Background: Thyroid ultrasound has been widely used to differentiate benign from malignant nodules; many investigators have tried to point out few ultrasonographic features in order to identify those lesions, which are at a higher risk of malignancy.Objectives: To evaluate the efficacy of selected conventional ultrasound (US) features of thyroid focal lesions useful for predicting malignancy and establishing indications for fine-needle aspiration cytology (FNAC).Patients and Methods:Two hundred and four consecutive patients with thyroid nodules who visited the outpatient clinic of the surgical department of Tikrit University teaching hospital for the period from January 2011 to April 2014, and who underwent surgery for clinical suspicion of malignancy; were examined by US before thyroidectomy. Conventional US evaluated the presence of a halo sign, hypoechogenicity and microcalcifications.Results: On histology, 60 nodules were diagnosed as malignant and 148 as benign nodules. On US, the echographic pattern most predictive for malignancy was microcalcification (P = 0.0001; specificity 78.0%; sensitivity 67.6%). The most specific combination on US, absent halo sign/microcalcifications (P < 0.005; specificity 92.2%, sensitivity 27.6%).Conclusion: Findings on US become effectively predictive for malignancy only when multiple signs are simultaneously present in a thyroid nodule. Thus the predictive value of these techniques increases at the expense of their sensitivity.
Background: Hernia is an unusual bulging of the intra-abdominal viscera through a weak area of the abdominal wall or groin region. Inguinal hernia repair is one of the most frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was changed from pure tissue repair to prosthetic laparoscopic repair. Objective: we propose to find a new application for the well-known surgical open mesh inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Patients and Methods: . A comparative study was designed to study the outcome of different sizes of mesh used in the hernia operations. In the present study, patients diagnosed with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020 at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two groups. Group A include patients who have inguinal hernia operated with all in one procedure (n=65) and group B included patients with inguinal hernia operated by the classical method (n=65). Spinal and general anaesthesia were used. Before incision for the patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was accomplished on a one-day surgery basis .According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasterico sheath avoiding contact with neural structures. Follow-up was carried out at 1week, 1month, 3months for evaluation of postoperative pain using numbering scale score, need of medication, patients' comfort, and postoperative complications. Results: all patients operated by all in one procedure were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and (07.69%) of them required pain medication at home. After the 1st postoperative week (95.36%) reported no pain and (04.62%) show bruising genitaliao, (01.54%) had seroma and no wound infection recorded. No relevant limitation of normal activities was reported. There have been no postoperative neuralgias. Conclusion: This new hernioplastyo technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgias with maximum comfort for the patients. We recommended to all in one technique o because gives better results and fewer complications. Keywords: Hernia ;Open mesh inguinal hernia; patients
BACKGROUND: Organisms blamed in acute appendicitis are right predictable and very susceptible to a wide range of broad-spectrum antibiotics. AIM: The aim of the study was to assess the clinical benefit of the routine intra-operative swab during an appendectomy in guiding antibiotic selection. METHODS: Four hundred and thirty patients underwent appendectomy halved into two groups, each 215. In Group 1, an intra-operative swab was routinely obtained for culture/sensitivity. The results of which were reviewed for helping direct antibiotic selection. No intra-operative swabs were obtained in Group 2. Both groups were given single-dose cefotaxime and metronidazole preoperatively intravenously at the time of induction of anesthesia. RESULTS: In swab group, 63/215 cultures (29.3%) revealed pathogens, while (70.7%) were negative or revealed isolated colonic commensals. Most cultures were negative or isolated colonic commensals. Fifty-two/63 cultures (82.54%) were sensitive to both cefotaxime and metronidazole, and only 11/63 (17.46%) reported resistant organisms to cefotaxime but not to metronidazole. Most pathogens were sensitive to empirical antibiotics. Twenty-two/215 patients (10.23%) developed infective complications, most (63.6%) had their cultures from the infected wound yielded different micro-organisms. Only 8/215 (3.72%) in the swab group needed a change in the empirical antibiotics for treating infective complications. In the non-swab group, 19/215 patients (8.83%) developed infective complications. Only 6/215 patients (2.8%) needed a change in the empirical antibiotics for treating infective complications. Collectively, only 14/430 patients (3.25%) required a change in the empirical antibiotics for treating infected wounds. CONCLUSIONS: Routine peritoneal swabs for culture/sensitivity during appendicectomy are of no clinical value. Such practice is considered a waste of laboratory resources and money. A single prophylactic dose of antibiotics has significant role in preventing surgical site infection.
Background: Anastomosis may be done with the help of stapling devices, by using double layered suturing technique or by a single layer technique.Patients and methods: A prospective study conducted in Baghdad Teaching Hospital, Iraq. A total of sixty- four patients were included in this study. They were divided into two groups; group A, 28 patients, single layer seromuscular continuous anastomosis was done and group B, 36 patients underwent conventional double layered anastomosis.Objective: The aim of the study is to prove that a single layer continuous technique can be constructed in a significantly less time with similar rate of complications compared with two layers technique. Results: There were, 15 male (53.6%) and 13 (46.4%) female within group A and 20 (55.6%) male and 16 (44.4%) female within the group B. There was no significant difference in gender distribution or mean age between or within groups. Bullet and sharp nail injuries to the abdomen were the most common causative agents followed by malignant disease of GIT. Wound infection was the most frequent complication in both groups as fourteen patient out of 64 (21.9%) developed wound infection; 8 of them were among group B. There was no significant difference in the incidence of anastomotic leakage; in group A was 3.6%, while in group B was 4.7%. The average time for the construction of the single layer anastomosis was 20 min and in double layer it was 35 min. The difference in average time is statistically significant Conclusion: The single-layer continuous anastomosis requires less time to construct and has a similar risk of leakage compared with the two-layer technique. It also costs less than any other method and can be safely introduced into a surgical training program.
Currently, there has been a tendency to prefer breast-conserving surgery (BCS) over mastectomy (MC). Therefore, this study came to assess whether this is true when compared with mastectomy. This retrospective study included early breast cancer patients who were registered in government and private hospitals in Kirkuk and Diyala governorates during the period from February 2015 to March 2017, and were followed up after surgery for five years. The enrolled patients (women) were set into (2) groups; the first one was for patients treated with BCS, while the second was for patients who underwent MC. As a preliminary result, it was found that out of the total of (172) participants, (72) were in the BCS, and (100) in the MC. Convergence of age groups was observed between patients in both surgical groups. The results proved that the local recurrence rate amounted to about (9%) in patients undergoing BCS and the survival rate was for the same group (97%). Thus, we concluded that the breast preservation approach is an appropriate and successful choice for early breast carcinoma patients. Keywords: carcinoma, conserving surgery, local recurrence.
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