Basrah Journal of Surgery

Thamer A Hamdan MB,ChB, FRCS, FRCP, FACS, FICS, Professor of Orthopaedic Surgery, Dean of Basrah College of Medicine, Chancellor of Basrah University, Basrah, IRAQ. The good outcome of surgery is the goal and what everybody is looking for. Sadly and particularly in our locality, the outcome is always thrown on the surgeon's side; not taking into consideration and even sometimes, ignoring many factors that may lead to the success or failure of this type of battle.

This is the third article in the series ‘Fundamentals of good medical practice’1,2. In this paper I will discuss the definitions of ‘Competence’ and ‘Performance’, the distinction and relationship between the two areas, and the possible/suggested different aspects of their assessment for the purpose of assuring the competence of current and future doctors, in particularly surgeons in practice.

L aparoscopy (Gr: Laparo-abdomen, scopein-to examine) is the art of examining the abdominal cavity and its contents. It requires insertion of a cannula through the abdomi¬nal wall, distention of the abdominal cavity with gas or air (pneumoperitoneum), and visualization and examination of the abdomen’s contents with an illuminated telescope. With the advent of videocameras and other ancillary instruments, laparoscopy rapidly advanced from a being a diagnostic procedure to one used in fallopian tubal occlusion for sterilization and eventually in the performance of numerous sur¬gical procedures in all surgical disciplines for a variety of indications.

Facts in gabapentin use are known about its effect on neuropathic pain management while its clinical significance as analgesic in laparoscopic cholecystectomy has not been studied much to clarify its importance and to know how and when it could be used or if this new analgesic strategy can be an alternative to others or be as a part of multimodal analgesic therapy in postoperative management. We conducted a prospective study to evaluate the significance of pre-emptive single dose gabapentin to reduce postoperative pain following laparoscopic cholecystectomy. Study group of hundred patients were analyzed in prospective study; Fifty of them were gabapentin group and another fifty were placebo group. Age, sex, body mass index, operation time and length of hospital stay were comparable in both groups. Analgesic requirements were recorded and pain assessment using 100 visual analogue scale in both groups were studied at three times intervals of 8,12 and 24 hours after surgery. In addition we studied the incidence of certain postoperative side effects in both groups as nausea, vomiting and drowsiness. Age, sex, body mass index, operation time and hospital stay were comparable in both groups. Opioid requirement two hours after surgery was significantly lower in gabapentin group than in placebo group (p

Laparoscopic cholecystectomy is performed rather commonly by general surgeons for symptomatic gall stones. This study is an analysis of experience for the timing of laparoscopic cholecystectomy for acute cholecystitis performed in Basrah, Iraq, by one surgeon. This study aimed to know the difference between early and delayed laparoscopic cholecystectomy in acute cholecystitis with respect to the hospital stay, conversion rate, and major complications rate. Data were collected from the medical records of patients with acute cholecystitis admitted to the surgical wards during (June 2009 to September 2011). Patients were divided into 2 groups on the basis of treatment received. Length of hospital stay, major complications, and conversion rates were analyzed. Ninety seven patients with acute cholecystitis underwent laparoscopic cholecystectomy. Thirty nine patients (40.2%) treated with early laparoscopic cholecystectomy, fifty eight patients (59.8%) treated with delayed laparoscopic cholecystectomy. Length of stay was significantly shorter in the early laparoscopic cholecystectomy group compared with the delayed laparoscopic cholecystectomy group (P Keywords

Cesarean delivery under general anesthesia requires effective postoperative analgesia for early ambulation and breast feeding. Transversus abdominis plane (TAP) block is done by injecting local anesthetic solution in the plane between internal oblique and transversus abdominis muscles on either sides of the abdominal wall to prolong postoperative analgesia. One hundred pregnant women who underwent general anesthesia for cesarean delivery were randomized in to two equal groups;TAP block group versus control group. This block was performed bilaterally using 20 mls of 0.25% plain bupivacaine on each side. Each patient was assessed postoperatively by a blinded investigator at 2, 4, 6,12, 24 hours using numerical pain score (NPS) 0-10 at rest and movement. Narcotics consumption, drug side effects, and patient`s satisfaction were recorded. There were no significant differences between patients characteristics. Postoperative pain at rest as measured by NPS showed; medians (3-6) and means (3-5.5) in the control group; which were significantly (p<0.05) higher than those in TAP block group which did not exceed. During movement, NPS medians (4.5-8) and means (4.5-8.5) in the control group were significantly (p Keywords

Faiz Abdulwahid Alwaeely Basra Medical College, Almanar Fertility and Endoscopy Center Abstract The aim of this study is to compare clinical pregnancy rates in ICSI-ET cycles where GnRH agonist or hCG was used to induce final maturation of the oocytes. A total of 97 women who produced more than 14 follicles following ovulation induction with recombinant FSH and GnRH antagonist were selected for randomization. Human chorionic gonadotropin (hCG, 5.000 IU, IM) or GnRH agonist (triptorelin 0.2 mg, SC) was used for the induction of final maturation. Women in GnRH agonist group received higher dose of progesterone (100 mg vs. 50 mg) and estradiol (6 mg orally per day vs. none) compared to women in hCG group in the luteal phase starting on the day of oocyte pick-up. Age, duration of stimulation, dose of gonadotropins, peak estradiol levels were similar in both groups. The mean number of collected oocytes (14.7±2.1 vs. 13.8±4.3) and fertilization rates (70.7 ±18 vs.71.8 ±21) were not significantly different between women allocated to hCG group (n=53) and GnRH agonist group (n=44). Clinical pregnancy rates (37.7 vs. 36.3), miscarriage rates (15% vs. 18.7%) and ongoing pregnancy rates (32% vs. 29.5%) were similar between hCG group and GnRH agonist group, respectively. Two cases of moderate/severe OHSS occurred in the hCG group, and none in the GnRH agonist group. In conclusion, GnRH-agonist triggering together with high dose steroid supplementation in the luteal phase yields similar clinical pregnancy rate to that obtained with lower dose of hCG administration for final maturation. However, lower dose of hCG was associated with a higher incidence of moderate/severe OHSS.

Salah Zuhair Al-Asadi MB,ChB, FRCS, FIBMS, Lecturer of Ophthalmology, College of Medicine, University of Basrah. Abstract Floaters and photopsia are common eye symptoms. This prospective study aims to detect the relative importance of floaters, photopsia, or both as predictors of vitreo-retinal pathology. In this study, 202 patients attending the outpatient clinic in Basra General hospital between 2009–2011 complaining of floaters, photopsia, or both were interrogated, starting with inquiry about the mode of presentation, then slit lamp examination of the anterior segment, and dilatation of the pupil by mydriacyl drops 0.5% and phenylphrine drops 10%, followed by 3 mirror examination of the vitreous and peripheral retina. The results showed that 98 patients were males while 104 patients were females, 104 patients (51.49%) presented with floaters; 24 patients (11.88%) presented with photopsia; and 74 patients (36.63%) presented with both floaters and photopsia, 102 patients (50.50%) had posterior vitreous detachment (PVD) while 52 patients (25.74%) had synchysis, and 48 patients (23.76%) had normal vitreous. The highest percentage of PVD was in the age group 60–69 years and was 40 patients (39.21%). Regarding the mode of presentation, the highest percentage of PVD was in the group of patients presenting with both floaters and photopsia and was 46 patients (62.16%). The total number of retinal tear cases detected was 14, 8 of them were present in patients having PVD and presenting with floaters and photopsia, while 4 cases of retinal tears were detected in patients having PVD and presenting with floaters, and finally 2 retinal tear cases were detected in patients having PVD and presenting with photopsia, 12 eyes (85.71%) who had retinal tears had vitreous pigment granules, while 2 eyes with retinal tears (14.29%) did not have vitreous pigment granules. In conclusion, the symptoms of floaters, photopsia, or both are an important predictors of vitreo- retinal pathology. A significant number of patients had PVD, and this was associated with retinal tears in a number of patients. Vitreous pigment granules in these patients were closely correlated with the presence of retinal tears. Careful examination of patients including 3 mirror contact lens examination is mandatory.

Nawfal Ali Mubark MB, ChB, DA, FICMS, Lecturer in Anesthesiology, Department of Surgery, College of Medicine, University of Basrah, IRAQ. Abstract The objective of this study is to evaluate the evidence of bronchospasm in patients with hyper-reactive airway disease (HRAD) following induction of anesthesia by thiopental sodium. The number of the patients participating in this study was 200. Patient`s physical status was class I and II according to American society of anesthesiologists (ASA). Age range was 17-55 years. Patients were subjected to different types of elective operations. The patients were assigned into two groups: - first group was100 patients with normal airway considered as control group (group A) their age range was 17-55 years with a mean ±SD 30.3±9.95. The second group included 100 patients with asymptomatic hyper-reactive airway disease which was the case group (group B) their age range was 17 -50 years with a mean ±SD 30.60 ±8.29. From each patient a full history was taken and auscultation of the chest before induction of anesthesia was done, then oxygenation for 5 minutes with 100% oxygen was achieved without premedication. Anesthesia was induced by sleeping dose of intravenous (IV) thiopental and oxygenation was carried out by face mask, followed by auscultation of the chest immediately. Intubation was achieved with l mg /kg IV of Suxamethonium followed by assisted ventilation of the lung, and then re-auscultation of the chest was performed. The frequency of bronchospasm after thiopental induction in different types of hyper-reactive airway diseases of the case group was: 14 patients (58.3 %) from the total 24 case who they were a known case of bronchial asthma were developed bronchospasm while only 2 patients (2.9%) from the total 41 case who they have allergic bronchitis were developed bronchospasm, but no one with allergic rhinitis patients had bronchospasm. The differences among different types of hyper-reactive airway diseases of the case group (disease group) regarding the evidence of bronchospasm is of statistically significant with P-value less than 0.05.It is concluded from this study that thiopental is not contraindicated in all patients with HRAD especially those with allergic rhinitis & allergic bronchitis who they don`t have brochospasm while its contraindicated in bronchial asthma who they have bronchospasm preoperatively.

Ihsan S Sahi*, Mukhallad A Ramadhan@ & Sadiq U Khadim# *CABS, Head, Dept. of Surgery. @#MSc, Department of Pathology, University of Missan, College of Medicine, Missan, IRAQ. Abstract Benign prostatic hyperplasia (BPH, benign prostatic hypertrophy), a non-malignant abnormal growth of the prostate gland, affects almost all men in some degree as they age and can cause a significant disruption of lifestyle due to urinary outflow obstructive and irritative symptoms. The present study was performed on patients with BPH and other group of normal persons (40 person for each) to evaluate some of hormonal changes that result in BPH. The blood samples were collected from the groups of study those were of ages 45 and more and serum levels of both estrogen and testosterone were evaluated, as well as tissue of prostate were collected from some of the patients after surgery and estrogen receptors were estimated by immunohistochemisitry. The results shows significant reduction of the testosterone with elevation of the estradiol levels with marked expression of estrogen receptors in both epithelial and stromal cells of the prostate in patients. In conclusion, the present study found that sex hormonal disturbances associated with increase age of the person was implicated in the pathogenesis of BPH.

TALIB A AHMED MB,ChB, Dip.Orth. Consultant Orthopaedic Surgeon. Al-Karama Teaching Hospital. AL-Kut, IRAQ. Abstract Out of 558 cases of internal fixation of long bones done within five years, 22 cases of implant failure were recorded at Al-Karama Teaching Hospital at Al-Kut city, IRAQ. This is a prospective and retrospective study to review the possible causes of implant failure and their management. This study included sex, age and the coincident diseases of the affected patients. The failure rate in this study was 3.9%. There were 4 females (18.27%) and 18 males (81.54%). Age range of the affected patients was ranged from 19-76 years with average of 34 years. Implants failure in the lower limbs form 77.27%. This study also pointed to the possible error in metallurgy of the fixation implants because we noticed that most of the failed plates are manufactured by one company!

RIYADH J FAKHRULDEEN PhD. The Royal Society, Amman, Jordan. E-mail: drreyad49@yahoo.com The first use of Bromide as a treatment was for human epileptics over 200 years ago as or potassium bromide (KBr). Over the passage of time and the discovery of new anticonvulsants, KBr apparently became less popular due to the hepatotoxicity of bromide. Once in the brain, the bromide component becomes negatively charged ions and causes the brain cells to be also negatively charged. It is this negative state which seems to inhibit the excitability of neuron cells and helps to prevent the cells of the brain from firing in a random and haphazard manner

Salam N Asfar@ & Jasim M Salman# @MB, ChB, MSc, Professor of Anesthesiology, College of Medicine, University of Basrah, and Al-Sadir Teaching Hospital, Basrah. #MB,ChB, DA, FICMS, Lecturer & Consultant Anesthesiologist, Basrah University and Al-Sadir Teaching Hospital, Basrah, IRAQ. C ardiac arrest can be defined as inability of heart action to maintain adequate cerebral circulation. Arrest in association with anaesthesia accounts for millions of cases around the world1-2. Cardiac arrest attributable to anaesthesia occurred at the rate of between 0.5 and 1 case per 10 000 cases overall and at the rate of 1.4 per 10 000 cases for the paediatric series; 55% of these were in children less than 1 year of age. The overall rate of cardiac arrest is up to 10 times higher than this, with uncontrolled bleeding, technical surgical problems, extensive co-morbidity, and advanced age3,4.

Mr. Mohammed Talib Al-Hassani, FRCS 23.11.1939 - 16.4.2013 Dr. Al-Hassani was born in the South of Iraq (Al-Emara), raised in a respected and holy family that is well known in science, religion and commerce.