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Article
The routine insertion of drains after total thyroidectomy by harmonic scalpel, is it always necessary?
الإدراج الروتيني للمنزح بعد استئصال الغدة الدرقية الكلي بواسطة مشرط متناسق، هل هو ضروري دائمًا؟

Author: Ali A. Al-Dabbagh
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2016 Volume: 20 Issue: 3 Pages: 1419-1423
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Routine use of drains after thyroidectomy is not evidence based; nevertheless most surgeons use drains to alert them to the presence of postoperative bleeding and for the prevention of hematoma and seroma. This comparative study was conducted to evaluate the necessity of routine drainage after total thyroidectomy.Methods: A total of 150 patients who underwent total thyroidectomy due to different indications at different hospitals in Erbil city, Iraq from June 2011 to December 2015, were included. A retrospective comparison was made between those drained (group 1) and those without drain (group 2). Operating time, postoperative complications and hospital stay were assessed.Results: Operation time was significantly less in group 2 compared to group 1; 64.9 ± 7.64 minutes versus 73.8 ± 9.81 minutes, respectively. There was no statistically significant difference in the incidence of postoperative complications. Only two patients, both from group 1, developed a postoperative hematoma. Wound infection occurred only in 2 patients in group 1. Hospital stay was significantly shorter in group 2 compared to group 1; 21.1 ± 3.98 hours versus 41.7 ± 8.64 hours, respectively.Conclusion: The routine use of drain is not necessary after total thyroidectomy; it increases the hospital stay and may increase the rate of postoperative sepsis.


Article
Randomized, Prospective Comparison of Post-Operative Pain In Low - Versus High -Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy
مقارنة عشوائية ، مستقبلية للألم بعد العملية الجراحية في منخفض - مقابل عالية الضغط Pneumoperitoneum في استئصال المرارة بالمنظار

Authors: Nabaz Hassan Ismaeel --- Ali A. Al-Dabbagh
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 2 Pages: 35-40
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: CO2 insuflation constitutes the commonest means of creat-ing the pneumoperitoneum (PP), but it is attributed to many post-laparoscopic cholecyste-comy adverse effects including pain triggering. The aim of this trial was to evaluate the effi-cacy of low-pressure CO2 PP during laparoscopic cholecystectomy (LC) in reducing the incidence of postoperative pain.Methods: A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into group A (n=50) who underwent LC with 8 mmHg CO2 PP throughout the procedure and those in group B (n=50) had LC with 12 mmHg CO2 PP. Abdominal and shoulder-tip pain were assessed with verbal rating scale (VRS) scoring at 4, 8, 12 and 24 hours postoperatively.Results: The low-pressure PP did not increase the duration of surgery. There were neither significant peri-operative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative VRS scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation.Conclusions: A CO2 PP at 8 mmHg reduces both the frequency and intensity of abdomi-nal and shoulder-tip pain following LC without increasing the rate of intra-operative compli-cations.


Article
The Effect of Placing 0.5% Bupivacaine-Soaked Gelfoam in the Gallbladder Bed on Pain after Laparoscopic Cholecystectomy
تأثير وضع الجلفوم بنسبة 0.5 ٪ في بوبيفاكايين المنقوع في قاع المرارة على الألم بعد استئصال المرارة بالمنظار

Authors: Ali A. Al-Dabbagh --- Saeed Dakheel Saeed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 1 Pages: 24-30
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Patients undergoing laparoscopic cholecystectomy (LC) experiences post operative abdominal pain. This study aimed to determine the character of pain after LC and its relief with 0.5% bupivacaine-soaked gelfoam placed in the gallbladder bed.Methods: A prospective randomized, double blinded placebo-controlled study was conducted on 200 patients with chronic cholecystitis, patients were divided into four groups of 50 patients :group A (2 mg/kg 0.5% bupivacaine-soaked gelfoam kept in gallbladder bed), group B (2 mg/kg 0.5% bupivacaine infiltrated at trocar sites), group C ( 1/2 of the required dose of 2 mg/kg 0.5% bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with verbal rating scale (VRS) scoring.Results: 77.50% of the patients had visceral, 60.50% had parietal, and 23.50% had shoulder pain postoperatively. The visceral pain was significantly less in group A patients than in the control patients (p < 0.01),the mean VRS score at 4, 8, 12 and 24 h in the group A patients also was less than in control group D. Trocar-site infiltration alone was not effective in relieving the parietal pain.Conclusions: Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked gelfoam in the gallbladder bed alone.


Article
Serum C - Reactive Protein Level in Diabetic Foot Patients and Their Relation with Bacterial Isolates
مستوى البروتين الفعال C في مرضى السكر المصابين بجرح القدم وعلاقته بالبكتريا المعزوله

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Abstract

Background: Foot infections are one of the major complications of diabetes mellitus and a significant risk factor for lower extremity amputation. C-reactive protein is an acute-phase reactant, rises dramatically in response to infection. Objective: To determine the microbial isolates of patients with diabetic foot infections and their relation with C-reactive protein level in their sera. Materials and Methods: A prospective study of 90 patients with diabetic foot infections admitted to different public and private hospitals in Erbil city center-Iraq between June 2011 and May 2012 was undertaken. Bacteriological specimens were obtained and processed using standard procedure. The patients serum had been tested for C-reactive protein by high sensitive Enzyme linked Immunosorbent Assay (ELISA). Results: A total of 130 pathogens were isolated from 90 diabetic foot patients 46 (51%) of the patients had polymicrobial infection, 37 (41%) had single organism and 7 (8%) had no growth. Gram positive (G+ve) bacteria 60(53%) were more commonly isolated than Gram negative (G-ve) bacteria 53(47%). Staphylococcus aureus and Escherichia coli were the most frequently among G+ve and G-ve isolates respectively. No significant difference was found between mean serum levels of C-reactive protein in patients infected with G+ve bacteria versus G-ve bacteria, although their concentration was more in the later. However, highly significant differences (P<0.01) were observed between both G+ve and G-ve bacteria versus no bacterial isolate in patients.Conclusion: C-reactive protein serum level was higher in patient with diabetic foot infected by G-ve bacteria, although G+ve bacteria represented a major bacterial isolates. Key words: Diabetic Foot; Infection; Microorganism; C-reactive protein.

خلفية الدراسة: يعدالتهاب القدم واحدة من مضاعفات مرض السكري ومن المخاطر الفعلية لبترالاطراف.اذ يعد البروتين الفعال Cواحدة من اهم تفاعلات الطور الحاد حيث اذ بشدة كاستجابة للاخماج.هدف الدراسة: التحري عن العلاقة بين البكتريا المعزوله من مرضى السكر المصابين بجرح القدم مع مستوى البروتين الفعال C في مصول هؤلاء المرضى. المواد وطرائق العمل: اجريت الدراسة على تسعون من مرضى السكر المصابين بجرح القدم ادخلو العديد من المستشفيات العامة والخاصة في مدينة اربيل ما بين شهر حزيران 2011ولغاية شهر مايس 2012. جمعت العينات البكتيرية وعوملت بالطرق المعيارية للزرع الجرثومي والتشخيصي. مصول المرضى كذلك استخدمت للتحري عن البروتين الفعال Cباستخدام اختبار الخميرة للامتزاز المناعي ذو الحساسية العالية.النتائج:اوضحت الدراسة الحالية بان 130كائن ممرض عزل من 90 مريضا بالسكري والمصابين بجرح القدم نسبةالمرضى المصابين بانواع متعددة من الكائنات الممرضة كانت46 (51%) , الاصابة بنوع واحد كان 37 (41%) بينما كانت النسبة 7(8%).للذين لم تظهر لديهم نمو بكتيري. البكتريا الموجبة لصبغة غرام60(53%) عزلت اكثر من البكتريا السالبة لصبغة غرام 53(47%) وكذلك كانتا Staphylococcus aureus و Escherichia coli من اكثر البكتريا المعزولة لدى المرضى. كما كشفت البيانات الاحصائية عن عدم وجود علاقة احصائية معتمدة بين مستوى البروتين الفعال C والمرضى المصابين بالبكتريا الموجبة لصبغة غرام والمصابين البكتريا السالبة لصبغة غرام على الرغم من ارتفاع مستواها عند السالبة بينما كانت العلاقة قوية عند المقارنة بالمرضى الذين لم تعزل منهم البكتريا. الاستنتاجات :المستوى المصلي للبروتين الفعال C كان اكثرفي مرضى السكر المصابين بجرح القدم والذين كانت لديهم اصابة بالبكتريا السالبة لصبغة غرام الاكثرعزلا علما ان البكتريا الموجبه كانت الاكثرمن بين المرضى. مفتاح الكلمات: مرضى السكري ذو جرح القدم, اصابة , كائنات ممرضة, البروتين الفعال .C

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