Background: Ischemic VSD or ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction (MI). Multi-system coronary disease is present in more than 50% of these patients. The event occurs 2-8 days after an infarction and often precipitates cardiogenic shock. The differential diagnosis of postinfarction cardiogenic shock should exclude free ventricular wall rupture and rupture of the papillary muscles. To avoid the high morbidity and mortality associated with the disorder, patients should undergo emergent surgery. Concomitant coronary artery bypass may be required.
Objective: This study stressed on a very serious complication of a common pathology (myocardial infarction), despite it,s lethal complication but still it is treatable and still surgery is the only salvageable option.
Patients & methods: Retrospective study of 7 consecutive cases with ischemic VSR encountered from (1st Jan. 2008-30 of September 2011). All of the cases were carefully assessed & fully investigated preoperatively (by echocardiography study, catheterization ...etc) & for all of them emergency open heart surgery was done with heart lung machine to close a post infract VSD using synthetic patch and ventriculotomy closed with reinforced Teflon felts , all of them(except the last case which died immediately post operatively) stayed for 2-3 days in the CICU under follow up .
Results: Seven patients have been operated upon, 4 males (57%) and 3 female (43%), and their ages ranged between 50-63 years (75% in the 6th decade). Three of them (43%) were diabetic only but all of them were hypertensive. All of them were haemodynamically unstable so operation carried on emergently within 12-18 days post infarction (one operation done within 27 hours of infarction) and in none of them the clinical status helped to postpone them until more than 3 weeks post infarct. Five Out of the seven patients survived the operation, one died immediately post operatively &another one died 7 days post operatively due to renal failure (due to pre operative impaired renal function). Operative & early post operative mortality is (28%).
Conclusion: We need to be more aware about this fatal complication of acute MI taking in consideration its late presentation (2-8) days.
We have to work hardly to improve early revascularization to decrease the incidence of VSR. Improvement in surgical technique using double patch and glue improve mortality & morbidity rates. More cases need to have a better understanding & management of these cases.
Background: Obesity is a global health issue. Laparoscopic sleeve gastrectomy has progressively become the most popular procedure among the surgical community as a definitive bariatric operation. The increasing number of surgeries performed will be likely be followed by increasing reports of patients experiencing weight loss failure.
Objectives: To determine the effectiveness of conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass in cases with weight loss failure.
Patient &methods: The retrospective review of patients who had operated with laparoscopic sleeve gastrectomy from October 2009 to January 2016 at Saint Raphael hospital, 21 patients includ
The present study was designed to determine the predictive capacity of Coronavirus’s impact, as well as, the psychological adjustment among university students in Oman. A total of (566) male and female students were employed to form the swtudy sample. The descriptive method was used. The findings showed that there is a significantly university student affected by Coronavirus; the dimensions of scale were arranged as follows: the Academic requirements of pandemic came first, the social communication came second, and the academic future stress came in third. The results also showed that Psychological Adjustment among University Students was affected by the Coronavirus pandemic, the average was low. Also, the result showed that the Corona
... Show MoreGames engagement has become one of the main concerns in game industry. Early study revealed that Malaysian digital traditional games are suffering with the same issue due to several factors. One of it is the lack of the game itself. Although many Malaysian traditional games have been digitized, none of them has incorporated rewards despite its importance in games engagement. Realizing the importance of rewards in games engagement, one of Malaysian traditional Congkak has been chosen to be enhanced by incorporating rewards. Experiments have been conducted among 50 gamers among the Millennials. Prior interview, game demo and human test are conducted. Experiments focused on the influence of rewards on games flow, games challenge, and its ef
... Show MoreOccupy public investment spending, a great deal of attention since the thirties of the last century, to play important role in economic and social development process and therefore most of the countries are trying different degree of economic development to the completion of the largest amount of public investment, especially in infrastructure, which is one of the pillars essential to economic development, and in order to maximize utilization of the completion of public investment should focus on achieving efficiency in completion.
The current reality of public projects in Iraq, indicating the absence of several key characteristics that must be provided if these proje
The main idea that led me to write such research paper within the framework of Germanic linguistics is that I have not found any topic dealing with the term correlate in the German language, except in several articles in linguistic journals as well as one topic in a book describing the use of such a linguistic phenomenon in the language system. The research initially deals with the definition of the correlate at the level of the German language system. Correlate is unity describes specific relation of two sentences and identifies denoted constructs. Correlate is called a placeholder at the syntactic level because it does not occupy its original topological fields in the syntactic structure. The correlate (es) or the prepositiona
... Show Moreيعد بيان التدفق النقدي من البيانات المهمة الصادرة من الوحدات الحكومية غير الهادفة للربح، بعد تبنيها معايير IPSASs ، مما يوفر معلومات اوسع تلبي حاجات المستخدمين لأتخاذ القرارات المناسبة . أذ يتضمن بيان التدفق النقدي بموجب المعيار رقم ( 2 ) التدفقات النقدية حسب الأنشطة التشغيلية و الاستثمارية والتمويلية ، وهذا لا ينسجم مع مخرجات النظام المحاسبي الحكومي العراقي . وان هدف البحث هو التعرف
... Show MoreBackground: Breast cancer composed of several biologic subtypes that have response to hormonal therapy. Tamoxifen is hormonal therapy with tissue- pecific antagonistic or agonist effects, the latter being responsible for multiple effects on lipid metabolism in women .
Objective: This study was designed to determine the impact of Tamoxifen on the serum lipid profile in breast cancer women.
Patients and methods: Prospective observation cohort study conducted at Oncology Teaching Hospital, Medical city complx.starting from October 2015 to October 2016. A total number of 40 premenopausal women with breast cancer were enrolled in this
... Show MoreIn this article, we introduce a new type of soft spaces namely, soft spaces as a generalization of soft paces. Also, we study the weak forms of soft spaces, namely, soft spaces, soft spaces, soft space, and soft spaces. The characterizations and fundamental properties related to these types of soft spaces and the relationships among them are also discussed.
This paper aims at providing the teaching staff members with the necessary skills so as to become capable of tackling various situations, and treating daily problems that face students learning Spanish as a Second Language. This is made as an attempt to make teachers of foreign languages in general acquainted with modern trends of teaching with less complicated methods, specifically in teaching e earlier stages of foreign languages.
Abstracto:
En el presente trabajo pretendemos dotar al docente no nativo de Lenguas extranjeras, con algunos de los métodos necesari
... Show MoreIt is noted in the title that the paper studies the viewpoint in the novel The Dog and the Long Night by the Iranian novelist Shahranoush Parsi Pour and in the novel Alibaba's Sad Night by the Iraqi novelist Abdulkhaliq Ar-Rikabi. Both are well known novelists, and about whose stories and novels many critical books, MA theses, and Ph.D. dissertations have been written. Also, some of their literary works have won prizes. Here, the researcher shed light on the concept of viewpoint, its types, and its importance in novels in general. This was done along with tackling the two viewpoints in both novels, where similarities and differences were identified. For this end, the researcher has adopted the analytic-descriptive appro
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