Pub Date : 2019-05-31DOI: 10.33762/BSURG.2019.163872
J. Hameed
{"title":"COMBINED SURGICAL EXCISION WITH LOCAL INFILTRATION OF VERAPAMIL FOR THE TREATMENT OF KELOID; A CLINICAL STUDY","authors":"J. Hameed","doi":"10.33762/BSURG.2019.163872","DOIUrl":"https://doi.org/10.33762/BSURG.2019.163872","url":null,"abstract":"","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47009332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160093
Mazin H Al-Hawaz
{"title":"abituary Dr. Ghassan","authors":"Mazin H Al-Hawaz","doi":"10.33762/BSURG.2018.160093","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160093","url":null,"abstract":"","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47808367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/bsurg.2018.160098
Fareed A Warid Al-Laftah A
The objective of this study is to assess pros and cons of intraoperative Briliant Blue G dye (BBG) injection in the early phase of Pars Plana Vitrectomy. This is a prospective non-consecutive case series study, a modification in timing for dye injection during vitrectomy. A single injection of 0.1 ml of Briliant Blue G (BBG dye) was used in the early phase of pars plana vitrectomy (PPV) promptly after an initial small core vitrectomy, and continued directly in completing vitrectomy; including induction of posterior vitreous detachment and peripheral vitrectomy +/vitreous base shaving. View of the underlying retina is initially obscured immediately after dye injection, however dye density fade gradually with continuation of vitrectomy. Fluid Turbulence caused by vitrectomy and continuous fluid infusion enhance dye dissemination within vitreous cavity and stain transparent tissues and also increase colour contrast between blue hued retina and underlying naturally red coloured choroid. Early staining technique will remove necessity for Air-Fluid Exchange for staining at end of vitrectomy. This study was conducted in the Ophthalmology department at Hamad General Hospital in Doha, Qatar in 2016 and General Port Hospital in Basrah, Iraq in 2017. Patients requiring vitrectomy for various indications were included. Thirty four eyes (34 patients) were involved in this study: 20 men and 14 women, average age 56 was years. Indications for surgery were variable, diabetic vitrectomy (20 cases, 5/16= Macular Epiretinal Membrane), Rhegmatogenous Retinal Detachment (10 cases), Full Thickness Macular hole (2 case), Penetrating Injury with Posterior IOFB (2 cases). Single case required additional re-injection of dye to augment staining. Non-diathermy drainage Retinotomy was done by soft tipped cannula in 5 cases of retinal detachment. No single case has developed a surgically significant discolouration of lens posterior capsule or seepage of dye to the subretinal space. In conclusion, this modified staining technique allows better visualization of the various vitreoretinal tissues during all steps of PPV and improve surgical techniques. Introduction he use of vital dyes in the vitrectomy procedure allows visualisation of the transparent pre-retinal tissues and membranes. Improper visualization of different vitreoretinal tissue layers can lead to incomplete vitreous removal, iatrogenic breaks, long surgical time, and gliosis. Various methods of staining vitreoretinal tissues, particularly the Internal Limiting Membrane (ILM) and Epiretinal Membrane (ERM), have been described to aid visualization of ILM and ERM. Chromovitrectomy is the use of chemicals to stain semi-transparent preretinal structures as an aid in successful vitreoretinal surgery. Several different dyes have been tried including indocyanine green (ICG), trypan blue (TB) and Triamcinolone (TA). Dye administration usually done by 2 techniques at late stage of Pars Plana Vitrectomy (PPV). The “dry” or “a
{"title":"A MODIFIED STAINING STRATEGY IN STAIN-ASSISTED VITRECTOMY","authors":"Fareed A Warid Al-Laftah A","doi":"10.33762/bsurg.2018.160098","DOIUrl":"https://doi.org/10.33762/bsurg.2018.160098","url":null,"abstract":"The objective of this study is to assess pros and cons of intraoperative Briliant Blue G dye (BBG) injection in the early phase of Pars Plana Vitrectomy. This is a prospective non-consecutive case series study, a modification in timing for dye injection during vitrectomy. A single injection of 0.1 ml of Briliant Blue G (BBG dye) was used in the early phase of pars plana vitrectomy (PPV) promptly after an initial small core vitrectomy, and continued directly in completing vitrectomy; including induction of posterior vitreous detachment and peripheral vitrectomy +/vitreous base shaving. View of the underlying retina is initially obscured immediately after dye injection, however dye density fade gradually with continuation of vitrectomy. Fluid Turbulence caused by vitrectomy and continuous fluid infusion enhance dye dissemination within vitreous cavity and stain transparent tissues and also increase colour contrast between blue hued retina and underlying naturally red coloured choroid. Early staining technique will remove necessity for Air-Fluid Exchange for staining at end of vitrectomy. This study was conducted in the Ophthalmology department at Hamad General Hospital in Doha, Qatar in 2016 and General Port Hospital in Basrah, Iraq in 2017. Patients requiring vitrectomy for various indications were included. Thirty four eyes (34 patients) were involved in this study: 20 men and 14 women, average age 56 was years. Indications for surgery were variable, diabetic vitrectomy (20 cases, 5/16= Macular Epiretinal Membrane), Rhegmatogenous Retinal Detachment (10 cases), Full Thickness Macular hole (2 case), Penetrating Injury with Posterior IOFB (2 cases). Single case required additional re-injection of dye to augment staining. Non-diathermy drainage Retinotomy was done by soft tipped cannula in 5 cases of retinal detachment. No single case has developed a surgically significant discolouration of lens posterior capsule or seepage of dye to the subretinal space. In conclusion, this modified staining technique allows better visualization of the various vitreoretinal tissues during all steps of PPV and improve surgical techniques. Introduction he use of vital dyes in the vitrectomy procedure allows visualisation of the transparent pre-retinal tissues and membranes. Improper visualization of different vitreoretinal tissue layers can lead to incomplete vitreous removal, iatrogenic breaks, long surgical time, and gliosis. Various methods of staining vitreoretinal tissues, particularly the Internal Limiting Membrane (ILM) and Epiretinal Membrane (ERM), have been described to aid visualization of ILM and ERM. Chromovitrectomy is the use of chemicals to stain semi-transparent preretinal structures as an aid in successful vitreoretinal surgery. Several different dyes have been tried including indocyanine green (ICG), trypan blue (TB) and Triamcinolone (TA). Dye administration usually done by 2 techniques at late stage of Pars Plana Vitrectomy (PPV). The “dry” or “a","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44588368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160100
M. Husseini, H. Mouawia, A. Mrad, Taghrid Chaaban
{"title":"TETHERED SPINAL CORD: REVIEW OF LITERATURE","authors":"M. Husseini, H. Mouawia, A. Mrad, Taghrid Chaaban","doi":"10.33762/BSURG.2018.160100","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160100","url":null,"abstract":"","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69678214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160091
Sajjad Halboos Mohammed Almansoori
The nose is the most prominent structure in human face, making it more susceptible to trauma which may reach 39% of all facial injuries. Although fracture nose is a common surgical problem, very few studies are conducted in Iraq on it. The aim of this study is to evaluate the efficiency of local anesthesia in fracture nose manipulation and to assess the degree of patient’s satisfaction from the functional and esthetic point of view. The majority of patients attended ENT department were males (68.5%) lying in the age group between 21 – 30 years and the reason for their injuries were assaults. Waiting for complete resolution of edema will result in less complications such as bleeding and pain sensation during fracture reduction. Fracture nose manipulation under local anesthesia gives high degree of satisfaction both for the functional (83.3%) and esthetic (88.9%) point of view, so this procedure can be recommended in ENT clinical practice in the view of these results as it is more safe, time saving and cost effective.
{"title":"MANIPULATION OF FRACTURED NASAL BONES UNDER LOCAL ANESTHESIA, ITS EFFICIENCY AND PATIENT SATISFACTION","authors":"Sajjad Halboos Mohammed Almansoori","doi":"10.33762/BSURG.2018.160091","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160091","url":null,"abstract":"The nose is the most prominent structure in human face, making it more susceptible to trauma which may reach 39% of all facial injuries. Although fracture nose is a common surgical problem, very few studies are conducted in Iraq on it. The aim of this study is to evaluate the efficiency of local anesthesia in fracture nose manipulation and to assess the degree of patient’s satisfaction from the functional and esthetic point of view. The majority of patients attended ENT department were males (68.5%) lying in the age group between 21 – 30 years and the reason for their injuries were assaults. Waiting for complete resolution of edema will result in less complications such as bleeding and pain sensation during fracture reduction. Fracture nose manipulation under local anesthesia gives high degree of satisfaction both for the functional (83.3%) and esthetic (88.9%) point of view, so this procedure can be recommended in ENT clinical practice in the view of these results as it is more safe, time saving and cost effective.","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43610750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/bsurg.2018.160099
A SalahKadhimMuslim
Peritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form and a large percent of them is due to perforation or impending gastrointestinal perforation. The prognosis depends on multiple factors by which Mannheim Peritonitis Index (MPI) appears to be more practical. This study aimed to assess the value of pre-operative aspiration of peritoneal fluid followed by peritoneal wash and drainage before proceeding to definitive surgery in patients with MPI score>20. This prospective study was conducted in Al-Hussein Teaching Hospital in Al Nasserya city and Basrah Teaching Hospital in Basrah city from October 2003 to July 2014. Each patient admitted to the emergency department in these hospitals with the provisional diagnosis of perforation peritonitis was evaluated with MPI score. If the score was less than 20; the patient managed with resuscitation and broad spectrum antibiotics for 2-3 hours then by definitive surgery while those with MPI more than 20 were randomly divided into two groups; the first were managed with 2-3 hours resuscitation with intra-venous fluid resuscitation and antibiotics followed by urgent surgical exploration (USE). The second group were managed with percutaneous peritoneal drainage (PPD) with aspiration of the fluid and then irrigation of the peritoneal cavity with isotonic saline and followed by a drainage with aid of the gravity through another catheter located in the right ileac fossa. Sixty two patients included in this study who fulfilled the criteria of perforation peritonitis and MPI score more than 20. Around half of them the score was between 26-30. Perforated peptic ulcer is the commonest etiology. The most common cause of their high MPI score is the late presentation and the evidence of organ failure. Renal failure is the most prevalent organ failed in both groups. The overall mortality is decreased in (PPD) group. Those with urgent surgical exploration(USE) showed no improvements in the pre-operative vital signs, prolonged operation time and a higher mortality and more severe post-operative complication than PPD group. In conclusion, the pre-operative percutaneous peritoneal aspiration of the fluid followed by peritoneal irrigation and drainage in patients with advanced stage perforation peritonitis is associated with a significant improvement in the pre-operative pulse rate and blood pressure, decrease in the operation time, a decrease in the overall mortality and deep seated wound infection and dehiscence but it is associated with a higher mortality in the first post-operative day. Introduction P eritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form. A large percentage of secondary peritonitis is due to perforation which if not treated surgically causes considerable mortality. Mortality of perforation peritonitis was as high a
{"title":"COMPARISON OF PRE-OPERATIVE PERITONEAL WASH AND DRAINAGE VERSUS URGENT LAPAROTOMY STRATEGY IN PATIENTS WITH LATE STAGE PERFORATION PERITONITIS. A RANDOMIZED CONTROLLED TRIAL","authors":"A SalahKadhimMuslim","doi":"10.33762/bsurg.2018.160099","DOIUrl":"https://doi.org/10.33762/bsurg.2018.160099","url":null,"abstract":"Peritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form and a large percent of them is due to perforation or impending gastrointestinal perforation. The prognosis depends on multiple factors by which Mannheim Peritonitis Index (MPI) appears to be more practical. This study aimed to assess the value of pre-operative aspiration of peritoneal fluid followed by peritoneal wash and drainage before proceeding to definitive surgery in patients with MPI score>20. This prospective study was conducted in Al-Hussein Teaching Hospital in Al Nasserya city and Basrah Teaching Hospital in Basrah city from October 2003 to July 2014. Each patient admitted to the emergency department in these hospitals with the provisional diagnosis of perforation peritonitis was evaluated with MPI score. If the score was less than 20; the patient managed with resuscitation and broad spectrum antibiotics for 2-3 hours then by definitive surgery while those with MPI more than 20 were randomly divided into two groups; the first were managed with 2-3 hours resuscitation with intra-venous fluid resuscitation and antibiotics followed by urgent surgical exploration (USE). The second group were managed with percutaneous peritoneal drainage (PPD) with aspiration of the fluid and then irrigation of the peritoneal cavity with isotonic saline and followed by a drainage with aid of the gravity through another catheter located in the right ileac fossa. Sixty two patients included in this study who fulfilled the criteria of perforation peritonitis and MPI score more than 20. Around half of them the score was between 26-30. Perforated peptic ulcer is the commonest etiology. The most common cause of their high MPI score is the late presentation and the evidence of organ failure. Renal failure is the most prevalent organ failed in both groups. The overall mortality is decreased in (PPD) group. Those with urgent surgical exploration(USE) showed no improvements in the pre-operative vital signs, prolonged operation time and a higher mortality and more severe post-operative complication than PPD group. In conclusion, the pre-operative percutaneous peritoneal aspiration of the fluid followed by peritoneal irrigation and drainage in patients with advanced stage perforation peritonitis is associated with a significant improvement in the pre-operative pulse rate and blood pressure, decrease in the operation time, a decrease in the overall mortality and deep seated wound infection and dehiscence but it is associated with a higher mortality in the first post-operative day. Introduction P eritonitis is inflammation of peritoneum which is most commonly due to generalized or localized infection. Secondary peritonitis is the commonest form. A large percentage of secondary peritonitis is due to perforation which if not treated surgically causes considerable mortality. Mortality of perforation peritonitis was as high a","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46050056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160097
A. A., S. A., Wigdan Nazar Ibraheem A, Nazar S Haddad A
This study aimed to evaluate the C-reactive protein (CRP) levels in patients with open angle glaucoma. This cross sectional study included 36 patients diagnosed with glaucoma compared to 36 healthy controls. Each patient went through a complete ophthalmic examination and blood sampling for CRP. A thirty six cases (23 males, 13 females, mean age 60±11.7 years) with glaucoma and 36 agematched controls (18 males, 18 females, mean age 58.25±10.45 years) were evaluated. Serum CRP levels were significantly higher in glaucoma cases than in controls (median 3.43, range 0.2-8.47 mg/dL) compared to 0.97, 0.17-6.30, P<0.002. The mean serum CRP levels were significantly elevated in the glaucoma cases compared with the controls (3.27±2.79 mg/dL and 1.50±1.56mg/dL respectively). Conclusion: The findings of this study suggest that higher CRP levels are associated with glaucoma. It is possible that there is a link between vascular inflammatory process and glaucoma. Introduction laucoma which is a disturbance of structural or functional integrity of the optic nerve due to intraocular pressure effect can usually be diminished by an adequate lowering of intraocular pressure (IOP). Glaucoma is the second important cause of visual field loss worldwide. Glaucoma is characterized by particular pattern of visual field loss which is associated with a continuous thinning of the retinal nerve fiber layer. It is estimated that glaucoma has affected over 60.5 million people's globally. C-reactive protein (CRP) is an early acute stage marker of inflammation that rises in response to acute inflammatory process or active infection, for that reason it can be used as an indicator for acute tissue injury which resulted from infection, and or inflammation. Although the diagnostic specificity of CRP is low, frequent and serial measurements of this protein in order to detect any change or fluctuation can be helpful in clinical management. It is a powerful screening test for organic, infectious or inflammatory diseases and their response to therapy. The CRP levels vary in different age groups and races. Woloshin et al reported the CRP levels in American adults increase from 1.4mg/L at age 20-30 to 2.7 mg/L at age >80, while Anand et al reported in Canada, the CRP level is highest among the original Americans, followed by South Asians, Europeans, and lowest in Chinese. Material and methods A 72 subjects underwent a detailed ophthalmic examination including visual acuity, slit lamp, angle of the anterior chamber, optic nerve head and visual field at the ophthalmic unit in Al-Sader Teaching Hospital and Basrah General Hospital, South Iraq, together with blood sampling for CRP. Patients were subdivided randomly into two groups: group 1; patients with open angle glaucoma (36 cases) and group 2; G
{"title":"C-REACTIVE PROTEIN IN PATIENTS WITH OPEN ANGLE GLAUCOMA","authors":"A. A., S. A., Wigdan Nazar Ibraheem A, Nazar S Haddad A","doi":"10.33762/BSURG.2018.160097","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160097","url":null,"abstract":"This study aimed to evaluate the C-reactive protein (CRP) levels in patients with open angle glaucoma. This cross sectional study included 36 patients diagnosed with glaucoma compared to 36 healthy controls. Each patient went through a complete ophthalmic examination and blood sampling for CRP. A thirty six cases (23 males, 13 females, mean age 60±11.7 years) with glaucoma and 36 agematched controls (18 males, 18 females, mean age 58.25±10.45 years) were evaluated. Serum CRP levels were significantly higher in glaucoma cases than in controls (median 3.43, range 0.2-8.47 mg/dL) compared to 0.97, 0.17-6.30, P<0.002. The mean serum CRP levels were significantly elevated in the glaucoma cases compared with the controls (3.27±2.79 mg/dL and 1.50±1.56mg/dL respectively). Conclusion: The findings of this study suggest that higher CRP levels are associated with glaucoma. It is possible that there is a link between vascular inflammatory process and glaucoma. Introduction laucoma which is a disturbance of structural or functional integrity of the optic nerve due to intraocular pressure effect can usually be diminished by an adequate lowering of intraocular pressure (IOP). Glaucoma is the second important cause of visual field loss worldwide. Glaucoma is characterized by particular pattern of visual field loss which is associated with a continuous thinning of the retinal nerve fiber layer. It is estimated that glaucoma has affected over 60.5 million people's globally. C-reactive protein (CRP) is an early acute stage marker of inflammation that rises in response to acute inflammatory process or active infection, for that reason it can be used as an indicator for acute tissue injury which resulted from infection, and or inflammation. Although the diagnostic specificity of CRP is low, frequent and serial measurements of this protein in order to detect any change or fluctuation can be helpful in clinical management. It is a powerful screening test for organic, infectious or inflammatory diseases and their response to therapy. The CRP levels vary in different age groups and races. Woloshin et al reported the CRP levels in American adults increase from 1.4mg/L at age 20-30 to 2.7 mg/L at age >80, while Anand et al reported in Canada, the CRP level is highest among the original Americans, followed by South Asians, Europeans, and lowest in Chinese. Material and methods A 72 subjects underwent a detailed ophthalmic examination including visual acuity, slit lamp, angle of the anterior chamber, optic nerve head and visual field at the ophthalmic unit in Al-Sader Teaching Hospital and Basrah General Hospital, South Iraq, together with blood sampling for CRP. Patients were subdivided randomly into two groups: group 1; patients with open angle glaucoma (36 cases) and group 2; G","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46087242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160085
T. Hamdan
On top of this, comes the response to pain. The best example is the delivery of a baby; while one lady shouts loudly, another is very quiet. Some consider the pain stimulus as intense, because of psychogenic factors, while others show a calm response for the same condition. A well-known fact is the individual variation in response to medication, like nonsteroidal anti-inflammatory drugs which might be very effective for Mr. X, but not for Mr. Y. Similarly, the healing power, immunity status and even the creation of some pathology like stone formation, are not homogeneous. I noticed, in my career, patients who are good callus formers, while others are poor callus formers. Same pathology may have different clinical presentation in relation to body distribution and even the type of inflammatory response. A recognized fact is the variation in geographical distribution of disease between countries. Other factors which are related to each individual patient and should be kept in mind, include the mental and psychosocial status. It is well-known that a depressed patient has low pain threshold. Patient cooperation to the planned therapeutic regimen is also very variable. Some habits and hobbies may play a role in the success of disease treatment. Smoking, for example, can influence healing and recovery of a disease, and can increase the incidence of infection, so as alcohol consumption. The degree of body and cloth cleanliness is another vital point to be considered.
{"title":"IS THERE A “FREE SIZE” IN SURGICAL PRACTICE?","authors":"T. Hamdan","doi":"10.33762/BSURG.2018.160085","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160085","url":null,"abstract":"On top of this, comes the response to pain. The best example is the delivery of a baby; while one lady shouts loudly, another is very quiet. Some consider the pain stimulus as intense, because of psychogenic factors, while others show a calm response for the same condition. A well-known fact is the individual variation in response to medication, like nonsteroidal anti-inflammatory drugs which might be very effective for Mr. X, but not for Mr. Y. Similarly, the healing power, immunity status and even the creation of some pathology like stone formation, are not homogeneous. I noticed, in my career, patients who are good callus formers, while others are poor callus formers. Same pathology may have different clinical presentation in relation to body distribution and even the type of inflammatory response. A recognized fact is the variation in geographical distribution of disease between countries. Other factors which are related to each individual patient and should be kept in mind, include the mental and psychosocial status. It is well-known that a depressed patient has low pain threshold. Patient cooperation to the planned therapeutic regimen is also very variable. Some habits and hobbies may play a role in the success of disease treatment. Smoking, for example, can influence healing and recovery of a disease, and can increase the incidence of infection, so as alcohol consumption. The degree of body and cloth cleanliness is another vital point to be considered.","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41787948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-28DOI: 10.33762/BSURG.2018.160088
J. R. Fadhl, Musaab A Alayoob
Upper gastrointestinal tract bleeding is a common emergency and life threatening condition. During the last three decades, many factors have been evolved that might change the incidence, age of presentation, site of bleeding and the outcome of patients with non variceal upper gastrointestinal tract bleeding. This study aimed to assess the profile and the mode of presentation of the patients with nonvariceal upper gastrointestinal tract bleeding and to assess the etiology and the effect of different factors (demographic, mode of presentation and the treatment options) on the patient's outcome. This observational prospective study was carried out from May 2008 to October 2014 in Basrah Teaching Hospital. All adult patients who were presented with non-variceal upper gastrointestinal tract bleeding were included. All the demographic, clinical and treatment modalities in addition to the mortality rate and complications data were collected and analyzed. A total of 238 patients with non-variceal upper gastrointestinal tract bleeding were included in this study, 161 (67.6 %) patients were males and 77 (32.3 %) were females. The mean age was 50.62±17.06. Hematemesis was the commonest presentation in 125 (52.5%) followed by melena in 81 (34.03%). Duodenal ulcer was the commonest cause in 99 (41.59%) patients followed by erosive gastritis in 37 (15.5%) patients. The most common treatment modality was the medical treatment used in 186 (78.15%) patients which was successful in 179 (96.23%) with relatively low complications and rebleeding rates. Interventional endoscopy was used for 40 (16.8%) and was successful in 38 (95%) with 2 (5%) patients developed rebleeding. Surgery was done for 12 (5.04%) patients and was successful in 8(66.6%) and it was associated with highest rate of mortality (33.3%). Concerning the factors that might affect the outcome, there was a statistically significant effect of mode of treatment (odd ratio 6.42, p=0.03) and smoking (odd ratio 5.86, p=0.047) on the rate of development of complications. The mode of treatment had a statistically significant effect on mortality rate (odd ratio 20.24 p=0.001). The use of aspirin and/or NSAID affects significantly the rebleeding rate (odd ratio 7.4 p=0.025). In conclusion, the profile of our patients with non-variceal upper gastrointestinal tract bleeding was not greatly different from that of surrounding Middle East countries. We found that peptic ulcer disease was the commonest cause for which medical treatment was the most successful mode of treatment. Among many known risk factors, the mode of treatment and smoking were the factors that increase the complication rate. The mode of treatment was the only factor that affects the mortality rate. Use of aspirin or non-steroidal anti-inflammatory drugs influenced the rebleeding rate. Introduction U pper gastrointestinal tract bleeding (UGIB) is defined as hemorrhage that emanates at a level above to the ligament of Treitz. It is a common life threa
{"title":"THE PROFILE OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL TRACT BLEEDING IN BASRAH TEACHING HOSPITAL","authors":"J. R. Fadhl, Musaab A Alayoob","doi":"10.33762/BSURG.2018.160088","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160088","url":null,"abstract":"Upper gastrointestinal tract bleeding is a common emergency and life threatening condition. During the last three decades, many factors have been evolved that might change the incidence, age of presentation, site of bleeding and the outcome of patients with non variceal upper gastrointestinal tract bleeding. This study aimed to assess the profile and the mode of presentation of the patients with nonvariceal upper gastrointestinal tract bleeding and to assess the etiology and the effect of different factors (demographic, mode of presentation and the treatment options) on the patient's outcome. This observational prospective study was carried out from May 2008 to October 2014 in Basrah Teaching Hospital. All adult patients who were presented with non-variceal upper gastrointestinal tract bleeding were included. All the demographic, clinical and treatment modalities in addition to the mortality rate and complications data were collected and analyzed. A total of 238 patients with non-variceal upper gastrointestinal tract bleeding were included in this study, 161 (67.6 %) patients were males and 77 (32.3 %) were females. The mean age was 50.62±17.06. Hematemesis was the commonest presentation in 125 (52.5%) followed by melena in 81 (34.03%). Duodenal ulcer was the commonest cause in 99 (41.59%) patients followed by erosive gastritis in 37 (15.5%) patients. The most common treatment modality was the medical treatment used in 186 (78.15%) patients which was successful in 179 (96.23%) with relatively low complications and rebleeding rates. Interventional endoscopy was used for 40 (16.8%) and was successful in 38 (95%) with 2 (5%) patients developed rebleeding. Surgery was done for 12 (5.04%) patients and was successful in 8(66.6%) and it was associated with highest rate of mortality (33.3%). Concerning the factors that might affect the outcome, there was a statistically significant effect of mode of treatment (odd ratio 6.42, p=0.03) and smoking (odd ratio 5.86, p=0.047) on the rate of development of complications. The mode of treatment had a statistically significant effect on mortality rate (odd ratio 20.24 p=0.001). The use of aspirin and/or NSAID affects significantly the rebleeding rate (odd ratio 7.4 p=0.025). In conclusion, the profile of our patients with non-variceal upper gastrointestinal tract bleeding was not greatly different from that of surrounding Middle East countries. We found that peptic ulcer disease was the commonest cause for which medical treatment was the most successful mode of treatment. Among many known risk factors, the mode of treatment and smoking were the factors that increase the complication rate. The mode of treatment was the only factor that affects the mortality rate. Use of aspirin or non-steroidal anti-inflammatory drugs influenced the rebleeding rate. Introduction U pper gastrointestinal tract bleeding (UGIB) is defined as hemorrhage that emanates at a level above to the ligament of Treitz. It is a common life threa","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41936577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART XV: SEPSIS","authors":"S. A, Jasim M Salman A","doi":"10.33762/BSURG.2018.160092","DOIUrl":"https://doi.org/10.33762/BSURG.2018.160092","url":null,"abstract":"Altered mental status Tachypnea Fever (> 38.3°C) or Hypothermia (core temperature < 36°C) Heart rate > 90/min Arterial hypotension (sBP < 90 mmHg) Arterial hypoxemia (PaO2/FiO2 < 300) Decreased capillary refill or mottling Acute oliguria (urine output < 0.5 ml/kg/hr for at least 2 hrs despite adequate fluid resuscitation) Ileus (absent bowel sounds) Significant edema or positive fluid balance (> 20 mL/kg over 24 hours) Hyperglycemia (plasma glucose >140 mg/dl) in the absence of diabetes Leukocytosis (WBC count >12,000/μl), leukopenia (WBC count < 4,000/μl) or normal WBC count with greater than 10% immature forms High serum creatinine High Plasma C-reactive Coagulation abnormalities (INR >1.5 or a PTT >60 sec) Thrombocytopenia (platelet count <100,000/μl) Hyperbilirubinemia (plasma total bilirubin >4 mg/dl) Unexplained metabolic acidosis Evidence of disseminated intravascular coagulopathy Postoperative respiratory failure Failure to reverse","PeriodicalId":52765,"journal":{"name":"Basrah Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45191037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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