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.
Abstract
The various countries seek to encourage their local investments through the various policies they follow. The most important of these is the monetary policy, which is a means and procedures taken by the monetary authority to control the supply of money and maintain its stability of its financial impact on economic activity.
The effect of monetary policy is to stimulate domestic investment through money supply that is inversely related to the interest rate and a direct relationship with domestic investment. When money supply increases, interest rates fall and local investment growth rates rise, but when the rise in money supply is high, Inflationary measure
This study dealt with the basics of financial inclusion in terms of concept, importance and objectives, The empowerment of women financially and bank,and then the relationship between financial inclusion and women, and determine the requirements of inclusion Financial resources for women. The analytical descriptive method was used for data, which included reviewing and analyzing information And data in economic and financial literature. The study: reached a number of conclusions, the most important of which are Financial inclusion contributes to women's financial and banking support, as there is a positive relationship between financial institutions Banking and women's access to financial and banking services, thus playing a role i
... Show MoreDeveloping countries have depended since long time on the developed countries to increase the levels of development and improving rates of growth direction to the best way where taking this dependence many shapes influenced by the evolution form of international relations and this dependence shows how the great deficiencies in sources of local financing, which called developing countries to increase their reliance on external funding sources, represented in the form of grants, subsidies, loans and foreign investment, pursuing States in that the application of economic reform policies in pursuit of faster economic growth and restructure its economy and achieve economic stability. In the early eighties of the last
... Show MoreThe arise of Islam as a multidimensional changing phenomenon with its own revolutionary and comprehensive character was inherent with a lot of alterations in social aspects , and this is explicit particularly in the scope of urban life and town planning . Essentially, Islamic style of life has its own urban identity. The urbanization process in Islam has been developed across two integrated sides, the first one concerned on ideational and theoretical aspects , while the other associated with practice .Many urban centers emerged during the Islamic era since the erection of Basrah , the first Islamic town in the middle of the 7th. centaury. Some contemporary urban concepts , both environmental and social could be noticed in Islamic
... Show MoreHypertrophic scars are fibroproliferative illnesses caused by improper wound healing, during that, excessive inflammation, angiogenesis, and differentiated human dermal fibroblast (HDF ) function contribute to scarring, whereas hyperpigmentation negatively affects scar quality. Over 100 million patients heal with a scar every year. To investigate the role of the beta 2 adrenergic receptor (β2AR); Ritodrine, in wound scarring, the ability of beta 2 adrenergic receptor agonist (β2ARag) to alter HDF differentiation and function, wound inflammation, angiogenesis, and wound scarring was explored in HDFs, zebrafish, chick chorioallantoic membrane assay (CAM), and a porcine skin wound model, respectively. A study identify a β2AR-mediated m
... Show MoreA reseach is carried out by using Alumina material type α-Al2O3 which has partical size 63μm doped with different percentage weight of MgO (0.1%,0.3%and0.5%) and by using dry press method to prepare the samples ,A force press 50KN used and sintering to 1500oC with soaking time of 6 hours. The physical properties were studied such as "Bulk density ,Porosity and water absorption "also the mechanical properties such as (hardness,compressive strength ), the result shows that the best ratio of maginsa(MgO) added to Alumina (Al2O3)is 0.5%and this worked to improve Physical and mechanical properties .
In this paper, we present a Branch and Bound (B&B) algorithm of scheduling (n) jobs on a single machine to minimize the sum total completion time, total tardiness, total earliness, number of tardy jobs and total late work with unequal release dates. We proposed six heuristic methods for account upper bound. Also to obtain lower bound (LB) to this problem we modified a (LB) select from literature, with (Moore algorithm and Lawler's algorithm). And some dominance rules were suggested. Also, two special cases were derived. Computational experience showed the proposed (B&B) algorithm was effective in solving problems with up to (16) jobs, also the upper bounds and the lower bound were effective in restr
... Show MoreThe control of prostheses and their complexities is one of the greatest challenges limiting wide amputees’ use of upper limb prostheses. The main challenges include the difficulty of extracting signals for controlling the prostheses, limited number of degrees of freedom (DoF), and cost-prohibitive for complex controlling systems. In this study, a real-time hybrid control system, based on electromyography (EMG) and voice commands (VC) is designed to render the prosthesis more dexterous with the ability to accomplish amputee’s daily activities proficiently. The voice and EMG systems were combined in three proposed hybrid strategies, each strategy had different number of movements depending on the combination protocol between voic
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