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EVALUATION OF PRE-OPERATIVE ULTRASOUND FINDINGS IN PREDICTING DIFFICULTIES IN LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS

Author: Ali J Awad علي جليل عواد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 1 Pages: 59-66
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Pre-operative prediction of difficulties which may occur during laparoscopic cholecystectomy can help in reduction of operative and postoperative complications.Objectives:To study the value of preoperative ultrasound findings for predicting difficulties encountered during laparoscopic cholecystectomy and to assess the usefulness of these findings to identify patients at high risk of conversion from laparoscopic to open cholecystectomy.Methods:A prospective study of 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. Pre-operative abdominal ultrasound was done. The diagnosis of gall stones was made and the presence of ancillary findings was recorded. Five ancillary ultrasound findings were assessed. These included; thickened gall bladder wall more than 4mm, presence of pericholecystic fluid, severely contracted gall bladder, empyma, and gall bladder filled with stones. Ultrasound findings were compared with the operative findings.Results:In 36 patients who had one or more of these findings laparoscopic Cholecystectomy was difficult in 22(61.1%) of them. Thick wall gall bladder > 4mm has the highest sensitivity (69%) and the presence of pericholecystic fluid has the highest specificity (100%) in predicting difficult laparoscopic cholecystectomy and the presence of more than 2 ancillary findings yielded an accuracy rate of (100%). Conversion to open cholecystectomy was needed in 13.9% of these patients. The rates of difficult laparoscopic cholecystectomy and conversion to laparotomy were much lower in those patients who had no ancillary findings (4.3%) and (1.2%) respectively.Conclusion:Preoperative ultrasound findings are of value for predicting difficulties encountered during laparoscopic cholecystectomy which may require conversion to open cholecystectomy.Keywords:Laparoscopic surgery, Cholecystectomy, Ancillary ultrasound findings.


Article
DIAGNOSTIC ACCURACY OF (FNAC) BIOPSY IN PALPABLE MAMMARY LESIONS

Authors: Thamer T Sharrief ثامر طارق شريف --- Abdul-Ameer J Awad عبد الامير جليل عواد --- Ali J Awad علي جليل عواد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 3 Pages: 273-277
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Fine Needle Aspiration Cytology (FNAC) has advantage of providing a diagnosis before the time of surgery; this situation enable the patient and surgeon to discuss and decide the type of surgery to be done and may obviate the need for a 2 stage procedure in surgical management of breast cancer.Objectives:To study the accuracy, sensitivity and specificity of FNAC of solid breast mass compared to histopathological examination.Methods:A retrospective study includes 126 female patients palpable solid breast mass aged 17 to 67 years with masses in the breast. FNAC and histopathological studies was done to all of them.Results:Fifty six patients had mass in the Rt. Breast and 70 (57.4%) had mass in the Lt. breast. 58 (47.5%) masses diagnosed as malignant (54 true-positive and 4 false negative) with diagnostic accuracy of 93% (54 of 58). Sixty four patients (52.5%) were diagnosed as benign (62 true-negative and 2 false positive) with diagnostic accuracy of 96.8% (62 of 64).Conclusions:FNAC is simple, quick and relatively low cost procedure, with minimal patient discomfort; it is helpful in reducing the number of breast biopsies done for benign breast disease. It can provide a diagnosis before the time that operation is performed and this may help to obviate the need for two stage procedure in surgical management of breast cancer.Keywords:Solid breast mass, FNAC, Histopathological examination.

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