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Article
Club Foot Deformity Conservative Versus
مرض القفد الفحجي (دراسة مقارنة بين العلاج التتحفظي والجراحي)

Author: Sadeq A . Al-Mukhtar
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 2 Pages: 245-256
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Congenital talipes equinovarus is a complex deformity of foot .It is a collection of different abnormalities, with different etiologies. Consequently, Severity varies with difficulties in evaluating treatment strategies with outcome results.Clubfoot deformity consists of adduction of the forefoot, inversion and varus of the hind foot, and equines at the ankle and subtalar joints, some cases are complicated by an additional cavus deformity. The severity of clubfoot varies widely from case to case, ranging from deformed but flexible to extremely rigid and difficult to move.The treatment of congenital club foot remains controversial. The results of any form of treatment vary according to the severity of the deformity. Usually, the orthopaedist"s goal is to obtain anatomically and functionally normal feet in all patients, but this is not realistic because in many club feet the deformities of the bone , joint, and ligaments of the foot and ankle are too severe to be fully corrected. Before 1950 extensive posteromedial soft-tissue releases were done commonly in different clinics to achieve an anatomical correction of the deformity. These operations often resulted in considerable stiffness of the foot and ankle, and recurrences or over-corrections of the deformity were observed.In this study which was done in three hospitals in Baghdad in the period between 5th of April 1995 and 20th of May 2004, we depended mainly on conservative methods of the treatment of clubfeet.Aim: Validity of early conservative treatment in clubfeetPatients and Methods: The number of patients involved in this study were 470(745 feet),323 were male and 147 were female. It involved only patients with age less than six months.Each patient in this study filled out a questionnaire that provides information. Full Examination, general and local, full neurological examination. Radiological assessment also done for every patient. The protocol of treatment was modified Ponseti method.Follow up of patients for four years. The patients were divided into two groups. Group A, included patients age less than one month, while group B, included patients age between One to six months.Results: The male to female ratio was 2.2:1. Group A- patients were 315, while group B, were 155 patients. Bilateral was 51.7%. Simple clubfoot was 77%.%.Radiologicl assessment; before starting the treatment, 85% of patients, their talo-calcaneal indices were 0-40 degrees and 15% were 40-50 degrees and after 9 months of treatment, we found that 80% of uncorrected patients their indices were 34-40 degrees and 205 with indices of 40-50 degrees . . After 6 weeks of conservative treatment in group A 83.8% got correction, while in group B, 56% only. After 9 weeks of conservative, in group A 91.4%were corrected, while in group B only 58.7% were corrected. Percutaneous tenotomy of T.A. was done in8.3% of group A , while in group B in 18.7%. Soft tissue release with or with out tendon transfer was done in 3.2% in group A and in group B was 25.8%. Follow up for 4 years,14 patients(4%) developed relapse in group A, while in group B, 22 patients(14.2%). The results, using rating system the result in both groups were excellent in 42% , good in 24%,fair in 8.4%, and poor in 25.6% (7.9% in group A, and 43.2% in group B). Conclusions: 1-Understanding the main pathology of club foot, and the ideal method of conservative methods of correction of the deformities systematically before starting the treatment.2- In all types of club foot, we must start conservative treatment.3- Starting the treatment from the first day of life give good results.4- In assessment of the patients, we must depend on clinical, radiological, and functional outcome.5- Follow up is important in long-term treatment, but not more than two years6- Parental compliance is very important in the treatment of clubfoot.

ان مرض القفد الفحجي هو تشوه مقعد القدم حيث يشمل تغيرات متعددة نتيجة لأسباب مختلفة وهذا بالضرورة ينعكس على اسلوب العلاج .ان هذا التشوه يتكون من كون الجهة الامامية للقدم مقربة الى الداخل ، انقلاب داخلي مع فحج الجهة الخلفية من القدم ،مع مفصل الكاحل ومفصل تحت العقب وفي بعض الحالات تكون الأكثر تعقيداً نلاحظ وجود تشوه اضافي وذلك في تجويف القدم (تقوس) .ان علاج هذا التشوه مختلف بأختلاف المدارس ونتيجة هذا العلاج ايضاًمختلفة وتعتمد على شدة التشوهوان هدف المعالج هو للحصول على قدم ذات شكل صحيح تشريحياً ووظيفياً وفي بعض الحالات لا يمكن الوصول الى هذا الهدف لكون التشوه شديد .في هذه الدراسة التي اجريت في ثلاث مستشفيات في بغداد للفترة ما بين شهر نيسان 1995 ولغاية مايس 2004 اعتمدت الدراسة على المعالجة بالطريقة التحفظية.ان الهدف من الدراسة هو لتقييم دور العلاج التحفظي منذ ولادة المريض ومقارنة مع العلاج في فترات اخرى من حياة الطفل.اجريت الدراسة على 470 مريض (745 قدم). (223)ذكر و(147) انثى لمرضى اعمارهمتقل عن ستة أشهر واجراء الفحوصات الشعاعية لتقييم الحالات وتمت معالجتهم تحفظياً الا في بعض الحالات يكون جراحياً وتمت المتابعة لأربع سنوات وكانت نتائج الدراسة مشجعة حيث انه كلما عولج المريض في الايام الاولى من الولادة كلما كانت النتائج ممتازة (91.4%) ونستنتج من هذه الدراسة بأن معالحة هذه التشوهات تحتاج الى معالج متفهم للتغيرات التشريحية والوظيفية الحاصلة في القدم. وطريقة العلاج التحفظي مبينة على اسس علمية بخطوات متتالية بالاضافة الى أهمية التعاون بين المعالج وذوي المريض للحصول على الهدف .


Article
Arthrocentesis versus conservative treatments for TMJ dysfunctions: A preliminary prospective study
بزل المفصل مقابل العلاجات المحافظة لخلل وظائف المفصل الفكي الصدغي: دراسة مستقبلية أولية

Authors: Reiadh K. Al-Kamali --- Saeed Hameed Saeed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2014 Volume: 18 Issue: 2 Pages: 739-745
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: The temporomandibular disorders present with a variety of signs and symptoms which include pain in the joint and its surrounding, jaw sounds, limited jaw opening, jaw deviation and headache. The aim of this study was to compare the results and efficacy of arthrocentesis with those of conservative treatments for temporomandibular joint disorders.Methods: In a clinical comparative prospective study, 45 patient of both sexes were enrolled in this study according to inclusion criteria’s. The arthrocentesis group consisted of 22 patients (31 joints). The conservative treatment group consisted of 23 patients (34 joints). For both groups, pretreatment and four months post treatment parameters (visual analogue scale for pain, maximum mouth opening and joint sounds score) were recorded.Results: The results revealed that highly statistically significant difference between all pretreatment and forth months post treatment parameter means for both groups (P < 0.001). Both arthrocentesis and conservative treatments were effective. There was a highly statistical significant difference between the four months post treatment parameter means for both groups (P < 0.001). Arthrocentesis was superior to conservative treatments. The overall success rate was 87.1% for arthrocentesis and 55.9% for conservative treatments.Conclusion: Both conservative treatment and arthrocentesis are effective in the treatment of temporomandibular joint dysfunctions. However, arthrocentesis seems to be superior.


Article
Anal Fissure Treatment by Medication and Surgery

Author: Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 323 -329
Publisher: Babylon University جامعة بابل

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Abstract

Anal fissure is a most common cause of anal pain [1].This prospective study includes 236 patients complaining of anal fissure treated from a period of September 2013 to December 2015 to assess options of management of anal fissure. Male patients were 121 (51%) and female were 115 (49%). All patients were clinically assessed in an outpatient clinic and conservative treatment started to all patients that shown to be effective in 141 patient (60%). Surgical treatment applied to 95 patients (40%)whom not responded to conservative treatment, or, patients with recurrent fissure. Lateral sphenectrotomy was the surgical procedure applied in open or close method (62 and 33 patients respectively), under local or general anesthesia (54 and 41 respectively). Local anesthesia was associated with a significant low duration of admission from 1 to 24 hours (mean of 3 hours) while general anesthesia with a significant higher duration of 12 to 36 hours (mean of 19 hours). The healing rate following surgery in a local or general anesthetic approach was 95%. No difference in a healing rate between open or closed technique of sphenectrotomy. Flatus incontinence was reported in 3 patients. Initial treatment of anal fissure should be conservative, lateral sphenectrotomy is a safe procedure with a high cure rate, low incidence of complications and could be performed under local or general anesthesia.


Article
Bile Leak Management Following Laparoscopic Cholecystectomy

Author: Ali Abdulhaleem Kadhim Al-Eessa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 580 -587
Publisher: Babylon University جامعة بابل

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Abstract

Laparoscopy now is the gold standard technique for cholecystectomy. Post laparoscopic cholecystectomy (LC) bile leak may occur. This prospective studyincludes 38 patientsfrom a period of May 2014 to May 2016 in Hilla teaching general hospital to assess options of management of bile leakfollowing LC.Conservative supportive measures alone was successful in 20 patients.ERCP intervention applied in 9 patients with a stent application, papillatomy or CBD stone extractionwith subsequent resolution. Explorative laparotomy by expert surgical team was done for 9 patients with Roux-en-Y-hepaticojejunostomy as a result of iatrogenicmassive injury to main biliary duct. Mortality rate was zero.Male to female ratio was 2:1 for whole bile leaked patients, and 3:1 for patients treated with interventions. Post laparoscopic cholecystectomy bile leak can be managed conservatively with close monitoring in a start.MRCP is valuable noninvasive test to assess biliary duct system. ERCP as a diagnostic and therapeutic measure was effective minimal invasive approach to control leak. Laparoscopic cholecystectomy should be performed meticulously in order to avoid catastrophic biliary ductal injury with a wise conversion to open when indicated. Proper clipping technique of cystic duct is essential to avoid cystic duct leak.


Article
Conservative treatment of acute appendicitis
العلاج التحفظي لإلتهاب الزائدة الدودية الحاد

Author: Haytham H. Al-Najafy هيثم حسين النجفي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2018 Volume: 40 Issue: 1 Pages: 56-59
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACTObjective: To define the value of Tamsulosin drug addition to antibiotics (Ceftriaxone and Metronidazole) in conservative treatment of nonperforated acute appendicitis.Patients and methods: Prospective clinical study performed in Al-Jamhoory Teaching Hospital covering a period from Jan 2010 to Jan 2012. Formal consent from the patients and ethical approval were obtained. One-hundred and two patients including 74 males and 28 females, with age range of 17-45 years were admitted to the surgical unit number 3 complaining of acute appendicitis. Detailed clinical history was taken and clinical examination was carried out. All the patients had general urine examination (G.U.E), ultra sound (U.S) of the right iliac fossa and determination of serum c.reactive protein level. Those who had complicated appendicitis were excluded from the study. The patients were randomly divided into two groups A and B.Group A: Fifty one patients were given 500 mg of Ceftriaxone and 500 mg Metronidazole, both I.V twice daily.Group B: Fifty one patients were given the antibiotics regime plus Tamsulosin 0.4 mg orally once daily.The patients who had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) in the first 24 hours of the treatment continued the treatment for further 5 days, if there was no good response immediate appendicectomy was done. There was follow up of discharged patients for 4 months. Results: Group A: Forty-one patients out of 51 (80.39%) had a good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation while 10 patients needed appendicectomy. Group B: Forty-nine patients (out of 51) 96.07% had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation and only 2 patients needed appendicectomy. Those who were discharged after conservative treatment were followed up for 4 months. Five patients in group A and 3 patients in group B had recurrence of symptoms and signs of acute appendicitis and appendicectomy was performed for them.Conclusion: Tamsulosin added to antibiotics for treatment of acute appendicitis is safe and resulted in speedy recovery of the patients with reduced recurrence of the condition.

الخلاصةالهدف: بيان فائدة إضافة عقار التامسوليسين إلى المضادات الحيوية في علاج إلتهاب الزائدة الدودية التحفظي.طريقة العمل: دراسة مستقبلية أجريب في المستشفى الجمهوري التعليمي في الموصل من ك2 2010 الى ك2 2012. شملت 102 مريض ومريضة مصابون بإلتهاب الزائدة الحاد, قسم المرضى بطريقة عشوائية إلى مجموعتين.مجموعة أ: أعطيت المضادات الحيوية، المجموعة ب: أعطيت المضادات الحيوية وعقار التامسوليسين.النتائج: تم متابعة المرضى خلال الأربع والعشرون ساعة الأولى من قبل جراحين يجهلون تماما تبعية المريض إلى مجموعة من المجموعتين.المجموعة أ:- واحد وأربعون مريض ومريضة من مجموع 51 مريض 80,39% أظهروا إستجابة جيدة للعلاح خلال الأربع وعشرون ساعة الأولى من بدء العلاج (إختفاء الآلام في البطن وعودة الشهية للطعام) بينما إحتاج 10 مرضى لعملية بتر الزائدة.المجموعة ب:- تسع وأربعون مريض ومريضة من مجموع 51 مريض 96,07% أظهروا إستجابة جيدة للعلاج في الأربع وعشرون ساعة الأولى من بدء العلاج وإحتاج مريضان فقط إلى عملية بتر الزائدة. جرت متابعة المرضى الذين شفوا بعد العلاج التحفظي لمدة أربع أشهر لظهور علامات إلتهاب الزائدة الدودية وكان هناك خمسة مرضى في المجموعة أو ثلاثة مرضى في المجموعة ب ممن عانوا من الرجعة وأجريت لهم عملية بتر الزائدة.الإستنتاج: إضافة عقار التامسوليسين إلى المضادات الحيوية في علاج إلتهاب الزائدة التحفظي أظهر نتائج جيدة وقلة عدد المرضى الذين عانوا من عودة المرض.


Article
Atypical Presentation of Thoracic Outlet Syndrome in Kurdistan of Iraq
عرض غير نمطي لمتلازمة مخرج الصدر في كوردستان العراق

Author: Zohair Mohsen Ahmad Al-saffar
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 1 Pages: 12-16
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of neurovascular structures at the superior aperture of the thorax which presents with varying symptoms The aim of this study was to analyze the different kinds of clinical presentation of thoracic outlet syndrome in Kurdistan region of Iraq and its management.Methods: In Erbil teaching hospital, 150 patients have been studied from February 2000-December 2006. These patients diagnosed as symptomatic thoracic outlet syndrome and have been managed conservatively and surgically.Results: In this study 97 (64.6%) patients were female, 53 (35.3%) patients were male. Their ages ranged from (17-40) years. There was pain, parasthesia in arm in 69 (46%). Shoulder pain, chest pain and pain in axillarys region with arm pain in 38 (25.3%) patients (diagnosed by cardiologist as they have cardiac problem and treated accordingly without benefit). Incidental findings in 27 (18%) patients with vague symptoms in upper limb, supraclavicular fullness in 2 (1.3%) patients, 12 (8%) patients diagnosed by psychiatrist as having psychological problem (misdiagnosed as obsessive or depressive cases because of there neck pain and headache) and one patient has wasting of hand muscles. Surgery done for 25 (20.5%) patients (supra clavicular approach).Conclusions: Careful patients history and proper physical and clinical evaluation including nerve conduction study, conventional radiography of cervical spine can decide proper management for symptomatic cases conservatively or surgically.

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