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Article
The Relation ship between Varicocele and Body Mass Index

Author: Saad D. Farhan*
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 1 Pages: 27-29
Publisher: Baghdad University جامعة بغداد

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Abstract

Background:Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility, yet controversy exists regarding their etiology. Anecdotal experience suggests that varicoceles are more prevalent in lean men, supporting the "nutcracker" effect of the superior mesenteric artery compressing the left renal vein over the aorta.
Materials and methods: A total of 206 males with varicocele attending the urological out patient clinic were evaluated from their physical screening examinations. All subjects underwent history taking and physical examinations to evaluate for the presence and severity of varicocele ht,weight and BMI, those compared with 206 men without varicocele (control group)were selected randomly from general population.
Results : The mean (± SD) BMI of the 206 patients with varicocele was 25.2721 While that of control group was 28.8441((P =0.0001).which is clinically significant. Varicocele grade significantly decreased with increasing BMI category (p =0.0001).
Conclusions: The results of this study indicate that there is a decreasing incidence of varicocele and varicocele grade with increasing BMI. Supporting the possibility that obesity results in a decreased nutcracker effect in which the adipose tissue prevents compression of the renal vein.
Keywords: Varicocele, Body Mass Index.

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Article
Laparoscopic Management of Symptomatic Renal Cysts

Author: Saad D. Farhan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 2 Pages: 163-168
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Simple renal cysts are common, with incidence increasing with age. Symptomatic renal cysts have traditionally been initially treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence.Open surgical cyst decortication for pain relief through a flank or chevron incision is associated with considerable morbidity and protracted convalescence.OBJECTIVE:To assess the efficacy of laparoscopic Surgery in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population.METHODS:From April 2007 to July2009 ,11patients (7 males and 4 females) underwent laparoscopic decortications of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan.RESULTS:Of the 11 procedures were completed laparoscopically , the mean operative time was 100 minutes (range 80 to 120). Symptomatic and radiographic success was achieved in 90.9% of patients, with a median follow-up of 12 months (range 6 to 18).CONCLUSION:Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities.


Article
Surgery for wilms' tumor, Does Preoperative Chemotherapy Ease its Surgical Procedure?
التداخل الجراحي لرفع ورم الكلية لدى الاطفال

Author: Saad D. Farhan سعد داخل
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2013 Volume: 55 Issue: 3 Pages: 204-209
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The optimal timing of surgery for Wilms' tumor has been debated for many years. It appears dubious whether surgical ease or per operative complications consistently improved after preoperative chemotherapy.Objective : To compare the use of immediate nephrectomy versus delayed nephrectomy or partial nephrectomy following neo adjuvant chemotherapy for treatment of non metastatic Wilms' tumor, in terms of surgical morbidity and per operative complications .Materials and Methods: This is a cross section study ,the sample collected from January 2009 to November 2012 .Thirty four patients were selected after informed consent . Patients aged between 10 months and 5 years who were newly diagnosed with Wilms' tumors. including (17) patients with unilateral wilms tumors received immediate nephrectomy without preoperative chemotherapy according to the National Wilms' Tumor Study Group protocol and (16) patients with unilateral Wilms' tumors and one patient with bilateral wilms tumor received delayed nephrectomy or partial nephrectomy following preoperative chemotherapy according to the International Society of Pediatric Oncology( SIOP) WILMS TUMOR 2001/UK Final Version /January 2002 protocol.Results: there is significant change in the maximal tumor size (more than 50% reduction in the maximal tumor diameter) was observed in 52.9% of patients receiving pre operative chemotherapy. There is reduction in the complication rate in that patient receiving pre operative chemotherapy. These observed specifically for decreasing residual tumor and tumor spillage episodes. Bilateral partial nephrectomy after neo adjuvant chemotherapy was done for one patient (5.6%) with bilateral wilms tumor. We found significant decrease in the complication rate mainly for those patients with high risk score receiving pre operative chemotherapy rather than those with low risk score.Conclusion: We would favor tumor resection when it is possible as early in therapy as is practical and safe, when there is concern about the safety of primary tumor resection the pre operative chemotherapy can be safely initiated.Keywords: Wilms’ tumor, Surgery for wilms’ tumor, pre op chemotherapy for wilms’ tumor.

مقدمة : هنالك اختلاف واضح حول الوقت المناسب لإجراء عملية رفع ورم الكلية"ورم ولمز" لدى الاطفال قبل او بعد اعطاء كورس من العلاج الكيمياوي . طريقة العمل : تشمل الدراسة 34 مريضا يعانون من ورم الكلية تتراوح اعمارهم بين 10 أشهر و5 سنوات ، تم تقسيم المرض الى مجموعتين : المجموعة الاولى وتشمل 17 مريضا يعانون من ورم الكلية في احدى الجانبين تم اجراء تداخل جراحي لهم لرفع الكلية مع الورم مباشرة دون اعطاء علاج كيمياوي قبل العملية والمجموعة الثانية وتشمل 16 مريضا يعانون من ورم الكلية في احد من الكليتين ومريضاً واحداً يعاني من ورم الكليتين كلاهما تم اعطائهم كورس من العلاج الكيمياوي قبل اجراء التداحل الجراحي لرفع الورم مع رفع الكلية كليا او جزئيا . النتائج : لوحظ من خلال الرقائق الشعاعية (المفراس الحلزوني) بان حجم الورم اصبح اصغر عند 52.9% من المرضى بعد اعطائهم كورس من العلاج الكيمياوي . كما لوحظ في هذه الدراسة بان المشكلات الجراحية اثناء التداخل الجراحي اصبحت اقل بعد اعطاء كورس من العلاج الكيمياوي بسبب صغر حجم الورم كما انه اصبح بالامكان رفع الورم مع رفع جزئي للكليتين عند احد المرضى المصابين بورم الكليتين كلاهما وبذلك تمكنا من الحفاظ على الكليتين بدلا من رفعهما معا . هذه النتائج تكون واضحة اكثر عند المرضى الذين يعانون من ورم الكلية كبير الحجم او من ورم الكلية ذو التحليل النسيجي غير المناسب او ورم الكليتين كلاهما معا . الاستنتاجات : يكون من الافضل اجراء التداخل الجراحي لرفع الورم مع رفع الكلية كليا او جزئيا في حالات ورم الكلية عند الاطفال غير المعقدة وفي حالة تعذر ذلك يمكن اعطاء المريض كورس من العلاج الكيمياوي قبل العملية لتسهيل عملية رفع الورم.مفاتيح الكلمات : ورم الكلى عند الاطفال ، عملية رفع ورم الكلى عند الأطفال , ورم ولمز .


Article
THE EFFECT OF BODY MASS INDEX AND WAIST CIRCUMFERENCE ON PROSTATE SPECIFIC ANTIGEN IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA (BPH)

Author: Saad D. Farhan سعد داخل فرحان
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 1 Pages: 34-40
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Obesity may be associated with lower prostate specific antigen(PSA) values, If true, this would result in fewer obese men having an elevated PSA, fewer biopsies performed, and fewer cancers detected , consequently cancers may be missed or not detected until at a more advanced stage.Objective: We examined the influences of age, body mass index (BMI) and waist circumference (WC) on PSA before and after adjusting for prostate volume. We also examined associations among age, body mass index, waist circumference and prostate volume (PV).Methods: We analyzed 125 Iraqi men aged 40 to 84 years old who attained the urological outpatient clinic for BPH evaluation during 2009. Curent health status information including prostate related problems, medical interview, basic physical examination and anthropometric measurements including height, weight, BMI and waist circumference were taken for all patients. Blood tests including PSA concentration were performed after overnight fast. A radiologist performed transrectal prostate ultrasound. PSA measurements preceded routine digital examination and transrectal prostate ultrasound.Results: The median serum PSA was significantly lower among obese subjects compared to normal BMI subjects. BMI showed a statistically significant moderately strong negative linear correlation (r = -0.5) with serum PSA. Waist circumference showed a similar pattern with a statistically significant linear correlation with serum PSA (r = -0.43); the median serum PSA was significantly lower among subjects with highest waist circumference compared to subjects in the lowest quartile of waist circumference. The median PSA was significantly higher among subjects with large prostate size compared to those with lowest quartile prostate size. The anthropometric measures were tested for association with PSA density, to adjust for the effect of prostate size on serum PSA.Conclusion: The current data suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity.Keywords: body mass index, waist circumference, prostate specific antigen.


Article
Laparoscopic Varicocelectomy for Bilateral Varicoceles in Infertile Males

Authors: Saad D. Farhan --- Muayed Abass Fadhel**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 317-322
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility.Despite the very long history of the disease and many records on different surgical and radiological solutions, the ideal method of spermatic vein ligation for varicocele is still a matter of controversy. The perfect technique would be one that preserves testicular function and eliminates the varicocele with a low rate of recurrence, hydrocele formation and any other complications.OBJECTIVE:To assess the efficacy of laparoscopic Varicocelectomy for management of bilateral palpable varicoceles in infertile males.METHODS:We analysed the result of 25 patients presented with history of infertility and diagnosed to have bilateral palpable varicoceles treated in our department with Bilateral laparoscopic ligation of the spermatic vessels between January 2009 and November 2010.RESULTS:The average operative (Bilateral Laparoscopic Varicocelectomy) time was 34 minutes. There were no intra operative complications in the study group. Hydrocele formation was seen in 3 (6%) patients recurrence was seen in one (2%) patient .The average hospital stay was 18 hours. postoperative analgesics (1-2) doses , daily activities initiation usually started after 48 hrs and physical exercise 72 hrs . non of the patient has developed an atrophic testis as a result of the laparoscopic procedure. eighteen patients (72% )of the patients had improvement of the seminal fluid parameters During follow up period (6 months),with seminal fluid analysis, clinical and ultrasonic examination.CONCLUSION:Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling rapid return to normal activity

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