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Papers by aleksandar shumkovski
Academic Medical Journal, 2022
Intraoperative lymphatic mapping and sentinel lymphadenectomy in patients with malignant melanoma... more Intraoperative lymphatic mapping and sentinel lymphadenectomy in patients with malignant melanoma of the extremities-results of our learning phase Noveski Lazo,
Prilozi - Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki, Nov 1, 2020
Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall... more Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal the risk benefit rationale for dunking either duct to mucosa anastomosis. Material and method: In our last series of 25 patients suffering pancreatic head carcinoma we performed a standard dodenopancreatectomy. After the preoperative diagnosis and staging with US, CICT, tumor markers, they underwent surgery. Invagination-dunking anastomosis was performed in 15, whereas, duct-to-mucosa, double layer anastomosis was performed in 10. In the first group with dunking anastomosis, we had 6 patients with soft pancreas and 8 with narrow main pancreatic duct, less than 3 mm. In the duct-to-mucosa group there were 5 patients with soft pancreas and 4 with narrow main pancreatic duct. All other stages of surgery were unified, so the only difference in the procedure remained on the pancreatojejunoanastomosis. The onset of the postoperative pancreatic fistula was estimated with revelation of 3 fold serum level of alfa amylases from the third postoperative day in the drain liquid. Results: In the duct to mucosa group there wasn't a clinically relevant postoperative pancreatic fistula, while in the dunking anastomosis group we had 4 postoperative pancreatic fistula B, 26 %. One of these 4 patients experienced intraabdominal collection-abscess, conservatively managed with lavation through the drain. Comparing the groups, there was no significant difference between the groups concerning the appearance of postoperative pancreatic fistula: p>0.05, p=0.125. From all 25 patients, in 21 patients biliary stent was installed preoperatively to resolve the preoperative jaundice. All 21 suffered preoperative and postoperative reflux cholangitis, extending the intra-hospital stay. Conclusion: So far, there have been many trials referring to opposite results while comparing these 2 techniques in creation of the pancreticojejunoanastomosis. In our study, the duct to mucosa anastomosis prevailed as a technique, proving its risk benefit rationale. However, further large randomized clinical
MACEDONIAN ASSOCIATION OF ANATOMISTS AND MORPHOLOGISTS, 2011
Целта на трудот беше да го утврди влијанието на раната перорална исхрана врз постоперативното вос... more Целта на трудот беше да го утврди влијанието на раната перорална исхрана врз постоперативното воспоставување на цревната функција и пероперативниот морбидитет кај пациентите оперирани од колоректален карцином. Материјал и методи: Во проспективната рандомизирана студија беа вклуче- ни 100 пациенти со колоректален карцином со стандардна предоперативна и оперативна процедура. Пациентите беа поделени на 2 групи: испитувана и контролна и секоја група вклучуваше по 50 паци- енти. Пациентите од испитуваната група започнаа со внес на течности во текот на првите 24 часа по- стоперативно и продолжија со регуларна диета во следните 24-48 часа во зависност од толерантноста кон истата. Пациентите од контролната група започнаа со внес на течности и храна по повлекување на постоперативниот илеус. Се следеше времето до воспоставување на цревната функција, должината на постоперативниот болнички престој, бројот и видот на пероперативните компликации и евенту- алните реадмисии во болница во првите 30...
Open Access Macedonian Journal of Medical Sciences, 2018
BACKGROUND: The understanding of the etiopathogenesis of gastric carcinoma (GC) can be a base for... more BACKGROUND: The understanding of the etiopathogenesis of gastric carcinoma (GC) can be a base for development of new therapeutic methods to reduce mortality and to increase survival in patients with GC. The percentage of Epstein - Barr virus (EBV) positive gastric carcinomas is uncertain, and the etiologic importance of EBV in the pathogenesis of GC has still not been elucidated. AIM: This study aimed to determine the percentage of EBV associated GC as well as to determine their clinicopathological characteristics. MATERIAL AND METHODS: The study included 80 patients with GC who were analysed for ethnicity, local growth of a tumour (T status), the presence of nodal metastases (N), the presence of distant metastases (M), stage of the disease and degree of carcinoma differentiation. For detection of EBV, immunostainings were performed on tumour tissue and the peripheral non-tumour gastric mucosa. RESULTS: Positive immunostaining with an antibody against EBV was found in 19 (23.75%) of...
Open access Macedonian journal of medical sciences, Jan 20, 2018
HER2 protein expression in gastric carcinoma, in correlation with existing, acknowledged prognost... more HER2 protein expression in gastric carcinoma, in correlation with existing, acknowledged prognostic factors which include the parameters that determine the TNM stage of the disease, could become the basis for ongoing research in the field of molecular targeted and personalised therapy. To determine the expression of the HER2 protein in gastric carcinoma and to correlate the expression of a HER2 protein with clinicopathological characteristics of the disease. The data of HER2 protein expression and the parameters of the TNM classification were obtained from the histopathological reports of the Institute of Pathology in Skopje, and for the clinical stage we used patient's files from the University Clinic for Abdominal Surgery in Skopje. The analysis of the correlation of HER2 protein expression and TNM classification parameters pointed out a significant correlation between HER2 protein expression and intragastric localisation of gastric carcinoma (P = 0.005), and the tumour grade ...
PRILOZI, 2020
Metastasis of renal cell carcinoma (RCC) to the pancreas is a rare entity accounting only 0.25–3%... more Metastasis of renal cell carcinoma (RCC) to the pancreas is a rare entity accounting only 0.25–3% of all pancreatic tumors. We present a rare case of isolated three focal pancreatic metastases from RCC, occurring 15 years after the left nephrectomy. The majority of the pancreatic metastases are asymptomatic, as it was in case of our patient excluding the weight loss for the last three months. We demonstrate the importance of the medical history, radiological examinations, histological and immunohistochemical analysis in making a definitive diagnosis.
Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall... more Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal t...
Academic Medical Journal, 2022
Intraoperative lymphatic mapping and sentinel lymphadenectomy in patients with malignant melanoma... more Intraoperative lymphatic mapping and sentinel lymphadenectomy in patients with malignant melanoma of the extremities-results of our learning phase Noveski Lazo,
Prilozi - Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki, Nov 1, 2020
Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall... more Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal the risk benefit rationale for dunking either duct to mucosa anastomosis. Material and method: In our last series of 25 patients suffering pancreatic head carcinoma we performed a standard dodenopancreatectomy. After the preoperative diagnosis and staging with US, CICT, tumor markers, they underwent surgery. Invagination-dunking anastomosis was performed in 15, whereas, duct-to-mucosa, double layer anastomosis was performed in 10. In the first group with dunking anastomosis, we had 6 patients with soft pancreas and 8 with narrow main pancreatic duct, less than 3 mm. In the duct-to-mucosa group there were 5 patients with soft pancreas and 4 with narrow main pancreatic duct. All other stages of surgery were unified, so the only difference in the procedure remained on the pancreatojejunoanastomosis. The onset of the postoperative pancreatic fistula was estimated with revelation of 3 fold serum level of alfa amylases from the third postoperative day in the drain liquid. Results: In the duct to mucosa group there wasn't a clinically relevant postoperative pancreatic fistula, while in the dunking anastomosis group we had 4 postoperative pancreatic fistula B, 26 %. One of these 4 patients experienced intraabdominal collection-abscess, conservatively managed with lavation through the drain. Comparing the groups, there was no significant difference between the groups concerning the appearance of postoperative pancreatic fistula: p>0.05, p=0.125. From all 25 patients, in 21 patients biliary stent was installed preoperatively to resolve the preoperative jaundice. All 21 suffered preoperative and postoperative reflux cholangitis, extending the intra-hospital stay. Conclusion: So far, there have been many trials referring to opposite results while comparing these 2 techniques in creation of the pancreticojejunoanastomosis. In our study, the duct to mucosa anastomosis prevailed as a technique, proving its risk benefit rationale. However, further large randomized clinical
MACEDONIAN ASSOCIATION OF ANATOMISTS AND MORPHOLOGISTS, 2011
Целта на трудот беше да го утврди влијанието на раната перорална исхрана врз постоперативното вос... more Целта на трудот беше да го утврди влијанието на раната перорална исхрана врз постоперативното воспоставување на цревната функција и пероперативниот морбидитет кај пациентите оперирани од колоректален карцином. Материјал и методи: Во проспективната рандомизирана студија беа вклуче- ни 100 пациенти со колоректален карцином со стандардна предоперативна и оперативна процедура. Пациентите беа поделени на 2 групи: испитувана и контролна и секоја група вклучуваше по 50 паци- енти. Пациентите од испитуваната група започнаа со внес на течности во текот на првите 24 часа по- стоперативно и продолжија со регуларна диета во следните 24-48 часа во зависност од толерантноста кон истата. Пациентите од контролната група започнаа со внес на течности и храна по повлекување на постоперативниот илеус. Се следеше времето до воспоставување на цревната функција, должината на постоперативниот болнички престој, бројот и видот на пероперативните компликации и евенту- алните реадмисии во болница во првите 30...
Open Access Macedonian Journal of Medical Sciences, 2018
BACKGROUND: The understanding of the etiopathogenesis of gastric carcinoma (GC) can be a base for... more BACKGROUND: The understanding of the etiopathogenesis of gastric carcinoma (GC) can be a base for development of new therapeutic methods to reduce mortality and to increase survival in patients with GC. The percentage of Epstein - Barr virus (EBV) positive gastric carcinomas is uncertain, and the etiologic importance of EBV in the pathogenesis of GC has still not been elucidated. AIM: This study aimed to determine the percentage of EBV associated GC as well as to determine their clinicopathological characteristics. MATERIAL AND METHODS: The study included 80 patients with GC who were analysed for ethnicity, local growth of a tumour (T status), the presence of nodal metastases (N), the presence of distant metastases (M), stage of the disease and degree of carcinoma differentiation. For detection of EBV, immunostainings were performed on tumour tissue and the peripheral non-tumour gastric mucosa. RESULTS: Positive immunostaining with an antibody against EBV was found in 19 (23.75%) of...
Open access Macedonian journal of medical sciences, Jan 20, 2018
HER2 protein expression in gastric carcinoma, in correlation with existing, acknowledged prognost... more HER2 protein expression in gastric carcinoma, in correlation with existing, acknowledged prognostic factors which include the parameters that determine the TNM stage of the disease, could become the basis for ongoing research in the field of molecular targeted and personalised therapy. To determine the expression of the HER2 protein in gastric carcinoma and to correlate the expression of a HER2 protein with clinicopathological characteristics of the disease. The data of HER2 protein expression and the parameters of the TNM classification were obtained from the histopathological reports of the Institute of Pathology in Skopje, and for the clinical stage we used patient's files from the University Clinic for Abdominal Surgery in Skopje. The analysis of the correlation of HER2 protein expression and TNM classification parameters pointed out a significant correlation between HER2 protein expression and intragastric localisation of gastric carcinoma (P = 0.005), and the tumour grade ...
PRILOZI, 2020
Metastasis of renal cell carcinoma (RCC) to the pancreas is a rare entity accounting only 0.25–3%... more Metastasis of renal cell carcinoma (RCC) to the pancreas is a rare entity accounting only 0.25–3% of all pancreatic tumors. We present a rare case of isolated three focal pancreatic metastases from RCC, occurring 15 years after the left nephrectomy. The majority of the pancreatic metastases are asymptomatic, as it was in case of our patient excluding the weight loss for the last three months. We demonstrate the importance of the medical history, radiological examinations, histological and immunohistochemical analysis in making a definitive diagnosis.
Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall... more Introduction: Pancreatic cancer is malignancy with poor prognosis for quality of life and overall survival. The incidence is variant, 7.7/100,000 in Europe, 7.6/100,000 in the USA, 2.2/100.000 in Africa. The only real benefit for cure is surgery, duodenopancreatectomy. The key points for this procedure are radicality, low morbidity and low mortality, the follow up and the expected overall survival. The benchmark of the procedure is the pancreaticojejunoanastomosis, with its main pitfall, postoperative pancreatic fistula B or C. Subsequently, the manner of creation of pancreaticojejunoanastomosis defines the safety, thus the postoperative morbidity and mortality. Finally, this issue remarkably depends on the surgeon and the surgical technique creating the anastomosis. We used 2 techniques with interrupted sutures, dunking anastomosis and duct-to-mucosa double layer technique. The objective of the study was to compare these 2 suturing techniques we applied, and the aim was to reveal t...