the density of fetal thalamus vs. surrounding brain tissue may become the new non-invasive technique for determination of fetal maturity.
Abstract Plethora of pediatric autoimmune, dermatological, neurological and atopic disease require chronic administration of steroid medication. Long-term use of corticosterioids can result in both local (atrophy of the skin, hypertrichosis, and telangiectasia) and systemic side effects (hypothalamic-pituitary-adrenal (HPA) axis disturbance, risk of infections). We report a case of 3.5-year-old boy, who developed Cushing syndrome and secondary adrenal insufficiency after corticosteroid cream maltreatment of his psoriasis. After initial hospitalization and recovery, physiological doses of hydrocortisone were used to normalize the HPA axis. In order to prevent Cushing syndrome development, adrenal insufficiencies, and secondary infections, precaution in use of steroid therapy in early childhood must be exercised.
Abstract Introduction. Biologic DMARDs (Disease Modifying Anti Rheumatic Drugs) have shown to be effective in the treatment of rheumatoid arthritis (RA) resistant to the use of synthetic DMARDs. The primary goal of this study wasto assess the long-term safety of the use of tocilizumab in patients with early rheumatoid arthritis, moderate to severe disease activity. The secondary goal was to assess the efficiency of tocilizumab in achieving and maintaining clinical remission of the disease. Methods. ML28133 is a long-term, extended study of 13 patients with rheumatoid arthritis treated with tocilizumab. Two patients were male (15.4%), 11(84.61%) female. The average age of patients was 53.27+/−10.68. Patients received 8mg/kg tocilizumab i.v. every four weeks, 104 weeks overall. Safety was assessed following side effects, blood tests, physical examination and vital signs. Efficiency was assessed by achieving and maintaining clinical remission according to DAS28 (Disease Activity Score 28), global assessment of disease activity, VAS score and HAQ-DI (Health Activity Score) questionnaire. Results. Incidence of side effects was 76.92%. Infections were of special interest and were most common (15.3%). Four patients had serious adverse events, three of which associated with tocilizumab, and therapy was stopped. In 11 (84.6%) of the 13 treated patients clinical remission was achieved at times. At the end of the study, 8 out of 9 patients were in remission. Conclusion. The results have shown significant therapeutic effect of tocilizumab even in the most severe forms of the disease, which gives hope for its use as a monotherapy.
Abstract Introduction. Autoimmune diseases are a family of more than 100 heterogeneous conditions that affect 5 to 8% of the world’s population. The etiology is still un-known but the disregulation of the regulatory T-lymphocytes play a central role inthe autoimmunity and the success of the long-term remission. Although conventional immunosuppression and new biological agents can provide disease control in severely affected patients, such treatments are rarely curative and alternative strategies are needed. Indeed, severe forms of systemic autoimmune diseases, such as multiple sclerosis (MS), systemic sclerosis (SSc), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), juvenile idiopathic arthritis (JIA), hematologic immune cytopenia (HIC) and Crohn’s disease are difficult to be treated. High-dose immunosuppressive therapy followed by autologous stem cells transplantation is reliable option for a successive treatment of this group of patients. Aim. To determine the safety of the procedure of autologous stem cell transplantation in patients with autoimmune diseases and concomitant malignant hematological disorders. Methods. During a period of 15 years (from September 2000 to September 2015) at the University Clinic of Hematology in Skopje we have treated 6 patients with autoimmune disease and concomitant hematological neoplasm. None of the patients was treated for primary autoimmune diseases. Two men and 4 women, with median age of 47 years were treated. Sjogren syndrome and multiple myeloma were found in 2 patients, polyartheritis nodosa and multiple myeloma in 1 patient, rheumatoid arthritis and acute myeloblastic leukemia in 1, systemic lupus erythematosus and non-Hodgkin lymphoma in 1; severe psoriasis and acute myeloblastic leukemia in 1 patient. Results. All treated patients are alive after trans-planted procedure, with transplant related mortality day +100: 0. Conclusion. Autologous stem cell transplantation is safe and recommended option for treatment ofpatients with autoimmune disease and hematologic neoplasm.
Abstract Introduction. Preeclampsia presents a medical condition in pregnancy that is manifested with increased blood pressure and protein urine. Ocular involvement is rare. Retinal detachment in preeclampsia is a rare complication; it only occurs in 1-2% of severe preeclampsia but in 10% of those with eclamptic seizures. Case report. A pregnant patient G1P0 visited the outpatient clinic of the University Clinic for Ophthalmology complaining on visual disturbances. The chief complaint was blurred vision and headaches. She was in 31 week of gestation and complained that she had increased blood pressure over the last month. After initial assessment she was suspected of central serous retinal ablation (CSCR). Ocular ultrasound and posterior segment OCT (optical coherence tomography) confirmed the diagnosis. Treatment and outcome. Obstetric examination confirmed high blood (TA180/130) pressure with dipstick urine showing(+++). Unfortunately, the ultrasound showed an eutrophic pregnancy in 31 g.w. with fetus mortus inutero. The patient was administered to the intensive care unit. She had an ophthalmologic check-upat 2 weeks and one month post-partum that showed regression and visual acuity was getting better. The final check-up after 6 months revealed that retina was in place with no subretinal substantial fluid and no macular edema. Conclusion. Serous retinal detachment is a rare complication of preeclampsia. In most case it resolves spontaneously few weeks post delivery.
Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.
Abstract Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. Attachments may occur congenitally at the base of the spinal cord (medullary cone) or they may develop near the site of an injury to the spinal cord. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. We present two patients that were diagnosed at age of three months and three years, respectively. Final diagnosis was made by magnetic resonance imaging, and both patients were referred to University Clinic of Neurosurgery for further treatment. Our aim is to illustrate the advantages of the early diagnostics of this progressive condition, to present diagnostic methods that are age-dependent and to illustrate the early clinical indicators for its existence.
Abstract Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.
Abstract Introduction. To compare the values and accuracy of the test in anticyclic citrullinated peptides antibodies, rheumatoid factor (RF), C-reactive protein (CRP) and disease activity index in early diagnosis of untreated psoriatic arthritis (PsA). Methods. Using the ELISA method of DIA-STATTM Anti CCP (Axis-Shield Diagnostics), sera of 70 participants were examined (35 untreated patients with PsA and 35 subjects from the healthy control group). RF and CRP were determined with the agglutination test (latex test). At the same time the sensitivity, specificity, predictive value for positive and negative testsand accuracy were determined. Results. Of 35 patientswith PsA, 1 patient showed presence of anti-CCP antibodies (sensitivity test 2.86%), while RF was foundin 0 patients(sensitivity test 0%). In the healthy control group positivevalues for RF, CRP and erythrocyte sedimentation rate were detected in 1 patient. Conclusion. ACPA antibodies have low sensitivity, but high specificity in PsA.
Abstract Introduction. Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders of adrenal steroidogenesis. In approximately 90-95% of the CAH cases, it is a deficiency of the enzyme steroid 21-hydroxylase. The degree of enzyme insufficiency determines the severity of the disease. In the simple virilizing type of CAH dominant symptoms are virilization in girls and precocious puberty in boys. Virilizing type of CAH is the most common etiology of ambiguous genitalia in women. There are several options for surgical reconstruction of such anomalies, which must always be optimized to the patient’s anatomy, to achieve a good esthetic and functional result. Detailed presentation of the case. The paper presents the case of a 36-year old woman with delayed pediatric diagnosis of simple virilizing type of CAH, due to deficiency of 21-hydroxylase, pronounced phenotypic virilization, clitoromegaly, hyperpigmentation of the external genitalia, vaginal hypoplasia and existence of low confluence of the urethra with the vagina in so called low type of urogenital sinus andbilateral micromastia, also called mammary hypoplasia. The patient underwent augmention mammoplasty, clitoroplasty, reduction of clitoral hood and proximal labioplasty. Discussion. CAH is a continuum of disorders, affecting patients throughout the life. Feminizing genitoplasty includes three parts: clitoroplasty, labioplasty and vaginoplasty. Clitorectomy in modern times is unacceptable option. Conclusion. Surgical management and reconstruction in women with simple virilizing type CAH and ambiguous genitalia remains still controversial and emotionally laden area in reconstructive surgical activity and requires a team approach.
Abstract Introduction. Acute myeloid leukemia (AML) represents an entity well defined among the hematological malignnant diseases from diagnostic and therapeutic point of view. Still, big concern remains for those patients where the induction therapy fails. Classified in the group of refractory AML these patients are with poor prognosis. There are numerous attempts in providing the best surviving results by administration of appropriate therapy. Our center presents its experience in treating patients with refractory AML by administration of FLAG-Ida regimen, followed by hematopoietic stem cell transplanttation, autologous or allogeneic, depending on the availability of HLA matched sibling donor of hematopoietic stem cells. Methods. In patients with refractory AML, administering FLAG-Ida chemotherapy we have achieved complete remission in 22 patients (47%). Average age of the treated group of patients was 36.6 years (17-53). All of them proceeded to high-dose chemotherapy and underwent hematopoietic stem cell transplantation (HSCT). We performed autologous HSCT in 13 patients, and allogeneic HSCT in 9 patients. Median time to HSCT was 6.6 months (4-10), and in most of the patients we used myeloablative conditioning (MAC). Results. The disease-free survival in our group of patients is 74 months (22-148). The longest overall survival was 148 months and was registered in a patient with allogeneic sibling HSCT. We can conclude that FLAG-Ida regimen is an appropriate and suitable salvage chemotherapy protocol for patients with refractory AML especially when it is used in the context of preparation for HSCT.
Abstract Introduction. Reactive stroma co-evolves with prostatic carcinoma. The aim of this study is to establish stromal changes in the prostatic cancer tissue and to quantify those changes. Methods. Samples from 70 patients treated with radical prostatectomy due to prostatic cancer were used for this analysis. Stromal changes in prostatic cancer tissue were analyzed using histochemical stain Trichrome Masson and immunohistochemical stains Vimentin and Desmin and those changes were compared to the stromal composition in the surrounding benign prostatic hyperplasia. These changes were quantified as following: for the histochemical stain Trichrome Masson we measured the intensity of the stain and for the immunohistochemical stains Vimentin and Desmin we used the “stromal index” that combines the frequency and intensity of the signal. We correlated the received data between each parameters and with tumor grade and tumor stage using the Spearman rank correlation test. Results. There was significant correlation between Trichrome Masson staining intensity and tumor grade (R=0,27 p=0,023) and tumor stage (R=0,24 p=0,049), between Vimentin expression and tumor grade (R=0,35 p=0,003) and tumor stage (R=0,28 p=0,019) and between Desmin expression and tumor grade (R=−0,25 p=0,035). Conclusion. Analyses of the stromal composition and the expression of stromal markers in prostatic carcinoma and their quantification could serve as an additional tool in evaluation of tumor aggressiveness and tumor extension.
Abstract Aim. To present new opportunities, clinical implications and benefits of the available VEGF therapy as a treatment of macular edema, which is a result of venous vascular occlusions, diabetic macular edema in diabetic retinopathy and age-related macular degeneration. Background. The pathophysiology of macular edema is complex and various processes are involved in its development. It is actually an abnormal retinal capillary permeability and a disorder in the blood retinal barrier, which only increases the vascular permeability. This causes an expansion of the extracellular spaces, which leads to fluid accumulation, which additionally leads to macular thickening and eventual vision loss. Methods. The studies included 40 patients, of whom17 was diagnosed with macular edema in diabetic retinopathy and were treated with anti-VEGF therapy. Also, there were 11 patients diagnosed with wet form of AMD, and 12 cases diagnosed with macular edema secondary to vein occlusion. This retrospective study of 18 months monitored the effects of visual acuity on Snellen chart and the effects of macula anatomy using Optical Coherent tomography /OCT/. All patients received intravitreal injection of Bevacizumab /Avastin/ of 1.25mg /0.04ml/ and were evaluated monthly or every 4 to 8weeks. We monitored the potential ocular and systematic side effects in all our cases. Results. In the first group which included patients with edema due to venous vascular occlusion improvement of visual acuity in 58.33% patients, 25.0% showed no change in visual acuity and 16.66% showed slight worsening of 0.029 and regression of CMT entirely to 393.22 after 4.6 intravitreal injections on average. In the second group there was no improvement of VA 0.172 and reducing central macular thickness for 218.34μm by 5.6 intravitreal applications. The third group, 17 patients with macular edema due to diabetic retinopathy had stabilization of visual acuity, i.e. slight improvement in 8 of them by 0.14; and, in 9 and improvement of 0.21 and regression CMT, an average of 174.3 μm. Although it has been shown that benefit of intravitreal use of Bevacizumab and improvement of visual acuity has not been always change hand in hand with the reduction of macular edema, the need for this kind of treatment in certain cases are needed to maintain stable CMT and VA in such patients. Conclusion. Over the last few years monoclonal antibodies have become a standard therapy in treatment of wet form of AMD. Switch on anti-VEGF drugs has shown significant results in clinical and visual out-comes in patients with changes of the macula as a result of other disease. In fact, they caused a revolution in the treatment of refractory macular edema.
Abstract Introduction. Within the heterogeneous group of extra-nodal lymphoma, the gastrointestinal tract is the most frequently involved extranodal site accounting for 30-50% of all extranodal cases. Gastrointestinal involvement most oftenoccurs secondarily, while the primary gastrointestinal lymphomasare relatively rare accounting for 30%-45% of all extranodal lymphomas and 0.9% of all gastrointestinal tumors. Within the gastrointestinal tract, lymphoma can arise in any region but the stomach is the most commonly involved organ being affected in 50-70% of all the gastrointestinal lymphomas, followed by the small intestine and ileocecal region. The aim of the study was to analyze and present data regarding the endoscopic aspects and clinical presentation of patients with gastrointestinal lymphoma. Methods. We retrospectively reviewed the medical records of patients with primary or secondary gastrointestinal lymphoma diagnosed at our Clinic over a fifteen-year period (January 1, 1999 to December 31, 2013). We analyzed the demographic data, clinical presentation, anatomic distribution, endoscopic aspect of the lesion, extension of the neoplastic process and occurrence of different histological subtypes. Results. We discovered 18 patients with gastrointestinal lymphoma (7 males and 11 females). Fourteen patients (77.7%) were considered primary, while 4 patients (22.2%) were considered secondary gastrointestinal lymphoma. The stomach was affected in 14 cases (11 primary and 3 secondary), there were 2 duodenal lymphomas, 1 lymphoma of the terminal ileum and 1 peritoneal lymphoma. In most patients (10) massive and diffuse gastrointestinal infiltration was diagnosed, 5 patients had ulcerated lesions in the stomach and 3 patients presented with polyploid mass. Six patients presented with upper gastrointestinal bleeding, 1 patient with biliary tract obstructtion, one patient with protein losing enteropathy, malabsorptionand consecutive bowel perforation and one patient presented only with ascites and pleural effusion. All the malignant lymphomas were Non-Hodgkin type and among them we registered only one T-cell lymphoma. Being diagnosed in 6 patients (33.33%), diffuse large B-cell lymphoma was the most prevalent histological type. The lymphoma was limited to the gastrointestinal tract in 6 patients, 7 patients had regional nodal involvement, in 2 patients there was an intra-abdominal spread and in 3 patients there was an extra-abdominal dissemination. Most patients received chemotherapy and only 2 patients were treated surgically. Two patients had rapidly progressive clinical course and lethal outcome shortly after the diagnosis was established and before chemotherapy was administered. Conclusion. The gastrointestinal lymphoma has a variable clinical presentation and endoscopic aspect that often makes the diagnosis challenging. Substantial level of diagnostic awareness and comprehensive clinical approach are necessary in order to establish the correct diagnosis, provide appropriate treatment and prolong survival.
Abstract Hearing impairment is the most common sensory disorder, which occurs in 1 of 1000 newborns. It is caused by heterogeneous conditions with more than a half due to genetic etiology. Although hundreds of genes are implicated in hearing process and have been found to be associated with nonsyndromic hearing loss, pathogenic variants in GJB2 gene have been considered as the main cause of deafness among nonsyndromic hearing loss (NSHL) population worldwide. Pathogenic variants in MT-RNR1 or mtDNA12SrRNA gene were also implicated predominantly in postlingual progresive deafness. The aim of this study was to analyze the implication of GJB2 and MT-RNR1 genes in the molecular etiology of deafness among 130 NSHL patients in the Republic of Macedonia. The presence of the del (GJB6-D13S1830) was also analysed. We performed SSCP and/or sequence analysis of GJB2 and identified sequence variants in 62 out of 130 patients (47.7%); (51 homozygous or compound heterozygous and 11 with only one variant allele). We found 8 different allelic variants, the most prevalent being c.35delG (65.49%), and p.W24*(23.01%), followed by other less frequent alleles (p.V27I, p.V37I, p. P175T and cd. delE120 or delGAG at 360). In addition, two polymorphic substitutions in the GJB2 gene with no clinical significance (p.V153I and p.R127H) were detected. No del(GJB6-D13S1830) was found. SNaPshot analysis was used to screen for the five most frequent allelic variants in the MT-RNR1 gene. Two MT-RNR1 mutations (A827G and T961G) were detected in three patients where only one GJB2 pathogenic variant was found. A new MT-RNR1 gene variant G1303A was also detected. In conclusion, MT-RNR1 mutations were not a significant contributor to the etiology of deafness in Macedonia, although could be considered as a modifier gene affecting the expression of deafness in patients carrying one GJB2 variant. On the other hand, the high percenttage of GJB2 pathogenic variants identified among NSHL cases indicates the necessity of molecular newborn screening for the two most common GJB2 variants (c.35delG and p.W24*) in the Republic of Macedonia.
Abstract The aim of this paper is to present the new laser technology using erbium laser JAG various minimally invasive, non-surgical procedures in gynecology. The laserhas its effect through photothermal action, leading to reconstructtion and stimulation of new collagen synthesis in the vaginal walls and fascia of the pelvic floor muscles. This results into hardening and tightening of the vaginal walls, which contributes to better leverage of the bladder and urine retention. In gynecology this laser treatment is used for treatment of vaginal walls failure, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. From 2010 to 2014 several clinical studies were conducted, all of them about the use of laser in the treatment of these 4 conditions and the aim was to confirm the efficacy and safety of this technology. The results showed that SMOOTH mode erbium laser is an effective and safe method for treatment of vaginal walls weakness, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy.
Abstract Introduction. Asthma is a chronic inflammatory disease of the airways in which many cells play a role with secreting a variety of mediators responsible for the clinical manifestation of asthma. It is assumed that IL-33 is one of the earliest-released mediators and can orchestrate the immune cascade of the disease. The aim of this study was to examine the role and clinical significance of IL-33 as a new and insufficiently explored mediator of inflammation in patients with uncontrolled moderate asthma. Methods. The study included 87 patients with asthma. Serum IL-33 was measured in all patients by ELISA method. The obtained data were statistically analyzedusing the Kolmogorov-Smirnov and Shapiro-Wilk's test. Qualitative data were presented in absolute and relative numbers, and quantitative data were presented with measures of descriptive statistics. Statistically significant values were considered forp <0.05. Results. Majority of included patients were female (75.86%). The average age of patientswas 42.3±15.9 years. The results of IL-33 in all patients were significantly increased compared to the reference value of IL-33 which is 0pg/ml. The average values of IL-33 ranged from 6.47±29.3 and they were insignificantly higher in the group with female patients compared to males (p=0.27), and insignificantly correlated with age (p=0.26). Conclusion. Even though a limited number of studies haveexplored the IL-33, results have shown higher serum level of IL-33 in asthma patients compared to healthy people, emphasizing the factthat IL-33 is an attrac tive candidate for targeted therapy and prognosis inasthma patients.
Abstract We present a case of a twenty-four-year old, nulligravid woman with suspicionof molar pregnancy and admittedat the University Clinic of Obstetrics and Gynecology in Skopje. On bimanual examination uniformly enlarged uterus was detected. Ultrasonography revealed snow storm echo signal in the uterine cavity. Dilation and curettage were performed and only a slight quantity of material was obtained. Serum bHCG was negative. MRI revealed a finding of the tumorous formation on the anterior wall of the uterus deforming and dislocating the uterus without any additional information. Open surgery was planned and tumorectomy was performedinour hospital. Histopathology analysis of the obtained material revealed symplastic myoma of the uterus. The patient got spontaneously pregnant later, but the pregnancy finished as a spontaneous missed abortion and instrumental revision was performed. Five months later the patient got pregnant again. She had regular pregnancy course and delivery at 37.5 gestational week.
Abstract Introduction. Central venous catheterization of the subclavian vein can be achieved with a landmark and an ultrasound-guided method. Using ultrasound the vein can be catheterized with a long axis in plane or a short axis out of plane approach and a combined approach. The aim of the study was to compare the success, average number of attempts and mechanical complication rate between the landmark and the combined ultrasound-guided method. Methods. A total of 162 adult patients from the Intensive Care Unit at Clinical Hospital Acibadem-Sistina, Skopje were included in this prospective study. Patients randomized in the examined group (n=71) were catheterized with real-time ultrasound guidance with a combined short axis out of plane and long axis in plane method. Patients randomized in the control group (n=91) were catheterized with the landmark method. Subclavian vein was catheterized in both groups. Overall success, success on first attempt, number of attempts and complications at the moment of catheterization were the main outcome measures. Results. Catheterization using the landmark method was successful in 94.5% of patients, 65.9% of which during the first attempt. Cannulation using real-time ultrasound guidance was successful in all patients with a first pas success of 83.1%. The complication rate in the ultrasound group was 2.82% and 16.5% in the landmark group (p=0.004404). Conclusion. Real-time ultrasound guidance with a combined short axis out of plane and long axis in plane approach improves success, decreases number of attempts, and reduces mechanical complications rate.
Abstract Doppler technique was first described by the Australian physicist and mathematician Christian Doppler. Doppler effect is defined as a reflection of high frequency sound waves of different frequency when they come in contact with the movable structure in the blood vessel. Waves that go to transducers are coded red, while waves that move away from the transducer are coded blue. Doppler main types can be classified as following: continuous wave (CW) Doppler, spectral Doppler, color Doppler and Power Doppler color. The study was realizedat the University Clinic for Plastic and Reconstructive Surgery. It is a randomized prospective study. During the study two groups of 30 patientseach were formed. Each patient was required a permission for reconstructive surgery procedure and an informed consent for participation in the study. For all patients a specially designed questionnaire (non-standardized) was filled out. 1. First (I) group of patients treated with flaps. In this group a type of reconstructive technique with skin or complex flapshas been applied. 2. Second group (II) of patients treated with grafts (split thickness grafts). In this group applied reconstruction comprised application of skin grafts with partial thickness. The study included patients with defects of the skin and soft tissues, whohad an indication for reconstructive surgery procedure. Exclusion criteria of patients for participation in the study were: children under 14 years of age, adults over 75 years, people with systemic diseases that can affect the results of reconstructive intervenetions and patients who have without periosteum bone-like surface defect as contraindication for skin grafting. The results of the reconstructive procedures according to the objectives set were investigated clinically into three time periods: preoperative, postoperative day 7 and day 30 postoperatively. The following investigations were carried out: determination of the circulation levels by means of Doppler; determination of the levels of limbs circulation is distal to the site of reconstruction in the pre-and postoperative period (day 7 and day 30); For the evaluation of blood flow the following parameters were used: • PSV-Peak systolic velocity • PI - Pulsatility index RI - Resistance indexPI and RI were calculated using the formula: • PI = PSV - EDV / Vmean • RI = PSV - EDV / PSV EDV indicates the flow velocity in late diastole and V mean, the average speed of blood flow through the artery. By assessment of arterial status before and after surgery through the analysis ofvascular waves at different locations of the vascular tree of the upper and lower extremities, we registered significant difference between the two examined groups, which speaks in favor of the use of flaps in reconstruction of the lower limbs.
