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EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS AT AL-KADHIMIYA TEACHING HOSPITAL

Authors: Osama M. Alabid اسامه محمد علي العبد --- Hassan A. Hassan حسن احمد حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2014 Volume: 12 Issue: 1 Pages: 37-43
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Despite the well-accepted success of laparoscopic cholecystectomy (LC) in the elective treatment of symptomatic gallstone, the safety and the efficacy of this technique has been subjected to some debate in the setting of acute cholecystitis (AC).Objective:To evaluate our institution’s experience with early LC and to evaluate the safety and effectiveness of LC in the treatment of AC.Methods:Eighty nine patients were diagnosed as having AC based on the clinical, laboratory and ultrasound findings; 80 patients were divided randomly into two equal groups.Group 1 included 40 patients who had early LC for AC within one week from onset of the symptoms and group 2 included 40 patients who had late LC around 6 weeks from onset of symptoms as interval LC after conservative treatment. Results:No significant difference in the conversion rate (in early group 8 patients (20%) versus delayed group 6 patients (15%). Complication rate was insignificant (in early group 4 patients (10%) versus delayed group 3 patients (7.5%). The delayed group had a significantly shorter operative time (early group = 128±53.5 min versus delayed group = 107±50.1 min) and significantly shorter postoperative stay (early = 2.4±3.2 days versus delay = 1.4±1.4 days). The early group had a significantly shorter total hospital stay (early = 5.5±3.1 days versus delay = 8.5±4.5 days). The male gender had a significant higher conversion rate in both groups.Conclusion:Early LC can be performed safely in most patients with AC and it is considered as effective treatment, allows significantly shorter total hospital stay with no significant differences in conversion rate or complications compared with delayed LC, in the hands of a safe and well trained surgeon.Keywords:Early laparoscopic cholecystectomy, acute cholecystitis.


Article
DOES POST-LAPAROSCOPIC CHOLECYSTECTOMY INTRA-ABDOMINAL DRAIN REDUCES POSTOPERATIVE SHOULDER PAIN?

Authors: Ahmed H. Ismael احمد حقي اسماعيل --- Anees K. Nile انيس خليل نايل --- Hassan A. Hassan حسن احمد حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 1 Pages: 4-10
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook post-laparoscopy pain as a serious problem, yet as many as 80% of patients will require opioid analgesia. It is generally accepted that pain after laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively minor changes in technique.Objective: To determine whether a drain placed in the peritoneal cavity during laparoscopy is both clinical and cost-effective method of reducing postoperative shoulder pain.Methods: One hundred female patients were having laparoscopic cholecystectomy were divided into two groups, a control group (50 patients) where no intra-peritoneal drain was inserted and second group (50 patients) in which the patients had intra-peritoneal gas drain sited in the subhepatic area. Patients' age, weight, height, operative time, total amount of CO2 and amount of analgesia used were recorded for each patient in both groups. Shoulder pain was assessed using visual analogue score (VAS) from 1-5 scale at 4, 8, 24 & 48 hours postoperatively, where as abdominal pain was assessed at 48 hour post-operatively. pH of the abdominal fluid was assessed in the second group of patients by using pH meter 48 hours postoperatively. ResultsShoulder pain may occur in many of patients of the control group more frequent than those of the second group, where as postoperative abdominal pain was found to be greater in patients with subhepatic drain after laparoscopic cholecystectomy.Conclusion: Low-cost drain decreased the frequency of shoulder pain and reduced the need for analgesia, but increases the abdominal pain; however it is less cost-effective than simple oral analgesia after laparoscopy.Keywords: laparoscopic cholecystectomy, intra-abdominal drain, shoulder pain


Article
Determination of the Locations of Ground Water Table Anomalies by the Ring and Central Point Method Study of Three Areas in Iraq
استخدام طريقة الحلقة والنقطة المركزية لتحديد مواقع الشذوذ في مناسيب المياه الجوفية دراسة ثلاث مواقع في العراق

Authors: Hassan A. Hassan حسن احمد حسن --- Ahmed S. Al-Banna احمد شهاب البنا --- Sabbar A. Salih صبار عبدالله صالح
Journal: Rafidain journal of science مجلة علوم الرافدين ISSN: 16089391 Year: 2005 Volume: 16 Issue: 1Eعدد خاص بعلوم الارض Pages: 32-44
Publisher: Mosul University جامعة الموصل

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Abstract

The groundwater table is observed in three areas in Iraq. Many wells are used to construct the ground water table maps in these areas. These maps are reflecting the irregularity in the water table.The observed values of groundwater table are converted to a regular grid of water table points, with different spacing interval from area to another. The regional groundwater table is calculated, using the ring and central point method, in each observation point. The residual (local) anomalies in the ground water table values for the grid points are obtained by the subtracting of the regional (average values) of ground water table from the observed values. The griding of water table and the calculations of regional and residual anomalies are done using QBASIC computer program build for this purpose. The regional ground water table and residual anomaly of groundwater table are mapped, the regional maps show the main water table level in the studied areas. The residual maps show many positive and negative anomalies of groundwater table. These maps reflect that the positive anomalies related to the leakage of water from the subsurface pipelines and drainage channels in the studied areas, while the negative anomaly related to the high pumping or discharge rate. This method can be used to determine the locations of leakage from pipelines and drainage channels

تم في هذه الدراسة قياس مناسيب المياه الجوفية في ثلاث مواقع في العراق ، رصدت مناسيب المياه الجوفية في عدد من الابار في كل موقع. ، ثم رسمت خرائط مناسيب المياه الجوفية فيها وتبين وجود عوامل غير طبيعية مؤثرة على المنسوب. مناسيب المياه الجوفية التي تم قياسها تم تحويلها الى شبكة منتظمة من القيم بواسطة الحاسوب وبمسافة بين نقاط الشبكة تختلف من موقع الى اخر. تم حساب المنسوب الاقليمي للمياه الجوفية في كل نقطة باستخدام طريقة الحلقة والنقطة المركزية. قيم الشواذ المحلية في منسوب المياه الجوفية حسبت من الفرق بين القراءة المرصودة حقليا في النقطة المعنية وبين المنسوب الاقليمي في تلك النقطة. رسمت الخريطة الكنتورية للمنسوب الاقليمي للمياه الجوفية ومن ثم رسمت خريطة الشواذ المحلية والتي بينت وجود شواذ موجبة وسالبة. عزيت الشواذ الموجبة الى تسرب المياه من الانابيب تحت السطحية ومن قنوات المجاري، بينما عزيت الشواذ السالبة الى الضخ الجائر للمياه الجوفية لاغراض الري او الى التصريف العالي للمياه الجوفية في بعض المناطق. ساعد تحديد مواقع الشواذ الموجبة في تحديد مواقع تسرب المياه من الانابيب ومن ثم معالجتها.

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Article
PCNA EXPRESSION IN CAGA STRAIN H. PYLORI GASTRITIS: IMMUNOHISTOCHEMICAL AND INSITU HYBRIDIZATION STUDY

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Abstract

Background: Carriage of Helicobacter Pylori (H. Pylori) in the human stomach is associated with increased risk of peptic ulcer disease, distal gastric adenocarcinoma and gastric B-cell mucosa associated lymphoid tissue lymphoma. Several studies have shown increased evidence of increased cell proliferation in the gastric mucosa both in human carrying H. Pylori, and animal model of H. Pylori infection.Objective: To study the immunohistochemical expression of Proliferating cell nuclear antigen (PCNA), as a proliferative marker in the gastric mucosa of patients infected with CagA Helicobacter Pylori demonstrated by insitu hybridization method.Methods: Gastric antrum and corpus biopsies from 99 patients with dyspeptic symptoms (50 men, 49 women, and median age 40) were analyzed for H. pylori, presence of chronic inflammation, intestinal metaplasia, and atrophy according to updated Sydney system. Insitu hybridization technique was done to detect cagA H. pylori. Immunostaining for PCNA (Avidin- Biotin method) was performed on paraffin embedded tissue specimens.Results: Forty four patients (44.44%) had H. Pylori cagA positive strain. Atrophy of gastric mucosa was present in 14 (14.14 %) patients. Intestinal metaplasia was present in 8 (8.08%) patients. The frequency of atrophy was significantly higher in cagA H. Pylori gastritis than non-cagA H. Pylori gastritis (p=0.041). The frequency of intestinal metaplasia was significantly higher in cagA H. Pylori gastritis than non-cagA H. Pylori gastritis (p=0.023). PCNA labeling index (LI) of the gastric glands was significantly higher in presence of atrophic alterations (p <0.001), intestinal metaplasia (p <0.001) and in cagA strain H. Pylori positive gastritis (p<0.001).Conclusion: The rates of gastric glandular atrophy, intestinal metaplasia, and epithelial proliferation increase in the presence of H. Pylori infection, and are further increased when H. Pylori is of cag A strain.Key words: cag A H. pylori gastritis, PCNA immunohistochemical expression.

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