ORIGINAL_ARTICLE
DOES ANTICOAGULANT THROMBOPROPHYLAXIS INCREASE BLEEDING COMPLICATIONS IN SPINAL SURGERY AND SPINAL CORD INJURY? A SYSTEMATIC REVIEW AND META-ANALYSIS
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.
https://bjsrg.uobasrah.edu.iq/article_165459_c81429412483de00ae4ebca97a759b83.pdf
2020-06-22
9
20
10.33762/bsurg.2020.165459
spine
surgery
spinal cord injury
Trauma
thromboprophylaxis
Anticoagulant
Bleeding
epidural spinal haematoma
wound
Complication
Anh
Nguyen
1
MBChB, MRCS(Eng), PGDipSurgAnat, MSc(Orth Tr Sci), Orthopaedic registrar, Saint George’s University Hospitals, London, UK.
AUTHOR
Sonia
BMed
2
MS (Surg Sci), Surgical registrar, The Children’s Hospital at Westmead, New South Wales, Australia
AUTHOR
Thamer
Hamdan
3
FRCS, FRCP, FACS, FICS, American Board (Neuro Ortho) Professor of Orthopaedic Surgery, Research fellow, Saint George's University Hospital, London, UK.
AUTHOR
Robin
Turner
4
PhD, MBiostat, Associate Professor and Director, Biostatistics Unit, University of Otago, Dunedin, New Zealand.
AUTHOR
Ahmed
Sadek
5
MBBS(Hons) BSc(Hons) DPhil.(Oxon), FRCS(SN), Spinal neurosurgeon, Department of Spinal Surgery, Royal London Hospital, London, United Kingdom.
AUTHOR
Darren
Lui
6
FRCS, Saint George's University Hospital, London, UK.
AUTHOR
Alexander
Montgomery
7
MBChB, MRCS(Eng), Dipl Orth(Eng), FRCS(Orth), Spinal surgeon and Clinical Lead, Department of Spinal Surgery, Royal London Hospital, London, United Kingdom.
AUTHOR
1.National Institute for Health and Clinical Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline (NG89)2018.
1
2.Bono CM, Watters WC, 3rd, Heggeness MH, Resnick DK, Shaffer WO, Baisden J, et al. An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. The spine journal : official journal of the North American Spine Society. 2009;9(12):1046-51.
2
3.Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S-e77S.
3
4.Schizas C, Neumayer F, Kosmopoulos V. Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis. European Spine Journal. 2008;17(7):970-4.
4
5.Frim DM, Barker FG, 2nd, Poletti CE, Hamilton AJ. Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. Neurosurgery. 1992;30(6):830-2; discussion 2-3.
5
6.Wetzel N, Anderson MC, Shields TW. Pulmonary embolism as a cause of death in the neurosurgical patient. Journal of neurosurgery. 1960;17:664-8.
6
7.Tribe CR. Causes of Death in the Early and Late Stages of Paraplegia. Paraplegia. 1963;1:19-47.
7
8.Teasell RW, Hsieh JT, Aubut J-AL, Eng JJ, Krassioukov A, Tu L. Venous Thromboembolism After Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation. 2009;90(2):232-45.
8
9.El Masri WS, Silver JR. Prophylactic anticoagulant therapy in patients with spinal cord injury. Paraplegia. 1981;19(6):334-42.
9
10.Mosenthal WP, Landy DC, Boyajian HH, Idowu OA, Shi LL, Ramos E, et al. Thromboprophylaxis in Spinal Surgery. Spine. 2018;43(8):E474-E81.
10
11.Singh S, Haut ER, Brotman DJ, Sharma R, Chelladurai Y, Shermock KM, et al. Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations. Rockville (MD); 2013.
11
12.Bryson DJ, Uzoigwe CE, Braybrooke J. Thromboprophylaxis in spinal surgery: a survey. Journal of Orthopaedic Surgery and Research 2012;7(14).
12
13.Jacobs LJ, Woods BI, Chen AF, Lunardini DJ, Hohl JB, Lee JY. Safety of thromboembolic chemoprophylaxis in spinal trauma patients requiring surgical stabilization. Spine. 2013;38(16):E1041-7.
13
14.Glotzbecker MP, Bono CM, Harris MB. Surgeon practices regarding postoperative thromboembolic prophylaxis after high- risk spinal surgery. Spine. 2008;33:2915-21.
14
15.Glotzbecker MP, Bono CM, Wood KB, Harris MB. Postoperative spinal epidural hematoma: a systematic review. Spine. 2010;35(10):E413-20.
15
16.Ploumis A, Ponnappan RK, Sarbello J, Dvorak M, Fehlings MG, Baron E, et al. Thromboprophylaxis in traumatic and elective spinal surgery: analysis of questionnaire response and current practice of spine trauma surgeons. Spine. 2010;35(3):323-9.
16
17.Hamidi S, Riazi M. Incidence of venous thromboembolic complications in instrumental spinal surgeries with preoperative chemoprophylaxis. Journal of Korean Neurosurgical Society. 2015;57(2):114-8.
17
18.Chang R, Scerbo MH, Schmitt KM, Adams SD, Choi TJ, Wade CE, et al. Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury. The journal of trauma and acute care surgery. 2017;83(6):1088-94.
18
19.Dhillon ES, Khanna R, Cloney M, Roberts H, Cybulski GR, Koski TR, et al. Timing and risks of chemoprophylaxis after spinal surgery: a single-center experience with 6869 consecutive patients. Journal of Neurosurgery: Spine. 2017;27(6):681-93.
19
20.Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). CHEST. 2008;133(6):381S-453S.
20
21.Cheng JS, Arnold PM, Anderson PA, Fischer D, Dettori JR. Anticoagulation risk in spine surgery. Spine. 2010;35(9 Suppl):S117-24.
21
22.The Cochrane Collaboration. Review Manager (RevMan). 5.3 ed. Copenhagen: The Nordic Cochrane Centre; 2014.
22
23.Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355.
23
24.Schünemann H, Brożek J, Guyatt G, Oxman A. The GRADE handbook published year 2013. Available from: http://gdt.guidelinedevelopment.org/app/handbook/handbook.html.
24
25.The Cochrane Consumers & Communication Review Group. GRADE approach to evaluating the quality of evidence: a pathway 2017 [Available from: http://training.cochrane.org/path/grade-approach-evaluating-quality-evidence-pathway.
25
26.Zeng X-J, Peng H. Prevention of Thromboembolic Complications After Spine Surgery by the Use of Low-Molecular-Weight Heparin. World Neurosurgery. 2017;104:856-62.
26
27.Cox JB, Weaver KJ, Neal DW, Jacob RP, Hoh DJ. Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis. Journal of Neurosurgery: Spine. 2014;21(4):677-84.
27
28.Cunningham JE, Swamy G, Thomas KC. Does preoperative DVT chemoprophylaxis in spinal surgery affect the incidence of thromboembolic complications and spinal epidural hematomas? Journal of spinal disorders & techniques. 2011;24(4):E31-4.
28
29.Dewan MC, Godil SS, McGirt MJ. Mechanical vs Chemical Prophylaxis for Deep Venous Thrombosis in Patients Undergoing Lumbar Spinal Fusion: Comparative Effectiveness and Cost-Benefit. Neurosurgery. 2013;60:S158.
29
30.Rokito SE, Schwartz MC, Neuwirth MG. Deep vein thrombosis after major reconstructive spinal surgery. Spine. 1996;21(7):853-8; discussion 9.
30
31.Green D, Rossi EC, Yao JS, Flinn WR, Spies SM. Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. Paraplegia. 1982;20(4):227-34.
31
32.Chunhong L, Jin L, Qin Z, Guohui X. Anticoagulant effects of Rivaroxaban after surgical fixation of spinal fracture. Pakistan journal of pharmaceutical sciences. 2018;31(3(Special)):1131-5.
32
33.Epstein. N, Hood. D.C, Ransohoff. J. Gastrointestinal bleeding in patients with spinal cord trauma. Journal of neurosurgery. 1981;54(1):16-20.
33
34.Sansone JM, del Rio AM, Anderson PA. The Prevalence of and Specific Risk Factors for Venous Thromboembolic Disease Following Elective Spine Surgery. 2010;92(2):304-13.
34
35.Brooks F, Lau S, Baddour E, Rao P, Bhagat S, Ahuja S. Thromboprophylaxis in Spinal Surgery – Current UK Practice. 2013.
35
36.Fang MC, Maselli J, Lurie JD, Lindenauer PK, Pekow PS, Auerbach AD. Use and Outcomes of Venous Thromboembolism Prophylaxis after Spinal Fusion Surgery. Journal of thrombosis and haemostasis : JTH. 2011;9(7):1318-25.
36
37.Glotzbecker MP, Bono CM, Wood KB, Harris MB. Thromboembolic disease in spinal surgery: a systematic review. Spine. 2009;34(3):291-303.
37
38.Smith JS, Fu K-MG, Polly JDW, Sansur CA, Berven SH, Broadstone PA, et al. Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine. 2010;35(24):2140-9.
38
39.Piran S, Bednar D, Drew B, Schulman S. Optimal timing of starting thromboprophylaxis for patients with acute spinal cord injury: A survey of Canadian spine surgeons. Thromb Res. 2017;160:38-40.
39
40.Dearborn JT, Hu SS, Tribus CB, Bradford DS. Thromboembolic complications after major thoracolumbar spine surgery. Spine. 1999;24(14):1471-6.
40
41.Nazareth A, D’Oro A, Liu JC, Schoell K, Heindel P, Jakoi A, et al. Risk Factors for Postoperative Venous Thromboembolic Events in Patients Undergoing Lumbar Spine Surgery. Global Spine Journal. 2018:2192568218797094.
41
42.Brambilla S, Ruosi C, La Maida GA, Caserta S. Prevention of venous thromboembolism in spinal surgery. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2004;13(1):1-8.
42
43.Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N. Deep venous thrombosis after posterior spinal surgery. Spine. 2000;25(22):2962-7.
43
44.Consortium for Spinal Cord Medicine. Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed. Topics in Spinal Cord Injury Rehabilitation. 2016;22(3):209-40.
44
45.Fehlings MG, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke DS, et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis. Global Spine Journal. 2017;7(3_suppl):212S-20S.
45
46.Velmahos GC, Kern J, Chan LS, Oder D, Murray JA, Shekelle P. Prevention of venous thromboembolism after injury: an evidence-based report--part II: analysis of risk factors and evaluation of the role of vena caval filters. The Journal of trauma. 2000;49(1):140-4.
46
47.Halim TA, Chhabra HS, Arora M, Kumar S. Pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury: an Indian perspective. Spinal cord. 2014;52(7):547-50.
47
48.Agarwal NK, Mathur N. Deep vein thrombosis in acute spinal cord injury. Spinal cord. 2009;47:769.
48
49.Merli GJ, Herbison GJ, Ditunno JF, Weitz HH, Henzes JH, Park CH, et al. Deep vein thrombosis: prophylaxis in acute spinal cord injured patients. Arch Phys Med Rehabil. 1988;69(9):661-4.
49
50.Smith MD, Bressler EL, Lonstein JE, Winter R, Pinto MR, Denis F. Deep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. A prospective analysis of three hundred and seventeen patients. The Journal of bone and joint surgery American volume. 1994;76(7):980-5.
50
51.Silver JR. The prophylactic use of anticoagulant therapy in the prevention of pulmonary emboli in one hundred consecutive spinal injury patients. Paraplegia. 1974;12:188.
51
52.Kim DY, Kobayashi L, Chang D, Fortlage D, Coimbra R. Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures. Spine. 2015;40(5):299-304.
52
ORIGINAL_ARTICLE
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.
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.
https://bjsrg.uobasrah.edu.iq/article_165461_6c4e9f1c75fe736fb91466dac2fda027.pdf
2020-06-22
21
31
10.33762/bsurg.2020.165461
Key words: stereotactic radiosurgery
surgery
conventional external beam radiotherapy
spinal oligometastatic disease
Priyanshu
Saha
1
MB,BS Student, Saint George’s University of London.
AUTHOR
Thamer
Hamdan
2
Hamdan FRCS, FRCP, FACS, FICS, American Board (Neuro Ortho) Professor of Orthopaedic Surgery, Research fellow, Saint George's University.
AUTHOR
Bisola
Ajayi
3
Ortho/Spine Physician Associate.
AUTHOR
Cristina
Lupu
4
Spine CNS
AUTHOR
Timothy
Bishop
5
FRCS.
AUTHOR
Jason
Bernard
6
MD, FRCS.
AUTHOR
Darren
Lui
7
FRCS, Saint George's University, London, UK.
AUTHOR
ORIGINAL_ARTICLE
THE BENEFICIAL EFFECTS OF TONSILLAR FOSSA CLOSURE AFTER TONSILLECTOMY; A PROSPECTIVE STUDY
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.
https://bjsrg.uobasrah.edu.iq/article_165463_cf5b488997d26284c69b8c9ac3bc460c.pdf
2020-06-22
32
37
10.33762/bsurg.2020.165463
surgery
tonsillectomy
Fossa closure
Bleeding
pain
Muhanned
Al-Ali
1
MB,ChB, FIBMS, Department of Otolaryngology, Basrah Teaching Hospital.
AUTHOR
Ahmed
Al-Abbasi
ahmed.mhoder@uobasrah.edu.iq
2
MB,ChB, FIBMS, FRCS, Professor of Otolaryngology, Department of Surgery, College of Medicine, University of Basrah, IRAQ.
AUTHOR
Haider
Hashim
3
FIBMS, Department of Otolaryngology, Basrah Teaching Hospital.
AUTHOR
Haider
Saeed
4
FIBMS, Department of Surgery, Medina General Hospital.
AUTHOR
Ali
Altaie
5
FIBMS, Abualkhaseeb General Hospital, Basrah, IRAQ.
AUTHOR
ORIGINAL_ARTICLE
THE EFFICACY AND SAFETY OF CERVICAL SPINE IMMOBILIZATION IN ELDERLY PATIENTS WITH CERVICAL SPINE FRACTURES: A SYSTEMATIC REVIEW
As both life expectancy and average population age continue to rise, so too does the incidence of cervical spine (c-spine) injuries. C-spine fractures are associated with high morbidity and mortality, but the question is how best to treat them? This review is to compare the safety and efficacy of c-spine immobilisation in a rigid collar with other treatment modalities in elderly population. Available literature was reviewed to determine how treatment efficacy is assessed, with particular focus on whether osseous union or fibrous non-bony union should be considered as a successful outcome. This study was designed in accordance with PRISMA guidelines. Pubmed/Medline databases were selected for analysis. When considering patients over the age of 65, it is unclear whether management with a collar is safer than operative management or immobilisation with HALO vest. However, amongst studies that further subdivide elderly patients according to age there is more of a consensus; it appears that in those under the age of 75, operative management is safer, whereas in those over the age of 85, immobilisation in a collar is associated with lower mortality rates. Between the ages of 75-85 there is less clarity. Osseous union occurs more commonly in patients managed operatively, but fibrous non-bony union was not associated with any adverse outcomes in these studies. Conclusion: At present, there are no randomised controlled trials that have tried to delineate whether management in a collar is safer or more effective than other treatments such as HALO vest or operative fixation. However, evidence from various cohort studies does suggest that “elderly” patients with c-spine fractures should not be considered as one homogenous cohort, but should instead be subdivided according to age. Interestingly, these studies suggest that fibrous non-bony union may be an adequate treatment outcome in older. Further research into this complex field is required. Keywords: Trauma, elderly care, spinal fractures, treatment outcome, survival rate
https://bjsrg.uobasrah.edu.iq/article_165466_83986d479be77c6238d597d4cf8614c2.pdf
2020-06-22
38
45
10.33762/bsurg.2020.165466
Trauma
elderly care
spinal fractures
treatment outcome
Survival rate
S.
Epton
1
Trauma and Orthopaedics Department, Saint George's University Hospital, London, UK.
AUTHOR
R.
Preece
2
Trauma and Orthopaedics Department, Saint George's University Hospital, London, UK.
AUTHOR
D.
Hay
3
Trauma and Orthopaedics Department, Saint George's University Hospital, London, UK.
AUTHOR
M.
kaminaris
4
Trauma and Orthopaedics Department, Saint George's University Hospital, London, UK.
AUTHOR
D.
Lui
5
Trauma and Orthopaedics Department, Saint George's University Hospital, London, UK.
AUTHOR
A.
Trompeter
6
Trauma and Orthopaedics Department, Saint George's University Hospital, London, UK.
AUTHOR
1. Krug. EG SG, Lozano. R. The global burden of injuries. American Journal of Public Health. 2000;90:523-6.
1
2. Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32:911-5.
2
3. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64-9.
3
4. Watanabe M, Sakai D, Yamamoto Y, Sato M, Mochida J. Upper cervical spine injuries: age-specific clinical features. J Orthop Sci. 2010;15:485-92.
4
5. Majercik S, Tashjian RZ, Biffl WL, Harrington DT, Cioffi WG. Halo vest immobilization in the elderly: a death sentence? J Trauma. 2005;59:350-6; discussion 6-8.
5
6. Delcourt T, Bégué T, Saintyves G, Mebtouche N, Cottin P. Management of upper cervical spine fractures in elderly patients: current trends and outcomes. Injury. 2015;46 Suppl 1:S24-7.
6
7. Koech F, Ackland HM, Varma DK, Williamson OD, Malham GM. Nonoperative management of type II odontoid fractures in the elderly. Spine (Phila Pa 1976). 2008;33:2881-6.
7
8. Patel A, Zakaria R, Al-Mahfoudh R, Clark S, Barrett C, Sarsam Z, et al. Conservative management of type II and III odontoid fractures in the elderly at a regional spine centre: A prospective and retrospective cohort study. Br J Neurosurg. 2015;29:249-53.
8
9. Scheyerer MJ, Zimmermann SM, Simmen HP, Wanner GA, Werner CM. Treatment modality in type II odontoid fractures defines the outcome in elderly patients. BMC Surg. 2013;13:54.
9
10. Molinari W, Khera O, Gruhn W, Molinari RW. Functional outcomes, morbidity, mortality and fracture healing rates in 58 consecutive geriatric odontoid fracture patients treated with cervical collar or posterior fusion. Evid Based Spine Care J. 2011;2:55-6.
10
11. Woods BI, Hohl JB, Braly B, Donaldson W, Kang J, Lee JY. Mortality in elderly patients following operative and nonoperative management of odontoid fractures. J Spinal Disord Tech. 2014;27:321-6.
11
12. Malik SA, Murphy M, Connolly P, O'Byrne J. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Eur Spine J. 2008;17:585-91.
12
13. Damadi AA, Saxe AW, Fath JJ, Apelgren KN. Cervical spine fractures in patients 65 years or older: a 3-year experience at a level I trauma center. J Trauma. 2008;64:745-8.
13
14. Tashjian RZ, Majercik S, Biffl WL, Palumbo MA, Cioffi WG. Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures. J Trauma. 2006;60:199-203.
14
15. Chen YR, Boakye M, Arrigo RT, Kalanithi PS, Cheng I, Alamin T, et al. Morbidity and mortality of C2 fractures in the elderly: surgery and conservative treatment. Neurosurgery. 2012;70:1055-9; discussion 9.
15
16. Fagin AM, Cipolle MD, Barraco RD, Eid S, Reed JF, Li PM, et al. Odontoid fractures in the elderly: should we operate? J Trauma. 2010;68:583-6.
16
17. Graffeo CS, Perry A, Puffer RC, Carlstrom LP, Chang W, Mallory GW, et al. Deadly falls: operative versus nonoperative management of Type II odontoid process fracture in octogenarians. J Neurosurg Spine. 2017;26:4-9.
17
18. Smith HE, Kerr SM, Maltenfort M, Chaudhry S, Norton R, Albert TJ, et al. Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study. J Spinal Disord Tech. 2008;21:535-9.
18
19. Schoenfeld AJ, Bono CM, Reichmann WM, Warholic N, Wood KB, Losina E, et al. Type II odontoid fractures of the cervical spine: do treatment type and medical comorbidities affect mortality in elderly patients? Spine (Phila Pa 1976). 2011;36:879-85.
19
20. van Middendorp JJ, Albert TJ, Veth RP, Hosman AJ. Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors. Spine (Phila Pa 1976). 2010;35:1079-87.
20
21. Barlow DR, Higgins BT, Ozanne EM, Tosteson AN, Pearson AM. Cost Effectiveness of Operative Versus Non-Operative Treatment of Geriatric Type-II Odontoid Fracture. Spine (Phila Pa 1976). 2016;41:610-7.
21
22. Anderson LD, D'Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56:1663-74.
22
ORIGINAL_ARTICLE
HYPOCALCEMIA FOLLOWING THYROIDECTOMY; A PROSPECTIVE STUDY IN BASRAH, IRAQ
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.
https://bjsrg.uobasrah.edu.iq/article_165483_9536511f17a0a6ba56d364158e1ff7ed.pdf
2020-06-22
46
50
10.33762/bsurg.2020.165483
Prospective study
hypocalcemia
Thyroidectomy
Basrah
surgery
Rabee
Qasim
1
MB,ChB, CABS, Department of Surgery, Basrah Teaching Hospital.
AUTHOR
Haider
Saeed
2
MB,ChB, FIBMS, Department of Otolaryngology, Basrah Teaching Hospital.
AUTHOR
Ahmed
Al-Abbasi
ahmed.mhoder@uobasrah.edu.iq
3
FRCS, FIBMS, Department of Surgery, College of Medicine, University of Basrah.
AUTHOR
Mohammed
Mohammed
4
FRCS, CABS, Department of Surgery, Basrah Teaching Hospital, Basrah, IRAQ.
AUTHOR
1.Van Gregory p. Sadler, Orlo H. Claek & Ton A. Heeeden, Thyroid and parathyroid" in: principles of surgery by: Seywour Schwartz, tenth edition McGraw-Hill, New York,1999,1661-1713.
1
2. M. H, Layth "One-year experience in thyroid surgery”. In: Iraqi Army Medical journal.vol.4, No. 1&2 1991:57-69.
2
3.John S, Kukora & James D. Hardy, "Complication of thyroid and parathyroid surgery" in: Complication in surgery and their management by James D. Hardy, fourth edition, W.B. Saunders, Philadelphia,1981:295-312.
3
4.Francois Patto & Frederic Combemale." Hypocalcemia following thyroid surgery: Incidence and prediction of outcome", World journal of surgery 1998:22:718-724.
4
5.A-Suliman N. N, Ryttov N. F. &Qvist N. Experience in specialist thyroid surgery unit: demographic study, surgical complication and outcome. Eur. Journal of surgery 1997Jan:163(1):13-20.
5
6.Bergamaschi R., Becouarn G.&Roucerray J. Morbidity of thyroid surgery, American Journal of surgery, 1998 Jul: 176(!):17-5.
6
7.Christian A. Seiler, Christine Glaser &Hans E. Wagner." Thyroid gland surgery in an endemic region”, World Journal of surgery 1996; 20;593-597.
7
8.John Webb. Breast and endocrine surgery in: An Aid to clinical Surgery by: Peter R. Scott,6th edition, Churchill Livingstone, Edinburgh,1998:179-193.
8
9. Rogério A.D., Elio G.P. J., Carlos E. M.N., Emmanuel C.D.B., Prospective study of clinical and laboratorial hypocalcemia after thyroid surgery. Braz J Otorhinolaryngology. 2010;76(1):71-7.
9
10.Ishtiaq Ahmed Chaudhary, Zia ud Din Afridi, Samiullah, Rehan Masood, Ashraf Ali Mallhi; To ligate or not the inferior thyroid artery to avoid hypocalcaemia after thyroid surgeryj Ayub Med Coll Abbottabad 2007; 19(2).
10
11.Barnouti N.H. The Iraqi pattern of goiter Iraqi Army Medical Journal, Vol.7. No. 1&2,1995:21-32.
11
12. Norman A. Matheson &Z. H. Krutowski, "The thyroid gland and thyroglossaal cyst" in: Short practice of surgery by: H. Baily and M. Love,25edition, Champion and Hall, London,1995: 506-529.
12
13. Thomusch O, Machens A, Sekulla C, Ukkat J, Braukhoff M Dralle H. The impact of surgical technique on post-Operative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery2003;133(2):180-5.
13
14. Hany Ali. Post thyroidectomy hypocalcaemia. Egyptian Journal of Surgery vol 27, No. 1, Jan.,2008.
14
15. W, Lamade, K. Renz & f. Willeue, Effect of training. The British journal of surgery,1999: 86: 388-391.
15
ORIGINAL_ARTICLE
ULTRASOUND ASSESSMENT OF RIGHT INTERNAL JUGULAR VEIN DIMENSIONS FOLLOWING PASSIVE LEGS ELEVATION VERSUS HEPATIC COMPRESSION
Central venous catheterization has an essential role in the management of patients who are critically ill, and patients who have special operative interventions. In general, the bigger the vein cross sectional area and diameter the easier the catheterization will be. There are different maneuvers to increase internal jugular vein caliber. These include; passive legs elevation, hepatic or abdominal compression, Trendelenburg position, Valsalva maneuver, and positive end-expiratory pressure.
The objective of the study is to evaluate the effect of passive legs elevation and hepatic compression on the diameter and the cross-sectional area of the right internal jugular vein.
This prospective study included 80 adult patients ASA class I and II. Patients who had any contraindication to the passive legs elevation or hepatic compression, or those with disruption of the local neck anatomy; were excluded from the study. Patients were evaluated for their right internal jugular vein cross-sectional area and diameter by the use of linear high frequency two-dimensional ultrasound. Each patient has three stages of measurement; supine, Passive legs elevation at (30o-45o) for one minute, and hepatic compression.
Of the 80 patients, 70% were males, the age range was (19–55 years) with a mean of (37.75±12.16) years, and the majority were overweight. The maximum diameter was achieved during hepatic compression with a stepwise statistically significant increase of about (0.44±0.27 cm) from the baseline in supine position, when compared to only (0.26±0.21 cm) during passive legs elevation. The cross-sectional area is significantly and maximally increased from the baseline of (0.93 ± 0.59 cm2), during hepatic compression. The increase in the diameter and the cross sectional area was more significant in males irrespective to age and weight.
In conclusion, Hepatic compression is significantly superior to the passive legs elevation in achieving more right internal jugular vein diameter and cross-sectional area.
https://bjsrg.uobasrah.edu.iq/article_165484_0d6cbec49f09ac2f44d857dbbe7c4cc6.pdf
2020-06-22
51
60
10.33762/bsurg.2020.165484
Internal jugular vein
supine position
passive legs elevation
hepatic compression
maximum diameter and cross sectional area
Jasim
Salman
jasim.salman@uobasrah.edu.iq
1
MB,ChB, DA, FICMS Anesth., Assist. Prof. & Consultant Anesthesiologist, College of Medicine, University of Basrah.
LEAD_AUTHOR
Mohammed
Jasim
2
MB,ChB, FICMS Anesth. Candidate, Alsadr Teaching Hospital.
AUTHOR
Salam
Asfar
3
MB,ChB, MSc Anesth., Professor of Anesthesiology, College of Medicine, University of Basrah, Basrah, IRAQ.
AUTHOR
References
1
1.Denys BG, Uretsky BF, and Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein, a prospective comparison to the external landmark-guided technique. Circulation May 1993; Vol 87 (5): 1557- 62.
2
2.Parmar S, Parikh S, and Mehtaet H. Anatomical variations of the internal jugular vein in relation to carotid artery: an ultrasound study. International Journal of Medical Science and Public Health 2013; Vol 2 (2): 223-8.
3
3.Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015;1(1):CD006962. Published 2015 Jan 9. doi: 10.1002/14651858.CD006962.pub2
4
4.Verghese ST, Nath A, Zenger D, Patel RI, Kaplan RF, and Patel KM. The effects of the simulated Valsalva maneuver, liver compression, and/or Trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children. Anesth Analg 2002; 94:250-4.
5
5.Kim WH, Lee JH, Lee SM, Kim CS, Kang R, Yoo CS et al. The Effect of passive leg elevation and/or Trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children undergoing surgery for congenital heart disease. Anesth Analg 2013; 116:178-84.
6
6.Lin BS, Kong CW, Tarng DC, Huang TP, and Tang GJ. Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients. Nephrol Dial Transplant (1998) 13: 134-8.
7
7.Ortega R, Song M, Hansen CJ, and Barash P. Ultrasound-guided internal jugular vein cannulation. Engl J Med 2010; 362: e57.
8
8.Solanki SL, Doctor JR, Kapila SJ, Jain A, Joshi M, Patil VP. Ultrasonographic assessment of internal jugular vein diameter and its relationship with the carotid artery at the apex, middle, and base of the triangle formed by two heads of sternocleidomastoid muscle: A pilot study in healthy volunteers. Saudi J Anaesth 2018; 12:578-83.
9
9.Lobato EB, Sulek CA, Moody RL, and Morey TE. Cross-sectional area of the right and left internal jugular veins. Journal of Cardiothoracic and Vascular Anesthesia April 1999; Vol 13(2): 136-8.
10
10.Ybarra LF, Ruiz H, Silva MP, Lederman HM, and Schettini ST. Ultrasound evaluations of internal jugular vein punction techniques in children: the easiest method to reach the target area. Pediatr Surg Int (2009) 25:99-104.
11
11.Tarnoki AD, Molnar AA, Tarnoki DL, Littvay L, Medda E, Fagnani C, et al. Heritability of the dimensions, compliance and distensibility of the human internal jugular vein wall. PLoS ONE 13(3): e0192948. https://doi.org/10.1371/journal.pone.0192948.
12
12.Bérczi V, Molnàr AA, Apor A, Kovács V, Ruzics C, Várallyay C, et al. Eur J Appl Physiol 2005; 95: 283-9.
13
13.Maheshwari P, Kelsheimer B, and Maheshwari P. Novel maneuvers to increase the internal jugular vein diameter during ultrasound-guided cannulation. Can J Anesth/J Can Anesth 2016; 63:898-900.
14
14.Gok F, Sarkilar G, Kilicaslan A, Yosunkaya A, Uzun ST. Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients. Int J Clin Exp Med. 2015;8(10):19037-43.
15
15.Kim JT, Kim HS, Lim YJ, Bahk JH, Lee KH, Kim CS, et al. The influence of passive leg elevation on the cross-sectional area of the internal jugular vein and the subclavian vein in awake adults. Anaesth Intensive Care 2008; 36: 65-8.
16
16.Dincyurek GN, Mogol EB, Turker G, Yavascaoglu B, Gurbet A, Kaya FN, et al. The effects of the Trendelenburg position and the Valsalva manoeuvre on internal jugular vein diameter and placement in children. Singapore Med J 2015; 56(8): 468-71.
17
17.Lobato EB, Florete Jr. OG, Paige GB, and Morey TE. Cross-sectional area and intravascular pressure of the right internal jugular vein during anesthesia: effects of Trendelenburg position, positive intrathoracic pressure, and hepatic compression. Journal of Clinical Anesthesia 1998; 10: 1-5.
18
18.Masjedi M, Sasani MR, Riahialam M, Hadavi MR, Rakhshan M, and Bakhodaei HH. The effect of passive leg raising maneuver on right internal jugular vein dimension in ICU patients under mechanical ventilation. World Family Medicine 2018;16(2):300-6.
19
19.Gu YJ, Lee JH, and Seo JI. Effect of lumbar elevation on dilatation of the central veins in normal subjects, American Journal of Emergency Medicine 2018; https://doi.org/10.1016/j.ajem.2018.07.032.
20
20.Bellazzini MA, Rankin PM, Gangnon RE, and Bjoernsen LP. Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease compressibility. American Journal of Emergency Medicine 2009; 27: 454-9.
21
21.Dhulkhed V, Reddy A, Gupta A, and Dhulkhed P. An observational study of change in diameter of right internal jugular vein with various body positions in volunteers with the aid of 2-dimensional ultrasonography. The Internet Journal of Anesthesiology Volume 21 (2): 1-6.
22
22.Erkan SO, Tuhanioğlu B, Arslan M, Erkan Z, Küçükoğlu T, Yildirim I. Assessment of internal jugular vein diameters in Turkish adults. Cumhuriyet Medical Journal June 2018, Volume 40(2): 142-9.
23
23.Seong H, Kang B, Kim G. Comparison of internal jugular vein dilation between Valsalva maneuver and proximal internal jugular vein compression. Clin Exp Emerg Med 2016;3(4):193-6.
24
24.Magnano C, Belov P, Krawiecki J, Hagemeier J, Beggs C, and Zivadinov R. Internal jugular vein cross-sectional area enlargement is associated with aging in healthy individuals. PLoS ONE 2016; 11(2): e0149532. doi: 10.1371/journal. pone.0149532.
25
25.Yoon HK, Lee HK, Jeon YT, Hwang JW, Lim SM, and Park HP. Clinical Significance of the Cross-Sectional Area of the Internal Jugular Vein. Journal of Cardiothoracic and Vascular Anesthesia August 2013; Vol 27(4): 685-9.
26
26.Judickas Š, Gineitytė D, Kezytė G, Gaižauskas E, Šerpytis M, and Šipylaitė J. Is the Trendelenburg position the only way to better visualize internal jugular veins? ACTA Medica Lituanica 2018; Vol 25(3): 125- 31.
27
27.Karaaslan P, Gokay BV, Karakaya MA, Darcin K, Karakaya AD, Ormeci T, et al. Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter. Ann Saudi Med 2017; 37(4): 308-12.
28
28.Armstrong PJ, Sutherland R, and Scott DHT. The effect of position and different manoeuvres on internal jugular vein diameter size. Acta Anaesthesiol Scand 1994: 38: 229-31.
29
29.Ewy GA. The abdominojugular test: technique and hemodynamic correlates. Annals of Internal Medicine. 1988; 109:456-60.
30
30.Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006; 34:1402-7.
31
31.Xavier Monnet X, and Teboul J. Passive leg raising. Intensive Care Med 2008; 34:659-63.
32
32.Mallory DL, Shawker T, Evans RG, McGee WT, Brenner M, Parker M, et al. Effects of clinical maneuvers on sonographically determined internal jugular vein size during venous cannulation. Crit Care Med. 1990 Nov; 18(11):1269-73.
33
ORIGINAL_ARTICLE
THE ACCURACY OF ABDOMINAL ULTRASONOGRAPHY IN THE DIAGNOSIS OF ACUTE APPENDICITIS
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.
https://bjsrg.uobasrah.edu.iq/article_165486_69687bbe0314561278b2649f5fce7cc0.pdf
2020-06-22
61
64
10.33762/bsurg.2020.165486
surgery
ultrasound
Abdomen
Acute appendicitis
Diagnosis accuracy
Ali
Kadhem
1
MB,ChB, CABS, Consultant General Surgeon, Alsadr Teaching Hospital.
AUTHOR
Shaymaa
Khalid
2
MB,ChB, CABS, Specialist General Surgeon, Alsadr Teaching Hospital, Basrah.
AUTHOR
Wisam
Al-Sewadi
3
CABS, FACS, FRCS, FICSMRCS, F.MAS, General and laparoscopic Surgeon, Al-Zahraa College of Medicine, University of Basrah, Basrah, IRAQ.
AUTHOR
1. Parsia Javidi Parsijani,NimaPourhhabibi Zarani and Shahram Bolandparvaz. Accuracy of U/S in acute appendicitis.Bulletin of Emergency and Trauma, 2013 Oct;(4):158-163.
1
2. Jerry L. Old., Reginald W. Dusing, Wendell Yap, and Jared Dirks. Imaging for suspected appendicitis. American family physician, Jan.1, 2005; 71-78.
2
3. Jonathan RL Wild, Nicole Abdul, Judith E Ritchie, Bo Rud, Sally Freels, RichardL Nelson. U/S for diagnosis of acute appendicitis. Cochrane data base of systemic review, 28 Feb.2013.
3
4. Subash K., Abhijit De, Mahesh Pathak and Brijesh Sathian. Diagnostic role of U/S in acute appendicitis. American journal of public health research, volume 3, no.5 A, 2015; p23-28.
4
5. Bimbam BA., Wilson SR. Appendicitis at the millennium RSNA radiology, May 2020; vol 215, issun 2,377-348.
5
6. Mohamed Samir, Mohamed Hefzy, Mohamed Gaber, Khaled Moghazy. Added value of graded compression UlS to the Alvarado score of right iliac fossa. African journal of emergency medicine, Sep 2016;vol.6(3):138-143.
6
7. Rodrigo de Oliveira Peixoto,Tarcizo Afonso Nunes. Indices of diagnostic abdominal U/S in acute appendicitis. Rev.Col.Brazil.Cir. vol -38 Rio de Janeiro, Marchl April2011;105-11.
7
8. Accuracy of ED sonography in the diagnosis of acute appendicitis. American journal of emergency medicine, vol.18,no.4, July2000;449-452.
8
9. Clinical presentation of acute appendicitis in adult at the Chrishani Baragwanth academic hospital. International journal of emergency medicine.17,Feb.2014;7:12.
9
10. Diagnosis of acute appendicitis. International journal of surgery. March2012; vol.19, issue3, 115-119.
10
11. Clinical value of total WBC and neutrophil counts in patients with suspected appendicitis. World journal of emergency surgery. 20,July2012;7:32.
11
12. Sonography of acute appendicitis and its mimicin children. Indian journal of radiology.2014;April-June,24(2):163-170.
12
ORIGINAL_ARTICLE
ASSESSMENT OF PAIN AND BLEEDING IN THE FIRST POSTOPERATIVE DAY FOLLOWING COBLATION TONSILLECTOMY
There are different techniques for tonsillectomy other than traditional such as; cold steel technique, bipolar diathermy, and nowadays the new plasma technology which is known as coblation (controlled ablation) tonsillectomy.
This study aimed to assess the first 24 hours postoperative pain and bleeding after coblation tonsillectomy.
Fifty patients aged between 4-10 years who underwent coblation tonsillectomy were included in this prospective descriptive study, the main indications for tonsillectomy were; recurrent tonsillitis and obstructive sleep apnoea.
The results showed that no bleeding at all within the first 24 hours with significant reduction in feeling of pain after.
In conclusion, coblation tonsillectomy is a promising technique to perform tonsillectomy.
https://bjsrg.uobasrah.edu.iq/article_165490_a2dbf5f56242ea91fcdbe6bf00f480cf.pdf
2020-06-22
65
68
10.33762/bsurg.2020.165490
tonsillectomy
Methods
coblation
Bleeding
pain
Rafid
Jabbar Almaidi
1
MB,ChB, MRCS ENT (Glasgow), DO-HNS (Glasgow), Jordanian Board of Otolaryngology, Head &Neck Surgery. ENT lecturer, Basrah College of Medicine, Basrah, IRAQ.
AUTHOR
1. Yelizaveta Shnayder, Kelvin C. Lee, Joseph M. Brenstien. management of Adenotosillar diseases, Chapter 20 , P.340 , Current diagnosis and treatment of otolaryngology (2008).
1
2. PL Dhingra & Shruti Dhingra, Diseases of ear ,nose and throat, & head and neck surgery, tonsillectomy ,Chapter 93 , P.428 , 2014 .
2
3. Exclusively coblation plasma technology Smith & Nephew coblation plasma technology (brochure).
3
4. Surgical indications of tonsillectomy, clinical and operative methods in ENT and head and neck surgery, Produl Hazarika, Dipak Ranjan Nayak, (2005), P.164 .
4
5. Surgical indications of tonsillectomy , clinical and operative methods in ENT and head and neck surgery, Produl Hazarika, Dipak Ranjan Nayak (2005), P.165.
5
6. Tonsils and adenoids, Logan Turners, 2016, P.537.
6
7. Tonsillectomy, Diseases of the ear, nose and throat, Hall&colmans, 2001, P.180.
7
8. Post-operative pain following coblation tonsillectomy, randomized clinical trial, Nastasha Polites, ANZ Journal of surgery, Volume 76, Issue 4, 2006.
8
ORIGINAL_ARTICLE
CONGENITAL INTESTINAL MALROTATION IN ADULT PATIENTS
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.
https://bjsrg.uobasrah.edu.iq/article_165493_5fae56a1963fe39a760dfba82730cfab.pdf
2020-06-22
74
80
10.33762/bsurg.2020.165493
Intestinal malrotation
congenital
surgery
conservative
adults
Firas
Jabir
1
MBChB, FIBMS General Surgery, FIBMS GIT & Hepatobiliary Surgery, FACS, Al Sadr Teaching Hospital, Basrah.
AUTHOR
Issam
Merdan
2
MBChB, FIBMS, CABMS, Professor of Surgery, Department of Surgery, College of Medicine, University of Basrah.
AUTHOR
Wissam
Saoud
3
MBChB, CABMS, FACS, FIBMS GIT & Hepatobiliary Surgery, FACS, Al Salam Teaching Hospital, Mosul, Iraq.
AUTHOR
Hamed
Laftah
4
MBChB, FIBMS, General Medicine, FIBMS GIT & Hepatobiliary Medicine, Al Fayhaa General Hospital, Basrah, IRAQ.
AUTHOR
1. Dott NM (1923) Anomalies of intestinal rotation: their embryology and reports from five cases. Br J Surg 11:251– 286View ArticleGoogle Scholar
1
2. Penco JM, Murillo JC, Hernàndez A, De La Calle Pato U, Masjohan DF, Aceituno FR (2007) Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age. Pediatr Surg Int 23:723–732View ArticleGoogle Scholar
2
3. Ladd W (1936) Surgical disease in the alimentary tract in infants. N Engl J Med 215:705–708View ArticleGoogle Scholar
3
4. Pickhardt PJ, Bhalla J (2002) Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR 179:1429–1435View ArticleGoogle Scholar
4
5. Stewart DR, Colodny AL, Daggett WC (1976) Malrotation of the bowel in infants and children: a 15 year review. Surgery 79(6):716–720Google Scholar
5
6. Vaos G, Misiakos EP (2010) Congenital anomalities of the gastrointestinal tract diagnosed in adulthood—diagnose and management. J Gastrointest Surg 14:916–925View ArticleGoogle Scholar
6
7. Nehra D, Goldstein AM (2011) Intestial malrotation: varied clinical presentation from early infancy through adulthood. Surgery 149(3):386–393View ArticleGoogle Scholar
7
8. Donnellan WL, Kimura K (1996) Malrotation, intestinal hernias, congenital band. In: Donnellan WL (ed) Abdominal surgery of infancy and childhood. Harwood Academic, Austria-United States, pp 1–27Google Scholar
8
9. Clark LA, Oldham KT (2002) Malrotation. In: Ashcraft KW, Murphy JP, Sharp RJ, Sigalet DL, Snyder CL (eds) Pediatric surgery, 3rd edn. WB Saunders, Philadelphia, pp 425–434Google Scholar
9
10. Adams SD, Stanton MP (2014) Malrotation and intestinal atresias. Early Hum Dev 90(12):921–925 (review)View ArticleGoogle Scholar
10
11. Coe T, Chang D, Sicklick J (2015) Small bowel volvulus in the adult populace of the United States: results from a population-based study. Am J Surg 210(2):201–210.e2. doi:10.1016/j.amjsurg.2014.12.048 (epub 2015 Apr 30)
11
12. Britt Husberg,Karin Salehi (2016) Congenital intestinal
12
malrotation in adolescent and adult patients: a 12-year clinical and radiological survey.
13
13. Emanuva OF, Ayantunde A, Davies TW (2011) Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review. World J Emerg Surg 6:22View ArticleGoogle Scholar
14
14. El-Gohary Y, Alagtal M, Gillick J (2010) Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int 26:203–206View ArticleGoogle Scholar
15
15. Nagdeve NG, Qureshi AM, Bhingare PD, Shinde SK (2012) Malrotation beyond infancy. J Pediatr Surg 47:2026–2032View ArticleGoogle Scholar
16
16. Freitz R, Vos A (1997) Malrotation: the postoperative period. J Pediatr Surg 32(9):1322–1324View ArticleGoogle Scholar
17
17. Durkin ET, Lund DP, Shaaban AF, Schurr MJ, Weber SM (2008) Agerelated differences in diagnose and morbidity in intestinal malrotation. J Am Coll Surg 206:658–663View ArticleGoogle Scholar
18
18. Raitio A, Green PA, Fawkner-Corbett DW, Wilkinson DJ, Baillie CT (2015) Malrotation: age-related differences in reoperation rate. Eur J Pediatr Surg (epub ahead of print)Google Scholar
19
19. Moldrem AW, Papaconstantinou H, Broker H, Megison S, Jeyarajah DR (2008) Late presentation of intestinal malrotation: an argument for elective repair. World J Surg 32:1426–1431View ArticleGoogle Scholar
20
ORIGINAL_ARTICLE
ACUTE APPENDICITIS AND ASSOCIATED PATHOLOGIES IN FEMALES
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.
https://bjsrg.uobasrah.edu.iq/article_165494_f2cc6c86cc76b476f75d26bc6d2be171.pdf
2020-06-22
69
73
10.33762/bsurg.2020.165491
surgery
Associated pathologies
Abdomen
Acute appendicitis
females
Ali
Kadhem
1
MB,ChB, CABS, Consultant General Surgeon, Alsadr Teaching Hospital.
AUTHOR
Aamena
Muhsin
2
MB,ChB, Arab Board Candidate, Alsadr Teaching Hospital, Basrah.
AUTHOR
Wisam
Al-Sewadi
3
CABS, FACS, FRCS, FICSMRCS, F.MAS, General and laparoscopic Surgeon, Al-Zahraa College of Medicine, University of Basrah, Basrah, IRAQ.
AUTHOR
ORIGINAL_ARTICLE
NASOPHARYNGOSCOPY VERSUS PLAIN RADIOGRAPHY IN ADENOID SIZE ASSESSMENT
This is a prospective comparative study of adenoid size assessment by using radiography versus nasopharyngoscopy using examination of the adenoid under general anesthesia (GA) as a standard method. This study was conducted on 35 children presented with signs and symptoms of adenoid hypertrophy. All patients were examined by both lateral radiograph view of the postnasal space and nasopharyngoscopy, then both results were compared.
The results for small size adenoid can not be calculated because of small sample size. For medium sized adenoid, the sensitivity for radiography and nasopharyngoscopy are 36.36%, 54.54% respectively, the specificity was 47.36%, 84.21% respectively and the accuracy was 43.33%, 73.33% respectively. For large sized adenoid the sensitivity for radiography and nasopharyngoscopy was 38.89%, 83.33% respectively, the specificity was 100%, 66.66% respectively, and the accuracy was 63.33%, 76.66% respectively.
In conclusion, nasopharyngoscopy is a simple, safe, repeatable, readily available at the ENT unit, with no radiation hazards, and with negligible trauma. Over all, nasopharyngoscopy has a higher sensitivity, specificity and accuracy than radiography.
https://bjsrg.uobasrah.edu.iq/article_165495_d5fbc99457125c5c20f664bf18ae3097.pdf
2020-06-22
81
88
10.33762/bsurg.2020.165495
Adenoid
Radiography
Nasopharyngoscopy
Size assessment
Safaa
Faleh
1
MB,ChB, FICMS, Otolaryngologist, ENT Dept., Al-Fayhaa Teaching Hospital, Basrah.
AUTHOR
Husam
Salman
2
FRCS, DLO, Consultant otolaryngologist, Basrah.
AUTHOR
Haidar
Salih
3
Al-Attar MB,ChB, FICMS, Otolaryngologist, Al-Basrah Teaching Hospital, Basrah, IRAQ.
AUTHOR