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Article
ANTHROPOMETRIC STUDY OF PUBIC TUBERCLE AND ITS CLINICAL IMPLICATIONS

Author: Thaer M Farhan ثائر محمود فرحان
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 4 Pages: 308-311
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

BackgroundAbdominal wall is the site of opposing physical forces that may eventually result in the appearance of the hernias. The external abdominal hernias are the most common forms, the inguinal hernia being the commonly encountered type [75% of the abdominal hernia]. Many factors are responsible for the formation of the inguinal hernia but, what makes a few people more susceptible to this situation is still clearly not proved. Few of the previous studies have concluded that the low lying pubic tubercle is associated with the development of the inguinal hernia.ObjectivesThis study was designed to investigate the distance between the anterior superior iliac spines and the perpendicular distance of the pubic tubercle from the interspinal line.Methods50 males with inguinal hernia compared with the control group comprising of 60 adult healthy males.ResultsThis study revealed that both parameters (interspinal SS distance and the pubic tubercle height ST) in the study group were significantly greater than that in the control group. The distance from mid inguinal point to the superficial inguinal ring was also measured in both the study and control groups and the results show that the distance is shorter in the individuals with the inguinal hernia. Identification of the structural characteristics of inguinal region enables the surgeon to perform the surgical technique appropriately.ConclusionThe low pubic tubercle group of cases has more tendencies for herniation. The unusual origin of internal oblique muscle in group II with low lying tubercle is far away, from the external half of the inguinal ligament, leaving the internal ring unprotected during abdominal muscle contraction, which is another causation of hernia development.Key words Inguinal hernia, pubic tubercle, inguinal canal, anterior superior iliac spine


Article
Sub- Inguinal Varicocelectomy in the Treatment of Infertile Males with Varicoceles

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 323-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is a disease of puberty and is only rarely detected in boys less than ten years of age.OBJECTIVE:Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III varicoceles.METHODS:A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18 to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles. All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all of them were sexually competent. Physical examination was performed with no apparent other clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination, color Doppler ultrasound was done for further documentation of the patient's condition. Only patients with grade II and grade III primary varicoceles were included in the study with exclusion of those with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The patients were followed for one year.RESULTS:The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% ) developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6 % ) developed hydrocele .CONCLUSION:Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can be achieved with successful results and minimal complications without microsurgery as long as they are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non microscopic one, the later can be done successfully with shorter operative time


Article
Analysis of Open Tension Free (Mesh plug and patch) Inguinal Hernia Repair
دراسه تحليليه لعملـــــــية رتق الفتق المغبني المفتوحـــــه بالشــــبكه(الســـد ّاد و الرقعـــــه)الخاليه من الشــَـــد

Author: Amer Hassan Salman د.عامر حسن سلمان
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2011 Volume: 24 Issue: 2 Pages: 138-146
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Inguinal hernia repair is the most frequent operation in general surgery. Until recently the standard has been open musculo-aponeurotic repair using sutures under tension to close the defect, but tension-free repair using prosthetic mesh is becoming increasingly common and considered the standard procedure. Many procedures have been used but still the most effective surgical technique is unknown. Objective: Assessment of open tension free (Mesh plug and patch) inguinal hernia repair regarding early return to normal activity, postoperative pain, complications and recurrence rate.Methods: A prospective study of (73) patients with inguinal hernia operated upon, in Al- Yarmouk Teaching Hospital (from Oct. 2005 to Oct. 2009) using the technique of open tension-free inguinal hernia repair (plug and mesh). The data was collected in the proforma designed for the study. The operative time, severity of post operative pain and analgesia, hospital stay, early mobilization, early and late complications and early return to activity, were all assessed.Results: The operative time was (36 minutes), there is mild postoperative pain that relieved by short term analgesia, and the time for return to activity was after (3-7days) and this was in 59 (95%) patients, and the time interval before carrying out the most strenuous activity was 14 days and it was in 42 (91.3%) patients out of 46 employed patients. There was mild scrotal swelling, Hematoma in 4(6.5%) patients, mild Seroma in one (1.6%) patient, surgical site infection (SSI) in 3(4.8%) patients, no one required surgical interference, one patient (1.6%) had groin hyperesthesia and one patient developed mild swelling relieved after 30 days. There is no recurrence and no chronic disabling pain.Conclusion: Using open mesh plug and patch inguinal hernia repair showed reduced post operative pain, early rehabilitation, early discharge (6 -24 hours) and early return to activity ( after one week) and no recurrence In comparison to other studies using the other open technique, this method looks to be superior to conventional tension repair of inguinal hernia in term of rehabilitation, early return to activity and recurrence. Key words: Inguinal hernia, open mesh plug and patch, repair

الهــــــدف: تقييم عملية رتق الفتق المغبني المفتوحه بالشــــبكه (الســــداد والرقــــــعه) الخاليه من الشــــَد , وسرعةالرجوع الى النشـــــــاطات الطبيعيه من بعد العملــــــــيه ,والم مابعد العمليه, والمضاعفات والفتق الراجع0الطريقــــــه: دراسه مستقبليــــــه ل 73 مريض أجريت لهم عملية رتق الفتق المغبني المفتوحه بالشــــبكه (الســــداد والرقــــــعه) الخاليه من الشــــَد , في قسم الجراحـــــه في مستشفى اليرموك التعليمي خلال (2005-2009) جمعت المعلومات في استماره خصصت للدراسة حيث تمت متابعة مابعد العملـــــيه في الاسبوع الاول والثاني والرابع وبعدها شهريا ً, تم فيها ملاحظـــــــــة(الوقت الذي إستغرقته العمليه , وشدة الالم بعد العمليه , والأدويـــــه المســّـــكنه والمضادات الحياتيه , وفترة البقاء في المستشفى , وعقابيل العمليه القريبه والبعيدة الأمـــد).النتــــــائج: كان الوقت المســــــتغرق اثناء العمليه بمعدل(36)دقيقه، كانت فترة النقاهــــــه قصيره والرجوع الى النشاط الطبيعي بعد (3-7)ايام من العمليه وكان هذا في 59(95%)مريضاً،وكان الرجوع الى الأعمال الشديده ،هي 14 يوماً حيث تمكن42 (91%)مريضا ً من الرجوع الى اعمالهم السابقه. لوحـَظ الم بسيط في العمليه تم علاجه بمسكنات لفترة قصيرة ،ولوحظ تورم بسيط في كيس الصفن عند 4(6,5%) مريض وتجمع بلازمي عند مريض واحد (1,6%)والتهاب سطحي لجرح العمليه عند 3 (4,8%) لم يحتاجوا الى تداخل جراحي و خدر في المنطقه المغبنيه عند مريض واحد (1,6%) وانتفاخ في العمليه عند مريض واحد(1,6%)ولم نلاحظ رجوع للفتق ولم نحصل على مرضى يعانون من الالم المزمن.الإســــــتنــــتاج:عملـــــية رتق الفتق المغبني المفتوحه بالشــــــبكه(الســــــد ّاد والرقعـــــــه)اظهروا الما ً بسيطا ًمابعد العمليه وســــرعه في النقاهــــــه والخروج من المستشفى المبكر (6-24) ساعه,وسرعة الرجوع الى النشاط الطبيعي (3-7)ايام بعد العمليه وبالمقارنه مع دراســــات اخرى استعملت طرق اخرى لإجراء العمليه تبين إن هذه الطريـــــــقه هي أرقى من العمليه التقليديه لرتق الفتق المغبني مقارنة ًفي سرعة النقاهه ومعــــاودة النشاط الطبيعي وعدم رجوع الفتق.

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