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The Surgical outcomes of fundus-first technique in lowering the rate of bile duct injuries and bleeding during open cholecystectomy that facing intraoperative difficulties: A single-center prospective study: The surgical outcomes of open fundus-first cholecystectomy technique.
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Background: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.

Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underwent elective open fundus-first cholecystectomy for intraoperative difficulties.

Results: the majority of cases had long-standing cholelithiasis with intraoperative difficulties revealed by pre-operative TUS and MRCP which required open fundus-first cholecystectomy in 173 (68.4%) of patients, (P-value <0.05). The operative surgical time was 120 minutes in 103 patients (40.7%), (P-value <0.05). During open cholecystectomy, variable intraoperative difficulties were found in all patients, (P-value <0.05) and were divided into: (A) Contracted intra-hepatic gallbladder seen in 157 (62.1%) of cases; (B) Distorted anatomy within Calot's triangle seen in 135 (53.4%) of patients; and (C) Intraoperative bleeding from the liver bed was observed as bloody oozing form in 150 (59.3%) of cases. Our patients had minimal postoperative complications like mild wound infection in 8 (3.2%) of cases and mortality rate was zero. 

Conclusions: There is a need for appropriate therapeutic and preventive strategies in healthcare systems for safe dealing with difficult cholecystectomy. Unclear anatomy due to severe inflammatory dense adhesions at Calot’s triangle and CBD stones needing difficult surgeries are the most important limiting factors for fundus-first laparoscopic cholecystectomy. Hence, we humbly recommend an open approach of fundus-first cholecystectomy as safe surgical option to reduce the incidence of bile duct injuries and intra-operative bleeding.

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Publication Date
Sat Dec 01 2012
Journal Name
Journal Of Economics And Administrative Sciences
Developing strategic leadership practices in the light of transparency and organizational citizenship behavior - A field study of a sample of the staff of the Office of the Inspector General at the Iraqi Ministry of Culture
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Diversity the terms and practice the organizational filed with different concepts and environment, which Iraqi environment part from them. Some organizational in Iraqi environment leave its basic oriented to agreement with the leader desire, their fore this research focus tow basic variable (organizational citizenship behavior & transparence), we supposition which is dependent to explanation the response variable (strategic leadership). The results justification in part and not justification in another part. For example the organizational citizenship behavior effect on some parte of the strategic leadership. The transparence have faraway to fly from the relation with organizational citizenship behavior and strategic leadershi

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Publication Date
Thu Mar 09 2023
Journal Name
Tajseer Journal For Multidisciplinary Research And Studies
The General Principle Governing the Duty of Care – A Study in Light of English Law
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The duty of care is the essence of the error of negligence under the English legal system, and without it, responsibility for negligence cannot be judged, regardless of the extent of the damage incurred. contained in English law. In view of the importance of proving the existence of the duty of care on the defendant so that it is possible to judge his responsibility for negligence, the need arises to find a general principle to which the defendant is subject in order to decide whether he owes the plaintiff with the duty of care and therefore responsible for the negligence, and this is what we will explain in the research topic the study.

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Publication Date
Sat Jun 06 2020
Journal Name
Journal Of The College Of Education For Women
Main Difficulties Faced by EFL Students in Language Learning
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Many undergraduate learners at English departments who study English as a foreign language are unable to speak and use language correctly in their post -graduate careers.  This problem can be attributed to certain difficulties, which they faced throughout their education years that hinder their endeavors to learn. Therefore, this study aims to discover the main difficulties faced by EFL students in language learning and test the difficulty variable according to gender and college variables then find suitable solutions for enhancing learning.  A questionnaire with 15 items and 5 scales were used to help in discovering the difficulties. The questionnaire was distributed to the selected sample of study wh

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Publication Date
Sat Jun 06 2020
Journal Name
Journal Of College Of Education For Women
Main Difficulties Faced by EFL Students in Language Learning
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Many undergraduate learners at English departments who study English as a foreign language are unable to speak and use language correctly in their post -graduate careers. This problem can be attributed to certain difficulties, which they faced throughout their education years that hinder their endeavors to learn. Therefore, this study aims to discover the main difficulties faced by EFL students in language learning and test the difficulty variable according to gender and college variables then find suitable solutions for enhancing learning. A questionnaire with 15 items and 5 scales were used to help in discovering the difficulties. The questionnaire was distributed to the selected sample of study which consists of 90 (male and female) stud

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Publication Date
Tue Mar 28 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Efficacy, safety and Cardiovascular Disease Risk Lowering Ability of ACE Inhibitors, B-Blockers and Combination Antihypertensive Drug Regimes in Iraq
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Hypertension is a major health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular diseases. It is defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. The aim of this study was to compare the efficacy, safety and cardiovascular disease risk lowering ability, of three antihypertensive drug regimens.

A retrospective study was carried out on 66 hypertensive patients, divided in to three groups based on their antihypertensive drug regimens (ACE inhibitors, β-blockers treated and combination antihypertensive therapy, the combination therapy consist of two or more of the following antihypertensive drugs ACE inhibitor di

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Publication Date
Sat Jun 01 2013
Journal Name
Journal Of Economics And Administrative Sciences
A field study of the problems of queues at some checkpoints in the city of Baghdad
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Abstract

Due to the momentum of winning in the streets of the city of Baghdad as a result of the large number of checkpoints so felt researcher to conduct a field visit to find out the main reasons that led to this congestion and to find practical solutions to mitigate wastage winning the arrival time citizen to where you want the least possible time.

This research aims to overcome the difficulties experienced by citizens to reach their places of work and reduce waste at the time of service and waiting time as well as reduce the cost of waiting.

Has emerged study a set of conclusions, including the use of model queue (G / G / C) and the mome

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Publication Date
Wed Jan 01 2014
Journal Name
International Journal Of Computer Applications
Enhancing the Delta Training Rule for a Single Layer Feedforward Heteroassociative Memory Neural Network
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In this paper, an algorithm is suggested to train a single layer feedforward neural network to function as a heteroassociative memory. This algorithm enhances the ability of the memory to recall the stored patterns when partially described noisy inputs patterns are presented. The algorithm relies on adapting the standard delta rule by introducing new terms, first order term and second order term to it. Results show that the heteroassociative neural network trained with this algorithm perfectly recalls the desired stored pattern when 1.6% and 3.2% special partially described noisy inputs patterns are presented.

Publication Date
Mon Oct 01 2018
Journal Name
International Journal Of Research In Social Sciences And Humanities
THE SOCIAL INTERACTION OF LANGUAGE IN A COMIC SERIES: A SOCIOLINGUISTIC STUDY
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Dell Hymesin 1964coined The Ethnography of Communication in an attempt to explain the ways in which people use the language to interact. It hypothesizes that ethnography is less applicable among participants who have the same sociocultural background. It was proven that all the basic speech components occur whenever there is an interactional situation. The elements of (SPEAKING) schema are closely connected. However, the findings establish the fact that these elements take place effectively among participants who have the same sociocultural background.One of the most outstanding conclusions is the capability of the (SPEAKING) model to analyze not only an interaction between two or more participants, but also any event which consists of a mo

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Publication Date
Thu Aug 16 2018
Journal Name
International Journal Of Research In Social Sciences And Humanities
The Social Interaction of Langauge in a Comic Series: A Sociolinguistic Study
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DBNRAHA Hameed, IJRSSH PUBLICATION, 2018

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Publication Date
Wed Jan 01 2020
Journal Name
Plant Archives J.
Evaluation of the performance of triple, single crosses and their inbred in bred lines of maize under two plant population
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