Table of content

Mustansiriya Medical Journal

مجلة المستنصرية الطبية

ISSN: 20701128 22274081
Publisher: Al-Mustansyriah University
Faculty: Medicine
Language: English

This journal is Open Access

About

Mustansiriya Medical Journal MMJ, a semi-annual peer-reviewed journal, is the official Journal of the College of Medicine, Al-Mustansiriya University. The journal was first published during the academic year 2001 - 2002 as the "Journal of Basic Medical Sciences" . Later on, an in order to expand the scope of publication and attract more scientific articles, the editorial board decided in late 2007 to switch the name from “ The Journal of Basic Medical Sciences” to “Mustansiriya Medical Journal”, the official Journal of the Faculty of Medicine at the University of Mustansiriya. The first issue with this new name was published in May 2008.

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Contact info

Iraq, Baghdad, College of Medicine, Al-Mustansiriya University, P.o.Box: 14132
Tel: 5413485
Fax: 5410584
email: mmj.mcom@yahoo.com

Table of content: 2010 volume:9 issue:1

Article
Post - Renal Transplant Tuberculosis

Authors: Nidham A. Jaleel
Pages: 1-5
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Abstract

Background Tuberculosis is increasing in Iraq population since 1980s. Studies from the surrounding countries showed that renal transplant recipients are more liable for TB infection. Aim To study the clinical presentation and outcome post renal transplant tuberculosis. Patient and Methods: 412 recipients are enrolled from May 2001 till November 2008. Age, gender, weight, waiting list duration, period between TB infection and transplant, history rejection. Investigation as blood urea, s.creatinine, hemoglobin, ESR, blood sugar, are recorded at time of TB diagnosis and at end of TB treatment. Diagnosis of TB depends on clinical finding supported by bacteriological, radiological, and/or hispothological. Results there are 18 (4.37%) PTTB cases (12 pulmonary, six extrapulmonary) are recorded. None of them has a history of TB, nor a radiological finding suggestive of TB at time of transplant. All these cases are HIV –ve. Most cases have been diagnosed within the first year of transplantation. Fever is present in 17/18 patients, mostly low grade fever. Diabetes 3/18 cases and history of acute rejection is 6/18 patients. Mortality was 5/18 (27.77%). Acute rejection and diabetics are strong associations. Renal impairment at time of TB diagnosis significantly associated with high mortality. Conclusion PTTB is high, and pulmonary TB is also the most common type here. When it is compared with immun‐competent TB cases, there is an increase in percentage of extra‐pulmonary TB.

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Article
Risk Factors for Childhood Poisoning : A Case – Control Study in Baghdad

Authors: Rabab H.Baaker
Pages: 6-12
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Background Acute poisoning is an important cause of morbidity and mortality in children all over the world. Objective:to find out the types of acute accidental poisoning (AAP) in children in Baghdad and various host and environmental factors responsible. Methods One hundred and seventy poisoning cases and hundred controls were enrolled in a case control study done in central teaching hospital for the period from 1st of Jan. 1998 to 30th of April 1998. Results Kerosene poisoning was the commonest type (56.4%) followed by drugs (23.5%) then organophosphorus insecticides (11.8%), household products (3.5%). The highest frequency was noticed at 8.00 am-12.00 noon followed by 12.00 noon – 4.00 pm. It has been found that there is no significant relationship between poisoning and sex of child, mother educational level but the followings found to be significant risk factors: age of 1-3 years followed by 3-5 years, urban residence, peak time of poisoning was during mid-morning hours and early afternoon, also order of the child (5th) besides family size (family of 4-7 members), mother's age of above 35 years, not working mother (housewife). Also it showed a relation with recurrence of poisoning in the same child (7.1%) or other sibling in the same family (16.5), being at home (86, 5%) and use inappropriate method of storing and placing poisonous materials. Conclusions and Recommendations Significant risk factors regarding younger age, larger family size, early day time occurrence and recurrence of accidents in the same family, in addition to improper storage places necessitate the need for earlier poison prevention education programs as an integral part of well child visits even before child is mobile.

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Article
Chances of Misdiagnosis between Acute Appendicitis & Ureteric Colic

Authors: Hamdan A. Abbas
Pages: 13-16
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Background The symptoms of acute appendicitis (A.A.) mimic sometimes the symptoms of ureteric colic (U.C.) due to stone leading to mistake in the diagnosis and delay in the management hence increased mortality and morbidity. Aim To compare the features of differential diagnosis between the two groups and to see how frequent cases of U.C managed and treated as A.A. Method Prospective study of 100 patients who are proved A.A and 100 patients proved U.C were taken to compare the features of differential diagnosis while 50 patients of histologically proved negative appendicectomies were followed up for ureteric stone. Result No urinary stones in the 50 cases of negative appendicectopmies have been found when followed up. A.A cause more often fever, localized pain in the right iliac fossa, nausea with or without vomiting, C - reactive protein (C.R.P) and white blood cell (W.B.C) count elevation more than U.C while general urine examination (G.U.E.) revealed more red blood cells (R.B.C) and pus cells in cases of U.C as compare with A.A. Conclusion Misdiagnosis between A.A and U.C is a rare clinical event in our hospital. U.C causes pain and tenderness in the flanks and revealed more R.B.C in the urine while A.A causes more fever, leucocytosis and elevated C.R.P.


Article
The Pattern and Optimal Surgical Treatment of High – Velocity Penetrating Duodenal Injuries

Authors: Haqqi I .Razzouki
Pages: 17-20
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Background The increased incidence of high velocity missile (H.V.M.)abdominal injuries in Iraq had been associated with an increase in the incidence of duodenal injuries. Setting Second and fourth surgical units at Al-Yarmouk Teaching Hospital. Objective To study the pattern of duodenal injuries, evaluate the proper surgical methods of duodenal injury management, to minimize the morbidity & mortality rates. Patients &methods Prospective study of forty two duodenal injury patients in 6 years period between Jan. 2003 – Dec. 2008 managed surgically. For Grade 2 duodenal injury we did primary repair with tube drainage, for grade 3; primary repair with tube duodenostomy or primary repair with triple ostomies, or primary repair with Pyloric exclusion and gastro-jejunostomy. Results Four hundred six laparatomy for (H.V.M.)abdominal injury, of these 42 cases (10.3%)associated with duodenal injury. 80% 35 male & 20% 7 female aged between (10-50)years with mean age of 32. There were no isolated duodenal injury, 43.8% had haemorragic shock on admission to the emergency room, 14 cases 33.3% died perioperatively, 4 cases 9.5% died postoperatively due to complications, no death in patients after leaving hospital. Conclusions Second part of the duodenum is the most common site of injury. Grade 3 duodenal injury has high morbidity & mortality rate. Time interval between the injury & operation is more important to decrease morbidity & mortality rate.

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Article
Pattern of Benign Female Breast Disease in Al-Yarmouk Teaching Hospital

Authors: Najeeb S Jabbo
Pages: 21-24
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Background Benign breast disease is the most common cause of breast problems. Its diagnosis is important to differentiate it from malignant one as they differ in treatment and prognosis. Objective To study the prevalence of different types, their relation to age, presentation and investigations used in diagnosis will be studied. Methods This is a retrospective study that had enrolled 114 female patients who were treated surgically at Al-Yarmouk Teaching Hospital for benign breast diseases, during the period from 1st Jan. 2006-30th April 2007. Data includes age, presenting symptoms, investigations and final diagnosis. Results The median age was 35.39 years (range 15-55y). Forty (35%) patients were in the 4th decade of life. Breast lump was the main presenting symptom in 95(83.4%) patients. Investigations carried out included; ultrasound for 65 (57%) patients. Sixty two (54.4%) patients had the investigation of FNAC with a sensitivity and specificity of 85% and 95.1% respectively. Mammography was done in 20 cases which gave the sensitivity of 81.8% and specificity of 88.8%. Fibroadenoma was the most common benign pathology and affected 70(61.4%) patients. Conclusion Most patients with benign breast diseases were in the 4th decade. Fine needle aspiration cytology had the highest sensitivity and specificity when taken alone. Fibroadenoma was the commonest pathology. Patients with benign breast diseases should have excisional biopsy or followed by according to the clinical impression of the examiner to exclude malignancy.

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Article
Some Parameters of Inflammation & Oxidative Stress in Relation to the Risk of Type 2 Diabetes Mellitus

Authors: Abdul Kareem H. Issa
Pages: 25-30
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Background Many clinical trials have indicated that lifestyle modification can delay or prevent the progression to type 2 diabetes in people with impaired glucose tolerance test (IGT). Detection of IGT requires a test which is inconvenient to screen for this condition in clinical practice or in the general population. Therefore, there is a need to search for additional significant risk factors for type 2 diabetes. Patients &methods Seventy two adults ≥ 40 years old (36 males and 36 females) were evaluated in this study. They were subjects who performed a brief 75-grams oral glucose tolerance test and were classified as having normal glucose tolerance (NGT group; 24 subjects), impaired glucose tolerance (IGT group; 24 subjects), or diabetes mellitus (DM group; 24 patients).In addition to hematocrit (PCV) and erythrocyte sedimentation rate (ESR), serum level of highly sensitive C-reactive protein (hsCRP) was measured. Also the serum levels of thiobarbituric acid-reactive substances (TBARS), iron, copper and ferric reducing ability of plasma (FRAP) were estimated in addition to erythrocyte glutathione (Ery-GSH) level. Results Both IGT group and DM group have a significantly high hsCRP mean level (2.59 ± 1.03 and 2.89 ± 0.90 respectively vs. 1.57 ± 1.40 mg /L in NGT group, P< 0.001), and a significantly decreased FRAP level (939.2 ± 157.4 and 961.5 ± 125.1 respectively vs. 1063 ± 104.5 µmole/L in NGT group, p< 0.01 ) as well as a significantly high TBARS and a significantly low Ery-GSH level in comparison with NGT group. The positive correlation between hsCRP and TBARS, although was statistically not significant, showed a step-wise increment from NGT, to IGT and to DM group (r = 0.01, 0.14 and 0.23 respectively). Conclusions IGT is associated with a state of low-grade inflammation and oxidative stress. Serum levels of hsCRP as a marker of inflammation and TBARS as a marker of oxidative stress may serve for identifying people at high risk for developing type 2 diabetes. Such people will be important targets for programs that are designed to prevent diabetes.


Article
Helicobacter Pylori Infection in Diabetic Patients

Authors: Sabeha M. Al-Bayati
Pages: 31-34
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Background H Pylori infection could be regarded as the commonest infection worldwide, it had been suggested that H pylori infection is more frequent among diabetics. Objective This study had been designed to define any significant association between diabetes and H pylori infection, to evaluate different demographic features of patients with diabetes mellitus who have H pylori infection, assess any relation between H pylori infection and the metabolic control of diabetes mellitus and to estimate the frequency of different oesophagogastroduodenoscopy findings among diabetic population with H pylori infection. Methods This study enrolled 50 patients with diabetes mellitus and another 50 non-diabetic patients (as a control group). The patients attended Gastrointestinal unit at Al-Yarmouk Teaching Hospital Baghdad/Iraq during the period between the 1st of March2004, to the 31st of November 2004. Full history was taken and clinical examination, investigation to assess the glycemic control and esophagogastroduodenoscopy (OGD)had been done to all of them. H pylori status had been detected by positive Rapid Urease test and histopathology and/or ELIZA test for anti-H pylori IgG. Results This study revealed that 26diabetic patients (52%) were H pylori positive, while 14 non-diabetic patients (28%) were H pylori positive which is statistically significant (X2=6.0,P=0.01). patients aging 60 year old or more (24 patients, 48% of the sample) 18 of them had positive H pylori status, 20 patients out of the 26patients with positive H pylori status (76.9%) had poor glycemic control, 84.6% of those with positive H pylori status (22 out of 26 patients) had glycated hemoglobin level of 8% and greater, 61.8% of those with positive H pylori status (16 patients) were diabetic for more than 10 years. 61.5% of those with positive H pylori status had one or more of the chronic diabetic complications, 12 patients had OGD finding consistent with duodenitis, all of them were H pylori positive, OGD examination revealed 20 cases without active disease, 18 of them had negative H pylori status. Conclusions This study indicates that Helicobacter pylori infection is more common in diabetic patients. Frequency of H pylori infection is higher among elderly diabetics, those with long standing, poorly controlled and with diabetic complications.


Article
The Effect of Smoking on Some Microvascular Complications in Type 2 Diabetics

Authors: Huda Abdul‐Ridha
Pages: 35-39
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Background Smoking is associated with increased risk and enhances progression of chronic diabetes related complications like nephropathy and retinopathy. Objective This study was designed to assess the effect of smoking on the development of some chronic diabetes related complications namely nephropathy and retinopathy. Methods This is a cross sectional study that enrolled 100 patients with diabetes mellitus, 50 patients were smokers and the other 50 patients were non-smokers. The patients had been randomly selected from those who had attended the National Diabetes Center-Baghdad/Iraq during the period between the 1st of January 2004, to the 1st of June 2004. All of the patients have been asked for their history of smoking by a questionnaire form and they had been examined and investigated to assess their glycaemic control and diagnosing any chronic diabetic complication that might be present. Statistical analysis had been done using Chi square test and P<0.05 is considered significant. Results This study revealed male to female ratio of 6:1, 66% of patients were 40-59 year-old, 70% had diabetes for less than 15 years, 92% had smoked for 10 years or longer time, 60% smoked more than 1 pack (20 cigarettes) per day, the male :female ratio ,age range of patients and duration of diabetes in the non-smoker group were almost identical to smoker diabetics .84% of smoker diabetics had HbA1c level of 7.0% or more, while 64% of non-smoker diabetics had HbA1c >=7.0%. 88% of non-smoker diabetics had abnormal BMI (being overweight, obese, and morbidly obese) compared to only 62% of smoker diabetics with abnormal BMI . 50% of smoker diabetics had positive Micral test for micro albuminuria, while only 28% of non-smoker diabetics had positive Micral test. 60% and 34% of smoker and non-smoker diabetics respectively had evidence of retinopathy in its different stages. Statistical analysis revealed significant association between being smoker diabetic and poorer glycaemic control (P<0.05), occurrence of microalbuminurea (P<0.05) and development of diabetic retinopathy (P<0.05). Conclusions This study indicated that smoking significantly enhances the development of chronic diabetes related complications namely nephropathy and retinopathy. In order to reach strict or near strict glycaemic control which is the corner stone in primary as well as secondary prevention of chronic diabetes related complications, smoking cessation must be encouraged to get better and longer life for diabetics.

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Article
Level of Interleukin–8 in the Sera of Asthmatic Patients in Baghdad

Authors: Hind J. Hassoon
Pages: 40-42
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Asthma is a common, chronic inflammatory, anaphylactic hypersensitivity disease .It is a world-wide distributed with a range extends from mild to severe fatal episodes. Fifty eight asthmatic patients sera have been collected from Al-Zahra'a consultant for asthma and allergy , during the period between July / 2008 – September / 2008 and thirty two sample of healthy peoples as a control group .The patients age ranged from ( 12-45 ) years .Enzyme linked immunosorbent assay ( ELISA) has been applied estimation of interleukin – 8(IL-8). The results showed that highly significant differences (P < 0.0001) between asthmatic patients – positive IL–8 and asthmatic patients – negative IL-8. There are no significant differences between residency (urban and rural regions) and levels of IL-8. There is a good relation between body mass index (BMI) and asthmatic patients (P < 0.005), but no relation between body mass index and levels of IL-8.


Article
Neuroimaging in Mentally Retarded Iraqi Children

Authors: Muna A.Gh. Z
Pages: 43-46
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Background Mental retardation is a common clinical problem in pediatrics, it present during infancy or preschool years as developmental delay. Objectives To determine the diagnostic yield of neuroimaging in children with mental retardation of unknown origin. Methods Neuroimaging (Computerized Tomography CT scan) was performed in a total of 59 patients with developmental delay/mental retardation, in AL-Yarmuk Teaching hospital in Baghdad from September 2006 to June 2008 where no etiological diagnosis could be made following clinical examination and preliminary investigations. Results Forty one (69%) had abnormal neuroimaging findings of which 13 (22%) were specific abnormalities useful in arriving at etiological diagnosis. Positive outcome of neuroimaging increased with the severity of mental retardation, presence of microcephaly and other neurologic deficits other than MR. Conclusions Neuroimaging (CT scan) should be the standard clinical practice for a child with global developmental delay where no cause is apparent after examination and relevant investigations.

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Neuroimaging --- Mental --- Retardation


Article
Medical Expulsive Therapy for Lower Ureteric Stones: A Comparative Study

Authors: Samir Ali Muter
Pages: 47-51
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Background Lower ureteric stones and accompanying ureteric colics represent one of the most common medical problems faced by urologist, the treatment usually starts with conservative therapy, however, if the stone fails to pass within 4-6 weeks, a prompts action should be taken to save the kidney, this usually involves one of the minimally invasive therapy options like shock wave lithotripsy (ESWL), of ureteroscopy. However this is not free of risk, and cost, for these reasons, urologists now concentrate on what's called medical expulsive therapy, which means using drugs to enhance stone passage. Objective In this study we evaluated and compared three of the most commonly used drugs, nifedipine, tamsulosin, and sildenafil citrate, for their expulsive role in lower ureteric stones. Methods Through out the period from Feb. 2008 until Nov. 2009, 98 patients with lower ureteric stones were enrolled in this study, they were thoroughly examined and investigated, then randomized into 4 groups, the first group patients received nifedipine, the second group patients received tamsulosin, the third group patients received sildenafil citrate, and the forth group patients served as control. Patients followed up for one month and monitored for stone passage, time of stone passage and number of ureteric colics experienced while on treatment. Data collected and analyzed statistically. Results Only patients on tamsulosin therapy showed a statistically significant improvement in stone passage rate (81.4%), compared to those on nifedipine(69.6%), sildenafil citrate (57.6%), and control (54.5%). Both nifedipine and tamsulosin significantly shortened the time needed for stone passage and reduced the number of ureteric colics, while sildenafil citrate failed to show any beneficial effect compared to control. Conclusions Tamsulosin may have a significant role in enhancing lower ureteric stone passage within shorter time and with less pain, and it is superior to nifedipine, and sildenafil citrate in this regard.


Article
Anti-Tuberculous Induced Hepatotoxicity

Authors: Basim S. Al-Mgoter
Pages: 52-56
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Background Anti-tuberculous drugs can induce liver injury. Although, it is usually mild and transient, but it can be presented in a form of markedly severe liver injury. Objective To assess the severity of hepatic injury that can be induced by the anti-tuberculous drugs and to evaluate the effect of different demographic features, duration of therapy and the presence of any other risk factors for liver injury on the frequency of anti-tuberculous drugs induced hepatotoxicity. Methods This cross sectional study had enrolled 30 patients who were on quadruple anti-tuberculous therapy regimen (Rifampicin and Isoniazid for 6 months and Pyrazinamide with streptomycin for the initial 2 months). They were randomly selected from those patients who had attend the outpatient clinic or admitted in the medical wards of Al-Yarmouk Teaching Hospital during the period between the 1st of Feb. 2006 to the 31st of January 2007. Results This study had enrolled 30 patients, 7 of them were female (23.3% of the sample), and 23 were male (76.7% of the sample). Male to female ratio was 3.28:1. This study revealed that 73.3% of those patients included in this study were older than 50 years old. 86.7% of the sample had less than 3 folds increase in their serum alanine aminotransferase (26 patients), only 4 patients (13.3% of the sample) had more than 3 fold increase in their serum alanine aminotransferase level more than the upper limit of normal range. 73.3% of the sample had increased serum bilirubin level by less than 3 times the upper limit of normal range. 46.7% of the sample (14 patients) were underweight. 70% of the sample (16 patients) had been included in this study within the first 2 months of anti-tuberculous therapy. 7 patients give history of regular alcohol intake (23.3% of the sample). While 4 patients had been discovered to be hepatitis B positive (13.3% of the sample). Jaundice was found in 9 patients (30% of the sample). Conclusion This study revealed that severe anti-tuberculous drugs induced liver injury is uncommon, increasing age is an important risk factor. It is unusual to find marked and very high level of alanine aminotransferase and bilirubin in patients using anti-tuberculous drugs. Being underweight can be regarded as a factor that may increase the risk of hepatotoxicity. Most of the cases of liver injury occur early from starting therapy. The presence of other risk factors that can induce liver injury can increase the risk of anti-tuberculous drug induced hepatotoxicity.


Article
Low Dose Inhaled Corticosteroid in Asthma & Prevention of Acute Coronary Syndrome

Authors: Abdul Hameed Al-Qaseer
Pages: 57-62
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Background Asthma is associated with higher risk of adverse cardiovascular outcomes. Hypoxemia and inflammation had been suggested to play a role and the use of inhaled corticosteroids is possibly associated with a major effect on reduction this higher risk with amelioration of the suggested mechanisms. Objective This study had been designed to assess the effect of the use of low dose inhaled corticosteroids on the frequency of myocardial infarction in asthmatic patients, compared to the effect of other anti-asthmatic medications. Methods This study is a prospective study that included 92 asthmatic patients who had unstable angina at the time of inclusion. The sample were randomly selected from those who had been admitted to the coronary care unit of Al-Yarmouk Teaching Hospital during the period between February 2008 to February 2009, with the mean period of follow up of 8.3± 2.1 months (6 months-1 year). Detailed medical history had been taken and thorough physical examination was made for all patients. The patients had been sub-classified according to the type of the used therapy for asthma. Results Twenty three male and 69 female patients had been enrolled in this study. The mean age was 52.48 ± 9.86 and 50.36 ± 6.8 year-old for male and female patients, respectively. After 1 year of follow up 17 patients (18.5% of the sample) had myocardial infarction during the period of follow up, the rest of the sample (75 patients, 81.5% of the sample) completed their period of follow up without any evidence of having myocardial infarction. Sixty patients had been treated with inhaled corticosteroid therapy (65.2%), while 20 patients (21.7%) and 12 patients (13%) had been treated with inhaled B2 agonist therapy alone and inhaled B2 therapy in addition to leukotrien receptor antagonist therapy, respectively. Nine out of the 17 patients (52.9% of those with MI) were 40-49 year-old. Only 5 out of the 60 patients who had been treated with inhaled corticosteroid therapy (29.4% of those having MI, 8.3% of those treated with inhaled corticosteroid therapy) had myocardial infarction during their follow up. This study revealed that 5 out of 17 patients with evidence of acquiring myocardial infarction during the period of follow up (29.4%) had at least one marker of asthma severity. Only 2 out of 18 patients with any marker of asthma severity had used low dose inhaled corticosteroid (11.1%), while the rest of them (16 patients, 88.9% of those with any marker of severity) were using other anti-asthmatic medications. Conclusion The use Low dose inhaled corticosteroid was associated with decreased frequency of acute myocardial infarction in asthmatic patients initially diagnosed to have unstable angina in comparison to the frequency of MI among patients treated with other anti-asthmatic medications. MI was more frequent among younger asthmatic patients. Having any marker of asthma severity is associated with higher risk of having myocardial infarction. Having any marker of asthma severity is associated with higher risk of having myocardial infarction. Use of low dose inhaled corticosteroid is associated with less severe asthma and lower frequency of developing acute myocardial infarction.


Article
Modalities of Management of Radial Nerve Injury presented with Fracture in different Sites of Humerus

Authors: Hamza N. Aboud
Pages: 63-66
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Background This topic has been the subject of interest for many authors for many years, because still there is a recurrent theme …should the nerve be explored routinely along with internal fixation of fracture or should exploration be limited to those cases in which spontaneous recovery has not occurred within expected time ? or when justify? Objectives This study is designed is to shed a light on the dilemma of management radial nerve injury, in surgically treated patients versus conservatively treated others. Methods A series of 25 patients presented with any degree of radial nerve palsy complicating140 case of closed fracture shaft humerus , were treated by surgical & conservative method , according to certain indicators and evaluated during three years period, in two teaching hospital in Baghdad, from 2006 to 2008. Most of patients were males 19 case & the remaining patients were females 6 cases ,their age ranging from 3 days old baby to 45 years old & the mean age was 25 years .Ten (10) patients treated conservatively , Fifteen (15 ) patient treated surgically by either early exploration ( too early & late early ) or delayed exploration. Results The radial nerve was explore in seventeen patients from total number of study 25 patients. Eight treated by early exploration .. ( five by too early exp. within few days & three by late early exp. within next two weeks).Nine patients treated by delayed exploration after ( 3.5~ 4 ) months post traumatic period .In the last eight patients , the radial nerve was not explored & treated conservatively? The overall useful recovery rate from applying our policy was (84 % ). Conclusion Treatment of radial nerve palsy complicated closed fracture shaft humerus should be programmed well, depending on many factors , such as severity & onset of nerve lesion and type & site of associated fractures.

Keywords

Radial --- Nerve --- Fracture --- Management.


Article
Open Drainage with Rib Resection in the Treatment of Organized Thoracic Empyema

Authors: Qais M. Ali
Pages: 67-70
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Objective The aim of the study is to re-emphasize the importance of open drainage in the treatment of advanced thoracic empyema. Methods Fifty two patients with different types of thoracic empyema were received in advanced state with thick pus accumulating in the pleural cavity, in the period between 1996 and 2005. Most of these patients were too catchexic to tolerate thoracotomy for decortication or more aggressive treatment. We treated them by open drainage with rib resection. Results Nine patients (17.41 %) died•'.while the rest of the patients survived. In 3 out of these 9 patients the death was due to the original pathology with empyema as an additional factor. Conclusion Open drainage should not be ignored as one of the therapeutic options in treatment of advanced thoracic empyema. It might be the best therapeutic modality in catchexic patients, and 'where the facilities for more aggressive treatment are not available.

Table of content: volume:9 issue:1