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Hepatocellular Carcinoma Presentation & Management , A Prospective Study in the Medical City Baghdad - Iraq

Author: Wissam Jaffar Altaee
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 2 Pages: 253-260
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND :The development of HCC is a major global health problem , It's incidence has increased world wide and nowadays it constitute the 5th most frequent cancer representing around 5% of all cancers, and estimated to rank 4th in terms of mortality of cancers incidence world wide , it accounts for 80 –90% of all primary liver tumors . The Etiology of this tumor is multifactorial , certain viral, environmental & hereditary causes of cirrhosis have a strong correlation with HCC . HCC is a highly malignant tumor with poor prognosis .OBJECTIVE:To evaluated the Etiological , Epidemiological , Patho physiological , Diagnostic series , Therapeutic approaches & Advanced studies in detection and prevention of HCC .PATIENTS AND METHODS :Across sectional study of (57) patients with HCC ( 43 males , 14 females ) during the period from January 2000 to December 2002 . The patients were collected from medical & surgical units of Baghdad teaching hospital & the gastroenterology & hepatology teaching hospital .History taken from these patients & physical examination , Lab investigation ,CBP, liver function test ,Virology study , serum AFP. Titer ,U/S study , MRI , CT scan . Ascitic fluid tapping , Liver biopsy.Modalities of treatment : Palliative Treatment, Chemotherapy, Injection of Alcohol , Hemilobectomy ,Segmental resection , Debulking resection of tumor in the liver, Conservative treatment , any complications or hazards during surgical procedures were recorded.RESULTS :Male to female ratio is approximately (3:1), The mean age of (57.1) yr . more common between (51-60) yrs old ( 28.25% ) , Most of the patients were from Baghdad ( 47.4% ) . Increasing no. of patients from 2000 ( 21.1 % ) to 2002 ( 45.6 % ). (84% ) have previous history of chronic liver disease & (16%) haven't such a history . Most of chronic liver diseases are due to previous history of hepatitis B- infection (41.6%) . High level of AFP ( 66.6% ), all of them are of standard type of HCC. Ascitic fluid cytological study bloody (14%) & positive malignant cells (17.2%) . Liver biopsy (82.7%) had chronic liver diseases, and (96.5%) moderate to poorly differentiated type of standard HCC,(3.5%) fibrolamellar type .Outcome of treatment , Conservative (35%), Injection therapy (3.5%) , Chemotherapy (28%), Surgical procedures (16%) , Segmental & Right lobectomy (3.5%) for each , Debulking (9%) .CONCLUSION :AFP and U/S study are very important in the early detection and follow up of the patient with HCC , Liver biopsy - very important study to detect various type of HCC , Surgical resection is the only potentially curative treatment of HCC


Article
Comparison Between Mechanical and Non Mechanical Bowel Preparation Prior To Elective Colorectal Surgery

Author: Wissam Jaffar Altaee وسام جعفر
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 85-90
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation which may cause discomfort to the patients, prolonged hospitalization and water & electrolyte imbalance. Objective: to assess whether elective colon and rectal surgery may be safely performed without preoperative mechanical bowel preparation. Method: the study includes all patients who had elective large bowel resection at Medical City – Baghdad Teaching Hospital between Feb, 2007 to Jan, 2010. Emergency operations were not included. The patients were randomly assigned to the 2 study groups (with or without mechanical bowel preparation. Results: A total of 165 patients participated in the study, 82 with mechanical bowel preparation and 83 without. The 2 groups were similar in age, sex and type of surgical procedure. 134 patients (81.2 %) underwent surgery owing to colorectal cancer & 31 patients (18.8 %) owing to benign disease. The hospitalization period was longer in the bowel-prepared group (mean ± SD, 8.2 ± 5.1 days) as compared with the non prepared group (mean ± SD, 8.0 ± 2.7 days). However, this difference was not statistically significant. The time until the 1st bowel movement was similar between the 2 groups : a mean ± SD of 4.2 ± 1.3 days in the non prepared group as compared with a men ± SD 4.3 ± 1.1 days in the prepared group ( P = NS ). Conclusion: Our results suggest that no advantage is gained by preoperative mechanical bowel preparation in elective colorectal surgery.


Article
The Effect of Ramadan Fasting on Duedenal Ulcer Perforation

Authors: Wissam Jaffar Altaee --- Safa M. Mahdi Alobaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 381-387
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Fasting during the month of Ramadan is one of the five holy pillars in the Islamic faith and is an important annual ritual practiced by all Muslims. This involves fasting from dawn to dusk, followed by a break of fast at designated times. The length of fasting varies from ten to 19 hours, depending on the season in which the fasting month of Ramadan falls and the geographical locations.OBJECTIVE:1st to evaluate the relation between Ramadan fasting & duodenal ulcer perforations & 2nd to asses the risk factors of this complications .PATIENTS & METHODS :This is a prospective study in Baghdad Teaching Hospital – Medical City . Data from 231 consecutive patients with perforated duodenal ulcer from the period of October 2007 to December 2010 were collected & analyzed & all the patients were managed surgically after resuscitation in emergency unit .RESULTS :(96/231, 41.6%) of patients with perforated duodenal ulcer during Ramadan vs. (135/231, 58.4%) during the rest of the years . (96/490, 19.5%) of patients with perforated duodenal ulcer from the total number of all patients with acute abdomeninal surgeries during Ramadan. 43 % of patients smoking & 47 % of patients had a previous history of acid peptic disease in Ramadan. 54 % of patients were in between (20 to 40) years age group and the male to female ratio was 6 :1 . 15% patients of perforated duodenal ulcer had history of regular use of non steroidal anti inflammatory drugs.. Erect chest x-ray demonstrated gas under the diaphragm in 86% . Only 2 patients had a previous surgery of duodenal ulcer perforation .CONCLUSION:This study suggests that the incidence of duodenal ulcer perforation is relatively high in Ramadan among the people, who are fasting & have predisposing factors ( smoking , history of acid peptic disease , non steroidal anti-inflammatory drugs ) and need special precaution during this month

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