ORIGINAL_ARTICLE
PENETRATION OF CEFOTAXIME INTO INTERVERTEBRAL DISCS REMOVED FROM PATIENTS UNDERGOING DISCECTOMY
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.
https://bjsrg.uobasrah.edu.iq/article_162890_9285712b155148611594f634ca195eff.pdf
2019-06-30
3
9
10.33762/bsurg.2031.162890
surgery
cefotaxime concentration
intervertebral disc
nucleus pulposus
discectomy3
Thamer
Hamdan
1
surgery, college of medicine, university of basrah, basra, iraq
LEAD_AUTHOR
Mohammed
hashim
2
AUTHOR
Nazar
Haddad
3
Biochemistry, college of medicine, university of basra, basra, iraq
AUTHOR
Abdullah
Jawad
4
pharmacology, college of medicine, university of basra, basra, iraq
AUTHOR
1.Osti OL, Vernon-Roberts B, Fraser RD (1990) Discitis after discography. The role of prophylactic
1
antibiotics. Spine 15:762–767. PMI:2312567
2
2. Motaghinasab S, Shirazi-Adl A, Urban JP, Parnianpour M (2012) Computational pharmacokinetics of solute
3
penetration into human intervertebral discs - effects of endplate permeability, solute molecular weight and disc
4
size. J Biotech 45:2195-2202. doi: 10.1016/j.jbiomech. 2012.06.033.
5
3. Lang R, Folman Y, Ravid M, Bental T, Gepstein R (1994) Penetration of ceftriaxone into the intervertebral
6
disc. J Bone Joint Surgery 76:689-691. PMID: 8175816
7
4. Walters R, Rahmat R, Fraser R, Moore R (2006) Preventing and treating discitis: cephazolin penetration in
8
ovine lumbar intervertebral disc. Eur Spine J 15: 1397-1403. PMID: 16830132
9
5. Lin CC, Wu YT, Yen JC, Chiang CJ, Tsuang YH, Tsai TH (2010) In vitro and in vivo methods to measure
10
the ceftriaxone distribution into the rat tail intervertebral disc. Anal Scio 26:979-982. PMID: 20834130
11
6. Yan D, Li J, Zhang Z, Zhu H (2012) Determination of cephazolin, ceftazidime, and ceftriaxone distribution
12
in nucleus pulposus. Arch Orthop Trauma Surg 132:969-976. PMID: 22526195
13
7. Riley LH, Banovac K, Martinez OV, Eismont FJ (1994) Tissue distribution of antibiotics in the
14
intervertebral disc. Spine 19:2619-25. PMID: 7899954
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8. Rohde V, Meyer B, Schaller C, Hassler WE (1998) Spondylodiscitis after lumbar discectomy. Incidence and
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a proposal for prophylaxis. Spine 23:615–620. PMID: 9530794
17
9. Eismont FJ, Wiesel SW, Brighton CT (1987) Antibiotic penetration into rabbit nucleus pulposus. Spine
18
12:254– 256. PMID: 3589822
19
10. Zhang L, Wang JC, Feng XM, Cai WH, Yang JD, Zhang N (2014). Antibiotic penetration into rabbit
20
nucleus pulposus with discitis. Eur J Orthop Surg Traumatol 24:453-458. doi: 10.1007/s00590-013-1317-8.
21
11. Scuderi GJ, Greenberg SS, Banovac K, Martinez OV, Eismont FJ (1993) Penetration of glycopeptide
22
antibiotics in nucleus pulposus. Spine 18:2039-2042. PMID: 8272956
23
12. Komatsu M, Takahata M, Sugawara M, Takekuma Y, Kato T (2010) Penetration of linezolid into rabbit
24
intervertebral discs and surrounding tissues. Eur Spine J 19:2149-2155. doi: 10.1007/s00586-010-1548-x.
25
13. Thomas Rde W, Batten JJ, Want S, McCarthy ID, Brown M, Hughes SP (1995) A new in-vitro model to
26
investigate antibiotic penetration of the intervertebral disc. J Bone Joint Surg Br 77:967–970. PMID: 7593116
27
14. Gibson MJ, Karpinski MR, Slack RC, Cowlishaw WA, Webb JK (1987) The penetration of antibiotics into
28
the normal intervertebral disc. J Bone Joint Surg Br 69:784–786. PMID: 3680343
29
15. Shanmugam S, Acharya LD, Mallayasamy SR, Rao A, Khan SA, Rajakannan T (2010) Study of tissue and
30
the plasma concentration of cefotaxime to assess its stability for prophylaxis in cholecystectomy. Journal of
31
Clinical and Diagnostic Research 4:2410-2415.
32
16. Walters R, Rahmat R, Fraser R, Moore R (2006) Preventing and treating discitis: cephazolin penetration in
33
ovine lumbar intervertebral disc. Eur Spine J 15.1397-1403. PMID: 16830132
34
17. El-Gindi S, Aref S, Salama M, Andrew J (1976) Infection of intervertebral discs after operation. J Bone
35
Joint Surg Br 58:114–116. PMID: 1270487
36
18. Hamdan TA (2012) Postoperative disc space infection after discectomy: A report on thirty-five patients. Int
37
Orthop 36: 445–450. doi: 10.1007/ s00264-011-1430-4.
38
19. Silber JS, Anderson DG, Vaccaro AR, Anderson PA, Mccormick P (2002) Management of post procedural
39
discitis. Spine J 2:279–287. PMID: 14589480
40
20. Sharma SK, Jones JO, Zeballos PP, Irwin SA, Martin TW (2009). The prevention of discitis during
41
discography. Spine J 9: 936-943. doi: 10.1016/j.spinee.2009.06.001
42
21. Snell RS, ed. (2012). Clinical anatomy by regions, 9th edition, Wolters Kluwer|Lippincott Williams&
43
Wilkins, Baltimore, Philadelphia.
44
22. Cai HX, Liu C, Fan SW (2011) Routinely using prophylactic antibiotic may not effectively prevent
45
intervertebral disc infection: a new strategy to preventing postoperative intervertebral disc infection. Med
46
hypothesis 76:464- 466. doi: 10.1016/j.mehy.2010.11.021.
47
23. Andrews JM (2001) Determination of minimum inhibitory concentrations. J Antimicrob Chemother 48
48
Suppl; 1:5-16. PMID: 11420333
49
24. Guiboux JP, Cantor JB, Small SD, Zervos M, Herkowitz HN (1995). The effect of prophylactic antibiotics
50
on iatrogenic intervertebral disc infections. a rabbit model. Spine 20:685-688. PMID: 7604344.
51
25. North American Spine Society, https://www.spine.org/ResearchClinicalCare/ClinicalGuidelines.aspx.
52
Clinical guidelines (2013).
53
26. Currier BL, Banovac K, Eismont FJ (1994) Gentamicin penetration into normal rabbit nucleus pulposus.
54
Spine 19:2614-2618. PMID: 7899953
55
27. Fraser RD, Osti OL, Vernon-Roberts B (1989) Iatrogenic discitis: the role of intravenous antibiotics in
56
prevention and treatment. An experimental Spine 14:1025-1032. PMID: 2781408
57
28. Köroğlu A, Acar O, Ustün ME, Tiraş B, Eser O (2001) The penetration of cefoperazone and sulbactam into
58
the lumbar intervertebral discs. J Spinal Discord 14:453-454. PMID: 1158614
59
ORIGINAL_ARTICLE
LOCAL EXPERIENCE OF TOTAL KNEE REPLACEMENT IN BASRAH
LOCAL EXPERIENCE OF TOTAL KNEE REPLACEMENT IN BASRAH Thamer A Hamdan@, Khalil I Sadek# & Mohammed AbedYasir* @FRCS, FICS, FACS, FRCP, American Board of Neurological & Orthopedic Surgery, Professor of Orthopedic Surgery. # FICMS, Orthopedic specialist, Basrah Teaching Hospital. * CABHS Orthopedic specialist, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Total knee arthroplasty (TKA) represents a major advance in the treatment of degenerative joint disease providing excellent restoration of joint function and pain relief. This is a prospective study undertaken in the Department of Orthopedic Surgery in Basrah Teaching Hospital, from October 2009 to June 2011. Thirty-three patients who underwent primary total knee arthroplasty were included (25 females 75.7% and 8 males 24.2%). The diagnosis was osteoarthritis in 20 knees and rheumatoid arthritis in 13 knees. The operation included primary cemented TKA (25 cruciate-retaining and 8 cruciate-substituting), by anterior approach. The knee function was evaluated by knee society score system. Preoperative functional knee scores were uniformly poor and improved postoperatively with excellent results in 18 knees (54.54%), good in 9 knees (27.27%), fair in 5 knees (15.15%), and poor in 1 knee (3%). Thus, excellent and good results were achieved in 81.8% of the cases (27 of 33 knees). For knee scores, 2 knees (6%) were fair preoperatively and another 31 knees (93.9%) were poor. Post TKA results were excellent in 28 knees (84.84%), good in 5 knees (15.15%), fair in (0%) and poor in (0%). Excellent and good results were achieved in 100% of cases. The most common complications were superficial infection and deep venous thrombosis In conclusion, this study showed good outcome for total knee replacement surgery in our region. Excellent relief of pain, range of motion, and restoration of function. Keywords: Total Knee Replacement, Osteoarthritis, Rheumatoid arthritis, Basrah, Surgery.
https://bjsrg.uobasrah.edu.iq/article_162891_20b959e9d92a1f691731dceae9cd2c24.pdf
2019-06-30
10
15
10.33762/bsurg.2031.162891
Total knee replacement
-- Osteoarthritis
-- Rheumatoid arthritis
-- Basrah
-- Surgery
Thamer
Hamdan
1
Surgery, College of Medicine, University of Basrah, basra, Iraq
LEAD_AUTHOR
Khalil
Sadek
2
surgery,Basrah Teaching Hospital, basrah, iraq
AUTHOR
Mohammed
Yasir
3
Al-Sadr Teaching Hospital, Basrah, IRAQ
AUTHOR
ORIGINAL_ARTICLE
COLUMELLAR STRUT GRAFT IN TIP RHINOPLASTY, IS IT OF BENEFIT?
Abstract Strut graft is an important, commonly used method to increase nasal tip projection and rotation. This study discuss its benefit by prospective analysis of a group of patients in which strut graft was used and compare it with a control group using digitalized photographs. The aim of this study is to evaluate the benefit of columellar strut graft and its effect on nasal projection and rotation using digital images. Thirty two patients were treated with external rhinoplasty. Using their photographs, we analyzed the projection and rotation of the nose before and after operation. The patients were classified into two groups: group A included 18 patients who have strut and group B included 14 patients without strut. The analysis of the photos of the two groups was done with a computer program. By using Goode method, nasal tip projection decreases from 0.63 to 0.62 for patients using the strut, while in patients without strut nasal tip projection decreases from 0.64 to 0.61. Nasal tip rotation slightly increased in patients with strut graft from 99 to 99.5 degrees, while in those without the graft, nasal tip rotation markedly increased from 95 to 103 degrees. In conclusion, external rhinoplasty decreases nasal tip projection and the use of strut graft is unnecessary in increasing nasal tip projection but it helps in preserving the projection and slightly increasing nasal tip rotation. Keywords: Rhinoplasty, Graft, Strut, Columella, Nasal, Projection, Rotation
https://bjsrg.uobasrah.edu.iq/article_163759_ce33f35760f0e01b3954cc21588bc56a.pdf
2019-06-30
16
21
10.33762/bsurg.2019.163759
rhinoplasty
Graft
Strut
Columella
Nasal
Projection
rotation
Al-Abbasi
Ahmed
1
surgery,medicine,basrah,basrah,Iraq
LEAD_AUTHOR
Muhanad
A Zahra
2
surgery,basrah,Iraq
AUTHOR
Haider
Saeed
3
surgery, basrah
AUTHOR
1. Tasman AJ., “Rhinoplasty; indications and techniques.” GMS Curr. Top. Otorhinolaryngol. Head Neck Surg., 2007;vol. 6, pp 9.
1
2. Gruber RP and Stepnick DW, Rhinoplasty : current concepts. Saunders, 2010.
2
3. Glasgold AI “Dynamics of the Columella Strut,” Am. J. Cosmet. Surg., 1984. vol. 1, no. 2, pp 41–44.
3
4. Rabie AN and El Begermy MM, “The broad base columellar strut for correction of retracted columella and under rotated tip,” Egypt. J. Ear, Nose, Throat Allied Sci., 2016; vol. 17, no. 2, pp 81–86.
4
5. Ingels K. Kadir S, and Orhan S. “Measurement of Preoperative and Postoperative Nasal Tip Projection and Rotation,” Arch Facial Plast Surg. 2006;8(6):411-415.
5
6. Rohrich RJ, Kurkjian TJ, Hoxworth RE, Stephan PJ and Mojallal A., “The Effect of the Columellar Strut Graft on Nasal Tip Position in Primary Rhinoplasty,” Plast. Reconstr. Surg., 2012, vol. 130, no. 4, pp. 926–932.
6
7. Vuyk HD, Oakenfull C, and Plaat RE. “A quantitative appraisal of change in nasal tip projection after open rhinoplasty.” Rhinology, 1997;vol. 35, no. 3, pp. 124–8.
7
8. Sadeghi M, Saedi B, Arvin Sazegar A, and Amiri M. “The role of columellar struts to gain and maintain tip projection and rotation: A randomized blinded trial,” Am. J. Rhinol. Allergy, 2009; vol. 23, no. 6, pp. 47–50.
8
9. Walter C. “The evolution of rhinoplasty,” J. Laryngol. Otol. 2017; vol. 102, pp. 1079–1085.
9
10. Nataraj RV, Jagade Mohan, Chavan Reshma, Parelkar Kartik, Hanawte Reshma, Singhal Arpita, Kulsange Kiran, Rengaraja Dev, Rao Kartik, Gupta Pallavi “Augmentation Grafts in Septorhinoplasty: Our Experience,” Int. J. Otolaryngol. Head Neck Surg. 2015; vol. 4, pp. 317–324.
10
11. Jewett BS and Baker SR. “History of Nasal Reconstruction,” in Principles of Nasal Reconstruction, New York, NY: Springer New York, 2011, pp. 3–12.
11
12. Pastorek NJ, Bustillo A, Murphy MR, and Becker DG, “The Extended Columellar Strut–Tip Graft,” Arch. Facial Plast. Surg. 2005; vol. 7, no. 3, p. 176.
12
ORIGINAL_ARTICLE
VALIDITY OF CERTAIN BEDSIDE TESTS IN PREDICTING DIFFICULT ENDOTRACHEAL INTUBATION
Abstract Unexpected difficult endotracheal intubation remains the main concern of anesthesiologists. This study aimed to compare validity and role of 7 bedside techniques of assessment used in predicting difficult intubation. This prospective study included 80 patients scheduled for surgery. Before induction of anesthesia, bedside tests for predicting difficult intubation were done, these tests are: Prayer sign, Thyromental distance, Mallampati test, The inter incisor distance, Palm print test, Upper lip bite test, and Wilson scoring system. During induction of anesthesia, laryngoscopic view was evaluated. Values for each test were calculated and compared. The results showed that, the highest sensitivity (62.5%) was for Mallampati and thyromental distance but despite that, they differed in their specificity and predictive values. Upper lip bite was 12.5% sensitive but had one of the highest specificity alongside with Mallampati test. Thyromental distance was 34.7% specific. Mallampati classes of more than class I was strongly associated with difficult intubation. The mouth gap of more than 4 cm was marginally associated with difficult intubation. The predictor Wilson showed a significant association with difficult intubation if the score exceeded 3.5. The upper lip bite of more than class I was slightly associated with difficult intubation. In conclusion, Mallampati classification and thyromental distance are superior to other available tests to predict difficult intubation, performing these two tests alone is relatively adequate to predict intubation difficulty. Keywords: Difficult endotracheal intubation, The inter incisor distance, Wilson scoring system, Mallampati test, Palm print test, Prayer sign, Upper lip bite test, and Thyromental distance.
https://bjsrg.uobasrah.edu.iq/article_163769_4e9f1921bec4772e3b77262773100bc2.pdf
2019-06-30
22
26
10.33762/bsurg.2019.163769
Difficult endotracheal intubation
The inter incisor distance
Wilson scoring system
Mallampati test
Palm print test
Prayer sign
Upper lip bite test
and Thyromental distance
Jasim
Salman
jasim.salman@uobasrah.edu.iq
1
surgery, college of medicine, university of Basrah, basrah, Iraq
AUTHOR
Sadad
Salman
2
anesthesiology, basrah, iraq
AUTHOR
Salam
asfar
3
surgery, college of medicine, university of basrah, basrah , iraq
AUTHOR
1. Rashid M Khan, Pradeep K Sharma, Naresh Kaul. Airway management in trauma. Indian J Anaesth. 2011 Sep-Oct; 55(5): 463–469.
1
2. Magboul M. Ali; The Dilemma of Airway Assessment and Evaluation. The Internet Journal of Anesthesiology. 2004 Volume 10 Number 1.
2
3. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98 (5):1269-77
3
4. Frerk CM. Predicting difficult intubation. Anaesthesia 1991; 46 (12):1005-1008
4
5. Verghese C, Brimacombe JR. Survey of laryngeal mask airway usage in 11,910 patients: safety and efficacy for conventional and nonconventional usage. Anesth Analg 1996; 82: 129–133.
5
6. Gupta S, Sharma R, Jain D. Airway assessment – Predictors of a Difficult Airway. Indian Journal Of Anaesthetics 2005; 49(4) : 257 -262.
6
7. Khan ZH, Kashfi A, Ebrachimkhani EA: Comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg, 2003; 96:595–599.
7
8. Zahid Hussain Khan and Shahriar Arbabi : Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray, Indian J Anaesth. 2013; 57(4): 381–386.
8
9. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P; Predicting difficult intubation. British Journal of Anaesthesia 1988, 61:211–216.
9
10. Tse JC, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: A prospective blind study. Anesth Analg. 1995; 81:254–258.
10
11. Naguib M, Scamman FL, O’Sullivan C, Aker J, Ross AF, Kosmach S, et al. Predictive performance of three multivariate difficult tracheal intubation models: A double-blind, case-controlled study. Anesth Analg. 2006; 102:818–824.
11
ORIGINAL_ARTICLE
PROPHYLACTIC TRANEXAMIC ACID VERSUS AUTOLOGOUS BLOOD TRANSFUSION TO REDUCE BLEEDING IN ELECTIVE CORONARY BYPASS GRAFT SURGERY
Abstract Many blood conservation strategies were developed in the past decades to reduce risk of bleeding and the need for blood products among patients undergoing cardiac surgeries. This study was conducted to define the benefit of reinfusion of preoperative collected autologous blood in reduction of the risk of bleeding and the need for blood and blood products in comparison with tranexamic acid. This single centre single-blinded, randomized study was conducted in Erbil cardiac centre during the period from 1st of November 2018 to 30th of April 2019. A total of 150 patients were divided into three groups with 50 patients for each. The 1st group received nothing, the 2nd group received initially infusion of 200mg/hr of tranexamic acid until reaching 1.5gm/hr, and the 3rd group received one pint of preoperative auto-transfused whole blood. Data on risk of bleeding and the need for blood and blood products were collected using special questionnaire prepared for the reason of this study and were analyzed using appropriate statistical tests. Patients receiving autologous blood showed lower chest tube drainage than the other study groups with a p value of
https://bjsrg.uobasrah.edu.iq/article_163859_447f56997479d5a1a94634d5911ff778.pdf
2019-06-30
27
31
10.33762/bsurg.2019.163859
Othman
Abdulmajeed
1
College of Medicine, Hawler Medical University, Erbil, IRAQ
AUTHOR
ORIGINAL_ARTICLE
PROMINENT EAR CORRECTION BY TWO PARALLEL INTERRUPTED FULL THICKNESS CARTILAGE INCISION LINES
PROMINENT EAR CORRECTION BY TWO PARALLEL INTERRUPTED FULL THICKNESS CARTILAGE INCISION LINES Mohammed Breesam Hatif@, Arwa Kasim* and Jabir R Hameed# @ MB,ChB, FICMS, Consultant Plastic & Reconstructive Surgeon, Al-Wasity Plastic and Reconstructive Surgery Teaching Hospital, Baghdad. * MB,ChB, FICMS, Plastic & Reconstructive Surgeon, Al-Karama General Teaching Hospital in Baghdad. # MB,ChB, FICMS, Consultant Plastic and Reconstructive Surgeon, Al-Sadir Teaching Hospital, Basrah, IRAQ. Abstract Prominent ear is the most common congenital ear deformity affecting 5% of children in western world and has profound psychological effects on the bearer. The most common causes of protruded external ear are: an under developed or flat antihelix, an over developed deep concha, or combination of both of these features. The aim of this study is to evaluate clinical outcome of otoplasty in prominent ears by two parallel interrupted full thickness cartilage incisions. from February 2015 to November 2018, a prospective study accomplished on 40 patients (74 ears), they were 32 males and 8 females. The condition was bilateral in 34 patients and unilateral in 6 patients. Surgery was done by a modification of combined methods of Mustarde and Furnas with partial resection of conchal cartilage . The preoperative helical rim, temporo-mastoid surface distance was 28-40 millimeters (mean 34.6 mm) and 10-15 mm postoperatively (mean 12.1 mm). The preoperative cephalo-auricular angle was 50-90 degrees (mean 75.4 degrees), and was kept at 20-25 degrees (mean 22.5 degrees) postoperatively. Good esthetic and satisfaction results were noted by the patients, their families, and the surgical staff. No complication had occurred and no one needed surgical revision. In conclusion, the procedure was found to be simple, easily applied with good esthetic and satisfaction results.
https://bjsrg.uobasrah.edu.iq/article_163860_20dad4673daa46e375962b9e1e1985c5.pdf
2019-06-30
32
36
10.33762/bsurg.2019.163860
Prominent ear
correction
satisfaction
Cartilage
Incision lines
Mohammed
Hatif
1
Al-Wasity Plastic and Reconstructive Surgery Teaching Hospital, Baghdad
AUTHOR
Arwa
Kasim
2
Al-Karama General Teaching Hospital in Baghdad
AUTHOR
1. Maslanskas K. ,Astranskas T.Comparison of Otoplasty out comes using different types of suture materials.Int.Surg.2010; 95:88-93. 2. Janis J.E., Rohrich R.J. Otoplasty. Plast. Reconstr.Surg.2005;115:60-72. 3. Adamson P.A.,Strecker H.D. Otoplasty techniques.Facial Plast.Surg.1995;11:284-300. 4. Ernani Coelho Alencar. Brazilian Journal of plastic surgery. Artigo original-Ano 2015-vol.30.Numero 3. 5. Ozturan O., DogunR. Percutaneous adjustable closed otoplasty for prominent ear deformity. J.Craniofacial Surg. 2013;24:398-404. 6. Strychowsky JE., Moitri M. Incisionless otoplasty: A retrospective review and out comes analysis. Int.J.Pediatr.Otorhinolaryngol. 2013;77:1123-7. 7. Mustarde JC. The correction of prominent ears using simple mattress sutures. Br. J. Plast. Surg. 1963. Apr;16:170- 178. 8. Calder JC. Naasan A. Morbidity of otoplasty: Areview of 562 consecutive cases. Br.J.Plast.Surg. 1994;47(3):170- 174. 9. Ferreira LM. Deformidades auricularis. In: Manual Cirugia Plastica. Sao Paulo:Athenen;1995;p.223-228. 10. Aygit AC. Molding the ears after anterior scoring and concha repositioning. Combined approach for protruding ear correction. Aesthtic Plast. Surg.2003 Jan-Feb;27(1);77-81. 11. Yugueros P, Friedland JA. Otoplsty. The experience of 100 consecutive patients. Plast.Reconstr.Surg. 2001;108:1045-1053. 12. Francisco DE Olivera. Correction of prom. ears by cartilage non incision technique, definition of the antihelix with Mustarde sutures and fixation of the ear cartilage at the mastoid. Rev.Bras.Cir.Plast.2011;26(4):602-607. 13. Erkan Yuce, Ali Can Gunenc. Surgical treatment of prominent ear: 5 year clinical experience in 108 patients.; Turkish journal of plastic surgery.2017;25(1):12-9. 14. Mallen RW. Otoplasty. Can.J. Otolaryngol.1974;3: 74. 15. Adamson JE, Horton CE. The growth pattern of the external ear. Plast. Reconstr. Surg.1965;36:466-470. 16. Wodak E.On the position and shape of the human auricle. Arch.Klin.Exp.Ohren Nasen. Kehl kopfheilkd.1967;188:331-335. 17. S.L.A.Jeffery. Complications following correction of prominent ears: An audit review of 122 cases. Department of plastic surgery, The Queen Victoria Hospital, East Grinstead,UK. 28 Sep. 1998. 18. Kakrinn Anesti. Otoplasty Morbidity. Modern Plastic Surgery.2013,3:28-33. 19. Felipe Yargas Borges. Complications of Otoplasty Surgeries. Artigo Original-Anno 2016-Vol. 31-Numero 2 . 20. Aki etal Coplicoes em Otoplastia: revisuo de 508 casos. Rev.Bras.Cir.Plast. 2006;21(3):140-144. 21. C.Bermneller. Quality of life and patient satisfaction after otoplasty. Europian Arch.of Otolaryngol.Nov.2012,Vol.269,Issue 11,PP. 2423-2431. 22. Murat Songu. Otoplasty in children younger than 5 years of age. Otolaryngology. Vol.74;Issue 3,March 2010 pp.292-296.
1
ORIGINAL_ARTICLE
TRANSLIMBAL INTRAOCULAR ENDOILLUMINATION DURING CATARACT SURGERY
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.
https://bjsrg.uobasrah.edu.iq/article_163867_feb7ce74cc6711d630eb99069c941ec6.pdf
2019-06-30
37
42
10.33762/bsurg.2019.163867
surgery
Cataract
Translimbal
Endo-illumination
Phacoemulsification
Fareed
Warid
1
College of Medicine, Basrah University, Basrah, IRAQ
AUTHOR
Maha
Elshafei
2
Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
AUTHOR
ORIGINAL_ARTICLE
BILE LEAK FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY, A PROSPECTIVE STUDY
Abdulkareem Jabbar Ghadban Al-Ebadi Consultant General & Laparoscopic Surgeon, MB,ChB, CABS, FACS, SAGES, Al-Sadr Teaching Hospital, Basrah, Iraq. Abstract Bile leakage is a very dangerous condition after laparoscopic cholecystectomy and may lead to fatal complications and serious care should be taken to diagnose the cause as early as possible because it may be sign of bile duct injury which is a major concern to the surgeons as if it is not diagnosed early, it will lead to dangerous complications such as biliary peritonitis, hepatic failure and even death. Early diagnosis is important to decrease morbidity and mortality. This study aimed to determine the incidence of bile leakage, its types of management and the outcome in patients with gall stone who are submitted to laparoscopic cholecystectomy. This prospective study was done in Basrah Al-Sadr Teaching Hospital in a two-year period from October 2013 to October 2015 on 560 patients, they were 378 females and 182 males. All of them have symptomatic gall stones and underwent laparoscopic cholecystectomy. All converted cases to open cholecystectomy were excluded. From the total number of 560 patients, nine patients developed bile leak in early post-operative period, 6 of them have drains and the other three have no drain and they were presented with signs and symptoms of intra-abdominal collection. The causes of leak were: common bile duct (CBD) injury in 2 cases, accessory duct in 3 patients, leak from the gall bladder bed in 3 cases and one case iatrogenic from intra-hepatic drain. All the patients were treated conservatively except the two patients with CBD injury who were treated; one with the aid endoscopic retrograde cholangio-pancreatography (ERCP) and the other by re-exploration. In conclusion, bile leak is a serious complication after laparoscopic cholecystectomy, although it is not common but it is important to identify the site of leak and should be treated urgently especially by drainage to avoid more severe results which may lead to increased morbidity and mortality
https://bjsrg.uobasrah.edu.iq/article_163871_800a6dbe1c619509df1d299bce0ba910.pdf
2019-06-30
43
47
10.33762/bsurg.2019.163871
Bile
Leak
Incidence
Laparoscopic
Cholecystectomy
complications
Abdulkareem
Ghadban Al-Ebadi
1
Consultant General & Laparoscopic Surgeon, MB,ChB, CABS, FACS, SAGES, Al-Sadr Teaching Hospital, Basrah, Iraq
AUTHOR
ORIGINAL_ARTICLE
COMBINED SURGICAL EXCISION WITH LOCAL INFILTRATION OF VERAPAMIL FOR THE TREATMENT OF KELOID; A CLINICAL STUDY
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.
https://bjsrg.uobasrah.edu.iq/article_163872_977f056412569e47524ed521ce418185.pdf
2019-06-30
48
55
10.33762/bsurg.2019.163872
Keloid
Scar
surgery
Excision
Verapamil
Jabir
Hameed
1
Plastic and Reconstructive Surgery, Al-Sadr Teaching Hospital, Basrah, IRAQ.
AUTHOR
ORIGINAL_ARTICLE
THE EFFECT OF LIMITED VERSUS EXTENDED AXILLARY LYMPH NODES DISSECTION IN THE DEVELOPMENT OF POST-MASTECTOMY MORBIDITY
THE EFFECT OF LIMITED VERSUS EXTENDED AXILLARY LYMPH NODES DISSECTION IN THE DEVELOPMENT OF POST-MASTECTOMY MORBIDITY Ahmed N Abdulnabi MB,ChB, CABS, Specialist of General Surgery, AL-Fayhaa Teaching Hospital, Basrah, IRAQ. Abstract Breast cancer is a common malignancy in female, modified radical mastectomy is widely used for the management of this tumour. Axillary lymph nodes dissection is accompanied by frequent postoperative morbidity including wound infection, paresthesia, seroma and upper limb lymphedema. This is a comparative study that was conducted to evaluate the frequency of postoperative morbidity in a limited and extended axillary lymph nodes dissection. One hundred and fifty patients were treated by modified radical mastectomy for invasive ductal carcinoma of the breast between January 2008 and October 2015 in Al-Fayhaa Teaching Hospital. This sample was divided into two groups; the first fifty patients were managed with limited N1 axillary dissection while the other one hundred patients with extended N2 axillary dissection. The postoperative morbidity in the form of wound infection, paresthesia, seroma formation and upper limb lymphedema were analyzed in respect to the N1 or N2 axillary lymph nodes dissection. The highest occurrence was in the age group between 36 and 45 years. Wound infection develops in 16% of patients in the first group and 12% in the second group. Seroma occurred in 20% in the first group and 23% in the second group. Paresthesia was obviously higher in the second group (19%) when compared with 4% in the first group. Lymphedema occurred more in the second group (26%), and less in the first group (4%). In conclusion, limited axillary lymph nodes dissection during modified radical mastectomy for patients with no or few axillary lymph nodes involvement is associated with low postoperative morbidity. Key words: Mastectomy,Axillary lymph nodes,Morbidity, Limited dissection, Extended dissection
https://bjsrg.uobasrah.edu.iq/article_163873_20f0818b23ffcaca9697d1f4a77107cd.pdf
2019-06-30
55
60
10.33762/bsurg.2019.163873
Mastectomy
Axillary lymph nodes
Morbidity
Limited dissection
Extended dissection
Ahmed
Abdulnab
1
Specialist of General Surgery, AL-Fayhaa Teaching Hospital, Basrah, IRAQ
AUTHOR
ORIGINAL_ARTICLE
MULTINODULAR GOITER AND RISK OF MALIGNANCY, SURGERY OR FOLLOW UP ?
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
https://bjsrg.uobasrah.edu.iq/article_163874_80e04151102d6c6a53a14031accc2635.pdf
2019-06-30
61
65
10.33762/bsurg.2019.163874
Goiter
malignancy
FNAC
surgery
Incidence
Ali
Alwajeeh
1
General Surgeon, Almawanee Teaching Hospital, Basrah, IRAQ.
AUTHOR
1. Shrestha D, Shrestha S. The incidence of Thyroid Carcinoma in Multinodular Goiter. Journal of college of medical science-Nepal, 2014, 10(4); 18-21. 2. Pang H-N, Chen C-M. Incidence of Cancer in nodular goiter. Ann Acad Med Singapore, 2007, 36; 241-43. 3. Hanumanthappa M.B., Gopinathan S., Rithin Suvarna. The incidence of Malignancy in Multinodular goiter. Journal of clinical and diagnostic research, 2012, 6(2); 267-70. 4. Ameet V. Khatawkar, Shreeharsha Mallappa Awati. Multinodular goiter: Epidimiology, Etiology, Pathogenesis and Pathology. IAIM, 2015, 2(9); 152-56. 5. Pier Paolo Gandolfi, Antonio Frisina, Maurizio Raffa, Flavia Renda, Alberto Tombolini. The incidence of Carcinoma in multinodular goiter: retrospective analysis. ABMAP, 2004,75; 114- 17. 6. Jie Luo, Catherine mcmanus, Herbert Chen, Rebecca S. Sippel. Are there predictors of malignancy in patient with multinodular goiter?. J Surg Res., 2012, 174(2); 207-10. 7. Mohammad Mostafizur Rahman, Mohammad Idrish, Abdul Karim, Mohammad Shahrior Arafat, Mohammad Hanif. Frequency of malignancy in Multinodular goiter. Bangladish J Otorhinolaryngeal, 2014, 20(2); 75-79. 8. Laszlo Hegedus, Steen J. Bonnema, Finn N Bennedbaek. Management of simple nodular Goiter: Current Status and Future perspectives. Endocrine Review, 2003, 24(1); 102-132. 9. Sharma R., Verma N., Kaushal V., Sharma DR. Diagnostic Accuracy of fine needle aspiration cytology of thyroid Gland lesion: A study of 200 cases in Himalayan belt. J CAN Res Ther, 2017, 13; 451-55. 10. Rozan K. A., William O. Q., Zalooma J. S., Multinodular goiter Epidimiology and Etiology: Retrospective Study. Ger J Thy., 2016, 5(2); 165-70. 11. Smith J. J. Cancer after thyroidectomy: a multi institutional experience with 1,523 patients. J Am Coll Surg, 2013, 216; 571-79. 12. Ullah I., Hafeez M., Ahmad N., Muhammad G., Gandapur S. Incidence of thyroid malignancy in multinodular goiter. J Med Sci., 2014, 22(4); 164-65. 13. Kuan-Chen Chen, Usama Iqbal, Chug-Huei Hsu, Cheng-Ling Huang. The impact of different surgical procedures on hypoparathyroidism after thyroidectomy. Md-journal, 2017, 96; 43-50. 14. Thomusch O, Machens A, Sekulla C. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multi-center study in germany. World j surg, 2000, 24; 1335-41.
1
ORIGINAL_ARTICLE
EVALUTION OF BILATERAL V-Y ROTATION ADVANCEMENT FLAPS FOR TREATMENT OF FINGERTIP AMPUTATION
EVALUTION OF BILATERAL V-Y ROTATION ADVANCEMENT FLAPS FOR TREATMENT OF FINGERTIP AMPUTATION Jabir Raheem Hameed* and Roaa Hamed Mahmood@*MB, ChB, FICMS, Consultant Plastic and Reconstructive Surgeon, Al-Sadr Teaching Hospital, Basrah. @MB, ChB, Candidate of CABHS, Plastic and Reconstructive Surgery, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Fingertip amputation is the most common injury of the upper limb. The goals of treating it are; covering the defect, achieve sensibility, preserving the length of the finger by using durable coverage, obtaining the satisfactory aesthetic appearance and allow the patient for faster return to work. This study aimed to evaluate the use of bilateral V-Y rotation advancement flaps for the management of fingertip amputations with exposed bones and to assess the functional and aesthetic outcome. Between January 2017 and August 2018, bilateral V-Y rotation advancement flaps was performed on eleven male patients, average age 32 years, whose fingertip amputation with variable planes and zones. Patients were followed-up for at least 6-12 months. Twenty two flaps were made on 11 fingers, there was no partial or total flap loss. Patients had neither cold intolerance nor scar hypersensitivity, no obvious hook nail deformity apart of one patient. Because flap have neurovascular bundle inside it, so no change in sensation or perfusion occur postoperatively. In conclusion, the V-Y rotation advancement flap is simple, single stage operation that is optimum for surgical reconstruction of any fingertip injury. It provides a good contour, finger pulp coverage and acceptable appearance. Keywords: Fingertip. Amputation, Pulpa, V-Y flap, Reconstruction.
https://bjsrg.uobasrah.edu.iq/article_163876_e1c99c4744d4694058f4d91ee7d72e0e.pdf
2019-06-30
66
73
10.33762/bsurg.2019.163876
Fingertip. Amputation
Pulpa
V-Y flap
Reconstruction
Jabir
Hameed
1
Al-Sadr Teaching Hospital, Basrah.
AUTHOR
1. Steven L. Moran, William P. Cooney, III. Master techniques in orthopedic surgery : soft tissue surgery, 1st ed., Wolters Kluwer, Lippincott Williams and Wilkins, Philadelphia, 2009; pp. 246-247. 2. Achilleas thoma, Larisa Kristine Vartija. Making the V-Y advancement flap safer in fingertip amputation, Can J plast surg, 2010; 18(4):e47-e49. 3. Charles H. Thorane. Grabb and smith’s plastic surgery, 5th. Ed., Lippincott- Raven, Philadelphia,1997;pp. 835. 4. Nezih sunger, yuksel kankaya, kaya yildiz. Bilateral V-Y rotation advancement flap for fingertip amputation, HAND, 2012;7:79-85. 5. Leo M.Rozmaryn. fingertip injuries: Diagnosis, Management and reconstruction, 1st ed., springer, New York,2015;pp.6-83-101. 6. Edward A. Jackson. The V-Y plasty in the treatment of fingertip amputation, American family physician, 2001;64(3):455-458. 7. Jeffrey E. Janis. Essential of plastic surgery, 2nd ed., CRC press, New York, 2014 ; pp. 812. 8. Scott w. wolfe, Robert N. Hotchkiss, William C. Pedrerson, Scott H. Kozin. Green’s operative hand surgery, Sixth ed., Elsevier, philadilphia, 2011;pp. 1888. 9. Joseph G. McCarthy, Robert D. Galiano, Sean G. Boutros. Current therapy in plastic surgery, 1st ed., Saunders Elsevier, Philadelphia, 2006 ; pp.556. 10. Scott W. Wolfe, Robert N. Hotchkiss, William C. Pedrson, Scott H. Kozin, Mark S. Cohen. Green’s operative hand surgery, seventh ed., Elservier, Philadelphia, 2017; pp. 1717-1713. 11. Terri M. Skirven , A. Lee Osterman, Jane M. Fedorczyk, Peter C. Amadio. Rehabilitation of the hand and upper extremity, Sixth ed. , Elsevier Mosby, philadelphia, 2011; pp. 259. 12. Ross D. Farhadieh, Neil W. Bulstrode, Sabrina Cuguo. Plastic and reconstructive surgery: Approaches and technique, 1st ed., Wiley Black well, UK, 2015; PP. 688. 13. Yeo C J, Sebastian S J,Chong A K S. Fingertip injuries , Singapore Med J, 2015;52(1):78-86. 14. Mahdi H Abood, Amer S Daood. A comparative study of the supraperiosteal and the subperiosteal dissection in the V-Y advancement (Atasoy) flap for the management of fingertip injury: Basrah Journal of Surgery, 2007;13(1):1-11.
1
ORIGINAL_ARTICLE
MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART XVI: HARMS LINKED TO DRUGS ADMINISTERED DURING ANESTHESIA
MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART XVI: HARMS LINKED TO DRUGS ADMINISTERED DURING ANESTHESIASalam N Asfar@ & Jasim M Salman# @MB,ChB, MSc, Professor of Anesthesiology, College of Medicine, University of Basrah. #MB,ChB, DA, FICMS, Assist. Prof. & Consultant Anesthesiologist, College of Medicine, University of Basrah, Basrah, IRAQ. Unpleasant drug incidents are common during medical action. In anesthetic practice, the probability of errors is greater because of more tension and rapidity. Morbidity and even mortality are more expected in the course of anesthesia. Apart from many hazards that patients are exposed to such as; Biological hazards, Mechanical hazards, Chemical hazards, Physical hazards, and Personal Hazards1, it seems that danger of drug problems are more.
https://bjsrg.uobasrah.edu.iq/article_163877_6f2753990d6d994176249f7e682f9e50.pdf
2019-06-30
74
75
10.33762/bsurg.2019.163877
Jasim
Salman
jasim.salman@uobasrah.edu.iq
1
College of Medicine, University of Basrah, Basrah, IRAQ
AUTHOR
Salma
Asfar
2
department of surgery, college of medicine, university of basrah
LEAD_AUTHOR
1. Sukhminder Jit Singh Bajwa, and Jasbir Kaur, Risk and safety concerns in anesthesiology practice: The present perspective. Anesth Essays Res. 2012;6 (1): 14–20. 2. Dilip Kothari, Suman Gupta, Chetan Sharma, and Saroj Kothari. Medication error in anaesthesia and critical care: A cause for concern. Indian J Anaesth. 2010 May-Jun; 54(3): 187–192. 3. Mike Stabile, Craig S. Webster, Alan F. Merry. Medication administration in anesthesia. APSF newsletter, 2007; Volume 22, No.3. 4.Beverley A. Orser, Sylvia Hyland, David U. Review article: Improving drug safety for patients undergoing anesthesia and surgery. Canadian Journal of Anesthesia. February 2013, Volume 60, Issue 2, pp 127–135. 5. Paix AD, Bullock MF, Runciman WB, Williamson JA; Crisis management during anaesthesia: problems associated with drug administration during anaesthesia. Qual Saf Health Care 2005;14:e15 (http://www.qshc.com/cgi/content/full/14/3/e15.
1