Table of content

Basrah Journal of Surgery

مجلة البصرة الجراحية

ISSN: 16833589
Publisher: Basrah University
Faculty: Medicine
Language: English

This journal is Open Access

About

Basrah Journal of Surgery


Editor-in- chief

Prof. Thamer A. Hamdan, FRCS
Prof. Salam N. Asfar, MSc

Information Administrator

Dr. Jasim M. Salman, MB,ChB, DA, FICMS

Associate Editors

Dr. Hashim S. Khayat, FRCS

Prof. Mazin H. Al-Hawaz, CABS, FRCS

Prof. Zeki A. Al-Faddagh, CABS, FRCS

Prof. Issam Merdan CABS, FICMS

Assist. Prof. Ali A. Alshawi, FFDRCSI, FDSRCS

Assist. Prof. Mazin Abdulsattar, CABS

Dr. Zuhair Al-Barazanchi, MSc, PhD



National Advisory Board



Prof. Ahmad M Al-Abbasi, FRCS

Prof. Abdulla M. Jawad, PhD

Dr. Hasan K. Muhamed, FRCS

Assist. Prof. Tahir A Hawrami, DS, CABS

Assist. Prof. Farhad K. Sulayvani, CABS

Prof. Hassan J Hasony, MPhil, PhD

Prof. Nadhim K. Mahdi, PhD



International Advisory Board











Dr. Majeed H Alwan, FRCS, New Zealand

Dr. Luay P Susan, MD, Cleveland, Ohio, USA

Prof. Stewart L Weinstein, MD, USA, Former president AAOS

Dr. Robert W Buchoiz, MD, USA, Former President AAOS

Dr. Cody Bünger, MD, USA, President SICOT

Dr. Scott A Hoffinger, MD, Oakland, CA, USA

Dr. Sebastian Gitter, Dr.med. Biberach, Germany

Dr. Alec Benjamin, FRCS, UK

Prof. W Al-Ma’ani, MD, Jordan

Prof. K Fathie, MD, FACS, USA

Prof. Hikmat Jamil, MD, PhD, USA

Prof. Wajdy L Haillo, MD, PhD, USA

Mr. David Gallaway, PhD, FRCS

Dr. Rick Wilkerson, MD, USA

Dr. Sabri Shukur, FDSRS, USA

Prof. Gary Selnow, USA

Dr. John Howe, USA

Dr. Karim A Shaikley, MD, USA

Dr. John Chalmers, FRCS, UK

Dr. J Frazer, MD, USA

Dr. M Zayer, MD, Sweden

Dr. S Al-Bodur, MD, Jordan




Administrative Secretary

Ms. Elham Altoma
Ms. Salima J Sa’ad
Instructions to Authors

Basrah Journal of Surgery publishes original articles, review articles, leading articles and case reports; all manuscripts are submitted to editorial review. Authors are requested to send two copies of their articles and other editorial material to:

The Editor
Basrah Journal of Surgery, Dept. of Surgery, College of Medicine, University of Basrah. IRAQ.
salamasfar@yahoo.com
OR basjsurg95@yahoo.com
An article is reviewed for publication on the understanding that the work it reports has not been submitted simultaneously to another journal, has not been accepted for publication by another journal, has not been accepted for publication by another journal nor has it been already published. Any such attempt, when detected, will result in automatic rejection and may prejudice acceptance of future contributions. The articles and their illustrations become property of the journal. The editorial board does not necessarily agree with views expressed by the authors.
A covering letter must accompany all submissions and must be signed by all authors. The first named author is responsible for ensuring that all authors have seen and approved the manuscript and are fully conversant with its contents.
Authors should consult “uniform requirements for manuscripts submitted to biomedical journals” produced by the international committee of medical Journal Editors and published in the British Medical Journal, 6 February 1988, 401-5. Only manuscripts, which comply with this, the Vancouver style, will be considered. The text of the articles is usually divided into sections with the headings, Summary (abstract), Introduc-tion, Methods, Results and Discussion. Long articles may need subheadings within some sections to clarify its content. Two good quality plain paper copies of all written and tubular material should be submitted. The manuscript must be typed double-spaced with a minimum of 3cm margins on A4 paper (210 × 297 mm) in the following order:
1. Title page with name of the author(s). The appointment of each author at the time of performance of the work reported should be mentioned; if an author has since moved then his new address is to be added as footnote. Authors names should be mentioned up to six, if there are more authors then the first three are mentioned followed by “et al.”.
2. Summary should be concise, complete in itself and outline the aim, results and conclusions of the paper. Randomized controlled trials should be identified.
3. The text of all articles should be short and to the point.
4. References should be numbered according to their sequence in the text and not alphabetically. They should be written down in compliance with Vancouver style; i.e.
A) Journal: Ferguson AJ, Mazier WP, Ganchrow MI, Friend WG. The closed technique of haemorrhoidectomy. Surgery 1971; 70: 480.
B) Book: Golgberg SM, Nivato-vongs S, Rothenberger DA, Colon, Rectum and Anus. In: Schwartz SI, Shire GT, Spencer FC, eds. Principles of surgery. 4th ed. Singapore: MacGraw Hill; 1984.
5. Tables should be separately typed each on one sheet and must have a Roman identifying number and a short descriptive title.
6. Illustrations should be submitted in duplicate. Photographs must be of the highest professional quality. Original line drawings may be sent instead of photographs. Never write on the front or back of drawing or photographs.
7. Pagination, all pages should be numbered in the sequence, title page, summary, text, acknowledgment, references, tables and legends for illustrations.
8. Abbreviations should be limited in the text. Terms, which are mentioned frequently, may be abbreviated, and clearly defined on first use.
9. Statistical analysis should include a clear description of which methods were used for which analysis. Results of statistical tests should be reported by stating the value of the test statistic, the number of degrees of freedom and the P value. For example, t=1.34, 16 d.f., p=0.2. There should also be an indication whether the results were statistically significant or not.
10. It is preferable to provide the manuscript on a compact disc using MS Word 2003 version.




Checklist for authors
1-Covering letter.
2-Two copies of the article.
3-Writing style according to the Vancouver style.
4-Tables, graphs and legends for the photos each on separate sheet of paper.
5-A copy of the article on a compact disc.


Announcement
The editorial board would like to inform our readers that the journal has been included in the Index Medicus for the WHO Eastern Mediterranean Region (IMEMR) starting from the March, 1999 issue (Vol.5, No.1). This issue as well as all forthcoming issues of the journal will appear in WHO/EMRO web site on the Internet at the address http://www.who.sci.eg The journal was also included in the collection of the National Library of Medicine, Bethesda, Maryland starting from the same issue (i.e. Vol.5, No. 1) as we were informed by the National Institutions of Health in their letter dated February 2, 2000.

Website: http://basjsurge.com email: basjsurg95@yahoo.com

Mobile: 009647801061850 Editor 009647801018133 Information Administrator

مجلة البصرة الجراحية 2015

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Contact info

Website: http://sites.google.com/site/basjsurg email:basjsurg95@yahoo.com, elhamaltoma74@gmail.com
Mobile: 009647801061850 Editor 009647801002992 Editorial Consultant
009647801537124 Secretary

The Editor: Basrah Journal of Surgery, Dept. of Surgery, College of Medicine, University of Basrah. IRAQ.
salamasfar@yahoo.com, OR basjsurg95@yahoo.com

Table of content: 2008 volume:14 issue:2

Article
INFORMED CONSENT, ARE WE DOING ENOUGH??.

Authors: THAMER A HAMDAN
Pages: 1
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Abstract

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Article
THE RELATIONSHIP BETWEEN CLINICAL EXPERIENCE AND QUALITY OF CARE AND ITS OUTCOME.

Authors: MAJEED H ALWAN
Pages: 3
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Abstract

Quality assurance and performance evaluations, have become central issues in medicine. There are several studies which indicates that general patients care is suboptimal in many different medical conditions and clinical settings1,2. Delivering high-quality care is important to all clinicians, but this issue may be more relevant to certain subgroups, such as those with less specialised training and those who deal with smaller number of patients3. There is also a general believe that the longer clinicians are in practice the more experienced they will be, and therefore it is assumed that this group of medical doctors are able to provide a high quality of care. But there are some studies that found a consistently or partially negative association. The aim of this report is to discuss this subject further and reach some conclusions.

Keywords


Article
PERECPECTIVE ON THE STRUCTURED ORAL EXAMINATION

Authors: THAMER A HAMDAN
Pages: 8
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Abstract

Oral examination, sometimes called viva which is a Spanish word means alive or vital, should be considered seriously because it gives a clear and direct impression about the student's level of education, and how to behave when facing difficult situation. Considerable number of students feels very unhappy about oral examination and probably prefers the written ones. Oral examination also gives an idea about the personality, the behavior, the way of communication, and the response of the student to a difficult situation. Napoleon the French commander said: it is easier for hire to participate thousand times in a battle field than to site once in the examination hall. Oral examination is one of the oldest methods of student's evaluation, and probably it was the only way to examine in the ancient days. In oral examination, the students rights should come on the top of everything and the benefit of doubt should be on the student's side always. Unfortunately, sometimes mix up occurs between under and post graduate students and even between different levels of post graduate students, the same question may be given to all levels for that reason a clear cut sharp line should be drawn between the different levels of students, and specifications in the questions for each level in mandatory. Almost all students are anxious during oral examination, this anxiety is usually associated with lower oral score, therefore sympathy and empathy is necessary from the examiners side. To perform oral examination, four corner stones are mandatory which consist of students, examiners, questions and examination hall. Perils and pitfalls may arise in any of the above. The author is putting down his perspective on the structured oral examination which consist of giving mark for each separate questions in addition to separate and secret score from each member of the examination committee, and how ideally should be performed to reduce or to avoid pitfalls and achieve justice as much as possible.

Keywords

STRUCTURED --- ORAL --- EXAMINATION


Article
THE EFFECT OF KETAMINE, DICLOFENAC AND THEIR COMBINATION ON FOUR MODELS OF INDUCED PAIN IN MICE

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Abstract

Adjuvant analgesics are drugs that have weak or nonexistent analgesic action when administered alone, but can enhance analgesic action when co-administered with known analgesic agents. Ketamine, an anesthetic drug, is an adjuvant analgesic drug. Its use in doses lower than therapeutic doses might be important in the management of certain types of pain as neuropathic pain. The present study was performed to investigate the effects of subanesthetic doses of ketamine in four animal models of induced pain and to compare its effects with diclofenac sodium. It is also intended to test the effectiveness of combining both drugs together in these animal models of pain. All experiments were performed on albino mice. Mice were evaluated for their responsiveness to noxious stimuli using four tests: tail-flick test, hot-plate test, formalin test and acetic acidinduced writhing test. These effects were measured before and one hour after intraperitoneal drug administration. In some experiments, they were followed for 6 and 24 hours. We found that Ketamine, in subanesthetic doses, resulted in a significant analgesic effect in all the four models of pain. It increased pain latencies in tail-flick test by 78% compared to preadministration time, and by 95% in hot plate test. It also decreased the number of lickings and bitings in formalin test by 41.9% and the number of abdominal writhing by 73.5%. These analgesic effects represented around 60% of diclofenac effect in heat-induced pain models, but it is similar to diclofenac in the other two models. The enhancement of diclofenac analgesic effect by ketamine ranged from 13.6% to 46% in the four tests. It is concluded that Ketamine in subanesthetic doses has a significant analgesic effect comparable to diclofenac. It can enhance diclofenac effect by a margin not exceeding 50% of diclofenac effect. Much smaller doses of ketamine are required to be tested in the future.

Keywords

KETAMINE --- DICLOFENAC


Article
HISTOLOGICAL STUDY ON THE STRUCTURAL CHANGES OF PLACENTA IN SMOKING IRAQI MOTHERS

Authors: KHALIDA K JBARA
Pages: 18
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Abstract

The placenta was chosen as a possible sample for detection of degenerative changes by tobacco smoking in the human pregnant female. Passive smoking mother during pregnancy is associated with increase of collagen content of the villi, decrease fetal weight, increase in the number of villi, increase of trophoblastic apoptosis and increase in the thickness of maternofetal barrier. Sections, 3-5 micron thickness of 40 full term placentae of passive smoking mothers and 30 number of gestational matched placenta were used as control, they were studied under light microscope. Appreciable degenerative changes were found in the group of passive smoker females, he main findings were: thickening of the basement membrane of placental villus, increase in the collagen content of the villus, and increase in the syncytial budding, increase in the materno-fetal barrier thickness and extensive loss of trophoblast. This study concluded that tobacco is harmful to the human tissue and vascular system in general suggesting that smoking results in deteriorating organ structure and function.�

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Article
6-DISCHARGING EAR (OTORRHEA), A CLINICO-MICROBIOLOGICAL STUDY

Authors: AHMED M AL-ABBASI --- ZAHRA KADUM SAEED
Pages: 25
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Abstract

This study aimed to assess the causes of otorrhea and causative organisms. A prospective clinicomicrobiological study of 153 discharging ears of 148 patients in Basrah General Hospital during 2 years period. This study showed that most commonly affected age group was below 10 years (44 patients=30%), the most common type of otorrhea was the purulent (127 ears=86%), the most common cause of purulent otorrhea was chronic otitis media (77 ears=61% of purulent discharging ears). Staph. aureus was the commonly isolated organism from purulent discharging ears (39 ears). It is concluded that otoscopic and otomicroscpic examination plus carefully and accurately taken swabs for cultures are essential for accurate diagnosis and precise treatment in all cases of ear discharge.

Keywords

OTORRHEA


Article
7-MEDIAL CANTHAL TENDON REPAIR IN TELECANTHUS PATIENTS

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Abstract

This study aimed to provide a comprehensive review of the techniques used for reconstruction of the medial canthal tendon in telecanthus cases and to analyze the most suitable reconstructive methods for different medial canthal tendon lesions methods. This clinical study has been done on 22 patients with a 25 medial canthal tendons (MCT) lesions and attended to Al-wasiti and surgical specialties hospitals in the period from February 2003 and march 2004. The cases studied from clinical, aesthetic and reconstructive aspects. All patients presented with telecanthus and either congenitally lax or injured medial canthal tendons. Reconstruction of the lesions was done using four different surgical techniques dirct repair of the medial canthal tendon (canthorraphy) done for four patients, medial canthal tendon (anterior limb) plication for six cases, transnasal canthopexy was done for nine patients with open reduction and fixation of frontal process of maxilla were done for six patients. We conclude that desired surgical outcome can be achieved where there is bony attachments of the medial canthal tendon.

Keywords

CANTHAL --- TELECANTHUS


Article
8-UPPER LIMB SALVAGE

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Abstract

Among the vascular injuries, the brachial artery injury is common one. This is a retrospective study of 90 patients admitted at Al-Sader teaching hospital in Najaf from the 1st of January 2007 to the 1st of January 2008. The most common mechanism of injury was bullet and shell injuries (57.8%) followed by stab (25.5%), and blunt injury (13.4%). The least was iatrogenic in (3.3%) of cases. The surgical technique used to repair the vessel was resection and end to end anastamosis in 47.8% of cases, in 27.8% of the patients venous graft was used. Arteriorhaphy was done in 8.8% of the cases. Associated venous injuries were dealt with by ligation of the veins. No attempt to do venous repair and no fasciotomy was needed. The outcome of the injury in this study was in general good. The morbidity of the patients due to nerve injury, wound infection and joint stiffness still a problem. Mortality was 7.7% was due to associated injuries and delayed presentation of the patients. This study aimed to analyze the cause of injury, surgical approach, outcome and complications of brachial artery injury.

Keywords

UPPER --- LIMB --- SALVAGESAEED


Article
9-ANALYSIS OF FACTORS CONTRIBUTING TO MORTALITY IN BURNS PATIENTS, RETROSPECTIVE STUDY

Authors: JASIM HASSAN SALIMEMH
Pages: 48
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Abstract

Burn injury result in a significant physical and psychological trauma to the burn patients. The highest mortality is among low socioeconomic status countries. This study aimed to analyze factors contributing to death in burn patients in Basrah General Hospital burn unit. One hundred fifty patients died in Basrah General Hospital unit from January 2000 to December 2001, retrospective analysis of their records including; residency, age, sex, percentage of total body surface area burned, cause and time of burn. Most patients were females 69% (04 patients), males 31% (64 patients), high mortality in age group (10-29years), 53% (79/150), females predominate in this age group 58%, males 39%. Males predominate 26% (12/46) over females 13% (13/104) at age group 0-3 years. Most of mortality within percentage of total body surface area burn of (31%-40%) is 18% (27/150), percentage of burn of 91%-100% is 21% (32/150). Commonest cause of death is infection 57% (85 patients), hypovolemia and inhalation injuries in 31% (47/150 patients). Number of deaths at first seven days post burn is 84% (126/150). It is concluded that the commenst cause of death is infection. High risk age group is children and young females which reflect lack of social security. Therefore preventive measures are essential.

Keywords

BURNS


Article
10- HUMAN PARVOVIRUS B19 ANTIBODY AMONG ARTHROPATHIC PATIENTS WITH ESPECIAL EMPHASIS ON SICKLE CELL DISEASES IN BASRAH

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A case control study was carried out during the period from October 2006 till September 2007 in Basrah Governorate. To estimate the overall prevalence of Human Parvovirus B19 (HPV B19) antibody and its association to Rheumatoid factor seropositivity among sickler and non sickler arthropathic patients. A total of 182 blood samples were collected. Ninety (90) from arthropathic patients with or without sickle cell diseases (SCD), who attended the orthopaedic, rheumatology and internal medicine consultant clinics in Basrah General Hospital and Hemoglobinopathies Center at the Maternity and Children Hospital. Ninety two (92) from control group, non arthropathic with or without SCD. Human parvovirus B19 IgG antibodies were serologically detected by an Enzyme- Linked Immunosorbent Assay (ELISA). The rheumatoid factor was detected by Latex agglutination test. The overall prevalence of HPV B19 antibody in Basrah among study population was 68.7% . The prevalence of this antibody was 76.9% among arthropathic non sickler and 65.8% in sickler arthropathic patients. These differences were shown statistically not significant P> 0.05 compared to control group where prevalence was 63.2% in non arthropathic sickler and 66.7% among non arthropathic non sickler individuals. Eighty percent of arthropathic patients who had positive rheumatoid factor were also positive for HPV B19 antibody, which indicate a significant association (P<0.05). In the present study the seropositivity of HPV B19 was shown to be increased with age. In relation to site of joint affected, the small joints of the hand and foot were the commonest site of manifestation 78.1%. HPV B19 antibody was significantly more (79.7%) among persons with history of blood transfusion. The types of SCD had no significant effect on the prevalence of HPV B19 antibody (P>0.05). However there was a positive relation between HPV B19 seropositivity and the duration of illness (P<0.0%). In conclusion, HPV B19 is common with high prevalence in our region. There is clear association between HPV B19 infection and rheumatoid factor positivity. Individuals with sickle cell diseases regardless the type and those with history of blood transfusion were considered as risk groups for acquiring HPV B19 infections.

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Article
11- THE EFFECT OF CHITOSAN ON OSTEOGENESIS, HISTOLOGICAL STUDY IN RABBITS........................................................................................................................

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Abstract

Bone regeneration is a major limiting factor in oral surgery regenerative therapy. The concept of guided tissue regeneration has provided the strongest evidence that tissue healing can be influenced exogenously by wound management. At the cellular level, the existence of osteoprogenitors with the capacity to produce bone in the wound site and the potential to exogenously influence the behavior of these cells offers the opportunity to further enhance regenerative wound healing. Chitosan, with a chemical structure similar to hyaluronate, has been implicated as a wound healing agent. The purpose of this research was to evaluate the effect of chitosan on osteoblast differentiation and bone formation in vitro.

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Article
12- SOFT TISSUE RECONSTRUCTION IN SEVERE OPEN LEG FRACTURES (GUSTILO TYPE III)

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Abstract

Eighteen patients who sustained severe open leg fractures (Gustilo�s III) were treated in ALBasrah General Hospital and Al-Sadder Teaching hospital between 2007 and 2008. They were12 males and 6 females, average age were 25 years. Middle third fractures occurred in 8 cases (44.4%) and the comminuted geometry of fracture was in 14 patients (77.7%). All patients were treated by meticulous wound excision with stabilization of fracture and then wound cover, which is done early in 6 patients (before 7 days) and late in 12 patients (after 7 days). Local muscle flap was done in 9 patients (50%), local fasciocutanous flap in 6 patients (33.3%) and free flap in 3(16.7%). The complications occurs more in late local reconstruction as flap infection in (55.5%), nonunion in (33.3%), flap necrosis in (22.2%) and osteomylitis in (33.3%) while in early reconstruction it is found only (16.6%) as a complication of each of the above. In muscle flap, flap infection found in (22.2%), flap necrosis in (11.1%) and nonunion in (22.2%) which was lower than other type of reconstruction, the muscle flap was more reliable flap in early period of reconstructions. In conclusion, primary reconstruction of Gustilo's type III open tibial fractures had advantages compared with secondary reconstruction.

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Article

Article
14- METHANOL POISONING, CASE REPORTS AND LITERATURE REVIEW

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Abstract

Acute methanol poisoning produces severe metabolic acidosis, increased anion and osmol gaps. These metabolic disturbances are chiefly due to accumulation of formic acid which can lead to serious neurological sequelae. If renal dysfunction develops then rapid deterioration and increased mortality can occur. Early diagnosis and treatment can reduce the morbidity and mortality. Treatment includes infusion of sodium bicarbonate and administration of ethanol parenterally or orally to inhibit the production of formic acid form methanol. Haemodialysis helps the removal of methanol and formic acid from circulation and also corrects the acidosis. Two cases of methanol poisoning are described. Both patients took a mixture of methanol and ethanol in different amount with different outcomes.

Keywords

METHANOL


Article
15- PANCEREATIC HYDATID AS A CAUSE OF EPIGASTRIC MASS, A CASE REPORT.....

Authors: MUSHTAQ CH ABU-ALHAIL
Pages: 88
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Primary hydatid cyst in the corpus of pancreas is a rare. A woman of 35 Years old came with a two-month history of epigastric Pain, occasional vomiting and an epigastric mass. On Physical examination the vital sign were normal. The only Positive sign besides ahard epigastric mass was mild tenderness. Ultrasonography and CT Showed a cyst at the Corpus of the Pancreas 4X5cm Diameter. The Patient under went midline laparotomy and an isolated hydatid cyst of the Pancreas was found. This is a rare manifestation of this disease.

Keywords

HYDATID


Article
Obituary DR. KHALID NAJJIp

Authors: H S K
Pages: 91-91
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Abstract

Obituary

Keywords

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