comparative study between small dose dexamethasone, tropisteron, metoclopramide and normal saline in reducing nausea and vomiting after laparoscopic cholecystectomy

Nausea and vomiting are among the most common distressing complications encountered by patients postoperatively. The aim of this study is to evaluate the prophylactic effect of small dose of dexamethasone [5 mg] on postoperative nausea and vomiting [PONV] after laparoscopic cholecystectomy [LC]. A prospective double blind placebo controlled study of 160 patients who under-went elective LC at Rizgary Teaching and Hawler Private Hospitals in Erbil, Kurdistan in a period between Jan 2009 and Dec 2009. Preoperatively the patients were allocated randomly to one of the four groups [n = 40 each]. 1. The dexamethasone group received dexamethasone 5mg. 2. The metoclopramide group received metoclopramide 10mg. 3. The tropisetron group received tropisetron 2mg. 4. The placebo group received normal saline 2ml. Both the dexamethasone and tropisetron groups were significantly different from the placebo group in the incidence of nausea and vomiting. The differences between the dexamethasone and tropisetron groups were not significant [P = 0.799]. prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing LC

clinicopathologic study of Ki-67 proliferation index in colorectal carcinoma

To investigate Ki-67 immunoexpressions in colorectal cancer and analyze possible correlations with variable clinicopathological prognostic factors. A cross-sectional study of tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined at the Histopathology Laboratory of Rezgary Teaching Hospital in Erbil, Iraq between January 2010 and July 2011. Ki-67 labeling index is calculated immunohistochemically using the monoclonal antibody MIB-1, and the standard streptavidin-biotin immunoperoxidase method. The clinicopathologic and prognostic features were statistically analyzed. Over-expression of Ki-67 proliferation protein was found in 31 [62%] cases. Statistical analyses revealed a significant relation between Ki-67 proliferation index and histologic type [p=0.005] and tumor grade [p=0.018]; but no significant relation was calculated with the other clinicopathological parameters such as age, gender, tumor's size, site, depth, stage, nodal status, and vascular invasion [p>0.05]. Ki-67 immune overexpression is a frequent finding in our colorectal cancer cases; but it is not enough to monitor Ki-67 proliferation index alone for prognosis in colorectal cancer

Para umbilical hernias in Erbil

To study the distribution and causes of Paraumbilical hernias in Erbil city. This is a prospective study comprising 182 consecutive patients with Paraumbilical hernias who attended general hospitals in Erbil city, during the period from 1[st] September 2008 to 31[st] May 2009. The data collected by a special questioner. All patients operated on under GA, except 2 of them who were operated upon by spinal anesthesia due to their unfitness for GA. The total number of the patients was 182 patients. The female: male ratio was 12:1. The age of the patients ranged from 1.5-76 years [mean was 41.7]. The most common age group was between [31-40] years. One-hundred- and-ten patients [61%] were obese, [67%] of patients had history of 4-15 pregnancies. Only one child [female] had this type of hernia. Recurrent hernias were found in 14% of the cases. Operation was done for [74%] of the patients [50% simple repair, 16% Mayo's repair, and 34% repair by prosthetic mesh]. Paraumbilical hernia is a common disease in Erbil. It is more common in females than males. It is more common in multiparous and obese adult female patients. It may rarely occur in children

role of preoperative ultrasound in predicting difficulties encountered during laparoscopic cholecystectomy

Pre-operative prediction of difficulties which may occur during laparoscopic cholecystectomy can help in reduction of operative and postoperative complications. The aim of our study was to study the value of preoperative ultrasound findings for predicting difficulties encountered during LC and to assess the usefulness of these findings to identify patients at high risk of conversion from laparoscopic to OC. A prospective study of 200 consecutive patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis in the period between October 2005 and March 2007 in Rizgary Teaching and Howler Private Hospitals in Erbil, Kurdistan, Iraq. Abdominal ultrasound was done pre-operatively, the diagnosis of gall stones was made and the presence of ancillary findings was recorded. Five ancillary ultrasound findings were assessed. These included; thickened gall bladder wall more than 4mm, presence of pericholecystic fluid, severely contracted gall bladder, empyma, and gall bladder filled with stones. Ultrasound findings were compared with the operative findings. In 36 patients who had one or more of these findings laparoscopic Cholecystectomy was difficult in 22 [61.1%] of them. The statistical analysis showed that thick wall gall bladder > 4mm has the highest sensitivity [69%] and the presence of pericholecystic fluid has the highest specificity [100%] in predicting difficult laparoscopic cholecystectomy and the presence of more than 2 ancillary findings yielded an accuracy rate of [100%]. Conversion to open cholecystectomy was needed in 13.9% of these patients. The rates of difficult laparoscopic cholecystectomy and conversion to laparotomy were much lower in those patients who had no ancillary findings [4.3%] and [1.2%] respectively. Preoperative ultrasound findings are of value for predicting difficulties encountered during laparoscopic cholecystectomy which may require conversion to open cholecystectomy

Immunoexpression of p53 and p21 [WAF1/CIP1] proteins in colorectal cancer: correlation with clinicopathological parameters

Both p53 and p21 [WAF1/CIP1] proteins belong to the cell cycle-regulating family of proteins, and the loss of their activity seems to be one of the most important regulatory mechanisms of carcinogenesis in colorectal cancer. The aim of this study was to evaluate the tumor suppressor genes p53 and p21 [WAF1/CIP1] expressions in colorectal cancer and assessment the relationship between p2 [WAF1/CIP1] and p53 immunoreactivity with special emphasis on the prognostic significance of their expression with variable clinicopathologic parameters. Tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined. The standard streptavidin-biotin immunoperoxidase method was used for immunostaining of p53 protein and p2[WAF1/CIP1] protein.The extent of positive p53 and p21 [WAF1/CIP1] staining was graded semiquantitatively. The clinicopathologic and prognostic features were statistically analyzed. Over-expression of p53 and p2l [WAF1/CIP1] were found in 27 cases [54%] and 22 cases [44%] respectively. Statistical analyses revealed a highly significant correlation between p21 [WAF1/CIP1] and p53 immunopositivity [p=0.003]; but no significant correlation could be calculated between p53 or p21 [WAF1/CIP1] proteins expression with the Clinicopathological parameters such as [age, sex, tumor size, gender, TNM staging, and vascular invasion] except there was significant statistical correlation of p53 expression with tumor type [p<0.05]. Our investigation results suggest that p53 and p2l [WAF1/CIP1] immunoexpression are common findings in colorectal cancer and the induction of p21 [WAF1/CIP1] occur in a p53-dependent or independent pathways

Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure

To study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A [37 patients] were treated by open method [excision and healing by secondary intention] and Group B [40 patients] for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years [mean 4.16] was through outpatient visits. The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups [p<0.0001]. The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference [p=0.0401], while the differences were insignificant for each complication when analyzed separately. Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus