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Article
Anal Fissure Treatment by Medication and Surgery

Author: Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 323 -329
Publisher: Babylon University جامعة بابل

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Abstract

Anal fissure is a most common cause of anal pain [1].This prospective study includes 236 patients complaining of anal fissure treated from a period of September 2013 to December 2015 to assess options of management of anal fissure. Male patients were 121 (51%) and female were 115 (49%). All patients were clinically assessed in an outpatient clinic and conservative treatment started to all patients that shown to be effective in 141 patient (60%). Surgical treatment applied to 95 patients (40%)whom not responded to conservative treatment, or, patients with recurrent fissure. Lateral sphenectrotomy was the surgical procedure applied in open or close method (62 and 33 patients respectively), under local or general anesthesia (54 and 41 respectively). Local anesthesia was associated with a significant low duration of admission from 1 to 24 hours (mean of 3 hours) while general anesthesia with a significant higher duration of 12 to 36 hours (mean of 19 hours). The healing rate following surgery in a local or general anesthetic approach was 95%. No difference in a healing rate between open or closed technique of sphenectrotomy. Flatus incontinence was reported in 3 patients. Initial treatment of anal fissure should be conservative, lateral sphenectrotomy is a safe procedure with a high cure rate, low incidence of complications and could be performed under local or general anesthesia.


Article
Bile Leak Management Following Laparoscopic Cholecystectomy

Author: Ali Abdulhaleem Kadhim Al-Eessa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 580 -587
Publisher: Babylon University جامعة بابل

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Abstract

Laparoscopy now is the gold standard technique for cholecystectomy. Post laparoscopic cholecystectomy (LC) bile leak may occur. This prospective studyincludes 38 patientsfrom a period of May 2014 to May 2016 in Hilla teaching general hospital to assess options of management of bile leakfollowing LC.Conservative supportive measures alone was successful in 20 patients.ERCP intervention applied in 9 patients with a stent application, papillatomy or CBD stone extractionwith subsequent resolution. Explorative laparotomy by expert surgical team was done for 9 patients with Roux-en-Y-hepaticojejunostomy as a result of iatrogenicmassive injury to main biliary duct. Mortality rate was zero.Male to female ratio was 2:1 for whole bile leaked patients, and 3:1 for patients treated with interventions. Post laparoscopic cholecystectomy bile leak can be managed conservatively with close monitoring in a start.MRCP is valuable noninvasive test to assess biliary duct system. ERCP as a diagnostic and therapeutic measure was effective minimal invasive approach to control leak. Laparoscopic cholecystectomy should be performed meticulously in order to avoid catastrophic biliary ductal injury with a wise conversion to open when indicated. Proper clipping technique of cystic duct is essential to avoid cystic duct leak.


Article
Prophylaxis of Hydrocele after Varicocelectomy

Authors: Hussein Oudah Al-Jasmawy --- Adel Ibraheem Muhi --- Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 3 Pages: 792-796
Publisher: Babylon University جامعة بابل

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Abstract

Hydrocele comes on the top of complications after surgical repair of varicocele.To evaluate the efficacy of selective vein ligation procedure by the aid of loupe optical magnification with creation of a window in tunica vaginalis to prevent the formation of hydrocele after varicocelectomy.Two hundred patients with varicocele treated were analyzed. A study is applied on two patient groups, of each one hundred patient. Group 1: Conventional procedures for varicocele, without use of optical magnification including: Paloma, inguinal mass ligation and subinguinal selective ligation, and a group 2; underwent subinguinal selective varicocelectomy with the aid of optical magnifications and completed by creation of a window in tunica vaginalis. Hydrocele, as a complication following varicocelectomy, is reduced from 15% in group 1 to 3% in group 2.By theaid of optical magnification with creation a window in tunica vaginalis,a significant decrease in incidence of post varicocelectomy hydrocele in group 2 was found. So this procedure seems effective and we recommend its addition to the standard procedures of varicocelectomy.


Article
Presentation and Options of Management of Undescended Testis in our Practice

Authors: Hussein Oudah Al-Jasmawy --- Adel Ibraheem Muhi --- Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 4 Pages: 1006 -1014
Publisher: Babylon University جامعة بابل

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Abstract

Undescended testis is a common congenital anomaly in pediatric population, associated with many complications if not managed properly. This study for clinical presentation, available investigations and the different modalities for treatment of undescended testis in our practice. One hundred twenty patients diagnosed with undescended testis in Hilla Teaching General Hospital and Private Hospitals during the period of June 2007 to June 2014. Age of patients included is from 6 months to 40 years age, intersex and ectopic testis were excluded. Ultrasonographydone for all patients, CT scan and MRI or diagnostic laparoscopy were added to investigate sonography undetectabletestis in groin. Management includes hormonal therapy for selected patients and surgical intervention for the others including those with failure of hormonal therapy. Diagnostic laparoscopy done for two cases. Presentation age were 42% at 2-5 years age and 33% were below 2 years. Best hormonal response were in bilateral than unilateral cases, 25% for bilateral versus 10 % for unilateral cases. One stage open orchiopexy was the common surgical procedure used (85.83%). The best results for surgical orchiopexy can be obtained when performed at age below two years. Hormonal therapy was benefit in some patients. One stage orchiopexy is a safe procedure in most of cases in our practice. We advise to start laparoscopic approach in diagnosis and treatment of intra-abdominaltestis.


Article
Efficacy of Combined Tramadol with Diclofenac in Comparison with Monotherapy Treatment Using Buscopan Diclofenac or Tramadol in Renal Pain Control

Authors: Hussein Oudah Al-Jasmawy --- Adel Ibraheem Muhi --- Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 4 Pages: 1070 -1076
Publisher: Babylon University جامعة بابل

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Abstract

Acute renal colic is a severe painful event; drugs used to treat this condition include anticholinergics, opioid analgesics and nonsteroidal anti-inflammatory drugs.To compare drug's efficacy in ureteric pain relief byusing monotherapy including Buscopan 20 mg IV, Diclofenac Sodium 75 mg IM and Tramadol 50 mg IV, with a combination of 2 drugs including Tramadol plus Diclofenac.160 patients (110 males and 50 females), 16 to 75 years of age, with moderate to severe renal pain were treated in emergency department of Hilla Teaching General Hospital and private clinics. Parameters were observed after 10, 30, 60, minutes and 2 hours of drugs treatment. Assessment of analgesic effect of the drugs was done by using Numerical Rating Scale (NRS). Drug side effects also observed.Buscopan was the least effective drug in pain relief with higher side effects, while Diclofenac and Tramadol have comparable efficacy. Combination of Diclofenac plus Tramadol had a significant efficacy with rapid and sustained pain relief.Incidence of ureteric colic are more common in males than females (male to female ratio is 3/1).For quick pain relief in acute renal colic, a combination of intravenous tramadol with diclofenac sodium is superior to each of them alone, while Buscopan is the least effective, with higher side effects.


Article
Causes and Prevention of Missing a Diagnosis and Late Management of Acute Appendicitis

Authors: Ali Abdulhaleem Kadhim --- Mohend Abbas Noori Al-Shalah --- Adnan Mohammad Kamil
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 370 -377
Publisher: Babylon University جامعة بابل

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Abstract

A delay in diagnosis and late management of appendicitis with appendectomy is still high with subsequent some serious sequelae. This study is to identify and prevent a causes of delay in diagnosis of appendicitis. Aprospective cross section study includes 308 appendectomies performed in a Hilla teaching hospital from January 2013 to July 2015 by same surgical team; 143 (46%) male and 165 (54%) female. Delayed diagnoses was considered when the duration of pain was more than 48 hours, or operative finding show obvious features of delay, like perforation, gangrenous appendix, abscess collection or mass formation. Average duration of symptoms for delayed patients was 96 hours and for early diagnosed was 29 hours, Reasons fordelay were sought and divided into two groups; the first is patient behavioral reason, and the second is medical assessment reason. Twenty one percent of appendectomised patients show delayed management despite more than 48 hours abdominal pain (3-10 days, average 4 days), 69%of them was male, and, 31% female. Average duration of hospitalization in a delayed cases was 3.5 days, while average duration of admission for early treated cases was 1.3 day. Mortality rate was zero. As a reason for delay in diagnosis; patient assessment was the main reason for delay diagnosis (44 patients, 68%); while patient behavior cause was 32% (21 patients). The patient assessment is the main cause of delay in diagnosis and should be improved by examining patients with abdominal pain by expert surgical team considering atypical presentation with proper follow up and investigations.Quality improving program is advised to reduce missed diagnosis of appendicitis.

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