Makedonski medicinski pregled. Revue medicale macedonienne最新文献

{"title":"Landmark Versus Ultrasound-Guided Subclavian Central Venous Catheterization with a Combined Short and Long Axis Approach in an Intensive Care Setting","authors":"Darko Sazdov, M. Srceva, Zorka Nikolova Todorova","doi":"10.1515/mmr-2017-0009","DOIUrl":"https://doi.org/10.1515/mmr-2017-0009","url":null,"abstract":"Abstract Introduction. Central venous catheterization of the subclavian vein can be achieved with a landmark and an ultrasound-guided method. Using ultrasound the vein can be catheterized with a long axis in plane or a short axis out of plane approach and a combined approach. The aim of the study was to compare the success, average number of attempts and mechanical complication rate between the landmark and the combined ultrasound-guided method. Methods. A total of 162 adult patients from the Intensive Care Unit at Clinical Hospital Acibadem-Sistina, Skopje were included in this prospective study. Patients randomized in the examined group (n=71) were catheterized with real-time ultrasound guidance with a combined short axis out of plane and long axis in plane method. Patients randomized in the control group (n=91) were catheterized with the landmark method. Subclavian vein was catheterized in both groups. Overall success, success on first attempt, number of attempts and complications at the moment of catheterization were the main outcome measures. Results. Catheterization using the landmark method was successful in 94.5% of patients, 65.9% of which during the first attempt. Cannulation using real-time ultrasound guidance was successful in all patients with a first pas success of 83.1%. The complication rate in the ultrasound group was 2.82% and 16.5% in the landmark group (p=0.004404). Conclusion. Real-time ultrasound guidance with a combined short axis out of plane and long axis in plane approach improves success, decreases number of attempts, and reduces mechanical complications rate.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"44 - 49"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036754","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}

{"title":"Symplastic Leiomyoma of the Uterus-Case Report","authors":"Snezana Georgieva, T. Nikolova, Natasha Nikolova","doi":"10.1515/mmr-2017-0013","DOIUrl":"https://doi.org/10.1515/mmr-2017-0013","url":null,"abstract":"Abstract We present a case of a twenty-four-year old, nulligravid woman with suspicionof molar pregnancy and admittedat the University Clinic of Obstetrics and Gynecology in Skopje. On bimanual examination uniformly enlarged uterus was detected. Ultrasonography revealed snow storm echo signal in the uterine cavity. Dilation and curettage were performed and only a slight quantity of material was obtained. Serum bHCG was negative. MRI revealed a finding of the tumorous formation on the anterior wall of the uterus deforming and dislocating the uterus without any additional information. Open surgery was planned and tumorectomy was performedinour hospital. Histopathology analysis of the obtained material revealed symplastic myoma of the uterus. The patient got spontaneously pregnant later, but the pregnancy finished as a spontaneous missed abortion and instrumental revision was performed. Five months later the patient got pregnant again. She had regular pregnancy course and delivery at 37.5 gestational week.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"72 - 74"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036796","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}

{"title":"Rheumatoid Factor as a Potentiator of Anti-Citrullinated Protein Antibody-Mediated Inflammation in Early Undifferentiated Seronegative Osteoarthropathy","authors":"D. Spasovski, S. Genadieva-Stavric, T. Sotirova, J. Brezovska-Kavrakova","doi":"10.1515/mmr-2017-0002","DOIUrl":"https://doi.org/10.1515/mmr-2017-0002","url":null,"abstract":"Abstract Introduction. To compare the values and accuracy of the test in anticyclic citrullinated peptides antibodies, rheumatoid factor (RF), C-reactive protein (CRP) and disease activity index in early diagnosis of untreated psoriatic arthritis (PsA). Methods. Using the ELISA method of DIA-STATTM Anti CCP (Axis-Shield Diagnostics), sera of 70 participants were examined (35 untreated patients with PsA and 35 subjects from the healthy control group). RF and CRP were determined with the agglutination test (latex test). At the same time the sensitivity, specificity, predictive value for positive and negative testsand accuracy were determined. Results. Of 35 patientswith PsA, 1 patient showed presence of anti-CCP antibodies (sensitivity test 2.86%), while RF was foundin 0 patients(sensitivity test 0%). In the healthy control group positivevalues for RF, CRP and erythrocyte sedimentation rate were detected in 1 patient. Conclusion. ACPA antibodies have low sensitivity, but high specificity in PsA.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"5 - 9"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036656","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}

{"title":"Mutation Analysis of the Common Deafness Genes in Patients with Nonsyndromic Hearing Loss in Republic of Macedonia","authors":"E. S. Stefanovska, G. Bozhinovski, A. Momirovska, M. Cakar, E. Sukarova-Angelovska, D. Plaseska‐Karanfilska","doi":"10.1515/mmr-2017-0005","DOIUrl":"https://doi.org/10.1515/mmr-2017-0005","url":null,"abstract":"Abstract Hearing impairment is the most common sensory disorder, which occurs in 1 of 1000 newborns. It is caused by heterogeneous conditions with more than a half due to genetic etiology. Although hundreds of genes are implicated in hearing process and have been found to be associated with nonsyndromic hearing loss, pathogenic variants in GJB2 gene have been considered as the main cause of deafness among nonsyndromic hearing loss (NSHL) population worldwide. Pathogenic variants in MT-RNR1 or mtDNA12SrRNA gene were also implicated predominantly in postlingual progresive deafness. The aim of this study was to analyze the implication of GJB2 and MT-RNR1 genes in the molecular etiology of deafness among 130 NSHL patients in the Republic of Macedonia. The presence of the del (GJB6-D13S1830) was also analysed. We performed SSCP and/or sequence analysis of GJB2 and identified sequence variants in 62 out of 130 patients (47.7%); (51 homozygous or compound heterozygous and 11 with only one variant allele). We found 8 different allelic variants, the most prevalent being c.35delG (65.49%), and p.W24*(23.01%), followed by other less frequent alleles (p.V27I, p.V37I, p. P175T and cd. delE120 or delGAG at 360). In addition, two polymorphic substitutions in the GJB2 gene with no clinical significance (p.V153I and p.R127H) were detected. No del(GJB6-D13S1830) was found. SNaPshot analysis was used to screen for the five most frequent allelic variants in the MT-RNR1 gene. Two MT-RNR1 mutations (A827G and T961G) were detected in three patients where only one GJB2 pathogenic variant was found. A new MT-RNR1 gene variant G1303A was also detected. In conclusion, MT-RNR1 mutations were not a significant contributor to the etiology of deafness in Macedonia, although could be considered as a modifier gene affecting the expression of deafness in patients carrying one GJB2 variant. On the other hand, the high percenttage of GJB2 pathogenic variants identified among NSHL cases indicates the necessity of molecular newborn screening for the two most common GJB2 variants (c.35delG and p.W24*) in the Republic of Macedonia.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"20 - 26"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036700","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}

{"title":"Crossover Alternatives of Default Right Radial Artery Access for Acute Myocardial Infarction Intervention","authors":"O. Kalpak, H. Pejkov, G. Kalpak, Marija Jovanoska, B. Zafirovska, S. Kedev","doi":"10.1515/mmr-2017-0008","DOIUrl":"https://doi.org/10.1515/mmr-2017-0008","url":null,"abstract":"Abstract Introduction. Being a default transradial access center we have encountered the need for alternative to the right radial artery. Determining the most frequent alternative access strategy for PCI in STEMI patientswasthe focus of our study. We sought to analyze whether the wrist access strategy impacts procedure time and success rate particularly for the STEMI interventions where time is of paramount importance. Methods. During four years, in our Center 2624 consecutive all-comers STEMI patients underwent urgent coronary intervention. TRA was used as the first-choice access strategy. We sought to assess crossover rate and safety of preferable access strategy. Crossover occurred according to the operator's decision. Primary outcomes were: access site crossover rate and In Lab time, secondary outcomes were PCI time, X-ray time, mortality and MACE at 30 days and at 6 months. Results. Overall crossover rate from default radial was 5.4% (144 out of 2624 patients). We treated 98.7% (2589) patients by wrist access and only 1.3% (35) patients with TFA. Crossover towards left radial occurred in 47.9% (69 out of 144 patients), towards ulnar 27.8% (40 patients) and towards TFA only 24.3% (35 patients). The meanIn-Lab time 40.4±17.7 minutes, PCI time was 21.4±7.4 min, X-ray time 9.2±4.7 minutes. Survival outcomes at 30 days were: MACE rate of 6.6% (174 patients), mortality rate of 5.0% (131 patients). At six months MACE rate was 8.6% and mortality rate was 5.6%. Conclusions. Default radial access is associated with alow crossover rate. Crossover towards femoral occurred less frequent than ulnar artery access.Complete wrist access strategy is safe and feasible for STEMI interventions with low mortality and MACE rate in unselected all-comers cohort.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"38 - 43"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036748","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}

{"title":"Detection of Placental Chromosomal Aberrations in Early Spontaneous Abortionsin Correlation with the Histologic Findings","authors":"Katerina Kubelka-Sabit, G. Bozinovski, Jasar Dzengis, V. Filipovski, S. Lazarevski, M. Ivanovski, D. Plaseska‐Karanfilska","doi":"10.1515/mmr-2017-0012","DOIUrl":"https://doi.org/10.1515/mmr-2017-0012","url":null,"abstract":"Abstract Using a variety of molecular techniques, it has been established that loss of pregnancy occurs in one to two thirds of all fertilized embryos in the first trimester. In about 50% of the cases, chromosomal abnormalities are the cause of early spontaneous abortion. Several histological characteristics of the placenta, such as presence of villous stromal cavitations, fetal erythrocytes, umbilical cord, fetal tissue, etc. are suggested as predictive factors for aneuploidy. Two hundred and thirty one cases were analyzed in this prospective study, 50 cases were control artificial abortions and 181 cases were early spontaneous abortionsanalyzed in the period from May 2012 to December 2014. Standard histopathological analysis and molecular techniques based on polymerase chain reaction were used to analyze the samples. Usingmolecular techniques, aneuploidy was detected in 53.1% of the samples. The most frequently detected aneuploidy was trisomy 16, followed by trisomy 22, 21, 14 and 18. The molecular analysis also enabled distinction of maternal and paternal origin of the alleles. In the histopathological sample analysis, binary logistic regression analysis indicated the presence of trophoblastic proliferation (p=0.008) and the absence of fetal red blood cells (p=0.001) as independent significant factors in the prediction of aneuploidy in early spontaneous abortion. In conclusion, our results show that clinically relevant and accurate diagnosis of early spontaneous abortion which can determine its causecan only be achieved bya controlled process of selection of the material, histo-pathological and molecular analysis, followed bya necessary correlation of these results.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"64 - 71"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036792","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}

{"title":"Treatment of Severe Autoimmune Diseases with Autologous Hematopoietic Stem Cell Transplantation","authors":"Z. Stojanoski, A. Karadzova-Stojanoska, Aleksandra Pivkova-Veljanovska, S. Genadieva-Stavrik, L. Cadievski, M. Ivanovski, O. Karanfilski, L. Cevreska, B. Georgievski","doi":"10.1515/mmr-2017-0003","DOIUrl":"https://doi.org/10.1515/mmr-2017-0003","url":null,"abstract":"Abstract Introduction. Autoimmune diseases are a family of more than 100 heterogeneous conditions that affect 5 to 8% of the world’s population. The etiology is still un-known but the disregulation of the regulatory T-lymphocytes play a central role inthe autoimmunity and the success of the long-term remission. Although conventional immunosuppression and new biological agents can provide disease control in severely affected patients, such treatments are rarely curative and alternative strategies are needed. Indeed, severe forms of systemic autoimmune diseases, such as multiple sclerosis (MS), systemic sclerosis (SSc), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), juvenile idiopathic arthritis (JIA), hematologic immune cytopenia (HIC) and Crohn’s disease are difficult to be treated. High-dose immunosuppressive therapy followed by autologous stem cells transplantation is reliable option for a successive treatment of this group of patients. Aim. To determine the safety of the procedure of autologous stem cell transplantation in patients with autoimmune diseases and concomitant malignant hematological disorders. Methods. During a period of 15 years (from September 2000 to September 2015) at the University Clinic of Hematology in Skopje we have treated 6 patients with autoimmune disease and concomitant hematological neoplasm. None of the patients was treated for primary autoimmune diseases. Two men and 4 women, with median age of 47 years were treated. Sjogren syndrome and multiple myeloma were found in 2 patients, polyartheritis nodosa and multiple myeloma in 1 patient, rheumatoid arthritis and acute myeloblastic leukemia in 1, systemic lupus erythematosus and non-Hodgkin lymphoma in 1; severe psoriasis and acute myeloblastic leukemia in 1 patient. Results. All treated patients are alive after trans-planted procedure, with transplant related mortality day +100: 0. Conclusion. Autologous stem cell transplantation is safe and recommended option for treatment ofpatients with autoimmune disease and hematologic neoplasm.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"10 - 14"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036687","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}

{"title":"Methods for Vascular Control in Liver Resections Due to Colorectal Metastases - Impact on Residual Parenchyma","authors":"S. Petrovski, E. Arabadzhieva, S. Bonev, D. Bulanov, V. Popov, V. Dimitrova","doi":"10.1515/mmr-2016-0013","DOIUrl":"https://doi.org/10.1515/mmr-2016-0013","url":null,"abstract":"Abstract Introduction. Massive blood loss while performing resections of the liver continues to be a serious problem with potentially lethal outcome. Therefore in the last 2-3 decades there has been a significant developement of techniques for vascular control during liver resections. Methods. In the period from 01.01.2006 to 31.12.2015 in KOCPH UMBAL \"Aleksnadrovska\" a total of 239 patients with colorectal liver metastases underwent surgery of whom: 179 patients were radicaly operated on and 57 patients were subjected to Pringle maneuver. Using the statistical software SPSS-19 we analyzed various factors that may affect the early postoperative results. Results. In resections of colorectal liver metastases there was a significant difference in the postoperative functional parameters (AST, ALT), which correlated with the degree of liver damage, in patients with Pringle and without Pringle maneuver 265.32 vs. 448 (p=0.001), and 300.53 vs. 481.91 (p=0.002),-respectively. There was no significant difference in the postoperative results in comparisson of resections <15 minutes, performed without Pringle and with Pringle maneuver. The blood loss is another factor that affects the postoperative complications (p = 0.048), and it was lowest in the Pringle group <15 min. Conclusion. Pringle maneuver is a simple and effecttive method for vascular control. As a result of its use we can observe the damage of the residual liver volume from the continuous ischemia to the reperfusion period. Thus, in liver resections, due to colorectal metastasis, vascular control strategy should be individual and corresponding to the extent of the procedure and associated diseases of the liver-fatty liver, cirrhosis, chronic hepatitis and others.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"63 - 67"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036178","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}

{"title":"Insulin Resistance in Patients with Chronic Hepatitis C","authors":"B. Todorovska, V. Caloska-Ivanova, Magdalena Dimitrova-Genadieva, E. Curakova, N. Joksimović","doi":"10.1515/mmr-2016-0018","DOIUrl":"https://doi.org/10.1515/mmr-2016-0018","url":null,"abstract":"Abstract Introduction. Insulin resistance is the most common extrahepatic manifestation associated with hepatitis C virus, which leads to developing more pronounced fibrosis and liver steatosis. The aim of the study was to assess the prevalence of insulin resistance in non-diabetic, treatment naive patients with chronic hepatitis C and to analyze the relation of insulin resistance with genotype, viral load, gender, age, laboratory parameters, inflammatory and fibrotic changes in the liver, body mass index (BMI) and the presence of steatosis. Methods. In this cross sectional study, 224 patients with hepatitis C viral infection were included. The patients were divided into two groups. The first group was with no insulin resistance and the second one with present insulin resistance. They were compared in terms of genotype, viral load, gender, age, inflammatory and fibrotic changes in the liver, BMI and liver steatosis. Results. Insulin resistance was present in 45.5% of patients. The following factors were associated with insulin resistance: age (p=0.0022), inflammatory and fibrotic changes in the liver (p=0.001, p=0.006, respectively), steatosis (p=0.015) and transaminase activities (for AST, p=0,002, for ALT, p=0.001). Conclusion. In the Republic of Macedonia, a high percent of 45.5% among non-diabetic and treatment naïve patients with chronic viral hepatitis C, had insulin resistance. Insulin resistance was more prevalent in older patients, in those with more pronounced inflammatory and fibrotic changes in the liver, in patients with steatosis and in those with higher transaminase activity.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"42 1","pages":"93 - 98"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036263","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}

{"title":"Carpenter Syndrome – Case Report and Treatment","authors":"Vladimir Mirchevski, E. Zogovska, A. Chaparoski, V. Filipče, L. Agai, Blagoj Shuntov, Mirko Michel Mirchevski, M. Srceva","doi":"10.1515/mmr-2016-0019","DOIUrl":"https://doi.org/10.1515/mmr-2016-0019","url":null,"abstract":"Abstract Introduction. Carpenter syndrome is a polymorphic disorder transmitted by autosomal recessive inheritance, caused by mutations in the RAB23 gene [1]. These genetic disorders are reflected on the biogenesis of intracranial structures. This syndrome was described for the first time in 1900 by the British doctor George Carpenter. It may include congenital heart diseases, mental retardation, hypogonadism, obesity, umbilical hernia, developmental disorder, bone anomalies and frequent respiratory infections. Carpenter syndrome has two main features: craniosynostosis and more than five fingers or toes [2-4]. Aim. To present our experience in treatment of an infant with Carpenter syndrome including trigonocephaly and polydactyly. Case report. In May 2003, an eleven-month-old male infant with Carpenter syndrome was hospitalized in the Pediatric Department of the University Clinic of Neurosurgery in Skopje, Republic of Macedonia. The infant was referred to our Department from the University Pediatric Clinic because of trigonocephaly and polydactyly with two thumbs on his right hand. The infant had already been twice hospitalized at the University Pediatric Clinic for two recurrent lung infections suggestive of Carpenter syndrome. The diagnosis of trigonocephaly and polydactyly with two thumbs on the right hand was made by physical examination, X-ray of the right infant’s hand and computed tomography of the head. According to Oi and Matsumoto classification from 1986 [5], the infant had a severe form of trigonocephaly. Surgical procedure. Under general endotracheal anesthesia, the infant was placed supine on the operating table, a bifrontal skin incision was made and the scalp flap was created. The bifrontal craniotomy was realized into one bony piece succeeded by a modified Di Rocco’s \"shell\" procedure including frontal translation and transposition rotating the flap for 180 degrees without /touching the orbital rims. Results. The postoperative period was uneventful except for the expected forehead swelling. The infant was discharged from the hospital on the 7th postoperative day, neurologically intact. Three months after surgery, the head had excellent esthetic appearance, with regular psychomotor development in line with the age of the patient. Six months after the first surgery the patient underwent a second plastic and reconstructive surgery in order to reduce the number of fingers. Conclusion. The early recognition and multidisciplinary approach could prevent new disabled individuals in the society. Our technique shortens the entire surgical procedure, diminishes the time under anesthesia and its complications, especially in departments where blood saving devices are not available.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"35 1","pages":"103 - 99"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036268","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}