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Article
Endoscopic dacryocystorhinostomy: The outcome of 25 patients.

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Abstract

Objective: To assess the outcome of endoscopic transnasal dacryocystorhinostomy (DCR) as a new approach in our center( Al-Jamhori Teaching Hospital) in treating 25 patients complaining of epiphora and recurrent or chronic dacryocystitis, comparing our results with the reviewed literature.
Patients and Methods: Twenty-five (25)patients, with age range(from 5-55 years), underwent endoscopic DCR in the period from March/2006- July/2007 in Al-Jamhori Teaching Hospital, Mosul. Standard procedure was implemented using the drill and inserting temporary stents. Patients were followed up for 6-24(average of 8.8) months to assess the outcome of surgery.
Results: There was improvement in symptoms in 18 patients with disappearance of epiphora with 72% success rate. One patient had orbital fat prolapse and 3 patients developed postoperative adhesions. No major complication, namely severe bleeding, CSF leak or serious orbital injury occurred. Revision surgery was done on 3 failed cases; only one patient had clinical improvement. The total success rate after revision surgeries is 76%.
Conclusion: We conclude that endoscopic DCR, which is a new experience in Iraq, is a safe technique in treating nasolacrimal duct obstruction with an acceptable success rate that matches many studies.

خلفية البحث: تشكل عملية مُفاغَرَةُ كِيسِ الدَّمْعِ بالأَنف بواسطة المنظار عن طريق الأنف ألحد الجائرٌ الأدنى لتجاوز القناة الدمعية .هدف الدراسة: تقييم نتائج العملية كطريقة جديدة في مركزنا( المستشفى الجمهوري التعليمي) في علاج 25 مريضا يعانون من دُماع و التهاب كيس الدمع المزمن أو المتكرر, ومقارنة نتائجنا مع البحوث المنشورة.طريقة الدراسة: تم إجراء العملية على 25 مريضا تتراوح أعمارهم من(5-55)سنة في الفترة من آذار/2006-تموز/2007 في المستشفى الجمهوري التعليمي الموصل. تم اعتماد الطريقة المتبعة وباستخدام المثقب وغرز دعامات مؤقتة.تم متابعة المرضى لفترة تتراوح من 6-24 (معدل8.8) شهرا .النتائج :حصل تحسن( اختفاء الدُماع) في 18 مريضا, وبنسبة نجاح (72%). حصل تدلي لدهن الحَجَاجّ في مريض واحد, وحصل التصاق انفي في ثلاثة مرضى. لم تحصل أي مضاعفات كبرى في المرضى. أجريت عمليات تنقيحية في ثلاث حالات فاشلة. حصل تحسن سريري في مريض واحد فقط. كانت نسبة النجاح الكلية بعد العمليات التنقيحية 76%. خلاصة الدراسة: نستنتج إن عملية مُفاغَرَةُ كِيسِ الدَّمْعِ بالأَنف بواسطة المنظار عن طريق الأنف, وهي خبرة جديدة في العراق, طريقة آمنة في علاج انسداد قناة الدمع وبنسبة نجاح مقبولة مقارنة مع العديد من الدراسات.


Article
ENDOSCOPIC FENSETRATION OF THIRD VENTRICULAR CYST

Author: Khalid N Mayah
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 1 Pages: 28-35
Publisher: Basrah University جامعة البصرة

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Abstract

AbstractArachnoids cyst is a common pathology although it is rarely to be in the third ventricle. A twelve years child has a third ventricle arachnoids cyst that leads to hydrocephalus, the cyst has been fenestrated by endoscope, most of the symptoms that sustained over five years has been relieved.

Keywords

ENDOSCOPIC --- FENSETRATION


Article
Endoscopic Endonasal Dacryocystorhinostomy Versus External Dacryocystorhinostomy

Authors: Najah K.M.Al-Quriashi --- Safa Noury M. Ali --- Qasim K. Farhood
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 214-219
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUD:Epiphora and recurrent dacryocystitis are common problems between adult patients consulting ophthalmic and ENT departments. They are occur mostly duo to obstruction of nasolacrimal duct for different causes. Surgical treatment is the only available way to treat them.OBJECTIVE:To study the clinical outcomes of a new endoscopic endonasal dacryocystorhinostomy (EENDCR) technique compared to the conventional external Dacryocystorhinostomy technique (Ext-DCR).METHODS:A retrospective, comparative cross sectional study on 105 cases with epiphora operated upon in 5 years (2004-2009), 60 consecutive EENDCRs and 45 Ext-DCRs. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery, functional nasolacrimal, canalicular obstruction and nasal problems were excluded. Two surgeons performed the EENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs.RESULTS:53 patients (15 men, 38 women) underwent 60 EENDCRs. The average age of the patients was 40 years (range, 5 to 70 years). In the Ext-DCR group, 45 patients (14 men, 31 women) underwent 45 DCRs. The average age was 30.5 years (range, 6 to 49 years). The average follow-up time was 10 months for the EENDCR group and 12.2 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein dye and syringing of lacrimal drainage system. The success rate was significantly higher in cases underwent Ext-DCRs {95.55% (43/45)} as compared to cases underwent EEDCRs {81.66% (49/60)}. (P < 0.05)CONCLUSIONS: Ext-DCR offers better symptom free outcomes (95.55%) than endoscopic DCR (81.66%). Patients who are more interested than others in cosmetic subject, their operations must be conducted with EENDR. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique.


Article
NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY (NOTES) A CRITICAL APPRAISAL

Authors: Jasim D Saud --- Mushtaq Ch Abu-AlHail
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 8-11
Publisher: Basrah University جامعة البصرة

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Article
Complications of Endoscopic Sinus Surgery

Authors: Alaa Mtashar Al-Mansoury --- Yaseen Adeeb Al-Dori --- Bahaa Mohsen Al-Anbary
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 2 Pages: 421-427
Publisher: Babylon University جامعة بابل

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Endoscopic sinus surgery (ESS) is obtained to restore paranasal sinus function which usually will lead to reestablishing the physiologic pattern of ventilation and muco-ciliary clearance.To evaluate the complication of endoscopic sinus surgery (ESS) after management of different sinonasal diseases and how to deal with these complications ninety patients with different sinonasal diseases who were underwent functional endoscopic sinus surgery were seen and evaluated in department of otolaryngology.They had been submitted to clinical and endoscopic examination of the nose.All patients had a coronal and axial CTscan preoperatively, and all procedures were performed under general anesthesia. The extent of surgery was mainly decided depending on the findings in pre-operative CT scan of paranasal sinuses.The main presenting symptoms of patients were nasal obstruction (71.1%), anterior nasal discharge (65.5%), facial pain (63.3%), headache (55.5%), postnasal drip (50%) & hyposmia/anosmia (31.1%). Most of the patients have got partial or complete symptomatic relief. The minor complications of endoscopic sinus surgery occurred in 18 cases (19.97%) which include adhesions (11.1%), minor epistaxis (5.55%), periorbital ecchymosis (2.22%) & infection (1.1%). Major complications occurred in 6 cases (4.27%) which was Major epistaxis (2.22%), CSF leakage (2.22%), Meningitis (1.1%) Pneumocephalus (1.1%).It was concluded that endoscopic sinus surgery (ESS) is an efficient method for treating different sinonasal diseases and can be performed with success rate to alleviate symptoms with less morbidity especially when there is good clinical and preoperative CT scan assessment with endoscopic sinus surgery training courses and proper hypotensive anaesthesia and good postoperative care.


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
Statistical Evaluation of The Effect of Endoscopic Sinus Surgery on Clinical Manifestations of Chronic Rhinosinusitis

Authors: Yasir L. Hassoun --- Firas Mowaffak Hassan
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 3 Pages: 737-743
Publisher: Babylon University جامعة بابل

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Background: Rhinosinusitis is a common problem that leads to a significant amount of health care expenditure due to direct costs of physician visits and antibiotics as well as indirect costs related to reduced productivity and a decrease in quality of life .Aim: The study evaluated the prevalence and severity of various symptom manifestations of chronic rhinosinusitis as well as to analyze the positive effects of endoscopic sinus surgery on the symptoms and quality of life of patients with chronic rhinosinusitis.Patients and Methods: This is a prospective study done in Al-Sader medical city in Najaf during eighteen months period from 1-1-2012 to 30-6-2013. The patients underwent endoscopic sinus surgery for medically refractory chronic rhinosinusitis and were assessed prospectively regarding the symptoms changes after this surgical intervention. Results: A total of 52 patients underwent endoscopic sinus surgery for chronic rhinosinusitis. The most common symptoms of chronic rhinosinusitis before endoscopic sinus surgery in this study were postnasal drip (94.3%), facial pain (90.4%), purulent rhinorrhoea (90.4%) , nasal blockage (86.5%) and headache (69.3%) . Postoperatively 72.4 % of the patients had subjective improvement in their symptoms with a statistically significant effect in the symptoms of nasal obstruction (88.9% success rate) postnasal drip(85.7%), facial pain(80.8%), and purulent rhinorrhea(78.7%). The p value was <0.05. On the other hand the symptom of headache improved in only 27.8% of the patients complained of it with p value = 0.07 Conclusion: Endoscopic sinus surgery results in significant improvement in the symptoms of patients with chronic rhinosinusitis and it is an effective treatment for those who fail to respond to medical treatment.Recommendations : it is recommended that endoscopic sinus surgery should be done in those patients with symptomatic chronic rhinosinusitis and not responding to full course of medical treatments.

المقدمة : التهاب الأنف والجيوب الأنفية هو مشكلة شائعة تؤدي إلى كمية كبيرة من الإنفاق بسبب التكاليف المباشرة لزيارة الطبيب واستخدام المضادات الحيوية وكذلك التكاليف غير المباشرة المرتبطة بانخفاض الإنتاجية وعدم الانتظام في نوعية الحياة.الهدف: تقييم انتشار و شدة الأعراض الناتجة عن التهاب الأنف والجيوب الأنفية المزمن وكذلك تحليل الآثار الإيجابية لجراحة الجيوب الأنفية بالمنظار على الأعراض و نوعية حياة المرضى الذين يعانون من هذا المرض بعد إجراء التداخل الجراحي.المنهجية: دراسة استطلاعية أجريت في المدينة الصدر الطبية في النجف خلال فترة ثمانية عشر شهرا من 1-1-2012 إلى 30-6-2013 خضع خلالها المرضى المصابين بالتهاب الأنف والجيوب الأنفية المزمن والذين لم يظهروا استجابة للعلاج الدوائي لجراحة الجيوب الأنفية بالمنظار و جرى خلال هذه الدراسة تقييم مستقبلي بشأن التغييرات الحاصلة على الأعراض المرضية التي يعانون منها بعد هذا التدخل الجراحي.النتائج : خضع ما مجموعه 52 مريضا لجراحة الجيوب الأنفية بالمنظار. كانت الأعراض الأكثر شيوعا والناتجة من التهاب الأنف و الجيوب الأنفية المزمن قبل إجراء العملية كالآتي: إفرازات خلف الأنف ( 94.3 ٪ ) ، آلام الوجه ( 90.4 ٪ ) ، إفراز الأنف القيحي ( 90.4 ٪ ) ، انسداد الأنف ( 86.5 ٪ ) و الصداع ( 69.3 ٪ ) . بعد العمل الجراحي 72.4 ٪ من المرضى اظهروا تحسن في الأعراض مع وجود تأثير ذات دلالة إحصائية في أعراض انسداد الأنف ( 88.9 ٪ نسبة النجاح ) إفرازات خلف الأنف ( 85.7 ٪ ) ، آلام الوجه ( 80.8 ٪ ) ، و إفراز الأنف القيحي ( 78.7 ٪). من ناحية أخرى أعراض الصداع تحسنت في 27.8 ٪ فقط من المرضى اللذين يعانون منها.الاستنتاج : أظهرت جراحة الجيوب الأنفية بالمنظار نتائج تحسن ملحوظ في أعراض المرضى المصابين بالتهاب الأنف و الجيوب الأنفية المزمن ويعتبر هذا العلاج علاجا فعالا لأولئك الذين لا تستجيب أعراضهم للعلاج الدوائي.التوصيات: توصي هذه الدراسة باعتبار جراحة الجيوب الأنفية باستخدام المنظار خطوة مهمة في علاج المرضى المصابين بالتهاب الأنف والجيوب الأنفية المزمن والذين لم يظهروا استجابة جيده للعلاج الدوائي .


Article
Outcome of Endonasal Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction

Authors: Ali A.Abdalwahid --- Ragheed T. Miteab --- Hussein J. Mohsin**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 3 Pages: 344-354
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Dacryocystorhinostomy (dcr) is the standard trcatmert for nasolacrimal duct Obstruction .based on opening the lacrimal sac, which is connected to the nose, by removing the bone and the mucosa between these two structures at the level of the middle meatus.OBJECTIVE: To highlight the procedure of endonasal endoscopic dacryocystorhinostomy. PATIENTS AND METHODS: This was a prospective study conducted at Ghazy Al- hariri teaching hospital for surgical specialties during the period from 22nd of February 2011to the 4th of March 2013. A total of 22 patients were referred from the ophthalmologist for endoscopic dacryocystorhinostomy after had been diagnosed as distal obstruction of nasolacrimal duct or sac. Data were collected and all patients were investigated with general pre-operative investigation in addition to CT scanning to exclude any associated abnormalities or neoplasm and rigid nasal endoscopy were performed for all patients. Intranasal decongestant and steroids along with oral antibiotic were given pre-operatively in 14 patients. Endoscopic dacryocystorhinostomy was performed; the patients were followed up for 6 months and evaluated regularly for any complication. RESULTS: The mean age of the patients was (32.9 ± 12.7) years with range of (12– 69) years. About 59% of the patients aged 21-40 years. Females were predominant with a female to male ratio of 3.4:1. All patients had mucopurulant conjunctival discharge. The median duration of presentation was 5-6 months. The DCR performed eleven in right side and eleven in left side, and 4 associated operation were conducted for management of associated abnormalities. Eight complications developed during different time of follow up and only one patient needed re insertion giving a success rate of 95.5%.CONCLUSION: The endoscopic endonasal DCR is a safe procedure for the treatment of nasolacrimal duct obstruction and with high success rate and less serious complications.


Article
Incidence of Recurrent Nasal Polyposis After Endoscopic Polypectomy

Authors: Harith Fathi Hameed --- Lateef Hussien Alwan --- Safaa Sahib Naji
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 4 Pages: 801 -809
Publisher: Babylon University جامعة بابل

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This a prospective study done to provide reference information about the incidence of recurrent nasal polyposis and associated risk factors among 30 patients operated on by means of Endoscopic Sinus Surgery between Jan. 2012 –Jan 2014. These patients presented in otorhinolaryngology dept. in Hilla General Teaching Hospital presented with symptoms and signs of sinonasal polyposis not responding to medical treatment, the diagnosis confirmed by history taken, clinical examination which involved: anterior and posterior rhinoscopy, flexible and rigid nasoendoscopy, with radiological examinations as plain X-ray films and CT- scan of nose &paranasal sinuses (mainly coronal view) taken to all patients to see middle meatal complex. Then the patients underwent polypectomy by means of Endoscopic Sinus Surgery, after that follow-up done during mean period of 12 months (range 3 months – 24 months) included: regular flexible & rigid nasoendoscopy. In our study we estimated the incidence of recurrent nasal polyposis after Endoscopic Sinus Surgery which was 30% and highlighted the risk factors affected this incidence as: age (mostly affected patients at 4th& 5th decade 66.67%), gender (males more than females 3.5:1), presence of some conditions (allergic rhinitis in 33.33%,allergic fungal sinusitis in 22.22%,childhood asthma in 22.22%, eczema in 11.11%, aspirin intolerance in 11.11%, and Samter's triad in 11.11%), previous nasal surgery(simple polypectomy) in 44.44%, and polyp extension as extensive polyposis in 77.78% .


Article
Outcome of Endoscopic Endonasal Dacryocystorhinostomy in Karbala, Iraq

Authors: Nadhim Omran Khadhim --- Ahmed Abdullah Alwan --- Imad Salih Mehdy
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2017 Volume: 10 Issue: 2 Pages: 2702-2708
Publisher: Kerbala University جامعة كربلاء

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background: Dacryocystorhinostomy (DCR) is an operation that has been used for the past 100 years. Endoscopic endonasal DCR is less invasive than external DCR; therefore, it has rapidly gained acceptance for the treatment of intractable nasolacrimal duct obstruction and chronic dacryocystitis. Many ophthalmologists still believe that external DCR is the gold standard treatment for nasolacrimal duct obstruction. However, because incision of the facial skin is required, patients are reluctant to undergo external DCR.Objectives: To analyze the results of Endonasal Endoscopic Dacryocystorhinostomy regarding complications and success rate. Methods: A prospective study was carried out on 26 patients at Department of Otolaryngology, Al-Hussian Teaching Hospital, Karbala during the period September 2013 to November 2016. Patients presented with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in this study. Endonasal Endoscopic Dacryocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacryocystorhinostomy tube. Complications during and after the procedure were recorded. Results: Out of total 26 patients 23 (88%) were females and 3 (12%) were males (F:M=7.7:1). The age range was 6 to 60 years with a mean age of 33 years. The duration of symptoms ranged between 8 months to 6 years. There were only 2 (8%) patients had bilateral symptoms while the other 24 (92%) patients had unilateral symptoms. Average duration of endoscopic DCR was 60 minutes. DCR tube was removed 6 months after operation in 24 (92%) patients and in 2 (8%) patients, it was removed after 3 months. Complications encountered during and after surgery were, haemorrhage in 4 (15%), ecchymosis in 2 (8%), nasal adhesions in 2 (8%), granulations at osteotomy site in 1 (4%), retrograde tube displacement in 2 (8%) patients. Overall, 24 (92%) patients were symptom-free 6 months after the removal of the tube. Out of the remaining 2 (8%) patients, one patient underwent revision surgery and was symptom-free 6 months after the removal of the tube whereas the other refused revision surgery. Overall success rate of endonasal DCR was 25 (96%). Conclusions: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.

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