case of giant uterine fibroid in a young woman

The incidence of uterine fibroid tumor increase as women grow older and they may occur in more than 30 percent of women 40 to 60 years of age. Risk factors include nulliparity, obesity, family history, black race, and hypertension. These neoplasms frequently cause abnormal period, pelvic pain, and pressure symptoms. We present a case report of a large leiomyoma in an adult woman

review of 100 cases of colonic injuries admitted to Baghdad teaching hospital according to ACS grading system

In Iraq nearly 95% of colonic injuries are caused by penetrating trauma [gun shot, blast injuries, stab injuries, or iatrogenic trauma], blunt injuries are rare and commonly result from road traffic accidents or fall from height. While in the rest of the world, penetrating trauma accounts for 80-90% of cases. This higher rate of penetrating trauma in Iraq is due to the high rate of terrorism attacks with low and high velocity missiles. The aim is to study cases with colonic injuries according to ACS [American College of Surgeons] grading system, the surgical management applied and the postoperative outcome of each grade. This prospective study compromise [100] patients with documented colonic injuries admitted to the surgical wards at Baghdad Teaching Hospital spanning the years 2006 to 2008. The parameters used in this study include: age, gender, mechanism of injury, part of the colon involved by injury, the grade of the injury, other associated organ injuries, the method chosen to manage the injury and the outcome [uneventful recovery, postoperative morbidity and death]. Colonic injuries were caused by bullet injuries in 50% of cases, sigmoid colon was the most common involved part [32%], 64% of cases were of grade 2 ACS, the most common associated organ injury was small intestine [60%], colonic injuries were primarily sutured in 48% of cases, while other 48% of vases ended with colostomy. Morbidity postoperatively were recorded in 32% of cases, most frequently with grade 2 and in cases treated by colostomy. Postoperative Death was recorded in 14% of cases. According to our study, ACS grading system proves to be highly beneficial to the applied in the coarse of management of colonic injuries

Hepatectomy experience in Baghdad teaching hospital

Hepatectomy is usually performed because it is the most effective way of removing liver tumour [s]. Cryosurgery, Radiofrequency, Laser, Microwave and Chemo-therapies are less effective alternatives. To review the experience of hepatectomy in Baghdad Teaching Hospital - Medical city Iraq with a review of the obstacles and needs for promotion and development. During the period from March 1999 to September 2005, Out of 27 patients admitted to the second surgical unit in Baghdad Teaching Hospital - Medical City with liver tumours, 15 had hepatectomy done by the same surgical team. The remaining 12 cases were beyond resection. The age of patients ranged from 2 to 65 years old with mean age of 34.4 years. Only one [6.7%] patient underwent left lobectomy, 2 [13.3%] left segmentectomy, while the rest 12 patients [80%] underwent right partial or total lobectomy, divided equally between anatomical and non-anatomical resection. Two main techniques were used in transection of liver parenchyma: CUSA Dissector which is used in 9 patients [60%] and clamp-crushing or finger fracture technique was used in the remainder. In addition to CUSA knife, argon beam was used in 5 cases [33.3%]. Postoperative mortality rate was 26.7% [4patients]. The histopathological examination of resected segments of the liver revealed 11 [73.3%] cases of hepatocellular carcinoma, 2 [13.3%] of hepatoblastoma, 1 [6.7%] case metastatic colorectal carcinoma, and 1 [6.7%] case of benign cells [haemangioma]. Hepatectomy for liver tumours can be performed with acceptable safety and efficacy in a suitably staffed and equipped center. The outcome will improve with time and experience

Post operative effect of bupivacaine as local anesthesia in abdominal incisions

Pain after abdominal incisions is responsible for many postoperative problems, especially pulmonary and thromboembolic complications. Although many analgesic drugs are available yet they have to be given systemically to be effective with a real danger of respiratory depression. The use of local anesthetic drug infiltrated in the wound at the end of surgery is a logical solution .The aim of this study is to evaluate the effect of local anesthesia in the control of postoperative pain During the period January 2007 until December 2007 hundred and twelve patients had abdominal operations at Baghdad Teaching hospital .Patients were randomly allocated to two groups .Group [1] included 56 patients who had 10 ml bupivacaine infiltrated in the wound by a sub facial catheter before wound closure and Group [2] 56 patients had placebo injected [2 ml of normal saline].Visual analogue scale was used for post operative pain assessment There was a significant decrease in pain score and the requirement of the systemic analgesic in Group [1] during the 1[st] 24h after surgery as compared to Group [2] with [P < 0.05] .The type of surgery which showed marked decrease in pain score were repair of hernia, open cholecystectomy and appendesectomy and was least obvious after midline incision. There was a significant decrease in pain intensity and the analgesic requirement in patients who had local wound infiltration with bupivacaine as compared to placebo group thus making it an effective, simple and cheap method in relieving pain after abdominal incisions. local anesthesia-bupivacaine -postoperative pain-abdominal incisions

Interval appendectomy: surgical and pathological basis

The treatment of appendiceal mass is controversial. For patients initially treated conservatively with antibiotics with or with out drainage, the role of interval appendectomy is an area of considerable debate. To evaluate the indications of interval appendectomy in patients presented with appendicular mass in correlation with post operative histopathological results. This is a prospective study of 97 cases with the diagnosis of appendicular mass admitted and treated conservatively in Baghdad Teaching Hospital during the period from December 2002 to December 2006 then scheduled for interval appendectomy. .Histopathology of the appendix examined and correlation of the result with certain clinical characteristic of the patients. The prevalent age group was 30-39 years [39%] and male to female ratio was 2.8:1. Postoperative histopathological features of the excised specimens showed that 85/97 [88%] of patients had chronically fibrosed appendix with obliterated lumen. The remaining 12/97 [12%] of patients were having inflamed appendices. There was a clear correlation the age of patient above 40 years [41%]and initial clinical response [94%] with the histopathologic support for appendectomy. Interval appendectomy was mandatory in the following groups of patients: Patients >/= 40 years old. Patients with poor initial response to conservative treatment. Patients with recurrent symptoms. Patients with WBC count >/= 12000 cell/cc

analytic study of 200 cases of head injuries admitted to teaching Hospital in Najaf

This is a prospective study of Head injury in Najaf. To study the causes and out come and way of transferring the RAT to the hospital and best way to investigate them. A prospective analytical study of 200 cases of Head injury patients, who were admitted to Saddam Teaching Hospital, in Najaf between 18[th] of November 1996 and 1[st] of September 1998. All age groups were included in this study, male to female ratio was 4:1 and the highest incidence was seen at the age group below 14 years. The two most common causes of head injury were road traffic accident [RTA] [51%] and assault [22%], of RTA pedestrians accounted for [87.25%]. RTA accounted of [80%] in those with severe head injury. The highest incidence of head injuries in both male and female was between 2pm and 6pm. All patients brought to hospital by personal means, most of them reached the hospital within the first hour of injury. 115 patients [57.5%] were minor head injuries [Glasgow coma scale [11-15]]. Skull x-ray was taken for 185 patients, it was positive for fracture in 48 patients [24%] and negative in 137 [68.5%]. There is a significant number of patients with negative skull X-ray who need not to be X-rayed. The commonest associated injuries were limb fractures 35% followed by injuries of abdominal viscera 11%. The incidence of operative treatment [10%]. The final outcome on discharge was complete recovery in 156 patients [78%], residual neurological deficits in 18 patients [9%], and death in 20 patients [10%], and 6 patients discharged against medical advice. The common cause of head injuries in those who died was RTA 85% and we give recommendation regarding traffic roads and culture of society and policy of investigation

Predictive values of risk factors in management of diabetic foot

Outcome of management of patients with diabetic foot is difficult to predict. Assessment of variables in history, examination and investigations were analyzed with outcome of management and whether can be assigned as prognostic factors. Prospective study of 300 patients with diabetic foot in Baghdad teaching hospital during the period from April 2000 to March 2004, certain criteria were taken in history and examination, these were investigated and treated either by conservative procedure or amputation. Most common age group was 50-59 years [33.3%]. The male to female ratio was 2:1. Conservative debridement was performed in [60%] of patients while amputation was employed in [40%]. Amputation was performed in 604 of patients above 60 years and in [75%] of patients who had diabetic foot lesions for > 2 weeks, and in 90% of smokers for 10 years or more. Amputation was needed in [71%] in those who had history of previous ulceration and 72.5% of patients who had positive history of previous amputation. Amputation was needed in [88%] of those who had their temperature >38°C, in [91%] of patients who had diabetic foot lesion of Wagner grade>III and 91% patients with X-ray findings of osteomyelitis. Highly significant association was found between amputations with following variables, smokers > 10 years, patients with a temperature of > 38°C, Hypertension > 140/90 mmHg Wagner grade >III, white blood cell count of > 20.000/cc and positive foot X-ray findings. Slight significant association of amputation and the following variables: Age >60 years, duration of foot lesion >2 weeks, history of previous amputation, previous ulceration, negative pedal pulses, deformed feet and patients who had impaired normal vision

Adrenal disorders, surgical approaches and postoperative complications

Adrenal disorders in surgical practice are. presented either as hyperfunctional disorders or non functional disorders [incidentalomas]. Functionally, medullary tumors [pheochromocytoma] result in excess secretion of catecholamines[l], on the other hand, functioning adrenocortical tumors could secrete excess of cortisol [Cushing syndrome], aldosterone [Conn's syndrome] or sex hormones [virilizing syndromes]. [2 The aim of our study is to identify and to show our experience in the surgical approach and postoperative complications of adrenal disorders. This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The data collected including age, gender, types of clinical adrenal disorders, surgical approaches and postoperative complications. Surgical excision was performed in 19 cases, eleven through anterior transabdominal approach [11/20, 55%], and eight through thoracoabdominal approach [8/20, 40%]. A better outcome was recorded in the thoracoabdominal approach. The most common encountered surgical morbidity was hypertension [3/19, 15.8%] and hypocalcemia [3/19, 15.8%]. Thoracoabdominal approach has better outcome especially in excising right adrenal tumor but transabdominal approach is preferable in excising a bilateral adrenal gland

Adrenal disorders, presentations and ways of investigations

Adrenal disorders in surgical practice are presented either as hyperfunctional disorders or non functional disorders [incidentalomas]. Functionally, medullary tumors [pheochromocytoma] result in excess secretion of catecholamines[1] on the other hand, functioning adrenocortical tumors could secrete excess of cortisol [Gushing syndrome], aldosterone [Conn's syndrome] or sex hormones [virilizing syndromes][2]. Aim of our study was to identify the most common types of adrenal tumors, its presentation and outlining the best diagnostic work up and to show our experiences in dealing with adrenal disorders in Iraq. This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The collected data including; age, gender, presentations, methods of investigations and histopathological records. Their assessment revealed that adrenal disorders were most commonly encountered in the [30-39] years age group [9/20, 45%]. The mean age was 40 years with a female preponderance and female: male ratio of 2: 1. Obesity was noted in [7/20, 35%]. Headache was manifested in [5/20, 25%], palpitation in [4/20, 20%] and uncontrolled hypertension in [4/20, 20%]. Plasma cortisol was elevated and its diurnal rhythm was lost in [8/20, 40%], 24-urinary VMA was elevated in [6/20, 30%]. 24-urniary 17-ketosteroid was elevated in [1/20, 5%]. The most commonly encountered clinical type of adrenal disorders was hypercortisonism in the form of Gushing disease and syndrome[8/20, 40%]. Adrenal disorders mostly affect young age group patients with a female preponderance. Functioning adrenal disorders have presented earlier than non functioning ones owing to the symptoms they had caused. U/S, CT scan, MRI and IVP are very important in visualization, localization, assessment of distant metastases and finally discrimination of benign from malignant disorders