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 aim of studying the role of environmental taxation is to reduce or mitigate the problem of environmental pollution and obtain a clean environment. And the importance of research lies in the fact that environmental taxation is one of the basic tools to achieve environmental balance. As it is considered one of the sustainable economic tools that focuses on the concept of environmental taxes and fees. Therefore, the incentives stimulated institutions to invest in clean energy and use environmentally friendly machines. Through it, the rules of the competition are updated in favor of organizations that respect the environment so that they can obtain a green competitive advantage. And that the mai
... Show MoreAfter 2003, Iraq witnessed new challenges represented by the predominance of sectarian discourses, hatred and extremism at the expense of moderate political discourse and the predominance of sub-affiliations and external agendas at the expense of national affiliation, which led to the creation of an unsafe or stable environment dominated by the character of violence and terrorism. Moderate discourse would work to fuse sub-affiliations into one melting pot in which it would be the first loyalty to the homeland and not to the tribe, party or sect... Etc., and this in turn will contribute to promoting peaceful coexistence between the various other sub-affiliations within the framework of one community construction
Publications are generally considered an effective visual artistic means that addresses the recipient (the audience), with the functional, aesthetic and expressive dimensions they carry that contribute to spreading a diverse cultural awareness, especially those publications that are concerned with their media, promotional and organizational performance, as well as specific cultural events at specific times, in pursuit Access to renewable and elaborate designs to achieve the functional and aesthetic purpose, as the completed design and construction process is subject to many variations, whether this diversity is intellectual or technical, internal or external, and all of them may overlap to obtain a comprehensive system of artistic format
... Show MoreThe aim of the research is to demonstrate of the relation and the influence of the components of economic intelligence (strategic alertness, information security policy, impact policy) in achieving of economic growth (creativity, competitiveness, quality improvement). The questionnaire was used as a main tool for selected sample. Answers analyzed by using the statistical program (SPSS) to calculate the arithmetic mean, standard deviation, weight percentage, correlation, F test, and Squared factor (R2).
The research derived its importance from the distinguished role of information systems in the work of industrial companies, and its impact toward achieving economic growth rates in its various activities. T
... Show MoreMany studies and researches related to the audio and visual medium have shed light on the creative process that has taken place through them as well as the aesthetic and artistic creation and have dealt with many fields of knowledge and creativity in this field of art, which managed to study and follow its intellectual and technical tools for creating achievements through this medium, in its forefront come the elements of the cinematic language, which is characterized by possessing multiple features of aesthetic and semantic employment to reach the recipient as it is a tool of the artistic expression that gives the material it deals with aesthetic and intellectual dimensions from various aspects. "The artistic expression cannot be achiev
... Show MoreThe tax base is one of the bases of the technical organizing of taxes, and that a good selection of the tax base effects the outcome of the tax and its fairness, and with the expansion of the tax range results a dangerous phenomenon called tax evasion, which became threaten the economies of countries and this phenomenon prevents the achievement of the state to its economic, political and social objectives which seeks to resolve this phenomenon and identifying all human and material potential and realize the real reasons that lie behind it. The researcher found that tax authorities are weak in terms of it the technical material and financial abilities, the analysis of data show that then is a significant reve
... Show MoreThe poor hole cleaning efficiency could causes many problems such as high torque, drag, poor hydraulics and pipe stuck. These inherent problems result in an avoidable high operation cost which this study tried to address. In this study, the effect of cutting density on hole cleaning efficiency in deviated and horizontal wells was investigated. Experiments were conducted using 40 feet (12 m) long of flow loop made from iron and PVC. However, the test section was made from PVC with (5.1m) long and (4” ID) for outer pipe and (2” OD) inner pipe. The cutting transport ratio (CTR) was determined from weight measurements for each test. Cutting Transport Ratio has been investigated for effects of the following parameters; flow rate, cu
... Show MoreThis research aims to assess the adoption of TQM in the Middle East Bank for Investment, and diagnosis means and techniques of technological innovation that applied in, as well as to determine the nature of the relationship between total quality management practices (operations management, employment relations, customer relations) and technological innovation (the incremental innovation of the service, incremental innovation process, a radical innovation of the service, a radical innovation of the operation), through use the checklists, derived from a study (Kim et al, 2012) the many styles of mathematical and statistical tools was adopted like the percentage, mean, duplicates, as well as the adoption of the Z test th
... Show MoreMany of researchers have written about social responsibility and business strategy and competitive advantage, and they have given particular attention to the relationship between economic and social responsibility , but what is missing in this aspect is how the economic units that use their core competencies to advance social responsibility initiatives so that they can achieve a significant competitive advantage and create value for it ?
The current research aims to verify the view that "the economic and social objectives in the long term is not contradictory in nature but complementary objectives essential", as well as make sure that the s
... Show More