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.‎

he 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.‎