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Article
IS THERE A “FREE SIZE” IN SURGICAL PRACTICE?

Author: Thamer A Hamdan
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 2 Pages: 1-2
Publisher: Basrah University جامعة البصرة

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Abstract

Several parameters should seriously be considered in, almost, every pathology before drawing the line of treatment. Patients are not alike even when they are twins. Individual variation is a reality that should be taken in consideration. On top of this, comes the response to pain. The best example is the delivery of a baby; while one lady shouts loudly, another is very quiet. Some consider the pain stimulus as intense, because of psychogenic factors, while others show a calm response for the same condition.

Keywords

surgery --- practice


Article
Electrosurgery

Author: Riyadh Mohamad Hasan *(MB CHB, CABS)
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2018 Volume: 14 Issue: 1 Pages: 1-3
Publisher: Baghdad University جامعة بغداد

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Abstract

Electrosurgery is the application of a high radio frequency of alternating polarity, electrical current to biological tissue as a means among many functions like cut, coagulate, desiccate, or fulgurate tissue in surgical practice . Many surgeons have faced during their lifetime one or more of the complications of these devices . It is either electrical, laser, ultrasonic and mechanical.


Article
BLEEDING FOLLOWING BARIATRIC SURGERY (TYPES & MANAGEMENT MODALITIES)

Authors: Falih Mohsen Al-Gazgooz --- Abdulkareem Jabbar Ghadban Al-Ebadi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 2 Pages: 49-55
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Bleeding is a serious complication following bariatric procedures such as Minigastric bypass (MGB), Roux-En-Y Gastric Bypass (RYGB) Surgery, and Sleeve Gastrectomy (SG). Post bariatric bleeding is either acute or chronic. Although this complication is declined now, but still it is important to know because if it is not managed urgently it will lead to serious results. The source of bleeding may be from the staple lines, unexpected injury to the spleen, or to one of the blood vessels around the surgical field. The other source of bleeding may be internal through the GIT and it is presented as hematemesis or melena. Gastrointestinal bleeding in patients underwent bariatric surgery may occur in the esophagus, gastric pouch, new sleeved stomach, the Roux limb just distal to the anastomosis, the remaining of the small intestine. The site of bleeding can be determined and treated mostly by endoscopy but in certain cases may require re-laparoscopy. The aim of this study is to analyze the incidence, types and management of this bleeding.This is a prospective study which has been done in Al-Sadr Teaching Hospital, Basrah, Iraq, from June 2015 to June 2017. The study included 540 case who were subjected to SG, RYGB, MGB and they were analyzed regarding; time of occurrence, postoperative bleeding, types whether intra-peritoneal or intra-luminal and type of approaches for treating this bleeding. In our study we don’t over sewn the staple line and didn't use any buttressing material or synthetic coagulation powder. The total number of patients developed post-operative bleeding were 18 cases out of 540, 12 after sleeve gastrectomy, 3 after mini gastric bypass and 3 after Roux-En-Y. Regarding sleeve gastrectomy; two patients of the required re-laparoscopy and evacuation of hematoma with treating site of bleeding by clipping or suturing according to the condition, three patients required aspiration under ultrasound guide, while the remaining 7 cases were kept only under conservative measures. The 3 patient of the MGB were managed conservatively and the 3 cases of Roux-En-Y were managed either conservatively in 2 cases or by endoscopic intervention in one case. In conclusion, we advise the surgeons to use reinforcement of staple line to decrease incidence of post-operative bleeding.


Article
Blood Glucose Level Intraoperatively and Effect on Recovery from General Anesthesia in Non-Diabetic Recipient in Renal Transplant Surgery

Author: Alaa Hussein Altaiee*, Raghad Hannon Alsudani**, Bushra khalid Altamimi***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 2 Pages: 109-113
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Blood glucose increment during surgery is part of stress response, this increment is due to insulin dysfunction and glucose production and hyperglycemia increases complications.OBJECTIVE:Assess glucose level change intraoperatively and effect on recovery in non-diabetic recipients in renal transplant surgery.PATIENTS AND METHODS:52 patients from 1-1-2016 to 1-3-2017 In renal transplant center. all with standardized anesthetic technique, monitoring of blood glucose pre-induction and every half hour, soluble insulin start to be given for patient when blood glucose reach 200mg/dl as 1 unit for each 10 mg above 200 and recovery assessed using aldrete score.RESULT: There is variable increase in blood glucose among patients, 39/52 above 110 mg/dl at pre induction,1 patient was 276mg. 18/52 had 200-250 mg at least once among them,11patients reached 250-300mg,6 patients300-400 and 3reahed above400. 5 patients had delayed recovery with no significance relation to pre-induction level but significant to other readings, risk assessment showed more odd’s ratio for delayed recovery in high glucose reading and assessment of increment from pre-induction is a valid test for delayed recovery.CONCLUSION: Blood glucose measurement is mandatory in non-diabetic in renal transplant recipients..


Article
Nurses' Practices regarding Patients Discharge Planning post Cardiac Surgery at Cardiac Centers in Baghdad city
ممارسات الممرضين المتعلقة بخطة مغادرة المرضى بعد جراحة القلب في المراكز القلبية في مدينة بغداد

Authors: Mustafa F. Abdulrdha مصطفى عبدالرضا --- Kalida A. Mansour خالدة منصور
Journal: nursing national Iraqi specility المجلة العراقية الوطنية للعلوم التمريضية ISSN: 18122388 Year: 2018 Volume: 31 Issue: 2 Pages: 117-128
Publisher: Baghdad University جامعة بغداد

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Abstract

Objective (s): to assess nurses' practices regarding discharge planning post-cardiac surgery and to find out the relationship between nurse practices and demographic characteristic (age, gander, level of education, years of experiences, and years of experiences in surgical ward). Methodology: A descriptive study was carried out at cardiac centers and hospitals in Baghdad (Ibn Al- Bitar specialized center for cardiac surgery; Iraqi center for heart disease and Ibn al Nafees hospital). For the period of 6th February 2017 up to 1st of June 2018. A non-probability (purposive) sample of (58) nurses (male & female) who were working in surgical wards. The data was collected, by using of a questionnaire, which consists of two parts, part (1) demographic data form that consists of (10) items, the part (2) that consists of (7) domains (52) items concerning nurses' practices level checklist was used to collect data from nurses. The validity of the checklist was determined by presenting it to (16) specialist experts and its reliability was determined through a pilot study. The data analysis through using descriptive statistical analysis procedures and inferential analysis procedures.Results: The study revealed that the nurses have poor practices in all aspects regarding patients discharge planning in surgical cardiac wards.Recommendations: Conduct of an educational program regarding discharge planning in order to improve nurses' practices.

الهدف: لتقييم ممارسات الممرضين المتعلقة بخطة مغادرة المرضى بعد جراحة القلب وايجاد العلاقة بين ممارسات الممرضين مع الخصائص الديموغرافية (العمر ، الجنس، المستوى التعليمي، سنوات الخبرة، سنوات الخبرة في الردهة الجراحية) .المنهجية : اجريت دراسة وصفية في المراكز والمستشفيات القلبية في بغداد (مركز ابن البيطار التخصصي لجراحة القلب، المركز العراقي لأمراض القلب ومستشفى ابن النفيس) للفترة من 6 شباط 2017 الى 1 حزيران 2018. اختيرت عينة غير احتمالية( غرضية) متكونة من (58) ممرضاً (ذكور واناث) من العاملين في الردهات الجراحية .جمعت البيانات بأستعمال استبانة مكونة من جزئيين الجزء الأول للمعلومات الديموغرافية للممرضين مكون من 10 فقرات . أما الجزء الثاني والذي تكون من سبعة محاور (52) فقرة متعلقة بممارسات الممرضين استخدمت طريقة الرصد لجمع البيانات من الممرضين. حددت مصداقية الاداة من خلال عرضها على (16) خبير من ذوي الاختصاص وحدد ثباتها من خلال اجراء دراسة مصغرة. كما تم تحليل البيانات باستخدام الأساليب الإحصائية الوصفية و الاستدلالية.النتائج : اظهرت الدراسة أن مستوى ممارسات الممرضين في الردهات الجراحية المتعلقة بخطة مغادرة المرضى بعد جراحة القلب كانت ضعيفة. التوصيات : تطبيق برنامج تعليمي بشأن خطة المغادرة من أجل تحسين ممارسات الممرضيين.


Article
Quality of life after functional endoscopic sinus surgery in patients with chronic rhinosinusitis
نوعية الحياة بعد جراحة الجيوب الأنفية بالمنظار الوظيفية لدى المرضى الذين يعانون من التهاب الجيوب الأنفية المزمن

Authors: Umed Khalid Hasan --- Arsalan Awlla Mustafa Shem
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2018 Volume: 22 Issue: 2 Pages: 172-179
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Chronic Rhinosinusitis characterized by inflammation of the mucosa of the nose and paranasal sinuses. The degree of sinonasal inflammation as measured by CT- scan or endoscopy fails to correlate with the extent of symptoms experienced by the individual patient. This study aimed to evaluate the effect of functional endoscopic sinus surgery in improving symptoms profile and quality of life for patients complaining of chronic rhinosinusitis.Methods: A prospective clinical study extended from January 2013- January 2015 & included 30 patients above 18 years old of chronic rhinosinusitis without polyp who were treated by functional endoscopic sinus surgery. The data were collected and interpreted using Sinonasal Assessment questionnaire -11 (SNAQ-11).Results: A total of 30 patients were included in the study; 18 patients were males (60%), and 12 patients were females (40%). Most of the patients (40%) were among the age group 25-34 years. The result shows no significant association between age and mean difference in SNAQ-11 score. The main preoperative complaint of our patients was the nasal obstruction (100% of patients), followed by nasal congestion (93.3%), and least complaint was sneezing (20%) and earache (20%). There was a statistically significant association between the patient's symptoms and SNAQ-11 score with a significant reduction in the total SNAQ-11 score after surgery.Conclusion: Functional endoscopic sinus surgery performed for chronic rhinosinusitis cases has been associated with significant improvement in the quality of life after 12 months follow up & the best outcome was for nasal obstruction.


Article
Percutaneous endoscopic spinal surgery for lumbar disc prolapse in Erbil city of Iraq: A study on 60 patients
جراحة العمود الفقري بالمنظار عن طريق الجلد بأزالة القرص القطني في مدينة اربيل في العراق:دراسة على 60 مريض

Author: Emad Kh Hammood عماد خليل حمود
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2018 Volume: 15 Issue: 2 Pages: 1-8
Publisher: Diyala University جامعة ديالى

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Abstract

Background: As an alternative to back surgeries, endoscopic spinal operations is the most effective and safe procedure that does not impose the fear reaction to the patients. Objective: In this study the results, complications, and outcomes of 60 patients complaining from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar discectomy (PELD) were reported.Patients and Methods: This is a prospective study conducted in three sentinel hospitals over a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to pre-operative MRI were the main diagnostic methods used for including patients who were suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD.Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24 hours post-operatively. After surgery, patients were followed up for two months to three years with a mean of 18 months. Seven (11.7%) patients developed complications including one (1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified Macnab criteria (excluding patients with long dural tear) showed excellence results for 36 patients, while good results were observed for 17 patients, reasonable results for 3 patients and poor results for 2 patients. The achievement rate was 91.4% .Conclusion:Although endoscopic spinal discectomy is a compelling procedure for management of lumbar disc prolapse, and although its final outcome is reasonable it is not devoid from complications.

خلفية الدراسة: تعتبر عملية جراحة الفقرات عن طريق المنظار طريقة أمنة ومؤثرة وبديلة للطرق الاخرى لعمليات الظهر الجراحية المفتوحة والتي تزيد من التوتر والخوف لدى المريض في اغلب الاحيان . اهداف الدراسة: هدفت هذه الدراسة لتسجيل الطرق والاستنتاجات و الصعوبات التى تم رصدها عند 60 حالة لخلع الفقرات القطنية والتي تتضمن ازاحة اقراص الغضاريف وفيها تم ازالة الغضروف عن طريق المنظار (PELD).المرضى والطرائق: اجريت البحث في قسم الجراحة العصبية في ثلاثة مستشفيات في مدينة اربيل في كردستان العراق خلال ثلاث سنوات ، جميع المرضى الذين اخضعوا للدراسة كان لديهم فتق للقرص القطني في مستويات مختلفة مع الام شعاعية نموذجية ، تم اعتبار الفحص السريري والفحص عن طريق جهاز الرنين المغناطيسي كاساس لتشخيص الحالات ، تم اجراء التقييم السريري مستخدما معيار ماكناب المعدل. تم استخدام عدسات Storz لاجراء عملية ازالة القرص القطني المنظاري المخترقة للجلد (PELD).النتائج: كان معدل زمن العمليات 50 دقيقة . جميع المرضى تم اخضاعهم للمشي خلال 6 ساعات من اجراء العملية وتم اخراجهم من المستشفى خلال 24 ساعة . مدة المتابعة بعد العملية تراوحت بين شهرين الى 34 شهر و بمعدل 18 شهر . تم رصد سبعة (11.7%) مضاعفات بضمنها واحد (1.7%) حالة اصابة عصب shallow nerve ، ثلاثة (5%) تمزق الغشاء الخارجي ، اثنان (3.3%) حالة لفتق القرص المؤقت المتاخر و حالة واحدة (1.7%) لالتهاب القرص مابعد العملية . اظهر تقييم النتائج باستخدام معيار ماكناب المعدل مستثنيا المرض الذين لديهم تمزق للاغشية الخارجية الطويلة اظهرت بان 36 مريض كانت لديهم نتائج ممتازة ، 17 مريض كانت لديهم نتائج جيدة ، ثلاثة منهم كانت لديهم نتائج معقولة ، في حين كانت هناك حالتان بنائج ضعيفة . مع كل ذلك كانت نسبة الانجاز 91.4% .الاستنتاجات : مع ان عملية ازالة القرص القطني المنظاري المخترق للجلد هي طريقة قهرية لعلاج حالات الفتق القطني للاقراص مابين الفقرات و نتائجها معقولة ولكنها لاتخلو من مضاعفات .


Article
Evaluation of postoperative gum chewing role in stimulating bowel motility in colonic surgery
دراسة تقويمية لدور مضغ العلكة في تحفيز حركة الأمعاء بعد عمليات القولون الجراحية

Authors: Layth Q. AL-Harbawia لؤي قاصد الحرباوي --- Luay A. Hasan لؤي عادل حسن
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2018 Volume: 40 Issue: 1 Pages: 60-63
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACTObjective: Postoperative ileus (POI) after abdominal surgery is an inevitable consequence of various etiologies. It causes much discomfort to patients by resultant vomiting, abdominal distention, and prolonged hospital stay; thus, exploring efficient and cost effective solutions could reduce the patients' suffering and hospital stay. This study aimed to evaluate the effect of gum chewing on the duration of POI following colonic surgery.Patients and methods: Ninety patients at Aljumhoory Teaching Hospital from October 2007 to October 2008, undergoing elective large bowel surgeries were randomly assigned to the study group (n=44) and the control group (n=46). Patients in the study group chewed gum 3 times daily for 20 minutes starting from the 1st postoperative day until the return of bowel function. The control group patients had standard postoperative treatment. All patients were assessed clinically and the data were collected using an inquiry forma for every patient.Results: Study and control group patients were comparable at inclusion. The mean time for the passage of first flatus as well as the time for the first bowel movement was shorter significantly in the study group (by 20.4 hours, P=<0.01; by 22 hours, P=<0.01) respectively. The first feeling of hunger was also experienced earlier in study group cases (by 14.7 hours, P=<0.01). The postoperative hospital stay was shorter in the study group, but the difference was not significant (P=<0.1). Conclusion: Early postoperative gum chewing significantly hastens the time of bowel function recovery following colonic surgery. Moreover, it is a cost-effective and well-tolerated treatment for POI.

الخلاصةالمقدمة: الشلل الأمعائي فيما بعد العمليات الجراحية هو نتيجة لايمكن تفاديها ولها أسباب مختلفة، ولأنها تسبب الكثير من المضايقات وعدم الراحة للمرضى بما تسببه من: تقيؤ، وإنتفاخ بطني، ومدة بقاء أطول في المستشفى، فإن حلا فعالا قد يقلل من هذه التبعات.الهدف: تقييم فعالية ودور مضغ العلكة بعد العمليات الجراحية للقولون في تحفيزعملية رجوع الوظيفة للمعي مبكرا.المرضى وطريقة العمل: هذه الدراسة المستقبلية ضمّت 90 مريضا ممن أجريت لهم عمليات جراحية للأمعاء الغليظة، وتم توزيعهم عشوائيا إلى مجموعتين: المجموعة الأولى مجموعة مضغ العلكة، وضمت 44 مريضا والمجموعة الثانية هي عدم مضغ العلكة، وضمت 46 مريضا. تم تقييمهم جميعا سريريا بواسطة جمع المعلومات عن طريق إستمارة إستبيان لكل مريض النتائج: كانت نسبة الإناث إلى الذكور هي 21:24 و20:25، ومعدل أعمار المرضى هو 56 سنة و51 سنة في المجموعة الأولى والثانية على التوالي. كانت الدواعي الجراحية كالتالي: سرطان القولون مع التوصيل المعوي 29 مريضا، سرطان القولون مع تفويه القولون 16 مريضا، الإلتواء المعوي للقولون 15 مريضا وغلق تفويه القولون 45 مريضا. كان وقت أول شعور بالجوع أبكر بـ 14,7 ساعة، ووقت أول خروج للريح أبكر بـ 20,4 ساعة، ووقت أول تغوّط أبكر بـ 22 ساعة في المجموعة التي مضغت العلكة عن المجموعة الأخرى، وكان الفرق مؤثرا إحصائيا، وأما فيما يخص مدة البقاء في المستشفى فهي أقل بـ 0,8 يوما في المجموعة الأولى، لكن الفرق لم يكن مؤثرا إحصائيا.الإستنتاجات: إن مضغ العلكة مبكرا بعد الجراحة يسرع من إسترجاع المعي لوظيفته، وبالتالي تحمل المرضى للطعام عن طريق الفم بصورة أبكر.


Article
Testicular Sparing Surgery For A 5-Year- Old Boy with Sertoli's Cell Tumour of the Testis: Case Report

Author: Karim AL-Araji
Journal: Journal of University of Babylon مجلة جامعة بابل ISSN: 19920652 23128135 Year: 2018 Volume: 26 Issue: 10 Pages: 192-196
Publisher: Babylon University جامعة بابل

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Abstract

Introduction: Steroli's cell tumors SCT are rare testicular tumor. Very few cases were published in the literature. A new case of Sertoli's cell tumor that is reported and treated by testicular sparing surgery.Case Presentation: A 5-year-old boy with Sertoli' cell tumor presents with gynaecomastia and precocious puberty. He was treated by successful testicular sparing surgery. Conclusions: SCTs are rare testicular tumors. Testicular sparing surgery can be applied.

يعتبر ورم سارتولي للخصية من الأورام النادرة و هناك حالات قليلة جدا مسجلة. في هذه المقالة حالة جديدة لورم الخصية تم تسجيلها لحالة ولد عمره 5 سنوات يعاني من تورم الثديين و النضوج المبكر بسبب ورم سارتولي في الخصية اليسرى ومعالجته بعملية المحافظة عليها. و تم الاستنتاج بأن هذه العملية يمكن تطبيقها لمعالجة ورم سارتولي للخصية.

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