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Article
Our Laparoscopic Experience in Management of Chronic Abdominal Pain: A Cross-sectional Study
تجربتنا مع التنظير البطني في تدبير حالات الألم البطني المزمن دراسة مقطعية

Author: Mahmoud M. Al-Mukhtar محمود جواد المختار
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2013 Volume: 10 Issue: 1 Pages: 173-178
Publisher: Babylon University جامعة بابل

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Abstract

Background:Laparoscopic and endoscopic surgery are currently worldwide surgical procedures. Laparoscopic surgery in particularis a minimal invasive surgery. The rapid evolution of laparoscopic surgical subspeciality have introduced it into a wide range of clinical applications regarding diagnosis and/or therapy of remarkable spectrum of diseases. Laparoscopy, in optimal circumstances , enables excellent visualization of the abdominal cavity. Accordingly, it has been practiced in this study to assess and/or treat cases of chronic abdominal pain.Objectives :This study tries to evaluate the significance of adopting laparoscopy in the management of patients with chronic abdominal pain in Al-Hilla General Teaching Hospital.Methods :This is a cross-sectional case series study that had assessed (49) patients of an average age of (35)years complaining of chronic abdominal pain for the period 01/09/2008-01/09/2011. Postoperative follow-up was conducted for (12) months. All cases of known intra-abdominal malignancies were excluded from this study. All data were collected using a formed questionnaire by the worker and information were filled by the worker single handly.Results :Thirty-four patients ( 69 %) of the study group had previous abdominal or pelvic surgery. Thirty-five patients (71 %) showed intra-abdominal adhesions. Thirty-one patients (63 %) had underwent laparoscopic adhesiolysis while the remaining four cases had their adhesions kept undisturbed as they were considered to be insignificant. Three patients (6.1%) exhibited mesenteric lymphadenopathy which was discovered to be secondary to chronic upper respiratory tract infections. Two cases (4%) of unilaterl left-sided inguinal hernias were disclosed. One case (2%) of abnormally looking appendix was detected and managed by laparoscopic appendectomy. Eight Patients (16.3 %) showed complete normality on laparoscopy. Conclusion :With standard laparoscopic equipements , techniques and postoperative care laparoscopy is a safe, useful and more informative invasive investigation to evaluate and/or resolve the problem of chronic abdominal pain.

خلفية البحث: أن الجراحة بأستخدام النواظير الداخلية ومن ضمنها ناظور الجوف البطني يعتبر من الممارسات الجراحية الحديثة و المعاصرة و قد سبب التقدم السريع في تقنياتها الى جعلها تخصص جراحي بحد ذاته ومنتشراعالميا و تم أدخاله الى العديد من التطبيقات السريرية لغرض تشخيص و/ أو علاج طيف كبير من الامراض . يعتبر تنظير الجوف البطني عند أجرائه حسب الضوابط القياسية أجراءا سليما و مفيدا. ومن هذا المنظور أستخدمنا تقنية التنظير البطني لدراسة و تقييم بعض من حالات الألم البطني المزمن.الأهداف: تهدف هذه الدراسة الى تقييم المنفعة من أستخدام و تبني أجراء تنظير الجوف البطني في تدبير و معالجة حالات المرضى الذين يشكون من الألم البطني المزمن .الطريقة :هذه دراسة مقطعية لسلسلة من حالات الألم البطني المزمن حيث تمت دراسة و تقييم (49) مريض و بمعدل عمري (35) سنة على مدى ثلاث سنوات . تمت متابعة هؤلاء المرضى لمدة (12) شهرا بعد أجراء فحص تنظير الجوف البطني. تـم أستثناء كل الحالات المشخصة مسبقا كحالة سرطان البطن من هذه الدراسة .النتائج :بينت هذه الدراسة أن (34) مريض (69%) في هذه المجموعة لديهم تأريخ مرضي سابق لجراحة فتح البطن أو الحوض . تبين وجود التصاقات صفاقية في (35) مريض (71%) و تم أجراء فتح الألتصاقات في (31) مريض (63%) منهم فيما لم يجرى اي تداخل في الاربعة الباقيين . كما وجدنا (3) مرضى (6.1%) يعانون من التهاب العقد اللمفاوية المساريقية الذي تبين فيما بعد أنه كان نتيجة لألتهابات المجاري التنفسية العلياالمستتر وتم أكتشاف حالتين لوجود فتق مغبني أيسر (4%) . وجدنا حالة واحدة لمريض يعاني من وجود زائدة دودية غير طبيعية (2%) . كان فحص التظير البطني طبيعيا في (8) مرضى (16.3%) .الأستنتاج :في حالة توفر الأدوات و التقنيات القياسية لأجراء عملية تنظير الجوف البطني مع توفر عناية قياسية لما بعد العملية فأن التنظير البطني يعتبر فحصا أمينا و مفيدا في تشخيص و علاج حالات الألم البطني المزمن.


Article
SONOGRAPHIC EVALUATION OF RIGHT UPPER QUADRANT ABDOMINAL PAIN

Author: Amer H Alkhuzaie
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 1 Pages: 66-69
Publisher: Basrah University جامعة البصرة

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Abstract

A large number of conditions can cause right upper quadrant abdominal pain. The aim of this paper is to report the sonographic abnormalities associated with right upper quadrant abdominal pain in a sample of 155 adult patients from Basrah. During the period from 1st of March to 1st of July 2013, 155 adult patients aged between 20 to 70 years (107 females, 48 males) with right upper quadrant abdominal pain were observed at The Port Hospital and private clinics in Basrah. A detailed medical history was taken and a thorough physical examination was made. All the patients were examined with abdominal ultrasound with aim of detecting any sonographic abnormalities that can help in the diagnosis and treatment of the patients. Eight patients had no sonographic abnormalities, 197 ultra-sonographic abnormalities were detected in 147 patients. Genito-urinary abnormalities were found in 95 patients, hepato-biliary abnormalities were found in 82 patients and gastrointestinal abnormalities were found in 20 patients. In conclusion, genito-urinary sonographic abnormalities found to be the most common sonographic abnormalities associated with upper quadrant abdominal pain as it were found in 95 patients (48%).


Article
Evaluate The Cytokine IL-1α as an Inflammatory Indicator against Isolated Fungi From Patients with Abdominal Pain

Author: Zeana Shaker Al-Hindi
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 497 -503
Publisher: Babylon University جامعة بابل

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Abstract

Acute abdominal pain generally refers to previously undiagnosed pain that arises suddenly and is of less than 48 hours. Fungal infections are considered as one of the most common causes in gastrointestinal disease, but virtually all fungi have been reported to cause infection in immune competent persons as well. Microbiological study was carried on 94 patients having abdominal pain by taking stool and blood from them. At periods from 9-2013 to 2-2014 in General Teaching Hilla Hospital..This study is done to determine the pathogenesis of fungi and the type of immune statue for abdominal pain caused by fungi by estimating concentrations of IL-1α as an immune marker and immuonoglobulins IgG and IgM . The rate of samples that gave positive results for fungal isolate was 60% , while 40%were negative , also the total number of isolated fungi was 12 genera. Cl.cladosporides have a highest rate of isolated fungi was 39.36%,another fungi also appear in stool samples wereCl.nacrosporum20.2% , Al.alternata 13.82% , Candida spp. 11.7%, Cryptococcus 5.31% ,Penicilum2.12% ,Candida albicanus2.12% ,Aspergillus flavas,Aspergillus fumigates ,Candida trubicalis , Candida crusi and Aurobasidium pull in rate 1.06% for each one. Immunological tests to sera of patients with abdominal disorder refer to significance increasing in the concentration of IL-1α for all patients at different age groups, compared to control and the highest concentration of them in the age group 19-26 years (51.371 ± 1.813pg/ml), The immunological study also included measuring the concentrations of each of the serum immunoglobulin IgG and IgM, the concentrations of highest 329 ±83.007, 1388.5 ± 391.645, mg / dL respectively, for different age groups and no significant difference compared with control for IgG while their present in IgM , This study refers to the role of both cellular and humeral immune response through fungal infection with different fungi.Distribute the fungal infection appear in both sex at female60% and male40% .


Article
Postoperative Pain Reduction with Bupivacaine Instillation After Laparoscopic Cholecystectomy

Authors: Sami Hasson --- Firas AL Chalabi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 186-191
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND:Pain occurs frequently following laparoscopic cholecystectomy leading to increased patientsdistress, delayed discharge, increase the need for analgesia and delayed oral intake. OBJECTIVE: To evaluate the effect of bupivacaine instillation on pain relief in the early post- operative periodfollowing laparoscopic cholecystectomy. MATERIALS AND METHODS: Eighty patients having symptomatic gall stones were included in this study. The procedure wasexplained to the patients and informed consent was obtained. The patients were divided into twogroups: group (A) received 40 ml of(0.125%) bupivacaine diluted in 60 ml of isotonic saline(0.9%)instilled in the subdiaphragmatic and subhepatic spaces, the remaining 40ml of (0.125%)bupivacaine were used for wounds infiltration. The post operative pain was assessed by visualanalogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded tothe group of the patients. Group (B) stood as a control group.RESULTS: The two groups were comparable in age, gender, weight, and duration of operation. The maleto female ratio was (1:4), the mean age in both groups were insignificantly different, theirweights ranged from (58- 96) kg. Post operative abdominal pain was significantly lower in group A(bupivacaine group) than group B ( control group) in the first twelve hours.The mean abdominal pain score ranged from (3.85 to 2.55) for the bupivacaine group, and from(6.62 to 3.16) in the control group, the p value is < 0.001which is highly significant in the first 6hours. Group A had a lower incidence of shoulder pain in comparison with the control groupalthough statistically not significant. CONCLUSION: Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly reduces post operative pain


Article
Role of Endoscopic Ultrasonography Guided Celiac Plexus Neurolysis in the Management of Pancreatic Cancer Pain

Author: Rayadh A. Z. Al-Sharifi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 1 Pages: 79-84
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Celiac plexus neurolysis (CPN), a chemical splanchnicectomy of the celiac plexus, is used to treat pain caused by pancreatic cancer. Originally performed by anesthesiologists and radiologists via a posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus neurolysis (CPN) is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior percutaneous approach.OBJECTIVE:To assess the efficacy and safety of EUS guided celiac plexus neurolysis in the management of pain caused by pancreatic cancer.METHODS:This study included (310) patients with painful and inoperable pancreatic cancer were submitted to EUS guided celiac plexus neurolysis (CPN) at a tertiary referral center. The following data were collected: age, gender, tumor location, vascular invasion, adjuvant therapy, and laboratory tests including prothrombin time, and complete blood counts were obtained at baseline (before EUS celiac plexus neurolysis).RESULTS:Of 310 procedures performed, 217(70%) patients develop immediate and complete pain relieves (within 24 hours of procedure) and no need for narcotic analgesia during follows up (12 weeks). Sixty-one (20%) patients had partial response to the procedure (decreasing in the need for narcotic analgesia during follow up). Thirty-two (10%) patients were lost to follow up and no outcome of procedure obtained.CONCLUSION:EUS is more safe, feasible, and more effective than other methods in performing CPN and controls pain caused by unresectable pancreatic cancer.


Article
Comparative study between ultrasound findings and intra-operative findings in non-traumatic Abdominal Pain:
دراسة مقارنة بين نتائج الموجات فوق الصوتية والنتائج أثناء العملية الجراحية في حالات آلام البطن الحادة غير المسببة بالصدمة

Author: Basim R. Gadban باسم رسام غضبان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 4 Pages: 377-380
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: acute abdominal pain is one of the most common presentations in surgical wards. Ultrasound has been grown in popularity as an easy, quick and non-invasive imaging the abdomen. US is very useful means of non-invasively, modality for assessment of acute abdominal pain.Objective: Study of the most common acute none traumatic abdominal diseases in adult patients admitted to Baghdad Teaching Hospital in department of surgery .Correlate the operative findings with sonographic features as to make the initial diagnosis of the diseases included in this study. Compare the diagnostic yield of abdominal ultrasound with that of computed tomography (CT). Methods :The present study included eighty nine consecutive adult patients with non traumatic abdominal pain as their chief complaint were admitted in the department of surgery at Baghdad Teaching Hospital during the period from April 2009 to January 2010.Ultrasound was performed in all patients in addition to CT scan as the first techniquesResults: The results showed that acute non traumatic abdominal pain was more frequently in female patients(73.46%) than male (26.53%).Gall bladder disease was the most common cause of upper abdominal surgeries (n= 45). No differences were observed between surgeries for intestinal obstruction or acute appendicitis(n=6) at P < 0.05 High accuracy of using of US, CT scan in the diagnosis of acute abdominal pain ,the compatibility with the operative finding was %89.79 , 83.33% respectively Conclusion: Sonography should be the first imaging technique in adult patients for the diagnosis of acute abdominal pain. CT scan should be used as a complementary study for suspected abdominal cases.

تعد آلام البطن الحادة واحدة من أهم الأسباب الشائعة لمراجعة المرضى لقسم الجراحة التابع للمستشفيات ويعتبر جهاز الأمواج فوق الصوتية واحدا من أهم الأجهزة المستخدمة على نطاق واسع لتشخيص الأمراض الجراحية نظرا لسهولة استخدامه وسرعته ولعدم اختراقه للبطن وأيضا يعتبر من أهم الأجهزة التي تحدد لنا السبب الرئيسي لألام البطن الحادة .الهدف :دراسة أمراض البطن الأكثر شيوعاً المسببة لألام البطن الحادة غير المسببة بالصدمة للمرضى البالغين الذين ادخلوا إلى قسم الجراحة العامة في مستشفى بغداد التعليمي.ربط نتائج العملية الجراحية مع مميزات الموجات فوق الصوتية لجعل التشخيص الأولي للإمراض المدرجة في هذه الدراسة .مقارنة التشخيص بواسطة الأمواج فوق الصوتية مع تلك بواسطة التصوير الطبقي .طريقة العمل:تضمنت الدراسة الحالية إحدى وتسعون مريضا بالغا يعانون من آلام البطن الحادة كانوا قد ادخلوا قسم الجراحة التابع لمستشفى بغداد التعليمي للفترة مابين نيسان 2009 ولغاية كانون الثاني 2010 وقد تم فحصهم جميعا بجهاز الأمواج فوق الصوتية إضافة إلى جهاز المفراس تشخيص تقني أولي للمرض الذي يعانون منه .النتائج: لقد تم التوصل من خلال الدراسة إلى أن آلام البطن الحادة كانت أكثر تكرارا في النساء المريضات (73.46 %) منه في الرجال (26،53%) . أيضا تم ملاحظة أن مرض المرارة كان من أكثر الأمراض شيوعا بالنسبة للمرضى موضوع الدراسة n=45 والتي اجري لهم تداخلا جراحيا فيما بعد . ولم يلاحظ وجود فروقاً معنوية بين المصابين بالانسدادات المعوية والمرضى المصابين بالتهاب الزائدة الدودية. ولوحظ أيضا دقة عالية لكل من جهازي الأمواج فوق الصوتية والمفراس عند مقارنتها بما تم ملاحظته خلال العمليات الجراحية حيث كانت النسب على التوالي 89،79% و 83،33% .الاستنتاجات :أن جهاز الأمواج فوق الصوتية كان يتمتع بدقة عالية في تشخيص آلام البطن الحادة ويمكننا استخدام جهاز المفراس كجهاز تكميلي للتشخيص التأكيدي للحالات المشكوك بها لبعض الأمراض الحادة . 89،79% و 83،33% .

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