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Article
The outcome of stapedotomy in adult patients with clinical otosclerosis in Erbil

Authors: Hanna Khanano Kasho --- Abdulkhaliq Emin --- Lana Abdul Razaq Dabbagh
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 1 Pages: 1-10
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Otosclerosis is a primary disease of the temporal bone that leads to stapes fixation. Hearing loss and tinnitus are the main symptoms. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. This study aimed to evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in Erbil city.Methods: A retrospective descriptive study. A total of 32 patients with clinical otosclerosis underwent unilateral stapedotomy in the specialized center between September 2011 and September 2013. These included 20 females and 12 males, aged 21 to 48 years, their mean age (±SD) was 31.9 (±10.91) years. Results: The average preoperative and postoperative air conduction threshold was 51.13 and 23.91 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 21.53 and 16.21dB, respectively. The average preoperative and postoperative air-bone gap was 29.03 and 8.51 dB, respectively. All 32 ears (100%) had a residual air-bone gap <10 dB. Conclusion: Stapes surgery showed significant functional hearing outcomes in this study. The very significant reduction in the air-bone gap is a good indicator of the success of the surgery.


Article
COMBINED SURGICAL EXCISION WITH LOCAL INFILTRATION OF VERAPAMIL FOR THE TREATMENT OF KELOID; A CLINICAL STUDY

Authors: Ahmed Mohammed kohil --- Jabir Raheem Hameed
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2019 Volume: 25 Issue: 1 Pages: 48-55
Publisher: Basrah University جامعة البصرة

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Abstract

COMBINED SURGICAL EXCISION WITH LOCAL INFILTRATION OF VERAPAMIL FOR THE TREATMENT OF KELOID; A CLINICAL STUDY Jabir Raheem Hameed* and Ahmed Mohammed kohil@*MB, ChB, FICMS, Consultant Plastic and Reconstructive Surgeon, Al-Sadr Teaching Hospital, Basrah. @MB, ChB, Candidate of CABMS Plastic and Reconstructive Surgery, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Keloid scar is one of the most challenging problems for physicians and surgeons. The current treatment of keloids is based on many ways and modalities which includes medical therapy, combined surgical excision with other modalities, physical treatment etc. The optimal curative treatment remains undefined. This study aimed to evaluate the effectiveness of the surgical excision combined with local infiltration of verapamil to treat patients with keloid. This prospective study involved 20 patients with keloid scars at different parts of the body. These keloid scars were surgically excised with local infiltration of Verapamil. This study was carried out at Al-Shaheed Ghazii Al-Harriri Hospital, Al-Wasity Hospital in Baghdad and Al-Sadr Teaching Hospital in Basrah Between January 2017 and May 2018. The age of the patients ranged between 11 to 44 years. Fourteen of them were females and 6 were males. After one year follow-up period, 11 patients had good results, 5 patients had moderate results and 4 patients had poor results. Patient’s satisfaction in those who had good results was excellent. No serious complications were recorded, only one patient got local wound dehiscence. In conclusion, surgical excision of keloid scar combined with post-surgical verapamil infiltration showed promising results in the management of keloid scar and reduction of its recurrence rate.Key words: Keloid, Scar, Surgery, Excision, Verapamil

Keywords

Keloid --- Scar --- Surgery --- Excision --- Verapamil


Article
MULTINODULAR GOITER AND RISK OF MALIGNANCY, SURGERY OR FOLLOW UP ?

Authors: Ali Yousif Alwajeeh --- Abutalib Bader Al Luaibi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2019 Volume: 25 Issue: 1 Pages: 61-65
Publisher: Basrah University جامعة البصرة

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Abstract

MULTINODULAR GOITER AND RISK OF MALIGNANCY, SURGERY OR FOLLOW UP ? Ali Yousif Alwajeeh@ & Abutalib Bader Al Luaibi* @MB,ChB, CABS, Consultant General Surgeon. MB,ChB, FIBMS, General Surgeon, Almawanee Teaching Hospital, Basrah, IRAQ. Abstract Nodular goiter is one of the most common presentation of thyroid gland diseases. The risk of development of thyroid cancer is relatively rare (1%) of all types of tumors, however, it is the most common endocrine malignancy, and usually presented as multinodular goiter. Fine needle aspiration cytology (FNAC) considered as the golden tool in the diagnosis of thyroid nodule though, it still has false negative rate which is variable depending on the experience and the technique being used. This means that even if the FNAC done prior to surgery shows negative finding, this doesn't exclude the presence of carcinoma, especially in multinodular goiter where it is possible not to sample the involved area. In this prospective study which was done in Almawanee Teaching Hospital between 2012-2018, 69 patients with Multinodular goiter where considered for the risk of harboring an incidental malignancy. The results of patients with multinodular goiter of benign origin was 57 patients (82.86%) while multinodular goiter which has an incidental malignancy was 12 patients (17.14%). Conclusion: due to relatively high risk of malignancy in multinodular goiter especially with noncompliance for follow-up from patients and risk of missing incidental malignancy by FNAC in multinodular goiter, it is preferable to do total or near total thyroidectomy. Key words: Goiter, Malignancy, FNAC, Surgery, Incidence

Keywords

Goiter --- Malignancy --- FNAC --- Surgery --- Incidence


Article
Techniques and suturing used In laparoscopic surgery in animals: Review

Authors: Rafid H. Farman --- Hala Abbas Naji --- Saad Hashim Al-Husseiny
Journal: Al-Qadisiyah Journal of Veterinary Medicine Sciences مجلة القادسية لعلوم الطب البيطري ISSN: 18185746 23134429 Year: 2019 Volume: 18 Issue: 1 Pages: 23-28
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

This review aimed to highlight on laparoscopic suturing techniques and difficulties of these techniques to the surgeon either the instruments used to release these difficulties. The researches confirm that the laparoscopic surgery were more appropriate when compared with conventional open surgery in veterinary medicine, because early recovery due to smaller surgical sites, earlier healing, lower post-operative illness, reduce postoperative pain, lesser infection rate, and the early return to activity. But need more practice and training to increase this skill. One of the most laparoscopic surgeon challenges are suturing and knot tying, so the solution of this problem was more practice and training either, special suture techniques and devices that have discovered by Surgeons and researches to release these difficulties like Side winding technique, barbed sutures, Mechanical Suturing Devices (Endostitch) device, and Mechanical stapling device. The conclusions of this review, the laparoscopic surgery had more advantage than open surgery with low morbidity to the patient. Same suture material and pattern were used in traditional and laparoscopic surgery.

Keywords

Animals --- Laparoscopy --- Suturing --- Surgery --- Techniques


Article
TRANSLIMBAL INTRAOCULAR ENDOILLUMINATION DURING CATARACT SURGERY

Authors: Fareed Warid --- Maha Elshafei
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2019 Volume: 25 Issue: 1 Pages: 37-42
Publisher: Basrah University جامعة البصرة

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Abstract

TRANSLIMBAL INTRAOCULAR ENDOILLUMINATION DURING CATARACT SURGERY Fareed Warid* and Maha Elshafei@*MB,ChB, CABO, FRCS-Ed, Consultant Ophthalmologist, Department of Ophthalmology, College of Medicine, Basrah University, Basrah, IRAQ. @MD, FRCSI, Senior Consultant Ophthalmologist, Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.Abstract The aim of this study is to describe a technique for intraoperative examination of macula and posterior capsule during phacoemulsification surgery in eyes with dense cataract. This work was done in Ophthalmology Department, Hamad Medical Corporation, Doha-Qatar on 36 patients (42 Eyes) with dense cataract and obscured fundus view. No data were recorded for macular status, and preoperative macular assessment was not conclusive by Ophthalmoscopy, B-Scan Ultrasound, and Optical Coherence Tomography (OCT). All patients were consented for cataract surgery plus additional vitreoretinal surgical procedure if indicated. Fundus examination done during phacoemulsification by translimbal insertion of endo-light probe after Irrigation/Aspiration step prior to lens implantation, capsular-bag expanded by viscoelastic to accommodate probe insert. Posterior capsule status checked by Endolight using microscope lens system only, macula checked by endolight with a vitreoretinal viewing lens system. Forty-two eyes (25 right and 17 left), (27 males, 15 females) in 39 patients were studied. The mean age was 59 years (47-78 years). Fourteen patients (18 eyes) were diabetics. Preoperative Visual Acuity of ≤6/60 was recorded in all patients. Cataract Density was graded by fundus visualization and in all cases, only shadow of optic disc and/or major vessels could be seen. Concurrent intravitreal injections was done in eight eyes (19%): seven of them were having Diabetic Macular Edema, and one has hemorrhagic Choroidal Neovascular Membrane (CNVM) due to age related macular degeneration. No complication was recorded in relation to Endoillumination. Posterior Capsule visualization was improved significantly and intracapsular lens implantation was done in all cases In conclusion, translimbal endo-illumination technique improved view to both Macula and posterior capsule during phacoemulsification with subsequent early surgical decision according to endolight findings. No extra incision required. Key words: Surgery, Cataract, Translimbal, Endo-illumination, Phacoemulsification.


Article
Outcomes of Gamma Knife Surgery in the Treatment of Patients with Metastatic Brain Tumors

Author: Abdulameer Jasim Al-Khafaji*, Hayder Ali Al-Saadi**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2019 Volume: 18 Issue: 1 Pages: 1-9
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND:Cerebral metastases are by far the most common intracranial tumors in adults. gamma kniferadiosurgery has arguably been the most important advancement in the management of metastaticbrain tumors since the 1980s.OBJECTIVE:To evaluate the effectiveness of gamma knife radiosurgery as a treatment of metastatic braintumors.METHODS:This is a prospective study (the first trial in Iraq) of 27 patients (42 tumors) of brain metastasisbetween March 2016 and October 2017. Imaging follow up done in 6 months and 12 months,clinical follow up done in 3 weeks and 3 months.RESULTS:In the first six months 81.0% of the MBTs were regressed or remain stable in size. After 3months post GKS, 81.5% patients showed neurological improvement. 82.4% of the patients<65years old survive for 12 months and 85% of patients with KPS>70 survive for 12 months.CONCLUSION:The routine blood investigations, the gender and the location were of no significance on patients’general outcome or the tumor/edema response to gamma knife. Presence of extracranialmetastasis, single or multiple MBTs found to have important effect on patients’ survival.


Article
Gingival recession and periodontal therapy

Authors: Maha A. Aziz --- Monya N. Hassan
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2019 Volume: 31 Issue: 1 Pages: 31-36
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Gingival recession is well-defined by means of the apical movement of the gingival margin below the cementoenamel junction (CEJ), causing in exposure of the root surface and it remains the foremost esthetic complaints of patients. The treatment of gingival recession is depend on a full assessment of the etiological factors and the amount of tissue envelopment


Article
Prevention of hypotension associated with the induction dose of remifentanil in open heart surgery for low ejection fraction patients, in Kurdistan region, Iraq

Author: Othman Ismat Abdulmajeed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 2 Pages: 283-289
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Hypotensive attacks commonly occur during induction of anesthesia and can result in irreversible ischemic damages to the vital body organs. This study aimed to assess the effect of using ephedrine at low doses in controlling hemodynamic changes induced by anesthesia.Methods: A single centered single-blinded, prospective comparative study was conducted in Erbil cardiac center in periods between January 2018 and July 2018. A total of 150 patients with left ventricular ejection fraction <40% and age younger than 80 years were included in this study. They were divided into three main groups; the 1st group was the placebo group, the 2nd group received ephedrine at a dose of 0.035mg/kg body weight, and the 3rd group received ephedrine at a dose of 0.07 mg/kg body weight. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and heart rate were reported in three different phases; before induction, two minutes after induction, and five minutes after induction of anesthesia.Results: In the placebo group, induction of anesthesia by 3mcg/Kg of remifentanil significantly reduces diastolic, systolic, and mean arterial pressure with P <0.001. At two minutes after using ephedrine at the dose of 0.035 mg/kg in the induction of anesthesia significantly increases the diastolic, systolic, and mean arterial pressure with P = 0.002, <0.001, and 0.007, respectively, and at five minutes after induction with P = 0.02, 0.03, and 0.04, respectively. Using ephedrine at a dose of 0.07mg/kg induction of anesthesia was found to significantly increase the diastolic, systolic, and mean arterial pressure with P <0.001 for all the readings. The heart rate was not significantly affected by using remifentanil alone or in combination with ephedrine during induction of anesthesia.Conclusion: Using ephedrine at different doses during induction of anesthesia with remifentanil in patients with low ejection fraction significantly prevents hypotensive attacks.


Article
PENETRATION OF CEFOTAXIME INTO INTERVERTEBRAL DISCS REMOVED FROM PATIENTS UNDERGOING DISCECTOMY

Authors: Thamer A Hamdan --- Mohammed S Hashim --- Nazar S Haddad --- Abdullah M Jawad
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2019 Volume: 25 Issue: 1 Pages: 3-9
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract The intervertebral disc is an avascular tissue, and penetration of antibiotics occurs by passive diffusion. Cefotaxime penetration has not been well studied. The aim is to investigate the penetration of cefotaxime into the intervertebral disc removed from patients undergoing discectomy. Twenty-six patients undergoing discectomy were recruited for this study. They were given one gram of cefotaxime intravenously as a prophylactic antibiotic. Cefotaxime was extracted from nucleus pulposus and serum and analyzed using an HPLC method with cefuroxime axetil as internal standard. Cefotaxime penetrated into all the 26 samples of nucleus pulposus resulting in a mean concentration of 0.66±0.13 µg/gm. The mean serum concentration at time of disc removal was 13.61±3.54 µg/ml. The concentration in 16 samples were below the minimum inhibitory concentration against Staph. aureus with an average of 0.27±0.03 µg/g. There is a statistically significant correlation between time after intravenous cefotaxime administration and its concentration in the nucleus pulposus. The greater increase is in the third hour after administration. Factors like age, body weight, gender, number of associated diseases and surgical history did not seem to affect nucleus pulposus cefotaxime concentration. In conclusion, cefotaxime can penetrate into the nucleus pulposus but its concentration is relatively low. This concentration has a strong positive correlation with time after cefotaxime intravenous administration. Cefotaxime, therefore, needs to be given at least two hours before disc removal, with re-dosing immediately before operation to maintain high serum concentration. Keywords: Surgery, cefotaxime concentration, intervertebral disc, nucleus pulposus, discectomy


Article
LOCAL EXPERIENCE OF TOTAL KNEE REPLACEMENT IN BASRAH

Authors: Thamer A Hamdan --- Khalil I Sadek --- Mohammed AbedYasir
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2019 Volume: 25 Issue: 1 Pages: 10-15
Publisher: Basrah University جامعة البصرة

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Abstract

LOCAL EXPERIENCE OF TOTAL KNEE REPLACEMENT IN BASRAH Thamer A Hamdan@, Khalil I Sadek# & Mohammed AbedYasir* @FRCS, FICS, FACS, FRCP, American Board of Neurological & Orthopedic Surgery, Professor of Orthopedic Surgery. #FICMS, Orthopedic specialist, Basrah Teaching Hospital. *CABHS Orthopedic specialist, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Total knee arthroplasty (TKA) represents a major advance in the treatment of degenerative joint disease providing excellent restoration of joint function and pain relief. This is a prospective study undertaken in the Department of Orthopedic Surgery in Basrah Teaching Hospital, from October 2009 to June 2011. Thirty-three patients who underwent primary total knee arthroplasty were included (25 females 75.7% and 8 males 24.2%). The diagnosis was osteoarthritis in 20 knees and rheumatoid arthritis in 13 knees. The operation included primary cemented TKA (25 cruciate-retaining and 8 cruciate-substituting), by anterior approach. The knee function was evaluated by knee society score system. Preoperative functional knee scores were uniformly poor and improved postoperatively with excellent results in 18 knees (54.54%), good in 9 knees (27.27%), fair in 5 knees (15.15%), and poor in 1 knee (3%). Thus, excellent and good results were achieved in 81.8% of the cases (27 of 33 knees). For knee scores, 2 knees (6%) were fair preoperatively and another 31 knees (93.9%) were poor. Post TKA results were excellent in 28 knees (84.84%), good in 5 knees (15.15%), fair in (0%) and poor in (0%). Excellent and good results were achieved in 100% of cases. The most common complications were superficial infection and deep venous thrombosis In conclusion, this study showed good outcome for total knee replacement surgery in our region. Excellent relief of pain, range of motion, and restoration of function. Keywords: Total Knee Replacement, Osteoarthritis, Rheumatoid arthritis, Basrah, Surgery.

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