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Thyroid Surgery with Drain Versus without Drain

Authors: Ammar Noori Muhammed --- Wassem Ahmed AL-Kateb --- Ramez AL-Mukhtar --- Tharwat Idrees Sulaiman
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 343-348
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The nature and indications for thyroid surgery vary and a perceived risk of postoperative complications such as seroma , haematoma , wound infection and haemorrhage post-surgery is one reason why wound drains are frequently inserted. They are generally used as a matter of the surgeon’s habit or preference more than a matter of proven benefit in the patient’s postoperative period.OBJECTIVE:To evaluate the differences in outcome and complications following thyroid surgery whether draining the wound or not .PATIENTS AND METHODS:One hundred forty five patients with different thyroid diseases requiring surgical intervention presenting to the first surgical unit in Baghdad teaching hospital between the first of October 2007 to the 31th of December 2009(27 months period) were enrolled. Patients were divided into two groups : those who had their wounds drained postoperatively ; (the drain group DG) and those who had their wounds closed without drain ; (the non drain group NG).RESULTS:Seroma occurred in three patients (3%) in the DG, and in two patients (4.4%) in the NG. Small haematoma occurred in three patients (3%) in the DG, and in two patients (4.4%) in the NG. Large haematoma occurred only in one patients (1%) in the DG, and it didn't occur in the NG. Wound infection occurs only in two patients (2%) in the DG, and in one patient (2.2%) in the NG. The mean of in-hospital stay was 2.07 days in the DG, and 1.06 days in the NG.CONCLUSION:The use of drain showed no effect on the prevention of wound infection , seroma , haematoma formation or the need for re-exploration, indeed the use of drain had lengthened the in hospital stay .So the Routine use of drains after thyroid surgery might be therefore not necessary, if not detrimental.


Article
The Value of Focused Assessment Sonography for Trauma the Management of Patients with Blunt Trauma to the Abdomen

Authors: Nabil Isam Naiem --- yahya Kareem Hammodi --- Tharwat Idrees Sulaiman --- Mohammed M.Habash
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 3 Pages: 379-384
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.OBJECTIVE: This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.PATIENTS AND METHOD: 210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive. In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on. Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition. Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture. RESULTS: From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results. After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%. CONCLUSION: FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value. FAST had a great effect in determining the type of treatment especially in case of mass causality.And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.


Article
The Value of Focused Assessment Sonography for Trauma (FAST) In The Management of Patients with Blunt Trauma to the Abdomen

Author: Nabeel Isam Naiem, Yahya Kareem Hammoodi, Mohammed mahmood ,Tharwat Idrees Sulaiman
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 4 Pages: 564-569
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.OBJECTIVE: This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.PATIENTS AND METHOD: 210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive. In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on. Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition. Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture. RESULTS: From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results.After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%. CONCLUSION:FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value. FAST had a great effect in determining the type of treatment especially in case of mass causality.And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.

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