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Article
DAY CASE SURGERY FOR SACROCOCCYGEAL PILONIDAL SINUS USING EXCISION AND PRIMARY MIDLINE CLOSURE

Author: Nizar Hamawandi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 111-117
Publisher: Basrah University جامعة البصرة

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Abstract

Sacrococcygeal pilonidal sinus (PNS) is a common disease. There are different lines oftreatment but the best surgical technique is still controversial. The aim of this study is to showthe effectiveness of treatment of sacrococcygeal PNS with excision and primary midline closureas day case surgery. This is the first study on sacrococcygeal PNS to be done in Sulaymaniagovernorate, Iraq.A prospective study was done over a period of 3 years, between 1st Jan 2003 and 31st Dec2005 in a private general surgical office, in Sulaymania city, Iraq, where 78 cases of chronicsymptomatic, uncomplicated, nonrecurrent sacrococcygeal PNS were seen. From these 78patients 6 patients refused operation and they were excluded from the study. Data collectedfrom the remaining 72 patients were age, gender, presenting complaint and its duration,operative findings, duration of the operation, time of wound healing, any hospitalization ifrequired, time to return to work, postoperative complications, postoperative pain, woundhematoma, wound infection, wound disruption, recurrence of the sinus, cost of the operation,patient satisfaction about the treatment and follow up compliance of the patients. They weretreated with excision and primary midline closure technique. From the total no of 72 patients, 7patients were unable to complete the follow up period and they were excluded from the study,and we continued the study of the outcome data of the remaining 65 patients.Of those 65 patients treated excision and primary midline closure, 1 patient (1.53%) developedwound disruption, 4 patients (6.14%) developed surgical site infection (SSI) and only 3 patients(4.61%) had reccurence of the sinus.It is concluded that excision and primary midline closure technique is simple, convenient,economic and successful treatment as day case surgery for chronic, sympotomatic,uncomplicated and non recurrent sacrococcygeal PNS.K

Keywords

SACROCOCCYGEAL --- PILONIDAL --- SINUS


Article
Sacrococcygealteratoma in Newborns: Management and Outcome

Author: Hasan K.Gatea*, Moaied A. Hassan**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 174-179
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Sacrococcygeal teratoma is the most common tumor in the newborn.. Approximately 90% of sacrococcygeal teratomas excised during the neonatal period are benign. The risk of malignancy increases in lesions removed after 6 months of age. OBJECTIVE::To discuss the management of newborns with sacrococcygeal teratomas and the importance of early surgical intervention in avoiding the risk of malignant transformation.PATIENTS AND METHODS: 11 neonates with sacrococcygeal teratomas were managed during the period from April 2008 through April 2013. In all cases, age, sex, mode of delivery, details of surgery, extent of resection, macroscopic tumor appearance, tumor histology, Altman classification and postoperative morbidity and mortality were all documented and analyzed. A two years follow up plan was designed to assess any complication and tumor recurrence.RESULTS: Classical sacrococcygeal approach was performed in all of the patients operated upon and complete excision of the tumor along with the coccyx was possible in all cases. According to the Altman classification 8 (72.7%) of the tumors were of type I. Macroscopically, 7(63.6%) tumors were mixed,. Histopathological examination of the excised tumors revealed the diagnosis of benign mature teratoma in all cases. All of the newborns survived with the exception of one patient with a giant sacrococcygeal mass who died because of heart failure . No tumor recurrence was documented in all of the patients operated on.CONCLUSION:Early detection including antenatal diagnosis is essential to define fetuses with poor prognostic signs and deciding the appropriate mode of delivery, and in some centers even fetal intervention. Early excision of these tumors during the neonatal period is essential to avoid the risk of malignant transformation.


Article
Case reportSacrococcygeal teratoma with yolk sac elements(endodermal sinus tumors) in two years old child

Authors: Enam A. Khalid --- Lubab F. Talal`
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2009 Volume: 51 Issue: 1 Pages: 109-111
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Sacrococcygeal teratoma is seen in 1 in every 35000 live births, and is the most common tumor presenting in newborn and children but also reported in adults.(1)Sacrococcygeal teratoma are the most common type of germ cell tumors (both benign and malignant) diagnosed in neonates , infants and children younger than 4 years.(2Case report: A 2 years old male child presented with a visible lump or mass under the skin at the top of the buttocks crease after falling on the ground on his buttocks, and the parents give a history that the child had a constipation since birth.The case was diagnosed as endodermal sinus tumor with yolk sac elements on the bases of clinical examination, ultrasonography, CTscan and fine-needle aspiration cytology..After diagnoses patient referred to the oncologist for multi-drug chemotherapy and surgical removal by the pediatric surgeon after shrinkage of the tumor mass.Conclusion: Infants and young children present with a palpable mass in the sacropelvic region have a greater likelihood of being malignant.


Article
Evaluation of the Outcomes of Rhomboidal Flap "Limberg Flap” Repair Procedure for Sacroccocygeal Pilonidal Sinus Disease in Baghdad Teaching Hospital

Author: Saad A.Sarsam , Sabah M.fatlawi , Ahmed M.Salih
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2019 Volume: 18 Issue: 1 Pages: 62-67
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Saccrococygeal Pilonidal sinus is a common surgical condition and its management is stilldebatable, as many surgical techniques were developed aiming to improve outcome, better patientsatisfaction, and most importantly to prevent recurrence. Rhomboidal flap procedure "limberg flap"is very safe and effective method for pilonidal sinus treatment due to its low complication ratespecially recurrence hence in this study we address the role of limberg flap procedure inmanagement of pilonidal sinus and how its complications are.OBJECTIVE:To analyze the outcome of "Limberg" Rhomboidal flap, in managing sacrococcygeal Pilonidalsinus as a novel, with a potentially less complication and recurrence rate surgical procedure.PATIENT AND METHOD:This is a prospective study on 44 patients suffered from sacroccocygeal pilonidal sinus, 36 patientswith primary disease and 8 patients had recurrent or previously managed pilonidal sinus collectedrandomly in the 5th floor surgical department in Baghdad teaching hospital from June 1st 2014 toDecember 10th 2015. All underwent rhomboidal flap procedure .there was no exclusion criteria,data collected included demographic distribution, primary or recurrent pilonidal sinus, woundcomplications, and recurrence. The minimum follow up period was 1 year after surgery.RESULTS:44 patients had undergone this procedure most of them were males (41 patients), and(3 patients) were females, youngest patient was a 16-year old and oldest one was 41-year old. Meanagewas26. 1years±5.6SD, 5 patients (11.4%) had a previous formal surgical repair of pilonidalsinus, 3 patients (6,8%) had a previous drainage of pilonidal abscess. The mean duration of thedisease is 10.9 months±6.9 SD.Our finding revealed that 3(6.8%) patients developed seroma ,2(4,5%)patients had wound infection that all responded to conservative treatment. Other suspectedcomplications including flap necrosis, wound dehiscence and hematoma were not reported with anyof our patients.CONCLUSION:Rhomboid flap is very safe and effective method for treatment of pilonidal sinus disease due to itslow complication rates especially recurrence of pilonidal disease, it also offers a good patientsatisfaction, although this procedure takes a longer operating time than the classical methods but itis easy to be learned and practiced with efficiency .


Article
Operative Treatment Of Acute Sacrococcygeal Pilonidal Sinus With A Single Opening Under The Effect Of Local Anesthesia
علاج الناسور العصعصي الحاد ذو الفتحة الواحدة تحت تأثير التخدير الموضعي

Author: Taqi Saadoon Atiyah تقي سعدون
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 2 Pages: 68-73
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Pilonidal sinus is an acquired disease due to the collection of fallen hair in the sacrococcygeal area; there may be one or more openings which communicate with one or more tracts lined by granulation tissue. There are many surgical operations to treat the condition, but no single operation carries a 100% cure rate without the risk of recurrence. Financial considerations are important in the management of patients with pilonidal sinus, because it affects young adult patients, so admission to the hospital and the work off time has significant considerations in choosing the type of operative management. Objective: To study the significance of operative treatment of acute uncomplicated sacrococcygeal sinus under the effect of local anesthesia.Patients and Methods: A randomized cross sectional analytic study performed at the Al-Imamain Al-Kadhimain Medical City, for patients with acute pilonidal sinus with a single opening, over the period from April 2007 to April 2015. The operation was done in the theater with the patient in the prone position, local anesthetic infiltration around the opening of the sinus, and along its tract; incision along the tract of the sinus and laying it open, removing the hair, debris, and the granulation tissue by gently curating it. Excision of the lateral wall of the sinus, and the skin edges are trimmed, secure hemostasis, and dress the wound. Follow up of patients was daily for one week, then every week till complete healing occurred (usually 2-4 weeks), looking for any complications; then follow up of the patients every month for three months, and every three months for one and a half year, for any recurrence.Results: A total of 53 patients; 52 males (98.11%), and one female (1.88%), their age ranged from 17-39 years, mean age was 25.16±76 years. The patients presented with pain 43 (81.13%), infection was 8 (15.09%), and abscess 2 (3.77%) patients. The average healing time was about 2-4 weeks. The patients returned to their work one week after the operation. There were no complications other than one patient 1 (1.88%) who had recurrence after 9 months, and the procedure was repeated to him successfully. Conclusion: Treatment of sacrococcygeal pilonidal sinus under the effect of local anesthesia is a safe and simple procedure; there is no need for admission to the hospital, the patient can return to his work after one postoperative week, and the procedure can be repeated in case of recurrence.

خلفية البحث: الناسور العصعصي هوناسور ناتج عن تجمع الشعر المتساقط أسفل الظهر فوق العصعص وسط الظهر بفتحة واحدة او اكثركثرة انواع العمليات لهذه الحالة تبين عدم وجود عملية واحدة نموذجية تشفي المريض تماما ان الفترة التي يقضيها المريض بدون عمل اثناء وبعد اجراء العملية الجراحية و حالات رجوع الناسور بعد العملية الجراحية يؤثر على اختيار اي نوع من العمليات يحتاجها المريضالهدف من الدراسة: دراسة امكانية واهمية اجراء عملية فتح وتنظيف الناسور العصعصي البسيط تحت تأثير التخدير الموضعي المرضى واسلوب البحث: دراسة تحليلية اجريت في مدينة الامامين الطبية للمرضى الذين يشكون من ناسور عصعصي بسيط ذو فتحة واحدة للفترة من نيسان 2007 الى نيسان 2015حقن التخدير الموضعي حول فتحة الناسور وعلى طول قناته ثم فتح قناة الناسور وتنظيفها من الشعر والاوساخ وجرفها بالمجرفة وقص جدران الناسور الجانبية وتنظيف و هندمة الجرح وايقاف النزيف ثم وضع ضمادة على الجرحمتابعة المريض يوميا وتغيير ضماده لمدة اسبوع ثم اسبوعيا حتى شفاء الجرح ثم كل شهر لمدة ثلاثة اشهر ثم كل 3 اشهر لمدة سنة ونصف لمتابعة حدوث اي رجوع للناسورالنتائج : عدد المرضى الكلي 53 مريض الذكور منهم 52 ذكر ومريضة واحدة انثى وتتراوح اعمارهم من 17-39 سنة الألم كان سبب مراجعة 43 مريض الى المستشفى بينما الالتهاب (الخمج ) كان سبب مراجعة 8 مرضى والخراج كان عند مرضين فقط ذكر وانثىالتئام الجرح استغرق من 4-2 أسابيع وكل المرضى كانوا مقتنعين بالعملية وراضين عنهااستطاع المرضى الرجوع الى اعمالهم بعد اسبوع واحد فقط من العمليةلم تحدث مضاعفات خطيرة اثناء وبعد العملية ما عدا مريض واحد فقط رجع اليه الناسور بعد 9 أشهر وكان يعمل في مكان حار نسبيا (خباز) وكان يتعرق كثيرا ولم يلتزم بتعليمات نظافة المنطقة من الشعرالاستنتاج : عملية فتح وتنظيف الناسور العصعصي البسيط تحت التخدير الموضعي هي عملية بسيطة وامنة وبدون مضاعفات خطيرة ولايحتاج المريض فيها للدخول الى المستشفى وحتى في حالة رجوع الناسور فمن الممكن اعادة اجراء العملية بنفس السهولة وبدون مضاعفات


Article
The frequency of ossification of the sacrococcygeal joint in Iraqis
تردد من التحجر المفصل العجزي العصعصي في العراقيين

Authors: Mohammad A. Abd-alla سعد علي محمد، محمد احمد عبدالله --- Saad A .Mohammad
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2007 Volume: 1 Issue: 131 Pages: 95-98
Publisher: Tikrit University جامعة تكريت

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Abstract

Sacrococcygeal joint fusion incidence has been studied at Forensic Medicine Department of Tikrit Teaching Hospital in Salah-Aldin governorate, One hundred body of equal number from males & females had been dissected as autopsy, sacrococcygeal joints were explored, freed from soft tissues, fusion of joints (ossification) was more prevalence in males (68%) than females (48%).and the incidence was high in aged than young people

وقد تمت دراسة العجزية العصعصية حدوث انصهار مشترك في ادارة الطب الشرعي من مستشفى تكريت في صلاح الدين محافظة، مائة جثة من عدد متساو من الذكور والإناث قد تم تشريح وتشريح الجثة، استكشاف المفاصل العجزية العصعصية، التي تحررت من الأنسجة الرخوة، والانصهار في المفاصل (التحجر) وكان أكثر انتشار في الذكور (68٪) من الإناث (48٪). والإصابة كانت مرتفعة في الفئة العمرية من الشباب

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