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Article
Risk factors for perforation in acute appendicitis

Author: Imad Hasan Sagir عماد حسن صكر
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 19 Pages: 35-40
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

This prospective study was carried out on 720 patients with acute appendicitis admitted to the surgical unit at Al-Diwaniya Teaching Hospital over a period of 3 years from January 2010 to December 2012. The data of the patients regarding clinical history,physical examination, investigations,operative findings and histopathology reports were analyzed .Acute appendicitis was more common in the second decade of life (44.4%) and was more common in males(55.97%) than in females (44.02%) .Perforated appendicitis was found in 144 pateints (20%).The incidence of perforated appendicitis was high in males (56.25%) as compared to females (43.75%). The risk factors for perforation in acute appendicitis include:extremes of age (< 10 years and > 60 years) ,delayed presentation (> 72 hours), diabetes mellitus ,steroid dependency , elevated temperature (>38˚C) ,raised WBC count (>18.000 mm3), pelvic appendix ,obstructive appendicitis (fecolith) , and pregnancy (the P-value was <0.05). The morbidity and mean hospital stay were more in perforated appendicitis than in non perforated appendicitis .The mortality rate in perforated appendicitis was (2.08%) , while there was no death recorded in non-perforated appendicitis. We should be aggressive in the treatment of appendicitis in high risk patients, so once acute appendicitis is diagnosed , the expedient surgery and appropriate use of perioperative antibiotics can help to minimize the morbidity and mortality.

أجريت هذه الدراسة المستقبلية على 720 مريض يعانون من التهاب الزائدة الدودية الحاد في ردهات قسم الجراحة , في مستشفى الديوانية التعليمي خلال مدة ثلاث سنوات وذلك من شهر كانون الثاني 2010 الى شهر كانون الاول 2012, وقد تم خلال هذه الدراسة تحليل معلومات المريض الكاملة والتي تشمل التأريخ المرضي ,الفحص السريري , التحاليل والفحوصات التي اجريت للمريض , تفاصيل العملية الجراحية , بالاضافة الى معلومات كاملة عن نتائج الفحص النسيجي للزائدة الدودية , وقد تبين من خلال هذة الدراسة ان التهاب الزائدة الدودية الحاد كان أكثر شيوعا في العقد الثاني من العمر (44,4%) واكثر شيوعا في الذكور (55,97%) منه في الأناث (44,02%) وقد كانت الزائدة الدودية منفجرة في 144 مريض (20%) وكانت نسبة الأنفجار أعلى في الذكور (56,25%) منه في الأناث (43,75%). عوامل الخطورة التي تؤدي الى زيادة نسبة انفجارالزائدة الدودية الملتهبة هي: أطراف العمر(الأطفال أقل من 10 سنوات والكبار أكثر من 60سنة من العمر) , التشخيص المتأخر للحالة (اكثر من 72 ساعة ) , مرض السكري , المرضى الذين يتناولون دواء الستيرويد بأستمرار, درجة حرارة الجسم المرتفعة اكثر من (38 مْ) , زيادة نسبة كريات الدم البيض (أكثرمن 18000 /ملم3) , موقع الزائدة الدودية الحوضي , وجود انسداد في تجويف الزائدة الدودية وحالات الحمل. كانت معدلات المضاعفات مابعد العملية ومعدلات الرقود في المستشفى أعلى في حالات التهاب الزائدة الدودية المنفجر, وكان معدل الوفيات في حالات التهاب الزائدة الدودية المنفجر (2,08%) بينما لم تسجل حالات وفيات في التهاب الزائدة الدودية غيرالمنفجر, وبناءا على ذلك فأن هذا يتطلب التركيز في علاج مثل هذه الحالات وذلك بأستخدام المضادات الحيوية المناسبة قبل وبعد اجراء العملية الجراحية وكذلك اجراء العملية الجراحية بالسرعة الممكنة وبالدقة المطلوبة لغرض الخروج بافضل النتائج.

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Article
Predictive factors for strangulated intestinal obstruction

Authors: Imad Hasan Sagir --- Usama Kadum Kredi
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2016 Volume: 12 Issue: 22 Pages: 130-138
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

This prospective study was carried out on 160 patients with acute intestinal obstruction admitted to the surgical unit at Al-Diwaniyah Teaching Hospital from January 2012 to June 2013 .The patients were divided, according to the results of treatment , into two groups : (1) patients who received early operation (76 patients ) , and (2) patients who received initial conservative treatment with nasogastric decompression and observation (84 patients). The conservative treatment was successful in 52 patients but in 32 patients, delayed operation was required .There were 54 cases of strangulated intestinal obstruction (33.75%) and 106 cases of simple obstruction (66.25%) .The causes of obstruction were adhesions in 52.5%, obstructed external hernia in 20%, tumor in 10% ,intussusception in 5% and miscellaneous group of causes which accounts for 12.5% of patients. There was positive correlation between bowel strangulation and the following factors: constant abdominal pain, feculent vomiting ,generalized tenderness ,rebound tenderness , rigidity ,absent bowel sounds, tachycardia (PR >110 min.) , fever (temperature >38˚C), signs of shock (systolic BP <90 mmHg) and WBC count above 18000mm3.The mean period of conservative treatment was 48 hours and the period of hospitalization was shorter in the conservative group as compared with the operative group . The morbidity was less in the conservative group than in the operative group. There was no death in the conservative group, while in the operative group the mortality rate was 7.4%. The mortality was closely related to the age, and the state of bowel involved by obstruction , since most deaths occurred in old aged patients and in patients with gangrenous bowel.

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Article
Role of the Triple Test in the Evaluation of Breast Mass

Authors: Imad Hasan Sagir --- Thair Wali Ali, --- Sheimaa Abd Alhamza Borhan
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2017 Volume: 13 Issue: 23 Pages: 46-52
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

This prospective study was carried out on 210 female patients with a diagnosis of breast mass admitted to the surgical unit of Al-Diwaniya Teaching Hospital over a period of 2 years from January 2013 to December 2014. Each patient was assessed by the triple test which includes physical examination, imaging studies , and fine needle aspiration cytology (FNAC). The results of each modality of the triple test were classified as benign, suspicious or malignant and then compared with the final diagnosis obtained by the histopathological examination. Breast mass was more common in the fourth decade of life (40.47 %), and the most common associated clinical feature was pain in 30.95 % of cases. Fibroadenoma was the most common benign breast mass ( 41.9 %), while invasive ductal carcinoma was the most common malignant breast mass (27.14 %). The most accurate element of the triple test was FNAC with a concordance rate of 0.89 (almost perfect agreement),while physical examination was the least accurate element with a concordance rate of 0.62(substantial agreement). The concordance rate of the triple test was 0.94 (almost perfect agreement) and it was higher than that of any modality used in the triple test. The sensitivity of the triple test was 93.85 % , specificity 99.31 % , positive predictive value (PPV) 98.39 %, negative predictive value (NPV) 97.30 % , and accuracy 97.62 % , and again these figures were higher than those of the elements of the triple test.So that the triple test can be safely used as an accurate and least invasive diagnostic test in the evaluation of patients with breast mass and to detect patients with breast cancer

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