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Article
Use of Fiberoptic Bronchoscopy for Removal of Inhaled Endobronchial Headscarf Pins in Adults
استعمال ناظور القصبات المرن في استخراج الدبابيس من قصبت النساء اللواتي يرتدين الحجاب

Author: Alaa Kassar Salih د. علاء كسار صالح
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2015 Volume: 10 Issue: 2 Pages: 175-184
Publisher: Thi-Qar University جامعة ذي قار

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Abstract

Abstract Background: Foreign body (FB) aspiration is a worldwide health problem which can result in a life threatening complications. It most commonly occurs among children younger than 4 years of age, yet inhalation of sharp foreign bodies are seen more commonly in adults.Headscarf pin inhalation is a common and unique form of foreign body inhalation among young Moslem women wearing a hijab. Standard flexible bronchoscopy (FOB) is used increasingly in the treatment of tracheobronchial foreign body inhalation in adults and older children, especially in the removal of inhaled foreign bodies which have entered into the peripheral bronchi.Objectives: The aim of this study is to investigate the success rate of fiberoptic bronchoscopy (FOB) in endobronchial headscarf pin removal, how to minimize complications, and recommend techniques to facilitate the application.Patients and methods: Patients with the diagnosis of headscarf pin inhalation admitted to Al-Kadhimyia teaching hospital, department of cardiothoracic and vascular surgery from January 2013 to September 2014 were included in the study. Standard FOB procedure using an oral approach in recumbent position under local anesthesia and conscious sedation was performed as the primary tool for retrieval, the process was not repeated when the foreign body could not be removed. In these cases, the foreign body was removed by rigid bronchoscopy under general anesthesia.

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Article
Outcome of Vascular Access in Pediatric Haemodialysis of Baghdad Hospitals

Authors: Shatha Hussain Ali --- Ali Sadiq Hassan --- Alaa Kassar Salih
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 435 -444
Publisher: Babylon University جامعة بابل

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Abstract

Vascular access is the ability to enter the vascular system. Three types of vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and central venous catheters (CVC) as permanent or temporary. The Aims of this study are to study the number of each type of vascular accesses,correlationwith some demographic data,complications, survival time and correlation with dialysis adequacy.This is retrospective study based on 55 pediatric patients with CRF receiving maintenance HD in four pediatric HD centers in Baghdad from 1stMarch 2013 till end of March 2014. As for Central venous catheters (CVC), we investigated: number of catheters inserted, insertion site; survival time and; and complications.As for arteriovenous fistula (AVF), we investigated: the number of failed and patent AVF, survival time and the complications.Adequacy of dialysis (Kt/V and URR) was calculated.There was 172 HD vascular accesses in 55 patients; 38 (69.1%) were males and 17 (30.9%) were females. Mean age was 11.9 years.TDL was the commonest VA among patients below 20 Kg (40%), while PDL was commonest among patients with 20 – 30 Kg and above 30 Kg body weight (41.2%) and (47.8%) respectively. For 120 patients (69.8%) temporary dual lumen (TDL) were inserted, and for 27 patients (15.7%) AVF, and for 25 (14.5%) permanent tunneled dual lumen (PDL).Majority of TDL were inserted in right internal jugular veins in 42.98%, and left internal jugular veins in 35.54%. Infection and thrombosis are commonest complications observed in both dual lumen (41.9%, 27.9%),) and AVF (33.3%, 30.1%). Six out of 27 AVF failed to mature (22.2%), Survival time of AVF was 456.3±80.1 days which is more than that of PDL (187.2±36.3 days) and TDL (132.3±1.13 days).Adequate dialysis was seen in 50% of patients dialyzed by AVF, in 26.7% with PDL and in 23.3% with TDL.CVC are the main type of VA used. Infection and thrombosis are the most common complication. AVF provide longer survival time than CVC.


Article
CT -GUIDED TRANSTHORACIC BIOPSY OF SOLITARY PULMONARY NODULES USING AUTOMATIC BIOPSY GUN
اخذ الخزعات النسيجية من العقد الرئوية المنفردة باستخدام بندقيةَ الخزعة الآلية بمساعدة المفراسِ.

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Abstract

Background: CT –guided percutaneous transthoracic fine needle aspiration biopsy (TFNAB) has become a widely accepted and effective minimally invasive technique for the diagnosis of a variety of intrathoracic lesions that are not readily accessible with bronchoscopy. It is generally regarded as a safe procedure with limited morbidity and extremely rare mortality. It provides high diagnostic accuracy and has a relatively low complications rate.Objectives: The aims of our study were to report our experience with regard to the accuracy & pneumothorax rate of percutaneous CT-guided biopsy of solitary pulmonary nodules using automatic biopsy gun.Patients and methods: Between January 2006 and August 2009, 54 patients (46 men and 8 women) with solitary pulmonary nodule underwent CT guided transthoracic biopsy at Al-Kadhimiya Teaching Hospital, Baghdad, Iraq. All the lesions could not be diagnosed with fiberoptic bronchoscopy. CT-guided biopsy was performed with an 18-gauge automatic biopsy gun. Chest radiography was done 2-4hr later and 24hr after biopsy for observation of pneumothorax. The overall diagnostic accuracy, pneumothorax rate, and chest tube insertion rate were determined. Diagnostic accuracy and pneumothorax rate were statistically compared according to lesion size & lesion depth (p value of less than 0.05 was considered to be significant).Results: Forty one patients (76%) diagnosed as malignant (diagnostic accuracy of 87.8%). Thirteen patients (24%) were diagnosed as benign (diagnostic accuracy of 92.3%). The overall diagnostic accuracy was 89% (48 of 54). The diagnostic accuracy did not differ with respect to the lesions size and lesions depth from the chest wall. Accurate diagnosis was made in 25 of the 29 nodules <20 mm (86%) and in 23 of the 25 nodules 20 mm (92%). Similarly accurate diagnosis was made for 36 (90%) of the 40 nodules shallower than 60 mm and for 12 (85.7%) of the 14 nodules 60 mm. Pneumothorax occurred in 23 (42%) patients. Pneumothorax occurred more frequently in small sized lesions (16 out of 29 lesions measuring <20 mm) as compared to (7 out of 25 lesions 20 mm) (P <0.05). similarly pneumothorax occurred more frequently in deeper lesions (10 out of 14 lesions 60mm in depth) as compared to (13 out of 40 lesions <60 mm in depth) (P <0.05). Only 7 (13%) patients requiring thoracostomy tube placement. Conclusions: CT- guided biopsy using automatic biopsy gun allowing a specific diagnosis for benign & probably malignant lesions. Diagnostic accuracy was not affected by the size and depth of the lesions. Deeper & small sized lesions have associated with an increased rate of pneumothorax.Keywords: solitary pulmonary nodule, CT – guided biopsy, automatic biopsy gun

خلفية الدراسة: اخذ العينات النسيجية باستخذام الابرة النحيفة بمساعدة المفراس اصبحت من التقنيات المقبولة جدا و الفعّالة و القليلة التّداخُل لتشخيص العديد من الافات الموجودة داخل الصدر والتي لَيستْ سهلة الوصولَ بسهولة بتنظيرِ القصبات. و يُعتَبرُ عموماً إجراء آمن مع تمارض محدودِ وفناءِ نادرِ جداً. هذه التقنية ذات مستوى عالي من الدقةَ التشخيصيةَ ولَهاُ نسبة تعقيداتِ منخفضةِ نسبيا.هدف الدراسة: كَانتْ تسجيل تجربتِنا فيما يتعلق بالدقةَ التشخيصية ونسبةَ حدوث الاسترواح الهوائي لتقنية اخذ الخزعات النسيجية من العقد الرئوية المنفردة باستخدام بندقيةَ الخزعة الآلية بمساعدة المفراسِ.المرضى و طرق البحث: بين كانون الثّاني 2006 واب 2009, 54 مريض (46 رجل و8 نِساءِ) مصابين بالعقد الرئويةِ الإنفراديةِ تم شمولهم بتقنية اخذ الخزعات النسيجية بمساعدة المفراسِ في مستشفى الكاظمية التعليمي، بغداد-العراق. كُلّ الافات المشمولة بالدراسة لم تُشخّصَ بتنظيرِ قصبات الألياف الضوئيةِ. اخذ الخزعات النسيجية بمساعدة المفراس تم بوساطة بندقيةَ الخزعة الآلية مقياسِ 18. تم اجراء فحص شعاعي للصدر بعد 2-4 ساعة و 24 ساعة بعد اخذ الخزعة لملاحظةِ الاسترواح الهوائي. تم تحديد الدقة التشخيصية العامّة , نسبة الاسترواح الهوائي، ونسبة إدخالِ إنبوبِ الصدرِ. الدقة التشخيصية ونسبة الاسترواح الهوائي تمت مقارنتها إحصائيا طبقاً لحجمِ الأفة وعمقِها (قيمة p أقل مِنْ 0.05 إعتبرت فرقا احصائيا مهما). النتائج: 49 مِنْ اصل 54 حالة (96 %)، اعطت نماذج كافية مِنْ الأفة للتشخيص النسيجي. المرضى الخمسة الذين لم يعطوا نماذج كافية للتشخيص تم اعادة العملية عليهم بعد اسبوع. 41 مريض (76 %) شخّصوا كحالات خبيثة (الدقة التشخيصية 87.8 %). 13 مريض (24 %) شُخّصوا كحالات حميدة (الدقة التشخيصية 92.3 %). الدقة التشخيصية العامّة كَانتْ 89 % (48 من اصل 54). الدقة التشخيصية لَمْ تُختلفْ فيما يتعلق بحجمِ الافات وعمقهاَ مِنْ جدار الصدرَ. التشخيص الدقيق كان في 25 مِنْ العقد الـ29 اقل من20 مليمتر (86 %) وفي 23 مِنْ العقدِ الـ25 اكثر من او مساوي الى20 مليمترَ (92 %). بنفس الطريقة التشخيص الدقيق كانَ في36 (90 %) مِنْ العقدِ الـ40 ذات عمق اقل مِنْ 60 مليمترِ وفي 12 (85.7 %) مِنْ العقدِ الـ14 أعمقِ مِنْ أَو مساويِ إلى 60 مليمترِ. الاسترواح الهوائي حَدثَ في 23 مريض (42 %). حَدثَ الاسترواح الهوائي أكثر في الافات الصغيرةِ الحجم (16 من اصل 29 افة اقل من20 مليمتر) بالمقارنة مع (7 من اصل25 افة اكثر من او مساوي الىِ 20 مليمترَ) (بي <0.05). بنفس الطريقة الاسترواح الهوائي حَدثَ أكثر في الافات الأعمقِ (10 من اصل 14 افة اعمق من او مساوي الى 60 مليمترَ) بالمقارنة مع (13 من اصل 40 افة اقل من 60 مليمتر) (بي <0.05). فقط 7 من المرضى (13 %) احتاجوا الى ادخال إنبوبِ الصدر. الاستنتاجات: تقنية اخذ الخزعات النسيجية من العقد الرئوية المنفردة باستخدام بندقيةَ الخزعة الآلية بمساعدة المفراسِ تعطي تشخيص محدد للافات الحميدةِ والمحتملة الخبيثةِ. الدقة التشخيصية لَمْ تتاثر بحجمِ وعمقِ الافةِ. الافات العمق و ذات الحجم اصغير إرتبطا بنسبةِ متزايدةِ لمعدل حدوث الاسترواح.مفتاح الكلمات: العقدة الرئوية الانفرادية، اخذ الخزعات النسيجية بمساعدة المفراسِ، بندقيةَ الخزعة الآلية .

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