Basrah Journal of Surgery

Pain and Patient's Behaviour

The spleen is not considered any more to be dispensable1. By the end of the last century, virtually ‎none of the dogma believed to be unequivocally true 25 years earlier in the management of the ‎injured spleen was practiced. In this review several changes in the management of injuries to the ‎spleen, in particularly blunt injuries are presented. These includes: diagnosis, attempts of operative ‎splenic salvage, nonoperative management, and emphasis of preventing postsplenectomy ‎infection versus controlling bleeding.‎
‎ Recently and during a period of less than two months, six patients with injury to the spleen (five ‎with blunt trauma and one atraumatic spontaneous rupture) were admitted under the care of the ‎present author. They are briefly presented before the rest of the review. As these cases have had ‎different presentation and management, it was thought that the discussion will give a further ‎account of the diversity of the management of injuries to this solid abdominal organ.‎

‏ ‏Samples of ligamenta flava were obtained after surgical operations from 50 patients with a ‎lumbar disc herniation, another 50 patients with a lumbar canal stenosis, and 25 patients with ‎spinal fractures who were used as control group. ‎
‎ Ligamenta flava from control patients aged below 46 years consisted of large elastic fibers, ‎thin bundles of collagen fibers, and few spindle-shaped fibroblast cells.‎
In close proximity to the laminal insertion, the ligamentum flavum had fibrocartilagineous ‎features. in the control patients who were aged 46 or older, the areas that had fewer and thinner ‎elastic fibers and a more abundant collagen component were visible occasionally. The spindle-‎shaped fibroblast cells were fewer compared with control patients aged below 46 years. Also ‎remnants of necrotic cells and few, short, thin, interwoven, fragmented, non-branching elastic ‎fibers, as well as small calcified areas, were occasionally visible. ‎
‎ In close proximity to the laminal insertion, the ligamentum flavum had larger fibrocartilaginous ‎features with more collagen fibers compared with younger patients. ‎
‎ In patients with disc herniation, the ligamenta flava had nearly similar morphologic features to ‎those of the control patients of similar ages. The ligamenta flava from patients with lumbar ‎spinal stenosis aged below 46 years showed areas of fibrosis in which the cells were often ‎represented by fibroblast cells and in stenotic patients older than 46 years, central portion of ‎ligamentum flavum showed areas of fibrosis, in which the elastic fibers appear normal in some ‎areas, showed little changes in others and in most of these areas showed great changes. ‎Fibrous septa, degenerating elastic fibers as well as small calcified areas were observed often.‎
‎ In conclusion, Lumbar ligamentum flavum as any tissue in human body undergo degenerative ‎changes during aging. In lumbar canal stenosis, the degenerative changes were more obvious ‎compared with normal spine or lumbar disc herniation. In stenotic patients, ligamenta flava ‎show a significant decrease in the elastic component as a result of fibrosis and chondroid ‎metaplasia of the tissue, as well as degeneration of the elastic fibers. These changes, and the ‎presence of calcified areas within the tissue, decrease the elasticity of the ligaments. An elastic ‎tissue can be deformed under traction and gradually return to its normal size, proportional to ‎the decrease of the elastic tension. Ligamenta flava do not normally bulge into the spinal canal ‎when spine is in the neutral position.‎

‎ We prospectively studied 64 patients with fracture shaft tibia, 23 patients with closed tibial fracture and ‎‎41 patients with open type. All fractures were stabilized by external fixation device AO/ASIF type after ‎failed manipulation under anesthesia (MUA) to restore the osseous alignment. In 28 patients cancellous ‎bone graft were used after the upper part of the tibia to enhance healing process, all these patients were ‎followed for an average of 8-12 months.‎
‎ Our findings showed that stabilization of the fracture shaft tibia by external fixation with cancellous bone ‎graft had significantly better results, than external fixation alone.‎
‎ The use of external fixation device with bone graft, is safe, effective, cheap and available in almost all ‎orthopaedic units n Iraq. ‎

This study aimed to correlate the diagnostic efficiency of brushing cytology versus endoscopic biopsies ‎in the diagnosis of various gastro-intestinal lesions with especial reference to gastric tumours.‎
‎ Eighty three patients who had visible mucosal lesions were studied. All lesions were brushed and ‎biopsied and were read blindly by one pathologist‏ ‏‎.‎
The sensetivety and positive predictive values for brushing cytology were 91.3% and 84.6% respectively, ‎while specificity and negative predictive value were 93.3% and 96.5%‎‏ ‏respectively. The cumulative ‎diagnostic yield for both test was 92.7%‎‏.‏‎ ‎‏ ‏
‎ We concluded that brush cytology is a convenient, safe & accurate technique for the diagnosis of ‎various gastro intestinal lesions which should be used concurrently with endoscopic biopsies

This study aimed to compare the efficacy of four clinical methods used for ripening unfavorable cervix in ‎Basra Maternity Hospital. ‎
‎ A prospective study was conducted to compare four methods of ripening the unfavourable cervix : ‎Foley's catheter with extraamniotic saline infusion, Foley's catheter alone, Oxytocin, and Sweeping of ‎membranes.‎
‎ The clinical trial involved a total of (121) pregnant women (47 primigravidae and 74 multiparae).‎
The success rates in achieving cervical ripening were (100%, 84.6%, 75%, and 54.5% for primigravidae) ‎and (100%, 91.3%, 88.8%, and 64.7% for multiparae) for method I-IV respectively. Post-ripening ‎Bishop's score was 6.9, 5.6, 4.6 and 4.1 for primigravidae &7.3, 6.05, 5.6 and 4.4 for multiparae, for ‎method I-IV respectively.‎
‎ The mean priming time was shortest in method-I (6.1 in primigravidae and 5.7 in multiparae) and longest ‎in method-IV (21.6 in primigravidae and 17.8 in multiparae). The induction delivery internal was longer as ‎we move from method-I toward IV. The caesarean section rate was highest in method-III and the lowest ‎rate was in method-I. In conclusion, Foley's catheter with extraamniotic saline infusion was found to be ‎the best method in comparison to the other three methods as it was safe, rapid, effective, inexpensive ‎and requires little training for application

This is a prospective study was conducted in Basrah University Hospital from January 1996–‎January 2001.‎
‎ Thirty patients with thirty closed tibial shaft fractures were treated until healing with a unilateral ‎uniplaner external fixation device that permits fracture site compression with weight bearing, ‎after failure to maintain adequate closed reduction in plaster. There were twenty-five men and ‎five women, age range from ten to fifty-five years with an average 29.9. Fractures were ‎classified depending on the anatomic location, fracture configuration and extent of concomitant ‎soft tissue injuries. Immediate bone graft was needed for two cases and delayed bone graft for ‎two cases. All patients were permitted early partial weight bearing when their fractures showed ‎early signs of union which took an average of eight to ten weeks and progressed to full weight ‎bearing, with fixator dynamization in seventeen cases. Cast immobilization after removal of ‎external fixation device was needed for all cases. Twenty-four cases showed complete healing. ‎The time to fracture union ranged from twenty-six to thirty weeks average of twenty-eight ‎weeks. The main complications were; four delayed union, two non-union, and twelve cases ‎screw site infection four of which require screw changes with the other eight require antibiotic ‎therapy and local cleaning and ten had stiffness of the ankle joint. ‎
The study highly recommends the use of external fixation as a good alternative to internal ‎fixation for treatment of closed unstable tibial shaft fracture in a compliant, tolerant patient. It ‎provides easy techniques to apply without the need of second surgery to remove it. Most of the ‎complications can be managed without removing the device. ‎

This is a prospective case control study conducted over a period of two years to evaluate the risk ‎factors of breast cancer in Basrah.‎
‎ One hundred and ten female patients with carcinoma of breast were admitted to the general surgical ‎department in three main referral hospitals in Basrah and those attended to Basrah breast clinic, ‎compared with (140) women who had no breast cancer from the population as a control group were ‎included in the study. The patients were diagnosed to have breast cancer according to the results of fine ‎needle aspiration cytology biopsy and the results of histopathological examination of excisional biopsy ‎taken from the primary growth in the breast.‎
‎ The study involved history, physical examination, laboratory & radiological investigations, ultrasonic ‎study and the results of fine needle aspiration cytology biopsy and histopathological examination.‎
‎ The data showed that the range of age of the group affected was (41-50 years); the patients were ‎mostly from urban areas (66.36%); the married patients were most commonly affected than single ‎patients (77.27%). Most of them (76.3%) had a history of breast feeding and (27.2%) of patients had a ‎history of contraceptive pills taking. ‎
‎ Sixty two patients had acceptable range of body mass index, and seven patients only had a family ‎history of breast cancer.‎
‎ The study showed that the epidemiological pattern of the risk factors of breast cancer were altered to ‎some extent according to the environmental, psychological and nutritional changes that occurred in our ‎country in the last decades.‎

‎ The aim of this review is to establish the correct diagnosis of malignant and benign compression ‎vertebral fractures by MRI to determine treatment and prognosis. ‎
‎ Over 5 months period all the MRI examination of fractured vertebrae reported by the radiology ‎department at KHMC were reviewed. Data collected for examination include MRI conventional T1W, T2W ‎spin echo sequences and fast spin echo with STIR (short inversion recovery) sequences. All the cases ‎selected were given intravenous gadolinium contrast medium. Evaluation of the compressed vertebrae ‎includes children and adults, males and females of different ages.‎
‎ Certain criteria are used to differentiate between benign and malignant collapsed vertebrae on MRI ‎based on the signal intensity, morphology and pattern of contrast enhancement for correct diagnosis. ‎
‎ In conclusion, homogenous and diffuse abnormal signal intensity, posterior convexity and involvement ‎of the pedicles are signs that are strongly suggestive of malignant vertebral compression; conversely, a ‎band-like area of low signal intensity adjacent to the depressed endplate or preservation of signal ‎intensity of the vertebra suggests benign nature of the collapse.‎

H.pylori is the cause of duodenal ulcer, and a lot of other gastrointestinal diseases, the aim of this study ‎was to see the extent of this microorganism in our patients and to study its antimicrobial sensitivity. The ‎study included 283 patients(148 males and 135 females) with upper gastrointestinal complaints including ‎dyspepsia, heartburn, bleeding, and malabsorption to evaluate the presence of Helicobacter pylori ‎‎(H.pylori) infection using rapid urease test (RUT) and culture to see there sensitivity to different ‎antibiotics.‎
‎ The study revealed that 199 patients (70.3%) have positive RUT compared to 218 patients (77.0%) ‎showed positive culture results. The positive culture results were confirmed by positive results of ‎biochemical tests (oxidase, catalase and urease).‎
‎ Antibiotic sensitivity testing was performed in 28 cultures of H. pylori, and the results showed that 26 ‎cultures ( 92.9%) were sensitive to amoxycillin, followed by clarithromycin, rifampicin and cephalexin with ‎figures of 23 (82.1%), 22 (78.6%) and 21 (75.0%) respectively. Whereas, 16 cultures (57.1%) were ‎resistant to metronidazole, 15 (53.4%) to erythromycin and 9 (32.1%) to both cephalothin and ‎tetracycline.‎
‎ It is concluded that, H.pylori infection is a predominant etiological factor of upper gastrointestinal ‎diseases, Also, RUT represent simple, convenient and reliable mean for the rapid diagnosis of H.Pylori ‎infection. Antibiotic sensitivity was the highest with amoxycillin and clarithromycin while the most ‎resistant antibiotic strains were encountered with metronidazole

Sickle cell anemia is an inherited disorder characterized primarily by chronic hemolytic anemia ‎and vaso-occlusive crises. It affects millions of people throughout the world. There is no tissue or ‎organ spared from injury by sickling disorder including the retina. ‎
‎ This studt aimed to determine the prevalence of retinopathy among patients with sickle cell disease.‎
‎ The study was done on 120 subjects, 60 patients and 60 healthy control. Beside electrophoretic testing, ‎all subjects underwent careful ophthalmoscopic examination (direct and indirect) by the same examiner.‎
‎ The American academy of Ophthalmology criteria for diagnosing and staging of sickle retinopathy was ‎followed in this study. ‎
‎ Retinopathy was more common patients with sickle cell disease (16%), than in control group (3%). ‎Those with SF hemoglobin were seem to be affected more than the other studied groups (AS, SS). Male ‎patients and those who were above 40 years showed more prevalence of retinopathy.‎