BACKGROUND AND AIMS During lung surgery, preoperative fluids are given in restrict manner. This is in correspondence with the fact that lungs produce polyphasic injury during surgery and increased levels of different inflammation, traumatic and stress markers, on one side and a lack of fluids that complicate the transfer of water and kidney function on the other side [1]. One lung ventilation additionally complicate ventilation/perfusion ratio in the lungs, has overall impact on the whole body and to novel knowledge it indirectly leads to kidneys hypoperfusion and injurie [2]. The aim of our study is to evaluate the level of postoperative acute kidney injurie (AKI) occurrence in patients who underwent OLV. METHOD In prospective study, 60 patients that underwent lung resection in OLV, BMI<30 m2 without hepatic or renal endocrine diseases, aged 45–65 at the University Clinic for thoracic surgery in Skopje were included. Patients who underwent prior haemotherapy or radiotherapy were exuded. In all patients, we evaluate the demographic, clinical, preoperative state, duration of OLV, operation data and fluid assessment. Primary, we evaluate the occurrence and staging of AKI according to KDGIO criteria [3, 4]. A total of 72 h postoperatively in all patients and post hoc, we corelate its occurrence to several factors. RESULTS On average, patients were 59.7 +5.9 SD years old. More males were operated (80%). Overall, AKI stage 1 occurred in total of 13.3% (8 patients), AKI stage 22 in 3.3% (2 patients) and AKI stage 3 in 1.6% (1 patient). OLV longer than 60 min was in 85% of the patients, and all stages AKI were after this time duration. Lobectomy was done in 65% of the patients, while pulmectomy in 18.3% and bilobectomy in 16.7%. In relation to type of surgery done most of the patients that had pneumectomy had AKI 1 (27.2%), and additionally, only in this analysed surgery group, AKI 3 occurred in 9%. In correspondence to the side operated, right side was operated in 57.7% of the patients, and most of the AKI occurred in the right-sided surgery. Most of the patients who developed AKI preoperatively had hypertension and other cardiovascular issues. CONCLUSION AKI occurs significantly after OLV, in relation to the type of surgery. Mainly when right-side surgery is done. However, more severe AKI occurs when pulmectomy is done. Fluid regiment, OLV longer than 60 min and some preoperative cardiovascular diseases may contribute to its occurrence.

Introduction: Spontaneous pneumothorax (SPT) is surgically treated with two different techniques: Video Assisted Thoracoscopy (VATS) or open thoracotomy (OT). Despite the different invasiveness of the techniques, literature gives controversial results in correlation of the techniques to the clinical outcomes (like length of hospital stay (LOHS), recurrences of the pneumothorax, duration, collection of the drains and etc). of our study was to analyze perioperativ The aim e clinical features in patients that underwent SPT treatment surgically. Materials and methods: prospectively, we evaluated data of patients treated for SPT in two-year period at the University clinic for thoracic surgery in Skopje. Patients were divided into VATS group and OT group, according to the surgical technique used for treatment. In both groups we analyzed demographical, laboratory data, duration of the chest drains presence, early inammatory markers and total LOHS. Patients with recurrent pneumothorax, older than 70 years with severe cardiological impairment were excluded. Results: The study included 42 patients, 23 patients (54.8%) underwent VATS treatment and 19 patients (45.2%) underwent OT. In both groups more patients were male. VATS group of patients showed nonsignicant difference in postoperative laboratory and inammatory ndings, nonsignicantly lower presence of the drains in terms of days, signicantly lower drain uid collections for the rst 3 days and signicantly shorter LOHS compared to the OT group. Conclusion: Our study has showed that patients treated for spontaneous pneumothorax with VATS have shorter length of hospital stay, shorter chest drain presence and overall show better outcome.

BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase. AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis. METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively. RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%). CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.

Esophageal cancer is one of the least studied cancers and has high mortality rates, mainly because it is diagnosed at rather late stage. It requires urgent attention and in patients where surgery is feasible, it is immediately performed. There is a considerable variation in terms of the surgical approach in different countries, but open esophagectomy is a treatment of choice.This study describes a case of esophageal squamous cell carcinoma that was successfully treated with open esophagectomy and therefore provides information about the present state of esophageal cancer surgery at the University Clinic in Skopje, North Macedonia. The patient underwent clinical examination after which she was admitted to our department for surgical treatment. Esophagography and CT imaging were done pre-and postoperatively and no complications were noted after surgery. The patient was discharged and a written informed consent was obtained for publication of this case and any accompanying images.