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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: 2009 Volume: 8 Issue: 1 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
A mucosal Flap for Periapical Surgery

Author: Dr. Lukman Fawzi Omar . B.D.S, M.S.C د.لقمان فوزي
Journal: MUSTANSIRIA DENTAL JOURNAL مجلة المستنصرية لطب الاسنان ISSN: 18138500 Year: 2009 Volume: 6 Issue: 3 Pages: 256-261
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

The function of flap is to raise the soft tissue overlying the surgical site to give the best possible view to the operator and sufficient exposure of the area to be operated on with minimal postoperative complications.The objective of this study is to evaluate a new flap design for exposure of periapical lesion, also to compare it with other common flaps used in periapical surgery.The study include 107 young patients apicectomized for one, two, or three anterior teeth from January2007 to June 2008, age ranged between 18-30 years old, using special case sheet.The flap has given good access to one, two or three apices apicectomized with less postoperative complications including pain, swelling, parasthesia of lip and wound healing.The flap described is an alternative approach to reach the periapical area that may be used to overcome the disadvantages of other flap designs used in periapical surgery.


Article
Non-Metastatic Breast Cancer : Clinical Presentation and Patterns of Surgical Treatment

Author: Abdulhadi J. Tlefih عبد الجليل طليفح
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2009 Volume: 5 Issue: 1 Pages: 40-46
Publisher: Baghdad University جامعة بغداد

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Abstract

Background : Breast cancer is the most common cancer of women. When breast cancer is detected and treated early, the chances for survival are better. Surgery is the most important treatment for non-metastatic breast cancer.Al-Kindy Col Med J 2008 Vol.5(1) 40 Original ArticleObjectives : The aim of this study is to review different clinical presentation and to evaluate types of surgical procedures and complications in treatment of non-metastatic breast cancer.Method : During the period from Jun 1998 to May 2005,93 patients with non-metastatic breast cancer werediagnosed and treated surgically in 2 hospitals in Baghdad (Hammad Shihab military hospital and Al-Kindy teachinghospital).Results : Women constituted ( 98.93% ), while menconstituted (1.07%), with male to female ratio of (0.01:1).The peak incidence of non-metastatic breast cancer (25.8%)was at age group 51-60 years, while (60.2 % ) of caseshappened in women over 50 years of age. The right breastwas the most common side affected, and the upper outerquadrant of the breast was the most common locationaffected by cancer. Painless lump (91.4%) was the mostcommon symptom, and the hard lump was the mostcommon sign (100%).The highest frequency of cases was diagnosed in stage IIfollowed by stage III, and invasive ductal cancer was themost common histopathologic type.(87.1 %) of patients underwent modified radical mastectomy, while (12.9%) underwent breast-conservation surgery. Breast-conservation surgery carried higher incidence of recurrent disease than modified radical mastectomy (33.3% vs.13.6%).Conclusion : The majority of patients with non-metastatic breast cancer were over 50 years of age, and the preponderance were diagnosed in stage II. Modified radical mastectomy may be preferable method for treatment as it carries a lower rate of local or distant recurrence than conventional breast-conservation surgery procedures.Key words: Non-metastatic breast cancer,


Article
Out-patient surgical prophylaxis Prospective study

Authors: Dr. Ali jabbar B.D.S, M.Sc د.علي جبار --- Dr. Taha Y. H. B.D.S, H.D.D, M.Sc. . د. طه ياسين --- Dr. Jabbar jasim kareem B.D.S, M.Sc. د.جبار جاسم
Journal: MUSTANSIRIA DENTAL JOURNAL مجلة المستنصرية لطب الاسنان ISSN: 18138500 Year: 2009 Volume: 6 Issue: 4 Pages: 376-380
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Antibiotic prophylaxis in oral surgery is well established practice; still there is no specific protocol followed in Iraqi dental surgical centers. The aim of this study is to compare between efficiency of 3 prophylactic protocols in preventing post operative infection and reducing healing period in out patient’s oral surgical procedures. Forty four patients, selected from the attendants of oral surgery clinic in college of dentistry Almustansiriyah University, were subjected to different oral surgical procedures (45 operations) under local anesthesia. These patients were given single dose antibiotic prophylaxis in 3 groups; 1st group were given 1 million i.u. of procaine penicillin (15 cases), 2nd group were given 500 mg ampicilline vial (15 cases), 3rd group were given 1 gm amoxicillin (15 cases). The maximum time for all procedures was 2 hours. We conclude that there is no difference between ampicilline (500mg), procaine penicillin (1 million i.u.), and Amoxicillin (1 gm) regimens concerning post operative infection, while patients of the 1st group healed in a shorter period than other two groups.


Article
Unilateral Sinonasal Disease: analysis of the clinical, radiological and pathological features

Author: Azzam M.A. Salami* FIBMS د. عزان محسن عباس عبد الحسين
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 4 Pages: 372-375
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary:Background: Unilateral sinonasal disease is commonly encountered during the practice of the otolaryngologists, the etiology include a wide variety of diseases ranging from simple acute inflammation to highly malignant diseases. The clinical, computed tomography and histopathology differs between inflammatory and neoplastic diseases.Patients and Methods: A prospective study carried out at the Otolaryngology department, Baghdad Medical City, Hospital of specialized surgeries between Jan.2007 to Nov.2008.The study involved 114 patients with symptoms and signs of unilateral sinonasal disease, a careful history, complete clinical examination and radiological investigations were done to all patients as well as flexible nasoendoscopic examination. Sinonasal surgery under general or local anaesthesia with histopathological examination of the removed tissues was done to all patients.Results: Chronic rhinosinusitis with or without nasal polyposis is the commonest cause of a unilateral sinonasal disease (33.3%), followed by antrochoanal polyp (20%) , mucor mycosis (16.7%), benign tumors (13.1%), allergic fungal sinusitis (9.6%) and then malignant tumors (7.6%) in that order. Male gender and the right side were predominant. Purulent discharge and foul odor were the commonest presenting symptoms under inflammatory conditions, while frequent epistaxis, facial swelling and exophthalmos were the main symptoms in neoplastic diseases. Calcifications were observed on CT scan mainly in patients with allergic fungal sinusitis, while bony erosion and destruction was detected in both malignant tumors as well as mucor mycosis, the pattern and extent of bony destruction is more sever in malignant tumors. Conclusion: Chronic rhinosinusitis with or without nasal polyposis is the commonest cause of unilateral sinonasal disease. History, clinical examination, endoscopic as well as radiological examinations are important to reach the diagnosis. However, histopathological confirmation remains obligatory. Keywords: Unilateral sinonasal disease, unilateral sinus opacity, sinus surgery.


Article
Atypical Presentation of Thoracic Outlet Syndrome in Kurdistan of Iraq
عرض غير نمطي لمتلازمة مخرج الصدر في كوردستان العراق

Author: Zohair Mohsen Ahmad Al-saffar
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 1 Pages: 12-16
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of neurovascular structures at the superior aperture of the thorax which presents with varying symptoms The aim of this study was to analyze the different kinds of clinical presentation of thoracic outlet syndrome in Kurdistan region of Iraq and its management.Methods: In Erbil teaching hospital, 150 patients have been studied from February 2000-December 2006. These patients diagnosed as symptomatic thoracic outlet syndrome and have been managed conservatively and surgically.Results: In this study 97 (64.6%) patients were female, 53 (35.3%) patients were male. Their ages ranged from (17-40) years. There was pain, parasthesia in arm in 69 (46%). Shoulder pain, chest pain and pain in axillarys region with arm pain in 38 (25.3%) patients (diagnosed by cardiologist as they have cardiac problem and treated accordingly without benefit). Incidental findings in 27 (18%) patients with vague symptoms in upper limb, supraclavicular fullness in 2 (1.3%) patients, 12 (8%) patients diagnosed by psychiatrist as having psychological problem (misdiagnosed as obsessive or depressive cases because of there neck pain and headache) and one patient has wasting of hand muscles. Surgery done for 25 (20.5%) patients (supra clavicular approach).Conclusions: Careful patients history and proper physical and clinical evaluation including nerve conduction study, conventional radiography of cervical spine can decide proper management for symptomatic cases conservatively or surgically.


Article
Clinical outcomes of acute appendicitis in children and the impact of diagnostic delay on its complications.

Author: Hassen K. Gatea*, F.I.C.M.S
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 2 Pages: 189-195
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background:Acute appendicitis is the most common condition in children requiring emergency abdominal surgery. The key to a successful outcome is early diagnosis followed by appendectomy before gangrene or perforation develops.:Aim of study:To analyze the time of presentation and complication s of acute appendicitisPatients and Methods:This is a retrospective study conducted in Al –Mustansiria Hospital over a period of three years from January 2005 to January 2008 .Data were collected from the patients case sheets. The patients were then divided into two groups according to the length of diagnostic period , group A including those children who presented in the first 48 hours after the onset of symptoms, and group B including those children who presented beyond the 48 hours after the onset of symptoms. Then the patients were subdivided into three age groups (<5 years,5-11 years ,and> 11 years).Results:Total number of (105) children with acute appendicitis were operated upon in Al-Mustansiria Hospital over a period extending from January 2005 to January 2008.63 (60%) were males and 42 (40%) of the patients were females; and the male to female ratio was 1.5:1. 38(36.2%) children fall into group A, while 67(63%) children fall into group B. Perforated appendicitis was observed in 25 out of the 105 patients (23.8%) when differentiated by age, perforation is more common in young children, both in group A and group B. Perforation were more frequent in group B compared to group A, 21 out of 63 (33.3%) and 4 out of 42 respectively. This was associated with higher incidence of post operative complications, 4 out of 42(9.5%) in group A and 21 out of 63 (33.3%) in group B (p>0.05). Four children from group A with non perforated appendix had wound infection .Of those cases in group A , non had perforation and non had postoperative paralytic ileus .Wound infection was observed in15 out of 63of children in group B(23.8%).Postoperative praralytic ileus was observed in 6 out of 63children in group B(9.5%).Postoperative complication in both groups.Conclusion:Appendicitis is the commonest surgical emergency in children .Diagnosis is mainly clinical .Delay in diagnosis and improper treatment increases morbidity .


Article
ENDOSCOPIC SINUS SURGERY VERSUS CONVENTIONAL METHOD IN MANAGEMENT OF NASO-ETHMOIDAL POLYPS AND THEIR ASSOCIATED INTRANASAL ABNORMALITIES
جراحة الجيوب الناظورية بالمقارنة مع الطرق التقليدية في علاج الزوائد اللحمية للأنف والجيوب الغربالية مع الأختلالات الأنفية المصاحبة

Author: Hiwa As’ad Rawandzi هيوا أسعد عبد الكريم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2009 Volume: 7 Issue: 2 Pages: 93-103
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: This is a prospective and comparative clinical study, implemented in department of Otolaryngology –Sulaimani Teaching Hospital, from Aug. 1st 2006 to Nov. 1st 2007.Objectives: This study was carried out to compare the influences and outcomes of endoscopic sinus surgery versus conventional intranasal method in management of patients with nasal polyps, which is the most common intranasal swelling.Methods: The sample of the study includes 50 patients’ aged 12-75 yeas old that are managed for nasal polyp, thirty patients managed by conventional method and twenty patients were managed by endoscopic sinus surgery.Patients are observed postoperatively by symptomatic score and endoscopicallyResults: Endoscopic sinus surgery resulted in better improvement in symptoms, better treatment of other associated sinonasal pathologies, less complication rate,and less recurrence rate than conventional polyoectomy.On the other hand endoscopic sinus surgery is more technically demanding and needs more operative time than the conventional way.Conclusion: We concluded from the study that Endoscopic Sinus surgery is better than conventional intranasal polypectomy, as endoscopy provides approximate field of vision and illumination, good access, hidden pathology are revealed and managed, and complication, recurrent rate are less.Keywords: nasal polyp, conventional polypectomy, endoscopic sinus surgery

خلفية الدراسة: هذه دراسة سريريه مقارنة أجريت في قسم الأنف والأذن والحنجرة-مستشفى السليمانية التعليمي من الأول من آب 2006 لغاية الأول من تشرين الثاني 2007 .هدف الدراسة: أجريت هذه الدراسة لمقارنة تأثير ونتائج جراحة الجيوب الناظورية بالمقارنة مع الطرق النقليدية في علاج المرضى المصابين بالزوائد اللحمية التي تعتبر من اكثر الأنتفاخات الأنفية شيوعا.طريقة العمل: شملت عينة الدراسة خمسون مريضا تتراوح اعمارهم بين 12 الى 75 سنة مصابون بالزوائد اللحمية الأنفية ثلاثون منهم عولجوا بالطرق الجراحية التقليدية وعشرون منهم عولجوا بجراحة الجيوب الناظورية.تم متابعة المرضى بعد اجراء العمليات الجراحية باستخدام معايير الأعراض المرضية والفحوصات الناظورية0 النتائــج: أظهرت النتائج إن جراحة الجيوب الناظورية ادت الى تحسن افضل في الأعراض وعلاج الأختلالات الأنفية المصاحبة مع انخفاض نسبة المظاعفات ونسبة تكرار الحالة المرضية.ومن جهة اخرى تتطلب جراحة الجيوب الناظورية خبرة عالية ووقت اكثر لأجرائها من الطرق التقليدية.الاستنتاج: استنتجنا من الدراسة ان جراحة الجيوب الناظورية افضل من الطرق الجراحية التقليدية في علاج الزوائد اللحمية الأنفية لأنها تعطي مجال رؤيا اقرب مع اضاءة افضل مع الوصول الى موضع الخلل بشكل افظل وان الأختلالات الغير ظاهرة ممكن الوصول اليها وعلاجها وان المضاعفات وتكرار حدوث الحالة المرضية نسبتها اقل.مفتاح الكلمات: الزوائد اللحمية الأنفية,استئصال الزوائد اللحمية التقليدي,جراحة الجيوب الناظورية.

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