Basrah Journal of Surgery

Diabetic foot ulceration is a serious and expensive complication with considerable morbidity that affects up to 15% of diabetic patients during their lifetime and 80-85% of amputations are preceded by foot ulcers. The aim of this work is to study the correlation between severity of clinical abnormalities and electrophysiological studies in diabetic foot ulcers. This study was a cross sectional evaluation of 44 patients with diabetic foot ulcers seen in 2 hospitals in Basrah (Al-Faiha General and Basrah Teaching) from October 2003 to July 2004. All patients were type 2 diabetes mellitus. The sensitivity of numbness, burning feeling, pricking feeling and worse symptom at night was 84.6%, 69.2%, 61.5% and 51.5% respectively. While sensitivity of decreased pin prick sensation, absent vibration sense, absent ankle jerk, decreased temperature sensations and absent position sense was 100%, 87.2%, 71.8%, 56.5% and 12.8% respectively. Sensitivity of combined clinical symptoms was 66.6%, with specificity of 40%, and predictive value of 89.6% while that of clinical signs 48.7% and 60% respectively and predictive value of 90.4 %. There was no significant difference in severity of electrophysiological abnormalities in the affected and non-affected feet. Clinical findings was correlated well with the severity of electrophysiological changes in patients with diabetic foot ulcers.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) continues to expand at a remarkable rate due both to their broad spectrum clinical applications. NSAIDs are particularly important to patients with a variety of musculoskeletal conditions and injuries. With mounting evidence that NSAIDs do in fact interfere with proper bone healing in various animal models, questions have arisen regarding the differences between the short-and long-term treatments with these drugs on fracture healing, in addition to, the effect of their combined treatment. Left tibias of 42 male rabbits were fractured by manual pressure under general anaesthesia and are stabilised by Zimmer plate. These animals are divided into seven groups; 6 rabbits each: group (1), control group, given normal saline; group (2), given aspirin (25mg/kg/day) for 2 days post-fracture; group (3), given aspirin for 14 days post-fracture; group (4), given diclofenac (2.5mg/kg/day) for 2 days post-fracture; group (5), given diclofenac for 14 days post-fracture; group (6), given aspirin and diclofenac for 2 days post-fracture; and group (7), given aspirin and diclofenac for 14 days post-fracture. Drugs were administered intramuscularly. All animals were sacrified 21 days after fracture. At this time, evaluation of fracture healing was performed blindly by two radiologists and a histologist according to a 5- point scale of a descriptive assessment and scores of each group were compared with control and other groups. Both aspirin and diclofenac, when given indivdually for 14 days, produced a statistically significant inhibitory effect on fracture healing, but they have no significant effect when given for 2 days. Administration of aspirin and diclofenac together had a significant delaying effect on fracture healing even after short duration (2 days). The latter effect appeared mainly in histological examinatiom indicating that histological methods of assessment may be more valuable than radiological ones. It is, therefore, concluded that aspirin and diclofenac should cautiously be used during fracture healing; firstly, they should be given for the shortest possible duration and secondly, should not be given in combination.

racture healing is a physiological process by which bone regenerates itself following injury. It occurs through five stages: haematoma, inflammation, callus formation, consolidation and remodeling1,2. These stages are not sharply demarcated and that two or more stages may be seen at same time in different parts of bone3.

Pregnancy is the only physiologic condition that is treated in the hospital environment. All other medical conditions that are treated in such a setting are pathologic. When a pregnant patient develops a pathologic condition that requires surgical intervention, it is imperative to remember that the lives of two individuals are involved, the mother and the foetus. In such settings it is essential that the treating surgeon understand the physiologic states of these two individuals as an interdependent symbiotic relationship. Not only must appropriate maternal care be rendered, prevention of foetal complications is also desirable. Changing physiology and anatomical landmarks frequently cause confusion and delay in dealing with surgical problems in the pregnant patient. Both symptoms and signs could be modified, contributing to delay in seeking medical attention, timely referral for surgical evaluation, or the initiation of appropriate diagnostic procedures. Surgery during pregnancy is an uncommon event, but one that creates a great deal of anxiety for both patients and medical practitioners. Delays in diagnosis and definitive treatment represent the most significant risk for untoward outcome in both the mother and the foetus. Laparoscopic surgery has rapidly and widely spread in the management of wide abdominal conditions, which resulted in several significant benefits to the non-gravid patients. Pregnant patients and their foetuses could drive the same benefits from minimally invasive surgery, which are received by the non-gravidas. However, due to the several physiological and anatomical factors encountered during pregnancy many issues need to be thought about and dealt with. Optimal surgical treatment of the pregnant patient will be realized when there is collaboration between the various subspecialties involved in her care.

Electrocautery is used increasingly for tissue dissection; fears of excessive scaring and poor wound healing curtailed its use for skin incisions. This study compared electrocautery incision with traditional scalpel incision for abdominal operations in general surgery. Two groups of 62 patients in each were compared prospectively, in one of them electrocautery knife used and in the other traditional scalpel used to incised the abdominal wall layers starting from the skin. Parameters measured included, the time needed to complete the incision with all the necessary hemostasis, the wound length, the macroscopic tissue response, the incidence of infection, the final tissue scar. The electrocautery knife is quicker than the traditional scalpel 4.2Cm/Minute in electrocautery knife versus 2.7Cm/Minute in scalpel; there was little increase in macroscopic tissue response in the first 3-4 days, which do not differ in both groups in the 4th5th day. There was no difference in the incidence of infection and the final scar after one year between the two groups. Electrocautery can be used as alternative to scalpel in creating abdominal skin incisions, with the advantages of shortening the time, and decreasing the blood loss without affecting wound healing or incidence of infection and the scar formation. Incidence.

The aim of this study is to compare between excision followed by primary closure as the first type of treatment and excision with laying the tract open, to heal by granulation, as a second type of treatment of pilonidal sinus. Seventy three patients were included in the study. They were divided randomly into two groups, group A and group B, the first group was treated by closed method and the other by open method. Data were collected and analyzed regarding recurrence rate, time needed for full healing, infection rate and duration of hospital stay. Thirty-five patients comprised group A (30 males and 5 females) compared to 38 patients in group B (31 males and 7 females). The mean hospital stay for group A ranged from 3 to 6 days (mean=4.4 days) while for group B it ranged from 1 to 2 days (mean=1.2 days), a difference that is statistically extremely significant (P value

The purpose of the study was to compare the suitability and safety of the laryngeal mask airway (LMA), for intranasal surgery (INS) anesthesia, with endotracheal tube (ET) anesthesia. we studied 65 patients (ASA grade I and II, according to American Society of Anesthesia classification), aged (18-39) years. The study population was scheduled for elective intranasal surgery. The patients were randomly assigned into two groups: the first group (33 patients), a laryngeal mask airway (LMA Group) was inserted under propofol , fentanyl and muscle relaxant (atracrium), anesthesia was maintained by using a mixture of halothane in N2O/O2. The second Group (32 patients), an endotracheal tube (ET Group) was inserted under propofol, fentanyl and muscle relaxant (atracrium), anesthesia was maintained with a mixture of halothane in N2O/O2. All complications concerning airway insertion, removal or interruption of surgery for compromised airway and ventilation were recorded. Mean blood pressure, heart rate and pulse oxymetry, were continuously monitored and recorded before and after induction and airway device insertion, followed by 10 minutes intervals. Data were analyzed using chi square statistical test; Null hypothesis was rejected at P> 0.05. In LMA Group, there were no episodes of post removal laryngospasm. The incidence of oxyhemoglobine desaturation at removal was significantly reduced compared with that in ET Group (P< O.O2). The number of patients with oxyhemoglobine desaturation less than 92% on airway device removal was 0% in LMA Group, 3 patients (9.375%) in ET Group. In ET Group, the mean blood pressure and heart rate showed significant variation between the different time measurements (P> 0.005). Intubation and extubation resulted in significant transient increase in mean blood pressure and heart rate. In LMA Group, the mean blood pressure was less than baseline value from 1 minute after induction onwards (P< 0.005) and did not show any significant changes during the different time points measurements. LMA application or removal did not cause any significant increase in mean blood pressure or heart rate (P< 0.001). We conclude that using LMA is suitable method for intranasal surgery. It provides a safe, protected airway with a smoother emergence from anesthesia than tracheal intubations. Anesthesia using LMA for intranasal surgery provides a stable circulation.

increased markedly in women with pregnancy induced hypertension (PIH) relative to
women with uncomplicated pregnancy and that these lipids decrease postpartum and
to clarify the relation of lipid profile changes with the severity of pregnancy induced
hypertension.
This study is a prospective, case-control study conducted at Basrah Maternity and
Child Hospital extended through a period of 12 months from the first of August 2000
till the first of August 2001.
Pre-labor venous blood samples were collected for 90 women with pregnancyinduced hypertension and 110 women with normal uncomplicated pregnancy with an
age range (16-40) years and gestational age range (34-42) weeks after 12 hours
fasting. Venous blood samples were also collected from only 30 women with PIH and 30
women with normal uncomplicated pregnancy after 24-48 hours postpartum. Serum was
analyzed for concentrations of triglyceride (TG), total cholesterol (TC), high-density lipoprotein
cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density
lipoprotein cholesterol (VLDL-C).
Pre-labor serum (TG), (TC), (LDL-C) and (VLDL-C) were increased in women with PIH
relative to uncomplicated pregnancies respectively P value (<0.001). (HDL-C)
concentration does not differ between studied groups (P = 0.1). Concentrations of all
lipids decreased significantly (P value <0.001) in both groups within the first 24 -48 hours
postpartum. However the levels of these lipids remained higher in women with PIH but
were statistically not significant. Serum triglyceride and VLDL concentrations but not total
cholesterol, HDL-C and LDL-C were significantly higher in severe PIH group in comparison with
mild PIH. There was no correlation between the age, parity and the lipid profiles changes in both
groups. There was a positive correlation between each of the (TG), (TC), (LDL-C) and (VLDLC). (HDL-C) does not correlate significantly with other different types of lipid. In conclusion,
plasma lipids and lipoproteins but not HDL-C are increased in PIH relative to normal pregnancy
and hypertriglyceridemia found in severely PIH may contribute to endothelial dysfunction in PIH.

This is a retrospective analytic study of the data collected from inpatients admitted to Basrah Teaching hospital during the period 1992 �1998. They were 1726 patients (not include those treated as outpatients) classified as males & females, adults and children (

Patients with major upper gastrointestinal (UGI) resections that were made nil by mouth for 7-10 days postoperatively with pre-existing weight loss and depleted energy reserves in addition to increased metabolic rate needs nutritional support which serves to shorten the postoperative recovery phase and minimizes the number of complications. This may be supplemented by total parenteral nutrition (TPN) which is not available in our hospitals for over a decade. This problem led us to use a feeding jejunostomy tube after major resections for UGI malignancies. This is a prospective study conducted between May 1999 and December 2004 at First Surgical Unit, Basrah General Hospital. The study aimed to examine the efficacy of Enteral Tube Feeding (ETF) as a method of nutritional support in patients with major resections for UGI malignancies. A total of 76 patients, 42 males and 34 females. Mean age, 50 years (range, 27-72 years) underwent major UGI resections for gastric(64), oesophageal (10) and pancreatic(2) malignancies. ETF lasted for 12-41 days with diarrhoea and abdominal discomfort were the major complications in 14 and 8 patients respectively. .Diarrhoeal tolerance was established in 12 out of 14 patients and controlled in the other two by antidiarrhoeal drugs. There were improved body weight and serum albumin level after ETF and no septic complications or related mortality. ETF is a safe, feasible, cost effective, with few controllable complications rendering it a satisfactory alternative to total parenteral nutrition.

Patients with major upper gastrointestinal (UGI) resections that were made nil by mouth for 7-10 days postoperatively with pre-existing weight loss and depleted energy reserves in addition to increased metabolic rate needs nutritional support which serves to shorten the postoperative recovery phase and minimizes the number of complications. This may be supplemented by total parenteral nutrition (TPN) which is not available in our hospitals for over a decade. This problem led us to use a feeding jejunostomy tube after major resections for UGI malignancies. This is a prospective study conducted between May 1999 and December 2004 at First Surgical Unit, Basrah General Hospital. The study aimed to examine the efficacy of Enteral Tube Feeding (ETF) as a method of nutritional support in patients with major resections for UGI malignancies. A total of 76 patients, 42 males and 34 females. Mean age, 50 years (range, 27-72 years) underwent major UGI resections for gastric(64), oesophageal (10) and pancreatic(2) malignancies. ETF lasted for 12-41 days with diarrhoea and abdominal discomfort were the major complications in 14 and 8 patients respectively. .Diarrhoeal tolerance was established in 12 out of 14 patients and controlled in the other two by antidiarrhoeal drugs. There were improved body weight and serum albumin level after ETF and no septic complications or related mortality. ETF is a safe, feasible, cost effective, with few controllable complications rendering it a satisfactory alternative to total parenteral nutrition.

Significant numbers of patients are seen for surgery and anesthesia with a history of chronic substance abuse. However, little is known about how these substances influences anesthetic physiology and pharmacology. Abuse of substances may involve a socially acceptable drug (e.g., alcohol, tobacco), a medically prescribed drug (e.g., diazepam), or an illegal substance (e.g., cocaine). Knowledge of a patient�s substance abuse prior to administration of analgesia or anesthesia may prevent adverse drug interactions, predict tolerance to anesthetic agents, and/or facilitate the recognition of drug withdrawal. As the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries and is more prone to have emergency surgery, so we stressed here on this substance. Cocaine abuse is associated with multi-target organ involvement, including the cardiovascular, respiratory, neurologic, and hematological systems. Its use during pregnancy is also an independent contributor to the risk of placental abruption, preterm labor and stillbirth.

Fifty seven patients with renal tumor were analyzed in terms of incidence, age, sex, histopathological type, clinical presentation and risk factors regarding renal carcinoma. This study was conveyed in Chwarbakh Surgical Hospital, Sulaimaniyah Teaching Hospital, Shorsh Teaching Hospital and the private hospitals in Sulaimaniyah from December 1999- December 2002 and the data were as the following: The commonest presenting age was between 60-80 years, apart from Wilm's tumor which was between 0.4-7 years of age, and the female to male ratio was 2.2:1.5. The tumor was more prevalent in urban than in rural areas. Most of the tumors were renal adenocarcinoma. Clear cell type was the predominant histological type, commoner on the left, with predilection to the upper pole. Abdominal pain, hematuria, and abdominal mass were the commonest presenting features. Ultrasound, intravenous urography, and computerized tomography scan were the important diagnostic tools. The most important risk factors were obesity, smoking and associated renal disease.

This study was conducted to determine the age distribution and mean age of female. Breast cancer patients from 1991-2000. Reports of breast lumpectomy and mastectomy were reviewed. About 648 reports of patients with breast cancer were found and reviewed for age only. Most patients were in the age group 41-50years of age. The mean age was 45 years. The study also shows that there has been no change in age distribution and mean age in 10 years period.

The different modes of injury to the heart extend from motor vehicle accidents to penetrating injury by a pencil tip1. The incidence of penetrating cardiac injuries appears to be rising, presumably because of an increase in civilian violence2. Penetrating cardiac injuries are still a challenge for surgeons because of their difficulty as to the diagnosis, bad prognosis and the necessity of acute operation3.

This present study was conducted on 436 diabetic patients, hand disorders were detected in 135 patients (180 hands). The incidence of Dupuytren�s contracture was the highest 34%, carpal tunnel syndrome was diagnosed in 21% of the patients, flexor tenosynovitis in 19%, limited joint mobility in about 15%, hand infections in 10%, tumors in less than 1%, and more than one hand abnormality observed in the same patient in 15% of the diabetics. The results of this article present the prevalence of each hand condition in this common disease in our department.

This is a prospective study was done on one hundred patients with late complications of the amputated stump between may 2001-2004 in Vincent Orthopedic center in Sulaimanya. There were eighty men and twenty women, their age range from seventeen to sixty years. Fifty patients with infected stump range from abscess formation in fifteen cases, infected epidermoid cysts in five cases to fissuring and ulceration of stump in thirty cases. Fifteen patients with painful neuromas attached to the scar tissue. Ten patients with below knee amputation had knee flexion deformity. Nine patients with below knee amputation with prominent bones compressing the skin of the stumps the fibula were long and the anterior edge of the tibia compressing the skin. Fifteen patients with loose cushion of muscles. One patient with recurrent infected above ankle amputation stump superadded by squamous cell carcinoma. All patients were treated by refashioning of the amputation stump, except one with squamous cell carcinoma.

Fascioliasis is one of the zoontic infestations which become world wide in distribution in the last twenty years. Clinical awareness of this entity of infestation is so important as it may masquerade as liver abscess and or infected liver cysts as hydatid as well as it is potentially reversible treatable infection and carries excellent prognosis if diagnosed early and treated properly

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