College of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228THE DISEASE BEHIND THE DISEASE125688310.33762/bsurg.2004.56883ENT. A. HamdanJournal Article20041201Not all that glitters is gold
(Shakespeare)https://bjsrg.uobasrah.edu.iq/article_56883_8123a55a177c8cd3f295ec6c40f22f68.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228COMPETENCE, VIRTUAL REALITY AND ROBOTICS IN SURGERY 3135752810.33762/bsurg.2004.57528ENMajeed H. AlwanJournal Article20041201Surgical operations have developed in the method which the surgeon’s hands and eyes are used to gain experience and advance the skills. However, to realize a new surgical therapy in the 21st century, it is necessary to use various advanced technologies. These include among many, three dimensional medical images, computer simulation and virtual reality technology, and robots in surgery. This is an outline of the various aspects of these technologies with some more details about robotics in surgery as it is the most recent advancement in that technology arena.https://bjsrg.uobasrah.edu.iq/article_57528_7453cbebb73073cae678340f19ebb155.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228FACTOR V LEIDEN AND THROMBOEMBOLISM14215752910.33762/bsurg.2004.57529ENZuhair Al-BarazanchiJournal Article20041201https://bjsrg.uobasrah.edu.iq/article_57529_7cadbbcb9dfe1558e88a0e8ce7cb87c0.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228THERMO THERAPY FOR RETENTION IN BPH : FIRST YEAR RESULT 22255753010.33762/bsurg.2004.57530ENMahmood S AbdulkareemJournal Article20041201Our objectives were to study and to evaluate thermotherapy for patients with retention of urine. The ability of the patient to pass urine without significant post voiding residue was also studied. Eighty six patients presented with urinary retention were treated by transurethral thermo therapy of the prostate, two weeks following thermo therapy 55 patients (63.9%) were catheter free and by the third week only 9 patients (10.4%) were still with catheter. It can be concluded that thermo therapy can be an option in the treatment of urinary retention and keeping the catheter for one more week can raise its effectivenesshttps://bjsrg.uobasrah.edu.iq/article_57530_ba013bbc1f98cda12792a74821e4b11f.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228INTRAOPERATIVE IMPRINT CYTOLOGY 26295753110.33762/bsurg.2004.57531ENMohammedand Rafid Abdul-JabbarNezar A. Al-MahfoozJasim M. Al-DiabJournal Article20041201A prospective study was conducted on 60 specimens; 33 breast lumps and 27 lymph nodes, to assess the value of intraoperative imprint cytology as an aid in surgical decision especially in the absence of the facility of frozen section examination. Imprint cytological examinations were done intraoperatively by a single pathologist. The results were ready after a period of 15-25 minutes. In all 60 specimens, 50 (83%) were correctly diagnosed, 8 were diagnosed as suspicious of malignancy and 2 were misdiagnosed.
The sensitivity was 97%, the specificity was 94.4% and the accuracy rate was 96.1%. We concluded that imprint cytology is a very simple technique and it remains a useful and cost effective tool, can aid in the surgical decision.https://bjsrg.uobasrah.edu.iq/article_57531_1c73086fb094e0714b0f1ef25b3eea39.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228ANALYSIS OF FALSE POSITIVE AND FALSE NEGATIVE FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST LUMP : A PERSONAL EXPERIENCE30375753210.33762/bsurg.2004.57532ENSawsan SAl-HaroonJournal Article20041201This study aimed to determine the reasons for sampling and interpretative errors in false negative and false positive diagnoses of breast carcinoma on fine-needle aspiration cytology (FNAC) material. The study design is that a totally 912 cases of breast FNAC were performed between 2000 and 2004, and 126 cases of them were diagnosed as breast carcinoma. Only those cases with cytohistological discrepancies were cytologically reviewed, in which the cytological material was abnormal and to some extent misinterpreted or both. There were 8 false negative diagnoses (false negative rate 6.3%) and 3 false positive diagnoses (false positive rate 2.3%). The results of this study showed that among 8 false negative cases, 5 showed hypocellular smears with minimal nuclear pleomorphism of the cells. Histology revealed 3 infiltrating ductal carcinomas of scirrhous subtype and 2 infiltrating lobular carcinomas. The smears of other 2 false negative cases, which histologically verified as well-differentiated infiltrating ductal and pure intraductal carcinomas, were hypercellular and composed predominantly of groups of cohesive, small, and uniform cells simulating fibroadenoma or fibrocystic changes. Smear of the last false negative case (histologically verified as infiltrating ductal carcinoma with extensive cystic degeneration) revealed large sheets of macrophages and degenerated epithelial cells on inflammatory background. In 3 false positive cases, 2 were histologically proved as fibroadenoma and 1 fibrocystic changes. Smears of the 2 false positive fibroadenomas showed very high cellularity, overlapped clusters, and frequent stripped bipolar nuclei. The fibrocystic case showed tight clusters of apocrine cells and sheets of loosely aggregated macrophages that were over interpreted. The conclusion of this study is that hypocellularity and relatively nuclear monomorphism are the reasons for failure to diagnose breast carcinoma. Careful attention should be paid to extreme nuclear monomorphism and absence of naked bipolar nuclei. So awareness of smear cellularity and subtle cytological features will aid in the correct preoperative diagnosis of lobular; scirrhous; and intraductal carcinomas, and false negative diagnoses can be minimized. A cytologically atypical or suspicious diagnosis together with positive mammographical and clinical findings should suggest a diagnosis of malignancy. Hypercellular smears with overlapped clusters should be carefully assessed for uniformity of the cells and detailed nuclear features. If the full-blown malignant cytomorphological features are not visible, a diagnosis of suspicious or inconclusive should be made and frozen section Created by Wameed Al-Hashimy intraoperative imprint cytology is recommended before surgery.https://bjsrg.uobasrah.edu.iq/article_57532_7bce2350238237fa3df25fc4abf539c9.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228Diabetic Foot Management; A 10-Year Study.38425753410.33762/bsurg.2004.57534ENIssam MerdanSafwan A TahaJournal Article20041201The medical records of 324 diabetic patients admitted to Al-Sader Teaching Hospital (Saddam Teaching Hospital previously) with foot lesions between April 1994 and April 2004 were studied retrospectively. Data were collected for various parameters, both personal and medical. The majority of patients were males, over fifty years of age and known diabetics. Peripheral neuropathy was the main predisposing factor while infected ulcer and gangrene of toe / toes were the most common forms of presentation. Wound swabs were positive for bacterial culture in 215 pts. (66.3%), 97.2% of which were polymicrobial. Dibridement was the most common surgical procedure. There were 6 deaths (1.85%) in the study group mainly due to uncontrolled sepsis with concurrent medical illnesses. It is concluded that foot complication is a common problem in elderly Iraqi diabetics, particularly males, peripheral neuropathy is the most common predisposing factor, foot infections are usually poly microbial and that the majority will need some form of surgical intervention that is mostly conservative rather than a major amputation. We suggest a team approach in the care for these patients which can be provided by establishing foot care clinic in large hospital. https://bjsrg.uobasrah.edu.iq/article_57534_6f68bf3c21ed87d2c40e0ed090e022d5.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228CLINICAL PRESENTATION AND BIOCHEMICAL EVALUATION OF BONE SECONDARIES43535753510.33762/bsurg.2004.57535ENThamir A HamdanLamia M Al-NaamaFalih W HashimJournal Article20041201The skeleton is one of the commonest sites for metastasis. Bone secondaries account for more than one third of the malignant disease of bone.
Seventy-six patients with bone secondaries were admitted in the orthopaedic department of Basrah Teaching Hospital from February 2000 to June 2002, age range 14-86 years; 34 were males and 42 were females. The dominant sites of bone metastases were spine, 60 patients (79%) and pelvis, 16 patients (21%). The common primary sites were breast, 19 patients (25%) and lung, 11 patients (14.4%); 9 patients (11.2%) had undetected primary site. Most secondaries (90%) were osteolytic in type and the most common histopathological type was adenocarcinoma, 47 patients (63%). In 63 patients (83%), pain was the dominant presenting feature. Late presentation was a major problem; it ranges between 4-8 months. Another problem was lack of clinical awareness in the early stage of the illness.
Serum and urinary biochemical markers of bone metabolism were significantly high in patients with bone secondaries than control group, no difference whether the metastasis was single or multiple and whichever the primary site or histopathological subtype. Special interest with urinary hydroxyproline, it was significantly elevated in patients with bone secondaries, some of them had negative radiography. Prognosis was poor with short life expectancy.https://bjsrg.uobasrah.edu.iq/article_57535_9a1dc7ebf6b3028881b35a5bcd44ad87.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228ARTERIAL LIGATION OF LOWER LIMB ANEURYSSM: IS IT SAFE ?54585753610.33762/bsurg.2004.57536ENAbdul-Salam Y. Al-MuseilihJournal Article20041201https://bjsrg.uobasrah.edu.iq/article_57536_35e3f2404e31754c8ec1a38c174947e7.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228BONE LENTHENING BY ‘Z’ CORTICOTOMY59665753710.33762/bsurg.2004.57537ENOmar Ali Rafiq BarawiJournal Article20041201This is a prospective study done on 40 patients presented with lower limb length discrepancies between March 1993 and September 2003. After correction of apparent shortening by correcting associated deformities like flexion deformities of the knee, bone lengthening for the remaining true shortening ranging from 3cm – 10.5 cm was done. The "Z" corticotomy involves cutting the cortex in Z manner with preservation of the periostieum and medullar cavity as much as possible, followed by manual distraction.
The advantages of Z corticotomy in comparison to transverse corticotomy or transverse osteotomy are; That there is no need for internal fixation by plate and screws, no need for bone graft to enhance osteogenesis, the chances of mal-alignment of the distracted fragments are minimal as the limbs of the Z – corticotomy maintaining the alignment during the distraction, and the stability of the external fixate is very important for the extent of ontogenesis but this was compensated by doing Z corticotomy. https://bjsrg.uobasrah.edu.iq/article_57537_9f241168a3912663d900ff70d197b83c.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228INTERNAL ILLIAC ARTERY LIGATION IN THE MANAGEMENT OF PELVIC HEMORRAGE. A DISTRICT GENERAL HOSPITAL EXPERIENCE 66705753810.33762/bsurg.2004.57538ENM R ZakariaMark A K TambertC KamathJournal Article20041201 Haemorrhage from obstetric and gynaecological surgery is a major causes of morbidity and mortality. Various methods have been described to treat women with intractable haemorrahage. Internal iliac artery ligation (IAL) is an under used but potentially very effective technique, We described four cases where the procedure was used in controlling sever pelvic haemorrhage when local surgical methods had failed. https://bjsrg.uobasrah.edu.iq/article_57538_5b5cd575e02aaeb3c1d094098f8caa76.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228ANAESTHETIC MANAGEMENT OF PATIENTS WITH PULMONARY HYDATID CYST71745753910.33762/bsurg.2004.57539ENSalam Najib AsfarJournal Article20041201 Hydatid cyst is a disease produced by the encysted Larvae of echinococcal worms. Echinococcus granuloses is endemic in areas of the Mediterranean coast and middle east, Surgical intervention to remove the cyst that is commonly seen in liver and lung is the primary treatment for hydated disease .
Sixty- three patients underwent lateral thoracotomy for pulmonary hydatd cyst in the last 4 years at Basra Teaching Hospital. Special anesthetic technique was set for them including omission of premedication drugs , rapid sequence indication, preference of single lumen endotracheal tube than double lumen endobronchial tube, nitrous oxide gas exclusion from maintenance of anesthesia, ready stand–by good suction machine, manual low pressure ventilation, and careful monitoring .
Nine out of 24 cases with double lumen endobronchial tube showed severe hypoxia intraoperatively that demand urgent change of this type of tubes to signal lumen endotracheal tube. Patient with endotracheal tube had smooth intraoperative environment and no postoperative complications.
It is concluded that using this anesthetic regimen from the start of operation for these particular cases makes anesthesia management more easy and safe. https://bjsrg.uobasrah.edu.iq/article_57539_377bf69b53a3dc1136a80e82941d70ce.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228CURRENT TREATMENT OF CHRONIC ANAL FISSURE.75805754010.33762/bsurg.2004.57540ENBahzad W HamadFaruk H FarajJournal Article20041201This is a prospective study to test the hypothesis that topical isosorbide dinitrate (Isordil) is the best first line of treatment of a chronic anal fissure. This study was done in the outpatient clinic of Sulaimani Teaching Hospital, Sulaimani, Iraq, from the 1st Dec. 2000 through 30th May 2002. There were 65 cases of chronic anal fissure treated with 0.5% Isordil ointment and reviewed at 2, 4, 6 and 12 weeks to assess the symptoms, side-effects, fissure healing and patient acceptance. The age range was 2-65 years with mean age of 31.2years, and female:male was 1.4:1. At 12 weeks 80% of patients had no fissure. In 20% the treatment was unsuccessful. At 6 months follow-up there was 2.5 % recurrence. The prevalence of headache was 46.1% on commencing treatment with 12.3% headache-related noncompliance. The cost of treatment with this new method was 12 ID for 8 weeks while it was 36 ID for the same period of traditional way of treatment. We conclude that medical sphincterotomy with 0.5% Isordil ointment is a feasible, cost-effective method of treatment of chronic anal fissure with high patient acceptance and satisfaction.https://bjsrg.uobasrah.edu.iq/article_57540_7a6b46bbcf35fde0691bc3c5f0d3a2e0.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228CUTANEOUS MANIFESTATION IN RENAL TRANSPLANT RECIPIENTS IN SOUTHERN IRAQ 81845754110.33762/bsurg.2004.57541ENSamir DhaherSafauldin AhmadJournal Article20041201 Forty–eight patients living in southern Iraq with renal transplantation were studied for dematological lesions between Jan. 2001 and Feb. 2002, at Basrah renal transplation follow-up center. All patients had skin problems of different kinds; Cushingoid features in 85.4%, hair and nail changes in 82%, infections in 20% and tumors in 28%. Among skin infections recalcitrant warts were the most frequent (17%). High incidence of skin cancer was recorded (4.2%) as compared to other Iraqi studies . Kaposi”s sarcoma was not seen during the study period.https://bjsrg.uobasrah.edu.iq/article_57541_e5cacaffa6788fca3e8c6343c9934aeb.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228COMPARATIVE STUDY OF DIFFERENT MODALITIES OF MEDICAL TREATMENT OF CHRONIC SUPPURATIVE OTITIES MEDIA85915754310.33762/bsurg.2004.57543ENAhmed M. Al-AbbasiJournal Article20041201 Active chronic suppurative otitis media poses a management problem. Different types of treatment strategy were tried for 136 patients, 36 patients received systemic antibiotics, 26 patients received local antibiotics, 42 patients combined local and systemic, and the last group (32 patients) received no antibiotics. The majority of patients had moderate size tympanic membrane perforation (59%). Eighty-two patients had severe (active) symptoms (60%). The commonest types of bacteria isolated were streptococcus pneumoniae and staphylococcus aureus (29%, 21% respectively). It is found that, the best type of treatment was the local antibiotic therapy (84% improvement), followed by combined antibiotic therapy (local and systemic) which equal to 83% improvement. There was no benefit of using systemic antibiotics without aural toilet (5% improvement). It is important to mention that the use of antibiotic/ steroid ear drop gave good improvement result (95%), in comparison with the use of antibiotic ear drop (50%). https://bjsrg.uobasrah.edu.iq/article_57543_d36dc6f6077d5e5e8933fffdf7b11973.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228ACUTE ABDOMEN in PREGNANCY: AETIOLOGY & OUTCOME in BASRAH92985754510.33762/bsurg.2004.57545ENFouad Hamad Al-DahhanEhab A. HassanJournal Article20041201This is a prospective study conducted in all major hospitals in Basrah (Basrah Maternity & Child Hospital, Basrah Teaching hospital and Basra General hospital) to prove that ‘acute abdomen in pregnancy’ is common and that the effect of delayed diagnosis can have serious implication on both maternal and fetal outcome. Two hundred and fourteen pregnant females were included. Their age ranged from 16-42 years (mean age was 27 years). Operations were performed whenever indicated by a registrar or consultant gynecologist. Abruption placenta was the causative factor in 33.17% of cases, ectopic gestation in 24.7%, acute appendicitis in 11.21% and the remaining 30.9% resulted from miscellaneous conditions. Most of the patients (94.39%) presented within the first twenty-four hours of their initial complaint. Delayed diagnoses were made in 12 with 50% maternal mortality and 100% perinatal mortality. One hundred and sixty nine patients (78.97%) underwent emergency operations, while forty-five patients (21.02%) were treated conservatively. Various complications were encountered; the most common was wound infection (19.8%).https://bjsrg.uobasrah.edu.iq/article_57545_afbd3671d93ca472234405573079bbc2.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228THE USE OF INTRA-UMBILICAL OXYTOCINE FOR THE MANAGEMENT OF RETAINED PLACENTA 991085754810.33762/bsurg.2004.57548ENMohsen H Al-SabbakFaiz A Al-WaeelyEdward Z KhoshoIbtisam ShiaaJournal Article20041201Postpartum haemorrhage & retained placenta are the most common serious abnormalities encountered during the third stage of labour, the aim of this study was to compare three different management protocols for retained placenta. This prospective study was carried out in Basrah Maternity & Children hospital during the period from march 2001 till march 2002. A total of 75 women with retained placenta after active management of third stage of labour were included, they were divided into three groups , the first group received oxytocin and normal saline injected in the umbilical vein, the second received normal saline and the third was the expectant group. In 56% of women in the oxytocin group, placental expulsion occurred within 45 minutes compared to 16% in the expectant group and 24% in the saline group respectively. Also 44% of women in the oxytocin group needed manual removal of the placenta compared to 84% in the expectant and 76% in the saline group. We conclude that intraumbilical vein injection in cases with retained placenta seems simple and promising technique to reduce the incidence of potentially morbid procedures. https://bjsrg.uobasrah.edu.iq/article_57548_37dd4dec46076fd91d1517395fae8c5c.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228MESENTERIC CYST-OVARIAN IMPLANT SYNDROME; CASE REPORT 1091125754910.33762/bsurg.2004.57549ENAli Y. AlwajahRafif A. Al-SaadyJournal Article20041201Mesenteric cyst ovarian implant syndrome have been rarely reported in the literature, we report the first case that occur in young female following trauma and it is the first case in which the ovarian tissue get implanted higher up in the jejunal mesentry out side the pelvis.https://bjsrg.uobasrah.edu.iq/article_57549_534bda3a8677124672a4af5533f0e38f.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228MICROLAPAROSCOPY (Needlescopic Laparoscopy)1131185755110.33762/bsurg.2004.57551ENNezar A. Al-MahfoozJournal Article20041201https://bjsrg.uobasrah.edu.iq/article_57551_b3bd809468927ad1f3e6f23ee26d0661.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228Perspective on the structured oral examination1191225755310.33762/bsurg.2004.57553ENThamer A HamdanJournal Article20041201https://bjsrg.uobasrah.edu.iq/article_57553_8864468da88e7d178aed143b7f2229ee.pdfCollege of Medicine, University of BasrahBasrah Journal of Surgery1683-358910220041228Obituary: Dr. Abdulhadi Al-Sayah1231235755610.33762/bsurg.2004.57556ENT.A. HamdanJournal Article20041201https://bjsrg.uobasrah.edu.iq/article_57556_d386d63cf9b5d9b7bdfd366eac81389e.pdf