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.
The advancements in horizontal drilling combined with hydraulic fracturing have been historically proven as the most viable technologies in the exploitation of unconventional resources (e.g., shale and tight gas reservoirs). However, the number of fractures, well timing, and arrangement pattern can have a significant impact on the project economy. Therefore, such design and operating parameters need to be efficiently optimized for obtaining the best production performance from unconventional gas reservoirs. In this study, the process of selecting the optimal number of fractures was conducted on a section of a tight gas reservoir model (based on data from the Whicher Range (WR) tight gas field in Western Australia). Then, the optimal number
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The current study aims to examine the level of cognitive management requirement among the governmental secondary schools' managers in al-hial province in the kingdom of Saudi Arabia. To do this, the author designed a questionnaire comprised (20) item which was applied on (250) managers included (113) manager hold bachelor degree and (137) manager hold master degree. To carry out this study, the researcher utilized the descriptive approach. The findings revealed that a high level of cognitive management requirements among secondary schools' managers as well as there is a significant difference at the (0.05) level regarding degree type, but there is no a significant difference according to gender variable.
The aim of the research is to find out the nature of the relationship between the interrelationships and the interrelationships between risk management strategies (avoiding danger, risk exposure, risk exhibition, preventive programs and activities to reduce risks) and the dangers of container transportation, as an independent variable in the dangers of container transportation as a dependent variable, the study started from the problem that the company suffers from The practical aspect of the study was applied at the National Insurance Corporation, and the researcher designed a diagram according to the study's schematic diagram. The study, and for the purpose of data and information related to that, it relied on the descriptive a
... Show MoreThe aim of this study is to investigate the effect of environmental management accounting information (EMAI) on the design process of environmental and sustainable products of Iraqi industrial companies. This process has five different sub-processes: research process, analysis process, conceptual design process, detailed design process and design production process. The study uses the quantitative approach as the questionnaire was designed and distributed to 87 quality managers, production managers, design managers and financial managers. The MANOVA analysis shows that EMAI has a positive and significant effect on three of these processes, namely research process, analysis process and detailed design process, while EMAI has an insi
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The international business environment faces many challenges, including the intensity of competition, the speed of expansion, and control of the market. This leads to its shadow on the local business environment, which prompted many economic units to adopt modern strategies, including mergers and acquisitions, for expansion and prosperity. The research was conducted to verify the role of internal audit in the governance of strategy operations (Mergers and acquisitions) and its reflection on management decisions and making them efficient and effective. Internal auditing is the independent variable related to the other variable, the governance of strategic operations and its impact on management decisions for strategic operations as a depende
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(1)
The selective information broadcasting service is one of the important services in libraries and information centers, as it is the link between the source and the beneficiary and between related sources, as it links similar sources through keywords and then sends them to beneficiaries, which contributes to reducing the time and effort spent by beneficiaries in obtaining sources or information. Therefore, the application of this service is an important matter and gives a positive indicator in the progress of the library towards the integration of its services. From this standpoint, this research came to answer some questions, including: 1. What are the outlets for beneficiaries (the research community) in obtaining information sources? 2. Wh
... Show MoreSoftware cost management is a significant feature of project management. As such, it needs to be employed in a project or line of work. Software cost management is integral to software development failures, which, in turn, cause software failure. Thus, it is imperative that software development professionals develop their cost management skills to deliver successful software projects. The aim of this study is to examine the impact of cost management success factors with project management factors and three agile methodologies – Extreme Programming (XP), Scrum and Kanban methodologies which are used in the Pakistani software industry. To determine the results, the researchers applied quantitative approach through an extensive survey on
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This 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
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Objective: study aims to identify the diabetes type2 clients self management skills toward dietary pattern
, and find out the relationship between variables which are (Age, gender, educational level, duration of DM
diagnosis, and monthly income) with diabetes type 2 clients self management skills toward dietary pattern
Methodology: descriptive study was carried out through the present investigation from January 2nd
2011to September 2nd 2011 in order to achieve the objectives of the present study. A non probability
(purposive) sample, (200) cases which consists of clients who were attending Al-Nasiriyha diabetic center.
Including (118) males and (82) females. The data were collected by utilization of the study instrument