Print ISSN: 1683-3589

Online ISSN: 2409-501X

Issue 2,

Issue 2


THE RELATIONSHIP BETWEEN CLINICAL EXPERIENCE AND QUALITY OF CARE AND ITS OUTCOME.

MAJEED H ALWAN

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55531

Quality assurance and performance evaluations, have become central issues in medicine.
There are several studies which indicates that general patients care is suboptimal in many
different medical conditions and clinical settings1,2. Delivering high-quality care is important to all
clinicians, but this issue may be more relevant to certain subgroups, such as those with less
specialised training and those who deal with smaller number of patients3. There is also a
general believe that the longer clinicians are in practice the more experienced they will be, and
therefore it is assumed that this group of medical doctors are able to provide a high quality of
care. But there are some studies that found a consistently or partially negative association. The
aim of this report is to discuss this subject further and reach some conclusions.

PERECPECTIVE ON THE STRUCTURED ORAL EXAMINATION

THAMER A HAMDAN

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55532

Oral examination, sometimes called viva which is a Spanish word means alive or vital,
should be considered seriously because it gives a clear and direct impression about the
student's level of education, and how to behave when facing difficult situation.
Considerable number of students feels very unhappy about oral examination and
probably prefers the written ones. Oral examination also gives an idea about the
personality, the behavior, the way of communication, and the response of the student to
a difficult situation. Napoleon the French commander said: it is easier for hire to
participate thousand times in a battle field than to site once in the examination hall.
Oral examination is one of the oldest methods of student's evaluation, and probably it
was the only way to examine in the ancient days.
In oral examination, the students rights should come on the top of everything and the
benefit of doubt should be on the student's side always. Unfortunately, sometimes mix
up occurs between under and post graduate students and even between different levels
of post graduate students, the same question may be given to all levels for that reason a
clear cut sharp line should be drawn between the different levels of students, and
specifications in the questions for each level in mandatory.
Almost all students are anxious during oral examination, this anxiety is usually
associated with lower oral score, therefore sympathy and empathy is necessary from the
examiners side.
To perform oral examination, four corner stones are mandatory which consist of
students, examiners, questions and examination hall. Perils and pitfalls may arise in any
of the above.
The author is putting down his perspective on the structured oral examination which
consist of giving mark for each separate questions in addition to separate and secret
score from each member of the examination committee, and how ideally should be
performed to reduce or to avoid pitfalls and achieve justice as much as possible.

THE EFFECT OF KETAMINE, DICLOFENAC AND THEIR COMBINATION ON FOUR MODELS OF INDUCED PAIN IN MICE

ABDULLAH M JAWAD; ASMAA M HUSSAIN AL-ALI

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55533

Adjuvant analgesics are drugs that have weak or nonexistent analgesic action when
administered alone, but can enhance analgesic action when co-administered with known
analgesic agents. Ketamine, an anesthetic drug, is an adjuvant analgesic drug. Its use in doses
lower than therapeutic doses might be important in the management of certain types of pain as
neuropathic pain.
The present study was performed to investigate the effects of subanesthetic doses of ketamine
in four animal models of induced pain and to compare its effects with diclofenac sodium. It is
also intended to test the effectiveness of combining both drugs together in these animal models
of pain.
All experiments were performed on albino mice. Mice were evaluated for their responsiveness
to noxious stimuli using four tests: tail-flick test, hot-plate test, formalin test and acetic acidinduced
writhing test. These effects were measured before and one hour after intraperitoneal
drug administration. In some experiments, they were followed for 6 and 24 hours.
We found that Ketamine, in subanesthetic doses, resulted in a significant analgesic effect in all
the four models of pain. It increased pain latencies in tail-flick test by 78% compared to preadministration
time, and by 95% in hot plate test. It also decreased the number of lickings and
bitings in formalin test by 41.9% and the number of abdominal writhing by 73.5%. These
analgesic effects represented around 60% of diclofenac effect in heat-induced pain models, but
it is similar to diclofenac in the other two models. The enhancement of diclofenac analgesic
effect by ketamine ranged from 13.6% to 46% in the four tests.
It is concluded that Ketamine in subanesthetic doses has a significant analgesic effect
comparable to diclofenac. It can enhance diclofenac effect by a margin not exceeding 50% of
diclofenac effect. Much smaller doses of ketamine are required to be tested in the future.

HISTOLOGICAL STUDY ON THE STRUCTURAL CHANGES OF PLACENTA IN SMOKING IRAQI MOTHERS

KHALIDA K JBARA

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55534

The placenta was chosen as a possible sample for detection of degenerative changes by
tobacco smoking in the human pregnant female. Passive smoking mother during pregnancy is
associated with increase of collagen content of the villi, decrease fetal weight, increase in the
number of villi, increase of trophoblastic apoptosis and increase in the thickness of maternofetal
barrier. Sections, 3-5 micron thickness of 40 full term placentae of passive smoking mothers
and 30 number of gestational matched placenta were used as control, they were studied
under light microscope. Appreciable degenerative changes were found in the group of passive
smoker females, he main findings were: thickening of the basement membrane of placental
villus, increase in the collagen content of the villus, and increase in the syncytial budding,
increase in the materno-fetal barrier thickness and extensive loss of trophoblast. This study
concluded that tobacco is harmful to the human tissue and vascular system in general
suggesting that smoking results in deteriorating organ structure and function.�

6-DISCHARGING EAR (OTORRHEA), A CLINICO-MICROBIOLOGICAL STUDY

AHMED M AL-ABBASI; ZAHRA KADUM SAEED

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55538

This study aimed to assess the causes of otorrhea and causative organisms. A prospective clinicomicrobiological
study of 153 discharging ears of 148 patients in Basrah General Hospital during 2
years period. This study showed that most commonly affected age group was below 10 years (44
patients=30%), the most common type of otorrhea was the purulent (127 ears=86%), the most
common cause of purulent otorrhea was chronic otitis media (77 ears=61% of purulent discharging
ears). Staph. aureus was the commonly isolated organism from purulent discharging ears (39 ears). It
is concluded that otoscopic and otomicroscpic examination plus carefully and accurately taken swabs
for cultures are essential for accurate diagnosis and precise treatment in all cases of ear discharge.

7-MEDIAL CANTHAL TENDON REPAIR IN TELECANTHUS PATIENTS

AMER S DAOOD; SADIQ ABADI ABDUL-HASSAN; MAHDI H ABOOD

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55539

This study aimed to provide a comprehensive review of the techniques used for reconstruction
of the medial canthal tendon in telecanthus cases and to analyze the most suitable reconstructive
methods for different medial canthal tendon lesions methods. This clinical study has been
done on 22 patients with a 25 medial canthal tendons (MCT) lesions and attended to Al-wasiti
and surgical specialties hospitals in the period from February 2003 and march 2004. The cases
studied from clinical, aesthetic and reconstructive aspects.
All patients presented with telecanthus and either congenitally lax or injured medial canthal
tendons. Reconstruction of the lesions was done using four different surgical techniques dirct
repair of the medial canthal tendon (canthorraphy) done for four patients, medial canthal tendon
(anterior limb) plication for six cases, transnasal canthopexy was done for nine patients with
open reduction and fixation of frontal process of maxilla were done for six patients. We conclude
that desired surgical outcome can be achieved where there is bony attachments of the medial
canthal tendon.

8-UPPER LIMB SALVAGE

WADHAH MAHBOBA; LAITH F SHARBAs; ALA; A M MUHSINI

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55540

Among the vascular injuries, the brachial artery injury is common one. This is a retrospective
study of 90 patients admitted at Al-Sader teaching hospital in Najaf from the 1st
of January 2007 to the 1st of January 2008. The most common mechanism of injury was
bullet and shell injuries (57.8%) followed by stab (25.5%), and blunt injury (13.4%). The
least was iatrogenic in (3.3%) of cases. The surgical technique used to repair the vessel
was resection and end to end anastamosis in 47.8% of cases, in 27.8% of the patients
venous graft was used. Arteriorhaphy was done in 8.8% of the cases. Associated venous
injuries were dealt with by ligation of the veins. No attempt to do venous repair and no
fasciotomy was needed. The outcome of the injury in this study was in general good. The
morbidity of the patients due to nerve injury, wound infection and joint stiffness still a
problem. Mortality was 7.7% was due to associated injuries and delayed presentation of
the patients. This study aimed to analyze the cause of injury, surgical approach, outcome
and complications of brachial artery injury.

9-ANALYSIS OF FACTORS CONTRIBUTING TO MORTALITY IN BURNS PATIENTS, RETROSPECTIVE STUDY

JASIM HASSAN SALIMEMH

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55541

Burn injury result in a significant physical and psychological trauma to the burn patients. The
highest mortality is among low socioeconomic status countries. This study aimed to analyze
factors contributing to death in burn patients in Basrah General Hospital burn unit.
One hundred fifty patients died in Basrah General Hospital unit from January 2000 to December
2001, retrospective analysis of their records including; residency, age, sex, percentage of
total body surface area burned, cause and time of burn.
Most patients were females 69% (04 patients), males 31% (64 patients), high mortality in age
group (10-29years), 53% (79/150), females predominate in this age group 58%, males 39%.
Males predominate 26% (12/46) over females 13% (13/104) at age group 0-3 years. Most of
mortality within percentage of total body surface area burn of (31%-40%) is 18% (27/150), percentage
of burn of 91%-100% is 21% (32/150). Commonest cause of death is infection 57% (85
patients), hypovolemia and inhalation injuries in 31% (47/150 patients). Number of deaths at
first seven days post burn is 84% (126/150).
It is concluded that the commenst cause of death is infection. High risk age group is children
and young females which reflect lack of social security. Therefore preventive measures are
essential.

10- HUMAN PARVOVIRUS B19 ANTIBODY AMONG ARTHROPATHIC PATIENTS WITH ESPECIAL EMPHASIS ON SICKLE CELL DISEASES IN BASRAH

MUBDER A MOHAMMED SAEED; HASSAN J HASONY; DANIAH M SHAKIR

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55542

A case control study was carried out during the period from October 2006 till September 2007
in Basrah Governorate. To estimate the overall prevalence of Human Parvovirus B19 (HPV
B19) antibody and its association to Rheumatoid factor seropositivity among sickler and non
sickler arthropathic patients.
A total of 182 blood samples were collected. Ninety (90) from arthropathic patients with or
without sickle cell diseases (SCD), who attended the orthopaedic, rheumatology and internal
medicine consultant clinics in Basrah General Hospital and Hemoglobinopathies Center at the
Maternity and Children Hospital. Ninety two (92) from control group, non arthropathic with or
without SCD.
Human parvovirus B19 IgG antibodies were serologically detected by an Enzyme- Linked
Immunosorbent Assay (ELISA). The rheumatoid factor was detected by Latex agglutination test.
The overall prevalence of HPV B19 antibody in Basrah among study population was 68.7% .
The prevalence of this antibody was 76.9% among arthropathic non sickler and 65.8% in sickler
arthropathic patients. These differences were shown statistically not significant P> 0.05
compared to control group where prevalence was 63.2% in non arthropathic sickler and 66.7%
among non arthropathic non sickler individuals.
Eighty percent of arthropathic patients who had positive rheumatoid factor were also positive for
HPV B19 antibody, which indicate a significant association (P<0.05).
In the present study the seropositivity of HPV B19 was shown to be increased with age. In
relation to site of joint affected, the small joints of the hand and foot were the commonest site of
manifestation 78.1%.
HPV B19 antibody was significantly more (79.7%) among persons with history of blood
transfusion. The types of SCD had no significant effect on the prevalence of HPV B19 antibody
(P>0.05). However there was a positive relation between HPV B19 seropositivity and the
duration of illness (P<0.0%).
In conclusion, HPV B19 is common with high prevalence in our region. There is clear
association between HPV B19 infection and rheumatoid factor positivity. Individuals with sickle
cell diseases regardless the type and those with history of blood transfusion were considered as
risk groups for acquiring HPV B19 infections.

11- THE EFFECT OF CHITOSAN ON OSTEOGENESIS, HISTOLOGICAL STUDY IN RABBITS........................................................................................................................

ALI TAHA YASSEN; ALI DARWEESH AL- SARRAG

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55543

Bone regeneration is a major limiting factor in oral surgery regenerative therapy. The concept of
guided tissue regeneration has provided the strongest evidence that tissue healing can be
influenced exogenously by wound management. At the cellular level, the existence of
osteoprogenitors with the capacity to produce bone in the wound site and the potential to
exogenously influence the behavior of these cells offers the opportunity to further enhance
regenerative wound healing. Chitosan, with a chemical structure similar to hyaluronate, has
been implicated as a wound healing agent. The purpose of this research was to evaluate the
effect of chitosan on osteoblast differentiation and bone formation in vitro.

12- SOFT TISSUE RECONSTRUCTION IN SEVERE OPEN LEG FRACTURES (GUSTILO TYPE III)

ZUHAIR F FATHALLAH; ALI H KHUDAIR; MAHMOOD A MAHMOODZ

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55544

Eighteen patients who sustained severe open leg fractures (Gustilo�s III) were treated in ALBasrah
General Hospital and Al-Sadder Teaching hospital between 2007 and 2008. They
were12 males and 6 females, average age were 25 years. Middle third fractures occurred in 8
cases (44.4%) and the comminuted geometry of fracture was in 14 patients (77.7%). All patients
were treated by meticulous wound excision with stabilization of fracture and then wound cover,
which is done early in 6 patients (before 7 days) and late in 12 patients (after 7 days). Local
muscle flap was done in 9 patients (50%), local fasciocutanous flap in 6 patients (33.3%) and
free flap in 3(16.7%). The complications occurs more in late local reconstruction as flap infection
in (55.5%), nonunion in (33.3%), flap necrosis in (22.2%) and osteomylitis in (33.3%) while in
early reconstruction it is found only (16.6%) as a complication of each of the above. In muscle
flap, flap infection found in (22.2%), flap necrosis in (11.1%) and nonunion in (22.2%) which was
lower than other type of reconstruction, the muscle flap was more reliable flap in early period of
reconstructions. In conclusion, primary reconstruction of Gustilo's type III open tibial fractures
had advantages compared with secondary reconstruction.

14- METHANOL POISONING, CASE REPORTS AND LITERATURE REVIEW

ABDULMOHSEN E A HUSSAINN; YASEEN H ALI; MOHAMMED NAEEM NIAZY

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55546

Acute methanol poisoning produces severe metabolic acidosis, increased anion and osmol
gaps. These metabolic disturbances are chiefly due to accumulation of formic acid which can
lead to serious neurological sequelae. If renal dysfunction develops then rapid deterioration and
increased mortality can occur. Early diagnosis and treatment can reduce the morbidity and
mortality. Treatment includes infusion of sodium bicarbonate and administration of ethanol
parenterally or orally to inhibit the production of formic acid form methanol. Haemodialysis helps
the removal of methanol and formic acid from circulation and also corrects the acidosis. Two
cases of methanol poisoning are described. Both patients took a mixture of methanol and
ethanol in different amount with different outcomes.

15- PANCEREATIC HYDATID AS A CAUSE OF EPIGASTRIC MASS, A CASE REPORT.....

MUSHTAQ CH ABU-ALHAIL

Basrah Journal of Surgery, Volume 14, Issue 2, Pages 0-0
DOI: 10.33762/bsurg.2008.55547

Primary hydatid cyst in the corpus of pancreas is a rare. A woman of 35 Years old came with a
two-month history of epigastric Pain, occasional vomiting and an epigastric mass. On Physical
examination the vital sign were normal. The only Positive sign besides ahard epigastric mass
was mild tenderness. Ultrasonography and CT Showed a cyst at the Corpus of the Pancreas
4X5cm Diameter. The Patient under went midline laparotomy and an isolated hydatid cyst of the
Pancreas was found. This is a rare manifestation of this disease.