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 main purpose of the research is to demonstrate the importance of the insurance sector in the economy through its role in providing security for all economic sectors and thus stimulating the gross domestic product and reducing dependence on the output of the oil sector, which may expose the Iraqi economy to several problems and imbalances, I have found that there is a great weakness in the role of the insurance sector in Iraq at the level of government, companies and individuals, and the reason for this is the lack of policies supporting the insurance sector and the lack of work in the strategy of economic diversity and the decrease of security awareness by individuals so became Developing the sector to ensure the urgent need
... Show MoreThe present study deals with the websites of Iraqi political parties on the internet to identify the effectiveness in providing communicative applications that help audience to participate, express their opinions, their positions, and other aspects reflecting the extent of employing modern technological tools to allow opportunities for political, and democratic participation since the internet has become an effective tool for political communications of political parties. The research sample includes eight political parties. The research concludes that the Iraqi political parties do not employ interactive communication patterns to reflect their interests in communicating with the public, providing opportunities for their participation an
... Show MoreForty – two elderly hypothyroidism patients and forty – two apparently healthy as control groups , divided to (21) male (M) and (21) female (F) also (21) control male C(M) and (21) control female C(F) aged > 60 years, were tested for the presence of thyroid peroxidase autoantibody (TPo – Ab) and thyroglobulin auto antibody (Tg – Ab) , also for Se and Zn levels in their sera . The results revealed a significant increase in (TPO – Ab) and (Tg – Ab) for group (M) and (F) compared to control group , also a siginificant increase in TPo – Ab and Tg – Ab for (F) compared to (M) was found. A significant decrease in Se and Zn level for (M) and (F) compared to control group, while no significant difference between (M) and (F). In conc
... Show MoreThe goal of the research is to highlight the role of the governance and its characteristics in increasing the tax outcome by implementing the laws, regulations and annual controls issued annually from the general authority for taxation for the financing of the general treasury of the state, Additional development and economic capacity, As the search shares a view of the governance and its characteristics and its ideas from increasing tax output. The analytical transparent approach was used by adopting the practice of practicalities of the general authority for tax For quotations in the senior cabinet section ,the revealing of the ongoing operations was relied on the revenue for each financial year, The tools adopted in the process of ana
... Show MoreThe poster is one of the means which can be communicate with others through it, to transfer ideas that the designer want to focus on, for its importance to accomplish the poster. It’s a visual mean contact aim to submit an idea to the audience to get a clear idea, and that would be through the shapes and subject to submit the idea. Depend on that our goal in this study is to find out, what follows:1-Finding the relationship between the shape and the idea.And the study comes up with several results, like:1-The drawings that contain themes connected with what the designer want to achieve, through the clearness of idea and to make those elements clear by putting more elements to surround the main shape.2-To assure that the strong connecti
... Show MoreThe agricultural activity has a great significance in the all four dimensions of sustainable development. Firstly, the economic dimension which it contributes with the GDP, as well as, it is considered as an important source to attract the investment. Secondly, the environmental dimension which also contributes with conserving of the biodiversity, combating the desertification, and increasing the farmlands. Thirdly, for its role in the social dimension to achieve the food security, to eradicate the poverty, and providing jobs. Fourthly, toward the institutional dimension as well it is considered as a source that allows all people to participate effectively, and to exchange of the local and universal experiences and perspectives. For conf
... Show MoreThis study aimed to recognize and understand the concept of strategic management accounting (SMA) and how it's the effect on the competitive advantage for industrial companies in Jordan. The study's importance arises due to the lack of Arab studies that dealt with this topic, in addition to the important and vital role of strategic management accounting on companies that represent the artery of the decision-making process, and to identify the benefits associated with SMA technology. The necessary data were collected through the literature review and theoretical study of the references that relevant to the study subject, in addition to a questionnaire developed for this purpose, the study used (124) out of (250) questionnaires tha
... Show MoreCovalent modification of protein by drugs may disrupt self-tolerance, leading to lymphocyte activation. Until now, determination of the threshold required for this process has not been possible. Therefore, we performed quantitative mass spectrometric analyses to define the epitopes formed in tolerant and hypersensitive patients taking the β-lactam antibiotic piperacillin and the threshold required for T cell activation. A hydrolyzed piperacillin hapten was detected on four lysine residues of human serum albumin (HSA) isolated from tolerant patients. The level of modified Lys541 ranged from 2.6 to 4.8%. Analysis of plasma from hypersensitive patients revealed the same pattern and leve