About Journal

Basrah journal of surgery ( An Open Access Journal ) indexed in DOAJ   scientific, open access journal licensed under a Creative Commons Attribution 4.0 International (CC-BY 4.0) journal is published biannually by University of Basrah, College of Medicine, Iraq since 1995. The edittor utilizes iThenticate to check  plagiarism and to ensure the originality manuscripts submitted to this journal. A double-blind peer reviewing system is also used to assure the quality of publication. Basrah Journal of Surgery publishes original articles, review papers and case reports in...
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Journal Information

Publisher: Basrah University

Email:  basjsurg95@yahoo.com

Editor-in-chief: Professor Dr. Thamer A. Hamdan, FRCS,FRCP,FACS,FICS

Editor-in-chief: Professor MSc. Salam N. Asfar, MSc

Print ISSN: 1683-3589

Online ISSN: 2409-501X

IS THERE A REMEDY FOR THE PERPLEXING PATHOLOGY?

Thamer A Hamdan

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 1-2
DOI: 10.33762/bsurg.2019.164507

 The existing dream in the mind of every physician allover the globe is to find a solution for so many problem cases such as; an incurable condition, a degenerative process, congenital anomalies and even more serious like malignancy.
 Every now and then a window opens for hope and optimism, makes all the physicians happy for a while, then it collapse because it did not stand the test of time like; the biological therapy, the immune therapy, the plasma rich platelet, and the serum therapy. So far all needs further approval, and more solid bases.
 We are to some extent optimistic with great hope to be capable of finding a solution for so many unsolved problems.

THE ROLE OF QUADRICEPSPLASTY IN TREATMENT OF POST-TRAUMATIC STIFF KNEE USING JUDET PROCEDURE

Thamer A Hamdan; Khalil I Sadek; Muwafaq S Mahde

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 3-12
DOI: 10.33762/bsurg.2019.164508

The lack of knee flexion is an increasingly recognized complication especially after trauma. This is a significant challenge for both surgeon and patients. In 1956, Judet proposed a quadricepsplasty technique that allow a graded release without the disruption of the vastus medialis, vastus lateralis, or rectus femoris.
 The aim of this study is to evaluate the beneficial outcome of the Judet quadricepsplasty in improving the range of movement of knee joint in those patients complaining from post-traumatic stiffness.
 This research was done for evaluating the clinical outcome of 15 patients who underwent a Judet's quadricepsplasty, they were 12 men and  3 women. The definitive flexion gain was classified according to Judet's criteria; excellent, if flexion was greater than 100°; good, from 80° to 99°, fair result are from 50° to 79°; and poor flexion degree is less than 50°. Patients were operated upon after an average of 19.40±17.63 months (range, 6-72 months) after first initial surgery. Average follow-up period was 6.5±3.6 months (range, 3-15 months). According to Judet criteria, 7 patients (47%) achieved excellent, 5 patients (33%) good, 2 patients (13%) fair, with zero poor results.  Final average flexion arc improvement was 97.67±18.6 degrees with a range of 60-120 degrees. The noticed complications included; one case of extension lag excluded from the study and one case of small area of skin necrosis.
 In conclusion, even though it was proposed in 1956, the Judet procedure seems to give a reproducible amount of good results today and still holds its leading role in the treatment of extra-articular knee stiffness.
Key words: Quadricepsplasty, Post-traumatic, Stiff joint, Knee joint, Judet procedure, Surgery

COMPARATIVE STUDY OF THE EFFICACY OF LIGNOCAINE AND FENTANYL AFTER PROPOFOL INDUCTION IN ATTENUATION OF HEMODYNAMIC CHANGES FOLLOWING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION DURING GENERAL ANESTHESIA

Fatima a Nasir; Jasim Salman; Salam N asfar

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 13-20
DOI: 10.33762/bsurg.2019.164509

Laryngoscopy and tracheal intubation are constantly connected with a reflex sympathetic reaction bringing about tachycardia, hypertension and dysrrhythmias. This may cause harm in high hazard patients. Different pharmacological methodologies have been utilized to limit or weaken such a reaction.
 This study aimed to assess the hemodynamic changes following laryngoscopy and endotracheal intubation following propofol induction utilizing a standard anesthesia procedure and to analyze the capability of lignocaine and fentanyl in lessening the cardiovascular reaction to laryngoscopy and intubation amid general anesthesia.
 Sixty patients aged between eighteen to fifty years, of either gender and ASA class I, weighing between forty to ninety kilograms were planned for elective procedures and were haphazardly allotted into three groups of 20 each. Induction of anesthesia was standard for all patients who received propofol 2mg/kg i.v. and were relaxed with succinylcholine 1mg/kg i.v. The first group received 10cc. normal saline, the second group had fentanyl  2µg/kg i.v.  bolus and the third group got lignocaine 1.5mg/kg 3 minutes before laryngoscopy and intubation. Heart rate and blood pressure were recorded noninvasively on arrival to the theatre and considered as a base line record, just after induction and then 1,3,5,7 and 10 minutes following intubation.
 There were no difference in statistical analysis between the groups regarding number, gender, age, weight and ASA class. There is significant rise in heart rate, systolic BP, diastolic BP and MAP in control group particularly in the first 3 minutes following intubation (p<0.05). Both fentanyl and lignocaine gave minimal protection against rise in heart rate after laryngoscopy and intubation and there is no significant difference between the two drugs (p>0.05). Both fentanyl and lignocaine were equally effective in prevention of major rise in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure.
 In conclusion,  Fentanyl 2µg/kg and lignocaine 1.5mg/kg are both equally effective for attenuation of  laryngoscopy and endotracheal intubation pressor response.
Keywords: Attenuation, changes in hemodynamics, laryngoscopy, endotracheal intubation, propofol, fentanyl, lignocaine.

The role of Tamsulosin in the treatment of ureteral stent related symptoms in Basrah General Hospital

Firas Shakir Attar; Adnan Odhafa Almayyahi; Ibrahim Mahjar Tuama Flayyih

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 21-27
DOI: 10.33762/bsurg.2019.164510

The role of Tamsulosin in the treatment of ureteral stent related symptoms in Basrah  General  Hospital
 Firas Shakir Attar@, Adnan Odhafa Almayyahi# & Ibrahim Mahjar Tuama Flayyih*
@MB,ChB, FIBMS, Assistant Professor at Basrah College of Medicine, Department of Surgery, Consultant Urologist at Basrah Teaching Hospital. #MB,ChB, FIBMS, Consultant Urologist at Basrah Teaching Hospital.  *MB,ChB, FIBMS, Specialist Urologist at Basrah Teaching Hospital, Basrah, IRAQ.
Abstract
This study aimed to evaluate the efficacy of tamsulosin which is an α1-blocker as a therapeutic agent to alleviate ureteral stent related symptoms.
 Seventy-two patients were included in this prospective study from August 2018 to August 2019 in Basrah Teaching Hospital. All patients underwent ureteroscopic management of ureteral stones and ureteral stent had been inserted for about one month period. Patients were divided into two groups; a tamsulosin group, and a control group. Then the International Prostatic Symptoms Scores (IPSS) & Quality of life (QoL) were compared after one-month period.
 This study shows a significant decrease in the total IPSS, irritative IPSS, obstructive IPSS and the QoL scores with the administration of tamsulosin.
 In conclusion: The administration of tamsulosin in patients with ureteral stent is useful in decreasing the ureteral stent related symptoms.

VALIDITY OF DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING AND APPARENT DIFFUSION COEFFICIENT MAP IN DIFFERENTIATING BENIGN FROM MALIGNANT UTERINE ENDOMETRIAL PATHOLOGIES

Marwa Majid Al-Adhab; Salam Mohammad Joori; Enam Azez Al-Tameemi

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 28-38
DOI: 10.33762/bsurg.2019.164511

 Endometrial pathologies represent a diagnostic challenge for radiologist and gynecologist due to dynamic changes of the endometrium, wide variability in imaging appearance and overlap between benign and malignant causes of endometrial abnormalities. Although tissue analysis via dilatation and curettage, endometrial biopsy or hysteroscopy is the backbone in the diagnosis, these tests are invasive, not without complications and may be difficult to perform in certain circumstances, hence the need for noninvasive imaging methods to aid in the diagnosis and triaging the patient for subsequent invasive procedures as well as contribution in treatment planning.
 This study aimed to evaluate the role of diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value measurement in differentiating benign from malignant uterine endometrial lesions.
 The study included 47 patients with endometrial lesions divided into two groups according to the result of histopathological analysis; the malignant group consisting from 18 cases and the benign group consisting from 29 cases, the latter was further subdivided into: polyp, hyperplasia and other benign entities. Pelvic magnetic resonance imaging with DWI performed for each patient with visual evaluation of signal intensity on diffusion and ADC value measurement. Subsequently mean ADC values for each group were calculated and compared, and validity measures for the optimal cut-off values for differentiating benign from malignant lesions were determined.
 The mean±standard deviation for ADC value (x10-3mm2/sec) for malignant group was 0.71±0.12, and for benign group was 1.52±0.42, with a significant difference between the two groups (P value <0.01), there was no significant difference in ADC value between the subdivision of benign group. At ADC cut-off value of 0.976x10-3mm2/sec, the sensitivity, specificity, positive predictive value and negative predictive value and accuracy of DWI in detecting endometrial carcinoma were 100%, 89.6%, 85.71%, 100% and 93.62% respectively.
 In conclusion, DWI with ADC value measurement is a valuable non-invasive diagnostic test, aiding in the differentiation of benign from malignant uterine endometrial cavity lesions.
Key words: diffusion weighted imaging, apparent diffusion coefficient map, benign endometrial lesions, malignant endometrial lesions.

THE ASSOCIATION BETWEEN HUMAN PAPILLOMA VIRUS AND LARYNGEAL MASSES

Ali Taleb Abdulsamad; Saad Abdulbaki; Haider MS Al-Attar; Isam Alshareda

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 39-46
DOI: 10.33762/bsurg.2019.164513

 The Human Papilloma Virus (HPV) can play a role in the development of head and neck tumors such as oropharyngeal tumors. Nevertheless, a real impact between Human Papilloma Virus and other head and neck sites such as the larynx is not well studied.
 This study aimed to assess the association of Human Papilloma Virus and laryngeal tumors. It is a prospective, case control study in which a random sample of 34 patients who have laryngeal masses was included in the period between November 2017 to December 2018. The study was carried out In the Department of Otolaryngology, Basrah Teaching Hospital.
 Patients were evaluated by a questioner according to gender, age, marital status, full medical history, and examination. A biopsy then was taken for histopathology study to confirm presence of tumors or other lesions. Malignant tumors were evaluated according to staging and grading systems. All lesions were examined for the presence of HPV by Immunohistochemistry (IHC) study.
 The results of this study revealed that there was HPV infection in 30% of the patients. Moreover, HPV was found in 30% of laryngeal squamous cell carcinoma and in 30% of benign lesions. Statistical tests showed no significant association between HPV and Laryngeal squamous cell carcinoma.
 In conclusion, although there was thirty percent of patients having HPV infections, but there was no significant association between HPV and laryngeal malignant tumours. A larger epidemiologic and more multicentric study is mandatory to evaluate the true prevalence of HPV infection in the mucosa of larynx and laryngeal malignancies.
 
Keywords: Human, papilloma Virus, laryngeal tumors , immunohistochemistry, laryngeal mass 

CORONARY ENDARTERECTOMY AND PATCH ANGIOPLASTY FOR DIFFUSE CORONARY ARTERY DISEASE. A PROSPECTIVE ANALYSIS OF 22 CASES

Shkar Saed; Hisham H Hasan; Abdulsalam Y Taha

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 47-53
DOI: 10.33762/bsurg.2019.164514

Diffusecoronaryarterydisease(CAD)isasurgicalchallengeinwhichconventionalcoronary arterybypassgrafting(CABG)maynotachieveadequatemyocardialrevascularizationunless adjuvantproceduressuchascoronaryendarterectomyandcoronarypatchangioplasty(CPA) areadded.Theaimofthisprospectivestudyistoevaluatetheoutcomeoftheseproceduresin ourinstitution in viewofthe relevantliterature.
DataofallpatientswhounderwentCPA±CABGbyonesurgeoninourinstitution  (n=22) betweenApril2018andApril2019werecollected.Patientsunderwentopencoronary endarterectomyandonlaypatchofleftinternalmammaryartery(LIMA)oravenouspatchunder cardiopulmonarybypass(CPB).
Of167CABGprocedures,22werecombinedwithCPA.Therewere15(68.2%)males.Age rangedbetween43-72yearswithameanof59.patientsincluded19isolatedleftanterior descendingarteries(LADs),tworightcoronaryarteriesandoneobtusemarginalbranch.The CPBtimewas88-198minutesandtheaorticcrossclamptimewas40-125minutes.The patientshad(includingLAD)2-4vesseldiseases.TheaverageICUstaywas29±14hoursand meanhospitalstaywas5dayswithnocomplicationsapartfromatrialfibrillation(n=4,18.2%). Thefollow-upperiodrangedfrom4to14months.Onthe40thpostoperativeday,coronaryCT angiographyrevealedpatentgrafts.Nopatientdied duetoCAD.
Inconclusion,coronaryendarterectomyandangioplastyisasafeandhighlyrewarding procedure in potentiallyinoperable patients with diffusecoronaryartery disease.
 
Keywords:Coronaryarterydisease,endarterectomy,angioplasty,venous,patch,leftanterior descending, left internal mammaryartery.

EFFECT OF PULSATILE FLOW ON RENAL FUNCTION IN ELDERLY PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY

Amanj Kamal Mohammed

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 54-59
DOI: 10.33762/bsurg.2019.164515

Abstract
 The incidence of acute kidney injury (AKI) after on-pump coronary artery bypass graft (CABG) varies among studies but can be reduced if pulsatile flow is used.
 The aim of this study is to evaluate pulsatile flow impact on renal function of elderly patients undergoing CABG.
 Over one year (April 2014 to April 2015) 48 patients above the age of 65 underwent on-pump CABG in our institute. Patients were divided into two groups; pulsatile flow (PFG) and non-pulsatile flow (NPFG) groups. Serum creatinine (S.Cr), creatinine clearance (Cr.Cl) and per-perfusion urine output (UO) were measured. AKI Network criteria were adopted for diagnosis.
 Mean age was 68 in PFG and 69 in NPFG. Males constituted 83.3% of PFG and 79.2% of NPFG. Although 37.5% of PFG and 41.7% of NPFG were hypertensive, all patients had normal ejection fraction (EF). Both groups had nearly 3 coronary anastomoses, cardiopulmonary bypass (CPB) time of 90 min, cross clamp time of 71 min and mean perfusion pressure of 70 mmHg. Mean S.Cr was the same (0.8 mg/dl) in both groups on 1st postoperative day (POD) but UO was significantly larger (708 ml in PFG vs. 648 ml in NPFG). On 3rd POD, S. Cr didn’t change in PFG but it has significantly increased in NPFG (from 0.76 to 1.0 mg/dl). Moreover, Cr.Cl has significantly improved in PFG (81 vs. 72 ml/min in NPFG). Seven of 48 patients (14.6 %) developed AKI (6; 25% in NPFG).
 In conclusion; Pulsatile perfusion technique is a simple and safe measure to minimize AKI in the elderly.
 
Keywords: Coronary artery bypass graft, elderly, cardiopulmonary bypass, pulsatile flow, non-pulsatile flow, acute kidney injury, serum creatinine, creatinine clearance

EFFECTIVENESS OF AUTOLOGOUS COSTAL CARTILAGE GRAFT IN AUGMENTATION RHINOPLASTY

MUAYED RAHEEM MEJTHAB; JABIR RAHEEM HAMEED

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 60-69
DOI: 10.33762/bsurg.2019.164516

Rhinoplasty is the most demanding aesthetic procedure that is currently shifted from ablative to conservative surgical procedures, one of these procedures is using cartilage grafts for correction and augmentation of congenital and acquired nasal deformities. The Autologous costal cartilage graft (ACCG) is a good choice for reconstruction of these deformities because its ample amount and good strength.
 The aim of this study is to assess the outcome of using autologous costal cartilage graft in augmentation rhinoplasty in severe congenital and acquired nasal deformities.
  This is a prospective study of 10 patients aged between 16-45 years (7 females and 3 males) in form of 4 cases of saddle nose, 3 cases of cleft lip nasal deformity, two cases of post-traumatic severely deviated nose, and one case of African nose. Patients underwent augmentation rhinoplasty by ACCG, from July 2018-June 2019. The follow-up period  was 6-12 months concentrating on preoperative and postoperative structural and functional evaluation.
 The outcome of augmentation rhinoplasty by ACCG was evaluated by 2 independent surgeons and the results were accepted by both surgeons and patients in 9 out of 10 cases (apart from one case that she had infection of the graft) with donor site complication rates near to the related studies.
 In conclusion, ACCG is one of the best choices for severe nasal deformities that need ample amount of cartilage for structural and functional support and good aesthetic outcome with low complication rate.
Keywords: Autologus graft, Costal cartilage, Surgery, Rhinoplasty, Augmentation.

THE ROLE OF N-ACETYLCYSTEINE IN THE TREATMENT OF OTITIS MEDIA WITH EFFUSION

Dhiaa Abdullah Fadhel; Isam M Al-Shareda; Haider MS Al-Attar; Ahmed A Alansary

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 70-75
DOI: 10.33762/bsurg.2019.164517

Otitis media with effusion (OME) is a chronic accumulation of fluid within the middle ear cleft and sometimes the mastoid air cells system. The disease is more common among children. Surgical management is cost effective and carry complications from anaesthesia and surgical intervention. The condition can be resolved with high percentage by using mucopeptide breaking agent N-acetylcysteine
 The aim of this study is to evaluate the effect of N-acetylcysteine on the resolution of otitis media with effusion in children.
 Fifty seven children (107 ears) aged between 4-15 years with OME were included in this study. Patients underwent a thorough otorhinolaryngological examination and were divided into two groups; in the study group of 30 patients, N-acetylcysteine was administered, and the control group of 27 patients did not receive this treatment.
  Patient were followed-up at attendance, one month, two months and three months later with microscopical ear examination, tympanometric and pure tone audiometric examination.
 Patients were 39 males (68.4%) and 18 females(31.6%), 50 of them were with bilateral and 7 with unilateral disease. Following the treatment, there was improvement in the hearing loss as air bone gap was decreased. This improvement was statically significant in comparing the study and control groups (P value= 0.022). Number of ears with type A tympanogram increased to a rate of 74%, 71% in the right and left ears respectively in the study group. This rate was statically significant in comparing with the control group (P value=0.014).
 In conclusion, N-acetylcysteine is effective in the treatment of children with OME as well as that N-acetylcysteine has minimal side effect and can be used safely in patients who are medically unfit for general anaesthesia

BILE INFECTION IN LOW RISK PATIENTS SUBJECTED TO ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Yaqoob Ayoob Yaqoob; Husham Salman Abdulkareem; Mohammed Khalaf Raheem; Sadq Ghaleb Kadem

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 76-83
DOI: 10.33762/bsurg.2019.164520

In healthy individuals, the bile is usually sterile, however, in cases of cholecystolithiasis and/or choledocholithiasis, it could be colonized with bacteria (bactibilia) and may lead to surgical site infection after cholecystectomy. In our hospital, the local regimen is to use antibiotics prophylaxis only for patients with high-risk factors, while in case of low-risk patients, the antibiotics used as postoperative treatment; this local regimen has no demonstrated bacteriological or epidemiological basis.
 The aim of this study is to determine the nature of bacteria in bile and their antimicrobial susceptibility in low-risk patients and the relationship between bactibilia and the presence of some predisposing factors as well as developing postoperative infectious complications.
 This study was conducted in Al-shiffa General hospital, Basrah, Iraq from April 2018 to May 2019. Forty-three patients with uncomplicated symptomatic gallstones who were candidates for elective laparoscopic cholecystectomy and have no risk factors for infection were included in the study.
 Under fully aseptic technique, a sterile laparoscopic needle connected to a sterile 10ml disposable syringe used to aspirate 5–7ml of bile from the fundus of gallbladder for culture and antibiotic sensitivity.  In this study culture assessment of bile demonstrate that, 20 patients (46.51%) have infected bile; Klebsiella spp. 7(35%) and   Pseudomonas spp. 7 (35%) are the most frequent causative agents. Factors like gender, age, duration of complaint and number of stones were found not significantly increase the risk of infection. Antibiotics sensitivity revealed maximum sensitivity to Meropenem (100%), Amikacin (90%) and less sensitivity to the most commonly used Ceftazidime. No cases of superficial or deep-seated surgical site infections were reported.
 In conclusion, bile infection reported in a significant rate in low risk patients for infection subjected to elective laparoscopic cholecystectomy. Klebsiella spp. and Pseudomonas spp. are the most common isolate which shows high sensitivity to Meropenem and Amikacin and less sensitivity to third generation Cephalosporine; so we recommend the use of Amikacin as a prophylactic antibiotic instead of third generation Cephalosporine.
 
Keywords: Bile infection, Cholecyctectomy, elective surgery, laparoscopy, low risk patients  

IS IT NECESSARY TO INSERT A SILICONE TUBE AFTER ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY? AND FOR HOW LONG? A COMPARATIVE PROSPECTIVE STUDY

Ahmed Fadhil Hasan

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 84-88
DOI: 10.33762/bsurg.2019.164524

This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal. 
 A prospective study was done at Al-sadr Teaching and Al-Shafaa General Hospitals in Basrah, Iraq on seventy two patients with nasolacrimal duct obstruction diagnosed and referred from ophthalmologist to ENT clinic. Preoperative assessment with investigations were done and all patients were subjected to endoscopic endonasal DCR. The patients were divided into three groups; the first group included those with long period stenting (silicone tube removed three months or more), the second group included those patients with short period stenting (tube removed 2-3 weeks after surgery), and the last group included those with no silicone tube stenting. The success rate and complications after surgery were studied in each group for more than one year. 
 The 72 patients were; 63 females (87.5%) who affected more than males (9, 12.5%). the most common age group was 21-45 years. Left side of disease 41(56.9%) is more than right side 31(43.1%).  Sixty eight operations (94.4%) out of 72 were primary surgery while four (5.6%) were revision surgery. Ancillary procedures were done also; 13 (18%) septal surgery and 3(4.1%) endoscopic sinus surgery.  Success rate was more among short period stenting group 22 out of 24 (91.6%), then without stenting group 19 (82.6%) and those with long period stenting was only 20 from 25 (80%). 
 In conclusion, no statistical significant difference (benefit) about the usage or not of the silicone tube and also about how long keeping the tube, but it is preferable to use silicone tube (for 2-3 weeks only) to improve success rate.
 
Keywords: Silicone tube, Insertion, Endonasal,  Endoscopic, Surgery  

CORRELATION BETWEEN HEMOGLOBIN A1C IN DIABETIC PATIENTS WITH RATE OF INFECTION AND WOUND COMPLICATIONS FOLLOWING DECOMPRESSIVE SPINE SURGERY

Saadi Abdulsalam Abdullah; Raqib S Tato; Muzahem M Taha

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 89-94
DOI: 10.33762/bsurg.2019.164527

Diabetes mellitus (DM) is known as an important risk factor for surgical site infection(SSI) in spine surgery. A chronic state of impaired glucose metabolism affects multiple components of the immune system, possibly leading to an increased incidence of post-operative infection. Such infection increases morbidity, length of stay, and overall cost. The present study was designed to assess the correlation between pre-operative hemoglobin A1c (HbA1c) and the incidence of post-operative infection in surgical patients undergoing decomperssive spine operations.
  Forty diabetic patients who underwent  decompressive spine surgery at different levels of spine were included in this retrospective study. These include 23 females and 17 males with mean age of 57.5 years. The patients data were collected from hospitals and private clinics archives including value of preoperative hemoglobin A1c, random blood sugar, postoperative C-reactive protein (CRP) and white blood cells count (WBC) as a diagnostic laboratory tests for identification of postoperative infection in follow-up periods.
 The overall rate of infection in our study was 12.5%, which was categorized into 2 groups (Uncontrolled diabetes hemoglobin A1c >7 and controlled hemoglobin A1C ≤7), so the rate of infection was 19.2% among patients with uncontrolled diabetes compared with 0% among patients with controlled diabetes (p=0.143). The mean hemoglobin A1c among patients with uncontrolled diabetes who developed infection was 9.72% compared with 7.34% among those with no infection (p <0.001)
 In conclusion, diabetic patients whose blood glucose levels were poorly controlled before surgery as indicated by high hemoglobin A1c were at high risk for postoperative wound infection. Preoperative hemoglobin A1c above 7.34% could serve as a threshold value for significant increased risk of postoperative surgical site infection.
 
Key words: Diabetes Mellitus, HbA1C, decompressive spine surgery, infection, complications.

EVALUATION OF SEPTAL EXTENSION GRAFT IN RHINOPLASTY

HUSAM M ALAAMER

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 95-100
DOI: 10.33762/bsurg.2019.164529

Septal extension graft is a unique technique for controlling nasal lengthening and tip projection, rotation, and shape by which a graft is fixed to the septum, leading to a strong and stable supporting structure. Nasal tip three-dimensional positioning is a vital and difficult component in the overall appearance of the tip.
 A total of 12 Middle Eastern patients with thick nasal envelope skin were subjected to rhinoplasty using the septal extension graft (SEG) method.
 Eleven out of the 12 patients, had pleasing results after primary rhinoplasty with SEG, while only one patient  had SEG as a secondary procedure.
 In conclusion, septal extension graft in rhinoplasty is an effective technique for achieving a strong supporting force of the nasal tip for adequate projection.
Keywords: Nasal tip, surgery, septal extension, graft, rhinoplasty

MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART XVII: HYPOTHERMIA AND MALIGNANT HYPERPYREXIA

Salam N Asfar; Jasim M Salman

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 101-102
DOI: 10.33762/bsurg.2019.164530

 





Low body temperature can affect the body in many ways such as; O2 dissociation curve shift to the left, acid base balance alteration, cardiovascular system changes, central nervous system will be affected by low cardiac output, metabolism also changed as there will be reduced functions of the liver and kidneys that’s why glucose and drugs in minimal doses should be given, electrolyte changes expressed in high serum potassium may affect the cold sensitive heart, as well as there is alters of non-depolarizing agents effect1.
 Normally, the human body can initiate mechanisms to maintain or generate heat but anesthesia disturbs these homeostatic mechanisms. Along with, exposure to the cold procedural situation and vasodilation induced by general or regional anesthesia contribute to intraoperative hypothermia development2

Professor Abdul-khalik Zaki Benyan 1946-2019 What we have done for ourselves alone dies with us; what we have done for others remains immortal. Albert Pike

Basrah Journal of Surgery, 2019, Volume 25, Issue 2, Pages 103-103
DOI: 10.33762/bsurg.2019.164531

 Dr. Abdul-khalik Zaki Benyan, Professor of Cardiovascular and Thoracic Surgery, graduated from MedicalCollege, University of Mosul in 1970. He was born in Mesan, Iraq in 1946 and passed away in 2019.
 He got his Fellowship of the Royal College of Surgeons, UK in 1982. After returning back to Iraq, he worked in many hospitals in Basrah Health Directorate as a specialist in cardiovascular and thoracic surgery. In 1985, he also worked in BasrahMedicalCollege, where he proved himself as an outstanding active person with participation in teaching and examining both undergraduate students in the Department of Surgery as well as postgraduate Iraqi board of cardiovascular and thoracic surgery for several years. He published large number of articles in different local and international journals for which he got professorship. He also worked as head of Department of Anatomy at Basrah College of Medicine till his retirement.
 
 The departure of Professor Abdul-Khalik, hopefully to heavens, was a real loss of an academic person who was keen, loveable, hard working, and caring for thousands of patients over his long career. Certainly his students and colleagues shall never forget him. He is alive by his wife, sons and daughters. God bless his soul.

TO TREAT OR TO SATISFY THE PATIENT; WHICH ONE IS THE BEST?

Thamer A Hamdan

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 1-2
DOI: 10.33762/bsurg.2017.141312

L
uckily, there is increasing interest in patient satisfaction in the present days. Many writers started differentiating between the two issues; treatment or satisfaction. Patient satisfaction is a top priority and it should be the target. Perfect treatment is not always satisfactory to the patient. Some surgeons, sadly, spoil their ideal treatment by misconduct. They are good enough to offer treatment, but not good enough in performing the art of communication, which is really vital. They do not know how to respect the dignity, the honor and rights of the patient. The first meeting is the key for success in achieving life-long friendship or, on the other hand “putting salt on the wound”

SILENT OSTEOPOROSIS IN ASSOCIATION WITH OTHER ORTHOPEDIC DISEASES

Thamer A Hamdan; Mubder A Mohammed Saeed; Saad J Abdulsalam

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 3-8
DOI: 10.33762/bsurg.2017.141313

Thamer A Hamdan*, Mubder A Mohammed Saeed# & Saad J Abdulsalam@
*FRCS, FRCP, FACS, FICS, Professor Of Orthopedic Surgery, Chancellor of Basrah University. #FICMS, Assistant Professor Of Orthopaedic Surgery, Basrah General Hospital, @FACMS, Orthopedic Surgeon, Al-Karkh General Hospital, Baghdad.

Abstract
Osteoporosis is the most common metabolic bone disease. It is a major global health problem that increases dramatically as people getting older than before because of good health services.
The aim of the study is to assess how far osteoporosis is associated with orthopedic diseases and to increase the awareness in the mind of orthopedic surgeons for osteoporosis in patients who are not suspected apparently to have this disease.
A sample of 522 patients referred to Dual-energy X-ray absorptiometry (DXA) clinic by orthopedic surgeons or rheumatologists was taken during a seven months period, in two centers, Basrah, 259 patients and Mosul, 263 patients. All the patients had back pain, joint pain, bone pain, fracture or other musculoskeletal complains. The only method used to assess osteoporosis in our patients was the DXA scan.
Of the total 522 patients, the results of DXA scan was normal in 136 patients (26%), osteopenia in 178 patients (34%), and osteoporosis in 208 patients (40%). Back pain was the main cause of referral 184 (35%), followed by joint pain 138 (26.5%), bone pain 74 (14%), fracture 28 (5.5%), and others 98 (19%).
In conclusion, osteoporosis may be a silent disease, even in patients with complains like joint pain, bone pain, or radicular symptoms.

COMPARATIVE STUDY BETWEEN STAPLER AND HAND SEWING IN GASTROINTESTINAL ANASTOMOSIS

Mustafa Adnan Maatooq; ssam Merdan

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 21-25
DOI: 10.33762/bsurg.2017.141316

COMPARATIVE STUDY BETWEEN STAPLER AND HAND SEWING IN GASTROINTESTINAL ANASTOMOSIS

Mustafa Adnan Maatooq* & Issam Merdan@
*MB,ChB, Board candidate, Al-Sadir Teaching Hospital, Basrah. @MB,ChB, FICMS, CABS, Professor of Surgery, Department of Surgery, College of Medicine, University of Basrah, IRAQ.

Abstract
Gastrointestinal anastomosis is an important part of gastrointestinal operations and can be achieved by hand sewn anastomosis or by the newly developed staplers.
The study aims to compare between the two surgical methods of anastomosis in a prospective , randomized design, regarding: operation time, post operative hospital stay and the incidence of post operative anastomotic leak in both groups. The study was carried out in Department of Surgery at Alsader Teaching Hospital in Basrah, Iraq from October 2015 to December 2016, it included 40 patients of both gender and with a different age, they divided into 2 groups (hand sewn and stapler groups), each group included 20 patients, comparing the following parameters: time of anastomosis, duration of surgery, post operative leak and hospital stay.
There were no significant differences in the age, gender distribution, the indication for resection, post operative anastomotic leak (p=1) and hospital stay (P Value 0.15 ) in both group but there was significant differences in duration of anastomosis (P Value0 .00001) and operation time (P Value 0.00001). Our study concluded the superiority of stapler on hand sewing in gastrointestinal anastomosis in term of reducing operative time.

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY

Mohammed Salim Mohammed; Jasim D Saud; Mansour Amin Mohammed; Mazin H Al-Hawaz

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 15-20
DOI: 10.33762/bsurg.2017.141315

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY

Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz@
*MB,ChB, Board Candidate. #MB,ChB, FICMS, CABS, Consultant Surgeon, Basrah General Hospital. $MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine. @ MB,ChB, CABS, DGS, FRCS, Prof. of General Surgery, Basrah Medical College., Basrah, IRAQ.

Abstract
Thyroid gland is highly vascularized organ, so good hemostasis during total or sub-total thyroidectomy is crucial to decrease the complications and to improve the outcome.
This study aimed to evaluate the advantages and disadvantages of using harmonic scalpel device in comparison with conventional hemostasis for total and subtotal thyroidectomy in terms of operative time, nerves injury, post-operative blood loss, hematoma development, hypocalcemia and length of hospital stay.
This study included 80 patients who underwent total or subtotal thyroidectomy. They were divided into two groups according to the type of hemostasis: conventional hemostasis group and harmonic hemostasis group. Different diseases were included (multinodular goiter, toxic goiter and malignant diseases).
The results showed that time of operation was significantly shorter in the harmonic hemostasis group (79.52±14.98 min) than conventional hemostasis group (100.92 ±10.64 min) with p value 0.0001, also post-operative blood loss was lower in harmonic hemostasis group (52.5±26.23 ml) than conventional hemostasis group (75.13±17.8 ml) with p value 0.0001. Other outcome such as recurrent laryngeal nerve injury, post-operative hematoma, post-operative hypocalcemia and length of hospital stay did not show significant difference between the groups.
In conclusion, using harmonic scalpel device in total or subtotal thyroidectomy reduced the operative time and post-operative blood loss, without any change in the incidence of nerve injury, hematoma, hypocalcemia and the length of hospital stay.

ENDOSCOPIC BIOPSIES , CELIAC DISEASE, SEROLOGICAL TEST

Zahraa A Hashim; Sarkis K Strak; Wassan M Jazi; Sura A AL-Namil

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 34-39
DOI: 10.33762/bsurg.2017.141318

THE VALUE OF ENDOSCOPIC BIOPSIES FROM FIRST AND SECOND PARTS OF DUODENUM IN THE DIAGNOSIS OF CELIAC DISEASE IN CORRELATION WITH A SEROLOGICAL TEST
Zahraa A Hashim*, Sura A AL-Namil@, Wassan M Jazi# & Sarkis K Strak$
*MB,ChB, Postgraduate board student. @MB,ChB, FIBMS, Consultant pathologist. #MB,ChB, FIBMS, Consultant pathologist, Al-Sadir Teaching Hospital. $MRCP, FRCPLond., FRCPI., Professor of Medicine, University of Basrah, IRAQ.

Abstract
Celiac disease is a chronic immune-mediated enteropathy of the small intestine caused by environmental exposure to gluten in genetically susceptible individuals. This study was conducted to evaluate and correlate the serological with histopathological findings of duodenal biopsies for the diagnosis of celiac disease.
Sixty-eight patients, 40 (59%) females whose ages ranged from 13-75 year (mean age 36.4 years), and 28 (41%) males whose ages ranged from 13-65 year (mean age 37.8 years), with symptoms of chronic diarrhea, weight loss, bloating and unexplained iron deficiency anemia, were tested for anti-tissue transglutaminase IgA tTG, and correlated with histopathological findings of duodenal biopsies obtained from 1st and 2nd parts according to modified Marsh's classification. Histopathological findings from the 1st and 2nd duodenal parts were also compared with each other.
The results of the 68 patients who were enrolled in the study showed that: 24(35.3%) patients tested positive for anti-tissue transglutaminase (titer >18U/ml), 37(55.8%) patients had positive histopathological changes (stage I–III). Twenty-three (33.8%) patients who had both positive anti tTG and histopathological changes were classified as a celiac disease. The sensitivity of 1st and 2nd parts of duodenal biopsies in detecting celiac disease were 83.7% and 100% respectively.
In conclusion; the histopathological changes from the 1st and 2nd parts of duodenum in detecting celiac disease were equally representative especially in stage IIIa, b, and c.

TO TREAT OR TO SATISFY THE PATIENT; WHICH ONE IS THE BEST?

Thamer A Hamdan

Basrah Journal of Surgery, 2017, Volume 23, Issue 2, Pages 1-2
DOI: 10.33762/bsurg.2017.141312

L
uckily, there is increasing interest in patient satisfaction in the present days. Many writers started differentiating between the two issues; treatment or satisfaction. Patient satisfaction is a top priority and it should be the target. Perfect treatment is not always satisfactory to the patient. Some surgeons, sadly, spoil their ideal treatment by misconduct. They are good enough to offer treatment, but not good enough in performing the art of communication, which is really vital. They do not know how to respect the dignity, the honor and rights of the patient. The first meeting is the key for success in achieving life-long friendship or, on the other hand “putting salt on the wound”

MESENTERIC CYST-OVARIAN IMPLANT SYNDROME; ‎CASE REPORT ‎

Ali Y. Alwajah; Rafif A. Al-Saady

Basrah Journal of Surgery, 2004, Volume 10, Issue 2, Pages 109-112
DOI: 10.33762/bsurg.2004.57549

Mesenteric cyst ovarian implant syndrome have been rarely reported in the literature, we report the first ‎case that occur in young female following trauma and it is the first case in which the ovarian tissue get ‎implanted higher up in the jejunal mesentry out side the pelvis.‎

TRANSDUODENAL SPHINCTEROPLASTY VERSUS CHOLEDOCHODUODENOSTOMY IN MANAGEMENT OF LOWER COMMON BILE DUCT STONES

Ali H Al-Azzawi

Basrah Journal of Surgery, 2012, Volume 18, Issue 1, Pages 33-39
DOI: 10.33762/bsurg.2012.54970

Common bile duct stones have been noted in 10-15% of patients with gall stones, these stones are either primary (formed in the common bile duct) or secondary (formed in the gallbladder and migrate down to the common bile duct). Their management includes ERCP (Endoscopic Retrograde Choledochopancreatography), biliary drainage procedure and choledochal exploration.
In this interventional study, we compare between transduodenal sphincteroplasty and choledochoduodenostomy regarding morbidity (anastamotic and duodenal leak, cholangitis, and pancreatitis) and mortality related to each surgical option.
A review of 68 patients with lower common bile duct stones presents with different clinical presentations in an interventional study carried in Basrah General Hospital and Al–Moussawi Private Hospital, 22 patients underwent transduodenal sphincteroplasty and, 46 patients underwent choledochoduodenostomy. Both groups received general anesthesia and comparable in age and sex. Statistical analysis done by SPSS (Statistical Package for Social Sciences) version 18.
Age and sex are comparable in both groups, the incidence of postoperative cholangitis is 9.09% in the transduodenal sphincteroplasty group and 32.6%in choledochoduodenostomy group which is statistically significant (P value 0.01). The incidence of duodenal and anastamotic leak is 13.6% and 10.9% in transduodenal sphincteroplasty and choledochoduodenostomy group respectively which is statistically not significant (P value 0.707). The incidence of postoperative pancreatitis is 0% and 8.7% in transduodenal sphincteroplasty and choledochoduodenostomy group respectively which is statistically not significant (P value 0.296). The mortality is 0% after transduodenal sphincteroplasty and 6.5% after choledochoduodenostomy.
In conclusion, transduodenal sphincteroplasty is better than choledochoduodenostomy in the management of lower common bile duct stones, less postoperative cholangitis, pancreatitis, and lower mortality rate.

EARLY DIAGNOSIS AND PROMPT SURGICAL EXCISION WITH COMPLETE DIVERTING COLOSTOMY: IMPROVE THE OUTCOME IN PATIENTS WITH FOURNIER’S GANGRENE.

Jasim D Saud; Noori H Jasim; Majid A Mohammed

Basrah Journal of Surgery, 2006, Volume 12, Issue 1, Pages 82-86
DOI: 10.33762/bsurg.2006.116963

Fournier’s gangrene is uncommon acute fulminating cellulitis of scrotum, perineum and groin which develops suddenly and often without any apparent causes. The aim of this study is to elucidate the effectiveness of early and extensive surgical excision with primarily performed complete diverting colostomy in outcome of patients.
Fourteen patients with Fournier’s gangrene were included from January 2000 to October 2005 at Basrah General Hospital. History and examination has been taken. Treatment was in form of giving triple antibiotics. Early wide extensive excision of necrotic skin with complete diverting colostomy at the same occasion has been done in all patients.
There were all male patients, their ages ranged between 4-75 years old, the average is 50 years. Determining the possible underlying cause finding that five patients has no obvious cause , three had perianal abscesses , determining the extent of disease , finding that in ten patients sloughing of tissue involved perineum , scrotum plus groin and or penis mortality were two out of fourteen patients ( 14%).
Fournier’s gangrene is a rapidly progressive, fulminate infection. With institution of aggressive treatment, including early Surgical intervention, formation of completely diverting colostomy in first operation, haemo- dynamic support if needed, intensive care monitoring and broad spectrum antibiotic coverage, the disease has a greatly reduced mortality.

THE RELATIONSHIP BETWEEN CLINICAL EXPERIENCE AND QUALITY OF CARE AND ITS OUTCOME.

MAJEED H ALWAN

Basrah Journal of Surgery, 2008, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55531

Quality assurance and performance evaluations, have become central issues in medicine.
There are several studies which indicates that general patients care is suboptimal in many
different medical conditions and clinical settings1,2. Delivering high-quality care is important to all
clinicians, but this issue may be more relevant to certain subgroups, such as those with less
specialised training and those who deal with smaller number of patients3. There is also a
general believe that the longer clinicians are in practice the more experienced they will be, and
therefore it is assumed that this group of medical doctors are able to provide a high quality of
care. But there are some studies that found a consistently or partially negative association. The
aim of this report is to discuss this subject further and reach some conclusions.

6-FACTORS AFFECTING MORBIDITY AND MORTALITY IN PERFORATED DUODENAL ULCER

Adnan Yassin Abdul-Wahab; kassim Trayem Hayef

Basrah Journal of Surgery, 2011, Volume 17, Issue 1, Pages 0-0
DOI: 10.33762/bsurg.2011.55109

kassim Trayem Hayef* & Adnan Yassin Abdul-Wahab@
*MBChB, Al-Sader Teaching Hospital, Basrah. @MBChB, FRCS, Assist. Professor, Department of
Surgery, College of Medicine, University of Basrah, Basrah, Iraq.
Abstract
Duodenal ulcer is a particular type of peptic ulcer disease that afflicts the lining of the
duodenum. The indications for surgery in duodenal ulcers are; bleeding, perforation, obstruction
and intractability or non-healing. Today, most patients undergoing operation for duodenal ulcer
disease have simple over-sewing of bleeding ulcer or simple patch of perforated ulcer.
Simultaneous performance of vagotomy either truncal or highly selective is increasingly
uncommon because of reliance on postoperative proton-pump inhibitor to decrease acid
secretion and eradication therapy for helicobacter pylori infection. Despite of the widespread
use of gastric anti-secretary agents and eradication therapy, the incidence of perforated
duodenal ulcer has changed little.
This study aimed to assess the factors that lead to increase the rate of morbidity and mortality
in patients with perforated duodenal ulcer in different age groups and to know the effect of time
lapsed between onset of symptoms and surgery.
This is a prospective study that included 100 patients who underwent emergency laparotomy
for perforated duodenal ulcer during a period from May 2008 to January 2011. The operations
were done in Al-Sader Teaching Hospital and Al-Basrah General Hospital. The clinical finding,
general risk factors, co-morbid medical diseases, operative finding and post–operative
complications were all taken in consideration. Follow-up period ranged from 2 weeks to 18
months.
Of the hundred cases who included in this study, 96% were males and 4% were females with
mean age of 43.13 years (range from 10 to more than 70 years). The disease was more
common in rural areas (58%) than in urban areas (42%). Fifty five percent of patients gave
previous history of duodenal ulcer and 45% had no previous history of duodenal ulcer. The most
common risk factors are smoking (32%) and NSIADs (25%). In this study most of elderly
patients presented with medical diseases such as hypertension, diabetes mellitus, ischemic
heart disease and chronic obstructive pulmonary disease. Most patients admitted to hospital
between 19–24 hours (21%), (8%) admitted during 6 hours and (2%) admitted after 120 hours.
Regarding the complications occurs in this study, wound infections, chest infections and
paralytic ileus were the most common complications. Mortality rate was 2%.
In conclusion, the most common factor that leading to development of postoperative
complications is delayed in hospital admission, so to improve the results of treatment of
perforated duodenal ulcer, the diagnosis and treatment should not be delayed and the
associated medical illness should be treated.

HEMORRHOIDAL ARTERY LIGATION WITH RECTO-ANAL REPAIR VERSUS TRADITIONAL HEMORRHOID-ECTOMY, A COMPARATIVE STUDY

Basrah Journal of Surgery, 2018, Volume 24, Issue 2, Pages 61-66
DOI: 10.33762/bsurg.2018.160090

Hemorrhoids, are vascular structures present in the anal canal as cushions that facilitate stool control. When swollen or inflamed they are regarded as hemorrhoidal disease; sometimes they are asymptomatic specially in the internal type which are presented with painless rectal bleeding while external type may present with painful swelling.
Although the traditional open hemorrhoidectomy (Milligan Morgan) is standard and effective technique, it is associated with many complications; the most important is post-operative pain and delayed return to normal activities. Nowadays Doppler-guided hemorrhoidal artery ligation (DG-HAL) with recto-anal repair (RAR) is a minimally-invasive technique for hemorrhoids, it is developed recently to overcome these complications.
The purpose of this prospective study is to compare between the classical open hemorrhoidectomy and HAL-RAR procedure, by assessment of post-operative pain, postoperative complications and outcome of the procedures.
This prospective, study was done between September 2014 and September 2016. Ninety six patients complaining of hemorrhoids were studied at Al-Sadr Teaching Hospital, Basrah, Iraq. They were divided equally into two groups; group A and B, group A underwent surgery by DG HAL and RAR, and group B were subjected to traditional procedure. Patients were followed for one year by evaluation at 1 week, 1 month, 6 months, and 1 year.
In conclusion, DG-HAL with RAR is an effective technique compared with traditional hemorrhoidectomy regarding complications, postoperative pain, in hospital stay, and time of return to normal activities.

THE RELATIONSHIP BETWEEN CLINICAL EXPERIENCE AND QUALITY OF CARE AND ITS OUTCOME.

MAJEED H ALWAN

Basrah Journal of Surgery, 2008, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55531

Quality assurance and performance evaluations, have become central issues in medicine.
There are several studies which indicates that general patients care is suboptimal in many
different medical conditions and clinical settings1,2. Delivering high-quality care is important to all
clinicians, but this issue may be more relevant to certain subgroups, such as those with less
specialised training and those who deal with smaller number of patients3. There is also a
general believe that the longer clinicians are in practice the more experienced they will be, and
therefore it is assumed that this group of medical doctors are able to provide a high quality of
care. But there are some studies that found a consistently or partially negative association. The
aim of this report is to discuss this subject further and reach some conclusions.

GIANT FIBROADENOMA; CASE REPORT AND REVIEW OF LITERATURE

Issam Merdan

Basrah Journal of Surgery, 2006, Volume 12, Issue 1, Pages 0-0
DOI: 10.33762/bsurg.2006.55319

Introduction
For a variety of reasons, giant breast tumors continue to pose a challenge in diagnosis and management. These tumors are poorly understood because of their rarity and unpredictable behavior. Their rapid growth, associated with skin congestion and ulceration, and tendency to recur, gives rise to a suspicion of malignancy1,2. In addition, owing to the varied histological features seen in these tumors, there have been widely varying interpretations and diagnoses by pathologists3. This has led to inappropriate, and at times unnecessarily radical, surgical therapy. In the 1950s, breasts were amputated for this relatively non-threatening condition4. However, the present trend is towards more conservative management. In order to ensure proper surgical management, an under-standing of the natural history of the disease and its biologic behavior is essential. Bas J Surg, March, 12 2006

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