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ULTRASONOGRAPHY FOR SUSPECTED ACUTE APPENDICITIS (RADIOPATHOLOGICAL STUDY)
دور الأمواج الفوق الصوتية في تشخيص التهاب الزائدة الدودية الحاد

Author: Maha shakir hassan مها شاكر حسن
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2010 Volume: 4 Issue: 3 Pages: 1-10
Publisher: Thi-Qar University جامعة ذي قار

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SUMMARYBackground: Acute appendicitis is one of the commonest surgical emergencies. Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality, and surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain.1in this study we asses the role of ultrasonography in adition to clinical and laboratory data to reach the final diagnosis of acute appendicitis.Patients and methods: in this combined retrospective and prospective study to 75 patients who referred to surgical service. A complete clinical history, physical examination, WBC count, neutrophils count, and ultrasonography. A histopathological correlation done for 57 cases undergo surgical operation.Results: for 57 cases of acute appendicitis most patients was between 11-30 years old ( 59.65), male: female ratio was 1: 1.5, most common symptoms was abdominal pain present in all cases. The sensitivity of ultrasonographic examination was 94.7%, specificity was 88.9% and accuracy was 93.3%. leukocytes count was ≥ 10x109 in 43 (75.43%) of acute appendicitis cases, and the neutrophil count ≥ 75% in 34 (59.64%) of acute appendicitis ccases.Conclusion: ultrasonography is an accurate procedure that leads to prompt diagnosis and early treatment of many cases of appendicitis.

الخلاصةالتهاب الزائدة الدودية الحاد واحدة من أكثر الحالات الجراحية شيوعا,التهاب الزائدة الدودية البسيط قد ينتهي بتمزق الزائدة الدودية المصحوبة بزيادة نسبة المعانات للمريض والتي قد تؤدي للوفاة, لذلك فان الجراحين يقومون بإزالتها عندما يكون التشخيص محتمل متجنبين الانتظار لحين التأكد من التشخيص.في هذه الدراسة نحن نقيم أهمية الأمواج الفوق الصوتية في تشخيص الالتهاب بالإضافة إلى المعلومات التي نحصل عليها من أعراض المرض,و فحص المريض, و النتائج المختبرية, ومقارنتها بالتحليلات النسيجية.من خلال دراسة 75 حالة 57 خضعوا للجراحة, وقد استنتجنا ان للفحص بالأمواج فوق الصوتية أهمية كبيرة للمساعدة في التشخيص, وان حساسية الفحص كانت 94,7%,وخصوصيته كانت 88,9%,و دقته كانت 93,3%.


Article
EARLY APPENDECTOMY DURING PREGNANCY
استئصال الزائده الدوديه المبكر عند الحوامل

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ABSTRACTBackground: Appendectomy for presumed acute appendicitis is the most common surgical emergency during pregnancy, acute appendicitis occurs at the same rate in pregnant and non pregnant women, but pregnant women have a higher rate of perforation. Patients &methods: This prospective study done 42 pregnant women between age 20 to 41 years all of them were complained from signs and symptoms of acute appendicitis arrived ER of Al Hussain teaching hospital in AL Nassyria during period 2010 either came directly or referred from gynecologist ,they underwent appendectomy early after diagnosis .Results: Most of patients succeeded pregnancy 38 patients (90.4%) { in spite of 3 patient (7%) have threatened abortion anther 3 patients have preterm uterine contraction but they continue of pregnancy successively},only 4 patient (9.5%) end with abortion.Most of women [21patients (50%)] complained from acute appendicitis during second trimester .Most of patients who did not delay operation till 48 hours can pass pregnancy successfly with some problems , while who delayed more liable to abortion [4 of 10 patient (40%)] . Aim: reduce fetal loss after appendectomy during pregnancy. Conclusion: we advices early operation in pregnancy with out delay, no place for conservative management in acute appendicitis .

ألخلاصه دراسه مستقبليه أجريت على 42 من النساء الحوامل بفترات متباينة من الحمل تتراوح اعمارهن بين 20 الى 42 عاما دخلن طوارئ مستشفى الحسين التعليمي في الناصريه خلال عام 2010 جميعهن أصبن بالتهاب الزائده الدوديه إثناء حملهن ( الكثير منهن مرسلات من قبل طبيبات نسائيه) وقد تم تشخيصها سريريا مع مساعده بعض الفحوصات المتوفره ثم أجرينا عمليه استئصال الزائده الدودبه بعد وصولهن الطوارئ بفترة وجيزة فكانت النتائج كالاتي :- 1- كان معظم النساء 38 أمراءه( 4،90 %) قد أكملن حملهن بسلام بالرغم من 3 نساء(7%) أصبن بإجهاض مهدد و 3 أخريات (7%) بألم قوي بسبب تقلصات رحميه مبكرة) لكنهن أكملن حملهن بسلام فقط أربعه مريضات (6،9 %) انتهى حملهن بالإجهاض 2-أكثر حالات الزائدة الدودية تحدث خلال الأشهر الثلاثة الوسطى21 مريضه 50% 3- وجد نا المريضات اللواتي يتأخرن بأجراء العملية ل 72 ساعة او أكثر هن اكثر عرضه للاجهاض من غيرهن ( 4 مريضات من اصل 10 ) او من مشاكل الحمل الأخرى مثل الإجهاض المهدد او التقلصات ألرحميهلذا ننصح بأجراء عمليه الزائدة الدودية اثتاء الحمل بعد تشخيصها سريريا وبعض الفحوصات المتوفرة بأقرب وقت ممكن لتفادي تلك المشاكل


Article
Parasitic Cause of Acute Appendicitis In Najaf
المسببات الطفيلية لالتهاب الزائدة الدودية الحاد في النجف

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Abstract

Background & objectives : Acute appendicitis is the most common acute surgical condition of the abdomen .In spite of many researches & studies that had been performed on the acute appendicitis in general, very limited works talking about the role of the parasites in the causation of acute appendicitis This study was performed to investigate the preformed to investigate the prevalence rate of intestinal parasites in appendices of patients with clinically diagnosed acute appendicitis who arrived to Al-Najaf city hospitals .Patients & methods : Prospective study included 500 patients from both sexes were done .from August 2001 to July 2002 .Excised appendices were examined macroscopically and microscopically for detection of parasitic infections . Examination of tissue digests was conducted for 80 specimens by using acidic pepsin solutions to determine the efficiency of different diagnostic methods of detecting parasitic infestations in appendix .Results : There were 318 males & 182 femals ,their ages ranging from 5 to 49 years .The total infection rate of appendices with intestinal parasites was 16.2 % (11.4% with heliminth and 4.8 % with protozoa). The prevalence of E.histolytica ; G. lamblia ; E.vermicular; A.lumbricoides ; H.nana and T.trichiura was 2.4 % ; 2.0% ; 10.0% ; 0.6% ; 0.6% and 0.2% respectively .H.nana and G.lamblia were isolated from the appendix for the first time in Iraq. The incidence of sigle parasitic infection was 85.18% against 14.81% for double infections, which was between E.vermicularis & E.histolytica (7.4%) while the lowest relationship was between E.vermicularis with T.trichiura and E.vermicularis with A.lumbricoides (102%) .Conclusion: Parasitic infection has a sensible role in the etiopathology of acute appendicitis in addition to its considerable affection on the human health in our people that require an intensive work to manage this problem .

شملت الدراسة فحص 500 مريض مصابون بالتهاب الزائدة الدودية الحاد . فحصت الزوائد المزالة بعد العمليات الجراحية مجهريا وعيانيا لتحديد الإصابات الطفيلية . بلغ عدد المرضى الرجال 318 والمرضى النساء 182واللذين تراوحت أعمارهم من 5 إلى 49 سنة . بلغت النسبة الكلية للإصابة بالطفيليات 16.2% منها 11.4% ديدان و 4.8% أو إلي طبية . كانت نسبة الإصابة بطفيليات الاميبا الحالة للنسيج ، الجارديا، الدودة الدبوسية ، الصفر الخراطيني ، الدودة القزمة والدودة السوطية هي 0.6% , 10% , 2% , 2.4% , 0.6% , 0.2% على التوالي . إصابة الزوائد الدودية بالدودة القزحة والجارديا سجلت لأول مرة في العراق .


Article
The Role of Ultrasound in the Diagnosis of Acute Appendicitis: A Prospective Study

Authors: Mumtaz Khudhur Hanna --- Zuhair Bashir Kamal --- Laith Naif Hindosh --- Wisam Abdullteef Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 226-229
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery, as the mortality and morbidity increase from 3 – 15 folds if appendix is perforated. Graded compression ultrasonography is one of the new diagnostic techniques that were introduced to improve the diagnostic accuracy and consequently the clinical outcome. OBJECTIVE:The aim of the current study is to assess the diagnostic accuracy of ultrasound in the diagnosis of suspected acute appendicitis.METHODS: One hundred-eighty patients admitted to the general surgical ward at Al Kindy Teaching Hospital from 1 June 2009 to 28 Feb. 2010. All patients were complaining of right iliac fossa pain and tenderness with a suspicion of acute appendicitis, a clinical assessment done for them by using modified Alvarado score (only patients with Alvarado score 5 and below were included). All patients were investigated by WBC count and general urine analysis. When the diagnosis of acute appendicitis was clinically equivocal, an abdominal ultrasound performed within 4 hours of admission. A dilated, Non- compressible appendix greater than 6 mm diameter, and edema and asymmetry of the appendicular wall were considered positive for the diagnosis of acute appendicitis. A normal appendix on histopathological examination with positive ultrasonographic findings was considered false positive result. RESULTS: The findings according to histopathological examination shows that 160 cases were true positive cases,14 cases were found to be true negative , 1 cases was false positive and 5 cases were false negative cases.:Ultrasonography yielded a sensitivity rate of 96% and specificity rate of 93%.CONCLUSION:Ultrasound by graded compression technique provides highly accurate, sensitive and specific test for clinically equivocal acute appendicitis. .


Article
THE ADVANTAGE OF ACUTE INFLAMMATORY MARKERS IN DIAGNOSIS OF ACUTE APPENDICITIS

Authors: Mazin H Al-Hawaz --- Mazin A Abdulla --- Hyder Dakhel Ali
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 2 Pages: 8-13
Publisher: Basrah University جامعة البصرة

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Abstract Acute appendicitis is the most common cause of emergency abdominal surgery with an estimated lifetime prevalence of 7%–8%. Despite advances in diagnosis and treatment, it is still associated with morbidity (10%) and mortality (1%–5%). This study was designed to investigate the results of WBC count, platelet distribution width and C-reactive protein values based on the pathology results in patients undergoing appendectomy with an early diagnosis of acute appendicitis. This prospective cross sectional study was carried out in Basrah Teaching Hospital from the period 1st of September 2015 to 1st of June 2017, a total of 154 consecutive patients were enrolled in the study. All patients were admitted to the emergency department with history suggestive of acute appendicitis, blood tests were done for inflammatory markers in form of WBC, CRP and PDW, a period of 24 hours prior to surgery was accepted, histopathological data were used to assess inflammation of the appendix. The majority of patients were males 61% while females were 39%, with age range between 14-46 years (mean 24.28 years). There was a correlation between WBC count and acute appendicitis(P value=0.004), with sensitivity range (53%-69%) and specificity range (25-89%), while positive predictive value (PPV) and negative predictive value (NPV) were 96% and 8% respectively. A significant correlation found between CRP and acute appendicitis (p value less than 0.0001) with sensitivity range (71%-85%), while specificity was (10%-74%) and PPV, NPV were 95% and 9% respectively. Regarding PDW, no correlation was found with acute appendicitis (p value=0.296) with sensitivity range (6%-16%) while specificity (17%-82%), PPV 78%, NPV 2%. There was significant correlation between inflammatory markers (WBC, CRP, PDW) and complication with a p value=0.0001, ruptured appendix and peri-appendicular abscess were the most common complications recorded, only 8(5.2%) patients had normal appendix after histopathological examination. In conclusion, acute inflammatory markers play an important role in diagnosis of acute appendicitis along with history and physical examination.


Article
The Assessment of Modified Alvarado Score in the Diagnosis of Acute Appendicitis

Author: Baha Al deen A.K. Almujamaee بهاء الدين خالد المجمعي
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2011 Volume: 1 Issue: 1 Pages: 1-5
Publisher: Diyala University جامعة ديالى

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Background: Acute appendicitis is the most common surgical emergency. The case fatality rate has fallen to less than 0.1% for uncomplicated appendicitis as a result of early diagnosis and intervention.Objective: To evaluate the accuracy of the modified Alvarado score in the preoperative diagnosis of acute appendicitis and to compare the result of our study with others.Methods: A prospective study was carried on including seventy eight patients with presumptive diagnosis of acute appendicitis in Baquba general hospital for one year period ( first of jan. 2001 through 30 first of Dec. 2001 ) and the data were analyzed using a modified Alvarado score.Result: The presence of high score was found to be an easy stationary aid to early diagnosis of appendicitis.Conclusion: The modified Alvarado score is simple to use easy to apply. Effective particularly in men while diagnosis laparoscopy is advised in woman to minimize the false negative appendectomies. Still its validity has to be assessed in pediatric age group.


Article
Laparoscopic versus open appendectomy in patients with acuteappendicitis

Author: Tariq Al-Aubaidi طارق العبيدي
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 78-84
Publisher: Baghdad University جامعة بغداد

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Background: Laparoscopic surgery for appendicitis is now a well established and advanced method of performing general surgical procedures. Objectives: To compare the outcome of laparoscopic and open appendectomies in terms of operative time, analgesic requirement, postoperative complications, hospital stay, return to normal activity and condition of scar. Methods: This prospective study was carried out from 1stMay 2008-1st January 2010, involving 110 patients (45 male and 65 female) with features suggestive of acute appendicitis were divided into 45 patients laparoscopic appendectomy (LA) group and 65 patients open appendectomy (OA) group, after taking informed consent. LA was done with the help of three trocars/cannulae creating pneumoperitoneum with CO2 whereas OA was performed by grid iron incision. Results: Forty five patients were assigned to the laparoscopic appendectomy group and 65 patients were assigned to the open appendectomy group. Five patients were converted intra-operatively from laparoscopic appendectomies to open procedures. The operating times in OA and LA were 20-110 minutes (mean 30) and 45-120 minutes (mean 55) respectively. Increased doses of analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative hospital stay in LA group was 1 day (range 1-3 days) where as it was; 2.2 days (range 2-5 days) in OA group. Conclusion: LA is safe and it has major benefits like less postoperative pain, decreased wound infection, early hospital discharge, early return to work and a better cosmetic scar than OA.


Article
Diagnostic Value of C Reactive Protein Measurement in Patients with Acute Appendicitis

Author: Maitham H. Kenber
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 4 Pages: 347-351
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:OBJECTIVES :To evaluate the role of crude measurement of C-reactive protein in the diagnosis of acute appendicitis.BACKGROUND:Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remain high(15%-30%) ; despite several techniques and investigations used to improve the diagnostic accuracy . Many studies investigated the role of raised C-reactive protein (CRP ) in improving the diagnosis of acute appendicitis, but with conflicting results.PATIENTS AND METHODS :This is a randomized prospective study from February to July 2006 . A total of 100patients were included in this study that presented to our hospital with acute right iliac fossa pain and later on operated and had appendicectomy .Blood for the measurement of serum C-reactive protein(CRP) was collected preoperatively from all the patients. The patients divided in to two groups ,those who are positive appendicitis proved by operative finding and histopathological examination and those with negative appendicitis proved by histopathological examination.RESULT:A total of 100 patients were included in this study, and out of these 16 (16%) had normal appendix giving an over all negative appendicectomy rate of 16% out of these 5 were males and 11 were females ,the age range was (6-47 years) with a median age of ( 25.92) years . Among the 84 who had appendicitis, 64 patients had obstructive type of appendicitis which were noticed during the operation ,and CRP was positive in all patients, but only 9 of them were with CRP negative . 4 perforated appendicitis were found in which all of them were CRP positive, and 16 patients with catarrhal appendicitis were diagnosed by histopathological examination and only 3 patients out of those had negative CRP while the remainder were positive.CONCLUSION:The positivity of CRP was related to the severity of inflammation; but it is more reliable to depend on negative results to postpone the operation and observe the patient .Thus unnecessary removal of normal appendices may be reduced.


Article
The role of urinary 5- Hydroxyindoleacetic acid determination in diagnosis of acute appendicitis

Authors: Hamid Hindi Sarhan --- Amina Hamed Alobaidi
Journal: Tikret Journal of Pharmaceutical Sciences مجلة تكريت للعلوم الصيدلانية ISSN: 18172716 Year: 2013 Volume: 9 Issue: 2 Pages: 305-311
Publisher: Tikrit University جامعة تكريت

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Background: Appendicitis is associated with high rate of wrong diagnosis. Objective. To evaluate the predictive value of 5-HIAA in diagnosis of appendicitis. Patients & Methods: Spot urine samples were collected from 147 patients with appendicitis and 45 healthy control. 5-HIAA was detected in urine samples in all patients using ELISA method. Results: The mean 5-HIAA level was 4.5 umol/mmol creatinine in healthy individuals, 5.8 umol/mmol creatinine in wrongly diagnosed appendicitis, and 15.7 umol/mmol creatinine in patients with appendicitis. The difference between patients group with appendicitis and other 2 groups was statistically highly significant [P<0.001], However, the difference between the normal individuals group and wrongly diagnosed group was statistically non significant. The test had 81% sensitivity and 85 specificity. Conclusion: This study indicated that determination of 5-HIAA as non- invasive test was with predictive value in diagnosis of appendicitis. Thus reducing the malpractice in surgical operation in Iraqi community.


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 .

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