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.
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 novel was generally distinguished from other literary arts in its connection with the living reality as an imaginative practice that relies on political, economic, social, intellectual and cultural references and as a crucial tool in reading cultural references and dive deep into reality. As every novelist has a vision to embody this reality. As every novelist has a vision to embody this reality. The novel of ("Exceeded border by Hammed Al-Kafa’i) is a considered a fertile field for presenting social issues in their apparent structure and revealing the cultural patterns behind them which lies in its deep structure. The novel here moves its characters in its imaginary world in a way that it becomes more capable of adaptation and crysta
... Show MoreThis study deals with the thems of "in-betweeness" in the modern Afro-American Drama, drawing upon the accumulated literature of the colonial and postcolonial studies. In-betweeness appears in these studies under the canopy of the terms mimicry, hybridity and liminality which refer to a transformative, in-between state of being. It also refers to themutual relations holdingbetween man and his cultural space.
This concept is fitting the Afro-American playwright Amiri Baraka's plays and his violent, revolutionary theatre. In his play Dutchman (1964), Clay, the protagonist, is a good example of the two-ness or in-betweeness. He finds difficulty choosing between the ethnocentric white culture and the black culture.He allows
... Show MoreRacism is a serious issue that impacts a lot of people around the world. Since slavery days, racial discrimination has been increasing to abhorrent levels in relation to black people. The aim of individual psychology by Alfred Adler is to study human behaviour by situating it in the social context which makes his writing ideal to explanation of racism. This paper aims to study racism in Roy Williams’ Fallout from the perspective of Alfred Adler’s theory. Alfred Adler's individual psychology emphasizes the importance of social factors in shaping individual behavior, including the ways in which individuals form their sense of self and identity. This makes it a valuable framework for understanding the complex social and psychological facto
... Show MoreThis study aims to examine how the lives of blacks are reduced and eliminated in Brother (2017) by David Chariandy. Black Lives Matter is a hash tag that appears after the killing of Trayvon Martin (17 years old African American) in 2012 by the savage hands of George Zimmerman (white person). This hash-tag has become a social movement that calls for equality in order to stop the violence against black people because their live is as valuable as white’s. The movement comes into being to highlight the “hypocritical democracy in service to the white males whose freedom are openly depended upon the oppression of blacks” (Lebron, 2017, P. 1). Those who have started this movement try to redeem a state and its arbitrary actions again
... Show MoreThe simulation is the oldest theory in art, since it appeared in the Greek aesthetic thought of the philosopher Plato, as we find in many of the thinkers and philosophers over a wide period of time to reach our world today. Our fascination with art in general and design art in particular is due to the creativity and innovations of the artist through the simulation, as well as the peculiarities in this simulation, which give objects signs and signals that may have an echo that sometimes does not exist in their physical reality.
The real representation of life and design construction, descriptions of the expression of each of them in the form of intellectual construction and the ideas of producti
... Show MoreBetween the 1980s and 1990s, the HURIER model was developed by Brownell and consist of six interrelated components, which are represented in these acronyms (Hearing, Understanding, Remembering, Interpreting, Evaluating, and Responding). This model can be considered as a framework of the behavioral approach which can be used to improve students’ listening performance and to foster a positive attitude toward listening. Many learners find it challenging to improve their listening skills when learning a second or foreign language because it requires the integration of both listening and speaking. Consequently, enhancing this skill will help students improve other language skills, including reading, speaking, and writing. The HURI
... Show More<p>There is an Increasing demand for the education in the field of E-learning specially the higher education, and to keep contiuity between the user and the course director in any place and time. This research presents a proposed and simulation multimedia network design for distance learning utilizing ATM technique. The propsed framework determines the principle of ATM technology and shows how multimedia can be integrated within E- learning conteext. The first part of this research presents a theoretical design for the Electricity Department, university of technology. The purpose is to illustrate the usage of the ATM and Multimedia in distance learning process. In addition, this research composes two entities: Software entity
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