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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
Fri Mar 01 2024
Journal Name
Partial Differential Equations In Applied Mathematics
A hybrid technique for solving fractional delay variational problems by the shifted Legendre polynomials
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This study presents a practical method for solving fractional order delay variational problems. The fractional derivative is given in the Caputo sense. The suggested approach is based on the Laplace transform and the shifted Legendre polynomials by approximating the candidate function by the shifted Legendre series with unknown coefficients yet to be determined. The proposed method converts the fractional order delay variational problem into a set of (n + 1) algebraic equations, where the solution to the resultant equation provides us the unknown coefficients of the terminated series that have been utilized to approximate the solution to the considered variational problem. Illustrative examples are given to show that the recommended appro

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Publication Date
Thu Mar 30 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Effect of Silibinin in Lowering the Intraocular Pressure in Normotensive Rabbits: Interaction with Betaxolol
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Previous reports demonstrated the effectiveness of silibinin hemisuccinate as a potential intraocular pressure-lowering agent. The exact mechanism by which silibinin exerted this effect has not yet been documented, but might suggested to interfere with aqueous humor formation. The present study was designed to evaluate the comparative efficacy of silibinin as IOP lowering agent to that of betaxolol in normotensive rabbits, and the interaction of silibinin with betaxolol as a way for investigating the possible mechanism of action of silibinin in this respect. The effects of instillation of 0.75% silibinin solution and 0.5% betaxolol eye drops in the eyes of normotensive rabbits were evaluated using indentation tonometry. The results showe

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Publication Date
Sun May 22 2022
Journal Name
International Journal Of Early Childhood Special Education
The impact of an instructional-learning design based on the brain- compatible model in systemic thinking among first intermediate grade female students in Mathematics
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The research aimed to identify “The impact of an instructional-learning design based on the brain- compatible model in systemic thinking among first intermediate grade female students in Mathematics”, in the day schools of the second Karkh Educational directorate.In order to achieve the research objective, the following null hypothesis was formulated:There is no statistically significant difference at the significance level (0.05) among the average scores of the experimental group students who will be taught by applying an (instructional- learning) design based to on the brain–compatible model and the average scores of the control group students who will be taught through the traditional method in the systemic thinking test.The resear

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Publication Date
Wed Mar 01 2023
Journal Name
Egyptian Journal Of Chemistry
First- and Second-Derivative Spectrophotometry for Simultaneous Determination of lorazepam and clonazepam in pharmaceutical formulations
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The present study describes employing zero-, 1st - and 2nd -order derivative spectrophotometric methods have been developed for determination of lorazepam (LORA) and clonazepam (CLON) in commercially available tablets. LORA was determined by means of 1st (D1), 2nd (D2) derivative spectrophotometric techniques using zero cross, peak height, and Peak area. D1 used for the determination of CLON by using zero cross and peak height while D2 (zero cross) was used for the determination of CLON. The method was established to be linear in concentration containing different ratios of LORA and CLON range of (20-200 mg/L) and (5-35 mg/L) at wavelength range (250 -370 nm), (210-370nm) respectively. The proposed techniques are highly sensitive, precise a

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Publication Date
Wed Jun 29 2022
Journal Name
Egyptian Journal Of Chemistry
First- and Second-Derivative Spectrophotometry for Simultaneous Determination of lorazepam and clonazepam in pharmaceutical formulations.
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Publication Date
Mon Aug 01 2016
Journal Name
Journal Of Engineering
Performance Evaluation of the Investment Projects during the Implementation Phase (Najaf province as a case study)
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The construction project is a very complicated work by its nature and requires specialized knowledge to lead it to success. The construction project is complicated socially, technically and economically in its planning, management and implementation aspects due to the fact that it has many variables and multiple stakeholders in addition to being affected by the surrounding environment. Successful projects depend on three fundamental points which are cost-time, performance and specifications. The project stakeholder's objective to achieve best specifications and the cost-time frame stipulated in the contract.

The question is, was the optimum implementation accomplished? The provision for the success of the project

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Publication Date
Mon Jul 01 2013
Journal Name
Http://www.i-csrs.org/volumes/gisars/vol.3/vol.3.1.1.july.12.pdf
Remote sensing technique to monitoring the risk of soil degradation using NDVI
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In order to take measures in controlling soil erosion it is required to estimate soil loss over area of interest. Soil loss due to soil erosion can be estimated using predictive models such as Universal Soil Loss Equation (USLE). The accuracy of these models depends on parameters that are used in equations. One of the most important parameters in equations used in both of models is (C) factor that represents effects of vegetation and other land covers. Estimating land cover by interpretation of remote sensing imagery involves Normalized Difference Vegetation Index (NDVI), an indicator that shows vegetation cover. The aim of this study is estimate (C) factor values for Part of Baghdad city using NDVI derived from satellite Image of Landsat-7

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Publication Date
Wed Jun 11 2003
Journal Name
Iraqi Journal Of Laser
The Use of Pulse Frequency Modulation Technique for Optical Video Communication System
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An optical video communication system is designed and constructed using pulse frequency modulation (PFM) technique. In this work PFM pulses are generated at the transmitter using voltage control oscillator (VCO) of width 50 ns for each pulse. Double frequency, equal width and narrow pulses are produced in the receiver be for demodulation. The use of the frequency doubling technique in such a system results in a narrow transmission bandwidth (25 ns) and high receiver sensitivity.

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Publication Date
Sun Oct 03 2010
Journal Name
Journal Of Educational And Psychological Researches
The Effect of Applying K-W-L Technique on Teaching ESP Students
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         Over the last few decades, many instructors have been trying all kinds of teaching methods, but without benefit. Nevertheless, in the 1986, a new technique is appeared which called K-W-L technique, it  is specified for reading comprehension passages because reading  skill is not easy matter for students for specific purposes (ESP).therefore, the K-W-L technique is a good one for thinking and experiences. To fulfill the aims and verify the hypothesis which reads as follows" it is hypothesized that there are no significant differences between the achievements of students who are taught according to K-W-L technique and those who are taught according to the traditional method

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Publication Date
Sun Feb 17 2019
Journal Name
Iraqi Journal Of Physics
Classification of the galaxy Milky Way using variable precision rough sets technique
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Astronomy image is regarded main source of information to discover outer space, therefore to know the basic contain for galaxy (Milky way), it was classified using Variable Precision Rough Sets technique to determine the different region within galaxy according different color in the image. From classified image we can determined the percentage for each class and then what is the percentage mean. In this technique a good classified image result and faster time required to done the classification process.

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