Main Subjects : Surgery


Split tibialis anterior tendon transfer to treat ambulatory children with spastic cerebral palsy who experienced dynamic equino varus deformity

Zmnako Amen; Omer Ali Rafiq

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 31-36
DOI: 10.33762/mjbu.2021.128592.1040

Background: Treatment of ambulatory children with spastic cerebral palsy complaining from dynamic equino varus deformity by split tibialis anterior tendon transfer (STATT), because over activity of tibialis anterior muscle and weak antagonist muscles are the main cause of the deformity.
Aim: The purpose of this study is to assess the postoperative results of split tibialis anterior tendon transfer, according to Garceau and Palmer criteria.
Patients and Methods: 13 feet in 13 ambulatory children with spastic cerebral palsy complaining from dynamic equino varus deformity, preoperatively 7 of the fair,6 of them were poor, while postoperatively 2 of them became excellent,10 of them good and 1 of the fair.
Results: The result of this prospective case series study assessed by using Garceau and Palmer criteria.
Conclusion: Split tibialis anterior tendon transfer, is a good method for treating ambulatory children with spastic cerebral palsy complaining of dynamic equinovarus deformity of the forefoot and midfoot which is due to overactivity of tibialis anterior muscle and weak antagonists.
Keywords: Dynamic equinovarus foot deformity; Split tibialis anterior tendon transfer; Hoffer’s procedure; and Garceau & Palmer criteria.

Effect of Reformation of the Anterior Chamber by Air or by Ringer’s lactate solution on Corneal Endothelial count and morphology after Phacoemulsification

Zaid abdulkhalik Zaki; Najah K. Mohammad

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 37-46
DOI: 10.33762/mjbu.2021.129641.1067

Background:The corneal endothelium has no ability of regeneration, so any decrease in its density is irreversible and can lead to permanent blurring of vision and pain. Direct contact between air and the corneal endothelium may cause endothelial damage.
Aim:To compare the effect of reformation of the anterior chamber after phacoemulsification, using air and ringer’s lactate solution injection, on corneal endothelial count and morphology.
Subject and method:A prospective interventional randomized comparative study includes 76 eyes of 76 patients, prepared for phacoemulsification surgery in the period from October 2018 to March 2019. Corneal endothelial morphology and count examined by specular microscopy, and the results recorded for all cases before the surgery. Patients examined by slit lamp biomicroscope and divided randomly into two groups, and both groups were diagnosed with grade 1-2 age related nuclear cataract (according to Lens opacity classification system III). Both groups underwent phacoemulsification surgery with IOL implantation by single well-trained surgeon, group 1 will be subjected to anterior chamber reformation with 0.1 ml air injection while group 2 will be subjected to reformation of the anterior chamber with ringer’s lactate solution. Corneal endothelial morphology and count to be evaluated at 1 week, 1 month and 3 months postoperatively.
Results:no significant statistical difference regarding the percentage of CCT changes, cell loss, coefficient of variation and hexagonality between the two groups at baseline and all subsequent visits.
Conclusion:no significant difference between air and ringer's lactate solution on the corneal endothelial count and morphology.

TINNITUS AND VERTIGO IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS IN BASRA HEMODIALYSIS CENTER

Ahmed Al Abbasi; Haider K Saeed

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 73-78
DOI: 10.33762/mjbu.2021.128922.1049

Objective: evaluation of the hemodialysis effect on the development of tinnitus and/or vertigo in patients with CKD. Materials and Method: 59 patients with CKD on regular hemodialysis were enrolled in this study. Results: patients mean age was 41.8 ± 9.2 years (range: 17–50 years). Male to Female ratio was 1.27:1. 16.95% of patients had tinnitus only, 16.95% had vertigo only, 30.51% had combination of both and only 35.59% didn’t develop symptoms. There was significant relation between the duration of hemodialysis and the development of tinnitus and vertigo (P value = 0.047). No significant relation was found between age, sex, serum electrolytes, blood urea and serum creatinine. Conclusion: Tinnitus and/or vertigo are common in patients with CKD on hemodialysis.

Objective: evaluation of the hemodialysis effect on the development of tinnitus and/or vertigo in patients with CKD. Materials and Method: 59 patients with CKD on regular hemodialysis were enrolled in this study. Results: patients mean age was 41.8 ± 9.2 years (range: 17–50 years). Male to Female ratio was 1.27:1. 16.95% of patients had tinnitus only, 16.95% had vertigo only, 30.51% had combination of both and only 35.59% didn’t develop symptoms. There was significant relation between the duration of hemodialysis and the development of tinnitus and vertigo (P value = 0.047). No significant relation was found between age, sex, serum electrolytes, blood urea and serum creatinine. Conclusion: Tinnitus and/or vertigo are common in patients with CKD on hemodialysis.

POST OPERATIVE FUNCTIONAL OUTCOME FOR ANORECTAL MALFORMATIONS IN INFANT AND CHILDREN IN ERBIL

salar sabah berdawd

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 109-114
DOI: 10.33762/mjbu.2020.128515.1039

ABSTRACT
Background/aims: Outcomes of anorectal malformations have greatly improved but many children still experience some form of urinary or fecal incontinence despite optimal management. The aim is to evaluate the functional outcome in infants with anorectal malformation for different surgical procedure including traditional and recent operations and outcome for different type of anorectal malformation.

Subjects and Methods : An analytical study include 28 cases of anorectal malformation (16 males and 12 females ) operated by different technique in Erbil city during 2010 - 2016. Cases of cloaca and early deaths were excluded from the study.
Results : In male Rectoperineal fistula (25% ) and in female Rectovestibular fistula (25% ) were the most common anomalies. the most common procedure were primary anorectoplasty for perineal fistula in both male and female infants in 10 cases ( 35.71% ) followed by transfistula anorectoplasty for rectovaginal fistula in 7 cases (25%) and PSARP for rectobladder neck and urethral fistula for male infants in 6 cases. The most common functional complication was constipation in 2 (7.15%) cases and only one case (3.57%) developed fecal incontinence . 89.29 percent of the patients had voluntary bowel movements and were totally continent.

Conclusion : Despite significant developments in the understanding of the pathophysiology and surgical techniques, the results of surgery of ARM remain far from perfect. An optimal operation restores normal anatomy and preserves all potential sphincter structures. Functional complications, especially treatable ones, such as constipation, should be detected and treated early to achieve an optimal outcome.

Hypopharyngeal Foreign Body in A 9-months-Old Male Baby

Raid M Al-Ani

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 127-130
DOI: 10.33762/mjbu.2020.127476.1023

Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy. Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy.

Perioperative Events of Laparoscopic Cholecystectomy in Patients with Hemoglobinopathies

Rafid Mohammed; Habeeb F Al-Ibadi; Ali G Redha

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 80-88
DOI: 10.33762/mjbu.2020.165440

Background: Hemoglobinopathies are common genetic disorders affecting the synthesis of one of the globin chains of hemoglobin molecule. Laparoscopic cholecystectomy is the standard procedure for treatment of patients with normal hemoglobin and symptomatic gall stones, but doubt is still to date regarding safety of this procedure in patients with hemoglobinopathy.
Aims:1. To assess the safety of laparoscopic cholecystectomy for hemoglobinopathic patients, 2. To describe the perioperative events that might happen before, during or after this procedure.
Patients and Methods: This is a record-based comparative study conducted over a period of seven years, involved 62 hemoglobinopathic patients and 148 patients with normal hemoglobin variant. All underwent laparoscopic cholecystectomy and comparison done regarding perioperative events.
Results: The overall complication rate was 56.5% in hemoglobinopathic patients and 21.6% in the other group and the difference was statistically significant (P- value ˂0.001). Vaso-occlusive crisis occurred in 9 patients (14.5%), respiratory complications (atelectasis and bronchitis) in (9.7%), acute chest syndrome in (4.8%) and hemolysis in (4.8%).
Conclusions: 1. Laparoscopic cholecystectomy is safe in well prepared hemoglobinopathic patients but it is associated with significantly higher rate of disease related complications, namely acute chest syndrome, hemolysis and vaso-occlusive crises.2- Hemoglobinopathic patients require special pre, intra and post-operative care which should be offered by the surgeon, the physician and the anesthetist