INTRODUCTIONHypospadias is a congenital defect due to incomplete tubularization of the urethral plate leading to abnormal location of the meatus anywhere along the ventral aspect of penile shaft and down on to the perineum. In the majority of cases (over 80%), the meatus is located distal to the midshaft.The objective of this study was to surgery in hypospadias is to achieve a functional penis with a normal cosmetic appearance. The commonest repairs to correct distal hypospadias are the Thiersch-Duplay, Mathieu, Mustarde, meatal advancement and glanuloplasty (MAGPI) and tubularized incised plate (TIP) urethroplasty.1-4 Of these procedures Mathieu and Snodgrass urethroplasty (Snodgrass repair) have been widely practiced. Snodgrass being now the preferred method since it creates a vertical slit-like normal appearing meatus, unlike a horizontally oriented and rounded meatus ('Fish mouth') produced by the meatal based (Mathieu) flap repair. This procedure allows ABSTRACT Background: Different modalities of procedures for hypospadial repair have been described in the literature. Data about the outcome of two main different procedure of repair are scares from Iraq. The aim of this study is to compare the results of these two methods of hypospadias repairs. The present study compared two single stage hypospadias repairs, namely, tubularized incised plate (Snodgrass) repair and Mathieu's repair. Methods: It involved 50 patients diagnosed with penile hypospadias, from March 2011 to April 2015 at the Department of Surgery, Al-Karama Teaching Hospital. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee, patients were randomly assigned as Group A of 26 patients in whom Snodgrass repair was accomplished and Group B having 24 patients in whom Mathieu's repair was performed. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethra-cutaneous fistula, and stricture formation. Results:The results showed that the mean age of presentation was 7±6 years (range 1-13years). The mean operative time was 90±15 (75-105) minutes and 60±15 (45-75) minutes in Snodgrass and Mathieu's repair respectively. Complications after surgery were urethero-cutaneous fistula in 2(7.69%) and 4 (16.67%), meatal stenosis in 1(3.84%) and 2(8.33%), wound infection in 4(15.38%) and 3(12.5%) cases in Snodgrass repair and Mathieu repair, respectively, wound dehiscence was equal in Snodgrass repair and Mathieu repair. Conclusions: It can be concluded that the cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus.
Background: Appendectomy is one of the most commonly performed operations. Accurate preoperative diagnosis has long been a great challenge, even to experienced surgeons. To determine the pattern of presentation and rate of atypical pathological presentation of appendicitis.Methods: This is a cross-sectional study in which patients who underwent appendectomy for presumed acute appendicitis from June 2012 to June 2016 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were collected.Results: It was found that the median age of the patients with acute appendicitis was 29 (male 27.3, female 30.7; range (4-67) years. The median length of hospital stay was 2 (range, 1-22) days. There were 184 (75%) patients with clinically and pathologically confirmed acute appendicitis. Out of the 243 patients, 47 appendices were normal, making the overall negative appendectomy rate (NAR) 19.3%; 14.0% in males and 24.6% in females (P<0.001).Conclusions: Appendectomy continues to be a very common surgical procedure. We suggest a more liberal utilisation of preoperative imaging in females of reproductive age, and patients at the extreme age.
INTRODUCTIONLymphedema is a collection of fluid in some parts of the body especially legs and arms. It is common after radical mastectomy. It was first described by Halsted.1 Axillary sampling (ALNS) is the removal of lymphnode posterior and lateral to pectoralis minor muscle, which is felt hard, enlarged,and fixed. Whereas axillary lymphadenectomy (ALND) which is done in breast cancer is the removal of level I and II lymphnodes from axilla axillary lymphnode dissection (ALND) for staging of breast carcinoma associated with considerable edema of the arm. 2-5The role of axillary surgery in breast cancer is to stage and treat the disease, the treatment of axilla does not affect long term survival suggesting that axillary nodes act not (reservoir) of the disease but amarker for metastatic potential assessment of lymphedema based on circumference of the arm on the side of dissected axilla compare to other side.6-8 Post-operative lymphedema in axillary lymphnode dissection frequently are seen and affect quality of life adversely.The main objective of present study was to know the prevalence of lymphedema after variable method of axillary lymphadenectomy and ALNS in Iraq.Axillary lymphnode sampling of axilla associated with negligible lymphedema compared with ALND the routine performance of axillary dissection in patient with breast ABSTRACT Background: Lymphedema is a collection of fluid in some parts of the body. It is common after surgical intervention. Different approaches of dealing with lymphnode involvement in axilla have been describe. The main objective of present study is to determine the prevalence of lymphedema after different methods of axillary lymphadenectomy and axillary sampling techniques in Iraq. Methods: This was a cross-sectional study in which post-operative lymphedema of the operated arm was compared in 25 patients with breast cancer after axillary ALND (the excised node more than 4 lymph node up to 18 node) and 25 patients following axillary ALNS of only enlarged hard lymphnode. Results:The results of post-operative follow up from three months to three years following ALND patients showed significant increase in the arm circumference over those exposed to ALNS of the axilla. Conclusions: It can be concluded that axillary lymphnode sampling of axilla associated with negligible lymphedema compared with ALND the routine performance of axillary dissection should be considered with caution.
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