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Article
Interval Appendectomy: Surgical and Pathological Basis

Author: Safa M. Al-Obaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 3 Pages: 184-189
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

SUMMARY:BACKGROUND:The treatment of appendiceal mass is controversial. For patients initially treated conservatively with antibiotics with or with out drainage, the role of interval appendectomy is an area of considerable debate.AIM :To evaluate the indications of interval appendectomy in patients presented with appendicular mass in correlation with post operative histopathological results.PATIENTS & METHODS:This is a prospective study of 97 cases with the diagnosis of appendicular mass admitted and treated conservatively in Baghdad Teaching Hospital during the period from December 2002 to December 2006 then scheduled for interval appendectomy. .Histopathology of the appendix examined and correlation of the result with certain clinical characteristic of the patients .RESULTS :The prevalent age group was 30-39 years (39%) and male to female ratio was 2.8:1. Postoperative histopathological features of the excised specimens showed that 85/97 (88%) of patients had chronically fibrosed appendix with obliterated lumen. The remaining 12/97 ( 12%) of patients were having inflamed appendices. There was a clear correlation the age of patient above 40 years (41%)and initial clinical response (94%) with the histopathologic support for appendectomy .CONCLUSION:Interval appendectomy was mandatory in the following groups of patients:Patients ≥ 40 years old.Patients with poor initial response to conservative treatment.Patients with recurrent symptoms.Patients with WBC count ≥ 12000 cell/cc.


Article
Adrenal Disorders, Presentations and Ways of Investigations

Author: Safa M Al- Obaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2006 Volume: 5 Issue: 3 Pages: 254-259
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Adrenal disorders in surgical practice are presented either as hyperfunctional disorders or non functional disorders (incidentalomas). Functionally, medullary tumors (pheochromocytoma) result in excess secretion of catecholamines(1), on the other hand, functioning adrenocortical tumors could secrete excess of cortisol (Cushing syndrome), aldosterone (Conn's syndrome) or sex hormones (virilizing syndromes).(2) . Aim of our study was to identify the most common types of adrenal tumors, its presentation and outlining the best diagnostic work up and to show our experiences in dealing with adrenal disorders in Iraq.METHODS:This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The collected data including; age, gender, presentations, methods of investigations and histopathological records.RESULTS:Their assessment revealed that adrenal disorders were most commonly encountered in the (30-39) years age group (9/20, 45%). The mean age was 40 years with a female preponderance and female: male ratio of 2: 1. Obesity was noted in (7/20, 35%). Headache was manifested in (5/20, 25%), palpitation in (4/20, 20%) and uncontrolled hypertension in (4/20, 20%). Plasma cortisol was elevated and its diurnal rhythm was lost in (8/20, 40%), 24-urinary VMA was elevated in (6/20, 30%). 24-urniary 17-ketosteroid was elevated in (1/20, 5%). The most commonly encountered clinical type of adrenal disorders was hypercortisonism in the form of Cushing disease and syndrome (8/20, 40%).CONCLUSION:Adrenal disorders mostly affect young age group patients with a female preponderance. Functioning adrenal disorders have presented earlier than non functioning ones owing to the symptoms they had caused. U/S, CT scan, MRI and IVP are very important in visualization, localization, assessment of distant metastases and finally discrimination of benign from malignant disorders.


Article
Post Operative Effect of Bupivacaine as Local Anesthesia in Abdominal Incisions

Author: Safa M.Al-Obaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 3 Pages: 209-214
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND:Pain after abdominal incisions is responsible for many postoperative problems, especially pulmonary and thromboembolic complications. Although many analgesic drugs are available yet they have to be given systemically to be effective with a real danger of respiratory depression.The use of local anesthetic drug infiltrated in the wound at the end of surgery is a logical solution .The aim of this study is to evaluate the effect of local anesthesia in the control of postoperative painMETHODS:During the period January 2007 until December 2007 hundred and twelve patients had abdominal operations at Baghdad Teaching hospital .Patients were randomly allocated to two groups .Group (1) included 56 patients who had 10 ml bupivacaine infiltrated in the wound by a sub facial catheter before wound closure and Group (2) 56 patients had placebo injected (2 ml of normal saline).Visual analogue scale was used for post operative pain assessmentRESULTS:There was a significant decrease in pain score and the requirement of the systemic analgesic in Group (1) during the 1st 24h after surgery as compared to Group (2) with (P. < 0.05) .The type of surgery which showed marked decrease in pain score were repair of hernia, open cholecystectomy and appendesectomy and was least obvious after midline incision.CONCLUSION:There was a significant decrease in pain intensity and the analgesic requirement in patients who had local wound infiltration with bupivacaine as compared to placebo group thus making it an effective, simple and cheap method in relieving pain after abdominal incisions.


Article
A case of Giant Uterine Fibroid in a Young Woman

Authors: Safa M.Al-Obaidi --- Mohammed Abd-Zaid Akool
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 4 Pages: 588-592
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:The incidence of uterine fibroid tumor increase as women grow older and they may occur in more than 30 percent of women 40 to 60 years of age. Risk factors include nulliparity, obesity, family history, black race, and hypertension.These neoplasms frequently cause abnormal period, pelvic pain, and pressure symptoms. We present a case report of a large leiomyoma in an adult woman


Article
malignant pediatric tumors in Najaf

Author: Safa M. Al-Obaidi صفاء مزهر مهدي العبيدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2006 Volume: 48 Issue: 2 Pages: 123-130
Publisher: Baghdad University جامعة بغداد

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Abstract


Article
Predictive values of risk factors in management of diabetic foot

Authors: Safa M..Al-Obaidi صفاء العبيدي --- Amine Mohammed Bakkour --- Salah Mahdi Tajer
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 1 Pages: 37-43
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Outcome of management of patients with diabetic foot is difficult to predict. Assessmentof variables in history , examination and investigations were analyzed with outcome of management andwhether can be assigned as prognostic factors .Methods: prospective study of 300 patients with diabetic foot in Baghdad teaching hospital duringthe period from April 2000 to March 2004,certain criteria was taken in history and examination, thesewere investigated and treated either by conservative procedure or amputation.Results: most common age group was 50-59 years ( 33.3%). The male to female ratio was 2:1.Conservative debridement was performed in ( 60%) of patients while amputation was employed in(40%). amputation was performed in 604 in patient above 60 years and in(75%) of patients who haddiabetic foot lesions for > 2 weeks,and in 90% of smokers for 10 years or more. Amputation wasneeded in (71%) in those who had history of previous ulceration and 72.5% of patients who hadpositive history of previous amputation. Amputation was needed in (88%) of those who had theirtemperature >38°C. in (91%) of patients who had diabetic foot lesion of Wagner grade>III and 91%.patients with X-ray findings of osteomyelitis.Conclusions: Highly significant association was found between amputation with following variable ,smokers > 10 years, patients with a temperature of > 38°C, Hypertension > 140/90 mmHg Wagnergrade > III, white blood cell count of > 20,000/cc and positive foot X-ray findings. Slightsignificant association of amputation and the following variables: Age >60 years, duration of footlesion >2 weeks, history of previous amputation, previous ulceration, negative pedal pulses, deformedfeet and patients who had impaired normal vision.


Article
Adrenal Disorders, Surgical Approaches andPostoperative complications

Authors: Salem A Al- sarraf --- Hadi M Al-Aubaidi, --- Safa M Al- Obaidi
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2006 Volume: 48 Issue: 4 Pages: 353-356
Publisher: Baghdad University جامعة بغداد

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Abstract

Backgraound: Adrenal disorders in surgical practice are presented either as hyperfunctional disorders or non functional disorders (incidentalomas). Functionally, medullary tumors (pheochromocytoma) result in excess secretion of catecholamines(l), on the other hand, functioning adrenocortical tumors could secrete excess of cortisol (Cushing syndrome), aldosterone (Conn's syndrome) or sex hormones (virilizing syndromes). (2
The aim of our study is to identify and to show our experience in the surgical approach and postoperative complications of adrenal disorders.
Patients & methods: This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The data collected including age, gender, types of clinical adrenal disorders, surgical approaches and postoperative complications.
Result: Surgical excision was performed in 19 cases, eleven through anterior transabdominal approach (11/20, 55%), and eight through thoracoabdominal approach (8/20, 40%). A better outcome was recorded in the thoracoabdominal approach. The most common encountered surgical morbidity was hypertension (3/19, 15.8%) and hypocalcemia (3/19, 15.8%).
Conclusion: Thoracoabdominal approach has better outcome especially in excising right adrenal tumor but transabdominal approach is preferable in excising a bilateral adrenal gland.


Article
Mesh repair versus non mesh repair of primaryinguinal hernia

Authors: Othman A.Salim --- Salem A. Al-Sarraf --- Safa M. Al-Obaidi
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 4 Pages: 403-406
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Techniques of Inguinal hernia repair have seen an evolution from the pure tissue repair to the prosthetic repair and in the recent years past to laparoscopic repair. High recurrence rates using fascia for the hernia repair or the use of sutures under tension prompted the development of polypropylene mesh to reinforce the posterior wall of the inguinal canal.The aim of this study is to compare the post operative results of Lichtenstein mesh technique with Dar ning repair.
Patients and methods:-A prospective study of "100" patients with inguinal hernia were conducted to evaluate two methods, of open repair of inguinal hernia Lichtenstein mesh technique with Traditional non-mesh technique (modified Bassini or Darning).Operation were done under general, epidural and local anaesthesia at the surgical units of Baghdad Teaching Hospital and Arbil Teaching Hospital.
Results: The study showed that Lichtenstein mesh technique is an effective operation for repair of inguinal hernia with low complication rate and less pain in comparison to the repair by traditional non-mesh technique. Also the results show that, mesh repair group returned to work earlier than non-mesh repair group.
Conclusion:Mesh repair of primary inguinal hernia repair is superior to non-mesh repair in term of early postoperative pain , return to the work and recurrence.


Article
Abdominal Operations without Nasogastric tube :A major advance inmodern surgery

Authors: Muqdad F.A. Al-karim --- Safa M. Al-Obaidi --- Salem A.H. Al-Sarraf
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 3 Pages: 303-307
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Routine use of nasogastric tubes, after abdominal operations, is intended to
hasten the return of bowel function, prevent pulmonary complications, diminish the risk of
anastomotic leakage, increase patient comfort and shorten hospital stay. Aim of this study is to
evaluate the efficacy of routine nasogastric decompression after abdominal surgery, in
achieving each of the above goals.
Patients and methods:Two hundred and twelve patients having abdominal operations of any
type, emergency and elective have been followed prospectively over a period of three years (1st

December 2004 until end of December 2007) in Baghdad teaching hospital. Patients were
randomized into two groups. Group 1 had nasogastric tube inserted and kept in place until
intestinal function has returned. Group 2 had no nasogastric tube or immediately removed at
the end of the operation. Excluded from the study , were laparoscopic surgeries , gastric and
duodenal surgeries.
Results: There was earlier return of bowel function and shorter hospital stay in the non tube
group. There were no significant statistical differences concerning the occurrence of
postoperative vomiting, pulmonary complications, anastamotic leakage and wound dehisence.
Conclusions: Routine nasogastric decompression does not accomplish any of its intended
goals and so should be abandoned in favor of selective use of nasogastric tube.


Article
The Predictive Value of Fine Needle Aspiration Cytology in The Assessment of Cervical Lymphadenopathy

Authors: Hayder M. Abdulnabi --- Safa M. Al-Obaidi --- Khalid M. Al-Hussaini,
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2006 Volume: 3 Issue: 3-4 Pages: 240-245
Publisher: Babylon University جامعة بابل

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Abstract

Cervical lymphadenopathy is a common clinical problem that needs a prompt diagnosis to manage. FNAC plays an increasing role in the differentiation of its pathology. The aim of this study was to show the value of cytological examination in the assessment of cervical lymphadenopathy in relation to histopathological examination. A prospective study where 50 randomly selected patients with cervical lymphadenopathy underwent fine needle aspiration cytology in the pathological department, college of medicine, Kufa university, for the period from Feb.2004 to Feb.2005. Non specific lymphadenitis was the common pathology in 20 patients (40%), followed by tuberculous lymphadenitis in 16 patients (32%), lymphoma in 22% and metastatic tumour in 12% of cases respectively.In 44 patients out of 50 the the pathology was confirmed histopathologically. It is proved by this study that FNAC play an important role in the diagnosis of cervical lymphadenopathy as accurate as histopathological examination.

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