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Article
The Outcome of Retained Metallic Foreign Bodies in Upper and Lower Limbs…………...

Author: Ali Khairi Toman
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2009 Volume: 2 no.8, 9 Issue: 5 Pages: 692-696
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Retained metallic fragments represent a common problem thatcan be encountered in surgical practice.They could be bullets, part of bullets or other fragments and shells frombombs or mines or in rare occasion, different foreign particles from the environment.They are always the cause of patients complain to whom they refer their pain ordisabilities and sometime they insist for their removal.Operations for removal of deep retained foreign bodies are not beneficial, take longtime and consume a lot of materials and sometime could be very risky, cause moredamage and in some cases, ended without finding the foreign body.There are only few indications for removal of retained metallic fragments.Objectives: We want to assess the problem of retained metallic foreign bodies andfind the indications of their removal.Patients and Methods: This is a prospective study of 300 patients with retainedmetallic foreign bodies presented to the out-patient department of Alhindiya generalhospital between July 2006 and July 2008 with different complains.Results: Three hundred patients were included in this study, 264 patients(82%) weremales and 36 patients (18%)were females, 270 patients about (90%) presented withinthe first week after injury, 243 patients(81%) have foreign bodies in the upper andlower limbs, 45 patients(15%) in the trunk and 12 patients(4%) in the head & neck.Conclusion: Palpable foreign body can be removed safely and successfully in most ofthe cases while deep foreign body should not be removed unless there are indications.


Article
Diabetic Mastopathy In Iraqi patients; Modalities Of Diagnosis And Management Options

Author: Ali Khairi Toman
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2014 Volume: 7 Issue: 1 Pages: 1797-1805
Publisher: Kerbala University جامعة كربلاء

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background: Diabetic fibrous mastopathy, also known as lymphocytic mastitis, is an un common lesion of the breast that occurs in women with long standing insulin dependent diabetes mellitus (IDDM) It is a distinct clinicopathologic entity with specific histopathological characteristics, which include keloid fibrosis, epithelioid fibroblast, widespread periductal/lobular lymphocytic infiltration and widespread perivascular lymphocytic infiltration.Objective: To confirm that: (a) Many diabetic patients can be spared from undergoing multiple, unwarranted surgical biopsies (b) Mastopathy can happen even in NIDDM, (c) Diabetic mastopathy can co-exist with malignant breast lesions.Patients And Methods: A study for 48 patients with palpable breast masses. The patients are divided into 3 groups: Group A (10 patients): contain the patients with long standing IDDM. Group B (14 patients): contain the patients with NIDDM. Group C (24 patients): contain age matched control non-diabetic patients selected with clinical finding similar to that present in diabetic mastopathy. FNAC, ultrasound and mammographic examinations were done before proceeding for excisional biopsy. Results & Discussion: We found that 7 out of 10 patients in Group A (70%) have features suggesting of diabetic mastopathy and only 4 out of 14 patients in group B (28.5%) and (0%) in group C, have the same features. So we demonstrate that, diabetic mastopathy could be the only cause of palpable breast mass in diabetic patients.Diabetic mastopathy is a distinct clinicopathologic entity with specific histopathological features, which include keloid fibrosis, epithelioid fibroblast, widespread Periductal/lobular lymphocytic infiltration and widespread perivascular lymphocytic infiltration. Our work confirmed the presence of the histopathological characteristics of diabetic mastopathy in palpable breast masses in long standing IDDM (group A). We also observed the presence of the histopathological characteristics of diabetic mastopathy in breast tissue in mastectomy specimens away from intraductal and infiltrating ductal carcinoma in NIDDM (group B).Conclusion: we should have awareness that this entity exists and a careful correlation of the patient history with physical, radiological and cytological examination should be applied.


Article
Laparoscopic Cholecystectomy in Alhindiya Hospital: Analysis Study

Author: Ali Khairi Toman
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2014 Volume: 7 Issue: 2 Pages: 1964-1970
Publisher: Kerbala University جامعة كربلاء

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Abstract

ackground: Cholecystectomy is one of the most frequently performedoperations. Open cholecystectomy has been the gold standard for over 100years. Laparoscopic cholecystectomy was introduced in the 1980s. Laparoscopic cholecystectomy has become the definitive treatment of choice for symptomatic gall bladder disease. It replaced the old traditional method of open approaches with lower complication rates.The laparoscope was introduced into Alhindiya hospital during early 2008 and after that the numbers of laparoscopic operations started to increase gradually and includes cholecystectomy, ovarian drilling, ovarian cysts, and appendectomy and diagnostic operations.Objective: This study summarizes the experiences associated with 150 laparoscopic cholecystectomies performed in Alhindiya hospital to assess the safety of these operations.Patients and Methods: This is an analysis study were the records of 150 consecutive patients who underwent laparoscopic cholecystectomy in Alhindiya hospital were reviewed. 125 patients were females and 25 patients were males (F to M ratio= 5-1). The age range was between 18 -75 years.Analysis of different data was performed.Results: The commonest indications for surgery were symptomatic cholelithiasis (100 cases) and acute/chronic cholecystitis (35 cases). The mean operating time was 36.8 minutes. The mean length of stay in the ward was 17.7 hours. Only 5 cases were converted to open procedures. The commonest postoperative complication was wound-infection. Mortality rate was zero.Conclusion: In summary, this study demonstrates that laparoscopic cholecystectomy can be performed safely in Alhindiya general hospital with good results and low complications rate.


Article
Predicting Factors for The Efficacy of Laparoscopic Ovarian Drilling for Ovulation Induction in Polycystic Ovary Disease

Authors: Ali Khairi Toman --- Falah A. Muhi
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 3 Pages: 599-605
Publisher: Babylon University جامعة بابل

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Abstract

Background: Laparoscopic ovarian drilling has been widely used to induce ovulation in women with polycystic ovarian syndrome. There are factors that affect the outcome of this procedure like age of the patient, duration of infertility, body mass index, hormonal changes and menstrual irregularities. Laparoscopic ovarian drilling may avoid or decrease the need for gonadotrophins or may facilitate their effectiveness. The procedure can be done with less trauma and fewer postoperative adhesions than with traditional surgical procedures. Objective: To evaluate the effectiveness and safety of laparoscopic ovarian drilling for ovulation induction in polycystic ovary patients and to identify which of the mentioned factors help to predict the outcome of the procedure.Patients And Methods: This prospective clinical study included 80 patients with failure of 12 weeks clomiphene citrate treatment for an ovulatory infertility due to (PCOS) who underwent (LOD) in Alhindiya general hospital between January 2008 and September 2011. The effect of various patients' pre-operative characteristics on the ovulation rate after (LOD) was assessed. The success rates were compared between these categories of each factor to identify the predictors of success of laparoscopic ovarian drilling. Results: Women with marked obesity (BMI 35 kg/m2) achieved significantly (P < 0.05) lower ovulation rate (40%) compared with those (61.5%) of moderately overweight (BMI 29–34 kg/m2) women and those (75%) of women with normal and slightly elevated BMI (<29 kg/m2). women with testosterone levels 4.5 nmol/l, the rate was 30 %, which was significantly (P < 0.05) lower than those (57%) of women with moderately elevated testosterone (2.6–4.4 nmol/l). Patients with normal serum testosterone levels (<2.6 nmol/l) showed significantly (P < 0.05) higher success rates (80%) than the other groupsConclusion: Marked obesity, marked hyperandrogenism and/or long duration of infertility in women with (PCOS) seem to predict resistance to (LOD). Ovarian drilling by laparoscopy is safe but should be used on selective scale.

خلفية: حفر المبيض بالمنظار تستخدم على نطاق واسع للحث على التبويض في النساء مع متلازمة المبيض المتعدد الكيسات. هناك عوامل تؤثر على نتائج هذا الإجراء مثل عمر المريض، ومدة العقم ومؤشر كتلة الجسم، والتغيرات الهرمونية واضطرابات الحيضحفر المبيض بالمنظار قد يجنب او يقلل الحاجة الى العلاج بالهرمونات او قد تسهل فعاليتها ويمكن اجراء العملية باقل الصدمات وأقل الالتصاقات بعد العملية الجراحية من العمليات الجراحية التقليدية. الهدف: تقييم فعالية وسلامة حفرالمبيض بالمنظار لتحريض الإباضة لدى مرضى المبيض المتعدد الكيسات والتعرف على اي العوامل المذكورة قد تساعد إلى التنبؤ بنتيجة هذا الإجراء.المرضى والطرق: شملت هذه الدراسة السريرية الارتقابية 80 مريضة اللات يعانين من فشل 12 أسبوعا عقار كلوميفين سترات علاج لعقم التبويض بسبب متلازمة تكيس المبايض اللاتي خضعن لعملية حفر المبايض بالمنظار في مستشفى الهندية العام بين يناير 2008 وسبتمبر 2011. تم تقييم تأثير الخصائص المختلفة للمرضى قبل الجراحة على معدل التبويض بعد عملية حفر المبايض بالمنظار . وتمت مقارنة معدلات النجاح بين هذه الفئات من كل عامل لتحديد تنبؤ نجاح حفر المبيض بالمنظار.النتائج: النساء ذوات السمنة المفرطة(معامل كتلة الجسم 35 كغمم) حصلت بصورة مهمة(قيمة P أقل من 0.05) على نسبة اباضة اقل(40%) مقارنة مع تلك (61.5٪) من زيادة الوزن بشكل معتدل (معامل كتلة الجسم 29-34 كغمم) وتلك (75٪ ) من النساء ذوات مؤشر كتلة الجسم طبيعية الى مرتفعة قليلا. النساء مع مستويات هرمون تستوستيرون 4.5 نانومول / لتر، كانت نسبة 30٪ والذي كان معنويا مهم (قيمة P أقل من 0.05) أقل من تلك (57٪) من النساء مع هرمون تستوستيرون مرتفعة باعتدال (2.6-4.4 نانومول / لتر) أظهرت معنويا مهم (قيمة P أقل من 0.05) أعلى معدلات النجاح (80٪) من المجموعات الأخرى .الأستنتاجات: فرط السمنة, فرط الأندروجين و / أو مدة طويلة من العقم في النساء ذوات متلازمة تكيس المبايض تشير ال مقاومة الأستجابة للعملية ,حفر المبيض بواسطة المنظار هو آمن ولكن ينبغي أن يستخدم على نطاق انتقائي


Article
Modified Uterine Incision To Decrease Mortality And Morbidity In Placenta Accreta: Cohort Study

Authors: Falah A. Muhi --- Ali Khairi Toman --- Haitham F. Hamzha
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 1 Pages: 2106-2112
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Placenta accreta is an un common but potentially lethal complication ofpregnancy. It occurs when the placenta is abnormally adherent to the uterinemyometrium causing massive obstetric hemorrhage and still theleading cause of pregnancy related deaths. The risk factors are previous lowersegment cesarean section, previous uterine surgery, endometrial defect like Sherman syndrome, presence of sub mucous fibroid, previous manual removal of placenta, vigorous and repeated curettage, previous myomectomy.Objective: To find the best strategy for dealing with placenta accreta patients and to decrease the associated maternal mortality and morbidity.Patients And Methods: 30 patients admitted in Alhindiya hospital between January 2008 and December 2013. Cohort study was conducted between 2 groups of patients with different management strategy. One group underwent the ordinary procedure of Caesarian section, while modification of uterine incision were done for the other group considering opening the uterus at a site distant from the placenta (high U shape incision), and delivering the baby without disturbing the placenta, then closure of the uterus in order to enable elective hysterectomy to be done. Analysis of data was done. Results & discussion: Thirty cases of placenta accreta were identified between January 2008 and December 2013. Placenta accreta was diagnosed either with ultrasound or MRI examinations. The patients had been divided into two groups with different management strategy. Analysis of operative and post-operative complications was done, and we found that scheduled caesarean hysterectomy performed under controlled circumstances with modified high uterine incision without attempting to remove the placenta before hysterectomy was associated with significantly decreased maternal morbidity and mortality. Conclusion: Scheduled caesarean hysterectomy performed under controlled circumstances with modified high uterine incision without attempting to remove the placenta before hysterectomy was associated with significantly decreased maternal morbidity and mortality.

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