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Article
Outcome of Endoscopic Endonasal Dacryocystorhinostomy in Karbala, Iraq

Authors: Nadhim Omran Khadhim --- Ahmed Abdullah Alwan --- Imad Salih Mehdy
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2017 Volume: 10 Issue: 2 Pages: 2702-2708
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Dacryocystorhinostomy (DCR) is an operation that has been used for the past 100 years. Endoscopic endonasal DCR is less invasive than external DCR; therefore, it has rapidly gained acceptance for the treatment of intractable nasolacrimal duct obstruction and chronic dacryocystitis. Many ophthalmologists still believe that external DCR is the gold standard treatment for nasolacrimal duct obstruction. However, because incision of the facial skin is required, patients are reluctant to undergo external DCR.Objectives: To analyze the results of Endonasal Endoscopic Dacryocystorhinostomy regarding complications and success rate. Methods: A prospective study was carried out on 26 patients at Department of Otolaryngology, Al-Hussian Teaching Hospital, Karbala during the period September 2013 to November 2016. Patients presented with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in this study. Endonasal Endoscopic Dacryocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacryocystorhinostomy tube. Complications during and after the procedure were recorded. Results: Out of total 26 patients 23 (88%) were females and 3 (12%) were males (F:M=7.7:1). The age range was 6 to 60 years with a mean age of 33 years. The duration of symptoms ranged between 8 months to 6 years. There were only 2 (8%) patients had bilateral symptoms while the other 24 (92%) patients had unilateral symptoms. Average duration of endoscopic DCR was 60 minutes. DCR tube was removed 6 months after operation in 24 (92%) patients and in 2 (8%) patients, it was removed after 3 months. Complications encountered during and after surgery were, haemorrhage in 4 (15%), ecchymosis in 2 (8%), nasal adhesions in 2 (8%), granulations at osteotomy site in 1 (4%), retrograde tube displacement in 2 (8%) patients. Overall, 24 (92%) patients were symptom-free 6 months after the removal of the tube. Out of the remaining 2 (8%) patients, one patient underwent revision surgery and was symptom-free 6 months after the removal of the tube whereas the other refused revision surgery. Overall success rate of endonasal DCR was 25 (96%). Conclusions: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.


Article
Patients’ and Clinicians’ Perception of Facial Esthetic Improvement as Determinant of Successful Orthosurgical Treatment

Authors: Wisam Wahab Al-Hamadi --- Fayez Saleh
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 1 Pages: 1-7
Publisher: Babylon University جامعة بابل

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Abstract

The purpose of this study was to compare patients’ and clinicians’ perception of facial esthetic improvement after orthognathic surgery. 22 adult females who underwent orthosurgical correction of certain dentofacial deformity were randomly selected with an average age of 24 years. Pretreatment and post-treatment set of good quality and standardized colored photographs (7 photographs for each patient) were collected and displayed in separate folders for evaluation. Structured open-ended questions were answered by evaluators and rated their perception on a percentage scale. Linear multiple regression analysis showed significant differences between patients’ and clinicians’ satisfaction with the orthosurgical outcome. There was a lower correlation between the patients’ self-ratings and that of the same patients by the orthodontist and the maxillofacial surgeon. The results indicated that the patients were not significantly impressed despite the esthetic improvement and due to relatively high cost of the orthosurgical procedures. Overall patients’ satisfaction rating was significantly lower than orthodontists (r = -0.07, p = 0.77) and maxillofacial surgeon (r = 0.07, p = 0.76). On the other hand, both orthodontist and maxillofacial surgeon had moderate significant association (r = 0.54, p = 0.009). Maxillofacial surgeons rated significantly higher than the orthodontist on the scale and much higher than the patients’ ratings.


Article
6.CHOLELITHIASIS FOLLOWING BARIATRIC SURGERY: A NEW APPROACH TO DEAL WITH

Authors: Sajid H.A. Al-Helfy ساجد حميد الحلفي --- Qasim S. Almayah قاسم شرهان المياحي --- Risala H. Allami
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 2 Pages: 143-150
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Obesity and rapid weight loss induced by weight-reducing surgery are well recognized as a risk factor for the development of gallbladder stones. There is no standard policy whether to perform prophylactic cholecystectomy at the time of the bariatric operation or to give postoperative treatment to decrease the risk.Objective: To evaluate the incidence and risk factors of gallstone formation post-bariatric surgery. The results may help to decide how to deal with and follow up patients with post-bariatric surgery.Methods: A total of 120 patients who underwent weight-reducing operations were recruited for this study. Several factors expected to influence gallstone formation were recorded such as body mass index and excessive weight loss. Study population was followed up for 12 months postoperatively. Ultrasonography examination was performed for those who developed symptoms suggesting gallstone formation.Results: Twenty-six (21.7%) patients were found to develop gallstones. Of the studied risk factors, the percentage of excess weight loss, family history and carrying allele A of the variant rs670 were significant for predicting development of gallstone post-bariatric procedures. Conclusion: Based on the results of this study, it is reasonable to put an index for the risk of developing gallstone following bariatric surgery, and according to this index, the surgeon could decide whether to perform concomitant cholecystectomy along with the bariatric procedure or do not.Keywords: Bariatric surgery, cholelithiasis, single nucleotide polymorphismCitation: Sajid H.A. Al-Helfy, Qasim S. Almayah, Risala H. Allami. Cholelithiasis following bariatric surgery: a new approach to deal with. Iraqi JMS. 2017; Vol. 15(2): 143-150. doi: 10.22578/IJMS.15.2.6


Article
Dental Students' Views of their Clinical Cognitive Skills, Qualitative Study

Author: Faaiz Alhamdani
Journal: Journal of Oral and Dental Research مجلة طب الفم والاسنان ISSN: 23106417 Year: 2017 Volume: 4 Issue: 1 Pages: 12-24
Publisher: Iraqi Association for Oral Research الجمعية العراقية لبحوث طب الفم

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Abstract


Article
Impact of Age, Procedural Duration and Impaction Type on Pain and Trismus After Surgery of Mandibular Wisdom Tooth

Author: Ahmed Salah Hameed Al-Noaman
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 2 Pages: 353 -360
Publisher: Babylon University جامعة بابل

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Abstract

This study assessed the impact of patient's age, duration of surgical procedure and type of impaction on pain and trismus after surgery of impacted mandibular wisdom tooth.Successive patients with impacted mandibular wisdom tooth were recruited. Winter's classification was used to classify impacted teeth. Surgical removal of impacted teeth was done using local anesthesia. The effect of age, duration of surgical operation and pattern of impaction on post-operative pain and trismus was studied after 3 and 7 days. Visual analogue score (VAS) was used to assess pain, trismus was measured as the inter-incisal distance using manual caliper and duration of surgical procedure was defined as the period between incision and finishing of suturing. Seventy nine patients with age ranged 15 to 41 years were recruited. The highest percentage were male gender (57%). The highest pain VAS score was recorded in the age group (30-41) after 3 days and the lowest mouth opening was seen in the same population after 3 and 7 days. The mean of operation time was 38.5 and its effect after < 20 minutes recorded the least pain score and trismus after 3 and 7 days. Highest pain score and more trismus were related to horizontal impaction on day 3 (p=0.04, p=0.000); whereas lowest pain value and better mouth opening were related to vertical impaction.Postoperative pain and trismus increased with advancing age, operation time and horizontally impacted tooth and trismus did not resolve within short time and may last for more than 10 days..


Article
Safety and Outcomes of Retrograde Semi-Rigid Ureteroscopy in the Treatment of Renal Pelvic Stones by Using Holmium: YAG Laser.

Authors: Mohammad Noori Al- Musawi --- Jasim Hassn Almail --- Riad Rasheed Toama --- Nabel Kareem Kadom
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 4 Pages: 688 -693
Publisher: Babylon University جامعة بابل

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Abstract

The aim of this study was to evaluate the clinical utility, safety and outcomes of semi-rigid ureteroscopy in the treatment of single renal pelvic stones by using Holmium: YAG laser lithotripsy.Hundred patients (56 females, 44 males), aged between (11) and (67) years (mean 41.5 years), with single renal pelvic stone range from 13-27 millimeter (mean size 21.8 millimeter). Inclusion criteria (any patient with single renal pelvic stone less than 30 millimeter in size regardless its composition and previous history of any urological intervention and the stone is visualized by uretroscope), treated with semi-rigid ureteroscopy by using Holmium: YAG laser for stones pulverization. DJ-stent had been inserted to all patients following stone fragmentation. Preoperative data, as well as stone free rate, operative time and associated perioperative complications were evaluated.The primary stone free rate (which was assessed by Ultrasonography and plain abdominal X-ray) was sixty-eight percent (68 patients) at the first postoperative day, which increased to eighty-six percent (86 patients) after one month by using ancillary procedures such as Extra Corporeal Shock Wave Lithotripsy and medical treatment. the operative time was ranges from 44.3 to 97.8 minute (mean of 72.4 minute), there was no major perioperative complications.The study can conclude that Reterograde semi-rigid ureteroscopy using holmium: YAG Laser is effective and safe option for managing single renal pelvic stone less than 27 mm.


Article
PROPOFOL - REMIFENTANIL VERSUS MIDAZOLAM - FENTANYL IN CORONARY ARTERY BYPASS GRAFT SURGERY AND INTENSIVE CARE UNIT
پروپوفول - ريميفينتانيل مقارنة ب ميدازولام - فينتانيل في عمليات زرع الشرايين التاجية والعناية المركزة

Authors: ABDULQADIR M. ZANGANA عبدالقادر زنكنة --- OTHMAN ISMAT ABDULMAJEED عثمان عصمت عبدالمجيد --- TWANA TAHER QADER توانا طاهر قادر
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2017 Volume: 11 Issue: 1 Pages: 38-46
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background: In this study, we aim to identify the efficiency of propofol-remifentanil anesthesia in reducing the postoperative intensive-care unit stay in patients undergoing cardiac surgery in our center, without compromising the hemodynamic stability.Subject and Methods: Two hundred patients undergoing first time elective coronary artery bypass graft surgery were recruited in this single-centered, single-blinded, prospective and controlled study. Study patients were randomized into two treatment groups: group 1 (P-R; Propofol-Remifentanil) (n=100 patients) and group 2 (M-F; Midazolam-Fentanyl) (n=100 Patients). Clinical measurement of Mean arterial blood pressure and heart rate for each patient were recorded before (T1) and after (T2) induction of anesthesia; after sternotomy (T3) and before cardiopulmonary bypass (CPB) (T4). Time from cessation of anesthesia to tracheal extubation was also recorded (T5).Results: Comparing the hemodynamic parameters between the two groups at T1, T2, T3 and T4 set points revealed statistically significant difference (P < 0.5) in hemodynamic variables in all parameters measured apart from HR at T3. The mean recorded times from cessation of anesthesia to tracheal extubation (T5) were 99.32 minutes and 183.33 minutes in group 1 and 2, respectively. A statistically significant difference was noted between T5 in both groups (P value = 0.003).Conclusions: Our study has shown that Propofol-Remifentanil anesthesia helps to reduce the time interval between cessation of anesthesia and extubation and, by doing so, it can potentially reduce the postoperative ICU stay, without compromising hemodynamic stability

خلفية وأهداف البحث: في هذه الدراسة، هدفنا هو ايجاد فعالية دواء الپروپوفول- ريميفينتانيل لغرض تقليص وقت بقاء المريض في العناية القلبية بعد العملية لمرضى عمليات زرع الشرايين التاجية في مركزنا، دون التأثير على استقرار الفعاليات الحيوية.طرائق البحث: مائتين مريض تجرى لهم عملية زرع شرايين تاجية لاول مرة. مئة من المرضى اعطوا تخدير البروبوفول مع الريميفينتانيل ومائة مريض اعطوا تخدير الميدازولام مع الفينتانيل. المعلومات جمعت قبل اعطاء التخدير (ت١)، بعد اعطاء التخدير (ت٢)، بعد فتح عظم القص (ت٣)، قبل عمل جهاز القلب الصناعي (ت٤).(ت٥) كان الوقت بين ايقاف التخدير لحين اخراج انبوبة القصبة الهوائية. تمت المقارنة بين المجاميع للمعلومات التي جمعت.النتائج: كان هناك فرق واضح في قراءات الدورة الدموية في ت١، ت٢، ت٣ و ت٤ بين المجموعتين.الاستنتاج: بالنسبة للوقت من قطع التخدير ولغاية اخراج انبوب القصبة الهوائية كان اقصر لمجموعة البروبوفول مع الريميفينتانيل وكان وقت اخراج الانبوبة اقصر. المجموعتين من الادوية كانت امينة ومستقرة فيها فعاليات الدورة الدموية اثناء عملية زرع الشرايين التاجية.


Article
The Effect of Anesthesia on Thyroid Hormones and Cortisol Levels Following Major Urological Surgery
تأثير التخدير على مستويات هورمونات الدرقية والكورتيزول بعد الجراحات الكبرى للمسالك البولية

Authors: Fayhaa M. Khaleel فيحاء مقداد خليل --- Ihsan A. AL-Shammari احسان علي الشمري --- Noor N. Oda نور نايف عوده
Journal: Baghdad Science Journal مجلة بغداد للعلوم ISSN: 20788665 24117986 Year: 2017 Volume: 14 Issue: 4 Pages: 751-755
Publisher: Baghdad University جامعة بغداد

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Abstract

This study was designed to evaluate the effect of anesthesia on thyroid hormones (T3, T4, rT3), thyrotropin(TSH), and cortisol levels in patients undergoing major urological surgery. The study included fifty patients scheduled for elective major urological surgery where 70% of the patients underwent general anesthesia, while30% underwent regional anesthesia. All patients were in stable control general conditions. The study showed that the thyroid hormones, thyrotropin and cortisol levels were affected with general anesthesia more than regional. The levels of these hormones responded to anesthetics and surgical stresses. This response was thought to be mainly mediated by afferent neurogenic impulses from the area of injury. Therefore, abolition of sensory as well as autonomic afferent stimuli by neurogenic blockaded types of anesthesia such as (epidural anesthesia) that may help in reducing the excretion and metabolic response to surgery.

أجريت هذه الدراسة لتقييم تأثير التخدير على تغير مستويات هورمونات الدرقية والهورمون المحفز للدرقية , والكورتيزول. ضمت الدراسة ( (50مريضا خضعوا لعمليات جراحية بولية اختيارية(غير طارئة) كبرى حيث 70% من المرضى كانوا تحت تأثير التخدير العام و 30% تحت تأثير التخدير الموضعي. لوحظ ان مستويات كل من (T3, T4 TSH, and Cortisol) تأثرت بالتخدير العام اكثر من تأثرها بالتخدير الموضعي، ووجد ان مستويات هذه الهرمونات تستجيب لأجهاد الجراحة والتخدير وان هذه الاستجابة تكون بواسطة نبضات عصبية قادمة من منطقة الاصابة لذلك فأن استخدام كابح عصبي مثلا(التخدير الموضعي) للتحفيز اللاارادي قد يساعد في الحد من استجابة الغدد الصماء و التمثيل الغذائي لتأثير الجراحة.

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