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.
The research tacklets the role of risks arising from the excessive use of derivative contracts for trading in financial crises, including the recent global financial crisis in (2008) which is known the mortgage crisis.
In order to prove the hypothesis of the research, the risk index of derivative contracts has been chosed as expressed in the measure of (value at risk) to be the main field for testing the hypothesis of research. The duration of the contract has been also chased for (15) years between the years (2001- 2015), the period preceding the global financial crisis, while the second represents the period of time that followed. The research reached a number of conclusions, bu
... Show MoreThe research seeks to identify the comprehensive electronic banking system and the role of the auditor in light of the customer's application of electronic systems that depend on the Internet in providing its services, as a proposed audit program has been prepared in accordance with international auditing controls and standards based on the study of the customer's environment and the analysis of external and internal risks in the light of financial and non-financial indicators, the research reached a set of conclusions, most notably, increasing the dependence of banks on the comprehensive banking system for its ability to provide new and diverse banking services, The researcher suggested several recommendations, the most important of whi
... Show Moreunacceptable social behaviors, particularly withdrawal behavior that appears in children with autism represent a major problem hindering the process of communication with those around them and therefore the process of mergence with them be difficult.
The withdrawal causes a real affect deficit for children with autism limits the possibility of development of their intellectual and mental growth due to their solitude and the weakness of their focus in the acquisition of pedagogical skills and lack the necessary social skills to maintain the relations of friendship and enjoyment of them.
withdrawal children fail to participate
... Show MoreAssessment of the in service behavior of asphalt stabilized subgrade soil under environmental impact has got little attention by the research workers. However, the sustainability of the roadway depends mainly on the welfare of its subgrade soil condition. In this work, Gypseous soil was stabilized with asphalt emulsion for subgrade usage, the durability of the mixture has been assessed in term of its ability to maintain the compressive strength when practicing the environmental impacts. Specimens of 38 mm in diameter , and 76 mm in height have been prepared with various water-asphalt percentages, and subjected to 30 cycles of (freezing-thawing), (heating-cooling) and (wetting-drying) processes. Specimens have been tested for unconfined comp
... Show MoreIn this study, the response of ten composite post-tensioned concrete beams topped by a reinforced concrete deck with adequate reinforcing shear connectors is investigated. Depending on the concrete compressive strength of the deck slab (20, 30, and 40 MPa), beams are grouped into three categories. Seven of these beams are exposed to a fire attack of 700 and 800 °C temperature simultaneously with or without the presence of a uniformly distributed sustained static loading. After cooling back to ambient temperature, these composite beams are loaded up to failure, using a force control module, by monotonic static loading in a four-point-bending setup with two symmetrical concentrated loads applied in
In this study, the response of ten composite post-tensioned concrete beams topped by a reinforced concrete deck with adequate reinforcing shear connectors is investigated. Depending on the concrete compressive strength of the deck slab (20, 30, and 40 MPa), beams are grouped into three categories. Seven of these beams are exposed to a fire attack of 700 and 800 °C temperature simultaneously with or without the presence of a uniformly distributed sustained static loading. After cooling back to ambient temperature, these composite beams are loaded up to failure, using a force control module, by monotonic static loading in a four-point-bending setup with two symmetrical concentrated loads applied in
Two groups of chronic hepatitis B and C virus patients were divided into Pre-treated patients (25 CHB patients with positive HBs Ag for more than 6 months and 40 CHC patients), and post-treated patients [12 CHB patients (4, 6, and 2 were treated with lamivudine, IFN-? and combination of LMV + IFN-? respectively), and 27 patients for CHC (3, 13 and 11 patients were treated with Ribavirin, IFN-? and combination therapy (RBV+ IFN-?) respectively].These patients were followed up for 6 months. By using ELISA technique, levels of IL-6, IL-10, IFN-? and TNF-? were measured in vivo and in vitro (supernatant of PBMCs stimulated with PHA) and compared with healthy control. The mean level of IL-6, IL-10 and TNF-? in CHB patients showed significant dif
... Show MoreAsthma is a chronic inflammatory disease of respiratory airways characterized by distinctive history of respiratory symptoms due to variable airflow obstruction which reverses either spontaneously or in response to certain medications. Acetylcholine is a parasympathetic neurotransmitter which plays fundamental roles in the development of persistent asthma. Treatment guidelines recommend using medium doses of inhaled corticosteroids in addition to another controller bronchodilator instead of using high doses inhaled steroid alone for treatment of moderate to severe persistent asthma. The inhaled long acting muscarinic antagonist, tiotropium, was approved recently to control unresponsive asthma to inhaled corticosteroid with or without a long
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