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Article
EMERGENCY THORACOTOMY FOR CARDIAC OR GREAT VESSEL INJURIES : A REPRT OF 5 CASES.

Author: Abdulsalam Y Al Museilih
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2005 Volume: 11 Issue: 1 Pages: 100-109
Publisher: Basrah University جامعة البصرة

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Abstract

The different modes of injury to the heart extend from motor vehicle accidents to penetrating injury by a pencil tip1. The incidence of penetrating cardiac injuries appears to be rising, presumably because of an increase in civilian violence2.Penetrating cardiac injuries are still a challenge for surgeons because of their difficulty as to the diagnosis, bad prognosis and the necessity of acute operation3.

Keywords

THORACOTOMY


Article
PULMONARY HYDATID CYST IN DUHOK PROVINCE
الاكياس المائية الرئوية في دهوك

Authors: AHMED M.S. TAHIR احمد طاهر --- ASHUR Y IZAC اشور اسحاق --- MOHAMMED SALIH AL-ANI محمد صالح العاني
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2013 Volume: 7 Issue: 1 Pages: 11-19
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background and objectives Thoracic surgery unit in Duhok was established in 2006 since then the majority of our thoracotomy was for treating pulmonary hydatid cysts and its complications. It is evident that pulmonary hydatid cyst is major problem in Duhok province.Hydatid cyst disease is known to be endemic in many parts of Iraq and Duhok province is one of them. As pulmonary hydatid cyst are common in Duhok, the study aims to discuss itsincidence , the way they present and the variation of symptoms from being asymptomatic to severe complications of ruptured cysts , beside the methods used for treatment.Methods Duhok is the centre of the province and is the only place in the province where thoracic surgery is available, nearly all cases of pulmonary hydatid cysts from all over the province are referred to Duhok centre. These cases are studied and evaluated before and after surgical management in order to find what is the best way of treating them. The types of surgery used in these cases are discussed as well as their complications. It’s a retro and prospective study including 100 cases of pulmonary hydatid cyst operated upon January 2007 and April 2011. The study include the age of the patient the size of cyst ,the compliant of the patient and whether the cyst was complicated or not, the types of surgery performed with its morbidity and mortality.Results Hundred patients had been operated by the authors in hospitals of Duhok province (public and private). Majority of patients is aged between 11-40 years, all of them through thoracotomy incision, cyst(s) removed with preserving lung tissue in 86 % where resection done in 14 % of cases, re exploration in 2% and no mortality recorded.Conclusions Surgical management is only proved curable therapy for pulmonary hydatid, multiplicity of cysts is not uncommon surgery is highly successful with no or very low mortality rate.

خلفية واهداف البحث: منذ عام 2006 عندما بوشرت عمليات فتح الصدر في دهوك اغلبية الحالات المرضية التي اجري لها فتح الصدر كانت لمعالجة الاكياس المائية الرئوية والمضاعفات الناتجة عن الاصابة بها حيث لوحظ انه مشكلة مرضية في محافظة دهوك مرض الاكياس الرئوية المائية هو مرض مستوطن في بعض أج ا زء الع ا رق. محافضة دهوك واحدة من هذه المناطق. كما ذكر ان الاكياس الرئوية المائية هو مرض مستوطن في محافظة دهوك , تبغي الد ا رسة لمعرفة نسب الاصابة وكيفية ظهور اع ا رض المرض والطرق الافضل للعلاج , اع ا رض المرض تت ا روح من كونه غير ظاهر (يكتشف بالصدفة ) الى المضاعفات الشديدة التي تتبع انفجار الكيس . دهوك مركز لمحافضة المكان التي تتم فيهج ا رحة الصدر ولهذا تقريبا كل حالات الاكياس المائية في المحافظة يتم احالتها الى المركز , هذه الحالات تمت د ا رستهاوتقييمها قبل وبعد التداخل الج ا رحي لتقييم افضل طرق العلاج, انواع التداخل الج ا رحي المتبعة نوقشت مع المضاعفات ,لم تستعمل مضادات الطفيليات قبل العملية ولكن استعملت بعد العملية في بعض الحالات, أخيرآ نوقشت التوصياتلاستئصال او على الاقل لتقليل الاصابة بهذا المرض.طرق البحث: هذه الد ا رسة لحالات الاكياس المائية في محافضة دهوك التي تم علاجها ج ا رحيآ في الفترة ما بين كانون الثاني 2007 ونيسان 2011 , الد ا رسة تضمنت العمر مكان الاصابة في الرئة , الشكوى الرئيسية للمريض وكون الكيس بسيط او مع اختلاطات.النتائج: تم اج ا رء التداخل الج ا رحي ل 100 مريض وتضمن الحالات الموجودة في كافة مستشفيات دهوك , معظم 40 سنة , كل المرضى تم علاجهم عن طريق فتح الصدر , الكيس ( أو ألاكياس) استئصلت - الم رضى بعمر ما بين 11 مع الحفاظ على النسيج الرئوي في 86 % وتم الاستئصال في 14 % من الحالات , أعادة فتح الصدر في 2% من المرضى مع عدم تسجيل اي حالة وفاة.الاستنتاجات: العملية الج ا رحية هو الحل الوحيد المثبت للشفاء من الاكياس المائية الرئوية , تعدد الاكياس ليس بغير شائع, التداخل الج ا رحي ناجح بنسبة كبيرة مع نسبة معدومة أو قليلة جدا للوفاة.


Article
Management of Traumatic Hemothorax a Retrospective Study of 165 Cases in AL-Jamhoori Teaching Hospital in Mosul

Author: Rabea Salim Abd Aljabbar Alsofi*, Saad Muwafaq Attash**, Omer mothafar Hammodat***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2019 Volume: 18 Issue: 1 Pages: 30-36
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Traumatic hemothorax is one of the most common thoracic injuries in the world. There are a lot ofdebates about the best method of management because of the possible risk of death anddevelopment of subsequent complications.OBJECTIVE:The objective of this study is to decide the best type of management of traumatic hemothorax(thoracostomy tube drainage versus thoracotomy) for life saving and prevention of subsequentcomplications such as trapped lung with fibrothorax, and empyema.METHODS:This is a retrospective study of 165 consecutive patients with traumatic hemothorax admitted toAl-Jamhoori teaching hospital in Mosul from 1st January 2010 to 1st January 2012. The parametersthat were used in this study were sex, age group, mechanism of injury, hemodynamic state at timeof according to volume of blood in the drainage bottle into5 groups. The patients were alsoclassified into 4 groups depending on their hemodynamic state at time of presentation.RESULTS:Thoracostomy tube drainage was done in the majority of cases as the mainstay of treatment, inminority of cases it was followed by thoracotomy for those with massive hemothorax, severehypovolemic shock, associated thoracic injuries, or those with complications.CONCLUSION:Traumatic hemothorax should be treated initially by thoracostomy tube drainage except in veryurgent cases, and the decision for thoracotomy should be based on the hemodynamic state, thevolume of drained blood and the presence of associated thoracic injuries. A good initial care andproper drainage of collected intrathoracic blood reduces the development of late complications andthe subsequent need for thoracotomy..


Article
A Review of 277 Cases of Patients with Chest Trauma in the Medical city Teaching Complex

Author: Abdulameer Mohsin Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 599-605
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. It represents 50% of all traumas. They are the cause of 25% of trauma deaths.OBJECTIVE:Describing the incidence, association with other injuries, understand the mechanism of common fatal injuries in chest trauma, diagnosis and operative morbidity and mortality.PATIENTS AND METHODS: A retrospective study of 277 patients, victims of chest trauma between August 2009 and August 2011 in Ghazi Al-hariri teaching surgical specialties hospital – Department of thoracic and vascular surgery/ medical city teaching complex. The records of all patients were reviewed and data were collected retrospectively. Management and follow up of the patients during hospitalization were evaluated. According to management patients were divided into two groups (conservative and surgical). RESULTS: Of 277 patients involved in this study 244(88.08%) of them were male and 33(11.91%) were female, with female /male ratio: (1/7.33). The majority of patients were in their third decade of life 100(36.10%) from 21-30 years. Penetrating chest trauma was seen in262 (94.58%) of the total number, 11(3.97%) had blunt chest trauma and 4(1.44%) had blunt and penetrating chest trauma. Bullets or shells in 205(74%), were the commonest penetrating injury, and commonest blunt trauma cause was blunt object in 8(2.88%) patients whereas 3(1.08%) patients due to RTA. The associated traumas were seen in 40.4% and the commonest one was limbs trauma in 57(20.57%) patients. The majority of the patients 219(79.06%) arrived to the hospital within hours of the injury mainly the first 4 hours. 190(68.59%) patients were treated as emergency cases and 87(31.40%) as cold cases. Chest x-ray performed to the all patients and the main radiological findings were haemothorax in 172 (62.1%). Conservative treatment in 37 (13.35%) patients and surgical treatment in 240 (86.64%) patients. The main Indication for thoracotomy was an initial drain more than 1500ml in 17(6.13%) patients, lung injuries were the commonest operative finding 29(10.46%). Hospital stay ranges from 1 day to 1 month and most of the patients 187(67.5%) discharged within the first 5 days of admission. Morbidity was seen in 19(6.85%) patients, wound infection was the commonest seen in 6(2.16%) patients, wound infection in 6(2.16%) patients, atelectasis in 5(1.8%) patients, respiratory distress syndrome in 4(1.44%) patients, CVA in 1(0.36%) patients, stress ulcer in 1(0.36%) patients, postoperative bleeding in 1(0.36%) patients and post intubation tracheal stenosis in 1(0.36%) patient. The overall mortality were 10(3.61%) patients, 2(0.72%) of them died perioperative were both of them they had associated injuries namely cardiac and central vessel injury respectively. All the 10 patients were male and the type of injury was penetrating in all. 8 out of 10 died had associated injuries.CONCLUSION:Penetrating chest injuries resulting from violence are the major public health problem in Iraq and bullets or shells are the commonest cause. Chest X-ray is diagnostic in most of cases. Associated injury should be carefully considered in the medical response strategies. The majority of patients with simple chest injuries can be managed by tube thoracostomy. Mortality is common with penetrating chest injuries.


Article
Traumatic Diaphragmatic Rupture
اصابات الحجاب الحاجز التمزقیة

Author: Sameer Mohi-Aldeen سمير محي الدين احمد
Journal: Al-Mustansiriyah Journal for Pharmaceutical Sciences مجلة المستنصرية للعلوم الصيدلانية ISSN: 18150993 Year: 2014 Volume: 14 Issue: 2 Pages: 108-115
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:To describe changes in the presentation, examination of the chest in patients withdiaphragmatic rupture, was reviewed to identify the difficulty in the diagnosis and treatmentof this injury. Between April 2006-and December 2012, 38-patients with traumaticdiaphragmatic rupture were treated, and analyzed demographic data , cause of injury, extentand location of the diaphragmatic lesion with herniated organs, were described the clinicalpresentation.Retrospective study of 38-cases, 36-male, 2-female, 37 cases left side, one case rightside. Main cause was penetrating injury 35-cases, blast injury (12), gunshot (16), stab (7).Blunt injury 3-cases, road traffic accident (2), post-operative damage and tear the diaphragm(1) case. Average age33-year, range (4-65years old).The diagnosis made by C-XR, C-T Scan,MRI, were grade of injury II-IV most common, associated injury stomach, spleen, bowel,kidney, retroperitoneal hematoma, liver. Repair through laparotomy and thoracotomy. Chestpain abdominal pain shock was the main presentation.The study showed the suspicion beside the radiological C-XR, C-T Scan are veryuseful in initial diagnostic approach to traumatic diaphragmatic rupture. The difficulty is thatdiaphragmatic injuries particularly after penetrating trauma may initially go unnoticed andwithout changes in the C-XR Images diagnosis is made difficult. Early diagnosed, treatmentreduces intra and postoperative morbidity and mortality.

الخلاصة:تھدف ھذه الدراسة لمعرفة التغیرات التي تصاحب إصابات تمزق الحجاب الحاجز من أعراض وفحص سریريللبطن والصدر، تم استعراض الصعوبات التي تواجھ التشخیص والعلاج المبكر لھذه الاصابات، حیث تم علاج 38 مریضامصابین بمزق الحجاب الحاجز نتیجة الاصابات للفترة بین نیسان (ابریل) 2006 وكانون الاول (دیسمبر) 2012 ، وتحلیلالبیانات الدیموغرافیة لمعرفة طرق الاصابات ونوع الاصابة وحجمھا ودخول أحشاء البطن الى الصدر ووصف علاماتسریریة لھذه الاصابات.بینت النتائج من خلال دراسة استرجاعیة ل 38 حالة ( 36 حالة من الذكور، 2–أناث)، منھا ( 37 حالة الجانبالایسر، وحالة واحدة في الجانب الأیمن)، حیث تبین أن السبب الرئیسي ھو اصابات الاختراقیة 35 حالة، منھا اصاباتالانفجار ( 12 )، طلق ناري ( 16 )، طعن بأداة حادة ( 7)، اصابات غیر مخترقة (شدة خارجیة) 3 حالات، منھا إصابةحادث مرور ( 2)، والضرر ما بعد الجراحة وتمزق الحجاب الحاجز ( 1) حالة، وكان متوسط العمر 33 سنة، ومعدل65 سنة)، وكان التشخیص عن طریق الاشعة السینیة، الأشعة المقطعیة، الرنین المغناطیسي، وكانت درجة - العمر ( 4الأكثر شیوعا في المعدة، الطحال، الأمعاء والكلى. II-IV الإصابةأظھرت الدراسة ان التشخیص ھو عن طریق اشتباه والشك وكذلك الفحوصات الإشعاعیة السینیة، الأشعةالمقطعیة ھي مفیدة للوصول للتشخیص الاولي لتمزق الحجاب الحاجز وتكمن الصعوبة في التشخیص الإصابات الحجابخصوصا بعد الاصابات الاختراقیة قد تذھب دون أن یلاحظھا أحد في البدایة وقد تحدث دون ظھور العلامات في الرقائقالشعاعیة الاولیة مما یؤدي الى صعوبة التشخیص. وأكدت الدراسة أن التشخیص المبكر والعلاج المبكر یقلل من نسبةالمضاعفات والوفیات.

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