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Article
Does fecal continence improve with time after posterior sagittal anorectoplasty for high type imperforate anus?

Author: Ahmed Zubar Zain
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 30-33
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: anorectal malformation represent a spectrum of defects, which may be benign, non complex with a good functional prognosis, to more severe malformations involving the genitourinary system with poor prognosis for bowel and urinary function. Aim: to assess fecal continence after posterior sagittal anorectoplasty (PSARP) with its relation to the post-operative time and to describe the complications of PSARP. Patients and method: this prospective study was conducted in the pediatric surgery department of Al-Kadhymia teaching hospital. The duration of the study was five years from 1st January 2009 to the 31st December 2013.Kelly's methods was applied for assessing the grade of continence after 6 months, one year, and two years after closure of colostomy. Also we describe the complications of PSARP after closure colostomy. PSARP was performed according to Pena method & the results were evaluated after colostomy closure. Results: forty patients with high type imperforate anus were included in this study. They were 25 males (62.5%) and 15 females (37.5%). Genitourinary anomalies were the commonest associated anomalies. There was no accidental defecation in 12 cases (30%) after six months, and 15cases (37.5%) after two years, while there was constant defecation in 4 patients (10%) after 6 months , in 3 patients(7.5%) after 1 year, and in two patients (5%) after two years. Wound infection was the commonest complication and occurred in 8 patients (20%), followed by rectal prolapse in 7 patients (17.5%). Conclusion:Initial poor results should not discourage the surgeon as the condition of the patient and grade of the continence keeps improving as child grows.


Article
Management of Intussusception in Children
عـــــــلاج تداخـــــــــــل الأمعـــــــــــاء عند الأطفـــــــــــــــال

Author: Ahmed Zubar Zain احمـــد زبــــار
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2012 Volume: 25 Issue: 1 Pages: 40-43
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Intussusception is an invagination of one segment of intestine (the intussusceptum) into another segment of intestine (the intussuscipiens) , commonly in a proximal to distal direction. The commonest area to be affected is the ileum intussuscepting into the cecum and ascending colon. Intussusception is a frequent cause of bowel obstruction in infants & children. Aims of the study: To describe the clinical presentation & management of intussusception cases admitted to the Central Teaching Hospital of Pediatric in Baghdad for the period from January 2008 to January 2010.Patients & methods: This study was conducted by patient's relative interview in Central Teaching Hospital of Pediatric in Baghdad for the period from January 2008 to January 2010 .All patients were under (12) years old who were admitted and underwent surgical interference & followed up under the study group, This study for analyzing (80) infants & children.Results: Intussusception was rank as a second most common surgical emergency in pediatric age group (20%) coming after acute appendicitis (35%) among total admission of 400 cases as emergency to our pediatric surgical unit during a period of our study. The peak incidence was between 6 months to 2 years of age & occurred in 55 patients (68.75%), also there was a seasonal variation with increased incidence in spring & winter which correlated with increased episodes of respiratory tract infection & viral gastroenteritis. Thirty-five patients (43.75%) have had duration of symptoms less than 24 hours while forty-one patients (51.25%) had duration of symptoms from one day to one week. Male affected more than the female (50 male: 30 female patients) in ratio of male to female (1.7 : 1). Conclusions: Intussusception is the second common surgical emergency in pediatric age group especially between 6 month – 2 year (which is the typical age group for intussusception).idiopathic type was the commonest type while Meckel's diverticulum considered as the commonest pathological lead point for secondary intussusception which required surgical resection.Recommendations: Early diagnosis and surgical interference are vital in management of intussusception to preserve the bowel & decrease morbidity & mortality.Keywords: Intussusception, Currant jelly stool, Meckel's diverticulum.

خلفية الدراسة :تداخل الأمعاء احد أكثر أسباب انسداد الأمعاء في الأطفال ويعتبر بول بار بيت أول من قام بوصف المرض عام 1670 م.يعتبر لاد أول من نشر صوره أشعة تشخيصية لتداخل الأمعاء.الهدف من الدراسةلوصف التمثيل ألسريري لمرضى تداخل الأمعاء وطريقة علاجهم . طريقة العملهذه الدراسة تمت في مستشفى الطفل المركزي التعليمي في بغداد خلال الفترة من كانون الثاني 2008 إلى كانون الثاني2010 وكان كل المرضى تحت عمر(12) سنه وقد ادخلوا المستشفى وتمت متابعتهم من قبل مجموعة الدراسة.هذه الدراسة لتحليل (80) طفل مصاب بتداخل الأمعاء. وكان عدد الذكور المصابين بهذا المرض (50) بينما كان عدد الإناث (۳0) وبنسبة (۱٫٧:۱).النتائـــــج: تداخل الأمعاء يعتبر من الأسباب الشائعة للحالات الطارئة التي تدخل ردهة جراحة الأطفال وتأتي بالترتيب الثاني وبنسبة (20%) وذلك بعد التهاب الزائدة الدودية( 35%) من بين 400 حاله مرضيه طارئة أدخلت إلى المستشفى خلال فترة الدراسة.كان تداخل الأمعاء أكثر تكرارا بين عمر 6 أشهر وسنتين حيث حدث المرض ل(55) طفل وبنسبة( 68.75%) مع وجود اختلاف موسمي واضح حيث كانت أكثر الحالات حدوثا في الربيع والشتاء وسببه زيادة حالات التهاب المجاري التنفسية والتهاب الأمعاء الفايروسي في هذين الفصلين.خمسة وثلاثون مريض تم تشخيصهم خلال 24 ساعة من بداية المرض وواحد أربعون مريض تم تشخيصهم خلال الفترة مابين الفترة 1-7 أيام من بداية المرض.الاستنتاجات:يعتبر تداخل الأمعاء من أكثر الحالات الجراحية الطارئة في الأطفال بعد التهاب الزائدة الدودية ويحدث بشكل رئيسي مابين عمر 6 أشهر وسنتان.يعتبر تداخل الأمعاء الأولي هو الأكثر شيوعا وتعتبر زائدة ميكل من أكثر الأسباب لتداخل الأمعاء الثانوي.النصائح:التشخيص والتداخل الجراحي المبكر يعتبران عنصرا هاما في علاج تداخل الأمعاء وتقليل المضاعفات التي تحدث نتيجة تأخر التشخيص. .


Article
Ultrasound Value in the Diagnosis of Intussusception

Authors: Ahmed Zubar Zain --- Nael A. Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 392-396
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Intussusception is an invagination of one portion of the intestine into the lumen of an immediately adjoining part.OBJECTIVE:To evaluate the sensitivity and specificity of ultrasound in the diagnosis of intussusception.PATIENTS AND METHODS:This is a prospective study of 50 cases of intussusception in the Central Child s Teaching Hospital in the period between April 2008 and February 2010.forty five patients (90%) were below 6 months and five patients ( 10%) were above 6 monthsMale patients predominated and the male to female ratio was (1.2:1).Seasonal variation was seen in primary intussusception (i.e. in age group of 6 to 24 months old) with peak incidence in spring and summer.Abdominal pain and vomiting were the most common symptoms in intussusception (92% and 88% respectively), followed by bleeding per rectum (76%), abdominal mass was found in 66% and constipation was found in 28%.RESULTS:The diagnostic tool used was the ultrasound for fifty patients; in forty five cases ,diagnosis was made by a characteristic ultrasonic findings of intussusception (i.e. target sign or pseudokidney sign), forty three patients of the group had a classical intussusceptions' mass during operative procedure, the rest (i.e. 2) had negative operative findings for intussusception.5 of the patients, the ultrasonic findings were negative for intussusception preoperatively (no mass), but during surgery we found an intussusception mass.CONCLUSION:So ultrasound study in our hospital gives us sensitivity of 95.5% to diagnose intussusception


Article
A Study of 100 Cases of Stomas Performed in Child’s Central Teaching Hospital in Baghdad

Authors: Ahmed Zubar Zain --- Tharwat I.Sulaiman --- Sara Zuhair Fadhi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 3 Pages: 300-305
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Colostomy is an artificial opening made in the large bowel to divert faeces and flatus to exterior, where it can be collected in an external appliance. As a method of treating intestinal obstruction, colostomies date back to the later part of the eighteenth century, and some of the first survivors of this procedure were children with imperforate anus.OBJECTIVE:To identify the common indications and complications of stoma formation in pediatric age group below two years old.PATIENTS AND METHODS:A total number of (100) temporary colostomies and ileostomies (96 colostomies and 6 ileostomies) were preformed for (100) neonates, infants and children below two years of age in the pediatric surgical department of Child’s Central Teaching Hospital in Baghdad in the period from January 2005 to January 2007.RESULTS:Most of the colostomies and ileostomies (52%) were done in the neonatal period and mainly for imperforate anus (57.6%) and Hirschsprung’s disease (23.8%). Colostomy prolapse was the commonest complication and occurred in twenty patients 20% .the right transverse loop colostomy was the commonest stoma used in our patients and had the higher rate of complications. Prolapse ands skin excoriation were the most common complications in our study.CONCLUSION:Hirschsprung’s disease and imperforate anus were the most common indications of stoma formation in pediatric age group. Prolapse, skin excoriation and wound sepsis were the most common complications after creation of stoma.


Article
Jejunoileal Atresia and Stenosis: a study of 50 cases done in Central Teaching Hospital of Pediatric in Baghdad
تضيق وانسداد الصائم واللفافي: دراسة خمسون حالة في مستتشفى الاطفال المركزي

Authors: Waad M. Salih وعد محمد صالح --- Ahmed Zubar Zain احمد زوبار زين --- Sara Zuheir Fadhil سارة زهير فاضل
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 2 Pages: 121-126
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: Congenital defects in continuity of the intestine are morphologically divided into either stenosis or atresia and constitute one of the most common causes of neonatal intestinal obstruction. Most Jejunoileal atresias result from intrauterine ischemia.Aims of the study: To Criticize and evaluate the surgical procedures that are used in the treatment of jejunoileal atresia & to Identify the postoperative complications.Patients & methods: This study was conducted in Central Teaching Hospital of Pediatric in Baghdad for the period from January 2005 to January 2008. All the patients were under (28) days old that were admitted and followed up under the study group. This study for analyzing (50) neonates with jejunoileal atresia .The number of males were (27) and the number of females were (23) and the ratio of/ male to female is 1.17:1. Results: Thirty one patients (62%) had jejunal atresia while ileal atresia was in(19) patients(38%).The most common type of jejunoileal atresia was type I (30%) of the cases and the second was the type IIIa (20%).The clinical presentation for jejunal atresia was mainly bilious vomiting and occurred in(77%)of the cases, while failure of passing meconeum in the first day of life was the most common presentation in ileal atresia and occurred in (89%) . Conclusions: Jejunal atresia most commonly presents with bilious vomiting while ileal atresia presents with abdominal distension and failure to pass meconium in first day of life. The most common type of the atresia in our study was type I while type IV is the rarest & there are several surgical procedures used in the treatment of atresia but wide proximal resection and end to end anastomosis was the commonest procedure doneRecommendations: Early diagnosis and surgical interference are vital in the management of jejunoileal atresia to reduce postoperative complications especially septicemia.Keywords: Jejunoileal atresia, bilious vomiting, anastomotic leak.

الملخص:خلفية الدراسهالتشوه الخلقي في استمرارية الامعاءيمكن تقسيمه حسب الشكل الضاهري للامعاء الى تضييق او انسداد ويشكل هذا التشوه واحد من اهم اسباب انسداد الامعاء لدى حديثي الولاده.معظم حالات الانسداد الخلقي للصائم واللفائفي ناجم عن قصور في الدم المجهز لامعاء الجنين داخل الرحم.الهدف من الدراسه:لتقييم الطرق الجراحيه التي استخدمت في علاج الانسداد الخلقي للصائم واللفائفي وللتعرف على المضاعفات التي تحدث بعد اجراء العمليات الجراحيه. طريقة العمل:هذه الدراسه تمت في مستشفى الطفل المركزي التعليمي في بغداد خلال الفترة من كانون الثاني 2005 إلى كانون الثاني 2008 وكان كل المرضى تحت عمر(28) يوم وقد ادخلوا المستشفى وتمت متابعتهم من قبل مجموعة الدراسه.هذه الدراسه لتحليل (50) طفل حديثي الولاده مصاب بلانسداد الخلقي للصائم واللفائفي. وكان عدد الذكور المصابين بهذا المرض (۲٧) بينما كان عدد الإناث (۲۳) وبنسبة (۱٫۱٧:۱).النتائج: كان عدد المرضى المصابين بالانسداد الخلقي للصائم (۳۱) وبنسبة (٦۲٪) من المجموع الكلي للمرضى بينما كان عدد المرضى المصابين بالانسداد الخلقي للفائفي (۱۹) وبنسبة (۳۸٪ ).ولقد كان النوع الأول من الانسداد الخلقي للصائم واللفائفي هو الأكثر شيوعا (۳۰٪)ويأتي بعدة النوع الثالث(أ) وبنسبة (۲۰٪).من المجموع الكلي. أن التمثيل السريري للإنسداد الخلقي للصائم كان بشكل رئيسي ناجم عن التقيؤ الصفراوي وقد حدث في(٧٧٪) من الحالات المرضية بينما كان تأخر خروج العق الولادي في اليوم الأول بعد الولادة هو الأكثر شيوعا" في الإنسداد الخلقي للفائفي وبنسبة(۸۹٪ ) . الاستنتاجات:الانسداد الخلقي للصائم يتمثل سريريا بالتقيؤ الصفراوي بينما الانسداد الخلقي للفائفي يتمثل بانتفاخ البطن و تأخر خروج العق الولادي في اليوم الاول بعد الولاده . كان النوع الاول لانسداد الامعاء الخلقي هو الاكثر شيوعا بينما كان النوع الرابع نادرا وقد استحدمت الكثير من الطرق الجراحيه في العلاج ولكن استئصال الجزء المتوسع من الامعاء مع اعادة ربطها كان اكثر الطرق الجراحيه شيوعا.النصائح:التشخيص والتداخل الجراحي المبكر يعتبران عنصرا هاما في علاج الانسداد الخلقي للصائم واللفائفي وتقليل المضاعفات التي تحدث بعد اجراء العمليات الجراحيه وخاصة تسمم الدم الجرثومي.

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