Basrah Journal of Surgery

This is a review article, about the incidence of law back pain in dentist, it also contains a detailed review about the relation between back pain, exercise and posture, with special emphasis on the prophylactic measurements.

Objective: To compare the effectiveness of monopolar diathermy haemorrhoidectomy and closure of haemorrhoidectomy wound with conventional Milligan-Morgan haemorrhoidectomy in reducing the post operative pain and complications. Also to determine the time of hospital stay, wound healing and return to activity.
Patients & Methods: A total of 180 patients with symptomatic haemorrhoids (3rd and 4th degree) were studied from May 2000 to March 2003 at Basrah General Hospital. Patients were randomized into two groups; group (A) treated by open haemorrhoidectomy according to Milligan –Morgan (no.=100), and group (B) treated by 30 watts monopolar diathermy haemorrhoidectomy with closure of haemorrhoidectomy wound (no=80).
Result: Significant differences between the two groups were noticed regarding the postoperative pain and complications, time of wound healing and return to activity.
Conclusion: patients with symptomatic haemorrhoids derive greater benefit from diathermy haemorrhoidectomy with wound closure regarding less postoperative pain and complications, short hospital stay and early return to normal life.

Absorbed dose from X-ray field of scattered stray radiation was monitored at presumably safety position. Lyoluminescence enhanced sensitivity in organic solid techniques were used to estimate the environmental and personal dosimeter based on tissue equivalent of glutamin amino acid. The cumulated percentage dose received by the person for one month period at safety position were about more than the dose received by the patient in one single exposure (at least 11.6% and 39.5% of chest and hand dose respectively).

This prospective study was designed to compare the three surgical procedures used in the treatment of pilonidal sinus. 103 patients divided in to three groups by simple random sampling, Group I, 45 patients treated by Excision alone, Group II, 45 patients treated by Excision and simple primary closure while group III, 13 patients treated by Excision and w plasty. Comparison between these procedures with regard to Gender, Sex, Obesity, operating time, hospital stay and complication include recurrence by using ANOVA test and other statistical tests. In conclusion, there is relation between obesity and PND and its Recurrence, also excision alone is satisfactory procedure, because it take less operative time with short hospital stay and associated with fewer complication including recurrence, also meticulous hygiene and shaving of present healing area as well as daily regime to obese patient should be taken in consideration to avoid recurrence.

Pulmonary resection is the operation that defines the thoracic surgeon. It represents the appropriate surgical treatment for many pulmonary lesions. This is the first study on pulmonary resection in Basrah, south of Iraq. The study is conducted in the Section of Thoracic and Cardiovascular Surgery in Basrah Teaching Hospital over a 5-year period (August 1996 to July 2001). The aim of the study is to present the personal experience of the author in lung resection, analyze the indications, surgical and anaesthetic management and outcome including morbidity and mortality in view of the literature. Thirty patients (17 males and 13 females) underwent pulmonary resection for different indications were retrospectively analyzed. The results of this study indicate that despite the small number of patients and the difficulties in anaesthetic management, pulmonary resection is practiced safely in Basrah, south of Iraq.

Highly selective vagotomy accepted by increasing number of surgeons due to its low operative risk and relative lack of all side effects associated with other types of surgery like Truncal Vagotomy and drainage procedures. Our study concentrates on cases of chronic duodenal ulcer operations by H.S.V.regarding morbidity, mortality and recurrence rates. At Port General Hospital in Basrah and one private hospital over a period of twelve years from January 1991 to January 2002(H.S.V.) Highly selective vagotomy was performed on 100 cases of chronic duodenal ulcer (D.U.) which were diagnosed by endoscopy. All patients were followed for periods ranged between (24-120) months post operative morbidity and mortality were recorded. Visick grading was used to assess the post- operative clinical results, and endoscopy was done for all patients with visick grades III and IV. Seventy four(74) cases were uncomplicated and twenty six (26) were complicated ulcers (12 with obstruction, 10 with bleeding and 4 with perforation). Seventy two (72) cases were males and 28 cases were females. Their age ranged between (16-72) years. No major post- operative complication was recorded apart from one case who developed recurrent obstruction corrected by Finney pyloroplasty. Minor complications recorded were transient dysphagia (in 32 cases 32%) parasttic diarrhoea in eight (8) cases (8%), and some other non- related complications. Mortality was nil. (11 cases) were in Visick grade III and IV. Nine (9) cases of them were proved to have recurrent ulceration 89 cases were in visick grades I and II. My result shows that H.S.V. is a safe and effective procedure in the Management of uncomplicated and complicated chronic D.U. with less morbidity and mortality with accepted and medically controllable recurrence rate

Cataract formation in the diabetic patients was studied on the basis of the determination of (Hb A1c%) using variant HPLC instrument and blood glucose enzymatic method for (42) blood specimens. These patients are; neglected blood glucose levels (patients are not using any treatment), on oral antidiabetic medications and insulin dependent. The effect of (Hb A1c %) when raise above the normal value (5.8%) in diabetic patients, is leading to disturb the transparency of the eye lens. The aim of this study is to show the relation between high values of (Hb A1c%) and cataract lens changes. (HbA1c%) of ten normal blood specimens were measured as control group.

Most colorectal cancers regardless of etiology are believed to arise from adenomatous polyps. Both environmental and genetic factors are important in colorectal carcinogenesis. Twenty five percent of patients with colorectal cancer have relevant family history. We tried to verify the spectrum of manifestations of hereditary non polyyposis colorectal cancer HNPCC and what practical preventive measures could be applied. In related families, 4 generations were studied via interviewing. Seventeen patients fulfilled the Amsterdam’s criteria for the diagnosis of HNPCC (Lynch II), with a mean age of 59.11 11.75, 10 patients were females and 7 were males. All were not smokers. The pedigree we mapped for these families showed an autosomal dominant inheritance. HNPCC is heterogeneous syndrome. Although has certain gene defect. We should always think of HNPCC in presence of positive family history of colorectal cancer or other malignancy specially those affecting young age groups. Regular colonoscopy and aspirin prophylaxis are important preventive measures.

A prospective study on 110 symptomatic patients (150 hands) with CTS. All were analyzed depending on history, clinical examination, EMG and NCS and 118 asymptomatic persons (150 hands) as control group. Five currently used clinical provocative tests were applied on both groups: original Duran's test, Phalen's test, reversed Phalen's test, tinels test and arm tourniquent test, in addition to our modification of Duran's test which was compared with the previous tests, regarding sensitivity, specificity and accuracy. It was concluded that modified Duran's test was the most sensitive (94.7%), specific (94.7%) and accurate (94.7) in relation to other provocative tests. The positivity rate of modified Duran's test in cases less than 1 month history of symptoms was 80% which is higher than the other tests. Modified Duran's test has the shortest reaction time (mean time 10.5seconds) as compared with other clinical tests apart from Tinel's test.

This is a prospective study of postoperative pain at iliac graft donor site in 40 selected cases undergoing bone graft procedures from the iliac bone. Comparison was made between 3 different surgical approaches (superior, medial and superior-lateral). Severity of pain after operation was assessed using 10cm. visual analogue scale (VAS). All patients were followed up as outpatient visits every 2 weeks for period of 3 months. All patients had significant donor site pain postoperatively; moreover, in 83.3% of patients the pain was more severe at donor site than the recipient site. The precise cause of donor site pain remained obscure. However, in 87.5% of cases pain which, was closely related to position as typically aggravated by walking could indicate a local muscular or periosteal origin. The superior-lateral approach was associated with the lowest level of measured pain at donor site which, was mostly due to minimal muscles stripping and also the use of outer table. The highest level of pain was associated with the use of the superior approach, which was probably due to excessive muscle stripping and reflection of both gluteal and abdominal muscles. Donor site pain was substantially higher in patients where both tables of ilium were involved. In 10 patients (superior-lateral approach), bupivacaine hydrochloride 0.5% (Marcaine) had been used to infiltrate their donor wound during operation and comparison was made with another 10 patients as control. Local infiltration with pubivacaine produced a significant reduction in postoperative donor site pain.

Sixteen patients with retrosternal goitre were operated upon in one surgical unit during the last 10 years. The chief presentation was difficulty in breathing and dyspnoea during sleep mainly. Thyroidectomy was done using different approaches, but the cervical approach was suitable in most of cases. Tracheostomy was considered as a complication and needed in one case with bilateral vocal cord pulsy pre-operatively.

The aim of this prospective study was to determine the frequency and degree of anaemia among pregnant women attending labour. One hundred-seventy seven pregnant women were included. We found that 78 (44.1%) women were anaemic, of them 64 (36.2%) having mild anaemia, 10 (5.6 %) with moderate anaemia and 4 (2.3%) with sever anaemia. The study revealed that low educational level, lack of antenatal care, increasing parity, lack of iron supplementation, close spaced pregnancy and antepartum haemorrhage were significant predisposing factor for the development of anaemia. On the other hand, the effects of the maternal age, lactation and postpartum haemorrhage on the development of anaemia were not significant. In conclusion, the frequency of anaemia among pregnant women at labour was high which necessitates an active intervention toward modifying the risk factors of anaemia.

A total of 1339 patients operated on from 1994 to 2000 for urinary tract calculi. There were 851 male patients (63.5%) and 488 female patients (36.5%) with 891 renal stones. Three hundred eighty three ureteric stones and 103 vesical stones. The age incidence, sex differences, anatomical sites, residency and seasonal variation were studied.

Tuberculosis is a chronic infectious disease that can involve almost any organ in the human body, on the other hand breast tuberculosis is considered to be rare entity through out the world. In this study we describe five cases of breast tuberculosis; three in the year 1999 and two cases in the year 2000. The five cases had various mode of presentation and clinical course but all the cases showed the same histological findings, which confirm the diagnosis. Review of the literature throughout the world was carried out including cases in Iraq.

Biliary parasites are known in endemic areas and their association with biliary stone is documented. We present a case of liver fluke affecting the biliary tract caused by fasciola hepatica which is reported for the first time in Iraq.

The object of this paper is to illustrate the surgical steps in sequence, which were found more ‎useful and informative for DDH of a limited age (8-12) years. Throughout a period of 25 ‎years of work in this field. The retrospective study showed clearly the pitfalls, complication, ‎how to avoid them, to be aware about them and how to solve them properly if they occurred. ‎Few remarks will be mentioned about neglected subluxated hips and the proper way of ‎dealing with them to serve the patient for few years before embarking on total hip ‎replacement. Such Chiari or periacetabular triple osteotomy. The conclusion I reached finally ‎was that experience in this part as in any other part of surgery comes slowly and gradually, it ‎grows with years and familiarity with the subject is established form early years of ‎management to adulthood. I believe that we can learn more from one mistake than from ten ‎successes. ‎