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Article
The Pattern and Optimal Surgical Treatment of High – Velocity Penetrating Duodenal Injuries

Author: Haqqi I .Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2010 Volume: 9 Issue: 1 Pages: 17-20
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background The increased incidence of high velocity missile (H.V.M.)abdominal injuries in Iraq had been associated with an increase in the incidence of duodenal injuries. Setting Second and fourth surgical units at Al-Yarmouk Teaching Hospital. Objective To study the pattern of duodenal injuries, evaluate the proper surgical methods of duodenal injury management, to minimize the morbidity & mortality rates. Patients &methods Prospective study of forty two duodenal injury patients in 6 years period between Jan. 2003 – Dec. 2008 managed surgically. For Grade 2 duodenal injury we did primary repair with tube drainage, for grade 3; primary repair with tube duodenostomy or primary repair with triple ostomies, or primary repair with Pyloric exclusion and gastro-jejunostomy. Results Four hundred six laparatomy for (H.V.M.)abdominal injury, of these 42 cases (10.3%)associated with duodenal injury. 80% 35 male & 20% 7 female aged between (10-50)years with mean age of 32. There were no isolated duodenal injury, 43.8% had haemorragic shock on admission to the emergency room, 14 cases 33.3% died perioperatively, 4 cases 9.5% died postoperatively due to complications, no death in patients after leaving hospital. Conclusions Second part of the duodenum is the most common site of injury. Grade 3 duodenal injury has high morbidity & mortality rate. Time interval between the injury & operation is more important to decrease morbidity & mortality rate.

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Article
Mustansiriya Medical Journal Volume 12 Issue 2 December 2013 | 34

Author: Haqqi I. Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 2 Pages: 34-39
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Despite the improvement in health care in general and antiseptic techniques in particular, cases of gluteal abscess following intra-muscular injections are still encountered. Although this condition is not considered a serious illness, still it causes complications and exerts a pressure on health resources. Objectives: To determine the factors responsible for the development of gluteal abscesses and to suggest measures to avoid this problem and to study the methods used in management. Methods: This is a prospective analytic study in which all patients admitted to the surgical ward with gluteal abscess over a six months period were included. Detailed demographic, clinical and investigative data were recorded. Predisposing factors and co-morbid conditions were documented, also, the persons who did the injection, the types of drugs used and other factors related to the process of injection were studied. The contribution of the human, technical and pharmacological elements were analysed. The methods used in management, early post-operative complications and the final outcome were recorded. Results: Forty-two patients were included in the study; of those, 30 were females (75%) and the mean age was 35 years. Eighteen were diabetic (42.8%) and 16 (38.04%) were over-weight. Thirty-eight patients (90.47%) had history of preceding intra-muscular injections. Most of the drugs used were antibiotics, mainly Cefotaxime used in 14 patients (33.33%). There was also 8 instances related to Diclofenac injection (19.04%) and 4 related to iron preparation (9.5%). There were 8 instances of mixed injections using more than one drug (19.04%). Twenty-eight episodes were related to under-trained personnel (66.67%); 20 female nurses (47.62%) and 8 male nurses (19%). Forty patients presented mainly as local pain(97%) and 36 patient as visible swelling(90%). The main method of diagnosis was clinical. All patients were treated surgically mostly using general anaesthesia (95%) and frank pus obtained in 34 patients(80.95%). The most common organisms obtained on culture were coagulase-positive staph.aureus and proteus. Conclusions: Gluteal abscess disease is still common despite advances in anti-septic techniques. Most of the cases are due to the lack of experience and improper training of para-medical personnel. This condition is seen more with certain types of drugs and in immune-compromised patients like diabetics.


Article
The benefit and feasibility of early laparoscopic cholecystectomy

Author: Haqqi I. Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 40-45
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Acute cholecystitis is a common disease. The best managementin early cases is surgical, but the optimal timing for surgery remainscontroversial. With advances and increased experience in laparoscopicsurgery, laparoscopic cholecystectomy is increasingly being used in themanagement of acute cholecystitis.Aims: To determine the best time to operate in acute cholecytitis (early vs.delayed) and to compare the results of laparoscopic approach with those ofopen surgery in the treatment of acute cholecystitis .Patients and Methods: This was a prospective study done at al‐Yarmoukteaching hospital, Baghdad from Sep. 1st 2012 to Sep. 2nd 2013. All patientsadmitted with a proved diagnosis of acute cholecystitis were included. Thepatients were divided into two groups, the first group had earlycholecystectomy, laparoscopic (LC) or open (OC). The second group wastreated conservatively and delayed cholecystectomy was done. Detailedclinical, investigative and imaging data were recorded. The details of theoperative findings, procedures and early post‐operative complications, weredocumented.Results: There were 146 patients, 82.2% female and 17.8% male. The mean agewas 40±2 years. Early surgery was done for 32.8% of patients, 58.4% as alaparoscopic procedure, and 41.6% as an open procedure. Delayedcholecystectomy was done in 67.2% of cases. In the early group,the difficultywas minimal in 27.2%, moderate in 39.5%, marked in 25 % and very difficult withconversion done in 8.3%. Early complications were noticed in 4.2% in the earlyLC group, and 8.3% in the early OC. For delayed LC, 8.1% had earlycomplications vs. 6.1% for delayed OC.Conclusions: Early laparoscopic cholecystectomy is a safe and feasibleapproach to the management of acute cholecystitis.


Article
The role of pre-operative investigations in deciding the outcome of thyroid surgery

Authors: Hussein Hadi --- Haqqi I. Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2012 Volume: 11 Issue: 1 Pages: 90-93
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Patients undergoing surgery for solitary thyroid nodules or multinodular goiter are investigated preoperatively. These investigations may define or possible cases of thyroid malignancy and so help in planning the surgical approach and affect the outcome of the management of the patient in general. Aims: To evaluate the roles played by preoperative investigations in cases of thyroid enlargement in deciding the probable outcome of the operative procedure with emphasis on cases of thyroid malignancies.Patients and Methods: All patients admitted for thyroid gland surgery at Al-Yarmouk teaching hospital for the period from Oct.1 2008 to Oct.1 2009 were fully evaluated preoperatively. Clinical, radiological, hormonal and FNA cytological findings were recorded. Operative findings were reported. Histopathological diagnosis followed and reported. Results: During the period of the study (102) patients were admitted with management, the majority were females (82) in the fourth decade of life (35 cases). The main clinical presentation was multinodular goiter (84) ultrasonography revealed (78) cystic lesions and (24) solid lesions. The main pre-operative investigation was F.N.A cytology. The majority of the reports were normal (78) with four reports of malignancy. The main finding at surgery was multinodular goiter (94 cases). The most common operative procedure was sub-total thyroidectomy (59). Histopathological examination revealed (85) benign pathology and (17) malignant all of them papillary carcinoma. Conclusions: F.N.A cytology is the most important pre-operative diagnosis and because of the reported low sensitivity further experience and training is recommended.

Keywords

Pre-0peration --- Thyroid


Article
Delayed Management in Acute Abdomen: causes and consequences
إرجاء التدابير العلاجية في حالات البطن الحادة: الاسباب والنتائج

Authors: Haqqi I. Razzouki حقي اسماعيل رزوقي --- Amer H. Salman عامر حسن سلمان
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 1 Pages: 78-84
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

ABSTRACT:Background: Acute abdomen is a serious life-threatening condition which needs prompt diagnosis and management. However, in many situations, there is a delay in management which may affect the clinical outcome and worsen the prognosis.Objectives: To determine the causes of delay in diagnosis and treatment in acute abdomen and to study the effects on prognosis.Patients and Methods: A prospective case-series study done in Al-Yarmouk teaching hospital, surgical department over a six months period from 1st of April 2011 to the 1st of October 2011.Ninety five Patients presented with acute abdomen were divided into two groups according to the duration of their symptoms. Thirty five patients who presented after 24 hours were considered delayed and 60 patients who presented before 24 hours were considered as controlled group. Both groups were followed closely and the operative findings, Post-operative complications and the final clinical outcome were documented.Results: There were 35 patients with delayed acute abdomen. The delay was due to the patient or his family in 19 (54.2%) cases and due to medical factors in 11(31.4%) patients. The most common operative finding was perforated duodenal ulcer 5 (14.2%) patients and perforated appendix 5 (14.2%) patients. Thirty (85.7%) patients developed post-operative complications mainly prolonged paralytic ileus, peritonitis and early surgical site infection. The total post operative complications were 25 (71.4%) patients and full recovery was 5 (14.3%).There were 5(14.3%) deaths due to septic shock or cardiovascular complications. Sixty patients presented within 24 hours and considered as controlled group, The most common operative finding was perforated duodenal ulcer 30 (50%) patients, and obstructed or strangulated hernia was 15 (25%) patients, the total post operative complications in this group was (25%) P-value 0.006 (significant), full recovery was found in 42 (66.6%) patients P-value 0.0007(significant), there was no deathConclusions: Although many factors causing delay management in cases of acute abdomen are mainly related to the patient, there were a significant number of cases in which the attending doctor was responsible for the delay. There was a definite relationship between the delay in diagnosis and management and the incidence of complications and Death. Keywords: Acute Abdomen; Delayed treatment; causes, consequences

خلفية البحث: ان حالات البطن الحاد تكون في اغلب الاحيان شديدة مع خطر الموت و تحتاج الى تشخيص سريع و تداخل عاجل . هناك في حالات عديدة تاءخير في المعالجة مما يؤثر على النتائج السريرية و يؤدي الى تدهور في التكهناهداف البحث: لتحديد اسباب التاخير في التشخيص و المعالجة لحالات البطن الحاد و لدراسة المضاعفات المترتبة على هذا التأخير ومدى تأثيرها على التكهنات.المرضى و طرق البحث: دراسة مستقبلية شملت المرضى المصابين بالبطن الحاد الداخلين الى قسم الجراحة في مستشفى اليرموك التعليمي لمدة ستة اشهر. تم تقسيم المرضى الى مجموعتين حسب الفترة ما بين ظهور الاعراض و وصولهم المستشفى واعتبرت الحالات الواصلة بعد 24 ساعة متأخرة0 لاغراض البحث تم متابعة المجموعتين تفصيليا وتوثيق مشاهدات العمليات الجراحية والمضاعفات بعد العمليات و النتائج السريرية.النتائـــــــــج: كانت هناك 35 حالة بطن حاد متأخرة .كانت العوامل المتعلقة بالمريض او عائلته هي سبب التأخير في 19 مريضا و العوامل المتعلقة بالكادر الطبي هي السبب في 11 مريضا.الحالات الاكثر حدوثا هي انثقاب قرحة الاثني عشري و انثقاب الزائدة الدودية.حدثت مضاعفا ت بعد العملية في 30 مريضا اكثرها شيوعا شلل الامعاء المطول و التهاب غشاء البريتون و التهاب جرح العملية. وحدوث خمس وفيات بسبب الصدمة الجرثومية او اختلاطات متعلقة بالقلب و جهاز الدوران .الاستنتاجات: ان العوامل المتعلقة بمعالجة حالات البطن الحادة المتأخره تعود اساسا الى المريض و عائلته الا ان هناك حالات كثيرة يعود السبب للكادر الطبي و لاسباب متعددة. هناك علاقة مؤكدة بين التدابير العلاجية في حالات البطن الحاد المتأخرة و بين زيادة الاختلاطات بعد العملية و كذلك زيادة وقوع الوفيات مقارنة بالحالات التي تم علاجها مبكرا.

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