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: 2004 volume:10 issue:2

Article
THE DISEASE BEHIND THE DISEASE

Authors: T. A. Hamdan
Pages: 1-2
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Abstract

Not all that glitters is gold (Shakespeare)

Keywords

DISEASE --- BEHIND DISEASE


Article
COMPETENCE, VIRTUAL REALITY AND ROBOTICS IN ‎SURGERY ‎

Authors: Majeed H. Alwan ‎
Pages: 3-13
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Abstract

Surgical operations have developed in the method which the surgeon’s hands and eyes are used to gain ‎experience and advance the skills. However, to realize a new surgical therapy in the 21st century, it is ‎necessary to use various advanced technologies. These include among many, three dimensional medical ‎images, computer simulation and virtual reality technology, and robots in surgery. This is an outline of ‎the various aspects of these technologies with some more details about robotics in surgery as it is the ‎most recent advancement in that technology arena.‎

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Article
FACTOR V LEIDEN AND THROMBOEMBOLISM

Authors: Zuhair Al-Barazanchi ‎
Pages: 14-21
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Abstract

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Article
THERMO THERAPY FOR RETENTION IN BPH :‎ FIRST YEAR RESULT ‎

Authors: Mahmood S Abdulkareem
Pages: 22-25
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Abstract

Our objectives were to study and to evaluate thermotherapy for patients with retention of urine. The ‎ability of the patient to pass urine without significant post voiding residue was also studied. Eighty six ‎patients presented with urinary retention were treated by transurethral thermo therapy of the prostate, two ‎weeks following thermo therapy 55 patients (63.9%) were catheter free and by the third week only 9 ‎patients (10.4%) were still with catheter. It can be concluded that thermo therapy can be an option in the ‎treatment of urinary retention and keeping the catheter for one more week can raise its effectiveness

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Article
INTRAOPERATIVE IMPRINT CYTOLOGY ‎

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Abstract

A prospective study was conducted on 60 specimens; 33 breast lumps and 27 lymph nodes, to assess the value of ‎intraoperative imprint cytology as an aid in surgical decision especially in the absence of the facility of frozen ‎section examination. Imprint cytological examinations were done intraoperatively by a single pathologist. The ‎results were ready after a period of 15-25 minutes. In all 60 specimens, 50 (83%) were correctly diagnosed, 8 were ‎diagnosed as suspicious of malignancy and 2 were misdiagnosed.‎ The sensitivity was 97%, the specificity was 94.4% and the accuracy rate was 96.1%. We concluded that imprint ‎cytology is a very simple technique and it remains a useful and cost effective tool, can aid in the surgical decision.‎

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Article
ANALYSIS OF FALSE POSITIVE AND FALSE NEGATIVE FINE NEEDLE ‎ASPIRATION CYTOLOGY OF BREAST LUMP : A PERSONAL ‎EXPERIENCE

Authors: Sawsan S, Al-Haroon ‎
Pages: 30-37
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Abstract

This study aimed to determine the reasons for sampling and interpretative errors in false ‎negative and false positive diagnoses of breast carcinoma on fine-needle aspiration ‎cytology (FNAC) material. The study design is that a totally 912 cases of breast FNAC were ‎performed between 2000 and 2004, and 126 cases of them were diagnosed as breast ‎carcinoma. Only those cases with cytohistological discrepancies were cytologically reviewed, ‎in which the cytological material was abnormal and to some extent misinterpreted or both. ‎There were 8 false negative diagnoses (false negative rate 6.3%) and 3 false positive ‎diagnoses (false positive rate 2.3%). The results of this study showed that among 8 false ‎negative cases, 5 showed hypocellular smears with minimal nuclear pleomorphism of the ‎cells. Histology revealed 3 infiltrating ductal carcinomas of scirrhous subtype and 2 ‎infiltrating lobular carcinomas. The smears of other 2 false negative cases, which ‎histologically verified as well-differentiated infiltrating ductal and pure intraductal carcinomas, ‎were hypercellular and composed predominantly of groups of cohesive, small, and uniform ‎cells simulating fibroadenoma or fibrocystic changes. Smear of the last false negative case ‎‎(histologically verified as infiltrating ductal carcinoma with extensive cystic degeneration) ‎revealed large sheets of macrophages and degenerated epithelial cells on inflammatory ‎background. In 3 false positive cases, 2 were histologically proved as fibroadenoma and 1 ‎fibrocystic changes. Smears of the 2 false positive fibroadenomas showed very high ‎cellularity, overlapped clusters, and frequent stripped bipolar nuclei. The fibrocystic case ‎showed tight clusters of apocrine cells and sheets of loosely aggregated macrophages that ‎were over interpreted. The conclusion of this study is that hypocellularity and relatively ‎nuclear monomorphism are the reasons for failure to diagnose breast carcinoma. Careful ‎attention should be paid to extreme nuclear monomorphism and absence of naked bipolar ‎nuclei. So awareness of smear cellularity and subtle cytological features will aid in the correct ‎preoperative diagnosis of lobular; scirrhous; and intraductal carcinomas, and false negative ‎diagnoses can be minimized. A cytologically atypical or suspicious diagnosis together with ‎positive mammographical and clinical findings should suggest a diagnosis of malignancy. ‎Hypercellular smears with overlapped clusters should be carefully assessed for uniformity of ‎the cells and detailed nuclear features. If the full-blown malignant cytomorphological features ‎are not visible, a diagnosis of suspicious or inconclusive should be made and frozen section ‎Created by Wameed Al-Hashimy intraoperative imprint cytology is recommended before ‎surgery.‎

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Article
Diabetic Foot Management; A 10-Year Study.‎

Authors: Issam Merdan --- Safwan A Taha
Pages: 38-42
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Abstract

The medical records of 324 diabetic patients admitted to Al-Sader Teaching Hospital (Saddam Teaching ‎Hospital previously) with foot lesions between April 1994 and April 2004 were studied retrospectively. ‎Data were collected for various parameters, both personal and medical. The majority of patients were ‎males, over fifty years of age and known diabetics. Peripheral neuropathy was the main predisposing ‎factor while infected ulcer and gangrene of toe / toes were the most common forms of presentation. ‎Wound swabs were positive for bacterial culture in 215 pts. (66.3%), 97.2% of which were polymicrobial. ‎Dibridement was the most common surgical procedure. There were 6 deaths (1.85%) in the study group ‎mainly due to uncontrolled sepsis with concurrent medical illnesses. It is concluded that foot ‎complication is a common problem in elderly Iraqi diabetics, particularly males, peripheral neuropathy is ‎the most common predisposing factor, foot infections are usually poly microbial and that the majority ‎will need some form of surgical intervention that is mostly conservative rather than a major amputation. ‎We suggest a team approach in the care for these patients which can be provided by establishing foot ‎care clinic in large hospital. ‎

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Article
CLINICAL PRESENTATION AND BIOCHEMICAL ‎EVALUATION OF BONE SECONDARIES

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Abstract

The skeleton is one of the commonest sites for metastasis. Bone secondaries account for more than one third of the ‎malignant disease of bone.‎ Seventy-six patients with bone secondaries were admitted in the orthopaedic department of Basrah Teaching ‎Hospital from February 2000 to June 2002, age range 14-86 years; 34 were males and 42 were females. The ‎dominant sites of bone metastases were spine, 60 patients (79%) and pelvis, 16 patients (21%). The common ‎primary sites were breast, 19 patients (25%) and lung, 11 patients (14.4%); 9 patients (11.2%) had undetected ‎primary site. Most secondaries (90%) were osteolytic in type and the most common histopathological type was ‎adenocarcinoma, 47 patients (63%). In 63 patients (83%), pain was the dominant presenting feature. Late ‎presentation was a major problem; it ranges between 4-8 months. Another problem was lack of clinical awareness ‎in the early stage of the illness.‎ Serum and urinary biochemical markers of bone metabolism were significantly high in patients with bone ‎secondaries than control group, no difference whether the metastasis was single or multiple and whichever the ‎primary site or histopathological subtype. Special interest with urinary hydroxyproline, it was significantly elevated ‎in patients with bone secondaries, some of them had negative radiography. Prognosis was poor with short life ‎expectancy.‎

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Article
ARTERIAL LIGATION OF LOWER LIMB ANEURYSSM: IS IT SAFE ?

Authors: Abdul-Salam Y. Al-Museilih
Pages: 54-58
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Article
BONE LENTHENING BY ‘Z’ CORTICOTOMY

Authors: Omar Ali Rafiq Barawi
Pages: 59-66
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Abstract

This is a prospective study done on 40 patients presented with lower limb length discrepancies ‎between March 1993 and September 2003. After correction of apparent shortening by ‎correcting associated deformities like flexion deformities of the knee, bone lengthening for the ‎remaining true shortening ranging from 3cm – 10.5 cm was done. The "Z" corticotomy involves ‎cutting the cortex in Z manner with preservation of the periostieum and medullar cavity as much ‎as possible, followed by manual distraction.‎ ‎ The advantages of Z corticotomy in comparison to transverse corticotomy or transverse ‎osteotomy are; That there is no need for internal fixation by plate and screws, no need for bone ‎graft to enhance osteogenesis, the chances of mal-alignment of the distracted fragments are ‎minimal as the limbs of the Z – corticotomy maintaining the alignment during the distraction, ‎and the stability of the external fixate is very important for the extent of ontogenesis but this ‎was compensated by doing Z corticotomy. ‎

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Article
INTERNAL ILLIAC ARTERY LIGATION IN THE ‎MANAGEMENT OF PELVIC HEMORRAGE. A DISTRICT ‎GENERAL HOSPITAL EXPERIENCE ‎

Authors: M R Zakaria ‎ --- Mark A K Tambert --- C Kamath
Pages: 66-70
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Abstract

‎ Haemorrhage from obstetric and gynaecological surgery is a major causes of morbidity and mortality. ‎Various methods have been described to treat women with intractable haemorrahage. Internal iliac artery ‎ligation (IAL) is an under used but potentially very effective technique, We described four cases where ‎the procedure was used in controlling sever pelvic haemorrhage when local surgical methods had failed. ‎

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Article
ANAESTHETIC MANAGEMENT OF PATIENTS ‎WITH PULMONARY HYDATID CYST

Authors: Salam Najib Asfar
Pages: 71-74
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Abstract

‎ Hydatid cyst is a disease produced by the encysted Larvae of echinococcal worms. Echinococcus ‎granuloses is endemic in areas of the Mediterranean coast and middle east, Surgical intervention to ‎remove the cyst that is commonly seen in liver and lung is the primary treatment for hydated disease .‎ ‎ Sixty- three patients underwent lateral thoracotomy for pulmonary hydatd cyst in the last 4 years at ‎Basra Teaching Hospital. Special anesthetic technique was set for them including omission of ‎premedication drugs , rapid sequence indication, preference of single lumen endotracheal tube than ‎double lumen endobronchial tube, nitrous oxide gas exclusion from maintenance of anesthesia, ready ‎stand–by good suction machine, manual low pressure ventilation, and careful monitoring .‎ ‎ Nine out of 24 cases with double lumen endobronchial tube showed severe hypoxia intraoperatively that ‎demand urgent change of this type of tubes to signal lumen endotracheal tube. Patient with endotracheal ‎tube had smooth intraoperative environment and no postoperative complications. ‎ ‎ It is concluded that using this anesthetic regimen from the start of operation for these particular cases ‎makes anesthesia management more easy and safe. ‎

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Article
CURRENT TREATMENT OF CHRONIC ANAL FISSURE.‎

Authors: Bahzad W Hamad‎ --- Faruk H Faraj
Pages: 75-80
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Abstract

This is a prospective study to test the hypothesis that topical isosorbide dinitrate (Isordil) is the best first ‎line of treatment of a chronic anal fissure. This study was done in the outpatient clinic of Sulaimani ‎Teaching Hospital, Sulaimani, Iraq, from the 1st Dec. 2000 through 30th May 2002. There were 65 cases ‎of chronic anal fissure treated with 0.5% Isordil ointment and reviewed at 2, 4, 6 and 12 weeks to assess ‎the symptoms, side-effects, fissure healing and patient acceptance. The age range was 2-65 years with ‎mean age of 31.2years, and female:male was 1.4:1. At 12 weeks 80% of patients had no fissure. In 20% ‎the treatment was unsuccessful. At 6 months follow-up there was 2.5 % recurrence. The prevalence of ‎headache was 46.1% on commencing treatment with 12.3% headache-related noncompliance. The cost ‎of treatment with this new method was 12 ID for 8 weeks while it was 36 ID for the same period of ‎traditional way of treatment. We conclude that medical sphincterotomy with 0.5% Isordil ointment is a ‎feasible, cost-effective method of treatment of chronic anal fissure with high patient acceptance and ‎satisfaction.‎

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Article
CUTANEOUS MANIFESTATION IN RENAL ‎TRANSPLANT RECIPIENTS IN SOUTHERN IRAQ ‎

Authors: Samir Dhaher --- Safauldin Ahmad
Pages: 81-84
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‎ Forty–eight patients living in southern Iraq with renal transplantation were studied for dematological ‎lesions between Jan. 2001 and Feb. 2002, at Basrah renal transplation follow-up center. All patients had ‎skin problems of different kinds; Cushingoid features in 85.4%, hair and nail changes in 82%, infections ‎in 20% and tumors in 28%. Among skin infections recalcitrant warts were the most frequent (17%). High ‎incidence of skin cancer was recorded (4.2%) as compared to other Iraqi studies . Kaposi”s sarcoma ‎was not seen during the study period.‎

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Article
COMPARATIVE STUDY OF DIFFERENT MODALITIES OF ‎MEDICAL TREATMENT OF CHRONIC SUPPURATIVE ‎OTITIES MEDIA

Authors: Ahmed M. Al-Abbasi ‎
Pages: 85-91
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Abstract

‎ Active chronic suppurative otitis media poses a management problem. Different types of ‎treatment strategy were tried for 136 patients, 36 patients received systemic antibiotics, 26 ‎patients received local antibiotics, 42 patients combined local and systemic, and the last ‎group (32 patients) received no antibiotics. The majority of patients had moderate size ‎tympanic membrane perforation (59%). Eighty-two patients had severe (active) symptoms ‎‎(60%). The commonest types of bacteria isolated were streptococcus pneumoniae and ‎staphylococcus aureus (29%, 21% respectively). It is found that, the best type of treatment ‎was the local antibiotic therapy (84% improvement), followed by combined antibiotic therapy ‎‎(local and systemic) which equal to 83% improvement. There was no benefit of using ‎systemic antibiotics without aural toilet (5% improvement). It is important to mention that the ‎use of antibiotic/ steroid ear drop gave good improvement result (95%), in comparison with ‎the use of antibiotic ear drop (50%). ‎

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Article
ACUTE ABDOMEN in PREGNANCY: AETIOLOGY & ‎OUTCOME in BASRAH

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This is a prospective study conducted in all major hospitals in Basrah (Basrah Maternity & Child ‎Hospital, Basrah Teaching hospital and Basra General hospital) to prove that ‘acute abdomen in ‎pregnancy’ is common and that the effect of delayed diagnosis can have serious implication on both ‎maternal and fetal outcome. Two hundred and fourteen pregnant females were included. Their age ranged ‎from 16-42 years (mean age was 27 years). Operations were performed whenever indicated by a registrar ‎or consultant gynecologist. Abruption placenta was the causative factor in 33.17% of cases, ectopic ‎gestation in 24.7%, acute appendicitis in 11.21% and the remaining 30.9% resulted from miscellaneous ‎conditions. Most of the patients (94.39%) presented within the first twenty-four hours of their initial ‎complaint. Delayed diagnoses were made in 12 with 50% maternal mortality and 100% perinatal mortality. ‎One hundred and sixty nine patients (78.97%) underwent emergency operations, while forty-five patients ‎‎(21.02%) were treated conservatively. Various complications were encountered; the most common was ‎wound infection (19.8%).‎

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Article
THE USE OF INTRA-UMBILICAL OXYTOCINE FOR THE ‎MANAGEMENT OF RETAINED PLACENTA ‎

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Postpartum haemorrhage & retained placenta are the most common serious abnormalities encountered ‎during the third stage of labour, the aim of this study was to compare three different management ‎protocols for retained placenta. This prospective study was carried out in Basrah Maternity & Children ‎hospital during the period from march 2001 till march 2002. A total of 75 women with retained placenta ‎after active management of third stage of labour were included, they were divided into three groups , the ‎first group received oxytocin and normal saline injected in the umbilical vein, the second received ‎normal saline and the third was the expectant group. In 56% of women in the oxytocin group, placental ‎expulsion occurred within 45 minutes compared to 16% in the expectant group and 24% in the saline ‎group respectively. Also 44% of women in the oxytocin group needed manual removal of the placenta ‎compared to 84% in the expectant and 76% in the saline group. We conclude that intraumbilical vein ‎injection in cases with retained placenta seems simple and promising technique to reduce the incidence ‎of potentially morbid procedures. ‎

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Article
MESENTERIC CYST-OVARIAN IMPLANT SYNDROME; ‎CASE REPORT ‎

Authors: Ali Y. Alwajah --- Rafif A. Al-Saady
Pages: 109-112
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Abstract

Mesenteric cyst ovarian implant syndrome have been rarely reported in the literature, we report the first ‎case that occur in young female following trauma and it is the first case in which the ovarian tissue get ‎implanted higher up in the jejunal mesentry out side the pelvis.‎

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Article
MICROLAPAROSCOPY (Needlescopic Laparoscopy)‎

Authors: Nezar A. Al-Mahfooz
Pages: 113-118
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Article
Perspective on the structured oral examination‎

Authors: Thamer A Hamdan
Pages: 119-122
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Article
Obituary: Dr. Abdulhadi Al-Sayah

Authors: T.A. Hamdan
Pages: 123-123
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Table of content: volume: issue: