Basrah Journal of Surgery

Nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most frequently prescribed medicine in the world. Their main disadvantages were related to their effect on the gut and kidney. Since the early 80s of the last century, drugs manufacturers try to discover a NSAIDs which does not affect the gut and kidney .The gut toxicity may be decrease by concomitant use of antisecretery agents, but this increase their cost and decrease the compliance. The fully selective cyclooxygenase inhibitors has been introduced recently as an alternative to old generation NSAIDs.Unfortunaltly subsequent long-term evaluation produced disappointing results, and opened the door for a lot of discussion and controversies.

Twenty-one patients with non-visualized kidney on intravenous urography (IVU), whose ultrasound (US) examinations showed moderate to severe hydronephrosis (3 of them subjected to non-conclusive retrograde uretropyelography), were included in this study. All of them underwent percutaneous antegrade pyelography (PAGP) under US guidance at Radiology Department, Saddam Teaching Hospital, Basah, form January 2000 to January 2002. Ninty-five percent of them had satisfactory and conclusive results; nine cases with radiolucent stones, 5 with congenital pelvi-ureteric junction (PUJ) obstruction, 5 with ureteric strictures and one case with severe hydrocalyces and contracted pelvis that was proved to be tuberculosis of the kidney. On the other hand, the technique failed in one case. The study included 15 males and 6 females, their ages ranged between 12-71 years and the mean age was 45 years. No complication was recorded. We conclude that this procedure is a relatively simple, safe, and useful technique to visualize the renal collecting system in certain cases allowing the surgeon to choose a more suitable operative approach for that particular condition.

This is a retrospective study, reviewing all surgically treated thyroid conditions in the period between September 1998 to September 2001. The results showed that the incidence of malignant thyroid conditions is 6.6%, and that papillary carcinoma is the most common thyroid cancer having an incidence of 82%. All patients presented with the complaint of neck swelling, in no patient manifestations of systemic dissemination found. Fine needle aspiration cytology was available for 11(39%) patients and was diagnostic in 7(63%) and highly suspicious in 4(37%). The number of re-operations was 9 (32%) and was always due to no use of FNAC in patients with multi-nodularity of one lobe. Thyroid carcinoma is not uncommon in our district. Preoperative diagnosis by more use of FNAC will decrease the incidence of re-operations that are more complicated than first operation.

This is a prospective study designed for the evaluation of the results of a modified surgical technique for the treatment of third and forth degree hemorrhoids in comparison with the classical milligan Morgan procedure. It was conducted during the period from January 1996 to January 2002 at Alzahrawi Hospital in Mosul. Three hundreds ninety-five patients with third and fourth degree hemorrhoids were randomized into two groups, the first one included 200 patients (120 male and 80 female), they were operated upon by our modified surgical technique, while the second group included 195 patients (110 male and 85 female), they were operated upon using Milligan Morgan procedure. Both groups had the same age sex distribution and clinical presentation. The same pre and postoperative care was applied to both groups, as well as the type of anesthesia and operative position. The early and late postoperative complications and follow-up were recorded and compared. It is concluded that the modified surgical technique that we used for third and fourth degree hemorrhoids gave less early and post operative complications, there were shorter convalescence period and hospitalization, with shorter healing time, and we advocate it for the treatment of third and fourth degree hemorrhoids.

The serum activity of creatine kinase was determined in 52 patients with hypothyroidism (19 males and 33 females), 110 patients with hyperthyroidism (27 males and 83 females) and 187 control subjects (47 males and 140 females). The creatine kinase activity in patients with hypothyroidism was on the average significantly higher than controls (p<0.005). In hyperthyroid patients, although the serum activity of creatine kinase was significantly lower as compared with controls, however, it is within the normal range. Hypothyroidism should be put into consideration in patients presented with symptoms suggestive of cardiovascular abnormality without other evidence of myocardial damage and have raised creatine kinase activity.

Infantile hypertrophic pyloric stenosis was described for the first time at the end of the 19th century, yet, its etiology and pathogenesis are largely obscure to date. This study retrospectively investigates 35 children who presented to Baghdad Central Teaching Hospital for Children with upper gastrointestinal tract obstruction suggestive of the disease. The clinical features, investigation and outcome are discussed.

The effect of ciprofloxacin treatment on semen analysis was studied. Six apparently healthy volunteers with age ranging from 30-51 years were included in this study. Ciprofloxacin tablet (500 mg) was given to each volunteer twice daily for 14 days. Semen analysis was performed for them before ciprofloxacin treatment and 2,4 and 6 weeks after treatment. Four weeks after treatment, there was a statistically significant reduction in total sperm count by 53.4% (from 157.16 ± 23.7 to 73.17 ± 19 millions, p < 0.001), in percentage of actively motile sperms by 40.5% (from 35±7.06 to 20.83± 5.23, p<0.001) and in percentage of viable sperms by 15.2% (from 67.6 ± 6.01 to 57.33± 9.48, p < 0.025). It is concluded that administration of ciprofloxacin (500 mg x 2 for 2 weeks) had, therefore, resulted in a significant reduction of various parameters of semen analysis. A finding, if proved to be true, should be taken in consideration during ciprofloxacin treatment for any type of infection in males.

A critical prospective analysis was conducted for the missile injuries of the extremities in Basrah University Department of Orthopaedic Surgery at the time of operation Iraqi Freedom (20th of March – 20th of April 2003). The wounds were classified into four grades according to the severity of the injuries. Wound closure was performed primarily in 20 (16%), secondarily in 44 (35.2%) while skin graft was necessary for 36 (28.8%) patients. Although the transportation time was less than two hours, the injuries were severe because of the close proximity of shortening. Collapses of the old houses in Basrah were responsible for the associated closed or open injuries. Primary wound excision was insufficient in 37(27%) patient, this was related to the lack of experience by the junior staff, and was the reason behind the high incidence of wound infection which was recorded in 78 (56.93%) patients. Compound fractures were recorded in 66 (48.17%) patients, soft tissue injuries were noticed in 43 (31.38%), while amputation was the final outcome in 24 (17.5%) patients. The injurious agents were fragments of shell in 74 (54.01%), bullets in 34 (24.81%) while closed injuries were noticed in 12 (8.65%) patients. The fractures were immbolished by external fixation in 24 (9.48%), temporary internal splint in 13 (9.48%), gypsona in 29 (21.16%). The mortality rate was 4.83%. The infection rate and other complications could have been lower if war surgical principles were accepted and performed precisely in the management.

A Retrospective case-control study conducted in Basrah maternity and child hospital during the period from December 2001 till September 2002. It aims at evaluating cases of wound infection in Basrah Maternity and Children hospital and comparing them to different variables, like, age, parity, medical illnesses, previous obstetric history and educational status. It included 139 patients (case and control), with an age range of 18-43 year and a parity range of 1-8. Out of 1670 parturient patients whose deliveries ended with cesarean section (elective and emergency) during the period of our study, 139 patients were included in our study. There were 49 cases of wound infection and 90 cases who were taken as control. Different variables were also studied as obesity, diabetes, anemia and social class.

A rare case of a twenty-six years old male, presented to emergency department of Mosul General Hospital in Mosul, as acute abdomen, on exploration, acute local- focal necrotizing pancreatitis was found, presented as a tumour like swelling related to the distal part of pancreas, treated by necrosectomy (distal pancreatectomy), followed-up for 10 years without any sequelae, complications or recurrence. The present report documents a careful necrosectomy as the basic principle of surgical management of patients with focal necrotizing pancreatitis, which was supported by many other reports, published recently abroad.

Gigantomastia or “Gravidic macromastia” during pregnancy is a massive diffuse enlargement of the breast during gestational period. It is a rare condition of undetermined aetiology, which may be due to hormonal excess, or hypersensitivity of the target organ to normal hormonal level. Histologically it is due to glandular hyperplasia with an increase in connective tissue. This paper reports an unusual case of gigantomastia in 22 years old lady, who is gravida 2, para nil, with total breast weight of 15,850 kg. Ulceration and haemorrhage of the breasts complicated the picture and end in abortion followed by subtotal mastectomy and free implantation of nipple areola complex.