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Article
endoscopic management of common bile duct stones

Authors: haider Kadhum --- Tharwat I. Sulaiman ثروت ادريس سليمان --- Nawal ali --- kassim Fadhil
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2006 Volume: 48 Issue: 2 Pages: 112-118
Publisher: Baghdad University جامعة بغداد

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Article
The treatment of non complicated sacrococcygeal pilonidal sinus by minimal excision and primary closure technique

Authors: Nabil I. Naiem نبيل عصام نعيم --- Tharwat I Sulaiman ثروت ادريس سليمان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2017 Volume: 59 Issue: 1 Pages: 9-13
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The surgical treatment of pilonidal sinus varies from wide excision and laying the wound open or excision with primary closure or excision with the use of skin graft in some special cases.Objectives: The objectives of this study is to determine the efficacy of treating non complicated pilonidal sinus disease with minimal excision and primary closure technique, complications and recurrence rate.Patients and methods: This is a prospective study conducted in shahid ahmed ismaiel hospital in rania – As sulaimania IRAQ during the period from December 2013 to January 2016 and was carried on one hundred (100) consecutive patients with non complicated non recurrent pilonidal sinus patients who were treated with minimal excision and primary closure technique. The data were analyzed focusing mainly on complications mainly infection, gapping, wound disruption, recurrence rate and patient’s compliance to antibiotics use and local wound care.The results obtained were compared with other similar studies.Result: One hundred patients with non complicated pilonidal sinus were treated with minimal excision and primary closure technique.Fifteen patients developed superficial wound infection, seventeen patients developed simple superficial wound gapping .Three patients developed deep wound infection with disruption. Four patients developed recurrence and they were treated with re-excision and skin graft placement. Minimal follow up was six months, Operations were done under general or spinal anesthesia .operative time ranged between 12 to 22 minutes (mean time 17 minutes).Conclusion: Minimal excision and primary closure technique for the treatment of pilonidal sinus disease is associated with short hospital stay, shorter off work time, less cost, low complications rate and low chance of recurrence.Key words: Pilonidal sinus, minimal excision, primary closure, recurrence rate.


Article
Dense breast as a risk factor in breast malignancy
زيادة كثافة الثدي كعامل مساعد في سرطان الثدي

Authors: Tharwat I. Sulaiman ثروت ادريس ل --- Enam A. Khalel انعام عزيز --- Saabh Ismail Khalil سبا اسماعيل خليل
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2014 Volume: 56 Issue: 4 Pages: 372-375
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: One of the strongest risk factors for breast cancer is high breast density, relatively little fat in the breast and more connective and glandular tissue.Objectives: this study aims to measure risk of increase breast density in correlation of CA breast & compare our results with results in other population, to compare the performance of ultrasonography and mammography in measuring breast density according to BIRDS systemMaterials &methods: The study included 45 females .Measuring risk of increase breast density in correlation of CA breast & comparing the performance of ultrasonography and mammography in measuring breast density according to BIRADS system.Results : there is strong influence of breast density as a risk factor of breast CA, according to mammography, it had been significantly found that mammographic density was the more prevalent among CA patients it found in According to mammography, also use of RI as significant and important way for estimation of density as use of 0.6 as a cutoff point, as 91% of dense breast had RI more than 0.6. Conclusions : increase breast density is associated with possible increase risk of CA breast and use of ultrasound, mammogram and RI play a role in estimating breast density.Keywords: Breast Density, Mammography, Doppler Ultrasound, Resistive Index.

خلفية البحث:واحد من اهم عوامل الخطر المعروفة لسرطان الثدي هو كثافة الثدي العالية وهو ان تكون نسبة الدهون قليلة في الثدي وزيادة بالأنسجة الضامة والانسجة الغدية المرضى وطرق العمل:شملت الدراسة 45 مريضة و تم فحص المرضى خلال فترة جمع البيانات وقياس كثافة الثدي وفقا لالماموجرام والموجات فوق الصوتية وقد تم على أساس نظام( تسجيل تصوير الثدي ونظام البيانات) ثم تقدير خطرالاصابة بسرطان الثدي النتائج: أظهرت الدراسة التأثيرالقوي ل كثافة الثدي كعامل خطرسرطان الثدي، وفقا لتصوير الثدي، زيادة كثافة بالأشعة كان أكثر انتشارا بين المرضى ، أيضا استخدام RI(مؤشر مقاوم) كطريقة لتقدير كثافة الثدي واستخدام مقدار 0.6 كنقطة قطع، و91٪ من الثدي الكثيف كان أكثر من 0.6 (مؤشر مقاوم)الاستنتاجات: ترتبط زيادة كثافة الثدي مع احتمال زيادة خطر سرطان الثدي واستخدام الموجات فوق الصوتية، والماموجرام مع ال (مؤشر مقاوم) تلعب دورا في تقدير كثافة الثدي. الكلمات الرئيسية: كثافة الثدي ,التصوير الشعاعي للثدي ,دوبلر بالموجات فوق الصوتية ,مؤشر مقاوم(RI)


Article
Management of Obstractive Jaundice Due to Common Bile Duct Stone in Baghdad Teaching Hospital
علاج اليرقان الانسدادي الناتج عن حصاة القناة الصفراوية المشتركة في مستشفى بغداد التعليمي

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Background: the most common cause of obstructive jaundice is CBD stones, and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution; several methods of investigations and treatment have been introduced, and each one has its own advantages and disadvantages.Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital.Patients and methods: a prospective study of 111 patients with clinical, laboratory, and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011; other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them, MRCP for 26 patients, and EUS for 9 patients. Four patients had primary stones, 95 patients had secondary stones, 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions, and they were excluded from the study, so the total number of the patients was 111; 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients, 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone (more than 15mm) Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries, because there is no intraoperative screening to avoid missing CBD stones in our hospital.Key wards: CBD stones, endoscopic management, surgical intervention

خلفيه الموضوع: اكثر اسباب اليرقان الانسدادي هو حصا القناه الصفراء,وهذا يمكن ان يولد مضاعفاه ووفياه مهمه.معالجه اليرقان الانسدادي الناتج من حصاه ه قناه الصفراء في تطور,عده طرق تشخيصيه وعلاجيه ادخلت في هذا الموضوع وكل منها له فوائده ومضاره.هدف الدراسه:لغرض دراسه وتقييم معالجه اليرقان الانسدادي الناتج عن حصاه القناه الصفراء في مستشفى بغداد التعليمي.المرضى والوسائط :دراسه مستقبليه مكونه من 111 مريض لديهم اعراض سريريه ونتائج مختبريه وصوريه تقترح وجود يرقان انسدادي ناتج عن حصاه القناه الصفراء عولجو في مستشفى بغداد التعليمي في الفتره من كانون الثاني 2011 الى تشرين الثاني 2011 14 مريض اخر ابعدو من الدراسه بسبب ثبوت ان سبب اليرقان الانسدادي لديهم كان باسباب اخرى.العمل المبذول لكل مريض كان اخذ تاريخ المرض والفحص السريري وفحوصات مختبريه فحص الامواج فوق الصوتيه (السونار) للبطن.نفس المرضى تعرضوا لعمليه تنظير القناه الصفراء لسببين لغرض التشخيص واستخراج حصاه قناه الصفراء .مريضين فقط ارسلوا مباشره الى العلاج الجراحي كان لديهم (متلازمه ميريزي).كذالك اجريت العمليات الجراحيه للمرضى الذين فشلت لديهم المعالجه الناظوريه.النتائج:من ال125 مريض الذين لديهم يرقان انسدادي والذين انضموا لهذه الدراسه ,14مريض لديهم اسباب غير حصاه القناه الصفراء ابعدوا من هذه الدراسه, فاصبح العدد الكلي للمرضى 111 مريض46 ذكر و65 انثى .جميع المرضى ليهم اعراض سريريه ولديهم نتائج تحاليل وظائف كبد غير طبيعيه , اجري الفحص السوناري لجميع المرضى ,وفحص الرنين المغناطيسي للقنوات الصفراء والبنكرياس اجري ل26 مريض وفحص السونار عن طريق ناظور المعده والاثني عشر ل9 مرضى ,4 مرضى كان لديهم حصاه القناه الصفراء الاوليه, 95 مريض كان لديهم حصاه القناه الصفراء الثانويه , 9 مرضى كان لديهم حصاه القناه الصفراء المحفوظه , و3 مرضى لديهم (متلازمه ميريزي ).المعالجه المنظاريه اجريت ل 108 مريض نجحت في 90% من المرضى.العلاج الجراحي اجري ل 13 مريض 10 منهم بعد فشل العلاج المنظاري و3 مرضى كان لديهم (متلازمه ميريزي) .الاستنتاجات:العلاج الناظوري لاستخراج حصاه القناه الصفراء المتبوع برفع المراره ما زال الطريقه الرشيده في علاج حصاه القناه الصفراء . حصاه القناه الصفراء الكبيره وتعددها ما زالا الاسباب الاكثر شيوعا لفشل العلاج المنظاري لاستخراج حصاه القناه الصفراء والعلاج الجراحي ,في هذه الدراسه كان هنالك نسبه حصاه محفوظه في القناه الصفراء اعلى من الدراسات المذكوره في الدول الغربيه,بسبب عدم وجود فحوصات خلال العمليه تجرى لغرض تشخيص حصاه القناه الصفراء لغرض تلافي ترك حصا في القناه الصفراء في مستشفانا مفتاح الكلمات: حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

Keywords

Background: the most common cause of obstructive jaundice is CBD stones --- and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution --- several methods of investigations and treatment have been introduced --- and each one has its own advantages and disadvantages. Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital. Patients and methods: a prospective study of 111 patients with clinical --- laboratory --- and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011 --- other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them --- MRCP for 26 patients --- and EUS for 9 patients. Four patients had primary stones --- 95 patients had secondary stones --- 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions --- and they were excluded from the study --- so the total number of the patients was 111 --- 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients --- 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone --- more than 15mm Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries --- because there is no intraoperative screening to avoid missing CBD stones in our hospital. Key wards: CBD stones --- endoscopic management --- surgical intervention --- حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي


Article
Abdominal computed tomography findings in patients with exudative ascites
مشاهدات المفراس الحلزوني في استسقاء البطن النضحي

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Background: peritoneal cavity can be involved in inflammatory and malignant diseases and using computed tomography(CT) findings of exudative ascites may help in the differentiation.Objectives: 1-Describe CT features in patients with exudative ascites.2-Obtain useful CT findings to differentiate between tuberculous (TB) peritonitis and peritoneal carc inomatosis.Patients &methods: A cross sectional study conducted in Medical City Teaching Complex from September 2009 to September 2010 studied patients with exudative ascites using CT scan and confirmed later with histopathology examination.CT scan results were presented according to cytology examination and biochemical analysis.Results: 35 patients with exudative ascites were studied, including 19 males &16 females, age varied from 20 to73 years. While the amount of ascites (large or small) did not show statistically significant association with malignant disease,the density of ascitic fluid was slightly higher in TB[range(18-22) Housnfield Unit (HU), mean is 20HU]compared to malignant ascites [range(15-20) HU, mean is 18HU].Right subphrenic ascitic collections are associated with malignant disease (12 or 60% compared to 2 or 13.3% in TB) and pelvic ascitic collections were associated with TB disease (8 or 53.3% compared to 3 or 15% in malignant disease).Conclusion: In addition to omental cake &thickened bowel wall, malignant exudative ascites on CT scan is likely to have lower density, located in the right subphrenic space than in the pelvic region compared to benign (tuberculous) exudative ascites Keywords: exudative, ascites, malignancy, TB, CT scan,

المقدمة :هذه الدراسة للتفريق بين مسببات الاستسقاء النضحي الحميدة والخبيثة باستخدام المفراس الحلزوني.الاهداف: وصف مشاهدات المفراس الحلزوني في الاستسقاء النضحي، استخدام مشاهدات المفراس الحلزوني للتفريق بين مسببات الاستسقاء النضحي الحميدة والخبيثةالمرضى والطرائق: لقد تم دراسة 35 مريض يعانون من استسقاء البطن عن طريق الاختيار العشوائي للمرضى في وحدة المفراس لمستشفيات مدينة الطب التعليمية للفترة من ايلول 2009 الى ايلول 2010, وتم تأكيد النتيجة من الفحص المختبري,هؤلاء المرضى مكونين من 19 ذكر و16 أنثى .وكانت أعمار المرضى تتراوح بين 20-73.النتائج: وجدنا ان كثافة سائل الاستسقاء كانت مرتفعة عند مرضى التدرن البريتوني (20 وحدة هاونسفيلد) بالمقارنة مع المسسببات الخبيثة للاستسقاء النضحي (15 وحدة هاونسفيلد)يكون تجمع الاستسقاء في الناحية تحت الحجاب اليمنى في المسببات الخبيثة (12 او 60% بالمقارنة مع 2 او 13.3% في المسببات الحميدة ) والتجمع في الناحية الحوضية اكثر في مرضى التدرن (8 او 53.3% بالمقارنة مع 3 او 15 % في المسببات الخبيثة). الاستنتاج: اضافة الى الكعكة الثربية والتثخن في جدار الامعاء, يكون الاستسقاء النضحي ذو المسببات الخبيثة بكثافة اقل ويكثر تواجده في الناحية تحت الحجاب اليمنى بالمقارنة مع المسببات الحميدة للاستسقاءمفتاح الكلمات: استسقاء ، النضحي ، الخبيث، المفراس الحلزوني

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