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Article
Managements Of Enterocutaneous Fistula (ECF)

Author: Majeed H. H.Alamiri مجيد حمود الاميري
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 20 Pages: 105-108
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background:- A fistula is an abnormal epithelialized tract Between two or Hollow organ to Another hollow organ or to the skin.It is estimated that 90% of ECF arise after surgical procedures, The mortality rate about 37% in post-operative high output ECF.Objectives:-The aim of present study to evaluate the standardized Guideline And prognostic factors for outcome of patients with ECF.Patients &Methods:- A prospective clinical trial conducted from January 2002-July 2013. done in the surgical ward of Al-Yarmouk Teaching Hospital.In this study a database was created consisting of 115 patients with ECF. All have Been treated according to the SOWATS guideline, which consists of the following Components, Sepsis, Optimization of nutritional state , Wound care, Anatomy of Fistula,Timing of surgery and Surgical strategy.Results :- Data from 115 patients. Mean age 42 year(range from 8-76 year).Postoperative fistula after initial surgery for any reason appeared after mean 20 day (range from 3-37 day). The mean length of hospital stay was 57 day(range from 8-106 day). Mean period of treatment was 80 day(range from 10-150day).Conclusion:- The main lesson to be learned is that adherence to SOWATS Guideline can result in good patient outcome. Surgical repair is performed when the Patient is stable. Treatment of sepsis plays a key role and ongoing sepsis is still the Most important cause of death.

تمهيد: النواسير المعوية هي اقنية شاذة )غير سوية( مبطنة بطبقة تظهرية بين اثنان من الاعضاء التي تحتوي -على فراغ او بين عضو يحتوي على فراغ والجلد. وقد قدرت الدراسات ان حوالي 00 % من النواسير تظهر بعداجراء العمليات الجراحية للبطن لمختلف الاسباب المرضية. وان نسبة موت المرضى المصابين بها حوالي%73 في النواسير ذات الانتاج العالي )الكثير اي اكثر من 100 مللتر باليوم(.الاهداف: لتقييم التعليمات العلاجية في علاج النواسير المعوية, ودراسة عوامل التكهنات في نتائج مرضى -النواسير.الطرق: دراسة مستقبلية تم اجرائها خلال التترة المحصورة بين كانون الثاني 2002 الى تموز 2057 . تم اجراء -الدراسة في قسم الجراحة مستشتى اليرموك التعليمي. 551 مريض مصابين بالنواسير المعوية تم علاجهم وفقالتعليمات العلاجية للنواسير, والتي تشمل على علاج الخراجات المصاحبة للنواسير,وتزويد المريض بالغذاءالمثالي,والعناية بالجروح وثقوب النواسير,ودراسة توع الناسور حسب التشريح العضوي,ومعرفة افضل وقتلاجراء العملية الجراحية واخيرا خطة العملية الجراحية.النتائج: تم جمع البيانات من 551 مريض مصابين بالنواسير المعوية المختلتة. معدل اعمارهم 22 سنة)تتراوح -بين 37 8 سنة(. ومعدل وقت ظهور النواسير حوالي 20 يوم)تتراوح بين 73 7 يوم( بعد موعد اجراء العمليات - -الجراحية للبطن لمختلف الاسباب المرضية. ومعدل الرقود بالمستشتى حوالي 13 يوم )تتراوح بين 507 8 يوم(. -ومعدل فترة العلاج الكلية حوالي 80 يوم )تتراوح بين 510 50 يوم(. -الاستنتاجات: الدرس المهم من الدراسة هو كلما تم تطبيق التعليمات العلاجية الخاصة بالنواسير بصرامة اكثر -كلما كانت نتائج العلاج افضل. التركيز على وقت اجراء العملية الجراحية عندما تكون الحالة الصحية للمريضمستقرة للوصول الى نتائج افضل. علاج الخراج مهم في علاج المرضى ولا زال السبب الرئيسي للوفاة فيالنواسير هو وجود الخراج والتغذية السيئة)غير المثالية


Article
Abdominal Transperitonial Approach in Management of Vesicovaginal Fistula in Iraqi Patients

Author: Mohammed Jabbar AL-Rubai
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 2 Pages: 238-241
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Vesicovaginal fistula (VVF) is an abnormal fistulous tract extending between the bladder and the vagina In addition to the medical sequel; they often have a profound effect on the patient's emotional well-being and social life. OBJECTIVE: Is to evaluate success of abdominal approach in treating vesicovaginal fistula in Iraqi patients. METHODS: Retrospective comparative study was carried out on fourteen Iraqi patients suffering from vesicoveginal fistula according to inclusion criteria and followed for 3-12 months after tranabdominal repair with omental interposition flap. RESULTS: Twelve (85%) patients have obstetrical causes while two (15%) patients have gynecological causes. Eight (75%) patients aged between 21-30 years while six (43%) patients aged between 31-45 years. Eight (57%) patients are primigravidae. Site of fistula either spratrigonal[seven cases (50%)] or infratrigonal [seven cases (50%)]. Only one of infratrigonal fistula is close to ureteric orifice. Size of fistula either <1cm [seven cases (50%)] or between 1-2 cm [five cases (36%)] or between 2.1-3 cm [two cases (14%)]. Twelvecases (85%) have correct repair. CONCLUSION: The results of suprapubic closure of a vesicovaginal fistula are very good


Article
HYDATID CYST OF THE RIB: A CASE REPORT

Author: Omar RH Al Dahhan عمر ربيع هاشم الدهان
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 4 Pages: 389-391
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

The hydatid cyst is endemic in our country, but bone lesions are less common. The disease often takes the appearance of abscess or malignant lesion. We report a case of a 31-year-old woman with a hydatid cyst of the rib complicated with cutaneous fistula. The surgery allowed both diagnosis and treatment.Keywords: hydatid cyst, rib, fistula.

Keywords

hydatid cyst --- rib --- fistula.


Article
8.THE VALUE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF PERI-ANAL FISTULA

Authors: Ammar M. Jawad --- Mohammed A. kadhim محمد عبد كاظم --- Zainab K. Al-Jobouri --- Mohssin A.A. Hussain
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 2 Pages: 166-176
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Perianal fistula accounts for 0.01% of general population and is frequently managed inadequately resulting in a significant morbidity. Magnetic resonance imaging (MRI) plays an essential role in the preoperative assessment of the disease, therefore improving post-operative surgical outcome.Objective: To study the role of MRI in the evaluation of perianal fistula and to show the value of using contrast enhanced MR study in the determination of the precise tract pathway, extensions and other associated pathologies.Methods: A cross sectional analytic study was conducted on a total of 32 patients with perianal fistulas in the MRI Department of Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq during the period from November 2015 to December 2016. Patients underwent MRI examination using axial and coronal T2 weighted images with and without fat suppression and T1 fat suppressed sequences before and after contrast administration. The type of fistula, location of the internal opening, associated abscesses and/or sinus tracts and horseshoe extension were evaluated using different MR sequences. Results: The most common type of fistula encountered was the inter-sphincteric type, which was seen in 21 patients (66%), of those patients 16 fistulas (50%) were grade I and 5 fistulas (16%) were grade II. Trans-sphincteric fistulas were seen in 9 patients (28%), 2 of them (6%) were grade III and 7 fistulas (22%) were grade IV. Two patients (6%) had extra-sphincteric type. T2 weighted TSE, T2 TSE with fat suppression and T1 weighted fat suppressed post contrast sequences all show significant correlation with surgical results (with p-value less than 0.05) and the highest significance was obtained by the post contrast sequence (p-value of 0.00001). The highest accuracy in the diagnosis of fistula in ano was with the use of T1 enhanced fat suppressed sequence (98.8%) followed by 87% for the T2 fat suppression sequence and only 57% for the T2 weighted TSE sequence.Conclusion: MRI is an essential, noninvasive tool in the preoperative assessment of perianal fistulous tracks, with the axial and coronal post contrast fat suppression T1 providing the highest accuracy and clinical significance with surgical data and therefore giving a highly promising decrement in the incidence of post-operative complications.Keywords: MRI, perianal fistulaCitation: Jawad AM, kadhim MA, Al-Jobouri ZK, Hussain MAA. The value of magnetic resonance imaging in the evaluation of peri-anal fistula. Iraqi JMS. 2018; 16(2): 166-176. doi: 10.22578/IJMS.16.2.8

Keywords

MRI --- perianal fistula


Article
MANAGEMENT OF SPINAL DURAL ARTERIOVENOUS FISTULA, A REVIEW WITH ONE CASE REPORT

Authors: Mohamed El Husseini --- Hussein Mouawia --- Adnan Mrad --- Taghrid Chaaban
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 1 Pages: 63-71
Publisher: Basrah University جامعة البصرة

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Abstract

MANAGEMENT OF SPINAL DURAL ARTERIOVENOUS FISTULA, A REVIEW WITH ONE CASE REPORT Mohamed El Husseini@, Hussein Mouawia#, Adnan Mrad$ & Taghrid Chaaban* @MD, PhD, Neurosurgeon, Hôpital Libano Français, Zahle, Lebanon. #Director, Lebanese University, 4th Branch, Lebanon. $Dean, Islamic University of Beirut. *Vice dean, Islamic University of Beirut, Lebanon. Abstract Spinal dural arteriovenous fistulas (SDAVFs) are rare acquired vascular malformations of the spinal cord which if not treated properly, can lead to inevitable severe morbidity with progressive spinal cord symptoms. The management is still at high interest among specialists. If microsurgical treatment is still considered as a treatment of choice for SDAVFs, endovascular treatment is increasingly growing in interest with the development of endovascular techniques and new embolization materials. In this article, a short discussion is made about the spinal dural arteriovenous fistulae in respect to anatomy, etiology, diagnosis and treatment. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications.


Article
Outcome of Snodgrass urethroplasty by modifying tubularization and dartos layer in Erbil
نتائج جراحة الإحليل البولية Snodgrass عن طريق تعديل طبقة الأنابيب والبلات في أربيل

Authors: Nihad Pauls Al-Ibraheem --- Hawkar Abdulla Kakahmed --- Jalal Hamasalih Fattah
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1715-1721
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994. This study aimed to find out whether there is any difference in the fistula rate with single versus double layer tubularization, and the use of ventral versus dorsal dartos layer.Methods: Between May 2009 and July 2014, tubularized incised plate urethroplasty was performed for correction of hypospadias in Erbil for 112 patients with age ranging from 1-32 years. Five patients were excluded from the study because of lack of adequate follow up. Data were analyzed using the statistical package for the social sciences.Results: Urethral fistula occurred in seven cases (6.5%).The use of an additional reinforcing second layer for the tubularization had a significant effect on decreasing the fistula formation (P = 0.05). The fistula rate was slightly lower with dorsal dartos flap (5.4%) than ventral dartos flap (7.8%).Conclusion: The urethral plate, when dissected, should be thick enough to allow for tubularizationin two layers. Both dorsal and ventral dartos flaps are effective in preventing urethral fistula.

Keywords

Hypospadias --- Dartos flap --- Fistula


Article
Left complete second branchial arch fistula in a 9 years old boy

Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2015 Volume: 2 Issue: 2 Pages: 46-49
Publisher: Al-Muthanna University جامعة المثنى

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Abstract

Anomaly of 2nd arch is the commonest among branchial arches anomalies and manifests as branchial sinus in majority of cases while branchial fistula is seldom to occur. We present a case of left branchial fistula in a 9 years old boy, which was confirmed by a fistulogram. The tract was completely excised by combined surgical approach with excellent outcome.

Keywords

Arch --- branchial --- cleft --- complete branchial fistula --- fistula --- sinus --- Anbr


Article
Pancreatic Fistula Following Surgery of Primary Pancreatic Hydatid Cyst Causing Pancreatitis

Author: Ghassan A .A .Nasir
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2006 Volume: 5 Issue: 3 Pages: 359-362
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Primary pancreatic hydatid cyst is rarely encountered and difficult to differentiate from pancreatic cystic neoplasm.THE AIM:Of this case report is to discus the mode of presentation and best management of this condition.CASE REPORT:A twenty-eight years old male, presented with recurrent upper abdominal pain of three years duration. The pain was radiating to the back and associated with vomiting and low-grade fever.The ultrasound as well as CT scan with oral and I.V. contrast revealed that there was a solid-cystic mass in the tail of the pancreas suggesting of pancreatic cystic tumors. Laparotomy revealed pancreatic hydatid cyst, which was communicating with pancreatic duct. The patient treated by endocystectomy, which was complicated by pancreatic fistula.CONCLUSION:Pancreatic hydatid cyst should be kept in mind in any cystic lesion of pancreas.This disease could be treated by endocystectomy or partial pancreatectomy.


Article
Role of MRI in assessment of perianal fistula
دور التصوير بالرنين المغناطيسي في تقييم الناسور حول الشرج

Authors: Hayam Yousif Odish --- Haven Azo Mohammed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1789-1795
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Perianal fistulae commonly occur in middle-aged men. It is important to determine the presence of fistula tracks, its grading and presence of abscess or inflammation. This study aimed to assess the role of MRI in diagnosis and classification of perianal fistula.Methods: This study included 20 patients with perianal sepsis that were referred to the MRI section of Radiology Department in Rizgary Teaching Hospital between August 2015 and April 2016. All patients underwent MRI examination.Results: The mean ± SD age of the 20 patients was 38.5 ± 10.4 years (range 22-55 years), of which 16 patients (80%) were males and four patients (20%) were females. Eighteen patients had a single external opening and two patients had two external opening. All the simple non-branching fistulas were successfully identified by axial and coronal planes of contrast enhanced T1Weighted image fast spin echo, of which five cases had simple intersphincter (G1) fistula and two had simple transphincter (G3), seven cases had intersphincter fistula either secondary tract or horse shoe and abscess (G2), five cases had complex transsphincter (G4). Two cases of complex G4 type had inflammation and edema in ischiorectal and ischioanal fossa and the internal openings were clearer in STIR T2axia.Conclusion: MRI non-invasively offers important information about perianal fistula that can reduce surgical complications and postoperative recurrence of the disease. Every patient with suspicious perianal sepsis should undergo MRI examination to prevent complications and morbidity.


Article
VASCULAR ACCESS OUTCOMES IN PATIENTS ON HAEMODIALYSIS IN DUHOK KIDNEY DISEASE CENTER
نتائج الموصلات الدموية للمرضى الخاضعين للديلزة الدموية في مركز دهوك الامراض الكي

Authors: ZANA S. MOHAMMED SALEEM زانا محمدسليم --- ASHUR Y. IZAC اشور اسحاق
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2013 Volume: 7 Issue: 2 Pages: 32-40
Publisher: University of Dohuk جامعة دهوك

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Abstract

ABSTRACTBackground and objectives Patients with chronic renal failure have only two options of treatment either renal transplantation or dialysis (peritoneal or haemodialysis), haemodialysis need efficient, comfortable, easy accessible, long duration and least complication vascular access. We try to analyze 102 patients and evaluating their vascular access. The aim of the study is compare between different types of vascular access and assessing, the efficiency, durability, and complications associated with that vascular access.Methods This is retro and prospective study for patients with vascular access on haemodialysis; sample is collected from Jun 2009 to 30th June, 2013 in Duhok Kidney Disease Center.Results Hundred two patients included in this study. Diabetes was the most common cause of end stage renal failure in the studied group. 76.4 % of the studied group was with arteriovenous fistula. Small vein was the most common reason for creation of graft fistula.Edema was the commonest complication among arteriovenous fistula where thrombosis was among the graft fistula.Conclusions Only 10% of the studied group present early for creation of vascular access before needing urgent dialysis. Complications seem to be equal in both sexes in arteriovenous fistula type of access but its more than four folds in women with graft fistula. Aneurysm in patients with arteriovenous fistula is high in this study in compares to other studies.

خلفية واهداف البحث: يوجد خيارين أثنين لاستم ا ررية الحياة لمرضى عجز الكلية وهما زرع الكلية أو الديلزة (الدموية أو البريتونية)، الديلزة الدموية تحتاج الى موصل دموي كفؤ، مريح، سهل الاستعمال يعمل لأطول فترة ممكنة مع أقل المضاعفات، سنحاول د ا رسة وتحليل ١٠٢ من المرضى وتقييم الموصلات الدموية لديهم. الهدف من الد ا رسة هو مقارنة الأنواع المختلفة من الموصلات وتقييم كفأتها، العمر الزمني والمضاعفات المصاحبة لها.طرق البحث: هذه د ا رسة استعادية ومسبقية للمرضى الذين اجريت لهم تصنيع الموصلات الدموية في محافظة دهوك من حزي ا رن ٢٠٠٩ ولغاية حزي ا رن ٢٠١٣ في مركز دهوك لام ا رض الكلى.النتائج: تم شكل مائة اثنين من المرضى ا في هذه الد ا رسة. وكان داء السكر السبب الأكثر شيوعا في المرضى الذي يعانون من الفشل الكلوي في المجموعة التي شملتها الد ا رسة ٧٦,٤ % من المرضى لديهم ناسور شرياني وريدي. كان الاو ردة الصغيرة السبب الأكثر شيوعا لإنشاء ناسور شرياني وريدي بمجازة اصطناعية.وكان أشيع المضاعفات هي ال وذمة في ناسور شرياني وريدي بينما كان التخثر الاكثر شيوعيا في ناسور شرياني وريدي بمجازة اصطناعية.الاستنتاجات: ١٠ ٪ فقط من عينة الد ا رسة تقدموا لخلق موصل الاوعية الدموية قبل أن يحتاجوا لغسيل الكلى العاجل. يبدو أن المضاعفات على قدم المساواة في كلا الجنسين في نوع ناسور شرياني وريدي من الوصول ولكنها أكثر من أربعة أضعاف في النساء مع ناسور شرياني وريدي بمجازة اصطناعية. تمدد الأوعية الدموية في المرضى الذين يعانون من ناسور شرياني وريدي عالية في هذه الد ا رسة في مقارنة مع غيرها من الد ا رسات.

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