Infection at the site of vascular anastomosis is a serious complication of vascular surgery and is associated with a high limb loss and mortality rate. The classical method of management is ligation of the injured artery, adequate wound debridement and restoration of circulation. The latter is achieved by either in situ or extra-anatomic bypass. If the distal circulation is not maintained, subsequent amputation is most likely.
Objectives: In this study we tried to assess the efficacy of extra-anatomic synthetic bypass grafts in the treatment of vascular infection in the groin to save the limb and avoid the inevitable amputation.
Methods: Between January 2006 and December 2007, ten male patients aged twenty to thirty five years (mean=27.3years), with previous vascular surgery (reversed saphenous vein grafting) for sub-inguinal penetrating injuries complicated with infection and bleeding were admitted and managed surgically in the Department of Thoracic and Vascular Surgery, Surgical Specialties Hospital, Medical City Teaching Complex, Baghdad. These patients were studied retrospectively regarding their demographic and clinical features as well as details of the operative procedures and surgical outcome.
All patients received emergency wound debridement, arterial ligation and extra-anatomic synthetic (PTFE) bypass grafts (External iliac or common femoral to distal superficial femoral or popliteal artery, six routed laterally and four routed medially in the thigh away from the original surgical field).
Results: Excellent results were obtained in nine patients who saved amputation while one patient ended with above knee amputation. No mortality recorded.
Conclusion: Extra-anatomic bypass is a useful approach in dealing with infected and disrupted vascular anastomosis and can be used in emergency as well as elective situations as mentioned in most literatures.
Iraq is changing from the centralized system of governance to the decentralized system, which assumes devolution of more authorities to the local governments of Iraqi provinces and cities. This puts a responsibility on the academics to produce more research work on the best framework for this change, to ensure the best results. The main objective of this research is to suggest a policy for the decentralized transformation in domain of Urban and Regional Planning in Iraq. A suggested program for the transformation is involved in the paper as well, with analysis for the new relationships between different levels of planning authorities depending on democracy. In addition, a description for planning process flows from bottom to top.
Provisions related to nails in Islamic Fiqh
This paper addresses the factors responsible for changes in crude oil prices, in real market and financial sector. In order to prepare the analytical background for further investigation, it highlights the patterns of correlations of the real oil price and the most related prices of assets, exchange rate and government bond yield. The paper reviews the statistical behavior of oil price, quantities and the global macroeconomic environment. Topics discussed include the theory of differential rent and scarcity effect ,the role of future market and speculation, strategies of energy of the major economies to investigate the prospects of oil market and the potential demand for OPEC's oil. The paper explores the
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Modal verbs are also called auxiliary verbs, helping verbs and modal auxiliaries. They are special auxiliary verbs that express the degree /of certainty of the action in the sentence, attitude or opinion of the writer concerning the action. These auxiliary verbs are can, could ,may, might, must, ought to, shall, should, will, would and had better. Modality is one of the most difficult aspects of learning English, because the form of modals does not follow the conventional rules of grammar, and there are so many meanings of modals that students often get confused about which modal to use. Also, many EFL learners face difficulty in choosing the proper modal verb that fit certain situations because each modal verb has many functions. The pr
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God is the source of every grace in which man lives and enjoys, and there is no one in the world told himself that created and destined and ridiculed and found out of nothing God Almighty alone.
The grace is an affliction from God Almighty, when God Almighty blesses his servant with money or children and others, the slave thinks the acceptance of God Almighty, but may be a source of affliction and scrutiny.
A stochastic process {Xk, k = 1, 2, ...} is a doubly geometric stochastic process if there exists the ratio (a > 0) and the positive function (h(k) > 0), so that {α 1 h-k }; k ak X k = 1, 2, ... is a generalization of a geometric stochastic process. This process is stochastically monotone and can be used to model a point process with multiple trends. In this paper, we use nonparametric methods to investigate statistical inference for doubly geometric stochastic processes. A graphical technique for determining whether a process is in agreement with a doubly geometric stochastic process is proposed. Further, we can estimate the parameters a, b, μ and σ2 of the doubly geometric stochastic process by using the least squares estimate for Xk a
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In his novel entitled Victory. Joseph Conrad asserts himself as a writer for man
as a moral agent in this universe. His characters exhibit the possibilities for isolation
and moral deterioration in modern life. The aim of this research is to investigate some
social issues that touch the core of humanity. In this novel, Conrad's perceptive eyes
has noted so many social issues that need to be tackled. Implicitly and explicitly,
Conrad launches so many controversial issues like : communication and
disengagement or skepticism , conflict between heart and mind ,fate, demonic
identification sense of guilt in man, men , women and homosexuality, the clash
between the civilized and the raw ,the disregarded local people and
Background .To know the incidence of adenoid hypertrophy in adults causing nasal obstruction and other nasal complains.
Methods.Prospective studyof(140 ) adult patientstheir main chief complaint were nasal obstruction , presented to Otolaryngology department at Aljumhory Teaching Hospital in Mosul , from the period (september 2010 to september 2011) ,their age ranged from (21 to 53) years . They were investigated clinically, radiologicaly ,and nasal endoscopic examination was carried out (rigid and fibro-optic ) . Adenoidectomy was performed for those with adenoid hypertrophy and sent for histopathological study .
Results:. we found adenoid enlargement in(24) patients (17.14%),in addition to nasalobstruction they were also complain
The problem of research tagged: (metaphor and its transformations in the surreal drawing) dealt with the nature of the concept of metaphor and the mechanisms of its work in the contemporary global achievement. The research came in four chapters: The first chapter was concerned with the systematic framework for the research represented by the problem of the research, as it was manifested through this study by metaphor and its transformations, which were associated with the Surreal drawing papers in Europe. The goal of the study has been crystallized with the following:
Exposing metaphor and its transformations in the visual system of the surreal drawing.
As for the limits of the research, I was interested in analyzing video mod
Learning education in the Islamic legacy vision considers a completed The Islamic learning education took its bases from origins of Quran and honored prophet Suna , and stressed on education child a good education and providing him with principles of religion and semantic moral values and Messenger (peace on him) considers the higher example for man in his moral, behavior and goodness and witness on this Higher God said
(you had in God Messenger a good leadership for those were requesting God and last day and mentioned God a lot). Al- Ahzab Surah :21. learning education converts man from religion to another and from culture to another and teacher left his signs on the generation if he accept or refuse.