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Article
Case report: Fasciola Hepatica worm swims in the gallbladder
تقرير الحالة: دودة فاسيولا هيباتيكا تسبح في المرارة

Author: Tahir Abdullah Hawrami
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 2 Pages: 1-4
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Human infestation with liver flukes is rare, as they are accidental host by ingestion of con-taminated water & vegetables. To document the presence of this disease in Iraq/ Kurdistan region, we are reporting this case of Fasciola Hepatica infestation to a young lady with recurrent attacks of Rt. Abdominal pain. The worm was found, during cholecystectomy, swimming in the bile of gallbladder.


Article
The Frequency of Gall Bladder Pathology in Consecutive 576 Cholecystectomies

Authors: Layth A. Alshareefi --- Mohammed A. Ali --- Nazar J. Metib --- Mahdei Jasim
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2019 Volume: 12 Issue: 1 Pages: 4154-4162
Publisher: Kerbala University جامعة كربلاء

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background: Cholecystectomies with relevant frequency of gall bladder pathologies is not clear. Patients and methods: Throughout 2016 and 2017 in pathology unites of two hospitals, 576 cholecystectomy cases were analysed. The age of the patients range from 2 to 80 years with a mean of 42.60±15.62 years. Male to female ratio was 152:424 (1:3).All the samples reviewed by two consultant pathologists.Aim of study: To Study the frequency of histopathological changes in 576 cholecystectomies.Results and discussion: Of the total sample which was 576, 437 cases (75.9%) had gall stones, 51 cases (8.9%) were acute cholecystitis, 464 cases (80.6%) were chronic cholecystitis, 9 were malignant (1.6%) and 52 were normal (9%). All the malignant cases were solid variant adenocarcinomas and only one was metastatic from sigmoid colon. Acute suppurative cholecystitis were seen in 24 cases (4.1%), xanthogranulomatous cholecystitis 34 (6.1%), Rokitansky – Aschoff sinuses were seen in 223 (38.7%), inspissated bile 24 (4.2%), adenomyomatous changes 146 (25.3%), focal abscess formation 26 (4.5%), cholesterosis 31 (5.4%), metaplasia 465 (80.7%), single adenomatous polyp, eosinophilic cholecystitis 25 (4.3%).In adenomyomatous changes the epithelial proliferation was florid with Rokitansky – Aschoff sinuses and smoth muscle hypertrophy. Metaplastic changes were of pyloric, intestinal and mucous glands types, the adenomatous polyp was of biliary type with low grade epithelial atypia.Conclusion: The available data may provide basic knowledge of the gall bladder pathology in holey Karbala


Article
Early post-operative course and complications in laparoscopic versus open cholecystectomy

Author: Hussein Hadi Jabber
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 1 Pages: 7-13
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Laparoscopic Cholecystectomy (L.C) is now considered the gold standard in gallbladder surgery. However, Open Cholecystectomy (O.C) is still being performed widely in Iraq. Both types of surgeries have unique problems in the early post-operative period which need to be recognized and dealt with properly. Even with better experience in laparoscopic surgery, complications in the early post-operative period should be expected and addressed promptly and efficiently. Aims: To observe and compare the clinical events in the early post-operative period (the first 48 hours) following L.C and O.C, and to recognize the special problems arising during this period. Also, to document and compare the early post-operative complications in both types of surgeries and the methods applied to deal with these complications. Patients and Methods: All patients admitted for cholecystectomy (open and laparoscopic) to the 2nd surgical team at Al-Yarmouk Teaching Hospital for one year were included in the study. They were evaluated pre-operatively and followed post-operatively with full documentation of the surgical procedures, findings and intra-operative complications. Early post-operative course starting from anesthetic recovery till discharge from hospital was followed very closely and documented. General and specific complications in the early post-operative period were studied and their management observed in details.Results: The number of patients operated upon was 110, 58 laparoscopicaly and 52 by open surgery. In the L.C group , the average pain score in the first 24 hours was 1 compared to 3 in the O.C group patients with L.C were given analgesia on day zero only, while 25% of patients with O.C received analgesia on day one also. Early nausea was present in 90% of patients in L.C group VS. 90% in O.C group, the L.C group 10.4 % had respiratory symptoms vs. 23.1% with O.C patients with L.C had earlier return of bowel function. In the LC group, there were 17 episodes of bleeding vs 4 episodes in the O.C group. In the L.C group 2.8% had common bile duct injury vs 4.6% in O.C group. Post-operative bile leak was 2.8% in L.C vs 1.9% in O.C, while spillage of gallstones was higher in L.C(65.6% vs. 9.7%). Conclusions: The early post-operative course is smoother in the L.C group although with better anesthetic techniques and good post-operative care, the course following O.C is improving. Vascular complications related to trocar site, blood vessels and solid organs mainly liver were more in the L.C group. Bile leakage and gallstone spillage were more with L.C but bile duct injuries more with O.C. Better training of surgeons is needed to improve the learning curve and decrease the incidence of complications.


Article
Ki 67 Expression in Various Diseases of Gallbladder

Authors: Salman Shafeeq Salman --- Alaa Hani Raziq --- Kareem Mohammed Ahmed
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 712 -721
Publisher: Babylon University جامعة بابل

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Abstract

Cell proliferation is an important prerequisite for the development of a neoplasm. Ki-67 is one of the most important cell proliferation markers. Its expression is correlated with the aggression of various histopathologic changes in the epithelium of gallbladder. This study aims to assess the expression of Ki-67 in various pathological processes that affects the epithelium of gallbladder.Gallbladders from 146 patients were studied histopathologically. Then sections from the paraffin embedded tissues were evaluated for the expression of Ki-67 by using immunohistochemical method. The results of Ki-67 labeling index were estimated for each pathologic category and were analyzed for their significance using Mann-Whitney test.The mean value of Ki-67 LI in the epithelium of normal gallbladder was (0.7%), in acute cholecystitis (1.14%), epithelial hyperplasia (8.38%), metaplasia (21.18%), dysplasia (38%) and (70.6%) in the carcinoma group. There was no statistically significant difference with regard to ki-67 between the epithelium of normal GB and those with acute inflammation (p= 0.904) and the difference was highly significant when the normal gallbladder epithelium was compared with carcinoma group. There was statistically highly significant difference when the comparison was performed between normal epithelium and metaplasia group (p< 0.001) and the group of dysplasia (p= 0.001).From the present study a conclusion can be made is that Ki-67 expression increases in chronic inflammation and further increment occurs in premalignant and malignant lesions of the gall bladder epithelium and can be used as a marker of aggression of histopatholgic lesions.


Article
The Safety of Laparoscopic Surgery in Treatment of Empyema Gall Bladder

Authors: Ibrahim Ekhlayef Mughir Al- Doghan --- Hasanain abdulameer jasim --- Haitham Khalid Hussein
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 3 Pages: 91-94
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Empyema Gallbladder is a sequel of severe acutecholecystitis. Previously, laparoscopic cholecystectomy was relativelycontraindicated because of fatal complications. Objectives: Todetermine the safety of laparoscopic surgery in treatment of empyema gallbladder. Methods: A retrospective study conducted on 92 patientsfrom Nov. 2007 to May 2017, with gallbladder empyema who underwentlaparoscopic cholecystectomy at Al-Yarmouk teaching hospital inBaghdad, Iraq. The operation was done by using four ports. Results: A retrospective study of 92 case of empyema gallbladder, laparoscopic cholecystectomy was performed for 92 cases proved to have empyema gallbladder. A successful laparoscopic cholecystectomy done to 75 cases(81.52%) (Group I), a conversion to open cholecystectomy was done to 17(18.47%) (Group II) patients due to various reasons, the most common asa gangrenous wall of gallbladder 6 (6.5%) patients, bleeding from cystic artery 5 (5.4%) patients, severe obscured anatomy of Calot’s triangle duo to adhesions 3 (3.2%) patients. Duodenal injury 2 (2.1%) patients and common bile duct injury 1 (1.08%) patient. Maximum operative time was 80 minutes for all cases. Postoperative complications occurred in 22(29.3%) patients of Group I, and 9(52.9%) patients of Group II. Group I (75 patients) in whom successively laparoscopic cholecystectomy (LC) was done, and Group II (17 patients) where conversion to open cholecystectomy. About 53(70.6%) of Group I patients discharged from hospital within 1-3days, and about 9 (52.9%) of Group II patients discharged from hospital within 7days. Conclusions: Gallbladder Empyema is a serious sequel of acute cholecystitis, where the laparoscopic cholecystectomy can be done to treat it safely.


Article
Biochemical and demographical study of lipid profile in sera of patients with gallstone
دراسة كيموحيوية وديموغرافية للدهون في مصول مرضى حصى المرارة

Authors: Sabah Abaas Al-Ardhi صباح عباس العارضي --- Narjis Hadi Al-Saadi نرجس هادي السعدي
Journal: Iraqi Journal of Science المجلة العراقية للعلوم ISSN: 00672904/23121637 Year: 2012 Volume: 53 Issue: 4 Pages: 760-768
Publisher: Baghdad University جامعة بغداد

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Abstract

Thirty patients with gallstone [aged 25-55 years]and thirty age-and sex-matched healthy subjects as control group were involved. Those patients were intended to undergo surgical removal of gallbladder in the surgical ward- Al Sadder Teaching Hospital and AL-Hakeem Hospital in Najaf city during the period from July/2009 to December /2009. The proportion of female was [86%] compared to the male t [14%]. The ratio of female: male was 5:1. Blood samples were obtained from all patients prior to surgery. Serum was obtained by usual methods and analyzed for lipid profile test [total cholesterol [TC], triglyceride [TG], high density lipoprotein- cholesterol [HDL-C], low density lipoprotein cholesterol [LDL-C] and very low density lipoprotein cholesterol [VLDL-C]}. The results showed that there were no significant differences between gallstone patients and control regarding HDL-C [p>0.05] but there was highly significant [p>0.05] difference in the concentrations of total cholesterol [TC], triglyceride [TG] and VLDL-C comparing with the control group. The study also showed that the sex has a significant effect [p>0.05] on the levels of TC, LDL-C, and VLDL-C in sera of patients with gallstone whereas, non significant sex variation had found with respect to HDL-C level. On the other hand, it was also found that there was a significant p>0.05 ] age variations with respect to serum levels of TC, TG and VLDL-C with effect with respect to both HDL-C and LDL-C levels in sera of patient with gallstone. Additionally, all items of lipid panel found to be significantly [p>0.05] varied with respect to the BMI. Similarly, smoking was found to be important cause and revealed a significant [p>0.05] difference regarding all parameters- but not LDL-C of lipid components. The objective of this study was to estimate the serum lipid profile, in sera of patients with gallstone and investigate their relationship with demographic factors.

تضمنت الدراسة ثلاثون مصابا بحصى المرارة تراوحت أعمارهم بين (25 – 55( سنة وثلاثون شخصاً اصحاء بنفس الأعمار ونفس الجنس للمقارنة . تم الحصول على أمصال المرضى عند مجيئهم الى ردهة العمليات في مستشفى الصدر التعليمي ومستشفى الحكيم في مدينة النجف الاشرف لاستئصال المرارة , للفترة من تموز / 2009 الى كانون الاول /2009 . كانت نسبة الاناث ( 86% ) مقارنة بالذكور ( 14 % ) , اي حوالي 1:5 . جمعت العينات قبل اجراء العملية لغرض قياس مستوى الكولسترول والدهون الثلاثية والدهون عالية الكثافة والدهون واطئة الكثافة وواطئة الكثافة جدا. اظهرت نتائج الدراسة عدم وجود فروق معنوية p>0.05]] بين مرضى حصى المرارة مقارنة بمجموعة السيطرة فيم يتعلق بتركيز الدهون عالية الكثافة لكن كان هناك زيادة معنوية (0.05 > p) في تركيز الكولسترول و الدهون الثلاثية والدهون واطئة الكثافة جدا مقارنة بمجموعة السيطرة.كذلك اظهرت الدراسة ان للجنس تأثير معنوي(0.05 > p) في مستويات الكولسترول و الدهون الثلاثية, و الدهون واطئة الكثافة والدهون واطئة الكثافة جدا في أمصال مرضى حصى المرارة مقارنة بالسيطرة بينما لم يكن هناك أي فرق معنوي في تركيز الدهون عالية الكثافة. من جهة اخرى وجد ان هناك تغايرعمري معنوي (0.05 > p) فيما يتعلق بمستويات الكولسترول, الدهون الثلاثية والدهون واطئة الكثافةجدا مع عدم وجود فروق معنوية( p>0.05) لمستويات الدهون الثلاثية عالية الكثافة والدهون الثلاثية واطئة الكثافة لمرضى الحصى مقارنة بالسيطرة. إضافة الى ذلك اظهرت جميع فحوصات الدهون فروق معنوية(0.05 > p) بالاعتماد على دليل كتلة الجسم .BMI كذلك بالنسبة للمدخنين اظهرت الدراسة فروق معنوية (0.05 > p) في مستويات الدهون لمرضى حصى المرارة باستثناء الدهون واطئة الكثافة.


Article
Laparoscopic Cholecystectomy in Alhindiya Hospital: Analysis Study

Author: Ali Khairi Toman
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2014 Volume: 7 Issue: 2 Pages: 1964-1970
Publisher: Kerbala University جامعة كربلاء

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Abstract

ackground: Cholecystectomy is one of the most frequently performedoperations. Open cholecystectomy has been the gold standard for over 100years. Laparoscopic cholecystectomy was introduced in the 1980s. Laparoscopic cholecystectomy has become the definitive treatment of choice for symptomatic gall bladder disease. It replaced the old traditional method of open approaches with lower complication rates.The laparoscope was introduced into Alhindiya hospital during early 2008 and after that the numbers of laparoscopic operations started to increase gradually and includes cholecystectomy, ovarian drilling, ovarian cysts, and appendectomy and diagnostic operations.Objective: This study summarizes the experiences associated with 150 laparoscopic cholecystectomies performed in Alhindiya hospital to assess the safety of these operations.Patients and Methods: This is an analysis study were the records of 150 consecutive patients who underwent laparoscopic cholecystectomy in Alhindiya hospital were reviewed. 125 patients were females and 25 patients were males (F to M ratio= 5-1). The age range was between 18 -75 years.Analysis of different data was performed.Results: The commonest indications for surgery were symptomatic cholelithiasis (100 cases) and acute/chronic cholecystitis (35 cases). The mean operating time was 36.8 minutes. The mean length of stay in the ward was 17.7 hours. Only 5 cases were converted to open procedures. The commonest postoperative complication was wound-infection. Mortality rate was zero.Conclusion: In summary, this study demonstrates that laparoscopic cholecystectomy can be performed safely in Alhindiya general hospital with good results and low complications rate.


Article
Laparoscopic Cholecystectomy : Retrieval of the Gallbladder Specimen and Spilled Gallstones, Inside a Sterile Male Condom as an Endobag, Reduces the Septic Complications

Author: Jawad Kadhim S. AL-Dhahiry
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 209-215
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: During the course of laparoscopic cholecystectomy .the gallbladder specimen and the spilled stones are retieved by the formal endobag , which is not available in Iraq , or directly through the umbilical or the epigastric port .Direct retrieval of the gallbladder specimen and the spilled stones may cause contamination of the port site . OBJECTIVE : To evaluate the safety,cost effectiveness and incidence rates of intraperitoneal and port site infections when using a sterile male condom as an endobag for retrieval of gallbladder specimen and spilled gallstones .METHODS : This is a prospective study performed in AL-Karama Teaching Hospital, Medical College / Wasit University, Iraq .A total of 306 patients, with symptomatic cholelithiasis underwent Laparoscopic Cholecystectomy (LC), were included in this study performed during the period from April 2011 to June 2014. A sterile male condom was inserted through 10 mm epigastric port. The gallbladder specimen / spilled gallstones of every patient were retrieved inside a sterile male condom. Patients less than 15 years old and those with liver cirrhosis, gallbladder carcinoma and obstructive jaundice, were excluded. The follow-up period ranged from 2 to 42 months.RESULTS:Dissected gallbladders / spilled gallstones of the 306 patients; 279 (91.2%) were females and 27(8.8%) were males with a mean age of 39±12.5 SD (range 16-75) years, were safely retrieved through 10 mm epigastric port inside male condoms. Incidental perforation of gallbladders ,during their dissection from the hepatic bed, was observed11(3.6 %) patients. Perforation of the condom during retrieval of the gallbladder specimens/spilled stones occurred in 12(3.8%) patients.This study had no intraperitoneal nor port site infections. No mortality occurred during the follow-up period.CONCLUSION:Use of a sterile male condom as endobag for retrieval of gallbladder specimen and spilled stones is simple, inexpensive and safe technique. It also reduces the intraperitoneal and port site septic complications .


Article
Molecular detection of Helicobacter species in the bile and histopathological evaluation of gall bladders of patients with calculus cholycystitis in Duhok province, Kurdistan region of Iraq
الاكتشاف الجزيئي لأنواع هيليكوباكتر في التقييم الصفراوي والنسيجي للمثانات المرارية المصابة بالتهاب الصفراوي الحصوي في محافظة دهوك ، إقليم كوردستان العراق

Authors: Sardar Hassan Arif --- Amir Hani Raziq --- Alaa Hani Raziq
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 1 Pages: 1653-1658
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: The presence of bile-resistant Helicobacter spp. in bile and gallbladder tissues has been proposed as a cause of gallbladder disease. This study aimed to assess the histopathological events in calculus cholecystitis and investigate the presence of the DNA of Helicobacter spp. in the bile. Methods: Forty patients who underwent cholecystectomy for calculus cholecystitis were evaluated for the presence of Helicobacter spp. by polymerase chain reaction methods and gallbladder tissue was evaluated histopathologically. Gall bladders were fixed in formalin and subjected to histopathological investigation while bile sample was used for the extraction of DNA.Results: The histopathological findings revealed that twenty-seven (67.5%) samples showed mild chronic inflammation, one (2.5 %) sample with acute inflammation, four (10 %) samples with acute on chronic inflammation, eight (20 %) samples have normal histological findings. The molecular investigation revealed that twenty one (52 %) samples out of the forty showed the presence of genomic DNA after being subjected to DNA extraction and that fourteen (66.7 %) samples out of the twenty one showed amplification bands of 300 bp after PCR amplification indicating the presence of Helicobacter spp. within the samples. But no sample revealed the presence of H. pylori DNA when PCR was applied. Conclusion: Helicobacter spp. are considered as a determining factor for the development of gall bladder inflammation.

Keywords

Helicobacter spp --- Gallbladder --- Bile --- PCR --- 16 S rRNA --- HPU1 --- HPU2


Article
TORSION OF THE GALLBLADDER IN AN ADULT: A RARE CASE OF ACUTE CHOLECYSTITIS
التفاف المرارة عند البالغين/ حالة مرضية نادرة لالتهاب المرارة الحاد " تقرير حالة "

Authors: Hassan Hadi Al-Sikafi حسن هادي السكافي --- Ali Jaliel Awad علي جليل عواد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2009 Volume: 7 Issue: 3 Pages: 110-111
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Torsion of the gallbladder is a rare condition that is generally due to an abnormal anatomical variation, i.e., the presence of a long mesocyst with loss of fixation of gall-bladder to the inferior margin of the liver. The clinical features closely mimic those of acute cholecystitis. In any case, the definitive diagnosis is made during surgery (1, 2). Keywords: Torsion gallbladder- Laparoscopy - Acute cholecystitis

التفاف المرارة هي حالة نادرة وعموماً بسبب الاختلاف التشريحي غير الطبيعي مثل وجود كيس طويل مع فقدان المرارة للحواف السفلى مع الكبد, والعلامات السريرية تقريباً مشابهة لالتهاب المرارة الحاد . وعلى أية حال التشخيص الصحيح يكون خلال الجراحة (أي خلال إجراء العملية).مفتاح الكلمات:التفاف المرارة , المنظار الجراحي , التهاب المرارة الحاد

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