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Article
Desmoid tumors of the abdominal wall:Two cases report

Author: Adel M. Al-Rekabi عادل موسى الركابي
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2008 Volume: 4 Issue: 6 Pages: 151-155
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Desmoid tumors are slow growing deep fibromatoses with aggressive infiltration of adjacent tissue but without any metastatic potential.We report on two female patients with desmoid tumor of the abdominal wall who underwent primary resection and proline mesh repair. Both patients had a history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound,and computed tomography. The histology in both cases revealed a desmoid tumor.Complete surgical resection and proline mesh repair is the first line management of this tumor entity.

اورام الدسمويد هي اورام بطيئة النمو مع ميل شديد نحو اختراق الانسجة المجاورة ولكنها لا تمتلك اية قوة انتشار.تم تسجيل حالتين من الاصابة بورم الدسمويد وهي لمريضتين سبق وان اجريت لهما عمليات فتح بطن(قيصرية)وكان الورم في كلتا الحالتين في جدار البطن عند الجرح القديم المندمل.اجريت فحوصات الامواج فوق الصوتية والمفراس ثم اجريت لهما عملية رفع الورم من جدار البطن مع رفع كامل للتليفات المصاحبة في الجرح السابق بغية منع الانتشار الموضعي للورم وبعدئذ رتقت الهوة المتخلفة في جدار البطن بشبكة من البرولين الصناعي.اثبثت الفحوصات النسيجية الاصابة بورم الدسمويد.

Keywords

Desmoid --- abdominal wall --- surgery


Article
3-ENDOSOCOPIC THYRIOD SURGERY

Author: Ghassan A A Nasir
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2008 Volume: 14 Issue: 1 Pages: 8-13
Publisher: Basrah University جامعة البصرة

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Abstract

Thyroid resection is one of the mostcommon operations performedthroughout the world. This procedure isclassically realized through a transversecervical incision and associated with avery low morbidity and mortality rate.However, the visible scar on theanterior surface of the neck is dislikedby many patients, especially by youngwomen in whom this

Keywords

ENDOSOCOPIC --- THYRIOD --- SURGERY


Article
12- CANCELED SCHEDULED ELECTIVE SURGERY IN OUR PUBLIC HOSPITALS, WHY?

Authors: Jasim M Salman --- Salam N Asfar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2008 Volume: 14 Issue: 1 Pages: 57-61
Publisher: Basrah University جامعة البصرة

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Abstract

Cancellation of operations increasestheatre costs and decreasesefficiency as well as causing emotionaltrauma to the patients and there families.Elective surgery cancellation is asignificant multifactor problem withfar-reaching consequences1. Obviously,all cancellations can not be avoided.Patients may have a change in theirmedical condition on the day of surgerywhich can not be expected or there isunpredictable condition in the hospital.Most problems, however, can beprevented with a little initiative as wenoticed that in private hospitals all thesereasons may be of negligiblesignificance.Postponing

Keywords

CANCELED --- ELECTIVE SURGERY


Article
Single Dose Antibiotic Prophylaxis in Outpatient Oral Surgery Comparative Study

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Abstract

It is clear that correct application of antibiotic prophylaxis can reduce the incidence of infection resulting from the bacterial inoculation in a variety of clinical situations; it cannot prevent all infections any more than it can eliminate all established infections. Optimum antibiotic prophylaxis depends on: rational selection of the drug(s), adequate concentrations of the drug in the tissues that are at risk, and attention to timing of administration. Moreover, the risk of infection in some situations does not outweigh the risks which attend the administration of even the safest antibiotic drug. The aim of this study was to compare between 2 prophylactic protocols in out patients undergoing oral surgical procedures. Thirty patients, selected from the attendants of oral surgery clinic in Al-Karamah Dental Center, were subjected to different oral surgical procedures under local anesthesia. These patients were given single dose antibiotic prophylaxis in 2 groups; 1st group were 15 patients given 1 million i.u. of procaine penicillin I.M. 30 minutes before oral surgery, 2nd group were 15 patients given 600mg clindamycin orally 1 hours before oral surgery. The maximum time for all procedures was 2 hours. There was no difference between procaine penicillin (1 million i.u.), and clindamycin (600mg), regimens concerning post operative infection in out patient’s oral surgical procedures.

من الواضح أن التطبيق الصحيـح لإعطاء المضــــادات الحيوية لإغراض وقائية يمكن أن يقــلل نسبة حدوث االاختــلاطات البكتيرية الناتجة من النمو البكتيري بسبب عــدد من الحالات السريريــة المتنوعة. إن التطبيـق ألصحيح لا يمنع كل الاختلاطات البكتيرية ولكنه يستطيع التخلص من الاختلاطات الموجودة فعلا. إن النتيجة االأفضل للتعامل الوقائي للمضاد الحيوي يعتمد على الاختيار المنطقي للعقار المعطى والتركيز الكافي للعقــار (المضاد الحيوي) في النسيج المهدد بالاختلاط البكتيري والانتباه للتوقيت عند إعطاء المضاد الحيوي . من الجدير بالذكر مخاطر بعض الاختلاطات البكتيرية لاتستدعي إعطاء المضاد وهو أمرله سلبياته حتى مع أكثر المضادات أمانا.إن غـرض هذه الدراسة هو المقارنـة بين بروتوكولين علاجيين وقائيين للمرضى الذين يخضعون لتداخلات جراحية في العيادات الجراحية لطب الأسنان (تحت التخدير الموضعي). تم اختيار ثلاثون مريضا من قبــل المراجعين الذين يزورون قسم الجراحة في مركز الكرامة التخصصــي لطب الأسنان حيث تم إخضاعهــم لتداخلات جراحية متنوعة تحت التخدير الموضعي. هؤلاء المرضى ، تم إعطاؤهم جرعة مفردة من عقـار البروكاين بنسلين وهي مليون وحدة عالمية وتم إعطاؤها عضليا (للمجموعة الأولى المكونة من 15مريضا) وعقار الكـلندمايسين 600 ملغم عن طريق الفم ( للمجموعة الثانية وتضم 15 مريضا) لــم يتجاوز الوقـت اللازم لإجراء التداخلات الجراحية ساعتان.كانت النتيجة انه لم يكن هناك أي اختلاف بين المجموعتين من ناحية عدم حدوث الاختلاطـات البكتيريــة بعد التداخل الجراحي الفموي بأنواعه.


Article
The Effect of Flap Design on Wound Healing after Periapical Surgery: A Comparative Study.

Author: Mohammad S. Suleiman
Journal: Al-Rafidain Dental Journal مجلة الرافدين لطب الأسنان ISSN: 18121217 Year: 2008 Volume: 8 Issue: 1 Pages: 120-127
Publisher: Mosul University جامعة الموصل

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Abstract

Aims: To assess the clinical effect of different flap design that used in periapical surgery and their
relation to untoward postoperative sequel. Materials and methods: Forty five patients were included
in the present study, they were divided randomly into three groups, each comprised of (15) patients. In
the first group, apicectomy was done using intrasulcular triangular (2–sided) flap. Whereas, in the
second group, a submarginal (Luebke–Ochsenbein) scalloped 2–sided flap was used. While in the third
group, a new experimental (straight mucogingival) 2–sided flap was tested. Postoperative healing was
evaluated clinically in regard to oedema, alteration of soft tissue colour, recession of marginal gingiva,
extent of scarring, and closure of the wound site. Assessment was done at 2, 7, 15 and 30 days
postoperative intervals. Results: Comparison among the three study groups was performed. Statistical
analysis revealed significant differences in the results of experimental flap over the other two types in
regard to oedema, colour and wound closure with the superiority of the former on the latter flaps. Both
experimental and Luebke–Ochsenbein flaps showed significant differences from intrasulcular incision
in their effect on gingival recession. In contrast, scarring was less evident in intrasulcular flap followed
by experimental flap while in Luebke–Ochsenbein incision, this complication was significant.
Conclusion: This study; however, revealed that the experimental flap allows for rapid and recession
free healing following periapical surgery. In addition, inflammatory changes persist for longer time in
the intrasulcular and submarginal (Luebke–Ochsenbein) incision than in experemintal incision. So it
was concluded that the new flap design could provide an alternative.


Article
A Abdominal T uberculosis in Yemen

Author: Salem A.H.AL-SARRAF
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 1 Pages: 1-10
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: tuberculosis is an endemic disease in Yemen. Abdominal Tuberculosis (AT) is the most common extra pulmonary manifestation of the disease.The clinical picture can be non specific.Laparoscopy is the most accurate diagnostic method but has its limitation depending on presentation. The aim of this study was to present the common clinical manifestation and the
different type of Abdominal TB,the surgical procedure used,the morbidity and
mortality of the disease.
Patient and Methods: This is a prospective study of 48 patients with Abdominal TB who were
admitted to Kuwait University hospital in Sana'a-Yemen between Jan 2002-Dec
2004.fourteen patients (29%) were treated medically with Anti TB drugs.Thirty
four patients (71%) required surgical Intervention for diagnosis and treatment.
Results : Thirty two patients (67%) were female ,16 patients ( 33%) were male with a ratio of 2:1 .Fifty percent of patients were in age group 20-40.The most common symptom was Anorexia (94%) abdominal pain (92%) fever (90%).The most common signs were Abdominal mass ,ascitis and abdominal tenderness.Smeares and culture of ascitis fluid were negative for A.F.B. . Out of the 34 patients who required surgical treatment ;17 patients (50%) had Tuberculous peritonitis,32% had tuberculosis of intestine, and 17%had tubeculous mesenteric lymphadenitis.Complication rate was 50%,and mortality was 9%.
Conclusions: Diagnosis of Abdominal TB should be suspected in patients of abdominal pain with vague clinical presentation coming from endemic areas.not all patients present with ascitis and whene ascitis is present smears and culture are usually negative for A.F.B. Laparoscopy has its limitation Surgery should be avoided unless complication occur and should be conservative.Tube drains can be used with no fear of TB Sinus.


Article
The Effect of Tranexamic Acid (Cyclokapron) on Post–Surgical Bleeding Following the Removal of Impacted Lower Wisdom Teeth in Healthy Individuals

Authors: Wael T. Al Wattar --- Wafaa K. Fathi --- Rayan S. Hamid
Journal: Al-Rafidain Dental Journal مجلة الرافدين لطب الأسنان ISSN: 18121217 Year: 2008 Volume: 8 Issue: 2 Pages: 225-230
Publisher: Mosul University جامعة الموصل

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Abstract

Aims: To evaluate the effect of local irrigation with tranexamic acid in minimizing post–operativebleeding following the removal of impacted lower wisdom teeth. Materials and Methods: This clinicaltrial was conducted at the Department of Oral and Maxillofacial Surgery / College of Dentistry / Universityof Mosul. The sample recruited comprised twenty healthy subjects who required surgical removalof clinically as well as radiographically evident impacted lower wisdom teeth. The sample wassubdivided into two groups of ten subjects each. The first group which is the control group included tensubjects where after removal of the tooth, local irrigation of socket was carried out with normal saline.The second group which is the trial group comprised ten subjects also, but in which tranexamic acid(injectable solution) in diluted form was used for local irrigation of socket. Both solutions were of equalamount. Estimation of amount of blood loss immediately following surgery was the criterion for comparisonand was based on weight of gauze used before and after application over extraction socket. Results:The results showed a statistically significant decrease in the amount of blood loss in the trialgroup when compared with the control group. Conclusions: Tranexamic acid as commercially availableor freshly prepared oral rinse may be used as an aid for the reduction or prevention of postoperativebleeding following the removal of third molars in healthy subjects as well as in patients with bleedingproblems.


Article
Faecal (Lower Enterocutaneous) Fistula after Colonic Surgery (Analysis of Its Occurrence & Recurrence)

Author: Haytham Hazim
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2008 Volume: 7 Issue: 2 Pages: 40-45
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: One of the major complications of colonic resections is anastomotic leak that may convert in some cases into permanent faecal fistula, presented with discharge of faecal material from the site of the wound or drain.Objective: To know the incidence of faecal fistula after colonic surgery, and to analyse the associated factors that enhance or reduce its formation and its recurrence. Method: A prospective study of one hundred and thirty seven patients who were undergone colonic surgery in the period from Jan.1996 to Jun.2005. Those patients were followed up for at least one month after the operation of the anastomosis of the colon. The operations were done for different pathologies or lesions. All of the operations in this study were elective with bowel preparation, while 126 patients (92%) had previous colostomy because of an urgent operation in the past.Results: It had been found that the majority of the operations on the colon were closure of the colostomy (92%), especially that due to missile injuries (75.5%). Anastomotic leak appeared in 14 cases (10.2%) of the total operations, ten of them closed spontaneously with conservative treatment and the remaining 4 cases (2.9% of the total) transformed into faecal fistulae. All of these fistulae were in the patients originally injured by high energy missiles. Re-operation for those four patients, after bowel preparation, included excision of the fistula with resection of the affected segment of the colon and reanastomosis. The fistula disappeared in three of them but recurred in the fourth.Conclusions: Although mortality reduced markedly in elective colonic operation, by the modern surgery, faecal fistula still remains a challenge to the surgeons. Bowel preparation, prophylactic antibiotics, good vascularity of the ends of the colon, proper approximation of the ends of the colon without tension, delicate suturing, prevention of perioperative hypotension, and good nutrition of the patient; all are prophylactic measures against formation of the fistula. Once the fistula was formed, then simple suture closure of the fistula alone is not beneficial, preferably resection of the affected segment of the colon is indicated.


Article
Urgent surgery in hydatid cyst disease
عاجل عملية جراحية في مرض كيس عداري

Author: Hamid H. Sarhan
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2008 Volume: 1 Issue: 141 Pages: 99-105
Publisher: Tikrit University جامعة تكريت

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Abstract

Hydatid still represents a serious problem in endemic areas. Medical treatment, aspiration of the cyst, laparoscopy, and surgical intervention all were used in the treatment of hydatid cyst. This study was assessing cases of hydatid cysts presented as urgent cases; in respect to their location, age and sex, type of presentation, surgical procedures, and results of surgery. Out of 94 patients operated upon for hydatid cyst, 20 were urgent. Urgent presentation included obstructive jaundice, infected hydatid cysts with intra-abdominal abscess formation and a patient with pressure effect on the cerebral hemisphere. Type of surgical treatment depends on site of the cyst, size of the cyst, and type of complications. The liver was affected in 18 out of the 20 urgent patients; one affected the spleen, and another the brain. The average age of the patients was 44.5 years; 13 were females (67%). Ten patients were operated upon for obstructive jaundice, 6 for intra- abdominal abscess, 3 for intraperitoneal rupture of the hydatid cyst, and one patient was sent to the neurosurgical department due to cerebral hydatid cyst. The mean hospital stay was 12 days .Postoperative complications followed four operations including one of billiary fistula, and two of persistent obstruction of common bile duct following surgery for obstructive jaundice; while one patient developed subphrenic abscess following operation for intra-abdominal abscess in the spleen. No mortality occurred. Most of the cases of hydatid cysts are operated upon selectively. Urgent hydatid cysts patients are of great concern to the surgeons in endemic areas. Obstructive jaundice represents the most common cause of urgent hydatid cyst surgery and is associated with highest morbidity and hospital stay. Despite the high morbidity and long hospital stay following urgent surgery, no mortality occurred and all the patients discharged in good condition

عداري لا يزال يمثل مشكلة خطيرة في المناطق الموبوءة. العلاج الطبي، وتطلع من الكيس، تنظير، والتدخل الجراحي كل استخدمت في علاج كيس عداري. وكانت هذه الدراسة تقييم حالات الخراجات العدارية كما عرضت الحالات العاجلة، في احترام لسنهم، والموقع والجنس، ونوع من العرض، والعمليات الجراحية، والنتائج من عملية جراحية. من أصل 94 مريضا تعمل عليها لكيس عداري، كان 20 عاجلة. وشملت عرض عاجلة اليرقان الانسدادي، الكيسات العدارية المصابة مع تشكيل الخراج داخل البطن والمريض مع تأثير الضغوط على نصف الكرة المخية. نوع من العلاج الجراحي يعتمد على موقع للكيس، وحجم الكيس، ونوع من المضاعفات. تأثر الكبد في 18 من أصل 20 من المرضى العاجلة، واحدة أثرت على الطحال، وأخرى في الدماغ. وكان متوسط ​​عمر المرضى 44.5 سنة و 13 من الإناث (67٪). تم تشغيل عشرة مرضى على لاليرقان الانسدادي، 6 لداخل البطن خراج، 3 للتمزق داخل الصفاق من كيس عداري، ومريض واحد تم ارساله الى وزارة جراحة الأعصاب بسبب كيس عداري الدماغي. كان يعني البقاء في المستشفى 12 يوما مضاعفات ما بعد الجراحة بعد أربع عمليات بما في ذلك واحدة من ناسور billiary، واثنين من العرقلة المستمرة من القناة الصفراوية المشتركة بعد عملية جراحية لاليرقان الانسدادي؛. في حين وجد أن أحد المرضى خراج تحت الحجاب بعد عملية داخل البطن خراج في الطحال . لم تحدث وفيات. ويتم تشغيل معظم الحالات من الكيسات العدارية عليها بشكل انتقائي. عاجل كيسات عدارية المرضى هم من قلق كبير للجراحين في المناطق الموبوءة. اليرقان الانسدادي تمثل السبب الأكثر شيوعا لجراحة عاجلة كيس عداري ويترافق مع أعلى معدلات الاعتلال والإقامة في المستشفى. لم تحدث وفيات على الرغم من ارتفاع معدلات المراضة والمستشفى لفترات طويلة البقاء بعد عملية جراحية عاجلة، وجميع المرضى الذين خرجوا في حالة جيدة


Article
Renal Impairment After Valvular Heart Surgery in Adult

Author: Wadhah A. Mahbuba
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 347-350
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Cardiac surgery can either induce acute renal failure or improve GFR by improving the cardiac performance. Acute renal shutdown (urine output <0.5ml/kg/hr.) is an uncommon but fatal complication which occurs in cases of insufficient cardiac function and may be accompanied with multi-organ failure. Acute renal failure (ARF) after open heart valve surgery occurs in about 8% of adult cardiac surgical patients with some preoperative renal impairment and in about 3-4% of patients with normal preoperative renal function test. This study was done to determine the frequency of acute renal shutdown after valvular open heart surgery and to detect any suggestive risk factors.METHODS:90 patients undergoing valve replacement (mitral and/ or aortic) were prospectively evaluated in three time periods: before, 24 hours after surgery and 48 hours after surgery. The association between preoperative, intra-operative and postoperative variables and the development of ARF was assessed thoroughly.RESULTS:Of the 90 consecutive patients 3 (3.49%) patients developed acute renal failure (serum creatinine>2.5 mg/dl) and 16 (18.6%) patients developed acute renal dysfunction (serum creatinine 1.6-2.4 mg/dl). The risk factors that were noted in the development of ARF were age, raised preoperative blood urea and creatinine, low cardiac output state, diabetes mellitus, oligurea, total cross clamp time total CPB time, and significant hypotension during the procedure or during intensive care unit (ICU) stay. Mortality rate for established ARF was extremely poor (50 %).CONCLUSION:Avoidance of this dangerous outcome looks better than trying to treat once it is fully established.

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