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REVIEW OF ACUTE ABDOMEN IN PEDIATRICS AGE GROUP
بحث الحالات البطنية الحادة في فئات الاطفال المراجعين لمستشفى الصدر التعليمي

Author: Dr. Ali Jabir Neima Al-khafaji, M.B.Ch.B., F.I.C.M.S.
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2011 Volume: 14 Issue: 2 Pages: 130-140
Publisher: University of Kufa جامعة الكوفة

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Abstract

ABSTRACTBackground:- Acute Abdominal pain in children presents a diagnostic dilemma, although many causes of acute Abdominal pain are benign, some require rapid diagnosis and treatment to minimize morbidity.Numerous disorders can cause abdominal pain. The most common medical cause is gastro-enteritis, and the most common surgical cause is appendicitis. This study evaluates the different cause of the acute abdomen in the pediatric age group in our hospital, including medical and surgical causes.Methods: - This is a prospective study over a period of six months (from March 15th to September 15th of 2007), a total of 200 kids were included in this study that presented to our hospital with the acute abdomen.Those kids divided into four groups depending on their age,as following:(1.those who are less than one year,2.from one to five years,3.from five to ten years,4.from ten to fifteen years old) and after careful clinical evaluation supplemented by laboratory and radiological investigations, those kids divided into (2) entities (medical and surgical).The result: - 200 kids suffering from acute abdominal pain were included in this study, 124 male and 76 female.From the total, 80 kids were diagnosed as medical where 120 kids undergone a surgical operation, 82 kids (44 male and 38 female) undergone appendicectomy. Seven kids from them had generalized peritonitis due to perforated appendices, 36 kids with intestinal obstruction (23 kids below one year and 13 above one year, the remaining two kids with torsion of an undescended testis).Conclusion: - Appendicitis is the most common surgical cause of the acute abdomen in the children and next common surgical cause is intestinal obstruction.Any child with an acute abdomen should be examined carefully and repeated examination done by the same surgeon.

الخلاصة:مقدمة: تعتبر الحالات البطنية الحادة من الصعوبات التشخيصية والتي تستوجب التشخيص السريع والعلاج وتندرج الحالات البطنية الحادة في شعبتين وهي الجراحية والغير جراحية ويعتبر التهاب الأمعاء من أكثر الحالات الغير جراحية شيوعا.الطريقة: هذه دراسة لـ200 طفل مصاب بحالة بطنية حادة تم فحصهم في ردهة طوارئ مستشفانا, قسمت هذه الحالات الى أربع مجاميع حسب أعمارهم وهذه المجاميع هي:1.الأطفال دون عمر السنة 2.من سنة الى خمس سنوات 3.من خمس الى عشر سنوات4.من عشر الى خمس عشرة سنة.النتائج: وجد ان من بين هؤلاء الأطفال 124 ذكر و76 أنثى من مجموع 200وجدت 80 حالة غير جراحية و120 حالة تحتاج تداخل جراحيمن الحالات الجراحية 82 مصابة بالالتهاب الزائدة الدودية36 حالة مصابة بانسداد الأمعاء, 23 دون السنة من العمر و 13 اكثر من سنة7 حالات مصابة بالتهاب غشاء البريتونحالتين مصابة بالتواء الخصية غير النازلةالمحصلة: الذكور المصابين بهذه الحالات أكثر من الإناثالتهاب الزائدة الدودية أكثر الحالات البطنية الجراحيةالفحص المتكرر السريع يقلل من تفاقم الحالات البطنية ويقلل من حالات الوفاة.

Keywords

Acute abdomen --- Pediatrics.


Article
Diagnostic Errors of Non-Traumatic Acute Abdomen

Author: Hadi Awad Hmoud
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 2 Pages: 2197-2201
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Acute abdomen is a relatively common issue that facing hospital casualties, which make it crucial for physicians to diagnose acute abdomen, as early as possible depending mainly on their clinical skills to avoid unnecessary delay or negative laparotomies. Every physician must be familiar with diagnosis of acute abdomen especially in situations where there is limited diagnostic facilities.Aim: This study was conducted as a comparison between preliminary and final diagnosis for 500 cases of acute abdomen, and to find out the role of clinical skill and diagnostic tools in avoiding diagnostic errors.Method: This study was performed from 1996-1998, and included 500 patients presented to casualty department with signs and symptoms of acute abdomen. Clinical skills were the major tools used for settling the diagnosis, due to shortage of the other diagnostic tools.Results: Acute abdomen was common in the age group of 21-30 years, with male gender predominance (60.80%). Laparotomy was done for 462 out of 500 patients with acute abdomen, and it was similar to the pre-operative diagnosis in 421 patients, so the incorrect post-operative diagnosis rate was 41 patients (8.88%).Also correct preliminary diagnosis was 454 out of 500 patient including the patients who underwent laparotomy, with false preliminary diagnosis rate (9.20%).Appendicitis was the major cause for acute abdomen (70.60%).Limited laboratory and imaging studies were done for some patients, GUE showed the highest negative predicted value (99.42%) and the x-ray showed the highest sensitivity (95.24%). Most of incorrect post-operative diagnosis was related to physiological and pathological gynecological issues.Conclusion: The diagnosis of acute abdomen should be based on the results of a good history and thorough physical examination aided by the secondary role of investigative tools. Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate diagnosis of acute abdomen can minimize unnecessary operations and reduces the rate of negative laparotomies.Keywords: Acute abdomen, Laparotomy, Diagnosis


Article
Follow Up of Women after Laparoscopy Versus Laparotomy in Emergency Gynecological Problems

Author: Enas Mahmood Yaseen
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2016 Volume: 2 Issue: 2 Pages: 193-209
Publisher: Tikrit University جامعة تكريت

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Article
Acute Abdomen in Al-Kindy Teaching Hospital

Author: Dr. Mohammed salih A. Ali M.B.Ch.B. C.A.B.S.
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 1 Pages: 46-53
Publisher: Baghdad University جامعة بغداد

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Abstract

Objective; Is to study and analysis the pattern of the non-traumatic acute abdomen cases that received by causality department of Al-Kindy Teaching Hospital in one year and to see the causes of acute abdomen and to compare it to other studies.Method: This prospective study was done for all cases of non-traumatic acute abdomen (370 patients) which were admitted to the causality department of Al-kindy Teaching Hospital from 1 march 2010 to 28 February 2011, clinical history and physical examination and resuscitation were done for all patients. WBC, GUE, plain abdomen were also done for all patients, and US was done for highly indicated cases, surgical operations done for patients indicated and reminder treated conservatively.Result;370 patients received in the causality department, the ratio of male to female is 1.23:1.Common age group involved is 11-20years (34%), followed by age group 21-30 years ( 28%), it occur least at old age group ≥ 60years (1.6%) . 45.5% patients presented after 24 hours from onset of pain.60.37% of patients have generalized abdominal pain and 60% of patients complain of vomiting. And only 57% of patients have WBC more than 10x109/L.Clinical preoperative diagnosis was acute appendicitis in 68.6% of patients, perforated viscous in 12.6%, acute cholcystitis 3.78%, peritonitis without clear cause 2.7%, renal disease 4.32%, non-specific disease group 5.9%, and 8 patients as case of intestinal obstruction.The final result was suppurative acute appendicitis 54.6%, Ruptured appendix 5.94%, Perforated DU 8.64%, perforated typhoid 5.67%, UTI 4.32% and non specific infection 10.8%The post operative complications not differ from other centers.Conclusion : The non-traumatic acute abdomen is one of the most common surgical condition, and acute appendix is the most common cause of acute abdomen and most of patient presented after 24hours after onset of symptom.Key worlds; - non-traumatic acute abdomen, -acute abdomen, - abdominal pain analysis.


Article
Gynecological Emergencies in the General Surgical Unit

Authors: Firas M. Kattof --- Najeeb S. Jabbo
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2006 Volume: 6 Issue: 2 Pages: 56-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Objectives: To evaluate the gynecological cases presented to our surgical unit as acute abdomen in respect to their clinical features, diagnosis and treatment. Methods: A prospective study of 60 female patients admitted to the surgical unit at AL-Yarmouk Teaching Hospital presenting with gynecological causes of acute abdomen excluding trauma emergencies.Results: The causes were; ruptured ovarian cyst in 36 patients (60%), pelvic inflammatory diseases in 15(25%) and ectopic pregnancy in 9 patients (15%). The clinical features were mainly abdominal pain, fever, nausea, vomiting and vaginal bleeding or shock state. Abdominal examination in all cases revealed abdominal tenderness. In ail patients the diagnosis was mainly confirmed at exploration and intervention depended mainly on clinical grounds. The most common differential diagnosis in these cases was acute appendicitis. Gynecological examination and U/S were not conclusive, and laparoscopy was not used in our study. Postoperative complications occur in 5 patients (8.33%) and there was no mortality. Conclusion: We conclude from this study; better experience in LJ/S examination is needed, and the importance of the use of laparoscopy in the diagnosis and treatment of such conditions.


Article
The value of ultrasound in diagnosing acute appendicitis
قيمة الموجات فوق الصوتية في تشخيص التهاب الزائدة الدودية الحاد

Author: Baha'a Mushref Abdulsalam بهاء مشرف
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2013 Volume: 19 Issue: 2 Pages: 353-358
Publisher: Tikrit University جامعة تكريت

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Objectives: Acute appendicitis considered one of the causes of acute abdomen. The diagnosis is usually straight forward in typical cases, but this is not true in atypical cases. This study is to assess the value of ultrasound modality in diagnosing acute appendicitis. Methods: From January 2009 to January 2012 in Al-Ramadi teaching hospital, 196 patients were included in this study, 10 patients were excluded, and 186 examined by ultrasound, after adequate clinical assessment, for their signs and symptoms that suggestive of acute appendicitis. Age groups were 6-75 years, Mean age 33.5 years, with 105(54%) males, and 91(46%) females. Results: 186 patients could be explained, and examined by ultrasound, with mean age of 33.5 years, the diagnosis had established in 34 patients. The false positive was three cases, and false negative was six cases, this means that the ultrasound had failed in these nine cases. The sensitivity is 81.8%, the specificity is 98%. 90% and 96.2% are the positive and negative predictive values respectively. The diagnostic accuracy is 95.5%. The P-value is الأهداف : التهاب الزائدة الدودية الحاد يعتبر واحدا من أسباب البطن الحادة . التشخيص عادة ما يكون على التوالي إلى الأمام في الحالات النموذجية ، ولكن هذا ليس صحيحا في حالات شاذة . هذه الدراسة هو تقييم قيمة طريقة الموجات فوق الصوتية في تشخيص التهاب الزائدة الدودية الحاد . الأساليب: خلال الفترة من يناير 2009 إلى يناير 2012 في مدينة الرمادي تعليم المستشفى ، أدرجت 196 مريضا في هذه الدراسة ، تم استبعاد 10 مريضا ، و 186 فحص بواسطة الموجات فوق الصوتية ، وبعد التقييم السريري الكافي، بحثا عن علامات و الأعراض التي توحي التهاب الزائدة الدودية الحاد . وكانت الفئات العمرية 6-75 سنة، متوسط ​​العمر 33.5 سنة، مع 105 ( 54 ٪ ) من الذكور ، و 91 ( 46 ٪ ) إناث.النتائج : يمكن تفسير 186 مريضا ، و فحص بواسطة الموجات فوق الصوتية ، مع متوسط ​​عمر 33.5 سنة، وكان التشخيص أنشئت في 34 مريضا . كانت إيجابية كاذبة ثلاث حالات ، و كانت سلبية كاذبة ست حالات ، وهذا يعني أن الموجات فوق الصوتية قد فشلت في هذه الحالات التسع. وحساسية هو 81.8 ٪، و خصوصية 98 ٪ . 90 ٪ و 96.2 ٪ هي القيم التنبؤية الإيجابية والسلبية على التوالي. دقة التشخيص هو 95.5 ٪ . و القيمة P هو < o.o1 .الاستنتاج : إن الموجات فوق الصوتية هو أداة قيمة التحقيق المرضى الذين يعانون من التهاب الزائدة الدودية الحاد يشتبه ، جنبا إلى جنب مع مع الفحص البدني السليم .


Article
The Value of Ultrasound in Diagnosing Acute Appendicitis

Author: Baha'a Mushref Abdulsalam
Journal: Tikret Journal of Pharmaceutical Sciences مجلة تكريت للعلوم الصيدلانية ISSN: 18172716 Year: 2012 Volume: 8 Issue: 2 Pages: 185-191
Publisher: Tikrit University جامعة تكريت

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Abstract

Acute appendicitis considered one of the causes of acute abdomen. The diagnosis is usually straight forward in typical cases, but this is not true in atypical cases. This study is to assess the value of ultrasound modality in diagnosing acute appendicitis. From January 2009 to January 2012 in Al-Ramadi teaching hospital, 196 patients were included in this study, 10 patients were excluded, and 186 examined by ultrasound, after adequate clinical assessment, for their signs and symptoms that suggestive of acute appendicitis. Age groups were 6-75 years, Mean age 33.5 years, with 105(54%) males, and 91(46%) females. 186 patients could be explained, and examined by ultrasound, with mean age of 33.5 years, the diagnosis had established in 34 patients. The false positive was three cases, and false negative was six cases, this means that the ultrasound had failed in these nine cases. The sensitivity is 81.8%, the specificity is 98%. 90% and 96.2% are the positive and negative predictive values respectively. The diagnostic accuracy is 95.5%. The P-value is


Article
Spontaneous Common Bile Duct Perforation in Adult:A Case Report and Review

Author: Ali J. Awad علي جواد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 1 Pages: 111-112
Publisher: Baghdad University جامعة بغداد

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Case Report: Common bile duct perforation has been reported in adults after invasive procedures, spontaneous common bile duct perforation is a rare entity as a cute abdomen in adults. A few cases due to choledocholithiasis have been reported as a cause of spontaneous perforation. We report an adult patient who presented with acute abdomen after spontaneous common bile duct perforation due to unknown etiology who was treated successfully. Keywords: Common bile duct-perforation- acute abdomen.


Article
Acute abdomen during pregnancy in Baghdad

Author: Ahmed R. Hizam*CABS Salam Othman Hamad*MBChBSafa M. AL-Obaidi* FRCS
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 2 Pages: 1-5
Publisher: Baghdad University جامعة بغداد

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BackgroundThe diagnosis and important aspects in treating acute abdomen during pregnancy tend to be delayed due to the peculiar physiological features of pregnancy and the restrictions imposed on imaging diagnostic techniques such as x-ray and CT.Aim of the studyTo identify the most common causes of acute abdomen during pregnancy and identifying the approaches for early diagnosis and to take a correct decision for surgery and assigning the complications that may occur during and/or after surgery for the mother and the fetus.Patients and Methods This is a prospective study that involves data obtained from 91 pregnant patients admitted in the surgical wards in Baghdad teaching hospital during the period from January 2008 to December 2009 .All mandated surgical intervention.ResultsTotal surgical admission in Baghdad Teaching Hospital in 2008-2009 was 13485, total number of cases operated onas acute abdomen was 3374 and the total cases of acute abdomen operated on during pregnancy were 91 cases. The most common cause of acute abdomen during pregnancy is acute appendicitis which represents 70.3%.The most common age group of acute abdomen during pregnancy is between 25-29 years .The most common gestational age is the second trimester.The most common complaint of acute abdomen during pregnancy is right lower abdominal pain.The fetal condition was normal in 91.7% of total cases operated.ConclusionAcute abdomen during pregnancy represents a small proportion of the total cases of acute abdomen.It mostly presents during the second trimester and mostly caused by acute appendicitis. With proper management, the maternal and fetal outcome is good.Key words: Acute abdomen; Pregnancy; Baghdad Teaching Hospital.


Article
Delayed Management in Acute Abdomen: causes and consequences
إرجاء التدابير العلاجية في حالات البطن الحادة: الاسباب والنتائج

Authors: Haqqi I. Razzouki حقي اسماعيل رزوقي --- Amer H. Salman عامر حسن سلمان
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 1 Pages: 78-84
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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ABSTRACT:Background: Acute abdomen is a serious life-threatening condition which needs prompt diagnosis and management. However, in many situations, there is a delay in management which may affect the clinical outcome and worsen the prognosis.Objectives: To determine the causes of delay in diagnosis and treatment in acute abdomen and to study the effects on prognosis.Patients and Methods: A prospective case-series study done in Al-Yarmouk teaching hospital, surgical department over a six months period from 1st of April 2011 to the 1st of October 2011.Ninety five Patients presented with acute abdomen were divided into two groups according to the duration of their symptoms. Thirty five patients who presented after 24 hours were considered delayed and 60 patients who presented before 24 hours were considered as controlled group. Both groups were followed closely and the operative findings, Post-operative complications and the final clinical outcome were documented.Results: There were 35 patients with delayed acute abdomen. The delay was due to the patient or his family in 19 (54.2%) cases and due to medical factors in 11(31.4%) patients. The most common operative finding was perforated duodenal ulcer 5 (14.2%) patients and perforated appendix 5 (14.2%) patients. Thirty (85.7%) patients developed post-operative complications mainly prolonged paralytic ileus, peritonitis and early surgical site infection. The total post operative complications were 25 (71.4%) patients and full recovery was 5 (14.3%).There were 5(14.3%) deaths due to septic shock or cardiovascular complications. Sixty patients presented within 24 hours and considered as controlled group, The most common operative finding was perforated duodenal ulcer 30 (50%) patients, and obstructed or strangulated hernia was 15 (25%) patients, the total post operative complications in this group was (25%) P-value 0.006 (significant), full recovery was found in 42 (66.6%) patients P-value 0.0007(significant), there was no deathConclusions: Although many factors causing delay management in cases of acute abdomen are mainly related to the patient, there were a significant number of cases in which the attending doctor was responsible for the delay. There was a definite relationship between the delay in diagnosis and management and the incidence of complications and Death. Keywords: Acute Abdomen; Delayed treatment; causes, consequences

خلفية البحث: ان حالات البطن الحاد تكون في اغلب الاحيان شديدة مع خطر الموت و تحتاج الى تشخيص سريع و تداخل عاجل . هناك في حالات عديدة تاءخير في المعالجة مما يؤثر على النتائج السريرية و يؤدي الى تدهور في التكهناهداف البحث: لتحديد اسباب التاخير في التشخيص و المعالجة لحالات البطن الحاد و لدراسة المضاعفات المترتبة على هذا التأخير ومدى تأثيرها على التكهنات.المرضى و طرق البحث: دراسة مستقبلية شملت المرضى المصابين بالبطن الحاد الداخلين الى قسم الجراحة في مستشفى اليرموك التعليمي لمدة ستة اشهر. تم تقسيم المرضى الى مجموعتين حسب الفترة ما بين ظهور الاعراض و وصولهم المستشفى واعتبرت الحالات الواصلة بعد 24 ساعة متأخرة0 لاغراض البحث تم متابعة المجموعتين تفصيليا وتوثيق مشاهدات العمليات الجراحية والمضاعفات بعد العمليات و النتائج السريرية.النتائـــــــــج: كانت هناك 35 حالة بطن حاد متأخرة .كانت العوامل المتعلقة بالمريض او عائلته هي سبب التأخير في 19 مريضا و العوامل المتعلقة بالكادر الطبي هي السبب في 11 مريضا.الحالات الاكثر حدوثا هي انثقاب قرحة الاثني عشري و انثقاب الزائدة الدودية.حدثت مضاعفا ت بعد العملية في 30 مريضا اكثرها شيوعا شلل الامعاء المطول و التهاب غشاء البريتون و التهاب جرح العملية. وحدوث خمس وفيات بسبب الصدمة الجرثومية او اختلاطات متعلقة بالقلب و جهاز الدوران .الاستنتاجات: ان العوامل المتعلقة بمعالجة حالات البطن الحادة المتأخره تعود اساسا الى المريض و عائلته الا ان هناك حالات كثيرة يعود السبب للكادر الطبي و لاسباب متعددة. هناك علاقة مؤكدة بين التدابير العلاجية في حالات البطن الحاد المتأخرة و بين زيادة الاختلاطات بعد العملية و كذلك زيادة وقوع الوفيات مقارنة بالحالات التي تم علاجها مبكرا.

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