Journal of Morphological Sciences is an official journal of the Macedonian Association of Anatomists . Its main objective is to contribute to the development of morphological sciences by publishing scientific papers created by researches all over the world. The journal seeks to publish original research, clinical reviews, case reports and opinion papers on all aspects of medicine All medical scientists are invited to submit papers to this journal.
Macedonian Association of Anatomists (MZA)
SUB-RETINAL FLUID (SRF) AS A PROTECTIVE FACTOR AGAINST MACULAR ATROPHY AND POSITIVE RETINAL BIOMARKER OF VISUAL OUTCOME
Age related macular degeneration is the leading cause of legal blindness in elderly people. Its prevalence increases significantly after the age of 50. Neovascular, exudative AMD accounts for less than 10% of cases, the wet form (nAMD) is responsible for the largest number of cases where severe central visual impairment occurs compared to the dry form of AMD. Neovascular AMD form is characterized by the growth of abnormal choroidal new blood vessels from pre-existing choriocapillaris vessels. The exudation resulting from the immaturity of the blood vessels resulting in accumulation of fluids in different retinal compartments depending on the MVN (macular neovascular ) extension and localization. Subretinal fluid is an exudation that is localized in the space between the neurosensory retina and the retinal pigment epithelium. VEGF-A plays a key role in the process of angiogenesis and vascular permeability. Anti-vascular endothelial growth factor (anti-VEGF) therapy currently plays a central role in the treatment of numerous retinal diseases, most notably exudative age-related macular degeneration (eAMD), diabetic retinopathy and retinal vein occlusions, offering significant functional and anatomic benefits in most of the patients. Of all retinal biomarkers subretinal fluid (SRF) is the only imaging biomarker, that is, the only "pathological" morphological parameter that is consistently associated with a positive effect on visual acuity and has protective role against development of macular atrophy. Kew words: wet AMD, sub-retinal fluid, anti-VEGF treatment, macular atrophy.
UMBILICAL CORD CORTISOL LEVELS IN NEWBORNS DEPENDING ON GENDER AND MODE OF DELIVERY
One of the most stressful experiences for a newborn is the act of childbirth, and multiple researchers confirmed increased levels of cortisol and catecholamines in the blood of the newborn immediately after spontaneous vaginal delivery (SVD). In contrast, completing the birth by elective cesarean section (SC) should be far less stressful for the newborn, presenting with lower cortisol levels. Prospective clinical study measuring serum cortisol levels in umbilical cord blood samples was conducted at the Mother Teresa Hospital in Skopje, and 88 samples were obtained for analysis. The aim was to compare cortisol levels in healthy and appropriate for gestational age (AGA) newborns, depending on gender and mode of delivery. The results showed a mean cortisol level of 93.41 [95%CI 82.72 – 104.10]. In those born with SVD, the mean cortisol level was higher with a mean value of 118.13 [95%CI 102.77 – 133.50], and was significantly higher than in those born with SC in which the mean cortisol level was with a mean value of 70.83 [95%CI 59.19 – 82.47], with a statistically significant difference (p<0.0001). There was no significant difference between cortisol levels when grouping was done by gender (p=0.424). According to the results and comparative literature, we can say that the level of cortisol in the umbilical cord, as well as its dependence on the method of delivery, can be a good early indicator of the stress experienced during pregnancy and the birth process. Keywords: cortisol, newborn, umbilical cord, delivery, gender.
RAISING AWARENESS OF MYIASIS: A CASE SERIES FROM AUTOCHTHONOUS AND IMPORTED INFESTATIONS
Myiasis is an infestation of the tissues of livinghumans and other vertebrates by the immature stages (larvae) of Diptera. According to the International Classification of Diseases, myiasis belongs to the morbidity classification ICD-10-CM, with the ICD code B87 (2025 edition). Myiasis is not mandatory to report, and through our experience, we aimed to raise awareness of this infestation among medical practitioners and the public. We discuss seven cases of myiasis diagnosed over five years (2019-2024) whose specimens (larvae) was submitted to the Institute for Microbiology and Parasitology, Medical Faculty - Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia. The collected maggots were analyzed through macroscopic and microscopic examination. Morphological identification of the larvae was conducted using identification keys. Photographs were taken using an Olympus SZX9 and a Carl Zeiss Stemi 508 stereo microscope with an integrated high-resolution digital camera. Our findings confirmed an infestation by larvae from two autochthonous species, Sarcophaga argyrostoma and Lucilia sericata. We also identified an imported fly species, Cordylobia anthropophaga. The larvae can cause various symptoms depending on their relationship with the host and the anatomical location in the body. The outcome is related to comorbidities and the provision of appropriate, timely treatment. Medical practitioners should consider myiasis in their differential diagnosis. Nosocomial myiasis is a significant concern and requires special attention and preventive measures. Key words: myiasis, Sarcophaga argyrostoma, Lucilia sericata, Cordylobia anthropophaga, Republic of North Macedonia
The MICROALBUMINURIA AS A POSSIBLE BIOMARKER IN EARLY DETECTION OF KIDNEY LESIONS IN PATIENTS WITH TYPE 2 DIABETES
Today, there is growing evidence supporting the association between renal failure and microalbumin (McA) concentration. The role of McA in the development of microcirculation damage in diabetic nephropathy (DN) has been proven. In our obsevational study were including 78 patients with type2 diabetes. The baseline level of McA showed to be significantly increased in patients with DN, and it was related to the severity of the renal disease. We were focusing on patients with a five-year-old diagnosis of diabetes mellitus type 2 (DM-2). After their a two-year follow-up, we found that microalbumin in urine increased afther 6 mounths and one year in some of patients. Microalbumin was determined using of turbidimetric method in the laboratory of the Institute of Medical and Experimental Biochemistry. For serum creatinine, we were using a standardized enzyme method. MDRD4 formula was the best for calculation of glomerular filtration rate. A statistical analysis of the data was performed with the statistical program IBM SPSS 26 for Windows. The results obtained regarding albumin in urine showed: mean 42.04 mg/L, extremely high CV, and were in negative correlation with GFR. Using a multivariate linear regression model, we proved the fact that the increased McA level in the urine significantly influenced the decline of GFR. In patients with a high risk of developing diabetic nephropathy, appropriate measures were taken in order to register and prevent the disease on time. The large variability could be due to differences in disease progression among individuals since microalbuminuria is a marker of early kidney damage, besides other promoters of progression. Keywords: microalbuminuria, glomerular filtration rate, MDRD formula.
PERIOPERATIVE MANAGEMENT OF CYSTIC FIBROSIS IN PATIENTS UNDERGOING ORAL AND MAXILLOFACIAL SURGERY CARE
Cystic Fibrosis (CF) is an autosomal recessive disorder and is considered one of the most fatal hereditary diseases. The average survival age of CF patients has significantly increased over the past 60 years, particularly with advances in neonatal and pediatric care, along with modern preventive care methods. There is a large number of CF patients who require interventions in oral and maxillofacial surgery. This paper will discuss the diagnosis, pathophysiology, and systemic complications of CF and will provide relevant information regarding the management of CF patients in oral and maxillofacial surgery. Recommendations for preoperative, perioperative, and postoperative care of these patients will be presented. Keywords: cystic fibrosis, premedication, protocol, surgery
MORPHOLOGICAL ANALYSIS OF METASTASES OF HEPAR WITH MR VOLUMETRY
Increased frequency of incidence of metastatic liver disease has been noted especially among young women with breast cancer and young men with colorectal cancer. Metastatic liver deposits have a specific morphological appearance on MR . MR morphological imaging of metastases is based on proton spin of the hepatocytes, while the hepatic metastases have in a different sequence different display. On T1-sequence they are shown as focal hypo to isosignal round to oval irregular lesions of varying diameter sometimes with deeper central signal. The T2-sequence has a mixed signal depending on the type of vascularization, but specificity is obtained after intravenous application contrast, where metastases were shown with deep central signal but significant peripheral hypersignal in the form of a peripheral ring. Liver volumetry using magnetic resonance imaging (MRI) is method for quantitative measurement of the size and volume of the liver using MRI data. This is a non-invasive technique that provides important information about the anatomy of the liver and can help in the assessment of diseases and liver conditions, such as cirrhosis, liver tumors, metastases or fatty liver disease. In metastatic liver disease, hepatic volumetry as a method of calculating the residual the volume of the liver began to develop more and more with the development of the treatment of metastases, either surgical or oncological. The method represents a mathematical approach in date residual and responsible for the regenerative hepatic process, without affecting its function. Magnetic resonance imaging and volumetry are superior methods for diagnosis and treatment of metastases. Keywords : MRI, Volumetry, Metastases, Liver.
FREQUENCY OF LEUKOPLAKIA OF THE BLADDER AND THE ROLE OF SURGICAL TREATMENT : AN ANALYSIS OF A SIX-YEAR PERIOD
Bladder leukoplakia, or squamous keratinizing metaplasia (SKM), is a rare disease in which the normal transitional epithelium is transformed into a squamous epithelium over which there is a layer of keratin. In most patients, typical non-specific symptoms of the lower urinary tract are expressed. Worldwide the representation of leukoplakia of the bladder is 1:10 000 cases. Surgical treatment is currently the gold standard in leukoplakia therapy. The goals of the study are to determine the prevalence of bladder leukoplakia, as well as the impact of surgical treatment of leukoplakia on the improvement of lower urinary tract symptoms. We analyze a series of 2,665 patients diagnosed with cystitis, out of a total of 70,620 patients from the entire territory of the Republic of N. Macedonia, who were examined and treated in the urology department at the GOB "8th of September " - Skopje, for the period from 01.01.2018 to 01.06.2024. Out of 70 620 patients, 2665 patients (3.77%) were diagnosed with cystitis, of which 1768 (66.4%) were female. The IPSS (international prostate symptom score) questionnaire showed a postoperative improvement of 65.4%. Leukoplakia of the bladder is a rare urological disease, which is exclusive to the female sex. the postoperative result of the IPSS score questionnaire showed a significant improvement in symptoms. Keywords: bladder leukoplakia, lower urinary tract symptoms, IPSS score
PATHOLOGIC AND MOLECULAR SUBTYPES CHARACTERISTICS OF OUR BREAST CANCER PATIENTS IN KOSOVO
To classify breast cancer cases by molecular subtypes (Luminal A, Luminal B [HER2-positive], Luminal B [HER2-negative], HER2-positive, and triple-negative). The secondary objective was to analyze associations between immunohistochemical markers, molecular subtypes, and established prognostic factors (stage, grade, age, and tumor location). This prospective study included 100 patients diagnosed with breast cancer and treated at an oncology clinic. All patients underwent various treatment modalities, including surgical intervention. Radical mastectomy (RM) remained the predominant surgical approach, performed in 83% of cases, compared to 16% who underwent breast-conserving surgery (BCS). Across all molecular subtypes, RM combined with lymph node dissection was the primary surgical treatment. Even among patients with the Luminal A subtype, the ratio of BCS to RM was 1:3. Molecular subtypes were found to correlate with tumor volume and disease stage, reflecting differences in disease progression. A considerable number of cases were diagnosed at locally advanced stages, contributing to the preference for mastectomy over BCS. This tendency may reflect the need for more aggressive treatment strategies at the time of diagnosis due to the advanced nature of the disease. Keywords: breast cancer, molecular subtypes.
THE SPECTRUM OF PULMONARY SARCOIDOSIS PRESENTED ON HRCT-WHAT RADIOLOGIST SHOULD KNOW?- REVIEW ARTICLE
Sarcoidosis is a multisystem disease of unknown etiology that very often affects the lung parenchyma with interstitial and granulomatous changes of varying intensity and expression depending on the stage of the disease. Very often mediastinal lymph nodes are affected with changes of different types. It is also called the “great mimicker”, because of the various aspects of this enigmatic disease. In this review we will present typical and atypical variants of pulmonary sarcoidosis according to their distribution detected on HRCT from our experience. HRCT is the method of choice in the evaluation of pathological changes in pulmonary sarcoidosis. Its capabilities for thin-section imaging and high spatial reconstruction to generate quality images results in better characterization and determination of abnormalities of the lung parenchyma and interstitium. Key words: sarcoidosis, HRCT, lung, interstitial lung disease.
HRCT PULMONARY FEATURES OF ILD PATIENTS ASSOCIATED WITH CONNECTIVE TISSUE DISEASES- AN OVERVIEW
Connective tissue diseases (CTDs) include a spectrum of disorders that affect the connective tissue of the human body, They include autoimmune disorders such as rheumatoid arthritis (RA), systemic lupus erythematous (SLE), scleroderma, polymyositis/dermatomyositis and mixed connective tissue disease (MCTD) characterized by immune-mediated chronic inflammation and the development of fibrosis. In this review article we will present cases of patients diagnosed with connective tissue disorders who developed interstitial lung diseases. Rheumatoid arthritis RA-ILD in our case is presented with usual interstitial pneumonia pattern (UIP) and NSIP pattern, SLE, scleroderma, dermatomyositis, MCTD are more common presented with nonspecific interstitial pneumonia pattern (NSIP). Sjogren syndrome in our case is presented on HRCT as organizing pneumonia (OP), but we can not exclude for sure primary postinfectious cause. Lymphocytic interstitial pneumonia pattern (LIP) is also presented in one patient diagnosed with Sjogren syndrome. HRCT of the lungs is a key component in the multidisciplinary approach to the diagnosis of connective tissue diseases associated with interstitial lung disease. The evaluation of radiological lung changes in correlation with clinical data not only leads to a correct diagnosis in many cases, but in this context plays an important role and helps in determining the prognosis, monitoring the effectiveness of treatment, detecting disease progression or complications, and evaluating patients with worsening or acute symptoms. Key words: Connective tissue diseases, ILD, HRCT, lungs, UIP, NSIP, OP, LIP.
ASSOCIATED RISK FACTORS AND PREVALENCE OF METABOLIC SYNDROME IN PEOPLE WHO ARE LIVING WITH HIV AND ARE ON ANTIRETYROVIRAL TREATMENT
The extended life expectancy of people living with HIV infection increases the risk of metabolic syndrome (MS). To assess the prevalence of MS, the association of triple regimen antiretroviral therapy (ART) and the role of the chronic inflammatory process caused by the HIV virus with the onset of MS. A prospective cross-sectional study was conducted on 141 HIV infected adult patients with confirmed HIV infection who regularly receive ART at the University Clinic for infectious diseases and febrile conditions in Skopje. In all patients, the presence of MS was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel ATP III (NCEP ATPIII) 2005. The statistical software SPSS (ver. 23.0; IBM, SPSS, USA) was used for statistical analysis. The prevalence of MS in persons with HIV infection in RNM was 17.96%. The group of patients with MS were significantly older and had significantly higher Body Mass Index and greater waist circumference (28.82 ± 4.6 kg/m2 vs 23.91 ± 3.6 kg/m2 p<0.0001) and (101.04 ± 12.4 vs 87.19 ± 9.8cm,p<0.0001), respectively. Treatment of patients with ART did not show a significant difference in the group with and without MS. There is a significant difference regarding the frequency of IL 6 (p=0.012). Aging and increasing Body Mass Index are significant risk factors in the developing of MS in persons with HIV infection who are on ART treatment. Key words: metabolic syndrome, HIV infection, antiretroviral treatment.
LOCAL FLAPS AND FULL-THICKNESS SKIN GRAFTS FOR MEDIAL CANTHAL REGION RECONSTRUCTION: A CLINICAL EXPERIENCE
Introduction: The medial canthal region, above the medial canthal tendon, is where the upper and lower eyelids, eyebrows, and nose converge. Its skin varies in color, texture, and thickness, remaining thin, supple, and concave around the periorbital area. These anatomical complexities pose challenges for reconstruction after skin cancer excision. Aim: This paper presents our five-year experience in reconstructing medial canthal defects using glabellar and nasal flaps, as well as full-thickness skin grafts (FTSG). Material and methods: At our hospital, 32 patients underwent medial canthal reconstruction using a single flap: glabellar flap (85%), rhomboid flap (9%), or full-thickness skin graft (FTSG) (6%). Satisfactory outcomes were achieved, including favorable pathology findings (mostly basal cell carcinoma), no recurrence, and good aesthetic results. Conclusion: Our findings highlight a clear preference for local flaps as the first choice in medial canthal reconstruction. As a one-stage procedure, they achieved satisfactory aesthetic results, with both the reconstructed and donor sites becoming acceptable to patients over time. When patient health or defect size posed limitations, full-thickness skin grafts (FTSG) served as a viable alternative. Key words: medial cantal region, local flaps, glabellar flap, Limberg flap, FTSG
Mechanical thrombectomy is a type of minimally invasive procedure in which an interventional radiologist uses specialized equipment to remove a clot from a patient’s artery. Using fluoroscopy, or continuous x-ray, the doctor guides instruments through patient’s arteries to the clot, extracting the clot all at once. The radiologist starts the procedure by making a small incision in either the wrist or the abdomen, giving them an access to an artery. After making the incision, the doctor threads a catheter through the artery to the clot. Next, a tiny net-like device called a stent retriever is inserted into the catheter and guided to the blockage. Then, the stent retriever is pushed through the clot. After the stent retriever is through, it expands to the size of the artery wall. At this point, the stent retriever has captured the clot, and the doctor is able to pull it out backwards, removing the clot entirely. Keywords: thrombectomy, stroke stent, interventional radiology.
NEUROENDOCRINE TUMOR AS A RARE CAUSE OF SMALL BOWEL ILEUS
Small bowel neuroendocrine tumors (SBNETs) are slow-growing neoplasms that have a tendency to metastasize and a relatively favorable prognosis. The presentation of Sb-NETs is diverse, although abdominal pain and obstructive symptoms are the most common symptoms. In patients with metastases, hypersecretion of serotonin and other bioactive amines results in carcinoid syndrome. Treatment of these tumors is multimodal and includes surgery, liver-directed therapy, somatostatin analogs, and peptide receptor radionuclide therapy. Keywords: neuroendokrine tumor, ileus.
INTERLEUKIN-18 AND EMPHYSEMA IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Emphysema involves the destruction of alveolar walls, resulting in diminished gas exchange and airflow constraint. Interleukin-18 (IL-18), a potent pro-inflammatory cytokine, plays a pivotal role in the immune response and inflammation regulation, implicated in various autoimmune and inflammatory diseases. Elevated IL-18 levels have been noted in emphysema patients, contributing to chronic inflammation, tissue damage, and airway remodeling. Aim: The aim of this study was to determine IL-18 values in patients with emphysema, compare their values in patients with different stages of the disease, and analyze their correlation with inflammatory and clinical parameters. Materials and Methods: This cross-sectional study was conducted at the University Hospital of Pulmonology and Allergology in Skopje, involving 30 COPD patients, randomly sampled, meeting specified inclusion and exclusion criteria. Signed informed consent was obtained from all participants. Data on demographic, clinical, and smoking history were obtained from medical records. Spirometry and imaging techniques were performed for lung function and emphysema assessment. Blood samples were collected for inflammatory parameters measurement and IL-18 concentration measurement using Luminex technology. The study included 30 COPD patients (10 women, 20 men), with an average age of 65.2 years, all of whom were smokers. Emphysema was present in 26 patients (86.5%): 11 with mild, 10 with moderate, and 5 with severe emphysema. Average age increased with severity: 52.3 years (no emphysema), 61.5 (mild), 66.4 (moderate), and 65.6 (severe). Cough prevalence was 75% (no emphysema) to 81.2% (mild) and 80% (moderate and severe). Dyspnea rose from 50% (no emphysema) to 100% (severe). Chest pain occurred in 80% of severe cases. FEV1 values decreased with severity: 64.5% (no emphysema), 60.3% (mild), 47.5% (moderate), and 37.2% (severe). Inflammatory parameters (leukocyte and neutrophil counts) did not vary by emphysema severity, but IL-18 levels significantly correlated with severity. In correlation analysis, higher IL-18 levels were associated with emphysema severity and decline in lung function (FEV1), while no significant correlations were found between IL-18 and age, chest pain, dyspnea, cough, or leukocyte counts. These findings highlight the potential utility of IL-18 as a biomarker in emphysema management and emphasize the need for further research to elucidate its therapeutic implications. Keywords: COPD, emphysema, Interleukin–18.
EVALUATION BIOMARKERS ON OPTICAL COHERENCE TOMOGRAPHY IN PATIENTS WITH MACULAR EDEMA DUE TO CENTRAL RETINAL VEIN OCCLUSION WITH ANTIANGIOGENE TREATMENT
Retinal vein occlusions (RVO) are the second leading cause of vision loss from retinal vascular diseases in the adult population. Vascular endothelial growth factor (VEGF) plays a major role in the pathophysiology of RVO. The aim of the study is to evaluate structural biomarkers and their impact on acuity, as well as to determine the correlation between visual acuity and the number of applications. The study includes 24 patients with macular edema as a result of central retinal vein occlusion, who are treated with an antiangiogenic drug - Aflibercept. Analysis of SD-OCT/OCTA tomograms was performed at 3 time points (before treatment, at 3 and 6 months) from the start of treatment. Biomarkers were analyzed: Central subfield thickness (CST), presence of epiretinal membrane, change in vascular density in the foveal zone before treatment and at the 6th month of treatment, evaluation of the effect on visual acuity and correlation with intravitreal applications. In the 24 patients (24 eyes) included, a decrease in CST was observed in all. In relation to visual acuity, there was an increase of 2 Snellen lines. Change in the vitreomacular interface was present in 42% of patients. Vascular density was evaluated with OCTA, the change of which was on average from 36.73% ± 11.13 to 23.58% ± 7.26. Antiangiogenic treatment is the first line of treatment for retinal vein occlusions. Timely use of these agents is crucial for better visual acuity, and analysis of biomarkers on optical coherence tomography has prognostic significance. Keywords: vein occlusion, optical coherence tomography, angiography, anti VEGF, biomarkers.
INSIGHTS FROM A TEN-YEAR RETROSPECTIVE STUDY ON CHORANGIOMAS
The most common benign neoplasms of the placenta are non-trophoblastic tumors. The most common subtype is chorioangioma, but teratoma, leiomyoma, and hepatocellular adenoma are also seen. Giant chorioangioma is a rare tumor, with diameter larger than 4 cm and seen in association with elderly primipara, twin pregnancies, hypertension and diabetes. Giant chorioangioma is associated with complications that can affect both the mother and the fetus or neonate. We present a retrospective study of chorangioma cases diagnosed at Institute of Pathology in Skopje in a 10-year period from 2012 to 2021. Macroscopic observations, gestational age at delivery, maternal age, and pregnancy outcomes were assessed. Histological and immunohistochemical examinations of the placental chorangiomas were conducted. Six cases of chorangiomas were clinically identified and histopathologically confirmed. Four cases involved giant chorangiomas ranging in size from 8 to 13 cm. One case was identified as chorangioma of the umbilical cord. Three of the cases showed potential maternal risk factors like primary infertility, extreme obesity and post COVID status. Four of the pregnancies had favorable outcomes with no complications during and after birth, one of the pregnancies resulted in a premature birth, while the other was complicated by fetal distress. Regular monitoring by serial ultrasound and fetal echocardiography is recommended to pick up complications early so that they can be dealt effectively.
To emphasize the role and value of hysterosalpingography (HSG) as a radiological procedure for investigation of the uterine cavity and the patency of the fallopian tubes. This is a retrospective study of a group of 43 patients with infertility examined at the University institute of radiology in Skopje, Republic of North Macedonia during a two months period in 2025. The HSG was part of the infertility examination, evaluation and treatment at the University clinic of gynecology and obstetrics in Skopje, Republic of North Macedonia. The mean age of the 43 patients included in the study was 34.02 years with a range of 20 to 47 years. Most of the participants, 27 (62.8%) had primary infertility. The period of infertility duration was under 5 years in 31 (72.1%) of the women. Hysterosalpingograms showed normal uterine morphology in 31(72.1%) of the included patients, tubal morphology was normal in 35 (81.4%) of the patients, while 42 (97.7%) of the 43 participants had normal cervical findings. The most prevalent uterine anomaly was the arcuate uterus present in 6 (13.9%) of the patients, while the rarest findings were the hypoplastic and the unicornuate uterus, each presenting in only 1 (2.3%) of the patients. Cervical insufficiency was detected in 15 (34.9%) of the patients. Patent tubal dilatation and hydrosalpinx were the most common tubal abnormalities, each finding appearing in 3 (7%) of the patients. Normal tubal patency was present in 36 (83.7%) of the included women, while 3 (7%) of the patients had bilateral tubal occlusion. HSG is a method of choice for demonstration of the uterine endometrial contour, filling of the fallopian tubes and intraperitoneal spillage of contrast with the purpose of establishing tubal patency. Key words: Hysterosalpingography, female infertility, Fallopian tubes.
A CASE REPORT ON EXTRANODAL NATURAL KILLER/T-CELL LYMPHOMA (ENKTCL) IN A CAUCASIAN ADULT
Peripheral T-cell lymphomas (PTCLs) are uncommon entities, accounting for fewer than 10% of all non-Hodgkin lymphomas. Initial evaluation of PTCLs includes history and physical examination, computed tomography (CT) of the chest, abdomen and pelvis or positron emission tomography (PET)/CT imaging, a marrow aspirate and a biopsy. Extra nodal NK/T-cell lymphoma (ENKTL) represents approximately 5% of PTCLs. Although the disease typically appears as a localized tumour at the initial diagnosis with a low (favorable) International Prognostic Index (IPI) and without B-symptoms, recurrence and frequent relapses are the main threats to the course of ENKTL. For this reason, patients with stage 1 of the disease have a worse outcome compared to those who initially appear with a tumor mass at other locations. We hereby present a case of a 38-year-old male patient, who firstly appeared with a localized mass in one of the testicles. Despite properly treating the condition with first-, second- and third-line chemotherapeutics plus adjuvant radiotherapy, the patient has had a total of two relapses in the past 4.5 years. After the last given regimen, the patient has been disease-free for three months, which is not an encouraging time given the cumulative side effect of polychemotherapy and the aggressiveness of the disease itself. Keywords: natural killer/T-cell lymphoma, testis,18F-FDG PET.
SUCCESSFUL PREGNACY OUTCOME IN A CASE OF OSTEOGENESIS IMPERFECTA WITH HIPOPITUITARISMUS
Case report Osteogenesis imperfecta (OI), first described in the seventeenth century, is a rare inherited connective tissue disease, characterized by bone fragility, low bone mass, and susceptibility to bone fractures with variable severity. Osteogenesis imperfecta (OI) or brittle bone disease is a phenotypically diverse disorder caused by deficiencies in the synthesis of type I collagen. We present hereby a case of a pregnant woman with osteogenesis imperfecta and hypopituitarismus. Pregnancy was achieved with IVF procedure, and hypertension occurred in the 32nd gestational week of pregnancy. A multidisciplinary team approach was mandatory and resulted in the delivery of a live baby girl in the 37th gestational week of pregnancy. The successful outcome of this high-risk pregnancy and delivery can be attributed to collaboration between different specialty teams and planning for the known complications that may affect pregnancy and delivery in women with these genetic skeletal disorders. Keywords: hypopituitarismus, osteogenesis imperfecta, pregnancy, childbirth
SURGICAL PROCEDURE AND MANAGEMENT OF LARGE MAXILLARY RADICULAR CYST - A CASE REPORT
Radicular cysts may constitute up to 70% of all cystic lesions of the jaw, with the incidence of occurrence being in the maxillary region. In fact, cysts are pathological lesions that are lined by epithelium and contain technical or semi-textured material that can range from a translucent yellow to a firm, curd-like mass. The aim of this paper is to present the enucleation of a large radicular cyst in the maxilla in the presence of scant x-ray documentation. The therapeutic approach consisted of opening a mucoperiosteal flap after Pether to access the cyst that had perforated the vestibular lamina. The cyst was completely extirpated using the Partch II method. However, despite the scarce radiological documentation, the oral surgical procedure for enucleation of the cyst was successfully performed. We report a case of 26-year-old male patient with the presence of a large cystic lesion on the right side of the maxilla in the area between the premolar-molar space. Radical surgical approach is the only treatment in most cases of large radicular cysts. Key words: radicular cyst, cystectomy, Partch II, sinus maxillaries, histopathological findings, X-rays recordings.
SURGICAL PROCEDURE OF IMPACTED MANDIBULAR CANINE- CASE REPORT
Failure of tooth eruption into the oral cavity, because of either insufficient space or the presence of an entity blocking its path of eruption, may lead to different conditions such as impaction, transmigration, retention, or malposition/displacement. The occurrence of impaction and/or non-eruption of mandibular canines is unusual, with prevalence rates from 0.05 to 0.4%.2 There are different methods for performing corticotomy, open and closed method.The aim of this case presentation is to show the closed method of corticotomy performed on the mandibular canine as a rare position of impacted teeth. In the case report, which was performed in 17 years old girl, It`s been used a closed surgical approach of corticotomy with placing a brace during the intervention. Control examinations were performed on the second and seventh postoperative days, when the sutures were removed. The postoperative curse was without any complication, with no pain, redness or oedema. The closed surgical approach of corticotomy is a minimally invasive technique. The side effects of the procedure are minimal. Key words: corticotomy, eruption, alveolar ridge, impacted canine, braces.
CASE REPORT: PRESERVATION OF THE ALVEOLAR RIDGE FOR SUCCESSFUL FIXED ZIRCONIA DENTAL RESTORATION
Alveolar ridge preservation is a common dental procedure designed to preserve the space left after tooth extraction. It involves the use of a natural collagen membrane derived from the porcine pericardium, used alone, or in combination with a bone graft to replace missing bone before implant placement and prosthodontic reconstruction. This case report aims to demonstrate the importance of alveolar ridge preservation after tooth extraction, the method, and its outcome for successfully placing a fixed prosthetic construction. Case report: The technique uses a natural collagen membrane (Jason membrane) derived from porcine pericardium that can be resorbed, in combination with the xenogeneic bone graft (Carebone, Botiss) and subsequent zirconium dioxide fabrication after 6 months in a 45-year-old female patient. Conclusion: Regeneration of the alveolus with Jason membrane and artificial bone Carebone, can minimize further bone resorption and allow for successful placement of prosthetic solution. Keywords: extraction, alveolus, alveolar ridge, PMMA, zirconium crowns.
IMMUNOTHERAPY IN TREATMENT OF ANAPLASTIC THYROID CANCER: A CASE REPORT
This case report describes a 55-year-old woman with diagnosed anaplastic thyroid cancer (ATC). Initially, the patient was treated surgically, followed by rapid progression. After that radiation therapy was performed, and the patient immediately progresses again. It was decided that the patient should start chemotherapy while waiting for molecular tests due to the rapid growth of the cancer. After six cycles of chemotherapy in which the disease was stable progression occurred again immediately after discontinuation of chemotherapy. Molecular test shows PD-L1 positive patient with CPS score of 20% and she was put on immunotherapy with pembrolizumab. After 1 year of immunotherapy treatment, PET CT scan showed metabolic and morphological regression of tumor mass in the neck and cervical lymph nodes. The patient had a good quality of life with no side effects throughout the immunotherapy. In this case, we want to emphasize that immunotherapy can also be considered as choice of treatment in anaplastic thyroid carcinoma who represents carcinomas with high lethality rate. Keywords: thyroid anaplastic carcinoma, immunotherapy, PD-L1, pembrolizumab.
PERFORATION OF SMALL INTESTINE IN PREMATURE NEONATE - POSTOPERATIVE MANAGEMENT CASE REPORT
­Gastrointestinal perforation (GIP) in neonates is a severe, acute, life-threatening condition associated with multiple complications and a high mortality rate. It is most often associated with necrotizing enterocolitis, but it also often occurs spontaneously due to local intestinal ischemia. Early detection and timely surgical intervention, with appropriate respiratory support and individualized nutritional support, are crucial in the outcome and survival of extremely premature neonates. We present a case of postoperative management of an extremely premature infant from a twin pregnancy after surgical intervention due to intestinal perforation. Keywords: premature neonate, spontaneous gastrointestinal perforation, necrotizing enterocolitis
DETECTION OF JAK2 V617F MUTATION IN A PATIENT WITH C-KIT POSITIVE GASTROINTESTINAL STROMAL TUMOR: CASE REPORT
C-Kit is receptor tyrosine kinase which is involved in various signaling pathways and has been recognized in pathogenesis of several types of cancers including gastrointestinal stromal tumor (GIST). More than 50 years, scientist have been studied GIST and made advances in treatment based on c-Kit inhibition. One of the signaling pathway involving activation via c-Kit is the JAK/STAT pathway located on hematopoietic cells resulting activation of transcription of a variety of genes. Here, we provide a case report of patient with two malignancy c-Kit positive GIST and Essential Thrombocytemia (ET) positive for JAK2 V617F mutation. Keywords: c-Kit, GIST, JAK2 V617F mutation, ET.
TRAUMATIC ABDOMINAL WALL HERNIA ; A CASE REPORT
Traumatic abdominal wall hernia remains a rarely reported event, despite the high prevalence of blunt abdominal trauma. The traumatic abdominal wall hernia was successfully managed by Intra peritoneal On lay Mesh technique, a repair procedure where a mesh is introduced into the abdominal cavity and placed from the inside over the hernia opening. Case report : We report a rare case of traumatic abdominal wall hernia caused by a traffic accident. A 33-year-old male was hospitalized after road traffic accident. He sustained facial and rib fractures and received emergency treatment and was presumably discharged after reasonable recovery. He attended our clinic two years later with complaints of pain and swelling in the left subcostal area. Computed tomography showed an abdominal wall defect. Type of abdominal wall, the size of the hernia defect and the presence of associated intra-abdominal injuries are main factors to decide how the hernia will be repaired, immediate versus delayed. IPOM plus technique is used in an elective treatment of traumatic abdominal wall hernias. Studies show that seroma formation was less often found in patients undergoing laparoscopic intra peritoneal on lay mesh treatment with fascial defect closure as compared to laparoscopic intra peritoneal on lay mesh placement without defect closure. Traumatic abdominal wall hernia presents a diagnostic as well as a therapeutic challenge. The therapeutic approach is governed by a multitude of factors emphasizing the need of a patient-tailored, case by case management plan. Keywords: trauma, hernia, IPOM, hernioplasty, mesh