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: 2007 volume:13 issue:2

Article
WHERE ARE WE FROM THE ART OF AVOIDING COMPLICATIONS

Authors: Thamer A Hamdan
Pages: 1-3
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Abstract

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Article
BARIATRIC SURGERY; RISK AND BENEFIT

Authors: ISSAM MERDAN
Pages: 4-18
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Abstract

Obese patients loss more weight with bariatric surgery than with medical weight loss treatment. ‎The laparoscopic Roux-en-Y gastric bypass procedure results in more short term weight loss ‎than laparoscopic adjustable gastric banding, but the latter has fewer postoperative ‎complication and lower mortality rate; long term comparative data are currently lacking. The ‎decision regarding which procedure to perform should be based on individual patient and ‎surgeon factors.‎ Early complications of gastric bypass surgery are bleeding, anastomotic leak, wound infection, ‎thromboembolism, and anastomotic stricture. Longer term complication scan include marginal ‎ulcers, bowel obstruction, gallstones, and nutritional deficiencies.‎ Complication of adjustable gastric banding includes prolapsed and erosion. Patient typically ‎loses more than 50% of their excess weight after bariatric surgery. Obesity related diseases ‎markedly improve after bariatric surgery, reducing cardiovascular risk and improving life ‎expectancy. Patient undergoing bariatric surgery must commit to a program of lifestyle ‎changes, diet, vitamin supplementation, and follow-up.‎

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Article
HOW TO EQUIP AN AMBULANCE‎

Authors: SALAM N ASFAR
Pages: 19-23
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Abstract

Almost four decades ago, the Committee on Trauma (COT) of the American College of ‎Surgeons (ACS) developed a list of standardized equipment for ambulances. Since 1988, the ‎American College of Emergency Physicians (ACEP) has published a similar list. Both of those ‎organizations collaborated on the existing joint document, published in 2000. With this revision, ‎the National Association of Emergency Medical Service Physicians (NAEMSP) has agreed to ‎participate in this collaboration. All three organizations adhere to the principle that emergency ‎medical technicians (EMTs) at all levels must have the appropriate equipment and supplies to ‎optimize prehospital delivery of care, since EMTs care for patients of all ages, with a wide ‎variety of medical and traumatic conditions.‎

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Article
BLOOD METALS LEVELS IN PATIENTS WITH RETAINED MISSILE

Authors: Thamer A Hamdan
Pages: 24-29
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Abstract

Our aim is to investigate the levels of blood lead, serum copper, zinc and iron in patients with ‎retained missile. Blood lead, serum copper, zinc and iron concentrations were measured in 54 ‎patients with retained missile and compared with 60 control apparently healthy individuals by ‎flame atomic absorption spectrophotometry technique. Blood lead levels were significantly ‎higher in the patients than in the controls, while no significant differences in serum copper, iron ‎and zinc concentrations were noticed. There were significant positive correlations between ‎blood lead levels and duration of exposure of the retained missile, as well as the size of ‎retained missile, but insignificant correlation between (copper, iron and zinc) with either the size ‎or the duration of exposure of retained missile was observed. These findings suggest that the ‎patients with retained missile had higher blood lead level and consequently undergoes lead ‎poisoning when compared to the control individuals. Also this data indicates an involvement of ‎size and duration of exposure of retained missile as important factors to lead poisoning.‎

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Article
KEY FEATURES PROBLEMS: A MORE VALID WRITTEN EXAMINATION TO ASSES ‎

Authors: SARKIS K STRAK
Pages: 30-34
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Article
THE PATTERN OF OSTEOSARCOMA IN SOUTHERN PART OF IRAQ

Authors: LAMIA JARRALLAH
Pages: 35-41
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Abstract

Osteosarcoma is a malignant tumor of mesenchymal cells characterized by the direct formation of bone or osteoid tissue by the proliferating malignant tumor cells. Grading of tumor is a good prog¬nostic indicator. It constitutes a basic factor of the current Enneking osteosarcoma staging system. The detection and identification of markers able to differentiate a high from a low malignant osteosarcoma which would substantially help the diagnosis, the prognosis and consequently the therapeutic approach of these tumors. This study is aimed to determine: The contribution of osteosarcoma to the total number of the malignant bone tumors registered in Basrah during the period of the study. The various histological subtypes and grades of osteosarcoma. A total number of thirty-seven cases of osteosarcoma diagnosed during the period 2000-2004 inclusive were collected from private and governmental hospital histopathological labrotaries in Basrah province. Clinical data concerning the age, sex, clinical presentations, radiological fea-tures and gross appearance of affected bone were evaluated. Histological sections of 25 out of 37 cases, were collected, re-evaluated and grades. Osteosarcoma was the most common primary malignant tumor of bone classified according to the tumor matrix into histological subtypes and analyzed for histological accounting for 35.92% of the primary malignant and 20.55% of the total malignant bone tumors. Of these 37 osteosarcoma cases, 35 (94.59%) were intramedullary and 2 (5.40%) were parosteal surface osteosarcoma. The male to female ratio was 1.1:1. The second decade was the most common age group of occurrence accounting for 23 out of 37 cases (62.2%). The main presenting clinical features were painless swelling recorded in 51.4%.The distal end femur, proximal end tibia and proximal end humerus were the most common sites of affection accounting for 27.02%, 32.43%, 16.21% respectively. The most common subtypes of osteosarcoma was osteoblastic (52%) followed by fibroblastic (Osteosarcoma 24%) and chondroblastic (20%); while telangiectatic subtypes was rare (4%). Parosteal osteosarcoma was a rare variant in our locality and other variants were not diagnosed during the period of the study. The majority of osteosarcoma cases (76%) were of grade III, followed by grade II (16%) and grade I (8%).

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Article
IDIOPATHIC SCLEROSING ENCAPSULATED PERITONITIS (ABDOMINAL COCOON) A CASE REPORT AND LITERATURE REVIEW

Authors: EMAD AL-EBRAHIM
Pages: 42-46
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Abstract

Sclerosing encapsulated peritonitis or abdominal cocoon is a rare disease that is characterized by a total or partial encasement of the small bowel by a thick and fibro tic membrane. Thirty eight cases were reported since it was first described. It occurs primarily in adolescent females in tropical and subtropical regions. Preoperative diagnosis is a matter of challenge and usually made at laparotomy. We report a patient with partial intestinal obstruction and abdominal co-coon that was diagnosed during surgery. We review the literature and discuss the etiology of this disease.

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Article
FACTORS INFLUENCING POST-OPERATIVE COMPLICATIONS AFTER PROSTHETIC "MESH" REPAIR OF INCISIONAL HERNIA (A prospective study)

Authors: Mazin Hawaz Al-Hawaz
Pages: 47-54
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Incisional hernia is frequently met by the general surgeon, its frequently complicate (3.8-11.5%) of patients after abdominal surgery. Repair of large incisional hernia is a difficult surgical problem with recurrence being a common. Numerous methods of repair have been described simple opposition in one layer or complex opposition and the use of prosthetic mesh. The aim of this study is to report our experience with use of mesh repair and risk factors that influence post operative complications. A prospective study done in Basrah General Hospital, Department of Surgery between January 2003 to December 2006.One hundred and ten patients with prosthetic repair of incisional hernia were included in this study. History was taken and thorough examination was done, all patients were asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations, primary or recurrent hernia and examined for their body mass index, size and duration of the hernial defect were recorded. A proforma was completed for each patient, noting prophylactic antibiotics had been given or not, type of the sac and whether opened or inverted, type and size of mesh had been used, intraoperative and postoperative complications and postoperative hospital stay. Of (110) patients, (62) were females, (48)were males,their median age was (45.5) years for women and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weight and had body mass index equal or more than(30).Forty eight patients (43.6%) were diabetic and (24)patients(21.8%)were corticosteroid used. The original operations were bowel related and gynecological in the majority of patients. Previous incisions were long midline in(38). Twenty patients had one past operation, (13)had two,(5) had three and one patient had four past repair, the remaining were new Incisional hernia patients. The main hernia size was (12.3) cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients had additional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of small bowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20) patients. In the majority of patients (78), standard polypropylene mesh had been used and vicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperative complications were seroma formation (17.3%), wound haematoma (10%), wound infection (9.1%), chest infection (6.4%), one patient developed intestinal fistula and mesh need to be removed. Five recurrent incisional hernias occurred. Most patients developed complications were obese, diabetic and corticosteroid used. No death in our series. It is concluded that tension free incisional hernia repair using prosthetic mesh is a safe and easy procedure with no major morbidity or recurrence. The patient-doctor should advice weight loss to help reduce risks of surgery and improve the surgical results. Control of diabetes, corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterile condition, precise and meticulous technique with the use of closed suction drains is important.

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Article
OPEN MIDLINE INTERNAL SPHINCTEROTOMY (WITH FISSURECTOMY) IN THE TREATMENT OF CHRONIC ANAL FISSURE

Authors: Safwan A Taha
Pages: 55-58
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Anal fissure represents one of the most common diseases of the ano-rectum in which there is denuded epithelium of the anal canal overlying internal sphincter. In this study 110 patients underwent posterior midline sphincterotomy as the treatment for their chronic anal fissures. Mean operating time was 5 minutes and no patient stayed at hospital overnight. All patients were followed-up for 6 months. Symptoms were relieved right following surgery. Four patients developed wound infection. Other 4 patients experienced some difficulty in micturition but none had retention. Six patients experienced relative incontinence to flatus for a couple of weeks postoperatively but all of them regained their sphincter control after that. No patient complained of incontinence for feces. There were no serious scarring of the area like keyhole deformities or its variants and none of the patients developed recurrence. Almost all the patients were satisfied with the outcome. We recommend posterior midline internal sphincterotomy as the surgical treatment of choice for chronic anal fissure because it is simple to perform and results in quick relief of pain and rapid healing in almost all cases, with very few complication and negligible recurrence.

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Article
MATERNAL HYDRATION FOR INCREASING AMNIOTIC FLUID VOLUME IN OLIGOHYDRAMNIOS

Authors: KHILUD S AL-SALAMI
Pages: 59-62
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The aim of this study was to evaluate the effect of acute maternal hydration on amniotic fluid volume in pregnancies with third tri¬mester olighydramnios. The study was done at Al-Basrah General and Al-Basrah Maternity and Child Hospitals. A prospective case control study in which amniotic fluid volume was evaluated in 100 pregnant women be¬tween (32-40) weeks of gestational age with oligohyramnios (Case) and normal amniotic fluid index (AFI) and normal AFI (Control). Fifty women of oligohydramnios and fifty of control were made to drink 2 litres of water over 2 hours before repeating AFI measurement. The pre & post-hydration AFI were compared between the two groups. The AFI in olighydramnios & control groups were increased significantly by mean of 1.91 ± 0.61, P< 0.001 and 2.57 ± 1.37, p< 0.001 respectively . The data were analyzed with paired t-test for statistical significance . In conclusion, maternal oral hydration could be of therapeutic value in women with oligohydramnios.

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Article
GASTROINTESTINAL STROMAL TUMOUR, PRESENTATION OF CASES AND OUTLINE OF THE DISEASE AND ITS MANAGEMENT

Authors: Majeed A Alwan
Pages: 63-72
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Gastrointestinal stromal tumour (GIST) is the most common mesenchymal tumour of the gastrointestinal tract. Although GIST has been clinically recognized for almost 20 years, a standard definition has only recently been clarified. These tumours were frequently classified as leiomyomas, leiomyosarcomas, leiomyoblastomas, or gastrointestinal autonomic nerve tumours1. Over the past few years, scientists have begun to unravel the molecular abnormalities that underlie the pathogenesis of these tumours. They are now considered to share a common progenitor cell with the interstitial cells of Cajal2. GISTs are characterized by immunohistochemical expression of the CD117 antigen. Surgery is the main line of treatment in operable cases. GISTs are highly resistant to conventional chemotherapy and radiotherapy. Imatinib, a tyrosine kinase inhibitor is an approved specific target for systemic therapy. The author had the chance of managing several patients diagnosed to have GISTs, recently three of them were managed during the last few months, and two more new cases are awaiting their surgery. This report is a presentation of these cases and a highlight of the clinical features, pathology, diagnosis and management of GISTs.

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Article
ULNAR DIMELIA, A CASE REPORT

Authors: AVADIS A MURADIAN
Pages: 73-74
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