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.
Warfarin dosing is challenging due to a multitude of factors affecting its pharmacokinetics (PK) and pharmacodynamics (PD). A novel personalised dosing algorithm predicated on a warfarin PK/PD model and incorporating CYP2C9 and VKORC1 genotype information has been developed for children. The present prospective, observational study aimed to compare the model with conventional weight-based dosing. The study involved two groups of children post-cardiac surgery: Group 1 were warfarin naïve, in whom loading and maintenance doses were estimated using the model over a 6-month duration and compared to historical case-matched controls. Group 2 were already established on maintenance therapy a
The goal of this study is to build an application that can be used in difficult cases and sudden circumstances during the pandemic and post-disaster state, which can be the development of digital risk management and mitigating the difficult impact of the epidemic through the improvement of IT and IoT that can be fine by finding initial solutions and make the world like a digital city that could be managed by the network. We provide this study to gain an overview of reasons for delayed and exceeded costs in a select of thirty Iraqi case projects by controlling the time and cost. The drivers of delay have been investigated in multiple countries/contexts. however, there is little country data available under the conditions that have ch
... Show MoreThat the structural changes in the environment, business and finance and the spread of business and the diversity of transactions between economic organizations and breadth of a commercial scale in the world have left their clear on the need to keep up with the accounting for these variables as one of the social sciences affect and are affected by the surrounding environment because of the various economic and social factors, technical, legal and others.
As a result of these variables emerged a new field of accounting called Forensic Accounting, which involves the use of expertise of multiple pour in the end to the accounting profession, where the Forensic Accounting cover a large area of disciplines including strengthening
... Show MoreThe correct and sincere process of socialization is working on appropriate social climate in
which this process is the provision, and the climate is achieved in the presence of a positive
environment free of negatives and contradictions, but when there is a socialization processes
inadequate and contradictory was not based on the principles of punishment and reward nor a
balance between methods soft and intensity of treatment and interaction with small and
adolescent does not require intensive social care formulas do not create the conditions
essential items required by the successful and effective socialization, the young and the young
people who are going through in such Altanisah and educational operations will be
This research aims to introduce the general tax on sales in gordan and the most important concepts related to this type of taxes and identify the most on characteristics and stand on its role in supplying the general budget of the necessary fundig to cover the over head of the state and the factorsinfluencing it and whether such a tax has been able to chieve the desired goals.including in contribute to an important and growing role in puplic revenues or not to be able to achieve these goals through the use of descriptive and analytical technique based on the data and information relevant.wasreached some conclusion and recommendations was most important is that the general sales tax comes in
... Show MoreThis paper presents a study to investigate the behavior of post-tensioned segmental concrete beams that exposed to high-temperature. The experimental program included fabricating and testing twelve simply supported beams that divided into three groups depending on the number of precasting concrete segments. All specimens were prepared with an identical length of 3150 mm and differed in the number of the incorporated segments of the beam (9, 7, or 5 segments). To simulate the genuine fire disasters, nine out of twelve beams were exposed to a high-temperature flame for one hour. Based on the standard fire curve (ASTM – E119), the temperatures of 300◦C (572◦F), 500◦C (932◦F), and 700◦C (1292◦F) were adopted. Consequently,
... Show MoreThis paper presents a study to investigate the behavior of post-tensioned segmental concrete beams that exposed to high-temperature. The experimental program included fabricating and testing twelve simply supported beams that divided into three groups depending on the number of precasting concrete segments. All specimens were prepared with an identical length of 3150 mm and differed in the number of the incorporated segments of the beam (9, 7, or 5 segments). To simulate the genuine fire disasters, nine out of twelve beams were exposed to a high-temperature flame for one hour. Based on the standard fire curve (ASTM – E119), the temperatures of 300◦C (572◦F), 500◦C (932◦F), and 700◦C (1292◦F) were adopted. Consequently,
... Show MoreTraumatic radial nerve injury in humeral shaft fracture is the most common traumatic nerve injury in long-bone fracture, with overall prevalence 2-18%, ranging from traction to complete transection. Spontaneous recovery may reach 88%. The aim of the study is to assess the sensitivity & specificity of the ultrasound to detect the radial nerve injury and to see if this can be used as a diagnostic test. This is a prospective study on 17 adult patients with a closed fracture of the humeral shaft, dividing into two groups, the first group of 7 patients had signs and symptoms of radial nerve palsy at presentation and the second group of 10 patients had intact radial nerve function was considered as a control group. All these patients had at leas
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