Print ISSN: 1683-3589

Online ISSN: 2409-501X

Current Issue
Volume 27, Issue 1

Volume 27, Issue 1, Winter and Spring 2021, Page 1-71


NONDISCOGENIC SCIATICA SYNDROME, A REPORT ON 41 PATIENTS.

Thamer Hamdan; Daren Lui; Raed Chasib

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 3-11
DOI: 10.33762/bsurg.2021.168420

41 patients with clinical features of discogenic sciatica during the last 25 years, proved later on by investigations and imaging to be a nondiscogenic in origin, The aim of the study is to inform spinal surgeons of possible differential diseases that mimic discogenic sciatica. All patients present clinically with a sciatica. They were recorded and treated accordingly and sent for investigations. Patients proved to have discogenic sciatica were excluded. Others further investigated and followed until finding a cause for the symptoms and recorded as nondiscogenic sciatica syndrome. 22 individual aetiologies were found to cause nondiscogenic including infectious, traumatic, oncogenic, degenerative, metabolic and ischemic causes. In conclusion a proper history and thorough physical examination, in addition to imaging and investigations were very useful in detecting the exact etiology of sciatica. The pain pattern and the related clinical features were the guide for the diagnosis. High index of suspicion is vital to achieve the definite diagnosis to avoid missing the diagnosis of nondiscogenic sciatica. One should maintain a high index of suspicion in patients with intractable sciatica. Keywords: [Nondiscogenic Sciatica syndrome, pseudosciatica, spine surgery, radicular pain.]

A CLINICAL EXPERIENCE IN ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL HYPOPHYSECTOMY IN SKULL BASE CENTER OF BASRAH

Mustafa Atiyah; Ahmed Al-Abbasi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 12-16
DOI: 10.33762/bsurg.2021.168427

Endoscopic Endo-nasal Trans-Sphenoidal (EETS) approach is a minimally invasive technique that has gained increased acceptability for removal of sellar and parasellar tumors. This prospective study was carried out on 50 patients in Basrah skull base center at Al-Sader Teaching Hospital between August 2017 and July 2019. The technique involved a unilateral, endoscopic, endonasal approach to the sella turcica via an anterior sphenoidotomy which is performed as a joint procedure by a consultant otolaryngologist and a consultant neurosurgeon The most common presenting symptom for pituitary tumor was; headache which present in 80% (40 patients) of the patients, followed by visual disturbance in 56% (28 patients). Infertility and hemiparesis are the least symptoms 2% for each (one patient). The MRI study of brain and sellar region showed that forty six patients (92%) was diagnosed as pituitary adenomas and one patient (2%) have Rathke’s cyst and another one have meningioma. Tumor location and extension which was assessed by MRI revealed that 70% (35 patients) had tumor located in sella with extension to suprasellar region, where only 2% (one patient) had sellar with supra- and parasellar extension. Eighty percent (40 patients) were virgin cases (not operated before), while only 20% (10 patients) were revised cases (operated before either open or transsphenoidal). We achieved complete resection of the tumor in 82% cases (41 patients). The most common method used for reconstruction of the surgical defect was underlay multilayers which was used in 62% (31 patients), while in 10%, posterior based middle turbinate flaps were used in reconstruction. We noticed that 3 patients (6%) developed significant epistaxis, CSF rhinorrhea in 3 patients (6%), and unfortunately 3 patients (6%) died postoperatively. In conclusion, this study shows that endoscopic, endonasal, transsphenoidal hypophysectomy is a minimally invasive, effective and safe procedure to remove pituitary tumors. Key words: Hypophysectomy, Endonasal, Endoscopy, Transsphenoidal.

OUTCOME OF TRANSORAL ENDOSCOPIC THYROIDECTOMY VESTIBULAR APPROACH (TOETVA) IN COMPARISON WITH OPEN THYROIDECTOMY FOR BENIGN THYROID NODULES

Sadq Kadem; Sabah Mohamd; Zainab Ibrahim

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 17-24
DOI: 10.33762/bsurg.2021.168428

Open thyroidectomy; is the gold standard surgical procedure for thyroid diseases, but the incision scar in the anterior aspect of the neck due to this approach cannot be avoided and may results in a permanent cosmetic defect. Therefore, there is a need to improve postoperative quality of life, including cosmetics. Recently, transoral endoscopic thyroidectomy has been developed; it is a natural orifice thyroid surgery, minimally invasive and completely scar free. This study aimed to describe the outcome, patient’s satisfaction, and complications after hemithyroidectomy for benign thyroid nodules by transoral endoscopic vestibular approach in comparison with open approach. This study was conducted in Al-Shiffa General hospital, Basrah, Iraq from August 2017 to June 2019 and was approved by a local ethical committee.Fifty patients with benign thyroid nodules who are candidate for hemithyroidectomy were included in the study; they were divided into two groups according to the method for thyroidectomy which was either conventional open or transoral endoscopic thyroidectomy vestibular approach based on the patients’ preferences. All operations were performed by the same surgical team. The results of this study showed that 24 (48%) of them operated upon by transoral endoscopic thyroidectomy vestibular approach, while the remaining 26 (52%) patients have been operated upon by open thyroidectomy approach. Transoral endoscopic thyroidectomy vestibular approach reported significant longer operative time, has comparable rate of complications with an excellent cosmetic outcome and better postoperative patients’ satisfaction in comparison to open thyroidectomy.In conclusion, transoral endoscopic thyroidectomy vestibular approach is a safe and feasible procedure with an excellent cosmetic outcome and better patients’ satisfaction. At present, it is a relatively time-consuming procedure and, therefore, candidate patients with a strong motivation for scar free surgery are recommended.Key words: Thyroidectomy; Endoscopic thyroidectomy; Transoral thyroidectomy; Benign, Nodule

COMPARISON OF SURGICAL OUTCOME OF ENDOSCOPIC DACRYOCYSTORHINOSTOMY WITH OR WITHOUT FLAP

Wissam Aziz; Ahmed Al-Abbasi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 25-29
DOI: 10.33762/bsurg.2021.168431

The goals of this study were to evaluate the results of endoscopic endonasal dacryocystorhinostomy (DCR) and to compare the surgical success rates of the different procedures (with or without mucosal flap) in patients with nasolacrimal duct obstruction. This prospective study investigated the results of 39 patients, they were 36 females (92.3%) and 3 males (7.7%). Endoscopic endonasal DCR was performed at the Basrah Teaching Hospital, Department of Otolaryngology in the period between July 2018 to July 2019. The patients were divided into two groups; with or without flap. During surgery, the mucosal flap was preserved in 13 patients (group B) and removed in 26 patients (group A). For all patients, silicone stents were put at the end of surgery. The silicone tube was removed within 6 months after surgery. After six months follow-up, the results were; patent ostium reported in 17 patients (81%) in group A and in 10 patients (90.9%) in group B. There was no statistically significant difference between the groups (P-Value 0.461). The overall incidence of crustation and adhesion is more in group A than in group B but it was also statistically not significant.In conclusion, endoscopic endonasal DCR carries no significant difference of success ratewhether it is with or without mucosal flap.Key words: Endoscopy, Dacryocyctorhinostomy, flap, Surgery.

RISK FACTORS FOR THE DEVELOPMENT OF BRAIN METASTASES IN PATIENTS WITH METASTATIC BREAST CANCER

Hayder Abdulsamad; Mazin Al-Hawwaz

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 30-35
DOI: 10.33762/bsurg.2021.168434

Metastatic breast cancer is the second most common cancer associated with brain metastases;it has become a major life-limiting problem in those patients with metastatic breast cancer.This study aimed to detect early brain metastasis and intent to manage so to decrease disability and mortality in patients with breast cancer.This is a retrospective study analysing patients with metastatic breast cancer during the period from February 2018 to August 2019 at Basrah Oncology Centre which is the main tertiary referral hospital serving the southern part of Iraq. During the study duration (around 18 months), we found that risk factors for developing brain metastasis are tumour size, nodal involvement, tumour grade, hormone receptor (if negative), human epidermal growth factor2 (If positive) and radiotherapy (if not given as adjuvant) .In conclusion, the tumour size, grade, nodal involvement, whether the hormone receptors positive or negative, and if the patient received radiotherapy or not, all are predictive factors tobe considered, so patients should have appropriate imaging technique.Key words: Brain metastasis, breast cancer, risk factors.

CLINICO-RADIOLOGICAL EVALUATION OF LEGG-CALVE-PERTHES DISEASE MANAGED BY PROXIMAL FEMORAL VARUS DEROTATION OSTEOTOMY: A RETROSPECTIVE STUDY

AMITOSH MISHRA; AJAI SINGH; SIBANANDA RATHA; SYED AFAQUE; ANIL PANDA

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 59-65
DOI: 10.33762/bsurg.2021.129221.1002

Introduction:
Legg-Calve-Perthes disease is a juvenile idiopathic aseptic, non-inflammatory, osteonecrosis of immature hip in which the blood supply of femoral epiphysis is not sufficient and the bone dies provisionally followed by a subchondral fracture, fragmentation, revascularization and remodeling. It is associated with both substantial hip pain and dysfunction during the disease process as well as later in adulthood. The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity. In the current study, authors evaluated the outcome of proximal femoral varus derotation osteotomy in children with Legg-Calve-Perthes disease.
Material & Methods:
All the children (up to 16 years) presenting with Perthes disease, of both sex and willing to get enrolled in the study and were managed by proximal femoral varus derotation osteotomy were included in the study. Evaluation were done in terms of clinical symptoms and signs, Harris hip score and radiologically with X-rays.
Results:
The study results indicated improvement in pain, limp, abduction, internal rotation and Harris Hip Score which was statistically significant in the study subjects.
Conclusion:
According to this study, proximal femoral varus derotation osteotomy is an acceptable method for management of patients with Legg-Calve-Perthes disease in all age group of patients. This surgery led to decrease in pain, limping, and increase in range of motion.

CLINICO-MICROBIOLOGY OF CHOLESTEATOMA OBTAINED DURING MASTOID SURGERY IN PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA

Marwah Abd Ali; Isam Al-Shareda

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 36-40
DOI: 10.33762/bsurg.2021.168435

Abstract Chronic Otitis Media (COM) is a long standing inflammation of the middle ear and mastoid, it is a common health problem. The evidence of microbiology in COM in different studies showed variable frequencies, but little studies showed the role of fungal colonization. This study aimed to identify the microbiology of cholesteatomatous COM concentrating on clarification of fungal colonization. A prospective study was done in otolaryngology department of Basrah Teaching Hospital from June 2018 till July 2019. This study was carried on a randomly collected data of 25 patients diagnosed as COM by a specific designed questionnaire including history and examination. The specimen was collected during mastoid surgery which included any cholesteatoma in the middle ear and mastoid and sent for bacteriological and mycological examination. Statistical study was done by using SPSS v.23 Bacteria were isolated in 84% of the cases in which Pseudomonas aeruginosa was the commonest one (33.3%). Fungi were isolated in 28% cases, in which the Aspergillosis was the commonest (19.3%). There is no recognizable pattern of significant association between the fungi and the reported complications or the stage of the disease. In conclusion, there is significant percentage of fungal colonization in COM with cholesteatoma so it may has a role in inflammatory response of perimatrix, but there is no clear mechanism of this interaction, so may need larger sample and longer duration of study with postoperative follow-up and trail of combined antibiotic-antimycotic treatment. Key words: clinical,microbiology, cholesteatoma, mastoid surgery, otitis media.

COBLATION TONSILLECTOMY, IS IT SUPERIOR TO COLD STEEL METHOD?

Haider Hashim; Ahmed Al-Abbasi; Sabah Al-Urabi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 41-44
DOI: 10.33762/bsurg.2021.168436

AbstractCoblation tonsillectomy is a new technique that was started in 1975, it involves passing a radiofrequency bipolar electrical current through a medium of normal saline, resulting in a plasma field of highly ionized particles which in turn break down intercellular bonds and thus melt tissue at around 40º to 70ºC (in comparison with electrocautery which cuts tissues at 400ºC)The aim of this study is to evaluate the benefit of coblation tonsillectomy over conventional (cold steel) tonsillectomy, comparing tonsillectomy duration, blood loss during the surgery, and the postoperative pain. This prospective randomised single-blinded clinical trial was done on 90 patients. Patients were divided into 2 equal groups; Group A: Underwent coblation tonsillectomy, and Group B who underwent cold steel tonsillectomy. The study was performed in Al-Musawy Private Hospital, Basrah Teaching Hospital, and Al-shifaa hospital, Basrah, Iraq. All surgeries were done by the three authors in the period between February 2018 to August 2020. The intraoperative bleeding, duration of surgery, and postoperative pain were evaluated and compared for both groups. The age range of the studied patients was 4–32 years, 52 were males and 38 were females. The average duration of tonsillectomy procedure was 31.8 minutes in coblation tonsillectomy (Group A), while the average duration in the cold steel tonsillectomy (Group B) was 25.8 minutes. The average operative blood loss in cold steel tonsillectomy was 31.5 ml while that incoblation was 3.2 ml. Average postoperative pain in coblation group was (20.7± 6.15), while in cold steel group was (27.5±7.27).In conclusion, coblation tonsillectomy is effective and beneficial in decreasing the volume of intraoperative blood loss but not for postoperative pain in comparison with conventional method, in addition that it take more time to be completed.Key words: coblation, cold steel, tonsillectomy.

THE EFFECT OF EARLY VERSUS LATE TRACHEOSTOMY ON DURATION OF MECHANICAL VENTILATION AND INTENSIVE CARE UNIT STAY IN TRAUMATIC BRAIN INJURY PATIENTS

Doaa Abdul-Samad; Abdul-Razzaq Alrubaye; Duraid Altameemi

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 45-50
DOI: 10.33762/bsurg.2021.168437

AbstractTracheostomy is a surgical procedure that frequently performed for patients in the intensive care units (ICUs). Prolonged mechanical ventilation (MV) is the main indication for tracheostomy in the ICU.This study aimed to compare the effect of early versus late tracheostomy on duration of mechanical ventilation and ICU length of stay in traumatic brain injury patients and to determine the appropriate timing to perform tracheostomy for those patients.A Prospective comparative study was performed for head trauma patients with Glasgow coma scale (GCS) less than eight who needed endotracheal intubation with or without mechanical ventilation in the ICU of Al-Sadr Teaching Hospital in Basrah from February 2019 up to December 2019.In this study, there were 94% males and 6% females, 52% were in the age group between 20-40 years, median duration on endotracheal tube in early tracheostomy (ET) group was 5 days while in late tracheostomy (LT) group was 11 days. Total duration on MV was significantly shorter in ET group (9.63±1.87 versus 17.81±6.66 days in LT group; p<0.05). Post tracheostomy MV duration was shorter in ET (6.23±1.48 versus 10.69±4.34 days p<0.05). The ICU length of stay also was significantly shorter in early group (12.70±1.80 versus 22.37±7.19 days; p<0.05).In conclusion; early tracheostomy in traumatic brain injury before 7 days from endotracheal intubation significantly shortens the duration of mechanical ventilation and ICU length of stay.Key words: early, late, tracheostomy, mechanical ventilation, ICU stay, brain injury

BREAST CANCER AMONG WOMEN IN BASRAH, IRAQ: A DESCRIPTIVE STUDY IN BIRAD 1 & 2 SCREENED CASES

Mazin Al-Hawwaz; Hayder Abdulsamad; Rajaa Mahmoud

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 51-58
DOI: 10.33762/bsurg.2021.168438

Breast cancer is the most commonly diagnosed cancer among women around the age of menopause. With an advice from WHO, screening programs are encouraged globally for detection of the breast cancer in early stage using mammography imaging technique that is used to understand the breast health and early detection of breast lumps.The study aimed to determine the socio-demographic characteristics of breast cancer screened cases among women aged above 35 years in Basrah with studying the time trend of registered breast cancer cases in Basrah from 2014 to 2020. In addition, it also aimed to detect malignant cases among Breast Imaging Reporting and Data System (BIRADS) 1 & 2 breast cancer screened cases. This is a database descriptive study using mammography medical records of women attended to Basrah Cancer screening Center in Basrah Teaching Hospital. A total of 448 female patients who had histopathological result indicating breast cancer and were classified according to mammogram (BI-RADS) grading methodology in the period 2014-2020. The study found that above 55 years of age multipara women were the highest group affected by breast cancer. Most importantly, malignancy was detected in 20% of breast cancer cases that were categorized as BIRAD 1 & 2.In conclusion, women with BIRAD 1 & 2 should be included in active follow-up examinations to detect any little risk that the lesions are malignant.Key words: Breast Cancer, Basrah, BIRAD, mammography screen

STAPLES VS SUBCUTICULAR SUTURES FOR SKIN CLOSURE IN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY

Ali Mohammed Redha; Adil Jaber; Aqeel Nassir

Basrah Journal of Surgery, 2021, Volume 27, Issue 1, Pages 66-70
DOI: 10.33762/bsurg.2021.168440

Inguinal hernia repair can be achieved by many techniques but skin closure still limited to only two methods; sutures and staples. In spite of that both have the same role in healing by approximation of skin edges; they differ in terms of cost, pain, cosmoses, wound complications,and time of wound closure.Two groups, each contain 50 patients were studied regarding inguinal hernia repair by using subcuticular suturing or staples for skin closure. The time of closure, cost, infection rate, pain at removal and scar acceptance were assessed and compared in the two groups.The mean time was shorter in staples group (8.77 min. Vs 2.35 min.) with a p-value <0.05.Stapler cost was significantly higher than sutures (12 USD VS 2 USD) and p<0.05. Infection rate was more with sutures than staples (8% VS 4%) however it was with no significant difference (p>0.05). Pain difference was significant at time of removal assessed by visual analog scale score which is mild with staples and moderate with sutures (p<0.05). No much difference in scare acceptance between the two groups with more than 90% good scar in both(p>0.05).In conclusion, staples are good alternatives to subcuticular sutures in closure of skin incision in inguinal hernia repair. They are associated with good cosmetic results, less pain at removal, less wound infection and shorter time of wound closure but there is a need to reduce their cost.Key words: Staples, Sutures, Skin closure, Wound complications