Basrah Journal of Surgery

Global comparison of The outcome of surgical techniques for spondylodiscitis Jessica Burton@, Thamer Hamdan*, Bisola Ajayi#, Mohsen Raza$, Angelo Fragkakis&, Cristina Lupu^, Timothy Bishop%, Jason Bernard! & Darren Lui**. @MB,ChB student. *Professor of Orthopaedic Surgery at Basrah University, Visiting Professor at London Imperial College and Research Fellow as Saint George’s Hospital London. #Orthopaedic and Spine Physician Associate. $Orthopaedic Registrar. &Spine Fellow. ^ Spine CNS. %Orthopaedic Spinal Surgeon. !Orthopaedic Spinal Surgeon. **Orthopaedic Spinal Surgeon. Department of Trauma and Orthopaedics, Saint George’s University Hospital, London, UK. Abstract Spondylodiscitis is an infection of the intervertebral disc and neighbouring bone. It is treated conservatively or surgically using a range of techniques. The aim of this review is to determine whether the surgical techniques between different countries have an effect on clinical outcome: postoperative complications, relapse rate, treatment failure rate or mortality rate. Many articles were screened using Ovid and Pubmed databases for studies pertaining to the surgical treatment of spondylodiscitis. Paediatric studies, tubercular/brucellar/fungal/ postoperative infection and case reports were excluded from this review. The results shows that no differences in the outcome of surgery between countries was found, and reasons for this along with solutions for moving forward with comparing surgical techniques worldwide are noted. Key words: Spondylodiscitis, Surgery, Outcome, Comparison, Literature review
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Abstract Treatment of sinonasal diseases is either conservative or surgical. The recent advances in surgical management is the use of endoscopic sinus surgery (ESS) as it causes less morbidity, complication, pain and above all, less recurrence rates. This study aimed to evaluate the effectiveness of ESS for the treatment of nasal & paranasal sinus diseases and to address the postoperative complications. A prospective study was done at the Department of Otolaryngology in Basrah Teaching Hospital in the period from January 2016 to August 2019. One hundred twenty six patients with sinonasal diseases were involved in this study, more than this number of patients was operated upon but they either refused participation in this study or dropped from follow-up. The main indications of surgery were; chronic rhinosinusitis without nasal polyp (33%), chronic rhinosinusitis with nasal polyp (28.6%), Allergic fungal sinusitis & mycetoma (17.4%), and acute recurrent sinusitis (16%). Main presenting symptoms were; nasal obstruction (85.7%), nasal discharge (69%), headache and facial pain (66.6%) and hyposmia and or anosmia (57.9%). The majority of operated upon patients were primary cases (98 patients, 77.7%), while (28 patients, 22.2%) were revision cases. The commonest causes of revision were; retained or incompletely removed uncinate process in 28.5% of cases, followed by incomplete removal or persistence of anterior ethmoid cells in 21.4% cases. In this series complications occurred in 15%, which were generally minor (9.5%), major complications occurred in 5.5% of operated upon patients. The commonest major complication is sever bleeding which was reported in 4.7% and anosmia which was reported in one patient. No CSF leak, retro orbital haemorrhage, or blindness was reported. Most of the patients in this series were improved (88.8%), complete symptom improvement occurred in (75 patients, 59.5%), partial improvement (37 patients, 29.3%), while (14 patients, 11%) were not improved. In conclusion, functional endoscopic sinus surgery is a safe surgery for sinonasal diseases, it carry good success rate with non-significant major complications. Key words: Nasal Sinus, Functional Surgery, Endoscopy

NONUNION OF LONG BONES IN BASRAH; EVALUATION AND MANAGEMENT Thamer A Hamdan* & Mofeed Y Alwaaly@*FRCS, FRCP, FICS, FACS, American Board (Orthopedic Surgery), Professor of Orthopedic Surgery. @MB,ChB, FIBMS, Specialist Orthopedic Surgeon, Basrah Teaching Hospital, Basrah, IRAQ.Abstract Nonunion of long bone fracture holds a big challenge for both the patient and the orthopedic surgeon. This study aimed to explore the possible causes and to evaluate the effectiveness of the treatment of nonunion in our region. Eighty-four patients with established nonunion of long bones were enrolled. All patients with primary fracture underwent; conservative, immediate or delayed operative treatment. Evaluation of nonunion was done by; careful general & local clinical examination, general & specific laboratory investigation, and radiological assessment with special emphasis to classify as atrophic or non-atrophic types. According to treatment modalities of nonunion, the patients were divided into three groups: Conservative (for those who refuse surgery or unfit for anesthesia), early, and delayed operative treatments. From the total 84 patients, 68 patients (81%) were males while 16 patients (19%) were females. Their age range was 13-77 years with a mean of 36.5 years. Five patients (6%) had co-morbidities including; diabetes, bronchial asthma, renal failure, hypertension. Cigarette smoking was not significant (p-value: 0.827). Tibia was the commonest bone involved in nonunion representing 46% (39 patients), followed by femur 36% (30 patients) and humerus 18% (15 patients). Forty-Five patients (54%) developed hypertrophic nonunion while 39 patients (46%) have atrophic nonunion. Non-union in this study was in seventeen cases (20.2%) due to single cause, while in fifty-five patients, (65.5%) due to two causes and the other twelve patients (14.3%) were due to combinations of three causes. Internal fixation with bone graft was performed for thirty patients (36%), external fixation with bone graft was applied to eighteen patients (21%), external fixation alone was done for 14 patients (17%), internal fixation alone was applied to 7 patient (8%), bone graft alone was done for 3 patients (4%), external and mini internal fixation with bone graft was done for 2 patients (2%). The mean time of follow up after definitive treatment for nonunion was 12.4 weeks. The majority of our patients (36 patients, 43%) were followed for 12-24weeks. The commonest bone that showed complete union in this study was femur (48%), tibia (30%), and humerus (22%). In conclusion, the chief causes that stand behind nonunion of the long bones which we revealed by our successive clinical, radiological, labrotary and active operative judgments in this study were; infection, insecure fixation, comminution, and soft tissue interposition. Internal fixation with autogenous bone graft proved to be the vital step to dissolve the obstacle of nonunion.Keywords: nonunion, bones, long, evaluation, treatment

Introduction: The pursuit of anatomical reduction in fracture fixation has been replaced by anatomic alignment and biologic fixation. Minimally invasive plate osteosynthesis (MIPO) is one such biological method. The aim of this study was to evaluate the clinical results and functional outcome of humeral shaft fractures treated with MIPO technique. Material and Methods: A hospital based prospective serial follow up study was conducted. We enrolled 30 patients for our study with displaced humeral shaft fractures, which were fixed by the technique of closed reduction and minimally invasive plate osteosynthesis (MIPO). Patients were followed-up for a period of 6 months. Different parameters were evaluated at follow up visits. Functional evaluation was done by UCLA (University of California & Los Angeles) scoring for shoulder and Mayo Elbow Performance Score (MEPS) for elbow. Results: 83.33% patients had anatomical alignment at 6 months. 6.67% had less than 5° varus angulation, 10% had less than 5 ° valgus angulation. 5 patients (16.67%) had radial nerve injury. 63.33% patients had excellent UCLA scores at 6 months. Majority of the patients (93.33%) had excellent MEPS scores. Conclusion: Our study supports that MIPO is a decent method of treating humeral shaft fractures but it requires adequate imaging and surgical experience. Optimum arm function is achieved at an early date with better cosmesis. Suitable healing and low infection rates are obtained with MIPO. Risks of iatrogenic nerve injuries are low if appropriate surgical technique is used.

Premature ejaculation (PE) is the most common sexual dysfunction in men with a prevalence rate reaching up to 75%. Varicocele is defined as elongated, dilated, and tortuous veins of the testicular pampiniform plexus. The link between PE and varicocele was demonstrated in many studies. This study aimed to evaluate the effect of varicocelectomy in improving PE in men with both PE and varicocele. This prospective study was conducted on sixty patients (age range 19-40 years) who had clinical varicocele and premature ejaculation. The study period was from January 2018 to January 2020 and was performed in Basrah Teaching Hospital. Forty patients met the inclusion criteria of this study. All patients had varicocelectomy and were followed up for the improvement of their PE. The study showed that majority of patients with concomitant PE and varicocele (26 patients, 65%) had improvement of PE after varicocelectomy with an ability to delay ejaculation. The development of PE in patients with varicocele may be related to the occurrence of prostatitis due to the backflow of blood from the varicocele to the prostatic venous plexus. The study concluded that improvement of PE in patient with concomitant varicocele could be achieved by performing varicocelectomy. Key words: Varicocele, premature, ejaculation, improvement, varicocelectomy.

Introduction: The pursuit of anatomical reduction in fracture fixation has been replaced by anatomic alignment and biologic fixation. Minimally invasive plate osteosynthesis (MIPO) is one such biological method. The aim of this study was to evaluate the clinical results and functional outcome of humeral shaft fractures treated with MIPO technique. Material and Methods: A hospital based prospective serial follow up study was conducted. We enrolled 30 patients for our study with displaced humeral shaft fractures, which were fixed by the technique of closed reduction and minimally invasive plate osteosynthesis (MIPO). Patients were followed-up for a period of 6 months. Different parameters were evaluated at follow up visits. Functional evaluation was done by UCLA (University of California & Los Angeles) scoring for shoulder and Mayo Elbow Performance Score (MEPS) for elbow. Results: 83.33% patients had anatomical alignment at 6 months. 6.67% had less than 5° varus angulation, 10% had less than 5 ° valgus angulation. 5 patients (16.67%) had radial nerve injury. 63.33% patients had excellent UCLA scores at 6 months. Majority of the patients (93.33%) had excellent MEPS scores. Conclusion: Our study supports that MIPO is a decent method of treating humeral shaft fractures but it requires adequate imaging and surgical experience. Optimum arm function is achieved at an early date with better cosmesis. Suitable healing and low infection rates are obtained with MIPO. Risks of iatrogenic nerve injuries are low if appropriate surgical technique is used.

Patients with penoscrotal, proximal shaft and mid shaft hypospadias who were previously circumcised or patients with insufficient urethral plate such as those with severe chordee that cannot be corrected just by simple degloving, or failure of previous hypospadias repair, such patients represent a challenge for subsequent repair and appropriate procedure choice. The aim of this study is to assess the outcome of longitudinal dorsal island flap (LDIF) by both onlay and tubularized repair for patients with hypospadias who were previously circumcised or had poorly developed urethral plate. This prospective study was done on 36 patients who had penoscrotal, proximal and mid shaft hypospadias and were previously circumcised or had poorly developed urethral plate. Twenty four of them were operated upon by using onlay LDIF and 12 patients by using tubularized LDIF. Patients were followed-up for 12 months to look for any complication for these 2 types of surgeries and for assessing the functional outcome of the repair. The success rate for onlay LIDF was 75% and for tubularized LIDF was 58.33%. Overall complications occurred in 11 (30.55%) children. In conclusion, LDIF can be used successfully for repair of hypospadias in circumcised children or those with failed previous repair. Keywords: Hypospadias, LDIF, failed repair, tabularized incised plate urethroplasty

Sinonasal tumors are not uncommon lesions, they are either benign or malignant, benign tumors are relatively common while the malignant are considered rare. The inverted papilloma of the paranasal sinuses is the commonest benign tumor and has a potential to become malignant. This is a report of three cases of inverted papilloma of the paranasal sinuses which were approached surgically by endoscopic sinus surgery with very good results. These cases were diagnosed by CT-scan of paranasal sinuses followed by biopsy taken via endoscopic guidance. Keywords: Endoscopy, maxillectomy, inverted papilloma

Wilms tumor is the commonest renal tumor in children. This study aimed to evaluate the characteristics, diagnosis, treatment, and outcome of Wilms tumor in pediatric age group and to analyze factors affecting the outcome. This retrospective study included 61 children younger than 15 years with Wilms tumor who were managed at Basrah Children Specialty Hospital during the period between 2011 and 2016. Patients` characteristics, mode of diagnosis, treatment modalities, complications, relapse, and outcome were all reviewed. The results showed that Wilms tumor was the commonest tumor affecting the kidneys (85%). The median age of onset was 30 months, and mostly in children aged 2-4 years. The most common presenting feature was abdominal mass (44.3%). Twenty three patients were diagnosed as stage 1 (37.7%). Favorable histology Wilms tumor was encountered in only 65.6%. Tumor relapse was seen in 12 patients (19.7%), eight of them died (66.7%). The overall 2-year survival was 70.5% (43 cases). In conclusion, Wilms tumor is the most common renal tumor with high rate of unfavorable histology (anaplasia) in our society. Stage I tumor is the predominant stage but unfortunately carries a relatively high mortality. Advanced stages still represent a significant proportion which may reflect poor awareness and delayed diagnosis which thereafter worsens the outcome. Advanced stages, presence of anaplasia, and tumor relapse are the major factors affecting survival of children with Wilms tumor. Keywords: Renal tumors, Wilms, Staging, Histology, Outcome

Premature ejaculation (PE) is the most common sexual dysfunction compliant in about 35 to 45% of men younger than 40 years. In this study, the efficacy of two drugs (Fluoxetine and Citalopram) which are selective serotonin reuptake inhibitors (SSRI) used for treatment of patients suffering from PE is evaluated. The effectiveness of both drugs in PE patients was studied with different protocol to find out the most effective drugs with least side effect. A total of 93 patients were referred to the Urology Clinic in Basrah Teaching Hospital for the treatment of PE. Patients were randomly divided into two groups; Patients in group 1 (N=49) received 40mg (2 capsules of 20mg) fluoxetine daily for 4 weeks, and patients in group 2 (N=44) received 40mg citalopram daily for 4 weeks. The mean intravaginal ejaculation latency time (IVELT) before treatment in patient of group 1 was 65.81±27.63 seconds, while after treatment it raised to 311.47± 43.29 seconds. In group 2, the mean IVELT before treatment was 61.42±32.65 seconds, while after treatment it raised to 293.15± 51.72 seconds. In conclusion, both drugs (Fluoxetine and Citalopram) improved ejaculation duration significantly.