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: 2013 volume:19 issue:1

Article
WHAT IS WITHIN THE SURGEON'S CONTROL AND WHAT IS BEYOND?

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

Thamer A Hamdan MB,ChB, FRCS, FRCP, FACS, FICS, Professor of Orthopaedic Surgery, Dean of Basrah College of Medicine, Chancellor of Basrah University, Basrah, IRAQ. The good outcome of surgery is the goal and what everybody is looking for. Sadly and particularly in our locality, the outcome is always thrown on the surgeon's side; not taking into consideration and even sometimes, ignoring many factors that may lead to the success or failure of this type of battle.

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Article
FUNDAMENTALS OF GOOD MEDICAL PRACTICE: COMPETENCE AND PERFORMANCE

Authors: Majeed H Alwan
Pages: 3-9
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Abstract

This is the third article in the series ‘Fundamentals of good medical practice’1,2. In this paper I will discuss the definitions of ‘Competence’ and ‘Performance’, the distinction and relationship between the two areas, and the possible/suggested different aspects of their assessment for the purpose of assuring the competence of current and future doctors, in particularly surgeons in practice.

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Article
LAPAROSCOPIC ENTRY: A REVIEW OF TECHNIQUES, TECHNOLOGIES, AND COMPLICATIONS

Authors: Issam Merdan
Pages: 10-23
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Abstract

L aparoscopy (Gr: Laparo-abdomen, scopein-to examine) is the art of examining the abdominal cavity and its contents. It requires insertion of a cannula through the abdomi¬nal wall, distention of the abdominal cavity with gas or air (pneumoperitoneum), and visualization and examination of the abdomen’s contents with an illuminated telescope. With the advent of videocameras and other ancillary instruments, laparoscopy rapidly advanced from a being a diagnostic procedure to one used in fallopian tubal occlusion for sterilization and eventually in the performance of numerous sur¬gical procedures in all surgical disciplines for a variety of indications.

Keywords

laparoscopy --- techniques


Article
PREOPERATIVE GABAPENTIN IN LAPAROSCOPIC CHOLECYSTECTOMY

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Abstract

Facts in gabapentin use are known about its effect on neuropathic pain management while its clinical significance as analgesic in laparoscopic cholecystectomy has not been studied much to clarify its importance and to know how and when it could be used or if this new analgesic strategy can be an alternative to others or be as a part of multimodal analgesic therapy in postoperative management. We conducted a prospective study to evaluate the significance of pre-emptive single dose gabapentin to reduce postoperative pain following laparoscopic cholecystectomy. Study group of hundred patients were analyzed in prospective study; Fifty of them were gabapentin group and another fifty were placebo group. Age, sex, body mass index, operation time and length of hospital stay were comparable in both groups. Analgesic requirements were recorded and pain assessment using 100 visual analogue scale in both groups were studied at three times intervals of 8,12 and 24 hours after surgery. In addition we studied the incidence of certain postoperative side effects in both groups as nausea, vomiting and drowsiness. Age, sex, body mass index, operation time and hospital stay were comparable in both groups. Opioid requirement two hours after surgery was significantly lower in gabapentin group than in placebo group (p<0.05). Also, significant difference was seen between gabapentin and placebo groups concerning the pain scores which were seen more in placebo as compared with gabapentin group in all study intervals (p<0.05). Significant difference between gabapentin and placebo groups was noticed regarding number of analgesic doses administered on the first 24 hours postoperatively which were more in placebo group (p<0.05). Insignificant difference was seen between gabapentin and placebo groups concerning certain postoperative side effects as nausea, vomiting and drowsiness (p>0.05). In conclusion, our work shows that a single preoperative dose of gabapentin has a significant effect on postoperative pain after a laparoscopic cholecystectomy.

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Article
EARLY VERSUS DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS

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Abstract

Laparoscopic cholecystectomy is performed rather commonly by general surgeons for symptomatic gall stones. This study is an analysis of experience for the timing of laparoscopic cholecystectomy for acute cholecystitis performed in Basrah, Iraq, by one surgeon. This study aimed to know the difference between early and delayed laparoscopic cholecystectomy in acute cholecystitis with respect to the hospital stay, conversion rate, and major complications rate. Data were collected from the medical records of patients with acute cholecystitis admitted to the surgical wards during (June 2009 to September 2011). Patients were divided into 2 groups on the basis of treatment received. Length of hospital stay, major complications, and conversion rates were analyzed. Ninety seven patients with acute cholecystitis underwent laparoscopic cholecystectomy. Thirty nine patients (40.2%) treated with early laparoscopic cholecystectomy, fifty eight patients (59.8%) treated with delayed laparoscopic cholecystectomy. Length of stay was significantly shorter in the early laparoscopic cholecystectomy group compared with the delayed laparoscopic cholecystectomy group (P<.001). Conversion rate and major complication rates were not statistically different. In conclusion, early laparoscopic cholecystectomy resulted in a statistically significant reduction of hospital stay, low major complications, and no significant difference in conversion rates when compared with initial antibiotic treatment and delayed laparoscopic cholecystectomy. Despite these advantages, early laparoscopic cholecystectomy is not the most common treatment for acute cholecystitis in practice.

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Article
POSTOPERATIVE ANALGESIA OF TRANSVERSUS ABDOMINIS PLANE BLOCK AFTER CESAREAN DELIVERY UNDER GENERAL ANESTHESIA

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Abstract

Cesarean delivery under general anesthesia requires effective postoperative analgesia for early ambulation and breast feeding. Transversus abdominis plane (TAP) block is done by injecting local anesthetic solution in the plane between internal oblique and transversus abdominis muscles on either sides of the abdominal wall to prolong postoperative analgesia. One hundred pregnant women who underwent general anesthesia for cesarean delivery were randomized in to two equal groups;TAP block group versus control group. This block was performed bilaterally using 20 mls of 0.25% plain bupivacaine on each side. Each patient was assessed postoperatively by a blinded investigator at 2, 4, 6,12, 24 hours using numerical pain score (NPS) 0-10 at rest and movement. Narcotics consumption, drug side effects, and patient`s satisfaction were recorded. There were no significant differences between patients characteristics. Postoperative pain at rest as measured by NPS showed; medians (3-6) and means (3-5.5) in the control group; which were significantly (p<0.05) higher than those in TAP block group which did not exceed. During movement, NPS medians (4.5-8) and means (4.5-8.5) in the control group were significantly (p<.05) higher than those in TAP block group where never exceeded. Narcotic consumptions decreased to 50% in TAP block group. Pethidine requested by 30% of patients in the control group versus 14% of TAP group. Unilateral block observed in 1/50 (0.02%), no other complications reported from TAP block. Patients satisfactions for analgesia rated good by 82% in TAP block group versus 40% in control group. In conclusion, transversus abdominis plane block provides good & prolonged postoperative analgesia after cesarean delivery performed under general anesthesia when it is combined to multimodal analgesia.

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Article
COMPARISON OF GNRH AGONIST WITH LOW-DOSE URINARY HCG FOR THE INDUCTION OF FINAL OOCYTE MATURATION IN HIGH-RISK PATIENTS UNDERGOING INTRACYTOPLASMIC SPERM INJECTION-EMBRYO TRANSFER (ICSI-ET)

Authors: Faiz Abdulwahid Alwaeely
Pages: 44-49
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Abstract

Faiz Abdulwahid Alwaeely Basra Medical College, Almanar Fertility and Endoscopy Center Abstract The aim of this study is to compare clinical pregnancy rates in ICSI-ET cycles where GnRH agonist or hCG was used to induce final maturation of the oocytes. A total of 97 women who produced more than 14 follicles following ovulation induction with recombinant FSH and GnRH antagonist were selected for randomization. Human chorionic gonadotropin (hCG, 5.000 IU, IM) or GnRH agonist (triptorelin 0.2 mg, SC) was used for the induction of final maturation. Women in GnRH agonist group received higher dose of progesterone (100 mg vs. 50 mg) and estradiol (6 mg orally per day vs. none) compared to women in hCG group in the luteal phase starting on the day of oocyte pick-up. Age, duration of stimulation, dose of gonadotropins, peak estradiol levels were similar in both groups. The mean number of collected oocytes (14.7±2.1 vs. 13.8±4.3) and fertilization rates (70.7 ±18 vs.71.8 ±21) were not significantly different between women allocated to hCG group (n=53) and GnRH agonist group (n=44). Clinical pregnancy rates (37.7 vs. 36.3), miscarriage rates (15% vs. 18.7%) and ongoing pregnancy rates (32% vs. 29.5%) were similar between hCG group and GnRH agonist group, respectively. Two cases of moderate/severe OHSS occurred in the hCG group, and none in the GnRH agonist group. In conclusion, GnRH-agonist triggering together with high dose steroid supplementation in the luteal phase yields similar clinical pregnancy rate to that obtained with lower dose of hCG administration for final maturation. However, lower dose of hCG was associated with a higher incidence of moderate/severe OHSS.

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Article
VITREOUS FLOATERS AND PHOTOPSIA AS PREDICTORS OF VITREORETINAL PATHOLOGY

Authors: Salah Zuhair Al-Asadi
Pages: 50-55
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Salah Zuhair Al-Asadi MB,ChB, FRCS, FIBMS, Lecturer of Ophthalmology, College of Medicine, University of Basrah. Abstract Floaters and photopsia are common eye symptoms. This prospective study aims to detect the relative importance of floaters, photopsia, or both as predictors of vitreo-retinal pathology. In this study, 202 patients attending the outpatient clinic in Basra General hospital between 2009–2011 complaining of floaters, photopsia, or both were interrogated, starting with inquiry about the mode of presentation, then slit lamp examination of the anterior segment, and dilatation of the pupil by mydriacyl drops 0.5% and phenylphrine drops 10%, followed by 3 mirror examination of the vitreous and peripheral retina. The results showed that 98 patients were males while 104 patients were females, 104 patients (51.49%) presented with floaters; 24 patients (11.88%) presented with photopsia; and 74 patients (36.63%) presented with both floaters and photopsia, 102 patients (50.50%) had posterior vitreous detachment (PVD) while 52 patients (25.74%) had synchysis, and 48 patients (23.76%) had normal vitreous. The highest percentage of PVD was in the age group 60–69 years and was 40 patients (39.21%). Regarding the mode of presentation, the highest percentage of PVD was in the group of patients presenting with both floaters and photopsia and was 46 patients (62.16%). The total number of retinal tear cases detected was 14, 8 of them were present in patients having PVD and presenting with floaters and photopsia, while 4 cases of retinal tears were detected in patients having PVD and presenting with floaters, and finally 2 retinal tear cases were detected in patients having PVD and presenting with photopsia, 12 eyes (85.71%) who had retinal tears had vitreous pigment granules, while 2 eyes with retinal tears (14.29%) did not have vitreous pigment granules. In conclusion, the symptoms of floaters, photopsia, or both are an important predictors of vitreo- retinal pathology. A significant number of patients had PVD, and this was associated with retinal tears in a number of patients. Vitreous pigment granules in these patients were closely correlated with the presence of retinal tears. Careful examination of patients including 3 mirror contact lens examination is mandatory.

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Article
EVIDENCE OF BRONCHOSPASM IN PATIENTS WITH HYPER-REACTIVE AIRWAY DISEASES (HRAD) FOLLOWING THIOPENTAL SODIUM INDUCTION OF ANESTHESIA

Authors: Nawfal Ali Mubark
Pages: 56-61
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Nawfal Ali Mubark MB, ChB, DA, FICMS, Lecturer in Anesthesiology, Department of Surgery, College of Medicine, University of Basrah, IRAQ. Abstract The objective of this study is to evaluate the evidence of bronchospasm in patients with hyper-reactive airway disease (HRAD) following induction of anesthesia by thiopental sodium. The number of the patients participating in this study was 200. Patient`s physical status was class I and II according to American society of anesthesiologists (ASA). Age range was 17-55 years. Patients were subjected to different types of elective operations. The patients were assigned into two groups: - first group was100 patients with normal airway considered as control group (group A) their age range was 17-55 years with a mean ±SD 30.3±9.95. The second group included 100 patients with asymptomatic hyper-reactive airway disease which was the case group (group B) their age range was 17 -50 years with a mean ±SD 30.60 ±8.29. From each patient a full history was taken and auscultation of the chest before induction of anesthesia was done, then oxygenation for 5 minutes with 100% oxygen was achieved without premedication. Anesthesia was induced by sleeping dose of intravenous (IV) thiopental and oxygenation was carried out by face mask, followed by auscultation of the chest immediately. Intubation was achieved with l mg /kg IV of Suxamethonium followed by assisted ventilation of the lung, and then re-auscultation of the chest was performed. The frequency of bronchospasm after thiopental induction in different types of hyper-reactive airway diseases of the case group was: 14 patients (58.3 %) from the total 24 case who they were a known case of bronchial asthma were developed bronchospasm while only 2 patients (2.9%) from the total 41 case who they have allergic bronchitis were developed bronchospasm, but no one with allergic rhinitis patients had bronchospasm. The differences among different types of hyper-reactive airway diseases of the case group (disease group) regarding the evidence of bronchospasm is of statistically significant with P-value less than 0.05.It is concluded from this study that thiopental is not contraindicated in all patients with HRAD especially those with allergic rhinitis & allergic bronchitis who they don`t have brochospasm while its contraindicated in bronchial asthma who they have bronchospasm preoperatively.

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Article
HORMONAL DISTURBANCES IN PATIENTS WITH BENIGN PROSTATE HYPERPLASIA

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Abstract

Ihsan S Sahi*, Mukhallad A Ramadhan@ & Sadiq U Khadim# *CABS, Head, Dept. of Surgery. @#MSc, Department of Pathology, University of Missan, College of Medicine, Missan, IRAQ. Abstract Benign prostatic hyperplasia (BPH, benign prostatic hypertrophy), a non-malignant abnormal growth of the prostate gland, affects almost all men in some degree as they age and can cause a significant disruption of lifestyle due to urinary outflow obstructive and irritative symptoms. The present study was performed on patients with BPH and other group of normal persons (40 person for each) to evaluate some of hormonal changes that result in BPH. The blood samples were collected from the groups of study those were of ages 45 and more and serum levels of both estrogen and testosterone were evaluated, as well as tissue of prostate were collected from some of the patients after surgery and estrogen receptors were estimated by immunohistochemisitry. The results shows significant reduction of the testosterone with elevation of the estradiol levels with marked expression of estrogen receptors in both epithelial and stromal cells of the prostate in patients. In conclusion, the present study found that sex hormonal disturbances associated with increase age of the person was implicated in the pathogenesis of BPH.

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Article
IMPLANTS FAILURE IN ORTHOPAEDIC SURGERY IN KUT

Authors: TALIB A AHMED
Pages: 68-73
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TALIB A AHMED MB,ChB, Dip.Orth. Consultant Orthopaedic Surgeon. Al-Karama Teaching Hospital. AL-Kut, IRAQ. Abstract Out of 558 cases of internal fixation of long bones done within five years, 22 cases of implant failure were recorded at Al-Karama Teaching Hospital at Al-Kut city, IRAQ. This is a prospective and retrospective study to review the possible causes of implant failure and their management. This study included sex, age and the coincident diseases of the affected patients. The failure rate in this study was 3.9%. There were 4 females (18.27%) and 18 males (81.54%). Age range of the affected patients was ranged from 19-76 years with average of 34 years. Implants failure in the lower limbs form 77.27%. This study also pointed to the possible error in metallurgy of the fixation implants because we noticed that most of the failed plates are manufactured by one company!

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Article
THE IMPORTANCE OF SERUM BROMIDE DETERMINATION IN THE CLINICAL LABORATORIES

Authors: RIYADH J FAKHRULDEEN
Pages: 74-75
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RIYADH J FAKHRULDEEN PhD. The Royal Society, Amman, Jordan. E-mail: drreyad49@yahoo.com The first use of Bromide as a treatment was for human epileptics over 200 years ago as or potassium bromide (KBr). Over the passage of time and the discovery of new anticonvulsants, KBr apparently became less popular due to the hepatotoxicity of bromide. Once in the brain, the bromide component becomes negatively charged ions and causes the brain cells to be also negatively charged. It is this negative state which seems to inhibit the excitability of neuron cells and helps to prevent the cells of the brain from firing in a random and haphazard manner

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Article
MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART IV: CARDIAC ARREST

Authors: Salam N Asfar --- Jasim M Salman
Pages: 76-78
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Abstract

Salam N Asfar@ & Jasim M Salman# @MB, ChB, MSc, Professor of Anesthesiology, College of Medicine, University of Basrah, and Al-Sadir Teaching Hospital, Basrah. #MB,ChB, DA, FICMS, Lecturer & Consultant Anesthesiologist, Basrah University and Al-Sadir Teaching Hospital, Basrah, IRAQ. C ardiac arrest can be defined as inability of heart action to maintain adequate cerebral circulation. Arrest in association with anaesthesia accounts for millions of cases around the world1-2. Cardiac arrest attributable to anaesthesia occurred at the rate of between 0.5 and 1 case per 10 000 cases overall and at the rate of 1.4 per 10 000 cases for the paediatric series; 55% of these were in children less than 1 year of age. The overall rate of cardiac arrest is up to 10 times higher than this, with uncontrolled bleeding, technical surgical problems, extensive co-morbidity, and advanced age3,4.

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Article
Obituary - Mohammed Talib Al-Hassani

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Mr. Mohammed Talib Al-Hassani, FRCS 23.11.1939 - 16.4.2013 Dr. Al-Hassani was born in the South of Iraq (Al-Emara), raised in a respected and holy family that is well known in science, religion and commerce.

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Table of content: volume: issue: