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.
Chronic lymphocytic leukaemia (CLL) patients display a highly variable clinical course, with progressive acquisition of drug resistance. We sought to identify aberrant epigenetic traits that are enriched following exposure to treatment that could impact patient response to therapy.
Epigenome-wide analysis of DNA methylation was performed for 20 patients at two timepoints during treatment. The prognostic significance of differentially methylated regions (DMRs) was assessed in independent cohorts of 139 and 1
The issue of insurance against unlawful risks raises a jurisprudential and judicial debate between two opposing trends: the first considers coverage of these risks invalid due to their impact on public order or morals, while the second—which this research analyses—calls for the possibility of covering these risks in specific circumstances, based on contractual considerations in accordance with the principle that the contract is the law of the contracting parties, and based on the obligation to compensate the harmed third party—the victim—who has no connection to the unlawful act. In this context, our research highlights that contractual considerations can justify coverage of some unlawful risks, provided that the goal is to achieve
... Show More- The sandy soil with high gypsum content (usually referred to as gypseous soil) covers vast area in south, east, middle and west regions of Iraq, such soil possess a type of cohesive forces when attached with optimum amount of water, then compacted and allowed to cure, but losses its strength when flooded with water again. Much work on earth reinforcement was published which concentrate on the gain in bearing capacity in the reinforced layer using different types of cohesive or cohesion less soil and various types of reinforcement such as plastic, metal, grids, and synthetic textile. Little attention was paid to there enforce gypseous soil. The objective of this work is to study the interaction between such soil and reinforcement strips
... Show MorePorous asphalt paving is a modern design method that differs from the usual asphalt pavements' traditional designs. The difference is that the design structure of porous pavements allows the free passage of fluids through their layers, which controls or reduces the amount of runoff or water accumulated in the area by allowing the flow of rain and surface runoff. The cross-structure of this type of paving works as a suitable method for managing rainwater and representing groundwater recharge. The overall benefits of porous asphalt pavements include environmental services and safety features, including controlling the build-up of contaminated metals on the road surface, rainwater management, resistance to slipping ac
... Show MoreTransportability refers to the ease with which people, goods, or services may be transferred. When transportability is high, distance becomes less of a limitation for activities. Transportation networks are frequently represented by a set of locations and a set of links that indicate the connections between those places which is usually called network topology. Hence, each transmission network has a unique topology that distinguishes its structure. The most essential components of such a framework are the network architecture and the connection level. This research aims to demonstrate the efficiency of the road network in the Al-Karrada area which is located in the Baghdad city. The analysis based on a quantitative evaluation using graph th
... Show MoreThe necessity of addressing global economic prosperity has garnered significant attention from recent studies and policymakers. This article analyses the effects of the digital economy, business synergies, and trade policies on the economic prosperity of China and India. The study examines the impact of political support on the digital economy, business synergies, trade policies, and global economic prosperity in China and India. The study collects data from prominent economists in India and China using questionnaires. The article utilised the SPSS-AMOS software to analyse the relationship between variables. The results showed that the digital economy, business synergies, and trade policies are positively linked to global economic prosperit
... Show MoreSand production in unconsolidated reservoirs has become a cause of concern for production engineers. Issues with sand production include increased wellbore instability and surface subsidence, plugging of production liners, and potential damage to surface facilities. A field case in southeast Iraq was conducted to predict the critical drawdown pressures (CDDP) at which the well can produce without sanding. A stress and sanding onset models were developed for Zubair reservoir. The results show that sanding risk occurs when rock strength is less than 7,250 psi, and the ratio of shear modulus to the bulk compressibility is less than 0.8 1012 psi2. As the rock strength is increased, the sand free drawdown and depletion becomes larger. The CDDP
... Show MoreThis research aims to Measurement provide the service from Two perspectives The first perspective Service Provider (doctors) and the second recipient of the service (patients) in Numan General Hospital, and represented the research problem in perceptions of medical staff in the hospital assigned to them responsibility by providing superior services satisfy customers, and how they maintained ready to assist customers and provide services that exceed their perceptions of these services through the use of the developer scale by (Frimpong and Wilson, 2012), includes orientation to provide the service scale four dimensions (Internal cooperative behaviors, service Competence, Service Responsiveness and Enhanced service) and includes do
... Show MoreAbstract:
The internal control is the tool through which it is possible to verify and ensure the implementation of tasks in accordance with the established plans and programs and to evaluate the level of performance that is implemented within the different companies.
A guarantee from the supplier with the absence of a specialized technical committee that follows up the stages of implementing the contract and disbursing all amounts of financial dues to the supplier before completing the implementation of the contract and overlooking the non-implementation of some clauses of the contract by the committee in charge of
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