E. Ristovska, M. Genadieva-Dimitrova, V. Caloska-Ivanova, B. Todorovska, N. Joksimović, E. Nikolovska, S. Genadieva-Stavric, M. Bojadzioska
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 di
{"title":"Gastrointestinal Lymphoma in Tertiary Gastroenterology Center: Epidemiological, Clinical and Endoscopic Features","authors":"E. Ristovska, M. Genadieva-Dimitrova, V. Caloska-Ivanova, B. Todorovska, N. Joksimović, E. Nikolovska, S. Genadieva-Stavric, M. Bojadzioska","doi":"10.1515/mmr-2017-0018","DOIUrl":"https://doi.org/10.1515/mmr-2017-0018","url":null,"abstract":"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 di","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"105 - 112"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45989062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Filipovski, Katerina Kubelka-Sabit, D. Jasar, G. Dimitrov, V. Janevska
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.
{"title":"Reactive Stroma in Prostatic Carcinoma and Correlation with Tumor Grade and Tumor Stage","authors":"V. Filipovski, Katerina Kubelka-Sabit, D. Jasar, G. Dimitrov, V. Janevska","doi":"10.1515/mmr-2017-0021","DOIUrl":"https://doi.org/10.1515/mmr-2017-0021","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"123 - 127"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42273453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irena Kafedziska, Snezhana Mishevska-Perchinkova, D. Antova, M. Nikolova, A. Stojanovska, Filip Guchev
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.
{"title":"Ml28133 -A Multicenter, Open-Label, Long-Term Extension Study of WA 19926 to Describe Safety During Treatment with Tocilizumab in Patients with Early, Moderate to Severe Rheumatoid Arthritis","authors":"Irena Kafedziska, Snezhana Mishevska-Perchinkova, D. Antova, M. Nikolova, A. Stojanovska, Filip Guchev","doi":"10.1515/mmr-2017-0015","DOIUrl":"https://doi.org/10.1515/mmr-2017-0015","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"83 - 90"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46873671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Dzikova, G. Dimitrov, O. Stojceva-Taneva, G. Dimitrov
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.
{"title":"Determination of Fetal Maturity Using Signal Transformations of Fetal Thalamus Estimating Fetal Maturity by Ultrasound","authors":"E. Dzikova, G. Dimitrov, O. Stojceva-Taneva, G. Dimitrov","doi":"10.1515/mmr-2017-0007","DOIUrl":"https://doi.org/10.1515/mmr-2017-0007","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"32 - 37"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Danevska, M. Spiroski, D. Donev, N. Pop-Jordanova, M. Polenaković
Abstract Introduction. The Internet has enabled an easy method to search through the vast majority of publications and has improved the impact of scholarly journals. However, it can also pose threats to the quality of published articles. New publishers and journals have emerged so-called open-access potential, possible, or probable predatory publishers and journals, and so-called hijacked journals. It was our aim to increase awareness and warn scholars, especially young researchers, how to recognize these journals and how to avoid submission of their papers to these journals. Methods. Review and critical analysis of the relevant published literature, Internet sources and personal experience, thoughts, and observations of the authors. Results. The web blog of Jeffrey Beall, University of Colorado, was greatly consulted. Jeffrey Beall is a Denver academic librarian who regularly maintains two lists: the first one, of potential, possible, or probable predatory publishers and the second one, of potential, possible, or probable predatory standalone journals. Aspects related to this topic presented by other authors have been discussed as well. Conclusion. Academics should bear in mind how to differentiate between trustworthy and reliable journals and predatory ones, considering: publication ethics, peer-review process, international academic standards, indexing and abstracting, preservation in digital repositories, metrics, sustainability, etc.
{"title":"How to Recognize and Avoid Potential, Possible, or Probable Predatory Open-Access Publishers, Standalone, and Hijacked Journals","authors":"L. Danevska, M. Spiroski, D. Donev, N. Pop-Jordanova, M. Polenaković","doi":"10.1515/mmr-2017-0014","DOIUrl":"https://doi.org/10.1515/mmr-2017-0014","url":null,"abstract":"Abstract Introduction. The Internet has enabled an easy method to search through the vast majority of publications and has improved the impact of scholarly journals. However, it can also pose threats to the quality of published articles. New publishers and journals have emerged so-called open-access potential, possible, or probable predatory publishers and journals, and so-called hijacked journals. It was our aim to increase awareness and warn scholars, especially young researchers, how to recognize these journals and how to avoid submission of their papers to these journals. Methods. Review and critical analysis of the relevant published literature, Internet sources and personal experience, thoughts, and observations of the authors. Results. The web blog of Jeffrey Beall, University of Colorado, was greatly consulted. Jeffrey Beall is a Denver academic librarian who regularly maintains two lists: the first one, of potential, possible, or probable predatory publishers and the second one, of potential, possible, or probable predatory standalone journals. Aspects related to this topic presented by other authors have been discussed as well. Conclusion. Academics should bear in mind how to differentiate between trustworthy and reliable journals and predatory ones, considering: publication ethics, peer-review process, international academic standards, indexing and abstracting, preservation in digital repositories, metrics, sustainability, etc.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"75 - 81"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Laser in the Treatment of Stress Urinary Incontinence and Syndrome of Relaxed Vaginal Walls","authors":"Simonida Kotlarova Poposka, Afrodita Stomnaroska Jovanoski","doi":"10.1515/mmr-2017-0001","DOIUrl":"https://doi.org/10.1515/mmr-2017-0001","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Anti-Vegf in Management of Macular Edema in Retinal Disease","authors":"N. T. Shekerinov, V. Jordanova, M. Bogoev","doi":"10.1515/mmr-2017-0004","DOIUrl":"https://doi.org/10.1515/mmr-2017-0004","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"15 - 19"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Janeva, Angelko Gjorchev, B. Kaeva, G. Breskovska, Z. Goseva, M. Zdraveska, Deska Dimitrievska, Z. Arsovski, S. Pejkovska, J. Minov, D. Trajkov, M. Dimitrova, B. Zafirova
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.
{"title":"Role and Clinical Significance of Il-33 in Patients with Asthma","authors":"E. Janeva, Angelko Gjorchev, B. Kaeva, G. Breskovska, Z. Goseva, M. Zdraveska, Deska Dimitrievska, Z. Arsovski, S. Pejkovska, J. Minov, D. Trajkov, M. Dimitrova, B. Zafirova","doi":"10.1515/mmr-2017-0010","DOIUrl":"https://doi.org/10.1515/mmr-2017-0010","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"50 - 55"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Chadievski, Sonja S. Genadieva Stavric, A. Veljanovska, Z. Stojanoski, D. Miloska, L. Cevreska, B. Georgievski
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.
{"title":"FLAG-IDA, Possible Breakthrough in Treatment of Refractory Acute Myeloid Leukemia in the Context of Hematopoietic Stem Cell Transplantation: Single Center Experience","authors":"L. Chadievski, Sonja S. Genadieva Stavric, A. Veljanovska, Z. Stojanoski, D. Miloska, L. Cevreska, B. Georgievski","doi":"10.1515/mmr-2017-0006","DOIUrl":"https://doi.org/10.1515/mmr-2017-0006","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"27 - 31"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Dzonov, L. Noveski, S. Nikolovska, Elizabeta Zhogovska
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.
{"title":"Doppler Comparative Measurements in the Reconstruction of Limbs with Flaps and Grafts","authors":"B. Dzonov, L. Noveski, S. Nikolovska, Elizabeta Zhogovska","doi":"10.1515/mmr-2017-0011","DOIUrl":"https://doi.org/10.1515/mmr-2017-0011","url":null,"abstract":"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.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"56 - 63"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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