Background: Laparoscopic cholecystectomy has many difficulties which include port Insertion, Dissectionof the Calot’s Triangle , Grasping of the Gallbladder , Wall thickness, Adhesion and extraction of theGallbladder. Aim of the Study: To predict how difficult cholecystectomy will be from assessing the patientpreoperatively which, in turn, help in decreasing the risks on the patients and preventing post-operativecomplications. Patients and Methods: A prospective study conducted in the department of General Surgeryat Al-Ramadi Teaching Hospital for the period of nine months from 15th of May 2018 till the 15th of February2019. It included 60 patients, all of them were undergone laparoscopic cholecystectomy for Gallstone. Patientswith common bile duct calculus, dilated common bile duct, current attack of acute cholecystitis, those withabsolute contraindications to laparoscopic cholecystectomy, The data were collected prospectively to predictthe significance of association with patients’ characteristics. The time of operation was calculated from thefirst port site incision until the last port closure. All the intra operative events were recorded. Conversionsto open cholecystectomy were done by median or subcostal laparotomy according to the surgeon’s decisionand each patient’s condition. Results: In this study, the highest proportion of operations was categorizedas easy (58.3%), 28.3% of operations were considered difficult and 13.3% of them were very difficult. Asignificant association (P < 0.05) between operation difficulty and all of the following characteristics: Aging,obesity, history of previous biliary hospitalization, thickened bladder wall, pericholecystic collection, andlarge stones. Conclusions: The difficult laparoscopic cholecystectomy can be predicted preoperativelybased on number of factors, like: obesity, previous biliary admission, gall bladder wall thickness, ultrasoundfindings (stone size and pericholecystic fluid) and aging process, evaluating of such factors minimize thecomplications of laparoscopic cholecystectomy and conversion to the open procedure.
Examining of 80 feces samples showed that 31 samples of the house and stray cats harbored either single or mixed infection with eight species of parasites and protozoa with a total infection rate 38.75 %.The results on parasite classes are: Toxocara cati (5%), Ancylostoma tubeforme (3.75%), Capillaria felis(3.75%), Isospora sp.(10%), Cryptosporidium parvum(3.75%), Cryptosporidium muris (6.25%), Toxoplasma gondi (3.75%), Giardia sp.(2.5%) infection from feces of cats that showed single, double and triple infections. Our findings revealed the risk for public health, thus preventive measures should be implemented.
Despite the multiplicity of institutions contributing to the decision-making process in the United States of America, they interact to crystallize positions regarding international and strategic situations. The formulation of the national security policy depends on a number of institutions that complement each other in order to achieve an advanced security situation. Thus, the decision reflects the process of interaction of the existing regulatory institutions. This is because the essence of the national security and achieving its requirements also stems from the existence of a coherent system of shared beliefs and principles in the American society. Besides, these elements are the bases for achieving
... Show MoreMoisture-induced damage is a serious problem that severely impairs asphaltic pavement and affects road serviceability. This study examined numerous variables in asphalt concrete mixtures to assess their impact on moisture damage resistance. Mix design parameters such as the asphalt content (AC) and aggregate passing sieve No. 4 (PNo. 4) were considered as variables during this study. Additionally, hydrated lime (HL) was utilized as a partial substitute for limestone dust (LS) filler at 1.5% by weight of the aggregate in asphalt concrete mixtures for the surface layer. This study also investigated the potential enhancement of traditional asphalt binders and mixtures by adding nano-additives, specifically nano-silica oxide (NS) and na
... Show MoreSmall and Medium Enterprises (SMEs) in Iraq have experienced low performance due to the limited usage of accounting information systems (AIS) and the inability to exploit knowledge of management capabilities (KMC). These deficiencies have led to competitive pressures in the marketplace that have adversely affected their sales and production. This study investigates the role of AIS in terms of operation support, knowledge support, regulatory support, and the role of KMC, including knowledge acquisition, knowledge transfer, and knowledge utilized to enhance organizational performance in Iraqi SMEs. The target population was managers and owners in SMEs using AIS in Iraq’s cities. A non-probability purposive sampling technique was use
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We can see the phenomena of small and medium-sized enterprises, by important and a new subject contemporary, thro related between important concept that develop and add. This research focused on the important concept of small and medium-sized enterprises, in public and privet sectors. small and medium-sized enterprises discrimination by large filer ratio in the especially at the first years when they started because of the limited managerial skills, financial recourses and marketing problems. On it they will creative new procedures. this research treatment the core issues about wakens local and international enterprises, so threat. the goals of this research are extended malty dimension concept o
... Show MoreThis research aims to learn about public relations programs and their role to enhance the morale of the State land Transport Company employees.The researcher relied on the survey method and use a questionnaire and scale tools to collect information from workers in the Department of Relations and Media and employees in all departments.
The research reached several conclusions, including:
1- Public relations seek to increase workers’ confidence in senior management and motivate them to improve their production, as well as their relentless endeavor to bring workers closer by following multiple and varied forms of communication with them.
2- The results of the study showed that there was a negative i
The knowledge of the quantity of total solar radiation on horizontal and inclined surfaces is very important in the calculations of heating and cooling loads in architecture and in the design of certain solar energy applications such as photovoltaic and solar collectors. This paper estimates the total solar radiation on inclined surfaces in Baghdad (Lat. 330 21' N 440 14' long and 34m above MSL). A good model was used to estimate hourly total solar radiation on the inclined surface with different elevations (150, 300, 450, 600, 750, 900) from a horizontal surface. The mean hourly, daily and monthl
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