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CHANGING PATTERN AND INCIDENCE OF GALLSTONE DISEASES IN AL–KADHIMIYA TEACHING HOSPITAL

Author: Bashar A Abdul Hassan بشار عباس عبد الحسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 2 Pages: 176-183
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Gallstone diseases remain a common health problem for human, affecting millions of people throughout the world. In Iraq, recent years has shown an increasing number of patients with gallstones with concurrent decreasing age of presentation, risk factors have been assessed taking in consideration the effect of stressful life events that Iraqi peoples had been suffered during these years on the development of gallstone diseases.Objective:To give an idea about, and possible causes for the changing in number, age of presentation and trend of surgical management of gallstone diseases in Iraq.Methods:Clinical assessment and risk factors assay including stressful life events were done for 1226 patients who have been cholecystectomised over seven years from Jun 2002 to Jun 2009 in Al-kadhimiya Teaching Hospital.Results:Significant increases in the number of symptomatic gallstone cases were noted, nearly 50% of them presented with abdominal pain, more than half of patients were young in the 3rd and 4th decades, female to male ratio was 5.9:1 and decreasing with age, 74% of patients had BMI > 25% (over weight), impact of stressful life event was obvious in the recent years on nearly two third of patients with gallstone diseases, minimal invasive technique (laparoscopic surgery) was evolving and most of the cases now done by this method.Conclusions:Gallstones diseases are increasing in our country with obvious decrease in the age of presentation, this might be due to stressful life events to which Iraqi peoples had been exposed, and also the revolution of minimal invasive surgery had a great impact in the management of this disease.Key words:Pattern, Incidence, Gallstone diseases.


Article
THE IDENTIFICATION OF RISK FACTORS THAT PREDICT OCCULT CYSTOBILIARY COMMUNICATION IN LIVER HYDATID CYSTS

Author: Bashar A. Abdul Hassan بشار عباس عبد الحسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 3 Pages: 288-296
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Post-operative biliary leakage in patients with liver hydatid diseases is still a major problem especially after conservative surgery. Radiologic and intraoperative findings may not be helpful to detect occult biliary communications in asymptomatic patients.Objective:To identify the risk factors to predict occult cystobiliary communications (CBC) preoperatively to avoid development of biliary leakage after surgery.Methods:This prospective study conducted at the Gastroenterlogy and Hepatology Teaching Hospital in Medical City, Baghdad from the 1st of December 2013 to the 29th of March 2016. Clinical assessment, laboratory tests and imaging studies were under taken for 85 patients with uncomplicated liver hydatid cysts. Endocystectomy and or partial pericystectomy were undertaken. Post-operative follow up and management of biliary leakage for those with cysto-biliary communication not detected intra operatively. Data were analyzed to predict risk factors for occult CBC.Results:Of the 85 patients, 64 patients had no evidence of CBC neither intra nor postoperative, while the remaining 24 patients had an occult CBC, that have been discovered during operation or evident in the following days. Significant clinical predictors of communication were cyst size ≥ 10 cm, elevated total serum bilirubin (TSB) and gamma glutamyl transferase (GGT) (P < 0.001). Other findings were associated more with patients having CBC than those without, including high white blood cell count (WBC), alkaline phospatase (ALP), aspartate transaminase (AST) and alanine transaminase (ALT) levels. Nine of 13 patients who developed post-operative bile leak stopped spontaneously, the other 4 patients mandate endoscopic retrograde cholangiopancreatgraphy (ERCP) to close their fistulas.Conclusion:Awareness about the risk factors for CBC can predict preoperative diagnosis of occult CBC. Endoscopic biliary interventions should be considered as a part of complementary treatment of those cases with refractory CBC and to be discussed in patients’s consent preoperatively.Keywords:Liver hydatid cyst, cystobiliary communication, biliary leakage. Citation:Abdul Hassan BA. The identification of risk factors that predict occult cystobiliary communication in liver hydatid cysts. Iraqi JMS. 2017; Vol. 15(3): 288-296. doi: 10.22578/IJMS.15.3.11


Article
CLINICAL PLUS COLOR DOPPLER ASSESSMENT OF BENIGN AND MALIGNANT BREAST DISEASES
الفحص ألسريري مع دوبلر الملون لتقييم أمراض الثدي الحميدة والخبيثة

Authors: Bashar A. Abdul Hassan بشار عباس عبد الحسن --- Hikmat Abdul Rasoul Hatam حكمت عبد الرسول حاتم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2007 Volume: 5 Issue: 3 Pages: 73-80
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Tumor growth and metastases require the development of new vessels (angiogenesis), and the extent of angiogenesis predicts metastases and correlate with early death. Recently developed color Doppler mapping can detect the tumor flow signals in breast cancer and help to distinguish it from benign lesions.Objective: Evaluation of differences between the blood supply in benign and malignant breast lesions by the use of color Doppler image assessment of the lesions vascularity. Method: Clinical assessment, ultrasound examination and color Doppler mapping were done for 83 female patients with breast lesions. The following flow data analyses were undertaken; presence or absence of color Doppler signal, number of blood vessels, architectural arrangement and the maximum systolic velocity of blood vessels in the lesions and around it.Results: Histopathological reveals that 21 cases had carcinoma of the breast and 62 had benign lesions. 27 patients provisionally diagnosed as having malignant lesions; of them 15 cases were truly malignant (sensitivity: 71.5%) and 56 benign one; of them 50 lesions were truly benign (specificity: 80.6%). An increasing number of blood vessels found in malignant lesions; (85.7%) showed more than 3 vessels in a given lesion, while this figure found only in (8%) of benign lesions. For a cutoff of more than 3 vessels sensitivity and specificity are (85.7%), (91.9%) subsequently. Architectural differences in the form of penetrating central neoplastic vessels were present in 18 (85.7%) of the malignant lesions with sensitivity (90.4%), while only in 3 (6.1%) of the benign lesions with specificity (93.8%). The maximum systolic velocity of tumor vessels showed an increasing velocity in malignant lesions, for a cutoff more than 15 cm/s the sensitivity was (90.4%) and specificity was (91.8%). Combination of the three parameters gave (90.4%) sensitivity and (96.7%) specificity.Conclusion: Color Doppler imaging considered as an adjuvant primary investigation tool in addition to the ultrasound examination in improving differential diagnosis of breast lesion. Keywords: Color Doppler, Breast diseases, Benign, Malignant.

خلفية الدراسة: يعتمد نمو وانتقال الأورام الخبيثة على تولد الأوعية الدموية ((Angiogenesis, كما ويعتبر التولد مؤشرا لقابلية انتقال الورم مبكرا.هدف الدراسة: استخدام إشارات دوبلر الملونة لدراسة وتقييم جريان الدم في أورام الثدي وتمييز الحميدة منها عن الخبيثة.طريقة العمل: دراسة مستقبلية شملت 83 مريضة, أجري الفحص السريري الدقيق مع فحص دوبلر الملون بواسطة جهاز الأمواج فوق الصوتية للثدي وأخذ بنظر الاعتبار مايلي؛ وجود أو عدم وجود إشارات دوبلر الملونة مع حساب عدد الأوعية الدموية, التوزيع الشكلي للأوعية الدموية و قياس أقصى سرعة لجريان الدم حول وداخل أورام الثدي . النتائج: بالاعتماد على الفحص ألسريري تم تشخيص 27 حالة مرضية خبيثة و56 حالة مرضية حميدة في الثدي وكانت الحساسية (71.5%) أما النوعية فكانت (80,6%). وجودت إشارات دوبلر الملونة في جميع الأورام الخبيثة (100%) و (79%) منها في الأورام الحميدة , بالإضافة إلى أن عدد الأوعية الدموية في الأورام الخبيثة أكثر مما هي في الأورام الحميدة حيث كانت الحساسية لأكثر من 3 أوعية دموية (85.7%) أما النوعية (91.9%). وجد أن شكل الأوعية الدموية في الأورام الخبيثة هي نافذة وسطية بينما هي محيطية في الأورام الحميدة وكانت الحساسية (90.4%) أما النوعية (93.8%). وجد أن سرعة جريان الدم في الأورام الخبيثة أعلى مما هي في الأورام الحميدة ,كانت الحساسية (90.4%) و النوعية (91.8%) لسرعة جريان أكثر من 15 سم/ثانية.وبجمع نتائج فحص دوبلر كانت حساسية التشخيص (90.4%) أما النوعية فكانت (96.7%).الاستنتاج: يعتبر فحص دوبلر الملون مكملا للفحوصات التشخيصية الأخرى لإمراض الثدي .مفاتيح الكلمات: دوبلر الملون, أمراض الثدي, الحميدة, الخبيثة

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