Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : surgery


THE BENEFICIAL EFFECTS OF TONSILLAR FOSSA CLOSURE AFTER TONSILLECTOMY; A PROSPECTIVE STUDY

Muhanned M Al-Ali; Ahmed M Al-Abbasi; Haider Sabri Hashim; Haider K Saeed; Ali M Altaie

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 32-37
DOI: 10.33762/bsurg.2020.165463

The objective of this study is to evaluate the effect of tonsillar fossa closure after tonsillectomy on the amount of intra-operative blood loss, post-operative pain and bleeding.
 Sixty patients enrolled in this single blind case control study held at Basrah Teaching Hospital in the period from July 2017 to November 2018.  Patients age was between 7 to 50 years, of them 28 (46.7%) females and 32 (53.3%) males. One of tonsillar fossae was selected for closure and the other was left open as a control side, the duration of dissection, the amount of bleeding for each side, the level of post-operative pain on (0, 3, 7, 10-14) days was estimated utilizing Visual Analogue  Score (VAS) together with any evidence of post-operative bleeding.
 There was statistically significant reduction in the level of post-operative pain in the sutured side compared to the control for all the follow-up periods. No significant differences in the amount of intra-operative blood loss between both sides were found. None of the patients experienced post-operative primary or secondary hemorrhage.
 In conclusion, Closure of tonsillar fossa has beneficial effect in reducing the level of
post-operative pain after tonsillectomy with no effect on post-operative bleeding. No difference was noted regarding the amount of intra-operative bleeding.

DOES ANTICOAGULANT THROMBOPROPHYLAXIS INCREASE BLEEDING COMPLICATIONS IN SPINAL SURGERY AND SPINAL CORD INJURY? A SYSTEMATIC REVIEW AND META-ANALYSIS

Anh TV Nguyen; Sonia Tran BMed; Thamer A Hamdan; Robin Turner; Ahmed Ramadan Sadek; Darren Lui; Alexander S Montgomery

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 9-20
DOI: 10.33762/bsurg.2020.165459

This study is a systematic review and meta-analysis. The routine use of anticoagulants for the prevention of venothromboembolism in spinal patients is controversial and the risk benefit analysis is poorly described. The objective of this study is to collate the current evidence and quantify the risk of bleeding associated with anticoagulant thrombophylaxis in the spinal patient, both in the elective and trauma settings. 
Medline, Embase, Cochrane Trial Register databases and the grey literature were searched. Data were pooled via a meta-analysis from randomized trials and cohort studies comparing the rates of spinal epidural haematoma and wound haemorrhagic complications in spinal surgery patients receiving low molecular weight and low dose unfractionated heparin (LMWH/UFH) thromboprophylaxis and those not anticoagulated. The risk of bias within individual studies and across all the studies was assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, respectively.
 The meta-analysis included 10 studies of 96,042 patients with 1,007 relevant bleeding complications. A significant increase in the risk of extra-spinal wound haemorrhage was found in patients receiving peri-operative LMWH/UFH thromboprophylaxis compared to controls (OR 1.56, 95% CI 1.18-2.06, p=0.002, I2=8%). The same comparison revealed no significant increase in the risk of spinal epidural haemorrhage (OR 1.20, 95% CI 0.65-2.22, p=0.56, I2=0%). The quality of evidence for both outcomes was low. There was insufficient data to conclude about the risk of haemorrhagic complications in spinal trauma and in patients receiving non-heparin thromboprophylaxis agents.
In conclusion, the results of this study raise concern about a possible increased risk of extraspinal wound haemorrhage associated with LMWH/LDUFH thromboprophylaxis in spinal surgery.  Level of evidence: Therapeutic level III.
 

CONGENITAL INTESTINAL MALROTATION IN ADULT PATIENTS

Firas Jabir; Issam Merdan; Wissam Saoud; Hamed Laftah

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 74-80
DOI: 10.33762/bsurg.2020.165493

 Congenital intestinal malrotation is an impaired embryological development of the gut causing incomplete rotation and attachment of the intestines to the abdominal wall.
 Three cases with congenital intestinal malrotation in adult patients were reviewed regarding their presentation, diagnosis and management. Two cases presented as emergency and the other one was incidental. Signs and symptoms of intestinal obstruction were the dominant presentation. A contrast computer tomography and upper gastrointestinal series confirmed the diagnosis of these cases. Ladd’s procedure was done in two cases.
 In conclusion, Intestinal malrotation should be considered as a cause of intestinal obstruction in all age groups. A contrast computer tomography is the best way to reveal this malformation. Surgical treatment is the greatest choice to relieve symptoms.
 

THE ACCURACY OF ABDOMINAL ULTRASONOGRAPHY IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Ali Hameed Kadhem; Shaymaa Yaqoop Khalid; Wisam Hamza Al-Sewadi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 61-64
DOI: 10.33762/bsurg.2020.165486

Acute appendicitis is the most common causes of abdominal emergencies that necessitate surgical intervention. This study aimed to evaluate the accuracy of abdominal ultrasonography in the diagnosis of acute appendicitis.
 This prospective study was performed in Alsadr Teaching Hospital from November 2015 to January 2017 involving 131 patients.
 The results showed that 84.7% of the patients who presented with positive features of acute appendicitis were confirmed by ultrasonographic study, while 15.2% of the patients showed negative ultrasound examination confirmation.
 In conclusion, ultrasound study is effective in the assessment of patients presented with clinical features of acute appendicitis.
 

ACUTE APPENDICITIS AND ASSOCIATED PATHOLOGIES IN FEMALES

Ali Hameed Kadhem; Aamena AbdulAmeer Muhsin; Wisam Hamza Al-Sewadi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 69-73
DOI: 10.33762/bsurg.2020.165491

In females with right lower quadrant acute abdominal pain, gynecological & obstetric pathologies are the main disorders that should be eliminated from the diagnosis of acute appendicitis. This study included pathologic findings in 120 appendectomies in Al-Sadr Teaching Hospital in which exploration was performed as emergency acute appendectomies in 52 cases, while other pathologic processes related to gynecological diseases are distanced from appendicitis intraoperatively.
 There is a high percentage of coexistence with ovarian cyst in all its types whether twisted, ruptured, hemorrhagic or corpus luteal cyst. Other conditions included: ectopic pregnancy, uterine fibroid, Pelvic Inflammatory Disease (PID), Tubo-Ovarian Abscess (TOA), benign cyst adenoma & endometriosis. Also rarely, meckel's diverticulum that was either incidental finding or discovered by imaging techniques.
 

HYPOCALCEMIA FOLLOWING THYROIDECTOMY; A PROSPECTIVE STUDY IN BASRAH, IRAQ

Rabee Hammed Qasim; Haider Kadhem Saeed; Ahmed M Al-Abbasi; Mohammed Mosa Mohammed

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 46-50
DOI: 10.33762/bsurg.2020.165483

This study aimed to find out the frequency of hypocalcemia in different thyroid procedures and the risk factors for its development.
 One hundred thirty six patients underwent different thyroid surgeries for different thyroid diseases in the Surgical and Otolaryngology Departments of Basrah Teaching Hospital for three years from July 2016 to July 2019.
 Patients mean age was 34.8±7.5 years (range: 18-65 years). Male to Female ratio was 2:5. Of the total 136 patients, 35 patients underwent isthmusectomy and lobectomy, no case of hypocalcemia was reported (0%). Out of 71 patients who underwent sub-total thyroidectomy, three of them developed hypocalcemia (4.2 %). Out of 30 patients who underwent near-total or total thyroidectomy, nine of them developed hypocalcemia (30%). Whether the inferior thyroid artery was ligated or not, there was no significant difference in the development of hypocalcemia. Of the total 136 patients, 129 patients had benign pathology, 9 of them developed hypocalcemia (6.9 %); 7 patients had malignant pathology; 3 of them developed hypocalcemia (42.8%).
 In conclusion, the frequency of hypocalcemia is correlated with the extent of thyroid resection; and it is more in malignant lesions but in most of the patients it was transient.

COMPARISON OF THE EFFECTIVENESS OF STEREOTACTIC RADIOSURGERY FOR SPINAL OLIGOMETASTATIC DISEASE WITH SURGICAL AND CONVENTIONAL EXTERNAL BEAM RADIOTHERAPY DETERMINED BY LOCAL CONTROL, OVERALL SURVIVAL, PAIN RESPONSE AND TOXICITIES: A SYSTEMATIC REVIEW.

Priyanshu Saha; Thamer A Hamdan; Bisola Ajayi; Cristina Lupu; Timothy Bishop; Jason Bernard; Darren Lui

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 21-31
DOI: 10.33762/bsurg.2020.165461

The aim of this study is to determine whether there is a benefit of using stereotactic radiosurgery (SRS) versus surgery or conventional external beam radiotherapy (cEBRT) for spinal oligometastatic disease in terms of tumor control, pain control, toxicity and morbidity.
 This systematic review was conducted by searching electronic databases such as Pubmed, Medline (Ovid) and Oxford Academic using an adapted version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) checklist. Retrospective and prospective studies were identified and investigated for methods of treatment such as SRS, surgery and radiotherapy of spinal oligometastatic disease. Local Control rates, Overall Survival (OS) rates, Pain Response (PR) and toxicities were extracted to be investigated and compared. A study eligibility criterion was made to ensure that results were valid, statistically significant and relevant to the investigation.
 One hundred and five articles were relevant to oligometastatic disease with the mention of spinal metastases however 89 of these articles were excluded based on irrelevance to investigation, title, abstract and duplication. Sixteen full text articles were thoroughly screened including 9 of them in the review. For 601 patients the average one year local control rate was 89%, average one year overall survival rate was 88%, evidence of pain relief was present, and some patients suffered low grade toxicities.
 In conclusion, stereotactic radiosurgery is an excellent modality of treatment of spinal oligometastatic disease as local control rates, overall survival rates, pain response and toxicities indicate improved outcomes in comparison to studies that investigated the same factors with the treatment of surgery or cEBRT. However, there is a lack of data here to make statistically valid claims and require more studies & data to be analyzed and compared.
 

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 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

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  

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

COMBINED SURGICAL EXCISION WITH LOCAL INFILTRATION OF VERAPAMIL FOR THE TREATMENT OF KELOID; A CLINICAL STUDY

Jabir Raheem Hameed

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 48-55
DOI: 10.33762/bsurg.2019.163872

Jabir Raheem Hameed* and Ahmed Mohammed kohil@ *MB, ChB, FICMS, Consultant Plastic and Reconstructive Surgeon, Al-Sadr Teaching Hospital, Basrah. @MB, ChB, Candidate of CABMS Plastic and Reconstructive Surgery, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Keloid scar is one of the most challenging problems for physicians and surgeons. The current treatment of keloids is based on many ways and modalities which includes medical therapy, combined surgical excision with other modalities, physical treatment etc. The optimal curative treatment remains undefined. This study aimed to evaluate the effectiveness of the surgical excision combined with local infiltration of verapamil to treat patients with keloid. This prospective study involved 20 patients with keloid scars at different parts of the body. These keloid scars were surgically excised with local infiltration of Verapamil. This study was carried out at Al-Shaheed Ghazii Al-Harriri Hospital, Al-Wasity Hospital in Baghdad and Al-Sadr Teaching Hospital in Basrah Between January 2017 and May 2018. The age of the patients ranged between 11 to 44 years. Fourteen of them were females and 6 were males. After one year follow-up period, 11 patients had good results, 5 patients had moderate results and 4 patients had poor results. Patient’s satisfaction in those who had good results was excellent. No serious complications were recorded, only one patient got local wound dehiscence. In conclusion, surgical excision of keloid scar combined with post-surgical verapamil infiltration showed promising results in the management of keloid scar and reduction of its recurrence rate.

PENETRATION OF CEFOTAXIME INTO INTERVERTEBRAL DISCS REMOVED FROM PATIENTS UNDERGOING DISCECTOMY

Thamer A Hamdan; Mohammed S hashim; Nazar S Haddad; Abdullah M Jawad

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 3-9
DOI: 10.33762/bsurg.2031.162890

The intervertebral disc is an avascular tissue, and penetration of antibiotics occurs by passive
diffusion. Cefotaxime penetration has not been well studied. The aim is to investigate the
penetration of cefotaxime into the intervertebral disc removed from patients undergoing
discectomy.
Twenty-six patients undergoing discectomy were recruited for this study. They were given one
gram of cefotaxime intravenously as a prophylactic antibiotic. Cefotaxime was extracted from
nucleus pulposus and serum and analyzed using an HPLC method with cefuroxime axetil as
internal standard.
Cefotaxime penetrated into all the 26 samples of nucleus pulposus resulting in a mean
concentration of 0.66±0.13 µg/gm. The mean serum concentration at time of disc removal was
13.61±3.54 µg/ml. The concentration in 16 samples were below the minimum inhibitory
concentration against Staph. aureus with an average of 0.27±0.03 µg/g. There is a statistically
significant correlation between time after intravenous cefotaxime administration and its
concentration in the nucleus pulposus. The greater increase is in the third hour after
administration. Factors like age, body weight, gender, number of associated diseases and
surgical history did not seem to affect nucleus pulposus cefotaxime concentration.
In conclusion, cefotaxime can penetrate into the nucleus pulposus but its concentration is
relatively low. This concentration has a strong positive correlation with time after cefotaxime
intravenous administration. Cefotaxime, therefore, needs to be given at least two hours before
disc removal, with re-dosing immediately before operation to maintain high serum concentration.

MULTINODULAR GOITER AND RISK OF MALIGNANCY, SURGERY OR FOLLOW UP ?

Ali Yousif Alwajeeh

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 61-65
DOI: 10.33762/bsurg.2019.163874

MULTINODULAR GOITER AND RISK OF MALIGNANCY, SURGERY OR FOLLOW UP ? Ali Yousif Alwajeeh@ & Abutalib Bader Al Luaibi* @MB,ChB, CABS, Consultant General Surgeon. MB,ChB, FIBMS, General Surgeon, Almawanee Teaching Hospital, Basrah, IRAQ. Abstract Nodular goiter is one of the most common presentation of thyroid gland diseases. The risk of development of thyroid cancer is relatively rare (1%) of all types of tumors, however, it is the most common endocrine malignancy, and usually presented as multinodular goiter. Fine needle aspiration cytology (FNAC) considered as the golden tool in the diagnosis of thyroid nodule though, it still has false negative rate which is variable depending on the experience and the technique being used. This means that even if the FNAC done prior to surgery shows negative finding, this doesn't exclude the presence of carcinoma, especially in multinodular goiter where it is possible not to sample the involved area. In this prospective study which was done in Almawanee Teaching Hospital between 2012-2018, 69 patients with Multinodular goiter where considered for the risk of harboring an incidental malignancy. The results of patients with multinodular goiter of benign origin was 57 patients (82.86%) while multinodular goiter which has an incidental malignancy was 12 patients (17.14%). Conclusion: due to relatively high risk of malignancy in multinodular goiter especially with noncompliance for follow-up from patients and risk of missing incidental malignancy by FNAC in multinodular goiter, it is preferable to do total or near total thyroidectomy. Key words: Goiter, Malignancy, FNAC, Surgery, Incidence

TRANSLIMBAL INTRAOCULAR ENDOILLUMINATION DURING CATARACT SURGERY

Fareed Warid; Maha Elshafei

Basrah Journal of Surgery, 2019, Volume 25, Issue 1, Pages 37-42
DOI: 10.33762/bsurg.2019.163867

TRANSLIMBAL INTRAOCULAR ENDOILLUMINATION DURING CATARACT SURGERY Fareed Warid* and Maha Elshafei@ * MB,ChB, CABO, FRCS-Ed, Consultant Ophthalmologist, Department of Ophthalmology, College of Medicine, Basrah University, Basrah, IRAQ. @MD, FRCSI, Senior Consultant Ophthalmologist, Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar. Abstract The aim of this study is to describe a technique for intraoperative examination of macula and posterior capsule during phacoemulsification surgery in eyes with dense cataract. This work was done in Ophthalmology Department, Hamad Medical Corporation, Doha-Qatar on 36 patients (42 Eyes) with dense cataract and obscured fundus view. No data were recorded for macular status, and preoperative macular assessment was not conclusive by Ophthalmoscopy, B-Scan Ultrasound, and Optical Coherence Tomography (OCT). All patients were consented for cataract surgery plus additional vitreoretinal surgical procedure if indicated. Fundus examination done during phacoemulsification by translimbal insertion of endo-light probe after Irrigation/Aspiration step prior to lens implantation, capsular-bag expanded by viscoelastic to accommodate probe insert. Posterior capsule status checked by Endolight using microscope lens system only, macula checked by endolight with a vitreoretinal viewing lens system. Forty-two eyes (25 right and 17 left), (27 males, 15 females) in 39 patients were studied. The mean age was 59 years (47-78 years). Fourteen patients (18 eyes) were diabetics. Preoperative Visual Acuity of ≤6/60 was recorded in all patients. Cataract Density was graded by fundus visualization and in all cases, only shadow of optic disc and/or major vessels could be seen. Concurrent intravitreal injections was done in eight eyes (19%): seven of them were having Diabetic Macular Edema, and one has hemorrhagic Choroidal Neovascular Membrane (CNVM) due to age related macular degeneration. No complication was recorded in relation to Endoillumination. Posterior Capsule visualization was improved significantly and intracapsular lens implantation was done in all cases In conclusion, translimbal endo-illumination technique improved view to both Macula and posterior capsule during phacoemulsification with subsequent early surgical decision according to endolight findings. No extra incision required. 

IS THERE A “FREE SIZE” IN SURGICAL PRACTICE?

Basrah Journal of Surgery, 2018, Volume 24, Issue 2, Pages 1-2
DOI: 10.33762/bsurg.2018.160085

Several parameters should seriously be considered in, almost, every pathology before drawing the line of treatment. Patients are not alike even when they are twins. Individual variation is a reality that should be taken in consideration.
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.