Thi-Qar Medical Journal

SUMMARY
Background: Acute appendicitis is one of the commonest surgical
emergencies. Simple appendicitis can progress to perforation, which is associated
with a much higher morbidity and mortality, and surgeons have therefore been
inclined to operate when the diagnosis is probable rather than wait until it is
certain.1
in this study we asses the role of ultrasonography in adition to clinical and
laboratory data to reach the final diagnosis of acute appendicitis.
Patients and methods: in this combined retrospective and prospective
study to 75 patients who referred to surgical service. A complete clinical history,
physical examination, WBC count, neutrophils count, and ultrasonography. A
histopathological correlation done for 57 cases undergo surgical operation.
Results: for 57 cases of acute appendicitis most patients was between 11-30 years
old ( 59.65), male: female ratio was 1: 1.5, most common symptoms was abdominal
pain present in all cases. The sensitivity of ultrasonographic examination was 94.7%,
specificity was 88.9% and accuracy was 93.3%. leukocytes count was ≥ 10x109 in 43
(75.43%) of acute appendicitis cases, and the neutrophil count ≥ 75% in 34 (59.64%)
of acute appendicitis ccases.
Conclusion: ultrasonography is an accurate procedure that leads to prompt diagnosis
and early treatment of many cases of appendicitis.

While carotid arteries ligation is uncommon procedure , but they are highly indicated
in management of some hemorrhagic lesions and injuries in maxillofacial region .
This will prevent possible fatal complications during surgical intervention due to
uncontrolled hemorrhage .At the same time in some of these lesions and injuries
urgent surgical therapy is required . Review of the anatomy , symptoms , treatment ,
diagnostic methods and complications is provided . As well , the successful treatment
of those hemorrhagic lesions and injuries is discussed as reminder that such ligation is
highly effective in controlling bleeding and saving patient`s life . Recommendations
of the surgical management of those cases which necessitate ligation of carotid system
are discussed .

Background:
Laparoscopic cholecystectomy is associated with a high incidence of postoperative
pain, nausea, and vomiting. To determine whether a drain in the peritoneal cavity
during laparoscopic cholecystectomy is both a clinical and cost-effective method of
reducing postoperative pain, nausea, vomiting and hospital stay.
Patients and methods:
Ninety nine patients undergoing successful laparoscopic cholecystectomy, randomized
blindly into two groups subhepatic drainage group and a control group, using a visual
analogue scale to assess postoperative pain, nausea and vomiting
Results:
The incidence of nausea was lower in the drainage group at 72 hours Although severity
of pain was lower at 12, 24,72hours in the drainage group, the difference was not
significant. There was also no difference between the groups regarding to hospital
stay.
Conclusion:
There is no significant effect to put a subhepatic drain after laparoscopic
cholecystectomy on postoperative pain, nausea, vomiting and hospital stay.

Background: Gentamicin is an antibiotic effective against gram negative infections,
whose clinical use is limited by its nephrotoxicity. In fact, the incidence of renal
dysfunction during the course of clinical treatment with gentamicin antibiotics is
approximately 10%. Direct proximal tubular necrosis and oxidative stress were the main
pathogenic factors
.
Aim: to investigate the effect of vitamin E and carvedilol pretreatment in ameliorating
gentamicin- induced nephrotoxicity in rabbit.
Materials and methods: eighteen local domestic male rabbits were used; they
were separated to three groups, one of them served as a control group. All animals were
injected with gentamicin 80 mg/Kg intramuscularly two hours after administration of the
tested agent which was distilled water in the control group, vitamin E 200mg/Kg in the
second group and carvedilol 3 mg/Kg in the third one for 6 successive days. Renal
function was assessed at day 7 by estimating blood urea nitrogen(BUN), serum creatinin,
serum potassium and sodium.
Results: treatment with vitamin E and carvedilol prior to nephrotoxic dose of
gentamicin results in significant reduction in the levels of BUN, serum creatinin and
serum potassium with significant elevation in serum sodium level when compared with
the control group.
Conclusion: vitamin E, and carvedilol at the tested doses, have significant
nephroprotective effect against gentamicin induced nephrotoxicity in rabbit with possible
role in preventing such type of renal insult.

War injuries is traumatic surgery applied under condition of war which cannot
modified by the surgeon .The fundamental principles which must be adhered to in the
treatment of those cases remain in force whatever circumstances may arise and the
important one is saving the patient life .Hippocrates ,writing in the fourth century B.C
(war is only the proper school for a surgeon) .The aim of this paper that during 16
years of work in management of five hundreds of severe maxillofacial war injuries in
three military hospitals one of them a forward hospital nearly all patients life were
saved for those with severe maxillofacial injuries they arrived alive to the hospital
.And the postoperative complications were few . So those severely injured patient
should be assessed carefully prior to the treatment to avoid unwanted complications
.And to keep in mind that the time factor with the wise decision is the key for
successful treatment of those patients , by saving their lives first and skillful surgical
approach in the theater to reduce post operative complications . It is good opinion that
not to waste that golden minutes when the critically injured patient received in the
hospital with e .g radiological examination and other investigations . And one of the
main things which I like to emphasize on is that not to disturb your patient more or to
try a blind intubation .Emergency tracheotomy with or without local anesthesia
saved nearly many patient lives from definite death .The completion of the operation
in one step give a very interesting results by reducing post operative complications .

Background
The main challenge facing the laparoscopic surgery is the primary abdominal access, as it
is usually a blind procedure associated with vascular and visceral injuries. It has been
proved from studies that 50% of laparoscopic major complications occur prior to the
commencement of the surgery. The surgeon must have adequate training and experience
in laparoscopic surgery before intending to perform any procedure independently. He
should be familiar with the equipment, instrument and energy source he intends to use.
Aim of the study
Aim of this dissertation is to study the incidence of complications according to different
techniques used for inducing pneumoperitoneum in laparoscopic surgery.
Patients and methods
Prospective and retrospective data was collected for (360) patients underwent
laparoscopic surgery from January 2009 to April 2010 in Al-Sader teaching hospital ,
private hospital in Najaf and Alhussien teaching hospital in Nassyriah , all these patients
were operated by different surgeons using different entry techniques
Result
Three hundred and sixty patients underwent laparoscopic surgery; 300 of them were
female and 60 were male. The operations included in our study were cholecystectomy
(254), hydatid cyst of the liver (15), perforated peptic ulcer (2), appendectomy (3),
diagnostic laparoscopy for infertility and abdominal pathology (56), undescended testes
(8), ovarian cyst (20), achalasia and Nissen fundoplication (1).
The
early
complications recorded in our study are abdominal wall vascular injuries ,visceral injuries
,bradycardia , preperitoneal insufflations .The incidence of laproscopic entry related
injuries in gynecological operations was 6.9% .But the incidence of laproscopic entry
related injuries in major pelvic operations was 7.8% .

This is prospective study conducted in department of surgery in Al Nasyria
general hospital The aim of study is attempt to reduce morbidity and mortality
rate in patients who suffering from burn injuries 116 patients admitted in the burn
unit in Al Nasyria hospital who suffering from moderate burn ( between 20- 50 %
of TBSA) 23 patients ( 20%) were died( group A ) patients who admit hospital for
less than 72 hours for resustation then go home and follow them as out patient ,
While (group B) complete there management and follow up at hospital until they
be well or die , I find the mortality rate in group A (11% ) is less than group
B (27%) inspit of they managed at hospital and under supervision of senior ,
The most age group suffering from burn injury is under 10 years 59 patients among
116 patients ( about 50% ) but subgroup ( who under 2years ) poorly resistance to
burn complications 10 among 21 patients ( about 48%) of them died during few
days of admission in hospital While subgroup ( 3- 10 years) have good resistance
to complications ( only 2 patients of 38 patients about 4.5%)are diedthat both
sexes are equally suffering from burn injury but mortality rate in female is
larger than male ( 24% in F , 15% in M ) Most cause of death in burn is
septicaemia specially most resistant nasocomial infection ( pseudomonas ) , because
at home those patients are less exposure to such infections so may be this is
cause of this dramatic drop in mortality rate So in poorly equipped hospital ( when
no good isolation of patient no good sterilization ,no ideal dressing or ventilation or
accommodation and so ) in such circumstances its better to treat moderate burn at
home because the ward become source of serous infections

Fractures of the middle third of the facial skeleton which associated with the
fractured zygomatic process of the frontal bone and or fractured zygomatic arch
are happened . And in these cases it was difficult to use frontal or zygomatic
suspension for fixation . A technique is described which enables the majority of
these fractures to be fixed by maxillary or mandibular suspension to the cranial
arch bar implanted inside a plaster of Paris head cap . The plaster head cap can be
done in the clinic or in the ward and the only thing you need to do in the theater is
reduction and suspension . The benefits of the
patient and the hospital are
highlighted .

This study involved ( 57) female medical student, aged between ( 19-24) years,
subdivided into two groups, control group that consist of (30) female with normal
level of G6PD enzyme and case group that consist of (27) female with severe G6PD
deficiency. Both groups have hemoglobin type AA, and white blood cells were
estimated for them. We tried in this study to identify the effect of sever G6PD
deficiency on the phagocytic activity of non isolated granulocytes from the whole
blood, to mirror the in vivo stimulation of granulocytes and the effect of severe G6PD
deficiency on their phagocytic activity. We demonstrate a statistically significant
proportion ( P < 0.05) between the granulocytes phagocytic activity and severe G6PD
deficiency. This could form the basis for drug development in order to prevent or treat
G6PDdeficiency-related disease and thus unburden the public health system.

This study reflects the effectiveness of metformin (hypoglycemic agent) in medical
treatment of ovarian cysts; compared with hormonal therapies (medroxyprogesteron
acetate and \or conjugated estrogens vaginal cream) .Or treatment by both metformin
together with medroxyprogesteron and\or conjugated estrogen vaginal cream .And it
shows that the use of both drugs (medroxyprogesteron 5mg\day for 20 days for two
courses with interval of 8 days in between ,and\or conjugated estrogen vaginal cream
0.625mg twice daily together with metformin 500mg) was more effective(89.48%)
than the uses of metformin alone(76.47), and medroxyprogesteron and\or conjugated
estrogens vaginal cream(68.75%), in the treatment of the ovarian cysts.

The present study was designed to evaluate the serum FSH, LH and testosterone levels in 75
infertile male affected with different male infertility factors. In this study, one hundred
infertile males were involved and according to cause of infertility were divided into 25
normozoospermia, 25 oligozoospermia, and 25 asthenozoospermia infertile couples. From
each male, semen samples were collected and sperm parameters including sperm
concentration, sperm motility, progressive sperm motility, and normal sperm morphology
were evaluated according to standard World Health Organization (WHO) criteria. For semen
processing, sperm prepared using conventional layering technique through incubation for 30
minute in 5% CO2 at 37ºC.The results of the present study demonstrated that serum FSH and
LH levels significantly (P<0.05) increase in infertile couples with normozoospermia,
oligozoospermia, and decrease in asthenozoospermia as compare with fertile control group
(No. =25). In contract, clearly significant decrease in serum testosterone levels (P<0.05) in
infertile men with normozoospermia and oligozoospermia and non significant increase
(P>0.05) in asthenozoospermia when compare with healthy fertile male. From the results of
the present study, it was concluded that evaluation of serum FSH, LH, and Testosterone are
diagnostic and prognostic tools in management of male infertility and acts as major control
device of germ cell development. Further studies are recommended to assess the effect of
elevated levels of FSH and LH and low levels of testosterone on DNA damage and embryo
quality after in vitro fertilization and embryo transfer (IVF-ET).

Trigonella foenum graecum (fenugreek) seeds has been suggested to have potential anti
diabetic effects. Twenty four white female rats were used to study the effect of oral
administration of Trigonella seed extract with water tap on some biochemical parameters
of alloxan induced diabetic rats. These animals were divided into four groups. The first
group was a negative group treated with water tap, while the other groups (2-4) were
treated with 150mg/kg alloxane for induced a diabetic. the second group was a positive
group (diabetic group) treated with water tap. The third group treated with 0.04 gm/ml
aqueous extract of fenugreek seeds for 28 days. The fourth group treated with 0.08
gm/ml aqueous extract of fenugreek seeds for 28 days. The result revealed a significant
decrease in the level of blood glucose of the animals groups treated with 0.04 gm/ml and
0.08 gm/ml aqueous extract of fenugreek seeds compared with positive control group.
Also, the results indicated non significant decreased in cholesterol, SGOT, SGPT third
and fourth groups compared with normal and a diabetic groups.

Background: Achillea santolina (As), a plant grown in Irak, has been used in
herbal medicine for thousands of years. It has anti-inflammatory properties, but its
antiplatelet or antithrombotic activities have not been explored.
Methods: The effects of As leaf crude extracts and fractions extracted with
chloroform (F1), diethyl ether (F2), ethyl acetate (F3) and water (F4) were assessed in
vitro on platelet human aggregation induced by ADP and collagen and on a rat
arteriovenous shunt thrombosis model in vivo after 10 days oral administration (10
mg/kg/d).
Results: A. santolina crude extract dose-dependently inhibited in vitro ADP and
collagen-induced human platelet aggregation (maximal inhibition respectively 34.4 
2.9% and 78.3 ± 2.5 %). This effect was mostly contained in the diethylester (F2)
fraction; F1 and F3 had about half the effect, and F4 was devoid of antiaggregant
effect. Achillea Santolina extracts given orally daily for 10 days at the dose of
10mg/kg/day decreased thrombus weight but not significantly.
The discrepancy between clear dose-dependent in vitro effects on ADP and Collagen
induced human platelet aggregation and unclear in vivo effects in rats raises questions
as to active concentrations, intestinal resorption and/or metabolisation of active
compounds.

The antimicrobial activity of three species of marine Mollusca extracts, Sepia sp.
,Loligo sp. and marine snail Tibia insulaechorab-curta marked as S, L and T
respectively were studied against five bacterial species of family Enterobacteriaceae
(Escherichia coli, Pseudomonas aeruginosa , Klebsiella oxytoca , Proteus mirablis and
Serratia liquefaciens ) that diagnosed by API 20 E technique . S & T extracts
exhibited significant differences to good antimicrobial activity more than L extract .
All bacteria were tested have shown susceptible to S and T extracts, Antibacterial
sensitivity test of 6 antibacterial antibiotic showed the crude extracts clear effect more
than the antibacterial antibiotic. The minimal inhibitory concentration of all extracts
were detection .